Abstract
Malaria is to-day a tropical disease that especially has major impact in Subsahelian Africa. The current largescale campaign against malaria focuses on better first line use of medication and prevention: (1) the combined use of an Artimisin derivative and one of several synthetic anti-malarials; and (2) the use of insecticidal bednets for transmission prevention, since the disease is transmitted between humans by female mosquitoes. The change from nets that were to be treated and often re-treated to factory pre-treated nets about 7 years ago, made the change from a promising research tool to a major campaign tool. However, once the first line problem of fast disappearance of insecticide treatment was solved, other problems appeared such as physical net durability and low use rate of bednets among people that do not see only the advantages of the nets, but also experience the inconvenience of their use in the daily life. Finally, resistance to insecticides is appearing, probably originating from agricultural use of the same insecticides, but now amplified by the extensive use of insecticides for malaria control. A call for use of common sense and diversified use of insecticides is concluded.
Highlights
Malaria is a disease where the parasite has separate development stages in humans and in mosquitoes
The human malaria parasites all belong to the genus Plasmodium and all 5 species are spread by mosquitoes of the genus Anopheles
There are many other interactions between these parasites and the human host and not all are well understood. It is the sexual stage of the parasite that is transmitted to the mosquitoes when sucking from infected blood
Summary
Malaria is a disease where the parasite has separate development stages in humans and in mosquitoes. Insecticide treated bednets (Fig. 1) have been important tools to reduce morbidity and mortality in the Roll Back Malaria campaign Their efficacy was first demonstrated for nets and curtains dipped in insecticide solutions and dispersions [1,2,3], but these tools were not yet practical. As in any other development, once you solve one problem, new problems appear These were: (1) durability of net material and (2) the insecticidal effect; (3) coverage and use; (4) insecticide resistance. These four subjects will be discussed one by one starting with a characterization of some of the long lasting bednets seen in the light of product development and some of the problems seen in the field
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