Insecticide-treated nets provide protection against malaria to children in an area of insecticide resistance in Southern Benin

John Bradley,Achille Massougbodji,Yolande Sissinto Savi De Tove,Adicath Adéola Adéothy,Alioun Adechoubou,Jacob Fassinou,Thibaut Legba,Patrick Makoutode,Telesphore Houansou,Dorothée Kinde-Gazard,Martin C Akogbeto,Immo Kleinschmidt,Aurore Ogouyèmi-Hounto,Tessa Bellamy Knox,Sylvie Cornélie,Martin Donnelly,Filémon T Tokponnon

doi:10.1186/s12936-017-1873-1

John Bradley, Achille Massougbodji + Show 15 more

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https://doi.org/10.1186/s12936-017-1873-1

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BackgroundMalaria control is heavily reliant on insecticides, especially pyrethroids. Resistance of mosquitoes to insecticides may threaten the effectiveness of insecticide-based vector control and lead to a resurgence of malaria in Africa.MethodsIn 21 villages in Southern Benin with high levels of insecticide resistance, the resistance status of local vectors was measured at the same time as the prevalence of malaria infection in resident children.ResultsChildren who used LLINs had lower levels of malaria infection [odds ratio = 0.76 (95% CI 0.59, 0.98, p = 0.033)]. There was no evidence that the effectiveness of nets was different in high and low resistance locations (p = 0.513). There was no association between village level resistance and village level malaria prevalence (p = 0.999).ConclusionsLLINs continue to offer individual protection against malaria infection in an area of high resistance. Insecticide resistance is not a reason to stop efforts to increase coverage of LLINs in Africa.

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Malaria control is heavily reliant on insecticides, especially pyrethroids
If long-lasting insecticidal nets (LLINs) and indoor residual spraying (IRS) ceased to be effective, many of the public health gains could be reversed. This is a possibility since resistance to insecticides in Anopheles malaria vectors is widespread [2]. This is especially true for insecticides in the pyrethroid class, the sole class of insecticide used in LLINs [2]
A steep decline in malaria incidence in South Africa after DDT replaced pyrethroids for IRS often cited as an example of control failure due to resistance could be due to a concurrent introduction of artemether/lumefantrine for malaria treatment [3]

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Introduction

Malaria control is heavily reliant on insecticides, especially pyrethroids. Resistance of mosquitoes to insecticides may threaten the effectiveness of insecticide-based vector control and lead to a resurgence of malaria in Africa. If LLINs and IRS ceased to be effective, many of the public health gains could be reversed This is a possibility since resistance to insecticides in Anopheles malaria vectors is widespread [2]. Studies in Malawi and Kenya have shown that LLINs continue to provide protection [7, 8] Those studies examined the impact of resistance on infection incidence. Because of the lack of evidence on this important issue, a study to measure the impact of insecticide resistance on epidemiological outcomes was launched in five countries; this paper reports on the results of the assessment conducted in Benin, West Africa [9]. In a sample of 21 villages, standard WHO susceptibility tests [11] were used to measure mortality of mosquitoes exposed to these insecticides; and this was compared to prevalence of malaria infection in children

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