Abstract
BackgroundLong-lasting insecticidal nets (LLINs) (with pyrethroids) and indoor residual spraying (IRS) are the cornerstones of the Sudanese malaria control program. Insecticide resistance to the principal insecticides in LLINs and IRS is a major concern. This study was designed to monitor insecticide resistance in Anopheles arabiensis from 140 clusters in four malaria-endemic areas of Sudan from 2011 to 2014. All clusters received LLINs, while half (n = 70), distributed across the four regions, had additional IRS campaigns.MethodsAnopheles gambiae (s.l.) mosquitoes were identified to species level using PCR techniques. Standard WHO insecticide susceptibility bioassays were carried out to detect resistance to deltamethrin (0.05%), DDT (4%) and bendiocarb (0.1%). TaqMan assays were performed on random samples of deltamethrin-resistant phenotyped and pyrethrum spray collected individuals to determine Vgsc-1014 knockdown resistance mutations.ResultsAnopheles arabiensis accounted for 99.9% of any anopheline species collected across all sites. Bioassay screening indicated that mosquitoes remained susceptible to bendiocarb but were resistance to deltamethrin and DDT in all areas. There were significant increases in deltamethrin resistance over the four years, with overall mean percent mortality to deltamethrin declining from 81.0% (95% CI: 77.6–84.3%) in 2011 to 47.7% (95% CI: 43.5–51.8%) in 2014. The rate of increase in phenotypic deltamethrin-resistance was significantly slower in the LLIN + IRS arm than in the LLIN-only arm (Odds ratio 1.34; 95% CI: 1.02–1.77). The frequency of Vgsc-1014F mutation varied spatiotemporally with highest frequencies in Galabat (range 0.375–0.616) and New Halfa (range 0.241–0.447). Deltamethrin phenotypic-resistance correlated with Vgsc-1014F frequency.ConclusionCombining LLIN and IRS, with different classes of insecticide, may delay pyrethroid resistance development, but the speed at which resistance develops may be area-specific. Continued monitoring is vital to ensure optimal management and control.
Highlights
Long-lasting insecticidal nets (LLINs) and indoor residual spraying (IRS) are the cornerstones of the Sudanese malaria control program
IRS spraying of deltamethrin became the most common practice with permethrin used for ultralow volume (ULV) and thermal-fog space spraying to control nuisance mosquitoes (Sudan-IVM: Integrated Vector Management Strategic Plan 2014–2018, unpublished data)
More details of the study design may be found in Kleinschmidt et al [27] and Kafy et al [28]. In this manuscript we present results describing the patterns of insecticide resistance and the impact of combined intervention on the evolution of resistance
Summary
Long-lasting insecticidal nets (LLINs) (with pyrethroids) and indoor residual spraying (IRS) are the cornerstones of the Sudanese malaria control program. This study was designed to monitor insecticide resistance in Anopheles arabiensis from 140 clusters in four malaria-endemic areas of Sudan from 2011 to 2014. With the advent of the malaria eradication era in the 1950s, indoor residual spraying (IRS) with BHC (Benzene hexachloride) was initiated as the main measure against adult vectors in malarious areas such as Gezira and Khashm Elgirba irrigated schemes [7, 8]. In response to the resistance problem, an organophosphate insecticide, malathion, was introduced for IRS in 1975 in Gezira irrigated areas. IRS spraying of deltamethrin became the most common practice with permethrin used for ultralow volume (ULV) and thermal-fog space spraying to control nuisance mosquitoes (Sudan-IVM: Integrated Vector Management Strategic Plan 2014–2018, unpublished data). Pyrethroid-treated bed net coverage has increased markedly in recent years [9]
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