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Proc Natl Acad Sci U S A. 2017 Dec 26;114(52):E11267-E11275. doi: 10.1073/pnas.1713814114. Epub 2017 Dec 11.

Impact of insecticide resistance in Anopheles arabiensis on malaria incidence and prevalence in Sudan and the costs of mitigation.

Author information

1
Vector Unit, Ministry of Health, Khartoum, Sudan.
2
School of Biological Sciences, Universiti Sains Malaysia, 11800 Pulau Penang, Malaysia.
3
State Malaria Control Programme, Khartoum, Sudan.
4
Malaria Programme, World Health Organization, 1202 Geneva, Switzerland.
5
Department of Disease Control, London School of Hygiene and Tropical Medicine (LSHTM), London WC1E 7HT, United Kingdom.
6
Kilimanjaro Christian Medical University College, Moshi, Tanzania.
7
Department of Information, Ministry of Health, Khartoum, Sudan.
8
Malaria Research and Training Centre, Sennar, Sudan.
9
State Malaria Control Programme, Gedarif, Sudan.
10
Department of Infectious Disease Epidemiology, LSHTM, London WC1E 7HT, United Kingdom.
11
Department of Vector Biology, Liverpool School of Tropical Medicine, Liverpool L35QA, United Kingdom.
12
Department of Vector Biology, Liverpool School of Tropical Medicine, Liverpool L35QA, United Kingdom; janet.hemingway@lstmed.ac.uk martin.donnelly@lstmed.ac.uk Immo.Kleinschidmt@LSHTM.ac.uk.
13
Ministry of Health, Khartoum, Sudan.
14
Center for Applied Malaria Research and Evaluation, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA 70112.
15
Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Hinxton CB10 1SA, United Kingdom.
16
Department of Infectious Disease Epidemiology, LSHTM, London WC1E 7HT, United Kingdom; janet.hemingway@lstmed.ac.uk martin.donnelly@lstmed.ac.uk Immo.Kleinschidmt@LSHTM.ac.uk.
17
School of Pathology, University of Witwatersrand, Braamfontein 2000, Johannesburg, South Africa.

Abstract

Insecticide-based interventions have contributed to ∼78% of the reduction in the malaria burden in sub-Saharan Africa since 2000. Insecticide resistance in malaria vectors could presage a catastrophic rebound in disease incidence and mortality. A major impediment to the implementation of insecticide resistance management strategies is that evidence of the impact of resistance on malaria disease burden is limited. A cluster randomized trial was conducted in Sudan with pyrethroid-resistant and carbamate-susceptible malaria vectors. Clusters were randomly allocated to receive either long-lasting insecticidal nets (LLINs) alone or LLINs in combination with indoor residual spraying (IRS) with a pyrethroid (deltamethrin) insecticide in the first year and a carbamate (bendiocarb) insecticide in the two subsequent years. Malaria incidence was monitored for 3 y through active case detection in cohorts of children aged 1 to <10 y. When deltamethrin was used for IRS, incidence rates in the LLIN + IRS arm and the LLIN-only arm were similar, with the IRS providing no additional protection [incidence rate ratio (IRR) = 1.0 (95% confidence interval [CI]: 0.36-3.0; P = 0.96)]. When bendiocarb was used for IRS, there was some evidence of additional protection [interaction IRR = 0.55 (95% CI: 0.40-0.76; P < 0.001)]. In conclusion, pyrethroid resistance may have had an impact on pyrethroid-based IRS. The study was not designed to assess whether resistance had an impact on LLINs. These data alone should not be used as the basis for any policy change in vector control interventions.

TRIAL REGISTRATION:

ClinicalTrials.gov NCT01713517.

KEYWORDS:

Anopheles; insecticide; malaria; pyrethroid; resistance

PMID:
29229808
PMCID:
PMC5748194
DOI:
10.1073/pnas.1713814114
[Indexed for MEDLINE]
Free PMC Article

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