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Implications of insecticide resistance for malaria vector control with long-lasting insecticidal nets: a WHO-coordinated, prospective, international, observational cohort study

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Kleinschmidt, Immo, Bradley, John, Bellamy Knox, Tessa, Mnzava, Abraham Peter, Toto Kafy, Hmooda, Mbogo, Charles, Ismail, Bashir Adam, Bigoga, Jude D, Adechoubou, Alioun, Raghavendra, Kamaraju, Cook, Jackie, Malik, Elfatih, Nkuni, Zinga Jose, MacDonald, Mike, Bayoh, Nabie, Ochomo, Eric, Fondjo, Etienne, Awono-Ambene, Herman Parfait, Etang, Josiane, Akogbeto, Martin, Bhatt, Rajendra, Chourasia, Mehul Kumar, Swain, Dipak K, Kinyari, Teresa, Subramaniam, Krishanthi, Massougbodji, Archille, Oke-Sopoh, Mariam, Ogouyemi-Hounto, Aurore, Kouamberg, Celestin, Abdin, Mujahid Sheikhedin, West, Philippa, Elmardi, Khalid, Cornelie, Sylvie, Corbel, Vincent, Valecha, Neena, Mathenge, Evan, Kamau, Luna, Lines, Jonathan and Donnelly, Martin ORCID: https://orcid.org/0000-0001-5218-1497 (2018) 'Implications of insecticide resistance for malaria vector control with long-lasting insecticidal nets: a WHO-coordinated, prospective, international, observational cohort study'. Lancet Infectious Diseases, Vol 18, Issue 6, pp. 640-649.

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Abstract

Background
Scale-up of insecticide-based interventions has averted more than 500 million malaria cases since 2000. Increasing insecticide resistance could herald a rebound in disease and mortality. We aimed to investigate whether insecticide resistance was associated with loss of effectiveness of long-lasting insecticidal nets and increased malaria disease burden.
Methods
This WHO-coordinated, prospective, observational cohort study was done at 279 clusters (villages or groups of villages in which phenotypic resistance was measurable) in Benin, Cameroon, India, Kenya, and Sudan. Pyrethroid long-lasting insecticidal nets were the principal form of malaria vector control in all study areas; in Sudan this approach was supplemented by indoor residual spraying. Cohorts of children from randomly selected households in each cluster were recruited and followed up by community health workers to measure incidence of clinical malaria and prevalence of infection. Mosquitoes were assessed for susceptibility to pyrethroids using the standard WHO bioassay test. Country-specific results were combined using meta-analysis.
Findings
Between June 2, 2012, and Nov 4, 2016, 40 000 children were enrolled and assessed for clinical incidence during 1·4 million follow-up visits. 80 000 mosquitoes were assessed for insecticide resistance. Long-lasting insecticidal net users had lower infection prevalence (adjusted odds ratio [OR] 0·63, 95% CI 0·51–0·78) and disease incidence (adjusted rate ratio [RR] 0·62, 0·41–0·94) than did non-users across a range of resistance levels. We found no evidence of an association between insecticide resistance and infection prevalence (adjusted OR 0·86, 0·70–1·06) or incidence (adjusted RR 0·89, 0·72–1·10). Users of nets, although significantly better protected than non-users, were nevertheless subject to high malaria infection risk (ranging from an average incidence in net users of 0·023, [95% CI 0·016–0·033] per person-year in India, to 0·80 [0·65–0·97] per person year in Kenya; and an average infection prevalence in net users of 0·8% [0·5–1·3] in India to an average infection prevalence of 50·8% [43·4–58·2] in Benin).
Interpretation
Irrespective of resistance, populations in malaria endemic areas should continue to use long-lasting insecticidal nets to reduce their risk of infection. As nets provide only partial protection, the development of additional vector control tools should be prioritised to reduce the unacceptably high malaria burden.

Item Type: Article
Subjects: QX Parasitology > Insects. Other Parasites > QX 510 Mosquitoes
QX Parasitology > Insects. Other Parasites > QX 600 Insect control. Tick control
WA Public Health > Preventive Medicine > WA 240 Disinfection. Disinfestation. Pesticides (including diseases caused by)
WA Public Health > WA 30 Socioeconomic factors in public health (General)
WA Public Health > Health Problems of Special Population Groups > WA 320 Child Welfare. Child Health Services.
WA Public Health > Health Problems of Special Population Groups > WA 395 Health in developing countries
WC Communicable Diseases > Tropical and Parasitic Diseases > WC 750 Malaria
WS Pediatrics > Diseases of Children and Adolescents > General Diseases > WS 200 General works
Faculty: Department: Biological Sciences > Vector Biology Department
Digital Object Identifer (DOI): https://doi.org/10.1016/S1473-3099(18)30172-5
Depositing User: Stacy Murtagh
Date Deposited: 24 Apr 2018 10:53
Last Modified: 09 Oct 2018 01:02
URI: https://archive.lstmed.ac.uk/id/eprint/8507

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