title: Underpinning sustainable vector control through informed insecticide resistance management.
abstract: BACKGROUND
  There has been rapid scale-up of malaria vector control in the last ten years. Both of the primary control strategies, long-lasting pyrethroid treated nets and indoor residual spraying, rely on the use of a limited number of insecticides. Insecticide resistance, as measured by bioassay, has rapidly increased in prevalence and has come to the forefront as an issue that needs to be addressed to maintain the sustainability of malaria control and the drive to elimination. Zambia's programme reported high levels of resistance to the insecticides it used in 2010, and, as a result, increased its investment in resistance monitoring to support informed resistance management decisions.
  
  
  RESULTS
  A country-wide survey on insecticide resistance in Zambian malaria vectors was performed using WHO bioassays to detect resistant phenotypes. Molecular techniques were used to detect target-site mutations and microarray to detect metabolic resistance mechanisms. Anopheles gambiae s.s. was resistant to pyrethroids, DDT and carbamates, with potential organophosphate resistance in one population. The resistant phenotypes were conferred by both target-site and metabolic mechanisms. Anopheles funestus s.s. was largely resistant to pyrethroids and carbamates, with potential resistance to DDT in two locations. The resistant phenotypes were conferred by elevated levels of cytochrome p450s.
  
  
  CONCLUSIONS
  Currently, the Zambia National Malaria Control Centre is using these results to inform their vector control strategy. The methods employed here can serve as a template to all malaria-endemic countries striving to create a sustainable insecticide resistance management plan.
authors.affiliation: Vector Biology Department, Liverpool School of Tropical Medicine, Liverpool, United Kingdom.
authors.forename: Edward K
authors.initials: EK
authors.lastname: Thomsen
authors.affiliation: Vector Biology Department, Liverpool School of Tropical Medicine, Liverpool, United Kingdom.
authors.forename: Clare
authors.initials: C
authors.lastname: Strode
authors.affiliation: Vector Biology Department, Liverpool School of Tropical Medicine, Liverpool, United Kingdom.
authors.forename: Kay
authors.initials: K
authors.lastname: Hemmings
authors.affiliation: Vector Biology Department, Liverpool School of Tropical Medicine, Liverpool, United Kingdom.
authors.forename: Angela J
authors.initials: AJ
authors.lastname: Hughes
authors.affiliation: National Malaria Control Centre, Lusaka, Zambia.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Chanda
authors.affiliation: Zambia Integrated Systems Strengthening Program, Abt Associates, Lusaka, Zambia.
authors.forename: Mulenga
authors.initials: M
authors.lastname: Musapa
authors.affiliation: National Malaria Control Centre, Lusaka, Zambia.
authors.forename: Mulakwa
authors.initials: M
authors.lastname: Kamuliwo
authors.affiliation: National Malaria Control Centre, Lusaka, Zambia.
authors.forename: Faustina N
authors.initials: FN
authors.lastname: Phiri
authors.affiliation: Zambia Integrated Systems Strengthening Program, Abt Associates, Lusaka, Zambia.
authors.forename: Lucy
authors.initials: L
authors.lastname: Muzia
authors.affiliation: National Malaria Control Centre, Lusaka, Zambia.
authors.forename: Javan
authors.initials: J
authors.lastname: Chanda
authors.affiliation: National Malaria Control Centre, Lusaka, Zambia.
authors.forename: Alister
authors.initials: A
authors.lastname: Kandyata
authors.affiliation: Zambia Integrated Systems Strengthening Program, Abt Associates, Lusaka, Zambia.
authors.forename: Brian
authors.initials: B
authors.lastname: Chirwa
authors.affiliation: Zambia Integrated Systems Strengthening Program, Abt Associates, Lusaka, Zambia.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Poer
authors.affiliation: Vector Biology Department, Liverpool School of Tropical Medicine, Liverpool, United Kingdom.
authors.forename: Janet
authors.initials: J
authors.lastname: Hemingway
authors.affiliation: Vector Biology Department, Liverpool School of Tropical Medicine, Liverpool, United Kingdom.
authors.forename: Charles S
authors.initials: CS
authors.lastname: Wondji
authors.affiliation: Vector Biology Department, Liverpool School of Tropical Medicine, Liverpool, United Kingdom.
authors.forename: Hilary
authors.initials: H
authors.lastname: Ranson
authors.affiliation: Vector Biology Department, Liverpool School of Tropical Medicine, Liverpool, United Kingdom.
authors.forename: Michael
authors.initials: M
authors.lastname: Coleman
mesh_terms: D000110:Acetylcholinesterase / Q000378:metabolism; D000818:Animals; D000852:Anopheles / Q000187:drug effects* / Q000469:parasitology; D004247:DNA / Q000235:genetics; D005786:Gene Expression Regulation / Q000187:drug effects; D017344:Genes, Insect; D005838:Genotype; D005843:Geography; D007303:Insect Vectors / Q000187:drug effects*; D007305:Insecticide Resistance / Q000187:drug effects* / Q000235:genetics; D007306:Insecticides / Q000633:toxicity*; D058977:Molecular Sequence Annotation; D009032:Mosquito Control; D009154:Mutation / Q000235:genetics; D010271:Parasites / Q000187:drug effects; D010641:Phenotype; D062211:Spatio-Temporal Analysis; D014944:World Health Organization; D015024:Zambia
chemical_list: D007306:Insecticides; D004247:DNA; D000110:Acetylcholinesterase