title: Culminating anti-malaria efforts at long lasting insecticidal net?
abstract: BACKGROUND
  Long-lasting insecticidal nets (LLINs) are a primary method in malaria control efforts. However, a decline in the biological efficacy and physical integrity over a period of comparatively lesser time than claimed, waning of naturally acquired immunity among regular users and misuse of LLINs are serious concerns.
  The literature for the current review was searched in PubMed, SCOPUS Database and Google using combined search strings of related key-words. Literature with sufficient data and information on the current subject was selected to reach a valid conclusion.
  
  
  RESULTS
  The World Health Organization (WHO) has emphasized that LLINs should be considered a public good for people inhabiting malaria endemic settings. LLINs exhibited a cumulative effect on the vector density and may force anthropophilic mosquito vectors to find alternative animal hosts for blood meal. However, the physical integrity and biological activity of LLINs declines faster than the anticipated time due to different operational conditions and the spread of insecticide resistance. LLINs have been successful in reducing malaria incidences by either reducing or not allowing human exposure to the vector mosquitoes, but at the same time, LLINs debilitate the natural protective immunity against malaria parasite. Misuse of LLINs for deviant purposes is common and is a serious environmental concern, as people believe that traditional methods of prevention against malaria that have enabled them to survive through a long time are effective and sufficient. Moreover, people are often ill-informed regarding the toxic effects of LLINs.
  
  
  CONCLUSIONS
  Specific criteria for determining the serviceable life and guidelines on the safe washing and disposal of LLINs need to be developed, kept well-informed and closely monitored. Malaria case management, environment management and community awareness to reduce the misuse of LLINs are crucial. Focused research on developing effective anti-malarial drugs, vaccines and new insecticides to reduce resistance is imperative to tackle malaria in the future.
authors.affiliation: Defense Research Laboratory, Govt. of India, Tezpur 784 001, India. Electronic address: sunildhiman81@gmail.com.
authors.forename: Sunil
authors.initials: S
authors.lastname: Dhiman
authors.affiliation: Defense Research Laboratory, Govt. of India, Tezpur 784 001, India.
authors.forename: Vijay
authors.initials: V
authors.lastname: Veer
mesh_terms: D003695:Delivery of Health Care / Q000592:standards; D018562:Disease Transmission, Infectious / Q000517:prevention & control*; D006266:Health Education; D006801:Humans; D007305:Insecticide Resistance; D057148:Insecticide-Treated Bednets; D008288:Malaria / Q000276:immunology / Q000517:prevention & control* / Q000635:transmission*; D010961:Plasmodium / Q000187:drug effects / Q000276:immunology; D014944:World Health Organization
keywords: Immunity; Insecticide resistance; LLIN; Malaria; Vector