title: The impact of pyrethroid resistance on the efficacy and effectiveness of bednets for malaria control in Africa.
abstract: Long lasting pyrethroid treated bednets are the most important tool for preventing malaria. Pyrethroid resistant Anopheline mosquitoes are now ubiquitous in Africa, though the public health impact remains unclear, impeding the deployment of more expensive nets. Meta-analyses of bioassay studies and experimental hut trials are used to characterise how pyrethroid resistance changes the efficacy of standard bednets, and those containing the synergist piperonyl butoxide (PBO), and assess its impact on malaria control. New bednets provide substantial personal protection until high levels of resistance, though protection may wane faster against more resistant mosquito populations as nets age. Transmission dynamics models indicate that even low levels of resistance would increase the incidence of malaria due to reduced mosquito mortality and lower overall community protection over the life-time of the net. Switching to PBO bednets could avert up to 0.5 clinical cases per person per year in some resistance scenarios.
authors.affiliation: MRC Centre for Outbreak Analysis and Modelling, Infectious Disease Epidemiology, Imperial College London, London, United Kingdom.
authors.forename: Thomas S
authors.identifier: 0000-0002-8442-0525
authors.initials: TS
authors.lastname: Churcher
authors.affiliation: Liverpool School of Tropical Medicine, Liverpool, United Kingdom.
authors.forename: Natalie
authors.initials: N
authors.lastname: Lissenden
authors.affiliation: MRC Centre for Outbreak Analysis and Modelling, Infectious Disease Epidemiology, Imperial College London, London, United Kingdom.|Queen Mary's University, London, United Kingdom.
authors.forename: Jamie T
authors.initials: JT
authors.lastname: Griffin
authors.affiliation: Liverpool School of Tropical Medicine, Liverpool, United Kingdom.
authors.forename: Eve
authors.initials: E
authors.lastname: Worrall
authors.affiliation: Liverpool School of Tropical Medicine, Liverpool, United Kingdom.
authors.forename: Hilary
authors.initials: H
authors.lastname: Ranson
mesh_terms: D000349:Africa; D000818:Animals; D000852:Anopheles / Q000502:physiology; D001681:Biological Assay / Q000706:statistics & numerical data; D006801:Humans; D007305:Insecticide Resistance / Q000502:physiology*; D057148:Insecticide-Treated Bednets / Q000706:statistics & numerical data* / Q000600:supply & distribution; D007306:Insecticides; D008288:Malaria / Q000517:prevention & control* / Q000635:transmission; D015233:Models, Statistical; D009032:Mosquito Control / Q000379:methods*; D000072138:Mosquito Vectors / Q000502:physiology; D009570:Nitriles; D026023:Permethrin; D010574:Pesticide Synergists / Q000600:supply & distribution; D010882:Piperonyl Butoxide / Q000600:supply & distribution; D011722:Pyrethrins
chemical_list: D007306:Insecticides; D009570:Nitriles; D010574:Pesticide Synergists; D011722:Pyrethrins; C017180:decamethrin; D026023:Permethrin; D010882:Piperonyl Butoxide
keywords: P. falciparum; bednets; epidemiology; global health; malaria; mosquito; pyrethroid resistance