Monitoring insecticide resistance in malaria control

As large scale distributions of insecticide treated bed-nets continue, the selection pressure for insecticide resistance increases. Insecticide resistance, particularly to DDT, helped destroy the malaria control efforts of many countries in the 1960s-70s. Monitoring insecticide resistance is part and parcel of any indoor residual spraying (IRS) program, and is arguably even more important for bed-nets. Currently, bed-nets are made with only one type of insecticide – pyrethroids. Pyrethroids are the only widely used insecticides which are both effective and safe for human contact. Since pyrethroid resistant mosquitoes are known to emerge, large scale resistance is likely inevitable.

The only way to detect insecticide resistance and be able to respond with adequate public health measures is by maintaining strong surveillance programs. In Lancet Infectious Diseases, Kelly-Hope et al. draw upon lessons provided by past campaigns and propose sound recommendations for the future. The authors call for insecticide resistance monitoring systems and outline actual specifics for such plans. In addition to country teams, regional centers are important. By conducting advanced biochemical and molecular assays they can detect emerging resistance and provide crucial lead time to plan for policy change. Many groups pay lip service to the importance of such work but few programs possess a concrete strategy. The costs for a quality surveillance program are minimal but the costs due to widespread insecticide resistant mosquitoes would be catastrophic. We cannot afford to continue flying blind.

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