Malaria vector control in sub-Saharan Africa: complex trade-offs to combat the growing threat of insecticide resistance.

Autor:	Oxborough RM; Parasitology and Vector Biology (PARAVEC) Laboratory, School of Public Health, University of Nevada, Las Vegas, NV, USA; Dr Richard Oxborough Consultancy, Las Vegas, NV, USA. Electronic address: DrRichardOxborough@gmail.com., Chilito KCF; Parasitology and Vector Biology (PARAVEC) Laboratory, School of Public Health, University of Nevada, Las Vegas, NV, USA; Department of Environmental and Occupational Health, School of Public Health, University of Nevada, Las Vegas, NV, USA., Tokponnon F; Centre de Recherche Entomologique de Cotonou (CREC), Cotonou, Benin; Ecole Polytechnique d'Abomey-Calavi (EPAC), Abomey-Calavi, Benin., Messenger LA; Parasitology and Vector Biology (PARAVEC) Laboratory, School of Public Health, University of Nevada, Las Vegas, NV, USA; Department of Environmental and Occupational Health, School of Public Health, University of Nevada, Las Vegas, NV, USA; Faculty of Infectious and Tropical Diseases, Department of Disease Control, London School of Hygiene & Tropical Medicine, London, UK. Electronic address: louisa.messenger@unlv.edu.
Jazyk:	angličtina
Zdroj:	The Lancet. Planetary health [Lancet Planet Health] 2024 Oct; Vol. 8 (10), pp. e804-e812.
DOI:	10.1016/S2542-5196(24)00172-4
Abstrakt:	Mass distribution of insecticide-treated nets (ITNs) has been a key factor in reducing malaria cases and deaths in sub-Saharan Africa. A shortcoming has been the over-reliance on pyrethroid insecticides, with more than 2·13 billion pyrethroid ITNs (PY ITNs) distributed in the past two decades, leading to widespread pyrethroid resistance. Progressive changes are occurring, with increased deployment of more effective pyrethroid-chlorfenapyr (PY-CFP) or pyrethroid-piperonyl butoxide (PY-PBO) ITNs in areas of pyrethroid resistance. In 2023, PY-PBO ITNs accounted for 58% of all ITNs shipped to sub-Saharan Africa. PY-PBO and PY-CFP ITNs are 30-37% more expensive than standard PY ITNs, equating to an additional US$132-159 million required per year in sub-Saharan Africa to fund the shift to more effective ITNs. Several countries are withdrawing or scaling back indoor residual spraying (IRS) programmes to cover the shortfall, which is reflected by the number of structures sprayed by the US President's Malaria Initiative decreasing by 30% from 5·67 million (2021) to 3·96 million (2023). Benin, located in West Africa, is a prime example of a country that ceased IRS in 2021 after 14 years of annual spraying. Our economic evaluation indicates that IRS in Benin cost $3·50 per person protected per year, around five times more per person protected per year compared with PY-PBO ($0·73) or PY-CFP ITNs ($0·76). Although costly to implement, a major advantage of IRS is the portfolio of at least three chemical classes for prospective resistance management. With loss of synergy to PBO developing rapidly, there is the danger of over-reliance on PY-CFP ITNs. As gains in global malaria control continue to reverse each year, current WHO projections estimate that key 2030 malaria incidence milestones will be missed by a staggering 89%. This Personal View explores contemporary malaria vector control trends in sub-Saharan Africa and cost implications for improved disease control and resistance management. Competing Interests: Declaration of interests LAM and KCFC were funded by the School of Public Health, University of Nevada, Las Vegas, NV, USA (internal grant number PG03008). RMO and FT received no funding for this study. The authors declare no competing interests. The opinions expressed herein are those of the authors and do not necessarily reflect the views of organisations mentioned in the article including the United States Agency for International Development (USAID), United States President's Malaria Initiative (US-PMI), The Global Fund, The Alliance for Malaria Prevention, and the Government of Benin. (Copyright © 2024 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 license. Published by Elsevier Ltd.. All rights reserved.)
Databáze:	MEDLINE
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