Threats to the effectiveness of insecticide-treated bednets for malaria control: thinking beyond insecticide resistance

Steve W. Lindsay*, Matthew B. Thomas, Immo Kleinschmidt

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review


From 2004 to 2019, insecticide-treated bednets (ITNs) have been the most effective tool for reducing malaria morbidity and mortality in sub-Saharan Africa. Recently, however, the decline in malaria cases and deaths has stalled. Some suggest that this inertia is due to increasing resistance in malaria vectors to the pyrethroid insecticides used for treating ITNs. However, there is presently little evidence to reach this conclusion and we therefore recommend that a broader perspective to evaluate ITN effectiveness in terms of access to nets, use of nets, bioefficacy, and durability should be taken. We argue that a single focus on insecticide resistance misses the bigger picture. To improve the effects of ITNs, net coverage should increase by increasing funding for programmes, adopting improved strategies for increasing ITN uptake, and enhancing the longevity of the active ingredients and the physical integrity of nets, while simultaneously accelerating the development and evaluation of novel vector control tools.

Original languageEnglish
Pages (from-to)e1325-e1331
Number of pages7
JournalThe Lancet Global Health
Issue number9
Early online date30 Jun 2021
Publication statusPublished - 1 Sept 2021

Bibliographical note

Funding Information:
SWL is supported by the Global Challenges Research Fund for Networks in Vector Borne Disease Research which is co-funded by the Biotechnology and Biological Sciences Research Council, the Medical Research Council, and the Natural Environment Research Council (grant number BB/R00532X/1). IK was supported by the UK Medical Research Council and the UK Department for International Development under the Concordat agreement, which is part of the European and Developing Countries Clinical Trials Partnership 2 programme supported by the EU ( grant number MR/R010161/1 ). MDT declares no competing interests.

Publisher Copyright:
© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license

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