Operational impact of insecticide resistance on malaria transmission: asking the right questions.

Over the last ten years, malaria control using insecticides impregnated bed nets (ITNs) or sprayed on walls during indoor residual spraying has reduced malaria cases and deaths. However, mosquitoes have become resistant to some insecticides thereby threatening the gains already made. Importantly, how insecticide resistance will affect malaria elimination is poorly understood and it’s not clear whether the persistence of malaria in some countries is due to insecticide resistance or to sub-optimal use of other malaria control measures. This study proposes new ways to measure the role of insecticide resistance in malaria transmission. First, we highlight how the pattern of malaria has changed and hence how previous ways of understanding how insecticide resistance might affect malaria transmission may no longer be correct. We will improve on these earlier approaches by recognizing resistant and susceptible mosquitoes as different populations with different behaviours. This will allow us to track how each population interact with humans and insecticides to bring about disease. Based on this, we will be able to suggest new types of research relevant for National Malaria Control Programmes.