Implications of insecticide resistance for malaria vector control with long-lasting insecticidal nets: evidence from health facility data from Benin

Filémon T Tokponnon , Yolande Sissinto (1) , Aurore Hounto Ogouyémi (1) , Adicath Adéola Adéothy (1) , Alioun Adechoubou , Télesphore Houansou , Mariam Oke , Dorothée Kindé-Gazard (1) , Achille Massougbodji (1) , Martin Akogbeto (2) , Sylvie Cornelie (3) , Vincent Corbel (4) , Tessa B Knox (5) , Abraham Peter Mnzava , Martin J Donnelly (6) , Immo Kleinschmidt (7) , John Bradley (7)

1 Faculté des Sciences de la Santé de Cotonou - Faculté des Sciences de la Santé de Cotonou
2 CREC - Centre de Recherche Entomologique de Cotonou
3 MIVEGEC-VCG - Vector Control Group
4 MIVEGEC - Maladies infectieuses et vecteurs : écologie, génétique, évolution et contrôle
5 Global malaria program [Genève, Suisse]
6 LSTM - Liverpool School of Tropical Medicine
7 LSHTM - London School of Hygiene and Tropical Medicine

Background: Insecticide-based interventions have averted more than 500 million malaria cases since 2000, but insecticide resistance in mosquitoes could bring about a rebound in disease and mortality. This study investigated whether insecticide resistance was associated with increased incidence of clinical malaria.Methods: In an area of southern Benin with insecticide resistance and high use of insecticide-treated nets (ITNs), malaria morbidity and insecticide resistance were measured simultaneously in 30 clusters (villages or collections of villages) multiple times over the course of 2 years. Insecticide resistance frequencies were measured using the standard World Health Organization bioassay test. Malaria morbidity was measured by cases recorded at health facilities both in the whole population using routinely collected data and in a passively followed cohort of children under 5 years old.Results: There was no evidence that incidence of malaria from routinely collected data was higher in clusters with resistance frequencies above the median, either in children aged under 5 (RR = 1.27 (95% CI 0.81-2.00) p = 0.276) or in individuals aged 5 or over (RR = 1.74 (95% CI 0.91-3.34) p = 0.093). There was also no evidence that incidence was higher in clusters with resistance frequencies above the median in the passively followed cohort (RR = 1.11 (0.52-2.35) p = 0.777).Conclusions: This study found no association between frequency of resistance and incidence of clinical malaria in an area where ITNs are the principal form of vector control. This may be because, as other studies have shown, ITNs continue to offer some protection from malaria even in the presence of insecticide resistance. Irrespective of resistance , nets provide only partial protection so the development of improved or supplementary vector control tools is required to reduce Africa's unacceptably high malaria burden.

Mots clés: Malaria; Insecticide; Resistance; Pyrethroid; Vector

Domaines: Santé publique et épidémiologie; Maladies infectieuses

Filémon T Tokponnon, Yolande Sissinto, Aurore Hounto Ogouyémi, Adicath Adéola Adéothy, Alioun Adechoubou, et al.. Implications of insecticide resistance for malaria vector control with long-lasting insecticidal nets: evidence from health facility data from Benin. Malaria Journal, 2019, 18, pp.37. ⟨10.1186/s12936-019-2656-7⟩. ⟨hal-02063564⟩