Abstract

The large-scale roll-out of insecticide-treated nets (ITNs) has been credited with most of the declines in malaria observed in sub-Saharan Africa over the past two decades [1]. The public health value of ITNs is primarily attributable to the insecticide in the netting fibre, which kills or repels host-seeking vector mosquitoes, providing protection against malaria for the user and the wider community. Pyrethroids have been the insecticide of choice on ITNs because they are highly effective, cheap, safe, and fast-acting [2]. Overreliance on pyrethroids has, however, selected for pyrethroid resistance in malaria vectors, which is now pervasive throughout sub-Saharan Africa [3]. Although the extent to which pyrethroid resistance is currently impacting the effectiveness of ITNs is unclear [4], malaria control progress has slowed on a global scale in recent years, and in many high-burden countries, downward trends in cases and deaths have reversed [5]. Concern that pyrethroid resistance is contributing to stalling malaria control progress has stimulated the development of new active ingredients (AIs) for use on ITNs.