Bed Nets Treated With Two Insecticides Instead of One Are Much More Effective Against Malaria
A resident of Ifakara tucked into a mosquito net

Bed nets treated with an additional insecticide are between 20% and 50% more effective in preventing malaria than those treated with the standard single pyrethroid insecticide, according to pilots in 17 sub-Saharan Africa. 

The New Nets Project successfully piloted nets impregnated with a new generation pyrrole insecticide in combination with pyrethroid in response to growing resistance by the malaria-carrying Anopheles mosquitoes to pyrethroid.

Between 2019 and 2022, the New Nets Project supported the deployment of 38.4 million nets across sub-Saharan Africa. 

In parallel, the Global Fund and US President’s Malaria Initiative (PMI) supported the deployment of millions of additional nets under an internal initiative. As a result, 56 million mosquito nets were introduced in 17 countries across sub-Saharan Africa. 

Two clinical trials and five pilot studies, delivered through the New Nets Project found the new nets could improve malaria control by approximately 20-50% in countries reporting insecticide resistance in sub-Saharan Africa, compared to standard nets. 

The intervention has the potential to avert about 13 million malaria cases and save 24,600 lives, according to its funders, Unitaid and the Global Fund, and the lead implementer, the Innovative Vector Control Consortium (IVCC).

The epidemiological evidence built throughout the project led the World Health Organization (WHO) to publish new recommendations supporting pyrethroid-chlorfenapyr nets instead of pyrethroid-only nets in countries facing pyrethroid resistance.

“We are delighted to see that the dual active ingredient insecticide-treated nets have demonstrated exceptional impact against malaria,” said Peter Sands, executive director of the Global Fund.

Unitaid’s executive director, Dr. Philippe Duneton, said “The New Nets Project has made a massive contribution to malaria control efforts, helping to accelerate the introduction of next-generation bed nets – a critically important tool for reducing malaria cases and deaths. “

Global burden of malaria. Most DALYs in Sub-Saharan Africa.

Malaria is a life-threatening infectious disease with an estimated 249 million cases and 608 000 deaths in 2022, according to the World Malaria Report. It is present in 85 countries, with 95% of cases in the African region. Children under the age of five account for as much as about 80% of malaria deaths.

While some malaria cases are mild, others prove deadly, progressing to severe illness and death within 24 hours. Symptoms range from fever, chills and headache to seizures, confusion and difficulty breathing.

As it is transmitted through mosquito bites, much of the malaria control efforts go into vector control, that is protection against mosquitoes through insecticide-treated bed nets and indoor residual spraying to prevent mosquitoes from staying on the house roof or walls.

Yet, as malaria-carrying mosquitoes adapt to insecticides, a new chemical is likely only a short-term solution. Malaria control requires broad action with multiple solutions implemented. Next to bed nets, many public and private actors concentrate on vaccines, treatments, preventive doses for risk groups and other measures.

 “The findings of the New Nets Project demonstrate the value of investments into state-of-the-art tools in the fight against malaria. We always say that there is no silver bullet to eliminating malaria and we cannot rely on single interventions but rather invest in a suite of tools, which when combined, will have the biggest impact on defeating this disease,” said Dr. Michael Charles, CEO of the RBM Partnership to End Malaria.

Image Credits: Peter Mgongo, IHME.

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