TY - JOUR TI - The impact of pyrethroid resistance on the efficacy and effectiveness of bednets for malaria control in Africa AU - Churcher, Thomas S AU - Lissenden, Natalie AU - Griffin, Jamie T AU - Worrall, Eve AU - Ranson, Hilary A2 - Hay, Simon I VL - 5 PY - 2016 DA - 2016/08/22 SP - e16090 C1 - eLife 2016;5:e16090 DO - 10.7554/eLife.16090 UR - https://doi.org/10.7554/eLife.16090 AB - Long lasting pyrethroid treated bednets are the most important tool for preventing malaria. Pyrethroid resistant Anopheline mosquitoes are now ubiquitous in Africa, though the public health impact remains unclear, impeding the deployment of more expensive nets. Meta-analyses of bioassay studies and experimental hut trials are used to characterise how pyrethroid resistance changes the efficacy of standard bednets, and those containing the synergist piperonyl butoxide (PBO), and assess its impact on malaria control. New bednets provide substantial personal protection until high levels of resistance, though protection may wane faster against more resistant mosquito populations as nets age. Transmission dynamics models indicate that even low levels of resistance would increase the incidence of malaria due to reduced mosquito mortality and lower overall community protection over the life-time of the net. Switching to PBO bednets could avert up to 0.5 clinical cases per person per year in some resistance scenarios. KW - mosquito KW - pyrethroid resistance KW - bednets KW - malaria JF - eLife SN - 2050-084X PB - eLife Sciences Publications, Ltd ER -