Although access to antimalarial treatment has improved, malaria remains a critical health challenge, especially in settings with high transmission. Infants, children, and pregnant women, because of their incompletely developed or immune-compromised status, remain at great risk for this disease. For about 75% of people worldwide who lack IRS protection, the standard of care for residential malaria control is the widespread use of insecticide-treated nets (ITNs). By the last decade of the 20th century, research had shown that ITNs effectively reduce residential mosquito contact to the point that the deployment of even a few nets per household could substantially lower the burden of malaria in the most affected communities. This article discusses the problem of insecticide resistance for pediatric malaria prevention, and describes possible ways to counteract resistance to improve malaria control.
The Rise of Insecticide Resistance
This means that, eventually, mosquitoes that are exposed to insecticides ‘survive’ and new ones evolve that carry the trait too. Resistance is essentially the last pin holding a malaria-control strategy together. It is not comprehensive, because resistance operates generation by generation.
Factors contributing to insecticide resistance include:
- Overuse of insecticides: All too often, and in all too many places, insecticides are used repeatedly and over widely dispersed areas, in agricultural and public health contexts.
- Gen: through natural and artificial selection, mosquitoes can evolve to be receptive to new genetic mutations that render them less sensitive to insecticide effects. These newly emerging populations can spread within a species over time.
- Environmental Factors: Not combining suitable environmental management and proper mosquito control often facilitates resistance by improving conditions for the survival of resistant mosquitoes.
- Cross-Resistance: In the case of mosquitoes developing resistance against several classes of insecticides, they can become resistant against all of them, causing quite a headache for those working to prevent disease.
Challenges in Pediatric Malaria Prevention Due to Insecticide Resistance
Reduced Effectiveness of Insecticide-Treated Nets (ITNs)
Given that ITNs form a cornerstone of malaria prevention, particularly for children who are at greater risk of severe malaria, insecticide resistance reduces their efficacy, facilitating mosquitoes biting through or around them.
Increased Malaria Transmission
If mosquito control tools no longer work as well, this could lead to increased transmission of malaria, and hence more children falling ill and even dying from the disease.
Compromised Indoor Residual Spraying (IRS)
Specifically, the IRS aims to spray insecticides inside homes to control mosquitoes. However insecticide resistance could decrease IRS effectiveness, ultimately leaving children living in treated homes unprotected.
Limited Treatment Options
With the progression of resistance, appropriate alternatives, including some simple means and other drugs, could well not be available when needed and sometimes at the right price in resource-limited settings.
Increased Healthcare Burden
Resistance to insecticides also means that the return of malaria will put further pressure on the same healthcare systems that were struggling when we first left them.
Solutions to Combat Insecticide Resistance in Pediatric Malaria Prevention
Integrated Vector Management (IVM)
Solution: IVM uses combinations of vector control measures that target at the same time the adult mosquitoes by using rotated insecticides and larvae by resorting to biological control methods like larviciding and environmental management.
Implementation: Local health authorities and communities can work together to identify and eliminate mosquito larval habitats and foster better sanitary environments, while also incorporating several different methods of control.
Development and Use of New Insecticides
Solution: Following novel strategies, such as correctly selecting active ingredients and application techniques; Research and development of new insecticides with novel modes of action, which is the most effective strategy in this context, provides coverage against a wide spectrum of the arthropod population and prevents the development of resistance.
Finally, implementation: international organizations, governments, and the private sector all have a role in advancing the development and deployment of new insecticides to the market.
Enhanced Surveillance and Monitoring
Solution: Strong monitoring systems for insecticide resistance could guide actions: if surveillance indicates new resistance, recommendations could be revised.
Implementation: When done correctly, this means that female mosquitoes regularly get under microscopes, where their bodies and cells provide feedback to gauges that, in turn, tell us whether the insecticides still work and how we need to tweak control strategies accordingly.
Community Education and Engagement
Solution: Community education about the proper use of ITNs, following IRS schedules, and participating in vector control efforts, can help preventive measures work more effectively.
Implementation: Educate community health workers and other local leaders to actively instruct others in using and maintaining prevention methods correctly.
Promotion of Alternative and Complementary Measures
Solution: Systematic promotion of repellents, mosquito nets with new technologies, and physical barriers can add supplementary levels of protection where insecticide resistance is high.
Implementation: Local health programs should disseminate information on the use of supplementary metrics and encourage the adoption of supplementary tools in addition to traditional instruments.
Research and Development of Resistance Management Strategies
Solution: Resistance management is an ongoing concern, and research into using insecticide mixtures or genetic control is important for developing long-term solutions to the situation.
Implementation: this calls for research investment and the close collaboration between researchers, policymakers, and health organizations developed to ensure coordinated and effective resistance management national policies.
Strengthening Healthcare Systems
Solution: Improving health infrastructure including early diagnosis, treatment and prevention of malaria will help to limit the effect of resistance in pediatric populations.
Implementation: Policy recommendations for governments and international agencies will include stepping up efforts to strengthen health systems, especially in delivering malaria treatment more effectively and ensuring that diagnosis remains available.
Case Studies of Successful Approaches
Kenya’s Integrated Vector Management Program
This includes the Kenya Integrated Vector Management program, which combines ITNs, IRS, and environmental management in an approach that rotates insecticides and fosters community participation and has so far been able to overcome the plaguing problem of resistance.
Cambodia’s Response to Insecticide Resistance
Cambodia’s toolbox approach to controlling malaria, which combines new insecticides, local involvement, and monitoring, along with funding for ongoing research to develop alternative methods of control, is one possible way forward.
Nigeria’s Efforts in Malaria Control
Nigeria’s control approach, according to a recent article on the website of the London School of Hygiene and Tropical Medicine, has also embraced the combination of ITNs, IRS, and larviciding, along with an emphasis on awareness of the need for proper net use, and mobilization of the community for other types of vector control.
Insecticide resistance remains the ‘Achilles’ heel’ of prevention of paediatric malaria, posing a threat to the implementation of key control measures such as ITNs and IRS. Strategies involving integrated vector management, development of new insecticides, improved surveillance, and strengthened community engagement can be carried out together to address the increasing challenge of insecticide resistance and improve malaria prevention in the context of vulnerable children. Governments, health organisations, researchers and the community have an important role in managing adoption of new vaccines and diagnostics, ensuring products are accepted and continue to be effective to disrupt the disease. Through coordination, we can strengthen healthcare systems to overcome the challenges of insecticide resistance and achieve sustainable control of malaria.
