Modelling the impact of declining insecticide resistance with mosquito age on malaria transmission.

Background: The evolution of insecticide resistance can lead to an increase in the entomological indicators of malaria transmission, such as mosquito survival and blood feeding rates, thus threatening efforts to control malaria. Yet, there is little evidence from the field that malaria control programmes are failing due to insecticide resistance. One explanation for this apparent contradiction is the growing evidence that insecticide resistance declines with mosquito age. Once a mosquito is first infected by Plasmodium parasites, it will not be able to transmit those parasites until they have undergone development, which lasts around 10 days. Thus, although the evolution of resistance in a population will enhance the survival of young mosquitoes, the insecticide may still kill old, and thus potentially infectious, mosquitoes, and thereby maintaining its efficacy in controlling malaria.

Materials and methods: The current evidence for age-related insecticide resistance is reviewed. A mathematical model is then described that predicts how the decline of resistance with the age of a mosquito will affect the intensity of transmission of malaria. The model combines the behavioural response of the mosquitoes to insecticides with an epidemiological model of malaria.

Results: It was found that phenotypic resistance decreases between 1.37% to 9.71% per day, independent of the mosquito species or strain. The models suggest that a decline in resistance within this range strongly diminishes the predicted impact of insecticide resistance on the effectiveness of malaria transmission-controlling interventions.

Conclusions: Our model can be used to assess the threat of insecticide-resistance for the control of malaria. The model confirms observations from the field suggesting that, even where genetically insecticide-resistant mosquitoes dominate populations, insecticides can substantially reduce the transmission of malaria.