Trends in insecticide resistance in Anopheles mosquitoes (Diptera: Culicidae) in Ghana: a systematic review.

Malaria continues to be a major public health issue in Ghana, contributing significantly to hospital outpatient visits. Vector control remains central to malaria prevention; however, the growing resistance of malaria vectors to insecticides presents a major obstacle to control and elimination efforts. This review examined the evolution of insecticide resistance in Ghana from 2001 to 2024, summarising resistance mechanisms across the country's bioclimatic zones to inform evidence-based vector control strategies aligned with Ghana's malaria elimination goals. A systematic literature search was conducted using PubMed, Google Scholar, and Scopus databases to identify studies on insecticide resistance in major malaria vectors. A total of 41 articles were retrieved, and data were analysed using Microsoft Excel 365 and GraphPad Prism v.9.1.2. Pyrethroids were the most frequently studied insecticides, particularly in the Coastal (48%, n = 17), Forest (37.1%, n = 13), and Sahel (14.3%, n = 5) zones. An increasing trend of pyrethroid resistance in Anopheles gambiae s.l. was observed across all transmission zones, with the vgsc-L995F mutation being the most reported resistance mechanism. Temporal analysis revealed significant differences in resistance levels over time across all zones. Resistance to dual-active ingredients (piperonyl butoxide + pyrethroid) was also detected nationwide. Notably, there are limited studies on An. funestus susceptibility and metabolic resistance driven by copy number polymorphisms or vgsc variants. Given these gaps, the application of genomic surveillance and whole genome sequencing is essential for identifying locally relevant resistance mechanisms to guide future vector control interventions in support of Ghana's malaria elimination efforts.