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National Malaria Control Programmes and decision makers could benefit from guidance about which vector control options they should deploy in different settings. Previous modelling studies using experimental hut data found pyrethroid-PBO ITNs to be more cost-effective while both nets were likely to report some benefit even with resistant mosquitoes. Resistance is thought to influence the effectiveness of pyrethroid and pyrethroid-PBO ITNs differently and they also vary in price. An added challenge of recent years is that in some areas mosquitoes have developed intense resistance to pyrethroids, the only insecticide class currently used on WHO recommended ITNs. Combining ITNs and IRS has shown epidemiological benefit, although cost-effectiveness is debated.

Cluster randomised controlled trials (RCTs) have shown that impact of these interventions vary substantially according to the type of net, whether IRS is also used, the epidemiological setting and the characteristics of the mosquitoes. WHO currently recommends two types of ITN, pyrethroid-only and pyrethroid plus piperonyl butoxide (PBO) nets, as well as different IRS products. Insecticide treated nets (ITNs) and the indoor residual spraying (IRS) of insecticide are the most effective method of preventing malaria. The Lancet Regional Health – Western Pacific.

The Lancet Regional Health – Southeast Asia.The Lancet Gastroenterology & Hepatology.