WHO now recommends that LLINs be distributed to and used by all people (“universal coverage”) in malarious areas, not just by the most vulnerable groups: pregnant women and children under 5 years. LLINs have been associated with sharp decreases in malaria in countries where malaria programs have achieved high LLIN coverage. WHO-Recommended Long-Lasting Insecticidal Mosquito Nets, February 2014 Cdc-pdf External Long-Lasting Insecticide-treated Nets (LLINs) To help manage resistance, some net products incorporate piperonyl butoxide (PBO) along with a pyrethroid insecticide, but there is not yet evidence that this significantly improves ITN effectiveness in areas with high levels of pyrethroid resistance, and WHO currently does not consider nets that incorporate PBO to be tools for managing pyrethroid resistance. Recent studies have suggested that the rise of pyrethroid resistance may undermine the effectiveness of nets. In addition, the additional cost of the insecticide and the lack of understanding its importance resulted in very low retreatment rates in most African countries. The need for frequent retreatment was a major barrier to widespread use of ITNs in endemic countries. Nets were retreated by simply dipping them in a mixture of water and insecticide and allowing them to dry in a shady place. Previously, nets had to be retreated every 6 to 12 months, or even more frequently if the nets were washed. These insecticides have been shown to pose very low health risks to humans and other mammals, but are toxic to insects and kill them. Only two insecticides classes are approved for use on ITNs (pyrroles and pyrethroids). Most nets are made of polyester, polyethylene, or polypropylene. Nets may vary by size, shape, color, material, and/or insecticide treatment status. To achieve such effects, more than half of the people in a community must use an ITN. When this happens, all members of the community are protected, regardless of whether or not they are using a bed net. In addition, if high community coverage is achieved, the numbers of mosquitoes, as well as their length of life will be reduced. The insecticides also repel mosquitoes, reducing the number that enter the house and attempt to feed on people inside. The insecticides that are used for treating bed nets kill mosquitoes, as well as other insects. However, bed nets treated with an insecticide are much more protective than untreated nets. How Do ITNs Work?īed nets form a protective barrier around people sleeping under them. In community-wide trials in several African settings, ITNs were shown to reduce the death of children under 5 years from all causes by about 20%. Insecticide-treated bed nets (ITNs) are a form of personal protection that has been shown to reduce malaria illness, severe disease, and death due to malaria in endemic regions.
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