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Resistance of mosquitoes to permethrin, the standard insecticidal treatment for protective bed nets, threatens the effectiveness of malaria-control programs. As a result, alternative insecticide agents and combinations of agents are being tested (NEJM JW Infect Dis Jul 2018 and Lancet 2018; 391:1577 and PLoS Genet 2017 Feb 2; 13:e1006539).
To assess the effectiveness of bed nets treated with permethrin alone versus a combination of permethrin and pyriproxyfen (an insect-growth regulator with a different mode of action than other insecticides), investigators conducted a two-group, step-wedge, cluster-randomized, controlled trial in Burkina Faso, a malaria-endemic area where most mosquitoes are resistant to permethrin. The researchers enrolled…