Why the World Health Organization should reconsider long lasting insecticide nets (LLIN) and indoor residual spraying (IRS) in primary mosquito/malaria control in favour of house screening

Abstract

Mosquitoes spread malaria parasites in closed/open environment when they feed endophagously/ exophagously. Indoor residual spraying (IRS) and long-lasting insecticide nets (LLIN) are control measures adopted by the World Health Organization (WHO) that have not led to malaria elimination. Delay in defeating mosquito/malaria is attributed to WHO’s espousal of the last line of intervention that at-risk persons often ignore. Mosquito control methods will have to change if we must make progress in this direction. This paper shows that mosquitoes must survive four barriers before successfully attacking a host in a bed net. Correspondingly, indoor hosts have four levels of defenses where mosquitoes could be challenged albeit with increasing impediments. The first line of defense consists of net-screened windows, doors and eaves which circumscribe houses-outdoor environment. At-risk persons do not resist/refuse net-screening the openings in their houses. The last defensive intervention which most at-risk persons often resist most is sleeping in bed nets. The Achilles heel of IRS and LLIN include but not limited to vector resistance to insecticides, discomfort to beneficiaries, harm to non-target organisms, inequity in supply and distribution of control materials. List of advantages attributable to LLIN use has only 7 items whereas disadvantages have 37 items. House screening has better appeal to control mosquito/malaria indoors. The WHO should replace LLIN and IRS with house screening as the primary control method. Governments in endemic regions must use legislation to drive house screening especially with the s/o channel/grip devices that is accessible, cheap, effective and sustainable