Developing an evidence-based decision support system for rational insecticide choice in the control of African malaria vectors.

The emergence of Anopheles species resistant to insecticides widely used in vector control has the potential to impact directly on the control of malaria. This may have a particularly dramatic effect in Africa, where pyrethroids impregnated onto bed-nets are the dominant insecticides used for vector control. Because the same insecticides are used for crop pests, the extensive use and misuse of insecticides for agriculture has contributed to the resistance problem in some vectors. The potential for resistance to develop in African vectors has been apparent since the 1950s, but the scale of the problem has been poorly documented. A geographical information system-based decision support system for malaria control has recently been established in Africa and used operationally in Mozambique. The system incorporates climate data and disease transmission rates, but to date it has not incorporated spatial or temporal data on vector abundance or insecticide resistance. As a first step in incorporating this information, available published data on insecticide resistance in Africa has now been collated and incorporated into this decision support system. Data also are incorporated onto the openly available Mapping Malaria Risk in Africa (MARA) Web site (http://www.mara.org.za). New data, from a range of vector population-monitoring initiatives, can now be incorporated into this open access database to allow a spatial understanding of resistance distribution and its potential impact on disease transmission to benefit vector control programs.