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Indeed, the kdr gene frequencies localities and also with the years , and observed were similar in and in Dangbo, Mis- covariates on the other hand. This regression has also serete, Adjohoun and Seme LLIN area but had signifi- been used to appreciate the kdr frequency in the inter- cantly increased in Table 1.

In the control area vention areas compared to the control areas. But in ariates. The Wald test has been used to compare kdr were detected in all localities 24 months after the first frequency and mortality rates in the intervention areas round of IRS, except in Adjohoun, Seme LLIN and con- with the control areas.

To compare the ace-1 frequency trol LLIN. Indeed, logistic regression performed, showed The susceptibility of adult mosquitoes reared from lar- a decrease of mosquito val collection to permethrin 0.

The resistance status of the 0. From , the 0. This finding was similar to susceptible strain Kisumu of An. The 24 h post-exposure mortality rate of An. Kdr and ace. Kdr frequen- cies were respectively in the range of 0. This is the same with the kdr compared to the control IRS area. Concerning the mor- allelic frequencies in dead mosquitoes, specimens which tality rate of An.

The susceptibility to bendiocarb did not rates to deltamethrin were respectively This increase Discussion was corroborated with the strong correlation correla- The results have shown that An. Oueme region. This corroborates previous reports [21] gambiae s. Recent ecological characteristics of the Oueme region that did studies have shown that this mutation is expanding in not support its selection.

The findings have also shown the South [21,38] and North Benin [38]. This high that kdr gene frequencies were stable from to mutation could explain the resistance to deltamethrin in in the LLIN area but had significantly increased in Simi- because the same results were obtained in the control larly, the resistance to permethrin and DDT has been area that has not benefited from the distribution of maintained and became higher.

These findings corrobo- LLINs. But, a similar trend reported by a study in Bioko rate previous studies that had reported resistance of An. It was on the basis of thrin. Although suspected, the selective pressure exerted this study that the decision was made to implement IRS by the promotion of mosquito nets by the Ministry of with a pyrethroid insecticide in Bioko [37].

However, in Health and the free distribution of LLINs in the Oueme , a significant increase of kdr mutation frequency region, causing the kdr increase within An. Because the findings showed a absence of selection pressure from organophosphates or significant decrease in deltamethrin mortality rates from carbamates insecticides [46]. Similarly, Djogbenou et al. Other previous studies have shown gambiae mosquitoes homozygous for the GS muta- that the selection of resistance to pyrethroids in the tion was that they were significantly more likely to die populations of malaria vectors was due to the extensive during pupation than their susceptible counterparts [47].

This using pesticides for crop protection [18] in the Oueme occurrence of heterozygous individuals, in the interven- region, could justify the resistance to deltamethrin in tion area in could be attributed to a high selection control and IRS areas who had not benefited from the pressure, because two rounds of IRS had been carried distribution of LLINs.

This hypothesis was supported by out that year. However, the occurrence of heterozygous previous studies in Mali that showed an increase in kdr individuals even at sites far from the sprayed areas, sug- frequencies in the absence of any wide-scale control gests other factors than those exerted by the vector con- program [12]. The ace-1 mutation may have migrated quito coils, aerosols, use of pesticides for crop protec- from treated to untreated areas, explaining the parallel tion that select individual resistant An.

Conversely, the greater fre- also explain the spatial variation of low susceptibility of quency of ace-1 mutation in An. Kdr resistance gene was not Seme IRS, despite the fact that they are interspersed by the only mechanism of resistance observed in the at least 5 km with untreated control area and LLIN Oueme region.

This could justify the highest kdr fre- area, may suggest a possible migration of ace-1 mutation quency observed among the strain susceptible to delta- to untreated areas. If migration is restricted, the selec- methrin.

According to previous studies in Benin, high tion pressure in the untreated areas may be caused by activity of esterases and oxidases was detected in popu- other than the one induced by IRS. Indeed, recent stu- lations of An. Hence, further investigations climatic characteristic with high rainfall 1, mm are required to determine the role of kdr in conferring annually , where insecticides are extensively used for resistance and the presence of other resistance mechan- agriculture.

This suggests that selection of resistant indi- isms involved in the different classes of insecticides [43]. Therefore, major sent study. In Africa This finding is in agreement with a previous study con- the pyrethroid resistance had highly increased in An ducted in Benin [20,21,44] and in Bioko where the num- gambiae populations. This increase coincided with the ber of An.

In this con- quent IRS rounds with a bendiocarb [4]. This suscept- text there was selection of resistant individuals in the ibility of An. In Culex pipiens populations the ace-1 have been caused by unknown factors other than LLINs mutation has been associated with a high fitness cost and IRS.

These findings have important implications for [45] and the same may be true in An. J Am Mosq Control Assoc , Trop Med Int Health expansion of insecticide resistance by the rotation or the , Thirdly, it is necessary to implement a dia- in the malaria vector Anopheles gambiae from Cameroon.

AmJTrop Med logue and partnerships between the fields of health and Hyg , 74 5 AmJTrop Med Hyg , Acknowledgements The authors would like to Anopheles gambiae s. Trop Med Int Health , A barrier to ITN use may be lack of knowledge regarding malaria transmission and prevention. This study is a controlled trial comparing ITN use and malaria knowledge levels between households in Piron, Mali, undertaken in Methods: Households received net impregnation services either with or without antecedent education.

The main outcome measure was ITN use, defined as impregnation of at least one of the household's existing bednets with insecticide during the study. Knowledge about malaria and prevention practices was assessed pre- and post- educational intervention.

Results were analysed by household and by individual. Conclusion: It is possible to educate individuals about malaria and to implement net impregnation services with limited resources.

Greater accessibility to net-impregnation services is necessary but not sufficient to increase ITN use. Households in hospital admissions for severe malaria were also found were then systematically assigned to receive either an edu- [5]. All households were then offered the chance to have their nets impregnated by vil- Although these trials have demonstrated that ITNs are an lage agent trainees during the net-treatment campaign effective malaria control strategy, there have been many period.

Lastly, individuals were given a post-test question- challenges to ITN distribution, acceptance and utilization naire during the evaluation period to measure ITN use when trying to implement large-scale ITN programs [2]. The study design Knowledge about the cause of malaria and about the exist- is shown Figure 1. For those areas which have been reached by Setting publicity campaigns, high cost and lack of access were This study was conducted during July-August in some of the reasons stated as to why ITNs were not used Piron village located in Bandiagara District, Mopti region, [].

Piron has no electricity or running water and no NMCP, unpublished data. In , a household survey health facilities are available within the village. Although was conducted in four villages of Mopti region in order to Piron is only 17 kilometres away from Goundaka — the identify the barriers to ITN use.

Although a government closest village with health and net impregnation facilities media campaign about ITNs reached all villages, knowl- — the roads are impassable during the rainy season and edge about malaria and about the benefits of ITN use was very few individuals have a method of transportation highly variable among the four villages.

Households treat- other than walking. Study design Reasons why people did not impregnate their bednets Sampling design included: not knowing anything about ITNs, cost, and not A complete village sample of adults estimated total pop- having net impregnation services readily available in the ulation , with adults was carried out with the village.

In the village of Piron, ten of 73 households stated household as the unit of allocation. To be eligible for the that they had previously treated their bednets and had household survey, subjects had to have children. The seen the benefits of ITNs but were not retreating their nets, Mopti Region Health Information System estimated because there were no net treatment services available in households in Piron, although only were present at close proximity to their households.

Every second household was systemati- cally assigned in equal proportions to receive the educa- Based on these findings, a net-impregnation service was tional intervention with net-treatment services study installed within Piron run by the community itself.

An group or net-treatment services alone control group. The objectives of this study were to Stanford University in the United States and the Institu- measure the impact of education plus service availability tional Ethical Committee at the Faculty of Medicine, Phar- on the level of knowledge about malaria and on ITN use.

Informed consent was obtained from the village leaders and all individuals participating in the study. All individuals were given standard treatment for simple ill- nesses regardless of their participation in the study. At the end of the study, a village guides who introduced them to households as is custom- meeting was held to discuss the parameters of the pro- ary, went door-to-door to orally administer the pre-inter- gram, namely the toxicity of the permethrin and the price vention questionnaires in the local languages to of net impregnation they must charge in order to keep the consenting individuals.

Questionnaires were first devel- program operating. The primary outcome measure was ITN use, as defined by impregnation of at least one of the households' existing Ten pre-test questions assessed individuals' knowledge of bednets with insecticide, at the end of the study period.

After the post-test evalu- Additional information solicited in the one-on-one, in- ation survey, control households received the educational depth interviews included individuals' demographic component.

The assigned to the education group were educated together as weighting scheme took into account that there can be one a unit immediately after pre-test questionnaires were or more household decision-makers, that everyone in the administered. Households in the control group received household had equal access to ITNs and that some house- no antecedent education.

All households were given the hold members may sleep under a single bednet. In a sep- opportunity to have their nets treated at the end of the arate analysis, ITN use was analysed by individual, that is, intervention study period, during the establishment of by 'treatment-per-protocol' logistic regression analysis, permanent net-impregnation services within the village.

Nonetheless, men and women were edu- education evaluation period. Net-impregnation period Days 9—16 In determining change in knowledge, each of ten inter- A community-based skills training format [14] was used view questions pertaining to malaria disease, symptoms, to train four members of the community to run the net- transmission, and prevention were assigned a point value impregnation program within their village.

They were of "1" for each correct answer and "0" for an incorrect educated on the following parameters: malaria transmis- answer to questions with only one response or "-1" for an sion and prevention, how to treat bednets with insecticide incorrect answer to questions with greater than one and how to use a self-monitoring system to collect data on response and summed for each respondent. This method how many nets are treated, how often and who uses them.

The paired t- ent age groups. Each item was weighted according to their market value. Most stated that they used these methods against the nuisance of mosquitoes, not for malaria. None of the households were using ITNs at the time of study. No one crossed over between groups. Five ducted the education and baseline characteristics which individuals from the control group were lost to follow-up: were significantly different between intervention and con- a husband and wife from one household, and two men trol groups.

The presented. In July , households individuals under- went systematic allocation: 70 households individu- Most baseline characteristics were similar in the two als, 61 men and 86 women to receive an educational groups Table 1. The mean age was 40 years and ages component with the offer to treat their bednets and 63 ranged from 14—80 in both groups.

What is the most common disease in your village? If you or your child has the following symptoms: fever, 98 98 headache, vomiting and chills, what is the disease? Do you know what malaria is? India — United States to take economic relationship to the next high l C : Allocation of additional quantity of MT for export of raw sugar to Centre releases two installments of tax devolution to State Government F : Penalty under service tax.

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