From 2004 to 2019, insecticide-treated bednets (ITNs) have been the most effective tool for reducing malaria morbidity and mortality in sub-Saharan Africa. Recently, however, the decline in malaria cases and deaths has stalled. Some suggest that this inertia is due to increasing resistance in malaria vectors to the pyrethroid insecticides used for treating ITNs. However, there is presently little evidence to reach this conclusion and we therefore recommend that a broader perspective to evaluate ITN effectiveness in terms of access to nets, use of nets, bioefficacy, and durability should be taken. We argue that a single focus on insecticide resistance misses the bigger picture. To improve the effects of ITNs, net coverage should increase by increasing funding for programmes, adopting improved strategies for increasing ITN uptake, and enhancing the longevity of the active ingredients and the physical integrity of nets, while simultaneously accelerating the development and evaluation of novel vector control tools.

从 2004 年到 2019 年，经过杀虫剂处理的蚊帐 (ITN) 一直是降低撒哈拉以南非洲疟疾发病率和死亡率的最有效工具。然而，最近疟疾病例和死亡人数的下降已经停滞。一些人认为这种惰性是由于疟疾媒介对用于治疗 ITN 的拟除虫菊酯杀虫剂的抗药性增加。然而，目前几乎没有证据可以得出这一结论，因此我们建议从更广泛的角度来评估 ITN 在蚊帐的获取、蚊帐的使用、生物功效和耐用性方面的有效性。我们认为，只关注杀虫剂抗性会忽略大局。为提高 ITN 的效果，应通过增加对计划的资助、采用改进的策略来提高 ITN 的使用率、