**6. Impact and Implications of insecticide resistance on the efficacy of LLINs, IRS and malaria transmission**

The increased bed nets ownership and its utilization have significantly reduced malariarelated cases and mortality in Kenya [107, 108], Tanzania [109, 110], Uganda [111] and Ethiopia [112]. However, the high coverage of IRS and scaling up of LLINs is believed to induce the development of resistance in vector species to various classes of insecticides. These have been documented in Kenya [21], Tanzania [79, 113], Uganda [114] and Ethiopia [70, 73, 115].

After the successful reduction of the malaria vector and disease transmission, the increased resistance among potential vector populations has been witnessed across East Africa [1, 21, 116]. The current status of pyrethroid resistance in malaria vectors and an increase in malaria incidence shows the compromised vector control system due to insecticide resistance, which calls the need for the development of new tools for malaria control. Insecticide resistance has shown to compromise the effectiveness of malaria control efforts in Kenya and other West African countries. The use of non-pyrethroid insecticides for IRS is a potential option as the ITN are mainly pyrethroid-based. It has been observed that pyrethroid resistance mosquitoes are entering and surviving exposure to LLINs, which may quantify the indoor transmission resurgence in areas with high level of pyrethroid resistance.
