Management of insecticides for use in disease vector control: Lessons from six countries in Asia and the Middle East

Interventions to control the vectors of human diseases, notably malaria, leishmaniasis and dengue, have relied mainly on the action of chemical insecticides. However, concerns have been raised regarding the management of insecticides in vector-borne disease-endemic countries. Our study aimed to analyze how vector control insecticides are managed in selected countries to extract lessons learned.A qualitative analysis of the situation of vector control insecticides management was conducted in six countries. Multi-stakeholder meetings and key informer interviews were conducted on aspects covering the pesticide lifecycle. Findings were compared and synthesized to extract lessons learned. Centrally executed guidelines and standards on the management of insecticides offered direction and control in most malaria programs, but were largely lacking from decentralized dengue programs, where practices of procurement, application, safety, storage, and disposal were variable between districts. Decentralized programs were better at facilitating participation of stakeholders and local communities and securing financing from local budgets. However, little coordination existed between malaria, visceral leishmaniasis and dengue programs within countries. Entomological capacity was concentrated in malaria programs at central level, while dengue and visceral leishmaniasis programs were missing out on expertise. Monitoring systems for insecticide resistance in malaria vectors were rarely used for dengue or visceral leishmaniasis vectors. Strategies for insecticide resistance management, where present, did not extend across programs or sectors in most countries. Dengue programs in most countries continued to rely on space spraying which, considering the realities on the ground, call for revision of international guidelines.Vector control programs in the selected countries were confronted with critical shortcomings in the procurement, application, safety measures, storage, and disposal of vector control insecticides, with implications for the efficiency, effectiveness, and safety of vector control. Further international support is needed to assist countries in situation analysis, action planning and development of national guidelines on vector control insecticide management.Author summary: Vector-borne diseases such as dengue, malaria and leishmaniasis are transmitted by insect vectors. Transmission can be interrupted through vector control. Chemical insecticides are the mainstay for controlling these insect vectors. However, the use of chemicals also introduces risks to health and the environment and may lead to insecticide resistance. Hence, proper management of those insecticides is critical. To find out how the insecticides used for vector control are being managed, the authors conducted investigations in six countries in Asia and the Middle East. They found that the practices of insecticide procurement, application, storage, and disposal depended on how a program is organized. Dengue programs were operated in a decentralized manner and, consequently, lacked coordination through guidelines and standards on best practices. Also, coordination between malaria, visceral leishmaniasis and dengue programs within countries was minimal, and expertise needed to guide decisions on vector control and to monitor insecticide resistance was in short supply. The identified shortcomings in how vector control insecticides are managed likely affected the efficiency, effectiveness, and safety of vector control operations.