Browsing by Author "Moore, Jason"

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A household randomized-control trial of insecticide-treated screening for malaria control in unimproved houses in Tanzania
(Springer Nature, 2025-06-08) Odufuwa, Olukayode; Moore, Sarah Jane; Mboma, Zawadi; Mwanga, Rehema; Matwewe, Fatuma; Hofer, Lorenz; Moore, Jason; Nguyen, Hien; Bosselmann, Rune; Skovmand, Ole; Stevenson,Jennifer; Muganga, Joseph; Bradley, John
Background Installing insecticidal netting on open eaves, windows, and holes in walls of unimproved houses is a potential malaria control tool. It prevents mosquito house-entry, induces lethal and sub-lethal effects on malaria vectors, and may reduce malaria transmission. Therefore, a household epidemiological trial was conducted to assess the efficacy of insecticide- treated screening (ITS) on malaria infection and indoor vectors in Tanzania. Methods In Chalinze district, Tanzania, 421 households were randomized into two arms. In June-July 2021, one group of households’ houses was fitted with ITS (incorporated with deltamethrin and piperonyl butoxide) on eaves, windows, and wall holes, while the second group did not receive screening. After installation, consenting household members (aged ≥ 6 months) were tested for malaria infection using quantitative polymerase chain reaction after the long rainy season (June/July 2022, primary outcome) and the short rainy season (January/February 2022, secondary outcome). Secondary outcomes included indoor total mosquito per trap/night (June–July 2022), adverse effects after one month of ITS installation (August 2021), and chemical bioavailability and retention of ITS samples after one year of field use (June/July 2022). At the end of the trial, the control group received ITS. Results Malaria prevalence among residents in the ITS arm was 19.9% (50/251) and 28.3% (65/230) in the control arm after the long rains, however, this difference was not significant [adjusted odds ratio (OR) 0.67 (95% CI 0.35–1.28), p = 0.227]. Similarly, no protection was seen for ITS after the short rains, [OR 1.27 (95% CI 0.68–2.38), p = 0.452]. However, school-age children in the ITS arm had lower malaria after the long rains [OR 0.11 (95% CI 0.02–0.73), p = 0.022]. No serious adverse effects were reported. The mean number of female Anopheles mosquitoes caught per trap/night was not significantly different between arms [1.7 vs 2.4, crude relative risk: 0.71 (95% CI 0.16–3.09), p = 0.650]. ITS showed reduced chemical bioavailability and retention post-field use. The trial reported high household refusals (17–30%) in both arms in both surveys. Conclusion The trial was inconclusive because households’ refusal resulted in low power. A large cluster randomized trial of the intervention, preferably with screens treated with longer-lasting insecticides installed in houses, is needed. Trial registry: The trial was registered at ClinicalTrials.gov (NCT05125133) on October 2021 Keywords Insecticide-treated screening, ITS, Insecticide-treated nets, ITNs, Eave nets, Malaria prevalence, Mosquitoes, Trial, House modification, Tanzania
Comparison of cone bioassay estimates at two laboratories with different Anopheles mosquitoes for quality assurance of pyrethroid insecticide-treated nets
(Springer Nature., 2022-07-07) Mbwambo, Stephen; Bubun, Nakei; Mbuba, Emmanuel; Moore, Jason; Mbina, Kasiani; Kamande, Dismas; Laman, Moses; Mpolya, Emmanuel; Odufuwa, Olukayode; Freeman, Tim; Karl, Stephan; Moore, Sarah
ckground: Quality assurance (QA) of insecticide-treated nets (ITNs) delivered to malaria-endemic countries is con ducted by measuring physiochemical parameters, but not bioefcacy against malaria mosquitoes. This study explored utility of cone bioassays for pre-delivery QA of pyrethroid ITNs to test the assumption that cone bioassays are consist ent across locations, mosquito strains, and laboratories. Methods: Double-blinded bioassays were conducted on twenty unused pyrethroid ITNs of 4 brands (100 nets, 5 subsamples per net) that had been delivered for mass distribution in Papua New Guinea (PNG) having passed pre delivery inspections. Cone bioassays were performed on the same net pieces following World Health Organization (WHO) guidelines at the PNG Institute of Medical Research (PNGIMR) using pyrethroid susceptible Anopheles farauti sensu stricto (s.s.) and at Ifakara Health Institute (IHI), Tanzania using pyrethroid susceptible Anopheles gambiae s.s. Additionally, WHO tunnel tests were conducted at IHI on ITNs that did not meet cone bioefcacy thresholds. Results from IHI and PNGIMR were compared using Spearman’s Rank correlation, Bland–Altman (BA) analysis and analysis of agreement. Literature review on the use of cone bioassays for unused pyrethroid ITNs testing was conducted. Results: In cone bioassays, 13/20 nets (65%) at IHI and 8/20 (40%) at PNGIMR met WHO bioefcacy criteria. All nets met WHO bioefcacy criteria on combined cone/tunnel tests at IHI. Results from IHI and PNGIMR correlated on 60-min knockdown (KD60) (rs=0.6,p=0.002,n=20) and 24-h mortality (M24) (rs=0.9,p<0.0001,n=20) but BA showed systematic bias between the results. Of the 5 nets with discrepant result between IHI and PNGIMR, three had confdence intervals overlapping the 80% mortality threshold, with averages within 1–3% of the threshold. Including these as a pass, the agreement between the results to predict ITN failure was good with kappa=0.79 (0.53–1.00) and 90% accuracy. Conclusions: Based on these study fndings, the WHO cone bioassay is a reproducible bioassay for ITNs with>80% M24, and for all ITNs provided inherent stochastic variation and systematic bias are accounted for. The literature
Cone Bioassays Provide Reproducible Bioefficacy Estimates with Different Anopheline Mosquitoes and Can Be Used for Quality Assurance of Pyrethroid Insecticide Treated Nets
(Research Square, 2022-01-24) Mbwambo, Stephen; Bubun, Nakei; Mbuba, Emmanuel; Moore, Jason; Mbina, Kasiani; Kamande, Dismas; Laman, Moses; Mpolya, Emmanuel; Odufuwa, Olukayode; Freeman, Tim; Karl, Stephan; Moore, Sarah
Background Quality assurance (QA) of insecticide-treated nets (ITNs) delivered to malaria-endemic countries is conducted by measuring physiochemical parameters, but not bioecacy against malaria mosquitoes. The cone bioassay provides a simple evaluation of ITN bioecacy and its conditions and parameters are prescribed by the World Health Organization (WHO). This study explored utility of cone bioassays for pre- delivery QA of pyrethroid ITNs in two test facilities using different mosquito species to test the assumption that cone bioassays are consistent and reproducible across locations, mosquito strains, and laboratories. Methods Double-blinded bioassays were conducted on unused pyrethroid ITNs of 4 brands (5 nets/brand, 5 subsamples/net) that had been delivered for mass distribution in Papua New Guinea (PNG) having passed physiochemical testing of chemical content. Cone bioassays were performed on adjacent net pieces following WHO guidelines at the PNG Institute of Medical Research (PNGIMR) using pyrethroid susceptible Anopheles farauti s.s. and at Ifakara Health Institute (IHI), Tanzania using pyrethroid susceptible Anopheles gambiae s.s. Additionally, WHO tunnel tests was conducted at IHI on ITNs that did not meet cone bioecacy thresholds. Results from IHI and PNGIMR were compared using Spearman’s Rank, Bland Altman and Cohen’s kappa. A literature review on the utility of cone bioassays for unused pyrethroid ITNs testing was also conducted. Results In cone bioassays, 13/20 nets (65%) met WHO bioecacy criteria at IHI and 8/20 (40%) at PNGIMR. All nets met WHO bioecacy criteria on combined cone/tunnel tests. Results from IHI and PNGIMR correlated on 60-minute knockdown (rs=0.6, p=0.002,n=20) and 24-hour mortality (rs=0.9, p<0.0001,n=20) but there was systematic bias between the results measured by Bland Altman. Of the 5 nets with discrepant result between IHI and PNGIMR, three had condence intervals overlapping the 80% mortality threshold, with averages within 1-3% of the threshold. The agreement between the results to predict ITN failure was good with kappa=0.79 (0.53-1.00) and 90% accuracy. Conclusions WHO cone is a reproducible means to measure pyrethroid ITN bioecacy using a combination of knockdown and mortality. In the absence of an alternative tests, cone tests could be used to assess the availability of active ingredients at the surface of ITN (where mosquitoes encounter it) as part of pre-delivery QA.
DENV-2 Circulation and Host Preference Among Highly Anthropophilic, Outdoor-Biting Aedes aegypti in Dar es Salaam, Tanzania
(MDPI, 2025-06-05) Tenywa, Frank; Hälg, Silvan; Makame, Haji; Moore, Jason; Dogan, Osward; Mapipi, Harubu; Machange, Jane; Lilolime, Nasoro; Hofer, Lorenz; Batao, Lewis; Mwamlima, Tunu; Müller, Pie; Moore, Sarah
In Tanzania, dengue outbreaks have occurred almost annually over the past decade, with each new outbreak becoming more severe. This study investigated the preva- lence of dengue virus (DENV) serotypes in the wild Aedes aegypti and their blood sources to determine human exposure risk in Dar es Salaam, Tanzania. A two-year longitudinal survey was conducted in the Ilala, Kinondoni, and Temeke districts of Dar es Salaam to sample Ae. aegypti mosquitoes using Biogents Sentinel trap (BGS), Prokopack aspira- tion, and Gravid Aedes trap (GAT). Collected mosquitoes were pooled in groups of 10 and tested for DENV1–4 serotypes using reverse transcription polymerase chain reaction (RT-qPCR). Blood meal sources were identified using an enzyme-linked immunosorbent assay (ELISA). Of 854 tested pools, only DENV-2 was detected and was found in all three districts: Temeke (3/371 pools), Ilala (1/206 pools), and Kinondoni (1/277 pools). Blood meal analysis showed a strong preference for humans (81%) as well as for mixed blood meals that contained human blood and other hosts (17%). Out of 354 collected hosts seeking Ae. aegypti, 78.5% were captured outdoors and 21.5% indoors. This study confirms the circulation of DENV-2 in Ae. aegypti populations, indicating a potential dengue outbreak risk in Tanzania. This study also demonstrates that xenomonitoring may be feasible in this setting. The mosquitoes’ strong preference for human hosts and predominance in outdoor settings pose challenges for dengue control effort
Efficacy of the spatial repellent SC Johnson Mosquito Shield™ against anophelines in free-flight chambers, semi-field systems, experimental huts, and in-home tests
(Frontiers, 2025-07-16) Swai, Johnson; Ntabaliba, Watson; Ngonyani, Hassan; Makungwa, Noely; Mseka, Antony; Ngoyani, Saphina; Kibwengo, Ibrahim; Mpelepele, Ahmadi; Moore, Jason; Chura, Madeleine; Mascari, Thomas; Moore, Sarah
Evaluation of vector control tools follows a phased approach, progressing from laboratory studies to semi-field trials in experimental huts, and finally to small-scale (in-home test) and large-scale (randomized control trials) field evaluations under user conditions. Method selection depends on the specific data objectives. Methods: We assessed the entomological efficacy of the transfluthrin-based spatial repellent product SC Johnson Mosquito Shield™ in free-flight chambers, semi-field and field experimental hut trials, and an in-home test against Afrotropical malaria vectors. We focused on efficacy endpoints and mosquito collection methods to inform evidence-based evaluation of spatial repellents. Results: Mosquito Shield reduced number of mosquitoes blood-feeding and landing, and also induced mortality, exophily, and deterrence at different magnitudes across the testing methods. However, not all endpoints were measurable with every method. Landing reductions were measured using] human landing catches and remained similar in magnitude across experimental hut tests in the semi-field (71%) and field (70%), as well as in-home tests (66%), but were higher in the free-flight chambers (96%) using a susceptible mosquito strain. Other endpoints (mortality, and exophily) generally showed higher estimates in controlled environments with lab-reared mosquitoes, compared to ambient conditions with wild, free-flying mosquitoes.
Estimating the hole surface area of insecticide-treated nets using image analysis, manual hole counting and exact hole measurements
(BMC, 2025-03-14) Mbuba, Emmanuel; Mañas‑Chavernas, Natalia; Moore, Sarah; Ruzige, Philipo; Kobe, Dickson; Moore, Jason; Philipo, Rose; Kisoka, Noela; Pontiggia, Gianpaolo; Chacky, Frank; Mwalimu, Charles; Cattin, Philippe; Wolleb, Julia; Sandkuehler, Robin; Ross, Amanda
Background The physical integrity of insecticidal‑treated nets (ITNs) is important for creating a barrier against host seeking mosquitoes and, therefore, influences people’s perception of the net’s effectiveness and their willingness to use it. Monitoring the physical integrity of ITNs over time provides information for replenishment schedules and purchasing decisions. Currently, the assessment of physical integrity of ITNs is conducted by manually counting holes and estimating their size to class the net as functional or not. This approach is laborious to routinely conduct during field surveys of ITNs. Automated image analysis may provide a rapid assessment of the physical integrity of ITNs but it is not known if the images can capture sufficient information. As a first step, this study aimed to assess the agreement between estimated hole surface areas derived from (1) manually segmented images, (2) manual hole counting compared to (3) ground truth obtained by calibrated close‑up shots of individual holes. Methods The physical integrity of 75 ITNs purposely selected from an ongoing study was assessed by manual hole counting, image analysis and ground truth. For the image analysis, a graphical user interface was developed and used for the segmentation of holes visible in photographs taken from each side of the net. The hole surface area was then computed from this data. The agreement between the estimates from image analysis and manual hole counting was compared to the ground truth using the Bland–Altman method. Results There was substantial agreement between the manually segmented image analysis estimates and the ground truth hole surface areas. The overall bias was small, with a mean ratio of the hole surface area from image analysis to the ground truth of 0.70, and the 95% limits of agreement ranging from 0.35 to 1.38. Manual hole counting underestimated the hole surface area compared to the ground truth, particularly among nets with holes above 10 cm in diameter. Conclusion Images coupled with manual segmentation contain sufficient information to calculate hole surface area. This lays the groundwork for incorporating automatic hole detection, and then assessing whether this method will offer a fast and objective method for routine assessment of physical integrity of ITNs. While the WHO
An experimental hut study to quantify the effect of DDT and airborne pyrethroids on entomological parameters of malaria transmission.
(Malaria Journal, 2014-04-01) Ogoma, Sheila; Lorenz, Lena; Ngonyani, Hassan; Sangusangu, Robert; Kitumbukile, Mohammed; Kilalangongono, Masoudi; Simfukwe, Emmanuel; Mseka, Anton; Mbeyela, Edgar; Roman, Deogratius; Moore, Jason; Kreppel, Katharina; Maia, Marta; Moore, Sarah
Background Current malaria vector control programmes rely on insecticides with rapid contact toxicity. However, spatial repellents can also be applied to reduce man-vector contact, which might ultimately impact malaria transmission. The aim of this study was to quantify effects of airborne pyrethroids from coils and DDT used an indoor residual spray (IRS) on entomological parameters that influence malaria transmission. Methods The effect of Transfluthrin and Metofluthrin coils compared to DDT on house entry, exit and indoor feeding behaviour of Anopheles gambiae sensu lato were measured in experimental huts in the field and in the semi-field. Outcomes were deterrence - reduction in house entry of mosquitoes; irritancy or excito-repellency – induced premature exit of mosquitoes; blood feeding inhibition and effect on mosquito fecundity. Results Transfluthrin coils, Metofluthrin coils and DDT reduced human vector contact through deterrence by 38%, 30% and 8%, respectively and induced half of the mosquitoes to leave huts before feeding (56%, 55% and 48%, respectively). Almost all mosquitoes inside huts with Metofluthrin and Transfluthrin coils and more than three quarters of mosquitoes in the DDT hut did not feed, almost none laid eggs and 67%, 72% and 70% of all mosquitoes collected from Transfluthrin, Metofluthrin and DDT huts, respectively had died after 24 hours. Conclusion This study highlights that airborne pyrethroids and DDT affect a range of anopheline mosquito behaviours that are important parameters in malaria transmission, namely deterrence, irritancy/excito-repellency and blood-feeding inhibition. These effects are in addition to significant toxicity and reduced mosquito fecundity that affect mosquito densities and, therefore, provide community protection against diseases for both users and non-users. Airborne insecticides and freshly applied DDT had similar effects on deterrence, irritancy and feeding inhibition. Therefore, it is suggested that airborne pyrethroids, if delivered in suitable formats, may complement existing mainstream vector control tools.
Fabric integrity, net type and risk index predicts attrition of insecticide-treated nets: evidence from a community durability trial of piperonyl butoxide (PBO) nets in Tanzania
(Malaria Journal, 2025-11-26) Mvungi, Nolvin; Olukayode, Odufuwa; Ruzige, Philipo; Muganga, Joseph; Mmasi, Dorin; Machange, Jane; Kamande, Dismas; Madumla,Edith; Moore, Jason; Mwema, Mwema; Moore, Sarah; Mbuba, Emmanuel
The fabric integrity of insecticide-treated nets (ITNs) deteriorates over time during household use, often leading households to discard or stop using damaged nets. This study quantified the extent to which net loss from households is attributable to declining fabric integrity, accounting for variation in user behaviour and environmental conditions. Methods This secondary analysis used data from an ITN durability trial in Bagamoyo, Tanzania. A total of 2,514 ITNs (three pyrethroid-PBO and one pyrethroid-only) distributed among 1,509 households were included because they had the outcome of interest (attrition). Fabric integrity was classified as good, damaged, or too-torn according to WHO ITN guidelines and assessed at 12-month intervals. The association between fabric integrity and net attrition over the subsequent 12 months was evaluated using an adjusted logistic regression model, accounting for net type, household risk index, household size, and age of the household head as fixed effects, with household as a random effect. Results Attrition increased over time, from 20% at one year to 53% at two years, and 83% at three years post-distribution, and it was associated with net type, household risk index, household size, and age of the household head. Damaged ITNs at one year were more likely to be lost by year two. Compared to nets in good condition, damaged nets had higher odds of attrition (OR: 1.73, 95% CI: 1.06-2.82), and too-torn nets were at greater risk (OR: 9.82, 95% CI: 5.87-16.4). Similar patterns were observed between years two and three (damaged: OR =1.55, 95% CI: 0.83-2.90; too- torn: OR=11.7, 95% CI: 6.16-22.3).ACCEPTED MANUSCRIPTARTICLE IN PRESS ARTICLE IN PRESSConclusion Fabric integrity was the main driver of rapid ITN attrition and the strongest predictor of loss. Damaged nets were approximately twice as likely to be discarded after one year and at least ten times more likely to be lost in years two and three. These findings highlight the importance of promoting proper net care practices and procuring durable nets that withstand harsh household conditions, ensuring sustained population coverage.
In starvation, a bone can also be meat”: a mixed methods evaluation of factors associated with discarding of long-lasting insecticidal nets in Bagamoyo, Tanzania
(Springer Nature., 2022-03-24) Madumla, Edith; Moore, Sarah; Moore, Jason; Mbuba, Emmanuel; Mbeyela, Edgar; Kibondo, Ummi; Mmbaga, Selemani; Kobe, Dickson; Baraka, Jitihada; Msellemu, Daniel; Swai, Johnson; Mboma, Zawadi; Odufuwa, Olukayode
Background: Between 2000 and 2019, more than 1.8 billion long-lasting insecticidal nets (LLINs) were distributed in Africa. While the insecticidal durability of LLINs is around 3 years, nets are commonly discarded 2 years post distribu tion. This study investigated the factors associated with the decision of users to discard LLINs. Methods: A mixed-method sequential explanatory approach using a structured questionnaire followed by focus group discussions (FGDs) to collect information on experiences, views, reasons, how and when LLINs are discarded. Out of 6,526 households that responded to the questionnaire of LLINs durability trial, 160 households were randomly selected from the households in four villages in Bagamoyo Tanzania for FGDs but only 155 households participated in the FGDs. Five of the household representatives couldn’t participate due to unexpected circumstances. A total of sixteen FGDs each comprising of 8–10 adults were conducted; older women (40–60 years), older men (40–60 years), younger women (18–39 years), younger men (18–39 years). During the FGDs, participants visually inspected seven samples of LLINs that were “too-torn” based on Proportionate Hole Index recommended by the World Health Organi zation (WHO) guidelines on LLIN testing, the nets were brought to the discussion and participants had to determine if such LLINs were to be kept or discarded. The study assessed responses from the same participants that attended FGD and also responded to the structured questionnaire, 117 participants fulflled the criteria, thus data from only 117 participants are analysed in this study. Results: In FGDs, integrity of LLIN infuenced the decision to discard or keep a net. Those of older age, women, and householders with lower income were more likely to classify a WHO “too-torn” net as “good”. The common methods used to discard LLINs were burning and burying. The fndings were seen in the quantitative analysis. For every addi tional hole, the odds of discarding a WHO “too-torn” LLIN increased [OR=1.05 (95%CI (1.04–1.07)), p<0.001]. Younger age group [OR=4.97 (95%CI (3.25–7.32)), p<0.001], male-headed households [OR=6.85 (95%CI (4.44 –10.59)), p<0.001], and wealthy households [OR=3.88 (95%CI (2.33–6.46)), p<0.001] were more likely to discard LLINs.
Long-lasting insecticidal nets retain bio-efficacy after 5 years of storage: implications for malaria control programmes
(Springer Nature, 2020-03-14) Musa, Jeremiah John; Moore, Sarah; Moore, Jason; Mbuba, Emmanuel; Mbeyela, Edgar; Kobe, Dickson; Swai, Johnson; Odufuwa, Olukayode
Background: Long-lasting insecticidal nets (LLINs) are the most sustainable and efective malaria control tool currently available. Global targets are for 80% of the population living in malaria endemic areas to have access to (own) and use a LLIN. However, current access to LLINs in endemic areas is 56% due to system inefciencies and budget limitations. Thus, cost-efective approaches to maximize access to efective LLINs in endemic areas are required. This study evaluated whether LLINs that had been stored for 5 years under manufacturer’s recommended conditions may be optimally efective against Anopheles mosquitoes, to inform malaria control programmes and governments on the periods over which LLINs may be stored between distributions, in an efort to maximize use of available LLINs. Methods: Standard World Health Organization (WHO) bioassays (cone and tunnel test) were used to evaluate the bio-efcacy and wash resistance of Olyset® and DawaPlus® 2.0 (rebranded Tsara® Soft) LLINs after 5 years of storage at 25 °C to 33.4 °C and 40% to 100% relative humidity. In addition, a small scale Ifakara Ambient Chamber test (I-ACT) was conducted to compare the bio-efcacy of one long stored LLINs to one new LLIN of the same brand, washed or unwashed. LLINs were evaluated using laboratory reared fully susceptible Anopheles gambiae sensu stricto (s.s.) (Ifakara strain) and pyrethroid resistant Anopheles arabiensis (Kingani strain). Results: After 5 years of storage, both unwashed and washed, Olyset® and DawaPlus® 2.0 (Tsara® Soft) LLINs passed WHO bio-efcacy criteria on knockdown (KD60) ≥95%, 24-h mortality ≥80% and ≥90% blood-feeding inhibition in WHO assays against susceptible An. gambiae s.s. DawaPlus® 2.0 LLINs also passed combined WHO bioassay criteria against resistant An. arabiensis. Confrmatory I-ACT tests using whole nets demonstrated that long-stored LLINs showed higher efcacy than new LLINs on both feeding inhibition and mortality endpoints against resistant strains. Conclusions: Even after long-term storage of around 5 years, both Olyset® and DawaPlus® 2.0 LLINs remain efcacious against susceptible Anopheles mosquitoes at optimal storage range of 25 °C to 33.4 °C for temperature and 40% to 100% relative humidity measured by standard WHO methods. DawaPlus® 2.0 (Tsara® Soft) remained efcacious against resistant strain.
PRONet Duo insecticide-treated net incorporated with chlorfenapyr and bifenthrin is superior to Interceptor® G2 nets against pyrethroid-resistant Anopheles gambiae sensu lato: a randomized experimental hut trial in Côte d’Ivoire and Tanzania using non-inferiority design
(Frontiers, 2025-03-14) Assenga, Alphonce; Ahoua Alou, Ludovic; Camara, Soromane; Koffi, Alphonsine; N’Guessan, Raphael; Kamande, Dismas; Ngonyani, Safina; Kibondo, Ummi; Odufuwa, Olukayode; Ntabaliba, Watson; Lekundayo, Ruth; Abilah, Faraji; Madumla, Edith; Muganga, Joseph; Moore, Jason; Moore, Sarah
Background: The widespread development of pyrethroid-resistant Anopheles populations, has reduced the efficacy of pyrethroid insecticide-treated nets (ITNs), hindering malaria control efforts. This study tested PRONet Duo, a new ITN with two active ingredients-bifenthrin and chlorfenapyr. Bifenthrin is a fluorinated pyrethroid that is highly stable and more slowly detoxified by pyrethroid-resistant mosquitoes. Chlorfenapyr disrupts cellular energy production. The efficacy of PRONet Duo was compared to Interceptor® G2, an alpha-cypermethrin and chlorfenapyr ITN with proven efficacy in malaria reduction. Methods: The study was conducted in two identical 9x9 Latin square experimental hut trials against wild free-flying Anopheles gambiae sensu lato in M’Bé, Côte d’Ivoire, and Lupiro, Tanzania using 18 experimental huts over 108 nights. The primary endpoint was the proportion of 72-hour mosquito mortality (M72) and the secondary endpoint was the proportion of mosquito blood-feeding. The study was done following World Health Organization guidelines. Data were analyzed using mixed-effect linear regression with a 7% margin of non-inferiority. Data were classified as non-inferior using delta and superior using the line of no difference. Results: PRONet Duo demonstrated a non-inferior and superior mosquito mortality compared to Interceptor® G2 in both study sites. In Côte d’Ivoire, the M72 of PRONet Duo was 84% [81,88], higher than that of Interceptor® G2 (72% [68,76], OR: 1.54 [1.27,1.88]) and it was superior to MAGNet® (30% [27,34], OR: 13.74 [11.35,16.63], p<0.0001). In Tanzania, M72 of PRONet Duo was 68% [62,73], higher than that induced by Interceptor® G2 (44% [40,49], Odds Ratio (OR): 2.77 [2.31, 3.33]), and MAGNet® (36% [32,41], OR:4.82 [4.06,5.72] p<0.0001). PRONet Duo also induced non-inferior and superior prevention of blood-feeding compared to Interceptor® G2, with less than 11% feeding success observed in either trial site. Conclusion: PRONet Duo ITNs are non-inferior and superior to the first-in-class Interceptor® G2 in terms of mosquito mortality and prevention of blood-feeding demonstrating the added benefit of bifenthrin for insecticide resistance management. Both chlorfenapyr nets offered superior mortality compared to the pyrethroid-only ITN. PRONet Duo offers an additional highly effective ITN for control of pyrethroid-resistant mosquitoes in malaria endemic regions.