Background: Long-lasting insecticidal nets (LLINs) are designed to survive and sustain their physical barrier for 3 years in household conditions. However, studies have shown that most of these nets are usually torn or no longer present in the households in less than 3 years. This study was initiated in Benin to compare the survivorship and physical integrity of seven types of LLINs in a same socio-geographic area. Methods: In August 2017, 1890 households were selected in 9 villages in the municipality of Zagnanado in central Benin. Each one of the selected households received one of the seven LLIN products: Aspirational ® , DawaPlus ® 2.0, OlysetNet ® , PermaNet ® 2.0, PermaNet ® 3.0, Royal Sentry ® and Yorkool ®. Overall, 270 LLINs of each type were freely distributed in Zagnanado, at a rate of 30 LLINs per type per village. These bed nets have been monitored and evaluated every 6 months to identify the most resilient and preferred LLINs in the community. Net survivorship was assessed using the rate of net loss and physical condition. Results: The survivorship of all types of LLIN was estimated at 92% (95% CI 90.33-92.96) after 6 months and 70% (95% CI 67.25-71.81) after a year of use. At 12 months, all bed nets monitored were below the NetCalc model threshold of 92.8% for an LLIN with a lifespan of 3 years. Only 1.73% of all types of LLIN had a visible loss of integrity after 6 months with a median proportionate hole index (PHI) estimated at zero. The percentage significantly increased after 12 months with 10.41% of damaged nets (all types of LLINs). The median PHI for each brand of net was 23, 196, 141, 23, 23, 121 and 72, respectively for Aspirational ® , DawaPlus ® 2.0, OlysetNet ® , PermaNet ® 2.0, PermaNet ® 3.0, Royal Sentry ® and Yorkool ®. A significant difference was noted between the PHI at 6 and 12 months (p < 0.0001). After 12 months, the DawaPlus ® 2.0, OlysetNet ® and Royal Sentry ® suffered significantly more damage compared to the others (p < 0.001). Conclusion: The results of this study showed that after a year of use, the survivorship of the 7 LLIN products in households was lower than expected. However, all the LLIN products successfully met WHO standards for physical integrity after 12 months of use. The monitoring continues. The next steps will help to identify the most sustainable LLINs.

Long-lasting insecticidal nets (LLINs) are an essential tool in the fight against malaria. Physical integrity, durability and bio-effectiveness are key variables in the effectiveness of LLINs. The objective of this study was to identify the main factors affecting the survival of three brands of LLINs with different physical characteristics and to assess their bio-effectiveness. A cohort consisting of 1500 LLINs (500 of each) of the brands: DawaPlus®2.0 (polyester, 150 denier, 40 g/m2 fabric weight), PermaNet®2.0 and Yorkool® (polyester, 75 denier, alternating knit pattern with 85 g/m2 fabric weight) was monitored every 6 months in the communes of Ketou, Dogbo and Djougou (from October 2017 to September 2019) based on attrition and integrity measures and median survival in years. We also determined bio-efficacy using the WHO cone test. The physical presence rate was 26.4%, 21.4% and 48.6% respectively for DawaPlus®2.0, PermaNet®2.0 and Yorkool®. The main cause of loss of the three LLINs was displacement, 43.6% (in rural areas) versus 43.2% (in urban areas) with no significant difference (p ˃ 0.05). The median proportional hole index (pHI) ranged from 578 (IQR: 219-843) at 6 months to 196 (IQR: 46-524.5). After 24 months of use, 86.1% were in good condition (0≤pHI<65), 9% were damaged (65≤pHI<643) and 4.2% were too torn (643≤pHI). A significant decrease in physical survival of LLINs (all brands) was observed at 24 months (37.9%, range 34.7-41.3%) compared to 6 months (90.3%, range 88.7-91.8%) (p<0.001). The 24-hour mortality of the three LLINs met WHO requirements for efficacy. The decline in LLIN survival rates during this study highlights the need to develop and implement new strategies to manage this important vector control tool.

Context: Recent publications on WHO recommended methods for estimating the survival of LLINs are good guidelines for assessing the performance of long-lasting insecticidal nets (LLINs). Thus, this field trial study was undertaken to evaluate the durability of the Yorkool ® LN mosquito net distributed during the 2017 campaign in Benin. Methods: The monitoring of Yorkool ® LN nets was carried out in two districts (Djougou III and Barienou) in Djougou, department of Donga, northern Benin from October 2017 to March 2019. A representative sample of 250 households that had received the Yorkool ® LN polyester LLINs during the 2017 campaign was selected in the rural and urban areas of each district and monitored for 6, 12 and 18 months. An evaluation of the survival of Yorkool ® LN nets was conducted based on the rate of loss and physical condition of the surviving nets as measured by the proportional hole index (pHI). Finally, the chemical efficacy of these LLINs during each period was determined using the WHO cone tests. Results: Survival of Yorkool ® LN nets was similar in both rural and urban areas, although there was a difference in survival between the 6-month (95.