Remarks The conditionality of the recommendation to deploy pyrethroid-pyriproxyfen ITNs instead of pyrethroid-only LLINs is based onthe GDG’s concerns that the available evidence indicates poor cost-effectiveness of pyrethroid-pyriproxyfen ITNs compared topyrethroid-only LLINs. Poor cost-effectiveness is a result of both the higher cost compared to a pyrethroid-only net, which wouldrequire extra resources to maintain the same coverage, and the relatively short-lived (12 months) additional impact obtained bydeploying pyrethroid-pyriproxyfen nets over pyrethroid-only nets.In deciding whether pyrethroid-pyriproxyfen ITNs should be deployed instead of pyrethroid-only LLINs, malaria programmesshould:

• determine whether resources are adequate to cover the extra cost compared to pyrethroid-only LLINs, while ensuringoptimal coverage of populations at risk of malaria;
• generate additional information or conduct analyses with the aim of maximizing impact through targeted deployment (e.g.stratification of malaria risk, assessment of the characteristics of local vectors, such as pyrethroid resistance mechanisms);and
• note that WHO recommends that ITNs prequalified by WHO be selected for deployment. Note: Recommendations on deployment of pyrethroid-pyriproxyfen nets were separated into two distinct recommendations forbetter clarity, but share the same evidence to decision, justification, practical info and research needs. Please refer to thefollowing section.