Remark: Note: Recommendations on deployment of pyrethroid-chlorfenapyr nets were separated into two distinct recommendations for better clarity, but share the same evidence to decision, justification, practical info and research needs. Please refer to the following section.

Practical info Given that pyrethroid‐chlorfenapyr ITNs are designed to provide improved impact against insecticide-resistant mosquitoes, pyrethroid resistance in potential target areas should be confirmed using standard procedures [21], as should the susceptibility of local vectors to chlorfenapyr. In any case, pyrethroid‐chlorfenapyr ITNs should not be considered a tool that alone can effectively manage insecticide resistance in malaria vectors. As with all malaria interventions, post-distribution monitoring of ITNs to estimate coverage in terms of access to and use of ITNs is recommended. WHO also recommends that programmes conduct studies of ITN survival, which includes assessments of ITN integrity, each time a campaign uses a new product such as pyrethroid‐chlorfenapyr ITNs. Such studies will provide information on the product’s life span under field conditions and thus enable estimation of the period over which the additional impact against malaria may be maintained. The systematic review reported that, two years after deployment, 34% of pyrethroid‐chlorfenapyr ITNs were torn (defined as hole area ≥ 790 cm²) and therefore not fit for use, compared to 28% of pyrethroid-only LLINs and 43% of pyrethroid-PBO ITNs.