Abstract

Malaria remains a major global health challenge, particularly in sub-Saharan Africa, where conventional vector 
control strategies such as insecticide-treated nets (ITNs) have significantly reduced morbidity and mortality. 
However, emerging pyrethroid resistance in mosquito populations threatens the long-term efficacy of ITNs, 
necessitating exploration of novel vector control approaches. This review compared the effectiveness of CRISPR
modified mosquitoes and insecticide-treated nets in reducing malaria transmission to inform integrated malaria 
control strategies. A narrative review approach was utilised, synthesising evidence from published studies on 
mechanisms of action, operational feasibility, effectiveness, ecological and ethical considerations, and integration 
prospects for both interventions. ITNs provide a physical barrier and insecticidal effect, reducing malaria incidence 
by approximately 50% and all-cause child mortality by 20%. However, widespread pyrethroid resistance undermined 
their effectiveness. CRISPR-modified mosquitoes, employing gene drive technologies to spread sterility or anti
Plasmodium traits, have demonstrated promising laboratory and semi-field results, achieving near-complete 
population suppression or high refractoriness rates. Nonetheless, their field efficacy remained unproven, with 
ecological, evolutionary, and ethical risks necessitating further research. Operationally, ITNs remained more feasible 
for immediate deployment, whereas gene drives require robust regulatory frameworks, community acceptance, and 
phased field testing. While ITNs continued as cornerstone interventions in malaria control, CRISPR-modified 
mosquitoes hold transformative potential if proven safe and effective. Their integration into malaria control 
programmes, alongside ITNs, could enhance elimination prospects, but deployment must be evidence-based, 
ethically grounded, and community endorsed to ensure sustainable public health impact. 
Keywords: CRISPR-modified mosquitoes, Insecticide-treated nets, Malaria transmission reduction, Gene drive 
technology, Vector control strategies.