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Background  Indoor Residual Spraying (IRS), insecticide-treated nets (ITNs) and long-lasting insecticidal nets (LLINs) are key components in malaria prevention and control strategy. However, the development of resistance by mosquitoes to insecticides recommended for IRS and/or ITNs/LLINs would affect insecticide-based malaria vector control. We assessed the susceptibility levels of  Anopheles arabiensis  to insecticides used in malaria control, characterized basic mechanisms underlying resistance, and evaluated the role of public health use of insecticides in resistance selection.    Methodology/Principal findings  Susceptibility status of  An. arabiensis  was assessed using WHO bioassay tests to DDT, permethrin, deltamethrin, malathion and propoxur in Ethiopia from August to September 2009. Mosquito specimens were screened for knockdown resistance ( kdr ) and insensitive acetylcholinesterase (ace-1 R ) mutations using AS-PCR and PCR-RFLP, respectively. DDT residues level in soil from human dwellings and the surrounding environment were determined by Gas Chromatography with Electron Capture Detector.  An. arabiensis  was resistant to DDT, permethrin, deltamethrin and malathion, but susceptible to propoxur. The West African  kdr  allele was found in 280 specimens out of 284 with a frequency ranged from 95% to 100%. Ace-1 R  mutation was not detected in all specimens scored for the allele. Moreover, DDT residues were found in soil samples from human dwellings but not in the surrounding environment.    Conclusion  The observed multiple-resistance coupled with the occurrence of high  kdr  frequency in populations of  An. arabiensis  could profoundly affect the malaria vector control programme in Ethiopia. This needs an urgent call for implementing rational resistance management strategies and integrated vector control intervention.

Multiple Insecticide Resistance: An Impediment to Insecticide-Based Malaria Vector Control Program