Comment citer
Résumé
Introduction
Malaria remains one of the most prevalent and deadly parasitic infections in the Democratic Republic of the Congo (DRC), posing a significant public health challenge.
Purpose
This literature review aimed to investigate the resistance and sensitivity of Anopheles mosquitoes to insecticides used in the DRC.
Methods
A bibliographic search was conducted using search engines such as Google Scholar, ScienceDirect, PubMed, and Scopus with keywords including "resistant Anopheles," "insecticide resistance," and "susceptible Anopheles" specific to the DRC. Additional keywords such as "molecular target of insecticides," "modes of action of insecticides," and "mechanisms of insecticide resistance" were used without geographical restrictions. Articles were selected based on criteria including relevance to the subject, source reliability, and recency. Special emphasis was placed on studies with robust methodologies. To ensure comprehensiveness, diverse studies were included to provide a holistic overview of the subject.
Results
Numerous scientific articles and reports were selected for analysis. The findings indicate that Anopheles mosquitoes exhibit resistance to key pyrethroid insecticides (e.g., permethrin, deltamethrin, and alpha-cypermethrin) commonly used for treating long-lasting insecticidal nets (LLINs) and in indoor residual spraying (IRS). Evidence from primary and secondary sources suggests that insecticide resistance is spreading across regions and increasing, primarily due to the use of insecticides in agriculture. Of the 22 studies reviewed, 12 reported the restoration of Anopheles sensitivity to pyrethroid insecticides when synergist piperonyl butoxide (PBO) was used.
Conclusions
The findings of this review provide a valuable reference for policymakers and public health authorities working to design effective malaria control strategies in the DRC. The results highlight the current status of Anopheles insecticide resistance and the progress and challenges associated with malaria control efforts in the region. Further investigation into the use of nanoparticles (NPs) as complementary tools in malaria vector control is recommended, given their potential to target mosquitoes at various life stages and contribute to the eradication of the disease.
Références
Acford-Palmer, H., Campos, M., Bandibabone, J., N’Do, S., Bantuzeko, C., Zawadi, B., Walker, T., Phelan, J. E., Messenger, L. A., Clark, T. G., & Campino, S. (2023). Detection of insecticide resistance markers in Anopheles funestus from the Democratic Republic of the Congo using a targeted amplicon sequencing panel. Scientific Reports, 13, 17363. https://doi.org/10.1038/s41598-023-44457-0
Althoff, R. A., & Huijben, S. (2022). Comparison of the variability in mortality data generated by CDC bottle bioassay, WHO tube test, and topical application bioassay using Aedes aegypti mosquitoes. Parasites and Vectors, 15(476). https://doi.org/10.1186/s13071-022-05583-2
Anses. (2021). Résistance des moustiques vecteurs aux insecticides. www.anses.fr
Baghela, V., & Kachhwaha, N. (2021). Efficacy of Nanoparticles as a research tool to control Mosquito vector: A review. Flora and Fauna, 27(2), 271–278. https://doi.org/10.33451/florafauna.v27i2pp271-278
Bandibabone, J., McLoughlin, C., N’Do, S., Bantuzeko, C., Byabushi, V., Jeanberckmans, M., Guardiola, M., Zawadi, B., Diabaté, A., Prudhomme, J., Walker, T., & Messenger, L. A. (2021). Investigating molecular mechanisms of insecticide resistance in the Eastern Democratic Republic of the Congo. Malaria Journal, 20(464). https://doi.org/10.1186/s12936-021-04002-8
Basosila, N., Inkoto, C., Maganga, O., Mbembo, B., Kasiama, G., Kabengele, C., Falanga, C., Masengo, C., Mpiana, P., & Ngbolua, K.-T.-N. (2023). Biogenic Synthesis, Spectroscopic Characterization and Bioactivity of Cymbopogon citratus Derived Silver Nanoparticles. Journal of Applied Sciences and Nanotechnology, 3(4), 33–41. https://doi.org/10.53293/jasn.2023.7012.1226
Basosila, N., Mukomena, E., Mbembo, M., Masengo, C., & Ngbolua, K. (2024). Efficacy of silver nanoparticles from Jatropha curcas leaf extracts against pyrethroid-resistant Anopheles gambiae. Orapuh Journal, 5(5), e1147.
Basosila, N., Ngbolua, J.-P., Eric, M., Mawunu, M., Irish, S., Basimike, M., & Jonas, N. (2022). Study of the Behavior and Entomological Parameters of Anopheles in Two Health Zones of The North-Ubangi Province, Democratic Republic of Congo. Egyptian Academic Journal of Biological Sciences, E. Medical Entomology & Parasitology, 14(2), 57–63. https://doi.org/10.21608/eajbse.2022.259846
Camponovo, F., Skrip, L. A., Symons, T. L., Connell, M., Gething, P., Visser, T., Le Menach, A., & Cohen, J. M. (2024). Malaria treatment for prevention: a modelling study of the impact of routine case management on malaria prevalence and burden. BMC Infectious Diseases, 24(1), 1267. https://doi.org/10.21203/rs.3.rs-4522031/v1
Chung, M. J., Mao, Y. C., Hsu, C. T., Chung, M. C., Wang, T. J., Yu, T. M., Liu, P. Y., Fu, P. K., & Hsieh, C. M. (2022). A Fatal Case of Chlorfenapyr Poisoning and the Therapeutic Implications of Serum Chlorfenapyr and Tralopyril Levels. Medicina (Kaunas, Lithuania), 58(11), 1630. https://doi.org/10.3390/medicina58111630
Cohen, J. M., Okumu, F., & Moonen, B. (2022). The fight against malaria: Diminishing gains and growing challenges. Science Translational Medicine, 14(651), eabn3256. https://doi.org/10.1126/scitranslmed.abn3256
Conrad, M. D., Asua, V., Garg, S., Giesbrecht, D., Niaré, K., Smith, S., Namuganga, J. F., Katairo, T., Legac, J., Crudale, R. M., Tumwebaze, P. K., Nsobya, S. L., Cooper, R. A., Kamya, M. R., Dorsey, G., Bailey, J. A., & Rosenthal, P. J. (2023). Evolution of Partial Resistance to Artemisinins in Malaria Parasites in Uganda. New England Journal of Medicine, 389(8), 722–732. https://doi.org/10.1056/nejmoa2211803
Emina, J. B. O., Doctor, H. V., & Yé, Y. (2021). Profiling malaria infection among under-five children in the Democratic Republic of Congo. PLoS ONE, 16(5), e0250550. https://doi.org/10.1371/journal.pone.0250550
Guttery, D. S., Zeeshan, M., Ferguson, D. J. P., Holder, A. A., & Tewari, R. (2022). Division and Transmission: Malaria Parasite Development in the Mosquito. Annual Review of Microbiology, 76, 113–134. https://doi.org/10.1146/annurev-micro-041320-010046
Kabalu Tshiongo, J., Zola Matuvanga, T., Mitashi, P., Maketa, V., Schallig, H. D. F. H., Mens, P. F., Muhindo Mavoko, H., & Matangila Rika, J. (2024). Prevention of Malaria in Pregnant Women and Its Effects on Maternal and Child Health, the Case of Centre Hospitalier de Kingasani II in the Democratic Republic of the Congo. Tropical Medicine and Infectious Disease, 9(5), 92. https://doi.org/10.3390/tropicalmed9050092
Karume, K., Mondo, J. M., Chuma, G. B., Ibanda, A., Bagula, E. M., Aleke, A. L., Ndjadi, S., Ndusha, B., Ciza, P. A., Cizungu, N. C., Muhindo, D., Egeru, A., Nakayiwa, F. M., Majaliwa, J. G. M., Mushagalusa, G. N., & Ayagirwe, R. B. B. (2022). Current Practices and Prospects of Climate-Smart Agriculture in Democratic Republic of Congo: A Review. Land, 11(1850). https://doi.org/10.3390/land11101850
Kojom Foko, L. P., & Singh, V. (2023). Malaria in pregnancy in India: a 50-year bird’s eye. Frontiers in Public Health, 11, doi: 10.3389/fpubh.2023.1150466. https://doi.org/10.3389/fpubh.2023.1150466
Kouadio, F. P. A., Wipf, N. C., Nygble, A. S., Fodjo, B. K., Sadia, C. G., Vontas, J., Mavridis, K., Müller, P., & Mouhamadou, C. S. (2023). Relationship between insecticide resistance profiles in Anopheles gambiae sensu lato and agricultural practices in Côte d’Ivoire. Parasites and Vectors, 16, 270. https://doi.org/10.1186/s13071-023-05876-0
Leal Filho, W., May, J., May, M., & Nagy, G. J. (2023). Climate change and malaria: some recent trends of malaria incidence rates and average annual temperature in selected sub-Saharan African countries from 2000 to 2018. Malaria Journal, 22, 248. https://doi.org/10.1186/s12936-023-04682-4
Loonen, J. A. C. M., Dery, D. B., Musaka, B. Z., Bandibabone, J. B., Bousema, T., Lenthe, M. Van, Stefanija, B. P., Fesselet, J. F., & Koenraadt, C. J. M. (2020). Identification of main malaria vectors and their insecticide resistance profile in internally displaced and indigenous communities in Eastern Democratic Republic of the Congo ( DRC ). Malaria Journal, 19(425). https://doi.org/10.1186/s12936-020-03497-x
Lubinda, J., Haque, U., Bi, Y., Hamainza, B., & Moore, A. J. (2021). Near-term climate change impacts on sub-national malaria transmission. Scientific Reports, 11, 751. https://doi.org/10.1038/s41598-020-80432-9
Matubi, E. M., Kaounga, G. I., Zanga, J., Mbuku, G. B., Maniania, J. N. K., Mulenda, B., Sodi, J. N. M., Tamfum, J. J. M., & Masiangi, P. (2020). Insecticide susceptibility of anopheles gambiae S.L and identification of some resistance mechanisms in Kwilu province in the Democratic Republic of Congo. Pan African Medical Journal, 37(79). https://doi.org/10.11604/pamj.2020.37.79.18635
Mbama Ntabi, J. D., Malda Bali, E. D., Lissom, A., Akoton, R., Djontu, J. C., Missontsa, G., Mouzinga, F. H., Baina, M. T., Djogbenou, L., Ndo, C., Wondji, C., Adegnika, A. A., Lenga, A., Borrmann, S., & Ntoumi, F. (2024). Contribution of Anopheles gambiae sensu lato mosquitoes to malaria transmission during the dry season in Djoumouna and Ntoula villages in the Republic of the Congo. Parasites and Vectors, 17, https://doi.org/10.1186/s13071-023-06102-7. https://doi.org/10.1186/s13071-023-06102-7
Metelo-Matubi, E., Zanga, J., Binene, G., Mvuama, N., Ngamukie, S., Nkey, J., Schopp, P., Bamba, M., Irish, S., Nguya-Kalemba-maniania, J., Fasine, S., Nagahuedi, J., Muyembe, J. J., & Mansiangi, P. (2021). The effect of a mass distribution of insecticide-treated nets on insecticide resistance and entomological inoculation rates of Anopheles gambiae s.l. in Bandundu City, Democratic Republic of Congo. Pan African Medical Journal, 40(118). https://doi.org/10.11604/pamj.2021.40.118.27365
Metelo-Matubi, E., Zanga, J., Nsabatien, V., Mbala, A., Ngamukie, S., Agossa, F., Niang, E. H. A., Jean Maniania-Nguya-Kalenga, & Basimike, M. (2022). Effect of the Mass Distribution of ITNs in an Endemic Area with a High Entomological Index, the Case of Bandundu-City, Kwilu, DRC. In IntechOpen (p. 13). http://dx.doi.org/10.1039/C7RA00172J%0Ahttps://www.intechopen.com/books/advanced-biometric-technologies/liveness-detection-in-biometrics%0Ahttp://dx.doi.org/10.1016/j.colsurfa.2011.12.014
Metelo, E., Zanga, J., Batumbo, D., Mandja, B., Lukoki, H., Bokulu, A., Iluku, T., Basosila, N., Manzambi, E., Agossa, F., & Mukomena, E. (2024). Complexity of Vector Control and Entomological Surveillance in Endemic Sentinel Sites of the National Malaria Control Program (NMCP) in the Democratic Republic of Congo (DRC). In IntechOpen (p. doi: 10.5772/intechopen.114044). https://doi.org/http://dx.doi.org/10.5772/57353
Monroe, A., Williams, N. A., Ogoma, S., Karema, C., & Okumu, F. (2022). Reflections on the 2021 World Malaria Report and the future of malaria control. Malaria Journal, 21, 154. https://doi.org/10.1186/s12936-022-04178-7
Mugenzi, L. M. J., Akosah-Brempong, G., Tchouakui, M., Menze, B. D., Tekoh, T. A., Tchoupo, M., Nkemngo, F. N., Wondji, M. J., Nwaefuna, E. K., Osae, M., & Wondji, C. S. (2022). Escalating pyrethroid resistance in two major malaria vectors Anopheles funestus and Anopheles gambiae (s.l.) in Atatam, Southern Ghana. BMC Infectious Diseases, 22, 799. https://doi.org/10.1186/s12879-022-07795-4
N’do, S., Bandibabone, J. B., Soma, D. D., Musaka, B. Z., Prudhomme, J., Habamungu, C. C., Namountougou, M., Sangaré, I., Kientega, M., Kaboré, D. A. P., Bayili, K., Yerbanga, R. S., Diabate, A., Dabire, R. K., Ouedraogo, J. B., Belem, A. M. G., Boëte, C., Guardiola-Claramonte, M., & Chimanuka, B. (2021). Insecticide resistance profiles in malaria vector populations from Sud-Kivu in the Democratic Republic of the Congo. Transactions of the Royal Society of Tropical Medicine and Hygiene, 115(11), 1339–1344. https://doi.org/10.1093/trstmh/trab116
Narcisse, B., Ngbolua, K., Mbembo, B., C, M., Agossa, F., Zanga, J., Mulenda, B., Ulrich, S., Nagahuedi, J., & Mukomena, E. (2024). Entomological study of Anopheles vector bionomics and persistent malaria transmission at National Malaria Control Program Sentinel sites in the Democratic Republic of the Congo. Orapuh Journal, 5(5), e1144.
Ngbolua, K., Rakotoarimanana, H., Rafatro, H., Ratsimamanga, U., Mudogo, V., Mpiana, P., & Tshibangu, D. (2011). Comparative antimalarial and cytotoxic activities of two Vernonia species: V. amygdalina from the Democratic Republic of Congo and V. cinerea subsp vialis endemic to Madagascar. International Journal of Biological and Chemical Sciences, 5(1), 345–353. https://doi.org/10.4314/ijbcs.v5i1.68111
Nguiffo-Nguete, D., Mugenzi, L. M. J., Manzambi, E. Z., Tchouakui, M., Wondji, M., Tekoh, T., Watsenga, F., Agossa, F., & Wondji, C. S. (2023). Evidence of intensification of pyrethroid resistance in the major malaria vectors in Kinshasa, Democratic Republic of Congo. Scientific Reports, 13(1), 14711. https://doi.org/10.1038/s41598-023-41952-2
Obeagu, E. I., & Obeagu, G. U. (2024). Emerging public health strategies in malaria control : innovations and implications. Annals of Medicine & Surgery, 86(11), 6576–6584.
Ogunah, J. A., Lalah, J. O., & Schramm, K. W. (2020). Malaria vector control strategies. What is appropriate towards sustainable global eradication? Sustainable Chemistry and Pharmacy, 18, 100339. https://doi.org/10.1016/j.scp.2020.100339
Oke, C. E., Ingham, V. A., Walling, C. A., & Reece, S. E. (2022). Vector control: agents of selection on malaria parasites? Trends in Parasitology, 38(10), 890–903. https://doi.org/10.1016/j.pt.2022.07.006
Onen, H., Luzala, M. M., Kigozi, S., Sikumbili, R. M., Muanga, C. J. K., Zola, E. N., Wendji, S. N., Buya, A. B., Balciunaitiene, A., Viškelis, J., Kaddumukasa, M. A., & Memvanga, P. B. (2023). Mosquito-Borne Diseases and Their Control Strategies: An Overview Focused on Green Synthesized Plant-Based Metallic Nanoparticles. Insects, 14(3), 221. https://doi.org/10.3390/insects14030221
Oxborough, R. M., Seyoum, A., Yihdego, Y., Chabi, J., Wat’senga, F., Agossa, F. R., Coleman, S., Musa, S. L., Faye, O., Okia, M., Bayoh, M., Alyko, E., Rakotoson, J. D., Masendu, H., Sovi, A., Gadiaga, L., Abong’o, B., Opondo, K., Baber, I., … Dengela, D. (2021). Determination of the discriminating concentration of chlorfenapyr (pyrrole) and Anopheles gambiae sensu lato susceptibility testing in preparation for distribution of Interceptor® G2 insecticide-treated nets. Malaria Journal, 20(316). https://doi.org/10.1186/s12936-021-03847-3
Palanisamy, K., Gurunathan, V., & Sivapriya, J. (2023). Ultrasonic Assisted Facile Synthesis of CuO Nanoparticles and Used as Insecticide for Mosquito Control. Asian Journal of Chemistry, 35(4), 986–990.
PMI. (2020). PMI VECTORLINK PROJECT THE DEMOCRATIC REPUBLIC OF CONGO ANNUAL ENTOMOLOGICAL MONITORING REPORT.
PMI. (2021). Rapport Annuel du suivi entomologique en République Démocratique du Congo (RDC) 2021.
PNLP. (2022). Rapport annuel 2022.
PNLP. (2023). Plan Strategique National de Lutte contre le Paludisme 2020-2023. https://doi.org/10.3138/9781442656505-toc
Prakash., N., Sujitha., S., Dass., K., & Mariappan., P. (2022). Synthesis of Silver Nanoparticles by Using Plants Extract and its Efficiency Against Aedes aegypti (Linn.). International Journal of Zoological Investigations, 08(01), 338–346. https://doi.org/10.33745/ijzi.2022.v08i01.036
Praulins, G., Murphy-fegan, A., Gillespie, J., Mechan, F., Gleave, K., & Lees, R. (2024). Unpacking WHO and CDC Bottle Bioassay Methods : A Gates Open Research. Gates Open Research Gates Open Research 2024, 8, 56.
Sadia, C. G., Bonneville, J. M., Zoh, M. G., Fodjo, B. K., Kouadio, F. P. A., Oyou, S. K., Koudou, B. G., Adepo-Gourene, B. A., Reynaud, S., David, J. P., & Mouahamadou, C. S. (2024). The impact of agrochemical pollutant mixtures on the selection of insecticide resistance in the malaria vector Anopheles gambiae: insights from experimental evolution and transcriptomics. Malaria Journal, 23(69), https://doi.org/10.1186/s12936-023-04791-0. https://doi.org/10.1186/s12936-023-04791-0
Siddiqui, J. A., Fan, R., Naz, H., Bamisile, B. S., Hafeez, M., Ghani, M. I., Wei, Y., Xu, Y., & Chen, X. (2023). Insights into insecticide-resistance mechanisms in invasive species: Challenges and control strategies. Frontiers in Physiology, 13, doi: 10.3389/fphys.2022.1112278. https://doi.org/10.3389/fphys.2022.1112278
Sinka, M. E., Pironon, S., Massey, N. C., Longbottom, J., Hemingway, J., Moyes, C. L., & Willis, K. J. (2020). A new malaria vector in Africa: Predicting the expansion range of Anopheles stephensi and identifying the urban populations at risk. Proceedings of the National Academy of Sciences of the United States of America, 117(40). https://doi.org/10.1073/pnas.2003976117
Sivapunniyam, A., Perumal, T., Vasu, N., Kavidasan, T., Seetharaman, P., Raja, K., & Stalin, M. (2024). Zinc Oxide Nanoparticles Fabricated With Phytoextracts For The Control Of Mosquito Vectors- A Systemic Review. Journal of Advanced Zoology, 45(2), 1663–1681. https://www.cabdirect.org/cabdirect/abstract/20013127238
Sonhafouo-Chiana, N., Nkahe, L. D., Kopya, E., Awono-Ambene, P. H., Wanji, S., Wondji, C. S., & Antonio-Nkondjio, C. (2022). Rapid evolution of insecticide resistance and patterns of pesticides usage in agriculture in the city of Yaoundé, Cameroon. Parasites and Vectors, 15(186). https://doi.org/10.1186/s13071-022-05321-8
Thellier, M., Gemegah, A. A. J., & Tantaoui, I. (2024). Global Fight against Malaria: Goals and Achievements 1900–2022. Journal of Clinical Medicine, 13(19), 5680. https://doi.org/10.3390/jcm13195680
Trinh, K. H., Kadam, U. S., Song, J., Cho, Y., Kang, C. H., Lee, K. O., Lim, C. O., Chung, W. S., & Hong, J. C. (2021). Novel dna aptameric sensors to detect the toxic insecticide fenitrothion. International Journal of Molecular Sciences, 22(19), 10846. https://doi.org/10.3390/ijms221910846
Venkatesan, P. (2023). The 2023 WHO World malaria report (Vol. 5, Issue 3). Elsevier. https://doi.org/10.1016/s2666-5247(24)00016-8
Wat’senga, F., Agossa, F., Manzambi, E. Z., Illombe, G., Mapangulu, T., Muyembe, T., Clark, T., Niang, M., Ntoya, F., Sadou, A., Plucinski, M., Li, Y., Messenger, L. A., Fornadel, C., Oxborough, R. M., & Irish, S. R. (2020). Intensity of pyrethroid resistance in Anopheles gambiae before and after a mass distribution of insecticide-treated nets in Kinshasa and in 11 provinces of the Democratic Republic of Congo. Malaria Journal, 19(1), 1–13. https://doi.org/10.1186/s12936-020-03240-6
WHO. (2021). Word Malaria Report 2021. In Geneva: World Health Organization. (2021). Licence: CC BY-NC-SA 3.0 IGO. https://www.who.int/teams/global-malaria-programme/reports/world-malaria-report-2021
WHO. (2022a). Standard Operating Procedure for Testing Insecticide Susceptibility of Adult Mosquitoes in WHO Bottle Bioassay. In World Health Organization.
WHO. (2022b). World malaria report 2022. In Geneva: World Health Organization. https://www.who.int/teams/global-malaria-programme/reports/world-malaria-report-2021
WHO. (2023). World malaria report 2023.
Wilson, A. L., Courtenay, O., Kelly-Hope, L. A., Scott, T. W., Takken, W., Torr, S. J., & Lindsay, S. W. (2020). The importance of vector control for the control and elimination of vector-borne diseases. In PLoS Neglected Tropical Diseases (Vol. 14, Issue 1). https://doi.org/10.1371/journal.pntd.0007831
Wilson, J. J., Ponmanickam, H. T., Ponnirul, & Lakshmi, M. P. (2022). Bacterial Silver Nanoparticles: Method, Mechanism of Synthesis and Application in Mosquito Control. In IntechOpen (p. DOI: http://dx.doi.org/10.5772/intechopen.104144). https://doi.org/10.1016/j.colsurfa.2011.12.014
Wipf, N. C., Duchemin, W., Kouadio, F. P. A., Fodjo, B. K., Sadia, C. G., Mouhamadou, C. S., Vavassori, L., Mäser, P., Mavridis, K., Vontas, J., & Müller, P. (2022). Multi-insecticide resistant malaria vectors in the field remain susceptible to malathion, despite the presence of Ace1 point mutations. PLoS Genetics, 18(2), e1009963. https://doi.org/10.1371/journal.pgen.1009963
Xu, M., Hu, Y. X., Lu, S. N., Idris, M. A., Zhou, S. D., Yang, J., Feng, X. N., Huang, Y. M., Xu, X., Chen, Y., & Wang, D. Q. (2023). Seasonal malaria chemoprevention in Africa and China’s upgraded role as a contributor: a scoping review. Infectious Diseases of Poverty, 12, 63. https://doi.org/10.1186/s40249-023-01115-x
Yamamura, K. (2021). Optimal rotation of insecticides to prevent the evolution of resistance in a structured environment. Population Ecology, 63(3), 190–203. https://doi.org/10.1002/1438-390X.12090
Yimam, Y., Nateghpour, M., Mohebali, M., & Afshar, M. J. A. (2021). A systematic review and meta-analysis of asymptomatic malaria infection in pregnant women in Sub-Saharan Africa: A challenge for malaria elimination efforts. PLoS ONE, 16(4), e0248245. https://doi.org/10.1371/journal.pone.0248245
Zanga, J., Metelo, E., Mbanzulu, K., Irish, S., Mulenda, B., Wumba, R. D., & Masiangi, P. (2022). Susceptibility status of Anopheles gambiae s.l. to insecticides used for malaria control in Kinshasa, Democratic Republic of the Congo. Annales Africaines de Médecine, 15(2), e4533–e4542. https://doi.org/https://dx.doi.org/10.4314/aam.v15i2.2
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