Background: Selection pressure from continued exposure to insecticides drives the development of insecticide resistance and changes in resting behavior of malaria vectors, which may support residual transmission in several endemic settings. There is a need to understand how resistance drives changes in resting behavior within vector species. Here, we examined the association between insecticide resistance and resting behavior of Anopheles gambiae s.l. in Northern Ghana. Methods: Adult

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... were collected both indoors and outdoors from two communities using mouth aspirators and pit shelters. F1 progenies from a subset of mosquitoes were exposed to dichloro diphenyl trichloroethane (DDT), deltamethrin, malathion and bendiocarb using WHO insecticide susceptibility tests. Insecticide resistance markers including voltage-gated sodium channel (Vgsc)- 1014F, Vgsc-1014S, Vgsc-1575Y, glutathione-S-transferase epsilon 2 (GSTe2)-114T and acetylcholinesterase (Ace1)-119S, as well as blood meal sources were investigated using PCR methods. Activities of metabolic enzymes, acetylcholine esterase (AChE), non-specific β-esterases, glutathione-S-transferase (GST) and monooxygenases (oxidases) were measured from unexposed F1 progenies using microplate assays. Results: Susceptibility of An. coluzzii to deltamethrin 24hr post-exposure was significantly higher in indoor (mortality=5%) than the outdoor (mortality=2.5%) populations (P=0.02). The mosquitoes were fully susceptible to malathion (mortality: indoor=98%, outdoor=100%). Susceptibility to DDT was significantly higher in outdoor (mortality=9%) than indoor (mortality=0%) mosquitoes (P=0.006). Mosquitoes were also found with suspected resistance to bendiocarb but mortality was not statistically different (mortality: indoor=90%, outdoor=95%. P=0.30). The frequencies of all resistance alleles were higher in F1 outdoor (0.11-0.85) than indoor (0.04-0.65) mosquito populations, while Vgsc-1014F in F0 An. gambiae s.s significantly associated with outdoor-resting behavior (P=0.01). Activities of non-specific β-esterase enzymes were significantly higher in outdoor than indoor mosquitoes (Mean enzyme activity: Outdoor=: 1.70/mg protein; Indoor=1.35/mg protein. P<0.0001). AChE activity was also more elevated in outdoor (0.62/mg protein) than indoor (0.57/mg protein) mosquitoes but this was not significant (P=0.08). Human blood index (HBI) was predominantly detected in indoor (18%) than the outdoor mosquito population (3%). Conclusions: These findings revealed higher phenotypic resistance in indoor than outdoor-resting mosquitoes, but genotypic and metabolic resistance levels were higher in outdoor than the indoor mosquito populations. However, the overall results did not establish that there was a significant preference of resistant malaria vectors to solely rest indoors or outdoors, but varied depending on the resistant alleles present. Indication that human and animal blood meal indices were more prevalent in indoor-resting mosquitoes was also shown. Continued monitoring of changes in resting behavior within An. gambiae s.l. populations is recommended.