Category: country

Malaria is endemic in Guinea, with stable and perennial transmission. Malaria is the leading cause of health facilities visits, with the entire populace at risk of the disease. It is estimated that between 2006 and 2016, about 934,165 outpatient visits were due to malaria every year. Children under 5 and pregnant women, the two most vulnerable groups, represent 37% and 5% respectively of the total malaria cases recorded between 2014 and 2016 (Malaria National Strategic Plan 2018–2023).

Insecticide-treated nets (ITNs) are distributed for children under 5 and pregnant women through antenatal care visits and the country’s expanded immunization programs. Mass campaigns are organized every three years to maintain high coverage and use of ITNs in Guinea. School-based net distribution, the community, and the private sector are additional channels used to increase ITN availability and use. The use of insecticide-treated nets among children under 5 and pregnant women increased from 26% and 28% in 2012 to 68% and 54% respectively in 2016 (MICS, 2016). In addition, mining companies in selected sous prefectures implement indoor residual spraying.

In year one (January 2022 – December 2022), VectorLink Guinea will provide technical and financial assistance to the NMCP to enable it to monitor malaria vector bionomics and insecticide resistance. VectorLink Guinea will support the National Malaria Control Program (NMCP) to extend the Malaria Vector Control Technical Working Group to an Integrated Vector Control Technical Working Group (IVCTWG). VectorLink will support the IVCTWG to review the entomological data, and to provide information for decision making regarding malaria vector control interventions in Guinea. In 2022 VectorLink Guinea will work with the NMCP to set up quarterly meetings of the IVCTWG and will scale up the capacity of prefectures and NMCP staff.

After a successful startup and handover of entomology activities from the Stop Palu Plus project, Vectorlink Guinea successfully trained 13 technicians on malaria entomology. The participants came from the NMCP and seven prefectures (districts): Kissidougou, Labe, Dabola, Kankan, Boffa, Faranah and Forecariah. The capacity strengthening effort will enable national and prefectural government staff to conduct quality entomological monitoring to provide data for decision making regarding malaria vector control in Guinea.

VectorLink Guinea will continue to support the NMCP in assessing the susceptibility status of An. gambiae s.l., in seven prefectures and in conducting comprehensive vector bionomic monitoring in four sentinel sites selected in Forecariah. The information collected on vector density, seasonal distribution, behavior, and infectivity will be used to support the NMCP on estimating the impact of vector control intervention conducted in Forecariah. The susceptibility data will support decision-making for ITN selection and for insecticide resistance management.

Additional objectives for VectorLink Guinea in 2022 are as follows:

• Determine the susceptibility of the main malaria vector, gambiae s.l., to deltamethrin, permethrin, alpha-cypermethrin, chlorfenapyr, pirimiphos-methyl, and clothianidin. Additionally, pyriproxyfen and broflanilide will be tested whenever the protocol is finalized and reagents available.
• Perform synergist assays with piperonyl butoxide (PBO) and pyrethroids and measure the intensity of resistance to insecticides, where appropriate and feasible.
• Monitor the density, species composition, behavior, infectivity, and parity of malaria vectors in four sentinel sites in Forecariah.
• Scale up the capacity of NMCP and district health staff to collect entomological data and use it in decision-making.
• Provide technical support to the integrated vector management technical working group.

For four years, 2014 through to 2017, PMI sprayed four districts (Chimanimani, Mutare, Mutasa, and Nyanga) in Manicaland Province. In 2018, IRS operations in Manicaland were transitioned to the Government of Zimbabwe (GoZ) to accommodate rotation from pirimiphos-methyl to DDT per the Zimbabwe Insecticide Resistance Management Plan, and the project began implementing IRS in Mudzi and Mutoko Districts in Mashonaland East Province. The project also continued to provide limited technical and material support to the GoZ spray campaigns in four districts in Manicaland Province.

In 2020, VL Zimbabwe targeted 147,636 structures in two districts, Mudzi and Mutoko District from November 2 to December 14, 2020. A total of 133,078 structures were sprayed out of 136,774 structures found by spray operators in the targeted districts, resulting in a coverage rate of 97.3%.

In 2021, VectorLink transitioned to include technical assistance to the NMCP to support IRS in five districts of Mashonaland East Province, on the job training for entomological surveillance in prioritized districts and continued conducting routine entomological surveillance in three sentinel sites and insecticide resistance in four sentinel sites. A total of 446,917 rooms were targeted in five districts in Mashonaland East Province from October 13, 2021, to January 8, 2022. A total of 450,690 rooms were sprayed out of 462,608 rooms found by spray operators in the targeted districts, resulting in a coverage rate of 97.4%. The IRS campaign was implemented during the COVID-19 pandemic. The project worked with the NMCP to strengthen COVID-19 mitigation measures.

In year five (March 2022 – February 2023), PMI VectorLink’s key goal and objectives are:

• Support the 2022 IRS campaign with technical assistance in environmental compliance (EC) and monitoring and evaluation (M&E) to five districts in Mashonaland East Province, including the two previously PMI-supported districts for direct spraying implementation – Mutoko and Mudzi.
• Support IRS trainings in Mashonaland East Province focusing on EC and M&E activities to improve the overall spraying campaign.
• Share with NMCP VectorLink’s best practices and lessons learnt from the 2021 IRS campaign to support the national 2022 IRS campaign.
• Conduct insecticide resistance monitoring in four sentinel sites – three in Mashonaland East Province and one in Manicaland – and wall bioassay, vector density monitoring, and other vector behavioral studies in three sentinel sites of Mashonaland East Province.
• Provide NMCP with technical support to close gaps in their DHIS 2 system to develop entomology indicators, training manuals and standard operating procedures and train NMCP’s national level staff.
• In coordination with the NMCP and partners, implement a landscape analysis on unreached populations/IRS refusals in high refusal rate districts.
• Develop the supplemental environmental assessment (SEA) given that the current one is expiring in October 2022.

Success Stories:

Strengthening Entomological Capacity for Malaria Elimination in Zimbabwe

*This country is now operating under the U.S. President’s Malaria Initiative Evolving Vector Control to Fight Malaria Project

IRS is one of the key malaria control strategies of the Ministry of Health (MOH)’s Zambian National Malaria Elimination Program (NMEP), which provides technical guidance, leadership, and coordination of malaria control and prevention activities in Zambia.

In 2017, the government officially launched the National Malaria Elimination Strategic Plan 2017–2021, which aims to transition Zambia from malaria control to malaria elimination. In the same year, the U.S. President’s Malari Initiative (PMI) continued IRS in the same 36 high-burden districts across Eastern, Luapula, Muchinga, and Northern Provinces and sprayed 634,410 structures out of 676,188 structures found. In 2018, PMI VectorLink, together with Zambia’s National Malaria Elimination Program (NMEP), supported IRS in Northern, Luapula and Muchinga Provinces and three pre-elimination districts (Chadiza, Katete, and Sinda) in Eastern Province. In 2018, PMI VectorLink sprayed 579,490 structures out of 644,677 structures found. In 2019, VectorLink conducted IRS in 20 districts, targeting 597,625 structures from October 2 to November 30, 2019. A total of 536,983 structures were sprayed out of 598,732 structures found by spray operators (SOPs) in the targeted districts, accounting for a coverage rate of 90%. From September 29-November 18, 2020, PMI VectorLink supported IRS in 15 districts across Eastern (all nine districts), Copperbelt (the three rural districts), and Luapula (three districts) Provinces, targeting 639,536 structures which was later adjusted to 629,255 structures (after removing ineligible structures in Nchelenge). VectorLink sprayed 648,914 structures out of 672,581 structures found, resulting in a spray coverage of 97%.

In 2021, VectorLink targeted 699,591 structures for IRS in 21 districts—all 14 districts in Eastern Province, four rural districts in Copperbelt (Kalulushi, Lufwanyama, Masaiti, and Mpongwe) and three districts in Luapula Province (Chienge, Kawambwa, and Nchelenge). The 2021 target was later adjusted to 706,298, due to an increase in the targets for Kalulushi and Lundazi districts. The team sprayed 717,351 structures out of 738,659 structures found across the 21 districts, resulting in a coverage of 97%.

In year five (April 2022 – March 2023), the PMI VectorLink Zambia project will support the NMEP as it prepares to shift to ITNs as the primary vector control strategy in 2023. This entails universal ITN coverage during the 2023 mass campaign, with targeted IRS in select districts/hotspots. According to April 2022 NMEC communications with potential campaign supporters, Zambia aims to continue a robust IRS program, but under the new NMESP, the footprint for IRS will be greatly reduced.

To support this transition, VectorLink will work with the NMEP to define future IRS targeting criteria and will help strengthen routine ITN distribution channels and entomological monitoring capacity to ensure any rebounds in malaria incidence at the district level are detected. The project will also support the NMEP to plan for the 2023 mass campaign, which is envisaged to be a universal campaign.

VectorLink will work with the NMEP, provinces, and districts to spray 590,204 targeted structures in 18 districts using clothianidin-based insecticides. The project’s objective is to implement high-quality and safe IRS operations attaining a minimum coverage of 85 percent of the targeted structures found in each targeted community in the 18 districts. The project will also pilot two insecticide products manufactured by Tagros (a clothianidin-only and a clothianidin-deltamethrin formulation) in one district each. Both products were pre-qualified by WHO in late 2021. The project will conduct the following activities:

• Conduct IRS in 18 districts (all 14 districts of Eastern Province, three rural Copperbelt districts (Lufwanyama, Mpongwe, and Masaiti) and Nchelenge district in Luapula Province), targeting 590,204 structures. Due to resource constraints, select Health Facility Catchment Area (HFCAs) reporting greater than 90% ITN coverage as of February 2022 have been excluded.
• Provide technical assistance to the NMEP to supervise IRS in the VectorLink supported districts, host statutory IRS meetings [Vector Control Technical Working Group (VCTWG), Technical Advisory Committee (TAC), national IRS planning meetings], and print a glossary of IRS terminologies/indicators to ensure that all IRS implementers use the same terms.
• Conduct entomological monitoring activities in four surveillance districts (Lufwanyama, Mambwe, Katete, Nchelenge) to assess the impact of IRS operations on standard PMI entomological indicators. In Year 5, VectorLink will be unable to fund a full package of entomology activities in three Government of the Republic of Zambia (GRZ) districts—Serenje, Chililabombwe, Milenge. Longitudinal surveillance at these sites will transition to GRZ, while VectorLink will continue to conduct only insecticide resistance testing.
• Conduct a feasibility assessment of targeted LSM in two towns in each of the pre-elimination districts of Katete and Chipata in Eastern Province.
• Maintain the satellite offices in Chipata and Ndola to decentralize IRS planning activities and provide direct TA to Eastern and Copperbelt Provinces. The Nchelenge provincial office and warehouse facilities will close given the reduction from three districts to one (Nchelenge) in 2022.
• Support the NMEP as it prepares to shift from IRS to ITNs as the main vector control intervention in 2023, leveraging mapping and data visualization expertise from key partners (PATH, Akros) to support integrated, data-driven decision making on targeting of IRS. VectorLink TA in this regard will be informed by WHO and PMI guidelines. Current guidance is that optimal targeting of IRS or ITNs is based on at least these seven factors: 1) insecticide resistance – resistance to ITN insecticide and IRS insecticides, 2) mosquito behavior – biting and resting behavior; 3) human behavior – ITN use and indoor resting behavior; 4) deployment logistics – ITN vs IRS coverage; 5) ITN and IRS durability – ITN durability vs. IRS residual efficacy, 6) impact of vector population; and 7) impact on epidemiology.
• Provide technical assistance to the NMEP in the planning and preparation of the 2023 mass ITN campaign, including support to enable the NMEP to absorb proposed ITNs from Against Malaria Foundation (AMF) and disseminating key findings and recommendations from the recently-completed ITN misuse assessment to support the social behavior change (SBC) strategy for the mass campaign.
• Implement the 24-month round of ongoing standard durability monitoring study of PBO ITNs distributed in Serenje in November/December 2021 and Nyimba in January 2021.
• In collaboration with the NMEP and the entomological data committee, facilitate the incorporation of entomology modules based on the standard VectorLink Collect entomological modules into the NMEP Malaria Rapid Reporting (MRR) District Health Information Software Version 2 (DHIS2).

Success stories from PMI VectorLink Zambia:

Twice the Protection

Malaria is the leading cause of morbidity and mortality in Uganda. Accounting for 30 – 50 percent of outpatient visits and 15 – 20 percent of hospital admissions, malaria places a huge burden on the Ugandan health system. Recent PMI-supported activities include IRS in high burden eastern and east-central districts with persistently high malaria prevalence rates; ITN distribution via ANC/EPI clinics and school outlets as well as social marketing of nets at a subsidized price; training and supervision of health workers in integrated management of malaria including malaria in pregnancy; a collection of surveillance data; management and monitoring of insecticide resistance; and behavior change communication activities that reach millions of Ugandans with key malaria messages.

In 2019, the PMI VectorLink Uganda project, conducted IRS in 15 districts, targeting 1,369,305 structures from March 18-June 26, 2019. A total of 1,291,569 structures were sprayed out of 1,393,562 structures found by spray operators in the targeted districts, resulting in a spray coverage rate of 92.7 percent.

In 2020, VectorLink Uganda conducted IRS in 16 districts, targeting 1,393,562 structures, starting with the remaining balance of 2019 Actellic 300CS in seven Phase I districts and SumiShield 50WG in eight Phase II districts, followed by Fludora Fusion in all the 16 Phase I and II districts from March 2 through June 23, 2020. The project sprayed a total of 1,395,569 structures out of 1,475,422 structures found by spray operators in the targeted districts during the 2020 IRS campaign, resulting in a 94.6% spray coverage rate.

In 2021, VectorLink Uganda conducted IRS in 14 districts (four of them the final FCDO districts), targeting 1,321,459 structures from March 1 through May 22, 2021. The project sprayed a total of 1,294,515 structures out of 1,387,270 structures found by spray operators in the targeted districts during the 2021 IRS campaign, resulting in a 93.3% spray coverage rate.

In year five (January 2022 – December 2022), VectorLink Uganda continued working with the MOH’s National Malaria Control Division (NMCD), districts, and sub-county stakeholders to target 1,125,143 eligible structures in 10 PMI-funded districts using Fludora Fusion in eight districts (Budaka, Butaleja, Butebo, Kibuku, Lira, Namutumba, Pallisa and Serere) and SumiShield in two districts (Bugiri and Tororo). The project paid keen attention to the lessons learned during the spray campaign in 2021 and built on that for the 2022 spray campaign. The project worked closely with the MOH and the district health management teams to ensure that all COVID-19 guidelines are observed in the course of project implementation to mitigate any transmission.

The project’s primary objective is to reach a minimum coverage of 85% of the structures found in each district by implementing high-quality IRS operations, but the project will aim to reach the highest coverage level possible. In addition to spraying, in Year 5, the project will carry out the following activities:

• Strengthen capacity at the national, regional, district, and local levels to manage IRS operations, including planning, spraying, resource allocation, and monitoring and evaluation (M&E).
• Support the six FCDO districts of Alebtong, Amolatar, Dokolo, Kaberamaido, Kalaki, and Otuke where IRS has been withdrawn and the 10 PMI-supported districts to strengthen routine entomological surveillance and monitor the implementation strategies to sustain the gains from IRS and other malaria interventions.
• Collaborate with PMI district leaders and other stakeholders on prioritizing implementation of activities in their IRS exit/sustainability plans and sourcing resources to implement those key priority activities.
• Conduct training with a focus on IRS supervision and spray techniques to improve the overall quality of spraying while observing COVID-19 protocols.
• Offer technical support to the MOH/NMCD in preparation for the Global Fund-supported IRS in the 12 West Nile districts which will be sprayed for the first time in 2022.
• Conduct regular M&E of project activities to ensure alignment with set targets and objectives and continue mobile data collection pilot in five operation sites in Bugiri district for a second year.
• Mainstream gender equality and female empowerment by ensuring women’s participation in all project activities.
• Involve youth in spray activities in the target districts by engaging them as parish mobilizers and sensitize youth groups in churches and encourage them to sensitize the community in turn about IRS. The project will also recruit youth over 18 years of age as spray team members and encourage them to sensitize the community in their villages in partnership with the Local Council 1s (LC1s (village leaders)) during spraying.
• Carry out a logistics assessment in all districts, and arrange all procurement, shipping, delivery, and storage of IRS commodities.
• Use digital scanning devices and open-source software to track movement of serialized insecticide at selected operation sites.
• Coordinate community mobilization activities in collaboration with stakeholders to raise awareness of IRS and encourage beneficiary and stakeholder ownership.
• Conduct insecticide resistance, wall bioassay, and vector density monitoring; vector behavioral studies; and ITN durability monitoring.
• Ensure safe and correct insecticide application, thus minimizing human and environmental exposure to IRS insecticides, in compliance with the Pesticide Evaluation Report and Safer Use Action Plan and Supplemental Environmental Assessment.

Success stories from PMI VectorLink Uganda:

Opening Doors for Women in IRS

It Takes A Village to Fight Malaria

Music for Malaria Prevention

 

According to Sierra Leone’s 2016 Malaria Indicator Survey (SLMIS), malaria is endemic in the country with the stable and perennial transmission. Malaria prevalence is 40% among children age 6-59 months and is the main cause of morbidity and mortality among children under 5 years. Malaria prevalence is two times higher in rural areas (49%) than in urban ones (25%).

Insecticide-treated bednets (ITNs) are distributed to children between 12 and 59 months of age upon successful completion of PENTA3 immunization, and to pregnant women during the first contact for antenatal care. The first mass distribution of ITNs took place in 2006 in Bo and Pujehun districts. The same year, a countrywide mass ITN distribution for children under 1 year of age occurred alongside a measles vaccine campaign. Mass distribution of ITNs was subsequently conducted in 2010, 2014, and 2017. These mass campaigns, together with other distribution channels, helped increase the ownership of ITNs from 37% in 2008 (SLDHS, 2008) to 60% in 2016 (SLMIS, 2016). In 2019, 67.9% of the households owned at least one ITN in Sierra Leone (DHS, 2019). The insecticide resistance monitoring conducted in 2018-2019 indicated strong resistance of the main malaria vector Anopheles gambiae in Sierra Leone to pyrethroids.

After pre-exposure to PBO, the mortality rate observed for both deltamethrin and permethrin increased in the four sentinel districts but was below the 90% cut-off point for confirmed resistance, indicating that a monooxygenase-based resistance mechanism is partially involved, but is not fully responsible for the pyrethroid resistance observed. Based on this finding, the NMCP implemented a countrywide Permethrin and Deltamethrin PBO ITN mass campaign in May and June 2020.

In 2019, VectorLink Sierra Leone supported the NMCP in the maintenance and management of the insectary established in Makeni (Bombali District) which was established in 2018. VectorLink continued to maintain the susceptible Kisumu strain of An. gambiae. VectorLink also supported the monitoring of vector bionomics, providing information on vector density, distribution, and behaviors. The susceptibility of An. gambiae s.l. to the insecticides used in public health was assessed, and these data guided the development of the Insecticide Resistance Monitoring and Management Plan (IRMMP), the Integrated Vector Management Policy (IVMP), and Strategic plans. The information also helped the NMCP select the appropriate ITNs for distribution during the 2020 mass campaign. In 2020, the project will continue to provide technical and financial assistance to the NMCP to conduct malaria vector bionomics monitoring in 15 sentinel sites in five districts and insecticide resistance of An. gambiae s.l. (see Table 1 in Section 3.1). In 2020, VectorLink will continue to support the NMCP in holding quarterly meetings of the VCTWG and semi-annual meetings of the IVM National Steering Committee to review entomological data for decision making on vector control interventions for malaria and other vector-borne diseases

The information collected on vector density, seasonal distribution, behavior, and infectivity will be used to determine the optimal time to do IRS and it will serve as baseline data for assessing IRS impact. In addition, VectorLink will support ITN durability monitoring after the 2020 ITN mass campaign and will start the baseline data collection for the assessment of the impact of the co-deployment of PBO nets and IRS  in Sierra-Leone.

In 2021, under the PMI VectorLink Sierra Leone project, IRS was conducted in two districts, targeting 147,992 structures using a neonicotinoid insecticide (SumiShield ^TM 50 WG) from May 8, 2021 to June 9, 2021. A total of 150,895 structures were sprayed out of 160,919 structures found by spray operators in the targeted districts, accounting for a coverage rate of 93.8%.

In year five (January 2022 – December 2022), the project, after consultation with PMI and NMCP, will carry out the following activities:

IRS

PMI VectorLink Sierra Leone project will work with stakeholders including NMCP, regions and districts, to spray 160,919 targeted structures in two districts using Sumishield ^TM 50WG. The project’s primary objective is to reach a minimum coverage of 85 percent of the structures found in each district by implementing high-quality IRS operations.

• Support the NMCP in spraying an estimated 160,919 eligible structures in 12 chiefdoms in Bombali District and 16 chiefdoms in Bo District, using SumiShield ^TM
• Ensure that the spraying is of high quality, achieves at least 85% spray coverage, and protects an estimated population of 698,552.
• Devise and implement a deliberate plan to begin building capacity at the national, district, and chiefdom levels to manage IRS operations, including planning, spraying, and monitoring and evaluation (M&E).
• Continue to engage District Health Management Teams (DHMT) and Peripheral Health Unit (PHU) staff in the planning, implementation, and supervision of IRS in the two districts.
• Promote gender equality and female empowerment by recruiting women to fill at least 30% of the IRS seasonal worker positions. VectorLink will encourage the DHMT selection committees to achieve the mandatory quota.
• Coordinate community mobilization activities in collaboration with PHU and local authorities to raise awareness and achieve high community acceptance of IRS.
• Conduct high-quality M&E of IRS, including daily performance monitoring during the IRS campaign, to ensure the achievement of the objectives and targets assigned.
• Under the leadership of the project Environmental Compliance Officer (ECO), provide capacity building and work in collaboration with the NMCP Directorate of Environmental Health in the Ministry of Environment to conduct environmental inspections.

Entomological Monitoring Activities

• Monitor the density, biting rate, behavior, infectivity and parity of malaria vectors in 10 sentinel sites.
• Continue to maintain functional insectaries in Makeni and Freetown with the gambiae Kisumu strain available at all times and annual colony verification.
• Continue measuring the susceptibility of the main malaria vector, gambiae s.l. (in order of priority) to deltamethrin, permethrin, clothianidin, chlorfenapyr, alpha-cypermethrin, and pirimiphos-methyl. Susceptibility of An. gambiae s.l. from Bo, Bombali, Kono, Port Loko, and Karene districts will be tested.
• Measure the intensity of resistance to pyrethroids, and perform synergist assays, where appropriate.
• Subcontract with the Sierra Leone locally-based Njala University Laboratory, as well as the Centre for Research in Infectious Diseases (CRID), a regional laboratory in Cameroon or other suitable laboratories to use polymerase chain reaction (PCR) to process mosquitoes to identify samples to the species level, and use enzyme-linked immunosorbent assay (ELISA) to test sample mosquitoes for infectivity and PCR for determination of blood meal origin.
• Build the capacity of Njala university laboratory in Sierra Leone in order to conduct in-country laboratory analysis of samples collected.
• Subcontract with CRID and Njala University to conduct PCR to identify the mechanism associated with the resistance observed (knockdown resistance (kdr) and acetylcholinesterase 1 (Ace-1) mutations).

ITN Activities

• Continue to support the NMCP in conducting the third round (24 months) of ITN durability monitoring covering the two types of ITNs distributed in 2020.
• Support NMCP in the monitoring and evaluation of the school-based ITN distribution program
• Support NMCP to develop an operations research concept in collaboration with Breakthrough Action to understand reasons for low net use and provide recommendations to NMCP for behavior change communications.

Assessment of the Co-deployment of piperonyl butoxide (PBO) Nets and IRS

• Monitor the co-deployment of IRS and PBO ITNs.
• Monitor the density, biting rate, behavior, infectivity and parity of malaria vectors in the 12 co-deployment sites
• Conduct an analysis of the entomological data for the co-deployment study
• Conduct an analysis of the HMIS data

National-level Support

• Continue to strengthen the capacity of the NMCP and district health staff in entomology and vector control, use of entomological data for decision making and identification of priority operational research questions once there is an established leadership within NMCP.
• Continue to support the NMCP in holding quarterly meetings of the Vector Control Technical Working Group (VCTWG) and semi-annual meetings of the Integrated Vector Management (IVM) National Steering Committee.
• Continue to provide technical support to the NMCP and other stakeholders for data review for IRS insecticide selection in 2022 (for the spray campaign beyond 2022).
• Support the NMCP in reviewing the Insecticide Resistance Monitoring and Management Plan (IRMMP).
• Strengthen the capacity of NMCP and national stakeholders for high quality leadership from NMCP during IRS implementation.

*This country is now operating under the U.S. President’s Malaria Initiative Evolving Vector Control to Fight Malaria Project. 

Malaria is endemic throughout Senegal and the entire population is at risk. While the number of reported malaria cases has dropped in recent years, malaria is still a major cause of morbidity and mortality and a high priority for the government. Senegal has made significant progress against malaria and remains one of the leaders in piloting and scaling up new recommendations and strategies to increase the reach and effectiveness of interventions.

As part of an effort to scale up vector control interventions, the National Malaria Control Program (NMCP) received support from the U.S. President’s Malaria Initiative (PMI) for Indoor Residual Spraying (IRS) and insecticide-treated net (ITN) distribution. In Senegal, IRS implementation began as a pilot in three health districts (Velingara, Nioro, and Richard-Toll) in 2007. Then in 2015, targeted IRS was implemented within districts where health posts reported the highest malaria incidence (> 15 cases/ 1000 inhabitants). The NMCP chose to discontinue IRS in 2018, but it later resumed in 2020 under the PMI VectorLink Project.

In 2020, 136,417 structures in four districts (Koungheul, Koumpentoum, Makacolibatang, and Kedougou) were sprayed out of 137,932 structures found for a coverage level of 98.9%. In 2021, PMI VectorLink continued spray activities in the same four districts, reaching a coverage level of 97.2%. In 2022, the project again sprayed the same four health districts reaching a spray coverage of 97.5%.

In 2022, PMI VectorLink Senegal also procured equipment for the University of Cheikh Anta Diop (UCAD) laboratories and insectary, conducted IRS quality testing and entomological monitoring, trained six UCAD entomologists on mobile data collection, supported the NMCP’s continuous distribution of ITNs, piloted a social inclusion project to reach children living in koranic schools with mosquito nets, and conducted ITN durability monitoring for pyrethroid and PBO nets.

The NMCP decided that they will not implement IRS in 2023, so PMI VectorLink Senegal supported the continuous distribution of ITNs, conducted entomological monitoring, and strengthened the technical capacity of the parasitology lab at UCAD.

Rwanda has made remarkable progress in the fight against malaria. All major malaria indicators have decreased significantly from 2005 to 2012. Rwanda’s health management information system reported an 86 percent reduction in malaria incidence, an 87 percent reduction in malaria morbidity, a 74 percent reduction in malaria mortality, and a 71 percent reduction in malaria test positivity rate. While there was an upsurge from 2012 to 2016, Rwanda decreased its malaria incidence by more than 50 percent from 2016-17 to 2019-20.

In September 2019 and January 2020, through VectorLink Rwanda, IRS was conducted in three districts, targeting 304,798 structures, using Fludora Fusion insecticide, a clothianidin/deltamethrin combination. Spraying was conducted on September 2-27 in Nyagatare and Kirehe Districts, and on January 20 up to February 11, 2020, in Ngoma District. The Spray operators found 226,170 structures in Nyagatare and Kirehe districts, and sprayed 221,719, for a coverage rate of 98%. The IRS spray campaign in Ngoma commenced on 20 January and ended on 11 February 2020. During the twenty-day spray campaign in Ngoma District, spray operators found more structures (93,603) than the original target of 89,331 structures and sprayed 92,805 which is 99.2% spray coverage.

In August–September 2020, through VectorLink Rwanda, IRS was conducted in three districts, targeting 312,362 structures, using Fludora® Fusion insecticide, a clothianidin/deltamethrin combination. Spraying was conducted from August 24 through September 18, 2020 in Nyagatare, Kirehe, and Ngoma Districts. Spray operators found 328,676 structures and sprayed 327,704, for a coverage rate of 99.7%.

In August–September 2021, through VectorLink Rwanda, IRS was conducted in three districts, targeting 327,712 structures, using organophosphate (Actellic® 300CS) insecticide. Spraying was conducted from August 23 through September 17, 2021 in Kirehe, Ngoma, and Nyagatare, Districts. Spray operators found 347,963 structures and sprayed 346,277, for an IRS coverage rate of 99.5%.

Rwanda has 15 districts with high malaria burden. In 2021, the Government of Rwanda and its IRS partners (the Global Fund and PMI) were able to spray 14 out of these 15 districts. The fifteenth district received effective vector control through Interceptor® G2 long-lasting insecticide-treated nets (LLINs). 

In year five (March 2022 – February 2023), PMI VectorLink Rwanda will work with the Ministry of Health (MOH)/Rwanda Biomedical Center (RBC)/Malaria and Other Parasitic Diseases Division (MOPDD), and the districts themselves, to spray 339,567 targeted structures in three districts in Eastern Province using Actellic® 300CS insecticide; an additional 6,710 structures will be targeted in Mahama Refugee Camp. The project’s primary objective is to reach a minimum spray coverage of 85% of the eligible structures found in each district by implementing high-quality IRS operations and protecting approximately 1,340,280 residents. The project will implement Government of Rwanda, World Health Organization (WHO) and PMI VectorLink guidelines on prevention of COVID-19 before and during implementation of IRS to ensure the safest possible conditions for the implementing teams and the communities.

In addition to spraying, the project will carry out the following activities:

• Strengthen capacity at the national, regional, district, and local levels to manage IRS operations, including planning, spraying, resource allocation, monitoring and evaluation (M&E), and entomological monitoring and quality controls.
• Support ITN durability monitoring of dual active ingredient (Interceptor® G2), piperonyl butoxide (PermaNet® 3.0), and standard (Yahe®, Olyset®) nets implemented by the Government of Rwanda.
• Support capacity strengthening of the MOPDD entomology lab, including the procurement of reagents and supplies for the entomology laboratory and the malaria Technical Working Group.
• Technical support to the entomology laboratory.
• Conduct training with a focus on IRS supervision and spray techniques to improve the overall quality of spraying.
• Conduct regular M&E of project activities to ensure alignment with set targets and objectives.
• Mainstream gender equality and female empowerment by ensuring women’s equitable participation across project activities, such as spray operations, supervision, community mobilization, entomology, and spray planning.
• Coordinate community mobilization activities in collaboration with stakeholders to raise awareness of IRS and to encourage beneficiary and stakeholder ownership. The project will recruit the head of the village and the in-charge of security to sensitize the community in their villages during spraying. All community mobilization activities will follow PMI VectorLink COVID-19 mitigation measures.
• Carry out a logistics assessment in all PMI-funded IRS districts, and arrange all procurement, shipping, delivery, and storage of IRS commodities.
• Strengthen the IRS logistics and warehousing system through enhanced training, supervision, and digitalization of insecticide tracking.
• Conduct wall bioassay, vector density monitoring, and behavioral studies and support the MOPDD in monitoring insecticide resistance.
• Collaborate with other implementing partners to implement IRS in 14 districts (11 supported by Government of Rwanda/The Global Fund and 3 supported by PMI VectorLink Rwanda) to complement each other’s work and avoid duplication of efforts. Additionally, VectorLink Rwanda will share training curricula, support data management and reporting, and supervision of IRS activities.
• Ensure safe and correct insecticide application, thus minimizing human and environmental exposure to IRS insecticides, in compliance with the Pesticide Evaluation Report and Safer Use Action Plan and Supplemental Environmental Assessment (SEA).

Some success stories from PMI VectorLink Rwanda:

PMI VectorLink in Rwanda – A Photo Story

Reducing Costs and Expanding Coverage

Mobilizing the Masses Against Malaria

Fighting Malaria and Poverty

PMI has supported entomological monitoring in Nigeria since 2012. The PMI AIRS project conducted entomological monitoring along with an IRS pilot in Nasarawa in 2012 and 2013. In 2014, monitoring expanded to six sites (Enugu, Jigawa, Lagos, Nasarawa, Plateau and Rivers) and to Sokoto and Jigawa in 2015. In 2016, Akwa Ibom, Bauchi, Ebonyi, and Oyo replaced Enugu, Lagos, Rivers, and Plateau, and monitoring continued in Nasarawa and Sokoto. Through AIRS and then VectorLink, entomological monitoring continued at these six sites in 2017 and 2018. In year two of the VectorLink project, longitudinal monitoring of vector bionomics continued in the six sites as well as in Plateau. The project also performed insecticide resistance monitoring in all seven PMI-focus sites as well as Benue, Zamfara, Cross River, and Kebbi. From October 2019 to September 2020 (year three of the project), VectorLink conducted entomological monitoring in 11 sites—monthly vector surveillance and longitudinal monitoring was conducted in five sites (Akwa Ibom, Ebonyi, Oyo, Plateau, and Sokoto), while insecticide resistance monitoring only was done in Bauchi, Benue, Cross River, Kebbi, Nasarawa, and Zamfara. Monthly surveillance has continued in the 11 sites during year four (October 2020-September 2021). In addition to the six sites where insecticide resistance monitoring was conducted in 2020, the project added four non-PMI-focus sites (Bayelsa, Enugu, and Federal Capital Territory Abuja, and Bonny Island in Rivers State) in 2021.

Results from VectorLink Nigeria’s entomological surveillance and insecticide resistance monitoring activities have highlighted an urgent need to develop and implement appropriate insecticide resistance management strategies in areas with high intensity of resistance. In particular, the data collected helped guide PMI’s decision to procure and deploy piperonyl butoxide (PBO) nets in Ebonyi (2019) and Oyo (2020) and Interceptor G2 (IG2) nets in Oyo (2021) and Kebbi (2022) to combat resistant malaria vectors with metabolic resistance mechanisms.

From October 2021 to September 2022, the PMI VectorLink Nigeria project continued to work with the National Malaria Elimination Program (NMEP), the Nigerian Institute for Medical Research (NIMR), State Malaria Elimination Programs (SMEPs), and PIs in Nigerian Universities to monitor trends in vector bionomics (longitudinally), insecticide resistance, and the programmatic impact of the distribution of next-generation nets in Kebbi and Sokoto States. Key accomplishments included:

Field Activities

• Conducted monthly longitudinal vector surveillance in seven sentinel sites (six PMI-focus states and one non-PMI-focus state) to measure vector species composition, density, distribution, seasonality, and behavior, as well as sporozoite infection rate, parity, and blood meal sources.
• Conducted insecticide resistance testing on Anopheles gambiae s.l. in 16 sites (11 PMI-focus and five non-PMI-focus states).
• Continued to collect entomological data from Interceptor G2 and piperonyl butoxide (PBO) net monitoring sites in Kebbi and Sokoto States, respectively.
• Conducted a survey to determine the feasibility of implementing larval source management (LSM) as a supplementary approach in Kebbi State, which has the highest malaria burden in the country. A report summarizing the results is currently being finalized.
• Transitioned all entomological data collection, management, and analysis for VectorLink Nigeria-supported sites to VectorLink Collect, a District Health Information Software Version 2 (DHIS2)-based system.

Insectary and Laboratory Activities

• Managed the Nasarawa State University insectary and laboratory in Keffi in support of the project’s capacity building objectives, supporting accurate sample identification and testing of technical grade insecticides.
• Provided technical guidance and facilitatory support to Nigeria Liquefied Natural Gas (NLNG) laboratory in Bonny Island, to support their interest in expanding their entomological testing capabilities.
• Collaborated with NIMR to conduct molecular analysis on mosquito samples identified in Keffi laboratory.
• Shared all entomological data collected with NIMR for storage and management.
• Supported the training of technicians and PIs implementing field activities.

Capacity Building at National and State Levels

• Supported the development of a national vector surveillance and insecticide resistance implementation guide, containing practical guidance as well as harmonized protocols and procedures for implementation of entomological activities by the NMEP and its partners. The guide was reviewed, validated by key stakeholders, and approved by the country’s Integrated Vector Surveillance Technical Working Group in February 2022.
• Facilitated the review of entomological monitoring data with stakeholders to inform and improve decision-making on vector control.
• Provided technical expertise during a refresher training organized by the NMEP on basic morphological identification and entomological methods for entomology technicians.
• Collaborated with the NMEP, NIMR, and other malaria partners to derive aggregates from a standard list of entomological indicators measured by all partners conducting entomological activities in Nigeria.
• Supported the NMEP through local and international procurement of materials required for insecticide resistance management activities in Global Fund-supported entomology sites.

Streamlined Durability and Program Monitoring

• Supported the NMEP to conduct pre-distribution bioassays on a sample of IG2 ITNs withdrawn from those planned for distribution in Kebbi State in 2022, as a first step in streamlined ITN durability monitoring.
• Concluded a programmatic assessment of PBO ITNs distributed in November 2019 in Ebonyi State.  Finalized an interrupted time series analysis and estimated the impact of PBO ITNs on key entomological and epidemiological indicators such as confirmed case incidence two years before and two years after net distribution. Results will be presented in late 2022 at ASTMH and in-country and a manuscript is currently under development.
• Developed a baseline presentation summarizing entomological and epidemiological data prior to IG2 and PBO ITN distributions in Kebbi and Sokoto States, respectively, as part of an ongoing program monitoring activity.

Success stories from PMI VectorLink Nigeria:

Building Capacity for Surveillance