Angola

Under construction.

More information about our work in Angola will be provided soon. 

A Community Heroine’s Sacrifice to Fight Malaria

Lidia Cipriano Shares a Portion of Her Land with Mozambique Government to Help Fight Malaria in Her Community

Lídia Cipriano is no stranger to sacrifice, a single mother of two children, she knows well that sometimes sacrifices are made for the health and benefit of family and community. Cipriano lives in Lualua, a village in Mopeia District in Mozambique’s Zambezia province where she offered a piece of her land to the local government to help fight against malaria in her community. In collaboration with the U.S. President’s Malaria Initiative (PMI) VectorLink Project, the Serviços Distritais de Saúde Mulher e Acção Social (SDSMAS) Mopeia used the donated land to establish an operation site to help the project implement indoor residual spray (IRS) activities in the district.

Malaria is considered the most important public health threat in Mozambique, where it accounts for nearly one-third of all deaths and 42 percent of deaths in children under five years old. PMI VectorLink equips countries to plan and implement safe, cost-effective and sustainable IRS programs and other proven life-saving malaria vector control interventions with the overall goal of reducing the burden of malaria. To safely and efficiently implement IRS, an operations site must be selected that is strategically located for accessibility and logistics is essential. 

Lídia Cipriano, in front of the storage facility at the newly established operations site in Lualua.
Lídia Cipriano, in front of the storage facility at the newly established operations site in Lualua.

Lualua Village is about 45 km away from the nearest operation site in Posto Campo. Last year, the IRS team faced enormous transportation and logistical challenges to spray Lualua Village and its surrounding communities. In Mozambique, all IRS operations sites are situated on local government land and close to a health facility. In Lualua, however, the local government did not have any land to accommodate an operations site. In their search, the Mopeia District Health Directorate and PMI VectorLink approached Cipriano about a piece of her land.

“When the project explained to me the purpose for which they needed the piece of land, I did not think twice, I accepted. They came to me because God appointed me to contribute to saving lives from malaria.  I think this is part of my mission here on earth.”  

– Lidia Cipriano

Lídia’s sacrifice means sharing a portion of her land with the project resulting in disruption of her day to day life during the spray campaign. Despite this, Lídia felt that protecting her community from malaria was more important.

The newly established operations site will allow the project to hire local talent and recruit 31 new staff members from Lualua village, unlike in previous years where seasonal workers had to be recruited from the neighboring Posto Campo village. The operations site will be used to implement IRS activities in about 40 communities targeting about 7,600 structures and protecting an estimated total population of 33,800 against malaria.

 

Zimbabwe

The PMI VectorLink Project will work with provincial and district health officials to lead, implement, and manage the IRS campaign in four districts: two in Mashonaland East province (Mudzi and Mutoko), and two in Mashonaland Central province (Mount Darwin and Rushinga), protecting at least 85 percent of the 214,073 structures found by the NMCP.

The project will also conduct nationwide entomological monitoring and surveillance in 20 sites and supply entomological reagents to two major institutions, National Institute of Health Research (NIHR) and Africa University (AU) that have laboratory facilities to conduct different entomological assays.

In addition, VectorLink Zimbabwe will provide assistance to various national-level IRS campaign issues as well as environmental compliance aspects when requested. This assistance might include the following activities:

Providing technical support to shift from traditional malaria vector control to integrated vector management to optimize use of resources for vector control;

  • Participating in malaria technical working groups and committees;
  • Providing technical support for the provinces implementing malaria elimination activities;
  • Supporting the NMCP and its partners in IRS campaign and malaria control messaging;
  • Increasing local capacity to plan, implement and monitor vector control programs.

Zambia

Although there are signs of improvement, malaria continues to be a major cause of morbidity and mortality in Zambia and the entire Zambian population is at risk of malaria. Currently, the Zambian national malaria control program aims to provide vector control to 100 percent of households and persons at risk in targeted areas by 2016. With support from PMI, the goal is to achieve and sustain universal ITN coverage in conjunction with a focused, data-driven approach to IRS. Other recent PMI-supported activities include: training of clinical care teams in providing IPTp supervision; procurement and distribution of rapid diagnostic tests for malaria case management and training in their use; and support of the country’s behavior change communication strategy.

Success stories from PMI VectorLink Zambia:

Twice the Protection

Uganda

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; collection of surveillance data; management and monitoring of insecticide resistance; and behavior change communication activities that reach millions of Ugandans with key malaria messages.

The PMI VectorLink Project aims to contribute to PMI’s goal to halve the burden of malaria in 70 percent of at-risk populations in sub-Saharan Africa. The project will continue to work closely with the Ministry of Health, the National Malaria Control Programme, district health offices, local NGOs, and community leaders to ensure that government, the private sector, and communities are able to sustain and lead future IRS and malaria control programs in their respective countries.

Success stories from PMI VectorLink Uganda:

Opening Doors for Women in IRS

It Takes A Village to Fight Malaria

Music for Malaria Prevention

 

Tanzania

The PMI VectorLink Project is implementing IRS operations to reduce the prevalence of malaria in Tanzania to further the National Malaria Control Program (NMCP) and PMI’s goal of reducing malaria-associated mortality and morbidity in selected districts in mainland Tanzania. The project will spray in nine districts: Ngara, Missenyi, Chato, Bukoba Rural, Musoma Rural, Butiama, Sengerema, Kwimba and Nyang’hwale. The districts to be sprayed in Zanzibar will be jointly determined with the Zanzibar Malaria Elimination Program (ZAMEP) and PMI Tanzania.

Objectives for the 2018 spray campaign include the following:

  • Achieve spray coverage of at least 85% of the 721,609 eligible structures targeted in mainland Tanzania and Zanzibar as follows: approximately 657,938 eligible structures targeted in nine districts of mainland Tanzania and approximately 63,671 eligible structures in Zanzibar
  • Ensure compliance with environmental regulations and establish best practices in the target districts for IRS insecticide handling and usage
  • Establish effective monitoring and evaluation (M&E) of all activities to measure the results of the IRS intervention

Additionally, the Project will:

  • Support training, capacity building, and advocacy at the national, regional, and district level as a means to achieving IRS sustainability
  • Provide regular M&E for the project, including a daily mobile-based performance tracker.
  • Carry out a logistics assessment in all districts and arrange all procurement, shipping, delivery, and storage of spray tanks, spare parts, insecticides, and personal protective equipment (PPE).
  • 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)
  • Coordinate information, education, and communication (IEC) and social and behavior change sensitization and mobilization activities with other stakeholders to raise community awareness of IRS and to encourage beneficiary and stakeholder ownership.
  • Help the National Institute for Medical Research (NIMR) and the Zanzibar Malaria Elimination Program (ZAMEP) conduct routine entomological monitoring in all spray sites and control unsprayed sites, including assessing malaria vector density, vector survival (age), and species composition in intervention and control areas; establish vector feeding time and location; monitor the quality of insecticide application and insecticide decay rates; and assess vector susceptibility to insecticides and prevailing mechanisms of resistance
  • Promote cost efficiency through due diligence and efficiency of operations.

Success stories from PMI VectorLink Tanzania:

PMI Pilots New WHO-Recommended Insecticide

Sierra Leone

Malaria is endemic in Sierra Leone, with stable and perennial transmission in all parts of the country. The entire populace is at risk of the disease. It is estimated that about 2,240,000 outpatient visits are due to malaria every year, of which about 1,000,000 patients are under 5 years old. Pregnant women and children under 5 years old constitute 4.4% and 17.7% of the total population, respectively, and are the most vulnerable groups.

The PMI VectorLink Project will conduct entomological monitoring activities in four sentinel sites selected in consultation with the NMCP. Western Area Rural district will represent the coastal areas of the country; Bo, which is the second-largest district in the country, will represent the South; Bombali, where the future insectary will be established, will represent the North; and Kono district, where there is large-scale mining activity, will represent the Eastern part of the country.

Monthly entomological data will be collected in the four sentinel sites, with involvement of technicians from the District Health Management team, who will be trained by the project entomologist. Collections will aim to determine species composition, density, behavior, parity, source of blood meal, and sporozoite infection rates of malaria vectors in the areas. Monitoring will be conducted once a month for 12 months using three collection methods: pyrethrum spray catches, CDC light traps, and human landing catches. Additionally, insecticide susceptibility tests and intensity assays will be carried out in all sentinel sites once in a year.

Senegal

Malaria is endemic throughout Senegal and the entire population is at risk. Transmission occurs seasonally and is affected by rainfall and persistent flooding, especially in peri-urban areas. 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 a leader in piloting and scaling up new recommendations and strategies to increase the reach and effectiveness of interventions. Striving toward malaria pre-elimination by 2018, malaria interventions in Senegal are targeted to the different transmission zones.

As part of an effort to scale up vector control (VC) interventions, the National Malaria Control Program (NMCP) has received support from the U.S. President’s Malaria Initiative (PMI) for Indoor Residual Spraying (IRS). In Senegal, IRS implementation began as a pilot in three health districts (Velingara, Nioro, and Richard-Toll) in 2007. Beginning in 2015, targeted IRS was implemented within districts where health posts reported high malaria incidence (> 15 cases/ 1000 inhabitants).

In 2018, the Senegal NMCP decided to discontinue PMI-funded IRS, but entomological monitoring will continue, particularly to evaluate monitor vector densities and sporozoite infection rates in areas following withdrawal of IRS. The Laboratory of Vector and Parasite Ecology (LEVP) of the Faculty of Science and Technology (FST) at the University Cheikh Anta Diop (UCAD) in Dakar, in collaboration with NMCP, has been implementing entomological monitoring activities in Senegal since 2007. Since 2015, UCAD continued the implementation of entomological monitoring activities as a subcontractor under the PMI Africa Indoor Residual Spraying Project. In 2018, the PMI VectorLink Project will be responsible for entomological monitoring in Senegal, and will continue to subcontract with UCAD for the implementation of project activities.

Rwanda

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. The national malaria control program has an ambitious vision of a Rwanda free from malaria and is aiming to achieve malaria pre-elimination status nationwide by 2018.

Through PMI support, Rwanda has conducted 17 spray rounds, nine of which have been implemented by the PMI Africa Indoor Residual Spraying (AIRS) project. The PMI VectorLink Project in Rwanda project will conduct IRS in the targeted districts according to an agreement between PMI and the MOH’s Malaria and Other Parasitic Diseases Division (MOPDD). The project also will support entomological monitoring and wall bioassay activities to assess insecticide decay rates and quality control for IRS.

In the 2018 spray round, the VectorLink Rwanda project will work with the MOPDD and other stakeholders to achieve at least 85 percent spray coverage of the 206,611 targeted structures in the 26 sectors that make up the two districts of Kirehe and Nyagatare, using the OP pirimiphos-methyl CS; 813,177 residents will be protected.

In addition to spraying, the project will:

  • Support training, capacity building, and advocacy at the national, regional, and district levels as a means of facilitating IRS sustainability. The VectorLink project will work to increase the role of the district and the MOPDD in supervising IRS in 2018. This will include training on the use of a smart phone application for spray supervision.
  • Provide regular M&E, including a daily Performance Monitoring Tracker (PMT).
  • Use mobile data collection tools to collect IRS data for real-time feedback and decision-making.
  • Carry out a logistics assessment in all districts and arrange all procurement, shipping, delivery, and storage of spray tanks, spare parts, insecticides, and personal protective equipment (PPE).
  • Prepare and submit an informational letter report in accordance with the approved 2017 Supplemental Environmental Assessment.
  • Ensure safe and correct insecticide application, thus minimizing human and environmental exposure to IRS insecticides.
  • Coordinate information, education, and communication (IEC) and behavior change communication (BCC) sensitization and mobilization activities with other stakeholders.
  • Promote cost efficiency through due diligence and efficiency of operations.
  • Provide technical assistance during spray rounds conducted by the MOPDD.

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

Nigeria

With a population of about 182 million, Nigeria is the most populous country in Africa. Malaria is transmitted throughout Nigeria, with the entire population at risk. According to the 2017 World Malaria Report, fifteen countries accounted for 80% of all malaria cases globally and Nigeria accounts for the highest proportion of cases globally (27%). In 2016 in sub-Saharan Africa, 54% of the population at risk slept under an ITN, increasing from 30% in 2010. Household ownership of at least one ITN was high (80%) in 2016 rising from 50% in 2010 (WMR, 2017). The Nigeria Malaria Indicator Survey (MIS)(2015)  reported that 71 percent of households in Nigeria possess at least one mosquito net (treated or untreated), 69 percent possess at least one insecticide-treated net (ITN) and 69 percent possess at least one insecticide-treated net (ITN).

As Nigeria continues to scale up mass distribution of ITNs, it becomes increasingly important to develop resistance management strategies/national entomological monitoring plans, and for the National Malaria Elimination Program (NMEP) to develop vector control strategies that articulate how and where ITNs and possibly Indoor Residual Spraying (IRS) will be used to provide the highest quality as well as greatest programmatic impact to mitigate the threat of insecticide resistance. In recognition of this threat, the NMEP, in conjunction with key malaria partners and stakeholders, initiated the development of an Insecticide Resistance Management (IRM) plan for Nigeria in 2017. The overall objective of the IRM plan is to provide guidance for effective monitoring and management of vector resistance, as well as the quality of vector control interventions in the country.

The PMI VectorLink Project plays an integral role in this partnership, conducting insecticide resistance testing. PMI VectorLink regularly monitors the resistance/susceptibility of anopheline mosquitoes, the vector that can transmit malaria, to all the four classes of IRS insecticides in six sentinel sites located in the six geopolitical zones of the country. The project also studies the mosquito vector species’ distribution, density, and bionomics.

The PMI VectorLink Project builds on the work of the PMI Africa Indoor Residual Spraying Project, which began in 2012 and conducted annual resistance tests at sentinel sites located in the different ecozones of the country. The project piloted and standardized the use of the CDC bottle bioassay and the WHO tube tests for insecticide resistance testing in the country. Data from these tests helped to shape Nigeria’s national IRM plan. The project’s information on the nature and distribution of resistance of these mosquitoes to insecticides has helped to drive effective, evidence-based decision-making for vector control programming.

The PMI VectorLink Project continues to work with the NMEP to guide and provide updates on future IRM planning. The IRM plan is a dynamic guideline that will be reviewed and updated regularly as more local data on mosquito susceptibility to insecticides becomes available. This will go a long way to support the country in monitoring the development of insecticide resistance in mosquito populations especially in areas where vector control interventions are currently being scaled up.

In 2018, the PMI VectorLink Project is carrying out vector surveillance activities work in seven PMI-supported states: Akwa Ibom, Bauchi, Ebonyi, Oyo, Nasarawa, Sokoto and Plateau states. The project will collect information to support the National Malaria Elimination Program (NMEP) and State Malaria Elimination Programs (SMEP) in making data-driven decisions for programming vector control activities.

Success stories from PMI VectorLink Nigeria:

Building Capacity for Surveillance