Angola

Malaria remains a serious public health problem in Angola despite sustained malaria control strategies. Malaria accounts for 35% of all-cause outpatient morbidity, 35% of mortality in children, 40% of prenatal mortality, and 25% of maternal morbidity, and causes 60% of hospital admissions in children under 5 and 10% of admissions of pregnant women. The vector-borne disease is endemic throughout the country and the entire population is at risk. According to the World Health Organization (WHO) 2017 World Malaria Report (WMR), the total number of malaria cases (suspected and confirmed) reported in the public health sector in 2015 was 3,254,270. This number increased by 32% in 2016 to 4,301,146, likely due to increased rainfall because of El Niño and stock-outs of anti-malarial drugs (FY2018 Malaria Operational Plan).

In 2014, PMI constructed and established an insectary in Huambo. It was the first insectary in Angola since the end of the civil war. PMI also supported the training of technicians on basic malaria entomology, including the sampling of aquatic and adult mosquitoes, rearing of adults from field-collected larvae/pupae, morphological species identification, ovary dissection, cone bioassays, susceptibility testing using U.S. Centers for Disease Control and Prevention (CDC) bottle bioassay and WHO tube test methods, preserving mosquito samples, and transport to a laboratory for molecular and biochemical assays. Insectary technicians also received on-the-job training and mentorship to support continuous improvement of their skills and competence. PMI also supported the training of provincial and municipal health authorities drawn from nine provinces (Benguela, Cunene, Huambo, Huila, Luanda, Malanje, Namibe, Uige, and Zaire) where insecticide resistance was evaluated in 2015-2016. These provinces represent three malaria transmission zones.

In Year 1 of the PMI VectorLink Angola project (May 2019 to April 2020), entomological surveillance was conducted in two sites—one in Huambo Province and the other in Lunda Sul Province. (The original plan was to conduct entomological surveillance in three sites, but Luanda Province was postponed due to the COVID-19 pandemic.) VectorLink conducted one month of entomological surveillance at each site during the peak mosquito season (January-March 2020) to determine species composition, vector behavior, and vector susceptibility to different insecticides. The project also hired a full-time Entomology Coordinator who facilitated preparations for data collection, including meeting with central, provincial, and district leadership, and obtaining ethical clearance from the Instituto Nacional de Saúde Publica (INSP). With the support from the VectorLink home office and a consultant who stayed in Angola throughout the sampling season, the project trained a total of 15 people (including eight members of the Provincial mosquito brigades, five technicians, a Field Epidemiology Training Program fellow, and the Entomology Coordinator) on adult mosquito collection methods and morphological identification.

In Year 2, the PMI VectorLink Angola project will work with PMI/Angola, the NMCP, INSP/INIS, and provincial/district authorities to conduct entomological monitoring. The project’s primary objective is to build sustainable entomological capacity within Angola. Key objectives for the Year 2 work plan are to:

  • Engage an international consultant to conduct insecticide susceptibility and community-based surveillance training and to supervise data collection. This will most likely consist of one trip for training and two trips for the supervision of data collection, each lasting for two months. If a qualified candidate is willing and able to relocate to Angola and work full-time, this will be considered in consultation with PMI.
  • As part of the capacity-building plan, conduct a weeklong central-level training with a priority focus on insecticide susceptibility test procedures including theoretical and practical sessions, reinforced by on-site training on larval and adult collections, bioassays, and sample preservation with NMCP mosquito brigade staff in each of the seven provinces.
  • Sponsor at least one entomologist from NMCP/MOH to attend a project-wide VectorLink training, focused on topics of importance to NMCP staff. This training will include insecticide susceptibility testing, morphological identification, sample processing, and standardized data collection and management.
  • Improve functionality of Huambo insectary, in coordination with NDPH and DPS, by adding shipping containers to provide more space for rearing a susceptible gambiae Kisumu colony and wild pyrethroid-resistant Anopheles as well as to provide adequate space for mosquito sample processing, susceptibility tests, and data entry.
  • Ensure that the Luanda insectary becomes functional through the importation of a susceptible colony and training of technicians.
  • Conduct insecticide susceptibility testing in seven provinces (Huambo, Kwanza Norte, Luanda, Lunda Sul, Malanje, Uige, and Zaire) during the peak mosquito season (November 2020-April 2021) to determine species composition and vector susceptibility to different insecticides.
  • With technical assistance from PMI, help build the laboratory capacity of INIS to perform polymerase chain reaction (PCR) for species identification and to determine resistance mechanisms, and enzyme-linked immunosorbent assays (ELISAs) to determine sporozoite infection rates.
  • Conduct local and international procurement of entomological surveillance items required by INIS, insectary, and selected entomological monitoring sites.
  • Submit quarterly, semi-annual, and annual reports as required.

 

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 President’s Malaria Initiative (PMI) has a long history of combating malaria in Zimbabwe through indoor residual spraying (IRS), dating back to August 2011. With support from PMI, The PMI VectorLink Project supports and implements vector control activities in Zimbabwe to prevent the spread of malaria. In the project’s first year of implementation (2017), PMI VectorLink conducted IRS in four districts, Chimanimani, Mutare, Mutasa, and Nyanga, in Manicaland Province. With guidance from NCMP and PMI, the project has relocated its operations to Mashonaland East Province to spray the high malaria-burdened Mudzi and Mutoko Districts during the second year of implementation. The change in location was supported by NMCP and is also in line with the country’s Insecticide Resistance Management Plan (IRMP). 

The project will continue to provide technical assistance and work with provincial and district health officials in Manicaland Province to allow for a smooth transition to NMCP management of  IRS operations. In addition, VectorLink Zimbabwe will continue entomological surveillance at six sentinel sites: four in Mashonaland East Province -Arcturus, Makarara, Dendera and Kawere, and two in Manicaland Province -Burma Valley and Vumba.

VectorLink Zimbabwe continues to provide technical assistance to the NMCP and partners on various national-level vector monitoring and control issues, as requested. This assistance includes:

  • Technical support to shift from traditional malaria vector control to integrated vector management in an effort to optimize the use of resources for vector control
  • Increased capacity to plan, implement and monitor vector control programs, including the introduction of a new class of insecticides, neonicotinoids, for IRS in Zimbabwe
  • Technical support to ensure environmental compliance for IRS activities, taking on board findings and recommendations in 2018 Environmental Compliance Operations Support (ECOS) field evaluation report
  • Participation in and support for malaria technical working groups, task forces, and committees
  • Technical support for implementing malaria elimination activities especially in vector control and entomological surveillance
  • Support the development of the national entomological monitoring plan.
  • Support for malaria control messaging.

Zambia

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 (NMESP) 2017-2021, which aims to graduate Zambia from striving for malaria control to malaria elimination. In line with the guidelines included in the NMESP, the approach changed from the historic targeting of 50-60% of structures per district in 2017 to target 80% of the population per district across the country. In the same year, 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, VectorLink sprayed 579,490 structures out of 644,677 structures found. In 2019, VectorLink conducted IRS in 20 districts, targeting 597,625 structures using a clothianidin-based insecticide from October 2 to November 30, 2019. A total of 536,983 structures were sprayed out of 598,732 structures found by spray operators in the targeted districts, accounting for a coverage rate of 90%.

In its third year of implementation, the project will conduct IRS in 15 districts (Lundazi, Mambwe, Chipata, Vubwi, Chadiza, Katete, Sinda, Petauke, and Nyimba in the Eastern Province, Masaiti, Mpongwe, and Lufwanyama in Copperbelt Province, and Nchelenge, Kawambwa, and Chiengi in Luapula Province) from September 29 to November 10, 2020, and will provide capacity-building support to the national and district governments to plan and implement quality IRS in the future. The project will conduct IRS in 15 districts (Lundazi, Mambwe, Chipata, Vubwi, Chadiza, Katete, Sinda, Petauke, and Nyimba in the Eastern Province, Masaiti, Mpongwe, and Lufwanyama in Copperbelt Province, and Nchelenge, Kawambwa, and Chiengi in Luapula Province) from September 29 to November 10, 2020, and will provide capacity-building support to the national and district governments to plan and implement quality IRS in the future.

Figure 1 to the right highlights the target districts for 2020.

2020 Target Districts

PMI VectorLink Zambia will continue to work with the NMEP, provinces, and districts to spray 639,536 targeted structures in 15 districts using a clothianidin-based insecticide. 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 15 districts. PMI VectorLink will not fund direct operational costs of the spray campaign in the seven urban Copperbelt districts that were sprayed in 2019, but will instead include Chiengi and Kawambwa, rural districts north and southeast of Nchelenge respectively, in Luapula province. The 15 districts include Lufwanyama, Mpongwe, and Masaiti in Copperbelt Province, Nchelenge, Kawambwa, and Chiengi in Luapula Province, and Katete, Sinda, Chadiza, Petauke, Chipata (5 pre-elimination districts), Vubwi, Nyimba, Lundazi, and Mambwe in Eastern Province. In addition to spraying, in Year 3, the project will carry out the following activities:

  • Build capacity of IRS managers and master trainers in Copperbelt Province.
  • Provide technical assistance to the NMEP and district health offices on the management of DDT in former PMI-supported provinces.
  • Use the Reveal tool to capture real-time spray data in all targeted areas in Nchelenge and Chadiza districts.
  • Conduct entomological monitoring activities in seven surveillance districts to assess the impact of IRS operations on standard PMI entomological indicators.
  • Establish one satellite office in Nchelenge in addition to the already existing two to decentralize IRS planning activities to the districts and provide direct technical assistance to the districts of Nchelenge, Chiengi, and Kawambwa.
  • Assist NMEP in strengthening engagement with the private sector through public-private partnerships, especially with selected mining companies on the Copperbelt.
  • Prepare a new nationwide supplemental environmental assessment (SEA) for 2020-2025 in view of the expiration of the current SEA in November 2019.
  • Support the NMEP to plan and implement the 2020 national ITN mass campaign.
  • Provide targeted subnational-level technical assistance for implementing the ITN mass campaign in the PMI-supported provinces of Luapula, Northern, Muchinga, and Eastern in 2020 and 2021.
  • Support NMEP to implement an assessment of ITN repurposing and misuse by communities in Luapula, Northern, and Muchinga Provinces.
  • Through the PATH-led integrated data analytics activity, provide technical assistance to the NMEP Vector Control Unit for visualization development and data review to support vector control decision-making.

 

 

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; 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 using Actellic® 300CS in 13 districts and SumiShield® 50WG in two districts 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 its third year of implementation, the project will conduct IRS in eight Phase I districts (Budaka, Bugiri, Butaleja, Butebo, Kibuku, Namutumba, Pallisa, and Tororo) from March 2, 2020–April 4, 2020, and eight Phase II districts (Alebtong, Amolatar, Dokolo, Kaberamaido, Kalaki, Lira, Otuke, and Serere) from April 20–May 23, 2020. Six districts (Alebtong, Amolatar, Dokolo, Kaberamaido, Kalaki, and Otuke) out of the 16 target districts are funded by DFID while the other 10 are funded by PMI. The project will continue to conduct entomological monitoring and will provide capacity-building support to the national and district governments to plan and implement quality IRS in the future. 

In 2020, the PMI VectorLink Uganda project will work with the Ministry of Health (MoH)/National Malaria Control Division (NMCD) and district, sub-county stakeholders to target 1,393,562 eligible structures in 16 districts (10 PMI districts and six DFID) using Fludora Fusion and the balance of Actellic 300CS and SumiShield 50WG from the 2019 spray campaign. Actellic 300CS (71,794 bottles) will be used in 14 of 16 districts, while SumiShield (28,161 sachets) will be used in Dokolo and Lira districts. Fludora Fusion will be used once the balance of old insecticide stock is exhausted in the first week of IRS. 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.

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

  • Build capacity at the national, regional, district, and local levels to manage IRS operations, including planning, spraying, resource allocation, and monitoring and evaluation (M&E).
  • Collaborate with districts on prioritizing implementation of activities in their IRS exit/sustainability plans. The PMI VectorLink project so far has held discussions with USAID/ Regional Health Integration to Enhance Services (RHITES) North-Lango, RHITES East, RHITES East Central, and Sustaining Uganda’s Response to Malaria (SURMa) projects which are the major implementing partners (IPs) of sustainability activities. It has been noted that there is a need for PMI VectorLink to provide leadership to the other IPs in the project target districts to coordinate streamlining of key activities for the sustainability of gains from IRS and other malaria interventions. This will require having activities beyond the IRS campaign period, such as technical support to social and behavior change (SBC) and long-lasting insecticidal net (LLIN) distribution as well as bi-monthly review meetings with stakeholders.
  • Prepare an exit strategy in collaboration with key stakeholders and other IPs working on malaria prevention and control given DFID’s plan to withdraw funding for IRS beginning in 2021.
  • 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 participation in all project activities.
  • Involve youth in spray activities in the target districts. The project will recruit youth as parish mobilizers and also 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 ones (LCIs; village leaders) during spraying.
  • Carry out a logistics assessment in all districts, and arrange all procurement, shipping, delivery, and storage of IRS commodities.
  • Strengthen the IRS logistics and warehousing system through enhanced training and supervision.
  • Coordinate community mobilization activities in collaboration with stakeholders to raise awareness of IRS and encourage beneficiary and stakeholder ownership.
  • Conduct insecticide resistance, wall bioassay, vector density monitoring, and vector behavioral studies.
  • Collaborate with other IPs in the 16 districts to complement each other’s work and ensure no duplication of efforts.
  • 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).
  • Finalize and share a new nationwide SEA for 2020 to 2025 in view of the expiration of the current SEA in November 2019.
  • Evaluate the extent to which the 2019 National Environmental Management Authority (NEMA) Audit and Environmental and Social Impact Assessment (ESIA) recommendations are implemented.

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 Tanzania Project supports the implementation of IRS in Mainland Tanzania and Zanzibar. It aims to move the country toward PMI’s goal of halving the burden of malaria in 70% of at-risk populations in sub-Saharan Africa. This fits into the mission of the Mainland Tanzania NMCP for 2014–2020, which is to ensure that Tanzanians have access to quality, effective, safe, and affordable malaria interventions through timely and sustainable collaborative efforts with partners and stakeholders at all levels. The project will also continue to support the work of the Zanzibar Malaria Elimination Programme (ZAMEP) to achieve Malaria Elimination in Zanzibar by 2023.

IRS in Tanzania Mainland

In 2018/2019, under the PMI VectorLink Tanzania project, IRS was conducted in seven Mainland Tanzania districts, targeting 516,396 structures using 154,744 sachets of the clothianidin insecticide (SumiShield 50WG) from October 24 – November 23, 2018. A total of 501,584 structures were sprayed out of 525,222 structures found by spray operators (SOPs) in the targeted districts, accounting for a coverage rate of 95.5%.

IRS in Zanzibar

In 2018/2019, under the PMI VectorLink Tanzania project, IRS was conducted in ten districts of Zanzibar (Pemba and Unguja), targeting 88,355 structures using 27,193 bottles of pirimiphos-methyl, (Actellic 300CS) from February 23 – March 17, 2019. A total of 94,339 structures were sprayed out of 99,126 structures found by SOPs in the targeted districts, accounting for a coverage rate of 95.2%.

In its second year of implementation, the PMI VectorLink Project will conduct IRS in six districts in four Mainland regions: Bukombe District in Geita Region; Biharamulo District in Kagera Region; Kakonko, Kasulu Rural, and Kibondon districts in Kigoma Region; and Ukerewe District in Mwanza Region. The project will also spray in Unguja and Pemba in Zanzibar and will continue to provide capacity-building support to the national and district governments to plan and implement quality IRS in the future. 

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.

Insecticide-Treated Net (ITN) Activities

To help the NMCP to achieve the Supplementary Malaria Midterm Strategic Plan 2018-2020[1] strategic objective “to reduce transmission of malaria by maintaining effective vector control intervention packages recommended per strata,” PMI VectorLink Tanzania will support the integrated malaria vector control-specific objective to “ensure adequate access to ITNs of the population at risk according to transmission setting.”

For seven months from July to January 2020, PMI VectorLink Tanzania will support the planning, implementation, monitoring, and supervision of a partial round of SNP. PMI VectorLink will support the distribution of 1.2 million PBO ITNs through primary schools in four regions of the lake zone.

To support the achievement of the Zanzibar Malaria Elimination Program’s 2018-2023 Strategic Plan IV strategy to “increase appropriate vector control measures to the population at the risk of malaria to 100 percent by 2023”, PMI VectorLink Tanzania will support Smart Push of 288,000 PBO ITNs to health facilities on Unguja and Pemba to support continuous distribution (via Chandarua Kliniki) and community distribution.

[1] Ministry of Health, Community Development, Gender, Elderly, and Children, National Malaria Control Programme, September 2018. Supplementary Malaria Midterm Strategic Plan 2018-2020

Success stories from PMI VectorLink Tanzania:

PMI Pilots New WHO-Recommended Insecticide

Sierra Leone

According to Sierra Leone’s Malaria Indicator Survey (SLMIS) 2016, 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 piperonyl butoxide (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 is planning an ITN mass campaign for May 2020. All ITNs distributed will contain either the pyrethroid deltamethrin or permethrin plus the synergist PBO. This will be the first time in Sierra Leone that a nationwide mass distribution campaign of ITNs with the PBO synergist will be undertaken.

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.

 PMI VectorLink Sierra Leone has the following objectives for its third year of implementation:

Entomological Monitoring:

  • Maintain a functional insectary in Makeni with An. gambiae Kisumu strain available at all times
  • Continue measuring the susceptibility of the main malaria vector, An. gambiae s.l., in order of priority, to deltamethrin, permethrin, alpha-cypermethrin, clothianidin, chlorfenapyr and pirimiphos-methyl from Bo, Bombali, Kono, and Western Area Rural districts and start the monitoring in Port Loko district
  • Measure the intensity of resistance to pyrethroids and perform synergist assays, where appropriate
  • Subcontract with Centre Suisse de Recherches Scientifiques (CSRS) a regional laboratory based in Cote d’Ivoire to use polymerase chain reaction (PCR) to process mosquitoes samples to identify them to the species level, and use PCR/ Enzyme-linked immunosorbent assay (ELISA) to test sample mosquitoes for infectivity
  • Subcontract with CSRS to use PCR to identify the mechanism associated with the resistance observed (kdr and Ace-1 mutations)
  • Monitor the density, biting rate, behavior, and parity of malaria vectors in 10 sentinel sites

Insecticide-treated Nets:

  • Support the NMCP in conducting ITN durability monitoring covering the two types of ITNs to be distributed in 2020

Assessment of Co-deployment of PBO Nets and IRS

  • Support the NMCP in the collection of baseline data for the assessment of the co-deployment of IRS and PBO nets

Indoor Residual Spraying:

  • Conduct geographical reconnaissance for IRS to assess logistics and procurement needs and identify appropriate IRS operations sites and insecticide storage facilities in Bombali and Bo districts
  • Conduct a Supplemental Environment Assessment (SEA) to ensure the environmental compliance of IRS in 2021
  • Conduct the enumeration of the eligible structures in Bombali and Bo for the IRS campaign in 2021
  • Support the NMCP in conducting master training on IRS
  • Develop and start the implementation of a social and behavior change communication (SBCC) plan for IRS based on Sierra Leone context
  • Support the NMCP in organizing IRS planning meetings

National-level support:

  • Build the capacity of the NMCP and district health staff to use entomological data for decision making
  • Support the NMCP to hold quarterly meetings of the VCTWG and semi-annual meetings of the IVM National Steering Committee
  • Provide technical support to the NMCP and other stakeholders for data review prior to the selection of ITNs, IRS insecticides, and target IRS districts
  • Provide technical support to NMCP to finalize the insecticide selection for IRS

 

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 the 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 2020, the PMI VectorLink Senegal project will work with the local partners to spray 134,883 targeted structures in four districts using Fludora® Fusion and SumiShield® 50WG. The project’s goal is to reach a minimum coverage of 85 percent of the structures found in each district by implementing high-quality IRS operations.

In addition to spraying, the project will carry work towards the following objectives:

  • Build capacity at the national, regional, district, and local levels to manage IRS operations, including planning, spraying, resource allocation, and monitoring and evaluation (M&E).
  • Mainstream gender equality and female empowerment by ensuring women’s participation in different project activities.
  • Strengthen the IRS logistics and warehousing system through enhanced training and supervision.
  • 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).
  • Support the routine distribution of ITNs at the national level and Piperonyl Butoxide (PBO) ITNs distribution in the district of Tambacounda.

These objectives will be achieved by implementing the following activities:

  • Prepare an exit strategy for the end of the project in 2022 in collaboration with key stakeholders and other implementing partners working on malaria prevention and control.
  • 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.
  • Using findings from the Year Two logistics assessment in the spray districts, arrange all procurement, shipping, delivery, and storage of IRS commodities.
  • Coordinate community mobilization activities in collaboration with stakeholders to raise awareness of IRS and to encourage beneficiary and stakeholder ownership.
  • Collaborate with other implementing partners in the four districts to complement each other’s work and ensure no duplication of efforts.
  • Prepare a new 2020 – 2025 nationwide supplemental environmental assessment (SEA).
  • Conduct insecticide susceptibility and synergist tests nationwide and measure the resistance intensity, as required, for the main malaria vectors, Anopheles gambiael. and An. funestus s.l.
  • Monitor the density, species composition, behavior, blood meal sources, and Plasmodium sporozoite infection rates of malaria vectors in the selected districts.
  • Monitor the residual life of the sprayed insecticides using wall cone bioassays in the four IRS districts.
  • Distribute ITNs to each of the Medical Regions as needed.
  • Provide technical assistance to the central, regional, and district-level for the routine distribution of ITNs.
  • Conduct distribution of Piperonyl Butoxide (PBO) ITNs in 60 villages in the district of Tambacounda

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.

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.

Rwanda has 15 districts with high malaria burden. In 2019, the Government of Rwanda and its IRS partners (the Global Fund and PMI) were able to spray 12 out of these 15 districts. 

In its third year, the project will conduct IRS in three districts: Kirehe and Nyagatare (from August 24, 2020), and Ngoma (from January 18, 2021), and will provide capacity-building support to the national and district governments to help them plan and implement quality IRS in the future. Figure 1 below shows the IRS target districts for Year 3 and other vector control interventions in Rwanda’s districts. 

In addition to spraying, in Year 3 the project will carry out the following activities:

  • Build 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 AI (Interceptor G2), PBO (PermaNet 3.0), and standard (Yahe, Olyset) nets implemented by the Government of Rwanda.
  • Collaborate with districts on prioritizing implementation of activities in their IRS exit/sustainability plans, which the previous project helped to develop.
  • 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 participation in various project activities, such as spray operations, supervision, and pump maintenance.
  • Involve youth in spray activities in the target districts. The project will recruit youth as team leaders to train spray operators and supervise spray quality at the household level. The project will also recruit the head of the village and the in-charge of security to sensitize the community in their villages during spraying.
  • 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 and supervision.
  • Coordinate community mobilization activities in collaboration with stakeholders to raise awareness of IRS and to encourage beneficiary and stakeholder ownership.
  • Conduct insecticide resistance, wall bioassay, vector density monitoring, and behavioral studies.
  • Collaborate with other implementing partners—the government of Rwanda/Global Fund in the 12 districts—to complement each other’s work and ensure no duplication of efforts.
  • 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).
  • Conduct environmental compliance assessments (Environmental Audit and Environmental Social and Impact Assessment) in consultation with PMI and the National Environmental Management Authority.
  • Prepare a Letter Report at least two months prior to the spray campaign.

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

PMI has supported entomological monitoring in Nigeria since 2012. The PMI AIRS project conducted monitoring along with IRS implementation in Nasarawa in 2012 and 2013. In 2014, monitoring expanded to six sites (Enugu, Lagos, Nasarawa, Plateau, Rivers, and Sokoto). In 2016, Akwa Ibom, Bauchi, Ebonyi, and Oyo replaced Enugu, Lagos, Rivers, and Plateau, while monitoring continued in Nasarawa and Sokoto. Through AIRS and then VectorLink, entomological monitoring continued at these six sites in 2017 and 2018. In Year 2 of VectorLink Nigeria (October 2018-September 2019), longitudinal monitoring of vector bionomics continued in the six sites and began in a seventh site (Plateau). The project performed insecticide resistance monitoring in all seven PMI-supported sites, plus four new sites: Benue, Zamfara, Cross River, and Kebbi. In addition, the Global Fund has supported vector surveillance and insecticide resistance monitoring in Kano, Niger, and Osun since 2018, and added Kwara and Adamawa as insecticide resistance monitoring sites in 2019, with technical assistance from VectorLink entomologists.

VectorLink Nigeria’s recent entomological surveillance and insecticide resistance monitoring data has highlighted an urgent need to develop and implement appropriate resistance management strategies in areas with high-intensity resistance. In particular, the data collected helped guide PMI’s decision to procure and deploy piperonyl butoxide (PBO) nets in Ebonyi in 2019 to combat resistant malaria vectors with proven metabolic resistance mechanisms. In June 2019, VectorLink began collecting monthly longitudinal monitoring for vector bionomics and conducting annual insecticide susceptibility tests, in an additional three local government areas (LGAs) in Ebonyi to provide baseline data for evaluation of the impact of the PBO nets.

In its third year, the project will conduct longitudinal monitoring of vector bionomics in five sites (Akwa Ibom, Ebonyi, Oyo, Plateau, and Sokoto) and will monitor insecticide resistance in 11 total sites—the five aforementioned sites plus an additional six sites (Bauchi, Benue, Cross River, Kebbi, Nasarawa, and Zamfara). The project will also provide capacity-building support to the national and district governments to plan and implement quality entomological monitoring. In addition to monitoring entomological and epidemiological indicators in relation to the PBO net distribution in Ebonyi, VectorLink Nigeria proposes to collect entomological data to inform the monitoring of the PBO and Interceptor G2 net distribution that PMI will support in Oyo in 2020.

In 2019-2020, VectorLink Nigeria will work with the National Malaria Elimination Program (NMEP), the Nigerian Institute for Medical Research (NIMR), State Malaria Elimination Programs (SMEPs) and Principal Investigators to monitor vector bionomics (longitudinally), insecticide resistance, and the programmatic impact of the distribution of next-generation nets in Ebonyi and Oyo.

Field Activities

  • Conduct monthly longitudinal vector surveillance in five sentinel sites across the major ecological zones of Nigeria, to measure vector species composition, density, distribution, seasonality, and behavior, as well as sporozoite infection rate, parity, and blood meal sources.
  • Conduct insecticide resistance testing on Anopheles gambiael. in 11 sites. The following insecticides will be tested, in order of priority: permethrin (0.75%), deltamethrin (0.05%), alpha-cypermethrin (0.05%), chlorfenapyr (100 µg/ml), pirimiphos-methyl (0.25%), and clothianidin. Pyrethroid insecticides will also be tested with and without the synergist PBO.
  • Continue to collect data on entomological indicators from expansion sites in Ebonyi; set up sites in one LGA each in Oyo to monitor the impact of IG2 and PBO nets (that will be distributed in 2020) on entomological indicators.
  • Develop a program monitoring dashboard to assess the epidemiological and entomological impact of next-generation nets distributed in Ebonyi.

Insectary and Laboratory Activities

  • Manage the Nasarawa State University insectary and laboratory in Keffi in support of the project’s capacity building objectives, and provide support on the correct identification of samples from sentinel sites and testing of technical grade insecticides.
  • Collaborate with NIMR to conduct molecular analysis on mosquito samples.

National-Level Support

  • Support the NMEP in updating the National Insecticide Resistance Management plan.
  • Facilitate review of entomological monitoring data with stakeholders to inform and improve integrated decision-making on vector control; share entomological data and tools for collection and management.
  • Facilitate a refresher training on basic morphological identification skills and malaria entomological methods for entomology technicians based on results of skills assessment conducted during supervisory visits.
  • Transfer skills needed for data management and entomological monitoring at the sentinel sites through on-the-job training and coaching provided during supportive supervision visits.
  • Support NMEP in the development of an annual entomology report for vector control decision-making at the national level.

Success stories from PMI VectorLink Nigeria:

Building Capacity for Surveillance