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).

Plasmodium falciparum is the primary malaria parasite in Angola, responsible for an estimated 87% of malaria cases. The Angola National Malaria Control Program (NMCP) strategy includes three vector control methods: insecticide-treated nets (ITNs), indoor residual spraying (IRS), and larviciding for malaria prevention. The NMCP’s goal is to cover 80% of the population at risk of malaria with at least one vector control and prevention measure. Recent evidence indicated that 31% of households in Angola owned at least one ITN in 2016 (2015–16 Demographic and Health Survey). By comparison, in sub-Saharan Africa in 2016, 80% of households owned at least one ITN. The U.S. President’s Malaria Initiative (PMI) and the Global Fund have been key partners supporting procurement and distribution of ITNs. Widespread and long-term use of ITNs is expected to exert selective pressure on malaria vectors and may affect the vector bionomics, the vectors’ response to insecticides, or both. Angola took a major step in 2017 towards universal coverage of ITNs, planning a three-phase nationwide mass campaign in 2017–2018.

Through the Africa Indoor Residual Spraying Project (AIRS), PMI conducted longitudinal entomological surveillance activities in Angola from 2012 to 2016. Throughout this period, AIRS collected data on key entomological indicators—vector species composition, seasonality, behavior, and insecticide resistance status and sporozoite infection rate—from three provinces (Cunene, Huambo, and Malanje), in collaboration with the Direcçao Provincial de Saúde/Provincial Health Directorate.

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 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 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.

The PMI VectorLink Project continues to increase the breadth and depth of entomological monitoring in Angola and has an expanded scope to include other proven life-saving vector control interventions such as ITNs. The project is building entomological capacity at the country level, as well as strengthening existing institutional structures. The project will provide technical assistance, in planning and carrying out vector surveillance activities in three PMI-supported provinces and to Angola’s NMCP on vector surveillance and control.

 

https://www.pmi.gov/where-we-work/angola

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 PMI VectorLink’s second year of implementation, the project will conduct IRS in all nine districts of Zambia’s Eastern Province, including six new districts previously supported by PMI from 2014 -2017; three rural districts in Copperbelt in Copperbelt (Lufwanyama, Masaiti, and Mpongwe); and the rural and peri-urban communities of the seven urbanized districts of the Copperbelt (Chingola, Chilabombwe, Kitwe, Kalulushi, Luanshya, Ndola, and Mufulira). 

The total number of target structures for 2019 is 617,000—Nchelenge (38,000), Copperbelt Province (153,016), six new districts of Eastern Province (308,540), and three pre-elimination districts of Eastern (117,444).

Insecticide-Treated Net (ITN) Activities

PMI VectorLink integrated data analytics and visualization technical area will continue to review data to support vector control decision-making. New datasets to be added include ITN data from DHIS2, mSpray structure enumeration, and vector distribution from the Malaria Atlas Project. The project will revise the prototype vector control data dashboards which were developed in 2018 based on stakeholder feedback. The team will create views to examine routine ITN distribution and HMIS case data quality

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.

During its first year of implementation, the PMI VectorLink Project successfully conducted a two-phase IRS campaign in 15 districts in Uganda using Actellic 300CS (an organophosphate insecticide). The project sprayed in eight districts during the first phase of the campaign: Alebtong, Amolatar, Budaka, Butaleja, Butebo, Dokolo, Namutumba, and Pallisa, on April 9–May 12, 2018; and seven districts in phase two of the campaign: Bugiri, Kaberamaido, Kibuku, Lira, Serere, Otuke, and Tororo, on June 11–July 14, 2018. The project sprayed in the two sub-counties of Amach and Agali in Lira district on September 3–18, 2018. VectorLink Uganda sprayed a total of 1,292,309 structures out of 1,369,305 structures that the spray operators found in the 15 IRS target districts, protecting 4,436,156 people, including 892,390 (20.1%) children under 5 and 121,590 (2.7 %) pregnant women.

In the second year of implementation, VectorLink Uganda will conduct IRS in the same 15 target districts and provide capacity-building support to the national and district governments to plan and implement quality IRS in the future.

 

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

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.

In its first year of implementation, the PMI VectorLink project in Sierra Leone supported the NMCP by establishing a functional insectary in Makeni (Bombali District) and making a susceptible Kisumu strain of  Anopheles gambiae available in Sierra Leone for the first time. VectorLink also supported the monitoring of the 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 provided technical assistance for the development of the Insecticide Resistance Monitoring and Management Plan (IRMMP), which is currently under review. Based on the findings from the insecticide resistance monitoring, VectorLink Sierra Leone provided technical guidance to the NMCP. The information will help NMCP to select the most appropriate LLIN for the 2020 mass campaign. In its second year of implementation, the project will continue to provide technical and financial assistance to the NMCP to monitor malaria vector bionomics and insecticide resistance.

The PMI VectorLink Project will continue to support the NMCP to assess the susceptibility of An. gambiae s.l., and to conduct comprehensive vector bionomic monitoring in 12 sentinel sites in four districts. 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. In Year 1, VectorLink Sierra Leone implemented entomological monitoring activities that include collecting data on vector bionomics, insecticide resistance and establishing and maintenance of an insectary. In Year 2, VectorLink Sierra Leone will continue entomological monitoring activities in selected and representative sentinel sites and provide support to LLIN distribution.  

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 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.

In 2019, the PMI VectorLink Project’s second year of implementation, PMI is expanding support through PMI VectorLink in Senegal to include a school-based distribution pilot of long-lasting insecticide-treated nets (LLINs), an urban landscape analysis to identify a vector control strategy in select areas, capacity-building of entomology and parasitology laboratories, and IRS planning activities to prepare for the 2020 campaign.

ITN Continuous Distribution Assessment

The purpose of this assessment is to support a comprehensive qualitative assessment of continuous ITN distribution in Senegal to provide the NMCP, PMI and key ITN partners with information to reinforce strategically planned and executed continuous distribution of ITNs, informed by global best practice.

Specific objectives are to:

  • Provide information to the NMCP and PMI to better understand and strengthen planned and strategic ITN continuous distribution processes, based on best practices adapted to the context.
  • Understand and identify NMCP and PMI priorities to strengthen the security and control of ITN distribution at the central, regional, district, and health facility levels.
  • Identify and prioritize improvements to strengthen the maintenance of coverage through the continuous distribution of ITNs.

 

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 18 spray rounds, nine of which have been implemented by the PMI AIRS Project and one by VectorLink Rwanda. The most recent spray round (September 2018) was carried out in Kirehe and Nyagatare districts, over 20 days between September 10 and October 2, 2018, using the organophosphate insecticide Actellic 300CS. Of the 208,687 structures that spray operators found in the targeted districts, 208,026 were sprayed, a coverage rate of 99.7 percent. In total, 831,735 residents were protected, including 117,878 children under the age of five years (14.2 percent) and 12,131 pregnant women (1.5 percent). Annex A lists coverage and population protected statistics for 2007-2020.

In the 2019 spray round (which includes the early-2020 spraying in Ngoma), VectorLink Rwanda will work with the MOPDD and other stakeholders to achieve at least 85 percent spray coverage of the 298,018 targeted structures identified in 40 sectors in the three aforementioned districts, thus protecting 1,215,859 residents. The insecticide used will be Fludora Fusion. Additionally, VectorLink Rwanda will provide technical support to MOPDD spraying of the Mahama refugee camp in Kirehe. The camp, which currently hosts about 53,325 Burundian refugees, has 6,780 structures.

In addition to spraying, the project will:

  • In addition to spraying, the project will carry out the following activities:
    • Support training, capacity building, and advocacy at the national, regional, and district levels as a means of facilitating IRS sustainability. The project will work to increase the role of the district and the MOPDD in supervising IRS in 2019. This will include training on the use of a smartphone application for spray supervision.
    • Provide regular monitoring and evaluation (M&E) updates and supervision, including a daily Performance Monitoring Tracker.
    • Use supervisory data collection tools through an m-Health system for real-time feedback and decision making.
    • Roll out VectorLink Collect, the new database system for IRS and entomological data, which has been built on the District Health Information System 2 (DHIS2) platform.
    • 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.
    • 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 in the eight districts of Bugesera, Gisagara, Huye, Kayonza, Gatsibo, Ngoma, Nyanza, and Rwamagana, plus the Mahama refugee camp in Kirehe District. The MOPDD is planning to spray high burden malaria districts mentioned above during the period of January through April 2019. The VectorLink technical assistance will include training of spray teams, data management, inventory management, environmental compliance and supervision of spray operations in the aforementioned districts.

Insecticide-Treated Net (ITN) Activities

  • VectorLink Rwanda, will support the MOPDD to conduct ITN durability monitoring following the 2019 mass campaign distribution. The study will provide MOPDD, PMI, and stakeholders with updated evidence on ITN survivorship, physical durability, and insecticide effectiveness to inform procurement and programmatic decisions for future ITN campaigns and continuous distribution.

 

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.

In Year 3, PMI VectorLink 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 monitor the programmatic impact of the distribution of PBO and Interceptor G2 nets that PMI plans to deploy in Oyo.

Success stories from PMI VectorLink Nigeria:

Building Capacity for Surveillance