Category: country

Malaria is endemic in Niger and is the leading cause of death and morbidity combined, disproportionately affecting children under 5 years of age. According to the Annual Health Statistics Report (2020), there were more than 4,332,909 malaria cases and 6,098 malaria deaths in Niger in 2020, compared to 3,621,972 malaria cases and 3,761 malaria deaths in 2019 (according to the Annual Health Statistics Report 2019), representing an increase in cases of 20% over the previous year and an increase in deaths of 62% over the previous year, putting it among the countries with the highest per capita rate of malaria fatalities globally.

According to the Niger 2017-2023 National Strategic Plan, the vast majority of Niger’s population (94%) resides in the two southernmost (moderate and high transmission) zones, where malaria is most prevalent. The rainy season in Niger lasts three to four months, from June to September, with peak malaria transmission during the second half (August and September) of this period. With the new malaria epidemiological stratification, there are four endemicity strata in Niger (very low transmission, low transmission, moderate transmission, and very high transmission).

Despite the enormous progress Niger has made in recent years in the fight against malaria, the disease remains a real public health problem in the country. The situation is worrying – the 2021 world malaria report of the World Health Organization (WHO) ranks Niger among the eight African countries which together account for about 60% of cases and deaths due to malaria. The WHO recommends universal population coverage with ITNs as a prevention strategy in malaria control programs. Since 2009, with the support of partners, Niger has been carrying out ITN mass distribution campaigns in addition to delivering ITNs through the continuous distribution (CD) channels of routine antenatal care for pregnant women and the Expanded Program on Immunization for children under 1 year of age. Nevertheless, according to the 2019 world malaria report, the ITN coverage rate has increased very little since 2015, which leaves the country far from its universal coverage goal.

From July 2018 to March 2021 (project years 1–3) the PMI VectorLink Niger Project supported entomological monitoring activities including insecticide susceptibility and vector surveillance in a total of 17 sentinel sites (ranging from nine to 15 in any given year) distributed across the country.

In 2019, with support from the PMI VectorLink Project, the national ITN CD guidance was developed and shared with the health district managers and health facility chiefs in order to clarify when ITNs should be distributed. In 2020, more than 8.5 million Olyset ITNs have been distributed through mass campaigns in 44 health districts in moderate and high-transmission districts (759 health facilities and 2,525 distribution sites).

From June to December 2021, vector surveillance activities collected 19,127 Anopheles species using human landing catch (HLC), pyrethrum spray catch (PSC), and U.S. Centers for Disease Control and Prevention (CDC) light trap (LT) methods. In 2021, the susceptibility status of the main malaria vectors, An. gambiae s.l. (in 15 sites) and An. funestus s.l. (in Guidimouni) was determined for pyrethroid insecticides (alpha-cypermethrin, deltamethrin, and permethrin), organophosphates (pirimiphos-methyl), pyrroles (chlorfenapyr), and neonicotinoids (clothianidin).     Furthermore, resistance intensity and piperonyl butoxide (PBO) synergism was conducted when resistance was confirmed to all pyrethroids tested.

In year five (April 2022 – March 2023), the PMI VectorLink Niger Project is continuing to work with the NMCP and CERMES to conduct entomological monitoring and implement ITN-related activities. The project is providing entomological monitoring technical support to the NMCP, with the primary objective of providing the program with data for vector control decision making. Additionally, the project has subcontracted with CERMES for all laboratory activities for mosquito sample analysis. The field teams are made up of trained entomological technicians from NMCP and CERMES. In the first year that CERMES is responsible for all field activities, to better ensure that all protocols are followed, and collection forms are properly completed, the VectorLink Niger Chief of Party (COP/Entomologist) and the NMCP entomologist will each carry out two formative supervision trips for bionomics and two for resistance monitoring. In addition, a social networking platform has been created for all field staff to ensure real-time data. The entomological monitoring approach was agreed upon with PMI, the NMCP, and CERMES and includes annual insecticide resistance monitoring in 15 sites and monthly vector bionomics surveillance (for up to seven consecutive months) in six sites, as in 2020 and 2021. The project is continuing to provide technical support for CD of ITNs to enhance integrated vector control programming in Niger.

The project’s key objectives for each component are as follows:

Entomological monitoring:

• Determine the susceptibility of the primary malaria vector, gambiae s.l., to insecticides in 15 sentinel sites selected by the NMCP, which are spread across the four transmission zones;
• Measure the intensity of resistance to insecticides and determine the mechanism of resistance in the sites where resistance is detected;
• Monitor the density, species composition, behavior, and infectivity of malaria vectors in the six sentinel sites;
• Ensure the use of the District Health Information System 2 (DHIS2)-based VectorLink Collect database for improved entomological data monitoring, reporting, and decision making by relevant stakeholders, and
• Conduct ITN cone bioassays in accordance with WHO recommendations using wild collected gambiae s.l. from two localities selected by the NMCP, with ITNs procured by PMI for routine distribution.

National entomological monitoring capacity-strengthening activities:

• Conduct monthly meetings with CERMES staff and technicians and the NMCP Entomology Unit technicians to monitor progress toward objectives, follow up on activities, and identify/resolve challenges;
• Provide technical support to the CERMES in insectary management and report-writing with NMCP supervision;
• Conduct a refresher training in entomological collection methods;
• Support an advanced laboratory training for experienced entomologists at CERMES provided by the University of Notre Dame to ensure total capacity building on all PCR and ELISA techniques as well as the interpretation of PCR results as requested by CERMES;
• Support successful access and use of the DHIS2-based VectorLink Collect database by relevant users including CERMES, and the NMCP;
• Continue to offer data quality control and data interpretation support to build NCMP capacity to make evidence-based vector control decisions;
• Train two field technicians from the Districts of Keita and Balleyara on basic entomological techniques (building district level capacity in addition to the two agents trained in Gaya and Agadez in 2021); and
• Support the organization of two meetings of the vector control working group, to review country national data for decision making.

National capacity building for ITN distribution:

• Coordinate with the NMCP and PMI Impact Malaria project to organize and carry out an integrated bi-annual supportive supervision including ITN Continuous Distribution follow-up in the two PMI focus regions (Dosso and Tahoua);
• Support the presentation of results from ITN durability monitoring activities held over the three years following the 2018 mass campaign, with the final product being a peer-reviewed publication;
• Support radio dissemination of key messages in local languages about prenatal care and child health services in the two targeted regions;
• Provide financial support for a 3-day information visit by high level MOH persons (members of the organizing committee of the 2022 ITN mass distribution campaign) to inform the local authorities on the organization of the campaign (in a context of insecurity). The visit will be conducted  in the form of a workshop in Dosso and Tahoua bringing together all the 13 prefects of the districts concerned by the 2022 campaign; and
• Provide technical assistance during the ITN 2022 mass distribution campaign if requested by NMCP and CRS.          

 

Malaria is considered the most important public health problem in Mozambique where it accounts for nearly one-third of all deaths and 42 percent of deaths in children less than five years old. Although malaria prevalence has decreased in all provinces, the country continues to face challenges that have slowed the progress of key malaria prevention and treatment interventions. PMI-supported activities include support for the national indoor residual spraying (IRS) program; free routine insecticide-treated Bed Net (ITN) distributions to pregnant women and to children; procurement and distribution of rapid diagnostic tests to all levels of the health system; provision of intermittent preventive treatment of pregnant women; and revitalization of the community health worker program.

IRS continues to be a critical component of Mozambique’s National Malaria Control Strategy launched in December 2017 for 2017–through 2022. Through the support of PMI, Mozambique has implemented 14 rounds of IRS since 2007; these include six rounds under the AIRS Project (2011–2017) and three rounds under the PMI VectorLink project (2018–2019).

In year two (March 2019 – February 2020), Mozambique did IRS in five provinces: in Maputo, Gaza, and Inhambane provinces, implemented by Tchau Tchau Malaria and funded through a public-private partnership, MOSASWA; in Nampula province, implemented by the NMCP and funded by the Government of Mozambique; and in Zambezia province, implemented by VectorLink Mozambique and funded by PMI/ USAID. The Global Fund provided support to the Ministry of Health (MOH) to procure insecticide for all five provinces. PMI VectorLink Mozambique conducted IRS in five districts in Zambezia province, using both SumiShield^® 50WG and Fludora^® Fusion, from October 28 to December 14, 2019. The original target was 331,360 structures; in the end, 338,330 structures were sprayed out of 350,172 structures found by spray operators (SOPs), accounting for an IRS coverage rate of 96.6%.

In year three (March 2020 – February 2021), Mozambique implemented IRS activities in five provinces: in Maputo, Gaza, and Inhambane provinces, implemented by Tchau Tchau Malaria and funded through a public-private partnership, Mozambique, South African and Swaziland Initiative; in Nampula province, implemented by the NMCP and funded by the Government of Mozambique; and in Zambezia province, implemented by VectorLink Mozambique and funded by PMI/ USAID. The Global Fund provided support to the Ministry of Health (MOH) to procure insecticide for all five provinces. PMI VectorLink Mozambique conducted IRS in five districts in Zambezia province, using both SumiShield® 50WG and Fludora® Fusion, from October 28 to December November 30, 2020. The target was 350,172 structures; in the end, 361,820 structures were sprayed out of 373,094 structures found by spray operators (SOPs), for an IRS coverage rate of 97%.

In year four (March 2021 – February 2022), Mozambique implemented IRS activities in five provinces. In Maputo, Gaza, and Inhambane provinces, IRS was implemented by Tchau Tchau Malaria and funded through a public-private partnership, the Mozambique, South African and Swaziland Initiative. In Nampula Province, IRS was implemented by the NMCP and funded by the Government of Mozambique. In Zambezia Province, IRS was implemented by VectorLink Mozambique and funded by PMI/ USAID (Figure 1). The Global Fund provided support to the Ministry of Health (MOH) to procure insecticide for all five provinces. PMI VectorLink Mozambique conducted IRS in four districts in Zambezia Province, using Actellic 300CS (pirimiphos-methyl) in Milange, Molumbo, and Morrumbala districts from November 8 to December 11 and Ficam (Bendiocarb) in Mopeia District from November 22 to December 23. The target was 304,238 structures, in the end, 309,547 structures were sprayed out of 319,732 structures found by spray operators, for an IRS coverage rate of 96.8%.

In Year five (March 2022 – February 2023), VectorLink Mozambique will continue to work with the NMCP, the Zambezia Provincial Directorate of Health (PDH) and Provincial Health Services (SPS), the District Services for Health, Women and Social Welfare (SDSMAS) in each of the two  target districts, the Ministry of Agriculture and Rural Development (MADER) and Ministry of Land and Environment (MITA) to spray 140,939  targeted structures using clothianidin /deltamethrin combination (Fludora Fusion) and bendiocarb 80WP-SB (Ficam). The project’s primary objective is to reach a minimum coverage of 85% of the structures found in each district by implementing high-quality IRS operations.

In addition to spraying, the VectorLink Mozambique will conduct the following activities:

• Support national and provincial governments in entomological monitoring in Cabo Delgado, Manica, Niassa, Sofala, Tete and Nampula and IRS capacity building in Nampula.
• Carry out a logistics assessment in all districts, and manage all international and local procurement, shipping, customs clearance, timely delivery, and storage of sprayer, spare parts and personal protective equipment (PPE).
• Ensure safe and correct insecticide application, thus minimizing human and environmental exposure to IRS insecticides.
• Continue to lead community mobilization, education, and communication (IEC) and social behavior change communication (SBCC) sensitization and mobilization activities to increase community awareness and acceptance of IRS.
• Conduct routine entomological monitoring in all PMI VectorLink supported spray sites.
• Complete the set-up of a replacement insectary in Zambezia.
• Continue with capacity strengthening of the PDH and SPS through weekly meetings to discuss all stages of IRS preparation and/implementation to equip them with capacity for the G2G implementation.
• Provide logistical support for training of trainers in Nampula Province.

Success stories from PMI VectorLink Mozambique:

A Community Heroine’s Sacrifice to Fight Malaria

*The PMI VectorLink Mali project closed out on March 31, 2023.

Malaria is the primary cause of morbidity and mortality in Mali, particularly among children under the age of five. The country’s entire population is at risk for malaria, although transmission varies by region. Mali’s malaria control strategy emphasizes universal coverage of key malaria interventions as well as targeted operational research, and specific epidemic and entomological surveillance.

PMI VectorLink Mali, in partnership with the National Malaria Control Program (NMCP), conducted indoor residual spraying (IRS) in four districts in Mopti Region (Bandiagara, Bankass, Djenné, and Mopti) in its first year (2018) to reduce the prevalence of malaria and further reduce malaria-associated morbidity and mortality. From 2019 to 2022, PMI VectorLink continued to implement IRS in three target districts in the region (Bandiagara, Djenné, and Mopti).

The project’s final IRS campaign took place in 2022 in 19 geographically contiguous health areas across the three districts. VectorLink Mali targeted a total of 66,214 structures, spraying Actellic 300CS in Bandiagara, Fludora Fusion WP-SB in Djenné, and SumiShield 50WG in Mopti. From May 30 to July 6, 2022, the project sprayed a total of 72,106 structures out of 73,586 structures found by spray operators in the targeted areas, for a coverage rate of 98%. Through these IRS efforts, PMI VectorLink protected 273,831 Malians against malaria.

Over the course of the project, PMI VectorLink Mali progressively strengthened the NMCP’s capacity to plan, implement, and supervise spray campaigns, as well as use data in decision-making, and collaborated with the NMCP to conduct high-quality entomological monitoring tracking the effectiveness of IRS and the growing resistance of mosquitoes to certain insecticides—to help guide the country’s decision making in vector control strategies. VectorLink also supported the development of a community-led surveillance approach to further strengthen mosquito monitoring efforts.   

PMI VectorLink Mali’s conclusion comes at a time when the Malian government is prioritizing the deployment of new-generation insecticide-treated bed nets as the main malaria vector control intervention over IRS. Mali is recognized as a leader in bed net coverage in Africa, with a nearly 200% increase in the number of pregnant women and young children sleeping under a mosquito net since PMI began partnering with the government in 2007.

Success Stories:

PMI VectorLink Mali’s Collaboration with Local Leaders in IRS Ensures Communities in Bandiagara, Djenne and Mopti Districts are Protected from Malaria

Despite progress, malaria continues to be a major public health problem in Malawi. The disease accounts for 33 percent of hospitalizations in children under five, 34 percent of all outpatient visits, and is one of the major causes of morbidity and mortality across all age groups. Transmission is perennial in most areas and peaks during the rainy season from November to April. With support from PMI and other partners, the Ministry of Health’s National Malaria Control Program has been able to scale up the distribution of ACTs, IPTp using SP, and ITNs. Progress to date is promising; between 2006 and 2015, the mortality rate for children under five years of age decreased to an estimated 64 deaths per 1,000 live births.

Through PMI support, VectorLink Malawi has conducted four rounds of IRS (in 2018, 2019, 2020, and 2021) in Nkhotakota District. Prior to 2018, IRS had not been carried out in Nkhotakota since 2012 due to lack of funding. In 2019, the NMCP, in collaboration with World Vision International (WVI) and with the financial support of the Global Fund, conducted IRS in Mangochi District using the organophosphate Actellic 300 Capsule Suspension (CS). In 2020, the NMCP and WVI extended IRS to Balaka and Nkhata Bay districts, bringing the number of IRS districts supported by the Global Fund to three. In 2021, the NMCP and WVI continued to conduct IRS in all the Global Fund supported-IRS districts using SumiShield 50 Water Dispersible Granule (WG) in Nkhata Bay and Fludora Fusion in Mangochi and Balaka districts.

In year five (April 2022 – March 2023), the PMI VectorLink Malawi Project will work with the NMCP, the Nkhotakota District health management team, and other stakeholders to spray 129,410 targeted structures in Nkhotakota District using Actellic 300CS in eight operations sites, and Fludora Fusion and SumiShield 50WG that remain from 2021 IRS campaign in one operations site. The project’s primary objective is to reach a minimum coverage of 85% of the eligible structures found in Nkhotakota District by implementing high-quality IRS operations. The project will also provide technical assistance, training support, and supervision to the Global Fund-supported IRS campaign in Mangochi, Balaka, and Nkhata Bay districts, which will be sprayed mainly with Actellic 300CS and the few sachets of SumiShield and Fludora Fusion that remain from the 2021 spray campaign.

Additionally, the project will carry out the following activities:

• Continue strengthening the capacity of the NMCP and district health teams in planning, implementation, and supervision of IRS activities.
• Provide technical assistance during the planning and implementation of spray operations implemented by the NMCP and WVI with Global Fund support.
• Work with the NMCP, Environmental Affairs Department (EAD), and District Environmental Sub-Committee (DESC) to ensure environmental compliance through inspections before, during, and after spraying.
• Carry out logistics assessments and arrange all procurement, shipping, delivery, and storage of all IRS equipment.
• Work with the NMCP and other local partners to coordinate information, education and communication (IEC), sensitization, and mobilization activities to raise awareness, encourage acceptance of IRS, and mitigate risk of refusals due to fear/misconceptions of insecticide use and expressed preference for ITNs.
• Provide regular monitoring and evaluation (M&E) for the IRS program.
• Integrate gender equality and women’s empowerment into IRS planning and implementation aligned with USAID’s Gender Equality and Women’s Empowerment Policy and VectorLink’s Gender Strategy
• Prepare a landscape analysis of population groups that are unreached by vector control activities and why they are not reached.
• Provide financial and technical support to the Malaria Alert Centre (MAC) of the Kamuzu University of Health Sciences for entomological monitoring.
• Strengthen the national Vector Control Technical Working Group (VCTWG) to ensure it meets quarterly and adequately advises the NMCP on issues related to malaria vector control.
• Assist the NMCP in conducting a NetCALC exercise to identify the most effective and efficient options for continuous distribution to achieve and maintain universal ITN coverage. The exercise will conclude with dissemination of results to key stakeholders.
• Continue working with NMCP to conduct and complete the ITNs and IRS impact evaluations.

PMI VectorLink in Malawi

PMI VectorLink Malaria Fighter: Jules Nahimana

Holding Hope in IRS

Women Lead the Way in Malawi

Partnering Up for Progress

 

Malaria remains a major health problem in Madagascar, particularly for children and pregnant women. Severe malaria is among the top five causes of reported overall mortality.

The cyclone season, extending from December to April, often results in flooding and increased risk of communicable diseases and malaria, compounded by the loss of Insecticide-treated Bed Nets (ITNs). The national strategy has organized the country into three geographic zones based on the local epidemiology and level of coverage of malaria interventions: control, consolidation, and pre-elimination zones.

In 2019, under the PMI VectorLink Madagascar project, Indoor Residual Spraying (IRS) was conducted in five districts, targeting 265,033 structures using organophosphate (Actellic CS 300), neonicotinoid (SumiShield® 50 WG), clothianidin & deltamethrin combination (Fludora Fusion) from November 4  to November 30, 2019. A total of 267,874 structures were sprayed out of 279,746 structures found by spray operators in the targeted districts, accounting for a coverage rate of 95.8 %.

In 2020, IRS was conducted in five districts, targeting 201,013 structures using organophosphate (Actellic CS 300), neonicotinoid (SumiShield® 50 WG), clothianidin & deltamethrin combination (Fludora Fusion) from November 2 to December 3, 2020. A total of 197,787 structures were sprayed out of 203,028 structures found by spray operators in the targeted districts, accounting for a coverage rate of 97.4%. 

In 2021, under the PMI VectorLink Madagascar project, IRS was conducted in five districts, targeting 202,820 structures using organophosphate (Actellic® CS 300), neonicotinoid (Sumishield 50 WG), clothianidin & deltamethrin combination (Fludora® Fusion) from November 2 to December 3, 2021. A total of 213,922 structures were sprayed out of 217,289 structures found by spray operators (SOPs) in the targeted districts, accounting for an IRS coverage rate of 98.5%.

In year five (April 2022 – March 2023), the PMI VectorLink Madagascar project will work with stakeholders including NMCP, regions and districts, to spray 182,210 targeted structures in five districts using Klypson, Actellic 300CS, and Fludora Fusion. The project’s primary objective is to reach a minimum spray coverage of 85 percent of the eligible structures found in each district by implementing high-quality IRS operations.

In addition to IRS, in year five, the project, after consultation with PMI and NMCP, will carry out the following activities:

• Conduct geographical reconnaissance in the three new districts of Ivohibe, Fort Dauphin and Isandra to assess the feasibility of IRS in those districts and determine the population and the number of structures for insecticide forecasting.
• Build capacity of NMCP at the national, regional, district, and local levels to manage IRS operations, including planning, spraying, resource allocation, supervision, and monitoring and evaluation (M&E).
• Collaborate with health districts on prioritizing implementation of activities in their IRS exit/sustainability plans, which the project helped develop.
• Conduct cascade training with a focus on IRS supervision and spray techniques to improve the overall quality of spraying.
• Carry out a logistics assessment in all districts, and arrange all procurement, shipping, delivery, and storage of IRS commodities, and 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, species identification of gambiae s.l. and An. funestus s.l. groups in country and/or at sentinel sites using a portable molecular laboratory platform and monitor the residual life of the sprayed insecticides using wall cone bioassays in the IRS districts.
• Build/expand molecular laboratory and insectary capacity at NMCP and district level sites to ensure species ID, insecticide resistance marker PCR and sporozoite detection for Plasmodium falciparum and vivax can be conducted with rapid turnaround for consideration in vector control decision making.
• Conduct an urban landscaping to identify and coordinate with existing urban vector (Aedes ) surveillance programs (for Aedes spp.) that can be leveraged for An. stephensi larval surveillance.
• Conduct larval surveillance in urban locations with high likelihood of introduction.
• Collaborate with existing PMI partners such as Access, IMPACT and PSI project in IRS districts (Ihosy, Ivohibe, Iakora, Isandra and Fort Dauphin) to complement each other’s work and avoid duplication of efforts more precisely in awareness raising and social mobilization.
• Implement community-based entomology programs in three districts to decentralize entomological surveillance efforts and build local malaria vector surveillance capacity.
• Conduct environmental compliance assessments (Environmental Audit and Environmental Social and Impact Assessment) in consultation with PMI and the National Environmental Management Authority.
• Gather medical entomology researchers from NMCP, universities and research institutes for a symposium on ongoing entomological surveillance methods and projects in Madagascar to ensure that there is no duplication of research efforts and ultimately to develop partnerships and collaborations and strengthen the national capacity for medical entomology in country.
• Conduct larviciding with acceptability/cost analysis and vector surveillance of rice fields in two districts (Morombe and Ankazobe) where there is known transmission of malaria, positive and narrower breeding sites, accessibility, availability of rainfall/ epidemiological data, baseline epidemiological data, and non-implementation of IRS.
• Implement streamlined durability monitoring in three districts following the mass campaign in July-August 2021.
• Conduct an epidemiological analysis for VectorLink Madagascar in 2022.
• Implement mobile data collection in two IRS districts (Ihosy and Isandra).

PMI supported IRS through AIRS in Liberia from 2009 to 2013, but due to widespread pyrethroid resistance and increased costs of new insecticides, the decision was made to suspend support for indoor residual spraying (IRS) in Liberia. Since that time, PMI has increased support for entomological surveillance, including vector bionomics and insecticide resistance monitoring, and concentrated on improving universal insecticide-treated net (ITN) coverage.

In Liberia, the PMI VectorLink Project works closely with the Ministry of Health (MOH), National Malaria Control Program (NMCP), and health research institutions for vector monitoring and insecticide resistance surveillance. From 2015 to present, relevant data was collected in different counties in Liberia which were used to guide decision-making on malaria preventive interventions. In 2019, Liberia Ministry of Health approved the use of registered Interceptor® G2 (IG2) nets for the mass net distribution in 2021. The decision was made based on the field data collected by PMI VectorLink and NMCP on malaria mosquito resistance status to pyrethroids and susceptibility to chlorfenapyr in various counties. In June – August 2021, the IG2 net was distributed throughout Liberia during a mass campaign despite logistic and road conditions challenges.

In year one (2017–2018), vector bionomics monitoring was conducted in three sites – Frank Town (Montserrado County), a peri-urban area; Tomato Camp (Bong County), a rural highland area; and Jeneta (Margibi County), a rural zone. In year two (2018–2019), these three sites were replaced with four new sites, which were selected in collaboration with NMCP, and included Medina (Grand Cape Mount County), Fissebu (Lofa County), Koryah (Bong County) and Saint John (Grand Bassa County). In year three (2019–2020), the number of sites was increased to eight, including Medina (Grand Cape Mount County), Fissebu (Lofa County), Koryah (Bong County), Saint John (Grand Bassa County), Zeanzue (Bong County), Gbedin (Nimba County), Suehn (Bomi County), Jackson Farm (Margibi County). Collections were suspended in March 2020 due the COVID-19 pandemic and resumed in August 2020. In year four (2020-2021), the team was able to perform field collections in the eight sites listed above without any interruption. Gbedin (Nimba County) and Suehn Town (Bomi County) had high vector densities of An. gambiae s.l., whereas An. funestus s.l. was more predominant in Zeanzue, Koryah and Fessibu.

In year five (October 2021 – September 2022), PMI VectorLink Liberia, in collaboration with NMCP/MOH, Liberian Institute of Biomedical Research (LIBR), University of Liberia (UL), as well as county and district staff, implemented routine monthly vector bionomics monitoring, and insecticide resistance surveillance in Liberia. The project’s primary objective was to generate data on malaria vector bionomics and insecticide resistance that can be used by the NMCP to make evidence-based strategies on malaria vector control interventions in Liberia.

Insectary and Laboratory Activities

• Managed the established insectary, maintained the mosquito colony, and ensured that all activities in the insectary followed standard protocols.
• Built the NPHIL/LIBR staff capacity in laboratory analyses of mosquito samples through virtual training and mentoring.
• Enabled in-country molecular analyses of entomological samples at LIBR to include analyses for mosquito species identification, Plasmodium falciparum sporozoite rate.

Field Activities

• Conducted insecticide susceptibility monitoring in ten sites across eight counties, prioritizing those insecticides that are used to treat ITNs. This included pyrethroids (deltamethrin, permethrin, alpha-cypermethrin) with and without pre-exposure to the synergist piperonyl butoxide (PBO) and chlorfenapyr.
• Conducted monthly vector bionomics monitoring in eight routine sites. These sites were selected to monitor the spatial and temporal distributions and densities of Anopheles vector species and characterize their biting and resting behavior.
• Provided practical training to local staff in routine entomological monitoring sites in the field and at the insectary.

ITN Activities

• Conducted Interceptor® G2 ITN streamlined durability monitoring.
• Continued with the post-distribution data collection for the entomological and epidemiological monitoring of Interceptor® G2 ITNs, including collection of entomological and insecticide resistance data in four sites.

National-Level Support

• Trained and supervised the NMCP technicians and UL staff in entomological techniques and provide on-the-job training and coaching of these staff at sentinel sites.
• Supported development of NMCP, UL, LIBR and county staff skills on data management and analysis, managing the insectaries and entomological monitoring.
• Supported the ITN streamlined durability monitoring activities planning and implementation in coordination with NMCP.

Success stories from PMI VectorLink Liberia

Forging Partnerships for Progress in Malaria Prevention

In Ghana, IRS is a core vector control intervention and a component of the current National Malaria Control Strategy and Ghana Strategic Plan for Malaria Control 2014-2020. PMI support for IRS started in 2008. In the ensuing 12 years, PMI has targeted between five and nine districts in the Northern region (recently divided into three regions: Northern, North East, and Savannah) per year, with the highest number of structures sprayed (383,142 structures) and population protected (941,240 people) in 2012. AngloGold Ashanti Malaria Control Ltd (AGAMal) has been conducting IRS since 2006 in the Obuasi district of the Ashanti region with its own funds. Since 2008, AGAMal has received financial support from the Global Fund to expand its IRS activities to the entire Upper West and three districts in the Upper East regions.

In the last five years of IRS implementation, PMI has targeted between five and nine districts in the Northern region (which, in 2019, was divided into three regions: Northern, North East, and Savannah) per year, with the largest population protected (965,467 people) in 2020. Another large IRS implementer, AngloGold Ashanti Malaria Control Ltd (AGAMal), has been conducting IRS since 2006 in Obuasi district of Ashanti region with its own funds. Since 2008, AGAMal has received financial support from the Global Fund to expand its IRS activities to the entire Upper West and three districts in Upper East regions.

In 2021, the PMI VectorLink Project in Ghana conducted IRS in nine districts between March 23 and May 4, using Fludora Fusion (a mixture of clothianidin and deltamethrin) and SumiShield (clothianidin) insecticides. It targeted 366,283 structures and sprayed a total of 329,838 structures out of 364,469 structures that spray operators (SOPs) found in the targeted districts, for a coverage rate of 90.5%. The project also sprayed 4,925 eligible animal shelters in five districts based on data on mosquito resting and feeding behaviors collected in previous years to improve vector control.

In year five (January 2022 – December 2022), the project conducted IRS in nine districts: Bunkpurugu-Nakpanduri (BND), East Mamprusi (EMD), Gushegu (GUD), Karaga (KAD), Kumbungu (KUD), Mamprugu Moagduri (MMD), Tatale-Sanguli (TSD), West Mamprusi (WMD), and Yunyoo-Nasuan (YND), from from March 2 through April 12, 2022, and will provide capacity-building support to the national and district governments to plan and implement quality IRS in the future. In addition to IRS, the project will conduct entomological monitoring and ITN activities.

For IRS, VectorLink Ghana will work with the NMCP, GHS Regional and District Health Directorates, District Assemblies, and community and religious leaders to spray 364,469 targeted structures in nine districts using SumiShield (in EMD, GUD, KUD, and TSD), and Fludora Fusion (in BND, KAD, MMD, WMD, and YND). The project’s primary objective is to reach a minimum coverage of 85% of the structures found in each district by implementing high-quality IRS operations (and at least 90% of eligible structures per the NMCP target).

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

• Continue mobile data collection for IRS in all IRS districts following its success in 2021 campaign and for all entomological data field collections and species identifications following a successful pilot.
• Continue the use of VectorLink Collect in Ghana to manage IRS and entomology data.
• Conduct monthly vector bionomics monitoring in 12 sentinel sites nationwide including six in PMI-supported IRS districts (two of which are national surveillance sites), two in non-sprayed sites, and four national surveillance sites outside the PMI IRS area.
• Monitor insecticide resistance in 13 sites (11 IRS, 2 non-sprayed) and residual efficacy of two insecticide formulations that will be sprayed in 2022.
• Continue supporting NIRMOP to collect annual insecticide resistance data at 15 sentinel sites.
• Provide technical support for strategic decision making and deployment of interventions for malaria control to the Malaria Vector Control Oversight Committee (MaVCOC).
• Continue skill transfer to the GHS at all levels on vector control to ensure proper monitoring, implementation, and sustainability of IRS and to the NHRC to take up and manage four national entomology surveillance sites.
• Support NMCP with school-based ITN distribution.
• Contribute to implementation of ISS and OTSS, and data analysis of ITN routine distribution through health facilities.
• Expand the SBC activity to widen the use of ITNs into the entire Eastern region (10 more districts).
• Support other partners to complete the large-scale pilot of integrating continuous ITN distribution into the GHS national supply and distribution chain in Eastern, Oti, and Volta regions.

VectorLink Ghana Fact Sheet 2022

Click here to see how PMI VectorLink Ghana recycles and repurposes materials from their indoor residual spraying campaign. 

Success stories:

Community Leaders Help to End Malaria

PMI VectorLink Ghana Celebrates a Decline in Malaria Cases this World Malaria Day

Record Reductions in Malaria Cases in IRS Districts

Malaria Fighter: Peace Dellor

Tweets:

USAID/PMI 🇬🇭 saw indoor residual spraying (IRS) in action. They visited PMI VectorLink Ghana in Tamale for an overview of the project’s #entomology work before observing the IRS campaign in the field. All part of the work to #endmalaria. @PMIgov @USAIDGH pic.twitter.com/OY0gG6BExU

— PMI VectorLink Project (@PMIVectorLink) March 29, 2022

Though malaria prevalence in Ethiopia is relatively low compared to other African nations, nearly 70 percent of the population lives in areas at risk of malaria. Prompt access to quality malaria case management, including laboratory-based diagnosis in remote rural areas, has improved dramatically over the last decade as have surveillance systems that capture malaria cases and deaths.

Since 2005, the Ethiopia Federal Ministry of Health (FMOH) IRS program, funded by the government and Global Fund, has protected between 9 and 17 million people annually from malaria. In 2018, the FMOH IRS program sprayed approximately 2.9 million structures across non-PMI target districts achieving 88% coverage of the target, and protecting more than 9.1 million people from malaria. The US Government has been supporting the FMOH to conduct IRS in Ethiopia since 2008. The 2018 and 2019 campaigns each targeted 44 districts, 20 in Benishangul-Gumuz, 14 in Gambela, and 10 in Oromia. In 2019, under the PMI VectorLink Ethiopia project, IRS was conducted in 44 districts, originally targeting 542,148 structures using Actellic 300CS from to May 20 to July 22, 2019. The target was reduced to 509,594 structures due to security issues that prohibited spray teams from reaching certain areas. A total of 487,746 structures were sprayed out of 510,449 structures found by spray operators in the targeted districts, accounting for a coverage rate of 95.5%.

Table 1 provides an overview of the number of sprayed structures and population protected from 2016 to 2019 including targets for 2020 by the PMI IRS program.

Table 1: Number Of Districts, Structures Sprayed, And Population Protected, 2016–2020

Year	Number of Districts	Structures Sprayed	Population Protected	Insecticide
2018	44 (20 in Benishangul-Gumuz,14 in Gambela,10 in Oromia)	472,569	1,264,189	Pirimiphos-methyl CS
2019	44 (20 in Benishangul-Gumuz,14 in Gambela,10 in Oromia)	487,746	1,334,868	Pirimiphos-methyl CS
2020	44 (20 in Benishangul-Gumuz,14 in Gambela,10 in Oromia)	527,375	1,511,728	Pirimiphos-methyl CS, (with SumiShield and Fludora Fusion piloted in one kebele each)
2021	37 (6 in Amhara, 10 in Benishangul-Gumuz, 14 in Gambela, 7 in Oromia)	604,921	1,618,765	Pirimiphos-methyl CS, clothianidin and clothianidin/ deltamethrin
2022  (target)	48 (6 in Amhara, 21 in Benishangul-Gumuz, 14 in Gambela, 7 in Oromia)	763,766	1,974,799 (est.)	Pirimiphos-methyl CS, clothianidin and clothianidin/ deltamethrin

In 2020, the FMOH IRS program sprayed approximately 2 million structures across non-PMI target districts, achieving 88% coverage of the target and protecting more than 5 million people from malaria. The U.S. Government has been supporting the FMOH in conducting IRS in Ethiopia since 2008. From 2018 to 2020, the PMI VectorLink Project conducted IRS in 44 districts: 20 in Benishangul-Gumuz, 14 in Gambela, and 10 in Oromia.

In 2021 PMI VectorLink targeted 48 districts for IRS, but 11 districts of Benishangul Gumuz Region were later removed from the target because of insecurity issues.  The target was adjusted to 37 districts in four regions (6 in Amhara, 10 in Benishangul-Gumuz, 14 in Gambela, and 7 in Oromia); 604,921 structures were sprayed out of the 637,138 structures found by spray operators (SOPs) in the districts between May 5 and September 20, for a coverage rate of 94.9%. Table 1 provides an overview of the number of structures sprayed and population protected by PMI VectorLink from 2018 to 2021 and targets for 2022.

In year five (January 2022 – December 2022), the PMI VectorLink Ethiopia project will work with the NMEP, regional health bureaus (RHBs), and district authorities to spray 763,766 targeted structures in the target 48 districts using pirimiphos-methyl CS (Actellic 300CS), SumiShield 50WG, and Fludora Fusion. Forty-two of the 48 districts will be sprayed with clothianidin-based products (SumiShield 50WG in 25 districts and Fludora Fusion in 17 districts). In the remaining six districts, in Amhara, Actellic 300 CS was sprayed in 2021, and will be used again in 2022. The project’s primary objective is to reach a minimum coverage of 85% of the structures found in each district by implementing high-quality IRS operations. The project will implement World Health Organization (WHO) and PMI guidelines on prevention of COVID-19 before, during and after implementation of IRS to ensure the safest possible conditions for the implementing teams and the beneficiaries.

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

• Build capacity at the district, and local/community levels to conduct IRS, including planning, implementation, environmental compliance and monitoring and evaluation (M&E).
• Train spray personnel with a focus on supervision, spray techniques, and IRS data quality.
• Mainstream gender equality by increasing the number of women participating in the various project activities in 2022 compared to 2021.
• Carry out geographical reconnaissance and logistics assessments in selected PMI-supported IRS and LSM districts, and arrange all procurement, shipping, and storage of IRS commodities.
• Conduct community mobilization activities as safely as possible following PMI VectorLink COVID-19 mitigation protocols and in collaboration with stakeholders to raise awareness of IRS and to encourage beneficiary and stakeholder ownership.
• Conduct insecticide resistance tests on three insecticides (primiphos-methyl CS, clothianidin and chlorfenapyr), wall bioassays and vector density monitoring and behavioral studies in nine districts.
• Conduct Anopheles stephensi larval surveys in rural and urban sites to map the extent of its geographical distribution.
• Evaluation of the larvicidal activities of two larvicides; Sumilarv 0.5G and Vectobac WG against larvae of stephensi in three towns.
• Support five towns to implement larval source management (LSM) particularly larviciding for the control of stephensi and conduct entomological monitoring. LSM will be implemented using community-based approaches.
• Expand and conduct community-based entomological surveillance in nine districts for arabiensis and eight towns for An. stephensi.
• Deploy mobile data collection for select entomological data.
• Conduct regular M&E of project activities to ensure alignment with set targets and objectives.
• Expand community-based IRS (CB-IRS) model implementation to Benishangul-Gumuz in addition to Amhara and Oromia regional states.
• Promote cost-efficiency options in the implementation of IRS activities by moving additional districts implementing DB-IRS model to CB-IRS model.
• Build entomological monitoring capacity of universities and research institutions

Success stories from PMI VectorLink Ethiopia:

Ethiopia Sees Dramatic Reduction in Malaria in IRS Region

 

 

 The Democratic Republic of the Congo

Malaria remains a serious public health problem in the Democratic Republic of the Congo (DRC) despite sustained malaria control strategies. Given that nearly all of the DRC population lives in high transmission zones, it has been estimated that the DRC accounts for 12% of all cases of malaria in sub-Saharan Africa (WHO, 2021). 

Due to a lack of data on insecticide susceptibility and vector bionomics in the country, PMI expanded its entomological support in 2014/15 under AIRS from four sentinel sites to seven sites. Insecticide susceptibility testing was extended further to 11 sites in 11 provinces in 2016/17 and under VectorLink in year one (2018) the scope of testing was expanded to include pyrethroid resistance intensity assays. In year two (2019), Institut National de Recherche Bio-médicale (INRB) conducted insecticide resistance monitoring activities in 10 sites (two sites in each of five provinces), while in year three susceptibility monitoring was conducted in 13 sites (one site per province) and 12 sites in year four. Sites were chosen strategically to ensure data was collected to inform ITN procurement for upcoming mass distribution campaigns.  

Monthly vector bionomics monitoring was conducted in Lodja (Sankuru Province) for 3 years from 2015-2017 and in Kapolowe (Haut Katanga Province) from 2016-2017. In 2018 and 2019 monthly vector bionomics monitoring was conducted through VectorLink in Kabondo (Tshopo Province) and Kalemie (Tanganyika Province), with Lodja reinstated in 2019. Monthly vector bionomics monitoring continued in 2020 and 2021 in Lodja along with two new sites, namely Inongo (Mai-Ndombe) and Kimpese (Kongo Central).

In addition to PMI support, the DRC NMCP received Global Fund financial support in 2019 to conduct additional entomological monitoring in nine sites (Boende (Tshuapa), Lisala (Mongala), Mweka (Kasaï), Nyankunde (Ituri), Bolenge (Equateur), Vanga (Kwilu), Kalima (Kasai), Kasai Oriental (Dibindi) and Lomami (Mweneditu), in partnership with the University of Kinshasa.

In year five (October 2021 – September 2022), the PMI VectorLink DRC project worked with the NMCP, INRB, the Kinshasa School of Public Health (PHSK), University of Kinshasa and other local stakeholders to conduct entomological monitoring. Key objectives listed below.

Insectary and Laboratory Activities

• Supported the INRB and PHSK to manage the insectary to include maintenance of the susceptible reference colony of coluzzii Ngousso, ensuring that all activities in the insectary follow standard protocols.
• Conducted laboratory analyses of a sub-sample of malaria vectors from all sites where insecticide resistance and vector bionomics monitoring is conducted. Tests included mosquito species identification, detection of sporozoites, and presence of molecular markers of insecticide resistance.

Field Activities

• Determined insecticide susceptibility status of gambiae s.l., and An. funestus s.l. where collected in sufficient numbers, in 14 sites across 14 provinces. Synergist assays with piperonyl butoxide (PBO) and pyrethroid resistance intensity assays were also conducted. The following insecticides were tested, in order of priority: deltamethrin, permethrin, alpha-cypermethrin, deltamethrin + piperonyl butoxide (PBO), permethrin + PBO, alpha-cypermethrin + PBO and chlorfenapyr, deltamethrin intensity, permethrin intensity, alpha-cypermethrin intensity.
• Conducted monthly vector bionomics monitoring in Kenge, Karawa, and Lodja. Vector species composition, spatial and temporal distribution, biting and resting densities, behavior, and Plasmodium sporozoite infection rates were determined. In addition, human behavior was monitored when human landing catches (HLCs) were being done to determine the relative biting risk indoors and outdoors.
• Conducted 14- and 27-month entomological and ITN bio-efficacy monitoring of PBO ITNs in Sud Ubangi Province (June 2022 and September 2022, respectively).
• Conducted 12-month durability monitoring of ITNs distributed in Tanganyika Province (December 2021).
• Conducted pre-distribution testing of ITNs distributed in Nord Ubangi Province.
• Conducted bi-annual monitoring (dry and rainy season) of reported and observed household net use in Tanganyika Province in November 2021 and February 2022.
• Piloted water hygiene and sanitation supervisors-based entomological monitoring in the provinces of Ituri, Kasai and Nord Kivu.

National-Level Support

• Facilitated bi-annual national vector control technical working group (TWG) meetings to report and discuss entomology data for use in NMCP decision-making. Participating organizations included the NMCP, Tenke-Fungurume Mining company (TFM), University of Kinshasa, INRB, PMI VectorLink, and Centre de Recherche en Sciences Naturelles.
• Organized two entomology dissemination meetings with the NMCP to share quarterly activities’ tracker, report and discuss entomology data for use in NMCP decision-making. Participating organizations included NMCP, University of Kinshasa, INRB and PMI VectorLink.
• Trained and supported three NMCP technicians located in the new sites of Kamina and Kenge, in entomological techniques for monitoring malaria vectors and provide refresher training during INRB visits to other sites on data management, running the insectary, and entomological monitoring at the sentinel sites through on-job-training and coaching.

Success stories from PMI VectorLink DRC:

PMI VectorLink Published in the Malaria Journal

Malaria is a leading public health challenge in Côte d’Ivoire. It accounts for about 43% of outpatient visits in health facilities. Malaria incidence in 2017 was 134 cases per 1,000 in the general population, and 247 per 1,000 among children under 5 (per the NMCP 2018 annual report).

The main malaria vector control method currently used in Côte d’Ivoire is the distribution and use of ITNs. ITN distribution is typically carried out through mass campaigns for universal coverage, and through routine distribution during antenatal visits and immunization of children under 1 year. The country’s 2016–2020 National Malaria Strategic Plan has selected IRS as an additional vector control method to reduce morbidity and mortality from malaria.

Since 2015, the NMCP has worked with four research institutes to conduct entomological monitoring including insecticide resistance monitoring and biannual vector surveillance (one collection in the dry and one in the rainy) in twelve sentinel sites selected across the country. These activities were implemented every two years in each of twelve sentinel sites (six sites one year and the other six the next year) from 2015-2017 with financial support from the Global Fund. PMI began supporting entomological monitoring in Cote d’Ivoire in 2018, enabling insecticide resistance monitoring in ten sites selected by the NMCP, four of which were also selected for monthly vector surveillance. In 2019, NMCP resumed biannual vector surveillance in all 12 sentinel sites with Global Fund support, PMI continued supporting monthly vector surveillance in another four sites (two selected for IRS and two control sites) through the VectorLink project, and insecticide resistance testing was conducted in 19 sites combined. Over the same period of time, several parallel entomological monitoring activities were conducted through the different research institute projects, including a three-year community evaluation of eave tubes funded by the Bill and Melinda Gates Foundation.  

In year three (2020), VectorLink Côte d’Ivoire implemented the first-ever large-scale IRS campaign in the country in two districts (Nassian and Sakassou, shown in Figure 1) selected by the NMCP, PMI, and the National Vector Control Steering Committee (VCSC), based on entomological and epidemiological data collected in 2018 and 2019 as well as a rapid feasibility study. The project targeted a total of 56,601 structures (based on results of a structure enumeration effort in 2019) protecting approximately 200,168 people, including 3,193 pregnant women and 28,523 children under 5 years. The project sprayed 53,962 structures out of the 56,601 targeted structures, resulting in 95.3% spray progress, and out of the 58,695 eligible structures found, resulting in 91.9% spray coverage. In 2021, the NMCP, PMI, and the National VCSC recommended repeating IRS in the same districts as in 2020 using the same insecticides in each district: Fludora Fusion in Sakassou and SumiShield 50WG in Nassian.

In year four (2021), the NMCP, PMI, and the National VCSC recommended repeating IRS in the same districts as in 2020 using the same insecticides in each district: Fludora Fusion in Sakassou and SumiShield 50WG in Nassian. In 2021, the IRS campaign was conducted in both districts over 30 operational days between August 2 and September 4. Using lessons learned from the 2020 campaign, VectorLink Côte d’Ivoire adapted the communications strategy, which reduced refusal cases by a significant 53%, from 1,520 in 2020 to 713 in 2021 At the end of the 2021 IRS campaign, the project had sprayed 60,496 structures (out of the 62,551 eligible structures found), corresponding to 96.7% coverage.

In year five (January 2022 – December 2022), the PMI VectorLink Côte d’Ivoire Project will work with the Ministry of Health, NMCP, and VCSC to spray an estimated 62,551 targeted structures in two health districts using SumiShield 50WG and Fludora Fusion. The project’s primary objective is to reach a minimum coverage of 85% of the structures found in each health district by implementing high-quality IRS operations.

In addition, the project will carry out the following key activities:

• Conduct training with a focus on IRS supervision and spray techniques to improve the overall quality of spraying.
• Conduct regular monitoring and evaluation (M&E) of project activities to ensure alignment with set targets and objectives.
• Carry out all procurement, shipping, delivery, and storage of IRS commodities.
• Maintain a robust IRS logistics and warehousing system through training and supervision.
• Work with the NMCP communication unit service to coordinate the information, education and communication (IEC), sensitization, and mobilization activities to raise awareness and encourage acceptance of IRS.
• Work with the NMCP and the Ministry of Environment to ensure environmental compliance through environmental compliance inspections before, during, and after spraying.
• Mainstream gender equality and female empowerment by ensuring women’s participation in different project activities including employment of seasonal workers.
• Promote cost efficiency through due diligence and efficiency of operations.
• Evaluate the impact of the delayed 2020 and 2021 IRS campaign on malaria case incidence.
• Support NMCP organizing a workshop on global Vector Control strategies in the future
• Conduct insecticide susceptibility tests (based on insecticides list in section 7.4) in 18 selected sites nationwide including the four bionomics sites and measure the resistance intensity, as required, for the main malaria vector, gambiae s.l.
• Monitor the density, species composition, behavior, and Plasmodium sporozoite infection rates of malaria vectors in the four sites (two IRS health districts and two controls).
• Monitor the residual life of the sprayed insecticides using cone bioassays in IRS health districts.
• Conduct the 12-month round of durability monitoring for PBO and IG2 ITNs distributed in the 2021 mass campaign.
• Coordinate with the NMCP to develop ITN guidelines for continuous distribution by leveraging findings from the PMI VectorLink 2021 ITN continuous distribution assessment.