Category: country

In 2020, nearly three million malaria cases and 4,121 deaths were recorded in health facilities in Cameroon. Children under five years of age are disproportionately at risk, accounting for around 32% of malaria cases and 64% of deaths. Entomological monitoring enables us to determine which mosquitoes transmit malaria, where they’re located, and what their feeding and resting habits are like. 

PMI has supported entomological monitoring in Cameroon since October 2018, conducting vector bionomics data collections either monthly or every other month in five sites: Gounougou (located in the North region in Lagdo district), Simatou (in the Far North in Maga district), Bonabéri (located in the Littoral region in Bonassama district), Mangoum (in the West region in Foumbot district), and Nyabessang (South region, Ambam district). Insecticide resistance monitoring was conducted in four sentinel sites (Gounougou, Simatou, Nyabessang, and Mangoum) in late 2018 and in all five sites in 2019 and 2020.

In 2020, vector surveillance data collected using three collection methods—human landing catches (HLCs), U.S. Centers for Disease Control and Prevention (CDC) light traps (LTs), and pyrethrum spray catches (PSCs)—showed a diversity of Anopheles species across sites. Anopheles gambiae s.l., An. pharoensis, and An. funestus s.l. were the most abundant and were found in all sites and through all collection methods, except Bonabéri where only An. gambiae s.l. was collected using HLCs. An. moucheti and An. nili were collected only at Nyabessang through HLCs and CDC LTs.

In Years three (May 2020 – April 2021) and four (May 2021 – April 2022), VectorLink Cameroon supported the NMCP in its goal to increase the entomological capacity at the regional and district level, facilitating trainings for health personnel on basic entomology, including collection and identification of larvae and mosquitoes. Over the two years, 81 health personnel were trained (49 from the Far North, North, Littoral, South, and West regions in Year 3, and 32 from the Adamawa and East regions in Year 4). A subset of those trained have since been involved as technicians in vector surveillance and insecticide resistance monitoring activities conducted by VectorLink at their specific sites included in the workplan. The remaining personnel trained are available for the NMCP to engage for entomological activities as the need arises.

In Year five (May 2022 – April 2023), the PMI VectorLink Cameroon project will continue its partnership with NMCP and local research institutes [Biotechnology Center (BTC), Center for Research in Infectious Diseases (CRID), and the Central African Organization for Endemic Diseases Control (OCEAC)] to conduct entomological monitoring and insecticide susceptibility testing. The project will subcontract with CRID to conduct all laboratory analyses of entomological samples collected during the work plan period and to conduct bioassay testing of ITNs as part of the durability monitoring activity (while CDC supports chemical testing). The project’s primary objective is to collect field and laboratory entomological data to support NMCP with data for vector control decision making for implementing life-saving malaria vector control interventions with the overall goal of reducing the burden of malaria.

Specific objectives are as follows:

Entomological Monitoring

• Continue to monitor the species composition, density, resting and biting behavior, and Plasmodium sporozoite infection rates of malaria vectors, as well as human behavior indoors and outdoors, in five longitudinal vector surveillance sites selected by the NMCP in various ecozones.
• Determine the susceptibility of the primary malaria vector gambiae s.l. to insecticides used for impregnation of ITNs and IRS, including chlorfenapyr and clothianidin, in the same 10 sentinel sites which were monitored in Year 4. Also, conduct susceptibility testing on adult An. pharoensis and An. ziemanni collected in Simatou and Gounougou and An. moucheti collected in Nyabessang.
• Measure the intensity of insecticide resistance, determine the resistance mechanism, and assess the synergist effect of piperonyl butoxide (PBO) on the susceptibility of gambiae s.l. in the 10 sites.
• Conduct larval surveys at three time points (June, October, and November) at four sites in Douala Port to assess presence of stephensi.
• Commence preparatory activities and conduct pre-distribution bioassays and chemical content analysis as part of streamlined durability monitoring of ITNs distributed in the North and/or Far North during the 2022 mass campaign.
• Assess the impact of human behavior and the ITN use (measuring using accelerometers) on vector bionomics (such as biting rate) in two sentinel sites in northern Cameroon (Simatou and Gounougou).

Entomological Scale Up of Capacity 

• Enhance the generation and use of entomological data for decision making through support to the NMCP’s national Vector Control Committee (VCC). Organize and present VectorLink data at quarterly meetings, build the capacity of key stakeholders to use and interpret entomological data, and work with the VCC to identify other potential research institutes in the country with insectary and/or molecular capabilities which could be targeted by capacity strengthening efforts and help decentralize entomological laboratory capabilities in the country.
• Train and support regional and district entomology technicians on malaria entomological techniques through international trainings in collaboration with international partners such as Institut de Recherche en Sciences de la Santé (IRSS) in Bobodioulasso, Burkina Faso.

Cambodia is progressing toward malaria elimination; there has been a significant reduction in malaria morbidity and mortality over the last 10 years. The overall malaria mortality rate has decreased from 0.98 per 100,000 in 2010 to 0.12 per 100,000 in 2014. No malaria deaths have been reported since 2017. Malaria cases in Cambodia are caused by Plasmodium falciparum, Plasmodium vivax, or a mix of both species and of the reported total malaria cases in last five years from 2016 to 2020, majority were Plasmodium (P.) vivax (62%). In 2020, there were 9,237 malaria cases (936 Plasmodium (P.) falciparum) detected by public health facilities and Village Malaria Workers (VMWs), a 71% decline from 2019, when 31,791 malaria cases (4,990 P. falciparum) were reported. The national malaria incidence in 2020 was 0.56 (0.05 for P. falciparum) among 1,000 population. In 2020, only 10% (936) of cases were P. falciparum or mixed infections compared to 16% in 2019 and 56% in 2017 (National Center for Parasitology, Entomology and Malaria Control 2020).

The National Strategic Plan for Elimination of Malaria in the Kingdom of Cambodia targets malaria elimination by 2025. The Malaria Elimination Action Framework for 2021-2025 describes new strategic updates based on recent changes in the country’s epidemiological and programmatic context. Foci investigations are identified as one of three key objectives of the surveillance program, which aims to determine the drivers of malaria transmission and trigger a targeted response. An intensified approach is required in endemic locations with highest risks, where mobile migrant populations and forest goers may be key to transmission.

Anopheles dirus, An. minimus s.l., and An. maculatus s.l. are the main malaria vectors in Cambodia. An. dirus is found in forested mountains and foothills, cultivated forests, and rubber plantations, whereas An. minimus s.l. is found outside the forests or in areas that have been cleared of forest. An. maculatus s.l. is found in hilly or mountainous areas and breeds in or near permanent or semi-permanent bodies of clean water such as streams or rivers (Sinka et al. 2011).

Entomological monitoring in Cambodia consists of two activities: (1) sentinel site longitudinal monitoring in locations where continuous malaria transmission is found, and (2) as a component of foci or outbreak investigations. Longitudinal monitoring activities include monitoring vector species abundance, biting behavior, infectivity rate and insecticide susceptibility testing. In 2021, longitudinal monitoring activities in Mondulkiri and Stung Treng provinces were jointly carried out by CNM and VectorLink Cambodia with financial support from PMI, and in Kampong Speu Province by CNM with financial support from Global Fund.

In year five (September 2022 – September 2023), the project’s primary objective is to support, in consultation with CNM, entomological surveillance in response to local malaria cases in the geographical areas with a high malaria burden. Emphasis is on helping Cambodia achieve its malaria elimination goals by strengthening foci investigations through entomological monitoring. Additionally, insecticide resistance monitoring, vector incrimination through molecular assays, and identification of members of primary malaria vector species existing as species complexes will be conducted. The project will develop local capacity to implement entomological surveillance, insecticide resistance monitoring, and molecular analysis of mosquito collections. It will also introduce the entomological monitoring data management module into the existing malaria information system.

Field Activities:

• VectorLink Cambodia will provide technical assistance to existing entomological surveillance in foci investigations in Mondulkiri and Stung Treng provinces during every other month and will support the introduction of HDNs, CDN and CDC LTs to the existing entomological monitoring system. The scope of entomological activities will be limited to the minimum required to inform an effective focus response, which is especially important in areas with limited resources but with many active foci. A component of the project’s effort in foci investigations will be to determine the essential entomological activities. VectorLink will analyze the applicability and sustainability of each of the complimentary entomological activities for the foci investigations, and develop recommendations from the lessons learned, to strengthen effective implementation in other provinces. These findings and capacity building will be an investment in the future prevention of reintroduction of malaria efforts of Cambodia.
• Conduct pyrethroid insecticide resistance testing in four sentinel sites (one forest and one village) in each of the target provinces.
• Continue on-site training and support to PHD and OD health staff on case-based entomological investigations as a component of foci investigations, particularly for mosquito trapping methods, handling, and processing mosquito samples in the field as well as training on Anopheles species identification supported by CNM.
• Train and support the CNM technicians in mosquito trapping methods, handling, and processing of mosquito samples in the field, morphological identification, and insecticide resistance testing data recording, entry and management, and reporting.
• Convene and support CNM to hold national Vector Control Working Group meetings by promoting the triangulation of existing entomological data, case prevalence data from the management information system (MIS), and insecticide resistance monitoring data, for an optimal response.

Insectary and Laboratory Activities:

• Rear F1 generation mosquitoes from forced oviposition of wild-collected malaria vectors at the CNM insectary for insecticide susceptibility tests.
• Maintain and expand the existing pinned reference collection of Anopheles Continue to develop a pictorial Anopheles species identification guide in Khmer and English for Mondulkiri and Stung Treng provinces.
• Work with CNM to label mosquito samples for storage and recording prior to in-country enzyme-linked immunosorbent assay (ELISA). A barcoding system for samples will be implemented with VectorLink home office guidance during this work plan period.
• Conduct circumsporozoite (CSP) ELISA in the National Institute of Health (NIH), National Institute of Allergy and Infectious Diseases (NIAID) laboratory at CNM, molecular species identification of all samples positive for CSP- ELISA and a subset of samples from each species first by conventional polymerase chain reaction (PCR) for primary vector species and sequencing for other vector species as needed in the genetics laboratory at laboratory at RUPP or alternate institution. In addition, VectorLink will support data recording, entry and management, and reporting.
• Support CNM laboratory capacity in molecular entomology work through international course, training, etc.
• Support developing capacity for species identification by sequencing and sequencing analysis at RUPP (or alternate institution)

Entomology Data Management and Use:

• Continue to support the customization and use of entomological modules in the national MIS that were started with support by VectorLink Cambodia in Year 4
• Support CNM to modify data collection, collation, and visualization of foci investigation data, if needed, as part of the process of integrating foci investigation entomological monitoring data into the existing MIS.
• Provide technical support to CNM on reporting and using vector control data for decision making at the national level.
• Facilitate review of entomological monitoring data by relevant parties to inform and improve integrated vector control decision making at the VectorLink l Dissemination Meeting as well as CNM-convened meetings (e.g., CNM Annual Conference) and other malaria stakeholder meetings.

Malaria remains the leading cause of morbidity and mortality in Burundi. In 2016, the number of malaria cases reached 8.3 million, out of a population of 11 million. The malaria epidemic is concentrated in the eastern, central, and northern parts of the country. The most important determinant of this situation is an increase in the number of vectors transmitting malaria. A mass distribution campaign of mosquito nets was conducted in December 2019 with the support from the Global Fund, UNICEF, and USAID. The campaign has distributed 6,784,254 insecticide-treated nets (ITNs) including standard deltamethrin-based nets (Yorkool) and PBO nets (Permanet 3.0). This ITN distribution is expected to increase ITN ownership – measured as the proportion of households owning at least one ITN – at 96.7% according to the mass distribution campaign report. The monitoring of mosquito populations and behaviors are critical for evidence-based planning to control malaria in Burundi.

In year five (October 2021 – September 2022), PMI VectorLink supported the NMCP to conduct entomological monitoring, insecticide resistance monitoring, ITN durability monitoring, and provide indoor residual spraying (IRS) technical assistance in the country. The project’s primary objective is to strengthen the national capacity in vector surveillance. The support included technical assistance; collection of data on vector species composition, behavior, and susceptibility to the main classes of insecticides used in vector control; the operationalization of nine sentinel sites; and development of national human resources for entomological surveillance.

Insectary and Laboratory Activities:

•  Supported the NMCP to manage the insectary, maintained the mosquito colonies.
• Ensured all activities in the insectary following the standard protocols.
• Transferred technical skills and insectary management to the NMCP.

Field Activities:

• Conducted insecticide susceptibility tests on mosquitoes collected from one site per each of the nine provinces, for a total of nine sites. The following insecticides were tested, in order of priority: clothianidin, pirimiphos-methyl, deltamethrin+PBO, permethrin, permethrin+PBO, alpha-cypermethrin, alpha-cypermethrin+PBO, chlorfenapyr and bendiocarb.
• In collaboration with the NMCP, supported capacity building of health centers with entomological monitoring activities and reporting at sentinel sites with regular support on mosquito identification and dissection in two of the existing sentinel sites (Mpanda and Mutaho). At Mpanda, vector density was leading to a high workload for two technicians at Mutaho (the new sentinel site), the technicians need more experience to run activities at the sentinel site. The support to all other sites was limited to the provision of material and consumables, per diem and remote technical support.
• Supported the NMCP in field entomological data collection to ensure a complete data set that will inform decision making on program activities for upcoming years.
• Monitored the insecticide (Fludora Fusion) decay rate through cone bioassay tests at Muyinga and Kiremba where IRS was implemented with Global Fund support.
• Implemented 24-month durability monitoring of ITNs through PSI in Vumbi and Gashoho districts.

National-Level Support:

• Supported the NMCP in planning and implementation, data collection, protocol/guideline development for IRS.
• Contributed to the training of a national pool of IRS supervisors.
• Trained and supported NMCP technicians in entomological surveillance techniques of malaria vectors.
• Strengthened skills on data management, insectary management, and entomological monitoring at the sentinel sites through on-the-job-training and coaching.
• Trained and supported NMCP leadership on reporting and using vector control data for decision making at the national level.

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

Malaria remains a major public health issue in Burkina Faso and is endemic throughout the country. In 2021, Burkina Faso accounted for 3.3 percent of total malaria cases and 3.4 percent of total malaria deaths. Malaria prevention and control activities are guided by a national malaria control strategy, which supports the long-term vision of eliminating malaria in Burkina Faso by 2030. The strategy includes support for vector control, seasonal malaria chemoprevention for children under five years of age, intermittent preventive treatment for pregnant women, case management, and behavior change communication. 

With the U.S. President’s Malaria Initiative (PMI) funding, indoor residual spraying (IRS) was included as a priority vector control strategy and was implemented annually from 2018 to 2021. PMI VectorLink conducted spray operations in Burkina Faso in 2018 in the district of Kampti, Solenzo and Kongoussi; in 2019 in Kampti, Solenzo and Kongoussi; in 2020 in Kampti and Solenzo; and in 2021 in Kampti and Solenzo. The Kongoussi district was only sprayed in 2018 and 2019, and later removed as an IRS district due to security issues. 

In addition, a mass distribution of 1.5 million piperonyl butoxide (PBO)-synergist PermaNet 3.0 and 2 million dual-AI Interceptor G2 brand ITNs was conducted between June and October 2019. ITNs were also delivered to pregnant women via antenatal care services and to children under one who have completed their vaccinations. PMI VectorLink assessed ITN delivery via these routine health services. 

In 2022, the project worked in close collaboration with the Institute of Research on Health Sciences/Institut de Recherche en Sciences de la Santé (IRSS) and the NMCP to conduct activities in-country. Those included conducting monthly entomological monitoring in seven sites from June 2022 to September 2022, completing an evaluation of the 2018 IRS campaign, and completing a remote training-of-trainers for the 36-month durability monitoring round of the 2019 mass ITN distribution of nets.  

PMI VectorLink Burkina Faso also provided technical support to the NMCP in planning and conducting a mini-IRS campaign in the district of Dangouna and Lokiéhoun with VectorLink Burkina Faso’s leftover Actellic 300CS insecticide. The campaign took place from August 12-16, 2022, in Dangouna and from October 18-25 in Lokiéhoun; the NMCP sprayed a total of 4,786 structures, protecting 15,510 people from malaria, including 2,435 children under five 404 pregnant women. 

In 2023, the team continued its entomological monitoring through IRSS, wrapped up its work on the 36-month durability monitoring report, and finalized the 2021 IRS impact evaluation.  

The Village That Sleeps