Category: Field Notes

Ghana has achieved quite the milestone that is sure to serve as great Monday motivation for all! At PMI VectorLink Ghana’s closeout meeting on June 27, 2023—attended by the heads of traditional areas, PMI representatives, National Malaria Elimination Program staff, Ghana Health Service representatives, district officials, research institutions, insecticide companies, and the Environmental Protection Agency—the NMEP shared that between 2011 and 2022, the malaria prevalence among children under five decreased by over 72% in the former Northern region, which has since broken up into three regions: Savannah, Northern, and North East.

Presentations by the health directorates in the Northern and Northeast regions showed that malaria mortality in some districts where VectorLink Ghana operates had decreased, with some districts recording no malaria-related deaths in children under five in the last three years. VectorLink Ghana, through implementing IRS, helped protect 1,021,269 people from malaria, including 168,872 children under five.

CDC Resident Advisor Nana Wilson echoed the achievement of this progress, stating that “we started in 2011 with a 27.5% [malaria] prevalence nationally and all the way to 2022, which is just last year, we’ve been able to reach 8.6% prevalence, which means that what we are doing is working… Even though it has reduced drastically, and we are happy with it, we are aiming [toward] zero malaria, so we have a lot of work to do. But this is an achievement. I think we have to be proud of ourselves.”

All stakeholders attending the closeout meeting expressed their commitment to supporting the continued implementation of vector control interventions under PMI Evolve.

Excellent work demonstrating continued success in reducing the burden of malaria, VL Ghana!

The PMI VectorLink Ethiopia team has been busy! Many would say they are a constant source of motivation, in this week’s case, Monday Motivation! They just completed the second and final phase of the 2023 indoor residual spraying campaign while simultaneously implementing the 11th consecutive month of Larval Source Management (LSM) for An. stephensi control in eight towns. In the same time frame, the team successfully transitioned ownership of LSM operations to six town administrations.

Despite enormous security challenges and road closures, VL Ethiopia completed both phases of IRS with no major incidents, and unlike previous years, reached the vast majority of targeted communities. While some districts in Amhara and Benishangul-Gumuz regions had a five-week pause in preparatory activities due to security concerns, all districts began the campaign within one to two weeks of their scheduled start date and finished within the planned number of operational days. Preliminary results show 92-97% progress across all originally targeted districts, and 91-97% coverage. The team also introduced IRS for the first time in seven refugee camps in Gambela region, where nearly half of the region’s population resides, based on the successful implementation of IRS in three refugee camps in Benishangul-Gumuz in 2022.

At the same time, the Ethiopia team sustained LSM at full capacity in eight towns, treating up to 90,000 individual larval habitats with either Bti-based larvicide application or source reduction every two weeks for up to 11 months. Preliminary results of the pilot show dramatic reductions in larval indices and anecdotal reports of fewer malaria cases among residents of the LSM target areas. The intervention has been so successful that community members and health officials alike have expressed strong desire to continue LSM.

Since March 2023, VL Ethiopia has been working with the town health administrations to carefully plan and implement a long-term strategy for community-based LSM. They clearly outlined roles and responsibilities, modified tools, designed and delivered trainings, and provided targeted technical support to maximize the towns’ chances of continued success in integrating LSM into their routine public health activities. The first six towns assumed full responsibility for LSM activities as of July 1, 2023, representing a major accomplishment toward USAID’s Local Capacity Strengthening Policy.

For this week’s Monday Motivation, we are featuring our team in Ghana who just had a new article published in Parasites & Vectors on “Estimating malaria transmission risk through surveillance of human-vector interactions in northern Ghana.”

This article looks at malaria transmission risk based on human-vector interactions in northern Ghana where indoor residual spraying and insecticide-treated nets are the main vector control interventions. From June 2017 to April 2019, monthly human landing catches were used to measure indoor and outdoor human biting rates, which were adjusted for the length of a mosquito’s infective life and human behavior observations.

Results show that Anopheles gambiae was the primary vector species in the IRS and control communities, and their indoor and outdoor biting pattern was similar in both areas. When accounting for human behavior observations, the combined efficacy of using IRS and ITNs in reducing malaria transmission risk was 58% compared to 27% with ITNs alone. This indicates that by accounting for human behavior, ITN use alone—compared to in combination with IRS—had less impact on malaria transmission indices. However, the study identified protection gaps due to human and vector behavior patterns that allow significant human–vector interaction beyond the current control interventions. Strengthening effective communication for behavior change in net use and IRS could reduce malaria transmission even more.

Excellent work VectorLink Ghana! What an informative article.

For this week’s Monday Motivation, we’re sharing PMI VectorLink Madagascar’s Innovation Competition win at the Society for International Development – United States’ Annual Conference. A video of the full presentation can be found here: Innovation Competition Showcase | Sponsored by Accenture | SID-US 2023 Conference – YouTube

Larval Source Management (LSM) Lead, Kerri-Ann Guyah presented on behalf of the team, delivering a compelling and informative presentation on “Drone Technology for Malaria Vector Control.” She highlighted the collaborative effort of VL Madagascar and NMCP in using drones to spray larvicide in rice fields as a complementary vector control tool in Madagascar. After the presentation, Kerri-Ann fielded questions on the challenges the team faced and on what’s next for this activity.

The VectorLink team was one of five teams competing in the Innovation Challenge. At the closing session, the Innovation Competition sponsor shared that the judges as well as the audience agreed that PMI VectorLink Madagascar’s innovation earned the win!

Congratulations again to the PMI VectorLink Madagascar Team and Kerri-Ann for highlighting our work in such an important forum.

This week’s Monday Motivation celebrates the addition of a new journal article highlighting PMI VectorLink’s contributions to counteracting gender barriers in vector control. The article, Expanding the Role of Women in Vector Control: Case Studies from Madagascar, Rwanda, and Zambia, was published in Global Health: Science and Practice and can be accessed through this link. Among the authors’ key findings: Women and men have equal ability to serve as spray operators, and best practices do exist to recruit and retain women in vector control. The article also examines how our Madagascar team has worked to transform social norms around women doing this type of work; how Rwanda has benefitted from the government’s commitment to gender equality and social inclusion; and how Zambia’s recruitment protocol boosted the number of female workers and helped increase IRS acceptance.

Kudos to our VectorLink authors: Tess Shiras, Meghan Tammaro, Kate Stillman, Godfrey Karera, Timothée Gandaho, and Nduka Iwuchukwu, and PMI’s Allison Belemvire. And a big thank you to the teams in Madagascar, Rwanda, and Zambia for protecting populations from malaria by increasing women’s involvement in vector control. PMI has long supported advancing gender equity in its projects. Our VectorLink efforts build on work done under the PMI AIRS Project, which published an article on the benefits of increased women’s employment in indoor residual spraying programs nearly six years ago in the same journal (linked here). We look forward to doing even more to advance gender equity and social inclusion with PMI Evolve.

How can insecticide resistance testing occur when certain areas within a country are inaccessible due to insecurity? In the Democratic Republic of Congo (DRC), the PMI VectorLink team dealt with just that. Insecticide resistance testing helps inform insecticide-treated net (ITN) selection, so it’s important that data collected from these tests is representative of the country. For this week’s Monday Motivation, we’re highlighting the PMI VectorLink DRC team for working with the National Malaria Control Program (NMCP) to pilot a community-based approach to insecticide resistance testing in areas with limited accessibility.

In the provinces of Ituri, Kasai, and Nord Kivu, PMI VectorLink DRC and the NMCP trained water, hygiene, and sanitation (WHS) health staff to conduct the testing. The health staff came to Kinshasa for a one-month training from August-September 2022, which was conducted through the Public Health School of Kinshasa. The trainees included two WHS supervisors and one provincial NMCP staff member per entomological surveillance site and covered topics such as insecticide susceptibility testing, insecticide resistance intensity and synergist assays, and adult sampling methods.

Following the training, the WHS supervisors conducted insecticide resistance testing in November 2022 and April 2023 in Rutshuru (Nord Kivu), Nyakunde (Ituri) and Mweka (Kasai) sentinel sites. The results from all provinces, including the ones with security issues, helped determine what type of ITN would be distributed in each province for future ITN distribution campaigns.

Excellent work enabling critical testing to occur in challenging circumstances, PMI VectorLink DRC!

Assessing the durability, or useful life, of mosquito nets in the field is critical to ensuring they are working properly by blocking and killing mosquitoes. This helps national malaria programs determine how frequently nets need to be replaced. Data collectors travel to communities to conduct durability monitoring (DM) on the same nets four times: a baseline assessment right after a mass distribution campaign, and then 12, 24, and 36 months after.

We all know that many communities are hard to reach, especially if they are only accessible on foot. For this week’s Monday Motivation, let’s turn our attention to the durability monitoring team in Sierra Leone, who made the trek to some of these communities for the recently completed 36-month durability monitoring assessments.

The 36-month DM survey round took place in Bo and Moyamba districts, located about 155 miles from the capital, Freetown. DM assessments take around two weeks to complete, and the team had to reach 30 targeted communities. Due to the remote location of many of these communities, data collection teams had long drives and then often left their vehicles to hike anywhere from 30 minutes to an hour, sometimes wading through creeks and in one case, crossing a river via a canoe, to reach the community. The team then spent the day there so they could catch people before they left for the farms or when they returned to make sure no households were missed.

All in all, these DM assessments are providing Sierra Leone’s National Malaria Control Program with information on indicators such as median mosquito net life and insecticide effectiveness.

Kudos to Sierra Leone’s data collection team and Regional Research Advisor Raymond Sudoi, who helped train the data collectors and accompanied them for some of the field work.

World Malaria Day may be April 25, but the commemoration was extended for Côte d’Ivoire. On Friday April 28, the Ministry of Health and the National Malaria Control Program celebrated its 16th Annual World Malaria Day event in Grand Morie Village, Agboville health district. This week’s Monday Motivation celebrates the PMI Evolve Côte d’Ivoire team for highlighting why their activities are so important to malaria control decision-making in Côte d’Ivoire.

The team took the opportunity to present a simulation of a small insectary to representatives from the health ministry along with other partners, including representatives from USAID/PMI, UNICEF, Global Fund, the French Embassy, and the World Health Organization. Implementing partners and the population of Grand Morie were also in attendance.

In this insectary, the PMI Evolve team demonstrated sampling methods such as the human landing catch, CDC light trap, and pyrethrum spray catch. They also had a magnifying glass and microscope to highlight vector density, behavior, and species composition. The WHO susceptibility and cone tests were also presented to show how insecticide resistance and bio efficacy tests for insecticide-treated nets or sprayed walls are conducted.

The PMI VectorLink Côte d’Ivoire team generated data that informed the 2021 ITN mass distribution using methods demonstrated at the event, and now under PMI Evolve, the project will continue to generate data to inform the upcoming 2024 mass distribution.

Excellent job representing the project, PMI Evolve Côte d’Ivoire!

We all know susceptible mosquitoes are necessary to test the effectiveness of malaria control interventions. Entomologists rely on sustained access to susceptible mosquitoes to advance knowledge about vector control. This week’s Monday Motivation goes to the VectorLink Uganda team who is working with the Ministry of Health to support not just one insectary, but four, located across the country at Gulu University, Kampala Vector Control Division (VCD), Muni University, and Tororo Hospital (the insectaries at Gulu University, Kampala VCD and Tororo Hospital have been open since the PMI VectorLink Project began).

The most recently opened insectary at Muni University, which became operational last July, provided mosquitoes for quality assurance tests done for the MOH-led IRS campaign that concluded in September. PMI Activity Manager Joel Kisubi recently visited and commented on how the insectary is an investment by the U.S. government to support malaria research and innovation in Uganda.

More recently, the insectaries at Tororo Hospital and Kampala VCD provided mosquitoes for the entomological assessments done during the PMI VectorLink-led IRS campaign that wrapped up at the end of March. Because mosquitoes were brought into the community for these assessments, some community members were resistant to these assessments occurring due to the belief that these mosquitoes would infect people with malaria. To address this hesitancy, the VectorLink Uganda team showed the community members and village leaders how these tests worked. The first few houses were sprayed, and then they got to see how the mosquitoes die when they rest on the sprayed walls. 

All four insectaries support research aligned to the national malaria research agenda. The Muni University insectary will support the insecticide chlorfenapyr susceptibility monitoring study in Arua District as well as insecticide-treated net (ITN) studies for the planned national mass ITN distribution campaign later this year. The MOH and Muni University will also explore collaborative research activities with other institutions within and outside Africa to make the insectary self-sustaining. Similar work is ongoing at Gulu University.

Excellent job enabling high-quality research to support vector control, VL Uganda!

This week’s Monday Motivation goes to the PMI VectorLink Cameroon team for their recently published article in Malaria Journal on “High vector diversity and malaria transmission dynamics in five sentinel sites in Cameroon.”

From October 2018 to September 2020, malaria vector surveillance was conducted at five sentinel sites where mosquitoes were collected to assess data like human biting rate and species composition. Results indicated that of the 18 species collected, 12 were vectors of malaria. Anopheles gambiae s.l. was the most common malaria vector collected.

These findings will help the National Malaria Control Program design effective malaria control strategies and implement effective interventions to prevent malaria in Cameroon.

Great work supporting vital research that will help the National Malaria Control Program, VL Cameroon! You can read the full article here.