Protecting Populations from Malaria through Mass ITN Distribution: Zambia’s Mateyo Moyo

Chief Moyo conducting monitoring of ITN distribution on Kilwa Island in Nchelenge district.

In the heart of Zambia’s Luapula Province, Mateyo Moyo, the chief environmental health officer in Luapula’s Provincial Health Office, stands as a beacon of dedication in the fight against malaria. Known by many simply as “Chief,” his vision, commitment, leadership, and unwavering passion drive the quest to dramatically reduce the burden of malaria in his province. This year, Luapula was the first province to receive and deliver ITNs in Zambia’s 2023 ITN nationwide mass campaign, and Chief Moyo played a major role.

Zambia has witnessed tremendous progress in reducing malaria deaths due in part to the harmonious collaboration of cooperating partners in deploying integrated vector control (IVC) interventions, including mass ITN distribution campaigns. In 2023, the U.S. President’s Malaria Initiative (PMI), the Against Malaria Foundation (AMF), and the Global Fund provided financial and technical support to help procure and distribute a total of 11.5 million ITNs to protect an approximate population of 19 million people spread across 10 provinces.

“Coordinating key stakeholders in the province has been exciting although not easy and at times somewhat stressful,” Chief Moyo states. Among the many stakeholders he has been working with are USAID’s Global Health Supply Chain Procurement and Supply Management (GHSC-PSM) Project, which oversees ITN warehousing and transportation from central warehouses in Lusaka directly to district health facilities; USAID’s Evidence for Health (E4H) Project, which oversees ITN campaign digitization including—for the first time in Zambia—digital data collection during household registration net and distribution; and USAID’s PAMO Plus Project, responsible for sharing key messages with communities about ITN use and how households can register to receive a net. He is also working with the PMI Evolving Vector Control to Fight Malaria Project (PMI Evolve), which oversees final-mile ITN distribution directly to households as well as coordinating technical assistance, timelines, and troubleshooting for the nationwide mass campaign. As Chief Moyo says, “A campaign of this magnitude relies on ensuring that the best coordinating mechanisms are put in place and effectively working together to protect the people from malaria.”

From micro-planning to execution and partner coordination at both provincial and district levels, Chief Moyo’s supervision and leadership have been instrumental, enabling his province to reach its targets for delivering ITNs to households and driving the nationwide campaign to a successful start. Reflecting on the 2023 campaign’s launch, Chief Moyo highlighted several key achievements.      

“The collaboration with partners was exemplary, and no population was left unreached,” said Chief Moyo. “We managed to distribute ITNs and protect people living in hard-to-reach communities, such as those in Kilwa and Chisenga islands as well as those in wetlands, to name a few. We distributed a total of 1,118,429 ITNs in the province, to protect approximately 2,236,856 people, which is 11% of the total population of Zambia.”

Chief Moyo delivering a session at the combined IRS-ITN microplanning session.

With logistical support from PMI Evolve, Chief Moyo visited all 12 districts in Luapula province himself, both during household registration to receive the nets, and then again during distribution, to ensure that resources were being used and allocated properly. In Lunga district, where families make a living by fishing, Chief Moyo anticipated the possibility of nets being misused as fishing nets once they were distributed, instead of for their intended purpose. Applying insights gleaned from a PMI-funded assessment of potential ITN misuse in northern Zambia, he engaged key local leaders, including representatives from the Ministry of Fisheries as well as traditional chiefs to educate communities on the need to use ITNs correctly. Through a series of meetings, they agreed on penalties for anyone found fishing with an ITN, another step to ensure that the nets would be used in communities as intended.    

Zambia, despite its progress, remains a high-burden malaria country with year-round transmission and varying intensities across regions. Chief Moyo, the hero at the heart of Luapula Province’s ITN campaign, embodies the spirit of dedication and collaboration needed to overcome malaria’s challenges and further the country’s progress to reduce malaria. His leadership stands as an inspiring example in the ongoing efforts to protect populations from this devastating disease, contributing significantly to PMI’s strategy to “end malaria faster.”




In Guinea, a Peace Corps Volunteer Supports Mosquito Monitoring

Growing up in Albany, New York, Blessing Uzoeshi didn’t spend much time thinking about mosquitoes. Now as a Peace Corps volunteer serving in Guinea, she thinks about them a lot, as she supports her community to learn more about malaria-transmitting mosquitoes and make strides in malaria prevention efforts.

Blessing Uzoeshi (left) watches as a community mosquito collector identifies a mosquito.

Guinea’s 12 million residents are at risk of contracting malaria, including the approximately 12,000 people who live in the town of Tormelin, a farming community where Blessing serves as a public health volunteer. In this role, she conducts outreach to pregnant women, providing education on malaria risk and prevention, since pregnant women and their babies can be at increased risk for complications due to malaria. Recently, she was trained to take on a new role in mosquito monitoring, as part of a collaborative initiative between the U.S. President’s Malaria Initiative (PMI) and the Peace Corps.

Community-based mosquito monitoring, a form of entomological surveillance, is an approach used in some countries to collect detailed information about mosquitoes. Data about their geographical distribution, resting and feeding habits, and other behaviors are needed to inform vector control methods that prevent malaria transmission—such as the distribution of insecticide-treated nets (ITNs). While this work is often led by trained scientists and vector control staff, community-based entomological surveillance (CBS) is an alternative approach in remote regions where local residents are trained to conduct mosquito collection.

In Guinea, the PMI Evolving Vector Control to Fight Malaria Project (PMI Evolve) is working with the National Malaria Control Program (NMCP) to help determine the drivers of malaria transmission in four high-burden areas, including Fria Prefecture, where Blessing lives. According to Yansane Alhousseny, the area’s entomological focal point, Fria Health District has the highest malaria incidence rate in the region, but there had been no entomological surveillance within affected communities, so he and his colleagues lacked the data they needed to make informed decisions about vector control.

Earlier this year, PMI Evolve trained Yansane and his counterparts in three other districts to overcome this challenge. “I was trained on the techniques of mosquito collection and identification in June 2023. In turn, I trained community volunteers from the Tormelin sub-prefecture on mosquito collection and identification techniques,” says Yansane. “After the training, these community volunteers collected mosquitoes in June and September 2023. This activity, which is a first in the prefecture of Fria, will provide data on malaria transmission, including the proportion of mosquitoes infected in Tormelin. This information will serve to raise awareness among the population and to develop our interventions at the community level.”

Peace Corps Volunteer Blessing Uzoeshi observing mosquito collection in Tormelin.

Blessing and four other Peace Corps volunteers in the high-burden communities took part in an online training to learn how to support the community mosquito collectors in their work. She is now providing supervision to Tormelin’s two community volunteers, to ensure that they are following the protocols they learned during training. She is also liaising with Yansane, who is 29 kilometers away from Tormelin, too far for him to regularly perform the supervision needed.

“Blessing’s involvement will allow close supervision and follow up on the others involved and will also enable us to think about expanding entomological surveillance into neighboring communities,” says Yansane.

Malaria awareness is a big part of my job here,” says Blessing. “This role is important because we’re searching and implementing ways to prevent malaria-related deaths. Through mosquito surveillance, we can identify the types of mosquitoes in our community and share this information with others who are working to reduce the transmission of malaria.”

Several activities are underway to advance Guinea’s entomological surveillance capacity to support malaria prevention and vector control efforts, which include strengthening mosquito collection processes and laboratory and insectary capabilities. However, this initiative with the Peace Corps is a fundamental example of how PMI is leveraging in-country resources to maximize the impact of malaria programming. These efforts will increase the effectiveness of mosquito monitoring and contribute to general malaria control activities that better protect people living in high-risk communities.





PMI VectorLink Adapts Durability Monitoring Assessment to COVID-19 Conditions

Data collectors in Ghana performing a net assessment. Photo by: Andy Asafu-Adjaye

When the COVID-19 global pandemic led to lockdowns and travel restrictions, the U.S. President’s Malaria Initiative (PMI) VectorLink Project adapted its work in the field to continue to protect people from malaria while mitigating the risk of COVID-19. Furthermore, the project modified its monitoring activities, including assessing the efficacy of vector control tools, such as insecticide-treated nets (ITNs).

The PMI VectorLink Project works with National Malaria Control Programs (NMCPs) to assess the durability and estimated average useful life of an ITN. These durability monitoring studies generate data on the survivorship, physical durability, and insecticidal effectiveness of ITNs over the three years following a mass distribution campaign.

However, the COVID-19 pandemic presented serious challenges to implementing durability monitoring since data is gathered using an in-depth household survey, net assessments, cone bioassays, and chemical content testing. The PMI VectorLink Project had to adapt quickly to mitigate the risk of COVID-19 for study participants and field teams so ITN durability monitoring activities could continue in nine countries.

These adaptations included wearing masks and gloves while in the field, frequent use of hand sanitizer, switching from written to oral consent to participate in the study round, limiting the number of individuals in field vehicles, and altering the method of net assessment by measuring holes with a ruler on the outside of the net to minimize contact with it.

Training processes were also altered in response to COVID-19. In all nine countries, PMI VectorLink Project conducted online training-of-trainers (TOT) followed by an in-person field worker training. In total, 162 hours of virtual TOT were conducted with 78 individuals from local data collection agencies, NMCPs, VectorLink, and global partners. Following TOT, local study leads conducted in-person fieldworker trainings to prepare fieldworkers for data collection. In-person activities reinforced COVID-19 mitigation measures, with trainings conducted outdoors where possible, participants maintaining physical distancing guidelines, and masks worn by all participants.

Burundi, Ghana, Liberia, Madagascar, and Niger were all scheduled to conduct data collection before August 2020, but a variety of in-country COVID-19 restrictions prevented activities from being carried out as planned. As soon as country restrictions were lifted, fieldwork continued with only minimal delays. Between September and December 2020, Burkina Faso, Kenya, Rwanda, and Sierra Leone conducted data collection as scheduled. By the end of 2020, PMI VectorLink had effectively and efficiently carried out all planned 2020 activities over five months rather than the originally planned 10 months.

For all nine countries combined, over a period of 140 days, data collectors visited 314 clusters where 126 fieldworkers were involved in administering surveys and assessing cohort mosquito nets. To date, 3,600 households have been visited, data has been collected on 7,600 nets, and more than 3,500 nets have been assessed for holes.

In addition to the household surveys and cohort nets, fieldworkers also collected 630 campaign nets to undergo bioassay analysis. These tests were conducted by seven different partners in Burkina Faso, Burundi, Ghana, Kenya, Liberia, Madagascar, and Niger.

Bioassays were also performed on new types of nets (piperonyl-butoxide [PBO] and Interceptor G2 brand [IG2]) for the first time as a part of the Burkina Faso study. PBO and IG2 nets are likely to play an important role in controlling pyrethroid-resistant malaria vector species and were distributed in Burkina Faso in 2019. Bioassay standard operating procedures (SOPs) for PBO and IG2 brand nets were developed by PMI, and Burkina Faso was the first PMI VectorLink-supported country to conduct durability monitoring of both PBO-synergist and dual active ingredient nets, in addition to standard pyrethroid nets. The Research Institute of Health Sciences (IRSS) in Bobo-Dioulasso successfully conducted cone bioassays of pyrethroid and PBO nets and tunnel tests with IG2 nets using well-characterized pyrethroid resistant and susceptible colonies of An. gambiae s.l. Experience from baseline tests led to SOP revisions, including a standardized approach to characterization of pyrethroid resistant Anopheles for use in bioassays and increasing the number of positive control new nets to quantify any loss of efficacy more accurately in field nets.

Dr. Gauthier Tougri, Medical Epidemiologist and Program Coordinator for the Burkina Faso NMCP said, “Burkina Faso introduced new generation ITNs [PBO and IG2 nets] for the first time during the universal ITN distribution campaign in 2019. It was therefore timely to conduct this durability study which should allow us to confirm not only that the insecticides used remain effective on existing Anopheles in areas where resistance had been observed, but also that these nets can indeed remain effective during the time interval between distributions.”

In 2021, PMI VectorLink will be conducting durability monitoring studies in 11 countries (Burkina Faso, Burundi, Cote d’Ivoire, Ghana, Liberia, Madagascar, Niger, Rwanda, Sierra Leone, Uganda, and Zambia). In addition, VectorLink will prepare for streamlined durability monitoring activities in Malawi and Nigeria to begin in 2022. VectorLink will draw on its COVID-19 lessons learned to successfully manage these studies: remote training of trainers’ sessions will be conducted to support local study teams, and all in-person trainings and fieldwork will comply with COVID-19 mitigation measures. VectorLink has strengthened in-person training guidelines to further minimize risks to participants and presenters. With advanced COVID-19 planning, all 2021 studies are expected to be conducted on schedule, continuing PMI’s commitment to support NMCPs to generate data on ITN durability.