Lidia Cipriano Shares a Portion of Her Land with Mozambique Government to Help Fight Malaria in Her Community
Lídia Cipriano is no stranger to sacrifice, a single mother of two children, she knows well that sometimes sacrifices are made for the health and benefit of family and community. Cipriano lives in Lualua, a village in Mopeia District in Mozambique’s Zambezia province where she offered a piece of her land to the local government to help fight against malaria in her community. In collaboration with the U.S. President’s Malaria Initiative (PMI) VectorLink Project, the Serviços Distritais de Saúde Mulher e Acção Social (SDSMAS) Mopeia used the donated land to establish an operation site to help the project implement indoor residual spray (IRS) activities in the district.
Malaria is considered the most important public health threat in Mozambique, where it accounts for nearly one-third of all deaths and 42 percent of deaths in children under five years old. PMI VectorLink equips countries to plan and implement safe, cost-effective and sustainable IRS programs and other proven life-saving malaria vector control interventions with the overall goal of reducing the burden of malaria. To safely and efficiently implement IRS, an operations site must be selected that is strategically located for accessibility and logistics is essential.
Lualua Village is about 45 km away from the nearest operation site in Posto Campo. Last year, the IRS team faced enormous transportation and logistical challenges to spray Lualua Village and its surrounding communities. In Mozambique, all IRS operations sites are situated on local government land and close to a health facility. In Lualua, however, the local government did not have any land to accommodate an operations site. In their search, the Mopeia District Health Directorate and PMI VectorLink approached Cipriano about a piece of her land.
“When the project explained to me the purpose for which they needed the piece of land, I did not think twice, I accepted. They came to me because God appointed me to contribute to saving lives from malaria. I think this is part of my mission here on earth.”
– Lidia Cipriano
Lídia’s sacrifice means sharing a portion of her land with the project resulting in disruption of her day to day life during the spray campaign. Despite this, Lídia felt that protecting her community from malaria was more important.
The newly established operations site will allow the project to hire local talent and recruit 31 new staff members from Lualua village, unlike in previous years where seasonal workers had to be recruited from the neighboring Posto Campo village. The operations site will be used to implement IRS activities in about 40 communities targeting about 7,600 structures and protecting an estimated total population of 33,800 against malaria.
Rates of Malaria-related Illnesses and Deaths Drop in 2018 after PMI VectorLink Conducts IRS Campaign
In Ethiopia, malaria is endemic to the country’s western Gambela Region and one of the region’s top three causes of sickness and death. The 2015 Malaria Indicator Survey indicated that malaria prevalence is higher in Gambela (18.4%) than in any other region in Ethiopia (national average of 1.2%). In 2017, Gambela’s health facilities reported 102,053 cases of malaria and 13 malaria deaths. To help reduce the burden of malaria, the U.S. President’s Malaria Initiative (PMI) VectorLink Project conducted indoor residual spraying (IRS) throughout Gambela in 2018. IRS involves spraying insecticide on the indoor walls and ceilings where mosquitoes that carry the malaria parasite tend to rest.
The PMI VectorLink Project worked with the Gambela Regional Health Bureau (RHB) to plan for and spray the homes of all residents in the 14 districts of the region with an estimated population of 315,577. The project successfully sprayed 95,564 structures over the course of 20 days, protecting 301,382 people from malaria, including 13,051 pregnant women and 62,792 children under five. The RHB described the 2018 results of the IRS campaign in Gambela Region as one of the best malaria interventions ever experienced in the region.
“There has been a drastic reduction in malaria burden in Gambela Region for first time in many years,” said Dr. Oman Amulu, Head of the Gambela RHB. “Over the years, the region has been implementing interventions for malaria, but there has been no drastic reduction in malaria burden until in 2018 when quality IRS was implemented. We noticed a huge reduction in malaria cases and malaria fatalities. This can only be because of the quality IRS supported by PMI VectorLink as it was the only difference in malaria intervention from previous years.”
According to data from the RHB, malaria cases in September 2018 were 39% lower than those recorded during the same month in 2017. Annual deaths attributed to malaria also fell from 13 in 2017 to 3 in 2018. In 2018, Gambela Region recorded a cumulative 57,882 cases of malaria compared to 94,257 in 2017 and 92,465 in 2016.
Regional Malaria Health Promotion Disease Prevention Officer, Jay Orem, said that the 2018 statistics are a result of good planning, quality training, and effective supervision, which led to high coverage and quality IRS. Although the region conducted spray campaigns in the past, in 2018, Orem said the teams received more systematic supervision and submitted performance data daily.
“PMI VectorLink Project has made a huge difference in planning, training and supervision for IRS. This is what has been missing for many years in Gambela Region to eliminate malaria,” said Orem.
January 30 – February 1, 2019
The Roll Back Malaria (RBM) Partnership to End Malaria is the global platform for coordinated action against malaria. RBM is comprised of more than 500 partners committed to combatting the disease, including malaria endemic countries and their governments, the private sector, and nongovernmental and community-based organizations.
Since 2017, The President’s Malaria Initiative (PMI) PMI VectorLink Project has supported the RBM Partnership through its co-chair position on the Vector Control Working Group (VCWG) and through hosting the Partnership’s premier resource hub and online community platform, the Vector LearningXchange.
Key staff from the PMI VectorLink Project travelled to Geneva to present new developments and key results on insecticide rotation, data and decision making in IRS, and data collection.
See below for presentations from the conference. These presentations have also been made available on the Vector LearningXchange.
PMI VectorLink VCWG 2019 Presentations:
In 2018, Victor Kasuzweni joined the U.S. President’s Malaria Initiative (PMI) VectorLink Project in Malawi as Environmental Compliance Officer (ECO). With a Bachelor of Environmental Science from the University of Malawi and a Master of Environmental Engineering from Suzhou University of Science & Technology in China, Kasuzweni committed himself to protecting the environment long ago. Growing up in Chikwawa, one of Malawi’s low-lying southern districts, he developed a passion for nature at a young age. Recently, Kasuzweni talked about his experience with the project.
How did you get involved in the field of environmental compliance and safety?
I used to watch nature channels on TV from a young age. My motivation to work in the environment came about when I started to hear about pollution and environmental problems, and how we can make the world a safe place. This motivated me to pursue a career in environmental sciences. I have worked for a number of organizations in the area of climate change, emergency response, environmental management and protection over the years. In 2010, I joined the Government’s Environmental Affairs Department, and I was posted to work in Nkhotakota District as an Environmental Officer responsible for the coordination of all the natural resources and environmental management activities at the district level. While working in the district, I was introduced to indoor residual spraying (IRS) which aims to reduce the malaria disease burden. I actively participated in the planning and implementation of IRS activities. The field of environmental compliance and safety in IRS is exciting and fulfilling because it ensures the safety of residents and workers from insecticide exposure and the protection of the general environment from chemical spills while ensuring substantial reduction of malaria disease burden among the communities.
I feel motivated and work hard to deal with demanding and challenging issues more particularly when I see that the initiative I am involved in, such as IRS, is impacting positively on people’s lives. I also feel good to receive feedback from the residents that benefitted from IRS and various stakeholders for the work I am doing. This provides important information for reviewing and reflecting on approaches and strategies to continuously improve on the project’s implementation.
Can you talk about your work with the PMI VectorLink Project?
I joined PMI VectorLink in 2018 and my key responsibility is to ensure the project is environmentally compliant and implemented in accordance with the IRS Best Management Practices and local guidelines. This involves the development of a number of documents to guide the project’s work. I am involved in the planning and implementation of a number of activities that minimize or eliminate potential risks to human health and ecological systems. For instance, I work in close collaboration with the PMI VectorLink project team, government counterparts and local leadership to identify appropriate areas for establishing operational sites needed for the project. I am also involved in the planning and delivery of environmental trainings for various cadres working in IRS, including conducting IRS spray supervision during and after implementation to ensure adherence to safety standards.
What kind of initiatives has the project taken on to protect the environment?
The project conducted EC trainings for stakeholders on various aspects, such as use of personal protective equipment, handling of insecticide exposures, spills, and construction of wash areas and soak pits to deal with effluents to ensure safe disposal. The project has outlined emergency response procedures to deal with adverse effects in times of emergencies and also developed memorandums of understanding (MOUs) with local recycling companies working with paper and plastics. The MOUs lay out guidelines for the proper handling of particular IRS wastes to protect human health and the environment. For instance, the MOUs state that any recycling waste from IRS will not result in the manufacturing of food packaging products or any products that will come in contact with food.
What kind of impact have you seen from the project?
The project is having a big impact on people’s lives especially through the reduction of malaria disease burden. Malaria has been an issue and remains a leading cause of morbidity and mortality in the district. The feedback we are getting from the residents is quite encouraging. They welcome IRS and are seeing immediate changes to mosquito density in their homes. Furthermore, the project has significant implications on socio-economic development. For instance, the project has been a source of employment and brought about economic empowerment in the process. The project design also gave women a chance to actively engage in IRS implementation at various levels. The communities really appreciate this initiative because it empowers women to work on various leadership positions. IRS is one of the most effective malaria control strategies. We encourage people to accept IRS and use it alongside other strategies such as using mosquito nets and keeping surroundings clean and with no stagnant water. Because there hasn’t been IRS in the area for six years the district also benefitted from the project trainings and capacity building sessions. It is envisaged that the knowledge and skills gained will go a long way in making IRS implementation more effective.
What is your hope from the project?
I have a great hope that the project will have made substantial reduction of malaria burden by 2022. Through the effective planning and implementation of IRS among stakeholders in the district, there will be a number of best practices to inform learning and programming and share with other partners working on IRS in Malawi.
PMI Collaborates with Malawi Government to Combat Malaria
The numbers were going the wrong way. After a six-year absence of indoor residual spraying (IRS) in Malawi, the number of people falling ill from malaria was steadily rising, with confirmed malaria cases more than doubling since 2012.
“Mortality is 19.8 per 100,000 people. That’s 10 deaths a day – 3,650 a year from malaria alone. That’s too many,” said Dr. Michael Kayanga, Vector Control Program Manager for Malawi’s National Malaria Control Program (NMCP). “We were the only country in the region not implementing IRS.”
IRS involves spraying an insecticide on the walls and ceilings where mosquitoes carrying the malaria parasite tend to rest. Eager to reverse the deadly upwards trend, the NMCP collaborated with the U.S. President’s Malaria Initiative (PMI) VectorLink Project to bring IRS back to Nkhotakota District – one of the country’s most vulnerable areas and a district that PMI last sprayed in 2012.
If the partnership continues the way it started, we should be very successful and each child under five can be free of malaria. With the PMI VectorLink Project, I hope we have reduced malaria by more than 50 percent of the current status in the next two years.
– Shadreck Mulenga
Deputy Vector Control Program Manager, NMCP
In October and November 2018, PMI VectorLink successfully sprayed 112,264 structures during a 32-day campaign, protecting 501,324 people including 11,066 pregnant women and 90,953 children under five, who are at the highest risk of dying from the disease. In addition to implementing IRS, PMI VectorLink provided training at district and national levels of government in spray quality, supervision, planning, logistics and environmental compliance and safety, including how to handle insecticide and dispose of IRS waste.
Peter Kamuloni, Nkhotakota District Environmental Health Officer, said, “Before, we were just learning in school, but not on the ground. The project training took it to the practical level and what we learned can be applied to dealing with other chemicals. The inventory tracking training was also key. IRS storekeepers learned enough that they can work for big companies now.”
While PMI conducted the IRS campaign, the government played a key role in the recruitment of seasonal workers, community mobilization, and donated the space for data collection centers.
“Most projects fail because of poor planning,” Kamuloni added. “PMI VectorLink had good leadership. Everyone was 100 percent committed. The incentive for us was that the NMCP was part and parcel of the project. We were respected and were not treated as if we were outside the project; and the project was in line with our goals as a district – to reduce malaria.”
PMI VectorLink is also helping the NMCP to develop a roadmap for its Insecticide Resistance Management Plan to ensure the long-term efficacy of IRS.
“We’ve collaborated well and we really own the project,” said Dr. Kayanga. “We’re quite happy. Since we sprayed, there’s already been a huge difference in the reduction of mosquitoes. People even called to tell us thank you.”
PMI VectorLink Ensures Successful IRS Campaign during Caterpillar Harvest
When the rainy season arrives in the south-central Africa country of Zambia, families both rejoice and worry. The wet months bring an onslaught of mopane worms, locally known as caterpillars. These insects are a healthy source of protein and revenue, particularly for rural communities who depend on the harvesting season for added income. A cup of caterpillars sells for the equivalence of US$4. During the hunting season, which spans about four weeks, an average household can make approximately $80. In Zambia, where 60 percent of the population lives below the poverty line, the added income during rainy season can provide much needed security.
But with those rains comes another insect that can wreak havoc on a family’s health and economic well-being: the malaria-carrying mosquito. Malaria accounted for 13.5 percent of Zambia’s annual hospital admissions in 2017 with children and pregnant women at highest risk of infection. To reduce the spread of the disease, the US President’s Malaria Initiative (PMI) VectorLink Project supports the Zambia government to implement indoor residual spraying (IRS). IRS involves spraying long-acting insecticides on the walls and ceilings of people’s homes to kill the mosquitoes. In 2018, the PMI VectorLink Project supported IRS campaigns in 29 districts in four provinces – Luapula, Muchinga, Northern and Eastern.
While offering life-saving protection, the 2018 spray campaign coincided with the period when households migrate to the forests to hunt for caterpillars. This activity would ordinarily have posed a major challenge for the 2018 IRS program since householders lock up their homes during the hunting exercise, thereby making access impossible for the spray teams. Furthermore, IRS requires beneficiary communities to remove their household items from their homes so that the indoor walls and ceilings can be sprayed.
The PMI VectorLink Project in collaboration with the National Malaria Elimination Program (NMEP) engaged authorities in 15 of the districts that hunt for caterpillars as well as the traditional leadership in these communities. PMI VectorLink tailored the IRS campaign to accommodate the movement of the communities. In some districts, the campaign was suspended for a few days to allow the migrating communities to return from their forest camp sites and have their homes sprayed. These accommodations ensured that the caterpillar hunting exercise could go on concurrently with the IRS campaign thereby creating a win-win situation for the community: they generated sizable incomes from the caterpillar harvesting while also being protected from malaria-carrying mosquitoes.
Dr. Emmanuel Kooma, Head of Vector Control at the NMEP, said, “Engaging the district and traditional leadership yielded very positive results with regards to the caterpillar harvesting situation in the communities.”
During the 2018 IRS campaign, PMI VectorLink sprayed 559,137 homes, surpassing its 85 percent coverage target and protecting more than 2,722,414 people, including 87,163 pregnant women and 397,483 children under five.
PMI VectorLink Increases Women’s Participation in IRS by Removing Barriers
Malaria remains the leading cause of morbidity in Uganda, accounting for 4% of all estimated malaria cases in 2017, according to the World Malaria Report 2018. To reduce the burden of malaria in Uganda, the President’s Malaria Initiative (PMI) VectorLink Project implements indoor residual spraying (IRS) to kill the mosquitoes that transmit the disease. PMI VectorLink works with Uganda’s Ministry of Health in planning and implementing IRS in 15 districts, strengthening the country’s capacity to manage IRS.
Because an important part of increasing capacity is ensuring the participation of women in IRS, the project encouraged women who were already working in the district health offices and the National Malaria Control Program (NMCP) to attend the training.
“Our aim is to strengthen the capacity of districts in all the malaria high-burden districts in Uganda so that they are able to plan and implement quality IRS and reduce malaria in their districts as one of core responsibilities. This is the responsibility of each person. I really appreciate the fact that the project has taken steps to increase female participation in IRS,” said Dr. Jimmy Opigo, Program Manager for NMCP Uganda. He added that the only way to defeat malaria is to involve every member of society affected by malaria, and women play a critical role in these efforts.
In the past, women’s participation in IRS has been significantly lower than that of men due partly to gender-based barriers that can constrain women’s participation. Mothers of young children can find it difficult to attend required trainings to qualify for IRS jobs. To increase women’s participation in IRS, and more specifically, to build a cadre of women in supervisory roles, the project provided meals and accommodations during trainings for participants and their babysitters. This allow for the full participation of mothers of young children during a recent five-day “boot camp” training held December 3-7, 2018. Nineteen women were trained on the implementation of IRS, supervision and gender inclusion, a 12 percent increase from last year.
Beatrice Apong, Health Inspector for Lira District, attended the training with her three-month-old baby. “I was really honored to be part of the IRS boot camp training,” she said. “I am grateful to the project for the support accorded to my baby helper which gave me ample time to be part of the training.” She added that she will work to ensure that more women are recruited and participate actively in IRS as a member of the district health team.
World Health Organization. (2018). World Malaria Report 2018. World Health Organization. http://www.who.int/iris/handle/10665/275867.
PMI VectorLink Boosts Women’s Roles in IRS, Promoting Gender Equity
For Agbethia Malenga, there is no job a woman can’t do. With a certificate in automobile mechanics, this 29-year-old is not your stereotypical woman. But it’s women like Malenga who are helping to challenge gender roles and making a difference doing it. Recently, Malenga played a key leadership role in helping the U.S. President’s Malaria Initiative (PMI) VectorLink Project in Malawi to successfully carry out the country’s first Indoor Residual Spraying (IRS) campaign since 2012. IRS kills mosquitoes that transmit malaria by spraying insecticide on the walls and ceilings where mosquitoes prefer to rest. PMI returned to Malawi in 2018 to help reduce the burden of malaria in one of the country’s hardest hit areas: Nkhotakota District.
Dr. Michael Kayanga, Program Manager for Malawi’s National Malaria Control Program, said that in this district, “Contracting malaria twice in one year is expected but more than once in a month is common for children. When sick so often, children can easily slide into malnutrition. Malaria affects the entire household.”
Mortality from malaria was 19.8 per 100,000 people, according to the 2015-16 Malawi Demographic and Health Survey. “That’s 10 deaths a day – 3,650 a year from malaria alone,” said Dr. Kayanga. “The incidence of malaria is 5.8 million cases or one-third of our population. If you consider that two people care for the ill, that’s affecting the whole population.”
Pregnant women and children under five are the most vulnerable to malaria. As the primary caregivers, women face an additional burden when malaria strikes a family.
Malenga is excited to help bring those numbers down. In 2018, PMI VectorLink sprayed 112,264 structures, protecting 501,324 people including 11,066 pregnant women and 90,953 children under five.
“I love my job. IRS is an area of work that is traditionally for men. Many men told me I couldn’t do it. At first I wasn’t sure I could – not because I’m a woman but because it’s a big job.”
Malenga served as an IRS Site Manager, overseeing 127 people, including Spray Operators, Team Leaders, Washers, Supervisors, Storekeepers, Security Guards, as well as a Monitoring and Evaluation Assistant, a Finance Assistant, and an Information, Education, and Communication Assistant. PMI VectorLink encourages women to apply for all positions on the project and ensures equal opportunity for women in supervisory roles. In PMI VectorLink Malawi’s first year of implementation, 40% of all seasonal staff were women.
Malenga said the project taught her how to work under pressure and gave her the confidence she needed to manage a large site. “PMI VectorLink was very transparent in the hiring process,” she said. “The security and safety precautions on the project were excellent. They ensured women had the right Personal Protective Equipment (PPE) and sufficient training to protect themselves.” The project provided sexual harassment guidelines to all its workers with posters and job aides in the local language Chichewa and regular SMS messages to workers’ phones to reinforce the training. The project also ensures women and men have separate changing areas to ensure privacy.
“One Spray Operator said he couldn’t work for a female Team Leader,” said Malenga. “I told him that if you have a problem with her, then you have a problem with me and that he wouldn’t be able to work on the project. He straightened up quickly.”
“When I walk by, some of the mothers in the community tell their children, ‘Look at her. She’s a woman in an important job. If you work hard, you can do something important, too.’”
– Agbethia Malenga, PMI VectorLink Malawi IRS Site Manager
Promoting the role of women in IRS – an area that has historically been male-dominated – is helping to improve the overall economic power of women.
Spray Operator Bertha Banda said that because the project hires women, it is helping to provide her extra security. “As a mother, the project has given me peace of mind. My son had malaria as a baby in 2015. He had fevers and diarrhea. I couldn’t work. I’m so happy to be a Spray Operator. I’m able to pay my son’s school fees, invest in my clothing business and buy seeds to plant maize. IRS gives us double protection.”
In the southeast African country of Malawi, malaria accounts for 40 percent of hospitalizations in children under five, 30 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. To help protect people from malaria during this year’s rainy season, the U.S. President’s Malaria Initiative (PMI) conducted an indoor residual spraying (IRS) campaign through the PMI VectorLink Project in October and early November 2018. IRS uses an insecticide that kills the mosquitoes that transmit the disease. PMI VectorLink successfully sprayed 112,264 structures during a 32-day campaign, protecting 501,324 people including 11,066 pregnant women and 90,953 children under five. Recently, we talked to some of the beneficiaries and seasonal workers for the project. Here is their story. Photos by Laura McCarty/Abt Associates