The Village That Sleeps

IRS Success in Burkina Faso Provides Sleep to Once-Weary Community

PMI VectorLink sprayed 126,961 homes in Kongoussi, exceeding the MOH and NMCP targets and protecting 365,430 people from malaria.

Malaria remains a major public health issue in Burkina Faso as it is endemic throughout the country. Eighty percent of the estimated 19 million residents of Burkina Faso live in rural areas, where they are at greater risk of poor health compared to urban communities. To reduce the burden of malaria in the country and enhance vector control, the U.S. President’s Malaria Initiative (PMI) VectorLink Project implements indoor residual spraying (IRS), which kills mosquitoes that transmit malaria by spraying insecticide on the walls and ceilings where mosquitoes prefer to rest. PMI VectorLink serves three major health districts in Burkina Faso, including Kongoussi – the country’s largest district.

Kongoussi is surrounded by swamps and lakes that provide optimal larval breeding sites for malaria carrying mosquitoes. Residents have long-suffered from mosquitoes’ nighttime feeding patterns so much so that they have named the district Kongoussi, which translates to “village that cannot sleep” from its original name, Bito. Mosquitoes enter homes late at night to feed on human hosts; their uncomfortable bites and the noise of their buzzing often wake residents and prevent them from getting a good night’s rest.

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 PMI VectorLink Project in Burkina Faso is working with the Ministry of Health (MOH), the National Malaria Control Program (NMCP), and other stakeholders to achieve at least 85% spray coverage in the IRS targeted districts.  When it was announced that PMI VectorLink would conduct IRS in Kongoussi, local authorities were enthusiastic and hopeful for Kongoussi’s sleepless population.

When spray operators arrived in the village at the start of the 30-day spray campaign, they were eagerly welcomed by residents of the community. After having their houses treated, beneficiaries proclaimed their first peaceful night’s sleep, free from the discomfort and nuisance of mosquitoes. Some people who had previously refused IRS treatment reportedly came running after spray operators asking them to please go back and treat their homes after hearing of success from their neighbors.

In Kongoussi, overall mortality of malaria-carrying mosquitoes 24 hours after spraying in houses treated was 100%, indicating that the insecticide used (Actellic 300 CS) was highly effective and spray quality was good. PMI VectorLink sprayed 126,961 homes in Kongoussi, covering 90% of the district, exceeding the MOH and NMCP goal. The IRS campaign protected 365,430 people, including 61,180 children under the age of five and 6,664 pregnant women in the once weary district.

PMI VectorLink Burkina Faso’s Chief of Party Adama Kone jokingly said to district authorities, that hopefully they could change the village’s name from Kongoussi to Nangoussi, “the village that sleeps.”

 

Reduce, Reuse, Repurpose – Environmental Success in Benin

PMI VectorLink Transforms Waste into Resources

For the past ten years, the U.S. President’s Malaria Initiative (PMI) has implemented key vector control interventions in Benin to reduce malaria-related morbidity and mortality. Working in partnership with local governments and the National Malaria Control Program (NMCP), the PMI VectorLink Project conducts indoor residual spraying (IRS) to kill malaria-carrying mosquitoes. IRS involves spraying insecticide on the walls, ceilings and indoor surfaces where the mosquitoes rest. Since PMI began conducting IRS in Benin and with the improvement of health services, the Government of Benin has seen a downtrend of morbidity and mortality from malaria.

The cardboard boxes used to transport insecticide bottles are recycled into new materials, such as planks of wood that can be used to build the guard house shown here.

Large-scale IRS operations involve transporting millions of bottles of insecticide and materials via cardboard boxes. To ensure materials are safely disposed, PMI follows strict environmental best practices that adhere to both local Beninese and U.S. Government environmental protection guidelines. In Benin, PMI VectorLink took additional measures to reduce the negative impact on the environment, introducing new ways to reduce and repurpose packaging waste.

At the end of the most recent 2018 IRS campaign, PMI VectorLink Benin, in collaboration with local NGO, GAMAF s.a.r.l, (Germain Amadji & Fils), collected and repurposed 6,337 empty cardboard boxes into sheets of material for other innovative uses. Empty cardboard shipment boxes that once stored insecticide are stripped of plastic labels, shredded into small pieces and then grinded into a paste. The paste is mixed with a binder, composed of glue and dyes, and then molded into planks of material for construction, partition rooms, ceilings, small furniture, manufacturing of art objects, etc.

Through recycling the cardboard, 3,926 kg of biogenic carbon that is sequestered in the raw material of the cardboard is not being emitted into the atmosphere through incineration.

Dr. Filemon Tokponnon, Head of Vector Control Unit at the NMCP, said, “In Benin, IRS waste goes from trash to treasure.”

 

 

 

Forging Partnerships for Progress in Malaria Prevention

PMI VectorLink Collaborates with Liberia NMCP to Build Local Capacity in Entomological Analysis for Vector Control

ELISA–CSP training held at Liberian Institute of Biomedical Research (LIBR), Charlesville, Margibi County, Liberia. Photo credit: Helbert Lincoln, LIBR Technician

In the West African country of Liberia, the entire population of ~4.85 million is at risk of contracting malaria. As the leading cause of hospitalization and in-patient deaths, malaria exacts a serious health and economic toll on the country. A comprehensive understanding of the mosquitoes that transmit malaria requires trained entomologists who can gather precise data on the composition of the vector species as well as information on mosquito densities, seasonality, geographical distribution, biting time and location, and insecticide resistance status. Such information is critical to inform evidence-based decisions for vector control interventions. The U.S. President’s Malaria Initiative (PMI) VectorLink Project, building on gains achieved under the Africa Indoor Residual Spraying (AIRS) project, works with the Government of Liberia to improve the capacity of local entomologists.

In collaboration with NMCP, PMI VectorLink conducts entomological monitoring in three sentinel sites in three counties: Montserrado, Margibi and Bong. Historically, Liberia has outsourced the laboratory analysis (including species identification and infection rates) of mosquito samples collected during entomological monitoring to other countries. To improve the national entomological monitoring capacity, PMI VectorLink working together with Liberia’s National Malaria Control Program (NMCP) established a partnership in 2018 with the Liberian Institute for Biomedical Research (LIBR), the country’s main vector biology research laboratory. The LIBR has since become a part of the National Public Health Institute of Liberia (NPHIL). The PMI VectorLink Project and NMCP worked closely with LIBR to identify laboratory space at the institute for processing of mosquito samples, renovated the space and equipped it with a freezer, furniture, lab supplies and reagents for conducting analyses.

The PMI VectorLink Project hosted two trainers from the U.S. Centers for Disease Control and Prevention (CDC) Atlanta in April 2018 for a one-week training on laboratory techniques for detecting infectious mosquitoes.  Six technicians (four from LIBR, two from NMCP) were trained on enzyme-linked immunosorbent assays (ELISAs) to assess the malaria sporozoite rate in mosquitoes collected during entomological monitoring.

Following the training, NMCP and LIBR staff began analyzing the 11,000 mosquito samples that were collected and preserved from 2015 and 2016. For the first time, the team was able to identify infection status of Anopheles gambiae s.l., the primary malaria vector in Liberia, using ELISA techniques. Thirty percent of the samples have already been analyzed, and the remaining archived samples are expected to be completed by November 2018.

“As a parasitologist and a researcher, training and working in the project has enabled me to learn and apply the skills and expertise I never had prior to the training,” said Julius Teahton from LIBR. “This has provided me the means to work with mosquito samples using ELISA techniques.”

The PMI VectorLink Project will continue to work closely with the NMCP and other local partners to expand the country’s entomological capacity, supporting further training on ELISA methods to determine mosquito blood meal source and polymerase chain reaction (PCR) techniques for identification mosquito species. Liberia’s increased laboratory capacity to analyze mosquito specimens will provide more data on status and trends of malaria vectors and better inform and guide the country’s efforts to prevent the spread of the disease.

 

 

World Mosquito Day: A Story of Strength and Progress as Told Through Photos

Malaria is a preventable and treatable disease transmitted by the female Anopheles mosquito. Alone, this mosquito poses a deadly threat to nearly half of the world’s population, but women and children in sub-Saharan Africa are most at risk. Carrying 80% of the global malaria burden, the region is most vulnerable to malaria-related illness and death. In addition to loss of life, malaria places an economic burden on African nations, costing an estimated US$12 billion a year.

Despite the devastation the Anopheles mosquito has caused, investments made by host-country governments and international donors have helped protect millions of people from malaria. With support from The President’s Malaria Initiative (PMI), The PMI VectorLink Project continues the work of the PMI Africa Indoor Residual Spraying Project, protecting 20 million people a year from the deadly disease. Focusing our efforts in countries with the highest burden has allowed us to have the greatest impact. This World Mosquito Day, August 20, we reflect on the progress made in the fight against malaria and the strength of communities that are free of its burden.

Record Reductions in Malaria Cases in IRS Districts

Traditional community leaders improve quality of life through their support of IRS

Malaria is an endemic disease in Ghana. This makes any effort which reduces malaria worth celebrating. Among the interventions used to help in the reduction of malaria is Indoor Residual Spraying (IRS). IRS involves spraying an insecticide on the ceilings and walls of homes, where the malaria-carrying mosquitoes rest after feeding. The insecticide kills the mosquitoes, preventing the further spread of the disease. The US President’s Malaria Initiative (PMI) directly supports IRS implementation in selected districts in the Northern Region of Ghana.

Over the years, a number of studies and observations made by community leadership reflect the impact made by IRS in the society. A recent study published in the Malaria Journal [Coleman S. et al., Malar J (2017) 16:324] shows that IRS reduced malaria transmission in the districts studied as compared to the districts where IRS was withdrawn.

Mba Tarana, Second-in-Command to the Overlord of the Mamprugu Traditional Area and first Public Health Official in Ghana’s Northern Region, encourages the involvement of community leadership to ensure the successful spraying of communities in their Mamprugu Traditional Area.

Another study conducted jointly by the World Health Organization (WHO) and the Ghana National Malaria Control Program [Aregawi et al. Malar J (2017) 16:177] corroborates these findings. In the study, the researchers reviewed all health records from 2005 to 2015. In districts where IRS was implemented, a significant reduction (47%) over a the ten-year period in the number of malaria cases, and a greater impact on key malaria indicators was observed as compared to non-IRS districts. Malaria admissions decreased by 68%, malaria deaths reduced by 88% and test positivity rate (TPR) reduced by 89%. In non-IRS regions, the reduction in malaria admissions was 35%, and malaria deaths and TPR decreased by only 44% and 38%, respectively.

Traditional leader Mba Tarana said, “Since you [PMI IRS] began spraying our communities, we rarely see mothers rushing their children who have severe malaria and are convulsing to the hospital.” Community leaders such as Mba Tarana have contributed to the significant impact made by IRS through mobilization and monitoring of spraying in their towns and villages. Their involvement in and support of IRS have been critical to the success of IRS as they encourage the full participation of all stakeholders, resulting in reduced prevalence of malaria and the improved health and livelihood of those living in the PMI-supported districts.

 

Malaria Fighter: Peace Dellor

Tamale, Ghana:

Peace Dellor began working on the PMI Africa Indoor Residual Spraying Project (AIRS) in 2015 as a Data Entry Clerk in Ghana. Due to her diligence and hard work she was promoted to be the Monitoring and Evaluation (M&E) Assistant for Kumbungu District, one of the seven districts targeted by PMI VectorLink, which followed after the AIRS Project ended in 2017. Peace, who comes from Keta in the Volta Region of southeastern Ghana, studied at the Intercom Programming and Manufacturing Company Limited in Tamale and holds a diploma in Database Technology. Dellor recently talked about her experience with malaria and her role on the PMI VectorLink Project.

M&E Assistant Peace Dellor reviews the IRS data collection tool with colleagues. Photo credit: PMI VectorLink Project

PMI VectorLink: Have you had any experience with malaria?

Dellor: Yes, I remember when I was admitted to the hospital for days because I had malaria. This caused me to miss classes. It took me time to recover and go back to school to catch up with my colleagues.

PMI VectorLink: What are your duties as the M&E Assistant for the Kumbungu District?

Dellor: My role is critical as I have to ensure that accurate data is reported to the project. Here are some of my core duties:

  1. Train Spray Operators on spray data recording at the district level.
  2. Supervise Data Entry Assistants to enter data on a daily basis.
  3. Verify data cards by using the error eliminator.
  4. Sample some compounds to verify spraying.
  5. Assist the District Operations Coordinator in planning.
  6. Supervise Spray Operators’ data recording in the field.

For malaria prevention, I visit some of the difficult communities (that tend to refuse spraying) to talk to them about the benefits of the project. I go the extra mile in helping them to pack their belongings and get a Spray Operator to spray their rooms.

PMI VectorLink: Do you think Ghana will ever be malaria free?

Dellor: Yes, because if we can sustain the effort and also if we can be as resilient as the malaria parasite, we can make Ghana malaria free.

 PMI VectorLink: What has surprised you most about working with the PMI VectorLink Project?

Dellor: I am always surprised about the energy and the zeal some workers and community members who understand the aim and benefits of the project apply to their work.

PMI VectorLink: What do you find most challenging about your job?

Dellor: In my line of work, I do need a means of transportation to carry out field supervision. However, this was not always readily available. Dialects of the language commonly used in the district, Dagbanli, sometimes serve as a barrier and lead to misperceptions about the project

PMI VectorLink: How did the project address these issues?

Dellor: The project provided a motorbike to enable me to carry out my duties.

In dealing with the dialect problem, I was able to get other people in the area to help me to communicate and overcome the language barrier.

To address misconceptions about the project, I used IRS messaging, such as the benefits and effectiveness of IRS, and worked with advocates of the project in the communities to help change false perceptions.

PMI VectorLink: What impact has the entomological monitoring had on malaria in Ghana?

Dellor: The entomological monitoring team selects the correct insecticide to be used for spraying each year and monitors how the program is affecting the mosquito population and their ability to transmit malaria. This monitoring is critical in helping us make informed decisions on the appropriate measures to take in helping to reduce malaria prevalence.

Peace Dellor explains the data management system at Kumbungu Data Center to the USAID Evaluate for Health Project’s Data Quality Assessment Team.

PMI VectorLink: What changes have you seen in IRS implementation since the project began?

Dellor: There have been some impressive changes in IRS implementation because the acceptance rate has increased, support from some communities is very high and the passion of workers on this project has also increased.

PMI VectorLink: How has the incidence of malaria changed since you began working for this project?

Dellor: There is a remarkable report by Ghana Health Service on how malaria has reduced at the number of out-patient cases, and my personal encounter with some community members tells me that there has been a significant reduction in reported malaria cases.

PMI VectorLink: What do you wish people knew about the project?

Dellor: PMI VectorLink is a project one has to embrace because it comes with personal hygiene in that community members use it as an opportunity to clean up their rooms. Aside from targeting mosquitoes, the chemical kills some other insects which are nuisance to the communities. This project aims at protecting our people.

PMI VectorLink: What might someone be surprised to know about you?

Dellor: I am very friendly despite the rigorous nature of my role.

PMI VectorLink: What is your hope from the project?

Dellor: My hope for the project is that in some years to come Ghana will be malaria free and in the unlikely event when PMI pulls out, the Ghana government will be able to take over.

PMI VectorLink: What kind of impact have you seen from the project?

Dellor: PMI VectorLink has not only reduced malaria cases but has also reduced the unemployment rate. It serves as a source of income for many who use money earned from the project to finance their education, purchase inputs for their farms, set up a business or learn a trade.

The Container Store

PMI VectorLink Innovates, Transforms Shipping Containers into IRS Stores

In the West African country of Benin, the U.S. President’s Malaria Initiative (PMI), working in partnership with the Government of Benin, has conducted large-scale indoor residual spraying (IRS) operations since 2008. The PMI VectorLink Project works in 23 countries across the continent to prevent the spread of malaria and implements IRS in 14 countries. IRS kills the mosquitoes that transmit malaria through spraying insecticide on the walls, ceilings and indoor surfaces where the mosquitoes rest.

The Government of Benin contributes to the spray campaign by providing storage facilities in operational sites for the insecticide and supplies used for operations. Safe and easily accessible storage is essential to the success of the IRS campaign.

In 2017, the Government of Benin shifted IRS operations from seven communes in Atacora Department to two other departments of northern Benin: Alibori and Donga. Alibori and Donga were designated as their own departments as recently as 2016. As a result, the departments still lack the necessary buildings needed for their contribution to the IRS operations. To address storage needs, the PMI VectorLink Project transformed six shipping containers into temporary stores (two at the operational site of Djougou1, one at the site of Barienou, one at Kassakou and two at the central store of Natitingou to increase its storage capacities.

By transforming shipping containers into IRS stores, the PMI VectorLink Project is ensuring successful, more cost-effective and environmentally-sound campaigns.
The new store maximizes space.

The PMI VectorLink Project creatively designed the narrow, 40-foot steel shipping containers to ensure the best use of space. To manage extreme temperatures, the project equipped the store containers with a thermal regulation system consisting of a triplex roof (wooden boards) with openings for the circulation of ambient air and added windows and front doors. The store containers were placed on cement-concrete bases and the waterproofing of the pavements was guaranteed by a plastic sheeting to prevent any flow of liquid product that could contaminate the soil.

Converting a container to a store costs around 2,240,000 CFA ($4,000), which is far more economical compared to the building a permanent structure/store with the same capacity, which can cost more than 10 million CFA or nearly $18,000. Thanks to this innovation, PMI VectorLink has been able to comply with best management practices for IRS in vector control and achieve its spraying coverage targets in the new intervention area during the 2018 IRS campaign.

In addition to the cost-efficiency of using containers as stores rather than permanent structures, the project also has the ability to move the containers to different operational sites, further minimizing expenses in setting up operational sites. Finally, the project is reducing overall environmental impact as the containers are being repurposed rather than discarded.

Multilateral Initiative on Malaria 2018

April 2018 was a significant and exciting month for malaria, rich with new commitments and milestones reached in the fight to end malaria once and for all. It stated with many partners and stakeholders convening in Dakar, Senegal, for the Multilateral Initiative on Malaria (MIM) conference. MIM, founded in 1997, is an alliance of individuals and organizations that work to strengthen and discover tools for malaria control in Africa through collaborative research and training. PMI VectorLink staff attended and gave presentations on a number of indoor residual spraying (IRS) topics from environmental compliance to data collection and mapping.

Peter Chandonait presented on Environmental Compliance Concerns and Solutions that Arise from Malaria Control via IRS.

Ashley Thomas presented on Technology and Vector Control: How Real-time Data, Mobile tools, and Mapping can Improve Operations and Results.

Allan Were and Dereje Dengela presented on Capacity Building for IRS in Africa.

Ashley Thomas and Dereje Dengela presented on The Impact of IRS on Measures of Malaria Transmission and Incidence.

 

To view the presentations in depth, head over to the Vector Learning Xchange to download and view at your leisure.

World Malaria Day 2018

This year, the PMI VectorLink Project celebrates World Malaria Day by recognizing the many spray operators who defend their communities from the threat of malaria. Since 2006 the President’s Malaria Initiative has protected millions of people in sub-Saharan Africa from malaria through Indoor Residual Spraying (IRS). Our spray operators go household to household to spray insecticide on walls and ceilings – targeting mosquitoes that carry the malaria parasite. The PMI VectorLink Project helps build the capacity of communities to deploy vector control tools like IRS, but without the commitment of our health workers and spray operators, the fight against malaria would be hard lost. We would like to recognize and thank the thousands of malaria fighters who suit up and spray to end malaria.

One such malaria fighter is very special to us. Meet Nidio Macie, a former IRS spray operator who rose in rank to become a district coordinator in Mozambique’s Milange District in Zambezia Province. As a young boy, Nidio dreamed of being a soldier in the military. He wanted to save lives and protect his country from threat. Each morning he would stand in awe as he watched his aunt gear up and head out to the field with her fellow spray operators to ward off the mosquitoes that had been ravaging his community with death and disease.

“Whenever I saw the spray operators, I used to follow them out to their work bases and watch them mix insecticide and load it into their spray pumps. I loved seeing them suited up in their protective overalls – they looked like soldiers to me.”

Watching the spray operators in action motivated Nidio to join the PMI VectorLink Project to fight against malaria. In 2017, PMI protected 1.7 million people in Mozambique from this deadly disease with IRS thanks to malaria fighters like Nidio.

To this day, Nidio’s childhood memories motivates him to serve and protect his community. “There is a motto we use here,” he says, “KILL MOSQUITO, SAVE THE PEOPLE! I go out and I save lives.”

PMI Prevails in Protection

Despite Political Unrest in Kenya, PMI AIRS Provides Protection Against Malaria

Pregnant women and children under five are at high risk of contracting malaria in areas where the disease is endemic. The PMI AIRS Project in Kenya carried out indoor residual spraying in the country’s Lake Victoria region, providing 2.2 million people protection against malaria.

Approximately three-quarters of Kenya’s population is at risk of contracting malaria. In 2017, the U.S. President’s Malaria Initiative (PMI) conducted a successful indoor residual spraying (IRS) campaign in Kenya’s Lake Victoria Region, protecting more than 900,000 people from malaria. The lake region accounts for the country’s highest malaria burden. Based on the success of the 2017 campaign, the PMI Africa Indoor Residual Spraying (AIRS) Project was eager to carry out the 2018 IRS campaign, which aimed to more than double the number of structures sprayed from approximately 212,000 in 2017 to more than 488,000 in 2018.

However, when Kenya’s Supreme Court annulled the country’s presidential election in August 2017, political unrest and violence broke out throughout the country, particularly in the lake region. The lake region is the homeland of Kenya’s opposition leader, center of Kenya’s opposition political party, and traditional home of the Luo minority ethnic community. Roads were frequently impassable because of barricades, tear gas and roadside checkpoints; and businesses and government offices were closed for weeks with key local partners and stakeholders unavailable.

Headquartered in the lakeside city of Kisumu, the project was faced with the challenge of continuing its activities, including IRS, entomological monitoring and health facility surveillance, while ensuring the safety of its project staff. Project staff are from diverse ethnic backgrounds and would need to risk their personal safety to access spray areas, continue pre-IRS planning activities, or collect entomological data to inform vector control.

These challenges could have easily provided reason to cancel the 2018 IRS campaign and delay IRS expansion for future years, however, the PMI AIRS Project and its staff refused to accept the delay, determined to protect people this year. Among the 2.2 million people targeted to receive IRS in 2018, roughly 15% are children under age five and 2% are pregnant women: populations of people with the highest malaria mortality rates and living with the greatest risk of the malaria disease burden.

To successfully increase IRS coverage, the project built 40 new operational sites across the region, purchased 113,990 bottles of insecticide plus other IRS commodities, and recruited and trained an additional 3,888 people to deliver IRS. These sites were in addition to the 28 operational sites and 3,067 people who were trained and worked in 2017. During the prolonged political unrest, expansion of coverage was particularly challenging.

On March 24, 2018, the project accomplished its goals in just six weeks, protecting more than 2.2 million people from malaria in the region burdened with the highest incidences of the illness.