The 2020 Annual Meeting of the American Society of Tropical Medicine & Hygiene (ASTMH).
Sunday, November 15 – Thursday, November 19, 2020
The ASTMH Annual Meeting draws tropical medicine and global health professionals representing academia, government, non-profits, philanthropy, NGOs, industry, military, and private practice. The meeting is designed for researchers, professors, government and public health officials, military personnel, travel clinic physicians, practicing physicians in tropical medicine, students, and all health care providers working in the fields of tropical medicine, hygiene, and global health. This year, the Annual Meeting will be a five-day virtual conference. The PMI VectorLink Project is at the forefront of innovative prevention and surveillance methods that protect vulnerable communities in sub-Saharan Africa from the burden of malaria.
The PMI VectorLink Project recently published an entomology manuscript in Malaria Journal on malaria vector species composition and entomological indices following indoor residual spraying in regions bordering Lake Victoria, Tanzania.
Vector control through long-lasting insecticidal nets (LLINs) and focal indoor residual spraying (IRS) is a major component of the Tanzania national malaria control strategy. In mainland Tanzania, IRS has been conducted annually around Lake Victoria basin since 2007. Due to pyrethroid resistance in malaria vectors, the use of pyrethroids for IRS was phased out and from 2014 to 2017 pirimiphos-methyl (Actellic® 300CS) was sprayed in regions of Kagera, Geita, Mwanza, and Mara. Entomological surveillance was conducted in 10 sprayed and 4 unsprayed sites to determine the impact of IRS on entomological indices related to malaria transmission risk.
This study contributes to the understanding of malaria vector species composition, behaviour and transmission risk following IRS around Lake Victoria and can be used to guide malaria vector control strategies in Tanzania.
The COVID-19 pandemic continues to affect communities around the world. It is key that we remain vigilant in deploying malaria control interventions to help prevent further strain on health systems. Syngenta recently partnered with Goodbye Malaria to host a webinar on how malaria control practices should be adapted to provide effective vector control and keep teams and communities safe from COVID-19. Technical Program Manager, Djenam Jacob, provided an insightful look at how The PMI VectorLink Project has done just that during the project’s most recent indoor residual spraying campaigns.
Read more about the event here and click here to watch the full webinar.
Uganda In Eastern Uganda’s Serere District, Ojok John works for the PMI VectorLink Project as a storekeeper for indoor residual spraying (IRS) campaigns. When not working on an IRS campaign, Ojok attends to his small-scale farm and volunteers with the village health team at the Adepi Village health center where he supports the outpatient department in the antiretroviral therapy clinic and immunization clinic to serve his community. Recently, PMI VectorLink’s Information, Education and Communication Coordinator Daniel Eninu spoke with Ojok about how malaria has affected Ojok’s community and how his earned income from fighting malaria has changed his life.
Can you talk a bit about how malaria has affected your life?
Malaria has affected my life in many ways. The community and my close relatives have been affected through deaths of loved ones, especially children. Malaria also has taken away our little income earned to pay for treatment, which should have been money for household growth. The disease has also affected my family through loss of time at work when we are sick or caring for others. As a Village Heath Volunteer, I can confess that malaria is a serious health problem in my community. I have witnessed children and mothers die of the disease. We live near a lake so my community has several mosquito breeding habitats that encourage breeding of the malaria vectors. But since 2015 when IRS began, I have witnessed a reduction in deaths due to malaria in my village.
Have you ever had malaria? If so, can you talk about it?
Yes, I have had malaria a number of times. It has been an agonizing experience with lots of fever, headaches, vomiting, among many other symptoms. I had to struggle to get to the nearby clinic where I was tested and given medication for treatment.
What have you learned from working with the project?
I have learned a lot, such as strategies for fighting malaria, including IRS, use of insecticide-treated nets (ITNs), visiting health facilities as soon as symptoms are noticed, and ensuring that pregnant mothers visit facilities for antenatal care and testing for malaria before treatment. I have a lot of experience in managing store documentation or records in IRS working as a storekeeper. I can also handle logistics within store settings. As an IRS team leader, I’ve gained the experience of interacting and mobilizing communities for IRS and other health actions leading to behavior change, especially with how to deal with difficult communities.
How has your job changed since being promoted to storekeeper?
While I was a spray operator, much of the work was to ensure I sprayed houses appropriately. This gave me a lot of opportunity to interact with the community. I learned that trust and dedication are critical as I worked in people’s houses. This level of commitment helped me to be noticed and promoted to a team leader and later to storekeeper. As storekeeper, I have been entrusted with important and expensive project equipment and supplies. I also have been able to manage spray teams to achieve targets and produce results at the end of spray campaign.
How has working on the project changed things for you?
The income I received from the project enabled me to register as a private candidate to complete my secondary education in 2017. Without IRS, I would not have managed to complete my education. This is a great achievement for me, and I hope to join a vocational college in the future. The opportunity provided to me by USAID/PMI, District Health Team/Ministry of Health and the local council has really changed my life. The financial earnings I receive each spray campaign also enabled me to construct three temporary houses for my family and also buy two bulls, which I use for ploughing during the planting season thus earning me extra income.
How have behaviors changed in your community?
At the beginning of spray activities there were a lot of myths around insecticide use, including causing men to become impotent and women to become barren, which caused resistance. But with a lot of health education and sensitization from local leaders on the benefits of IRS these myths were addressed and people accepted spraying their houses to protect themselves from malaria. The integrated messages on malaria we provide to the communities have led to improvement in use of the malaria control measures such as use of ITNs, visiting health facilities early for testing and treatment, and draining stagnant water pools to eliminate breeding of mosquitoes. My community, I would say, is adopting healthy behaviors.
Are fewer people getting sick and how has the community responded?
Since the start of IRS and distribution of ITNs, the number of people getting sick and visiting health facilities has drastically reduced. People are able to spend more time on productive activities. The community has responded well since they have realized the benefits of malaria prevention.
What do you find most challenging about your job?
The biggest challenge of being an IRS storekeeper is managing spray teams with people from different backgrounds and different levels of motivation. I have learned how to deal with difficult people so that our work of IRS proceeds. The work involves ensuring proper store records are kept at all times.
What do you find most rewarding?
The most rewarding thing is the skills that I have attained over time in store management, which I think can take me to another level of working in other logistical management jobs. Besides the reward of revenue earned, I have learned how best to work within a large and busy organization such as the PMI VectorLink Project.
What might someone be surprised to know about you?
Someone may be surprised to know that despite dropping out of school due to lack of school fees I hold a secondary level education certificate, all through my dedication and earnings from IRS.
What are your hopes and dreams for the future?
I am hopeful that I can attend a small course in records or logistics and get recruited into the government or any public or private company as a records or logistics assistant to work and further my skills so that I can better support my community and family.
PMI VectorLink Builds Niger’s Capacity for Evidence-Based Decision Making in Vector Control
In the West African country of Niger, 94 percent of the population is at risk of contracting malaria. As evidenced throughout sub-Saharan Africa over the past 15 years, gains in reducing morbidity and mortality from malaria depends on the use of effective insecticides in vector control measures, such as insecticide-treated nets (ITNs) and indoor residual spraying (IRS). As insecticide resistance grows in malaria vector populations, testing the bioefficacy of insecticides used to kill mosquitoes is increasingly important to reducing the malaria burden. To support Niger in malaria vector entomological monitoring and contribute to quality data collection for decision making, the U.S. President’s Malaria Initiative (PMI) has invested in Niger since 2018 to build capacity and improve entomological data collection in several sites across the country.
Until recently, Niger lacked an up-to-date insectary to test vector control interventions. While there was adequate space for an insectary, Niger did not have the proper and standardized mosquito rearing conditions in place nor the equipment needed to breed and maintain a susceptible mosquito colony. As a result, Niger’s Medical and Health Research Center (CERMES) was unable to conduct certain types of tests, including the assessment of the bioefficacy of vector control tools and determine how long an insecticide remains effective on a treated tool, such as on ITNs.
In its efforts to build capacity of national institutions, the PMI VectorLink Project, rehabilitated the space being used by CERMES into a fully functional insectary in July 2020 and provided equipment for it. PMI VectorLink is also in the process of importing mosquito eggs of Anopheles gambiae Kisumu, a susceptible strain from Liverpool, England, for rearing and testing, and will provide robust training to the designated insectary technicians. As the only internationally-recognized research institution within Niger’s Ministry of Public Health, CERMES will now be able to draw on scientific evidence on the bioefficacy of the insecticides used to support the National Malaria Control Program (NMCP) in vector control decision making.
According to Dr. Boube Hamani, Head of Entomology for the Vector Control Unit of Niger’s NMCP, the insecticide bioefficacy testing has been a huge challenge for years as the country has had to call on external expertise in the West African Region to carry out bioefficacy tests.
“The rehabilitated and equipped insectary will enable the country to support insecticide bioefficacy tests at the country level,” said Dr. Hamani.
He also noted that the PMI VectorLink Project has contributed to building capacity of the NMCP and CERMES technicians in entomological monitoring and data collection, both in the field and in the laboratory. He added that this increased capacity has enabled the NMCP to have good quality entomological data that will be used for vector control strategic decision making in efforts to eliminate malaria.
This year, PMI VectorLink will be rolling out the use of VectorLink Collect, the integrated database for entomological and IRS data. The goal is to establish a functional work flow for entomologic data within the field office teams, with the purpose of entering timely, high-quality data. In line with that, CERMES will be contracted to manage all data management responsibilities as well as providing monthly data interpretation instruction to support the NMCP entomology unit to understand the impact and implications of vector control tools and better plan their elimination strategy.
In the second episode of the PMI VectorLink Podcast, our technical experts discuss the challenges of implementing malaria prevention interventions during the global pandemic. Our experts also share some of the adaptions the project has made to continue operations safely and efficiently.
PMI works with a wide range of partners including faith-based organizations for desired health outcomes
In Northern Uganda’s Otuke District, faith leaders are heeding the call to fight malaria. Reverend (Rev.) Jimmy Max Ajon of St. Paul’s Church of Uganda is committed to ensuring that no woman, child or community member loses his or her life to malaria amidst the COVID-19 pandemic and lockdown challenges. In response to pockets of resistance to indoor residual spraying (IRS) among some communities in Otuke District and other regions, the United States President’s Malaria Initiative (PMI) VectorLink Project in Uganda has engaged religious leaders to improve acceptance of IRS and other malaria control interventions, such as the use of insecticide-treated mosquito nets (ITNs).
Malaria is still the leading cause of morbidity in Uganda and is responsible for most outpatient visits, hospital admissions and deaths. The PMI VectorLink Project, in collaboration with the Ministry of Health’s (MOH) National Malaria Control Division, conducts IRS in 16 districts in Uganda.
Recognizing that religious leaders have the potential to promote and sustain positive change in the community through their well-established outreach and community programs, the project organized community dialogues and sensitization meetings with key religious, cultural and opinion leaders. The project trained the leaders on the benefits of IRS and ITNs, community mobilization and advocacy techniques, and also enlisted their support in promoting IRS and supervising its implementation in their respective communities.
“Religious leaders have a role to play – to not only preach the word of God but also to ensure our people are safe from any form of illness for the betterment of the Kingdom of God,” said Rev. Ajon.
Rev. Ajon shared what he learned with his fellow parish priests and a total of 102 faith leaders, who subsequently promoted lifesaving integrated malaria messages and COVID-19 prevention measures. He and other local leaders joined the project supervision teams to mobilize, monitor and supervise the spray activities in various sites in Otuke District. Rev. Ajon also participated in scheduled radio talk shows and called upon every community member to open their house for spraying and support the spray teams in controlling malaria. Through door-to-door mobilization, he personally reached out to communities, particularly those individuals who were resisting IRS, successfully convincing them to allow their houses to be sprayed.
“Fighting malaria and COVID-19 is not the role of the health workers alone. We need everybody’s contribution, and the first contribution is personal responsibility for your safety and that of your loved ones so that we can protect the communities from both malaria and COVID-19.”
– Rev. Jimmy Max Ajon
“Before IRS was introduced, many community members, including my family used to frequently visit the health facilities due to malaria. Now the malaria episodes have reduced in my household,” he said. “Many communities in Otuke have directly benefited from the intervention, and there is a reduction in the numbers of people who line up at the health facilities.”
The project noted increased IRS acceptance in the communities with the demand for IRS greatly increased as well, thanks to the involvement of religious and community leaders like Rev. Ajon. For example, in Otuke District, the project surpassed the spray target by 12% and protected 20,000 more people than planned with no cases of COVID-19 transmission reported during the campaign. The project protected approximately 5 million people from malaria overall.
Rev. Ajon has pledged to continue speaking at funerals, church services and other faith community outreach meetings about the benefits of spraying houses and sleeping under mosquito nets to ensure that the burden of malaria is drastically reduced. He also pledged to remind communities to go to the health centres for testing and treatment if they have signs and symptoms of malaria and also participate in clearing any stagnant pools of water in order to eradicate malaria out of Otuke District.
PMI VectorLink Adapts Entomological Tool to Ensure Insecticide Residual Efficacy Testing Continues during COVID-19
When COVID-19 began to ripple across the globe, the Government of Zambia quickly put in place strict lockdown measures to prevent the spread of the virus. In response, the U.S. President’s Malaria Initiative (PMI) VectorLink Project rapidly adapted core malaria vector control interventions, namely indoor residual spraying (IRS) and distribution of insecticide-treated nets (ITNs), following PMI and global guidelines, to minimize the risk of COVID-19 infection while continuing to protect communities from malaria and prevent further strain on health systems during the pandemic.
Field assessments to measure the impact of these interventions, however, were interrupted due to the increased risk of transmission of the coronavirus. Impact assessments are critical to generating timely information to inform decisions on optimal vector control approaches and rational use of resources. PMI VectorLink conducts wall cone bioassays to assess how long the insecticide sprayed on walls during IRS remains effective. The longer the insecticide lasts, the longer household members are protected from potential malaria vectors. The traditional method of conducting wall cone bioassays involves the use of mouth aspirators to transfer mosquitoes from holding cups to cones attached on sprayed walls and back to holding cups after the insecticide exposure period. Because staff cannot keep their face coverings on and perform mouth aspiration at the same time, this step was temporarily suspended in Zambia and other PMI VectorLink country entomology programs.
To continue measuring efficacy while maintaining safety precautions, PMI VectorLink ordered handheld, battery-operated aspirators to conduct the cone assays, which would allow staff to keep their protective face coverings on while conducting the tests. The design of the aspirators, however, made it difficult to release mosquitoes from the collection vial inside the unit into the cone on the wall or the holding paper cups. The team responded quickly, modifying the aspirator to improve the mosquito release function, and then deploying them after training for field staff was conducted on their proper use. The field teams are now using the modified aspirators for wall cone bioassays to monitor the insecticide’s residual efficacy on walls while safely wearing their protective face coverings and maintaining social distance. This adaptation is also being replicated in other VectorLink country programs.
As of June 2020, the cone bioassays have shown positive results, with residual efficacy of eight months. This means that the insecticides used during IRS (Fludora Fusion and SumiShield) last throughout the malaria transmission season, providing longer protection to the communities than the previous insecticide used. Without the aspirator innovation, testing during COVID-19 would not have been possible. Knowing that the insecticide lasts longer allows the National Malaria Elimination Program (NMEP) and PMI to begin IRS earlier next year before the rainy season begins, ensuring hard-to-reach areas are protected and that people do not have to bring their belongings out of the house and into the rain during spraying.
“The VectorLink Zambia team’s coordinated effort to ensure continuity in residual efficacy monitoring by successful modification and testing of handheld aspirators for deployment in the field was much appreciated,” said Dr. Emmanuel Kooma, Head of Vector Control, at the NMEP. “I am particularly satisfied that the method can safely be used as a replacement to the conventional mouth aspirators for the wall bioassay tests, a needed intervention during this pandemic.”
PMI Continues Malaria Control Interventions in Uganda during COVID-19 to prevent further strain on health systems
Around the world, countries are grappling with the COVID-19 pandemic while also trying to maintain health services to protect people from life-threatening diseases, such as malaria. In Uganda, where malaria is endemic, the government put in place strict lockdown measures to slow down the COVID-19 pandemic. Measures included a shutdown of public transportation, a limit on the number of people in private vehicles, a nightly curfew and a limit on the number of people gathering together. While these measures aid in the prevention of the spread of the novel coronavirus, there was also a temporary halt to critical malaria prevention services, such as indoor residual spraying (IRS).
To reduce the burden of malaria in Uganda, the United States President’s Malaria Initiative (PMI) VectorLink Project in collaboration with Uganda Ministry of Health (MOH) National Malaria Control Division (NMCD) implements IRS to kill mosquitoes that transmit the disease in 16 high-burden districts to protect approximately 4.7 million people. In April 2020, the nationwide lockdown delayed the start of the project’s second phase of IRS in eight districts (Serere, Kaberamaido, Kalaki, Amolatar, Dokolo, Lira, Alebtong and Otuke). The project completed its first phase before the lockdown, protecting 2.9 million people.
To ensure continuity of malaria prevention measures, the project worked closely with the MOH, NMCD, partners and stakeholders and received clearance from government of Uganda leadership to continue implementing IRS amid the lockdown with strict protocols in place. The project worked closely with local government leaders through the District COVID-19 taskforce and District IRS taskforce to implement quality IRS. The project leveraged the coordination of both taskforces, including community mobilization platforms already in place for COVID-19 at district, sub county and village levels. The Local Council Chairpersons served as key IRS mobilizers while holding security/ coordination responsibilities as the COVID-19 focal points at the village level.
In addition to the standard personal protective equipment provided to spray operators, the project provided face masks for all training participants and facilitators, portable handwashing facilities at entrances to all training rooms, and hand sanitizers at operational sites, all while observing the recommended number of people per gathering to embrace social distancing. Training was conducted in small teams of 10 participants in large halls or classrooms with facilitation from the District Health teams and trainers from other districts.
At operation sites, the project posted posters and flyers indicating signs, symptoms and prevention measures for COVID-19 and incorporated COVID-19 mitigation strategies in all training materials. On May 25th VectorLink Uganda successfully started its second phase of IRS, and by June 20th, the project had sprayed approximately 1.4 million structures over the two spray phases, protecting a population of about 5 million people including 132,089 pregnant mothers and 950,163 children under five years.
Mr. George Edward Onya, the Resident District Coordinator (RDC) of Kaberamaido District during an IRS planning meeting said, “COVID-19 transmission is yet to take hold so let us fight malaria now so that by the time COVID-19 arrives our facilities will not be congested with malaria cases and our frontline workers will have the time and resources to fight COVID-19.” He further noted that PMI VectorLink Uganda was quite exemplary in implementing IRS amidst COVID-19 and achieving high coverage, which will go a long way in preventing malaria transmission in the district.
PMI Pilots Integrated, Global Database with IRS and Entomological Data to Manage and Guide Timely-Vector Control Decisions
Insecticide resistance is rising across the globe, threatening the massive gains made in the control of malaria over the past 15 years. These gains can be attributed to the increased use of indoor residual spraying (IRS) and insecticide-treated nets (ITNs), which use insecticides to kill or repel mosquitoes that carry the malaria parasite. Timely, evidence-based vector control decision-making is essential to ensuring the most effective insecticides are being used.
The U.S. President’s Malaria Initiative (PMI) VectorLink Project conducts robust entomological monitoring efforts to understand malaria vectors – species that carry malaria – and their geographical and temporal distribution, feeding and resting behaviors, and resistance to insecticides. In 2018, PMI VectorLink developed a comprehensive District Health Information Software (DHIS2)-based data management system, VectorLink Collect, to support routine IRS data needs across project countries. Now, the project is expanding the database to manage entomological data across 17 African countries.
This advancement enables PMI-funded IRS and entomological data to be managed in a single system, and supports improved data quality and integrated analytics. VectorLink Collect also allows both internal and external decision-makers, such as National Malaria Control and Elimination Programs (NMCP/NMEP), and PMI/USAID in the U.S. and in country, to access comprehensive data at multiple levels. Furthermore, building VectorLink Collect on DHIS2, a platform that is used by Ministries of Health in every PMI-focus country where VectorLink works, also supports country-level priorities and systems, and aligns with PMI’s goal to support sustainability and the journey to self-reliance.
The project piloted the VectorLink Collect entomology instance in Zambia in February 2020. The Zambia country team had already been using VectorLink Collect for IRS data, and carries out comprehensive entomological activities. The pilot has helped the project to better understand data work flow needs, quality review processes, and general ease of use of this new system for entomological data. The VectorLink Zambia team provided comprehensive feedback and recommendations to inform critical updates to program design and minimize challenges as more countries start using the system. It became apparent that certain field work factors, such as the remoteness of collection sites, needed to be accounted for in determining realistic data entry timeframes. In addition, Zambia introduced a monthly plan to guide data review and data entry processes and expectations. The successful pilot concluded in April 2020, and the project continues to enter ongoing entomological data into VectorLink Collect.
The success of this important pilot and overall positive feedback from the VectorLink Zambia field entomologists and data managers supports the use and expansion of VectorLink Collect for entomological data. It formed the basis for finalizing training approaches for the broader roll out to remaining country teams. This is especially valuable as all trainings will now be conducted remotely. The use of VectorLink Collect for entomological data will allow for an integrated, global database to manage and use timely data to guide malaria control work.
Rabecca Ngwira, VectorLink Zambia entomology field coordinator, said, “We have longed for a system that allows rapid generation of entomological data summaries and graphical representations without a need for elaborate Excel worksheets and complicated use of formulae, and here we have it in the VectorLink Collect.”