Community Leaders Help to End Malaria

Village chief Ubore Ali Bechanignan meets with VL Ghana Chief of Party Lena Kolyada after spraying. Photo: Taufiq Mohammed Osman

In Tatale-Sanguli District (TSD) of Northern Ghana malaria mortality dropped by 80 percent from 2018 to 2020, according to reports from the regional health directorate. This decrease corresponds to the support the district started receiving from the U.S. President’s Malaria Initiative (PMI) VectorLink Project, which conducts indoor residual spraying (IRS) to kill the mosquitoes that carry the malaria parasite. By 2021, with the help of the project, the leaders of the district’s Tangbabong community knew that fighting this deadly disease required commitment. For IRS to be successful, 85 percent of the homes in the targeted area must be sprayed to achieve community protection. In Tangbabong, these community leaders see IRS as a top priority in their efforts to end malaria.

When the chief and elders are informed about the spraying date, they prepare the community. A gongong (a local drum at the chief palace used to make important announcements) is beaten to inform community members about the benefits of the spraying and the date it will occur. Community leaders mobilize households and support community health volunteers to remind homeowners to prepare for spraying and to comply with health and safety guidelines.

On the day of spraying, every household removes their belongings from their homes and dedicates the day to spraying-related activities, including providing water for mixing insecticide. In some instances, a community health volunteer together with community members prepare the homes of neighbors who have traveled to ensure that no one is missed in benefiting from IRS. This support is also extended to neighbors who are unable to remove their belongings themselves. Upon the arrival of the spray team, homeowners are so eager to have their homes sprayed early that they will urge spray operators to come to their homes first.

While the spray team is in the community, the chief and elders meet with the project team to express their appreciation and hope that together malaria can be eliminated just as guinea worm was in the Northern Region in 2010. If a home is not sprayed during the first IRS visit, community elders follow up with a community health volunteer or community health nurse, and in some instances, through a recruited project staff living in the community, to request the spray team to revisit the community.

The success of IRS in Tangbabong (98.8% spray coverage) in 2021 is largely due to community leaders taking the steps needed to ensure that the community is protected from the disease and because community members recognize that vector control is a part of their communal responsibility.  It was after the 2020 spray campaign when spray coverage reached 92.9% that the chiefs and elders of Tangbabong decided to increase coverage in subsequent campaigns. Engaging the community in the 2021 IRS campaign resulted in the improved coverage of 98.8%, protecting 410 community members. Today, community leadership is happy to have one of the best spray coverages comparable to their 10 neighboring villages where the average coverage is 94%.

Chief Bechanignan said, “I previously could not enjoy the evening breeze in my home because of mosquitoes, but now I am able to do so for a long while before going to bed.”  He expressed his gratitude and pledged to “always ensure that his community participates in IRS.”

 

PMI VectorLink Extended to further Its Work in Ending Malaria

The U.S. President’s Malaria Initiative (PMI) recently extended the PMI VectorLink Project another 12 months, continuing its work to September 2023. Led by Abt Associates in partnership with Population Services International and PATH along with the support of Liverpool School of Tropical MedicineMalaria ConsortiumInnovative Vector Control ConsortiumMcKinsey & Company, Inc., EnCompass LLCBAO Systems LLCDigital Globe, and Dimagi, Inc., the PMI VectorLink Project initially began in September 2017 as a five-year project to reduce the burden of malaria.

The one-year extension reflects the project’s success in planning, implementing, and monitoring life-saving vector control programs for indoor residual spraying (IRS) of insecticides and distribution of insecticide-treated bed nets (ITNs) across 24 countries in sub-Saharan Africa as well as in Cambodia and Columbia.

PMI VectorLink successfully navigated the challenges presented by COVID-19, including border closures, national lockdowns, and serious delays and drastic cost increases in the production, supply, and delivery of malaria commodities. Some of the highlights from 2020 include:

  • 21.3 million people protected from malaria through 16 timely, high-quality IRS campaigns

  • 3.49 million children and 636,527 pregnant women protected

  • >58,000 seasonal workers hired to support IRS (33% female)

  • >5.8 million insecticide treated nets (ITNs) distributed

  • 5 peer-reviewed journal articles published on studies that assessed malaria risks and increased trust in new vector control approaches

PMI VectorLink is excited to continue its fight to end malaria! Keep following us on our journey.

 

 

PMI VectorLink Wins Social Impact Award

A PMI VectorLink spray operator prepares the insecticide tank for spraying. Photos by: Arnaud Rakotonirina

The U.S. President’s Malaria Initiative (PMI) VectorLink Project recently won the 2021 Clark Abt Award for Outstanding Social Impact, the highest award given by Abt Associates.

Working across 24 countries in Africa as well as Cambodia and Colombia, the PMI VectorLink Project protects more than 31 million people a year from malaria by equipping countries to deliver safe, cost-effective, and sustainable indoor residual spraying (IRS), insecticide-treated nets (ITNs), and other life-saving malaria vector control interventions. The project is implemented by Abt Associates in partnership with Population Services International and PATH along with the support of Liverpool School of Tropical MedicineMalaria ConsortiumInnovative Vector Control ConsortiumMcKinsey & Company, Inc., EnCompass LLCBAO Systems LLCDigital Globe, and Dimagi, Inc.

When COVID-19 began spreading rapidly across the globe, the World Health Organization (WHO) called on countries to continue malaria services to prevent further strain on health systems. Preventable malaria cases would compete with COVID-19 cases for hospital beds and medical attention. Countries battling the fight against malaria are often the same countries that struggle with overburdened health systems. Populations frequently have limited access to safe, affordable, and adequate health care.

Tens of millions of lives were at stake. Heeding WHO’s call was essential, and PMI VectorLink needed to continue implementation while also protecting frontline workers, staff, partners, and beneficiaries from COVID-19. Contending with border closures, national lockdowns, and serious delays and drastic cost increases in the production, supply, and delivery of malaria commodities, the project successfully carried out 16 high-quality, timely IRS campaigns and helped to distribute nearly 6 million ITNs, despite the challenges presented by the COVID-19 pandemic. The project quickly identified ways to adapt implementation of a variety of vector control activities to the COVID-19 context through innovative approaches, allowing for minimal disruptions in implementation of life-saving vector control interventions while mitigating the risk of project activities to beneficiaries and project staff.

Malaria kills more than 400,000 people every year, and millions more fall sick from this vector-borne disease. Young children and pregnant women are among the most vulnerable. Healthy populations contribute to healthier economies, which can translate into stability and peace in a country, region and the world. When children are healthy, they can go to school, and parents, particularly women, who are most often the family caregivers, can focus on income-generating activities. Malaria protection also allows countries’ health systems to allocate funds to emerging health crises, such as COVID-19, rather than malaria.

PMI VectorLink’s senior management team (Bradford Lucas, Allan Were, Mariandrea Chamorro, Angela Sanchez, Kathryn Stillman, Aklilu Seyoum, and Peter Chandonait) accepted the award on behalf of the project. Named in honor of Abt Associates’ founder, the annual Clark Abt Prize recognizes a project that has had significant social impact. In 2014, the PMI Africa Indoor Residual Spraying Project, the predecessor to the PMI VectorLink Project, also won the Clark Abt Prize. Learn more here.

PMI VectorLink Study Findings of Invasive Malaria Vector in Africa Published

PMI VectorLink published its findings on the invasive malaria vector Anopheles stephensi in Ethiopia in Malaria Journal this week.

Collection of An. atephensi larval from breeding containers in Awash Subah, Ethiopia. PMI VectorLink collected An. stephensi larvae in urban and rural sites in eastern Ethiopia. An. stephensi larvae were not found in western Ethiopian sites.

The study, “An update on the distribution, bionomics, and insecticide susceptibility of An. stephensi in Ethiopia, 2018-2020,” looks at the distribution, bionomics, insecticide susceptibility, and transmission potential of the vector.

One of the primary malaria vectors in South Asia, the vector was first reported in Africa in 2012 in Djibouti. Since then, the vector has been found in Ethiopia, Somali, and Sudan, and poses grave concern malaria control.

While more data is needed, the study will help inform Ethiopia’s vector control decisionmakers on how to reduce this vector’s population and its spread of malaria as it unveils more information on this invasive species in Africa. Read more here.

 

https://malariajournal.biomedcentral.com/articles/10.1186/s12936-021-03801-3

 

PMI VectorLink Compares Outdoor Mosquito Traps

PMI VectorLink Findings on Outdoor Mosquito Traps Published in Parasites & Vectors

Understanding the behavior of malaria-carrying mosquitoes, such as when and where they bite, is essential to reducing the spread of the disease. Human landing catch (HLC) remains one of the most common methods for measuring human biting rates indoors and outdoors. The high costs and ethical concerns related to increased risk of infectious bites from HLC, however, spurred PMI VectorLink to study alternative trapping methods in western Kenya. Those findings, which were recently published in Parasites & Vectors, showed that baited Centers for Disease Control and Prevention Light Traps may be the most appropriate tool currently available for assessing outdoor-biting and malaria transmission risk. Read more here.

Responsible Waste

PMI VectorLink Malawi Reduces Environmental Impact of IRS

The U.S. President’s Malaria Initiative VectorLink Project, in partnership with National Malaria Control Programs, protects millions of people every year from malaria, a deadly infectious disease. Indoor residual spraying (IRS) controls malaria by spraying insecticide on the walls and ceilings where malaria-carrying mosquitoes rest. The project ensures the environmental impact of IRS is minimal and responsibly manages waste such as plastic bottles, cardboard boxes, worn personal protective equipment, and other materials. The PMI VectorLink Project adheres to strict environmental guidelines and protocols to protect land, water, air, and human health when implementing IRS and  follows a hierarchy of reducing waste and recycling waste to mitigate environmental impact.

Solid waste that cannot be reused and has not come into contact with insecticides or has been washed clean of the insecticides meet the criteria for recycling. Waste management remains a challenge in Malawi, however, as there are few companies able and licensed to work in the country. The PMI VectorLink Project established public-private partnerships with two reputable waste recyclers in Malawi that are approved and licensed by the Government of Malawi through the Department of Environmental Affairs.

The project now donates the eligible waste for recycling, which reduces the amount of waste being sent to the landfill, to O.G. Plastic Industries (2008) Limited, CSH Investments, and HongSheng Packaging Limited. The PMI VectorLink Project signed memorandums of understanding (MoUs) with the companies which lays out how the waste should be handled, recycled, and managed. This past year the PMI VectorLink Project was able to recycle 93,191 insecticide bottles; 6,688 Kg of cardboard/cartons and paper; 2,764 face shields; 39,429 water bottles (500 ml) and 41,250 Maheu Energy Drink bottles. Other items that were recycled included unrepairable Goizper Sprayers, worn out helmets; damaged plastic basins, containers, jerry cans, cups, and other plastic ware; and torn and used black plastic sheets used for covering household items during spray.

These products have been transformed in many different ways. For instance, insecticide bottles and spray operators’ scratched face shields have been recycled into solvent containers, laundry jugs, and liquid soap bottles. The plastic containers from the energy drinks consumed by spray operators before the day’s work are made into black plastic sheets, which can be used together with grass as roof covers for houses.

“The work being done by PMI VectorLink Malawi to combat malaria through indoor residual spraying is very commendable,” said Patrick Medius Nyirenda, Environmental Officer, from Malawi’s Environmental Affairs Department. “The battle against diseases such as malaria cannot be won by government alone. It is pleasing to note that in order to ensure sustainable implementation of the project, PMI VectorLink has committed itself towards recycling of waste and unwanted materials from their operations. This is in line with [Malawi’s] National Waste Management Strategy (2019-2023), which promotes waste segregation, reuse, recycling, and resource recovery as key strategies to address waste management challenges in the country.”

Recycling conserves natural resources, strengthens the economy through sales of products from the recycling processes and helps to create jobs in the industry. Recycling is an essential method of sustainable materials management, which emphasizes the productive and sustainable use of materials across their entire life cycle while minimizing the environmental impact. Recycling also further conserves material which would have been used as raw materials from the natural environment to produce the same needed products.

IRS waste loaded and ready to be transported to the recycling companies.

World Malaria Day 2021

The PMI VectroLink Project works to end malaria across sub-Saharan Africa. This World Malaria Day, we want to recognize our Malaria Fighters from the past year who have shown and proven their dedication to defeating this disease. Scroll down below to check out the full interviews.

World Malaria Day 2021 Malaria Fighters by PMI VectorLink

Check out the full interviews with our Malaria Fighters below:

Zeddy Bore

Patricia Chirombo

Ojok John

Dr. Oliver Lulembo

Josephine Tossa

Prince Owusu

 

PMI Malaria Fighter: Zeddy Bore

“There has been a great reduction of malaria morbidity and mortality in Kenya’s lake regions since PMI started working in these malaria endemic areas. This reduction can be attributed to key interventions like indoor residual spraying (IRS) and the use of insecticide-treated nets (ITNs).”

VL Kenya Operations Manager Zeddy Bore talks to spray teams before the day begins.

Nairobi, Kenya

Professionally, PMI VectorLink Kenya Operations Manager Zeddy Bore has spent the past 13 years fighting malaria. Growing up in Kenya’s Rift Valley regions, Zeddy battled her fair share of malaria personally, too. “I managed to pull through, unlike some children in the malaria endemic regions who succumbed to it,” said Zeddy.

As VectorLink Kenya Operations Manager, Zeddy leads the complex logistics of planning and implementing IRS, which kills the mosquitoes that transmit malaria by spraying insecticide on the walls, ceilings, and other indoor resting places of those mosquitoes. Zeddy’s interest in fighting malaria began in school when she was studying for her Bachelor of Science in Environmental Health from Moi University. She then went on to completing a Master of Public Health in Epidemiology and Population Health from Maseno University. Recently, Zeddy talked about her work with the PMI VectorLink Project and the journey she’s taken to get there.

What is your personal experience with malaria? Malaria was a common illness in our home and community with many people regularly affected. They often associated the illness with eating unripe sugarcane or being rained on. These myths were later demystified for me when I went to school and learned that malaria is transmitted by a female mosquito infected with the malaria parasite. I also learned that malaria is highly preventable as well as treatable.

In my family, the last time we had a malaria case was in 2010. Since then, I have always ensured that my house is sprayed as regularly as required, everyone sleeps under an insecticide treated net, and all the windows are screened. I have also trained my children to ensure that the doors and windows are closed around 5 pm and only opened if needed. When any of my family members is unwell and has a fever, I take them to the health facility. Luckily, we have not had an episode recently. I always discourage self-medication for any fever.

No life should be lost to malaria. As a malaria advocate and champion, I have sensitized my relatives and community members about the dangers of malaria, how it is spread, and the various prevention and treatment options available. VL Kenya with the Ministry of Health came up with different strategies, such as community meetings, and the use of community health volunteers and provincial administration as IRS community mobilizers, to demystify the myths and encourage residents to accept IRS.

Recently, the Zero Malaria Starts with Me campaign was launched in Kenya. This campaign advocates for everyone to take action to prevent malaria wherever they are. As a mother and as part of the PMI VectorLink Project, I encourage residents to actively play their part to prevent malaria in their communities by preparing their houses for spray.

What is your role as Operations Manager? I work very closely with national and county government leadership to plan and implement the spray operations in the country and lead advocacy strategies to promote behavior change activities that lead to reduced malaria mortality and morbity in the counties where PMI VectorLink sprays. IRS is currently being implemented in two counties (Homa Bay and Migori) out of the 47 counties in Kenya. Apart from coordinating IRS activities, I also serve as the gender focal person advocating for gender equity and social inclusion in project activities.

As the Gender Focal Person, Zeddy advocates for gender equity across project activities.

How did you get involved with malaria prevention? I am a trained environmental and public health professional. During my internship with the Ministry of Health in 2007, I participated in mosquito net treatment and health education on malaria control. Through this, I developed an interest in malaria prevention activities. In 2008, I began working on an IRS project and I have been doing it ever since.

What do you find most challenging about your job? The biggest challenge is convincing community members who believe in myths and misconceptions to accept their houses to be sprayed. It’s always heartbreaking for me to see a household owner refuse their house to be sprayed when they have children under five and/or have an expectant mother sleeping in those houses. Sometimes they have recently had an episode of malaria, yet they still refuse because of these myths.

What is challenging about reaching every household? IRS is conducted in eligible structures made of wood, reeds, stones, bricks, and mud. The insecticide is applied on the walls and ceilings. Not all structures in the two counties we spray are eligible because of the type of materials their house is made of. Ineligible materials include such things as iron sheets, glass, or metal. During the rainy season, some villages are cut off by floods. To address that challenge, we always plan to start in the hard-to-reach areas before the rains start. Some refusals are also experienced when a member of the household is sick. The good news is that once the 85% coverage is achieved, the missed households also enjoy the herd protection from IRS.

How has IRS implementation changed with COVID-19? We adjusted the way we implement IRS activities. PMI VectorLink established standards and protocols to mitigate the spread of COVID-19 while conducting the various activities. For example, we hold virtual meetings, and where needed, hold in-person meetings outdoors with all the required Ministry of Health and global protocols observed, including social distancing, wearing masks and regular washing of hands. During the campaign, all personnel were provided with masks and advised to always wear them properly. Supervisors always checked to ensure this was adhered to with constant reminders during morning mobilization and through job aid messages. Temperature screening was required to access operations sites, stores, and offices. Handwashing facilities were put up in all the entrances and monitored to ensure compliance. We also provided hand sanitizer and hand wipes in all vehicles, data centers, and stores.

Do you think Kenya will ever be free of malaria?

Yes. With integrated efforts in the different regions to fight malaria and everyone taking up their role to fight malaria, thanks to the Zero Malaria Starts with Me campaign, I believe Kenya is headed to be a malaria-free zone.

 

PMI VectorLink Study Helps Côte d’Ivoire Make Critical Decisions for the Distribution of New Generation ITNs (PBO-ITNs and Interceptor G2)

A group of entomologists from the PMI VectorLink Cote d’Ivoire team. This photo was taken prior to the COVID 19 pandemic.

A group of entomologists from the PMI VectorLink Cote d’Ivoire team. This photo was taken prior to the COVID 19 pandemic.
A new study funded by the U.S. President’s Malaria Initiative (PMI) and led by the PMI VectorLink Project found that new vector control tools, such as insecticide-treated nets (ITNs) treated with chlorfenapyr and the synergist piperonyl butoxide (PBO), may help to provide better protection against malaria in Côte d’Ivoire than those currently used. Previously, ITNs treated with pyrethroids alone were the primary net choice in Côte d’Ivoire because they were the only type of ITN available and the pyrethroid insecticide was effective in killing vector mosquitoes on contact. The nets provided additional benefits by serving as a physical barrier between people and malaria-carrying mosquitoes, protecting communities from malaria as they slept. Unfortunately, the widespread use of pyrethroid insecticides has resulted in mosquitoes building up resistance to the insecticide, making the pyrethroid-treated nets less effective.

The mosquito’s resistance to pyrethroid insecticides has had serious implications in the efforts made to control the Anopheles mosquito population in Côte d’Ivoire. As mosquitoes increasingly become resistant to all pyrethroid insecticides across the country and much of Africa, National Malaria Control Programs (NMCPs) are challenged with finding new ways to protect populations from malaria. This study, published in the Malaria Journal in December 2020, demonstrated the relative increase in effectiveness observed when exposing the pyrethroid-resistant mosquitoes to either PBO in combination with pyrethroids or to chlorfenapyr. Both options represent avenues for NMCPs to develop insecticide resistance management strategies. In Côte d’Ivoire specifically, Interceptor® G2 (IG2), a chlorfenapyr- and alpha-cypermethrin-treated net was identified as an option for a stratified distribution campaign in addition to PBO nets.

Despite multiple mass distribution and education campaigns to promote the continuous use of ITNs in country, malaria still accounts for about 33% of consultations in health facilities, with children and women being the most vulnerable populations. WHO 2019 (World Malaria Report) reports Côte d’Ivoire having an incidence of more than 250 cases per thousand people in at-risk populations. In the same period, malaria incidence has doubled in children under the age of five years old (NMCP Annual Report 2019). Given the variable insecticide resistance trends of vectors and the heterogeneity of malaria endemicity across the country, implementing a strategy for the distribution of the new nets required extra consideration. VectorLink Côte d’Ivoire provided technical support to the NMCP to conduct entomological monitoring to help select the most appropriate nets for use in country. Insecticide resistance data collected by the project and the country’s research institute consortium in previous years were used to profile the country and stratify districts for the upcoming 2021 mass net distribution campaign. Once the most appropriate nets were selected based on entomological findings, Global Fund, PMI, and NMCP allocated PBO and Interceptor G2 nets across districts where each type of net’s active ingredients was found to be efficacious against the local mosquito population.

With 113 health districts and varying resistance patterns across the country, PMI VectorLink’s ability to prioritize the districts based on mosquito susceptibility to insecticides used on the Interceptor G2 and PBO nets helped the country make the best use of limited resources. The NMCP Coordinator, Dr. Antoine Mea Tanoh, commended the project’s use of entomological and epidemiological data to guide the strategic deployment of insecticide-based vector control interventions to protect the population. Armed with the most accurate and relevant entomological data, Côte d’Ivoire was able to procure the necessary 19, 313,573 nets to ensure the entire population of nearly 28 million people across 113 districts received the most appropriate ITN intervention for the upcoming campaign.