PMI VectorLink Zambia is Named a Winner of the USAID 2022 Digital Development Award

The U.S. President’s Malaria Initiative (PMI) VectorLink Zambia Project has been named a winner in the USAID 2022 Digital Development Awards, which recognizes the use of technology to promote inclusive growth, foster resilient democratic societies, and empower communities around the world, including the most vulnerable and marginalized. PMI VectorLink Zambia, implemented by Abt Associates, was recognized for deploying a suite of digital tools that supports map-based data collection, monitoring, and capacity building to improve malaria control programs.

In 2020, malaria killed more than 600,000 people globally, with the disease burden exacerbated by shocks such as emerging disease threats like COVID-19, conflict, and climate change. Vector control programs such as distribution of insecticide-treated nets (ITNs) and indoor residual spraying (IRS) are some of the best ways of combating malaria, but the effectiveness of these campaigns relies upon real-time monitoring and evaluation data at community levels. To address this need, the PMI VectorLink Zambia Project mobilizes the digital tools necessary for Zambia to have quality, timely, secure, and accessible health information and is working with the Zambian government to apply them.

PMI VectorLink Zambia, in partnership with Akros, has developed a suite of digital tools, including the use of satellite imagery, digital micro planning maps, and a mobile application (Reveal), to guide and track the delivery of indoor residual spraying at the household level to ensure no communities or structures are missed. The project has supported the Zambian National Malaria Elimination Programme (NMEP) and stakeholder workforce to use and apply the geospatial data for decision-making and to build a culture around data-use and technology. Additionally, PMI VectorLink Zambia is supporting the Zambian Ministry of Health to integrate project files into their routine data systems for expanded, long-term use of the datasets.

PMI VectorLink Chief of Party Nduka Iwuchukwu notes that having ready access to accurate, geographically distributed population and structure counts is essential to successfully plan and deploy malaria control interventions.

“The digital micro-planning and mapping tools helped the NMEP in 2021 to maximize the impact and coverage of its vector control strategy by delineating which communities would receive nets and which would be sprayed, based on their epidemiologic and operational profiles,” said VectorLink Zambia Chief of Party Nduka Iwuchukwu. “Incorporating the latest population and satellite data at a granular, sub-district level enhanced the planning exercise, and the continued use of the maps moving forward will benefit not only the country’s malaria elimination program, but other health programming across Zambia.”

Man looking at smart phone.
Supervisor review of map created by Reveal tool. This photo and photo above courtesy of Akros.

PMI VectorLink Zambia is part of the global PMI VectorLink Project, which works across 25 countries, supporting national governments to plan and implement proven, life-saving vector control programs, including IRS and the distribution of ITNs, with the overall goal of reducing the burden of malaria. The project uses a variety of rigorous data capture, data management, and data analytics tools across its portfolio, and country teams work side-by-side with their respective National Malaria Control Programs (NMCPs). Through the project-developed VectorLink Collect, a DHIS2-based database system, VectorLink manages a tremendous volume of data, and makes it accessible at all levels to internal and external stakeholders including NMCPs, USAID missions, in-country health teams and research partners, and PMI and USAID clients in Washington.

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USAID’s Innovation, Technology, and Research Hub received nearly 200 applications from around the world for this year’s awards. Each project was judged on its ability to support the digital ecosystem or digital technology development as outlined in USAID’s Digital Strategy. The other winners of this year’s Digis include the USAID/Colombia Rural Finance Initiative, USAID/RDMA Digital Asia Accelerator, USAID/Georgia Economic Security Program, and USAID/Nepal Building Hope Along the Karnali River Basin (BHAKARI) Program.

Go to https://www.usaid.gov/digital-development/digis/ to learn more about the 2022 Digital Development Awards winners.

School children in Atebubu ATSEC Model Primary School holding their ITNs after receiving them through school-based distribution.

Delivering Malaria Control Services in the Face of Global Shocks

The world has been rocked by high inflation and fuel shortages throughout 2022, and these challenges have impacted the delivery of malaria control services in many countries. Rising costs and limited supplies complicated routine vector control interventions—the distribution of insecticide-treated nets (ITNs) in Ghana and the deployment of indoor residual spraying (IRS) in Sierra Leone. But with the help of strong local partners and some creative planning, the U.S. President’s Malaria Initiative (PMI) VectorLink Project supported both countries in meeting their intended goals despite the obstacles in their way.

Ghana

In Ghana, teachers in public schools embarked on a nationwide strike in July over the increasing cost-of-living and demanded the government pay them a cost-of-living allowance to help cope with the impacts of high inflation.

Ghana’s school-based ITN distribution coincided with the teachers’ strike. The National Malaria Elimination Program (NMEP) and the School Health Education Program (SHEP), assisted by PMI VectorLink Ghana had originally planned to distribute 1,476,362 nets to students in primary two (second grade) and primary six (sixth grade) who would take these ITNs home for their households to use.

To facilitate the distribution, the NMEP and SHEP, with PMI VectorLink Ghana’s assistance, organized and trained 3,331 regional and district officers from the Ghana Education Service (GES) and Ghana Health Service to assist in the planning and management of the distribution, as well as supervision. A mobile app called Net4Schs was used in the exercise to record and report the distribution data.                

 At the beginning of the second week of the strike action, when the public school teachers were no longer in the schools, PMI VectorLink, the NMEP, and SHEP amended the plan and used community information centers in rural and semi-urban areas to mobilize parents and students to receive nets since the public schools were not in session due to the strike.  Head teachers and their assistants, who GES directed to remain in school, led the mobilization effort. They were also supported by school improvement support officers (similar to a school district’s superintendent) responsible for record keeping and data entry of nets distributed to students. In the private schools, which constitute 45 percent of primary schools in Ghana, students were able to receive their ITNs as originally planned because schools were in session. Students attending public schools in urban areas had to wait until the strike action was called off due to the difficulty in mobilizing parents who did not respond to requests from school authorities at the same rate as those in more rural areas.

In total, PMI VectorLink Ghana, the NMEP, and SHEP distributed over 1.4 million nets to students in 25,245 public and private schools. Together, the NMEP, SHEP, and PMI VectorLink Ghana monitored the distribution, ensuring students received the correct ITNs.

School children in Atebubu ATSEC Model Primary School holding their ITNs after receiving them through school-based distribution.
School children in Atebubu ATSEC Model Primary School after receiving ITNs through school-based distribution.
Photo Credit: Kwasi Djan

Sierra Leone

Prices of oil began to skyrocket towards the end of 2021 as the global economy bounced back from the lull caused by the COVID-19 pandemic. With fuel stations not operating at full capacity because of a shortage of reserves in Sierra Leone, adequate fuel supply was hard to find.

PMI VectorLink covers vast distances during its campaigns to spray people’s homes with mosquito-killing insecticide. In Sierra Leone, the project sprays in two districts, Bo and Bombali. For 24 days in May 2022, the team had the immense challenge of finding enough fuel, so they could protect close to 700,000 people in the two districts with IRS before the rainy season began in early June.

To reach these people, many of whom live in remote communities, vehicles are crucial. Spray teams often need to travel long distances to reach the communities where spraying occurs. In 2021, fuel logistics were relatively simple—teams used local fuel stations—but in 2022, most local stations had major fuel shortages. As a result, PMI VectorLink Sierra Leone contracted a major fuel provider, National Petroleum, to ensure enough supply throughout the campaign. The team also had support from the District Health Management Teams, who had intermittent strategic stocks of fuel.

To cope with a limited fuel supply, PMI VectorLink Sierra Leone adjusted their daily spray calendar based on fuel availability, and they fully utilized community mobilizers to maintain regular communication with the target communities, so that residents would be as flexible as possible for potential spray date changes. For most villages, that occurred twice on average. If fuel supply was very low or not available on a specific date, the team would quickly reassess their calendar and conduct IRS in communities close to the base of operations versus spraying remote villages that day.

This strategy allowed the team to minimize disruptions as much as possible. In addition, quick coordination across all operational sites was possible due to the strong partnership with the local District Health Management Teams, who were integrated as part of the overall PMI VectorLink team and assigned to specific operational sites for local government capacity strengthening.

During the 2022 spray campaign, PMI VectorLink Sierra Leone targeted 160,919 structures over 24 working days with a goal to protect an estimated population of 698,552 people. The PMI VectorLink team did not let the fuel challenges impede their efforts to make this campaign a successful one. The team’s efforts paid off. PMI VectorLink Sierra Leone reached most of the houses they intended to spray and successfully met the 85 percent coverage goal as outlined by the World Health Organization.    

Spray operators in a car on their way to the community from the operational site.
Spray teams on their way to the community from the operational site.
Photo credit: Program Manager Djenam Jacob.

Mosquito vector control efforts often have challenges that need to be overcome, so malaria services can be delivered to those that need them most. While global challenges can impact the delivery of these services, careful planning and flexibility can enable successful interventions despite the challenges.  

The 2022 Annual Meeting of the American Society of Tropical Medicine and Hygiene (ASTMH)

The American Society of Tropical Medicine and Hygiene (ASTMH) Annual Meeting is the premier forum for the exchange of scientific advances in tropical medicine, global health, and hygiene. This year’s event is taking place at the Seattle Convention Center in Seattle, Washington, USA.

VectorLink is pleased to announce our participation through the following symposium, oral presentations, and poster presentations, as follows. 

Symposium 119 | Wednesday, November 2 | 3:00 – 4:45 p.m. PST | In-person & Livestreamed

The Expansion of Anopheles Stephensi into the Horn of Africa and Beyond: How African Malaria Vector Surveillance and Control Is Adapting

Organizer: Matt Kirby, PMI VectorLink Project, Abt Associates

This symposium offers a pivotal opportunity to help build global consensus on a unified response to the urgent issue of the invasion and expansion of Anopheles Stephensi in Africa. It provides a forum for discussion around the challenges faced by four of the currently impacted countries—Ethiopia, India, Kenya, and Sudan—as well as the most feasible and scalable activities that should be implemented to address these challenges. We ask whether the goal should be elimination from Africa or containment and control.  

View at: http://app.core-apps.com/astmh22/event/d96b3f24a6e2995bcc7c5e2977c081b9

Scientific Session 128 | Thursday, November 3 | 8:00 – 9:45 a.m. PST | In-person + Livestreamed

Multi-Country Review of ITN Routine Distribution Data: Are ANC and EPI Channels Achieving Their Potential?

Speaker: Jane Miller, The PMI VectorLink Project, PSI. 

View at: http://app.core-apps.com/astmh22/event/c71a3811aa9da3c1a3f45d3229ad702e

Scientific Session 134 | Thursday, November 3 | 8:00 – 9:45 a.m. PST | In-person

Efficacy of Partial Versus Full Surface Indoor Residual Spraying Against Wild Populations of Anopheles gambiae Sensu Lato in Experimental Huts in Tiassalé, Côte d’Ivoire

Speaker: Joseph Chabi, The PMI VectorLink Project, Abt Associates

View at: http://app.core-apps.com/astmh22/event/c71a3811aa9da3c1a3f45d3229afb785

Poster Session A | Monday, October 31 | 11:00 a.m. – 12:45 p.m. PST

Poster Number 107: Response of An. funestus s.l. and An. gambiae s.l. to Different Insecticides in Malawi.

Presenter: Leonard Dandalo, The PMI VectorLink Project, Abt Associates.

Poster Number 116: Status of Insecticide Resistance in Malaria Vectors in Three Provinces in Zambia: Informing the National Insecticide Resistance Management Plan.

Presenter: Mohamed Bayoh, The PMI VectorLink Project, Abt Associates.

Poster Number 117: Heterogeneity of Insecticide Susceptibility from Six Ecological Zones in Nigeria Suggest a Highly Evolving Anopheles gambiae s.l. Population Under Selection Pressure.

Presenters: Adedayo Oduola, The PMI VectorLink Project, Abt Associates; Okefu O. Ohoji, National Malaria Elimination Program, Nigeria.

Poster Number 131: Ecological Determinants & Recorded Distribution of Anopheles stephensi in Ethiopia.

Presenters: Meshesha Balkew, The PMI VectorLink Project, Abt Associates; Achamyelesh Sisay, Ministry of Health, Ethiopia.

Poster Number 311: Applying a Standardized, Molecular Entomology Data Labeling System in Ghana to Effectively Integrate into Central DHIS2 Database.

Presenters: Marianne Parrish, Allison Hendershot, Edem Obum, and Louisa Antwi-Agyei, The PMI VectorLink Project, Abt Associates.

Poster Number 409: Effect of Deltamethrin-Piperonyl Butoxide (PBO) Insecticide-Treated Nets on Malaria Case Incidence and Entomological Indicators in Ebonyi, Nigeria.

Presenters: Kelly Davis, The PMI VectorLink Project, PATH; Adedayo Oduola, The PMI VectorLink Project, Abt Associates.

Poster Session B | Tuesday, November 1 | 12:00 p.m. – 1:45 p.m. PST

Poster Number 754: Assessment of Behavior and Sociocultural Risk Factors Impacting Durability of Insecticide-Treated Nets in Mali.

Presenter: Moussa Cisse, Laboratoire de Biologie Moléculaire Appliqué. 

Poster Number 755: Results of Expanded Insecticide Resistance Monitoring to Several Ecological Zones in Cameroon for Appropriate Vector Control Decision Making Data.

Presenter: Etienne Fondjo, The PMI VectorLink Project, Abt Associates. 

Poster Number 764: The Entomological Impact of ITNs and IRS in the Americas: Filling the Knowledge Gaps.

Presenter: Manuela Hererra-Varela, The PMI VectorLink Project, Abt Associates. 

Poster Number 774: Longitudinal Surveillance of Malaria Vectors Using Four Different Mosquito Collection Methods from Village and Forest areas of Stung Treng and Mondulkiri Provinces, Cambodia.

Presenter: Matthew Kirby, the PMI VectorLink Project, Abt Associates; Dr. Siv Sovannaroth and Mao Sokny, National Center for Parasitology, Entomology, and Malaria Control, Cambodia.

Poster Number 1016: Community-Based Surveillance: A Key Procedure for Continuous Field Entomological Data Collection in Areas of Difficult Access in Mali.

Presenter: Libasse Gadiaga, The PMI VectorLink Project, Abt Associates. 

Poster Number 1021: Ecology, Distribution, and Insecticide Susceptibility Status of the Major Malaria Vector An. funestus s.l. in Guidimouni, Eastern Niger.

Presenters: Hadiza Soumaila, The PMI VectorLink Project, Abt Associates; Boube Hamani, National Malaria Control Program, Niger; Ibrahim Issa Arzika, Centre de Recherche Médicale et Sanitaire, Niger. 

Poster Session C | Wednesday, November 2 | 11:00 a.m. – 12:45 p.m. PST

Poster Number 1305: Vector Bionomics and Insecticide Resistance in Sierra Leone: Opportunities and Challenges in Decision-Making for Malaria Vector Control.

Presenters: Kevin Opondo, Laurent Iyikirenga, The PMI VectorLink Project, Abt Associates; Frederick Yamba, National Malaria Control Program, Sierra Leone.  

Poster Number 1603: Evaluating the Impact of Indoor Residual Spraying on Malaria Transmission in Madagascar Using Existing Data Sources.

Presenters: Emily Hilton, The PMI VectorLink Project, PATH; Tovotshimihefo Andriamanampisoa Orieux, National Malaria Control Program, Madagascar. 

Poster Number LB-5424: High Median Life of DuraNet Brand Insecticide-Treated Nets in Liberia: Results from Durability Monitoring in Two Sites, 2018-2021.

Presenters: Stephen Poyer, The PMI VectorLink Project, PSI

 

A community health worker in Madagascar’s Toamasina II district holds an ITN while the durability monitoring team identifies and counts holes in the net.

PMI VectorLink Malaria Fighter: Jacky Raharinjatovo

Madagascar

Jacky Raharinjatovo, seen below, joined the U.S. President’s Malaria Initiative (PMI) VectorLink Project as a regional research manager, based in Madagascar, in February 2022. A Malagasy citizen, he has a Master’s degree in statistics from the University of Antananarivo, and has been conducting public health research for 18 years. Much of his current work focuses on durability monitoring of insecticide-treated nets (ITNs), but he has deep experience in all kinds of malaria research, including contributing data for the Malaria Indicator Survey and studying malaria case management among private sector outlets. Jacky recently took the time to share more about his work for PMI VectorLink. 

Photo of Jacky Raharinjatovo at a desk in front of a computer.

Tell us a little bit about your career path.

After university, I started my professional career in research, which aligned with my academic interests. Since 2004, I’ve been working for PSI Madagascar, where I started as a deputy research coordinator. I was part of the first team to pioneer the use of electronic data collection (EDC) in Madagascar, using a personal digital assistant (PDA) to collect data during a household survey related to malaria prevention and treatment. Following the initial success of that initiative, EDC was expanded to other PSI countries, and I was asked to develop a toolkit and document the lessons learned for research colleagues in other countries. The introduction of EDC was a big innovation that helped to improve data quality and provide data faster for malaria surveys. PSI is one of the partners on the PMI VectorLink Project, and when the opportunity arose to serve as a regional research manager for the project, I took it, because malaria remains a major challenge in many parts of the world and research is critical to continue the fight against malaria.

How does your role as regional research manager contribute to the fight against malaria?

I support activities in six countries within the PMI VectorLink Project: Madagascar, Burkina Faso, Burundi, Cameroon, Côte d’Ivoire, and Senegal. I interact regularly with each country team including the chief of party, in-country research agencies, and other partners to monitor progress on all research-related activities, identify challenges, and provide solutions.

Insecticide-treated nets (ITNs) are an important component in malaria control, and durability monitoring—which generates evidence on ITN survivorship, physical durability, and insecticide effectiveness—is a key part of my work with the project. Durability monitoring helps to inform procurement and programmatic decisions for ITN campaigns and continuous distribution. My day-to-day work varies, depending upon any country’s timeline within the durability monitoring process, but can include designing study protocols, supporting training of trainers, and in-person training, conducting remote data quality checks for countries with ongoing field work, data cleaning and data analysis, and writing study reports.

Ultimately, my job is to provide high-quality evidence to governments, donors, and manufacturers of ITNs to support their decision-making regarding vector control. This can include data being used to inform social and behavior change communication (SBC) messages regarding ITNs. As a member of the dynamic PMI VectorLink team, I contribute to the saving of lives indirectly through the surveillance of ITN durability.

Why is studying the effectiveness of ITNs so important?

A ruler used to measure net hole size has color-coded markings for each of the four standard hole sizes measured during a durability monitoring study.
A ruler used to measure ITN hole size has color-coded markings for each of the four standard hole sizes measured during a durability monitoring study. Photo Credit: Jacky Raharinjatovo

The goal for malaria intervention programs is to reduce malaria-related mortality and morbidity. Malaria control programs generally combine prevention and case management, which are complementary and work together. PMI VectorLink’s focus is controlling malaria vectors through the use and study of ITNs, indoor residual spraying (IRS), and entomological monitoring. In terms of ITNs, the insecticides used on them are needed to repel mosquitoes and to prevent mosquito bites. The effectiveness of these insecticides decreases over time, as demonstrated by the surveillance of the durability monitoring study conducted in PMI VectorLink countries.  Measuring ITN durability like this provides evidence to donors and governments on the effectiveness of ITNs, which helps them to make decisions on where to prioritize their malaria control efforts and which nets to use and helps insecticide manufacturers improve their products’ efficacy to kill and repel mosquitoes.

The evidence generated through durability monitoring contributes to making ITNs more durable, which helps in the efficient use of funds. The longer the lifespan of ITNs, the more resources we save for other priorities.

What do you find most challenging and rewarding about your job?

After several years of implementation, the biggest challenge is data use. There is often no clear action plan at the community level once data has been collected and analyzed. When there is a plan, monitoring is often lacking. In addition, the timeline between data collection, analysis, developing a data dissemination and action plan, and budgeting implementation of activities takes too long in relation to the timeline of the research activity itself.

For me as a researcher, I recommend the use of data at all levels—at the highest level among governments, donors, the Ministry of Health, and at the regional level within communities that collaborated during data collection. The government should be the first to use data to adjust strategies. Seeing my work used in an official document, such as a proposal or a national strategic plan, or when it is published in an official journal, makes me very happy and is rewarding.

What do you wish other people knew about the project?

People should know that our ITN mass distribution campaigns are supported by a three-year longitudinal prospective study which includes a net durability study to evaluate how long nets last, their physical integrity, and insecticide effectiveness. ITN-related decisions in many countries—including net characteristics such as the type of net and chemical content, as well as SBC messages such as recommended frequency for washing nets, type of soap used during washing, and drying method—are based on the evidence derived from the net durability study.

What are your hopes for the future in the fight against malaria?

I am hopeful that malaria will be eliminated from Madagascar in the next 10 years. In the short term, I think that malaria morbidity and mortality will be significantly reduced within the next three to five years, and then people will be able to live and work without the fear of contracting malaria. I believe that there will be a widely available, cost-effective, and efficacious malaria vaccine.

Transitioning Malaria Services to the Zanzibar Malaria Elimination Programme

In June 2022, the U. S. President’s Malaria Initiative (PMI) VectorLink Tanzania team transitioned all indoor residual spraying (IRS) activities in Zanzibar to the Zanzibar Malaria Elimination Programme (ZAMEP), as the program continues its progress towards eliminating malaria in Zanzibar by 2023.

In a close-out ceremony, the Ministry of Health (MOH) Zanzibar’s Director of Preventative Services, Dr. Ali Nyanga, thanked PMI and PMI VectorLink Tanzania for three successful IRS campaigns that achieved coverage rates above 90 percent, as well as for contributions to strengthening the “sustained capacity and ability of ZAMEP staff to handle IRS.”

PMI has partnered with ZAMEP over the last seven years to conduct IRS campaigns. Since 2018, this partnership has been through the PMI VectorLink Project. In 2021, PMI VectorLink transitioned the management of the IRS campaign to ZAMEP, providing technical assistance as needed, with the goal of handing off full IRS responsibilities directly to ZAMEP this year. ZAMEP is now transitioning from full, large-scale IRS campaigns to rapid-response IRS in areas that experience malaria outbreaks.

A spray operator is accompanied to a structure in Zanzibar (2017) to spray it with insecticide. Photo Credit: Laura McCarty

In addition to supporting the government of Zanzibar’s efforts to strengthen capacity in planning and implementing safe, cost-effective, and sustainable IRS campaigns, PMI VectorLink Tanzania worked with ZAMEP and its partners to strengthen their information systems and build their capacity to collect, manage, and use IRS data. Over the past year, the project team guided ZAMEP to establish interoperability between Coconut Surveillance, an integrated data system to support malaria surveillance and elimination in Zanzibar, and the Zanzibar Ministry of Health District Health Information Software (DHIS) 2 system—allowing the two systems to exchange information for evidence-based decision making in a timely manner.

PMI VectorLink Tanzania also introduced ZAMEP to mobile data collection during IRS campaigns, enhancing their team’s digital capabilities. Over the last year, the project guided the ZAMEP team to develop its own mobile application, which it will use to collect data during rapid response IRS activities. These efforts have left the ZAMEP team with increased competence and confidence in their data collection, reporting, and analysis skills.

At the close-out event, Dr. Nyanga commended PMI VectorLink Tanzania for contributing to strengthening gender equity and youth employment through IRS work as well. Since the program’s inception, PMI VectorLink Tanzania has identified barriers to women’s participation in IRS and implemented policies to overcome those barriers. In Zanzibar and mainland Tanzania, PMI VectorLink piloted a 1:2 male-to-female ratio of spray operator recruitment in 2019/2020, after low participation of women in prior years. This initiative resulted in 42% of the seasonal IRS workforce being female, and women’s employment has remained high through the subsequent IRS campaigns. Dr. Nyanga cited this as a “great achievement” in his remarks, further noting that “90 percent of those employed are under the age of 35. This empowerment of youth is what the Government of Zanzibar is striving for.”

With the increasing use of the new type of nets, including pyrethroid-PBO insecticide-treated nets, mass IRS campaigns will be less frequent and rapid response efforts will occur as needed when there are malaria outbreaks.

Director of Preventative Services Dr. Ali Nyanga addressing the audience at the closeout celebration at the Golden Tulip Hotel in Zanzibar. Photo Credit: Leonard Mutani, photographer

 

Reaching the Unreached with IRS

PMI VectorLink Ghana works to bring indoor residual spraying (IRS) to hard-to-reach communities by working with the government of Ghana to implement IRS in nine districts. They reach nearly 1,500 communities, close to 18 percent of which are in hard-to-reach areas. Some of these areas are only accessible through roads that can become impassible during heavy rains; others are nestled between mountains and can only be reached on foot.  Successful implementation of IRS in hard-to-reach communities is thanks to dedicated communities and their leadership, supportive stakeholders, and committed governments in Ghana and the United States. 

New Insectary in Côte d’Ivoire Boosts Country’s Capacity in the Fight Against Malaria

Malaria is endemic in Côte d’Ivoire, where it is the leading cause of death among children under age five, and the primary reason for all medical consultations and hospitalizations. Understanding how to best control the mosquitoes that carry the malaria parasite is critical to reducing the country’s malaria burden. The opening of a new insectary at the Institut National d’Hygiene Publique (National Institute of Public Health, or INHP) is a critical step in ensuring that Côte d’Ivoire is well equipped to study mosquito behaviors, respond to malaria outbreaks, and move forward in the fight against malaria.

Dr. Lucien Konan, chief of the Institut National d’Hygiene Publique Vector Control Unit (with microphone), explains some of the equipment to U.S. Ambassador to Côte d’Ivoire Richard Bell.

The U.S. President’s Malaria Initiative (PMI) has been working with the Government of Côte d’Ivoire since 2017 on malaria vector control. Through the PMI VectorLink Project, it has been building the capacity of local scientists in the National Malaria Control Program (NMCP) to conduct entomological monitoring for malaria through training and knowledge sharing. Over the past year, it has also supported the renovation of the INHP insectary.

On Friday, July 29, the U.S. Ambassador to Côte d’Ivoire, Richard Bell, along with Côte d’Ivoire’s Director General of Health, Professor Mamadou Samba, and INHP Director Professor Joseph Benie Bi Vroh, presided over the official opening of the insectary. Each of the facility’s original four rooms for breeding mosquitoes have been partitioned into two rooms, one side for breeding mosquito larvae and one side for adults—with each room dedicated to a specific strain of mosquito. An entomology laboratory and additional rooms for research and testing needs were also restructured and renovated.

Left to right: Côte d’Ivoire’s Director General of Health, Professor Mamadou Samba; U.S. Ambassador to Côte d’Ivoire, Richard Bell; INHP Director Professor Joseph Benie Bi Vroh

Professor Samba thanked PMI for its support to end malaria, including the expansion and refurbishment of the insectary. The new facility will enable INHP and the Ministry of Health, through the NMCP, to understand the habits of mosquitoes, their malaria transmission dynamics, and which type of insecticides kill mosquitoes that carry malaria. This information will be used to develop effective strategies in vector control to protect the population from vector-borne diseases, including malaria, dengue fever, and others. In addition, the INHP insectary and its local staff are better positioned to support further training of entomologists and others working in vector control, strengthening the country’s overall capacity in the fight against malaria.

Strengthening Entomological Capacity for Malaria Elimination in Zimbabwe

After years of schooling to become a medical entomologist, Dr. Hieronymo (Ron) Masendu (below), technical manager for the U.S. President’s Malaria Initiative (PMI) VectorLink Project in Zimbabwe, recently returned to the classroom to facilitate an entomological capacity strengthening training for Africa University (AU) staff.

PMI VectorLink Zimbabwe Technical Manager, Dr. Hieronymo Masendu in the field.

In Zimbabwe, there are few experienced entomologists working on malaria. These specialists study and work to control the mosquitoes that transmit malaria, and play a critical role as the country moves towards malaria elimination. One of the major obstacles to ending malaria is mosquitoes’ ability to develop resistance to insecticides that previously killed them. So, monitoring mosquitoes is necessary to discover when and how resistance develops to better understand how to overcome it. In addition, accurate and up-to date information on malaria-carrying mosquitoes—such as which mosquito species carry the malaria parasite, where they are located, and what insecticides will be most effective to control them—helps Zimbabwe’s National Malaria Control Program (NMCP) and other stakeholders decide how to deploy interventions for malaria control and elimination, including outbreak situations. To strengthen local capacity, Dr. Masendu, in collaboration with AU’s PMI-funded Zimbabwe Entomology Support in Malaria Programme (ZENTO) project, a partner of the NMCP, organized a two-day training on insecticide resistance monitoring and species identification of Anopheles mosquitoes.

PMI VectorLink Zimbabwe has worked in partnership with AU since 2017, strengthening the skills of AU staff; procuring entomological materials, supplies, and equipment; and helping to construct a state-of-the-art Malaria Research and Reference Insectary on the AU campus.  This partnership has, in turn, helped to strengthen the NMCP’s preparedness and response to malaria. The NMCP’s evidence-based decisions have been informed by AU’s knowledge of the mosquitoes that transmit the disease. AU analyzes mosquitoes that PMI VectorLink and the NMCP collect and is able to identify different mosquitoes species, confirming the initial species identification done by PMI VectorLink Zimbabwe. However, the AU team lacks the ability to conduct tests for insecticide resistance. Dr. Masendu’s training was geared to fill that gap.

Six AU staff members attended the insecticide resistance monitoring training: one insectary manager, two laboratory assistants, one district coordinator for the ZENTO project, and two interns from AU. The training covered two insecticide resistance test methods—CDC bottle bioassay, the method PMI VectorLink Zimbabwe uses, as well as the widely used WHO tube test. Dr. Masendu started the training with background on recent gains in malaria control and the major threats to control and elimination globally. He then reviewed the theory behind the insecticide resistance testing methods before moving to practical sessions, in which participants practiced conducting CDC bottle bioassay and WHO tube tests with live, non-infected mosquitoes collected from the insectary on campus.

Participants checking mosquitoes to be tested during insecticide resistance training.
Photo Credit: PMI VectorLink Zimbabwe Technical Manager, Dr. Ron Masendu

Fourteen people attended the mosquito species identification training, some of whom had attended the insecticide resistance monitoring training. One insectary manager, three laboratory scientists, three laboratory assistants, six laboratory interns and one project coordinator for the International Centers of Excellence for Malaria Research learned how to identify Anopheles mosquitoes using standard morphological identification keys, which identify different species of mosquitoes. Mosquito morphology deals with the form and structure of mosquitoes, focusing on visible features. This is an essential preliminary step in mosquito monitoring that helps save time in the laboratory.

“Most [participants] had no previous knowledge of using identification keys. It was also apparent most of the participants were not familiar with the terminology of the mosquito body parts that is essential in identification,” shared Dr. Masendu.

Using illustrations, the class discussed the terms and body parts used for species identification: the head, the thorax (midsection), and the abdomen of adult mosquitoes. Participants then viewed preserved mosquito specimens under a microscope, referencing the identification keys to categorize the mosquitos, and then practiced analyzing and identifying several specimens to test their knowledge.

A participant examining a mosquito specimen during training on morphological identification.
Photo Credit: PMI VectorLink Zimbabwe Technical Manager, Dr. Ron Masendu

The training was well-received by its participants.

“Even though I did participate in an entomology training workshop a few years ago, it was very helpful to go through this two-day capacity-building training with Dr. Masendu,” stated Wietske Mushonga, a lab scientist at AU. “Our group was mixed, with some of us already having some entomology work experience, and others who did not have any. Dr. Masendu was able to take the time to give attention to everyone.”

By the end of the training, all participants were able to identify different species of mosquitoes and test for insecticide resistance using standard operating procedures, expanding the number of AU staff who can contribute to this work. Increasing the number of staff who can accurately identify different mosquito species will also reduce potential bottlenecks in analysis. Before the training, only three AU staff could conduct morphological identifications, now four more can with continued practice and guidance from their colleagues. While AU does not currently conduct insecticide resistance tests, they can now do so with guidance from PMI VectorLink Zimbabwe.

Dr. Masendu is optimistic about the future of AU’s entomological capacity. He stated that “strengthening staff knowledge of mosquito identification will help position AU to further build capacity in medical entomology at the national and regional level especially in morphological identification of mosquitoes that spread disease.”

Promoting Equity in Vector Control: Examples from Ghana, Rwanda, and Senegal

People living with disabilities. People living in prisons and refugee camps. Orphans and vulnerable children. These are specific populations who may not be reached during countries’ malaria prevention campaigns. But with support from the U.S. President’s Malaria Initiative (PMI) and the PMI VectorLink Project, Ghana, Rwanda, and Senegal are making strides to ensure that these high-need and high-risk groups are receiving equitable protection against malaria. Recently, PMI VectorLink hosted a webinar, Promoting Equity in Vector Control: Successes and Challenges in Reaching the Unreached, which highlighted some of their specific efforts.

The deployment of insecticide-treated bed nets (ITNs) and indoor residual spraying (IRS) are two primary vector control interventions that have provided proven protection for millions of people for decades. Ghana aims to reach at least 80 percent of its population with these and other malaria prevention interventions, according to Otubea Akrofi, vector control lead for Ghana’s National Malaria Control Program (NMCP). Among the country’s most vulnerable groups are children living in orphanages, migrant workers, and people living with disabilities. To reach people living with disabilities, the NMCP has worked with the Ghana Society of the Physically Disabled and similar groups, both to engage people living with disabilities in these efforts and to get reliable figures for planning campaigns.

Ghana’s strategy involves reaching people living with disabilities through existing platforms—such as regular meetings of the Federation of Disability Organizations, for example—so that individuals are comfortable in sharing their needs and feedback about IRS and ITN campaigns. Some people living with disabilities take on specific roles in these efforts, serving as community mobilizers, for example, and ensuring a two-way flow of information. Some people living with disabilities may require support from ‘packers’—people tasked with packing up and moving household goods out of homes while insecticide spraying occurs; others may need help in ensuring correct hanging of mosquito nets. Relying on existing community organizations and residents helps to overcome resistance to IRS and increase people’s comfort level with receiving insecticide spray teams into their homes. 

In Rwanda, the Ministry of Health identified prisons and refugee camps as needing targeted strategies to implement IRS. The structures and the people living within them have different challenges than many of the standard populations served by malaria control efforts, said Dr. Emmanuel Hakizimana, vector control lead for Rwanda’s Ministry of Health. For example, access to prisons and refugee camps is strictly controlled. Authorization from the ministries involved with prisons and refugees was first needed; then the Ministry of Health identified key stakeholders and involved them in all phases of the IRS campaign, including planning and intervention, supervision, monitoring and evaluation, and adaptation. In addition, to protect the health of the residents after the IRS was completed, the spray teams had to identify convenient sites for soak pits—outdoor areas to safely dispose of the wash water used as part of the spraying process—that were not too close to sites used by residents within these locations.

Senegal’s NCMP emphasizes an inclusive and equitable approach to malaria prevention and treatment in its strategic plan, striving to reach the entire population regardless of socioeconomic level or geographic location, said Dr. Amdy Thiam, vector control lead for Senegal’s NCMP, where he is also the focal point for the distribution of ITNs.

“Equity is really a priority,” said Dr. Thiam. “An inclusive and equitable approach with tailor-made solutions for special groups is necessary to achieve our national goal of malaria elimination by 2030.”

Recently, the NMCP in Senegal has begun piloting a program to reach Talibé students, boys ages 7 to 15 who live in Koranic schools known locally as daaras, which often lack necessities, including mosquito nets. Since the number of daaras and the students they serve are not well documented, the NMCP launched a census with trained community members, reaching out to religious and education leaders at the community level to gain access to the schools and learn more about the students’ living conditions. They noted that in some schools, three to five children were sharing one bed and in others, children were sleeping on the floor, making it difficult to ensure proper ITN coverage. The NMCP worked with the daaras’ leadership to find solutions so that all children were properly protected with ITNs.

As Dr. Thiam noted, since the Talibé program is in the pilot phase, the NMCP will assess and analyze the lessons learned once it is concluded, before proceeding with scale up. Ideally this intervention will be scaled to the national level to reach the entire country and accelerate Senegal’s elimination of malaria.

The effectiveness of piloting new programs as part of an overall strategy to reach those who might otherwise be excluded was endorsed by all the webinar presenters, who recommended pilots as a best practice to further equity in malaria control interventions. The aim of pilot programs, Dr. Hakizimana noted, should be to identify key bottlenecks and jointly solve these issues with the appropriate stakeholders, so that when scaled-up, these programs can be fully integrated into national IRS campaigns, thus avoiding separate logistics for special groups, and maximizing resources in the long run.

“In planning for the vulnerable or the populations that are really hard to reach, you can’t do business as usual,” said Ms. Akrofi. “There has to be purposeful planning, you have to have them in mind, and put in the various strategies that you need to get to them.” 

“We really need to move away from the status quo,” echoed PMI VectorLink’s Tess Shiras, the project’s gender equality and social inclusion advisor who moderated the event. “It’s really imperative that national leaders are champions of this work,” she said, citing the inclusion of the Talibé outreach in Senegal’s national malaria strategy.

Watch the recording to see the full discussion about how PMI VectorLink, Senegal, Ghana, and Rwanda are promoting equity in vector control.

At Tanzania’s Refugee Camps, Local Health Teams Take the Lead

In 2021, over 220,000 people—mostly from Burundi—resided in the Nyarugusu, Nduta, and Mtendeli refugee camps in Tanzania’s Kigoma region. Refugees living in these camps are often confined within them, with limited work opportunities, and must rely on humanitarian assistance to meet their basic needs. They also face multiple health challenges, including malaria, with pregnant women and children under five particularly at risk. With these groups making up a large percentage of the camp population, malaria prevention was critical to protect them from illness.

Indoor residual spraying (IRS) is important to combat malaria. Tanzania’s National Malaria Control Program reached out to the U.S. President’s Malaria Initiative VectorLink Project, requesting a study be made to see if IRS could be conducted safely and effectively within each camp environment. Then, working in partnership with the local district health authorities, PMI VectorLink Tanzania sprayed Nyarugusu camp in Kasulu district, Nduta camp in Kobondo District, and Mtendeli camp in Kakonko district in 2019.

For the subsequent IRS campaign in 2021, in order to strengthen local capacity, PMI VectorLink Tanzania transitioned leadership to the District IRS Technical Teams (DITTs) to lead spraying within the refugee camps, with PMI VectorLink providing support through the provision of supervisory tools and assistance with the recruitment process. PMI VectorLink Tanzania shared all necessary IRS training materials with the DITTs before the start of the supervisor training. The DITTs in Kasulu and Kibondo handled individual sessions of the supervisor training classes while the DITT in Kakonko district managed the trainings with remote oversight from PMI VectorLink. The DITTs in the three districts held supportive supervision spray operator training a week later. While the DITT staff had supervisory roles within the districts, a near total hand off was done at the refugee camps.  

The District Malaria Focal Person is happy to protect children under-five from malaria. Photo credit: Christopher Mshana, PMI VectorLink Tanzania regional coordinator

Tanzania’s Ministry of Home Affairs and the United Nations High Commissioner for Refugees (UNHCR), which manages the camps, recognized that it was vital to recruit camp residents to play a role in IRS, to support IRS acceptance in the camp community. They hired camp residents—50 percent of whom were women—to work as mobilizers, security guards, water fetchers, and washers. Having these local residents conduct mobilization efforts helped to increase IRS acceptance within the camps, since the mobilizers were known and trusted within the community and were also able to communicate the importance of IRS in their native language.

Mercy Msirikale has worked as a public health officer for the Ministry of Home Affairs for three years. She witnessed the devastating impact of malaria on the camp residents as well as the drop in cases after IRS implementation.

“We appreciate the presence of IRS in the refugee camps because the cases of patients presenting with malaria were frequent sometime back before implementation of IRS, but this has changed over the last three years; malaria cases significantly dropped,” shared Mercy.

IRS has made a substantial impact in malaria prevention as seen by the sizable reductions in malaria cases. In the Mtendeli refugee camp, malaria prevalence fell from 63 percent in 2018 to 15 percent in 2021. During the same time frame, malaria prevalence in Nyarugusu refugee camp decreased from 43 percent to 12 percent. Nduta refugee camp saw a smaller decrease—a trend that is consistent with Kibondo district, where malaria cases were lower to begin with—at 25 percent pre-spray and just below 24 percent after IRS. Due to the number of ineligible structures (often made of plastic) at Nduta camp, the team is planning to coordinate with UNHCR and other partners such as Médecins Sans Frontièrs and Tanzania Red Cross to harmonize other malaria prevention interventions, such as larviciding, insecticide-treated net distribution, social and behavior change, and monitoring and evaluation to harness greater impact.

This capacity strengthening initiative led to Nyarugusu camp attaining a spray coverage of 97 percent, while Nduta and Mtendeli camps achieved coverage of 99 and 96 percent, respectively. In total, the project was able to protect a vulnerable population of 224,393 people (98 percent) within the three refugee camps. Of those protected, 10,346 were pregnant women and 50,368 were children under five.

The head of household assists the spray operator during the insecticide mixing procedure. Photo Credit: Isaya Mihayo, photographer