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 Mtendeli camp in Kakonko district in 2018, and Nyarugusu camp in Kasulu District and Nduta camp in Kobondo 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

Solar Powered Systems: Reliable Electricity for Cooling Systems and Data Collection

Malaria continues to be a serious health threat in much of Sub-Saharan Africa. With the impacts of climate change becoming more extreme, countries are increasingly concerned with how climate change will affect vectors, like malaria-transmitting mosquitoes. The U.S. Agency for International Development’s (USAID) Climate Strategy 2022-2030 supports actions that prevent, limit, or sequester six billion metric tons of carbon dioxide. Transitioning to solar power, a renewable energy source, helps achieve that target and enables malaria services to remain resilient against shocks like climate change.

A key malaria control intervention is indoor residual spraying (IRS). The U.S. President’s Malaria Initiative (PMI) VectorLink Project implements IRS in 13 countries, including Madagascar and Tanzania. In each country, IRS operational sites are established to support the teams going door-to-door to spray houses with insecticide. Historically, the electric grid and generators have provided the necessary electricity for powering cooling systems for insecticide storerooms and charging electronic devices for mobile data collection. However, solar power, a renewable energy source, can provide the required electricity, is more reliable, and is becoming more affordable.

Adapting to High Temperatures in Madagascar

In Madagascar, solar panels were a necessary adaptation to high temperatures. The maximum recommended storeroom temperature for IRS insecticides is 35°C (approximately 95°F). Higher temperatures could lead to insecticide degradation or damage the integrity of insecticide containers. In Betioky District, temperatures can reach 42°C (approximately 107°F) even in the shade.

“One of the major concerns in Madagascar is the impact of climate change like high temperatures and violent storms. These interfere with the storage conditions of the insecticides because either the storerooms are not electrified, or the power is cut for several days after the passage of storms,” said Environmental Compliance Officer Tahina Masihelison of PMI VectorLink Madagascar.

PMI VectorLink Madagascar tested the use of a solar-powered cooling and ventilation system in the Tongobory operations site. The ventilation system comprises a solar panel that can produce 500 watts of electricity, plus a battery, an AC/DC inverter, a humidifier, and a fan. The battery stores the energy collected by the solar panel and powers the fan and humidifier when the sun is not shining. The ventilation system keeps the storeroom cool and distributes the air evenly, eliminating hot spots.

Generators, an alternative method to cooling storerooms, are widely available and easy to install. However, disadvantages include pollution from the fuel, recurring fuel costs, noise, and size/weight. Solar panels on the other hand are a renewable energy source, and they are quiet and light. In Madagascar, a 500-watt installation with a humidifier costs around $430, which is less expensive than the approximately $738 to run the generator up to eight hours a day for 30 days.

After the solar powered system was installed, the storeroom temperature decreased by 12°C on average. Therefore, if the outside temperature was 40 – 44°C (approximately 104 to 111°F), the temperature inside the storeroom was cooled to between 28 and 32°C (approximately 82 to 90°F). Solar-powered systems are thus effective at cooling storerooms to below the recommended maximum storage temperature at a lower economic and environmental cost.

Reliable Power for Data Collection

In 2021, PMI VectorLink Tanzania transitioned to full mobile data collection to support IRS activities and scaled-up the use of solar panels for charging devices, which was previously piloted during the 2020 campaign. PMI VectorLink Tanzania’s spray operators used solar panels to charge mobile devices to collect information during the spray campaign. Key information collected included structures visited and key populations protected to inform IRS campaign monitoring and track spray coverage. Mobile data collection increases efficiency by enabling same day processing of data but requires a reliable source of electricity to keep mobile devices charged each day. In the past, the project used rented generators and purchased fuel, power stabilizers, and extension cables. They also used electricity at sites where it was available. However, electricity can often be unreliable due to maintenance issues and frequent power cuts.

Transitioning to solar power provided the team with reliable electricity, especially in hard-to-reach areas, and reduced costs. Since the project owns the solar panels and charging banks, they can be used for a prolonged period and the portability of the solar chargers allows for a smooth reallocation of the panels across IRS operational sites. While electricity costs less in the short-term, approximately $4,152 per campaign, it is limited in rural settings where generators were previously used to provide the necessary electricity. However, solar power is more cost effective than generators—approximately $12,266 initially compared to $33,959 per campaign. Currently, the Tanzania team has 532 solar panels and enough phone chargers for the 1,325 active devices.

“The rollout of solar charging systems enhanced the quick availability of data that helped timely decision-making and adjusted field supervision priorities among operations sites. Spray Operators were able to operate with charged phones every day, establishing a stable synchronization process at the end of the spray day,” stated Monitoring and Evaluation Officer Ditrick Novat of PMI VectorLink Tanzania.

Solar-powered systems provide a renewable, reliable, and cost-effective way to meet electricity needs. In Madagascar, the solar installation supports electrification of the central store during the rest of the year, and trained storekeepers are responsible for maintenance until the next IRS campaign. In Tanzania, the panels are available to the NMCP if they are requested. Scaling up these systems can help significantly with a spray campaign’s electricity needs, enabling malaria services to remain resilient.

PMI VectorLink Malaria Fighter: Sana Diop Dieng

Senegal

Sana Diop Dieng is a malaria survivor. During primary school, she sometimes suffered from the disease almost every month; at one point, her case of malaria was severe enough to require injections at the hospital before and after school and she missed a great deal of school. However, she was resilient and after completing secondary school in Dakar, Senegal, she continued her university studies at the Sidi Mohamed Ben Abdellah University in Fez City, Morocco where she received her BSC in Chemistry. Sana also has an MSC in Environmental Management from the Institut Supérieur de Developpement Local, in Dakar. Sana, the U.S. President’s Malaria Initiative (PMI) VectorLink’s Regional Environmental Compliance Manager, is not just an environmental expert; she is part of the U.S. Department of State’s Young Africa Leadership Initiative, currently serving as a mentor to young leaders that would like guidance on implementing their project ideas. She has also dabbled in fashion design, creating traditional and modern outfits for herself, her family, and for sale. In honor of Earth Month, Sana took the time to share her experience working in environmental compliance with us.

Tell us about what you do.

I am the Regional Environmental Compliance Manager for the PMI VectorLink project based in Dakar, Senegal. I currently support the indoor residual spraying (IRS) countries, Côte d’Ivoire, Mali, Rwanda, and Senegal and partly support entomology-only countries such as Cameroon, the Democratic Republic of the Congo, and Niger. At the country level, I work with Environmental Compliance Officers (ECOs) and Chiefs of Party (COPs) on how to comply with environmental requirements outlined in the Best Management Practices (BMP) guide. This includes strengthening the capacity of the ECOs, preparing supplemental environmental assessments when needed, supporting ECOs with their duties, and supervising country teams on mobile health implementation.

How does the project minimize the environmental impact of insecticides?

The BMP guide describes all environmental compliance guidelines in detail to safely handle insecticide and minimize potential impacts of insecticide usage. The project is a model of environmental impact mitigation for the National Malaria Control Program (NMCP) and other government partners like the Ministry for the Environment. The BMP guide is applicable to other industries where chemicals are used such as pesticide use in agriculture.

How does the project minimize waste?

The project works closely with all countries to minimize waste generated by the project. The project follows the preferred hierarchy for waste disposal. For each type of solid waste, the ECO assesses the feasibility (including cost and safety) of disposal; they first assess the feasibility of reuse, then recycling, then landfilling, before considering incineration. For example, in Malawi, the project partners with local recycling companies that can turn plastic bottles and scratched face shields into solvent containers, laundry jugs, and liquid soap bottles.

Are there efforts to utilize renewable energy when electricity is required?

Yes, some countries use solar panels in operations sites for lighting, keeping storage rooms cool, and/or charging mobile devices for data collection during IRS campaigns.

How does the project strengthen the capacity of the NMCP to be leaders in environmental compliance?

The PMI VectorLink project has tailored capacity building trainings for each country. For example, an environmental compliance virtual training was held in 2020 for ECOs, environmental agencies, and NMCP staff that covered how to properly wear personal protective equipment (PPE), safely store insecticides, and manage site rehabilitation and waste management. In Senegal, the NCMP was part of the master training on all IRS components, including environmental compliance in 2021.

What are some innovations in environmental compliance?

There are many. The environmental compliance team was a leader in introducing mobile phone applications for the inspection of operations sites and supervision of spray activities. We also introduced wide-spread recycling of materials such as plastic and cardboard. The project also worked a lot on personal protective equipment alternatives regarding gender equity in the field such as two-piece uniforms that were more comfortable for women. Lately, we have been implementing the installation of roofs over wash areas and covers on fixed soak pits to minimize rainwater influent to the soak pit and to help maintain the operational status of these areas.

How does the project ensure environmental compliance efforts help reach the unreached?

The introduction and use of mobile soak pits is solving a lot of the issues with reaching the unreached as spray teams can transport the soak pit. Permanent soak pits are large, in-ground filters that absorb chemicals from liquid waste. Mobile soak pits can be carried to a site, installed in minutes, and catch and treat insecticide waste. When spray operations are complete, the soak pit is dug-up and carried to the next location. The previous site is then restored to its original condition.

I have also recently proposed a mentoring pilot program that is being implemented by PMI VectorLink Senegal to support supervisors, storekeepers, and health post nurses to adequately oversee project activities. The health post nurse in a hard-to-reach area for could be trained as an environmental compliance team member for example.

How do you think climate change will impact environmental compliance efforts related to IRS and insecticide-treated net (ITN) distribution?

Climate change could impact environmental compliance efforts, for high temperatures can degrade the active ingredients in insecticides, and cyclones and floods can destroy insecticide. Extreme weather events can also severely impact transportation of goods and spray operators to where they are needed by washing out roads and bridges.

What are some ways we can work to protect the environment?

Each of us can be an environmentalist, and each of us should be. We can get involved in so many ways, through personal action like separating out plastic to bring to recycling points or using thermoses for coffee rather than disposable cups; and collective action such as advocacy, volunteering to help build the capacity of communities, or supporting policy initiatives. We should all do our part!

World Malaria Day 2022

The Women in Charge: Leading the Fight to End Malaria

Effective leadership is vital for successful malaria control interventions. On this World Malaria Day, the PMI VectorLink project is highlighting five female leaders across positions and countries to showcase their roles, inspiration, challenges, and advice for aspiring female leaders dedicated to ending malaria once and for all.

World Malaria Day

Adapting Malaria Services to Crises

In the face of the ongoing COVID-19 pandemic, climate change, and security challenges, malaria prevention is as crucial as ever. The U.S. President’s Malaria Initiative (PMI) VectorLink Project supports countries that carry out indoor residual spraying (IRS) and distribute insecticide-treated nets (ITNs) to kill malaria-transmitting mosquitoes. Recurring conflict in Mali led to challenges in preparation for the IRS campaign, and Ethiopia’s unstable security situation caused delays or suspension of IRS operations in impacted districts. To be effective, IRS spray coverage needs to reach at least 85%. Despite the challenges, PMI VectorLink Mali and Ethiopia demonstrated grit and flexibility, enabling both teams to successfully complete their 2021 IRS campaigns with high spray coverage.

In Mali, the PMI-supported IRS campaigns are in the Mopti region. This region has security conditions which make certain target communities inaccessible to non-residents. In preparation for an IRS campaign, the Environmental Compliance Officer (ECO) must inspect and rehabilitate all operations sites using a mobile checklist prior to the delivery of insecticide to the site.

Due to the security conditions in the Mopti region, PMI VectorLink Mali’s ECO worked closely with the nurse in charge of the health post for the area to remotely conduct the inspections and take requisite photos for both initial and final pre-season environmental compliance assessments (PSECAs). The nurse led the site rehabilitation with guidance and recommendations from the ECO at every step of the way. Using pictures, they had daily discussions to ensure adequate quality. As a result, the PMI VectorLink Mali team was able to obtain the authorization to deploy insecticide on time in all 19 operations sites.

In Ethiopia, the first two phases (out of three phases total) of PMI VectorLink’s 2021 IRS campaign occurred in areas with recurrent ethnic conflicts, which resulted in postponing or suspending operations in 14 out of 42 districts from those phases. In nearby districts, the IRS campaign experienced minor delays due to rental vehicle drivers’ hesitancy to travel to these volatile areas. The PMI VectorLink team went to extraordinary lengths to arrange transportation using locally available resources in some districts and changed the IRS implementation model from district-based to community-based in others, thereby prioritizing community ownership and minimizing the need for travel. Despite these setbacks, PMI VectorLink in collaboration with dedicated local partners, managed to start operations in all districts within a few days of the scheduled start date.

The success of the first two phases is a glowing testament to the mutual trust and confidence PMI VectorLink built with regional and district health bureaus, which enabled the team to pivot to community-based IRS where needed, engage local (Kebele) administrations and health extension workers (HEWs), and protect as many people as possible from malaria. When the national election date shifted from June 5th to June 21st, the team shifted IRS operations, too. The plans for phase three (which included six new IRS districts in a new region) were designed in a flexible manner in anticipation of possible election-related interruptions. The team was able to adapt the activity schedule with minimal disruptions.

When communities are inaccessible due to security challenges, communities impacted tend to be the most vulnerable to malaria. Working with local partners, such as the nurse in charge of the health post in Mali and the local administrations and HEWs in Ethiopia, enables malaria prevention services to be delivered to those that need protection against malaria the most.

PMI VectorLink Malaria Fighter: Therese Dembele

Mali

Therese Dembele has been the entomology data manager for the U.S. President’s Malaria Initiative (PMI) VectorLink Project in Mali since 2020. She is of Malian origin, and is a member of the Bwa community. She has a Master’s degree in Bacteriology-Virology from the Catholic University of West Africa, University Unit of Bobo in Burkina Faso. Therese is no stranger to malaria having contracted the disease several times with the last time being in 2017. As a woman in science, Therese took time to share her experience in entomology and monitoring and evaluation (M&E) with us.

What is your role in malaria prevention and control with the PMI VectorLink project?

I am in charge of entomological data management for the PMI VectorLink Mali Project. I started as an entomological technician in 2012 under the PMI Africa IRS (AIRS) Mali Project, then I participated in the long-lasting insecticide-treated nets (LLIN) study as a supervisor in 2013. In 2016, I shifted my focus to complete a master’s degree in bacteriology-virology, and rejoined the VectorLink team in July 2018 as a part-time entomological data entry agent. I was promoted in March 2020 to entomology data manager.

My daily work consists of verifying and validating, with the Lead entomologist, the entomological data collection forms from the field, recording the data, cleaning and ensuring quality control of the recorded data, preparing samples of Anopheles gambiae s.l. mosquitoes and delivering them to the Applied Molecular Biology Laboratory (LBMA) for analysis, and assisting the Lead entomologist in the preparation of reports.

How has the incidence of malaria changed since the beginning of the project?

In the project’s IRS intervention area (Mopti region), the malaria parasite prevalence was 60% compared to the national average of 30%. Between 2017 and 2021, parasite prevalence has dropped from 60% to about 25% in the Mopti region.

How does the project innovate and lead in entomological data collection?

The implementation of the VectorLink Collect data platform is an innovation in terms of entomological data collection. The project currently uses paper data collection forms, but plans to start the collection of data from smartphones and tablets with the open data collect (ODK) software, a tool for collecting data using android mobile devices and sending it to an online server this year. VectorLink Collect/DHIS2 has allowed us to obtain quality data while staying organized. From our experience, simultaneous use of previous tools such as Excel-Access, Excel-DMS or even Excel-VL collection is less efficient in terms of the quality of data.

Therese Dembele studies mosquitoes through a microscope. Photo Credit: PMI VectorLink Mali

How does the project share entomological data with local partners?

Data is shared with local partners through reports and workshops. For example, the addition of piperonyl-butoxide (PBO), a synergist, improves the effectiveness of pyrethroid nets, prompting interest in new types of mosquito nets. The data collected is critical to decision-making on choices like site selection, distribution and type of ITNs, and insecticides for IRS.

How has gender equity been addressed in the project?

Efforts such as the encouragement of female candidates when recruiting technicians and local mosquito collectors are made daily to increase women’s participation in project activities. The field activities coordinator in particular motivates women to participate in field activities. However, this often comes up against the cultural beliefs of the area. The project supports equity and inclusion, but it is very difficult to get women to work, especially at night for reasons such as pregnancy and family constraints.

What advice do you have for women who wish to pursue work in data management or entomology?

I would urge women to have confidence in themselves and not underestimate their abilities to deliver very good results and to excel in this field. Personally, during my university education I was not among the best in biostatistics, but I believed that I could succeed in this field and have gained the required skills.

In what ways can women get involved in M&E in Mali?

Women who have the same experience as I do need to communicate and sensitize the women in their lives such as family members and friends about the possibilities for success in M&E. We need to promote women in this area through network discussion groups for example. Discussion groups allow women to express themselves freely most of the time. They share challenges, which allow them to help others with their experience and advice.

What does it mean to you to be a woman working in entomology?

Working in entomology as a woman is a way for me to show that I am capable of doing this work as much as a man, and I can be an effective field agent. Through me, I want women in Mali and elsewhere to be aware of their ability to excel in this field.

Equity in Vector Control: Engaging Hard-to-Reach Populations with Indoor Residual Spraying (IRS)

The PMI VectorLink project works with country governments to implement indoor residual spraying (IRS) to prevent malaria. While IRS is designed to have far-reaching coverage, there are some populations left behind in IRS planning and implementation.

PMI VectorLink strives to identify these populations, ensuring that disadvantaged, minority, and geographically hard-to-reach populations are protected from malaria and tailoring strategies to increase IRS acceptance and access. Across country teams, PMI VectorLink is collaborating with community organizations, governments, and village leaders to reach certain populations including people with disabilities in Ghana, people in prisons, the military, and police in Rwanda, and ethnic groups in Côte d’Ivoire.

Community meeting
A district stakeholders’ meeting in the West Mamprusi District Assembly Hall in Walewale, Ghana. Photo Credit: IEC Assistant for Walewale, Gamel Bayensi

In Ghana, PMI VectorLink works with the Ghana Federation of Disability to engage people with disabilities and ensure that IRS strategies and messaging are inclusive of their needs. The team uses the Association’s regular meetings as a platform to provide community education on IRS before each year’s campaign and invites Association leaders to participate in district-level stakeholder meetings and national IRS campaign launch events. PMI VectorLink Ghana disseminates messaging asking households and communities to support their neighbors who are elderly, ill, or disabled to adequately prepare their households before the arrival of spray teams, which involves moving items out of the home. Including people with disabilities in community IRS events provides a platform for an often-disadvantaged group to have a voice in IRS mobilization and planning efforts.

Working with the Ministry of Health, PMI VectorLink Rwanda collaborates with government agencies including the District Authorities and Rwanda Correctional Services (RCS)to reach prisons, military and police quarters with IRS. The Government of Rwanda is a champion in this work, requesting that these structures receive IRS more than ten years ago. In 2021, IRS acceptance in selected prisons, military and police quarters was 100% because the District Authorities are committed to these activities, liaising closely with RCS and with military and police leadership. This high spray coverage demonstrates the impact that government leadership can have when they prioritize equity in health promotion interventions.

A Lobi woman with her household items. Photo Credit: PMI VectorLink Cote d’Ivoire IEC/BCC Manager, Biba Coulibaly

In Côte d’Ivoire, PMI VectorLink identified a community, predominantly comprised of the Lobi ethnic group, that had lower-than typical acceptance of IRS. Married Lobi women typically live separate from their husbands in small homes where they sleep and store all their household items and harvested food. The accumulation of household items signifies wealth in the Lobi community, so many women have an abundance of goods, thus were hesitant to move their household items outside of their dwellings due to the inconvenience and sensitivity around publicly displaying their wealth. PMI VectorLink Côte d’Ivoire engaged community leaders to better understand these barriers and worked to emphasize the benefits of spraying. Messaging was tailored to promote not only the health benefits, but also the opportunity for Lobi women to conduct a deep cleaning of items stored in their homes. Now, the annual IRS campaign is also an annual cleaning.

These efforts demonstrate close collaboration with national, regional, and community counterparts to ensure that implementation is informed by local priorities, data, and information. Cross-country peer learning exchanges within the PMI VectorLink project have provided a valuable platform for country teams to share successes and challenges as well as spread innovative ideas about effective strategies to reach disadvantaged populations. For example, PMI VectorLink Zambia is supporting the government to expand spray coverage to prisons in 2022 based on the successes learned in Rwanda. In the coming months, PMI VectorLink country teams plan to expand their equity work by systematically identifying populations that are not currently reached by vector control and collaboratively developing tailored strategies to reach those groups.

PMI VectorLink Malaria Fighter: Mohamed Bayoh

Zambia

Mohamed Bayoh conducts a spot check on CDC bottle assays. Photo: PMI VectorLink Zambia

Mohamed Bayoh has served as Entomology Technical Manager for the U.S. President’s Malaria Initiative (PMI) VectorLink Project in Zambia since 2018. Originally from Sierra Leone, Mohamed holds a PhD in Medical Entomology from Durham University, England, UK, and a Master of Applied Science in Experimental Parasitology from University of Glasgow, Scotland, UK. As a child, Mohamed frequently contracted malaria, so often he said that missing school seemed normal. Recently, Mohamed shared his experience as an entomologist across Africa and how he is working to build local capacity in Zambia.

 Can you tell us a little about your role as an Entomology Technician Manager and your work experience?

I am responsible for PMI VectorLink Zambia’s entomological monitoring to determine the impact of the project’s indoor residual spraying (IRS) and insecticide-treated nets (ITN) campaigns in Zambia. I also provide technical assistance to the Zambia National Malaria Elimination Program (NMEP) on vector control and entomological monitoring. Recent activities include drafting standard operating procedures for entomological monitoring for use by the NMEP. Two important achievements include the training of district-based government health officers in entomological monitoring and the establishment of a PMI-funded laboratory space at the NMEP premises for advanced analysis of mosquito samples.

Before I started with VectorLink, I was a Public Health Specialist and Senior Technical Advisor with the US Embassy/Kenya Centers for Disease Control and Prevention (CDC), based in Kisumu, Kenya, after serving as the Head of Entomology at the Kenya Medical Research Institute/CDC Public Health Collaboration Program in Kisumu. During both periods I worked very closely with the Kenya National Malaria Control Program for 12 years as a resource person in malaria programmatic activities and operational research, the development of malaria vector control strategies, operational guidelines, and program monitoring and evaluation. I contributed to several evidence- based programmatic decision-making processes, for example, the shift from pyrethroid insecticides to non-pyrethroids for IRS, developing technical specification and guidelines for selection of ITNs for national campaigns and other distribution mechanisms.

What changes have you seen in your work and vector control since the VectorLink Zambia project began?

I’ve seen a change in the increased motivation of the Zambia national program in the use of data for decision making as more reliable and robust data has become available. Each decision must be linked to data evidence such that the program is currently developing a national entomological database to guarantee quality data availability and access.

 How has the project strengthened entomology at the local or community level?

PMI VectorLink engages community members in mosquito collection activities. Community members are trained to do the collections themselves. This has helped a lot with the community’s understanding and acceptance of vector control interventions and the link between IRS and ITN activities and a reduction in mosquito bites.

How does the project invest in local partners to lead malaria programs?

The project provides training for malaria control officers in different parts of Zambia on entomological monitoring so that there is human capacity to implement such activities in the districts. The project supports a fully-fledged insectary where a susceptible mosquito strain is reared and a molecular laboratory for mosquito analysis. The PMI-supported insectary and molecular laboratory are available for use by local partners, including university students to learn or do research.

Also, entomological monitoring sentinel sites have been established in many districts, making it easier for the national program to continue such activities in these districts. PMI VectorLink has provided hands-on training and provided equipment, such as vector collection traps and entomological supplies, to the NMEP in areas where PMI isn’t funding activities. Ideally, every district should be able to conduct surveillance. One way we can further assist is to ensure that the training we’ve provided is used in other districts that we don’t work in by providing basic equipment and materials to those districts.

How does the project ensure malaria services, including entomological activities, are resilient against pandemics and other shocks? The project adopted standard World Health Organization and PMI- approved protocols, quickly applying what has been learned from other countries and from what has been tried and tested in data handling and reporting. The project’s commitment to innovation and ways of ensuring the work continues with safety of staff and the public paramount. In 2020, VectorLink Zambia replaced mouth aspirators with battery-operated aspirators as a Covid-19 mitigation measure. (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. To continue measuring efficacy while maintaining safety precautions, PMI VectorLink used handheld, battery-operated aspirators to conduct the cone assays, which would allow staff to keep their protective face coverings on while conducting the tests.)

How does the project share entomological data with local partners? The Zambian Ministry of Health actively participates in the selection of PMI VectorLink-supported sentinel sites, the training of mosquito collectors and the supervision of data collectors during entomological monitoring. The data collected by PMI VectorLink is being used to make vector control programming decisions. This is done through regular vector control technical working group meetings and written reports shared with the NMEP. The most important consumer of this data is the NMEP. Recommendations on the insecticides available for IRS and the type of ITNs and where they can be deployed is based on insecticide resistance data, the environment, and type of mosquito species. The data collected is synthesized into a visualization model which helps the NMEP determine which insecticide to use and where to use them. (PMI VectorLink collaborated with the key partners to compile the entomological data and produce a series of integrated visualizations, incorporating over 600 data points on vector composition and insecticide resistance from 2000-2019. This was the first time that these datasets had been combined and viewed at the same time, and together they painted a comprehensive picture of insecticide resistance and species predominance across the country.)

How does the project ensure that we are reaching the unreached with our entomological activities? In the districts in which we work, we monitor entomological parameters in IRS sites as well as sites where IRS is not being implemented. These sites are usually far to reach areas or communities with scattered households over a large terrain.

What is your hope for the project’s future?  

My hope is that our hard work can continue and that the changes we have recommended based on current data from the various countries are implemented.

 

 

 

 

 

From the Lab to the Field, PMI Equips Local Partners to Fight Malaria

Across the globe, scientists, health professionals, and governments struggle to secure adequate funding to study and fight infectious diseases. While COVID-19 remains one of our greatest disease threats, the World Health Organization (WHO) has called on the global health community to maintain malaria prevention services to protect the most vulnerable from this vector-borne disease. According to the WHO World Malaria Report 2021, malaria killed more than 627,000 people in 2020 (up from 558,000 in 2019) and sickened more than 241 million people. Most of those deaths and illnesses were among pregnant women and children under the age of five in sub-Saharan Africa, where malaria is endemic, and resources and health systems can be severely strained. An estimated 49,000 of those deaths were attributed to a disruption of malaria services during the COVID-19 pandemic.

Fortunately, the increase was far lower than WHO’s prediction that deaths would double if malaria services were discontinued during the pandemic. The success goes to country governments and their communities who have raised awareness about malaria and built capacity to carry out services at local levels. The U.S. President’s Malaria Initiative (PMI) partners with countries to prevent, detect, and respond to malaria and to support vector control. PMI funding provides equipment, knowledge, implementation, and training in entomological monitoring and vector control interventions, such as indoor residual spraying and insecticide-treated nets.

Malaria control requires a deep understanding and knowledge of the mosquitoes carrying the parasite that causes the disease. PMI supports governments and local research institutes and universities to study mosquito behavior and determine key entomological indices including vector density, Plasmodium sporozoite infection rates, and vector lifespan, with a comprehensive plan for insecticide resistance monitoring, so that vector control stakeholders can make evidence-based decisions on how to fight disease.

Niger’s fully-functional insectary enables entomological technicians to conduct locally insecticide resistance testing and analyze mosquito samples for the malaria parasite. Photo: PMI VectorLink Niger

Trained entomologists are critical to ensuring the necessary monitoring is conducted and applied to crucial decision making in the deployment of mosquito control interventions. In many countries, PMI has helped to establish modern entomological laboratories to identify malaria-carrying mosquitoes and monitor the efficacy of vector control interventions. Local laboratories offer opportunities to further train students in advanced entomological techniques and reduce the costs and time in analyzing collected samples for vector species identification, insecticide resistance mechanism and determination of sporozoite infection, allowing for near real-time data for quick decision making.

For example, in Niger, PMI rehabilitated, equipped, and made functional the Center for Medical and Health Research (CERMES) insectary, a public institution that is part of the Institut Pasteur International Network and functions within the Ministry of Health. For the first time, CERMES is now able to rear the susceptible Anopheles gambiae Kisumu strain locally. PMI also trained 18 CERMES technicians in entomological field techniques and laboratory analysis, such as testing mosquito samples for the malaria parasite.

With that training, CERMES technicians have conducted WHO cone and tunnel tests on durability of insecticide-treated nets. This entomological monitoring data was used by Niger’s National Malaria Control Program to prioritize the distribution of next generation nets for the 2022 campaign.

Similarly, in Burkina Faso, PMI partners with the Research Institute of Health Sciences (IRSS) to conduct entomological monitoring. This partnership has been particularly important this year as increased insecurity in country combined with heavy rains have limited travel to the entomological sites. The government, along with donors like PMI and partners like IRSS, needed data on next generation nets for crucial decision making and to enhance acceptance and use of the nets. To access these hard-to-reach sites and continue with critical net durability monitoring, IRSS worked with local communities, including, local health units, law enforcement officials, and local village chiefs to secure the field investigators to collect net samples and survey households about net use.

Dedicated engagement of field investigators and local community ensured that the project reached some difficult localities and collected both mosquitoes and ITN samples for lab analysis at IRSS despite the exceptional heavy rainy season and security situation in Burkina Faso. Photo: PMI VectorLink Burkina Faso

IRSS also continued with mosquito collection in two inaccessible areas with the collaboration of community-based mosquito collectors, who received advanced training and support from the PMI-funded IRSS team. The training enabled the collectors to carry out human landing catch and pyrethrum spray catch to measure biting rates, indoor resting density, and malaria transmission.

Local partnerships at the national, district and local levels are critical to fighting malaria. Community health workers, local entomology technicians, and vector control decision makers are among key players in the global strategy to combat malaria.