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A Collaborative Commitment to Health Helps Rwanda Drastically Reduce Malaria Cases and Related Deaths.

Imagine. It is coming toward the end of a stressful week, and you have finally made it home after a long day at work. You remember that today is trash day, but cannot be bothered to separate out your recycling. Saturday morning approaches and you wake to a surprise visit from your city’s mayor who noticed that you failed to recycle properly. She gently reminds you that recycling is important to the health and cleanliness of your community and hopes that you will make every effort to do your part. That is how committed Rwanda’s district officials are to protecting communities from malaria.

Since 2017, the United States President’s Malaria Initiative (PMI) VectorLink Project has worked closely with district health officials throughout Rwanda’s Eastern Province to deploy indoor residual spraying (IRS) to kill malaria-carrying mosquitoes. Mobilizing communities to gain their support and participation is essential to successfully conducting an IRS campaign to protect individuals from malaria. According to Nyagatare District’s Health Director Elia Kamanzi, mobilizing communities is the most important component of IRS.

When a district prepares for an IRS campaign, it’s all hands on deck as health officials, village leaders, and members of the community work together to ensure the community is appropriately prepared for the life-saving intervention. It is essential that everyone understands what indoor residual spraying is, how it is conducted and how to prepare one’s home properly for spray. Nyagatare District takes this mobilization effort to the next level.

 “IRS doesn’t just save lives, it changes lives. When there is a political will, anything is possible. Not just possible, but easy.”- Nyagatare District Mayor David-Claudian Mushabe.

To reach the most people, district officials host mobilization campaigns during Umuganda, a nationwide day of community service that takes place the last Saturday of every month, and where every single member of the community is present. The PMI VectorLink Project establishes a comprehensive understanding and acceptance of IRS activities that village leaders pass on to their communities to ensure that every household accepts spray operators when they arrive. In the rare event that a household refuses IRS on the day of spray, it is not uncommon for district health officials – or even the mayor – to pay that household a visit. Health officials will emphasize the importance of IRS in preventing malaria and will often liaise with spray operators to reschedule a better time for spray should the head of the household be at work that day.

Not only are community leaders and health officials well versed in IRS operations,  government officials also have a working knowledge of the intervention, its importance, and its effectiveness in reducing malaria prevalence.

When asked about Nyagatare’s collaborative approach to mobilization, District Mayor David-Claudian Mushabe said, “Everyone is called and tasked in IRS mobilization – each person has a part to play. Everyone is involved down to the security guard.” Nyagatare is the largest and second most populous district in Rwanda. Located in the northern part of the country’s Eastern Province, Nyagatare borders Uganda in the North and Tanzania in the East. The district once saw nearly 65,000 cases of malaria a year. Thanks to a collaborative mobilization effort from district health officials, the Government of Rwanda, and PMI, Nyagatare had a 99% IRS acceptance rate that resulted in the protection of over 550,000 people from malaria during the most recent 2018 IRS campaign.

Kirehe District in Rwanda Thrives as Indoor Residual Spraying Keeps Community Healthy and Malaria-Free.

Before the sun meets the sky, indoor residual spraying (IRS) spray operators make their way from their home to the local IRS operations site where they gather for a filling breakfast. At 5:30 am, they collect their IRS supplies: a daily allotment of insecticide bottles, personal protective equipment, and their spray pumps. By 6:00 am they set off to the communities to begin the day’s work.

IRS kills mosquitoes that transmit malaria by spraying insecticide on the walls, ceilings, and other indoor resting places of mosquitoes inside peoples’ homes. The United States President’s Malaria Initiative (PMI) has supported IRS in Rwanda since 2007, to reduce the burden of malaria. Following the success of the predecessor PMI Africa IRS project, PMI VectorLink now conducts IRS in Rwanda’s Eastern Province, an area that accounts for nearly 60% of the country’s disease burden.

Blandina Mukabanya, lovingly referred to as Mama, has lived in Eastern Province’s Kirehe District, in the same house where her first son was born over 30 years ago. Though she can’t remember the last time she had malaria since IRS was introduced in her village, Blandina vividly remembers the devastating effects it had on her family and community. In addition to severe illness and loss of life, malaria places an economic strain on individuals and community resources. 

Before IRS was implemented in 2015, Kirehe District had over 41,000 cases of malaria a year. The sheer volume of cases put such a strain on the District Health Centers’ resources that caregivers were unable to effectively treat everyone. The ill would be too sick to work, and caretakers would miss work to care for family members suffering from malaria. The burden of this disease created an economic strain that prevented the community from thriving.

Since IRS has been introduced, malaria cases and related deaths have been significantly reduced. Kirehe District now has less than 5,000 mild cases of malaria a year.  People now spend less time in health centers seeking care for themselves or their family. Fewer sick days allow people to work more, save more, and invest in their futures. Liberta Kayitesi has worked with The PMI VectorLink project since 2017, healthy and able to work consistently, Liberta not only gained skills in her role as a Spray Operator, but she was also able to pay off her bank loans with her earnings – she’s now debt free! “We’re fighting malaria and poverty at the same time,” she says.

“[Kirehe] had the highest number of malaria cases, but now that we spray, we haven’t had it for years. To see fewer sick people in my village keeps me hopeful.” – Josette Munyana, Community Mobilizer and Head of Social Affairs.

From September to October 2018, The PMI VectorLink Project conducted its most recent IRS campaign in Kirehe District. Over a 20-day period, PMI VectorLink sprayed over 88,000 structures protecting 411, 261 people from malaria.

Indoor Residual Spraying Doesn’t Just Save Lives, It Changes Them.

The U.S President’s Malaria Initiative (PMI) VectorLink Project deploys indoor residual spraying (IRS) in Kirehe and Nyagatare District located in Rwanda’s Eastern Province. These districts once carried the highest malaria burden in the country, but have since made remarkable progress in reducing malaria cases and related deaths. During the September-October 2018 spray campaign, The PMI VectorLink Project worked closely with Rwanda’s district health officials in a campaign effort that protected over 840,000 people from malaria, thus improving the quality of life of many families and communities. We recently spoke to some of the beneficiaries to hear their stories. Here’s what they have to say about the impact IRS has had on their lives. Photos by Cheyenne Cook/Abt Associates. 

This is Blandina Mukabanya, lovingly referred to as Mama. She has lived in Rwanda’s Kirehe District in the same house where her first son was born over 30 years ago. Blandina vividly remembers how malaria devastated her community with illness and death. Now, she’s happy to say that she can’t remember the last time she or a loved one suffered from malaria since IRS was introduced in 2015.

“After people have their homes sprayed and notice that there are no more mosquitoes,” Blandina says, “they come running after spray operators, greeting them and asking them to please spray their houses again next time.” IRS cards like the ones pictured here are provided to each household to keep track of when the home is sprayed. Blanida proudly displays the IRS cards she’s kept since 2015 when she first received IRS in her home.

The importance and benefits of IRS are often communicated by word of mouth in many villages where we work. Beneficiaries often share testimonies with their neighbors about how IRS reduced the number of malaria cases in their homes. The PMI VectorLink Project also works closely with village leaders to establish a comprehensive understanding and acceptance of  IRS so that the community is properly informed and ready on the day of spray.

Edward Salambo, a farmer from Kirehe, hasn’t experienced a case of malaria in the last five years, thanks to IRS. He used to spend the majority of his earnings on malaria medication and treatment. Now, Edward is able to save that money and invest it in grain for his farm. In addition to loss of life, malaria places an economic burden on the people it effects — mostly poor, rural households that don’t have immediate access to prevention and treatment services. Interventions like IRS keep people healthy and communities thriving.

This is Cedric Niyonkuru. He is a 25-year-old refugee who fled his home in Burundi during his second year at university. He is now living at Mahama Refugee Camp, often referred to as the “13th sector” of Kirehe District. Cedric has seen firsthand how destructive malaria can be to a community. “Before IRS, it was rare to pass 5 houses without coming across someone who was suffering from malaria. Everyone in the family would get sick – so much so, that no one would be able to care for one another,” he said. “It was terrible. Because of this, other health complications came up. Every day people were dying.”

The PMI VectorLink Project has deployed indoor residual spraying in Mahama Refugee Camp since 2017, thus drastically reducing the prevalence of malaria in the camp by nearly 90%.  The camp, located in Kirehe District in Eastern Province, Rwanda, was once responsible for over 50% of the malaria cases reported in the district. Pictured above (from left to right) is Cedric Niyonkuru, a member of the camp’s youth committee; Jean-Claude Nzeyimana, apostle and owner of the camp’s church; Chantal Bibonimana, director of health and social affairs; and Clementine Mukabano, vice president of Mahama Refugee Camp.

In addition to the 53,325 people protected from malaria at Mahama Refugee Camp, the PMI VectorLink Project protected 9,810 children under five and 1,328 pregnant women. Children under five and expecting mothers are particularly vulnerable to illness and death caused by malaria. PMI VectorLink makes it a priority to protect them and their loved ones from malaria so that the entire family can live a happy and healthy life.

PMI VectorLink Gains Community Support for IRS and Malaria Control Interventions in Uganda.

Maria Wamagali is no stranger to malaria and the deepest sorrow it can bring having lost four children to the disease. In fact, in her village of Busibira in Butaleja District in Eastern Uganda, malaria is one of the leading causes of death among young children. According to the World Malaria Report 2018[1], malaria remains the leading cause of morbidity in Uganda, accounting for 4% of all estimated malaria cases worldwide in 2017. The high burden of malaria exceptionally affects children and women, particularly pregnant mothers.

Since 2006, the United States President’s Malaria Initiative (PMI) has supported the Ministry of Health (MOH) in Uganda to fight this deadly disease. In 2017, the PMI VectorLink Project began implementing an integrated vector control approach in collaboration with the MOH with the overall goal of reducing the burden of malaria in the country. The project conducts indoor residual spraying (IRS) in 15 high disease burden districts, including Butaleja District. 

In Uganda, the PMI VectorLink Project works directly with Butaleja District’s local government to raise awareness about the disease and the benefits of IRS. The project mobilizes communities to prepare for spray and supervises and monitors the implementation of IRS with a focus on spray techniques, compliance to environmental safety, data management, and reporting.

Before PMI VectorLink began working in the village, Maria Wamagali saw many people die from malaria. A mother of 10 surviving children, she was so afraid of the disease she did not allow her sons and daughters to bring their children to her home for fear of the children being infected

“Since indoor residual spraying was introduced to us in this village with the continued community engagement and sensitization outreach and dialogue, there has been a huge change in the health of my family,” she said.

Through the support of PMI, Wamagali says she now understands how to prevent malaria and welcomes IRS. As a result, there are fewer hospital visits and her grandchildren are safe. She said that children in her village no longer die of malaria like they had before and that now she visits the health center with the children only for immunizations. Wamagali also added that spraying has not only reduced malaria in the community but has also reduced the number of crawling insects, such as cockroaches and flies, in her house.

Wamagali urges the community to fill in ditches which could contain stagnant water and thus be potential breeding grounds for mosquitoes and to always sleep under mosquito nets, especially children. She also encourages them to allow their houses to be sprayed to help eliminate malaria.

[1]World Health Organization. (2018). World Malaria Report 2018. World Health Organization. http://www.who.int/iris/handle/10665/275867. 

 

World Malaria Day is celebrated worldwide on April 25th. It is a day where vector control stakeholders, national malaria control programs, international organizations, and individuals renew their commitments to finally ending this treatable and preventable disease.

Malaria continues to claim a significant number of lives: in 2017, 435,000 people died from malaria globally compared to 607,000 in 2010 (WHO World Malaria Report, 2018).” These figures illustrate how far we’ve come, and how far we have yet to go. Sharing our success and impact on this day inspires us all to continue this challenging work. Questions surface: How can we do more? Where can we improve? How can we save more lives? What will it take to end malaria for good?

The most important question remains, why?  Why, in such a challenging and complex landscape, do we continue to devote ourselves to this fight? What inspires us to continue to find new and innovative ways to tackle this complex disease?

This World Malaria Day, The PMI VectorLink Project joins the global vector control community in brainstorming new solutions that tackle these questions. But, we also want to take a moment and reflect on why we are committed to this fight.

Malaria is preventable and treatable – no one needs to suffer the burden of this disease.

Malaria kills more than 400,000 people every year, and millions more fall sick from this vector-borne disease. Young children and pregnant women are among the most vulnerable. Despite malaria’s crippling effects on people’s health, education, and employment, the world has seen major reductions in morbidity and mortality from malaria in the past decade. The majority of those gains have been in Africa and are primarily due to investments in vector control interventions by the U.S. President’s Malaria Initiative (PMI), the Global Fund, and country governments.

Working across 23 countries in sub-Saharan Africa as well as Cambodia, the PMI VectorLink Project is equipping countries to plan and implement safe, cost-effective and sustainable vector control programs, with the overall goal of reducing the burden of malaria.

Meet some members of The PMI VectorLink team. Together we have dedicated decades to fighting malaria. We all have our “why?” Each one of us has an individual reason as to why we are committed to end malaria. Our whys bring us together as a fortified team devoted to this fight because we want to do the most good for the world’s most vulnerable people. No one needs to suffer the burden of malaria.

Laura McCarty (left), Director of Communications and Ana Maria Paddack (right), Finance and Contracts Manager. Having watched a family member suffer from malaria and friends die from the disease, Laura is committed to raising awareness about the importance of fighting this treacherous disease. Ana Maria has been working in malaria vector control for nearly seven years. She feels that “a child’s right should be to enjoy a healthy and happy childhood rather than to be threatened by illness, poor growth and even death. We can save lives and promote economic development by protecting women and children under five against malaria.”

 

“My name is Kizi N’Kodia and I’m the Senior Procurement and Logistics Specialist on the PMI VectorLink Project. I have been part of this project for a little over a year now and I am committed to fighting malaria to put an end to its deadly impact around the world.”

 

This is Miriam Mokuena, Finance and Contracts Analyst and Technical Program Manager. Her work fighting against malaria started in 2011 under the PMI AIRS project (a predecessor to PMI VectorLink). She is fighting malaria because she believes that people should be able to live to their full potential without being hampered by severe illnesses.

 

This is Megan Tammaro (left) and Abdoulaye Bangoura (right), they’re both part of the Monitoring and Evaluation (M&E) team on the project. Meghan has been a part of the team for nearly three years. “Malaria disproportionately impacts the lives of pregnant women and children under 5,” she says. “I have a strong interest in maternal and child health so working on this project has been a great way to not only make an impact across the population of Sub-Saharan Africa but particularly amongst those who are affected by malaria the most!” Abdoulaye has been with the project for 1O months now. He wanted to be a part of the fight against malaria because he has lost loved ones at the hands of malaria.

 

“My name is Lilly Siems and I am a Monitoring and Evaluation Specialist on The PMI VectorLink Project. I have been working with the team for five months and I fight malaria because we have the tools to eliminate this disease and the chance to create a better world for the future.”

 

“Coming from Nigeria, a country that accounted for a quarter of all malaria cases globally in 2017, I have experienced firsthand, the needless and avoidable deaths of pregnant women and children due to malaria. The statistics for malaria cases and deaths in sub-Saharan Africa is worrisome. All hands should be on deck to rid Africa of this scourge”. – Dr. Nduka Iwuchukwu, Chief of Party for PMI VectorLink Zambia.

 

Peter Mumba is a Doctor with a Master’s of Science in Infectious Diseases (Malariology). He managed complex public health programs for 14 years, including nine years in malaria control programming in Zambia, Ghana and Ethiopia. Dr. Mumba is currently the Chief of Party for PMI VectorLink Ethiopia. As a physician, he has a passion to eliminate malaria because he understands how devastating the malaria disease can be to the community. Dr. Mumba lives in a malaria-endemic country and therefore supporting malaria control and prevention is a priority for him to ensure elimination. That is why he is excited to lead the PMI Vectorlink Ethiopia team. Studies show that IRS is one of the most effective proven interventions for elimination of malaria in communities.

 

“I have over 15 years of experience in health, ten of which are in malaria vector control. As a medical entomologist by profession, I enjoy working with the community in matters of health. I am passionate about mentoring upcoming health leaders. Formerly, as Chief of Party of the AIRS Rwanda project, I led my team to successful implementation of Indoor Residual Spraying (IRS). It was very inspiring to see the prevalence of malaria in the districts where we worked, and throughout the country in general, go down. I am currently the Chief of Party of The PMI VectorLink Project Mozambique, implementing IRS in conjunction with the Mozambique National Malaria Control Program. My greatest inspiration in working in the field of malaria control is the contribution to save one more life; this gives me a lot of joy.” – Rodaly Muthoni, Chief of Party PMI VectorLink Mozambique.

 

We are committed to the fight against malaria because we want to do the most good for the world’s most vulnerable. No one needs to suffer the burden of this preventable disease.

Top (from left to right): Megan Tammaro, M&E Specialist; Dereje Dengela, Technical Director Entomology; Cheyenne Cook, Communications Specialist; Kizi N’Kodia, Procurement Specialist; Allan Were, Director of Vector Control. Bottom: Ana Maria Paddack, FCA; Abdoulaye Bangoura, M&E Specialist.

Rates of Malaria-related Illnesses and Deaths Drop in 2018 after PMI VectorLink Conducts IRS Campaign

In Ethiopia, malaria is endemic to the country’s western Gambela Region and one of the region’s top three causes of sickness and death. The 2015 Malaria Indicator Survey indicated that malaria prevalence is higher in Gambela (18.4%) than in any other region in Ethiopia (national average of 1.2%). In 2017, Gambela’s health facilities reported 102,053 cases of malaria and 13 malaria deaths. To help reduce the burden of malaria, the U.S. President’s Malaria Initiative (PMI) VectorLink Project conducted indoor residual spraying (IRS) throughout Gambela in 2018. IRS involves spraying insecticide on the indoor walls and ceilings where mosquitoes that carry the malaria parasite tend to rest.

The PMI VectorLink Project worked with the Gambela Regional Health Bureau (RHB) to plan for and spray the homes of all residents in the 14 districts of the region with an estimated population of 315,577. The project successfully sprayed 95,564 structures over the course of 20 days, protecting 301,382 people from malaria, including 13,051 pregnant women and 62,792 children under five. The RHB described the 2018 results of the IRS campaign in Gambela Region as one of the best malaria interventions ever experienced in the region.

“There has been a drastic reduction in malaria burden in Gambela Region for first time in many years,” said Dr. Oman Amulu, Head of the Gambela RHB. “Over the years, the region has been implementing interventions for malaria, but there has been no drastic reduction in malaria burden until in 2018 when quality IRS was implemented. We noticed a huge reduction in malaria cases and malaria fatalities. This can only be because of the quality IRS supported by PMI VectorLink as it was the only difference in malaria intervention from previous years.”

According to data from the RHB, malaria cases in September 2018 were 39% lower than those recorded during the same month in 2017. Annual deaths attributed to malaria also fell from 13 in 2017 to 3 in 2018. In 2018, Gambela Region recorded a cumulative 57,882 cases of malaria compared to 94,257 in 2017 and 92,465 in 2016.

Regional Malaria Health Promotion Disease Prevention Officer, Jay Orem, said that the 2018 statistics are a result of good planning, quality training, and effective supervision, which led to high coverage and quality IRS. Although the region conducted spray campaigns in the past, in 2018, Orem said the teams received more systematic supervision and submitted performance data daily.

“PMI VectorLink Project has made a huge difference in planning, training and supervision for IRS. This is what has been missing for many years in Gambela Region to eliminate malaria,” said Orem.

Geneva, Switzerland

January 30 – February 1, 2019

The Roll Back Malaria (RBM) Partnership to End Malaria is the global platform for coordinated action against malaria. RBM is comprised of more than 500 partners committed to combatting the disease, including malaria endemic countries and their governments, the private sector, and nongovernmental and community-based organizations.

Since 2017, The President’s Malaria Initiative (PMI) PMI VectorLink Project has supported the RBM Partnership through its co-chair position on the Vector Control Working Group (VCWG) and through hosting the Partnership’s premier resource hub and online community platform, the Vector LearningXchange.

Key staff from the PMI VectorLink Project travelled to Geneva to present new developments and key results on insecticide rotation, data and decision making in IRS, and data collection.

See below for presentations from the conference. These presentations have also been made available on the Vector LearningXchange.

PMI VectorLink VCWG 2019 Presentations:

Evaluation of Pirimiphos-Methyl Efficacy in Experimental Huts with Partially Sprayed Surfaces Against Natural Populations of Anopheles gambiae in Ghana

VectorLink Collect: Using the DHIS 2 Platform to Standardize Data Collection and Reporting for IRS

Increasing the Use of Data in IRS Decision Making

Malawi

In 2018, Victor Kasuzweni joined the U.S. President’s Malaria Initiative (PMI) VectorLink Project in Malawi as Environmental Compliance Officer (ECO). With a Bachelor of Environmental Science from the University of Malawi and a Master of Environmental Engineering from Suzhou University of Science & Technology in China, Kasuzweni committed himself to protecting the environment long ago. Growing up in Chikwawa, one of Malawi’s low-lying southern districts, he developed a passion for nature at a young age. Recently, Kasuzweni talked about his experience with the project.

How did you get involved in the field of environmental compliance and safety?

I used to watch nature channels on TV from a young age. My motivation to work in the environment came about when I started to hear about pollution and environmental problems, and how we can make the world a safe place. This motivated me to pursue a career in environmental sciences. I have worked for a number of organizations in the area of climate change, emergency response, environmental management and protection over the years. In 2010, I joined the Government’s Environmental Affairs Department, and I was posted to work in Nkhotakota District as an Environmental Officer responsible for the coordination of all the natural resources and environmental management activities at the district level. While working in the district, I was introduced to indoor residual spraying (IRS) which aims to reduce the malaria disease burden. I actively participated in the planning and implementation of IRS activities. The field of environmental compliance and safety in IRS is exciting and fulfilling because it ensures the safety of residents and workers from insecticide exposure and the protection of the general environment from chemical spills while ensuring substantial reduction of malaria disease burden among the communities.

I feel motivated and work hard to deal with demanding and challenging issues more particularly when I see that the initiative I am involved in, such as IRS, is impacting positively on people’s lives. I also feel good to receive feedback from the residents that benefitted from IRS and various stakeholders for the work I am doing. This provides important information for reviewing and reflecting on approaches and strategies to continuously improve on the project’s implementation.

Can you talk about your work with the PMI VectorLink Project?

I joined PMI VectorLink in 2018 and my key responsibility is to ensure the project is environmentally compliant and implemented in accordance with the IRS Best Management Practices and local guidelines. This involves the development of a number of documents to guide the project’s work. I am involved in the planning and implementation of a number of activities that minimize or eliminate potential risks to human health and ecological systems. For instance, I work in close collaboration with the PMI VectorLink project team, government counterparts and local leadership to identify appropriate areas for establishing operational sites needed for the project. I am also involved in the planning and delivery of environmental trainings for various cadres working in IRS, including conducting IRS spray supervision during and after implementation to ensure adherence to safety standards.

What kind of initiatives has the project taken on to protect the environment?

The project conducted EC trainings for stakeholders on various aspects, such as use of personal protective equipment, handling of insecticide exposures, spills, and construction of wash areas and soak pits to deal with effluents to ensure safe disposal. The project has outlined emergency response procedures to deal with adverse effects in times of emergencies and also developed memorandums of understanding (MOUs) with local recycling companies working with paper and plastics. The MOUs lay out guidelines for the proper handling of particular IRS wastes to protect human health and the environment. For instance, the MOUs state that any recycling waste from IRS will not result in the manufacturing of food packaging products or any products that will come in contact with food.

What kind of impact have you seen from the project?

The project is having a big impact on people’s lives especially through the reduction of malaria disease burden. Malaria has been an issue and remains a leading cause of morbidity and mortality in the district. The feedback we are getting from the residents is quite encouraging. They welcome IRS and are seeing immediate changes to mosquito density in their homes. Furthermore, the project has significant implications on socio-economic development. For instance, the project has been a source of employment and brought about economic empowerment in the process. The project design also gave women a chance to actively engage in IRS implementation at various levels. The communities really appreciate this initiative because it empowers women to work on various leadership positions. IRS is one of the most effective malaria control strategies. We encourage people to accept IRS and use it alongside other strategies such as using mosquito nets and keeping surroundings clean and with no stagnant water. Because there hasn’t been IRS in the area for six years the district also benefitted from the project trainings and capacity building sessions. It is envisaged that the knowledge and skills gained will go a long way in making IRS implementation more effective.

What is your hope from the project?

I have a great hope that the project will have made substantial reduction of malaria burden by 2022. Through the effective planning and implementation of IRS among stakeholders in the district, there will be a number of best practices to inform learning and programming and share with other partners working on IRS in Malawi.

PMI Collaborates with Malawi Government to Combat Malaria

The numbers were going the wrong way. After a six-year absence of indoor residual spraying (IRS) in Malawi, the number of people falling ill from malaria was steadily rising, with confirmed malaria cases more than doubling since 2012.

“Mortality is 19.8 per 100,000 people. That’s 10 deaths a day – 3,650 a year from malaria alone. That’s too many,” said Dr. Michael Kayanga, Vector Control Program Manager for Malawi’s National Malaria Control Program (NMCP). “We were the only country in the region not implementing IRS.”

IRS involves spraying an insecticide on the walls and ceilings where mosquitoes carrying the malaria parasite tend to rest. Eager to reverse the deadly upwards trend, the NMCP collaborated with the U.S. President’s Malaria Initiative (PMI) VectorLink Project to bring IRS back to Nkhotakota District – one of the country’s most vulnerable areas and a district that PMI last sprayed in 2012.

If the partnership continues the way it started, we should be very successful and each child under five can be free of malaria. With the PMI VectorLink Project, I hope we have reduced malaria by more than 50 percent of the current status in the next two years.

 – Shadreck Mulenga
Deputy Vector Control Program Manager, NMCP

In October and November 2018, PMI VectorLink successfully sprayed 112,264 structures during a 32-day campaign, protecting 501,324 people including 11,066 pregnant women and 90,953 children under five, who are at the highest risk of dying from the disease. In addition to implementing IRS, PMI VectorLink provided training at district and national levels of government in spray quality, supervision, planning, logistics and environmental compliance and safety, including how to handle insecticide and dispose of IRS waste.

Peter Kamuloni, Nkhotakota District Environmental Health Officer, said, “Before, we were just learning in school, but not on the ground. The project training took it to the practical level and what we learned can be applied to dealing with other chemicals. The inventory tracking training was also key. IRS storekeepers learned enough that they can work for big companies now.”

While PMI conducted the IRS campaign, the government played a key role in the recruitment of seasonal workers, community mobilization, and donated the space for data collection centers.

“Most projects fail because of poor planning,” Kamuloni added. “PMI VectorLink had good leadership. Everyone was 100 percent committed. The incentive for us was that the NMCP was part and parcel of the project. We were respected and were not treated as if we were outside the project; and the project was in line with our goals as a district – to reduce malaria.”

PMI VectorLink is also helping the NMCP to develop a roadmap for its Insecticide Resistance Management Plan to ensure the long-term efficacy of IRS.

“We’ve collaborated well and we really own the project,” said Dr. Kayanga. “We’re quite happy. Since we sprayed, there’s already been a huge difference in the reduction of mosquitoes. People even called to tell us thank you.”