A Common Cause

PMI VectorLink’s Collaboration with Communities, Civil Society, and Government Leads to Success

At 72 years old, Vwawa Village Chief Rachel Longwe walked more than 10 hours over two days to ensure her whole village knew the U.S. President’s Malaria Initiative’s VectorLink Project was coming to spray their homes with an insecticide that kills malaria-carrying mosquitoes. Having lost two children and one grandchild to malaria, Chief Vwawa is adamant that everyone accept indoor residual spraying (IRS) because of the impact it has on reducing malaria.

Vwawa Village is located in Malawi’s Nkhotakota District along the shores of Lake Malawi, Africa’s third largest lake. In this lakeside district, malaria profoundly affects communities. The economic hardships associated with malaria include loss of income for both the sick and the caregiver, transport expenses to clinics for those in hard-to-reach areas, and missed days of school for children.

In 2018, the U.S. President’s Malaria Initiative VectorLink Project began implementing IRS in the district to reduce the burden of malaria.

“The children in the village were suffering from malaria frequently, almost three times a year,” said Chief Vwawa. “Things have changed with IRS. Before the project began, a lot of people were going to hospital for malaria, particularly pregnant women. Now people are living happily, busy with their economic activities. Now I’m able to cultivate maize and a variety of crops.”

Vwawa Village Chief Rachel Longwe helped PMI VectorLink to increase acceptance of IRS in her community.

Chief Vwawa, who has 24 grandchildren, also takes part in the project’s entomological studies, allowing her house to be used for mosquito collection to help the project’s entomologists study the behavior of malaria-carrying mosquitoes.

Support and participation from communities is vital for protecting the health of individuals and achieving IRS objectives. While PMI VectorLink has always engaged communities, the project scaled up its engagement efforts when the number of refusals increased during the last campaign and resulted in a drop in spray coverage from 94.9% in 2018 to 88.8% in 2019.

Nkhotakota Director of Health and Social Services (DHSS) Dr. Wezi Mumba said that communities began to believe myths around IRS, such as the idea that IRS brings bedbugs. IRS can cause existing bedbugs to crawl out of walls and surfaces as they try to avoid the insecticide.

“In remote districts, such as Nkhotakota, people’s education is a bit low. A lot of times, people don’t know how to protect themselves from getting sick. For instance, bedbugs often result from lack of hygiene. Communities need information and sensitization. Education is key,” said Dr. Mumba.

In 2020, the PMI VectorLink Project began working more closely with village chiefs as well as with Traditional Authorities (TAs), group village headmen, and community health action groups to ensure higher acceptance of IRS. The project also includes community-based mobilizers on the spray teams to help notify and prepare households for the arrival of the spray teams.

Sub-Traditional Authority Andrew Thupilauma, for the Kalimanjira area has 198 village chiefs under his leadership with a population of approximately 20,000. “Previously, coordination between the project and community and the chiefs wasn’t as strong,” he said. “Now, VectorLink starts with Traditional Authorities (TAs). We pass the messages to the village chiefs and at funerals and other community meetings. The village chiefs then pass the messages to community members. This year communication is so much better. When community members receive messages from trusted sources, acceptance of IRS goes up.”

Working in collaboration with the National Malaria Control Program, PMI VectorLink crafts custom messages to increase the acceptance of IRS and ensure community members are prepared for spray and adhere to safety precautions after their home is sprayed. Through radio talk shows and community meetings, the project can answer community’s questions and concerns.

“We emphasized figures, such as deaths due to malaria before and after IRS,” said Dr. Mumba. “The numbers encourage people to accept IRS and gives communities encouragement. With IRS we’ve decreased the number of deaths by half since 2018. IRS is helping to keep people from getting sick and reducing the cost of expenditures for the hospitals. With the money saved, we can save more people.”

In addition to consulting with TAs during community mobilization, the project’s site managers and team supervisors check in with the village chiefs when entering and exiting the village for the spray campaign. The project also ensures spray operators are recruited locally to promote further trust and buy-in from the community while also bringing income opportunities to the community.

Malawi Minister of Health Honorable Khumbize Kandodo (left) listens as VL Site Manager Nellie Ruben explains the Spray Performance Tracker Data.

Support for this year’s IRS campaign came from all levels of government, including from Malawi’s Minister of Health, Honorable Khumbize Kandodo Chiponda, who visited the project site on the last day of spray in early December 2020. “The Government is very grateful to PMI VectorLink for the intervention,” she said. “This project will help reduce malaria cases, which are high in the district. We understand IRS is expensive but life has no price tag.”

Carrying On IRS in Zambia during COVID-19

PMI VectorLink Zambia Implements COVID-19 Mitigation Measures and Successful 2020 IRS Campaign

When cases of COVID-19 were first recorded in Zambia, the Ministry of Health quickly established strict guidance to prevent the spread of the virus. These measures were received with some apprehension about the prospect of continuing malaria prevention activities during COVID-19. The PMI VectorLink Project, funded by USAID and the US President’s Malaria Initiative (PMI), supports the implementation of both indoor residual spraying (IRS) and distribution of insecticide-treated nets (ITNs), along with entomological monitoring to guide vector control decision making. After extensive consultation and in alignment with national as well as PMI and global guidelines, VectorLink developed tailored adaptations to mitigate the risk of COVID-19 infection while protecting the communities from malaria in the three IRS target provinces, and four ITN target provinces where the project works. This guidance was shared with and validated by key stakeholders – the National Malaria Elimination Program (NMEP) and PMI – before implementation.

Temperature screening at a training in Petauke.

In accordance with the guidance, recruitment and training of hundreds of seasonal workers was conducted outdoors (in some cases under open tents) to allow for proper ventilation. Hand wash stations were set up at the entrance. All participants had their temperature checked upon arrival, were required to wear facemasks and maintain social distancing throughout the duration of the training. Advocacy meetings with district and traditional leaders adhered to the same measures.

During IRS implementation in 15 districts across three provinces, the same safety standards of daily temperature checks, provision of hand washing facilities, outdoor assemblies, adhering to full PPE use including N95 facemasks, were replicated. VectorLink also secured additional vehicles to ensure that spray teams maintained social distancing while being transported to and from the communities. COVID-19 posters were displayed at all 70 IRS operation bases. Spray teams were also provided with hand sanitizing wipes to wipe down their gloves after spraying each house. All mobilizers who worked with spray teams in the communities were provided with facemasks.

Storekeeper Training took place under a tent in Copperbelt Province.

Other members of the project team also adhered to the same safety standards. Project data entry clerks waited a minimum of 24 hours to process data collection forms, entered spray data under open tents, and wiped down their dedicated laptops prior to and at the end of each work day. The project entomology team, whose role is to assess the quality of spray using mosquitoes and follow up on how long the spray insecticides lasts on the sprayed surfaces, observed the same standards.

These rigorous safety measures, which cut across every aspect of implementation, ensured that the 2020 IRS campaign, which utilized more than 2,500 seasonal staff over a 30-day period, sprayed more than 640,000 structures (96% spray coverage), and protected more than 2.7 million Zambians from malaria, did not record one incident of COVID-19. The Head of Vector Control at the NMEP, Dr. Emmanuel Kooma, summed it up thus…“it was a tense situation conducting IRS under the COVID environment. However, I thank VectorLink for strictly observing the COVID prevention guidelines such that we never recorded a single case of COVID. The job is done – a huge relief on my part.”

Recruitment for seasonal staff: Lufwanyama
A spray operator uses handwashing station while morning mobilization is conducted at Chikando Site in Eastern Province.

 

Data Entry Clerk Trainings

 

There’s An App for That

Mobile Technology Improves School-Based Distribution of Insecticide-Treated Nets

Since 2012 Ghana has distributed insecticide-treated nets (ITNs) to primary school students as part of larger efforts to achieve universal coverage of ITNs and to sustain gains made in the reduction of malaria transmission. Ghana conducts mass ITN distribution campaigns every three years, while school-based distribution (SBD) occurs annually between mass distribution campaign years. Previously, data collection and monitoring of ITN distribution have been done manually using paper forms, which are prone to data quality challenges and delays in submission reports from schools to districts and to the national level.

A junior high school student in Akropong MA Basic School receives an ITN from a class teacher.

To address these challenges, the U.S. President’s Malaria Initiative (PMI) VectorLink Project in Ghana supported the National Malaria Control Program (NMCP) to develop a mobile technology application, Net4Schs App, for recording and reporting data during the 2020 SBD. The USAID-funded Global Health Supply Chain – Procurement and Supply Management Project (GHSC-PSM) project, and the Schools Health Education Program of the Ghana Education Service also supported this initiative.

The Net4Schs App improves data quality, eliminates delays in data capture and enhances accuracy as data can be synchronized daily and retrieved from the application platform housed by NMCP. The mobile application reduces reporting errors, improves data transfer and reduces the turn-around time for data entry, analysis and reporting.

To assess its field practicality and address any challenges before a full deployment for the 2020 SBD, a small-scale field assessment was carried out in March 2020 in two districts: Cape Coast (CC) Metro and Twifo Hemang Lower Denkyira (THLD) in the Central Region. The Net4Schls App showed a total of 13,479 ITNs distributed to students in class 2 and 6 among 267 primary schools across the two districts. Eighty percent of reported data were entered by circuit supervisors within one week of distribution with minimal data entry errors. Previously, the same data could take a month to be collected, processed with many data errors arising from the circuit, district, and regional levels.

A student from the community junior high school, in Adukrom receives an ITN from a class teacher.

The application allows for offline data entry when there is no internet access and synchronizes the data when the application is subsequently connected to the internet. Such near real-time data entry, reporting, and monitoring allows NMCP and partners to identify lagging districts and address any challenges in an expedited manner.

More than 1.2 million ITNs were planned for distribution to students in 26,776 schools across the country in May 2020. Due to COVID-19 movement restrictions schools were closed and the distribution was delayed until November 2020 when schools were partially reopened. Students from primary 2 and 6 levels were kept at home, thus the NMCP and partners had to recalibrate the distribution approach. They prioritized primary 6 students, who had the last chance to obtain the nets through SBD before moving to the next school level, and junior high school 2 students, who resumed in-person classes. At the time of reporting, distribution has been completed to 26,207 schools out of 26,776 schools targeted. Ninety-eight percent of targeted students received ITNs and the Net4Schls App provided quick data updates to monitor the progress.

A snapshot of the Net4SChls App, December 15, 2020

PMI VectorLink Malaria Fighter Patricia Chirombo

Patricia Chirombo in Nkhotakota District where PMI VectorLink conducts IRS.

Malawi
Patricia Chirombo knows a hard day’s work. Starting her days as early as 4 a.m. during indoor residual spraying campaigns and ending often late in the night, Chirombo serves as the Information, Education and Communication (IEC) Coordinator as well as Gender Focal Point for the U.S. President’s Malaria Initiative (PMI) VectorLink Project in Malawi. She’s dedicated to delivering the right message to the right audience via the right media channel at the right time. Sometimes that means drafting mass media messages late at night to address concerns raised during the campaign that day so the next day is even more successful.

Chirombo, who grew up in Nsanje District in the Lower Shire River Valley, received her Bachelor of Science for Environmental Health from Polytechnic College at the University of Malawi. She has seen the rewards of her work with malaria incidence 50 percent lower in 2020 in Nkhotakota District compared to 2018 when the project began implementing IRS in the district.

Recently, after a long day in the field, Chirombo took time to speak about her work with the project.

What is your experience with malaria?

My career started as a Health Promotion and Communication Officer in 2003 with Catholic Development Commission of Malawi (CADECOM). Part of my role was to encourage mothers to promptly seek medical care for their sick children. There was a malaria component to the job. From there, my passion for malaria prevention grew.

Also, malaria affects me and my family. When my son was two years old (in 2012), he had malaria with diarrhea. He didn’t respond to the first line of treatment and was admitted to the hospital for four days. It was a bad experience for me as a mother with my son admitted. Since then, it became a rule in my house that everyone has to sleep under a net. My family and I haven’t had malaria in five years. Before, it occurred once a year.

What are the biggest challenges to increasing understanding and acceptance of IRS?

In our first year (2018), acceptance was easy because people were excited. Malawi had not received IRS since 2012. But in the second year of the project, it was difficult to convince people to accept IRS because many also wanted insecticide-treated nets (ITNs) even though malaria incidence reduced after IRS. People often want nets instead of, or in addition to, IRS. There are many myths around both, such as IRS bringing bedbugs and ITNs causing infertility. Getting people to understand all the issues is difficult and we work very hard with our messaging to increase acceptance of IRS.

So the second year, it was a challenge to convince communities. This year, we made extra targeted efforts to engage local leaders, which made a big difference. They have really helped us. Community health workers have done a lot of work too, but village chiefs also played a big role because they asked their people to open up their homes for us to spray.

What have you learned from working with the project?

I’ve learned you need to be proactive. The IRS campaign is only 30 days, so it requires quick responses when faced with any challenges, such as homeowners refusing to have their homes sprayed. If you delay, you lose. In one day, you have to change and address issues to achieve the objectives you have. I’ve learned to bring everyone, particularly those who are influential, into action, which has helped improve my leadership skills.

Patricia Chirombo (left) works with a village chief leader from Katimbira Village in Nkhotakota District, Malawi, on IRS acceptance. Here, the village leader is providing a signature with her thumbprint for a meeting attendance sheet. The village chief agreed to have her village sprayed after having her concerns addressed.

What do you see as the most effective means of communication to evoke change in IRS?

The most effective, I think, is direct interpersonal communication because it allows you to share information directly with the homeowner, to listen to their concerns and then to address them. Often, an individual’s concern is the concern of many, which we can address with mass media, such as the radio talk shows we conduct during the campaign.

 

What do you find most rewarding about your job? Statistics are showing that we’ve reduced malaria by half in Nkhotakota District. It’s a real motivator. People are opening their doors so we can spray. Reducing malaria by half is a real achievement. Fewer people are getting sick, which means the project has done a lot in Nkhotakota District. Malaria is the number one killer in the country. When we reach the end of the campaign and all are targets are met, I feel relieved. The project is improving people’s lives.

 

Tell me about your role as Gender Focal Point?

I work to ensure PMI VectorLink is a conducive environment for everyone to excel in his or her roles. Increasing women’s involvement in IRS not only increases women’s economic empowerment but positions them as role models for other women and young girls in their communities. Personally, as a woman, I feel proud that my salary is improving my family’s well-being. I’m a working mother, contributing to my country.

PMI VectorLink at ASTMH 2020

The 2020 Annual Meeting of the American Society of Tropical Medicine & Hygiene (ASTMH).

Sunday, November 15 – Thursday, November 19, 2020

The ASTMH Annual Meeting draws tropical medicine and global health professionals representing academia, government, non-profits, philanthropy, NGOs, industry, military, and private practice. The meeting is designed for researchers, professors, government and public health officials, military personnel, travel clinic physicians, practicing physicians in tropical medicine, students, and all health care providers working in the fields of tropical medicine, hygiene, and global health. This year, the Annual Meeting will be a five-day virtual conference. The PMI VectorLink Project is at the forefront of innovative prevention and surveillance methods that protect vulnerable communities in sub-Saharan Africa from the burden of malaria.

See our full list of ASTMH Presentations below:

PMI VectorLink study contributes to the understanding of Tanzanian malaria vector transmission risk following IRS.

The PMI VectorLink Project recently published an entomology manuscript in Malaria Journal on malaria vector species composition and entomological indices following indoor residual spraying in regions bordering Lake Victoria, Tanzania. 

Vector control through long-lasting insecticidal nets (LLINs) and focal indoor residual spraying (IRS) is a major component of the Tanzania national malaria control strategy. In mainland Tanzania, IRS has been conducted annually around Lake Victoria basin since 2007. Due to pyrethroid resistance in malaria vectors, the use of pyrethroids for IRS was phased out and from 2014 to 2017 pirimiphos-methyl (Actellic® 300CS) was sprayed in regions of Kagera, Geita, Mwanza, and Mara. Entomological surveillance was conducted in 10 sprayed and 4 unsprayed sites to determine the impact of IRS on entomological indices related to malaria transmission risk.

This study contributes to the understanding of malaria vector species composition, behaviour and transmission risk following IRS around Lake Victoria and can be used to guide malaria vector control strategies in Tanzania.

Read the article here

The PMI VectorLink Project teams up with Syngenta and Goodbye Malaria to rethink IRS in times of COVID-19

The COVID-19 pandemic continues to affect communities around the world. It is key that we remain vigilant in deploying malaria control interventions to help prevent further strain on health systems. Syngenta recently partnered with Goodbye Malaria to host a webinar on how malaria control practices should be adapted to provide effective vector control and keep teams and communities safe from COVID-19. Technical Program Manager, Djenam Jacob, provided an insightful look at how The PMI VectorLink Project has done just that during the project’s most recent indoor residual spraying campaigns.

Read more about the event here and click here to watch the full webinar.

 

PMI Malaria Fighter Ojok John

Uganda
In Eastern Uganda’s Serere District, Ojok John works for the PMI VectorLink Project as a storekeeper for indoor residual spraying (IRS) campaigns. When not working on an IRS campaign, Ojok attends to his small-scale farm and volunteers with the village health team at the Adepi Village health center where he supports the outpatient department in the antiretroviral therapy clinic and immunization clinic to serve his community. Recently, PMI VectorLink’s Information, Education and Communication Coordinator Daniel Eninu spoke with Ojok about how malaria has affected Ojok’s community and how his earned income from fighting malaria has changed his life.

Ojok John keeps detailed records to track insecticide and equipment as an IRS storekeeper.

Can you talk a bit about how malaria has affected your life?

Malaria has affected my life in many ways. The community and my close relatives have been affected through deaths of loved ones, especially children. Malaria also has taken away our little income earned to pay for treatment, which should have been money for household growth. The disease has also affected my family through loss of time at work when we are sick or caring for others. As a Village Heath Volunteer, I can confess that malaria is a serious health problem in my community. I have witnessed children and mothers die of the disease. We live near a lake so my community has several mosquito breeding habitats that encourage breeding of the malaria vectors. But since 2015 when IRS began, I have witnessed a reduction in deaths due to malaria in my village.

Have you ever had malaria? If so, can you talk about it?

Yes, I have had malaria a number of times. It has been an agonizing experience with lots of fever, headaches, vomiting, among many other symptoms. I had to struggle to get to the nearby clinic where I was tested and given medication for treatment.

What have you learned from working with the project?

I have learned a lot, such as strategies for fighting malaria, including IRS, use of insecticide-treated nets (ITNs), visiting health facilities as soon as symptoms are noticed, and ensuring that pregnant mothers visit facilities for antenatal care and testing for malaria before treatment. I have a lot of experience in managing store documentation or records in IRS working as a storekeeper. I can also handle logistics within store settings. As an IRS team leader, I’ve gained the experience of interacting and mobilizing communities for IRS and other health actions leading to behavior change, especially with how to deal with difficult communities.

How has your job changed since being promoted to storekeeper?

While I was a spray operator, much of the work was to ensure I sprayed houses appropriately. This gave me a lot of opportunity to interact with the community. I learned that trust and dedication are critical as I worked in people’s houses. This level of commitment helped me to be noticed and promoted to a team leader and later to storekeeper. As storekeeper, I have been entrusted with important and expensive project equipment and supplies. I also have been able to manage spray teams to achieve targets and produce results at the end of spray campaign.

How has working on the project changed things for you?

The income I received from the project enabled me to register as a private candidate to complete my secondary education in 2017. Without IRS, I would not have managed to complete my education. This is a great achievement for me, and I hope to join a vocational college in the future. The opportunity provided to me by USAID/PMI, District Health Team/Ministry of Health and the local council has really changed my life. The financial earnings I receive each spray campaign also enabled me to construct three temporary houses for my family and also buy two bulls, which I use for ploughing during the planting season thus earning me extra income.

 How have behaviors changed in your community?

At the beginning of spray activities there were a lot of myths around insecticide use, including causing men to become impotent and women to become barren, which caused resistance. But with a lot of health education and sensitization from local leaders on the benefits of IRS these myths were addressed and people accepted spraying their houses to protect themselves from malaria. The integrated messages on malaria we provide to the communities have led to improvement in use of the malaria control measures such as use of ITNs, visiting health facilities early for testing and treatment, and draining stagnant water pools to eliminate breeding of mosquitoes. My community, I would say, is adopting healthy behaviors.

 Are fewer people getting sick and how has the community responded?

Since the start of IRS and distribution of ITNs, the number of people getting sick and visiting health facilities has drastically reduced. People are able to spend more time on productive activities. The community has responded well since they have realized the benefits of malaria prevention.

 What do you find most challenging about your job?

The biggest challenge of being an IRS storekeeper is managing spray teams with people from different backgrounds and different levels of motivation. I have learned how to deal with difficult people so that our work of IRS proceeds. The work involves ensuring proper store records are kept at all times.

What do you find most rewarding?

The most rewarding thing is the skills that I have attained over time in store management, which I think can take me to another level of working in other logistical management jobs. Besides the reward of revenue earned, I have learned how best to work within a large and busy organization such as the PMI VectorLink Project.

What might someone be surprised to know about you?

Someone may be surprised to know that despite dropping out of school due to lack of school fees I hold a secondary level education certificate, all through my dedication and earnings from IRS.

 What are your hopes and dreams for the future?

I am hopeful that I can attend a small course in records or logistics and get recruited into the government or any public or private company as a records or logistics assistant to work and further my skills so that I can better support my community and family.

Niger Puts Mosquitoes to the Test

PMI VectorLink Builds Niger’s Capacity for Evidence-Based Decision Making in Vector Control

In the West African country of Niger, 94 percent of the population is at risk of contracting malaria[1]. As evidenced throughout sub-Saharan Africa over the past 15 years, gains in reducing morbidity and mortality from malaria depends on the use of effective insecticides in vector control measures, such as insecticide-treated nets (ITNs) and indoor residual spraying (IRS). As insecticide resistance grows in malaria vector populations, testing the bioefficacy of insecticides used to kill mosquitoes is increasingly important to reducing the malaria burden. To support Niger in malaria vector entomological monitoring and contribute to quality data collection for decision making, the U.S. President’s Malaria Initiative (PMI) has invested in Niger since 2018 to build capacity and improve entomological data collection in several sites across the country.

Niger’s new, fully-functional insectary enables the country to conduct insecticide resistance testing.

Until recently, Niger lacked an up-to-date insectary to test vector control interventions. While there was adequate space for an insectary, Niger did not have the proper and standardized mosquito rearing conditions in place nor the equipment needed to breed and maintain a susceptible mosquito colony. As a result, Niger’s Medical and Health Research Center (CERMES) was unable to conduct certain types of tests, including the assessment of the bioefficacy of vector control tools and determine how long an insecticide remains effective on a treated tool, such as on ITNs.

In its efforts to build capacity of national institutions, the PMI VectorLink Project, rehabilitated the space being used by CERMES into a fully functional insectary in July 2020 and provided equipment for it. PMI VectorLink is also in the process of importing mosquito eggs of Anopheles gambiae Kisumu, a susceptible strain from Liverpool, England, for rearing and testing, and will provide robust training to the designated insectary technicians. As the only internationally-recognized research institution within Niger’s Ministry of Public Health, CERMES will now be able to draw on scientific evidence on the bioefficacy of the insecticides used to support the National Malaria Control Program (NMCP) in vector control decision making.

According to Dr. Boube Hamani, Head of Entomology for the Vector Control Unit of Niger’s NMCP, the insecticide bioefficacy testing has been a huge challenge for years as the country has had to call on external expertise in the West African Region to carry out bioefficacy tests.

“The rehabilitated and equipped insectary will enable the country to support insecticide bioefficacy tests at the country level,” said Dr. Hamani.

He also noted that the PMI VectorLink Project has contributed to building capacity of the NMCP and CERMES technicians in entomological monitoring and data collection, both in the field and in the laboratory. He added that this increased capacity has enabled the NMCP to have good quality entomological data that will be used for vector control strategic decision making in efforts to eliminate malaria.

This year, PMI VectorLink will be rolling out the use of VectorLink Collect, the integrated database for entomological and IRS data. The goal is to establish a functional work flow for entomologic data within the field office teams, with the purpose of entering timely, high-quality data. In line with that, CERMES will be contracted to manage all data management responsibilities as well as providing monthly data interpretation instruction to support the NMCP entomology unit to understand the impact and implications of vector control tools and better plan their elimination strategy.

[1] World Health Organization

The PMI VectorLink Podcast – Managing Malaria in the Midst of COVID-19

In the second episode of the PMI VectorLink Podcast, our technical experts discuss the challenges of implementing malaria prevention interventions during the global pandemic. Our experts also share some of the adaptions the project has made to continue operations safely and efficiently.

Be sure to check out The PMI VectorLink Podcast on Soundcloud: https://soundcloud.com/pmi-vectorlink