PMI IRS Data Can Improve Studies on Impact of IRS on Malaria Incidence

Indoor residual spraying for malaria control in sub‑Saharan Africa 1997 to 2017: an adjusted retrospective analysis

An article recently published in the Malaria Journal shows the importance data can have on improving studies on the impact of indoor residual spraying (IRS) on malaria incidence and its role in helping to guide future malaria control efforts. The research article draws on data from indoor residual spraying campaigns funded by the U.S. President’s Malaria Initiative from 2012 to 2017.

From the article: “IRS is a vital prevention measure for controlling and eliminating malaria by targeting vectors. To support the development of effective intervention strategies it is important to understand the impact of vector control tools on malaria incidence and on the spread of insecticide resistance. In 2006, the World Health Organization (WHO) stated that countries should report on coverage and impact of IRS, yet IRS coverage data are still sparse and unspecific. Here, the subnational coverage of IRS across sub‑Saharan Africa for the four main insecticide classes from 1997 to 2017 were estimated.”

“Data on IRS deployment were collated from a variety of sources, including the President’s Malaria Initiative spray reports and National Malaria Control Programme reports, for all 46 malaria‑endemic countries in sub‑Saharan Africa from 1997 to 2017. The data were mapped to the applicable administrative divisions and the proportion of households sprayed for each of the four main insecticide classes; carbamates, organochlorines, organophosphates and pyrethroids was calculated.

The number of countries implementing IRS increased considerably over time, although the focal nature of deployment means the number of people protected remains low. From 1997 to 2010, DDT and pyrethroids were commonly used, then partly replaced by carbamates from 2011 and by organophosphates from 2013. IRS deployment since the publication of resistance management guidelines has typically avoided overlap between pyrethroid IRS and ITN use. However, annual rotations of insecticide classes with differing modes of action are not routinely used.

This study highlights the gaps between policy and practice, emphasizing the continuing potential of IRS to drive resistance.”

Read the article here.

 

Commemorating World Malaria Day in Ghana

During this past World Malaria Day, celebrated on April 25th, the global community was tasked with responding to the COVID-19 pandemic brought on by the novel coronavirus while maintaining its commitment to fighting malaria. With support from the U.S President’s Malaria Initiative (PMI), The PMI VectorLink Project continued to deploy life-saving interventions like indoor residual spraying (IRS) to help reduce the overall strain on health systems by keeping the most vulnerable people malaria-free.

In collaboration with Ghana Health Service, PMI VectorLink Ghana commemorated World Malaria Day by calling attention to the importance of reducing malaria across the country in a radio program hosted on April 28, 2020.

Panelists during the discussion included, Regional Malaria Focal Person Dr. Barikisu Seidu, former Director of Health Services, Abdul-Rahman, and Abukari Yakubu, the Environmental Compliance Officer for PMI VectorLink Ghana.

Dr. Barikisu Seidu made a call to action, describing a malaria-free Ghana as everyone’s responsibility, noting the importance of accepting malaria interventions like insecticide-treated bed nets (ITNs) and IRS. She indicated that in Ghana, out of every 100 outpatient healthcare visits, 22 are malaria cases, and out of 10 patients admitted, three are malaria cases with two of those three more likely to be children under 5.

As a result of PMI VectorLink’s IRS interventions, the Ghana Health Service has indicated that malaria incidences in IRS districts have reduced by half and are below the northern regional average. This data is further supported by a study* conducted by The World Health Organization (WHO)  during a review of health records in facilities across the country. As PMI VectorLink Ghana continues to achieve and go beyond its IRS targets, we are hopeful to further drive down malaria cases in IRS districts.

*Reference: WHO study published by Aregawi et al. Malar J (2017) 16:177 (A total of 210,709 hospital and laboratory records from 2005 to 2015 examined.)

World Malaria Day 2020

Our Commitment to Saving Lives

April 25th is World Malaria Day, and while the global community responds to the COVID-19 pandemic brought on by the novel coronavirus, it is vital that the vector control community continues its commitment to fighting malaria. The interventions used to combat malaria also help strengthen countries’ capacity to respond to other health threats and public health emergencies, like COVID-19. 

With support from the U.S. President’s Malaria Initiative (PMI), The PMI VectorLink Project continues to deploy life-saving interventions, like insecticide-treated bed nets and indoor residual spraying, to help reduce the overall strain on health systems by keeping the most vulnerable people malaria-free.
 
As we know, malaria disproportionately affects the poor – particularly pregnant women and children under five years of age across sub-Saharan Africa – and traps families in a cycle of disease and poverty.
 
In 2019, the PMI VectorLink Project:

  • Sprayed 5.5 million structures with an insecticide that kills the malaria-carrying mosquito
  • Helped distribute over 7 million insecticide-treated bed nets
  • Protected 20.1 million people from malaria including over 584,000 women and 3.3 million children under five years of age

The PMI VectoLink Project conducts indoor residual spraying to help kill malaria-carrying mosquitos – here’s how it works!

 

Malaria Fighter: Jean-Pierre Rucakibungo

Kigali, Rwanda

Jean-Pierre Rucakibungo, Senior Finance and Administration Manager, oversees all the financial, accounting, and compliance aspects for PMI VectorLink Rwanda. Born and raised in Rwanda’s capital city of Kigali, Rucakibungo is fluent in English, French, Swahili and Kinyarwanda and holds a Bachelor of Science from the National University of Rwanda and an MBA from the University of Roehampton, London. In his spare time, he enjoys studying the history and culture of Rwanda in his mother language (Kinyarwanda). Recently, Rucakibungo took time to talk to us about his work.

VL: How did you get started working with malaria?

JPR: After the genocide, we had a lack of people who were qualified in finance. There were many NGOs, so I started with Médecins sans Frontières in finance. I continued working with projects in finance, and in 2011, I started working with the PMI Africa Indoor Residual Spraying (AIRS) Project. I ensure that the office management, budgeting, operations, procurement, financial, subcontracting, and human resources systems are compliant with USAID rules and regulations.

VL: Do you have any personal experience with malaria?

JPR: When I was a child, we all used to have malaria. Anytime someone wasn’t well, we would think it was malaria. Our mother used to give us Nivaquine, which is a preventative medicine that my siblings and I had to take it daily. It was very bitter, so we had to take it in front of her. When we used it, we tended not to get malaria. If someone had a fever and tested positive for malaria, then he/she was treated with a more effective drug. The last time I had malaria was in 2001. When I’m traveling to those districts with high malaria, I’m afraid to see mosquitoes. It’s a bad illness. After you have it, you have to build up your strength. Everybody should sleep under a mosquito net to protect themselves from contracting it.

VL: What has surprised you most about working with PMI VectorLink (or AIRS)?

JPR: When IRS first came to Kigali, I was not aware that malaria was an illness that could be eliminated. I knew people were doing research on mosquitoes but I didn’t know it was to reduce malaria. It’s a disease that can be controlled, but it’s very costly. Elimination will require coordination with Burundi and the DRC to sustain the gains we are making in Rwanda.

VL: What do you find most challenging about your job?

JPR: The most challenging aspect is eliminating mistakes from the field, such as ensuring that the mobile phone numbers we collect for mobile money payments are registered to the corresponding seasonal workers. In the past, there have been discrepancies and it resulted in delayed payments. After every campaign we look at the challenges we faced and develop a strategy to ensure we don’t make mistakes. Most of the time, the budget is 96-98 percent on target. I use the budget tracker and can manage activities not planned. For instance, the Government of Rwanda has sought our assistance in protecting Mahama Refugee Camp with IRS. While not in the initial work plan budget, we were able to make this happen in 2018 and 2019 by covering operational costs while the government provided the insecticide.

In 2018, we moved to mobile payments for seasonal workers. We had the training for a week. I was excited to know that these things could happen. At the time, I had finished my MBA and I had worked on eMoney with businesses in Kigali. I had the knowledge of how things work. When I was asked to implement online payments for the project, I really understood them well.

By paying our accounts and staff with mobile money I was able to move around the country and follow training for seasonal staff, which helped me to better understand what was happening in the field. As I managed the budget over the years, I’ve learned a lot about IRS and entomology outside of finance, such as when we rehabilitated an entomology laboratory and managed entomological monitoring sentinel sites.

VL: What kind of impact have you seen on malaria in Rwanda from IRS?

JPR: In 2010, the district with the most burden was Nyagatare with 45% of the country’s cases. We’ve sprayed Nyagatare since the beginning of AIRS in 2011. With epidemiological data, the impact is very visible. They now have few cases. Ngoma District was first sprayed in 2019 by the Government of Rwanda. They saw right away the impact of IRS. So when PMI VectorLink sprayed there this year, everyone wanted their homes sprayed. We were impressed to see how much the people liked IRS because they understand the impact.

VL: What do you wish other people knew about the project?

JPR: Most people know there is a project spraying houses to fight malaria. I often explain the impact the spray can have. We explain that we are not eliminating all mosquitoes rather mosquitoes that carry the malaria parasite. I’m often explaining the impact of IRS and why we spray the walls and ceilings of every house. When the insecticide we had been using previously was shown to have reduced efficacy, we changed to a bendiocarb insecticide. People were happy because they could see it was working. Later, when we started spraying with the organophosphate Actellic, the population could see it was killing the mosquitoes and other insects. Before people used to tell stories that the pyrethroid insecticide brought fleas into the house, but now they do not. They don’t hear mosquitoes in the house at night, so they can sleep. With the new insecticide, people like it more. When people aren’t experiencing malaria, they don’t understand why we are still spraying. So we often have to explain why we need to continue with IRS in order to maintain control.

VL: What is your hope from the project?

JPR: As we start the third year of the project, I see that we have a well-equipped laboratory, so the entomology is going well. But we don’t have enough entomologists and continued efforts are needed to build local capacity. With project trainings and time, we will be better able to fight malaria. One thing I’ve seen is the increased use of mosquito nets. We are moving more toward using nets for fighting malaria. The Government of Rwanda is now distributing nets across the country. We are combining IRS with nets, and in the three years, we will see where we will be.

VL: What could other countries learn from Rwanda?

JPR: The one number one thing is how we implement IRS as a team. Since we started, our entire operations staff is involved in all aspects of the project. While our environmental compliance officer conducts environmental assessments, she’s not the only person who knows how to do the job. We work as a team, so when I’m in the field I can support the team. Or if we’re spraying in two districts at the same time, we can support each other. The teamwork makes IRS in Rwanda successful.

PMI VectorLink Study Published in Scientific Reports

Impact of indoor residual spraying with pirimiphos-methyl (Actellic 300CS) on entomological indicators of transmission and malaria case burden in Migori County, western Kenya

A study conducted by the U.S. President’s Malaria Initiative VectorLink Project (the follow-on project to the PMI Africa Indoor Residual Spraying Project) in western Kenya shows that IRS with pirimiphos-methyl was highly effective for the control of indoor biting and indoor resting, pyrethroid-resistant An. funestus mosquitoes and resulted in substantially reduced numbers of this primary vector species coupled with reduced malaria cases. The study found that due to the long residual effect of pirimiphos-methyl, it was possible to achieve year-round protection with a single round of IRS. Sustaining these gains is a priority for the Kenya National Malaria Control Program and development partners. The authors of the study say that IRS should continue to be implemented to sustain the impact on An. funestus. Because there was less of an impact of spraying on An. arabiensis populations, likely due to their exophilic (outdoor-biting and resting) nature, additional control measures are needed to control outdoor biting and resting An. arabiensis. The peer-reviewed Scientific Reports is the 11th most cited journal in the world, with more than 300,000 citations in 2018*, and receives widespread attention in policy documents and the media. 

*2019 Journal Citation Reports® Science Edition (Clarivate Analytics, 2019)

 

https://rdcu.be/b2Pdr 

 

PMI Assists Ethiopia along Journey to Self-Reliance in IRS

PMI Support Goes beyond Targeted-Districts

In 2017, more than 1.5 million cases of malaria were reported in Ethiopia with an additional 1 million cases estimated to have occurred, according to the World Health Organization World Malaria Report 2019. Although Ethiopia’s malaria incidence is significantly lower than much of sub-Saharan Africa, the country’s government is committed to further reducing the risks of infection. To protect its population from this deadly disease, the Government of Ethiopia (GOE) conducts indoor residual spraying (IRS), one of the most-effective strategies proven to reduce the burden of malaria and envisaged to eliminate the disease by 2030.

The U.S. President’s Malaria Initiative (PMI) has supported Ethiopia’s Federal Ministry of Health (FMOH) National Malaria Control Program (NMCP) in conducting IRS since 2008. Working with the FMOH, the Benishangul-Gumuz, Gambela, and Oromia regional health bureaus (RHBs) and the district health offices, the PMI VectorLink Project sprayed 487,746 structures in 2019, across 44 districts, protecting more than 1.3 million people.

Ethiopia’s NMCP also implements IRS in hundreds of other districts without PMI support. The FMOH reports that more than 5 million structures are sprayed and more than 15 million people are protected every year under the national IRS program. In 2019, PMI continued its technical support to 60 additional districts the GOE sprays while also extending its reach to share IRS best practices to five additional regions of the country, including Amhara, Afar, Somali, Tigray and Southern Nations, Nationalities, and People’s Region (SNNPR).

In 2018, VectorLink Ethiopia, in collaboration with the NMCP, observed that the RHBs) had insufficient capacity to carry out IRS while ensuring adherence to PMI best practices. The team identified challenges around spray quality and environmental and safety compliance (EC) in non-PMI-supported districts, primarily due to a shortage of skilled personnel and inadequate operational budget at the district level.

To increase the GOE’s ability to implement safe and effective IRS on its own, the PMI VectorLink Project held a five-day training in November 2019 for 129 participants from the five additional regions. The training introduced participants to basic IRS techniques and EC procedures to ensure PMI Best Management Practices are followed. Previously, for example, participants from non-PMI districts were reported to lack the knowledge and skills around formal rinsing procedures in IRS. Such procedures protect both the spray operators and the environment from exposure to the insecticide. During the training, the participants also learned how to construct a cost-effective and permanent soak pit that allows operations to meet EC standards. The two constructed soak pits acted as model soak pits in the training and will be used as centers of excellence during future trainings. In addition, the concept of field simulation was introduced and participants took part in homeowner preparation in the field.

PMI VectorLink held a five-day training to help the Government of Ethiopia implement IRS safe and effectively across the country. Photo: PMI VectorLink Ethiopia

NMCP Team Leader Mebrahtom Haile Zeweli described the training as a ‘game changer’ as it was going to ensure quality IRS is implemented in non-PMI-supported districts. The NMCP Team Leader was optimistic that the participants will use all the techniques learned to implement safe and quality IRS in their respective districts. Mebrahtom also asked the project to extend this training to more districts as it was key to ensuring safe and effective IRS as well as the sustainability of IRS since it is implemented at the district level.

Abebech Asres, a training participant and the Malaria Focal Point Person from Amhara Region, South Gondar Zone, said that the skills and knowledge acquired on soak pit construction and rinsing procedures will be used to implement safe IRS by protecting IRS actors, residents and the environment from contamination.

The soak pit constructed for training purposes will be used as center of excellence in future trainings for the non-PMI districts. Photo: VectorLink Ethiopia

Better Data, Better Results

Field-Based Mobile Data Collection in Burkina Faso Helps Improve Spray Coverage

Team leaders comparing tablet data to paper form data with SOPs.

Indoor residual spraying (IRS), proven to reduce the burden of malaria, entails spraying the interior walls and ceilings with an insecticide that kills malaria-carrying mosquitoes. IRS requires high-quality data to plan, implement, and track progress during a spray campaign. Having real-time data readily available and accessible facilitates reporting and decision-making on the ground without delay, and more quickly mitigates operational challenges. Until recently, field teams relied on paper data collection forms, which required an additional step of manually entering data into an electronic system, delaying the time between collection and the data being processed for use in decision making. That all changed when the PMI VectorLink Project piloted its mobile data collection strategy in Burkina Faso during the 2019 spray campaign.

Traditionally, spray operators serve as the primary point of data collection. Once they’ve sprayed a house, they record the home on their data collection form. If a home could not be sprayed (e.g. the head of the household was not home to accept IRS), the spray operator would note that on the data collection form. At the end of each day, spray operators would return their data collection forms at the operation site where data clerks then entered the information into a computer. The data is then cleaned, analyzed, processed, and sent to a global server where the information can be accessed from a real-time database.

Screenshot of the data collection form on the mobile data tablet.

Now, with mobile data collection, the need to manually enter data is removed – along with potential data entry errors that can skew the data overall and influence results. During the pilot, 547 spray operators across all three spray districts (Kongoussi, Solenzo, and Kampti) collected their household data using mobile tablets, each set up with the Open Data Kit (ODK) application. The ODK application was configured specifically for household-level data based on the standard, the paper form that spray operators were familiar with and formatted to reduce data entry error. Once collected via the mobile tablets, data is then synced to the project’s DHIS 2-based VectorLink Collect server on a daily basis for analysis and reporting.

IRS can require thousands of people to work together in a short period of time to reach a set of targets. Improving processes and procedures to increase efficiency and save costs is essential for sustainability. Field-based mobile data collection speeds up the team’s ability to identify and respond to problems, allowing the team to better serve the community by protecting them more effectively from malaria.

For instance, the VectorLink team was able to make quick and informed decisions in regards to the improvement of spray performance, by immediately intensifying mobilization activities in response to high refusals in certain areas with specific and adapted messages. The project plans to scale mobile data collection in 2020 IRS campaigns in Benin, Cote d’Ivoire, Mali, and Senegal as well as continue its use in Burkina Faso.

While conducting this pilot, VectorLink Burkina Faso sprayed more than 200,000 structures, protecting more than 580,000 people, including 92,000 children under five years of age and 11,000 pregnant women.

 

Exploring the Contribution of 3rd Generation IRS Products with NgenIRS

The NgenIRS partnership led by IVCC and funded by Unitaid with support from The U.S. President’s Malaria Initiative, The Global Fund, PATH, and Abt Associates is establishing a sustainable, competitive and growing market for effective 3GIRS products at affordable prices.

NgenIRS is making the most effective, long-lasting insecticides available to malaria programs and implementation partners to support insecticide resistance management strategies. In an upcoming webinar hosted by The Vector LearningXchange, representatives from the NgenIRS partnership will discuss the role of 3rd generation IRS products in reducing malaria in light of increasing pyrethroid resistance.

Register here: https://www.vectorlearningxchange.com/register/

2019 World Malaria Report

The World Health Organization has just released its 2019 World Malaria Report. The report provides a comprehensive update on global and regional malaria data and trends. The report tracks investments in malaria programs and research as well as progress across all intervention areas. The 2019 report is based on information collected from over 80 countries and areas with ongoing malaria transmission. 

Check out the report here: 2019 World Malaria Report

 

PMI VectorLink @ 2019 Global Digital Health Forum

The PMI VectorLink Project joins the Global Digital Health Network in celebrating innovation and supporting proven practices at scale. This event seeks to balance the need for evidence-based scaling of proven systems with the urgent need to determine how emerging technologies and approaches can improve health outcomes. 

The 2019 forum will host 600-700 attendees with engaging sessions to connect government stakeholders, digital health technologists, researches, donors, implementers and field experts from across the globe. 

To RSVP and for more information visit: https://gdhf2019.dryfta.com/ 

December 9 – 11, 2019
Bethesda North Marriott Hotel & Conference Center
5701 Marinelli Rd
Rockville, MD

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