The U.S. President’s Malaria Initiative Fights Malaria in Malawi and Helps Keep Kids in School
When kids fall sick from malaria, they often miss weeks of school and can easily fall behind in their learning. In 2017, many of the children in Malawi’s Nkhotakota District were contracting the disease three times a year. Children sick that often can easily slide into malnutrition. Find out how the U.S. President’s Malaria Initiative VectorLink Project protected more than 500,000 people in Malawi and is helping kids to stay in school and learn.
The PMI VectorLink Project is hard at work in Cameroon today, highlighting the important work and lessons learned in malaria prevention and control in Africa at the 2019 Pan-African Mosquito Control Association (PAMCA) Conference. PAMCA brings together mosquito-control experts and researchers from Africa and beyond. The theme of this year’s conference is Strengthening surveillance systems for vector-borne disease elimination in Africa.
Tuesday, September 24 | Workshop Hall (BETE ABC)
3:00 – 3:15 p.m. Increasing intensity of pyrethroid resistance in An. gambiae s.l. and the implication for vector control in Democratic Republic of Congo. Abt Presenter: Francis Wat’senga
The PMI VectorLink Project delivers vector control interventions and protects millions of people from contracting malaria. An integral part of our work is robust entomological monitoring, that enables entomologists to identify which mosquitoes carry malaria, the relative geographical and temporal distribution of the mosquitoes transmitting malaria, and the feeding and resting habits of the vector. Watch how we use entomological monitoring to better understand and mitigate mosquitoes’ growing resistance to insecticide, to ensure that we protect vulnerable communities from malaria.
PMI VectorLink reports on a set of indicators to national partners and PMI for each spray campaign. The key outcomes achieved by the end of the campaign include the total number of structures sprayed, people protected against malaria with IRS, and country personnel trained to conduct various IRS tasks. As the project expands its vector control interventions to include insecticide-treated nets (ITNs), PMI VectorLink will also report on a specific set of indicators related to the intervention. Below is a summary of results from PMI VectorLink’s first indoor residual spray campaign, held in 2018.
Integrated vector control for malaria, according to the WHO Guidelines for Malaria Vector Control, requires “rational decision-making for the optimal use of resources for vector control”. For the U.S. President’s Initiative (PMI) VectorLink Project, it involves making vector control decisions—whether to deploy IRS or ITNs—based on epidemiological, entomological, and cost data to ensure the most vulnerable communities are protected from the burden of malaria. With the rise in mosquitoes’ resistance to certain insecticides, it is important to consider a country’s specific vector control profile – its history with IRS and ITN interventions, and the malaria vector’s resistance to each type of insecticide – when making these decisions.
Hover over the map below for a snapshot of our indoor residual spray, insecticide-treated net, and entomological monitoring activities by country.
The U.S. President’s Malaria Initiative (PMI) VectorLink Zambia team recently hosted a group of Johns Hopkins University (JHU) Master of Engineering students for a three-day hands-on entomological training. As part of their biomedical engineering program, the students focused on ways to provide innovative engineering solutions to some of the challenges entomologists face when monitoring and surveilling the Anopheles mosquito, the malaria vector.
The PMI VectorLink Project delivers vector control interventions, protecting millions of people every year from malaria. Entomological monitoring, which is an integral part of the PMI VectorLink Project, enables entomologists to identify which mosquitoes carry malaria, the relative geographical and temporal distribution, along with the feeding and resting habits of these mosquitoes. Monitoring also allows entomologists to determine which insecticides are the most effective at killing the malaria-carrying mosquitoes.
PMI VectorLink Zambia’s technical manager, Mohamed Bayoh, organized a series of lectures on entomology, vector control, and surveillance, and insecticide resistance to provide the students with an understanding of the current trends and challenges in vector control. The team also gave students an overview of the PMI VectorLink Project and the entomological activities currently being conducted in Zambia. Kentzo Mumba, Chief Vector Control Officer at the National Malaria Elimination Center (NMEC), and Reuben Zulu, Principal indoor residual spraying (IRS) Officer, guided the students through an in-depth analysis of Zambia’s unique country context, outlining progress made and challenges faced in implementing vector control and vector surveillance strategies at the national level. The discussion provided relevant information for the students to start thinking about ways to approach the challenges discussed and to think about what kinds of innovative solutions are needed most in vector control and surveillance. The students then toured the local insectary supported and staffed by PMI VectorLink at the NMEC, and saw how the insectary is established and maintained to better understand the role the insectary plays in national malaria elimination.
The visit concluded with a field trip to one of VectorLink’s entomological monitoring sites in Zambia’s Lufwanyama District in Copperbelt Province. VectorLink field entomologist Westone Hamwata guided the students on a tour of the site where they met with community members and health workers and participated in vector surveillance activities. The JHU group also met with VectorLink-trained environmental health technicians and public health personnel from the community who are employed by the Zambian Government. The technicians showed the students how they supervise the mosquito collectors and perform morphological identification of collected mosquito samples. The technicians also gave a live demonstration of the two methods currently used for vector surveillance; pyrethrum spray catches and human landing catches. At the health technician facility, the students were given a crash course on morphological identification, provided copies of the Anopheles identification keys, and by the day’s end, they were able to identify at least one Anopheles species.
In his farewell, Professor Tristan Ford, who accompanied the student group, noted that they had “learned a lot in a few days, and were all very impressed with the support that the PMI and the PMI VectorLink Project provides to the community.”
PMI VectorLink Ghana helps integrate IRS education into government-based health promotion campaigns.
Implementing health interventions can prove challenging in countries where a lack of resources poses limitations on what governments can do to help keep communities healthy. Working across 23 countries in sub-Saharan Africa and Cambodia, The U.S. President’s Malaria Initiative (PMI) VectorLink Project works to build the capacity of country governments to plan and implement safe, cost-effective vector control interventions to reduce the burden of malaria.
Building capacity involves close collaboration with a country’s government and requires an in-depth understanding of a country’s unique health context. Working with Ghana’s Health Service (GHS), PMI VectorLink established the importance of IRS as a life-saving intervention and helped gain its acceptance in communities. To do this, VectorLink Ghana helped GHS, the national entity responsible for health promotion in the country, to integrate IRS messaging into their routine government health promotion activities in districts where IRS is conducted. VectorLink Ghana trained community health nurses (CHNs) from each of the project’s 25 operational sites on key messaging around IRS as key to malaria prevention. These messages served to promote the importance and benefit of the intervention, dispel myths and allay concerns about the IRS process, and to help prepare households appropriately to receive IRS on the day of spray.
Community health nurses in Ghana are at the foundation of the health promotion structure. CHNs routinely educate villages and communities on how to adopt healthy behaviors and encourage them to accept health interventions. After their training, the community health nurses were invited to experience an IRS campaign firsthand to understand the effect of their messaging on the community’s acceptance and readiness for spray. During the campaign, CHNs were able to answer questions and reduce the number of IRS refusals on the spot.
According to Ghana Health Service records, 46 of the PMI VectorLink-trained community health nurses conducted 920 IRS-related community engagement campaigns in March and April 2019. Half of the outreach was conducted in the communities while the other half was conducted in health facilities. In the 398 communities where the IRS promotion activities occurred, the average spray acceptance increased to 99.9% compared to 93.2% the previous year.
Managing Insecticide Resistance Starts with Entomological Monitoring & Surveillance
Since the launch of the U.S. President’s Malaria Initiative (PMI) in 2006, malaria control interventions across sub-Saharan Africa have scaled up dramatically, resulting in a significant decline in malaria burden. From 2010 to 2017, the number of people who died from malaria went down from 607,000 to 435,000 (WHO World Malaria Report, 2018).
Much of this progress can be attributed to the scale-up of vector control interventions like insecticide-treated nets (ITNs) and indoor residual spraying (IRS); two key components of the global malaria control strategy supported by the PMI VectorLink Project.
However, mosquitoes’ growing resistance to insecticides threatens further progress and could potentially reverse the gains made in malaria control recorded in the last decade.
As a step towards addressing the issue, PMI VectorLink implements a comprehensive insecticide resistance monitoring program across sub-Saharan Africa to understand the problem and guide vector control programming. Accordingly, insecticide resistance surveillance of the primary carriers of malaria; specifically Anopheles gambiae s.l. and An. funestus s.l. is part of PMI VectorLink’s vector control efforts in Africa. Data in each project country is systematically collected to account for the different types of malaria-carrying mosquito, a country’s insecticide use practices, and vector control interventions. In most cases, all classes of insecticides, including those approved by WHO, have been continuously monitored.
Given that mosquitoes have become resistant to pyrethroids (the insecticides used in standard ITNs) in some areas, the project performs further tests to understand the level of resistance and its potential impact on the effectiveness of ITNs and IRS being implemented. The malaria-carrying mosquitoes are tested to higher concentrations of the most common pyrethroids used in bed nets. Tests are also regularly performed to understand the type of resistance involved. One such test involves exposing mosquitoes to a synergist that does not have insecticidal properties itself, but when combined with insecticides of a particular class, considerably enhances the insecticides potency. This test determines whether the combination of synergist and insecticide is potent enough to kill the otherwise resistant mosquito. The potential for new tools that include a synergist and an insecticide can significantly help in managing insecticide resistance.
PMI VectorLink strives to stay ahead of the curve by working with global organizations and the private sector to test new insecticide and synergist products like clothianidin and chlorfenapyr. PMI VectorLink has not only developed and shared protocols for field testing these new insecticides but has also produced a significant amount of data that now informs decisions on insecticide resistance management.
The PMI VectorLink Approach to Managing Insecticide Resistance Includes:
Database: PMI VectorLink generates a large amount of multidimensional data on insecticide resistance, its intensity, and mechanism.
Share: The project stores, analyzes, and presents insecticide resistance data in a way that information becomes readily available for making decisions by the project and national malaria control programs. PMI VectorLink is widely known as a reliable source for insecticide resistance data among national and international stakeholders.
New Products: PMI VectorLink takes a leading role as a source for up-to-date information on the susceptibility of mosquitoes to new products.
Decisions: Several countries are now making decisions on the deployment of different types of vector control tools based on the information PMI VectorLink is generating. For example, PMI VectorLink data is helping countries decide which next-generation insecticide products to deploy.
Rotate and Stop the Spread of Insecticide Resistance: Rotation or large scale mosaic spray of different classes of insecticides are now being increasingly practiced as insecticide resistance management strategies in several countries. PMI VectorLink has developed a rotation plan of insecticides used for indoor residual spraying in each country it works in. Rotation is being utilized as a pre-emptive measure to slow down the development or prevent the spread of insecticide resistance and relies on credible data.
Capacity Building: The project works with local universities, research institutions and other partners in the development of local capacity to advance molecular surveillance of insecticide resistance.
Sustainability: PMI VectorLink is developing local capacity in insecticide resistance monitoring at all levels of the health system and transferring ownership of the program to national health leaders.
The PMI VectorLink manuscript “susceptibility testing of Anopheles malaria vectors with the neonicotinoid insecticide clothianidin; results from 16 African countries, in preparation for indoor residual spraying with new insecticide formulations” was recently published in the peer-reviewed journal, Malaria Journal on August 1, 2019.
While the World Health Organization (WHO) continues to develop a suitable bottle bioassay procedure, there is currently no published guidance regarding clothianidin susceptibility procedures or diagnostic concentrations. The PMI VectorLink Project, therefore, developed a protocol for impregnating filter papers with 2% w/v SumiShield™ 50WG dissolved in distilled water. Susceptibility tests were conducted using insectary-reared reference Anopheles and wild-collected malaria vector species. All tests were conducted within 24 hours of treating papers, with mortality recorded daily for 7 days, due to the slow-acting nature of clothianidin against mosquitoes. Anopheles gambiae sensu lato (s.l.) adults from wild-collected larvae were tested in 14 countries, with wild-collected Anopheles funestus s.l. tested in Mozambique and Zambia.
Read more about the study in the publication here.
PMI VectorLink Burkina Faso is our first IRS country to pilot and implement mobile data collection by the Spray Operator at the household level. 547 Spray Operators collected IRS data on tablets across all the VL Burkina Faso spray districts! The Burkina Faso M&E team worked for months with NMCP and District Health Officials to design the data collection tool.
M&E Manager Asseta Sigue and Database Manager Jean Dieudonne Damiba developed the new training tool, working with former SOPs to improve its usability, and then trained Supervisors how to use it.
The mobile data collection enabled the M&E team to quickly inform the Operations team and Supervisors in the field on spray progress, coverage, and reasons for non-spray cases. In turn, those in the field could make rapid decisions to correct course. Congratulations to the team on a job well done!