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“There has been a great reduction of malaria morbidity and mortality in Kenya’s lake regions since PMI started working in these malaria endemic areas. This reduction can be attributed to key interventions like indoor residual spraying (IRS) and the use of insecticide-treated nets (ITNs).”

Nairobi, Kenya

Professionally, PMI VectorLink Kenya Operations Manager Zeddy Bore has spent the past 13 years fighting malaria. Growing up in Kenya’s Rift Valley regions, Zeddy battled her fair share of malaria personally, too. “I managed to pull through, unlike some children in the malaria endemic regions who succumbed to it,” said Zeddy.

As VectorLink Kenya Operations Manager, Zeddy leads the complex logistics of planning and implementing IRS, which kills the mosquitoes that transmit malaria by spraying insecticide on the walls, ceilings, and other indoor resting places of those mosquitoes. Zeddy’s interest in fighting malaria began in school when she was studying for her Bachelor of Science in Environmental Health from Moi University. She then went on to completing a Master of Public Health in Epidemiology and Population Health from Maseno University. Recently, Zeddy talked about her work with the PMI VectorLink Project and the journey she’s taken to get there.

What is your personal experience with malaria? Malaria was a common illness in our home and community with many people regularly affected. They often associated the illness with eating unripe sugarcane or being rained on. These myths were later demystified for me when I went to school and learned that malaria is transmitted by a female mosquito infected with the malaria parasite. I also learned that malaria is highly preventable as well as treatable.

In my family, the last time we had a malaria case was in 2010. Since then, I have always ensured that my house is sprayed as regularly as required, everyone sleeps under an insecticide treated net, and all the windows are screened. I have also trained my children to ensure that the doors and windows are closed around 5 pm and only opened if needed. When any of my family members is unwell and has a fever, I take them to the health facility. Luckily, we have not had an episode recently. I always discourage self-medication for any fever.

No life should be lost to malaria. As a malaria advocate and champion, I have sensitized my relatives and community members about the dangers of malaria, how it is spread, and the various prevention and treatment options available. VL Kenya with the Ministry of Health came up with different strategies, such as community meetings, and the use of community health volunteers and provincial administration as IRS community mobilizers, to demystify the myths and encourage residents to accept IRS.

Recently, the Zero Malaria Starts with Me campaign was launched in Kenya. This campaign advocates for everyone to take action to prevent malaria wherever they are. As a mother and as part of the PMI VectorLink Project, I encourage residents to actively play their part to prevent malaria in their communities by preparing their houses for spray.

What is your role as Operations Manager? I work very closely with national and county government leadership to plan and implement the spray operations in the country and lead advocacy strategies to promote behavior change activities that lead to reduced malaria mortality and morbity in the counties where PMI VectorLink sprays. IRS is currently being implemented in two counties (Homa Bay and Migori) out of the 47 counties in Kenya. Apart from coordinating IRS activities, I also serve as the gender focal person advocating for gender equity and social inclusion in project activities.

How did you get involved with malaria prevention? I am a trained environmental and public health professional. During my internship with the Ministry of Health in 2007, I participated in mosquito net treatment and health education on malaria control. Through this, I developed an interest in malaria prevention activities. In 2008, I began working on an IRS project and I have been doing it ever since.

What do you find most challenging about your job? The biggest challenge is convincing community members who believe in myths and misconceptions to accept their houses to be sprayed. It’s always heartbreaking for me to see a household owner refuse their house to be sprayed when they have children under five and/or have an expectant mother sleeping in those houses. Sometimes they have recently had an episode of malaria, yet they still refuse because of these myths.

What is challenging about reaching every household? IRS is conducted in eligible structures made of wood, reeds, stones, bricks, and mud. The insecticide is applied on the walls and ceilings. Not all structures in the two counties we spray are eligible because of the type of materials their house is made of. Ineligible materials include such things as iron sheets, glass, or metal. During the rainy season, some villages are cut off by floods. To address that challenge, we always plan to start in the hard-to-reach areas before the rains start. Some refusals are also experienced when a member of the household is sick. The good news is that once the 85% coverage is achieved, the missed households also enjoy the herd protection from IRS.

How has IRS implementation changed with COVID-19? We adjusted the way we implement IRS activities. PMI VectorLink established standards and protocols to mitigate the spread of COVID-19 while conducting the various activities. For example, we hold virtual meetings, and where needed, hold in-person meetings outdoors with all the required Ministry of Health and global protocols observed, including social distancing, wearing masks and regular washing of hands. During the campaign, all personnel were provided with masks and advised to always wear them properly. Supervisors always checked to ensure this was adhered to with constant reminders during morning mobilization and through job aid messages. Temperature screening was required to access operations sites, stores, and offices. Handwashing facilities were put up in all the entrances and monitored to ensure compliance. We also provided hand sanitizer and hand wipes in all vehicles, data centers, and stores.

Do you think Kenya will ever be free of malaria?

Yes. With integrated efforts in the different regions to fight malaria and everyone taking up their role to fight malaria, thanks to the Zero Malaria Starts with Me campaign, I believe Kenya is headed to be a malaria-free zone.

A new study funded by the U.S. President’s Malaria Initiative (PMI) and led by the PMI VectorLink Project found that new vector control tools, such as insecticide-treated nets (ITNs) treated with chlorfenapyr and the synergist piperonyl butoxide (PBO), may help to provide better protection against malaria in Côte d’Ivoire than those currently used. Previously, ITNs treated with pyrethroids alone were the primary net choice in Côte d’Ivoire because they were the only type of ITN available and the pyrethroid insecticide was effective in killing vector mosquitoes on contact. The nets provided additional benefits by serving as a physical barrier between people and malaria-carrying mosquitoes, protecting communities from malaria as they slept. Unfortunately, the widespread use of pyrethroid insecticides has resulted in mosquitoes building up resistance to the insecticide, making the pyrethroid-treated nets less effective.

The mosquito’s resistance to pyrethroid insecticides has had serious implications in the efforts made to control the Anopheles mosquito population in Côte d’Ivoire. As mosquitoes increasingly become resistant to all pyrethroid insecticides across the country and much of Africa, National Malaria Control Programs (NMCPs) are challenged with finding new ways to protect populations from malaria. This study, published in the Malaria Journal in December 2020, demonstrated the relative increase in effectiveness observed when exposing the pyrethroid-resistant mosquitoes to either PBO in combination with pyrethroids or to chlorfenapyr. Both options represent avenues for NMCPs to develop insecticide resistance management strategies. In Côte d’Ivoire specifically, Interceptor® G2 (IG2), a chlorfenapyr- and alpha-cypermethrin-treated net was identified as an option for a stratified distribution campaign in addition to PBO nets.

Despite multiple mass distribution and education campaigns to promote the continuous use of ITNs in country, malaria still accounts for about 33% of consultations in health facilities, with children and women being the most vulnerable populations. WHO 2019 (World Malaria Report) reports Côte d’Ivoire having an incidence of more than 250 cases per thousand people in at-risk populations. In the same period, malaria incidence has doubled in children under the age of five years old (NMCP Annual Report 2019). Given the variable insecticide resistance trends of vectors and the heterogeneity of malaria endemicity across the country, implementing a strategy for the distribution of the new nets required extra consideration. VectorLink Côte d’Ivoire provided technical support to the NMCP to conduct entomological monitoring to help select the most appropriate nets for use in country. Insecticide resistance data collected by the project and the country’s research institute consortium in previous years were used to profile the country and stratify districts for the upcoming 2021 mass net distribution campaign. Once the most appropriate nets were selected based on entomological findings, Global Fund, PMI, and NMCP allocated PBO and Interceptor G2 nets across districts where each type of net’s active ingredients was found to be efficacious against the local mosquito population.

With 113 health districts and varying resistance patterns across the country, PMI VectorLink’s ability to prioritize the districts based on mosquito susceptibility to insecticides used on the Interceptor G2 and PBO nets helped the country make the best use of limited resources. The NMCP Coordinator, Dr. Antoine Mea Tanoh, commended the project’s use of entomological and epidemiological data to guide the strategic deployment of insecticide-based vector control interventions to protect the population. Armed with the most accurate and relevant entomological data, Côte d’Ivoire was able to procure the necessary 19, 313,573 nets to ensure the entire population of nearly 28 million people across 113 districts received the most appropriate ITN intervention for the upcoming campaign.

The U.S. President’s Malaria Initiative (PMI) VectorLink Project promotes gender equity at every level of indoor residual spray (IRS) operations. IRS treats the inside walls of homes with long-lasting insecticides; it kills mosquitoes and disrupts the transmission of malaria. To celebrate International Women’s Day the PMI VectorLink Project is highlighting just a few of the women working hard to protect those most vulnerable from malaria. From supervisors to spray operators to truck drivers, women are doing it all.

https://spark.adobe.com/page/uGQdufFfi7qqu/

PMI VectorLink Study Finds New ITNs Effective Against Pyrethroid-Resistant Mosquitoes in Côte d’Ivoire

A new study conducted by the U.S. President’s Malaria Initiative (PMI) VectorLink Project found that new vector control tools, such as chlorfenapyr- and the synergist piperonyl butoxide (PBO)-combination insecticide-treated nets (ITNs) may help to provide better protection against malaria in Côte d’Ivoire than those currently used. 

Pyrethroid-treated mosquito nets are currently the mainstay of vector control in Côte d’Ivoire. As mosquitoes increasingly become resistant to all pyrethroid insecticides across the country and much of Africa, National Malaria Control Programs (NMCPs) are challenged with finding new ways to protect populations from malaria. This study, which was published in the Malaria Journal in December, demonstrated the relative increase in effectiveness observed when exposing the pyrethroid-resistant mosquitoes to either PBO in combination with pyrethroids or to chlorfenapyr. Both options represent avenues for many African country NMCPs to develop insecticide resistance management strategies. In Côte d’Ivoire, Interceptor® G2, a chlorfenapyr- and alpha-cypermethrin-based ITN could therefore be considered for a stratified distribution campaign in addition to PBO ITNs. The data gathered across the country within this study could also support the determination of the diagnostic concentration for testing the susceptibility status of An. gambiae s.l. against chlorfenapyr while the molecule is still being tested for appropriate concentrations in ITNs and IRS.

Read about the study here.

Learn more about the PMI VectorLink Project’s innovative efforts in mobile data collection.

In the third episode of the PMI VectorLink Podcast, our technical experts discuss recent innovations in mobile data collection to better track, monitor, and implement our IRS campaigns.

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.”

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.

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.”

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.

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.

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.”