Category: Uncategorized

PMI Pilots Integrated, Global Database with IRS and Entomological Data to Manage and Guide Timely-Vector Control Decisions

Insecticide resistance is rising across the globe, threatening the massive gains made in the control of malaria over the past 15 years. These gains can be attributed to the increased use of indoor residual spraying (IRS) and insecticide-treated nets (ITNs), which use insecticides to kill or repel mosquitoes that carry the malaria parasite. Timely, evidence-based vector control decision-making is essential to ensuring the most effective insecticides are being used.

The U.S. President’s Malaria Initiative (PMI) VectorLink Project conducts robust entomological monitoring efforts to understand malaria vectors – species that carry malaria – and their geographical and temporal distribution, feeding and resting behaviors, and resistance to insecticides. In 2018, PMI VectorLink developed a comprehensive District Health Information Software (DHIS2)-based data management system, VectorLink Collect, to support routine IRS data needs across project countries. Now, the project is expanding the database to manage entomological data across 17 African countries.

This advancement enables PMI-funded IRS and entomological data to be managed in a single system, and supports improved data quality and integrated analytics. VectorLink Collect also allows both internal and external decision-makers, such as National Malaria Control and Elimination Programs (NMCP/NMEP), and PMI/USAID in the U.S. and in country, to access comprehensive data at multiple levels. Furthermore, building VectorLink Collect on DHIS2, a platform that is used by Ministries of Health in every PMI-focus country where VectorLink works, also supports country-level priorities and systems, and aligns with PMI’s goal to support sustainability and the journey to self-reliance.

The project piloted the VectorLink Collect entomology instance in Zambia in February 2020. The Zambia country team had already been using VectorLink Collect for IRS data, and carries out comprehensive entomological activities. The pilot has helped the project to better understand data work flow needs, quality review processes, and general ease of use of this new system for entomological data. The VectorLink Zambia team provided comprehensive feedback and recommendations to inform critical updates to program design and minimize challenges as more countries start using the system. It became apparent that certain field work factors, such as the remoteness of collection sites, needed to be accounted for in determining realistic data entry timeframes. In addition, Zambia introduced a monthly plan to guide data review and data entry processes and expectations. The successful pilot concluded in April 2020, and the project continues to enter ongoing entomological data into VectorLink Collect.

The success of this important pilot and overall positive feedback from the VectorLink Zambia field entomologists and data managers supports the use and expansion of VectorLink Collect for entomological data. It formed the basis for finalizing training approaches for the broader roll out to remaining country teams. This is especially valuable as all trainings will now be conducted remotely. The use of VectorLink Collect for entomological data will allow for an integrated, global database to manage and use timely data to guide malaria control work.

Rabecca Ngwira, VectorLink Zambia entomology field coordinator, said, “We have longed for a system that allows rapid generation of entomological data summaries and graphical representations without a need for elaborate Excel worksheets and complicated use of formulae, and here we have it in the VectorLink Collect.”

 

 

 

While the global community responds to the COVID-19 pandemic brought on by the novel coronavirus, the vector control community continues its commitment to fighting malaria. Although this pandemic may have changed the way that we live and work, our commitment to saving lives remains as strong as ever.

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 (ITNs) and indoor residual spraying (IRS), to help reduce the overall strain on health systems by keeping the most vulnerable people malaria-free. Working in close collaboration with country governments, national malaria control programs, and ministries of health, we have been able to adapt our programming to adhere to social distancing guidelines and country-specific practices to continue to reduce the burden of malaria.

 

 Zambia

Dr. Oliver Lulembo has dedicated his life to treating and caring for people’s health. From his days as a pediatrician to his work as a public health practitioner, Dr. Lulembo has seen the rewards treatment and prevention can have in reducing the burden of malaria. He received his Master of Medicine in Pediatrics and his Bachelor of Medicine and Surgery from the University of Zambia in Lusaka and a Master of Public Health from San Diego State University in California. After years as a pediatrician and clinician, he shifted his career to designing, implementing and managing health programs in Zambia, Botswana and Malawi. From 2008-2012, Dr. Lulembo served as PMI Zambia’s Resident Advisor for USAID. In 2012, Dr. Lulembo retired from full-time work so he could spend more time with his four grandchildren. Now he works part-time as Senior Insecticide-Treated Net (ITN) Technical Advisor for the PMI VectorLink Project in Zambia. Recently, Dr. Lulembo took time late in his evening to talk about his current work with the PMI VectorLink Project.

Can you tell me about your role on the PMI VectorLink Project?
In my previous role with PMI, I worked with the Zambia National Malaria Elimination Program (NMEP) on their strategy for vector control interventions to distribute nets, amongst other responsibilities. This was mostly with routine net distribution through antenatal care, the Expanded Programme on Immunizations and supported mass campaigns. Now I am working with the NMEP and the Ministry of Health to help build their capacity to plan, implement, monitor and evaluate the upcoming ITN mass distribution campaign. It’s a very exciting assignment. PMI plans to procure an estimated 2.1 million ITNs for the 2020 campaign targeting Eastern, Luapula, Northern, and Muchinga Provinces.

What is your experience with malaria?

I have experience from many perspectives. One, of course, is as a patient of malaria. Several times. As you grow older, the attacks get less severe because you develop a bit of immunity. So I don’t get many attacks now. Also, I live in Lusaka, which is an urban area. The incidence of malaria here is quite low.

My first born also had malaria, and it was quite a big deal as he became very, very sick. That’s quite typical of malaria. You never know how patients fare in a short period of time, especially if they have not yet developed any immunity. If you don’t intervene with medical treatment, they die. My youngest son also had very severe malaria, which was quite serious.

I also have experienced malaria as a pediatrician. I saw babies and young children who tend to get very severe cases of malaria. Sometimes they come for care very late with complications, with severe anemia, and you can lose them. It’s very sad when you’re working with children. The last thing you want is to lose a young life.

Can you talk about the importance of the ITN campaign in the face of COVID?

It’s extremely important, and the good thing is that the government, MOH and partners, such as PMI, are communicating that. We know that COVID-19 and malaria share symptoms, so you get things that are common in both the virus and malaria. Our messaging tries to address that. We cannot afford to let our guard down. We need to maintain our interventions to avoid or abate deaths. That’s been the message consistently. Let’s maintain the prevention control measures, the treatment and other things that make sure we control malaria in this country.

Unfortunately, COVID-19 has diverted part of the workforce from the key interventions related to malaria. It also has changed the way people seek healthcare. So we may not be seeing as many people coming through for care. The international supply chains, including nets, have been delayed slightly. We’ve also seen commodities for testing malaria delayed, so it’s worrisome. But the message has been very clear. We must maintain intervention services.

What has surprised you most about the project?

With the PMI VectorLink Project, the main program has been IRS. Now, it’s working in nets and that’s when I became involved. We are helping the NMEP to implement this huge campaign, which is very different from the previous campaigns that have been implemented before. The past campaign in 2017 was a universal campaign, so it was one net for every 1.8 people. This time around it’s a very special type of campaign. It’s complicated because there will be some communities that receive IRS and some that receive nets. Zambia’s vector control interventions include the use of ITNs, IRS, and, where applicable, larval source management. For the 2020 ITN mass campaign, the NMEP will implement a unique, data-driven approach to the deployment of IRS and distribution of ITNs in a “patchwork” or mosaic configuration.

The ITN campaign will be a door-to-door distribution. We’ve determined quantities of nets for districts and how they flow to the health centers and then to the communities. We’ll have community-based volunteers to register the households and then those volunteers will return to distribute the nets while observing COVID-19 precautions. We had planned this campaign to occur before the rainy season and before the IRS campaign. Because of COVID-19, there’s been a disruption to the supply chain, so it looks like both IRS and ITN campaigns will happen at the same time.

Was this door-to-door approach decided on because of COVID?

This approach came as a lesson from the 2017 campaign, which used fixed distribution points. Communities were primed and sensitized to come to the distribution points to receive their nets. Back in 2013, we did a door-to-door campaign that seemed to work better because the net use-to-access ratio was better. So we’ve gone back to the door-to-door approach.

In this country, malaria incidence is plateauing and we really want to drive down that incidence. Last year’s floods brought an upsurge in malaria incidence and rise in deaths, so that’s worrisome, and we are trying to address that. It has not only affected Zambia but the entire region.

Is there anything else you’d like to add?

As a pediatrician, you see patients with malaria come into the hospital. When you treat them and then they go home ok, the feeling is really good. It’s a special feeling you get. It’s out of this world. Then, when you switch over to public health, you are part of planning, implementing, and evaluating strategies that affect not one patient but communities. You are talking in terms of thousands, millions of people who benefit from the work that you are a part of, and that special feeling is magnified so many, many more times. So this work becomes extremely addictive. It’s a privilege and an honor to be part of the work to protect people against malaria. In the malaria world, I think I’m in this for the long, long haul.

 

 

 

PMI VectorLink Wins 2nd and 3rd Place

PMI VectorLink won 2nd and 3rd place in the Abt Associates 2020 Photo Contest. With four photos among the top ten finalists, the photographers helped to further highlight the wonderful work PMI VectorLink is carrying out every day to reduce the burden of malaria. All four photos come from Tanzania where VectorLink conducts IRS and supports broad access to ITNs at health facilities and through mass campaigns and school-based distribution. 

 

Cotonou, Benin

Joséphine Tossa has spent the past 12 years fighting malaria in Benin on projects supported by the U.S. President’s Malaria Initiative. As a child growing up in southern Benin’s Mono District, Tossa suffered from malaria more than once and saw many others suffer as well.

“After my academic studies,” Tossa said, “I worked in many organizations in the field of community development. It was during this journey that I realized that malaria was not only a disease but also a cause of underdevelopment in underprivileged areas. That’s when I became interested in working in the field of malaria prevention.”

In her career with malaria prevention projects, particularly those managed by Abt Associates, Tossa has served as Finance & Administrative Manager as well as the Gender Focal Point for VectorLink Benin. Tossa shared a few of her insights about her work, the project and malaria in Benin.

VL: What impact has PMI VectorLink had on malaria in your country?

Tossa: Benin has all the environmental conditions for endemic malaria. The burden of malaria was such that health services were almost overwhelmed. With malaria interventions, such as indoor residual spraying (IRS) and insecticide-treated nets (ITNs), some severe forms of malaria have decreased, allowing health services to have time to deal with other diseases. Vector control interventions are implemented in areas that have extensive agriculture. Therefore, malaria prevention activities allow people to stay active and maintain economic growth.

 VL: What changes have you seen in malaria prevention since the project began?

Tossa: Thanks to information, education, and communication activities, populations are increasingly aware of the risk factors for malaria. Increasingly, people are protecting themselves by properly using ITNs, and accepting the spraying of their houses. If these trends continue, Benin can expect a significant reduction in the burden of morbidity and mortality attributable to malaria by the end of this decade.

VL: Can you tell us a bit about your job?

Tossa: As F&A Manager, I ensure finance and administrative requirements are strictly followed. Most of the malaria prevention activities are carried out in campaign mode. Managing financial, administrative, and procurement aspects of thousands of seasonal workers requires a lot of work.

Also, VectorLink Benin is promoting cost-saving initiatives to cope with the increasing prices of new and more effective insecticides. I adopted a systematic approach to cost control, categorizing expenses according to whether they are fixed or variable, direct or indirect to spraying. Cost reduction efforts are now better targeted so they do not impact efficiency in implementation.

VL: Can you tell us about your role as Gender Focal Point on the project?

Tossa: Given the low female participation in malaria prevention, I’ve actively advocated with IRS stakeholders at the national and departmental level for the removal of cultural and social barriers to increase the involvement of women in spraying campaigns. When procuring overalls, boots and other personal protective equipment for IRS campaigns, I always ensure that the gender dimension is taken into account. During spray campaigns, women have easy access to sanitary pads provided by the project, which was not guaranteed two years ago because of cultural barriers. In 2008, around 10% of women were involved in the IRS campaign. Today female participation has almost doubled.

VL: What kind of impact have you seen from the project?

Tossa: The project contributes to a reduction in morbidity due to malaria in rural areas less covered by health services, and provides income opportunities to the local population as seasonal workers, which helps them to improve their living conditions every year.

VL: What has been one thing you’ve learned or loved about working with PMI VectorLink?

Tossa: PMI VectorLink offers safe working conditions and professional development for all its staff. This makes VectorLink a great place to work and have a professional career.

VL: How do you see the country moving forward with malaria prevention or mosquito control?

Tossa: Most vector control interventions take place inside houses. Previously, Benin had lacked interventions that protected people while they are outside. Recently, the country has put a lot of effort in improving the living environment, repairing roads and clearing gutters. Cleaning up the environment to rid it of stagnant water would help to improve protection from malaria. Also, educating and informing the populations on the causes and preventive measures of malaria would enable them to participate and take ownership of the fight against malaria vectors. These activities will optimize the existing interventions, namely ITNs and IRS.

Join PMI VectorLink as we discuss ways in which the U.S. President’s Malaria Initiative has worked to ensure that women and men are able to participate fully and equally in vector control programming. Abigail Donner, Gender Advisor for the PMI VectorLink Project, and two of the project’s most seasoned Gender Focal Points, Zeddy Bore in Kenya and Helen Amegbletor in Ghana, talk about some of the ways the project has addressed inequality in vector control and how the project can move further toward gender equality and female empowerment.

Les équipes nationales de PMI VectorLink renforcent les capacités des intervenants dans le domaine de la collecte de données par la technologie mobile

Le projet PMI VectorLink lutte contre le paludisme dans 24 pays africains. La mission a notamment pour but de déployer la pulvérisation intra domiciliaire d’insecticide à effet rémanent (PID), méthode qui a fait ses preuves pour réduire le paludisme. La PID consiste à la pulvérisation sur les murs intérieurs et les plafonds d’un insecticide à effet rémanent qui tue les moustiques porteurs des parasites du paludisme. Des données fiables et complètes doivent être disponibles pour planifier, mettre en œuvre et suivre les progrès d’une campagne de pulvérisation.

Le projet PMI VectorLink a conduit une stratégie de collecte de données par la technologie mobile au Burkina Faso dans le cadre de la campagne PID de 2019 pour aider les équipes de pulvérisation à prendre des décisions rapides et éclairées visant à l’amélioration de leurs performances. À cet égard et face à un taux de refus important dans certaines zones, les activités de mobilisation ont été renforcées avec des messages spécifiques et adaptés. La disponibilité et l’accessibilité de données en temps réel facilitent la communication, accélèrent la prise de décision sur le terrain et diminuent rapidement les défis opérationnels. L’amélioration des processus et des procédures permet d’optimiser l’efficacité et de réduire les coûts de l’intervention.

Suite à la réussite de l’expérience pilote au Burkina Faso, PMI VectorLink a élargi la collecte de données par la technologie mobile lors des campagnes PID de 2020 au Bénin, en Côte d’Ivoire, au Mali et au Sénégal. Le premier déploiement à grande échelle était prévu au Bénin pour le mois d’Avril 2020 et le gestionnaire de la base de données VectorLink du Burkina Faso devait se rendre au Bénin pour dispenser des formations pratiques. Cela n’a toutefois pas été possible suite aux restrictions des voyages trans-frontaliers.

L’équipe de suivi-évaluation du programme VectorLink Burkina Faso a alors mis en place des séances de formation à distance avec le gestionnaire de la base de données du Bénin, le responsable suivi-évaluation et le spécialiste de l’informatique. Echangeant par Skype, WebEx et WhatsApp, l’équipe du Bénin est restée en étroite communication avec l’équipe du Burkina Faso, ce qui leur a permis de découvrir tous les aspects de la collecte de données par la technologie mobile. VL Burkina Faso a organisé des démonstrations pratiques à distance des différents outils et applications de collecte de données par la technologie mobile pour aider l’équipe du Bénin à configurer plus de 1 600 téléphones mobiles et à former les équipes de pulvérisation à la collecte de données en utilisant cette technologie. Des réunions d’étapes ont eu lieu hebdomadairement pour suivre les progrès et résoudre progressivement les problèmes rencontrés.

Alliée à la technologie, cette étroite coopération Sud-Sud entre les différentes équipes nationales de VectorLink a renforcé les capacités de tous les intervenants en les aidant à identifier et résoudre les difficultés rencontrées dans la gestion des données. L’équipe PMI VectorLink Bénin, quant à elle, est parvenue à mieux servir sa communauté en la protégeant plus efficacement contre le paludisme. En 2020, VectorLink Bénin a ciblé plus de 387 711 structures dans le but de protéger du paludisme environ 1 218 679 personnes par la PID.