Malaria remains a serious public health problem in Angola despite sustained malaria control strategies. Malaria accounts for 35% of all-cause outpatient morbidity, 35% of mortality in children, 40% of prenatal mortality, and 25% of maternal morbidity, and causes 60% of hospital admissions in children under 5 and 10% of admissions of pregnant women. The vector-borne disease is endemic throughout the country and the entire population is at risk. According to the World Health Organization (WHO) 2017 World Malaria Report (WMR), the total number of malaria cases (suspected and confirmed) reported in the public health sector in 2015 was 3,254,270. This number increased by 32% in 2016 to 4,301,146, likely due to increased rainfall because of El Niño and stock-outs of anti-malarial drugs (FY2018 Malaria Operational Plan).
In 2014, PMI constructed and established an insectary in Huambo. It was the first insectary in Angola since the end of the civil war. PMI also supported the training of technicians on basic malaria entomology, including the sampling of aquatic and adult mosquitoes, rearing of adults from field-collected larvae/pupae, morphological species identification, ovary dissection, cone bioassays, susceptibility testing using U.S. Centers for Disease Control and Prevention (CDC) bottle bioassay and WHO tube test methods, preserving mosquito samples, and transport to a laboratory for molecular and biochemical assays. Insectary technicians also received on-the-job training and mentorship to support continuous improvement of their skills and competence. PMI also supported the training of provincial and municipal health authorities drawn from nine provinces (Benguela, Cunene, Huambo, Huila, Luanda, Malanje, Namibe, Uige, and Zaire) where insecticide resistance was evaluated in 2015-2016. These provinces represent three malaria transmission zones.
In Year 1 of the PMI VectorLink Angola project (May 2019 to April 2020), entomological surveillance was conducted in two sites—one in Huambo Province and the other in Lunda Sul Province. (The original plan was to conduct entomological surveillance in three sites, but Luanda Province was postponed due to the COVID-19 pandemic.) VectorLink conducted one month of entomological surveillance at each site during the peak mosquito season (January-March 2020) to determine species composition, vector behavior, and vector susceptibility to different insecticides. The project also hired a full-time Entomology Coordinator who facilitated preparations for data collection, including meeting with central, provincial, and district leadership, and obtaining ethical clearance from the Instituto Nacional de Saúde Publica (INSP). With the support from the VectorLink home office and a consultant who stayed in Angola throughout the sampling season, the project trained a total of 15 people (including eight members of the Provincial mosquito brigades, five technicians, a Field Epidemiology Training Program fellow, and the Entomology Coordinator) on adult mosquito collection methods and morphological identification.
In Year 2, the PMI VectorLink Angola project will work with PMI/Angola, the NMCP, INSP/INIS, and provincial/district authorities to conduct entomological monitoring. The project’s primary objective is to build sustainable entomological capacity within Angola. Key objectives for the Year 2 work plan are to:
- Engage an international consultant to conduct insecticide susceptibility and community-based surveillance training and to supervise data collection. This will most likely consist of one trip for training and two trips for the supervision of data collection, each lasting for two months. If a qualified candidate is willing and able to relocate to Angola and work full-time, this will be considered in consultation with PMI.
- As part of the capacity-building plan, conduct a weeklong central-level training with a priority focus on insecticide susceptibility test procedures including theoretical and practical sessions, reinforced by on-site training on larval and adult collections, bioassays, and sample preservation with NMCP mosquito brigade staff in each of the seven provinces.
- Sponsor at least one entomologist from NMCP/MOH to attend a project-wide VectorLink training, focused on topics of importance to NMCP staff. This training will include insecticide susceptibility testing, morphological identification, sample processing, and standardized data collection and management.
- Improve functionality of Huambo insectary, in coordination with NDPH and DPS, by adding shipping containers to provide more space for rearing a susceptible gambiae Kisumu colony and wild pyrethroid-resistant Anopheles as well as to provide adequate space for mosquito sample processing, susceptibility tests, and data entry.
- Ensure that the Luanda insectary becomes functional through the importation of a susceptible colony and training of technicians.
- Conduct insecticide susceptibility testing in seven provinces (Huambo, Kwanza Norte, Luanda, Lunda Sul, Malanje, Uige, and Zaire) during the peak mosquito season (November 2020-April 2021) to determine species composition and vector susceptibility to different insecticides.
- With technical assistance from PMI, help build the laboratory capacity of INIS to perform polymerase chain reaction (PCR) for species identification and to determine resistance mechanisms, and enzyme-linked immunosorbent assays (ELISAs) to determine sporozoite infection rates.
- Conduct local and international procurement of entomological surveillance items required by INIS, insectary, and selected entomological monitoring sites.
- Submit quarterly, semi-annual, and annual reports as required.