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 (May 2020 – April 2021), the VectorLink team continued to strengthen the entomological capacity of the VectorLink technicians as well as DPS mosquito brigades in each province. The project piloted community-based entomological surveillance in Huambo Province and began collecting monthly trapping data in November 2020. VectorLink also successfully collected insecticide susceptibility data from seven provinces (Huambo, Kwanza Norte, Luanda, Lunda Sul, Malanje, Uige, and Zaire), including data on the synergist piperonyl butoxide (PBO). This was the first wide scale insecticide susceptibility survey in Angola since 2016 and showed that malaria vectors are resistant to pyrethroid insecticides, but that PBO synergist produces substantial increases in mortality. This data will be critical in supporting PMI, the NMCP, and other donors with deciding which type of ITNs to purchase for national bed net distribution campaigns. Recently, the Global Fund announced plans to purchase PBO ITNs for distribution in Benguela and Kwanza Sul Provinces in 2022. This will be the first time that PBO nets are distributed in Angola. Entomological monitoring in these provinces will be conducted by the MENTOR Initiative. VectorLink Angola will coordinate with Global Fund, United Nations Development Program, World Vision, and the MENTOR Initiative and provide technical assistance to support the collection of high-quality entomology data in these provinces.
In Year 3 (May 2021 – April 2022), the PMI VectorLink Angola project will work with PMI Angola, the NMCP, DNSP/Instituto Nacional de Investigação em Saúde (INIS), and provincial/district authorities to conduct entomological monitoring. The project’s primary objective is to build sustainable entomological capacity within Angola. Key objectives are to:
- Strengthen entomological technical capacity in-country through continuous on-the-job training and supervision of local personnel and DPS/NMCP brigade personnel. The project will conduct entomological activities throughout the year (versus seasonally) and will engage four full-time staff.
- Determine species composition in three provinces (Huambo, Luanda, and Lunda Norte) and vector susceptibility to different insecticides in eight provinces (Huambo, Kwanza Norte, Luanda, Lunda Norte, Lunda Sul, Malanje, Uige, and Zaire) during the peak mosquito season (November 2021-April 2022).
- Expand community-based entomological surveillance to three provinces (Huambo, Luanda, and Lunda Norte) through training of community collectors and district brigade staff.
- Coordinate and provide technical assistance to entomological monitoring conducted by Global Fund through the MENTOR Initiative in Benguela and Kwanza Sul Provinces.
- As part of the capacity-building plan, develop an online entomology syllabus for entomology technicians and mosquito brigade staff, focusing on insecticide susceptibility test procedures and establishing community-based entomological surveillance.
- Sponsor one entomologist from NMCP/MOH to attend a project-wide VectorLink regional 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.
- Support training of NMCP/MOH and VectorLink entomology technicians in insectary management through partnership with an active insectary in sub-Saharan Africa, with the end goal being sustained establishment of a susceptible An. gambiae colony in Angola.
- With technical assistance from PMI, help establish molecular laboratory capacity in Angola to perform key entomological analysis, including 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 for working insectaries, selected entomological monitoring sites and to carry out laboratory activities at INIS.
- Liaise with WHO, NMCP and GEPE/GTI to ensure that entomology modules are adopted in the Angola DHIS2 using the WHO entomological modules, including pre-programmed forms and dashboards. Facilitate stakeholder meetings to determine how to best ensure that VectorLink Angola entomological data from the VectorLink Collect system can be shared with the Angola DHIS2.
- Prepare a manuscript for a peer-reviewed journal covering Year 2 insecticide susceptibility testing results.