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).
Plasmodium falciparum is the primary malaria parasite in Angola, responsible for an estimated 87% of malaria cases. The Angola National Malaria Control Program (NMCP) strategy includes three vector control methods: insecticide-treated nets (ITNs), indoor residual spraying (IRS), and larviciding for malaria prevention. The NMCP’s goal is to cover 80% of the population at risk of malaria with at least one vector control and prevention measure. Recent evidence indicated that 31% of households in Angola owned at least one ITN in 2016 (2015–16 Demographic and Health Survey). By comparison, in sub-Saharan Africa in 2016, 80% of households owned at least one ITN. The U.S. President’s Malaria Initiative (PMI) and the Global Fund have been key partners supporting procurement and distribution of ITNs. Widespread and long-term use of ITNs is expected to exert selective pressure on malaria vectors and may affect the vector bionomics, the vectors’ response to insecticides, or both. Angola took a major step in 2017 towards universal coverage of ITNs, planning a three-phase nationwide mass campaign in 2017–2018.
Through the Africa Indoor Residual Spraying Project (AIRS), PMI conducted longitudinal entomological surveillance activities in Angola from 2012 to 2016. Throughout this period, AIRS collected data on key entomological indicators—vector species composition, seasonality, behavior, and insecticide resistance status and sporozoite infection rate—from three provinces (Cunene, Huambo, and Malanje), in collaboration with the Direcçao Provincial de Saúde/Provincial Health Directorate.
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 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 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.
The PMI VectorLink Project continues to increase the breadth and depth of entomological monitoring in Angola and has an expanded scope to include other proven life-saving vector control interventions such as ITNs. The project is building entomological capacity at the country level, as well as strengthening existing institutional structures. The project will provide technical assistance, in planning and carrying out vector surveillance activities in three PMI-supported provinces and to Angola’s NMCP on vector surveillance and control.