The Democratic Republic of the Congo
The Democratic Republic of Congo (DRC) sits on raw mineral ores worth approximately $24 trillion. However, the income generated from the mining sector is having little direct benefit to the majority of people who live there (thinkprogress.org). The DRC ranks 176 out of 188 countries in terms of the 2015 Human Development Index, and an estimated 80% of the population lives on less than $1 a day (United Nations Development Program, 2015).
Malaria remains a serious public health problem in the DRC despite sustained malaria control strategies. Given that nearly all of the DRC population lives in high transmission zones, it has been estimated that the DRC accounts for 11% of all cases of Plasmodium falciparum in sub-Saharan Africa (WHO, 2015). Between 2010 and 2014, vector control with insecticide-treated nets (ITNs) and strengthening of diagnosis and treatment have contributed to a 10% reduction of malaria morbidity and 37% reduction of deaths in children under five (DRC National Malaria Control Plan, 2016-2020).
Under current National Malaria Control Program (NMCP) guidance, the DRC seeks to achieve high ownership and use of ITNs among the general population by ensuring that at least 80% of people at risk of malaria sleep under an ITN to lower malaria transmission. ITN mass distribution campaigns have been organized with the support of donors, including the U.S. President’s Malaria Initiative (PMI) throughout DRC. Since 2007, the NMCP has planned ITN distributions every three years. Between mass distributions, ITNs are distributed to pregnant women during antenatal care visits and to children under one year of age at health clinics. Since 2011, the DRC and international partners such as Department for International Development, Global Fund, PMI, UNICEF, and the World Bank distributed more than 40 million ITNs in universal coverage campaigns in all provinces. Routine distribution in health facilities complemented the campaigns. As a result of these efforts, 2013-14 Demographic and Health Survey (DHS) showed that 70% of households report owning at least one insecticide-treated net, a substantial increase from 9% and 51%, as reported by the 2007 DHS and 2010 Multiple Indicator Cluster Survey (MICS), respectively. Starting in FY2018, PMI also started supporting the school-based distribution of ITNs to increase access.
To help evaluate the impact of ITN use on malaria vectors (seasonal vector distribution, behavior, and species composition), PMI has been supporting entomological monitoring activities in DRC–a key component of vector control activities. In 2013, the PMI Africa Indoor Residual Spraying (AIRS) Project established a subcontract with the National Institute of Biomedical Research (INRB) for the implementation of entomological monitoring (EM) in the DRC. In project year one, data on key entomological indicators were collected from four districts in collaboration with INRB. Due to a lack of data on vector bionomics in the country, PMI expanded its entomological support in 2014/15 from four sentinel sites to seven sites. Entomological monitoring was extended to 11 sites in 11 provinces in 2016/17.
The PMI VectorLink Project will conduct insecticide resistance monitoring activities in 13 provinces namely, Tshopo, Sankuru, Tanganyika, Haut Katanga, Kasai Central, Sud Kivu, Kinshasa, Mai-Ndombe, Equateur, Mongala, Lomami, Kasai Oriental and Kongo Central; and longitudinal vector bionomics monitoring in three sites in Kimpese (Kongo Central Province), Inongo (Mai-Ndombe Province) and Lodja (Sankuru Province). In addition, PMI VectorLink DRC will initiate the evaluation of the impact of PermaNet 2.0 and 3.0 at baseline, 6 months, and 12 months post-distribution in Sud Ubangi. Capacity-building support will be provided to the national and district governments to plan and implement quality entomological monitoring in the future.
In Year 4, the PMI VectorLink DRC project will work with the NMCP, INRB, the University of Kinshasa (PHSK) and other local stakeholders to conduct entomological monitoring. Key objectives are listed below.
Insectary and Laboratory Activities
- Support the INRB to manage the insectary to include maintenance of the susceptible reference colony of coluzzii Ngousso, ensuring that all activities in the insectary follow standard protocols.
- Conduct laboratory analyses of a sub-sample of malaria vectors from all sites where insecticide resistance and vector bionomics monitoring is conducted. Tests will include mosquito species identification, detection of sporozoites, and presence of molecular markers of insecticide resistance.
- Determine insecticide susceptibility status of gambiae s.l., and An. funestus s.l. where collected in sufficient numbers, in 12 sites across 12 provinces. Synergist assays with piperonyl butoxide (PBO) and pyrethroid resistance intensity assays will also be conducted. The following insecticides will be tested, in order of priority: deltamethrin, permethrin, alpha-cypermethrin, deltamethrin + piperonyl butoxide (PBO), permethrin + PBO, alpha-cypermethrin + PBO and chlorfenapyr, deltamethrin intensity, permethrin intensity, alpha-cypermethrin intensity.
- Conduct monthly vector bionomics monitoring in Kimpese, Inongo, and Lodja. Vector species composition, spatial and temporal distribution, biting and resting densities, behavior, and Plasmodium sporozoite infection rates will be determined. In addition, human behavior will be monitored when HLCs are being done to determine the relative biting risk indoors and outdoors.
- Conduct entomological and ITN bio-efficacy monitoring of PBO ITNs in Sud Ubangi Province.
- Conduct baseline durability monitoring of ITNs distributed in Tanganyika Province.
- Conduct bi-annual monitoring (dry and rainy season) of reported and observed household net use in Tanganyika Province.
- Facilitate bi-annual national vector control technical working group (TWG) meetings to report and discuss entomology data for use in NMCP decision-making. Participating organizations include NMCP, Tenke-Fungurume Mining company (TFM), University of Kinshasa, INRB, VectorLink, and Centre de Recherche en Sciences Naturelles.
- Support the National Malaria Scientific Conference for dissemination and data sharing.
- Support the update and ratification of the National Insecticide Resistance Management Plan.
- Train and support three NMCP technicians located in the new site of Boende in entomological techniques for monitoring malaria vectors and provide refresher training during INRB visits to other sites on data management, running the insectary, and entomological monitoring at the sentinel sites through on-job-training and coaching..