Though malaria prevalence in Ethiopia is relatively low compared to other African nations, nearly 70 percent of the population lives in areas at risk of malaria. Prompt access to quality malaria case management, including laboratory-based diagnosis in remote rural areas, has improved dramatically over the last decade as have surveillance systems that capture malaria cases and deaths.

Since 2005, the Ethiopia Federal Ministry of Health (FMOH) IRS program, funded by the government and Global Fund, has protected between 9 and 17 million people annually from malaria. In 2018, the FMOH IRS program sprayed approximately 2.9 million structures across non-PMI target districts achieving 88% coverage of the target, and protecting more than 9.1 million people from malaria. The US Government has been supporting the FMOH to conduct IRS in Ethiopia since 2008. The 2018 and 2019 campaigns each targeted 44 districts, 20 in Benishangul-Gumuz, 14 in Gambela, and 10 in Oromia. In 2019, under the PMI VectorLink Ethiopia project, IRS was conducted in 44 districts, originally targeting 542,148 structures using Actellic 300CS from to May 20 to July 22, 2019. The target was reduced to 509,594 structures due to security issues that prohibited spray teams from reaching certain areas. A total of 487,746 structures were sprayed out of 510,449 structures found by spray operators in the targeted districts, accounting for a coverage rate of 95.5%.

Table 1 provides an overview of the number of sprayed structures and population protected from 2016 to 2019 including targets for 2020 by the PMI IRS program.

Table 1: Number Of Districts, Structures Sprayed, And Population Protected, 2016–2020

Year Number of Districts Structures Sprayed Population Protected Insecticide
2016 36 (Oromia Region) 715,541 1,688,745 Pirimiphos-methyl CS
2017 44 (8 in Benishangul-Gumuz and 36 in Oromia) 738,810 1,877,154 Pirimiphos-methyl CS
2018 44 (20 in Benishangul-Gumuz,14 in Gambela,10 in Oromia) 472,569 1,264,189 Pirimiphos-methyl CS
2019 44 (20 in Benishangul-Gumuz,14 in Gambela,10 in Oromia) 487,746 1,334,868 Pirimiphos-methyl CS
2020 (Target) 44 (20 in Benishangul-Gumuz,14 in Gambela,10 in Oromia) 537,155* 1,411,268 (est.) Pirimiphos-methyl CS

* The 2020 target includes all areas not reached in 2019 for security reasons.

This PMI VectorLink Ethiopia Project Year 3 work plan covers activities for the period from January 1 to December 31, 2020. The project will conduct IRS in the same 44 districts in three regions (Benishangul-Gumuz, Gambela, and Oromia) from May 19 to July 10, 2020, and will provide capacity-building support to the national and district governments to plan and implement quality IRS in the future. Figure 1 below highlights the target districts for 2020.

In 2021, the PMI VectorLink Ethiopia project will work with the NMEP, regional health bureaus (RHBs), and district authorities to spray 792,891 targeted structures in the target 48 districts using pirimiphos-methyl CS (Actellic 300CS), SumiShield 50WG, and Fludora Fusion to conduct IRS. Twenty-six of the 48 districts will be sprayed with clothianidin-based products (SumiShield 50WG in 22 districts and Fludora Fusion in four districts)). The project’s primary objective is to reach a minimum coverage of 85% of the structures found in each district by implementing high-quality IRS operations. The project will implement World Health Organization (WHO) and PMI guidelines on prevention of COVID-19 before and during implementation of IRS to ensure the safest possible conditions for the implementing teams and the beneficiaries.

In addition to spraying, in Year 4 (2021) the project will carry out the following activities:

  • Scale up capacity at the national, regional, district, and local levels to conduct IRS, including planning, implementation, and monitoring and evaluation (M&E).
  • Provide technical and limited material support to 63 graduated districts in Oromia Region.
  • Conduct structure enumeration in three out of six new PMI-supported districts of Amhara Region.
  • Train spray personnel with a focus on supervision, spray techniques, and IRS data quality.
  • Mainstream gender equality by ensuring women’s participation in different project activities.
  • Carry out a logistics assessment in all districts, and arrange all procurement, shipping, and storage of IRS commodities.
  • Conduct community mobilization activities as safely as possible following PMI VectorLink COVID-19 mitigation protocols and in collaboration with stakeholders to raise awareness of IRS and to encourage beneficiary and stakeholder ownership.
  • Conduct insecticide resistance tests, wall bioassays, vector density monitoring, and behavioral studies.
  • Expand the evaluation of the residual life of SumiShield 50WG and Fludora Fusion.
  • Conduct Anopheles stephensi surveys in rural and urban sites to map its geographical distribution.
  • Evaluate the effectiveness of larvicides for the control of stephensi.
  • Conduct a community-based surveillance pilot for arabiensis and An. stephensi.
  • Organize virtual workshop on stephensi in May 2021.
  • Scale up entomological monitoring capacity of universities, research, RHBs, and public health institutes.
  • Evaluate the impact of piperonyl butoxide (PBO) nets in combination with and without IRS on entomological indicators and malaria incidence.

PMI VectorLink will continue to update the dashboards monitoring IRS, malaria case incidence, entomological, and environmental factors, in Benishangul-Gumuz and Gambela for the year following the 2020 IRS campaign (through June 2021).

Success stories from PMI VectorLink Ethiopia:

Ethiopia Sees Dramatic Reduction in Malaria in IRS Region