Approximately three-quarters of the Kenyan population is at risk for malaria. All four species of the malaria parasite that infect humans occur in Kenya. Plasmodium falciparum, which causes the most severe form of the disease, is the most common species and accounts for nearly all malaria infections in the country. The Kenyan government places a high priority on malaria control and tailors its malaria control efforts according to malaria risk to achieve maximum impact. Recent household surveys show improvements in coverage with malaria prevention and treatment measures and reductions in malaria parasitemia and illness.
Working in close coordination with the Kenya NMCP and county-level MOH officials, the PMI AIRS Project successfully implemented IRS in Kenya in 2017 after a lapse of five years. AIRS targeted structures in six sub-counties in Migori County (Awendo, Nyatike, Rongo, Suna East, Suna West, and Uriri).
Following the successful 2017 IRS implementation, in 2018 the PMI AIRS Project expanded IRS to include Homa Bay County, more than doubling the scale of the previous year’s malaria control intervention. This IRS campaign included the six sub-counties in Migori County plus eight sub-counties in Homa Bay County. The PMI AIRS Project transitioned to the PMI VL Project in July 2018 and implemented its first campaign in 2019 in all 14 sub-counties covered in 2018 (Migori County: Awendo, Nyatike, Rongo, Suna East, Suna West, and Uriri and Homa Bay County: Homa Bay Township, Rachuonyo East, Ruchuonyo South, Suba North, Ndhiwa, Rachuonyo North, Rangwe and Suba South)), with the exception of Mfangano Island due to inaccessibility and concerns over cost-efficiency.
In 2019, under the PMI VectorLink Project, IRS was conducted in 14 sub-counties, targeting 465,862 structures using Actellic 300 CS and a small pilot of SumiShield from January 28 – March 16, 2019. A total of 507,777 structures were sprayed out of 551,689 structures found by spray operators in the targeted counties, accounting for a coverage rate of 92.0%. In 2020, PMI VectorLink Kenya again conducted IRS in the 14 sub-counties, targeting 384,639 structures (70% of those found in 2019), using Actellic® 300CS, from February 10 to March 21, 2020.
In 2021, the PMI VectorLink Kenya project will work with the DNMP and the Migori and Homa Bay county ministries of health and environment to spray 408,101 targeted structures in the two counties, using Fludora® Fusion. The project’s primary objective is to reach a minimum coverage of 85% of the structures found in each county by implementing high-quality IRS operations.
In addition to spraying, in Year 3 the project will carry out the following activities:
- Conduct training with a focus on IRS supervision and spray techniques to improve the overall quality of spraying.
- Manage all logistics (i.e., procurement, shipping, delivery, and storage) for insecticide, spray equipment, and personal protective equipment (PPE).
- Update the IRS seasonal personnel excel database in line with Journey to Self-Reliance (J2SR.)
- Support training and capacity building at the national, county, and sub-county levels to promote IRS sustainability. The PMI VectorLink team will work closely with the DNMP as well as the county MOH officials on planning and supervision of the 2021 IRS campaign. This includes providing training on best practices for spray planning, spray supervision, and logistics management.
- Provide regular monitoring and evaluation (M&E) updates from the 2021 IRS campaign.
- Coordinate an integrated vector control information, education, and communication (IEC) and behavior change communication (BCC) strategy and activities working closely with county MOH officials, county health promotion officers, village-level community health volunteers (CHVs), and Breakthrough Action and other PMI implementing partners to raise community awareness, understanding, and demand for IRS and ITNs.
- Prepare and submit Environmental Impact Assessment (EIA) license variation reports to the National Environment Management Authority (NEMA) six months before the start of the 2021 IRS campaign to rationalize the change of IRS insecticides used from Actellic® 300CS to Fludora® Fusion, identify the health and safety concerns that Fludora® Fusion poses to the environment and the community, and indicate the mitigation measures put in place to eliminate, reduce, or control any adverse impacts arising from its use.
- Prepare and submit the annual statutory risk assessment and occupational safety and health audits of registered workplaces for review by the Directorate of Occupational Safety and Health Services (DOSHS) and renewal of the workplace registration certification for each county.
- Ensure safe and correct insecticide application, thus protecting environmental health and human safety during the IRS campaign in compliance with the approved Supplemental Environmental Assessment (SEA).
- Conduct monthly entomological monitoring at 18 sites for monthly monitoring in the context of IRS around Lake Victoria, with four sites in IRS areas (two in Homa Bay and two in Migori), four in unsprayed areas in Kisumu County, and two each in unsprayed Siaya and Vihiga counties. Monthly monitoring of vector densities will be conducted in two sites in Busia, two sites in Bungoma, and two sites in Kakamega counties to monitor the impact of piperonyl-butoxide (PBO) ITNs on entomological indices.
- Conduct community-based entomological surveillance in Kakamega and Vihiga using the Centers for Disease Control and Prevention (CDC) light traps that are charged by rooftop solar panels installed by the project. In line with the J2SR VectorLink will build the capacity of county entomology teams in the supervision of community surveillance program and county team will also be involved in coordinating collection of larvae for insecticide resistance monitoring
- Conduct insecticide susceptibility testing (including pyrethroid, organophosphate, pyrrole, and neonicotinoid insecticides), pyrethroid intensity testing, and PBO synergist bioassays in eight endemic counties (Homa Bay, Migori, Kisumu, Siaya, Kakamega, Vihiga, Bungoma and Busia).
- Conduct 36 months post-distribution of ITN durability monitoring in Kwale and Busia.
- Support and encourage women’s participation in project activities across the counties.
- Support data-driven decision making with DNMP and counties for future IRS programming, and complete all data compilation and archival activities for program close-out, per contract requirements and PMI guidance.
In 2021, VectorLink Kenya will continue to minimize its costs by conducting a scope of work within advised funding levels and continuing or adopting practices to realize cost efficiencies:
- Each county’s spray campaign will last 24 days.
- To minimize procurements, the counties will be sprayed consecutively rather than simultaneously, so that reusable supplies and equipment, such as coveralls, spray pumps, etc., can be taken from Migori to Homa Bay for use. There will be two business days between the end of the Migori campaign and the start of the Homa Bay campaign to allow movement of these items between the counties.
- VectorLink Kenya will continue scheduling two walk-to-work days for SOPS who spray close to their operations sites, and rotate vehicles for the teams spraying in faraway sub-locations, thereby saving two days of vehicle transportation costs. The schedule for the walk-to-work days will be incorporated in the spray calendars.
- VectorLink Kenya will continue on the job orientations to washers, security guards, and drivers on the first day they report to work, rather than have them attend more costly classroom trainings prior to the spray campaign. In 2020, VectorLink site coordinators conducted health worker orientations at health centers. This approach did not work well because, although the site coordinators had attended the project training of trainers (TOT), not all of them were medical practitioners and were not able to present the needed uniform messaging about medical examination and poison management in the IRS context This year, VectorLink plans to bring health workers together at the sub-county level and have sub-county medical officers and VectorLink sub-county coordinator conduct health worker training.
- In 2021, all trainings and meetings will not require any lodging except for TOT and microplanning, to avoid paying trainee per diems.
As a result of the success of a bicycle initiative at a Homa Bay site in 2018 and 2019, the project will continue with SOPs’ use of bicycles to travel in one operations site within Homa Bay.