Madagascar

Malaria remains a major health problem in Madagascar, particularly for children and pregnant women. Severe malaria is among the top five causes of reported overall mortality.

The cyclone season, extending from December to April, often results in flooding and increased risk of communicable diseases and malaria, compounded by the loss of ITNs. The new national strategy has organized the country into three geographic zones based on the local epidemiology and level of coverage of malaria interventions: control, consolidation, and pre-elimination zones.

PMI VectorLink aims to spray at least 85 percent of eligible structures found in all communes/districts targeted for spraying. The four main objectives of the project in Madagascar include:

In 2019, under the PMI VectorLink Madagascar project, IRS was conducted in five districts, targeting 265,033 structures using organophosphate (Actellic CS 300), neonicotinoid (SumiShield® 50 WG), clothianidin & deltamethrin combination (Fludora Fusion) from November 4  to November 30, 2019. A total of 267,874 structures were sprayed out of 279,746 structures found by spray operators in the targeted districts, accounting for a coverage rate of 95.8 %.

The table below provides an overview of the number of sprayed structures and population protected from 2016, including targets for 2020.

PMI supported IRS Districts, Structures Sprayed, and Population Protected, 2016-2020

Year Number of Districts Number of Communes Structures Sprayed Population Protected Insecticide
           
2016 5 91/103 310,426  1,257,036 Pirimiphos-methyl CS
2017 8 173/199 487,636  2, 008,963 Pirimiphos-methyl CS
2018 9 187/221     548,775  2,232,097 Pirimiphos-methyl CS and clothianidin
2019 5 92/109  267,874 1,150,922 Organophosphate

clothianidin, clothianidin & deltametrin combination

2020 (Target) 5 77/94 203,513 866,403 Pirimiphos-methyl CS, clothianidin, clothianidin & deltametrin

The PMI VectorLink Madagascar Project 2020 work plan covers activities for the period of April 01, 2020, to March 31, 2021. The project will conduct IRS in five districts (Ihosy, Iakora, Betioky Sud, Tulear II, Sakaraha) from November 2 to December 05, 2020, and will provide capacity-building support to the national and district governments to plan and implement quality IRS in the future. The project has maintained the four previously sprayed districts of Ihosy, Betioky Sud, Tulear II and Sakaraha, and has added the new district of Iakora (which replaced the district of Ampanihy that had low malaria incidence rate) based on the higher malaria incidence rate in that area. Figure 1 below highlights the target districts for 2020 including entomological sentinel and control sites. 

In 2020, the PMI VectorLink Madagascar project will work with stakeholders including NMCP, regions and districts, to spray 203,513 targeted structures in five districts using Actellic 300 CS, Sumishield 50WG and Fludora Fusion. The project’s primary objective is to reach a minimum coverage of 85 percent of the structures found in each district by implementing high-quality IRS operations.

In addition to spraying, in year three, the project, after consultation with PMI and NMCP, will carry out the following activities:

  • Build capacity of NMCP at the national, regional, district, and local levels to manage IRS operations, including planning, spraying, resource allocation, and monitoring and evaluation (M&E).
  • Collaborate with health districts on prioritizing implementation of activities in their IRS exit/sustainability plans, which the project helped develop.
  • Conduct cascade training with a focus on IRS supervision and spray techniques to improve the overall quality of spraying.
  • Carry out a logistics assessment in all districts, and arrange all procurement, shipping, delivery, and storage of IRS commodities, and strengthen the IRS logistics and warehousing system through enhanced training and supervision.
  • Coordinate community mobilization activities in collaboration with stakeholders to raise awareness of IRS and to encourage beneficiary and stakeholder ownership.
  • Conduct insecticide resistance, wall bioassay, vector density monitoring, and behavioral studies, species identification of gambiae sl and An. funestus sl groups in country and/or at sentinel sites using a portable molecular laboratory platform, and monitor the residual life of the sprayed insecticides using wall cone bioassays in the IRS districts.
  • Collaborate with ACCESS project, in Sakaraha, Tulear II and Betioky districts to complement each other’s work and ensure no duplication of efforts more precisely in awareness raising and social mobilization.
  • Conduct environmental compliance assessments (Environmental Audit and Environmental Social and Impact Assessment) in consultation with PMI and the National Environmental Management Authority.
  • Gather medical entomology researchers from NMCP, universities and research institutes for a symposium on ongoing entomological surveillance methods and projects in Madagascar to ensure that there is no duplication of research efforts and ultimately to develop partnerships and collaborations and strengthen the national capacity for medical entomology in country.
  • Pilot a community-led entomological surveillance pilot program in Sakaraha and Ampanihy to determine whether a community-based approach can be used to scale up entomological surveillance activities and improve efficiency for insecticide resistance monitoring.
  • Larviciding assessment of rice paddies in locations where there is known transmission and they are few, fixed, and findable; identification of the potential larviciding sites through satellite imagery and confirmation of the physical presence of the breeding sites and existence of larvae in them. The stratification according to the malaria burden will be taken into account during the selection of the sites where larviciding will be implemented.
  • Conduct ITN durability monitoring to assess the presence and physical condition of ITNs in the cohort at 24 months after the mass campaign distribution in 2018.
  • Conduct an epidemiological analysis for VectorLink Madagascar in 2020.