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 Insecticide-treated Bed Nets (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.

In 2019, under the PMI VectorLink Madagascar project, Indoor Residual Spraying (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 %.

In 2020, IRS was conducted in five districts, targeting 201,013 structures using organophosphate (Actellic CS 300), neonicotinoid (SumiShield® 50 WG), clothianidin & deltamethrin combination (Fludora Fusion) from November 2 to December 3, 2020. A total of 197,787 structures were sprayed out of 203,028 structures found by spray operators in the targeted districts, accounting for a coverage rate of 97.4%. 

In 2021, the PMI VectorLink Madagascar project will work with stakeholders including NMCP, regions and districts, to spray 203,028 targeted structures in five districts using Sumishield 50WG, Actellic 300CS, 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 four, the project, after consultation with PMI and NMCP, will carry out the following activities:

  • Scale up the capacity of the NMCP at the national, regional, district, and local levels to manage IRS operations, including planning, spraying, resource allocation, supervision, 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 An. 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.
  • Under the leadership of NMCP, pilot community-based entomological surveillance in TBD districts (pending final selection from NMCP).
  • Conduct larval surveillance for Anopheles stephensi in urban locations with high likelihood of introduction
  • Collaborate with existing PMI partners such as Access, IMPACT and PSI project, in Betioky, Sakaraha, and Tulear II 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.
  • Conduct larviciding assessment and actual larviciding of rice paddies in Morombe and Ankazobe, where there is known transmission of malaria, positive and narrower breeding sites, accessibility, availability of rainfall/ epidemiological data, and non-implementation of IRS; identify larviciding sites through drone-enabled 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 36 months after the mass campaign distribution in 2018.
  • Implement streamlined durability monitoring in three TBD districts following the mass campaign in August 2021.
  • Conduct an epidemiological analysis for VectorLink Madagascar in 2021.