Niger

Of the estimated 20 million people who live in Niger, 94 percent are considered at risk for malaria infection. Malaria transmission is concentrated in the southern part of the country and occurs primarily during the rainy season, which runs from June to September. Although child and maternal deaths are declining, malaria remains the first cause of illness and death among these two vulnerable population groups. Pregnant women are four times more likely to suffer from the complications of malaria than non-pregnant women, and more than half (56 percent) of all deaths in health facilities are attributed to malaria.

According to Niger’s Annual Health Statistic Report (2016), there were over 3.3 million uncomplicated malaria cases, over 172,000 severe malaria cases, and 1,561 malaria deaths in 2016, putting it among the countries with the highest per capita rate of malaria fatalities globally1, 2.

The National Malaria Control Program (NMCP) has historically used intermittent preventative treatment of malaria in pregnancy, seasonal malaria chemoprevention, and vector control interventions such as insecticide-treated net (ITN) distribution as the main malaria prevention measures in Niger. Since August 2018, the PMI VectorLink Project has conducted entomological monitoring activities that provide baseline data to support the allocation of resources and/or deployment of various insecticide-based vector control interventions (not limited to ITNs). Vector surveillance is a key component of malaria vector control as it provides important entomological information, including identification of the major vector mosquito species, their spatial and temporal distribution, density, ecology, biting and resting behavior, and susceptibility to insecticides used for malaria control. Comprehensive information on vector bionomics and insecticide resistance data, paired with health facility-based malaria incidence data and population density, could provide a robust platform for decision making in line with the global strategy on integrated vector management.

In 2018, the PMI VectorLink Niger Project supported entomological monitoring activities in nine sentinel sites (vector surveillance in six sites and insecticide resistance monitoring in all nine sites). In 2019, in consultation with the NMCP, the project conducted comprehensive monitoring (both vector surveillance and insecticide resistance monitoring) in ten sites across the three malaria endemicity zones: Agadez, Balleyara, Farrarat, Gaya, Guidimouni, Ingall, Niamey V, Say, Tessaoua, and Zindarou.

In 2019, with support from the PMI VectorLink Project, the national ITN continuous distribution guidance was updated to instruct the health district and health facility chiefs to provide ITNs free of charge to pregnant women at their first ANC visit and to children under one year of age during their first measles vaccine (VAR1) vaccine. In 2020, more than 8.5 million Olyset ITNs will be distributed through mass campaign in 44 health districts (759 Health Centers (CSI) and 2,525 distribution sites); more than 8.5 nets will be distributed in meso- and hyper-endemic districts.

In 2020, the PMI VectorLink Niger project will work with CERMES and the NMCP to conduct entomological monitoring and implement ITN-related activities. The VectorLink Niger PMI project will continue to provide entomological monitoring technical support to the NMCP, with the primary objective of providing the NMCP data for vector control decision making. Additionally, the project will subcontract with CERMES for all laboratory activities for mosquito sample analysis. The field teams will be made up of trained entomological technicians from CERMES and the NMCP. The VectorLink Niger COP and the NMCP entomologist will each carry out three formative supervision trips for bionomics and resistance monitoring. In addition, a social networking platform has been created for all field staff to ensure real-time data quality checks, all level communications, and problem-solving (technical or logistical) that could be encountered during the field collections.  The entomological monitoring approach was agreed upon with PMI, the NMCP, and CERMES and will include annual insecticide resistance monitoring in 15 sites and monthly vector bionomics surveillance (for up to seven consecutive months) in six sites. The project will also conduct the third of four rounds of ITN durability monitoring and continue providing technical support for the continuous distribution of ITNs to enhance integrated vector control programming in Niger.

The project’s key objectives for each component are as follows:

Entomological monitoring:

  • Determine the susceptibility of the primary malaria vector, gambiae s.l., to insecticides in 15 sentinel sites selected by the NMCP, which are spread across the three endemicity zones;
  • Measure the intensity of resistance to insecticides and determine the mechanism of resistance in the sites where resistance is detected;
  • Monitor the density, species composition, behavior, and infectivity of malaria vectors in the six sentinel sites; and
  • Implement the DHIS2-based VectorLink Collect database for improved entomological data monitoring and use with all relevant stakeholders.

National entomological monitoring capacity strengthening activities:

  • Provide CERMES with susceptible mosquito colonies of gambiae Kisumu;
  • Train CERMES to maintain laboratory colonies and ensure that all activities in the insectary follow standard protocols;
  • Work with CERMES to prepare mosquito samples for molecular analysis;
  • Conduct refresher training in entomological collection methods;
  • Support an advanced laboratory training for experienced entomologists at CERMES provided by the University of Notre Dame;
  • Offer monthly data interpretation training sessions to support NCMP in building capacity to make evidence-based vector control decisions;
  • Provide technical support to CERMES staff and students to acquire applied entomological skills; and
  • Promote and support the NMCP to set up a vector control working group and help organize two meetings of the group, to review country national data for decision making.

ITN durability monitoring:

  • Conduct the 24-month assessment of the physical durability and the insecticide effectiveness of Olyset mosquito nets distributed through the 2018 mass campaign at sites selected by the NMCP and PMI (Madaoua in the Tahoua region and Gazaoua in the Maradi region).

National capacity-building for ITN distribution:

  • By leveraging the findings of the PMI VectorLink 2018 ITN continuous distribution assessment, support the NMCP to identify mains gaps and opportunities which if addressed will maintain ITN coverage in Niger;
  • Build on the validation and dissemination of new ITN directives to support ITN continuous distribution activities at the levels of CSI and Health Huts by integrating the guideline activities into health records, EPI, and supervision tools;

During quarterly coordination meetings at the district level, additional time will be allocated to remind the meeting participants on the importance of the routine ITN distribution guidelines.