Niger

Malaria is endemic in Niger and is the leading cause of death and morbidity combined, disproportionately affecting children under 5 years of age. According to the Annual Health Statistics Report (2019), there were over 3,621,972 malaria cases and 3,761 malaria deaths in Niger in 2019, putting it among the countries with the highest per capita rate of malaria fatalities globally.

According to the PMI FY20 Niger Malaria Operational Plan, the vast majority of Niger’s population (94%) resides in the two southernmost (moderate and high transmission) zones, where malaria is most prevalent. The rainy season in Niger lasts three to four months, from June to September, with peak malaria transmission during the second half (August and September) of this period.

Niger’s National Malaria Control Program (NMCP) has historically used intermittent preventive treatment of malaria in pregnancy, seasonal malaria chemoprevention, and vector control interventions such as ITN distribution as the main malaria prevention measures in the country. In 2018, PMI funded the VectorLink Project to conduct detailed entomological monitoring and ITN evaluation activities that would provide baseline data in anticipation of expanded insecticide-based vector control programs. In 2019 and 2020, VectorLink Niger expanded the scope beyond entomological monitoring, to include the second and the third rounds of ITN durability monitoring, which will be followed by the fourth and final round in 2021, as well as technical support for ITN continuous distribution (CD) nationwide.

From July 2018 to March 2021 (project Years 1–3) the PMI VectorLink Niger Project supported entomological monitoring activities including insecticide susceptibility and vector surveillance in a total of 17 sentinel sites (ranging from nine to 15 in any given year) distributed across the country.

In 2019, with support from the PMI VectorLink Project, the national ITN CD guidance was developed and shared with the health district managers and health facility chiefs in order to clarify when ITNs should be distributed. In 2020, more than 8.5 million Olyset ITNs have been distributed through mass campaigns in 44 health districts in moderate and high-transmission districts (759 health facilities and 2,525 distribution sites).

In 2021, the PMI VectorLink Niger Project will continue working with the NMCP and CERMES to conduct entomological monitoring and implement ITN-related activities. The project will continue to provide entomological monitoring technical support to the NMCP, with the primary objective of providing the NMCP with 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 NMCP and CERMES. The VectorLink Niger Chief of Party (COP) and the NMCP entomologist will each carry out three formative supervision trips for bionomics and three for resistance monitoring. In addition, a social networking platform has been created for all field staff to ensure real-time data quality checks, and all-level communication and problem solving (technical or logistical) that is 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 as in 2020. The project will also conduct the fourth and final round of ITN durability monitoring and continue providing technical support for CD 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, An. gambiae s.l., to insecticides in 15 sentinel sites selected by the NMCP, which are spread across the four transmission 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;
  • Promote the use of the District Health Information System 2 (DHIS2)-based VectorLink Collect database for improved entomological data monitoring, reporting, and decision making by relevant stakeholders;
  • Conduct ITN cone bioassays in accordance with WHO recommendations using wild collected An. gambiae s.l. from two localities selected by the NMCP, with ITNs procured by PMI for routine distribution.

National entomological monitoring capacity-strengthening activities:

  • Support the recruitment and training of a contractual technician to ensure the insectary management;
  • Provide CERMES with susceptible mosquito colonies of An. gambiae Kisumu;
  • Train dedicated CERMES staff to maintain laboratory colonies and ensure that all activities in the insectary follow standard protocols;
  • Conduct monthly meeting with CERMES staff and technicians to monitor progress toward objectives, follow up on activities, and identify/resolve challenges;
  • Work with CERMES to prepare mosquito samples for molecular analysis;
  • Conduct a refresher training in entomological collection methods;
  • Support an advanced laboratory training for experienced entomologists at CERMES provided by the University of Notre Dame;
  • Continue to offer data quality control and data interpretation support to build NCMP 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 36-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).

Scaling Up National Capacity for ITN distribution:

  • By leveraging the findings of the PMI/VectorLink Project activities carried out in Year 3, support the NMCP and the Maternal and Child Directorate to address the weaknesses identified to improve CD activities and increase ITN coverage in the country;
  • Build on the dissemination of new ITN directives to support and improve ITN CD activities at the health facility level.
  • During quarterly coordination meetings at the district levels, the ITN CD process will be reminded to continue to strengthen participants’ capacity.