Category Archives: IRS

Rwanda Celebrates World Malaria Day 2017 – community is a major focus

Dr. Noella Umulisa, the Malaria Team Lead or the USAID Maternal and Child Survival Program in Kigali Rwanda shares with us experiences from Rwanda’s recent observance of World Malaria Day 2017.

The Malaria Day celebration took place in Huye districts in the southern Province. Why the southern province? – because among the 10 high endemic districts, 6 are the southern province. Why Huye district? – because IRS has been launched in Huye district yesterday and in another district Nyanza in Southern province.

The ceremony was attended by USAID and WHO representative, local leaders, MOH staff, partners, population of Simbi sector and the guest of honour was Dr Jeannine Condo the Director General of Rwanda Biomedical Center (which houses malaria activities).

A special recognition was given to community health workers (CHWs) who are playing a key role and are on the front line of fighting Malaria through sensitization of the population, testing and treating the population through community case management (iCMM and HBM) of Malaria, and now when a big number of CHWs will be involved in spraying households in their community.

The World Malaria Day celebration in Rwanda is marked by different activities for Malaria prevention conducted at community level from 24th to 29th April 2017.  Also, Malaria prevention and control messages are being disseminated using different communication tools and approaches such as radio and TV programs, community outreach activities, educating communities on proper use of bed nets.

Door to door mobilization is being conducted about the Indoor Residual Spraying (IRS) in high malaria burden districts of Huye and Nyanza. MCSP, with support from the US President’s Malaria Initiative, has participated actively in this event by supporting Community outreaches though theatre skits in the first 10 high endemic district.

The Director General made the following statement:

In January 2016, the Government of Rwanda and partners developed a Malaria Contingency Plan in response to the increase in malaria cases. The following interventions were implemented to address malaria rise in Rwanda: A Home Based Management of fever for adults at community level was set up countywide to reduce the malaria burden and prevent severe malaria and death. From Nov 2016 up to March 2017, the country distributed more than 6 million nets in 30 districts ensuring universal coverage of the entire population.

The country has increased access to health services for all through Community Based Health Insurance (CBHI). The Government of Rwanda provides free treatment of malaria to the most vulnerable population (Ubudehe 1&2 categories) to ensure that all financial barriers are no more to hinder the health service delivery for the community. Extension of Indoor residual spraying (IRS) in districts with high malaria burden where 5 out of 8 were sprayed (Nyagatare, Kirehe, Bugesera, Gisagara and Gatsibo).

We hope that this commitment will keep Rwanda on track to control and eventually eliminate malaria.

Investing in Antenatal Care to Defeat Malaria

For many years malaria in pregnancy (MIP) was the proverbial neglected step-child of malaria control programs. Partly this was due to structural problems – the challenge of coordination between different units and departments within a ministry of health – malaria programs and reproductive health programs in separate and parallel divisions.

Another reason for neglect may lie in the fact that it is been difficult to achieve the MDG 5 as outlined in the United Nations’ 2014 Millennium Development Goals Report. One still finds that worldwide, almost 300,000 women died in 2013 from causes related to pregnancy and childbirth. Maternal death is mostly preventable and much more needs to be done to provide care to pregnant women.

Maternal death prevention includes providing pregnant women 3 or more doses of sulphadoxine-pyrimethamine (SP) for intermittent preventive treatment in pregnancy (IPTp) and ensuring women have AND sleep under insecticide treated bednets (ITNs) during antenatal care (ANC). Unfortunately recent Demographic and Health Surveys (DHS) and Malaria Information Surveys (MIS) from endemic countries show slow or stagnating progress in reaching Roll Back Malaria goals of 80% coverage of pregnant women with these interventions. Recent DHS/MIS have found that only 15% of recently pregnant women got two doses of IPTp in Nigeria, with only slightly better coverage in Burkina Faso (46%). Now that targets have shifted to three or more doses, the coverage challenge is even greater.

TPI pregnancy-2The irony is that these same DHS reports show that a large proportion (>90%) of pregnant women in malaria endemic countries of Africa get registered for ANC. In order to achieve full coverage of IPTp pregnant women should attend ANC at least four times, but the recommended minimum of four ANC visits is difficult to achieve. According to WHO, “The proportion of pregnant women in developing countries who attended at least four antenatal care visit has increased from approximately 37% in 1990 to about 52% in 2012 but, in low-income countries, only 38% of pregnant women attended four times or more antenatal care during 2006-2013.”

In their article, “The quality–coverage gap in antenatal care: toward better measurement of effective coverage,” Stephen Hodgins and Alexis D’Agostino offer an explanation. They point out that it is not the number of ANC contacts alone that matters; it is the content of each visit that is equally important. They explain that a “coverage gap” exists when women who attended ANC four or more times did not receive the elements of basic package of services spelled out in the concept of Focused Antenatal Care (FANC).

Specific findings from Hodgins and D’Agostino’s DHS review showed that, “Blood pressure and tetanus toxoid performed best, with median quality–coverage gaps of 5% and 18%, respectively. The greatest gaps were for iron–folate supplementation (72%) and malaria prevention (86%).” Simply put, the lesson is that attending ANC does not equal receiving lifesaving maternal health services.

Many factors affect the quality of ANC services ranging from the major gaps in availability of trained health workers at the frontline in endemic countries to poor procurement and supply systems for even the cheapest drugs like SP. Even when health workers are in place, their understanding of and attitudes toward using SP for IPTp may be inadequate. These issues are where the gap between attending ANC and receiving needed services emerges. We will not be able to defeat malaria in pregnancy until we invest in strengthening the whole ANC system and pay better attention of women’s health.

Impact of Indoor Residual Spraying on the Parity rate of Anopheles mosquitoes in Nasarawa State, North Central Nigeria

Picture3 aInyama, P.U., Samdi, L., Nsa, H., Iwuchukwu, N. Suleiman, H., Kolyada, L.,  Dengela, D., Lucas, B., Seyoum, A. and Fornadel, C. Are associated with the PMI/AIRS Project in Nigeria. They presented their experiences with IRS at the recently concluded Multilateral Initiative for Malaria 6th Pan African Malaria Conference in Durban South Africa.  They have shared their presentation here.

The President’s Malaria Initiative’s Africa Indoor Residual project (PMI/AIRS), IRS 2 Task Order 4, executed the year 2 spray operation in Nasarawa Eggon and Doma Local Government Areas (LGA) of Nasarawa State, Nigeria. The objectives of the program being the reduction of malaria – associated morbidity and mortality, a total of 62,592 structures were sprayed.  To measure the impact of the IRS program on the malaria vectors  the proportion of parous mosquitoes in  the  vector population  was determined before and after Indoor Residual Spraying.

Picture1 aOne thousand, six hundred and twenty one (1,621) female Anopheles gambiae s.l. specimens drawn from a pool of 3,356  Female Anopheline   mosquitoes  captured by Human Landing Catches  from  three LGAs of Nassarawa Eggon and Doma (intervention areas)  and Lafia (Control) of Nasarawa State Nigeria    were dissected using WHO-recommended techniques for parity. The degree of coiling of ovarian tracheoles was observed  pre-IRS intervention in March 2013  and monthly post IRS intervention up to September 2013. Proportion of parous females was compared pre-and between intervention and control villages. Similarly, pre-and post-spray proportion of parous comparison was made within both intervention and control villages.

Picture2 aOverall, a total of 1,621 ovaries of An. gambiae s.l. were dissected before and after IRS intervention.  Of the ovaries dissected at baseline, 71.43% were parous in Nassarawa Eggon, 76.70% in Doma and 77% in the control area. After IRS in May 2013, it was found that the parity had declined dramatically to 17.69% in Nassarawa Eggon, 27.98% in Doma (p <0.05) while in the control area (Lafia) Parity remained as high as 68%. As insecticide residual efficacy continued to decline, slight increase in parity rate was observed in the intervention areas (38% and 31% in N/Eggon and Doma respectively for September) while it remained high (71%) in the control area for the same month.

spraying 2This study has shown a reduction in the longevity of Anopheles mosquitoes post spraying as compared to pre-spraying in the intervention villages.   The longevity of the vector was also significantly declined post spraying in the intervention villages as compared to unsprayed villages. The observed reduction of the expectation of life of the vector associated with IRS is promising. But further study is needed to fully understand how this will be translated to reduction of malaria transmission in the area.

spraying 3We wish to thank all technicians who participated in the entomological surveillance activities and dissection of mosquitoes. This work was funded by the President’s Malaria Initiative. www.africairs.net and info@africairs.net