Category Archives: Vector Control

Malaria Control and Earth Day: are they compatible?

Clearly no one wants to argue against efforts to curb a deadly disease. The question is whether the approaches to doing so have any negative consequences that can be easily ameliorated.

dscn7103-sm.jpgVector control gets the most attention. One concern is the plastic bagging in which long-lasting insecticide treated nets are packaged. Rwanda, which has outlawed commercial use of plastic bags for shopping, is taking the LLIN packaging seriously.  The photo shows net packaging that has been removed at a health center and stored for later incineration. Clients take their nets home in paper bags and are encouraged to hang them immediately.

Another net concern is disposal of old, used, damaged nets. LLINs do not have under ‘normal’ conditions the 5-year lifespan originally hoped. Plans for proper disposal are not fully developed in most settings, but the massive distribution of nets to achieve universal coverage from about 2009-12 are about to need replacement. It is possible that some of the net misuse reported in the media is actually repurposing of old nets. More information from communities and local health authorities is needed.

Insecticides for indoor residual spraying usually are the first thought that comes to mind concerning environmental impact of malaria control. While arguments primarily focus on DDT, it is important to note that WHO has approved over a dozen different insecticides for IRS.  The problem is not so much the use of chemicals for actual IRS, but the misuse outside approved spraying programs for farms and fish kills. At present IRS is a highly geographically focused activity in most countries, and control of the activities seems to be working for the large part, but even the process of preparing for and cleaning up after a spraying exercise can results in spills and contamination. Guidelines exist, but are they followed?

dscn3829sm.jpgThen we get to the issue of medical waste from rapid diagnostic tests.  Some health centers sharps and waste boxes for short term disposal and as pictured here in Burkina Faso, have incinerators tor final disposal.  Community health worker use of RDTs is usually accompanied by sharps and disposal boxes that can be returned to health centers.  All of this needs careful monitoring.

One must even think about packaging of artemisinin-based combination therapy medicines which are prepackaged by age group. These packets are small and are sent home with patients and care-givers. The paper may be burned or composted, but there are also plastic blisters in the packet. This may not account for much on an individual family basis, but on the community level it may be substantial.

dscn3738-safety-box-sm.jpgReaders may think of other environmental concerns from their own experiences and share success stories for environmental management accompanying malaria control in their countries.  So, as noted, we will not stop malaria control efforts on Earth Day, but at least we can be more conscious of the materials used, whether they can naturally decompose in the environment and thus make some contribution to a healthier planet.

Geographical factors affecting the implementation of alternative strategies for lymphatic filariasis elimination in post-conflict countries

Lymphatic filariasis, like malaria, is a mosquito-born disease. Below, Michelle C. Stanton, Moses J. Bockarie and Louise A. Kelly-Hope of the Centre for Neglected Tropical Diseases, Liverpool School of Tropical Medicine, share an abstract of their study on vector control for lymphatic filariasis. Michelle was one of the candidates for the Young Investigators’ Award at the 2012 American Society for Tropical Medicine and Hygiene meeting in Atlanta.


Vector control, including the use of bed nets, is recommended as a possible strategy for eliminating lymphatic filariasis (LF) in post-conflict countries such as the Democratic Republic of Congo (DRC).

This study examined the geographical factors that influence community bed net coverage in DRC in order to identify the hard-to-reach areas that need to be better targeted. In particular, urban/rural differences and the influence of population density, proximity to cities and health facilities, plus access to major transport networks were investigated.

Demographic and Health Survey geo-referenced cluster data were used to map the proportion of households with at least one bed net (unspecified), with at least one insecticide-treated net (ITN) and ITNs per person for 300 communities. Spatial statistical methods and bivariate and multiple logistic regression analyses were used to determine significant relationships.

Overall, bed net (30%) and ITN (9%) coverage were very low with significant differences found between urban and rural communities. In rural communities coverage was significantly positively correlated with population density (p<0.01), and negatively with the distance to the two largest cities, Kinshasa or Lubumbashi (p<0.0001). Further, coverage was significant negatively correlated with the distance to primary national roads and railways (all bed net measures), distance to the main river (unspecified only) and the distance to the nearest health facility (ITNs only).

Logistic and Poisson regression models fitted to the rural community data indicated that, after controlling for the effects of the measured covariates, coverage levels in the Bas-Congo province close to Kinshasa were much larger than expected. This was most noticeable when considering ITNs and ITN density which were 5.1 times higher in the Bas-Congo province compared to all other provinces.

These maps and spatial analyses provide key insights into the barriers of bed net coverage, which will help inform both LF and malaria bed net distribution campaigns as part an integrated vector management (IVM) strategy.

The Role of Malaria Prevention and Vector Control in Rwanda’s Progress toward Malaria Elimination

A second working group at the recently completed First Rwanda Malaria Forum examined issues around “Malaria Prevention and Vector Control.” A key message from the Forum was the need to protect existing vector control technologies (IRS and LLINs) and well as develop and test new ones in the local setting. These can be deployed in a focused manner as better entomological and epidemiological data are available on district, sub-district and cross-border areas.

dscn7129asm.jpgMembers of the group included – Hakizimana Emmanuel, MOPDD-Rwanda; Abraham Mnzava, WHO/HQ; Beata Nukorugwiro, JHPIEGO; Cait Unites, PSI; Beatus Cyubahiro, RBC-MOPDD; Dunia Mwuyakango, RBC-MOPDD; David Wainaina, Bayer; Arielle Mancuso, PMI/RFHP; Moses Turyazooka, CREST Technologies; Richmond Ato Selby, Networks; Christine Ochieng, Vestergaard Frandsen; Tessa  Knox, Vestergaard Frandsen; Levin Nsabiyumva, USAID/Burundi; Kagabo Jean Bosco, World Vision Rwanda; Athanase Munyaneza, RBC/KFHIK; Duschuze Clemence, RBC/MOPDD; Sangala Freddy, Nyagatare Hospital; John Githure, MOPDD/RBC; Francisco Saute, USAID/PMI

The group suggested the following Strategic Objectives to be achieved by or before 2017 …

  1. Generate local evidence to guide optimization and diversification of available vector control interventions
  2. Build sustainable capacity for entomological  monitoring and vector control at national, district and community levels
  3. Formulate policies and procedures for effective and sustainable mobilization of vector control activities
  4. 90% of the population at risk of malaria will have access to locally appropriate vector control  interventions based on evidence
  5. Establish harmonized mechanism for cross border collaboration on vector control interventions

Key Actions For Strategy 1:

  • Establish a national entomological profile (vector ecology and behavior, species composition and distribution, susceptibility to insecticides)
  • Re-enforce and expand entomological  surveillance sentinel sites
  • Determine the appropriateness of vector control interventions – including new tools
  • Conduct operational research on the effectiveness of vector control interventions

Key Actions for Strategy 2:

  • Recruit and train entomologists for deployment at district level for vector control interventions and entomological surveillance
  • Strengthen and expand field lab/insectary facilities for entomological monitoring at sentinel sites
  • Collaborate with the existing Dept. of Environmental Health at the KHI to include medical entomology programme
  • Empower the communities through training on vector control

Key Actions for Strategy 3:

  • Develop insecticide resistance management plan
  • Establish regulatory processes to support timely deployment of existing and new tools as they become available
  • Develop a transition plan for decentralization of vector control activities
  • Re-orient IEC/BCC strategy to better support pre-elimination efforts
  • Evaluate human and other factors influencing the effective lifespan and acceptability of vector control tools

Key Actions for Strategy 4:

  • Maintain universal coverage with LLINs in the population at  risk
  • Rational deployment of IRS in prioritized risk areas
  • Evidence-based deployment of other supplementary vector control interventions (e.g. repellents, screening, LSM) where appropriate


  • Establish a national inter-sectoral steering coordination mechanism for planning and implementation of  integrated vector management (IVM)
  • Enhance entomological capacity in moving towards pre-elimination phase
  • Integrate vector control within district development plans and operational targets
  • Long term financial commitment of Government of Rwanda and development partners is essential to achieve and sustain the gains in malaria prevention

A goldmine of private sector assistance against malaria

Guest Posting by Emmanuel Fiagbey, Voices, Ghana, August 4, 2011: Sefwi Etwebo, Western Region of Ghana

Chirano Gold Mines Ltd. just launched a $5.6 million Integrated Malaria Control Program and joined the United Against Malaria Partnership. Private sector involvement in malaria control has received a big boost in Ghana with the launching of a $5.6 million malaria control program by the Chirano Gold Mines Ltd, a Kinross Company. Over 600 people including chiefs, queen mothers, government officials, mine workers and the people of the Sefwi Wiawso and Bibiani Anhwiaso Bekwai District attended the lively durbar which marked the occasion.

chirano-goldmines-local-chiefs-at-launching-sm.jpgA section of the chiefs and community members who attended the launching are pictured to the right.

“Malaria is a killer, it is the largest cause of death in the Sefwi area. With this effort directed at improving prevention and treatment, this insidious malaria cycle can be reduced and broken. Reducing the impact of this disease on our workforce, the surrounding communities and the socio-economic structure is our goal.” So says Mr. John Seaward, General Manager of the Chirano Gold Mines, speaking at the launch ceremony.

Developed and modeled on the highly successful integrated malaria control program of Anglo Gold Ashanti, the Chirano Gold Mines program extends over 13 communities within and outside the operational area of the Chirano Mines.

The first phase of the program which began in September, 2008 as a Mosquito Abatement Project with a major focus on larval control and environmental management grew into a fully integrated program in May 2009 and the results so far are astounding. At the Chirano Mines Clinic, the incidence of malaria has reduced from 912 treated cases per 1000 in 2008 to 210 cases per 1000 people this year 2011 amounting to a reduction of 77% in four years.

chirano-general-manager-sm.jpgThe General Manager (photo at left) hinted that after a successful implementation of the first phase of the project (2008-2011) and sustaining the level of achievement being made, the interventions will be intensified and extended to cover 50% of the communities in the two districts through 2016.  Implementation activities would therefore focus on vector control measures such as IRS, targeted larviciding and the distribution of LLINs supported with engagement of community leaders and people in prevention and treatment community education activities.

A representative of the Manager of the National Malaria Control Program, James Frimpong commended the efforts of Chirano Gold Mines in supplementing the country’s efforts at working towards eliminating malaria from Ghana. He promised the NMCP’s continued support for the Chirano Gold Mines Integrated Malaria Control Program. Also present at the event was the World Health Organisation Malaria Program Adviser Dr. Felicia Owusu-Antwi.

The UAM partnership was not left out of this event. Mr. Emmanuel Fiagbey, Country Director of the JHU CCP Voices project presented a UAM Ball and 10 copies each of the UAM Malaria-Safe Playbook and CDs of the Black Stars Malaria Cheer song to the General Manager, Mr. John Seaward and invited Chirano Mines to the fold of the UAM partnership. “The UAM Black Stars Cheer Song will not only provide messages on prevention and treatment but also help in mobilizing community members to actively participate in the program’s community level educational activities,” Mr. Fiagbey stressed. The UAM Malaria Safe Plabook provides guidance to Private Sector companies on ways in which they could sustain their malaria control activities applying the four pillars of Education, Protection, Visibility and Advocacy.

In his response Mr. Seaward who was moved by the presentation remarked, “I am humbled by the fact that the Ghana Black Stars are also part of the campaign against malaria”. “We at Chirano Mines are pleased that our efforts are being recognized and are ready to work with all others to ensure the malaria cycle is broken. Malaria can be eliminated and Ghana can be malaria free,” he declared.

Other partners on the Chirano Gold Mines Integrated Malaria Control Program include the Vector Control Consult Ltd (Principal Implementer), the Noguchi Memorial Institute of Medical Research, the District Assemblies of Sefwi Wiawso and Bibiani Anhwiaso-Bekwai and their District Health Management Teams and the Ghana Education Service.