IRS in Uganda – a call for monitoring resistance

The National Academy of Sciences reports that, “The Ugandan government recently started spraying insecticides in homes and settlements to combat mosquitoes that spread malaria, the country’s leading cause of death.  A new report from a committee of the Uganda National Academy of Sciences (UNAS) says that as the spraying continues, the government needs to monitor mosquitoes for resistance to insecticides, and manage the spraying program in ways that minimize resistance.  UNAS is a participant in the African Science Academy Development Initiative, a joint effort of several African academies and the U.S. National Academies to advance science-based policy advice in Africa.”

The Committee that met to assess malaria vector resistance to insecticides used for indoor residual spraying in Uganda has looked at the strengths and weaknesses of the proposed “best practices” in IRS with an aim to maximize the effectiveness of DDT and other insecticides as well as identify contextual issues that would have a bearing on successful implementation of the “best practices.” In short the committee is not against IRS, but wants to ensure that it is carried out in the most safe and effective way.

The report of the Committee is available online. The report documents national policy and the fact that the Ministry of Health was authorized to begin IRS using DDT in August 2007 with support from the US President’s Malaria Initiative. Committee recommendations include establishment of sentinel surveillance sites, baseline entomological assessment, use a variety of factors ranging from susceptibility to cost and reliability of supply in selecting insecticides, and plan for long-term implementation, among others.

irs_worker.jpgPMI’s updated Uganda profile states that, “To date, more than 4,000 local personnel have been trained on proper spraying technique. Spraying has covered almost every targeted household in Uganda and benefited more than 1.8 million people.” In addition PMI’s Malaria Operational Plan for Uganda documents that PMI established insecticide resistance monitoring to IRS in Kabale with a training course in 2006 on the use of the bottle bioassay for mosquito insecticide resistance testing. Additional training and capacity building was planned for 2007. As a result of these activities, “The NMCP intends to monitor the level of susceptibility of malaria vectors to the insecticides scheduled for use in 2008, 2010, and 2012,” in selected sentinel sites as well as consider rotating insecticides to slow the development of resistance.

It would appear that the scientific, programmatic and donor communities are poised to deliver a safe and effective IRS intervention in Uganda. We would feel a bit more comfortable knowing whether Uganda is achieving some of the early milestones implied above – deployment and support of trained personnel, establishment of sentinel centers and conduct of baseline, for a start.

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