Tropical Health Matters

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.

Members 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

Recommendations

• 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

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