The President s Malaria Initiative (PMI) Indoor Residual Spraying (IRS) in Motion: Malaria Stories from the Field

Transcription

1 The President s Malaria Initiative (PMI) Indoor Residual Spraying (IRS) in Motion: Malaria Stories from the Field Presenters: Allison Belemvire, Christen Fornadel & Kristen George

2 Presentation Outline PMI: Background & Achievements Video 1: Entomology 101 Video 2: Community-based IRS Video 3: Women in IRS Discussion & Questions

3 PMI s History & Goal Malaria remains a key objective of U.S. Government foreign assistance History Announced in 2005 as $1.265 billion Initiative over 5 years Initiative now includes 19 focus countries in Africa and programs in the Greater Mekong Subregion with priority focus on Burma and Cambodia Clear Goal Work with partners to halve the burden of malaria (morbidity and mortality) in 70% of at risk populations (450 million people) in sub-saharan Africa, thereby: Removing malaria as a major public health problem Promoting economic growth

4 PMI s Key Targets 85% coverage of vulnerable groups with four proven malaria control interventions: Insecticide-treated Mosquito Nets (ITNs) Indoor Residual Spraying (IRS) Artemisinin-based Combination Therapies (ACTs) Intermittent Preventative Treatment for pregnant women (IPTp)

5 PMI s Contributions are Paying Off Declines range from 16% (in Malawi) to 50% (in Rwanda).

6 2014 IRS Results >5 Million Houses Sprayed in 13 countries >19 Million Residents Protected by IRS >27,000 Personnel Trained As spray operators, team leaders, or supervisors High Coverage Average of 95% coverage across all countries 6

7 Entomological Monitoring

8 PMI Recognizes the Importance of Entomological Monitoring Malaria vector control relies on a handful of insecticides in four insecticide classes. Scaled-up LLIN and IRS programs have increased insecticide selection pressure on vector mosquito populations Can expect changes in the species composition of vector populations, as well as changes in their susceptibility to insecticides and possibly their behavior PMI s large investments in vector control and the limited number and classes of available insecticides make it imperative that national programs monitor and evaluate entomological parameters

9 Malaria Mosquito Basics Plasmodium falciparum cycles exclusively between humans and female Anopheles mosquitoes

10 These are Anopheles mosquitoes Anopheles arabiensis Anopheles darlingi

11 Malaria Mosquito Fun Facts Undergo complete metamorphosis: egg, larva, pupa, adult Males often emerge first and form swarms, cannot copulate until genitalia rotate 180 o Females emerge, enter swarm, copulate in the air Females may mate more than once Sperm is stored in the spermatheca for lifetime Males feed on nectar, females primarily on blood Majority of anophelines have limited dispersal (1.5-2km) Must survive a minimum of 15 days to deliver an infectious bite with Plasmodium

12 Primary Vector Control Interventions Sugar feeding Mating Host seeking Oviposition.. Indoor Residual Spraying Insecticide Treated Bed Nets

13 How do we know if vector control is working?

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15 Entomological Monitoring in Support of IRS Includes: Resistance Monitoring Quality Control Residual Efficacy IRS Impact o Mosquito Density o Mosquito Age

16 Armed in Malaria Prevention: Entomological Monitoring in the Africa Indoor Residual Spraying Program

17 Focused on: Fostering sustainability Community-based IRS Improving operations mhealth pilots IRS Innovations Reducing risk to humans & environment Mobile soak pits Enabling science-based decision making Insectary-in-a-box

18 Video 2: Piloting Community-based IRS in Ethiopia

19 Innovation #1: Community-Based IRS New approach to IRS was piloted in Ethiopia instead of operating at the district level, health extension workers were trained to lead IRS from their community health posts. CB model saves on costs, but also: Encourages community ownership of IRS campaign Gives opportunities to females in leadership roles Facilitates trust between Spray Operators and communities

20 Innovation #2: mhealth Mobile phones used for: Environmental compliance Dissemination of spray data for real-time analysis IEC/BCC messaging to community members Dissemination of lessons learned and useful reminders to spray operators

21 Innovation #3: Mobile Soak Pit Reduces Construction costs Spray operator travel time Vehicle requirements Spray operator exposure Greater operational flexibility Improved control over toxics and assets

22 Innovation #4: Insectary-in-a-box Cheap easy solution for ento monitoring Without building or renting space, a mini-insectary can be created using a shipping container

23 Video 3: Women in IRS Women Take Charge in Malaria Prevention

24 Gender: Country Examples % Women trained to deliver IRS (5 key cadres) % Women trained during IRS campaign (all cadres) Senegal 9.7% 11% 13.2% 30.7% Ghana 17.7% 21.8% 14% 13.9% Rwanda 49.7% 51.2% 25.7% 27% Average: 13 Countries 16.9% 20.6% 22.8% 24.9%

25 The PMI AIRS Project: New Gender Policies Target women during recruitment Community outreach re: stereotypes Women s organizations Adjust operational structure Buddy system for women Women only camp facilities Procurement practices (PPE, lighter pumps, etc.) Gender awareness training/sensitization Support position re-assignment in case of pregnancy Set gender targets for reporting

26 Summary Points Data driven decision making Innovate to improve operational effectiveness Sustainable methods of implementation Expanding the workforce to promote safe and effective IRS programs for malaria prevention

27 Questions? Thank You!