Achievements and Challenges in Malaria Vector Control Implementation in EMR

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• Achievements and Challenges in Malaria Vector
  Control Implementation in EMR
• Abraham MnzavaScientist Vector Control,
  WHO/EMRO3 July 2006

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Key to effective implementation of vector control
interventions

• Capacity
• Plan
• .supervise
• .monitor
• Targeting
• Timely application
• Quality application
• Coverage

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Strengthening IRS and LLINs Implementation

• GMP has identified IRS and LLINs as two of the
  main vector control interventions
• The approach calls for high coverage for maximum
  impact
• It targets 1 LLIN per 2 person or per sleeping
  arrangement
• Where resources are limiting a targeted and
  phased approach is recommended
• In the EMR this is what we have been promoting
• But promoting the interventions well is a
  different story

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IRS in Malaria Endemic Countries
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IRS in Countries Targeting Malaria Elimination
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IRS in Countries with a Malaria Residual Foci
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Type of insecticides used and amounts
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IRS the main issues..

• Coverage below 80 is not acceptable
• Stick to a WP formulation for IRS
• formulation could be cheaper but not
  cost-effective
• Where coverage does not correspond to amount of
  insecticides used
• Is selection and targeting criteria correct?
• Are teams able to estimate required amounts?

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IRS the main issues..

• High coverage reported - disease burden not
  decreased
• Are the teams well trained?
• Are spraying equipment up to specifications?
• How well are they maintained and stored?
• Length of transmission known but application
  not enough and not on time
• Procurement and delivery a lengthy process
• Is it well planned and budgeted for?
• Do different spray rounds take into account
  epidemiological stratification?
• Where accessibility is an issue are other
  interventions (LLINs) considered?

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Expansion of IRS..

• Innovative approach of implementing IRS in a
  decentralized system Pakistan
• Strengthening capacity to respond to epidemics in
  Somalia and Djibouti
• Introducing IRS in the border areas of
  Afghanistan and Tajiskan (joint activity with
  EURO)
• Explore the introduction of IRS in S. Sudan where
  infrastructure is still non-existence

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No. of ITNs/LLINs Distributed in 2005 in
Malaria endemic countries
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The main issues in the implementation of
ITNs/LLINs..

• All malaria endemic countries have national
  ITN/LLINs plans
• Except Sudan and Somalia others are unable to
  estimate population targeted
• Lack criteria to estimate population at risk
• If records on no. distributed and tear/wear known
  for the last 3 years it would be possible to
• Estimate number available
• Determine pop. protected

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Monitoring ITN/LLIN implementation

• The following are key indicators for monitoring
  ITNs/LLINs implementation
• Proportion of LLINs distributed out of total
  needed
• Proportion of target pop who slept under LLINs
  night before survey
• New LLINs indicator
• Proportion of households with an average of 1
  LLIN for 2 persons

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Monitoring vector resistance to insecticides

• Importance of routine monitoring vector
  resistance
• Managing resistance when detected
• Given the limited choices of insecticides
  available
• In 2005 continued to support countries by
• Supplying them with kits and papers
• Intensified technical support in Sudan, Morocco,
  Oman and Saudi Arabia
• Through expert visits and/or national workshops

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Summary of Vector Resistance Data in 2005
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Magnitude of Pyrethroid Resistance in Gezira,
Sudan
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Susceptibility status in Sennar, Sudan
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Critical issues on monitoring resistance

• Except in Sudan and Morocco number of sentinel
  sites not adequate
• 25 resistance to DDT in Morocco switch to
  pyrethroids for epidemic response
• gt46 resistance to pyrethroids in Gezira and
  Khartoum
• Requires immediate change to a carbamate
• Implementation of a management strategy
• In Oman gt89 resistance to temephos larval
  control is the strategy
• Change to BTi and IGRs

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Capacity strengthening in vector control

• Member States through Resolution EM/RC.52/R.6
  endorsed the Regional Strategic Framework for
  integrated vector management (IVM)
• Committed themselves to ensure that they
• have national capacity to plan and implement
  vector control
• allocate a specific budget line for vector
  control
• establish a functional intersectoral mechanism
  for the collaboration and coordination of all
  sectors in their countries
• develop national strategies and plans of actions
  based on the carrying out of regular vector
  control needs assessment (VCNA) to identify
  needs, gaps and opportunities for vector control
• Requested WHO
• to strengthen regional capacity by establishing
  an MSc. Degree programme in entomology and vector
  control

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Conclusions

• Capacity
• Plan
• .supervise
• .monitor
• Targeting
• Timely application
• Quality application
• Coverage