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Preventing malaria transmission by indoor residual spraying in Malawi: grappling with the challenge of uncertain sustainability.

Chanda E, Mzilahowa T, Chipwanya J, Mulenga S, Ali D, Troell P, Dodoli W, Govere JM, Gimnig J - Malar. J. (2015)

Bottom Line: The future of the IRS programme in Malawi is uncertain due to limited funding, high cost of alternative insecticides and technical resource challenges being experienced in the country.The availability of a long-lasting formulation of the organophosphate pirimiphos-methyl makes the re-introduction of IRS a possibility and may be a useful approach for the management of pyrethroid resistance.Implementing the IVM strategy, advocating for sustainable domestic funding, including developing an insecticide resistance monitoring and management plan and vector surveillance guidelines will be pivotal in steering entomologic monitoring and future vector control activities in Malawi.

View Article: PubMed Central - PubMed

Affiliation: Malaria Vector Control Consultant, Lusaka, Zambia. emmanuel_chanda@yahoo.co.uk.

ABSTRACT

Background: In the past decade, there has been rapid scale-up of insecticide-based malaria vector control in the context of integrated vector management (IVM) according to World Health Organization recommendations. Endemic countries have deployed indoor residual spraying (IRS) and long-lasting insecticidal nets as hallmark vector control interventions. This paper discusses the successes and continued challenges and the way forward for the IRS programme in Malawi.

Case description: The National Malaria Control Programme in Malawi, with its efforts to implement an integrated approach to malaria vector control, was the 'case' for this study. Information sources included all available data and accessible archived documentary records on IRS in Malawi. A methodical assessment of published and unpublished documents was conducted via a literature search of online electronic databases.

Discussion: Malawi has implemented IRS as the main malaria transmission-reducing intervention. However, pyrethroid and carbamate resistance in malaria vectors has been detected extensively across the country and has adversely affected the IRS programme. Additionally, IRS activities have been characterized by substantial inherent logistical and technical challenges culminating into missed targets. As a consequence, programmatic IRS operations have been scaled down from seven districts in 2010 to only one district in 2014. The future of the IRS programme in Malawi is uncertain due to limited funding, high cost of alternative insecticides and technical resource challenges being experienced in the country.

Conclusions: The availability of a long-lasting formulation of the organophosphate pirimiphos-methyl makes the re-introduction of IRS a possibility and may be a useful approach for the management of pyrethroid resistance. Implementing the IVM strategy, advocating for sustainable domestic funding, including developing an insecticide resistance monitoring and management plan and vector surveillance guidelines will be pivotal in steering entomologic monitoring and future vector control activities in Malawi.

No MeSH data available.


Related in: MedlinePlus

First map location of indoor residual spraying sites. First map: dark green = early adopting areas; light green = second phase. Second map Malaria prevalence. Source [3].
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Fig1: First map location of indoor residual spraying sites. First map: dark green = early adopting areas; light green = second phase. Second map Malaria prevalence. Source [3].

Mentions: In Malawi malaria is endemic in more than 95% of the country and the entire population is considered to be at risk of the disease [11] (Figure 1). Transmission is high, defined as greater than one case per 1,000 residents and perennial with substantial seasonal variation in intensity [12]. Although An. funestus is the primary vector, Anopheles gambiae s.s. and Anopheles arabiensis also exist and may predominate in some areas at certain times of the year [13]. Vectorial capacity is high due to abundant rainfall (725 to >2,000 mm/annum), elevated year-round temperatures and high humidity, especially in low-lying areas along the lakeshore, Shire River Valley, and central plains [13], while the lowest risk areas fall along the highland areas of Rumphi, Mzimba, Chitipa, and Kirk Range [3, 14, 15]. Approximately 98% of malaria cases are due to Plasmodium falciparum and is responsible for all severe forms of the disease and deaths [3]. Attempts to control the anopheline vectors have been limited and intermittent and have had little apparent impact on the huge malaria burden [12].Figure 1


Preventing malaria transmission by indoor residual spraying in Malawi: grappling with the challenge of uncertain sustainability.

Chanda E, Mzilahowa T, Chipwanya J, Mulenga S, Ali D, Troell P, Dodoli W, Govere JM, Gimnig J - Malar. J. (2015)

First map location of indoor residual spraying sites. First map: dark green = early adopting areas; light green = second phase. Second map Malaria prevalence. Source [3].
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4477419&req=5

Fig1: First map location of indoor residual spraying sites. First map: dark green = early adopting areas; light green = second phase. Second map Malaria prevalence. Source [3].
Mentions: In Malawi malaria is endemic in more than 95% of the country and the entire population is considered to be at risk of the disease [11] (Figure 1). Transmission is high, defined as greater than one case per 1,000 residents and perennial with substantial seasonal variation in intensity [12]. Although An. funestus is the primary vector, Anopheles gambiae s.s. and Anopheles arabiensis also exist and may predominate in some areas at certain times of the year [13]. Vectorial capacity is high due to abundant rainfall (725 to >2,000 mm/annum), elevated year-round temperatures and high humidity, especially in low-lying areas along the lakeshore, Shire River Valley, and central plains [13], while the lowest risk areas fall along the highland areas of Rumphi, Mzimba, Chitipa, and Kirk Range [3, 14, 15]. Approximately 98% of malaria cases are due to Plasmodium falciparum and is responsible for all severe forms of the disease and deaths [3]. Attempts to control the anopheline vectors have been limited and intermittent and have had little apparent impact on the huge malaria burden [12].Figure 1

Bottom Line: The future of the IRS programme in Malawi is uncertain due to limited funding, high cost of alternative insecticides and technical resource challenges being experienced in the country.The availability of a long-lasting formulation of the organophosphate pirimiphos-methyl makes the re-introduction of IRS a possibility and may be a useful approach for the management of pyrethroid resistance.Implementing the IVM strategy, advocating for sustainable domestic funding, including developing an insecticide resistance monitoring and management plan and vector surveillance guidelines will be pivotal in steering entomologic monitoring and future vector control activities in Malawi.

View Article: PubMed Central - PubMed

Affiliation: Malaria Vector Control Consultant, Lusaka, Zambia. emmanuel_chanda@yahoo.co.uk.

ABSTRACT

Background: In the past decade, there has been rapid scale-up of insecticide-based malaria vector control in the context of integrated vector management (IVM) according to World Health Organization recommendations. Endemic countries have deployed indoor residual spraying (IRS) and long-lasting insecticidal nets as hallmark vector control interventions. This paper discusses the successes and continued challenges and the way forward for the IRS programme in Malawi.

Case description: The National Malaria Control Programme in Malawi, with its efforts to implement an integrated approach to malaria vector control, was the 'case' for this study. Information sources included all available data and accessible archived documentary records on IRS in Malawi. A methodical assessment of published and unpublished documents was conducted via a literature search of online electronic databases.

Discussion: Malawi has implemented IRS as the main malaria transmission-reducing intervention. However, pyrethroid and carbamate resistance in malaria vectors has been detected extensively across the country and has adversely affected the IRS programme. Additionally, IRS activities have been characterized by substantial inherent logistical and technical challenges culminating into missed targets. As a consequence, programmatic IRS operations have been scaled down from seven districts in 2010 to only one district in 2014. The future of the IRS programme in Malawi is uncertain due to limited funding, high cost of alternative insecticides and technical resource challenges being experienced in the country.

Conclusions: The availability of a long-lasting formulation of the organophosphate pirimiphos-methyl makes the re-introduction of IRS a possibility and may be a useful approach for the management of pyrethroid resistance. Implementing the IVM strategy, advocating for sustainable domestic funding, including developing an insecticide resistance monitoring and management plan and vector surveillance guidelines will be pivotal in steering entomologic monitoring and future vector control activities in Malawi.

No MeSH data available.


Related in: MedlinePlus