Ghana shares their story using SumiShield® 50WG
Ministry officials highlighted the successes over the past few years and emphasized the challenges faced in the country, in particular, the growing threat insecticide resistance.
The timely availability and launch of SumiShield® 50WG in Ghana, now provides the country with an alternative insecticide for indoor residual spraying (IRS) in a region in Ghana where entomological monitoring flagged up resistance to all other available insecticides. It has a new mode of action, and was prequalified by the World Health Organization (WHO) for indoor residual spraying in October 2017. The National Malaria Control Programme(link is external)(NMCP) in Ghana is now able to implement sub-national rotation in the country with 2, third generation insecticides SumiShield® 50WG and Actellic® 300CS.
Indoor residual spraying is one of several tools supporting the NMCP’s goal of reducing malaria morbidity and mortality by 75 percent in Ghana between 2012 and 2020. The two IRS implementation partners in Ghana working closely in partnership with the NMCP are AGAMal malaria control programme(link is external), supported by the Global Fund, and the President’s Malaria Initiative (link is external)(PMI) VectorLink(link is external) project.
Ghana has been a NgenIRS country partner since 2017, procuring 3GIRS insecticides at reduced prices as a result of participation in consolidated forecasting, followed by manufacturer discounts and a co-pay mechanism to reduce prices further. The NgenIRS project has enabled the country to expand its coverage compared to the 2016 campaign, with the inclusion of Karaga District.
During 2017, thirteen districts were sprayed by the AGAMal and seven by PMI VectorLink respectively, protecting an estimated 1.9 million people.
The Malaria Programme Manager, Dr. Kezia Malm, stated that malaria is still the number one cause of death in children under 5 in the country and the programme and partners are working tirelessly to reduce these numbers. The areas most affected by insecticide resistance is the Ashanti Region. Districts targeted for IRS in this region during 2018 would have been excluded due to resistance levels, if a new insecticide was not available at the time of spraying.
After the press briefing and a visit to the Noguchi Memorial Institute for Medical Research Institute, the press delegation went to Ashanti region where they were introduced to the AGAMal malaria control programme and the operational implementation of IRS using the new insecticide SumiShield® 50WG.
Village leaders, community members and spray operators were given the opportunity to directly tell their story to journalists.
Journalists talking to village leaders and community members in a village in the Ashanti region, Ghana.
Press event in Accra, from left, Samuel Asiedu (Project Director, AGAMAL), David McGuire (NgenIRS Project Director, IVCC) Atsuko Hirooka (Executive Officer, Sumitomo Chemical Co., Ltd.), HE Tsutomu Himeno (Ambassador, Japan), Tina Mensah (Deputy Minister of Health), Dr Gloria J Quansah Asare (Deputy Director General, Ghana Health Services), Alexandra Cameron (Technical Manager, Unitaid) and at the podium Dr. Keziah Malm (National Malaria Programme Manager).
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Unitaid, IVCC and Sumitomo Chemical Company announced the inclusion of the new insecticide SumiShield® 50WG, as part of the NgenIRS project. This announcement followed the prequalification listing by WHO in October 2017.
With two long-lasting IRS (3GIRS) products now available, SumiShield® 50WG and Actellic® 300CS, the pre-emptive annual rotation goal outlined in the Global Plan for Insecticide Resistance
Management in malaria vectors (GPIRM) is achievable. Bayer’s 3GIRS product, Fludora® Fusion is currently undergoing final stage trials required for WHO prequalification and we hope this 3rd long lasting product can join the NgenIRS programme in 2019. BASF´s Sylando® 240SC is under WHO-evaluation.
Funders and procurers now have the opportunity to simultaneously prevent resistance build up and affect the cost-effectiveness of IRS by adopting pre-emptive, subnational rotation strategies where appropriate. Rotating all effective and available insecticides is key as a wholesale shift from one effective long-lasting IRS product to another within the market would undermine the goals of increasing competition, reducing product cost, and the market volatility of IRS products. Experts have proposed a new strategic approach based on pre-emptive rotation of multiple 3GIRS products within a country to:
Half of the NgenIRS partner countries adopted a sub-national rotation strategy for 2018, as part of their national insecticide resistance management plan. Tanzania has completed their IRS sub-national rotation campaign for 2018, Ghana and Burkina Faso are in the process of adopting this strategy and the remaining four countries will follow.
At the 7th Conference of the Multilateral Initiative on Malaria in April members of the NgenIRS project, along with colleagues from around the world, met during a windy week in Dakar, Senegal to discuss the most recent malaria research, control, and elimination findings. Some of the key results presented by members of the NgenIRS project were included in a symposium on the cluster randomized trial taking place in Mozambique to determine the public health impact and cost-effectiveness of indoor residual spraying (IRS) with Actellic®300 CS.
PATH has been partnering with the National Malaria Control Program (NMCP), Centro de Investigação em Saúde de Manhiça (CISM), and the US PMI AIRS project since 2016 to conduct the trial in Mopeia District, Zambezia Province. The study team presented preliminary results describing the epidemiologic and entomologic impact of the 2016 IRS campaign. The trial, which is taking place in an area where parasite prevalence is significantly above 50% in children under five years of age, is broken into two study arms: one arm where households used LLINs, the standard malaria vector control tool in Mopeia (LLINs only), and one arm where households received IRS with Actellic® in addition to LLINs (IRS + LLINs).
Preliminary results to date have shown that in the first six months after the 2016 IRS campaign, RDT-confirmed malaria case incidence at district health facilities was 20% lower in children from villages with IRS + LLINs than from villages with LLINs only. After adjusting for health care utilization rates (around 56% in Zambezia), the analysis shows that an estimated 4,000 cases of childhood (under 5-year old) malaria were averted in Mopeia district during the 12 months after IRS. Entomological surveillance also revealed that the density of An. Funestus mosquitoes collected by CDC light traps during that same time period was 50% lower in IRS versus non-IRS clusters. Further analyses on complete passive case detection, active case detection, and cross-sectional survey data will be forthcoming, along with a comprehensive costing analysis that will shed light on the health system and societal costs of malaria and the cost-effectiveness of 3GIRS interventions in Mozambique.Working together with partners to expand the evidence base 26th June 2018
In the last two years, NgenIRS has been working in close collaboration with a number of stakeholders in Mali to study the impact of IRS. The team’s first trip was conducted in September 2016 to introduce the NgenIRS evidence team, discuss current vector control/malaria landscape, review data sources and availability, prioritize research questions, and discuss study designs. The key partners in Mali include the National Malaria Control Program (NMCP), the US President’s Malaria Initiative (funds IRS implementation in Mali), Africa Indoor Residual Spray Project (implements IRS in Mali), and the MEASURE Evaluation project (supporting NMCP on health information systems management and monitoring and evaluation activities). From the outset, all stakeholders were enthusiastic about the collaboration and expressed interest in conducting the IRS impact evaluations. Ideas, approaches, and data sets—including implementation and routine malaria surveillance data— were shared and the analysis process began. Two additional trips took place in 2018 to present preliminary analysis, review data gaps, and discuss future plans. During these visits, the NgenIRS team received feedback from NMCP, PMI, and MEASURE Evaluation and the analysis was refined and additional research questions posed.
Engaging country-level partners and providing frequent status updates on the analytic process has proven successful in building sustained and productive partnerships in Mali. As a result of this successful collaboration, the evidence base demonstrating that IRS is a cost-effective malaria control intervention has grown: a manuscript recently co-authored by study partners was published in early 2018 and its results have been discussed at length by multiple stakeholders during several presentations at ASTMH 2017, ASTMH West Africa 2018, and at MIM 2018.
As further NgenIRS analyses of more recent spray campaigns get underway, it’s clear that enthusiasm of in-country partners remains strong. MEASURE Evaluation, NMCP, and PMI have promptly validated and shared the latest malaria surveillance data and provided feedback on the data challenges and caveats to consider in the analysis as well as providing inputs for integrating the latest entomological surveillance data.Analysis on new IRS product SumiShield® 50WG in Ghana 30th November 2018
In September 2018, members of the PATH NgenIRS team visited the Upper West Region in Ghana to conduct a site visit in areas where the AGAMal malaria control programme is piloting the use of SumiShield® 50WG, a third-generation indoor residual spraying (3GIRS) product, in 3 districts. Sumishield, prequalified by the WHO in October of 2017, is effective against pyrethroid-resistant mosquitoes and now, along with Actellic®300 CS, provides vector control programmes the ability to annually and pre-emptively rotate between different 3GIRS products to prevent the emergence of resistance. With the introduction of SumiShield into Ghana, the NgenIRS evidence team now has an opportunity to analyze through routine data the public health impact of introducing a second 3GIRS product into an existing spray program. For the purpose of this impact evaluation, PATH is partnering with AGAMal to enhance routine epidemiological surveillance in the study sites through an assessment and selection of sentinel sites for accurate, timely, and complete monthly reporting of routine data in the DHIMS2 database.
Available to view/download – Evidence Snapshot: 3rd generation IRS (3GIRS) in northern savannah, Ghana