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
The NgenIRS project, funded by Unitaid(link is external), assists country and implementation partners to procure 3rd generation IRS insecticides at lower prices. This results in our partners protecting more people.
The Global Fund(link is external) supported AngloGold Ashanti Malaria Control Programme(link is external) (AGAMal) is a NgenIRS implementation partner who works closely with the Ghana National Malaria Control Programme(link is external) (NMCP) and PMI VectorLink(link is external) to protect at-risk populations in Ghana. This year, in addition to covering communities living in risk areas, all prisons in Ghana will be sprayed by AGAMal with a 3rd generation insecticide, SumiShield® 50WG(link is external). The 10 day campaign will result in the spraying of an estimated 13,707 structures.
The partnership between AngloGold Ashanti and the Government of Ghana is a good example of the success of a public private partnership to improve health and prosperity in Ghana.
Click on the link to read more.. https://www.graphic.com.gh/news/general-news/anglogold-malaria-control-programme-starts-spraying-prisons.htmlNgenIRS at VCWG 2019 20th April 2019
The RBM Vector Control Working Group meeting was an ideal opportunity for NgenIRS to engage with country partners and other stakeholders. We took the opportunity to discuss the project’s catalytic market impact and new evidence showing the public health impact and cost-effectiveness of 3GIRS.
Two talks were presented during the meeting, one during the plenary session by Christen Fornadel (IVCC Technical Coordinator) on market access interventions – link to the presentation can be found to the right of this page, and another by Molly Robertson (NgenIRS Evidence Lead, PATH) during the IRS IRM workstream elaborating on the emerging evidence base, see link below.
You can find all the IRS and IRM workstream presentation links below:
Mark Hoppe & Dereje Dengela Introduction(link is external)
Molly Robertson – NgenIRS Project Update: Building an Evidence Base for 3GIRS(link is external)
Brad Lucas – Insecticide Rotation PMI VL Campaigns(link is external)
Jocelyn Ratovonjato – Smooth deployment of more than one insecticide in IRS: experience from the field(link is external)
Aklilou Seyoum – Evaluation of Pirimiphos-Methyl Efficacy in Experimental Huts with Partially Sprayed Surfaces Against Natural Populations of Anopheles gambiae in Ghana(link is external)
Meghan Tammaro – VectorLink Collect: Using the DHIS 2 platform to standardize data collection and reporting for IRS(link is external)
Megan Litrell – Increasing the use of data in IRS decision making(link is external)
Derek Pollard – Spatial intelligence to optimize vector control planning, implementation and impact(link is external)
Ayman Ahmed – Insecticide resistance in Anopheles arabiensis, the primary malaria vector in Sudan(link is external)
Andy South & Ian Hastings – Windows of Selectio
Mozambique represents 3% of the global burden of malaria but the fight-back is in motion. Public-private partnerships in the region are showing great progress in tackling malaria, protecting people and saving lives. Partnerships over the years supporting malaria control efforts have included ministries of health, The Global Fund, The US President’s Malaria Initiative (PMI), Bill & Melinda Gates Foundation, Goodbye Malaria, Nando’s, Coca Cola, Vodacom, BHP Billiton, Mozal, the Unitaid-supported NgenIRS project among others.
In southern Mozambique malaria has become much less of a threat to the lives of people living in the area. The Tchau Tchau malaria programme has been instrumental in this fight, by spraying the inner walls of houses in all of Maputo Province with long lasting insecticides. These insecticides are effective against pyrethroid resistant mosquitoes, but more expensive than the older insecticide options. The Unitaid-funded NgenIRS project has assisted Mozambique since 2017 with the procurement of 3GIRS at lower prices through a co-payment system. Savings to Mozambique have allowed the NMCP and its partners to expand, thereby protecting vulnerable populations from the devastating health and socio-economic impact of malaria.
The Tchau Tchau programme is part of the MOSASWA initiative, that commenced in 2014 to accelerate progress towards malaria elimination goals in this region and includes collaboration between Mozambique, South Africa and eSwatini (previously Swaziland).
Malaria incidence in Maputo province has decreased by almost 50% since 2014. The programme spanned all eight districts in the province in 2018 with a coverage rate of greater than 90%, protecting more than 1.2 million people. The successes, especially the great reduction of burden of disease in southern Mozambique, attest to the value of public-private partnerships with support and leadership from the National Malaria Control Programme. Funding from a consortium of donors, including the Global Fund, the private sector and more recently the Bill & Melinda Gates Foundation, supports further expansion to areas in the Gaza and Inhambane provinces.
MOSASWA is part of the broader southern African Elimination Eight (E8) Malaria Initiative consisting of eight endemic countries in this region. The frontline countries of Botswana, Namibia, South Africa and eSwatini are aiming to achieve zero local malaria transmission by 2020. Other countries including Angola, Mozambique, Zambia and Zimbabwe are setting their goal of saying “tchau-tchau” (bye-bye) to malaria by 2030. The success of NgenIRS in making multiple affordable 3GIRS products available to enable insecticide-resistance management will be a significant factor in helping to achieve this goal.
A summary through April 2019
Evidence from multiple countries demonstrates that IRS with new 3GIRS products is a wise public health investment, especially in areas with documented pyrethroid resistance, where house structures and population densities are appropriate, and even where net coverage is high.
A cluster randomised trial is underway in Mopeia District in the Zambezia Province of Mozambique, an area of high malaria endemicity(1). Evidence generated through this study will determine the incremental benefit of 3GIRS in reducing malaria incidence and at what level of cost-effectiveness. All villages in the study area have access to LLINs through mass and routine distribution campaigns, and half of the villages were randomised to receive IRS with Actellic® 300CS as well. Preliminary results from entomological monitoring and passive case reporting in 2017 show:
There was a 50% reduction in An. funestus densities in IRS villages
There were 20% fewer cases presenting at health facilities from IRS villages compared to non-IRS villages
Other project countries
Retrospective observational analyses of the impact of IRS are being supported in Zambia, Mali(2), Ghana, and Uganda. Results to date indicate that:
After introducing IRS in Mopti region in 2017, there was a 40% reduction in incidence over 4 months (~3,800 cases averted at district health facilities) in IRS communities
In Ségou region, IRS campaigns from 2012 – 2014 averted more than 300K cases over the 3 years
After removal of IRS, sharp increases in incidence were observed in both Bla (70% in 2015) and Barouéli (125% in 2017) districts
In 2017, there were 414 fewer cases per 10,000 person-months in IRS vs. non-IRS districts in Northern Region
In 2017, IRS operations were reintroduced in the Upper East region – Kassena and Builsa districts – and case incidence rates fell by an average of 309 cases per 10,000 person months compared to 2016
The odds of malaria infection were reduced in areas with IRS:
Non-3GIRS coverage was associated with a 9% reduction in parasite prevalence (AOR=0.91, 95% BCI 0.68-1.20)
IRS coverage with Actellic® 300CS, a 3GIRS product, was associated with a 26% reduction in parasite prevalence (AOR=0.74, 95% BCI 0.44-1.26)
IRS with bendiocarb in 2015 (2 rounds) was associated with a 20% decrease in cases (AOR 0.8 [0.7 – 0.9])
IRS with Actellic in 2016 was associated with a 47% decrease (AOR 0.53 [0.43 – 0.66])
Further research and evaluation activities assessing the health impact and cost-effectiveness of 3GIRS are ongoing, and dissemination of final results are expected throughout 2019.
1. Chaccour, et al. 2018. BMJ Glob Health.3:e000610
2. Wagman, et al. 2018. Mal J. 17:19
Links to more news on evidence:
MIM conference, April 2018: sharing preliminary trial results
Working together with partners to expand the evidence base
NgenIRS at VCWG 2019