Maximizing Entomological Monitoring (EM) in

Low Resource Settings

Dereje DengelaAbt Associates

November 15, 2012

Building Local Capacity

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Why is Maximizing EM Important?

Significant scale-up of insecticide-based vector control interventions in last 10 years

May lead to changes in:◦ Susceptibility of vector to insecticides

◦ Species composition

◦ Vector behavior

EM helps:◦ monitor if there is any changes

◦ assess entomological impact of vector control

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Integral part of IRS projects in 15 countries under AIRS

Entomological indicators monitored

PMI primary indictors in all AIRS countries◦ Species of malaria vectors in intervention areas

◦ Vector distribution and seasonality

◦ Vector feeding time and location

◦ Insecticide susceptibility

◦ Quality assurance of IRS programs and persistence

Entomological Monitoring(EM): Experience from AIRS Project Countries

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PMI Secondary Indicators in Some Countries Identification of mosquito infectivity Age grading Blood meal analysis

Benin, Burkina Faso, Ghana, Ethiopia Insecticide Resistance (IR) monitoring—important

part of EM EM conducted routinely

Entomological Monitoring(EM): Experience from AIRS Project Countries

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IR and insecticide persistence data—key inputs for IRS insecticide selection◦ conducted annually on four classes of insecticides

◦ meeting organized and results presented to in-country partners

◦ Decision usually made after detailed discussion

Persistence—time of spraying

Data on density, behavior, longevity, infectivity is being collected—will hopefully inform IRS program once completed

How are EM data used for decisionmaking?

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Current EM mainly tied to AIRS project and designed to generate evidence for IRS programming

Good amount of data collected to serve the intended purpose of informing IRS

But might need to be revisited in view of addressing and responding to growing global threat of IR

In countries such as Mali, Zimbabwe, Ethiopia, Burundi, and DRC, PMI moving towards collecting more representative data

Entomological Monitoring(EM)

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Technical Capacity

◦ Currently most AIRS countries have good technical capacity to implement EM to inform IRS programming

Exceptions: Angola, Mozambique

PMI support instrumental in building this capacity over time

◦ Examples: Mali, Ethiopia, Liberia

Some countries had capacity before PMI support

◦ Examples: Benin, Senegal, Burkina Faso

Local Capacity of AIRS Project Countries for EM

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Physical capacity/infrastructure for EM

◦ There is at least one insectary in all AIRS project countries except Angola

◦ Insectary could be owned by NMCP, research institutes, universities or the project

Local Capacity of AIRS Project Countries for EM

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To build technical capacity

◦ Entomologists are very scarce and rarely available in those countries with ongoing capacity challenges.

◦ Can we take some temporary measures?

Improving Local Capacity to Enhance EM

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Strategy: Recruit health professional/malaria focal person, or even high school graduates

Within a few weeks, develop their capacity to carry out basic EM

Up to 10 days extensive training followed by mentoring in the field

Improving Local Capacity to Enhance EM

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Improving Local Capacity

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Examples from Angola and Mozambique:

◦ Hired as junior entomology coordinators young, enthusiastic people (high school graduates)

◦ One week intensive training

◦ They then were attached for 1-2 weeks to experienced entomologist

◦ Demonstrated ability to independently conduct susceptibility tests and send good quality data

Improving Local Capacity to Enhance EM

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Physical infrastructure/Insectary◦ Insectary is key to sustain susceptibly mosquito

colonies ◦ Not the only place to rear wild mosquitoes for tests

The Ethiopia experience of IR:◦ Trained local technicians secure 1-2 rooms within

nearest health facilities (if available) or rent hotel rooms

◦ Collect larvae and pupae with enough water from their aquatic habitats

◦ Rear to adult in these rooms and perform the test in same place

N.B.: Protect adult mosquitoes from ants and spiders

Improving Local Capacity

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Physical infrastructure/Insectary The Mali experience: Insectary in a Box

Cost effective and time saving Fully served the purpose.

Improving Local Capacity

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In absence of entomologists, with proper training and mentoring, technicians can lead basic EM, including IR monitoring

Insectary not mandatory: For EM activities such as IR, field offices or hotel rooms can be used to rear mosquitoes and conduct tests

Where insectary is needed, we can build “insectary in a box”

◦ Cost-effective, saves time

Lessons Learned

Thank you!