pdf.usaid.govpdf.usaid.gov/pdf_docs/PA00MGH9.pdfTanzania Vector Control Scale-up Project: Spray Performance Report . October 2012–June 2013 . Contract No. 621-A-00-10-00015-00

Tanzania Vector Control Scale-up Project: Spray Performance Report October 2012–June 2013 Contract No. 621-A-00-10-00015-00 March 9, 2010–March 8, 2015 Prepared for: U.S. Agency for International Development/Tanzania

Prepared by: RTI International 3040 Cornwallis Road Post Office Box 12194 Research Triangle Park, NC 27709-2194 July 30, 2013

The authors’ views expressed in this publication do not necessarily reflect the views of the U.S. Agency for International Development or the U.S. Government.

Tanzania Vector Control Scale-up Project: Spray Performance Report October 2012–June 2013 Contract No. 621-A-00-10-00015-00 March 9, 2010–March 8, 2015 Submitted to: U.S. Agency for International Development/Tanzania ATTN: Jessica Kafuko, Susan Scott-Vargas and Naomi Kaspar 2140 Dar es Salaam Place Washington, DC 20521-2140 E-mail: [email protected] [email protected] [email protected]

Submitted by: RTI International 3040 Cornwallis Road Post Office Box 12194 Research Triangle Park, NC 27709-2194 Submitted on: July 30, 2013

RTI International is one of the world’s leading research institutes, dedicated to improving the human condition by turning knowledge into practice. Our staff of more than 3,700 provides research and technical services to governments and businesses in more than 75 countries in the areas of health and pharmaceuticals, education and training, surveys and statistics, advanced technology, international development, economic and social policy, energy and the environment, and laboratory testing and chemical analysis.

The authors’ views expressed in this publication do not necessarily reflect the views of the U.S. Agency for International Development or the U.S. Government

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Tanzania Vector Control Scale-up Project iii Spray Performance Report

Table of Contents Table of Contents ........................................................................................................................... iii

List of Annexes ...............................................................................................................................vi

List of Tables ................................................................................................................................. vii

List of Figures .............................................................................................................................. viii

List of Boxes ...................................................................................................................................ix

List of Abbreviations...................................................................................................................... x

I. Executive Summary ..................................................................................................... 1

II. Country Background ................................................................................................... 2

Intervention Areas ............................................................................................................... 2

Zanzibar ........................................................................................................................ 2

Mainland Tanzania ....................................................................................................... 3

Regions in the Lake Zone Area of Mainland Tanzania ................................................ 4 Malaria Transmission in Zanzibar ....................................................................................... 5

Malaria Transmission in Mainland Tanzania....................................................................... 5

III. IRS in the Context of Malaria Strategies in Zanzibar ................................................ 6

Malaria Medium-Term Strategic Plan for Zanzibar ............................................................. 6

Recent History of IRS in Zanzibar ....................................................................................... 7

IRS Strategic Design for Zanzibar .................................................................................... 10 Zanzibar ...................................................................................................................... 10

Selection of Eligible Spray Areas ...................................................................................... 10

IV. 2012–2013 IRS Preliminary Activities ....................................................................... 13

Assessing the Environment and Planning Mitigation Options for the Safer Use of Pesticides .......................................................................................................................... 13

Environmental Assessment ........................................................................................ 13

Insecticide Management and Environmental Mitigation Plan ..................................... 14

Selection and Management of Insecticide for IRS ............................................................ 14

Insecticide Resistance in Zanzibar ............................................................................. 14

Insecticide Resistance Mitigation Plan ....................................................................... 14

Selection of Appropriate Insecticide ........................................................................... 15 Assessing IRS Logistics ............................................................................................. 15

Selecting the Ideal Spray Period and Preparing the Operations Plan .............................. 16

Rationale for Selection of Spray Period in Zanzibar .................................................. 16

Spray Season ............................................................................................................. 16

Establish District IRS Management .................................................................................. 17

Developing and Organizing the IRS Sites: Design and Phases ....................................... 17 Insecticide Quantification, Procurement, Safe Transport, and Storage ............................ 19

iv Tanzania Vector Control Scale-up Project Spray Performance Report

Handling Equipment, Materials, and Vehicles .................................................................. 19

Managing Human Resources for IRS ............................................................................... 19

Staff Training ..................................................................................................................... 21 Training Modalities ..................................................................................................... 21

Types of Training ........................................................................................................ 21

Training Tools ............................................................................................................. 21

Informing and Mobilizing Communities ............................................................................. 21

Implementation of Information, Education, and Communication Activities (IEC): IEC Design in 2012–2013 Spray Season .......................................................................... 21 Organization of Interpersonal Communication in Zanzibar ........................................ 21

Other IEC Supportive Activities .................................................................................. 22

Printed IEC Materials .................................................................................................. 22

Monitoring the IRS Process .............................................................................................. 22

Monitoring of Training Activities.................................................................................. 22

V. Implementation of IRS Activities .............................................................................. 22

Quality Control of Spray .................................................................................................... 22

Monitoring Performances of Spray Teams and Use of Insecticide ................................... 24

Environmental Monitoring and Mitigation Activities .......................................................... 24

Monitoring and Evaluation ................................................................................................ 24

Logistics ............................................................................................................................ 26

Storage and Movement of Insecticide and Other Supplies ........................................ 26 Provision of Transport for Operators and Supervisors ..................................................... 28

End of Spray Activities ...................................................................................................... 28

Post-spray Environmental Compliance Inspections and Site Decontamination and Decommissioning ....................................................................................................... 28

Solid Waste Disposal .................................................................................................. 28 End of Spray Inventory in Storage Facilities .............................................................. 29

VI. IRS Results ................................................................................................................. 29

IRS Results—Zanzibar...................................................................................................... 29

Population and House Structures Found ................................................................... 29

Spray Results ............................................................................................................. 30

Usage of ITNs ............................................................................................................. 33

VII. Monitoring Insecticide After Spray: Insecticide Decay Rate ................................. 34

Monitoring Insecticide Decay by Using Cone Bioassay .................................................... 34

VIII. IRS in the Context of Malaria Strategies in Mainland Tanzania ............................. 36

Malaria Medium-Term Strategic Plan for Mainland Tanzania ........................................... 36

Recent History of IRS in Mainland Tanzania .................................................................... 36

Mainland Tanzania ..................................................................................................... 36 IRS Strategic Design for Mainland Tanzania .................................................................... 42

Mainland Tanzania ..................................................................................................... 42

Tanzania Vector Control Scale-up Project v Spray Performance Report

Spray Seasons .................................................................................................................. 42

Selection of Eligible Spray Areas ...................................................................................... 43

Mainland Tanzania ..................................................................................................... 43

IX. 2012–2013 IRS Preliminary Activities ....................................................................... 46

Assessing the Environment and Planning Mitigation Options for the Safer Use of Pesticides .......................................................................................................................... 46

Environmental Assessment ........................................................................................ 46

Insecticide Management and Environmental Mitigation Plan ..................................... 46

Selection and Management of Insecticide for IRS ............................................................ 47 Insecticide Resistance in Mainland Tanzania ............................................................ 47

Insecticide Resistance Mitigation Plan ....................................................................... 47

Assessing IRS Logistics .................................................................................................... 47

Selecting the Ideal Spray Period and Preparing the Operations Plan .............................. 47

Rationale for Selection of Spraying Period in Lake Zone ........................................... 47

Setting the Structure Targets ............................................................................................ 50 Establish District IRS Management .................................................................................. 50

Developing and Organizing the IRS Sites......................................................................... 51

Insecticide Quantification, Procurement, Safe Transport, and Storage ............................ 51

Handling Equipment, Materials, and Vehicles .................................................................. 51

Managing Human Resources for IRS ............................................................................... 52

Informing and Mobilizing Communities ............................................................................. 54 Advocacy to Local Government Authorities: Region, District, Division, Ward, and Village Levels ......................................................................................................................... 54

Implementation of Information, Education, and Communication Activities: IEC Design in 2012–2013 Spray Season .......................................................................................... 54

Managing Knowledge and Skills ....................................................................................... 56 IRS Teams Training in Lake Zone .............................................................................. 56

Training of Trainers (ToT) ........................................................................................... 56

IRS Teams .................................................................................................................. 57

Monitoring the IRS Process .............................................................................................. 57

Monitoring of Training Activities.................................................................................. 58

IRS Coverage and Use of Insecticides ....................................................................... 58 Getting RTI Prepared to Support the IRS Process ........................................................... 58

Public-Private-Partnership (PPP) in IRS implementation in the Lake Zone ..................... 59

X. Implementation of IRS Activities .............................................................................. 59

Quality Control of Spray .................................................................................................... 59

Environmental Monitoring and Mitigation Activities .......................................................... 59

Logistics ............................................................................................................................ 60 Storage of Insecticide and Other Supplies ................................................................. 60

Provision of Transport for Operators and Supervisors ..................................................... 63

vi Tanzania Vector Control Scale-up Project Spray Performance Report

End of Spray Activities ...................................................................................................... 63

Post-spray Environmental Compliance Inspections and Site Decontamination and Decommissioning ....................................................................................................... 63 Solid Waste Disposal .................................................................................................. 63

End of Spray Inventory in Storage Facilities .............................................................. 63

XI. IRS Results—Mainland .............................................................................................. 64

Population and House Structures Found .......................................................................... 64

House Characteristics and Population Profile ............................................................ 64

Spray Results .................................................................................................................... 65 Main Spray Indicators ................................................................................................. 65

Refusal and Houses Not Reached ............................................................................. 67

Use of Insecticides ............................................................................................................ 67

Population Protected ......................................................................................................... 69

Community Sensitization Results ..................................................................................... 70

Source of Information ................................................................................................. 70 Perceived Advantages and Disadvantages from Previous IRS Rounds .................... 72

Usage of ITNs ................................................................................................................... 74

XII. Monitoring Insecticide Quantification After Spray, Insecticide Decay, and Insecticide Resistance ....................................................................................... 75

2013 Preliminary Results ofInsecticide Decay Monitoring Using Cone Bioassay ............ 75

Insecticide Resistance Monitoring in Lake Zone and Zanzibar ........................................ 76

XIII. Lessons Learned ........................................................................................................ 78

XIV. Challenges .................................................................................................................. 78

XV. Recommendations ..................................................................................................... 78

XVI. IRS in Action .............................................................................................................. 79

List of Annexes Annex A. Zonal Regional and District Targets: IRS Operational Sites, Ward/Shehia, Village,

and Hamlets Annex B. Summary Operation Staff by District, Region, and Zone Annex C. Summary of Household Characteristics and Population by District, Region,

and Zone Annex D. Summary of Spray Indicators by District, Region, and Zone Annex E. Population Protected by Broad Age Group, District, Region,

and Zone Annex F. Net Usage per District, Region, and Zone Annex G. Reasons for No Spray by District (only Lake Zone) Annex H. Perceived Advantages and Disadvantages after IRS

(only Lake Zone) Annex I. Source of Information (only Lake Zone) Annex J. Houses Sprayed by Type and Amount of Insecticide Annex K. Environmental Compliance Report

Tanzania Vector Control Scale-up Project vii Spray Performance Report

List of Tables Table 1. Spray performance in Zanzibar (structures sprayed), 2006–2013................................. 8

Table 2. Strategic design for IRS implementation in Zanzibar ................................................... 10

Table 3. Zanzibar regional targets ............................................................................................. 17

Table 4. Temporary staff recruited to support IRS operations ................................................... 20

Table 5. PPE Consumables Movements by Type and Warehouse ........................................... 26

Table 6. Selected PPE and spray equipment movement by type and warehouse .................... 27

Table 7. Vehicles hired during IRS operations ........................................................................... 28

Table 8. Characteristics of visited households ........................................................................... 29

Table 9. Population recorded during spray in visited households ............................................. 29

Table 10. Main spray indicators in Zanzibar ................................................................................ 31

Table 11. Use of insecticide ......................................................................................................... 32

Table 12. Population protected by spray zone ............................................................................. 32

Table 13. LLIN usage by region and zone by age group ............................................................. 33

Table 14. Spray performance in Mainland Tanzania (structures sprayed), 2007–2013 .............. 38

Table 15. Number of eligible structures, previous rounds IRS, strategic phase, frequency of spraying, and insecticide class used in 2013 per district ........................ 44

Table 16. Temporary staff recruited to support IRS operations ................................................... 52

Table 17. Proportion of temporary staff recruited during IRS campaign, by gender .................... 53

Table 18. Key IEC actors and targets by category....................................................................... 55

Table 19. Insecticide movements by type and by warehouse ..................................................... 60

Table 20. PPE consumables movements by type and by warehouse ......................................... 61

Table 21. Selected PPE and spray equipment movement by type and warehouse .................... 62

Table 22. Vehicles hired during IRS operations ........................................................................... 63

Table 23. Visited household characteristics ................................................................................. 65

Table 24. Population recorded during spray in visited households ............................................ 65

Table 25. Main spray indicators by area ...................................................................................... 66

Table 26. Reasons for non-spray ................................................................................................. 67

Table 27. Use of insecticide ......................................................................................................... 68

Table 28. Population protected by spray zone ............................................................................. 69

Table 29. IRS information and source by administrative level ..................................................... 71

Table 30. Advantages and disadvantages cited by communities after IRS by administrative level ....................................................................................................... 73

Table 31. LLIN usage by region and zone by age group ............................................................. 74

viii Tanzania Vector Control Scale-up Project Spray Performance Report

Table 32. Summary of susceptibility levels of malaria vectors to insecticides using WHO susceptibility test kits .......................................................................................... 77

List of Figures Figure 1. Map of Zanzibar showing Unguja and Pemba islands ................................................... 3

Figure 2. Map of Tanzania showing regional boundaries, 2013 .................................................... 4

Figure 3. IRS Districts in the Lake Zone ........................................................................................ 5

Figure 4. Tanzania malaria prevalence in U5 children .................................................................. 6

Figure 5. Malaria morbidity for Unguja and Pemba Islands, 2011 MEEDS ................................ 12

Figure 6. Shehias targeted for one round in 2013 spray season, Unguja and Pemba ............... 13

Figure 7. IRS teams organizational structure .............................................................................. 18

Figure 8. Family size per district, Zanzibar.................................................................................. 30

Figure 9. Spray coverage in districts of Zanzibar ........................................................................ 31

Figure 10. Sachet per house structure ratio by district in Zanzibar ............................................... 32

Figure 11. 2013 universal net coverage by district, Zanzibar........................................................ 34

Figure 12. Bioassay results March 2013 ....................................................................................... 35

Figure 13. Efficacy of bendiocarb at Shungi (Pemba) 30 days post spraying .............................. 35

Figure 14. Strategic design for IRS implementation in Mainland Tanzania ................................... 42

Figure 15. Spray seasons in Mainland Tanzania, November 2012–May 2013 ............................. 48

Figure 16. Organizational structures for district IRS implementation teams ................................. 50

Figure 17. Types and number of storage facilities by levels and responsible TVCSP team ............................................................................................................................. 52

Figure 18. Organization of IEC/BCC from region to community level ........................................... 54

Figure 19. IEC design in spray seasons, 2007–2013 ................................................................... 56

Figure 20. Cascade training model for IRS operation ................................................................... 57

Figure 21. 2012–2013 M&E Organogram ..................................................................................... 58

Figure 22. House walls characteristics by district in the Lake Zone ............................................. 64

Figure 23. Spray coverage by districts of Lake Zone .................................................................... 66

Figure 24. Sachet per house structure ratio by district in the Lake Zone ...................................... 69

Figure 25. Source of Information of IRS ........................................................................................ 72

Figure 26. Universal net coverage 2012 and 2013 by regions and zone ...................................... 75

Figure 27. Insecticide decay on various surfaces up to week 29 after bendiocarb application in 2013 IRS campaign ................................................................................ 76

Figure 28. Insecticide decay up to week 13 after deltamethrin application in 2013 IRS campaign ...................................................................................................................... 76

Tanzania Vector Control Scale-up Project ix Spray Performance Report

List of Boxes Box 1. Criteria for selecting targeted areas in Zanzibar .......................................................... 11

Box 2. Activities included in comprehensive logistics assessment ......................................... 16

Box 3. Criteria for IRS operators’ selection ............................................................................. 20

Box 4. Monitoring inputs, process, and outputs ...................................................................... 25

Box 5. Inclusion and Exclusion Criteria for Targeted IRS Approach ....................................... 46

x Tanzania Vector Control Scale-up Project Spray Performance Report

List of Abbreviations ACT artemisinin-based combination therapy

BCC behavior change communication

CFR U.S. Code of Federal Regulations

CS capsulated suspension

DEMO District Environmental Management Officer

DITC District IRS Technical Committee

DITT District IRS Technical Team

DMO District Medical Officer

EIA Environmental Impact Assessment

EMA Environmental Management Act

FAO United Nations Food and Agriculture Organization

GGM Geita Gold Mine

IEC information, education and communication

IMCI Integrated Management of Childhood Illness

IMVC Integrated Malaria Vector Control

IPTp Intermittent Preventive Treatment for Pregnancy

IRS Indoor Residual Spraying

ITN insecticide-treated net

LLIN long-lasting insecticide-treated net

LSM larval source management

M&E monitoring and evaluation

MEEDS malaria early epidemic detection system

MIS Malaria Indicator Survey

MoHSW Ministry of Health and Social Welfare

MOP Malaria Operational Plan

NEMC National Environment Management Council

NGO nongovernmental organization

NIMR National Institute for Medical Research

NMB National Microfinance Bank

NMCP National Malaria Control Programme

PEA Preliminary Environmental Assessment

Tanzania Vector Control Scale-up Project xi Spray Performance Report

PMI U.S. President's Malaria Initiative

PPE personal protective equipment

PPP public private partnership

SEA Supplemental Environmental Assessment

SIM Site IEC Mobilizer

SOP standard operating procedure

THMIS Tanzania HIV and Malaria Indicator Survey

ToT training of trainers

TPRI Tropical Pesticide Research Institute

TVCSP Tanzania Vector Control Scale up Project

U5 under five years of age

USAID United States Agency for International Development

VCO vector control officers

WEO Ward Executive Officer

WHO World Health Organization

WHOPES World Health Organization Pesticide Evaluation Scheme

WP Wettable powder

ZMCP Zanzibar Malaria Control Programme

Tanzania Vector Control Scale-up Project 1 Spray Performance Report

Section A: Overview and Background

I. Executive Summary In 2006, RTI International was awarded a Cooperative Agreement by the U.S. Agency for International Development (USAID) under the U.S. President’s Malaria Initiative to implement indoor residual spraying (IRS) and other malaria control and prevention activities in Mainland Tanzania and Zanzibar. Between 2006 and July 2010, RTI conducted IRS in Zanzibar and Kagera Region in the Lake Zone in Mainland Tanzania. In 2010, IRS was expanded to cover two additional Lake Zone regions, Mwanza and Mara. Over the course of the 2010–2012 IRS spray season, a total of 18 districts in the Lake Zone (seven districts in Kagera Region, six districts in Mwanza Region, and five districts in Mara Region) and 10 districts in Zanzibar benefited from IRS.

Prior to conducting any spray activities in 2012–2013, many preparatory and foundational activities were carried out, such as the following in both Zanzibar and Mainland Tanzania:

• Select eligible spray areas based on national strategic priorities and logistic and epidemiological considerations;

• Conduct a preliminary logistics assessment to quantify eligible house structures, target population, spray equipment, insecticide, and spray teams, as well as identify suitable sites to host temporary storage and effluent waste-disposal facilities;

• To satisfy both USAID and Government of Tanzania environmental requirements, submit documentation for the shift from pyrethroids to carbamate insecticide;

• Refurbish existing IRS sites for temporary, proper storage of IRS equipment, insecticide, and effluent waste disposal facilities;

• Implement a plan for safer use of insecticide and institute an environmental mitigation plan, including safe transport and secure storage of insecticide, testing of female spray technicians for pregnancy, and training of clinicians on treatment of pesticide side-effects;

• Perform insecticide quality assurance tests; • Introduce the Insecticide Quantification Kit for bendiocarb; • Procure, transport, and store all necessary spray and personal protective

equipment, insecticides, and consumables; • Train spray teams in a variety of positions, including site managers, team

leaders, spray operators, suit washers, site attendants, security guards, and water fetchers; and

• Promote acceptance of IRS in the targeted communities through information, education, and communication activities.

2 Tanzania Vector Control Scale-up Project Spray Performance Report

In Zanzibar, a total of 51,904 house structures were sprayed (96% of those eligible), with 250,505 people protected. This includes 5,703 pregnant women and 43,635 children under the age of five (U5). During this reporting period, about 5,082 (89%) of pregnant women and 39,222 (90%) of U5 children were declared to have slept under ITNs the previous night in the house structures visited.

In Mainland Tanzania, following the 2011–2012 IRS season, the USAID-funded Tanzania Vector Control Scale-up Project implemented changes to its IRS strategy such as scale down in Muleba, Karagwe, and Zanzibar, as well as an insecticide rotation to carbamate in these areas, as recommended by an expert panel working on the country’s Insecticide Resistance Mitigation Plan. As a result, for 2012–2013, the TVCSP further shifted toward target spraying and insecticide rotation in the remaining districts in the Lake Zone. Due to the imminent scale-down of IRS, 30% of the eligible areas were excluded from spraying. A total of 773,929 house structures (95% of those eligible) were sprayed, of which 103,201 were sprayed twice in selected districts of Kagera, Mara, and Mwanza regions. Results showed that 4,052,354 people were protected, including 138,281 pregnant women and 841,451 children under the age of five. During this reporting period, 136,184 (93%) of pregnant woman and 818,455 (94%) of U5 children in the Lake Zone were declared to have slept under ITNs the previous night in the house structures visited.

In addition, entomological monitoring was conducted by the Zanzibar Malaria Control Programme in Zanzibar and the National Institute for Medical Research in Mainland Tanzania. The main parameters monitored included annual insecticide susceptibility in sentinel sites to determine the efficacy of insecticide and selection of the appropriate and cost-effective one, as well as cone bioassay to monitor duration of insecticide after IRS on different treated walls.

II. Country Background Intervention Areas The United Republic of Tanzania is located between longitudes 28°E and 40°E and latitudes 1°S and 12°S. The country has a total area of 947,480 km2, of which 883,349 km2 constitute land; the remainder is made up of water bodies. Administratively, the country includes Mainland Tanzania and the archipelago of Zanzibar.

Zanzibar

The Zanzibar archipelago consists of two main islands of Unguja and Pemba, together with several minor islands (see Figure 1). The total land surface area is 1,658 km2, with a population of 1,303,565 million (Tanzania National Bureau of Statistics 2012 census data). The administrative setup in Zanzibar includes five regions—three in Unguja and two in Pemba—10 districts, and 335 shehias1.

1 Shehia is the equivalent of a ward in Zanzibar’s administrative setup.


Figure 1. Map of Zanzibar showing Unguja and Pemba islands

Mainland Tanzania

Mainland Tanzania is divided into seven zones (East, South, Southern Highlands, West, Central, Lake, and North). It has 30 regions (see Figure 2) and 132 local councils. Each council is divided into 4–5 divisions, which in turn are composed of 3–4 wards. Approximately 5–7 villages form a ward; each village is subdivided into hamlets (3–6 per village). There are approximately 10,496 villages and 9,362,758 households, with an average of 4.8 people per household in Mainland Tanzania. The country has an estimated population of 43.6 million (Tanzania National Bureau of Statistics 2012 census estimate), with an annual growth rate of 2.7%. Seventy-six percent of the population lives in rural communities. Twenty percent of the population is made up of children under five years of age (U5), 27% is 5–15 years old, and 20% of the population of women is of reproductive age (between 15 and 49 years of age).


Figure 2. Map of Tanzania showing regional boundaries, 2013

Regions in the Lake Zone Area of Mainland Tanzania

The Lake Zone area has a total population of 10,298,049. It is made up of five regions around Lake Victoria, with respective resident populations shown in parentheses—Kagera (2,458,023); Mwanza (2,772,509); Mara (1,743,830); Geita (1,739,530); and Simiyu (1,584,157).

In the Lake Zone area, two new regions were recently established, Simiyu and Geita, with a consequent redistribution of the administrative districts, surface area, and population. In this report, we use the administrative designations prior to this new rearrangement, made up of three regions along with their respective district. These regions are Kagera (Biharamulo, Bukoba DC, Chato, Karagwe, Missenyi, Muleba, and Ngara districts), Mara (Bunda, Musoma Rural, Rorya, Serengeti, and Tarime districts), and Mwanza (Geita, Kwimba, Missungwi, Magu, Sengerema, and Ukerewe). See Figure 3 for a map of IRS districts in the Lake Zone.

The new geographic demarcations led to a slight reorganization of indoor residual spraying (IRS) advocacy meetings. Additional advocacy meetings for the newly formed region of Geita (including both areas of Geita rural and urban) and the new district of Busega, which contains a few villages that were previously in Magu District (which is now located in Simiyu Region) were conducted. Through these meetings, relevant authorities were informed about IRS in their areas of jurisdiction and their roles in supporting IRS.


Figure 3. IRS Districts in the Lake Zone

Malaria Transmission in Zanzibar Malaria transmission in Zanzibar recorded in the recent national population-based survey data, using malaria rapid diagnostic tests (mRDTs), estimated malaria parasite prevalence among children aged 6–59 months tested at 0% in Pemba and Unguja.

Malaria Transmission in Mainland Tanzania Malaria transmission in Mainland Tanzania is highly variable, depending on geographic, climatic, and human settings. The most recent national population-based survey data (Tanzania HIV/AIDS and Malaria Indicator Survey [THMIS] 2011–12 of March 2013) show that 9% of children aged 6–59 months tested positive (using mRDTs) for malaria in Mainland Tanzania, in contrast to only 0% in each of the two islands of Pemba and Unguja in Zanzibar (see Figure 4). The data show marked regional variations, ranging from 0.9% in Arusha to 32.9% in Geita Region among U5 children in Mainland Tanzania. The Tanzania Vector Control Scale-up Project’s (TVCSP’s) IRS target regions are among those with high malaria prevalence, with Mara estimated at 25.6%, Mwanza at 19.1%, and Kagera at 8.5%.

The THMIS 2011–12 shows that the intense, perennial malaria transmission is typical in the Lake Zone (upper northwest) and coastal belt (east and south), with a prevalence of more than 30% down to 8%, respectively. There is seasonal malaria transmission, with a prevalence between 0.2% and 2.6% in the Central Plateau. The low or mild seasonal transmission (shorter than three months per year) pattern is typical for the Southern and Northern Highlands, with a prevalence of lower than 0.4%. Dar es Salaam City has exceptionally low malaria transmission. In Mainland Tanzania, rural areas have a higher prevalence (11%) compared to urban areas (3%).


Figure 4. Tanzania malaria prevalence in U5 children

Source: THMIS 2011-12, published in March 2013.

Section B: Zanzibar

III. IRS in the Context of Malaria Strategies in Zanzibar Malaria Medium-Term Strategic Plan for Zanzibar The medium-term goal of the current Zanzibar Medium-Term Strategic Plan (2008–2013) is to assess the potentialities for malaria elimination and to reduce malaria-related morbidity and mortality in Zanzibar’s population to a level that the disease no longer poses a public health threat, especially among most vulnerable groups, such as U5 children, pregnant women, and the poor. The Zanzibar medium-term targets, which follow, are similar to those for Mainland Tanzania:

• 80% of malaria patients diagnosed and treated with effective antimalarial medicines, such as artemisinin-based combination therapy (ACT), within 24 hours of the onset of fever;

• 80% of all pregnant women receive two or more doses of intermittent preventive treatment (IPTp);

• 80% of people in malarious areas protected through the use of insecticide-treated nets (ITNs);

• 80% of people in target areas protected through IRS; and


• Early detection and containment of 80% of malaria epidemics within two weeks from onset.

However, Zanzibar has three additional targets for effective malaria epidemic preparedness and response:

• 100% of health facilities’ weekly reports are submitted on time in order to detect any abnormal rise in malaria cases early on;

• Investigation of reported epidemics is initiated within 24 hours; and

• Medical supplies are at hand to mount a response, if necessary, within two weeks from the notification of the outbreak

Furthermore, the strategic plan includes a target to assess the potential for sustainable elimination of malaria from Zanzibar, using newly available data from surveillance and operational research, as well as experience from implementation of previous IRS rounds.

Recent History of IRS in Zanzibar The U.S. President’s Malaria Initiative (PMI) has supported Zanzibar Malaria Control Programme (ZMCP) with its IRS program since 2006, contributing to the substantial drop in malaria transmission. Between June 2006 and June 2012, RTI International, in collaboration with ZMCP, conducted IRS in Zanzibar for six blanket rounds (see Table 1), two reactive focal spray initiatives (2008 in Bumbwini and 2011 in Tumbe), and one targeted spray round in select areas of nine districts of Zanzibar in 2012. About 200,000 structures were sprayed per blanket round, protecting almost 1.2 million people. The spray coverage was consistently over 90%. In 2013, RTI and ZMCP conducted another targeted round and a focal IRS in select areas of Zanzibar, as highlighted in Table 1. All spray rounds between 2006 and 2011 were done using pyrethroid insecticides. In the 2012 and 2013 targeted IRS campaigns, bendiocarb was introduced. This massive effort, together with other interventions, has contributed significantly to reducing malaria prevalence to less than 1% (see Figure 4) and advancing Zanzibar to a pre-elimination phase.


Table 1. Spray performance in Zanzibar (structures sprayed), 2006–2013

Location

Round 1

Round 2

Round 3

Focal Spray

Round 4

Round 5

Round 6

Focal Spray

Targeted Spray

Targeted Spray

Targeted Spray

Focal Spray

2006 2007 2007 2008 2008 2010 2011 2011 2012 2012 2013 2013

Unguja

Central 15,167 (92%)

15,258 (89%)

15,737 (95%) — 13,897

(94%) 15,046 (89%)

14,883 (94%) — 15,392

(93%) 4,536 (92%)

10,171 (95%)

—

North A 21,729 (98%)

21,575 (96%)

22,961 (100%) — 22,097

(97%) 18,595 (88%)

21,524 (100%) — 18,274

(93%) — 3,102

(94%) —

North B 11,829 (95%)

10,819 (93%)

11,737 (95%) 4,797 10,562

(93%) 10,397 (89%)

11,480 (97%) — 11,294

(99%) 2,653 (95%)

8,288 (95%)

—

South 8,036 (99%)

8,871 (100%)

9,167 (99%) — 9,417

(100%) 8,604 (88%)

8,472 (94%) — 5,644

(93%) 1,840 (90%) —- —

Urban 25,670 (92%)

23,764 (79%)

25,828 (88%) — 27,464

(97%) 22,355 (78%)

23,127 (86.7%) — — — — —

West 41,182 (92%)

37,370 (81%)

47,739 (98%) — 43,053

(84%) 40,202 (88%)

40,422 (94.9%) — 24,463

(90%) 3,065 (92%)

4,702 (96%)

—

Pemba

Chakechake 16,211 (99%)

16,829 (100%)

16,637 (99%) — 16,437

(96%) 16,280 (88%)

16,866 (94%) — 8,682

(98%) 2,461 (93%)

1,406 (95%)

—

Micheweni 21,015 (100%)

20,824 (100%)

20,920 (100%) — 18,164

(97%) 16,811 (87%)

20,305 (96%)

2,003 12,744 (98%)

7,230 (99%)

12,157 (99%) 501


Location

Round 1

Round 2

Round 3

Focal Spray

Round 4

Round 5

Round 6

Focal Spray

Targeted Spray

Targeted Spray

Targeted Spray

Focal Spray

2006 2007 2007 2008 2008 2010 2011 2011 2012 2012 2013 2013

Unguja

Mkoani 19,804 (100%)

20,067 (100%)

19,560 (98%) — 18,653

(98%) 18,224 (98%)

18,267 (100%) — 10,047

(100%) 1,497 (95%)

2,506 (99%)

—

Wete 21,376 (100%)

21,596 (100%)

22,371 (99%) — 20,987

(98%) 19,532 (90%)

19,462 (93%) — 8,318

(98%) 2,988 (98%)

7,308 (96%)

—

Total 202,019 (96%)

196,973 (91%)

212,657 (97%) 4,797 200,731

(94%) 186,046 (88%)

194,808 (95%) — 114,858

(95%) 26,270 (95%)

49,640 (96%) 501


IRS Strategic Design for Zanzibar

Zanzibar

After completing the sixth round of blanket spraying in Zanzibar in 2011, the islands reached a stage where only targeted IRS application is used. The IRS strategic design is now linked and integrated with the following initiatives: (1) implementation of targeted IRS to complement the universal coverage of long-lasting insecticide-treated nets (LLINs); (2) implementation of focal spraying as a response to abnormal increases in malaria cases; (3) implementation of an aggressive behavior change communication (BCC) campaign that will promote the continuous use of LLINs; (4) consolidation and improvement of the malaria surveillance system, including active malaria case detection; and (5) effective use of entomological monitoring as part of surveillance (see Table 2).

Table 2. Strategic design for IRS implementation in Zanzibar

Spray phase 2006–2007

2007–2008

2008–2009

2009–2010

2010–2011

2011–2012

2012–2013

2013–2014

2014–2015

Blanket

Targeted

Focal

Selection of Eligible Spray Areas Over the past two years (2010–2011), a strong foundation was established for scaling up malaria surveillance, adopting a revised insecticide mitigation plan, and instituting multiple control interventions, such as LLIN universal coverage and larval source management (LSM), thereby enabling Zanzibar to shift its IRS strategy from blanket to targeted spraying.

Similar to 2012, the selection process for targeted spraying was deliberated by ZMCP and partners, who examined a number of criteria (including operational, epidemiological, entomological, and socioeconomic, as shown in Box 1). They subsequently selected specific criteria selected based on evidence to determine high- and low-risk areas from which eligibility could be obtained.


Box 1. Criteria for selecting targeted areas in Zanzibar

♦ Operational: This criterion considers the established number of structures that ZMCP will be targeting for IRS. According to the PMI 2012 Malaria Operational Plan (MOP), funding was provided for focal spraying of 50,000 structures out of the eligible 220,000 in Zanzibar. The implication is that approximately 168,000 structures (78% of the population) will be excluded.

♦ Socio-demographic indicators: This indicator considers the type of housing and population density.

♦ Malaria transmission risk: Factors that can induce higher (or lower) transmission patterns—such as precipitation levels, house characteristics (specifically type of wall surfaces), as well as urban or rural settings—should be considered for inclusion or exclusion of IRS.

♦ Epidemiological factors: According to retrospective reference data, such as the malaria early epidemic detection system (MEEDS), malaria epidemiology is highly seasonal, peaking after the rainy periods, with inter-peak caseload lower than what it was in 2008 and before. Stratification of cases shows they come from a specific location in certain districts, which can be targeted for IRS.

♦ Costs: This criterion overlaps with operational costs, whereby the cost of the currently used carbamate pesticide (US$12) is four times the price of previously used lambda- cyhalothrin. However, this should not be a major concern, given that other operational costs are optimized through experience and improved efficiency.

♦ Malaria control coverage: This criterion considers other control interventions (specifically LLIN coverage and LSM) that can be compared across districts and other areas to prioritize IRS in places where exposure to multiple interventions is low.

♦ Insecticide selection and duration: This criterion considers the period of residual effect on treated walls for the currently used insecticide (carbamate) and its relation to the frequency of spray rounds to optimize the duration of effectiveness in sprayed areas.

♦ Entomological factors: This criterion has a number of key parameters (such as vector density in urban versus rural areas) that can be useful in decision making for target spraying. Unfortunately, lack of timely data limits the use of this criterion.

♦ Insecticide resistance: By rotating a different class of insecticide and spraying across the regions, it is possible to reduce mutations in mosquitoes and counter resistance. This criterion can be specifically applied to areas where there is resistance to pyrethroid and are considered for IRS.

♦ BCC: This criterion is important to consider, because it has implications on the population excluded from IRS. A BCC strategy must be developed in a well-defined, properly understood manner to address concerns or questions of the public within and outside the target area for spraying

Using the weekly aggregated cases from health facilities, an extensive analysis was done by stratifying the malaria morbidity at defined catchment areas comprising shehias for each allocated health facility. This approach gives a more specific variance of morbidity, thereby giving a more precise result in decision making when considering eligible targeted areas.

Malaria morbidity for Unguja (see Figure 5, left) illustrates the variance in different areas in and within the districts. Malaria morbidity for Pemba also illustrates varying morbidity at the defined catchment areas in the four districts (see Figure 5, right).


Figure 5. Malaria morbidity for Unguja and Pemba Islands, 2011 MEEDS

Using the annual morbidity rate of 1,000 persons for each of the allocated health facility catchment area, around 50,000 houses were selected to be sprayed in a single round of IRS (rate >2 per 1000 population)

Areas that received IRS and those that were excluded are illustrated in Figure 6.


Figure 6. Shehias targeted for one round in 2013 spray season, Unguja and Pemba

IV. 2012–2013 IRS Preliminary Activities

Assessing the Environment and Planning Mitigation Options for the Safer Use of Pesticides

Environmental Assessment

RTI, in collaboration with ZMCP, prepared and sent to USAID a justification letter report (see Annex K) to inform them of the status of environmental management in IRS, as stipulated in Tanzania Supplemental Environmental Assessment (SEA) of 2010, and in compliance with the U.S. regulation 22 CFR 216. The letter included the environmental risk mitigation actions undertaken by TVCSP and the rationale for shifting from one class of insecticide to another, according to the insecticide rotation management to mitigate the insurgence of resistance. After USAID approved the letter, RTI started the procurement process for bendiocarb insecticide for the upcoming IRS round. In order to comply with Programmatic Environmental Assessment (PEA) requirements, RTI—in collaboration with ZMCP—sought an insecticide importation permit from the Zanzibar Food, Drugs and Cosmetics Board in December 2012.


Insecticide Management and Environmental Mitigation Plan

TVCSP prepared environmental mitigation guidelines and standard operating procedures (SOPs) for spray operators and pump technicians, including on use of triple-rinsing for pump cleaning at the end of the spray day, inspection of pumps for leakage and their general maintenance, as well as disposal of washouts and solid waste. Before the start of operations, all spray teams were trained on all aspects of environmental compliance. During operations, spray teams were supervised to maintain protection and safety measures for themselves and for residents, as well as emergency preparedness in case of insecticide adverse reactions and accidental exposure to insecticide.

In addition, to manage insecticide stocks, a control system was instituted that included bin cards, ledgers, issue vouchers, and daily/weekly trackers. Measures for strictly tracking the movement of insecticide sachets from the temporary storage facilities to the spray teams were meant to prevent pilferage and potential misuse, to promote safer use of insecticide, and to protect the environment and human health. At the end of every spray day, empty sachets were returned by spray operators and counted. All observed discrepancies were reported and investigated. SOPs guided the disposal of solid waste, including empty sachets, according to best management practices.

Pregnancy tests were given to all female IRS staff before spray operations began, and medical attendance forms were available for monitoring undesirable and adverse reactions to insecticides for all IRS staff.

Selection and Management of Insecticide for IRS

Insecticide Resistance in Zanzibar

In 2010, malaria vector resistance to pyrethroids was reported in Pemba for the first time. Since the reintroduction of IRS in Zanzibar in 2006, the program has relied entirely on the use of a pyrethroid. This is the same class of insecticide used to treat LLINs. The continuous use of the same class of insecticide for IRS and LLIN, as well as for agriculture, has been associated with the evolution of resistance.

Insecticide Resistance Mitigation Plan

To mitigate vector resistance to pyrethroid insecticide, RTI, in collaboration with ZMCP, hired a consultant to develop an insecticide resistance mitigation plan. In addition, an expert consultative meeting was convened in August 2011 to deliberate (1) the process of formulating an insecticide resistance mitigation plan and (2) immediate interim measures to mitigate resistance pressure in the country. The meeting attendees recommended that ZMCP and the Mainland Tanzania National Malaria Control Programme (NMCP) consider replacing a pyrethroid with a carbamate for IRS in a rotational strategy for at least two years until new formulations become available. Carbamate was recommended to be introduced immediately in the areas where pyrethroids were used for several years in Zanzibar. The panel also recommended the intensification of monitoring insecticide susceptibility in the areas where IRS is conducted.


In July 2012, NMCP, ZMCP, RTI and the World Health Organization (WHO) met to explore a comprehensive plan for resistance mitigation in Tanzania. A one-week workshop was convened in Zanzibar, drawing local experts from diverse institutes (e.g., research and academic institutions, as well as NMCP, ZMCP, and WHO). Among other conclusions, the workshop recommended the adoption of an interim plan for insecticide resistance mitigation while the comprehensive plan is finalized. The idea was presented and approved by various partners, including NMCP, ZNMCP, RTI, and USAID. The long-term insecticide resistance mitigation plan is awaiting ratification and is expected to be completed in 2013.

Selection of Appropriate Insecticide

Selection of an IRS insecticide for a public health intervention is usually based on (1) approval by the World Health Organization Pesticide Evaluation Scheme (WHOPES); (2) approval by Zanzibar Food, Drugs and Cosmetics Board; (3) availability of a good profile on vector susceptibility in Zanzibar; and (4) expected longer residual duration compared to decreases in the frequency of spraying and reductions in cost.

RTI—in collaboration with ZMCP—selected bendiocarb (FICAM® wettable powder [WP]), an insecticide of the carbamate class, for the applications in Zanzibar

Assessing IRS Logistics

In Zanzibar, this activity was conducted in collaboration with ZMCP and district authorities in February 2013. The reassessment involved collecting updated information to facilitate the planning, designing, budgeting, implementation, and monitoring and evaluation (M&E) of IRS operations (see Box 2). An RTI Environmental Compliance Officer visited all IRS operational sites and temporary district storage facilities to determine the needs for repairs and refurbishment.


Box 2. Activities included in comprehensive logistics assessment

Data collected by logistics reassessment teams

♦ Updated demographic statistics

♦ Changes in administrative setup

♦ Updated meteorological indicators

♦ Updated epidemiological malaria data

♦ Estimate of average sprayable surface for insecticide quantification

Tasks performed by logistics reassessment teams

♦ Selection of target areas suitable for IRS implementation, according to strategic option (blanket or targeted spraying)

♦ Identification of new main regional warehouse

♦ Identification of refurbishment needs for IRS sites

♦ Redefinition of catchment areas and population for the respective IRS substations

♦ Calculation of total insecticide required per district and substation

♦ Quantification of human resources requirements per district and substation

♦ Realignment of the operational organogram

♦ Quantification of consumables and replacement/repair of spraying equipment and personal protective equipment (PPE)

♦ Setup of stakeholder teams, technical committees, and operations teams (e.g., logistics, advocacy and health education, vector control, M&E)

♦ Meetings with relevant partners/stakeholders; definition of roles and responsibilities

♦ Definition of a preliminary time frame for activities

♦ Tentative budget for the operation

Important considerations for the application of residual insecticides included the number of structures to be sprayed, as well as their type, location, number of eligible sprayable surfaces of different substrates, and accessibility.

Selecting the Ideal Spray Period and Preparing the Operations Plan

Rationale for Selection of Spray Period in Zanzibar

Malaria cases in Zanzibar tend to occur at higher rates between May and August. This is a result of higher-than-average precipitation, resulting from seasonal rainfall between early April and late May. As such, ZMCP and TVCSP decided to start IRS by mid-March to enable the insecticide residual effect to cover this period, thereby reducing transmission and eventually the number of cases than anticipated.

Spray Season

In Zanzibar, RTI, in collaboration with ZMCP, conducted the eighth round of IRS (second targeted round) in 9 out of 10 districts. The spray period was selected based on the same logistical and entomological rationale described above and timed for a minimal overlap with the previous round of implementation in order to optimize the


use of insecticide. Unlike 2012, only one spray round was conducted in all eligible areas to cover the May–August peak transmission period. It is hoped that the second spray round, scheduled for September–October 2013, will be conducted using a different class of insecticide as part of mitigating resistance to insecticide in the island. Table 3 shows the regional targets for 2013 IRS.

Table 3. Zanzibar regional targets Region/Zone Unguja Pemba Zanzibar

Eligible household 30,087 23,868 53,955

Eligible population 122,338 127,265 249,603

# Sites 6 4 10

# Wards (shehia) 72 36 108

Ward (shehia) per site 12 3 11

Village/site N/A N/A N/A

# Districts 5 4 9

Establish District IRS Management In Zanzibar, the functional IRS management and implementation units make up the District IRS Technical Team (DITT). The DITT is located at the zonal level in the two ZMCP offices in Zanzibar, in Unguja and in Wete, in Pemba. The DITT is chaired by the District Medical Officer (DMO) with support from Zonal Medical Officer. Members include the District Health Officer, District Administrative Secretary, and four more district technical staff. RTI supported the DITT through initial training in IRS implementation and by allocating supervisors and consultants during IRS operations for further on-the-job training team and mentoring.

Implementation teams (sub-units) for advocacy and health education, vector control, and M&E met daily during the IRS operations, while the DITT was scheduled to meet weekly.

Developing and Organizing the IRS Sites: Design and Phases RTI continued to maintain an IRS delivery model initiated in 2006. This model involves extensive use of human resources and deployment logistics. The program requires a high degree of organization and capacity (see Figure 7).


Figure 7. IRS teams organizational structure

The general TVCSP IRS design is based on the operation site. Each site has an operation target, ranging from 5,000 to 10,000 houses. The operation site receives adequate infrastructure for effluent waste disposal, sanitary accommodations for operators, and storage facilities. The operation site effort is led by a site manager supported by an average of four spray teams (ranging 2–8 persons per team) and 4–8 site attendants, depending on the size of the site. Time of operation per site, number of operation days, and allocated resources (e.g., human resources, insecticide, equipment, and consumables) are calculated based on targets. The TVCSP decided to select an average duration of operation of about 11 days per site.

There are seven operators per team in Zanzibar, with an average of 54 spray operators per site. Each team is headed by a team leader. The team leaders and spray operators are selected from the targeted communities. The operation site manager is assisted by support staff who maintain spray equipment, wash suits, clean the site, fetch water, and handle security. A level of effort of 10 sprayed houses per operator per day is used to develop the spray schedule and to monitor progress. An average of 30 liters of


water per each operator per day was calculated. Water for charging spray pumps was provided by households as operators moved from one house to the other.

The 2012–2013 IRS season covered a total of 10 operation sites in Zanzibar (one site per district and one site for the targeted Uzi satellite islands). All sites were refurbished/renovated before the start of the operations to comply with international and local environmental impact and mitigation measures for safe pesticide use, storage, and sound effluent waste disposal. The sites therefore complied with the Pesticide Storage and Stock Control/User Guidelines of WHO and the United Nations Food and Agriculture Organization (FAO).

Insecticide Quantification, Procurement, Safe Transport, and Storage The TVCSP technical team, in collaboration with the ZMCP, quantified the required bendiocarb insecticide during the logistical assessment after establishing the sizes and numbers of structures to be sprayed. The calculations were based on the dosage range 0.1–0.4 g active ingredient/m2 for bendiocarb WP. All insecticides, PPE, and other equipment were procured according to USAID and RTI policy. Insecticide samples received from the supplier were sent to Tropical Pesticide Research Institute (TPRI) and Zanzibar Food, Drugs and Cosmetics Board-designated reference laboratories to be analyzed for quality. Results from the analysis indicated a sufficient active potency level of the active ingredient for bendiocarb.

Insecticides and other IRS supplies were stored at the main warehouse in Zanzibar and distributed, as needed, to district sites when IRS was conducted.

Handling Equipment, Materials, and Vehicles The central RTI IRS unit provided quantification and procurement of insecticide, IRS equipment, PPE, and consumables. The quantification included the reconciliation of available supplies in the warehouses, replacement requirements, and coverage of new areas.

The RTI IRS unit also quantified vehicles for operator transport for each district and site. A total of 55 vehicles and 1 boat were needed to transport operators from IRS operational sites to targeted villages and to the islands of Zanzibar. All vehicles were inspected and certified by competent road and marine authorities. All vehicle drivers and boat captains were instructed on environmental mitigation measures during and after the end of spray operations.

Managing Human Resources for IRS Active IRS operations require a large number of temporary operational IRS field staff and other technical, coordination, mobilization and supervisory support staff. RTI, in collaboration with district authorities, recruited 866 temporary staff that were directly involved in the implementation of IRS in Zanzibar (see Table 4 and Annex B). The selection process was led by local government authorities and supervised by the delegated DITT and RTI personnel (see Box 3 for the selection criteria). Broad and equal opportunity representation from targeted communities was sought.


Table 4. Temporary staff recruited to support IRS operations

Unguja Pemba Zanzibar

Spray operators 315 294 609

Tem leaders 45 42 87

Site managers 6 4 10

Drivers 49 42 91

Pump technicians 12 12 24

Cleaners 5 4 9

Suit washers 13 12 25

Watchmen 10 8 18

Water fetchers 12 8 20

Storekeepers 5 4 9

Assistant storekeepers 6 5 11

Total IRS staff 478 435 913

Box 3. Criteria for IRS operators’ selection

♦ Age: 18–40 years

♦ Gender: Either (50% or more women)

♦ Education: Standard 7 and above and efficient in reading and writing Kiswahili

♦ Possession of a valid National Microfinance Bank (NMB) personal account

♦ Acceptance in the community

♦ Good enough health to carry pumps and walk long distances and negative pregnancy test results among women

♦ Physical and mental fitness

♦ Residence in the service area

♦ Possession of M-Pesa account with Vodacom mobile network

Mechanisms were set up to guarantee a transparent and fair process. However, even though gender balance was set as a selection criterion, only around 18% of the temporary laborers selected by the community were female.

The selected staff provided personal details, a photograph, medical certificate of good health, and bank account details. The RTI finance team transferred compensation for temporary staff to their personal bank accounts at regular intervals of two weeks.


The respective RTI offices filed all documents and provided an identity card. The selected individuals also signed a consent form. All staff were subjected to medical and physical examination. In addition, all female operators were tested for pregnancy prior to enrollment. Those found medically unfit and females who tested positive for pregnancy were excluded for medical safety reasons.

Staff Training

Training Modalities

Before IRS operations in Zanzibar, training was conducted for all cadres involved in the operation using the cascade mode. Through this approach, training of trainers (ToTs) were conducted first and then ToTs went to train the lower cadres. This training took place between January and March 2013.

Types of Training

ToT as well as training for spray operators, store keepers, site managers, and training for clinicians on insecticide poisoning management were conducted prior to IRS operations.

Training Tools

The staff trainings were performed using IRS modules developed by RTI in collaboration with ZMCP and FAO/WHO guidelines on insecticide storage and management.

Informing and Mobilizing Communities

Implementation of Information, Education, and Communication Activities (IEC): IEC Design in 2012–2013 Spray Season

IEC is an essential component for successful delivery of IRS at the community level. The ultimate purpose of this component is to inform and mobilize all residents in IRS-eligible areas to ensure their active participation in IRS activities and to increase the level of acceptance. In previous IRS rounds, interpersonal communication was used effectively to convey messages and information to the communities. The component also targets various stakeholders, including government leaders at regional, district, shehia, village, and hamlet levels.

During the 2012–2013 campaign, a cascade of events were initiated to reach every single household. The main actors of the IEC component were identified as the shehas, 4 shehia mobilizers, and a local councilor. The program approached these community leaders in a systematic way, facilitated by local government authorities to whom they were responsible.

Organization of Interpersonal Communication in Zanzibar

In Zanzibar, district authorities organized and supervised IEC. Three categories of mobilizers were identified at national, district, and shehia levels. A total of 34 district mobilizers were trained and responsible for supervising the respective shehia’s


mobilizers. Each shehia in the IRS eligible areas recruited five mobilizers to inform communities about IRS through house-to-house visits. At the national level, an IEC campaign was supervised by four health educators, two in Pemba and two in Unguja. Their role was to coordinate central (ZMCP) and district IEC activities. Apart from the house-to-house approach, the IEC campaign included audio programs, using radio and community announcements, that were broadcast through megaphones. Over 214,691 people (102,976 in Pemba and 111,715 in Unguja) were reached through such IEC efforts, of which 105,450 (49%) were males, and the remaining 109,241 (51%) were females. The spray schedule was planned in advance, in collaboration with shehia leaders, and shared with mobilizers at all levels.

Other IEC Supportive Activities

For IRS, interpersonal communication is the primary vehicle for communication in IEC. Interpersonal communication is supplemented with other routes of message delivery, including fact sheets, TV spots, radio spots, and mass meetings.

Printed IEC Materials

Approximately 150,000 fact sheets were distributed, targeting different groups who either used the materials: (1) for reference while educating others; or (2) to get more clarity on and reinforce messages previously communicated from other sources. Also, banners were provided for display at each of the 10 IRS operational sites

Monitoring the IRS Process

Monitoring of Training Activities

Before implementation of IRS, field trainings were conducted for various cadres in Zanzibar. The M&E unit at ZMCP was primarily responsible for tracking the number of people trained in different capacities in each of their respective districts. Training tools, such as enrollment sheets and summary sheets, were utilized with the help of the facilitators at every training. Trainees recorded their names and signatures on a sign-in form, and the number of participants were aggregated at the end of training sessions. M&E officers summarized the training outcomes, including the number of participants by gender, in pre-designed electronic MS Excel templates, which captured the number of trainees in each district by gender and cadre.

V. Implementation of IRS Activities

Quality Control of Spray A major challenge to conducting a successful IRS program is ensuring an acceptable quality of spray and that a large number of spray operators adhere to SOPs and best practices in their spray technique. Quality control of spraying is an integral part of IRS implementation. Quality control was maintained by conducting appropriate training supported by multilevel supervision of spray personnel.


The key personnel implementing quality control on the ground were the district supervisors (or the District Vector Control Officers [DVCO]), site managers, and team leaders, who are the immediate supervisors of the spray operators. During the 2012–2013 spray seasons, a number of innovations, which follow below, were introduced to facilitate their duties:

• Rigorous selection process to identify qualified candidates for the role of team leaders;

• Comprehensive training of team leaders; • Development of an original protocol for daily operators’ follow up on quality

of spraying during operations; • Introduction of quality assessment tools with a score system; • Empowerment of site managers to adopt disciplinary action in case of

deviation from SOPs; and • Introduction of segregation of duties for vector control officers to alleviate

them from other management duties and enable them to be dedicated to quality control.

DVCOs were tasked to perform full-time field supervision of team leaders and spray operators. Each team leader was tasked with intensively supervising four spray operators per day. The team leader assessed the operators and awarded performance scores. At the end of the day, he/she completed the summary form with recommendations on corrective measures.

Daily feedback to all operators was provided in the morning by site managers and team leaders after compiling the previous day’s reports.

Feedback concerning spray supervision was provided in the following areas: • Compliance with use of PPE; • Compliance with preparations of the household and general environmental

protection prior to spraying; • Compliance with spray techniques (insecticide dilution, pump pressure, speed

of movement, distance from the wall, and overlapping); • Coverage of eligible sprayable surfaces (e.g., rooms, corridors and ceiling); • Uniformity of insecticide concentration at all levels of spray surfaces (e.g.,

upper, middle, and lower); • Coverage of households targeted in the hamlet and in the village; • Documentation of the correct information/education messages delivered to

members of the sprayed households; • Appropriate recording of all indicators monitored; and • Good customer-service practices.

The newly developed system provided an action-oriented approach at IRS operational levels. Each site could evaluate each day’s performance and could take action on the


eventual gaps found. The district was able to access IRS quality reports through the VCO at weekly meetings.

Monitoring Performances of Spray Teams and Use of Insecticide The daily performance and output of every spray operator, team leader, and supervisor was tracked daily using data sheets (e.g., daily spray cards, team leader, and supervisor cards).

The data sheets reflected the number of structures sprayed per sachet of insecticide used. Through this method, the monitoring teams were able to detect operational problems. Recommendations were put in place immediately, as needed, to support the spray operations and to improve the quality of data on the IRS project.

The insecticide used was monitored by store keepers at the site store at district, regional, and zonal levels, with close collaboration from the environmental officers. The insecticides used were tracked using insecticide control books and forms. Other IRS supplies and equipment were tracked using books, such as store ledgers.

Environmental Monitoring and Mitigation Activities During IRS operations in Zanzibar, pre- and mid-spray environmental compliance inspections were conducted by the RTI Environmental Team in the respective districts. A total of three inspections were conducted at different stages of the operations. First round pre-environmental compliance inspections in Zanzibar were conducted in January 2013. Mid-spray compliance inspections for Zanzibar were conducted in March 2013 (see Annex K for environmental compliance reports).

Monitoring and Evaluation With IRS ongoing concurrently at several sites in multiple districts, systematic monitoring was established to follow up on the inputs, processes, and outputs (see Box 4).

The RTI M&E unit in conjunction with the SME unit at ZMCP was constantly involved in the collection and utilization of data before, during, and after spray operations. Relevant indicators were utilized to monitor performances, measure results, and ultimately maintain and/or improve the management of IRS. Daily monitoring was established during operations to ensure that processes and outcomes were tracked, allowing timely detection of gaps and constraints in order to trigger adequate responses, accordingly.


Box 4. Monitoring inputs, process, and outputs

Inputs

♦ Inputs—such as quantification of materials, PPE, and insecticide for procurement—as well as fuel consumption of vehicles—were tracked mainly before the start of IRS.

Processes

♦ The RTI M&E unit monitored spray performances, along with other indicators related to sensitizing communities before IRS despite being the most demanding component of the monitoring process. The training process for IRS staff was also monitored.

Outputs

♦ Output indicators—such as spray management, safety procedures used by operators, and house structures visited and sprayed—were also tracked consistently.

ZMCP and RTI supervised operations and facilitated the collation and collection of IRS data in the field. During spray campaigns, operators interviewed respondents of visited households and collected the required information on Spray Operator Forms. These were then aggregated by the team leaders in their respective Team Leader Forms. Eventually, the site manager followed the same process of aggregating the team leaders’ entries on specially designed Site Manager Forms.

At the end of each operation day, completed hard copies of spray forms were then delivered to the central data unit in ZMCP offices in Pemba and Unguja. These forms were sorted, filed, and then entered electronically in the IRS templates. The data entry team entered the Site Manager Spray Forms and the Team Leader Spray Forms into separate electronic IRS database templates.

These electronic templates generated reports on key spray performance indicators on a daily basis, which were used for interpretation and action by the IRS technical team, along with the district teams.

The technical team monitored the daily performances up to the site level in IRS districts. Among the numerous information collected, the number of structures sprayed (and not sprayed) was assessed against the daily target. The number of structures sprayed per day was also captured. Insecticide consumption and stock for each day was also captured and monitored. Feedback on performances was periodically relayed to site managers and supervisors, as well as DMOs and the District Commissioners Office to assess progress and respond to gaps, if any, in a timely manner.

In addition, vehicle and fuel usage, equipment and consumable stocks, training, quality of spray, and compliance measures were tracked in a timely manner.

After the completion of IRS, RTI produced summary tables, charts, and maps for dissemination to partners and stakeholders on progress and results achieved.


Logistics

Storage and Movement of Insecticide and Other Supplies

Insecticide and other IRS supplies were stored at the warehouses provided by the Ministry of Health and Social Welfare (MoHSW) at regional level and district levels. TVCSP rents a district warehouse only in North A District. Zonal and district storage sites are managed by RTI staff while district and subsite stores are managed by temporary hired staff, who work as district store keepers and site managers for the site substores. A total of 14,122 sachets (1,765 kg) of FICAM were used out of the 27,323 sachets (3,415 kg) initially in balance leaving a balance of 13, 201 sachets (5,181 kg). Tables 5 and 6 show the movement of IRS items—such as PPE, which includes gloves, masks, boots, and overalls, as well as spray pumps—according to the number of spray personnel on the ground during IRS operations.

Table 5. PPE Consumables Movements by Type and Warehouse

Gloves Mask

Warehouse Initial Used Remaining Initial Used Remaining

Zanzibar 2,165 1,400 765 7,216 6,400 816

Total 2,165 1,400 765 7,216 6,400 816


Table 6. Selected PPE and spray equipment movement by type and warehouse

Spray Pumps Hudson Expert Overall Boots

Warehouse Initial Received Remaining Intact Worn out Initial Received Remaining Intact

Worn out Initial Received Remaining Intact

Worn out

Zanzibar 790 0 790 790 0 2,277 0 2,277 2,277 0 1,007 0 1,007 1,007 0

Total 790 0 790 70 0 2,277 0 2,277 2,277 0 1,007 0 1,007 1,007 0


Provision of Transport for Operators and Supervisors During IRS operations, numerous vehicles were hired to transport operators at district levels. Supervisors at national and district levels were provided with fuel to run official transport used for IRS. The operators were transported by vans; where not feasible, 4-wheel drive vehicles or trucks were used. On the islands, both operators and supervisors were transported daily by hired boats. Operators were transported from IRS operational sites to targeted villages located 5–15 km away. Efficient transportation arrangements increased the operations’ effectiveness by reducing travel time. This also provided the ideal controlled situation for transporting spray equipment and insecticide. Transportation for supervisors (average two per district) was provided daily to reach different locations with ongoing IRS operations. Table 7 indicates the number of cars and boats hired during the last IRS round.

Table 7. Vehicles hired during IRS operations

Zanzibar Total

Vehicles

Operators cars 46 46

Supervisor cars 9 9

Boats 1 1

Total vehicles 56 56

End of Spray Activities

Post-spray Environmental Compliance Inspections and Site Decontamination and Decommissioning

RTI Environmental Compliance Officers conducted post-spray environmental compliance inspections in all IRS sites of Zanzibar. IRS site decontamination and decommissioning was carried out by making sites and storage areas safe for the surrounding community. After the inspections, the IRS operational sites were handed over to the local authorities for safe custody until the next IRS operation.

Solid Waste Disposal

After the end of IRS operations, all insecticide-contaminated waste were transported back to the zonal warehouse for storage to await disposal in a proper incinerating facilities that met international disposal requirements for contaminated insecticide. RTI in collaboration with ZMCP continued incinerating insecticide- contaminated wastes stored in the zonal warehouse using a project incinerator located at Kivunge Hospital in North A District. To date, approximately 600 kgs of IRS waste from this and previous rounds has been incinerated.


End of Spray Inventory in Storage Facilities

End of spray inventory was conducted at three levels—site sub-store, district, and zonal stores. The inventory process guides the tasks of equipment maintenance and repair, accounting for losses, and forecasts procurement for the following round.

VI. IRS Results

IRS Results—Zanzibar

Population and House Structures Found

House Structure Characteristics and Population Profile

In Zanzibar, 53,955 were visited. In a typical house structure in Zanzibar, the wall surface area was 86 m2 and 54 m2 in Unguja and Pemba, respectively (see Table 8).

Table 9 presents the population breakdown of households visited in Zanzibar. The family size was 4.8 per household in Zanzibar. Figure 8 shows the family size breakdown for each of the IRS districts. In total, 259,899 people were recorded during spray operations, of which 20% were high-risk groups (pregnant women and U5 children).

A summary of household characteristics and population by district, region, and zone is presented in Annex C.

Table 8. Characteristics of visited households


House structures found 30,087 23,868 53,955

Average # of rooms per house structure

4.7 5.0 4.9

Average house structure size (sqm)

86 54 70

Table 9. Population recorded during spray in visited households


Population visited Total 132,634 127,265 259,899

Average Family size 4 5 5



Risk group

U5 (%) 20,919 (16%) 24,289 (19%) 45,208 (17%)

Pregnant women (%) 2,874 (2%) 3,039 (2%) 5,913 (2%)

Five years and above

Male (%) 54,340 (41%) 51,110 (40%) 105,450 (41%)

Female (%) 54,501 (41%) 48,827 (38%) 103,328 (40%)

Figure 8. Family size per district, Zanzibar

Spray Results

Main Spray Indicators

All eligible houses were visited in Zanzibar (see Table 10). Spray coverage reflects the houses that were visited and sprayed out of those targeted (i.e., eligible). This coverage was estimated at 96% (see Figure 9).

In Zanzibar, the range was between 94% (North A District in Unguja Island) and 100% (Micheweni District in Pemba Island).

A summary of spray indicators by district region and zone are reported in Annex D.


Table 10. Main spray indicators in Zanzibar

House structures Unguja Pemba Zanzibar

Eligible 30,087 23,868 53,955

Visited 30,087 23,868 53,955

Visited % 100% 100% 100%

Sprayed 28,527 23,377 51,904

Visited and not sprayed 1,560 491 2,051

Not reached - - -

Spray coverage 94.8% 97.9% 96.2%

Figure 9. Spray coverage in districts of Zanzibar

Use of Insecticides

Over 14,000 sachets were used, with an average consumption of 0.29 sachets per house structure in this round of IRS in Zanzibar (see Table 11 and Figure 10).


Table 11. Use of insecticide


Bendiocarb sachets used 9,847 5,035 14,882

Total kgs used 1,231 629 1,860

Sachets per house structure 0.35 0.22 0.29

Figure 10. Sachet per house structure ratio by district in Zanzibar

Population Protected

A total of 250,505 people were protected with IRS in Zanzibar. The estimated number of pregnant women and U5 children protected by IRS2 was 5,703 and 43,635, respectively (see Table 12 and Annex E).

Table 12. Population protected by spray zone

Population protected Unguja Pemba Zanzibar

U5 19,843 23,792 43,635

Pregnant women 2,725 2,978 5,703

Five years and above male 51,552 50,093 101,645

2 As per PMI’s definition, the protected risk groups are those living in houses that have been sprayed.


Population protected Unguja Pemba Zanzibar

Five years and above female 51,673 47,850 99,523

Five years and above all 103,225 97,943 201,168

Eligible Population 132,634 127,265 259,899

Population Protected 125,793 124,712 250,505

Percent Protected 95% 97% 96%

Usage of ITNs

In Zanzibar, about 5,082 (89%) of pregnant women and 39,222 (90%) of U5 children were declared to have slept under ITNs the previous night in the house structure visited during this reporting period (see Table 13 and Annex F).

Figure 11 illustrates ITN usage in Pemba and Unguja among pregnant women, U5 children, and the population above five years of age.

Table 13. LLIN usage by region and zone by age group

Group Unguja Pemba Zanzibar

U5

Slept under LLIN/ITN previous night

17,741 21,481 39,222

Net usage % (89%) (92%) (90%)

Pregnant women


2,305 2,777 5,082

Net usage % (86%) (93%) (89%)



79,236 76,405 155,641

Net usage % (80%) (81%) (80%)


Figure 11. 2013 universal net coverage by district, Zanzibar

VII. Monitoring Insecticide After Spray: Insecticide Decay Rate

Monitoring Insecticide Decay by Using Cone Bioassay In Unguja, the bioassay results after 13 and 30 days following spraying various surfaces with bendiocarb (see Figures 12 and 13 below) showed compelling residues on all surfaces (84%) except for mud surfaces, which were a bit low (40% knock down and 82% 24-hour mortality). The low residues could be attributed to the fact that the soil has a high absorption capacity. However, in Pemba, mortality rates among mosquitoes exposed to treated surfaces varied according to the type of walls on which insecticide was applied. There was a significant difference in mortality between oil-painted surfaces and other treated surfaces. However, there is a rapid decline in effectiveness in cement and lime wash. Special considerations must be taken where ever these types of structures are increasingly developed.


Figure 12. Bioassay results March 2013

Figure 13. Efficacy of bendiocarb at Shungi (Pemba) 30 days post spraying


Section C: Tanzania Mainland

VIII. IRS in the Context of Malaria Strategies in Mainland Tanzania

Malaria Medium-Term Strategic Plan for Mainland Tanzania In Mainland Tanzania, the goal of the second 2008–2013 Medium-Term Strategic Plan is to reduce malaria prevalence by 50% by the end of 2013. The main targets are as follows:

• 80% of malaria patients diagnosed and treated with effective antimalarial medicines, such as ACT, within 24 hours of the onset of fever;

• 80% of all pregnant women receive two or more doses of IPTp; • 80% of people in malarious areas protected through the use of ITNs; • 80% of people in target areas protected through IRS; and • Early detection and containment of 80% of malaria epidemics within two

weeks from onset.

The current plan aims to rapidly scale up the levels of coverage for the main interventions and includes a comprehensive array of activities such as IRS, LLIN distribution, improved case management, as well as strengthening malaria surveillance systems to inform decision makers and institutes, timely preventive measures.

Recent History of IRS in Mainland Tanzania

Mainland Tanzania

In its 2008–2013 Medium-Term Strategic Plan, the NMCP targets IRS scale up from 1 district in 2007 to cover about 60 districts by 2013, protecting 50% of the country’s population. This scale-up will be implemented through the NMCP’s Integrated Malaria Vector Control (IMVC) strategy, which includes malaria preventive methods such as ITNs and LLINs, LSM in large urbanized areas, and effective environmental management.

PMI began supporting IRS in Mainland Tanzania in 2007. PMI first contracted RTI to provide technical support to the MoHSW in controlling malaria outbreaks in the malaria-unstable areas of Karagwe and Muleba districts in Kagera Region. In 2009, IRS operations were scaled up in Kagera to cover the remaining stable and high-transmission areas covering the other five districts (Biharamuro, Bukoba Rural, Chato, Misenyi, and Ngara). In 2010, IRS operations were scaled up to cover 11 districts of Mara and Mwanza regions (see Table 14). In 2012, a second IRS round was conducted in five and six districts of Mara and Mwanza Regions respectively,


while a third round took place in five districts of Kagera Region. In Muleba District, a targeted spray was initiated in 2012; in Karagwe District, another blanket spray was conducted. Pyrethroids (lambda-cyhalothrin) were used for IRS in the area from 2007. In the 2011–2012 IRS season, bendiocarb was introduced in Muleba and Karagwe districts.


Table 14. Spray performance in Mainland Tanzania (structures sprayed), 2007–2013

Houses eligible, sprayed, and percent covered

Region/ Districts

2006–2007 2007–2008 2008–2009 2009–2010 2010–2011 2011–2012 2012–2013

Kagera Region

Biharamulo Sprayed Visited (coverage)

— — — 31,382 32,253 (97.3%)

38,032 40,304 (94.4%)

40,331 44,510 (91%)

— 13,548 14,768 (92%)

—

Blanket Blanket Blanket Target

Bukoba R Sprayed Visited (coverage)

— — — 55,183 57,783 (95.5%)

60,548 62,730 (96.5%)

58,925 61,312 (96%)

— 16,708 17,159 (97%)

18,235 18,303 (99%)

Blanket Blanket Blanket Target Target

Chato Sprayed Visited (coverage)

— — —

56,233 57,972 (97.0%) Blanket

60,571 62,337 (97.2%) Blanket

58,319 61,259 (95%) Blanket

—

20,514 21,604 (95%) Target

—

Karagwe Sprayed Visited (coverage)

—

59,177 60,078 (98.5%) Selected

103,631 107,057 (96.8%) Blanket

111,047 111,270 (99.8%) Blanket

115,669 115,972 (99.7%) Blanket

109,102 117,277 (93%) Blanket

—

52,331 55,930 (94%) Target

30,073 30,791 (98%) Target

Missenyi Sprayed Visited (coverage)

— — — 36,891 38,751 (95.2%)

37,698 40,135 (93.9%)

37,580 40,813 (92%)

— 11,319 11,595 (98%)

11,582 11,871 (98%)

Blanket Blanket Blanket Target Target



Region/ Districts

2006–2007 2007–2008 2008–2009 2009–2010 2010–2011 2011–2012 2012–2013

Muleba Sprayed Visited (coverage)

34,745 36,612 (94.9%) Selected

36,371 36,850 (98.7%) Selected

81,586 85,163 (95.8%) Blanket

86,163 86,336 (99.8%) Blanket

101,394 101,491 (99.9%) Blanket

52,312 56,148 (93%) Target

37,874 39,946 (95%) Target

16,692 17,738 (94%) Target

16,287 17,766 (92%) Target

Ngara Sprayed Visited (coverage)

— — — 48,219 54,118 (89.1%)

46,264 54,578 (84.8%)

46,069 54,066 (85%)

— 13,126 15,600 (84%)

—

Blanket Blanket Blanket Target

Mara Region

Bunda Sprayed Visited (coverage)

— — — — 45,811 51,710 (88.6%)

54,744 57,457 (95%)

— 39,519 41,731 (95%)

8,238 8,750 (94%)

Blanket Blanket Target Target

Musoma Sprayed Visited (coverage)

— — — — 60,363 70,597 (85.5%)

73,157 79,401 (92%)

— 53,549 54,981 (97%)

8,861 11,430 (78%)


Rorya Sprayed Visited (coverage)

— — — — 47,200 49,306 (95.7%)

70,218 74,665 (94%)

— 28,867 30,587 (94%)

—

Blanket Blanket Target



Region/ Districts

2006–2007 2007–2008 2008–2009 2009–2010 2010–2011 2011–2012 2012–2013

Serengeti Sprayed Visited (coverage)

— — — — 58,993 59,366 (99.4%)

51,761 55,614 (93%)

— 39,952 43,277 (92%)

—


Tarime Sprayed Visited (coverage)

— — — — 53,136 54,838 (96.9%)

74,645 82,363 (91%)

— 42,621 43,764 (97%)

—


Mwanza Region

Geita Sprayed Visited (coverage)

— — — — 127,075 127,454 (99.7%)

123,196 130,475 (94%)

— 75,199 80,305 (94%)

—


Geita Town Sprayed Visited (coverage)

— — — — — 18,206 20,193 (90%)

— 20,830 22,374 (93%)

—

Kwimba Sprayed Visited (coverage)

— — — — 52,718 58,180 (91.7%)

57,467 61,348 (94%)

— 39,272 40,372 (97%)

6,441 7,186 (90%)


Magu Sprayed — — — — 65,462 75,218 — 48,463 8,301



Region/ Districts

2006–2007 2007–2008 2008–2009 2009–2010 2010–2011 2011–2012 2012–2013

Visited (coverage)

78,767 (83.1%)

81,228 (93%)

52,356 (93%)

9,468 (88%)


Missungwi Sprayed Visited (coverage)

— — — — 38,693 43,839 (89.3%)

45,385 49,154 (92%)

— 32,184 33,243 (97%)

6,765 6,866 (99%)


Sengerema Sprayed Visited (coverage)

— — — — 84,558 87,134 (97.0%)

86,065 91,547 (94%)

— 63,197 64,721 (98%)


Ukerewe Sprayed Visited (coverage)

— — — — 50,436 52,859 (95.4%)

53,520 55,229 (97%)

— 31,255 33,300 (94%)


Total Sprayed (coverage)

34,745 (94.9%)

95,548 (98.6%)

185,217 (96.3%)

425,118 (96.2%)

1,144,621 (94.5%)

1,224,095 (93%)

659,146 (95%)

114,783 (94%)


IRS Strategic Design for Mainland Tanzania

Mainland Tanzania

In the NMCP 2008–2013 Medium-Term Strategic Plan, IRS is envisaged as being used in various settings and in an integrated manner, with other vector control interventions, mainly LLINs. The current strategic design for IRS is oriented with consideration of the geographic and climatic diversity in Mainland Tanzania and the consequent variation in the malaria situation. The strategic design for IRS is expected to provide a rapid “knock-down” effect (generally over a 1–2 year period of blanket spraying) on malaria transmission and prevalence. The knock-down phase should, at least, halve the malaria cases, ideally reducing them by up to 75%. After this initial knock-down phase, IRS will contribute to the maintenance phase (or “keep-down” phase, which involves another one to two years of targeted spraying in large geographic areas) to keep the area at its anticipated low endemic level. Following the introduction of appropriate surveillance and a strategy to maintain high coverage of LLINs, IRS will be scaled down to cover selected areas (through an additional two years of IRS campaigns). After achieving the above milestones, IRS will be implemented on a targeted basis to preempt or contain focal transmission in identified hot spots to prevent malaria resurgence (see Figure 14). This ultimate step requires establishing effective surveillance and epidemic preparedness and response systems.

Figure 14. Strategic design for IRS implementation in Mainland Tanzania

1st 2nd 3rd 4th 5th

Knock down 1 2

Keep down/Targeted

Targeted/Focal

Since the inception of IRS in Muleba and Karagwe districts of Kagera Region in 2007 and 2008, respectively, the intervention has expanded to cover all 18 districts of the Lake Zone. Currently, all districts have transitioned from knock-down to targeted spraying. While knock down was implemented as blanket spraying, keep-down envisages targeting areas in which malaria reduction has not reached 75% from the pre-IRS levels.

Spray Seasons IRS operations in the Lake Zone were conducted in two seasons (see Figure 15)— December 2012–March 2013 (season one) and May–June 2013 (season two). Within the seasons, IRS operations are organized in phases. The two approaches, seasons and phases, provide the following advantages (1) provide ideal logistics for the operations


(minimal rainy days) and (2) maximize human protection during the transmission peaks, and (3) optimize the use of human resources for training and supervision. Figure 15 shows the timing of IRS in relation to precipitation and malaria transmission for the Lake Zone. It also illustrates the type of insecticide and estimated decay rate, which was used during this round in the respective districts.

Selection of Eligible Spray Areas

Mainland Tanzania

Selection of eligible areas for IRS in 2012–2013 was influenced by a number of factors, such as MOP targets, changes of IRS from blanket spraying to targeted spraying among all three regions in the Lake Zone, and change of insecticides as means of resistance mitigation plan. The MOP for 2012–2013 allocated 800,000 house structures to be sprayed. This was lower by 400,000 when compared to the 2011–2012 target of 1,200,000.

The other factor considered was insecticide resistance mitigation. Prior to IRS in 2012–2013, NMCP in collaboration with partners developed an interim plan for insecticide resistance mitigation intended to guide implementation of IRS for 2012–2013. The interim plan provided gradual change from pyrethroids to other insecticide classes, such as carbamates, as shown in Table 15.


Table 15. Number of eligible structures, previous rounds IRS, strategic phase, frequency of spraying, and insecticide class used in 2013 per district

Region/District Eligible

Structures targeted

# of previous IRS rounds

IRS strategic

phase Type of Spray

Proportion of eligible structures

Frequency of spray

Insecticide class used

KAGERA

Missenyi, Chato, Biharamulo, Ngara, Bukoba

159,208 3

Keep down

Targeted 66%

Once or twice depending on transmission pattern

Carbamate

Insecticide resistance management

Muleba, Karagwe 65,765 4-6

Outbreak control

Targeted / Focal 33% Twice Carbamate


Total KAGERA 224,973

MWANZA

Kwimba, Missungwi, Magu, Geita, Sengerema, Ukerewe

238,710 2 Keep down Targeted 80% Once Pyrethroid


Region/District Eligible

Structures targeted

# of previous IRS rounds

IRS strategic

phase Type of Spray

Proportion of eligible structures

Frequency of spray

Insecticide class used

Kwimba, Missungwi, Magu, Geita, Sengerema, Ukerewe

120,503 2

Keep down

Targeted 75%


Carbamate


Total MWANZA 359,213

MARA

Bunda, Musoma Rural, Rorya, Tarime, Serengeti

168,753 2 Keep down Targeted 80% Once Pyrethroid

Bunda, Musoma Rural, Rorya, Tarime, Serengeti

85,188 2

Keep down

Targeted 75%


Carbamate


Total MARA 253,941

Total Lake Zone 838,127


Inclusion Criteria

♦ The higher the malaria incidence, the higher likelihood it is to be included

♦ Malaria incidence was also used to allocate insecticide with carbamate allocated in areas with highest incidence

♦ The lower the LLIN coverage, the higher likelihood it is to be included

Exclusion Criteria

♦ Urban areas

♦ Low malaria incidence (<10%)

♦ Small highlands with high percentage on non-sprayable structures

Based on the interim resistance management plan, RTI in collaboration with beneficiary districts developed and employed criteria for selection of eligible house structures for spraying (see Box 5). The criteria included malaria incidence at the village level (the main criteria), possession of LLINs, and rural urban setting (the urban settings were strictly excluded).

The process of stratification included data collection from 844 health facilities among which 341 were from Mwanza, 265 from Kagera, and 238 from Mara. MTUHA Book 23 was used as a source of malaria cases. Names and total population of services area per health facility were collected. Furthermore, names of catchment areas per heath facility and geolocation of each health facility were collected.

Box 5. Inclusion and Exclusion Criteria for Targeted IRS Approach

IX. 2012–2013 IRS Preliminary Activities

Assessing the Environment and Planning Mitigation Options for the Safer Use of Pesticides

Environmental Assessment

As was the case in Zanzibar (see Section Environmental Assessment under Section B—Zanzibar), RTI in collaboration with NMCP complied with PEA requirements by seeking an insecticide importation permit from TPRI in December 2012. This fulfilled the Plant Protection Act of 1997, which regulates importation of insecticides in Tanzania.

Insecticide Management and Environmental Mitigation Plan

The process of insecticide management and environmental mitigation measures in Mainland Tanzania were almost similar to Zanzibar (see Insecticide Management and Environmental Mitigation Plan under Section B—Zanzibar), with the exception

3 Mfumo wa Taarifa za Uendeshaji wa Huduma za Afya (MTUHA) is part of the HMIS, which collects the main parameters of different diseases within the health facilities, including malaria.


of the storage facility levels, which had four levels: (1) zonal (two permanent warehouses); (2) regional (three warehouses); (3) district (18 temporary stores); and (4) and IRS sites (129 temporary IRS sub-stores). A total of 129 effluent waste disposal structures and temporary storage and sanitation facilities were repaired/refurbished in preparation for IRS operations.

Selection and Management of Insecticide for IRS

Insecticide Resistance in Mainland Tanzania

Pyrethroid resistance was once again reported in several districts in Mainland Tanzania in 2012. NIMR and Malaria Prevention Trial (PAMVERC) reported important insecticide resistance to pyrethroids in anopheline mosquitoes in Muleba District. There is evidence that continuous use of the same class of insecticide for IRS and LLIN, as well as for agriculture, may be associated with the observed evolution of resistance.

Insecticide Resistance Mitigation Plan

In order to mitigate the vector resistance to pyrethroid insecticide, RTI, in collaboration with NMCP, embarked on developing an insecticide resistance mitigation plan (see Insecticide Resistance Mitigation Plan under Section B—Zanzibar). The interim plan recommends replacing pyrethroids with carbamates for IRS in a rotational strategy for at least two years until new formulations become available. Meanwhile monitoring vectors for their susceptibility to a range of insecticides was intensified. With the above considerations, a selection of bendiocarb (FICAM® WP) and deltamethrin (K-Othrine) were chosen for the operations.

The insecticides used were a carbamate with a residual effect of 2–4 months, per IQK data collected in Karagwe and Muleba districts. The other insecticide was deltamethrin, which has an anticipated residual time of 3–6 months. Based on these data and onset of rainfall, some areas sprayed with carbamate in December–February 2013 were re-sprayed again with the same class of insecticide in May 2013. These districts included Karagwe, Muleba, Missenyi, and Bukoba in Kagera Region; Magu, Kwimba, and Misungwi in Mwanza Region; and Bunda and Musoma in Mara Region.

Assessing IRS Logistics In November 2012, RTI and NMCP staff, in collaboration with regional and district authorities, conducted a logistics reassessment in all IRS districts in the Lake Zone. The process followed similar steps as in Zanzibar (see Assessing IRS Logistics under Section B—Zanzibar).

Selecting the Ideal Spray Period and Preparing the Operations Plan

Rationale for Selection of Spraying Period in Lake Zone

See Rationale for Selection of Spraying Period under Section B—Zanzibar.


Figure 15. Spray seasons in Mainland Tanzania, November 2012–May 2013

Determinant Insecticide Duration (months)

Oct 2012

Nov 2012

Dec 2012

Jan 2013

Feb 2013

Mar 2013

Apr 2013

May 2013

Jun 2013

Jul 2013

Aug 2013

Sep 2013

Start Date

End Date Districts

Precipitation

Vector Abundance

Malaria Incidence

Kagera Season 1

Bendiocarb 2 to 6

X May-13

4 Dec

20 Dec

Karagwe

Kagera Season 2

X May-13

21 Jan

2 Feb

Bukoba, Muleba, Missenyl

Zanzibar X

Kagera Season 2b

Dec 13

X 11 Feb

22 Feb

Ngara, Biharamulo

Kagera Season 3

X 27 Feb

12 Mar

Chato

Mwanza Season 1

X May 13

24 Jan

15 Feb

Kwimba, Magu, Missungwi

Mwanza Season 2

Dec 13

X 25-Feb

28-Mar

Geita, Sengerema, Ukerewe

X May 24- 12- Bunda,


Determinant Insecticide Duration (months)

Oct 2012

Nov 2012

Dec 2012

Jan 2013

Feb 2013

Mar 2013

Apr 2013

May 2013

Jun 2013

Jul 2013

Aug 2013

Sep 2013

Start Date

End Date Districts

Mara Season 1

13 Jan Feb Musoma

Mara Season 2

Dec 13

X 11-Feb

28-Feb Serengeti

Mara Season 2b

Dec 13

X 11-Mar

28-Mar

Rorya, Tarime

Mwanza Season 1

Deltamethrin 3 to 6

X 24-Jan

15-Feb

Kwimba, Magu, Missungwi

Mwanza Season 2

X 25-Feb

28-Mar

Geita, Sengerema, Ukerewe

Mara Season 1

X 24-Jan

12-Feb

Bunda, Musoma

Mara Season 2

X 11-Feb

28-Feb Serengeti

Mara Season 2b

X 11-Mar

28-Mar

Rorya, Tarime


Setting the Structure Targets Based on the targeted IRS approach, eligible household targets for the Lake Zone were captured from household registers, which were established in the last IRS round, as well as actual performance data captured on spray cards. Using these two sources, the targeted house structures and population were then updated accordingly for this IRS season for each of the regions, districts, wards, and villages.

Establish District IRS Management In Mainland Tanzania, the basic IRS management and implementation unit is the DITT. Under the DITT, 18 District IRS Technical Committees (DITCs) were established, one in each district.

In IRS campaigns conducted in 2012–2013, the DITT composition remained the same as 2011–2012, and it was chaired by the District Medical Officer (DMO). Other members included five main staff positions: (1) Malaria Integrated Management of Childhood Illness (IMCI) focal person, (2) vector control specialist, (3) data manager, (4) logistics officer/storekeeper, and (5) health education focal persons (see Figure 16).

The Malaria IMCI focal person was selected as the overall IRS coordinator and was responsible for the day-to-day implementation of the activities.

RTI teamed with DITT during the initial training and appointed supervisors and consultants during IRS operations for further on-the-job training and mentoring. In addition, an overall RTI supervisor from the RTI zonal or regional office was appointed for each district.

Figure 16. Organizational structures for district IRS implementation teams


Developing and Organizing the IRS Sites RTI continued to maintain the IRS delivery model initiated in 2006.This model involves extensive use of human resources and deployment logistics. The program requires a high degree of organization capacity (see Developing and Organizing the IRS Sites: Design and Phases under section B—Zanzibar).

Following this delivery model, the 2012–2013 IRS season covered a total of 167 operation sites in Mainland Tanzania—six less than in the previous season due to the scale-down in a number of areas within the three regions of the Lake Zone.

Insecticide Quantification, Procurement, Safe Transport, and Storage The TVCSP technical team, in collaboration with the NMCP, quantified the deltamethrin and bendiocarb requirements during the logistical assessment and after establishing the sizes and numbers of structures to be sprayed. The quantifications of calculations were based on the dosage range 0.02–0.03 g active ingredient/m2 for deltamethrin (CS) and 0.1–0.4 g active ingredient /m2 for bendiocarb WP. The logistics assessment anticipated a total of around 840,000 structures to be sprayed in Mainland Tanzania. Based on the above assumptions, 11,199 liters of K-Othrine® WP and 23,686 kg of FICAM® WP were quantified and procured and then transported from Dar es Salaam to the zonal warehouse in Mwanza and Bukoba regional warehouses.

Handling Equipment, Materials, and Vehicles With the exception of determining quantities, the process of equipment, material, and vehicle handling was similar to Zanzibar (see Handling Equipment, Materials, and Vehicles under Section B—Zanzibar)A total of 455 vehicles were needed to transport operators from IRS sites to targeted villages in both the first and second cycles of IRS. Insecticide and other IRS supplies were stored and distributed at four levels (see Figure 17)—from zonal to regional warehouses under the control of the TVCSP logistics team and from district to temporary storage facilities of IRS staging sites under the management of the TVCSP technical team. Special transport was provided for distribution at all four levels.

The logistics for insecticide storage and other IRS materials was organized by four levels. The highest level is the zonal warehouse, which receives supplies from domestic and international suppliers and serves three regions of Mwanza, Kagera, and Mara. From the zonal level, supplies are distributed to regional warehouses one month before IRS; from the regional warehouses, supplies are distributed to 18 districts stores (six in Mwanza, seven in Kagera, and five in Mara). Two weeks before IRS operations, supplies are transported from the district stores to the 128 IRS sites stores, where IRS activities are conducted on a day-to-day basis. Throughout, distribution is guided by quantification needs at each level.


Figure 17. Types and number of storage facilities by levels and responsible TVCSP team

Managing Human Resources for IRS TVCSP in partnership with the DITT recruited 7,222 temporary staff who were directly involved in the implementation of IRS (see Table 16). The selection process was led by local government authorities and supervised by the delegated DITT and RTI personnel. Criteria for selection of seasonal staff was similar to Zanzibar (see Managing Human Resources for IRS under Section B—Zanzibar).

Overall figures show that 70% of staff involved in operations was male, although RTI and DITT always make strong efforts to improve the target for female involvement in IRS operations and to meet the USAID target (50%-50%). Table 17 presents a breakdown of temporary staff recruited by gender.

Table 16. Temporary staff recruited to support IRS operations

Kagera Region

Mara Region

Mwanza Region

Total Lake Zone

Spray operators 1,522 1,524 1,827 4,873

Tem leaders 189 191 228 608

Site managers 59 48 60 167

Drivers 94 94 115 303

Pump technicians 96 48 80 224


Kagera Region

Mara Region

Mwanza Region

Total Lake Zone

Cleaners 58 48 60 166

Suit washers 58 48 60 166

Watchmen 116 96 120 332

Water fetchers 102 120 161 383

Storekeepers - - - -

Assistant storekeepers - - - -

Total IRS staff 2,294 2,217 2,711 7,222

Table 17. Proportion of temporary staff recruited during IRS campaign, by gender

Staff cadre Male Female

IRS field staff

Team leaders and site managers 72% 28%

Drivers 100% 0%

Spray operators and site attendants 67% 33%

IRS teams total 69% 31%

District staff

Clinician trainer of trainers – –

Clinician 71% 29%

Data management specialists 56% 44%

DITT 76% 24%

Master trainers, IEC 50% 50%

Master trainers, IRS 70% 30%

Storekeepers 84% 16%

Field and District IRS staff total 70% 30%


Informing and Mobilizing Communities

Advocacy to Local Government Authorities: Region, District, Division, Ward, and Village Levels

In implementing IRS in 2012–2013, IEC/BCC continued to be an essential component for successful delivery at all levels of influence such as regional, district, division, ward, and the community levels (i.e., village and hamlet levels). As part of this component’s scope, the TVCSP technical team identified local government authorities (regional and district local authorities and ward and village executive officers) to serve as key actors in leading IEC activities (see Table 18).

TVCSP staff in collaboration with the respective DITT sensitized local government authorities and mobilized them to provide needed support for the implementation of IRS. Regional and district IRS advocacy committee meetings were organized in all 3 regions and 18 districts. In all, 600 participants attended regional-, district-, and ward-level meetings.

Implementation of Information, Education, and Communication Activities: IEC Design in 2012–2013 Spray Season

The ultimate purpose of this component is to inform and mobilize decision makers and all residents in IRS-eligible areas to increase the level of acceptance and ensure their active participation in IRS activities. IEC/BCC was conducted vertically from the regional level to the household (see Figure 18). The major route of communication was interpersonal communication through hamlet leaders to family members

Figure 18. Organization of IEC/BCC from region to community level

The cascade illustrated in Figure 18 involved 3 regions, 18 districts, 457 wards, 1,294 villages and 7,536 hamlets. Through this cascade, TVCSP’s IRS message reached an estimated 3 million people. The key actors and targets involved in this BCC approach are listed in Table 18.


Table 18. Key IEC actors and targets by category

IEC/BCC Actor Targeted Level Number of People Targeted

Regional IEC coordinator 3 regional IRS advocacy meetings 60

District IEC coordinator 18 District advocacy meetings 540

Site IEC Mobilizers Ward and village authorities 457 ward 1,294 village authorities

Hamlet leaders Household members (5yrs and above) 3,018,935

In addition to person-to-person communication, other means of communication that supported IEC/BCC for IRS included the following:

• Radio programs: Four national and local stations were hired to air 42 radio spots that propagated IRS messages. These radio stations include RFA in Mwanza, Radio FADECO in Karagwe, Radio Kasibante in Bukoba District, and Radio Kwizera in Ngara District.

• Use of megaphones: SIMs used megaphones in communities to announce the date of IRS a particular village.

• Use of tear-off sheets: Tear-off sheets were produced and included simple message such as what actions household members should take before, during, and after IRS. These were distributed during IEC campaigns for IRS.

TVCSP maintained the same IEC design that was introduced in the second phase of the 2011–2012 IRS campaign. The cascade of events to reach the households was modified to simplify and shorten the messaging from seven steps to four. Also, the primary IEC delivering partners shifted from local authorities, NGOs, and CBOs to the more community-based IRS SIMs (see Figure 19). This design led to significant cost reduction in implementation of IEC activities.


Figure 19. IEC design in spray seasons, 2007–2013

Managing Knowledge and Skills

IRS Teams Training in Lake Zone

Prior to implementing IRS in 2012–2013, RTI in collaboration with NMCP, Centre for Educational Development in Health, Arusha, The Nelson Mandela African Institute of Science and Technology, and Muheza Vector Control Training Institute conducted a National IRS Core Facilitator Training course. Participants included Regional and District Malaria Focal Persons, two NMCP representatives, one representative from the MoHSW Vector Control Unit, and one Vector Control Officer from the Tanzania People’s Defence Force (TPDF). The training covered IRS management and other supportive aspects of IEC, logistics planning and management, M&E, and environmental compliance at all levels. The training consisted of 14 modules developed prior the training. In turn, trainees of this course facilitated other trainings to field IRS teams. These trainings were conducted in a cascade fashion to manage the large number of trainees located across a large area of more than 100km2

(see Figure 20). In the Lake Zone, a total of 9,070 (6,197 and 2,873 male and female, respectively) staff were trained before IRS operations. Among them, 7,222 were personnel directly involved in the implementation of IRS; the remaining 1,848 were temporary staff involved at different capacities to support IRS, such as SIMS, clinicians, as well as other regional, district, ward, and village authorities facilitating supervision and IEC sensitization at the respective levels.

Training of Trainers (ToT)

As stated in the previous section, National IRS Core Facilitators were mandated to organize and conduct ToT sessions in their respective districts. The ToT targeted site managers and team leaders. A total of 775 participants were trained, with female trainees totaling 28% of participants.


IRS Teams

TVCSP provided different trainings for new and returning IRS staff. A total of 4,873 spray operators and site attendants were trained in 137 training sessions, with an average of 35 participants per session. Among the trainees, 33% were female. Figure 20 shows the cascade model of training from the core facilitators down to the spray operator level.

Figure 20. Cascade training model for IRS operation

Monitoring the IRS Process Monitoring of IRS is performed by the TVCSP M&E unit in collaboration with partners at the district level (see Figure 21). Monitoring involves collection of information, storage, processing and informing the implementer of rational decision along the course of IRS implementation. Tools used included computers at RTI central and regional offices and DMOs offices, templates for handling collected data, various forms for data collection. Components that are monitored include trainings, IRS coverage, insecticide usage, and other IRS supplies.


Figure 21. 2012–2013 M&E Organogram

Monitoring of Training Activities

Like in Zanzibar, (see monitoring of training activities under Monitoring of Training Activities under Section B—Zanzibar), RTI and the DITT were primarily responsible for tracking the number of people trained in different capacities in each of their respective districts.

IRS Coverage and Use of Insecticides

This component measured inputs, processes, and outputs more effectively. It involved collection of information by spray operators that covered type and size of sprayed structure, protected people categorized as children < 5 and ≥ 5 and pregnant women, and use of nets against mosquito bites. Team leaders compiled the collected information for every eight spray operators; site managers aggregated the data for entire IRS sites to reflect performance for each operation day. These data were sent to the DMOs’ offices, where the information was processed and analyzed using pre-designed MS Excel templates. The processed information was regularly used by IRS supervisors to monitor the progress of the implementation.

At the site level, a daily monitoring chart was used to track the daily monitoring of spray performance. Stock and property control booklets were used to account for the receiving, requisition, and return of IRS items. In addition, insecticide management and transport monitoring tools were also used.

Getting RTI Prepared to Support the IRS Process The zonal office in collaboration with the two regional offices in Bukoba and Musoma provided support to implementing partners (district authority, communities, and the private sector) to conduct IRS in the Lake Zone.


Public-Private-Partnership (PPP) in IRS implementation in the Lake Zone During the reporting period (2012–2013), a unique PPP among RTI, Geita Gold Mine (GGM), and Geita District Council was revamped again. The partnership facilitated IRS of urban and a peri-urban wards of Kalangalala and Mtakuja in Geita District, in Geita Region. IRS was conducted between May 27, 2013, and June 11, 2013. In this partnership, RTI provided technical and financial management support; GGM provided financial support while GTC was responsible for field implementation of the IRS intervention.

As part of the collaboration, TVCSP determined the quantity of insecticide and equipment required and procured and supplied 10,000 sachets of deltamethrin (K-Othrine) and 160 spray pumps (Hudson® Expert). The pumps were returned to the project after spray operations concluded. TVCSP also supervised the advocacy, sensitization, and community mobilization for IRS. The multifaceted community media approach utilized a combination of radio spots, flyers, and public address systems, in addition to interpersonal communication through hamlet chairpersons. This multifaceted approach ensured that the districts’ residents were prepared for the operation.

The overall target for Geita were estimated at 20,789 structures. Some 10,755 of these structures were located in Mtakuja Ward and 10,034 in Kalangalala Ward.

X. Implementation of IRS Activities

Quality Control of Spray Refer to Quality Control of Spray under Section B—Zanzibar.

Environmental Monitoring and Mitigation Activities Environmental monitoring and environmental compliance inspections were carried out in all operational sites in Mara, Mwanza, and Kagera by the RTI Environmental Officer and RTI Regional Environmental Compliance Inspector. The inspections were carried out in the first round, where pyrethroid (Mara and Mwanza) and bendiocarb (Kagera, Mara, and Mwanza) insecticides were used, and in a second round, where bendiocarb re-spraying was conducted in selected areas of Mara, Mwanza, and Kagera regions. The compliance inspections were carried out between January and May 2013 to ensure program compliance with mitigation measures stipulated in SEA of 2010 and PEA of 2011.

A total of three inspections were conducted at different stages of the operations. In the first round, pre- and mid-spray environmental compliance inspections were conducted in January 2013. A mid-spray compliance inspection was conducted in March 2013, (see Annex K) on environmental compliance inspections reports of 2013).

The second round pre- and mid- spray environmental compliance inspection was conducted between May 22, 2013, and May 30, 2013. Observations from all


inspectors present at these inspections noted that improvements were made in all storage documentation from IRS sites.

During the pre- and mid-IRS inspections, randomly selected IRS sites in Mara, Mwanza, and Kagera were selected and visited to assess the teams’ preparedness and compliance with best practices and environmental requirements. Following the rigorous inspection, the sites were found to be in compliance with all the environmental and human safety requirements (see Annex K on environmental compliance inspection reports).

Logistics

Storage of Insecticide and Other Supplies

Insecticide and other IRS supplies were stored at the zonal, regional, and district warehouses. Movement and management of supplies were handled by RTI through each of the offices located in Kagera, Mara, and Mwanza regions. Table 19 shows the movement of insecticide; Tables 20 and 21 show the movement of IRS consumables and PPE during operations.

Table 19. Insecticide movements by type and by warehouse

Bendiocarb Sachet and weight movement

Warehouse Initial Kgs Used Remaining

Mwanza 53,021 6,628 31,939 21,082

Bukoba 98,988 12,374 94,313 4,675

Mara 37,483 4,685 24,485 12,998

Total 189,492 23,687 150,737 38,755

Deltamethrin Sachet and volume movement

Warehouse Initial Liters Used Remaining

Mwanza 113,933 7,117 113,523 410

Bukoba - - - -

Mara 65,351 4,082 64,451 900

Total 179,284 11,199 177,974 1,310


Table 20. PPE consumables movements by type and by warehouse

Mask

Warehouse Initial Used Remaining

Mwanza 33,365 24,137 9,228

Bukoba 25,440 13,479 11,961

Musoma 10,070 15,005 (4,935)

Total 68,875 52,621 16,254


Table 21. Selected PPE and spray equipment movement by type and warehouse

Spray Pumps Hudson Expert Overall Boots

Warehouse Initial

Balance Issued Final

Balance Working

Out of

Order Initial

Balance Issued Remaining Intact Worn out

Initial Balance Received Remaining Intact

Worn out

Mwanza 1,577 0 1,577 1,510 67 4,755 0 1,755 896 713 1,729 1,902 1,902 1,573 329

Bukoba 1,066 0 1,066 1,056 10 1,704 0 1,704 3,776 170 1,212 1,333 1,333 808 525

Musoma 842 0 842 800 42 1,770 0 1,770 2,013 212 849 934 934 675 259

TOTAL 3,485 0 3,485 3,366 119 8,229 0 8,229 9,216 1,096 3,790 4,169 4,169 3,056 1,113


Provision of Transport for Operators and Supervisors During IRS operations, numerous vehicles were hired to transport operators and supervisors from the national, regional, and district levels. Table 22 indicates the number of cars hired during the last IRS round.

Table 22. Vehicles hired during IRS operations

Kagera Mara Mwanza Lake Zone

Vehicles

Operators cars 116 131 180 427

Supervisor cars 12 6 10 28

Total vehicles 128 137 190 455

End of Spray Activities

Post-spray Environmental Compliance Inspections and Site Decontamination and Decommissioning

Post-spray environmental compliance inspections were conducted in all IRS sites in Kagera, Mara, and Mwanza regions. RTI Environmental Compliance Officers carried out IRS site decontamination and decommissioning, making sites and storage areas safe for the surrounding communities. After the post-spray inspections, the IRS operational sites were handed over to the local authorities for safe custody until the next IRS operation.

Solid Waste Disposal

After the end of IRS operations, all insecticide-contaminated waste were transported to the regional and zonal warehouse for storage to await disposal at the incinerating facility recently commissioned by RTI at the Nyanguge Health Centre, located 33 km from Mwanza City. The facility is currently operational, having started incinerating a stockpile of 15 tons of waste that was safely accumulated from the previous rounds, since 2007. Thus far, 4 tons of waste has been disposed, with the disposal of remaining 11 tons estimated to take another 1 year.

End of Spray Inventory in Storage Facilities

See End of Spray Inventory in Storage Facilities under Section B—Zanzibar.


Section D: IRS Results

XI. IRS Results—Mainland

Population and House Structures Found

House Characteristics and Population Profile

In Mainland Tanzania, out of 817,836 eligible house structures (see Annex A) in the Lake Zone, 776,425 were visited (95%). Wall characteristics of houses were only captured for Mainland Tanzania, where 82% of houses were mud-walled, 16% were cement, and 2% were classified as “other” (see Table 23). The district variations are illustrated in Figure 22. On average, the size of houses in Mwanza Region was the largest (108 sqm) and the lowest in Mara Region (97 sqm). House size in Kagera Region was average (106 sqm).

Table 24 presents the population breakdown of households visited in Mainland Tanzania. In total, 4,277,436 people were recorded during the spray operations, of which 24% were high-risk groups (pregnant women and U5 children). The family size was 5.5 per household.

A summary of household characteristics and population by district, region, and zone is presented in Annex C.

Figure 22. House walls characteristics by district in the Lake Zone


Table 23. Visited household characteristics


House structures found 221,571 221,920 332,934 776,425

Wall materials

Mud wall houses (%) 79% 84% 83% 82%

Bricks wall houses (%) 18% 16% 15% 16%

Other wall materials (%) 3% 0% 1% 2%

Average # of rooms per house structure

4.3 2.9 3.5 3.5

Average house structure size (sqm)

106 97 108 104

Table 24. Population recorded during spray in visited households


Population Total 1,071,291 1,165,584 2,040,561 4,277,436

Average Family size 5 5 6 5

Risk group

U5 (%) 190,600 (18%) 258,551 (22%) 439,671 (22%) 888,822 (21%)

Pregnant women (%) 25,924 (2%) 46,143 (4%) 73,951 (4%) 146,018 (3%)


Male (%) 426,517 (40%) 423,228 (36%) 757,437 (37%) 1,607,182 (38%)

Female (%) 428,250 (40%) 437,662 (38%) 769,502 (38%) 1,635,414 (38%)

Spray Results

Main Spray Indicators

In Mainland Tanzania, out of the eligible households, 95% were visited4 by spray operators. The remaining eligible houses were unreached because spray operators

4 “Visited” is defined as houses that spray operators were able to reach, which are made up of sprayed and unsprayed houses.


could not get to them. Table 25 gives a breakdown of the main spray indicators for the Lake Zone.

The spray coverage results reflect houses that were visited and sprayed out of those targeted (i.e., eligible). In 2012–2013, nearly 95% spray coverage was attained in Mainland Tanzania. Spray coverage by district in Mainland Tanzania is illustrated in Figure 23. The lowest IRS coverage was recorded in the second cycle of carbamate spraying in the targeted areas of Musoma District (78%) while the highest was in Bukoba DC (100%), also conducted in the second cycle of carbamate spraying.

Summary of spray indicators by district region and zone are reported in Annex D.

Table 25. Main spray indicators by area

House structures Kagera Mara Mwanza Lake Zone

Eligible 233,125 234,520 350,191 817,836

Visited 221,571 221,920 332,934 776,425

Visited % 95% 95% 95% 95%

Sprayed 220,415 221,607 331,907 773,929

Visited and not sprayed 1,156 313 1,027 2,496

Not reached 11,554 12,600 17,257 41,411

Spray coverage 94.5% 94.5% 94.8% 94.6%

Figure 23. Spray coverage by districts of Lake Zone


Refusal and Houses Not Reached

A total of only 2,496 house structures in the Lake Zone were visited but not sprayed, which represents < 1% of eligible house structures. This was due to a combination of reasons ( e.g., funeral ceremonies, a very sick person in a house, crops stored inside the structure eligible for spray). Almost 25% of nonsprayed houses were closed at the time of the visit. The interpretation of this event is difficult, such as silent refusal or being uninformed about the operation (see Table 26 and Annex G for district data).

A higher proportion of houses, about 5%, were not reached by spray teams (41,411). The main reason for failure to reach all eligible houses is due to their accessibility during the scheduled time. Unfavorable road conditions during the rainfall period significantly contributed to the missed houses.

Table 26. Reasons for non-spray

Kagera Region Mara Region Mwanza Region Lake Zone

Crops inside

480 36% 27 9% 447 57% 954 39%

Funeral 107 8% 10 3% 52 7% 169 7%

Sick person

148 11% 35 12% - 0% 183 8%

House closed

366 27% 68 24% 177 22% 611 25%

Refused 193 14% 139 48% 76 10% 408 17%

Other reasons

48 4% 10 3% 38 5% 96 4%

Use of Insecticides A total of 328,711 sachets of deltamethrin and bendiocarb were used to spray 776,425 house structures in the 18 eligible districts of Mainland Tanzania at a ratio of 0.41 sachets per house structure. Figure 24 gives a summary of sachet to house ratio in each of the rounds conducted in the 18 districts. An average of nine rooms was sprayed per sachet. A total of 3,559 kg (11,118 litres) of K-Othrine WP and 18,842 kg of FICAM were used in the Lake Zone.

Table 27 gives a summary breakdown of type and quantity of insecticide used, as well as the proportion of the different classes in relation to the targeted structures that were sprayed in Kagera, Mara, and Mwanza regions. For district breakdown see Annex J.


Table 27. Use of insecticide


Bendiocarb Bendiocarb Deltamethrin Bendiocarb Deltamethrin Bendiocarb Deltamethrin

Sachets used 94,313 24,485 64,451 31,939 113,523 150,737 177,974

Kgs 11,789 3,061 1,289 3,992 2,270 18,842 3,559

Number of houses sprayed by type of insecticide

220,415 58,395 163,212 74,076 257,831 352,886 421,043

% of houses sprayed by type of insecticide

100% 26% 74% 22% 78% 46% 54%


Figure 24. Sachet per house structure ratio by district in the Lake Zone

Population Protected A total of 4,052,354 people were protected with IRS in the Lake Zone out of the 4,505,752 targeted eligible populations. The estimated number of pregnant women and U5 children protected by IRS5 was 138,281 and 841,451, respectively (see Table 28 and Annex E).

Table 28. Population protected by spray zone

Population protected Kagera Mara Mwanza Lake Zone

U5 179,876 244,477 417,098 841,451

Pregnant women 24,445 43,761 70,075 138,281

Five years and above male

403,856 400,407 718,771 1,523,034

Five years and above female

405,373 414,059 730,156 1,549,588

Five years and above all 809,229 814,465 1,448,927 3,072,621

Total 1,013,550 1,102,703 1,936,100 4,052,353

Eligible 1,127,554 1,232,638 2,145,560 4,505,752

Percent 90% 89% 90% 90%

5 As per PMI’s definition, the protected risk groups are those living in houses that have been sprayed.


Community Sensitization Results

Source of Information

A large proportion (93%) of households (776,425) received information prior to an IRS operator’s visit to the respective houses. Interpersonal communication from community leaders and other members was by far the largest source of information and constituted the majority of our IEC/BCC efforts (91%). In total, 3,018,935 people (1,496,500 males and 1,522,435 females) were reached through various IEC approaches in the Lake Zone. Other sources of information are reported in Table 29 Figure 25, and Annex I.


Table 29. IRS information and source by administrative level


Information on IRS not received

8% 9% 5% 7%

Information on IRS received 92% 91% 95% 93%

Source of information

Interpersonal communication (community leaders and others)

96% 93% 92% 89%

Printed media (leaflets, posters) 1% 2% 1% 2%

Electronic media (radio, TV) 2% 2% 1% 1%

Public address system 1% 3% 6% 7%

Other sources 0% 0% 0% 0%

No answer 0% 0% 0% 0%


Figure 25. Source of Information of IRS

Perceived Advantages and Disadvantages from Previous IRS Rounds

Information for this indicator was specifically collected for the Lake Zone. The response rate was over 98%. Around 85% of respondents felt the main advantages of IRS were to reduce malaria, as well as the number of mosquitoes. About 80% of the respondents did not perceive any negative effects of IRS. The proportion is much higher in Mara and Mwanza (about 90% and 89%, respectively). In some districts of Kagera, respondents complained about proliferation of fleas (see Table 30). However, this finding did not affect acceptance of IRS as demonstrated by the high spray coverage in the same districts (see Annex H for details).


Table 30. Advantages and disadvantages cited by communities after IRS by administrative level

Perception/Region Kagera Mara Mwanza Lake Zone

Perceived Advantages of IRS

No advantages 6% 18% 12% 12%

Malaria/mosquitoes reduced 91% 79% 86% 85%

Other advantages 2% 2% 1% 2%

No answer 1% 1% 1% 1%

Perceived Disadvantages of IRS

None 60% 90% 89% 80%

Pest/fleas proliferation 37% 4% 5% 15%

Side effects 2% 4% 4% 3%

Other disadvantages 0% 0% 1% 1%

No answer 1% 2% 1% 1%


Usage of ITNs In the Lake Zone, 136,184 (93%) of pregnant woman and 818,455 (94%) of U5 children were declared to have slept under ITNs the previous night in the house structure visited during this reporting period (see Table 31; for district breakdown, see Annex F).

The results showed that overall net usage in the Lake Zone is 93% and 92% for pregnant woman and U5 children, respectively (see Table 31).

Universal LLIN coverage (82%) in 2013 IRS campaign shows a slightly lower figure than the 2012 IRS (84%) campaign (see Table 31 and Figure 26).

Table 31. LLIN usage by region and zone by age group

Group Kagera Mara Mwanza Lake Zone

U5


170,086 235,208 413,161 818,455

Net usage % 90% 92% 96% 92%

Pregnant women


22,808 42,532 70,844 136,184

Net usage % 89% 92% 97% 93%



632,356 658,699 1,251,833 2,542,888

Net usage % 74% 77% 85% 79%

All ages


825,250 936,439 1,735,839 3,497,527

Net usage % 77% 80% 85% 82%


Figure 26. Universal net coverage 2012 and 2013 by regions and zone

XII. Monitoring Insecticide Quantification After Spray, Insecticide Decay, and Insecticide Resistance

2013 Preliminary Results of Insecticide Decay Monitoring Using Cone Bioassay Seven districts were selected to monitor insecticide effectiveness on the walls sprayed with deltamethrin (Ukerewe, Sengemera, Tarime, and Serengeti) and with bendiocarb (Chato, Karagwe, Muleba, Serengeti, Tarime, Sengerema, and Ukerewe). Six months after the last spray round, bendiocarb elicited 100% mortality on wood and painted wall surfaces. On the other hand, poor performance was recorded on mud and wall surfaces, with a drop in mortality to below 80% in 3–4 weeks after spraying (see Figure 27).

Results for bioassays on walls sprayed with deltamethrin show that wood and painted wall surfaces could elicit 100% mortalities up to 13 weeks after spraying. Cement wall surfaces elicited slightly above 70% mortality and mud 60% mortality up to 13 weeks after spraying (see Figure 28).


Figure 27. Insecticide decay on various surfaces up to week 29 after bendiocarb application in 2013 IRS campaign

Figure 28. Insecticide decay up to week 13 after deltamethrin application in 2013 IRS campaign

Insecticide Resistance Monitoring in Lake Zone and Zanzibar NIMR-Amani Centre regularly monitors country-wide insecticide resistance in collaboration with NMCP. RTI subcontracted the NIMR-Amani Centre to monitor insecticide resistance in national representative sites, making up a total of 10 district sentinel sites. Three districts in which IRS is ongoing are among those sites regularly


monitored—Tarime, Geita, and Ngara. Table 32 shows that resistance to both pyrethroids tested (permethrin and lambda-cyhalothrin) was recorded in Ngara and Geita districts.

Table 32. Summary of susceptibility levels of malaria vectors to insecticides using WHO susceptibility test kits

Sentinel Districts

% Mortalities of malaria vectors observed 24 hours post exposure insecticides

DDT -4% Bendiocarb

Fenitrothrin

1%

Permethrin

0.75%

Lambda cyhalothrin

.05%

Moshi 99 100 98 60 56

Arumeru 92 97 100 74 68

Sumbawanga 100 100 100 100 100

Manyoni 100 100 100 100 100

Ngara - 100 - 60 54

Geita 98 - 100 80 78

Tarime 100 100 100 100 99

Bariadi 97 100 100 97 91

Kigoma 100 100 100 100 100

Bagamoyo 100 100 100 97 100

Resistant

Suspected

Susceptible


Section E: Lessons Learned, Challenges & Recommendations

XIII. Lessons Learned • SIMs continued to be a good linkage between site managers and community

leaders. SIMs played a big role in advocating IRS to the community and are attributed with much of the good coverage attained during this round.

• Deltamethrin (K-Othrine), which was used for the first time in this IRS campaign, was well accepted by community members, claiming that it was very effective, even against bedbugs.

• The cascade mode of training has significant impact in team leaders’ supervision of spray operators.

• Staff compensation payments made through Vodacom M-Pesa proved to be efficient and timely compared to payments made through bank accounts with NMB.

• District Malaria Focal Persons that were trained as National IRS Core Facilitators were very supportive in the training of site managers, team leaders, and spray operators.

XIV. Challenges • We observed a discrepancy between the number of targeted structures and those

found on the ground during IRS. Available data from national and district authorities is based on households and is not up to date.

• Lack of sufficient epidemiological and entomological data at the ward level poses difficulties during the stratification of eligible villages for IRS as we move towards targeted and focal spraying.

• Complaints from household members observing an increase of fleas immediately after spraying houses affected households’ compliance with spray activities in certain villages in Kagera Region, to the extent of being a major reason for refusals. As a result, spray operators spent significant time convincing home owners to allow spraying to continue as planned.

XV. Recommendations • Before IRS, registration data for eligible structures to be sprayed should be

updated through logistic assessment.


• With the increasing trend of resistance to pyrethroids and carbamate, it would be important to explore other classes of insecticides, such as Vectron (Etophenprox) and (Actellic) Pirimiphos-methyl 300 CS, among the list of insecticides being monitored for vector susceptibility.

XVI. IRS in Action

An incineration in progress at Nyanguge site in Mwanza Region.

Incineration attendants loading empty sachets in the incineration machine.

Spray operators cleaning their work gear in the washing bay at Buhemba IRS operation site in Musoma District.

Spray operator collecting relevant information from a resident of Mtakuja Ward in Geita District immediately

after the spraying activity.


Spray operators’ overalls hanging on the washing bay at the Ilyamchele IRS operation site in Chato District.

Spray operators in training.

IRS spray operator applying insecticide on a wall.

Tanzania Vector Control Scale-up Project A-1 Spray Performance Report

Annex A. Zonal Regional and District Targets: IRS Operational Sites, Ward/Shehia, Village, and Hamlets

A-2 Tanzania Vector Control Scale-up Project Spray Performance Report

Reg

ion/

Zone

Dis

tric

t

Elig

ible

H

ouse

hold

Elig

ible

Po

pula

tion

# Si

tes

# W

ards

(s

heih

a)

# Vi

llage

s

# ha

mle

ts

Villa

ges

per

war

d

ham

lets

per

vi

llage

war

d (s

heih

a)

per s

ite

villa

ge/s

ite

Kagera

Bukoba DC 17,159 79,473 6 13 23 161 2 7 2 4

Bukoba DC 2 18,303 82,606 6 13 23 161 2 7 2 4

Missenyi 11,595 52,272 3 9 19 97 2 5 3 6

Missenyi 2 11,871 54,855 3 9 19 97 2 5 3 6

Muleba 17,738 84,920 5 12 26 125 2 5 2 5

Muleba 2 17,766 83,630 5 12 26 125 2 5 2 5

Karagwe 55,930 272,345 8 28 74 518 3 7 4 9

Karagwe 2 30,791 144,689 7 19 37 259 2 7 3 5

Biharamulo 14,768 79,448 4 4 17 121 4 7 1 4

Chato 21,604 121,005 7 19 42 202 2 5 3 6

Ngara 15,600 72,311 5 10 19 91 2 5 2 4

Total 233,125 1,127,554 59 148 325 1,957 2 6 3 6

Mara Bunda 41,731 241,187 8 29 89 400 3 4 4 11

Bunda 2 8,750 50,103 6 21 65 302 3 5 4 11

Tanzania Vector Control Scale-up Project A-3 End of Spray Report

Reg

ion/

Zone

Dis

tric

t

Elig

ible

H

ouse

hold

Elig

ible

Po

pula

tion

# Si

tes

# W

ards

(s

heih

a)

# Vi

llage

s

# ha

mle

ts

Villa

ges

per

war

d

ham

lets

per

vi

llage

war

d (s

heih

a)

per s

ite

villa

ge/s

ite

Musoma 54,981 283,240 10 28 79 518 3 7 3 8

Musoma 2 11,430 64,112 3 11 30 179 3 6 4 10

Serengeti 43,277 228,666 6 27 70 367 3 5 5 12

Rorya 30,587 138,890 7 17 39 221 2 6 2 6

Tarime 43,764 226,440 8 15 47 230 3 5 2 6

Total 234,520 1,232,638 48 148 419 2,217 3 5 3 9

Mwanza

Kwimba 40,372 263,019 7 24 73 519 3 7 3 10

Kwimba 2 7,186 44,731 3 10 31 233 3 8 3 10

Magu 52,356 338,558 9 27 78 506 3 6 3 9

Magu 2 9,468 61,294 4 14 31 219 2 7 4 8

Missungwi 33,243 212,797 7 14 50 398 4 8 2 7

Missungwi 2 6,866 41,977 2 3 15 109 5 7 2 8

Geita 80,305 467,772 12 31 121 482 4 4 3 10

Geita Town 22,374 124,523 1 2 23 108 12 5 2 23

A-4 Tanzania Vector Control Scale-up Project Spray Performance Report

Reg

ion/

Zone

Dis

tric

t

Elig

ible

H

ouse

hold

Elig

ible

Po

pula

tion

# Si

tes

# W

ards

(s

heih

a)

# Vi

llage

s

# ha

mle

ts

Villa

ges

per

war

d

ham

lets

per

vi

llage

war

d (s

heih

a)

per s

ite

villa

ge/s

ite

Sengerema 64,721 403,904 9 22 86 491 4 6 2 10

Ukerewe 33,300 186,984 6 14 42 297 3 7 2 7

Total 350,191 2,145,560 60 161 550 3,362 3 6 3 9

Lake Total 817,836 4,505,752 167 457 1,294 7,536 3 6 3 8

Pemba

Chakechake 1,481 7,982 1 2 NA NA NA NA 2 NA

Micheweni 12,216 66,607 1 18 NA NA NA NA 18 NA

Mkoani 2,522 13,634 1 6 NA NA NA NA 6 NA

Wete 7,649 39,042 1 10 NA NA NA NA 10 NA

Total 23,868 127265 4 36 NA NA NA NA 9 NA

Unguja

Central 10,737 47,506 2 30 NA NA NA NA 15 NA

North A 3,316 14,812 1 6 NA NA NA NA 6 NA

North B 8,731 37,231 1 22 NA NA NA NA 22 NA

South 2,415 10,296 1 6 NA NA NA NA 6 NA

West 4,888 22,789 1 8 NA NA NA NA 8 NA

Total 30,087 132,634 6 72 NA NA NA NA 12 NA

Tanzania Vector Control Scale-up Project A-5 End of Spray Report

Reg

ion/

Zone

Dis

tric

t

Elig

ible

H

ouse

hold

Elig

ible

Po

pula

tion

# Si

tes

# W

ards

(s

heih

a)

# Vi

llage

s

# ha

mle

ts

Villa

ges

per

war

d

ham

lets

per

vi

llage

war

d (s

heih

a)

per s

ite

villa

ge/s

ite

Zanzibar 53,955 259,899 10 108 NA NA NA NA 11 NA

Tanzania 871,791 4,765,651 177 565 NA NA

NA: Not applicable. Zanzibar administrative set up does not include villages and hamlets.

Tanzania Vector Control Scale-up Project B-1 Spray Performance Report

Annex B. Summary Operation Staff by District, Region, and Zone

B-2 Tanzania Vector Control Scale-up Project Spray Performance Report

R

egio

n

Dis

tric

t

# of

Spr

ay

Ope

rato

rs

Team

lead

ers

Supe

rvis

ors

Site

man

ager

s

Driv

ers

Pum

p te

chni

cian

Cle

aner

s

Suit

was

hers

wat

chm

en

wat

er fe

tche

r

stor

e ke

eper

s

Ass

ista

nt s

tore

ke

eper

s

Kagera

Bukoba DC 132 17 6 8 7 6 6 12 9 0 0

Bukoba DC 2 152 19 6 9 7 6 6 12 8 0 0

Missenyi 66 8 3 4 6 3 3 6 6 0 0

Missenyi 2 76 9 3 5 6 3 3 6 6 0 0

Muleba 1 130 16 5 8 10 5 5 10 7 0 0

Muleba 2 130 16 5 8 10 5 5 10 6 0 0

Karagwe 264 33 8 16 9 7 7 14 18 0 0

Karagwe 2 204 25 7 13 9 7 7 14 18 0 0

Biharamulo 100 13 4 6 8 4 4 8 7 0 0

Chato 144 18 7 9 14 7 7 14 10 0 0

Ngara 124 15 5 8 10 5 5 10 7 0 0

Total 1522 189 0 59 94 96 58 58 116 102 0 0

Mara Bunda 247 31 8 15 8 8 8 16 21 0 0


Reg

ion

Dis

tric

t

# of

Spr

ay

Ope

rato

rs

Team

lead

ers

Supe

rvis

ors

Site

man

ager

s

Driv

ers

Pum

p te

chni

cian

Cle

aner

s

Suit

was

hers

wat

chm

en

wat

er fe

tche

r

stor

e ke

eper

s

Ass

ista

nt s

tore

ke

eper

s

Bunda 2 247 31 6 15 6 6 6 12 10 0 0

Musoma 315 39 10 20 10 10 10 20 27 0 0

Musoma 2 71 9 3 4 3 3 3 6 6 0 0

Serengeti 220 28 6 14 6 6 6 12 19 0 0

Rorya 179 22 7 11 7 7 7 14 16 0 0

Tarime 245 31 8 15 8 8 8 16 21 0 0

Total 1524 191 0 48 94 48 48 48 96 120 0 0

Mwanza

Kwimba 204 26 7 13 9 7 7 14 18 0 0

Kwimba 2 86 11 3 5 4 3 3 6 8 0 0

Magu 268 33 9 17 12 9 9 18 23 0 0

Magu 2 112 14 4 7 5 4 4 8 10 0 0

Missungwi 202 25 7 13 9 7 7 14 18 0 0

Missungwi 2 57 7 2 4 2 2 2 4 5 0 0

Geita 367 46 12 23 16 12 12 24 32 0 0

B-4 Tanzania Vector Control Scale-up Project Spray Performance Report

Reg

ion

Dis

tric

t

# of

Spr

ay

Ope

rato

rs

Team

lead

ers

Supe

rvis

ors

Site

man

ager

s

Driv

ers

Pum

p te

chni

cian

Cle

aner

s

Suit

was

hers

wat

chm

en

wat

er fe

tche

r

stor

e ke

eper

s

Ass

ista

nt s

tore

ke

eper

s

Geita Town 75 9 1 5 3 1 1 2 7 0 0

Sengerema 277 35 9 17 12 9 9 18 24 0 0

Ukerewe 179 22 6 11 8 6 6 12 16 0 0

Total 1827 228 0 60 115 80 60 60 120 161 0 0

Lake Total 4873 608 0 167 303 224 166 166 332 383 0 0

Pemba

Chakechake 70 10 1 10 3 1 3 2 2 1 1

Micheweni 70 10 1 12 3 1 3 2 2 1 1

Mkoani 70 10 1 10 3 1 3 2 2 1 1

Wete 84 12 1 10 3 1 3 2 2 1 2

Total 294 42 0 4 42 12 4 12 8 8 4 5

Unguja

Central 91 13 2 13 3 1 3 2 4 1 2

North A 56 8 1 12 3 1 3 2 2 1 1

North B 56 8 1 8 2 1 2 2 2 1 1

South 28 4 1 4 1 1 2 2 2 1 1


Reg

ion

Dis

tric

t

# of

Spr

ay

Ope

rato

rs

Team

lead

ers

Supe

rvis

ors

Site

man

ager

s

Driv

ers

Pum

p te

chni

cian

Cle

aner

s

Suit

was

hers

wat

chm

en

wat

er fe

tche

r

stor

e ke

eper

s

Ass

ista

nt s

tore

ke

eper

s

West 84 12 1 12 3 1 3 2 2 1 1

Total 315 45 0 6 49 12 5 13 10 12 5 6

Zanzibar 609 87 0 10 91 24 9 25 18 20 9 11

Tanzania 5482 695 0 177 394 248 175 191 350 403 9 11

Tanzania Vector Control Scale-up Project C-1 Spray Performance Report

Annex C. Summary of Household Characteristics and Population by District, Region, and Zone

C-2 Tanzania Vector Control Scale-up Project Spray Performance Report

Reg

ion/

Zone

Dis

tric

t

Hou

se

stru

ctur

es

visi

ted

wal

l mat

eria

ls

Ave

rage

room

s pe

r hou

se

Tota

l pop

ulat

ion

foun

d

Fam

ily s

ize

Ris

k gr

oup

Five

yea

rs a

nd

abov

e

Mud (%)

Cement (%)

Other (%)

Under fives % Pregnant

women % Male % Female %

Kagera

Bukoba DC 16,716 75% 22% 3% 4.7 77,421 4.6 11,454 15% 1,432 2% 32,650 42% 31,885 41%

Bukoba DC 2 18,237 76% 22% 3% 4.8 82,308 4.5 11,495 14% 1,510 2% 34,464 42% 34,839 42%

Missenyi 11,333 69% 26% 5% 4.2 51,091 4.5 8,517 17% 1,127 2% 20,640 40% 20,807 41%

Missenyi 2 11,591 70% 27% 3% 4.4 53,561 4.6 8,777 16% 1,241 2% 21,774 41% 21,769 41%

Muleba 16,707 79% 18% 3% 5.0 79,984 4.8 13,537 17% 1,874 2% 32,437 41% 32,136 40%

Muleba 2 16,311 80% 18% 2% 5.1 76,781 4.7 12,645 16% 1,727 2% 31,613 41% 30,796 40%

Karagwe 52,411 80% 16% 4% 4.6 255,210 4.9 44,295 17% 4,797 2% 102,481 40% 103,637 41%

Karagwe 2 30,086 76% 21% 3% 4.6 141,376 4.7 23,946 17% 2,879 2% 56,885 40% 57,666 41%

Biharamulo 13,782 88% 8% 4% 3.2 74,144 5.4 16,224 22% 2,506 3% 27,750 37% 27,664 37%

Chato 20,683 85% 13% 2% 3.2 115,846 5.6 27,134 23% 5,014 4% 42,019 36% 41,679 36%

Ngara 13,714 88% 8% 4% 3.6 63,569 4.6 12,576 20% 1,817 3% 23,804 37% 25,372 40%

Total 221,571 79% 18% 3% 4.3 1,071,291 4.8 190,600 18% 25,924 2% 426,517 40% 428,250 40%


Reg

ion/

Zone

Dis

tric

t

Hou

se

stru

ctur

es

visi

ted

wal

l mat

eria

ls

Ave

rage

room

s pe

r hou

se

Tota

l pop

ulat

ion

foun

d

Fam

ily s

ize

Ris

k gr

oup

Five

yea

rs a

nd

abov

e

Mud (%)

Cement (%)

Other (%)



Mara

Bunda 39,560 83% 17% 1% 3.2 228,640 5.8 47,036 21% 9,182 4% 84,080 37% 88,342 39%

Bunda 2 8,238 86% 14% 0% 3.1 47,171 5.7 10,040 21% 1,920 4% 17,384 37% 17,827 38%

Musoma 53,583 83% 16% 1% 2.9 276,038 5.2 60,366 22% 9,576 3% 100,665 36% 105,431 38%

Musoma 2 9,090 83% 17% 0% 3.1 50,987 5.6 11,745 23% 1,303 3% 18,607 36% 19,332 38%

Serengeti 39,958 90% 10% 0% 2.5 211,129 5.3 50,188 24% 9,237 4% 74,597 35% 77,107 37%

Rorya 28,870 75% 25% 0% 2.4 131,093 4.5 28,484 22% 4,688 4% 48,876 37% 49,045 37%

Tarime 42,621 88% 12% 0% 3.1 220,526 5.2 50,692 23% 10,237 5% 79,019 36% 80,578 37%

Total 221,920 84% 16% 0% 2.9 1,165,584 5.3 258,551 22% 46,143 4% 423,228 36% 437,662 38%

Mwanza

Kwimba 39,318 93% 5% 2% 4.6 256,152 6.5 55,623 22% 7,245 3% 94,858 37% 98,426 38%

Kwimba 2 6,455 94% 5% 1% 4.1 40,181 6.2 8,313 21% 1,311 3% 15,137 38% 15,420 38%

Magu 48,612 89% 11% 0% - 314,348 6.5 69,172 22% 9,498 3% 116,648 37% 119,030 38%

Magu 2 8,301 92% 8% 0% 4.4 53,739 6.5 12,006 22% 1,765 3% 19,762 37% 20,206 38%

Missungwi 32,431 88% 12% 0% 4.1 207,599 6.4 45,504 22% 5,417 3% 76,620 37% 80,058 39%

C-4 Tanzania Vector Control Scale-up Project Spray Performance Report

Reg

ion/

Zone

Dis

tric

t

Hou

se

stru

ctur

es

visi

ted

wal

l mat

eria

ls

Ave

rage

room

s pe

r hou

se

Tota

l pop

ulat

ion

foun

d

Fam

ily s

ize

Ris

k gr

oup

Five

yea

rs a

nd

abov

e

Mud (%)

Cement (%)

Other (%)



Missungwi 2 6,849 90% 9% 0% 3.9 41,873 6.1 8,700 21% 1,139 3% 15,991 38% 16,043 38%

Geita 75,503 87% 11% 1% 3.4 439,799 5.8 97,574 22% 18,424 4% 160,461 36% 163,340 37%

Geita Town 20,968 38% 60% 2% 3.5 116,698 5.6 23,609 20% 6,590 6% 42,684 37% 43,815 38%

Sengerema 63,236 78% 20% 1% 3.8 394,637 6.2 83,386 21% 15,361 4% 148,994 38% 146,896 37%

Ukerewe 31,261 80% 15% 4% 3.4 175,535 5.6 35,784 20% 7,201 4% 66,282 38% 66,268 38%

Total 332,934 83% 15% 1% 3.5 2,040,561 6.1 439,671 22% 73,951 4% 757,437 37% 769,502 38%

Lake Total 776,425 82% 16% 2% 3.5 4,277,436 5.5 888,822 21% 146,018 3% 1,607,182 38% 1,635,414 38%

Pemba

Chakechake 1,481 NA NA NA 4.2 7,982 5.4 1,561 20% 257 3% 3,218 40% 2,946 37%

Micheweni 12,216 NA NA NA 5.1 66,607 5.5 12,647 19% 1,593 2% 26,825 40% 25,542 38%

Mkoani 2,522 NA NA NA 5.3 13,634 5.4 2,414 18% 322 2% 5,619 41% 5,279 39%

Wete 7,649 NA NA NA 4.9 39,042 5.1 7,667 20% 867 2% 15,448 40% 15,060 39%

Total 23,868 NA NA NA 5.0 127,265 5.3 24,289 19% 3,039 2% 51,110 40% 48,827 38%

Unguja Central 10,737 NA NA NA 4.6 47,506 4.4 7,250 15% 1,042 2% 19,270 41% 19,944 42%


Reg

ion/

Zone

Dis

tric

t

Hou

se

stru

ctur

es

visi

ted

wal

l mat

eria

ls

Ave

rage

room

s pe

r hou

se

Tota

l pop

ulat

ion

foun

d

Fam

ily s

ize

Ris

k gr

oup

Five

yea

rs a

nd

abov

e

Mud (%)

Cement (%)

Other (%)



North A 3,316 NA NA NA 4.5 14,812 4.5 2,349 16% 338 2% 5,980 40% 6,145 41%

North B 8,731 NA NA NA 4.7 37,231 4.3 5,921 16% 751 2% 15,515 42% 15,044 40%

South 2,415 NA NA NA 5.1 10,296 4.3 1,478 14% 203 2% 4,340 42% 4,275 42%

West 4,888 NA NA NA 5.1 22,789 4.7 3,921 17% 540 2% 9,235 41% 9,093 40%

Total 30,087 NA NA NA 4.7 132,634 4.4 20,919 16% 2,874 2% 54,340 41% 54,501 41%

Zanzibar 53,955 NA NA NA 4.9 259,899 4.8 45,208 17% 5,913 2% 105,450 41% 103,328 40%

Tanzania 851,690 NA NA NA 4.2 4,537,335 5.3 934,030 21% 151,931 3% 1,712,632 38% 1,738,742 38%

NA: Not applicable. Zanzibar administrative set up does not include villages and hamlets.

Tanzania Vector Control Scale-up Project D-1 Spray Performance Report

Annex D. Summary of Spray Indicators by District, Region, and Zone

D-2 Tanzania Vector Control Scale-up Project Spray Performance Report

Reg

ion/

Zone

Dis

tric

t

Elig

ible

Hou

seho

ld

Visi

ted

Visi

ted

%

Spra

yed

Visi

ted

and

not

spra

yed

Not

reac

hed

Spra

y co

vera

ge

Type

of I

nsec

ticid

e

Sach

ets

used

Sach

et ra

tio p

er

hous

e

Roo

ms

spra

yed

per

sach

et

Spra

yed

surf

ace

sqm

Ave

rage

spr

ayab

le

surf

ace

per h

ouse

sq

m

Kagera

Bukoba DC 17,159 16,716 97% 16,708 8 443 97.4% Bendiocarb 7,011 0.42 11 1,752,750 105

Bukoba DC 2 18,303 18,237 100% 18,235 2 66 99.6% Bendiocarb 8,473 0.46 10 2,118,250 116

Missenyi 11,595 11,333 98% 11,319 14 262 97.6% Bendiocarb 4,296 0.38 11 1,074,000 95

Missenyi 2 11,871 11,591 98% 11,582 9 280 97.6% Bendiocarb 4,935 0.43 10 1,233,750 107

Muleba 17,738 16,707 94% 16,692 15 1,031 94.1% Bendiocarb 7,981 0.48 10 1,995,250 120

Muleba 2 17,766 16,311 92% 16,287 24 1,455 91.7% Bendiocarb 8,023 0.49 10 2,005,750 123

Karagwe 55,930 52,411 94% 52,331 80 3,519 93.6% Bendiocarb 22,503 0.43 11 5,625,750 108

Karagwe 2 30,791 30,086 98% 30,073 13 705 97.7% Bendiocarb 13,012 0.43 11 3,253,000 108

Biharamulo 14,768 13,782 93% 13,548 234 986 91.7% Bendiocarb 4,601 0.34 9 1,150,250 85

Chato 21,604 20,683 96% 20,514 169 921 95.0% Bendiocarb 8,397 0.41 8 2,099,250 102

Ngara 15,600 13,714 88% 13,126 588 1,886 84.1% Bendiocarb 5,081 0.39 10 1,270,250 97

Total 233,125 221,571 95% 220,415 1,156 11,554 94.5% 94,313 0.43 10 23,578,250 106

Mara

Bunda 41,731 39,560 95% 39,519 41 2,171 94.7% δ-methrin; bendiocarb

16,030 0.41 8 4,007,500 101

Bunda 2 8,750 8,238 94% 8,238 - 512 94.1% Bendiocarb 3,584 0.44 7 896,000 109


Reg

ion/

Zone

Dis

tric

t

Elig

ible

Hou

seho

ld

Visi

ted

Visi

ted

%

Spra

yed

Visi

ted

and

not

spra

yed

Not

reac

hed

Spra

y co

vera

ge

Type

of I

nsec

ticid

e

Sach

ets

used

Sach

et ra

tio p

er

hous

e

Roo

ms

spra

yed

per

sach

et

Spra

yed

surf

ace

sqm

Ave

rage

spr

ayab

le

surf

ace

per h

ouse

sq

m

Musoma 54,981 53,583 97% 53,549 34 1,398 97.4% δ-methrin; bendiocarb

20,702 0.39 7 5,175,500 97

Musoma 2 11,430 9,090 80% 8,861 229 2,340 77.5% Bendiocarb 4,297 0.48 6 1,074,250 121

Serengeti 43,277 39,958 92% 39,952 6 3,319 92.3% δ-methrin; bendiocarb

15,767 0.39 6 3,941,750 99

Rorya 30,587 28,870 94% 28,867 3 1,717 94.4% δ-methrin; bendiocarb

11,508 0.40 6 2,877,000 100

Tarime 43,764 42,621 97% 42,621 - 1,143 97.4% δ-methrin; bendiocarb

8,876 0.21 15 2,219,000 52

Total 234,520 221,920 95% 221,607 313 12,600 94.5% 80,764 0.36 8 20,191,000 97

Mwanza

Kwimba 40,372 39,318 97% 39,272 46 1,054 97.3% δ-methrin; bendiocarb

15,883 0.40 11 3,970,750 101

Kwimba 2 7,186 6,455 90% 6,441 14 731 89.6% Bendiocarb 2,430 0.38 11 607,500 94

Magu 52,356 48,612 93% 48,463 149 3,744 92.6% δ-methrin; bendiocarb

22,524 0.46 - 5,631,000 116

Magu 2 9,468 8,301 88% 8,301 - 1,167 87.7% Bendiocarb 3,800 0.46 10 950,000 114

Missungwi 33,243 32,431 98% 32,184 247 812 96.8% δ-methrin; bendiocarb

15,152 0.47 9 3,788,000 118

D-4 Tanzania Vector Control Scale-up Project Spray Performance Report

Reg

ion/

Zone

Dis

tric

t

Elig

ible

Hou

seho

ld

Visi

ted

Visi

ted

%

Spra

yed

Visi

ted

and

not

spra

yed

Not

reac

hed

Spra

y co

vera

ge

Type

of I

nsec

ticid

e

Sach

ets

used

Sach

et ra

tio p

er

hous

e

Roo

ms

spra

yed

per

sach

et

Spra

yed

surf

ace

sqm

Ave

rage

spr

ayab

le

surf

ace

per h

ouse

sq

m

Missungwi 2 6,866 6,849 100% 6,765 84 17 98.5% Bendiocarb 2,885 0.43 9 721,250 107

Geita 80,305 75,503 94% 75,199 304 4,802 93.6% δ-methrin; bendiocarb

36,448 0.48 7 9,112,000 121

Geita Town 22,374 20,968 94% 20,830 138 1,406 93.1% δ-methrin 9,603 0.46 8 2,400,750 115

Sengerema 64,721 63,236 98% 63,197 39 1,485 97.6% δ-methrin; bendiocarb

25,186 0.40 9 6,296,500 100

Ukerewe 33,300 31,261 94% 31,255 6 2,039 93.9% δ-methrin; bendiocarb

11,551 0.37 9 2,887,750 92

Total 350,191 332,934 95% 331,907 1,027 17,257 94.8% 145,462 0.44 8 36,365,500 108

Lake Total 817,836 776,425 95% 773,929 2,496 41,411 94.6% 320,539 0.41 9 80,134,750 104

Pemba

Chakechake 1,481 1,481 100% 1,406 75 - 94.9% Bendiocarb 150 0.11 - 37,500 27

Micheweni 12,216 12,216 100% 12,157 59 - 99.5% Bendiocarb 1,790 0.15 - 447,500 37

Mkoani 2,522 2,522 100% 2,506 16 - 99.4% Bendiocarb 927 0.37 - 231,750 92

Wete 7,649 7,649 100% 7,308 341 - 95.5% Bendiocarb 2,168 0.30 - 542,000 74

Total 23,868 23,868 100% 23,377 491 - 97.9% 5,035 0.22 - 1,258,750 54

Unguja Central 10,737 10,737 100% 10,171 566 - 94.7% Bendiocarb 3,302 0.32 - 825,500 81


Reg

ion/

Zone

Dis

tric

t

Elig

ible

Hou

seho

ld

Visi

ted

Visi

ted

%

Spra

yed

Visi

ted

and

not

spra

yed

Not

reac

hed

Spra

y co

vera

ge

Type

of I

nsec

ticid

e

Sach

ets

used

Sach

et ra

tio p

er

hous

e

Roo

ms

spra

yed

per

sach

et

Spra

yed

surf

ace

sqm

Ave

rage

spr

ayab

le

surf

ace

per h

ouse

sq

m

North A 3,316 3,316 100% 3,102 214 - 93.5% Bendiocarb 1,301 0.42 - 325,250 105

North B 8,731 8,731 100% 8,288 443 - 94.9% Bendiocarb 2,772 0.33 - 693,000 84

South 2,415 2,415 100% 2,264 151 - 93.7% Bendiocarb 760 0.34 - 190,000 84

West 4,888 4,888 100% 4,702 186 - 96.2% Bendiocarb 1,712 0.36 - 428,000 91

Total 30,087 30,087 100% 28,527 1,560 - 94.8% 9,847 0.35 - 2,461,750 86

Zanzibar 53,955 53,955 100% 51,904 2,051 - 96.2% 14,882 0.29 - 3,720,500 72

Tanzania 871,791 851,690 98% 825,833 4,547 41,411 94.7% 343,593 0.36 - 85,898,250 104

-

Tanzania Vector Control Scale-up Project E-1 Spray Performance Report

Annex E. Population Protected by Broad Age Group, District, Region, and Zone

E-2 Tanzania Vector Control Scale-up Project Spray Performance Report

Total Population High Risk Five years of age and above

Region/Zone District Protected Percent Under Fives Pregnant

Male Female Protected

Kagera

Bukoba DC 75,386 95% 11,153 1,394 31,792 31,047 62,839

Bukoba DC 2 82,002 99% 11,452 1,504 34,336 34,710 69,046

Missenyi 49,875 95% 8,314 1,100 20,149 20,312 40,460

Missenyi 2 52,257 95% 8,563 1,211 21,244 21,239 42,483

Muleba 75,267 89% 12,739 1,763 30,524 30,241 60,765

Muleba 2 70,389 84% 11,592 1,583 28,981 28,232 57,214

Karagwe 238,788 88% 41,445 4,488 95,887 96,968 192,855

Karagwe 2 138,079 95% 23,388 2,812 55,559 56,321 111,880

Biharamulo 68,019 86% 14,884 2,299 25,458 25,379 50,836

Chato 110,001 91% 25,765 4,761 39,899 39,576 79,475

Ngara 53,488 70% 10,582 1,529 20,029 21,348 41,377

Total 1,013,551 90% 179,876 24,445 403,856 405,373 809,229

Mara

Bunda 216,521 90% 44,543 8,695 79,623 83,659 163,283

Bunda 2 44,411 89% 9,453 1,808 16,367 16,784 33,151

Musoma 268,848 95% 58,794 9,327 98,043 102,685 200,728

Musoma 2 39,527 62% 9,105 1,010 14,425 14,987 29,412

Tanzania Vector Control Scale-up Project E-3 Spray Performance Report




Serengeti 194,908 85% 46,332 8,527 68,866 71,183 140,048

Rorya 123,721 89% 26,882 4,424 46,128 46,287 92,415

Tarime 214,766 95% 49,368 9,970 76,955 78,474 155,429

Total 1,102,703 86% 244,477 43,761 400,407 414,059 814,465

Mwanza

Kwimba 249,173 95% 54,107 7,048 92,273 95,744 188,018

Kwimba 2 36,015 81% 7,451 1,175 13,568 13,821 27,389

Magu 290,974 86% 64,029 8,792 107,974 110,179 218,154

Magu 2 47,115 77% 10,526 1,547 17,326 17,715 35,042

Missungwi 200,986 94% 44,054 5,244 74,179 77,508 151,687

Missungwi 2 41,257 98% 8,572 1,122 15,756 15,807 31,563

Geita 411,836 88% 91,370 17,253 150,259 152,954 303,213

Geita Town 108,645 87% 21,980 6,135 39,738 40,791 80,530

Sengerema 385,344 95% 81,422 14,999 145,486 143,437 288,923

Ukerewe 164,755 88% 33,586 6,759 62,212 62,198 124,410

Total 1,936,100 89% 417,098 70,075 718,771 730,156 1,448,927

Lake Total 4,052,354 88% 841,451 138,281 1,523,034 1,549,588 3,072,622

E-4 Tanzania Vector Control Scale-up Project Spray Performance Report




Pemba

Chakechake 7,578 95% 1,482 244 3,055 2,797 5,852

Micheweni 66,285 100% 12,586 1,585 26,695 25,419 52,114

Mkoani 13,548 99% 2,399 320 5,583 5,246 10,829

Wete 37,301 96% 7,325 828 14,759 14,389 29,148

Total 124,712 97% 23,792 2,978 50,093 47,850 97,943

Unguja

Central 45,021 95% 6,867 986 18,278 18,889 37,167

North A 13,856 94% 2,197 316 5,594 5,748 11,343

North B 35,342 95% 5,621 713 14,728 14,281 29,008

South 9,652 94% 1,386 190 4,069 4,008 8,076

West 21,922 96% 3,772 519 8,884 8,747 17,631

Total 125,793 95% 19,843 2,725 51,552 51,673 103,225

Zanzibar 250,505 96% 43,635 5,703 101,645 99,523 201,167

Tanzania 4,302,859 92% 885,086 143,984 1,624,679 1,649,110 3,273,789

Tanzania Vector Control Scale-up Project F-1 Spray Performance Report

Annex F. Net Usage per District, Region, and Zone

F-2 Tanzania Vector Control Scale-up Project Spray Performance Report

Under Fives Pregnant women Over fives

Region/Zone Indicators/Districts Slept under LLIN/ITN the previous night Net usage Slept under LLIN/ITN the

previous night Net usage Slept under LLIN/ITN the previous night Net usage

Kagera

Bukoba DC 11,102 97% 1,405 98% 54,136 84%

Bukoba DC 2 11,199 97% 1,455 96% 60,713 88%

Missenyi 8,000 94% 1,108 98% 31,001 75%

Missenyi 2 8,144 93% 1,172 94% 34,225 79%

Muleba 12,200 90% 1,658 88% 44,731 69%

Muleba 2 11,272 89% 1,409 82% 41,565 67%

Karagwe 39,471 89% 3,837 80% 151,079 73%

Karagwe 2 20,890 87% 2,322 81% 83,864 73%

Biharamulo 13,493 83% 2,032 81% 36,513 66%

Chato 24,895 92% 4,895 98% 61,926 74%

Ngara 9,420 75% 1,515 83% 32,603 66%

Total 170,086 90% 22,808 89% 632,356 74%

Mara Bunda 44,373 94% 9,182 100% 140,214 81%

Bunda 2 9,622 96% 1,819 95% 29,422 84%





Musoma 57,832 96% 8,766 92% 168,655 82%

Musoma 2 10,598 90% 1,105 85% 28,756 76%

Serengeti 43,282 86% 7,742 84% 110,576 73%

Rorya 26,823 94% 4,688 100% 81,524 83%

Tarime 42,678 84% 9,230 90% 99,552 62%

Total 235,208 92% 42,532 92% 658,699 77%

Mwanza

Kwimba 53,012 95% 6,805 94% 164,224 85%

Kwimba 2 8,278 100% 1,311 100% 26,639 87%

Magu 65,742 95% 8,933 94% 199,045 84%

Magu 2 11,492 96% 1,707 97% 32,144 80%

Missungwi 43,549 96% 5,417 100% 139,553 89%

Missungwi 2 8,432 97% 1,139 100% 29,890 93%

Geita 86,806 89% 17,472 95% 225,394 70%

Geita Town 22,791 97% 6,590 100% 74,907 87%

F-4 Tanzania Vector Control Scale-up Project Spray Performance Report




Sengerema 77,822 93% 14,493 94% 237,716 80%

Ukerewe 35,237 98% 6,977 97% 122,321 92%

Total 413,161 96% 70,844 97% 1,251,833 85%

Lake Total 818,455 92% 136,184 93% 2,542,888 79%

Pemba

Chakechake 1,484 95% 237 92% 5,313 86%

Micheweni 10,656 84% 1,359 85% 36,621 70%

Mkoani 2,300 95% 296 92% 9,280 85%

Wete 7,041 92% 885 102% 25,191 83%

Total 21,481 92% 2,777 93% 76,405 81%

Unguja

Central 5,673 78% 689 66% 24,992 64%

North A 2,207 94% 333 99% 10,488 86%

North B 4,759 80% 620 83% 19,532 64%

South 1,447 98% 197 97% 8,411 98%

West 3,655 93% 466 86% 15,813 86%





Total 17,741 89% 2,305 86% 79,236 80%

Zanzibar 39,222 90% 5,082 89% 155,641 80%

Tanzania 857,677 91% 141,266 91% 2,698,529 79%

Tanzania Vector Control Scale-up Project G-1 Spray Performance Report

Annex G. Reasons for No Spray by District (only Lake Zone)

G-2 Tanzania Vector Control Scale-up Project Spray Performance Report

Reg

ion/

Zone

Dis

tric

t

Cro

ps in

side

%

Fune

ral

%

Sick

per

son

%

Hou

se c

lose

d

%

Ref

used

%

Oth

er

reas

ons

%

Kagera

Bukoba DC 106 87% 12 10% 1 1% 2 2% 1 1% - 0%

Missenyi - 0% 1 9% 8 73% 2 18% - 0% - 0%

Muleba 2 106 87% 12 10% 1 1% 2 2% 1 1% - 0%

Karagwe 1 4% 1 4% 4 15% 21 78% - 0% - 0%

Biharamulo 9 4% 1 0% 35 15% 112 48% 73 31% 4 2%

Chato 77 100% - 0% - 0% - 0% - 0% - 0%

Ngara 181 24% 80 11% 99 13% 227 30% 118 16% 44 6%

Total 480 36% 107 8% 148 11% 366 27% 193 14% 48 4%

Mara

Bunda 14 35% 6 15% 8 20% 9 23% 1 3% 2 5%

Musoma 3 15% 2 10% 4 20% 2 10% 5 25% 4 20%

Musoma 2 4 2% 2 1% 23 10% 57 26% 133 60% 4 2%

Serengeti 6 100% - 0% - 0% - 0% - 0% - 0%

Total 27 9% 10 3% 35 12% 68 24% 139 48% 10 3%

Mwanza Kwimba 6 13% 4 9% 8 17% 7 15% 9 20% 12 26%

Tanzania Vector Control Scale-up Project G-3 Spray Performance Report

Reg

ion/

Zone

Dis

tric

t

Cro

ps in

side

%

Fune

ral

%

Sick

per

son

%

Hou

se c

lose

d

%

Ref

used

%

Oth

er

reas

ons

%

Kwimba 2 17 71% 1 4% 1 4% 2 8% - 0% 3 13%

Magu 91 61% 7 5% 19 13% 26 17% 5 3% 1 1%

Magu 2 101 80% 21 17% 2 2% - 0% 2 2% - 0%

Missungwi 42 17% 5 2% 27 11% 112 45% 47 19% 15 6%

Geita 145 73% 10 5% 17 9% 16 8% 6 3% 5 2%

Geita Town 21 46% 2 4% 12 26% 7 15% 3 7% 1 2%

Sengerema 22 59% 1 3% 3 8% 7 19% 4 11% - 0%

Ukerewe 2 33% 1 17% 2 33% - 0% - 0% 1 17%

Total 447 51% 52 6% - 0% 177 20% 76 9% 38 4%

Lake Total 954 39% 169 7% 183 8% 611 25% 408 17% 96 4%

Tanzania Vector Control Scale-up Project H-1 Spray Performance Report

Annex H. Perceived Advantages and Disadvantages after IRS (only Lake Zone)

H-2 Tanzania Vector Control Scale-up Project End of Spray Report

Perceived Advantages of IRS Perceived Disadvantages of IRS R

egio

n/Zo

ne

Dis

tric

t

No

adva

ntag

es

(%)

Mal

aria

/Mos

quito

es re

duce

d (%

)

Oth

er

adva

ntag

es

(%)

No

answ

er (%

)

Non

e (%

)

Pest

/flea

s pr

olife

ratio

n (%

)

Side

effe

cts

(%)

Oth

er

disa

dvan

tage

s (%

)

No

answ

er (%

)

Kagera

Bukoba DC 4% 95% 1% 0% 46% 50% 3% 0% 1%

Bukoba DC 2 5% 94% 1% 0% 45% 50% 3% 0% 2%

Missenyi 5% 93% 2% 0% 38% 60% 1% 0% 1%

Missenyi 2 4% 95% 1% 0% 40% 60% 0% 0% 0%

Muleba 3% 95% 2% 0% 80% 18% 1% 1% 0%

Muleba 2 3% 93% 3% 1% 79% 18% 2% 0% 1%

Karagwe 4% 94% 1% 1% 60% 37% 2% 1% 0%

Karagwe 2 4% 94% 2% 0% 62% 34% 1% 1% 2%

Biharamulo 7% 89% 1% 3% 73% 25% 2% 0% 0%

Chato 7% 89% 1% 3% 90% 4% 2% 1% 3%

Ngara 19% 70% 10% 1% 47% 49% 1% 0% 3%

Total 6% 91% 2% 1% 60% 37% 2% 0% 1%

Mara Bunda 15% 83% 1% 1% 90% 4% 4% 1% 1%

Tanzania Vector Control Scale-up Project H-3 Spray Performance Report

Perceived Advantages of IRS Perceived Disadvantages of IRS

Reg

ion/

Zone

Dis

tric

t

No

adva

ntag

es

(%)

Mal

aria

/Mos

quito

es re

duce

d (%

)

Oth

er

adva

ntag

es

(%)

No

answ

er (%

)

Non

e (%

)

Pest

/flea

s pr

olife

ratio

n (%

)

Side

effe

cts

(%)

Oth

er

disa

dvan

tage

s (%

)

No

answ

er (%

)

Bunda 2 14% 82% 2% 2% 90% 3% 4% 0% 3%

Musoma 17% 80% 2% 1% 90% 6% 4% 0% 0%

Musoma 2 20% 78% 1% 1% 87% 7% 3% 0% 3%

Serengeti 20% 78% 2% 0% 95% 2% 3% 0% 0%

Rorya 19% 75% 3% 3% 90% 4% 3% 1% 2%

Tarime 21% 74% 2% 3% 90% 4% 2% 1% 3%

Total 18% 79% 2% 2% 90% 4% 3% 0% 2%

Mwanza

Kwimba 8% 91% 0% 1% 90% 4% 3% 1% 2%

Kwimba 2 9% 88% 2% 1% 89% 5% 2% 2% 2%

Magu 13% 86% 0% 1% 89% 5% 4% 2% 0%

Magu 2 12% 85% 2% 1% 88% 6% 3% 2% 1%

Missungwi 11% 84% 1% 4% 90% 5% 2% 2% 1%

Missungwi 2 11% 85% 1% 3% 91% 6% 2% 1% 0%

H-4 Tanzania Vector Control Scale-up Project End of Spray Report

Perceived Advantages of IRS Perceived Disadvantages of IRS

Reg

ion/

Zone

Dis

tric

t

No

adva

ntag

es

(%)

Mal

aria

/Mos

quito

es re

duce

d (%

)

Oth

er

adva

ntag

es

(%)

No

answ

er (%

)

Non

e (%

)

Pest

/flea

s pr

olife

ratio

n (%

)

Side

effe

cts

(%)

Oth

er

disa

dvan

tage

s (%

)

No

answ

er (%

)

Geita 18% 80% 1% 1% 92% 5% 2% 0% 1%

Geita Town 20% 78% 2% 0% 75% 6% 15% 2% 2%

Sengerema 11% 87% 0% 2% 90% 4% 4% 2% 0%

Ukerewe 5% 94% 1% 0% 93% 3% 1% 3%

Total 12% 86% 1% 1% 89% 5% 4% 2% 1%

Lake Total 12% 85% 2% 1% 80% 15% 3% 1% 1%

Tanzania Vector Control Scale-up Project I-1 Spray Performance Report

Annex I. Source of Information for IRS Spray (only Lake Zone)

I-2 Tanzania Vector Control Scale-up Project End of Spray Report

Reg

ion/

Zone

Dis

tric

t

No

Info

rmat

ion

Rec

eive

d (%

)

Info

rmat

ion

Rec

eive

d (%

)

Ham

let l

eade

r (%

)

Oth

er le

ader

s (%

)

Fam

ily, N

eigh

bour

, fr

iend

(%)

Leaf

lets

, pos

ters

(%

)

Rad

io (%

)

Publ

ic a

ddre

ss

syst

em (%

)

Ano

ther

(%)

No

Ans

wer

(%)

Inte

rper

sona

l C

omm

unic

atio

n (c

omm

unity

lead

ers

and

othe

rs) (

%)

Oth

er S

ourc

es (%

)

Kagera

Bukoba DC 5% 95% 86% 8% 4% 1% 1% 0% 0% 0% 98% 2%

Bukoba DC 2 6% 94% 86% 8% 4% 1% 1% 0% 0% 0% 98% 2%

Missenyi 9% 91% 73% 10% 6% 3% 1% 7% 0% 0% 89% 11%

Missenyi 2 6% 94% 75% 9% 6% 2% 1% 7% 0% 0% 89% 11%

Muleba 6% 94% 89% 6% 3% 1% 0% 1% 0% 0% 98% 2%

Muleba 2 9% 91% 86% 8% 4% 1% 1% 0% 0% 0% 98% 2%

Karagwe 4% 96% 90% 3% 3% 1% 3% 0% 0% 0% 96% 4%

Karagwe 2 4% 96% 90% 3% 3% 1% 3% 0% 0% 0% 96% 4%

Biharamulo 19% 81% 53% 14% 9% 3% 2% 18% 0% 0% 76% 24%

Chato 11% 89% 83% 11% 3% 1% 1% 1% 0% 0% 97% 3%

Ngara 21% 79% 55% 15% 13% 2% 13% 1% 1% 1% 83% 17%

Total 8% 92% 79% 9% 5% 2% 2% 3% 0% 0% 93% 7%

Mara Bunda 10% 90% 83% 11% 3% 1% 1% 1% 0% 0% 97% 3%

Tanzania Vector Control Scale-up Project I-3 Spray Performance Report

Reg

ion/

Zone

Dis

tric

t

No

Info

rmat

ion

Rec

eive

d (%

)

Info

rmat

ion

Rec

eive

d (%

)

Ham

let l

eade

r (%

)

Oth

er le

ader

s (%

)

Fam

ily, N

eigh

bour

, fr

iend

(%)

Leaf

lets

, pos

ters

(%

)

Rad

io (%

)

Publ

ic a

ddre

ss

syst

em (%

)

Ano

ther

(%)

No

Ans

wer

(%)

Inte

rper

sona

l C

omm

unic

atio

n (c

omm

unity

lead

ers

and

othe

rs) (

%)

Oth

er S

ourc

es (%

)

Bunda 2 4% 96% 77% 11% 3% 1% 0% 5% 2% 0% 91% 9%

Musoma 8% 92% 89% 5% 3% 1% 0% 2% 0% 0% 97% 3%

Musoma 2 11% 89% 81% 4% 3% 0% 1% 11% 0% 0% 88% 12%

Serengeti 14% 86% 74% 8% 6% 1% 2% 9% 0% 0% 88% 12%

Rorya 5% 95% 86% 6% 3% 1% 1% 4% 0% 0% 94% 6%

Tarime 7% 93% 65% 13% 10% 3% 2% 8% 0% 0% 87% 13%

Total 9% 91% 79% 8% 4% 1% 1% 6% 0% 0% 92% 8%

Mwanza

Kwimba 8% 92% 81% 8% 3% 1% 0% 6% 0% 0% 92% 8%

Kwimba 2 5% 95% 88% 9% 1% 1% 0% 1% 0% 0% 98% 2%

Magu 0% 100% 93% 4% 1% 0% 0% 1% 0% 0% 99% 1%

Magu 2 1% 99% 94% 4% 1% 0% 0% 1% 0% 0% 99% 1%

Missungwi 4% 96% 70% 7% 2% 2% 1% 17% 0% 0% 79% 21%

Missungwi 2 5% 95% 92% 6% 1% 0% 0% 0% 0% 0% 99% 1%

I-4 Tanzania Vector Control Scale-up Project End of Spray Report

Reg

ion/

Zone

Dis

tric

t

No

Info

rmat

ion

Rec

eive

d (%

)

Info

rmat

ion

Rec

eive

d (%

)

Ham

let l

eade

r (%

)

Oth

er le

ader

s (%

)

Fam

ily, N

eigh

bour

, fr

iend

(%)

Leaf

lets

, pos

ters

(%

)

Rad

io (%

)

Publ

ic a

ddre

ss

syst

em (%

)

Ano

ther

(%)

No

Ans

wer

(%)

Inte

rper

sona

l C

omm

unic

atio

n (c

omm

unity

lead

ers

and

othe

rs) (

%)

Oth

er S

ourc

es (%

)

Geita 7% 93% 59% 13% 8% 3% 4% 12% 1% 0% 80% 20%

Geita Town 9% 91% 38% 20% 11% 5% 5% 20% 1% 0% 68% 32%

Sengerema 6% 94% 82% 10% 3% 1% 1% 3% 0% 0% 95% 5%

Ukerewe 4% 96% 70% 9% 6% 2% 1% 12% 0% 0% 85% 15%

Total 5% 95% 77% 9% 4% 2% 1% 7% 0% 0% 89% 11%

Lake Total 7% 93% 78% 9% 4% 1% 2% 5% 0% 0% 91% 9%

Tanzania Vector Control Scale-up Project J-1 Spray Performance Report

Annex J. Houses Sprayed by Type and Amount of Insecticide

J-2 Tanzania Vector Control Scale-up Project Spray Performance Report

Reg

ion/

Zone

Dis

tric

t

Spra

yed

# of

hou

se

stru

ctur

es s

pray

ed

with

ben

dioc

arb

% o

f str

ucte

s sp

raye

d w

ith

bend

ioca

rb

# of

Ben

dioc

arb

Sach

ets

used

# of

hou

se

stru

ctur

es s

pray

ed

with

δ-m

ethr

in

% o

f str

uctu

res

spra

yed

with

δ-

met

hrin

# of

δ-m

ethr

in

sach

ets

used

# of

tota

l Sac

hets

us

ed

Am

ount

of

bend

ioca

rb u

sed

(kg)

Am

ount

of δ

-m

ethr

in u

sed

(kg)

Kagera

Bukoba DC 16,708 16,708 100% 7,011 - - - 7,011 876.38 -

Bukoba DC 2 18,235 18,235 100% 8,473 - - - 8,473 1,059.13 -

Missenyi 11,319 11,319 100% 4,296 - - - 4,296 537.00 -

Missenyi 2 11,582 11,582 100% 4,935 - - - 4,935 616.88 -

Muleba 16,692 16,692 100% 7,981 - - - 7,981 997.63 -

Muleba 2 16,287 16,287 100% 8,023 - - - 8,023 1,002.88 -

Karagwe 52,331 52,331 100% 22,503 - - - 22,503 2,812.88 -

Karagwe 2 30,073 30,073 100% 13,012 - - - 13,012 1,626.50 -

Biharamulo 13,548 13,548 100% 4,601 - - - 4,601 575.13 -

Chato 20,514 20,514 100% 8,397 - - - 8,397 1,049.63 -

Ngara 13,126 13,126 100% 5,081 - - - 5,081 635.13 -

Total 220,415 220,415 100% 94,313 - - - 94,313 11,789 -

Tanzania Vector Control Scale-up Project J-3 End of Spray Report

Reg

ion/

Zone

Dis

tric

t

Spra

yed

# of

hou

se

stru

ctur

es s

pray

ed

with

ben

dioc

arb

% o

f str

ucte

s sp

raye

d w

ith

bend

ioca

rb

# of

Ben

dioc

arb

Sach

ets

used

# of

hou

se

stru

ctur

es s

pray

ed

with

δ-m

ethr

in

% o

f str

uctu

res

spra

yed

with

δ-

met

hrin

# of

δ-m

ethr

in

sach

ets

used

# of

tota

l Sac

hets

us

ed

Am

ount

of

bend

ioca

rb u

sed

(kg)

Am

ount

of δ

-m

ethr

in u

sed

(kg)

Mara

Bunda 39,519 7,727 20% 3,233 31,792 80% 12,797 16,030 404.13 256

Bunda 2 8,238 8,238 100% 3,584 - 0% - 3,584 448.00 -

Musoma 53,549 11,077 21% 4,181 42,472 79% 16,521 20,702 522.63 330

Musoma 2 8,861 8,861 100% 4,297 - 0% - 4,297 537.13 -

Serengeti 39,952 8,916 22% 3,526 31,036 78% 12,241 15,767 440.75 245

Rorya 28,867 5,321 18% 2,362 23,546 82% 9,146 11,508 295.25 183

Tarime 42,621 8,255 19% 3,302 34,366 81% 13,746 17,048 412.75 275

Total 221,607 58,395 26% 24,485 163,212 74% 64,451 88,936 3,061 1,289

Mwanza

Kwimba 39,272 6,956 18% 2,585 32,316 82% 13,298 15,883 323.13 266

Kwimba 2 6,441 6,441 100% 2,430 - 0% - 2,430 303.75 -

Magu 48,463 7,924 16% 3,716 40,539 84% 18,808 22,524 464.50 376

Magu 2 8,301 8,301 100% 3,800 0% 3,800 475.00 -

Missungwi 32,184 6,294 20% 2,607 25,890 80% 12,545 15,152 325.88 251

J-4 Tanzania Vector Control Scale-up Project Spray Performance Report

Reg

ion/

Zone

Dis

tric

t

Spra

yed

# of

hou

se

stru

ctur

es s

pray

ed

with

ben

dioc

arb

% o

f str

ucte

s sp

raye

d w

ith

bend

ioca

rb

# of

Ben

dioc

arb

Sach

ets

used

# of

hou

se

stru

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# of

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# of

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ed

Am

ount

of

bend

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rb u

sed

(kg)

Am

ount

of δ

-m

ethr

in u

sed

(kg)

Missungwi 2 6,765 6,765 100% 2,885 0% 2,885 360.63 -

Geita 75,199 13,273 18% 7,309 61,926 82% 29,139 36,448 913.63 583

Geita Town 20,830 0% 20,830 100% 9,603 9,603 - 192

Sengerema 63,197 12,335 20% 4,613 50,862 80% 20,573 25,186 576.63 411

Ukerewe 31,255 5,787 19% 1,994 25,468 81% 9,557 11,551 249.25 191

Total 331,907 74,076 22% 31,939 257,831 78% 113,523 145,462 3,992 2,270

Lake Total 773,929 352,886 46% 150,737 421,043 54% 177,974 328,711 18,842 3,559

Pemba

Chakechake 1,406 1,406 100% 150 - 0% - 150 18.75 -

Micheweni 12,157 12,157 100% 1,790 - 0% - 1,790 223.75 -

Mkoani 2,506 2,506 100% 927 - 0% - 927 115.88 -

South 2,264 2,264 100% 760 - 0% - 760 95.00 -

Wete 7,308 7,308 100% 2,168 - 0% - 2,168 271.00 -

Total 23,377 23,377 100% 5,035 - 0% - 5,035 629 -

Tanzania Vector Control Scale-up Project J-5 End of Spray Report

Reg

ion/

Zone

Dis

tric

t

Spra

yed

# of

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with

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# of

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Am

ount

of

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(kg)

Am

ount

of δ

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(kg)

Unguja

Central 10,171 10,171 100% 3,302 - 0% - 3,302 412.75 -

North A 3,102 3,102 100% 1,301 - 0% - 1,301 162.63 -

North B 8,288 8,288 100% 2,772 - 0% - 2,772 346.50 -

West 4,702 4,702 100% 1,712 - 0% - 1,712 214.00 -

Total 28,527 28,527 100% 9,847 - 0% - 9,847 1,231 -

Zanzibar 51,904 51,904 100% 14,882 - 0% - 14,882 1,860 -

Tanzania 825,833 404,790 49% 165,619 421,043 51% 177,974 343,593 20,702 3,559

Tanzania Vector Control Scale-up Project K-1 Spray Performance Report

Annex K. Environmental Compliance Report

Tanzania Vector Control Scale-up Project Spray Performance Report

Mid-spraying Environmental Compliance Inspection Report – Zanzibar: As of December 2012

Tanzania Vector Control Scale-up Project (TVCSP): Environmental Compliance Unit, Indoor Residual Spraying Mid-Spraying Environmental Compliance Inspection Report, Zanzibar Contract No. 621-A-00-10-00015-00 March 9, 2010–March 8, 2015 Prepared for: U.S. Agency for International Development/Tanzania Prepared by: RTI International 3040 Cornwallis Road Post Office Box 12194 Research Triangle Park, NC 27709-2194 January 31, 2013

This publication was produced for review by the U.S. Agency for International Development. It was prepared by RTI International.

Tanzania Vector Control Scale-up Project (TVCSP): Environmental Compliance Unit, Indoor Residual Spraying Mid-Spraying Environmental Compliance Inspection Report, Zanzibar Contract No. 621-A-00-10-00015-00 March 9, 2010–March 8, 2015 Submitted to: U.S. Agency for International Development/Tanzania ATTN: Jessica Kafuko, Kenneth P. LuePhang, Samuel S. Kiranga, and Naomi Kaspar 2140 Dar es Salaam Place Washington, DC 20521-2140 E-mail: [email protected], [email protected], [email protected]; [email protected] Submitted by: RTI International 3040 Cornwallis Road Post Office Box 12194 Research Triangle Park, NC 27709-2194 Submitted on: January 31, 2013 RTI International is one of the world’s leading research institutes, dedicated to improving the human condition by turning knowledge into practice. Our staff of more than 3,700 provides research and technical services to governments and businesses in more than 75 countries in the areas of health and pharmaceuticals, education and training, surveys and statistics, advanced technology, international development, economic and social policy, energy and the environment, and laboratory testing and chemical analysis. RTI International is a trade name of Research Triangle Institute.

The author’s views expressed in this publication do not necessarily reflect the views of the U.S. Agency for International Development or the U.S Government.


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Tanzania Vector Control Scale-up Project iii

Table of Contents Page Table of Contents ............................................................................................................................. iii List of Tables .................................................................................................................................... iii List of Figures ................................................................................................................................... iii List of Acronyms ...............................................................................................................................iv I. Scope of Inspection ................................................................................................................ 1 II. Objectives of Inspection ......................................................................................................... 1 III. Approach/Methodology/Duration ............................................................................................ 1 IV. Inspection Findings ................................................................................................................ 1

Areas of Strength ................................................................................................................... 1 Security at the Central Warehouses and Site Stores, Segregation of Insecticide, and Other IRS Requirements ............................................................................................ 1 Stock/Inventory Management System............................................................................... 2 Health and Safety .............................................................................................................. 2 Emergency Preparedness ................................................................................................. 3 IRS Wastewater Management .......................................................................................... 4 IRS Solid Waste Management .......................................................................................... 4

Areas of Weakness ................................................................................................................ 4 Supervision and Reporting of Deficits in IRS Sites ........................................................... 4 Housekeeping at Pemba Store ......................................................................................... 5

V. Recommendations ................................................................................................................. 5 VI. Timeframe for the Action Plan ................................................................................................ 5

List of Tables Table 1. Action needed ................................................................................................................ 5 Table 2. People interviewed ......................................................................................................... 5

List of Figures Figure 1. Mwanakwerekwe zonal warehouse in Zanzibar and a new separate building

for Insecticide storage (Unguja) ..................................................................................... 2 Figure 2: Hudson pumps stacked on shelves and insecticide on wooden pallets

(in a separate building) at Mwanakwerekwe central warehouse ................................... 2 Figure 3. Bin card at Konde IRS site ............................................................................................. 2 Figure 4. MSDS at Mwanakwerekwe central warehouse, Unguja ................................................ 3 Figure 5. Fire extinguisher and bucket of sand with a shovel to be used in the event

of fires or insecticide spills ............................................................................................. 3 Figure 6. Temperature monitoring at Konde IRS site .................................................................... 4 Figure 7. IRS effluent and solid waste management in Zanzibar IRS sites .................................. 4

iv Tanzania Vector Control Scale-up Project

List of Acronyms IRS Indoor Residual Spraying

MSDS Material Safety Data Sheet

PPE personal protective equipment


TVCSP Tanzania Vector Control Scale-Up Project

USAID U.S. Agency for International Development

Tanzania Vector Control Scale-up Project 1

I. Scope of Inspection This activity included the mid-spray environmental compliance inspection in Zanzibar (Unguja and Pemba).

II. Objectives of Inspection • To determine whether the indoor residual spraying (IRS) activities are implemented in

accordance with USAID environmental regulations (22CFR 216) and the Supplemental Environmental Assessment (SEA) as stipulated in the environmental monitoring and mitigation plan

• To point out noncompliance issues and recommend corrective actions in a given timeframe

• To determine, in consultation with the RTI technical team in Tanzania, the support required to improve and ensure future compliance with SEA and Best Management Practice Manual requirements

III. Approach/Methodology/Duration The approaches used during this compliance inspection include unstructured interviews with people directly involved with IRS, checklists, review of IRS program documents and records, and onsite visits whereby inspection of spray operators, suit washers, etc., were conducted This compliance inspection was conducted from October 2 to 5, 2012.

IV. Inspection Findings Areas of Strength

Security at the Central Warehouses and Site Stores, Segregation of Insecticide, and Other IRS Requirements The central warehouse in Zanzibar is well secured with a concrete fence and is guarded 24 hours a day by a hired security company. An additional building was constructed in the warehouse compound to eliminate the problem of storing insecticides alongside other IRS supplies and equipment (Figure1).

2 Tanzania Vector Control Scale-up Project

Figure 1. Mwanakwerekwe zonal warehouse in Zanzibar and a new separate building for Insecticide storage (Unguja)

The IRS supplies, including Hudson pumps, are properly stacked and arranged on shelves and pallets in compliance with the recommend stacking height of less than two meters high, thereby making it easier to locate items during issuance or during stock verification (Figure 2).

Figure 2: Hudson pumps stacked on shelves and insecticide on wooden pallets (in a separate building) at Mwanakwerekwe central warehouse

Stock/Inventory Management System IRS stocks at the site level were managed properly, as evidenced by the match between the store register and bin cards and the physical inventory (e.g., insecticides and empty sachets at Konde IRS site, Figure 3).

Health and Safety Safety precautions were observed at the central warehouse, including mounting of the fire extinguishers outside to ensure they were easily accessible during emergencies. The IRS site, which is located by the zonal warehouse, is well built with effluent waste disposal, changing, and washing facilities to help ensure staff are properly clean before

Figure 3. Bin card at Konde IRS site


returning home at the end of each spray day. The Material Safety Data Sheet (MSDS) for the stored insecticide is displayed where all staff can view and access it if needed (Figure 4).

The targeted IRS households were well prepared before spraying, and all beneficiaries interviewed were knowledgeable on steps to be taken before and after their houses were sprayed. In addition, before and after spraying, spray operators reiterated that household owner must move all movable items outside of their home to avoid accidental contamination, must not enter their home for at least two hours after the house has been sprayed, and must clean after spraying, burying any generated waste in a pit or dumping it in a toilet pit.

Although spray operators were fully equipped with appropriate personal protective equipment (PPE) during field

operations (and when they returned to the field operational site), the inspection found that some IRS staff, such as suit washers, were left without proper PPE for the entire duration of the IRS round. (This observation was made on the last day of spraying at Konde IRS site at Micheweni District in Pemba Island.)

Emergency Preparedness Firefighting devices such as powdered fire extinguishers were mounted in all IRS sites. Spill kits were also located onsite for accidental insecticide spills, and buckets of sand (Figure 5) were on site to be used for putting out fires or as an adsorbent material in case of insecticide spillage.

Figure 5. Fire extinguisher and bucket of sand with a shovel to be used in the event of fires or insecticide spills

Figure 4. MSDS at Mwanakwerekwe central warehouse, Unguja


Temperature Monitoring

Temperature monitoring was performed daily at all IRS sites and at the central warehouse (Figure 6). The temperature is recorded three times a day (morning, afternoon, and evening), and the readings assist store managers in deciding whether the store conditions are appropriate for the insecticide. Ideally, conditions for long-term storage of insecticide, especially bendiocarb, should not exceed a temperature of 35 degree Celsius. Exceeding that temperature increases the chance that the insecticide quality will be compromised.

IRS Wastewater Management IRS liquid wastes are well managed and disposed in properly designed biological effluent waste disposal structures consisting of a washing bay, drying lines, a water reserve tank (1,000 liters), and soak pits. Effluents from the washing slab were channeled to the soak pits, which were designed specifically for treatment of insecticide-contaminated effluents (Figure 7).

Figure 7. IRS effluent and solid waste management in Zanzibar IRS sites

IRS Solid Waste Management All contaminated solid waste, including empty insecticide sachets, were collected from spray operators and stored in plastic barrels and thereafter transferred to the district stores for storage. These items will eventually be taken to Kivunge Hospital for incineration using the program incinerator.

Areas of Weakness

Supervision and Reporting of Deficits in IRS Sites One of the suit washers was found without gum boots at Konde IRS site in Micheweni District, and when asked why he had no boots, the washer responded that the boots he was issued were too small. When asked about the problem, the site manager indicated that he knew about it but did not take any action. Prior to the introduction of bendiocarb, the program

Figure 6. Temperature monitoring at Konde IRS site


committed itself to proper adherence to PPE requirements, but there appears to be some laxity on the part of some staff or inadequate supervision in ensuring these requirements are met.

Housekeeping at Pemba Store The Pemba store is overcrowded, making it difficult to maintain proper housekeeping; this store accommodates all IRS supplies for Pemba Island and currently is overloaded.

V. Recommendations • It is recommended that all site managers—if they see any shortcomings in IRS

operations—take immediate action by reporting issues to the next higher authority for immediate action.

• Training of IRS staff should emphasize that although Bendiocarb does not cause an immediate burning sensation like lambda cyhalothrin (ICON® 10CS), its effects on human health are more severe than ICON®, and therefore the PPE requirements must be strictly adhered to.

• The Pemba store should be decongested by relocating inventory to a more spacious warehouse; because the warehouse is so overcrowded that it is very difficult to locate items, and it would be difficult to deal with any emergencies that arise.

VI. Timeframe for the Action Plan Table 1. Action needed

S/N Recommendation Responsible Person Time Frame

1 Ensure that all personnel engaged in IRS operation are fully protected with all the PPE, as recommended in Environmental Mitigation and Monitoring Plan

Site manager and team leader for Pemba

ASAP

2 Decongest the Pemba warehouse or shift the items to other stores

Pemba storekeeper Before the next IRS round

Table 2. People interviewed Name Designation Location

Said N. Sheh Pemba assistant storekeeper Pemba store

Masood R. Omari Pemba storekeeper Pemba store

Mohamed O. Mjaron Pump technician Pemba store

Yahya S. Hamis Site manager Konde IRS site–Micheweni

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Name Designation Location

Khalfan Mattar Storekeeper Konde IRS site–Micheweni

Masood A. Saleh Pump technician Konde IRS site–Micheweni

Salum Mbaruku Pump technician Konde IRS site–Micheweni

Hamad Abdala Cleaner Konde IRS site–Micheweni

Mr. Jaffer Mwanakwerekwe storekeeper Zanzibar

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Pre-spray Environmental Compliance Inspection Report—Zanzibar and Lake Zone (Mwanza, Mara, and Kagera): As of April 2013

Tanzania Vector Control Scale-up Project (TVCSP): Pre-Spray Environmental Compliance Inspection Report—Zanzibar and Lake Zone (Mwanza, Mara, and Kagera) Contract No. 621-A-00-10-00015-00 March 9, 2010–March 8, 2015 Prepared for: U.S. Agency for International Development/Tanzania Prepared by: Autman Tembo, RTI International April 7, 2013

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Tanzania Vector Control Scale-up Project (TVCSP): Pre-Spray Environmental Compliance Inspection Report—Zanzibar and Lake Zone (Mwanza, Mara, and Kagera) Contract No. 621-A-00-10-00015-00 March 9, 2010–March 8, 2015 Submitted to: U.S. Agency for International Development/Tanzania ATTN: Jessica Kafuko, Kenneth P. LuePhang, Samuel S. Kiranga, and Naomi Kaspar 2140 Dar es Salaam Place Washington, DC 20521-2140 E-mail: [email protected], [email protected], [email protected]; [email protected] Submitted by: RTI International 3040 Cornwallis Road Post Office Box 12194 Research Triangle Park, NC 27709-2194 Submitted on: April 7, 2013

RTI International is one of the world’s leading research institutes, dedicated to improving the human condition by turning knowledge into practice. Our staff of more than 2,600 provides research and technical services to governments and businesses worldwide in the areas of health and pharmaceuticals, education and training, surveys and statistics, advanced technology, international development, economic and social policy, energy, and the environment. RTI also employs about 1,200 term employees who support projects in more than 40 countries. For more information, visit www.rti.org.



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Tanzania Vector Control Scale-up Project iii

Table of Contents

Acknowledgements ................................................................................................................................ iv Main Objective ........................................................................................................................................ 1 Specific Objectives .................................................................................................................................. 1 Methodology ............................................................................................................................................ 1 Findings ................................................................................................................................................... 1

Zonal Warehouse in Mwanza ........................................................................................................... 1 Regional Warehouses in Kagera, Mara, and Zanzibar .................................................................... 2

Regional Warehouse in Bukoba, Kagera Region ......................................................... 2 Regional Warehouse in Musoma, Mara Region ........................................................... 3 Regional Warehouse Zanzibar ..................................................................................... 4

District and Site Warehouses and Soak Pits .................................................................................... 4 IRS Facilities in Zanzibar .............................................................................................. 4 IRS Facilities in Mainland Tanzania .............................................................................. 5 Security of Site Storage Facilities ................................................................................. 6

Conclusion............................................................................................................................................... 7 Annex 1: Selected Key Persons Met ..................................................................................................... 8

iv Tanzania Vector Control Scale-up Project

Acknowledgements The author would like to express his gratitude to the Tanzania Vector Control Scale-up Project’s (TVCS) Chief of Party and the entire team for the warm welcome and the support and guidance they provided. Their assistance and sense of teamwork enabled the author to quickly learn about the TVCSP and fulfill his objectives.

The author is indebted to the Ministry of Health and Social Welfare in Zanzibar and Mainland Tanzania for their leadership at the regional and district level and for their commitment to the project. District Health Officers and Malaria Focal Persons in all the visited districts provided their full support. The fruitful technical discussions in the field made enabled the resolution of many implementation issues in the field.

The author wishes to commend the exceptional work of Mr. Lukumba and Mr. Ngaiza in Kagera Region for their zeal, commitment, and earnestness, especially with regard to following up on the issues identified.

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Main Objective The purpose of RTI International Regional Environmental Compliance Inspector Autman Tembo’s visit was to provide technical support to the Tanzania Vector Control Scale-up Project (TVCSP) and to conduct pre-spray environmental compliance inspection of the project’s IRS activities in Zanzibar, Mwanza, Mara and Kagera regions.

Specific Objectives • Evaluate, in consultation with RTI staff and the National Malaria Control

Programme (NMCP) in Mainland Tanzania and the Zanzibar Malaria Control Programme (ZMCP), the TVCSP’s preparedness and assess the conditions and appropriateness of IRS infrastructure (e.g., soak pits, rinsing areas, and storage facilities) before commencement of the 2013 spray campaign.

• Undertake pre-spray inspections of the zonal-, regional-, district-, and site-level warehouses and make recommendations for improvement, as needed.

• Assess the preparatory activities (e.g., logistics) for the 2013 IRS spray operations and the support needed to ensure that the TVCSP IRS campaign is fully compliant with U.S. Agency for International Development requirements, as specified in the approved Supplemental Environmental Assessment (SEA) and USAIDs IRS BMP manual

• Create baseline of current compliance activities for the purpose of evaluating improvement in during spraying and in future IRS activities.

• Brief and debrief the key stakeholders and others partners

Methodology Mr. Tembo made three visits (December 2012, January 2013, and March 2013) to evaluate and support IRS activities in Zanzibar and Mainland Tanzania. During the pre-spray inspection, his focus was to assess the readiness of the program to start spraying. Mr. Tembo visited the zonal warehouse in Mwanza Region; regional warehouses in Zanzibar, Kagera, and Mara regions; and district and site storage facilities.

Findings Zonal Warehouse in Mwanza The zonal warehouse in Mwanza is a solid building designed for warehousing. It is well maintained; items are well stacked and very secure. At the time of the pre-spray inspection, however, the warehouse had no storekeeper. As such, records were not

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well reconciled. The following issues were observed and recommended for improvement:

• Proportionate to the size of the warehouse and quantity of materials contained therein, the number of fire extinguishers was inadequate. The second compartment did not have any firefighting equipment. This has been implemented.

• Empty ICON sachets, which were returned to their original boxes, are occupying a large amount of space, thereby taking up needed space for new, incoming insecticide. The empty sachets could have been removed from their original containers and compacted in fewer boxes to reduce overall volume. The waste has been since sent for incineration.

• Although there was need to streamline the amount of documentation for commodity management in the central warehouse, the recommendation could not be implemented immediately because some of the downstream trainings had already been done. This problem was observed up to the site level.

• It was pleasing to note that each Hudson pump was inscribed with a serial number. The same should apply to all pieces of PPE (e.g., helmets, coveralls and sometimes boots).

• A chain of custody for the keys to the main warehouse in which no one person will would possess all the keys into the warehouse could not be implemented, because the storekeeper was not yet recruited.

Regional Warehouses in Kagera, Mara, and Zanzibar During the pre-spray inspection, the regional warehouses in Bukoba, Kagera, Musoma, Mara, and Zanzibar were inspected for compliance.

Regional Warehouse in Bukoba, Kagera Region The warehouse is spacious, well fenced, and guarded (see Figure A-1).

Figure A-1. Regional Warehouse in Bukoba, Kagera Region


However, the following observations were observed: • Not all records were well updated: A new storekeeper had joined the team

recently, and at the time, he was undergoing orientation. During the inspection, not all records (e.g., store ledger, bin cards, issue vouchers) were well updated. Some of the bin cards were missing. The new storekeeper was tasked with counting every item in the warehouse and cross-checking totals against existing records before the start of the campaign. This task was completed.

• Numbering of insecticide boxes: In the next IRS round, insecticide containers or boxes need to be assigned a serial number for tracking purposes. Whenever containers or boxes are sent to a site, the issue vouchers should indicate by serial number which boxes have been sent to what site. In case there is an anomaly in one box, it is easier to specify by the serial number.

Regional Warehouse in Musoma, Mara Region The warehouse is spacious but required reorganization, because a large space was taken up by pump hangers, which crowded other inventory into tight spaces (see Figure A-2).

Figure A-2. Commodities in the Musoma regional warehouse require reorganization

Insecticide boxes were so crowded that they were stacked up against walls and to up to the ceiling, leaving no access in between the stacks. The storekeeper was instructed to reorganize the warehouse by stacking the hangers and moving the insecticide to the less crowded area. He was also instructed to move the insecticide away from the walls.


Regional Warehouse Zanzibar The regional warehouse in Zanzibar is spacious, well managed, and supported by very good documentation (see Figure A-3). The storekeeper demonstrated knowledge and experience about warehouse management.

Figure A-3. Commodities in the Zanzibar regional warehouse are well organized

District and Site Warehouses and Soak Pits All the districts visited had good storage facilities and good soak pits. Although at the time of the visit, some were not yet maintained. However, most required only small touch ups to make them complete and ready for spray operation.

IRS Facilities in Zanzibar At the time of the pre-spray inspection, most of the IRS sites were not maintained, because the project had not yet decided on the exact areas to be included in the targeted spraying. Most of the sites needed fencing, trimming of bushes, and rehabilitation of soak pits (see Figure A-4). These tasks were completed

Figure A-4. Mahonda (left) and Gamba (right) sites require slight rehabilitation and fencing


IRS Facilities in Mainland Tanzania The warehouses and soak pits generally were in good condition (see Figure A-5).

Figure A-5. A well-maintained soak pit in Kyaka, Missenyi District, Kagera Region

All sites were fenced and relatively secure. The only issue encountered was that some soak pits were covered with a top layer of organic regrowth made up of fallen leaves (see Figure A-6). This layer would minimize infiltration of contaminated water. It was advised that in sites covered in this condition, one should excavate a few centimeters of the top layer to remove the dirt and replace it with new aggregate.

Figure A-6. Clogging and regrowth should be removed from soak pits


Security of Site Storage Facilities Most storage facilities, including at site level, were already installed with doors and windows secured by metal grills. In addition, windows and the door were double- locked. Danger warning signs were conspicuously posted and visible from a distance at most sites (see Figure A-7). Although in some sites in Kwimba and other districts, signs needed to be redone.

Figure A-7. Danger warning signs posted by storage facilities—some of which need to be rewritten prior to the next campaign

The storage facility at Nansimo, in Bunda District did not have metal grills on the windows. It was advised that metal grills be installed as soon as possible (see Figure A-8). A metal grill was observed to be installed on the doors.

Figure A-8. Although, a metal grill is installed on the main door, the windows lack metal grills


Conclusion The Tanzania IRS program has very good warehouses, soak pits, and incinerators.

All the sites visited had the minimum applicable standards in place in readiness for the next IRS campaign. Prior to the next IRS operation, efforts were made to excavate and replace the top layer of most soak pits, which have become clogged with organic material.

It was pleasing to note that during the follow-up visit (i.e., mid-spray inspection), almost all the recommendations discussed during the pre-spray inspections were implemented.


Annex 1: Selected Key Persons Met

RTI/Tanzania Dar es Salaam

1 Dr. Madhi Ramsan Mohamed Chief of Party

2 Mr. Uche Ukenna RTI Home Office Technical Manager

3 Mr. Mubita Lifwatila Finance Director

4 Dr. Abdullah S. Ali Program Manager, ZMCP

5 Mr. David Ngilangwa PMI/CDC

6 Dr. Elias Mayala DMO, Karagwe

7 Mr. Joshua Mutagahywa Zone Manager, Lake Region

8 Mr. Ally Nyange Team Leader, Kagera Region

9 Mr. Nick Nyamanda Malaria Focal Person, Karagwe

10 Mr. Issa Garimo RTI, Zanzibar

11 Mr. Enerst Lukumba IRS Coordinator, Kagera

12 Dr. Mohamed Mpunjo DMO, Karagwe

13 Mr. Juma H. Mcha ZMCP

14 Dr. Andrew John DMO, Ngara District

15 Mr. Abdallah Rashid Zanzibar

16 Dr. Josephat Maro Acting DMO, Kwimba District

17 Mr. Joseph Mandago MFP, Magu District

18 Dr. Kihulya Mageda DMO, Biharamulo

19 Dr. Kalabaele MFP, Biharamulo

20 Dr. Madina Kilariti MFP, Ngara District

21 Mr. Correl Ngudungi District Executive Officer, Ngara

22 Dr. Ndaki DMO, Sengerema District

23 Ms. Adella Jeremiah Mara Region

24 Mr. Joel Mpemba MFP, Geita

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Mid-spray Environmental Compliance Inspection Report— Lake Zone (Mwanza, Mara, and Kagera): As of April 2013

Tanzania Vector Control Scale-Up Project (TVCSP): Mid-Spray Environmental Compliance Inspection Report—Lake Zone (Mwanza, Mara and Kagera) Contract No. 621-A-00-10-00015-00 March 9, 2010–March 8, 2015 Prepared for: U.S. Agency for International Development/Tanzania Prepared by: RTI International April 7, 2013

Tanzania Vector Control Scale-up Project (TVCSP): Mid-Spray Environmental Compliance Inspection Report—Lake Zone (Zanzibar, Mwanza, Mara and Kagera) Contract No. 621-A-00-10-00015-00 March 9, 2010–March 8, 2015 Submitted to: U.S. Agency for International Development/Tanzania ATTN: Jessica Kafuko, Kenneth P. LuePhang, Samuel S. Kiranga, and Naomi Kaspar 2140 Dar es Salaam Place Washington, DC 20521-2140 E-mail: [email protected], [email protected], [email protected]; [email protected] Submitted by: RTI International 3040 Cornwallis Road Post Office Box 12194 Research Triangle Park, NC 27709-2194 Submitted on: April 7, 2013 RTI International is one of the world’s leading research institutes, dedicated to improving the human condition by turning knowledge into practice. Our staff of more than 2,600 provides research and technical services to governments and businesses worldwide in the areas of health and pharmaceuticals, education and training, surveys and statistics, advanced technology, international development, economic and social policy, energy, and the environment. RTI also employs about 1,200 term employees who support projects in more than 40 countries. For more information, visit www.rti.org.



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Table of Contents

Table of Contents .......................................................................................................................................... 1 Scope of Inspection ....................................................................................................................................... 2 Objectives of Inspection ................................................................................................................................ 2 Approach/Methodology ................................................................................................................................. 2 Findings/Results ............................................................................................................................................ 2 Recommendations for Improvement/Corrective Action .............................................................................. 11 Timeframe for Action Plan.......................................................................................................................... 12 Conclusion................................................................................................................................................... 12 Annex 1. Selected key persons met ................................................................................................. 14


Scope of Inspection • Conduct mid spraying environmental compliance inspections in Zanzibar and the

Lake Zone (Mwanza, Mara, and Kagera regions).

Objectives of Inspection • Determine whether the IRS round three activities in the Lake Zone (Mwanza, Mara

and Kagera regions) are implemented in accordance with USAID environmental regulations and local environmental requirements, as stipulated in the environmental monitoring and mitigation plans.

• Observe whether spray activities for the 2013 targeted IRS in Zanzibar are in compliance with IRS procedures.

• Point out noncompliant issues and recommend corrective actions in a specific timeframe prior to the next IRS season.

• Determine, in consultation with the TVCSP technical team in Tanzania, the support required to improve and ensure future compliance with SEA and BMP requirements.

Approach/Methodology Mr. Autman Tembo, Regional Environmental Advisor, and Mr. Isaac Emmanuel, Environmental Compliance Officer, Mwanza, conducted field inspections at various times in year because at different districts sprayed and during different times. Karagwe District was the first to spray in December 2012 while the rest were split in Season A and Season B from January to March 2013. Zanzibar sprayed in March 2013. All the districts were visited for environmental compliance inspection except Chato in Kagera Region, Ukerewe in Mwanza Region, Serengeti in Mara Region, and Pemba in Zanzibar. During the inspections, the officers were accompanied by malaria focal persons in the respective districts. Mr. Tembo and Mr. Emmanuel visited the storage facilities and observed field activities to evaluate compliance with the standard IRS procedures. Any shortfalls were discussed onsite and, where possible, corrective measures were implemented almost immediately. The officers held briefing and debriefing meetings with the DMOs (in some cases DITTs); interviewed sample beneficiaries; reviewed checklists, documents, and records (e.g., IRS record forms, issue vouchers, GRNs certificates etc.); and conducted onsite observations / verification (spray operators, households etc.).

Findings/Results The findings in this section are grouped into strengths and weaknesses observed in the field for all the site visits.

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Strength

Security at the central Warehouses and Site Stores The central warehouses in Zanzibar, Mwanza, Mara, and Kagera regions were well secured, double-locked, fenced, and guarded 24 hours a day through a hired security company. All warehouses are spacious with adequate ventilation and are located away from water bodies and approximately >500m and away from schools and residences.

Warehouse Arrangements and Stock/Inventory Management IRS commodities in warehouses were stacked and arranged well on shelves and pallets, with less than a 2-m height providing friendly environment during issuing and receiving and even verification between records and physical stocks except for some few cases (see Figure 1 and 2).

The IRS supplies, equipment, and consumable inventories were well managed through a well-established system consisting of issue vouchers, GRNs, DNs, bin cards, store ledgers, and e-mails (acts as requisition order), which corresponded with physical stocks. The storekeepers demonstrate competencies in warehouse best practices.

Figure 1. Well-Managed Zonal Warehouse in Mwanza (left) and Regional Warehouse in Zanzibar (right)

Figure 2. Storekeeper responds to technical questions from NMCP delegates during concurrent NMCP supervision and environmental compliance inspection


IRS Infrastructure (Soak Pits and Site Storage Facilities) All operational sites have very good soak pits and good storage facilities (see Figure 3). Although in some operational sites, the stores are relatively smaller (e.g., Manyamanyama site in Bunda District), the stores are in good condition to support IRS.

Figure 3. Well-maintained soak pit

Health and Safety Activities In general, safety precautions are understood and well demonstrated in all district warehouses, including operational sites. Material safety data sheets (MSDS) for Ficam VC and K-Othrine insecticides were also available at the central warehouses and site stores (see Figure 4).

Figure 4. Safety precautions at Kinesi site in Mara Region (left) and Chikobe site in Mwanza Region (right)

Spray operators wore full PPE (e.g., helmets with face shields, overalls, gloves, gumboots, and masks) while in working (see Figure 5). PPE provides preventive measures against any accidental exposure of insecticide during operations.


Figure 5. Operators in full PPE during triple-rinsing at Masanga site in Tarime District, Mara Region

In many districts, households were are of and understood information about what to do before, during, and after spray operations. This information (i.e., cleaning after spraying, not entering the house structure for at least 2 hours after spraying) was given by hamlet leaders and reinforced by spray operators. Movable household items were taken outside the houses to avoid accidental contamination, and spray operators were given a cover sheet to protect items that remained in the house but moved to the center of the room. There were a few incidences observed where households were not guided properly on what items to remove or not to remove.

Temperature monitoring in storage rooms for both regional warehouses and site stores was being monitored thrice a day (morning, afternoon, and evening), and the records reveal maximum of 33 0C, which is below recommended/tolerance limits of <40 0C for both Ficam VC and K-Othrine (see Figure 5).

Figure 6. Temperature monitoring at Chikobe site in Geita District, Mwanza


Medical examinations of all spray teams were done by district medical officers before spraying. Temporary staff were randomly interviewed for medical checks such as general physical fitness and pregnancy testing for women. However, medical records were not available onsite. A few sites did not have pregnancy test kits on the first few days of operation.

Spray Technique Spray operators are well trained in spraying techniques, including swathing (overlap of 5 cm), spraying stance (45 cm parallel from wall), mixing and pressurizing the content, and sourcing leakages, among others. All operators were observed to be competent, which reflects appropriate training before IRS. None of the spray contents were observed to leak from the pump or drip from the nozzle during the inspection.

Figure 7. Spray operators and other temporary staff in training at Sirari site, Tarime District, Mara Region

Effluent Waste Management Effluent waste was well managed and disposed of in properly designed biological disposal structures consisting of washing bays, drying lines, water reserve tanks (1,000 l) and soak pits. The bathrooms’ waste water also drained into the soak pits. Water used for cleaning PPE and bathrooms was collected and then drained to the pits and degraded biologically (see Figure 7).


Figure 8. Triple rinsing done on washing bay (left) and the wastewater is directed to biological soak pit (right)

Solid Waste Management Solid waste—especially insecticide-contaminated items such as empty sachets, outer cartons, plastics, damaged PPEs—are kept in the temporary stores, i.e., they are not disposed onsite. The incinerator for disposal of solid waste is installed at Nyanguge Health Centre in Magu District in Mwanza Region (see Figure 8). Currently, more than 500 kg of waste has been disposed since the installation of the incineration on March 25, 2013.

Figure 9. Incinerator shelter (left) and ash pit (left)

Weak Points to Be Addressed

Proper Documentation for Site Storage Facilities In Mainland Tanzania, site warehouses are managed by site managers, some of whom have not yet mastered the documentation process. As such, there was no uniformity in the system used to record stock movement. For example

• In some sites, bin cards were not updated on a daily basis, because the site managers were sometimes busy with field operations.


• A daily insecticide control booklet #15 was prepared to control the return of insecticide sachets from site managers to team leaders and vice-versa. Team leaders were supposed to sign a form when they collect insecticides in the morning and sign it again when the sachets are returned from the field. Some sites did not being follow this procedure—Nyamatongo site, Sengerema District (Mwanza), Utegi site in Rorya District (Mara), and other sites.

• Although no losses were reported, there was a lack of clarity among some site managers on how to use the equipment control booklet and materials issue voucher. In the next campaign, this issue needs to be addressed during training.

• Some sites did not have a store ledger, issue voucher, and/ or equipment control booklet. This was due to the distribution problems, because so many sites started spraying on the same day.

• Issue vouchers were not being used in a number of sites, e.g., Kituntu in Karagwe, Salamakati in Bunda, and many other sites. This was due to lack of understanding by the site managers on how these booklets are supposed to be used.

• There were some differences among the site managers in the way the bin card for insecticide was completed. Some were recording the insecticide used at the end of the day while the correct way was to record what was issued in the morning and then recording returns in the evening. This helps not only to properly track the movement of insecticide but also to ensure that at any point in time, the bin card correctly reflects the quantity of insecticide available in the store.

Bin Cards for Insecticides Were Not Updated on Daily Basis The bin card for insecticide e.g. (Ficam VC) at Kinesi site, Rorya District in Mara Region was not updated according to the physical stock. A similar situation was found at Rosana site in Tarime District. These situations jeopardize best practices in stores management and may trigger loss of items.

Inappropriate Stacking/Arrangement of IRS Items in Mara Warehouse The arrangement of IRS items especially insecticide was found stacked at the higher than recommended limit of <2 m height, which threatens safety and best practices in store management (see Figure 9). The storekeeper lacked enough space, because the materials were not properly arranged.


Figure 9. Ficam VC stacked >2 m higher in Mara warehouse

No Separate Storekeeper Office and Storage of Empty Sachets The Mara warehouse is lacking a separate storekeeper’s office for him to complete paperwork and in which to keep IRS documents. This was also the case in Gamba site in Zanzibar. The warehouse also lacks a separate storage room for empty sachets and other IRS wastes.

No Tracking of Issued Masks or Used Masks Many site managers were not tracking or keeping records of masks issued and those that were returned from the field as used. On the day of the visit, each site manager was told to start keeping the records, including opening a bin card for used masks. During the visits, site managers were instructed to organize, count, and label the containers for used masks, including creating a bin card for them. The quantities will be compared to the amounts that were issued.

Improved Management of Empty Sachets and Solid Wastes After daily verification from team leaders, empty sachets were kept in boxes in a disorganized manner that made it difficult to verify how many empty sachets were physically available. Site managers were advised to count and organize the empty sachets into multiples of 100 in one plastic bag, 10 plastic bags (each with 100) placed into a box (making 1,000 sachets), which is then labeled and sealed. This makes verification easy. All remaining empty boxes were collapsed and packed to create space in the warehouses.

Plastic Gloves Still a Chronic Problem Needs Attention Plastic gloves again were observed to be weak and easily pierced by slightly sharp objects (see Figure 10). This can pose a threat of exposure to insecticide and hence threaten operators’ health. Procurement estimates for gloves were done properly, but at the time, this high rate of damage was not taken into account; as a result, many sites experienced stock-outs of gloves.


Figure 10. Gloves appear weak and are easily pierced by sharp objects

Face Shields are Wearing Out In some sites, face shields are wearing out and have become almost opaque. During spraying, some become obscured after spraying a few houses because of accumulated insecticide deposits. The old face shields need to be replaced; in the meantime, it is recommended to provide a small towel to each spray operator for cleaning the visor while in the field.

Medical Examination and Pregnancy Test Records Were Not Available Onsite Medical examinations and pregnancy tests were conducted, however, there were no records found onsite. There is need to clarify as to who should keep the medical records. In some districts, medical records were found in personal files, while in others, they remained at the health facility where examinations took place.

Need to Increase Supervision in the Field When spray operators are not adequately supervised, they tend to relax some of the strict controls. Sometimes they don’t even use the cover sheets in situations when it was supposed to be use. Sometimes they go ahead to spray while some items are still in the rooms. This raises the risk of contamination to the beneficiaries.

Dissolving 10 l of insecticides unto an 8 l tank In Zanzibar, spray operators use an 8 l tank for spray operations. The spray operators, who were trained to use 10 l of water for each sachet had problems managing the remaining 2 l, which were left over after the mixing because the pump’s capacity was 8 l. This posed an increased risk to the operator and to the environment due to possible spills. It is highly recommended that for an 8 l pump, one should use 8 l of water, while with a 10 l pump, one should use 10 l of water.


The Soak Pit in Kiagata Was Water Logged The area in Kiagata, Bunda District is in a low-lying area (see Figure 11). As a result, the soak pit was water logged due to heavy rains that were falling at that time. Aggregate was required to conceal the high level of water and to minimize the risk to birds from drinking contaminated water.

Figure 11. Water logged soak pit

Recommendations for Improvement/Corrective Action • Emphasize during trainings use of daily insecticide control booklet #15, the roles of

each staff member, and that the record should be endorsed daily by each responsible staff member.

• Emphasize during trainings the use of stores ledgers and the importance of updating them on daily basis, per best practices in stores management.

• Rearrange IRS items in Mara warehouse and comply with the recommended limit for stacking items (<2 m high).

• Recommend to construct a temporary structure (using corrugate iron sheets) for storekeeper office and storage room for temporary storage of empty sachets and other IRS waste.

• Recommend technical to review the quality of the plastic gloves and come up with permanent solution.

• Always make available medical examinations during IRS operations (onsite).


Timeframe for Action Plan


1 Add 2 days of in-depth training of Site Managers to focus on IRS Commodity Management

Technical Manager Before next round

2 Emphasize during trainings the use of stores ledgers and the importance of updating them on daily basis, per best practices in stores management

Storekeeper – all regions During training

3 Properly organize the IRS items in Mara warehouse and comply with the recommended limit for stacking items (<2 m high)

Storekeeper Mara Region ASAP

4 Recommend to construct a temporary structure (using corrugate iron sheets) for storekeeper office and storage room for temporary storage of empty sachets and other IRS waste

Ag. Team leader – Mara Region

ASAP

5

Recommend technical to review the quality of the plastic gloves and come up with permanent solution. Note that there should be a balance between durability and comfort for the spray operator. The toughest gloves may not be user friendly to the operator

Technical team – Lake Zone

Before next IRS

6 Review and communicate the decision as to who should have custody of medical forms so that they are accessible for verification during site supervision

Team leaders – lake zone During IRS

7. Provide more aggregate on the soak pit in Kiagata to conceal the contaminated water

MFP ASAP

8

The technical team should decide the strategy for increased supervision in the next round. This can be coupled with empowering the beneficiaries that they ensure that the operators sprayed their house well.

Technical Manager Before next campaign

9 In Zanzibar, train the operators and ensure that all sites use 8 l of water for an 8 l pump, 10 l for a 10 l pump

Technical Manager During training

10 Supervisors should ensure that all worn out face shields (visors) should be replaced. Take stock now and separate out all worn out shields

Team Leader ASAP

11 Make available the national IRS guidelines to all Malaria Focal Persona (MFPs) in each district.

Technical Manager Before next campaign

Conclusion TVCSP has solid infrastructure (warehouses and soak pits) in all the IRS sites. An area for improvement is to fine-tune and build uniformity among practices during IRS implementation. This can be achieved through training and requiring that all regions and districts use the same printed NMCP IRS guidelines and the USAID’s BMP manual. The guidelines prescribe how specific activities should be implemented at all levels. If the


program ensures that everybody is using the same guidelines, there will be minimal variations.

Field supervision was one of the weaknesses observed. When spray teams know that they will not be supervised anytime soon, they become lax and miss some of the critical controls and best management practices.


Annex 1. Selected key persons met RTI/Tanzania Dar es Salaam

1 Dr. Madhi Ramsan Mohamed Chief of Party

2 Dr. Uche Ukenna HOTM

3 Mr. Mubita Lifwatila Finance Director

4 Dr. Abdullah S. Ali Program Manager, ZMCP

5 David Ngilangwa PMI/CDC

6 Dr. Elias Mayala DMO, Karagwe



9 Mr. Nick Nyamanda Malaria Focal Person, Karagwe

10 Issa Garimo RTI Zanzibar


12 Dr. Mohamed Mpunjo DMO’s office, Karagwe

13 Juma H. Mcha ZMCP

14 Dr Andrew John DMO, Ngara District

15 Abdallah Rashid Zanzibar

16 Dr Josephat Maro Act DMO, Kwimba District

17 Joseph Mandago MFP, Magu District

18 Dr. Kihulya Mageda DMO Biharamulo

19 Dr Kalabaele MFP, Biharamulo

20 Dr. Madina Kilariti MFP, Ngara District

21 Mr Correl Ngudungi District Executive Officer, Ngara

22 Dr Ndaki DMO, Sengerema district

23 Ms Adella Jeremiah Mara Region

24 Mr Joel Mpemba MFP, Geita

25 Mr. Juma Rutta Compliance Manager

26 Mr Shabulla Lalji M&E

26 Ms Jessica Byassee Peace Corp Volunteer

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26 Mr. Shabir Lalji M&E Officer

26 Ms. Jessica Byassee U.S. Peace Corp Volunteer

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Tanzania Vector Control Scale-up Project End of Spray Report

Environmental Compliance Inspection Report (Pre-Spray and Mid-Spray for Mwanza, Mara and Kagera Region): As of July 2013

Tanzania Vector Control Scale-Up Project (TVCSP): Environmental Compliance Unit, Indoor Residual Spraying Environmental Compliance Inspection Report (Pre-Spray and Mid-Spray for Mwanza, Mara and Kagera Region) Contract No. 621-A-00-10-00015-00 March 9, 2010–March 8, 2015 Prepared for: U.S. Agency for International Development/Tanzania Prepared by: RTI International 3040 Cornwallis Road Post Office Box 12194 Research Triangle Park, NC 27709-2194 July 31, 2013

Tanzania Vector Control Scale-up Project (TVCSP): Environmental Compliance Unit, Indoor Residual Spraying Environmental Compliance Inspection Report (Pre-Spray and Mid-Spray for Mwanza, Mara and Kagera Region) Contract No. 621-A-00-10-00015-00 March 9, 2010–March 8, 2015 Submitted to: U.S. Agency for International Development/Tanzania ATTN: Jessica Kafuko, Susan Scott-Vargas Samuel S. Kiranga, and Naomi Kaspar 2140 Dar es Salaam Place Washington, DC 20521-2140 E-mail: [email protected], [email protected] [email protected]; [email protected] Submitted by: RTI International 3040 Cornwallis Road Post Office Box 12194 Research Triangle Park, NC 27709-2194 Submitted on: July 31, 2013 RTI International is one of the world’s leading research institutes, dedicated to improving the human condition by turning knowledge into practice. Our staff of more than 2,600 provides research and technical services to governments and businesses worldwide in the areas of health and pharmaceuticals, education and training, surveys and statistics, advanced technology, international development, economic and social policy, energy, and the environment. RTI also employs about 1,200 term employees who support projects in more than 40 countries. For more information, visit www.rti.org. The author’s views expressed in this publication do not necessarily reflect the views of the U.S. Agency for International Development or the U.S Government.


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Table of Contents Acknowledgement ..................................................................................................................................................................... 3 1.0 MAIN OBJECTIVE ........................................................................................................................................................ 4 1.1 Specific Objectives ....................................................................................................................................................... 4 2.0 BACKGROUND ............................................................................................................................................................ 4 3.0 INSPECTION METHODOLOGY .................................................................................................................................. 5 4.0 IRS BEST PRACTICES OBSERVED ........................................................................................................................... 6 4.1 Improved Documentation in all the storage facilities ..................................................................................................... 6 4.2 Physical Verification of materials supplied and received .............................................................................................. 6 4.3 Proper Training in Commodity Management ................................................................................................................ 7 4.4 Use of the right vehicles for transportation of IRS materials ......................................................................................... 7 4.5 Material Safety Data Sheets available in the warehouses ............................................................................................ 7 5.0 OBSERVATIONS NEEDING ACTION.......................................................................................................................... 8 5.1 Timing of Procurement and delivery of materials to the Regions .................................................................................. 8 5.2 Late Distribution of Pregnancy Test kits ....................................................................................................................... 8 5.3 Space Constraints in the Regional Warehouse in Mara ............................................................................................... 9 5.3 Incineration at Nyanguge Hospital ................................................................................................................................ 9 5.4 Maintenance of Soak pits in all the sites ..................................................................................................................... 10 5.5 Improvements in Ngenge Site, Muleba district ........................................................................................................... 11 5.6 Need for maintenance of the wash slab at Rubare Site in Bukoba Rural ................................................................... 12 5.7 Low coverage Performance in number of Sites in Mara Region. ................................................................................ 12 5.8 Use of Site Managers as Storekeepers ...................................................................................................................... 13 6.0 TIMELINE FOR ACTIONS .......................................................................................................................................... 13 7.0 CONCLUSION ............................................................................................................................................................ 15 8.0 ANNEXE 1: Some of the key persons met ................................................................................................................ 16

Tanzania Vector Control Scale Up Project Page 2

List of Acronyms

BMP Best Management Practice Manual

DMO District Medical Officer

DITT District IRS Technical Team

IRS Indoor Residual Spraying

MSDS Material Safety Data Sheet

NEMC National Environment Management Council

PPE Personal Protective Equipment

RTI RTI International


TVCSP Tanzania Vector Control Scale-Up Project

USAID U.S. Agency for International Development


Acknowledgement

I am again very grateful to the TVCSP Chief of Party (COP) and the entire Tanzania IRS team for

the support they accorded unto me, without which it would have been impossible to achieve so much

within a very short period of time. The Team had put up a compact program which was matched

with logistic support such that within the time, I was able to visit all the three regions of the Lake

Zone and managed to sample a significant number of operational sites. For this I say thank you.

The Malaria Focal Persons for Muleba, Magu, Misungwi and Bunda districts are highly commended

for taking me to the sites and for the nice technical discussions which allowed us not only to resolve

the observed implementation issues in the field but also to generally add value to the program.

Lastly I wish to say thank you to the administrative staff for facilitating my movements, arranging

for reservations and making sure that everything I needed on this trip was available on time.


1.0 MAIN OBJECTIVE

Thee regional Environmental Compliance inspector from regional office at Nairobi, Mr Autman

Tembo was invited to undertake an environmental compliance (pre-spray and mid-spray) inspection.

The inspection was done for the round 2 of IRS Campaign in the Lake Zone, which is a repeat spray

for districts and sites that used Bendiocarb in Round 1.Because the round two spraying season’s

campaign was small and relatively short, it was not realistic to separate out the pre-spray and mid-

spray inspections rather combined the effort into one environmental compliance inspection. This

second campaign was targeting only villages that used bendiocarb conducted before March 2013.

1.1 Specific Objectives

i. Undertake pre-spray inspection and determine the program preparedness and evaluate the

appropriateness of IRS infrastructure (Soak pits, rinsing areas and storage facilities) before

the commencement of spraying campaign.

ii. To determine whether the pre-spraying and mid-spraying activities in lake zone (Mwanza,

Mara and Kagera) are implemented in accordance with USAID environmental regulations

and local environmental requirements as stipulated in the environmental monitoring and

mitigation plan – reflecting Best Management Practice Guideline (BMP)

iii. To point out non compliance issues for spraying activities and recommend corrective actions

in a given timeframe before the next IRS season

iv. To determine, in consultation with RTI technical team in Tanzania the support required to

improve and ensure future compliance with USAID environmental regulations, SEA and

BMP requirements.

v. To provide any other technical support as requested by technical team including follow-up of

previous action points.

vi. Brief and debrief the key stakeholders and others partners

2.0 BACKGROUND

The Round 2 of IRS Campaign in the Lake Zone is a repeat spray for districts and sites that used

Bendiocarb in Round 1. The repeat spray compensates for the short residual efficacy of bendiocarb

which falls within three to four months. The Round 2 campaign under this compliance inspection

comprises three districts in Mwanza Region (Kwimba, Misungwi and Magu), four districts in Kagera

(Bukoba rural, Karagwe, Missenyi and Muleba) and two districts in Mara Region (Bunda and

Musoma Rural). Within the respective districts, only a few sites used bendiocarb. Kagera Region has

the largest number of operational sites (21 sites).

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3.0 INSPECTION METHODOLOGY

Mr Tembo’s visit was purposely timed so that he would be able to visit some sites before the

commencement of spraying activities (pre-spray) and another set of sites after the start of spraying

(mid-spray). This enabled him to see the conditions before and during spraying. Since this visit

directly follows the previous visit in January and March 2013 (Round 1) during which most of the

sites sprayed were visited, the priority now was to visit all participating sites that were not visited

before. The only sites not visited before were Lukungu and Kisesa in Magu district; Ngenge and

Mubunda in Muleba District; Kashenye site in Missenyi ditrict; Kashozi, Rubare, Katoro, Kishogo

sites in Bukoba Rural district; Mugeta site in Bunda district and Rusoli-Bukima site in Musoma

district. In addition to these, a couple of sites were revisited including the central warehouses and a

selected mix of site storage facilities in Kagera, Mwanza and Mara Regions.

DAY

TIME ACTIVITY

Mon, May 20 15:30 Arrival in Nairobi

TUES May 21 12:30 am 15:00 pm

Arrive Airport Mwanza In-Brief and Planning Meeting at RTI Manza Office

WED, May 22 6:00 am

Field visit Misungwi and Kwimba Districts

THURS, May 23 6:00 a.m

Field Visit Lukungu and Kisesa sites in Magu District

FRID, May 24 7:30 am 12:00 noon

Travel to Bukoba, Kagera Region Travel to Muleba District

SAT, May 25 8:00 am Filed visit Bukoba Rural

SUN, May 26 MON, May 27 7:30 am

Field Visit

TUE, May 28 5:00 pm

Depart for Musoma, Mara Region

WED, May 29 6:00 am Field Visit Musoma Rural (Bukima, Kyawazarwe Sites)

THUR, May 30 6:00 am 16:00 pm

Field visit Bunda (Butiama, Mugeta, Manyamanyama) Visit Regional Warehouse

FRID, May 31 12:00 noon 14:00 pm

Return to Mwanza Depart for airport to Nairobi at 16:30

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SAT, JUN 1 6:00 am Depart Nairobi for Lilongwe

4.0 IRS BEST PRACTICES OBSERVED

From the Round 1 and the previous environmental compliance inspection reports, there were a

number of notable improvements and lessons learnt which has been observed and reflected in the

current inspection visit.

4.1 Improved Documentation in all the storage facilities

In the previous campaign, lack of proper documentation was one of the biggest shortfalls which the

program had to work on and resolve. It has been noted during this visit that proper orientation has

been conducted which was evidenced by proper documentation at all sites visited. All sites had Store

Ledgers and all kept a folder of all Issue Vouchers from the Zone or Regional Warehouses as proof

of origin and quantity of IRS materials supplied.

4.2 Physical Verification of materials supplied and received

During material delivery, there was evidence of physical verification which was not the case in the

last campaign. The quantity of material recorded in the Store Ledger would correspond with the

physical quantity available in the storage facility.

Product verification and physical counting at Bukima and Mugeta Sites


4.3 Proper Training in Commodity Management

All the sites visited demonstrated adequate knowledge of the documentation requirement. In

Mwanza and Kagera Regions, each item in the warehouse had its own Bin Card even at site level

while in Mara Region, only insecticides and masks had a bin card.

4.4 Use of the right vehicles for transportation of IRS materials

The program made a good effort to select vehicles which were appropriate for transportation of IRS

materials from the central warehouses to the districts and the local sites. This minimizes risks to the

people and the environment.

Transport Vehicle for IRS materials

4.5 Material Safety Data Sheets available in the warehouses

The material safety data sheet (MSDS) for bendiocarb was distributed and available in almost all the

storage facilities. The MSDS provides at fingertips the technical information about the chemical

being stored, the risks associated with it, the storage conditions, the handling requirements and what

to do in case of exposure, fire and environmental spill.


5.0 OBSERVATIONS NEEDING ACTION

While there were a number of positive improvements from the previous spray campaign, the

following observations which require further improvements were noted.

5.1 Timing of Procurement and delivery of materials to the Regions

The delivery of IRS commodities from the Zonal Warehouse to the Regions was done two days

before commencement of spray operations. This creates a lot of pressure in the Regions to ensure

that every site is catered for properly. In Kagera for example, the Store Keeper had to load 21

vehicles within two hours which resulted in a number of anomalies and differences between the

quantities supplied and the quantities written on the Issue Vouchers.

Recommendations:

In the next campaign:

• The program should develop a clear countdown calendar and plan with realistic lead times and deadlines.

• The technical team should have material quantification very early (not less than 5 months before spraying) to give enough time for procurement process to happen without due pressure.

• Delivery of IRS materials from Zonal warehouse to the Regional warehouses should be done at least 2 weeks before the commencement of spraying. This will allow the Regions to properly sort, plan and distribute to the districts and sites with minimal errors.

5.2 Late Distribution of Pregnancy Test kits

The pregnancy test kits for all female spray operators were supposed to reach the sites a day before

the training so that all female personnel engaged in IRS activities should be tested for pregnancy

during training or before commencement of spray operations. During the inspection, it was observed

that some sites like Kashozi in Bukoba Rural and Kyawazarwe in Musoma Rural did not get the test

kits in time, as a result they started spraying without conducting the pregnancy test. The best practice

is for all female spray operators to delay joining the operation until they were tested for pregnancy.

Recommendations:

• Site Managers were supposed to consult the DMO and explore the possibility of using pregnancy test kits from the government like what was done in some districts.

• Female team members were supposed to wait for the tests before engaging in spray operation. Stopping female team members from operation would signify the importance and seriousness of the pregnancy test requirement.


• Next time, distribution of IRS materials should be done early, otherwise all female spray operators have to delay joining the campaign until they are tested for pregnancy.

5.3 Space Constraints in the Regional Warehouse in Mara

The Regional Warehouse in Musoma for Mara Region has the challenge of space limitation. The

problem is worsened after the spraying activities when all materials are brought back to the

warehouse.

Recommendations:

• The program should consider identifying a bigger warehouse that may contain all the IRS materials especially after spraying.

• Alternatively the program may consider erecting a temporary storage facility within the compound

• The program has plans to fix shelves for stacking of materials which might help to maximize the use of available space. While provision of shelves may help reduce the burden, shelves alone may not solve the whole problem.

• The waste materials which are occupying a significant amount of space in Musoma should be sent for incineration. The program should make it a priority to incinerate the waste materials from Mara Region first because this warehouse is heavily constrained in space.

Regional Warehouse in Musoma –Shelves required

5.3 Incineration at Nyanguge Hospital


Incineration of IRS wastes started a month ago at a newly constructed incinerator at Nyanguge

Hospital. The operator has full PPE and the area is well fenced. However, there is no waste receiving

and temporary storage structure which can be used as a holding bay. Currently the wastes are being

kept on the open. This poses the risk of unauthorized access by humans, birds and animals.

Well constructed Incinerator at Nyanguge hospital – Lacks waste receiving and storage structure

Recommendations

• The program should evaluate whether the incineration process is happening at an optimal and efficient level so as to maximize on time and resources. The program has a large volume of wastes to be incinerated.

• There is need to post a “Danger Warning” sign on the facility. • There is need to construct a waste receiving structure or waste holding bay with a top cover.

5.4 Maintenance of Soak pits in all the sites

Most of the soakpits have been in use for a couple of spray rounds already and now they exhibit

signs of clogging because of the organic material that are blown into the pits and the mud which is

washed from spray operator boots during cleaning. The mixture of mud and organic material on the

top layer of the soakpit makes wastewater percolation difficult and enables grass (which is a

attraction to animals) to grow inside the soakpit


Soak pits in Koromije and Misasi Sites, Misungwi district, Mwanza –require refurbishment

Recommendation:

• All soakpits that have not been in maintained in Kwimba, Misungwi and Magu should be cleared of debris and grass before use in Round 2. The top layer should be excavated and cleaned to remove mud and organic material.

• Before the next campaign, the top layer (6cm of gravel) of all soakpits should be excavated, cleaned and replaced.

5.5 Improvements in Ngenge Site, Muleba district

In Ngenge site, Muleba district, the location of the temporary storage area share a veranda with other

health centre activities. Patients and health centre visitors share the veranda as a resting place which

may increase the risk of contamination in case of accidental spill.

Common veranda access at Ngenge Site, Muleba


Recommendations:

• Resolve that during this campaign, a temporary barrier should be used to separate out the IRS activities. Visitors will not be allowed beyond the barrier.

• In the next campaign, explore the possibility of another temporary storage, located at a safe distance from other non-IRS heath facility activities.

5.6 Need for maintenance of the wash slab at Rubare Site in Bukoba Rural

The washing slab at Rubare Site in Bukoba Rural District has developed cracks on one side. For

now, the teams can use the other side which is in good condition to facilitate this IRS campaign only.

However, before the next campaign, the whole washing slab should be resurfaced.

Recommendations:

• In the next campaign the entire washing slab at Rubare need to be resurfaced. • The wastewater delivery pipe which was broken at Kashozi site should be replaced.

5.7 Low coverage Performance in number of Sites in Mara Region.

Coverage performance in the sites visited in Mara Region was very low for the first three days of the

campaign. Some sites had on average, coverage of as low as less than 40% during the first three

days. During the field visits to the villages and through community and SIM interviews, we got

some feedback on the reasons for low coverage. Any feedback from the community, whether a fact,

myth or misconception, is of vital importance and should be considered during IRS campaign

mobilization. The following are some of the reasons captured:

• There was no proper information given to the community prior to the campaign. For example,

the communities, which were used to one spray round a year were not told in advance that

there will be a repeat spray within few months of each other. Many people did not see the

reason why their house should be sprayed again after it was sprayed only a few months ago.

• Some did not like the idea of moving everything out of the house. An alternative, which

could be adopted, would have been to encourage the community to move everything only to

the centre of the room (except water, utensils and foodstuffs which should be moved out) and

the operator can use a plastic sheet to cover the centre-moved items during spraying.

• In some areas, there was no cooperation from the hamlet leaders. Some wanted to be paid in

advance while the normal practice is to pay only after someone has worked.


• Some said that they don’t see the impact of spraying. To some, “impact” is only when they

see no mosquito or bedbug in the house after spraying. This should be properly investigated

and explained.

• The myths that spraying brings fleas and bedbugs and that it inhibits sexual desire.

The community perception, whether right or wrong, should be taken seriously because it has serious

impact and should be the basis for community mobilization.

Recommendations:

In the next campaign:

• The program should never assume that the communities are used to IRS and that they are already aware about everything. Good community mobilization is required prior to embarking on another round especially when there is significant change in strategy.

• Every feedback from the community should be considered and adequately addressed.

5.8 Use of Site Managers as Storekeepers

While Site Managers are now doing a wonderful job in commodity management at site level, the

idea should be evaluated as to whether this approach is a better use of the technical resource at the

site. The concern is that commodity management is so demanding, as a result most Site Managers

never have time to supervise field operation. When Site Managers never visit the field, quality of

spray and the quality of data can easily be compromised.

Recommendations:

• The program should weigh the costs and benefits of keeping the site manager at the storage facility being used for managing stock versus him/her spending most of his time supervising field operations.

• In the health centres where the sites are located, the program should explore training and engaging one staff from the health facility to assist in commodity management. In so doing the site manager will have time to supervise quality of spraying in the field and at the end of the program there will also be capacity at local level in commodity management.

6.0 TIMELINE FOR ACTIONS


Logistics

1 Develop a clear countdown calendar and plan with realistic lead times and deadlines.

Technical Team Leader (Mr Joshua Mutagahywa)

Next campaign

2 The technical team should have material quantification very early (not less than 5 months

Technical Team Leader (Mr Joshua Mutagahywa)

Next

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before spraying) campaign

3 Deliver IRS materials from Zonal warehouse to the Regional warehouses at least 2 weeks before the commencement of spraying

Procurement Manager 2 weeks before next campaign

4 Distribute pregnancy test kits early and test female operators before commencement of spraying activities. All untested should delay joining operations until tested.

Procurement Manager and Team Leader

2 weeks before next campaign

Warehousing

5 The program should consider identifying a bigger warehouse in Musoma that may contain all the IRS materials especially after spraying else erect temporary storage facility.

Team Leader As soon as possible

6 Fix shelves for stacking of materials in Musoma warehouse which might help to maximize the use of available space.

Team Leader As soon as possible

7 Isolate IRS activities at Ngenge storage facility using a temporary barrier.

Team Leader Kagera Immediately

Incineration of waste

7 Incinerate wastes from Musoma warehouse first so that we have to ease the space constraint at the site

Environmental Manager Lake Zone

Immediately

8 Install a “Danger Warning Sign” at the incinerator

Environmental Manager Immediately

9 Construct a waste holding bay at the Nyanguge Environmental Manager As soon as possible

Maintenance of Soakpits

10 The top layer of all soakpits should be excavated and cleaned to remove mud and organic material

Environmental Manager Immediately after this campaign

11 Resurface the soakpit at Rubare Site in Bukoba Rural

Team Leader Kagera Before next campaign

12 Replace a broken bend at Kashozi Site in Bukoba Rural district

Team leader Kagera Immediately

Community Mobilization

13 Plan for a more detail community mobilization before any campaign to resolve all community issues learnt from the previous campaign

Team Leader Mwanza Before Next campaign

14 Redesign the mobilization program to take into account every feedback from the community

Team Leader, Mwanza Before next campaign

Efficient Use of Site Managers

15

Re-evaluate whether using the site managers as storekeepers is contributing to the lower quality of spraying in the field and determine if this setup is an efficient use of the technical resource at site level.

Team Leader, Mwanza Soon after this campaign


7.0 CONCLUSION

The IRS program has made strides in implementing the recommendations from the last

environmental inspection. The program has also made significant improvements in commodity

management which was one of the serious issues in the previous campaign. There is need now to

consolidate these gains by improving in timing of IRS material quantification, procurement and

distribution which currently is an issue that affects the operations.

The other outstanding issue is on the minor maintenance of the soakpits. In the next campaign, effort

has to be made to excavate and replace the top layer of most of the soakpits which has been clogged

with mud, sand or organic material. The top layer can be cleaned and replaced.

Community mobilization is one of the key issue that need to be re-strategized in Mara Region to

effectively address all the community concerns in order to make progress in the operation.


8.0 ANNEXE 1: Some of the key persons met



2 Dr. Stephen Magesa Vector Control Operations Director


4 Mr. Joseph Mandago MFP, Magu District

5 Dr. Mwita DMO, Missungwi

6 DMO, Muleba District

7 Mr Selemani Mzee Selemani DC, Kwimba

8 Mrs Joyce Kasambazi MFP, Kwimba

9 Mr Gibson Buzohera Kwimba

10 Dr Luhaga Kisesa Health Centre


12 Gaspar Rwegaswa MFP, Missenyi

13 Egidius Matalemwa Lugafunga Missenyi

14 Mr Enosy Matthias Storekeeper, Bukoba Warehouse

15 Ms Primtiva Pastory Kashozi

16 Dr Josephat Maro Acting DMO, Kwimba District


18 Mr Shabbir Lalji M&E

19 Mr Wakil Jacob Site Manager, Bukima

20 Ms Matrida Mussa Site Manager, Kyawazarwe

21 Margaret Nyambwa Butiama Site Manager

22 Ezekiel Gamaya Muheta Site Manager

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Documents

pdf.usaid.govpdf.usaid.gov/pdf_docs/PA00MGH9.pdfTanzania Vector Control Scale-up Project: Spray Performance Report . October 2012–June 2013 . Contract No. 621-A-00-10-00015-00