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

Malaria Journal

Case Study

John Gimnig¹  Themba Mzilahowa²  Emmanuel Chanda³  John M Govere⁴  Shadreck Mulenga⁵  Doreen Ali⁵  John Chipwanya⁵  Peter Troell⁶  Wilfred Dodoli⁷ 

[1] Centers for Disease Control and Prevention, Atlanta, GA, USA;Malaria Alert Centre, Chichiri, Blantyre, Malawi;Malaria Vector Control Consultant, Lusaka, Zambia;Malaria Vector Control Consultant, Nelspruit, Mpumalanga, South Africa;Ministry of Health, National Malaria Control Programme, Lilongwe, Malawi;USAID/PMI, Country Office, Lilongwe, Malawi;World Health Organization, Country Office, Lilongwe, Malawi;

关键词: Malaria vector control;    Indoor residual spraying;    Integrated vector management;    Insecticide resistance management;    Vector surveillance;    Sustainability;    Malawi;   

DOI  :  10.1186/s12936-015-0759-3

 received in 2015-04-07, accepted in 2015-06-03,  发布年份 2015

来源: Springer

【 摘 要 】

BackgroundIn the past decade, there has been rapid scale-up of insecticide-based malaria vector control in the context of integrated vector management (IVM) according to World Health Organization recommendations. Endemic countries have deployed indoor residual spraying (IRS) and long-lasting insecticidal nets as hallmark vector control interventions. This paper discusses the successes and continued challenges and the way forward for the IRS programme in Malawi.Case descriptionThe National Malaria Control Programme in Malawi, with its efforts to implement an integrated approach to malaria vector control, was the ‘case’ for this study. Information sources included all available data and accessible archived documentary records on IRS in Malawi. A methodical assessment of published and unpublished documents was conducted via a literature search of online electronic databases.DiscussionMalawi has implemented IRS as the main malaria transmission-reducing intervention. However, pyrethroid and carbamate resistance in malaria vectors has been detected extensively across the country and has adversely affected the IRS programme. Additionally, IRS activities have been characterized by substantial inherent logistical and technical challenges culminating into missed targets. As a consequence, programmatic IRS operations have been scaled down from seven districts in 2010 to only one district in 2014. The future of the IRS programme in Malawi is uncertain due to limited funding, high cost of alternative insecticides and technical resource challenges being experienced in the country.ConclusionsThe availability of a long-lasting formulation of the organophosphate pirimiphos-methyl makes the re-introduction of IRS a possibility and may be a useful approach for the management of pyrethroid resistance. Implementing the IVM strategy, advocating for sustainable domestic funding, including developing an insecticide resistance monitoring and management plan and vector surveillance guidelines will be pivotal in steering entomologic monitoring and future vector control activities in Malawi.

【 授权许可】

CC BY   
© Chanda et al. 2015