ITMs and Other Vector Control Interventions: IVM approach Dr Birkinesh Ameneshewa WHO Regional Offic

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ITMs and Other Vector Control Interventions IVM
approachDr Birkinesh AmeneshewaWHO Regional
Office for Africa
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Overview

• Definition of IVM
• Why vector control/IVM?
• Rationale
• Available vector control methods
• Main VC methods currently applied in Africa
• Constraints
• Needs
• WHO activities
• Possible roles of NGOs
• Opportunities
• Conclusion

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Integrated Vector Management

• Evidence based selection, targeting,
  implementation, monitoring and evaluation of one
  or combinations of more than one vector control
  interventions

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Why vector control/IVM

• High EIR in Africa reduction in EIR contributes
  to the reduction in malaria transmission
• Resistance of malaria parasites to drugs

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EIR and parasite prevalence
Beier, et al 1999
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EIR and all-cause mortality Infant Mortality
Rate (0-11 mos) green circleChild Mortality Rate
(12 59 mos) open squares
Smith, et al 2001
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In vivo chloroquine resistance in the African
Region 1995-2001
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In vivo Sulfadoxine-Pyrimethamine Resistance in
the African Region 1995-2001
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The rational for IVM

• Biological rational
• -Vector -resting, feeding and breeding
  behaviors
• -insecticide resistance
• -Human behavior, life stile etc
• Epidemiological rational
• Level of endemicity
• Disease transmission pattern

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The rational for IVM cont.

• Environmental rational
• Risk factors in the environment
• Socio-economic set up (urban/rural)
• Programmatic rational
• -Focus on transmission reduction with the
  concept of integrated disease control
• -Localized program management in
  decentralized health system

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The rational for IVM (cont.)

• Economic rational
• -Rationalize and focus current investments in
  vector control
• -Reduce negative impact of other sectors
  (agriculture, construction etc) and engage them
  in the promotion of development in healthy
  environments

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Available vc methods

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Impact on malaria transmission
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VC methods currently applied in the African Region
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Constraints of vc programs

• Inadequate technical capacity for implementation,
  monitoring and evaluation
• Inadequate capacity for program management
  (planning, budgeting, supervision, documentation,
  reporting) decentralized health system
• Shortage of finance, logistics and equipment
• Weak maintenance capacity
• Limited capacity for OR for evidence-based
  implementation of interventions

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Constraints of vc programs cont.

• Weak link between research and operations
• Lack of motivation of staff
• Weak retention capacity of MOHs to trained staff
• High staff turn over (epidemic prone countries)
• Limited community involvement
• Uncoordinated partnership

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Needs

• Capacity building Training of environmental
  health workers and communities
• Technical guidelines (implementation, monitoring
  and evaluation)
• Systematic guidelines (program management)
• Operational research
• Adequate finance, logistics and equipment, and
  maintenance capacity

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Needs cont.

• Coordinated partnership
• System(s) to motivate staff
• Empowering communities
• Link between research institutes and MOHs

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WHO activities

• Technical capacity building
• Training
• Generic guidelines
• Strategic frameworks
• System development program implementation
• - Generic tools (needs assessment situation
  analysis)
• -Program review

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WHO activities cont.

• Link between research and operations
• -Database on entomologists
• -Network of Entomologists
• -Support in vector resistance monitoring
• Partnership
• -Work closely with governments, collaborate with
  research institutes
• Operational research

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Possible roles of NGOs

• Train health staff and communities
• Support and collaborate in the adaptation and
  dissemination of guidelines
• Promote, support and collaborate in operational
  research
• Strengthen programs with logistics and equipment
• Increase coordination/ collaboration with MOHs,
  UN agencies, commercial sector

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Possible roles of NGOs cont.

• Promote community empowerment
• Facilitate inter-sectoral collaboration
• Support the development and implementation of
  systems to motivate staff

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Opportunities for vc/IVM

• Availability of options in vc methods
• Recognition of vector control as an important
  component of malaria control
• Political commitment of endemic countries
• Mobilization of resources through RBM partnership

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Conclusion

• Less than 20 of at risk population have access
  to vector control measures in the African region.
• Scaling up of vector control implementation
  should be achieved through establishment,
  strengthening and re-orientation of vector
  control systems with the concept of IVM.
• No single vector control method could
  significantly reduce malaria transmission in all
  circumstances. So, no effective and sustainable
  program could rely only on a single method.