Progress Report and Challenges of Implementing Vector Control in EMR

1
Progress Report and Challenges of Implementing
Vector Control in EMR

• Abraham Mnzava
• Scientist, Vector Control
• RBM WHO/EMRO
• CAIRO, EGYPT

2
Problem of Vector-borne diseases

• Contribute to 2.2 total burden and 7 all
  communicable diseases
• Malaria contributes the greatest burden
• Other vector-borne diseases
• Bancroftian filariasis
• Leishmaniasis
• Onchocerciasis
• Trypanosomiasis
• Arboviruses
• Other vectors/pests of PH importance

3

Group 1 10 countries interrupted transmission
Bah, Cyp, Jor, Kuw, Leb, Lib, Pal, Tun, UAE Group
2 4 countries targeting elimination Egy, Mor,
Oma, SyrGroup 3 4 countries low- moderate
endemicity Ira, Iraq, Pak, SAAGroup 4 5
countries high burden Afghanistan, Dji, Som,
Sud, Yem
4
Distribution of other vector-borne diseases
Filariasis
Leishmaniasis (major problem)
Leishmaniasis (lesser problem)
Onchorceciasis
Typanasomiasis
Arboviruses
5
Vector Control in Countries of Conflict

• A number of countries in EMR are under conflict
• VBD have increased in recent years as a result
  of
• Break-down of essential health services
• Population movement their increased
  vulnerability
• Access to health care and other resources
  affected
• Malnutrition
• Lack of expertise on VC among NGOs and Agencies
• Implementation of VC under these conditions offer
  a big challenge

6
Available Control Methods

• Source reduction (filling in of breeding sites
  and intermittent irrigation)
• Biological methods (larvivorous fish, insect
  growth regulators, bacteria and other parasites)
• Use of chemicals and oils (e.g Abate)
• Space spraying (during emergency)
• Indoor residual house spraying (IRHS)
• Insecticide-treated bednets (ITNs)
• Repellants
• House improvement

7
Impact on disease transmission

• Vectorial capacity (C) is expressed as
• C ma2pn/-loge p
• Where
• m density of vectors in relation to man
• a number of blood meals taken on man per vector
  per day
• p proportion of vectors surviving per day
• n incubation period in the vector (days) - 8
  days
• When they survive (1/-logep) days

8
Appropriateness of Control Measures

• Larval and adult control impact on vector
  densities (m)
• Effectiveness of larval control methods depends
  on types of breeding sites
• IRHS and ITNs reduce vector survivorship (p8)
• ITNs unlike IRHS reduce man/vector contact (a2)
• Important to consider cost community acceptance
• Use of safe chemicals for IVC seems inevitable at
  least for now

9
Problems of implementation of VC in the EMR

• In most countries VC measures are not applied
  cost-effectively
• Targeting more than one VBD
• Applied timely and correctly
• Using products with approved specifications
• Coverage of interventions low to give
  epidemiological impact

10
Entomological monitoring
11
Entomological surveillance

• In a region where VBD are distributed unevenly
  even within same country
• Entomological surveillance is crucial spp
  composition, abundance and distribution
• Must include insecticide resistance monitoring
• Establishment of sentinel sites preferably same
  as those of the diseases
• Increased entomological capacity at national,
  provincial and districts
• Establishment of national databases on
  information collected
• Application of GIS and remote sensing in mapping
  distribution of vectors
• In most countries of EMR ES is very weak and
  needs strengthening

12
Problem of Insecticide Resistance
13
Status of insecticide resistance in malaria
vector species in the EMR

• DDT
• Dieldrin/BHC
• Malathion
• Fenitrothion
• Temephos
• Propoxur
• Primiphos methyl
• Chlorophoxim
• Phoxim
• Iodophenphos
• Chlorpyriphos
• Fenthion
• Bromophos
• Carbaryl
• Pyrethroid (permethrin)
• Phenthoate
• Diazinone

14
Insecticide Resistance Status
15
(No Transcript)
16
Technical support

• Sudan
• Strategic planning for malaria vector control
• Capacity building in entomology
• Afg PK
• Assessment of Leishmaniasis situation among
  displaced people
• Appropriateness of interventions and methods of
  implementation
• Syria
• Supported malaria and leishmaniasis VC programme
• Weaknesses in selection of insecticides (types
  formulations)
• Entomology and implementation capacity weak
• Yemen
• Trained field teams in VC spraying, ITNs, ento
  surveillance
• Draft National ITN strategic plan

17
Technical support cntd.

• Iraq
• Rehabilitation of the Malaria Centre
• Implementation of ITNs (200 000) in northern Iraq
• SAA
• Mapping distribution of mosquito vectors
• Use of IGR for larval control
• Qatar
• Strengthening ento surveillance
• Oman
• Documentation of successful malaria control
• Entomological, epidemiological, financial and
  economic impact
• Cost effective lt than recommended health budget
  spending
• Model other countries with similar resources

18
(No Transcript)
19
Logistic Support

• Test kits for insecticide resistance monitoring
  UAE, Sudan, Yemen, SAA, EGY
• Insecticide spraying equipment SAA, DJI, Yemen
• Insecticide-treated bednets Iraq (LLNs
  Olyset), Sudan
• Insecticides for vector control Yemen, DJI
• Entomological supplies Iraq, Yemen, SAA

20
Operational Research

• Monitoring and mapping insecticide resistance
• Vector behaviour in relation to VC interventions
  e.g. ITNs
• Mapping distribution of other VBD
• Cost-effectiveness of interventions
• TDR-supported research
• Feasibility of larvivorous fish for mosquito
  control
• Vector human behaviour in relation to ITNs
  acceptability
• Improving on tools to detect insecticide
  resistance
• Net washing practices and efficacy

21
Capacity building in VC

• Except in a few countries trained local
  entomologists are few
• Where they are available are either about to
  retire or are expatriates
• Where they have been trained no high retention
  rate (lack of incentives)
• The WHO Malaria Planning Course has very little
  ento component
• Identify an institution to conduct the training
  in collaboration with WHO/EMRO

22
Information Dissemination and Sharing

• Sharing
• Larval Symposium in Kampala organized by USAID
  YEM, SUD
• Informal Consultation on Elimination and
  Prevention of Malaria Re-introduction
• ITN Technical Support Network ITN Global
  Strategy
• WHO/TDR SWG on Disease Vectors
• Sixth WHOPES SWG to evaluate two products for VC
• Other organized meetings by the RO Complex
  emergency, Surveillance etc

23
Dissemination

• Manual on Integrated Vector Management
• Manual on Larvivorous fish for mosquito control
• Instructions on treatment of mosquito nets
  translated
• Draft Regional Framework for Implementation of
  Integrated Vector Management
• Guidelines on Monitoring Insecticide Resistance

24
Challenges of VC in EMR

• DCD/EMRO adopted the integration of communicable
  diseases
• Integrated Vector Management as one of the
  component
• VC in many countries is done haphazardly need a
  policy and national plans based on IVM principles
• Management of pesticides usage
• Establishment of databases (insecticide
  resistance, pesticide usage etc) based on a
  strong ME
• Increasing ITN coverage national ITN strategies
  and policies
• Implementation of IVM supported by vector/disease
  distributional maps

25
Draft Regional Framework for IVM

• General objective
• Specific objectives

26
Content of the Regional Strategy on IVM

• Introduction
• Justification and guiding principles
• Objectives
• Key elements for successful national response
• General framework for implementation
• Partnership and inter-sectoral collaboration
• Monitoring and evaluation
• Specific framework for implementation
• References
• What else needs to be included in the strategy?
• How would you improve this document?
• What would you like omitted from this document?

27
Conclusions

• EMR boasts of VC experiences to build on IVM
• Development of a Regional Strategy on IVM will
  provide direction and guidance on implementation
  of VC
• Regional strategy will form the basis in which
  countries will formulate national plans on IVM
• These will be coupled with strengthening of
• ME including entomological surveillance
• Appropriate pesticide safety and management
• Capacity for OR
• Monitoring insecticide resistance
• Vector behaviour in relation to VC acceptability
  and impact
• Distribution of other VBD
• Application of VC interventions cost-effectively