Nigeria

Nigerian beneficiary. Photo Credit: Lena Kolyada

Malaria is a major cause of morbidity and mortality in Nigeria, accounting for an estimated 110 million clinical cases and 300,000 deaths per year. The disease is responsible for 25 percent of the nation’s infant mortality, 30 percent of childhood mortality and 11 percent of maternal deaths. Nigeria contributes to 23 percent of the world’s malaria cases and 97 percent of the population is at risk. To combat malaria, the National Malaria Elimination Program of Nigeria initiated indoor residual spraying (IRS) pilot projects in 2006 and 2007.

Since 2011, the President’s Malaria Initiative’s Africa Indoor Residual Spraying Project (AIRS) has worked to reduce malaria-associated mortality through indoor residual spraying, entomological monitoring, and capacity building. In Nigeria, AIRS has worked to establish a model IRS program at the state and local government area (LGA) level that will set national performance standards and serve as a best practice for national and international implementers working to expand IRS. During the first two years of the project, AIRS introduced and piloted IRS in two LGAs of Nasarawa State. These IRS campaigns served as a model for implementing IRS according to international best practices.

Focusing on Entomological Monitoring

For IRS to be effective, the malaria-carrying mosquito must be susceptible to the sprayed insecticide. Currently, only a limited number of insecticides are effective as mosquitoes are becoming increasingly resistant to the common insecticides used in IRS, threatening malaria prevention programs. PMI AIRS conducts entomological surveillance to test mosquito resistance to, and the residual life of, insecticides throughout the malaria transmission period. In 2014, entomological surveillance became the main focus of the PMI AIRS Nigeria program.  The project captures data on a monthly basis for entomology indicators in five geopolitical zones of the country. These indicators are compared by the type of malaria control interventions and coverage across the geopolitical and ecological zones of the country. Through activities planned, information collected helps the National Malaria Elimination Program in making data-driven decisions for programming vector control activities. The PMI AIRS Project is also working with the National Malaria Control Program to develop and support malaria policies.

Entomological surveillance and investigations are essential aspects of malaria vector control because they provide information on vector species, including their distribution, density, bionomics (ecology and behavior of mosquitoes), and susceptibility/resistance to insecticides used for malaria control. Information collected through entomological surveillance assists in understanding the spatial and temporal changes in vector species composition, behavior and the efficacy of vector control measures employed for malaria. Entomological investigations are carried out in sentinel sites across the country where malaria transmission intensity is expected to range from moderate to high. PMI AIRS Nigeria conducts entomological surveillance in six sentinel sites (Bauchi, Oyo, Ebonyi, Akwa Ibom, Nasarawa and Sokoto) which were strategically selected to represent all ecological zones of the country.

Capacity Building

The PMI AIRS project collaborated successfully with Nasarawa State University in Keffi to establish an insectary. The project team has used the insectary to rear mosquitoes for entomological studies. The insectary also services the research and training needs of the university and has formed the basis for the proposed establishment of a department of medical entomology in the institution.

PMI AIRS also installed an entomological database, allowing the NMEP to have real-time access to the data collected monthly at the sentinel sites. The project built capacity for implementing best practice IRS campaigns in all the states of the federation and the Federal Capital Territory (FCT) by training their State Roll Back Malaria managers and vector control officers. AIRS trained entomology technicians from all the 36 states of the federation and the FCT on entomology surveillance methods.

The project has empowered the Nasarawa state government to carry out IRS by donating IRS equipment and materials to the Ministry of Health and training 653 spray personnel. The project donated molecular entomology equipment to the University of Jos thereby providing contemporary research equipment for training the future generation of entomologists in Nigeria.

Results

Most importantly, AIRS Nigeria established a positive perception toward IRS among beneficiaries as well as state- and district-level implementers.

Entomological monitoring in spray areas showed that density of mosquitoes decreased remarkably and number of bites a person received per day was significantly lower after the IRS campaign when compared to the control area. This indicates that the IRS campaign had a strong impact on reducing malaria transmission in the IRS intervention areas in Nasarawa state.

Moving into the next three years, the PMI AIRS Project looks forward to fruitful and sustainable work with its Nigerian partners to strengthen the evidence-based entomological monitoring and national capacity in designing and implementing vector control strategies.

“The PMI AIRS project has really supported the National Malaria Elimination Program by building capacity of all state rollback malaria managers and vector control officers on IRS planning, coordination and implementation.”

Dr. Joel Akilah, Head Integrated Vector Management, NMEP