MCDI has been providing technical and operational support to integrated vector control since 1986, including extensive experience since 2004.
Integrated vector control in moderate to high transmission settings
Distribution of Long Lasting Insecticide Treated Bed-nets (LLINs)
MCDI has managed the procurement and distribution of LLINs at the community level in Madagascar, Benin and Equatorial Guinea, working with partners on social marketing and distribution. We have distributed hundreds of thousands of LLINs, with special focus on protecting pregnant women and newborns. Net distribution has occurred through mass, door-to-door, top-up campaigns designed to ensure universal coverage (defined as one net per two people), where beneficiaries are helped to hang their nets and are taught how use, clean and repair them appropriately. Between mass distribution rounds, MCDI has supported routine keep-up through distribution via antenatal care clinics and through school-based distribution.
Indoor Residual Spraying (IRS)
MCDI's experience in IRS began almost 25 years ago, with the provision of technical and management support to a national IRS program in Belize. More recently, since 2004, MCDI has been responsible for planning, managing, implementing, and monitoring and evaluating an extensive and intensive IRS program both on Bioko Island and mainland Equatorial Guinea through two programs: The Bioko Island Malaria Control Project (BIMCP, 2004-present) funded by a consortium of oil companies including Marathon Oil, Noble Energy and AMPCO with the Government of Equatorial Guinea, and the Equatorial Guinea Malaria Control Initiative (EGMCI, 2006-2011) funded by the Global Fund to Fight AIDS, TB and Malaria. Since the first round of IRS was conducted on Bioko Island in 2004, MCDI has sprayed approximately 650,000 houses and over 2.9 million rooms. Depending on insecticide choice (insecticides are rotated as part the national Insecticide Resistance Management Plan developed with the support of MCDI and the Liverpool School of Tropical Medicine), MCDI has sprayed one or two times per year, targeting at least 80% of all inhabited households, schools and churches. Starting in 2014 on Bioko Island, MCDI has been using a focal approach to IRS where only households located in areas with the highest relative risk of transmission are sprayed, where the relative transmission risk is measured through a combination of parasite prevalence rates, importation risk, and household vulnerability to mosquito infestation.
Larval Source Management (LSM)
As part of an integrated vector management approach, MCDI has evaluated the feasibility and sustainability of community-based larval source management on Bioko Island. Larvaciding has historically demonstrated some success in vector control in urban settings where breeding sites are few, fixed and findable, but evidence regarding the feasibility, impact and sustainability of LSM in rural and peri-urban settings has been less clear. As such, MCDI conducted a two-year pilot LSM initiative in 13 communities to evaluate the potential for integrating LSM within on-going indoor-oriented control. Evidence from this pilot determined that long-term community-led LSM was unfeasible and unsustainable on Bioko Island.
MCDI is currently implementing a targeted community-led environmental management-based LSM intervention in El Salvador and Guatemala under the USAID-funded ZICORE project. Together with the Red Cross from these countries, MCDI is utilizing a key-container approach that identifies the principal breeding sites for the Zika-transmitting Aedes vector through baseline pupal and demographic survey, and then teaches the community to locate and clean out these key containers. This key container approach has been shown to be the most cost-effective and sustainable LSM approach.
Other vector control interventions
MCDI has researched the efficacy of a number of other vector control interventions with varying results, including insecticide-treated durable wall linings, BTI-sugar baits/strips, repellents, housing improvements and genetic vector control through the release of genetically modified mosquitoes.
Institutional capacity building
MCDI has provided intensive and systematic support to the development and capacity building of National Malaria Control Programs (NMCPs) in Belize, Benin and Equatorial Guinea. This has included assisting the Ministries of Health in hiring and training NMCP officers in entomology, vector control, case management, diagnostics, epidemiology, and IEC/BCC.
Information, Education and Communications (IEC) and Behavior Change Communication (BCC)
As a core component of all MCDI vector control initiatives, a broad range of IEC/BCC interventions designed to promote acceptance of IRS, use and care of LLINs and personal protection have been implemented. In Equatorial Guinea, MCDI supported the National Malaria Control Program (NMCP) to develop the country's first ever National Malaria Communication Strategy in 2012.
In Benin, under the USAID-funded Accelerating the Reduction of Malaria Morbidity and Mortality Project (ARM3), MCDI developed the BCC National Strategic Plan to help promote regular LLIN use and other interventions in collaboration with the NMCP. Additionally, ARM3 developed supporting materials for health workers and scripts for mass media spots including radio and television for malaria prevention. ARM3 has been recognized for the use of ‘infotainment', an innovative approach that links gaming with information for behavioral change, working, for example, with theater groups to increase the public's knowledge of malaria and encourage healthy behaviors.
Integrated vector control in pre-elimination and elimination settings
Development of stratified approaches for elimination
MCDI is supporting the National Malaria Control Program in Equatorial Guinea to implement a malaria elimination strategy for the country. This strategy, which is focused initially on Bioko Island, uses data from the BIMCP's routine monitoring system to generate predictive malaria infection models using spatial clustering techniques to identify transmission hot spots for focal intensified vector control intervention.
Vector control monitoring and evaluation
Applications development, testing and implementation
With support from the University of Southern Maine, MCDI has developed and is currently further enhancing an Android-based tablet application called the Campaign Information Management Systems (CIMS) that is being used as the primary data collection portal to collect field-level malaria control data at the household and individual level. The CIMS enables MCDI to track the coverage integrated vector control and other interventions such as active case detection and treatment and ultimately mass vaccination relative to a census of households and individuals, and to communicate via text of voicemail to non-compliant individuals and households in order to maximize coverage.
MCDI has also deployed the Malaria Decision Support System (MDSS), a web-based program that allows for the coordination, storage, representation and modeling of data collected through the BIMCP.
MCDI has also used the Collector for ArcGIS, a geospatial Android application that uses real time georeferenced data collection to locate and monitor the treatment of Anopheles breeding sites, for LSM on Bioko Island. This platform is currently being deployed to locate and monitor environmental control of key Aedes breeding sites in Guatemala and El Salvador to reduce Zika transmission through MCDI's ZICORE project.
Monitoring IRS, LLINs, LSM
Data collected through MCDI's tablet-based Campaign Information Management System (CIMS) application has been used by MCDI to plan, manage and monitor all malaria control interventions under BIMCP including those deployed as part of MCDI's integrated vector control. Using the CIMS, MCDI has been able to monitor and evaluate IRS sprayer productivity as well as the quality of spraying within households. CIMS is also used to plan and manage mass LLIN distribution campaigns on Bioko Island. MCDI has used the Collector for ArcGIS platform to develop a tablet-based application to identify larval sites and monitor LSM.
Evaluating the impact of IRS and LLINs
On Bioko Island, MCDI has been conducting annual Malaria Indicator Surveys (MIS) since 2004. The annual MIS includes over 300 questions covering the household's socio-economic and demographic characteristics, health seeking behavior, utilization of malaria interventions, and parasite prevalence of all household members available and willing to be tested. Using these data, it was determined in 2008 that vector control interventions led to a marked decrease in under-five mortality on the island.
Entomological monitoring and surveillance
MCDI has designed, established and conducted entomological surveillance on Bioko Island since 2004. This has included the design and construction of several insectaries where Anopheles mosquitoes are bred and used to evaluate for insecticide efficacy and resistance. The routine trapping of mosquitoes using window traps, light traps and human landing catches has also allowed for monitoring of species composition, vector densities, infectivity rates and biting behaviors. Insecticide susceptibility testing and target site resistance monitoring are also routine monitoring procedures on Bioko Island.
Insecticide resistance management
MCDI, with the support of the Liverpool School of Tropical Medicine, has led the way in working with the National Malaria Control Program of Equatorial Guinea to develop the first national Insecticide Resistance Management Plan in Africa. In an effort to assure the effective management of insecticide resistance and to comply with the World Health Organization's Global Plan on Insecticide Resistance Management for Malaria Vectors (GPIRM) guidance, MCDI, LSTM, Texas A&M University, and the National Malaria Control Program of Equatorial Guinea has conducted routine monitoring of target site resistance (kdr and ACE-1) and periodic metabolic resistance, and based on these findings assisted the NMCP in producing its first operational plan in 2012.