Jaipal SinghJaipal Singh

Entomologist Entomologist

GFATM SSF R-10GFATM SSF R-10

DOMC Islamabad PakistanDOMC Islamabad Pakistan

What determines the What determines the spread of malaria?spread of malaria?

Female Anopheles mosquitoWhat do you notice about it?

Malaria spread Malaria spread depends on:depends on:

•Rainfall patternRainfall pattern(How does this (How does this affect mosquito affect mosquito breeding?)breeding?)

•Types of mosquitoes in the areaTypes of mosquitoes in the area

•How close are people to the breeding How close are people to the breeding sites?sites?

Some areas constantly have a high rate Some areas constantly have a high rate of malaria.of malaria.

Other areas have “malaria seasons” or Other areas have “malaria seasons” or occasional epidemics of malaria.occasional epidemics of malaria.

Mosquitoes and MalariaMosquitoes and Malaria The spread of malaria The spread of malaria

depends on the life cycle depends on the life cycle of the mosquito.of the mosquito.

Adult mosquitoes lay Adult mosquitoes lay their eggs on water.their eggs on water.

The eggs hatch to The eggs hatch to become larvae and then become larvae and then pupae, before turning pupae, before turning into adults.into adults.

Adult females mosquitoes Adult females mosquitoes only live 2 to 4 weeks.only live 2 to 4 weeks.

So you can reduce So you can reduce malaria by attacking any malaria by attacking any of these four stages of of these four stages of the mosquito.the mosquito.

Where do mosquitoes Where do mosquitoes breed?breed?

Tire tracks Irrigation water

Rice paddiesRice paddies

Any place there is water!

So what is one way to reduce malaria?

.

.

.

Full surface applicationIRS application

. ...

. ........ ......

Mating

Sugar feeding Host seeking Rest 2-3 days Oviposition

Point-source application

Partial surface application

.

Importance of Indoor Importance of Indoor Residual Residual Spraying {IRS}Spraying {IRS}

Pillar of Malaria Control ProgramPillar of Malaria Control Program IRS application of long-lasting chemical IRS application of long-lasting chemical

insecticides on the walls and roofs of all insecticides on the walls and roofs of all houses and domestic animals shelters in houses and domestic animals shelters in given areas, in order to kill the adult vector given areas, in order to kill the adult vector mosquitoes that land and rest on these mosquitoes that land and rest on these surface.surface.

To reduce the life span of vector To reduce the life span of vector mosquitoes also reduce the density of the mosquitoes also reduce the density of the vector mosquitoesvector mosquitoes

To reduce the rate of malaria To reduce the rate of malaria transmission and prevent malaria transmission and prevent malaria epidemics in the TGF districts.epidemics in the TGF districts.

HYPOTHETICAL MALARIA AND VECTOR PEAKS AND CONTROL PERIODS

Series 1=Vector peak, Series 2= Disease peak, Series3 =Adulticiding, Series 4= Larviciding, series 5= Spring Mal Peak Professor. DR. H.R.Rathor Ph.D

Jan

Feb

Mar

Apr

May

Jun

Jul

Aug

Sep Oct

Nov

Dec

0

20

40

60

80

100

120

Series 1

Series 2

Series 3

Series 4

Series 5

Disease peakVector peak

Adulticiding period

Larviciding period

Spring Peak

Indoor Residual Spraying (IRS)

The main strategy for The main strategy for malaria control: Attack the malaria control: Attack the

adult mosquitoes, or adult mosquitoes, or prevent them from biting prevent them from biting

people.people. What is happening here?What is happening here?Can you Can you think of any think of any risks to risks to these these approaches?approaches?

Some risks:1. Toxicity of

Deltamethrine 25% WG

2. Resistance of mosquitoes

How does indoor residual spraying work?

Investigate indoor residual Investigate indoor residual sprayingspraying

Who is doing it in your Who is doing it in your community?community?

What chemical are they using?What chemical are they using? Are there any problems or side Are there any problems or side

effects?effects? What does it cost?What does it cost?

Operational Plan for Monitoring, Operational Plan for Monitoring, Evaluation and Management of Evaluation and Management of

Vector Control Vector Control Vector Control Methods Step 1 Describe analyze the

vector borne diseases situation e.g. Malaria

Chemical Non-chemical Step 2 Stratify malaria problems based on relevant variables

IRS Environmental Management

Step 3 Determine whether there is a role for vector control in each stratum

LLINs Biological Agent

Step 4 If there is a role for vector control, determine which method (s) is are suitable

Larviciding Genetics Step 5 Where insecticides used in essential, select method of application

Space Spraying

Personal Protection

Step 6 Determine what insecticides to used when, where and how to apply it

Repellents and coils

Non organic material

Step 7 Establish operational outputs and targets and select monitoring and evaluation methods

Use of IRS guidelines in TGF Use of IRS guidelines in TGF Districts?Districts?

Indoor residual spraying in one of the primary Indoor residual spraying in one of the primary vector control intervention for reducing and vector control intervention for reducing and interrupting malaria transmission (WHO)interrupting malaria transmission (WHO)

IRS is the spraying of the inside surface of IRS is the spraying of the inside surface of the sleeping structure to deliver a targeted the sleeping structure to deliver a targeted dosage (g/mdosage (g/m2 of chemical that sustain its efficacy 2 of chemical that sustain its efficacy on disease vectors for given durationon disease vectors for given duration

Estimated the target areas for IRS Estimated the target areas for IRS implementationimplementation

Select timing for field operationSelect timing for field operation The choice of IRS, or any other vector The choice of IRS, or any other vector

intervention, must be made by careful intervention, must be made by careful consideration of the factors consideration of the factors

Realizing the Potential of Realizing the Potential of IRS IRS

There are currently 12 insecticides There are currently 12 insecticides recommended by WHO for IRS, belonging recommended by WHO for IRS, belonging to four chemical groups (one to four chemical groups (one organochlorin, six pyrethroids, three organochlorin, six pyrethroids, three organophosphate and two carbamate)organophosphate and two carbamate)

The choice of insecticides must be The choice of insecticides must be informed by the following considerations:informed by the following considerations:

insecticides susceptibility and vector insecticides susceptibility and vector behaviorbehavior

Safety for human and the environment Safety for human and the environment Efficacy and cost-effectivenessEfficacy and cost-effectiveness

Planning of Indoor Residual Planning of Indoor Residual Spraying Spraying

The planning process, involving all The planning process, involving all stakeholders in defining the area to be stakeholders in defining the area to be spraying, logistics, budget, timing and post spraying, logistics, budget, timing and post campaign evolution campaign evolution

Spraying techniques and training of spray Spraying techniques and training of spray team and understanding the role of community team and understanding the role of community in the IRS campaign needs for engaging and in the IRS campaign needs for engaging and having dialogue with communities to foster having dialogue with communities to foster ownership and acceptance of the programownership and acceptance of the program

Understand the target areas/coverage spray Understand the target areas/coverage spray campaign should cover 15% rural areas campaign should cover 15% rural areas (selection on API basis)(selection on API basis)

Spraying Techniques Spraying Techniques

The success of an IRS activity relies on the The success of an IRS activity relies on the efficient and uniform application of efficient and uniform application of recommended insecticides dosage recommended insecticides dosage (Deltamethrine 25% WG 25 grams in 10 liter of (Deltamethrine 25% WG 25 grams in 10 liter of water) on wall surface, the technical skills of water) on wall surface, the technical skills of spray men area a critical requirement.spray men area a critical requirement.

Describe the safety issues related to use of the Describe the safety issues related to use of the spray pumps demonstrate skills in pressurizing spray pumps demonstrate skills in pressurizing and handling of the spray pumps.and handling of the spray pumps.

Carry out nozzle calibration and also Carry out nozzle calibration and also demonstrate skill in spraying techniques demonstrate skill in spraying techniques through maintain uniform swath, width and through maintain uniform swath, width and speedspeed

Spraying Techniques Spraying Techniques cont.....cont.....

Demonstrate the triple rinse Demonstrate the triple rinse techniques techniques

Pressuring the spray pumps and use Pressuring the spray pumps and use of pressure gauge 25-55 (psi)of pressure gauge 25-55 (psi)

Nozzles calibration (380 ml/30 Nozzles calibration (380 ml/30 second at 40 PSIsecond at 40 PSI

Swath, width and practices on the Swath, width and practices on the wall surface (75 cm swath at 45 cm wall surface (75 cm swath at 45 cm nozzles distance from the wallsnozzles distance from the walls

Spraying speed (2 ml per 4.5 Spraying speed (2 ml per 4.5 second )second )

Planning of Indoor Residual Planning of Indoor Residual Spraying Spraying cont…cont…

The role of supervision , emphasizing that The role of supervision , emphasizing that during spraying , supervisors must continually during spraying , supervisors must continually check that mean spray correctly ensure, check that mean spray correctly ensure, recording, reporting and rectify mistakes recording, reporting and rectify mistakes

Planning of spray team, with consideration of Planning of spray team, with consideration of requirements, personnel protective equipment requirements, personnel protective equipment (PPE), insecticides to cover targeted houses(PPE), insecticides to cover targeted houses

Complete IRS tools accurately and send to the Complete IRS tools accurately and send to the right level in the data flow structure right level in the data flow structure

Effective ImplementationEffective Implementation Malaria vector control operations have to be Malaria vector control operations have to be

targeted, treating only where and when targeted, treating only where and when necessary, IRS is a method for community necessary, IRS is a method for community protection, and given tis mode of action, the protection, and given tis mode of action, the highest possible level of coverage is required to highest possible level of coverage is required to achieve the maximum impact on malaria achieve the maximum impact on malaria transmission.transmission.

Achieving this level of coverage and timing Achieving this level of coverage and timing spraying correctly (in short period of time before spraying correctly (in short period of time before the onset of the transmission seasons) area the onset of the transmission seasons) area crucial to realize the full potential of IRS crucial to realize the full potential of IRS

IRS require effective leadership and management IRS require effective leadership and management for planning, organization and implementation.for planning, organization and implementation.

Effective Implementation Effective Implementation cont.....cont.....

IRS operation must managed by technical , IRS operation must managed by technical , skilled and professional staff, based on analysis skilled and professional staff, based on analysis of local epidemiological data and a sound of local epidemiological data and a sound understanding of transmission patterns, vector understanding of transmission patterns, vector behavior and insecticides resistance status behavior and insecticides resistance status

Significant strengthen of human and technical Significant strengthen of human and technical resources, accompanied by sufficient financial resources, accompanied by sufficient financial resources, is needed to develop or reorganize resources, is needed to develop or reorganize existing IRS activityexisting IRS activity

Post- spraying operations will be conducted and Post- spraying operations will be conducted and observation from the IRS campaign and to observation from the IRS campaign and to lessons learned, discuss and generally share the lessons learned, discuss and generally share the epidemiological outcomes of the IRS campaignepidemiological outcomes of the IRS campaign

Supervision of field spray operationSupervision of field spray operation

The purpose of supervisor is to solve problems The purpose of supervisor is to solve problems and offer support not to criticize or find fault and offer support not to criticize or find fault

To ensure that the spray team movement To ensure that the spray team movement schedule is strictly adhered to and the agreed schedule is strictly adhered to and the agreed target numbers of houses to be sprayed per target numbers of houses to be sprayed per day are being maintainedday are being maintained

To take corrective measure, on the spot, on To take corrective measure, on the spot, on spray application techniques and take note of spray application techniques and take note of any equipment deficiencies for remedial actionany equipment deficiencies for remedial action

To stimulate, encourage and advice on good To stimulate, encourage and advice on good comments with house holder and village or comments with house holder and village or community leaders community leaders

To ensure good team work for total and To ensure good team work for total and complete coverage of areas to be sprayedcomplete coverage of areas to be sprayed

Indoor Residual Spraying ReportingIndoor Residual Spraying Reporting

IRS strategy and practicesIRS strategy and practices Outputs amount of insecticides usedOutputs amount of insecticides used Insecticides resistance testing resultsInsecticides resistance testing results Quality and bioassays resultsQuality and bioassays results Out come No. of structure household Out come No. of structure household

sprayed and No of people protectedsprayed and No of people protected Post Evaluation of IRS Post Evaluation of IRS Impact, prevalence ,API district free of Impact, prevalence ,API district free of

Malaria Malaria Develop the success stories of districtDevelop the success stories of district

In conclusionIn conclusion

ReferencesReferences Indoor Residual Spraying Strategy (IRS ) 2013 (GFATM DOMC Indoor Residual Spraying Strategy (IRS ) 2013 (GFATM DOMC

Islamabad Islamabad

Centers for Disease Control and Prevention. 2010. Centers for Disease Control and Prevention. 2010. Malaria. Malaria. Available Available from: http://www.cdc.gov/malaria/from: http://www.cdc.gov/malaria/

Health Education Program for Developing Countries. 2009. Available Health Education Program for Developing Countries. 2009. Available from:http://www.hepfdc.info/from:http://www.hepfdc.info/

Wikipedia. 2010. Wikipedia. 2010. Malaria. Malaria. Available from: Available from: http://en.wikipedia.org/wiki/Malariahttp://en.wikipedia.org/wiki/Malaria

Wikipedia. 2010. Wikipedia. 2010. Mosquito. Mosquito. Available from: Available from: http://en.wikipedia.org/wiki/Mosquaitohttp://en.wikipedia.org/wiki/Mosquaito

Wikipedia. 2010. Wikipedia. 2010. Mosquito control. Mosquito control. Available from: Available from: http://en.wikipedia.org/wiki/Mosquito_control http://en.wikipedia.org/wiki/Mosquito_control

World Health Organization. World Health Organization. Integrated Management of Childhood Integrated Management of Childhood Illness Illness chart booklet.chart booklet.

World Health Organization. 2009. World Health Organization. 2009. Malaria Fact File. Malaria Fact File. Available from: Available from: http://www.who.int/mediacentre/factsheets/fs094/en/index.htmlhttp://www.who.int/mediacentre/factsheets/fs094/en/index.html

World Health Organization. 2010. World Health Organization. 2010. Ten Facts on Malaria. Ten Facts on Malaria. Available from: Available from: http://www.who.int/features/factfiles/malaria/en/index.htmlhttp://www.who.int/features/factfiles/malaria/en/index.html

World Health Organization. World Health Organization. Roll back malaria. Roll back malaria. Available from: Available from: http://rbm.who.int/cmc_upload/0/000/015/372/RBMInfosheet_1.htmhttp://rbm.who.int/cmc_upload/0/000/015/372/RBMInfosheet_1.htm

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