A Case Study: How the Rephaiah Project Combats Malaria in Young Children

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Smaller farms coupled with soil erosion have degraded agricultural land consequently af-

fecting agricultural production. This has, therefore, had serious consequences especially

on marginalized groups in the country like the poor, women and children, making them

highly vulnerable to food insecurity.

17.4

WHO OPERATION AND MOSQUITO CONTROL IN MALAWI

mosquitos of the genus Anopheles transmit malaria, that accounts for a large propor-

tion of deaths in Malawi. Anopheles gambiae and Anopheles funestus species groups are

the principal malaria vectors in Malawi. The Ministry of Health with support from partners

developed the first ever Malaria Vector Control Strategy, to guide and implement recom-

mendations towards an effective malaria vector control intervention, that is also sustain-

able and cost-effective for malaria control and reducing morbidity and mortality caused by

malaria. This strategy was developed within the context of Integrated Vector Management

and universal access to key malaria vector control interventions in line with the national

Malaria Strategic Plan (MSP) and Global Technical Strategy (GTS). The plan focused

on major malaria prevention methods such as distribution of Long Lasting Insecticide-

Treated Nets (LLITNs) and Indoor Residual House Spraying (IRS), other vector control

measures such as Larval Source and environmental management, entomological monitor-

ing and surveillance, and capacity building.

Control of malaria transmission conventionally relies heavily on two insecticide-based

interventions: LLIN (Long Lasting Insecticide Nets) and IRS. Use of LLINs is the primary

vector control intervention in the country. In the current Malaria Strategic Plan, the NMCP

(National Malaria Control Program) has prioritized universal coverage of LLINs to reduce

morbidity and mortality due to malaria by 50% by 2022. In order to achieve the set tar-

get, Malawi continues pursuing distribution of nets through the routine antenatal care and

periodic nationwide distribution models. In 2008, first free mass distribution of LLIN was

launched, targeting children and pregnant women. Since then national wide distribution of

ITNs have been done at least every three years the last one to be done was in 2018. Apart

from the mass distribution, routinely ITNs are being distributed through antenatal clinics

targeting pregnant women and children under one years of age. Households in Malawi that

own at least one LLIN greatly improved from 2% in 2007 to 82% by 2017. The 2017,

42% of households had at least one ITN for every two people. The LLIN use rate was 55%

among the household population, 68% in children under five and 63% in pregnant women.

The first IRS pilot project was launched in Nkhotakota district in 2007 with support

from President Malaria Initiative (PMI). In line with the national malaria strategic plan,

IRS implementation was expected to be scaled up to 11 high burden districts. The program

was extended to five then seven other districts for only one year. Due to the emergence

of pyrethroid insecticide resistance, a switch to the organophosphate pirimiphos-methyl

was necessary. By 2014, the spraying program was halted due to high cost of procuring

organophosphate insecticides and lack of viable alternatives. In order to manage resistance

in IRS implementing districts, annual rotation of insecticides has been adopted in line with

Insecticide Resistance Management plan for the years 2019-2022. Although the resistance