Luanshya District pushes towards malaria elimination through application of geospatial technologies to guide and deliver malaria interventions
Malaria elimination requires consistent high coverage of effective malaria prevention and treatment interventions—and high coverage is challenging to achieve particularly in developing countries where highly urban or highly rural areas may not have address systems, limited maps, and challenging access due to rains, poor infrastructure, flooding, or severe events or conflict.
In order for insecticides, such as Fludora Fusion or other chemicals, to most effectively kill mosquitoes and reduce malaria burden, high coverage is required. Envu, in collaboration with Akros and the National Malaria Control Program (NMCP) in Zambia conducted an exciting rollout of geospatial planning and delivery of indoor residual spray (IRS) in Luanshya District Zambia during the 2022 spray season. The open source platform, Reveal, was used to support the planning of the campaign, including target areas, households which would be visited and sprayed, as well as the human resources and commodities required to deliver the campaign.
Spray teams, including each team lead, were outfitted with the Reveal application on their smartphones or tablets. Through this application, each team was able to clearly see which settlements in Luanshya District were targeted during microplanning prior to navigating to these areas and could clearly visualize on their phone where they were in relationship to each sprayable structure and whether it had been visited or not.
The use of Reveal meant the teams weren’t “operating in the dark” and unclear where all the structures within a settlement were, or whether they had achieved high coverage in each location. The Luanshya team ambitiously targeted 34,200 structures out of a total of 44,462 residential structures within their District, focusing on the 10 more urban health facilities out of the 28 health facilities in the district.
Data from Reveal in 2022 compared to the previous years 2021 paper reports indicated that 2.25 times as many structures were visited and sprayed in 2022 and although the percentage of eligible structures sprayed increased from 7.4% to 16.7%, challenges over targeting, resource availability, and IRS uptake did prevent high coverage from being achieved—these are common challenges facing IRS in urban areas.
However, collecting structure level data through Reveal provided the Luanshya team, for the first time, deeper insights into why so many structures were not being sprayed, where exactly those structures were and what the predominant reasons were in each settlement for structures not being sprayed. This real time spatially displayed information, never available before, was critical in understanding where to respond and how to respond to low uptake in order to increase coverage. These insights provide valuable contributions towards districts and the program rethinking their IRS strategy on how and where to deploy their IRS sensitization and implementation campaigns, especially in more urban districts, that are more likely to achieve higher uptake and coverage.
The Reveal app puts realtime (offline) decision making data into field teams hands through web-based dashboard. Meanwhile, more central district teams are able to monitor intervention progress and effectiveness as well as surveillance of field team protocol adherence through dashboards. In the disease control and elimination space, Reveal has been used in 10 countries by 28 different partners across multiple Malaria, NTD (Neglected Tropical Diseases), and Vaccination programs and has shown to improve delivery as well as identify critical gaps in delivery. Research has demonstrated the impact of this platform indicating use of Reveal significantly improves intervention coverage, reduces disease burden, reduces cost per disease case averted while adding minimal operational costs as investments are made in transitioning to digitized geospatial approaches.
Luanshya district manager, Francis Matoka, who oversaw the IRS operation in Luanshya (and has done so for 15 years) commented that the Reveal program has been key for managers; “Now I know how much area I need to cover with IRS and how much we can perform, making decisions locally here. With the (Reveal) program we can visualize and channel resources where they need to be. We can make decisions there and then during the campaign. The program has helped us make decisions timely, and instantly, before the campaign is complete.”
Some lessons learned during this implementation included phone batteries required top-up charging during field data collection. There was also a high degree of IRS refusals and lockouts—this is attributed to Luanshya being more urban than other districts in Zambia, which is more typical for these high refusal rates. However, during IRS “mop ups” the health promotion teams used the maps on the Reveal app to show them the specific locations of structures which had not been sprayed, and the reasons why these structures had been refused. Through this targeted and precise data, behavior change communications were focused to improve uptake of the IRS intervention. Further benefit was the collection of field based data in 2022, which will be used in 2023 to further refine and guide the IRS intervention.
Given the successful intervention support and impact achieved during this campaign, the NMEP and Luanshya district want to use Reveal again next year to continue to guide precision SBC response activities that increase uptake in more urban settings in addition to wanting to have digitized structure level coverage data that will allow an evaluation on how effective newly implemented campaign strategies actually were.
About Envu: For over 50 years, Envu has been working with Mosquito Control Professionals around the world to fight against mosquitoes that may carry diseases. Envu invests in innovative solutions, ongoing research and training. Fludora Fusion is one of the key products in Envu’s portfolio, and is the first two way IRS combination product utilized in an insecticide resistance management strategy.
About Akros: Akros supports the use of basic and innovative data surveillance and response systems to support global health applications across Africa. Akros has been the custodian of the digital global good, Reveal, since its inception alongside the National Malaria Control Program in Zambia, as well as 10 other countries. www.akros.com