Indoor Residual Spraying {IRS} Strategy Jaipal Singh Entomologist GFATM SSF R-10 DOMC Islamabad Pakistan

What determines the spread of malaria? Female Anopheles mosquito What do you notice about it? Malaria spread depends on: Rainfall patternRainfall pattern (How does this affect mosquito breeding?) Types of mosquitoes in the areaTypes of mosquitoes in the area How close are people to the breeding sites?How close are people to the breeding sites? Some areas constantly have a high rate of malaria. Other areas have “malaria seasons” or occasional epidemics of malaria.

Mosquitoes and Malaria The spread of malaria depends on the life cycle of the mosquito. Adult mosquitoes lay their eggs on water. The eggs hatch to become larvae and then pupae, before turning into adults. Adult females mosquitoes only live 2 to 4 weeks. So you can reduce malaria by attacking any of these four stages of the mosquito.

Where do mosquitoes breed? Tire tracks Irrigation water Rice paddies Any place there is water! So what is one way to reduce malaria?

... Full surface application IRS application Mating Sugar feedingHost seekingRest 2-3 daysOviposition Point-source application Partial surface application.

Importance of Indoor Residual Spraying {IRS} Importance of Indoor Residual Spraying {IRS} Pillar of Malaria Control Program Pillar of Malaria Control Program IRS application of long-lasting chemical insecticides on the walls and roofs of all houses and domestic animals shelters in given areas, in order to kill the adult vector mosquitoes that land and rest on these surface. IRS application of long-lasting chemical insecticides on the walls and roofs of all houses and domestic animals shelters in given areas, in order to kill the adult vector mosquitoes that land and rest on these surface. To reduce the life span of vector mosquitoes also reduce the density of the vector mosquitoes To reduce the life span of vector mosquitoes also reduce the density of the vector mosquitoes To reduce the rate of malaria transmission and prevent malaria epidemics in the TGF districts. To reduce the rate of malaria transmission and prevent malaria epidemics in the TGF districts.

Indoor Residual Spraying (IRS)

The main strategy for malaria control: Attack the adult mosquitoes, or prevent them from biting people. What is happening here? What is happening here? Can you think of any risks to these approaches? Some risks: 1.Toxicity of Deltamethrine 25% WG 2.Resistance of mosquitoes How does indoor residual spraying work?

Investigate indoor residual spraying Investigate indoor residual spraying Who is doing it in your community? What chemical are they using? What chemical are they using? Are there any problems or side effects? Are there any problems or side effects? What does it cost? What does it cost?

Operational Plan for Monitoring, Evaluation and Management of Vector Control Vector Control MethodsStep 1Describe analyze the vector borne diseases situation e.g. Malaria ChemicalNon-chemicalStep 2Stratify malaria problems based on relevant variables IRSEnvironmental Management Step 3Determine whether there is a role for vector control in each stratum LLINsBiological AgentStep 4If there is a role for vector control, determine which method (s) is are suitable LarvicidingGeneticsStep 5Where insecticides used in essential, select method of application Space SprayingPersonal Protection Step 6Determine what insecticides to used when, where and how to apply it Repellents and coils Non organic material Step 7Establish operational outputs and targets and select monitoring and evaluation methods

Use of IRS guidelines in TGF Districts? Indoor residual spraying in one of the primary vector control intervention for reducing and interrupting malaria transmission (WHO) Indoor residual spraying in one of the primary vector control intervention for reducing and interrupting malaria transmission (WHO) IRS is the spraying of the inside surface of the sleeping structure to deliver a targeted dosage (g/m 2 of chemical that sustain its efficacy on disease vectors for given duration IRS is the spraying of the inside surface of the sleeping structure to deliver a targeted dosage (g/m 2 of chemical that sustain its efficacy on disease vectors for given duration Estimated the target areas for IRS implementation Estimated the target areas for IRS implementation Select timing for field operation Select timing for field operation The choice of IRS, or any other vector intervention, must be made by careful consideration of the factors The choice of IRS, or any other vector intervention, must be made by careful consideration of the factors

Realizing the Potential of IRS There are currently 12 insecticides recommended by WHO for IRS, belonging to four chemical groups (one organochlorin, six pyrethroids, three organophosphate and two carbamate) There are currently 12 insecticides recommended by WHO for IRS, belonging to four chemical groups (one organochlorin, six pyrethroids, three organophosphate and two carbamate) The choice of insecticides must be informed by the following considerations: The choice of insecticides must be informed by the following considerations: insecticides susceptibility and vector behavior insecticides susceptibility and vector behavior Safety for human and the environment Safety for human and the environment Efficacy and cost-effectiveness Efficacy and cost-effectiveness

Planning of Indoor Residual Spraying The planning process, involving all stakeholders in defining the area to be spraying, logistics, budget, timing and post campaign evolution The planning process, involving all stakeholders in defining the area to be spraying, logistics, budget, timing and post campaign evolution Spraying techniques and training of spray team and understanding the role of community in the IRS campaign needs for engaging and having dialogue with communities to foster ownership and acceptance of the program Spraying techniques and training of spray team and understanding the role of community in the IRS campaign needs for engaging and having dialogue with communities to foster ownership and acceptance of the program Understand the target areas/coverage spray campaign should cover 15% rural areas (selection on API basis) Understand the target areas/coverage spray campaign should cover 15% rural areas (selection on API basis)

Spraying Techniques Spraying Techniques The success of an IRS activity relies on the efficient and uniform application of recommended insecticides dosage (Deltamethrine 25% WG 25 grams in 10 liter of water) on wall surface, the technical skills of spray men area a critical requirement. The success of an IRS activity relies on the efficient and uniform application of recommended insecticides dosage (Deltamethrine 25% WG 25 grams in 10 liter of water) on wall surface, the technical skills of spray men area a critical requirement. Describe the safety issues related to use of the spray pumps demonstrate skills in pressurizing and handling of the spray pumps. Describe the safety issues related to use of the spray pumps demonstrate skills in pressurizing and handling of the spray pumps. Carry out nozzle calibration and also demonstrate skill in spraying techniques through maintain uniform swath, width and speed Carry out nozzle calibration and also demonstrate skill in spraying techniques through maintain uniform swath, width and speed

Spraying Techniques cont..... Demonstrate the triple rinse techniques Demonstrate the triple rinse techniques Pressuring the spray pumps and use of pressure gauge (psi) Pressuring the spray pumps and use of pressure gauge (psi) Nozzles calibration (380 ml/30 second at 40 PSI Nozzles calibration (380 ml/30 second at 40 PSI Swath, width and practices on the wall surface (75 cm swath at 45 cm nozzles distance from the walls Swath, width and practices on the wall surface (75 cm swath at 45 cm nozzles distance from the walls Spraying speed (2 ml per 4.5 second ) Spraying speed (2 ml per 4.5 second )

Planning of Indoor Residual Spraying cont… The role of supervision, emphasizing that during spraying, supervisors must continually check that mean spray correctly ensure, recording, reporting and rectify mistakes The role of supervision, emphasizing that during spraying, supervisors must continually check that mean spray correctly ensure, recording, reporting and rectify mistakes Planning of spray team, with consideration of requirements, personnel protective equipment (PPE), insecticides to cover targeted houses Planning of spray team, with consideration of requirements, personnel protective equipment (PPE), insecticides to cover targeted houses Complete IRS tools accurately and send to the right level in the data flow structure Complete IRS tools accurately and send to the right level in the data flow structure

Effective Implementation Malaria vector control operations have to be targeted, treating only where and when necessary, IRS is a method for community protection, and given tis mode of action, the highest possible level of coverage is required to achieve the maximum impact on malaria transmission. Malaria vector control operations have to be targeted, treating only where and when necessary, IRS is a method for community protection, and given tis mode of action, the highest possible level of coverage is required to achieve the maximum impact on malaria transmission. Achieving this level of coverage and timing spraying correctly (in short period of time before the onset of the transmission seasons) area crucial to realize the full potential of IRS Achieving this level of coverage and timing spraying correctly (in short period of time before the onset of the transmission seasons) area crucial to realize the full potential of IRS IRS require effective leadership and management for planning, organization and implementation. IRS require effective leadership and management for planning, organization and implementation.

Effective Implementation cont..... IRS operation must managed by technical, skilled and professional staff, based on analysis of local epidemiological data and a sound understanding of transmission patterns, vector behavior and insecticides resistance status IRS operation must managed by technical, skilled and professional staff, based on analysis of local epidemiological data and a sound understanding of transmission patterns, vector behavior and insecticides resistance status Significant strengthen of human and technical resources, accompanied by sufficient financial resources, is needed to develop or reorganize existing IRS activity Significant strengthen of human and technical resources, accompanied by sufficient financial resources, is needed to develop or reorganize existing IRS activity Post- spraying operations will be conducted and observation from the IRS campaign and to lessons learned, discuss and generally share the epidemiological outcomes of the IRS campaign Post- spraying operations will be conducted and observation from the IRS campaign and to lessons learned, discuss and generally share the epidemiological outcomes of the IRS campaign

Supervision of field spray operation The purpose of supervisor is to solve problems and offer support not to criticize or find fault The purpose of supervisor is to solve problems and offer support not to criticize or find fault To ensure that the spray team movement schedule is strictly adhered to and the agreed target numbers of houses to be sprayed per day are being maintained To ensure that the spray team movement schedule is strictly adhered to and the agreed target numbers of houses to be sprayed per day are being maintained To take corrective measure, on the spot, on spray application techniques and take note of any equipment deficiencies for remedial action To take corrective measure, on the spot, on spray application techniques and take note of any equipment deficiencies for remedial action To stimulate, encourage and advice on good comments with house holder and village or community leaders To stimulate, encourage and advice on good comments with house holder and village or community leaders To ensure good team work for total and complete coverage of areas to be sprayed To ensure good team work for total and complete coverage of areas to be sprayed

Indoor Residual Spraying Reporting IRS strategy and practices IRS strategy and practices Outputs amount of insecticides used Outputs amount of insecticides used Insecticides resistance testing results Insecticides resistance testing results Quality and bioassays results Quality and bioassays results Out come No. of structure household sprayed and No of people protected Out come No. of structure household sprayed and No of people protected Post Evaluation of IRS Post Evaluation of IRS Impact, prevalence,API district free of Malaria Impact, prevalence,API district free of Malaria Develop the success stories of district Develop the success stories of district

In conclusion

References Indoor Residual Spraying Strategy (IRS ) 2013 (GFATM DOMC Islamabad Indoor Residual Spraying Strategy (IRS ) 2013 (GFATM DOMC Islamabad Centers for Disease Control and Prevention Malaria. Available from: Centers for Disease Control and Prevention Malaria. Available from: Health Education Program for Developing Countries Available from: Health Education Program for Developing Countries Available from: Wikipedia Malaria. Available from: Wikipedia Malaria. Available from: Wikipedia Mosquito. Available from: Wikipedia Mosquito. Available from: Wikipedia Mosquito control. Available from: Wikipedia Mosquito control. Available from: World Health Organization. Integrated Management of Childhood Illness chart booklet. World Health Organization. Integrated Management of Childhood Illness chart booklet. World Health Organization Malaria Fact File. Available from: World Health Organization Malaria Fact File. Available from: World Health Organization Ten Facts on Malaria. Available from: World Health Organization Ten Facts on Malaria. Available from: World Health Organization. Roll back malaria. Available from: World Health Organization. Roll back malaria. Available from:

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