By Stacey Naggiar
Advocacy and Communications Officer, MACEPA and Global Health Corps Fellow
In early August, 27 environmental health technologists (EHTs) from Zambia’s 13 districts gathered in a conference room in Choma, the capital of Southern Province. They underwent a five-day, hands-on training of one of the most crucial elements in the fight against malaria: IRS.
IRS, public health shorthand for indoor residual spraying, was one of the first assets in the malaria toolbox and is one of the main methods of controlling the mosquitoes that carry malaria parasites. This vector control technique involves spraying insecticides on surfaces where mosquitos rest inside homes, to reduce mosquito populations and decrease malaria cases.
In Zambia, which is striving to become one of the first sub-Saharan African countries to eliminate malaria, IRS has been part of the national arsenal since 2003. Partnering with the Ministry of Health, MACEPA recently supported a training workshop to ensure that IRS is rolled out effectively.
“We’re approaching elimination in an integrated way. No single intervention will eliminate malaria. We must combine preventive [strategies] that will clear the vector along with curative [strategies] which will clear the parasites,” said Reuben Zulu, the principal indoor residual spraying officer for the Ministry of Health.
Mr. Zulu explained the current goal was to train district officers on how to most effectively train the spray operators who travel door to door, spraying homes.
One of the biggest challenges for the spray operators are household residents who refuse IRS. During the training, the EHTs were taught public relations techniques to encourage households to participate. The work starts immediately upon arrival at a home:an introduction by the operators and showing of Ministry of Health IDs. Then the team explains the purpose of the visit and what homeowners should do before and after spraying.1
The communication skills are meant to complement the highly technical work of IRS, the primary focus of the workshop. The EHTs were taught detailed lessons to relay to their districts during subsequent cascade trainings including the components of a spray pump, insecticide mixing and handling, and environmental and personal safety issues.
The work is grueling. During spray season, operators are expected to spray an average of 15 structures per day, carrying 10-litre pumps and spraying for up to eight hours. However, the benefits of this physically taxing and highly technical work should not be underestimated. “We can easily tell from the human-biting rate whether or not an area has been sprayed,” MACEPA entomological surveillance officer Kochelani Saili said.
“Elimination without IRS isn’t possible,” he continued. “In addition to the effect on the individual household, spraying offers a very large community effect by reducing the population of mosquitos and bringing down the biting rates.”
With growing resistance to the chemicals used on insecticide-treated nets (ITNs) in recent years, increasing interest has been paid to IRS. “IRS uses a class of chemicals called organophosphates which is responsible for actually killing off the mosquito population,” Saili explained. “It has been shown that where IRS and ITNs are used in combination, the effect is the greatest.”
There’s no silver bullet for eliminating malaria. It requires a complex mix of interventions from environmental mosquito control, to spraying and net use in the home, to testing and treatment of suspected malaria cases. As with any ambitious task, successfully achieving elimination will depend on these elements being carefully choreographed, on the support and participation of communities, and on continued investment in research and programs.
An EHT for nine years in Mazabuka, Fortune Bweenje is concerned about complacency. “People don’t want malaria in the first place,” he said, “but the biggest challenge is because of inconsistency in control. Sometimes it’s cost-related—no money to fund programs. . . if we can get consistent control even elimination is possible.”
- For example:
- Remove all water, food, and cooking utensils from the house.
- Move furniture to the center of the room and cover; this allows for easy access to the walls.
- Wait at least two hours after spraying before entering the home, and open windows and doors after entering.
- Seek medical attention in case of skin irritation.
- Do not paint or wash walls for six months.