Brazzaville, 31 October  2011 -- An expert consultation on malaria vector control has ended in Brazzaville, Congo, with key recommendations on principles and decision making criteria upon which vector control methods and products are to be used to accelerate malaria control and eventual elimination in the African Region.
Meeting under the auspices of the World Health Organization, the experts recommended that the process of deciding which malaria vector control method is appropriate in a given situation should be guided by five factors:  an analysis of the level of malaria prevalence, a consideration of the relationship between mosquitoes and the environment, the eco-epidemiological setting, the health management system and ability to sustain a chosen control programme.
The experts also recommended that in selecting a vector control method, indoor residual spraying (IRS) should be adopted only if the necessary capabilities exist or can be created to achieve and sustain high coverage for impact, and where local vectors are susceptible to the insecticides used. 

According to the experts the use of insecticide treated nets (ITNs) as an intervention for malaria control should be based on long lasting insecticidal nets (LLINs), targeting one LLIN for every two people (or for one sleeping place).LLIN should be made available not only through free mass distribution   campaigns but also on a continuous basis through routine channels such as ante-natal care attendance and immunization activities or campaigns.  

It was also recommended that larval control could be used as a supplementary measure under specific conditions where breeding sites are fixed, easy to find, and accessible, and as long as the treatment operation can reach a very high proportion of  breeding sites within the mosquito-flight-range of the community to be protected. 

Other recommendations include putting in place regulatory measures or proper vector management for preventing the creation of man-made vector breeding sites; the inclusion in all malaria control programmes of monitoring and evaluation of epidemiological and entomological indices, based on existing standard operating procedures; and the pre-emptive implementation of an insecticide resistance management strategy in sustained vector control programmes relying on the use of insecticides.

The experts recommended that considering the magnitude of malaria transmission and the urgent need for resistance management, there may be a need to combine IRS and ITNs in the context of Integrated Vector Management (IVM).  If IRS and ITNs are combined, a non-pyrethroid must be used for IRS.   In specific circumstances such as urban settings larviciding and environmental management might be useful as a complement to IRS or ITNs.   

The remaining recommendations related to collaboration between malaria control programmes and research institutions to undertake operational research in support of the interventions; the  setting up of vector control services and building capacity for operational and managerial skills (particularly entomological skills), and for logistic resources; health education and effective community mobilization and sensitization; routine monitoring of vector resistance to insecticides of malaria control programmes and projects using an insecticidal intervention (including LLINs),  inter-sectoral collaboration and coordination of various initiatives, as well as involvement of all stakeholders including communities in the implementation of IVM activities

The experts confirmed the usefulness of IRS using DDT as a major intervention for malaria control within the Stockholm Convention on Persistent Organic Pollutants (POP) which aims to protect human health and the environment by banning the production and use of some of the most toxic chemicals known to humankind.

Accordingly, they recommended the use of DDT in malaria control wherever this choice of insecticide is justified by cost-effectiveness and insecticide susceptibility.The experts, however, recognized that DDT should not be used for IRS where resistance among malaria vectors is widespread.

For more information, please contact:

Technical Contact: Dr Magaran Bagayoko; tel: + 4724139903, email: bagayokom [at] afro.who.int
Media Contact: Samuel Ajibola tel: + 47-241-39378 , e-mail: ajibolas [at] afro.who.int