Scale-up of integrated malaria vector control: lessons from Malawi.
OBJECTIVE
Indoor residual spraying and long-lasting insecticidal nets (LLINs) are key tools for malaria vector control. Malawi has struggled to scale up indoor residual spraying and to improve LLIN coverage and usage.


METHODS
In 2002, the Malawian National Malaria Control Programme developed guidelines for insecticide treated net distribution to reach the strategic target of at least 60% coverage of households with an LLIN. By 2005, the target coverage was 80% of households and the Global Fund financed the scale-up. The US President's Malaria Initiative funded the indoor residual spraying intervention.


METHODS
Malawi's entire population is considered to be at risk of malaria. Poor vector control, insecticide resistance in malaria vectors and insufficient technical and financial support have exacerbated the malaria burden.


RESULTS
Between 2002 and 2012, 18 248 206 LLINs had been distributed. The coverage of at least one LLIN per household increased from 27% (3689/13 664) to 58% (1974/3404). Indoor residual spraying coverage increased from 28 227 to 653 592 structures between 2007 and 2011. However, vector resistance prompted a switch from pyrethroids to organophosphates for indoor residual spraying, which increased the cost and operations needed to be cut back from seven to one district. Malaria cases increased from 2 853 315 in 2002 to 6 748 535 in 2010, and thereafter dropped to 4 922 596 in 2012.


CONCLUSIONS
A single intervention-based approach for vector control may have suboptimal impact. Well-coordinated integrated vector management may offer greater benefits. A resistance management plan is essential for effective and sustainable vector control.
Malaria Vector Control Consultant, 11 Granite Street, Off Kamwala South Road, Plot 33421/917, PO Box 30146, Kamwala South, 10101 Lusaka, Zambia .
Emmanuel
E
Chanda
Malaria Alert Centre, Chichiri, Blantyre, Malawi .
Themba
T
Mzilahowa
Ministry of Health, National Malaria Control Programme, Lilongwe, Malawi .
John
J
Chipwanya
Ministry of Health, National Malaria Control Programme, Lilongwe, Malawi .
Doreen
D
Ali
Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America (USA).
Peter
P
Troell
World Health Organization, Country Office, Lilongwe, Malawi .
Wilfred
W
Dodoli
Global Malaria Programme, World Health Organization, Geneva, Switzerland .
Abraham P
AP
Mnzava
World Health Organization, Regional Office for Africa, Brazzaville, Congo .
Birkinesh
B
Ameneshewa
Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America (USA).
John
J
Gimnig
D000818:Animals; D006801:Humans; D007303:Insect Vectors / Q000254:growth & development; D057148:Insecticide-Treated Bednets; D008288:Malaria / Q000517:prevention & control*; D008295:Malawi; D009032:Mosquito Control / Q000379:methods* / Q000458:organization & administration*; D011640:Public Policy