Standard Operational Procedures for Indoor Residual Spraying for Malaria Control and Elimination

Transcription

1 Standard Operational Procedures for Indoor Residual Spraying for Malaria Control and Elimination APMEN IV Annual Business and Technical meeting Seoul, Republic of Korea May 7 10, May 2012

2 Outlines : SOPs Indoor residual Spraying Roles of IRS o Control vs Elimination Operational Manual Planning of IRS o Mapping o Insecticides and spraying surfaces o Insecticide and spraying equipment Training of IRS (steps and procedures) Safety procedures Spraying procedures Care and maintenance of spray equipment Supervision check list Monitoring and Evaluation Reporting

3 Roles of IRS in Malaria Control Programme IRS aimed at reducing human vector contact and the vectorial capacity (shorten life span) of local mosquito vectors. Control epidemics in the focal area Control of seasonal transmission Prevention of epidemics Special risk situations (mobile population, development projects etc)

4 IRS in malaria elimination to accelerate the achievement of a set local malaria elimination target Focal spraying of hot spots with robust active surveillance/case investigation, even in areas with high LLINs coverage Elimination of Foci where and when occurred

5 IRS in Malaria elimination Elimination Stages IRS 1 Pre elimination Total coverage of malaria risk areas/prevention of epidemics 2. Elimination Targeted IRS operation in well delineated areas (2-5 years) 3. Post- elimination Focal IRS operations as part of remedial measure Epidemiological criteria API > 5; PP>1 (1-2 cycles per year) API > 1 < 5; PP <1 (1-2 cycle/year) 1 Indigenous case

6 Characteristic of malaria foci Type of focus Characteristics Remarks Residual focus Non -active Active Transmission interrupted, relapsing case only Transmission not completely interrupted, relapses and new indigenous cases New focus Potential Presence of imported cases; vector presence, but no evidence of actual transmission Active Evidence of transmission, imported cases and new cases (introduced or indigenous)

7 What is focal spraying An epidemic response process based on epidemiological and entomological evidences All houses/structures (where people overnight/resting at night) of a malaria focus Case s place of work or overnight stays Whole locality or group of epidemiologically related localities Focal spraying, to be repeated ( 3 monthly) when indicated

8 Planning 1 : Mapping GR map GIS map

9 Planning 2: Measure the sprayable surfaces The average size of the surface structure to be sprayed has to be calculated to determine all of the following: Amount of insecticide required (a.i g per m 2 ) Number of structures that can be sprayed by an individual spray operator in one day Amount of insecticide required per day Accurate dosage, by equating the quantity of insecticide actually used against the estimated amounts

10 Planning of IRS Insecticides formulations and sprayable surfaces Insecticide formulations and sprayable surfaces: Different surfaces, different insecticide : WP and SC = longer residual effect. CS= capsule suspension release slowly, longer residual, safety to operators. Most insecticide last longer on wood and thatch than mud WP effective on porous surface like concrete wall, mud. EC more effective on wood or lumber, oil based painted surface

11 Common Pyrethroid Insecticides-IRS ICON 10 CS Lamdacyhalothrin) Victor 20 WP (Etofenprox) K-Othrine 25 WG (Deltamethrin)

12 Spraycan-Hudson x-pert 11.3 L = 3 gallons (Max 8 L of spray solution can spray 200 m 2 (since 1 L spray 25 m 2 ) 15.1 L = 4 gallons (Max 10 L spray solution can spray 250 m 2 ) Airhead inside tanks proportioned to the spray time Ideal situation: Amount of insecticide sachet use = size of spraycan use ( e.g. 1 sachet of 10% ICON to 10 litres of water) to achieve a desire dosage of 25 mg per m 2

13 Nozzles =80 angle of spray fan 02=0.2 US gallons/ minute or 760 ml per minute = 80 angle of spray fan 01= 0.1 US gallons/ minute or 380 mls per minute

14 8001 vs 8002 TEEJET 8001 can be used on nonabsorbent surfaces where early run-off would normally result in target deposit not being achieved. Here the spray concentration needs to be adjusted: double the concentration applied at half the rate over the same area will give the same deposit rate.

15 Calibration of nozzle 45psi/30sec INTERPR ETATION 380 ml Normal > 380 ml Worn but serviceabl e >418 ml Discard and replace

16 Spraying operational team Provincial/state entomologist National entomologist Provincial malaria supervisor Provincial malaria supervisor Provincial malaria supervisor Square leader Square leader Square leader Square leader Square leader Square leader Driver Syrayman Sprayman

17 Operation team for Focal Spray Malaria supervisor Square leader Sprayman Sprayman Sprayman Driver/boatman

18 Training Contents (10 days) Group training/demonstration sessions (6 days) Preparing the sprayer (assembly and disassembly) Insecticide, calculation, mixing, handling and safety precuations Spraying with water on training wall Sprayer pressurization. Spray pattern (distance from nozzle tip to surface to be sprayed) and spray swaths. Spray rhythm. Care and cleaning of the sprayer. Spraying in difficult situations underneath table, floor, ceiling, eave. Preparation of insecticide suspension, mixture and calculation of dosage ( per m 2 ). Final Test: hands-on trouble-shooting and spraying demonstration Community communication- role play Care and cleaning of the sprayer. Practical house spraying (individual team with supervisors) and communication 4 days

19 Training Philippines-Palawan Vanuatu - Tafea

20 Spraying Wall START DIRECTION OF SPRAY 5 CM OVERLAP 2 m 75 CM 70 cm

21 Training -Vanuatu Practical vertical spraying Mixture of insecticide sachet

22 How to avoid underspray and overspray

23 Community mobilization & 1. Safety of the insecticide communication 2. Number of dead insects ( cockroaches, ants and flies etc) after spraying; 3. Inconvenience of preparing for the activity and then waiting for the walls to dry; 4. Lack of or late information alerting community members about the spray activity; 5. Inconsistency of messages provided by the health worker on IRS, especially on the safety to humans and domestic animals.

24 Flyer - Vanuatu

25 Communication approaches Personal Communication Recruit IEC Implementers Go to each household and meetings at village level to explain malaria prevention and IRS Remind community of IRS spray operators ahead of spray team Media Pamphlets, Posters on IRS, Radio, News paper, TV drama IRS Launch Official launch of IRS operations Use IEC implementers and spray operators to reinforce messages and compliance

26 Vertical and horizontal spray Maintaining correct distance and angle for spray pattern or swath Spraying doors and windows Spraying the ceiling (horizontal spraying) Spraying eaves and openings Spraying the underside of floor boards Spraying hard-to-reach surfaces (underneath Table) etc and other structures

27 Hard to reach surfaces Spraying eaves Vanuatu Underneath of house-vanuatu

28 Extension assembly The extension sub-assembly for 24" and 36" length is optional item to spray higher portion Bend extension (Swan extension) allows spray man to spray underneath bed, table etc. The difference between the normal extension is straight for the whole extension and the Swan extension is bent at the end. Recommend: One set of extension sub- assembly (e.g. 2x36 or 1x etc) and one swan neck per team of 4 persons.

29 Use of CF Valve to maintain even pressure and constant flow rate Example : CF Valve of 2 BAR (29 PSI), when the pressure inside the tank down up to 29 PSI, the sprayer will stop to spray Normal is 50 PSI, the higher PSI inside the tank, the longer time can spray until the pressure down to 29 PSI. CF Valve

30 Safety precautions Storage Transportation of insecticide, Opening of the package, Mixing insecticide, Loading the spray pump, Maintaining the equipment, Spraying, especially in high places, Spillage, Disposal.

31 Personal protective equipment Broad rim hat (protects head, face and neck from spray droplets); Full face shields or goggles (protect eyes against spray fallout); Face mask/respirator (protects nose and mouth from airborne particles of the spray fall-out and to avoid inhalation); Face shield (protects face from the spray fall-out and splashes); Long sleeved overalls (keep overalls outside of boots); Rubber gloves (protect the hands); Boots (protect the feet); Raincoat (protects spray operator when it is raining).

32 Four Supervisory Check lists HOUSEHOLD PREPARATION BEFORE SPRAYING OPERATIONS COMMENCE OBSERVATION OF SPRAY OPERATORS (SO) AT SPRAY SITE SPRAYING OPERATIONS HOUSEHOLD AFTER SPRAY ACTIVITIES

33 Maintenance of spraycan Multi-tool assembly Storage of spraycan

34 Monitoring Reports Indicator process outputs Coverage (%) Dosage ( g a.i/m 2 ) Per spray round Total population protected IRS plan schedules Total insecticide used (sachets) - Household - Other structures Total insecticide used/total m 2 Village sprayed Target areas covered No. of operational day per village Total used per village Complete sprayed Incomplete sprayed Insecticide use per m 2 % population protected No of operational day per target area (zone) Total used per target area (Zone) per round

35 Core Evaluation Indictors Operational Entomological 1.Insecticide Quantification Kits (IQK) recently developed by IVCC (contact bioassay on walls) 1. Indoor man biting rate 2 Coverage 2. Parity rate 3. House hold refusal rate 3. Sporozoite rate 4. Insecticide used per m 2 4. Insecticide susceptibility level 5 Total charge ( 1 charge per spray tank) 5. Indoor resting and 24 hours mortality rate