Oxfam’s malaria and dengue programming promotes an evidence-based approach, targeting regions where malaria or dengue carries the greatest risk of mortality and morbidity. A malaria control project can be implemented as either part of a WASH project or as a stand-alone project. However, all WASH projects should adhere to vector control minimum standards by ensuring effective drainage of water - even if a specific malaria control element is not included.
- Oxfam’s malaria programming strengths include the provision of community education to ensure effective prevention of malaria (use of long-lasting insecticide treated mosquito nets (LLINs), vector control, and community participation) and distribution of LLINs (either to whole communities or targeted to pregnant women and children under 5).
- The decision to intervene with a malaria programme should be based on knowledge of the malaria profile for the area: all WASH assessments should include an appraisal of malaria risk and the capacity and intention of other agencies (including the government) to intervene.
- Permission should be sought from the National Malaria Control Programme (NMCP) or Ministry of Health before an intervention is initiated.
- As far as possible work in conjunction with existing longer-term malaria control programmes (e.g. Roll Back Malaria, Global Fund).
- The provision of mosquito nets should not be seen as the automatic choice of intervention, as they may not always be appropriate.
- Where the decision is made to distribute nets, only LLINs should be purchased. The following brands are acceptable:4 Permanet, Bestnet (Netprotect), Olyset, Yorkool, Interceptor, DuraNet and Dawa Plus.
- The choice of nets should be based on an assessment of sleeping habits and user preference as well as discussions with the NMCP.
- Minimum Requirements for the Distribution of Hygiene Kits will apply for a distribution of LLINs.
- Indoor Residual Spraying (IRS) of mosquito insecticide may be undertaken if it is the most appropriate option and there are no other actors capable of implementing it. If so:
- Staff should receive comprehensive training on safe, effective spraying techniques.
- Spraying should be carried out just before the rainy season to ensure the insecticide is still effective when malaria peaks.
- Spraying should be confined to camp situations or well-defined geographic areas, as wider coverage will limit effectiveness.
- All insecticide purchased for use in a particular country should be licensed by that country.
- DT should not be purchased using Oxfam funding.
- Oxfam does not provide curative care as part of its WASH programmes, but adequate access to treatment is important if malaria control is to be successful. If access to health care or treatment is severely compromised, Oxfam should advocate for the involvement of other agencies.
- The decision to intervene with dengue activities should be based on knowledge of the dengue profile for the area, for example aedes mosquitoes that transmit dengue and can have varying breeding preferences.
- The most effective prevention of dengue is to minimise mosquito bites, especially during daylight hours. If WASH assessments reveal dengue to be a public health problem in the project area, activities should be focussed on minimising and treating breeding sites (aedes aegypti do not breed in open water but prefer enclosed containers such as water tanks, cisterns or drums, tin cans or old tyres etc.); and messaging on minimising opportunities for getting bitten and identification of dengue symptoms.
- Dengue activities should be coordinated with existing government policies and other specialist NGO‘s.
Vector Control - General Principles
- Vector control should be based on an assessment of the local impact of vectors on communicable disease such as malaria and dengue, and undertaken as an integral part of wider malaria or WASH activities.
- Vector control activities should pursue all available opportunities for community participation, and be accompanied by education to explain the work.
- Any chemicals used should conform to national and international (WHO) safety and environmental standards.
- Disposal of expired or surplus vector control chemicals should follow national guidelines and standards (or international if not available) for hazardous waste management. See Solid Waste Management section.
Physical Vector Control (Source Reduction)
- Physical vector control should focus on improving drainage around water points, providing adequate rainwater drainage, and filling-in or draining ponds, swamps and other breeding sites. Affected communities should be provided with the necessary tools and safety equipment, and knowledge on vectors, for this work.
- Solid waste management activities for the purpose of vector control (e.g. clean-up campaigns, facilitating local government waste collections) should be linked to vector risks identified by public health assessments. See Solid Waste Management section.
- Clearing of vegetation is often undertaken in an attempt to reduce opportunities for mosquitoes to find resting places. However the impact of this is minimal compared to other control measures: resources should not be wasted on mobilising communities to embark on vegetation clearance.
Chemical Vector Control
- Oxfam does support Indoor Residual Spraying (IRS) with WHO-approved insecticides for the control of mosquitoes as a malarial control method (see 12.1).
- Evidence shows that the provision of toilets and removal of open defecation is the most effective method for reducing the spread of WASH-related disease (including cholera and trachoma): Oxfam should not advocate for, or implement, chemical fly control methods such as spraying, outdoor fogging or dusting for the sole purpose of eradicating or controlling flies.
- Insecticide-treated plastic sheeting (ITPS) is a vector control measure sometimes found as wall coverings on latrines, family shelters, and clinic buildings. The effectiveness of ITPS as a vector control method is still under debate, so Oxfam should not promote or use ITPS in latrine or shelter construction, nor distribute ITPS as an NFI.