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AMF activity update: August 2019


A short update on activities going on in-country this month.

  • In DRC, the registration of 500,000 households in Équateur province is complete and the paper records have been sent to Kinshasa where the household information has been entered into AMF's database by our partner AGAPE. The data was entered by 170 data entry clerks, organised in three shifts, over a three-week period. Photos below. Analysis of the registration data begins this week, with the distribution of 1.5 million nets due to take place in early October. Registration in Sud Ubangi province of 600,000 households will take place at the end of September using electronic devices, and in Haut Katanga of 1.4 million households at the beginning of October.
     
  • In Zambia, our partner CHAZ has just finished a round of post-distribution monitoring (PDM) activities in Central province and they are now entering into AMF's database the data collected from approximately 4,000 households. Data from the North-Western province PDM have been entered and show sleeping space coverage of 72%, 14 months post distribution. The next PDM in Western province takes place at the end of August.
     
  • In Ghana, our partner World Vision is collecting data for the second PDM in Upper East region. The results of the first PDM in Brong Ahafo region are currently being imported into AMF's database. 3.6 million nets were distributed in 2018.
     
  • In Malawi, our partner the Red Cross has started PDM activity in Southern region. Data is being collected using smartphones from 17,000 households. 4.3 million nets were distributed in 2018.
     
  • In Guinea, the last wave of the distribution, of 940,000 nets, took place in the prefectures of Siguiri and Kankan. Photos below. Our partner organisation, United Purpose, monitored the distribution at a number of distribution sites which were randomly selected by AMF. Monitoring data was collected on electronic devices providing AMF with real-time access to the information. This completes the distribution of 4.8 million AMF-funded nets. Distribution data for the final wave will be entered into AMF's database by our partner Cabinet Diagnostic in the coming two weeks.
     
  • In Uganda, the 24-month PDM is taking place in selected districts in the Western region. PDMs in Uganda are staggered across many different months, as the distribution took place in four waves and monitoring is happening at 6-monthly intervals in randomly selected districts, and at 9-monthly intervals in other randomly selected districts.
     
  • In PNG, the rolling distribution of nets continues (year round activity, province by province) and PDM data has been collected in the provinces of Chimbu, Western Highlands and Eastern Highlands. The data is currently being entered into AMF's database for review. In 2019, a total of 1.0 million nets will be distributed.
     
  • In Togo, the 24-month PDM will take place in September. 2.4 million nets were distributed in 2018.
DRC 01 - Registration data arrives at the data entry centre DRC 02 - Registration data is organised in a filing cabinet prior to being entered into AMF's database DRC 03 - Data is entered into AMF's database by 170 data entry clerks working for three weeks Guinea 01 - Members of the community are informed of the upcoming distribution in various ways, including via public banners Guinea 02 - A poster in a health centre shows malaria prevention and treatment techniques. The poster makes clear that all prevention and treatment is free. Guinea 03 - Nets are stored securely at the distribution site in Sanfina community Guinea 04 - All AMF funded nets bear the AMF logo for easy identification during monitoring Guinea 05 - Members of the Sanfina community in Kankan region queue up with their registration coupons to receive their nets Guinea 06 - Members of Kankan town queuing for nets Guinea 07 - Distribution staff members find the recipients' details in the registration books and cross check the number of nets to be handed out Guinea 08 - A member of Sanfina community receives her nets Guinea 09 - A beneficiary listens to net usage messages given by a member of the distribution staff Guinea 10 - A beneficiary takes her nets back to her household and airs them before use

AMF activity update: July 2019


Checking the condition and installation of the net

A short update on activities going on in-country this month. We will aim to post a brief update like this each month.

  • In DRC, the registration of 500,000 households in Équateur province is underway and our partner RHA is in the field carrying out independent monitoring of the registration. The distribution of 1.5 million nets is scheduled for September. A further 1.9 million nets will arrive shortly by ship in DRC for distribution in Sud Ubangi province in October. The production of 8.4 million nets is underway with these nets scheduled for distribution in Haut Lomami, Tanganyika and Haut Katanga provinces in December, January and February.
     
  • In Zambia, our partner CHAZ has just finished a round of post-distribution monitoring (PDM) activities in North-Western province and started data entry yesterday so that all records will shortly be in electronic form and ready for independent review by the AMF team. 3.0 million nets were distributed in 2018.
     
  • In Ghana, our partner World Vision is carrying out a PDM in Brong Ahafo region. Data is being collected electronically (see photos). 3.6 million nets were distributed in 2018.
     
  • In Malawi, we have put in place an agreement with the Red Cross to start PDMs later this month. 4.3 million nets were distributed in 2018.
     Carrying out a PDM survey
  • In Guinea, 940,000 nets are arriving in a second shipment and will be distributed in three weeks, completing the distribution of 4.8 million nets
     
  • In Uganda, the 24-month PDM, i.e. monitoring that takes place 24 months after the distribution of nets in the respective districts, is continuing. Sleeping space coverage at 24 months (partial results) is 84%. 12.7 million nets were distributed in 2017/8.
     
  • In PNG, the rolling distribution of nets continues (year round activity, province by province) and PDM activity starts this week. In 2019, a total of 1.0 million nets will be distributed.
     
  • In Togo, the 18-month PDM was carried out in May using electronic devices and showed a sleeping space coverage of 88%. 2.4 million nets were distributed in 2018.
     

US$200m milestone passed!


We have now reached a total raised of US$200,000,000 since AMF started and the donation that took us past that milestone was one from New York, USA!

This equates to the funding of more than 91 million nets to protect 165 million people and an expected impact of more than 30 million cases of malaria and 65,000 deaths averted.

We have also just passed 439,000 donations received, with this coming from over 121,485 people in 187 countries!

As always, our sincere thanks to everyone for their support and generosity which is both humbling and thrilling. Humbling, given the repeated support of donors and the magnitude of some of the donations, and thrilling in knowing what these donations can achieve.

I am pleased to report we have raised more than US$3,000,000 in the last month from more than 6,487 donations and this has made a dent in the funding we continue to raise to fund the need for further nets in the Democratic Republic of Congo, one of the two most malarious countries in the world, where we have the potential to have a large impact on health outcomes. Donations have ranged from US$1 to US$2,000,000, and they all matter as each US$2 buys a net and helps close the funding gap.


Guinea 4 million net distribution – Registration phase completed


The registration has just finished in Guinea of 2.3 million households that will receive nets in the nationwide universal coverage campaign that will take place in April and May 2019. Registration establishes the net need for each household individually.

The four regions that will receive 3.86 million AMF-funded nets are Boké, Faranah, N'zérékoré and Kankan. In these regions 990,000 households were registered in 12 days by 6,900 community health volunteers with management and supervision at sub-district, district and regional level by Guinea's National Malaria Control Programme (NMCP).

A number of data-driven mechanisms are in place to maximize, and provide evidence for, the accuracy of the registration.

  1. "105% Registration"
    Community health workers, coordinated by the NMCP, carry out "105% registration" whereby 100% of the households are visited to establish net need for each individual household, and then a random sample of 5% of the households are re-visited by a separate group of data collectors with no knowledge of the 100% data collected. Importantly, those carrying out the 100% registration are aware re-visits will take place. This acts as a mechanism to encourage accurate registration.
     
  2. Independent monitoring
    AMF funds an independent organisation to monitor the way the registration is managed and carried out by the NMCP. The 100% and 5% registrations are monitored closely in 40 randomly selected villages. This monitoring provides quantitative and qualitative insight into the registration process and is carried out in the spirit of wishing to know how well things are going, what challenges are faced by the teams carrying out the work and what lessons can be learned for this and future campaigns.
     
  3. Independent Village Re-registration (IVR)
    An independent organisation, funded by AMF, carries out the whole village re-registration of 40 villages, selected at random, with the very specific objective of recording the details of all households in each of the villages. The data collected can be compared with the 100% registration data. This provides AMF with an independent source of information to help assess the accuracy of the NMCP-led registration.
     
  4. Electronification of household records
    Household registration data collected on paper are sent to a data entry centre located in the capital, Conakry, where they are entered into AMF's Data Entry System (DES). AMF funds this work, carried out by 400 data entry clerks. This transparent process allows visibility for all partners of household records, and analysis of them. This would not be possible if paper-based records remained at individual health facilities and only summary numbers were sent to the NMCP.

3.5 million nets funded by AMF have now arrived in Guinea. Once the registration data has been analysed, the final number of nets required to ensure complete protection of the population in the four regions will be ordered, produced and shipped to Guinea for distribution in May. This 'split-shipment' approach, with the second quantity shipped guided by actual registration data, allows us to be accurate and not wasteful with the number of nets we fund and distribute whilst ensuring all those that need to be protected receive nets.


US$190m milestone passed!


We have now reached a total raised of US$190,000,000 since AMF started - thanks to a donation from Phoenix, Arizona, USA!

We have also just passed 398,000 donations received, with this coming from over 114,000 people in 187 countries! Closing in on 400,000 donations!

As always, our sincere thanks to everyone for their support and generosity which is both humbling and thrilling. Humbling, given the repeated support of donors and the magnitude of some of the donations, and thrilling to know what these donations can achieve.

I am pleased to report we have raised close to US$10,000,000 in the last month from more than 8,900 donors and this has made a dent in the funding we are hoping to raise to fund the further nets needed in the Democratic Republic of Congo, one of the two most malarious countries in the world, where we have the potential to have a large impact on health outcomes. Donations have ranged from US$2 to US$2.5 million, and they ALL matter, as each US$2 buys a net and helps close the funding gap.


'Double Up Drive' - Very generous matching donations to AMF - Last day tomorrow!


If you are considering donating to AMF on or before 29 Dec 18, please check out https://doubleupdrive.com/. These guys are fantastically generous and will double your donation to AMF.

You can either donate directly to AMF and send the donation receipt we email you (minus the link to your private donations page) to receipts@doubleupdrive.com or donate via the Effective Altruism Foundation via the form on the Double Up Drive page.

Thank you!


2018 Round up and update - Thank you for your support!


As 2018 draws to a close we would like to thank all who have supported and worked with AMF this year as without donors, distribution partners, volunteers and pro bono supporters we would not be able to do what we do in contributing to the fight against malaria. Thank you!

Distributions update

Distributions and follow-up surveys are currently being undertaken in a number of countries. We have just completed the distribution of 1.0 million nets in Papua New Guinea, 3.6 million nets in Ghana and 4.3 million nets in Malawi. Approximately 4 million nets are about to be shipped to Guinea and the first of 11.8 million nets for distribution in the Democratic Republic of Congo. In total, these nets will protect 43 million people.

Future distributions

There remains a huge need for nets. The gap for the next few years runs into tens of millions of nets. We are involved in discussions in a number of countries requiring individually between 3.5 million and 18 million nets for the period 2019 to 2020, including a significant gap in DRC.

AMF's gap for more funding remains large and we agree with GiveWell's assessment that the total funding gap for LLINs for 2019-2020 appears to be hundreds of millions of dollars.

We will publish commitments as they are made.

393,000th donation and over US$185 million raised so far!

We are thrilled to have recently received our 393,000th donation, with most donations ranging from a few dollars (and £, €, CAN$, NZ$, AUS$, bitcoin and more) to many thousands.

We are so grateful for your support. Thank you!

Tax-Deductibility

We now have tax-deductible status in a dozen countries, most recently in Norway. We continue to assess the need for tax-deductibility status in other countries, some of which are already in the application stage and we hope to complete in the very near future.

AMF top ranked!

AMF has again been top-ranked by the two leading organisations 'dedicated to finding outstanding giving opportunities'.

GiveWell has ranked AMF a top charity, for the seventh time in eight years

The Life You Can Save has AMF as a top-ranked charity for the eighth year in a row

A suggestion for the Christmas/Holiday season!

Donate nets instead of gifts.

We send the recipient/s an email (on a date you choose e.g. 25th Dec) with your personal message and a link to their 'gift page', allowing them to follow the progress of their nets.

May we wish you a very happy and healthy 2019!

Rob, Andrew, Peter, Julian, Jenny, Shaun, Andy and David


'Brilliantly simple charity' National Post video about AMF


A short, informative video about what AMF does and how we do it.

"Why one brilliantly simple charity is the best in Canada (and probably the world)"

Especially nice to see as we weren’t aware it was being put together and we didn’t have any involvement with it.

Thanks folks!

We'd be very grateful if people would share this!


Update on future distributions and immediate funding gaps


The immediate need for funding nets far exceeds the amount we have available.

There is a currently unfunded need for AMF to provide 22 million nets for people in the Democratic Republic of Congo. DRC is one of the two largest contributors to malaria deaths and illness, so there is the potential to have an extremely large impact on health outcomes. The total funding gap is US$45 million.

Thanks to our donors' incredible commitment to fighting malaria, we have recently been able to sign agreements to fund 3.86 million nets for distribution in Guinea (Mar-Apr 2019) and 11.8 million nets for distribution in the Democratic Republic of Congo (April and November 2019). These nets will protect an estimated 28.1 million people.

The time to identify funding for the major gap in DRC is now in order to allow adequate time for preparations for what is a significant national-level logistics operation. Extensive planning is needed for proper accountability and transparency, which is particularly needed in a country such as DRC. This needs to be done prior to manufacture, international shipment and distribution within the country. The earlier funding can be identified in the next five months the better will be the preparations for the distribution.

This is the most significant opportunity AMF has had to date:

  • protect 40.5 million people
  • avert 10-15,000 deaths and 10-15 million cases of malaria
  • improve GDP in DRC by an estimated $540m
  • influence materially the accountability of the universal coverage campaign in one of the world's two most malarious countries
  • slow down the growth of insecticide resistance which threatens to undermine the whole country net programme through the purchase of PBO nets

AMF is well placed to assist with this opportunity:

  • a track record of successful multi-million net distributions
  • direct experience and established relationships in DRC
  • Global Fund partnership covers non net costs and reduces risk
  • agreement for 11.8 nets recently signed with the Ministry of Health so no agreement hurdles to overcome
  • our leadership in dealing with insecticide resistance through use of next generation nets

There is no other funding currently identified. The gap exists after all commitments from AMF, The Global Fund and other funders have been taken into account, including our latest commitment of nets.

This is not an 'all or nothing' situation, every extra net funded by our donors will fill the need of someone at risk from malaria and we remain exceptionally grateful to all donors of small or large amounts.


AMF ranked as a top charity for seventh time!


GiveWell has updated its top charity list and we are delighted to be ranked again as a top charity!

From GiveWell's recent update review of AMF:

"The Against Malaria Foundation (AMF) is one of our top-rated charities, and an organization that we feel offers donors an outstanding opportunity to accomplish good with their donations."

"We believe that AMF is likely to be constrained by funding. There is a high degree of uncertainty in the maximum amount that AMF could use productively, but given AMF's track record of finding and filling funding gaps for LLINs and the large size of the global funding gap (estimated to be in the hundreds of millions of dollars for 2018-2020), we expect the maximum to be significantly greater than what AMF is likely to receive."


Milestone: US$180 million raised!


We are delighted to report that we - all of us together - have now reached a cumulative total since AMF started of US$180 million raised!

This has been possible through the support of 112,000 people in 189 countries who have made 386,392 donations. Our smallest single donation has been US$1, our largest US$22.8 million. And every donation matters as each US$2 buys a net and protects two people when they sleep at night from the bites of malaria-carrying mosquitoes.

These funds equate to 81 million nets protecting 145 million people with an estimated 65,000 lives saved and 65 million cases of malaria averted. The positive contribution to GDP is estimated to be $2.2 billion.

Thank you for all your support!

We are privileged to witness first-hand the generosity, and repeated generosity, of donors and receive truly wonderful letters and emails of good wishes and support. Thank you for your confidence in our work.

There is a significant gap between the nets we can fund and the requests we currently have so we will continue to work hard to contribute all we can to close the net funding gaps that exist.


AMF funds 11.8 million nets for distribution in the Democratic Republic of Congo (DRC) in 2019


AMF has signed an agreement with the DRC Ministry of Health to fund 11.8 million nets for distribution from April to December 2019. This represents 40% of DRC’s long-lasting insecticide treated net (LLIN) need for the 2019 portion of their three-year rolling universal coverage campaign.

The nets will be distributed in five of DRC's 26 provinces, specifically:
  • Equateur: 1.5m nets to protect 2.7m people, distribution during April 2019
  • Sud Ubangi: 1.9m nets to protect 3.4m people, distribution in June 2019
  • Tanganyika: 2.0m nets to protect 3.6m people, distribution in Q3 2019
  • Haut Katanga: 4.0m nets to protect 7.2m people, distribution in Q4 2019
  • Haut Lomami: 2.4m nets to protect 4.3m people, distribution in Q4 2019

In total, 21.2 million people will be protected.

Malaria is one of the primary health issues in DRC, with high incidence levels seen across the majority of the country. DRC is one of the two most malarious countries in the world with malaria responsible for the deaths of at least 100 children under 5 each day in DRC alone.

These nets have the potential to play a major part in reducing deaths and illness. This quantity of nets could be expected to prevent 8,000 deaths, 8 million cases of malaria and make a material impact on the economy of DRC. It is estimated that the improvement in GDP (Gross Domestic Product), a measure of economic performance, would be about US$280 million.

AMF allocates individual donations to specific distributions and so far we have allocated 28,040 individual donations from 12,941 donors from 94 countries. These figures will increase as further donations are allocated. Many donations, large and small, help fund these nets.

We will report openly on progress and performance throughout and after the distribution.

Key elements of our agreement include:

  • AMF is funding 11,800,000 LLINs for distribution in 2019
  • This is a co-funding partnership with non-net costs (shipping, pre-distribution, distribution) funded by the Global Fund
  • To support accurate data gathering, re-checks of net need numbers will take place by re-visiting a material number of households chosen at random.
  • AMF will collect household registration data from the entirety of a proportion of villages as an independent check on registration and population numbers
  • Household-level data will be collected on paper or using electronic-devices and then entered into AMF’s Data Entry System (DES) for analysis and verification. This, and the above elements combined, are the basis for a highly accountable distribution.
  • Post-distribution monitoring of net use and condition (PDMs) will take place every nine months for two and a half years in all districts. AMF will fund this.

Distribution in Equateur and Sud Ubangi

Distribution in Tanganyika, Haut Katanga and Haut Lomami


AMF is hiring! Data Analyst


AMF's net distributions continue to grow and with this comes the need for us to analyse the data we receive to ensure every distribution has the maximum impact. We are now seeking exceptional candidates for the role of Data Analyst.

Reporting to AMF’s Operations Manager, and working closely with all the other members of the AMF team, the successful candidate will have strong technical skills but also be open, collegiate and enjoy working in a small, highly impactful team.

The Data Analyst will have exceptional organisational and analytical skills, together with a bias for identifying and solving issues. They will have strong attention to detail and excel capability, appreciate the importance of visual presentation of material for clarity and an interest in using data to improve health outcomes for the poorest communities. They will be comfortable learning about financial matters, and be willing to examine budgets in detail.

Prior experience in international development is not necessary. For the right candidate AMF would be willing for them to have flexible working arrangements.

The current members of the AMF team are based in their home offices, and it would be ideal if the Data Analyst is able to do the same. The successful candidate is likely to be in the UK/Europe/Africa time zones.

Job description and details of how to apply


Milestone: 75 million nets!


We are delighted to say we have now reached a cumulative total since AMF started of 75 million nets funded or able to be funded!

This has been possible through the support of 111,000 people in 189 countries who have made 348,468 donations. Thank you!

Once all are distributed, these nets, protecting 135 million people, can be expected to prevent the deaths of 50,000 to 70,000 people and avert 50 to 70 million cases of malaria.

Our first net distribution was in 2006 and was of 3,000 nets and our largest distribution to date has been of 12.8m nets in 2017. The total number of nets distributed or planned for distribution is 41.5m nets and distributions totalling more than 30m nets are being assessed now. The net distributions we now fund are multiple millions of nets at a time as this is the way we can best contribute to the fight against malaria.

There is a significant gap between the nets we can fund and the requests we currently have so we will continue to work hard to contribute all we can to close the net gap.


Good read: 'Mosquito: The Story of Man's Deadliest Foe'


This is an accessible book that tells the story of malaria very well.

I have just finished reading it and would recommend it if you are looking for an easy, enjoyable read that leaves you with a much greater understanding of the how and why of malaria.

The book focuses on people and countries and is not at all technical.

Dr Andrew Spielman and Michael D'Antonio wrote the book in 2002 so it doesn’t cover the last 15+ years of progress fighting malaria but it is no less relevant for that. In fact, many of the stories of malaria – the victories and subsequent resurgence – are as relevant today as when the book was written.

If you have recommendations for other books that similarly tell well the story of malaria please do let me know.

Declaration: I have no connection with the authors and neither AMF, nor anyone associated with AMF, has any financial interest in the book or its sales.


Congratulations to extraordinary Atlantic Challenge 'Oardinary Boys' Oli and George


Hot on the heels of our previous blogpost, albeit completed before, we’d like to offer our admiration and congratulations to the not-so Oardinary Boys, Oli Glanville and George Randell, for successfully Rowing the Atlantic - 3,000 miles in a very small boat.

And they didn’t just row it, they smashed it: they are now the second fastest pair in history to row the Atlantic.

Oli and George took part in the 2017 Talisker Atlantic Challenge, setting off from San Sebastian in the Canary Islands at 6am UTC on 14 December 2017. They made land in English Harbour, Antigua and Barbuda at 22:01 UTC on 20 January 2018, just 37 days, 16 hours and 1 minute later.

This is an extraordinary challenge: 2 hours rowing, 2 hours rest, for a period of up to 60 days. Relentless. Non-stop. Burning 10,000 calories a day, consuming 6,000. You lose 20% of your body weight. 1.5 million oar strokes. It would require paragraphs here to give even a flavour of the dedication, training, strength – both physical and mental – discomfort and pain that goes into completing a successful Atlantic Challenge. We'll leave you to imagine it, if you can.

Oli and George chose to have two charities benefit from their pain and efforts, Alzheimer's Research UK and AMF.

We are delighted to report they raised an extraOARdinary £26,419 for AMF, 100% of which has been used to buy 18,606 long-lasting insecticidal nets (LLINs) to protect 33,500 people when they sleep at night from the bites of malaria-carrying mosquitoes - that would otherwise cause severe illness, or worse. That's the equivalent of 67 entire villages covered. These nets can be expected to save the lives of 10 to 15 people and prevent 13,000 cases of malaria.

Oarsome. HUGE congratulations Oli and George – and thank you.


Congratulations to Anna Doubell on her English Channel Swim


Image from: https://doubs-swims.squarespace.com/ecswim

We don't generally blog about a fundraising event, completed or otherwise, but an English Channel Swim is different.

What's different is that it is an extraordinary challenge. It is rightly one of the iconic challenges. 21 miles, as the crow flies, you and a swim suit and some grease to keep you warm-er. It requires years of training, courage, fitness and a never-give-up attitude. You have to swim some of it in the dark, cope with the wind, tides, swells, jellyfish and possibly sea-sickness when you are close to physical and mental exhaustion. You can't touch the support boat and are burning calories faster than you can take them in. Most failed attempts come through people running out of stamina - physical or mental.

So, we offer our heartfelt congratulations to Anna Doubell for successfully completing her English Channel swim! An incredible achievement. Anna swam the channel in 12 hours and 24 minutes.

Anna has also raised A$8,444 (at time of writing) for AMF that will fund 3,131 long-lasting insecticidal nets that will protect 5,600 people when they sleep at night from the bites of malaria-carrying mosquitoes that would otherwise cause severe illness, or worse. These nets can be expected to save the lives of two people and prevent several thousand cases of malaria.

Anna, a huge well done - and thank you.

PS: If you’d like to understand a little of what it takes to be a Channel Swimmer, watch this.


Accounts for FY to 30 June 2018 (unaudited) now available


Our Financial Year has just ended and, as part of our commitment to efficiency, our annual accounts have been generated and are available to view on our Easier-to-understand accounts page.

We are able to show our pre-audit numbers within a few hours of the end of our financial year due to the level of automation of our financial systems which brings a number of benefits:

  1. Accurate management information - On any aspect of our finances at any time
  2. Improved transparency - For management, governance and audit purposes
  3. Improved efficiency - Minimal administrative input to prepare the accounts at year end (data is entered most working days during the year)
  4. Swift production of our annual accounts - Within 24 hours of the FY end i.e. once the closing balances on our accounts are known the next day
  5. Assisting our auditors - Swift availability of our draft annual accounts to give our auditors maximum flexibility in scheduling their work
  6. Keeping stakeholders up to date – Providing donors, trustees and other stakeholders with timely information on our financial status and performance

A further benefit is we now have 'real-time' financials in our 'Easier-to-Understand' section of our financial information.

Note: We have posted this today, rather than on Monday 2nd July, as this year we have been completing other developments in our internal financial management system.


AMF funds 3.86 million nets for distribution in Guinea from March to April 2019


AMF has signed an agreement with the Guinea Ministry of Health to fund 3.86 million nets for distribution from March to April 2019. This represents 45% of Guinea's long-lasting insecticidal net (LLIN) need for their 2019 universal coverage campaign and a financial contribution of 25% of the cost of the universal coverage campaign.

The nets will be distributed in all 20 prefectures of four of Guinea’s regions, specifically Boké, Faranah, Kankan and Nzérékoré.

In total, 6.9 million people will be protected when they sleep at night from the bites of malaria-carrying mosquitoes – which would otherwise cause servere illness, or worse. Malaria is one of the primary health issues in Guinea, with high incidence levels seen across the majority of the country. These nets have the potential to play a major part in reducing deaths and illness.

AMF allocates individual donations to specific distributions and so far we have allocated 14,933 individual donations from 6,954 donors from 80 countries. These figures will increase as further donations are allocated. Many donations, large and small, help fund these nets.

We will report openly on progress and performance throughout and after the distribution.

Key elements of our agreement include:

  • AMF is funding 3,860,000 LLINs for distribution in 2019 with the possibility of this rising to 5 million nets if registration data reliably indicates a higher population figure than that used in planning
  • This is a co-funding partnership with non-net costs (shipping, pre-distribution, distribution) funded by the Global Fund and the President's Malaria Initiative
  • '105%' data collection will be used for the household-level registration process to support accurate data gathering – 5% of households will be re-visited as a check on registration numbers
  • AMF will collect household registration data from the entirety of a proportion of villages as an independent check on registration and population numbers
  • Household-level data will be collected on paper and then entered into AMF's Data Entry System (DES) for analysis and verification
  • The above elements combined are the basis for a highly accountable distribution
  • Post-distribution monitoring of net use and condition (PDMs) will take place every six months for two and a half years in all four regions. AMF will fund this.

Further information


Update on actions to deal with insecticide resistance in some mosquitoes


Summary

A new type of net called a PBO net is being trialed that could prove effective in killing those mosquitoes that are showing resistance to the insecticide used on standard nets.

PBO, piperonyl butoxide, is a chemical synergist that is safe for humans that is added to the net and works by ‘switching off’ the mosquitoes’ insecticide resistance mechanism allowing the insecticide on the net to do its job – cause ‘knock down’ – i.e. kill the malaria-carrying mosquitoes.

AMF funded six million PBO nets that were distributed in Uganda between March 2017 and March 2018 to protect 10.8 million people and an 18-month randomized controlled trial (RCT), a gold-standard study, to help answer the following question:

Are PBO nets more effective at preventing malaria in areas where some mosquitoes have developed resistance to the insecticide used on LLINs and, if so, how much more effective and under what conditions?

Work has been proceeding well, on time and on budget with the results planned for publication in Spring 2019.

Full detail

The current situation

Malaria is decreasing globally. In the last 15 years, malaria deaths and cases have fallen by 60% with long-lasting insecticide-treated nets credited in studies for being responsible for 70% of this decline.

However, there are currently two significant challenges to achieving further reductions in malaria. First, there is not enough funding to ensure basic malaria control activities take place in all malaria-affected countries. Second, some mosquitoes are showing resistance to the insecticide that is used on long-lasting insecticide-treated nets (LLINs).

Darwin showed how species adapt to their environment and that is what some populations of mosquitoes are doing. It is not surprising, therefore, that some mosquitoes are showing insecticide resistance.

Although only a small proportion of all mosquitoes, estimated at <2%, show this resistance, we must act now to ensure the population of resistant mosquitoes does not spread and existing resistance levels are reversed.

Although LLINs can still be effective in acting as a physical barrier to prevent a malaria-carrying mosquito reaching a person sleeping underneath the net, we do not want to lose the very important element in malaria control - the ‘knock down’ (killing) of mosquitoes that occurs when they land on and walk on a net and pick up insecticide via their feet.

Defeating insecticide resistance: PBO Nets

A major tool in defeating insecticide resistance could be the PBO net. This is a standard LLIN that has a chemical ‘synergist’ called piperonyl butoxide (PBO) added to it. PBO, which is safe for humans, works by switching off the mosquitoes’ insecticide resistance mechanism leaving the net to have its normal knock down effect.

In recent years, the results from laboratory and small-scale hut trials indicated that the PBO net could be highly effective against insecticide resistant mosquitoes. There was widespread agreement in the scientific community that the PBO nets needed to be tried at scale. As PBO nets provide protection that is at least as good as that from standard LLINs, there is no ethical issue when considering the distribution of PBO nets at scale.

AMF agreed to back this view and funded 6 million PBO nets that were distributed in Uganda between March 2017 and March 2018, including in areas where levels of insecticide resistance had been recorded. All of these nets were funded by AMF donors to whom we had made the promise that 100% of their donations would fund nets. Two different types of PBO nets were funded from two different manufacturers.

Assessing the effectiveness of PBO nets

As this was the first time PBOs had been deployed at scale, AMF also funded a rigorous academic study to test their effectiveness compared to standard (‘non-PBO’) LLINs. Funding for the study was provided only by donors who were comfortable funding research.

The study has a clear aim to answer the following question:

Are PBO nets more effective at preventing malaria in areas where some mosquitoes have developed resistance to the insecticide used on the nets and if so, how much more effective and under what conditions?

The AMF-funded study is being led by the Liverpool School of Tropical Medicine (LSTM) who are working closely with the London School of Hygiene and Tropical Medicine (LSHTM), University of California San Francisco (UCSF) and researchers at the Infectious Diseases Research Collaboration (IDRC) in Kampala and at Makerere University, both of the latter in Uganda.

The study has been designed to provide results that are statistically significant. This has been achieved by having many study sites, 124 ‘clusters’, so that the study has statistical ‘power’, and by ensuring that clusters can be compared with the only relevant difference between them being whether they received standard LLINs or PBO nets. In this way, any differences in outcome can be linked to the net type.

The primary indicator being monitored in the study is malaria prevalence in children and this is being done using highly accurate testing methodologies. The effect of PBO nets on the mosquito population is also being studied. The study team carried out tests and collected data before nets were distributed, a baseline study, and has collected data in two further stages, at 6 months and 12 months post-distribution of the nets.

Work has been proceeding well, on time and on budget with the results planned for publication in Spring 2019. Another organisation has agreed to fund data collection at 18-months and a further study at 24-months may occur.

It is important to us that the study be open to all. During the planning and consultative phase, AMF shared widely the study protocol and received valuable input. All results will be published in full.

By understanding to what extent PBO nets can play a role in combatting insecticide resistance in mosquitoes, the ultimate value of this study is to help net funders, including health ministries, make informed decisions about the nets they purchase and distribute that will optimize malaria control.

Of note, a recent trial in Tanzania has reported positive results from a smaller scale deployment of PBO nets: malaria prevalence was less in areas using PBO nets than in control areas using standard nets. At 9 months after nets were distributed, malaria prevalence was 531 out of the 1,852 children tested (29%) compared to 767/1,809 (42%) in the control area; at 21 months 865/1,930 (45%) compared to 1,255/2,034 (62%). These are significant improvements.

We will keep our supporters up to date both with the results of the study and as we continue to explore innovations in the fight against malaria.


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