7th PAMCA (and 1st Virtual) Conference and Exhibition – 2021: Day 2

MESA Correspondents bring you cutting-edge coverage from the 1st Virtual and 7th PAMCA Conference & Exhibition 2021

Day 2: Tuesday, 21st September 2021 

Plenary Session 2: Challenges of vector control in the wake of COVID-19 pandemic in Africa: innovating new solutions for vector-borne disease elimination

Audrey Lenhart (Centers for Disease Control and Prevention – CDC, USA) challenged the idea of technological innovation as the main focus for malaria elimination and the need to explore new solutions after COVID-19. The challenges vector control programs faced during the pre-COVID-19 era were mainly limited funding, stagnation, limited vector control toolbox, how the agenda was run by external funders, and the rampant widespread of insecticide resistance. During the pandemic, various research projects were delayed or paused and countries faced competing public health priorities with extra demand on already stressed systems. Overall, countries tried not to lose the gains achieved in vector control before the pandemic. Lenhart shared how we can reimagine vector control surveillance in the post COVID-19 era by innovations and new areas.  These areas are innovation in engagement by strengthening connections between countries and regional networks to exchange expertise and knowledge. There should also be innovation in research practices that tackle inequality faced by African scientists and acknowledge the imbalance in power dynamics between external and local institutions. She then spoke of innovations in partnerships that broaden the scope of which expertise is most valued, innovations that remove the dichotomy between international and local organizations or lead versus local organizations and innovations that increase investment in non-western organizations. This would then form a platform where structural and institutional innovations can take place empowering and recognising non-western institutions and experts as leaders. Consequently, they would become direct recipients of funding for training and equipping institutions in endemic areas. She acknowledged how corruption needed to be mitigated and not be used as an excuse to not fund institutions. Finally, resilient innovations are necessary to create strong local leadership, cultivate expertise and alleviate poverty. Lenhart concluded with how technological innovations are important but not sufficient to achieve malaria elimination.

Symposium Session 2:

Parallel symposium 3 – Data Sharing in the African Context – Opportunities to Reshape the Conversation

This session was moderated by Elijah Juma (Programme Manager, PAMCA). He gave a brief overview of the session as activities and opportunities in data sharing on the African continent.

The first speaker, Duncan Athinya (Vestergaad, Kenya),  talked on the topic “Africa-led entomological aggregation and visualization efforts and advances in entomological sharing: are we making progress”. He explained how strategic information can impact the ‘high burden to high impact strategy’ of the WHO and the relevance of quality entomological data in malaria control, using the Insecticide Resistance (IR) Mapper.  Duncan identified IR as a major threat to malaria vector control. Hence, the need for the IR Mapper, an African-led initiative that aggregates and visualizes insecticide resistance data to aid planning and implementation of insecticidal vector control approaches. The platform can be used to identify IR data gaps and strategically use quality data to help countries deploy the most effective control tools and predict risks and spread of diseases.

The second speaker, Samuel Rund (University of Notre Dame, USA) talked about the collection and public dissemination of US mosquito surveillance data. He highlighted the large number of institutions involved in mosquito surveillance and the way they collect and disseminate data. Using the National Association of County and City Health Officials (NACCHO) study as an example, he described how needs assessment for core competencies was carried out in the United States (US) as a way of filling the gap in the quality of data generated. He hinted that data is made available through diverse methods including annual reports, datasheets, weekly trap results, statewide reports, vector surveillance maps and charts, among others. Rund concluded by pointing out some open data sharing concerns.

Jane Wyngaard (University of Cape Town, South Africa) talked about the value of open scientific data. Her talk hinged on examples of the value of open data sharing and technical challenges to open data sharing. She used examples of several projects which help in the correct forecast of natural disasters, drought and issues relating to wetlands. Also highlighted were technology, standards, regulatory and ethical requirements, data practices and infrastructure, as the main challenges to open data sharing. Wyngaard suggested solutions to these challenges as, making data findable, accessible, interoperable and reusable (FAIR); digitized and automated, with the requisite community collaboration.

Louise Bezuidenhout (University of Cape Town, South Africa) spoke on hidden challenges to openness in African research. She discussed effective data sharing in the context of support from the environment, motivations of individual researchers and characteristics of the data. Bezuidenhout pointed out that underreporting of Low/Middle-Income countries (LMICs) in Open Data (OD) discussions and use of binaries when distinguishing LMICs from high-income countries (HICs), are reasons for the unfavourable scientific research environment in LMICs. Ways of addressing binaries, motivations, concerns in sharing data and practices, were pointed out as building trust and facilitating openness through proper networking.

Scientific Sessions:

Parallel session 4: LLINS, IRS and Insecticide Resistance Management

Fotso Toguem Yvan Gaétan (University of Yaounde 1, Cameroon) presented “Polymorphism analysis of CYP6M2, a main metabolic resistance gene in Anopheles gambiae from Yaoundé, Cameroon.” Malaria incidence is still high in Cameroon, accounting for 3,263 deaths in health facilities, with 68.7% deaths occurring in children under 5. There has been an equally rapid evolution of insecticide resistance which has extended to all classes of insecticides in Cameron. Nonetheless, the role of allelic variation and information on polymorphism is lacking. Thus this study assessed the genetic diversity of the enzyme CYP6M2, to detect potential resistance markers of resistance, in An. gambiae. Bioassays were used to assess the resistance profile of both field and lab-bred hybrid An. gambiae while cone assays were used to assess bed net efficacy. Results showed higher resistance to DDT, permethrin and deltamethrin. There was partial recovery (~46%) after exposure suggesting the implication of P450s genes. There was a loss of efficacy (<20%) against Olyset® Net compared to Olyset Plus ® Net (>80%); which was attributed to insecticide selection pressure due to the massive use of LLINs and selection of resistance from breeding sites due to agricultural pesticide use. Finally, CYP6P4, CYP6Z2 and CYP6M2 were significantly upregulated in wild An. gambiae. CYP6M2 was found to be upregulated up to 8.3 folds in the wild and 12 folds in hybrid F4 generation.

Delia Doreen Djuicy (Centre for Research in Infectious Diseases – CRID, Cameroon) presented on “CYP6P9-Driven Signatures of Selective Sweep of Metabolic Resistance to Pyrethroids in the Malaria Vector Anopheles funestus Reveal Contemporary Barriers to Gene Flow.”  Pyrethroid resistance in An. funestus is a major constraint to malaria control in Africa, with a rapid expansion rate across southern Africa, and its main mechanism being: P450-based metabolic resistance (CYP6P9 genes). This study was to determine whether the resistance mechanism is confined to this part of the continent or whether it faces some barriers preventing its spread into other countries. Researchers tracked contemporary gene flow in An. funestus mosquitoes in 9  locations across 7 countries covering southern and east-central Africa. Preliminary results showed 45 haplotypes of the CYP6P9a gene were found to be guttered into 3 groups across the study locations: Group A was made up of samples from Mozambique, Malawi, Zambia and Tanzania; Group B from the Democratic Republic of the Congo (DRC) and Cameroon; and Group C from Uganda.  Further genetic diversity analyses of CYP6P9a gene showed low polymorphism, low haplotype and low nucleotide diversity in the mosquito population sampled from southern Africa. There was a strong selection at CYP6P9a particularly in the coding region (1^st exon); a clear geographic divergence between southern Africa (Mozambique, Malawi, Zambia and Tanzania) and eastern-central Africa (Uganda, DRC, and Cameroon); and only a single major haplotype (freq. = 118): from southern Africa were found to form a defined clade from east-central populations dominated by this nucleotide from southern Africa. They concluded that there was very low genetic differentiation but high gene flow within southern Africa, which is contrary to what is observed globally.

Amélie N.R. Wamba (University of Yaounde 1, Cameroon) presented “The Cytochrome P450 CYP325A is a major driver of pyrethroid resistance in the major malaria vector Anopheles funestus in Central Africa.” There are no target-site linked to pyrethroid resistance in Anopheles funestus. Although it is known that metabolic resistance is the main mechanism that involves major detoxification enzymes especially cytochrome P450. CYP325A is one of the overexpressed P450s in central Africa. Thus, the need to understand how this biochemical resistance is acquired and spread in the field. The process involved characterization and implication of CYP325A; In silico prediction of homology modeling then in vitro validation sub-cloned into pCW and co-expressed with CPR in E.coli. Data analyses were made using polymorphism analysis PoolSeq readings from pooled population data aligned to the An. funestus chromosomal assembly, and gene ontology and transcript detection and amino acid sequence characterization. Results on the susceptibility profile of An. funestus mosquitoes to insecticide showed that there is high resistance to pyrethroids (permethrin and deltamethrin) in Mibellon, Cameroon. Piperonyl butoxide (PBO) synergist assays pointed to the major role of P450 in pyrethroid-based resistance in Cameroon. It was concluded that CYP325A is present in all resistant species of An. funestus from Cameroon.

Parallel session 5: LLINS, IRS and Insecticide Resistance Management

Duncan Kobia Athinya (Vestergaard Frandsen Limited, Kenya) began his talk by introducing his study which aimed at understanding the long-term efficacy of PermaNet®3.0,  pyrethroid-based piperonyl butoxide (PBO) long lasting-insecticide net (LLIN). Pyrethroid-PBO is now becoming the new standard of care in countries where confirmed or conferred pyrethroid resistance has been detected in mosquito vectors. This is because pyrethroid-PBO nets have been demonstrated to be more effective than the conventional non-PBO LLINs. However, due to the physicochemical properties of PBO, little information exists on the long-term durability and efficacy of PBO LLINs. He highlighted studies they performed on PBO nets collected from Nigeria, Sudan, Ethiopia, Uganda and Bioko (Equatorial Guinea). The team conducted chemical content analyses and bioefficacy tests according to WHO standards. The results were thereafter compared to those obtained from three former World Health Organization Pesticide Evaluation Scheme (WHOPES) Phase III countries; Ghana, Kenya and India. They found that the durability of the PermaNet®3.0 varies, as it is dependent on usage and environmental conditions. Chemical analyses showed that post-market surveillance data fell within WHOPES Phase III observed ranges, whilst bioefficacy results revealed that used PermaNet®3.0 nets were more efficacious than new ones. Lastly, PBO was detected on all PermaNet®3.0 samples consistent with the expected useful life of three years. Athinya concluded with an appeal to expand the current WHO guidelines to include testing with well characterised pyrethroid-resistant strains as well as post-market surveillance. This is in addition to routine, long-term monitoring of PBO nets in order to better understand their efficacy.

Thomas Syme (London School of Hygiene and Tropical Medicine – LSHTM, UK) began his talk by explaining that pyrethroid-PBO nets are a new class of insecticide treated net (ITN) that have demonstrated improved vector control. Syme went on to explain that most households combine ITN and indoor residual spraying (IRS) to prevent malaria transmission thus the combined use of PBO ITNs and IRS is an operational possibility. The aim of the study was to assess whether pyrethroid-PBO nets would reduce the efficacy of IRS when used in combination. To test this hypothesis, Syme used a pyrethroid ITN and two different pyrethroid-PBO nets in IRS applied households. The results obtained from these experiments demonstrated that the toxicity of IRS was more reduced in pyrethroid-PBO nets but not with the pyrethroid nets. Syme thus recommended the combined use of ITNs and IRS as this increases protection against blood-feeding mosquitoes. As the study was conducted on a small scale, the epidemiological impact is uncertain and much work needs to be done to better understand this as it may influence decision-making strategies. He concluded his talk by stating that the purpose of his presentation is not to discourage the combined use of ITNs and IRS but there are circumstances where it is suboptimal and these factors must be put into consideration when implementing vector control measures.

Barnabas Zogo (Sumitomo Chemical, UK) started with an overview of insecticide resistance in Africa, pointing out its increasing usage. It is based on this that Sumitomo Chemical formulated the SumiShield 50WG (clothianidin-based insecticide) for malaria vector control through indoor residual spraying (IRS). He explained that the product, which was prequalified by the World Health Organization (WHO) in 2017, has been tested extensively in about 13 African countries, with good results. In this study, they carried out tests using susceptible and resistant malaria vectors, comparing the novel product to other pyrethroid-based products that are also used for IRS. The results show that, unlike pyrethroid-based insecticides, SumiShield 50WG treated surfaces allowed for significantly longer contact time, thereby reducing the chances of development of resistance. This is in addition to its excellent durability and killing effect. Zogo concluded by stressing that SumiShield 50WG is a valuable tool for use alongside other vector control interventions.

Borel Djiappi Tchamen (University of Dschang, Cameroon) gave an overview of arboviruses and their vectors, narrowing it down to the situation in Cameroon. He pointed out that vector control, an effective measure against arbovirus transmission, is threatened by an increase in insecticide resistance. Hence, the aim of the study was to understand the molecular mechanisms mediating insecticide resistance in Ae. Aegypti and Ae. Albopictus populations found in Yaoundé, Douala and Dschang. Through larval sampling, immature stages of the mosquitoes were collected and reared to adults. Adults were morphologically identified, subjected to insecticide resistance bioassays and molecular analyses for kdr and metabolic resistance.  Findings revealed that genetic mutations and metabolic based mechanisms were associated with insecticide resistance in the Aedes populations, though the mosquitoes were still susceptible to some insecticides. Tchamen concluded with an urgent call to control arbovirus vectors so as to forestall outbreaks of arboviruses.

Parallel session 6: Larval source management, IVM, Global Health, and public engagement

Doumbe Belisse Patricia (University of Yaounde, Cameroon) started her talk on “Assessing malaria transmission and vector dynamics in a context of larviciding trial in the city of Yaoundé, Cameroon” with an overview of the situation of malaria in urban areas. Although the consensus is that urban areas reduce malaria transmission this has not generally been the case. Unplanned urbanization and agricultural urbanization create breeding sites and malaria cases are on the rise. Therefore, the aim of the project was to assess the impact of larvicide on mosquito density, malaria transmission and parasite prevalence. The trial was conducted in 26 study sites in the city. Most of the sites were crossed by a river or surrounded by swamps. Pre intervention and post intervention lasted from 2017 to 2020. Larvicide intervention achieved a rate reduction of 53.3% in anopheline mosquitoes with no impact on species composition. There was a steady decrease in mosquito density measured by CDC traps and human landing catches. Entomological inoculation rate was very high before intervention (90 infective bites per month per year) and was reduced by 79% after the intervention. Malaria prevalence experienced a decrease in the second and third years after the intervention compared to the control, however,  this difference was not significant. This trial presented evidence of high efficacy of larviciding in reducing adult population numbers and malaria transmission, therefore this tool can be used to control vector population in urban areas as part of an integrated control approach.

Mark Lwakatare (FHI 360, USA) started his talk on “Achieving improvements in malaria behaviours and behavioural determinants through integrated social and behaviour change activities in Tanzania Mainland” by explaining that this program was offering support to the Government of Tanzania towards social and behavioral changes and programming in behavior change. The  USAID Tulonge Afya project is implemented using two platforms: Naweza and FHI 360, categorized according to age and cohorts of the beneficiaries. Lwakatare emphasized that the USAID Tulonge Afya project under the Naweza platform focuses on the pregnancy and birth behaviors in women, which involves different health changes including malaria. It also focuses on caregiving and parenting of children up to five years of age, with a concentration on sleeping under insecticide treated nets and seeking care at health facilities. Therefore, Lwakatare’s team focused on national and community level media like public announcements and cultural theatre performances. He reported that the USAID Tulonge Afya project has been successful, with an increase in knowledge on risks of malaria during pregnancy, an improved attitude of women towards insecticide treated mosquitoes and IPTP usage during pregnancy. Thus, Lwakatare highlighted that the project illuminated the importance of resonance and integration in addressing people related issues.

Sandra Ngadjeu (University of Yaoundé, Cameroon) started the talk on “Perceptions and practices of communities during a larviciding trial in the city of Yaounde, Cameroon” by highlighting that malaria still remains a major public health problem in Cameroon. She however explained that anti larval control measures were used to reduce the vector densities and transmission of malaria. She stated that one of the control measures that has been instrumental in Cameroon is the free distribution of mosquito nets. However, the knowledge and perception of malaria among the larval control population are expected to either increase or reduce. From her study, she found out that the knowledge of mosquito breeding sites increased in the intervention areas with larviciding treatment than in the control areas. Furthermore, Long Lasting Insecticidal Nets (LLINs) were the main methods used to fight mosquitoes, through regular usage of the LLINs decreased in the non-intervention and intervention areas with time. Moreover, people in the treated sites also have good knowledge of malaria transmission. Finally, Ngadjeu concluded that the high knowledge of people in the treated areas was due to adequate knowledge on malaria symptoms and mosquito breeding sites in treated areas as compared to the control sites.

Symposium Session 3:

Parallel symposium 5: Using entomological surveillance data and programmatic tools for evidence-based planning and selection of vector control interventions

The session was moderated by Sheila Ogoma (Ifakara Health Institute, Tanzania). She introduced the speakers and invited them to present.

Elodie Vadja (University of San Francisco, USA) introduced the Entomological Surveillance Planning Tool (ESPT) as a decision-support tool designed to empower local programmes and institutions to formulate priority programme questions. It also enables programmes to utilize available capacity and funding to formulate an achievable, adaptable and sustainable surveillance framework. Vadja stressed how driving entomological surveillance optimises use of funds, capacity and data towards evidence-based decision-making. She showed an example of how the tool can enable decision-makers to identify human-vector contact points that are not targeted by current interventions (gaps in protection). Vadja concluded that LLINs are appropriate and effective intervention but are not sufficient as sole intervention and should be complemented with other interventions that could address some gaps in protection such as outdoor biting.

Charles Ntege (National Malaria Control Division – Ministry of Health – NMCD-MOH, and Malaria Consortium, Uganda) presented on the use of entomological surveillance data to inform vector control decisions in Uganda. Entomological data has been used in Uganda to enhance community participation in vector control, to help in deployment of LLINs for insecticide resistance management, and to guide in the rotation of indoor residual spraying (IRS) chemicals. Currently, the insecticide resistance data shows that there is moderate resistance in An. gambie due to partial or full involvement of mixed functional oxidates. Ntege reported that the delivery of Malaria control interventions in this project was based on entomological data. Some of these interventions included decision making on the net types to use, the geographical distribution of nets, and net funding. Thus, he emphasized the use of entomological data in malaria control decision making.

Stark Katokele (Ministry of Health and Social Services, Namibia) highlighted the components of good quality entomological data for making data-driven decisions which include the right interventions as well as the management and sustainability of limited resources. According to him, the endemicity of malaria did not improve in the country, despite decades of using dichlorodiphenyltrichloroethane (DDT) and deltamethrin in IRS. Hence, insecticide resistance monitoring and vector surveillance were carried out between 2018 and 2020. Results show very little indoor biting and resting activities. Pyrethroid resistance moved from suspected resistance in 2018 to resistance across all districts in 2020, while the mosquitoes were susceptible to Actellic. Residual efficacy tests also showed effectiveness of Actellic on metallic surfaces. Stark concluded his talk by sharing the successes of how the National Malaria Control Programme had to switch to Actellic for IRS and from standard pyrethroid-only nets to Piperonyl Butoxide (PBO) nets.

Bernard Kouassi (PMI VectorLink, Ivory Coast) talked about the standard entomological data collection methods they deployed across well-selected entomological monitoring sites in the country. From his results, there was pyrethroid resistance across all sites, while insecticides (chlorfenapyr, pirimiphos-methyl and clothianidin) from other classes revealed that the local population of mosquitoes were either susceptible, suspected resistant or outright resistant from one district to the other. Biting and infectivity rates were also found to be high in several sites, leading to relatively high entomological inoculation rates. Based on these findings, there was stratification of Insecticide Treated Nets (ITNs) in the 2020 mass campaign. Piperonyl Butoxide (PBO) nets were distributed to districts where the mosquitoes showed susceptibility to it, while Interceptor G2 (IG2) nets were distributed to districts where chlorfenapyr susceptibility was recorded. The same evidence-based decision-making methods were applied to sites chosen for IRS.

Tom Burkot (Institute of Tropical Health and Medicine, Australia) presented the findings of a global analysis of the capacity of the National Malaria Control Programme (NMCP) to implement vector surveillance and control, a research that was conducted together with Tanya Russel. The study was conducted in 35 countries: 18 from Africa, 14 from Asia-Pacific, and 3 from the Americas. The findings revealed that capacity for vector surveillance, ITN, IRS  and larval source management was insufficient in most of the countries. Burkot pointed out that the huge limitations in the capacity to implement activities are due to inadequate governance, funding, human resources, information systems, logistics and infrastructure. He emphasized that governance and human resources were by far the greatest limitations. Acknowledging that insecticide resistance monitoring and laboratory analyses are strengths in Africa, Burkot suggested that using data collected for decision-making, adequate training for available human resources and tracking progress in vector surveillance will improve the capacity for National Malaria Control Programmes to implement vector surveillance and control.

Roundtable discussion: A conversation between funders and implementers of malaria control and elimination in Africa

This discussion was hosted by Silas Majambere (Pan African Mosquito Control Association – PAMCA, Kenya) and Ghislaine Aquedeogo-Ametchie (Pan African Mosquito Association – PAMCA, Ivory Coast). The funders were represented by Helen Jamet (Bill and Melinda Gates Foundation – BMGF, USA) and Rick Steketee (President’s Malaria Initiative – PMI, USA). The implementers were represented by Aimable Mbituyumuremy (National Malaria Control Programme – NMCP, Rwanda), Perpetua Uhomoibhi (National Malaria Elimination Programme – NMCP, Nigeria) and Yacine Djimbo (Speak Up Africa, Senegal). The discussion covered three topics: 1. The role of the funders and implementers in malaria control. 2. How funders and implementers each set their agendas. 3. How the funders and implementers set their priorities.

Q) How do funders and implementers set their priorities?

Funders set their agenda based on the strategies of funding organizations. They evaluate the success of existing programs to determine the continuation of support. Implementers on the other hand try to align their strategies to global and national strategies based on epidemiological and ecological data and funding availability. Thereon existing and new programs are assessed to determine how community health systems are supported.

Q) Silas Majambere took the chance to bring on the table and ask the speakers a concerning point that arose during the previous plenary session by Audrey Lenhart on the friction that can arise between local implementers and funders resulting from different priorities and/or implementation strategies. How do funders and implementers deal with these situations when they arise? 

It is complicated but funders acknowledge the power imbalance and disproportionate allocation of funds particularly in northern countries. Funders are accountable to their local authorities and it is in their best interest to fund global strategies which may not align with a recipient country’s strategies. There is a need for funders to align their strategies to local strategies.

Q) Is there an equitable relationship between funders and implementers?

There is no equitable relationship and striking a balance between both parties is a challenge, however, “funders are committed to changing the power imbalance”. It is imperative that host countries are given more leeway in decision-making strategies so as not to always align their decisions with those of the funders.

Q) Are there any problems with directly funding local organisations? 

Funders need help in identifying local organisations that are transparent in their management of resources. Unfortunately, some local organisations lack the expertise and experience. There is therefore a need to build capacity and technology transfer in organisations that lack experience in managing resources. Partnerships at national levels are required and the phenomenon is not malaria specific.

Q) When does the decision from a country supersede the funder’s decision? Do funders feel like they have the responsibility to pull out in such a scenario especially if the country’s vision does not align with theirs? 

Donors decisions are data driven and are trying to meet country specific needs. It is difficult for them to fund novel tools that are not WHO recommended unless the new tools demonstrate to work better than the current ones. It is a trade off and public safety becomes a priority.

Symposium Session 2:

Parallel symposium 4 – PAMCA WIVC professional development

Emma Orefuwa (Pan-African Mosquito Control Association – PAMCA) started the session with an overview of the PAMCA Women in Vector Control (WIVC) program whose vision is an Africa free of vector-borne diseases and a mission to empower women by creating an enabling environment to enact a paradigm shift. She underlined the fact that out of 394 medical entomologists in Africa, only 28% are women (UNESCO, 2015) and the complexity of global health problems demands leadership that is representative of the pluralism of our society. To increase the representation of women in vector control, priority areas for the WIVC program are mentorship, capacity building, networking, gender policy advocacy and non-professional empowerment.

Helen Jamet (Bill Melinda Gates Foundation – BMGF, USA) shared her experience as a woman working in vector control in different fields such as industry with Vestergaard and now with the BMGF. During her work experience, she worked usually under the leadership of men. In addition, having a baby made it difficult to enroll for an MBA like others in the field. Consequently, she had to learn on the job and was able to have much lateral growth. However, it wasn’t easy to grow up the promotional ladder which was frustrating and dispiriting sometimes. She had to persevere and was fortunate to have someone in leadership who believed in her, as well as a very supportive partner. Jamet believes it is important to know your worth, build self-confidence, help others grow professionally and establish dialogue to identify any issues team members may have and help them build capacity by delegating. Fostering a safe space in the workplace can be done internally and externally through the Human Resource by creating a support system to detect predatory behaviours.

Prosper Chaki (Pan African Mosquito Control Association – PAMCA) used his experience to talk about three things he believed when available in the workspace will not only help bridge the gender gap but also help develop women. First, having strong supervision, which challenges both genders in the workspace to improve and be equally competent, so opportunities and roles could be rightly distributed. Secondly, having team members who are very cooperative in the work done. Thirdly, having a mix of men and women in the workspace helps the team to see things from different perspectives and get a broader and objective picture of goals and targets to be achieved. He affirmed that having a number of women, who encouraged him, in his workspace during his early career contributed greatly to his ability to believe in himself and push forward to where he is now. Chaki concluded that the major constraint to the gender equity/equality gap is the feeling of not being valued and not being heard, which is mostly among women. Thus, the challenge is for us all, men especially, to ensure that whenever we find women who demonstrate management and leadership abilities, we should give them leading roles. So that other women will use those that they see as springboards to overcome their fears.

Pamela Mbabazi (World Health Organization – WHO,  Africa) pointed out that in her career experience, she has been working and interacting with pregnant women and nursing mothers. She argued that vaccinations are not the only solution to reducing child mortality, since there were cases of children contracting malaria and other vector-borne diseases. Thus, she emphasized the need for an integrated intervention approach in health care. Further, she reiterated that the burden of children suffering from malaria and other vector diseases was her drive in her career. Mbabazi highlighted that there were fewer women up the career ladder in her sector, thus, there is a need to empower women in vector control, since the challenges cut across all cultural situations and usually involve striking a balance between life and work, especially among African women. Mbabazi stressed the importance of being professionally inclusive in the workplace by creating a safe workplace for women. Where a safe place is defined as an articulated and defined area that identifies and punishes inappropriate behaviors. In conclusion, she advised women to comprehend their vulnerabilities and to create a plan to mitigate and/or eliminate them.

This report is brought to you by the MESA Correspondents Stella Riunguh, Amelie Wamba, Eggrey Aisha Kambewa, Mauro Pazmino Betancourth, Udoka Nwangwu, Thoan Ho Dac, Faith Hungwe and Jackson Nyarko. Senior editorial support has been facilitated by Charles Quaye (Noguchi Memorial Institute for Medical Research, Ghana). It is cross-posted on the MESA website and on MalariaWorld.