September 2017

This publication was produced for review by the United States Agency for International Development. It was prepared

by the Uganda IRS Project Phase II, Abt Associates, Inc.

UGANDA INDOOR RESIDUAL SPRAYING

PROJECT PHASE II

END OF SPRAY REPORT May 2 – August 19, 2017

Contract No. AID-617-C-12—00004

i

Recommended Citation: Uganda Indoor Residual Spraying (IRS) Project Phase II, End of Spray Report

August, 2017 Uganda Indoor Residual Spraying Project Phase II, Abt Associates Inc.

Contract/Project No.: AID-617-C-12-00004

Submitted to: Mr. Joel Kisubi, Contracting Officer’s Representative

United States Agency for International Development

Kampala/Uganda

Abt Associates 4550 Montgomery Avenue, Suite 800 North Bethesda,

Maryland 20814 Tel: 301.347.5000. Fax:

301.913.9061www.abtassociates.com

Abt Associates Uganda IRS Project

P.O.Box 37443 / Plot 86 Luthuli Avenue Kampala, Uganda.

Tel: 256 (0).414.251.300

Abt Associates Uganda IRS Project, Tororo Plot 20, Masaba Road,

Tororo, Uganda. Tel: 256 (0).392.177.264

Cover: A beneficiary provides water to a spray operator in Agwingiri sub county, Amolatar District

DISCLAIMER

The author’s views expressed in this publication do not necessarily reflect the views of the United States

Agency for International Development or the United States Government

UGANDA INDOOR RESIDUAL SPRAYING (IRS) PROJECT PHASE II

END OF SPRAY REPORT

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ACRONYMS

Abt Abt Associates Inc.

CDFU Communication for Development Foundation Uganda

CO Contracting Officer

DEO District Environment Officer

DFID-UK Department for International Development–United Kingdom

DHT District Health Team

DSO District Supplies Officer

FC Field Coordinator

HC Health Center

HIV/AIDS Human Immunodeficiency Virus and Acquired Immune Deficiency Syndrome

IPC Interpersonal Communication

IRS Indoor Residual Spraying

LC Local Council

LLINs Long-lasting Insecticide Treated Nets

M&E Monitoring and Evaluation

MoH Ministry of Health

NMCP National Malaria Control Program

PMI President’s Malaria Initiative

PSCs Pyrethrum Spray Catches

SBCC Social Behavior Change Communication

SK Store Keeper

SMs Store Managers

SMS Short Messaging System

SO Spray Operator

USAID United States Agency for International Development

WHO World Health Organization

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TABLE OF CONTENTS

Acronyms ...................................................................................................................................................... ii

Table of Contents ......................................................................................................................................... iii

Executive Summary ...................................................................................................................................... 1

1.0 Background ............................................................................................................................................. 2

2.0 Key Spray Round Activities ................................................................................................................... 2

2.1 Logistics .......................................................................................................................................... 3

2.2 Monitoring and Evaluation Activities ............................................................................................. 4

2.3 Social Behavior Change Communication Activities ...................................................................... 5

3.0 Summary of Results and Data Analysis .................................................................................................. 5

ANNEX 1: Spray data tables from group A and group B districts ............................................................. 10

1

Executive Summary

This end of spray report covers the May 2 – August 19, 2017 spray round of the Uganda Indoor Residual

Spraying (IRS) Project - Phase II. This last spray round of this project covered all 14 districts: including:

the group B districts of Alebtong, Amolatar, Budaka, Butaleja, Dokolo, Namutumba and Pallisa, (May 2

– June 6, 2017), followed by the group A districts of Bugiri, Kaberamaido, Kibuku, Lira, Otuke, Serere

and Tororo (July 17 – August 19, 2017). All districts were sprayed with pirimiphos-methyl (Actellic 300

CS), a broad spectrum organophosphate. The three districts of Alebtong, Amolatar and Budaka were

sprayed with Actellic for the first time, since previously they were sprayed with Bendiocarb. Spraying in

Alebtong, Amolatar, Dokolo, Kaberamaido and Otuke is funded by Department for International

Development, United Kingdom (DFID-UK), while spraying in the remaining nine districts is funded by

the United States Agency for International Development/President’s Malaria Initiative (USAID/PMI).

In spite of the stiff resistance in some target districts like Lira, Kaberamaido and Tororo, the project’s

efforts in collaboration with the district and sub-county stakeholders helped attain high overall coverage

of 95.2 percent in the 14 districts. The project sprayed 1,225,644 (95.2 percent) of the 1,287,697 houses

found in the 14 districts, and protected 4,227,236 (97.2 percent) people out of the total population found

(4,350,514). The protected population included 846,448 (19.5 percent) children under five and 103,504

(2.4 percent) pregnant women (Table 1).

This high coverage is the result of extensive efforts made by the project, the district leadership and the

Ministry of Health (MoH) officials to mobilize the communities for IRS. Throughout the entire spray

campaign, especially in the resistant communities, the project in partnership with the village, sub-county

and district leaders focused on interpersonal communication (IPC). The project also conducted

community dialogues in the resistant communities. The project’s social behavior change communication

(SBCC) activities also focused on disseminating integrated malaria prevention and control messages and

emphasized the importance of adopting these measures to augment and sustain the benefits of IRS. The

project conducted all routine entomological monitoring activities including bionomic studies, pre- and

post-IRS pyrethrum spray catches (PSCs), monthly wall bio assays and routine surveillance in the six

pervious project IRS districts. Some of the details regarding entomological monitoring activities are

included in the April-June 2017 quarterly report and the monthly entomological reports for July and

August 2017.

The project’s Monitoring and Evaluation (M&E) team in partnership with the District Biostatisticians,

conducted technical supervision to ensure correct data capture, entry, validation and reporting. The store

keepers (SKs) at all parish stores used mobile phones to report via short messaging system (SMS), the

daily spray data to the field coordinators (FCs). This real time daily reporting enabled continuous

monitoring of progress and informed decision-making to improve spray performance.

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1.0 Background

The primary objective of the five-year Uganda IRS Project Phase II is to achieve the PMI Uganda targets

in IRS. In particular, the project contributes to USAID/Uganda’s Development Objective 3, a

comprehensive effort to improve outcomes in health, HIV/AIDS and education in Uganda through the

following project objectives: high quality, safe and effective IRS program implemented; national capacity

to conduct IRS developed, and comprehensive M&E of the IRS program performed.

Abt Associates, Inc, (Abt) as the prime contractor, manages and directs all technical component activities

in support of IRS planning, procurement, implementation, monitoring, and capacity building. The project

is supported through two subcontractors: Communication for Development Foundation Uganda (CDFU)

and EnCompass, LLC. CDFU provides expertise and support for SBCC activities, while EnCompass

collaborates with project staff, MoH and National Malaria Control Program (NMCP) counterparts to

develop and upgrade IRS training materials and training capacity.

2.0 Key Spray Round Activities

District level consultations/sensitization and micro-planning

In preparation for the spray round, the project’s field team in collaboration with MoH/NMCP conducted

courtesy visits in all the 14 districts to inform the district stakeholders about the upcoming spray round.

These visits were also an opportunity to discuss with the district leadership the challenges and successes

of the previous spray round, identify gaps and plan for the upcoming spray round. The project team also

emphasized the importance of district buy-in and support for spraying to ensure IRS compliance in the

target communities.

The project field teams together with the District Health Team (DHT) members also conducted micro-

planning meetings with the sub-county leaders of all the 14 districts to share the IRS schedule and solicit

their support for IRS activities. During micro-planning, the team also confirmed the availability of sub-

county supervisors and parish SKs who worked in the previous spray round and confirmed the availability

of previously used parish stores.

Recruitment, verification and training of the spray teams

The project, in collaboration with the DHT and sub-county leaders confirmed the availability of previous

spray team members and assessed their medical fitness to be part of the upcoming spray round. The

project also recruited new spray team members to replace those who dropped out or were unavailable, as

well as one parish mobilizer for each parish store to lead the daily community mobilization activities at

the village level ahead of the spray team.

The project recruited 3,940 spray team members (37.1

percent female, 62.9 percent male) including sub-county

supervisors, SKs, spray operators (SOs), parish store

mobilisers, village data validators and wash persons. 58.8

percent of the recruited members had previously worked

as spray team members, while the remaining 41.2 percent

were new recruits.

From April 3–21, 2017, the project conducted recruitment

for the group B districts, followed by that for the group A

districts from June 26–July 7, 2017. The project

conducted the recruitment of spray teams, concurrently

with the sensitization of sub-county and local council one

(LCI) leaders.

Trained sub-county supervisors and parish SKs conducted the training of the spray team members, at their

respective sub-county headquarters. Project staff together with the DHT members, MoH officials and IRS

A female youth spray operator in Amolatar

district

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focal persons from six previous IRS districts, supervised these five-day trainings. The trainings

emphasized the different aspects of IRS operations, including: spray techniques to ensure safe and high

quality spraying, environmental compliance, spray pump maintenance, logistics management, community

mobilization and data capture, and also reiterated the need to disseminate integrated SBCC messages on

malaria prevention and control.

The project subjected all recruited spray personnel to a medical examination conducted by the clinical

officers at their respective health facilities before they could engage in spraying. To ensure safety of the

spray team, the project screened all female spray team candidates for pregnancy during recruitment. The

project reassigned the six women who tested positive for pregnancy as mobilizers to ensure they are not

exposed to insecticide while still participating in spray activities. The project also provided sanitary pads

to all female spray team members to encourage their participation in spraying, increase their comfort and

minimize absenteeism.

Youth engagement and gender

The project has continued to be

committed to gender and youth

participation in IRS implementation,

and targeted women and youth

groups during recruitment. As a

result, in this spray round, the project

recorded an increase in proportion of women recruited (from 29.6 to 37.1 percent) as compared to the

previous April – July 2016 spray round. This is due to the project’s continuous engagement with district,

sub-county and village leaders about the need to encourage female and youth participation in the spray

program. In addition, the project also sensitized the church leaders and women groups to ensure women

and youth participation in IRS. For the first time, the project has tracked by gender, the number of youth

recruited to the spray teams. This data is extremely interesting and shows that in the youth age group (18-

24 years), the proportions of male and female participation in IRS are virtually equal and that if the

project wants to increase female participation, then it should be recruiting more youth.

2.1 Logistics

In preparation for the May-August 2017 spray round, the project’s logistics team in partnership with the

District Supplies Officers (DSOs), distributed logistics from district stores to all the parish stores. The

logistics team together with the trained SOs serviced 6,763 spray pumps. The store managers (SMs) and

the DSOs supervised the entire process of pump servicing, including identifying and replacing all

damaged pump parts. Prior to spraying each group, the SKs received and verified supplies from the

respective district stores and delivered them to the parish stores, using a check list to address any

shortcomings in the distribution process.

This spray round, the project procured 602,000 bottles of Actellic 300 CS, and used 557,834 bottles to

spray all 14 districts. During this spray round, the project experienced delays in procurement of

insecticide for the group A districts. This delay was due to the fact that Syngenta had overcommitted on

their production of the insecticide as well as changes in the transportation/shipment schedule of the

insecticide. These circumstances were beyond the project’s control, and the project requested approval of

the Contracting Officer (CO) to extend the spray period for the group A districts. The CO approved the

change in the spray period for these districts from June 26 – July 29 to July 17 – August 19, 2017.

Some insecticide cartons were damaged prior to delivery and returned to Arysta. Discussion was initiated

with Arysta concerning their removal or disposal. A report has been prepared and will be discussed at the

project monthly meeting in September 2017.

18 – 24 years 25 + years Overall

Female (%) Male (%) Female (%) Male (%) Total

402 (49.3) 414 (50.7) 1,195 (33.4) 2,382 (66.6) 4,393

18.6% 81.4%

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2.2 Monitoring and Evaluation Activities

Environmental compliance activities

From April 17-28, 2017 and July 1-10, 2017, the project’s environmental compliance team together with

the District Environment Officers (DEOs) carried out routine store and soak-pit assessments for group B

and A districts respectively. The primary purpose of this assessment was to confirm readiness of the soak

pits and parish stores for IRS logistics storage and to recommend the necessary repairs to meet WHO

recommended standards. The project continues to use live poles (stems that sprout into new plants) for the

construction of the soak-pits and bath shelters as a cost saving innovation, and saved the project expenses

that would have been otherwise incurred in refurbishing new soak-pits and bath shelters.

Given the gap of almost one year since spray activities were conducted in 11 districts, a large number of

soak-pits (397) required major repairs, while 62 soak pits needed to be relocated due to change in store

position. Details regarding environmental compliance activities are provided in the April-June 2017

quarterly report and in the July monthly report.

From April 27 – 28, 2017, the project trained 30 clinicians and 32 laboratory technicians from hospitals

and health center (HC) IIIs and IVs in eight districts of: Alebtong, Amolatar, Budaka, Butaleja,

Namutumba, Kaberamaido, Otuke and Pallisa. The project’s environmental compliance team together

with the MoH staff, conducted these meetings in Mbale for the eastern-region districts and in Lira for the

Lango districts. The training focused on equipping the participants with knowledge and skills to

effectively manage all cases of insecticide poisoning. Based on the initial assessment of availability of

Atropine Sulphate in all HC IIIs, IVs and hospitals, the environmental compliance team supplied the

health facilities with Atropine to supplement the balances from the previous supply. Atropine is used as

an antidote for managing cases of insecticide poisoning.

The National Drug Authority assessed and certified the suitability of two central stores and 14 district

stores for storing Actellic 300 CS and other IRS supplies and materials.

Upon completion of spraying in the seven group B project districts, the project’s environmental team in

collaboration with the DEOs from all the 14 districts closely tracked the inflow of the empty (Actellic 300

CS) bottles into the waste stores in Lira and Bugiri districts. Upon completion of spraying in all the 14

districts, the environmental compliance team collected and ensured that all empty Actellic bottles were

perforated to avoid reuse.

Quantification of IRS waste

During this spray round, the project’s environmental team sorted, quantified and disposed IRS waste in an

environmentally compliant manner. The environmental compliance team quantified and transported

11,081 kgs of incinerable waste to Green Label Services Limited, Iganga Wastes Management Facility for

incineration. The DEOs of Lira and Bugiri witnessed the loading and dispatch of the waste, while the

project’s environmental compliance team supervised the actual incineration process. The project collected

22,901 kgs of plastic waste this spray round from the 14 districts and transported it to Gentex plastic

recycling plant in Matugga, Wakiso District. This helped the project save 8,015,350 UGX that would

have otherwise been spent on incinerating this waste.

Following the assessment and sorting of the damaged gumboots in the waste stores, 174 pairs of

gumboots were identified to be in reusable condition and will be given to SKs whose performance has

been exemplary.

The project under the supervision of the Environmental Compliance Officer also delivered 28.8 tons of

cardboard to the Uganda Pulp and Paper Industries in Jinja for recycling. This process saved the project

space and funds (5,184,000 UGX), which would have been spent on disposal of this cardboard waste.

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Entomological monitoring activities

The project conducted all routine entomological monitoring activities including bionomic studies, pre-

and post-IRS PSCs, monthly wall bio assays and routine surveillance in the 14 current and six previous

IRS districts.

Details regarding entomological monitoring activities are included in the April – June 2017 quarterly

report and the July and August 2017 monthly entomological reports.

The project conducted a total of 336 pre- and post-IRS PSCs in the sentinel sites in the current 14 IRS

districts in northern and eastern Uganda. During the post-IRS PSCs, a total 70 indoor resting female

vectors were caught (70 Anopheles gambiae s.l. and 0 An. funestus), compared to 1,257 indoor resting

female vectors (1,217 Anopheles gambiae s.l. and 40 An. funestus) caught during the pre-IRS PSCs. The

results indicate that there was a dramatic decrease in the number of malaria vectors post-IRS in these

districts. However, despite the reduction in the number of indoor resting vector numbers, there is still

need for district authorities in all the IRS districts to encourage communities to use the recently

distributed long lasting insecticide treated nets correctly and consistently every night and to seek for

prompt and appropriate treatment for any fever.

Supervision of spray operations

The project’s M&E team together with the District Biostatisticians conducted technical support

supervision visits to the data entry centers of the 14 project districts. The technical supervision helped

monitor correct data entry, data validation and reporting. The project also used SMS to monitor the spray

round progress and make informed decisions to improve spray performance. The project’s M&E team

cleaned, analyzed and generated spray data from all the districts in a timely manner (refer to Table 1 and

Annex 1).

During the support supervision visits of spray activities, the project’s environmental compliance team,

FCs, SMs, MoH officials as well as the district IRS supervisors ensured that the spray teams complied

with the IRS-related environmental compliance guidelines including: proper and consistent use of

personal protective equipment by the spray teams, following the correct procedure for triple rinsing and

bathing at the end of the day before the spray team members return home.

2.3 Social Behavior Change Communication Activities

During this spray period, IRS resistance was high in many districts, in comparison to the previous spray

round where there were pockets of resistance primarily from the organic farmers in Dokolo and some

religious sects and traditional healers in Budaka. IPC and dissemination of integrated malaria prevention

and control messages to the community, continued to be the cornerstone of the project’s SBCC activities.

During the spraying of the group A districts, the project encountered significant resistance, especially in

Kaberamaido, Lira and Tororo. To combat this stiff resistance, the project briefly stopped the spraying to

solicit the support of the district and sub-county leaders and together with their help mobilized the

resistant communities, before resuming spraying. This helped raise the IRS compliance in these districts,

and even though all these districts started off with sub-optimal compliance, in the end the project was able

to attain 90 percent or above coverage in all these districts (refer to Table 1 and Annex 1). Apart from

door-to door mobilization, the project also held community dialogues in the 14 districts and used radio to

disseminate spray schedules, address the myths and misconceptions about IRS, and remind the

community to open their houses for spraying.

3.0 Summary of Results and Data Analysis

This spray round commenced on May 2 and ended on August 19, 2017. The project sprayed 1,225,644

houses (95.2 percent) of the 1,287,697 houses found in all the 14 districts. The average insecticide usage

rate in the 14 districts was 2.2 houses per bottle, with an average number of 8.6 houses sprayed per SO

per day. The project protected 4,227,236 (97.2 percent) people of the total population found (4,350,514).

6

The protected population included: 846,448 (19.5 percent) children under five and 103,504 (2.4 percent)

pregnant women (refer to Table 1 below).

This was the fourth round of spraying in Budaka, Bugiri, Butaleja, Kibuku, Namutumba, Pallisa and

Serere, while it was the fifth round for, Alebtong, Amolatar, Dokolo, Kaberamaido, Lira, Otuke and

Tororo.

In the group B districts that were sprayed from May 2 – June 6, the project attained an overall coverage of

97.4 percent, protecting 1,936,923 people (99.0 percent of the total population found). Of this, 385,469

(19.7 percent) were children under five, and 47,820 (2.4 percent) were pregnant women (refer to Table 1

in Annex 1). The project used a total of 255,928 bottles of Actellic, in group B districts, with an overall

insecticide usage rate of 2.2 houses sprayed per bottle.

In group A districts that were sprayed during July 17–August 19, the project attained an overall coverage

of 93.4 percent, protected 2,290,313 people (95.7 percent of the total population found). Of this, 460,979

(19.3 percent) were children under five, and 55,684 (2.3 percent) were pregnant women (refer to Table 2

in Annex 1). In the seven group A districts, the project used a total of 301,906 bottles of Actellic, with an

overall insecticide usage rate of 2.2 houses sprayed per bottle.

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TABLE 1: SUMMARY OF KEY IRS INDICATORS FOR 14GROUP A AND B DISTRICTS, MAY 2 – AUGUST 19, 2017

INDICATOR DISTRICTS

Total Alebtong Amolatar Budaka Butaleja Dokolo Namutumba Pallisa Bugiri Kaberamaido Kibuku Lira Otuke Serere Tororo

No. of districts sprayed 1 1 1 1 1 1 1 1 1 1 1 1 1 1 14

Targeted households 82,378 58,944 62,781 70,493 63,536 81,428 108,438 126,362 79,574 59,423 134,020 39,489 95,560 164,387 1,226,813

Total households found 91,760 61,447 62,211 73,326 69,702 93,415 119,347 131,815 84,118 62,465 134,561 40,653 103,038 159,839 1,287,697

Households fully sprayed 89,225 57,927 52,248 67,823 66,267 87,316 110,665 111,147 74,506 50,040 113,361 38,815 96,232 133,488 1,149,060

Households partly sprayed 942 942 7,149 3,956 1,789 5,690 4,664 10,612 2,508 8,987 7,761 506 2,836 18,242 76,584

Total households fully and partly sprayed

90,167 58,869 59,397 71,779 68,056 93,006 115,329 121,759 77,014 59,027 121,122 39,321 99,068 151,730 1,225,644

Households not sprayed 1,593 2,578 2,814 1,547 1,646 409 4,018 10,056 7,104 3,438 13,439 1,332 3,970 8,109 62,053

Percentage of households

partly or fully sprayed 98.3 95.8 95.5 97.9 97.6 99.6 96.6 92.4 91.6 94.5 90 96.7 96.1 94.9 95.2

Percentage of households

not sprayed at all 1.7 4.2 4.5 2.1 2.4 0.4 3.4 7.6 8.4 5.5 10 3.3 3.9 5.1 4.8

Targeted population (Based

on 2014 census) 210,530 153,144 243,091 256,463 173,466 297,735 367,278 428,345 219,543 207,698 402,316 102,810 291,744 568,466 3,922,629

Total population found 230,739 163,851 241,018 305,526 187,906 384,352 443,779 468,751 240,897 235,744 451,986 107,597 308,628 579,740 4,350,514

Female population protected 116,745 80,963 122,856 153,566 96,071 194,384 227,015 229,549 114,824 117,079 210,510 52,820 156,653 286,448 2,159,483

Male population protected 111,317 80,315 114,472 148,345 89,582 189,324 211,968 221,023 109,544 112,226 204,158 52,833 146,233 276,413 2,067,753

Total population protected 228,062 161,278 237,328 301,911 185,653 383,708 438,983 450,572 224,368 229,305 414,668 105,653 302,886 562,861 4,227,236

Total population not protected

2,677 2,573 3,690 3,615 2,253 644 4,796 18,179 16,529 6,439 37,318 1,944 5,742 16,879 123,278

Percentage of population

protected 98.8 98.4 98.5 98.8 98.8 99.8 98.9 96.1 93.1 97.3 91.7 98.2 98.1 97.1 97.2

Percentage of population not protected

1.2 1.6 1.5 1.2 1.2 0.2 1.1 3.9 6.9 2.7 8.3 1.8 1.9 2.9 2.8

No. of children under five

protected 39,637 30,257 49,768 66,269 32,492 77,872 89,174 105,828 44,980 50,605 64,790 21,149 67,515 106,112 846,448

No. of pregnant women protected

4,005 3,488 5,883 8,123 3,631 12,614 10,076 13,896 4,578 5,819 11,209 2,292 7,354 10,536 103,504

No. of mosquito nets found 128,118 89,165 132,303 95,837 106,567 154,802 143,924 242,460 123,732 120,594 239,748 58,283 165,896 314,143 2,115,572

No. of children under 5

sleeping under a net 34,567 25,945 41,783 33,751 26,524 50,599 46,574 83,851 37,796 40,811 53,970 17,798 60,237 93,319 647,525

No. of insecticide bottles

used 41,682 24,373 26,985 33,395 34,268 38,609 56,616 55,786 33,986 24,513 64,785 15,296 42,625 64,915 557,834

Average number of

households sprayed per bottle

2.2 2.4 2.2 2.1 2 2.4 2 2.2 2.3 2.4 1.9 2.6 2.3 2.3 2.2

Number of spray operators 379 248 313 370 454 377 555 637 372 298 918 176 396 708 6,201

Average number of

households sprayed per spray operator per day

10.1 9.8 8.6 9.2 7.1 9.3 9.8 8.6 8.7 8.6 5.7 11.2 9.8 8.2 8.6

Average number of spray

days 23 24 22 21 21 26 21 22 24 23 23 20 26 26 23

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Challenges

As mentioned in Section 2.1, the project experienced delays in the procurement of insecticide. This

delay was due to Syngenta overcommitting on their production, as well as several changes in the

arrival date of the insecticide. These circumstances were beyond the project’s control, and the project

requested and received CO approval to extend the spray dates for the group A districts from the

original schedule of June 26 – July 29 to July 17 – August 19, 2017.

In this spray round, there was stiff resistance to IRS in several districts including Budaka, Dokolo,

Lira, Kaberemaido, Kibuku and Tororo. A religious sect identified as Amut Aber was the main cause

of resistance in Kaberamaido, while the Kanyiriri sect in Kibuku was resisting all government-

sponsored programs. In Lira, there was substantial resistance by the organic farmers in Agali and

Amach sub-counties. During the verification of the soak pits and bath shelters status, the majority

were in sub-optimal condition due to the prolonged drought which dried up the live fences. The time

lapse in between the spray rounds also led to the soak pits being exposed to vandalism and bush fire,

thereby making their construction or repair expensive.

In some resistant communities, there were rumors that IRS increases bed bug infestation. There were

also complaints regarding the strong odor of the insecticide, and some of the community members

threatened to smear their houses after spraying, as they did not want the smell inside their house. In

these communities, the project used SBCC interventions such as IPC to debunk some of these IRS

myths and change adverse behaviors.

Some community members resisted IRS as they felt they already had in possession LLINs which

were needed for malaria prevention and hence there was no need for additional interventions such as

IRS.

The project recorded small quantities of insecticide pilferage in the group B districts primarily in

Budaka and Butaleja. The culprits were handed over to police and district leaders who decided on the

punitive measures including: termination from IRS activities and prosecution in the courts of law.

In some districts, like Pallisa, where the communities are experiencing food shortage, they were

resisting IRS and other government-sponsored programs, and instead demanding for food for their

families.

Many houses in some districts like Butaleja had wall curtains made from cloth as well as clothes

hanging from bed curtains. These all provided safe and ideal resting places for mosquitoes without

getting in contact with the sprayed wall surfaces. This was associated with high indoor resting vector

densities in Butaleja as discovered during the entomological monitoring activities. The project will

continue to educate community members about the negative implications of having untreated curtains

and clothes hanging in their rooms, with respect to malaria transmission. These curtains and clothes

should be kept in boxes or bags to enable mosquitoes entering houses to rest on the sprayed wall

surfaces and be killed.

Conflicting activities had an adverse impact on the ability of the sub-county supervisors to focus on

IRS, and their attention was diverted by multiple activities such as prevention of mass measles

campaign, immunizations campaigns and other activities being implemented by the different

implementing partners in the districts.

Successes

By engaging young men and women in spray related activities, the Uganda IRS Project has created

income-generating opportunities for thousands of young men and women, especially in rural

communities where paid employment opportunities are rare. It is encouraging to note that some of the

youth have invested their earnings in income generating activities like goat rearing which has helped

to empower them economically.

9

The encouragement of women to work in spray related activities by the project has resulted in a

substantial increase in the number of women working on spray teams. These empowered women are

positive role models in their communities, and an inspiration to other women, since they generated

their own income to improve their families’ well being and made a niche for themselves in what was

considered to be traditionally men’s work. The project registered a significant improvement in female

participation (from 26.9 percent in the previous spray round to 37.1 percent in this spray round).

The project’s targeted SBCC interventions were spot on, and helped mitigate the stiff resistance in

some of the districts. Several measures adopted to mitigate the resistance included: involving the

project’s SBCC team, district and religious leaders to reach to out to the resistant communities;

involving district and sub-county leaders in community dialogues to dispel the myths and

misconceptions about IRS.

The district leaders were supportive of spraying and worked with the project to increase IRS

compliance in their communities. For instance, in Kibuku, the leaders placed a fine of 100,000 UGX

for whoever smears or paints their house after spraying. The engagement of stakeholders at all levels

coupled with intense SBCC measures and increased supervision helped enhance IRS coverage in the

resistant communities.

The enlisting and training of some SOs as parish store-based village data validators proved to be

effective, as they moved door-to-door to ensure that all houses in a particular village were reached

and sprayed. They reported on unsprayed houses which were then sprayed during the mop-up

exercise. This intervention improved community coverage and encouraged the homeowners to be

available the next day.

For the first time, the project has tracked the number of youth, by gender, recruited to the spray

teams. The project expanded its recruitment data base to include age, enabling the project to analyze

youth engagement in spray teams. This data is extremely interesting and shows that in the youth age

group, the proportions of male and female participation in IRS are virtually equal and that if we want

to increase female participation in IRS, we should be recruiting more youth.

Lessons Learnt

There is need to continue disseminating integrated malaria prevention and control messages in the

districts even after the conclusion of the spray campaign. This will help the communities understand

the importance of preventive measures to reduce the risk of malaria after the spray campaign. It will

help prepare the community for the next spray and to establish positive prevention behaviors for the

future withdrawal of IRS.

During the spray round, especially if there is significant resistance, there is need to immediately re-

group and strategize regarding measures to enhance IRS compliance. This allows the project to

review performance and progress, together with the district, sub-county, village leaders and spray

teams, and adjust the mobilization strategies to counter the resistance and increase IRS coverage in

the target districts.

Involvement of district and sub-county councilors and youths as well other grass-root leaders in

mobilization for IRS is a very helpful approach for overcoming resistance.

10

ANNEX 1: Spray data tables from group A and group B districts

TABLE 1: SPRAY DATA FROM THE GROUP B DISTRICTS, MAY 2 - JUNE 6, 2017

S/No INDICATOR

DISTRICTS

TOTAL Alebtong Amolatar Budaka Butaleja Dokolo Namutumba Pallisa

1 No. of districts sprayed 1 1 1 1 1 1 1 7

2 Targeted households 82,378 58,944 62,781 70,493 63,536 81,428 108,438 527,998

3 Total households found 91,760 61,447 62,211 73,326 69,702 93,415 119,347 571,208

4 Households fully sprayed 89,225 57,927 52,248 67,823 66,267 87,316 110,665 531,471

5 Households partly sprayed 942 942 7,149 3,956 1,789 5,690 4,664 25,132

6 Total households fully and partly sprayed 90,167 58,869 59,397 71,779 68,056 93,006 115,329 556,603

7 Households not sprayed 1,593 2,578 2,814 1,547 1,646 409 4,018 14,605

8 Percentage of households partly or fully sprayed 98.3 95.8 95.5 97.9 97.6 99.6 96.6 97.4

9 Percentage of households not sprayed at all 1.7 4.2 4.5 2.1 2.4 0.4 3.4 2.6

10 Targeted population (Based on 2014 census) 210,530 153,144 243,091 256,463 173,466 297,735 367,278 1,701,707

11 Total population found 230,739 163,851 241,018 305,526 187,906 384,352 443,779 1,957,171

12 Female population protected 116,745 80,963 122,856 153,566 96,071 194,384 227,015 991,600

13 Male population protected 111,317 80,315 114,472 148,345 89,582 189,324 211,968 945,323

14 Total population protected 228,062 161,278 237,328 301,911 185,653 383,708 438,983 1,936,923

15 Total population not protected 2,677 2,573 3,690 3,615 2,253 644 4,796 20,248

16 Percentage of population protected 98.8 98.4 98.5 98.8 98.8 99.8 98.9 99.0

17 Percentage of population not protected 1.2 1.6 1.5 1.2 1.2 0.2 1.1 1.0

18 No. of children under five protected 39,637 30,257 49,768 66,269 32,492 77,872 89,174 385,469

19 No. of pregnant women protected 4,005 3,488 5,883 8,123 3,631 12,614 10,076 47,820

20 No. of mosquito nets found 128,118 89,165 132,303 95,837 106,567 154,802 143,924 850,716

21 No. of children under 5 sleeping under a net 34,567 25,945 41,783 33,751 26,524 50,599 46,574 259,743

22 No. of insecticide bottles used 41,682 24,373 26,985 33,395 34,268 38,609 56,616 255,928

23 Average number of households sprayed per bottle 2.2 2.4 2.2 2.1 2.0 2.4 2.0 2.2

24 Number of spray operators 379 248 313 370 454 377 555 2,696

25 Average number of households sprayed per spray operator per day 10.1 9.8 8.6 9.2 7.1 9.3 9.8 9.4

26 Average number of spray days 23 24 22 21 21 26 21 22

11

TABLE 2: SPRAY DATA FROM THE GROUP A DISTRICTS, JULY 17-AUGUST 19

S/No INDICATOR

Districts

Total Bugiri Kaberamaido Kibuku Lira Otuke Serere Tororo

1 No. of districts sprayed 1 1 1 1 1 1 1 7

2 Targeted households 126,362 79,574 59,423 134,020 39,489 95,560 164,387 698,815

3 Total households found 131,815 84,118 62,465 134,561 40,653 103,038 159,839 716,489

4 Households fully sprayed 111,147 74,506 50,040 113,361 38,815 96,232 133,488 617,589

5 Households partly sprayed 10,612 2,508 8,987 7,761 506 2,836 18,242 51,452

6 Total households fully and partly sprayed 121,759 77,014 59,027 121,122 39,321 99,068 151,730 669,041

7 Households not sprayed 10,056 7,104 3,438 13,439 1,332 3,970 8,109 47,448

8 Percentage of households partly or fully sprayed 92.4 91.6 94.5 90.0 96.7 96.1 94.9 93.4

9 Percentage of households not sprayed at all 7.6 8.4 5.5 10.0 3.3 3.9 5.1 6.6

10 Targeted population (Based on 2014 census) 428,345 219,543 207,698 402,316 102,810 291,744 568,466 2,220,922

11 Total population found 468,751 240,897 235,744 451,986 107,597 308,628 579,740 2,393,343

12 Female population protected 229,549 114,824 117,079 210,510 52,820 156,653 286,448 1,167,883

13 Male population protected 221,023 109,544 112,226 204,158 52,833 146,233 276,413 1,122,430

14 Total population protected 450,572 224,368 229,305 414,668 105,653 302,886 562,861 2,290,313

15 Total population not protected 18,179 16,529 6,439 37,318 1,944 5,742 16,879 103,030

16 Percentage of population protected 96.1 93.1 97.3 91.7 98.2 98.1 97.1 95.7

17 Percentage of population not protected 3.9 6.9 2.7 8.3 1.8 1.9 2.9 4.3

18 No. of children under five protected 105,828 44,980 50,605 64,790 21,149 67,515 106,112 460,979

19 No. of pregnant women protected 13,896 4,578 5,819 11,209 2,292 7,354 10,536 55,684

20 No. of mosquito nets found 242,460 123,732 120,594 239,748 58,283 165,896 314,143 1,264,856

21 No. of children under 5 sleeping under a net 83,851 37,796 40,811 53,970 17,798 60,237 93,319 387,782

22 No. of insecticide bottles used 55,786 33,986 24,513 64,785 15,296 42,625 64,915 301,906

23 Average number of households sprayed per bottle 2.2 2.3 2.4 1.9 2.6 2.3 2.3 2.2

24 Number of spray operators 637 372 298 918 176 396 708 3,505

25 Average number of households sprayed per spray operator per day 8.6 8.7 8.6 5.7 11.2 9.8 8.2 8.1

26 Average number of spray days 22 24 23 23 20 26 26 23