Protection of Refugees Through PMI-Kenya Donated Insecticide

Canisters used for indoor residual spraying (IRS) activities to control malaria. Source: Brant Stewart, RTI International

The President’s Malaria Initiative (PMI) was launched in 2005 with the goals of reducing the intolerable burden of malaria and helping to relieve poverty on the African continent. Indoor residual spraying (IRS) is a proven and highly effective malaria control measure. IRS involves the spraying of residual insecticide on the interior walls of homes for vector control, thereby interrupting malaria transmission and conferring community protection when at least 80 percent of houses in a targeted area are sprayed. PMI-supported IRS activities include assessing the environment to ensure safe and effective use of insecticides, educating residents about the benefits of IRS, training spray teams, procuring insecticide and equipment and developing and evaluating spraying activities.

Since 2008, PMI has supported Kenya’s national IRS program. Over time, however, resistance to pyrethroids, a class of insecticide, emerged widely in Kenya.  In response, the national malaria control program changed the IRS policy in 2013 to use a different class of insecticide in areas with a long history of IRS activities and high insecticide-treated mosquito net (ITN) coverage.

There was a problem, though.  In 2013, the project inherited 121,470 sachets of the pyrethroid insecticide: K-Othrine, with an expiry date of July 2014 and was faced with a dilemma: what to do with all those sachets of insecticide? The program had a few options: (1) return the product to the manufacturer; (2) locally incinerate the product in an environmentally-compliant facility; or, (3) donate the product to another PMI country or United Nations High Commissioner for Refugees (UNHCR) for use in refugee camps.

After deliberation and consultation with UNHCR, the Centers for Disease Control and Prevention’s Refugee Health Program, and the Norwegian Refugee Council (NRC), the PMI-Kenya team determined that instead of destroying or returning the product, donation of a portion of the insecticide to NRC for use in a refugee camp in Kenya was the best available option.

Located in the northwestern corner of Kenya in Turkana County, Kakuma Refugee Camp is currently administered by NRC under the auspices of UNHCR. Kakuma Refugee Camp is home to refugees primarily from Somalia and South Sudan with smaller numbers from Eritrea, Rwanda, Democratic Republic of the Congo, Burundi, Sudan and Ethiopia. Over the past two years, there has been a record influx of refugees and asylum seekers coming to Kakuma Refugee Camp due to increased inter-ethnic conflict and violence in South Sudan. While Kakuma Refugee Camp provides protection and basic services for refugees, the close quarters, very high temperatures, lack of infrastructure and frequent dust storms make living in the camp difficult for the nearly 160,000 inhabitants.

Malaria has also been a recurrent problem in Kakuma Refugee Camp, particularly following large-scale population influxes from South Sudan, where malaria is endemic. Both ITNs and IRS have been used historically for malaria prevention in the camp along with prompt, effective case management for persons diagnosed with malaria. With the pyrethroid donation from PMI-Kenya, NRC implemented a successful IRS program in June 2014 prior to the onset of seasonal rains. Seventy trained operators sprayed over 34,000 structures inside the camp covering an estimated 143,000 people. In addition, NRC sprayed 27 schools in the camp and 10 schools in the surrounding host community.

To facilitate environmentally-compliant and effective use of the donated insecticide, PMI-Kenya requested AIRS provide technical assistance to NRC ahead of the donation in February 2014. A USAID-Kenya environmental officer and PMI program officer conducted a post-spray review with the NRC team in Kakuma in late June 2014.

Since the AIRS project began in 2010, IRS has protected more than 24 million people against malaria in 13 PMI countries. The President’s Malaria Initiative is committed to protecting the most vulnerable populations on earth from the burden of malaria.  The successful donation of insecticide and execution of spray activities within the Kakuma Refugee Camp has not only insured that no commodity goes to waste, but also that thousands of refugees are protected from this ancient and deadly disease.