Outcome of capacity building intervention for malaria vector surveillance, control and research in Nigerian higher institutions

Malaria is a major public health problem in most parts of the world. Approximately 216 million people contracted the disease in 2016 resulting in an estimated 445,000 deaths, with the WHO African Region accounting for 91% of all these deaths [1]. Nigeria and The Democratic Republic of Congo account for over 37% of the estimated total cases of malaria deaths globally [1].

In Nigeria, the disease accounts for about 60% of outpatient visits, 30% of hospitalizations, 10% of low birth weight and 11% of maternal mortality in Nigeria [2]. The use of long-lasting insecticidal nets (LLINs) and indoor residual spraying (IRS) are two strategies under the integrated vector management (IVM) for malaria control. While there have been several mass campaign to distribute and promote the use of LLIN, IRS remains very limited because of high costs. These strategies are also known to have a community-wide effect; thus persons who do not receive personal protection can still benefit from these interventions [3].

In spite of the high coverage campaign and accessibility associated with LLINs, only very few states had adopted and implemented IRS as a major component of the malaria control programme. In the few states where IRS had been adopted, re-spraying implementation remains limited and the utilization of other interventions, such as larval source management, remains marginal. Where these strategies are deployed, the research capacity for monitoring insecticide resistance and transmission dynamics and vector control activities in most of the local control programmes remain very limited and unsustainable. In most cases, implementation of vector control programmes have always preceded a careful systematic and continuous monitoring and surveillance of target species, thus putting control programmes at risk of failure [4]. The unavailability of malaria entomological data to guide implementation and monitoring of vector control strategies is often attributed to weak capacities in local control programmes. Existing literatures have clearly shown that over 100 million nets across have been distributed in the last 8 years in Nigeria [2]. Despite this, only very few control programmes have been strengthened to monitor the impact of these interventions on vector population, behaviour and continued susceptibility to insecticides approved for malaria vector control.

Okorie et al. [4] have shown that the proportion of malaria entomological studies carried out between year 2000 and 2010 was lowest in the North East followed by North West, South South, South East and the North Central geo-political zones of Nigeria. The South West geopolitical zone was observed to have an extensive data set on malaria entomology within the same time frame. The reason behind this has not been investigated. However, interaction with managers at the National Malaria Elimination Programme shows that the very few scientists available and capable of sustaining vector control programmes are located in research institutes or the universities (Oduola pers. comm.). However, there exists a major gap between research and programme implementation. This assertion is buttressed by the availability of research information that has not been designed to meet the operational health needs of state malaria control programmes. It is based on this background that this study was designed to assess and build the capacities of eligible personnel identified from institutions in each of the six geopolitical zones in Nigeria. This group of personnel will form a critical mass that will improve the generation of malaria vector control research data capable of guiding the implementation of interventions that can support local vector control activities and reduce malaria burden.

Implementing sustainable malaria control programmes require strong institutions, funding and a critical mass of skilled personnel to drive the well-proven vector control strategies. A good operational research component is also required to generate data capable of bridging health need gaps and the formulation of policy capable of reducing malaria burden. Identifying the right personnel and institution with focus on the field of specialization is particularly important in building sustainable national vector control and surveillance programmes. The distribution of applicants across all six geopolitical zones in Nigeria emphasizes the need of empowering scientists in these regions to consistently generate this body of knowledge, which is a precursor to implementing effective vector control programmes. Higher number of applications received from the South Western geopolitical zones of Nigeria when compared to the other regions confirmed the earlier speculations of existing active facilities involved in malaria vector monitoring and surveillance in South West Nigeria. According to Okorie et al. [4] the South-West geopolitical zone was observed to have an extensive data set on malaria entomology when compared to other regions considered within the same time frame. This simply confirmed the presence of active entomologists [8] and may have stimulated the higher training-seeking behaviour of researchers from this region.

While the South East, South West, North Central and North East had suitable number of qualified applicants to make up the four training slots allocated to each of the six geopolitical zones, this was not the same for the South South and North West geopolitical zones. This necessitated the consideration of some additional applicants from zones that had fully utilized their slots. This outcome may likely be an indication of an existing weak research infrastructures and a dearth of professionals available for malaria vector control research. In order to avoid labour crisis [9] or in availability of professionals to carry out interventions, such as vector monitoring and surveillance, there is the need for stakeholders which includes funders, training institutions and the NMEP to consider training and equipping a pool of competent scientists that will be able to support local research needs and capacity for a sustainable malaria vector control and surveillance programmes in each of the six geopolitical zones in Nigeria. According to Uneke et al. [9] short falls in the supply of professional personnel should be prioritized. Training of personnel should be prioritized and not be left to chance or be driven by disease incidences as it is reported to be done in most low medium income countries [10].

The outcome of this capacity building intervention has provided information on existing gap in the access of scientists or practicing Medical Entomologists in Nigeria to relevant skills required to engage in malaria vector surveillance information gathering. According to Beaglehole [11] low number of competent researchers is a major problem facing research and development in Nigeria. Nigeria and Ghana have been featured as countries with the lowest researchers per million [12].

The non-familiarity of participants selected from 22 higher institutions in Nigeria with relevant and important tools, skills and techniques indicate a wide gap between knowledge and practice of Medical Entomology in Nigerian Institutions. The majority of the participants in this study were not familiar with important laboratory and field tools to carry out vector borne disease surveillance. This requires a conscious implementation of a sustainable training programme to update the knowledge of personnel in this field. Another way out would be the upgrading of current curriculum of selected tertiary institutions to meet the demands and challenges of recent trends in vector borne diseases. It is evident that there is either the absence of tools or skilled personnel to communicate this knowledge to students in training. The age (26–45) distribution of the participants from the 22 institutions across six geopolitical zones in Nigeria who attended the CBP also attested to this. The distribution also showed that majority of these participants (54.5%) and (40.9%) were at their earlier and middle career stage respectively. The non-familiarity of majority of these participants with vector surveillance, control and research tools is worrisome suggesting that they may not have been exposed to this during their tertiary or university training. These categories of personnel without exposure to these tools were likely to have passed through several institutions within the country in the last 5–20 years (considering the age group of the participants). These graduates without this training are in the helms of vector control, research, monitoring. They are also likely to be involved in the training of vector biologists that are to support future local control programmes. The assessment of participants’ previous entomological experience was used to conclude that the capacity available for vector control research at institutional level in Nigeria is weak. Strengthening research, teaching and training in Nigerian institutions will increase the required generation of a critical mass of well-trained scientists that can support local malaria vector control and research programmes. Control programmes that require these skills will have to look for an avenue of organizing additional training to meet these needs.

The significant improvement in knowledge of the participants after the capacity building training intervention laid emphasis on existing dearth in knowledge of potential pool of skilled workforce that can be enlisted to support vector surveillance and research activities in Nigeria. This present gap justifies the need to implement further CB training in the management of knowledge in vector control, surveillance and research. The knowledge acquired will improve the practice and productivity of the trained personnel for effective malaria vector control research and surveillance activities.

Establishment of improvement in knowledge after training is not sufficient in evaluating the impact of a CB training programme. As such, a checklist of activities or mutually agreed goals was designed to develop participants on specific areas of competencies [13]. Experienced researchers in relevant field of malaria research were assigned as mentors to follow up on the mentees, providing assistance to ensure that they comply with series of activities which will allow them build upon the needs and knowledge gaps identified during the training [14]. Mentors assigned to each of the trainee provided information on the compliance of the participants from each of the geopolitical zones. According to Strauss et al. [15], the goal of assigning mentors was to retain faculty that will be productive. Productivity here may be the generation of data that can support local malaria vector surveillance and control programme or implementation of malaria control activities. Mentoring has been described as a way by which well-experienced professionals can connect with less-experienced or junior colleagues in order to offer guidance and assistance in their career progress [16, 17]. The initial response from the first activities earmarked for the short-term assessment was encouraging and had a higher degree of compliance among the participants. The dwindling trend in compliance with the checklist of activities by the participants indicated a major weakness and flaw to drive conceptual ideas at the academic level to the community for implementation. The absence of funds and inability of trainees to access funds to support the implementation of their proposal at the latter stage became an impediment and limitation to the mentoring aspect of this CB programme. As such, capacity building training organizers in collaboration with the NMEP arranged that trained entomologists and vector control researchers who benefited from the training programme be linked to their states malaria programmes, where each individual can develop proficiency and support the strategic plan of the national body to establish new sentinel sites for vector surveillance and insecticide monitoring in each state of the country.

The capacity available for vector control research and surveillance at institutional level in Nigeria is weak. Increased training and access of personnel to relevant tools in malaria vector surveillance research is required in several institutions in all the six geopolitical zones. This will enhance the generation of a critical mass of well-trained scientists that can support local malaria vector control surveillance and research programmes.