scholarly journals Addressing key gaps in implementation of mosquito larviciding to accelerate malaria vector control in southern Tanzania: results of a stakeholder engagement process in local district councils

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Salum A. Mapua ◽  
Marceline F. Finda ◽  
Ismail H. Nambunga ◽  
Betwel J. Msugupakulya ◽  
Kusirye Ukio ◽  
...  

Abstract Background Larval source management was historically one of the most effective malaria control methods but is now widely deprioritized in Africa, where insecticide-treated nets (ITNs) and indoor residual spraying (IRS) are preferred. However, in Tanzania, following initial successes in urban Dar-es-Salaam starting early-2000s, the government now encourages larviciding in both rural and urban councils nationwide to complement other efforts; and a biolarvicide production-plant has been established outside the commercial capital. This study investigated key obstacles and opportunities relevant to effective rollout of larviciding for malaria control, with a focus on the meso-endemic region of Morogoro, southern Tanzania. Methods Key-informants were interviewed to assess awareness and perceptions regarding larviciding among designated health officials (malaria focal persons, vector surveillance officers and ward health officers) in nine administrative councils (n = 27). Interviewer-administered questionnaires were used to assess awareness and perceptions of community members in selected areas regarding larviciding (n = 490). Thematic content analysis was done and descriptive statistics used to summarize the findings. Results A majority of malaria control officials had participated in larviciding at least once over the previous three years. A majority of community members had neutral perceptions towards positive aspects of larviciding, but overall support for larviciding was high, although several challenges were expressed, notably: (i) insufficient knowledge for identifying relevant aquatic habitats of malaria vectors and applying larvicides, (ii) inadequate monitoring of programme effectiveness, (iii) limited financing, and (iv) lack of personal protective equipment. Although the key-informants reported sensitizing local communities, most community members were still unaware of larviciding and its potential. Conclusions The larviciding programme was widely supported by both communities and malaria control officials, but there were gaps in technical knowledge, implementation and public engagement. To improve overall impact, it is important to: (i) intensify training efforts, particularly for identifying habitats of important vectors, (ii) adopt standard technical principles for applying larvicides or larval source management, (iii) improve financing for local implementation and (iv) improve public engagement to boost community awareness and participation. These lessons could also be valuable for other malaria endemic areas wishing to deploy larviciding for malaria control or elimination.

2020 ◽  
Author(s):  
Salum Abdallah Mapua ◽  
Marceline F. Finda ◽  
Ismail H. Nambunga ◽  
Betwel J. Msugupakulya ◽  
Kusirye Ukio ◽  
...  

Abstract Background: Larval source management was historically one of the most effective malaria control methods but is now widely deprioritized in Africa, where insecticide treated nets (ITNs) and indoor residual spraying (IRS) are preferred. However, in Tanzania, following initial successes in urban Dar-es-Salaam starting early-2000s, the government now encourages larviciding in both rural and urban councils nationwide to complement other efforts; and a biolarvicide production-plant has been established outside the commercial capital. This study investigated key obstacles and opportunities relevant to effective rollout of larviciding for malaria control, with a focus on the meso-endemic region of Morogoro, southern Tanzania. Methods: Key-informants were interviewed to assess awareness and perceptions regarding larviciding among designated health officials (malaria focal persons, vector surveillance officers and ward health officers) in nine administrative councils (N = 27). Interviewer-administered questionnaires were used to assess awareness and perceptions of community members in selected areas regarding larviciding (N = 490). Thematic content analysis was done and descriptive statistics used to summarize the findings.Results: A majority of malaria control officials had participated in larviciding at least once over the previous three years. A majority of community members had neutral perceptions towards positive aspects of larviciding, but overall support for larviciding was high, although several challenges were expressed, notably: i) insufficient knowledge for identifying relevant aquatic habitats of malaria vectors and applying larvicides, ii) inadequate monitoring of program effectiveness, iii) limited financing, and iv) lack of personal protective equipment. Although the key-informants reported sensitizing local communities, most community members were still unaware of larviciding and its potential. Conclusion: The larviciding program was widely supported by both communities and malaria control officials, but there were gaps in technical knowledge, implementation and public engagement. To improve overall impact, it is important to: i) intensify training efforts, particularly for identifying habitats of important vectors, ii) adopt standard technical principles for applying larvicides, iii) improve financing for local implementation and iv) improve public engagement to boost community awareness and participation. These lessons could also be valuable for other malaria endemic areas wishing to deploy larviciding for malaria control or elimination.


2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Mphatso Kamndaya ◽  
Dumisani Mfipa ◽  
Kingsley Lungu

Abstract Background Mosquito larval source management (LSM) is a key outdoor malaria vector control strategy in rural communities in sub-Saharan Africa. Knowledge of this strategy is important for optimal design and implementation of effective malaria control interventions in this region. This study assessed household knowledge, perceptions and practices of mosquito LSM methods (draining stagnant water, larviciding, clearing grass/bushes and clean environment). Methods A cross-sectional design was used whereby 479 households were selected using two-stage sampling in Mwanza district, Malawi. A household questionnaire was administered to an adult member of the house. Respondents were asked questions on knowledge, perceptions and practices of mosquito LSM methods. Multivariable logistic regression model was used to identify factors associated with high-level knowledge of mosquito LSM methods. Results Majority of the respondents (64.5%) had high-level knowledge of mosquito LSM methods. Specifically, 63.7% (200/314) had positive perceptions about draining stagnant water, whereas 95.3% (223/234) practiced clean environment for malaria control and 5.2% had knowledge about larviciding. Compared to respondents with primary education, those with secondary education were more likely, whereas those without education were less likely, to have high-level knowledge of mosquito LSM methods (AOR = 3.54, 95% CI 1.45–8.63 and AOR = 0.38, 95% CI 0.23–0.64, respectively). Compared to respondents engaged in crop farming, those engaged in mixed farming (including pastoralists) and the self-employed (including business persons) were more likely to have high-level knowledge of mosquito LSM methods (AOR = 6.95, 95% CI 3.39–14.23 and AOR = 3.61, 95% CI 1.47–8.86, respectively). Respondents living in mud-walled households were less likely to have high-knowledge of mosquito LSM methods than those living in brick-walled households (AOR = 0.50, 95% CI 0.30–0.86). Conclusions A high-level knowledge of mosquito LSM methods was established. However, when designing and implementing this strategy, specific attention should be paid to the uneducated, crop farmers and those living in poor households.


2020 ◽  
Author(s):  
Mphatso Kamndaya ◽  
Dumisani Mfipa ◽  
Kingsley Lungu

Abstract Background Mosquito larval source management (LSM) is a key outdoor malaria vector control strategy in rural communities in sub-Saharan Africa. Knowledge of this strategy is important for optimal design and implementation of effective malaria control interventions in this region. This study assessed household knowledge, perceptions and practices of mosquito LSM methods (draining stagnant water, larviciding, clearing grass/bushes and clean environment). Methods A cross-sectional design was used whereby 479 households were selected using two-stage sampling in Mwanza district, Malawi. A household questionnaire was administered to the head of the house. Respondents were asked questions on knowledge, perceptions and practices of mosquito LSM methods. Multivariable logistic regression model was used to identify factors associated with high-level knowledge of mosquito LSM methods. Results Majority of the respondents (64.3%) had high-level knowledge of mosquito LSM methods. Specifically, 63.7% (200/314) had positive-perceptions about draining stagnant water whereas 95.3% (223/234) practiced clean environment for malaria control and 5.2% had knowledge about larviciding. Compared to respondents with primary education, those with secondary education were 3.04 times more likely to have high-level knowledge of mosquito LSM methods (AOR = 3.04, 95% CI 1.30–7.14), whereas those with no education were 0.40 times less likely to have high-level knowledge of mosquito LSM methods (AOR = 0.40, 95% CI 0.24–0.67). Respondents living in mudwalled households were 0.54 times less likely to have high-level knowledge of mosquito LSM methods as compared with those living in brickwalled households (AOR = 0.54, 95% CI 0.32–0.92). Conclusions Larviciding was the least mentioned method whereas positive-perceptions for larviciding and clearing grass/bushes were low. Targeted health promotion interventions may improve knowledge, perceptions and practices of mosquito LSM methods in communities.


2020 ◽  
Author(s):  
Marceline Francis Finda ◽  
Nicola Christofides ◽  
Javier Lezaun ◽  
Brian Tarimo ◽  
Prosper Chaki ◽  
...  

Abstract Background: Malaria control in Tanzania currently relies primarily on long-lasting insecticidal nets and indoor residual spraying, alongside effective case management and behaviour change communication. This study explored opinions of key stakeholders on the national progress towards malaria elimination, the potential of currently available vector control interventions in helping achieve elimination by 2030, and the need for alternative interventions that could be used to supplement malaria elimination efforts in Tanzania.Methods: In this exploratory qualitative study, focus group discussions were held with policy-makers, regulators, research scientists and community members. Malaria control interventions discussed were: a) improved housing, b) larval source management, c) mass drug administration (MDA) with ivermectin to reduce vector densities, d) release of modified mosquitoes, including genetically modified or irradiated mosquitoes, e) targeted spraying of mosquito swarms, and f) spatial repellents. Results: Larval source management and spatial repellents were widely supported across all stakeholder groups, while insecticide-spraying of mosquito swarms was the least preferred. Support for MDA with ivermectin was high among policy makers, regulators and research scientists, but encountered opposition among community members, who instead expressed strong support for programmes to improve housing for poor people in high transmission areas. Policy makers, however, challenged the idea of government-supported housing improvement due to its perceived high costs. Techniques of mosquito modification, specifically those involving gene drives, were viewed positively by community members, policy makers and regulators, but encountered a high degree of scepticism among scientists. Overall, policy-makers, regulators and community members trusted scientists to provide appropriate advice for decision-making. Conclusion: Stakeholder opinions regarding alternative malaria interventions were divergent except for larval source management and spatial repellents, for which there was universal support. MDA with ivermectin, housing improvement and modified mosquitoes were also widely supported, though each faced concerns from at least one stakeholder group. While policy-makers, regulators and community members all noted their reliance on scientists to make informed decisions, their reasoning on the benefits and disadvantages of specific interventions included factors beyond technical efficiency. This study suggests the need to encourage and strengthen dialogue between research scientists, policy makers, regulators and communities regarding new interventions.


2020 ◽  
Author(s):  
Marceline Francis Finda ◽  
Nicola Christofides ◽  
Javier Lezaun ◽  
Brian Tarimo ◽  
Prosper Chaki ◽  
...  

Abstract Background Malaria control in Tanzania currently relies primarily on long-lasting insecticidal nets and indoor residual spraying, alongside effective case management and behaviour change communication. This study explored opinions of key stakeholders on the national progress towards malaria elimination, the potential of currently available vector control interventions in helping achieve elimination by 2030, and the need for alternative interventions that could be used to supplement malaria elimination efforts in Tanzania. Methods In this exploratory qualitative study, focus group discussions were held with policy-makers, regulators, research scientists and community members. Malaria control interventions discussed were: a) improved housing, b) larval source management, c) mass drug administration (MDA) with ivermectin to reduce vector densities, d) release of modified mosquitoes, including genetically modified or irradiated mosquitoes, e) targeted spraying of mosquito swarms, and f) spatial repellents. Results Larval source management and spatial repellents were widely supported across all stakeholder groups, while insecticide-spraying of mosquito swarms was the least preferred. Support for MDA with ivermectin was high among policy makers, regulators and research scientists, but encountered opposition among community members, who instead expressed strong support for programmes to improve housing for poor people in high transmission areas. Policy makers, however, challenged the idea of government-supported housing improvement due to its perceived high costs. Techniques of mosquito modification, specifically those involving gene drives, were viewed positively by community members, policy makers and regulators, but encountered a high degree of scepticism among scientists. Overall, policy-makers, regulators and community members trusted scientists to provide appropriate advice for decision-making. Conclusion Stakeholder opinions regarding alternative malaria interventions were divergent except for larval source management and spatial repellents, for which there was universal support. MDA with ivermectin, housing improvement and modified mosquitoes were also widely supported, though each faced concerns from at least one stakeholder group. While policy-makers, regulators and community members all noted their reliance on scientists to make informed decisions, their reasoning on the benefits and disadvantages of specific interventions included factors beyond technical efficiency. This study suggests the need to encourage and strengthen dialogue between research scientists, policy makers, regulators and communities regarding new interventions.


2019 ◽  
Author(s):  
Marceline Francis Finda ◽  
Nicola Christofides ◽  
Javier Lezaun ◽  
Brian Tarimo ◽  
Prosper Chaki ◽  
...  

Abstract Background Malaria control in Tanzania currently relies primarily on long-lasting insecticidal nets and indoor residual spraying, alongside effective case management and behaviour change communication. This study explored opinions of key stakeholders on suitability and potential of six alternative vector control interventions for supplementing ongoing malaria control and elimination efforts in Tanzania.Methods Focus group discussions were held with policy-makers, regulators, research scientists and community members, each group having 6-10 participants. Alternative interventions discussed included: a) improved housing, b) larval source management, c) mass drug administration (MDA) with ivermectin to reduce vector densities, d) modified mosquitoes including genetically-modified or irradiated mosquitoes, e) targeted spraying of mosquito swarms, and f) spatial repellents. Discussions focused on stakeholder opinions on comparative value of these interventions for supplementing efforts towards the 2030 malaria elimination target.Results Larval source management and spatial repellents were widely supported across all stakeholder groups, while insecticide-spraying of mosquito swarms was least preferred. Support for MDA with ivermectin was high among policy makers, regulators and research scientists, but encountered opposition among community members due to perceptions that it requires significant efforts and compliance. Community members expressed strong desire and support for programmes to improve housing for poor people in high transmission areas, while policy makers challenged sustainability of this strategy given its high costs. Techniques of mosquito modification, specifically those involving gene drives, were viewed positively by community members, policy makers and regulators, but encountered high degrees of scepticism among scientists. Overall, policy-makers, regulators and community members trusted scientists to provide appropriate advice for decision making.Conclusion Stakeholder opinions regarding alternative malaria interventions were divergent, except for larval source management and spatial repellents for which there was universal support. MDA with ivermectin, house improvement and modified mosquitoes were also widely supported though each faced concerns from at least one stakeholder group. While policy-makers, regulators and community members all noted their dependence on scientists to make informed decisions, their reasoning on benefits and drawbacks of specific interventions included factors beyond technical efficiency. This study suggests the need to encourage and strengthen dialogue between scientists, policy makers, regulators and communities regarding new interventions.


2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Henry Ddumba Mawejje ◽  
Maxwell Kilama ◽  
Simon P. Kigozi ◽  
Alex K. Musiime ◽  
Moses Kamya ◽  
...  

Abstract Background Long-lasting insecticidal nets (LLINs) and indoor residual spraying (IRS) are the malaria control interventions primarily responsible for reductions in transmission intensity across sub-Saharan Africa. These interventions, however, may have differential impact on Anopheles species composition and density. This study examined the changing pattern of Anopheles species in three areas of Uganda with markedly different transmission intensities and different levels of vector control. Methods From October 2011 to June 2016 mosquitoes were collected monthly using CDC light traps from 100 randomly selected households in three areas: Walukuba (low transmission), Kihihi (moderate transmission) and Nagongera (high transmission). LLINs were distributed in November 2013 in Walukuba and Nagongera and in June 2014 in Kihihi. IRS was implemented only in Nagongera, with three rounds of bendiocarb delivered between December 2014 and June 2015. Mosquito species were identified morphologically and by PCR (Polymerase Chain Reaction). Results In Walukuba, LLIN distribution was associated with a decline in Anopheles funestus vector density (0.07 vs 0.02 mosquitoes per house per night, density ratio [DR] 0.34, 95% CI: 0.18–0.65, p = 0.001), but not Anopheles gambiae sensu stricto (s.s.) nor Anopheles arabiensis. In Kihihi, over 98% of mosquitoes were An. gambiae s.s. and LLIN distribution was associated with a decline in An. gambiae s.s. vector density (4.00 vs 2.46, DR 0.68, 95% CI: 0.49–0.94, p = 0.02). In Nagongera, the combination of LLINs and multiple rounds of IRS was associated with almost complete elimination of An. gambiae s.s. (28.0 vs 0.17, DR 0.004, 95% CI: 0.002–0.009, p < 0.001), and An. funestus sensu lato (s.l.) (3.90 vs 0.006, DR 0.001, 95% CI: 0.0005–0.004, p < 0.001), with a less pronounced decline in An. arabiensis (9.18 vs 2.00, DR 0.15 95% CI: 0.07–0.33, p < 0.001). Conclusions LLIN distribution was associated with reductions in An. funestus s.l. in the lowest transmission site and An. gambiae s.s. in the moderate transmission site. In the highest transmission site, a combination of LLINs and multiple rounds of IRS was associated with the near collapse of An. gambiae s.s. and An. funestus s.l. Following IRS, An. arabiensis, a behaviourally resilient vector, became the predominant species, which may have implications for malaria vector control activities. Development of interventions targeted at outdoor biting remains a priority.


2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Corine Ngufor ◽  
Renaud Govoetchan ◽  
Augustin Fongnikin ◽  
Estelle Vigninou ◽  
Thomas Syme ◽  
...  

AbstractThe rotational use of insecticides with different modes of action for indoor residual spraying (IRS) is recommended for improving malaria vector control and managing insecticide resistance. Insecticides with new chemistries are urgently needed. Broflanilide is a newly discovered insecticide under consideration. We investigated the efficacy of a wettable powder (WP) formulation of broflanilide (VECTRON T500) for IRS on mud and cement wall substrates in laboratory and experimental hut studies against pyrethroid-resistant malaria vectors in Benin, in comparison with pirimiphos-methyl CS (Actellic 300CS). There was no evidence of cross-resistance to pyrethroids and broflanilide in CDC bottle bioassays. In laboratory cone bioassays, broflanilide WP-treated substrates killed > 80% of susceptible and pyrethroid-resistant An. gambiae sl for 6–14 months. At application rates of 100 mg/m2 and 150 mg/m2, mortality of wild pyrethroid-resistant An. gambiae sl entering experimental huts in Covè, Benin treated with VECTRON T500 was similar to pirimiphos-methyl CS (57–66% vs. 56%, P > 0.05). Throughout the 6-month hut trial, monthly wall cone bioassay mortality on VECTRON T500 treated hut walls remained > 80%. IRS with broflanilide shows potential to significantly improve the control of malaria transmitted by pyrethroid-resistant mosquito vectors and could thus be a crucial addition to the current portfolio of IRS insecticides.


2021 ◽  
Author(s):  
Abebe Asale ◽  
Zewdu Abro ◽  
Bayu Enchalew ◽  
Alayu Tesager ◽  
Aklilu Belay ◽  
...  

Abstract Background: Key program components of malaria control in Ethiopia include community empowerment and mobilization, vector control using long-lasting insecticidal nets (LLINs), indoor residual spraying (IRS), prompt diagnosis and treatment, and disease surveillance. However, the effectiveness of these interventions is often undermined by various challenges, including insecticide and drug resistance, the plasticity of malaria vectors feeding and biting behavior, and certain household factors that lead to misuse and poor utilization of LLINs. The primary objective of this study was to document households’ perceptions towards malaria and assess the prevalence of the disease and the constraints related to the ongoing interventions in Ethiopia (LLINs, IRS, community mobilization house screening). Method: The study was conducted in Jabi Tehnan district, Northwestern Ethiopi,a from November 2019 to March 2020. A total of 3,010 households distributed over 38 kebeles (villages) were randomly selected for socio-economic and demographic survey. Focus group discussions (FGDs) were conducted in 11 different health clusters taking into account agro-ecological differences. A total of 1,256 children under 10 years of age were screened for malaria parasites using microscopy in order to determine malaria prevalence. Furthermore, five-year malaria trend analysis was undertaken based on data obtained from the district health office to understand the disease dynamics.Result: Malaria knowledge in the area was high as all FGD participants correctly identified mosquito bites during the night as sources of malaria transmission. Delayed health seeking behavior remains a key behavioral challenge in malaria control as it took patients on average 4 days before reporting the case at the nearby health facility. On average households lost 2.53 working days per person-per malaria episode and theey spent US$ 18 per person perepisode. Out of the 1,256 randomly selected under 10 children tested for malaria parasites, 11 (0.89%) were found to be positive. Malaria disproportionately affected the adult segment of the population more, 50% of the total cases reported from households whose age was 15 and beyond. The second most affected group was the age group between 5 and 14 years followed by children under 10, with 31% and 14% burden,respectively.Conclusion: Despite the achievement of universal coverage in terms of LLINs access, utilization of vector control interventions in the area remained low.Using bed nets for unintended purposes remained a major challenge. Therefore, continued community education and communication work should be prioritised in the study area to bring about the desired behavioral changes.


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