scholarly journals Opinions of key stakeholders on alternative interventions for malaria control and elimination in Tanzania

2019 ◽  
Author(s):  
Marceline Francis Finda ◽  
Nicola Christofides ◽  
Javier Lezaun ◽  
Brian Tarimo ◽  
Prosper Chaki ◽  
...  
Keyword(s):  
Malaria Control ◽  
Poor People ◽  
Community Members ◽  
Policy Makers ◽  
Larval Source Management ◽  
Alternative Interventions ◽  
Key Stakeholders ◽  
Spatial Repellents ◽  
Research Scientists ◽  
Source Management

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.

scholarly journals Opinions of key stakeholders on alternative interventions for malaria control and elimination in Tanzania

2020 ◽  
Author(s):  
Marceline Francis Finda ◽  
Nicola Christofides ◽  
Javier Lezaun ◽  
Brian Tarimo ◽  
Prosper Chaki ◽  
...  
Keyword(s):  
Malaria Control ◽  
Community Members ◽  
Policy Makers ◽  
Larval Source Management ◽  
Housing Improvement ◽  
Alternative Interventions ◽  
Key Stakeholders ◽  
Spatial Repellents ◽  
Research Scientists ◽  
Source Management

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.

scholarly journals Opinions of key stakeholders on alternative interventions for malaria control and elimination in Tanzania

2020 ◽  
Author(s):  
Marceline Francis Finda ◽  
Nicola Christofides ◽  
Javier Lezaun ◽  
Brian Tarimo ◽  
Prosper Chaki ◽  
...  
Keyword(s):  
Malaria Control ◽  
Community Members ◽  
Policy Makers ◽  
Larval Source Management ◽  
Housing Improvement ◽  
Alternative Interventions ◽  
Key Stakeholders ◽  
Spatial Repellents ◽  
Research Scientists ◽  
Source Management

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.

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 ◽  
...  
Keyword(s):  
Malaria Control ◽  
Public Engagement ◽  
Indoor Residual Spraying ◽  
Malaria Vectors ◽  
Malaria Vector Control ◽  
Production Plant ◽  
Community Members ◽  
Key Informants ◽  
Larval Source Management ◽  
Source Management

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.

scholarly journals Process Evaluation of a Community-Based Microbial Larviciding Intervention for Malaria Control in Rural Tanzania

2020 ◽  
Vol 17 (19) ◽  
pp. 7309
Author(s):  
Nina Berlin Rubin ◽  
Leonard E.G. Mboera ◽  
Adriane Lesser ◽  
Marie Lynn Miranda ◽  
Randall Kramer
Keyword(s):  
Process Evaluation ◽  
Malaria Control ◽  
Community Based ◽  
Larval Source Management ◽  
Management Interventions ◽  
Rural Tanzania ◽  
Breeding Habitats ◽  
Mosquito Breeding ◽  
Larvicide Application ◽  
Source Management

Microbial larviciding can be an effective component of integrated vector management malaria control schemes, although it is not commonly implemented. Moreover, quality control and evaluation of intervention activities are essential to evaluate the potential of community-based larviciding interventions. We conducted a process evaluation of a larval source management intervention in rural Tanzania where local staff were employed to apply microbial larvicide to mosquito breeding habitats with the aim of long-term reductions in malaria transmission. We developed a logic model to guide the process evaluation and then established quantitative indicators to measure intervention success. Quantitative analysis of intervention reach, exposure, and fidelity was performed to assess larvicide application, and interviews with larviciding staff were reviewed to provide context to quantitative results. Results indicate that the intervention was successful in terms of reach, as staff applied microbial larvicide at 80% of identified mosquito breeding habitats. However, the dosage of larvicide applied was sufficient to ensure larval elimination at only 26% of sites, which does not meet the standard set for intervention fidelity. We propose that insufficient training and protocol adaptation, environment and resource issues, and human error contributed to low larvicide application rates. This demonstrates how several small, context-specific details in sum can result in meaningful differences between intervention blueprint and execution. These findings may serve the design of other larval source management interventions by demonstrating the value of additional training, supervision, and measurement and evaluation of protocol adherence.

scholarly journals Household knowledge, perceptions and practices of mosquito larval source management for malaria prevention and control in Mwanza district, Malawi: a cross‐sectional study

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Mphatso Kamndaya ◽  
Dumisani Mfipa ◽  
Kingsley Lungu
Keyword(s):  
Malaria Control ◽  
Sub Saharan Africa ◽  
Malaria Vector Control ◽  
Multivariable Logistic Regression Model ◽  
Stagnant Water ◽  
Cross Sectional ◽  
Larval Source Management ◽  
Clean Environment ◽  
High Level ◽  
Source Management

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.

scholarly journals Household knowledge, perceptions and practices of mosquito larval source management for malaria prevention and control in Mwanza district, Malawi: A cross-sectional study

2020 ◽  
Author(s):  
Mphatso Kamndaya ◽  
Dumisani Mfipa ◽  
Kingsley Lungu
Keyword(s):  
Malaria Control ◽  
Sub Saharan Africa ◽  
Malaria Vector Control ◽  
Multivariable Logistic Regression Model ◽  
Stagnant Water ◽  
Cross Sectional ◽  
Larval Source Management ◽  
Clean Environment ◽  
High Level ◽  
Source Management

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.

scholarly journals Cost of community-led larval source management and house improvement for malaria control: a cost analysis within a cluster-randomized trial in a rural district in Malawi

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Mphatso Dennis Phiri ◽  
Robert S. McCann ◽  
Alinune Nathanael Kabaghe ◽  
Henk van den Berg ◽  
Tumaini Malenga ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Cost Analysis ◽  
Malaria Control ◽  
Wire Mesh ◽  
Sensitivity Analyses ◽  
Larval Source Management ◽  
House Improvement ◽  
Implementation Costs ◽  
Cluster Randomized ◽  
Source Management

Abstract Background House improvement (HI) to prevent mosquito house entry, and larval source management (LSM) targeting aquatic mosquito stages to prevent development into adult forms, are promising complementary interventions to current malaria vector control strategies. Lack of evidence on costs and cost-effectiveness of community-led implementation of HI and LSM has hindered wide-scale adoption. This study presents an incremental cost analysis of community-led implementation of HI and LSM, in a cluster-randomized, factorial design trial, in addition to standard national malaria control interventions in a rural area (25,000 people), in southern Malawi. Methods In the trial, LSM comprised draining, filling, and Bacillus thuringiensis israelensis-based larviciding, while house improvement (henceforth HI) involved closing of eaves and gaps on walls, screening windows/ventilation spaces with wire mesh, and doorway modifications. Communities implemented all interventions. Costs were estimated retrospectively using the ‘ingredients approach’, combining ‘bottom-up’ and ‘top-down approaches’, from the societal perspective. To estimate the cost of independently implementing each intervention arm, resources shared between trial arms (e.g. overheads) were allocated to each consuming arm using proxies developed based on share of resource input quantities consumed. Incremental implementation costs (in 2017 US$) are presented for HI-only, LSM-only and HI + LSM arms. In sensitivity analyses, the effect of varying costs of important inputs on estimated costs was explored. Results The total economic programme costs of community-led HI and LSM implementation was $626,152. Incremental economic implementation costs of HI, LSM and HI + LSM were estimated as $27.04, $25.06 and $33.44, per person per year, respectively. Project staff, transport and labour costs, but not larvicide or screening material, were the major cost drivers across all interventions. Costs were sensitive to changes in staff costs and population covered. Conclusions In the trial, the incremental economic costs of community-led HI and LSM implementation were high compared to previous house improvement and LSM studies. Several factors, including intervention design, year-round LSM implementation and low human population density could explain the high costs. The factorial trial design necessitated use of proxies to allocate costs shared between trial arms, which limits generalizability where different designs are used. Nevertheless, costs may inform planners of similar intervention packages where cost-effectiveness is known. Trial registration Not applicable. The original trial was registered with The Pan African Clinical Trials Registry on 3 March 2016, trial number PACTR201604001501493

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