Community factors affecting participation in larval source management for malaria control in Chikwawa District, Southern Malawi

Steven Gowelo,Robert S Mccann,Lucinda Manda-Taylor,Willem Takken,Constantianus J M Koenraadt,Henk Van Den Berg

doi:10.1186/s12936-020-03268-8

Abstract

BackgroundTo further reduce malaria, larval source management (LSM) is proposed as a complementary strategy to the existing strategies. LSM has potential to control insecticide resistant, outdoor biting and outdoor resting vectors. Concerns about costs and operational feasibility of implementation of LSM at large scale are among the reasons the strategy is not utilized in many African countries. Involving communities in LSM could increase intervention coverage, reduce costs of implementation and improve sustainability of operations. Community acceptance and participation in community-led LSM depends on a number of factors. These factors were explored under the Majete Malaria Project in Chikwawa district, southern Malawi.MethodsSeparate focus group discussions (FGDs) were conducted with members from the general community (n = 3); health animators (HAs) (n = 3); and LSM committee members (n = 3). In-depth interviews (IDIs) were conducted with community members. Framework analysis was employed to determine the factors contributing to community acceptance and participation in the locally-driven intervention.ResultsNine FGDs and 24 IDIs were held, involving 87 members of the community. Widespread knowledge of malaria as a health problem, its mode of transmission, mosquito larval habitats and mosquito control was recorded. High awareness of an association between creation of larval habitats and malaria transmission was reported. Perception of LSM as a tool for malaria control was high. The use of a microbial larvicide as a form of LSM was perceived as both safe and effective. However, actual participation in LSM by the different interviewee groups varied. Labour-intensiveness and time requirements of the LSM activities, lack of financial incentives, and concern about health risks when wading in water bodies contributed to lower participation.ConclusionCommunity involvement in LSM increased local awareness of malaria as a health problem, its risk factors and control strategies. However, community participation varied among the respondent groups, with labour and time demands of the activities, and lack of incentives, contributing to reduced participation. Innovative tools that can reduce the labour and time demands could improve community participation in the activities. Further studies are required to investigate the forms and modes of delivery of incentives in operational community-driven LSM interventions.

Highlights

To further reduce malaria, larval source management (LSM) is proposed as a complementary strategy to the existing strategies
In Kenya, the deployment of LSM as a complementary measure to communities already using Long-lasting insecticide treated bed nets (LLINs) was shown to significantly improve malaria control compared to the situation with LLINs used as a stand-alone method [9].‬ ‬ A number of other studies have reported similar results showing the contribution of LSM to malaria reduction in Africa [12, 15,16,17,18,19]
All the In-depth interviews (IDIs) were conducted with the community members that were not health animators (HAs) or LSM committee members

Summary

Introduction

Larval source management (LSM) is proposed as a complementary strategy to the existing strategies. Long-lasting insecticide treated bed nets (LLINs) and indoor residual spraying (IRS) as vector control interventions have made major contributions towards the recent gains [3, 4]. Despite these gains, malaria still remains a major public health problem in Africa as reported by stable or increasing incidence rates over the past few years in many African countries [1]. Other factors cited for adoption of LSM as a complimentary tool include cost-effectiveness when compared with other tools [12, 13] and its ability to control vector populations that avoid contact with insecticide-based tools [14]. In Kenya, the deployment of LSM as a complementary measure to communities already using LLINs was shown to significantly improve malaria control compared to the situation with LLINs used as a stand-alone method [9].‬ ‬ A number of other studies have reported similar results showing the contribution of LSM to malaria reduction in Africa [12, 15,16,17,18,19]

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Discussion

Conclusion