Abstract
BackgroundCommunity participation in vector control and health services in general is of great interest to public health practitioners in developing countries, but remains complex and poorly understood. The Urban Malaria Control Program (UMCP) in Dar es Salaam, United Republic of Tanzania, implements larval control of malaria vector mosquitoes. The UMCP delegates responsibility for routine mosquito control and surveillance to community-owned resource persons (CORPs), recruited from within local communities via the elected local government.MethodsA mixed method, cross-sectional survey assessed the ability of CORPs to detect mosquito breeding sites and larvae, and investigated demographic characteristics of the CORPs, their reasons for participating in the UMCP, and their work performance. Detection coverage was estimated as the proportion of wet habitats found by the investigator which had been reported by CORP. Detection sensitivity was estimated as the proportion of wet habitats found by the CORPS which the investigator found to contain Anopheles larvae that were also reported to be occupied by the CORP.ResultsThe CORPs themselves perceived their role as professional rather than voluntary, with participation being a de facto form of employment. Habitat detection coverage was lower among CORPs that were recruited through the program administrative staff, compared to CORPs recruited by local government officials or health committees (Odds Ratio = 0.660, 95% confidence interval = [0.438, 0.995], P = 0.047). Staff living within their areas of responsibility had > 70% higher detection sensitivity for both Anopheline (P = 0.016) and Culicine (P = 0.012): positive habitats compared to those living outside those same areas.Discussion and conclusionsImproved employment conditions as well as involving the local health committees in recruiting individual program staff, communication and community engagement skills are required to optimize achieving effective community participation, particularly to improve access to fenced compounds. A simpler, more direct, less extensive community-based surveillance system in the hands of a few, less burdened, better paid and maintained program personnel may improve performance and data quality.
Highlights
Community participation in vector control and health services in general is of great interest to public health practitioners in developing countries, but remains complex and poorly understood
At the end of each visit, a structured questionnaire was administered to collect data regarding the individual characteristics of the community-owned resource persons (CORPs), including gender, age, place of residence and recruitment history (Additional file 1)
This study used both qualitative and quantitative methods to explore the perspectives of CORPs and their respective supervisors about the management of Urban Malaria Control Program (UMCP), employment conditions and community engagement practices
Summary
Community participation in vector control and health services in general is of great interest to public health practitioners in developing countries, but remains complex and poorly understood. There is general consensus about the benefits of community involvement on public health development, the strategies adopted are widely variable depending on the socio-political context, institutional culture and the nature of community organization [12,13] It is possible, for the same strategy, to produce quite different effects; where there is a high level of social solidarity, communities will actively involve themselves, whereas where there is not the response things may be more passive [5,6]. While community mobilization is perceived as a potentially powerful, unexploited resource, and a means to appropriately and efficiently meet basic health needs [7,13,14], comprehending and converting the rhetoric of community participation into reality remains a great challenge in public health [6,15,16] This is especially true in the fragmented urban societies that are characterized by heterogeneous needs and mobile human populations
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