Abstract
The rapid expansion of insecticide resistance and outdoor malaria transmission are affecting the efficacy of current malaria control measures. In urban settings, where malaria transmission is focal and breeding habitats are few, fixed and findable, the addition of anti-larval control measures could be efficient for malaria vector control. But field evidences for this approach remains scarce. Here we provide findings of a randomized-control larviciding trial conducted in the city of Yaoundé that support the efficacy of this approach. A two arms random control trial design including 26 clusters of 2 to 4 km2 each (13 clusters in the intervention area and 13 in the non-intervention area) was used to assess larviciding efficacy. The microbial larvicide VectoMax combining Bacillus thuringiensis var israelensis (Bti) and Bacillus sphaericus in a single granule was applied every 2 weeks in all standing water collection points. The anopheline density collected using CDC light traps was used as the primary outcome, secondary outcomes included the entomological inoculation rate, breeding habitats with anopheline larvae, and larval density. Baseline entomological data collection was conducted for 17 months from March 2017 to July 2018 and the intervention lasted 26 months from September 2018 to November 2020. The intervention was associated with a reduction of 68% of adult anopheline biting density and of 79% of the entomological inoculation rate (OR 0.21; 95% CI 0.14–0.30, P < 0.0001). A reduction of 68.27% was recorded for indoor biting anophelines and 57.74% for outdoor biting anophelines. No impact on the composition of anopheline species was recorded. A reduction of over 35% of adult Culex biting densities was recorded. The study indicated high efficacy of larviciding for reducing malaria transmission intensity in the city of Yaoundé. Larviciding could be part of an integrated control approach for controlling malaria vectors and other mosquito species in the urban environment.
Highlights
The rapid expansion of insecticide resistance and outdoor malaria transmission are affecting the efficacy of current malaria control measures
The rapid demographic changes in major sub-Saharan Africa cities which are associated to large-scale unplanned urbanization including poor housing, poor drainage, inadequate waste management, multiplication of slums and environmental changes have significantly influenced the epidemiology of vector-borne diseases such as malaria and arboviruses and population health[2,3,4,5]
According to the World Health Organization (WHO) guidelines[34], Larval source management (LSM) could be integrated into malaria control or general mosquito abatement programmes once transmission has been reduced to low or moderate levels after the use of Long-lasting insecticidal nets (LLINs) or indoor residual spraying (IRS), or once these interventions have reached their maximum practical impact
Summary
The rapid expansion of insecticide resistance and outdoor malaria transmission are affecting the efficacy of current malaria control measures. Despite historical facts and new evidences on larviciding efficacy this intervention is still not largely implemented for malaria control in sub-Saharan Africa due to the limited number of unbiased studies on its efficacy or effectiveness[27,28]. The World Health Organization (WHO) issued an interim position on larviciding recommending its use in moderate to low transmission settings as a supplement to core interventions (LLINs and IRS) in areas where aquatic habitats are few fixed and findable[11]. According to the WHO guidelines[34], LSM could be integrated into malaria control or general mosquito abatement programmes once transmission has been reduced to low or moderate levels after the use of LLINs or IRS, or once these interventions have reached their maximum practical impact
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