Abstract

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.

Highlights

  • Of the more than 200 million cases of malaria occurring annually worldwide, 90% take place in sub-Saharan Africa, and 5% of global malaria deaths in 2018 were concentrated in the United Republic of Tanzania [1]

  • Implementation evaluation can have multiple priorities of Metrics objectives according to the Standard stakeholders involved [14], we follow the approach outlined by Percentage of breeding habitats identified with this study, we focus on reach, exposure, fidelity, and larvicide resources

  • Village by village frequencies of larvicide application when larvae or pupae were reported as present ranged from 79% (Mbogo) to 100% (Dibamba and Hembeti)

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Summary

Introduction

Of the more than 200 million cases of malaria occurring annually worldwide, 90% take place in sub-Saharan Africa, and 5% of global malaria deaths in 2018 were concentrated in the United Republic of Tanzania [1]. Due to structural constraints within communities and the biological interactions between parasite, vector, and environment, it is difficult to determine best practices for malaria control [2]. Popular malaria reduction strategies, such as deployment of insecticide-treated mosquito nets (ITN). Indoor residual spraying, often result in unintended downstream outcomes such as mosquito. Res. Public Health 2020, 17, 7309; doi:10.3390/ijerph17197309 www.mdpi.com/journal/ijerph

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