Community-based environmental management for malaria control: evidence from a small-scale intervention in Dar es Salaam, Tanzania

Abstract

BackgroundHistorically, environmental management has brought important achievements in malaria control and overall improvements of health conditions. Currently, however, implementation is often considered not to be cost-effective. A community-based environmental management for malaria control was conducted in Dar es Salaam between 2005 and 2007. After community sensitization, two drains were cleaned followed by maintenance. This paper assessed the impact of the intervention on community awareness, prevalence of malaria infection, and Anopheles larval presence in drains.MethodsA survey was conducted in neighbourhoods adjacent to cleaned drains; for comparison, neighbourhoods adjacent to two drains treated with larvicides and two drains under no intervention were also surveyed. Data routinely collected by the Urban Malaria Control Programme were also used. Diverse impacts were evaluated through comparison of means, odds ratios (OR), logistic regression, and time trends calculated by moving averages.ResultsIndividual awareness of health risks and intervention goals were significantly higher among sensitized neighbourhoods. A reduction in the odds of malaria infection during the post-cleaning period in intervention neighbourhoods was observed when compared to the pre-cleaning period (OR = 0.12, 95% CI 0.05–0.3, p < 0.001). During the post-cleaning period, a higher risk of infection (OR = 1.7, 95% CI 1.1–2.4, p = 0.0069) was observed in neighbourhoods under no intervention compared to intervention ones. Eighteen months after the initial cleaning, one of the drains was still clean due to continued maintenance efforts (it contained no waste materials and the water was flowing at normal velocity). A three-month moving average of the percentage of water habitats in that drain containing pupae and/or Anopheles larvae indicated a decline in larval density. In the other drain, lack of proper resources and local commitment limited success.ConclusionAlthough environmental management was historically coordinated by authoritarian/colonial regimes or by industries/corporations, its successful implementation as part of an integrated vector management framework for malaria control under democratic governments can be possible if four conditions are observed: political will and commitment, community sensitization and participation, provision of financial resources for initial cleaning and structural repairs, and inter-sectoral collaboration. Such effort not only is expected to reduce malaria transmission, but has the potential to empower communities, improve health and environmental conditions, and ultimately contribute to poverty alleviation and sustainable development.

Informing new or improved vector control tools for reducing the malaria burden in Tanzania: a qualitative exploration of perceptions of mosquitoes and methods for their control among the residents of Dar es Salaam

“…During the colonial era LSM in Dar es Salaam was the responsibility of local authorities and enforced through regulation [56]; today the majority of participants in this study perceived that LSM activities should be the collective responsibility between community members and local governments. Achieving successful LSM in democratic regimes needs four elements: political will and commitment, community sensitization and participation [62]. …”

Enhancing Malaria Prevention in Cameroon Through Community Participation: An in-Depth Review

“…[69] Communicating environmental management through social gatherings in Tanzania improved knowledge on cleaning activities by 96% (p < 0.001). [90] Community human investment in the North West Region of Cameroon usually involved male and female working together, with less gender inequity, hence, highly acceptable. [32] It is highly organisationally feasible because it follows a horizontal approach, [90] empowers local residents and strengthens local communities to deal with malaria locally.…”

“…[90] Community human investment in the North West Region of Cameroon usually involved male and female working together, with less gender inequity, hence, highly acceptable. [32] It is highly organisationally feasible because it follows a horizontal approach, [90] empowers local residents and strengthens local communities to deal with malaria locally. [91] The use of local skills and "person power" promoted ownership and reduced cost, making environmental management highly financially feasible.…”

“…[91] The use of local skills and "person power" promoted ownership and reduced cost, making environmental management highly financially feasible. [90] Community participation in environmental management promoted individual behaviour change, [32] hence is highly sustainable in malaria prevention but `grossly underused in most endemic areas. [49] b) Water, Sanitation and Hygiene (WASH) Despite being the most cost-effective means of preventing infectious diseases, [92] WASH practices dropped from 60% in 1990 to 47% in 2000 and attract less investment in SSA countries.…”

A community based model for effective malaria control in a known endemic area of a metropolitan city

“…This is probably attributable to the consistent interventions implemented in study area since year 2009 (Table 2). 5,6 The slide positivity rate in study area is estimated amongst the total number of fever cases only whereas in control area it is estimated with the denominator including both fever and non-fever cases (as per available data). Hence SPR appears to be higher in study area as compared to the control area, the "at risk" population is clearly defined in the study area and therefore the sequential decrease in the SPR in the study area is an indirect indication of the effect of the interventions carried out in the study area (Table 3).…”