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

Abstract

Background: To 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. Methods: Separate 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. Results: Nine 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. Conclusion: Community 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.

Household knowledge, perceptions and practices of mosquito larval source management for malaria prevention and control in Mwanza district, Malawi: a cross‐sectional study

“…These educational programmes have the potential to change the health status through new knowledge gained, changing perceptions, gaining and practicing new skills and behaviour [ 20 ]. A lack of incentives, labour-intensiveness and the time-demanding nature of LSM activities were barriers to community participation in Malawi [ 12 ].…”

“…Mosquito larval source management (LSM) methods would be useful to eliminate the main malaria vectors in SSA: Anopheles gambiae and Anopheles arabiensis [ 11 ]. Limited community participation, however, has been identified as the main barrier to LSM in Malawi [ 12 ]. Evidence suggests that the strategy is cheap and easily implementable at household and community levels [ 11 ].…”

A Comparative Analysis of Determinants of Household Knowledge of Split and Grouped Mosquito Larval Source Management for Malaria Prevention and Control in Rural Malawi

“…In general, people who live in grass-thatched and mudwalled homes are considered poor [6], as such these results re ect the differences in socio-economic status among respondents in the study area and elsewhere. Another Malawian study highlighted the importance of incentivizing community members to get them involved in larval control [17]. Interestingly, the odds of having knowledge of larviciding for malaria prevention and control were higher among respondents who were widowed as compared to those who were married.…”

The Role of Larval Source Management (LSM) as Malaria Elimination

“…5 In the past decade, malaria elimination activities have achieved good results. 6 However, progress in malaria elimination measures has also been followed by rapidly growing resistance, changes in vector genetics, and human behaviour that can slow malaria control, such as non-compliance with eliminating programs. 7 The current shortage of malaria interventions demonstrates the need for more effective strategies to reduce malaria transmission.…”