Malaria vector control tools in emergency settings: What do experts think? Results from a DELPHI survey

Abstract

Background The use and implementation of novel tools for malaria control such as long lasting impregnated bednets (LLINs) and Indoor Residual Spraying (IRS) over the last decade has contributed to a substantial reduction in malaria burden globally. However numerous challenges exist particularly in relation to vector control in emergency settings. This study seeks to explore expert opinion on the utility of existing tools within the emergency context setting and to better understand the attitude towards emerging and innovative tools (including Genetically Modified Mosquitoes) to augment current approaches. Methods 80 experts in the field of malaria and vector control were invited to participate in a two-round Delphi survey. They were selected through a combination of literature (academic and policy publications) review and snowball sampling reflecting a range of relevant backgrounds including vector control experts, malaria programme managers and emergency response specialists. The survey was conducted online through a questionnaire including the possibility for free text entry, and concentrated on the following topics: Utility and sustainability of current vector control tools, both in and outside emergency settings Feasibility, utility and challenges of emerging vector control tools, both in and outside emergency settings Current and unmet research priorities in malaria vector control and in malaria control in general. Results 37 experts completed the first round and 31 completed the second round of the survey. There was a stronger consensus about the increased utility of LLIN compared to IRS in all settings, while insecticide-treated covers and blankets ranked very high only in emergency settings. When considering the combination of tools, the ones deemed most interesting always involved LLINs and IRS regardless of the setting, and the acceptability and the efficacy at reducing transmission are essential characteristics. Regarding perceptions of tools currently under development, consensus was towards improvement of existing tools rather than investing in novel approaches and the majority of respondents expressed distrust for genetic approaches. Conclusion Malaria vector control experts expressed more confidence for tools whose efficacy is backed up by epidemiological evidence, hence a preference for the improvement rather than the combination of existing tools. Moreover, while several novel tools are under development, the majority of innovative approaches did not receive support, particularly in emergency settings. Stakeholders involved in the development of novel tools should involve earlier and raise awareness of the potential effectiveness amongst a wider range of experts within the malaria community to increase acceptability and improve early adoption once the evidence base is established.

Mixed-method evaluation study of a targeted mass drug administration of long-acting anti-malarials among children aged 3 months to 15 years in the Bossangoa sub-prefecture, Ouham, Central African Republic, during the COVID-19 pandemic

“…A more standardized methodology for evaluating malaria prevention interventions, such as LLIN, IRS, IPTi or packages of interventions in humanitarian emergencies, including common epidemiological endpoints, would help inform the selection and prioritization of interventions [ 28 , 29 ]. In the interim, while further evidence and information amasses, decision-makers will need to base decisions on other contextual factors such as past and present intervention coverage; acceptability; equality and equity of access and use; and available resources while ensuring the core intervention of LLIN and case management achieve high coverage.…”

Exploring the hidden mental health consequences of malaria beyond the fever

“…In terms of lowering mortality or treatment-related effects such as neurocognitive impairments, current malarial biology therapeutics are still insufficient and ( Siddiqui et al, 2020 ) there is no effective therapy available for addressing the cognitive and behavioral effects resulting from malaria, which necessitates the need for conducting psychological research, developing comprehensive healthcare strategies, and targeted therapies, and collaborating across sectors to address malaria’s impact on cognition. Implementing preventive measures like insecticide-treated bed nets and rapid access to care and effective treatment of uncomplicated malaria is crucial for preventing SM and its complications ( Conroy et al, 2019 ; Boëte et al, 2021 ).…”