Laboratory of Entomology, Wageningen University & Research, Wageningen, The Netherlands.
Training and Research Unit of Excellence, School of Public Health, College of Medicine, Blantyre, Malawi.
Malar J. 2020 Jun 2;19(1):195. doi: 10.1186/s12936-020-03268-8.
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.
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.
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.
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.
为了进一步减少疟疾，提出了幼虫源管理（LSM）作为现有策略的补充策略。LSM 具有控制抗杀虫剂、户外叮咬和户外栖息媒介的潜力。在许多非洲国家，该策略未被利用的原因之一是对成本和大规模实施的运营可行性的担忧。让社区参与 LSM 可以提高干预措施的覆盖率，降低实施成本，并提高运营的可持续性。社区对社区主导的 LSM 的接受度和参与度取决于许多因素。在马拉维南部奇克瓦瓦区的 Majete 疟疾项目下，探讨了这些因素。
分别对普通社区成员（n=3）、卫生宣传者（HA）（n=3）和 LSM 委员会成员（n=3）进行了焦点小组讨论（FGD）。对社区成员进行了深入访谈（IDI）。采用框架分析来确定促成社区接受和参与本地驱动干预的因素。
共进行了 9 次 FGD 和 24 次 IDI，涉及社区 87 名成员。记录了对疟疾作为健康问题、传播方式、蚊子幼虫栖息地和蚊子控制的广泛了解。报告了对创建幼虫栖息地与疟疾传播之间关联的高度认识。对 LSM 作为疟疾控制工具的认识很高。使用微生物幼虫剂作为 LSM 的一种形式被认为既安全又有效。然而，不同受访者群体的实际 LSM 参与情况有所不同。劳动密集型和 LSM 活动所需的时间、缺乏财务激励以及在水体中跋涉时对健康风险的担忧，导致参与度降低。
社区参与 LSM 提高了当地对疟疾作为健康问题、其危险因素和控制策略的认识。然而，受访者群体之间的社区参与度存在差异，活动的劳动和时间需求以及缺乏激励措施导致参与度降低。可以减少劳动和时间需求的创新工具可以提高社区对活动的参与度。需要进一步研究在操作社区驱动的 LSM 干预措施中激励措施的形式和交付方式。
