Browsing by Author "Matoke-Muhia, Damaris"

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Elevating larval source management as a key strategy for controlling malaria and other vector-borne diseases in Africa
(BMC, 2025-02-07) Okumu, Fredros; Moore, Sarah; Selvaraj, Prashanth; Yafin, Arnon; Juma, Elijah; Shirima, GloriaSalome; Majambere, Silas; Hardy, Andy; Knols, Bart; Msugupakulya, Betwel; Finda, Marceline; Kahamba, Najat; Thomsen, Edward; Ahmed, Ayman; Zohdy, Sarah; Chaki, Prosper; DeChant, Peter; Fornace, Kimberly; Govella, Nicodem; Gowelo, Steven; Hakizimana, Emmanuel; Hamainza, Busiku; Ijumba, Jasper; Jany, William; Kafy, Hmooda; Kaindoa, Emmanuel; Kariuki, Lenson; Kiware, Samson; Kweka, Eliningaya; Lobo, Neil; Marrenjo, Dulcisária; Matoke-Muhia, Damaris; Mbogo, Charles; McCann, Robert; Monroe,n April; Ndenga, Bryson; Ngowo, Halfan; Ochomo, Eric; Opiyo, Mercy; Reithinger, Richard; Sikaala, Chadwick; Tatarsky, Allison; Takudzwa, David; Trujillano, Fedra; Sherrard-Smith, Ellie
Larval source management (LSM) has a long history of advocacy and successes but is rarely adopted where funds are limited. The World Health Organization (WHO) guidelines on malaria prevention recommend the use of LSM as a supplementary intervention to the core vector control methods (insecticide-treated nets and indoor residual spraying), arguing that its feasibility in many settings can be limited by larval habitats being numerous, transient, and difficult to find or treat. Another key argument is that there is insufficient high-quality evidence for its effectiveness to support wide-scale implementation. However, the stagnation of progress towards malaria elimination demands that we consider additional options to the current emphasis on insecticidal commodities targeting adult mosquitoes inside homes. This letter is the result of a global, crossdisciplinary collaboration comprising: (a) detailed online expert discussions, (b) a narrative review of countries that have eliminated local malaria transmission, and (c) a mathematical modeling exercise using two different approaches. Together, these efforts culminated in seven key recommendations for elevating larval source management as a strategy for controlling malaria and other mosquito-borne diseases in Africa (Box 1). LSM encompasses the use of larvicide (a commodity) as well as various environmental sanitation measures. Together, these efforts lead to the long-term reduction of mosquito populations, which benefits the entire community by controlling both disease vector and nuisance mosquitoes. In this paper, we argue that the heavy reliance on large-scale cluster-randomized controlled trials (CRTs) to generate evidence on epidemiological endpoints restricts the recommendation of approaches to only those interventions that can be measured by functional units and deliver relatively uniform impact and, therefore, are more likely to receive financial support for conducting these trials. The explicit impacts of LSM may be better captured by using alternative evaluation approaches, especially high-quality operational data and a recognition of locally distinct outcomes and tailored strategies. LSM contributions are also evidenced by the widespread use of LSM strategies in nearly all countries that have successfully achieved malaria elimination. Two modelling approaches demonstrate that a multifaceted strategy, which incorporates LSM as a central intervention alongside other vector control methods, can effectively mitigate key biological threats such as insecticide resistance and outdoor biting, leading to substantial reductions in malaria cases in representative African settings. This argument is extended to show that the available evidence is sufficient to establish the link between LSM approaches and reduced disease transmission of mosquito-borne illnesses. What is needed now is a significant boost in the financial resources and public health administration structures necessary to train, employ and deploy local-level workforces tasked with suppressing mosquito populations in scientifically driven and ecologically sensitive ways. In conclusion, having WHO guidelines that recognize LSM as a key intervention to be delivered in multiple contextualized forms would open the door to increased flexibility for funding and aid countries in implementing the strategies that they deem appropriate. Financially supporting the scale-up of LSM with high-quality operations monitoring for vector control in combination with other core tools can facilitate better health. The global health community should reconsider how evidence and funding are used to support LSM initiatives.
Perspectives of men and women working in vector control in Africa regarding barriers and opportunities for achieving gender inclusivity
(BMC, 2025-05-11) Ampuriire, Patience; Bofu, Ramadhani; Msugupakulya, Betwel; Mponzi, Winifrida; Matoke-Muhia, Damaris; Finda, Marceline; Okumu, Fredros
Background Gender-inclusive strategies are crucial for tackling vector-borne diseases in Africa, but most programs still overlook the lived experiences of local practitioners regarding cultural norms, power imbalances, gender stereotypes, and workplace dynamics. This study investigated the gender-related perspectives of men and women working in vector control in Africa and their recommendations for effective gender inclusivity. Methods An exploratory mixed-methods study was conducted, starting in Tanzania with 22 in-depth interviews with team leaders, seven focus group discussions with scientists and vector control practitioners and two group discussions with vector control students. This was followed by an online survey of 150 researchers, academics, technicians, students, and vector-control staff from 16 African countries. Data on gender distribution, inclusivity, divergent male–female perspectives, and related experiences, including sexual harassment, were analysed thematically for qualitative responses and descriptively for survey responses. Results The study revealed significant gender disparities in staffing and leadership of vector control programmes in Africa, with 70.3% of men and only 40.7% of women having held leadership roles. Men occupied most vector-control roles, except in acadaemia where parity is maintained until master's degree level but biased towards men at PhD levels. Marriage weighed more heavily on women, with 44.1% of female staff remaining unmarried, compared to only 18.7% of men. Most respondents said mixed-gender teams strengthen community engagement, but they differed on effects for creativity, cost and morale, with some insisting that merit alone matters, while others seeing diversity as essential for better results. Women were more likely than men to dismiss the claims that inclusivity is ineffective or disruptive. Challenges to gender inclusivity included cultural norms limiting women's participation in overnight fieldwork, work-family pressures, and scant workplace accommodations. Men recognized the benefits of working with women but noted challenges related to societal expectations and workplace accommodations. Majority of participants (84.1%) reported had never experienced gender-based violence, but women were more likely than men to report sexual harassment. Over half of respondents believed their manager's gender significantly impacted their work environment; and some women preferred female leaders for relatability and support, while others were indifferent. Conclusion The study reveals wide gender gaps in African vector-control staffing and leadership and provides key insights for stakeholders to develop fairer workplace practices. Although the value of inclusivity is broadly recognized, cultural norms, family demands, and social expectations still weigh more heavily on women. These challenges can be addressed by incorporating a gender lens considering the perspectives of both men and women in vector control.
Preferred resting surfaces of dominant malaria vectors inside different house types in rural south-eastern Tanzania
(Springer Nature, 2020-01-15) Msugupakulya, Betwel J.; Kaindoa, Emmanuel W.; Ngowo, Halfan; Kihonda, Japhet M.; Kahamba, Najat F.; Msaky, Dickson S.; Matoke-Muhia, Damaris; Tungu, Patrick K.; Okumu, Fredros O.
Background: Malaria control in Africa relies extensively on indoor residual spraying (IRS) and insecticide-treated nets (ITNs). IRS typically targets mosquitoes resting on walls, and in few cases, roofs and ceilings, using contact insecticides. Unfortunately, little attention is paid to where malaria vectors actually rest indoors, and how such knowledge could be used to improve IRS. This study investigated preferred resting surfaces of two major malaria vectors, Anopheles funestus and Anopheles arabiensis, inside four common house types in rural south-eastern Tanzania. Methods: The assessment was done inside 80 houses including: 20 with thatched roofs and mud walls, 20 with thatched roofs and un-plastered brick walls, 20 with metal roofs and un-plastered brick walls, and 20 with metal roofs and plastered brick walls, across four villages. In each house, resting mosquitoes were sampled in mornings (6 a.m.–8 a.m.), evenings (6 p.m.–8 p.m.) and at night (11 p.m.–12.00 a.m.) using Prokopack aspirators from multiple surfaces (walls, undersides of roofs, foors, furniture, utensils, clothing, curtains and bed nets). Results: Overall, only 26% of An. funestus and 18% of An. arabiensis were found on walls. In grass-thatched houses, 33–55% of An. funestus and 43–50% of An. arabiensis rested under roofs, while in metal-roofed houses, only 16–20% of An. funestus and 8–30% of An. arabiensis rested under roofs. Considering all data together, approximately 40% of mosquitoes rested on surfaces not typically targeted by IRS, i.e. foors, furniture, utensils, clothing and bed nets. These proportions were particularly high in metal-roofed houses (47–53% of An. funestus; 60–66% of An. arabiensis). Conclusion: While IRS typically uses contact insecticides to target adult mosquitoes on walls, and occasionally roofs and ceilings, signifcant proportions of vectors rest on surfaces not usually sprayed. This gap exceeds one-third of malaria mosquitoes in grass-thatched houses, and can reach two-thirds in metal-roofed houses. Where feld opera‑ tions exclude roofs during IRS, the gaps can be much greater. In conclusion, there is need for locally-obtained data on mosquito resting behaviours and how these infuence the overall impact and costs of IRS. This study also emphasizes the need for alternative approaches, e.g. house screening, which broadly tackle mosquitoes beyond areas reachable by IRS and ITNs.