Browsing by Author "Msugupakulya, Betwel"

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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.
The needs and opportunities for housing improvement for malaria control in southern Tanzania
(BMC, 2023-02-27) Bofu, Ramadhani; Santos, Ellen; Msugupakulya, Betwel; Kahamba, Najat; Swilla, Joseph; Njalambaha, Rukiyah; Kelly, Ann; Lezaun, Javier; Christofides, Nicola; Okumu, Fredros; Finda, Marceline;
Background Malaria disproportionately afects low-income households in rural communities where poor housing is common. Despite evidence that well-constructed and mosquito-proofed houses can reduce malaria risk, housing improvement is rarely included in malaria control toolboxes. This study assessed the need, magnitude, and opportuni ties for housing improvement to control malaria in rural Tanzania. Methods A mixed-methods study was conducted in 19 villages across four district councils in southern Tanzania. A structured survey was administered to 1292 community members to assess need, perceptions, and opportunities for housing improvement for malaria control. Direct observations of 802 houses and surrounding environments were done to identify the actual needs and opportunities, and to validate the survey fndings. A market survey was done to assess availability and cost of resources and services necessary for mosquito-proofng homes. Focus group discussions were conducted with key stakeholders to explore insights on the potential and challenges of housing improvement as a malaria intervention. Results Compared to other methods for malaria control, housing improvement was among the best understood and most preferred by community members. Of the 735 survey respondents who needed housing improvements, a majority needed window screening (91.1%), repairs of holes in walls (79.4%), door covers (41.6%), closing of eave spaces (31.2%) and better roofs (19.0%). Community members invested signifcant eforts to improve their own homes against malaria and other dangers, but these eforts were often slow and delayed due to high costs and limited household incomes. Study participants suggested several mechanisms of support to improve their homes, including government loans and subsidies. Conclusion Addressing the need for housing improvement is a critical component of malaria control eforts in southern Tanzania. In this study, a majority of the community members surveyed needed modest modifcations and had plans to work on those modifcations. Without additional support, their eforts were however generally slow; households would take years to sufciently mosquito-proof their houses. It is, therefore, crucial to bring together the key players across sectors to reduce barriers in malaria-proofng housing in endemic settings. These may include government subsidies or partnerships with businesses to make housing improvement more accessible and afordable to residents.
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.
Societal uses of the main water bodies inhabited by malaria vectors and implications for larval source management
(Springer Nature, 2024-11-09) Kahamba, Najat; Tarimo, Felista; Kifungo, Khamisi; Mponzi, Winifrida; Kinunda, Siaba; Simfukwe, Alfred; Mapua, Salum; Msugupakulya, Betwel; Baldini, Francesco; Ferguson, Heather; Okumu, Fredros; Finda, Marceline
Background: Larval source management (LSM) effectively reduces mosquito populations at their breeding sites, addressing issues like insecticide resistance that limit the effectiveness of primary interventions such as insecticide-treated nets (ITNs). Although traditionally used in urban and dry areas, recent research suggests it might also be effective in rural settings in eastern and southern Africa, where Anopheles funestus thrives in permanent water bodies that sustain year-round transmission. Targeting these habitats could enhance LSM, but it requires understanding local community practices, as mosquito breeding sites often overlap with community water resources. This study examined how communities use aquatic habitats and how these practices may impact LSM strategies, with a focus on habitats used by An. funestus. Methods: This study was conducted in three villages in the Ulanga and Malinyi districts of southeastern Tanzania using a mixed-methods approach. Quantitative data were collected through cross-sectional surveillance, and qualitative data through unstructured interviews, focus group discussions, and field observations. Data analysis integrated both quantitative and qualitative findings to develop a comprehensive understanding of community perspectives. Results: A survey of 931 aquatic habitats found mosquito larvae in 73% of them, with late instar An. funestus present in 23%. River streams made up 41% of the habitats, while ground pools accounted for 4%. Most habitats (90%) were used by communities, including 95% of those with An. funestus larvae, for activities such as domestic chores, agriculture, livestock rearing, brickmaking, and fishing. Focus group discussions revealed a willingness to adopt LSM, with a preference for larviciding and habitat modification over habitat removal, as the water sources were vital for daily use. Community concerns centered on the safety of larvicides for humans and animals, the environmental impact, and the need for better awareness of how LSM affects health and livelihoods. Conclusion: This study highlights community perspectives on LSM, focusing on the dual function of aquatic habitats as mosquito breeding sites and essential community water sources. This dual role presents both challenges and opportunities, suggesting that LSM strategies must balance public health needs with socio-economic realities. There was a clear preference for larviciding and habitat modification over removal, with a strong emphasis on health and environmental safety. The study emphasizes the importance of educating communities on the safety and effectiveness of LSM, and tailoring LSM strategies to fit the needs and preferences of local communities.