Process Evaluation of a Community-Based Microbial Larviciding Intervention for Malaria Control in Rural Tanzania.

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2020-10-07

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Abstract

Microbial larviciding can be an effective component of integrated vector management malaria control schemes, although it is not commonly implemented. Moreover, quality control and evaluation of intervention activities are essential to evaluate the potential of community-based larviciding interventions. We conducted a process evaluation of a larval source management intervention in rural Tanzania where local staff were employed to apply microbial larvicide to mosquito breeding habitats with the aim of long-term reductions in malaria transmission. We developed a logic model to guide the process evaluation and then established quantitative indicators to measure intervention success. Quantitative analysis of intervention reach, exposure, and fidelity was performed to assess larvicide application, and interviews with larviciding staff were reviewed to provide context to quantitative results. Results indicate that the intervention was successful in terms of reach, as staff applied microbial larvicide at 80% of identified mosquito breeding habitats. However, the dosage of larvicide applied was sufficient to ensure larval elimination at only 26% of sites, which does not meet the standard set for intervention fidelity. We propose that insufficient training and protocol adaptation, environment and resource issues, and human error contributed to low larvicide application rates. This demonstrates how several small, context-specific details in sum can result in meaningful differences between intervention blueprint and execution. These findings may serve the design of other larval source management interventions by demonstrating the value of additional training, supervision, and measurement and evaluation of protocol adherence.

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10.3390/ijerph17197309

Publication Info

Berlin Rubin, Nina, Leonard EG Mboera, Adriane Lesser, Marie Lynn Miranda and Randall Kramer (2020). Process Evaluation of a Community-Based Microbial Larviciding Intervention for Malaria Control in Rural Tanzania. International journal of environmental research and public health, 17(19). pp. 1–11. 10.3390/ijerph17197309 Retrieved from https://hdl.handle.net/10161/24530.

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Scholars@Duke

Kramer

Randall Kramer

Juli Plant Grainger Professor Emeritus of Global Environmental Health

Before coming to Duke in 1988, he was on the faculty at Virginia Polytechnic Institute and State University. He has held visiting positions at IUCN--The World Conservation Union, the Economic Growth Center at Yale University, and the Indonesian Ministry of Forestry. He has served as a consultant to the World Bank, World Health Organization and other international organizations. He was named Duke University's Scholar Teacher of the Year in 2004.

Kramer's research is focused on the economics of ecosystem services and on global environmental health. He is currently conducting a study on the effects of human land use decisions on biodiversity, infectious disease transmission and human health in rural Madagascar. Recent research projects have used decision analysis and implementation science to evaluate the health, social and environmental impacts of alternative malaria control strategies in East Africa. He has also conducted research on health systems strengthening, economic valuation of lives saved from air pollution reduction. and the role of ecosystems services in protecting human health.


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