Assessment of the growth in social groups for sustainable agriculture and land management
Pretty, Jules ; Attwood, Simon ; Bawden, Richard ; Berg, Henk Van Den; Bharucha, Zareen P. ; Dixon, John ; Flora, Cornelia Butler ; Gallagher, Kevin ; Genskow, Ken ; Hartley, Sue E. ; Ketelaar, Jan Willem ; Kiara, Japhet K. ; Kumar, Vijay ; Lu, Yuelai ; Macmillan, Tom ; Maréchal, Anne ; Morales-Abubakar, Alma Linda ; Noble, Andrew ; Prasad, P.V.V. ; Rametsteiner, Ewald ; Reganold, John ; Ricks, Jacob I. ; Rockström, Johan ; Saito, Osamu ; Thorne, Peter ; Wang, Songliang ; Wittman, Hannah ; Winter, Michael ; Yang, Puyun - \ 2020
Global Sustainability 3 (2020). - ISSN 2059-4798
collective management - land management - social capital - social groups - sustainable agriculture
Non-technical summaryUntil the past half-century, all agriculture and land management was framed by local institutions strong in social capital. But neoliberal forms of development came to undermine existing structures, thus reducing sustainability and equity. The past 20 years, though, have seen the deliberate establishment of more than 8 million new social groups across the world. This restructuring and growth of rural social capital within specific territories is leading to increased productivity of agricultural and land management systems, with particular benefits for those previously excluded. Further growth would occur with more national and regional policy support.
Pesticide lifecycle management in agriculture and public health : Where are the gaps?
Berg, Henk van den; Gu, Baogen ; Grenier, Beatrice ; Kohlschmid, Eva ; Al-Eryani, Samira ; Silva Bezerra, Haroldo Sergio da; Nagpal, Bhupender N. ; Chanda, Emmanuel ; Gasimov, Elkhan ; Velayudhan, Raman ; Yadav, Rajpal S. - \ 2020
Science of the Total Environment 742 (2020). - ISSN 0048-9697
Insecticide resistance - Lifecycle management - Pest control - Pesticide management - Risk reduction - Vector control
Pesticide lifecycle management encompasses a range of elements from legislation, regulation, manufacturing, application, risk reduction, monitoring, and enforcement to disposal of pesticide waste. A survey was conducted in 2017–2018 to describe the contemporary global status of pesticide lifecycle management, to identify where the gaps are found. A three-tiered questionnaire was distributed to government entities in 194 countries. The response rate was 29%, 27% and 48% to the first, second and third part of the questionnaire, respectively. The results showed gaps for most of the selected indicators of pesticide management, suggesting that pesticide efficacy and safety to human health and the environment are likely being compromised at various stages of the pesticide lifecycle, and at varying degrees across the globe. Low-income countries generally had the highest incidence of gaps. Particular shortcomings were deficiencies in pesticide legislation, inadequate capacity for pesticide registration, protection against occupational exposure to pesticides, consumer protection against residues in food, and environmental protection against pesticide contamination. Policy support for, and implementation of, pesticide use-reduction strategies such as integrated pest management and integrated vector management has been inadequate across regions. Priority actions for structural improvement in pesticide lifecycle management are proposed, including pesticide use-reduction strategies, targeted interventions, and resource mobilization.
Characterisation of anopheline larval habitats in southern Malawi
Gowelo, Steven ; Chirombo, James ; Koenraadt, Constantianus J.M. ; Mzilahowa, Themba ; Berg, Henk van den; Takken, Willem ; McCann, Robert S. - \ 2020
Acta Tropica 210 (2020). - ISSN 0001-706X
Habitat characterization - Larval ecology - Malaria mosquito
Introduction: Increasing the knowledgebase of anopheline larval ecology could enable targeted deployment of malaria control efforts and consequently reduce costs of implementation. In Malawi, there exists a knowledge gap in anopheline larval ecology and, therefore, basis for targeted deployment of larval source management (LSM) for malaria control, specifically larvicides. We set out to characterize anopheline larval habitats in the Majete area of Malawi on the basis of habitat ecology and anopheline larval productivity to create a basis for larval control initiatives in the country. Methods: Longitudinal surveys were conducted in randomly selected larval habitats over a period of fifteen months in Chikwawa district, southern Malawi. Biotic and abiotic parameters of the habitats were modelled to determine their effect on the occurrence and densities of anopheline larvae. Results: Seventy aquatic habitats were individually visited between 1-7 times over the study period. A total of 5,123 immature mosquitoes (3,359 anophelines, 1,497 culicines and 267 pupae) were collected. Anopheline and culicine larvae were observed in sympatry in aquatic habitats. Of the nine habitat types followed, dams, swamps, ponds, borehole runoffs and drainage channels were the five most productive habitat types for anopheline mosquitoes. Anopheline densities were higher in aquatic habitats with bare soil making up part of the surrounding land cover (p<0.01) and in aquatic habitats with culicine larvae (p<0.01) than in those surrounded by vegetation and not occupied by culicine larvae. Anopheline densities were significantly lower in highly turbid habitats than in clearer habitats (p<0.01). Presence of predators in the aquatic habitats significantly reduced the probability of anopheline larvae being present (p=0.04). Conclusions: Anopheline larval habitats are widespread in the study area. Presence of bare soil, culicine larvae, predators and the level of turbidity of water are the main determinants of anopheline larval densities in aquatic habitats in Majete, Malawi. While the most productive aquatic habitats should be prioritised, for the most effective control of vectors in the area all available aquatic habitats should be targeted, even those that are not characterized by the identified predictors. Further research is needed to determine whether targeted LSM would be cost-effective when habitat characterisation is included in cost analyses and to establish what methods would make the characterisation of habitats easier.
Is the farmer field school still relevant? Case studies from Malawi and Indonesia
Berg, Henk van den; Ketelaar, Jan Willem ; Dicke, Marcel ; Fredrix, Marjon - \ 2020
NJAS Wageningen Journal of Life Sciences 92 (2020). - ISSN 1573-5214
Adult education - Farmer field school - Impact evaluation - Rural development - Sustainable rural livelihoods
The capacity of farmers to adapt to changing environments is critical for sustainable, economically viable and resilient rural development. The Farmer Field School (FFS) was developed by FAO in the late 1980s to build farmers’ knowledge and skills for adaptive management. The FFS was subsequently implemented in over 90 countries by a multitude of stakeholders. We conducted case studies in Malawi and Indonesia to answer contemporary questions about the FFS, regarding its relevance at field level, its position in the institutional environment, and its contribution to rural development. We show that the FFS remains relevant at field level, helping farmers to adapt their agricultural practices and livelihood situation to changing circumstances. Differences in institutional arrangements between the two countries highlight the importance of a coordinated support for the FFS. Long-term impacts were found at farmer and institutional level. This study provides insight into the FFS, regarding the causal factors of change, institutional factors, and the role in continued development. As an approach that empowers rural people, the FFS thus contributes to achieving the Sustainable Development Goals.
Impacts of farmer field schools in the human, social, natural and financial domain : a qualitative review
Berg, Henk van den; Phillips, Suzanne ; Dicke, Marcel ; Fredrix, Marjon - \ 2020
Food Security (2020). - ISSN 1876-4517
Adult education - Farmer field school - Impact assessment - Sustainable rural livelihoods
The Farmer Field School (FFS) is a widely used method seeking to educate farmers to adapt agricultural decisions to diverse and variable field conditions. Out of 218 screened studies, 65 were selected to review the impact of the FFS. An analytical framework was developed with effects (outputs, outcomes and impacts) arranged according to the human, social, natural and financial domains. Impacts on non-participants of the FFS were addressed as peripheral effects. The FFS demonstrated its potential to enhance human, social, natural and financial capital of rural communities. Human capital was built in the form of critical thinking, innovation, confidence, and quality of life. Effects on social capital included mutual trust, bonding, collective action, networking, and emancipation. Natural capital was enhanced through improvements in field practices, food production, agricultural diversification, and food security. Financial capital was enhanced through increased income and profits, savings and loans schemes, with a potential to reduce poverty. The available body of evidence was unbalanced across the capital domains, providing high coverage of the natural domain but low coverage of the human, social and financial domains. In-depth case studies are needed to elucidate the interactions between livelihood assets, and the influences of the policy, institutional and external environment, in order to adjust FFS interventions aiming to optimize their impacts. Considering the positive effects the FFS can have on rural livelihoods, the FFS has potential to contribute to achieving the Sustainable Development Goals. However, quality assurance of the FFS and a balanced evaluation across the capital domains require attention.
Community factors affecting participation in larval source management for malaria control in Chikwawa District, Southern Malawi
Gowelo, Steven ; McCann, Robert S. ; Koenraadt, Constantianus J.M. ; Takken, Willem ; Berg, Henk van den; Manda-Taylor, Lucinda - \ 2020
Malaria Journal 19 (2020)1. - ISSN 1475-2875 - 1 p.
Bacillus thuringiensis israelensis - Community - Larval source management - Malaria - Malawi
BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSION: 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.
Effects of larval exposure to sublethal doses of Bacillus thuringiensis var. israelensis on body size, oviposition and survival of adult Anopheles coluzzii mosquitoes
Gowelo, Steven ; Chirombo, James ; Spitzen, Jeroen ; Koenraadt, Constantianus J.M. ; Mzilahowa, Themba ; Berg, Henk Van Den; Takken, Willem ; McCann, Robert - \ 2020
Parasites & Vectors 13 (2020)1. - ISSN 1756-3305
Bacillus thuringiensis var. israelensis - Larval source management - Mosquito - Sublethal dose - Vector control
Background: Application of the larvicide Bacillus thuringiensis var. israelensis (Bti) is a viable complementary strategy for malaria control. Efficacy of Bti is dose-dependent. There is a knowledge gap on the effects of larval exposure to sublethal Bti doses on emerging adult mosquitoes. The present study examined the effect of larval exposure to sublethal doses of Bti on the survival, body size and oviposition rate in adult Anopheles coluzzii. Methods: Third-instar An. coluzzii larvae were exposed to control and sublethal Bti concentrations at LC20, LC50 and LC70 for 48 h. Surviving larvae were reared to adults under standard colony conditions. Thirty randomly selected females from each treatment were placed in separate cages and allowed to blood feed. Twenty-five gravid females from the blood-feeding cages were randomly selected and transferred into new cages where they were provided with oviposition cups. Numbers of eggs laid in each cage and mortality of all adult mosquitoes were recorded daily. Wing lengths were measured of 570 mosquitoes as a proxy for body size. Results: Exposure to LC70 Bti doses for 48 h as third-instar larvae reduced longevity of adult An. coluzzii mosquitoes. Time to death was 2.58 times shorter in females exposed to LC70 Bti when compared to the control females. Estimated mortality hazard rates were also higher in females exposed to the LC50 and LC20 treatments, but these differences were not statistically significant. The females exposed to LC70 concentrations had 12% longer wings than the control group (P < 0.01). No differences in oviposition rate of the gravid females were observed between the treatments. Conclusions: Exposure of An. coluzzii larvae to sublethal Bti doses reduces longevity of resultant adults and is associated with larger adult size and unclear effect on oviposition. These findings suggest that anopheline larval exposure to sublethal Bti doses, though not recommended, could reduce vectorial capacity for malaria vector populations by increasing mortality of resultant adults.[Figure not available: See fulltext.]
A qualitative exploration of the experiences of community health animation on malaria control in rural Malawi
Malenga, Tumaini ; Griffiths, Frances E. ; Berg, Marrit Van Den; Berg, Henk Van Den; Vugt, Michèle Van; Phiri, Kamija Samuel ; Manda-Taylor, Lucinda ; Umar, Eric - \ 2020
Globalization and Health 16 (2020)1. - ISSN 1744-8603
Behaviour change communication - Community engagement - Community health animator - Health animation - Health education - Malaria
Background: While great strides have been achieved in fighting malaria through the Roll Back Malaria (RBM) strategy, the recent world malaria report shows an increase in malaria-related deaths compared to previous years. Malaria control tools are efficacious and effective in preventing the disease; however, the human behaviour aspect of the intervention strategies is weak due to heavy reliance on positive human health behaviour. The challenge lies in adoption of control interventions by the target population which, to an extent, may include access to prevention and treatment tools. We present a qualitative assessment of the use of the Health Animator (HA) model for Information, Education and Communication (IEC) to improve adoption and use of malaria control by promoting positive health behaviours. Results: We conducted 3 Focus Group Discussions (FGDs) and 23 individual in-depth interviews (IDIs) with HAs. Each FGD consisted of 8 participants. Data was analysed using QSR International NVivo 10 software. There are four main themes emerging regarding HA experiences. The perceptions include; collaborative work experience, personal motivation and growth, community participation with health animation and challenges with implementation. Results suggest that HAs were pleased with the training as they gained new information regarding malaria, which affected their use of malaria control interventions within their families. Knowledge was well assimilated from the trainings and influenced personal growth in becoming a community leader. Support from the leadership within the village and the health system was important in legitimising the main messages. The community responded positively to the workshops valued the information imparted. The voluntary nature of the work in a poverty-stricken community affected sustainability. Conclusions: There is need to empower communities with strategies within their reach. Functioning traditional social support structures are a crucial element in sustainability. Voluntarism is also key for sustainability, especially for rural and remote communities with limited sources of income.
The role of health animators in malaria control: A qualitative study of the health animator (HA) approach within the Majete malaria project (MMP) in Chikwawa District, Malawi
Kaunda-Khangamwa, Blessings N. ; Berg, Henk Van Den; McCann, Robert S. ; Kabaghe, Alinune ; Takken, Willem ; Phiri, Kamija ; Vugt, Michele Van; Manda-Taylor, Lucinda - \ 2019
BMC Health services research 19 (2019)1. - ISSN 1472-6963
Community health workers - Malaria volunteers - Malaria workshop meetings - Malawi - Social capital theory
Background: Malaria continues to place a high burden on communities due to challenges reaching intervention target levels in Chikwawa District, Malawi. The Hunger Project Malawi is using a health animator approach (HA) to address gaps in malaria control coverage. We explored the influence of community-based volunteers known as health animators (HAs) in malaria control. We assessed the impact of HAs on knowledge, attitudes, and practices towards malaria interventions. Methods: This paper draws on the qualitative data collected to explore the roles of communities, HAs and formal health workers attending and not attending malaria workshops for malaria control. Purposive sampling was used to select 78 respondents. We conducted 10 separate focus group discussions (FGDs)-(n = 6) with community members and (n = 4) key informants. Nine in-depth interviews (IDIs) were held with HAs and Health Surveillance Assistants (HSAs) in three focal areas near Majete Wildlife Reserve. Nvivo 11 was used for coding and analysis. We employed the framework analysis and social capital theory to determine how the intervention influenced health and social outcomes. Results: Using education, feedback sessions and advocacy in malaria workshop had mixed outcomes. There was a high awareness of community participation and comprehensive knowledge of the HA approach as key to malaria control. HAs were identified as playing a complementary role in malaria intervention. Community members' attitudes towards advocacy for better health services were poor. Attendance in malaria workshops was sporadic towards the final year of the intervention. Respondents mentioned positive attitudes and practices on net usage for prevention and prompt health-seeking behaviours. Conclusion: The HA approach is a useful strategy for complementing malaria prevention strategies in rural communities and improving practices for health-seeking behaviour. Various factors influence HAs' motivation, retention, community engagement, and programme sustainability. However, little is known about how these factors interact to influence volunteers' motivation, community participation and sustainability over time. More research is needed to explore the acceptability of an HA approach and the impact on malaria control in other rural communities in Malawi.
Biting patterns of malaria vectors of the lower Shire valley, southern Malawi
Mburu, Monicah M. ; Mzilahowa, Themba ; Amoah, Benjamin ; Chifundo, Duster ; Phiri, Kamija S. ; Berg, Henk van den; Takken, Willem ; McCann, Robert S. - \ 2019
Acta Tropica 197 (2019). - ISSN 0001-706X
Anophelines - Biting - Culicines - HLC - Indoors - Malawi - Outdoors
Assessing the biting behaviour of malaria vectors plays an integral role in understanding the dynamics of malaria transmission in a region. Biting times and preference for biting indoors or outdoors varies among mosquito species and across regions. These behaviours may also change over time in response to vector control measures such as long-lasting insecticidal nets (LLINs). Data on these parameters can provide the sites and times at which different interventions would be effective for vector control. This study assessed the biting patterns of malaria vectors in Chikwawa district, southern Malawi. The study was conducted during the dry and wet seasons in 2016 and 2017, respectively. In each season, mosquitoes were collected indoors and outdoors for 24 nights in six houses per night using the human landing catch. Volunteers were organized into six teams of two individuals, whereby three teams collected mosquitoes indoors and the other three collected mosquitoes outdoors each night, and the teams were rotated among twelve houses. All data were analyzed using Poisson log-linear models. The most abundant species were Anopheles gambiae sensu lato (primarily An. arabiensis) and An. funestus s.l. (exclusively An. funestus s.s.). During the dry season, the biting activity of An. gambiaes.l. was constant outdoors across the categorized hours (18:00 h to 08:45 h), but highest in the late evening hours (21:00 h to 23:45 h) during the wet season. The biting activity of An. funestus s.l. was highest in the late evening hours (21:00 h to 23:45 h) during the dry season and in the late night hours (03:00 h to 05:45 h) during the wet season. Whereas the number of An. funestuss.l. biting was constant (P = 0.662) in both seasons, that of An. gambiaes.l. was higher during the wet season than in the dry season (P = 0.001). Anopheles gambiae s.l. was more likely to bite outdoors than indoors in both seasons. During the wet season, An. funestus s.l. was more likely to bite indoors than outdoors but during the dry season, the bites were similar both indoors and outdoors. The biting activity that occurred in the early and late evening hours, both indoors and outdoors coincides with the times at which individuals may still be awake and physically active, and therefore unprotected by LLINs. Additionally, a substantial number of anopheline bites occurred outdoors. These findings imply that LLINs would only provide partial protection from malaria vectors, which would affect malaria transmission in this area. Therefore, protection against bites by malaria mosquitoes in the early and late evening hours is essential and can be achieved by designing interventions that reduce vector-host contacts during this period.
Assessment of the Suna trap for sampling mosquitoes indoors and outdoors
Mburu, Monicah M. ; Zembere, Kennedy ; Hiscox, Alexandra ; Banda, Jomo ; Phiri, Kamija S. ; Berg, Henk Van Den; Mzilahowa, Themba ; Takken, Willem ; McCann, Robert S. - \ 2019
Malaria Journal 18 (2019)1. - ISSN 1475-2875
Anophelines - CDC-LT - Culicines - Efficiency - HLC - Indoors - Outdoors - Sampling - Simultaneous use - Suna trap
Background: Entomological monitoring is important for public health because it provides data on the distribution, abundance and host-seeking behaviour of disease vectors. Various methods for sampling mosquitoes exist, most of which are biased towards, or specifically target, certain portions of a mosquito population. This study assessed the Suna trap, an odour-baited trap for sampling host-seeking mosquitoes both indoors and outdoors. Methods: Two separate field experiments were conducted in villages in southern Malawi. The efficiency of the Suna trap in sampling mosquitoes was compared to that of the human landing catch (HLC) indoors and outdoors and the Centers for Disease, Control and Prevention Light Trap (CDC-LT) indoors. Potential competition between two Suna traps during simultaneous use of the traps indoors and outdoors was assessed by comparing mosquito catch sizes across three treatments: one trap indoors only; one trap outdoors only; and one trap indoors and one trap outdoors used simultaneously at the same house. Results: The efficiency of the Suna trap in sampling female anophelines was similar to that of HLC indoors (P = 0.271) and HLC outdoors (P = 0.125), but lower than that of CDC-LT indoors (P = 0.001). Anopheline catch sizes in the Suna trap used alone indoors were similar to indoor Suna trap catch sizes when another Suna trap was simultaneously present outdoors (P = 0.891). Similarly, catch sizes of female anophelines with the Suna trap outdoors were similar to those that were caught outdoors when another Suna trap was simultaneously present indoors (P = 0.731). Conclusions: The efficiency of the Suna trap in sampling mosquitoes was equivalent to that of the HLC. Whereas the CDC-LT was more efficient in collecting female anophelines indoors, the use of this trap outdoors is limited given the requirement of setting it next to an occupied bed net. As demonstrated in this research, outdoor collections are also essential because they provide data on the relative contribution of outdoor biting to malaria transmission. Therefore, the Suna trap could serve as an alternative to the HLC and the CDC-LT, because it does not require the use of humans as natural baits, allows standardised sampling conditions across sampling points, and can be used outdoors. Furthermore, using two Suna traps simultaneously indoors and outdoors does not interfere with the sampling efficiency of either trap, which would save a considerable amount of time, energy, and resources compared to setting the traps indoors and then outdoors in two consecutive nights.
Reducing contamination risk in cluster-randomized infectious disease-intervention trials
McCann, Robert S. ; Berg, Henk van den; Takken, Willem ; Chetwynd, Amanda G. ; Giorgi, Emanuele ; Terlouw, Dianne J. ; Diggle, Peter J. - \ 2018
International Journal of Epidemiology 47 (2018)6. - ISSN 0300-5771 - p. 2015 - 2024.
Cluster-randomized trial - Contamination - Randomization - Spatial heterogeneity - Statistical precision - Study design
Background: Infectious disease interventions are increasingly tested using cluster-randomized trials (CRTs). These trial settings tend to involve a set of sampling units, such as villages, whose geographic arrangement may present a contamination risk in treatment exposure. The most widely used approach for reducing contamination in these settings is the so-called fried-egg design, which excludes the outer portion of all available clusters from the primary trial analysis. However, the fried-egg design ignores potential intra-cluster spatial heterogeneity and makes the outcome measure inherently less precise. Whereas the fried-egg design may be appropriate in specific settings, alternative methods to optimize the design of CRTs in other settings are lacking. Methods: We present a novel approach for CRT design that either fully includes or fully excludes available clusters in a defined study region, recognizing the potential for intra-cluster spatial heterogeneity. The approach includes an algorithm that allows investigators to identify the maximum number of clusters that could be included for a defined study region and maintain randomness in both the selection of included clusters and the allocation of clusters to either the treatment group or control group. The approach was applied to the design of a CRT testing the effectiveness of malaria vector-control interventions in southern Malawi. Conclusions: Those planning CRTs to evaluate interventions should consider the approach presented here during trial design. The approach provides a novel framework for reducing the risk of contamination among the CRT randomization units in settings where investigators determine the reduction of contamination risk as a high priority and where intra-cluster spatial heterogeneity is likely. By maintaining randomness in the allocation of clusters to either the treatment group or control group, the approach also permits a randomization-valid test of the primary trial hypothesis.
Prevention Efforts for Malaria
Tizifa, Tinashe A. ; Kabaghe, Alinune N. ; McCann, Robert S. ; Berg, Henk van den; Vugt, Michele van; Phiri, Kamija S. - \ 2018
Current Tropical Medicine Reports 5 (2018)1. - ISSN 2196-3045 - p. 41 - 50.
Community mobilization - Malaria - Methods under development - Prevention in high-risk populations - Sub-Saharan Africa - Vector control
Purpose of Review: Malaria remains a global burden contributing to morbidity and mortality especially in children under 5 years of age. Despite the progress achieved towards malaria burden reduction, achieving elimination in more countries remains a challenge. This article aims to review the prevention and control strategies for malaria, to assess their impact towards reducing the disease burden and to highlight the best practices observed. Recent Findings: Use of long-lasting insecticide-treated nets and indoor residual spraying has resulted a decline in the incidence and prevalence of malaria in Sub-Saharan Africa. Other strategies such as larval source management have been shown to reduce mosquito density but require further evaluation. New methods under development such as house improvement have demonstrated to minimize disease burden but require further evidence on efficacy. Development of the RTS,S/AS01 malaria vaccine that provides protection in under-five children has provided further progress in efforts of malaria control. Summary: There has been a tremendous reduction in malaria burden in the past decade; however, more work is required to fill the necessary gaps to eliminate malaria.
Community-based malaria control in southern Malawi : A description of experimental interventions of community workshops, house improvement and larval source management
Berg, Henk van den; Vugt, Michèle van; Kabaghe, Alinune N. ; Nkalapa, Mackenzie ; Kaotcha, Rowlands ; Truwah, Zinenani ; Malenga, Tumaini ; Kadama, Asante ; Banda, Saidon ; Tizifa, Tinashe ; Gowelo, Steven ; Mburu, Monicah M. ; Phiri, Kamija S. ; Takken, Willem ; McCann, Robert S. - \ 2018
Malaria Journal 17 (2018)1. - ISSN 1475-2875
Community participation - Community workshops - Health education - House improvement - Integrated vector management - Larval source management - Malaria transmission - Vector control
Background: Increased engagement of communities has been emphasized in global plans for malaria control and elimination. Three interventions to reinforce and complement national malaria control recommendations were developed and applied within the context of a broad-based development initiative, targeting a rural population surrounding a wildlife reserve. The interventions, which were part of a 2-year research trial, and assigned to the village level, were implemented through trained local volunteers, or 'health animators', who educated the community and facilitated collective action. Results: Community workshops on malaria were designed to increase uptake of national recommendations; a manual was developed, and training of health animators conducted, with educational content and analytical tools for a series of fortnightly community workshops in annual cycles at village level. The roll-back malaria principle of diagnosis, treatment and use of long-lasting insecticidal nets was a central component of the workshops. Structural house improvement to reduce entry of malaria vectors consisted of targeted activities in selected villages to mobilize the community into voluntarily closing the eaves and screening the windows of their houses; the project provided wire mesh for screening. Corrective measures were introduced to respond to field challenges. Committees were established at village level to coordinate the house improvement activities. Larval source management (LSM) in selected villages consisted of two parts: one on removal of standing water bodies by the community at large; and one on larviciding with bacterial insecticide Bacillus thuringiensis israelensis by trained village committees. Community workshops on malaria were implemented as 'core intervention' in all villages. House improvement and LSM were implemented in addition to community workshops on malaria in selected villages. Conclusions: Three novel interventions for community mobilization on malaria prevention and control were described. The interventions comprised local organizational structure, education and collective action, and incorporated elements of problem identification, planning and evaluation. These methods could be applicable to other countries and settings.
Malaria control in rural Malawi : Implementing peer health education for behaviour change
Malenga, Tumaini ; Kabaghe, Alinune Nathanael ; Manda-Taylor, Lucinda ; Kadama, Asante ; McCann, Robert S. ; Phiri, Kamija Samuel ; Vugt, Michèle van; Berg, Henk van den - \ 2017
Globalization and Health 13 (2017)1. - ISSN 1744-8603
Behaviour change - Community workshops - Health animator - Health education - Implementation - Malaria
Background: Interventions to reduce malaria burden are effective if communities use them appropriately and consistently. Several tools have been suggested to promote uptake and use of malaria control interventions. Community workshops on malaria, using the 'Health Animator' approach, are a potential behaviour change strategy for malaria control. The strategy aims to influence a change in mind-set of vulnerable populations to encourage self-reliance, using community volunteers known as Health Animators. The aim of the paper is to describe the process of implementing community workshops on malaria by Health Animators to improve uptake and use of malaria control interventions in rural Malawi. Methods: This is a descriptive study reporting feasibility, acceptability, appropriateness and fidelity of using Health Animator-led community workshops for malaria control. Quantitative data were collected from self-reporting and researcher evaluation forms. Qualitative assessments were done with Health Animators, using three focus groups (October-December 2015) and seven in-depth interviews (October 2016-February 2017). Results: Seventy seven health Animators were trained from 62 villages. A total of 2704 workshops were conducted, with consistent attendance from January 2015 to June 2017, representing 10-17% of the population. Attendance was affected by social responsibilities and activities, relationship of the village leaders and their community and involvement of Community Health Workers. Active discussion and participation were reported as main strengths of the workshops. Health Animators personally benefited from the mind-set change and were proactive peer influencers in the community. Although the information was comprehended and accepted, availability of adequate health services was a challenge for maintenance of behaviour change. Conclusion: Community workshops on malaria are a potential tool for influencing a positive change in behaviour towards malaria, and applicable for other health problems in rural African communities. Social structures of influence and power dynamics affect community response. There is need for systematic monitoring of community workshops to ensure implementation fidelity and strengthening health systems to ensure sustainability of health behaviour change.
Global trends in the production and use of DDT for control of malaria and other vector-borne diseases
Berg, Henk van den; Manuweera, Gamini ; Konradsen, Flemming - \ 2017
Malaria Journal 16 (2017). - ISSN 1475-2875 - 8 p.
Insecticide resistance - Leishmaniasis - Malaria - Vector control - 017-4049
Background: DDT was among the initial persistent organic pollutants listed under the Stockholm Convention and continues to be used for control of malaria and other vector-borne diseases in accordance with its provisions on acceptable purposes. Trends in the production and use of DDT were evaluated over the period 2001-2014. Results: Available data on global production of DDT showed a 32% decline over the reporting period, from 5144 to 3491 metric tons of active ingredient p.a. Similarly, global use of DDT, for control of malaria and leishmaniasis, showed a 30% decline over the period 2001-2014, from 5388 metric tons p.a. to 3772 metric tons p.a. India has been by far the largest producer and user of DDT. In some countries, DDT is used in response to the development of resistance in malaria vectors against pyrethroid and carbamate insecticides. Some other countries have stopped using DDT, in compliance to the Convention, or in response to DDT resistance in malaria vectors. Progress has been made in establishing or amending national legal measures on DDT, with the majority of countries reportedly having measures in place that prohibit, or restrict, the production, import, export and use of DDT. Limitations in achieving the objectives of the Stockholm Convention with regard to DDT include major shortcomings in periodic reporting by Parties to the Stockholm Convention, and deficiencies in reporting to the DDT Register. Conclusion: Global production and global use of DDT have shown a modest decline since the adoption of the Stockholm Convention.
Assessment of the effect of larval source management and house improvement on malaria transmission when added to standard malaria control strategies in southern Malawi : Study protocol for a cluster-randomised controlled trial
Mc Cann, Robert ; Berg, Henk van den; Diggle, Peter J. ; Vugt, Michèle van; Terlouw, Dianne J. ; Phiri, Kamija S. ; Pasquale, Aurelio Di; Maire, Nicolas ; Gowelo, Steven ; Mburu, Monicah M. ; Kabaghe, Alinune N. ; Mzilahowa, Themba ; Chipeta, Michael G. ; Takken, Willem - \ 2017
Bmc Infectious Diseases 17 (2017). - ISSN 1471-2334 - 15 p.
Anopheles mosquitoes - Community participation - House improvement - Integrated vector management - Larval source management - Malaria transmission - Vector control - 017-4010
Background: Due to outdoor and residual transmission and insecticide resistance, long-lasting insecticidal nets (LLINs) and indoor residual spraying (IRS) will be insufficient as stand-alone malaria vector control interventions in many settings as programmes shift toward malaria elimination. Combining additional vector control interventions as part of an integrated strategy would potentially overcome these challenges. Larval source management (LSM) and structural house improvements (HI) are appealing as additional components of an integrated vector management plan because of their long histories of use, evidence on effectiveness in appropriate settings, and unique modes of action compared to LLINs and IRS. Implementation of LSM and HI through a community-based approach could provide a path for rolling-out these interventions sustainably and on a large scale. Methods/design: We will implement community-based LSM and HI, as additional interventions to the current national malaria control strategies, using a randomised block, 2 × 2 factorial, cluster-randomised design in rural, southern Malawi. These interventions will be continued for two years. The trial catchment area covers about 25,000 people living in 65 villages. Community participation is encouraged by training community volunteers as health animators, and supporting the organisation of village-level committees in collaboration with The Hunger Project, a non-governmental organisation. Household-level cross-sectional surveys, including parasitological and entomological sampling, will be conducted on a rolling, 2-monthly schedule to measure outcomes over two years (2016 to 2018). Coverage of LSM and HI will also be assessed throughout the trial area. Discussion: Combining LSM and/or HI together with the interventions currently implemented by the Malawi National Malaria Control Programme is anticipated to reduce malaria transmission below the level reached by current interventions alone. Implementation of LSM and HI through a community-based approach provides an opportunity for optimum adaptation to the local ecological and social setting, and enhances the potential for sustainability. Trial Registration: Registered with The Pan African Clinical Trials Registry on 3 March 2016, trial number PACTR201604001501493.
Setting international standards for the management of public health pesticides
Berg, H. van den; Yadav, R.S. ; Zaim, M. - \ 2015
PLOS Medicine 12 (2015)5. - ISSN 1549-1676 - 9 p.
vector-borne diseases - insecticide resistance - malaria control - countries - africa - risk
Recent developments have highlighted the urgency of sound management of public health pesticides in vector-borne–disease–endemic countries. Major shortcomings are evident in national-level management practices throughout the pesticide life cycle from production to disposal; these shortcomings will adversely affect the cost-effectiveness and increase the risks of pesticides used. A major thrust has occurred towards developing international standards for improvement of public health pesticide management and towards expanding WHO’s global network on pesticide evaluation. However, to face current and future challenges, such as insecticide resistance in malaria vectors, the global capacity for evaluation of new insecticide products and vector-control tools should be further enhanced. Another area requiring urgent attention is the actual adoption and implementation of the recommended standards, calling for support to strengthen policy, legislation, and capacity.
Benefit of insecticide-treated nets, curtains and screening on vector borne diseases, excluding malaria: a systematic review and meta-analysis
Wilson, A.L. ; Dhiman, R.C. ; Kitron, U. ; Scott, T.W. ; Berg, H. van den; Lindsay, S.W. - \ 2014
PLoS Neglected Tropical Diseases 8 (2014)10. - ISSN 1935-2727 - 13 p.
cluster-randomized-trial - papua-new-guinea - lambdacyhalothrin-impregnated bednets - visceral leishmaniasis - cutaneous leishmaniasis - lymphatic filariasis - aedes-aegypti - bed nets - dengue vectors - phlebotomine sandflies
Introduction Insecticide-treated nets (ITNs) are one of the main interventions used for malaria control. However, these nets may also be effective against other vector borne diseases (VBDs). We conducted a systematic review and meta-analysis to estimate the efficacy of ITNs, insecticide-treated curtains (ITCs) and insecticide-treated house screening (ITS) against Chagas disease, cutaneous and visceral leishmaniasis, dengue, human African trypanosomiasis, Japanese encephalitis, lymphatic filariasis and onchocerciasis. Methods MEDLINE, EMBASE, LILACS and Tropical Disease Bulletin databases were searched using intervention, vector- and disease-specific search terms. Cluster or individually randomised controlled trials, non-randomised trials with pre- and post-intervention data and rotational design studies were included. Analysis assessed the efficacy of ITNs, ITCs or ITS versus no intervention. Meta-analysis of clinical data was performed and percentage reduction in vector density calculated. Results Twenty-one studies were identified which met the inclusion criteria. Meta-analysis of clinical data could only be performed for four cutaneous leishmaniasis studies which together showed a protective efficacy of ITNs of 77% (95%CI: 39%–91%). Studies of ITC and ITS against cutaneous leishmaniasis also reported significant reductions in disease incidence. Single studies reported a high protective efficacy of ITS against dengue and ITNs against Japanese encephalitis. No studies of Chagas disease, human African trypanosomiasis or onchocerciasis were identified. Conclusion There are likely to be considerable collateral benefits of ITN roll out on cutaneous leishmaniasis where this disease is co-endemic with malaria. Due to the low number of studies identified, issues with reporting of entomological outcomes, and few studies reporting clinical outcomes, it is difficult to make strong conclusions on the effect of ITNs, ITCs or ITS on other VBDs and therefore further studies be conducted. Nonetheless, it is clear that insecticide-treated materials such as ITNs have the potential to reduce pathogen transmission and morbidity from VBDs where vectors enter houses.
Strengthening public health pesticide management in countries endemic with malaria or other major vector-borne diseases: an evaluation of three strategies
Berg, H. van den; Yadav, R.S. ; Zaim, M. - \ 2014
Malaria Journal 13 (2014). - ISSN 1475-2875 - 9 p.
Background Public health pesticides has been the mainstay control of vectors of malaria and other diseases, and public health pests, but there is increasing concern over how these pesticides are being managed. Poor pesticide management could lead to risks to human health and the environment, or diminish the effectiveness of interventions. Strategies for strengthening the management of public health pesticides, from manufacture to disposal, should be evaluated to propose future directions. Methods The process and outcomes of three strategies were studied in five regions of the WHO (African Region, Eastern Mediterranean Region, South-East Asia Region, Western Pacific Region, and American Region) and 13 selected countries. These strategies are: regional policy development, in-depth country support and thematic support across countries. Results Consensus, frameworks and action plans on public health pesticide management were developed at regional level. Country support for situation analysis and national action planning highlighted weaknesses over the entire spectrum of pesticide management practices, mainly related to malaria control. The thematic support on pesticide quality control contributed to structural improvements on a priority issue for malaria control across countries. Conclusions The three strategies showed promising and complementary results, but guidelines and tools for implementation of the strategies should be further improved. Increased national and international priority should be given to support the development of policy, legislation and capacity that are necessary for sound management of public health pesticides.