Using Decision Analysis to Improve Malaria Control Policy Making

Malaria and other vector-borne diseases represent a significant and growing burden in many tropical countries. Successfully addressing these threats will require policies that expand access to and use of existing control methods, such as insecticide-treated bed nets (ITNs) and artemesinin combination therapies (ACTs) for malaria, while weighing the costs and benefits of alternative approaches over time. This paper argues that decision analysis provides a valuable framework for formulating such policies and combating the emergence and re-emergence of malaria and other diseases. We outline five challenges that policy makers and practitioners face in the struggle against malaria, and demonstrate how decision analysis can help to address and overcome these challenges. A prototype decision analysis framework for malaria control in Tanzania is presented, highlighting the key components that a decision support tool should include. Developing and applying such a framework can promote stronger and more effective linkages between research and policy, ultimately helping to reduce the burden of malaria and other vector-borne diseases

Factors influencing malaria control policy-making in Kenya, Uganda and Tanzania

Abstract Background Policy decisions for malaria control are often difficult to make as decision-makers have to carefully consider an array of options and respond to the needs of a large number of stakeholders. This study assessed the factors and specific objectives that influence malaria control policy decisions, as a crucial first step towards developing an inclusive malaria decision analysis support tool (MDAST). Methods Country-specific stakeholder engagement activities using structured questionnaires were carried out in Kenya, Uganda and Tanzania. The survey respondents were drawn from a non-random purposeful sample of stakeholders, targeting individuals in ministries and non-governmental organizations whose policy decisions and actions are likely to have an impact on the status of malaria. Summary statistics across the three countries are presented in aggregate. Results Important findings aggregated across countries included a belief that donor preferences and agendas were exerting too much influence on malaria policies in the countries. Respondents on average also thought that some relevant objectives such as engaging members of parliament by the agency responsible for malaria control in a particular country were not being given enough consideration in malaria decision-making. Factors found to influence decisions regarding specific malaria control strategies included donor agendas, costs, effectiveness of interventions, health and environmental impacts, compliance and/acceptance, financial sustainability, and vector resistance to insecticides. Conclusion Malaria control decision-makers in Kenya, Uganda and Tanzania take into account health and environmental impacts as well as cost implications of different intervention strategies. Further engagement of government legislators and other policy makers is needed in order to increase funding from domestic sources, reduce donor dependence, sustain interventions and consolidate current gains in malaria.http://deepblue.lib.umich.edu/bitstream/2027.42/109455/1/12936_2014_Article_3344.pd

Are individuals willing to pay for community-based eco-friendly malaria vector control strategies? A case of mosquito larviciding using plant-based biopesticides in Kenya

This study was carried out to assess individuals’ willingness to pay (WTP) for UZIMAX, a novel plant-based biopesticide developed for malaria vector control. The biopesticide is estimated to kill up to 100% of Anopheles larvae within 48 h of application and poses no risks to human health and the environment. However, scaling-up of its adoption requires clear evidence of its acceptance by individuals in malaria-prone areas. We conducted Becker-DeGroot-Marschak (BDM) revealed preference auctions with 204 participants to determine their willingness to pay (WTP) for community-based application of the biopesticide to control malaria vectors. Nearly all participants were willing to pay at the lowest bid price of the biopesticide, and the majority of them expressed great interest in pooling resources to facilitate biopesticide application. Household per capita income and building capacity of households through training significantly increased WTP. These findings imply high adoption potential of the technology and the need to devise inclusive policy tools, especially those that enhance collective action, resource mobilization and capacity building to empower both men and women and stimulate investment in eco-friendly technologies for malaria prevention. Financial and labor resource mechanisms managed by the community could potentially spur adoption of the biopesticides, and in turn, generate health, environmental and economic benefits to households in malaria-prone communities.The Biovision Foundation Switzerland. The article processing charge (APC) was funded by ICIPE core funding from the UK’s Foreign, Commonwealth & Development Office (FCDO), the Swiss Agency for Development and Cooperation (SDC), the Federal Democratic Republic of Ethiopia and the Kenyan Government.http://www.mdpi.com/journal/sustainabilityam2021UP Centre for Sustainable Malaria Control (UP CSMC

Evaluating the impact of larviciding with Bti and community education and mobilization as supplementary integrated vector management interventions for malaria control in Kenya and Ethiopia

BACKGROUND : Malaria prevention in Africa is mainly through the use of long-lasting insecticide treated nets (LLINs). The objective of the study was to assess the effect of supplementing LLINs with either larviciding with Bacillus thuringiensis israelensis (Bti) or community education and mobilization (CEM), or with both interventions in the context of integrated vector management (IVM). METHODS : The study involved a factorial, cluster-randomized, controlled trial conducted in Malindi and Nyabondo sites in Kenya and Tolay site in Ethiopia, to assess the impact of the following four intervention options on mosquitoes and malaria prevalence: LLINs only (arm 1); LLINs and Bti (arm 2); LLINs and CEM (arm 3); and, LLINs combined with Bti and CEM (arm 4). Between January 2013 and December 2015, CDC light traps were used to sample adult mosquitoes during the second, third and fourth quarter of each year in 10 houses in each of 16 villages at each of the three study sites. Larvae were sampled once a fortnight from potential mosquito-breeding habitats using standard plastic dippers. Cross-sectional malaria parasite prevalence surveys were conducted involving a total of 11,846 primary school children during the 3-year period, including 4800 children in Tolay, 3000 in Malindi and 4046 in Nyabondo study sites. RESULTS : Baseline relative indoor anopheline density was 0.11, 0.05 and 0.02 mosquitoes per house per night in Malindi, Tolay and Nyabondo sites, respectively. Nyabondo had the highest recorded overall average malaria prevalence among school children at 32.4%, followed by Malindi with 5.7% and Tolay 1.7%. There was no significant reduction in adult anopheline density at each of the three sites, which could be attributed to adding of the supplementary interventions to the usage of LLINs. Malaria prevalence was significantly reduced by 50% in Tolay when using LLINs coupled with application of Bti, community education and mobilization. The two other sites did not reveal significant reduction of prevalence as a result of combining LLINs with any of the other supplementary interventions. CONCLUSION : Combining LLINs with larviciding with Bti and CEM further reduced malaria infection in a low prevalence setting in Ethiopia, but not at sites with relatively higher prevalence in Kenya. More research is necessary at the selected sites in Kenya to periodically determine the suite of vector control interventions and broader disease management strategies, which when integrated would further reduce adult anopheline populations and malaria prevalence beyond what is achieved with LLINs.The work was conducted with funding from Biovision Foundation (Grant No. BV HH-07/2013-2015), UK’s Foreign, Commonwealth & Development Office (FCDO); the Swedish International Development Cooperation Agency (Sida); the Swiss Agency for Development and Cooperation (SDC); the Federal Democratic Republic of Ethiopia; and the Government of the Republic of Kenya.Biovision Foundation; UK’s Foreign, Commonwealth & Development Office (FCDO); the Swedish International Development Cooperation Agency (Sida); the Swiss Agency for Development and Cooperation (SDC); the Federal Democratic Republic of Ethiopia; and the Government of the Republic of Kenya.http://www.malariajournal.comam2021School of Health Systems and Public Health (SHSPH

Outdoor malaria vector species profile in dryland ecosystems of Kenya

Outdoor biting by anopheline mosquitoes is one of the contributors to residual malaria transmission, but the profile of vectors driving this phenomenon is not well understood. Here, we studied the bionomics and genetically characterized populations of An. gambiae and An. funestus complexes trapped outdoors in three selected dryland areas including Kerio Valley, Nguruman and Rabai in Kenya. We observed a higher abundance of Anopheles funestus group members (n = 639, 90.6%) compared to those of the An. gambiae complex (n = 66, 9.4%) with An. longipalpis C as the dominant vector species with a Plasmodium falciparum sporozoite rate (Pfsp) of 5.2% (19/362). The known malaria vectors including An. funestus s.s. (8.7%, 2/23), An. gambiae (14.3%, 2/14), An. rivulorum (14.1%, 9/64), An. arabiensis (1.9%, 1/52) occurred in low densities and displayed high Pfsp rates, which varied with the site. Additionally, six cryptic species found associated with the An. funestus group harbored Pf sporozoites (cumulative Pfsp rate = 7.2%, 13/181). We detected low frequency of resistant 119F-GSTe2 alleles in An. funestus s.s. (15.6%) and An. longipalpis C (3.1%) in Kerio Valley only. Evidence of outdoor activity, emergence of novel and divergent vectors and detection of mutations conferring metabolic resistance to pyrethroid/DDT could contribute to residual malaria transmission posing a threat to effective malaria control

Health impact assessment of increased irrigation in the Tana River Basin, Kenya

In Blank, H. G.; Mutero, C. M.; Murray-Rust, H. (Eds.), The changing face of irrigation in Kenya: Opportunities for anticipating changes in Eastern and Southern Africa. Colombo, Sri Lanka, IWM

Understanding the links between agriculture and health: Agriculture, malaria, and water-associated diseases

Malaria, schistosomiasis (bilharzia), and Japanese encephalitis are the major vector-borne diseases whose increase or decrease can be attributed to agricultural water development (see table). Others include dengue fever, yellow fever, and filariasis. Young children in poor communities are particularly affected: malaria is among the top five causes of death among under-fives in Sub-Saharan Africa; schistosomiasis among children affects growth, nutritional status, and cognitive development; and encephalitis occurs mainly in young children... Water development projects bring important benefits locally and globally. Yet it is often assumed that irrigation will bring health benefits to all, regardless of their socioeconomic standing within a community. In reality, the economic and social impacts of irrigation are diverse and widespread, and neither costs nor benefits are evenly distributed among community members. In Sub-Saharan Africa, as elsewhere in the world, there is increasing recognition of the need to reduce the negative impacts of agricultural development on ecosystems and peoples’ health. Unless well-targeted interventions are made, the most vulnerable—notably poor children and their mothers—will continue to benefit least from the promise of irrigation and suffer most from the adverse health impacts." -- From textNon-PRIFPRI1; 2020DG

From government to farmer-managed smallholder rice schemes: The unresolved case of the Mwea Irrigation Scheme

In Blank, H. G.; Mutero, C. M.; Murray-Rust, H. (Eds.), The changing face of irrigation in Kenya: Opportunities for anticipating changes in Eastern and Southern Africa. Colombo, Sri Lanka, IWM