Elevating larval source management as a key strategy for controlling malaria and other vector-borne diseases in Africa
Abstract 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 (insect...
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2025-02-01
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| Series: | Parasites & Vectors |
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| Online Access: | https://doi.org/10.1186/s13071-024-06621-x |
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| author | Fredros Okumu Sarah J. Moore Prashanth Selvaraj Arnon Houri Yafin Elijah O. Juma GloriaSalome G. Shirima Silas Majambere Andy Hardy Bart G. J. Knols Betwel J. Msugupakulya Marceline Finda Najat Kahamba Edward Thomsen Ayman Ahmed Sarah Zohdy Prosper Chaki Peter DeChant Kimberly Fornace Nicodem Govella Steven Gowelo Emmanuel Hakizimana Busiku Hamainza Jasper N. Ijumba William Jany Hmooda Toto Kafy Emmanuel W. Kaindoa Lenson Kariuki Samson Kiware Eliningaya J. Kweka Neil F. Lobo Dulcisária Marrenjo Damaris Matoke-Muhia Charles Mbogo Robert S. McCann April Monroe Bryson Alberto Ndenga Halfan S. Ngowo Eric Ochomo Mercy Opiyo Richard Reithinger Chadwick Haadezu Sikaala Allison Tatarsky David Takudzwa Fedra Trujillano Ellie Sherrard-Smith |
| author_facet | Fredros Okumu Sarah J. Moore Prashanth Selvaraj Arnon Houri Yafin Elijah O. Juma GloriaSalome G. Shirima Silas Majambere Andy Hardy Bart G. J. Knols Betwel J. Msugupakulya Marceline Finda Najat Kahamba Edward Thomsen Ayman Ahmed Sarah Zohdy Prosper Chaki Peter DeChant Kimberly Fornace Nicodem Govella Steven Gowelo Emmanuel Hakizimana Busiku Hamainza Jasper N. Ijumba William Jany Hmooda Toto Kafy Emmanuel W. Kaindoa Lenson Kariuki Samson Kiware Eliningaya J. Kweka Neil F. Lobo Dulcisária Marrenjo Damaris Matoke-Muhia Charles Mbogo Robert S. McCann April Monroe Bryson Alberto Ndenga Halfan S. Ngowo Eric Ochomo Mercy Opiyo Richard Reithinger Chadwick Haadezu Sikaala Allison Tatarsky David Takudzwa Fedra Trujillano Ellie Sherrard-Smith |
| author_sort | Fredros Okumu |
| collection | DOAJ |
| description | Abstract 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. Graphical Abstract |
| format | Article |
| id | doaj-art-869a9574c93344448e65a4acfad77198 |
| institution | Kabale University |
| issn | 1756-3305 |
| language | English |
| publishDate | 2025-02-01 |
| publisher | BMC |
| record_format | Article |
| series | Parasites & Vectors |
| spelling | doaj-art-869a9574c93344448e65a4acfad771982025-02-09T12:15:19ZengBMCParasites & Vectors1756-33052025-02-0118111910.1186/s13071-024-06621-xElevating larval source management as a key strategy for controlling malaria and other vector-borne diseases in AfricaFredros Okumu0Sarah J. Moore1Prashanth Selvaraj2Arnon Houri Yafin3Elijah O. Juma4GloriaSalome G. Shirima5Silas Majambere6Andy Hardy7Bart G. J. Knols8Betwel J. Msugupakulya9Marceline Finda10Najat Kahamba11Edward Thomsen12Ayman Ahmed13Sarah Zohdy14Prosper Chaki15Peter DeChant16Kimberly Fornace17Nicodem Govella18Steven Gowelo19Emmanuel Hakizimana20Busiku Hamainza21Jasper N. Ijumba22William Jany23Hmooda Toto Kafy24Emmanuel W. Kaindoa25Lenson Kariuki26Samson Kiware27Eliningaya J. Kweka28Neil F. Lobo29Dulcisária Marrenjo30Damaris Matoke-Muhia31Charles Mbogo32Robert S. McCann33April Monroe34Bryson Alberto Ndenga35Halfan S. Ngowo36Eric Ochomo37Mercy Opiyo38Richard Reithinger39Chadwick Haadezu Sikaala40Allison Tatarsky41David Takudzwa42Fedra Trujillano43Ellie Sherrard-Smith44Environmental Health and Ecological Science Department, Ifakara Health InstituteSchool of Life Science and Bioengineering, The Nelson Mandela African Institution of Science and Technology, (NM-AIST)Institute for Disease Modeling, Bill and Melinda Gates FoundationZzappMalariaPan-African Mosquito Control Association (PAMCA)Environmental Health and Ecological Science Department, Ifakara Health InstituteValent Biosciences LLCDepartment of Geography and Earth Sciences, Aberystwyth UniversityK&S ConsultingEnvironmental Health and Ecological Science Department, Ifakara Health InstituteEnvironmental Health and Ecological Science Department, Ifakara Health InstituteEnvironmental Health and Ecological Science Department, Ifakara Health InstituteMalaria Elimination Initiative, University of California San FranciscoInstitute of Endemic Diseases, University of KhartoumDivision of Parasitic Diseases and Malaria, Entomology Branch, U.S. President’s Malaria Initiative, U.S. Centers for Disease Control and PreventionEnvironmental Health and Ecological Science Department, Ifakara Health InstituteDeChant Vector Solutions LLCFaculty of Infectious and Tropical Diseases and Centre for Climate Change and Planetary Health, London School Hygiene and Tropical MedicineEnvironmental Health and Ecological Science Department, Ifakara Health InstituteKamuzu University of Health SciencesRwanda Biomedical Centre, Ministry of HealthNational Malaria Elimination CentreMwanza UniversityClarke InternationalGlobal Fund Program Management Unit, RSSH and Malaria Grant, Federal Ministry of HealthEnvironmental Health and Ecological Science Department, Ifakara Health InstituteMinistry of Health-Vector Borne and Neglected Tropical DiseasesEnvironmental Health and Ecological Science Department, Ifakara Health InstitutePesticides Bioefficacy Section, Tanzania Plant Health and Pesticides AuthorityUniversity of Notre DameNational Malaria Control Program, Ministry of HealthCentre for Biotechnology Research and Development, Kenya Medical Research InstituteKenya Medical Research Institute (KEMRI)Center for Vaccine Development and Global Health, University of Maryland School of MedicineU.S. President’s Malaria Initiative, U.S. Agency for International DevelopmentCentre for Global Health Research, Kenya Medical Research InstituteEnvironmental Health and Ecological Science Department, Ifakara Health InstituteDepartment of Vector Biology, Liverpool School of Tropical MedicineCentro de Investigação Em Saúde de Manhiça (CISM)RTI InternationalSADC Malaria Elimination Eight SecretariatMalaria Elimination Initiative, University of California San FranciscoPrivate ConsultantSchool of Geographical & Earth Sciences, University of GlasgowDepartment of Vector Biology, Liverpool School of Tropical MedicineAbstract 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. Graphical Abstracthttps://doi.org/10.1186/s13071-024-06621-xSource reductionIntegrated vector controlCore malaria strategyLarvicidingCommunity actionPublic health |
| spellingShingle | Fredros Okumu Sarah J. Moore Prashanth Selvaraj Arnon Houri Yafin Elijah O. Juma GloriaSalome G. Shirima Silas Majambere Andy Hardy Bart G. J. Knols Betwel J. Msugupakulya Marceline Finda Najat Kahamba Edward Thomsen Ayman Ahmed Sarah Zohdy Prosper Chaki Peter DeChant Kimberly Fornace Nicodem Govella Steven Gowelo Emmanuel Hakizimana Busiku Hamainza Jasper N. Ijumba William Jany Hmooda Toto Kafy Emmanuel W. Kaindoa Lenson Kariuki Samson Kiware Eliningaya J. Kweka Neil F. Lobo Dulcisária Marrenjo Damaris Matoke-Muhia Charles Mbogo Robert S. McCann April Monroe Bryson Alberto Ndenga Halfan S. Ngowo Eric Ochomo Mercy Opiyo Richard Reithinger Chadwick Haadezu Sikaala Allison Tatarsky David Takudzwa Fedra Trujillano Ellie Sherrard-Smith Elevating larval source management as a key strategy for controlling malaria and other vector-borne diseases in Africa Parasites & Vectors Source reduction Integrated vector control Core malaria strategy Larviciding Community action Public health |
| title | Elevating larval source management as a key strategy for controlling malaria and other vector-borne diseases in Africa |
| title_full | Elevating larval source management as a key strategy for controlling malaria and other vector-borne diseases in Africa |
| title_fullStr | Elevating larval source management as a key strategy for controlling malaria and other vector-borne diseases in Africa |
| title_full_unstemmed | Elevating larval source management as a key strategy for controlling malaria and other vector-borne diseases in Africa |
| title_short | Elevating larval source management as a key strategy for controlling malaria and other vector-borne diseases in Africa |
| title_sort | elevating larval source management as a key strategy for controlling malaria and other vector borne diseases in africa |
| topic | Source reduction Integrated vector control Core malaria strategy Larviciding Community action Public health |
| url | https://doi.org/10.1186/s13071-024-06621-x |
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