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Table 1 Descriptions of alternative interventions to complement current malaria control and elimination efforts, as discussed with key stakeholders in Tanzania

From: Opinions of key stakeholders on alternative interventions for malaria control and elimination in Tanzania

Intervention Description
Improved housing House improvement as malaria control intervention involves mosquito-proofing houses to limit mosquito entrance into the house [26, 37]. General housing improvement was a key factor in the elimination of malaria in developed countries [24]. In developing countries, simple modifications like screening windows and doors and closing eave spaces have resulted in some cases, in a 50% decline in entomological inoculation rates [38]. In Tanzania for example, housing improvement was linked to significant historical declines of malaria in Dar es Salaam [39], and was likely a major factor in more than 99% decline in malaria in Ifakara town, the main town in the area of our study [33]
Larval source management Larval source management (LSM) refers to environmental manipulations to target mosquito larval habitats [13]. LSM can include the use of larvicides as well as environmental management methods [13, 14, 40]. In Tanzania, large-scale larviciding resulted in 21% reduction in malaria prevalence in Dar es Salaam between 2006 and 2008 [41]. The Tanzanian government is currently conducting targeted larviciding in urban and rural settings as a means to reduce malaria incidence and speed up the elimination agenda [42]
Mass drug administration of ivermectin Ivermectin is an anti-helminthic drug commonly used to control parasitic nematodes in humans and animals [43]. It has been extensively used in mass campaigns for the elimination of lymphatic filariasis and onchocerciasis in Tanzania [44, 45]. Ivermectin is currently being evaluated as a malaria control tool, since it significantly reduces female mosquito fecundity and survival when mosquitoes blood-feed on hosts that have taken the drug [18, 43, 46]
Targeted spraying of mosquito swarms Male mosquitoes aggregate in swarms as they compete for attention of female mosquitoes searching for mating partners [47]. Swarms usually occur at approximately the same time, usually at sunset, and repeatedly at same locations throughout the year [47]. Studies done in Burkina Faso and Tanzania have shown that Anopheles mosquito swarms can be located and targeted, and are effective in reducing overall mosquito density [21,22,23]
Modified mosquitoes This intervention refers to alterations of mosquito genes or physiology for the purpose of reducing their competence in diseases transmission. The modified mosquitoes are released into the environment so that they can interbreed with the wild mosquitoes and, depending on the trait they carry, either reduce the density of malaria vectors or replace its population with mosquitoes unable to transmit the pathogen. Interventions currently under study include Sterile Insect-technique, which relies on irradiation of mosquitoes to make them sterile [48], genetic modification of mosquitoes to introduce sterility or other disadvantageous traits [49], and use of gene drive systems to spread novel traits (e.g. lethality or refractoriness to pathogen transmission) in mosquito populations [19, 50]. While the technology has never been integrated into a malaria control programme, laboratory studies, mathematical models and preliminary field trials indicate its potential [51]
Spatial repellents Spatial repellents prevent host-seeking mosquitoes from entering certain areas, thus limiting contact between humans and mosquitoes [27]. SP can be based on a variety of botanical products and chemical compounds, such as citronella, transfluthrin and metofluthrin [27, 52]. They can be delivered in different formats, such as mosquito coils, repellent-treated clothing, repellent sandals (Finda et al. unpublished), kerosene lamps [53], and eave ribbons [27, 28, 54]. Compared to widely available topical repellents, some SP can provide long-lasting repellency, requiring minimal participation from the users