Table 6 Key challenges facing larviciding programs in Morogoro region, southern Tanzania

1

Insufficient technical knowledge on habitat identification and larviciding

Malaria Focal Persons, District Surveillance Officers and Ward Health Officers reported that they did not have adequate technical knowledge for assessing whether specific water bodies were likely to contain mosquito larvae, and whether those larvae were likely to belong to Anopheles species or other mosquitoes. As a result, ward health officers reported that they often treated all the water bodies they could find in their wards

The MFPs also reported that they did not have accurate information on the proper amount of larvicides to apply in specific water bodies. Instead, they often just guessed the amount, based on their perceived volumes of the habitats

There was also no uniformity on methods of monitoring efficacy of the larvicides. Some reported that they used number of malaria cases at the health centers as an indicator of efficacy and some used community testimonials on reduced mosquito nuisance bites

“it is not easy to differentiate mosquito breeding sites, however, there are areas that you can recognize as breeding sites upon seeing. For example, we have areas with ponds that last the whole year and a great example is an area close to the secondary school where brick laying created ponds which obvious attract mosquitoes as a breeding site.” (Ward Health Officer, Male)

“Like I said, we lack knowledge on this aspect. We do not even know how much larvicides to spray in a water pond for example. Even if you ask the VSO he will tell you the same. So then we do a lot of guess work, but we do not know for sure if we are putting too much or too little.” (Malaria Focal Person, Female)

“We do monitoring by asking community members, they are the ones who report sleeping comfortably.” (Ward Health Officer, Female)

“We look at the statistics, as to whether number of malaria patients increasing or decreasing.” (Ward Health Officer, Female)

2

Lack of knowledge regarding safety of the larvicides

There were also inconsistencies in knowledge about risks posed by the larvicides. MFPs and VSOs claimed that the larvicides did not pose any harm to people or their livestock, but were not sure whether the larvicides could cause harm to other aquatic organisms. In contrast, most ward health officers believed the larvicides could harm people or animals, since they smelled like poison and turned the color of the water

“I know that it is safe on humans, but I really do not know if they pose any harm on other insects in the water, on animals or on vegetation around the water. I only know that it does not have any harm on humans.” (Malaria Focal Person, Male)

“It has to have harm, I can just tell from the smell that comes when you apply it, the water also turns milky, so it just looks poisonous. So I advise people to not use the water immediately after the application, but if they wait after a while the smell disappears and the color goes back to normal.” (Ward Health Officer, Female)

3

Inadequate funding

All participants reported that lack of sufficient funding was a significant obstacle for successful implementation of larviciding. Funding was needed to provide compensations and wages to the CHWs or the volunteers, procure personal protective gear and application equipment and for transportation

In some cases the participants reported limiting larviciding activities due to limited financial support

“When you ask people in the community to help with this exercise, they expect to get a wage. But when we were implementing this there wasn’t any money set aside for paying the volunteers or the CHWs. Sometimes I had to give them my own money, because I saw how hard they were working.” (Ward Health Officer, Male)

“In my district we had to stop before finishing because we just did not have any money to implement this project. We had the larvicides only, but nothing else. We requested money for protective gear, transportation, or for paying people that were doing the application but we did not receive it, so after some time we just had to stop.” (Vector Surveillance Officer, Female)

“For an example, my district has 31 wards, and it is not like the breeding habitats are at the headquarters of the wards. You have to go deep into the villages. It is hard to walk with a can containing 20-liters of larvicide. There is only one car at the district, and even that is currently not functioning.” (Vector Surveillance Officer, Male)

4

Inadequate supply of larvicides:

Some of the ward health officers reported that the larvicides they received were not enough to treat all mosquito breeding habitats in their area of jurisdiction. In particular, communities living in swampy areas, needed a lot more supplies than they received

“I will tell you that the larvicides were not enough. In all the breeding habitats that I had surveyed, we could not cover all of them before running out of the larvicides. We needed more, but there was none.” (Ward Health Officer, Female)

“In 2018, I have received two cans of twenty liters which cannot be enough for my ward. In another round, I had received two cans of twenty liters per village which was not enough either, so we decided to prioritize the most significant settings.” (Ward Health Officer, Female)

5

Some resistance from members of the community

Key informants reported initially facing resistance from some community members who feared that the larvicides would be poisonous to chicken, livestock or fish. This was mostly due to the smell of the larvicides, and by the fact that the water turned milky immediately after application. This initial resistance was however reported to ease once the health officials spent time explaining the benefits and safety of the larvicides. Community sensitization was primarily done by ward health officers with assistance from CHWs

“The uptake was not very good in the beginning as people were not educated on what larvicides are, how they work or their safety. So they were always reluctant to let people spray near their homes.” (Vector Surveillance Officer, Female)

“Once people were sensitized, the uptake improved. People would even follow us and ask when we would be spraying again, or point me to breeding habitats that I had missed.”(Ward Health Officer, Male)

6

Inadequate involvement of VSOs and Ward health officers in early stages

VSOs and ward health officers reported to not being involved in the initial planning of the larviciding programme at the district level, but rather receiving implementation plan from malaria focal person. This overshadows their significant inputs as they have spent more time in the settings on average compared to malaria focal persons

“I was not involved in the planning and these larvicides are new which requires training but we have only been given pamphlets. Only if we can be involved from the early stages, I think it will improve the practice.” (Vector Surveillance Officer, Female)

7

Insufficient collaboration with non-governmental organizations

Key informants reported inadequate involvement of the non-governmental organizations (NGOs) in the implementation of the larviciding programme. This has been attributed to larviciding not being priority among these NGOs

“Providing awareness to the community, maybe we could try but even Boresha Afya indicated disease prevention is not in their priorities but rather case management. SolidarMed priorities are in behavioural change, so we have no stakeholders in disease prevention.” (Malaria Focal Person, Male)