The Role of Community Participation in Planning and Executing Malaria Interventions: Experience from Implementation of Biolarviciding for Malaria Vector Control in Southern Tanzania

Abstract

Background. Malaria remains a disease of great public health importance in 85 countries globally. Developing countries face resource constraints in implementing public health interventions aiming at controlling malaria. Promoting community participation may contribute to rational and effective use of resources and therefore facilitating achievement of intervention goals in a cost-effective manner while fostering sustainability. However, this can be possible if the community is engaged at all stages of the intervention, from designing, implementation, monitoring, and evaluation of results. This study aimed at understanding community participation in the implementation of a biolarviciding intervention for malaria vectors control in Southern Tanzania. Methods. The current study adopted explanatory mixed method study design in collecting data. Quantitative data were collected from 400 community members and 12 vector control coordinators using structured questionnaire while qualitative data was collected through key informant interviews to 32 participants and in-depth interviews to 5 vector control coordinators who were purposively selected from the 12 councils. Quantitative data analysis involved descriptive and inferential statistics. Thematic analysis was used to analyse qualitative data. Results. Of 400 community members, only 90 (22.5%) participated in biolarviciding implementation. Predictors of community participation were willingness to participate ( AOR = 3.15 , 95 % CI = 1.14 − 8.71 , P value = 0.027) and community involvement ( AOR = 6.07 , 95 % CI = 2.69 − 13.71 , P value < 0.001). The study revealed that the main barriers to community participation were lack of effective involvement and lack of incentive to community volunteers while high willingness to participate was a facilitating factor for community participation. Conclusion. The study revealed low community participation in biolarviciding implementation in Southern Tanzania with willingness to participate and community involvement being the main predictors for community participation while lack of incentive to community volunteers was one major barrier to community participation. This explains the persistence of an unresolved challenge of community participation in malaria interventions. Therefore, more efforts are needed to improve the participation of community members in Malaria interventions through advocacy, awareness creation of respective roles, and responsibilities of the community members and fostering community ownership. Additionally, councils need to design customized motivation package for the community members.

Community engagement approaches for malaria prevention, control and elimination: a scoping review

“…Thirty studies also reported changes in knowledge of malaria prevention (n=30),14 30 33 36 38–40 43 44 49 50 57–59 62 64 68 73 74 76 80 84–88 90 91 97 98 including improvement in the overall knowledge for malaria transmission, signs and symptoms, prevention using LLINs,14 38–40 44 57–59 64 73 74 85 86 88 90 91 97 98 vector control,36 43 98 and MDA 14 90. Behaviour outcomes were reported by 23 studies35 36 39 40 43–46 48 51 52 58 60 61 71 75 77 85 86 92 96 98 of which most of the studies reported improved use of LLIN (n=12)33 36 40 44 45 48 58 60 75 77 85 96 followed by treatment-seeking behaviour for malaria (n=7) 44 45 51 52 58 61 86. Although improved participation in vector control activities were reported by some studies (n=3),43 44 46 low participation was observed by one study71 despite the community having a good vector knowledge.…”

“…Using the World Bank classification of countries by regions (online supplemental figure 2a), the majority of the studies were conducted in SSA (n=46)17 30–72 (table 1) followed by EAP (n=24)14 73–95 (table 2), SEA (n=3),96–98 and LAC (n=2)91 99 regions (table 3). More than half of the SSA studies were conducted in three countries: Uganda (n=12);34 51–56 58–61 63 Kenya (n=8);30 32 41 46 62 64 66 69 and Malawi (n=5) 17 49 50 68 70 72.…”

“…Similarly, two-thirds of the EAP studies were conducted in Myanmar (n=10)78 80 81 86 88 89 91 93–95 and Cambodia (n=7) 74–76 82 83 87 90. The study designs were: qualitative studies (n=25);17 30 35 39 46 49–51 59–61 63 66 73 74 76 80 82 87 89 91 93 94 99 100 quantitative studies (n=21);14 33 36 38 41 42 44 45 48 62 64 65 67 69 72 78 83–85 96 97 and mixed methods studies (n=21) 32 34 37 40 43 47 52–56 58 70 71 75 86 88 90 95 98 101. Of the remaining eight studies, five were descriptive case studies,57 68 81 92 102 and three were project reviews/reports31 77 79 (online supplemental figure 2b).…”

“…Based on the IAPP framework categories, the majority of the studies (n=37) were categorised as the Inform level, with most being from SSA (n=27)17 30 34 35 37 40–42 44 45 47–50 52–56 58 60 61 63 64 66 67 69 and EAP (n=8),76 79 81 82 84 85 88 95 while there was one study each from SSA97 and LAC 99. Twenty-six studies were categorised at the involve level (n=26), with SSA contributing the most studies (n=14)32 33 36 38 43 46 51 59 62 68 71 72 100 101 followed by EAP (n=9),74 75 77 80 82 86 87 90 103 SEA (n=2),96 97 and LAC (n=1) 102. Four studies were categorised as consult, of which three were from SSA57 65 70 and one from EAP 93.…”

“…In SSA, the majority of the studies included an intervention activity related to HE (n=15),39 40 44 45 49–51 57–60 62 70 and a combination of HE and HS (n=18) 17 31 32 35 42 47 48 52–56 61 64–66 69 101. Some studies (n=7) focused on HE and EM,33 36 43 46 68 71 72 while some were standalone HS (n=5)30 34 41 63 67 or EM (n=2)37 100 intervention activities. In the EAP region, most of the intervention activities focused on HE and HS (n=14),14 73 75 80 81 84–86 89–91 93–95 followed by HE (n=7),74 76 77 82 87 88 92 HS and EM (n=1),79 and all three areas (HE, HS and HM) (n=1) 78.…”