Table 2 |
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Conceptual principles underlying development of the Dar es Salaam Urban Malaria Control Programme on the basis of direct practical experience [23, 24, 29, 35-38] and an extensive literature review [5, 6, 12, 29] |
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| Rapid response |
An. gambiae sibling species readily develop from egg to adult within a week in habitats that often
occur transiently and unpredictably [61, 70] so surveillance and larvicide application
must be implemented in cycles of a week or less, with consequent responses to observed
failures executed within 24 hours [14, 17, 36]. |
| Community-based implementation |
Sustainable programmes in Africa will be predominantly staffed by community-based
personnel with minimal educational qualifications [29, 71-73] so simple protocols
and readily-verifiable targets that can be managed with minimal technology are essential
to achieve effectiveness [12]. |
| Decentralization |
Given these resource limitations and the sheer abundance of mosquito aquatic habitats
in tropical Africa, responsibility for surveillance and response to operational monitoring
observations must therefore be devolved to staff assigned to geographic sub-units
small enough to be traversed daily on foot. |
| Comprehensive coverage |
Until reliable, generalizable and practical procedures are developed which allow targeting
of the most productive malaria vector habitats [10, 11] under such programmatic circumstances,
high coverage of all potential sources [4, 5, 14-17, 74] is necessary to achieve satisfactory
reductions of malaria transmission and burden in African settings [12, 75]. |
| Rigorous vertical management |
To achieve sufficient coverage, such decentralized, community-based approaches will
require new tools for hierarchical, centralized management that individualize responsibility
for all program activities [5, 17] and allow rigorous monitoring, evaluation and adaptive
tuning [24]. Each level of management from the CORPs up to the City Mosquito Control
Coordinator is responsible for identifying and addressing all programmatic shortcomings
under their purview before they are detected by the next highest level within the
program or external evaluators such as donors or research partners. |
| Adult mosquito densities as a priority performance indicator |
Larval surveillance alone is inadequate to monitor or evaluate larviciding programs
because it only reflects observations in habitats successfully covered by surveillance
activities. Weekly monitoring of adult mosquitoes is necessary to allow rigorous monitoring,
evaluation and management. While clinical or parasitological indicators are essential
for rigorous evaluation of program impact, these are usually collected and reported
on timescales too slow to enable day-to-day management for optimal performance. |
| Separation of surveillance and treatment responsibilities |
Larvicidal treatment, monitoring and evaluation activities should each be implemented
by distinct groups of personnel so that competing interests in data collection and
interpretation are minimized [5, 14, 17] |
| Integration with existing infrastructure and governance mechanisms |
Larval control programs must be integrated with pre-existing local government structures
and public health systems to minimize costs, maximize effectiveness and ensure sustained
acceptance by communities, public services and governments [29, 71-73]. |
| Full time staff |
Larval control program staff must be allocated to the program full time. New responsibilities
can not be taken over by established and often overburdened public health staff. Larval
control staff will be recruited and managed through existing infrastructure and governance
mechanisms as described above. |
| Satisfactory evidence must precede scale up. |
Although some encouraging evidence does exist [14-17, 36, 74], strategies targeting
aquatic stage mosquitoes, including systematic larviciding remain underdeveloped and
have yet to be evaluated on scales that are meaningful for scale-up as priority malaria
prevention measures in Africa. |
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Fillinger et al. Malaria Journal 2008 7:20 doi:10.1186/1475-2875-7-20 |
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