Digitally managed larviciding as a cost-effective intervention for urban malaria: operational lessons from a pilot in São Tomé and Príncipe guided by the Zzapp system

• Published in: Malaria Journal
• Main Authors: Arbel Vigodny, Michael Ben Aharon, Alexandra Wharton-Smith, Yonatan Fialkoff, Arnon Houri-Yafin, Fernando Bragança, Flavio Soares Da Graça, Dan Gluck, João Alcântara Viegas D’Abreu, Herodes Rompão
• Format: Article in Journal/Newspaper
• Language: English
• Published: BMC 2023
• Subjects: Urban malaria; Vector control; Larval source management; Digitally managed larviciding; Arctic medicine. Tropical medicine; RC955-962; Infectious and parasitic diseases; RC109-216; Arctic; DML
• Online Access: https://doi.org/10.1186/s12936-023-04543-0; https://doaj.org/article/5b70bf1294c143b18567ff7a0d700367

Abstract Background Once a mainstay of malaria elimination operations, larval source management (LSM)—namely, the treatment of mosquito breeding habitats–has been marginalized in Africa in favour of long-lasting insecticidal nets (LLINs) and indoor residual spraying (IRS). However, the development of new technologies, and mosquitoes' growing resistance to insecticides used in LLINs and IRS raise renewed interest in LSM. Methods A digitally managed larviciding (DML) operation in three of the seven districts of São Tomé and Príncipe (STP) was launched by the Ministry of Health (MOH) and ZzappMalaria LTD. The operation was guided by the Zzapp system, consisting of a designated GPS-based mobile application and an online dashboard, which facilitates the detection, sampling and treatment of mosquito breeding sites. During the operation, quality assurance (QA) procedures and field management methods were developed and implemented. Results 12,788 water bodies were located and treated a total of 128,864 times. The reduction impact on mosquito population and on malaria incidence was 74.90% and 52.5%, respectively. The overall cost per person protected (PPP) was US$ 0.86. The cost varied between areas: US$ 0.44 PPP in the urban area, and US$ 1.41 PPP in the rural area. The main cost drivers were labour, transportation and larvicide material. Conclusion DML can yield highly cost-effective results, especially in urban areas. Digital tools facilitate standardization of operations, implementation of QA procedures and monitoring of fieldworkers’ performance. Digitally generated spatial data also have the potential to assist integrated vector management (IVM) operations. A randomized controlled trial (RCT) with a larger sample is needed to further substantiate findings.