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

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.

Biolarviciding implementation in southern Tanzania: Scalability opportunities and challenges.

BACKGROUND: The resistance to insecticides among malaria vectors poses a global challenge in the efforts towards malaria elimination. This calls for an addition of larval control methods such as biolarviciding. However, the implementation of biolarviciding in Tanzania has been very low. Therefore, this study explored factors affecting the implementation of biolarviciding in the councils of Southern Tanzania. METHODS: A mixed method descriptive qualitative, cross-sectional study design was used to collect data from 32 community leaders through key informant interviews and 12 Vectors Control Coordinators through in-depth interviews and questionnaire interviews and document review of implementation reports in 12 councils. Data were analysed using ATLAS.ti version 8, where content analysis was performed and SPSS for the quantitative data. RESULTS: The study found low implementation of biolarviciding intervention in 9 out of 12 (75%) surveyed councils. All Vector Control Coordinators reported a shortage of at least one type of resources: funds, trained personnel, transport, supply of biolarvicide, and equipment; low community involvement (50%) and low level of community participation 83.3% (10/12). CONCLUSION: This study highlights resource inadequacy and low community participation as main barriers to the implementation of biolarviciding. Availing adequate resources and strengthening community participation through involvement in all stages of implementation is crucial for successful and sustainable implementation.

A gene variant in the Atp10d gene associates with atherosclerotic indices in Japanese elderly population.

BACKGROUND: ATP10D belongs to a subfamily of P-type ATPases implicated in phospholipids translocation from the exoplasmic to the cytoplasmic leaflet of cellular biological membrane. Previous genome-wide association study (GWAS) identified that a variant in Atp10d gene (rs2351791) associates with serum lipid profile and myocardial infarction. The objective of this study is to assess the effect of this variant on atherosclerosis in Japanese elderly population. METHOD: Consecutive autopsy cases registered in JG-SNP study were recruited (n = 1536). The samples were pathologically assessed for atherosclerosis using macroscopic examination of the formalin-fixed arteries, and coronary stenotic index (CSI), intracranial atherosclerotic index (ICAI) and pathological atherosclerotic index (PAI), which represent systemic arteries were calculated. The variant rs2351791 (G/T) in Atp10d gene was genotyped by Taqman genotyping assay and association determined. RESULT: Both CSI and ICAI were significantly higher in GG genotype than GT genotype and TT genotype (p = 0.003 and p = 0.001, respectively). Both associations remained significant in minor allele dominant model after adjusting for age, hypertension, diabetes, HDL, smoking and drinking (p = 0.001 and p = 0.001, respectively). PAI was not associated with this variant. Consistent with the previous report, plasma HDL cholesterol level was lower in GG genotype compared to GT + TT genotypes (p = 0.001). CONCLUSION: The rs2351791 SNP in the Atp10d gene affects the susceptibility for cardiac and intracranial vascular stenosis in the elderly Japanese population.

Effectiveness of health sector reforms in reducing disparities in utilization of skilled birth attendants in Tanzania.

Improving maternal health is a Millennium Development Goal adopted at the 2000 Millennium Summit of the United Nations. As part of the improving maternal health in Tanzania, it has been recommended that skilled birth attendants be present at all births to help reduce the high maternal mortality ratio. However, utilization of these attendants varies across socio-economic groups. The government of Tanzania has repeatedly attempted to carry out health sector reforms (HSRs) to alleviate disparities in health service utilization. In particular, around 1999, HSRs were incorporated into two approaches, including Decentralization by Devolution and Sector Wide Approach. This study aims to clarify the unresolved questions with little published evidence on the effect of HSRs on reducing disparities in utilization of skilled birth attendants across socio-economic groups over time. We used four cross-sectional datasets from the Tanzania Demographic and Health Survey: 1992, 1996, 1999, and 2004/05. Subjects included 14,752 women of reproductive age (15-49 years) and data on the most recent birth in the 5 years before each survey. Logistic regression analysis was performed with the dependent variable of whether respondents utilized skilled birth attendants or not, and with the main independent variables of time and socio-economic group. Results showed that the disparity in utilization of skilled birth attendants was significantly decreased from 1999 to 2004/05. These findings suggest that the two strategies, Decentralization by Devolution and Sector Wide Approach, in the process of HSRs are effective in reducing the disparities in utilization of skilled birth attendants among socio-economic groups.