Background
Methods
LSM using Bti
Study site
Study procedures
Stakeholder pre-engagement meetings
Quantitative study: socio-economic baseline questionnaire
Qualitative study: focus group discussions
Ethical considerations
Data analysis
Results
Quantitative study: socio-economic baseline questionnaire
Socio-demographic characteristics
Experience with and knowledge about malaria
Awareness and perceptions about LSM
Rice farmers’ willingness to physically participate in Bti application
Variable | Univariate OR (95% CI) |
p value | Multivariate OR (95% CI) |
p value |
---|---|---|---|---|
Age (years) | ||||
20–34 | 1 | |||
35–50 | 1.173 (0.621–2.214) | 0.623 | ||
51 + | 0.741 (0.381–1.442) | 0.377 | ||
Gender | ||||
Male | 1.567 (0.957–2.567) |
0.074
| ||
Female | 1 | |||
Marital status | ||||
Married or living together | 2.059 (1.094–3.875) |
0.025
| ||
Single/divorced/widow | 1 | |||
Educational level | ||||
None | 1 | |||
Primary | 1.607 (0.921–2.806) | 0.095 | ||
Post-primary/vocational | 1.059 (0.182–6.156) | 0.949 | ||
Secondary school or higher | 1.324 (0.379–4.619) | 0.660 | ||
Family size | ||||
1–5 people | 1.601 (0.977–2.625) |
0.062
| ||
6 + | 1 | |||
Involvement in rice farming (years) | ||||
0–5 | 6.344 (2.061–19.529) |
0.001
| 4.939 (1.504–16.218) |
0.008
|
6–14 | 3.229 (1.889–5.521) | 0.000 | 1.900 (1.007–3.587) |
0.048
|
15 + | 1 | |||
Household income from rice cultivation | ||||
0–50% | 2.155 (1.226–3.788) |
0.008
| ||
51% + | 1 | |||
Capital given for cooperative membership | ||||
0–3000 RWF | 7.765 (3.697–16.308) |
0.000
| 6.103 (2.639–14.113) |
0.000
|
3001–20,000 RWF | 2.144 (1.211–3.794) |
0.009
| 1.870 (0.966–3.620) |
0.063
|
20,001 RWF+ | 1 | |||
Rice profitable | ||||
No/hardly/modestly | 1.995 (1.197–3.325) |
0.008
| 1.843 (1.021–3.328) |
0.043
|
Yes, very much | 1 | |||
Malaria transmission | ||||
No | 1 | |||
Mosquito/Anopheles
| 1.441 (0.617–3.365) | 0.399 | ||
Malaria symptoms | ||||
1–3 symptoms | 1 | |||
4 + | 3.114 (1.658–5.848) |
0.000
| 3.115 (1.565–6.203) |
0.001
|
Frequent mosquito bites in marshlands | ||||
Almost never/once in a while | 1 | |||
Often/very often | 1.624 (0.572–4.611) | 0.362 | ||
Rice cultivation as potential mosquito breeding site | ||||
Not at all important/minor importance | 1 | |||
Important/very important | 0.784 (0.211–2.916) | 0.716 | ||
Ever heard about larviciding | ||||
No | 1 | |||
Yes | 3.985 (1.377–11.534) |
0.011
| ||
Larviciding safety on rice consumers | ||||
None/little | 1 | |||
Much/very much | 1.557 (0.852–2.846) | 0.150 | ||
Larviciding safety on rice farmers | ||||
None/little | 1 | |||
Much/very much | 1.490 (0.814–2.727) | 0.196 | ||
Larviciding safety on living organisms | ||||
None/little | 1 | |||
Much/very much | 2.442 (1.217–4.901) |
0.012
| 2.357 (1.114–4.985) |
0.025
|
Larviciding reduce mosquito abundance | ||||
None/little | 1 | |||
Much/very much | 1.386 (0.827–2.322) | 0.215 | ||
Larviciding reduce malaria risk | ||||
None/little | 1 | |||
Much/very much | 1.003 (0.612–1.644) | 0.990 |
Qualitative study: baseline and endline outcomes from FGDs
Demographical characteristics
Baseline outcomes: knowledge on mosquito larval habitat
Lay community FGD, Female, 34 years“Many times we see mosquito larvae in pots and jerry-cans used to collect rain water in our homes. These can be breeding sites for mosquitoes, more especially when left uncovered for long.”
Local authorities FGD, Male, 38 years“We cannot remove dams, because they are very useful in providing water for irrigation, and this has been our campaign to encourage people to practise irrigation of crops so as to fight shortage of foods during the dry season. So we shall be contradicting ourselves telling them to close those dams. Instead I think there should be other measures for killing mosquito larvae in these dams.”
Baseline outcomes: perceptions on Bti intervention
Sprayers FGD, Male, 41 years“This is something everyone may be happy with, because if you observe well you will find that the existing methods used were not showing a satisfactory outcome. I feel that attacking mosquitoes at the breeding site will provide better results. Though even other existing methods will continue to be used; but if the added method of destroying mosquito larvae is implemented, a more satisfactory outcome will be realized.”
Baseline outcomes: perceived advantages and concerns associated with Bti
Local community FGD, Female, 34 years“Once malaria is reduced and people’s health improves, even economic development will be realized. When people are suffering from malaria, they don’t work, and hence no development. Once malaria is gone for good, there is nothing so good like living in a malaria free world!”
Baseline outcomes: recommendations for Bti implementation
Rice farmers FGD, Male, 40 years“If Bti will be applied in rice fields and the people involved in spraying would be outsiders, then it may not work well. I would suggest that people to be involved in the spraying exercise are rice farmers, since they know well how to walk in their fields. Each cooperative should select their people who will spray in their rice fields.”
Endline outcomes: awareness of Bti
Sprayer-CB arm, FGD, Male, 33 years“We were thoroughly educated about mosquito reproduction. We even participated in catching these larvae in swamps in areas where they can be commonly found. We later participated in Bti spraying exercise. What I have observed is that really this intervention works well, because wherever we sprayed, we could go back and check, only to find that all mosquito larvae were dead. And before they die, they first bulge and then burst. So this method is very effective.”
Endline outcomes: perceived benefits
Lay community FGD, Female, 60 years.“Generally the programme was so beneficial, especially in reducing mosquitoes. You could find to many mosquitoes swarming around homes in the evenings. In fact, we had no peace. But now we can sit out in the evening and enjoy fresh air. Even when you forget to close the windows, still you find no mosquitoes in the house. This is a benefit enjoyed by the whole sector; even malaria in the whole sector has reduced.”
Mosquito larvae monitoring FGD, Male, 36 years“There is something that I noticed with this programme. Before Bti spraying began, we could find mosquitoes from swamps swarming like bees, especially in rainy seasons (March and April). People and animals in this sector had no peace in that period. But now, the whole community is at peace, no more swarming of mosquitoes and this shows how effectively this program has reduced mosquitoes in this sector.”
Sprayer- CB arm, FGD, Male, 35 years“We observed and found that there was much change in swamps where the intervention was done. Mosquitoes greatly reduced, some to the extent of zero mosquito larvae, whereas in the control area, mosquito larvae continued to multiply daily.”
Mosquito larvae monitoring team FGD, Male, 33 years“We could check and record the plots and the field where we found plenty of mosquito larvae and the name of the owner. Then we could direct sprayers where we found larvae. So our relationship was good. Besides, we are all rice farmers from the same cooperatives, so we could discuss and tell them that the plot for so and so has plenty of mosquitoes, the next spray you should concentrate there. After all our goal was to control mosquitoes that transmit malaria in our sector.”
Endline outcomes: challenges regarding Bti application
Sprayer- CB arm, FGD Male, 35 years“The challenge we met in Gatare swamp is that there is one big ridge which is difficult to climb; it had been suggested that, they will bring a spraying machine that would help in spraying Bti from that ridge, but it was never brought. Though we tried to spray from the edges of that ridge, we couldn’t reach far enough; hence eliminating mosquito larvae in that area was never possible.”
Sprayer- PS arm FGD, Male, 41 years“There was also a challenge of thirst and hunger, because most of the time we could leave early in the morning sometimes without taking anything and spend the whole day in rice swamps walking and carrying pumps. By the time you finish to return home, one would be so exhausted and feeling sick.”
Mosquito larvae monitoring FGD, Male, 26 years“In the swamp where I worked, we met the challenge of thorny plants in the swamp that were hidden in the water such that whenever one makes a step, he/she could step on thorny plant, which could hurt you. That was before they gave us gum boots, but after boots were provided, that problem ended.”
Endline outcomes: community concerns
Rice farmers’ FGD, not involved in spraying, Female, 37 years“Our cooperatives leaders, who are also rice farmers, assured us that this substance is safe and since we trust them, we agreed. Even after starting the spraying activities, some of us could go to the fields to check if there was no effect to our rice crops, but we found that the substance had no negative effect on our rice.”
Sprayer-PS arm, FGD, Male, 39 years“We faced the problem of poor rice crop yield, mainly due to change of weather and crop disease that dried rice plants. But this was not related to Bti spray in the rice fields. It is a problem that tends to occur often whenever weather changes and this did not affect our sector only, even other sectors in this region were affected.”
Endline outcomes: recommendations for future scale-up of Bti application
Rice farmers’ FGD, not involved in spraying. Female, 44 years“There were very few persons to cover all swamps. They were so scattered such that covering the whole swamp was not possible. For example, in the swamp where we grow our rice, only a small part that has rice crops was sprayed, the bigger portion of the swamp where rice is not grown was not sprayed, because they were few. We wish you could increase the number of sprayers, so as to cover all swamps.”
Endline outcomes: community mobilization, education and participation
Larvae monitoring team FGD, Male, 26 years“There is a need to explain to them (community members) that mosquito larval control does not take away other malaria control measures, but supplements them. Spraying Bti in rice swamps does not mean that sleeping under bed nets or IRS should stop. Instead they should all continue, if we are to eradicate malaria.”
Lay community FGD, Male, 61 years“I think through rice farmers’ cooperatives, people would easily contribute towards a mosquito larval control program, simply because members in these cooperatives have a better understanding of contributing to communal activities. Later on, even other citizens could be involved after having seen the example from the rice farmers’ cooperatives.”
Local leaders FGD, Male, 32 years“… Once the community understands the programme and then observes the benefits, contributing towards its (LSM programme) sustainability will not be a problem. …. I feel even with the mosquito larval control programme the community can contribute towards its sustainability. For instance, in the initial stage, they may contribute about 50% and the government supports with the other 50% of the costs, but later they would be able to support it 100%.”
Endline outcomes: role of government
Local leaders FGD, Male, 48 years“I do agree that this programme has been effective in reducing malaria in our sector and once it is continued, and combined with other existing malaria control measures, no doubt malaria can be eradicated. I would suggest that the research team presents the research findings to the Government, so that they may consider it in their programmes for malaria control and plan how to implement it in collaboration with the citizens. Not only in this sector, but in the whole country.”