Stakeholders' perception, acceptability, and sustainability of larviciding intervention in Tanga Region, Tanzania

Fadhila Kihwele¹Tegemeo Gavana^1,2,3*Denis Kailembo^2,3Elizabeth Kasagama²Charles Dismas Mwalimu⁴Jubilate Bernard Minja⁴Best Yoram⁵Leah Ndekuka⁴Stella Kajange⁵Samwel Lazaro⁴Noela Kisoka²Prosper Pius Chaki¹Christian Lengeler^2,3Angel Dillip⁶

• ¹Environmental Health and Ecological Sciences, Ifakara Health Institute, Dar es Salaam, Tanzania
• ²Swiss Tropical and Public Health Institute, Kreuzstrasse 2, 4123, Allschwil (near Basel), Switzerland
• ³University of Basel, Petersplatz 1, Basel, Switzerland
• ⁴National Malaria Control Programme, Ministry of Health, Dodoma, Tanzania
• ⁵President Office, Regional Administration and Local Government, Government City – Mtumba TAMISEMI street, Dodoma, Tanzania
• ⁶Apotheker Health Access Initiative, Dar es Salaam, Tanzania

Background: In 2019, the Government of Tanzania endorsed the countrywide implementation of mosquito larviciding to complement insecticide treated nets (ITNs) and indoor residual spraying (IRS) as vector control interventions. Between 2022 and 2024, a large-scale pilot project covering over one Million population was implemented in Tanga Region, in the North-East of the country. The programme was implemented entirely by the government system and made use of Community Owned Resource Persons (CORPs). This manuscript presents the key results of a qualitative study assessing the stakeholders' perception, awareness, acceptability, facilitating factors, barriers and sustainability of the intervention. Companion publications are reporting on operations, entomological and epidemiological impact, and costing. Methodology: This cross-sectional qualitative study used in-depth interviews (IDIs) and focus group discussions (FGDs) to assess the perception, acceptability, and sustainability of larviciding. A total of 44 IDIs were conducted with government officials overseeing project implementation. Additionally, 13 FGDs were held with 156 community participants: 72 CORPs involved in larviciding activities and 84 other community members. Data were analyzed using a framework analysis. Results: The study findings showed that community based larviciding was perceived as safe, acceptable, effective, feasible and sustainable. However, several key challenges were identified, including unpleasant smell of larvicide, turnover of CORPS, logistic problem and discontinuous implementation. Conclusion: The pilot larviciding intervention implemented in Tanga Region was perceived as safe, effective, feasible, sustainable, and was widely accepted by the community. However, addressing key operational challenges such as the unpleasant odor of the larvicide, high turnover of CORPs, logistical constraints, and discontinuous implementation will be essential to ensure the effectiveness and sustainability of future large-scale rollouts.