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

AbstractBackgroundOnce a mainstay of malaria elimination operations, larval source management—the treatment of mosquito breeding habitats–has been marginalized in Africa, due to insufficient effectiveness. However, the development of new technologies, and mosquitoes’ growing resistance to insecticides used in bed nets and house spraying raise renewed interest in this method.MethodsA digitally managed larviciding operation in three of the seven districts of São Tomé and Príncipe (STP) was launched by the Ministry of Health and ZzappMalaria LTD, guided by the Zzapp map-and-GPS mobile application and dashboard. During the operation, quality assurance procedures and field management methods were developed and implemented.Findings12,788 water bodies were located and treated a total of 128,864 times. The reduction impact on mosquito population and on malaria cases was 74·90% and 52·65%, respectively. The overall cost per person protected (PPP) was US$0·78 and US$0·41 PPP in the urban areas. Various cost and effectiveness drivers were identified.InterpretationDigitally managed larviciding can yield highly cost-effective results, especially in urban areas. Digital tools facilitate standardization of operations, implementation of quality assurance procedures, and monitoring of fieldworkers’ performance. Digitally generated spatial data also have the potential to assist integrated vector management operations. A randomized controlled trial with a larger sample is needed to further substantiate findings.FundingThe operation was funded by ZzappMalaria LTD and the STP Ministry of Health (MOH).