Community participation in tsetse control: A mixed methods assessment of feasibility, effectiveness, acceptability and empowerment in three villages of the Democratic Republic of Congo

Vander Kelen, Catiane (2023) Community participation in tsetse control: A mixed methods assessment of feasibility, effectiveness, acceptability and empowerment in three villages of the Democratic Republic of Congo, Thesis (Doctoral), Liverpool School of Tropical Medicine.

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Abstract

Introduction
DRC is the country most affected by gambiense human African trypanosomiasis (g-HAT), a neglected tropical disease caused by subspecies of Trypanosoma brucei gambiense transmitted by tsetse (Glossina). The World Health Organization (WHO) aims to eliminate the transmission of g-HAT by 2030, and epidemiological models suggest that achieving this aim requires a combination of case detection and treatment of human cases and tsetse control.
The use of Tiny Targets, small panels of insecticide-treated material which attract and kill tsetse, is a new and cost-effective method of tsetse control introduced to DRC in 2015. Deployment of Tiny Targets is expert-led and communities have little or no involvement. In other vector control contexts, community-based approaches are recommended because they offer the prospect of cost-effective
control with wider benefits to the community. The aim of this study was to determine whether a community-based approach could form part of a national HAT elimination strategy in DRC, and to explore the extent to which community based deployment of Tiny Targets would facilitate community empowerment.
Method
I employed a mixed methods study design that included quantitative and qualitative methods, using action research and cross-sectional approaches. The qualitative studies included 38 focus group discussions, seven semi-structured interviews, nine participatory workshops and 289 hours of observation. The geographical distributions of 2429 Tiny Targets deployed by the community
were quantified using global positioning systems (GPSs) and the likely efficacy of the targets was estimated using a quality evaluation grid applied to each Tiny Target deployed.
Results
My findings showed that deployment of Tiny Targets by communities was effective, feasible and suitable for g-HAT elimination. Community knowledge led to an adapted Tiny Target deployment strategy that was better suited to their environment and way of life, yet also complemented the expert-led approach. Communities showed motivation, proactivity and good application of the acquired knowledge resulting in an effective deployment. This research revealed that positive perceptions and acceptability towards Tiny Targets and the wider g-HAT elimination strategy is better when communities are involved with respect for their community norms and better communication. Through participation in the intervention, the community gained empowerment, despite community identifies some power imbalance between the community and the partners.
Conclusion
Community-based deployment of Tiny Targets can be an asset for a
national strategy to eliminate transmission of g-HAT. When communities are actively involved and the intervention is implemented within local customs there is a positive perception of Tiny Targets and their benefits which leads to a greater likelihood of success. The intervention had broader benefits of community empowerment but this was limited by perceptions of being part of wider “top down” programme and by stakeholders attitude toward community participation. If empowerment is to be an important objective of projects and programmes then the needs identified by communities must be recognised and attitude of sharing power encouraged.

Item Type:	Thesis (Doctoral)
Subjects:	QX Parasitology > Insects. Other Parasites > QX 505 Diptera QX Parasitology > Insects. Other Parasites > QX 600 Insect control. Tick control WA Public Health > Preventive Medicine > WA 110 Prevention and control of communicable diseases. Transmission of infectious diseases WA Public Health > WA 30 Socioeconomic factors in public health (General) WA Public Health > Health Administration and Organization > WA 546 Local Health Administration. Community Health Services
Faculty: Department:	Biological Sciences > Vector Biology Department
Depositing User:	Lynn Roberts-Maloney
Date Deposited:	07 Feb 2024 11:47
Last Modified:	07 Feb 2024 11:47
URI:	https://archive.lstmed.ac.uk/id/eprint/23986

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