title: Microbial larvicide application by a large-scale, community-based program reduces malaria infection prevalence in urban Dar es Salaam, Tanzania.
abstract: BACKGROUND
  Malaria control in Africa is most tractable in urban settlements yet most research has focused on rural settings. Elimination of malaria transmission from urban areas may require larval control strategies that complement adult mosquito control using insecticide-treated nets or houses, particularly where vectors feed outdoors.
  
  
  RESULTS
  Microbial larvicide (Bacillus thuringiensis var. israelensis (Bti)) was applied weekly through programmatic, non-randomized community-based, but vertically managed, delivery systems in urban Dar es Salaam, Tanzania. Continuous, randomized cluster sampling of malaria infection prevalence and non-random programmatic surveillance of entomological inoculation rate (EIR) respectively constituted the primary and secondary outcomes surveyed within a population of approximately 612,000 residents in 15 fully urban wards covering 55 km(2). Bti application for one year in 3 of those wards (17 km(2) with 128,000 residents) reduced crude annual transmission estimates (Relative EIR [95% Confidence Interval] = 0.683 [0.491-0.952], P = 0.024) but program effectiveness peaked between July and September (Relative EIR [CI] = 0.354 [0.193 to 0.650], P = 0.001) when 45% (9/20) of directly observed transmission events occurred. Larviciding reduced malaria infection risk among children < or =5 years of age (OR [CI] = 0.284 [0.101 to 0.801], P = 0.017) and provided protection at least as good as personal use of an insecticide treated net (OR [CI] = 0.764 [0.614-0.951], P = 0.016).
  
  
  CONCLUSIONS
  In this context, larviciding reduced malaria prevalence and complemented existing protection provided by insecticide-treated nets. Larviciding may represent a useful option for integrated vector management in Africa, particularly in its rapidly growing urban centres.
authors.affiliation: Department of Public Health and Epidemiology, Swiss Tropical Institute, Basel, Switzerland.
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Geissbühler
authors.forename: Khadija
authors.initials: K
authors.lastname: Kannady
authors.forename: Prosper Pius
authors.initials: PP
authors.lastname: Chaki
authors.forename: Basiliana
authors.initials: B
authors.lastname: Emidi
authors.forename: Nicodem James
authors.initials: NJ
authors.lastname: Govella
authors.forename: Valeliana
authors.initials: V
authors.lastname: Mayagaya
authors.forename: Michael
authors.initials: M
authors.lastname: Kiama
authors.forename: Deo
authors.initials: D
authors.lastname: Mtasiwa
authors.forename: Hassan
authors.initials: H
authors.lastname: Mshinda
authors.forename: Steven William
authors.initials: SW
authors.lastname: Lindsay
authors.forename: Marcel
authors.initials: M
authors.lastname: Tanner
authors.forename: Ulrike
authors.initials: U
authors.lastname: Fillinger
authors.forename: Marcia Caldas
authors.initials: MC
authors.lastname: de Castro
authors.forename: Gerry Francis
authors.initials: GF
authors.lastname: Killeen