title: Strategies and approaches to vector control in nine malaria-eliminating countries: a cross-case study analysis.
abstract: BACKGROUND
  There has been progress towards malaria elimination in the last decade. In response, WHO launched the Global Technical Strategy (GTS), in which vector surveillance and control play important roles. Country experiences in the Eliminating Malaria Case Study Series were reviewed to identify success factors on the road to elimination using a cross-case study analytic approach.
  
  
  METHODS
  Reports were included in the analysis if final English language draft reports or publications were available at the time of analysis (Bhutan, Cape Verde, Malaysia, Mauritius, Namibia, Philippines, Sri Lanka, Turkey, Turkmenistan). A conceptual framework for vector control in malaria elimination was developed, reviewed, formatted as a matrix, and case study data was extracted and entered into the matrix. A workshop was convened during which participants conducted reviews of the case studies and matrices and arrived at a consensus on the evidence and lessons. The framework was revised and a second round of data extraction, synthesis and summary of the case study reports was conducted.
  
  
  RESULTS
  Countries implemented a range of vector control interventions. Most countries aligned with integrated vector management, however its impact was not well articulated. All programmes conducted entomological surveillance, but the response (i.e., stratification and targeting of interventions, outbreak forecasting and strategy) was limited or not described. Indoor residual spraying (IRS) was commonly used by countries. There were several examples of severe reductions or halting of IRS coverage and subsequent resurgence of malaria. Funding and operational constraints and poor implementation had roles. Bed nets were commonly used by most programmes; coverage and effectiveness were either not measured or not articulated. Larval control was an important intervention for several countries, preventing re-introduction, however coverage and impact on incidence were not described. Across all interventions, coverage indicators were incomparable, and the rationale for which tools were used and which were not used appeared to be a function of the availability of funding, operational issues and cost instead of evidence of effectiveness to reduce incidence.
  
  
  CONCLUSIONS
  More work is required to fill gaps in programme guidance, clarify the best methods for choosing and targeting vector control interventions, and support to measure cost, cost-effectiveness and cost-benefit of vector surveillance and control interventions.
authors.affiliation: Malaria Elimination Initiative, Global Health Group, University of California, San Francisco, 550 16th Street, 3rd Floor, San Francisco, CA, USA. cara.smith@ucsf.edu.
authors.forename: Cara
authors.initials: C
authors.lastname: Smith Gueye
authors.affiliation: Malaria Elimination Initiative, Global Health Group, University of California, San Francisco, 550 16th Street, 3rd Floor, San Francisco, CA, USA. gretchen.newby@ucsf.edu.
authors.forename: Gretchen
authors.initials: G
authors.lastname: Newby
authors.affiliation: Malaria Elimination Initiative, Global Health Group, University of California, San Francisco, 550 16th Street, 3rd Floor, San Francisco, CA, USA. roly.gosling@ucsf.edu.
authors.forename: Roland D
authors.initials: RD
authors.lastname: Gosling
authors.affiliation: Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA, USA. m.whittaker@sph.uq.edu.au.
authors.forename: Maxine A
authors.initials: MA
authors.lastname: Whittaker
authors.affiliation: London School of Tropical Medicine and Hygiene, Keppel Street, London, WC1E 7HT, UK. daniel.chandramohan@lshtm.ac.uk.
authors.forename: Daniel
authors.initials: D
authors.lastname: Chandramohan
authors.affiliation: The University of Queensland School of Public Health, Herston, QLD, Australia. lms5@cdc.gov.
authors.forename: Laurence
authors.initials: L
authors.lastname: Slutsker
authors.affiliation: Swiss Tropical and Public Health Institute, Socinstrasse 57, 4051, Basel, Switzerland. marcel.tanner@unibas.ch.|University of Basel, Basel, Switzerland. marcel.tanner@unibas.ch.
authors.forename: Marcel
authors.initials: M
authors.lastname: Tanner
mesh_terms: D000818:Animals; D001631:Bhutan; D055726:Cabo Verde; D006801:Humans; D008288:Malaria / Q000517:prevention & control* / Q000635:transmission; D008296:Malaysia; D008436:Mauritius; D009032:Mosquito Control / Q000379:methods*; D009276:Namibia; D010679:Philippines; D013188:Sri Lanka; D014421:Turkey; D014423:Turkmenistan