Abstract
In regions where mosquito-borne diseases are endemic, like Zanzibar, hospitals may act as transmission hotspots. Preventative interventions designed and co-created with stakeholders in hospital settings may help reduce disease risks and address related user needs. A structured co-creation process, guided by the PRODUCES+ framework and adopting a situated living labs approach, was used to design and implement interventions in four district hospitals from December 2024 to September 2025. Stakeholders and needs were identified through stakeholder mapping and a mixed-methods needs assessment. Participatory workshops using co-creation methods were used to develop the interventions, evaluations conducted, and outcomes reported to participants. Interventions targeting larval source reduction, building and landscape modifications were developed and implemented. Seventy-five participants were engaged, including staff, patients and specialists. Initial evaluation indicated high satisfaction among participants, and capacity-building and preventative behaviours were observed after the process. Co-creation and situating the process within a living labs framework enabled context-specific mosquito control interventions. The approach required adaptability owing to resource and time intensity and ongoing staff or clinical demands. Findings will inform subsequent intervention rounds planned in 2026 and could support the adoption of co-created vector control in similar health care environments.
Practice relevance
This study demonstrates how co-creation with hospital staff, patients, and other key stakeholders can generate novel, context-specific interventions to reduce mosquito-borne disease risks in health care environments. By integrating environmental surveillance, participatory workshops, and iterative feedback, the co-creation process developed practical modifications to wards, waiting areas, sanitation systems and waste management. The process fostered knowledge exchange and capacity-building among participants, increasing the likelihood of preventative measures being integrated into other aspects of their lives and practice. For practitioners, the findings highlight the value of participatory methods to identify site-specific risks and co-create effective vector control strategies to address them. Key actions include involving diverse stakeholders, embedding evaluation throughout intervention development, and adapting interventions to user needs and operations. This approach can inform future design, retrofitting and operational practices in hospitals and similar institutional settings facing mosquito-borne disease challenges.