Integrating participatory community mobilization processes to improve dengue prevention: an eco-bio-social scaling up of local success in Machala, Ecuador

Mitchell-Foster, Kendra; Ayala, Efraín Beltrán; Breilh, Jaime; Spiegel, Jerry; Wilches, Ana Arichabala; Leon, Tania Ordóñez; Delgado, Jefferson Adrian

doi:10.1093/trstmh/tru209

Cited by 39 publications

(48 citation statements)

References 30 publications

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“…This could have contributed to the observed lower BIs, through more vigilant and knowledgeable pupils who were active in cleaning up garbage around schools. Similar results have been found in Ecuador [75], where pupal indices were lower in schools which received integrated intervention strategies (including dengue education, patio and container clean-up campaigns through community empowerment and social mobilization) compared to the conventional dengue prevention government program (including routine temephos larval control and reactive/targeted deltamethrin and malathion fogging).…”

Section: Discussionsupporting

confidence: 83%

A Cluster-Randomized Controlled Trial to Reduce Diarrheal Disease and Dengue Entomological Risk Factors in Rural Primary Schools in Colombia

et al. 2016

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BackgroundAs many neglected tropical diseases are co-endemic and have common risk factors, integrated control can efficiently reduce disease burden and relieve resource-strained public health budgets. Diarrheal diseases and dengue fever are major global health problems sharing common risk factors in water storage containers. Where provision of clean water is inadequate, water storage is crucial. Fecal contamination of stored water is a common source of diarrheal illness, but stored water also provides breeding sites for dengue vector mosquitoes. Integrating improved water management and educational strategies for both diseases in the school environment can potentially improve the health situation for students and the larger community. The objective of this trial was to investigate whether interventions targeting diarrhea and dengue risk factors would significantly reduce absence due to diarrheal disease and dengue entomological risk factors in schools.Methodology/Principal FindingsA factorial cluster randomized controlled trial was carried out in 34 rural primary schools (1,301 pupils) in La Mesa and Anapoima municipalities, Cundinamarca, Colombia. Schools were randomized to one of four study arms: diarrhea interventions (DIA), dengue interventions (DEN), combined diarrhea and dengue interventions (DIADEN), and control (CON). Interventions had no apparent effect on pupil school absence due to diarrheal disease (p = 0.45) or on adult female Aedes aegypti density (p = 0.32) (primary outcomes). However, the dengue interventions reduced the Breteau Index on average by 78% (p = 0.029), with Breteau indices of 10.8 and 6.2 in the DEN and DIADEN arms, respectively compared to 37.5 and 46.9 in the DIA and CON arms, respectively. The diarrhea interventions improved water quality as assessed by the amount of Escherichia coli colony forming units (CFU); the ratio of Williams mean E. coli CFU being 0.22, or 78% reduction (p = 0.008).Conclusions/SignificanceIntegrated control of dengue and diarrhea has never been conducted before. This trial presents an example for application of control strategies that may affect both diseases and the first study to apply such an approach in school settings. The interventions were well received and highly appreciated by students and teachers. An apparent absence of effect in primary outcome indicators could be the result of pupils being exposed to risk factors outside the school area and mosquitoes flying in from nearby uncontrolled breeding sites. Integrated interventions targeting these diseases in a school context remain promising because of the reduced mosquito breeding and improved water quality, as well as educational benefits. However, to improve outcomes in future integrated approaches, simultaneous interventions in communities, in addition to schools, should be considered; using appropriate combinations of site-specific, effective, acceptable, and affordable interventions.Trial RegistrationClinicalTrials.gov no. ISRCTN40195031

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Section: Discussionsupporting

confidence: 83%

A Cluster-Randomized Controlled Trial to Reduce Diarrheal Disease and Dengue Entomological Risk Factors in Rural Primary Schools in Colombia

et al. 2016

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“…Some of the trial educational materials101000CI, BI, HI and PPI measured at baseline, 5 m and 10 mAt 10 m there were significant reductions in the HI, BI, CI and PPI in the intervention vs control clusters.A community-based approach involving multiple stakeholders to implement control actions reduced dengue vector indices.Abeyewickreme (2012),Sri Lanka [48]Feb 2009 – Feb 2010>Building partnerships of local stakeholders>Household solid waste management promoted by HH volunteers>Promoting composting of biodegradable waste>Improvement of local gov rubbish collection4803Local government services4790Measured PPI, HI, CI and BI at baseline, 3 m, 9 m and 15 mNo significant differences between intervention and control clusters for HI, CI. BI significantly lower at 15 m. PPI significantly reduced in intervention clusters.Household and community involvement helped reduce solid waste containers which are major site of dengue breeding.Castro (2012) Cuba [49]Oct 2004 –Dec 2007Participatory strategy:> Organisation and management structures > entomological risk surveillance>capacity building at local & intermediate level>community work in vector control, led by community working groups (CWGs) who visited HH, planned actionsGovernment routine vector control programme continued16389Government routine vector control programme: House inspections, temephos to water containers, space spraying with cypermethrin or cloripyriphos, health education, fines for law infringements16390BI measured monthly from government surveillance figures before and during intervention from mid 2005 to Dec 2007.Over the intervention period, the BI remained significantly lower in the intervention clusters than in the control clusters; the difference was bigger after the CWGs began their activities.The empowerment strategy increased community involvement and added effectiveness to routine vector control.Caprara (2015) Brazil [50]Jun 2012 – May 2013>Community workshops>Mobilising elders and schoolchildren for solid waste management>Government workers encouraged covering water containers>Educational materials101689Routine government vector control programme.101580HI, CI, BI, PPI measured at baseline and 6 mAll indices significantly lower in the intervention clusters at 6 m.Social participation and environmental management is feasible and significantly reduced vector indices.Mitchell-Foster (2015)Ecuador [51]Nov 2012 – Nov 2013An integrated intervention strategy (IIS)>Elementary school education programme>Clean Patio Safe Container programme with community volunteer activators10993Government control programme:>Initially temephos and space spraying with insecticide>Midway, changed to biolarvicide (Bti) and HH education for source reduction…”

Section: Resultsmentioning

confidence: 99%

“…In the trial from Ecuador [51], the analysis was complicated by a change in the government programme midway through the intervention: from a programme based on temephos in water and insecticide space spraying to use of a biolarvicide (Bti) and education for source reduction.…”

Section: Resultsmentioning

confidence: 99%

Assessing the effects of interventions for Aedes aegypti control: systematic review and meta-analysis of cluster randomised controlled trials

et al. 2017

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BackgroundThe Aedes aegypti mosquito is the vector for dengue fever, yellow fever, chikungunya, and zika viruses. Inadequate vector control has contributed to persistence and increase of these diseases. This review assesses the evidence of effectiveness of different control measures in reducing Aedes aegypti proliferation, using standard entomological indices.MethodsA systematic search of Medline, Ovid, BVS, LILACS, ARTEMISA, IMBIOMED and MEDIGRAPHIC databases identified cluster randomised controlled trials (CRCTs) of interventions to control Aedes aegypti published between January 2003 and October 2016. Eligible studies were CRCTs of chemical or biological control measures, or community mobilization, with entomological indices as an endpoint. A meta-analysis of eligible studies, using a random effects model, assessed the impact on household index (HI), container index (CI), and Breteau index (BI).ResultsFrom 848 papers identified by the search, eighteen met the inclusion criteria: eight for chemical control, one for biological control and nine for community mobilisation. Seven of the nine CRCTs of community mobilisation reported significantly lower entomological indices in intervention than control clusters; findings from the eight CRCTs of chemical control were more mixed. The CRCT of biological control reported a significant impact on the pupae per person index only. Ten papers provided enough detail for meta-analysis. Community mobilisation (four studies) was consistently effective, with an overall intervention effectiveness estimate of −0.10 (95%CI -0.20 – 0.00) for HI, −0.03 (95%CI -0.05 – -0.01) for CI, and −0.13 (95%CI -0.22 – -0.05) for BI. The single CRCT of biological control had effectiveness of −0.02 (95%CI -0.07– 0.03) for HI, −0.02 (95%CI -0.04– -0.01) for CI and −0.08 (95%CI -0.15– -0.01) for BI. The five studies of chemical control did not show a significant impact on indices: the overall effectiveness was −0.01 (95%CI -0.05– 0.03) for HI, 0.01 (95% CI -0.01– 0.02) for CI, and 0.01 (95%CI -0.03 – 0.05) for BI.ConclusionGovernments that rely on chemical control of Aedes aegypti should consider adding community mobilization to their prevention efforts. More well-conducted CRCTs of complex interventions, including those with biological control, are needed to provide evidence of real life impact. Trials of all interventions should measure impact on dengue risk.

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“…Balancing fluids and electrolytes are very important, when DSS is happened. Real-time polymerase chain reaction (RT-PCR) assays, IgM and IgG-ELISA, and the NS1 ELISA-based antigen assay are commercially available for diagnosis of dengue virus (7,8). Until now, there is no approved vaccine to prevent infection.…”

Section: Contextmentioning

confidence: 99%

“…Until now, there is no approved vaccine to prevent infection. Mosquito control is the main way for the prevention of dengue and for control of epidemic, coordinated inter-organizational efforts are needed (3,7,8). Here, we aimed to review published papers about this disease and study about the epidemiology, clinical manifestation, treatment, and prevention.…”

Section: Contextmentioning

confidence: 99%

Dengue: A Re-Emerging Disease

Sharifi-Mood

Mardani

2016

Arch Clin Infect Dis

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Context: Dengue fever (DF) is caused by an arbovirus, which transmitted to humans through the bite of an infected mosquito (Aedes species). Near 2.5 billion people are living in regions where the risk of transmission is high. Until the mid of 20 th century, DF was restricted to special parts of tropical and subtropical regions. Dengue hemorrhagic fever (DHF) was first reported in the 1950s when two epidemics happened in the Philippines and Thailand. Now, with international travels and climate changes, its geographical distribution has been changed and increased. Evidence Acquisition: We searched medical databases (PubMed and Scopus) from March 1960 to Feb 2015. The key words for the review of literature were as follows: dengue, dengue fever, dengue hemorrhagic fever, epidemiology, transmission routes, clinical manifestation, treatment and prevention of dengue.Results: Upon the results from literature search, the researchers found that human is the main reservoir for this virus. There are four serotypes of virus. Infection with one serotype cannot protect human against the other three serotypes. Dengue fever begins suddenly with an onset of an influenza-like syndrome and sometimes progresses to severe form of the disease. Treatment is supportive and includes diminishing the fever and balancing fluids and electrolytes. Real-time polymerase chain reaction assays, IgM and IgG-ELISA, and the NS1 ELISA-based antigen assay are available for diagnosis of DHF. There is no FDA-approved vaccine. Mosquito control is the main way for the prevention of dengue. Conclusions: Dengue virus is not highly contagious and virus cannot be spread directly from person to person. Understanding the epidemiology, clinical manifestation, prompt diagnosis, suitable prevention routes such as mosquito control, and also coordinated effort in the community for disease control are important issues.

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Integrating participatory community mobilization processes to improve dengue prevention: an eco-bio-social scaling up of local success in Machala, Ecuador

Cited by 39 publications

References 30 publications

A Cluster-Randomized Controlled Trial to Reduce Diarrheal Disease and Dengue Entomological Risk Factors in Rural Primary Schools in Colombia

A Cluster-Randomized Controlled Trial to Reduce Diarrheal Disease and Dengue Entomological Risk Factors in Rural Primary Schools in Colombia

Assessing the effects of interventions for Aedes aegypti control: systematic review and meta-analysis of cluster randomised controlled trials

Dengue: A Re-Emerging Disease

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