Sustainable, healthy cities: protocol of a mixed methods evaluation of a cluster randomized controlled trial for Aedes control in Brazil using a community mobilization approach

Abstract

Background: Dengue is increasing in its global presence with an estimated 4 billion people at-risk of infection in at least 128 countries. Despite the promising results of EcoHealth and community mobilization approaches to Aedes reduction, more evidence of their efficacy on reducing dengue risk is needed. The principal research question is to determine if interventions based upon community mobilization reduce the risk of dengue virus infection among children 3 to 9 years old compared to usual dengue control practice in Fortaleza, Brazil. Methods: The present study will follow a pragmatic cluster randomized controlled trial (cRCT) design with randomization at the census tract level with equal allocation to the two arms. In each arm, there will be 34 clusters of 86 children between 3 to 9 years old for an expected total of 5848 children enrolled in the study, assuming a risk reduction of 29.5% based upon findings from a previous multi-site cRCT. The primary outcomes are rates of antidengue Immunoglobulin G (IgG) seroconversion and adult female Aedes density. The intervention is based upon a participatory health research approach, Socializing Evidence for Participatory Action (SEPA), where the research evidence is used to foster community engagement and ownership of the health issue and solution. Following allocation, intervention communities will develop and implement their own solutions that will likely include a wide variety of collective events and media approaches. Data collection activities over a period of 3 years include household visits for blood collection, household surveys, and entomological surveys; and qualitative activities including focus groups, in-depth interviews, and document analysis to evaluate the process, acceptability, fidelity, and sustainability of the intervention. Study participants will be aware of their assignment and all research staff will be blinded although the intervention assignment will likely be revealed to field staff through interaction with participants.

Knowledge, attitude and practice (KAP) and risk factors on dengue fever among children in Brazil, Fortaleza: A cross-sectional study

“…This analysis is based on cross-sectional data collected as part of the baseline data collection of a larger international research project. 16 The original project was a pragmatic cluster randomized controlled trial (cRCT) in Fortaleza, Brazil, which aimed to evaluate a community mobilization intervention for dengue control. The study initially planned to collect data from 68 clusters with a target recruitment of 5,848 children between 2 and 12 years old.…”

Social Media and the Influence of Fake News on Global Health Interventions: Implications for a Study on Dengue in Brazil

“…The COESA study was a pragmatic cluster randomized controlled trial, implemented in 2019 and conducted by a partnership of Canadian and Fortaleza researchers, aimed at reducing dengue incidence in children aged 3–9 years old using a participatory mobilization approach in Fortaleza, in the northeastern Brazilian state of Ceará [ 28 ]. Dengue, transmitted by the Aedes mosquito, is the fastest-spreading vector-borne viral disease worldwide.…”

“…It is endemic in Brazil, with over 2.2 million cases reported in 2019, with a national incidence of 1078 cases per 100,000 inhabitants [ 29 , 30 ]. Fortaleza is particularly burdened by dengue, with children under the age of 15 representing most of the cases [ 28 , 31 ]. Its tropical climate, high population density, rapid urbanization, and inadequate sanitation conditions make the population of Fortaleza particularly vulnerable to dengue [ 28 , 32 ].…”

“…Fortaleza is particularly burdened by dengue, with children under the age of 15 representing most of the cases [ 28 , 31 ]. Its tropical climate, high population density, rapid urbanization, and inadequate sanitation conditions make the population of Fortaleza particularly vulnerable to dengue [ 28 , 32 ]. With high poverty rates and income inequalities, Fortaleza is also one of the most violent cities in the country and worldwide due to drug trafficking and related gang violence [ 32 ].…”

School and community driven dengue vector control and monitoring in Myanmar: Study protocol for a cluster randomized controlled trial

“…Teachers will be trained in using a logbook for documenting their experiences with the curriculum and the manual, to be able to record their own implementation fidelity and adaptation from the educational/knowledge transfer interventions. The logbook assessment will focus on the dynamics of the educational interventions, the teachers' roles, adaptation to changes brought about by activities, implementation fidelity moderating factors (i.e., comprehensiveness of policy description, strategies to facilitate implementation, quality of delivery, and participant responsiveness), barriers, and facilitators of the implementation, and any unintended effects 62 . Notes from the logbooks will be compiled into a manual that will serve as adaptation guidelines for the following years.…”