Abstract
Author summaryThe available strategy for controlling the diseases transmitted by Aedes ægypti (dengue fever, Zika, and chikungunya) relies on continued community participation. Despite slogans emphasizing how easy it should be, no country has achieved it since the seventies. To better investigate potentially sustainable interventions, we developed a systemic model based on a multidisciplinary approach, integrating as deeply as possible specialized knowledge and field experience. The resulting model is composed of 4 external and 8 internal subsystems and 31 relationships, consistent with the literature and checked over multiple iterations with specialists of the many areas. We analyzed the model and the main feedback loops responsible for the system’s stability, searching for possible interventions that could shift the existing balance. We suggest the introduction of 1 more player, the local primary health care structure, with the potential to change the undesired equilibrium. The health agents in the areas are the first to detect disease cases, and they could stimulate individuals to inform about potential mosquitoes’ breeding sites and bring timely information to the vector-control program. Triggering such an action could introduce changes in people's attitude through a positive feedback loop in the desired direction.
Highlights
Due to the Zika virus epidemic in Brazil, an enormous effort has been set in motion to control A. ægypti, the main vector of several globally important arboviruses including yellow fever [1], dengue [2], and chikungunya virus [3]
This problem can be described as a complex situation in which several components interact nonlinearly, with feedback routes and various time lags generating an emerging dynamic stability [17]. Moving this system in the desired direction—here defined as A. ægypti population control—has no simple and obvious solution, or one of the countries in which dengue fever has thrived would have already implemented it [7]. The objective of this proposed systemic model is to build a systems map addressing the complexity of A. ægypti surveillance and control in urban areas in order to inform government authorities, especially the staff working in the vector-control program structure, on possible integrated and encompassing actions besides the usual focused interventions and media campaigns
In addition to the experience accumulated in the Brazilian dengue control program, we incorporated in this paper several interactions with entomologists, environmentalists, geographers, climatologists, sociologists, and anthropologists from other countries as well
Summary
The available strategy for controlling the diseases transmitted by Aedes ægypti (dengue fever, Zika, and chikungunya) relies on continued community participation. The health agents in the areas are the first to detect disease cases, and they could stimulate individuals to inform about potential mosquitoes’ breeding sites and bring timely information to the vector-control program. Triggering such an action could introduce changes in people’s attitude through a positive feedback loop in the desired direction. LMTG receives a postdoctoral scholarship from the Conselho Nacional de Desenvolvimento Cientıfico e Tecnologico
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