Abstract
.Zika virus, which is transmitted by Aedes aegypti mosquitoes and through sexual transmission, disproportionally affects the human fetus. Guatemala experienced a surge of Zika cases beginning in 2016. We conducted a qualitative study of community perceptions of the seriousness of Zika, as well as the effectiveness, feasibility, and collective efficacy of Zika prevention actions. Free listing elicited the preventive actions salient for 68 participants comprising pregnant women, men with a pregnant partner, and women likely to become pregnant; 12 focus group discussions in a highland and a lowland town explored other concepts through rank orderings of prevention practices depicted on cards. Participants’ initial concern about Zika, based on recent experience with chikungunya and high media coverage, diminished because of its mild symptoms and reduced media coverage. Participants identified more than 32 salient preventive actions, many of which are considered effective by programs. Participants ranked water storage container cleaning and regular unspecified cleaning of the house and its surroundings as highly effective, feasible, and of high collective efficacy; however, the actions lacked the specificity needed to effectively destroy mosquito eggs. Community-level removal of tires and discarded containers had lower collective efficacy than household-level implementation because of the municipal and community cooperation needed. Condom use, although salient for Zika prevention, was hindered by gender roles. The findings indicate space for increasing self-efficacy for condom use among fathers-to-be, abandoning nonspecific terms such as “cleaning” and “standing water,” increasing people’s skills in using bleach as an ovicide, and promoting antenatal care and family planning counseling.
Highlights
Zika is the latest known arbovirus transmitted by the Aedes aegypti mosquito in the Americas
Zika virus, which is transmitted by Aedes aegypti mosquitoes and through sexual transmission, disproportionally affects the human fetus
We aimed to gain insights into five behavioral determinants among study participants in Guatemala: the perceived seriousness of Zika illness and how it may have changed over the course of the outbreak, the cultural salience of freely elicited actions that people in the community take to avoid Zika, the relative effectiveness and feasibility of Zika prevention recommendations, and relative collective efficacy to practice them in the community context
Summary
Zika is the latest known arbovirus transmitted by the Aedes aegypti mosquito in the Americas. The first cases of the disease were identified starting in May 2015 in Brazil, and they expanded rapidly through the vector’s range in the region because of the lack of population immunity.[1] This variety of Ae. aegypti can transmit yellow fever, dengue, and chikungunya, which appeared historically in that order, in the Americas.[2] Aedes aegypti is diurnal and bites its human targets indoors or in shaded outdoor areas around the home.[3] Its eggs are laid just above the waterline in human-generated containers, where they remain dormant until the water level rises, and they stay protected when water pools dry up.[2] In Guatemala, households typically store water in large drums and cement laundry washbasins, referred to as pilas. In addition to the mosquito-borne route of infection, Zika is sexually transmitted.[5] The WHO, pronounced Zika a public health emergency of international concern from February to November 2016 and an endemic health problem in Latin America and the Caribbean (LAC) ever since.[6]
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