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

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

doi:10.1093/trstmh/tru209

Abstract

BackgroundThis project investigates the effectiveness and feasibility of scaling-up an eco-bio-social approach for implementing an integrated community-based approach for dengue prevention in comparison with existing insecticide-based and emerging biolarvicide-based programs in an endemic setting in Machala, Ecuador.MethodsAn integrated intervention strategy (IIS) for dengue prevention (an elementary school-based dengue education program, and clean patio and safe container program) was implemented in 10 intervention clusters from November 2012 to November 2013 using a randomized controlled cluster trial design (20 clusters: 10 intervention, 10 control; 100 households per cluster with 1986 total households). Current existing dengue prevention programs served as the control treatment in comparison clusters. Pupa per person index (PPI) is used as the main outcome measure. Particular attention was paid to social mobilization and empowerment with IIS.ResultsOverall, IIS was successful in reducing PPI levels in intervention communities versus control clusters, with intervention clusters in the six paired clusters that followed the study design experiencing a greater reduction of PPI compared to controls (2.2 OR, 95% CI: 1.2 to 4.7). Analysis of individual cases demonstrates that consideration for contexualizing programs and strategies to local neighborhoods can be very effective in reducing PPI for dengue transmission risk reduction.ConclusionsIn the rapidly evolving political climate for dengue control in Ecuador, integration of successful social mobilization and empowerment strategies with existing and emerging biolarvicide-based government dengue prevention and control programs is promising in reducing PPI and dengue transmission risk in southern coastal communities like Machala. However, more profound analysis of social determination of health is called for to assess sustainability prospects.

Highlights

Dengue is a major public health problem in Ecuador,[1,2] with a diverse array of contributing factors and a lack of intersectoral organization within governance systems exacerbating it
While control and intervention communities did not have statistically significant differences in their per person index (PPI) values prior to the intervention, significantly reduced overall PPI values were observed in the intervention clusters following the intervention strategy (IIS) implementation period (Table 1)
A total of 230 children in the 10 intervention clusters participated in the dengue elementary school education program (DESE) arm of the IIS (Table 3), with a reduction in both house index (HI) and Breteau index (BI) in their own households

Summary

Introduction

Dengue is a major public health problem in Ecuador,[1,2] with a diverse array of contributing factors and a lack of intersectoral organization within governance systems exacerbating it. The World Health Organization has granted Oxford University Press permission for the reproduction of this article This project investigates the effectiveness and feasibility of scaling-up an eco-bio-social approach for implementing an integrated community-based approach for dengue prevention in comparison with existing insecticide-based and emerging biolarvicide-based programs in an endemic setting in Machala, Ecuador

Methods

Results

Discussion

Conclusion