Abstract

BackgroundDengue virus, an Aedes mosquito-borne flavivirus, is associated with close to 400 million reported infections per annum worldwide. Reduction of dengue virus transmission depends entirely on limiting Aedes breeding or preventing adult female contact with humans. Currently, the World Health Organization promotes the strategic approach of integrated vector management in order to optimise resources for mosquito control.Main textNeglected tropical disease researchers focus on geographical zones where the incidence of clinical cases, and prevalence of vectors, are high. In combatting those infectious diseases such as dengue that affect mainly low-income populations in developing regions, a mosquito-centric approach is frequently adopted. This prioritises environmental factors that facilitate or impede the lifecycle progression of the vector. Climatic variables (such as rainfall and wind speed) that impact the vector’s lifecycle either causally or by happenstance also affect the human host’s ‘lifecycle’, but in very different ways. The socioeconomic impacts of the same variables that influence vector control impact host vulnerability but at different points in the human lifecycle to those of the vector. Here, we argue that the vulnerability of the vector and that of the host interact in complex and unpredictable ways that are characteristic of (complex and intransigent) ‘wicked problems’. Moreover, they are treated by public health programs in ways that may ignore this complexity. This opinion draws on recent evidence showing that the best climate predictors of the scale of dengue outbreaks in Bangladesh cannot be explained through a simple vector-to-host causal model.ConclusionsIn mapping causal pathways for vector-borne diseases this article makes a case to elevate the lifecycle of the human host to a level closer in equivalence to that of the vector. Here, we suggest value may be gained from transferring Rittel and Webber’s concept of a wicked (social) problem to dengue, malaria and other mosquito-transmitted public health concerns. This would take a ‘problem definition’ rather than a ‘solution-finding’ approach, particularly when considering problems in which climate impacts simultaneously on human and vector vulnerability.

Highlights

  • Neglected tropical disease researchers focus on geographical zones where the incidence of clinical cases, and prevalence of vectors, are high

  • In mapping causal pathways for vector-borne diseases this article makes a case to elevate the lifecycle of the human host to a level closer in equivalence to that of the vector

  • We suggest value may be gained from transferring Rittel and Webber’s concept of a wicked problem to dengue, malaria and other mosquito-transmitted public health concerns

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Summary

Main text

The growing public health threat of dengue With 390 million reported infections per annum, 96 million symptomatic cases per annum [2], at least 500 000 hospitalisations [3], and approximately 22 000 fatalities [4], dengue ranks as a highly significant global VBD. An illustration of this latter, less commonly acknowledged association in VBD studies is a recent investigation of malaria trends in Uganda that revealed a causal relationship between electrification of households (an indicator of socioeconomic status) and incidence of clinical infection [29]. These authors suggested that by attracting Anopheles mosquitoes the use of domestic electric lights and outdoor night lighting may inadvertently increase the exposure of humans to vectors of malaria transmission. A number of researchers, for example [30], have identified the possibility that causation pathways between low socioeconomic status and VBDs travel in both directions

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