![Figure][1] ![Figure][1] PHOTO: THINKSTOCK According to the U.S. Centers for Disease Control and Prevention, one-third of the world's population is at risk for contracting dengue fever ([ 1 ][2]), a mosquito-borne viral infection so painful it is sometimes referred to as “breakbone fever.” Although only nine countries experienced severe dengue epidemics before 1970, today the disease is endemic in more than 100 countries ([ 2 ][3]). These dire statistics are familiar to many in public health, but the story of dengue's rise in the 21st century is less well known. Alex M. Nading's Mosquito Trails: Ecology, Health, and the Politics of Entanglement is a timely exploration of dengue prevention efforts in Ciudad Sandino, a slum outside Nicaragua's capital city, Managua. To tell this story, Nading, an anthropologist by training, embedded himself in the lives of those on the front lines of the dengue epidemic. His interviewees range from the community health workers known as brigadistas, who go from house to house stamping out mosquito breeding grounds, to the garbage collectors who have become scapegoats for the epidemic, implicated for their role in providing mosquito breeding places. He also spent time with the epidemiologists charged with implementing control efforts and families affected by dengue. Nading offers a much-needed discussion of the broader context in which the dengue epidemic is taking place. An environment tailor-made for the virus and its vector has been produced by the global trade in garbage, the growth of peri-urban slums, changes in insecticide use, and an approach to public health that increasingly shifts the responsibility for mosquito control from the government to individual households. This book provides a fascinating, if meandering, tour of dengue and the changing face of public health in Nicaragua from the 1979 Sandinista revolution up to the current era of structural readjustment. Nading devotes a substantial part of the book to discussing “entanglement,” defined as “the unfolding, often incidental attachments and affinities, antagonisms and animosities that bring people, nonhuman animals, and things into each other's worlds.” Certainly, his descriptions of life in Ciudad Sandino illustrate the dense web of interactions between people, places, politics, mosquitos, and the dengue virus, providing insight into why control is so challenging. Unfortunately, the lengthy sections of the book devoted to entanglement are often convoluted and disappointing when it comes to potential solutions. For example, Nading calls for a solution in which “basic and complex infrastructures, national and transnational belonging, and, above all, a recognition that environments and bodies are entangled, lead to a more relational ethic of health” but fails to elaborate on what such an approach might look like. Similarly, he argues that factors such as climate change and uneven urban development necessitate a “holistic, even radical” solution to mosquito control, but again, we are left to wonder what such a solution might look like. Ultimately, it is not clear how entanglement, as an analytical framework, represents a conceptual advance over simply describing dengue control as complicated. Nading concludes the book with three practical considerations for those who would confront dengue. The first is the idea that politics and poverty are critical components of the disease process. The second is that community health workers are underpaid and underappreciated. His final recommendation for tackling vector-borne diseases is to consider the relationships between people and other creatures. All of these conclusions are well supported by the book's vignettes. However, while Nading considers disruption of current approaches to be a goal of his framework of entanglement, his conclusions are consistent with ideas long espoused by global health institutions, including the World Health Organization and the Rockefeller Foundation ([ 3 ][4], [ 4 ][5]). Although this book is light on solutions to the dengue epidemic, researchers and clinicians involved in dengue research and care, medical anthropologists, and anyone interested in the intersection of politics and global health will likely find this a worthwhile read. Mosquito Trails documents the many challenges inherent in Nicaragua's struggle with dengue and gives a voice to the residents of Ciudad Sandino who have found themselves entangled with virus, vector, and one other. 1. [↵][6] Centers for Disease Control and Prevention, Dengue (2014); [www.cdc.gov/dengue][7]. 2. [↵][8] World Health Organization, Dengue and Severe Dengue (2014); [www.who.int/mediacentre/factsheets/fs117/en][9]. 3. [↵][10] World Health Organization, World Health Report Executive Summary (1995); [www.who.int/whr/1995/media\_centre/executive\_summary1/en][11]. 4. [↵][12] The Rockefeller Foundation, Annual Report for 1918; [www.rockefellerfoundation.org/uploads/files/1a897fb6-dd34-4ce6-9f17-13c9e1478fdc-1918.pdf][13]. [1]: pending:yes [2]: #ref-1 [3]: #ref-2 [4]: #ref-3 [5]: #ref-4 [6]: #xref-ref-1-1 View reference 1 in text [7]: http://www.cdc.gov/dengue [8]: #xref-ref-2-1 View reference 2 in text [9]: http://www.who.int/mediacentre/factsheets/fs117/en [10]: #xref-ref-3-1 View reference 3 in text [11]: http://www.who.int/whr/1995/media_centre/executive_summary1/en [12]: #xref-ref-4-1 View reference 4 in text [13]: http://www.rockefellerfoundation.org/uploads/files/1a897fb6-dd34-4ce6-9f17-13c9e1478fdc-1918.pdf
Search from 250 M+ research papersSearch from 250 M+ research papers
Open Access
Jul 31, 2020
Charles Muleke Inyagwa + 4
