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NICARAGUA: EVIDENCE-BASED, COMMUNITY DERIVED INTERVENTIONS FOR PREVENTION AND CONTROL OF DENGUE, 2004-2007 |
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Nicaragua: Evidence-based, community derived interventions for prevention and control of dengue, 2004-2007
Traditional policies and programmes have failed to curb the spread of dengue epidemics, and prevention continues to rely on controlling the Aedes mosquito population. The current thinking has moved towards evidence-based vector control strategies, recognizing the failure of the doctrine-based approach to bring Ae. aegypti under control. Community participation is the only sustainable approach, but most strategies have failed to sustain changes in behaviour and practice that reduce mosquito breeding sites. The key to dengue control is to close the "motivation gap" between community knowledge and practice. In collaboration with the University of California at Berkeley, we are applying a new tool to the age-old problem of motivating community participation in mosquito control.
The kingpin of this approach is an informed dialogue with community members based on their own
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| Empty bottles: breeding place for Aedes | evidence. The evidence includes 1) questionnaires that follow the CASCADA approach, bridging 7 steps from knowledge to action; 2) entomological surveys that identify Aedes larvae and pupae in participants' housholds; and 3) serological evidence for dengue virus infection in children, obtained by analyzing the change in dengue virus-specific antibody levels in the children's saliva.
A panel of 30 sentinel sites (130 houses each, for a total of 3,956 households) was selected to represent the population of Managua. In the first year, entomological surveys detected a house index of 8-44% in the 30 sites, while serological results indicated that 8-44% of children had been bitten by a dengue-infected mosquito. Entomological, serological and interview data are not only used to measure the impact of an intervention, but are given back to the community through house visits and focus groups to catalyze and direct an informed intervention. Currently, interventions are being implemented in 7 communities and consist of a communication strategy based on local knowledge and experience, led by community leaders and dengue brigadistas. The second cycle in October 2005, measured the impact of the first year's interventions and refined them with community input. By Year 3, we hope to be able to determine whether the communities are likely to carry on the process independently.
During this process, key elements for motivation of community participation in mosquito control are being identified, and the intended final outcome of the initiative is a dengue control "package" that can be implemented in other dengue-affected countries.
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