2009.12.02 - Camino Verde: sustainable dengue control in Mexico and Nicaragua
Camino Verde: a cluster randomised controlled trial in Mexico and Nicaragua to reduce dengue risk though evidence-based community mobilisation
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.
Aedes Aegypti larva
|Photo: U. of Sydney, Australia
This trial applies lessons learned from a 2004-2007 pilot exercise in Nicaragua that mobilised community participation in dengue control based on evidence. The kingpin of this approach is an informed dialogue with community members based on their own evidence. The evidence includes:
data from questionnaires that follow the CASCADA approach, bridging 7 steps from knowledge to action;
entomological surveys that identify Aedeslarvae and pupae in participants' households;
serological evidence for dengue virus infection in children, obtained by analyzing the change in dengue virus-specific antibody levels in the children's saliva.
These 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 informed action.
Some 100,000 individuals in 170 clusters in the two countries will participate. After the baseline survey small community action research team (CART) in Mexico and local brigadistasin Nicaragua (three to five people in each community) will receive training in pesticide free vector control and provide continuity for the duration of the intervention.
After the baseline survey, 120 clusters will be randomised to intervention or control, balanced by area and entomological and immunological status of children. The intervention involves feedback of the survey results to each household – which we call socialisation of evidence for participatory action (SEPA) –to inform community-led pesticide-free interventions (for example, cleaning and sealing water tanks).
A special website on the Camino Verde project was launched in Spanish on 20 January, 2012. It is available at http://caminoverde.ciet.org/es/