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Nicaragua: Pilot dengue control intervention, 2004-2007
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 piloted a new approach to the age-old problem of motivating community participation in mosquito control. 
 
The kingpin of this approach was an informed dialogue with community members based on their own evidence. The evidence includes 1) questionnaires that follow the CASCADA approach,

Inspection of a water storage barrel

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.
 
For this pilot exercise we chose a panel of 30 sentinel sites (130 houses each, for a total of 3,956 households) to represent the population of Managua. In the first year, entomological, serological and interview data were not only gathered as a baseline, but were given back to the community through house visits and focus groups to catalyze and direct an informed intervention. A communication strategy based on local knowledge and experience, led by community leaders and dengue brigadistas was then implemented in seven of the communities. The second cycle in October 2005, measured the impact of the first year's interventions and refined them with community input.
 
During this process, the survey instruments and techniques were refined, key elements for motivation of community participation in mosquito control were identified, and a dengue control "package" was developed that could be implemented in other dengue-affected countries.
 
This project set the stage for "Camino Verde", a multi-country randomised controlled cluster trial  initiated at the end of 2009 in both Nicaragua and Mexico. ISRCTN27581154

 See the special site created for the Camino Verde project at http://caminoverde.ciet.org/en.