Addressing vulnerability, building resilience: community-based adaptation to vector-borne diseases in the context of global change

Evaluating the public's readiness to combat vector-borne disease threats in Jazan, Saudi Arabia: A cross-sectional survey

Vector-borne diseases (VBDs) pose a significant public health challenge in Saudi Arabia, particularly in the Jazan region. This study aimed to assess the knowledge, attitudes, and practices regarding VBDs among the population of Jazan and to identify factors associated with these variables. A cross-sectional survey was conducted among 642 adult residents of Jazan using a convenience random sampling technique. The survey tool consisted of 6 domains: demographics, knowledge of VBDs, preventive practices, care-seeking behavior, knowledge of specific VBDs, and attitudes towards VBDs. Data were analyzed using descriptive statistics, chi-square tests, t tests, ANOVA, and multivariable logistic regression. The majority of participants (60.0%) had high knowledge scores, while (75.5%) and (77.7%) had high attitude and practice scores, respectively. However, knowledge gaps were identified in specific areas, such as the transmission of leishmaniasis and Rift Valley fever. Gender was a significant predictor of both knowledge and practice scores, with males having higher knowledge and females demonstrating higher levels of preventive practices. Age, education, income, and working status were also associated with knowledge scores. The findings highlight the need for targeted interventions and educational campaigns to address the identified gaps in knowledge, attitudes, and practices. Future research should focus on exploring the effectiveness of different intervention strategies and investigating the integration of VBD prevention and control measures into existing healthcare systems. By employing a multi-disciplinary approach, evidence-based strategies can be developed to prevent and control VBDs, ultimately improving public health outcomes in Jazan and other endemic regions worldwide.

Adapting to the shifting landscape: Implications of climate change for malaria control: A review

Malaria, a global public health challenge, continues to affect millions of lives, particularly in regions where its transmission is endemic. The interplay between climate change and malaria dynamics has emerged as a critical concern, reshaping the landscape of this vector-borne disease. This review publication, titled "Adapting to the shifting landscape: Implications of climate change for malaria control," explores the multifaceted relationship between climate change and the control of malaria. The paper begins by dissecting the influence of climate change on malaria dynamics, including alterations in temperature, precipitation, and other climatic factors that impact the habitat and life cycle of malaria vectors. It delves into the evolving ecology and behavior of malaria vectors in response to changing climatic conditions, emphasizing the importance of understanding these adaptations. As a response to this shifting landscape, the review discusses adaptive strategies for malaria control, ranging from vector control measures to the utilization of climate data in early warning systems. Community engagement and education are highlighted as essential components of these strategies, recognizing the vital role of local communities in effective malaria control efforts. The paper also identifies future directions and research needs, underscoring the importance of staying ahead of the evolving climate-malaria relationship. This review underscores the urgency of adapting to the changing landscape of malaria transmission driven by climate change. It emphasizes the significance of proactively addressing climate-related challenges to enhance malaria control and protect the health and well-being of vulnerable populations.

Impact of climate change on the global circulation of West Nile virus and adaptation responses: a scoping review

BACKGROUND

West Nile virus (WNV), the most widely distributed flavivirus causing encephalitis globally, is a vector-borne pathogen of global importance. The changing climate is poised to reshape the landscape of various infectious diseases, particularly vector-borne ones like WNV. Understanding the anticipated geographical and range shifts in disease transmission due to climate change, alongside effective adaptation strategies, is critical for mitigating future public health impacts. This scoping review aims to consolidate evidence on the impact of climate change on WNV and to identify a spectrum of applicable adaptation strategies.

MAIN BODY

We systematically analyzed research articles from PubMed, Web of Science, Scopus, and EBSCOhost. Our criteria included English-language research articles published between 2007 and 2023, focusing on the impacts of climate change on WNV and related adaptation strategies. We extracted data concerning study objectives, populations, geographical focus, and specific findings. Literature was categorized into two primary themes: 1) climate-WNV associations, and 2) climate change impacts on WNV transmission, providing a clear understanding. Out of 2168 articles reviewed, 120 met our criteria. Most evidence originated from North America (59.2%) and Europe (28.3%), with a primary focus on human cases (31.7%). Studies on climate-WNV correlations (n = 83) highlighted temperature (67.5%) as a pivotal climate factor. In the analysis of climate change impacts on WNV (n = 37), most evidence suggested that climate change may affect the transmission and distribution of WNV, with the extent of the impact depending on local and regional conditions. Although few studies directly addressed the implementation of adaptation strategies for climate-induced disease transmission, the proposed strategies (n = 49) fell into six categories: 1) surveillance and monitoring (38.8%), 2) predictive modeling (18.4%), 3) cross-disciplinary collaboration (16.3%), 4) environmental management (12.2%), 5) public education (8.2%), and 6) health system readiness (6.1%). Additionally, we developed an accessible online platform to summarize the evidence on climate change impacts on WNV transmission ( https://2xzl2o-neaop.shinyapps.io/WNVScopingReview/ ).

CONCLUSIONS

This review reveals that climate change may affect the transmission and distribution of WNV, but the literature reflects only a small share of the global WNV dynamics. There is an urgent need for adaptive responses to anticipate and respond to the climate-driven spread of WNV. Nevertheless, studies focusing on these adaptation responses are sparse compared to those examining the impacts of climate change. Further research on the impacts of climate change and adaptation strategies for vector-borne diseases, along with more comprehensive evidence synthesis, is needed to inform effective policy responses tailored to local contexts.

Land system governance shapes tick-related public and animal health risks

Land cover and land use have established effects on hazard and exposure to vector-borne diseases. While our understanding of the proximate and distant causes and consequences of land use decisions has evolved, the focus on the proximate effects of landscape on disease ecology remains dominant. We argue that land use governance, viewed through a land system lens, affects tick-borne disease risk. Governance affects land use trajectories and potentially shapes landscapes favourable to ticks or increases contact with ticks by structuring human-land interactions. We illustrate the role of land use legacies, trade-offs in land-use decisions, and social inequities in access to land resources, information and decision-making, with three cases: Kyasanur Forest disease in India, Lyme disease in the Outer Hebrides (Scotland), and tick acaricide resistance in cattle in Ecuador. Land use governance is key to managing the risk of tick-borne diseases, by affecting the hazard and exposure. We propose that land use governance should consider unintended consequences on infectious disease risk.

An optical system to detect, surveil, and kill flying insect vectors of human and crop pathogens

Sustainable and effective means to control flying insect vectors are critically needed, especially with widespread insecticide resistance and global climate change. Understanding and controlling vectors requires accurate information about their movement and activity, which is often lacking. The Photonic Fence (PF) is an optical system that uses machine vision, infrared light, and lasers to identify, track, and interdict vectors in flight. The PF examines an insect's outline, flight speed, and other flight parameters and if these match those of a targeted vector species, then a low-power, retina-safe laser kills it. We report on proof-of-concept tests of a large, field-sized PF (30 mL × 3 mH) conducted with Aedes aegypti, a mosquito that transmits dangerous arboviruses, and Diaphorina citri, a psyllid which transmits the fatal huanglongbing disease of citrus. In tests with the laser engaged, < 1% and 3% of A. aegypti and D. citri, respectfully, were recovered versus a 38% and 19% recovery when the lacer was silenced. The PF tracked, but did not intercept the orchid bee, Euglossa dilemma. The system effectively intercepted flying vectors, but not bees, at a distance of 30 m, heralding the use of photonic energy, rather than chemicals, to control flying vectors.

Climate change: A driver of increasing vector-borne disease transmission in non-endemic areas

In this Perspective, Shlomit Paz discusses the link between climate change and transmission of vector-borne diseases in non-endemic areas.

Human spotted fever group Rickettsia seroprevalence and associated epidemiologic factors among diverse, marginalized populations in South Carolina

Illness caused by spotted fever group Rickettsia (SFGR) is increasing nationally, with affluent, white residents most likely to be diagnosed. The common under-representativeness of marginalized populations in research studies and these vulnerable populations' health inequities make veritable epidemiologic risk factor profiling challenging, which inhibits equitable public health intervention. The current study leveraged 749 banked sera and associated surveys from a cross-sectional minority-represented COVID-19 study to perform an SFGR seroprevalence investigation. SFGR titers (1:64, 1:128, 1:256, 1:512, and 1:1024) were measured using commercially available indirect fluorescent antibody slides-SFGR positive cases were defined as titers ≥1:128. Multivariable logistic regression and Getis-Ord-Gi* hotspot analyses were used to identify seropositivity-associated factors and determine seropositive clusters. Among a mostly minority and lower socioeconomic population, a 3.4 % SFGR seropositivity was noted at the ≥1:128 titer level. Male gender (Odds Ratio (OR): 3.20; adjusted Odds Ratio (aOR)s: 3.73), age (aOR: 1.05), any frequency of tick bite (OR: 2.29), and spending time working outdoors (OR: 5.05) were associated with SFGR IgG seropositivity. Moreover, the geospatial analysis showed clusters of seropositivity in areas where previous case reports occurred, suggesting potential endemic foci.

Biosorption potential of viable and dead Aspergillus flavus biomass on polluted pond water

The State Industries Promotion Corporation of Tamil Nadu Ltd (SIPCOT) Lake is never dry; it is always full of water and was recently used as a waste reservoir by the native peoples and industrialists. Thus, this investigation was performed to assess the quality of the lake water and evaluate the possible biosorption potential of Aspergillus flavus on this lake water sample through batch model biosorption study. The water quality parameters analyses revealed that the lake water has been polluted with number of contaminates which including organic and inorganic. The most of the parameters such as pH (9.5 ± 0.7), turbidity (38 ± 1.1 NT unit), TDS (2350.12 ± 31.24 mg L^-1), BOD (40.21 ± 3.27 mg L^-1), and COD (278.61 ± 11.84 mg L^-1), Ca (212.85 ± 9.64 mg L^-1), Fe (3.1 ± 0.8 mg L^-1), NH₃ (15.62 ± 0.5 mg L^-1), NO_3-(5.84 ± 0.14 mg L^-1), Cl^- (1257.85 ± 4.6 mg L^-1),Cd (15.64 ± 0.29 mg L^-1), Cr (6.86 ± 0.34 mg L^-1), Pb (25.61 ± 3.41 mg L^-1), and Hg (1.8 ± 0.024 mg L^-1) content of water sample were beyond the acceptable limits. Fortunately, the A. flavus dead biomass showed considerable biosorption potential (Cd: 27.5 ± 1.1%, Cr: 13.48 ± 1.2%, Pb: 21.27 ± 1.5%, and Hg: 6.49 ± 0.86% in 180 min of contact time) than viable form on polluted lake water. Since, reduced the quantities of most of the parameters which beyond the permissible limit and also increased remarkable percentage of DO in the water sample in a short period of contact time. These findings suggest that A. flavus dead biomass can be used for bioremediation of polluted water in a sustainable manner.

A Methodological Framework for Economic Evaluation of Operational Response to Vector-Borne Diseases Based on Early Warning Systems

Despite significant advances in improving the predictive models for vector-borne diseases, only a few countries have integrated an early warning system (EWS) with predictive and response capabilities into their disease surveillance systems. The limited understanding of forecast performance and uncertainties by decision-makers is one of the primary factors that precludes its operationalization in preparedness and response planning. Further, predictive models exhibit a decrease in forecast skill with longer lead times, a trade-off between forecast accuracy and timeliness and effectiveness of action. This study presents a methodological framework to evaluate the economic value of EWS-triggered responses from the health system perspective. Assuming an operational EWS in place, the framework makes explicit the trade-offs between forecast accuracy, timeliness of action, effectiveness of response, and costs, and uses the net benefit analysis, which measures the benefits of taking action minus the associated costs. Uncertainty in disease forecasts and other parameters is accounted for through probabilistic sensitivity analysis. The output is the probability distribution of the net benefit estimates at given forecast lead times. A non-negative net benefit and the probability of yielding such are considered a general signal that the EWS-triggered response at a given lead time is economically viable. In summary, the proposed framework translates uncertainties associated with disease forecasts and other parameters into decision uncertainty by quantifying the economic risk associated with operational response to vector-borne disease events of potential importance predicted by an EWS. The goal is to facilitate a more informed and transparent public health decision-making under uncertainty.

Communication research to improve engagement with climate change and human health: A review

Because of the world's dependence on fossil fuels, climate change and air pollution are profoundly harming both human and planetary health. Fortunately, climate solutions are also health solutions, and they present both local and global opportunities to foster cleaner, healthier, and safer communities. In this review, we briefly discuss the human health harms of climate change, climate and health solutions, and provide a thorough synthesis of social science research on climate and health communication. Through our review, we found that social science research provides an evidence-based foundation for messaging strategies that can build public and political will for climate and health solutions. Specifically, messages that convey the health harms of climate change and highlight the health benefits of climate solutions may be especially effective in building this public and political will. We also found that health professionals are trusted sources of information about climate change, and many have shown interest in engaging with the public and policymakers about the health relevance of climate change and clean energy. Together, the alignment between message strategies and the interest of highly trusted messengers strongly suggests the potential of health students and health professionals to create the conditions necessary to address climate change as a public health imperative. Therefore, our review serves as a resource for those interested in communicating about climate change and health and suggests that social scientists can continue to support practitioners with research and advice on the most effective communication strategies.

Use of equity-informed social media COVID-19 risk communication tools: a scoping review protocol

INTRODUCTION

Health agencies and community organisations play a crucial role in disseminating information to the public about COVID-19 risks and events, providing instructions on how to change behaviour to mitigate those risks, motivating compliance with health directives and addressing false information. Social media platforms are a critical tool in risk communication, providing a medium for rapid transmission of messages as well as providing the opportunity for engagement and immediate feedback. Access to health information, services and support are especially important for marginalised and underserved ('equity-deserving') populations who are disproportionately affected by COVID-19. This scoping review aims to review the breadth and depth of the academic and grey literature on equity-informed social media risk communication tools to provide guidance on promising practices and principles for reaching equity-deserving populations through social media.

METHODS AND ANALYSIS

Arksey and O'Malley's (2005) framework guided the identification of the research question; identification and selection of relevant studies from electronic databases and hand-searches of discipline-specific journals; extraction and charting of the data; and collating and reporting of findings. The results of the screening process will be reported using the Preferred Reporting Items for Systematic Review and Meta-Analysis-Scoping Review guidelines.

FINDINGS

We will identify reported facilitators and barriers to the development of risk communications that target equity-deserving communities. We will also identify recommendations for equity-informed risk communication for COVID-19.

ETHICS AND DISSEMINATION

This study does not require ethics approval. We intend to disseminate the results through publication in an open-access peer-reviewed journal, conference presentations, lay summaries (eg, checklists) for health organisations and messages to be shared through social media.

Vector control strategies in Brazil: a qualitative investigation into community knowledge, attitudes and perceptions following the 2015-2016 Zika virus epidemic

OBJECTIVE

The World Health Organization declared a Public Health Emergency of International Concern following the rapid emergence of neonatal microcephaly in Brazil during the 2015-2016 Zika virus (ZIKV) epidemic. In response, a national campaign sought to control Aedes mosquito populations and reduce ZIKV transmission. Achieving adherence to vector control or mosquito-bite reduction behaviours, including the use of topical mosquito repellents, is challenging. Coproduction of research at the community level is needed to understand and mitigate social determinants of lower engagement with Aedes preventive measures, particularly within disempowered groups.

DESIGN

In 2017, the Zika Preparedness Latin America Network (ZikaPLAN) conducted a qualitative study to understand individual and community level experiences of ZIKV and other mosquito-borne disease outbreaks. Presented here is a thematic analysis of 33 transcripts from community focus groups and semistructured interviews, applying the Health Belief Model (HBM) to elaborate knowledge, attitudes and perceptions of ZIKV and vector control strategies.

PARTICIPANTS

120 purposively sampled adults of approximate reproductive age (18-45); 103 women participated in focus groups and 17 men in semistructured interviews.

SETTING

Two sociopolitically and epidemiologically distinct cities in Brazil: Jundiaí (57 km north of São Paolo) and Salvador (Bahia state capital).

RESULTS

Four key and 12 major themes emerged from the analysis: (1) knowledge and cues to action; (2) attitudes and normative beliefs (perceived threat, barriers, benefits and self-efficacy); (3) behaviour change (household prevention and community participation); and (4) community preferences for novel repellent tools, vector control strategies and ZIKV messaging.

CONCLUSIONS

Common barriers to repellent adherence were accessibility, appearance and effectiveness. A strong case is made for the transferability of the HBM to inform epidemic preparedness for mosquito-borne disease outbreaks at the community level. Nationally, a health campaign targeting men is recommended, in addition to local mobilisation of funding to strengthen surveillance, risk communication and community engagement.

Charting the evidence for climate change impacts on the global spread of malaria and dengue and adaptive responses: a scoping review of reviews

Background

Climate change is expected to alter the global footprint of many infectious diseases, particularly vector-borne diseases such as malaria and dengue. Knowledge of the range and geographical context of expected climate change impacts on disease transmission and spread, combined with knowledge of effective adaptation strategies and responses, can help to identify gaps and best practices to mitigate future health impacts. To investigate the types of evidence for impacts of climate change on two major mosquito-borne diseases of global health importance, malaria and dengue, and to identify the range of relevant policy responses and adaptation strategies that have been devised, we performed a scoping review of published review literature. Three electronic databases (PubMed, Scopus and Epistemonikos) were systematically searched for relevant published reviews. Inclusion criteria were: reviews with a systematic search, from 2007 to 2020, in English or French, that addressed climate change impacts and/or adaptation strategies related to malaria and/or dengue. Data extracted included: characteristics of the article, type of review, disease(s) of focus, geographic focus, and nature of the evidence. The evidence was summarized to identify and compare regional evidence for climate change impacts and adaptation measures.

Results

A total of 32 reviews met the inclusion criteria. Evidence for the impacts of climate change (including climate variability) on dengue was greatest in the Southeast Asian region, while evidence for the impacts of climate change on malaria was greatest in the African region, particularly in highland areas. Few reviews explicitly addressed the implementation of adaptation strategies to address climate change-driven disease transmission, however suggested strategies included enhanced surveillance, early warning systems, predictive models and enhanced vector control.

Conclusions

There is strong evidence for the impacts of climate change, including climate variability, on the transmission and future spread of malaria and dengue, two of the most globally important vector-borne diseases. Further efforts are needed to develop multi-sectoral climate change adaptation strategies to enhance the capacity and resilience of health systems and communities, especially in regions with predicted climatic suitability for future emergence and re-emergence of malaria and dengue. This scoping review may serve as a useful precursor to inform future systematic reviews of the primary literature.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12992-021-00793-2.

Tick-Borne Pathogens and Diseases in Greece

Tick-borne diseases (TBDs) are recognized as a serious and growing public health epidemic in Europe, and are a cause of major losses in livestock production worldwide. This review is an attempt to present a summary of results from studies conducted over the last century until the end of the year 2020 regarding ticks, tick-borne pathogens, and tick-borne diseases in Greece. We provide an overview of the tick species found in Greece, as well as the most important tick-borne pathogens (viruses, bacteria, protozoa) and corresponding diseases in circulation. We also consider prevalence data, as well as geographic and climatic conditions. Knowledge of past and current situations of TBDs, as well as an awareness of (risk) factors affecting future developments will help to find approaches to integrated tick management as part of the ‘One Health Concept’; it will assist in avoiding the possibility of hotspot disease emergencies and intra- and intercontinental transmission. Increased surveillance in Greece is required to ensure clear and effective policies for TBD control.

Integrated disease management: arboviral infections and waterborne diarrhoea

Water-related diseases such as diarrhoeal diseases from viral, bacterial and parasitic organisms and Aedes-borne arboviral diseases are major global health problems. We believe that these two disease groups share common risk factors, namely inadequate household water management, poor sanitation and solid waste management. Where water provision is inadequate, water storage is essential. Aedes mosquitoes commonly breed in household water storage containers, which can hold water contaminated with enteric disease-causing organisms. Microbiological contamination of water between source and point-of-use is a major cause of reduced drinking-water quality. Inadequate sanitation and solid waste management increase not only risk of water contamination, but also the availability of mosquito larval habitats. In this article we discuss integrated interventions that interrupt mosquito breeding while also providing sanitary environments and clean water. Specific interventions include improving storage container design, placement and maintenance and scaling up access to piped water. Vector control can be integrated into sanitation projects that target sewers and drains to avoid accumulation of stagnant water. Better management of garbage and solid waste can reduce the availability of mosquito habitats while improving human living conditions. Our proposed integration of disease interventions is consistent with strategies promoted in several global health frameworks, such as the sustainable development goals, the global vector control response, behavioural change, and water, sanitation and hygiene initiatives. Future research should address how interventions targeting water, sanitation, hygiene and community waste disposal also benefit Aedes-borne disease control. The projected effects of climate change mean that integrated management and control strategies will become increasingly important.

Genetic diversity in a restricted-dispersal kissing bug: The centre-periphery hypothesis halfway

The centre-periphery hypothesis (CPH) postulates that populations close to the centre of a species distribution will exhibit higher genetic diversity and lower genetic differentiation than populations located at the edge of the distribution. The centre of a species' distribution might represent an optimum for the environmental factors influencing the species absolute fitness and, therefore, genetic diversity. In species with wide distribution, the geographical variation of biotic and abiotic variables is crucial to understand the underlying mechanisms of the CPH. We evaluated the CPH and specifically tested which environmental variables better explained the patterns of genetic diversity in the kissing bug Mepraia spinolai, one of the main wild vectors of Chagas disease in southern South America, distributed across three Mediterranean climatic ecoregions in Chile. We analysed 2380 neutral single nucleotide polymorphisms to estimate genetic diversity. Mean winter temperature, mean summer temperature, vegetation cover, population abundance, proportion of winged individuals and female abdomen area were measured for each kissing bug population to construct a model. Lower genetic diversity was detected in populations at the edge of the distribution compared to those in the centre. However, genetic differentiation was not higher in the periphery. Genetic diversity was related to climatic and biological variables; there was a positive relationship with mean winter temperature and a negative association with mean summer temperature and body size. These results partially support the CPH and identify biotic (abdomen area) and abiotic (winter/summer temperatures) factors that would affect genetic diversity in this restricted-dispersal species of epidemiological relevance.

Impact of Covid-19 on Transgender Persons: The Need for an Inclusive Approach

Objectives

The Covid-19 pandemic created significant impact and challenges particularly for vulnerable persons like transgender individuals worsening the prevailing stigma, discrimination, and exclusions against them. This review intends to assimilate the literature on the outbreak of Covid-19 and its impacts on transgender individuals across the world.

Methods

A narrative literature review on the impact of the Covid-19 pandemic among transgender persons has been done.

Results

This review reveals that transgender persons face exclusive structural, interpersonal, and personal risks from this pandemic and its response measures, endangering their lives, livelihoods, economy, health, and wellbeing.

Conclusions

Findings point to the need to design proactive and multi-level interventions that are sensitive to the unique needs of transgender individuals.

Community engagement to control dengue and other vector-borne diseases in Alappuzha municipality, Kerala, India

Introduction Vector-borne diseases (VBDs) are a serious threat in many Indian states, including Kerala. Community-based decentralized planning and engagement are effective strategies that can make positive behavioral changes to control VBDs. Methods This community-based implementation research was conducted during November 2016 - October 2018 in Alappuzha municipality in Kerala, India. It was conducted in two phases. In the first phase, formative research was conducted to know the community's profile and perceptions and thus to plan and develop an appropriate intervention. Baseline data on some entomological indicators were also collected. These data were used to assess the impact of the intervention by comparing with the post-intervention data. In the second phase, an intervention through the community's engagement was implemented in selected wards. The activities included the formation of community committees and the vector control and source reduction activities with the community engagement and inter-sectoral coordination. Results The intervention resulted in a positive change among the community to engage in vector control activities. These efforts along with inter-sectoral coordination resulted in successfully implementing vector source reduction activities. In both wards, pre- and post-intervention entomological data (house index: 16.7 vs 6.0 and 64.2 vs. 8.6; container index: 24.8 vs. 12.1 and 37.7 vs. 18.1; and Breteau index: 21.3 vs. 7.3 and 47.7 vs. 8.6) revealed a considerable vector source reduction. Conclusion The findings of this study suggest considering and including community engagement in public health policy as the main thrust to control VBDs.

A Realist Synthesis of Community-Based Interventions in Vector-Borne Diseases

Randomized control trials have provided evidence that some community-based interventions (CBIs) work in vector-borne diseases (VBDs). Conversely, there is limited evidence on how well those CBIs succeed in producing specific outcomes in different contexts. To conduct a realist synthesis for knowledge translation on this topic, we examined the extent to which realist concepts (context, mechanisms, and outcomes) and their relationships are present in the existing literature on CBIs for VBDs. Articles on CBIs were identified from prior scoping reviews of health interventions for VBDs. Content of the articles was extracted verbatim if it referred either to realist concepts or CBI features. The number of articles and the average number of words extracted per category per CBI were quantified. Content of the articles was scrutinized to inductively gather qualitative evidence on the interactions between realist concepts. We reviewed 41 articles on 17 CBIs from 12 countries. The average number of words used for mechanisms was much lower than those used for outcomes and context (309,474, and 836, respectively). The average number of words used for mechanisms increased when a CBI was described in three or more articles. There were more extensive accounts on CBI features than on mechanisms. It was difficult to gather evidence on the interactions among realist concepts from the content of the articles. Scarce reporting on mechanisms in published articles limits conducting a realist synthesis of CBIs in VBDs. More transdisciplinary research that goes beyond the biomedical paradigm is needed to boost the development of intervention mechanisms in this field.

'None of my ancestors ever discussed this disease before!' How disease information shapes adaptive capacity of marginalised rural populations in India

Smallholder farmer and tribal communities are often characterised as marginalised and highly vulnerable to emerging zoonotic diseases due to their relatively poor access to healthcare, worse-off health outcomes, proximity to sources of disease risks, and their social and livelihood organisation. Yet, access to relevant and timely disease information that could strengthen their adaptive capacity remain challenging and poorly characterised in the empirical literature. This paper addresses this gap by exploring the role of disease information in shaping the adaptive capacity of smallholder farmer and tribal groups to Kyasanur Forest Disease (KFD), a tick-borne viral haemorrhagic fever. We carried out household surveys (n = 229) and in-depth interviews (n = 25) in two affected districts-Shimoga and Wayanad-in the Western Ghats region. Our findings suggest that, despite the generally limited awareness about KFD, access to disease information improved households' propensity to implement adaptation strategies relative to households that had no access to it. Of the variety of adaptation strategies implemented, vaccination, avoiding forest visits, wearing of protective clothing and footwear, application of dimethyl phthalate (DMP) oil and income diversification were identified by respondents as important adaptive measures during the outbreak seasons. Even so, we identified significant differences between individuals in exposure to disease information and its contribution to substantive adaptive action. Households reported several barriers to implement adaptation strategies including, lack of disease information, low efficacy of existing vaccine, distrust, religio-cultural sentiments, and livelihood concerns. We also found that informal information sharing presented a promising avenue from a health extension perspective albeit with trade-offs with potential distortion of the messages through misinformation and/or reporting bias. Altogether, our findings stress the importance of contextualising disease information and implementing interventions in a participatory way that sufficiently addresses the social determinants of health in order to bolster households' adaptive capacity to KFD and other neglected endemic zoonoses.

Towards a Semi-Automatic Early Warning System for Vector-Borne Diseases

The emergence and spread of vector-borne diseases (VBDs) is a function of biotic, abiotic and socio-economic drivers of disease while their economic and societal burden depends upon a number of time-varying factors. This work is concerned with the development of an early warning system that can act as a predictive tool for public health preparedness and response. We employ a host-vector model that combines entomological (mosquito data), social (immigration rate, demographic data), environmental (temperature) and geographical data (risk areas). The output consists of appropriate maps depicting suitable risk measures such as the basic reproduction number, R₀, and the probability of getting infected by the disease. These tools consist of the backbone of a semi-automatic early warning system tool which can potentially aid the monitoring and control of VBDs in different settings. In addition, it can be used for optimizing the cost-effectiveness of distinct control measures and the integration of open geospatial and climatological data. The R code used to generate the risk indicators and the corresponding spatial maps along with the data is made available.

Spatiotemporal transmission dynamics of co-circulating dengue, Zika, and chikungunya viruses in Fortaleza, Brazil: 2011-2017

The mosquito-borne viruses dengue (DENV), Zika (ZIKV), and chikungunya (CHIKV), now co-endemic in the Americas, pose growing threats to health worldwide. However, it remains unclear whether there exist interactions between these viruses that could shape their epidemiology. This study advances knowledge by assessing the transmission dynamics of co-circulating DENV, ZIKV, and CHIKV in the city of Fortaleza, Brazil. Spatiotemporal transmission dynamics of DENV, ZIKV, and CHIKV were analyzed using georeferenced data on over 210,000 reported cases from 2011 to 2017 in Fortaleza, Brazil. Local spatial clustering tests and space-time scan statistics were used to compare transmission dynamics across all years. The transmission of co-circulating viruses in 2016 and 2017 was evaluated at fine spatial and temporal scales using a measure of spatiotemporal dependence, the τ-statistic. Results revealed differences in the diffusion of CHIKV compared to previous DENV epidemics and spatially distinct transmission of DENV/ZIKV and CHIKV during the period of their co-circulation. Significant spatial clustering of viruses of the same type was observed within 14-day time intervals at distances of up to 6.8 km (p<0.05). These results suggest that arbovirus risk is not uniformly distributed within cities during co-circulation. Findings may guide outbreak preparedness and response efforts by highlighting the clustered nature of transmission of co-circulating arboviruses at the neighborhood level. The potential for competitive interactions between the arboviruses should be further investigated.

Malaria outbreak response in urban Santo Domingo, Dominican Republic: lessons learned for community engagement

Community engagement is crucial for public health initiatives, yet it remains an under-studied process within national disease elimination programs. This report shares key lessons learned for community engagement practices during a malaria outbreak response in the Los Tres Brazos neighborhood of urban Santo Domingo, Dominican Republic from 2015-2016. In this two-year period, 233 cases of malaria were reported—more than seven times the number of cases (31) reported in the previous two years. The initial outbreak response by the national malaria program emphasized “top-down” interventions such as active surveillance, vector control, and educative talks within the community. Despite a transient reduction in reported cases in mid-2015, transmission resurged at the end of 2015. The program responded by introducing active roles for trained community members that included door-to-door fever screening, testing with rapid diagnostic tests and treatment. Malaria cases declined significantly throughout 2016 and community-based active surveillance infrastructure helped to detect and limit a small episode of transmission in 2017. Results from qualitative research among community members revealed two key factors that facilitated their cooperation with community-based surveillance activities: motivation to help one’s community; and trust among stakeholders (community health workers, their neighbors and other key figures in the community, and malaria program staff and leadership). This experience suggests that community-led interventions and the program’s willingness to learn and adapt under changing circumstances can help control malaria transmission and pave the way for elimination.

Emerging arboviruses (dengue, chikungunya, and Zika) in Southeastern Mexico: influence of socio-environmental determinants on knowledge and practices

The proliferation of arboviruses and their vectors is influenced by a complex interplay between vector, environment and human behaviors. The aim of this work is to analyze the influence of socio-environmental determinants on knowledge and practices regarding arboviruses transmission, among the residents of three communities on the southern border of Mexico. Between June 2017 and August 2018, a set of 149 households from three communities of Tapachula (Chiapas) and Villahermosa (Tabasco) were covered. This study consists of the application of a community prevention project. Different surveys and methodological approaches were used. Associations between socio-environmental determinants and knowledge and practices for arboviruses transmission control were estimated by odds ratio. Logistic regression and qualitative techniques were used. Although around 75% of households had an adequate knowledge about arboviruses' origin and transmission, only 30% of them adopted adequate practices. Domestic risk practices were associated with serious deficiencies in water and sanitation services. Furthermore, a perception of greater risk and difficulty in complying with preventive measures were detected. An adequate knowledge does not necessarily lead to adequate prevention practices. Intermediate social determinants influence on the persistence of risk behaviors for arboviruses proliferation. Addressing such related aspects requires the achievement of an effective and sustainable vector management.

Analysis of the implementation of a community-based intervention to control dengue fever in Burkina Faso

BACKGROUND

A community-based dengue fever intervention was implemented in Burkina Faso in 2017. The results achieved vary from one area to another. The objective of this article is to analyze the implementation of this intervention, to better understand the process, and to explain the contextual elements of performance variations in implementation.

METHODOLOGY

The research was conducted in the former sector 22 of the city of Ouagadougou. We adapted the Consolidated Framework for Implementation Research (CFIR) to take into account the realities of the context and the intervention. The data collected from the participants directly involved in the implementation using three techniques: document consultation, individual interview, and focus group.

RESULTS

Two dimensions of CFIR emerge from the results as having had a positive influence on the implementation: (i) the characteristics of the intervention and (ii) the processes of the intervention implementation. The majority of the CFIR constructions were considered to have had a positive effect on implementation. The quality and strength of the evidence received the highest score. The dimension of the external context had a negative influence on the implementation of the intervention.

CONCLUSION

The objective of the study was to analyze the influence of contextual elements on the implementation process of a community-based dengue fever intervention. We used the CFIR framework already used by many studies for implementation analysis. Although it was not possible to test this framework in its entirety, it is useful for the analysis of the implementation. Its use is simple and does not require any special skills from users. Usability is indeed an essential criterion for the relevance of using an analytical framework in implementation science.

New methodologies for the estimation of population vulnerability to diseases: a case study of Lassa fever and Ebola in Nigeria and Sierra Leone

Public health practitioners require measures to evaluate how vulnerable populations are to diseases, especially for zoonoses (i.e. diseases transmitted from animals to humans) given their pandemic potential. These measures would be valuable to support strategic and operational decision making and allocation of resources. Although vulnerability is well defined for natural hazards, for public health threats the concept remains undetermined. Here, we develop new methodologies to: (i) quantify the impact of zoonotic diseases and the capacity of countries to cope with these diseases, and (ii) combine these two measures (impact and capacity) into one overall vulnerability indicator. The adaptive capacity is calculated from estimations of disease mortality, although the method can be adapted for diseases with no or low mortality but high morbidity. As an example, we focused on the vulnerability of Nigeria and Sierra Leone to Lassa Fever and Ebola. We develop a simple analytical form that can be used to estimate vulnerability scores for different spatial units of interest, e.g. countries or regions. We show how some populations can be highly vulnerable despite low impact threats. We finally outline future research to more comprehensively inform vulnerability with the incorporation of relevant factors depicting local heterogeneities (e.g. bio-physical and socio-economic factors). This article is part of the theme issue 'Modelling infectious disease outbreaks in humans, animals and plants: epidemic forecasting and control'. This theme issue is linked with the earlier issue 'Modelling infectious disease outbreaks in humans, animals and plants: approaches and important themes'.

Preparedness for Chagas disease spreading worldwide

Chagas disease remains a serious problem for public health due to the high disease burden together with its global spreading patterns. However, current treatment and vector control are highly challenged by drug and insecticide resistance. Chemotherapy and vector control have been proved to be effective attempts to minimize the disease burden. Continued efforts are necessary to keep adapting the surveillance-response systems to the dynamic health systems. More attention and investments are needed to improve appropriate strategy and technology in different settings. This may be accomplished by creating effective risk early warning, addressing vulnerability and building resilience systems, implementing a vector surveillance system, as well as innovating research and technology.

Lizards and rabbits may increase Chagas infection risk in the Mediterranean-type ecosystem of South America

Studies of host-parasite relationships largely benefit from adopting a multifactorial approach, including the complexity of multi-host systems and habitat features in their analyses. Some host species concentrate most infection and contribute disproportionately to parasite and vector population maintenance, and habitat feature variation creates important heterogeneity in host composition, influencing infection risk and the fate of disease dynamics. Here, we examine how the availability of specific groups of hosts and habitat features relate to vector abundance and infection risk in 18 vector populations along the Mediterranean-type ecosystem of South America, where the kissing bug Mepraia spinolai is the main wild vector of the parasite Trypanosoma cruzi, the etiological agent of Chagas disease. For each population, data on vectors, vertebrate host availability, vegetation, precipitation, and temperature were collected and analyzed. Vector abundance was positively related to temperature, total vegetation, and European rabbit availability. Infection risk was positively related to temperature, bromeliad cover, and reptile availability; and negatively to the total domestic mammal availability. The invasive rabbit is suggested as a key species involved in the vector population maintenance. Interestingly, lizard species -a group completely neglected as a potential reservoir-, temperature, and bromeliads were relevant factors accounting for infection risk variation across populations.

Climate Change Impacts on Waterborne Diseases: Moving Toward Designing Interventions

PURPOSE

Climate change threatens progress achieved in global reductions of infectious disease rates over recent decades. This review summarizes literature on potential impacts of climate change on waterborne diseases, organized around a framework of questions that can be addressed depending on available data.

RECENT FINDINGS

A growing body of evidence suggests that climate change may alter the incidence of waterborne diseases, and diarrheal diseases in particular. Much of the existing work examines historical relationships between weather and diarrhea incidence, with a limited number of studies projecting future disease rates. Some studies take social and ecological factors into account in considerations of historical relationships, but few have done so in projecting future conditions. The field is at a point of transition, toward incorporating social and ecological factors into understanding the relationships between climatic factors and diarrheal diseases and using this information for future projections. The integration of these components helps identify vulnerable populations and prioritize adaptation strategies.

Vector-borne disease and climate change adaptation in African dryland social-ecological systems

BACKGROUND

Drylands, which are among the biosphere's most naturally limiting and environmentally variable ecosystems, constitute three-quarters of the African continent. As a result, environmental sustainability and human development along with vector-borne disease (VBD) control historically have been especially challenging in Africa, particularly in the sub-Saharan and Sahelian drylands. Here, the VBD burden, food insecurity, environmental degradation, and social vulnerability are particularly severe. Changing climate can exacerbate the legion of environmental health threats in Africa, the social dimensions of which are now part of the international development agenda. Accordingly, the need to better understand the dynamics and complex coupling of populations and environments as exemplified by drylands is increasingly recognized as critical to the design of more sustainable interventions.

MAIN BODY

This scoping review examines the challenge of vector-borne disease control in drylands with a focus on Africa, and the dramatic, ongoing environmental and social changes taking place. Dryland societies persisted and even flourished in the past despite changing climates, extreme and unpredictable weather, and marginal conditions for agriculture. Yet intrusive forces largely out of the control of traditional dryland societies, along with the negative impacts of globalization, have contributed to the erosion of dryland's cultural and natural resources. This has led to the loss of resilience underlying the adaptive capacity formerly widely exhibited among dryland societies. A growing body of evidence from studies of environmental and natural resource management demonstrates how, in light of dryland system's inherent complexity, these factors and top-down interventions can impede sustainable development and vector-borne disease control. Strengthening adaptive capacity through community-based, participatory methods that build on local knowledge and are tailored to local ecological conditions, hold the best promise of reversing current trends.

CONCLUSIONS

A significant opportunity exists to simultaneously address the increasing threat of vector-borne diseases and climate change through methods aimed at strengthening adaptive capacity. The integrative framework and methods based on social-ecological systems and resilience theory offers a novel set of tools that allow multiple threats and sources of vulnerability to be addressed in combination. Integration of recent advances in vector borne disease ecology and wider deployment of these tools could help reverse the negative social and environmental trends currently seen in African drylands.

Social determinants of health associated with topical repellent use in pregnancy: a cross-sectional study during a Zika outbreak in Brazil

Background

Repellent use during pregnancy was strongly recommended after uncovering Zika virus (ZIKV) involvement with congenital malformations. In this context, Pernambuco, Brazil played a key role since it was the epicentre for the main studies suggesting ZIKV teratogenicity and one of Brazil's most affected states during the 2014-2016 epidemics. Thus we aimed to identify possible associations between social determinants of health and repellent use in pregnancy during the ZIKV outbreak in Pernambuco.

Methods

We conducted a cross-sectional study (July-December 2016) with 539 pregnant women residing in Pernambuco and estimated the associations by prevalence ratio and multivariable logistic regression.

Results

Repellents were associated with pregnant women ≥30 y; graduates, employed, health professionals, private health system users and with a monthly income per person greater than two minimum wages. Women whose domiciles favour mosquitoes (ground-floor houses, intermittent water supply from general distribution or water trucks and for ≤6 d/week, cesspools/open wastewater, indoor household water storage) were less likely to use repellents. There was no association for peridomiciles.

Conclusions

Repellents were not associated with ZIKV in most vulnerable pregnant women, despite all the general recommendations made during the Pernambuco epidemic. This study observed a demand for public policies focused on health, education and sanitation problems related to deprived social groups along with their co-responsibility rather than focusing on individual attitudes against mosquitoes.

Beating the odds: Sustained Chagas disease vector control in remote indigenous communities of the Argentine Chaco over a seven-year period

BACKGROUND

Rapid reinfestation of insecticide-treated dwellings hamper the sustained elimination of Triatoma infestans, the main vector of Chagas disease in the Gran Chaco region. We conducted a seven-year longitudinal study including community-wide spraying with pyrethroid insecticides combined with periodic vector surveillance to investigate the house reinfestation process in connection with baseline pyrethroid resistance, housing quality and household mobility in a rural section of Pampa del Indio mainly inhabited by deprived indigenous people (Qom).

METHODOLOGY/PRINCIPAL FINDINGS

Despite evidence of moderate pyrethroid resistance in local T. infestans populations, house infestation dropped from 31.9% at baseline to 0.7% at 10 months post-spraying (MPS), with no triatomine found at 59 and 78 MPS. Household-based surveillance corroborated the rare occurrence of T. infestans and the house invasion of other four triatomine species. The annual rates of loss of initially occupied houses and of household mobility were high (4.6-8.0%). Housing improvements did not translate into a significant reduction of mud-walled houses and refuges for triatomines because most households kept the former dwelling or built new ones with mud walls.

CONCLUSIONS/SIGNIFICANCE

Our results refute the assumption that vector control actions performed in marginalized communities of the Gran Chaco are doomed to fail. The larger-than-expected impacts of the intervention program were likely associated with the combined effects of high-coverage, professional insecticide spraying followed by systematic vector surveillance-and-response, broad geographic coverage creating a buffer zone, frequent housing replacement and residential mobility. The dynamical interactions among housing quality, mobility and insecticide-based control largely affect the chances of vector elimination.

Lowering hospital walls to achieve health equity

Hospitals have a pivotal role in reducing health inequities for indigenous people and other marginalised groups, argue Anna Matheson and colleagues

Establishing research priorities in prevention and control of vector-borne diseases in urban areas: a collaborative process

BACKGROUND

In 2015, following a call for proposals from the Special Programme for Research and Training in Tropical Diseases (TDR), six scoping reviews on the prevention and control of vector-borne diseases in urban areas were conducted. Those reviews provided a clear picture of the available knowledge and highlighted knowledge gaps, as well as needs and opportunities for future research. Based on the research findings of the scoping reviews, a concept mapping exercise was undertaken to produce a list of priority research needs to be addressed.

METHODS

Members of the six research teams responsible for the "VEctor boRne DiseAses Scoping reviews" (VERDAS) consortium's scoping reviews met for 2 days with decision-makers from Colombia, Brazil, Peru, Pan-American Health Organization, and World Health Organization. A total of 11 researchers and seven decision-makers (from ministries of health, city and regional vector control departments, and vector control programs) completed the concept mapping, answering the question: "In view of the knowledge synthesis and your own expertise, what do we still need to know about vector-borne diseases and other infectious diseases of poverty in urban areas?" Participants rated each statement on two scales from 1 to 5, one relative to 'priority' and the other to 'policy relevance', and grouped statements into clusters based on their own individual criteria and expertise.

RESULTS

The final map consisted of 12 clusters. Participants considered those entitled "Equity", "Technology", and "Surveillance" to have the highest priority. The cluster considered the most important concerns equity issues, confirming that these issues are rarely addressed in research on vector-borne diseases. On the other hand, the "Population mobility" and "Collaboration" clusters were considered to be the lowest priority but remained identified by participants as research priorities. The average policy relevance scores for each of the 12 clusters were roughly the same as the priority scores for all clusters. Some issues were not addressed during the brain-storming. This is the case for governance and for access and quality of care.

CONCLUSIONS

Based on this work, and adopting a participatory approach, the concept mapping exercise conducted collaboratively with researchers from these teams and high-level decision-makers identified research themes for which studies should be carried out as a priority.

Phospho-proteomic analysis of primary human colon epithelial cells during the early Trypanosoma cruzi infection phase

The protozoan parasite Trypanosoma cruzi, the causative agent of Chagas disease, causes severe morbidity and mortality in afflicted individuals. About 30% of T. cruzi-infected individuals present with cardiac, gastrointestinal tract, and/or neurological disorders. Megacolon, one of the major pathologies of Chagas disease, is accompanied by gastrointestinal motility disorders. The molecular mechanism of T. cruzi-mediated megacolon in Chagas disease is currently unknown. To decipher the molecular mechanism of T. cruzi-induced alteration in the colon during the early infection phase, we exposed primary human colonic epithelial cells (HCoEpiC) to invasive T. cruzi trypomastigotes at multiple time points to determine changes in the phosphoprotein networks in the cells following infection using proteome profiler Human phospho-kinase arrays. We found significant changes in the phosphorylation pattern that can mediate cellular deregulations in colonic epithelial cells after infection. We detected a significant increase in the levels of phosphorylated heat shock protein (p-HSP) 27 and transcription factors that regulate various cellular functions, including c-Jun and CREB. Our study confirmed significant upregulation of phospho (p-) Akt S473, p-JNK, which may directly or indirectly modulate CREB and c-Jun phosphorylation, respectively. We also observed increased levels of phosphorylated CREB and c-Jun in the nucleus. Furthermore, we found that p-c-Jun and p-CREB co-localized in the nucleus at 180 minutes post infection, with a maximum Pearson correlation coefficient of 0.76±0.02. Increased p-c-Jun and p-CREB have been linked to inflammatory and profibrotic responses. T. cruzi infection of HCoEpiC induces an increased expression of thrombospondin-1 (TSP-1), which is fibrogenic at elevated levels. We also found that T. cruzi infection modulates the expression of NF-kB and JAK2-STAT1 signaling molecules which can increase pro-inflammatory flux. Bioinformatics analysis of the phosphoprotein networks derived using the phospho-protein data serves as a blueprint for T. cruzi-mediated cellular transformation of primary human colonic cells during the early phase of T. cruzi infection.

Progress, challenges, and the role of public engagement to improve tick-borne disease literacy

Vector-borne diseases have increased worldwide, facilitated by globalization and variations in climate. Tick and tick-borne disease researchers, veterinarians, medical practitioners, and public health specialists are working to share their expertise on tick ecology, disease transmission, diagnostics, and treatment in order to control tick-borne epidemics and potential pandemics. This review will be a brief overview of the current status of tick-borne diseases, challenges on the scientific and public fronts, and the role of public engagement in improving citizen education within the context of ticks and tick-borne disease research.

Towards a science of global health delivery: A socio-anthropological framework to improve the effectiveness of neglected tropical disease interventions

BACKGROUND

Over the last decade, implementation research and a science of global health delivery have emerged as important vehicles to improve the effectiveness of interventions. Efforts to control neglected tropical diseases (NTD) operate in challenging circumstances and with marginalized populations, making attention to context-specific details particularly relevant. Socio-anthropological insights have much to offer a science of NTD delivery. In this paper, an accessible and actionable framework for understanding NTD intervention effectiveness, based on socio-anthropological research, is presented and its utility for program planning and monitoring and evaluation is outlined.

METHODOLOGY/PRINCIPAL FINDINGS

The framework was developed inductively by comparatively analyzing three rapid ethnographic studies undertaken in Eastern Africa (2010-2013) on three different large-scale NTD interventions: rabies elimination in Tanzania, sleeping sickness control in Uganda and the prevention of parasitic worms in Zambia. The framework includes five "intervention domains" where the effectiveness of these interventions was negotiated and determined at the local level. This involves: 1) the terrain of intervention (including seasonality and geographical variability); 2) community agency (including local knowledge, risk perceptions, behaviors, leadership and social pressure); 3) the strategies and incentives of field staff (skills, motivations, capabilities and support); 4) the socio-materiality of technology (characteristics of intervention tools and the adoption process itself); and 5) the governance of interventions (policy narratives, available expertise, bureaucracy, politics and the utilization of knowledge). The paper illustrates the importance of each of these domains by drawing on the case study research, presenting lessons learnt and practical recommendations for how such insights could improve intervention delivery.

CONCLUSIONS/SIGNIFICANCE

To help close the gap between efficacy and effectiveness in NTD programs, it is important that field staff: 1) generate meaningful knowledge about contextual factors; 2) use this knowledge to tailor field strategies; and 3) create routine mechanisms to account for the dynamic process of implementation itself. The framework presented here offers a simple analytical tool to strengthen these knowledge-to-action relationships existing project planning tools, drawing on the insights of socio-anthropology.

Beyond Climate Change and Health: Integrating Broader Environmental Change and Natural Environments for Public Health Protection and Promotion in the UK

Increasingly, the potential short and long-term impacts of climate change on human health and wellbeing are being demonstrated. However, other environmental change factors, particularly relating to the natural environment, need to be taken into account to understand the totality of these interactions and impacts. This paper provides an overview of ongoing research in the Health Protection Research Unit (HPRU) on Environmental Change and Health, particularly around the positive and negative effects of the natural environment on human health and well-being and primarily within a UK context. In addition to exploring the potential increasing risks to human health from water-borne and vector-borne diseases and from exposure to aeroallergens such as pollen, this paper also demonstrates the potential opportunities and co-benefits to human physical and mental health from interacting with the natural environment. The involvement of a Health and Environment Public Engagement (HEPE) group as a public forum of “critical friends” has proven useful for prioritising and exploring some of this research; such public involvement is essential to minimise public health risks and maximise the benefits which are identified from this research into environmental change and human health. Research gaps are identified and recommendations made for future research into the risks, benefits and potential opportunities of climate and other environmental change on human and planetary health.

Polisye Kont Moustik: A Culturally Competent Approach to Larval Source Reduction in the Context of Lymphatic Filariasis and Malaria Elimination in Haiti

Community engagement has become an increasingly important focus of global health programs. Arbovirus emergence in the Americas (Zika and chikungunya virues), and global goals for malaria and lymphatic filariasis elimination, mean that community-based mosquito control has taken on a new salience. But how should mosquito control initiatives be designed and implemented in ways that best engage local people? What are the challenges and trade-offs of different strategies, not only for effectiveness but also for scale-up? In this paper, we describe the social and political dynamics of a pilot study in a small town in northern Haiti. With the aim of developing a culturally-competent approach to larval source management (LSM), our pilot project combined larval surveillance with environmental management, social engagement, community education, and larvicide application. Orientated around a network of 'Mosquito Police' (Polisye Kont Moustik, in Haitian Creole), our approach integrated elements of formative research, social learning, and community participation. Here, we reflect on the challenges we encountered in the field, from larval mapping, staff management, education and behavior change, engagement with formal and informal leaders, and community-based environmental cleanup. We discuss how these programmatic efforts were influenced and shaped by a complex range of social, cultural, political, and economic realities, and conclude by discussing the implications of our community-based approach for the elimination of lymphatic filariasis and malaria, and other vector-borne diseases, in Haiti.