Fostering social innovation and building adaptive capacity for dengue control in Cambodia: a case study

Systematic Review of Impacts of Educational Interventions to Control Breeding Sites of Aedes aegypti and Aedes albopictus Mosquitoes

Community participation is a critical element in the management of Aedes aegypti and Aedes albopictus breeding sites. Many educational interventions have been conducted to encourage prevention and elimination of breeding sites among different community actors, such as government-run programs for vector surveillance aimed at preventing and eliminating breeding sites at the household level within a community. Getting people involved in prevention and elimination of vector breeding sites in their communities requires communication and social mobilization strategies to promote and reinforce those prevention actions that, in turn, should be effective from the entomological standpoint. Articles published in English, Spanish, and Portuguese, were reviewed to assess whether educational interventions targeting Ae. aegypti and Ae. albopictus were effective in reducing entomological indicators or in improving practices to prevent the presence of or eliminate breeding sites. The most widely used indicators were larval indices and the practices associated with reducing/eliminating breeding sites. We found that using a community-based approach adapted to eco-epidemiological and sociocultural scenarios explains the reduction of entomological indicators by educational interventions. Those who design or implement educational interventions should strengthen the evaluation of those interventions using qualitative approaches that provide a more complete picture of the social context and the barriers and facilitators to implementing vector control. Engaging school children in cross-sectorial collaboration involving the health and education spheres promotes the participation of the community in vector surveillance and reduces the risk of arboviral disease transmission.

Social innovation in health training to engage researchers in resource-limited settings: process description and evaluation

Research on social innovations in health has increased in recent years. However, little training is geared toward enhancing social innovation research capacity. Most health training for low- and middle-income countries (LMICs) is developed by individuals in high-income countries, disregarding LMIC researchers' wisdom and insights and the communities' needs. Our team organized a multi-phase investigation involving a series of surveys and co-creation group discussions to assess individuals' training needs that directly informed a subsequent co-created training workshop series. We conducted a Hennessy-Hicks Training Needs Assessment among the Social Innovation in Health Initiative (SIHI) network and formed a co-creation group comprising SIHI fellows to design related training workshops. We ran a final evaluation survey and analyzed the workshop series' strengths, weaknesses and threats. Descriptive and thematic analysis were employed to analyze survey data and open-ended responses. The final evaluation survey captured data from 165 learners in 35 countries, including 26 LMICs. Most participants (67.3%, 111/165) rated the training workshop series as excellent, and 30.3% (50/165) rated it as good on a five-point scale. The need for writing research grants and manuscripts was rated the highest priority. Learners were interested in community-engaged research and diversity, equity and inclusion. This workshop illustrated how co-creation could be an effective tool for developing training materials tailored for LMIC researchers. We also offer a template for conducting a needs assessment and subsequent training workshops for LMICs. The ground-up, locally developed courses may be more effective than externally developed training programs intended for LMICs.

Knowledge, compliance, and challenges in anti-malarial products usage: a systematic review of at-risk communities for zoonotic malaria

BACKGROUND

Zoonotic malaria is a growing public health threat in the WHO Southeast Asia (SEA) and Western Pacific (WP) regions. Despite vector-control measures, the distribution of Macaque fascicularis and M. nemestrina, and Anopheles mosquitoes carrying non-human simian malaria parasites poses challenges to malaria elimination. The systematic review assesses the literature on knowledge and malaria-preventive practices in zoonotic malaria-affected areas across the WHO SEA and WP, aiming to identify challenges for malaria control.

METHODS

Peer-reviewed articles published in English, Malay and Indonesian between January 2010 and December 2022 were searched in OVID Medline, Scopus, Web of Science, and Google Scholar. Studies of any design-excluding reviews, conference proceedings, and reports from all WHO SEA and WP countries vulnerable to zoonotic malaria-were included. Backwards-reference screening and thematic analysis were conducted.

RESULTS

Among 4,174 initially searched articles, 22 peer-reviewed articles met the inclusion criteria. An additional seven articles were identified through backwards-reference screening, resulting in a total of 29 articles for this review. Half of these studies were conducted in Cambodia, Myanmar, Malaysia, and Thailand, mainly in forests and remote communities. The review highlighted inconsistencies in the operationalization of knowledge, and five major themes were identified related to knowledge: causation and transmission, symptoms, treatment, severity and complications, and malaria prevention. While participants generally had some understanding of malaria causation/transmission, minority and indigenous ethnic groups demonstrated limited knowledge and held misconceptions, such as attributing malaria to drinking dirty water. Preventive practices included traditional and non-traditional or modern methods-with a preference for traditional approaches to avoid mosquito bites. Challenges to malaria control included feasibility, cost, and access to healthcare services.

CONCLUSION

This review provides insights into knowledge, local understandings, and preventive practices related to malaria in the WHO SEA and WP regions. The findings highlight the need for future research to explore the knowledge of at-risk communities regarding zoonotic malaria, their perceive threat of the disease and factors exposing them to zoonotic malaria. New strategies must be developed for zoonotic malaria programs tailored to local contexts, emphasizing the significance of community participation, health education, and socio-behavioural change initiatives. It is important to consider the interconnectedness of human health, environmental and non-human primates conservation. Socio-cultural nuances should also be carefully considered in the design and implementation of these programs to ensure their effect tailored to local contexts.

School and community driven dengue vector control and monitoring in Myanmar: Study protocol for a cluster randomized controlled trial

Background

Dengue is the most common and widespread mosquito-borne arboviral disease globally estimated to cause >390 million infections and >20,000 deaths annually. There are no effective preventive drugs and the newly introduced vaccines are not yet available. Control of dengue transmission still relies primarily on mosquito vector control. Although most vector control methods currently used by national dengue control programs may temporarily reduce mosquito populations, there is little evidence that they affect transmission. There is an urgent need for innovative, participatory, effective, and locally adapted approaches for sustainable vector control and monitoring in which students can be particularly relevant contributors and to demonstrate a clear link between vector reduction and dengue transmission reduction, using tools that are inexpensive and easy to use by local communities in a sustainable manner.

Methods

Here we describe a cluster randomized controlled trial to be conducted in 46 school catchment areas in two townships in Yangon, Myanmar. The outcome measures are dengue cases confirmed by rapid diagnostic test in the townships, dengue incidence in schools, entomological indices, knowledge, attitudes and practice, behavior, and engagement.

Conclusions

The trial involves middle school students that positions them to become actors in dengue knowledge transfer to their communities and take a leadership role in the delivery of vector control interventions and monitoring methods. Following this rationale, we believe that students can become change agents of decentralized vector surveillance and sustainable disease control in line with recent new paradigms in integrated and participatory vector surveillance and control. This provides an opportunity to operationalize transdisciplinary research towards sustainable health development. Due to the COVID-19 pandemic and political instability in Myanmar the project has been terminated by the donor, but the protocol will be helpful for potential future implementation of the project in Myanmar and/or elsewhere.Registration: This trial was registered in the ISRCTN Registry on 31 May 2022 ( https://doi.org/10.1186/ISRCTN78254298).

Facilitators and barriers to engaging communities in health service research on dengue control in Indo-Pacific region: a systematic review

BACKGROUND

Dengue is a public health problem in the Indo-Pacific countries. There are concerns over the facilitators and barriers to community engagement in health service research aimed at dengue control. The objective of his study was to identify and synthesize facilitators and barriers to community engagement in health service research aimed at dengue control.

METHODOLOGY

The Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) checklist was used to perform this review. Health-related databases including PubMed, Ovid, and Google Scholar were searched for relevant studies. A consolidated framework with five domains was developed after undertaking a six-phase reflective thematic assessment of the data.

RESULTS

Thirteen studies were identified, spanning eight low-and middle-income countries of the Indo-Pacific region including Cambodia, India, Indonesia, Myanmar, Philippines, Sri Lanka, Thailand, and Vietnam. The studies in this review covered the period from 2002 to 2021. A broad range of study designs and objectives were revealed across these 13 studies. An array of communities such as the local government, project-related health staff, local health services staff, community leaders, local communities/residences/general public, heads of households, community health volunteers, school teachers, and schoolchildren participated in these dengue related studies. The five Consolidated Framework for Implementation Research (CFIR) domains of 'intervention characteristics', 'inner setting', 'outer setting',' individual characteristics', and 'program implementations' were used to identify and describe barriers and facilitators.

CONCLUSIONS

The findings indicate a range of barriers and facilitators to community engagement in dengue control in the selected LMIC in the Indo-Pacific countries. Future health services research on dengue control approaches should be carefully planned, methodologically constructed, aligned with community engagement principles, and involve considerable community participation at all stages of the research.

National dengue surveillance, Cambodia 2002-2020

Global dengue incidence has increased dramatically over the past few decades from approximately 500 000 reported cases in 2000 to over 5 million in 2019. This trend has been attributed to population growth in endemic areas, rapid unplanned urbanization, increasing global connectivity, and climate change expanding the geographic range of the Aedes spp. mosquito, among other factors. Reporting dengue surveillance data is key to understanding the scale of the problem, identifying important changes in the landscape of disease, and developing policies for clinical management, vector control and vaccine rollout. However, surveillance practices are not standardized, and data may be difficult to interpret particularly in low- and middle-income countries with fragmented health-care systems. The latest national dengue surveillance data for Cambodia was published in 2010. Since its publication, the country experienced marked changes in health policies, population demographics, climate and urbanization. How these changes affected dengue control remains unknown. In this article, we summarize two decades of policy changes, published literature, country statistics, and dengue case data collected by the Cambodia National Dengue Control Programme to: (i) identify important changes in the disease landscape; and (ii) derive lessons to inform future surveillance and disease control strategies. We report that while dengue case morbidity and mortality rates in Cambodia fell between 2002 and 2020, dengue incidence doubled and age at infection increased. Future national surveillance, disease prevention and treatment, and vector control policies will have to account for these changes to optimize disease control.

Community engagement: The key to tackling Antimicrobial Resistance (AMR) across a One Health context?

Antimicrobial resistance (AMR) is a One Health problem underpinned by complex drivers and behaviours. This is particularly so in low - and middle-income countries (LMICs), where social and systemic factors fuel (mis)use and drive AMR. Behavioural change around antimicrobial use could safeguard both existing and future treatments. However, changing behaviour necessitates engaging with people to understand their experiences. This publication describes a knowledge-exchange cluster of six LMIC-based projects who co-designed and answered a series of research questions around the usage of Community Engagement (CE) within AMR. Findings suggest that CE can facilitate AMR behaviour change, specifically in LMICs, because it is a contextualised approach which supports communities to develop locally meaningful solutions. However, current CE interventions focus on human aspects, and demand-side drivers, of AMR. Our cluster suggests that broader attention should be paid to AMR as a One Health issue. The popularity of mixed methods approaches within existing CE for AMR interventions suggests there is interdisciplinary interest in the uptake of CE. Unfortunately, the specificity and context-dependency of CE can make it difficult to evaluate and scale. Nevertheless, we suggest that in synthesising learnings from CE, we can develop a collective understanding of its scope to tackle AMR across contexts.   .

Women's participation in the prevention and control of dengue using environmental methods in the global south: a qualitative meta-synthesis

Background

Dengue, a mosquito-borne viral disease, causes significant mortality and morbidity in low- to middle-income countries. A body of research indicates that women can be effective in implementing vector borne disease control, but they still face inequitable opportunities for participation, leadership and decision-making in the execution of dengue prevention and vector control programmes. Yet implementing informal environmental management practices to prevent mosquito vector breeding forms part of their domestic household responsibilities. Understanding the enablers and barriers to women’s equitable roles with men in formal and informal disease prevention, and the benefits of their participation could help to increase their role and may be a contributing factor to reducing disease rates. The objective of this qualitative meta-synthesis was to synthesise evidence about women’s roles in dengue prevention and control in the global south and generate insights around the barriers, enablers, and benefits.

Methods

Eight databases were searched from inception to 7^th December 2020. One investigator independently reviewed all titles and abstracts for relevant articles. Grey literature was searched using 34 websites of global health and international development organisations.

Results

A total of 18 articles representing qualitative research or the qualitative component of mixed methods studies from Latin American and Caribbean (n = 8), Asia (n = 9), and one international review were included in the meta-synthesis. Relevant scholarship from Africa was lacking. This meta-synthesis revealed five unique themes surrounding women’s participation, seven categories of barriers, six of enablers, four health, well-being and social benefits for individuals, and four for communities .

Conclusion

An analysis of the results confirmed that women’s participation in dengue prevention was not gender equitable, gender sensitive nor transformative although women are the primary human resource for household and community-based prevention. Women demonstrated specific qualities aiding successful implementation. Corrective action is urgently needed to shift unhelpful gender norms, and empower women into leadership and decision-making roles.

School and community driven dengue vector control and monitoring in Myanmar: Study protocol for a cluster randomized controlled trial

Background. Dengue is the most common and widespread mosquito-borne arboviral disease globally estimated to cause >390 million infections and >20,000 deaths annually. There are no effective vaccines or preventive drugs. Control of dengue transmission relies primarily on mosquito vector control. Although most vector control methods currently used by national dengue control programs may temporarily reduce mosquito populations, there is little evidence that they affect transmission. There is an urgent need for innovative, participatory, effective, and locally adapted approaches for sustainable vector control and monitoring in which students can be particularly relevant contributors and to demonstrate a clear link between vector reduction and dengue transmission reduction, using tools that are inexpensive and easy to use by local communities in a sustainable manner. Methods. Here we describe a cluster randomized controlled trial to be conducted in 46 school catchment areas in two townships in Yangon, Myanmar. The outcome measures are dengue cases confirmed by rapid diagnostic test in the townships, dengue incidence in schools, entomological indices, knowledge, attitudes and practice, behavior, and engagement. Conclusions. The trial involves middle school students that positions them to become actors in dengue knowledge transfer to their communities and take a leadership role in the delivery of vector control interventions and monitoring methods. Following this rationale, we believe that students can become change agents of decentralized vector surveillance and sustainable disease control in line with recent new paradigms in integrated and participatory vector surveillance and control. This provides an opportunity to operationalize transdisciplinary research towards sustainable health development. Due to the COVID-19 pandemic and political instability in Myanmar the project has been terminated by the donor, but the protocol will be helpful for potential future implementation of the project in Myanmar and/or elsewhere. Registration: This trial was registered in the ISRCTN Registry on 31 May 2022 (https://doi.org/10.1186/ISRCTN78254298).

Systematic Literature Review: Inter-Reletedness of Innovation, Resilience and Sustainability - Major, Emerging Themes and Future Research Directions

Rationale

Research has been using resilience, sustainability and innovation interchangeably, but there is a lack of research that would provide an insight into how they are related to each other. This systematic literature review thus investigates research on sustainability, innovation and resilience, how they are related to each other, and also identifies major, emerging themes and future research directions on these topics.

Procedure

We used Bibliometrix software to visually describe articles with the highest number of citations, to present the thematic evolution of the field and present a historical map. The triangulation and thematic groups were identified and compared by two independent researchers.

Results

Resilience is involved in processes, sustainability is concerned with the outcomes, while innovation represents a pathway to achieving both resilience and sustainability. Resilience can ensure the provision of the system functions in the face of shocks and stresses and sustainability can ensure the adequate performance of the system in general. Three major themes were identified, 'socio-ecological systems', 'transformational innovation' and 'political governance', as well as three emerging themes, 'food security and agriculture', 'businesses and finance' and 'interconnected systems'. There is a need for longitudinal, multi-scale and interdisciplinary research that would explore various aspects of integrating these concepts.

Conclusion

There is a great overlap between the concepts of resilience, sustainability and innovation. Future research could study these concepts in relation to each other.

Supplementary Information

The online version contains supplementary material available at 10.1007/s43615-022-00187-5.

Public Engagement Improvement in STI Policies: Challenges and Solutions

Studies show that actors who are directly involved with science, technology and innovation (STI), such as scientists and managers, are more likely to participate. Therefore, policy documents, as an important guiding factor, need to emphasize the engagement of various stakeholders. On the other hand, due to the need for innovative models in public engagement, social innovation has provided new ways to promote it. Therefore, this study aims to strengthen public engagement in STI policies through social innovation in Iran.

In order to data gathering, questionnaires, interviews, document analysis and literature review were used in different stages of the research. In the first step, after interviewing experts on the dimensions and components of public engagement in STI, in the context of macro-policy documents, a model was extracted using thematic analysis and fuzzy delphi techniques. Then, in the second step, this study identified the statements related to public engagement in STI in macro-policy documents using quantitative content analysis, and thus the degree of attention to public engagement in STI macro-policy documents was determined. In the next step, this study sought to find solutions to its weaknesses in STI by examining the opinions of knowledgeable people about public engagement methods. Then, these solutions were evaluated in terms of their relevance to the Iranian context and social innovativeness, and finally, the selected solutions were ranked by Analytic Hierarchy Process (AHP) method.

Effectiveness of Positive Deviance, an Asset-Based Behavior Change Approach, to Improve Knowledge, Attitudes, and Practices Regarding Dengue in Low-Income Communities (Slums) of Islamabad, Pakistan: A Mixed-Method Study

Simple Summary

Dengue is a mosquito-borne infection caused by the Aedes mosquito, expanding at an alarming pace around the world. Recently, Pakistan has witnessed some major dengue outbreaks, affecting thousands of individuals across the country. As there is no specific cure or vaccine, prevention and vector control remain the key methods to avoid dengue infection. In Pakistan, dengue control activities are mainly focused on information-sharing through mass media and communication materials such as pamphlets and posters. The main challenge is a lack of community participation that can create an enabling environment for communities to follow the desired behaviors. There is a strong need to design and implement community-led behavior change approaches to ensure community participation and translate the knowledge into practices. This study was conducted to better understand the effectiveness of a community engagement approach, ‘positive deviance’, on dengue prevention and control. The study was carried out in two slums affected by the recent dengue outbreak in Islamabad, Pakistan. A total of 112 persons participated in the study, which was conducted from June–October 2020. The community discovered already-existing positive behaviors surrounding dengue prevention and control, which were shared with other participants through interactive activities. The study demonstrated positive changes in knowledge, attitudes, and practices, and could be a potential tool for dengue prevention and control programs worldwide.

Abstract

Dengue is a mosquito-borne, viral disease that has emerged as a global health concern in recent years. In the absence of specific antiviral treatment and vaccines, prevention remains the key strategy for dengue control. Therefore, innovative and community-driven approaches are required to improve the vector control practices. This study applied and evaluated the positive deviance (PD) approach on dengue prevention and control in selected slums of Islamabad during June–October 2020. The two most dengue-affected slums, the Faisal colony and France colony, were purposively selected as intervention and control groups, respectively. A total of 112 participants (56 for the intervention and 56 for the control group) participated in the study. The intervention group was exposed for two months to locally identified role model behaviors through weekly interactive sessions, dengue sketch competitions, and role plays. Another two months enabled the community to practice these behaviors without any external support in order to explore the intervention’s sustainability. Three surveys were conducted: before the intervention, after two months, and after four months, to assess any changes in the knowledge, attitudes, and practices of participating communities. Results found that the PD intervention had a significant positive impact on dengue knowledge, attitudes, and practices in the intervention group. PD could offer an empowering and efficient community engagement tool for future dengue prevention and control, both in Pakistan and more globally.

Entomological outcomes of cluster-randomised, community-driven dengue vector-suppression interventions in Kampong Cham province, Cambodia

Cambodia has one of the highest dengue infection rates in Southeast Asia. Here we report quantitative entomological results of a large-scale cluster-randomised trial assessing the impact on vector populations of a package of vector control interventions including larvivorous guppy fish in household water containers, mosquito trapping with gravid-ovitraps, solid waste management, breeding-container coverage through community education and engagement for behavioural change, particularly through the participation of school children. These activities resulted in major reductions in Container Index, House Index, Breteau Index, Pupal Index and Adult Index (all p-values 0.002 or lower) in the Intervention Arm compared with the Control Arm in a series of household surveys conducted over a follow-up period of more than one year, although the project was not able to measure the longer-term sustainability of the interventions. Despite comparative reductions in Adult Index between the study arms, the Adult Index was higher in the Intervention Arm in the final household survey than in the first household survey. This package of biophysical and community engagement interventions was highly effective in reducing entomological indices for dengue compared with the control group, but caution is required in extrapolating the reduction in household Adult Index to a reduction in the overall population of adult Aedes mosquitoes, and in interpreting the relationship between a reduction in entomological indices and a reduction in the number of dengue cases. The package of interventions should be trialled in other locations.

Navigating the COVID-19 Crisis to Sustain Community-Based Malaria Interventions in Cambodia

Cambodia has made impressive progress in reducing malaria trends and, in 2018, reported no malaria-related deaths for the first time. However, the coronavirus disease (COVID-19) pandemic presents a potential challenge to the country's goal for malaria elimination by 2025. The path toward malaria elimination depends on sustained interventions to prevent rapid resurgence, which can quickly set back any gains achieved.Malaria Consortium supported mobile malaria workers (MMWs) to engage with target communities to build acceptance, trust, and resilience. At the start of the pandemic, Malaria Consortium conducted a COVID-19 risk assessment and quickly developed and implemented a mitigation plan to ensure MMWs were able to continue providing malaria services without putting themselves or their patients at risk. Changes in malaria intervention coverage and community uptake have been monitored to gauge the indirect effects of COVID-19. Comparisons have been made between output indicators reported in 2020 and from the same month-period of the previous year.In general, malaria service intervention coverage and utilization rates did not decline in 2020. Rather, the reported figures show there was a substantial increase in service utilization. Preliminary internal reviews and community meetings show that despite a heightened public risk perception toward COVID-19, malaria testing motivation has been well sustained throughout the pandemic. This may be attributable to proactive program planning and data monitoring and active engagement with the communities and the national authorities to circumvent the indirect effect of COVID-19 on intervention coverage in Cambodia during the pandemic.