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Castillo-Neyra R, Larson AJ, Tamayo LD, Arevalo-Nieto C, Brown J, Condori-Pino C, Ortega E, Levy MZ, Paz-Soldan VA. Perceptions of Problems with Household Insects: Qualitative and Quantitative Findings from Peri-Urban Communities in Arequipa, Peru. Am J Trop Med Hyg 2023; 109:1372-1379. [PMID: 37931314 DOI: 10.4269/ajtmh.23-0266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 09/19/2023] [Indexed: 11/08/2023] Open
Abstract
Vector-borne diseases continue to impose a major health burden on Peru and neighboring countries. The challenge of addressing vector-borne disease is compounded by changing social, economic, and climatic conditions. Peri-urban Arequipa is an important region to study insect infestations because of ongoing challenges with disease vectors such as triatomines and a variety of other insects. We conducted surveys (N = 1,182) and seven focus groups (average seven participants) in peri-urban Arequipa to explore knowledge of and perception toward various insects that infest the region. Focus group participants reported the presence of a wide variety of insects in and around the home, including disease vectors such as triatomines (also identified by 27.2% of survey households), mosquitoes, spiders, and bed bugs, as well as nuisance insects. Health concerns related to insects included vector-borne diseases, spider bites, allergies, and sequelae from bed bug bites, and hygiene concerns. A majority of participants in the quantitative surveys identified triatomines as the insect they were most worried about (69.9%) and could identify Chagas disease as a health risk associated with triatomines (54.9%). Insect infestations in peri-urban Arequipa present multiple burdens to residents, including injury and illness from triatomines and other insects, as well as potential mental and economic concerns related to insects such as bed bugs. Future initiatives should continue to address triatomine infestations through educational outreach and implement a more holistic approach to address the burden of both disease and nuisance insects.
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Affiliation(s)
- Ricardo Castillo-Neyra
- Zoonotic Disease Research Lab, One Health Unit, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, San Martín de Porres, Lima, Peru
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine at University of Pennsylvania, Philadelphia, Pennsylvania
| | - Anika J Larson
- University of Washington, School of Medicine, Seattle, Washington
| | - Laura D Tamayo
- Zoonotic Disease Research Lab, One Health Unit, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, San Martín de Porres, Lima, Peru
| | - Claudia Arevalo-Nieto
- Zoonotic Disease Research Lab, One Health Unit, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, San Martín de Porres, Lima, Peru
| | | | - Carlos Condori-Pino
- Zoonotic Disease Research Lab, One Health Unit, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, San Martín de Porres, Lima, Peru
| | - Emma Ortega
- Department of Tropical Medicine, Tulane School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | - Michael Z Levy
- Zoonotic Disease Research Lab, One Health Unit, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, San Martín de Porres, Lima, Peru
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine at University of Pennsylvania, Philadelphia, Pennsylvania
| | - Valerie A Paz-Soldan
- Zoonotic Disease Research Lab, One Health Unit, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, San Martín de Porres, Lima, Peru
- Department of Tropical Medicine, Tulane School of Public Health and Tropical Medicine, New Orleans, Louisiana
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Lenhart A, Morrison AC, Paz-Soldan VA, Forshey BM, Cordova-Lopez JJ, Astete H, Elder JP, Sihuincha M, Gotlieb EE, Halsey ES, Kochel TJ, Scott TW, Alexander N, McCall PJ. The impact of insecticide treated curtains on dengue virus transmission: A cluster randomized trial in Iquitos, Peru. PLoS Negl Trop Dis 2020; 14:e0008097. [PMID: 32275653 PMCID: PMC7176142 DOI: 10.1371/journal.pntd.0008097] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 04/22/2020] [Accepted: 01/28/2020] [Indexed: 11/18/2022] Open
Abstract
Dengue is one of the most important vector-borne diseases, resulting in an estimated hundreds of millions of infections annually throughout the tropics. Control of dengue is heavily dependent upon control of its primary mosquito vector, Aedes aegypti. Innovative interventions that are effective at targeting the adult stage of the mosquito are needed to increase the options for effective control. The use of insecticide-treated curtains (ITCs) has previously been shown to significantly reduce the abundance of Ae. aegypti in and around homes, but the impact of ITCs on dengue virus (DENV) transmission has not been rigorously quantified. A parallel arm cluster-randomized controlled trial was conducted in Iquitos, Peru to quantify the impact of ITCs on DENV seroconversion as measured through plaque-reduction neutralization tests. Seroconversion data showed that individuals living in the clusters that received ITCs were at greater risk to seroconverting to DENV, with an average seroconversion rate of 50.6 per 100 person-years (PY) (CI: 29.9–71.9), while those in the control arm had an average seroconversion rate of 37.4 per 100 PY (CI: 15.2–51.7). ITCs lost their insecticidal efficacy within 6 months of deployment, necessitating re-treatment with insecticide. Entomological indicators did not show statistically significant differences between ITC and non-ITC clusters. It’s unclear how the lack of protective efficacy reported here is attributable to simple failure of the intervention to protect against Ae. aegypti bites, or the presence of a faulty intervention during much of the follow-up period. The higher risk of dengue seroconversion that was detected in the ITC clusters may have arisen due to a false sense of security that inadvertently led to less routine protective behaviors on the part of households that received the ITCs. Our study provides important lessons learned for conducting cluster randomized trials for vector control interventions against Aedes-transmitted virus infections. Dengue is one of the most important mosquito-borne diseases affecting humans, resulting in an estimated hundreds of millions of infections annually throughout the tropics. To control dengue, most public health programs use a variety of methods to kill the primary mosquito vector, Aedes aegypti. Water holding containers that harbor larvae (and other immature stages) are treated or eliminated. During emergencies, large insecticide spray campaigns are deployed to kill infected adult mosquitoes. Innovative interventions that are effective at targeting adult mosquitoes in sustainable ways are needed to increase the options for control of dengue and other Aedes borne virus diseases. The use of insecticide-treated curtains (ITCs) has previously been shown to significantly reduce Ae. aegypti numbers in and around homes, but the impact of ITCs on dengue virus (DENV) transmission has not previously been quantified. Using a rigorous study design in which 10 clusters (~90 houses per cluster) were provided multiple ITCs to place in their homes was compared to 10 clusters of homes without ITCs. Assignment of which clusters received ITCs was randomized. Blood samples were obtained at 9-month intervals from residents living in all the clusters, so that people with serological evidence of a DENV infection could be identified by comparing paired samples. Seroconversion data showed that individuals living in the clusters that received ITCs were at greater risk to DENV seroconverting, with an average seroconversion rate of 50.6 per 100 person-years (PY) (CI: 29.9–71.9). Conversely, those in the control arm had an average seroconversion rate of 37.4 per 100 PY (CI: 15.2–51.7). ITCs lost their insecticidal efficacy within 6 months of deployment, necessitating re-treatment with insecticide. Ae. aegypti populations did not show statistically significant differences between ITC and non-ITC clusters. The reason for higher transmission in the ITC treated clusters could be attributable to failure of the curtains (loss of efficacy) and/or that the curtains were not sufficiently effective at protecting against mosquito bites. The higher risk of DENV seroconversion in ITC clusters may be due to a false sense of security that inadvertently led to less routine protective behaviors on the part of households that received the ITC.
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Affiliation(s)
- Audrey Lenhart
- Vector Biology Department, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Amy C. Morrison
- Department of Pathology, Microbiology, and Immunology, School of Veterinary Medicine, University of California, Davis, California, United States of America
- Department of Virology, U.S. Naval Medical Research Unit-6, Lima and Iquitos, Peru
- * E-mail:
| | - Valerie A. Paz-Soldan
- Department of Global Community Health and Behavioral Sciences, Tulane School of Public Health and Tropical Medicine, New Orleans, Louisiana, United States of America
- Facultad de Salud Pública y Administración, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Brett M. Forshey
- Department of Virology, U.S. Naval Medical Research Unit-6, Lima and Iquitos, Peru
| | - Jhonny J. Cordova-Lopez
- Department of Pathology, Microbiology, and Immunology, School of Veterinary Medicine, University of California, Davis, California, United States of America
| | - Helvio Astete
- Department of Virology, U.S. Naval Medical Research Unit-6, Lima and Iquitos, Peru
| | - John P. Elder
- San Diego State University, San Diego, California, United States of America
| | - Moises Sihuincha
- Director, Department of Internal Medicine, Hospital de Apoyo Iquitos, Peru
| | - Esther E. Gotlieb
- Department of Global Community Health and Behavioral Sciences, Tulane School of Public Health and Tropical Medicine, New Orleans, Louisiana, United States of America
| | - Eric S. Halsey
- Department of Virology, U.S. Naval Medical Research Unit-6, Lima and Iquitos, Peru
| | - Tadeusz J. Kochel
- Department of Virology, U.S. Naval Medical Research Unit-6, Lima and Iquitos, Peru
| | - Thomas W. Scott
- Department of Entomology and Nematology, University of California, Davis, California, United States of America
| | - Neal Alexander
- MRC Tropical Epidemiology Group, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Philip J. McCall
- Vector Biology Department, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
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Che-Mendoza A, Medina-Barreiro A, Koyoc-Cardeña E, Uc-Puc V, Contreras-Perera Y, Herrera-Bojórquez J, Dzul-Manzanilla F, Correa-Morales F, Ranson H, Lenhart A, McCall PJ, Kroeger A, Vazquez-Prokopec G, Manrique-Saide P. House screening with insecticide-treated netting provides sustained reductions in domestic populations of Aedes aegypti in Merida, Mexico. PLoS Negl Trop Dis 2018; 12:e0006283. [PMID: 29543805 PMCID: PMC5870999 DOI: 10.1371/journal.pntd.0006283] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Revised: 03/27/2018] [Accepted: 01/30/2018] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND There is a need for effective methods to control Aedes aegypti and prevent the transmission of dengue, chikungunya, yellow fever and Zika viruses. Insecticide treated screening (ITS) is a promising approach, particularly as it targets adult mosquitoes to reduce human-mosquito contact. METHODOLOGY/PRINCIPAL FINDINGS A cluster-randomised controlled trial evaluated the entomological efficacy of ITS based intervention, which consisted of the installation of pyrethroid-impregnated long-lasting insecticide-treated netting material fixed as framed screens on external doors and windows. A total of 10 treatment and 10 control clusters (100 houses/cluster) were distributed throughout the city of Merida, Mexico. Cross-sectional entomological surveys quantified indoor adult mosquito infestation at baseline (pre-intervention) and throughout four post-intervention (PI) surveys spaced at 6-month intervals corresponding to dry/rainy seasons over two years (2012-2014). A total of 844 households from intervention clusters (86% coverage) were protected with ITS at the start of the trial. Significant reductions in the indoor presence and abundance of Ae. aegypti adults (OR = 0.48 and IRR = 0.45, P<0.05 respectively) and the indoor presence and abundance of Ae. aegypti female mosquitoes (OR = 0.47 and IRR = 0.44, P<0.05 respectively) were detected in intervention clusters compared to controls. This high level of protective effect was sustained for up to 24 months PI. Insecticidal activity of the ITS material declined with time, with ~70% mortality being demonstrated in susceptible mosquito cohorts up to 24 months after installation. CONCLUSIONS/SIGNIFICANCE The strong and sustained entomological impact observed in this study demonstrates the potential of house screening as a feasible, alternative approach to a sustained long-term impact on household infestations of Ae. aegypti. Larger trials quantifying the effectiveness of ITS on epidemiological endpoints are warranted and therefore recommended.
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Affiliation(s)
- Azael Che-Mendoza
- Vector Biology Department, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Unidad Colaborativa para Bioensayos Entomologicos, Universidad Autonoma de Yucatan, Merida, Yucatan, Mexico
- Centro Nacional de Programas Preventivos y Control de Enfermedades, Secretaria de Salud, Ciudad de Mexico, Mexico
| | - Anuar Medina-Barreiro
- Unidad Colaborativa para Bioensayos Entomologicos, Universidad Autonoma de Yucatan, Merida, Yucatan, Mexico
| | - Edgar Koyoc-Cardeña
- Unidad Colaborativa para Bioensayos Entomologicos, Universidad Autonoma de Yucatan, Merida, Yucatan, Mexico
| | - Valentín Uc-Puc
- Unidad Colaborativa para Bioensayos Entomologicos, Universidad Autonoma de Yucatan, Merida, Yucatan, Mexico
| | - Yamili Contreras-Perera
- Unidad Colaborativa para Bioensayos Entomologicos, Universidad Autonoma de Yucatan, Merida, Yucatan, Mexico
| | - Josué Herrera-Bojórquez
- Unidad Colaborativa para Bioensayos Entomologicos, Universidad Autonoma de Yucatan, Merida, Yucatan, Mexico
| | - Felipe Dzul-Manzanilla
- Centro Nacional de Programas Preventivos y Control de Enfermedades, Secretaria de Salud, Ciudad de Mexico, Mexico
| | - Fabian Correa-Morales
- Centro Nacional de Programas Preventivos y Control de Enfermedades, Secretaria de Salud, Ciudad de Mexico, Mexico
| | - Hilary Ranson
- Vector Biology Department, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Audrey Lenhart
- Vector Biology Department, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Centers for Disease Control and Prevention, Entomology Branch, Atlanta, Georgia, United States of America
| | - Philip J. McCall
- Vector Biology Department, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Axel Kroeger
- Vector Biology Department, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Special Programme for Research and Training in Tropical Diseases (TDR), World Health Organization, Geneva, Switzerland
| | - Gonzalo Vazquez-Prokopec
- Department of Environmental Sciences, Emory University, Atlanta, Georgia, United States of America
| | - Pablo Manrique-Saide
- Unidad Colaborativa para Bioensayos Entomologicos, Universidad Autonoma de Yucatan, Merida, Yucatan, Mexico
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Pérez D, Van der Stuyft P, Toledo ME, Ceballos E, Fabré F, Lefèvre P. Insecticide treated curtains and residual insecticide treatment to control Aedes aegypti: An acceptability study in Santiago de Cuba. PLoS Negl Trop Dis 2018; 12:e0006115. [PMID: 29293501 PMCID: PMC5766245 DOI: 10.1371/journal.pntd.0006115] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Revised: 01/12/2018] [Accepted: 11/14/2017] [Indexed: 11/21/2022] Open
Abstract
Background Within the context of a field trial conducted by the Cuban vector control program (AaCP), we assessed acceptability of insecticide-treated curtains (ITCs) and residual insecticide treatment (RIT) with deltamethrin by the community. We also assessed the potential influence of interviewees’ risk perceptions for getting dengue and disease severity. Methodology/principal findings We embedded a qualitative study using in-depth interviews in a cluster randomized trial (CRT) testing the effectiveness of ITCs and RIT in Santiago de Cuba. In-depth interviews (N = 38) were conducted four and twelve months after deployment of the tools with people who accepted the tools, who stopped using them and who did not accept the tools. Data analysis was deductive. Main reasons for accepting ITCs at the start of the trial were perceived efficacy and not being harmful to health. Constraints linked to manufacturer instructions were the main reason for not using ITCs. People stopped using the ITCs due to perceived allergy, toxicity and low efficacy. Few heads of households refused RIT despite the noting reasons for rejection, such as allergy, health hazard and toxicity. Positive opinions of the vector control program influenced acceptability of both tools. However, frequent insecticide fogging as part of routine AaCP vector control actions diminished perceived efficacy of both tools and, therefore, acceptability. Fifty percent of interviewees did feel at risk for getting dengue and considered dengue a severe disease. However, this did not appear to influence acceptability of ITCs or RIT. Conclusion/significance Acceptability of ITCs and RIT was linked to acceptability of AaCP routine vector control activities. However, uptake and use were not always an indication of acceptability. Factors leading to acceptability may be best identified using qualitative methods, but more research is needed on the concept of acceptability and its measurement. We aimed to understand what makes insecticide-treated curtains (ITCs) and residual insecticide treatment (RIT) with deltamethrin acceptable or not to users of these tools. In-depth interviews were conducted as part of a field trial conducted by the Cuban vector control program (AaCP) to test the effectiveness of these tools in Santiago de Cuba. Perceived efficacy was the main reason for interviewees who accepted the tools. Constraints linked to manufacturer instructions were the main reason for not using the ITCs when offered at the start of the trial. People stopped using the ITCs due to perceived allergy, toxicity and low efficacy. Few heads of households refused RIT despite identifying various reasons for rejection, such as allergy, health hazard and toxicity. Positive opinions of the Cuban vector control program influenced acceptability of both tools. On the contrary, perceptions of dengue risk did not appear to influence acceptability of ITCs or RIT. Our findings add on the importance of the growing body of qualitative research assessing acceptability of health interventions.
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Affiliation(s)
- Dennis Pérez
- Department of Epidemiology, Institute of Tropical Medicine Pedro Kourí, Havana, Cuba
- * E-mail:
| | - Patrick Van der Stuyft
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
- Department of Public Health, Ghent University, Ghent, Belgium
| | - María Eugenia Toledo
- Department of Epidemiology, Institute of Tropical Medicine Pedro Kourí, Havana, Cuba
| | - Enrique Ceballos
- Department of Vector Control, Polyclinic Armando García, Santiago de Cuba, Cuba
| | - Francisco Fabré
- Department of Vector Control, Provincial Surveillance and Vector Control Unit, Santiago de Cuba, Cuba
| | - Pierre Lefèvre
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
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Kenneson A, Beltrán-Ayala E, Borbor-Cordova MJ, Polhemus ME, Ryan SJ, Endy TP, Stewart-Ibarra AM. Social-ecological factors and preventive actions decrease the risk of dengue infection at the household-level: Results from a prospective dengue surveillance study in Machala, Ecuador. PLoS Negl Trop Dis 2017; 11:e0006150. [PMID: 29253873 PMCID: PMC5771672 DOI: 10.1371/journal.pntd.0006150] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 01/17/2018] [Accepted: 12/03/2017] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND In Ecuador, dengue virus (DENV) infections transmitted by the Aedes aegypti mosquito are among the greatest public health concerns in urban coastal communities. Community- and household-level vector control is the principal means of controlling disease outbreaks. This study aimed to assess the impact of knowledge, attitudes, and practices (KAPs) and social-ecological factors on the presence or absence of DENV infections in the household. METHODS In 2014 and 2015, individuals with DENV infections from sentinel clinics in Machala, Ecuador, were invited to participate in the study, as well as members of their household and members of four neighboring households located within 200 meters. We conducted diagnostic testing for DENV on all study participants; we surveyed heads of households (HOHs) regarding demographics, housing conditions and KAPs. We compared KAPs and social-ecological factors between households with (n = 139) versus without (n = 80) DENV infections, using bivariate analyses and multivariate logistic regression models with and without interactions. RESULTS Significant risk factors in multivariate models included proximity to abandoned properties, interruptions in piped water, and shaded patios (p<0.05). Significant protective factors included the use of mosquito bed nets, fumigation inside the home, and piped water inside the home (p<0.05). In bivariate analyses (but not multivariate modeling), DENV infections were positively associated with HOHs who were male, employed, and of younger age than households without infections (p<0.05). DENV infections were not associated with knowledge, attitude, or reported barriers to prevention activities. DISCUSSION Specific actions that can be considered to decrease the risk of DENV infections in the household include targeting vector control in highly shaded properties, fumigating inside the home, and use of mosquito bed nets. Community-level interventions include cleanup of abandoned properties, daily garbage collection, and reliable piped water inside houses. These findings can inform interventions to reduce the risk of other diseases transmitted by the Ae. aegypti mosquito, such as chikungunya and Zika fever.
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Affiliation(s)
- Aileen Kenneson
- Center for Global Health & Translational Sciences, SUNY Upstate Medical University, Syracuse, NY, United States of America
| | - Efraín Beltrán-Ayala
- Facultad de Medicina, Universidad Técnica de Machala, Machala, El Oro Province, Ecuador
| | - Mercy J. Borbor-Cordova
- Facultad de Ingeniería Marítima, Ciencias Biológicas, Oceánicas y Recursos Naturales, Escuela Superior Politecnica del Litoral (ESPOL), Guayaquil, Ecuador
| | - Mark E. Polhemus
- Center for Global Health & Translational Sciences, SUNY Upstate Medical University, Syracuse, NY, United States of America
- Department of Medicine, SUNY Upstate Medical University, Syracuse, NY, United States of America
| | - Sadie J. Ryan
- Center for Global Health & Translational Sciences, SUNY Upstate Medical University, Syracuse, NY, United States of America
- Department of Geography, University of Florida, Gainesville, FL, United States of America
- Emerging Pathogens Institute, University of Florida, Gainesville, FL, United States of America
- College of Life Sciences, University of Kwazulu-Natal, Durban, South Africa
| | - Timothy P. Endy
- Center for Global Health & Translational Sciences, SUNY Upstate Medical University, Syracuse, NY, United States of America
- Department of Medicine, SUNY Upstate Medical University, Syracuse, NY, United States of America
- Department of Microbiology & Immunology, SUNY Upstate Medical University, Syracuse, NY, United States of America
| | - Anna M. Stewart-Ibarra
- Center for Global Health & Translational Sciences, SUNY Upstate Medical University, Syracuse, NY, United States of America
- Department of Medicine, SUNY Upstate Medical University, Syracuse, NY, United States of America
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Abstract
The available strategy for controlling the diseases transmitted by Aedes ægypti (dengue fever, Zika, and chikungunya) relies on continued community participation. Despite slogans emphasizing how easy it should be, no country has achieved it since the seventies. To better investigate potentially sustainable interventions, we developed a systemic model based on a multidisciplinary approach, integrating as deeply as possible specialized knowledge and field experience. The resulting model is composed of 4 external and 8 internal subsystems and 31 relationships, consistent with the literature and checked over multiple iterations with specialists of the many areas. We analyzed the model and the main feedback loops responsible for the system’s stability, searching for possible interventions that could shift the existing balance. We suggest the introduction of 1 more player, the local primary health care structure, with the potential to change the undesired equilibrium. The health agents in the areas are the first to detect disease cases, and they could stimulate individuals to inform about potential mosquitoes’ breeding sites and bring timely information to the vector-control program. Triggering such an action could introduce changes in people's attitude through a positive feedback loop in the desired direction.
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Paz-Soldan VA, Bauer KM, Lenhart A, Cordova Lopez JJ, Elder JP, Scott TW, McCall PJ, Kochel TJ, Morrison AC. Experiences with insecticide-treated curtains: a qualitative study in Iquitos, Peru. BMC Public Health 2016; 16:582. [PMID: 27422403 PMCID: PMC4947330 DOI: 10.1186/s12889-016-3191-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Accepted: 06/08/2016] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Dengue is an arthropod-borne viral disease responsible for approximately 400 million infections annually; the only available method of prevention is vector control. It has been previously demonstrated that insecticide treated curtains (ITCs) can lower dengue vector infestations in and around houses. As part of a larger trial examining whether ITCs could reduce dengue transmission in Iquitos, Peru, the objective of this study was to characterize the participants' experience with the ITCs using qualitative methods. METHODS Knowledge, attitudes, and practices (KAP) surveys (at baseline, and 9 and 27 months post-ITC distribution, with n = 593, 595 and 511, respectively), focus group discussions (at 6 and 12 months post-ITC distribution, with n = 18 and 33, respectively), and 11 one-on-one interviews (at 12 months post-distribution) were conducted with 605 participants who received ITCs as part of a cluster-randomized trial. RESULTS Focus groups at 6 months post-ITC distribution revealed that individuals had observed their ITCs to function for approximately 3 months, after which they reported the ITCs were no longer working. Follow up revealed that the ITCs required re-treatment with insecticide at approximately 1 year post-distribution. Over half (55.3 %, n = 329) of participants at 9 months post-ITC distribution and over a third (34.8 %, n = 177) at 27 months post-ITC distribution reported perceiving a decrease in the number of mosquitoes in their home. The percentage of participants who would recommend ITCs to their family or friends in the future remained high throughout the study (94.3 %, n = 561 at 9 months and 94.6 %, n = 488 at 27 months post-distribution). When asked why, participants reported that ITCs were effective at reducing mosquitoes (81.6 and 37.8 %, at 9 and 27 months respectively), that they prevent dengue (5.7 and 51.2 %, at 9 and 27 months), that they are "beautiful" (5.9 and 3.1 %), as well as other reasons (6.9 and 2.5 %). CONCLUSION ITCs have substantial potential for long term dengue vector control because they are liked by users, both for their perceived effectiveness and for aesthetic reasons, and because they require little proactive behavioral effort on the part of the users. Our results highlight the importance of gathering process (as opposed to outcome) data during vector control studies, without which researchers would not have become aware that the ITCs had lost effectiveness early in the trial.
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Affiliation(s)
- Valerie A. Paz-Soldan
- />Department of Global Community Health and Behavioral Sciences, Tulane University School of Public Health and Tropical Medicine, 1440 Canal Street, Suite 2200, New Orleans, LA USA
- />Facultad de Salud Pública y Administración, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Karin M. Bauer
- />Department of Global Community Health and Behavioral Sciences, Tulane University School of Public Health and Tropical Medicine, 1440 Canal Street, Suite 2200, New Orleans, LA USA
| | - Audrey Lenhart
- />Entomology Branch, Division of Parasitic Diseases and Malaria, United States Centers for Disease Control and Prevention, Atlanta, GA USA
| | | | - John P. Elder
- />Division of Health Promotion and Behavioral Sciences, Graduate School of Public Health, San Diego State University, San Diego, CA USA
| | - Thomas W. Scott
- />Department of Entomology and Nematology, University of California Davis, Davis, CA USA
- />Fogarty International Center, National Institutes of Health, Bethesda, MD USA
| | - Philip J. McCall
- />Department of Vector Biology, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Tadeusz J. Kochel
- />Virology Department, Naval Medical Research Center, Silver Spring, MD USA
| | - Amy C. Morrison
- />Department of Entomology and Nematology, University of California Davis, Davis, CA USA
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