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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Buttenheim A, Castillo-Neyra R, Arevalo-Nieto C, Shinnick JE, Sheen JK, Volpp K, Paz-Soldan V, Behrman JR, Levy MZ. Do Incentives Crowd Out Motivation? A Feasibility Study of a Community Vector-Control Campaign in Peru. Behav Med 2023; 49:53-61. [PMID: 34847825 PMCID: PMC9869690 DOI: 10.1080/08964289.2021.1977603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 06/20/2021] [Accepted: 08/22/2021] [Indexed: 01/28/2023]
Abstract
Incentives are a useful tool in encouraging healthy behavior as part of public health initiatives. However, there remains concern about motivation crowd out-a decline in levels of motivation to undertake a behavior to below baseline levels after incentives have been removed-and few public health studies have assessed for motivation crowd out. Here, we assess the feasibility of identifying motivation crowd out following a lottery to promote participation in a Chagas disease vector control campaign. We look for evidence of crowd out in subsequent participation in the same behavior, a related behavior, and an unrelated behavior. We identified potential motivation crowd out for the same behavior, but not for related behavior or unrelated behaviors after lottery incentives are removed. Despite some limitations, we conclude that motivation crowd out is feasible to assess in large-scale trials of incentives.
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Affiliation(s)
- Alison Buttenheim
- Department of Family and Community Nursing, University of Pennsylvania, Philadelphia, USA
- Center for Health Incentives and Behavioral Economics, University of Pennsylvania, Philadelphia, USA
| | - Ricardo Castillo-Neyra
- Department of Biostatistics and Epidemiology, Perelman School of Medicine, Philadelphia, USA
- Department of Health Management, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Claudia Arevalo-Nieto
- Department of Biostatistics and Epidemiology, Perelman School of Medicine, Philadelphia, USA
- Department of Health Management, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Julianna E. Shinnick
- Department of Biostatistics and Epidemiology, Perelman School of Medicine, Philadelphia, USA
| | - Justin K. Sheen
- Department of Biostatistics and Epidemiology, Perelman School of Medicine, Philadelphia, USA
| | - Kevin Volpp
- Center for Health Incentives and Behavioral Economics, University of Pennsylvania, Philadelphia, USA
| | - Valerie Paz-Soldan
- Department of Health Management, Universidad Peruana Cayetano Heredia, Lima, Peru
- Department of Global Community Health and Behavioral Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, USA
- Asociasión Benéfica PRISMA, Lima, Peru
| | - Jere R. Behrman
- Departments of Economics and Sociology, University of Pennsylvania, Philadelphia, USA
| | - Michael Z. Levy
- Department of Biostatistics and Epidemiology, Perelman School of Medicine, Philadelphia, USA
- Department of Health Management, Universidad Peruana Cayetano Heredia, Lima, Peru
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Arevalo-Nieto C, Sheen J, Condori-Luna GF, Condori-Pino C, Shinnick J, Peterson JK, Castillo-Neyra R, Levy MZ. Incentivizing optimal risk map use for Triatoma infestans surveillance in urban environments. PLOS Glob Public Health 2022; 2:e0000145. [PMID: 36962496 PMCID: PMC10021448 DOI: 10.1371/journal.pgph.0000145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 06/24/2022] [Indexed: 11/18/2022]
Abstract
In Arequipa, Peru, a large-scale vector control campaign has successfully reduced urban infestations of the Chagas disease vector, Triatoma infestans. In addition to preventing new infections with Trypanosoma cruzi (etiological agent of Chagas disease), the campaign produced a wealth of information about the distribution and density of vector infestations. We used these data to create vector infestation risk maps for the city in order to target the last few remaining infestations, which are unevenly distributed and difficult to pinpoint. Our maps, which are provided on a mobile app, display color-coded, individual house-level estimates of T. infestans infestation risk. Entomologic surveillance personnel can use the maps to select homes to inspect based on estimated risk of infestation, as well as keep track of which parts of a given neighborhood they have inspected to ensure even surveillance throughout the zone. However, the question then becomes, how do we encourage surveillance personnel to actually use these two functionalities of the risk map? As such, we carried out a series of rolling trials to test different incentive schemes designed to encourage the following two behaviors by entomologic surveillance personnel in Arequipa: (i) preferential inspections of homes shown as high risk on the maps, and (ii) even surveillance across the geographical distribution of a given area, which we term, 'spatial coverage.' These two behaviors together constituted what we termed, 'optimal map use.' We found that several incentives resulted in one of the two target behaviors, but just one incentive scheme based on the game of poker resulted in optimal map use. This poker-based incentive structure may be well-suited to improve entomological surveillance activities and other complex multi-objective tasks.
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Affiliation(s)
- Claudia Arevalo-Nieto
- Zoonotic Disease Research Laboratory, One Health Unit, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Arequipa, Perú
| | - Justin Sheen
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Gian Franco Condori-Luna
- Zoonotic Disease Research Laboratory, One Health Unit, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Arequipa, Perú
| | - Carlos Condori-Pino
- Zoonotic Disease Research Laboratory, One Health Unit, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Arequipa, Perú
| | - Julianna Shinnick
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Jennifer K. Peterson
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Ricardo Castillo-Neyra
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Michael Z. Levy
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
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Larson AJ, Paz-Soldán VA, Arevalo-Nieto C, Brown J, Condori-Pino C, Levy MZ, Castillo-Neyra R. Misuse, perceived risk, and safety issues of household insecticides: Qualitative findings from focus groups in Arequipa, Peru. PLoS Negl Trop Dis 2021; 15:e0009251. [PMID: 33956803 PMCID: PMC8101955 DOI: 10.1371/journal.pntd.0009251] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 02/17/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The current body of research on insecticide use in Peru deals primarily with application of insecticides offered through Ministry of Health-led campaigns against vector-borne disease. However, there is a gap in the literature regarding the individual use, choice and perceptions of insecticides which may influence uptake of public health-based vector control initiatives and contribute to the thousands of deaths annually from acute pesticide poisoning in Peru. METHODS Residents (n = 49) of the Alto Selva Alegre and CC districts of peri-urban Arequipa participated in seven focus group discussions (FGD). Using a FGD guide, two facilitators led the discussion and conducted a role-playing activity. this activity, participants insecticides (represented by printed photos of insecticides available locally) and pretended to "sell" the insecticides to other participants, including describing their qualities as though they were advertising the insecticide. The exercise was designed to elicit perceptions of currently available insecticides. The focus groups also included questions about participants' preferences, use and experiences related to insecticides outside the context of this activity. Focus group content was transcribed, and qualitative data were analyzed with Atlas.ti and coded using an inductive process to generate major themes related to use and choice of insecticides, and perceived risks associated with insecticide use. RESULTS The perceived risks associated with insecticides included both short- and long-term health impacts, and safety for children emerged as a priority. However, in some cases insecticides were reportedly applied in high-risk ways including application of insecticides directly to children and bedding. Some participants attempted to reduce the risk of insecticide use with informal, potentially ineffective personal protective equipment and by timing application when household members were away. Valued insecticide characteristics, such as strength and effectiveness, were often associated with negative characteristics such as odor and health impacts. "Agropecuarios" (agricultural supply stores) were considered a trusted source of information about insecticides and their health risks. CONCLUSIONS It is crucial to characterize misuse and perceptions of health impacts and risks of insecticides at the local level, as well as to find common themes and patterns across populations to inform national and regional programs to prevent acute insecticide poisoning and increase community participation in insecticide-based vector control campaigns. We detected risky practices and beliefs about personal protective equipment, risk indicators, and safety levels that could inform such preventive campaigns, as well as trusted information sources such as agricultural stores for partnerships in disseminating information.
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Affiliation(s)
- Anika J. Larson
- University of Washington, School of Medicine, Seattle, Washington, United States of America
| | - Valerie A. Paz-Soldán
- Department of Global Community Health and Behavioral Sciences, Tulane School of Public Health and Tropical Medicine, New Orleans, Louisiana, United States of America
- Zoonotic Disease Research Lab (LIEZ), One Health Unit, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Claudia Arevalo-Nieto
- Zoonotic Disease Research Lab (LIEZ), One Health Unit, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Joanna Brown
- Zoonotic Disease Research Lab (LIEZ), One Health Unit, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Carlos Condori-Pino
- Zoonotic Disease Research Lab (LIEZ), One Health Unit, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Michael Z. Levy
- Zoonotic Disease Research Lab (LIEZ), One Health Unit, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine at University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Ricardo Castillo-Neyra
- Zoonotic Disease Research Lab (LIEZ), One Health Unit, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine at University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
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Castillo-Neyra R, Buttenheim AM, Brown J, Ferrara JF, Arevalo-Nieto C, Borrini-Mayorí K, Levy MZ, Becerra V, Paz-Soldan VA. Behavioral and structural barriers to accessing human post-exposure prophylaxis and other preventive practices in Arequipa, Peru, during a canine rabies epidemic. PLoS Negl Trop Dis 2020; 14:e0008478. [PMID: 32692739 PMCID: PMC7394441 DOI: 10.1371/journal.pntd.0008478] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 07/31/2020] [Accepted: 06/12/2020] [Indexed: 02/01/2023] Open
Abstract
A canine rabies epidemic started in early 2015 in Arequipa, Peru and the rabies virus continues to circulate in the dog population. Some city residents who suffer dog bites do not seek care or do not complete indicated post-exposure prophylaxis (PEP) regimens, increasing the risk of human rabies. The objectives of our study are to qualitatively assess knowledge about rabies, and preventive practices, such as rabies vaccine administration, following a dog bite. We conduct eight focus group discussions in peri-urban and urban communities with 70 total participants. In our results, we observe low awareness of rabies severity and fatality, and different practices following a dog bite, depending on the community type: for example, whereas participants in the urban communities report cleaning the wound with hydrogen peroxide rather than soap and water, participants in peri-urban areas cover the wound with herbs and hair from the dog that bit them. Misconceptions about rabies vaccines and mistreatment at health centers also commonly prevent initiating or completing PEP. We identify important behavioral and structural barriers and knowledge gaps that limit evidence-based preventive strategies against rabies and may threaten successful prevention of dog-mediated human rabies in this setting. The city of Arequipa, Peru has been experiencing an outbreak of dog rabies since 2015. The Peruvian Ministry of Health has implemented measures to prevent human infection, including no-cost rabies vaccinations for people bitten by dogs, but health posts report that many people do not utilize the service or complete treatment. We conduct focus groups in urban and peri-urban areas of Arequipa to examine community perceptions and attitudes towards PEP, and organizational and behavioral barriers to initiate and complete the PEP regimen. We observe low awareness of rabies severity, and different practices following a dog bite depending on the community type. Misconceptions about rabies vaccines and mistreatment at health centers also commonly prevent participants from initiating or completing PEP. We identify important behavioral and structural barriers and knowledge gaps that limit preventive strategies against rabies and may threaten successful prevention of dog-mediated human rabies in this setting. Finally, disparate landscapes and topography seem to have different effects on urban and peri-urban participants’ use of healthcare resources. Thus, strategies should target the specific needs of each population.
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Affiliation(s)
- Ricardo Castillo-Neyra
- Department of Biostatistics, Epidemiology & Informatics, Perelman School of Medicine at University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
- Zoonotic Disease Research Lab, One Health Unit, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
- Center for Health Incentives and Behavioral Economics, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
- * E-mail:
| | - Alison M. Buttenheim
- Zoonotic Disease Research Lab, One Health Unit, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
- Center for Health Incentives and Behavioral Economics, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
- Department of Family and Community Health, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, United States of America
| | - Joanna Brown
- Zoonotic Disease Research Lab, One Health Unit, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - James F. Ferrara
- School of Veterinary Medicine, University of Pennsylvania, Pennsylvania, United States of America
| | - Claudia Arevalo-Nieto
- Zoonotic Disease Research Lab, One Health Unit, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Katty Borrini-Mayorí
- Zoonotic Disease Research Lab, One Health Unit, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Michael Z. Levy
- Department of Biostatistics, Epidemiology & Informatics, Perelman School of Medicine at University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
- Zoonotic Disease Research Lab, One Health Unit, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Victor Becerra
- Microred Mariano Melgar, Ministerio de Salud, Arequipa, Peru
| | - Valerie A. Paz-Soldan
- Zoonotic Disease Research Lab, One Health Unit, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
- Department of Global Community Health and Behavioral Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, United States of America
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Berry ASF, Salazar-Sánchez R, Castillo-Neyra R, Borrini-Mayorí K, Arevalo-Nieto C, Chipana-Ramos C, Vargas-Maquera M, Ancca-Juarez J, Náquira-Velarde C, Levy MZ, Brisson D. Dispersal patterns of Trypanosoma cruzi in Arequipa, Peru. PLoS Negl Trop Dis 2020; 14:e0007910. [PMID: 32150562 PMCID: PMC7082062 DOI: 10.1371/journal.pntd.0007910] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 03/19/2020] [Accepted: 02/18/2020] [Indexed: 12/30/2022] Open
Abstract
Anthropogenic environmental alterations such as urbanization can threaten native populations as well as create novel environments that allow human pests and pathogens to thrive. As the number and size of urban environments increase globally, it is more important than ever to understand the dispersal dynamics of hosts, vectors and pathogens of zoonotic disease systems. For example, a protozoan parasite and the causative agent of Chagas disease in humans, Trypanosoma cruzi, recently colonized and spread through the city of Arequipa, Peru. We used population genomic and phylogenomic tools to analyze whole genomes of 123 T. cruzi isolates derived from vectors and non-human mammals throughout Arequipa to determine patterns of T. cruzi dispersal. The data show significant population genetic structure within city blocks-parasites in the same block tend to be very closely related-but no population structure among blocks within districts-parasites in neighboring blocks are no more closely related to one another than to parasites in distant districts. These data suggest that T. cruzi dispersal within a block occurs regularly and that occasional long-range dispersal events allow the establishment of new T. cruzi populations in distant blocks. Movement of domestic animals may be the primary mechanism of inter-block and inter-district T. cruzi dispersal.
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Affiliation(s)
- Alexander S. F. Berry
- Division of Gastroenterology, Hepatology, and Nutrition, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, United States of America
- Department of Biology, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Renzo Salazar-Sánchez
- Zoonotic Disease Research Lab, One Health Unit, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Arequipa, Peru
| | - Ricardo Castillo-Neyra
- Zoonotic Disease Research Lab, One Health Unit, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Arequipa, Peru
- Department of Biostatistics, Epidemiology and Informatics, The Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Katty Borrini-Mayorí
- Zoonotic Disease Research Lab, One Health Unit, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Arequipa, Peru
| | - Claudia Arevalo-Nieto
- Zoonotic Disease Research Lab, One Health Unit, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Arequipa, Peru
| | - Claudia Chipana-Ramos
- Zoonotic Disease Research Lab, One Health Unit, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Arequipa, Peru
| | - Melina Vargas-Maquera
- Zoonotic Disease Research Lab, One Health Unit, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Arequipa, Peru
| | - Jenny Ancca-Juarez
- Zoonotic Disease Research Lab, One Health Unit, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Arequipa, Peru
| | - César Náquira-Velarde
- Zoonotic Disease Research Lab, One Health Unit, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Arequipa, Peru
| | - Michael Z. Levy
- Zoonotic Disease Research Lab, One Health Unit, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Arequipa, Peru
- Department of Biostatistics, Epidemiology and Informatics, The Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Dustin Brisson
- Department of Biology, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
- * E-mail:
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Castillo-Neyra R, Toledo AM, Arevalo-Nieto C, MacDonald H, De la Puente-León M, Naquira-Velarde C, Paz-Soldan VA, Buttenheim AM, Levy MZ. Socio-spatial heterogeneity in participation in mass dog rabies vaccination campaigns, Arequipa, Peru. PLoS Negl Trop Dis 2019; 13:e0007600. [PMID: 31369560 PMCID: PMC6692050 DOI: 10.1371/journal.pntd.0007600] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 08/13/2019] [Accepted: 07/03/2019] [Indexed: 12/25/2022] Open
Abstract
To control and prevent rabies in Latin America, mass dog vaccination campaigns (MDVC) are implemented mainly through fixed-location vaccination points: owners have to bring their dogs to the vaccination points where they receive the vaccination free of charge. Dog rabies is still endemic in some Latin-American countries and high overall dog vaccination coverage and even distribution of vaccinated dogs are desired attributes of MDVC to halt rabies virus transmission. In Arequipa, Peru, we conducted a door-to-door post-campaign survey on >6,000 houses to assess the placement of vaccination points on these two attributes. We found that the odds of participating in the campaign decreased by 16% for every 100 m from the owner’s house to the nearest vaccination point (p = 0.041) after controlling for potential covariates. We found social determinants associated with participating in the MDVC: for each child under 5 in the household, the odds of participating in the MDVC decreased by 13% (p = 0.032), and for each decade less lived in the area, the odds of participating in the MDVC decreased by 8% (p<0.001), after controlling for distance and other covariates. We also found significant spatial clustering of unvaccinated dogs over 500 m from the vaccination points, which created pockets of unvaccinated dogs that may sustain rabies virus transmission. Understanding the barriers to dog owners’ participation in community-based dog-vaccination programs will be crucial to implementing effective zoonotic disease preventive activities. Spatial and social elements of urbanization play an important role in coverage of MDVC and should be considered during their planning and evaluation. In Peru and other dog rabies-affected countries, mass dog vaccination campaigns (MDVC) are implemented primarily through fixed-location vaccination points: owners have to bring their dogs to the vaccination points where they receive the vaccination. To stop rabies virus transmission, a high and even dog vaccination coverage is desired. In Arequipa, Peru, following a MDVC, we conducted a door-to-door survey of >6,000 houses to assess how the placement of vaccination points affected coverage of the campaign. When comparing dog owners with similar characteristics, we found that the odds of participating in the MDVC was reduced by 16% for every 100 m distance from the nearest vaccination point. Some social conditions were also associated with participating in the MDVC: for each child under 5 in the household, odds of participating in the MDVC decreased by 13%, and for each decade less lived in the area, the odds of participating in the MDVC decreased by 8%. Distance to the vaccination point and variation in social conditions across the city play important roles in achieving coverage of MDVC and should be considered during campaign planning and evaluation.
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Affiliation(s)
- Ricardo Castillo-Neyra
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States of America
- Zoonotic Disease Research Lab, One Health Unit, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Arequipa, Peru
- * E-mail:
| | - Amparo M. Toledo
- Zoonotic Disease Research Lab, One Health Unit, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Arequipa, Peru
| | - Claudia Arevalo-Nieto
- Zoonotic Disease Research Lab, One Health Unit, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Arequipa, Peru
| | - Hannelore MacDonald
- Department of Biology, School of Arts and Sciences, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Micaela De la Puente-León
- Zoonotic Disease Research Lab, One Health Unit, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Arequipa, Peru
| | - Cesar Naquira-Velarde
- Zoonotic Disease Research Lab, One Health Unit, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Arequipa, Peru
| | - Valerie A. Paz-Soldan
- Zoonotic Disease Research Lab, One Health Unit, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Arequipa, Peru
- Global Community Health and Behavioral Sciences, Tulane School of Public Health and Tropical Medicine, New Orleans, Louisiana, United States of America
| | - Alison M. Buttenheim
- Zoonotic Disease Research Lab, One Health Unit, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Arequipa, Peru
- Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Michael Z. Levy
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States of America
- Zoonotic Disease Research Lab, One Health Unit, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Arequipa, Peru
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Gutfraind A, Peterson JK, Billig Rose E, Arevalo-Nieto C, Sheen J, Condori-Luna GF, Tankasala N, Castillo-Neyra R, Condori-Pino C, Anand P, Naquira-Velarde C, Levy MZ. Integrating evidence, models and maps to enhance Chagas disease vector surveillance. PLoS Negl Trop Dis 2018; 12:e0006883. [PMID: 30496172 PMCID: PMC6289469 DOI: 10.1371/journal.pntd.0006883] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 12/11/2018] [Accepted: 09/29/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Until recently, the Chagas disease vector, Triatoma infestans, was widespread in Arequipa, Perú, but as a result of a decades-long campaign in which over 70,000 houses were treated with insecticides, infestation prevalence is now greatly reduced. To monitor for T. infestans resurgence, the city is currently in a surveillance phase in which a sample of houses is selected for inspection each year. Despite extensive data from the control campaign that could be used to inform surveillance, the selection of houses to inspect is often carried out haphazardly or by convenience. Therefore, we asked, how can we enhance efforts toward preventing T. infestans resurgence by creating the opportunity for vector surveillance to be informed by data? METHODOLOGY/PRINCIPAL FINDINGS To this end, we developed a mobile app that provides vector infestation risk maps generated with data from the control campaign run in a predictive model. The app is intended to enhance vector surveillance activities by giving inspectors the opportunity to incorporate the infestation risk information into their surveillance activities, but it does not dictate which houses to surveil. Therefore, a critical question becomes, will inspectors use the risk information? To answer this question, we ran a pilot study in which we compared surveillance using the app to the current practice (paper maps). We hypothesized that inspectors would use the risk information provided by the app, as measured by the frequency of higher risk houses visited, and qualitative analyses of inspector movement patterns in the field. We also compared the efficiency of both mediums to identify factors that might discourage risk information use. Over the course of ten days (five with each medium), 1,081 houses were visited using the paper maps, of which 366 (34%) were inspected, while 1,038 houses were visited using the app, with 401 (39%) inspected. Five out of eight inspectors (62.5%) visited more higher risk houses when using the app (Fisher's exact test, p < 0.001). Among all inspectors, there was an upward shift in proportional visits to higher risk houses when using the app (Mantel-Haenszel test, common odds ratio (OR) = 2.42, 95% CI 2.00-2.92), and in a second analysis using generalized linear mixed models, app use increased the odds of visiting a higher risk house 2.73-fold (95% CI 2.24-3.32), suggesting that the risk information provided by the app was used by most inspectors. Qualitative analyses of inspector movement revealed indications of risk information use in seven out of eight (87.5%) inspectors. There was no difference between the app and paper maps in the number of houses visited (paired t-test, p = 0.67) or inspected (p = 0.17), suggesting that app use did not reduce surveillance efficiency. CONCLUSIONS/SIGNIFICANCE Without staying vigilant to remaining and re-emerging vector foci following a vector control campaign, disease transmission eventually returns and progress achieved is reversed. Our results suggest that, when provided the opportunity, most inspectors will use risk information to direct their surveillance activities, at least over the short term. The study is an initial, but key, step toward evidence-based vector surveillance.
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Affiliation(s)
- Alexander Gutfraind
- Laboratory for Mathematical Analysis of Data, Complexity and Conflicts, Division of Epidemiology and Biostatistics, University of Illinois at Chicago, Chicago, IL, United States of America
- Division of Hepatology, Department of Medicine, Loyola University Medical Center, Maywood, IL, United States of America
| | - Jennifer K. Peterson
- Department of Biostatistics, Epidemiology & Informatics; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States of America
| | - Erica Billig Rose
- Department of Biostatistics, Epidemiology & Informatics; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States of America
| | - Claudia Arevalo-Nieto
- Zoonotic Disease Research Laboratory, One Health Unit, Facultad de Salud Pública y Administración, Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Justin Sheen
- Department of Biostatistics, Epidemiology & Informatics; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States of America
- Zoonotic Disease Research Laboratory, One Health Unit, Facultad de Salud Pública y Administración, Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Gian Franco Condori-Luna
- Zoonotic Disease Research Laboratory, One Health Unit, Facultad de Salud Pública y Administración, Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Narender Tankasala
- Laboratory for Mathematical Analysis of Data, Complexity and Conflicts, Division of Epidemiology and Biostatistics, University of Illinois at Chicago, Chicago, IL, United States of America
| | - Ricardo Castillo-Neyra
- Department of Biostatistics, Epidemiology & Informatics; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States of America
| | - Carlos Condori-Pino
- Zoonotic Disease Research Laboratory, One Health Unit, Facultad de Salud Pública y Administración, Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Priyanka Anand
- Department of Biostatistics, Epidemiology & Informatics; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States of America
| | - Cesar Naquira-Velarde
- Zoonotic Disease Research Laboratory, One Health Unit, Facultad de Salud Pública y Administración, Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Michael Z. Levy
- Department of Biostatistics, Epidemiology & Informatics; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States of America
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Buttenheim AM, Paz-Soldán VA, Castillo-Neyra R, Toledo Vizcarra AM, Borrini-Mayori K, McGuire M, Arevalo-Nieto C, Volpp KG, Small DS, Behrman JR, Naquira-Verlarde C, Levy MZ. Increasing participation in a vector control campaign: a cluster randomised controlled evaluation of behavioural economic interventions in Peru. BMJ Glob Health 2018; 3:e000757. [PMID: 30271624 PMCID: PMC6157568 DOI: 10.1136/bmjgh-2018-000757] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 07/30/2018] [Accepted: 08/03/2018] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To assess the efficacy of strategies informed by behavioural economics for increasing participation in a vector control campaign, compared with current practice. DESIGN Pragmatic cluster randomised controlled trial. SETTING Arequipa, Peru. PARTICIPANTS 4922 households. INTERVENTIONS Households were randomised to one of four arms: advanced planning, leader recruitment, contingent group lotteries, or control. MAIN OUTCOME MEASURES Participation (allowing the house to be sprayed with insecticide) during the vector control campaign. RESULTS In intent-to-treat analyses, none of the interventions increased participation compared with control (advanced planning adjusted OR (aOR) 1.07 (95% CI 0.87 to 1.32); leader recruitment aOR 0.95 (95% CI 0.78 to 1.15); group lotteries aOR 1.12 (95% CI 0.89 to 1.39)). The interventions did not improve the efficiency of the campaign (additional minutes needed to spray house from generalised estimating equation regressions: advanced planning 1.08 (95% CI -1.02 to 3.17); leader recruitment 3.91 (95% CI 1.85 to 5.97); group lotteries 3.51 (95% CI 1.38 to 5.64)) nor did it increase the odds that houses would be sprayed in an earlier versus a later stage of the campaign cycle (advanced planning aOR 0.94 (95% CI 0.76 to 1.25); leader recruitment aOR 0.68 (95% CI 0.55 to 0.83); group lotteries aOR 1.19 (95% CI 0.96 to 1.47)). A post hoc analysis suggested that advanced planning increased odds of participation compared with control among households who had declined to participate previously (aOR 2.50 (95% CI 1.41 to 4.43)). CONCLUSIONS Achieving high levels of household participation is crucial for many disease prevention efforts. Our trial was not successful in improving participation compared with the existing campaign. The trial highlights persistent challenges to field experiments as well as lessons about the intervention design process, particularly understanding barriers to participation through a behavioural lens. TRIAL REGISTRATION NUMBER American Economic Association AEARCTR-0000620.
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Affiliation(s)
- Alison M Buttenheim
- Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Valerie A Paz-Soldán
- Global Community Health and Behavioral Sciences, Tulane University, New Orleans, Louisiana, USA
| | - Ricardo Castillo-Neyra
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Amparo M Toledo Vizcarra
- Zoonotic Disease Research Lab, OneHealth Unit, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Arequipa, Peru
| | - Katty Borrini-Mayori
- Zoonotic Disease Research Lab, OneHealth Unit, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Arequipa, Peru
| | - Molly McGuire
- Global Community Health and Behavioral Sciences, Tulane University, New Orleans, Louisiana, USA
| | - Claudia Arevalo-Nieto
- Zoonotic Disease Research Lab, OneHealth Unit, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Arequipa, Peru
| | - Kevin G Volpp
- Medical Ethics and Health Policy, School of Medicine, University of Pennsylvania Perelman, Philadelphia, Pennsylvania, USA
| | - Dylan S Small
- Department of Statistics, University of Pennsylvania Wharton School, Philadelphia, Pennsylvania, USA
| | - Jere R Behrman
- Department of Economics School of Arts and Sciences, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | - Michael Z Levy
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
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