Sanchez L, Perez D, Pérez T, Sosa T, Cruz G, Kouri G, Boelaert M, Van der Stuyft P
Institute of Tropical Medicine Pedro Kouri, Havana City, Cuba.
Trop Med Int Health. 2005 Jan;10(1):82-91. doi: 10.1111/j.1365-3156.2004.01347.x.
Background The 55th World Health Assembly declared dengue prevention and control a priority and urged Member States to develop sustainable intersectoral strategies to this end. To provide evidence for the reorientation of the dengue prevention policy in Cuba, we launched an intervention study to document the effectiveness of a local-level intersectoral approach.
We used a quasi-experimental design. Social scientists introduced participatory methods to facilitate dialogue in the biweekly meetings of the intersectoral Health Council of the intervention area. This council subsequently developed an intersectoral plan for dengue prevention, of which the core objective was to design and implement activities for communication and social mobilization. In the control area, routine dengue control activities continued without additional input. Knowledge, attitudes and perceptions of dengue, and entomological indices were compared inside and between the areas before and after the 1-year intervention period.
In the intervention area the Health Council elaborated an intersectoral plan for dengue prevention focused on source reduction. The Aedes aegypti control methods consisted in eliminating useless containers in the houses and surroundings, covering tanks, and cleaning public and inhabited areas. It was implemented through communication and social mobilization. The Health Council in the control area occasionally discussed dengue issues but did not develop a coordinated action plan. Good knowledge about breeding sites and disease symptoms increased significantly (by 49.7% and 17.1% respectively) in the intervention area as well as the proportion of respondents eliminating containers in and around their houses (by 44%). No changes were observed in the control area. The House Index in the intervention area was 3.72% at baseline and decreased to 0.61% after 1 year. In the control area it remained stable throughout the study period (1.31% and 1.65% respectively).
The introduction of a participatory approach by social scientists promotes changes in intersectoral management. This facilitates social mobilization which, in its turn, leads to significant changes in knowledge, attitudes and dengue-related practices in the population and eventually to more effective control of Ae. aegypti.
背景 第55届世界卫生大会宣布登革热预防与控制为优先事项，并敦促会员国为此制定可持续的跨部门战略。为了为古巴登革热预防政策的重新定位提供证据，我们开展了一项干预研究，以记录地方层面跨部门方法的有效性。
我们采用了准实验设计。社会科学家引入了参与式方法，以促进干预地区跨部门卫生委员会双周会议中的对话。该委员会随后制定了一项登革热预防跨部门计划，其核心目标是设计和实施沟通及社会动员活动。在对照地区，常规登革热控制活动继续进行，没有额外投入。在为期1年的干预期前后，对各地区内部及之间的登革热知识、态度和认知以及昆虫学指标进行了比较。
在干预地区，卫生委员会制定了一项以减少源头为重点的登革热预防跨部门计划。埃及伊蚊控制方法包括清除房屋及周边无用容器、遮盖水箱以及清洁公共区域和居住区域。该计划通过沟通和社会动员来实施。对照地区的卫生委员会偶尔讨论登革热问题，但未制定协调行动计划。在干预地区，对滋生地和疾病症状的良好认知显著提高（分别提高了49.7%和17.1%），以及受访者清除房屋内外容器的比例（提高了44%）。对照地区未观察到变化。干预地区的房屋指数在基线时为3.72%，1年后降至0.61%。在对照地区，整个研究期间保持稳定（分别为1.31%和1.65%）。
社会科学家引入参与式方法促进了跨部门管理的变革。这有助于社会动员，进而导致人群中与登革热相关的知识、态度和行为发生重大变化，并最终更有效地控制埃及伊蚊。
