Mitchell-Foster Kendra, Ayala Efraín Beltrán, Breilh Jaime, Spiegel Jerry, Wilches Ana Arichabala, Leon Tania Ordóñez, Delgado Jefferson Adrian
Global Health Research Program, School of Population and Public Health, University of British Columbia, Vancouver, Canada, V6 T 1Z3 Interdisciplinary Studies Graduate Program, University of British Columbia, Vancouver, Canada, V6 T 1Z4
Facultad de Ciencias Médicas, Universidad Técnica de Machala, Machala, Ecuador, Km.5 1/2 Via Machala Pasaje Servicio Nacional de Control y Prevención de Enfermedades Transmitidas por Vectores Artrópodos, Ministerio de Salud Pública, Machala, Ecuador.
Trans R Soc Trop Med Hyg. 2015 Feb;109(2):126-33. doi: 10.1093/trstmh/tru209.
This project investigates the effectiveness and feasibility of scaling-up an eco-bio-social approach for implementing an integrated community-based approach for dengue prevention in comparison with existing insecticide-based and emerging biolarvicide-based programs in an endemic setting in Machala, Ecuador.
An integrated intervention strategy (IIS) for dengue prevention (an elementary school-based dengue education program, and clean patio and safe container program) was implemented in 10 intervention clusters from November 2012 to November 2013 using a randomized controlled cluster trial design (20 clusters: 10 intervention, 10 control; 100 households per cluster with 1986 total households). Current existing dengue prevention programs served as the control treatment in comparison clusters. Pupa per person index (PPI) is used as the main outcome measure. Particular attention was paid to social mobilization and empowerment with IIS.
Overall, IIS was successful in reducing PPI levels in intervention communities versus control clusters, with intervention clusters in the six paired clusters that followed the study design experiencing a greater reduction of PPI compared to controls (2.2 OR, 95% CI: 1.2 to 4.7). Analysis of individual cases demonstrates that consideration for contexualizing programs and strategies to local neighborhoods can be very effective in reducing PPI for dengue transmission risk reduction.
In the rapidly evolving political climate for dengue control in Ecuador, integration of successful social mobilization and empowerment strategies with existing and emerging biolarvicide-based government dengue prevention and control programs is promising in reducing PPI and dengue transmission risk in southern coastal communities like Machala. However, more profound analysis of social determination of health is called for to assess sustainability prospects.
本项目调查了在厄瓜多尔马查拉的地方病流行地区，扩大一种生态 - 生物 - 社会方法以实施基于社区的登革热综合预防方法的有效性和可行性，并与现有的基于杀虫剂和新兴的基于生物杀幼虫剂的项目进行比较。
2012年11月至2013年11月，采用随机对照整群试验设计（20个整群：10个干预组，10个对照组；每组100户家庭，共1986户家庭），在10个干预整群中实施了登革热预防综合干预策略（IIS）（一个基于小学的登革热教育项目，以及清洁庭院和安全容器项目）。现有的登革热预防项目作为比较整群中的对照处理。人均蛹指数（PPI）用作主要结局指标。IIS特别关注社会动员和赋权。
总体而言，与对照整群相比，IIS成功降低了干预社区的PPI水平，在遵循研究设计的六对整群中，干预整群的PPI降低幅度比对照组更大（优势比为2.2，95%置信区间：1.2至4.7）。对个体案例的分析表明，根据当地社区情况调整项目和策略对于降低登革热传播风险的PPI非常有效。
在厄瓜多尔迅速变化的登革热控制政治环境中，将成功的社会动员和赋权策略与现有的和新兴的基于生物杀幼虫剂的政府登革热预防和控制项目相结合，有望降低马查拉等南部沿海社区的PPI和登革热传播风险。然而，需要对健康的社会决定因素进行更深入的分析，以评估可持续性前景。
