You need people on your side in the fight against dengue

Image courtesy of RITM

As reported in our previous blog on the Asian study exploring the impact of eco-bio-social factors in Aedes aegypti breeding, phase one identified appropriate interventions. These amounted to targeting periodic checking on key water-holding containers backed by continuous improvements such as putting on lids and disposing of trash. Phase one identified 1,200 households within Masagana* City, a rapidly-developing area of metropolitan Manila, to participate in the study. Households were grouped into 12 clusters, identified by low/high dengue incidence and by low/high crowding. The low-crowding – and more affluent – clusters were in an area labelled as Village A, while the higher-crowding clusters, where the settlers lived, were known as Village B. In Village A, the intervention was first introduced to households through meetings and workshops. Attendance was extremely low, so instead health workers were dispatched to teach households how to inspect containers for pupa and clean them if any were found. Each household was given a guide and a checklist. Following this experience, though meetings were better attended in Village B, health worker home visits were planned there from the outset. In Village A, household awareness increased and more containers were covered despite considerable reluctance and communication difficulties, largely unrelated to the study. In Village B, however, the residents were happy to participate in discussions. They described how they felt safer and had become more aware of dengue control while the number of cases had fallen.

Image courtesy of RITM

Dr. Fe Espino, from the Research Institute for Tropical Medicine (RITM), explained the importance of support from the local administration: “When we started, the mayor helped by delivering an ordinance for the creation of a Dengue Task Force and for water container management. But local authorities have to get buy-in from communities to enforce it properly. They need to find a way to penetrate the community and its mindset – to understand what is going on.”

Image courtesy of RITM

Inevitably, local politics can be another factor, as Dr. Fe describes: “There was a change of government before we started phase two and the Dengue Task Force became less active. We were dealing with a whole new administration and had a hard time getting an audience with the mayor because our project was identified with the previous administration. We had the evidence, we knew it would work, but we had to deal with a new set of stakeholders.” The study and its findings have since led to a change in the way dengue vector control is approached, not just in the city of Masagana*, but across the whole of the Philippines. “We presented our findings – around community health workers training and supervising households in inspecting key containers – during national forums and I was told that the National Dengue Prevention and Control Program is planning to use this approach.” *Name of city has been anonymized for privacy reasons