VIII. Prevention

1
VIII. Prevention
2
Early Eradication CampaignsSucceeded

• Adequate local and external funding for
  personnel, equipment and insecticides
• Emphasis on source reduction
• Effective residual insecticide
• Centralized, vertically-structured programs with
  military-type organization, strict supervision,
  high level of discipline

3
Reinfestation by Aedes aegypti
1930s 1970 1998
4
Hemispheric Eradication ofAedes aegypti No
Longer Realistic

• Problem greater than during previous campaign
• Insufficient resources
• Resistance to vertical disease control programs
  and use of insecticides
• Lack of effective insecticides
• Low priority, lack of sustainability

5
Lessons for FutureDengue Prevention Programs

• Efforts should focus on sustainable environmental
  control rather than eradication
• Control programs should be community-based and
  -integrated. They cannot rely solely on
  insecticides nor require large budgets
• Need to promote dengue as a priority among health
  officials and the general public

6
Community Approaches

• Typically define communities geographically
• More likely to be sustainable
• Advantages built-in manpower, help develop
  resources and empower community organizations
• Disadvantages more difficult to organize, take
  longer to get off the ground

7
Community Participation

• First must educate the public in the basics of
  dengue, such as
• Where the mosquito lays her eggs
• The link between larvae and adult mosquitoes
• General information about dengue transmission,
  symptoms and treatment

8
Skills Deficit

• Knowledge is not sufficient to produce behavior
  change
• People may lack the skills necessary to carry out
  the recommended behaviors
• Need to address this skills deficit

9
Barriers and Motivation (Part 1)

• Knowledge combined with skills still may not be
  sufficient to change behavior
• Need to understand what barriers may prevent the
  behavior, and what factors may motivate people to
  take the desired action
• Barriers and motivating factors vary in different
  regions

10
Barriers and Motivation (Part 2)

• Structural factors
• laws regarding Aedes aegypti habitats
• Environmental factors
• lack of potable water, need to store water
• inadequate solid waste disposal
• Attitudinal factors
• beliefs causes, treatment, prevention of febrile
  illnesses
• Community factors
• community history and structure
• other priority problems in the community

11
Cues for Dengue Preventive Behaviors

• People need reminders when they are learning a
  new behavior
• Behavioral cues are prompts or signals to remind
  the person to engage in the desired behavior

12
Cues Feedback

• Use regular feedback of entomologic and
  epidemiologic data
• Every time someone receives the information, it
  can serve as a reminder to act
• If the data indicate control activities are
  successful, they serve as positive reinforcement

13
Cues Presence ofAdult Mosquitoes

• Idea to promote
• Person sees adult mosquito
• Asks him/herself, Where did it come from?
• Immediately searches for larval habitats
• Eliminates or controls all potential habitats
  found

14
Cues Water Shortagesand Rationing

• For locations where there are seasonal or other
  temporary water shortages
• Provide information on how to properly store water

15
Cues Rainfall

• Link rainfall to the creation of larval habitats
• This mental link can remind people to look for
  and eliminate larval habitats after it rains
• Eliminates larval habitats influenced by
  rainfall, and perhaps others as well

16
Example of Community Programs Puerto Rico

• Elementary school and Head Start programs to
  teach children about dengue control
• Public service announcements
• Interactive exhibit at the Childrens Museum
• Boy Scout merit badge program

17
The Challenge

• Achieve active community involvement
• Solicit input from the earliest program planning
  stages
• Encourage community ownership
• Programs that emphasize telling communities what
  to do, without involving them or taking their
  views into account, are not likely to be
  effective
• True community participation is key