A social-ecological analysis of community perceptions of dengue fever and Aedes aegypti in Machala, Ecuador

BMC Public Health

Sadie J Ryan⁴  Efraín Beltrán Ayala⁵  Tania Ordoñez¹  Mercy Silva¹  Mercy J Borbor Cordova²  Valerie A Luzadis³  Anna M Stewart Ibarra¹ 

[1] Ministerio de Salud Pública, Machala, El Oro, Ecuador;Escuela Superior Politécnica del Litoral, Guayaquil, Guayas, Ecuador;Department of Environmental Studies, State University of New York College of Environmental Science and Forestry, Syracuse, NY, USA;School of Life Sciences, College of Agriculture, Engineering, and Science, University of KwaZulu-Natal, Durban, South Africa;Facultad de Medicina, Universidad Técnica de Machala, Machala, El Oro, Ecuador

关键词: Social-ecological systems;    Ecuador;    Vector control;    Community perceptions;    Aedes aegypti;    Dengue fever;   

Others  :  1123064
DOI  :  10.1186/1471-2458-14-1135

 received in 2014-05-19, accepted in 2014-10-23,  发布年份 2014

【 摘 要 】

Background

The growing burden of dengue fever and the lack of a vaccine or specific medical treatment have increased the urgency of the public health sector to identify alternative management strategies. A prevailing trend in Latin America has been a shift towards decentralized vector control programs with integrated management strategies, requiring significant intersectoral coordination, community engagement, and knowledge of the local social-ecological system (SES). Community perceptions and responses are a critical component of this system, since perceptions shape actions, and thus govern behavioral responses and acceptance of shifts in policy and management.

Methods

We investigated perceptions, misconceptions, and local SES risk factors for dengue in high risk communities located at the urban periphery and center in Machala, Ecuador. We facilitated twelve focus group discussions with community members using semi-structured question guides and causal diagrams. Focus groups were recorded, transcribed, and coded to identify emergent themes using qualitative methods for theme analysis. To estimate the relative importance of the themes in each study area, we tabulated the number of focus groups in which each theme was present. Household surveys (n = 79) were conducted to further explore these themes, and we compared survey responses from the two areas using descriptive statistics.

Results

We identified thirty biophysical, political-institutional, and community-household risk factors for dengue. People at the periphery identified a greater number of risk factors. Dengue control required considerable investment of time and resources, which presented a greater challenge for women and people at the periphery. Common misperceptions included confusion with other febrile diseases, lack of knowledge of transmission mechanisms, and misconceptions about mosquito behavior. People perceived that dengue control programs had been limited by the lack of inter-institutional coordination and lack of social cohesion.

Conclusions

There is a need for local, policy-relevant research that can be translated to strengthen the design, implementation, and evaluation of new dengue management strategies. This study contributes to a growing body of research in this area. Based on these findings, we identify key policy and management recommendations that will inform the ongoing transition to a decentralized dengue control program in Ecuador and other dengue endemic countries.

【 授权许可】

   
2014 Stewart Ibarra et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

Figure 3.

【 参考文献 】

• [1]San Martín JL, Brathwaite O, Zambrano B, Solórzano JO, Bouckenooghe A, Dayan GH, Guzmán MG: The epidemiology of dengue in the Americas over the last three decades: a worrisome reality. The Am J Trop Med Hyg 2010, 82:128-135.
• [2]Guzmán MG, Brathwaite O, Enria D, Hunsperger E, Kouri G, Montoya R, Rodriguez-Roche R, Vasconcelos P, San Martín JL: Dengue in the American Region. An Update. 2013. [http://www.tropika.net/svc/review/Guzman-20110704-Review-Dengue webcite]
• [3]Dirección Nacional de Vigilancia Epidemiológica: Anuario Epidemiológico. Quito, Ecuador: Ministerio de Salud Pública de Ecuador; 1994–2014. [http://www.salud.gob.ec/direccion-nacional-de-vigilancia-epidemiologica/ webcite]
• [4]Arunachalam N, Tana S, Espino F, Kittayapong P, Abeyewickrem W, Wai KT, Tyagi BK, Kroeger A, Sommerfeld J, Petzold M: Eco-bio-social determinants of dengue vector breeding: a multicountry study in urban and periurban Asia. Bull World Health Organ 2010, 88:173-184.
• [5]Quintero J, Brochero H, Manrique-Saide P, Barrera-Pérez M, Basso C, Romero S, Caprara A, Cunha JCDL, Beltran Ayala E, Mitchell-Foster K, Kroeger A, Sommerfeld J, Petzold M: Ecological, biological and social dimensions of dengue vector breeding in five urban settings of Latin America: a multi-country study. BMC Infect Dis 2014, 14:38. BioMed Central Full Text
• [6]Departamento de Epidemiologia: Casos de dengue reportados en el epi local por semanas epidemiológicas. Machala, Ecuador: Dirección Provincial de Salud de El Oro, Ministerio de Salud Pública; 2010.
• [7]INEC: Censo de población y viviendo. Quito, Ecuador: Instituto Nacional de Estadística y Censos (INEC); 2010.
• [8]WHO: Global Strategy for Dengue Prevention and Control, 2012–2020. Geneva: World Health Organization; [http://www.who.int/denguecontrol/9789241504034/en/ webcite]
• [9]Morrison AC, Zielinski-Gutierrez E, Scott TW, Rosenberg R: Defining challenges and proposing solutions for control of the virus vector Aedes aegypti. PLOS Medicine 2008, 5:e68.
• [10]Gubler DJ, Clark GG: Community involvement in the control of Aedes aegypti. Acta Trop 1996, 61:169-179.
• [11]San Martín JL, Brathwaite-Dick O: Integrated strategy for dengue prevention and control in the region of the americas. Rev Panam Salud Publica 2007, 21:55-63.
• [12]Sommerfeld J, Kroeger A: Eco-bio-social research on dengue in Asia: a multicountry study on ecosystem and community-based approaches for the control of dengue vectors in urban and peri-urban Asia. Pathog Glob Health 2012, 106:428-435.
• [13]Stewart Ibarra AM, Ryan SJ, Beltrán E, Mejía R, Silva M, Muñoz Á: Dengue vector dynamics (Aedes aegypti) influenced by climate and social factors in Ecuador: implications for targeted control. PLoS One 2013, 8:e78263.
• [14]Stewart Ibarra AM, Lowe R: Climate and non-climate drivers of dengue epidemics in southern coastal Ecuador. Am J Trop Med Hyg 2013, 88:971-981.
• [15]Stewart Ibarra AM, Muñoz AG, Ryan SJ, Borbor MJ, Ayala EB, Finkelstein JL, Mejía R, Ordoñez T, Recalde-Coronel GC, Rivero K: Spatiotemporal clustering, climate periodicity, and social-ecological risk factors for dengue during an outbreak in Machala, Ecuador, in 2010. 2014. in press at BMC Infectious Diseases arXiv:14077913 [q-bio]
• [16]Wilcox BA, Colwell RR: Emerging and reemerging infectious diseases: biocomplexity as an interdisciplinary paradigm. Ecohealth 2005, 2:244-257.
• [17]Spiegel J, Bennett S, Hattersley L, Hayden MH, Kittayapong P, Nalim S, Wang DNC, Zielinski-Gutiérrez E, Gubler D: Barriers and bridges to prevention and control of dengue: the need for a social–ecological approach. Ecohealth 2005, 2:273-290.
• [18]Parkes MW, Bienen L, Breilh J, Hsu LN, McDonald M, Patz JA, Rosenthal JP, Sahani M, Sleigh A, Waltner-Toews D, Yassi A: All hands on deck: transdisciplinary approaches to emerging infectious disease. Ecohealth 2005, 2:258-272.
• [19]Liu J, Dietz T, Carpenter SR, Alberti M, Folke C, Moran E, Pell AN, Deadman P, Kratz T, Lubchenco J, Ostrom E, Ouyang Z, Provencher W, Redman CL, Schneider SH, Taylor WW: Complexity of coupled human and natural systems. Science 2007, 317:1513.
• [20]Berkes F, Colding J, Folke C: Navigating Social-ecological Systems: Building Resilience for Complexity and Change. New York: Cambridge Univ Pr; 2003.
• [21]Meadows DH: Thinking in Systems: A Primer. White River Junction: Chelsea Green Publishing; 2008.
• [22]Zielinski-Gutierrez EC, Hayden MH: A model for defining West Nile virus risk perception based on ecology and proximity. Ecohealth 2006, 3:28-34.
• [23]Spiegel JM, Bonet M, Ibarra AM, Pagliccia N, Ouellette V, Yassi A: Social and environmental determinants of Aedes aegypti infestation in Central Havana: results of a case–control study nested in an integrated dengue surveillance programme in Cuba. TM& IH 2007, 12:503-510.
• [24]Hayden MH, Uejio CK, Walker K, Ramberg F, Moreno R, Rosales C, Gameros M, Mearns LO, Zielinski-Gutierrez E, Janes CR: Microclimate and human factors in the divergent ecology of Aedes aegypti along the Arizona, US/Sonora, MX border. Ecohealth 2010, 7:64-77.
• [25]BeLue R, Carmack C, Myers KR, Weinreb-Welch L, Lengerich EJ: Systems thinking tools as applied to community-based participatory research a case study. Health Educ Behav 2012, 39:745-751.
• [26]Quintero J, Carrasquilla G, Suárez R, Gonzalez C, Olano V: An ecosystemic approach to evaluating ecological, socioeconomic and group dynamics affecting the prevalence of Aedes aegypti in two Colombian towns. Cad Saúde Publica 2009, 25(Sup 1):S93-S103.
• [27]Plowright RK, Sokolow SH, Gorman ME, Daszak P, Foley JE: Causal inference in disease ecology: investigating ecological drivers of disease emergence. Front Ecol Environ 2008, 6:420-429.
• [28]Greenland S, Brumback B: An overview of relations among causal modelling methods. Int J Epidemiol 2002, 31:1030-1037.
• [29]Greenland S, Pearl J, Robins JM: Causal diagrams for epidemiologic research. Epidemiology 1999, 10:37-48.
• [30]Joffe M, Mindell J: Complex causal process diagrams for analyzing the health impacts of policy interventions. Am J Public Health 2006, 96:473-479.
• [31]IFAD Gender Strengthening Programme for Eastern and Southern Africa Division: Toolkit for Practitioners. 2002. [http://www.ifad.org/gender/tools/gender/Toolkit.pdf webcite]
• [32]The Overseas Development Institute: Planning Tools: Problem Tree Analysis. [http://www.odi.org.uk/publications/5258-problem-tree-analysis webcite]
• [33]Bogdan R, Biklen SK: Qualitative Research for Education: An Introduction to Theories and Methods. 5th edition. Boston: Pearson; 2006.
• [34]Saldaña J: The Coding Manual for Qualitative Researchers. 2nd edition. Los Angeles: SAGE Publications Ltd; 2012.
• [35]R Core Team: R: A Language and Environment for Statistical Computing. Vienna, Austria: R Foundation for Statistical Computing; 2013. http://www.R-project.org webcite; 2013
• [36]Mitchell-Foster K: Interdisciplinary knowledge translation and evaluation strategies for participatory dengue prevention in Machala, Ecuador. In PhD Thesis. University of British Columbia, Program in Interdisciplinary Studies; 2013. [http://circle.ubc.ca/handle/2429/45297 webcite]
• [37]Parks W, Lloyd L: Planning Social Mobilization and Communication for Dengue Fever Prevention and Control. Geneva: World Health Organization; 2004.
• [38]Mulla MS, Thavara U, Tawatsin A, Kong-Ngamsuk W, Chompoosri J: Mosquito burden and impact on the poor: measures and costs for personal protection in some communities in Thailand. J Am Mosq Control Assoc 2001, 17:153-159.
• [39]Wiseman V, McElroy B, Conteh L, Stevens W: Malaria prevention in The Gambia: patterns of expenditure and determinants of demand at the household level. TM & IH 2006, 11:419-431.
• [40]Ramos MM, Mohammed H, Zielinski-Gutierrez E, Hayden MH, Lopez JLR, Fournier M, Trujillo AR, Burton R, Brunkard JM, Anaya-Lopez L, Banicki AA, Morales PK, Smith B, Muñoz JL, Waterman SH, The Dengue Serosurvey Working Group: Epidemic dengue and dengue hemorrhagic fever at the Texas–Mexico border: results of a household-based seroepidemiologic survey, December 2005. Am J Trop Med Hyg 2008, 78:364-369.
• [41]Pérez-Guerra CL, Zielinski-Gutierrez E, Vargas-Torres D, Clark GG: Community beliefs and practices about dengue in Puerto Rico. Rev Panam Salud Publica 2009, 25:218-226.
• [42]Whiteford LM: The ethnoecology of dengue fever. Med Anthropol Q 1997, 11:202-223.
• [43]Fajardo P, Monje CA, Lozano G, Realpe O, Hernández LE: Popular notions surrounding “dengue” and rompehuesos, two models of the disease in Colombia. Rev Panam Salud Publica 2001, 10:161-168.
• [44]Claro LBL, Tomassini HCB, Rosa MLG: Dengue prevention and control: a review of studies on knowledge, beliefs, and practices. Cad Saude Publica 2004, 20:1447-1457.
• [45]Suarez MR, Olarte SM, Ana MF, Gonzalez UC, others: Is what I have just a cold or is it dengue? Addressing the gap between the politics of dengue control and daily life in Villavicencio-Colombia. Soc Sci Med 2005, 61:495.
• [46]Phuanukoonnon S, Brough M, Bryan JH: Folk knowledge about dengue mosquitoes and contributions of health belief model in dengue control promotion in Northeast Thailand. Acta Trop 2006, 99:6-14.
• [47]Sanchez L, Perez D, Perez T, Sosa T, Cruz G, Kouri G, Boelaert M, Van Der Stuyft P: Intersectoral coordination in Aedes aegypti control. A pilot project in Havana City. Cuba TM & IH 2005, 10:82-91.
• [48]Sanchez L, Perez D, Cruz G, Castro M, Kouri G, Shkedy Z, Vanlerberghe V, Van Der Stuyft P: Intersectoral coordination, community empowerment and dengue prevention: six years of controlled interventions in Playa Municipality, Havana, Cuba. TM & IH 2009, 14:1356-1364.
• [49]Parks W, Lloyd L, Nathan MB, Hosein E, Odugleh A, Clark GG, Gubler DJ, Prasittisuk C, Palmer K, San Martin JL, Siversen SR, Dawkins Z, Renganathan E: International experiences in social mobilization and communication for dengue prevention and control. Dengue Bull 2004, 28:S1-S7.