VIII. Prevention

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

Reinfestation by Aedes aegypti 1930s

Hemispheric Eradication of Aedes aegypti No Longer Realistic n Problem greater than during previous campaign n Insufficient resources n Resistance to vertical disease control programs and use of insecticides n Lack of effective insecticides n Low priority, lack of sustainability

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

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

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

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

Barriers and Motivation (Part 1) n Knowledge combined with skills still may not be sufficient to change behavior n Need to understand what barriers may prevent the behavior, and what factors may motivate people to take the desired action n Barriers and motivating factors vary in different regions

Barriers and Motivation (Part 2) n Structural factors laws regarding Aedes aegypti habitats laws regarding Aedes aegypti habitats n Environmental factors lack of potable water, need to store water lack of potable water, need to store water inadequate solid waste disposal inadequate solid waste disposal n Attitudinal factors beliefs: causes, treatment, prevention of febrile illnesses beliefs: causes, treatment, prevention of febrile illnesses n Community factors community history and structure community history and structure other priority problems in the community other priority problems in the community

Cues for Dengue Preventive Behaviors n People need reminders when they are learning a new behavior n Behavioral cues are prompts or signals to remind the person to engage in the desired behavior

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

Cues: Presence of Adult Mosquitoes n Idea to promote: Person sees adult mosquito Person sees adult mosquito Asks him/herself, “Where did it come from?” Asks him/herself, “Where did it come from?” Immediately searches for larval habitats Immediately searches for larval habitats Eliminates or controls all potential habitats found Eliminates or controls all potential habitats found

Cues: Water Shortages and Rationing n For locations where there are seasonal or other temporary water shortages n Provide information on how to properly store water

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

Example of Community Programs: Puerto Rico n Elementary school and Head Start programs to teach children about dengue control n Public service announcements n Interactive exhibit at the Children’s Museum n Boy Scout merit badge program

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