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Vander Kelen C, Mpanya A, Hasker E, Miaka E, Nzuzi R, Torr S, Perez D, Pulford J. 'Where are the dead flies!': perceptions of local communities towards the deployment of Tiny Targets to control tsetse in the Democratic Republic of the Congo. BMJ Glob Health 2022; 7:bmjgh-2021-006879. [PMID: 34992076 PMCID: PMC8739071 DOI: 10.1136/bmjgh-2021-006879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 11/25/2021] [Indexed: 11/05/2022] Open
Abstract
The National Programme for the control of human African trypanosomiasis in Democratic Republic of Congo includes a large-scale vector control operation using Tiny Targets. These are small panels of insecticide-impregnated cloth that are deployed in riverine habitat where tsetse flies concentrate. The effectiveness of Tiny Targets depends partly on acceptance by local communities. In 2018, we conducted research to explore the perception and acceptability of Tiny Targets in two different village clusters where Tiny Targets had been deployed by the local community or external teams. We conducted fourteen focus group discussions and seven semistructured interviews in three villages from each cluster in the Yasa Bonga health zone. Our findings showed that acceptability was better in the cluster where communities were involved in the deployment of Tiny Targets. Also in this cluster, awareness about Tiny Targets was satisfactory and the project was implemented within local customs, which promoted a positive perception of Tiny Targets and their benefits. In the cluster where external teams deployed Tiny Targets, a lack of information and communication, stereotypes applied by communities towards the deployment teams and the impression of inadequate respect for local customs led to anxiety and a misleading interpretation of the purpose of Tiny Targets and negatively influenced acceptability. This study highlights the importance of involving communities for programme acceptance. Our research underlined how awareness campaigns and communication are essential, but also how working within the scope of community social norms and customs are equally important. Prospects for the successful use of Tiny Targets are greater when communities are involved because the use can be adapted to social norms.
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Affiliation(s)
| | - Alain Mpanya
- Coordination, Programme National de Lutte contre la Trypanosomiase Humaine Africaine, Kinshasa, Congo
| | - Epco Hasker
- Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Erick Miaka
- Coordination, Programme National de Lutte contre la Trypanosomiase Humaine Africaine, Kinshasa, Congo
| | - Ruth Nzuzi
- Coordination, Programme National de Lutte contre la Trypanosomiase Humaine Africaine, Kinshasa, Congo
| | - Steve Torr
- Vector Biology, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Dennis Perez
- Epidemiology, Pedro Kouri Institute of Tropical Medicine Center for Diagnostic and Reference Research, La Habana, Cuba
| | - Justin Pulford
- International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
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Pinchoff J, Silva M, Spielman K, Hutchinson P. Use of effective lids reduces presence of mosquito larvae in household water storage containers in urban and peri-urban Zika risk areas of Guatemala, Honduras, and El Salvador. Parasit Vectors 2021; 14:167. [PMID: 33741050 PMCID: PMC7977570 DOI: 10.1186/s13071-021-04668-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 03/04/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In 2015, an outbreak of Zika virus spread across Latin America and the Caribbean (LAC). Public health programs promoted vector control behaviors, including covering water storage containers with lids. Such approaches disrupt Zika transmission by eliminating the habitats of the Aedes aegypti mosquito, which breeds in stagnant water. METHODS A quantitative household survey and observation checklist with trained enumerators were undertaken between August and October 2018 in selected urban/peri-urban USAID implementation communities in El Salvador, Guatemala, and Honduras. The survey included questions regarding knowledge, attitudes, and practices related to Zika virus. An accompanying checklist was implemented to observe water storage containers, including for short-term and long-term water use. The characteristics of these containers were tabulated, including the presence of a lid. The lids were examined for key features to determine their potential effectiveness to prevent mosquito breeding: fully covering and sealing the container, not having holes, and not having water on them (potentially creating a secondary breeding site). Multivariate logistic regression was used to estimate the effectiveness of lid types and characteristics on the presence of larvae. RESULTS Overall, in adjusted models, using an effective lid versus no lid was associated with a 94% decrease in odds of larval presence in long-term water storage containers (odds ratio = 0.06; 95% confidence interval [0.029, 0.152]); however, similar impacts were not observed for washbasins in the adjusted models. Models adjusted for household wealth, receiving a visit from a vector control technician, scrubbing the container in the last 7 days, and perception of more mosquitoes around. CONCLUSIONS Effective lids, if made available and coupled with complementary behavioral messaging, may reduce transmission of Zika and other Aedes mosquito-borne diseases in the LAC region.
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Quintero J, Ronderos Pulido N, Logan J, Ant T, Bruce J, Carrasquilla G. Effectiveness of an intervention for Aedes aegypti control scaled-up under an inter-sectoral approach in a Colombian city hyper-endemic for dengue virus. PLoS One 2020; 15:e0230486. [PMID: 32236142 PMCID: PMC7112230 DOI: 10.1371/journal.pone.0230486] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2019] [Accepted: 03/03/2020] [Indexed: 11/18/2022] Open
Abstract
Aedes aegypti transmitted arboviral diseases are of significant importance in Colombia, particularly since the 2014/2015 introduction of chikungunya and Zika in the Americas and the increasing spread of dengue. In response, the Colombian government initiated the scaling-up of a community-based intervention under inter and multi-sector partnerships in two out of four sectors in Girardot, one of the most hyper-endemic dengue cities in the country. Using a quasi-experimental research design a scaled-up community-led Aedes control intervention was assessed for its capacity to reduce dengue from January 2010 to August 2017 in Girardot, Colombia. Reported dengue cases, and associated factors were analysed from available data sets from the Colombian disease surveillance systems. We estimated the reduction in dengue cases before and after the intervention using, Propensity Score Matching and an Autoregressive Moving Average model for robustness. In addition, the differences in dengue incidence among scaling-up phases (pre-implementation vs sustainability) and between treatment groups (intervention and control areas) were modelled. Evidence was found in favour of the intervention, although to maximise impact the scaling-up of the intervention should continue until it covers the remaining sectors. It is expected that a greater impact of the intervention can be documented in the next outbreak of dengue in Girardot.
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Affiliation(s)
- Juliana Quintero
- Eje de Salud Poblacional, Fundación Santa Fe de Bogotá, Bogotá, Colombia
- Universidad Santo Tomas, Bogotá, Colombia
| | | | - James Logan
- Eje de Salud Poblacional, Fundación Santa Fe de Bogotá, Bogotá, Colombia
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Thomas Ant
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Jane Bruce
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Bardach AE, García-Perdomo HA, Alcaraz A, Tapia López E, Gándara RAR, Ruvinsky S, Ciapponi A. Interventions for the control of Aedes aegypti in Latin America and the Caribbean: systematic review and meta-analysis. Trop Med Int Health 2019; 24:530-552. [PMID: 30771267 DOI: 10.1111/tmi.13217] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To determine the effectiveness and degree of implementation of interventions for the control of Aedes aegypti in Latin America and the Caribbean (LAC) as reported in scientific literature. METHODS We searched MEDLINE, EMBASE, CENTRAL, SOCINDEX, and LILACS, for experimental and observational studies, economic assessments and qualitative experiences carried out in LAC from 2000 to 2016. We assessed incidence and morbimortality of Aedes aegypti-related diseases and entomological indices: Breteau (containers), House, and Pupae per Person. We used GRADE methodology for assessing quality of evidence. RESULTS Of 1826 records retrieved, 75 were included and 9 cluster randomised clinical trials could be meta-analysed. We did not identify any intervention supported by a high certainty of evidence. In consistency with qualitative evidence, health education and community engagement probably reduces the entomological indices, as do the use of insecticide-treated materials, indoor residual spraying and the management of containers. There is low certainty of evidence supporting the use of ovitraps or larvitraps, and the integrated epidemiological surveillance strategy to improve indices and reduce the incidence of dengue. The reported degree of implementation of these vector control interventions was variable and most did not extend to whole cities and were not sustained beyond 2 years. CONCLUSIONS We found a general lack of evidence on effectiveness of vector control in the region, despite a few interventions that showed moderate to low certainty of evidence. It is important to engage and educate the community, apart from achieving the implementation of integrated actions between the health and other sectors at national and regional level.
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Affiliation(s)
- Ariel Esteban Bardach
- Instituto de Efectividad Clínica y Sanitaria, Centro de Investigación de Epidemiología y Salud Pública, Buenos Aires, Argentina.,Consejo Nacional de Investigaciones Científicas y Técnicas and Centro Cochrane, Buenos Aires, Argentina
| | | | - Andrea Alcaraz
- Instituto de Efectividad Clínica y Sanitaria, Centro de Investigación de Epidemiología y Salud Pública, Buenos Aires, Argentina
| | - Elena Tapia López
- Instituto de Efectividad Clínica y Sanitaria, Centro de Investigación de Epidemiología y Salud Pública, Buenos Aires, Argentina
| | - Ruth Amanda Ruano Gándara
- Instituto de Efectividad Clínica y Sanitaria, Centro de Investigación de Epidemiología y Salud Pública, Buenos Aires, Argentina
| | - Silvina Ruvinsky
- Hospital de Pediatría "Pedro Garrahan", Ciudad Autónoma de Buenos Aires, Buenos Aires, Argentina
| | - Agustín Ciapponi
- Instituto de Efectividad Clínica y Sanitaria, Centro de Investigación de Epidemiología y Salud Pública, Buenos Aires, Argentina.,Consejo Nacional de Investigaciones Científicas y Técnicas and Centro Cochrane, Buenos Aires, Argentina
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Pérez D, Van der Stuyft P, Toledo ME, Ceballos E, Fabré F, Lefèvre P. Insecticide treated curtains and residual insecticide treatment to control Aedes aegypti: An acceptability study in Santiago de Cuba. PLoS Negl Trop Dis 2018; 12:e0006115. [PMID: 29293501 PMCID: PMC5766245 DOI: 10.1371/journal.pntd.0006115] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Revised: 01/12/2018] [Accepted: 11/14/2017] [Indexed: 11/21/2022] Open
Abstract
Background Within the context of a field trial conducted by the Cuban vector control program (AaCP), we assessed acceptability of insecticide-treated curtains (ITCs) and residual insecticide treatment (RIT) with deltamethrin by the community. We also assessed the potential influence of interviewees’ risk perceptions for getting dengue and disease severity. Methodology/principal findings We embedded a qualitative study using in-depth interviews in a cluster randomized trial (CRT) testing the effectiveness of ITCs and RIT in Santiago de Cuba. In-depth interviews (N = 38) were conducted four and twelve months after deployment of the tools with people who accepted the tools, who stopped using them and who did not accept the tools. Data analysis was deductive. Main reasons for accepting ITCs at the start of the trial were perceived efficacy and not being harmful to health. Constraints linked to manufacturer instructions were the main reason for not using ITCs. People stopped using the ITCs due to perceived allergy, toxicity and low efficacy. Few heads of households refused RIT despite the noting reasons for rejection, such as allergy, health hazard and toxicity. Positive opinions of the vector control program influenced acceptability of both tools. However, frequent insecticide fogging as part of routine AaCP vector control actions diminished perceived efficacy of both tools and, therefore, acceptability. Fifty percent of interviewees did feel at risk for getting dengue and considered dengue a severe disease. However, this did not appear to influence acceptability of ITCs or RIT. Conclusion/significance Acceptability of ITCs and RIT was linked to acceptability of AaCP routine vector control activities. However, uptake and use were not always an indication of acceptability. Factors leading to acceptability may be best identified using qualitative methods, but more research is needed on the concept of acceptability and its measurement. We aimed to understand what makes insecticide-treated curtains (ITCs) and residual insecticide treatment (RIT) with deltamethrin acceptable or not to users of these tools. In-depth interviews were conducted as part of a field trial conducted by the Cuban vector control program (AaCP) to test the effectiveness of these tools in Santiago de Cuba. Perceived efficacy was the main reason for interviewees who accepted the tools. Constraints linked to manufacturer instructions were the main reason for not using the ITCs when offered at the start of the trial. People stopped using the ITCs due to perceived allergy, toxicity and low efficacy. Few heads of households refused RIT despite identifying various reasons for rejection, such as allergy, health hazard and toxicity. Positive opinions of the Cuban vector control program influenced acceptability of both tools. On the contrary, perceptions of dengue risk did not appear to influence acceptability of ITCs or RIT. Our findings add on the importance of the growing body of qualitative research assessing acceptability of health interventions.
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Affiliation(s)
- Dennis Pérez
- Department of Epidemiology, Institute of Tropical Medicine Pedro Kourí, Havana, Cuba
- * E-mail:
| | - Patrick Van der Stuyft
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
- Department of Public Health, Ghent University, Ghent, Belgium
| | - María Eugenia Toledo
- Department of Epidemiology, Institute of Tropical Medicine Pedro Kourí, Havana, Cuba
| | - Enrique Ceballos
- Department of Vector Control, Polyclinic Armando García, Santiago de Cuba, Cuba
| | - Francisco Fabré
- Department of Vector Control, Provincial Surveillance and Vector Control Unit, Santiago de Cuba, Cuba
| | - Pierre Lefèvre
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
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Toledo ME, Vanlerberghe V, Rosales JP, Mirabal M, Cabrera P, Fonseca V, Gómez Padrón T, Pérez Menzies M, Montada D, Van der Stuyft P. The additional benefit of residual spraying and insecticide-treated curtains for dengue control over current best practice in Cuba: Evaluation of disease incidence in a cluster randomized trial in a low burden setting with intensive routine control. PLoS Negl Trop Dis 2017; 11:e0006031. [PMID: 29117180 PMCID: PMC5695847 DOI: 10.1371/journal.pntd.0006031] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 11/20/2017] [Accepted: 10/11/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Aedes control interventions are considered the cornerstone of dengue control programmes, but there is scarce evidence on their effect on disease. We set-up a cluster randomized controlled trial in Santiago de Cuba to evaluate the entomological and epidemiological effectiveness of periodical intra- and peri-domiciliary residual insecticide (deltamethrin) treatment (RIT) and long lasting insecticide treated curtains (ITC). METHODOLOGY/PRINCIPAL FINDINGS Sixty three clusters (around 250 households each) were randomly allocated to two intervention (RIT and ITC) and one control arm. Routine Aedes control activities (entomological surveillance, source reduction, selective adulticiding, health education) were applied in the whole study area. The outcome measures were clinical dengue case incidence and immature Aedes infestation. Effectiveness of tools was evaluated using a generalized linear regression model with a negative binomial link function. Despite significant reduction in Aedes indices (Rate Ratio (RR) 0.54 (95%CI 0.32-0.89) in the first month after RIT, the effect faded out over time and dengue incidence was not reduced. Overall, in this setting there was no protective effect of RIT or ITC over routine in the 17months intervention period, with for house index RR of 1.16 (95%CI 0.96-1.40) and 1.25 (95%CI 1.03-1.50) and for dengue incidence RR of 1.43 (95%CI 1.08-1.90) and 0.96 (95%CI 0.72-1.28) respectively. The monthly dengue incidence rate (IR) at cluster level was best explained by epidemic periods (Incidence Rate Ratio (IRR) 5.50 (95%CI 4.14-7.31)), the IR in bordering houseblocks (IRR 1.03 (95%CI 1.02-1.04)) and the IR pre-intervention (IRR 1.02 (95%CI 1.00-1.04)). CONCLUSIONS Adding RIT to an intensive routine Aedes control programme has a transient effect on the already moderate low entomological infestation levels, while ITC did not have any effect. For both interventions, we didn't evidence impact on disease incidence. Further studies are needed to evaluate impact in settings with high Aedes infestation and arbovirus case load.
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Affiliation(s)
- Maria Eugenia Toledo
- Department of Epidemiology, Institute of Tropical Medicine “Pedro Kourí”, La Habana, Cuba
| | - Veerle Vanlerberghe
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Julio Popa Rosales
- Provincial Center of Surveillance and Vector Control, Santiago de Cuba, Cuba
| | - Mayelin Mirabal
- Finlay Institute - Center for Vaccines Research and Production, Habana, Cuba
| | - Pedro Cabrera
- Provincial Center of Surveillance and Vector Control, Santiago de Cuba, Cuba
| | - Viviana Fonseca
- Provincial Center of Surveillance and Vector Control, Santiago de Cuba, Cuba
| | | | | | - Domingo Montada
- Department of Epidemiology, Institute of Tropical Medicine “Pedro Kourí”, La Habana, Cuba
| | - Patrick Van der Stuyft
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
- University of Ghent, Ghent, Belgium
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Paz-Soldan VA, Bauer KM, Lenhart A, Cordova Lopez JJ, Elder JP, Scott TW, McCall PJ, Kochel TJ, Morrison AC. Experiences with insecticide-treated curtains: a qualitative study in Iquitos, Peru. BMC Public Health 2016; 16:582. [PMID: 27422403 PMCID: PMC4947330 DOI: 10.1186/s12889-016-3191-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Accepted: 06/08/2016] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Dengue is an arthropod-borne viral disease responsible for approximately 400 million infections annually; the only available method of prevention is vector control. It has been previously demonstrated that insecticide treated curtains (ITCs) can lower dengue vector infestations in and around houses. As part of a larger trial examining whether ITCs could reduce dengue transmission in Iquitos, Peru, the objective of this study was to characterize the participants' experience with the ITCs using qualitative methods. METHODS Knowledge, attitudes, and practices (KAP) surveys (at baseline, and 9 and 27 months post-ITC distribution, with n = 593, 595 and 511, respectively), focus group discussions (at 6 and 12 months post-ITC distribution, with n = 18 and 33, respectively), and 11 one-on-one interviews (at 12 months post-distribution) were conducted with 605 participants who received ITCs as part of a cluster-randomized trial. RESULTS Focus groups at 6 months post-ITC distribution revealed that individuals had observed their ITCs to function for approximately 3 months, after which they reported the ITCs were no longer working. Follow up revealed that the ITCs required re-treatment with insecticide at approximately 1 year post-distribution. Over half (55.3 %, n = 329) of participants at 9 months post-ITC distribution and over a third (34.8 %, n = 177) at 27 months post-ITC distribution reported perceiving a decrease in the number of mosquitoes in their home. The percentage of participants who would recommend ITCs to their family or friends in the future remained high throughout the study (94.3 %, n = 561 at 9 months and 94.6 %, n = 488 at 27 months post-distribution). When asked why, participants reported that ITCs were effective at reducing mosquitoes (81.6 and 37.8 %, at 9 and 27 months respectively), that they prevent dengue (5.7 and 51.2 %, at 9 and 27 months), that they are "beautiful" (5.9 and 3.1 %), as well as other reasons (6.9 and 2.5 %). CONCLUSION ITCs have substantial potential for long term dengue vector control because they are liked by users, both for their perceived effectiveness and for aesthetic reasons, and because they require little proactive behavioral effort on the part of the users. Our results highlight the importance of gathering process (as opposed to outcome) data during vector control studies, without which researchers would not have become aware that the ITCs had lost effectiveness early in the trial.
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Affiliation(s)
- Valerie A. Paz-Soldan
- />Department of Global Community Health and Behavioral Sciences, Tulane University School of Public Health and Tropical Medicine, 1440 Canal Street, Suite 2200, New Orleans, LA USA
- />Facultad de Salud Pública y Administración, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Karin M. Bauer
- />Department of Global Community Health and Behavioral Sciences, Tulane University School of Public Health and Tropical Medicine, 1440 Canal Street, Suite 2200, New Orleans, LA USA
| | - Audrey Lenhart
- />Entomology Branch, Division of Parasitic Diseases and Malaria, United States Centers for Disease Control and Prevention, Atlanta, GA USA
| | | | - John P. Elder
- />Division of Health Promotion and Behavioral Sciences, Graduate School of Public Health, San Diego State University, San Diego, CA USA
| | - Thomas W. Scott
- />Department of Entomology and Nematology, University of California Davis, Davis, CA USA
- />Fogarty International Center, National Institutes of Health, Bethesda, MD USA
| | - Philip J. McCall
- />Department of Vector Biology, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Tadeusz J. Kochel
- />Virology Department, Naval Medical Research Center, Silver Spring, MD USA
| | - Amy C. Morrison
- />Department of Entomology and Nematology, University of California Davis, Davis, CA USA
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Paz-Soldan VA, Bauer K, Morrison AC, Cordova Lopez JJ, Izumi K, Scott TW, Elder JP, Alexander N, Halsey ES, McCall PJ, Lenhart A. Factors Associated with Correct and Consistent Insecticide Treated Curtain Use in Iquitos, Peru. PLoS Negl Trop Dis 2016; 10:e0004409. [PMID: 26967157 PMCID: PMC4788147 DOI: 10.1371/journal.pntd.0004409] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Accepted: 01/05/2016] [Indexed: 01/31/2023] Open
Abstract
Dengue is an arthropod-borne virus of great public health importance, and control of its mosquito vectors is currently the only available method for prevention. Previous research has suggested that insecticide treated curtains (ITCs) can lower dengue vector infestations in houses. This observational study investigated individual and household-level socio-demographic factors associated with correct and consistent use of ITCs in Iquitos, Peru. A baseline knowledge, attitudes, and practices (KAP) survey was administered to 1,333 study participants, and ITCs were then distributed to 593 households as part of a cluster-randomized trial. Follow up KAP surveys and ITC-monitoring checklists were conducted at 9, 18, and 27 months post-ITC distribution. At 9 months post-distribution, almost 70% of ITCs were hanging properly (e.g. hanging fully extended or tied up), particularly those hung on walls compared to other locations. Proper ITC hanging dropped at 18 months to 45.7%. The odds of hanging ITCs correctly and consistently were significantly greater among those participants who were housewives, knew three or more correct symptoms of dengue and at least one correct treatment for dengue, knew a relative or close friend who had had dengue, had children sleeping under a mosquito net, or perceived a change in the amount of mosquitoes in the home. Additionally, the odds of recommending ITCs in the future were significantly greater among those who perceived a change in the amount of mosquitoes in the home (e.g. perceived the ITCs to be effective). Despite various challenges associated with the sustained effectiveness of the selected ITCs, almost half of the ITCs were still hanging at 18 months, suggesting a feasible vector control strategy for sustained community use. Dengue is an arthropod-borne virus of great public health importance. Vector control is currently the only available method for dengue prevention. This cluster-randomized trial investigated individual and household-level socio-demographic factors associated with correct and consistent use of insecticide-treated curtains (ITCs)—one promising vector control method—in Iquitos, Peru. Most people preferred to hang the ITCs in doorways and as room dividers, but also hung them as curtains on windows and on their walls. We assessed who still had their ITCs hanging or tied up at 9 months and 18 months after distribution, and found that use of the ITCs decreased over time to about half. When we explored who was more likely to be using the ITCs correctly (having them hanging in place, or tied up in place, or washed without bleach and avoiding direct sunlight), we found that those who knew more about dengue, knew someone who had dengue, had young children in their homes sleeping under an insecticide treated mosquito net, or who perceived the ITCs to work well, were more likely to be using their ITCs than others. Despite various challenges in sustained ITC effectiveness in this study, the fact that almost half of the homes still had the ITCs hanging at 18 months suggests this vector control strategy is feasible for long term community use.
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Affiliation(s)
- Valerie A. Paz-Soldan
- Department of Global Health Systems and Development, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, United States of America
- * E-mail:
| | - Karin Bauer
- Department of Global Health Systems and Development, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, United States of America
| | - Amy C. Morrison
- United States Naval Medical Research Unit No. 6 (NAMRU-6), Iquitos Laboratory, Iquitos, Peru
- Department of Entomology and Nematology, University of California Davis, Davis, California, United States of America
| | - Jhonny J. Cordova Lopez
- United States Naval Medical Research Unit No. 6 (NAMRU-6), Iquitos Laboratory, Iquitos, Peru
| | - Kiyohiko Izumi
- Department of Global Health Systems and Development, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, United States of America
| | - Thomas W. Scott
- Department of Entomology and Nematology, University of California Davis, Davis, California, United States of America
| | - John P. Elder
- Division of Health Promotion and Behavioral Sciences, Graduate School of Public Health, San Diego State University, San Diego, California, United States of America
| | - Neal Alexander
- MRC Tropical Epidemiology Group and Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Eric S. Halsey
- Malaria Branch, United States Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Philip J. McCall
- Department of Vector Biology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Audrey Lenhart
- Entomology Branch, Division of Parasitic Diseases and Malaria, United States Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
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Murray N, Jansarikij S, Olanratmanee P, Maskhao P, Souares A, Wilder-Smith A, Kittayapong P, Louis VR. Acceptability of impregnated school uniforms for dengue control in Thailand: a mixed methods approach. Glob Health Action 2014; 7:24887. [PMID: 25183313 PMCID: PMC4152550 DOI: 10.3402/gha.v7.24887] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2014] [Revised: 08/04/2014] [Accepted: 08/05/2014] [Indexed: 01/01/2023] Open
Abstract
Background As current dengue control strategies have been shown to be largely ineffective in reducing dengue in school-aged children, novel approaches towards dengue control need to be studied. Insecticide-impregnated school uniforms represent an innovative approach with the theoretical potential to reduce dengue infections in school children. Objectives This study took place in the context of a randomised control trial (RCT) to test the effectiveness of permethrin-impregnated school uniforms (ISUs) for dengue prevention in Chachoengsao Province, Thailand. The objective was to assess the acceptability of ISUs among parents, teachers, and principals of school children involved in the trial. Methodology Quantitative and qualitative tools were used in a mixed methods approach. Class-clustered randomised samples of school children enrolled in the RCT were selected and their parents completed 321 self-administered questionnaires. Descriptive statistics and logistic regression were used to analyse the quantitative data. Focus group discussions and individual semi-structured interviews were conducted with parents, teachers, and principals. Qualitative data analysis involved content analysis with coding and thematic development. Results The knowledge and experience of dengue was substantial. The acceptability of ISUs was high. Parents (87.3%; 95% CI 82.9–90.8) would allow their child to wear an ISU and 59.9% (95% CI 53.7–65.9) of parents would incur additional costs for an ISU over a normal uniform. This was significantly associated with the total monthly income of a household and the educational level of the respondent. Parents (62.5%; 95% CI 56.6–68.1) indicated they would be willing to recommend ISUs to other parents. Conclusions Acceptability of the novel tool of ISUs was high as defined by the lack of concern along with the willingness to pay and recommend. Considering issues of effectiveness and scalability, assessing acceptability of ISUs over time is recommended.
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Affiliation(s)
- Natasha Murray
- Institute of Public Health, University of Heidelberg, Heidelberg, Germany
| | - Suphachai Jansarikij
- Center of Excellence for Vectors and Vector-Borne Diseases, Faculty of Science, Mahidol University, Salaya, Nakhon Pathom, Thailand
| | - Phanthip Olanratmanee
- Center of Excellence for Vectors and Vector-Borne Diseases, Faculty of Science, Mahidol University, Salaya, Nakhon Pathom, Thailand
| | - Pongsri Maskhao
- Faculty of Humanities and Social Sciences, Rajabhat Rajanagarindra University, Chachoengsao, Thailand
| | - Aurélia Souares
- Institute of Public Health, University of Heidelberg, Heidelberg, Germany
| | - Annelies Wilder-Smith
- Institute of Public Health, University of Heidelberg, Heidelberg, Germany; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore; Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Pattamaporn Kittayapong
- Center of Excellence for Vectors and Vector-Borne Diseases, Faculty of Science, Mahidol University, Salaya, Nakhon Pathom, Thailand
| | - Valérie R Louis
- Institute of Public Health, University of Heidelberg, Heidelberg, Germany;
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10
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Jones CH, Benítez-Valladares D, Guillermo-May G, Dzul-Manzanilla F, Che-Mendoza A, Barrera-Pérez M, Selem-Salas C, Chablé-Santos J, Sommerfeld J, Kroeger A, O'Dempsey T, Medina-Barreiro A, Manrique-Saide P. Use and acceptance of long lasting insecticidal net screens for dengue prevention in Acapulco, Guerrero, Mexico. BMC Public Health 2014; 14:846. [PMID: 25124670 PMCID: PMC4152567 DOI: 10.1186/1471-2458-14-846] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Accepted: 07/24/2014] [Indexed: 11/29/2022] Open
Abstract
Background Dengue, recognized by the WHO as the most important mosquito-borne viral disease in the world, is a growing problem. Currently, the only effective way of preventing dengue is vector control. Standard methods have shown limited effect, and there have been calls to develop new integrated vector management approaches. One novel tool, protecting houses with long lasting insecticidal screens on doors and windows, is being trialled in a cluster randomised controlled trial by a joint UADY/WHO TDR/IDRC study in various districts of Acapulco, Mexico, with exceptionally high levels of crime and insecurity. This study investigated the community’s perspectives of long lasting insecticidal screens on doors and windows in homes and in schools, in order to ascertain their acceptability, to identify challenges to further implementation and opportunities for future improvements. Methods This was a sequential mixed-methods study. The quantitative arm contained a satisfaction survey administered to 288 houses that had received the intervention examining their perspectives of both the intervention and dengue prevention in general. The qualitative arm consisted of Focus Group Discussions (FGDs) with those who had accepted the intervention and key informant interviews with: schoolteachers to discuss the use of the screens in schools, program staff, and community members who had refused the intervention. Results Overall satisfaction and acceptance of the screens was very high, with only some operational and technical complaints relating to screen fragility and the installation process. However, the wider social context of urban violence and insecurity was a major barrier to screen acceptance. Lack of information dissemination and community collaboration were identified as project weaknesses. Conclusions The screens are widely accepted by the population, but the project implementation could be improved by reassuring the community of its legitimacy in the context of insecurity. More community engagement and better information sharing structures are needed. The screens could be a major new dengue prevention tool suitable for widespread use, if further research supports their entomological and epidemiological effectiveness and their acceptability in different social and environmental contexts. Further research is needed looking at the impact of insecurity of dengue prevention programmes. Electronic supplementary material The online version of this article (doi:10.1186/1471-2458-14-846) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Pablo Manrique-Saide
- Universidad Autónoma de Yucatán, Carretera Mérida-Xmatkuil Km, 15,5, Mérida C,P, 97315, Mexico.
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11
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Kovacic V, Tirados I, Esterhuizen J, Mangwiro CTN, Torr SJ, Lehane MJ, Smith H. Community acceptance of tsetse control baits: a qualitative study in Arua District, North West Uganda. PLoS Negl Trop Dis 2013; 7:e2579. [PMID: 24349593 PMCID: PMC3861179 DOI: 10.1371/journal.pntd.0002579] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2013] [Accepted: 10/26/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND There is renewed vigour in efforts to eliminate neglected tropical diseases including sleeping sickness (human African trypanosomiasis or HAT), including attempts to develop more cost-effective methods of tsetse control. In the West Nile region of Uganda, newly designed insecticide-treated targets are being deployed over an area of ∼500 km(2). The operational area covers villages where tsetse control has not been conducted previously. The effectiveness of the targets will depend, in part, on their acceptance by the local community. METHODOLOGY/PRINCIPAL FINDINGS We assessed knowledge, perceptions and acceptance of tsetse baits (traps, targets) in villages where they had or had not been used previously. We conducted sixteen focus group discussions with male and female participants in eight villages across Arua District. Discussions were audio recorded, translated and transcribed. We used thematic analysis to compare the views of both groups and identify salient themes. CONCLUSIONS/SIGNIFICANCE Despite the villages being less than 10 km apart, community members perceived deployed baits very differently. Villagers who had never seen traps before expressed fear, anxiety and panic when they first encountered them. This was related to associations with witchcraft and "ghosts from the river" which are traditionally linked with physical or mental illness, death and misfortune. By contrast, villagers living in areas where traps had been used previously had positive attitudes towards them and were fully aware of their purpose and benefits. The latter group reported that they had similar negative perceptions when tsetse control interventions first started a decade ago. Our results suggest that despite their proximity, acceptance of traps varies markedly between villages and this is related to the duration of experience with tsetse control programs. The success of community-based interventions against tsetse will therefore depend on early engagements with communities and carefully designed sensitization campaigns that reach all communities, especially those living in areas new to such interventions.
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Affiliation(s)
- Vanja Kovacic
- Department of Vector Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Inaki Tirados
- Department of Vector Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Johan Esterhuizen
- Department of Vector Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Clement T. N. Mangwiro
- Department of Animal Science, Bindura University of Science Education, Bindura, Zimbabwe
| | - Stephen J. Torr
- Department of Vector Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Michael J. Lehane
- Department of Vector Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Helen Smith
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
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12
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Loroño-Pino MA, García-Rejón JE, Machain-Williams C, Gomez-Carro S, Nuñez-Ayala G, Nájera-Vázquez MDR, Losoya A, Aguilar L, Saavedra-Rodriguez K, Lozano-Fuentes S, Beaty MK, Black WC, Keefe TJ, Eisen L, Beaty BJ. Towards a Casa Segura: a consumer product study of the effect of insecticide-treated curtains on Aedes aegypti and dengue virus infections in the home. Am J Trop Med Hyg 2013; 89:385-97. [PMID: 23732254 DOI: 10.4269/ajtmh.12-0772] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
The home, or domicile, is the principal environment for transmission of dengue virus (DENV) between humans and mosquito vectors. Community-wide distribution of insecticide-treated curtains (ITCs), mimicking vector control program-driven interventions, has shown promise to reduce DENV infections. We conducted a Casa Segura consumer product intervention study in Mérida, Mexico to determine the potential to reduce intradomicillary DENV transmission through ITC use in individual homes. Dengue virus infections in mosquitoes and in humans were reduced in homes with ITCs in one of two study subareas. Overall, ITCs reduced intradomicillary DENV transmission; ITC homes were significantly less likely to experience multiple DENV infections in humans than NTC homes. Dengue virus-infected Aedes aegypti females were reduced within the ITC homes where curtain use was highest. Some homes yielded up to nine infected Ae. aegypti females. This study provides insights regarding best practices for Casa Segura interventions to protect homes from intradomicillary DENV transmission.
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Affiliation(s)
- María Alba Loroño-Pino
- Laboratorio de Arbovirología, Centro de Investigaciones Regionales Dr. Hideyo Noguchi, Universidad Autónoma de Yucatán, Mérida, Yucatán, Mexico.
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Vanlerberghe V, Trongtokit Y, Jirarojwatana S, Jirarojwatana R, Lenhart A, Apiwathnasorn C, McCall PJ, Van der Stuyft P. Coverage-dependent effect of insecticide-treated curtains for dengue control in Thailand. Am J Trop Med Hyg 2013; 89:93-8. [PMID: 23669233 DOI: 10.4269/ajtmh.13-0015] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Evidence on the effectiveness of insecticide-treated curtains (ITCs) for reducing densities of Aedes mosquitoes, the principal vectors of dengue, is scarce. In Laem Chabang southeast of Bangkok, Thailand, the Breteau Index (BI) (number of positive containers/100 houses) was 45 in October 2006. In March 2007, we distributed long-lasting ITCs in 22 clusters (2,032 houses) and selected 66 control clusters (661 houses). Routine control activities continued in all clusters. Six months after distribution, the BI was 25.8 and 77.6 in intervention and control areas, respectively (P < 0.001). Eighteen months after distribution, the BI was 21.8 and 23.8, respectively (P = 0.28). The average number of ITCs/house at cluster level was associated with the BI (P < 0.01) after six months, when 70.5% of households still used ITCs, but not at 18 months, when ITC coverage had decreased to 33.2%. Deployment of ITCs can result in considerable reductions in Aedes infestation levels, but the effect is coverage dependent.
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Affiliation(s)
- Veerle Vanlerberghe
- Unit of General Epidemiology and Disease Control, Institute of Tropical Medicine, Antwerp, Belgium.
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14
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Lenhart A, Trongtokit Y, Alexander N, Apiwathnasorn C, Satimai W, Vanlerberghe V, Van der Stuyft P, McCall PJ. A cluster-randomized trial of insecticide-treated curtains for dengue vector control in Thailand. Am J Trop Med Hyg 2012; 88:254-9. [PMID: 23166195 DOI: 10.4269/ajtmh.2012.12-0423] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
The efficacy of insecticide-treated window curtains (ITCs) for dengue vector control was evaluated in Thailand in a cluster-randomized controlled trial. A total of 2,037 houses in 26 clusters was randomized to receive the intervention or act as control (no treatment). Entomological surveys measured Aedes infestations (Breteau index, house index, container index, and pupae per person index) and oviposition indices (mean numbers of eggs laid in oviposition traps) immediately before and after intervention, and at 3-month intervals over 12 months. There were no consistent statistically significant differences in entomological indices between intervention and control clusters, although oviposition indices were lower (P < 0.01) in ITC clusters during the wet season. It is possible that the open housing structures in the study reduced the likelihood of mosquitoes making contact with ITCs. ITCs deployed in a region where this house design is common may be unsuitable for dengue vector control.
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Affiliation(s)
- Audrey Lenhart
- Vector Group, Liverpool School of Tropical Medicine, Liverpool, UK.
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Baly A, Flessa S, Cote M, Thiramanus T, Vanlerberghe V, Villegas E, Jirarojwatana S, Van der Stuyft P. The cost of routine Aedes aegypti control and of insecticide-treated curtain implementation. Am J Trop Med Hyg 2011; 84:747-52. [PMID: 21540384 PMCID: PMC3083742 DOI: 10.4269/ajtmh.2011.10-0532] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2010] [Accepted: 01/17/2011] [Indexed: 11/07/2022] Open
Abstract
Insecticide-treated curtains (ITCs) are promoted for controlling the Dengue vector Aedes aegypti. We assessed the cost of the routine Aedes control program (RACP) and the cost of ITC implementation through the RACP and health committees in Venezuela and through health volunteers in Thailand. The yearly cost of the RACP per household amounted to US$2.14 and $1.89, respectively. The ITC implementation cost over three times more, depending on the channel used. In Venezuela the RACP was the most efficient implementation-channel. It spent US$1.90 (95% confidence interval [CI]: 1.83; 1.97) per curtain distributed, of which 76.9% for the curtain itself. Implementation by health committees cost significantly (P = 0.02) more: US$2.32 (95% CI: 1.93; 2.61) of which 63% for the curtain. For ITC implementation to be at least as cost-effective as the RACP, at equal effectiveness and actual ITC prices, the attained curtain coverage and the adulticiding effect should last for 3 years.
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Affiliation(s)
- Alberto Baly
- Institute of Tropical Medicine Pedro Kourí, Autopista Novia del Mediodia Km. 6½, La Lisa, Havana City, Cuba.
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Vanlerberghe V, Villegas E, Oviedo M, Baly A, Lenhart A, McCall PJ, Van der Stuyft P. Evaluation of the effectiveness of insecticide treated materials for household level dengue vector control. PLoS Negl Trop Dis 2011; 5:e994. [PMID: 21468313 PMCID: PMC3066153 DOI: 10.1371/journal.pntd.0000994] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2010] [Accepted: 03/03/2011] [Indexed: 11/23/2022] Open
Abstract
Objective To assess the operational effectiveness of long-lasting insecticide treated materials (ITMs), when used at household level, for the control of Aedes aegypti in moderately infested urban and suburban areas. Methods In an intervention study, ITMs consisting of curtains and water jar-covers (made from PermaNet) were distributed under routine field conditions in 10 clusters (5 urban and 5 suburban), with over 4000 houses, in Trujillo, Venezuela. Impact of the interventions were determined by comparing pre-and post-intervention measures of the Breteau index (BI, number of positive containers/100 houses) and pupae per person index (PPI), and by comparison with indices from untreated areas of the same municipalities. The effect of ITM coverage was modeled. Results At distribution, the proportion of households with ≥1 ITM curtain was 79.7% in urban and 75.2% in suburban clusters, but decreased to 32.3% and 39.0%, respectively, after 18 months. The corresponding figures for the proportion of jars using ITM covers were 34.0% and 50.8% at distribution and 17.0% and 21.0% after 18 months, respectively. Prior to intervention, the BI was 8.5 in urban clusters and 42.4 in suburban clusters, and the PPI was 0.2 and 0.9, respectively. In both urban and suburban clusters, the BI showed a sustained 55% decrease, while no discernable pattern was observed at the municipal level. After controlling for confounding factors, the percentage ITM curtain coverage, but not ITM jar-cover coverage, was significantly associated with both entomological indices (Incidence Rate Ratio = 0.98; 95%CI 0.97–0.99). The IRR implied that ITM curtain coverage of at least 50% was necessary to reduce A. aegypti infestation levels by 50%. Conclusion Deployment of insecticide treated window curtains in households can result in significant reductions in A. aegypti levels when dengue vector infestations are moderate, but the magnitude of the effect depends on the coverage attained, which itself can decline rapidly over time. An estimated 40% of the world's population lives at risk of contracting dengue, and it inflicts a significant health, economic and social burden on the populations of endemic areas. In the absence of a vaccine, vector control is the only available strategy to prevent transmission. Some control methods against Aedes aegypti (the main dengue vector) have been successful in reducing vector infestation levels, but rarely sustained the reductions for a prolonged period. We report here on the first effectiveness trial of insecticide treated curtains and jar covers against A. aegypti implemented under ‘real-life’ conditions. The coverage of tools was high at distribution, but declined quickly over the 18 months of follow up. The vector infestation levels showed a sustained 55% decrease in the intervention clusters, while no discernable pattern was observed at the municipal level. At least 50% curtain coverage was needed to reduce A. aegypti infestation levels by 50%. We concluded that deployment of insecticide treated window curtains in households can result in significant reductions in dengue vector levels, which are related to dengue transmission risk. The magnitude of the effect depends on the curtain coverage attained, which itself can decline rapidly over time.
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