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Table 3 Main findings for all multi-component interventions (n = 20)

From: Interventions for vector-borne diseases focused on housing and hygiene in urban areas: a scoping review

Author Year Country
VBDS
Study design
Sample size
Duration
Components of interventiona Effectiveness of intervention based on outcomes measuresb Challenges faced, lessons learnt and/or recommendations
Community-based Approach (n = 15)
Castro et al. (2009) [37] Tanzania
Malaria
•Quanti non randomized
• 3 groups of 2 drains in 6 different area of around 300 houses each (n = around 1800 houses)
•1 year
• Initial assessment of drains,
• community sensitization and drain cleaning
• evaluation.
•↓ malaria infection in intervention neighborhoods vs pre-cleaning period (OR = 0.12, 95% CI: 0.05–0.3, P < 0.001).
•↑ risk of infection (OR = 1.7, 95% CI: 1.1–2.4, P < 0.001) in neighbourhoods under no intervention after cleaning
•18 months after: only 1 drain still clean with continued maintenance efforts (other drain = lack of proper resources and local commitment limited success)
4 elements are needed for sustainable environmental management: i) political will and commitment, ii) community participation, iii) financial resources iv) and inter-sectoral collaboration.
Abeyewickreme et al. (2013) [29] Sri Lanka
Dengue
• Mixed methods (C-RCT)
• 4 clusters of 200 households each in intervention and control (n = 1600 houses)
•1 year
•Mobilization of the community and promotion of proper solid waste management at household level
• Raising awareness on solid waste management among multi-stakeholders + improving garbage collection with the assistance of local government.
•Awareness program and cleaning campaigns for school children in 8 schools.
• Distribution of low-cost compost bins free of charge + 50% discount coupons given to buy additional bins
• Qualitative analysis including: focus group discussions to plan and monitor interventions and to assess community mobilization; in-depth key informant interview to plan the intervention; stakeholder and gender analyses
•↑ regular of garbage collection by local authorities in and beyond intervention clusters
• Women identified as key actors in the entire process of cleaning homesteads and solid waste management at household level.
• On average, over 100 persons participated in each voluntary campaign to clean the outdoor environment (8 campaigns in total)
• ↓ BI from 11.75 and 9.75 at baseline to 3.13 and 6.25 in the intervention and the control clusters respectively
The mobilization of the community was essential for the successful implementation and sustainability of the programmes.
Coordination of local authorities and increased household responsibility is vital for effective and sustained dengue control.
Andersson et al. (2015) [30] Nicaragua and Mexico
Dengue
• Quanti C- RCT
• 75 clusters in intervention (45 in Mexico and 30 in Nicaragua) and 75 control clusters (about 140 houses each) (n = around 19 000 houses)
• 1 year
• All clusters = pesticide-free communities with ongoing standard vector control programs
•3-steps mobilization program and each community chose and implemented individual prevention actions based on community resources:
- permission asked from community leaders and engaged them in discussion of baseline evidence
-Facilitators ran Intervention Design Groups to discuss results, costs, and specific prevention strategies
-Volunteers received training as organizers and educators.
Relative risk reductions (95% CI) =
Serology: 29.5% (3.8–55.3%)
Dengue cases: 24.7% (1.8–51.2%)
HI: 44.1% (13.6–74.7%)
CI: 36.7% (24.5–44.8%)
BI: 35.1% (16.7–55.5%)
PI: 51.7% (36.2–76.1%)
Each site implementing the intervention in its own way has the advantage of local customization and strong community engagement. In contrast with current largely vertical programs distributing temephos or fumigating, dengue control should be rebuilt with fuller community engagement, collaboration with schools, and operational integration with local/municipal services
Pengvanich et al. (2011) [31] Thailand
Dengue
•Quanti descriptive
•120 family leaders
•8 weeks
• 2-day workshop for family leader about prevention and control of dengue and to provide a family leader’ activity manual.
• Community leaders invited to discuss problems and obstacles involved in implementing dengue preventive programs and to suggest solutions.
•Family leaders were asked to practice the knowledge gained and to record their behaviour in record form.
• Weekly visit of volunteer for follow-up and collect data
• ↓ CI from 11.86 (SD: 10.93) to 0.24 (SD: 1.36) (P < 0.001) vs ↓ from 10.52 (SD: 10.31) to 6.81 (SD: 7.51) for control
• ↓ HI from 62.31 (SD: 16.93) to 3.21 (SD: 2.46) (P < 0.001) vs ↓ from 60.63 (SD: 15.34) to 54.03 (SD: 12.51) for control
It was recommended that the family leaders when well trained are capable of carrying out the vector control protocol effectively.
Raju et al. (2003) [32] Fiji Islands
Dengue
•Quanti descriptive
•100 premises per survey for a total of 9 surveys (n = 900 premises)
• 9 months
•Radiobroadcasts and house visits for education of source reduction and awareness of dengue risks.
• Community training for elimination of breeding sites.
• communities encouraged to collect solid waste and trash in and around their houses and placed these along the roadside for collection and disposal
• Most abundant breeding sites = tyres and drums. Tins, flower vases, plant containers, shells and others were of secondary importance.
• ↓ CI from 33 to 5% for rubber tyres and from 42 to 8% for drums.
• ↓ BI (Ae. aegypti) from 29 to 0.
• ↓ BI (Ae. albopictus) from 44 to 4.
Dengue and vector control programmes must convince people to remove breeding habitats or, alternatively, to prevent Ae. aegypti from having access to water containers and other household items that are its potential breeding sites
Sanchez et al. (2008) [33] Cuba
Dengue
•Qualitative study
•Involvement of 3 circumscription of around 1000 inhabitants each. No clear sample of interviews conducted
•2 years
• Community working group (CWG) coordinate and implement actions to community level.
• Learning group met quarterly to exchange and analyze experiences, and to develop proposals, reformulation of the work of the CWG.
• Development of strategy of local communication and social mobilization: analysis of risk and local maps of transmission risks, development of targeted messages
•Educational pamphlets and other educational material.
• ↓ 79% larval-pupal index
• No cases of dengue detected
• Qualitative analysis of satisfactory of participants and community leaders, empowerment of the communities highly appreciated
Educational activities are effective to promote behavior change and raise awareness.
Winch et al. (2002) [34] Puerto Rico
Dengue
• Mixed methods (quanti non randomized)
• No clear sample size
• No clear duration
•Four community-based programs:
-Head Start federal program for low income preschool children (classroom and community activities)
-Public school program with preventive in the regular fourth grade social science curriculum
-Posters and televised public service announcements
-Children’s Museum exhibit on Ae. Aegypti
• Semi-structured interviews and focus groups with parents, teachers, and officials + surveys on knowledge and exposure administered in the classroom to children and at home to the parents
• ↑ overall dengue-related knowledge associated to exposure of children
• ↑ tires protected from mosquitoes
• ↑ parent-child communication about dengue
• ↑ use of aerosol insecticides with the parent’s exposure to Posters.
• Overall, programs ↑ awareness and some behavior change
• no differences on larval infestation
• no differences with numbers of disposable containers
The results suggest that schoolchildren do communicate with their parents about dengue prevention, and that school programs can increase parental involvement in dengue control, but more specific messages about the behaviors to be performed need to be directed directly at parents
Arunachalam et al. (2012) [51] India
Not VBD specific (Ae. Aegypti)
•Mixed methods (C-RCT)
•10 clusters of 100 houses each in intervention (n = 4639 inhabitants) and control (n = 4439 inhabitants)
•10 months
• 17 meetings with multiple stakeholders to discuss vector control activities + mobilization of women’s self-help groups for clean-up campaigns. •Involvement of community to distribute water container covers and culturally and linguistically relevant health education materials.
•Mobilization of school children regarding dengue prevention and environmental sanitation. •Fostering of waste disposal and recycling measures to eliminate small discarded containers.
• ↓ PI to 0.004 from 1.075 (P = 0.020).
• ↓ HI to 4.2% from 19.6%;
• ↓ CI to 1.05% from 8.91%.
• ↓ BI to 4.3 from 30.8
• Knowledge of respondents about
vector and disease transmission was enhanced significantly (P < 0.05).
A community-based approach and alliance with multiple stakeholders led to a substantial reduction in dengue vector density. The most prominent benefit was the satisfaction created by ‘working together’, expressed during the in-depth interviews.
Caprara et al. (2015) [52] Brazil
Not VBD specific (Ae. Aegypti)
•Mixed methods (C-RCT)
•10 clusters of 100 houses in each intervention and control groups (n = 1000 houses)
•5 months
•Community workshops + community involvement in clean-up campaigns
•Covering elevated containers and in-house rubbish disposal without larviciding + source reduction of productive container.
•Mobilizing schoolchildren and senior inhabitants
•Distributing health education materials
•Establishing partnerships with inter-sectorial groups
•Requested the regional secretariat for a truck for waste collection
•↓ vector population via 100% elimination of most productive container types in all visited houses
•↑ knowledge of dengue and willingness to participate in preventive actions.
• Social participation was heterogeneous and shaped by historical and actual community dynamics
The results showed the effectiveness of the intervention package in comparison with the routine control programme. It is recommended that such a participatory eco-health approach offers a promising alternative to routine vector control measures such as larvicide treatment or space spraying without any social participation.
Castro et al. (2012) [53] Cuba
Not VBD specific (Ae. Aegypti)
• Quanti RCT
• 16 clusters intervention and 16 controls of 390 houses each (n = 780 houses)
• 2 years
• Creation of Management Group with researchers and community leaders;
• Modification of routine entomological surveillance to optimise the relationship between the vector control programme and the communities
• Community Working Groups (CWG) created for capacity building rooted in popular education theories;
• CWG initiated the community work for dengue vector control organised as a cycle of sequential phases developed at circumscription level
• ↑ 36.2% adequate Ae. aegypti control practices at household level (vs no change for control; OR: 3.23)
• ↑ 52.8% knowledge of breeding sites (vs 27.5% for control; OR: 1.50)
• ↑ 316% risk perception of contracting dengue fever (vs 211% for control; OR: 1.63)
• BI ↓ 53% (95% CI: 22–92%)
The empowerment strategy increased community participation and effectiveness of intervention than only routine Ae. aegypti control.
Pai et al. (2006) [54] Taiwan
Not VBD specific (Ae. Aegypti)
•Quanti descriptive
•90 households, 190 respondents
•5 months
• Evaluation post-intervention of a short-term community-based cleanliness campaign (no details)
• Ovitraps placed indoors and outdoors for 5 days + knowledge and behaviour survey
• Ovitrap index ↓ from 66.7 to 39.3% 3 months after the campaign (P < 0.05).
• Significant improvement in behaviour of source reduction after campaign (P < 0.05).
The study recommended that a short-term community-based cleanliness campaign is an effective alternative to rapidly reduce the sources of dengue vector at the onset of a new epidemic.
Qunitero et al. (2015) [55] Colombia
Not VBD specific (Ae. Aegypti)
• Quanti C-RCT
• 10 clusters of around 100 houses each in intervention and control (n = 1825 households included)
•6 months
• 3 LLINs for windows and 1 LLINs for door distributed/households (1st phase)
• Mean 1.2 lid distributed to cover water containers (2nd phase)
• Household heads interviewed by field staff + focal group discussions with local people organised to assess coverage, use and satisfaction
• LLINs alone: ↓ BI from 14 to 6 vs 8 to 5 for control (P = 0)
• + containers lids: ↓ PI 71% vs 25% for control (P = 0.01).
• Mainly, participants were impressed by the number and diversity of dead insects below curtains and they would recommend the interventions to others
The results indicate that the intervention package can reduce dengue vector density. Successful and adequate use of the intervention packages should be enhanced through appropriate social mobilisation to achieve long-lasting behavioural change.
Toaliu et al. (2004) [56] Vanuatu island
Not VBD specific (Ae. Aegypti)
•Quanti descriptive
•1500 inhabitants
• 5 year
•Identification of partners for assisting in advocacy and knowledge dissemination
• Formation of a community committee including chief, youth and women representatives
• Series of meetings and workshop for the community on dengue fever, its prevention and control.
• Play performed during workshop and in local school involving the audience walking around to identify and destroy breeding habitats, either by complete removal or by application of temephos + distribution of leaflets with key messages from the play
• Same theatre company developed TV/radio spots
• Development of videos and school handbook on key messages of dengue prevention
• Mobilization for waste removal (garbage bags; old car tyres management; lories for waste collection).
• ↓ epidemic outbreaks after intervention and only around 100 cases of dengue were recorded with no mortality Vertical programmes run by the health sector without community participation will struggle to be successful. Instead, programmes that develop horizontal partnerships, with community committees, will encourage community action and lead to more successful and sustainable outcomes.
Vanlerberghe et al. (2009) [57] Cuba
Not VBD specific (Ae. Aegypti)
•Mixed methods (C-RCT)
•16 clusters of 2000 inhabitants each in intervention and control (n = 6400 inhabitants)
• 1 year
• Routine vector control programmes (entomological surveillance, source reduction, selective adulticiding, and health education) implemented in all clusters
•Discussion with relevant local stakeholders and formation of local steering committee
• Creation of formal task forces (community working groups) at grassroots level to secure community involvement in environmental management
•Each community working group carried out a situation assessment with the community, identified local needs and priorities for environmental and dengue control, and elaborated action plans
•Action plans varied between circumscriptions including activities such as [1] locally designed social communication intending to mobilise the population and change behaviour; [2] negotiations with community and governmental inter-sectoral groups to eliminate environmental risks outside households; [3] surveillance of environmental risks with locally produced and periodically updated maps; [4] visits by teams of community members to houses with repeated Aedes infestation.
↓ Entomological indices in intervention vs control clusters:
• HI: 0.49 (0.27 to 0.88)
• PI: 0.27 (0.09 to 0.76).
• Overall community involvement assessed as “fair” (average overall score 3.34) compared with almost non-existent before intervention
• A community based environmental management strategy embedded in routine control program is effective.
• Involving the community takes time and is not a spontaneous activity. A suitable formal organisation must be identified or set up to guide the community involvement strategy and members of these organisations need training
Wai et al. (2012) [58] Myanmar
Not VBD specific (Ae. Aegypti)
•Mixed method (C-RCT)
•13 clusters of 100 households each in intervention and control (n = 2600 houses)
•9 months
• Eco-friendly multi-stakeholder partner groups (EFG) (led by ward authorities + midwives, members of Maternal and Child Welfare Association, trusted persons and school teachers) organize/ mobilize householders to accept interventions
•10 ward-based volunteers selected by EFG to participate actively in controlling dengue vectors and visiting houses
•Vector control tools applied according to the type of container and peoples’ preferences: chemical (insecticide), mechanical (cover nets), biological (dragon fly nymphs) + waste-collection bags for removing discarded small containers.
•intensive awareness-raising campaign for the local communities through group discussions
• Focus group discussions to underscore satisfaction and opinions + formal household survey for the acceptance of intervention tools
• Combined measures most frequently favoured (44.8%), then chemical (34.2%) and mechanical measures (16.5%).
• ↑ people’s awareness of appropriate vector control options for specific containers as well as positive attitudes towards joint actions
• ↑ householders’ responsibility in managing vector breeding sites
• Massive larviciding programme in response to cyclone struck happened during the study and the intervention programme was as good in ↓ vector densities as the massive larviciding in the routine service areas: ↓ PPI from 0.34 to 0.23 (32% reduction) in intervention clusters and from 0.33 to 0.15 (54.5% reduction) in routine service clusters.
In terms of sustainability and empowerment of communities and other stakeholders, the partnership approach with targeted containers interventions was found to be superior to the vertical approach.
The efficacy of the intervention was equivalent to the massive vertical larviciding programme in the aftermath of cyclone
Vertical Approach (n = 5)
Moosa-Kazemi et al. (2007) [39] Iran
Anthropo-notic cutaneous leismaniasis (ACL)
• Quanti RCT
• 3 groups of 160 houses (n = 380 houses)
• One year
• Distribution of bed nets and curtains impregnated or not with deltamelthrin SC 5%
• Health education messages were relayed to encourage use of bed nets and curtains, to explain the role of sand flies in transmission of ACL during the distribution via face-to-face and focus groups.
• Schools visited, and teachers urged to educate on the importance to protect themselves from sandfly bites
• ↓ ACL rates in impregnated area (P = 0.02) vs non-impregnated and control areas
• Use of nets and knowledge over 80%
Personal protection is an effective and sustainable means of preventing and controlling ACL and can reduce dependence on insecticides
Gurtler et al. (2009) [6] Argentina
Dengue
• Descriptive
• City wide (168 603 houses visited; 120 000 surveyed; 37 000 treated)
• 5 years (14 cycles of 4 months)
• Pre-intervention = media campaign to inform the community
• House visit = treatment of water containers with temephos + manually source reduction (removal of containers) + householders encouraged to maintain appropriate containers management
• Inspection and larvicide efforts in cemeteries and used tire lots
• ↓ Dengue cases (by DEN-1): 10.4 per 10 000 in 2000 to 0 per 10 000 in 2006
• ↑ Dengue cases (by DEN-3): 4.5 per 10 000 in 2007
• ↓ BI and HI in nearly all focal cycles compared to pre-intervention but failed to keep them below the desired target levels
(i) achievement of
sustained community acceptance; (ii) most likely averted new dengue outbreaks between 2003 and 2006, and (iii) limited to alarge extent the 2007 outbreak of DEN-3 in an immunologically
naive population.
Abramides et al. (2011) [65] Spain
Not VBD Specific (Ae. Albopictus)
• Quanti non randomized
• 6 areas of 100 to 470 houses each (n = 2104 houses visited phase 1 and n = 1000 houses visited phase 2)
• 2 years
• House visits to reduce container habitats and education about VBDs + larvicide treatment for containers that could not be emptied;
• Larvicide treatments in scuppers, water tanks and street drains containing stagnant water;
• Sanitization of municipal sites and wooded terrains, with removal of uncontrolled rubbish dumps
• Insecticide sprayed monthly on vegetation in public gardens
↓ mosquito eggs (P < 0.05) Combination of the 4 strategies was effective in reducing the number of eggs and a high level of public cooperation was obtained.
Door-to-door communication programme can have a long-term effect on the behaviour of the population.
Che-Mendoza et al. (2014) [59] Mexico
Not VBD Specific (Ae. Aegypti)
• Quanti C-RCT
• 10 clusters of 100 households each in intervention and control (n = 2000 houses)
• 2 years
• Installation of Duranet LLINs treated with 0.55% alpha-cypermethrin
• Person-to-person information on use and maintenance of LLINs
• Water tanks and drums/barrels treated with larvicide Natular DT.
• Only LLINs: ↓ infestation with Ae. Aegypti at 5 and 12 months after
• LLINs + water tanks treated: ↓ infestation with Ae. Aegypti at 18 and 24 months after
Combination LLIS fitted to external windows and doors and targeted treatment of the most productive Ae. aegypti breeding sites can impact significantly on dengue vector for up to 24 months
Espinoza-Gómez et al. (2002) [60] Mexico
Not VBD specific (Ae. Aegypti)
• Quanti RCT
• 4 groups of 45 to 49 households each (n = 187 houses)
• 6 months
• 1 group = Educational campaign = 3 visits per house (principally to housewives) + group meetings + video + small gift (sweets, stickers and calendars about dengue)
• 1 group = Malathion ULV spraying + routine vector control operations (water containers treated)
• 1 group with both and 1 control
• Overall CI ↓: 0.97 to 0.77
• More ↓ for educational group (F = 8.4, P < 0.005) than malathion
spraying group (F = 0.38, P > 0.5)
• Combination = discrete negative interaction (F = 6.52, P < 0.05)
• No differences in Knowledge And Practice indicator (F = 1.14, P > 0.1)
Inter-sectorial integration with the community for an educational campaign is an effective measure and use of chemicals (ULV) should be reserved for epidemical outbreaks.
  1. aAbbreviations: ULV Ultra Low Volume spraying, ITNs Insecticide Treated Nets, ITMs Insecticide Treated Material, LLINs Long Lasting Insecticidal Nets;
  2. bAbbreviations: BI Breteau Index, HI House Index, CI Container Index, PI Pupae / Person Index;