Community-centred eco-bio-social approach to control dengue vectors: an intervention study from Myanmar

Abstract

Objectives: To build up and analyse the feasibility, process, and effectiveness of a partnership-driven ecosystem management intervention in reducing dengue vector breeding and constructing sustainable partnerships among multiple stakeholders.

Methods: A community-based intervention study was conducted from May 2009 to January 2010 in Yangon city. Six high-risk and six low-risk clusters were randomized and allocated as intervention and routine service areas, respectively. For each cluster, 100 households were covered. Bi-monthly entomological evaluations (i.e. larval and pupal surveys) and household acceptability surveys at the end of 6-month intervention period were conducted, supplemented by qualitative evaluations.

Intervention description: The strategies included eco-friendly multi-stakeholder partner groups (Thingaha) and ward-based volunteers, informed decision-making of householders, followed by integrated vector management approach.

Findings: Pupae per person index (PPI) decreased at the last evaluation by 5·7% (0·35–0·33) in high-risk clusters. But in low-risk clusters, PPI remarkably decreased by 63·6% (0·33–0·12). In routine service area, PPI also decreased due to availability of Temephos after Cyclone Nargis. As for total number of pupae in all containers, when compared to evaluation 1, there was a reduction of 18·6% in evaluation 2 and 44·1% in evaluation 3 in intervention area. However, in routine service area, more reduction was observed. All intervention tools were found as acceptable, being feasible to implement by multi-stakeholder partner groups.

Conclusions: The efficacy of community-controlled partnership-driven interventions was found to be superior to the vertical approach in terms of sustainability and community empowerment.

Keywords:

• Partnership-driven ecosystem management intervention
• Dengue vector breeding
• Informed decision-making
• Integrated vector management
• Community empowerment

We would like to express our heartfelt thanks to WHO/TDR funding support of Project ID A 60629: ‘Ecobiosocial dynamics for better informed dengue prevention in Myanmar’. Our gratitude goes to Ministry of Health, Myanmar for approval and to Dr Khin Pyone Kyi, Former Director General and Dr Kyaw Min, Former Deputy Director General (Department of Medical Research, Lower Myanmar), Dr Myo Khin, Acting Director General, Dr Ye Htut, Deputy Director General, Directors, and colleagues from DMR-LM for necessary support and encouragement. We are especially grateful to Dr W. Tun Lin, Director (Retd.) DMR-LM, for initiation of this project. Thanks are also due to Department of Health and all collaborators, research teams from Entomology Research Division and Epidemiology Research Division, DMR-LM for their enthusiasm and continuing efforts. We are deeply appreciated to multi-stakeholder groups and community members for their active participation. Special thanks go to Sumitomo Chemicals, Japan, for donating pyriproxyfen.