Intersectoral coordination in Aedes aegypti control. A pilot project in Havana City, Cuba.
Background The 55th World Health Assembly declared dengue prevention and control a priority and urged Member States to develop sustainable intersectoral strategies to this end. To provide evidence for the reorientation of the dengue prevention policy in Cuba, we launched an intervention study to document the effectiveness of a local-level intersectoral approach.


METHODS
We used a quasi-experimental design. Social scientists introduced participatory methods to facilitate dialogue in the biweekly meetings of the intersectoral Health Council of the intervention area. This council subsequently developed an intersectoral plan for dengue prevention, of which the core objective was to design and implement activities for communication and social mobilization. In the control area, routine dengue control activities continued without additional input. Knowledge, attitudes and perceptions of dengue, and entomological indices were compared inside and between the areas before and after the 1-year intervention period.


RESULTS
In the intervention area the Health Council elaborated an intersectoral plan for dengue prevention focused on source reduction. The Aedes aegypti control methods consisted in eliminating useless containers in the houses and surroundings, covering tanks, and cleaning public and inhabited areas. It was implemented through communication and social mobilization. The Health Council in the control area occasionally discussed dengue issues but did not develop a coordinated action plan. Good knowledge about breeding sites and disease symptoms increased significantly (by 49.7% and 17.1% respectively) in the intervention area as well as the proportion of respondents eliminating containers in and around their houses (by 44%). No changes were observed in the control area. The House Index in the intervention area was 3.72% at baseline and decreased to 0.61% after 1 year. In the control area it remained stable throughout the study period (1.31% and 1.65% respectively).


CONCLUSIONS
The introduction of a participatory approach by social scientists promotes changes in intersectoral management. This facilitates social mobilization which, in its turn, leads to significant changes in knowledge, attitudes and dengue-related practices in the population and eventually to more effective control of Ae. aegypti.
Sanchez
L
L
Institute of Tropical Medicine Pedro Kouri, Havana City, Cuba. lsanchez@ipk.sld.cu
Perez
D
D
Pérez
T
T
Sosa
T
T
Cruz
G
G
Kouri
G
G
Boelaert
M
M
Van der Stuyft
P
P
D000330:Aedes; D000818:Animals; D003142:Communication; D003462:Cuba; D003715:Dengue / Q000517:prevention & control* / Q000523:psychology / Q000635:transmission; D007722:Health Knowledge, Attitudes, Practice; D006293:Health Promotion / Q000379:methods; D006798:Housing; D006801:Humans; D007303:Insect Vectors; D007400:Interprofessional Relations; D009032:Mosquito Control / Q000379:methods*; D017063:Outcome Assessment, Health Care; D010865:Pilot Projects