title: The unbearable lightness of technocratic efforts at dengue control.
abstract: OBJECTIVE
  To identify key elements that should provide an added value and assure sustainable effects of the deployment of technical tools for Aedes aegypti control.
  
  
  METHODS
  An observational study was conducted between April 2001 and March 2002 in 30 blocks (1574 houses) in the central zone of Guantanamo city. A trial that combined two complementary technical interventions, the distribution of new ground level water tanks and the intensive use of insecticide, was nested in May 2001. Another 30 blocks (1535 houses) were selected as control area. We assessed community perceptions and household risk behaviour at baseline and after 9 months, and measured the trial's impact through entomological indices.
  
  
  RESULTS
  Perceived self efficacy to solve A. aegypti infestation and prevent dengue was not modified. We found no changes in behaviour. In the study area the container indices decreased significantly from 0.7% before to 0.1% 1 month after the intervention. Six months later, they had increased to 2.7% and uncovered new water tanks constituted 75.9% of all breeding sites. Over the 9 months after the trial the average monthly house indices were similar in the study and control areas. A technical approach and lack of community involvement in the trial's implementation were the main causes of these short-lived results.
  
  
  CONCLUSIONS
  Top-down deployment of technical tools without active involvement of the community has a temporary effect and does not lead to the behavioural changes necessary for sustainable A. aegypti control.
authors.affiliation: Institute of Tropical Medicine Pedro Kouri, Ciudad de La Habana, Cuba. mariaeugeniatoledo@yahoo.es
authors.forename: Maria E
authors.initials: ME
authors.lastname: Toledo
authors.forename: Alberto
authors.initials: A
authors.lastname: Baly
authors.forename: Veerle
authors.initials: V
authors.lastname: Vanlerberghe
authors.forename: Maritza
authors.initials: M
authors.lastname: Rodríguez
authors.forename: Juan R
authors.initials: JR
authors.lastname: Benitez
authors.forename: Jacinto
authors.initials: J
authors.lastname: Duvergel
authors.forename: Patrick
authors.initials: P
authors.lastname: Van der Stuyft
mesh_terms: D000330:Aedes; D000818:Animals; D001294:Attitude to Health; D003462:Cuba; D003715:Dengue / Q000517:prevention & control*; D015438:Health Behavior; D006801:Humans; D007306:Insecticides; D009032:Mosquito Control / Q000379:methods*; D012309:Risk-Taking; D014867:Water / Q000469:parasitology; D014881:Water Supply
chemical_list: D007306:Insecticides; D014867:Water