title: Entomological impact and social participation in dengue control: a cluster randomized trial in Fortaleza, Brazil.
abstract: BACKGROUND
  This study intended to implement a novel intervention strategy, in Brazil, using an ecohealth approach and analyse its effectiveness and costs in reducing Aedes aegypti vector density as well as its acceptance, feasibility and sustainability. The intervention was conducted from 2012 to 2013 in the municipality of Fortaleza, northeast Brazil.
  
  
  METHODS
  A cluster randomized controlled trial was designed by comparing ten intervention clusters with ten control clusters where routine vector control activities were conducted. The intervention included: community workshops; community involvement in clean-up campaigns; covering the elevated containers and in-house rubbish disposal without larviciding; mobilization of schoolchildren and senior inhabitants; and distribution of information, education and communication (IEC) materials in the community.
  
  
  RESULTS
  Differences in terms of social participation, commitment and leadership were present in the clusters. The results showed the effectiveness of the intervention package in comparison with the routine control programme. Differences regarding the costs of the intervention were reasonable and could be adopted by public health services.
  
  
  CONCLUSIONS
  Embedding social participation and environmental management for improved dengue vector control was feasible and significantly reduced vector densities. Such a participatory ecohealth approach offers a promising alternative to routine vector control measures.
authors.affiliation: University of Ceará State (UECE), Centro de Ciências da Saúde, Department of Public Health, UECE Av. Dr. Silas Munguba, 1700, Itaperi- Fortaleza, 60740-000, CE Brasil andreacaprara1@gmail.com.
authors.forename: Andrea
authors.initials: A
authors.lastname: Caprara
authors.affiliation: University of Ceará State (UECE), Centro de Ciências da Saúde, Department of Public Health, UECE Av. Dr. Silas Munguba, 1700, Itaperi- Fortaleza, 60740-000, CE Brasil.
authors.forename: José Wellington De Oliveira
authors.initials: JW
authors.lastname: Lima
authors.affiliation: University of Ceará State (UECE), Centro de Ciências da Saúde, Department of Public Health, UECE Av. Dr. Silas Munguba, 1700, Itaperi- Fortaleza, 60740-000, CE Brasil.
authors.forename: Ana Carolina Rocha
authors.initials: AC
authors.lastname: Peixoto
authors.affiliation: University of Ceará State (UECE), Centro de Ciências da Saúde, Department of Public Health, UECE Av. Dr. Silas Munguba, 1700, Itaperi- Fortaleza, 60740-000, CE Brasil.
authors.forename: Cyntia Monteiro Vasconcelos
authors.initials: CM
authors.lastname: Motta
authors.affiliation: University of Ceará State (UECE), Centro de Ciências da Saúde, Department of Public Health, UECE Av. Dr. Silas Munguba, 1700, Itaperi- Fortaleza, 60740-000, CE Brasil.
authors.forename: Joana Mary Soares
authors.initials: JM
authors.lastname: Nobre
authors.affiliation: Special Programme for Research and Training in Tropical Diseases (TDR), World Health Organization, Geneva, Switzerland.
authors.forename: Johannes
authors.initials: J
authors.lastname: Sommerfeld
authors.affiliation: Special Programme for Research and Training in Tropical Diseases (TDR), World Health Organization, Geneva, Switzerland Liverpool School of Tropical Medicine, Liverpool, UK.
authors.forename: Axel
authors.initials: A
authors.lastname: Kroeger
mesh_terms: D000330:Aedes / Q000469:parasitology; D000818:Animals; D001294:Attitude to Health; D001938:Brazil / Q000453:epidemiology; D016000:Cluster Analysis; D003153:Community Health Services / Q000458:organization & administration*; D003715:Dengue / Q000517:prevention & control*; D004197:Disease Reservoirs / Q000469:parasitology*; D017753:Ecosystem; D004772:Entomology; D005240:Feasibility Studies; D007722:Health Knowledge, Attitudes, Practice; D006293:Health Promotion / Q000458:organization & administration; D006798:Housing; D006801:Humans; D007303:Insect Vectors / Q000472:pathogenicity; D009032:Mosquito Control / Q000458:organization & administration*; D058992:Social Participation
keywords: Brazil; Cluster randomized trial; Dengue; Intervention study; Social participation; Vector management