title: Integrating participatory community mobilization processes to improve dengue prevention: an eco-bio-social scaling up of local success in Machala, Ecuador.
abstract: BACKGROUND
  This project investigates the effectiveness and feasibility of scaling-up an eco-bio-social approach for implementing an integrated community-based approach for dengue prevention in comparison with existing insecticide-based and emerging biolarvicide-based programs in an endemic setting in Machala, Ecuador.
  
  
  METHODS
  An integrated intervention strategy (IIS) for dengue prevention (an elementary school-based dengue education program, and clean patio and safe container program) was implemented in 10 intervention clusters from November 2012 to November 2013 using a randomized controlled cluster trial design (20 clusters: 10 intervention, 10 control; 100 households per cluster with 1986 total households). Current existing dengue prevention programs served as the control treatment in comparison clusters. Pupa per person index (PPI) is used as the main outcome measure. Particular attention was paid to social mobilization and empowerment with IIS.
  
  
  RESULTS
  Overall, IIS was successful in reducing PPI levels in intervention communities versus control clusters, with intervention clusters in the six paired clusters that followed the study design experiencing a greater reduction of PPI compared to controls (2.2 OR, 95% CI: 1.2 to 4.7). Analysis of individual cases demonstrates that consideration for contexualizing programs and strategies to local neighborhoods can be very effective in reducing PPI for dengue transmission risk reduction.
  
  
  CONCLUSIONS
  In the rapidly evolving political climate for dengue control in Ecuador, integration of successful social mobilization and empowerment strategies with existing and emerging biolarvicide-based government dengue prevention and control programs is promising in reducing PPI and dengue transmission risk in southern coastal communities like Machala. However, more profound analysis of social determination of health is called for to assess sustainability prospects.
authors.affiliation: Global Health Research Program, School of Population and Public Health, University of British Columbia, Vancouver, Canada, V6 T 1Z3 Interdisciplinary Studies Graduate Program, University of British Columbia, Vancouver, Canada, V6 T 1Z4 kmitchellfoster@gmail.com.
authors.forename: Kendra
authors.initials: K
authors.lastname: Mitchell-Foster
authors.affiliation: Facultad de Ciencias Médicas, Universidad Técnica de Machala, Machala, Ecuador, Km.5 1/2 Via Machala Pasaje Servicio Nacional de Control y Prevención de Enfermedades Transmitidas por Vectores Artrópodos, Ministerio de Salud Pública, Machala, Ecuador.
authors.forename: Efraín Beltrán
authors.initials: EB
authors.lastname: Ayala
authors.affiliation: Área de Salud, Universidad Andina Simón Bolívar sede Ecuador, Quito, Ecuador, EC1701.
authors.forename: Jaime
authors.initials: J
authors.lastname: Breilh
authors.affiliation: Global Health Research Program, School of Population and Public Health, University of British Columbia, Vancouver, Canada, V6 T 1Z3.
authors.forename: Jerry
authors.initials: J
authors.lastname: Spiegel
authors.affiliation: Facultad de Ciencias Médicas, Universidad Técnica de Machala, Machala, Ecuador, Km.5 1/2 Via Machala Pasaje Área de Salud 1, Ministerio de Salud Pública, Machala, Ecuador.
authors.forename: Ana Arichabala
authors.initials: AA
authors.lastname: Wilches
authors.affiliation: Servicio Nacional de Control y Prevención de Enfermedades Transmitidas por Vectores Artrópodos, Ministerio de Salud Pública, Machala, Ecuador.
authors.forename: Tania Ordóñez
authors.initials: TO
authors.lastname: Leon
authors.affiliation: Servicio Nacional de Control y Prevención de Enfermedades Transmitidas por Vectores Artrópodos, Ministerio de Salud Pública, Machala, Ecuador.
authors.forename: Jefferson Adrian
authors.initials: JA
authors.lastname: Delgado
mesh_terms: D000330:Aedes / Q000254:growth & development* / Q000469:parasitology; D000818:Animals; D002980:Climate; D016000:Cluster Analysis; D003715:Dengue / Q000517:prevention & control* / Q000635:transmission; D004197:Disease Reservoirs / Q000469:parasitology*; D017753:Ecosystem; D004484:Ecuador / Q000453:epidemiology; D005240:Feasibility Studies; D006801:Humans; D007306:Insecticides; D009032:Mosquito Control / Q000458:organization & administration*; D011634:Public Health; D011679:Pupa / Q000254:growth & development; D012572:School Health Services / Q000458:organization & administration*; D014867:Water / Q000469:parasitology; D014881:Water Supply
chemical_list: D007306:Insecticides; D014867:Water
keywords: Dengue prevention; Eco-bio-social; Ecosystem; Ecuador; Pupa per person index; Social mobilization