title: Development of a community-based intervention for the control of Chagas disease based on peridomestic animal management: an eco-bio-social perspective.
abstract: BACKGROUND
  Integrated vector management strategies depend on local eco-bio-social conditions, community participation, political will and inter-sectorial partnership. Previously identified risk factors for persistent Triatoma dimidiata infestation include the presence of rodents and chickens, tiled roofs, dirt floors, partial wall plastering and dog density.
  
  
  METHODS
  A community-based intervention was developed and implemented based on cyclical stakeholder and situational analyses. Intervention implementation and evaluation combined participatory action research and cluster randomized pre-test post-test experimental designs. The intervention included modified insecticide application, education regarding Chagas disease and risk factors, and participatory rodent control.
  
  
  RESULTS
  At final evaluation there was no significant difference in post-test triatomine infestation between intervention and control, keeping pre-test rodent and triatomine infestations constant. Knowledge levels regarding Chagas disease and prevention practices including rodent control, chicken management and health service access increased significantly only in intervention communities. The odds of nymph infection and rat infestation were 8.3 and 1.9-fold higher in control compared to intervention communities, respectively.
  
  
  CONCLUSIONS
  Vector control measures without reservoir control are insufficient to reduce transmission risk in areas with persistent triatomine infestation. This integrated vector management program can complement house improvement initiatives by prioritizing households with risk factors such as tiled roofs. Requirement for active participation and multi-sectorial coordination poses implementation challenges.
authors.affiliation: Centro de Estudios en Salud, Universidad del Valle de Guatemala, Guatemala 01015, Guatemala.
authors.forename: Sandra M
authors.initials: SM
authors.lastname: De Urioste-Stone
authors.affiliation: Centro de Estudios en Salud, Universidad del Valle de Guatemala, Guatemala 01015, Guatemala pamelap@uvg.edu.gt.
authors.forename: Pamela M
authors.initials: PM
authors.lastname: Pennington
authors.affiliation: Centro de Estudios en Salud, Universidad del Valle de Guatemala, Guatemala 01015, Guatemala.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Pellecer
authors.affiliation: Centro de Estudios en Salud, Universidad del Valle de Guatemala, Guatemala 01015, Guatemala.
authors.forename: Teresa M
authors.initials: TM
authors.lastname: Aguilar
authors.affiliation: Centro de Estudios en Salud, Universidad del Valle de Guatemala, Guatemala 01015, Guatemala.
authors.forename: Gabriela
authors.initials: G
authors.lastname: Samayoa
authors.affiliation: Centro de Estudios en Salud, Universidad del Valle de Guatemala, Guatemala 01015, Guatemala.
authors.forename: Hugo D
authors.initials: HD
authors.lastname: Perdomo
authors.affiliation: Centro de Estudios en Salud, Universidad del Valle de Guatemala, Guatemala 01015, Guatemala.
authors.forename: Hugo
authors.initials: H
authors.lastname: Enríquez
authors.affiliation: Centro de Estudios en Salud, Universidad del Valle de Guatemala, Guatemala 01015, Guatemala.
authors.forename: José G
authors.initials: JG
authors.lastname: Juárez
mesh_terms: D000818:Animals; D014355:Chagas Disease / Q000517:prevention & control* / Q000635:transmission; D002645:Chickens / Q000469:parasitology*; D003256:Community Participation; D004283:Dog Diseases / Q000469:parasitology* / Q000635:transmission; D004285:Dogs; D004781:Environmental Exposure / Q000009:adverse effects / Q000517:prevention & control; D006166:Guatemala / Q000453:epidemiology; D007722:Health Knowledge, Attitudes, Practice; D006798:Housing / Q000592:standards; D006801:Humans; D007300:Insect Control; D007306:Insecticides; D011201:Poultry Diseases / Q000469:parasitology* / Q000635:transmission; D051381:Rats; D012307:Risk Factors; D014224:Triatoma / Q000469:parasitology*; D014349:Trypanosoma cruzi / Q000302:isolation & purification / Q000472:pathogenicity*
chemical_list: D007306:Insecticides
keywords: Cluster randomized; PRECEDE-PROCEED; Participatory action research; Rodent control; Vector control