Background
Methods
Study sites and timeline
Country | Mexico | Colombia | Ecuador | Brazil | Uruguay |
---|---|---|---|---|---|
Study sites
| Ciudad Renacimiento | Girardot | Machala | Fortaleza | Salto |
Total population for study site
| 48460 | 132.456 | 281.500 | 2.447.409 | 123.000 |
Mean 46 population per study area cluster (per season) Dry – wet season | 453 (370–542) 416 (313–526) | 366 (261–454) 373 (215–479) | 399 (364–449) 403 (357–438) | 354 (202–454) 355 (202–462) | 307 (221–418) |
Geographical position
| 32º43′-14º32′ N 86º42′-118º22′ W | 4°18′ 18″ N 74°48′ 06″ W | 3.26°S 79.97° W | 3°43′01″ S 38°32′35″ W | 31º23′S, 57º58′ |
Average annual temperature (°C)
| 27.8 (Max 38.7; Min 16.2) | 28.0 (Max 38.3; Min 23.2) | 25.0 (Max 34; Min 18) | 30.0 (Max 27; Min 23) | 18.1 (Max 24.1; Min 12.5) |
Mean annual relative humidity %
| 75 | 61,5 | 84 | 90 | 72 |
Annual rainfall in 2011 (mm)
| 1145 | 530 | 448 | 1378 | 1322 |
Rainy season(s)
| May to October | March to April and October to November | November to April | February to May | Irregular; potential virus development only from mid November to April |
Area cluster definition and sampling
Sample size calculation
Grid sampling of study clusters
Data collection instruments
Cluster and household surveys
Larval and pupal productivity surveys
Data management and analysis
Ethical aspects
Results
Characteristics of the study populations
Characteristics of the study clusters
Mexico | Colombia | Ecuador | Brazil | Uruguay | |
---|---|---|---|---|---|
Social class
| 20/20 Lower middle | 14/20 Lower middle | 17/20 lower middle | 6/10 lower middle | 14/20 lower middle |
Purpose of buildings*
| 18/20 residential & commercial | 16/20 residential | 14/20 residential | 7/10 residential & commercial | 14/20 residential |
Housing conditions
| 18/20 satisfactory | 17/20 good | 15/20 satisfactory | 8/10 satisfactory | 15/20 satisfactory |
Houses with one floor**
| 20/20 | 19/20 | 19/20 | 10/10 | 17/20 |
Neighboorhoods with green areas
| 4/20 | 18/20 | 10/20 | 0/10 | 19/20 |
Neighborhoods with public recreation areas
| 11/20 | 17/20 | 10/20 | 1/10 | 11/20 |
Houses with glass windows
| 23,1% | 77,9% | 61,20% | 22,00% | 94,90% |
Houses with backyards
| 45,2% | 82,2% | 76,60% | 74,10% | 92,30% |
Indoor WC
| 82.3% | 74.9% | 67.9% | 95.5% | 95.4%*** |
Water storage (% of houses)
| 99.0% | 89.0% | 89.0% | 64.5% | 11.2% |
Stored water for drinking****
| 34.6% | 10.4% | 66.9% | 13.7% | 1.9% |
Study sities | Characteristics of the study city | Characteristics of study clusters |
---|---|---|
México
| Acapulco is a major seaport in Guerrero State. Tourism is the main economic activity; most inhabitants are involved in commerce, touristic/hotel/restaurant services & transport. 34.6% of dengue cases in Guerrero state occurred in Acapulco (1556 of 4493). The study area “Ciudad Renacimiento” is on the north side of Acapulco built as a “social project” for people living on the hills. It is primarily residential, but also with schools, small businesses, markets, automobile & tyre repair shops. It is a high-risk area for dengue. | Mainly lower middle class residents in satisfactory housing conditions. Mixed commercial (restaurants, and shops) and residential neighborhoods. The one-floor houses had usually open windows (one quarter with glass), most had indoor flush toilets and half of them backyards. Water storage was frequent, mainly for washing and cleaning but also for drinking (35%). Green areas in the neighborhood and recreational areas were rare. Public infrastructure and waste collection was good. |
Colombia
| Girardot is a municipality in the department of Cundinamarca. It is the second most important city of the department, located along Magdalena river which makes it a central spot for commerce, communication and tourism. Due to its proximity to Bogota (129 km), particularly on weekends many visitors are in the city. Day temperatures vary between 25–30. The Department belongs to the areas with highest dengue endemicity in the country. Girardot reported 50% of all dengue cases in the department. | Mainly lower middle-class residents in good housing conditions. Mainly residential areas. Some multi-storey buildings. The one-floor buildings had usually glass windows, indoor flush toilets and more than 80% had back yards. Water storage was frequent, mainly for washing and cleaning. Recreational areas and green areas were frequent. Public infrastructure and waste collection was good. |
Ecuador
| Machala, the capital of El Oro Province, lies on the Pacific Coast, is situated within an agricultural region (banana, cacao, shrimp), intensive production has contaminated the environment and watershed with agrochemicals. The Greater Municipality of Machala is marked by patchy provision of adequate basic sanitary infrastructure (piped water, sewers and paved roads often lacking in peri-urban communities) and continued rapid, unplanned urbanization; 41.4% of the population lives below the poverty line. Peri-urban neighbourhoods continue to expand into “unauthorized” territory. Dengue is a major Public Health issue. | Mainly lower middle-class residents in satisfactory housing conditions. Mainly residential areas. Some multistory buildings. The one floor buildings often had indoor flush toilets (68%), glass windows (61%) and a back yard. Water storage was frequent, mainly for drinking (67%) but also for washing and cleaning. Half of the neighborhoods had green and recreational areas. Public infrastructure and waste collection was good some with poor access roads. |
Brazil
| Fortaleza is the Capital of Ceara State in Northeast Brazil. The city has a high-income concentration, with huge differences between the poorest and the richest. The city is located in a hot semi-arid region. The city is a high risk area for dengue. | Mainly lower middle-class residents in satisfactory housing conditions. Mixed commercial (restaurants, shops) and residential areas. The one-floor buildings had almost all indoor flush toilets but no glass windows (only 22%). Most had backyards. Recreational and green areas were very rare. Public infrastructure and waste collection was good. |
Uruguay
| Salto is located in the North-east of Uruguay on the Argentinian border. It has the characteristics of a “border-city” with heavy traffic of private vehicles, international passenger transport and truckload transportation from areas in which the vector is present and cases of dengue are reported. | Mainly lower middle-class residents in satisfactory housing conditions. Mainly residential areas; some multistory buildings. The onefloor buildings had almost all indoor flush toilets, glass windows and back yards. Green and recreational areas were frequent. |
Water and sanitation
Mexico (n = 20) | Colombia (n = 20) | Ecuador (n = 20) | Brazil (n = 10) | Uruguay**** (n = 20) | ||||||
---|---|---|---|---|---|---|---|---|---|---|
Season | Dry | Wet | Dry | Wet | Dry | Wet | Dry | Wet | Dry | Wet |
Private water containers per cluster
| 728 | 603 | 184 | 263 | 443 | 582 | 445 | 927 | 54 | 47 |
% outdoor containers
| 92.4 | 97.2 | 85.2 | 79.6 | 76.3 | 52.3 | 24.1 | 25.3 | 79.4 | 84.3 |
Number of Public containers per cluster
| 16 | 19 | 13 | 35 | 4 | 2 | 30 | 35 | 1 | 1 |
Most frequent container types*
| Buckets, barrels, wash tanks | Wash tanks, barrels, buckets | Buckets, cans, wash tanks | Tires, barrels, buckets | Buckets, wash tanks | |||||
Container types most frequently with larvae**
| Tank 1.6% Barrel 1.3% | Can 19.1% Tire 15.0% | Can 44.1% Small cont. 34.3% | Tire 54.1% Tank 27.5% | Tank 21.7 Flower vase 20.8% | Tire 39.6% Tank 27.9% | Tire 7.1% Small cont. 1.7% | Nat. Prod 16.7% Tire 8.3% | Pot 60% Small Cont. 7.7% | Pot 70.6% Tire 55.5% |
Most productive container types (% of all pupae)***
| Bucket 34.5% Barrel3 0.6% Tank 23.1% | Small used 25.4% Bucket 21.0% Barrel 18.1% Cans 14.2% | Tank 71.2% Barrel 24.1% | Tank 72.5% Barrel 8.9% Tire 6.1% | Tank 47.9% Bucket 22.6% | Tank 35.5% Tire 15.9% Small Cont. 13.9% Cans 9.4% | Small cont. 50.9% Barrel 29.1% | Barrel 36.4% Cans 32.5% Bucket 8.0% | Barrel 65.3% Cans 34.7% | Cans 29.9% Others used 15.4% Bucket 13.9% Barrel 12.1% |
Number of pupae per cluster, rounded (with CIs)
| 13 (6–20) | 83 (53–112) | 465 (270–661) | 390 (293–488) | 146 (97–195) | 576 (419–734) | 6 (0.6- 10.4) | 54 (25–82) | 4 (0–7.6) | 20 (8–32) |
PPI (CIs)
| 0.03 (0.01- 0.05) | 0.2 (0.14- 0.26) | 1.24 (0.73- 1.75) | 1.03 (0.81- 1.25) | 0.37 (0.25- 0.49) | 1.42 (1.02- 1.82) | 0.01 (0.00- 0.03) | 0.15 (0.07- 0.23) | 0.01 (0.00- 0.03) | 0.07 (0.03- 0.11) |
PPH (CIs)
| 2.4 (1.24- 3.64) | 18.1 (12.8- 23.4) | 296.1 (82.8- 510.0) | 213.3 (103–323.7 | 35.0 (12.7- 57.2) | 150.2 (68.1- 232.3) | 1.8 (0.27-3.37) | 29.7 (9.1- 50.3) | 0.32 (0.00- 0.66) | 1.7 (0.76-2.61) |
BI (CIs)
| 5.5 (3.5- 7.3) | 29.2 (23.6- 34.8) | 29.2 (24.5- 33.8) | 39.8 (33.5- 46.0) | 32.9 (28.0- 37.8) | 57.9 (48.6- 67.2) | 3.3 (1.7- 4.8) | 9.6 (5.9- 13.3) | 0.7 (0.27- 1.06) | 6.2 (4.0-8.5) |
Household knowledge and practices regarding dengue vector
Current vector control by government and communities and expected actions from the government
Activities by vector control staff | Mexico (n = 2000) | Colombia (n = 1994) | Ecuador (n = 2000) | Brazil (n = 1251) | Uruguay (n = 1968) |
---|---|---|---|---|---|
Visit by control staff in last 6 months (%)
| 96.5 | 31.5 | 27.5 | 92.16 | 29.8 |
Inspect water (%)
| 33.2 | 8.9 | 9.0 | 1.1 | 37.7 |
Larviciding (%)
| 72.5 | 24.9 | 11.7 | 5.0 | 0.25 |
Indoor fogging (%)
| 27.3 | 7.0 | 2.0 | 3.1 | 1.3 |
Outdoor fogging (UVL) (%)
| 87.3 | 67.1 | 67.2 | 34.8 | 57.0 |
Health education (%)
| 6.5 | 21.4 | 15.6 | 32.8 | 13.7 |
Supply lids, recommend fish, cut plants
| Negligible | Negligible | Negligible | Negligible | Negligible |
Vector breeding and productive containers in the dry and wet season
Risk factors for vector breeding
Dry season | Wet season | |||||
---|---|---|---|---|---|---|
Container | IRRb
| 95% CI | P-value | IRRb
| 95% CI | P-value |
Not under shrubbery
| Reference | Reference | ||||
Fully or partially under shrubbery | 0.81 | 0.43-1.50 | 0.497 | 0.96 | 0.61- 1.49 | 0.862 |
Used during past 7 days
| Reference | Reference | ||||
Not used during past 7 days | 3.48 | 1.71-7.05 | 0.001 | 2.44 | 1.60- 3.72 | <0.001 |
Fully covered
| Reference | Reference | ||||
Partially covered | 0.90 | 0.39-2.05 | 0.807 | 6.22 | 2.98- 12.96 | <0.001 |
Not covered | 15.10 | 7.70- 29.58 | <0.001 | 9.88 | 5.67- 17.19 | <0.001 |
Localization indoor
| Reference | Reference | ||||
Outdoor | 3.87 | 2.03-7.36 | <0.001 | 1.39 | 0.94- 2.04 | 0.092 |
Faucet water
| Reference | Reference | ||||
Rain water | 3.42 | 1.14- 10.26 | 0.028 | 1.28 | 0.79- 2.06 | 0.315 |
Filled with rain water and tap water
| 5.20 | 2.21- 12.21 | <0.001 | 1.24 | 0.62- 2.50 | 0.538 |