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      Community-Based Control of Aedes aegypti By Using Mesocyclops in Southern Vietnam

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          Abstract

          We previously reported a new community-based mosquito control strategy that resulted in elimination of Aedes aegypti (Linn.) in 40 of 46 communes in northern and central Vietnam, and with annual recurrent total costs (direct and indirect) of only $0.28–$0.89 international dollars per person. This control strategy was extended to four provinces in southern Vietnam in Long An and Hau Giang (2004–2007) and to Long An, Ben Tre, and Vinh Long (2005–2010). In a total of 14 communes with 124,743 residents, the mean ± SD of adult female Ae. aegypti was reduced from 0.93 ± 0.62 to 0.06 ± 0.09, and the reduction of immature Ae. aegypti averaged 98.8%. By the final survey, no adults could be collected in 6 of 14 communes, and one commune, Binh Thanh, also had no immature forms. Although the community-based programs also involved community education and clean-up campaigns, the prevalence of Mesocyclops in large water storage containers > 50 liters increased from 12.77 ± 8.39 to 75.69 ± 9.17% over periods of 15–45 months. At the conclusion of the study, no confirmed dengue cases were detected in four of the five communes for which diagnostic serologic analysis was performed. The rate of progress was faster in communes that were added in stages to the program but the reason for this finding was unclear. At the completion of the formal project, sustainability funds were set up to provide each commune with the financial means to ensure that community-based dengue control activities continued.

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          Paradigms lost: toward a new understanding of community participation in health programmes.

          Community participation has been a critical part of health programmes, particularly since the acceptance of primary health care as the health policy of the member states of the World Health Organisation. However, it has rarely met the expectations of health planners/professionals. This paper argues that the reason for this failure is that community participation has been conceived in a paradigm which views community participation as a magic bullet to solve problems rooted both in health and political power. For this reason, it is necessary to use a different paradigm which views community participation as an iterative learning process allowing for a more eclectic approach to be taken. Viewing community participation in this way will enable more realistic expectations to be made. Community participation in disease control programmes focusing on community health workers is used as an example to show the limitations of the old paradigm. Participatory rapid appraisal is used to illustrate the new.
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            New strategy against Aedes aegypti in Vietnam.

            The container-breeding mosquito, Aedes aegypti, is the major global vector of dengue viruses, causing around 50 million infections annually. We have developed a mosquito control strategy, incorporating four elements: (1) a combined vertical and horizontal approach that depends on community understanding; (2) prioritised control according to the larval productivity of major habitat types; (3) use of predacious copepods of the genus Mesocyclops as a biological control agent; delivered by (4) community activities of health volunteers, schools, and the public. We have previously reported that, from 1998 to 2003, community-based vector control had resulted in A aegypti elimination in six of nine communes, with only small numbers of larvae detected in the others. Here, we report eradication in two further communes and, as a result of local expansion after the project in three northern provinces, elimination from 32 of 37 communes (309730 people). As a result, no dengue cases have been detected in any commune since 2002. These findings suggest that this strategy is sustainable in Vietnam and applicable where the major sources of A aegypti are large water storage containers.
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              Elimination of dengue by community programs using Mesocyclops(Copepoda) against Aedes aegypti in central Vietnam.

              From September 2000 to June 2003, a community-based program for dengue control using local predacious copepods of the genus Mesocyclops was conducted in three rural communes in the central Vietnam provinces of Quang Nam, Quang Ngai, and Khanh Hoa. Post-project, three subsequent entomologic surveys were conducted until March 2004. The number of households and residents in the communes were 5,913 and 27,167, respectively, and dengue notification rates for these communes from 1996 were as high as 2,418.5 per 100,000 persons. Following knowledge, attitude, and practice evaluations, surveys of water storage containers indicated that Mesocyclops spp. already occurred in 3-17% and that large tanks up to 2,000 liters, 130-300-liter jars, wells, and some 220-liter metal drums were the most productive habitats for Aedes aegypti. With technical support, the programs were driven by communal management committees, health collaborators, schoolteachers, and pupils. From quantitative estimates of the standing crop of third and fourth instars from 100 households, Ae. aegypti were reduced by approximately 90% by year 1, 92.3-98.6% by year 2, and Ae. aegypti immature forms had been eliminated from two of three communes by June 2003. Similarly, from resting adult collections from 100 households, densities were reduced to 0-1 per commune. By March 2004, two communes with no larvae had small numbers but the third was negative; one adult was collected in each of two communes while one became negative. Absolute estimates of third and fourth instars at the three intervention communes and one left untreated had significant correlations (P = 0.009-< 0.001) with numbers of adults aspirated from inside houses on each of 15 survey periods. By year 1, the incidence of dengue disease in the treated communes was reduced by 76.7% compared with non-intervention communes within the same districts, and no dengue was evident in 2002 and 2003, compared with 112.8 and 14.4 cases per 100,000 at district level. Since we had similar success in northern Vietnam from 1998 to 2000, this study demonstrates that this control model is broadly acceptable and achievable at community level but vigilance is required post-project to prevent reinfestation.
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                Author and article information

                Journal
                Am J Trop Med Hyg
                Am. J. Trop. Med. Hyg
                tpmd
                The American Journal of Tropical Medicine and Hygiene
                The American Society of Tropical Medicine and Hygiene
                0002-9637
                1476-1645
                01 May 2012
                01 May 2012
                : 86
                : 5
                : 850-859
                Affiliations
                General Department of Preventive Medicine and Environmental Health, Ministry of Health, Hanoi, Vietnam; National Institute of Hygiene and Epidemiology, Hanoi, Vietnam; Pasteur Institute, Ho Chi Minh City, Vietnam; Australian Foundation for Peoples of Asia and the Pacific, Ltd., Sydney, New South Wales, Australia; Queensland University of Technology, Brisbane, Queensland, Australia; Queensland Institute of Medical Research, Brisbane, Queensland, Australia
                Author notes
                * Address correspondence to: Brian H. Kay, Queensland Institute of Medical Research, Post Office Royal Brisbane Hospital, Brisbane 4029, Queensland, Australia. E-mail: brian.kay@ 123456qimr.edu.au
                Article
                10.4269/ajtmh.2012.11-0466
                3335693
                22556087
                f007c1e3-9fbb-4586-b0d1-ea98b9e1ee4b
                ©The American Society of Tropical Medicine and Hygiene

                This is an Open Access article distributed under the terms and of the American Society of Tropical Medicine and Hygiene's Re-use License which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 18 July 2011
                : 16 February 2012
                Categories
                Articles

                Infectious disease & Microbiology
                Infectious disease & Microbiology

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