Managing Regional Public Goods for Health: Community-Based Dengue Vector Control

Publication | September 2013

This report documents a promising, feasible, low-cost measure for controlling Aedes aegypti mosquitoes, the primary household-associated dengue vector.

Dengue is the most rapidly expanding mosquito-borne viral disease affecting humans worldwide. Globally, 50 million-100 million cases of dengue fever occur annually. This includes more than 500,000 cases of severe dengue (previously known as dengue hemorrhagic fever), hundreds of thousands of hospitalizations, and more than 20,000 deaths, mainly among children and young adults.

Unfortunately, dengue prevention and control efforts are proving less than successful in reducing the global spread and negative impacts of the disease. Control programs tend to mainly comprise emergency responses to epidemics, leaving limited resources and capacity for sustained action. Innovative and more effective measures for controlling dengue are needed to form a toolkit of vector control interventions that can be applied across a wide variety of ecological and epidemiological settings.

A new approach

This report describes a promising, low-cost, year-round vector control measure that is feasible to implement, is acceptable and safe to the public, and, once established, has minimal recurring costs. Cambodia and the Lao People's Democratic Republic (Lao PDR) participated in an intervention research project using integrated vector management (IVM), to determine whether households would accept the use of guppy fish in their large water storage jars, tanks, and drums to control mosquito larvae and pupae, and if development of effective guppy distribution programs was feasible.

The project also assessed whether household members could be motivated through community action and/or school-based programs to eliminate other, smaller, breeding sites on their property. The project teams used the Communication for Behavioral Impact (COMBI) planning tool of the World Health Organization (WHO) in developing the framework for delivering the interventions to selected villages.

Findings

The project resulted in a decline in the number of mosquito larvae present in three key water containers (jars, cement tanks, and drums). Prior to project implementation, almost 40% of the containers in the Cambodian households had mosquito larvae; by the end of the intervention, less than 3% contained larvae. Similar results were obtained in the Lao PDR.

Further, the project resulted in successful establishment of guppy breeding and distribution systems at the national, provincial, and local levels in both countries, and generated multisector collaboration between ministries, nonprofit groups, schools, and health centers. In Cambodia, 88% of the water containers contained guppies at the end of the study, while in the Lao PDR, 76% of the containers had guppies.

The project results indicate that the pilot interventions were effective and successful in mobilizing communities to establish and to maintain the guppy fish intervention, and in obtaining high levels of community acceptance of the fish in drinking water containers. Scale-up of the low-cost intervention is recommended in both countries.

Contents 

  • Foreword
  • Executive Summary
  • Introduction
  • Dengue Vector Control
  • Biological Control Agents for Mosquito Control
  • COMBI: Communication for Behavioural Impact
  • Impact of Community Mobilization and Use of Guppy Fish on Mosquito Breeding in Cambodia and the Lao PDR: A Research Project
  • Project Evaluation
  • Lessons Learned and a Way Forward
  • Annex: Revised COMBI Planning Process
  • References