ABSTRACT
Background In Ecuador, dengue fever and other febrile diseases transmitted by the Aedes aegypti mosquito are among the greatest public health concerns in urban coastal communities. Community- and household-level vector control is the principal means of controlling disease outbreaks. The aim of this study was to assess the impact of dengue prevention knowledge, attitudes, and practices (KAPs), as well as social-ecological factors, on the presence or absence of acute or recent dengue infections in the household.
Methods As part of dengue surveillance in Machala, Ecuador, we invited individuals with an acute dengue illness to participate, along with other members of the household and members of four neighboring households. We conducted diagnostic testing for dengue on all study participants, and we surveyed heads of households (HOHs) regarding KAPs. We compared KAPs and social-ecological factors between households with (n=139) versus without (n=80) acute or recent dengue infections, using bivariate analyses and multivariate logistic regression models with and without interactions.
Results In bivariate analyses (but not multivariate modeling), the presence of dengue infections was positively associated with HOHs who were male, employed, and of younger age than households without recent or acute dengue infections (p<0.05). Dengue infection was not associated with knowledge or attitude, or on reported barriers to prevention activities. Significant risk factors in multivariate models included proximity to abandoned properties, interruptions in piped water, and shaded patios (p<0.05). Significant protective factors included use of mosquito nets, fumigation inside the home, piped water inside the home (p<0.05).
Discussion Specific effective actions that can be considered to decrease the risk of dengue infections in the household include alteration of shade on the property, fumigating inside the home, and use of mosquito nets. Community-level interventions include clean-up of abandoned properties, daily trash pick-up, and reliable piped water inside houses. These interventions could potentially reduce the risk of other diseases transmitted by the Ae. aegypti mosquito, such as chikungunya and Zika fever.
Author summary Dengue, chikungunya and Zika viruses are transmitted to people primarily by the Aedes aegypti mosquitoes in tropical and subtropical regions. Diseases transmitted by the Ae. aegypti mosquito are a growing public health concern. Mosquito control is the principal means to preventing and controlling disease outbreaks, since vaccines are not readily available. In this study, we compared the characteristics of households with and without dengue infections in the city of Machala, Ecuador. We found that risk factors for dengue infection included proximity to abandoned properties, interruptions in the piped water supply, and a highly shaded patio. Protective factors included the use of mosquito nets, fumigation inside the home, and piped water inside the home. These findings can be used to inform targeted vector control interventions by the public health sector at the household and community levels.