Prevention Approaches

Prevention is that action that stops something from happening or arising.

Prevention is an action or a set of actions designed to stop something before it actually happens. We all take preventive action ever day: we wear seat belts to save ourselves from death or serious injury in car accidents, we built our house in high ground to save ourselves from drowning in water during flood etc.

Long Term Prevention Strategy

Community Participation

Community participation (CP) has been defined “as a process whereby individuals, families and communities are involved in the planning and conduct of local vector control activities so as to ensure that the programme meets the local needs and priorities of the people who live in the community, and promotes community’s self-reliance in respect to development.” In short, CP entails the creation of opportunities that enable all members of the community and extended society to actively contribute to, influence the development of, and share equitably in the fruits of accrued benefits. Objectives of community participation in dengue prevention and control:

  • To extend the coverage of the programmer to the whole community by creating community awareness. This however often requires intensive inputs.
  • To make the programmer more efficient and cost-effective, with greater coordination of resources, activities and efforts pooled by the community.
  • To make the programmer more effective through joint community efforts to set goals, objectives and strategies for action.
  • To promote equity through sharing of responsibility, and through solidarity in serving those in greatest need and at greatest risk.
  • To promote self-reliance among community members and increase their sense of control over their own health and destiny.

How to invoke community participation

  • By showing concern: Community and government organizers should reflect the true concern for human suffering, i.e. morbidity and mortality due to dengue in the country, economic losses to the families and the country, and how the benefits of the programmer fit into the people’s needs and expectations.
  • Initiating dialogue: Community organizers and opinion leaders or other key personnel in the power structure of the community, namely women’s groups, youth groups and civic organizations, should be identified. Dialogue should be undertaken through personal contacts, group discussions and film show. Interaction should generate mutual understanding, trust and confidence, enthusiasm and motivation. The interaction should not be a one-time affair, but should be a continuing dialogue to achieve sustainability.
  • Creating community ownership: Organizers should use community ideas and participation to initiate the programmer, community leaders to assist the programmer, and community resources to fund the programmer. Mosquito control, abatement agency and community partnerships should be strong, but limited to providing technical guidance and expertise.
  • Health education (HE): Health education should not be based on telling people the do’s and don’ts through a vertical, top-down communication process. Instead, health education should be based on formative research to identify what is important to the community and should be implemented at three levels, i.e. the community level, systems level and political level.

Community level: People should not only be provided with knowledge and skills on vector control, but education materials should empower them with the knowledge that allows them to make positive health choices and gives them the ability to act individually and collectively.

Systems level: To enable people to mobilize local actions and societal forces beyond a single community, i.e. health, development and social services.

Political level: Mechanisms must be made available to allow people to articulate their health priorities to political authorities. This will facilitate placing vector control high on the priority agenda and effectively lobby for policies and actions.

Defining community actions: For sustaining DF/DHF prevention and control programmes, the following community actions are essential:

  • At the individual level, encourage each household to adopt routine health measures that will help in the control of DF and DHF, including source reduction and implementation of proper personal protection measures.
  • At the community level, organize “clean-up” campaigns two or more times a year to control the larval habitats of the vectors in public and private areas of the community. Some key factors for the success of such campaigns include extensive publicity via mass media, posters and pamphlets, proper planning, pre-campaign evaluation of foci, execution in the community as promised, and follow-up evaluations. Participation by municipal sanitation services should be promoted.
  • Where community-wide participation is difficult to arrange for geographical, occupational or demographic reasons, participation can be arranged through voluntary associations and organizations. The people in these organizations may interact daily in work or institutional settings, or come together for special purposes, i.e. religious activities, civic clubs, women’s groups and schools.
  • Emphasize school-based programmes targeting children and parents to eliminate vector breeding at home and at school.
  • Challenge and encourage the private sector to participate in the beautification and sanitary improvement of the community as sponsors, emphasizing source reduction of dengue vectors.
  • Combine community participation in DHF prevention and control with other priorities of community development. Where municipal services (such as refuse collection, wastewater disposal, provision of potable water, etc.) are either lacking or inadequate, the community and their partners can be mobilized to improve such services, and at the same time reduce the larval habitats of Aedes vectors as part of an overall effort at community development.
  • Combine dengue vector control with the control of all species of disease-bearing and nuisance mosquitoes as well as other vermin, to ensure greater benefits for the community and consequently greater participation in neighborhood campaigns.
  • Arrange novel incentives for those who participate in community programmes for dengue control. For example, a nationwide competition can be promoted to identify the cleanest communities or those with the lowest larval indices within an urban area.

Intersectoral Coordination

Developing economies in countries of the South-East Asia Region have recognized many social, economic and environmental problems which promote mosquito breeding. The dengue problem thus exceeds the capabilities of ministries of health. The prevention and control of dengue requires close collaboration and partnerships between the health and non-health sectors (both government and private), nongovernmental organizations (NGOs) and local communities. During epidemics such cooperation becomes even more critical, since it requires pooling of resources from all groups to check the spread of the disease. Intersectoral cooperation involves at least two components:

  • Resource-sharing
  • Policy adjustments among the various ministries and nongovernmental sectors.

Resource sharing

Resource sharing should be sought wherever the dengue control coordinator can make use of underutilized human resources, e.g. for local manufacture of needed tools, seasonal government laborer’s for water supply improvement activities, or community and youth groups to clean up discarded tires and containers in neighborhoods. The dengue control programmer should seek the accommodation or adjustment of existing policies and practices of other ministries, sectors, and municipal governments to include public health as a central focus for their goals. For instance, the public works sector could be encouraged to adjust its policies to give first priority to water supply improvements for communities at highest risk of dengue.

Role of the ministry responsible for public works

The ministry responsible for public works and its municipal counterparts should play a key role in dengue control. They can contribute to source reduction by providing a safe, dependable water supply, adequate sanitation, and effective solid waste management. In addition, through the adoption and enforcement of housing and building codes, a municipality may mandate the provision of utilities such as individual household piped water supplies or sewerage connections, and rainwater (storm water) run-off control for new housing developments, or forbid open surface wells.

Role of the Ministry of Education

The Ministry of Health should work closely with the Ministry of Education to develop a health education (health communication) component targeted at school children, and devise and communicate appropriate health messages. Health education models can be jointly developed, tested, implemented and evaluated for various age groups. Research programmers in universities and colleges can be encouraged to include components that produce information of direct importance (e.g. vector biology and control, case management) or indirect importance (e.g. improved water supply, educational interventions to promote community sanitation, waste characterization studies) to dengue control programmers.

Role of the ministry responsible for the environment

The Ministry of Environment can help the Ministry of Health collect data and information on ecosystems and habitats in or around cities at high risk of dengue. Data and information on local geology and climate, land usages, forest cover, surface waters, and human populations are useful in planning control measures for specific ecosystems and habitats. The Ministry of Environment may also be helpful in determining the beneficial and adverse impacts of various Ae. aegypti control tactics (chemical, environmental and biological).

Role of Nongovernmental organization (NGOs)

NGOs can play an important role in promoting community participation and implementing environmental management for dengue vector control. This will most often involve health education, source reduction, and housing improvement related to vector control. Community NGOs may be informal neighborhood groups or formal private voluntary organizations, service clubs, churches or other religious groups, or environmental and social action groups.

After proper training by the Ministry of Health staff in source reduction methods, NGOs can collect discarded containers (tyres, bottles, tins, etc.), clean drains and culverts, fill depressions, remove abandoned cars and roadside junk, and distribute sand or cement to fill tree holes. NGOs may also play a key role in the development of recycling activities to remove discarded containers from yards and streets. Such activities must be coordinated with the environmental sanitation service.

Model Development

Model development for dengue control through a community participation approach should be initiated in order to define potential prime movers in the communities and to study ways to persuade them to participate in vector control activities. Social, economic and cultural factors that promote or discourage the participation of these groups should be intensively studied in order to gain more participation from the community. Model development focusing on school children has been studied in several countries and this strategy should be modified and introduced into each country.

Social Mobilization

Advocacy meetings should be conducted for policy makers to attain political commitment for mass clean-up campaigns and environmental sanitation. Intersectoral coordination meetings should be conducted to explore possible donors for m\ass antilarval control campaigns and measures and to help finance the programme. Reorientation training of health workers should be conducted to improve their technical capability and ability to supervise prevention and control activities. A “DHF month” should be identified twice a year, during the pre-transmission season and during the peak transmission period.

Health Education

Health education is very important in achieving community participation. It is a long-term process to achieve human behavioral change, and thus should be carried out on a continuous basis. Even though countries may have limited resources, health education should be given priority in endemic areas and in areas at high risk for DHF. Health education is conducted through the different channels of personal communication, group educational activities, and mass media. Health education can be implemented by women’s groups, school teachers, formal and informal community leaders, and health workers. Health education efforts should be intensified before the period of dengue transmission as one of the components of social mobilization. Th\e main target groups are school children and women.