Social-ecological factors and preventive actions decrease the risk of dengue infection at the household-level: Results from a prospective dengue surveillance study in Machala, Ecuador

PLoS Negl Trop Dis. 2017 Dec 18;11(12):e0006150. doi: 10.1371/journal.pntd.0006150. eCollection 2017 Dec.

Abstract

Background: In Ecuador, dengue virus (DENV) infections 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. This study aimed to assess the impact of knowledge, attitudes, and practices (KAPs) and social-ecological factors on the presence or absence of DENV infections in the household.

Methods: In 2014 and 2015, individuals with DENV infections from sentinel clinics in Machala, Ecuador, were invited to participate in the study, as well as members of their household and members of four neighboring households located within 200 meters. We conducted diagnostic testing for DENV on all study participants; we surveyed heads of households (HOHs) regarding demographics, housing conditions and KAPs. We compared KAPs and social-ecological factors between households with (n = 139) versus without (n = 80) DENV infections, using bivariate analyses and multivariate logistic regression models with and without interactions.

Results: 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 the use of mosquito bed nets, fumigation inside the home, and piped water inside the home (p<0.05). In bivariate analyses (but not multivariate modeling), DENV infections were positively associated with HOHs who were male, employed, and of younger age than households without infections (p<0.05). DENV infections were not associated with knowledge, attitude, or reported barriers to prevention activities.

Discussion: Specific actions that can be considered to decrease the risk of DENV infections in the household include targeting vector control in highly shaded properties, fumigating inside the home, and use of mosquito bed nets. Community-level interventions include cleanup of abandoned properties, daily garbage collection, and reliable piped water inside houses. These findings can inform interventions to reduce the risk of other diseases transmitted by the Ae. aegypti mosquito, such as chikungunya and Zika fever.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aedes / virology*
  • Animals
  • Dengue / epidemiology
  • Dengue / prevention & control*
  • Dengue / virology
  • Dengue Virus / physiology*
  • Disease Outbreaks
  • Ecuador / epidemiology
  • Epidemiological Monitoring
  • Family Characteristics
  • Female
  • Housing
  • Humans
  • Insect Vectors / virology*
  • Logistic Models
  • Male
  • Middle Aged
  • Mosquito Control*
  • Prospective Studies
  • Risk Factors
  • Social Environment

Grants and funding

This study was supported in part by the U.S. Department of Defense Global Emerging Infection Surveillance (GEIS) grant (P0220_13_OT) and the Department of Medicine of SUNY Upstate Medical University. AMSI and SJR were additionally supported by NSF DEB EEID 1518681 and NSF DEB RAPID 1641145. Additional support was provided to AMSI through the Prometeo program of the National Secretary of Higher Education, Science, Technology, and Innovation (SENESCYT) of Ecuador. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.