Arredondo-Jiménez JI,(1) Torreblanca-López SR,(2) Ordóñez-González JG,(3) Rivero NE,(3) Valdez-Delgado KM,(3) López T,(3) Cirerol BE,(3) Malo IR,(3) Pérez-Ramírez M,(3) Manrique-Saide P(4) (1) Universidad Autónoma de Nuevo León, San Nicolás de los Garza, Nuevo León, México (2) Jurisdicción Sanitaria 7, Servicios de Salud de Chiapas, Tapachula, Chiapas, México (3) Centro Regional de Investigación en Salud Pública, INSP, Tapachula, Chiapas, México (4) Universidad Autónoma de Yucatán, Mérida, Yucatán, México International Seminar on Integrated Water-Related Disease Control 12-14 May 2014, Norwegian University of Life Sciences (NMBU), Ås, Norway
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Arredondo-Jiménez JI,(1) Torreblanca-López SR,(2)
Ordóñez-González JG,(3) Rivero NE,(3) Valdez-Delgado
KM,(3) López T,(3) Cirerol BE,(3) Malo IR,(3) Pérez-Ramírez
M,(3) Manrique-Saide P(4)
(1) Universidad Autónoma de Nuevo León, San Nicolás de los Garza,
Nuevo León, México
(2) Jurisdicción Sanitaria 7, Servicios de Salud de Chiapas,
Tapachula, Chiapas, México
(3) Centro Regional de Investigación en Salud Pública, INSP,
Tapachula, Chiapas, México
(4) Universidad Autónoma de Yucatán, Mérida, Yucatán, México
International Seminar on Integrated Water-Related Disease Control12-14 May 2014, Norwegian University of Life Sciences (NMBU), �Ås, Norway
Dengue transmission: factors actingindependently to disease control and prevention activities
Vector distribution and disease prevalence
Vector distribution and abundance
• Climate
• Urban infrastructure
• Income
• House construction
• Public services
• Population practices with regards
to disease transmission
Diarrhea transmission: factors actingindependently to disease control and prevention activities
*Prevention and control of dengue and diarrheashould not be undertaken exclusively by healthservices*It is necessary to involve the community in
prevention and control: government, leaders, residents*A community-based communication strategy to
should be developed to promote social mobilization and behavioral change toreduce/eliminate the risks of dengue and diarrhea
*
1. To study ecological, socioeconomic and cultural factors with emphasis on gender analysis, associated with household water management in southern Chiapas, Mexico, as a basis to develop community-based communication strategies to prevent and control diarrhea and dengue.
2. To develop, validate, implement and evaluate a community-based communication strategy for the prevention and control of dengue and diarrhea, through proper handling of water within households, by means of effective community participation, strategic partnerships and social mobilization.
*
*Longitudinal prospective study with five transversal surveys*Sampling surveys:*Time zero line*Baseline*Middle line 1*Middle line 2*Sampling in 300
randomly selected houses per survey per cityGuatemalaMéxico
Ciudad Hidalgo
14º41’ N, 92º09’W,
alt. 10 m
Tapachula
Huixtla
15º08’ N, 92º15’W,
alt. 50 m
*
*Knowledge, attitudes and practices interviews (KAP) with respect to dengue and diarrhea *Determination of indicators of potential risk of dengue vectors or
diarrheogenic agents in households. *Entomological surveys and microbiological water quality analysis of
total and fecal coliforms*Qualitative studies *In depth interviews *Design of ideal, real and refined practices*Household trials
*Design of strategy
*
*Coordination Meetings*Huixtla y Ciudad Hidalgo*Weekly meetings with all social actors:*County authority*Health services* Schools*Community leadersLíderes comunitarios y de manzana*Volunteers
*TRAINING *Field personnel *Volunteers
Premise condition index for risk of Aedes aegypti, score based on
Appearance of house Containers in or out house
Screening on windows, doors and brick ornamnetsShadow and tidiness of backyard
*
Search for indoor resting mosquitoesDetection and inspection of wet
containers searching for mosquito larvae
* Premise condition index for risk of diarrheogenic agents,
scored on
Water samples taken from drinking and general use water
Validation of rapid assessment: water quality analysis
*Achieve behavioral/cultural with regards that residents take charge in proper water handling that reduce the risk of dengue and diarrhea
*That such change be sustainable
What can/could be (desirably) modified?
Lack of knowledge of risks by residents to
unsafe water handling
unsafe solid waste handling by residents
Impact of promoting disease preventionactivities
Negligence or refusal of residents toparticipate on individual and collectiveactions for safe water handling in theirhouseholds
Strategy design, validation, monitoring and evaluation
Logistics to start theOrganizationCompromise by actorsFacilitators + volunteersTraining Disposal of useless containersDistribution of pamphlets (1 per house per month)Follow-up of community volunteersGathering of pamphletsData processing and analysis
Transversal surveys: Time zero, baseline, middle line 1 (three monthsafter the beginning of the intervention), middle line 2 (six months), final line (twelve months, still on progress)
Sampling of 300 houses per cityData processing and analysis
Involvement of all social actors
Useless containers elimination campaign (descacharrización) with community participation: household heads, Oportunidades program affiliates (poorer families that receive monthly stipend by government), leaders of city blocks, health committees, local health services, tyre shop owners, tricycles (taxis) drivers, media available (newspaper, radio), public offices, and private businesses.
Training of proper “untadita” to: Oportunidades affiliates, leaders of city blocks, students of local high schools, health service personnel.
Main antimosquito activity performed by residentes: La untadita
Untadita: A paste made with powdersoap and undilutedchlorine that isfirmly brushed onthe walls of cementwash basins (mainmosquito containersin the area). It ishoped to killmosquito eggsattached to walls.Must be carried outonce a weeks
Beginning of the intervention
25 february, 2005
NAME: AGUA SEGURA (SAFE WATER)
SLOGAN: CON AGUA SEGURA, NI DIARREA NI DENGUE (WITH SAFE WATER, NO DIARRHEA NOR
DENGUE)
Centro de Investigación de Paludismo
Lists of household tasks
patrocinadores
Presidencia Municipal de Huixtla, Chiapas
The Untadita consists in the
brushing of a paste made
soap powder and undiluted
chlorine on cement
washbasins
AN EASY WAY TO HANDLE WATER TO PREVENT
DENGUE AND DIARRHEA
Household tasks
Yes No Reason?
Washed clothes
(diapers)
Prepared food
Boiled water
Cleaned backyards
Disposed trash
Changed diapers
Ate (at home)
Ate (outside home)
Yes No Reason?
Washed cement washbasin/drum
(“untadita”)
Washed elevated tank/cistern
(tighly covered containers)
Bagged tyres or other useful
containers
Changed animal feeding/drinking
containers
Changed water of flower pots
Eliminated aquatic plants/drained
pot bases
Covered water storing containers
Turned bottoms down all small
containers (bottles, etc.)
Filled up or drained water
puddles
Unclogged drainage
City
Date
Name
Address
More than once a week
15 min per week
Observations________________________________
___________________________________________
___________________________________________
___________________________________________
___________________________________________
_________________
Name of volunteer ______________________________
Mr./Mrs. resident: Signal with a cross if
you made these activities
With safe water…… no diarrhea, no dengue
No diarrhea, daily undertake: Every day:
boil drinking water, boil or use bottled watergeneral use: do not contaminatewater
No dengue, 15 min/week: wash the cement wash basin and drums applying the untadita, Carry out patio limpio, covercontainers, and dispose, destroy orturn bottoms down uselesscontainers
Result: Healthy kids and adultsA clean and healthy community
*No.
Community volunteers trained 350
Lost/substitution of volunteers 20
Gender: proportion of females involved 56%
AGUA SEGURA pamphlets distributed (approx.)40,000 (1 per
household)
Volunteers that did not comply 14
Pamphlets answered and recovered per month 10 per city block
Proportion of households that claimed to comply with all
recommendations of AGUA SEGURA pamphlets4806-4992
Verification by community monitoring of housed negative
to Aedes94%
Community volunteers trained 99.2%
Indicator Ciudad Hidalgo (control) Huixtla (intervention)