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BARRIERS THAT LIMIT IMPLEMENTATION OF
THERMAL FOGGING INTERVENTION FOR
VECTOR CONTROL IN MEDELLIN, COLOMBIA
ANDRÉS F. USUGA, LINA M. ZULUAGA-IDÁRRAGA, RAÚL
ROJO, ENRIQUE HENAO, GUILLERMO L. RÚA-URIBE
30 JUNE 2019
DHAKA, BANGLADESH
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Thermal fogging
• Dispersion of a liquid insecticide into the air
• Use for abatement of adult mosquitoes
• Only effective while the droplets remain airborne
• Guidelines for use are set by PAHO/WHO
INTRODUCTION
Integrated Management Strategy for Dengue (IMS-Dengue)
Thermal fogging in Medellin
• Scheduling
• Preparation
• Awareness
• Applied inside houses due to access problems
for vehicles needed for outdoor fogging
Source: http://iris.paho.org/xmlui/bitstream/handle/123456789/34860/PAHOCHA17039_eng.pdf?sequence=5&isAllowed=y
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Expected control of dengue not achieved
JUSTIFICATION FOR RESEARCH
Problems with implementation
Difficulty interveningwhen and where it is
needed
Weak adherence to application guidelines
Low coverage -residents reject fogging
in their homes
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OBJECTIVE
Propose solutions to improve effectivity ofintervention
Acceptability ofthe intervention
by residents
Temporal and spatial
opportunity of the intervention
Identify barriers
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METHODOLOGY
Cross-sectional observational study
Mixed methods design
• Explanatory sequential type
Neighborhoods prioritized for intervention
• Timeliness of the treatment
• Rejection by residents
• Factors associated with rejection described and quantified
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9/21 city sectors
18/250 neighborhoods
Study site: Medellin, Colombia
METHODOLOGY
Neighborhoods
visited
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Data collection
METHODOLOGY
Analyzing how quickly intervention occurspost-notification and if it targets thelocation of infection
Public Health Surveillance System(SIVIGILA)
Report of intervened areas
Analyzing reasons residents reject
interventions
Focus group
Categories: Experiences, Meanings,
Reasons
Awareness
Rejection
Active rejection
Passiverejection
Acceptance
Format 1
Format 2
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Time to intervention; n:64
RESULTS
Variable Median (IQR)
Days between onset of symptoms and treatment 32 (25.0-40.0)
Days between notification of surveillance system and treatment 25 (20.0-36.5)
Did intervention occur in the location of infection; n:23
Probable place of infection n (%) Places of
intervention
Opportunity
Intervención
Home 5 (21.7) Home Yes
Home and Educational
institution or Job15 (65.2) Home Partially
Job/Outside Medellin 3 (13.0) Home No
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RESULTS
89.0%
4.9%4.5%
0.6% 0.6%0.5%
Causes of passive rejection
Closed House
Minor alone at home
Bedridden sick person
Person with disabilitiesalone at homeOfficial recommends notinterveningSick person who cannotget out at home
Acceptancen=2393 (53. 7%)
Passive rejectionn=1633 (36.7%)
Active rejectionn=429 (9.6%)
Acceptance and rejection of
intervention
10.3%
12.8%
8.4%
33.1%
24.5%
3.0% 7.9%
Causes of active rejection
Nursing or pregnant woman
Sick person not bedridden
Pets
Busy
Not interest
No reason given
Othersn=4455
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No previousinterventions
Perception thatfogging affectspeople’s health
Don’t see ordon’t feelmosquitoesinside home
Perception that fogging doesn’t
control pests other than mosquitoes
Rejection of interventionassociated with
RESULTS
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CONCLUSIONS/RECOMMENDATIONS
High rejection rate was the main barrier to full coverage
Time between notification of dengue cases and intervention is longer than expected
Residents understand thermal-fogging helps to reduce densities of mosquitoes. However, it is also perceived as harmful to human health
We recommend 1) to strengthen community education about thermal fogging, 2) to carry out interventions on schedules that will maximize access to houses and 3) to identify bottlenecks in the notification system to reduce time of intervention
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