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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
Water quality in natural sources, tap, bottled
Foods and food handling
Diarrheal agents distribution
• Climate
• Urban infrastructure
• Income
• House construction
• Public services
• Population practices with regards
to disease transmission
http://radio.rpp.com.pe/nutricion/la-amenaza-de-las-infecciones-respiratorias-y-
diarreicas/diarrea/
http://es.dreamstime.com/foto-de-archivo-libre-de-regal%C3%ADas-patio-trasero-estrecho-sucio-image29334525
http://fr.wikipedia.org/wiki/Latrines
http://residentescuauhtemoc.org.mx/donde-prefieres-comer/
http://www.hielofiesta.com.mx/web/productos.php
*
*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
1. Source of water forgeneral use
2. Source of drinkingwater
3. Treatment (if any) of drinking water
4. Water storage devices
5. Toilet type (latrine, W.C.
Premise condition
index
No. of houses
sampled
Proportion of
positive houses
Positive containers
per house
Low risk 38 (8%) 0.08 (1) 0.07 (1)
Medium risk 271 (59%) 0.18 (2.25) 0.22 (3.1)
High risk 151 (33%) 0.37 (4.6) 0.58 (8.3)
460
Premise condition
index
No. of houses
sampled
Proportion of
positive houses
Average adults
per house
Low risk 38 (8%) 0.22 (1) 0.28 (1)
Medium risk 271 (59%) 0.40 (1.81) 0.90 (2.48)
High risk 151 (33%) 0.50 (2.27) 1.50 (5.35)
460
Risk of Aedes aegypti larvae
Risk of Ae. aegypti adults
Baseline results (Huixtla)
Premise condition
index
No. of houses
sampled
Proportion of
houses with total
coliforms
Proportion of
houses with fecal
coliforms
Low risk 15 (3%) 0.04 (1) 0.018 (1)
Medium risk 225 (49%) 0.06 (1.5) 0.04 (2.22)
High risk 220 (48%) 0.1 (2.5) 0.06 (3.33)
460
Risk of diarreheogenic agents
Baseline results (Huixtla)
*Community workshops of awareness and training
Social communication instruments
Training of volunteers
“Untadita”
http://www.quintanarooaldia.com/noticia/patio-limpio-en-casas-de-la-colosio/5373
Patio limpio
Boil water Use bottled water
Wash hands
https://recursoslibres.wordpress.com/category/alimentacion/
http://www.aguaquecuidadeti.com/hervir-el-agua-no-suficiente/hervir-agua-cuidadeti/
http://www.sitioandino.com/nota/114089-las-consecuencias-de-no-lavarse-las-manos/
*
*County authorities
*Health services
*Schools
*Religious groups
*Organizaciones comunitarias
*Services providers
*General population
*Reaserchers (facilitators)
*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)
Baseline 3 months 6 months Baseline 3 months 6 months
N N N N N N
Premiseconditionindex
300 6.5 300 6.6 300 6.3 300 6.7 300 5.7 300 6.7
Houseindex
81 27% 86 29% 96 32% 72 24% 50 17% 49 16%
Pupal index 47 16% 54 18% 60 20% 47 16% 25 8% 14 4%
Adult index 243 81% 260 83% 283 94% 250 83% 205 68% 105 35%
*
Indicator Ciudad Hidalgo (control) Huixtla (intervention)
Baseline 3 months 6 months Baseline 3 months 6 months
N N N N N N
CT cons. 300 92% 300 98% 300 93% 300 84% 300 85% 300 95%
CF cons. 300 62% 300 56% 300 43% 300 20% 300 21% 300 46%
CHL resid. 300 30% 300 40% 300 33% 300 32% 300 40% 300 36%
CT drink. 300 94% 300 92% 300 82% 300 75% 300 77% 300 93%
CF drink. 300 34% 300 36% 300 46% 300 12% 300 11% 300 34%
CHL resid. 300 30% 300 27% 300 29% 300 40% 300 42% 300 48%
CT: total coliforms cons.: general use waterCF: fecal coliforms drink.: drinking waterCHL resid. : residual chlorine
Sustainability challenges
Stan Hurricane: Delayed final line assessments: all field personnel was reassigned to help in emergency disease prevention
Luckily, in undamaged households, AGUA SEGURA activities were continued by residents.
Elder volunteers (100) and community health students (20)were hired on AGUA SEGURA inititiative to distibute and collect pamphlets.
Approx. 25,000 pamphlets were distributed
Following the study, in 2008, Tapachula’s sanitary district included the untadita as a part to health promotion activities.
DEJAR SECAR
15 MINUTOS
MEZCLAR UNA PORCION
IGUAL 1/1
DE CLORO Y DETERGENTE
CEPILLE LAS PAREDES
CON CLORO Y JABON
ENJUAGANDO LLENAR CON AGUA
E
N
C
U
E
S
T
A
E
N
T
O
M
O
L
O
G
I
C
A PROMOCION DE TANQUE
LIMPIO
E
N
C
U
E
S
T
A
D
E
P
E
R
C
E
P
C
I
O
N
SUPERVISION SEMANAL DE CASAS QUE ENTREN A LA UNTADITA
POR VISITADORES VOLUNTARIOS DE MANZANA
*
KAP questionnaire.
Prestadores de Servicio Social realizando entrevista a los habitantes.
N= 350 household heads
1. What is dengue?
2. Knowledge about the disease and mosquito life cycle?
3.Signs of symptoms?
4.Wash water storage tank each week?
5.Knowledge about disease prevention?
6.Clean patio once every week?
0
10
20
30
40
50
60
70
80
90
Q1 Q2 Q3 Q4 Q5 Q6
Yes 81.61 66.12 67.74 33.54 83.87 74.19
No 28.38 33.87 32.25 66.45 16.12 25.8
Gradodeconocimientodepoblacionencuestadaenlascolonias5deFebreroyCol.Palmeras2013*
Yes
N: 350 Viviendas
ENCUESTA ENTOMOLÓGICA DE LAS COLONIAS PARA PROYECTO «LA LIMPIEZA EMPIEZA EN CASA USANDO LA UNTADITA» 2012-
2013
350 CASAS VISITADAS
RECIPIENTES
%
Training
Doña Miriam se mostraba emocionada al momento de hacer las iluminaciones
*
Explicación por parte del facilitador.
0
20
40
60
80
100
P 1 P 2 P 3 P 4 P 5 P 6Si 100 95 98 94 99 98
No 0 5 2 6 1 2
Grado de conocimiento de poblacion encuestada en las colonias 5 de Febrero y Col. Palmeras despues de la intervencion 2013
Si No N: 350 Viviendas
RESULTADOS
VERIFICACIÓN ENTOMOLÓGICA EN LAS COLONIAS SELECCIONADAS PARA PROYECTO «LA LIMPIEZA EMPIEZA EN CASA USANDO LA UNTADITA»
350 CASAS VISITADAS
RESULTADOS
%
RECIPIENTES
EVALUACION MENSUAL DE TANQUES Y TAMBOS EN LAS COLONIAS SELECCIONADAS PARA PROYECTO «LA UNTADITA» TAPACHULA 2012-2013
n:=350
RESULTADOS
RESULTADOS
*