Evidence based community mobilization for dengue prevention in Nicaragua and Mexico (Camino Verde, the Green Way): cluster randomized controlled trial.
Evidence based community mobilization for dengue prevention in Nicaragua and Mexico (Camino Verde, the Green Way): cluster randomized controlled trial.
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DOI：
10.1136/bmj.h3267
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发表时间：
2015-07-08
期刊：
影响因子：
--
通讯作者：
Harris E
中科院分区：
文献类型：
--
作者：
Andersson N;Nava-Aguilera E;Arosteguí J;Morales-Perez A;Suazo-Laguna H;Legorreta-Soberanis J;Hernandez-Alvarez C;Fernandez-Salas I;Paredes-Solís S;Balmaseda A;Cortés-Guzmán AJ;Serrano de Los Santos R;Coloma J;Ledogar RJ;Harris E
目的检验社区动员是否能增加常规登革热控制的有效性。设计实用开放标签平行组整群随机对照试验。那些评估结果和分析数据的人对分组不知情。基线研究后的集中计算机随机化将一半的研究中心分配到干预组，按国家、3-9岁儿童近期登革热病毒感染的证据和病媒指数分层。在尼加拉瓜首都马那瓜和墨西哥南部格雷罗州的三个沿海地区的社区随机抽样。参与者两国人口普查查点地区的随机样本居民：75个干预组和75个对照组（每组约140户）进行了随机化和分析（尼加拉瓜60个组，墨西哥90个组），包括18838户85182名居民。干预措施社区动员协议开始与社区讨论的基线结果。每个干预组都根据自己的情况调整了基本的干预措施-不使用化学品防止蚊子繁殖。所有集群继续政府运行的登革热控制计划。主要结局指标主要结局为自我报告的登革热病例、近期登革热病毒感染的血清学证据和常规昆虫学指标（房屋指数：有幼虫或脓疱的家庭/检查的家庭;容器指数：有幼虫或脓疱的容器/检查的容器; Breteau指数：有幼虫或脓疱的容器/检查的家庭;和每人的脓疱数：发现的脓疱数/居民人数）。符合方案的次要分析检查了Camino Verde在使用替美磷的背景下的影响。结果以聚类为分析单位，来自干预点的血清学证据显示儿童感染登革病毒的风险较低（相对风险降低29.5%，95%置信区间3.8%至55.3%），登革热疾病报告减少（24.7%，1.8%至51.2%），在所访问的房屋中，（房屋指数）（44.1%，13.6%至74.7%），在检查的容器中，（容器指数）（36.7%，24.5%~ 44.8%）、所访房屋中有幼虫或蛹的容器较少（Breteau指数）（35.1%，16.7%~ 55.5%）、人均蛹较少（51.7%，36.2%~ 76.1%）。需要治疗的人数为30人（95%置信区间20至59）儿童感染风险较低，71（48至143）登革热病例报告较少，房屋指数为14至20，集装箱指数为37（35至67），Breteau指数为10（6至29），人均减少的人数为12（7至31）。次级符合方案分析显示，没有血清学证据表明替美磷具有保护作用。结论以证据为基础的社区动员可以提高登革热病媒控制的有效性。每一个以自己的方式实施干预措施的地点都具有因地制宜和社区参与度高的优势。 试验注册ISRCTN 27581154
Objective To test whether community mobilization adds effectiveness to conventional dengue control. Design Pragmatic open label parallel group cluster randomized controlled trial. Those assessing the outcomes and analyzing the data were blinded to group assignment. Centralized computerized randomization after the baseline study allocated half the sites to intervention, stratified by country, evidence of recent dengue virus infection in children aged 3-9, and vector indices. Setting Random sample of communities in Managua, capital of Nicaragua, and three coastal regions in Guerrero State in the south of Mexico. Participants Residents in a random sample of census enumeration areas across both countries: 75 intervention and 75 control clusters (about 140 households each) were randomized and analyzed (60 clusters in Nicaragua and 90 in Mexico), including 85 182 residents in 18 838 households. Interventions A community mobilization protocol began with community discussion of baseline results. Each intervention cluster adapted the basic intervention—chemical-free prevention of mosquito reproduction—to its own circumstances. All clusters continued the government run dengue control program. Main outcome measures Primary outcomes per protocol were self reported cases of dengue, serological evidence of recent dengue virus infection, and conventional entomological indices (house index: households with larvae or pupae/households examined; container index: containers with larvae or pupae/containers examined; Breteau index: containers with larvae or pupae/households examined; and pupae per person: pupae found/number of residents). Per protocol secondary analysis examined the effect of Camino Verde in the context of temephos use. Results With cluster as the unit of analysis, serological evidence from intervention sites showed a lower risk of infection with dengue virus in children (relative risk reduction 29.5%, 95% confidence interval 3.8% to 55.3%), fewer reports of dengue illness (24.7%, 1.8% to 51.2%), fewer houses with larvae or pupae among houses visited (house index) (44.1%, 13.6% to 74.7%), fewer containers with larvae or pupae among containers examined (container index) (36.7%, 24.5% to 44.8%), fewer containers with larvae or pupae among houses visited (Breteau index) (35.1%, 16.7% to 55.5%), and fewer pupae per person (51.7%, 36.2% to 76.1%). The numbers needed to treat were 30 (95% confidence interval 20 to 59) for a lower risk of infection in children, 71 (48 to 143) for fewer reports of dengue illness, 17 (14 to 20) for the house index, 37 (35 to 67) for the container index, 10 (6 to 29) for the Breteau index, and 12 (7 to 31) for fewer pupae per person. Secondary per protocol analysis showed no serological evidence of a protective effect of temephos. Conclusions Evidence based community mobilization can add effectiveness to dengue vector control. Each site implementing the intervention in its own way has the advantage of local customization and strong community engagement. Trial registration ISRCTN27581154
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影响因子：
3.4
作者：
Kittayapong, Pattamaporn;Thongyuan, Suporn;Butraporn, Piyarat
通讯作者：
Butraporn, Piyarat
DOI：
10.1590/s0074-02762004000200015
发表时间：
2004-03-01
期刊：
Memórias do Instituto Oswaldo Cruz
影响因子：
--
作者：
Braga, Ima Aparecida;Lima, José Bento Pereira;Valle, Denise
通讯作者：
Valle, Denise
影响因子：
105.7
作者：
Hawe, P;Shiell, A;Riley, T
通讯作者：
Riley, T
影响因子：
1
作者：
Rodriguez, Maria M.;Bisset, Juan A.;Fernandez, Ditter
通讯作者：
Fernandez, Ditter
影响因子：
6.3
作者：
Espinoza-Gómez, F;Hernández-Suárez, CM;Coll-Cárdenas, R
通讯作者：
Coll-Cárdenas, R