Published 9 June 2009, doi:10.1136/bmj.b1959
Cite this as: BMJ 2009;338:b1959

Research

Community involvement in dengue vector control: cluster randomised trial

¹ Epidemiology and Disease Control Unit, Public Health Department, Institute of Tropical Medicine, Nationalestraat 155, 2000 Antwerp, Belgium, ² Department of Epidemiology, Institute of Tropical Medicine "Pedro Kourí", Ciudad de La Habana, Cuba, ³ Provincial Center of Surveillance and Vector Control, Guantanamo, Cuba

Objective To assess the effectiveness of an integrated community based environmental management strategy to control Aedes aegypti, the vector of dengue, compared with a routine strategy.

Design Cluster randomised trial.

Setting Guantanamo, Cuba.

Participants 32 circumscriptions (around 2000 inhabitants each).

Interventions The circumscriptions were randomly allocated to control clusters (n=16) comprising routine Aedes control programme (entomological surveillance, source reduction, selective adulticiding, and health education) and to intervention clusters (n=16) comprising the routine Aedes control programme combined with a community based environmental management approach.

Main outcome measures The primary outcome was levels of Aedes infestation: house index (number of houses positive for at least one container with immature stages of Ae aegypti per 100 inspected houses), Breteau index (number of containers positive for immature stages of Ae aegypti per 100 inspected houses), and the pupae per inhabitant statistic (number of Ae aegypti pupae per inhabitant).

Results All clusters were subjected to the intended intervention; all completed the study protocol up to February 2006 and all were included in the analysis. At baseline the Aedes infestation levels were comparable between intervention and control clusters: house index 0.25% v 0.20%, pupae per inhabitant 0.44x10^–3 v 0.29x10^–3. At the end of the intervention these indices were significantly lower in the intervention clusters: rate ratio for house indices 0.49 (95% confidence interval 0.27 to 0.88) and rate ratio for pupae per inhabitant 0.27 (0.09 to 0.76).

Conclusion A community based environmental management embedded in a routine control programme was effective at reducing levels of Aedes infestation.

Trial registration Current Controlled Trials ISRCTN88405796 [controlled-trials.com] .

© Vanlerberghe et al 2009
This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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