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

*