Cadernos de Saúde Públicahttps://scielosp.org/feed/csp/2009.v25suppl1/2017-01-28T00:11:00ZVol. 25 - 2009WerkzeugEcosystem approaches to controlling of vector-borne diseases: dengue and Chagas diseaseS0102-311X20090013000012017-01-28T00:11:00Z2017-01-28T00:11:00ZTeixeira, Maria GlóriaBoischio, AnaCosta, Maria da Conceição N.
<em>Teixeira, Maria Glória</em>;
<em>Boischio, Ana</em>;
<em>Costa, Maria Da Conceição N.</em>;
<br/><br/>
Dengue: twenty-five years since reemergence in BrazilS0102-311X20090013000022017-01-28T00:11:00Z2017-01-28T00:11:00ZTeixeira, Maria GlóriaCosta, Maria da Conceição N.Barreto, FlorisneideBarreto, Maurício Lima
<em>Teixeira, Maria Glória</em>;
<em>Costa, Maria Da Conceição N.</em>;
<em>Barreto, Florisneide</em>;
<em>Barreto, Maurício Lima</em>;
<br/><br/>
This article revisits the epidemiology of dengue in Brazil, 25 years after its reemergence in the country, discussing the main determinants and implications for its control. The authors emphasize the clinical and epidemiological peculiarities of this viral disease in Brazil, which leads the world in both the number of cases reported and risk of occurrence of the disease. The article presents the changes occurring in the dengue epidemiological pattern in recent years, like the sudden age shift in the incidence of dengue hemorrhagic fever, and discusses possible associated factors. The article focuses specifically on the epidemic in Rio de Janeiro in 2008, this episode's impact on the international community, and the fear that the disease could spread to Europe. The authors conclude that the current situation emphasizes the need for the international scientific community to renew its efforts to generate knowledge allowing improvement and progress in the development of new tools and strategies for dengue prevention.Dengue in the Americas: challenges for prevention and controlS0102-311X20090013000032017-01-28T00:11:00Z2017-01-28T00:11:00ZGómez-Dantés, HéctorWilloquet, Janine Ramsey
<em>Gómez-Dantés, Héctor</em>;
<em>Willoquet, Janine Ramsey</em>;
<br/><br/>
Dengue is the most important vector-borne disease in the Americas and threatens the lifes of millions of people in developing countries. Imprecise morbidity and mortality statistics underestimate the magnitude of dengue as a regional health problem. As a result, it is considered a low priority by the health sector with no timely steps for effective control. Dengue is perceived as a problem of "others" (individually, collectively and institutionally), therefore responsibility for its control is passed on to others (neighbors, the community, municipality, health institutions, or other governmental agencies). With no precise risk indicators available there is little opportunity for timely diagnoses, treatment, health interventions or vector control (poor surveillance). Solutions only targeting the vector reduce the impact of interventions and there is no sustainable control. Without political commitment there are insufficient resources to face the problem. This paper discusses the challenges for prevention and control in the Americas.Environment, interactions between Trypanosoma cruzi and its host, and healthS0102-311X20090013000042017-01-28T00:11:00Z2017-01-28T00:11:00ZTeixeira, Antonio R. L.Gomes, CleverLozzi, Silene P.Hecht, Mariana M.Rosa, Ana de CássiaMonteiro, Pedro S.Bussacos, Ana CarolinaNitz, NadjarMcManus, Concepta
<em>Teixeira, Antonio R. L.</em>;
<em>Gomes, Clever</em>;
<em>Lozzi, Silene P.</em>;
<em>Hecht, Mariana M.</em>;
<em>Rosa, Ana De Cássia</em>;
<em>Monteiro, Pedro S.</em>;
<em>Bussacos, Ana Carolina</em>;
<em>Nitz, Nadjar</em>;
<em>Mcmanus, Concepta</em>;
<br/><br/>
An epidemiological chain involving Trypanosoma cruzi is discussed at the environmental level, and in terms of fine molecular interactions in invertebrate and vertebrate hosts dwelling in different ecosystems. This protozoan has a complex, genetically controlled plasticity, which confers adaptation to approximately 40 blood-sucking triatomine species and to over 1,000 mammalian species, fulfilling diverse metabolic requirements in its complex life-cycle. The Tr. cruzi infections are deeply embedded in countless ecotypes, where they are difficult to defeat using the control methods that are currently available. Many more field and laboratory studies are required to obtain data and information that may be used for the control and prevention of Tr. cruzi infections and their various disease manifestations. Emphasis should be placed on those sensitive interactions at cellular and environmental levels that could become selected targets for disease prevention. In the short term, new technologies for social mobilization should be used by people and organizations working for justice and equality through health information and promotion. A mass media directed program could deliver education, information and communication to protect the inhabitants at risk of contracting Tr. cruzi infections.Preliminary evaluation of the "Dengue-MI" technology for Aedes aegyptimonitoring and controlS0102-311X20090013000052017-01-28T00:11:00Z2017-01-28T00:11:00ZEiras, Álvaro EduardoResende, Marcelo Carvalho
<em>Eiras, Álvaro Eduardo</em>;
<em>Resende, Marcelo Carvalho</em>;
<br/><br/>
Limitations in the laboratory identification of Aedes aegypti and processing of field data based on larval surveys led to the development of the "Intelligent Dengue Monitoring" technology (MI-Dengue). MI-Dengue consists of a trap that captures gravid female Ae. aegypti, coupled with a computerized system for field data collection, transmission, and access to georeferenced maps in real time. The current study describe the first experience with a system for monitoring adult Ae. aegypti and presents the preliminary results in three municipalities that adopted MI-Dengue as a strategy to identify key areas and orient control measures. Weekly georeferenced maps and an entomological indicator (Mean Female Aedes Index) provided information on infested areas and infestation levels, color-coded according to the number of captured female Ae. aegypti, and indicated risk-free, dengue alert, and critical situations that triggered appropriate control measures. The preliminary results suggest that the adoption of this control strategy with house-to-house visits in a 200m radius of the positive trap helped reduce dengue in the municipalities that adopted the system.Estrategia intersectorial y participativa con enfoque de ecosalud para la prevención de la transmisión de dengue en el nivel localS0102-311X20090013000062017-01-28T00:11:00Z2017-01-28T00:11:00ZDíaz, CristinaTorres, YiselCruz, Ana Margarita de laÁlvarez, Ángel M.Piquero, María EugeniaValero, AidaFuentes, Omar
<em>Díaz, Cristina</em>;
<em>Torres, Yisel</em>;
<em>Cruz, Ana Margarita De La</em>;
<em>Álvarez, Ángel M.</em>;
<em>Piquero, María Eugenia</em>;
<em>Valero, Aida</em>;
<em>Fuentes, Omar</em>;
<br/><br/>
Cuba está ubicada en una zona de países con alta incidencia de dengue. En los últimos 10 años ha sido afectada por varias epidemias, es por ello que se diseñó, implementó y evaluó una estrategia participativa, basada en el enfoque de ecosalud, la cual estuvo dirigida a propiciar acciones intersectoriales en la gestión del ecosistema para disminuir las poblaciones del mosquito Aedes aegypti y prevenir la transmisión de dengue en el municipio Cotorro de Ciudad de La Habana, Cuba. Para el desarrollo de este trabajo se utilizó la metodología de investigación acción participativa. Como resultado del proceso se pudo describir una estrategia que garantiza la participación activa de la comunidad, los sectores y el gobierno en la producción de ecosistemas saludables, se desarrollaron acciones de prevención y control oportunas e integrados que disminuyeron los riesgos para la proliferación del vector y la transmisión local de la enfermedad. Este enfoque permitió el análisis holístico de los problemas, su priorización y la gestión de sus soluciones; la estrategia se sostiene dos años después de concluido el proceso.La enfermedad de Chagas en las Américas: una perspectiva de ecosaludS0102-311X20090013000072017-01-28T00:11:00Z2017-01-28T00:11:00ZBriceño-León, Roberto
<em>Briceño-León, Roberto</em>;
<br/><br/>
El proceso de transmisión de la enfermedad de Chagas ha estado históricamente relacionado con los patrones de ocupación territorial de los asentamientos humanos. En las áreas rurales puede ocurrir más fácilmente el encuentro del vector, los agentes patógenos y los seres humanos, por las condiciones de la vivienda y la pobreza existente en estas zonas. Los procesos migratorios permanentes o estacionales han jugado un papel igualmente importante en el transporte de los vectores y en la infección de la población en las zonas urbanas. Las nuevas fronteras agrícolas del Amazonas se han establecido nuevas áreas de transmisión de la enfermedad. La atención dada a los bancos de sangre ha permitido disminuir la transmisión transfusional, pero la inmigración internacional ha cambiado la situación epidemiológica, pues en Estados Unidos y España viven miles de enfermos que habían sido infectados décadas antes y no encuentran adecuada atención. Los avances en el conocimiento y el control de la enfermedad son mostrados en el artículo, señalando las limitaciones existentes en cuanto al mejoramiento de las condiciones ambientales y de vivienda de los pobres.Risk factors for intradomiciliary infestation by the Chagas disease vector Triatoma dimidiatain Jutiapa, GuatemalaS0102-311X20090013000082017-01-28T00:11:00Z2017-01-28T00:11:00ZBustamante, Dulce MariaMonroy, CarlotaPineda, SandyRodas, AntonietaCastro, XochitlAyala, VirgilioQuiñónes, JavierMoguel, BárbaraTrampe, Ranferi
<em>Bustamante, Dulce Maria</em>;
<em>Monroy, Carlota</em>;
<em>Pineda, Sandy</em>;
<em>Rodas, Antonieta</em>;
<em>Castro, Xochitl</em>;
<em>Ayala, Virgilio</em>;
<em>Quiñónes, Javier</em>;
<em>Moguel, Bárbara</em>;
<em>Trampe, Ranferi</em>;
<br/><br/>
Seventeen variables were evaluated as possible risk factors for the intradomiciliary infestation with Triatoma dimidiata in 644 houses in Jutiapa, Guatemala. During 2004 the houses were assessed for vector presence and evaluated for hygiene, cluttering, material comfort, construction conditions and number of inhabitants, among other factors. Chi-square analysis detected significant associations between vector presence and eight variables related to domestic sanitary and construction conditions. Log-linear models showed that regardless of the age of the house, the odds of vector presence were 4.3 and 10 times lower in houses with a good socioeconomic status compared with poor and very poor houses respectively. Log-linear models also pointed to a greater chance of vector presence when walls lacked plastering (3.85 times) or walls had low quality-incomplete plastering (4.56 times), compared with walls that were completely plastered. Control strategies against T. dimidiata should include the introduction of better-quality but inexpensive plastering formulations and better sanitation practices should also be promoted among the population. Such control strategies should not only reduce or eliminate infestation, but also prevent vector reinfestation.An ecosystemic approach to evaluating ecological, socioeconomic and group dynamics affecting the prevalence of Aedes aegypti in two Colombian townsS0102-311X20090013000092017-01-28T00:11:00Z2017-01-28T00:11:00ZQuintero, JulianaCarrasquilla, GabrielSuárez, RobertoGonzález, CatalinaOlano, Victor A.
<em>Quintero, Juliana</em>;
<em>Carrasquilla, Gabriel</em>;
<em>Suárez, Roberto</em>;
<em>González, Catalina</em>;
<em>Olano, Victor A.</em>;
<br/><br/>
This article focuses on the epidemiological methods and results of a global Ecohealth study that explored the complexity of the relationship between ecological, biological, economical, social and political factors and vector presence. The study was carried out in two dengue endemic areas of Colombia. A transdisciplinary team gathered quantitative and qualitative data. A survey in randomly sampled households was applied and, simultaneously, direct observation of potential breeding sites was carried out. Logistic regressions and qualitative techniques were used. Qualitative and quantitative data were compared using triangulation. The presence of low water containers increases seven-fold the risk of finding immature forms ofAedes aegypti in the household (OR = 7.5; 95%CI: 1.7-32.2). An inverse association between socioeconomic stratum and presence of the vector was identified (Low stratum OR = 0.9; 95%CI: 0.6-1.4; High stratum OR =0.4; 95%CI: 0.07-1.7). Water management is a complex social dynamic associated with the presence of Ae. aegypti. Dengue control is a challenge for public health authorities and researchers as they should address promotion and prevention strategies that take into account cultural, behavioral, socioeconomic and health factors.An ecosystem perspective in the socio-cultural evaluation of dengue in two Colombian townsS0102-311X20090013000102017-01-28T00:11:00Z2017-01-28T00:11:00ZSuárez, RobertoGonzález, CatalinaCarrasquilla, GabrielQuintero, Juliana
<em>Suárez, Roberto</em>;
<em>González, Catalina</em>;
<em>Carrasquilla, Gabriel</em>;
<em>Quintero, Juliana</em>;
<br/><br/>
Despite extensive public health efforts, dengue is still a major health concern in Colombia. The objective of this study was to provide an ecosystem and cross-disciplinary perspective on the dengue situation in two Colombian towns. The article focuses on presenting the anthropological methodology and research findings. An interdisciplinary team gathered quantitative (cross-sectional), meteorological, entomological, and qualitative data (based on medical anthropology) through fieldwork and archival research. According to the qualitative data, dengue can be described as a point of convergence between public health policies, the affected population, the environment, and the social dynamics generated through this interaction. Dengue is illustrative as a disease, in that it has a negative impact on public health, but individuals in Colombia have learned to live and cope with it. Dengue prevalence and its on-going historical presence have made it part of everyday community life, viewed as a minor health issue.Dengue in Southeast Asia: epidemiological characteristics and strategic challenges in disease preventionS0102-311X20090013000112017-01-28T00:11:00Z2017-01-28T00:11:00ZOoi, Eng-EongGubler, Duane J.
<em>Ooi, Eng-Eong</em>;
<em>Gubler, Duane J.</em>;
<br/><br/>
Dengue emerged as a public health burden in Southeast Asia during and following the Second World War and has become increasingly important, with progressively longer and more frequent cyclical epidemics of dengue fever/dengue hemorrhagic fever. Despite this trend, surveillance for this vector-borne viral disease remains largely passive in most Southeast Asian countries, without adequate laboratory support. We review here the factors that may have contributed to the changing epidemiology of dengue in Southeast Asia as well as challenges of disease prevention. We also discuss a regional approach to active dengue virus surveillance, focusing on urban areas where the viruses are maintained, which may be a solution to limited financial resources since most of the countries in the region have developing economies. A regional approach would also result in a greater likelihood of success in disease prevention since the large volume of human travel is a major factor contributing to the geographical spread of dengue viruses.Irregular water supply, household usage and dengue: a bio-social study in the Brazilian NortheastS0102-311X20090013000122017-01-28T00:11:00Z2017-01-28T00:11:00ZCaprara, AndreaLima, José Wellington de OliveiraMarinho, Alice Correia PequenoCalvasina, Paola GondimLandim, Lucyla PaesSommerfeld, Johannes
<em>Caprara, Andrea</em>;
<em>Lima, José Wellington De Oliveira</em>;
<em>Marinho, Alice Correia Pequeno</em>;
<em>Calvasina, Paola Gondim</em>;
<em>Landim, Lucyla Paes</em>;
<em>Sommerfeld, Johannes</em>;
<br/><br/>
Despite increased vector control efforts, dengue fever remains endemic in Fortaleza, Northeast Brazil, where sporadic epidemic outbreaks have occurred since 1986. Multiple factors affect vector ecology such as social policy, migration, urbanization, city water supply, garbage disposal and housing conditions, as well as community level understanding of the disease and related practices. This descriptive study used a multi-disciplinary approach that bridged anthropology and entomology. A multiple case study design was adopted to include research in six study areas, defined as blocks. The water supply is irregular in households from both under-privileged and privileged areas, however, clear differences exist. In the more privileged blocks, several homes are not connected to the public water system, but have a well and pump system and therefore irregularity of supply does not affect them. In households from under-privileged blocks, where the water supply is irregular, the frequent use of water containers such as water tanks, cisterns, barrels and pots, creates environmental conditions with a greater number of breeding areas. In under-privileged homes, there are more possible breeding areas and environmental conditions that may improve the chances of Aedes aegypti survival.Información, conocimiento y percepción sobre el riesgo de contraer el dengue en Argentina: dos experiencias de intervención para generar estrategias locales de controlS0102-311X20090013000132017-01-28T00:11:00Z2017-01-28T00:11:00ZSchweigmann, NicolasRizzotti, AndreaCastiglia, GabrielaGribaudo, FabioMarcos, EdgardoBurroni, NoraFreire, GabrielaD'Onofrio, VanesaOberlander, SaraSchillaci, HéctorGómez, SandraMaldonado, SantiagoSerrano, Claudia
<em>Schweigmann, Nicolas</em>;
<em>Rizzotti, Andrea</em>;
<em>Castiglia, Gabriela</em>;
<em>Gribaudo, Fabio</em>;
<em>Marcos, Edgardo</em>;
<em>Burroni, Nora</em>;
<em>Freire, Gabriela</em>;
<em>D'onofrio, Vanesa</em>;
<em>Oberlander, Sara</em>;
<em>Schillaci, Héctor</em>;
<em>Gómez, Sandra</em>;
<em>Maldonado, Santiago</em>;
<em>Serrano, Claudia</em>;
<br/><br/>
Con objetivos de prevención de dengue, promoción de la salud e investigación-acción se desarrollaron dos experiencias en zonas piloto de Buenos Aires y Vicente López. En cada zona se identificaron referentes comunitarios, gubernamentales y no gubernamentales. Se realizó un diagnóstico entomológico (mediante ovitrampas), ambiental (con observaciones en terreno, encuestas y talleres), y social (utilizando cuestionarios, entrevistas y reuniones). Se construyeron espacios de diálogo y trabajo conjunto con la comunidad, generando acciones participativas y empoderamiento. Se fomentó el ordenamiento ambiental y la reducción de criaderos de mosquitos a través de incorporación de temas ambientales y prevención de enfermedades vectoriales a los currícula escolares; talleres vecinales de difusión; capacitación de promotoras ambientales para transmitir información y para capacitar a pares; planificación de proyectos ambientales de la comunidad. Se entró en los domicilio, buscando integrar a sus habitantes en el diagnóstico ambiental propio y comunitario. Se registraron diferencias significativas entre conocimientos y prácticas sociales, para ambas zonas piloto, pero no por nivel socioeconómico. Las escuelas y los entornos de promoción de salud resultaron ser los principales referentes comunitarios para fomentar prácticas ambientales saludables.Health and sustainable development: challenges and opportunities of ecosystem approaches in the prevention and control of dengue and Chagas diseaseS0102-311X20090013000142017-01-28T00:11:00Z2017-01-28T00:11:00ZBoischio, AnaSánchez, AndrésOrosz, ZsófiaCharron, Dominique
<em>Boischio, Ana</em>;
<em>Sánchez, Andrés</em>;
<em>Orosz, Zsófia</em>;
<em>Charron, Dominique</em>;
<br/><br/>
A world of healthy people living in healthy ecosystems has proven to be an elusive goal of the sustainable development agenda. Numerous science-based assessments agree on the fundamental interdependence between people's health, the economy, and the environment, and on the urgency for more determined and concerted action based on multi-sector participatory approaches at the global and local levels. For knowledge to be policy-relevant and capable of contributing to healthy and sustainable development, it must take into account the dynamic and complex interactions between ecological and social systems (systems thinking), and it must be linked to development actions. This in turn requires greater interaction and exchange between decision-makers, researchers and civil society (a multi-stakeholder participatory process); and the harnessing of different disciplines and of different kinds of knowledge (a transdisciplinary approach). Ecosystem approaches to human health (ecohealth) link these elements in an adaptable framework for research and action. This paper presents an overview of ecohealth research approaches applied to vector-borne diseases, with particular attention to multi-stakeholder participation given its prominence in the sustainable development policy discourse.The ecological dimensions of vector-borne disease research and controlS0102-311X20090013000152017-01-28T00:11:00Z2017-01-28T00:11:00ZEllis, Brett R.Wilcox, Bruce A.
<em>Ellis, Brett R.</em>;
<em>Wilcox, Bruce A.</em>;
<br/><br/>
Alarming trends in the resurgence of vector-borne diseases are anticipated to continue unless more effective action is taken to address the variety of underlying causes. Social factors, anthropogenic environmental modifications and/or ecological changes appear to be the primary drivers. The ecological dimension of vector-borne disease research and management is a pervasive element because this issue is essentially an ecological problem with biophysical, social, and economic dimensions. However there is often a lack of clarity about the ecological dimension, the field of ecology (e.g. role, limitations), and related concepts pertinent to ecosystem approaches to health. An ecological perspective can provide foresight into the appropriateness of interventions, provide answers to unexpected vector control responses, and contribute to effective management solutions in an ever-changing environment. The aim of this paper is to explore the ecological dimension of vector-borne diseases and to provide further clarity about the role of "ecological thinking" in the development and implementation of vector control activities (i.e. ecosystem approaches to vector-borne diseases).House improvements and community participation in the control of Triatoma dimidiata re-infestation in Jutiapa, GuatemalaS0102-311X20090013000162017-01-28T00:11:00Z2017-01-28T00:11:00ZMonroy, CarlotaBustamante, Dulce MariaPineda, SandyRodas, AntonietaCastro, XochitlAyala, VirgilioQuiñónes, JavierMoguel, Bárbara
<em>Monroy, Carlota</em>;
<em>Bustamante, Dulce Maria</em>;
<em>Pineda, Sandy</em>;
<em>Rodas, Antonieta</em>;
<em>Castro, Xochitl</em>;
<em>Ayala, Virgilio</em>;
<em>Quiñónes, Javier</em>;
<em>Moguel, Bárbara</em>;
<br/><br/>
The deterioration or absence of plaster walls in houses and poor hygienic conditions are the most important risk factors for indoor Triatoma dimidiata infestation in Guatemala. A cross-disciplinary study was conducted addressing T. dimidiata infestation, household hygiene, and housing construction. The study focused on local materials and cultural aspects (including gender roles) that could lead to long-term improvements in wall construction. A new plaster mix for walls was developed on the basis of laboratory studies on construction materials recommended by local villagers. Four villages with persistent (post-spraying) T. dimidiata infestation were studied. In two villages, an ecosystem approach was implemented, and the homeowners conducted wall improvements and household sanitation with the support of the interdisciplinary team (the ecosystem intervention). In the other two villages, a vector control approach based on insecticide spraying was adopted (traditional intervention). Both interventions were associated with a reduction in T. dimidiata infestation, but only the ecosystem approach produced important housing improvements (sanitation and wall construction) capable of preventing T. dimidiata re-infestation in the long term.La enfermedad de Chagas en una historia de vida: conocer la enfermedad, cambiar el mundo. Entrevista a João Carlos Pinto DiasS0102-311X20090013000172017-01-28T00:11:00Z2017-01-28T00:11:00ZBriceño-León, Roberto
<em>Briceño-León, Roberto</em>;
<br/><br/>