Successful dengue control is reliant upon integrated and cross-disciplinary approaches, including collaboration across entomology and vector-control, epidemiology, case management, community engagement etc. A growing body of research has been looking at the benefits of social and ethnographic considerations, particularly to highlight the relationship between nature, society and health, and has been applying this in order to provide a better understanding of how communities in dengue-endemic areas are both affected by disease outbreaks and can be encouraged to prevent or curtail transmission.
Recent research in Brazil using an EcoHealth approach has been studying social and environmental dynamics and their impact on dengue infections in the capital of the State of Ceará, Fortaleza, where the study highlighted that a large part of the population (about 20%) is living in unsuitable housing with unsafe water and sanitation and a substantial waste and garbage problem, providing plenty of opportunities for disease-carrying mosquitoes to breed. In addition, this study from the Universidade Estadual do Ceará also confirmed that dengue infections were affecting women disproportionately. An important reason for which women's health was identified as more vulnerable to dengue infections was the fact that the dengue vector is an urban and domestic vector, with intra-household and peridomicile habits, and the observation that women were traditionally more likely to be responsible for homecare, including being in direct vicinity of breeding grounds.
Poor neighborhood in the suburbs of Fortaleza, Brazil
According to this research, a focus on improving municipal and individual waste-disposal systems and habits, and targeting women as both high-risk for dengue infections as well as key participants for the destruction of breeding grounds should be prioritised as strategies for improving dengue control. Community engagement efforts should be aimed at women but women's efforts, however, could in turn be compromised by work and social obligations, as well as political and social inequality represented, for example, by unsuitable or inexistent waste disposal systems in the most deprived areas.
The bio-social approach underpinning such research is crucial in developing a sound understanding of disease dynamics and also in informing prevention strategies in-line with community habits and characteristics. Successful systemic approaches to the control of vector-borne diseases should seek to include insights from vector biology, behaviour and control, but also a broader context from ecology, the environment as well as political and economic factors where potential patients live.
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The social face of Aedes control: women take the floor in a suburban district of Fortaleza, Brazil