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1.
BMC Public Health ; 17(Suppl 1): 395, 2017 05 30.
Artigo em Inglês | MEDLINE | ID: mdl-28699544

RESUMO

BACKGROUND: Studies in different countries have identified irregular water supply as a risk factor for dengue virus transmission. In 2013, Camino Verde, a cluster-randomised controlled trial in Managua, Nicaragua, and Mexico's Guerrero State, demonstrated impact of evidence-based community mobilisation on recent dengue infection and entomological indexes of infestation by Aedes aegypti mosquitoes. This secondary analysis of data from the trial impact survey asks: (1) what is the importance of regular water supply in neighbourhoods with and without the trial intervention and (2) can community interventions like Camino Verde reasonably exclude households with adequate water supply? METHODS: Entomological data collected in the dry season of 2013 in intervention and control communities allow contrasts between households with regular and irregular water supplies. Indicators of entomological risk included the House Index and pupa positive household index. Generalised linear mixed models with cluster as a random effect compared households with and without regular water, and households in intervention and control communities. RESULTS: For the House Index, regular water supply was associated with a protection in both intervention households (OR 0.7, 95%CI 0.6-0.9) and control households (OR 0.6, 95%CI 0.5-0.8). For the pupa positive household index, we found a similar protection from regular water supply in intervention households (OR 0.6, 95%CI 0.4-0.8) and control households (OR 0.7, 95%CI 0.5-0.9). The Camino Verde intervention had a similar impact on House Index in households with regular water supply (OR 0.7, 95%CI 0.5-1.0) and irregular water supply (OR 0.6, 95%CI 0.4-0.8); for the pupa positive household index, the effect of the intervention was very similar in households with regular (OR0.5, 95%CI 0.3-0.8) and irregular (OR 0.5, 95%CI 0.3-0.9) water supply. CONCLUSION: While Aedes aegypti control efforts based on informed community mobilisation had a strong impact on households without a regular water supply, this intervention also impacted entomological indices in households with a regular water supply. These households should not be excluded from community mobilisation efforts to reduce the Aedes aegypti vector. TRIAL REGISTRATION: ISRCTN27581154 .


Assuntos
Aedes , Participação da Comunidade , Dengue/prevenção & controle , Controle de Mosquitos , Características de Residência , Abastecimento de Água , Água , Animais , Dengue/virologia , Vírus da Dengue , Características da Família , Humanos , Insetos Vetores , Nicarágua , Razão de Chances , Pupa , Estações do Ano
2.
BMC Public Health ; 17(Suppl 1): 406, 2017 05 30.
Artigo em Inglês | MEDLINE | ID: mdl-28699551

RESUMO

Camino Verde (the Green Way) is an evidence-based community mobilisation tool for prevention of dengue and other mosquito-borne viral diseases. Its effectiveness was demonstrated in a cluster-randomised controlled trial conducted in 2010-2013 in Nicaragua and Mexico. The Nicaraguan arm of the trial was preceded, from 2004 to 2008, by a feasibility study that provided valuable lessons and trained facilitators for the trial itself. Here, guided by the Template for Intervention Description and Replication (TIDieR), we describe the Camino Verde intervention in Nicaragua, presenting its rationale, its time and location, activities, materials used, the main actors, modes of delivery, how it was tailored to encourage community engagement, modifications made from the feasibility study to the trial itself, and how fidelity to the process originally designed was maintained. We also present information on costs and discuss the place of this study within the literature on implementation science. TRIAL REGISTRATION: ISRCTN27581154 .


Assuntos
Aedes , Dengue/prevenção & controle , Controle de Mosquitos/métodos , Adulto , Animais , Criança , Pré-Escolar , Participação da Comunidade , Dengue/virologia , Vírus da Dengue , Humanos , Insetos Vetores , Nicarágua
3.
BMC Health Serv Res ; 11 Suppl 2: S3, 2011 Dec 21.
Artigo em Inglês | MEDLINE | ID: mdl-22375610

RESUMO

BACKGROUND: Four social audits in 1998, 2003, 2006 and 2009 identified actions that Nicaragua could take to reduce corruption and public perception in primary health care and other key services. METHODS: In a 71-cluster sample, weighted according to the 1995 census and stratified by geographic region and settlement type, we audited the same five public services: health centres and health posts, public primary schools, municipal government, transit police and the courts. Some 6,000 households answered questions about perception and personal experience of unofficial and involuntary payments, payments without obtaining receipts or to the wrong person, and payments "to facilitate" services in municipal offices or courts. Additional questions covered complaints about corruption and confidence in the country's anti-corruption struggle. Logistic regression analyses helped clarify local variations and explanatory variables. Feedback to participants and the services at both national and local levels followed each social audit. RESULTS: Users' experience of corruption in health services, education and municipal government decreased. The wider population's perception of corruption in these sectors decreased also, but not as quickly. Progress among traffic police faltered between 2006 and 2009 and public perception of police corruption ticked upwards in parallel with drivers' experience. Users' experience of corruption in the courts worsened over the study period--with the possible exception of Managua between 2006 and 2009--but public perception of judicial corruption, after peaking in 2003, declined from then on. Confidence in the anti-corruption struggle grew from 50% to 60% between 2003 and 2009. Never more than 8% of respondents registered complaints about corruption.Factors associated with public perception of corruption were: personal experience of corruption, quality of the service itself, and the perception that municipal government takes community opinion into account and keeps people informed about how it uses public funds. CONCLUSIONS: Lowering citizens' perception of corruption in public services depends on reducing their experience of it, on improving service quality and access and--perhaps most importantly--on making citizens feel they are well-informed participants in the work of government.


Assuntos
Crime/economia , Percepção , Atenção Primária à Saúde/economia , Política Pública/economia , Mudança Social , Distribuição de Qui-Quadrado , Análise por Conglomerados , Crime/legislação & jurisprudência , Crime/estatística & dados numéricos , Regulamentação Governamental , Pesquisas sobre Atenção à Saúde , Humanos , Modelos Logísticos , Nicarágua , Razão de Chances , Polícia , Atenção Primária à Saúde/estatística & dados numéricos , Política Pública/tendências
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