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Opening the Door to Public Health Work: Dengue Fever in Costa Rica
Victoria Egedus Associated Colleges of the Midwest, San Pedro, San Jose, Costa Rica
Lake Forest College, Lake Forest, IL
ACM Symposium 2014 April 11th
Most prevalent and deadly arthropod-borne human illness worldwide
4 viral serotypes DENV1-DENV4 11kb and 10 genes
Tang, Y et al. Genomic sequence of 10 dengue serotype 1 viruses associated with different genotypes, epidemics, and disease severity isolated in thailand over 22 years. Am J Trop Med Hyg. 2012; 83(5):1156-1165 www.rcsb.org/pdb/101/motm.do?momID=103 news.thomasnet.com
Transmitted by Aedes, which live exclusively with humans
What is dengue fever?
Dengue Can Kill
Young child in Dominican Republic with Severe Dengue-suffering extravasation
Child in Tarcoles, CR with a rash break out
What is Dengue?
•Number of incidence is 30X > it was 50 years ago •Estimated 390 million dengue infections annually (Bhatt et al., 2013)
WHO, 2009
•2.5 billion people live in areas of risk > 40% of world’s population
Study Site: Quebrada Ganado, Garabito, Puntarenas, Costa Rica
Population: 1,916
Prior to my arrival: 2-3 new cases a
week
Objectives for this Study in Quebrada Ganado
Evaluate Community Knowledge and Opinions about Dengue and its Prevention
Relate Findings from Property Inspections with the Knowledge or
Opinions of Property Owners
Gather Opinions on How to Effectively Educate the Community and Solicit
Involvement
61%
39%
0% 10% 20% 30% 40% 50% 60% 70%
Previous Infection
No Previous Infection
Percentage of Participants
Infe
ctio
n St
atus
of H
ouse
hold
Previous Dengue Infection within the Household for Participants Interviewed in
Quebrada Ganado, Costa Rica, March-April, 2013
Source: Interviews conducted in Quebrada Ganado, 2013
Average of 2 people/household
Education Level of Participants Interviewed in Quebrada Ganado,
Costa Rica, March-April, 2013
Source: Interviews conducted in Quebrada Ganado, 2013
7%
52%
32%
9%
0% 10% 20% 30% 40% 50% 60%
No Education
Primary Eductation
Secondary Education
University
Percentage of Participants
Educ
atio
n Le
vel
89%
11%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Know Dengue Symptoms
Do Not Know Dengue Symptoms
Percentage of Respondents
Know
ledg
e of
Den
gue
Sym
ptom
s
Knowledge of Dengue Symptoms for Participants Interviewed in Quebrada
Ganado, Costa Rica, March-April, 2013
Source: Interviews conducted in Quebrada Ganado, 2013
98% of Participants Knew…
…Dengue is Transmitted by a Mosquito …The Dengue Mosquito Reproduces in Stagnant Water
But there was a Misunderstanding of the Type of Water Aedes aegypti Prefers
blog.smu.edu/studentadventures/2012/raamis-in-india/dont-let-them-see-you-grimace/
abc.com.py/nacionales/salu-publica-y-comuna-asuncena-unen-fuerzas-440885.html
Source: Interviews conducted in Quebrada Ganado, 2013
Participant Responses for Type of Water Preferred by Dengue Mosquito in Quebrada
Ganado, Costa Rica, March-April, 2013
Status of Inspection at Time of Interview TOTAL
Number who Reported Aedes Prefers Clean Water N %
No Previous Inspection 238 84 35 Previous Inspection 5 Weeks Prior 45 29 64 Question not Realized 37 TOTAL 320
Education by Ministry of Health Workers was retained 5 weeks later
Most Frequent Participant Responses on “Who has the Responsibility of Protecting the Community from Dengue?" in Quebrada Ganado, Costa Rica, March-
April, 2013
Who is Responsible? Total %
Us; The Community 167 52
Community + Ministry of HealthTogether 54 17
Ministry of Health 43 13
Everyone 26 8
Other --- ---
Source: Interviews conducted in Quebrada Ganado, 2013
20% reported no responsibility is held by the community
Most Frequent Participant Responses on "How Can the Community be Educated about Dengue and its
Prevention?" in Quebrada Ganado, Costa Rica, March-April, 2013
How Can the Community be Educated about Dengue and Its Prevention? TOTAL % Talks/Lectures 119 37 Work and Inspections by the Ministry of Health 43 13 Educating Children 43 13 Do Not Know 39 12 Campaigns 29 9 Education is Already Sufficient 20 6 Giving Examples and Training 19 6
Other --- ---
Source: Interviews conducted in Quebrada Ganado, 2013
A breadth of different ideas…
How Can the Community be Convinced to Eliminate Stagnant Water? TOTAL %
Do Not Know 72 23
Campaigns 47 15
Information on the Risks and Dangers 36 11
Talks/Lectures 35 11
House Visits and Inspections by Ministry of Health 32 10
Contracting Dengue is the Only Way 30 9
Other --- ---
Most Frequent Participant Reponses on "How Can the Community Members be Convinced to
Eliminate Stagnant Water in their Properties?" in Quebrada Ganado, March-April 2013
Source: Interviews conducted in Quebrada Ganado, 2013
Through education and raising awareness
Results from Inspections by Ministry of Health
•264 houses inspected. 100% with possible breeding sites
•Mode=5, median=7, range from 2-51 possible breeding sites
•9% of houses inspected had at least 1 breeding site positive for Aedes aegypti
Citizens display a hazy understanding of the dengue vector versus other mosquitoes (Culex and Chironomidae) More education is needed to differentiate the vector’s habits
Conclusions
biologie.uni-regensburg.de/Zoologie/Boeckh/Bosch/
Target audiences for dengue education include:
Households with: more frequent infections, lower education level, lower perception on the importance of dengue prevention actions, and lower perceived danger of dengue
teamtarget.org/home.asp
Majority of community believe prevention is their responsibility, and perceive that the Ministry of Health plays an important role in educating and convincing the community to eliminate breeding sites
-Allowed me publish as a first author in the Tropical Biology Journal
(September 2014)
What has this program done for me?
-Created a passion for the country, their culture, and their way of
life.
-Set the foundation for the work I will do during my gap year- return to Costa
Rica and do public health work
-Opened the door to many new connections and lifetime friendships in Costa Rica
Acknowledgements
Chris Vaughan, PhD
Mike McCoy, MS
Mario Morera, PhD
ACM
Area of Jacó, Health Ministry of Costa Rica José Morales Ortega, MD
Vector Control workers:
Jaime Rodriguez Arguedas
José Valerín Cordero
Maynor Peraza Solas
Zulema Conejo Mora
Community members of Quebrada Ganado Lynn Westley, PhD
Anabelle Alfaro, MD, Advisor
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Study Site: Quebrada Ganado, Garabito, Puntarenas, Costa Rica
Population: 1,916
Prior to my arrival: 2-3 new cases a
week