10.1371/journal.pntd.0005106
Hans J. Overgaard
Hans
J. Overgaard
Neal Alexander
Neal
Alexander
Maria Ines Matiz
Maria Ines
Matiz
Juan Felipe Jaramillo
Juan Felipe
Jaramillo
Victor Alberto Olano
Victor Alberto
Olano
Sandra Vargas
Sandra
Vargas
Diana Sarmiento
Diana
Sarmiento
Audrey Lenhart
Audrey
Lenhart
Thor Axel Stenström
Thor Axel
Stenström
A Cluster-Randomized Controlled Trial to Reduce Diarrheal Disease and Dengue Entomological Risk Factors in Rural Primary Schools in Colombia
Public Library of Science
2016
ISRCTN
dengue entomological risk factors
risk factors
dengue interventions
dengue risk factors
dengue vector mosquitoes
CON
Trial Registration ClinicalTrials.gov
diarrhea interventions
diarrheal disease
DIADEN
Escherichia coli colony
DIA
factorial cluster randomized
Cluster-Randomized Controlled Trial
pupil school absence
water storage containers
Aedes aegypti density
water quality
Dengue Entomological Risk Factors
CFU
2016-11-07 17:37:50
Dataset
https://plos.figshare.com/articles/dataset/A_Cluster-Randomized_Controlled_Trial_to_Reduce_Diarrheal_Disease_and_Dengue_Entomological_Risk_Factors_in_Rural_Primary_Schools_in_Colombia/4215744
<div><p>Background</p><p>As many neglected tropical diseases are co-endemic and have common risk factors, integrated control can efficiently reduce disease burden and relieve resource-strained public health budgets. Diarrheal diseases and dengue fever are major global health problems sharing common risk factors in water storage containers. Where provision of clean water is inadequate, water storage is crucial. Fecal contamination of stored water is a common source of diarrheal illness, but stored water also provides breeding sites for dengue vector mosquitoes. Integrating improved water management and educational strategies for both diseases in the school environment can potentially improve the health situation for students and the larger community. The objective of this trial was to investigate whether interventions targeting diarrhea and dengue risk factors would significantly reduce absence due to diarrheal disease and dengue entomological risk factors in schools.</p><p>Methodology/Principal Findings</p><p>A factorial cluster randomized controlled trial was carried out in 34 rural primary schools (1,301 pupils) in La Mesa and Anapoima municipalities, Cundinamarca, Colombia. Schools were randomized to one of four study arms: diarrhea interventions (DIA), dengue interventions (DEN), combined diarrhea and dengue interventions (DIADEN), and control (CON). Interventions had no apparent effect on pupil school absence due to diarrheal disease (p = 0.45) or on adult female <i>Aedes aegypti</i> density (p = 0.32) (primary outcomes). However, the dengue interventions reduced the Breteau Index on average by 78% (p = 0.029), with Breteau indices of 10.8 and 6.2 in the DEN and DIADEN arms, respectively compared to 37.5 and 46.9 in the DIA and CON arms, respectively. The diarrhea interventions improved water quality as assessed by the amount of <i>Escherichia coli</i> colony forming units (CFU); the ratio of Williams mean <i>E</i>. <i>coli</i> CFU being 0.22, or 78% reduction (p = 0.008).</p><p>Conclusions/Significance</p><p>Integrated control of dengue and diarrhea has never been conducted before. This trial presents an example for application of control strategies that may affect both diseases and the first study to apply such an approach in school settings. The interventions were well received and highly appreciated by students and teachers. An apparent absence of effect in primary outcome indicators could be the result of pupils being exposed to risk factors outside the school area and mosquitoes flying in from nearby uncontrolled breeding sites. Integrated interventions targeting these diseases in a school context remain promising because of the reduced mosquito breeding and improved water quality, as well as educational benefits. However, to improve outcomes in future integrated approaches, simultaneous interventions in communities, in addition to schools, should be considered; using appropriate combinations of site-specific, effective, acceptable, and affordable interventions.</p><p>Trial Registration</p><p>ClinicalTrials.gov no. <a href="https://clinicaltrials.gov/ct2/show/ISRCTN40195031" target="_blank">ISRCTN40195031</a></p></div>