The Camino Verde trial of community mobilisation for control of dengue reported a significant impact on entomological indices of the Aedes aegypti vector , and on serological dengue virus infection and self-reported dengue cases .
One reason for doing r and omised controlled trials ( RCTs ) is that experiments can be convincing .
Early epidemiological experimenters , such as Jenner and the smallpox vaccine and Snow and his famous Broad Street pump h and le , already knew the answer they were demonstrating ; they used the experiments as knowledge translation devices to convince others .
More sophisticated modern experiments include cluster r and omised controlled trials ( C RCTs ) for experiments in the public health setting .
Those who are convinced by a trial and want to act , need to know how the trial relates to their own context , what contributed to success , and what might make it even more effective .
Evidence based community mobilization for dengue prevention in Nicaragua and Mexico (Camino Verde, the Green Way): cluster randomized controlled trial
Objective To test whether community mobilization adds effectiveness to conventional dengue control . Design Pragmatic open label parallel group cluster r and omized controlled trial . Those assessing the outcomes and analyzing the data were blinded to group assignment . Central ized computerized r and omization after the baseline study allocated half the sites to intervention , stratified by country , evidence of recent dengue virus infection in children aged 3 - 9 , and vector indices . Setting R and om sample of communities in Managua , capital of Nicaragua , and three coastal regions in Guerrero State in the south of Mexico . Participants Residents in a r and om sample of census enumeration areas across both countries : 75 intervention and 75 control clusters ( about 140 households each ) were r and omized and analyzed ( 60 clusters in Nicaragua and 90 in Mexico ) , including 85 182 residents in 18 838 households . Interventions A community mobilization protocol began with community discussion of baseline results . Each intervention cluster adapted the basic intervention — chemical-free prevention of mosquito reproduction — to its own circumstances . All clusters continued the government run dengue control program . Main outcome measures Primary outcomes per protocol were self reported cases of dengue , serological evidence of recent dengue virus infection , and conventional entomological indices ( house index : households with larvae or pupae/households examined ; container index : containers with larvae or pupae/containers examined ; Breteau index : containers with larvae or pupae/households examined ; and pupae per person : pupae found/number of residents ) . Per protocol secondary analysis examined the effect of Camino Verde in the context of temephos use . Results With cluster as the unit of analysis , serological evidence from intervention sites showed a lower risk of infection with dengue virus in children ( relative risk reduction 29.5 % , 95 % confidence interval 3.8 % to 55.3 % ) , fewer reports of dengue illness ( 24.7 % , 1.8 % to 51.2 % ) , fewer houses with larvae or pupae among houses visited ( house index ) ( 44.1 % , 13.6 % to 74.7 % ) , fewer containers with larvae or pupae among containers examined ( container index ) ( 36.7 % , 24.5 % to 44.8 % ) , fewer containers with larvae or pupae among houses visited ( Breteau index ) ( 35.1 % , 16.7 % to 55.5 % ) , and fewer pupae per person ( 51.7 % , 36.2 % to 76.1 % ) . The numbers needed to treat were 30 ( 95 % confidence interval 20 to 59 ) for a lower risk of infection in children , 71 ( 48 to 143 ) for fewer reports of dengue illness , 17 ( 14 to 20 ) for the house index , 37 ( 35 to 67 ) for the container index , 10 ( 6 to 29 ) for the Breteau index , and 12 ( 7 to 31 ) for fewer pupae per person . Secondary per protocol analysis showed no serological evidence of a protective effect of temephos . Conclusions Evidence based community mobilization can add effectiveness to dengue vector control . Each site implementing the intervention in its own way has the advantage of local customization and strong community engagement . Trial registration IS RCT
The Camino Verde trial of community mobilisation for control of dengue reported a significant impact on entomological indices of the Aedes aegypti vector , and on serological dengue virus infection and self-reported dengue cases .
One reason for doing r and omised controlled trials ( RCTs ) is that experiments can be convincing .
Early epidemiological experimenters , such as Jenner and the smallpox vaccine and Snow and his famous Broad Street pump h and le , already knew the answer they were demonstrating ; they used the experiments as knowledge translation devices to convince others .
More sophisticated modern experiments include cluster r and omised controlled trials ( C RCTs ) for experiments in the public health setting .
Those who are convinced by a trial and want to act , need to know how the trial relates to their own context , what contributed to success , and what might make it even more effective .