Dengue: main difficulties in prevention are revealed by study

A new study carried out by the United Nations Children’s Fund (Unicef), launched this Thursday (24) with the support of biopharmaceutical company Takeda, showed that, although a large part of the population knows that it is necessary to “avoid standing water” to prevent dengue invest only in communication strategies focused on this message is not enough to bring about significant changes in the fight against arboviruses (diseases transmitted by mosquitoes).

The finding of search It is relevant and worrying in a scenario where dengue cases are increasing in Brazil and around the world. In June 2024, the country had surpassed the mark of 6 million confirmed cases of the disease, according to the Ministry of Health’s monitoring panel. This number represents a significant increase compared to 2023, when the country had just over 1.6 million records.

With climate change, which leads to extreme natural events, such as intense rains and floods, the risk of dengue cases increasing even further is real. Given this scenario, the need to reinforce prevention strategies against arboviruses which, in addition to dengue, also include zika and chikungunya, resurfaces.

“The moment is more serious and, therefore, all care, campaigns and attention to dengue must be intensified. Intersectorality has to happen; community engagement has to be even greater; it is also necessary to increase the risk perception of the disease, also raising climate issues, and also increase the resilience of services, schools, basic health units so that they can, in times of environmental disasters, respond to this without discontinuing its services”, says Luciana Phebo, head of health at Unicef ​​in Brazil, in a press conference held virtually this Thursday (24).

The research, titled “Combating dengue, zika and chikungunya – Behavioral study on adherence to prevention practices “, used as a theoretical framework the Behavioral Drivers Model, developed by Unicef ​​to work on Social and Behavior Change (SBC).

This model considers that behavior is multi-determined by psychological, sociological and environmental aspects (including public policies), allowing an analysis that goes beyond explanations that attribute responsibility for adopting preventive behaviors to an individual’s decision, such as lack of knowledge or interest.

The work included a qualitative stage carried out with 24 ethnographic groups (interviews conducted in people’s homes, with participants from their own social circle), in two medium-sized municipalities, selected through epidemiological data. The qualitative collection of perceptions with populations was carried out in the municipalities of Montes Claros (MG) and Sinop (MT), in addition to interviews with public managers from eight other cities in the Amazon and Semi-Arid regions.

What is behind the difficulty in adhering to dengue prevention?

After an extensive literature review, followed by field research and interviews, the study explains which aspects motivate or hinder the adoption of disease prevention practices. Aedes aegypti. The research organizes these aspects into three levels, according to a Unicef ​​methodology for working with social and behavioral changes: psychological, sociological and structural.

Among the psychological factors related to mosquito prevention, the study points out:

• Infection history and risk perception : Those who have never had the disease tend not to believe in its seriousness. Risk perception and prevention practices may increase in an epidemic situation, but decrease in different scenarios;
• Effort : preventive practices – including cleaning gutters, water tanks and hard-to-reach places – are seen as something difficult, time-consuming, complex, for which people do not have time or availability;
• Financial costs : especially in more vulnerable locations, spending resources on cleaning water tanks, purchasing repellents, among others, may not be viable.

Among the sociological factors, the following were identified:

• Collective organization : Participating in neighborhood organizations is associated with increased prevention practices. But in many regions, many people don’t know their neighbors, they don’t see themselves as part of a group, and there is no collective organization to take care of the neighborhood;
• Community influence : Many people feel morally obligated to comply with prevention practices that they believe are expected of them.

The study also raised structural factors, such as:

• Urban structure : lack of garbage collection and the presence of vacant land encourages inadequate waste disposal.
• Action of endemic agents : action of agents is associated with a reduction in arboviruses. In some places, however, there may not be enough agents, or there may be obstacles in the agents’ relationship with the community.
• Trust in public authorities : low trust in government bodies can be a barrier to following health and prevention guidelines.

From the researchers’ point of view, each of these factors can impact the population’s attitudes towards preventing, or not, arboviruses.

“Common sense says that when someone has information about what is good for themselves and their family, they adopt a behavior or habit. But there is a difference between what people say they do and the habits they actually incorporate into their daily routines. Doing or not doing something depends on a huge confluence of factors, behaviors, social norms, infrastructure and access to public policies. These are the aspects that we revealed in this study”, explains Phebo.

Recommendations to face challenges in adhering to arbovirus prevention measures

The research also brings together important recommendations to address the difficulty of adhering to preventive measures against dengue, zika and chikungunya. One of them is to associate vector control with behaviors seen as “desirable” by the population, such as keeping the house clean or not throwing trash on the street.

Another recommendation is to increase risk perception, especially in relation to children. The study observed that there is a high perception of the risk of infection by parents when related to children, for fear that their children are infected. This insight could be used more effectively in risk communication campaigns and community involvement in preventive actions.

Reducing costs and efforts associated with adopting preventive behaviors and increasing investments in infrastructure is also a possible solution highlighted by the study. This includes investment in public policies that reduce the cost and efforts of prevention practices that can have a positive effect on reducing arboviruses.

Furthermore, investing in improvements in infrastructure and urban cleaning can strengthen the population’s adherence to prevention measures, according to the study.

Finally, the work considers it important to strategically evaluate how to engage the community and carry out community actions. It is a case of adopting more community engagement policies, in addition to stimulating and mediating discussions on the topic in communities, from the study’s point of view.

“The research reveals the challenges in adopting preventive measures against these diseases and points to a way to overcome them. Adherence to measures integrated in the prevention of dengue, such as vector control, training of health professionals, adequate diagnosis and clinical management, in addition to effective preventive actions, is urgent and we believe that this initiative will be fundamental to boost strategies focused on combating dengue fever. arboviruses”, says Eduardo Almeida, executive director of Strategic Access and Public Affairs at Takeda Brasil.

“We know the importance of guaranteeing, for each boy and girl, the right to live in an environment free from diseases that can affect not only their physical health, but also impact a child’s school attendance and routine, such as playing, eating appropriately, among other activities. We hope that the findings of this study can contribute to public policies and communication actions nationally and in each municipality, with a focus on behavioral changes necessary to combat Aedes”, adds Phebo.

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This content was originally published in Dengue: main difficulties in prevention are revealed by study on the CNN Brasil website.

Source: CNN Brasil