Sociological Component

• To gain in-depth insight into people’s perceptions of dengue, its prevention and treatment.

• To use trusted, culturally-appropriate and context-specific communication approaches for different target audiences in the intervention communities.

• To gain community acceptance of the intervention.

• To understand potential structural and socio-cultural barriers to the intervention and ways to remove these barriers.

• To gain community acceptance of trial procedures.

• To improve the effectiveness of the different interventions.

Adherence study

The percentage of schools and households that keep guppy fish in water containers will be measured on random monthly household visits. Mixed methods social science research, using both ethnographic methods and surveys, will be conducted to evaluate the barriers and enabling factors contributing to the effectiveness of using guppy fish for vector control, including acceptability, feasibility and adherence to the intervention.

In-depth interviews

Individual, in-depth, semi-structured interviews with key informants (KIIs) will be conducted. These interviews will help the researchers understand new aspects of the research that they had not yet considered. They will also help researchers to understand theories that they had already considered.

Focus-group discussions

In focus group discussions, social mapping, timelines and charts describing daily routine and seasonal calendars will be used to encourage participants to actively engage in discussions. Village chiefs, parents, other child guardians, monks and adults over 18 years of age will be invited to participate. Discussions will be held in the local language and will touch on topics such as:

• Teaching and learning practices;

• Seasonal employment;

• Movement between schools, homes and other places;

• Use of dengue preventative measures, including repellent use, bed net ownership and use, and measures other than source reduction;

• Treatment-seeking behavior;

• Daytime social activities, nocturnal activities and resting habits; and

• Perceptions of dengue and mosquito density.

Participant observations

Researchers will participate in everyday activities in community settings, observing events in their usual context and carrying out informal conversations and interviews. This method will build confidence among research participants and allow the research team to gain an in-depth understanding of more sensitive and complex issues. The informal conversations are expected to lead to new ideas about community-level factors in vector control. The field experiences are also expected to help the researchers gain more holistic perspectives on the implementation strategies.

Participatory group discussion

This will be the main participatory research technique. Participants will include representatives of different political, gender-related, and health-related stakeholders, who will propose implementation strategies based on results from the baseline study. The “best implementation strategies” will be selected following an adapted strengths, weaknesses, opportunities and threats (SWOT) analysis.

Participatory epidemiological mapping

During the preliminary PEM sessions, key actors in the community were mapped and identified. Participants from the villages will be involved in transect walks with researchers along a specific route, where they will help to map dengue incidence, the location of schools and the different types of human activities along that route. By actively involving community members in this process, they will become aware of the value of their local knowledge, and more inclined to acquire a stronger ownership of and capacity for their vector control responsibilities and activities.

Communication for Behavioural Impact (COMBI)

Information gathered from the interviews, participant observations and group discussions will be used to develop an effective COMBI strategy in the communities. COMBI is a toolkit for designing outbreak prevention and control measures. It is a 7-step approach intended for risk communication, developmental communication and health promotion. It is also used to help health care workers from multidisciplinary teams to understand the local contexts and dynamics of disease outbreaks. This ensures that control measures are not only technically-sound, but also culturally appropriate. Activities have included the following:

• 40 health education sessions have been organized with between 20–45 villagers participating in each. Local authorities, community health workers and students actively contributed to these.
• Key stakeholder meetings have been held to achieve participative planning, to guide the intervention activities, to get involvement in monitoring and evaluation, and to help mobilize local resources and give support. A series of dialogues on interventions were also set up and a working system was developed among key stakeholders.

Community engagement and empowerment assessment

Community empowerment is a key indicator of the successful operationalization of multidisciplinary approaches involving academics and the local communities. The “community health development framework” was used to assess community engagement using 5 indicators including: leadership; planning and management; women’s involvement; external support for programme development; and monitoring and evaluation. Activities have included the following:

• Women’s groups were trained to mass produce mosquito traps. This has resulted in 9528 traps being produced and deployed.
• Parent-school meetings have been held at 16 locations to discuss the education strategic approach, and the action plan at the school and community level.

Overall, there was not a significant difference in entomological indices between intervention arm 1 (biophysical interventions and empowerment interventions) and arm 2 (biophysical interventions only). However, although this is not captured by the methodology, the research team strongly believes that the positive results would not have been achieved without extensive community engagement. However, the interventions showed a very clear and significant reduction in both mosquito adults and immature stages between the Intervention Arms and Control Arm, meaning that the interventions are a success in reducing populations of dengue vector mosquitoes.

Adherence study

• Success in guppy fish community uptake: the percentage of households in the intervention communities who had guppy fish increased from 11% in August 2018 to 42% in August 2019.
• Guppy fish use in the control areas is increasing as awareness is spreading.

Knowledge, Attitude and Practice survey

• The initial baseline surveys showed that knowledge of dengue transmission, symptoms and prevention was high. Ninety percent of people knew that fever was a sign of dengue and nearly everyone knew at least three signs or symptoms.
• The reported use of prevention practices, as reported in the baseline survey, was also high.

Participatory epidemiological mapping (PEM)

• 650 villagers (mostly women) participated in PEM sessions, developing action plans for community protection and prevention against dengue and other mosquito-borne diseases.
• Maps were produced to show different locations in the community, including where people work and gather, as well as mosquito breeding sites and habitats.