Background to the programme
In Southeast Asia, dengue fever and dengue hemorrhagic fever (DF / DHF) has become one of the most important public health issues. In Vietnam 1.3 million cases and 25,000 deaths were recorded in the last 25 years. Outbreaks more frequent and widespread show a constant increase in the incidence and range of the disease. A difficult disease to diagnose, dengue is also a difficult disease to treat because there is no specific antiviral treatment at present and a vaccine is not yet available. The only way to mitigate this disease is to reduce populations of Aedes mosquito vectors.
Objectives of the programme
The National Institute of Hygiene and Epidemiology (NIHE) and "Alliance pour le Développement" implemented the “Programme Meso-Vietnam”, from October 2007 to December 2010, to reduce dengue and DHF incidence and to improve the quality of life in 4 project communes (Minh Thuan, Trung Dong, Dien Kim, Dien Hai). This dengue control project was based on a biological control using Mesocyclops and on the establishment of a strong community involvement to educate the population on dengue transmission and reduce Aedes breeding by removal of containers.
- A Community Management Committee (CMC) was set up in each municipalities (representatives of schools, health services, local authorities and the community) to plan and organize activities and mobilize the community
- Collaborators established a dozen key containers for the reproduction of Mesocyclops in each village . Each month, they checked for the presence of Mesocyclops with a surveillance kit
- Training workshops for healthcare professionals to improve knowledge about the disease. Collaborators received training tailored to their duties and professional health centers to strengthen their serological surveillance
- Teachers (secondary schools) taught students on dengue vector mosquitoes and Mesocyclops (courses and workshops)
- Campaigns for collecting solid waste (potential breeding sites) took place each month
- Communication media have been created and disseminated: schedules, posters, flyers, giant billboards, radio messages and regular information meetings
- 3 KAP studies conducted (100 people/commune/study;) to measure the ultimate impact of health promotion’s activities
- Entomological surveillance (100 houses) to know the presence of the different species of Mesocyclops in all containers and the distribution of Aedes adult mosquitoes and larvae. Every 3 months, entomological surveillance took place, allowing information in qualitative and quantitative changes in adult mosquitoes, larval, Mesocyclops populations
- In the community health centers, a blood sample was performed in all patients with suspected dengue.
Quantitative and qualitative results from the implemented actions
- 2008-2010, 12 “cross-checks” were held (meetings between employees of 2 communes), 2 competitions involving collaborators from the 3 communes were held, and one important festival involving plays, songs and skits
- 277,665 Collaborators’ regular visits : 96% of households, 35 campaigns for the introduction of Mesocyclops, and 1614 containers treated with Mesocyclops
- 35 clean-up campaigns occurred; 294,527 destroyed discards collected; 102 meetings (27,705 listeners and participants)
- Training workshops to 40 health professionals : 102 local staff trained in light version, 2 refresher training, 35 health professionals have received additional training
- 140 teachers were trained 4 times, got a training manual, and integrated a specific course on dengue vector mosquitoes
- In Minh Thuan, 37 speeches on the topic of dengue have been made: 16.540 high school students, 67 classes, 4.664 students. In Trung Dong, 30 speeches were held: 8.064 pupils, 44 classes, 1.807 students. In Dien Kim, 25 teachers were trained and taught specific courses on dengue to 1260 students. 30 clean-up campaigns involving students were held
- In total, more than 444,000 persons-contacts were informed directly about dengue and the current programme. At the end of the programme, 100% of the inhabitants have heard of dengue and know that dengue can be a dangerous disease. 78.7% can recognize the symptoms of a suspected case. 96% is aware that dengue is transmitted by mosquitoes (95% knew that the vectors are “tiger mosquitoes”). 96% knew that the methods for dengue control are essentially methods of controlling mosquitoes and larvae. 72% now know that larvivorous fish can also be used, as well as regular cleaning of water containers, solid waste disposal and using of Mesocyclops
The use of these larvivorous micro-crustaceans as a biological control strategy against dengue in the medium and long term, which when combined with community activities and effective health promotion, allows a significant reduction in larval of mosquitoes present in the medium, thus limiting in an ecological way the risk of epidemics.
Partnership(s) developed in the context of the programme
The Vietnamese Ministry of Health, the Centers for Preventive Medicine of the respective Provinces for serological testing, NIHE laboratory, the Centres for Preventive Medicine
Difficulties and/or obstacles encountered during the programme’s implementation :
To compensate for the cessation of external funding at the end of the program.
Solutions used to overcome the difficulties and/or obstacles :
A micro-credit income generating system has been established in all 3 communes. The profits will support local community vector control activities and pay collaborators.
Suggestions for future improvement :
It could be envisaged that a training program on dengue fever be officially enrolled in the curriculum of secondary schools in Vietnam at the national level.
Summary of factors responsible for the programme’s success :
- Meetings have encouraged ownership of the program by the villagers, and exchanges have helped to refocus if necessary certain actions or activities of the programme
- The water storage containers represent the major Aedes breeding sites that facilitate this model of intervention
- The local leadership has been strengthened at national, provincial and local levels. This organizational model has generally improved capacity for surveillance, diagnosis and integrated control of dengue and DHF at all levels of the Vietnamese health system
- The involvement of the school system seems to receive the agreement of all
- The Vietnamese government, through its National Program against Dengue, will continue to play a catalytic role, and foster multidisciplinary interactions
- The programme confirms that there is an alternative to systematic use of insecticides to control dengue vector population.
Authors, “Validation of Mesocyclops (Copepoda) and community participation as an effective combination for dengue control in Northern Vietnam”, FACTS Reports in press
To know more
In Vietnam, ten species of copepods (larvorious micro-crustaceans) exist in natural and artificial environments. The Mesocyclops spp. feed on organic matter, but also on the early instars (1 & 2) of mosquito larvae, particularly Aedes larvae. Each Mesocyc