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Chandra E, Johari A, Syaiful S, Fahri S. Alternatives to Improve Mosquito Eradication Behavior: A Systematic Review. J Res Dev Nurs Midw. 2021; 18 (2) :53-59
URL: http://nmj.goums.ac.ir/article-1-1326-en.html
1- . Department of Environmental Health, Health Polytechnic of the Ministry of Health Jambi, Indonesia , emiliachandra4@gmail.com
2- Concentration of Public Health Education, Jambi University, Indonesia
3- Department of Environmental Health, Health Polytechnic of the Ministry of Health Jambi, Indonesia
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What is current knowledge?
There are several strategies to improve community behavior in eradicating or controlling MBDs.
What is new here?
Effective strategies in controlling dengue vectors by the community are increasing community participation, decreasing house index, container index, and Breteau index, decreasing population exposure to dengue vector bites, decreasing Pupa index.
Mosquito-Borne Diseases (MBDs) is an essential issue in the theme of public health because the situation is very complex. Several important factors, such as biological, ecological, and socioeconomic factors, greatly influence the incidence of MBDs in a particular area of the community or society (1, 2). Various diseases are included in MBDs, such as malaria, dengue fever, typhoid, chikungunya, lymphatic filariasis, and Japanese encephalitis. These diseases have contributed significantly to the morbidity and mortality rates since they were first discovered. The prevalence of MBDs is common in areas with poor environmental sanitation conditions (3).
MBDs are a growing urban problem due to unplanned urbanization, industrialization, and overpopulation, coupled with rural to urban migration. In 2017, an estimated 219 million cases of malaria happened worldwide. Fifteen countries in sub-Saharan Africa and Southeast Asia account for 80% of global malaria incidence (1).
With the still high incidence of diseases caused by Mosquito-Borne Diseases (MBDs), it is necessary for the government and the public to make efforts to overcome both prevention and control, one of which is vector control. Vector control is the immediate action that can be taken on a community basis. Community empowerment has been an essential pillar in the approach to principal health care since the 1970s. At the International Conference on Primary Health Care in 1978, the Alma Ata Declaration placed community participation at the center of effective primary health care delivery. It was also emphasized that the active participation of the community in planning and implementing programs could be in the form of contributing resources, money, or their own time, which is then expected to principal to a logic of ownership, responsibility, and ultimately more control over the determinants of their health (4). Community participation is vital for the prevention and control of the MBDs outbreak. Community participation is far below expectations because it depends on people's awareness and practice of the disease (5).
The primary purpose of community empowerment is to mobilize the community to deal with health problems or other problems of concern to them. Community empowerment strategies can cause social cohesion, experience of community, and reinforce community assets, improving health consequences. The community empowerment approach has proven to be effective in promoting behavioral alteration in various health parts, including adolescent health growth (6), women's health (7), and HIV/AIDS prevention (8).
Control of larval sources leftovers an effective mosquito control plan. Classifying and reducing inundation on a large scale is impractical, expensive, and unsuitable for sustainable vector control if the government does it alone (9, 10). Meanwhile, mosquito control by involving the community has proven successful in both the short and long term. Therefore, complementary efforts from centralized (government) and community initiatives are needed to increase effectiveness and sustainability as mosquito control methods (3, 11, 12).
Several survey results explain the importance of the community's role in preventing and controlling the incidence of diseases caused by mosquitoes. The results of Sitti Chadijah's research (13) in Palu City, Central Sulawesi, Indonesia, found that community empowerment participation in dengue vector control was surveyor larvae (jumantik). Furthermore, Wiwik Trapsilowati's research (14) in Semarang City, Central Java Province, Indonesia, showed that the application of community empowerment methods in controlling dengue vectors (PMPV-DHF) in the intervention area obtained very good participation from DHF cadres, both in capacity building, involvement, volunteerism and scope of activities, with a score above 80% entomological evaluation in the intervention area with the indicator The larva free rate has a tendency to increase.
Therefore, it is crucial to comprehend interventions to intensify or transform community behavior in eradicating mosquito nests to reduce the incidence of Mosquito-Borne Diseases (MBD). The review aims to examine some relevant literature that focuses on improving the behavior of the community to eradicate mosquito nests in their respective living areas. This study provides an overview of several alternatives for policymakers in the success of national and international goals related to MBDs.
This review was showed using the Preferred Reporting Items for Systematic Review and Meta-analyses (PRISMA) statement. Through this study, various models or strategies are seen to improve community behavior in eradicating or preventing MBDs.
Identification of relevant studies
Relevant articles were searched and collected using databases such as ScienceDirect, Google Scholar, Cochrane Library, and Wiley Online Library, with a publication period between 2010 to 2021. Keywords were adjusted according to Mesh terms for health studies. The keywords used vary, depending on the search engine used. In general, the keywords focus on 'community participation' OR 'health promotion' OR 'community behavior' OR 'community engagement' OR 'citizen science' OR 'com-munity empowerment' OR empower* AND 'mosquito borne disease' OR 'mosquito vectors ' OR dengue OR Dengue Hemorrhagic Fever OR Malaria OR Aedes OR Anopheles OR 'disease vectors' AND surveillance OR 'communicable disease control' OR 'behavior control' or 'mosquito control' OR prevention OR management.
Selection of studies according to the pre-established criteria
Inclusion criteria include intervention studies, programs, training, or educational strategies to support the improvement of community behavior in eliminating mosquito nests; analyze the effectiveness of the intervention by measuring changes in people's knowledge, attitudes, perceptions, or practices in eradicating mosquito nests; focuses on the community or groups or groups in society. Our search strategy focuses on English and Indonesian language databases and publications. Articles were excluded or not reviewed if they only discussed the prevalence of MBDs incidence, analysis of risks associated with MBDs incidence (not referring to intervention strategies or health promotion), comment to editor, or systematic review.
Data Extraction and Analysis
Titles and abstracts are screened in each database. Complete text filtering was performed using Mendeley and extracted into Microsoft Word. The first author determined the selection of articles after a joint review of all authors' first sixteen full-text articles to establish explicit inclusion and exclusion criteria. The interpretations are presented in the table by taking the critical parts of the article.
Quality appraisal
  Overall, articles were assessed using the NIH study quality assessment tool. A scoring sheet was advanced to measure the research methodology and devotion to the scoring criteria for each study that met the inclusion criteria of this study. Studies with scores <30% of the criteria are classified as “poor,” scores between 30 and 70% are classified as “moderate,” and scores >70% are classified as “good” study quality. The studies taken are studies that are classified as moderate and reasonable.
The search returned 19,206 articles; after removing the duplicated articles, 11,638 articles were remaining, of which 11,615 articles were removed after screening titles and abstracts. The remaining 23 articles were reviewed and checked for eligibility, so seven articles were excluded. The final results were collected as many as 16 articles that encountered the inclusion criteria.
Characteristics of studies included
Sixteen articles were included in this review, four studies conducted in Indonesia, three studies in India, two studies in Cuba, and one each in Australia, Brazil, Bhutan, Burkina Faso, Malaysia, Philippines, and Thailand. The studies used a variety of designs, including quasi-experimental (n=12), RCT (n=3), and longitudinal (n=1). The sample size varied from 100 to 27,030, the study population with various ethnic backgrounds, including Asian, Hispanic, Australian, and African.
Analysis of community role enhancement model
This study identifies several strategies to improve community behavior in eradicating or controlling MBDs, including group management, where this model focuses on collaboration between researchers, Puskesmas, local government (Kelurahan/Village, sub-district) , supervisors, city sanitation, Barangay (Kelurahan/subdistrict) officers, health cadres (15, 16), community leaders, community organizations, private waste officers (17) , health cadres (18). Another strategy is a direct action to the community, including Health education (19-21), intensive campaign (22), Educational training (23-25), Fight the Bite (26), Community workshops, clean-up campaigns, distributing Information Education, and Communication (IEC) (16, 27-29), Counseling (15), and, Control cards (18).
The effect of intervention on community's behavior
Five studies are showing positive results on dengue vector control by the community, such as increased community participation  (17, 28), decreased house index, container index, and Breteau index (25, 27, 29) decreased population exposure to dengue vector bites, decreased Pupae index (22). Furthermore, seven studies focused on increasing public awareness and or behavior towards Mosquito-Borne Diseases (MBDs), including management of water reservoirs (17), use of control cards (18), Improved preventive actions (25, 26, 30), cleaning up places that are breeding grounds for mosquitoes (16, 20), healthy home conditions (19). The other four studies focused on improving community KAPs with the expected result being an increase in public awareness of the importance of preventing MBDs through healthy living behaviors, one of which is keeping the house and the surrounding environment clean (15, 21, 23, 24).
All reviewed studies used various strategies to increase public awareness, behavior, knowledge, perceptions, or practices, especially those related to reducing mosquito breeding through eradicating possible or favorable places as nests. Knowledge is a critical element of an individual or community empowerment (31). Gubler and Clark emphasize the importance of enhancing information in mosquito management, including changing attitudes toward the 'acceptance' of raising grounds in and around people's houses (32). The tactics identified in this review suggest that active education (e.g., door-to-door education) is more effective than passive education strategies like pamphlet distribution, television, and radio commercials. When carried out separately from other strategies, the passive education approach shows little or no influence on mosquito management outcomes (33-36). These findings are reinforced by the broader behavioral alteration literature, which has shown that knowledge gaining as a strategy alone is often not sufficient to attain sustainable health outcomes (37, 38).
In general, this review found that an effort to improve community behavior towards eradicating mosquito nests requires good cooperation between the local government, health services, community or community organizations, community leaders, or people who can represent in carrying out the planned program. The cross-sectoral collaboration shows effectiveness with the expected results (23, 27, 39, 40). Several studies have shown that health workers responsible for community health, including people who represent the community, are given training for some time in preparation to assist the community directly to increase awareness or change people's behavior about MBDs (39). In 2012, while another study in India only gave briefings to the Women Self-Help Group (SHG) related to monitoring activities of community houses, especially water reservoirs in each community's house (27). In addition, women's SHGs also show an active role in inviting the community to participate directly in cleaning their environment, especially the environment around their respective homes (27).
SHGs are informal groups of people who come together to solve their problems together. Self-assist companies can serve many exclusive functions relying at the state of affairs and wishes (41). In the setting of ladies's empowerment, it's miles assumed that after ladies come together, they discover energy and pass toward similarly understanding and awareness. This process forms the basis for further empowering women. Self-assist organizations are a precious platform for enhancing women's health finished increasing knowledge and awareness about health issues and financial security during health emergencies (42). The contribution of individuals, families, and groups is integral in promoting health. Individuals, families, and groups are considered as participating in the health field when they are collectively accountable for their health, their families, and the environment, and are interested in establishing plans, implementing them, and solving problems in society (43).
Water management interventions such as closing water reservoirs are included in the main activities to reduce the number of mosquitoes that cause disease (44). The study in the Philippines implemented an intervention to control water reservoirs by involving the city sanitation inspectorate, sub-district officers (Barangay), and health cadres. Instructions and guidance were given to the community to observe immature forms of mosquitoes in water reservoirs and report difficulties encountered to health workers assigned to the area or local CHW. Although the desired results were not achieved, observations of the behavior change process provide an illustration of significance of information the social nature of urban communities, one of which is not responsive to the government's recommendation to participate in the provided training as evidenced by the lack of community members attending the training conducted by researchers (45). It is in line with a study in Pakistan which stated that the inactivity or indifference of the community to government programs related to eradicating mosquito nests increased in epidemic conditions that occurred in a region. Good dengue control practices depend on public awareness campaigns and disseminating data approximately dengue; therefore, communities can eliminate dengue breeding locates if they contribute in dengue awareness campaigns and discuss dengue fever (46).
One of the studies conducted an intervention in the form of giving a control card to each household. This control card contains a list of activities for cleaning the house and the environment; homeowners are encouraged to put a mark or checklist on the activity items listed on the control card. A designated field officer will visit each house at an unspecified time or not known by the community to check the control card given. If an activity is not checked on the control card, the officer will ask why do not do it. At the end of the study, it was found that many households did not provide a checklist on their control card for reasons of forgetting or being lazy to fill it out (18). Both the government initiatives and the intervention research provided here are top-down, which may have contributed to resistance to intervention involvement. The community is, of course, involved in the research, but as participants rather than co-creators. It could explain the poor participation rate in the feasibility study, with just around one-fourth of participants using the control card as intended. There are three main reasons behind the community's refusal to participate, according to field officers: They believe that field officers, not themselves, are responsible for maintaining cleanliness (18). Previous research has suggested that bottom-up approaches are much more likely to be successful and sustainable (47). Therefore, it is imperative for the health authorities to know the community's opinion on the programmed DHF control program, in addition to continuously increasing the knowledge and motivation of the community to participate.
The embodiment of a bottom-up strategy that can be applied and has proven effective in understanding public perception is the Small Group Discussion (SGD). A study conducted in Indonesia even found significant results compared to the lecture method (16). Group Discussions allow participants to express their complaints and opinions on a problem topic without feeling intimidated by the discussion group leader or other participants (48).
Several obstacles in implementing Health Education in the community include lack of personnel, public health experts, and inadequate materials. The community is not interested in contributing in these educational activities, and they feel unable to control various things in life where they have to prioritize efforts in terms of their livelihoods (20). However, for dengue-related health education at the academic (student) level at universities, Health Education may increase student awareness quite significantly. Health Education is provided through a social media platform, so it is highly recommended that the government use this method nationally, considering the number of social media users to date has increased very rapidly (21). In line with other studies in Malaysia, it is stated that good knowledge about Dengue positively improves people's attitudes and practices towards Dengue prevention (49). The type of knowledge needed by the community is, of course, about the morphological process of the vector, the signs and symptoms are shown by Dengue sufferers, to what actions must be taken to break the life chain of the Dengue vector, including family actions that must be taken if a family member suffers from Dengue or MBDs (50).
The health campaign carried out by Australia as a developed country is very massive and structured under the name of the Fight the Bite program. It is insufficient to conduct MBDs campaign on social media, television, radio, and even magazines/newspapers; for expansion of this national campaign program by advertising or calling on the public to work together with the government to make the Fight the Bite program a success through posters distributed on strategic places such as bus terminals, airports, including the installation of billboards on the main streets of the city. In addition, this program also provides fight the Bite branding including stickers. After two years of intense implementation of this program, the results showed a significant increase in community awareness and prevention efforts independently (51).
This systematic review was carried out to find effective strategies in supporting public awareness, ultimately in developing countries, concerning eradicating mosquito nests, better known as Vector control, where activities include cleaning places that can potentially become vector breeding locations. This study provides a clear view and evidence of the effectiveness of strategies implemented by the government and new strategies developed by academics.
The current review is limited on the literature search, where some databases are not used due to the limited resources to access some sources. However, the author's database in this study is considered representative of the entire existing study. This study in several studies does not thoroughly discuss the domain that is the variable. In addition, the selection of the language used is limited only to English-language studies.
The best strategy to improve or change people's behavior in eradicating mosquito nests or controlling MBDs is to recognize the root causes of problems in the community, especially the desires and obstacles in the community. Group Discussion can be an excellent choice to dig deeper into the community's perception and what steps are desired or best for themselves. Health Education, using control cards, door-to-door monitoring, empowering groups in the community, and promoting MBDs through social media is effective for the community, as long as it is under what is needed or following the community's ability.
We would like to express our gratitude to the chief of the Poltekkes Jambi for her kind suggestions and input for the development of this research and to all participants for their cooperation in this research
Funding source
The authors received no financial support for the research, authorship, and/or publication of this article.
Ethical statement
The study was approved by the Health Research Ethics Committee of Komisi Etik Penelitian Kesehatan Poltekkes Kemenkes Jambi (Reference number LB.02.06/2/190/2021).
Conflict of interest
The authors declare that there is no conflict of interest.

Author contributions
ECH and AJ were responsible for the study conception and design; AJ, SY, SF performed the data collection; AJ and SY performed the data analysis;  ECH, and SF were responsible for the drafting of the manuscript; ECH and SF made critical revisions to the paper for important intellectual content.

Type of Study: Review Article | Subject: Nursing

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