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An intervention focused on the elimination of mosquito breeding sites has proven to be both effective and economical
A partnership between public health, police and the army to reduce the mosquito population in Sri Lanka has resulted in over 50% reduction in dengue fever and cost savings, a study by International team of researchers led by the NYU College of Global Public Health. The results are Posted in Lancet Global Health.
Dengue fever is a viral disease transmitted by mosquitoes and can cause fever, pain, skin rashes and other flu-like symptoms. Severe cases require hospitalization, which places an economic burden on dengue-affected areas. A new dengue vaccine offers hope for a reduction in the impact of the disease, but the risks it poses limit its use, which has made it possible to continue to fight against mosquito populations to stop the spread of the disease. disease.
Dengue fever is particularly prevalent in South Asian countries and has become a major public health problem in Sri Lanka, which has experienced a dramatic increase in the disease in recent years. As a result, in 2014, the Ministry of Health of Sri Lanka launched a proactive mosquito control program in partnership with its military and police forces.
The program aimed to reduce the number of mosquitoes in high-risk communities by conducting large-scale door-to-door inspections. Teams of public health officials, police officers, and military personnel have inspected at least 50 sites each day to identify and eliminate mosquito breeding sites, such as containers. stagnant water around dwellings. The program has increased routine mosquito control interventions with larvicides and insecticides.
This study evaluated the impact of the mosquito control intervention from June 2014 to December 2016 in an urban area of western Sri Lanka heavily affected by dengue fever. The researchers badyzed dengue rates in symptomatic patients in the presence and absence of the intervention, taking into account climatic variables, including precipitation and temperature, to measure the impact of the program. The researchers also evaluated the costs and profitability of the program.
"Evaluating the effectiveness and cost-effectiveness of population-level interventions is essential to guide public health planning and enable decision-makers to deploy the most effective and efficient interventions in the world." particularly in resource-limited countries, "said Yesim Tozan, badistant professor of global health. at the NYU World Public Health College and lead author of the study.
The mosquito control program had a significant effect on mosquito larval populations in the region as well as on dengue fever, with researchers measuring a 57% reduction in the incidence of dengue fever. They estimate that 2,192 cases of dengue fever were prevented during the 31 months of intervention.
The program cost $ 271,615, the majority (89%) of which was due to the labor-intensive nature of the response including door-to-door inspections and the removal of mosquito breeding. To badyze its cost-effectiveness, researchers calculated costs using three scenarios of the proportion of dengue cases treated in hospitals: moderate hospitalization (50%), low hospitalization (25%) and high hospitalization (75%).
The researchers found that the savings achieved through the treatment of a reduced number of dengue cases in medical settings through the intervention amounted to $ 291,990 in the moderate hospitalization scenario , offsetting the costs of the mosquito control program and saving $ 20,247. It was estimated that the program avoided 176 disability-adjusted life years during the study period, or $ 98 in life-year savings adjusted for disability. The scenario with high hospitalization rates also included cost reduction, while the low hospitalization scenario was cost-effective by some calculations but not by others.
Leptospirosis cases in Sri Lanka
"Our study suggests that dengue-affected communities can benefit from investments in mosquito control if interventions are implemented rigorously and coordinated across sectors." In doing so, it is possible to reduce the disease and the economic burden of dengue, "said Prasad Liyanage of the Sri Lankan Ministry of Health and Sweden's Umeå University, lead author of the study.
"Even if a safe dengue vaccine becomes available in the future, mosquito control would likely remain an essential complementary strategy to limit the spread and intensification of dengue fever," said Tozan.
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Besides Tozan and Liyanage, the authors of the study include Joacim Rocklöv of Umeå University; Hasitha Tissera and Paba Palihawadana from the Sri Lankan Ministry of Health; and Annelies Wilder-Smith of the University of Umeå and the London School of Hygiene & Tropical Medicine.
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