Knowledge, attitude and practice (KAP) and risk factors on dengue fever among children in Brazil, Fortaleza: A cross-sectional study.

BACKGROUND: Dengue fever is a mosquito-borne viral disease that is associated with four serotypes of the dengue virus. Children are vulnerable to infection with the dengue virus, particularly those who have been previously infected with a different dengue serotype. Sufficient knowledge, positive attitudes, and proper practices (KAP) are essential for dengue prevention and control. This study aims to estimate the dengue seropositivity for study participants and to examine the association between households' dengue-related knowledge, attitudes, and practices (KAP), and children's risk of dengue seropositivity, while accounting for socioeconomic and demographic differences in Brazil. METHODOLOGY/PRINCIPAL FINDINGS: This analysis was based on a cross-sectional study from Fortaleza, Brazil between November 2019, and February 2020. There were 392 households and 483 participant children who provided a sample of sufficient quality for serological analysis. The main exposure was a household's dengue-related knowledge, attitudes, and practices, assessed through a questionnaire to construct a composite KAP score categorized into three levels: low, moderate, and high. The main outcome is dengue immunoglobulin G(IgG) antibodies, collected using dried blood spots and assessed with Panbio Dengue IgG indirect ELISA (enzyme-linked immunosorbent assays) test commercial kits. The estimated crude dengue seroprevalence among participating children (n = 483) was 25%. Five percent of households (n = 20) achieved a score over 75% for KAP, sixty-nine percent of households (n = 271) scored between 50% and 75%, and twenty-six percent of households (n = 101) scored lower than 50%. Each KAP domain was significantly and positively associated with the others. The mean percentage scores for the three domains are 74%, 63%, and 39% respectively. We found high household KAP scores were associated with an increased adjusted relative risk (aRR) of seropositivity (aRR: 2.11, 95% CI: 1.11-4.01, p = 0.023). Household adult respondents' education level of elementary school or higher was negatively associated with children's risk of being seropositive (aRR: 0.65, 95% CI: 0.48-0.87, p = 0.005). The risk of seropositivity in older children (6-12 years old) was over 6 times that of younger children (2-5 years old) (aRR: 6.08, 95% CI: 3.47-10.64, p<0.001). Children living in households with sealed water tanks or no water storage had a lower risk of being seropositive (aRR: 0.73, 95% CI: 0.54-0.98, p = 0.035). CONCLUSIONS/SIGNIFICANCE: Our results provide insight into the prevalence of dengue seropositivity in Fortaleza, Brazil in children, and certain demographic and socioeconomic characteristics associated with children's risk of being seropositive. They also suggest that KAP may not identify those more at-risk for dengue, although understanding and enhancing households' KAP is crucial for effective community dengue control and prevention initiatives.

Sustainable, healthy cities: protocol of a mixed methods evaluation of a cluster randomized controlled trial for Aedes control in Brazil using a community mobilization approach.

BACKGROUND: Dengue is increasing in its global presence with an estimated 4 billion people at-risk of infection in at least 128 countries. Despite the promising results of EcoHealth and community mobilization approaches to Aedes reduction, more evidence of their efficacy on reducing dengue risk is needed. The principal research question is to determine if interventions based upon community mobilization reduce the risk of dengue virus infection among children 3 to 9 years old compared to usual dengue control practice in Fortaleza, Brazil. METHODS: The present study will follow a pragmatic cluster randomized controlled trial (cRCT) design with randomization at the census tract level with equal allocation to the two arms. In each arm, there will be 34 clusters of 86 children between 3 to 9 years old for an expected total of 5848 children enrolled in the study, assuming a risk reduction of 29.5% based upon findings from a previous multi-site cRCT. The primary outcomes are rates of anti-dengue Immunoglobulin G (IgG) seroconversion and adult female Aedes density. The intervention is based upon a participatory health research approach, Socializing Evidence for Participatory Action (SEPA), where the research evidence is used to foster community engagement and ownership of the health issue and solution. Following allocation, intervention communities will develop and implement their own solutions that will likely include a wide variety of collective events and media approaches. Data collection activities over a period of 3 years include household visits for blood collection, household surveys, and entomological surveys; and qualitative activities including focus groups, in-depth interviews, and document analysis to evaluate the process, acceptability, fidelity, and sustainability of the intervention. Study participants will be aware of their assignment and all research staff will be blinded although the intervention assignment will likely be revealed to field staff through interaction with participants. DISCUSSION: The results of our study will provide evidence on community mobilization as an intervention for dengue control. We anticipate that if community mobilization is effective in Fortaleza, the results of this study will help develop evidence-based vector control programs in Brazil, and also in other countries struggling with Aedes-transmitted diseases. TRIAL REGISTRATION: ISRCTN66131315, registration date: 1 October 2018.

Aprendizagens com o corpo todo na (trans)formação de educadores (as) populares do Curso Livre de Educação Popular em Saúde (EdPopSUS) / Aprendizaje con todo el cuerpo en la (trans) formación de educadores populares del Curso Libre de Educación Popular en Salud (EDPopSUS) / Learning with the whole body in the (trans) formation of educators in the Free Course of Health Popular Education (EdPopSUS)

No intuito de reafirmar os princípios do Sistema Único de Saúde (SUS), institui-se a Política Nacional de Educação Popular em Saúde (PNEPS-SUS), tendo como estratégia um curso de educação popular em saúde para trabalhadores do SUS e movimentos sociais. Objetivou-se analisar o tema das aprendizagens com o corpo todo surgido no processo formativo dos (as) educadores (as) do curso, relacionado à produção de autonomia. A formação de educadores tem atuado na lógica de prerrogativas a serem seguidas, porém, a educação popular propõe a aprendizagem como exercício da autonomia para a responsabilidade política. Neste estudo exploratório, com base na abordagem qualitativa, ancorado no estudo de caso, produzimos os dados com entrevistas em profundidade e observação participante. O curso revelou-se tecido por aprendizagens com o corpo todo que demarcaram inovações na educação em saúde, ao incluir a corporeidade, a espiritualidade, as histórias e vulnerabilidades dos (as) educadores (as), possibilitando sua (trans) formação.(AU)

Con el objetivo de reafirmar los principios del Sistema Brasileño de Salud (SUS), se instituyó la Política Nacional de Educación Popular en Salud (PNEPS-SUS), con la estrategia de un curso de educación popular en salud para trabajadores del SUS y sus movimientos sociales. El enfoque fue analizar el tema de los aprendizajes con todo el cuerpo, surgido en el proceso formativo de los (las) educadores (as) del curso, relacionado a la producción de autonomía. La formación de formadores han actuado en la lógica de prerrogativas a seguir, pero la educación popular propone el aprendizaje como ejercicio de la autonomía para la responsabilidad política. En este estudio exploratorio con base en el abordaje cualitativo, anclado en el estudio de caso, producimos los datos con entrevistas en profundidad y observación participante. El curso se reveló tejido por aprendizajes con todo el cuerpo que demarcaron innovaciones en la educación en salud, al incluir la corporeidad, la espiritualidad, las historias y vulnerabilidades de de los (as) educadores (as) posibilitando su (trans) formación.(AU)

The PNEPS-SUS was instituted to reinforce the principles of the Brazilian National Health System (SUS), having as strategy a popular health education course for workers of the SUS and social movements. The objective of this study was to analyze the subject of learning with the whole body that emerged in the formative process of the course' educators related to the production of autonomy. The formation of educators acted following a logic of prerogatives to be followed. Instead, popular education proposes learning as an exercise of autonomy for political responsibility. In this exploratory study, based on the qualitative approach, anchored in the case study, we produced the data with in-depth interviews and participant observation. The course proved to be interwoven by whole-body learning that singled out innovations in health education, by including the corporeity, spirituality, histories and vulnerabilities of the educators, enabling their (trans) formation.(AU)