Scaling up of Eco-Bio-Social Strategy to Control Aedes aegypti in Highly Vulnerable Areas in Fortaleza, Brazil: A Cluster, Non-Randomized Controlled Trial Protocol.

Aedes aegypti is a cosmopolitan vector for arboviruses dengue, Zika and chikungunya, disseminated in all Brazilian states. The Eco-Bio-Social (EBS) strategy is vital in Aedes aegypti control as it mobilizes stakeholders (government, professionals, society, and academics) to promote healthy environments. This paper describes the rationale and methods of expanding the EBS strategy for Aedes aegypti control in Fortaleza, Northeast Brazil. A cluster, non-randomized controlled clinical trial was developed to analyze the strategy's effectiveness in vulnerable territories (high incidence of dengue and violent deaths; low HDI; substandard urban infrastructure, high population density, and water scarcity). We selected two intervention and two control groups, resulting in a sample of approximately 16,000 properties. The intervention consisted of environmental management by sealing large elevated water tanks, introduction of beta fish in waterholes, elimination of potential breeding sites, and mobilization and training of schoolchildren, endemic disease workers, health workers, social mobilizers, and community leaders; community surveillance of arboviruses; construction and validation of a booklet for the prevention of arboviruses in pregnant women. We analyzed the costs of arboviruses to government and households, the intervention cost-effectiveness, chikungunya's chronicity, and acceptance, sustainability, and governance of vector control actions. The primary outcome (infestation) was analyzed using the house, container, and Breteau indices. We hope that this study will help us understand how to scale up strategies to fight Aedes aegypti in vulnerable areas.

Organização do processo de trabalho no manejo da dengue em uma capital do Nordeste / Organization of the work process in the handling of dengue in a northeastern capital

Este estudo tem como objetivo descrever a organização do processo de trabalho na atenção primária como uma ferramenta de cuidado para os pacientes com suspeita de dengue. A situação de epidemias, em 2011 e 2012, impôs a execução do plano de contingência da dengue, elaborado de forma participativa com Equipes de Saúde da Família. As ações organizadas foram: qualificação dos profissionais, organização do serviço e monitoramento dos casos de dengue. A unidade atuou como a principal porta de entrada para a população. Foram notificados, respectivamente, 677 e 1081 casos em 2011 e 2012, sem o registro de óbitos. Implantar essas ferramentas no âmbito do serviço público constitui-se em um desafio.

This study aims to describe the organization of the work process in primary care as a care tool for patients with suspected dengue. The situation of epidemics in 2011 and 2012 imposed the execution of the dengue's contingency plan, elaborated in a participatory manner with Family Health Teams. The organized actions were: qualification of the professionals, service organization and monitoring of dengue cases. The unit served as the main gateway to the population. Were notified, respectively, 677 and 1081 cases in 2011 and 2012, without the register of deaths. Deploying these tools within the public service constitutes a challenge.