Diarrhea and dengue control in rural primary schools in Colombia: study protocol for a randomized controlled trial

Abstract

BackgroundDiarrheal diseases and dengue fever are major global health problems. Where provision of clean water is inadequate, water storage is crucial. Fecal contamination of stored water is a common source of diarrheal illness, but stored water also provides breeding sites for dengue vector mosquitoes. Poor household water management and sanitation are therefore potential determinants of both diseases. Little is known of the role of stored water for the combined risk of diarrhea and dengue, yet a joint role would be important for developing integrated control and management efforts. Even less is known of the effect of integrating control of these diseases in school settings. The objective of this trial was to investigate whether interventions against diarrhea and dengue will significantly reduce diarrheal disease and dengue entomological risk factors in rural primary schools.Methods/designThis is a 2×2 factorial cluster randomized controlled trial. Eligible schools were rural primary schools in La Mesa and Anapoima municipalities, Cundinamarca, Colombia. Eligible pupils were school children in grades 0 to 5. Schools were randomized to one of four study arms: diarrhea interventions (DIA); dengue interventions (DEN); combined diarrhea and dengue interventions (DIADEN); and control (C). Schools were allocated publicly in each municipality (strata) at the start of the trial, obviating the need for allocation concealment. The primary outcome for diarrhea is incidence rate of diarrhea in school children and for dengue it is density of adult female Aedes aegypti per school. Approximately 800 pupils from 34 schools were enrolled in the trial with eight schools in the DIA arm, nine in the DEN, eight in the DIADEN, and nine in the control arms. The trial status as of June 2012 was: completed baseline data collections; enrollment, randomization, and allocation of schools. The trial was funded by the Research Council of Norway and the Lazos de Calandaima Foundation.DiscussionThis is the first trial investigating the effect of a set of integrated interventions to control both dengue and diarrhea. This is also the first trial to study the combination of diarrhea-dengue disease control in school settings.Trial registrationCurrent Controlled Trials ISRCTN40195031

Unsuspected Dengue as a Cause of Acute Febrile Illness in Children and Adults in Western Nicaragua

“…However, recogition of the importance of dengue in semi-urban and rural areas is increasing [15,20]. Some studies have suggested that transmission at rural schools may play a role [21,22]. Additionally, lack of access to tap water and use instead of discarded water storage jars and concrete tanks have been implicated as important breeding sites for the vector [23], and mosquito populations may, therefore, be higher in some rural than urban areas [24].…”

Concentración de los anticuerpos en contra de proteínas de las glándulas salivares de Aedes aegypti e historia de la exposición al virus del dengue en residentes de una zona endémica colombiana

“…Barrera, et al, found that the most important factor determining DENV endemicity was the practice of water storage, which provided a source of mosquito breeding sites (19), especially when the water was not frequently replaced (20). In addition, improvements to water distribution infrastructure have been shown to decrease the incidence of vector-transmitted diseases by decreasing the amount of exposure to infected bites (21). Production of Ae.…”

A Cluster-Randomized Controlled Trial to Reduce Diarrheal Disease and Dengue Entomological Risk Factors in Rural Primary Schools in Colombia

“…Inclusion and exclusion criteria for schools and pupils are described in detail in Overgaard et al . [54]. In brief, large schools (>100 pupils and >five grades) were excluded due to different teaching strategies, teacher-student dynamics, and number of pupils compared to primary schools.…”

“…Details of the interventions are provided in Overgaard et al . [54]. No dengue or diarrhea interventions by governmental or other actors were carried out in the rural schools during the study period.…”