Malaria outbreak response in urban Santo Domingo, Dominican Republic: lessons learned for community engagement

Abstract

Community engagement is crucial for public health initiatives, yet it remains an under-studied process within national disease elimination programs. This report shares key lessons learned for community engagement practices during a malaria outbreak response in the Los Tres Brazos neighborhood of urban Santo Domingo, Dominican Republic from 2015-2016. In this two-year period, 233 cases of malaria were reported—more than seven times the number of cases (31) reported in the previous two years. The initial outbreak response by the national malaria program emphasized “top-down” interventions such as active surveillance, vector control, and educative talks within the community. Despite a transient reduction in reported cases in mid-2015, transmission resurged at the end of 2015. The program responded by introducing active roles for trained community members that included door-to-door fever screening, testing with rapid diagnostic tests and treatment. Malaria cases declined significantly throughout 2016 and community-based active surveillance infrastructure helped to detect and limit a small episode of transmission in 2017. Results from qualitative research among community members revealed two key factors that facilitated their cooperation with community-based surveillance activities: motivation to help one’s community; and trust among stakeholders (community health workers, their neighbors and other key figures in the community, and malaria program staff and leadership). This experience suggests that community-led interventions and the program’s willingness to learn and adapt under changing circumstances can help control malaria transmission and pave the way for elimination.

Rapid ethnographic assessment for potential anti-malarial mass drug administration in an outbreak area of Santo Domingo, Dominican Republic

“…Neighbourhood associations ( juntas de vecinos ) are widespread throughout the Dominican Republic and are common entry-points for public health programs to begin community outreach [ 4 , 18 ]. Presumably, community engagement for a future MDA in Los Tres Brazos would also involve working closely with juntas de vecinos in the transmission focus.…”

“…In the Dominican Republic, recent outbreaks in the capital, Santo Domingo, have signaled a major shift from rural to urban transmission [ 4 , 5 ]. Historically, malaria was most abundant along the Haiti border and in agricultural areas populated by migrant workers [ 6 ].…”

“…Since the start of the outbreak in late 2014/early 2015, the country’s national malaria programme (housed within the country’s vector-borne disease agency; Spanish acronym, CECOVEZ) implemented standard anti-malaria interventions in Los Tres Brazos. These included indoor residual spraying (IRS) and distribution of long-lasting insecticidal nets (LLINs), as well as community outreach and enhanced surveillance by community health volunteers [ 4 ]. This resulted in, or at least was associated with, suppressed transmission between 2016 and 2018, with only four cases reported in the foci in 2018.…”

Rapid ethnographic assessment for potential anti-malarial mass drug administration in an outbreak area of Santo Domingo, Dominican Republic

“…In the Dominican Republic, recent outbreaks in the capital, Santo Domingo, have signaled a major shift from rural to urban transmission [4,5]. Historically, malaria was most abundant along the Haiti border and in agricultural areas populated by migrant workers [6], however a recent study indicates the absence of malaria from such rural areas [5].…”

“…Since the start of the outbreak in late 2014/early 2015, the country's national malaria programme (housed within the country's vector-borne disease agency; Spanish acronym, CECOVEZ) implemented standard anti-malaria interventions in Los Tres Brazos. These included indoor residual spraying (IRS) and distribution of long-lasting insecticidal nets (LLINs), as well as community outreach and enhanced surveillance by community health volunteers [4]. This resulted in, or at least was associated with, suppressed transmission between 2016-2018, with only four cases reported in the foci in 2018.…”