Systematic review of community-based strategies to control emerging zoonotic infectious diseases in Southeast Asia

Abstract

Background: Countries in Southeast Asia have been at the epicentre of epidemics of emerging and re-emerging zoonotic infectious diseases. Successful infection control requires a multi-sectoral and multi-disciplinary approach that incorporates communitybased surveillance and control activities. The objective of this systematic review is to provide a comprehensive analysis of the evidence regarding the effectiveness and efficiency of communitybased programs for the control of emerging zoonotic diseases in Southeast Asia.Methods: PubMed, CINAHL, ProQuest, EBSCOhost, Web of Science, Science Direct, the Cochrane database of systematic reviews, the WHO library database, British Development Library, LILACS, World Bank (East Asia) and the Asian Development Bank were searched (from Jan 1980 to Dec 2011) to identify potentially relevant articles using keywords to reflect i) disease terms, ii) intervention terms and iii) countries of interest. Only studies that met the inclusion criteria of randomised controlled trials, controlled before-after trials or interrupted time series were included. Standardised tools from the Joanna Briggs Institute were used for critical appraisal of study quality and data extraction.Results: The majority of included studies focused on control of dengue or rabies, with less evidence available for Nipah virus and avian influenza. Most studies were controlled before-after trials and all had methodological weaknesses which could potentially bias findings. When grouped by infection, studies varied widely with respect to the intervention evaluated and target groups. A range of outcome measurements were used, with most studies reporting intermediate outcomes such as impact on larval indices or hygiene knowledge scores rather than final outcomes such as cases of infection.Conclusion: Community-based disease control programs either in isolation or in combination with other activities appear to be effective in improving intermediate outcomes such as a reduction in larval indices or improvements in hygiene practices; but evidence that they are able to reduce incidence of infection is more limited. Studies that did show a reduction in incidence of infection used a coordinated multi-sectoral approach which was believed to have contributed to the success of the intervention.