The Evaluation of Ecosystem Approach for Dengue Prevention and Control

Abstract

Dengue has become the commonest mosquito-borne disease in almost 100 countries worldwide, which poses significant public health threat. With ineffective and unsustainable current dengue control measure in resource limited setting, the dengue trend is continuing to increase. Until the effective vaccine available, identifying for better and effective dengue control measure is a public health priority. The ecosystem approach is a method to strategize the dengue prevention and control activities through interdisciplinary analysis with integrated vector management, and to develop a locality specific intervention. Since the ecosystem approach is widely implemented in the Petaling District since July 2015, therefore it has never been evaluated. The aim of this study is to evaluate the impact of ecosystem approach implementation for dengue prevention and control. An interrupted time series design was used to determine the impact of the ecosystem approach implementation involving 175 localities in two randomly selected ecosystems. The duration of this study was from 1 January 2013 to 31 December 2018. Dengue surveillance data were obtained from the National Surveillance System while meteorological data (temperature, relative humidity and total rainfall) were extracted from a nearby meteorological monitoring station. While, sociodemographic data were obtained from Department of Statistic Malaysia. The mean cumulative incidence before ecosystem approach implementation was 64 per 100,000 population and 53 per 100,000 after ecosystem approach implementation, with a decrease of 54.8% [relative risk (RR) 0.452; 95% confidence interval (CI) 0.283,0.722; p = 0.001]. There was also a significant reduction in the proportion of dengue outbreak localities following the ecosystem approach implementation with a decrease of 50.6% (RR: 0.494; 95% CI 0.311, 0.784; p= 0.01). Well-coordinated ecosystem approach implementation involving various sectors and communities is an effective new method for dengue prevention and control. However, further action is needed to ensure the sustainability of the ecosystem approach.