2004 Bridges Summer Research Report Michelle Kirian School of Public Health "Evidence-based, community-derived interventions for prevention and control of dengue in Nicaragua"

This summer I traveled to Managua, Nicaragua to work on a joint project between the Ministry of Health, Nicaragua and the University of California, Berkeley. The over all aim of the still-ongoing project is to control and prevent dengue fever, which is endemic in Managua. Currently, no denge vaccine exists and treatment is only supportive. Furthermore, government-mandated insecticide spraying campaigns intended to kill the adult stages of the dengue virus vectors, Aedes aegypti and Aedes albopictus, have proven inadequate, unstable and inefficient. As a result community-led vector reservoir removal and vaccine development are now the main focuses of dengue control/ eradication programs.

To achieve these goals, various activities are undertaken concurrently by the ministry of Health and their associated health centers. During the past three months I was involved in 2 aspects of their dengue program: “El Proyecto del Dengue, Distrito 2” and “Ceit”.

“El Proyecto del Dengue” and “Ceit” involve health workers interacting at various levels with community members. All skills are practiced before going into the field during interactive workshops. Here health workers are shown practicing on themselves.

“El Proyecto del Dengue” is a prospective cohort study intended to characterize the natural history and range of clinical manifestations of dengue in district 2, Managua. I assisted in the design and implementation phase of this study whose future hope is to set up a cohort suitable for phase three dengue vaccine trials. One of my specific tasks was to create maps of the study area and to teach the mapping software to my co-worker. Also, I worked with staff from a health center and the national reference laboratory to design educational materials covering dengue transmission, effective mosquito control, and general study information. Many other study needs including the development of the database, questionnaires, new worker training sessions and study operational protocols were undertaken by an executive committee of which I was a part.

Ceit is a program which aims to “personalize” community-based vector control methods according to each community’s specific needs. Entomological indices, serological surveys, key informant interviews, and focus groups are utilized to determine the strengths and weaknesses of each program. This information is passed back to the community members so that they can make the appropriate changes to their vector control strategies.

My role with CEIT was to search for traditional and non-traditional methods for mosquito control used around the world, which could serve as alternative methods in Managua. I also participated in the classification of methods currently in use in Managua, data analysis, and discussions regarding various obstacles to vector control and how to remove them.

A mother assists a visiting nurse in taking blood for serologic surveys.

The full spectrum of outcomes of these projects has yet to be determined. However, collaborations in the past have led to enhanced diagnostic techniques and training. Also, the results of these investigations will be utilized to create and support effective, evidence-based interventions.

As a student in public health I am required to complete an internship. My work in Nicaragua helped me to satisfy that requirement and also gave me practical experience in both scientific research and applied public health in an international setting. In addition to the projects I was assigned, I was able to participate in public relations workshops for community health workers, to attend meetings with various other international health organizations such as PAHO and to observe general operations at the Ministry of Health. This experience reinforced my intentions to continue working in Central and South America upon graduation. Furthermore, directly as a result of my experience this summer, I have decided to study medicine, thus widening the potential impact of my work in the future.