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Tropical Medicine and International Health


volume 14 no 12 pp 1542–1551 december 2009

Systematic Review

Multi-modal Aedes aegypti mosquito reduction interventions
and dengue fever prevention
Kara K. Ballenger-Browning and John P. Elder
Graduate School of Public Health, San Diego State University, San Diego, CA, USA


objective To systematically review the effectiveness of biological, chemical and educational dengue
fever prevention programs on the reduction of entomologic indicators.
methods Searches of PubMed, GoogleScholar, CabDirect databases and reference lists yielded over
1000 articles containing mosquito abatement interventions. Inclusion criteria were: Vector control
programs targeting Aedes aegypti and Aedes albopictus mosquitoes; Studies providing pre- and post-test
data. Intervention effectiveness was assessed using Mulla’s formula to determine percent reductions for
all studies with control groups. Twenty-one studies were reviewed.
results Twelve dependent variables were presented, however, the Breteau, House and Container
indices were the primary measurement tools for monitoring larval populations. Behavioural methods
consisting of educational campaigns and maintaining water containers to reduce the mosquito population were applied in eight studies. Eight studies involved the use of biological methods such as
predatory organisms or bacteria. Finally, eight studies used chemical control techniques including
insecticide sprays, larvicides, insecticide-treated materials, and cleaning water of containers with
household chemicals with three studies using a combination of intervention techniques. Post-intervention reduction in entomologic indices ranged from 100% to an increase of 13.9% from baseline.
conclsuion Little evidence exists to support the efficacy of mosquito abatement programs owing to
poor study designs and lack of congruent entomologic indices. Creation of a standard entomological
index, use of clustered and randomized-controlled trials, and testing the generalizability of proven
methods are recommended for future research.
keywords dengue, Aedes aegypti, vector control, review

Dengue fever is the most rapidly advancing vector-borne
disease in the world (WHO 2004; Kroeger et al. 2006;
Farrar et al. 2007). In 2002, the WHO estimated that
2.5 billion people worldwide were at risk of contracting
the disease (WHO 2002). Today, there are an estimated
50 million new infections annually (World Health Organization 2002; Farrar et al. 2007). Although dengue fever
is not often fatal in healthy adults, the attack rate can be
as high as 80–90% during epidemics (World Health
Organization 2002). In the past, the cyclical nature of the
disease allowed roughly 10–40 years to pass between
epidemics; however, the interval has dramatically
decreased due to a variety of social, economic and
political factors (Gubler & Clark 1995). Despite efforts
to control dengue, the incidence rate continues to climb

and the disease is spreading to new locations (World
Health Organization 2002; Rogers et al. 2006; Farrar
et al. 2007).
Dengue infections are caused by one of four virus
serotypes of the genus Flavivirus and are transmitted via
Aedes aegypti and Aedes albopictus mosquitoes (Gubler
1989; Sulaiman et al. 2002; World Health Organization
2004). A secondary infection with a differing serotype can
lead to dengue hemorrhagic fever (DHF) or dengue shock
syndrome. The case fatality rate for dengue fever is usually
less than 1%; however, in extreme circumstances the rate
for DHF can exceed 20% (World Health Organization
2002). Aedes aegypti prefer sheltered domestic environments and commonly breed in artificial containers with
fresh water such as flower vases, jars, concrete tanks (Kay
et al. 2002; Khun & Manderson 2007), tires, pet water
dishes and discarded items that have filled with rain water

ª 2009 Blackwell Publishing Ltd

Ballenger-Browning & J. aegypti reduction and dengue prevention (Koenraadt et al. Like Erlanger et al. Aedes albopictus. no studies have investigated the role of human behaviour in the effectiveness and sustainability of an intervention. aegypti and A. (2008) conducted a recent review of studies that had as little as a 1 month post-intervention evaluation. Methods Inclusion criteria Searches in PubMed. Science Direct. Similarly. randomized control trials (RCT). Although their liberal inclusion criteria allowed for a larger number of programs to be reviewed and thus was sufficient for a meta-analysis to be conducted. Included: (n = 231) Aedes aegypti and albopictus control studies Excluded (n = 177) Cross-sectional studies Figure 1 Selection process for dengue fever articles. which focused primarily on study design. the 57 studies they reviewed indicated that integrated. ‘Aedes albopictus’. Google Scholar. K. on the other hand. however. P. to build upon previous reviews. Studies measuring mosquitoes other than A. Cab Direct. 2002). To the best of our knowledge. Together. Science Direct. studies with only a 1 month post-intervention may not accurately reflect the sustainability of these methods over a longer period of time. individuals or Assessed for Eligibility (n = 1238) PubMed. complicated interventions were divided into distinct treatment groups and longer follow-up times were assessed using percent reductions to standardize results. beliefs. breeds primarily outdoors in natural containers such as coconut shells and tree holes (Gould et al. (2007) and Elder and Ballenger-Browning (2009) found only weak evidence that community-based vector control methods combined with biological or chemical interventions reduced mosquito populations.Tropical Medicine and International Health volume 14 no 12 pp 1542–1551 december 2009 K. albopictus mosquito reduction interventions. vector control activities often require substantial human intervention. and reference lists Excluded (n = 1007) Studies describing vector behaviour. ª 2009 Blackwell Publishing Ltd Included: (n = 54) Intervention with pre and post data Excluded (n = 33) Statistics not included Included: (n = 21) Larval or adult mosquito indices 1543 . ‘dengue interventions’. As both mosquito species are diurnal and anthropophilic. etc. ‘dengue fever’ and ‘dengue vector control’ to identify potential articles and reference lists were used to locate other resources. Dieng et al. 1971. Google Scholar. ‘Aedes aegypti’. a review by Heintze et al. (2008) and Heintze et al. and Cab Direct databases were conducted from July 2007 to January 2008 using keywords such as ‘dengue control’. ‘Breteau index (BI)’. aegypti or A. Articles were included if an intervention was implemented and quantitative pre ⁄ post-data on larval or adult indices was reported. studies were catalogued by intervention method and compared the effectiveness of various techniques by dependent variable. The purpose of this paper is to review published literature on A. (2007). However. only 11 community-based studies were included for their review. treatment. Figure 1 illustrates article inclusion process. Erlanger et al. 2006). Elder Ae. community-based interventions were the most effective methods of dengue control for large populations while environmental management had the least impact. Study designs were organised into cluster randomized controlled trials (CRT) in which units were grouped into neighbourhoods or villages and were randomly assigned to receive the condition. ‘mosquito control’. albopictus were excluded.

interrupted time series designs (ITS) in which there was no control group but multiple data points were collected before and after the intervention. and. five measured the effectiveness of insecticide sprays and ⁄ or chemical larvicides. 2002. 2006) and one study contained only one baseline measurement (Pai et al. Kroeger et al. the Ovitrap index (number of mosquito traps with eggs divided by the total number of traps multiplied by 100. EspinozaGomez et al. Perich et al. The BI was defined as the number of positive containers per 100 houses (Lloyd et al. 1998. Study design Three studies were CRTs. WHO 1997]. 2005). The BI was reported in eight studies. Umniyati & Umayah 2000. bacteria (Bacillus thuringiensis) was also included in this 1544 category due to its organic nature. Kroeger et al. 2006). three studies contained behavioural and biological or chemical components. Over 1000 articles were reviewed and 21 met the inclusion criteria. Although the rates of infestation were relatively low to start. The HI was defined as the number of positive houses per 100 houses [Pan American Health Organization (PAHO) 1994.6%). and the Pupae per Person index (number of pupae collected per human population in a sector. Additional variables used to measure larval populations were the Larva Density index (mean number of larva per container). the Adult Density index (number of adult mosquitoes per number of houses surveyed. P. House index (HI) and Container index (CI). 2005). aegypti populations occurred in Cuba where a 12-month social mobilization campaign to eliminate water containers was implemented (Sanchez et al. Alternatively. Perich et al. 2003. Serological data was not reported as the primary dependent variable. 2006) and eight studies presenting P-values (Lloyd et al. Unlike the selection criteria set forth by Erlanger and colleagues. 1995. cleaning or disposal of water containers. sample size and outcome measures. Three studies employed CRTs which are considered the gold standard design for dengue fever (Lloyd et al.6% (range 4. 2006). Ballenger-Browning & J. Of the eight studies within this category. the HI was reported in five studies and the CI was reported in seven studies. 1992. only a 4% reduction was found for an intervention designed to teach individuals a specific water container cleaning method ª 2009 Blackwell Publishing Ltd . 2002. Mani et al. 2003. the Indoor Landing Density (number of female mosquitoes caught per man-hour. The known monitoring durations ranged from 18 weeks to 15 months with an average reduction of 41. 14 studies were CTs and two studies were ITSs. at 15 months post-intervention. 2006). 1971): 100–(C1 ⁄ T1 · T2 ⁄ C2) · 100. 2006). Percent reductions using Mulla’s formula were calculated for five studies (Table 2). Kroeger et al. 2005). Kroeger et al.Tropical Medicine and International Health volume 14 no 12 pp 1542–1551 december 2009 K. The CI was defined as the number of containers with immature stages per 100 containers with water (PAHO 1994. 2006). 2005. Table 1 provides further information on each publication’s geographical location. Percent reductions of A. Pai et al. it was given as an ancillary measurement. Chemical interventions were also commonly implemented. Fernandez et al. Two studies measured the effectiveness of insecticidetreated materials and one used an insecticide-treated strip in an ovitrap. study design. Entomological indices Among the most commonly used entomologic indices used were the Breteau index (BI). two studies were RCTs. This formula corrects for natural increases or decreases occurring in the control group that may have similarly affected the treatment group over time. aegypti mosquitoes were calculated using Mulla’s formula (Mulla et al. Pupae per person was only reported in one study (Kroeger et al. Results Campaigns to increase knowledge or change human behaviour were applied in eight studies with three involving the screening. Intervention techniques Approximately one-third of the studies reviewed contained educational or behaviour-altering elements. Mahilum et al. K. Kroeger et al. and therefore are listed in both categories. The presentation of results varied greatly with only two studies presenting confidence intervals (Espinoza-Gomez et al. nonrandomized control trials (CT) in which intervention and control groups were not assigned through a random process. 2008). 2006). 1992. Finally. Although not a true biological control. Biological interventions involving copepods or other predatory organisms comprised another eight of the 21 studies. Phan-Ural et al. Nam et al. 2006). Most studies used either clustered or non-clustered designs that compared the intervention and control groups. cross-sectional studies were not included. 1992. 1971.0–87. aegypti reduction and dengue prevention units were randomly assigned to the condition. 2006). nor were there geographic restrictions (Erlanger et al. Kroeger et al. the most significant decrease in A. Elder Ae. intervention type. The inclusion of studies and statistics were independently assessed by two authors and differences were resolved through discussion. Two studies were of questionable quality and did not contain control groups (Gould et al. Pai et al.

n = 6 units of five water containers (one control) RCT. n = 12 four-block communities (six controls) CT. HI. (2006) Vera Cruz. n = 3 residential communities. (1998) El Progreso. India Chemical: indoor and peridomestic deltacide insecticide fog ª 2009 Blackwell Publishing Ltd CT. (2002) Colima City. Washbasin Infestation Index Adult mosquitoes per trap per hour CI CI BI and serological testing BI. K. n = 13 neighbourhoods (five controls) CT. insecticide sprays. (1971) Koh Samui. n = 42 ovitraps (20 control) N = 7 adult traps (two controls) RCT. n = 2 urban communes (one control) n = 8 rural communes (three controls) 100 houses per commune CRT. (2002) Nagasaki. aegypti reduction and dengue prevention Table 1 Summary of dengue fever interventions Reference Setting Intervention type Design and sample size Borjas et al. (1987) New Orleans. Vietnam Kroeger et al. 1095 houses (nine clusters controls) T2:n = 18 clusters of houses. T1:n = 64 peri-domestic drums 36 with routine water use. Philippines Biological: larvicide Bacillus thuringiensis Mani et al. T1:n = 6 laundry tanks T2:n = 30 laundry tanks (in progress at time of publication) CT. T1:n = 18 clusters of houses. (1999) Merida. P. 1122 houses (nine clusters controls) ITS. (2002) Hai Phong. Mexico Biological: Mesocyclops longisetus copepods Gould et al. Elder Ae. Philippines Mahilum et al. 18 with no water use (10 controls) T2:n = 28 tires (10 controls) T3:n = 68 flower vases at cemetery (23 controls) ITS. Japan Biological: copepods in the natural environment Espinoza-Gomez et al. Venezuela Biological and Behavioural: copepods and face-to-face educational campaign during dengue fever outbreak Chemical: insecticide-treated window curtains and water container covers Lardeux et al. n = 1108 indoor containers n = 1318 outdoor containers (no control) CT. Honduras Focks et al. (1993) El Progreso. no data on sample size given. Pupae per person and serological testing CI BI and HI BI. 216–260 homes in multistory buildings per community (one control community) Outcome Measurement Cumulative Larva Density Index for all containers Larva Density Index BI and KAP CI. Ballenger-Browning & J. n = 187 houses (45 controls) GorrochoteguiEscalante et al. (2005) Chennai. Mexico and Trujillo. USA Chemical and Behavioural: larvicide. n = 130 households in two barangays (65 households in one barangay control) CT. Thailand Chemical: ground-applied malathion insecticide and Abate larvicide Kay et al. individual and mass media educational campaign Behavioural: cleaning cement washbasins using the ‘Untadita’ method Chemical: ground-applied malathion insecticide CT. no control information given CRT. Hung Yen and Nam Dinh provinces.Tropical Medicine and International Health volume 14 no 12 pp 1542–1551 december 2009 K. Mexico Behavioural: door-to-door educational campaign Chemical: permethrin treated curtains Cebu City. (2002) French Polynesia Biological: copepods in water containers Lloyd et al. (1998) Monterrey. HI and CI Larva Density Index and serological testing BI and Landing Density 1545 . Mexico Fernandez et al. (1992) Madarieta et al. Honduras Biological: juvenile Trachemys scripta turtles in laundry containers Dieng et al. n = 11 breeding sites (containers selected for control) CT. (2005) Cebu City. Tamil Nadu.

0 151. washing and removing water containers with mosquito larva BI.2 115. Thailand Havana City. P. Brazil Biological and Behavioural: copepods and face-to-face educational campaign during dengue fever outbreak Behavioural: mass media water container clean-up campaign Chemical: insecticide impregnated strip in mosquito ovitrap ITS. n = 30 houses at two neighbourhoods in two municipalities (one neighbourhood per municipality control) CT. (2005) Amphoe Khlung. exposed to radio spots T: door-to-door education campaign C: no treatment T: covering and elimination of unused containers and education of health professionals C: untreated neighbourhood T1: emptying. n = 3 sectors of 10 houses each (one sector control) CT. HI. n = 2 villages.7 129. Elder Ae.1 29. 1546 Nearly all biological interventions such as copepods. KAP and serological testing Pai et al. (1995) Sanchez et al.0 113.7 18 weeks 28. T. CI. covering containers and removing discarded materials outdoors C2: untreated neighbourhood BI BI CI 125. K. with only one using clustered randomization (Lloyd et al.5 102. Ovitrap index. control group.2 18 weeks 33. CI and Landing Density Index HI.6 1. 153 houses (92 houses in control village) CT. BI. n = 4 communes. (2003) Phan-Ural et al. HI. Intervention monitoring periods ª 2009 Blackwell Publishing Ltd . Malaysia Yogyakarta. Vietnam CT. Percent of Mosquito-Free blocks Percent Mortality BI and Ovitrap Index CT. Cuba Sulaiman et al. household visits to teach container cleaning technique.3 Reference Treatment and control groups Index Baseline measure Espinoza-Gomez et al.9 12 months 87. (1992) Sanchez et al.3 0.Tropical Medicine and International Health volume 14 no 12 pp 1542–1551 december 2009 K. RCT. radio spots C1: neighbourhoods in two towns.9 3.4 24. in South Taiwan Areia Branca and Nilopolis.5 19. (2002) Umniyati and Umayah (2000) Kuala Lumpur. sample size. covering containers and removing discarded materials indoors C1: untreated neighbourhood T2: emptying. 1992).0 6 months 22. interrupted time series.9 26.4 54. n = 90 households in three districts (no control) Ovitrap Index and knowledge and behaviour survey CI.6 38. turtles and bacteria concluded in complete eliminations of mosquito larva (Table 3). randomized controlled trial. 100 houses per commune (one control) Adult Density Index. Indonesia CRT. cleaning. 1998). clustered randomized control trial. Adult Density Index Perich et al. (2005) Umniyati and Umayah (2000) Last measure T. Breteau index.6 35. n = 2 neighbourhoods of 187 houses (90 houses in control neighbourhood) Biological: larvicide Bacillus thuringiensis Behavioural: social mobilization and education Chemical: cypermethrin and cyfluthrin insecticide spray Behavioural: emptying.7 CI 31. treatment group. Table 2 Summary of results of behavioural interventions Duration Mulla’s percent reduction unknown 73. n = community leaders in two communities (one control community) CT. (Fernandez et al. non-randomized controlled trial.6 HI OI 1. Ballenger-Browning & J.2 29. (2005) Quang Nam and Khanh Hoa provinces.7 28. (1998) T3: educational campaign only C: no treatment T1: banners. treatment group. Container index. (2002) Fernandez et al. House index. n.3 48. (2006) Three districts of Kaohsiung.2 26. Subjects were randomized in only two studies.1 34. cleaning. C. ITS.5 OI OI OI Lloyd et al. CRT. aegypti reduction and dengue prevention Table 1 (Continued) Reference Setting Intervention type Design and sample size Outcome Measurement Nam et al.1 15 months 4. OI.2 BI BI HI 126.

chemical interventions may not be a long-term solution due to the ª 2009 Blackwell Publishing Ltd short-term effectiveness of these products.7 0.0 0. Weak study designs. Breteau index.0 35.0 0. 2005).7 57.1 0.0 25.0 100.0 0. (2002)* Nam et al.8–13.0 21 months (–) Reference Treatment and control groups Index Borjas et al. *Contain both biological and behavioural (integrated) interventions. Despite this.1 1. and Lardeux et al. 1992. LD. Elder Ae. incongruent indices and poorly reported statistics contribute to the questionable results. aegypti reduction and dengue prevention Table 3 Summary of results of biological interventions Baseline measure Last measure Duration Mulla’s percent reduction 2 months 100. who used a RCT design. Two studies used clustered randomization (Perich et al.0 0. spanned from 2 months to 3 years with a mean reduction of 96. P. Kroeger et al.1 0. The known intervention monitoring periods spanned 7 days to 5 months and showed the greatest range in mosquito populations post-intervention (Table 4). no studies employing these techniques met our inclusion criteria. Discussion Overall. 1547 . the results of this review have demonstrated that little concrete evidence exists to support the efficacy of mosquito abatement programs on reducing the incidence of dengue fever.0 AD AD AD BI BI 0.0 LD LD LD LD LD LD BI 42.0 100.7 429.0 0.2 0. treatment group.0 10. (1995) 21 21 21 21 months months months months 100.0 51.1 T. Based on the results of this review. Four studies used CTs.0 3 years 100.7 3.0 1. (2002).5 0. One advantage is that responsibility for health issues is placed in the hands of individuals and communities (Lloyd et al.0 4 months 75. All studies within this category utilized CT study designs with the exception of Gorrochotegui-Escalante et al. (1993) T1: 6 month old turtles in household water containers C1: water containers without turtles T1: Macrocyclops copepods in containers T2: Megacyclops copepods in water containers T3: Mesocyclops copepods in water containers T4: Mixture of three copepod species C: no copepods T1: educational campaign and Mesocyclops copepods in urban neighbourhood C1: untreated urban neighbourhood T2: educational campaign and Mesocyclops copepods in rural neighbourhood T3: same as T2 T4: same as T2 T5: same as T2 T6: same as T2 C2: untreated rural neighbourhood T1: educational campaign and Mesocyclops copepods T2: same as T1 T3: same as T1 C: untreated village T: Bacillus thuringiensis in water containers C: untreated village LD 20. 2006). 2003).0 23. CI.7 88.1–100%).0 BI BI 53. AD.0 3 years 3 years 100. Two interventions within this category contained integrated methods in which educational campaigns were simultaneously employed.0 0.3% (range 75.0 16. one used an ITS design and one study was a RCT.and post-tests within the same sample.Tropical Medicine and International Health volume 14 no 12 pp 1542–1551 december 2009 K. (2002) Kay et al.5 0.0 100.0 0.0 0. however. Container index. Although the average reduction was 27.0 0.8 344. Ballenger-Browning & J.0 BI BI BI BI BI AD 32. valuable information regarding the practicality of vector control interventions was discussed.9 100.0 91. BI. who only used pre. K. Chemical sprays have been widely used during dengue fever epidemics for their ability to quickly and effectively eradicate mosquito populations (WHO 1997). (1998).0 1.0 15.1 14.0 100.2% (range 73.0 21 months 92. the most significant decreases were found 5 months postintervention using an ovitrap treated with insecticide (Perich et al. control group.0 167.4 52.0 2.6 3.0 3 3 3 3 months months months months 100.0 0. Larva density index. 2003. Sanchez et al.9%). Behavioural interventions Most behavioural interventions target human behaviour change.0 30. Mixed or slow release chemical products may provide longer lasting results.0 0.1 Dieng et al. (2005)* Phan-Ural et al. either directly or indirectly through changes in knowledge and attitude. Adult density index. C.

1998). Fernandez et al.0 6. *Contain both chemical and behavioural (integrated) interventions. Erlanger et al. com1548 munity leaders and governmental bodies help to ensure that this infrastructure exists to continue dengue programs once an intervention has concluded. Ballenger-Browning & J. there are distinct disadvantages. However. Breteau index. 1992.0 102.1 BI BI BI BI BI BI BI CI CI CI CI 34.0 12. As one study found. Heintze et al. emptying and improper scrubbing of containers may not kill mosquito eggs (Sherman et al. (1987) Kroeger et al. Firstly. (2002)* T1: malathion ULV spraying T2: malathion spraying and educational campaign C: no treatment T: ULV malathion sprays C: untreated neighbourhood T1: insecticide-treated net curtains and pyriproxyfen in water containers C1: untreated neighbourhood T2: PermaNet insecticide-treated curtains and covered water containers C2: untreated neighbourhood T: 2–3 permethrin-treated curtains C: untreated neighbourhood T1: vehicle mounted peridomestic fogging C1: untreated neighbourhood T2: ground-sprayed indoor fogging C2: same as C1 T1: ovitrap with deltamethrin insecticide C1: untreated neighbourhood T2: same as T1 C2: same as C1 BI BI BI MT MT BI 110.7 4 months 59.9 7.5 76. Nam et al. control group. We present examples of the interface between actions and the vector’s cycle in Figure 2 (adapted from Elder & Ballenger-Browning 2009). 2007). 2002. 2002.2 5. Substantial success has been realized through interventions that use integrated educational and either chemical or biological methods of vector control (Heintze et al.2 32.9 T. but instead utilize the strengths of each level (Gubler 1989.5 47. Cooperative involvement of individual homeowners. biological techniques were the most successful and sustainable class of interventions. while others believed that an illfitting lid was still effective (Phuanukoonnon et al. Thirdly.0 98. 2005). yet the description matches that of the Breteau index: proportion of containers positive per house. (2006) Madarieta et al.9 14 days 32.8 53. 1992).6 –13.8 55.Tropical Medicine and International Health volume 14 no 12 pp 1542–1551 december 2009 K. The studies examined in the present review also suggest that efforts to mobilize community members are essential for the sustainability of vector control methods.0 50. there are misconceptions regarding the management of water containers.5 11.1 4.9 7.0 55.1 10.0 3. (2003)  Last measure Mulla’s percent reduction Baseline measure Duration unknown unknown 7 days 18. 1998.0 38.5 14 days 12. K.9 4 months 73.0 11. Elder & Lloyd 2007). clinical surveillance of dengue fever was evidence of disease decline (Kay et al. (2005) Perich et al. MT.5 37. people often forgot to cover them.6 115. Container index.8 Focks et al. time and resources. P. 2006). education programs must target behaviours that are feasible for target population in terms of skills. treatment group. (1999) Mani et al. Winch et al. 2007. Both studies utilized an integrated ª 2009 Blackwell Publishing Ltd . For example. An optimally integrated approach would concurrently consider the mosquito’s lifecycle and the various control actions that best address the vector at each of these stages. BI. 2006).2 17. CI.3 9. see below) and that can be monitored (Parks & Lloyd 2004.0 42. adult mosquitoes ⁄ trap per 24 h.8 10.6 17.7 40. aegypti reduction and dengue prevention Table 4 Summary of results of chemical interventions Reference Treatment and control groups Index Espinoza-Gomez et al. clean-up campaigns that encourage community members to remove trash from the premises require an infrastructure for the disposal of waste (Lloyd et al.0 Unknown –9. C.6 5 months 10. This analysis mirrors several authors’ conclusions that successful mosquito control efforts should neither be purely ‘top down’ nor ‘bottom up’. Biological interventions When solely looking at Mulla’s percent reductions.0 102.3 13. 2008). Secondly.3 60. In two cases.0 46.0 38. Pai et al. Although protecting and emptying water containers is a relatively simple and inexpensive method of reducing mosquito populations. Elder Ae. Additionally.  Data is given using the Container index.4 45.0 Unknown 42.2 12. increased knowledge does not necessarily equate to behaviour change (Lloyd et al.0 131.9 BI BI 113. the new behaviours must produce results that are visible (or at least measurable.

aegypti prefer indoor environments which often prevents contact with insecticides (Gubler 1989. yet certain groups may benefit. the effectiveness of these studies is questionable owing to comparable reductions in the control groups (Madarieta et al. Despite reductions in the intervention groups. 2005). resulting in the death or escape of the organism (Borjas et al. 2002. Foremost. leishmaniasis and chagas disease (Kroeger et al. 2006). as people must leave their doors and windows open when spraying occurred (Focks et al. aegypti are primarily diurnal. Chadee et al. The results of Mulla’s percent reductions were the most diverse for chemical interventions. Lardeux et al. a high level of community involvement was necessary for success. Ballenger-Browning & J. the results can be seen and felt immediately (Phuanukoonnon et al. 2005). Gorrochotegui-Escalante et al. Mani et al. 2006). Nam et al. Chemical interventions It is widely accepted that insecticides are effective at reducing mosquito populations. Interventions conducted in Mexico. Interviewees cited the chemical as causing coughs and irritation of the respiratory tract (Kroeger et al. 1998. 1993. In some instances. 2005). Kay et al. no articles included in this study measured the effectiveness of larvicides alone. An alternative to insecticide spraying is the use of insecticide-treated materials. however. were lethal only to the targeted vector and did not chemically contaminate the environment (World Health Organization 1997). while some populations increased (–13. 1993. 1987. Espinoza-Gomez et al. 1995). approach in which community members were taught modify their existing practices to maintain copepods in water containers and to dispose of unsuitable water containers. while others believed that insecticide sprays would contaminate food and condoned outdoor spraying only (Phuanukoonnon et al. (1987). Several authors reported that water was emptied or was subject to seasonal drying. aegypti reduction and dengue prevention Insecticide sprays Treated materials Adult mosquito Source reduction Water removal Ovitraps Ova Human Education Repellent Adult mosquito Turtles Larva and Copepods pupa Fish Larvicide Figure 2 Mosquito life cycle and related intervention strategies. Several studies noted that for insecticides to be effective. A.Tropical Medicine and International Health volume 14 no 12 pp 1542–1551 december 2009 K. P. Health concerns regarding insecticide application were mentioned in a variety of analyses. 2005) and one concern issued by the World Health Organization (1997) was that stronger. 1998. the HI and CI under-estimate the mosquito population by failing to describe larva densities (Service 1976.9%). Mahilum et al. 1998). Curtains also had the added benefit of providing visual reinforcement since individuals could see dead mosquitoes. larval populations decreased dramatically (73. 2006). 1971. K. Lardeux et al. the protection offered by curtains was somewhat limited (World Health Organization 1997). Being able to easily identify pupae of a particular species and to count the absolute number of individuals makes this index 1549 . Venezuela (Kroeger et al. moreover. Given that A. There are a number of disadvantages to insecticide spraying. The BI. 2002. mosquito populations rebounded quickly from insecticide sprays since one-third of adult mosquitoes survived and larva populations were not affected. were also highly accepted by homeowners (Borjas et al. According to field reports. 2005). healthier adult mosquitoes might result from lower larval densities. Secondly. Nevertheless. Biological methods of vector control such as copepods and bacteria. Kroeger et al. Lardeux et al. six biological studies (75%) were non-randomized assessments which inherently provide limited information. 2006) and the Philippines (Madarieta et al. 2002) and high turnover of organisms for containers with frequent use (Fernandez et al. This finding illustrates the frustration of having limited study ª 2009 Blackwell Publishing Ltd Limitations The studies were limited by the lack of congruency and inherent weaknesses in the entomological measurements. designs. Evidence suggests that impregnated curtains might also protect against other vector-borne diseases like malaria. the use of insecticides as a primary control method has led to widespread chemical resistance (Gould et al. the primary disadvantages of using predatory organisms included labour intensive maintenance (World Health Organization 1997. Tun-Lin et al. The recent trend in dengue research has turned away from the use of larval indices in favour of pupal indices because of the high correlation between pupae and adult mosquitoes. such as bed-ridden or infirm individuals and babies (Chadee et al. 2002). Gorrochotegui-Escalante et al. 2005). Elder Ae. 2002. as no true comparison can be made between randomized and non-randomized studies.8%). 1999) hung chemically impregnated window curtains. 1996. Mani et al. compared to all other categories. 2006). The use of chemical larvicides effectively reduces mosquito populations. According to Focks et al. 1999.

As a result. Elder JP & Ballenger-Browning K (2009) Community involvement in dengue vector control (editorial). 148–152. Tsuda Y & Takagi M (2002) A laboratory and field evaluation of Macrocyclops distinctus. only three studies met this criterion. in 1998. 943–946. Heintze C. Another significant limitation of the collective body of published literature is poor surveillance of dengue fever. (2000) Transmission thresholds for dengue in terms of Aedes aegypti pupae per person with discussion of their utility in source reduction efforts. creating the potential for individuals making sincere attempts to become frustrated and others to remain confident that little or no action is warranted. Scanlon JE. 203–221. American Journal of Tropical Medicine and Hygiene 40. 2000). dengue fever is a global problem that shows no signs of slowing (Gubler 1989). Acta Tropica 70. Brenner RJ. Velasco Garrido M & Kroeger A (2007) What do community-based dengue control programmes achieve? A systematic review of published evaluations. In: Report of the Scientific Working Group on Dengue 2006 WHO. American Journal of Tropical Medicine and Hygiene 20. Journal of Medical Entomology 30. BMJ 338. 171–183. K. Validity and affordability must be in balance. Also. none of the indices can be directly tied to human behaviours required to control these containers. Likewise. This is indeed a limitation of this review. Fernandez E & Portillo H (1993) Juvenile turtles for mosquito control in water storage tanks. Gubler D et al. 2007. pp. Finally. Tropical Medicine and International Health 12. Fernandez EA. First. P-values were present in only eight studies and therefore advanced statistical comparisons could not be made. American Journal of Tropical Medicine and Hygiene 52. 140–149. 639– 647. Tuno N. Tropical Medicine and International Health 10. Espinoza-Gomez F. Emerging Infectious Diseases 1. studies published in languages other than English were not included. 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