Innovative vector control methods for improving dengue control in Papua New Guinea
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Background: Dengue Fever (DF) is a common vector-borne disease of the tropical and sub-tropical world where more than 50% of global population lives, and recognised by the World Health Organization (WHO) as a notifiable public health disease transmitted by the Aedes mosquito. With the changing climatic temperatures, increased international travel and trade, and poor disposal of water holding objects in home environments, DF is rapidly expanding to new geographical areas once virgin to the Aedes vector. DF is also an opportunistic infection in persons with low immunity including young children, pregnant women, and adults living with an on-going illness. DF is a significant public health issue in Papua New Guinea (PNG). The aim of study is to review literature on: (1) the effectiveness of the PNG Dengue Control Program (DCP) and; (2) the effectiveness of Innovative Vector Control Methods (IVCMs) implemented or piloted in other dengue-endemic countries and their feasibility to a PNG context. The two research questions decided for this study to answer are: (1) “In light of the socio-economic, cultural and environmental determinants impacting on DF control in PNG, how successful has the PNG DCP been?” (2) “What IVCMs that were either trialled, piloted or implemented in other dengue-endemic countries, may be applicable in a PNG context to improve DF control and prevention?” Methodology: Given the significance of this study, a “Critical Literature Review” (CLR) was considered the most relevant approach for this study. The search strategy used for an online AUT Library search on 17/09/17 to identify 6182 references included the use of key databases as search machines were Pub-Med, Google Scholar and Med-Line. Key search terms used were, but not limited to; “dengue fever,” “dengue fever control,” “PNG dengue control,” “dengue prevention,” “climate change and socio-economic, cultural and environmental factors,” and “innovative vector control methods.” Through an inclusion criterion, 98% (6078/6182) irrelevant articles or those written in a non-English language or published before 2000 were eliminated followed by a further elimination of 54 systemic reviews, non-scholarly state documents and agency reports outside of PNG. Of the retained 50 articles, 20% (10/50) were directly to PNG DCP, while IVCM-related articles constituted 80% (40/50). Data analysis: Going beyond routine descriptive methods of data analysis, a thematic analysis of findings from both reviews using sub-themes and supplementary questions to draw conclusions. Results of review 1: The effectiveness of the PNG DCP: Burden of DF in PNG remains unknown due to lack of skilled staff, poor diagnostic facilities and an absence of a DF surveillance system. While young age is a risk factor for DF infection in PNG, the impact of socio-economic, environmental and cultural influences in DF transmission and its control was significant with little or no effort in community mobilization, empowerment and participation. Results of review 2: The effectiveness and feasibility of IVCMs in a PNG context. The non-insecticide-based IVCMs including the Health Belief Model (HBM) for community DF education and the inter-sectoral participatory methods are likely to be sustainable under PNG socio-economic, cultural and health system contexts. Conclusions: Despite DF been a very important public health disease expanding rapidly to new areas, little effort has been done to control its transmission in PNG with the current PNG DCP achieving little success. The impact of socio-economic, environmental and cultural factors including globalization, trade and climate change on DF transmission and its control was significant. Recommendations: HBM-based DF education and youth and women group participation as examples of both participatory and inter-sectoral IVCMs are considered immediate to intermediate intervention measures for promoting social mobilization, empowerment and participation. These strategies are particularly important for communities to sustain environmental hygiene, proper waste disposal and sanitation including safe water supply. In comparison, insecticide-based IVCMs including larviciding, using repurposed insecticides, can be considered long-term strategies for comprehensive destruction of mosquito populations from the environment. While an effective DF surveillance system remains a top priority in PNG for evidence-based DF control, participatory action research (PAR) is necessary to advocate for social justice to improve and empower deprived under-privileged communities to have equal access to information on DF control.