Educational resources developed to fight outbreak of mosquito-borne illness

LAWRENCE — Dengue fever, the mosquito-borne tropical infectious disease, was nearly wiped out before World War II. It has made a dramatic resurgence, infecting more than 50 million people annually, and Central American countries have been significantly affected. Researchers at the University of Kansas and University of Costa Rica have teamed up to educate community, promote civic engagement and tap into local resources to fight the disease.

According to data from the Costa Rican Social Administration, this year the country is experiencing one of the worst outbreaks of dengue in recent history, with inhabitants in suburban and rural areas being the most affected. In addition to the human toll and suffering, dengue is also straining financial resources because of a decrease in productivity and the payments the Costa Rican Social Administration has to make for sick days.

The pilot project is in the second year of a two-year grant funded by the Office of International Programs at KU and the Office of Research at the University of Costa Rica. In the first year, the team established collaboration and built the research infrastructure to allow them to work in impoverished local communities. The second year has been spent conducting on-site research on knowledge, attitudes and behaviors related to dengue prevention as well as identifying major local issues that raise barriers toward the successful implementation of dengue prevention strategies. An intervention to try to address some of these issues and increase awareness about dengue is planned for the end of the year.

“We’re working with our partners to make this a sustainable intervention,” said Mugur Geana, principal investigator, associate professor of strategic communication and director of the Center for Excellence in Health Communications to Underserved Populations at KU. “Our ultimate goal is to develop a set of tools and strategies for communicating about dengue prevention that can be used for years to come and be used in other communities as well.”

The disease is not new to Latin America. Once prevalent, it was nearly wiped out but made a resurgence in the early 1990s. The mosquitoes that carry the virus became more prevalent and poverty, tropical climate and many other factors led to its rebound. The researchers conducted community surveys, interviews and focus groups to gauge what residents know about the disease, their attitudes toward it, what community opinion leaders feel about it and what local challenges exist in fighting dengue.

“There is knowledge of dengue there,” Geana said. “It’s not that they’ve never heard of it. Almost everybody we talked with had a family member that battled the disease. One of the problems we’ve found is that local residents feel left behind, they feel they’ve been abandoned by their local government. There is only a minimal sense of cohesion and almost no concentrated action at community level to address any of the major public health and environmental issues that sustain the dengue epidemic.”

Working in some of the nation’s poorest communities the researchers have found that lack of local government intervention is only one of the problems. Garbage collection is severely lacking in one of the communities, leaving discarded tires and other items to collect the abundant rain and provide standing water — ideal mosquito breeding grounds. Because of the barriers identified while conducting the initial assessment, researchers have also teamed up with KU School of Business students and faculty to develop entrepreneurial projects to remove garbage, start recycling programs and take other steps to address these problems. It is no insignificant challenge as dumps are often located far away from population centers and funding can be difficult to obtain. They are also working with community opinion leaders to encourage local buy in to such plans.

The program has developed online courses on community-based participatory research for Costa Rican researchers. Workshops aim to educate residents on the disease, share what has been learned in the community and point out resources they can use in fighting dengue A more comprehensive communication campaign will be launched in the fall and researchers will analyze its effectiveness over the coming year. If the pilot study proves successful the goal is to search for external funding to take it to additional communities. As dengue is a widespread problem, Geana said he hopes the program can provide a model that will help communities beyond the borders of Costa Rica work together to fight the disease.

Geana said the international experience has been positive for both universities.

Barbara Barnett, associate professor of journalism, is one of KU’s co-principal investigators for the project. Her expertise in working with underserved populations in Africa, and her research in feminist studies have been instrumental in informing some of the approaches currently used in Costa Rica. Geana and Barnett collaborated with K. Allen Greiner, research director at the KU School of Medicine’s Department of Family Medicine, as well as other KUMC faculty in the development of community-based participatory research training materials. KU researchers also expanded their knowledge of international cooperation and research, as Costa Rican faculty members provided education, training and practical assistance in conducting research in their country.

Lissette Marroquin, principal investigator on the project for the University of Costa Rica, has been supportive and hopeful for the potential of the pilot study.

“This project is of vital importance as it has allowed or department to develop a research agenda in the field of health communication, an area in which our department wanted to set foot but had not explored,” she said. “Also our research is having an impact in two small communities, for the moment, where the dengue fever is proliferating.”

Earlier this year Geana presented data about the capacity-building and collaborative experience resulting from the project at the Second Latin-American and Caribbean Conference on Global Health in Santiago, Chile.

“Dengue is a huge problem in Latin America, but it is complex, and there are no easy solutions,” Geana said. “This project shows that universities 3,000 miles apart can collaborate for the betterment of communities and bring their expertise and resources together to help people.”