Disease Prevention and Control / Communicable Diseases / Dengue
New Generation of Dengue Prevention and Control Programs in the Americas
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La high incidence of dengue and of dengue hemorrhagic fever, the presence of the four serotypes of the dengue virus in the Region of the Americas, and the high levels of vector infestation signal the need to intensify prevention and control activities. The problem is growing exponentially, and a vaccine for dengue is a long way off. Thus, the current strategies must be reexamined and a new approach to program management must be adopted to address forms this public health problem. Put that way, dengue is a challenge for the different levels of government (local, regional, and national) in every country in the Region.
Despite huge sums of money invested by the countries of the Region, there are no signs that the situation is improving. In 1996, 23 countries invested US$ 331 million; and in 1997, US$ 671 million in control programs. Economic analyses done by the Pan American Health Organization (PAHO) indicate that an integrated control program for dengue aimed at actions to avoid, treat, replace, and eliminate breeding sites can reduce by 30% what is being invested today.
La New Generation of Programs for Prevention and Control of Dengue operates under the aegis of health promotion, since health is a collective social good. The paradigm for promotion is centered on the principle that health is the greatest resource for social, economic, and personal development, as well as an important dimension of the quality of life. It also recognizes that political, economic, social, cultural, environmental, behavioral and biological factors can help a person's health as much they can damage it.
La solution to the dengue problem lies in this holistic vision of promotion. When it comes to dengue, nothing is easy, simple, or cheap. It is essential to promote changes—behavioral changes—not only in the community, but also in the structure and organization of prevention and control programs. The current interventions in the countries are not working. They have been successful or sustainable over the years because of their very costly vertical structure, based on chemical control (the use of insecticides), and because they utilize community participation and health education only in epidemics and emergencies. Community participation is normally centered around mass clean-up campaigns (trash removal), the distribution of printed matter, and mass radio and television campaigns to disseminate information about the vector, its breeding sites and the disease.
Because dengue a problem linked to the residential environment, the existence of breeding sites is due to specific human behaviors (individual, community, and institutional), since any receptable capable of holdingwater is a potential breeding site for Aedes eggs. Thus, a new approach must be adopted for program management: integrated control and social communication for public health, the foundations and strategies for health promotion.
The New Generation of Prevention and Control Programs demands changes in program management. It demands changes in the profile of the new manager, changes in the interventions and instruments, changes in the successive voids in evaluation, systematization and documentation, and also changes in programmed health activities. In truth, it demands changes preceding the behavioral changes we wish to investigate, select, and apply, appropriate to the situation of each individual, family, or other institutions outside the health sector.
Thus, for the new generation of dengue prevention and control programs, health management—integrated control programs—is considered a synergistic point. The ingredientes of this new generation of dengue programs are contained in the following ten key points (decalog).
The new Generation of programs includes strategies such as the following:
The New Generation of Dengue Prevention and Control Programs is a necessity, given the framework of of the new Resolution CD43.R4, adopted unanimously on 26 September 2001, by the 43rd Directing Council of the Pan American Health Organization (PAHO). This Council is made up of the Ministers of Health of the member countries of the Americas.