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Nicaragua Roadmap

       Managua Pilot Study (2004-2007)


Tires turned into steps, plant pots and embankments during the pilot study
in Managua

The Camino Verde project began in Nicaragua between 2004 and 2007 with a pilot study coordinated by CIET and the University of California, Berkeley, in neighbourhoods of Managua. This initiative tested a new way of approaching the old problem of how to motivate community participation for sustainable and pesticide-free mosquito control.

The intervention was based on CIET’s methodology for communication, which promotes the socialisation of evidence for participatory action (SEPA). In this case, we established a permanent dialogue with community members, household by household, led by local volunteers and based on evidence and experiences from the neighbourhoods themselves. This evidence included: 1) data from questionnaires about knowledge, attitudes, perceived household and neighbourhood self-efficacy, discussions among households and neighbours, and action plans, following CIET’s CASCADA model; 2) entomological surveys to identify Aedes larvas and pupas in the participants’ households; 3) serological evidence of dengue infection among children, gathered through saliva sample analyses that indicated recent changes in the levels of dengue-specific antibodies.

Intervention mechanics

For this pilot exercise we chose a panel of 30 sentinel sites (130 houses each, for a total of 3,956 households) to represent the population of Managua. In the first year, entomological, serological and interview data were not only gathered as a baseline, but were given back to the community through household visits and focus groups to generate debates and raise awareness, as well as to catalyze evidence-based household actions and community interventions. The mobilisation generated from within the communities included exchanges of experiences among neighbourhoods, assessment visits between participating neighbourhoods and coordinating activities with government health centres. The second cycle, carried out in October 2005, measured the impact of the first year’s interventions and refined them with community input. The last measurement took place between October 2007 and February 2008.

The pilot study included a comparative analysis of costs and benefits between our proposal and the government’s interventions for dengue control, with an emphasis on the effectiveness of actions in each case.

During this process, we refined survey instruments and techniques, identified key elements for motivation of community participation in mosquito control, and developed a dengue control “package” that could be implemented in other dengue-affected areas. The trial left behind several benefits and “added values” from the intervention, such as the training of human resources for evidence-based mobilisation, both in neighbourhoods as well as health services; a higher capacity for autonomous organisation for prevention among the communities; and strengthened local leaderships at the intervention sites. The numerous lessons learned during this pilot study shaped the intervention proposal for the Camino Verde trial.