Pilot Study in Managua (2004-2007)
The Camino Verde project had its beginnings in Nicaragua between 2004 and 2007 with a pilot study coordinated by CIET and the University of California, Berkeley, in the neighbourhoods of Managua. This initiative tested a new way of facing the old problem of closing the community’s “motivation gap” to participate in sustainable and pesticide-free mosquito control.
The intervention was based on CIET’s communications methodology, which promotes socialising evidence for participatory action (SEPA). In this case we conducted a recurrent house-to-house dialogue with community members, led by local volunteers, based on their own evidence. The evidence includes:
Questionnaires about conscious knowledge, attitudes, subjective norms, intention to change, agency, discussion and actions/practices/behaviours (CASCADA approach);
Entomological surveys that identify Aedes larvae and pupae in participants’ households;
Serological evidence for dengue virus infection in children, obtained by analyzing the change in dengue virus-specific antibody levels in the children’s saliva.
The mechanics of the intervention
For this pilot exercise we chose a panel of 30 sentinel sites (130 houses each, for a total of 3,956 households). In the first year, we gathered entomological, serological and interview data as a baseline, and fed these data back to the community through house visits and focus groups to catalyze and direct discussion and awareness-raising as the groundwork for informed, evidence-based community-led interventions. The community-led mobilisation included exchanging experiences and assessment visits between participating neighbourhoods, and coordinating activities with government health centres. The second cycle in October 2005, measured the impact of the first year’s interventions and refined them with community imput. The last measurement cycle was carried out between October 2007 and February 2008.
The pilot study included a comparative cost-benefit analysis between our proposal and government interventions for dengue control, with an emphasis on each case’s effectiveness. During this process, survey instruments and techniques were refined, key elements to motivate the community and persuade it to participate in mosquito control were identified, and a dengue control “package” was developed that could be implemented in other countries affected by the disease. The trial left behind a series of the intervention’s benefits and “added values,” such as evidence-based human resources training for mobilisation, both in the neighbourhoods and in the health services; a higher capacity for autonomous community prevention organisation; and strengthened local leadership in the intervention sites. The numerous lessons learned in this pilot study shaped the intervention proposal for the Camino Verde trial.