A Successful Community-Based Pilot Programme to Control Insect Vectors of Chagas Disease in Rural Guatemala

The adoption of novel integrated vector management (IVM) strategies requires proof-of-concept demonstrations. To implement a community-based intervention, for the control of vectors of Chagas disease in Guatemala, we engaged all relevant stakeholder groups. Based on this and previous experiences of the authors on engaged research and community-based interventions, several key factors can help facilitate effective integration of stakeholders in support of area-wide integrated vector management (AW-IVM) programmes. First and foremost, the diversity of stakeholders needs to be engaged early-on in the participatory action research and implementation processes, to provide ownership and contribute ideas on how to design and implement an intervention. Another important component, situational analysis regarding current pest control policies, practices and relevant stakeholders, is generated through interviews with key informants, at both national and local levels (governmental and non-governmental organizations); it can facilitate the joint identification of strengths, weaknesses, opportunities and threats regarding current pest control strategies and proposing solutions through an AW-IVM approach. In addition, successful AW-IVM can result from identifying locally relevant strategies to implement the proof-of-concept demonstrative project. Further, it is critical to maintain constant communication with the local and national leaders, involving them throughout the implementation and evaluation processes. Flexibility should also be built into the project to allow for community-driven changes in the strategy, through a cyclical joint reflective process. Periodic feedback of project development needs to be scheduled with key stakeholders to maintain rapport. Finally, the results of the evaluation should be shared and discussed with stakeholders to ensure long-term sustainability of the programme, intervention, or project. Here we present the citizen engagement procedures used to integrate community members, health officials, and non-governmental organization staff for Chagas disease control in a region of Guatemala. We demonstrate how these methods can be applied to support AW-IVM programmes, so that communities and authorities are actively involved in the development and implementation of a jointly agreed intervention. In 2012, we developed the IVM intervention in an area of Guatemala with persistent Triatoma dimidiata (Latreille) infestation that is associated with the presence of infected rodents (rats and mice), that act as reservoirs of the Trypanosoma cruzi Chagas parasites inside the households. Nine control communities received only the Ministry of Health insecticide application against the vector and nine intervention communities participated in the AW-IVM intervention. The intervention included a programme for rodent control by the community members, together with education about the risk factors for vector infestation, and insecticide application by the Ministry of Health. Entomological evaluations in 2014 and 2015 showed that vector infestation remained significantly lower in both intervention and control communities. In 2015, we found that there was a higher acceptance of vector surveillance activities in the intervention communities compared to control communities, suggesting that participatory activities increase programme sustainability. Finally, we found that there was a significant increase over time in the number of households with infected vectors in the control group, whereas there was no significant increase in the communities that participated in the programme. Thus, an AW-IVM programme including simultaneous rodent and vector control could reduce the risk of Chagas infection in communities with persistent vector infestation.