School and community-based student-driven dengue vector control and monitoring in Myanmar: A cluster randomized controlled trial

Dengue is the most common and widespread mosquito-borne arboviral disease globally, causing more than 390 million infections and more than 20,000 deaths annually. There are no effective vaccines, preventive drugs or treatments. Therefore, current efforts to reduce dengue transmission rely primarily on mosquito vector control. Although most vector control methods used by national dengue control programs may temporarily reduce mosquito populations, there is little evidence that they affect transmission. There is a compelling need for innovative, effective and locally adapted approaches for sustainable vector control and monitoring, to which school children can be particularly relevant contributors. Schools have been engaged in national dengue control programs in several countries and school-based vector control research projects have been associated with better dengue knowledge uptake and contributed to improved school and community-based vector control activities. In this project, we aim to involve middle school students and encourage them to become actors in dengue knowledge transfer to their communities and lead the delivery of vector control interventions and monitoring methods. Following this rationale, we believe that students can become pilots of decentralized vector surveillance and agents of sustainable disease control in line with recent new paradigms in integrated vector surveillance and control. This provides an opportunity to operationalize transdisciplinary research towards sustainable health development. The project aims to improve knowledge of dengue and vector control in students and their parents by inducing active student involvement in community vector control and monitoring and to facilitate improved teaching capabilities by training of teachers and optimizing public health curriculum. The long-term project objectives are to reduce dengue transmission and exposure to dengue risk factors in Myanmar. The main project objective is to carry out a randomized controlled trial to reduce dengue transmission and risk factors through school- and community-based educational and vector control interventions. The specific objectives are to: 1) Reduce dengue incidence in schools and communities; 2) Reduce dengue risk factors and entomological indices in schools and communities; 3) Improve knowledge of dengue, entomology, and vector control in school children and their parents; 4) Engage students, teachers and relevant stakeholders in community vector control and monitoring; 5) Facilitate improved teaching capabilities, training of teachers, enhancing dengue curriculum; 6) Conduct a process evaluation to determine implementation fidelity and adaptation of interventions. The project is a collaboration between the Ministry of Health and Sports, Ministry of Education in Myanmar, Malaria Consortium (Myanmar), Mahidol-Oxford Tropical Medicine Research Unit (Thailand), Global Health Group International (Thailand) and Norwegian University of Life Sciences (Norway). The project was planned to be implemented in two townships in Yangon, Myanmar. However, due to the COVID-19 pandemic and political instability in Myanmar the project has been terminated by the donor. Despite this, the study protocol will be helpful for future implementation of the project in Myanmar or elsewhere.

The expected impacts of the project were to reduce dengue transmission and exposure to dengue risk factors in Myanmar. This could not be achieved since the project was terminated due to the Covid-19 pandemic (in 2020) and a military coup (in 2021). For the same reasons, project outcomes could not be achieved. However, the project team did collectively increase their general competency in transdisciplinarity, gained an improved understanding of the underlying factors that may affect anticipated results of any trial, and to carefully manage difficult disrupting health and political situations. Even though the intervention was not realized, the project team gained insights into implementation research methodology, operationalization of transdisciplinary research, thus providing team capacity building as a participatory process, including group learning about what the logic model and transdisciplinary research are—focusing on describing in detail the required protocols and ways of measuring the extent to which such a project would be able to achieve participatory objectives. The projects publications, especially the study protocol will be useful for future projects. The postdoctoral student was successful in retrieving additional funds and publishing several articles. The PhD student will write up his PhD thesis in 2022 and publish a systematic review of dengue control in the region. He will return to his position in the Ministry of Health in Myanmar and will support future dengue and vector control activities in the country with knowledge gained in the project.

Dengue is the most common and widespread mosquito-borne arboviral disease globally, causing >390 million infections and >20,000 deaths annually. There are no effective vaccines, preventive drugs or treatments. Therefore current efforts to reduce dengue transmission rely primarily on mosquito vector control. Although most vector control methods used by national dengue control programs may temporarily reduce mosquito populations, there is little evidence that they affect transmission. There is a compelling need for innovative, effective and locally adapted approaches for sustainable vector control and monitoring, to which school children can be particularly relevant contributors. Schools have been engaged in national dengue control programs in several countries and school-based vector control research projects have been associated with better dengue knowledge uptake and contributed to improved school and community-based vector control activities. Hence, in this project, we aim to involve middle school students and encourage them to become actors in dengue knowledge transfer to their communities and lead the delivery of vector control interventions and monitoring methods. Following this rationale, we believe that students can become pilots of decentralized vector surveillance and agents of sustainable disease control in line with recent new paradigms in integrated vector surveillance and control. This provides an opportunity to operationalize transdisciplinary research towards sustainable health development. The project aims to improve knowledge of dengue and vector control in students and their parents by inducing active student involvement in community vector control and monitoring and to facilitate improved teaching capabilities by training of teachers and optimizing the general public health curriculum. This will contribute to the long-term project objective to reduce dengue transmission and exposure to dengue risk factors in Myanmar. The implemementaiton of the trial is delayed until June 2022 due to Covid-19 and military coup in Myanmar.