Entomological outcomes of cluster-randomised, community-driven dengue vector-suppression interventions in Kampong Cham province, Cambodia

Cambodia has one of the highest dengue infection rates in Southeast Asia. Here we report quantitative entomological results of a large-scale cluster-randomised trial assessing the impact on vector populations of a package of vector control interventions including larvivorous guppy fish in household water containers, mosquito trapping with gravid-ovitraps, solid waste management, breeding-container coverage through community education and engagement for behavioural change, particularly through the participation of school children. These activities resulted in major reductions in Container Index, House Index, Breteau Index, Pupal Index and Adult Index (all p-values 0.002 or lower) in the Intervention Arm compared with the Control Arm in a series of household surveys conducted over a follow-up period of more than one year, although the project was not able to measure the longer-term sustainability of the interventions. Despite comparative reductions in Adult Index between the study arms, the Adult Index was higher in the Intervention Arm in the final household survey than in the first household survey. This package of biophysical and community engagement interventions was highly effective in reducing entomological indices for dengue compared with the control group, but caution is required in extrapolating the reduction in household Adult Index to a reduction in the overall population of adult Aedes mosquitoes, and in interpreting the relationship between a reduction in entomological indices and a reduction in the number of dengue cases. The package of interventions should be trialled in other locations

Operationalizing One Health Employing Social-Ecological Systems Theory: Lessons From the Greater Mekong Sub-region

The idea of the interdependency of the health of humans, animals, and ecosystems emerged from the interplay of theory and concepts from medicine, public health and ecology among leading thinkers in these fields during the last century. The rationale for One Health and its focus on the “human, animal, and environmental interface” stems from this legacy and points to transdisciplinary, ecological and complex systems approaches as central to One Health practice. Demonstration of One Health's efficacy, its wider adoption and continual improvement require explicit operational criteria and evaluation metrics on this basis. Social-Ecological Systems Theory with its unique conception of resilience (SESR) currently offers the most well-developed framework for understanding these approaches and development of performance standards. This paper describes operational criteria for One Health developed accordingly, including a protocol currently being tested for vector borne disease interventions. Wider adoption of One Health is most likely to occur as One Health practitioners gain an increasing familiarity with ecological and complex systems concepts in practice employing a transdisciplinary process. Two areas in which this inevitably will be required for significant further progress, and where the beginnings of a foundation for building upon exist, include: (1) Emerging and re-emerging zoonotic diseases, and (2) successful implementation of the United Nations (UN) Sustainable Development Goals (SDGs). The former includes the challenge of stemming the threat of new microbial pathogens, anti-microbial resistant variants of existing pathogens, as well as resurgence of malaria and other recalcitrant diseases. The applicability of SESR in this regard is illustrated with two case examples from the Greater Mekong Subregion, Avian Influenza (H5N1) and Liver Fluke (Opisthorchis viverrini). Each is shown to represent a science and policy challenge suggestive of an avoidable social-ecological system pathology that similarly has challenged sustainable development. Thus, SESR framing arguably is highly applicable to the SDGs, which, to a large extent, require consideration of human-animal-environmental health linkages. Further elaboration of these One Health operational criteria and metrics could contribute to the achievement of many of the SDGs

Fostering social innovation and building adaptive capacity for dengue control in Cambodia: a case study

Background: The social-ecological systems theory, with its unique conception of resilience (social-ecological systems & resilience, SESR), provides an operational framework that currently best meets the need for integration and adaptive governance as encouraged by the Sustainable Development Goals. SESR accounts for the complex dynamics of social-ecological systems and operationalizes transdisciplinarity by focusing on community engagement, value co-creation, decentralized leadership and social innovation. Targeting Social Innovation (SI) in the context of implementation research for vector-borne diseases (VBD) control offers a low-cost strategy to contribute to lasting and contextualized community engagement in disease control and health development in low and middle income countries of the global south. In this article we describe the processes of community engagement and transdisciplinary collaboration underpinning community-based dengue management in rural primary schools and households in two districts in Cambodia. Methods: Multiple student-led and community-based interventions have been implemented focusing on empowering education, communication for behavioral change and participatory epidemiology mapping in order to engage Cambodian communities in dengue control. We describe in particular the significance of the participatory processes that have contributed to the design of SI products that emerged following iterative consultations with community stakeholders to address the dengue problem. Results: The SI products that emerged following our interaction with community members are 1) adult mosquito traps made locally from solid waste collections, 2) revised dengue curriculum with hands-on activities for transformative learning, 3) guppy distribution systems led by community members, 4) co-design of dengue prevention communication material by students and community members, 5) community mapping. Conclusions: The initiative described in this article put in motion processes of community engagement towards creating ownership of dengue control interventions tools by community stakeholders, including school children. While the project is ongoing, the project's interventions so far implemented have contributed to the emergence of culturally relevant SI products and provided initial clues regarding 1) the conditions allowing SI to emerge, 2) specific mechanisms by which it happens and 3) how external parties can facilitate SI emergence. Overall there seems to be a strong argument to be made in supporting SI as a desirable outcome of project implementation towards building adaptive capacity and resilience and to use the protocol supporting this project implementation as an operational guiding document for other VBD adaptive management in the region

Does anthropogenic introduction of guppy fish (Poecilia reticulata) impact faunal species diversity and abundance in natural aquatic habitats? A systematic review protocol

Abstract Background The guppy fish (Poecilia reticulata) is a tropical fish ancestrally linked to northern South America and the Caribbean. It is known to be very tolerant of and adaptable to new environments, and able to consume multiple food sources, including mosquito larvae. Consequently, guppies have been frequently introduced to non-native ecosystems to control mosquito populations, resulting in near-global distribution. Indeed, due to the increasing need for mosquito-borne disease control, guppy releases will likely continue, however there are concerns about potential adverse impacts on other species, biodiversity, and certain ecosystem functions. The most significant of these is local species extinction, and by extension, reduced biodiversity. Yet, the extent of these impacts has not been evaluated by scientific review. Accordingly, this study will examine and evaluate whether anthropogenic introduction of guppy fish (Poecilia reticulata) has impacts on faunal species diversity and abundance in natural aquatic habitats. The results of this review may have implications for environmental management and policy and inform ecosystem-based integrated vector management and public health policy. Methods Relevant scientific articles will be identified by searching electronic databases. Articles will be included if they report changes or differences, associated with guppy fish introduction, in at least one of these population parameters: (1) abundance of individuals in any species, (2) total abundance of individuals in all species present, (3) species richness, (4) species diversity, and (5) community evenness. Each article will be assessed by at least two independent reviewers against pre-defined inclusion/exclusion criteria. Snowballing reference lists of included articles will be conducted. At least two reviewers will critically appraise all included studies using the Collaboration for Environmental Evidence Critical Appraisal Tool (CEECAT) and any discrepancies will be resolved by discussion between the two or adjudication by a third author if agreement is not reached. Each study will also be subjected to data extraction against pre-defined qualitative and quantitative outcomes and results will be tabulated/presented in figures where appropriate. A meta-analysis will be carried out on outcome parameters with sufficient evidence. </jats:sec

Entomological outcomes of clusterrandomised, community-driven dengue vector-suppression interventions in Kampong Cham province, Cambodia

Cambodia has one of the highest dengue infection rates in Southeast Asia. Here we report quantitative entomological results of a large-scale cluster-randomised trial assessing the impact on vector populations of a package of vector control interventions including larvivorous guppy fish in household water containers, mosquito trapping with gravid-ovitraps, solid waste management, breeding-container coverage through community education and engagement for behavioural change, particularly through the participation of school children. These activities resulted in major reductions in Container Index, House Index, Breteau Index, Pupal Index and Adult Index (all p-values 0.002 or lower) in the Intervention Arm compared with the Control Arm in a series of household surveys conducted over a follow-up period of more than one year, although the project was not able to measure the longer-term sustainability of the interventions. Despite comparative reductions in Adult Index between the study arms, the Adult Index was higher in the Intervention Arm in the final household survey than in the first household survey. This package of biophysical and community engagement interventions was highly effective in reducing entomological indices for dengue compared with the control group, but caution is required in extrapolating the reduction in household Adult Index to a reduction in the overall population of adult Aedes mosquitoes, and in interpreting the relationship between a reduction in entomological indices and a reduction in the number of dengue cases. The package of interventions should be trialled in other locations.The WHO Special Programme for Research and Training in Tropical Diseases (TDR).https://journals.plos.org/plosntdsdm2022UP Centre for Sustainable Malaria Control (UP CSMC

Systems Thinking in Practice: Participatory Modeling as a Foundation for Integrated Approaches to Health

One Health (OH), EcoHealth (EH), and Planetary Health (PH) share an interest in transdisciplinary efforts that bring together scientists, citizens, government and private sectors to implement contextualized actions that promote adaptive health management across human, animal and ecosystem interfaces. A key operational element underlying these Integrated Approaches to Health (IAH) is use of Systems Thinking as a set of tools for integration. In this paper we discuss the origins and epistemology of systems thinking and argue that participatory modeling, informed by both systems theory and expertise in facilitating engagement and social learning, can help ground IAH theoretically and support its development. Participatory modeling is iterative and adaptive, which is necessary to deal with complexity in practice. Participatory modeling (PM) methods actively involve affected interests and stakeholders to ground the field of inquiry in a specific social-ecological context. Furthermore, PM processes act to reconcile the diverse understandings of the empirical world that stem from divergent discipline and community viewpoints. In this perspective article, we argue that PM can support systems thinking in practice and is essential for IAH implementation. Accordingly we invite PH, OH, and EH practitioners to systematically incorporate specialists in systems science and social engagement and facilitation. This will enable the appropriate contextualization of research practice and interventions, and ensure a balanced representation of the roles and relationships of medical, biological, mathematical, and social disciplines. For completeness, funding schemes supporting IAH need to follow the same iterative, adaptive, and participative processes to accompany IAH projects throughout their implementation

The Native Wolbachia Endosymbionts of Drosophila melanogaster and Culex quinquefasciatus Increase Host Resistance to West Nile Virus Infection

The bacterial endosymbiont Wolbachia pipientis has been shown to increase host resistance to viral infection in native Drosophila hosts and in the normally Wolbachia-free heterologous host Aedes aegypti when infected by Wolbachia from Drosophila melanogaster or Aedes albopictus. Wolbachia infection has not yet been demonstrated to increase viral resistance in a native Wolbachia-mosquito host system.In this study, we investigated Wolbachia-induced resistance to West Nile virus (WNV; Flaviviridae) by measuring infection susceptibility in Wolbachia-infected and Wolbachia-free D. melanogaster and Culex quinquefasciatus, a natural mosquito vector of WNV. Wolbachia infection of D. melanogaster induces strong resistance to WNV infection. Wolbachia-infected flies had a 500-fold higher ID50 for WNV and produced 100,000-fold lower virus titers compared to flies lacking Wolbachia. The resistance phenotype was transmitted as a maternal, cytoplasmic factor and was fully reverted in flies cured of Wolbachia. Wolbachia infection had much less effect on the susceptibility of D. melanogaster to Chikungunya (Togaviridae) and La Crosse (Bunyaviridae) viruses. Wolbachia also induces resistance to WNV infection in Cx. quinquefasciatus. While Wolbachia had no effect on the overall rate of peroral infection by WNV, Wolbachia-infected mosquitoes produced lower virus titers and had 2 to 3-fold lower rates of virus transmission compared to mosquitoes lacking Wolbachia.This is the first demonstration that Wolbachia can increase resistance to arbovirus infection resulting in decreased virus transmission in a native Wolbachia-mosquito system. The results suggest that Wolbachia reduces vector competence in Cx. quinquefasciatus, and potentially in other Wolbachia-infected mosquito vectors

Cross-cutting principles for planetary health education

Since the 2015 launch of the Rockefeller Foundation Lancet Commission on planetary health,1 an enormous groundswell of interest in planetary health education has emerged across many disciplines, institutions, and geographical regions. Advancing these global efforts in planetary health education will equip the next generation of scholars to address crucial questions in this emerging field and support the development of a community of practice. To provide a foundation for the growing interest and efforts in this field, the Planetary Health Alliance has facilitated the first attempt to create a set of principles for planetary health education that intersect education at all levels, across all scales, and in all regions of the world—ie, a set of cross-cutting principles