Decreasing Household Costs of Dengue Prevention at Low-Altitudes in Colombia: Redirecting Resources into the Hands of People Who Slap Mosquitoes Everyday

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Squito

Photo by James Gathany

Colombia bears high burdens associated with dengue.  During the 2010 epidemic, disability-adjusted-life-years lost were 1178.93 (per 1 million inhabitants) versus just 88.38 averaged for 2011-2012.  Rodriguez et. al (2016) estimated economic burdens higher than $129.9 million USD each year, with most of the burden at the individual household level (46%, 62%, and 64%) for preventing/controlling mosquitos.

The Colombian Ministry of Health and Social Protection uses the 1,800m elevation mark when allocating money to low-altitude departments for dengue-related expenditures.  This suggests that only half of Colombia’s 47 million residents are at risk for dengue.  However, many people vacation at low altitudes where they risk becoming infected and bringing dengue back home.  If low-altitude residents were better equipped to control mosquitos, then both residents and visitors would be better protected.  Unfortunately, low-altitude residents shoulder a greater financial burden for mosquito prevention than the government.  Rodriquez et al. (2016) reported that almost $85 million USD was the highest household burden (for prevention alone) between 2010 and 2012, while the highest government burden was only $35 million USD (for prevention, awareness campaigns, and control combined).

If the Ministry of Health and Social Protection’s vision of equity-based protection and healthcare resources for all is to come to fruition, more money must flow into prevention and control.  Residents should not have to buy expensive sprays when they already live in poverty.  If Ministry-controlled finances were earmarked for inexpensive yet effective household supplies, such as curtains and water container covers, then less money would be required for treatment.  I advocate for reshuffling some of the dengue-related funds to reflect the prevention priority; increase amounts for household prevention and decrease treatment allocations.

Let’s not make low-altitude residents choose between buying expensive sprays or food to eat.  It’s hard enough already just to slap together supper.

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7 Responses to “Decreasing Household Costs of Dengue Prevention at Low-Altitudes in Colombia: Redirecting Resources into the Hands of People Who Slap Mosquitoes Everyday”

  1. Decreasing Household Costs of Dengue Prevention at Low-Altitudes in Colombia … | Tropical Health Matters Says:

    […] Class members from the course “Social and Behavioral Foundations of Primary Health Care” at the Johns Hopkins Bloomberg School of Public Health write a policy advocacy blog as part of their assignments. Here we are sharing the blog posted by elizabethwetzler. read more on this and other SBFPHC blog posts by clicking here.  […]

  2. Malik Burnett, MD MBA Says:

    Thanks for your post on this topic. I definitely appreciate the point you are making about importance of equity in the distribution of health resources for dengue virus in Columbia. However, given the growing prevalence of dengue, it is also critical that the country invest in dengue surveillance. Currently there is limited seroprevalene data for dengue in Columbia, without this data it is difficult if not impossible to appropriately distribute resources where the need is greatest. Having an elevation cutoff is arbitrary and flies in the face of science. In fact the WHO put out comprehensive guide (http://www.who.int/rpc/guidelines/9789241547871/en/) which recommends collecting seroprevalance data as part of a comprehensive dengue surveillance program.

    Moreover, earlier this year a vaccine for Dengue, (Dengevaxia) was released to the public, it currently has approval for use in 5 countries. The WHO Strategic Advisory Group of Experts (SAGE) made recommendations (http://www.denguevaccines.org/sites/default/files/DVI%20Statement%20%20SAGE%20Recommendations%20Dengue%20Vaccines%20April%202016_0.pdf) regarding eligibility for the vaccine. None of the 5 countries where the vaccine is currently approved for use meet the WHO recommendations, primarily due to a lack of robust surveillance data. Overall, in order to get better control of this emerging public health threat governments will need to invest in surveillance programs in order to ensure resources are being disseminated to the areas of greatest need.

    • elizabethwetzler Says:

      Thanks for your reply (and for everyone’s)! I just read a 2016 article on the surveillance piece that looked at wild caught mosquitoes in rural areas of Colombia. It is titled “Detection of all four dengue serotypes in Aedes aegypti female mosquitoes collected in a rural area in Colombia” and they did find evidence of all four serotypes in two specific rural areas that are popular with tourists (Anapoima and La Mesa). I was one of those tourists (at Anapoima) in Dec 2009 right before the 2010 epidemic year. We went with an embassy group for a weekend trip and we happened to have our newborn son with us…talk about a new mom becoming a nervous wreck – there were mosquitoes everywhere, including all over the finca, inside the villas (that had no screens, curtains, or roofs over some parts), and they landed all over me and my baby as I tried to nurse him! I woke my husband up to slap mosquitoes while I had my hands full trying to nurse. Luckily, we had brought a fan with us and a screen for the baby bassinet so they would stay away from the baby (for the most part). It was not exactly the relaxing getaway we hoped for! Anyway, the authors of the study I mentioned above advocate that detection rates for wild-caught mosquitoes in rural areas should be included in forecasting models, and I think that this goes right along with what you were saying about the surveillance part of the cycle. Thanks again for your thoughtful comments! Beth Sorry – the hyperlink did not work for the article, but here is the url: http://www.scielo.br/scielo.php?pid=S0074-02762016000400233&script=sci_arttext

  3. Umar J Says:

    It was nice to learn about some of the health related issues in South America. Once the government adopts cost-effective methods to prevent dengue, it can use the money to eliminate poverty, promote businesses and spend the money in research.

  4. shogokubota Says:

    The title is creative. Very interesting local context, especially on consideration on geographical and human movement factors. The argument is specific and convincing.

  5. jleblan5jhmiedu Says:

    Elizabeth,
    I appreciate your post. When I hear Dengue, I do not usually immediately think about Columbia, so this post was really enlightening for me. You highlighted such an important point here by commenting about people needing to spend money on mosquito sprays when they are already experiencing hardship.
    It would be so ideal if all territories were treated equally. If such were the case, perhaps then citizens would be less burdened with disease and thus more likely to be able to work and obtain a better quality of life.

  6. raheelc Says:

    Thank you for sharing such an informative and illuminating post. It was nice to learn so much about certain health related issues in Colombia. I think its very interesting you pointed out how the government should invest more money in prevention as it can be a cost effective strategy to combat such a common health issue in South America. It seems like an excellent initiative, and if implemented in a proper manner it could prove very beneficial for the people of Colombia. Great post!

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