Exploring the eco-bio-social determinants of the dengue virus episystem in urban centres of Latin America and the Caribbean

Abstract

As Latin America and the Caribbean (LAC) is challenged with climate change, rampant urbanization, and the control of the Aedes aegypti mosquito, the ecological, biological, and social (eco-bio-social) factors that determine dengue virus (DENV) transmission are important to consider. This thesis challenges reductionist research approaches and applied three principles of an ecosystems approach to health (Ecohealth) to identify, conceptualize, and investigate the eco-bio-social factors operating the urban dengue epidemiological system (episystem) in LAC. First, we conducted two scoping reviews to summarize the distinct and intersecting eco-bio-social factors. Then, we brought together a panel of eleven dengue researchers and practitioners from seven LAC countries using a qualitative, three-round e-Delphi method to achieve consensus on an evidence-informed and consensus-based eco-bio-social conceptual framework of the urban dengue episystem in LAC. Panelists also established research, and policy and program agendas for dengue research, prevention and vector control. Finally, we implemented a concurrent nested mixed-methods study, using an online survey, focus group discussions (FGDs), and a participatory action research (PAR) method called Photovoice in the metropolitan city of São Paulo, Brazil, to investigate knowledge, attitudes, practices, and perceptions (KAPP) of the eco-bio-social factors, the dengue vaccine, and dengue prevention measures among urban residents. Individual- and household- level socioeconomic and demographic factors associated with KAPP were investigated. Overall, knowledge about the eco-bio-social determinants was generally high. Higher level of educational attainment was significantly associated with positive vaccine attitudes. FGDs and Photovoice participants perceived climate change, socioeconomic vulnerability, and the spread of misinformation as key risk factors for community dengue transmission. Ultimately, by considering the factors determining urban dengue transmission, and the experiences of dengue-affected populations, this thesis advances research on the eco-bio-social determinants of urban dengue transmission in LAC and informs the design of community-oriented interventions for mosquito control and dengue prevention in urban, climate-vulnerable settings.