Misuse, perceived risk, and safety issues of household insecticides: Qualitative findings from focus groups in Arequipa, Peru

Background: The current body of research on insecticide use in Peru deals primarily with application of insecticides offered through Ministry of Health-led campaigns against vector-borne disease. However, there is a gap in the literature regarding the individual use, choice and perceptions of insecticides which may influence uptake of public health-based vector control initiatives and contribute to the thousands of deaths annually from acute pesticide poisoning in Peru. Methods: Residents (n = 49) of the Alto Selva Alegre and CC districts of peri-urban Arequipa participated in seven focus group discussions (FGD). Using a FGD guide, two facilitators led the discussion and conducted a role-playing activity. this activity, participants insecticides (represented by printed photos of insecticides available locally) and pretended to "sell" the insecticides to other participants, including describing their qualities as though they were advertising the insecticide. The exercise was designed to elicit perceptions of currently available insecticides. The focus groups also included questions about participants' preferences, use and experiences related to insecticides outside the context of this activity. Focus group content was transcribed, and qualitative data were analyzed with Atlas.ti and coded using an inductive process to generate major themes related to use and choice of insecticides, and perceived risks associated with insecticide use. Results: The perceived risks associated with insecticides included both short- and long-term health impacts, and safety for children emerged as a priority. However, in some cases insecticides were reportedly applied in high-risk ways including application of insecticides directly to children and bedding. Some participants attempted to reduce the risk of insecticide use with informal, potentially ineffective personal protective equipment and by timing application when household members were away. Valued insecticide characteristics, such as strength and effectiveness, were often associated with negative characteristics such as odor and health impacts. "Agropecuarios" (agricultural supply stores) were considered a trusted source of information about insecticides and their health risks. Conclusions: It is crucial to characterize misuse and perceptions of health impacts and risks of insecticides at the local level, as well as to find common themes and patterns across populations to inform national and regional programs to prevent acute insecticide poisoning and increase community participation in insecticide-based vector control campaigns. We detected risky practices and beliefs about personal protective equipment, risk indicators, and safety levels that could inform such preventive campaigns, as well as trusted information sources such as agricultural stores for partnerships in disseminating information.

Efecto del sacrificio de perros vagabundos en el control de la rabia canina / Effect of free-roaming dogs culling on the control of canine rabies

RESUMEN En la ciudad de Arequipa, Perú, se han detectado perros con rabia desde marzo de 2015, señal de la reintroducción del virus de la rabia (VR) en esta zona previamente declarada libre de esta enfermedad. La alta densidad de perros vagabundos ha sido considerada una de las causas de la continua transmisión del VR en el brote de la ciudad de Arequipa, alentando el sacrificio de perros como medida de salud pública. Sin embargo, la efectividad de esta medida de control no ha sido evaluada. El objetivo de esta revisión fue determinar la efectividad del sacrificio de perros vagabundos como medida de control de la rabia urbana. Se realizó la búsqueda de artículos sobre control de rabia canina o urbana en las bases de datos de Medline, Scopus y LILACS. Se incluyeron estudios originales y revisiones que hayan evaluado algún efecto del sacrificio de perros en la transmisión del VR. Veinte de 21 artículos concluyen que el sacrificio de perros vagabundos es inefectivo en reducir la trasmisión del VR e, incluso, puede tener consecuencias imprevistas que empeoren el problema. En conclusión, la evidencia disponible indica que sacrificar perros vagabundos no es efectivo para controlar la rabia urbana. Además, las diversas consecuencias negativas del sacrificio de los perros vagabundos reportadas en otras partes del mundo sugieren que el sistema de rabia urbana es altamente complejo y todos sus componentes deben ser tomados en cuenta durante la implementación de actividades de control.

ABSTRACT In the Peruvian city of Arequipa, rabid dogs have been detected since March 2015, signaling the reintroduction of the rabies virus (RV) in this previously officially-declared rabies free zone. High dog density is considered one of the causes for the continuous transmission of the RV in the outbreak in the city of Arequipa, which seemingly lends support to the culling of dogs as a public health measure. However, the effectiveness of culling free-roaming dogs to control urban rabies has not been evaluated. Objective to determine the effectiveness of free-roaming dog culling as a control measure of urban rabies. Source of data: We searched for articles on dog rabies control or urban rabies control in the databases of PubMed, Scopus and LILACS. The characteristics and results of the documents obtained were recorded. Eligibility criteria: We included original studies and reviews that have evaluated an effect of culling dogs in the transmission of RV. Data collection and evaluation: One of the authors (RCN) screened the articles found in the search based on their titles and abstracts. The data and results of the articles selected for full reading were evaluated by at least two authors. Results: 21 articles were eligible for full reading. 20 of 21 articles conclude that free-roaming dog culling is ineffective in reducing the transmission of RV and may even have unintended consequences that worsen the problem. We believe that the available evidence indicates that the sacrifice of free-roaming dogs is not effective to control urban rabies. In addition, the various negative consequences of free-roaming dog culling reported in other parts of the world suggest that the system of urban rabies is highly complex and all its components must be taken into account during the implementation of control activities.