Risk factors for the presence of dengue vector mosquitoes, and determinants of their prevalence and larval site selection in Dhaka, Bangladesh.

Dengue viruses are responsible for over 100 million infections a year worldwide and are a public health concern in Bangladesh. Although risk of transmission is high, data on vector population characteristics are scanty in Bangladesh; therefore, a comprehensive prediction of the patterns of local virus transmission is not possible. Recognizing these gaps, multi-year entomological surveys were carried out in Dhaka, where the disease is most frequently reported. The specific objectives of the present study are threefold: i) to determine the risk factors for the presence of Aedes mosquitoes; ii) to identify the types of most productive and key containers; and iii) to estimate the effects of climatic factors on Aedes abundance in the city of Dhaka, Bangladesh. Entomological surveys were conducted in 12 out of 90 wards in Dhaka. These wards were selected using a probability proportional sampling procedure during the monsoon seasons in 2011, 2012 and 2013 and in the dry season in 2012. All containers inside and around sampled households were inspected for mosquito larvae and pupae, and containers were classified according to their relative size, use pattern, and materials of construction. During the study period (2011-2013), 12,680 larvae and pupae were collected. About 82% of the identified immature mosquitoes were Aedes aegypti, while the remainder were Ae. albopictus and other mosquito species. The largest number of immature mosquitoes was collected from tires and refrigerator trays during 2011 and 2012 monsoon seasons. Conversely, plastic drums were the most productive during the 2012 dry and 2013 monsoon season. Vehicle parts and discarded construction materials were the most efficient producers of Aedes mosquitoes in all surveys. The presence of Aedes mosquitoes was significantly (p < 0.05) higher in low socio-economic zones of Dhaka. Container location, presence of vegetation, and availability of shade for containers were also significantly associated with finding immature Aedes mosquitoes, based on multivariable analysis after confounder adjustment. Rainfall, temperature, and relative humidity also significantly affected the mean abundance of mosquitoes. Proper use, disposal, and recycling of the containers that effectively produce large numbers of Aedes vector mosquitoes may decrease the risk of arboviral transmission.

Dengue seroprevalence, seroconversion and risk factors in Dhaka, Bangladesh.

BACKGROUND: Dengue virus (DENV) activity has been reported in Dhaka, Bangladesh since the early 1960s with the greatest burden of dengue fever and dengue hemorrhagic fever cases observed in 2000. Since this time, the intensity of dengue activity has varied from year to year, and its determining factors remained relatively unknown. In light of such gaps in knowledge, the main objectives of this study were to determine the magnitude of seroprevalence and seroconversion among the surveyed population, and establish the individual/household level risk factors for the presence of DENV antibodies among all age groups of target populations in the city of Dhaka. METHODOLOGY/PRINCIPAL FINDINGS: Considering the lack of fine scale investigations on the factors driving dengue activity in Bangladesh, a prospective cohort study involving serological surveys was undertaken with participant interviews and blood donation across the city of Dhaka in 2012. Study participants were recruited from 12 of 90 wards and blood samples were collected during both the pre-monsoon (n = 1125) and post-monsoon (n = 600) seasons of 2012. The findings revealed that the seroprevalence in all pre-monsoon samples was 80.0% (900/1125) while the seropositivity in the pre-monsoon samples that had paired post-monsoon samples was 83.3% (503/600). Of the 97 paired samples that were negative at the pre-monsoon time point, 56 were positive at the post-monsoon time point. This resulted in a seroprevalence of 93.2% (559/600) among individuals tested during the post-monsoon period. Seroprevalence trended higher with age with children exhibiting a lower seropositivity as compared to adults. Results from this study also indicated that DENV strains were the only flaviviruses circulating in Dhaka in 2012. A multivariate analysis revealed that age, possession of indoor potted plants, and types of mosquito control measures were significant factors associated with DENV seroprevalence; while attendance in public/mass gatherings, and use of mosquito control measures were significantly associated with DENV seroconversion after adjusting for all other variables. CONCLUSIONS/SIGNIFICANCE: Our study suggests that there is a high level of endemic dengue virus circulation in the city of Dhaka which has resulted in significant DENV seroprevalence among its residents. Seropositivity increased with age, however, a substantial proportion of children are at risk for DENV infections. Our serological analysis also documents considerable DENV seroconversion among study participants which indicates that a large proportion of the population in the city of Dhaka were newly exposed to DENV during the study period (pre-and post-monsoon 2012). High levels of seroconversion suggest that there was an intense circulation of DENV in 2012 and this may have resulted in a significant risk for viral associated illness. Findings of our study further indicated that home-based interventions, such as removing indoor potted plants and increased bed net use, in addition to vector control measures in public parks, would reduce exposure to DENV and further decrease risk of viral associated disease.

Socioeconomic and Ecological Factors Influencing Aedes aegypti Prevalence, Abundance, and Distribution in Dhaka, Bangladesh.

This study examined household risk factors and prevalence, abundance, and distribution of immature Aedes aegypti and Aedes albopictus, and their association with socioeconomic and ecological factors at urban zonal and household levels in the city of Dhaka, Bangladesh. During the 2011 monsoon, 826 households in 12 randomly selected administrative wards were surveyed for vector mosquitoes. Results revealed that the abundance and distribution of immature Ae. aegypti and Ae. albopictus, and pupae-per-person indices did not vary significantly among the zones with varied socioeconomic status. Of 35 different types of identified wet containers, 30 were infested, and among the 23 pupae-positive container types, nine were defined as the "most productive" for pupae including: disposable plastic containers (12.2% of 550), sealable plastic barrels (12.0%), tires (10.4%), abandoned plastic buckets (9.6%), flower tub and trays (8.5%), refrigerator trays (6.5%), plastic bottles (6.4%), clay pots (4.9%), and water tanks (1.6%). When the function of the containers was assessed, ornamental, discarded, and household repairing and reconstruction-related container categories were found significantly associated with the number of pupae in the households. The purpose of storing water and income variables were significant predictors of possession of containers that were infested by vector mosquitoes.

Dengue Disease Risk Mental Models in the City of Dhaka, Bangladesh: Juxtapositions and Gaps Between the Public and Experts.

Worldwide, more than 50 million cases of dengue fever are reported every year in at least 124 countries, and it is estimated that approximately 2.5 billion people are at risk for dengue infection. In Bangladesh, the recurrence of dengue has become a growing public health threat. Notably, knowledge and perceptions of dengue disease risk, particularly among the public, are not well understood. Recognizing the importance of assessing risk perception, we adopted a comparative approach to examine a generic methodology to assess diverse sets of beliefs related to dengue disease risk. Our study mapped existing knowledge structures regarding the risk associated with dengue virus, its vector (Aedes mosquitoes), water container use, and human activities in the city of Dhaka, Bangladesh. "Public mental models" were developed from interviews and focus group discussions with diverse community groups; "expert mental models" were formulated based on open-ended discussions with experts in the pertinent fields. A comparative assessment of the public's and experts' knowledge and perception of dengue disease risk has revealed significant gaps in the perception of: (a) disease risk indicators and measurements; (b) disease severity; (c) control of disease spread; and (d) the institutions responsible for intervention. This assessment further identifies misconceptions in public perception regarding: (a) causes of dengue disease; (b) dengue disease symptoms; (c) dengue disease severity; (d) dengue vector ecology; and (e) dengue disease transmission. Based on these results, recommendations are put forward for improving communication of dengue risk and practicing local community engagement and knowledge enhancement in Bangladesh.

Community perspectives on dengue transmission in the city of Dhaka, Bangladesh.

BACKGROUND: The recurrence of dengue has become a growing public health threat. This research examines the knowledge, beliefs, attitudes and practice of local community members regarding dengue transmission in the city of Dhaka, Bangladesh. It also investigates explanatory demographic and socioeconomic factors that affect community knowledge, beliefs and practices. METHODS: In July-August 2011, a random sample of household heads or alternatives (n=300) was surveyed in 12 wards of Dhaka. This survey was supplemented by 12 focus group discussions (n=107) and 18 key informant interviews in three selected wards. RESULTS: Most community members had heard about dengue (91.3%; 274/300) and knew (93.7%; 281/300) that mosquitoes act as the primary vector of its transmission. In contrast, most (87.3%; 262/300) was unaware that Aedes mosquitoes prefer to lay their eggs in water containers. Multivariate logistic regression modeling revealed that the respondents in age group 45-60 years were 2.83 times more likely to have positive attitudes towards undertaking precautionary measures to prevent dengue than the respondents aged <25 years. CONCLUSIONS: These findings confirm the presence in local communities of misconceptions and considerable knowledge gaps about dengue transmission that could be improved by formulating interventions targeting specific subgroups of the population.