Improving knowledge, attitudes, and practices on dengue and diarrhea in rural primary school students, their parents, and teachers in Colombia: A cluster-randomized controlled trial.

BACKGROUND: Improved education on water-related diseases in schools could help to reduce disease burden. This paper presents specific results on knowledge, attitudes and practices (KAP) of a cluster-randomized controlled trial to reduce diarrheal disease and dengue entomological risk factors in rural primary schools in Colombia. The aim was to investigate whether enhanced educational interventions on dengue and diarrheal disease in schools could improve KAP scores related to these diseases in students and teachers in rural primary schools, as well as the students' parents. METHODOLOGY/PRINCIPAL FINDINGS: A factorial cluster-randomized controlled trial was carried out in 35 rural primary schools in two municipalities in Cundinamarca, central Colombia. Schools were randomized into four arms: interventions related to diarrheal disease (DIA), dengue (DEN), both (DIADEN), or no interventions (control, CON). Both educational and physical interventions to reduce risk factors of dengue and diarrhea were implemented. Comprehensive teachers' manuals were developed and deployed to guide the learning activities. The intervention was carried out over two school years. The knowledge scores of students receiving dengue interventions (DEN, DIADEN) increased by 1.16 point score (0.75-1.56, p<0.001) and those receiving diarrhea interventions (DIA, DIADEN) increased by 1.15 point score (0.67-1.63, p<0.001). The attitude and practice scores of students receiving the diarrhea interventions increased (Attitudes: 0.41 [0.11-0.71, p = 0.01]; Practices: 0.33 [0.01-0.65, p = 0.042]), but not for those receiving the dengue interventions (p = 0.31 and p = 0.08, respectively). CONCLUSIONS/SIGNIFICANCE: There were increases in knowledge scores among students, their teachers and their parents for both diseases. However, the attitudes and practices components were not affected to the same extent. The hypothesis that the students would disseminate knowledge acquired from the educational interventions to their parents was confirmed for dengue, but not for diarrhea. TRIAL REGISTRATION: ISRCTN40195031 The trial is registered in the Current Controlled Trials under Infections and Infestations category.

Multidisciplinary approach for surveillance and risk identification of yellow fever and other arboviruses in Colombia.

Arbovirus, a critical threat to human health, have complex and dynamic life cycles. With reports of Yellow fever virus (YFV) causing spillover from sylvatic transmission cycles, and dengue (DENV), chikungunya (CHIKV), and Zika (ZIKV) viruses expanding from urban to rural areas. We explored a multidisciplinary approach to analyze arbovirus transmission through vectors, and identify biological and sociodemographic determinants associated with their transmission risk in urban and rural areas in a Colombian municipality. We visited 178 urban and 97 rural households, registered sociodemographic characteristics and vaccination status for each of these households, collected adult and immature mosquitoes at the intra-, peri-, and extra-domicile, and surveyed forest patches in rural areas. Infections of YFV, DENV, ZIKV, and CHIKV in the mosquitoes collected in the wild were analyzed using a reverse transcriptase PCR. We identified various risk factors of transmission associated with a high Aedes aegypti infestation in urban areas and their presence in rural settlements and Haemagogus janthinomys and other sylvatic mosquitoes near urban areas. The collected Ae. aegypti females from urban areas had a high infection rate of YFV (5.8%) and CHIKV (58.8%), and those from rural settlements had a high infection rate of DENV (33%), CHIKV (16.7%), and ZIKV (16.7%). The infection rates of YFV in the thorax of the sylvatic mosquitoes H. janthinomys and Aedes serratus collected from the forest patches were 14.3 and 42.1%, respectively. We could discern the transmission determinants associated with climatic, socioeconomic, and anthropogenic factors and YFV vaccination status. This multidisciplinary approach for surveillance of arboviral diseases allowed us to independently detect and integrate factors indicating an early risk of rural transmission of DENV, CHIKV, and ZIKV and rural and urban outbreaks of YFV in the study area. This study provides a helpful tool for designing and focalizing prevention strategies.

Multilevel analysis of social, climatic and entomological factors that influenced dengue occurrence in three municipalities in Colombia.

According to the World Health Organization, dengue is a neglected tropical disease. Latin America, specifically Colombia is in alert regarding this arbovirosis as there was a spike in the number of reported dengue cases at the beginning of 2019. Although there has been a worldwide decrease in the number of reported dengue cases, Colombia has shown a growing trend over the past few years. This study performed a Poisson multilevel analysis with mixed effects on STATA® version 16 and R to assess sociodemographic, climatic, and entomological factors that may influence the occurrence of dengue in three municipalities for the period 2010-2015. Information on dengue cases and their sociodemographic variables was collected from the National Public Health Surveillance System (SIVIGILA) records. For climatic variables (temperature, relative humidity, and precipitation), we used the information registered by the weather stations located in the study area, which are managed by the Instituto de Hidrologia, Meteorologia y Estudios Ambientales (IDEAM) or the Corporación Autónoma Regional (CAR). The entomological variables (house index, container index, and Breteau index) were provided by the Health office of the Cundinamarca department. SIVIGILA reported 1921 dengue cases and 56 severe dengue cases in the three municipalities; of them, three died. One out of four cases occurred in rural areas. The age category most affected was adulthood, and there were no statistical differences in the number of cases between sexes. The Poisson multilevel analysis with the best fit model explained the presentation of cases were temperature, relative humidity, precipitation, childhood, live in urban area and the contributory healthcare system. The temperature had the biggest influence on the presentation of dengue cases in this region between 2010 and 2015.

Reasons for absenteeism in rural primary schools in two Colombian municipalities / Razones de ausentismo en escuelas primarias rurales de dos municipios colombianos / Razões do não comparecimento nas escolas primarias rurais nos municípios colombianos

Background: School absenteeism is a considerable problem generally related to higher dropout rates, poor academic achievement and school lag. This study determined the frequency and causes of overall and illness-related absenteeism of students in rural schools from two Colombian municipalities. Methods: A prospective and descriptive study was conducted in a population of 948 school children from 34 rural schools. Absenteeism data were collected for 2013 academic year consisted of the number of students registered and absent by grade, school, day and reason for absence. Absence rates (overall and illness-related absenteeism) were recorded, based on full or partial days absence, measured both as episodes, and accumulating the number of days. Results: From the students included in the study, 55.1% were male and 71.6% were between 5 and 9 years old. The overall absence rate was 5.7 episodes per child-year (95% confidence interval 5.5 to 5.8) and 8.6 days per child-year (8.4 to 8.9). The main reasons for non-attendance were illness (24.4%), medical or dental check-up (12.9%), travel (12.3%), lack of motivation to attend school (10.0%) and bad weather (9.3%). The illness- related absence rate was 1.4 episodes per child-year (95% confidence interval 1.3 to 1.5) and 2.5 days per child-year (2.4 to 2.6). The main reasons for illness-related absence were cold (37.0%), nonspecific fever (10.9%) and stomach pain or vomiting (8.4%). Conclusions: In this study, the most common reasons for non-attendance were illness-related. The importance of respiratory and gastrointestinal infections in absenteeism was evident, showing rates similar to other urban school studies. Then, the results of this study provide knowledge on the magnitude and reasons for absenteeism in rural schoolchildren.

Antecedentes. El ausentismo escolar es un problema importante relacionado con altas tasas de abandono escolar, bajo rendimiento académico y rezago escolar. Este estudio determinó la frecuencia y las causas del ausentismo general y el ausentismo relacionado con la enfermedad en estudiantes de escuelas rurales de dos municipios de Colombia. Métodos. Se realizó un estudio descriptivo en una población de 948 escolares de 34 escuelas rurales. Los datos de ausentismo recopilados para el año 2013 consistieron en el número de episodios y días de ausentismo por grado y motivo de ausencia general y por enfermedad. Se calcularon las tasas de ausentismo general y por enfermedad. Resultados. El 55,1% de la población participante eran hombres y el 71,6% tenían entre 5 y 9 años. La tasa de ausentismo general fue 5,7 episodios por niño-año, IC 95% (5,5-5,8) y 8,6 días por niño-año, IC 95% (8,4-8,9). Las principales razones del ausentismo fueron enfermedades (24,4%), chequeo médico u odontológico (12,9%), viajes (12,3%), falta de motivación para asistir a la escuela (10,0%) y mal clima (9,3%). La tasa de ausentismo por enfermedad fue 1,4 episodios por niño-año IC 95% (1,3-1,5) y 2,5 días por niño-año IC 95% (2,4-2,6). Las principales razones del ausentismo por enfermedad fueron el resfriado común (37,0%), la fiebre inespecífica (10,9%) y el dolor de estómago o vómito (8,4%). Conclusiones. Las razones más comunes para la no asistencia estuvieron relacionadas con la enfermedad. La importancia de las infecciones respiratorias y gastrointestinales en el absentismo fue evidente, mostrando tasas similares a las de otros estudios en escuelas urbanas. Los resultados de este estudio proporcionan conocimiento sobre la magnitud y las razones del absentismo en la población escolar rural.

Antecedentes. O absentismo escolar é um grande problema relacionado às altas taxas de evasão escolar, baixo desempenho acadêmico e atraso escolar. Este estudo determinou a frequência e causas do não comparecimento geral e por doenças em estudantes de escolas rurais de dois municípios da Colômbia. Métodos. Estudo descritivo, realizado em uma população de 948 escolares de 34 escolas rurais. Os dados de absentismo coletados para 2013 consistiram no número de episódios e dias de não comparecimento por grau e motivo da ausência geral e por doença, foram calculadas as taxas de cada evento. Resultados. 55,1% da população participante eram crianças masculinas do primeiro grau, 71,6% entre 5 e 9 anos de idade. A taxa geral de absentismo foi de 5,7 episódios por criança-ano, IC95% (5,5-5,8) e 8,6 dias por criança-ano, IC95% (8,4-8,9). Os principais motivos do não comparecimento foram doenças (24,4%), check-up médico ou odontológico (12,9%), viagens (12,3%), falta de motivação para frequentar a escola (10,0%) e mau tempo (9,3%). A taxa de absentismo da doença foi de 1,4 episódios por IC95% criança-ano (1,3-1,5) e 2,5 dias por IC95% criança-ano (2,4-2,6). Os principais motivos da ausência de doença foram resfriado comum (37,0%), febre inespecífica (10,9%) e dor de estômago ou vômito (8,4%). Conclusões. Os motivos mais comuns de não comparecimento foram relacionados à doença. A importância das infecções respiratórias e gastrointestinais no absenteísmo foi evidente, mostrando taxas semelhantes às de outros estudos em escolas urbanas. Os resultados deste estudo fornecem informações sobre a magnitude e as razões para evasão escolar na população escolar rural.

Knowledge, attitudes, and practices about dengue among pupils from rural schools in an endemic area in Colombia / Conocimientos, actitudes y prácticas sobre dengue en estudiantes de escuelas rurales de un área endémica en Colombia

INTRODUCTION: Dengue is a public health problem in tropical and subtropical regions of the world. Studies on dengue in rural areas are scarce since the disease is considered mainly urban. OBJECTIVE: To determine the knowledge (K), attitudes (A) and practices (P) of dengue in an endemic area in Colombia. MATERIALS AND METHODS: We conducted a cross-sectional study with 515 pupils (7-16 years old) in 34 rural schools in Anapoima and La Mesa municipalities during 2011. Each KAP category was evaluated independently by a scoring system and then categorized into high, medium or low. RESULTS: Pupils recognized knowledge variables such as the symptoms (fever, bone pain), transmission route (mosquito bites), and mosquito breeding sites (uncovered water tanks, solid waste). Average scores on attitude were high in both municipalities indicating a well-developed perception of disease severity. Seeking treatment in medical centers and self-medication for fever management and the use of mosquito net and space-spraying of insecticides were the most frequently identified practices. DISCUSSION: This is the first KAP dengue study performed in a rural area in Colombia and as such it contributes to the understanding of dengue perceptions by the inhabitants of these areas. It showed a medium level of knowledge about dengue and a lower level of preventive practices in pupils from rural schools. It also showed that pupils considered space-spraying as crucial for vector control. The presence of the vector in rural areas of the country underlines the need to improve surveillance and education to more effectively control the vector and promote prevention methods including community participation.

Introducción. El dengue es un problema de salud pública en las regiones tropicales y subtropicales del mundo. Los estudios sobre la enfermedad en áreas rurales son escasos debido a que se presenta principalmente en los núcleos urbanos. Objetivo. Determinar los conocimientos, las actitudes y las prácticas sobre el dengue en un área rural endémica en Colombia. Materiales y métodos. Se hizo un estudio transversal con 515 estudiantes, entre los 7 y los 16 años de edad en 34 escuelas rurales de los municipios de Anapoima y La Mesa en el 2011. Cada categoría se evaluó por separado con un puntaje clasificado como alto, medio o bajo. Resultados. Los estudiantes reconocieron los síntomas (fiebre, dolor de huesos), la ruta de transmisión (picadura de mosquitos) y los criaderos (depósitos de agua destapados, residuos sólidos). El promedio de los puntajes de actitudes fue alto en ambos municipios, lo que indica que percibían la gravedad del dengue. Las prácticas más frecuentes de tratamiento de la fiebre fueron la consulta médica y la automedicación, en tanto que los métodos de control más frecuentes fueron el uso de mosquiteros y el rociamiento con insecticidas. Discusión. Este es el primer estudio de conocimientos, actitudes y prácticas sobre el dengue en un área rural de Colombia. Los resultados contribuyen a entender las percepciones de la enfermedad en sus habitantes y evidenciaron niveles medios de conocimiento y puntuaciones bajas en cuanto a las prácticas entre los estudiantes de las escuelas rurales. Los estudiantes consideraron que la fumigación es importante para el control del vector. La presencia del mosquito en áreas rurales del país resalta la necesidad de mejorar la vigilancia y la educación para lograr un control efectivo del vector y promover métodos de prevención que incluyan la participación comunitaria.

Knowledge, attitudes and practices about dengue among pupils from rural schools in Colombia / Conocimientos, actitudes y prácticas sobre dengue en estudiantes de escuelas rurales en Colombia

Abstract Introduction: Dengue is a public health problem in tropical and subtropical regions of the world. Studies on dengue in rural areas are scarce since the disease is considered mainly urban. Objective: To determine the knowledge (K), attitudes (A) and practices (P) of dengue in an endemic area in Colombia. Materials and methods: We conducted a cross-sectional study with 515 pupils (7-16 years old) in 34 rural schools in Anapoima and La Mesa municipalities during 2011. Each KAP category was evaluated independently by a scoring system and then categorized into high, medium or low. Results: Pupils recognized knowledge variables such as the symptoms (fever, bone pain), transmission route (mosquito bites), and mosquito breeding sites (uncovered wáter tanks, solid waste). Average scores on attitude were high in both municipalities indicating a well-developed perception of disease severity. Seeking treatment in medical centers and self-medication for fever management and the use of mosquito net and space-spraying of insecticides were the most frequently identified practices. Discussion: This is the first KAP dengue study performed in a rural area in Colombia and as such it contributes to the understanding of dengue perceptions by the inhabitants of these areas. It showed a medium level of knowledge about dengue and a lower level of preventive practices in pupils from rural schools. It also showed that pupils considered space-spraying as crucial for vector control. The presence of the vector in rural areas of the country underlines the need to improve surveillance and education to more effectively control the vector and promote prevention methods including community participation.

Resumen Introducción. El dengue es un problema de salud pública en las regiones tropicales y subtropicales del mundo. Los estudios sobre la enfermedad en áreas rurales son escasos debido a que se presenta principalmente en los núcleos urbanos. Objetivo. Determinar los conocimientos, las actitudes y las prácticas sobre el dengue en un área rural endémica en Colombia. Materiales y métodos. Se hizo un estudio transversal con 515 estudiantes, entre los 7 y los 16 años de edad en 34 escuelas rurales de los municipios de Anapoima y La Mesa en el 2011. Cada categoría se evaluó por separado con un puntaje clasificado como alto, medio o bajo. Resultados. Los estudiantes reconocieron los síntomas (fiebre, dolor de huesos), la ruta de transmisión (picadura de mosquitos) y los criaderos (depósitos de agua destapados, residuos sólidos). El promedio de los puntajes de actitudes fue alto en ambos municipios, lo que indica que percibían la gravedad del dengue. Las prácticas más frecuentes de tratamiento de la fiebre fueron la consulta médica y la automedicación, en tanto que los métodos de control más frecuentes fueron el uso de mosquiteros y el rociamiento con insecticidas. Discusión. Este es el primer estudio de conocimientos, actitudes y prácticas sobre el dengue en un área rural de Colombia. Los resultados contribuyen a entender las percepciones de la enfermedad en sus habitantes y evidenciaron niveles medios de conocimiento y puntuaciones bajas en cuanto a las prácticas entre los estudiantes de las escuelas rurales. Los estudiantes consideraron que la fumigación es importante para el control del vector. La presencia del mosquito en áreas rurales del país resalta la necesidad de mejorar la vigilancia y la educación para lograr un control efectivo del vector y promover métodos de prevención que incluyan la participación comunitaria.

[Sustainability of interventions to prevent dengue and diarrhea in rural schools in two municipalities in Colombia: a two-year post-project evaluation]. / Sostenibilidad en intervenciones para la prevención de dengue y diarrea en escuelas rurales de dos municipios de Colombia: evaluación de dos años post-proyecto.

This study evaluated the sustainability of a set of interventions to prevent dengue and diarrhea in 33 rural schools in the municipalities (counties) of Anapoima and La Mesa, Colombia, two years post-project. The study measured sustainability in two categories: maintenance of the benefits and the interventions, and institutionalization and community capacity-building. The sustainability of the interventions was compared across four arms: interventions to prevent diarrhea, to prevent dengue, combined interventions to prevent diarrhea and dengue, and control. The final score for each arm was classified in five levels of sustainability: regressive, not sustainable, moderately sustainable, sustainable, and highly sustainable. The arms were compared with ANOVA and Kruskal-Wallis test, with significance set at 0.05. At two years post-project, the overall sustainability for the prevention of diarrhea was moderate in the four arms, while dengue prevention was not sustainable in three of the four arms, without statistically significant differences. Sustainability levels also varied in terms of benefits, interventions, capacity-building, and institutionalization. Maintenance of benefits and interventions in both diseases was more sustainable than institutionalization and capacity-building. The analysis of these variables is important for identifying the different factors that influence projects' sustainability, related to their design and execution, organizational framework, and social context.

Este estudio evaluó la sostenibilidad de un conjunto de intervenciones para la prevención del dengue y la diarrea, en 33 escuelas rurales en los municipios de Anapoima y La Mesa, Colombia, dos años post-proyecto. Se midió la sostenibilidad en dos categorías: mantenimiento de los beneficios e intervenciones, e institucionalización y desarrollo de capacidades de la comunidad. Se comparó la sostenibilidad de las intervenciones que fueron distribuidas en cuatro brazos: intervenciones para prevenir la diarrea, para prevenir el dengue, combinadas para prevenir la diarrea y el dengue, y control. El puntaje final de cada brazo se clasificó en uno de cinco niveles de sostenibilidad: regresivo, no sostenible, moderadamente sostenible, sostenible y altamente sostenible. Se compararon los brazos mediante las pruebas ANOVA y Kruskal-Wallis, con un nivel de significancia de 0,05. A los dos años post-proyecto, se observa que el nivel total de sostenibilidad para la prevención de diarrea fue moderadamente sostenible en los cuatro brazos y para dengue no sostenible en tres de los cuatro brazos, sin encontrar diferencias estadísticamente significativas entre estos. También se observa que los niveles de sostenibilidad varían, en cuanto a los beneficios, intervenciones, desarrollo de capacidades e institucionalización. El mantenimiento de los beneficios y de las intervenciones en ambas enfermedades fue más sostenible que la institucionalización y desarrollo de capacidades. Es importante el análisis de estas variables para identificar los diferentes factores que influyen en la sostenibilidad de los proyectos, relacionados con el diseño y ejecución de estos, con el marco organizacional, y con el contexto social.

Este estudo avaliou a sustentabilidade de um conjunto de intervenções para a prevenção de dengue e diarreia, em 33 escolas rurais nos municípios de Anapoima e La Mesa, Colômbia, dois anos pós-projeto. A sustentabilidade foi medida em duas categorias: manutenção dos benefícios e intervenções, e institucionalização e desenvolvimento de capacidades da comunidade. Foi comparada a sustentabilidade das intervenções que foram distribuídas em quatro áreas: intervenções para prevenir a diarreia, e também o dengue, combinadas para prevenir a diarreia e o dengue, e o controle. A pontuação final de cada área foi classificada em um entre cinco níveis de sustentabilidade: regressivo, não sustentável, moderadamente sustentável, sustentável e altamente sustentável. As diferentes áreas foram comparadas através das provas ANOVA e Kruskal-Wallis, com um nível de significância de 0,05. Em dois anos pós-projeto, foi observado que o nível total de sustentabilidade para a prevenção de diarreia foi moderadamente sustentável nas quatro áreas e para dengue não sustentável em três das quatro áreas, sem encontrar diferenças estatisticamente significativas entre elas. Também foi observado que os níveis de sustentabilidade variam, em quanto aos benefícios, intervenções, desenvolvimento de capacidades e institucionalização. A manutenção dos benefícios e das intervenções em ambas as doenças foi mais sustentável do que a institucionalização e desenvolvimento de capacidades. É importante o análise destas variáveis para identificar os diferentes fatores que influem na sustentabilidade dos projetos, em relação com o desenho e execução destes, com o marco organizativo, e com o contexto social.

Sostenibilidad en intervenciones para la prevención de dengue y diarrea en escuelas rurales de dos municipios de Colombia: evaluación de dos años post-proyecto / Sustainability of interventions to prevent dengue and diarrhea in rural schools in two municipalities in Colombia: a two-year post-project evaluation / Sustentabilidade em intervenções para a prevenção de dengue e diarreia em escolas rurais de dois municípios da Colômbia: avaliação de dois anos pós-projeto

Este estudio evaluó la sostenibilidad de un conjunto de intervenciones para la prevención del dengue y la diarrea, en 33 escuelas rurales en los municipios de Anapoima y La Mesa, Colombia, dos años post-proyecto. Se midió la sostenibilidad en dos categorías: mantenimiento de los beneficios e intervenciones, e institucionalización y desarrollo de capacidades de la comunidad. Se comparó la sostenibilidad de las intervenciones que fueron distribuidas en cuatro brazos: intervenciones para prevenir la diarrea, para prevenir el dengue, combinadas para prevenir la diarrea y el dengue, y control. El puntaje final de cada brazo se clasificó en uno de cinco niveles de sostenibilidad: regresivo, no sostenible, moderadamente sostenible, sostenible y altamente sostenible. Se compararon los brazos mediante las pruebas ANOVA y Kruskal-Wallis, con un nivel de significancia de 0,05. A los dos años post-proyecto, se observa que el nivel total de sostenibilidad para la prevención de diarrea fue moderadamente sostenible en los cuatro brazos y para dengue no sostenible en tres de los cuatro brazos, sin encontrar diferencias estadísticamente significativas entre estos. También se observa que los niveles de sostenibilidad varían, en cuanto a los beneficios, intervenciones, desarrollo de capacidades e institucionalización. El mantenimiento de los beneficios y de las intervenciones en ambas enfermedades fue más sostenible que la institucionalización y desarrollo de capacidades. Es importante el análisis de estas variables para identificar los diferentes factores que influyen en la sostenibilidad de los proyectos, relacionados con el diseño y ejecución de estos, con el marco organizacional, y con el contexto social.

This study evaluated the sustainability of a set of interventions to prevent dengue and diarrhea in 33 rural schools in the municipalities (counties) of Anapoima and La Mesa, Colombia, two years post-project. The study measured sustainability in two categories: maintenance of the benefits and the interventions, and institutionalization and community capacity-building. The sustainability of the interventions was compared across four arms: interventions to prevent diarrhea, to prevent dengue, combined interventions to prevent diarrhea and dengue, and control. The final score for each arm was classified in five levels of sustainability: regressive, not sustainable, moderately sustainable, sustainable, and highly sustainable. The arms were compared with ANOVA and Kruskal-Wallis test, with significance set at 0.05. At two years post-project, the overall sustainability for the prevention of diarrhea was moderate in the four arms, while dengue prevention was not sustainable in three of the four arms, without statistically significant differences. Sustainability levels also varied in terms of benefits, interventions, capacity-building, and institutionalization. Maintenance of benefits and interventions in both diseases was more sustainable than institutionalization and capacity-building. The analysis of these variables is important for identifying the different factors that influence projects' sustainability, related to their design and execution, organizational framework, and social context.

Este estudo avaliou a sustentabilidade de um conjunto de intervenções para a prevenção de dengue e diarreia, em 33 escolas rurais nos municípios de Anapoima e La Mesa, Colômbia, dois anos pós-projeto. A sustentabilidade foi medida em duas categorias: manutenção dos benefícios e intervenções, e institucionalização e desenvolvimento de capacidades da comunidade. Foi comparada a sustentabilidade das intervenções que foram distribuídas em quatro áreas: intervenções para prevenir a diarreia, e também o dengue, combinadas para prevenir a diarreia e o dengue, e o controle. A pontuação final de cada área foi classificada em um entre cinco níveis de sustentabilidade: regressivo, não sustentável, moderadamente sustentável, sustentável e altamente sustentável. As diferentes áreas foram comparadas através das provas ANOVA e Kruskal-Wallis, com um nível de significância de 0,05. Em dois anos pós-projeto, foi observado que o nível total de sustentabilidade para a prevenção de diarreia foi moderadamente sustentável nas quatro áreas e para dengue não sustentável em três das quatro áreas, sem encontrar diferenças estatisticamente significativas entre elas. Também foi observado que os níveis de sustentabilidade variam, em quanto aos benefícios, intervenções, desenvolvimento de capacidades e institucionalização. A manutenção dos benefícios e das intervenções em ambas as doenças foi mais sustentável do que a institucionalização e desenvolvimento de capacidades. É importante o análise destas variáveis para identificar os diferentes fatores que influem na sustentabilidade dos projetos, em relação com o desenho e execução destes, com o marco organizativo, e com o contexto social.