full article
Manirat Therawiwat1, Wijitr Fungladda2, Jaranit Kaewkungwal2, Nirat Imamee1 and Allan Steckler3
Abstract
An action research design was conducted in two villages of Mueang District, Kanchanaburi Province to assess the effectiveness of a community-based approach program. Knowledge, perceived susceptibility, self-efficacy, and regular larval survey behavior were measured for program outputs. Container Index (CI), House Index (HI), and Breteau Index (BI) were used to confirm program outcomes. Key community stakeholders in the experimental village were identified and empowered through active learning in the village. Monthly meetings with the key stakeholders were used to share experiences learned, to reflect on the program outputs and outcomes as well as to plan for the next cycle of program activities. The program was quite successful. Knowledge, perception, self-efficacy, and larval survey practices in the experimental group were significantly higher than before the experiment, and higher than the comparison group. CI, HI, and BI were decreased sharply to better than the national target. Community status as community leaders was the best predictor for larval survey behavior at the first survey. Participating in the study program activities was the best predictor at the end of the program. The results from this study suggest that the dengue hemorrhagic fever (DHF) prevention and control program at the sub-district health level should be more proactive and emphasized at the village level. Monitoring the disease control program outputs and outcomes should be performed regularly during monthly meetings. Finally, local health officers need to be empowered for these matters
OPINION
Efforts to control Aedes mosquitoes have been redirected from local health services at the provincial level to community-based control using village health volunteers. Efforts have not been effective and DHF is still a major health problem in all areas of the country. The one cost-effective measure that provides effective disease control over the long run is involving the persons who are responsible for creating or tolerating Aedes aegypti larval habitats in the local community environment in control or elimination of those habitats. They will learn that it is in their best interest to participate with other members of their community to create community ownership of their program (Gubler and Clark, 1996).
the community-based empowerment program that allowed the key community stakeholders to actively participate in continuing education activities starting from conducting a community survey, identifying the problem, planning, action and observation, reflection, and re-planning with the sub-district health officers and researcher. Representatives of each household developed the control or elimination of mosquito breeding places and weekly larval survey activities with the assistance of the key stakeholders of that village zone. The activities at the household level were more specific to each household context, specifically the mosquito breeding places. The activities were also developed around the basic concept of the problem solving process. In this case, the activities were started from mapping of possible breeding places of mosquitoes in and around the house, identification of the breeding places, identification of possible solutions, implementation the selected solutions, monitoring and evaluation of the implementation outcomes through regular larval surveys. Besides these activities, the learning experiences of each key community stakeholder were shared and discussed in a monthly meeting in the village. The experiences were used as the inputs for project activities monitoring and re-planning.
Empowering key community stakeholders through active participation in on going activities played a great role in program success. Working for DHF prevention and control in the village as a partnership among primary, secondary, and tertiary stakeholders was also crucial.
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