Reducing Aedes albopictus breeding sites through education: A study in urban area

Aedes albopictus tends to proliferate in small, often man-made bodies of water, largely present in urban private areas. For this reason, education and community participation are considered crucial for source reduction and mosquito control. In the current study, we identify mosquito breeding habitat and evaluate the effectiveness of resident education. Since 2010 several outbreaks of West Nile virus infection occurred in Greece however urban population has no previous experience with mosquito–borne disease related to Aedes species, such as Dengue, Zika and Chikungunya. After the introduction of Ae. albopictus in Greece, urban areas have been considered to be at risk of epidemic arboviral outbreaks and identifying effective control strategies is imperative. Our study examines the relationship between mosquito breeding sources and socioeconomic or demographic characteristics of different households in a Greek municipality and evaluates efficacy of resident education. The results revealed that only a minority of residents knew where mosquitoes breed (18.6%) and only 46% felt that residents had any responsibility for managing breeding habitat. Our findings strongly suggest that only the presence of scientific staff inspecting possible habitats in their properties, could be enough to stimulate practices towards source reduction. However, educational interventions alone with printed education material cannot enhance significant community participation and source reduction.


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The Asian tiger mosquito, Aedes (Stegomyia) albopictus (Skuse, 1895) (Diptera: Culicidae), is considered 22 one of the 100 most invasive species in the world presenting a significant expansion in many parts of the 23 globe [1][2][3]. Aedes albopictus is a vector of viruses for dengue, chikungunya, yellow fever, Japanese 24 encephalitis [4][5], and zoonoses, such as dirofilarioses [6] presenting thus a notable threat to public health. The attitude score was estimated based on answers to four questions aimed at elucidating respondent 119 attitudes concerning exposure to mosquitoes and management activities. Question one asked if and how 120 often respondents were bothered by mosquitoes. With this question, we assumed that respondents who 121 are often bitten by mosquitoes will be favorably predisposed to undertake preventive measures. Thus, 122 respondents who answered, "every day" or "a few days a week" scored 1 while any other answer scored 123 0 points. The second question asked the respondents if mosquitoes altered their outdoor activities. If they 124 did, the score was 1, otherwise they scored 0 points. The third question of the group, asked the 125 respondents if they undertake any actions to control mosquitoes in their properties. If they answered yes, 126 they scored 1 point otherwise 0 points. The respondents were then asked the kind of actions undertaken, 127 although these activities were not scored. The fourth question asked them how concerned they were by 128 diseases carried by mosquitoes. In a scale from one to five, those ansewered four or five, scored 1 while 129 any other answer scored 0.

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After the distribution of education material, there was a 54% and 71% total container reduction in the first 189 control group and the treatment group respectively. The reduction was mainly attributed to the reduction 190 of the yard containers which accounted for the 76% and 77% of the total containers in the first control 191 group and the treatment group. The mean number of yard containers in the 1 st visit was 6.8 (±4.6) and 9.5 192 (±7.3) in the control and treatment group respectively (Fig 2). The same values were reduced to 3.6 (±2.5) 193 and 4.5 (±4.0) respectively at the 2 nd visit (Fig 3). Relatevely to the structural containers, the mean number greater among the respondents with higher formal education attainment (Fig 4 and Fig 5).

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More than 30% of the respondents across all three treatment groups were able to identify the correct 209 diseases transmitted with mosquitoes in the area of Attica ( with "5" being the "perfect" knowledge score. The knowledge score was not a significant predictor of 228 initial container habitat. The knowledge scores did not differ among the three education treatment groups 229 at the initial visit (F=1.1, df=2 and 61, p >.05) which was made before the actual treatment.

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Respondents who were also building administrators were more motivated to achieve source reduction 242 (Fig 6). The motivation score varied with the ownership status and also with the house owners presenting 243 higher motivation score compared to the tenants (Fig 7). Overall motivation varied with level of formal 244 education attained. Lower formal education level was associated with higher motivation score (Fig 8).
245 Figure 6. Mean (±SE) motivation score whether the respondent was a building administrator or not. 248 Question 2(iii) -A majority of residents reported altering their outdoor activities due to mosquito nuisance 249 (70.7%) and taking some action to limit mosquito exposure (67.7%). In our study, most of the residents 250 reported actions which were related to source reduction, such as emptying water containers, metallic 251 mosquito mesh and application of larvicides.

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Although there were no significant associations between reported practices and total numbers of Trash or 253 Structural containers, the numbers of Yard containers were negatively associated with reported avoidance 254 and exposure management (cor=-0.37, t=-2.34, df=35, p=0.02). Practice scores did not differ among the 255 three education treatment groups at the initial visit (F=0.54, df=2 and 61, p >.05).

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Question3-There were fewer containers during the second sampling period in all but two households, 257 where container number was unchanged (1 household each in Treatment and Control group). This is 258 reflected in the proportional reductions shown in the Table 3.  and control group and even though the reduction of total containers was important, our education 292 campaign found to have no effect on the habitat reduction. After including the 2 nd control group, the effect 293 of the printed educational material was found significant between the treatment group and the 2 nd control 294 group. The above results strongly suggest that only the presence of scientific staff inspecting possible 295 habitats in their properties, could be enough to stimulate practices towards source reduction. The 296 presence of mosquito personnel counting containers might have raised concern about being fined for 297 producing mosquitoes in their property [17]. Their concern was further amplified since they did not receive 299 The changes in any types of containers were not significantly associated with the motivation metrics.

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Nevertheless, residents attitude scores associated with greater concern, had yards with fewer of the 301 removable containers. This was probably because of the greater level of nuisance which urged them to 302 limit their exposure to mosquitoes and to the larger number of breeding sites.

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Our study also found that the total number of containers found in the first visit did not differ between 304 respondents with different formal education level. However, at the second visit, and after the distribution 305 of the educational material, the decrease in the number of total containers was higher among respondents 306 with higher formal educational attainment. This result suggests that educational interventions need to be 307 better designed in order to make greater gains when targeted to households with less formal education.

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The abovementioned results are particularly interesting when combined with respondents from 309 households with higher educational level were considered less motivated to take action to control 310 mosquitoes in their properties, still they seem to have accomplished greater source reduction in their