Using a Digital Health tool for Community Engagement in Arboviral Disease Prevention: An Implementation Study in Colombia

Using a Digital Health tool for Community Engagement in Arboviral Disease Prevention: An Implementation Study in Colombia | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Using a Digital Health tool for Community Engagement in Arboviral Disease Prevention: An Implementation Study in Colombia Maria Angelica Carrillo, Rocio Cardenas Sanchez, Susana Koo Chong, and 5 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9267857/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 9 You are reading this latest preprint version Abstract Background Arboviral diseases remain major public health problems in Colombia. Mobile applications such as WhatsApp are increasingly being used to support health interventions by improving user engagement and preventive practices. Given its widespread use in Colombia, this study aimed to evaluate WhatsApp as a tool to promote preventive practices and enhance community engagement in vector control activities, particularly the application of insecticidal coating (IC) in water tanks. Methods A quasi-experimental study with three groups (control, community visits only, and community visits plus WhatsApp) was conducted in two municipalities in Colombia. Around 300 households per group were recruited. Preventive practices and entomological indices were assessed before and after the intervention using household surveys and larval/pupal inspections. Within-group changes were analyzed using McNemar’s and Wilcoxon signed-rank tests, and intervention effects over time were estimated using difference-in-differences analysis. WhatsApp acceptability was also assessed using Likert-scale items. Results A total of 874 households were included in the final analysis. The community visits plus WhatsApp (CV + WA) group showed significant improvements in preventive practices after the intervention, such as proper management of small breeding sites (+ 15.9 percentage points, p < 0.001). Reductions in vector abundance were observed in both intervention groups, but they were greater in the group that integrated WhatsApp; the house index decreased by 22.8 percentage points in the CV + WA group vs 14.7 percentage points in the community visits-only group. At 4 months, entomological indices were significantly lower in both intervention groups than in the control group, and no larvae or pupae were found in treated tanks. Community engagement related to IC application was high in the CV + WA group, and WhatsApp was well-accepted by community users, with most mean scores above 4.8 out of 5. Conclusions The integration of WhatsApp into vector control operations was acceptable and more effective than community visits alone in improving preventive practices and reducing vector densities. WhatsApp may strengthen community engagement in prevention programmes in endemic urban settings. Dengue Zika Chikungunya Aedes mosquito digital Health WhatsApp disease prevention community engagement behaviour change coating Colombia Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Introduction Arboviral diseases transmitted mainly by Aedes mosquitoes are an increasing global health threat, with over 5.6 billion people at risk worldwide [ 1 ]. Among the most widespread diseases in urban settings are dengue, chikungunya, and Zika, which are transmitted mainly by the primary vector, Aedes aegypti [ 2 , 3 ]. They are characterized by recurrent outbreaks, and the potential to cause severe health complications [ 4 , 5 ] or chronic sequelae associated with chikungunya [ 6 , 7 ]. In Colombia, there is cocirculation of four dengue virus (DENV) serotypes and multiple lineages that have contributed to large outbreaks with higher fatality rates than the average reported in the Americas [ 8 ]. In 2019, more than 127,000 dengue cases were reported, exceeding the epidemic threshold in the country, with severe cases concentrated in the departments of Meta, Tolima, Huila, Santander, Cesar, Valle del Cauca, Sucre, Norte de Santander, Antioquia, and Casanare. [ 9 ]. The chikungunya epidemic of 2014–2015 accounted for more than 450,000 reported cases and affected 96% of municipalities nationwide [ 10 , 11 ]. Likewise, the Zika epidemic of 2015–2016 resulted in more than 90,000 suspected cases and numerous cases of congenital Zika syndrome, Guillain–Barré syndrome (GBS), and other neurological manifestations [ 12 ]. Norte de Santander is one of the states most affected by dengue, with high vector densities (e.g., the proportion of households with larvae and pupae exceeding 25%) in three municipalities: Cúcuta, Villa del Rosario, and Los Patios [ 13 ]. The coexistence of dengue, Zika, and chikungunya, together with factors such as a hot climate, increasing population density, sanitation inequalities, human behaviours related to domestic water storage, deficiencies in vector control policies, and poor household infrastructure, increases the complexity of prevention efforts. [ 15 – 19 ]. To combat these diseases, preventive strategies have relied on vertically managed programs based on chemical, biological, and environmental vector control [ 20 ], as well as vaccine development [ 21 ]. However, these approaches face important limitations, including low levels of community participation, increasing insecticide resistance [ 22 , 23 ], and the restricted effectiveness of the currently available vaccine [ 24 , 25 ]. These challenges highlight the need to shift toward more effective models that actively integrate communities into sustained source reduction efforts. To address these challenges, an innovative vector control tool, known as insecticidal coating (IC), was applied to laundry tanks in Norte de Santander, Colombia, to disrupt larval/pupal development and cause adult mosquito mortality [ 26 ]. This dual effect results from the combined action of two microencapsulated components, alphacypermethrin and pyriproxyfen, which allow their gradual release in water containers. A recent study conducted in Cúcuta, Colombia, showed its efficacy for up to 12 months in inhibiting the emergence of larvae and pupae [ 26 ]. However, its sustained effectiveness depends heavily on community engagement, since residents must empty the tanks and keep them dry for about one day to ensure proper adhesion of the product to the inner walls. In recent years, digital interventions using mobile phones have emerged as promising tools to strengthen community engagement in the prevention and control of dengue, chikungunya, and Zika [ 28 ]. Recent experiences in Asia show that mobile surveillance and communication platforms can mobilize communities and generate innovative local solutions for dengue prevention, even in resource-limited settings [ 28 , 29 ]. In the Americas, mobile platforms such as DengueChat and ZIKAMOB have shown encouraging results in reinforcing preventive behaviours through reminders, education, and digital support among students and community members [ 30 , 31 ]. More recently, a feasibility study in Colombia demonstrated that sending WhatsApp messages to women in urban communities increased acceptance and usability. In addition, it improved intentions to adopt to key preventive practices, such as weekly cleaning of water tanks [ 32 ]. Despite this increasing evidence, no structured digital intervention explicitly grounded in behaviour change principles and integrated with local vector control strategies, such as the IC, has yet been evaluated at community level. In a context where more than 90% of households own a smartphone and use WhatsApp daily [ 33 , 34 ], this application may represent a valuable opportunity to strengthen health behaviours and community engagement in the control of dengue and other arboviral diseases. Therefore, to address this gap, the present study evaluated the use of WhatsApp as a digital health promotion and behavioural reinforcement tool to encourage the application of a IC in laundry tanks, one of the main breeding sites of Aedes mosquitoes in Colombia [ 13 ], as an example of fostering community engagement in arboviral disease prevention. Methods Aim The purpose of this study was to evaluate a digital tool, WhatsApp, aimed at promoting preventive practices and enhancing community engagement in vector control activities, with a particular focus on the application of a vector control tool (IC) in water containers in two municipalities in Colombia. Setting of the Study The study was conducted in the Metropolitan Area of Cúcuta, in the department of Norte de Santander. This region is located in the valley of the same name, at the foot of the Eastern Cordillera of the Colombian Andes. The Metropolitan Area is composed of the municipalities of Villa del Rosario, Los Patios, El Zulia, San Cayetano, and Puerto Santander, and has temperatures ranging from 28 to 37 °C [35]. For this study, the municipalities of Los Patios and Villa del Rosario were selected because they have been historically affected by dengue, chikungunya, and Zika with high vector densities and documented resistance in Aedes mosquitoes [13,36]. According to DANE projections, by 2026 these two municipalities will have a combined population of 232,053 inhabitants. In 2025, the population of Villa del Rosario represented 7.3% of the total population of Norte de Santander, while Los Patios accounted for 6.1% [37]. Study design This study was an implementation study that used a quasi-experimental design with three groups: one control group, one community visits-only (CV only) intervention group, and one community visits plus WhatsApp (CV+WA) intervention group. Both intervention groups received the IC. The three groups were geographically separated to reduce the risk of contamination. The study measured changes in respondents’ preventive practices and changes in vector abundance at the household level through pre- and post-intervention surveys. In addition, community engagement was assessed through observations recorded by the field team, and acceptability was evaluated using additional questions in the post-intervention survey. Study participants With support from the regional Ministry of Health (MoH), highly endemic neighbourhoods were identified and mapped. These neighbourhoods had similar sociodemographic characteristics and comprised approximately 200 to 400 households each. They were grouped into three large study groups located in different corners of the study area in particular, the two intervention groups were separated, with one located in each municipality (Figure 1). A lottery method was used to assign the study groups. Each study group consisted of approximately four to five neighbourhoods. From each household, one adult member was recruited as a study participant. Participants were considered eligible if they owned a smartphone with WhatsApp installed and were able to receive and read messages. They also had to reside within the study group and have a laundry tank in their household. Sample size and sampling technique The study recruited 300 households per group using a sampling interval of 8 households, with one adult member selected from each household. This sample size was considered adequate to achieve a statistical power of 95% and to detect a difference of at least 15% in preventive practices between groups. The sample size was calculated using a proportions-based approach with OpenEpi software (version 3.01) [38]. Therefore, a total of 900 households were initially enrolled in the study. All selected households in the three study groups were visited for the pre-intervention survey. At the final evaluation, 28 households did not take part in the post-intervention survey; therefore, the final analysis included socio-demographic and entomological data from 874 households. A random subsample of approximately 60 households per group was visited by the field team to monitor the intervention after 4 months. This subsample was selected using Excel’s randomization function. In addition, users from the CV + WA group were surveyed at the end of the intervention to assess the acceptability of the WhatsApp messaging as a digital tool for arboviral disease prevention. Interventions components The interventions in this study included: (a) Health promotion through community visits (CV only), during which a field team distributed stickers and flyers about the IC and (b) community visits combined with WhatsApp reminders sent via smartphone (CV + WA). Health promotion through community visits was carried out by field teams composed of community volunteers and health workers from each study group. These teams received one week of training from the principal investigator (PI) on how to announce the intervention, provide instructions of the IC, and distribute the promotional materials needed to support application of the IC in tanks. The materials were designed according to the product application procedure and based on previous application tests conducted by the Freiburg research team [26]. In addition, loudspeakers were used as part of the promotional activities in both intervention groups. Three months after completion of the pre-intervention survey, the IC application began and lasted approximately three to four weeks in each group. On the day before painting the tank, health promotion activities were carried out in each household in both the CV only and CV + WA groups during regular home visits. WhatsApp reminder and delivery The WhatsApp reminder component consisted of health prevention and promotion messages based on arboviral disease prevention information developed by the Colombian campaigns [39] and on the technical specifications for the IC provided by the manufacturer (Inesfly Co., Spain). These messages had four main functions: (i) to educate participants about general and relevant concepts related to arboviral diseases; (ii) to promote and encourage participants to use the IC; (iii) to reinforce the application of the IC and other preventive practices; and (iv) to maintain regular communication with participants through general project-related information [32]. These messages were validated and tested by 45 community members in a previous study and by health experts through a workshop [32]. Additional messages were later included to provide specific information about application dates and further instructions regarding the product. The messages were short, with approximately 350 characters each. All messages were written in Spanish and were reviewed and approved by coordinators from MoH in Norte de Santander. Further details about the messages are provided in the previous research project [40]. Message delivery started six weeks after the pre-intervention survey, with approximately one message sent per week. However, on the day before IC application (painting of the tank), two reminder messages were sent on the same day, one in the morning and one in the afternoon, to reinforce preparation for the coating application. After the IC application in tanks, participants in the CV + WA group continued receiving preventive DZC messages, with a total of 30 messages delivered during the 35-week intervention period. Messages were usually sent on Tuesdays, Wednesdays, and Thursdays, according to the schedule of each neighbourhood, and were generally delivered in the morning by a facilitator trained by the PI [40]. The study participants did not incur any cost for receiving the messages, as WhatsApp is a free application that uses internet connectivity. Efforts were made to ensure that participants saved the project phone number so that they could receive the messages properly. Participants in the control group did not receive any intervention (neither IC nor WhatsApp). They only received the standard routine visits carried out by the vector control programme [40]. Research Instruments This study employed three different research instruments for quantitative data collection. This study employed three different research instruments for quantitative data collection. The pre- and post-intervention surveys consisted of a household questionnaire and a larval/pupal household survey. The household questionnaire was used and adapted from published studies in Colombia [13,32,41]. This questionnaire collected socio-demographic and health data, as well as household practices of participants. In addition, questions were added to assess the acceptability of messages, based on a previous study conducted in Nepal [42]. This household questionnaire is available in Supplementary File 1. The larval/pupal household survey was developed by the Special Programme for Research and Training in Tropical Diseases (TDR) of the WHO [43]. This standard survey was adapted to include specific breeding sites relevant to the study setting. This instrument is available in Supplementary File 2. Both instruments (household questionnaire and larval/pupal household survey) were used in pre-intervention, monitoring (after 4 months) and post-intervention period (after 9 months). Five university students trained by the research team conducted the household questionnaire, while, in parallel, five health workers carried out the entomological inspections and recorded the breeding sites in the larval/pupal household survey. The third research instrument was employed during the intervention (application of IC in tanks). The research team developed a field form to register households that accepted the application of the IC and followed the instructions (e.g. emptying and cleaning tank) in the CV only and CV+WA groups. This form is available in Supplementary File 3. All research instruments were pre-tested and modified based on feedback from members of the vector control program in each municipality to check flow, consistency, and validity. Statistical analysis This study used RStudio software (R Foundation, version 4.4.2) for data management and statistical analysis of quantitative data. Descriptive analyses were performed for the socio-demographic characteristics of participants. Categorical variables were summarized as frequencies and percentages with confidence intervals, whereas continuous variables were described using means and standard deviations (SD). Chi-square tests were used to compare baseline socio-demographic characteristics and other categorical variables (i.e. house painting, willingness to paint again, and tank emptying) between study groups. For preventive practices, proportions were calculated before and after the intervention in each study group. McNemar’s test was used to assess within-group changes in paired categorical responses. In addition, difference-in-differences (DiD) analyses using linear probability models were conducted to estimate the effect of the intervention over time at the household level. Comparisons of binary practice variables across the three groups were performed using chi-square tests. Multivariable logistic regression models were further conducted to identify factors associated with preventive practices after the intervention, adjusting for potential confounders such as sex, age, and education. Entomological indices (the House Index:HI, Container Index:CI, Breteau Index:BI, and Pupae per Person Index: PPI) were analysed by cluster to assess changes in vector abundance at pre-intervention and post-intervention period. These indices were calculated following the WHO standard operating procedures [43] and the pupal count methodology described by Romero-Vivas [44]. Normality of the pre–post changes was assessed using the Shapiro–Wilk test. As the changes in CI, BI, and PPI were not normally distributed in any of the three groups (all p < 0.001), within-group comparisons were performed using the Wilcoxon signed-rank test. For HI, which was analysed as a paired binary outcome, McNemar’s test was employed. Differences across groups were further analysed using difference-in-differences analysis. Comparisons between groups were performed using chi-square tests for HI and CI, and Poisson-based methods for BI and PPI. Acceptability of the WhatsApp intervention was assessed using 5-point Likert scale items based on a previous study [42]. Each item (perceived usefulness, enjoyment, and satisfaction) was rated on a scale from 1 = strongly disagree to 5 = strongly agree. Mean scores and standard deviations were calculated for each acceptability item, and average agreement scores were used to summarize participants’ perceptions of the intervention. Higher scores (more than 3) indicate agreement or positive acceptability. All p -values were considered statistically significant at p < 0.05. Results Sociodemographic characteristic of residents Sociodemographic information on residents was obtained from an adult respondent in each household. Most respondents were women (71.17%; 95% CI: 68.1%–74.1%). The mean household size was 4 residents (SD = 1.7). The field team collected information on 3,252 residents in this study (Table 1). Most residents were female (53.7%; 95% CI: 51.9%–55.4%) and were mainly aged 35–64 years (36.5%; 95% CI: 34.9%–38.2%). More than half had or reached secondary or higher education (57.3%; (95% CI: 55.5%–59.1%) and reported remaining within their neighbourhood during the day (67.8%; 95% CI: 66.2%–69.4%). Table 1 Social demographic characteristics of residents Characteristics of residents Total n (%) Control n (%) CV only n (%) CV + WA n (%) p -value Total residents 3,252 (100) 1,062 (100) 1,051 (100) 1,139 (100) Sex Female 1,745 (53.7) 564 (53.1) 576 (54.8) 605 (53.1) 0.664 Male 1,507 (46.3) 498 (46.9) 475 (45.2) 534 (46.9) Age group in years < 1 32 (1.0) 14 (1.3) 5 (0.5) 13 (1.1) 0.053 1-4 146 (4.5) 58 (5.5) 44 (4.2) 44 (3.9) 5-9 251 (7.7) 93 (8.8) 65 (6.2) 93 (8.2) 10-19 484 (14.9) 146 (13.7) 150 (14.3) 188 (16.5) 20-34 719 (22.1) 238 (22.4) 232 (22.1) 249 (21.9) 35-64 1,187 (36.5) 376 (35.4) 396 (37.7) 415 (36.4) > 64 433 (13.3) 137 (12.9) 159 (15.1) 137 (12.0) Education level No formal education 124 (4.1) 36 (3.7) 45 (4.5) 43 (4.0) 0.002 Primary 1,171 (38.6) 416 (43.0) 340 (34.0) 415 (38.9) Secondary above 1,738 (57.3) 515 (53.3) 614 (61.5) 609 (57.1) Mobility status Within-neighborhood* 2,202 (67.8) 707 (6.9) 726 (69.1) 769 (67.5) 0.519 Outside-neighborhood** 1,044 (32.2) 350 (33.1) 324 (30.9) 370 (32.5) *Within-cluster mobility = residents who stayed mostly within their neighborhood during the day **Outside-cluster mobility = residents who spent most of the day outside their neighborhood during the day Monitoring after IC application Four months after the application of IC in tanks, the field team visited a total of 174 households and collected information from 756 residents in the three groups (Table 2). Vector control workers inspected a total of 596 water containers (CV+WA=188; CV only=166; control group=240). Entomological indices were significantly lower in the intervention groups, with the CV + WA group showing the lowest values (e.g. HI = 8.9%; p =0.0005), while the control group consistently presented the highest indices (e.g. HI = 33.3%). No larvae or pupae were observed in treated tanks in either intervention group. Additionally, most users (76.8%) perceived WhatsApp as a useful digital tool for delivering health promotion information related to arboviral disease prevention (mean score: 4.7/5), and no technical problems were reported. Table 2 Entomological indices in the three groups after 4 months of IC painting Variable Total Control CV only CV + WA p -value Households inspected 174 60 58 56 - Residents involved 756 288 217 251 - HI [CI 95%] 17.8% [12.4%-24.3%] 33.3% [21.7%-46.7%] 10.3% [3.9%-21.2%] 8.9% [2.9%-19.6%] 0.0005* CI [CI 95%] 8.3% [6.2%-10.8%] 14.2% [10.0%-19.2%] 6.0% [2.9%-10.8%] 2.7% [0.9%-6.1%] <0.001* BI a [CI 95%] 28.2 [21.6-35.5] 56.7 [43.2-69.4] 17.2 [8.59-29.4] 8.9 [3-19.6] <0.001** PPI a [CI 95%] 0.19 [0.16-0.22] 0.44 [0.38-0.50] 0.05 [0.02-0.09] 0.03 [0.01-0.06] <0.001** * HI and CI were compared across groups using chi-square tests. ** BI and PPI were compared as rate-based indices using Poisson-based comparisons of aggregated counts. Effects of intervention on key preventive practices Pre- and post-intervention proportions of key preventive practices are presented in Table 3. Initially, there were no statistically significant differences in pre-intervention practices between the study groups. After the intervention, the highest increases in key preventive practices were observed only in the CV + WA group, with significant percentage-point increases of 19.4 in cleaning of laundry tanks, 15.5 in the proper management of small breeding sites, and 9.3 in the covering of large breeding sites ( p = < 0.001). No change was observed in the use of chlorine in tanks in the three groups (Figure 2). Table 3 Preventative practices before and after intervention in the three study groups Practice Estimations Control CV only CV+WA Cleaning of laundry tanks Preintervention % [95% CI] 65.9% [60.4%, 71.3%] 66.8% [61.4%, 72.2%] 61.9% [56.3%, 67.5%] Postintervention % [95% CI] 67.6% [62.2%, 72.9%] 74.3% [69.3%, 79.3%] 81.3% [76.8%, 85.8%] Percentage-point change 1.7 7.5 19.4 p -value* 0.733 0.066 < 0.001 Proper management of small breeding sites Preintervention % [95% CI] 25.6% [20.6%, 30.6%] 29.8% [24.5%, 35%] 23.9% [19%, 28.8%] Postintervention % [95% CI] 26.3% [21.2%, 31.3%] 27.7% [22.6%, 32.9%] 39.4% [33.8%,45.1%] Percentage-point change 0.7 -2.1 15.9 p -value* 0.752 0.114 < 0.001 Covering of large breeding sites Preintervention % [95% CI] 32.4% [27.1%, 37.8%] 27.7% [22.6%, 32.9%] 34.3% [28.8%, 39.7%] Postintervention % [95% CI] 33.4% [28%, 38.8%] 27.4% [22.3%, 32.5%] 43.6% [36.9%, 48.3%] Percentage-point change 1.0 -0.3 < 0.001 p -value* 0.863 1 0.016 Use of chlorine in tanks Preintervention % [95% CI] 34.6% [29.1%-40.1%] 36.6% [31.1%-42.2%] 34.8% [29.4%-40.3%] Postintervention % [95% CI] 31.8% [26.5%-37.2%] 36.3% 30.8%-41.8%] 35.8% [30.3%-41.3%] Percentage-point change -2.8 -0.3 1.0 p -value* 0.523 1 0.863 * p -values for within-group pre–post comparisons were obtained using McNemar’s test. Difference-in-differences analysis showed that improvements in the CV + WA group were greater than those observed in the CV-only group and the control group combined for all practices, except chlorine use [Supplementary File 4]. In addition, multivariable logistic regression showed that the CV + WA group had higher odds of adopting key preventive practices than the control group, while chlorine tablet use was not associated with the intervention and was more related to sociodemographic factors [Supplementary File 5]. Effects of intervention on vector abundance Pre- and post-intervention entomological proportions are presented in Table 4. Before the intervention, high proportion of vector abundance was found in the three groups. After the intervention, the highest reductions in entomological indices were observed in the CV + WA group, followed by the CV-only group. HI decreased by 22.8 percentage points in the CV + WA group and by 14.7 percentage points in the CV-only group, while it increased by 3.8 percentage points in the control group. Similar reductions were observed for other indices in the intervention groups (Figure 3). No improvement was seen in the control group. Difference-in-differences analysis showed that reductions in HI, CI, and BI were greater in the CV + WA group than in the CV-only and control groups combined [Supplementary File 4]. Table 4 Entomological indicators before and after intervention in the three study groups Indicator Estimates Control CV only CV + WAM House index Preintervention % [95% CI] 29.4% [24.2, 34.9] 27.1% [22.0, 32.5] 31.5% [26.2,37.2] Postintervention % [95% CI] 33.1% [27.7, 38.8] 12.3% [8.8, 16.7] 8.7% [5.7, 12.5] Percentage-point change 3.8 -14.7 -22.8 p -value * 0.371 <0.001 <0.001 Container index Preintervention % [95% CI] 12.8% [10.2, 15.4] 11.2% [8.8, 13.5] 11.8% [9.6,14.0] Postintervention % [95% CI] 12.8% [10.2, 15.3] 5.9% [3.8, 8.0] 3.8% [2.2, 5.4] Percentage-point change -0.1 -5.2 -8.0 p -value * 0.911 0.001 <0.001 Breteau index Preintervention % [95% CI] 0.35 [0.28, 0.42] 0.28 [0.23, 0.34] 0.37 [0.30, 0.44] Postintervention % [95% CI] 0.42 [0.34, 0.50] 0.15 [0.10, 0.21] 0.11 [0.06, 0.16] Percentage-point change 0.07 -0.13 -0.26 p -value * 0.176 <0.001 <0.001 Pupae per person index Preintervention % [95% CI] 1.026 [0.636, 1.415] 0.817 [0.476, 1.157] 0.657 [0.331, 0.984] Postintervention % [95% CI] 0.642 [0.310, 0.975] 0.113 [0.040, 0.186] 0.141 [-0.010, 0.293] Percentage-point change -0.384 -0.704 -0.516 p -value * 0.115 <0.001 <0.001 * p -values for Control group, CV only group, and CV + WA group were analysed using McNemar's test for HI and Wilcoxon signed-rank tests for CI, BI, and PPI. Community engagement Community engagement in vector control activities was particularly evident during the IC application. During household visits in both groups, the field team observed and recorded households that followed the instructions, particularly emptying and cleaning the tanks and allowing the IC to be applied. Willingness to reapply the product was also assessed. All three indicators were higher in the CV + WA group than in the CV-only group (Figure 4). Perception of WhatsApp High ratings were observed for most items of WhatsApp acceptability, particularly perceived usefulness (4.87), family prevention support (4.80), perceived enjoyment (4.85), and user satisfaction (4.82) (Figure 5). Responses to these items were predominantly positive, with most participants selecting “totally agree” or “agree.” In contrast, the item related to perceived annoyance received a very low mean score (1.10), indicating that participants generally did not find the messages annoying. Discussion This implementation study evaluated the use of WhatsApp as a digital tool to promote key practices for arboviral disease prevention and community engagement in vector control activities in urban endemic communities in Colombia. The CV + WA intervention group showed the greatest improvements in key preventive practices. Larval and pupal indices decreased in both intervention groups compared with the control group, but the reduction was significantly greater in the group that integrated WhatsApp (CV + WA group). Strong community engagement was reflected in the high proportion of households that participated in IC application and followed the instructions delivered through WhatsApp and community visits. In addition, community users gave positive ratings to the WhatsApp messages, suggesting that this app was well accepted in urban communities in Colombia. Digital technologies have been increasingly used to support health promotion, including in low-resource settings [ 45 ]. For arboviral disease prevention, SMS-based interventions have shown potential to improve household practices and, in some settings, reduce Aedes indices in Nepal and Peru [ 42 , 46 ]. However, unidirectional SMS-only interventions may limit interactivity, which can make sustained engagement more challenging, particularly in remote settings [ 47 ]. As smartphone access has expanded, researchers have developed new digital systems consisting of web-based platforms and mobile apps for dengue prevention and control (e.g., VECTOS, VazaDengue, MEWAR) [ 48 – 50 ]. In this study, rather than developing a new application, we leveraged a familiar and widely used platform. WhatsApp, Facebook Messenger, and WeChat enable rapid two-way communication and multimedia sharing, which can strengthen message reinforcement and user engagement [ 51 ]. Given the need to reach many households and engage the community in the vector control operations, WhatsApp was chosen as a two-way communication tool in areas where smartphones and WhatsApp were widely used. This approach aligns with evidence suggesting that adapting mHealth interventions to local technological preferences and capacities are essential for sustainability [ 27 ]. In this study, WhatsApp was not implemented as an isolated tool; rather, it was combined within other communication components such as the use of loudspeakers and community visits during the IC application period. This approach aligns with the WHO Communication for Behavioural Impact framework, which emphasizes the combination of interpersonal communication and community mobilization, often supported by mass media, to facilitate the adoption and maintenance of preventive behaviors [ 52 ]. A recent systematic review highlighted that this approach could improve knowledge, attitudes, and practices and thus reductions in mosquito breeding sites and subsequently of dengue incidence [ 53 ]. In this study, households exposed to multiple communication components, including WhatsApp, experienced greater improvements in preventive practices and larger reductions in vector densities compared to those with little exposure. Although these effects cannot be fully attributed to WhatsApp alone, its integration into vector control programs may well support dengue, chikungunya, and Zika prevention. Community engagement was another positive outcome observed in this study, particularly regarding the application of IC among households exposed to WhatsApp messaging. Previous research has shown that engagement in mHealth interventions can be strengthened through the use of reminders, personalized messages, timely feedback, opportunities for peer support within the app, and incentives or other forms of compensation. [ 54 , 55 ]. In our study, several of these features were incorporated into the WhatsApp group intervention. Although no monetary incentives were provided to the community, the provision of IC at no cost may have been perceived as a non-financial benefit. As IC was provided in both intervention groups (CV + WA and CV only), the higher engagement observed in the CV + WA group may be partly attributed by the additional elements incorporated into the WhatsApp intervention. Technical issues are among the most commonly reported barriers in digital health interventions. Problems related to infrastructure, geographical access, low or unstable internet connectivity, and incompatibility between apps and devices have been identified as barriers to the sustained use of app-based interventions [ 56 – 58 ], and these challenges are often greater in low- and middle-income countries [ 59 ]. Although some of these barriers cannot be fully eliminated, they may be mitigated when using WhatsApp compared with other health applications, as users are already familiar with its ease of use [ 59 ]. In addition, mobile operators may offer low-cost bundles or zero-rated access for specific applications. For example, in Colombia, many operators include zero-rated access to WhatsApp and Facebook in their postpaid and prepaid mobile plans [ 60 ], which may facilitate continued participation and reduce cost-related barriers. Technical issues are among the most commonly reported barriers in digital health interventions. Challenges related to infrastructure, network access, low or unstable internet connectivity, and incompatibility between apps and devices have been identified as barriers to the sustained use of app-based interventions [ 56 – 58 ], particularly in low- and middle-income countries [ 59 ]. Although some of these barriers cannot be fully eliminated, they may be mitigated in settings where WhatsApp is widely used and where mobile operators offer low-cost bundles or zero-rated access for specific applications. In Colombia, for example, many operators include zero-rated access to WhatsApp and Facebook in their postpaid and prepaid mobile plans [ 60 ], which may support continued use and lower cost-related barriers. Data protection is another critical issue in digital interventions, particularly given the variation in ethical standards and regulatory frameworks across countries [ 61 , 62 ]. Although WhatsApp is a familiar app to many users, its use in health-related programs raises challenges related to privacy, informed consent, and record keeping [ 63 ]. WhatsApp may not fully meet the requirements expected under health data protection frameworks [ 64 ]. Legal requirements for data storage and protection are complex and depend on the legislation of each country [ 63 ]. For the implementation of WhatsApp, this study followed the national data protection law, which regulates the processing of personal data and requires informed consent and appropriate security safeguards [ 65 ]. However, future work should be accompanied by clear protocols and guidelines for data management and protection. Despite these challenges, this study provides pioneering evidence that the use of WhatsApp can strengthen community engagement and support the uptake of household-level vector control interventions in endemic urban settings. The findings suggest that integrating WhatsApp into routine vector control activities may improve preventive practices, support vector control operations, and enhance community engagement. This study, together with another recent study, supports the idea that WhatsApp is a feasible tool for arboviral disease prevention [ 27 ]. However, important questions remain regarding its scalability and sustainability within routine public health programmes. Therefore, future research should include economic and operational analyses to assess the long-term sustainability and scalability of adding WhatsApp to vector control programmes for arboviral disease prevention. Limitations Although this study adds valuable evidence on the use of WhatsApp as a digital tool for dengue, chikungunya, and Zika prevention, some contextual and methodological considerations should be taken into account when interpreting the findings. First, the intervention was mainly designed to promote household preventive behaviours, with a strong emphasis on the promotion of the IC in tanks. Therefore, generalizability to other prevention practices may be limited, particularly for behaviours that are promoted in isolation or require different enabling conditions. Second, this was an implementation-oriented, exploratory study using a quasi-experimental design. A randomized controlled trial was not feasible given the community-based and behavioural nature of the intervention and operational constraints. The findings should be interpreted within the context of a pragmatic evaluation conducted under real-world program conditions. Third, preventive practices were evaluated using self-reported data and may be subject to recall and social desirability bias. However, the inclusion of entomological indicators and direct observation related to IC intervention provided objective measures that strengthen community involvement beyond self-report alone. Finally, the intervention was conducted in urban communities in Colombia with high smartphone penetration and a generally favourable attitude toward receiving preventive messages. Transferability to settings with lower digital access, different communication preferences, or weaker connectivity may therefore be limited and should be assessed in future studies. Conclusions The integration of WhatsApp into arboviral disease prevention activities demonstrated the potential of digital tools to strengthen community engagement in health programmes. Improvements in preventive practices and reductions in vector abundance were observed when WhatsApp was combined with community visits. These findings suggest that adding WhatsApp messaging to vector control programmes may support preventive actions, particularly those requiring household preparation and active participation. WhatsApp was also found to be an acceptable tool within communities; however, further research is needed to assess implementation processes and the scalability of the intervention. List of Abbreviations BI Breteau index CI Container index CV Community visits DiD Difference-in-Differences HI House index IC Insecticidal coating Minciencias Ministry of Science, Technology and Innovation MoH Ministry of Health PPI Pupae per person index WA WhatsApp Declarations Ethics approval and consent to participate Participation in this study was voluntary and anonymous, and it posed no risk to the participants or their households. Written informed consent was obtained from all participants prior to data collection. No financial or other compensation was provided for participation. Registration in WhatsApp was completed using codes, and no names were entered into the mobile application. Individuals under 18 years of age were excluded from the study. Original documents were stored securely in a locked place and were not accessible to unauthorized individuals. All procedures involving human participants were performed in accordance with relevant guidelines and regulations, including the Declaration of Helsinki and its later amendments. The study protocol was approved by the Ethics Committee of the University of Freiburg (protocol study number: 142/19), and the intervention was also authorized by the local health authorities in Colombia. Registration of the trial, ClinicalTrials.gov ID: NCT07517731. Consent for publication Not applicable. Availability of data and materials The datasets generated and/or analysed during the current study are available in the bwSync&Share repository, https://bwsyncandshare.kit.edu/s/G8Fi63cZLoRESL8. Competing interests The authors declare no competing interests. Funding Open Access funding enabled and organized by Projekt DEAL. MAC and RCS were awarded doctoral scholarships by the Ministry of Science, Technology and Innovation (Minciencias) and the Government of Norte de Santander, Colombia (Call No. 753). TRR was also awarded a national doctoral scholarship by Minciencias. Neither Minciencias nor the Government of Norte de Santander had any active role in the study design, data collection, data analysis, interpretation of the findings, or preparation of the manuscript. Authors' contributions All authors contributed to the concept and design of the study. MAC and AK drafted the paper. WVK, JL, and AK provided substantial edits on the paper. MAC prepared the submission to the ethical committee. All authors read and approved the study and the procedures. MAC, RCS, SKC, and TRR prepared and conducted interviewer training. MAC, RCS, SKC, TRR, and JY prepared the field study, contacted the local leaders and organized the logistics. MAC coordinated and managed the WhatsApp messages. MAC contributed to the statistical analysis. MAC, WVK, JL, SKC, and AK formatted, revised and corrected the article until its final version. All authors read and commented on the draft paper and approved the final version. Acknowledgements The authors thank the study participants, the local associations, IDS Norte de Santander, and the vector control teams in both municipalities for their support. We also acknowledge the members of the Centre for Planetary Health at the University of Freiburg for their encouragement, Juan Camilo Ardila for his support with WhatsApp message management, and Adrian Ostre, Diego Fernando Carrillo, Gloria Liliana Mendoza, and Camila Andrea Barbosa for their valuable contributions. MAC, TRR, and RCS also acknowledge Minciencias, while MAC and RCS particularly thank the Government of Norte de Santander, Colombia, for supporting their doctoral studies. References WHO guidelines for clinical management of arboviral diseases: dengue, chikungunya, Zika and yellow fever [Internet]. Geneva: World Health Organization. 2025 [cited 2025 Apr 01]. Available from: https://www.who.int/publications/i/item/9789240111110 Leta S, Beyene TJ, De Clercq EM, Amenu K, Kraemer MUG, Revie CW. Global risk mapping for major diseases transmitted by Aedes aegypti and Aedes albopictus. Int J Infect Dis. 2018;67:25–35. Kraemer MU, Sinka ME, Duda KA, Mylne AQ, Shearer FM, Barker CM, et al. The global distribution of the arbovirus vectors Aedes aegypti and Ae. albopictus. Elife. 2015;4:e08347. 10.7554/eLife.08347 . Ventura CV, Ventura LO. Ophthalmologic manifestations associated with Zika virus infection. Pediatrics. 2018;141(Suppl 2):S161–6. 10.1542/peds.2017-2038E . Faiçal AV, de Oliveira JC, Oliveira JVV, Almeida BL, Agra IA, Alcantara LCJ, et al. Neurodevelopmental delay in normocephalic children with in utero exposure to Zika virus. BMJ Paediatr Open. 2019;3(1):e000486. 10.1136/bmjpo-2019-000486 . Jing Q, Wang M. Dengue epidemiology. Glob Health J. 2019;3(2):37–45. 10.1016/j.glohj.2019.06.002 . Weaver SC, Lecuit M. Chikungunya virus and the global spread of a mosquito-borne disease. N Engl J Med. 2015;372(13):1231–9. 10.1056/NEJMra1406035 . Gutierrez-Barbosa H, Medina-Moreno S, Zapata JC, Chua JV. Dengue Infections in Colombia: Epidemiological Trends of a Hyperendemic Country. Trop Med Infect Dis. 2020;5(4):156. 10.3390/tropicalmed5040156 . Instituto Nacional de Salud. Boletín Epidemiológico Semanal. Semana 52 de 2019 [Internet]. Bogotá: INS. 2019 [cited 2026 Apr 03]. Available from: https://www.ins.gov.co/buscador-eventos/BoletinEpidemiologico/2019_Boletin_epidemiologico_semana_52.pdf Instituto Nacional de Salud. Informe final del evento chikunguña, Colombia, 2014 [Internet]. Bogotá: INS. 2014 [cited 2025 Feb 21]. Available from: https://www.ins.gov.co/buscador-eventos/Informesdeevento/Chikunguña%202014.pdf Instituto Nacional de Salud. Informe final del evento chikunguña, Colombia, 2015 [Internet]. Bogotá: INS. 2015 [cited 2026 Apr 03]. Available from: https://www.ins.gov.co/buscador-eventos/Informesdeevento/Chikunguña%202015.pdf Organización Panamericana de la Salud. Zika: actualización epidemiológica [Internet]. Washington (DC): Organización Panamericana de la Salud; 2016 Jun 16 [cited 2026 Apr 03]. Available from: https://iris.paho.org/server/api/core/bitstreams/71f0882a-be4e-4765-b0f7-074f14eb1199/content Carrillo MA, Cárdenas R, Yañez J, Petzold M, Kroeger A. Risk of dengue, Zika, and chikungunya transmission in the metropolitan area of Cúcuta, Colombia: cross-sectional analysis, baseline for a cluster-randomised controlled trial of a novel vector tool for water containers. BMC Public Health. 2023;23(1):1000. 10.1186/s12889-023-15893-4 . Young PR. Arboviruses: a family on the move. Adv Exp Med Biol. 2018;1062:1–10. Kraemer MUG, Reiner RC Jr, Brady OJ, Messina JP, Gilbert M, Pigott DM, et al. Publisher correction: Past and future spread of the arbovirus vectors Aedes aegypti and Aedes albopictus. Nat Microbiol. 2019;4(5):901. 10.1038/s41564-019-0440-7 . Mayer SV, Tesh RB, Vasilakis N. The emergence of arthropod-borne viral diseases: a global prospective on dengue, chikungunya and Zika fevers. Acta Trop. 2017;166:155–63. 10.1016/j.actatropica.2016.11.020 . Liang G, Gao X, Gould EA. Factors responsible for the emergence of arboviruses; strategies, challenges and limitations for their control. Emerg Microbes Infect. 2015;4(3):e18. 10.1038/emi.2015.18 . Lindahl JF, Grace D. The consequences of human actions on risks for infectious diseases: a review. Infect Ecol Epidemiol. 2015;5:30048. 10.3402/iee.v5.30048 . Villar LA, Rojas DP, Besada-Lombana S, Sarti E. Epidemiological trends of dengue disease in Colombia (2000–2011): a systematic review. PLoS Negl Trop Dis. 2015;9(3):e0003499. 10.1371/journal.pntd.0003499 . Kamtchum-Tatuene J, Makepeace BL, Benjamin L, Baylis M, Solomon T. The potential role of Wolbachia in controlling the transmission of emerging human arboviral infections. Curr Opin Infect Dis. 2017;30(1):108–16. 10.1097/QCO.0000000000000342 . Capeding MR, Tran NH, Hadinegoro SR, Ismail HI, Chotpitayasunondh T, Chua MN, Luong CQ, Rusmil K, Wirawan DN, Nallusamy R, Pitisuttithum P, Thisyakorn U, Yoon IK, van der Vliet D, Langevin E, Laot T, Hutagalung Y, Frago C, Boaz M, Wartel TA, Tornieporth NG, Saville M, Bouckenooghe A, CYD14 Study Group. Clinical efficacy and safety of a novel tetravalent dengue vaccine in healthy children in Asia: a phase 3, randomised, observer-masked, placebo-controlled trial. Lancet. 2014;384(9951):1358–65. 10.1016/S0140-6736(14)61060-6 . World Health Organization. Monitoring and managing insecticide resistance in Aedes mosquito populations: interim guidance for entomologists [Internet]. Geneva: World Health Organization. 2016 [cited 2026 Apr 03]. 13 p. Available from: https://www.who.int/publications-detail/monitoring-and-managing-insecticide-resistance-in-aedes-mosquito-populations Scientific Working Group on Dengue; UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases. Report of the Scientific Working Group meeting on Dengue, Geneva, 1–5 October 2006 [Internet]. Geneva: World Health Organization. 2007 [cited 2026 Apr 01]. Available from: https://iris.who.int/handle/10665/69787 Halstead SB. Dengvaxia sensitizes seronegatives to vaccine enhanced disease regardless of age. Vaccine. 2017;35(47):6355–6358. 10.1016/j.vaccine.2017.09.089 . Epub 2017 Oct 10. https://doi.org/10.1016/j.vaccine.2017.09.089. Ferguson NM, Rodríguez-Barraquer I, Dorigatti I, Mier-Y-Teran-Romero L, Laydon DJ, Cummings DA. Benefits and risks of the Sanofi-Pasteur dengue vaccine: Modeling optimal deployment. Science. 2016;353(6303):1033–6. 10.1126/science.aaf9590 . Cárdenas R, Cabrera OL, Carrillo MA, Pineda A, Ahumada ML, Yañez Y, Ismail H, Paine M, Rivera T, Kroeger A. Aedes aegypti control in breeding sites through an insecticidal coating with dual effect: Laboratory trials and safety assessment. Med Vet Entomol. 2025;39(2):252–65. Epub 2024 Nov 14. PMID: 39543943; PMCID: PMC12054347. Carrillo MA, Kroeger A, Cardenas Sanchez R, Diaz Monsalve S, Runge-Ranzinger S. The use of mobile phones for the prevention and control of arboviral diseases: a scoping review. BMC Public Health. 2021;21(1):110. 10.1186/s12889-020-10126-4 . Sri-Pathmanathan C, Bao H, Diluka PAE, Mee A, Andari B, Saunders E, Wijegunawardana A, Weerasinghe I, Hetti NP, Samaraweera S, Tang W, Tucker JD. Enhancing Community Participation in Dengue Control Through Digital Crowdsourcing: An Analysis of a World Mosquito Program Digital Open Call in Sri Lanka. J Infect Dis. 2023;228(11):1482–90. 10.1093/infdis/jiad439 . Lwin MO, Sheldenkar A, Panchapakesan C, Ng JS, Lau J, Jayasundar K, Horathalge K, Rathnayake VS, Crawley AW, Wimalaratne P. Epihack Sri Lanka: development of a mobile surveillance tool for dengue fever. BMC Med Inf Decis Mak. 2019;19(1):111. 10.1186/s12911-019-0829-5 . Holston J, Suazo-Laguna H, Harris E, Coloma J. DengueChat: a social and software platform for community-based arbovirus vector control. Am J Trop Med Hyg. 2021;105(6):1521–35. 10.4269/ajtmh.20-0808 . Abel Mangueira FF, Smania-Marques R, Dutra Fernandes I, Alves Albino V, Olinda R, Acácia Santos-Silva T, Traxler J, Matheson D, Santos S. The prevention of arboviral diseases using mobile devices: a preliminary study of the attitudes and behaviour change produced by educational interventions. Trop Med Int Health. 2019;24(12):1411–26. 10.1111/tmi.13316 . Carrillo MA, Gessler AM, Rivera Ramirez T, Cárdenas Sanchez R, Lindenmeier J, Kern WV, Kroeger A. WhatsApp-based intervention in urban Colombia to support the prevention of arboviral diseases: a feasibility study. Pathog Glob Health. 2024;118(4):334–47. 10.1080/20477724.2024.2358263 . Departamento Administrativo Nacional de Estadística (DANE). Boletín técnico: indicadores básicos de TIC en hogares [Internet]. Bogotá: DANE. 2019 [cited 2026 Apr 3]. Available from: https://www.dane.gov.co/files/investigaciones/boletines/tic/bol_tic_hogares_2019.pdf Statista. Most popular social networks based on share of users in Colombia in 2018 [Internet]. 2024 [cited 2026 Apr 1]. Available from: https://www.statista.com/statistics/754482/colombia-penetration-social-networks/ Área Metropolitana de Cúcuta. Cúcuta [Internet]. Institucional, normativa, Cúcuta. 2021 Dec 28 [cited 2026 Apr 4]. Available from: https://amc.gov.co/amc/cucuta/ Grisales N, Poupardin R, Gomez S, Fonseca-Gonzalez I, Ranson H, Lenhart A. Temephos resistance in Aedes aegypti in Colombia compromises dengue vector control. PLoS Negl Trop Dis. 2013;7:e2438. Departamento Administrativo Nacional de Estadística (DANE). Proyecciones de población [Internet]. Bogotá: DANE; [cited 2026 Apr 4]. Available from: https://www.dane.gov.co/index.php/estadisticas-por-tema/demografia-y-poblacion/proyecciones-de-poblacion Sullivan KM, Dean AG, Soe MM, OpenEpi. Open Source Epidemiologic Statistics for Public Health [Internet]. Version 3.01. Atlanta (GA): Emory University; 2013 [cited 2026 Apr 3]. Available from: https://www.openepi.com Ministerio de Salud y Protección Social. Cortalé las alas al dengue [Internet]. Bogotá: Ministerio de Salud y Protección Social; 2019 [cited 2026 Apr 1]. Available from: https://www.minsalud.gov.co/Paginas/Hay-que-cortarle-las-alas-al-dengue-ministro-Juan-Pablo-Uribe.aspx Carrillo-Diaz MA. Use of technology for social mobilization to improve the prevention and control of Aedes borne diseases (Dengue, Zika and Chikungunya) in Colombia [doctoral thesis]. Freiburg im Breisgau: Albert-Ludwigs-Universität Freiburg; 2026. 10.6094/UNIFR/277113 Higuera-Mendieta DR, Cortés-Corrales S, Quintero J, González-Uribe C. KAP surveys and dengue control in Colombia: disentangling the effect of sociodemographic factors using multiple correspondence analysis. PLoS Negl Trop Dis. 2016;10(9):e0005016. 10.1371/journal.pntd.0005016 . Bhattarai AH, Sanjaya GY, Khadka A, Kumar R, Ahmad RA. The addition of mobile SMS effectively improves dengue prevention practices in community: an implementation study in Nepal. BMC Health Serv Res. 2019;19(1):699. 10.1186/s12913-019-4541-z . Special Programme for Research and Training in Tropical Diseases, World Health Organization. Operational guide for assessing the productivity of Aedes aegypti breeding sites [Internet]. Geneva: World Health Organization. 2011 [cited 2026 Apr 3]. Available from: https://tdr.who.int/publications/m/item/2011-10-31-operational-guide-for-assessing-the-productivity-of-aedes-aegypti-breeding-sites Romero-Vivas CM, Llinás H, Falconar AK. Three calibration factors, applied to a rapid sweeping method, can accurately estimate Aedes aegypti (Diptera: Culicidae) pupal numbers in large water-storage containers at all temperatures at which dengue virus transmission occurs. J Med Entomol. 2007;44(6):930–7. 10.1603/0022-2585(2007)44[930:tcfata]2.0.co;2 . Kruse C, Betancourt J, Ortiz S, Valdes Luna SM, Bamrah IK, Segovia N. Barriers to the use of mobile health in improving health outcomes in developing countries: systematic review. J Med Internet Res. 2019;21(10):e13263. 10.2196/13263 . Dammert AC, Galdo JC, Galdo V. Preventing dengue through mobile phones: evidence from a field experiment in Peru. J Health Econ. 2014;35:147–61. 10.1016/j.jhealeco.2014.02.002 . Emeran A, Burrows R, Loyson J, Behardien MR, Wiemers L, Lambert E. The Effect of Text Message-Based mHealth Interventions on Physical Activity and Weight Loss: A Systematic Review and Meta-Analysis. Am J Lifestyle Med 2024 Aug 15:15598276241268324. doi: 10.1177/15598276241268324. Epub ahead of print. PMID: 39554952; PMCID: PMC11562155. Ocampo CB, Mina NJ, Echavarria MI, Acuña M, Caballero A, Navarro A, Aguirre A, Criollo IS, Forero F, Azuero O, Alexander ND. VECTOS: an integrated system for monitoring risk factors associated with urban Arbovirus transmission. Glob Health Sci Pract. 2019;7(1):128–37. 10.9745/GHSP-D-18-00300 . Sousa L, de Mello R, Cedrim D, Garcia A, Missier P, Uchôa A, Oliveira A, Romanovsky A. VazaDengue: An information system for preventing and combating mosquito-borne diseases with social networks. Inform Syst. 2018;75:26–42. 10.1016/j.is.2018.02.003 . Aldosery A, Musah A, Birjovanu G, Moreno G, Boscor A, Dutra L, Santos G, Nunes V, Oliveira R, Ambrizzi T, Massoni T, Dos Santos WP, Kostkova P. MEWAR: Development of a Cross-Platform Mobile Application and Web Dashboard System for Real-Time Mosquito Surveillance in Northeast Brazil. Front Public Health. 2021;9:754072. 10.3389/fpubh.2021.754072 . Brody C, Star A, Tran J. Chat-based hotlines for health promotion: a systematic review. Mhealth. 2020;6:36. 10.21037/mhealth-2019-di-13 . World Health Organization. Communication for behavioural impact (COMBI): a toolkit for behavioural and social communication in outbreak response [Internet]. Geneva: World Health Organization. 2012 [cited 2026 Apr 3]. Report No.: WHO/HSE/GCR/2012.13. Available from: https://www.who.int/publications/i/item/communication-for-behavioural-impact-(combi) Kunasagran PD, Syed Abdul Rahim SS, Chun Chao GG, Muyou AJ, Sidek ZN, Hidrus A, Atil A, Dapari R. A Systematic Review of Communication for Behavioural Impact (COMBI) as a Dengue Prevention Programme. Malays J Med Sci. 2025;32(3):73–83. 10.21315/mjms-07-2024-527 . Bidargaddi N, Almirall D, Murphy S, et al. To prompt or not to prompt? A microrandomized trial of time-varying push notifications to increase proximal engagement with a mobile health app. JMIR Mhealth Uhealth. 2018;6(11):e10123. 10.2196/10123 . Amagai S, Pila S, Kaat AJ, Nowinski CJ, Gershon RC. Challenges in participant engagement and retention using mobile health apps: literature review. J Med Internet Res. 2022;24(4):e35120. 10.2196/35120 . Giebel GD, Speckemeier C, Abels C, Plescher F, Börchers K, Wasem J, Blase N, Neusser S. Problems and Barriers Related to the Use of Digital Health Applications: Scoping Review. J Med Internet Res. 2023;25:e43808. 10.2196/43808 . Borges do Nascimento IJ, Abdulazeem H, Vasanthan LT, Martinez EZ, Zucoloto ML, Østengaard L, Azzopardi-Muscat N, Zapata T, Novillo-Ortiz D. Barriers and facilitators to utilizing digital health technologies by healthcare professionals. NPJ Digit Med. 2023;6(1):161. 10.1038/s41746-023-00899-4 . Aovare P, Beune E, Chilunga FP, Moens N, van Moll EP, Agyemang C. The acceptability, adoption and feasibility of mobile health interventions for diabetes and hypertension care among Ghanaian healthcare workers. PEC Innov. 2026;8:100456. 10.1016/j.pecinn.2026.100456 . Osei E, Mashamba-Thompson TP. Mobile health applications for disease screening and treatment support in low-and middle-income countries: A narrative review. Heliyon. 2021;7(3):e06639. 10.1016/j.heliyon.2021.e06639 . Organisation for Economic Co-operation and Development (OECD). The effects of zero-rating [Internet]. Paris: OECD Publishing. 2019. [cited 2026 Feb 20]. Available from: https://www.oecd.org/content/dam/oecd/en/publications/reports/2019/07/the-effects-of-zero-rating_45c41e82/6eefc666-en.pdf Dove ES, Townend D, Meslin EM, Bobrow M, Littler K, Nicol D, et al. RESEARCH ETHICS. Ethics review for international data-intensive research. Science. 2016;351(6280):1399–400. Farnham A, Röösli M, Blanke U, Stone E, Hatz C, Puhan MA. Streaming data from a smartphone application: a new approach to mapping health during travel. Travel Med Infect Dis. 2018;21:36–42. 10.1016/j.tmaid.2017.11.005 . Morris C, Scott RE, Mars M. WhatsApp in Clinical Practice-The Challenges of Record Keeping and Storage. A Scoping Review. Int J Environ Res Public Health. 2021;18(24):13426. 10.3390/ijerph182413426 . Masoni M, Guelfi MR. WhatsApp and other messaging apps in medicine: opportunities and risks. Intern Emerg Med. 2020;15(2):171–3. 10.1007/s11739-020-02292-5 . Función Pública. Ley 1581 de 2012 [Internet]. Bogotá: Función Pública; 2012 [cited 2026 Apr 1]. Available from: https://www.funcionpublica.gov.co/eva/gestornormativo/norma.php?i=49981 Additional Declarations No competing interests reported. Supplementary Files SupplementaryFile1.docx SupplementaryFile2.docx SupplementaryFile3.docx SupplementaryFile4.xlsx SupplementaryFile5.xlsx Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 30 Apr, 2026 Reviewers agreed at journal 20 Apr, 2026 Reviewers agreed at journal 18 Apr, 2026 Reviewers agreed at journal 16 Apr, 2026 Reviewers invited by journal 15 Apr, 2026 Editor invited by journal 13 Apr, 2026 Editor assigned by journal 08 Apr, 2026 Submission checks completed at journal 07 Apr, 2026 First submitted to journal 07 Apr, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9267857","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":626484931,"identity":"19a09235-d0a2-47fb-bf54-a2b031244823","order_by":0,"name":"Maria Angelica Carrillo","email":"data:image/png;base64,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","orcid":"","institution":"University of Freiburg","correspondingAuthor":true,"prefix":"","firstName":"Maria","middleName":"Angelica","lastName":"Carrillo","suffix":""},{"id":626484935,"identity":"822931ac-57c7-40bd-8591-30c932e758ea","order_by":1,"name":"Rocio Cardenas Sanchez","email":"","orcid":"","institution":"University of Freiburg","correspondingAuthor":false,"prefix":"","firstName":"Rocio","middleName":"Cardenas","lastName":"Sanchez","suffix":""},{"id":626484936,"identity":"c3cd7bc6-5604-483d-87c8-12f803428df8","order_by":2,"name":"Susana Koo Chong","email":"","orcid":"","institution":"University of Freiburg","correspondingAuthor":false,"prefix":"","firstName":"Susana","middleName":"Koo","lastName":"Chong","suffix":""},{"id":626484937,"identity":"838a3bde-780a-4510-8eb2-7c0a04619793","order_by":3,"name":"Tatiana Rivera Ramirez","email":"","orcid":"","institution":"University of Freiburg","correspondingAuthor":false,"prefix":"","firstName":"Tatiana","middleName":"Rivera","lastName":"Ramirez","suffix":""},{"id":626484938,"identity":"1326cb56-600c-4432-a450-f0f7e8a7d00b","order_by":4,"name":"Johanna Yañez","email":"","orcid":"","institution":"Instituto Departamental de Salud Norte de Santander","correspondingAuthor":false,"prefix":"","firstName":"Johanna","middleName":"","lastName":"Yañez","suffix":""},{"id":626484939,"identity":"707f87a7-3db3-4b33-987c-d54424842600","order_by":5,"name":"Winfried V. Kern","email":"","orcid":"","institution":"University Medical Centre Freiburg","correspondingAuthor":false,"prefix":"","firstName":"Winfried","middleName":"V.","lastName":"Kern","suffix":""},{"id":626484941,"identity":"538bfda3-8caa-45cd-8dc9-f9fd10a93d8b","order_by":6,"name":"Jörg Lindenmeier","email":"","orcid":"","institution":"University of Freiburg","correspondingAuthor":false,"prefix":"","firstName":"Jörg","middleName":"","lastName":"Lindenmeier","suffix":""},{"id":626484948,"identity":"e93a71e2-15cf-42d3-9009-dd4d1c3622d7","order_by":7,"name":"Axel Kroeger","email":"","orcid":"","institution":"University of Freiburg","correspondingAuthor":false,"prefix":"","firstName":"Axel","middleName":"","lastName":"Kroeger","suffix":""}],"badges":[],"createdAt":"2026-03-30 13:53:21","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9267857/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9267857/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":107704510,"identity":"6072f699-c28e-4149-9553-7c21588d8ce4","added_by":"auto","created_at":"2026-04-24 08:45:50","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":143961,"visible":true,"origin":"","legend":"\u003cp\u003eMap of the study area showing intervention and control groups in Los Patios and Villa del Rosario\u003c/p\u003e\n\u003cp\u003eCV: community visits-only intervention group; CV+WA: community visits plus WhatsApp intervention group. This figure was created using QGIS software.\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-9267857/v1/c7ca08a6b10f3d0a5c2ba3dc.jpeg"},{"id":107489847,"identity":"7bc76cf3-07bd-4610-937e-c9b978d29c12","added_by":"auto","created_at":"2026-04-22 02:49:10","extension":"jpeg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":514950,"visible":true,"origin":"","legend":"\u003cp\u003eEffects in key practices in the three study groups\u003c/p\u003e\n\u003cp\u003eBars show the proportion of households reporting each practice before and after the intervention. *** indicates \u003cem\u003ep \u003c/em\u003e\u0026lt; 0.001. Graphs were created using RStudio version 4.4.2\u003c/p\u003e","description":"","filename":"floatimage2.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-9267857/v1/bc1fd43e5257b11d7ae492ae.jpeg"},{"id":107488915,"identity":"e18dea86-6658-432a-96a7-a192776dc306","added_by":"auto","created_at":"2026-04-22 02:46:10","extension":"jpeg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":449824,"visible":true,"origin":"","legend":"\u003cp\u003eEffects of intervention in vector abundance in the three study groups\u003c/p\u003e\n\u003cp\u003eBars represent mean values of entomological indices before and after the intervention, with 95% confidence intervals. *** indicates p ≤ 0.001 and ** indicates p ≤ 0.01. Graphs were developed using RStudio version 4.4.2\u003c/p\u003e","description":"","filename":"floatimage3.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-9267857/v1/2f556ee4d312292cf3017c4d.jpeg"},{"id":107472196,"identity":"657674da-21fe-4b67-a5ab-d7f864eb9f84","added_by":"auto","created_at":"2026-04-21 20:49:36","extension":"jpeg","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":115813,"visible":true,"origin":"","legend":"\u003cp\u003eCommunity engagement in the IC application\u003c/p\u003e\n\u003cp\u003eBars represent the proportions of households that followed the instructions during household visits for the IC intervention, with 95% confidence intervals. *** indicates p ≤ 0.001. The graph was created using RStudio version 4.4.2.\u003c/p\u003e","description":"","filename":"floatimage4.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-9267857/v1/a2ed49f3d372a005121533fd.jpeg"},{"id":107488767,"identity":"930f2a36-9fc5-4557-91f6-d9d97ea65a25","added_by":"auto","created_at":"2026-04-22 02:45:49","extension":"jpeg","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":174294,"visible":true,"origin":"","legend":"\u003cp\u003eResponses to acceptability items using a 5-Point Likert Scale\u003c/p\u003e\n\u003cp\u003eBars show the distribution of responses across five items assessing acceptability on a 5-point Likert scale, ranging from totally disagree to totally agree. Black dots indicate the mean score for each item. The graph was created using RStudio version 4.4.2.\u003c/p\u003e","description":"","filename":"floatimage5.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-9267857/v1/57ce8610de7c1f4ad682376e.jpeg"},{"id":107708506,"identity":"8990c61b-403d-4c00-b1a5-47aff712bffe","added_by":"auto","created_at":"2026-04-24 09:27:57","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2077859,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9267857/v1/c40f4042-8011-4f48-869d-e7e1158e7af9.pdf"},{"id":107472188,"identity":"488fd0c4-9ea0-412a-b269-d8ed0d5f2d84","added_by":"auto","created_at":"2026-04-21 20:49:36","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":22697,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementaryFile1.docx","url":"https://assets-eu.researchsquare.com/files/rs-9267857/v1/acf2e09e7a8684b2f5017246.docx"},{"id":107472190,"identity":"642d9b1d-c2ef-4dac-a494-52ec60651f36","added_by":"auto","created_at":"2026-04-21 20:49:36","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":26774,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementaryFile2.docx","url":"https://assets-eu.researchsquare.com/files/rs-9267857/v1/33ddaf165f351027ca0c9323.docx"},{"id":107472191,"identity":"496cb7fd-aee5-41be-9515-859eadcd4c96","added_by":"auto","created_at":"2026-04-21 20:49:36","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":17907,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementaryFile3.docx","url":"https://assets-eu.researchsquare.com/files/rs-9267857/v1/bcc512aeb4e3e6cbab6e2bcc.docx"},{"id":107472194,"identity":"ae4d0bc3-7acd-4040-93ed-7df470e4f7c0","added_by":"auto","created_at":"2026-04-21 20:49:36","extension":"xlsx","order_by":3,"title":"","display":"","copyAsset":false,"role":"supplement","size":10469,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementaryFile4.xlsx","url":"https://assets-eu.researchsquare.com/files/rs-9267857/v1/866f54a5ab01676a6c4f8955.xlsx"},{"id":107488913,"identity":"1665c136-8f90-41c3-971e-8d679e888bfc","added_by":"auto","created_at":"2026-04-22 02:46:09","extension":"xlsx","order_by":4,"title":"","display":"","copyAsset":false,"role":"supplement","size":10665,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementaryFile5.xlsx","url":"https://assets-eu.researchsquare.com/files/rs-9267857/v1/c4936db169051495edb17212.xlsx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Using a Digital Health tool for Community Engagement in Arboviral Disease Prevention: An Implementation Study in Colombia","fulltext":[{"header":"Introduction","content":"\u003cp\u003eArboviral diseases transmitted mainly by \u003cem\u003eAedes\u003c/em\u003e mosquitoes are an increasing global health threat, with over 5.6\u0026nbsp;billion people at risk worldwide [\u003cspan class=\"CitationRef\"\u003e1\u003c/span\u003e]. Among the most widespread diseases in urban settings are dengue, chikungunya, and Zika, which are transmitted mainly by the primary vector, \u003cem\u003eAedes aegypti\u003c/em\u003e [\u003cspan class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e3\u003c/span\u003e]. They are characterized by recurrent outbreaks, and the potential to cause severe health complications [\u003cspan class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e5\u003c/span\u003e] or chronic sequelae associated with chikungunya [\u003cspan class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn Colombia, there is cocirculation of four dengue virus (DENV) serotypes and multiple lineages that have contributed to large outbreaks with higher fatality rates than the average reported in the Americas [\u003cspan class=\"CitationRef\"\u003e8\u003c/span\u003e]. In 2019, more than 127,000 dengue cases were reported, exceeding the epidemic threshold in the country, with severe cases concentrated in the departments of Meta, Tolima, Huila, Santander, Cesar, Valle del Cauca, Sucre, Norte de Santander, Antioquia, and Casanare. [\u003cspan class=\"CitationRef\"\u003e9\u003c/span\u003e]. The chikungunya epidemic of 2014–2015 accounted for more than 450,000 reported cases and affected 96% of municipalities nationwide [\u003cspan class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e11\u003c/span\u003e]. Likewise, the Zika epidemic of 2015–2016 resulted in more than 90,000 suspected cases and numerous cases of congenital Zika syndrome, Guillain–Barré syndrome (GBS), and other neurological manifestations [\u003cspan class=\"CitationRef\"\u003e12\u003c/span\u003e]. Norte de Santander is one of the states most affected by dengue, with high vector densities (e.g., the proportion of households with larvae and pupae exceeding 25%) in three municipalities: Cúcuta, Villa del Rosario, and Los Patios [\u003cspan class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe coexistence of dengue, Zika, and chikungunya, together with factors such as a hot climate, increasing population density, sanitation inequalities, human behaviours related to domestic water storage, deficiencies in vector control policies, and poor household infrastructure, increases the complexity of prevention efforts. [\u003cspan class=\"CitationRef\"\u003e15\u003c/span\u003e–\u003cspan class=\"CitationRef\"\u003e19\u003c/span\u003e]. To combat these diseases, preventive strategies have relied on vertically managed programs based on chemical, biological, and environmental vector control [\u003cspan class=\"CitationRef\"\u003e20\u003c/span\u003e], as well as vaccine development [\u003cspan class=\"CitationRef\"\u003e21\u003c/span\u003e]. However, these approaches face important limitations, including low levels of community participation, increasing insecticide resistance [\u003cspan class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e23\u003c/span\u003e], and the restricted effectiveness of the currently available vaccine [\u003cspan class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e25\u003c/span\u003e]. These challenges highlight the need to shift toward more effective models that actively integrate communities into sustained source reduction efforts.\u003c/p\u003e \u003cp\u003eTo address these challenges, an innovative vector control tool, known as insecticidal coating (IC), was applied to laundry tanks in Norte de Santander, Colombia, to disrupt larval/pupal development and cause adult mosquito mortality [\u003cspan class=\"CitationRef\"\u003e26\u003c/span\u003e]. This dual effect results from the combined action of two microencapsulated components, alphacypermethrin and pyriproxyfen, which allow their gradual release in water containers. A recent study conducted in Cúcuta, Colombia, showed its efficacy for up to 12 months in inhibiting the emergence of larvae and pupae [\u003cspan class=\"CitationRef\"\u003e26\u003c/span\u003e]. However, its sustained effectiveness depends heavily on community engagement, since residents must empty the tanks and keep them dry for about one day to ensure proper adhesion of the product to the inner walls.\u003c/p\u003e \u003cp\u003eIn recent years, digital interventions using mobile phones have emerged as promising tools to strengthen community engagement in the prevention and control of dengue, chikungunya, and Zika [\u003cspan class=\"CitationRef\"\u003e28\u003c/span\u003e]. Recent experiences in Asia show that mobile surveillance and communication platforms can mobilize communities and generate innovative local solutions for dengue prevention, even in resource-limited settings [\u003cspan class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e29\u003c/span\u003e]. In the Americas, mobile platforms such as DengueChat and ZIKAMOB have shown encouraging results in reinforcing preventive behaviours through reminders, education, and digital support among students and community members [\u003cspan class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e31\u003c/span\u003e]. More recently, a feasibility study in Colombia demonstrated that sending WhatsApp messages to women in urban communities increased acceptance and usability. In addition, it improved intentions to adopt to key preventive practices, such as weekly cleaning of water tanks [\u003cspan class=\"CitationRef\"\u003e32\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eDespite this increasing evidence, no structured digital intervention explicitly grounded in behaviour change principles and integrated with local vector control strategies, such as the IC, has yet been evaluated at community level. In a context where more than 90% of households own a smartphone and use WhatsApp daily [\u003cspan class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e34\u003c/span\u003e], this application may represent a valuable opportunity to strengthen health behaviours and community engagement in the control of dengue and other arboviral diseases. Therefore, to address this gap, the present study evaluated the use of WhatsApp as a digital health promotion and behavioural reinforcement tool to encourage the application of a IC in laundry tanks, one of the main breeding sites of \u003cem\u003eAedes\u003c/em\u003e mosquitoes in Colombia [\u003cspan class=\"CitationRef\"\u003e13\u003c/span\u003e], as an example of fostering community engagement in arboviral disease prevention.\u003c/p\u003e "},{"header":"Methods","content":"\u003ch3\u003eAim\u003c/h3\u003e\n\u003cp\u003eThe purpose of this study was to evaluate a digital tool, WhatsApp, aimed at promoting preventive practices and enhancing community engagement in vector control activities, with a particular focus on the application of a vector control tool (IC) in water containers in two municipalities in Colombia.\u003c/p\u003e\n\u003ch3\u003eSetting of the Study\u003c/h3\u003e\n\u003cp\u003eThe study was conducted in the Metropolitan Area of C\u0026uacute;cuta, in the department of Norte de Santander. This region is located in the valley of the same name, at the foot of the Eastern Cordillera of the Colombian Andes. The Metropolitan Area is composed of the municipalities of Villa del Rosario, Los Patios, El Zulia, San Cayetano, and Puerto Santander, and has temperatures ranging from 28 to 37 \u0026deg;C [35]. For this study, the municipalities of Los Patios and Villa del Rosario were selected because they have been historically affected by dengue, chikungunya, and Zika with high vector densities and documented resistance in \u003cem\u003eAedes\u003c/em\u003e mosquitoes [13,36]. According to DANE projections, by 2026 these two municipalities will have a combined population of 232,053 inhabitants. In 2025, the population of Villa del Rosario represented 7.3% of the total population of Norte de Santander, while Los Patios accounted for 6.1% [37].\u003c/p\u003e\n\u003ch3\u003eStudy design\u0026nbsp;\u003c/h3\u003e\n\u003cp\u003eThis study was an implementation study that used a quasi-experimental design with three groups: one control group, one community visits-only (CV only) intervention group, and one community visits plus WhatsApp (CV+WA) intervention group. Both intervention groups received the IC. The three groups were geographically separated to reduce the risk of contamination. The study measured changes in respondents\u0026rsquo; preventive practices and changes in vector abundance at the household level through pre- and post-intervention surveys. In addition, community engagement was assessed through observations recorded by the field team, and acceptability was evaluated using additional questions in the post-intervention survey.\u003c/p\u003e\n\u003ch3 id=\"_Toc205212836\"\u003eStudy participants\u0026nbsp;\u003c/h3\u003e\n\u003cp\u003eWith support from the regional Ministry of Health (MoH), highly endemic neighbourhoods were identified and mapped. These neighbourhoods had similar sociodemographic characteristics and comprised approximately 200 to 400 households each. They were grouped into three large study groups located in different corners of the study area in particular, the two intervention groups were separated, with one located in each municipality (Figure 1). A lottery method was used to assign the study groups. Each study group consisted of approximately four to five neighbourhoods. From each household, one adult member was recruited as a study participant. Participants were considered eligible if they owned a smartphone with WhatsApp installed and were able to receive and read messages. They also had to reside within the study group and have a laundry tank in their household.\u003c/p\u003e\n\u003ch4\u003eSample size and sampling technique\u003c/h4\u003e\n\u003cp\u003eThe study recruited 300 households per group using a sampling interval of 8 households, with one adult member selected from each household. This sample size was considered adequate to achieve a statistical power of 95% and to detect a difference of at least 15% in preventive practices between groups. The sample size was calculated using a proportions-based approach with OpenEpi software (version 3.01) [38].\u0026nbsp;Therefore, a total of 900 households were initially enrolled in the study.\u003c/p\u003e\n\u003cp\u003eAll selected households in the three study groups were visited for the pre-intervention survey.\u0026nbsp;At the final evaluation, 28 households did not take part in the post-intervention survey; therefore, the final analysis included socio-demographic and entomological data from 874 households. A random subsample of approximately 60 households per group was visited by the field team to monitor the intervention after 4 months. This subsample was selected using Excel\u0026rsquo;s randomization function. In addition, users from the CV + WA group were surveyed at the end of the intervention to assess the acceptability of the WhatsApp messaging as a digital tool for arboviral disease prevention.\u003c/p\u003e\n\u003ch3 id=\"_Toc192162762\"\u003eInterventions components\u003c/h3\u003e\n\u003cp\u003eThe interventions in this study included: (a) Health promotion through community visits (CV only), during which a field team distributed stickers and flyers about the IC and (b) community visits combined with WhatsApp reminders sent via smartphone (CV + WA).\u003c/p\u003e\n\u003cp\u003eHealth promotion through community visits was carried out by field teams composed of community volunteers and health workers from each study group. These teams received one week of training from the principal investigator (PI) on how to announce the intervention, provide instructions of the IC, and distribute the promotional materials needed to support application of the IC in tanks. The materials were designed according to the product application procedure and based on previous application tests conducted by the Freiburg research team [26]. In addition, loudspeakers were used as part of the promotional activities in both intervention groups.\u003c/p\u003e\n\u003cp\u003eThree months after completion of the pre-intervention survey, the IC application began and lasted approximately three to four weeks in each group. On the day before painting the tank, health promotion activities were carried out in each household in both the CV only and CV + WA groups during regular home visits.\u003c/p\u003e\n\u003cp\u003eWhatsApp reminder and delivery\u003c/p\u003e\n\u003cp\u003eThe WhatsApp reminder component consisted of health prevention and promotion messages based on arboviral disease prevention information developed by the Colombian campaigns [39] and on the technical specifications for the IC provided by the manufacturer (Inesfly Co., Spain). These messages had four main functions: (i) to educate participants about general and relevant concepts related to arboviral diseases; (ii) to promote and encourage participants to use the IC; (iii) to reinforce the application of the IC and other preventive practices; and (iv) to maintain regular communication with participants through general project-related information [32].\u003c/p\u003e\n\u003cp\u003eThese messages were validated and tested by 45 community members in a previous study and by health experts through a workshop [32]. Additional messages were later included to provide specific information about application dates and further instructions regarding the product. The messages were short, with approximately 350 characters each. All messages were written in Spanish and were reviewed and approved by coordinators from MoH in Norte de Santander. Further details about the messages are provided in the previous research project [40].\u003c/p\u003e\n\u003cp\u003eMessage delivery started six weeks after the pre-intervention survey, with approximately one message sent per week. However, on the day before IC application (painting of the tank), two reminder messages were sent on the same day, one in the morning and one in the afternoon, to reinforce preparation for the coating application. After the IC application in tanks, participants in the CV + WA group continued receiving preventive DZC messages, with a total of 30 messages delivered during the 35-week intervention period. Messages were usually sent on Tuesdays, Wednesdays, and Thursdays, according to the schedule of each neighbourhood, and were generally delivered in the morning by a facilitator trained by the PI [40].\u003c/p\u003e\n\u003cp\u003eThe study participants did not incur any cost for receiving the messages, as WhatsApp is a free application that uses internet connectivity. Efforts were made to ensure that participants saved the project phone number so that they could receive the messages properly.\u003c/p\u003e\n\u003cp\u003eParticipants in the control group did not receive any intervention (neither IC nor WhatsApp). They only received the standard routine visits carried out by the vector control programme [40].\u003c/p\u003e\n\u003ch3\u003eResearch Instruments\u0026nbsp;\u003c/h3\u003e\n\u003cp\u003eThis study employed three different research instruments for quantitative data collection. This study employed three different research instruments for quantitative data collection. The pre- and post-intervention surveys consisted of a household questionnaire and a larval/pupal household survey. The household questionnaire was used and adapted from published studies in Colombia [13,32,41]. This questionnaire collected socio-demographic and health data, as well as household practices of participants. In addition, questions were added to assess the acceptability of messages, based on a previous study conducted in Nepal [42]. This household questionnaire is available in Supplementary File 1.\u003c/p\u003e\n\u003cp\u003eThe larval/pupal household survey was developed by the Special Programme for Research and Training in Tropical Diseases (TDR) of the WHO [43]. This standard survey was adapted to include specific breeding sites relevant to the study setting. This instrument is available in Supplementary File 2. Both instruments (household questionnaire and larval/pupal household survey) were used in pre-intervention, monitoring (after 4 months) and post-intervention period (after 9 months). Five university students trained by the research team conducted the household questionnaire, while, in parallel, five health workers carried out the entomological inspections and recorded the breeding sites in the larval/pupal household survey.\u003c/p\u003e\n\u003cp\u003eThe third research instrument was employed during the intervention (application of IC in tanks). The research team developed a field form to register households that accepted the application of the IC and followed the instructions (e.g. emptying and cleaning tank) in the CV only and CV+WA groups. This form is available in Supplementary File 3. All research instruments were pre-tested and modified based on feedback from members of the vector control program in each municipality to check flow, consistency, and validity.\u0026nbsp;\u003c/p\u003e\n\u003ch3 id=\"_Toc205212839\"\u003eStatistical analysis\u003c/h3\u003e\n\u003cp\u003eThis study used RStudio software (R Foundation, version 4.4.2) for data management and statistical analysis of quantitative data. Descriptive analyses were performed for the socio-demographic characteristics of participants. Categorical variables were summarized as frequencies and percentages with confidence intervals, whereas continuous variables were described using means and standard deviations (SD). Chi-square tests were used to compare baseline socio-demographic characteristics and other categorical variables (i.e. house painting, willingness to paint again, and tank emptying) between study groups.\u003c/p\u003e\n\u003cp\u003eFor preventive practices, proportions were calculated before and after the intervention in each study group. McNemar\u0026rsquo;s test was used to assess within-group changes in paired categorical responses. In addition, difference-in-differences (DiD) analyses using linear probability models were conducted to estimate the effect of the intervention over time at the household level. Comparisons of binary practice variables across the three groups were performed using chi-square tests. Multivariable logistic regression models were further conducted to identify factors associated with preventive practices after the intervention, adjusting for potential confounders such as sex, age, and education.\u003c/p\u003e\n\u003cp\u003eEntomological indices (the House Index:HI, Container Index:CI, Breteau Index:BI, and Pupae per Person Index: PPI) were analysed by cluster to assess changes in vector abundance at pre-intervention and post-intervention period. These indices were calculated following the WHO standard operating procedures [43] and the pupal count methodology described by Romero-Vivas [44]. Normality of the pre\u0026ndash;post changes was assessed using the Shapiro\u0026ndash;Wilk test. As the changes in CI, BI, and PPI were not normally distributed in any of the three groups (all p \u0026lt; 0.001), within-group comparisons were performed using the Wilcoxon signed-rank test. For HI, which was analysed as a paired binary outcome, McNemar\u0026rsquo;s test was employed. Differences across groups were further analysed using difference-in-differences analysis. Comparisons between groups were performed using chi-square tests for HI and CI, and Poisson-based methods for BI and PPI.\u003c/p\u003e\n\u003cp\u003eAcceptability of the WhatsApp intervention was assessed using 5-point Likert scale items based on a previous study [42]. Each item (perceived usefulness, enjoyment, and satisfaction) was rated on a scale from 1 = strongly disagree to 5 = strongly agree. Mean scores and standard deviations were calculated for each acceptability item, and average agreement scores were used to summarize participants\u0026rsquo; perceptions of the intervention. Higher scores (more than 3) indicate agreement or positive acceptability. All \u003cem\u003ep\u003c/em\u003e-values were considered statistically significant at p \u0026lt; 0.05.\u003c/p\u003e"},{"header":"Results","content":"\u003ch3\u003eSociodemographic characteristic of residents\u003c/h3\u003e\n\u003cp\u003eSociodemographic information on residents was obtained from an adult respondent in each household. Most respondents were women (71.17%; 95% CI: 68.1%\u0026ndash;74.1%). The mean household size was 4 residents (SD = 1.7). The field team collected information on 3,252 residents in this study (Table 1). Most residents were female (53.7%; 95% CI: 51.9%\u0026ndash;55.4%) and were mainly aged 35\u0026ndash;64 years (36.5%; 95% CI: 34.9%\u0026ndash;38.2%). More than half had or reached secondary or higher education (57.3%; (95% CI: 55.5%\u0026ndash;59.1%) and reported remaining within their neighbourhood during the day (67.8%; 95% CI: 66.2%\u0026ndash;69.4%).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;text-align:justify;line-height:125%;font-size:13px;font-family:\"Arial\",sans-serif;font-weight:bold;'\u003e\u003cspan style=\"font-family:Arial;\"\u003eTable 1 Social demographic characteristics of residents\u003c/span\u003e\u003c/p\u003e\n\u003cdiv align=\"center\" style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:115%;font-size:16px;font-family:\"Aptos\",sans-serif;'\u003e\n \u003ctable style=\"width:390.05pt;border-collapse:collapse;border:none;\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 147.05pt;border: 1pt solid windowtext;background: rgb(209, 209, 209);padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;font-family:\"Arial\",sans-serif;color:black;'\u003eCharacteristics of residents\u0026nbsp;\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;font-family:\"Arial\",sans-serif;color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 53.3pt;border-width: 1pt 1pt 1pt medium;border-style: solid solid solid none;border-color: windowtext windowtext windowtext currentcolor;border-image: initial;background: rgb(209, 209, 209);padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;color:black;'\u003eTotal\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;color:black;'\u003en (%)\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46.35pt;border-width: 1pt 1pt 1pt medium;border-style: solid solid solid none;border-color: windowtext windowtext windowtext currentcolor;border-image: initial;background: rgb(209, 209, 209);padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;color:black;'\u003eControl\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;color:black;'\u003en (%)\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 51.3pt;border-width: 1pt 1pt 1pt medium;border-style: solid solid solid none;border-color: windowtext windowtext windowtext currentcolor;border-image: initial;background: rgb(209, 209, 209);padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;color:black;'\u003eCV only\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;color:black;'\u003en (%)\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55.3pt;border-width: 1pt 1pt 1pt medium;border-style: solid solid solid none;border-color: windowtext windowtext windowtext currentcolor;border-image: initial;background: rgb(209, 209, 209);padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;font-family:\"Arial\",sans-serif;color:black;'\u003eCV + WA\u0026nbsp;\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;color:black;'\u003en (%)\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 36.75pt;border-width: 1pt 1pt 1pt medium;border-style: solid solid solid none;border-color: windowtext windowtext windowtext currentcolor;border-image: initial;background: rgb(209, 209, 209);padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;'\u003e\u003cstrong\u003e\u003cem\u003e\u003cspan style='font-size:13px;font-family:\"Arial\",sans-serif;color:black;'\u003ep\u003c/span\u003e\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;font-family:\"Arial\",sans-serif;color:black;'\u003e-value\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 147.05pt;border-width: medium 1pt 1pt;border-style: none solid solid;border-color: currentcolor windowtext windowtext;border-image: initial;padding: 0in 5.4pt;height: 13.5pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Arial\",sans-serif;color:black;'\u003eTotal residents\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 53.3pt;border-width: medium 1pt 1pt medium;border-style: none solid solid none;border-color: currentcolor windowtext windowtext currentcolor;padding: 0in 5.4pt;height: 13.5pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;color:black;'\u003e3,252 (100)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46.35pt;border-width: medium 1pt 1pt medium;border-style: none solid solid none;border-color: currentcolor windowtext windowtext currentcolor;padding: 0in 5.4pt;height: 13.5pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;color:black;'\u003e1,062 (100)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 51.3pt;border-width: medium 1pt 1pt medium;border-style: none solid solid none;border-color: currentcolor windowtext windowtext currentcolor;padding: 0in 5.4pt;height: 13.5pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;color:black;'\u003e1,051 (100)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55.3pt;border-width: medium 1pt 1pt medium;border-style: none solid solid none;border-color: currentcolor windowtext windowtext currentcolor;padding: 0in 5.4pt;height: 13.5pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;color:black;'\u003e1,139 (100)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 36.75pt;border-width: medium 1pt 1pt medium;border-style: none solid solid none;border-color: currentcolor windowtext windowtext currentcolor;padding: 0in 5.4pt;height: 13.5pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 67.25pt;border-width: medium 1pt 1pt;border-style: none solid solid;border-color: currentcolor windowtext windowtext;border-image: initial;padding: 0in 5.4pt;height: 13.5pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Arial\",sans-serif;color:black;'\u003eSex\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79.8pt;border-width: medium 1pt 1pt medium;border-style: none solid solid none;border-color: currentcolor windowtext windowtext currentcolor;padding: 0in 5.4pt;height: 13.5pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Arial\",sans-serif;'\u003eFemale\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 53.3pt;border-width: medium 1pt 1pt medium;border-style: none solid solid none;border-color: currentcolor windowtext windowtext currentcolor;padding: 0in 5.4pt;height: 13.5pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;color:black;'\u003e1,745 (53.7)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46.35pt;border-width: medium 1pt 1pt medium;border-style: none solid solid none;border-color: currentcolor windowtext windowtext currentcolor;padding: 0in 5.4pt;height: 13.5pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;color:black;'\u003e564 (53.1)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 51.3pt;border-width: medium 1pt 1pt medium;border-style: none solid solid none;border-color: currentcolor windowtext windowtext currentcolor;padding: 0in 5.4pt;height: 13.5pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;color:black;'\u003e576 (54.8)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55.3pt;border-width: medium 1pt 1pt medium;border-style: none solid solid none;border-color: currentcolor windowtext windowtext currentcolor;padding: 0in 5.4pt;height: 13.5pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;color:black;'\u003e605 (53.1)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 36.75pt;border-width: medium 1pt 1pt medium;border-style: none solid solid none;border-color: currentcolor windowtext windowtext currentcolor;padding: 0in 5.4pt;height: 13.5pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;color:black;'\u003e0.664\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 79.8pt;border-width: medium 1pt 1pt medium;border-style: none solid solid none;border-color: currentcolor windowtext windowtext currentcolor;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Arial\",sans-serif;'\u003eMale\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 53.3pt;border-width: medium 1pt 1pt medium;border-style: none solid solid none;border-color: currentcolor windowtext windowtext currentcolor;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;color:black;'\u003e1,507 (46.3)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46.35pt;border-width: medium 1pt 1pt medium;border-style: none solid solid none;border-color: currentcolor windowtext windowtext currentcolor;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;color:black;'\u003e498 (46.9)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 51.3pt;border-width: medium 1pt 1pt medium;border-style: none solid solid none;border-color: currentcolor windowtext windowtext currentcolor;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;color:black;'\u003e475 (45.2)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55.3pt;border-width: medium 1pt 1pt medium;border-style: none solid solid none;border-color: currentcolor windowtext windowtext currentcolor;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;color:black;'\u003e534 (46.9)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"7\" style=\"width: 67.25pt;border-width: medium 1pt 1pt;border-style: none solid solid;border-color: currentcolor windowtext windowtext;border-image: initial;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Arial\",sans-serif;color:black;'\u003eAge group in years\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Arial\",sans-serif;color:black;'\u003e\u0026nbsp;\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Arial\",sans-serif;color:black;'\u003e\u0026nbsp;\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79.8pt;border-width: medium 1pt 1pt medium;border-style: none solid solid none;border-color: currentcolor windowtext windowtext currentcolor;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Arial\",sans-serif;color:black;'\u003e\u0026lt; 1\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 53.3pt;border-width: medium 1pt 1pt medium;border-style: none solid solid none;border-color: currentcolor windowtext windowtext currentcolor;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;color:black;'\u003e32 (1.0)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46.35pt;border-width: medium 1pt 1pt medium;border-style: none solid solid none;border-color: currentcolor windowtext windowtext currentcolor;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;color:black;'\u003e14 (1.3)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 51.3pt;border-width: medium 1pt 1pt medium;border-style: none solid solid none;border-color: currentcolor windowtext windowtext currentcolor;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;color:black;'\u003e5 (0.5)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55.3pt;border-width: medium 1pt 1pt medium;border-style: none solid solid none;border-color: currentcolor windowtext windowtext currentcolor;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;color:black;'\u003e13 (1.1)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"7\" style=\"width: 36.75pt;border-width: medium 1pt 1pt medium;border-style: none solid solid none;border-color: currentcolor windowtext windowtext currentcolor;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;color:black;'\u003e0.053\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 79.8pt;border-width: medium 1pt 1pt medium;border-style: none solid solid none;border-color: currentcolor windowtext windowtext currentcolor;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Arial\",sans-serif;color:black;'\u003e1-4\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 53.3pt;border-width: medium 1pt 1pt medium;border-style: none solid solid none;border-color: currentcolor windowtext windowtext currentcolor;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;color:black;'\u003e146 (4.5)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46.35pt;border-width: medium 1pt 1pt medium;border-style: none solid solid none;border-color: currentcolor windowtext windowtext currentcolor;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;color:black;'\u003e58 (5.5)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 51.3pt;border-width: medium 1pt 1pt medium;border-style: none solid solid none;border-color: currentcolor windowtext windowtext currentcolor;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;color:black;'\u003e44 (4.2)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55.3pt;border-width: medium 1pt 1pt medium;border-style: none solid solid none;border-color: currentcolor windowtext windowtext currentcolor;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;color:black;'\u003e44 (3.9)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 79.8pt;border-width: medium 1pt 1pt medium;border-style: none solid solid none;border-color: currentcolor windowtext windowtext currentcolor;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Arial\",sans-serif;color:black;'\u003e5-9\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 53.3pt;border-width: medium 1pt 1pt medium;border-style: none solid solid none;border-color: currentcolor windowtext windowtext currentcolor;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;color:black;'\u003e251 (7.7)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46.35pt;border-width: medium 1pt 1pt medium;border-style: none solid solid none;border-color: currentcolor windowtext windowtext currentcolor;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;color:black;'\u003e93 (8.8)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 51.3pt;border-width: medium 1pt 1pt medium;border-style: none solid solid none;border-color: currentcolor windowtext windowtext currentcolor;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;color:black;'\u003e65 (6.2)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55.3pt;border-width: medium 1pt 1pt medium;border-style: none solid solid none;border-color: currentcolor windowtext windowtext currentcolor;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;color:black;'\u003e93 (8.2)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 79.8pt;border-width: medium 1pt 1pt medium;border-style: none solid solid none;border-color: currentcolor windowtext windowtext currentcolor;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Arial\",sans-serif;color:black;'\u003e10-19\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 53.3pt;border-width: medium 1pt 1pt medium;border-style: none solid solid none;border-color: currentcolor windowtext windowtext currentcolor;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;color:black;'\u003e484 (14.9)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46.35pt;border-width: medium 1pt 1pt medium;border-style: none solid solid none;border-color: currentcolor windowtext windowtext currentcolor;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;color:black;'\u003e146 (13.7)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 51.3pt;border-width: medium 1pt 1pt medium;border-style: none solid solid none;border-color: currentcolor windowtext windowtext currentcolor;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;color:black;'\u003e150 (14.3)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55.3pt;border-width: medium 1pt 1pt medium;border-style: none solid solid none;border-color: currentcolor windowtext windowtext currentcolor;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;color:black;'\u003e188 (16.5)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 79.8pt;border-width: medium 1pt 1pt medium;border-style: none solid solid none;border-color: currentcolor windowtext windowtext currentcolor;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Arial\",sans-serif;color:black;'\u003e20-34\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 53.3pt;border-width: medium 1pt 1pt medium;border-style: none solid solid none;border-color: currentcolor windowtext windowtext currentcolor;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;color:black;'\u003e719 (22.1)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46.35pt;border-width: medium 1pt 1pt medium;border-style: none solid solid none;border-color: currentcolor windowtext windowtext currentcolor;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;color:black;'\u003e238 (22.4)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 51.3pt;border-width: medium 1pt 1pt medium;border-style: none solid solid none;border-color: currentcolor windowtext windowtext currentcolor;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;color:black;'\u003e232 (22.1)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55.3pt;border-width: medium 1pt 1pt medium;border-style: none solid solid none;border-color: currentcolor windowtext windowtext currentcolor;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;color:black;'\u003e249 (21.9)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 79.8pt;border-width: medium 1pt 1pt medium;border-style: none solid solid none;border-color: currentcolor windowtext windowtext currentcolor;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Arial\",sans-serif;color:black;'\u003e35-64\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 53.3pt;border-width: medium 1pt 1pt medium;border-style: none solid solid none;border-color: currentcolor windowtext windowtext currentcolor;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;color:black;'\u003e1,187 (36.5)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46.35pt;border-width: medium 1pt 1pt medium;border-style: none solid solid none;border-color: currentcolor windowtext windowtext currentcolor;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;color:black;'\u003e376 (35.4)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 51.3pt;border-width: medium 1pt 1pt medium;border-style: none solid solid none;border-color: currentcolor windowtext windowtext currentcolor;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;color:black;'\u003e396 (37.7)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55.3pt;border-width: medium 1pt 1pt medium;border-style: none solid solid none;border-color: currentcolor windowtext windowtext currentcolor;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;color:black;'\u003e415 (36.4)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 79.8pt;border-width: medium 1pt 1pt medium;border-style: none solid solid none;border-color: currentcolor windowtext windowtext currentcolor;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Arial\",sans-serif;color:black;'\u003e\u0026gt; 64\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 53.3pt;border-width: medium 1pt 1pt medium;border-style: none solid solid none;border-color: currentcolor windowtext windowtext currentcolor;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;color:black;'\u003e433 (13.3)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46.35pt;border-width: medium 1pt 1pt medium;border-style: none solid solid none;border-color: currentcolor windowtext windowtext currentcolor;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;color:black;'\u003e137 (12.9)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 51.3pt;border-width: medium 1pt 1pt medium;border-style: none solid solid none;border-color: currentcolor windowtext windowtext currentcolor;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;color:black;'\u003e159 (15.1)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55.3pt;border-width: medium 1pt 1pt medium;border-style: none solid solid none;border-color: currentcolor windowtext windowtext currentcolor;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;color:black;'\u003e137 (12.0)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" style=\"width: 67.25pt;border-width: medium 1pt 1pt;border-style: none solid solid;border-color: currentcolor windowtext windowtext;border-image: initial;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Arial\",sans-serif;color:black;'\u003eEducation level\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79.8pt;border-width: medium 1pt 1pt medium;border-style: none solid solid none;border-color: currentcolor windowtext windowtext currentcolor;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Arial\",sans-serif;'\u003eNo formal education\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 53.3pt;border-width: medium 1pt 1pt medium;border-style: none solid solid none;border-color: currentcolor windowtext windowtext currentcolor;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;'\u003e124 (4.1)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46.35pt;border-width: medium 1pt 1pt medium;border-style: none solid solid none;border-color: currentcolor windowtext windowtext currentcolor;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;'\u003e36 (3.7)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 51.3pt;border-width: medium 1pt 1pt medium;border-style: none solid solid none;border-color: currentcolor windowtext windowtext currentcolor;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;'\u003e45 (4.5)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55.3pt;border-width: medium 1pt 1pt medium;border-style: none solid solid none;border-color: currentcolor windowtext windowtext currentcolor;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;'\u003e43 (4.0)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" style=\"width: 36.75pt;border-width: medium 1pt 1pt medium;border-style: none solid solid none;border-color: currentcolor windowtext windowtext currentcolor;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;color:black;'\u003e0.002\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 79.8pt;border-width: medium 1pt 1pt medium;border-style: none solid solid none;border-color: currentcolor windowtext windowtext currentcolor;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Arial\",sans-serif;'\u003ePrimary\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 53.3pt;border-width: medium 1pt 1pt medium;border-style: none solid solid none;border-color: currentcolor windowtext windowtext currentcolor;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;'\u003e1,171 (38.6)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46.35pt;border-width: medium 1pt 1pt medium;border-style: none solid solid none;border-color: currentcolor windowtext windowtext currentcolor;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;'\u003e416 (43.0)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 51.3pt;border-width: medium 1pt 1pt medium;border-style: none solid solid none;border-color: currentcolor windowtext windowtext currentcolor;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;'\u003e340 (34.0)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55.3pt;border-width: medium 1pt 1pt medium;border-style: none solid solid none;border-color: currentcolor windowtext windowtext currentcolor;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;'\u003e415 (38.9)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 79.8pt;border-width: medium 1pt 1pt medium;border-style: none solid solid none;border-color: currentcolor windowtext windowtext currentcolor;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Arial\",sans-serif;'\u003eSecondary above\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 53.3pt;border-width: medium 1pt 1pt medium;border-style: none solid solid none;border-color: currentcolor windowtext windowtext currentcolor;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;'\u003e1,738 (57.3)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46.35pt;border-width: medium 1pt 1pt medium;border-style: none solid solid none;border-color: currentcolor windowtext windowtext currentcolor;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;'\u003e515 (53.3)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 51.3pt;border-width: medium 1pt 1pt medium;border-style: none solid solid none;border-color: currentcolor windowtext windowtext currentcolor;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;'\u003e614 (61.5)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55.3pt;border-width: medium 1pt 1pt medium;border-style: none solid solid none;border-color: currentcolor windowtext windowtext currentcolor;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;'\u003e609 (57.1)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 67.25pt;border-width: medium 1pt 1pt;border-style: none solid solid;border-color: currentcolor windowtext windowtext;border-image: initial;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Arial\",sans-serif;color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Arial\",sans-serif;color:black;'\u003eMobility status\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79.8pt;border-width: medium 1pt 1pt medium;border-style: none solid solid none;border-color: currentcolor windowtext windowtext currentcolor;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Arial\",sans-serif;color:black;'\u003eWithin-neighborhood*\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 53.3pt;border-width: medium 1pt 1pt medium;border-style: none solid solid none;border-color: currentcolor windowtext windowtext currentcolor;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;color:black;'\u003e2,202 (67.8)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46.35pt;border-width: medium 1pt 1pt medium;border-style: none solid solid none;border-color: currentcolor windowtext windowtext currentcolor;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;color:black;'\u003e707 (6.9)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 51.3pt;border-width: medium 1pt 1pt medium;border-style: none solid solid none;border-color: currentcolor windowtext windowtext currentcolor;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;color:black;'\u003e726 (69.1)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55.3pt;border-width: medium 1pt 1pt medium;border-style: none solid solid none;border-color: currentcolor windowtext windowtext currentcolor;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;color:black;'\u003e769 (67.5)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 36.75pt;border-width: medium 1pt 1pt medium;border-style: none solid solid none;border-color: currentcolor windowtext windowtext currentcolor;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;color:black;'\u003e0.519\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 79.8pt;border-width: medium 1pt 1pt medium;border-style: none solid solid none;border-color: currentcolor windowtext windowtext currentcolor;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Arial\",sans-serif;color:black;'\u003eOutside-neighborhood**\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 53.3pt;border-width: medium 1pt 1pt medium;border-style: none solid solid none;border-color: currentcolor windowtext windowtext currentcolor;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;color:black;'\u003e1,044 (32.2)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46.35pt;border-width: medium 1pt 1pt medium;border-style: none solid solid none;border-color: currentcolor windowtext windowtext currentcolor;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;color:black;'\u003e350 (33.1)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 51.3pt;border-width: medium 1pt 1pt medium;border-style: none solid solid none;border-color: currentcolor windowtext windowtext currentcolor;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;color:black;'\u003e324 (30.9)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55.3pt;border-width: medium 1pt 1pt medium;border-style: none solid solid none;border-color: currentcolor windowtext windowtext currentcolor;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;color:black;'\u003e370 (32.5)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp style='margin:0in;text-align:left;font-size:13px;font-family:\"Arial\",sans-serif;'\u003e*Within-cluster mobility = residents who stayed mostly within their neighborhood during the day\u003cbr\u003e\u0026nbsp;**Outside-cluster mobility = residents who spent most of the day outside their neighborhood during the day\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003ch3\u003eMonitoring after IC application\u003c/h3\u003e\n\u003cp\u003eFour months after the application of IC in tanks, the field team visited a total of 174 households and collected information from 756 residents in the three groups (Table 2). Vector control workers inspected a total of 596 water containers (CV+WA=188; CV only=166; control group=240). Entomological indices were significantly lower in the intervention groups, with the CV + WA group showing the lowest values (e.g. HI = 8.9%; \u003cem\u003ep\u003c/em\u003e=0.0005), while the control group consistently presented the highest indices (e.g. HI = 33.3%). No larvae or pupae were observed in treated tanks in either intervention group. Additionally, most users (76.8%) perceived WhatsApp as a useful digital tool for delivering health promotion information related to arboviral disease prevention (mean score: 4.7/5), and no technical problems were reported.\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;text-align:justify;line-height:125%;font-size:13px;font-family:\"Arial\",sans-serif;font-weight:bold;'\u003e\u003cspan style=\"font-family:Arial;\"\u003eTable\u0026nbsp;\u003c/span\u003e\u003cspan style=\"font-family:Arial;\"\u003e2 Entomological indices in the three groups after 4 months of\u0026nbsp;\u003c/span\u003e\u003cspan style=\"font-family:Arial;\"\u003eIC painting\u003c/span\u003e\u003c/p\u003e\n\u003cdiv align=\"center\" style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:115%;font-size:16px;font-family:\"Aptos\",sans-serif;'\u003e\n \u003ctable style=\"width:379.5pt;border-collapse:collapse;border:none;\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 77.2pt;border: 1pt solid windowtext;background: rgb(209, 209, 209);padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;color:black;'\u003eVariable\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62.95pt;border-width: 1pt 1pt 1pt medium;border-style: solid solid solid none;border-color: windowtext windowtext windowtext currentcolor;border-image: initial;background: rgb(209, 209, 209);padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;color:black;'\u003eTotal\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52.6pt;border-width: 1pt 1pt 1pt medium;border-style: solid solid solid none;border-color: windowtext windowtext windowtext currentcolor;border-image: initial;background: rgb(209, 209, 209);padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;color:black;'\u003eControl\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61.9pt;border-width: 1pt 1pt 1pt medium;border-style: solid solid solid none;border-color: windowtext windowtext windowtext currentcolor;border-image: initial;background: rgb(209, 209, 209);padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;color:black;'\u003eCV only\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 68.75pt;border-width: 1pt 1pt 1pt medium;border-style: solid solid solid none;border-color: windowtext windowtext windowtext currentcolor;border-image: initial;background: rgb(209, 209, 209);padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;color:black;'\u003eCV + WA\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56.1pt;border-width: 1pt 1pt 1pt medium;border-style: solid solid solid none;border-color: windowtext windowtext windowtext currentcolor;border-image: initial;background: rgb(209, 209, 209);padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cstrong\u003e\u003cem\u003e\u003cspan style='font-size:13px;font-family:\"Arial\",sans-serif;color:black;'\u003ep\u003c/span\u003e\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;font-family:\"Arial\",sans-serif;color:black;'\u003e-value\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 77.2pt;border-width: medium 1pt 1pt;border-style: none solid solid;border-color: currentcolor windowtext windowtext;border-image: initial;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Arial\",sans-serif;color:black;'\u003eHouseholds inspected\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62.95pt;border-width: medium 1pt 1pt medium;border-style: none solid solid none;border-color: currentcolor windowtext windowtext currentcolor;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;color:black;'\u003e174\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52.6pt;border-width: medium 1pt 1pt medium;border-style: none solid solid none;border-color: currentcolor windowtext windowtext currentcolor;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;color:black;'\u003e60\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61.9pt;border-width: medium 1pt 1pt medium;border-style: none solid solid none;border-color: currentcolor windowtext windowtext currentcolor;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;color:black;'\u003e58\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 68.75pt;border-width: medium 1pt 1pt medium;border-style: none solid solid none;border-color: currentcolor windowtext windowtext currentcolor;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;color:black;'\u003e56\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56.1pt;border-width: medium 1pt 1pt medium;border-style: none solid solid none;border-color: currentcolor windowtext windowtext currentcolor;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;color:black;'\u003e-\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 77.2pt;border-width: medium 1pt 1pt;border-style: none solid solid;border-color: currentcolor windowtext windowtext;border-image: initial;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Arial\",sans-serif;color:black;'\u003eResidents involved\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62.95pt;border-width: medium 1pt 1pt medium;border-style: none solid solid none;border-color: currentcolor windowtext windowtext currentcolor;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;color:black;'\u003e756\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52.6pt;border-width: medium 1pt 1pt medium;border-style: none solid solid none;border-color: currentcolor windowtext windowtext currentcolor;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;color:black;'\u003e288\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61.9pt;border-width: medium 1pt 1pt medium;border-style: none solid solid none;border-color: currentcolor windowtext windowtext currentcolor;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;color:black;'\u003e217\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 68.75pt;border-width: medium 1pt 1pt medium;border-style: none solid solid none;border-color: currentcolor windowtext windowtext currentcolor;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;color:black;'\u003e251\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56.1pt;border-width: medium 1pt 1pt medium;border-style: none solid solid none;border-color: currentcolor windowtext windowtext currentcolor;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;color:black;'\u003e-\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 77.2pt;border-width: medium 1pt 1pt;border-style: none solid solid;border-color: currentcolor windowtext windowtext;border-image: initial;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Arial\",sans-serif;color:black;'\u003eHI \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Arial\",sans-serif;color:black;'\u003e[CI 95%]\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62.95pt;border-width: medium 1pt 1pt medium;border-style: none solid solid none;border-color: currentcolor windowtext windowtext currentcolor;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;color:black;'\u003e17.8%\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;color:black;'\u003e[12.4%-24.3%]\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52.6pt;border-width: medium 1pt 1pt medium;border-style: none solid solid none;border-color: currentcolor windowtext windowtext currentcolor;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;color:black;'\u003e33.3%\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;color:black;'\u003e[21.7%-46.7%]\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61.9pt;border-width: medium 1pt 1pt medium;border-style: none solid solid none;border-color: currentcolor windowtext windowtext currentcolor;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;color:black;'\u003e10.3%\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;color:black;'\u003e[3.9%-21.2%]\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 68.75pt;border-width: medium 1pt 1pt medium;border-style: none solid solid none;border-color: currentcolor windowtext windowtext currentcolor;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;color:black;'\u003e8.9%\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;color:black;'\u003e[2.9%-19.6%]\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56.1pt;border-width: medium 1pt 1pt medium;border-style: none solid solid none;border-color: currentcolor windowtext windowtext currentcolor;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;color:black;'\u003e0.0005*\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 77.2pt;border-width: medium 1pt 1pt;border-style: none solid solid;border-color: currentcolor windowtext windowtext;border-image: initial;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Arial\",sans-serif;color:black;'\u003eCI\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Arial\",sans-serif;color:black;'\u003e[CI 95%]\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62.95pt;border-width: medium 1pt 1pt medium;border-style: none solid solid none;border-color: currentcolor windowtext windowtext currentcolor;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;color:black;'\u003e8.3%\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;color:black;'\u003e[6.2%-10.8%]\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52.6pt;border-width: medium 1pt 1pt medium;border-style: none solid solid none;border-color: currentcolor windowtext windowtext currentcolor;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;color:black;'\u003e14.2%\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;color:black;'\u003e[10.0%-19.2%]\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61.9pt;border-width: medium 1pt 1pt medium;border-style: none solid solid none;border-color: currentcolor windowtext windowtext currentcolor;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;color:black;'\u003e6.0%\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;color:black;'\u003e[2.9%-10.8%]\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 68.75pt;border-width: medium 1pt 1pt medium;border-style: none solid solid none;border-color: currentcolor windowtext windowtext currentcolor;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;color:black;'\u003e2.7%\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;color:black;'\u003e[0.9%-6.1%]\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56.1pt;border-width: medium 1pt 1pt medium;border-style: none solid solid none;border-color: currentcolor windowtext windowtext currentcolor;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;color:black;'\u003e\u0026lt;0.001*\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 77.2pt;border-width: medium 1pt 1pt;border-style: none solid solid;border-color: currentcolor windowtext windowtext;border-image: initial;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Arial\",sans-serif;color:black;'\u003eBI \u003csup\u003ea\u003c/sup\u003e\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Arial\",sans-serif;color:black;'\u003e[CI 95%]\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62.95pt;border-width: medium 1pt 1pt medium;border-style: none solid solid none;border-color: currentcolor windowtext windowtext currentcolor;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;color:black;'\u003e28.2\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;color:black;'\u003e[21.6-35.5]\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52.6pt;border-width: medium 1pt 1pt medium;border-style: none solid solid none;border-color: currentcolor windowtext windowtext currentcolor;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;color:black;'\u003e56.7\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;color:black;'\u003e[43.2-69.4]\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61.9pt;border-width: medium 1pt 1pt medium;border-style: none solid solid none;border-color: currentcolor windowtext windowtext currentcolor;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;color:black;'\u003e17.2\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;color:black;'\u003e[8.59-29.4]\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 68.75pt;border-width: medium 1pt 1pt medium;border-style: none solid solid none;border-color: currentcolor windowtext windowtext currentcolor;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;color:black;'\u003e8.9\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;color:black;'\u003e[3-19.6]\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56.1pt;border-width: medium 1pt 1pt medium;border-style: none solid solid none;border-color: currentcolor windowtext windowtext currentcolor;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;color:black;'\u003e\u0026lt;0.001**\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 77.2pt;border-width: medium 1pt 1pt;border-style: none solid solid;border-color: currentcolor windowtext windowtext;border-image: initial;padding: 0in 5.4pt;height: 27.3pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Arial\",sans-serif;color:black;'\u003ePPI \u003csup\u003ea\u003c/sup\u003e\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Arial\",sans-serif;color:black;'\u003e[CI 95%]\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62.95pt;border-width: medium 1pt 1pt medium;border-style: none solid solid none;border-color: currentcolor windowtext windowtext currentcolor;padding: 0in 5.4pt;height: 27.3pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;color:black;'\u003e0.19\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;color:black;'\u003e[0.16-0.22]\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52.6pt;border-width: medium 1pt 1pt medium;border-style: none solid solid none;border-color: currentcolor windowtext windowtext currentcolor;padding: 0in 5.4pt;height: 27.3pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;color:black;'\u003e0.44\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;color:black;'\u003e[0.38-0.50]\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61.9pt;border-width: medium 1pt 1pt medium;border-style: none solid solid none;border-color: currentcolor windowtext windowtext currentcolor;padding: 0in 5.4pt;height: 27.3pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;color:black;'\u003e0.05\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;color:black;'\u003e[0.02-0.09]\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 68.75pt;border-width: medium 1pt 1pt medium;border-style: none solid solid none;border-color: currentcolor windowtext windowtext currentcolor;padding: 0in 5.4pt;height: 27.3pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;color:black;'\u003e0.03\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;color:black;'\u003e[0.01-0.06]\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56.1pt;border-width: medium 1pt 1pt medium;border-style: none solid solid none;border-color: currentcolor windowtext windowtext currentcolor;padding: 0in 5.4pt;height: 27.3pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;color:black;'\u003e\u0026lt;0.001**\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp style='margin:0in;text-align:left;font-size:13px;font-family:\"Arial\",sans-serif;'\u003e* HI and CI were compared across groups using chi-square tests.\u003c/p\u003e\n\u003cp style='margin:0in;text-align:left;font-size:13px;font-family:\"Arial\",sans-serif;'\u003e** BI and PPI were compared as rate-based indices using Poisson-based comparisons of aggregated counts.\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003ch3\u003eEffects of intervention on key preventive practices\u003c/h3\u003e\n\u003cp\u003ePre- and post-intervention proportions of key preventive practices are presented in Table 3. Initially, there were no statistically significant differences in pre-intervention practices between the study groups. After the intervention, the highest increases in key preventive practices were observed only in the CV + WA group, with significant percentage-point increases of 19.4 in cleaning of laundry tanks, 15.5 in the proper management of small breeding sites, and 9.3 in the covering of large breeding sites ( \u003cem\u003ep\u003c/em\u003e = \u0026lt; 0.001). No change was observed in the use of chlorine in tanks in the three groups (Figure 2).\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;text-align:justify;line-height:125%;font-size:13px;font-family:\"Arial\",sans-serif;font-weight:bold;'\u003e\u003cspan style=\"font-family:Arial;\"\u003eTable 3 Preventative practices before and after intervention in the\u0026nbsp;\u003c/span\u003e\u003cspan style=\"font-family:Arial;\"\u003ethree study groups\u003c/span\u003e\u003c/p\u003e\n\u003cdiv align=\"center\" style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:115%;font-size:16px;font-family:\"Aptos\",sans-serif;'\u003e\n \u003ctable style=\"width:436.1pt;border-collapse:collapse;border:none;\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 69.25pt;border: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:center;line-height:125%;font-size:13px;font-family:\"Arial\",sans-serif;font-weight:bold;'\u003e\u003cspan style=\"font-family:Arial;\"\u003ePractice\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 118.75pt;border-width: 1pt 1pt 1pt medium;border-style: solid solid solid none;border-color: windowtext windowtext windowtext currentcolor;border-image: initial;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:center;line-height:125%;font-size:13px;font-family:\"Arial\",sans-serif;font-weight:bold;'\u003e\u003cspan style=\"font-family:Arial;\"\u003eEstimations\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:center;line-height:125%;font-size:13px;font-family:\"Arial\",sans-serif;font-weight:bold;'\u003e\u003cspan style=\"font-family:Arial;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83.25pt;border-width: 1pt 1pt 1pt medium;border-style: solid solid solid none;border-color: windowtext windowtext windowtext currentcolor;border-image: initial;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:center;line-height:125%;font-size:13px;font-family:\"Arial\",sans-serif;font-weight:bold;'\u003e\u003cspan style=\"font-family:Arial;\"\u003eControl\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83.2pt;border-width: 1pt 1pt 1pt medium;border-style: solid solid solid none;border-color: windowtext windowtext windowtext currentcolor;border-image: initial;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:center;line-height:125%;font-size:13px;font-family:\"Arial\",sans-serif;font-weight:bold;'\u003e\u003cspan style=\"font-family:Arial;\"\u003eCV only\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81.65pt;border-width: 1pt 1pt 1pt medium;border-style: solid solid solid none;border-color: windowtext windowtext windowtext currentcolor;border-image: initial;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:center;line-height:125%;font-size:13px;font-family:\"Arial\",sans-serif;font-weight:bold;'\u003e\u003cspan style=\"font-family:Arial;\"\u003eCV+WA\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" style=\"width: 69.25pt;border-width: medium 1pt 1pt;border-style: none solid solid;border-color: currentcolor windowtext windowtext;border-image: initial;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:center;line-height:125%;font-size:13px;font-family:\"Arial\",sans-serif;font-weight:bold;'\u003e\u003cspan style=\"font-family:Arial;font-weight:normal;\"\u003eCleaning of laundry tanks\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 118.75pt;border-width: medium 1pt 1pt medium;border-style: none solid solid none;border-color: currentcolor windowtext windowtext currentcolor;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:center;line-height:125%;font-size:13px;font-family:\"Arial\",sans-serif;font-weight:bold;'\u003e\u003cspan style=\"font-family:Arial;font-weight:normal;\"\u003ePreintervention %\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:center;line-height:125%;font-size:13px;font-family:\"Arial\",sans-serif;font-weight:bold;'\u003e\u003cspan style=\"font-family:Arial;font-weight:normal;\"\u003e[95% CI]\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83.25pt;border-width: medium 1pt 1pt medium;border-style: none solid solid none;border-color: currentcolor windowtext windowtext currentcolor;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;'\u003e65.9%\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;'\u003e[60.4%, 71.3%]\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83.2pt;border-width: medium 1pt 1pt medium;border-style: none solid solid none;border-color: currentcolor windowtext windowtext currentcolor;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;'\u003e66.8%\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;'\u003e[61.4%, 72.2%]\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81.65pt;border-width: medium 1pt 1pt medium;border-style: none solid solid none;border-color: currentcolor windowtext windowtext currentcolor;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;'\u003e61.9%\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;'\u003e[56.3%, 67.5%]\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 118.75pt;border-width: medium 1pt 1pt medium;border-style: none solid solid none;border-color: currentcolor windowtext windowtext currentcolor;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:center;line-height:125%;font-size:13px;font-family:\"Arial\",sans-serif;font-weight:bold;'\u003e\u003cspan style=\"font-family:Arial;font-weight:normal;\"\u003ePostintervention %\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:center;line-height:125%;font-size:13px;font-family:\"Arial\",sans-serif;font-weight:bold;'\u003e\u003cspan style=\"font-family:Arial;font-weight:normal;\"\u003e[95% CI]\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83.25pt;border-width: medium 1pt 1pt medium;border-style: none solid solid none;border-color: currentcolor windowtext windowtext currentcolor;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;'\u003e67.6%\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;'\u003e[62.2%, 72.9%]\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83.2pt;border-width: medium 1pt 1pt medium;border-style: none solid solid none;border-color: currentcolor windowtext windowtext currentcolor;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;'\u003e74.3%\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;'\u003e[69.3%, 79.3%]\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81.65pt;border-width: medium 1pt 1pt medium;border-style: none solid solid none;border-color: currentcolor windowtext windowtext currentcolor;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;'\u003e81.3%\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;'\u003e[76.8%, 85.8%]\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 118.75pt;border-width: medium 1pt 1pt medium;border-style: none solid solid none;border-color: currentcolor windowtext windowtext currentcolor;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:center;line-height:125%;font-size:13px;font-family:\"Arial\",sans-serif;font-weight:bold;'\u003e\u003cspan style=\"font-family:Arial;font-weight:normal;\"\u003ePercentage-point change\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83.25pt;border-width: medium 1pt 1pt medium;border-style: none solid solid none;border-color: currentcolor windowtext windowtext currentcolor;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;'\u003e1.7\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83.2pt;border-width: medium 1pt 1pt medium;border-style: none solid solid none;border-color: currentcolor windowtext windowtext currentcolor;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;'\u003e7.5\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81.65pt;border-width: medium 1pt 1pt medium;border-style: none solid solid none;border-color: currentcolor windowtext windowtext currentcolor;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;'\u003e19.4\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 118.75pt;border-width: medium 1pt 1pt medium;border-style: none solid solid none;border-color: currentcolor windowtext windowtext currentcolor;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:center;line-height:125%;font-size:13px;font-family:\"Arial\",sans-serif;font-weight:bold;'\u003e\u003cem\u003e\u003cspan style=\"font-family:Arial;font-weight:normal;\"\u003ep\u003c/span\u003e\u003c/em\u003e\u003cspan style=\"font-family:Arial;font-weight:normal;\"\u003e-value*\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83.25pt;border-width: medium 1pt 1pt medium;border-style: none solid solid none;border-color: currentcolor windowtext windowtext currentcolor;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;color:black;'\u003e0.733\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83.2pt;border-width: medium 1pt 1pt medium;border-style: none solid solid none;border-color: currentcolor windowtext windowtext currentcolor;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;'\u003e0.066\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81.65pt;border-width: medium 1pt 1pt medium;border-style: none solid solid none;border-color: currentcolor windowtext windowtext currentcolor;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;color:black;'\u003e\u0026lt; 0.001\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" style=\"width: 69.25pt;border-width: medium 1pt 1pt;border-style: none solid solid;border-color: currentcolor windowtext windowtext;border-image: initial;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:center;line-height:125%;font-size:13px;font-family:\"Arial\",sans-serif;font-weight:bold;'\u003e\u003cspan style=\"font-family:Arial;font-weight:normal;\"\u003eProper management of small breeding sites\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 118.75pt;border-width: medium 1pt 1pt medium;border-style: none solid solid none;border-color: currentcolor windowtext windowtext currentcolor;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:center;line-height:125%;font-size:13px;font-family:\"Arial\",sans-serif;font-weight:bold;'\u003e\u003cspan style=\"font-family:Arial;font-weight:normal;\"\u003ePreintervention %\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:center;line-height:125%;font-size:13px;font-family:\"Arial\",sans-serif;font-weight:bold;'\u003e\u003cspan style=\"font-family:Arial;font-weight:normal;\"\u003e[95% CI]\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83.25pt;border-width: medium 1pt 1pt medium;border-style: none solid solid none;border-color: currentcolor windowtext windowtext currentcolor;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;'\u003e25.6%\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:center;line-height:125%;font-size:13px;font-family:\"Arial\",sans-serif;font-weight:bold;'\u003e\u003cspan style=\"font-family: Arial;color:black;font-weight:normal;\"\u003e[20.6%, 30.6%]\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83.2pt;border-width: medium 1pt 1pt medium;border-style: none solid solid none;border-color: currentcolor windowtext windowtext currentcolor;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;'\u003e29.8%\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:center;line-height:125%;font-size:13px;font-family:\"Arial\",sans-serif;font-weight:bold;'\u003e\u003cspan style=\"font-family: Arial;color:black;font-weight:normal;\"\u003e[24.5%, 35%]\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81.65pt;border-width: medium 1pt 1pt medium;border-style: none solid solid none;border-color: currentcolor windowtext windowtext currentcolor;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;'\u003e23.9%\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:center;line-height:125%;font-size:13px;font-family:\"Arial\",sans-serif;font-weight:bold;'\u003e\u003cspan style=\"font-family: Arial;color:black;font-weight:normal;\"\u003e[19%, 28.8%]\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 118.75pt;border-width: medium 1pt 1pt medium;border-style: none solid solid none;border-color: currentcolor windowtext windowtext currentcolor;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:center;line-height:125%;font-size:13px;font-family:\"Arial\",sans-serif;font-weight:bold;'\u003e\u003cspan style=\"font-family:Arial;font-weight:normal;\"\u003ePostintervention %\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:center;line-height:125%;font-size:13px;font-family:\"Arial\",sans-serif;font-weight:bold;'\u003e\u003cspan style=\"font-family:Arial;font-weight:normal;\"\u003e[95% CI]\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83.25pt;border-width: medium 1pt 1pt medium;border-style: none solid solid none;border-color: currentcolor windowtext windowtext currentcolor;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;'\u003e26.3%\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:center;line-height:125%;font-size:13px;font-family:\"Arial\",sans-serif;font-weight:bold;'\u003e\u003cspan style=\"font-family: Arial;color:black;font-weight:normal;\"\u003e[21.2%, 31.3%]\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83.2pt;border-width: medium 1pt 1pt medium;border-style: none solid solid none;border-color: currentcolor windowtext windowtext currentcolor;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;'\u003e27.7%\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:center;line-height:125%;font-size:13px;font-family:\"Arial\",sans-serif;font-weight:bold;'\u003e\u003cspan style=\"font-family: Arial;color:black;font-weight:normal;\"\u003e[22.6%, 32.9%]\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81.65pt;border-width: medium 1pt 1pt medium;border-style: none solid solid none;border-color: currentcolor windowtext windowtext currentcolor;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;'\u003e39.4%\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:center;line-height:125%;font-size:13px;font-family:\"Arial\",sans-serif;font-weight:bold;'\u003e\u003cspan style=\"font-family: Arial;color:black;font-weight:normal;\"\u003e[33.8%,45.1%]\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 118.75pt;border-width: medium 1pt 1pt medium;border-style: none solid solid none;border-color: currentcolor windowtext windowtext currentcolor;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:center;line-height:125%;font-size:13px;font-family:\"Arial\",sans-serif;font-weight:bold;'\u003e\u003cspan style=\"font-family:Arial;font-weight:normal;\"\u003ePercentage-point change\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83.25pt;border-width: medium 1pt 1pt medium;border-style: none solid solid none;border-color: currentcolor windowtext windowtext currentcolor;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:center;line-height:125%;font-size:13px;font-family:\"Arial\",sans-serif;font-weight:bold;'\u003e\u003cspan style=\"font-family:Arial;font-weight:normal;\"\u003e0.7\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83.2pt;border-width: medium 1pt 1pt medium;border-style: none solid solid none;border-color: currentcolor windowtext windowtext currentcolor;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:center;line-height:125%;font-size:13px;font-family:\"Arial\",sans-serif;font-weight:bold;'\u003e\u003cspan style=\"font-family:Arial;font-weight:normal;\"\u003e-2.1\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81.65pt;border-width: medium 1pt 1pt medium;border-style: none solid solid none;border-color: currentcolor windowtext windowtext currentcolor;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:center;line-height:125%;font-size:13px;font-family:\"Arial\",sans-serif;font-weight:bold;'\u003e\u003cspan style=\"font-family:Arial;font-weight:normal;\"\u003e15.9\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 118.75pt;border-width: medium 1pt 1pt medium;border-style: none solid solid none;border-color: currentcolor windowtext windowtext currentcolor;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:center;line-height:125%;font-size:13px;font-family:\"Arial\",sans-serif;font-weight:bold;'\u003e\u003cem\u003e\u003cspan style=\"font-family:Arial;font-weight:normal;\"\u003ep\u003c/span\u003e\u003c/em\u003e\u003cspan style=\"font-family:Arial;font-weight:normal;\"\u003e-value*\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83.25pt;border-width: medium 1pt 1pt medium;border-style: none solid solid none;border-color: currentcolor windowtext windowtext currentcolor;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:center;line-height:125%;font-size:13px;font-family:\"Arial\",sans-serif;font-weight:bold;'\u003e\u003cspan style=\"font-family: Arial;color:black;font-weight:normal;\"\u003e0.752\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83.2pt;border-width: medium 1pt 1pt medium;border-style: none solid solid none;border-color: currentcolor windowtext windowtext currentcolor;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:center;line-height:125%;font-size:13px;font-family:\"Arial\",sans-serif;font-weight:bold;'\u003e\u003cspan style=\"font-family: Arial;color:black;font-weight:normal;\"\u003e0.114\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81.65pt;border-width: medium 1pt 1pt medium;border-style: none solid solid none;border-color: currentcolor windowtext windowtext currentcolor;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:center;line-height:125%;font-size:13px;font-family:\"Arial\",sans-serif;font-weight:bold;'\u003e\u003cspan style=\"font-family: Arial;color:black;font-weight:normal;\"\u003e\u0026lt; 0.001\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" style=\"width: 69.25pt;border-width: medium 1pt 1pt;border-style: none solid solid;border-color: currentcolor windowtext windowtext;border-image: initial;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:center;line-height:125%;font-size:13px;font-family:\"Arial\",sans-serif;font-weight:bold;'\u003e\u003cspan style=\"font-family:Arial;font-weight:normal;\"\u003eCovering of large breeding sites\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 118.75pt;border-width: medium 1pt 1pt medium;border-style: none solid solid none;border-color: currentcolor windowtext windowtext currentcolor;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:center;line-height:125%;font-size:13px;font-family:\"Arial\",sans-serif;font-weight:bold;'\u003e\u003cspan style=\"font-family:Arial;font-weight:normal;\"\u003ePreintervention %\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:center;line-height:125%;font-size:13px;font-family:\"Arial\",sans-serif;font-weight:bold;'\u003e\u003cspan style=\"font-family:Arial;font-weight:normal;\"\u003e[95% CI]\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83.25pt;border-width: medium 1pt 1pt medium;border-style: none solid solid none;border-color: currentcolor windowtext windowtext currentcolor;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;'\u003e32.4%\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:center;line-height:125%;font-size:13px;font-family:\"Arial\",sans-serif;font-weight:bold;'\u003e\u003cspan style=\"font-family: Arial;color:black;font-weight:normal;\"\u003e[27.1%, 37.8%]\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83.2pt;border-width: medium 1pt 1pt medium;border-style: none solid solid none;border-color: currentcolor windowtext windowtext currentcolor;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;'\u003e27.7%\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:center;line-height:125%;font-size:13px;font-family:\"Arial\",sans-serif;font-weight:bold;'\u003e\u003cspan style=\"font-family: Arial;color:black;font-weight:normal;\"\u003e[22.6%, 32.9%]\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81.65pt;border-width: medium 1pt 1pt medium;border-style: none solid solid none;border-color: currentcolor windowtext windowtext currentcolor;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;'\u003e34.3%\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:center;line-height:125%;font-size:13px;font-family:\"Arial\",sans-serif;font-weight:bold;'\u003e\u003cspan style=\"font-family: Arial;color:black;font-weight:normal;\"\u003e[28.8%, 39.7%]\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 118.75pt;border-width: medium 1pt 1pt medium;border-style: none solid solid none;border-color: currentcolor windowtext windowtext currentcolor;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:center;line-height:125%;font-size:13px;font-family:\"Arial\",sans-serif;font-weight:bold;'\u003e\u003cspan style=\"font-family:Arial;font-weight:normal;\"\u003ePostintervention %\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:center;line-height:125%;font-size:13px;font-family:\"Arial\",sans-serif;font-weight:bold;'\u003e\u003cspan style=\"font-family:Arial;font-weight:normal;\"\u003e[95% CI]\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83.25pt;border-width: medium 1pt 1pt medium;border-style: none solid solid none;border-color: currentcolor windowtext windowtext currentcolor;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;'\u003e33.4%\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:center;line-height:125%;font-size:13px;font-family:\"Arial\",sans-serif;font-weight:bold;'\u003e\u003cspan style=\"font-family: Arial;color:black;font-weight:normal;\"\u003e[28%, 38.8%]\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83.2pt;border-width: medium 1pt 1pt medium;border-style: none solid solid none;border-color: currentcolor windowtext windowtext currentcolor;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;'\u003e27.4%\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:center;line-height:125%;font-size:13px;font-family:\"Arial\",sans-serif;font-weight:bold;'\u003e\u003cspan style=\"font-family: Arial;color:black;font-weight:normal;\"\u003e[22.3%, 32.5%]\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81.65pt;border-width: medium 1pt 1pt medium;border-style: none solid solid none;border-color: currentcolor windowtext windowtext currentcolor;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;'\u003e43.6%\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:center;line-height:125%;font-size:13px;font-family:\"Arial\",sans-serif;font-weight:bold;'\u003e\u003cspan style=\"font-family: Arial;color:black;font-weight:normal;\"\u003e[36.9%, 48.3%]\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 118.75pt;border-width: medium 1pt 1pt medium;border-style: none solid solid none;border-color: currentcolor windowtext windowtext currentcolor;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:center;line-height:125%;font-size:13px;font-family:\"Arial\",sans-serif;font-weight:bold;'\u003e\u003cspan style=\"font-family:Arial;font-weight:normal;\"\u003ePercentage-point change\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83.25pt;border-width: medium 1pt 1pt medium;border-style: none solid solid none;border-color: currentcolor windowtext windowtext currentcolor;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:center;line-height:125%;font-size:13px;font-family:\"Arial\",sans-serif;font-weight:bold;'\u003e\u003cspan style=\"font-family:Arial;font-weight:normal;\"\u003e1.0\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83.2pt;border-width: medium 1pt 1pt medium;border-style: none solid solid none;border-color: currentcolor windowtext windowtext currentcolor;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:center;line-height:125%;font-size:13px;font-family:\"Arial\",sans-serif;font-weight:bold;'\u003e\u003cspan style=\"font-family:Arial;font-weight:normal;\"\u003e-0.3\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81.65pt;border-width: medium 1pt 1pt medium;border-style: none solid solid none;border-color: currentcolor windowtext windowtext currentcolor;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:center;line-height:125%;font-size:13px;font-family:\"Arial\",sans-serif;font-weight:bold;'\u003e\u003cspan style=\"font-family: Arial;color:black;font-weight:normal;\"\u003e\u0026lt; 0.001\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 118.75pt;border-width: medium 1pt 1pt medium;border-style: none solid solid none;border-color: currentcolor windowtext windowtext currentcolor;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:center;line-height:125%;font-size:13px;font-family:\"Arial\",sans-serif;font-weight:bold;'\u003e\u003cem\u003e\u003cspan style=\"font-family:Arial;font-weight:normal;\"\u003ep\u003c/span\u003e\u003c/em\u003e\u003cspan style=\"font-family:Arial;font-weight:normal;\"\u003e-value*\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83.25pt;border-width: medium 1pt 1pt medium;border-style: none solid solid none;border-color: currentcolor windowtext windowtext currentcolor;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:center;line-height:125%;font-size:13px;font-family:\"Arial\",sans-serif;font-weight:bold;'\u003e\u003cspan style=\"font-family: Arial;color:black;font-weight:normal;\"\u003e0.863\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83.2pt;border-width: medium 1pt 1pt medium;border-style: none solid solid none;border-color: currentcolor windowtext windowtext currentcolor;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:center;line-height:125%;font-size:13px;font-family:\"Arial\",sans-serif;font-weight:bold;'\u003e\u003cspan style=\"font-family: Arial;color:black;font-weight:normal;\"\u003e1\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81.65pt;border-width: medium 1pt 1pt medium;border-style: none solid solid none;border-color: currentcolor windowtext windowtext currentcolor;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:center;line-height:125%;font-size:13px;font-family:\"Arial\",sans-serif;font-weight:bold;'\u003e\u003cspan style=\"font-family: Arial;color:black;font-weight:normal;\"\u003e0.016\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" style=\"width: 69.25pt;border-width: medium 1pt 1pt;border-style: none solid solid;border-color: currentcolor windowtext windowtext;border-image: initial;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:center;line-height:125%;font-size:13px;font-family:\"Arial\",sans-serif;font-weight:bold;'\u003e\u003cspan style=\"font-family:Arial;font-weight:normal;\"\u003eUse of chlorine in tanks\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 118.75pt;border-width: medium 1pt 1pt medium;border-style: none solid solid none;border-color: currentcolor windowtext windowtext currentcolor;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:center;line-height:125%;font-size:13px;font-family:\"Arial\",sans-serif;font-weight:bold;'\u003e\u003cspan style=\"font-family:Arial;font-weight:normal;\"\u003ePreintervention %\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:center;line-height:125%;font-size:13px;font-family:\"Arial\",sans-serif;font-weight:bold;'\u003e\u003cspan style=\"font-family:Arial;font-weight:normal;\"\u003e[95% CI]\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83.25pt;border-width: medium 1pt 1pt medium;border-style: none solid solid none;border-color: currentcolor windowtext windowtext currentcolor;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;'\u003e34.6%\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:center;line-height:125%;font-size:13px;font-family:\"Arial\",sans-serif;font-weight:bold;'\u003e\u003cspan style=\"font-family: Arial;color:black;font-weight:normal;\"\u003e[29.1%-40.1%]\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83.2pt;border-width: medium 1pt 1pt medium;border-style: none solid solid none;border-color: currentcolor windowtext windowtext currentcolor;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;'\u003e36.6%\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:center;line-height:125%;font-size:13px;font-family:\"Arial\",sans-serif;font-weight:bold;'\u003e\u003cspan style=\"font-family: Arial;color:black;font-weight:normal;\"\u003e[31.1%-42.2%]\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81.65pt;border-width: medium 1pt 1pt medium;border-style: none solid solid none;border-color: currentcolor windowtext windowtext currentcolor;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;'\u003e34.8%\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:center;line-height:125%;font-size:13px;font-family:\"Arial\",sans-serif;font-weight:bold;'\u003e\u003cspan style=\"font-family: Arial;color:black;font-weight:normal;\"\u003e[29.4%-40.3%]\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 118.75pt;border-width: medium 1pt 1pt medium;border-style: none solid solid none;border-color: currentcolor windowtext windowtext currentcolor;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:center;line-height:125%;font-size:13px;font-family:\"Arial\",sans-serif;font-weight:bold;'\u003e\u003cspan style=\"font-family:Arial;font-weight:normal;\"\u003ePostintervention %\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:center;line-height:125%;font-size:13px;font-family:\"Arial\",sans-serif;font-weight:bold;'\u003e\u003cspan style=\"font-family:Arial;font-weight:normal;\"\u003e[95% CI]\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83.25pt;border-width: medium 1pt 1pt medium;border-style: none solid solid none;border-color: currentcolor windowtext windowtext currentcolor;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;'\u003e31.8%\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:center;line-height:125%;font-size:13px;font-family:\"Arial\",sans-serif;font-weight:bold;'\u003e\u003cspan style=\"font-family: Arial;color:black;font-weight:normal;\"\u003e[26.5%-37.2%]\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83.2pt;border-width: medium 1pt 1pt medium;border-style: none solid solid none;border-color: currentcolor windowtext windowtext currentcolor;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;'\u003e36.3%\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:center;line-height:125%;font-size:13px;font-family:\"Arial\",sans-serif;font-weight:bold;'\u003e\u003cspan style=\"font-family: Arial;color:black;font-weight:normal;\"\u003e30.8%-41.8%]\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81.65pt;border-width: medium 1pt 1pt medium;border-style: none solid solid none;border-color: currentcolor windowtext windowtext currentcolor;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;'\u003e35.8%\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:center;line-height:125%;font-size:13px;font-family:\"Arial\",sans-serif;font-weight:bold;'\u003e\u003cspan style=\"font-family: Arial;color:black;font-weight:normal;\"\u003e[30.3%-41.3%]\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 118.75pt;border-width: medium 1pt 1pt medium;border-style: none solid solid none;border-color: currentcolor windowtext windowtext currentcolor;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:center;line-height:125%;font-size:13px;font-family:\"Arial\",sans-serif;font-weight:bold;'\u003e\u003cspan style=\"font-family:Arial;font-weight:normal;\"\u003ePercentage-point change\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83.25pt;border-width: medium 1pt 1pt medium;border-style: none solid solid none;border-color: currentcolor windowtext windowtext currentcolor;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:center;line-height:125%;font-size:13px;font-family:\"Arial\",sans-serif;font-weight:bold;'\u003e\u003cspan style=\"font-family:Arial;font-weight:normal;\"\u003e-2.8\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83.2pt;border-width: medium 1pt 1pt medium;border-style: none solid solid none;border-color: currentcolor windowtext windowtext currentcolor;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:center;line-height:125%;font-size:13px;font-family:\"Arial\",sans-serif;font-weight:bold;'\u003e\u003cspan style=\"font-family:Arial;font-weight:normal;\"\u003e-0.3\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81.65pt;border-width: medium 1pt 1pt medium;border-style: none solid solid none;border-color: currentcolor windowtext windowtext currentcolor;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:center;line-height:125%;font-size:13px;font-family:\"Arial\",sans-serif;font-weight:bold;'\u003e\u003cspan style=\"font-family:Arial;font-weight:normal;\"\u003e1.0\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 118.75pt;border-width: medium 1pt 1pt medium;border-style: none solid solid none;border-color: currentcolor windowtext windowtext currentcolor;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:center;line-height:125%;font-size:13px;font-family:\"Arial\",sans-serif;font-weight:bold;'\u003e\u003cem\u003e\u003cspan style=\"font-family:Arial;font-weight:normal;\"\u003ep\u003c/span\u003e\u003c/em\u003e\u003cspan style=\"font-family:Arial;font-weight:normal;\"\u003e-value*\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83.25pt;border-width: medium 1pt 1pt medium;border-style: none solid solid none;border-color: currentcolor windowtext windowtext currentcolor;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:center;line-height:125%;font-size:13px;font-family:\"Arial\",sans-serif;font-weight:bold;'\u003e\u003cspan style=\"font-family: Arial;color:black;font-weight:normal;\"\u003e0.523\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83.2pt;border-width: medium 1pt 1pt medium;border-style: none solid solid none;border-color: currentcolor windowtext windowtext currentcolor;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:center;line-height:125%;font-size:13px;font-family:\"Arial\",sans-serif;font-weight:bold;'\u003e\u003cspan style=\"font-family: Arial;color:black;font-weight:normal;\"\u003e1\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81.65pt;border-width: medium 1pt 1pt medium;border-style: none solid solid none;border-color: currentcolor windowtext windowtext currentcolor;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:center;line-height:125%;font-size:13px;font-family:\"Arial\",sans-serif;font-weight:bold;'\u003e\u003cspan style=\"font-family: Arial;color:black;font-weight:normal;\"\u003e0.863\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003csup\u003e\u003cspan style='font-size:16px;line-height:115%;font-family:\"Aptos\",sans-serif;'\u003e*\u003c/span\u003e\u003c/sup\u003e\u003cem\u003e\u003cspan style='font-size:16px;line-height:115%;font-family:\"Aptos\",sans-serif;'\u003ep\u003c/span\u003e\u003c/em\u003e\u003cspan style='font-size:16px;line-height:115%;font-family:\"Aptos\",sans-serif;'\u003e-values for within-group pre\u0026ndash;post comparisons were obtained using McNemar\u0026rsquo;s test.\u003cbr\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003eDifference-in-differences analysis showed that improvements in the CV + WA group were greater than those observed in the CV-only group and the control group combined for all practices, except chlorine use [Supplementary File 4]. In addition, multivariable logistic regression showed that the CV + WA group had higher odds of adopting key preventive practices than the control group, while chlorine tablet use was not associated with the intervention and was more related to sociodemographic factors [Supplementary File 5].\u0026nbsp;\u003c/p\u003e\n\u003ch3\u003eEffects of intervention on vector abundance\u003c/h3\u003e\n\u003cp\u003ePre- and post-intervention entomological proportions are presented in Table 4. Before the intervention, high proportion of vector abundance was found in the three groups. After the intervention, the highest reductions in entomological indices were observed in the CV + WA group, followed by the CV-only group. HI decreased by 22.8 percentage points in the CV + WA group and by 14.7 percentage points in the CV-only group, while it increased by 3.8 percentage points in the control group. Similar reductions were observed for other indices in the intervention groups (Figure 3). No improvement was seen in the control group. Difference-in-differences analysis showed that reductions in HI, CI, and BI were greater in the CV + WA group than in the CV-only and control groups combined [Supplementary File 4].\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;text-align:justify;line-height:125%;font-size:13px;font-family:\"Arial\",sans-serif;font-weight:bold;'\u003e\u003cspan style=\"font-family:Arial;\"\u003eTable 4\u0026nbsp;\u003c/span\u003e\u003cspan style=\"font-family:Arial;\"\u003eEntomological indicators before and after intervention in the three study groups\u003c/span\u003e\u003c/p\u003e\n\u003cdiv align=\"center\" style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:115%;font-size:16px;font-family:\"Aptos\",sans-serif;'\u003e\n \u003ctable style=\"width:389.6pt;border-collapse:collapse;border:none;\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 72.75pt;border: 1pt solid windowtext;background: rgb(209, 209, 209);padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;font-family:\"Arial\",sans-serif;color:black;'\u003eIndicator\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95.1pt;border-width: 1pt 1pt 1pt medium;border-style: solid solid solid none;border-color: windowtext windowtext windowtext currentcolor;border-image: initial;background: rgb(209, 209, 209);padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;font-family:\"Arial\",sans-serif;color:black;'\u003eEstimates\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61.55pt;border-width: 1pt 1pt 1pt medium;border-style: solid solid solid none;border-color: windowtext windowtext windowtext currentcolor;border-image: initial;background: rgb(209, 209, 209);padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;color:black;'\u003eControl\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82.2pt;border-width: 1pt 1pt 1pt medium;border-style: solid solid solid none;border-color: windowtext windowtext windowtext currentcolor;border-image: initial;background: rgb(209, 209, 209);padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;color:black;'\u003eCV only\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78pt;border-width: 1pt 1pt 1pt medium;border-style: solid solid solid none;border-color: windowtext windowtext windowtext currentcolor;border-image: initial;background: rgb(209, 209, 209);padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;color:black;'\u003eCV + WAM\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" style=\"width:72.75pt;border:solid windowtext 1.0pt;border-top:none;padding:0in 5.4pt 0in 5.4pt;height:13.5pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;font-family:\"Arial\",sans-serif;'\u003eHouse index\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Arial\",sans-serif;color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95.1pt;border-width: medium 1pt 1pt medium;border-style: none solid solid none;border-color: currentcolor windowtext windowtext currentcolor;padding: 0in 5.4pt;height: 13.5pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:125%;font-size:13px;font-family:\"Arial\",sans-serif;font-weight:bold;'\u003e\u003cspan style=\"font-family:Arial;font-weight:normal;\"\u003ePreintervention %\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Arial\",sans-serif;'\u003e[95% CI]\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61.55pt;border-width: medium 1pt 1pt medium;border-style: none solid solid none;border-color: currentcolor windowtext windowtext currentcolor;padding: 0in 5.4pt;height: 13.5pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;'\u003e29.4%\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;'\u003e[24.2, 34.9]\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:82.2pt;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:13.5pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;'\u003e27.1%\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;'\u003e\u0026nbsp;[22.0, 32.5]\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:78.0pt;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:13.5pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;'\u003e31.5%\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;'\u003e[26.2,37.2]\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 95.1pt;border-width: medium 1pt 1pt medium;border-style: none solid solid none;border-color: currentcolor windowtext windowtext currentcolor;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:125%;font-size:13px;font-family:\"Arial\",sans-serif;font-weight:bold;'\u003e\u003cspan style=\"font-family:Arial;font-weight:normal;\"\u003ePostintervention %\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Arial\",sans-serif;'\u003e[95% CI]\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:61.55pt;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;'\u003e33.1%\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;'\u003e[27.7, 38.8]\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:82.2pt;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;'\u003e12.3%\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;'\u003e\u0026nbsp;[8.8, 16.7]\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:78.0pt;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;'\u003e8.7%\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;'\u003e[5.7, 12.5]\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 95.1pt;border-width: medium 1pt 1pt medium;border-style: none solid solid none;border-color: currentcolor windowtext windowtext currentcolor;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Arial\",sans-serif;'\u003ePercentage-point change\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:61.55pt;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;'\u003e3.8\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:82.2pt;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;'\u003e-14.7\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:78.0pt;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;'\u003e-22.8\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 95.1pt;border-width: medium 1pt 1pt medium;border-style: none solid solid none;border-color: currentcolor windowtext windowtext currentcolor;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;'\u003e\u003cem\u003e\u003cspan style='font-size:13px;font-family:\"Arial\",sans-serif;'\u003ep\u003c/span\u003e\u003c/em\u003e\u003cspan style='font-size:13px;font-family:\"Arial\",sans-serif;'\u003e-value\u003c/span\u003e\u003cspan style='font-size:15px;font-family:\"Arial\",sans-serif;'\u003e*\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:61.55pt;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;'\u003e0.371\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:82.2pt;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;'\u003e\u0026lt;0.001\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:78.0pt;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;'\u003e\u0026lt;0.001\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" style=\"width:72.75pt;border:solid windowtext 1.0pt;border-top:none;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;font-family:\"Arial\",sans-serif;'\u003eContainer index\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Arial\",sans-serif;color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95.1pt;border-width: medium 1pt 1pt medium;border-style: none solid solid none;border-color: currentcolor windowtext windowtext currentcolor;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:125%;font-size:13px;font-family:\"Arial\",sans-serif;font-weight:bold;'\u003e\u003cspan style=\"font-family:Arial;font-weight:normal;\"\u003ePreintervention %\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Arial\",sans-serif;'\u003e[95% CI]\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:61.55pt;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;'\u003e12.8%\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;'\u003e[10.2, 15.4]\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:82.2pt;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;'\u003e11.2%\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;'\u003e[8.8, 13.5]\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:78.0pt;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;'\u003e11.8%\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;'\u003e[9.6,14.0]\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 95.1pt;border-width: medium 1pt 1pt medium;border-style: none solid solid none;border-color: currentcolor windowtext windowtext currentcolor;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:125%;font-size:13px;font-family:\"Arial\",sans-serif;font-weight:bold;'\u003e\u003cspan style=\"font-family:Arial;font-weight:normal;\"\u003ePostintervention %\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Arial\",sans-serif;'\u003e[95% CI]\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:61.55pt;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;'\u003e12.8%\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;'\u003e\u0026nbsp;[10.2, 15.3]\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:82.2pt;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;'\u003e5.9%\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;'\u003e[3.8, 8.0]\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:78.0pt;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;'\u003e3.8%\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;'\u003e[2.2, 5.4]\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 95.1pt;border-width: medium 1pt 1pt medium;border-style: none solid solid none;border-color: currentcolor windowtext windowtext currentcolor;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Arial\",sans-serif;'\u003ePercentage-point change\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:61.55pt;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;'\u003e-0.1\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:82.2pt;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;'\u003e-5.2\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:78.0pt;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;'\u003e-8.0\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 95.1pt;border-width: medium 1pt 1pt medium;border-style: none solid solid none;border-color: currentcolor windowtext windowtext currentcolor;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;'\u003e\u003cem\u003e\u003cspan style='font-size:13px;font-family:\"Arial\",sans-serif;'\u003ep\u003c/span\u003e\u003c/em\u003e\u003cspan style='font-size:13px;font-family:\"Arial\",sans-serif;'\u003e-value\u003c/span\u003e\u003cspan style='font-size:15px;font-family:\"Arial\",sans-serif;'\u003e*\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:61.55pt;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;'\u003e0.911\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:82.2pt;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;'\u003e0.001\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:78.0pt;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;'\u003e\u0026lt;0.001\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" style=\"width:72.75pt;border:solid windowtext 1.0pt;border-top:none;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Arial\",sans-serif;color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;font-family:\"Arial\",sans-serif;'\u003eBreteau index\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Arial\",sans-serif;color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95.1pt;border-width: medium 1pt 1pt medium;border-style: none solid solid none;border-color: currentcolor windowtext windowtext currentcolor;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:125%;font-size:13px;font-family:\"Arial\",sans-serif;font-weight:bold;'\u003e\u003cspan style=\"font-family:Arial;font-weight:normal;\"\u003ePreintervention %\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Arial\",sans-serif;'\u003e[95% CI]\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:61.55pt;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;'\u003e0.35\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;'\u003e[0.28, 0.42]\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:82.2pt;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;'\u003e0.28\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;'\u003e[0.23, 0.34]\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:78.0pt;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;'\u003e0.37\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;'\u003e[0.30, 0.44]\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 95.1pt;border-width: medium 1pt 1pt medium;border-style: none solid solid none;border-color: currentcolor windowtext windowtext currentcolor;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:125%;font-size:13px;font-family:\"Arial\",sans-serif;font-weight:bold;'\u003e\u003cspan style=\"font-family:Arial;font-weight:normal;\"\u003ePostintervention %\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Arial\",sans-serif;'\u003e[95% CI]\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:61.55pt;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;'\u003e0.42\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;'\u003e[0.34, 0.50]\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:82.2pt;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;'\u003e0.15\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;'\u003e[0.10, 0.21]\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:78.0pt;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;'\u003e0.11\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;'\u003e[0.06, 0.16]\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 95.1pt;border-width: medium 1pt 1pt medium;border-style: none solid solid none;border-color: currentcolor windowtext windowtext currentcolor;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Arial\",sans-serif;'\u003ePercentage-point change\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:61.55pt;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;'\u003e0.07\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:82.2pt;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;'\u003e-0.13\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:78.0pt;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;'\u003e-0.26\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 95.1pt;border-width: medium 1pt 1pt medium;border-style: none solid solid none;border-color: currentcolor windowtext windowtext currentcolor;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;'\u003e\u003cem\u003e\u003cspan style='font-size:13px;font-family:\"Arial\",sans-serif;'\u003ep\u003c/span\u003e\u003c/em\u003e\u003cspan style='font-size:13px;font-family:\"Arial\",sans-serif;'\u003e-value\u003c/span\u003e\u003cspan style='font-size:15px;font-family:\"Arial\",sans-serif;'\u003e*\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61.55pt;border-width: medium 1pt 1pt medium;border-style: none solid solid none;border-color: currentcolor windowtext windowtext currentcolor;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;'\u003e0.176\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:82.2pt;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;'\u003e\u0026lt;0.001\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:78.0pt;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;'\u003e\u0026lt;0.001\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" style=\"width:72.75pt;border:solid windowtext 1.0pt;border-top:none;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;font-family:\"Arial\",sans-serif;'\u003ePupae per person index\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95.1pt;border-width: medium 1pt 1pt medium;border-style: none solid solid none;border-color: currentcolor windowtext windowtext currentcolor;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:125%;font-size:13px;font-family:\"Arial\",sans-serif;font-weight:bold;'\u003e\u003cspan style=\"font-family:Arial;font-weight:normal;\"\u003ePreintervention %\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Arial\",sans-serif;'\u003e[95% CI]\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:61.55pt;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;'\u003e1.026\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;'\u003e[0.636, 1.415]\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:82.2pt;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;'\u003e0.817\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;'\u003e[0.476, 1.157]\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:78.0pt;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;'\u003e0.657\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;'\u003e[0.331, 0.984]\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 95.1pt;border-width: medium 1pt 1pt medium;border-style: none solid solid none;border-color: currentcolor windowtext windowtext currentcolor;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:125%;font-size:13px;font-family:\"Arial\",sans-serif;font-weight:bold;'\u003e\u003cspan style=\"font-family:Arial;font-weight:normal;\"\u003ePostintervention %\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Arial\",sans-serif;'\u003e[95% CI]\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:61.55pt;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;'\u003e0.642\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;'\u003e[0.310, 0.975]\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:82.2pt;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;'\u003e0.113\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;'\u003e[0.040, 0.186]\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:78.0pt;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;'\u003e0.141\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;'\u003e[-0.010, 0.293]\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 95.1pt;border-width: medium 1pt 1pt medium;border-style: none solid solid none;border-color: currentcolor windowtext windowtext currentcolor;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Arial\",sans-serif;'\u003ePercentage-point change\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:61.55pt;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;'\u003e-0.384\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:82.2pt;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;'\u003e-0.704\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:78.0pt;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;'\u003e-0.516\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 95.1pt;border-width: medium 1pt 1pt medium;border-style: none solid solid none;border-color: currentcolor windowtext windowtext currentcolor;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;'\u003e\u003cem\u003e\u003cspan style='font-size:13px;font-family:\"Arial\",sans-serif;'\u003ep\u003c/span\u003e\u003c/em\u003e\u003cspan style='font-size:13px;font-family:\"Arial\",sans-serif;'\u003e-value\u003c/span\u003e\u003cspan style='font-size:15px;font-family:\"Arial\",sans-serif;'\u003e*\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:61.55pt;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;'\u003e0.115\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:82.2pt;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;'\u003e\u0026lt;0.001\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:78.0pt;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family: \"Arial\",sans-serif;'\u003e\u0026lt;0.001\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp style='margin:0in;text-align:justify;font-size:13px;font-family:\"Arial\",sans-serif;'\u003e\u0026nbsp;\u003csup\u003e*\u003c/sup\u003e\u003cem\u003ep\u003c/em\u003e-values for Control group, CV only group, and CV + WA group were analysed using McNemar\u0026apos;s test for HI and Wilcoxon signed-rank tests for CI, BI, and PPI.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003ch3\u003eCommunity engagement\u003c/h3\u003e\n\u003cp\u003eCommunity engagement in vector control activities was particularly evident during the IC application. During household visits in both groups, the field team observed and recorded households that followed the instructions, particularly emptying and cleaning the tanks and allowing the IC to be applied. Willingness to reapply the product was also assessed. All three indicators were higher in the CV + WA group than in the CV-only group (Figure 4).\u003c/p\u003e\n\u003ch3\u003ePerception of WhatsApp\u003c/h3\u003e\n\u003cp\u003eHigh ratings were observed for most items of WhatsApp acceptability, particularly perceived usefulness (4.87), family prevention support (4.80), perceived enjoyment (4.85), and user satisfaction (4.82) (Figure 5). Responses to these items were predominantly positive, with most participants selecting \u0026ldquo;totally agree\u0026rdquo; or \u0026ldquo;agree.\u0026rdquo; In contrast, the item related to perceived annoyance received a very low mean score (1.10), indicating that participants generally did not find the messages annoying.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis implementation study evaluated the use of WhatsApp as a digital tool to promote key practices for arboviral disease prevention and community engagement in vector control activities in urban endemic communities in Colombia. The CV\u0026thinsp;+\u0026thinsp;WA intervention group showed the greatest improvements in key preventive practices. Larval and pupal indices decreased in both intervention groups compared with the control group, but the reduction was significantly greater in the group that integrated WhatsApp (CV\u0026thinsp;+\u0026thinsp;WA group). Strong community engagement was reflected in the high proportion of households that participated in IC application and followed the instructions delivered through WhatsApp and community visits. In addition, community users gave positive ratings to the WhatsApp messages, suggesting that this app was well accepted in urban communities in Colombia.\u003c/p\u003e \u003cp\u003eDigital technologies have been increasingly used to support health promotion, including in low-resource settings [\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e]. For arboviral disease prevention, SMS-based interventions have shown potential to improve household practices and, in some settings, reduce \u003cem\u003eAedes\u003c/em\u003e indices in Nepal and Peru [\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e, \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e]. However, unidirectional SMS-only interventions may limit interactivity, which can make sustained engagement more challenging, particularly in remote settings [\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e]. As smartphone access has expanded, researchers have developed new digital systems consisting of web-based platforms and mobile apps for dengue prevention and control (e.g., VECTOS, VazaDengue, MEWAR) [\u003cspan additionalcitationids=\"CR49\" citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e]. In this study, rather than developing a new application, we leveraged a familiar and widely used platform. WhatsApp, Facebook Messenger, and WeChat enable rapid two-way communication and multimedia sharing, which can strengthen message reinforcement and user engagement [\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e]. Given the need to reach many households and engage the community in the vector control operations, WhatsApp was chosen as a two-way communication tool in areas where smartphones and WhatsApp were widely used. This approach aligns with evidence suggesting that adapting mHealth interventions to local technological preferences and capacities are essential for sustainability [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn this study, WhatsApp was not implemented as an isolated tool; rather, it was combined within other communication components such as the use of loudspeakers and community visits during the IC application period. This approach aligns with the WHO Communication for Behavioural Impact framework, which emphasizes the combination of interpersonal communication and community mobilization, often supported by mass media, to facilitate the adoption and maintenance of preventive behaviors [\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e]. A recent systematic review highlighted that this approach could improve knowledge, attitudes, and practices and thus reductions in mosquito breeding sites and subsequently of dengue incidence [\u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e]. In this study, households exposed to multiple communication components, including WhatsApp, experienced greater improvements in preventive practices and larger reductions in vector densities compared to those with little exposure. Although these effects cannot be fully attributed to WhatsApp alone, its integration into vector control programs may well support dengue, chikungunya, and Zika prevention.\u003c/p\u003e \u003cp\u003eCommunity engagement was another positive outcome observed in this study, particularly regarding the application of IC among households exposed to WhatsApp messaging. Previous research has shown that engagement in mHealth interventions can be strengthened through the use of reminders, personalized messages, timely feedback, opportunities for peer support within the app, and incentives or other forms of compensation. [\u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e, \u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e]. In our study, several of these features were incorporated into the WhatsApp group intervention. Although no monetary incentives were provided to the community, the provision of IC at no cost may have been perceived as a non-financial benefit. As IC was provided in both intervention groups (CV\u0026thinsp;+\u0026thinsp;WA and CV only), the higher engagement observed in the CV\u0026thinsp;+\u0026thinsp;WA group may be partly attributed by the additional elements incorporated into the WhatsApp intervention.\u003c/p\u003e \u003cp\u003eTechnical issues are among the most commonly reported barriers in digital health interventions. Problems related to infrastructure, geographical access, low or unstable internet connectivity, and incompatibility between apps and devices have been identified as barriers to the sustained use of app-based interventions [\u003cspan additionalcitationids=\"CR57\" citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e58\u003c/span\u003e], and these challenges are often greater in low- and middle-income countries [\u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e59\u003c/span\u003e]. Although some of these barriers cannot be fully eliminated, they may be mitigated when using WhatsApp compared with other health applications, as users are already familiar with its ease of use [\u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e59\u003c/span\u003e]. In addition, mobile operators may offer low-cost bundles or zero-rated access for specific applications. For example, in Colombia, many operators include zero-rated access to WhatsApp and Facebook in their postpaid and prepaid mobile plans [\u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e60\u003c/span\u003e], which may facilitate continued participation and reduce cost-related barriers.\u003c/p\u003e \u003cp\u003eTechnical issues are among the most commonly reported barriers in digital health interventions. Challenges related to infrastructure, network access, low or unstable internet connectivity, and incompatibility between apps and devices have been identified as barriers to the sustained use of app-based interventions [\u003cspan additionalcitationids=\"CR57\" citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e58\u003c/span\u003e], particularly in low- and middle-income countries [\u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e59\u003c/span\u003e]. Although some of these barriers cannot be fully eliminated, they may be mitigated in settings where WhatsApp is widely used and where mobile operators offer low-cost bundles or zero-rated access for specific applications. In Colombia, for example, many operators include zero-rated access to WhatsApp and Facebook in their postpaid and prepaid mobile plans [\u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e60\u003c/span\u003e], which may support continued use and lower cost-related barriers.\u003c/p\u003e \u003cp\u003eData protection is another critical issue in digital interventions, particularly given the variation in ethical standards and regulatory frameworks across countries [\u003cspan citationid=\"CR61\" class=\"CitationRef\"\u003e61\u003c/span\u003e, \u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e62\u003c/span\u003e]. Although WhatsApp is a familiar app to many users, its use in health-related programs raises challenges related to privacy, informed consent, and record keeping [\u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e63\u003c/span\u003e]. WhatsApp may not fully meet the requirements expected under health data protection frameworks [\u003cspan citationid=\"CR64\" class=\"CitationRef\"\u003e64\u003c/span\u003e]. Legal requirements for data storage and protection are complex and depend on the legislation of each country [\u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e63\u003c/span\u003e]. For the implementation of WhatsApp, this study followed the national data protection law, which regulates the processing of personal data and requires informed consent and appropriate security safeguards [\u003cspan citationid=\"CR65\" class=\"CitationRef\"\u003e65\u003c/span\u003e]. However, future work should be accompanied by clear protocols and guidelines for data management and protection.\u003c/p\u003e \u003cp\u003eDespite these challenges, this study provides pioneering evidence that the use of WhatsApp can strengthen community engagement and support the uptake of household-level vector control interventions in endemic urban settings. The findings suggest that integrating WhatsApp into routine vector control activities may improve preventive practices, support vector control operations, and enhance community engagement. This study, together with another recent study, supports the idea that WhatsApp is a feasible tool for arboviral disease prevention [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. However, important questions remain regarding its scalability and sustainability within routine public health programmes. Therefore, future research should include economic and operational analyses to assess the long-term sustainability and scalability of adding WhatsApp to vector control programmes for arboviral disease prevention.\u003c/p\u003e \u003cp\u003eLimitations\u003c/p\u003e \u003cp\u003eAlthough this study adds valuable evidence on the use of WhatsApp as a digital tool for dengue, chikungunya, and Zika prevention, some contextual and methodological considerations should be taken into account when interpreting the findings. First, the intervention was mainly designed to promote household preventive behaviours, with a strong emphasis on the promotion of the IC in tanks. Therefore, generalizability to other prevention practices may be limited, particularly for behaviours that are promoted in isolation or require different enabling conditions. Second, this was an implementation-oriented, exploratory study using a quasi-experimental design. A randomized controlled trial was not feasible given the community-based and behavioural nature of the intervention and operational constraints. The findings should be interpreted within the context of a pragmatic evaluation conducted under real-world program conditions. Third, preventive practices were evaluated using self-reported data and may be subject to recall and social desirability bias. However, the inclusion of entomological indicators and direct observation related to IC intervention provided objective measures that strengthen community involvement beyond self-report alone. Finally, the intervention was conducted in urban communities in Colombia with high smartphone penetration and a generally favourable attitude toward receiving preventive messages. Transferability to settings with lower digital access, different communication preferences, or weaker connectivity may therefore be limited and should be assessed in future studies.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThe integration of WhatsApp into arboviral disease prevention activities demonstrated the potential of digital tools to strengthen community engagement in health programmes. Improvements in preventive practices and reductions in vector abundance were observed when WhatsApp was combined with community visits. These findings suggest that adding WhatsApp messaging to vector control programmes may support preventive actions, particularly those requiring household preparation and active participation. WhatsApp was also found to be an acceptable tool within communities; however, further research is needed to assess implementation processes and the scalability of the intervention.\u003c/p\u003e"},{"header":"List of Abbreviations","content":"\u003cp\u003eBI\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Breteau index\u003c/p\u003e\n\u003cp\u003eCI\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Container index\u003c/p\u003e\n\u003cp\u003eCV\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Community visits\u003c/p\u003e\n\u003cp\u003eDiD\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Difference-in-Differences\u003c/p\u003e\n\u003cp\u003eHI\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;House index\u003c/p\u003e\n\u003cp\u003eIC\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Insecticidal coating\u003c/p\u003e\n\u003cp\u003eMinciencias\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Ministry of Science, Technology and Innovation\u003c/p\u003e\n\u003cp\u003eMoH\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Ministry of Health\u003c/p\u003e\n\u003cp\u003ePPI\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Pupae per person index\u003c/p\u003e\n\u003cp\u003eWA \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;WhatsApp\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eEthics approval and consent to participate\u003c/h2\u003e\n\u003cp\u003eParticipation in this study was voluntary and anonymous, and it posed no risk to the participants or their households. Written informed consent was obtained from all participants prior to data collection. No financial or other compensation was provided for participation. Registration in WhatsApp was completed using codes, and no names were entered into the mobile application. Individuals under 18 years of age were excluded from the study. Original documents were stored securely in a locked place and were not accessible to unauthorized individuals. All procedures involving human participants were performed in accordance with relevant guidelines and regulations, including the Declaration of Helsinki and its later amendments. The study protocol was approved by the Ethics Committee of the University of Freiburg (protocol study number: 142/19), and the intervention was also authorized by the local health authorities in Colombia. Registration of the trial, ClinicalTrials.gov ID: NCT07517731.\u003c/p\u003e\n\u003ch2\u003eConsent for publication\u003c/h2\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003ch2\u003eAvailability of data and materials\u003c/h2\u003e\n\u003cp\u003eThe datasets generated and/or analysed during the current study are available in the bwSync\u0026amp;Share repository, https://bwsyncandshare.kit.edu/s/G8Fi63cZLoRESL8.\u003c/p\u003e\n\u003ch2\u003eCompeting interests\u003c/h2\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\n\u003ch2\u003eFunding\u003c/h2\u003e\n\u003cp\u003eOpen Access funding enabled and organized by Projekt DEAL. MAC and RCS were awarded doctoral scholarships by the Ministry of Science, Technology and Innovation (Minciencias) and the Government of Norte de Santander, Colombia (Call No. 753).\u0026nbsp;TRR was also awarded a national doctoral scholarship by Minciencias. Neither Minciencias nor the Government of Norte de Santander had any active role in the study design, data collection, data analysis, interpretation of the findings, or preparation of the manuscript.\u003c/p\u003e\n\u003ch2\u003eAuthors\u0026apos; contributions\u003c/h2\u003e\n\u003cp\u003eAll authors contributed to the concept and design of the study. MAC and AK drafted the paper. WVK, JL, and AK provided substantial edits on the paper. MAC prepared the submission to the ethical committee. All authors read and approved the study and the procedures. MAC, RCS, SKC, and TRR prepared and conducted interviewer training. MAC, RCS, SKC, TRR, and JY prepared the field study, contacted the local leaders and organized the logistics. MAC coordinated and managed the WhatsApp messages. MAC contributed to the statistical analysis. MAC, WVK, JL, SKC, and AK formatted, revised and corrected the article until its final version. All authors read and commented on the draft paper and approved the final version.\u0026nbsp;\u003c/p\u003e\n\u003ch2\u003eAcknowledgements\u003c/h2\u003e\n\u003cp\u003eThe authors thank the study participants, the local associations, IDS Norte de Santander, and the vector control teams in both municipalities for their support. We also acknowledge the members of the Centre for Planetary Health at the University of Freiburg for their encouragement, Juan Camilo Ardila for his support with WhatsApp message management, and Adrian Ostre, Diego Fernando Carrillo, Gloria Liliana Mendoza, and Camila Andrea Barbosa for their valuable contributions. MAC, TRR, and RCS also acknowledge Minciencias, while MAC and RCS particularly thank the Government of Norte de Santander, Colombia, for supporting their doctoral studies.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eWHO guidelines for clinical management of arboviral diseases: dengue, chikungunya, Zika and yellow fever [Internet]. Geneva: World Health Organization. 2025 [cited 2025 Apr 01]. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.who.int/publications/i/item/9789240111110\u003c/span\u003e\u003cspan address=\"https://www.who.int/publications/i/item/9789240111110\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLeta S, Beyene TJ, De Clercq EM, Amenu K, Kraemer MUG, Revie CW. Global risk mapping for major diseases transmitted by Aedes aegypti and Aedes albopictus. Int J Infect Dis. 2018;67:25\u0026ndash;35.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKraemer MU, Sinka ME, Duda KA, Mylne AQ, Shearer FM, Barker CM, et al. The global distribution of the arbovirus vectors Aedes aegypti and Ae. albopictus. Elife. 2015;4:e08347. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.7554/eLife.08347\u003c/span\u003e\u003cspan address=\"10.7554/eLife.08347\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVentura CV, Ventura LO. Ophthalmologic manifestations associated with Zika virus infection. Pediatrics. 2018;141(Suppl 2):S161\u0026ndash;6. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1542/peds.2017-2038E\u003c/span\u003e\u003cspan address=\"10.1542/peds.2017-2038E\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFai\u0026ccedil;al AV, de Oliveira JC, Oliveira JVV, Almeida BL, Agra IA, Alcantara LCJ, et al. Neurodevelopmental delay in normocephalic children with in utero exposure to Zika virus. BMJ Paediatr Open. 2019;3(1):e000486. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1136/bmjpo-2019-000486\u003c/span\u003e\u003cspan address=\"10.1136/bmjpo-2019-000486\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJing Q, Wang M. Dengue epidemiology. Glob Health J. 2019;3(2):37\u0026ndash;45. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.glohj.2019.06.002\u003c/span\u003e\u003cspan address=\"10.1016/j.glohj.2019.06.002\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWeaver SC, Lecuit M. Chikungunya virus and the global spread of a mosquito-borne disease. N Engl J Med. 2015;372(13):1231\u0026ndash;9. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1056/NEJMra1406035\u003c/span\u003e\u003cspan address=\"10.1056/NEJMra1406035\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGutierrez-Barbosa H, Medina-Moreno S, Zapata JC, Chua JV. Dengue Infections in Colombia: Epidemiological Trends of a Hyperendemic Country. Trop Med Infect Dis. 2020;5(4):156. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3390/tropicalmed5040156\u003c/span\u003e\u003cspan address=\"10.3390/tropicalmed5040156\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eInstituto Nacional de Salud. Bolet\u0026iacute;n Epidemiol\u0026oacute;gico Semanal. Semana 52 de 2019 [Internet]. Bogot\u0026aacute;: INS. 2019 [cited 2026 Apr 03]. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.ins.gov.co/buscador-eventos/BoletinEpidemiologico/2019_Boletin_epidemiologico_semana_52.pdf\u003c/span\u003e\u003cspan address=\"https://www.ins.gov.co/buscador-eventos/BoletinEpidemiologico/2019_Boletin_epidemiologico_semana_52.pdf\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eInstituto Nacional de Salud. Informe final del evento chikungu\u0026ntilde;a, Colombia, 2014 [Internet]. Bogot\u0026aacute;: INS. 2014 [cited 2025 Feb 21]. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.ins.gov.co/buscador-eventos/Informesdeevento/Chikungu\u0026ntilde;a%202014.pdf\u003c/span\u003e\u003cspan address=\"https://www.ins.gov.co/buscador-eventos/Informesdeevento/Chikungu\u0026ntilde;a%202014.pdf\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eInstituto Nacional de Salud. Informe final del evento chikungu\u0026ntilde;a, Colombia, 2015 [Internet]. Bogot\u0026aacute;: INS. 2015 [cited 2026 Apr 03]. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.ins.gov.co/buscador-eventos/Informesdeevento/Chikungu\u0026ntilde;a%202015.pdf\u003c/span\u003e\u003cspan address=\"https://www.ins.gov.co/buscador-eventos/Informesdeevento/Chikungu\u0026ntilde;a%202015.pdf\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOrganizaci\u0026oacute;n Panamericana de la Salud. Zika: actualizaci\u0026oacute;n epidemiol\u0026oacute;gica [Internet]. Washington (DC): Organizaci\u0026oacute;n Panamericana de la Salud; 2016 Jun 16 [cited 2026 Apr 03]. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://iris.paho.org/server/api/core/bitstreams/71f0882a-be4e-4765-b0f7-074f14eb1199/content\u003c/span\u003e\u003cspan address=\"https://iris.paho.org/server/api/core/bitstreams/71f0882a-be4e-4765-b0f7-074f14eb1199/content\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCarrillo MA, C\u0026aacute;rdenas R, Ya\u0026ntilde;ez J, Petzold M, Kroeger A. Risk of dengue, Zika, and chikungunya transmission in the metropolitan area of C\u0026uacute;cuta, Colombia: cross-sectional analysis, baseline for a cluster-randomised controlled trial of a novel vector tool for water containers. BMC Public Health. 2023;23(1):1000. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s12889-023-15893-4\u003c/span\u003e\u003cspan address=\"10.1186/s12889-023-15893-4\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYoung PR. Arboviruses: a family on the move. Adv Exp Med Biol. 2018;1062:1\u0026ndash;10.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKraemer MUG, Reiner RC Jr, Brady OJ, Messina JP, Gilbert M, Pigott DM, et al. Publisher correction: Past and future spread of the arbovirus vectors Aedes aegypti and Aedes albopictus. Nat Microbiol. 2019;4(5):901. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1038/s41564-019-0440-7\u003c/span\u003e\u003cspan address=\"10.1038/s41564-019-0440-7\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMayer SV, Tesh RB, Vasilakis N. The emergence of arthropod-borne viral diseases: a global prospective on dengue, chikungunya and Zika fevers. Acta Trop. 2017;166:155\u0026ndash;63. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.actatropica.2016.11.020\u003c/span\u003e\u003cspan address=\"10.1016/j.actatropica.2016.11.020\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLiang G, Gao X, Gould EA. Factors responsible for the emergence of arboviruses; strategies, challenges and limitations for their control. Emerg Microbes Infect. 2015;4(3):e18. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1038/emi.2015.18\u003c/span\u003e\u003cspan address=\"10.1038/emi.2015.18\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLindahl JF, Grace D. The consequences of human actions on risks for infectious diseases: a review. Infect Ecol Epidemiol. 2015;5:30048. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3402/iee.v5.30048\u003c/span\u003e\u003cspan address=\"10.3402/iee.v5.30048\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVillar LA, Rojas DP, Besada-Lombana S, Sarti E. Epidemiological trends of dengue disease in Colombia (2000\u0026ndash;2011): a systematic review. PLoS Negl Trop Dis. 2015;9(3):e0003499. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1371/journal.pntd.0003499\u003c/span\u003e\u003cspan address=\"10.1371/journal.pntd.0003499\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKamtchum-Tatuene J, Makepeace BL, Benjamin L, Baylis M, Solomon T. The potential role of Wolbachia in controlling the transmission of emerging human arboviral infections. Curr Opin Infect Dis. 2017;30(1):108\u0026ndash;16. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1097/QCO.0000000000000342\u003c/span\u003e\u003cspan address=\"10.1097/QCO.0000000000000342\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCapeding MR, Tran NH, Hadinegoro SR, Ismail HI, Chotpitayasunondh T, Chua MN, Luong CQ, Rusmil K, Wirawan DN, Nallusamy R, Pitisuttithum P, Thisyakorn U, Yoon IK, van der Vliet D, Langevin E, Laot T, Hutagalung Y, Frago C, Boaz M, Wartel TA, Tornieporth NG, Saville M, Bouckenooghe A, CYD14 Study Group. Clinical efficacy and safety of a novel tetravalent dengue vaccine in healthy children in Asia: a phase 3, randomised, observer-masked, placebo-controlled trial. Lancet. 2014;384(9951):1358\u0026ndash;65. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/S0140-6736(14)61060-6\u003c/span\u003e\u003cspan address=\"10.1016/S0140-6736(14)61060-6\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWorld Health Organization. Monitoring and managing insecticide resistance in Aedes mosquito populations: interim guidance for entomologists [Internet]. Geneva: World Health Organization. 2016 [cited 2026 Apr 03]. 13 p. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.who.int/publications-detail/monitoring-and-managing-insecticide-resistance-in-aedes-mosquito-populations\u003c/span\u003e\u003cspan address=\"https://www.who.int/publications-detail/monitoring-and-managing-insecticide-resistance-in-aedes-mosquito-populations\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eScientific Working Group on Dengue; UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases. Report of the Scientific Working Group meeting on Dengue, Geneva, 1\u0026ndash;5 October 2006 [Internet]. Geneva: World Health Organization. 2007 [cited 2026 Apr 01]. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://iris.who.int/handle/10665/69787\u003c/span\u003e\u003cspan address=\"https://iris.who.int/handle/10665/69787\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHalstead SB. Dengvaxia sensitizes seronegatives to vaccine enhanced disease regardless of age. Vaccine. 2017;35(47):6355\u0026ndash;6358. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.vaccine.2017.09.089\u003c/span\u003e\u003cspan address=\"10.1016/j.vaccine.2017.09.089\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Epub 2017 Oct 10. https://doi.org/10.1016/j.vaccine.2017.09.089.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFerguson NM, Rodr\u0026iacute;guez-Barraquer I, Dorigatti I, Mier-Y-Teran-Romero L, Laydon DJ, Cummings DA. Benefits and risks of the Sanofi-Pasteur dengue vaccine: Modeling optimal deployment. Science. 2016;353(6303):1033\u0026ndash;6. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1126/science.aaf9590\u003c/span\u003e\u003cspan address=\"10.1126/science.aaf9590\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eC\u0026aacute;rdenas R, Cabrera OL, Carrillo MA, Pineda A, Ahumada ML, Ya\u0026ntilde;ez Y, Ismail H, Paine M, Rivera T, Kroeger A. Aedes aegypti control in breeding sites through an insecticidal coating with dual effect: Laboratory trials and safety assessment. Med Vet Entomol. 2025;39(2):252\u0026ndash;65. Epub 2024 Nov 14. PMID: 39543943; PMCID: PMC12054347.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCarrillo MA, Kroeger A, Cardenas Sanchez R, Diaz Monsalve S, Runge-Ranzinger S. The use of mobile phones for the prevention and control of arboviral diseases: a scoping review. BMC Public Health. 2021;21(1):110. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s12889-020-10126-4\u003c/span\u003e\u003cspan address=\"10.1186/s12889-020-10126-4\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSri-Pathmanathan C, Bao H, Diluka PAE, Mee A, Andari B, Saunders E, Wijegunawardana A, Weerasinghe I, Hetti NP, Samaraweera S, Tang W, Tucker JD. Enhancing Community Participation in Dengue Control Through Digital Crowdsourcing: An Analysis of a World Mosquito Program Digital Open Call in Sri Lanka. J Infect Dis. 2023;228(11):1482\u0026ndash;90. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1093/infdis/jiad439\u003c/span\u003e\u003cspan address=\"10.1093/infdis/jiad439\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLwin MO, Sheldenkar A, Panchapakesan C, Ng JS, Lau J, Jayasundar K, Horathalge K, Rathnayake VS, Crawley AW, Wimalaratne P. Epihack Sri Lanka: development of a mobile surveillance tool for dengue fever. BMC Med Inf Decis Mak. 2019;19(1):111. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s12911-019-0829-5\u003c/span\u003e\u003cspan address=\"10.1186/s12911-019-0829-5\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHolston J, Suazo-Laguna H, Harris E, Coloma J. DengueChat: a social and software platform for community-based arbovirus vector control. Am J Trop Med Hyg. 2021;105(6):1521\u0026ndash;35. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.4269/ajtmh.20-0808\u003c/span\u003e\u003cspan address=\"10.4269/ajtmh.20-0808\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAbel Mangueira FF, Smania-Marques R, Dutra Fernandes I, Alves Albino V, Olinda R, Ac\u0026aacute;cia Santos-Silva T, Traxler J, Matheson D, Santos S. The prevention of arboviral diseases using mobile devices: a preliminary study of the attitudes and behaviour change produced by educational interventions. Trop Med Int Health. 2019;24(12):1411\u0026ndash;26. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1111/tmi.13316\u003c/span\u003e\u003cspan address=\"10.1111/tmi.13316\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCarrillo MA, Gessler AM, Rivera Ramirez T, C\u0026aacute;rdenas Sanchez R, Lindenmeier J, Kern WV, Kroeger A. WhatsApp-based intervention in urban Colombia to support the prevention of arboviral diseases: a feasibility study. Pathog Glob Health. 2024;118(4):334\u0026ndash;47. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1080/20477724.2024.2358263\u003c/span\u003e\u003cspan address=\"10.1080/20477724.2024.2358263\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDepartamento Administrativo Nacional de Estad\u0026iacute;stica (DANE). Bolet\u0026iacute;n t\u0026eacute;cnico: indicadores b\u0026aacute;sicos de TIC en hogares [Internet]. Bogot\u0026aacute;: DANE. 2019 [cited 2026 Apr 3]. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.dane.gov.co/files/investigaciones/boletines/tic/bol_tic_hogares_2019.pdf\u003c/span\u003e\u003cspan address=\"https://www.dane.gov.co/files/investigaciones/boletines/tic/bol_tic_hogares_2019.pdf\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eStatista. Most popular social networks based on share of users in Colombia in 2018 [Internet]. 2024 [cited 2026 Apr 1]. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.statista.com/statistics/754482/colombia-penetration-social-networks/\u003c/span\u003e\u003cspan address=\"https://www.statista.com/statistics/754482/colombia-penetration-social-networks/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003e\u0026Aacute;rea Metropolitana de C\u0026uacute;cuta. C\u0026uacute;cuta [Internet]. Institucional, normativa, C\u0026uacute;cuta. 2021 Dec 28 [cited 2026 Apr 4]. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://amc.gov.co/amc/cucuta/\u003c/span\u003e\u003cspan address=\"https://amc.gov.co/amc/cucuta/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGrisales N, Poupardin R, Gomez S, Fonseca-Gonzalez I, Ranson H, Lenhart A. Temephos resistance in Aedes aegypti in Colombia compromises dengue vector control. PLoS Negl Trop Dis. 2013;7:e2438.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDepartamento Administrativo Nacional de Estad\u0026iacute;stica (DANE). Proyecciones de poblaci\u0026oacute;n [Internet]. Bogot\u0026aacute;: DANE; [cited 2026 Apr 4]. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.dane.gov.co/index.php/estadisticas-por-tema/demografia-y-poblacion/proyecciones-de-poblacion\u003c/span\u003e\u003cspan address=\"https://www.dane.gov.co/index.php/estadisticas-por-tema/demografia-y-poblacion/proyecciones-de-poblacion\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSullivan KM, Dean AG, Soe MM, OpenEpi. Open Source Epidemiologic Statistics for Public Health [Internet]. Version 3.01. Atlanta (GA): Emory University; 2013 [cited 2026 Apr 3]. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.openepi.com\u003c/span\u003e\u003cspan address=\"https://www.openepi.com\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMinisterio de Salud y Protecci\u0026oacute;n Social. Cortal\u0026eacute; las alas al dengue [Internet]. Bogot\u0026aacute;: Ministerio de Salud y Protecci\u0026oacute;n Social; 2019 [cited 2026 Apr 1]. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.minsalud.gov.co/Paginas/Hay-que-cortarle-las-alas-al-dengue-ministro-Juan-Pablo-Uribe.aspx\u003c/span\u003e\u003cspan address=\"https://www.minsalud.gov.co/Paginas/Hay-que-cortarle-las-alas-al-dengue-ministro-Juan-Pablo-Uribe.aspx\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCarrillo-Diaz MA. Use of technology for social mobilization to improve the prevention and control of Aedes borne diseases (Dengue, Zika and Chikungunya) in Colombia [doctoral thesis]. Freiburg im Breisgau: Albert-Ludwigs-Universit\u0026auml;t Freiburg; 2026. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.6094/UNIFR/277113\u003c/span\u003e\u003cspan address=\"10.6094/UNIFR/277113\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHiguera-Mendieta DR, Cort\u0026eacute;s-Corrales S, Quintero J, Gonz\u0026aacute;lez-Uribe C. KAP surveys and dengue control in Colombia: disentangling the effect of sociodemographic factors using multiple correspondence analysis. PLoS Negl Trop Dis. 2016;10(9):e0005016. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1371/journal.pntd.0005016\u003c/span\u003e\u003cspan address=\"10.1371/journal.pntd.0005016\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBhattarai AH, Sanjaya GY, Khadka A, Kumar R, Ahmad RA. The addition of mobile SMS effectively improves dengue prevention practices in community: an implementation study in Nepal. BMC Health Serv Res. 2019;19(1):699. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s12913-019-4541-z\u003c/span\u003e\u003cspan address=\"10.1186/s12913-019-4541-z\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSpecial Programme for Research and Training in Tropical Diseases, World Health Organization. Operational guide for assessing the productivity of Aedes aegypti breeding sites [Internet]. Geneva: World Health Organization. 2011 [cited 2026 Apr 3]. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://tdr.who.int/publications/m/item/2011-10-31-operational-guide-for-assessing-the-productivity-of-aedes-aegypti-breeding-sites\u003c/span\u003e\u003cspan address=\"https://tdr.who.int/publications/m/item/2011-10-31-operational-guide-for-assessing-the-productivity-of-aedes-aegypti-breeding-sites\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRomero-Vivas CM, Llin\u0026aacute;s H, Falconar AK. Three calibration factors, applied to a rapid sweeping method, can accurately estimate Aedes aegypti (Diptera: Culicidae) pupal numbers in large water-storage containers at all temperatures at which dengue virus transmission occurs. J Med Entomol. 2007;44(6):930\u0026ndash;7. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1603/0022-2585(2007)44[930:tcfata]2.0.co;2\u003c/span\u003e\u003cspan address=\"10.1603/0022-2585(2007)44[930:tcfata]2.0.co;2\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKruse C, Betancourt J, Ortiz S, Valdes Luna SM, Bamrah IK, Segovia N. Barriers to the use of mobile health in improving health outcomes in developing countries: systematic review. J Med Internet Res. 2019;21(10):e13263. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.2196/13263\u003c/span\u003e\u003cspan address=\"10.2196/13263\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDammert AC, Galdo JC, Galdo V. Preventing dengue through mobile phones: evidence from a field experiment in Peru. J Health Econ. 2014;35:147\u0026ndash;61. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.jhealeco.2014.02.002\u003c/span\u003e\u003cspan address=\"10.1016/j.jhealeco.2014.02.002\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEmeran A, Burrows R, Loyson J, Behardien MR, Wiemers L, Lambert E. The Effect of Text Message-Based mHealth Interventions on Physical Activity and Weight Loss: A Systematic Review and Meta-Analysis. Am J Lifestyle Med 2024 Aug 15:15598276241268324. doi: 10.1177/15598276241268324. Epub ahead of print. PMID: 39554952; PMCID: PMC11562155.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOcampo CB, Mina NJ, Echavarria MI, Acu\u0026ntilde;a M, Caballero A, Navarro A, Aguirre A, Criollo IS, Forero F, Azuero O, Alexander ND. VECTOS: an integrated system for monitoring risk factors associated with urban Arbovirus transmission. Glob Health Sci Pract. 2019;7(1):128\u0026ndash;37. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.9745/GHSP-D-18-00300\u003c/span\u003e\u003cspan address=\"10.9745/GHSP-D-18-00300\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSousa L, de Mello R, Cedrim D, Garcia A, Missier P, Uch\u0026ocirc;a A, Oliveira A, Romanovsky A. VazaDengue: An information system for preventing and combating mosquito-borne diseases with social networks. Inform Syst. 2018;75:26\u0026ndash;42. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.is.2018.02.003\u003c/span\u003e\u003cspan address=\"10.1016/j.is.2018.02.003\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAldosery A, Musah A, Birjovanu G, Moreno G, Boscor A, Dutra L, Santos G, Nunes V, Oliveira R, Ambrizzi T, Massoni T, Dos Santos WP, Kostkova P. MEWAR: Development of a Cross-Platform Mobile Application and Web Dashboard System for Real-Time Mosquito Surveillance in Northeast Brazil. Front Public Health. 2021;9:754072. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3389/fpubh.2021.754072\u003c/span\u003e\u003cspan address=\"10.3389/fpubh.2021.754072\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBrody C, Star A, Tran J. Chat-based hotlines for health promotion: a systematic review. Mhealth. 2020;6:36. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.21037/mhealth-2019-di-13\u003c/span\u003e\u003cspan address=\"10.21037/mhealth-2019-di-13\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWorld Health Organization. Communication for behavioural impact (COMBI): a toolkit for behavioural and social communication in outbreak response [Internet]. Geneva: World Health Organization. 2012 [cited 2026 Apr 3]. Report No.: WHO/HSE/GCR/2012.13. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.who.int/publications/i/item/communication-for-behavioural-impact-(combi)\u003c/span\u003e\u003cspan address=\"https://www.who.int/publications/i/item/communication-for-behavioural-impact-(combi)\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKunasagran PD, Syed Abdul Rahim SS, Chun Chao GG, Muyou AJ, Sidek ZN, Hidrus A, Atil A, Dapari R. A Systematic Review of Communication for Behavioural Impact (COMBI) as a Dengue Prevention Programme. Malays J Med Sci. 2025;32(3):73\u0026ndash;83. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.21315/mjms-07-2024-527\u003c/span\u003e\u003cspan address=\"10.21315/mjms-07-2024-527\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBidargaddi N, Almirall D, Murphy S, et al. To prompt or not to prompt? A microrandomized trial of time-varying push notifications to increase proximal engagement with a mobile health app. JMIR Mhealth Uhealth. 2018;6(11):e10123. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.2196/10123\u003c/span\u003e\u003cspan address=\"10.2196/10123\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAmagai S, Pila S, Kaat AJ, Nowinski CJ, Gershon RC. Challenges in participant engagement and retention using mobile health apps: literature review. J Med Internet Res. 2022;24(4):e35120. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.2196/35120\u003c/span\u003e\u003cspan address=\"10.2196/35120\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGiebel GD, Speckemeier C, Abels C, Plescher F, B\u0026ouml;rchers K, Wasem J, Blase N, Neusser S. Problems and Barriers Related to the Use of Digital Health Applications: Scoping Review. J Med Internet Res. 2023;25:e43808. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.2196/43808\u003c/span\u003e\u003cspan address=\"10.2196/43808\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBorges do Nascimento IJ, Abdulazeem H, Vasanthan LT, Martinez EZ, Zucoloto ML, \u0026Oslash;stengaard L, Azzopardi-Muscat N, Zapata T, Novillo-Ortiz D. Barriers and facilitators to utilizing digital health technologies by healthcare professionals. NPJ Digit Med. 2023;6(1):161. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1038/s41746-023-00899-4\u003c/span\u003e\u003cspan address=\"10.1038/s41746-023-00899-4\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAovare P, Beune E, Chilunga FP, Moens N, van Moll EP, Agyemang C. The acceptability, adoption and feasibility of mobile health interventions for diabetes and hypertension care among Ghanaian healthcare workers. PEC Innov. 2026;8:100456. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.pecinn.2026.100456\u003c/span\u003e\u003cspan address=\"10.1016/j.pecinn.2026.100456\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOsei E, Mashamba-Thompson TP. Mobile health applications for disease screening and treatment support in low-and middle-income countries: A narrative review. Heliyon. 2021;7(3):e06639. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.heliyon.2021.e06639\u003c/span\u003e\u003cspan address=\"10.1016/j.heliyon.2021.e06639\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOrganisation for Economic Co-operation and Development (OECD). The effects of zero-rating [Internet]. Paris: OECD Publishing. 2019. [cited 2026 Feb 20]. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.oecd.org/content/dam/oecd/en/publications/reports/2019/07/the-effects-of-zero-rating_45c41e82/6eefc666-en.pdf\u003c/span\u003e\u003cspan address=\"https://www.oecd.org/content/dam/oecd/en/publications/reports/2019/07/the-effects-of-zero-rating_45c41e82/6eefc666-en.pdf\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDove ES, Townend D, Meslin EM, Bobrow M, Littler K, Nicol D, et al. RESEARCH ETHICS. Ethics review for international data-intensive research. Science. 2016;351(6280):1399\u0026ndash;400.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFarnham A, R\u0026ouml;\u0026ouml;sli M, Blanke U, Stone E, Hatz C, Puhan MA. Streaming data from a smartphone application: a new approach to mapping health during travel. Travel Med Infect Dis. 2018;21:36\u0026ndash;42. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.tmaid.2017.11.005\u003c/span\u003e\u003cspan address=\"10.1016/j.tmaid.2017.11.005\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMorris C, Scott RE, Mars M. WhatsApp in Clinical Practice-The Challenges of Record Keeping and Storage. A Scoping Review. Int J Environ Res Public Health. 2021;18(24):13426. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3390/ijerph182413426\u003c/span\u003e\u003cspan address=\"10.3390/ijerph182413426\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMasoni M, Guelfi MR. WhatsApp and other messaging apps in medicine: opportunities and risks. Intern Emerg Med. 2020;15(2):171\u0026ndash;3. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s11739-020-02292-5\u003c/span\u003e\u003cspan address=\"10.1007/s11739-020-02292-5\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFunci\u0026oacute;n P\u0026uacute;blica. Ley 1581 de 2012 [Internet]. Bogot\u0026aacute;: Funci\u0026oacute;n P\u0026uacute;blica; 2012 [cited 2026 Apr 1]. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.funcionpublica.gov.co/eva/gestornormativo/norma.php?i=49981\u003c/span\u003e\u003cspan address=\"https://www.funcionpublica.gov.co/eva/gestornormativo/norma.php?i=49981\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Dengue, Zika, Chikungunya, Aedes mosquito, digital Health, WhatsApp, disease prevention, community engagement, behaviour change, coating, Colombia","lastPublishedDoi":"10.21203/rs.3.rs-9267857/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9267857/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eArboviral diseases remain major public health problems in Colombia. Mobile applications such as WhatsApp are increasingly being used to support health interventions by improving user engagement and preventive practices. Given its widespread use in Colombia, this study aimed to evaluate WhatsApp as a tool to promote preventive practices and enhance community engagement in vector control activities, particularly the application of insecticidal coating (IC) in water tanks.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA quasi-experimental study with three groups (control, community visits only, and community visits plus WhatsApp) was conducted in two municipalities in Colombia. Around 300 households per group were recruited. Preventive practices and entomological indices were assessed before and after the intervention using household surveys and larval/pupal inspections. Within-group changes were analyzed using McNemar\u0026rsquo;s and Wilcoxon signed-rank tests, and intervention effects over time were estimated using difference-in-differences analysis. WhatsApp acceptability was also assessed using Likert-scale items.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eA total of 874 households were included in the final analysis. The community visits plus WhatsApp (CV\u0026thinsp;+\u0026thinsp;WA) group showed significant improvements in preventive practices after the intervention, such as proper management of small breeding sites (+\u0026thinsp;15.9 percentage points, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Reductions in vector abundance were observed in both intervention groups, but they were greater in the group that integrated WhatsApp; the house index decreased by 22.8 percentage points in the CV\u0026thinsp;+\u0026thinsp;WA group vs 14.7 percentage points in the community visits-only group. At 4 months, entomological indices were significantly lower in both intervention groups than in the control group, and no larvae or pupae were found in treated tanks. Community engagement related to IC application was high in the CV\u0026thinsp;+\u0026thinsp;WA group, and WhatsApp was well-accepted by community users, with most mean scores above 4.8 out of 5.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eThe integration of WhatsApp into vector control operations was acceptable and more effective than community visits alone in improving preventive practices and reducing vector densities. WhatsApp may strengthen community engagement in prevention programmes in endemic urban settings.\u003c/p\u003e","manuscriptTitle":"Using a Digital Health tool for Community Engagement in Arboviral Disease Prevention: An Implementation Study in Colombia","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-04-21 20:49:31","doi":"10.21203/rs.3.rs-9267857/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-04-30T19:25:13+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"155352886462253788308953593823712072873","date":"2026-04-20T16:34:09+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"131859037790372089672223472054113507684","date":"2026-04-18T18:10:27+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"262764017995192716847472476134678680337","date":"2026-04-16T11:07:22+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-04-15T10:41:50+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-04-13T04:33:39+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-04-08T11:57:28+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-04-08T02:22:02+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Public Health","date":"2026-04-08T02:16:12+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"b92eaf45-1028-48b5-b7ce-30127b0e18d0","owner":[],"postedDate":"April 21st, 2026","published":true,"recentEditorialEvents":[{"type":"editorInvitedReview","content":"","date":"2026-04-30T19:25:13+00:00","index":43,"fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-04-21T20:49:31+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-21 20:49:31","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9267857","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9267857","identity":"rs-9267857","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}