Dengue vector control through multisectoral and community-based interventions in Abidjan, Côte d’Ivoire: study protocol for a cluster-randomised trial {1}

Dengue vector control through multisectoral and community-based interventions in Abidjan, Côte d’Ivoire: study protocol for a cluster-randomised trial {1} | 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 Dengue vector control through multisectoral and community-based interventions in Abidjan, Côte d’Ivoire: study protocol for a cluster-randomised trial {1} Julien Zahouli, Pélagie E.B. Aboa, Claver N. Adjobi, Véronique Koffi, and 13 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5416379/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background In Africa, most governmental arbovirus control programmes and outbreak responses mainly follow a vertical, top-down approach for Aedes vector control, leading to short-term effects and re-emergence of dengue in intervened areas once campaigns are over. This study evaluates a horizontal, bottom-up approach built on multisectoral collaborations aiming to empower and engage local communities in controlling Aedes mosquitoes with the guidance of stakeholders and scientists in Abidjan, Côte d’Ivoire. Methods The trial is a two-by-two factorially designed cluster-randomised trial (CRT) of (i) community participatory interventions based on larval source management (LSM) and (ii) adult mass trapping (AMT) of Aedes aegypti using Biogents Gravid Aedes Traps (BG-GATs). It includes 20 contiguous equal area (625 ha) clusters in each of the Anono and Gbagba neighbourhoods, totalling 40 clusters, within the Cocody-Bingerville health district of Abidjan. Initially, baseline entomological, sociocultural, socio-economic and environmental data were collected. In the intervention clusters, local community members were then empowered and engaged in identifying how they could prevent and remove potential Aedes breeding sources, including household water and solid waste containers, and to install, maintain and handle the BG-GATs. The trial protocol was co-designed and co-created by the target community members and leaders, the local and governmental stakeholders and the research team members. Data collection pursued in order to measure the effectiveness of these novel interventions and their tangible benefits upon acceptability of and adherence to their use. Discussion This stepwise and holistic approach based on strengthening local community capacities for taking own preventive actions against Aedes vectors might build citizen resilience and improve adherence for the sustainable control of dengue in intervened areas. Lessons learned from this inclusive and multisectoral intervention model may help with designing regional and global dengue control programmes in Africa. Trial registration {2a and 2b}: ClinicalTrials.gov, ID NCT06648603. Registered on 1 July 2024. Aedes aegypti sustainable vector control larval source management adult mass trapping Gravid Aedes trap cluster-randomised control trial Africa Figures Figure 1 Figure 2 Figure 3 Figure 4 Background {6a} The last 15 years have seen an unprecedented increase in dengue emergence with the heaviest burden in tropical megacities. The West African region contains many active dengue foci and is projected to be next front of disease outbreaks [ 1 – 3 ]. This rapid spread is fuelled by unplanned urbanisation, globalisation and climate change [ 4 ] and constitutes a wake-up call to strengthen global and local control programmes in emerging foci [ 2 , 5 ]. No licensed vaccine is available for dengue in sub-Saharan Africa and, therefore, surveillance and control of its vectors, Aedes mosquitoes, are key to effective disease prevention. Abidjan in Côte d’Ivoire with an estimated population of 7 million faced multiple large outbreaks of dengue (serotypes DENV-1, DENV-2 and DENV-3) between 2017 and 2024 [ 6 – 8 ]. The principal dengue vector in Africa, Aedes aegypti , is highly anthropophilic, perfectly adapted to the urban environment and exceedingly prevalent in a growing number of tropical megacities [ 9 , 10 ]. It is well known that it breeds in small containers such as used tyres, discarded cans, and water storage containers and bites and rests outdoors [ 11 – 14 ]. It has a plastic ecology and uses avoidance behaviours such as breeding in cryptic or ephemeral containers that may remain unnoticed, skipping containers, disseminating small lots of eggs among diverse containers or avoiding outdoor interventions by refuging indoors [ 15 ]. Aedes aegypti is also a main vector of several other viruses such as chikungunya, yellow fever and Zika viruses [ 2 , 5 , 16 ]. Space spraying of insecticides targeting the Aedes adults and removing larval breeding sites are frequent components of governmental vector control programmes in sub-Saharan Africa. In Abidjan, the National Institute for Public Hygiene (NIPH) of the Ministry of Health (MoH) of Côte d’Ivoire conducted dengue outbreak responses based on Aedes larval source management (LSM) and sporadic outdoor space spraying of insecticides against adult vector populations. For the 2017-dengue outbreak response, over 250,000 larval breeding sites were eliminated, destroyed or treated with insecticides among 17,000 households [ 6 ]. However, it is challenging to identify the key Aedes breeding sites, adult resting and biting behaviours, and places for insecticide space spraying while many areas are also not accessible to the vehicles deployed for space spraying. These vertical and sporadic actions lacking involvement of local communities are expensive, their impacts are limited and short-term [ 17 ]. The Abidjan campaigns were followed by multiple re-emergences of dengue (3,201 suspected, 281 confirmed and 2 fatal cases), coupled with yellow fever outbreaks (89 confirmed and 1 fatal case) in the same intervention areas in 2019. Moreover, the widespread use of insecticides has led to selection of resistance in the vectors, which may exacerbate future outbreaks of mosquito-borne disease [ 18 – 20 ]. Aedes aegypti occurrence and abundance are closely linked to the behaviours and the activities of local people, implying that there is untapped potential to make interventions and surveillance strategies better locally adapted, more cost-effective and sustainable by enlisting the active participation of communities living in dengue foci. A community-based approach to LSM offers an excellent opportunity to leverage context-specific understandings of the ecology of Aedes vectors and their interactions with the cultural, social, behavioural and economic characteristics of local communities [ 21 – 24 ]. A community-based approach can also be applied to killing adult female mosquitoes. This may be more efficient than LSM, both because these mosquitoes may already be carrying a pathogen acquired at an earlier feed, and because it averts population expansion: each female has the potential to produce between 50–100 eggs per gonotrophic cycle [ 15 ]. A recent study in the USA successfully used a community-based approach for mosquito adult mass trapping (AMT) of gravid females of a main dengue vector, Aedes albopictus , using the Biogents Gravid Aedes Traps (BG-GAT; Biogents AG, Regensburg, Germany) [ 25 ]. The BG-GAT system with sticky cards is a passive trap targeting egg-laying female Aedes . This means it does not require power or supplemental attractants like CO 2 or chemical lures and does not use insecticides. Although the BG-GAT is relatively expensive in the African context (about USD 20 per piece), it remains one of the cheapest commercially available traps and if mass trapping is scaled up, the price per trap is likely to decrease. The trap is easy to set up and deploy, making it an ideal tool for use within a community-based programme. This paper describes the design of a cluster-randomised trial (CRT) in Abidjan to evaluate the two interventions of LSM and AMT using BG-GATs, both implemented via community mobilisation strategies that involved the community in co-designing the trial intervention protocol. The outcomes and lessons learned may help with designing the regional and global dengue surveillance programmes. Methods/design Objectives {7} Primary objectives The primary objectives are to test the effects on A. aegypti adult densities of mobilising and engaging local communities in the development and implementation of Aedes (i) LSM, and (ii) AMT using BG-GATs. Secondary objectives There are four interlinked secondary objectives: To assess the spatial and temporal distribution of Aedes mosquitoes in association with housing, human behaviour and mosquito habitat suitability to design a community-based CRT. To evaluate the effectiveness of the community mobilisation programme to co-design the CRT and implement the LSM, with and without AMT. To analyse any incremental benefit of combining the LSM and AMT interventions. To conduct stakeholder advocacy activities to sustain the community engagement programme and to develop policy recommendations for sustainable control of Aedes mosquitoes and dengue and other mosquito-borne viral diseases. Study area and participant eligibility {9 and 10} The study was located in the neighbourhoods of Anono (5°20'39.7"N, 3°58'16.4"W) and Gbagba (5°20'55.4"N, 3°53'10.7"W) in the health district of Cocody-Bingerville in Abidjan, Southern Côte d’Ivoire in West Africa (Fig. 1). Over 80% of reported dengue cases in Côte d’Ivoire have occurred in the health district of Cocody-Bingerville [6-8]. Previous studies conducted by the research team showed that Anono and Gbagba are dominated by A. aegypti mosquitoes [26]. Both areas are characterised by a rapid and uncontrolled urbanisation, and there are various Aedes larval breeding sites, such as tyres, discarded cans, water storage containers, derived from human activities and the poor management of solid and plastic waste [26]. The population of Anono are mostly Ebrié people and estimated at 5,000 inhabitants, while the population of Gbagba is more heterogeneous, composed of locals and immigrants from neighbouring countries (e.g. Burkina Faso, Guinea, Mali, etc.) and estimated at 6,000 inhabitants. Anono and Gbagba thus represent appropriate settings for evaluating the effectiveness of a community-based intervention trial for sustainable Aedes dengue vector control. > Intervention trial design {8} The community-based intervention trial was a two-by-two factorially designed CRT, with four parallel study arms (Table 1) and an intervention period of 12 months: LSM - Aedes larval source management (study arm 1): The LSM consisted of managing containers that can potentially or actually hold water and serve as ovipositing or larval breeding sites for Aedes mosquitoes. Community members were trained to remove, empty, or destroy such sites to eliminate discarded, abandoned or unused containers, and to clean and cover potable water storage containers. AMT – Aedes adult mass trapping (study arm 2): Two BG-GATs (Biogents Gravid Aedes Traps Neighbourhood Protection, BG-GAT 2; Biogents AG, Regensburg, Germany) model were deployed per household. The community members were trained in the maintenance of the traps, including cleaning them, topping up the water, and replacing sticky papers to kill the trapped mosquitoes, and were monitored and advised by local well-trained supervisors (more information on community training materials (pamphlets) and supervision checklist is provided in Additional file 1). LSM - AMT (study arm 3): Both LSM and AMT interventions were conducted in the combination LSM - AMT clusters. Control (study arm 4): Neither LSM nor AMT interventions were conducted in the control clusters. > Cluster assignment {16a} Using an existing map of geotypologies for Abidjan [27] loaded into ArcGIS Pro2.2.4 (ESRI, Redlands, California, USA), we removed all spaces (‘geotypologies’) that could not be sampled, such as water bodies or industrial zones from consideration as part of the trial. We then identified a contiguous zone of 125 ha in each of the neighbourhoods of Anono and Gbagba (Fig. 1), each composed of 2,000 pixels and each measuring 25 m by 25 m (625 m 2 ). Using a custom-written script in R 1.4.1 [28], we constructed clusters using a nearest neighbour algorithm to aggregate 100 pixels into each cluster yielding a total of 40 clusters each with a surface area of 6.25 ha (Fig. 2). We labelled each house and each cluster with unique codes. Fig. 3 shows the flow chart of the trial. Fig. 4 displays the timeline for enrolment, intervention and assessment for pre-trial to post-trial activities. > Randomisation {16c and 15} We allocated the interventions among the 40 clusters, with five clusters per study arm in each neighbourhood (i.e. 10 clusters per study arm in total). Each cluster was randomly assigned to one of the four study arms using the R function ‘sample’. Since the aim was to sample space (randomly), while a BG-Sentinel two trap (Biogents, Regensburg, Germany) may not be placed randomly in space since it has to be set up in a shaded, protected spot away from the public, we divided the area into pixels. We randomly chose the pixels in which the field team placed one BG-Sentinel trap was placed, while the field team found the most suitable spot within the selected pixel. For each cluster, we sampled from one pixel over two consecutive days from dawn to dusk every other week. Around the grid with the pixels for adult mosquito samplings a border of one pixel width was defined in which no traps were placed, while we still implemented the intervention arm (Fig. 2). The border shall act as a buffer zone in case adult mosquitoes move between clusters. In addition to the continuous adult mosquito sampling, we performed household surveys and larval sampling during the baseline study and then every third month until the end of the trial. The larval sampling took place in and around randomly selected houses. If a house had more than one household, only one household was subject to the survey, while the field team aimed at inspecting all potential breeding sites from the entire house including the area around it. For the household survey and the larval sampling, we selected randomly 11 houses per cluster. As we did not have a list with households, we selected 11 random points using the in-build function in ArcGIS Pro while setting the minimal distance between points at 25 m. In the field, the team visited the house closest to the random point on the map. Allocation concealment {16b} The trial is a single-blinded study in which the data analysis is conducted by a statistician who is unaware of the arm allocations. It is not feasible to conceal the allocations from the participants. Data collection and evaluation {33} We monitored the study outcomes using multidisciplinary study protocols: entomological, environmental and socio-behavioural protocols described (detailed monitoring protocols are given in Additional file 2). Data collections started with a pre-trial baseline for a period of 8 months (from December 2022 to July 2023), followed by an intervention period lasting 12 months (from August 2023 to July 2024) and post-trial surveys for two months (Fig. 4). > Data entry and management {19} Well-trained experienced surveyors collected the entomological, environmental and social data using Open Data Kit (ODK) software on electronic tablets. We checked the electronic databases daily for errors and upon validation, we transferred them to a secure sever located at the Swiss Tropical and Public Health Institute (Swiss TPH) for storing. Power and sample size calculations {14} The power and sample size calculations were based on the baseline data and allowing for possible spillover effects due to local mosquito or human movement and are presented in a companion paper [29]. Outcome measures {12 and 18a} Primary outcome The primary outcome is Aedes mosquito mean number per trap per day. Secondary outcomes Entomological outcomes The entomological secondary outcomes are [30, 31]: Larval indices : house index (HI), container index (CI), Breteau index (BI) and Stegomyia index (SI). HI is the proportion of houses with at least one larva, CI is the proportion of positive containers, BI is the number of positive containers per 100 houses and SI is the proportion of positive containers per population. Pupal productivity indices: pupae per person index (PPI), pupal index per house (PI) and pupae per hectare index (PHI). PPI is the number of pupae per person, PI is the number of pupae per house, and PHI is the number of pupae per hectare Adult indices: proportions of unfed, fed, half-gravid and gravid females, and parity rate (i.e. proportion of parous females); Environmental outcomes We assessed the following environmental parameters: Household surveys : correlate household survey responses with location, number and description of Aedes larval breeding sites Geographical surveys :location and description of micro- and macro-environmental factors that are prevalent in each treatment arm; and correlation of the distribution of Aedes larval habitats and environmental features in space and time. Social outcomes In addition to the entomological outcomes, we assessed the following social outcomes: Knowledge, attitudes, and practices on dengue prevention and Aedes vector control among the local communities and stakeholders Perception and awareness of risk of dengue and mosquitoes Strategies to engage communities in prevention of dengue and Aedes vector control Data analysis and reporting {20a, 20b and 21b} A statistician dedicated to the study will support data analysis. Data analysis and reporting will conform to the CONSORT guidelines for reporting of CRTs, insofar as these are relevant to a trial with no human health outcomes [32]. An analytical plan is provided as supplementary document (more details on the analytical plan of the data are given in Additional file 3). Discussion As in most sub-Saharan African countries, in Côte d’Ivoire, the government dengue outbreak responses often follow a top-down approach lacking local community involvement, have resulted in a limited and short-term impact on Aedes vector control, thus leading to multiple re-emergences of dengue and other arboviruses once the intervention campaigns are over [ 6 – 8 ]. Therefore, the current intervention trial uses a bottom-up approach, with a special focus on the mobilisation and the engagement of the local communities for the control of Aedes dengue vectors in Abidjan, Côte d’Ivoire. This intervention trial aims to assess and compare the efficacy of community-led LSM [ 22 , 23 ] and AMT [ 25 ], alone or in combination, for controlling A. aegypti in a multisectoral framework to sustain the intervention over the trial period. To build African citizen resilience against arboviral outbreaks, our current project aimed at training, mobilising and engaging local residents in the sustainable control of Aedes mosquitoes guided by scientific advisors. The interventions targeted to the built environments aim at reducing Aedes mosquito densities by removal of their larval breeding sites and mass trapping of adult gravid females in Anono and Gbagba in the arboviral foci in the health district of Cocody-Bingerville in Abidjan, Côte d’Ivoire. This study opts for a stepwise and integrated approach with three steps, pre-intervention, intervention and post-intervention, and involvement of scientists, stakeholders and local communities in the design and the implementation of the trial. The outcomes of the current study provide information about the efficacy of community based LSM and AMT interventions on the densities and parity of A. aegypti , Aedes larval indices, the risk of transmission of dengue virus and the environmental and sociological outcomes. The study settings, Anono and Gbagba, harboured high numbers of A. aegypti mosquitoes those larvae massively breed containers, inducing tyres, discarded cans, water storage containers, derived from human activities poor management of potable water and mismanagement of solid and plastic waste [ 26 ]. Thus, Anono and Gbagba represented suitable areas for testing the effectiveness of a community-led intervention trial for the sustainable control of Aedes dengue vectors. Our trial design allowed for before-and-after and contemporaneous measures of intervention effects, and clustering of the intervention allows measurement of a possible spillover effect of LSM, AMT or both into neighbouring non-intervened areas [ 22 – 25 ]. With 8-month baseline measurements before the commencement of the intervention, 12 months of follow-up for its completion, and post-intervention assessment, an understanding of the time taken to achieve an impact through LSM or AMT will be gained. By collecting data on multiple outcomes (i.e. entomological, environmental and sociological outcomes), we anticipate that it will be possible to attribute an effect on the control of local dengue vectors to the LSM and AMT interventions alone and in combination. In contrast, if the intervention is not effective, it will be possible to provide explanations for this outcome. Understanding the mechanism behind a successful intervention will be vitally important in optimising the system for future scale-up and, in the instance of no observed effect, understanding this result will also allow improvements to the approach, which could lead to success in the future. Beyond the anticipated impact on dengue vectors, we expect the community members of the study population to benefit immediately from the reduction of the risk of getting other Aedes mosquito-borne arboviruses (e.g. yellow fever, chikungunya and Zika) and the mosquito nuisance, as well as an improvement of the environmental hygiene and sanitation possibly induced by LSM or AMT in Anono and Gbagba. In addition to including local community leaders and members in co-designing the trial protocol, these expected benefits might increase the acceptability, the adherence and the participation of the target communities to the current LSM and AMT interventions. The outcomes of this community-based participatory interventional trial might help with designing national, regional and global prevention and control programmes of dengue and other Aedes mosquito-borne arboviral diseases. Trial status {3} The intervention trial ran over 12 months, from August 2023 to July 2024. Before the trial, we implemented a baseline study over three months to evaluate the initial situation. While data are not yet analysed, the trial was complete at the time the protocol manuscript was submitted for review by Trials . The recruitment and training of participants, the multisectoral stakeholder workshops, the exploitation of the entomological, environmental and sociological outcomes of the baseline study for co-designing the intervention trial protocol, the amendment of the co-designed trial protocol and entomological monitoring of intervention efficacy were completed in November 2023. This study protocol was not submitted early (i.e. before the last visit), since it was adjusted along the trial implementation according to the feedback and recommendations from workshops with the local community members and stakeholders. This complex integrated intervention for dengue vector control by local communities was designed and implemented within a multisectoral framework with active participations of residents, community leaders and stakeholders for smooth installation and successfully completion of the trial. Abbreviations AMT adult mass trapping BG-GAT Biogents Gravid Aedes Trap BI Breteau index CI container index CRT cluster-randomised trial GLMM generalised linear mixed model HI house index KAP knowledge, attitudes, and practice LSM larval source management ODK Open Data Kit PHI pupae per hectare index PI pupa index PPI pupae per person SI Stegomyia index Swiss TPH Swiss Tropical and Public Health Institute WHO World Health Organization Declarations Acknowledgments We extend our thanks to everyone who helped in the co-design and implementation of this study protocol, and a heartfelt thanks to political, health, traditional and religious authorities, local community leaders and the populations of Anono and Gbagba. We thank Biogents for supporting a part of the costs of BG-GATs used in this study. Name, contact and role information for the sponsor {5b and 5c} The sponsors of the study are the Swiss Network for International Studies (Grant number: C21047), Bern, Basel Switzerland the Leading House Africa Programme (LHA) (Research Partnership Grant I) of University of Basel, Basel Switzerland, and INOVEC (HORIZON-MCSA-SE Grant Agreement 101086257). The roles of the sponsors are to provide financial resources and evaluate the technical and financial reports of the projects. Dissemination policy {31a} The results of this study will be disseminated through peer reviewed journals, academic or scientific conferences, stakeholder meetings and policy briefs and reports to health authorities, policy-makers and decision-makers at the health districts, the national vector control programmes and the Ministry of health (MoH) of Côte d’Ivoire. Authors’ contributions {31b} JZBZ, VK, ELEA, TAS, AL, LV, JP, SRB and PM designed and developed the study protocol. JZBZ, VK, ELEA, and PM co-drafted the manuscript. JZBZ, TAS, LV, JP, PM, SRB and GF reviewed the final manuscript. VK, ELEA, TAS, PM and GF were responsible for the methodology of the statistical analyses of the data. JZBZ, PEBA, CNA, and AL prepared the ethical review application. CNA, PEBA and PM recruited households. JZBZ, PEBA and CNA performed the intervention. TAS critically revised the manuscript and the data analysis plan. JZBZ, CNA, VK, ELEA, FD, SRB and PM contributed to the acquisition of financial support. PEBA, CNA, MAK, CAB, GKK and AG were responsible of the data collection. All authors read and approved the final version of the manuscript. Funding {4} The project is funded by the Swiss Network for International Studies (Grant number: C21047), the Leading House Africa Programme (LHA) (Research Partnership Grant I) of University of Basel and INOVEC (HORIZON-MCSA-SE Grant Agreement 101086257). The roles of the sponsors are to provide financial resources and evaluate the technical and financial reports of the projects. The funders were not involved in the design of the study or the writing of the manuscript and did not have any impact on the data collection, analysis, or publication of the manuscript (more information on the funding is given in Additional file 4). Availability of data and materials {29} The results of this study will be published through scientific journals or presented at scientific conferences and meetings. To date, there are still no plans to make any of the trial data sets available to the public. However, community training supervision and participant information materials and informed consent forms can be obtained from the corresponding author. Ethics approval and consent to participate {24} Ethical clearance for the study was obtained from the Ethics Committee of the North and Central Switzerland EKNZ (Ref. no.: AO_2022-00023) and by the National Ethics Committee for Research of the Ministry of Health of Côte d’Ivoire (Ref. no.: 026-22/MSHPCMU/CNESVS-km). All participants were provided with written and oral information regarding the project objectives, the implementation of the intervention, mosquito sampling, entomological and environmental data collection, social surveys and multisectoral workshops with scientists, stakeholders and local community leaders and members. All participants provided written informed consent in French agreeing to participate in the interventions (more information on the ethical approval is given in Additional file 5). Competing interests {28} The authors declare that they have no competing interests. Consent for publication {32} Not applicable. 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Asgarian TS, Vatandoost H, Hanafi-Bojd AA, Nikpoor F. Worldwide Status of Insecticide Resistance of Aedes aegypti and Ae. albopictus , Vectors of Arboviruses of Chikungunya, Dengue, Zika and Yellow Fever. J Arthropod Borne Dis. 2023;17(1):1–27. 10.18502/jad.v17i1.13198 . PMID: 37609563; PMCID: PMC10440498. Arunachalam N, Tyagi BK, Samuel M, Krishnamoorthi R, Manavalan R, Tewari SC, Ashokkumar V, Kroeger A, Sommerfeld J, Petzold M. Community-based control of Aedes aegypti by adoption of eco-health methods in Chennai City, India. Pathog Glob Health. 2012;106(8):488–96. 10.1179/2047773212Y.0000000056 . PMID: 23318241; PMCID: PMC3541894. Saré D, Pérez D, Somé PA, Kafando Y, Barro A, Ridde V. Community-based dengue control intervention in Ouagadougou: intervention theory and implementation fidelity. Glob Health Res Policy. 2018;3:21. 10.1186/s41256-018-0078-7 . PMID: 30123837; PMCID: PMC6091010. Bonnet E, Fournet F, Benmarhnia T, Ouedraogo S, Dabiré R, Ridde V. Impact of a community-based intervention on Aedes aegypti and its spatial distribution in Ouagadougou, Burkina Faso. Infect Dis Poverty. 2020;9(1):61. 10.1186/s40249-020-00675-6 . PMID: 32503665; PMCID: PMC7275586. Sombié I, Degroote S, Somé PA, Ridde V. Analysis of the implementation of a community-based intervention to control dengue fever in Burkina Faso. Implement Sci. 2020;15(1):32. 10.1186/s13012-020-00989-x . PMID: 32408903; PMCID: PMC7222308. Johnson BJ, Brosch D, Christiansen A, Wells E, Wells M, Bhandoola AF, Milne A, Garrison S, Fonseca DM. Neighbors help neighbors control urban mosquitoes. Sci Rep. 2018;8(1):15797. 10.1038/s41598-018-34161-9 . PMID: 30361483; PMCID: PMC6202375. Adjobi CN, Zahouli JZB, Guindo-Coulibaly N, Ouattara AF, Vavassori L, Adja MA. Assessing the ecological patterns of Aedes aegypti in areas with high arboviral risks in the large city of Abidjan, Côte d’Ivoire. PLoS Negl Trop Dis., 2024. Accepted. In press. Kolomazník StonáčekV, Orlitová J, E., Fretin D. (2019): EO4SD-Urban Project: Abidjan City Report (AO/1-8346/15/I-NB). Earth Observation for Sustainable Development. https://www.thegpsc.org/sites/gpsc/files/eo4sd_urban_abidjan_city_oper ationsreport_2_0.pdf . Accessed 05 November 2024. Core Team R. 2020. — European Environment Agency. (n.d.). [Methodology Reference]. https://www.eea.europa.eu/data-and-maps/indicators/oxygen-consuming-substances-in-rivers/r-development-core-team-2006 . Accessed 22 October 2024. Smith TA, Felber LN, Alexander NA, Aboa PEB, Adjobi CN, Zahouli JZB, Müller P. A diffusion model for mosquito control trials with spillover. Submitted to Trials . World Health Organization. (WHO). 1971. Technical guide for a system of yellow fever surveillance = guide technique pour l’établissement d’un système surveillance de la fièvre jaune. Weekly Epidemiological Record = Relevé Épidémiologique Hebdomadaire , 46 (49), 493–500. https://iris.who.int/bitstream/handle/10665/218621/WER4;jsessionid = 5B9DF7A234983E68325D7B98D3BBB792?sequence = 1. Accessed 07 November 2024. Pan American Health Organisation (PAHO). Dengue and dengue hemorrhagic fever in the Americas: guidelines for prevention and control. Washington DC. 1994. https://iris.paho.org/bitstream/handle/10665.2/40300/9275115486_eng.pdf?sequence=1&isAllowed=y . Accessed 07 November 2024. Campbell MK, Elbourne DR, Altman DG, CONSORT group. CONSORT statement: extension to cluster randomised trials. BMJ. 2004;328(7441):702–8. 10.1136/bmj.328.7441.702 . PMID: 15031246; PMCID: PMC381234. Supplementary Files Table1.pdf Additionalfile1.pdf Additional file 1: Community training materials (pamphlets) and supervision checklist. Additionalfile2.pdf Additional file 2: Detailed monitoring protocols. Additionalfile3.pdf Additional file 3: Analytical plan of the data. Additionalfile6.pdf Additional file 6: Participant information materials and informed consent form. Cite Share Download PDF Status: Posted Version 1 posted 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-5416379","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":469784209,"identity":"79c5ef68-b871-4658-a5da-05fa840f9c19","order_by":0,"name":"Julien Zahouli","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA6klEQVRIie3PPQrCMBTA8VcKulRcM5krvC7iUOxVUgqdHDxCRIhL3ZVeoqNjS6EuRdeCDvUGuiko2A9BHUxXh/yhpCT8SB6ASvWHaVznUf1Hyq9A67WPMqJ9EIZeO6kQvAkk7Q/TV84sumzA7gfzlLDpntJgW8B1Krlj5fB4nYFOjqlHGB7McDdBzZfNUpKkJ6AD+WRYEYaGAbp0/Io8BBi0ITtG/W7RTjQBBBsSMcgA5cQ/8XgpCJq5544YumaYGRjLZjEXbnK+Ccse5G6cn+9jWj7sVFzvEsLrhXzvRr8BAJUdqlQqlaruCc0YT8TR6PNvAAAAAElFTkSuQmCC","orcid":"https://orcid.org/0000-0002-2351-4309","institution":"Centre Suisse de Recherches Scientifiques en Cote d'Ivoire","correspondingAuthor":true,"prefix":"","firstName":"Julien","middleName":"","lastName":"Zahouli","suffix":""},{"id":469784210,"identity":"c4da6c63-b741-4fad-b54c-3157f7155533","order_by":1,"name":"Pélagie E.B. 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Smith","email":"","orcid":"","institution":"Swiss Tropical and Public Health Institute: Schweizerisches Tropen- und Public Health-Institut","correspondingAuthor":false,"prefix":"","firstName":"Thomas","middleName":"A.","lastName":"Smith","suffix":""},{"id":469784221,"identity":"c11b0111-bed4-4078-b235-faec82df1220","order_by":12,"name":"Andrea Leuenberger","email":"","orcid":"","institution":"Swiss Tropical and Public Health Institute: Schweizerisches Tropen- und Public Health-Institut","correspondingAuthor":false,"prefix":"","firstName":"Andrea","middleName":"","lastName":"Leuenberger","suffix":""},{"id":469784222,"identity":"32b225da-b2a3-45bd-ab73-4f65f7ea06d1","order_by":13,"name":"Laura Vavassori","email":"","orcid":"","institution":"Swiss Tropical and Public Health Institute: Schweizerisches Tropen- und Public Health-Institut","correspondingAuthor":false,"prefix":"","firstName":"Laura","middleName":"","lastName":"Vavassori","suffix":""},{"id":469784223,"identity":"f622d961-a531-483f-9b98-1958cbd8a6fd","order_by":14,"name":"Sarah Ruel-Bergeron","email":"","orcid":"","institution":"International Society for Urban health, New York, NY, USA","correspondingAuthor":false,"prefix":"","firstName":"Sarah","middleName":"","lastName":"Ruel-Bergeron","suffix":""},{"id":469784224,"identity":"f683094a-5745-4310-8b6a-aad0282e4962","order_by":15,"name":"Giovanfrancesco Ferrari","email":"","orcid":"","institution":"Swiss Tropical and Public Health Institute: Schweizerisches Tropen- und Public Health-Institut","correspondingAuthor":false,"prefix":"","firstName":"Giovanfrancesco","middleName":"","lastName":"Ferrari","suffix":""},{"id":469784225,"identity":"a12696fb-43ce-4381-a88e-5652bb6c11e7","order_by":16,"name":"Pie Müller","email":"","orcid":"","institution":"Swiss Tropical and Public Health Institute: Schweizerisches Tropen- und Public Health-Institut","correspondingAuthor":false,"prefix":"","firstName":"Pie","middleName":"","lastName":"Müller","suffix":""}],"badges":[],"createdAt":"2024-11-08 12:05:07","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5416379/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5416379/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":84598776,"identity":"9c2e0827-d8ce-40af-87f8-15f8876e329c","added_by":"auto","created_at":"2025-06-14 07:55:59","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":385951,"visible":true,"origin":"","legend":"\u003cp\u003eMaps showing the study areas of Anono and Gbagba located in the health district of Cocody-Bingerville in Abidjan, southern Côte d’Ivoire. \u003cstrong\u003eA:\u003c/strong\u003eCôte d’Ivoire located in West Africa, \u003cstrong\u003eB:\u003c/strong\u003eAbidjan situated in southern Côte d’Ivoire, \u003cstrong\u003eC:\u003c/strong\u003e Anono and Gbagba located in eastern part of the city of Abidjan.\u003c/p\u003e","description":"","filename":"Fig1.png","url":"https://assets-eu.researchsquare.com/files/rs-5416379/v1/4cb2c45c3a14c4c58ec4f2de.png"},{"id":84598355,"identity":"fdbcfb91-2a89-4d96-8e5c-903a574d6e24","added_by":"auto","created_at":"2025-06-14 07:48:00","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":477173,"visible":true,"origin":"","legend":"\u003cp\u003eIntervention clusters. Coloured areas represent the clusters, while the grids indicate the sampling ‘pixels’ for adult mosquitoes. In each cluster, two grid cells were selected in each of which a BG-Sentinel trap was placed for adult mosquito sampling. In contrast, the interventions were implemented across the entire clusters. The clusters were based on pixels measuring 25 m by 25 m. Each cluster contains 100 pixels with a total surface area of 6.25 ha. \u003cstrong\u003eA:\u003c/strong\u003e Anono, \u003cstrong\u003eB:\u003c/strong\u003e Gbagba.\u003c/p\u003e","description":"","filename":"Fig2.png","url":"https://assets-eu.researchsquare.com/files/rs-5416379/v1/150f1ece38c937b273563361.png"},{"id":84598348,"identity":"2de01e70-000c-48f9-99ed-6357dfd078b2","added_by":"auto","created_at":"2025-06-14 07:47:59","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":52268,"visible":true,"origin":"","legend":"\u003cp\u003eFlow chart of cluster selection in Anono and Gbagba in the health district of Cocody-Bingerville, Abidjan, Côte d’Ivoire. LSM: Larval source management, AMT: Adult mass trapping, BG-GAT: Biogents Gravid \u003cem\u003eAedes\u003c/em\u003e trap.\u003c/p\u003e","description":"","filename":"Fig3.png","url":"https://assets-eu.researchsquare.com/files/rs-5416379/v1/8458ea61db3ed5c8411e00b7.png"},{"id":84598347,"identity":"8c31bd4a-cbab-4cab-bbb7-f3b3d247a264","added_by":"auto","created_at":"2025-06-14 07:47:59","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":59252,"visible":true,"origin":"","legend":"\u003cp\u003eSchedule of enrolment, interventions and assessments of the standard protocol items corresponding to those of the SPIRIT recommendations for intervention trials. BG-GAT: Biogents Gravid \u003cem\u003eAedes\u003c/em\u003e Trap, LSM: larval source management, AMT: adult mosquito-trapping.\u003c/p\u003e","description":"","filename":"Fig4.png","url":"https://assets-eu.researchsquare.com/files/rs-5416379/v1/45f552b673d2c1d0411f38bc.png"},{"id":90448711,"identity":"393a386b-df9f-4864-81a5-8f7344745d6b","added_by":"auto","created_at":"2025-09-02 21:40:26","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1860972,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5416379/v1/813f15b7-d51d-4257-ae0f-8339d52fdda5.pdf"},{"id":84598350,"identity":"b8e1ce60-4ffb-486d-9fc7-479ca328edc1","added_by":"auto","created_at":"2025-06-14 07:47:59","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":123958,"visible":true,"origin":"","legend":"","description":"","filename":"Table1.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5416379/v1/69c7bb60b8ee7af664b7fc2c.pdf"},{"id":84598360,"identity":"a56e9bfa-f648-406d-b791-1d6421105ce9","added_by":"auto","created_at":"2025-06-14 07:48:00","extension":"pdf","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":7170502,"visible":true,"origin":"","legend":"\u003cp\u003eAdditional file 1: Community training materials (pamphlets) and supervision checklist.\u003c/p\u003e","description":"","filename":"Additionalfile1.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5416379/v1/eb1b70c9cdf3f3d76f5e9fd1.pdf"},{"id":84598779,"identity":"49fc0c7a-613b-4d7f-9d5a-9834400638c7","added_by":"auto","created_at":"2025-06-14 07:56:00","extension":"pdf","order_by":3,"title":"","display":"","copyAsset":false,"role":"supplement","size":590899,"visible":true,"origin":"","legend":"\u003cp\u003eAdditional file 2: Detailed monitoring protocols.\u003c/p\u003e","description":"","filename":"Additionalfile2.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5416379/v1/f4f9b015d73f83dd84d68e5d.pdf"},{"id":84598781,"identity":"403eb3cf-b0aa-4269-bff8-6f725677b087","added_by":"auto","created_at":"2025-06-14 07:56:00","extension":"pdf","order_by":4,"title":"","display":"","copyAsset":false,"role":"supplement","size":240782,"visible":true,"origin":"","legend":"\u003cp\u003eAdditional file 3: Analytical plan of the data.\u003c/p\u003e","description":"","filename":"Additionalfile3.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5416379/v1/29fa34dd47d1c949bf7eb418.pdf"},{"id":84598777,"identity":"930d905a-693c-4843-9be2-374caf41359e","added_by":"auto","created_at":"2025-06-14 07:56:00","extension":"pdf","order_by":5,"title":"","display":"","copyAsset":false,"role":"supplement","size":736937,"visible":true,"origin":"","legend":"\u003cp\u003eAdditional file 6: Participant information materials and informed consent form.\u003c/p\u003e","description":"","filename":"Additionalfile6.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5416379/v1/57a8c6bc4bc1d6a49dda166f.pdf"}],"financialInterests":"","formattedTitle":"\u003cp\u003eDengue vector control through multisectoral and community-based interventions in Abidjan, Côte d’Ivoire: study protocol for a cluster-randomised trial {1}\u003c/p\u003e","fulltext":[{"header":"Background {6a}","content":"\u003cp\u003eThe last 15 years have seen an unprecedented increase in dengue emergence with the heaviest burden in tropical megacities. The West African region contains many active dengue foci and is projected to be next front of disease outbreaks [\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. This rapid spread is fuelled by unplanned urbanisation, globalisation and climate change [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e] and constitutes a wake-up call to strengthen global and local control programmes in emerging foci [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. No licensed vaccine is available for dengue in sub-Saharan Africa and, therefore, surveillance and control of its vectors, \u003cem\u003eAedes\u003c/em\u003e mosquitoes, are key to effective disease prevention. Abidjan in C\u0026ocirc;te d\u0026rsquo;Ivoire with an estimated population of 7\u0026nbsp;million faced multiple large outbreaks of dengue (serotypes DENV-1, DENV-2 and DENV-3) between 2017 and 2024 [\u003cspan additionalcitationids=\"CR7\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe principal dengue vector in Africa, \u003cem\u003eAedes aegypti\u003c/em\u003e, is highly anthropophilic, perfectly adapted to the urban environment and exceedingly prevalent in a growing number of tropical megacities [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. It is well known that it breeds in small containers such as used tyres, discarded cans, and water storage containers and bites and rests outdoors [\u003cspan additionalcitationids=\"CR12 CR13\" citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. It has a plastic ecology and uses avoidance behaviours such as breeding in cryptic or ephemeral containers that may remain unnoticed, skipping containers, disseminating small lots of eggs among diverse containers or avoiding outdoor interventions by refuging indoors [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. \u003cem\u003eAedes aegypti\u003c/em\u003e is also a main vector of several other viruses such as chikungunya, yellow fever and Zika viruses [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eSpace spraying of insecticides targeting the \u003cem\u003eAedes\u003c/em\u003e adults and removing larval breeding sites are frequent components of governmental vector control programmes in sub-Saharan Africa. In Abidjan, the National Institute for Public Hygiene (NIPH) of the Ministry of Health (MoH) of C\u0026ocirc;te d\u0026rsquo;Ivoire conducted dengue outbreak responses based on \u003cem\u003eAedes\u003c/em\u003e larval source management (LSM) and sporadic outdoor space spraying of insecticides against adult vector populations. For the 2017-dengue outbreak response, over 250,000 larval breeding sites were eliminated, destroyed or treated with insecticides among 17,000 households [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. However, it is challenging to identify the key \u003cem\u003eAedes\u003c/em\u003e breeding sites, adult resting and biting behaviours, and places for insecticide space spraying while many areas are also not accessible to the vehicles deployed for space spraying. These vertical and sporadic actions lacking involvement of local communities are expensive, their impacts are limited and short-term [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. The Abidjan campaigns were followed by multiple re-emergences of dengue (3,201 suspected, 281 confirmed and 2 fatal cases), coupled with yellow fever outbreaks (89 confirmed and 1 fatal case) in the same intervention areas in 2019. Moreover, the widespread use of insecticides has led to selection of resistance in the vectors, which may exacerbate future outbreaks of mosquito-borne disease [\u003cspan additionalcitationids=\"CR19\" citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e \u003cem\u003eAedes aegypti\u003c/em\u003e occurrence and abundance are closely linked to the behaviours and the activities of local people, implying that there is untapped potential to make interventions and surveillance strategies better locally adapted, more cost-effective and sustainable by enlisting the active participation of communities living in dengue foci. A community-based approach to LSM offers an excellent opportunity to leverage context-specific understandings of the ecology of \u003cem\u003eAedes\u003c/em\u003e vectors and their interactions with the cultural, social, behavioural and economic characteristics of local communities [\u003cspan additionalcitationids=\"CR22 CR23\" citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eA community-based approach can also be applied to killing adult female mosquitoes. This may be more efficient than LSM, both because these mosquitoes may already be carrying a pathogen acquired at an earlier feed, and because it averts population expansion: each female has the potential to produce between 50\u0026ndash;100 eggs per gonotrophic cycle [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. A recent study in the USA successfully used a community-based approach for mosquito adult mass trapping (AMT) of gravid females of a main dengue vector, \u003cem\u003eAedes albopictus\u003c/em\u003e, using the Biogents Gravid \u003cem\u003eAedes\u003c/em\u003e Traps (BG-GAT; Biogents AG, Regensburg, Germany) [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. The BG-GAT system with sticky cards is a passive trap targeting egg-laying female \u003cem\u003eAedes\u003c/em\u003e. This means it does not require power or supplemental attractants like CO\u003csub\u003e2\u003c/sub\u003e or chemical lures and does not use insecticides. Although the BG-GAT is relatively expensive in the African context (about USD 20 per piece), it remains one of the cheapest commercially available traps and if mass trapping is scaled up, the price per trap is likely to decrease. The trap is easy to set up and deploy, making it an ideal tool for use within a community-based programme.\u003c/p\u003e \u003cp\u003eThis paper describes the design of a cluster-randomised trial (CRT) in Abidjan to evaluate the two interventions of LSM and AMT using BG-GATs, both implemented via community mobilisation strategies that involved the community in co-designing the trial intervention protocol. The outcomes and lessons learned may help with designing the regional and global dengue surveillance programmes.\u003c/p\u003e"},{"header":"Methods/design","content":"\u003ch3\u003eObjectives {7}\u003c/h3\u003e\n\u003cp\u003e\u003cstrong\u003ePrimary objectives\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe primary objectives are to test the effects on \u003cem\u003eA. aegypti\u003c/em\u003e adult densities of mobilising and engaging local communities in the development and implementation of \u003cem\u003eAedes\u003c/em\u003e (i) LSM, and (ii) AMT using BG-GATs.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSecondary objectives\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThere are four interlinked secondary objectives:\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eTo assess the spatial and temporal distribution of \u003cem\u003eAedes\u003c/em\u003e mosquitoes in association with housing, human behaviour and mosquito habitat suitability to design a community-based CRT.\u003c/li\u003e\n \u003cli\u003eTo evaluate the effectiveness of the community mobilisation programme to co-design\u0026nbsp;\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003ethe CRT and implement the LSM, with and without AMT.\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eTo analyse any incremental benefit of combining the LSM and AMT interventions.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eTo conduct stakeholder advocacy activities to sustain the community engagement programme and to develop policy recommendations for sustainable control of \u003cem\u003eAedes\u003c/em\u003e mosquitoes and dengue and other mosquito-borne viral diseases.\u003c/li\u003e\n\u003c/ul\u003e\n\u003ch3\u003eStudy area and participant eligibility\u0026nbsp;{9 and 10}\u003c/h3\u003e\n\u003cp\u003eThe study was located in the neighbourhoods of Anono (5\u0026deg;20\u0026apos;39.7\u0026quot;N, 3\u0026deg;58\u0026apos;16.4\u0026quot;W) and Gbagba (5\u0026deg;20\u0026apos;55.4\u0026quot;N, 3\u0026deg;53\u0026apos;10.7\u0026quot;W) in the health district of Cocody-Bingerville in Abidjan, Southern C\u0026ocirc;te d\u0026rsquo;Ivoire in West Africa (Fig. 1). Over 80% of reported dengue cases in C\u0026ocirc;te d\u0026rsquo;Ivoire have occurred in the health district of Cocody-Bingerville [6-8].\u003c/p\u003e\n\u003cp\u003ePrevious studies conducted by the research team showed that Anono and Gbagba are dominated by \u003cem\u003eA. aegypti\u003c/em\u003e mosquitoes\u0026nbsp;[26]. Both areas are characterised by a rapid and uncontrolled urbanisation, and there are various \u003cem\u003eAedes\u003c/em\u003e larval breeding sites, such as tyres, discarded cans, water storage containers, derived from human activities and the poor management of solid and plastic waste [26]. The population of Anono are mostly Ebri\u0026eacute; people and estimated at 5,000 inhabitants, while the population of Gbagba is more heterogeneous, composed of locals and immigrants from neighbouring countries (e.g. Burkina Faso, Guinea, Mali, etc.) and estimated at 6,000 inhabitants. Anono and Gbagba thus represent appropriate settings for evaluating the effectiveness of a community-based intervention trial for sustainable \u003cem\u003eAedes\u003c/em\u003e dengue vector control.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026lt;˂ Fig. 1 near here \u0026gt;\u0026gt;\u003c/strong\u003e\u003c/p\u003e\n\u003ch3\u003eIntervention trial design\u0026nbsp;{8}\u003c/h3\u003e\n\u003cp\u003eThe community-based intervention trial was a two-by-two factorially designed CRT, with four parallel study arms (Table 1) and an intervention period of 12 months:\u0026nbsp;\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eLSM - Aedes larval source management (study arm 1): The LSM consisted of managing containers that can potentially or actually hold water and serve as ovipositing or larval breeding sites for Aedes mosquitoes. Community members were trained to remove, empty, or destroy such sites to eliminate discarded, abandoned or unused containers, and to clean and cover potable water storage containers.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eAMT \u0026ndash; Aedes adult mass trapping (study arm 2): Two BG-GATs (Biogents Gravid Aedes Traps Neighbourhood Protection, BG-GAT 2; Biogents AG, Regensburg, Germany) model were deployed per household. The community members were trained in the maintenance of the traps, including cleaning them, topping up the water, and replacing sticky papers to kill the trapped mosquitoes, and were monitored and advised by local well-trained supervisors (more information on community training materials (pamphlets) and supervision checklist is provided in Additional file 1).\u003c/li\u003e\n \u003cli\u003eLSM - AMT (study arm 3): Both LSM and AMT interventions were conducted in the combination LSM - AMT clusters.\u003c/li\u003e\n \u003cli\u003eControl (study arm 4): Neither LSM nor AMT interventions were conducted in the control clusters.\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026lt;˂ Table 1 near here \u0026gt;\u0026gt;\u003c/strong\u003e\u003c/p\u003e\n\u003ch3\u003eCluster assignment\u0026nbsp;{16a}\u003c/h3\u003e\n\u003cp\u003eUsing an existing map of geotypologies for Abidjan [27] loaded into ArcGIS Pro2.2.4 (ESRI, Redlands, California, USA), we removed all spaces (\u0026lsquo;geotypologies\u0026rsquo;) that could not be sampled, such as water bodies or industrial zones from consideration as part of the trial. We then identified a contiguous zone of 125 ha in each of the neighbourhoods of Anono and Gbagba (Fig. 1), each composed of 2,000 pixels and each measuring 25 m by 25 m (625 m\u003csup\u003e2\u003c/sup\u003e). Using a custom-written script in R 1.4.1 [28], we constructed clusters using a nearest neighbour algorithm to aggregate 100 pixels into each cluster yielding a total of 40 clusters each with a surface area of 6.25\u0026nbsp;ha (Fig. 2). We labelled each house and each cluster with unique codes. Fig. 3 shows the flow chart of the trial. Fig.\u0026nbsp;4 displays the timeline for enrolment, intervention and assessment for pre-trial to post-trial activities.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026lt;˂ Fig. 2 and Fig. 3 near here \u0026gt;\u0026gt;\u003c/strong\u003e\u003c/p\u003e\n\u003ch3 id=\"_Toc168257271\"\u003eRandomisation {16c and 15}\u003c/h3\u003e\n\u003cp\u003eWe allocated the interventions among the 40 clusters, with five clusters per study arm in each neighbourhood (i.e. 10 clusters per study arm in total). Each cluster was randomly assigned to one of the four study arms using the R function \u0026lsquo;sample\u0026rsquo;. Since the aim was to sample space (randomly), while a BG-Sentinel two trap (Biogents, Regensburg, Germany) may not be placed randomly in space since it has to be set up in a shaded, protected spot away from the public, we divided the area into pixels. We randomly chose the pixels in which the field team placed one BG-Sentinel trap was placed, while the field team found the most suitable spot within the selected pixel. For each cluster, we sampled from one pixel over two consecutive days from dawn to dusk every other week. Around the grid with the pixels for adult mosquito samplings a border of one pixel width was defined in which no traps were placed, while we still implemented the intervention arm (Fig.\u0026nbsp;2). The border shall act as a buffer zone in case adult mosquitoes move between clusters.\u003c/p\u003e\n\u003cp\u003eIn addition to the continuous adult mosquito sampling, we performed household surveys and larval sampling during the baseline study and then every third month until the end of the trial. The larval sampling took place in and around randomly selected houses. If a house had more than one household, only one household was subject to the survey, while the field team aimed at inspecting all potential breeding sites from the entire house including the area around it. For the household survey and the larval sampling, we selected randomly 11 houses per cluster. As we did not have a list with households, we selected 11 random points using the in-build function in ArcGIS Pro while setting the minimal distance between points at 25\u0026nbsp;m. In the field, the team visited the house closest to the random point on the map.\u003c/p\u003e\n\u003ch3 id=\"_Toc168257272\"\u003eAllocation concealment {16b}\u003c/h3\u003e\n\u003cp\u003eThe trial is a single-blinded study in which the data analysis is conducted by a statistician who is unaware of the arm allocations. It is not feasible to conceal the allocations from the participants.\u003c/p\u003e\n\u003ch3 id=\"_Toc168257273\"\u003eData collection and evaluation {33}\u003c/h3\u003e\n\u003cp\u003eWe monitored the study outcomes using multidisciplinary study protocols: entomological, environmental and socio-behavioural protocols described (detailed monitoring protocols are given in Additional file 2). Data collections started with a pre-trial baseline for a period of 8 months (from December 2022 to July 2023), followed by an intervention period lasting 12 months (from August 2023 to July 2024) and post-trial surveys for two months (Fig. 4).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026lt;˂ Fig. 4 near here \u0026gt;\u0026gt;\u003c/strong\u003e\u003c/p\u003e\n\u003ch3\u003eData entry and management\u0026nbsp;{19}\u003c/h3\u003e\n\u003cp\u003eWell-trained experienced surveyors collected the entomological, environmental and social data using Open Data Kit (ODK) software on electronic tablets. We checked the electronic databases daily for errors and upon validation, we transferred them to a secure sever located at the Swiss Tropical and Public Health Institute (Swiss TPH) for storing.\u0026nbsp;\u003c/p\u003e\n\u003ch3 id=\"_Toc168257275\"\u003ePower and sample size calculations {14}\u003c/h3\u003e\n\u003cp\u003eThe power and sample size calculations were based on the baseline data and allowing for possible spillover effects due to local mosquito or human movement and are presented in a companion paper [29].\u0026nbsp;\u003c/p\u003e\n\u003ch3 id=\"_Toc168257276\"\u003eOutcome measures {12 and 18a}\u003c/h3\u003e\n\u003cp\u003e\u003cstrong\u003ePrimary outcome \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe primary outcome is \u003cem\u003eAedes\u0026nbsp;\u003c/em\u003emosquito mean number per trap per day.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSecondary outcomes\u003c/strong\u003e\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eEntomological outcomes\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eThe entomological secondary outcomes are [30, 31]:\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003e\u003cstrong\u003e\u003cem\u003eLarval indices\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e:\u003c/strong\u003e house index (HI), container index (CI), Breteau index (BI) and \u003cem\u003eStegomyia\u0026nbsp;\u003c/em\u003eindex (SI). HI is the proportion of houses with at least one larva, CI is the proportion of positive containers, BI is the number of positive containers per 100 houses and SI is the proportion of positive containers per population.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003e\u003cem\u003ePupal productivity indices:\u003c/em\u003e\u003c/strong\u003e pupae per person index (PPI), pupal index per house (PI) and pupae per hectare index (PHI). PPI is the number of pupae per person, PI is the number of pupae per house, and PHI is the number of pupae per hectare\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003e\u003cem\u003eAdult indices:\u003c/em\u003e\u003c/strong\u003e proportions of unfed, fed, half-gravid and gravid females, and parity rate (i.e. proportion of parous females);\u003c/li\u003e\n \u003cli\u003eEnvironmental outcomes\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eWe assessed the following environmental parameters:\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003e\u003cstrong\u003e\u003cem\u003eHousehold surveys\u003c/em\u003e\u003c/strong\u003e: correlate household survey responses with location, number and description of \u003cem\u003eAedes\u003c/em\u003e larval breeding sites\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003e\u003cem\u003eGeographical surveys\u003c/em\u003e\u003c/strong\u003e:location and description of micro- and macro-environmental factors that are prevalent in each treatment arm; and correlation of the distribution of \u003cem\u003eAedes\u003c/em\u003e larval habitats and environmental features in space and time.\u003c/li\u003e\n \u003cli\u003eSocial outcomes\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eIn addition to the entomological outcomes, we assessed the following social outcomes:\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eKnowledge, attitudes, and practices on dengue prevention and \u003cem\u003eAedes\u0026nbsp;\u003c/em\u003evector control among the local communities and stakeholders\u003c/li\u003e\n \u003cli\u003ePerception and awareness of risk of dengue and mosquitoes\u003c/li\u003e\n \u003cli\u003eStrategies to engage communities in prevention of dengue and \u003cem\u003eAedes\u003c/em\u003e vector control\u003c/li\u003e\n\u003c/ul\u003e\n\u003ch3\u003eData analysis and reporting\u0026nbsp;{20a, 20b and 21b}\u003c/h3\u003e\n\u003cp\u003eA statistician dedicated to the study will support data analysis. Data analysis and reporting will conform to the CONSORT guidelines for reporting of CRTs, insofar as these are relevant to a trial with no human health outcomes [32]. An analytical plan is provided as supplementary document (more details on the analytical plan of the data are given in Additional file 3).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eAs in most sub-Saharan African countries, in C\u0026ocirc;te d\u0026rsquo;Ivoire, the government dengue outbreak responses often follow a top-down approach lacking local community involvement, have resulted in a limited and short-term impact on \u003cem\u003eAedes\u003c/em\u003e vector control, thus leading to multiple re-emergences of dengue and other arboviruses once the intervention campaigns are over [\u003cspan additionalcitationids=\"CR7\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Therefore, the current intervention trial uses a bottom-up approach, with a special focus on the mobilisation and the engagement of the local communities for the control of \u003cem\u003eAedes\u003c/em\u003e dengue vectors in Abidjan, C\u0026ocirc;te d\u0026rsquo;Ivoire. This intervention trial aims to assess and compare the efficacy of community-led LSM [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e] and AMT [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e], alone or in combination, for controlling \u003cem\u003eA. aegypti\u003c/em\u003e in a multisectoral framework to sustain the intervention over the trial period. To build African citizen resilience against arboviral outbreaks, our current project aimed at training, mobilising and engaging local residents in the sustainable control of \u003cem\u003eAedes\u003c/em\u003e mosquitoes guided by scientific advisors. The interventions targeted to the built environments aim at reducing \u003cem\u003eAedes\u003c/em\u003e mosquito densities by removal of their larval breeding sites and mass trapping of adult gravid females in Anono and Gbagba in the arboviral foci in the health district of Cocody-Bingerville in Abidjan, C\u0026ocirc;te d\u0026rsquo;Ivoire. This study opts for a stepwise and integrated approach with three steps, pre-intervention, intervention and post-intervention, and involvement of scientists, stakeholders and local communities in the design and the implementation of the trial.\u003c/p\u003e \u003cp\u003eThe outcomes of the current study provide information about the efficacy of community based LSM and AMT interventions on the densities and parity of \u003cem\u003eA. aegypti\u003c/em\u003e, \u003cem\u003eAedes\u003c/em\u003e larval indices, the risk of transmission of dengue virus and the environmental and sociological outcomes. The study settings, Anono and Gbagba, harboured high numbers of \u003cem\u003eA. aegypti\u003c/em\u003e mosquitoes those larvae massively breed containers, inducing tyres, discarded cans, water storage containers, derived from human activities poor management of potable water and mismanagement of solid and plastic waste [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. Thus, Anono and Gbagba represented suitable areas for testing the effectiveness of a community-led intervention trial for the sustainable control of \u003cem\u003eAedes\u003c/em\u003e dengue vectors. Our trial design allowed for before-and-after and contemporaneous measures of intervention effects, and clustering of the intervention allows measurement of a possible spillover effect of LSM, AMT or both into neighbouring non-intervened areas [\u003cspan additionalcitationids=\"CR23 CR24\" citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. With 8-month baseline measurements before the commencement of the intervention, 12 months of follow-up for its completion, and post-intervention assessment, an understanding of the time taken to achieve an impact through LSM or AMT will be gained. By collecting data on multiple outcomes (i.e. entomological, environmental and sociological outcomes), we anticipate that it will be possible to attribute an effect on the control of local dengue vectors to the LSM and AMT interventions alone and in combination. In contrast, if the intervention is not effective, it will be possible to provide explanations for this outcome. Understanding the mechanism behind a successful intervention will be vitally important in optimising the system for future scale-up and, in the instance of no observed effect, understanding this result will also allow improvements to the approach, which could lead to success in the future.\u003c/p\u003e \u003cp\u003eBeyond the anticipated impact on dengue vectors, we expect the community members of the study population to benefit immediately from the reduction of the risk of getting other \u003cem\u003eAedes\u003c/em\u003e mosquito-borne arboviruses (e.g. yellow fever, chikungunya and Zika) and the mosquito nuisance, as well as an improvement of the environmental hygiene and sanitation possibly induced by LSM or AMT in Anono and Gbagba. In addition to including local community leaders and members in co-designing the trial protocol, these expected benefits might increase the acceptability, the adherence and the participation of the target communities to the current LSM and AMT interventions. The outcomes of this community-based participatory interventional trial might help with designing national, regional and global prevention and control programmes of dengue and other \u003cem\u003eAedes\u003c/em\u003e mosquito-borne arboviral diseases.\u003c/p\u003e \u003cdiv id=\"Sec26\" class=\"Section2\"\u003e \u003ch2\u003eTrial status {3}\u003c/h2\u003e \u003cp\u003eThe intervention trial ran over 12 months, from August 2023 to July 2024. Before the trial, we implemented a baseline study over three months to evaluate the initial situation. While data are not yet analysed, the trial was complete at the time the protocol manuscript was submitted for review by \u003cem\u003eTrials\u003c/em\u003e. The recruitment and training of participants, the multisectoral stakeholder workshops, the exploitation of the entomological, environmental and sociological outcomes of the baseline study for co-designing the intervention trial protocol, the amendment of the co-designed trial protocol and entomological monitoring of intervention efficacy were completed in November 2023. This study protocol was not submitted early (i.e. before the last visit), since it was adjusted along the trial implementation according to the feedback and recommendations from workshops with the local community members and stakeholders. This complex integrated intervention for dengue vector control by local communities was designed and implemented within a multisectoral framework with active participations of residents, community leaders and stakeholders for smooth installation and successfully completion of the trial.\u003c/p\u003e \u003c/div\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eAMT\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eadult mass trapping\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eBG-GAT\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eBiogents Gravid \u003cem\u003eAedes\u003c/em\u003e Trap\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eBI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eBreteau index\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003econtainer index\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCRT\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ecluster-randomised trial\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eGLMM\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003egeneralised linear mixed model\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eHI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ehouse index\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eKAP\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eknowledge, attitudes, and practice\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eLSM\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003elarval source management\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eODK\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eOpen Data Kit\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003ePHI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003epupae per hectare index\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003ePI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003epupa index\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003ePPI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003epupae per person\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eSI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003e \u003cem\u003eStegomyia\u003c/em\u003e index\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eSwiss TPH\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eSwiss Tropical and Public Health Institute\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eWHO\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eWorld Health Organization\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003ch3\u003eAcknowledgments\u003c/h3\u003e\n\u003cp\u003eWe extend our thanks to everyone who helped in the co-design and implementation of this study protocol, and a heartfelt thanks to political, health, traditional and religious authorities, local community leaders and the populations of Anono and Gbagba. We thank Biogents for supporting a part of the costs of BG-GATs used in this study.\u003c/p\u003e\n\u003ch3\u003eName, contact and role information for the sponsor {5b and 5c}\u003c/h3\u003e\n\u003cp\u003eThe sponsors of the study are the Swiss Network for International Studies (Grant number: C21047), Bern, Basel Switzerland the Leading House Africa Programme (LHA) (Research Partnership Grant I) of University of Basel, Basel Switzerland, and INOVEC (HORIZON-MCSA-SE Grant Agreement 101086257). The roles of the sponsors are to provide financial resources and evaluate the technical and financial reports of the projects.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDissemination policy {31a}\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe results of this study will be disseminated through peer reviewed journals, academic or scientific conferences, stakeholder meetings and policy briefs and reports to health authorities, policy-makers and decision-makers at the health districts, the national vector control programmes and the Ministry of health (MoH) of C\u0026ocirc;te d\u0026rsquo;Ivoire.\u003c/p\u003e\n\u003ch3 id=\"_Toc168257283\"\u003eAuthors\u0026rsquo; contributions {31b}\u003c/h3\u003e\n\u003cp id=\"_Toc168257284\"\u003eJZBZ, VK, ELEA, TAS, AL, LV, JP, SRB and PM designed and developed the study protocol. JZBZ, VK, ELEA, and PM co-drafted the manuscript. JZBZ, TAS, LV, JP, PM, SRB and GF reviewed the final manuscript. VK, ELEA, TAS, PM and GF were responsible for the methodology of the statistical analyses of the data. JZBZ, PEBA, CNA, and AL prepared the ethical review application. CNA, PEBA and PM recruited households. JZBZ, PEBA and CNA performed the intervention. TAS critically revised the manuscript and the data analysis plan. JZBZ, CNA, VK, ELEA, FD, SRB and PM contributed to the acquisition of financial support. PEBA, CNA, MAK, CAB, GKK and AG were responsible of the data collection. All authors read and approved the final version of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding {4}\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe project is funded by the Swiss Network for International Studies (Grant number: C21047), the Leading House Africa Programme (LHA) (Research Partnership Grant I) of University of Basel and INOVEC (HORIZON-MCSA-SE Grant Agreement 101086257). The roles of the sponsors are to provide financial resources and evaluate the technical and financial reports of the projects. The funders were not involved in the design of the study or the writing of the manuscript and did not have any impact on the data collection, analysis, or publication of the manuscript (more information on the funding is given in Additional file 4).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e{29}\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe results of this study will be published through scientific journals or presented at scientific conferences and meetings. To date, there are still no plans to make any of the trial data sets available to the public. However, community training supervision and participant information materials and informed consent forms can be obtained from the corresponding author.\u003c/p\u003e\n\u003ch3 id=\"_Toc168257286\"\u003eEthics approval and consent to participate {24}\u003c/h3\u003e\n\u003cp\u003eEthical clearance for the study was obtained from the Ethics Committee of the North and Central Switzerland EKNZ (Ref. no.: AO_2022-00023) and by the National Ethics Committee for Research of the Ministry of Health of C\u0026ocirc;te d\u0026rsquo;Ivoire (Ref. no.: 026-22/MSHPCMU/CNESVS-km). All participants were provided with written and oral information regarding the project objectives, the implementation of the intervention, mosquito sampling, entomological and environmental data collection, social surveys and multisectoral workshops with scientists, stakeholders and local community leaders and members. All participants provided written informed consent in French agreeing to participate in the interventions (more information on the ethical approval is given in Additional file 5).\u003c/p\u003e\n\u003ch3\u003eCompeting interests {28}\u003c/h3\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication {32}\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable. No identifying images or other personal or details of participants are presented here or will be presented in reports of the trial results. The participant information materials and informed consent form are attached as supplementary materials (more information is given in Additional file 6).\u003c/p\u003e\n\u003ch3\u003eAuthor details {5a}\u003c/h3\u003e\n\u003cp\u003e\u003csup\u003e1\u003c/sup\u003eCentre d\u0026rsquo;Entomologie M\u0026eacute;dicale et V\u0026eacute;t\u0026eacute;rinaire of Universit\u0026eacute; Alassane Ouattara, Bouak\u0026eacute;, C\u0026ocirc;te d\u0026rsquo;Ivoire. \u003csup\u003e2\u003c/sup\u003eCentre Suisse de Recherches Scientifiques en C\u0026ocirc;te d\u0026rsquo;Ivoire, Abidjan, C\u0026ocirc;te d\u0026rsquo;Ivoire. \u003csup\u003e3\u003c/sup\u003eSwiss Tropical and Public Health Institute, Allschwil, Switzerland. \u003csup\u003e4\u003c/sup\u003eUniversit\u0026auml;t Basel, Basel, Switzerland. \u003csup\u003e5\u003c/sup\u003eUniversit\u0026eacute; F\u0026eacute;lix Houphou\u0026euml;t-Boigny, Abidjan, C\u0026ocirc;te d\u0026rsquo;Ivoire. \u003csup\u003e6\u003c/sup\u003eInstitut National d\u0026rsquo;Hygi\u0026egrave;ne Publique, Minist\u0026egrave;re de la Sant\u0026eacute;, Abidjan, C\u0026ocirc;te d\u0026rsquo;Ivoire. \u003csup\u003e7\u003c/sup\u003eInternational Society for Urban Health, New York, NY, USA.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eStoler J, Al Dashti R, Anto F, Fobil JN, Awandare GA. 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PMID: 15031246; PMCID: PMC381234.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"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":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Aedes aegypti, sustainable vector control, larval source management, adult mass trapping, Gravid Aedes trap, cluster-randomised control trial, Africa","lastPublishedDoi":"10.21203/rs.3.rs-5416379/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5416379/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn Africa, most governmental arbovirus control programmes and outbreak responses mainly follow a vertical, top-down approach for \u003cem\u003eAedes\u003c/em\u003e vector control, leading to short-term effects and re-emergence of dengue in intervened areas once campaigns are over. This study evaluates a horizontal, bottom-up approach built on multisectoral collaborations aiming to empower and engage local communities in controlling \u003cem\u003eAedes\u003c/em\u003e mosquitoes with the guidance of stakeholders and scientists in Abidjan, Côte d’Ivoire.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe trial is a two-by-two factorially designed cluster-randomised trial (CRT) of (i) community participatory interventions based on larval source management (LSM) and (ii) adult mass trapping (AMT) of \u003cem\u003eAedes aegypti\u003c/em\u003e using Biogents Gravid \u003cem\u003eAedes\u003c/em\u003e Traps (BG-GATs). It includes 20 contiguous equal area (625 ha) clusters in each of the Anono and Gbagba neighbourhoods, totalling 40 clusters, within the Cocody-Bingerville health district of Abidjan. Initially, baseline entomological, sociocultural, socio-economic and environmental data were collected. In the intervention clusters, local community members were then empowered and engaged in identifying how they could prevent and remove potential \u003cem\u003eAedes\u003c/em\u003e breeding sources, including household water and solid waste containers, and to install, maintain and handle the BG-GATs. The trial protocol was co-designed and co-created by the target community members and leaders, the local and governmental stakeholders and the research team members. Data collection pursued in order to measure the effectiveness of these novel interventions and their tangible benefits upon acceptability of and adherence to their use.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDiscussion\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis stepwise and holistic approach based on strengthening local community capacities for taking own preventive actions against \u003cem\u003eAedes\u003c/em\u003e vectors might build citizen resilience and improve adherence for the sustainable control of dengue in intervened areas. Lessons learned from this inclusive and multisectoral intervention model may help with designing regional and global dengue control programmes in Africa.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTrial registration\u003c/strong\u003e {2a and 2b}: ClinicalTrials.gov, ID NCT06648603. Registered on 1 July 2024.\u003c/p\u003e","manuscriptTitle":"Dengue vector control through multisectoral and community-based interventions in Abidjan, Côte d’Ivoire: study protocol for a cluster-randomised trial {1}","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-06-14 07:47:55","doi":"10.21203/rs.3.rs-5416379/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"b85bf396-7ecb-4d56-9672-52b2e9071269","owner":[],"postedDate":"June 14th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-09-02T21:32:18+00:00","versionOfRecord":[],"versionCreatedAt":"2025-06-14 07:47:55","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5416379","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5416379","identity":"rs-5416379","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}