Positive deviance study to inform a Chagas disease control program in southern Ecuador

Area of Science:

• Vector-borne disease control
• Environmental health
• Housing and community development

Background:

• Chagas disease, caused by Trypanosoma cruzi, is transmitted by triatomine insects often found in poorly constructed homes.
• Persistent triatomine infestations in Ecuador's Loja province persist despite insecticide and educational efforts.

Purpose of the Study:

• To develop a sustainable strategy for Chagas disease transmission interruption.
• To design an anti-triatomine prototype house using insights from families who remain triatomine-free.

Main Methods:

• Utilized the positive deviance approach to identify effective practices of triatomine-free households.
• Collected data on knowledge, attitudes, and practices of families in Loja, Ecuador (2010-2012).

Main Results:

• Positive deviants employed practices like structural maintenance, fumigation, using insect-repellent plants, and relocating animals.
• Preferred construction materials included adobe walls and tile roofs, aligning with current practices.
• Participants recognized the link between a clean home and health; economic factors influence household space use.

Conclusions:

• Housing improvements can be a viable protective measure against Chagas disease.
• The prototype house design should incorporate traditional materials and consider family economic dynamics.
• Community acceptance is favorable for implementing housing modifications to prevent triatomine colonization.