Beyond the Mosquito: Social Determinants of Health and Global Strategies for Aedes-Borne Disease Control

Aedes-borne diseases, including dengue, chikungunya and Zika, have emerged as a growing global health concern, particularly in tropical and subtropical regions. Their spread is not only driven by biological and environmental factors but also shaped by a wide range of social determinants of health (SDH). This systematic review synthesizes available evidence on SDH that shape the transmission, prevention and control of these diseases, as well as the strategies implemented internationally to address them.

We conducted five systematic reviews following PRISMA guidelines, each corresponding to one of the major Aedes-borne diseases (dengue, chikungunya, Zika and other Aedes-related illnesses). Searches were performed in PubMed and Scopus for the period 2000-2024, using both MeSH terms and free-text keywords. Quality appraisal was conducted using appropriate checklists, that is, CASP, STROBE and results were synthesized narratively. Thematic coding was applied to identify patterns across social, economic and environmental determinants, while intervention data were summarized descriptively.

The systematic search figured out a large number of potentially relevant records across the five reviews. One hundred sixty-nine studies were included for full analysis including 27 studies on Aedes in general, 54 on dengue, 3 on chikungunya, 14 on Zika and 71 on preventive interventions. The main themes that emerged from the study analysis included: Poverty and Related Indicators, Education and Health Literacy, Community Engagement, Urban Infrastructure and Social Support, Access to Health Services, Demographic Factors, Culture and Beliefs and Migration and Human Mobility. Interventions that engaged communities and combined educational, infrastructural and environmental actions demonstrated the greatest impact and sustainability.

Findings of the study suggest that effective and sustainable Aedes-borne disease control depends on tackling structural inequities-particularly poverty and poor urban infrastructure-while promoting health literacy and community engagement. Future research should further investigate underexplored determinants, including cultural and migratory factors, to inform context-specific, multisectoral responses.