{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T16:48:47Z","timestamp":1791996527895,"version":"4.4.0"},"reference-count":87,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2021,1,31]],"date-time":"2021-01-31T00:00:00Z","timestamp":1612051200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000193","name":"International Development Research Centre","doi-asserted-by":"publisher","award":["108412-001"],"award-info":[{"award-number":["108412-001"]}],"id":[{"id":"10.13039\/501100000193","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Aedes aegypti is a cosmopolitan vector for arboviruses dengue, Zika and chikungunya, disseminated in all Brazilian states. The Eco-Bio-Social (EBS) strategy is vital in Aedes aegypti control as it mobilizes stakeholders (government, professionals, society, and academics) to promote healthy environments. This paper describes the rationale and methods of expanding the EBS strategy for Aedes aegypti control in Fortaleza, Northeast Brazil. A cluster, non-randomized controlled clinical trial was developed to analyze the strategy\u2019s effectiveness in vulnerable territories (high incidence of dengue and violent deaths; low HDI; substandard urban infrastructure, high population density, and water scarcity). We selected two intervention and two control groups, resulting in a sample of approximately 16,000 properties. The intervention consisted of environmental management by sealing large elevated water tanks, introduction of beta fish in waterholes, elimination of potential breeding sites, and mobilization and training of schoolchildren, endemic disease workers, health workers, social mobilizers, and community leaders; community surveillance of arboviruses; construction and validation of a booklet for the prevention of arboviruses in pregnant women. We analyzed the costs of arboviruses to government and households, the intervention cost-effectiveness, chikungunya\u2019s chronicity, and acceptance, sustainability, and governance of vector control actions. The primary outcome (infestation) was analyzed using the house, container, and Breteau indices. We hope that this study will help us understand how to scale up strategies to fight Aedes aegypti in vulnerable areas.<\/jats:p>","DOI":"10.3390\/ijerph18031278","type":"journal-article","created":{"date-parts":[[2021,1,31]],"date-time":"2021-01-31T21:31:56Z","timestamp":1612128716000},"page":"1278","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":15,"title":["Scaling up of Eco-Bio-Social Strategy to Control Aedes aegypti in Highly Vulnerable Areas in Fortaleza, Brazil: A Cluster, Non-Randomized Controlled Trial Protocol"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1450-8628","authenticated-orcid":false,"given":"Suyanne Freire de","family":"Mac\u00eado","sequence":"first","affiliation":[{"name":"Collective Health Postgraduate Program, State University of Cear\u00e1, Fortaleza 60714-903, Brazil"},{"name":"Nursing Department, Federal University of Piau\u00ed, Picos 64607-670, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1413-8137","authenticated-orcid":false,"given":"Kellyanne Abreu","family":"Silva","sequence":"additional","affiliation":[{"name":"Collective Health Postgraduate Program, State University of Cear\u00e1, Fortaleza 60714-903, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Renata Borges de","family":"Vasconcelos","sequence":"additional","affiliation":[{"name":"Collective Health Postgraduate Program, State University of Cear\u00e1, Fortaleza 60714-903, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Izautina Vasconcelos de","family":"Sousa","sequence":"additional","affiliation":[{"name":"Collective Health Postgraduate Program, State University of Cear\u00e1, Fortaleza 60714-903, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lyvia Patr\u00edcia Soares","family":"Mesquita","sequence":"additional","affiliation":[{"name":"Collective Health Postgraduate Program, State University of Cear\u00e1, Fortaleza 60714-903, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2305-1794","authenticated-orcid":false,"given":"Roberta Duarte Maia","family":"Barakat","sequence":"additional","affiliation":[{"name":"Collective Health Postgraduate Program, State University of Cear\u00e1, Fortaleza 60714-903, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"H\u00e9lida Melo Conrado","family":"Fernandes","sequence":"additional","affiliation":[{"name":"Collective Health Postgraduate Program, State University of Cear\u00e1, Fortaleza 60714-903, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana Carolina Melo","family":"Queiroz","sequence":"additional","affiliation":[{"name":"Collective Health Postgraduate Program, State University of Cear\u00e1, Fortaleza 60714-903, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gerarlene Ponte Guimar\u00e3es","family":"Santos","sequence":"additional","affiliation":[{"name":"Collective Health Postgraduate Program, State University of Cear\u00e1, Fortaleza 60714-903, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4769-4068","authenticated-orcid":false,"given":"Valter Cordeiro Barbosa","family":"Filho","sequence":"additional","affiliation":[{"name":"Collective Health Postgraduate Program, State University of Cear\u00e1, Fortaleza 60714-903, Brazil"},{"name":"Federal Institute of Education, Science and Technology of Cear\u00e1, Aracati Campus, Aracati 62800-000, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9449-4931","authenticated-orcid":false,"given":"Gabriel","family":"Carrasquilla","sequence":"additional","affiliation":[{"name":"Santa Fe de Bogot\u00e1 Foundation, Bogota 110311, Colombia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Caprara","sequence":"additional","affiliation":[{"name":"Collective Health Postgraduate Program, State University of Cear\u00e1, Fortaleza 60714-903, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jos\u00e9 Wellington","family":"de Oliveira Lima","sequence":"additional","affiliation":[{"name":"Collective Health Postgraduate Program, State University of Cear\u00e1, Fortaleza 60714-903, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,1,31]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"504","DOI":"10.1038\/nature12060","article-title":"The global distribution and burden of 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