Dengue is an emerging public health problem Latin America and the Caribbean; dengue incidence, as well as the frequency of outbreaks have dramatically increased during the last decade in the region . According to World Health Organization (WHO), dengue transmission is currently reported in all Latin American countries, except for Uruguay [2–4]. In 2011, Brazil reported almost 71% (764,032) of all dengue cases for South Cone (807,191), followed by the Andean region (11% of cases, principally reported in Colombia, 33,207 cases, and Ecuador, 7659 cases, and by Mexico (6.3% of 67,918 cases) .
Dengue virus is transmitted by Aedes aegypti and occasionally by other species such as Aedes albopictus. Vector breeding sites are most commonly found in the intra- and peri-domestic environment, however, pre-imago stages have been found in public spaces, cemeteries, schools, hospitals, health centres and hotels [6, 7]. Breeding sites of Aedes aegypti are closely related to macro- and micro-ecological factors that are determined by human behaviours - individual, collective and institutional - and their related social, economic and political contexts. Ecological, biological and social (i.e., “eco-bio-social”) variables are interdependent factors for dengue vector production with a direct impact, however complex, on dengue control measures and prevention [7–10]. Ecological factors refer to climate (rainfall, humidity, temperature etc.) and the natural and man-made ecological setting (including the urban, peri-urban and agricultural environment etc.). Biological factors relate to the behaviour of Ae. aegypti, and the transmission dynamics of dengue virus (vector population dynamics and feeding behaviour). Social factors incorporate a series of variables relating to health systems, including vector control and health services, and their political context (e.g. health sector reforms), public and private services such as sanitation and sewage, garbage collection and water supply as well as “macro-social” events such as demographic growth and urbanization, as well as community and household-based practices, knowledge and attitudes and how these are shaped by large-scale forces such as poverty, social inequality and community dynamics . This broad eco-bio-social conceptual framework informed the present investigation of the ecosystem--specific (i.e. ecohealth) context in participant research sites. The research effort reported here is based on a longstanding research partnership between the Special Programme for Research and Training for Tropical Diseases (TDR) at the World Health Organization with the Ecosystems and Human Health (EcoHealth) programme of Canada’s International Development Research Centre (IDRC). Earlier, pilot research towards a comprehensive understanding of dengue vector development was conducted in Brazil  and in Colombia  and later on a comprehensive study in six Asian countries was conducted . This programme lead to developing tools and strategies for community-focused partnership models for dengue vector management with a spatial perspective (neighbourhoods and their surrounding; public and private spaces) rather than the more traditional, however, restrictive household-based perspective . The recognition of both private (intra- and peri-domestic) and public spaces, as well as the varied ecological characteristics of different kinds of urban neighbourhoods, has helped to cultivate a better understanding of vector dynamics and broaden the view for vector control interventions . Clearly, the local transmission of dengue in Latin America are different from those in Asia [10–15]. Different socio-economic, including housing conditions, variable delivery mechanisms and quality of public services, local variability in water storage practices, different social structures and community dynamics, and vector control practices, both at the municipal as well as personal levels [16, 17]. The study reported here is a multi-country research effort with a universal core protocol developed following a TDR/IDRC proposal development/study design/methods workshop on Innovative Community Based Ecosystem Management Interventions for Improved Chagas and Dengue Disease Prevention in Latin America and the Caribbean, held in Antigua, Guatemala in July 2009, and a Third Community of practice workshop held in Merida, Mexico, in August 2011.
The jointly developed protocol was applied in five Latin-American study sites in two phases. The purpose was 1) to explore in the first phase (which is the subject of this paper) the ecological, biological, and social (“eco-bio-social) factors that have contributed to the development of increased dengue mosquito populations in high-burden countries of Latin America 2) for comparative purposes, in a country where the vector is present but no dengue cases have yet been reported (Uruguay) and 3) to identify options for innovative community-based ecosystem management interventions to be designed, implemented and evaluated in phase 2, with active participation of all stakeholders involved, including communities, their governing structures (policy and decision makers etc.) and related services (water supply, waste management etc.).