When Dr Vanessa Cruvinel started her career in public health, she could never have dreamt that she’d be working in Latin America’s largest open waste site, trying to improve the health of one of the most vulnerable populations in Brazil.
Until recently, Estrutural City in Brasilia had the largest open waste site in Latin America. While the site was closed in 2018 and many waste pickers are now employed in indoor waste sorting facilities, extreme poverty of people living in this area still contributes to the transmission of diseases, particularly dengue. As of April 2024, Brazil is the country with the highest number of cases in the world, with 6.3 million suspected dengue cases, more than 80% of cases globally reported to WHO.
“This community in Estrutural City, initially formed by waste pickers 60 years ago and which now has 35 000 inhabitants, is more vulnerable than the other poor communities in Brazil,” Dr Cruvinel, a professor at the Public Health School of the University of Brasilia, said in a recent presentation to TDR’s Joint Coordinating Board.
Inadequate sanitation services contributes to the transmission of dengue. Photos courtesy of Vanessa Cruvinel.
TDR in 2020 published a conceptual framework covering the essential elements of successful multisectoral collaborations. TDR has been supporting research teams in Africa and Latin America that have been implementing the multisectoral approach.
Dr Marcos Obara and Dr Cruvinel have been leading the research team in Brazil. With technical and financial support from TDR, the team conducted research to develop public health solutions to reduce the incidence of dengue infection in Estrutural City, the poorest region in Brasilia, through the participation of three sectors having an impact on health: sanitation, urban services and education.
In
Estrutural City, the lack of adequate sanitation contributes to the growth of
dengue-carrying mosquitoes. Although the study’s qualitative survey showed that
many inhabitants knew how to prevent the spread of dengue by using special
water storage tanks and removing trash from breeding sites, because of extreme
poverty they could not afford to change their behaviour. Over 70% of
inhabitants had had dengue at some point in their lives.
Dr Cruvinel noted some key preliminary findings and actions taken to address them:
- Due to close living conditions, mobile waste disposal units cannot access houses to collect rubbish. For 7000 people, only five waste disposal sites are available, which means waste is often left in ditches. The Government of Brasilia’s Urban Cleaning Service is now implementing educational efforts to focus on correct waste disposal. And Dr Cruvinel’s team has donated trash cans to households as well as water tanks used by schools.
- An indoor waste sorting building has been provided so less waste is left in open areas, near living accommodations.
- The study group installed 150 stations with the larvicide pyriproxyfen. In areas of high incidence of dengue, this has helped to reduce the number of dengue cases by killing mosquito larvae. The Secretariat of Health of Brasilia now intends to implement this strategy of mosquito-disseminated larvicide in the areas of high incidence of dengue.
The
partnership with the sanitation department and urban services was essential to
give more strength to the programme, and the partnership with the education
sector for adults and children empowered the population with knowledge on
protection measures.
Dr
Cruvinel said that one of the most important steps they took as researchers was
to listen to the community: “We met with the waste pickers, the community
leaders, those working in education as well as the parents of the children in
kindergarten, even the children. We knew how important it was to listen to the
people directly affected to understand how they suffer. This helped us develop
our research methodology. Without doing this, we couldn’t have helped reduce
dengue rates in their community.”
While the study is still ongoing, there has been a 64% reduction of dengue cases in Estrutural City between 2022 and 2023. This outcome is likely linked to the dissemination of the larvicide pyriproxyfen, Dr Cruvinel said.
Dr Cruvinel and her team are now sharing their experiences with other countries, including in West Africa.
For more information, please contact Dr Florence Fouque.