"We need people to collaborate together against this disease": A qualitative exploration of perceptions of dengue fever control in caregivers' of children under 5 years, in the Peruvian Amazon

Background: Dengue Fever presents a significant and growing burden of disease to endemic countries, where children are at particular risk. Worldwide, no effective anti-viral treatment has been identified, thus vector control is key for disease prevention, particularly in Peru where no vaccine is currently available. This qualitative study aimed to explore the perceptions of dengue control in caregivers’ of children under 5 years in Peru, to help direct future mosquito control programmes and strategy. Methods: Eighteen semi-structured interviews were conducted in one health centre in Iquitos, Peru. Interviews were audio-recorded, transcribed and translated by an independent translator. Data were analysed using an inductive thematic approach. Findings: Three core analytic themes were interpreted: (1) awareness of dengue and its control, (2) perceived susceptibility of children, rural riverside communities and city inhabitants, and (3) perceived responsibility of vector control. Participants were aware of dengue symptoms, transmission and larvae eradication strategies. Misconceptions about the day-time biting behaviour of the Aedes aegypti mosquito and confusion with other mosquito-borne diseases influenced preventative practice. Community-wide lack of cooperation was recognised as a key barrier. This was strengthened by attitudes that the government or health centre were responsible for dengue control and a belief that the disease cannot be prevented through individual actions. Participants felt powerless to prevent dengue due to assumed inevitability of infection and lack of faith in preventative practices. However, children and rural communities were believed to be most vulnerable. Conclusions: Perceptions of dengue control amongst caregivers to under 5’s were important in shaping their likelihood to participate in preventative practices. There is a need to address the perceived lack of community cooperation through strategies creating a sense of ownership of community control and enhancing social responsibility. The belief that dengue cannot be prevented by individual actions in a community also warrants attention. Specific misconceptions about dengue should be addressed through the community health worker system and further research directed to identify the needs of certain vulnerable groups. Author summary: Dengue fever is the most rapidly spreading mosquito-borne viral disease in the world and is a significant international health problem. It is endemic in the Peruvian Amazon and since there is no available vaccine or effective treatment, mosquito control is key. This novel study used qualitative interviews to explore the perceptions and experiences of dengue control in caregivers’ to children under 5 years, to help inform future Peruvian mosquito control programmes. Findings suggested that caregivers had basic knowledge about dengue, but that misconceptions around the mosquito itself and confusion with other diseases (like malaria) influenced people’s protective practice. Furthermore, participants felt powerless to prevent dengue since the invisible mosquito, perceived ineffective prevention methods, and rural riverside environment made the disease seem inevitable. Despite this, children and rural riverside communities were identified as most vulnerable groups. Key findings suggested a lack of community cooperation in mosquito prevention due to an attitude that the government and health centre were responsible for disease control, and the belief that dengue cannot be prevented through individual actions alone. These were important barriers to community mosquito prevention efforts. The findings from this study provide novel insights into how perceptions of dengue control can impact prevention in an endemic country.