# School and home-based educational intervention in urban Kenya: Sustained improvements in knowledge, attitudes, and practices for Aedes aegypti control

## TL;DR

An educational program in Kenya improved long-term knowledge and practices for controlling Aedes aegypti mosquitoes, which spread diseases like dengue.

## Contribution

A sustained school and home-based intervention effectively improved knowledge and practices for Aedes aegypti control in urban Kenya.

## Key findings

- At 12 months, the intervention group showed significant improvements in knowledge, attitudes, and practices compared to the control group.
- Both intervention and control groups saw an increase in the house index, indicating ongoing challenges in vector control despite improved knowledge.

## Abstract

Aedes aegypti mosquitoes are the primary vectors for important arboviral health threats including chikungunya (CHIKV) and dengue (DENV) viruses, primarily breeding in domestic plastic containers. Previous studies have highlighted a severe lack of knowledge about non-malarial mosquito-borne diseases in Kenya, so we proposed a household and school-based educational intervention in urban coastal Kenya to determine whether it could bring about long-term improvements in knowledge, attitudes, and practices related to the source reduction of arboviral disease vectors. In this cluster-randomized controlled trial, 249 households from 5 villages were placed in the intervention arm and 243 households from 5 other similar villages were placed in the control arm. From each household, one fourth grade child was enrolled. Data on the child participants’ knowledge, attitudes, and practices (KAP) were collected at baseline and 3- and 12-months post-intervention, along with counts of immature mosquitoes in containers in the participants’ households. At 3 months, the intervention group showed significantly greater improvement in attitude scores compared to the control group (p = 0.01), with no significant differences in knowledge or practices. However, by 12 months, the intervention group demonstrated significant improvements in knowledge (1.51 vs. 0.35, p < 0.001), attitude (0.268 vs. −0.263, p < 0.001), and practice (0.118 vs. −0.235, p < 0.001) scores compared to the control group. Additionally, the house index (houses with at least one productive container) increased in both the intervention (13.9% to 25.6%) and control (9.4% to 28.4%) households, signifying that although the intervention improved knowledge and some practices, a more targeted approach is needed to address challenges in vector control. This study demonstrates that long-term advances in knowledge, attitudes, and practices regarding arboviral diseases can be achieved through household and school-based educational interventions.