# Evaluating the impact of the ‘Four Pest-Free Villages’ program on mosquito-borne disease control in Zhejiang Province, China: a cross-sectional study on knowledge, attitudes, and practices

## TL;DR

A study in Zhejiang Province, China, found that a mosquito and pest control program improved residents' knowledge and practices related to mosquito-borne diseases.

## Contribution

The study evaluates the effectiveness of the 'Four Pest-Free Villages' program version 4.0 in improving public health knowledge and practices.

## Key findings

- Residents in 'Four Pest-Free Villages' showed significantly better knowledge, attitudes, and practices regarding mosquito-borne diseases.
- Factors like age, education, and minority status were linked to better knowledge and attitudes in these villages.
- Customized interventions based on demographics are recommended to enhance vector control and public health outcomes.

## Abstract

Mosquito-borne diseases (MBDs) pose a persistent public health threat globally. The "Four Pest-Free Villages" program, which targets mosquitoes, flies, cockroaches, and rats, has been in place in Zhejiang Province, China, for more than 9 years. It was recently improved to version 4.0 as a crucial tactic for long-term vector management.

This cross-sectional study, which included eight "Four Pests Control Villages" and eight matching control villages, was carried out in 2024 in 16 villages spread across five cities in Zhejiang Province. To evaluate knowledge, attitude, and practice (KAP) about infectious diseases spread by mosquitoes, a stratified-cluster random sampling technique was used. In every dimension, KAP ratings of 70% or greater were deemed satisfactory. Chi-square tests and multivariate logistic regression analysis were used to find influential factors (α = 0.05). Ten stakeholders, including community managers, public health specialists, and resident representatives, participated in in-depth, semi-structured interviews to further examine the project’s efficacy and overall worth.

Residents of the "Four Pest-Free Village" (which targets mosquito, fly, cockroach, and rodents) showed significantly higher levels of knowledge (P < 0.01), attitudes (P < 0.05), and preventive practices (P < 0.01) regarding mosquito-borne diseases compared to control villages, according to 1447 valid questionnaires. While older age [odds ratio (OR) = 1.7–1.9], higher education (OR = 2.2), and minority status (OR = 2.4, all P < 0.05) predicted better knowledge and attitudes within “Four Pest-Free Villages”, younger residents, migrant workers, and individual farmers showed higher levels of preventive practice (P < 0.05) in control villages; gender effects on practice varied between sites.

The “Four Pest-Free Village” program—targeting mosquito, fly, cockroach, and rodents—significantly improved residents’ health literacy and their adoption of vector control practices. This underscores the necessity of customized interventions based on demographic variables and the significance of integrating health education programs with environmental management. The results offer useful recommendations for maximizing vector control initiatives and enhancing public health outcomes in both urban and rural regions. To further improve and bolster these tactics, future studies should incorporate more variables and broaden the data sources.

The online version contains supplementary material available at 10.1186/s40249-026-01422-z.