Dengue is an endemic-epidemic disease. The main vector in urban areas is Aedes aegypti, with Aedes albopictus as a secondary vector in the Americas. Its transmission dynamics depend on interactions between the environment, the host population, and the vector.

In the last 50 years, dengue incidence has increased 30-fold, with a growing geographical expansion into new countries and regions. The World Health Organization (WHO) considers it the second most re-emerging infection among tropical diseases and has classified it as a high-priority disease for research.

Therefore, the only way to prevent dengue is through vector control, and four key elements are essential for this: political will, intersectoral coordination in health, strengthening of public health laws, and community participation.

Aedes is the genus of mosquito that transmits diseases such as yellow fever, West Nile fever, and dengue. Dengue is an endemic-epidemic disease, and today it is the most important arboviral disease worldwide in terms of morbidity, mortality, and economic impact. In recent decades, its incidence has increased significantly, with more than 2.5 billion people (more than 40% of the world's population) at risk of contracting it.

The first records of this disease were made in Asia, Africa, and North America in 1780, and by 1970 it had spread throughout Southeast Asia, with reintroduction into the Pacific islands. In that same year, a reduction in cases was observed following an intensive campaign against the yellow fever vector (Aedes) led by the World Health Organization in 1961. However, due to the suspension of the program, the vector not only regained its geographical distribution but also expanded its range of distribution and infection, which led to it being considered a global public health problem.

Dengue affects people of all ages and socioeconomic levels; it is estimated that 2.5 billion people live in at-risk countries and that there are 50 to 100 million cases per year. The American continent is no exception; between 2008 and 2012, more than 1.2 million cases were reported. Furthermore, in 2013, the disease burden was the highest ever recorded, with the largest dengue epidemic in the history of the continent: a total of 2.3 million cases (37,898 severe cases and 1,318 deaths). The estimated economic cost is 2.1 billion US dollars per year.6 The challenges facing disease control stem from the scarcity of human, technical, and financial resources to address the growing urban areas and high vector densities. The public's perception of the risk is often very low; therefore, it is difficult to gather accurate information on the magnitude of the disease burden, and this leads to dengue fever being recognized only after the outbreak is beyond the reach of control interventions.8 Within the sustainable vector control component, the objective is to ensure that breeding sites are controlled to prevent mosquito reproduction and reduce the mosquito population. This is achieved by involving families in controlling mosquito breeding sites in their homes and by instilling an understanding of the risks they pose, thus improving the quality and effectiveness of vector control activities.6 In 2009 and 2011, in Bucaramanga and Medellín, Colombia, pre- and post-intervention surveys were conducted using workshops, interactive activities, games, songs, puppets, rhymes, stories, role-playing, and videos. The results showed a significant increase in knowledge, in addition to the training of school leaders who demonstrated creativity and ingenuity in modifying family behaviors.11,12 In 2013, a community intervention study was conducted in Quechultenango, Guerrero, with 4th and 5th grade primary school students. Prior to the intervention, a baseline assessment was conducted to identify their level of knowledge. The intervention consisted of activities such as crosswords, word searches, images, and discussions about the characteristics of the vector. The results showed changes in the students' knowledge, indicating that educational interventions can be a strategy that contributes to behavioral changes leading to safer management of Aedes aegypti breeding sites.¹³

Finally, in 2014, an educational strategy called "Mosquito-Free School" was implemented in Chiapas. This strategy assessed the level of knowledge, attitudes, and practices regarding dengue fever among primary school students through a pre- and post-test survey and through in vivo observation of biological material. The results showed a great interest among students in learning about the disease, as well as an increase in their level of knowledge.⁹

Since the introduction of Aedes aegypti into the country, several reemerging diseases have appeared, including yellow fever, West Nile virus, dengue fever, and, in recent years, chikungunya and Zika. This has led to dengue fever being considered a public health problem and a subject of research.

Among the strategies for dengue control, the most impactful disease caused by Aedes aegypti, were the strengthening of epidemiological surveillance and the laboratory network, improved clinical management of patients, vector control (chemical, biological, and environmental), and social communication. This last aspect involved using the media to influence public behavior, providing information about the vector, and leveraging various information and education techniques to create an effective strategy.

This research project focuses on teaching about Aedes aegypti, the vector of dengue fever, a disease that threatens the health of millions of people living in urban, suburban, and rural areas. Despite the implemented control strategies, last year it was still able to cause outbreaks.

Dengue fever is perceived as "someone else's problem," and responsibility for its control is often shifted to others (neighbors, neighborhoods, communities, municipalities, health institutions, other government agencies, etc.), although ultimately the responsibility lies with the health services. However, due to inaccuracies in morbidity and mortality statistics, the magnitude of the disease as a regional public health problem is underestimated, leading the health sector to consider it a low-priority issue. Consequently, timely actions for its prevention and control are not taken. For this reason, this research protocol proposes a strategy for vector control and prevention through playful learning, evaluating its impact on children. It has been observed that children's enthusiasm significantly motivates adults to implement preventive measures, self-care practices, and learning activities. Since children are the most vulnerable population to this problem, they will be the ones who benefit the most, as their skills, confidence, and understanding will be strengthened, leading to positive changes in their living conditions. The objective was to determine the impact of a new Aedes aegypti mosquito prevention strategy on 5th and 6th grade elementary school students attending Family Health Center No. 1, implemented through playful learning activities.

A quasi-experimental, analytical, prospective, and longitudinal study was conducted at a primary healthcare facility in Ciudad Obregón, Sonora, which provides outpatient services to 72 neighborhoods. The study population consisted of children in the 5th and 6th grades of primary school, registered at Family Health Unit No. 1, who met the selection criteria. The study was conducted from March 1 to November 31, 2016.

The variables investigated were knowledge levels regarding the Aedes aegypti mosquito, school grade level, sex, age, and the presence of mosquito breeding sites.

The study included children of both genders, in the 5th and 6th grades of primary school, registered at Family Health Unit No. 1, and whose parents had provided written informed consent. Participants who had been surveyed about dengue fever or the Aedes aegypti mosquito within the previous 3 months were excluded. Children who were expected to move within one month were also excluded. Children whose parents did not consent to their participation or who were unable to participate due to time constraints, as well as children with learning difficulties, were excluded from the study.

A univariate analysis was performed, describing quantitative variables using parametric and non-parametric measures of central tendency, as appropriate. Qualitative variables were described using frequencies and proportions. Bivariate analysis was performed using the Student's t-test as a comparison measure for numerical variables, with 95% confidence intervals (CI), considering statistical significance at a p-value of ≤ 0.05. The statistical software programs Excel and SPSS 24.0 were used for data analysis, and for creating tables and graphs. The recruitment process took place at Family Health Center No. 1, targeting children in the 5th and 6th grades of primary school who were either attending a medical appointment or accompanying a patient. Parents or guardians were invited to a meeting in the center's auditorium to learn about the study's purpose, benefits, activity schedule, and overall duration. The games to be used in the study were explained, including a reading of the instructions for each game (memory game, mosquito-rain game, anti-Aedes war game, bingo, and model demonstration), all of which are included in the appendix. The meeting concluded with parents signing the informed consent form for their child's participation. On the scheduled date, the participants and their families gathered in the auditorium of Family Health Center No. 1. The survey form was then presented and its completion explained. The educational intervention then proceeded as follows: Powerpoint presentation using a projector: 1. Information about the vector, its life cycle, and the diseases it transmits; 2. Signs and symptoms of dengue fever; 3. Vector control and prevention measures (strategy slogan).

Playful learning strategy: Presentation of models created by the researcher, implementation of games with the group divided into subgroups, where the researcher assigned one person to read the instructions (parents) and then proceeded with the activity. Finally, a survey was administered to assess the impact of the strategy.

The data was entered into a Microsoft Excel 2013 database for Windows, for analysis.

A structured survey was used as the data collection instrument, consisting of 15 questions based on the variables of the study "Impact of a New Prevention Strategy for the Aedes aegypti Mosquito in 5th and 6th Grade Elementary School Students Attending Family Health Center No. 1 through Playful Learning." The survey focused on identifying the vector and its prevention measures, with dichotomous, single-choice answers (Yes or No).

The final instrument was validated by three experts: a psychologist, a family physician, and an epidemiologist. A pilot test was conducted to validate the quality and effectiveness of the questions regarding their clarity, ease of completion, response time, and relevance, as well as the reliability of the instrument. The pilot test showed clear wording, an appropriate time estimate, active participation of the respondents, and a Cronbach's Alpha reliability score of 0.7; therefore, no modifications to the instrument were deemed necessary.

For data analysis, the questions were categorized by indicators: knowledge of the disease, knowledge of the vector, and preventive medical control: A) Knowledge of the disease: 3 questions were addressed, each assigned a numerical value of 1 point. B) Knowledge of the vector: 4 questions were addressed; each assigned a numerical value of 1 point. C) Preventive medical control: 8 questions were addressed, emphasizing activities to eradicate Aedes aegypti, each assigned a numerical value of 1 point. D) For the final evaluation, the following classification was used: "Good" for a score of 11 to 15, "Fair" for a score of 6 to 10, and "Poor" for a score of 5 or lower.

The results were entered into a database and statistically analyzed using SPSS version 24.0 (2016).

The study adhered to the guidelines of the Helsinki Declaration of 1969 and the amendments adopted by the 52nd World Medical Assembly in Edinburgh, which governs biomedical research involving human subjects. Therefore, the study was approved by the Local Research Ethics Committee for Health Research.

A total of 52 schoolchildren were included in the study, of which 26 (50%) were in 5th grade and 26 (50%) in 6th grade. The average age and standard deviation of these students were 9.46 ± 0.753 years, with ages ranging from 8 to 11 years. The predominant gender was male, with 31 students (60%), compared to 21 females (40%) (Table 1). Regarding overall knowledge, at baseline, students had a mostly satisfactory level of knowledge (40, 77%), some good knowledge (8, 15%), and some deficient knowledge (4, 8%). This improved after the intervention, with more students demonstrating good knowledge (31, 59%), satisfactory knowledge (19, 37%), and less students with deficient knowledge (2, 4%) (Table 3 and Figure 1).

Regarding knowledge of the disease's symptoms, 60% of the students could identify them, and 88% knew about other diseases transmitted by Aedes aegypti. Regarding preventive measures, 85% of students avoided self-medication, and 87% recognized seeking medical attention as an important measure; 71% of students understood that the disease can be fatal (Table 2). Furthermore, 53% of the students knew the name of the disease-transmitting vector, 61% knew the time of day when the vector bites, and they also had some knowledge about the vector's life cycle. It was also observed that, although people are aware of preventive measures, only 58% actively search for mosquito breeding sites at home when the vector is present, and 84% eliminate these sites. This is because people are unaware of potential breeding sites for this vector, such as animal water bowls (only 14.26% knew this), flower vases (20.38%), and the bases of potted plants (27.51%). The study also found other locations where this vector does not breed due to unsuitable conditions, but which the schoolchildren considered to be breeding sites, such as vacant lots (43.94%) and rivers with fish (42.83%) (Table 2). It is worth mentioning that after the intervention, an increase in knowledge was observed, primarily regarding the name of the vector and its characteristics (35.67%), preventive measures such as searching for breeding sites at home (46.89%) and eliminating them (49.94%). Similarly, knowledge increased regarding potential breeding sites such as flower vases (38.73%) and the bases of potted plants (42.80%). A Student's t-test was also performed, which yielded the following statistically significant results: knowledge of the vector's name (Aedes aegypti) p=0.05; knowledge of the biting times p=0.02; preventive measures: searching for breeding sites p=0.00 and eliminating breeding sites p=0.09; potential breeding sites: animal water bowls p=0.00, flower vases p=0.00, and bases of potted plants p=0.00; and overall scores p=0.05 (Table 2).

This research study aimed to evaluate the effectiveness of an educational intervention using a knowledge survey: an information session with models made of resin and four games (“Anti-Aedes War”, memory game, lottery game, and “mosquito-rain”) as teaching tools for conveying information about the symptoms, mode of transmission, life cycle of the vector, and prevention measures. The results obtained in this intervention were consistent with those of Vesga and Cáceres, as well as Restrepo and Pineda, who conducted interventions in Colombia in 2009 and 2011, where a statistically significant improvement was observed after the intervention.^{11, 12}

Regarding knowledge about the characteristics of the vector (name, biting time, and diseases it transmits), there was an increase from 46% to 67%, as described by Vences and Gallardo in their community intervention in Quechultenango, Guerrero in 2013, where the increase was from 16% to 83%, and also described in the intervention by Torres and Ordoñez in Tapachula, Chiapas in 2014, which was from 30% to 84%.^13,9

For prevention measures, the increase in our study was: for identifying breeding sites, from 58% to 89% and for eliminating breeding sites, from 84% to 94%, which corresponds to what was reported in the study by Vences and Gallardo, where the variation was from 20% to 31% and from 20% to 25%.¹³

Likewise, it was evident that although schoolchildren possess some knowledge about measures to prevent breeding sites, they maintain inappropriate behaviors and practices, a consequence of not recognizing the risk of disease, not changing habits and customs, and not being aware of the magnitude of the problem.¹⁰

As seen, vector control must be comprehensive, combining different types of methods with criteria of rationality, safety, effectiveness, adaptability, and acceptability, targeting the different stages of the vector's life cycle. This was observed in our study, as the strategy used had good acceptability, high participation from the schoolchildren, and above all, enthusiasm for learning. Therefore, it is a good option for promoting behavioral changes related to this disease and improving quality of life. This study shows that educational strategies for schoolchildren are an effective tool for understanding concepts and preventing diseases, in addition to being an engaging, stimulating, and rewarding activity. It is important to continue promoting these types of interventions in more locations, as our research showed that in Mexico they have only been implemented in Guerrero and Chiapas. The goal is to evaluate their effectiveness and to help schoolchildren understand the health issues affecting their communities. Furthermore, and as a limitation of our study, it is important to conduct periodic follow-up evaluations of vector control practices to identify strengths and weaknesses and ensure the continuity of these actions, as our study only assessed them at one point in time. Likewise, if adequate control measures are not maintained at all stages of the vector's life cycle, the disease will never be eradicated and will continue to reappear, becoming increasingly difficult to control. On the other hand, it was demonstrated that increased knowledge, positive attitudes, and improved practices promoted self-care among students, school staff, and families, which would lead to a reduction in the use of chemical substances that pollute the environment. This is important, given the growing resistance of the vector's larvae and adult stages to these chemicals, as has been observed in recent years.

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Moreno-Gaspar O,Rosales-Salas N, Impact of a playful strategy to prevent the presence of the Aedes aegypti Mosquito in a primary school, ERSJ 2025,1(2) 76-87