Understanding the social determinants of Aedes-borne diseases in Iran: A qualitative exploration of challenges and policy solutions

Efat Mohamadi, Jawad Jafarzadeh, Fatemeh Mohamadi, Hakimeh Mostafavi, Ahad Bakhtiari, Ghobad Moradi, Maryam Sargolzaei Moghaddam, Mohammadreza Mobinizadeh, Fateme Yaftian, Amin Ghanbarnejad, Mehrnaz Mozafari, Enayatollah Homaie Rad, Ehsan Sheykh Noori, Marziyeh Najafi, Amirhossein Takian and Alireza Olyaeemanesh

PLOS Neglected Tropical Diseases, 2025, vol. 19, issue 12, 1-24

Abstract: Background: Aedes-borne diseases pose escalating public health challenges globally, influenced not only by ecological and biological factors but critically by social determinants of health (SDH). In Iran, emerging local transmission of dengue highlights these diseases as effective proxies to examine the impact of social and environmental factors on health equity. However, evidence on context-specific drivers and effective responses remains scarce. This study aimed to identify key SDH and propose prioritized interventions to inform evidence-based policymaking. Methods: This mixed-method study included a two scoping review on SDH of Aedes-Borne Diseases and SDH-focused interventions, complemented by qualitative data from in-depth interviews with 21 national and provincial health experts in Iran. Data were analyzed using an inductive content analysis approach and MAXQDA 25 software was used throughout the analysis. The identified interventions were prioritized through a multi-criteria decision analysis, incorporating expert input via an online checklist and digital platform, based on four key criteria: effectiveness, feasibility, social acceptability, and political support. Results: Findings reveal that socioeconomic inequalities, weak community awareness, and limited health system capacity substantially drive disease risk. Notably, the local emergence and spread of dengue serve as a sensitive indicator reflecting broader social vulnerabilities affecting health outcomes. Integrated multisectoral strategies—encompassing health education, environmental management, digital surveillance, and cross-sector collaboration—are vital for effective control. Priority actions include healthcare worker training, embedding disease prevention within educational curricula, and tailored communication leveraging native languages and trusted community leaders. Conclusion: The study underscores that Aedes-borne diseases are not only biological threats but also reflections of underlying social and structural inequities. By framing dengue and related diseases as sentinel indicators of SDH, policymakers can better design integrated and equity-oriented strategies. Controlling Aedes-borne diseases requires a shift from disease-centric approaches toward comprehensive, SDH-informed strategies that strengthen community engagement, improve environmental and health infrastructure, and enhance cross-sector coordination. The prioritized interventions identified in this study provide a practical roadmap for strengthening preparedness and response in Iran and similar settings. Author summary: Aedes mosquitoes, which can spread dengue and other viral infections, are now appearing in several provinces of Iran. We wanted to understand how social and economic conditions, local environments, and the health system together shape the risk of these diseases and the success of control efforts. To do this, we reviewed international evidence and spoke with national and provincial health experts across affected regions in Iran. We then used a structured ranking process to identify which social factors and policy actions should be prioritized. Our findings show that poverty, poor housing and water management, limited public awareness, and gaps in health services all increase the risk of Aedes borne diseases. We also highlight practical, high priority actions, e.g., training health workers, integrating mosquito borne disease prevention into school curricula, and using local languages and trusted community leaders for communication. These results can help health authorities design fairer and more effective strategies to prevent future outbreaks in Iran and similar settings.

Date: 2025
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Persistent link: https://EconPapers.repec.org/RePEc:plo:pntd00:0013850

DOI: 10.1371/journal.pntd.0013850

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