Effectiveness of COMBI in Dengue Prevention and Control and Participation Factor: A Systematic Review in Malaysia

Most of the disease prevention, control and mitigation strategies rely heavily on community engagement, participation and ownership. Thus, behavioural and social interventions have become essential to outbreak mitigation efforts. The Communication for Behavioural Impact (COMBI) approach has been implemented in Malaysia to mobilise the community as the primary agent to prevent dengue transmission. This systematic review aimed to assess the effectiveness of COMBI in dengue prevention and control within Malaysia and identify factors influencing participation therein. This systematic review was registered with the PROSPERO database (CRD42022341967) and reported based on the PRISMA guideline. Original articles published in English from 2001 to 2023, reporting the level of knowledge, attitude and practice (KAP) and/or entomological indices, as well as factors influencing COMBI participation in Malaysia, were collected electronically from four databases. The mixed methods appraisal tool (MMAT) was used to evaluate the quality of the included articles. Four articles were included in this review, encompassing quantitative and qualitative study designs. They showed that COMBI had improved the level of KAP and reduced the presence of vectors during the active implementation period. Factors hindering participation in COMBI and its sustainability included poor leadership and commitment at the community level, as well as a lack of publicity and monitoring by health authorities due to limited resources. More well-conducted cluster randomised controlled trials are needed to provide evidence of real-life impact. Such trials should also measure COMBI’s impact on dengue infection. Additionally, new implementation strategies must be explored to maintain active participation in COMBI and achieve sustainability.