Unmanned Aerial Vehicle Mapping of Dengue Vector Principal Investigator: Kelli Peterman

Habitats in Ecuador

Unmanned Aerial Vehicle Mapping of Dengue Vector Habitats in

Ecuador
Principal Investigator:

Kelli Peterman

Faculty Advisor:

Dr. Joseph Eisenberg, Ph.D., M.P.H., Dr. Gwenyth Lee, Ph.D., M.H.S.

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Table of Contents

List of Abbreviations 3
Protocol Summary 4

1 Key Roles 5
2 Background Information and Scientific Rationale 6
2.1 Background Information 6
2.2 Scientific Rationale 6
2.3 Potential Risks and Benefits 6
3 Objectives 7
4 Study Design 8
5 Study Population 9
5.1 Selection of the Study Population 9
5.2 Inclusion and Exclusion Criteria 9
6 Study Procedures and Evaluations 10
6.1 Study Procedures 10
6.2 Data Management 10
7 Statistical Considerations 11
7.1 Study Outcome Measures 11
7.2 Sample Size Considerations 11
7.3 Participant Enrollment and Follow-Up 11
7.4 Analysis Plan 11
8 Subject Confidentiality 12
8.1 Future Use of Stored Specimens 12
9 Informed Consent Process 13
10 Literature References 14

Supplements and Appendices 15

i. Interview Guide
ii. Informed Consent

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List of Abbreviations

Acronym Full name

UAV Unmanned Aerial Vehicle

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Protocol Summary

Title: Unmanned Aerial Vehicle Mapping of Dengue Vector Habitats

Population: Communities in Quito, Ecuador and Esmeraldas, Ecuador

Number of Sites: Quito, Ecuador; Esmeraldas, Ecuador

Study Duration:
10 weeks: Analyzing UAV images in Quito, Ecuador.
2 weeks: Focus groups in the Esmeraldas region of Ecuador.

Study Design: Mixed Methods

Objectives:

Primary Objective: Identify water habitats to characterize likely mosquito habitats and thus
areas possibly at high risk of dengue

Secondary Objective: Identify possible areas at high risk of dengue through community
participatory research.

Tertiary Objective: Validate use of UAVs in dengue surveillance.

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1 Key Roles
Principal Investigator:

Kelli Peterman
petermkl@umich.edu
University of Michigan

Faculty Advisor:

University of Michigan Faculty:

Dr. Joseph Eisenberg, Ph.D., M.P.H.

734-764-5435
jnse@umich.edu

Dr. Gwenyth Lee, Ph.D., M.H.S.

859-537-4913
golee@umich.edu

In Country Faculty, Ecuador:

Dr. Carlos Mena, Ph.D.

+593 9844239927
cmena@usfq.edu.ec
Universidad San Francisco de Quito

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2 Background Information and Scientific Rationale

2.1 Background Information

Dengue virus is a vector-borne disease resulting in dengue fever and dengue hemorrhagic
fever. Dengue is endemic to Ecuador and in the region of the Americas, resulting in 1,300
disability-adjusted life years per million, similar to other tropical diseases (Guzman et al., 2010).
Without a vaccine, dengue prevention focuses on reducing transmission, for example, by
removing containers that can hold stagnant water to eliminate mosquito breeding grounds
(Guzman et al., 2010). Containers used as breeding grounds can include objects such as tanks
used to store drinking water, sinks, discarded tires in garages, cemeteries, or even takeout
containers. The types and concentrations of these may vary by urbanicity and by season, either
wet or dry. Unmanned aerial vehicles (UAVs) are a promising new method for mapping
mosquito habitats. UAVs can provide efficient, low-cost, and high-resolution images of cities and
villages that complement satellite images. Due to their flexibility, they can be used to repeatedly
map the same area to document changes in the environment. Detailed maps with the ability to
update quickly may be useful in dengue surveillance, due to the impermanent nature of
containers as breeding grounds. Additionally, drones can be used to find water containers that
are difficult for humans to access in field surveys, such as containers located on roofs, such as
water tanks (Fornace, Drakeley, William, Espino, & Cox, 2014).

2.2 Scientific Rationale

Much of dengue surveillance focuses on household containers but given the UAV’s ability to
quickly cover large areas, we are interested in characterizing both household habitats, and
habitats beyond or outside the households. Using UAVs in dengue surveillance is relatively
new; however, a recent feasibility study used algorithms to identify tires in UAV images, with the
potential to identify new objects (Andrade et al., 2018). Additionally, participatory risk mapping
will be used to validate the use of UAVs for identifying dengue risk areas in these communities.
Identifying mosquito habitats through UAV mapping will improve dengue surveillance, adding a
new tool to use to reduce transmission.

2.3 Potential Risks and Benefits

The largest potential risk to participants will be breach of confidentiality of their data. The focus
group discussions will be audio recorded if participants consent, so there is a possibility of their
identity being linked to the discussion. Participants may feel uncomfortable answering questions
in a focus group or may feel tired because the discussion is expected to last 2-3 hours.

There are no direct benefits to participate in this study. The research will contribute to dengue
surveillance in Ecuador with the hope of better understanding vector habitats. Participants will
be able to directly contribute their knowledge and expertise to research that involves their
community.

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3 Objectives
Primary Objective
Identify water habitats to characterize likely mosquito habitats and thus areas possibly at high
risk of dengue.

Primary Outcome Measures

Processed UAV images of different communities in Ecuador will be analyzed using Agisoft and
ArcGIS software. Areas will be identified in the UAV images as likely mosquito habitats, looking
for containers or areas that may have high concentrations of water containers.

Secondary Objective
Identify possible areas at high risk of dengue through community participatory research.

Secondary Outcome Measures

Community knowledge about areas of high risk will be collected through participatory risk
mapping during focus group discussions. Areas identified in participatory risk mapping will be
transferred to digital images.

Tertiary Objective
Validate use of UAVs in dengue surveillance.

Tertiary Outcome Measures

Compare similarities and differences between maps of UAV identified risk areas with maps of
community identified risk areas.

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4 Study Design
UAV images have been previously collected from different communities in the Esmeraldas
region of Ecuador. These images will be processed and then the image will be analyzed for
water containers and other likely mosquito habitats. This process will continue for all collected
images until they have all been characterized.

When two thirds of the images have been characterized, participatory risk mapping activities will
take place in some of the communities with UAV images. The participatory risk mapping will
consist of 8-10 focus groups in the Esmeraldas region. The focus group members will be asked
to draw maps that represent their communities and to identify areas they view as high risk.
These maps will be used to guide a discussion about dengue, their definition of high risk, areas
in the community that are viewed as high risk, and how risk in these areas has changed over
time.

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5 Study Population
5.1 Selection of the Study Population
The study population for the participatory risk mapping will be selected from communities that
have collected UAV images that have been analyzed for high risk areas.

5.2 Inclusion and Exclusion Criteria

Participants will eligible for inclusion if they are adults aged 18 or older, live in the communities
where the participatory risk mapping is occurring, and if they have lived in the community for five
years or more.

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6 Study Procedures and Evaluations

6.1 Study Procedures
UAV images have been previously collected and will be analyzed for likely mosquito habitats.
Focus group discussions will occur two thirds into the project. Participants will be enrolled into
the study and given informed consent to participate. Participants will be led through a risk
mapping exercise and then a discussion about risks related to dengue in the community.
Recordings will be kept on an audio recording device until researchers return to Quito, at which
point recordings will be transferred to computers and maps drawn by the community will be
transferred to digital copies.

6.2 Data Management

Focus group recordings will be stored in computers only to be accessed by study personnel.
Informed consent forms will be kept with study personnel while in Esmeraldas, and then stored
in Quito. UAV images will be stored on computers in Quito and accessed by study personnel.

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7 Statistical Considerations
7.1 Study Outcome Measures
Processed UAV images of different communities in Ecuador will be analyzed using Agisoft and
ArcGIS software. Areas will be identified in the UAV images as likely mosquito habitats, looking
for containers or areas that may have high concentrations of water containers.

Community knowledge about areas of high risk will be collected through participatory risk
mapping during focus group discussions. Areas identified in participatory risk mapping will be
transferred to digital images.

7.2 Sample Size Considerations

UAV images have been previously collected to be analyzed in the study, attempting to sample a
representative part of the Esmeraldas region of Ecuador.

The sample of focus groups will reflect the UAV images collected for the region, with 8-10 focus
groups in the region and 6-8 participants per focus group to reach saturation, when no new
information about dengue is relayed.

7.3 Participant Enrollment and Follow-Up

Participants will be enrolled through drawing upon existing community groups, asking
participants to recommend other eligible participants to the focus group, and cold calling
community members. Participants will be compensated with food during the focus group to
thank them for participation.

Participants will not be contacted for follow-up, unless participants specifically request more
information. In this case, participants will be given contact information for the local research
team to request more in depth information.

7.4 Analysis Plan

The UAV images will be characterized using GIS and spatial analysis to identify mosquito
habitats. The focus group discussions will first be transcribed and translated. The transcripts will
be coded to analyze any themes that emerge. The maps drawn by focus groups will be
transferred to digital maps and will be compared with likely mosquito habitats identified by UAV
images to analyze areas of similarity and discrepancies.

Primary Objective
Identify water habitats to characterize likely mosquito habitats and thus areas possibly at high
risk of dengue.

Secondary Objective
Identify possible areas at high risk of dengue through community participatory research.

Tertiary Objective
Validate use of UAVs in dengue surveillance.

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8 Subject Confidentiality

8.1 Future Use of Stored Specimens

The audio recordings generated from the focus groups will be deleted after the study concludes.
Any transcriptions and translations kept from the study will not have any identifying information.
Any names or other information that can directly identify participants will be deleted from the
research data collected as part of the project. Research may be shared with other investigators,
but it will not contain information that could identify participants.

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9 Informed Consent Process

Potential participants in the focus group will be given an informed consent form to read before
joining the focus group discussion. Researchers will be available to answer any questions the
participant may have. Participants will be asked to sign a consent form to participate in the study
and a form to consent to be audio recorded. If the participant does not wish to be audio
recorded, the study will continue without the recording. If the participant declines to sign the
consent form or participate in the study, they will be thanked and released from the study.

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10 Literature References
Andrade, G. S., Dias, T. M., Alves, V. C., Junior, H. M. A., Pinheiro, L. F., Silva, P. M. C., ...
Silva, B. P. (2018). Fighting back Zika, Chikungunya and Dengue: Detection of
Mosquito-breeding Habitats Using an Unmanned Aerial Vehicle, 12.
Fornace, K. M., Drakeley, C. J., William, T., Espino, F., & Cox, J. (2014). Mapping infectious
disease landscapes: unmanned aerial vehicles and epidemiology. Trends in Parasitology,
30(11), 514–519.
Guzman, M. G., Halstead, S. B., Artsob, H., Buchy, P., Farrar, J., Gubler, D. J., ... Peeling, R.
W. (2010). Dengue: a continuing global threat. Nature Reviews. Microbiology, 8(12 0), S7-
16.

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Supplements and Appendices

Interview Guide

Italics are not to be read to participants but are added for extra clarity for the interviewer.

Introduction

Welcome to this focus group. This focus group is part of collaborative research between the University of
Michigan and la Universidad San Francisco de Quito. My name is ______, and I will be moderating the
discussion today.

We would like to record the audio of our conversation if you give us permission to do so. The reason is that
we want to remember everything we talk about today - everything is important. But, if someone does not
want to be recorded, we will not do it, and we will continue with the conversation. The conversation will
last approximately 2-3 hours.

This focus group session is one of many we are conducting in the region to obtain a better idea of the
community and the factors that do or don’t contribute to dengue in the region. The idea today is to talk a
little about your community and the risks you see for dengue. We hope to learn from you about your
community, so please remember that all responses are valid – there are no wrong opinions in this space.

1. Introductory Questions
a. To begin, we want to give you the opportunity to introduce yourselves and tell us:
your job, and how long you have lived in the community.

2. General Questions
a. We are now going to orient ourselves to the map of the community by first
identifying central landmarks. Next, we want you to identify/draw other features
in the community that you think are important.
- Landmarks could be roads, houses, bridges, schools, churches,
cemeteries, health clinics, water sites, restaurants, stores, etc
- Clarify that the maps don’t need to be perfect and that they can be
different than other people’s maps
b. We would like to talk a little about your maps/drawings. Going through the group,
can you each briefly explain the details of your maps/drawings?

3. Risk Classification
a. Now, we want you as a group to identify risk of dengue in your community. First,
take a moment to discuss what “risks” are to you so we can all have the same
definition.
- First, we would like you to discuss what you know about dengue, or
your perceptions of dengue.

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b. Using the maps/drawings, shade in or mark areas with different types of risk. Use
red for high risk areas, yellow for medium-risk areas, and green for little to no-
risk areas.
c. We would now like to talk about the areas you have identified as risks. Going
through the group, can you each explain the areas you identified as risks and
explain why you think they are risky? Or why you think areas have little risk?

4. Risk Analysis
a. Now that we have identified areas of risk, we would like to know more about your
perceptions of these areas.
- What areas were most at risk in the past? Are they the same areas now?
Why or why not?
- Has the risk of dengue changed in your community over time?
- How do people cope with the risks or avoid the risks?
- Are there seasonal variations in the risks, such as between wet and dry
seasons?
- Which people are most at risk?

5. Future Research
a. The map that you have been looking at was collected using a drone, which is a
small flying machine that can take photos.
- How would you like to see drones used in your community in the future?
Are there any areas of concern in your community that drones might be
useful for?
- Do you have any concerns or worries about using drones in your
community?

6. Final Questions
a. Today, we’ve talked about many things and we thank you for your collaboration.
Thinking back on our discussion, in your opinion, is there anything else important
to bring up that has been left out?

End of Discussion

We have finished our discussion and we thank you for your time and collaboration. Once we have
finished all the focus groups in the region, we will transcribe and analyze the information you have
presented. If you have any questions about how this information will be utilized or are interested in
knowing more about the project, please let us know and we will gladly provide you with this information.

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Consent to be Part of a Research Study

Title: Unmanned Aerial Vehicle Mapping of Dengue Vector Habitats in Ecuador
Principal Investigator: Kelli Peterman, B.A., University of Michigan
Faculty Advisor: Gwenyth Lee, Ph.D., M.H.S., University of Michigan; Joseph
Eisenberg, PH.D., M.P.H., University of Michigan

Invitation to be Part of a Research Study

You are invited to participate in a research study. In order to participate, you must be 18
years of age or older and live in the Esmeraldas region where this research is occurring.
Taking part in this research project is voluntary.

What is the study about and why are we doing it?

The purpose of the study is to learn about your community and the factors that do or
don’t contribute to dengue in the region. From this research, we hope to understand
more about areas with risk of dengue and compare these areas we have determined to
be likely mosquito habitats through unmanned aerial vehicle mapping.

What will happen if you take part in this study?

If you agree to take part in this study, you will be asked to participate in a focus group
with other members from your community. The focus group will be audio recorded. You
will be asked to create a map of your community and answer a series of questions
about dengue risks in the area, using your self-generated maps. We expect the focus
group discussion to take approximately 2-3 hours over a single day, with a break in the
middle. The information you provide will be deidentified and compared to data from
unmanned aerial vehicle maps.

How could you benefit from this study?

Although you will not directly benefit from being in this study, others might benefit from
the information we gather about factors that influence dengue in your community.

What risks might result from being in this study?

You may experience minimal risks from being in this study. If you feel uncomfortable
with any of the questions asked in the focus group, you may stop your participation or
refuse to answer the question. If you feel tired during the study, you may also stop your
participation or request a break. Because these discussions will be audio recorded,
there is a possibility of your identity being linked to this discussion. To minimize this risk,
we will ask you not to use names during the discussion and transcriptions and
translations will not include names. Only study personnel will have access to the audio
recordings.

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How will we protect your information?

We will protect the confidentiality of your research records by not using names during
the focus group discussion. Any transcriptions, translations, and future documents from
these discussions will not include names or other identifying information. Your name
and any other information that can directly identify you will be stored separately from the
data collected as part of the project and can only be accessed by study personnel.

It is possible that other people may need to see the information we collect about you.
These people work for the University of Michigan, Universidad San Francisco de Quito,
and government offices that are responsible for making sure the research is done safely
and properly.

What will happen to the information we collect about you after the study is over?
The audio recordings generated from this focus group will be deleted after the study is
over. Any transcriptions and translations kept from this study will not have any
identifying information. Your name and other information that can directly identify you
will be deleted from the research data collected as part of the project.

We may share your research data with other investigators without asking for your
consent again, but it will not contain information that could directly identify you.

How will we compensate you for being part of the study?

You will receive food during the break as compensation for your participation in the
study. If you choose to withdraw from the research before the end of the study, you may
still receive the food.

Your Participation in this Study is Voluntary

It is totally up to you to decide to be in this research study. Participating in this study is
voluntary. Even if you decide to be part of the study now, you may change your mind
and stop at any time. You do not have to answer any questions you do not want to
answer. If you decide to withdraw before this study is completed, your data will be kept
as part of the audio recording without any identifying information.

Contact Information for the Study Team and Questions about the Research
If you have questions about this research, you may contact Kelli Peterman,
petermkl@umich.edu, 810-4498431; Carlos Mena, cmena@usfq.edu.ec, +593 1-
984-423-9927; or Gwenyth Lee, golee@umich.edu, 859-537-4913.

Contact Information for Questions about Your Rights as a Research Participant

If you have questions about your rights as a research participant, or wish to obtain
information, ask questions, or discuss any concerns about this study with someone
other than the researcher(s), please contact the following:

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Comité Nacional de Bioética de Ecuador

UNESCO, Quito
Foch 265, Apartado 17-07-8998
Quito
Ecuador
Phone: +593 2529085
Email: eestevez@cmb.uce.edu.ec

University of Michigan
Health Sciences and Behavioral Sciences Institutional Review Board
2800 Plymouth Road
Building 520, Room 1169
Ann Arbor, MI 48109-2800
Phone: (734) 936-0933 or toll free, (866) 936-0933
Email: irbhsbs@umich.edu

Your Consent
By signing this document, you are agreeing to be in this study. Make sure you
understand what the study is about before you sign. We will give you a copy of this
document for your records. We will keep a copy with the study records. If you have any
questions about the study after you sign this document, you can contact the study team
using the information provided above.

I understand what the study is about and my questions so far have been answered. I
agree to take part in this study.

_________________________________________________
Printed Subject Name

_________________________________________________
Signature Date

Consent to be Audio Recorded

I agree to be audio recorded.

YES__________ NO___________

_________________________________________________
Signature Date

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