Muddying the waters: A political ecology of mosquito-borne disease in coastal Ecuador.

The mosquito-borne arboviral diseases dengue, chikungunya, and Zika are major public health burdens in Latin America. To analyze the socio-environmental dynamics of these diseases, we apply a political ecology of health and disease framework that is attentive to local etiological frameworks, structural sociopolitical conditions, processes of identity construction, and the contested, politicized nature of public health work. We use multiple qualitative methods to analyze perceptions and interactions with the local environment in relation to mosquito-borne disease across three small communities in Manabí Province, Ecuador. We find that participants' perceptions and practices are complex and multilayered: subjects possess a mixed theory of causation, where these diseases are caused not only by mosquitoes, but also by people's interactions with a changing environment; most environmental management to control vector mosquitoes is carried out informally by women as part of domestic routines; and contrary to public health messaging that stresses the importance of individual agency, participants prefer some of the most invasive techniques for mosquito control (i.e. fumigation with insecticides). However, individual agency in disease control is constrained by poor water infrastructure and lack of public health coordination. Our approach advocates for recognition of local knowledges and sociopolitical constraints in the development of public health messages and interventions.