This online guide presents behaviors that have the greatest potential to prevent transmission of the Zika virus and therefore Congenital Zika Syndrome. It is designed for program planners and implementers working on Zika response programs in Latin America and the Caribbean, with a focus on ensuring healthy pregnancies and births.

The behaviors were selected based on reviews of evidence and analysis by Breakthrough ACTION + RESEARCH, the United States Agency for International Development (USAID), and other partner organizations. The behaviors that reduce the mosquito population or prevent them from biting can also help prevent viruses such as dengue and chikungunya, which are transmitted by the same species of mosquito as Zika. The instructions for each behavior must be followed carefully and consistently to maximize effectiveness in preventing Zika and related diseases.


During the first year of the U.S. response to Zika in Latin America and the Caribbean, USAID found that its implementing partners were promoting more than 30 behaviors to prevent transmission of the virus. Such a large number challenged the success of social and behavior change efforts. When too many prevention behaviors are promoted or when they lack precision, people may not adopt them, or they may do them in a way that is ineffective or counterproductive. Further, individuals are far more likely to act if they are exposed to messages repeatedly and through multiple channels such as television, radio, posters, and interpersonal communication. The Zika response could therefore have greater potential for impact if the organizations involved spoke with one voice and promoted a prioritized set of effective behaviors to increase the chances the behaviors would be adopted and done correctly.


To determine which of the many behaviors promoted have the greatest potential to prevent Zika transmission and therefore Congenital Zika Syndrome, the Breakthrough ACTION+RESEARCH project conducted a literature review and consultative process with USAID, UNICEF, and USAID’s partners in the U.S. Zika response, culminating in the creation of a Zika Prevention Behavior Matrix. 

The project team reviewed behaviors that would help reduce the mosquito population overall as well as those that would offer personal protection for pregnant women. Because research and data on Zika prevention are limited, the team also reviewed literature on dengue, chikungunya, and other diseases transmitted by the Aedes aegypti mosquito. Additionally, for a subset of behaviors, the team studied lessons learned and supporting evidence from the reproductive health field, including family planning, antenatal care, and prevention of HIV and other sexually transmitted infections.


The project team developed five criteria, listed below, to determine which behaviors had the greatest potential to prevent Zika transmission: 

  • Efficacy of the behavior to reduce exposure to mosquitos or their bites. 
  • Potential to reduce Zika transmission at the population level.
  • Frequency of the behavior required to be effective.
  • Feasibility of the behavior. 
  • Ease of access to the necessary materials.

In collaboration with USAID and implementing partners, the team assessed the behaviors according to each of the five criteria, drawing on evidence from the research literature, program experience (for assessing feasibility), and contextual information (for determining access to necessary materials). The resulting behavior matrix contains seven behaviors with high potential to prevent Zika transmission.


  • Zika is spread mostly by the bite of an infected Aedes species mosquito, which bites during the day and night.
  • Zika can be passed from a pregnant woman to her fetus. Infection during pregnancy can cause certain birth defects.
  • There is no vaccine or medicine for Zika.

Centers for Disease Control and Prevention (CDC). 2018. “About Zika: What We Know.”

Congenital Zika Syndrome

Congenital Zika Syndrome is a unique pattern of birth defects found among fetuses and babies infected with Zika virus during pregnancy. It is described by five features:

  • Severe microcephaly where the skull has partially collapsed.
  • Decreased brain tissue with a specific pattern of brain damage.
  • Damage (scarring, pigment changes) to the back of the eye.
  • Joints with limited range of motion, such as clubfoot.
  • Too much muscle tone restricting body movement soon after birth.

Centers for Disease Control and Prevention (CDC). 2018. “Zika and Microcephaly.”

Aedes aegypti

Aedes aegypti is a small, dark mosquito with white markings that can spread dengue, chikungunya, yellow fever, Zika, and other viral diseases. The virus is transmitted to humans through the bite of an infective female Aedes mosquito, which mainly acquires the virus while feeding on the blood of an infected person.


This online guide was developed by the Population Reference Bureau (PRB), a partner on the Breakthrough RESEARCH consortium. It draws from two Breakthrough ACTION + RESEARCH reports, “Technical Specifications Content Guide for Behaviors With High Potential to Prevent Zika” and Zika Prevention Behavior Matrix. Reshma Naik, program director at PRB, provided technical direction for the online guide and Lori Ashford, independent consultant, developed the content based on technical reports written by staff from Breakthrough ACTION + RESEARCH. The following Breakthrough ACTION + RESEARCH staff coauthored the original technical reports and reviewed the online guide for technical accuracy: Paul Hewett and Jessie Pinchoff of the Population Council; Martha Silva of Tulane University School of Public Health and Tropical Medicine; and Gabrielle Hunter, Alice Payne Merritt, and Priya Parikh of Johns Hopkins Center for Communication Programs. The team is grateful to Arianna Serino of USAID for her valuable input; Heidi Worley and Peter Goldstein of PRB for editorial support; Jessica Woodin of PRB for graphic design; Pamela Mathieson and N’Namdi Washington of PRB for video production; Alpha Omega Translations for Spanish translation; Mary Alice Jackson of the Population Council for Spanish review. This guide is made possible by the generous support of the American people through the United States Agency for International Development (USAID) under the terms of the Breakthrough RESEARCH Project (No. AID-0AA-A-17-00018). The contents are the responsibility of Breakthrough ACTION + RESEARCH and do not necessarily reflect the views of USAID or the United States Government.

About Breakthrough ACTION + RESEARCH

Breakthrough ACTION and Breakthrough RESEARCH are USAID’s flagship programs for social and behavior change working to increase the practices of priority health behaviors for improved health and development outcomes.

Suggested citation

Breakthrough ACTION + RESEARCH, “Effective Behaviors to Prevent Zika Transmission Online Guide” (Washington, DC: Population Reference Bureau, 2018), available at

Photo credit

USAID ASSIST Project, taken in Honduras

This online guide was created as part of the USAID Zika Response, 2016-2019.

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