Evaluating community needs and the effect of community-based intervention in preventing dengue and chikungunya in urban hotspots of Jammu city: a mixed-method study

INTRODUCTION

Vector-borne diseases (VBDs) remain a major public health concern in India, accounting for nearly one-sixth of all communicable diseases. Dengue and Chikungunya fever, transmitted primarily by Aedes aegypti mosquitoes, have emerged as rapidly expanding arboviral illnesses globally. Although the case fatality rate is relatively low compared to other infectious diseases, the absolute mortality burden, combined with prolonged morbidity, frequent hospitalizations, and the risk of severe complications make them a formidable public-health challenge.¹ India, with its diverse climate patterns and densely populated urban environments, continues to report significant seasonal outbreaks, particularly during and after the monsoon months.

Rapid and often unplanned urbanization have contributed to overcrowded settlements, inadequate waste disposal and poor drainage systems—all of which create abundant breeding habitats for Aedes mosquitoes. Water storage practices in areas with irregular municipal supply further facilitate vector proliferation. Additionally, increased human mobility complicate outbreak control and contribute to recurrent epidemics across India, including previously low-risk regions.²

Despite sustained efforts under the National Vector Borne Diseases Control Programme (NVBDCP), vector control continues to face major operational challenges. Evidence increasingly shows that knowledge, attitudes, and practices (KAP) of community members play a central role in disease prevention. Poor awareness about transmission, delayed health-seeking behaviour, and inadequate household-level vector control allow transmission to persist even in areas with ongoing public-health interventions. In contrast, communities with better understanding of dengue prevention demonstrate higher adoption of protective behaviours such as eliminating stagnant water, covering containers, improving environmental sanitation, and participating in local clean-up initiatives.³

Understanding community needs and gaps in awareness is crucial for designing interventions that are acceptable and effective. This study aims to evaluate community needs and assess the impact of community-based preventive strategies, contributing evidence that can help policymakers strengthen dengue-control programs and reduce the disease burden in urban hotspots of Jammu region. This study aims to assess the gaps in the knowledge, attitude and practices of the urban community of Jammu region for prevention and control of dengue and chikungunya and to identify the barriers perceived by the local health workers involved in the implementation of the VBD control programme.

METHODS

Study design

This study adopted a mixed-methods research design, integrating both quantitative and qualitative approaches to obtain a comprehensive understanding of VBDs among the community, with a specific focus on dengue and chikungunya.

Study area, duration, and population

This was a community-based study which was conducted over a period of two months (from 01 October 2025 to 30 November 2025) in four selected areas: Muthi (M), Durga Nagar (DN), Gandhi Nagar (GN), and Satwari (S) which comprised 5 urban wards of Jammu Municipality. These areas were selected as they reported the maximum rising trend in dengue and chikungunya cases in 2024 as compared to the last year (2023).

Operational definition of hotspot, a disease hotspot in the study is a geographical area with a significantly higher incidence (≥10% increase) of dengue/chikungunya compared to the previous year due to favourable ecological, social or epidemiological factors.

Inclusion criteria

Quantitative part of the study

The study population consisted of residents aged ≥18 years, including both males and females, who had been residing in the study area for more than two years and were willing to provide written informed consent.

Qualitative part of the study

The participants included sanitation and malaria workers who were actively involved in the implementation of the VBD control programme in the surveyed areas.

Exclusion criteria

Exclusion criteria included individuals who did not consent to participate or were unable to comprehend the questionnaire were excluded from the study.

Sample size

The sample size was initially estimated to be 440, based on an assumed 50% prevalence of knowledge regarding dengue and chikungunya and allowing for a 10% non-response rate. However, data collection continued throughout the predefined study period, and finally, a total of 682 participants were interviewed.

Sampling technique

A two-stage sampling technique was employed for the quantitative component of the study, with the household considered as the primary sampling unit. In stage 1, simple random sampling (SRS) was used to select the primary enumeration areas (wards). In stage 2, from each selected ward, systematic sampling was used to select the required number of households. Participants aged ≥18 years were selected using the Kish method, whereby one eligible adult was randomly chosen from each selected household to ensure equal probability of selection. House-to-house visits were conducted sequentially until the desired sample size was achieved. If no eligible participant was available in a selected household, the next household was approached.

For the qualitative component, three focused group discussions (FGDs) were conducted. The participants for these 3 FGDs included local health workers actively involved in the implementation of the VBD control programme in the surveyed areas.

Data collection and tools

Quantitative data collection

The quantitative survey was conducted at the household level in the selected areas. Data about sociodemographic variables was collected through face-to-face interviews with any adult member (>18 years) of the sampled household. It was followed by the administration of a pre-tested, semi-structured KAP questionnaire about dengue and chikungunya.

Qualitative data collection

FGDs were conducted with local health workers who were directly involved in the prevention and control of vector-borne diseases in the surveyed areas. The discussions were conducted in the local languages. The primary focus of the FGDs was to explore the challenges faced by health workers during prevention and control activities.

Data analysis

Quantitative data were entered into Microsoft Excel and interpreted as ratios and proportions, analyzed using statistical software.

Qualitative data from the focus group discussions were audio-recorded, transcribed verbatim, and translated into English where necessary. Thematic analysis was carried out using a systematic approach, involving familiarization with the data, coding, theme generation, and interpretation. The findings from the qualitative component were used to complement and enrich the quantitative results.

RESULTS

Quantitative

The study population was predominantly male (82.8%), middle-aged to elderly (75%), and largely Hindu (94.6%). Slightly more than half of the respondents belonged to nuclear families. Service and business were the major occupations (Table 1).

Awareness of dengue was almost universal, while knowledge of chikungunya was comparatively lower. Most participants correctly identified mosquito transmission and key symptoms, though gaps existed regarding breeding sites and resting habits. Misconceptions such as belief in home remedies were common (Table 2).

Most participants perceived dengue and chikungunya as serious public health problems. However, a significant proportion believed prevention to be the government’s responsibility and overestimated the effectiveness of fogging alone. Positive attitudes towards health education and community participation were observed (Table 3).

Preventive practices such as covering water containers were commonly reported, while the use of repellents, nets, and protective clothing was inconsistent. Community participation in cleaning activities was moderate. Government facilities were the preferred choice for treatment, though home remedies were still practiced (Table 4).

Qualitative

Focus group discussions with sanitary workers and Malaria workers highlighted strong community resistance, poor risk perception, and non-cooperation as major barriers to dengue control. Operational challenges included manpower shortages, salary disparities, and inadequate protective equipment, leading to demotivation and health risks (Tables 5 and 6). Malaria workers also pointed out the diversion of staff to other duties limited sustained awareness and surveillance activities (Table 6). Overall, the findings point to behavioural, institutional, and infrastructure-related constraints affecting effective vector control.

DISCUSSION

Study was conducted for the period of one month i.e. 1^st KAP assessment is generally considered a good initial step for planning public health intervention. A reasonably good KAP about dengue and chikungunya was reported by the study population. Transmission of the disease was correctly reported for 83% in dengue and 68.2% in chikungunya in the current study which are lower than those reported by Akhiljit et al and Animesh et al.^4,5 Majority of the respondents knew that dengue patients had high fever and the disease can be prevented which reflected in good practices wherein 90% of the respondents reported to government hospitals for treatment. In an earlier study conducted by Gupta et al in the rural area of Jammu district, the main source of information regarding malaria was television/newspaper and more than two-third of the respondents (71.6%) preferred going to doctors at government hospitals for malaria treatment.⁶

Priyadarsini reported that though half of the population had good knowledge regarding preventive strategies for vector borne diseases but most of them had high perceptions about preventive strategies for vector borne diseases but most of them had high perceptions about preventive strategies.⁷ Akhiljit et al reported that majority of participants considered dengue, chikungunya malaria a serious health problem and the attitude was positive in almost all study subjects.⁵ Alobuia et al, in a study from Jamaica reported that most respondents scored low on knowledge and practice items but scored high on attitude items.⁸ Ghimire et al reported that only 64.9% were knowing about dengue fever, attitude was positive in 91.51% and 50% respondents reported actively engaging in dengue fever prevention measures.³ Debayan et al, reported unsatisfactory KAP regarding disease prevention/control from slums of Kolkata.⁹ Desjardins et al, in a study from Colombia noted that knowledge is related to community characteristics while attitudes and practices were more related to individual level factors.¹⁰

The findings from the focus group discussions provided a comprehensive understanding of the multi-level barriers that hinder effective control of VBDs in the study area. The issues identified span community behaviour, socio-economic conditions, environmental risks, workforce limitations, and gaps in institutional coordination, which together create a persistent environment for dengue, chikungunya, and malaria transmission. These findings are consistent with literature from similar urban contexts across India and other low- and middle-income countries.^11,12

A dominant theme was the low level of risk perception and awareness among community members. Workers reported that many residents, even after repeated visits, continued to keep open containers, store water improperly, or leave discarded waste in their surroundings. This behaviour reflects a pattern described in earlier studies, which show that low perceived severity and susceptibility remain major barriers to dengue prevention.^13,14 Even though some participants compared dengue to severe illnesses, the general population often trivializes its risk unless personally affected, aligning with the health belief model, which predicts action only when the perceived threat is sufficiently high.¹⁵

The FGDs also revealed substantial behavioural resistance in the community, including refusal to open doors, fear of challans (fines), and distrust of municipal or health staff. Such resistance has also been documented in other Indian VBD settings, where fear of punitive action reduces cooperation with surveillance and spraying teams.¹⁶ Furthermore, stigma-related behaviours were evident: tenants and labourers often concealed illness or gave incorrect contact details, fearing eviction or discrimination. Similar stigma-related avoidance behaviours have been widely reported in communicable diseases such as tuberculosis, leprosy, HIV, and malaria.^17,18

Socio-economic constraints, especially in slum areas, were highlighted as significant contributors to persistent mosquito breeding. Water scarcity compels poor households to store water in large containers—often uncovered—creating multiple breeding sites for Aedes mosquitoes.¹¹ The inability of families to afford repellents, nets, or proper container covers further exacerbates vulnerability, consistent with global findings that poverty is strongly associated with higher VBD incidence.¹⁹

Environmental conditions in slums, such as narrow lanes, open drains, and accumulation of domestic waste, compound these risks. However, it was also noted that middle-class households inadvertently maintain breeding sites, including refrigerator trays, potted plants, and tyres, which aligns with urban dengue literature.²⁰

The FGDs highlighted critical operational and manpower shortages. Workers reported covering multiple wards single-handedly, leading to inadequate surveillance and delayed intervention. Manpower gaps within VBD programmes have been consistently cited as a major limiting factor in India’s vector control capacity.²¹

A concern frequently raised by workers was the lack of safety equipment and absence of risk allowances for those performing fogging, a task associated with burns, inhalational exposure, and machine explosions. Similar occupational hazards among vector-control personnel have been documented internationally, highlighting the need for protective gear and structured risk compensation.²²

Despite these challenges, participants proposed realistic solutions. Strong emphasis was placed on stricter enforcement mechanisms, with workers suggesting higher penalties for non-compliance. Evidence shows that regulatory enforcement, when combined with community education, can improve sanitation and waste-management behaviour.²³

Participants also advocated for mass awareness campaigns using social media, public figures, posters in markets, and messages broadcast through municipal garbage vehicles. School-based education was highlighted as an effective method for long-term behavioural change, consistent with existing literature showing positive outcomes of school-centered VBD education.²⁴

Overall, the integrated findings suggest that while technical interventions—fogging, larval surveillance, waste collection—are in place, these alone are insufficient. Sustainable VBD control requires behaviour change interventions, improved community trust, adequate staffing, improved worker safety, effective enforcement, and robust inter-sectoral collaboration. These conclusions align strongly with WHO’s framework for integrated vector management, which emphasizes combining environmental management, community participation and strengthened institutional systems.²⁵

Limitations

The cross-sectional design of the present study limits causal inference. Purposive selection of urban wards may restrict generalizability of the findings. Focus group discussion could not be conducted in the community due to time and resource constraints.

CONCLUSION

The study demonstrates that despite good awareness and generally positive attitudes towards dengue and chikungunya, significant gaps persist in preventive practices, risk perception, and community cooperation. Behavioural resistance, socio-economic constraints, and operational shortcomings among field workers limit effective vector control, highlighting the need for integrated, community-centred and system-strengthening interventions.

Funding: No funding sources

Conflict of interest: None declared

Ethical approval: The study was approved by the Institutional Ethics Committee

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