Descriptive study on knowledge, attitude and practice regarding dengue fever and its vector control in Aligarh

INTRODUCTION

In the past decade, there was a substantial increase in dengue burden on health services and economy of the nation. Dengue is a major public health illness that is preventable with active community participation in vector control. Knowledge on dengue is the understanding of a definite phenomenon that focuses on transmission, symptoms, and ways of prevention of this illness. Attitude towards dengue refers to the organization of thinking around an approach that predisposes an individual to act in some specific way favouring the prevention of this disease. Practices against DF are a group of actions that trigger a definite outcome in health such as prevention of mosquito bites and reduction in vector breeding sites. For good practice among the members of the community, there should be an adequate level of knowledge and attitude regarding the disease. Lack of knowledge regarding various aspects of this disease and its vector along with inadequate utilization of health services act as barriers to successful control and prevention of dengue in India. Several factors such as a large population, lack of education, and poverty can hinder people from adopting effective vector control measures. The practices of using stored water and improper garbage disposal are very common in India, especially in rural areas. These practices along with water logging due to rainfall can cause increased breeding of vector. Knowledge and preventive practice regarding dengue are not sufficient in Indian population. Hence, there is a need to provide more understanding of this disease in terms of its symptoms, transmission, vector behaviour and prevention strategies.

Uttar Pradesh is endemic to DF with cases being reported throughout the year. From July to November, there is an upsurge of dengue cases. Generally, dengue is considered as a disease of high-density tropical urban areas; however, dengue transmission occurs equally in both rural and urban areas in this state.¹ The increasing incidence of DF and the lack of relevant studies on the KAP of Aligarh community regarding DF prompted us to conduct the present study. The objective of this study is to ascertain the KAP of adult population in Aligarh, India, regarding DF and its vector control.

METHODS

Study area

The study was conducted in all field practice areas such as Firdous Nagar, Nagla Qila, Patwari Nagla, Bada Jawan, Chotta Jawan, Sumera, Garhia Bhojpur, Jawan Sikandarpur and Tejpur affiliated with health training centres of the department of community medicine, Jawaharlal Nehru medical college, Aligarh. This district is situated in Western Uttar Pradesh about 133 km southeast of Delhi on the Delhi Kolkata railway line and Grand Trunk Road. Aligarh experiences maximum temperature reaches up to 47⁰C in summer while the minimum temperature is about 3-5 ⁰C in winter.

Inclusion criteria

HHs members of age 18-65 years and registered non rental HHs in RHTC and UHTC were included in study.

Exclusion criteria

HHs residing in a rental house, not willing for the study and HH member with any serious illness were excluded.

Sample size

This study was done as a pre-test of community based interventional study on KAP of DF and its vector control. With an assumption of 50% baseline knowledge and a change of at least 10% after intervention, the minimum sample was 168 after adding 5% non-response and 5% loss to follow up.²

Field based data collection

A HH survey was carried out between February 2022 and May 2022 using a pre-tested and structured questionnaire translated into local language. Head of the family or any adult family member above 18 years of age available at home during the survey was interviewed following informed consent. The questionnaire was divided into various sections covering sociodemographic information about the respondents, KAP regarding dengue prevention and vector control. Overall, data was obtained from 192 HHs.

Data analysis

The data collected from the survey were analysed using IBM SPSS version 26. Microsoft office home and student 2019 was used to draw graphs and charts wherever appropriate.

KAP score

Bloom’s cut-off criteria were used to assess the scores.³ The total knowledge score was divided into good, moderate and poor grade based on this cut-off. The maximum knowledge score was 20 and the minimum score was zero. According to Bloom’s cut-off, 80-100% of the total score was termed as good knowledge (16 or above), 60-79% of the total score was termed as moderate knowledge (12-15) and less than 60% of the total score was termed as poor knowledge (less than 12). Similarly, attitude with a maximum score of 60 and a minimum score of 12 was termed as positive attitude (48 or above), neutral attitude (36-47) and negative attitude (less than 36). Practice score with a maximum score of 12 and a minimum score of zero was termed as good practice (9.6 or above), moderate practice (7.2-9.5) and poor practice (less than 7.2).

RESULTS

Study population largely comprised of individuals in 18-35 years age group 102 (53.1%) with females 120 (62.5%) more than males 72 (37.5%). Most of the participants from rural area 123 (64.1%) and 70 (36.5%) participants had no formal education. Around 60% participants unemployed and nearly half of participants belonged to lower middle-class families (Table 1).

Dengue related knowledge

Table 2 and 3 shows that 37.5% of participants recognised DF as a disease, 45.8% knew about the transmission and 15.6% of participants knew the initial symptoms. More than half of the participants were aware of the recurrence and fatality of DF. It was also noticed that 31.8% of participants knew about the biting behaviour, 18.2% were aware of the breeding place and a few knew the name of the vector. About 64.5% of participants knew that dengue could be prevented; however, only a few participants had awareness regarding larvivores fish and insecticides.

Dengue related attitude

Table 4 and 5 shows that 60.9% of participants agreed that a healthy person could also contract this disease, 51.6% agreed that there was an equal risk of dengue infection for all family members and 85.9% were in view of seeking immediate treatment for high fever. The majority of participants had an attitude of using some form of preventive measures against mosquito bites and nearly 3/4^th of participants considered dengue prevention as a collective responsibility. It was also noted that most participants were against leaving any water collection sources outside their houses. About 66.1% of participants agreed to the need of checking the mosquito breeding sources; however, 14.1% of participants considered this as a wasted effort. More than 75% of participants had an attitude of granting permission for insecticide spraying inside their houses and less than 50% of participants supported levying a fine for the presence of larvae in and around their houses.

Dengue related practice

Table 6 shows that more than half of the participants did not listen to dengue awareness programs, 93.2% of participants used some form of personal protective measure, 70.3% used these measures daily and 46.4% of participants used more than one personal protective measure. About 70.8% of participants practiced wearing fully covered clothes during day time, 28.6% of participants used light-coloured mosquito nets, and 18.8% of participants used neem smoke to repel mosquitoes. Most participants practiced the use of cover for water containers and cleaned these containers at least once a week. It was also noted that 88% of participants emptied water from cooler and tray behind the fridge every week, 77.6% of participants practiced proper disposal of house waste and 16.1% of participants practiced pouring oil in stagnant water to prevent larval growth.

DISCUSSION

In this study, the main source of information regarding dengue was from family, friends and relatives (38%), probably due to higher community interactions in the rural areas. Similarly, a study from Bangladesh identified that 26.8% of participants responded their source as friends and family.⁴ About 37.5% of participants identified dengue to be a disease, comparable to a study from Malaysia.⁵ Most participants considered mosquitoes as a nuisance in their locality and around 46% of participants knew that mosquitoes transmit DF similar to the finding from Delhi.⁶ Around 43% of participants knew that DF will not be transmitted by direct contact. A similar result was reported from Nepal (44%).⁷

Only 15.6% of participants rightly mentioned the initial symptoms of dengue. This low response could be attributed to less prevalence of DF in the study population comparable to a study from Chandigarh (13.75%).⁸ About 62.5% of participants identified that a person could contract dengue infection more than once, similar to the findings from Yemen (59%).⁹ Most of the participants had no previous experience with DF and probably due to the apprehension of this disease, 78.1% identified dengue to be fatal. This result was consistent with a study from Kerala (74%).¹⁰ Around 65% of participants knew that dengue could be prevented comparable to a study from Nepal (71.9%).¹¹

About 85.4% of participants responded that covering water containers or turning the containers upside down could prevent mosquito breeding. This was consistent with a study conducted in China (92.7%).¹² Most of the participants had the misconception that the term “dengue” itself denotes the name of the vector. Hence, only 3.6% of participants were aware of Aedes mosquitoes. This response was similar to the findings of studies from Delhi (3.7%).^6,13

It was observed that only 31.8% of participants identified the vector to be a day-biter, probably due to less frequency of mosquito bites during day time. Similarly, a study from Brasilia found that 30.8% of their participants identified the vector to bite during day.¹⁴ Several other studies reported inadequate knowledge regarding biting behaviour, notably from Indonesia.¹⁵ About 52.1% of participants identified an abundance of mosquitoes in rainy and post-rainy seasons. Like this result, more than half of the participants reported rainy season as the period of higher dengue transmission in a study from Srilanka.¹⁶

In the present study, only 18.2% of participants identified stagnant clean water as the breeding source of Aedes. This low response might be due to the linking of mosquito breeding to dirty water as there were more open drainages in the community. This finding was comparable to a study from Delhi (25.9%).⁶ While, a Sri Lankan study identified a high level of knowledge regarding the breeding source.¹⁶ Higher percentage of participants (93.8%) were aware that pouring chemicals into standing water could kill mosquito larvae. The respondents might have related this to the use of phenyl disinfectant which was commonly used for cleaning purposes in the study population. A similar response was obtained by study done from Indonesia.¹⁷

The overall dengue knowledge was identified to be poor which may be attributed to the fact that nearly half of the participants had an educational qualification of primary level or below and only a few respondents had a previous history of DF. This finding was similar to a study from Haryana in which they found 81% of their participants with poor, 18% with satisfactory and 1% with good knowledge scores.¹⁸ Similarly, Delhi study identified inadequate knowledge regarding vector breeding and biting habits. Studies from Chandigarh, Nepal and Indonesia also found the knowledge to be generally inadequate among their participants.^7,8,15

About 60.9% of participants agreed that a healthy person could also get dengue infection. Similar findings were reported from Yemen (62.1%) and Malaysia (53.3%).^9,19 About 51.6% of participants agreed that there was an equal risk for all family members to get dengue infection comparable to a study from Venezuela.²⁰ Around 86% of participants preferred seeking immediate treatment for high fever similar to the findings of Kolkata (79.2%) and Malaysia (79%).^21,22 About 92.7% of respondents had an attitude of following some form of preventive measures against mosquito bites. This finding was identical to a study done from Bangladesh, in which they found 89.7% of their participants with a similar response.²³

In the present study, 66.1% of participants agreed that dengue prevention should be a shared responsibility which was similar to the finding from Kolkata (61.8%).²¹ Around 83% of participants positively responded to the need of sleeping in mosquito nets to prevent the spread of DF. This was comparable to a study done in Yemen in which they found that 85.2% of participants favoured the use of bed nets for dengue prevention.⁹

Around 66% of participants agreed to the need of checking mosquito breeding sources. Malaysian study recorded similar findings in 60.5% of their participants.¹⁹ It was also found that 62.5% of participants did not consider checking larval sources as a waste of time. This was consistent with another similar Malaysian study.²²

About 70.3% participants agreed to permit insecticide spraying inside their house. Similarly, studies from Kolkata (79.2%) and Malaysia (86.2%) noted the same response.^19,21 It was seen that only 42.2% of participants supported levying a fine for the presence of larvae in and around their houses. This unfavourable response might be due to the low-income status of the participants. Unlike the present findings, a study from Malaysia obtained favourable responses from 72.9%.²⁴

It was identified that 14.1% of participants had positive attitude towards DF and its vector control. Like the present findings, a study from Indonesia identified 10.1% of participants with a positive attitude and nearly 50% of participants with a neutral attitude.²⁵

Around 93% of participants used some personal protective measures like mosquito nets/repellents/coils, etc against mosquito bites, mostly due to the high burden of mosquitoes in their locality. Similarly, in Chandigarh more than 90% of their participants took some form of preventive measure against mosquito bites.⁸ About 70.3% of participants used these preventive measures daily. This finding was similar to a study from Kerala (95.2%).¹⁰ Light-colored mosquito nets were used by 28.6% of participants. Similar result was obtained in Rajasthan (24.3%).²⁶ Whereas a study by Nepal found that more than 90% of their participants practiced use of bed nets.¹¹

It was identified that 70.8% of participants used full-sleeve clothing during daytime, which was comparable to the findings from Nepal (61.4%).²⁷ Around 19% of participants had the practice of burning neem leaves to stay away from mosquitoes. Even though neem was easily available, a lack of knowledge regarding its effectiveness to repel mosquitoes restricted its usage by the participants. A study from Delhi found that 12.9% of their participants used neem leaves against mosquitoes.¹³ Interestingly, in the present study, we found a few participants utilizing the smoke of burned egg craters to repel mosquitoes.

We identified that 77.6% of participants practiced proper waste disposal through door-to-door collection, composting, landfilling, etc similar to a study from Malaysia.¹⁹ Almost everyone covered water storage containers comparable to studies from Nepal, Rajasthan and Kerala, in which they observed this practice in more than 80% of participants.^10,11,26,27Around 95% of participants cleaned the containers at least once a week. A similar study from Indonesia found that 91.8% cleaned water containers more than once a week.¹⁵

It was observed that 88.0% participants emptied water from cooler, tray behind fridge, etc at least once a week. This higher level of practice could be attributed to frequent home visits by ASHA workers to check the breeding sources of mosquitoes. Similar to the present finding, Telangana study found that 65% of participants checked for water collection in coolers and 77% of participants emptied unused containers.²⁸ Whereas a study from Rajasthan identified that most of their respondents neither checked coolers for mosquito breeding nor changed the water weekly.²⁹ Around16% of participants poured oil into stagnant water to prevent larval growth. A similar result was obtained from Nepal in which 10.1% of participants had this practice.¹¹

Overall, 14.1% of participants had good practice regarding dengue prevention and vector control, comparable to studies from Indonesia (16.9%) and Uttar Pradesh (10.2%).^25,30

Limitations

The major limitation of this study is essentially small number of participants as it was a pre-test of community based interventional study on KAP regarding DF and its vector control.

CONCLUSION

In this study, it was found that more than 3/4^th of the participants had poor knowledge, 83.3% had neutral attitude and 50.5% had poor level of practice regarding DF and its vector control. Hence, we recommend health education intervention to enhance KAP regarding dengue prevention and vector control in Aligarh community.

Funding: No funding sources

Conflict of interest: None declared

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

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