Vector borne diseases are one of the major public health problems worldwide today. There is significant disease burden contributed to morbidity and mortality due to disease such as Dengue, Malaria, Kala azar, Lymphatic filariasis, Japanese encephalitis and Chikungunya. Dengue is the most common arthropod borne viral infection.1 The origins of the word dengue are not clear, but one theory is that it is derived from the Swahili phrase “Ka dinga pepo” meaning “Cramp like seizure caused by an evil spirit”. The Swahili word “ dinga” may possibly have its origin in the Spanish word “dengue” meaning fastidious or careful, which would describe the gait of a person suffering the bone pain of dengue fever. Alternatively, the use of the Spanish word may derive from the similar sounding Swahili. Slaves in the West Indies who contracted dengue were said to have the posture and gait of a dandy, and the disease was known as “Dandy Fever”.
The first record of a case probable dengue fever is in a Chinese medical encyclopaedia from the Jin Dynasty (265-420 AD) which referred to a “water poison” associated with flying insects. The first recognized Dengue epidemics occurred almost simultaneously in Asia, Africa and North America in the 1780, shortly after the identification and naming of the disease in 1779. The first confirmed case report dates from 1789 and by Benjamin Rush, who coined the term “breakbone fever” because of the symptoms of myalgia and arthralgia.11
Dengue fever is caused by a mosquito –borne human viral pathogen belonging to the genus flavivirus of the family Flaviviridae (single strand, non-segmented RNA viruses). Dengue is transmitted in humans by two species of Aedes mosquitoes namely, Aedes aegypti (principal vector) and Aedes albopictus. There are four dengue serotypes(DEN-1,DEN-2,DEN-3,DEN-4) which disseminate disease in two main forms, dengue fever and dengue hemorrhagic fever(DHF).4 Aedes mosquito is day biting mosquito and peri –domestic in habitat.1 Aedes aegypti mosquito and Aedes albopictus are usually found in manmade containers like flower vases, water storage jars, un used toilets bowls, etc. Infection with one serotype gives lifelong immunity against re-infection by same serotype but not against other serotypes. So we can have disease several times during our lifetime.5 Dengue fever is characterized by sudden onset of high fever(103°to106°F), headache, muscle and joints pain, rash, nausea, and vomiting.6,7 Some infection results in Dengue Hemorrhagic Fever (DHF) a syndrome that in its severe form can threaten the patient’s life primarily through increased vascular permeability and shock.6
Over the past three decades, there has been dramatic global increase in the frequency of Dengue disease and their epidemics.2 Vector-borne diseases account for more than 17% of all infectious diseases, causing more than 1 million deaths every year globally.3 About 200 million infections per year and affects approximately 3.6 billion people worldwide.12 World Health Organization (WHO) has declared Dengue and Dengue hemorrhagic fever to be endemic in Asian sub-continent. Presently, Dengue is endemic in 112 countries of the world.5 In India dengue is endemic in 31 states/Union Territories.8 Particularly in India, it is occurring in epidemic form almost on an annual basis. This is largely attributed to rapid urbanization with improper water management.1
In India during 2014, 33,320 cases and 86 deaths have been reported.10 National vector borne Disease control Programme (NVBDCP) under the edges of National Rural Health Mission (NRHM) is one of most comprehensive and multifaceted public health activities in India including prevention and control of mosquito-borne diseases.9 The mosquito-borne diseases results in avoidable ill health and death which also has been emphasized in National health Policy and Millennium Development goals (MDGs) in India.9
Since there is no vaccine available, vector control is the ideal way to control dengue. But vector control methods can be successful with community participation. Hence it becomes important to assess the community’s perception regarding the disease, its mode of transmission and breeding sites. Knowledge, attitude and practice studies act as educational diagnosis of population. So knowledge, attitude and preventive practices study will not only help in assessing the level of awareness and practices in relation to dengue disease as well as also help Government and policy makers to formulate strategies to fill the gap in level of awareness, practices and implementation of control programme acceptable to risk population. Hence the present study was planned to assess the Knowledge, Attitude and Preventive Practices among people in an urban area of Belagavi.
Source reduction becomes the only effective way to control the spread of Dengue disease .So Knowledge, Attitude and Preventive Practices study will not only help in assessing the level of awareness and practices in relation to Dengue disease but will also help Government and policy makers to formulate strategies to fill the gap in level of awareness, practices and implementation of control programme acceptable at risk population. Hence the present study is planned to assess the Knowledge, Attitude and Preventive Practices among people in an urban area of Belagavi.
What is the Knowledge, Attitude and Preventive Practices regarding dengue disease among people living in an urban area?
To assess the knowledge, attitude and preventive practices regarding dengue disease among people in an urban area.
A descriptive cross-sectional study conducted in April 2016, in the city of Villavicencio, the capital of Meta country showed that 70% of subjects were aware that dengue, chikungunya or zika are viral diseases. Fever was considered the most important symptom and could be related to the experience of having these diseases at home. 79.45% knew that a mosquito transmits these diseases but did not know the scientific name or that only the female bites. 81.36% did not know the life cycle of the mosquito but were aware that the elimination of breeding sites and destruction of containers with water could aid in transmission prevention. 88.46% recognized that the community should be responsible for these control actions at home, but the recommendations are not implemented due to the lack of interest or apathy. The average house index was 40.3%, and Breteau index was 47.66%. Low tanks represented the most common breeding site. 13
The study conducted on knowledge, attitude and practice regarding dengue and chikungunya in secondary school children in a city of north India in 2016 showed that the fact of dengue and chikungunya caused by mosquito bite was known to 96% and 71% children respectively. 43% children knew female mosquito bites spread diseases. Only 21% knew that they are caused by Aedes mosquito. 47% knew that it breeds in clean stagnant water and 49% knew that it bites during day. Only 50-60% children took personal protective measures against mosquito bites and checked for breeding of mosquitoes. 95% children felt that prevention of these diseases should be taught in schools.3
A community based, cross sectional study carried out in an urban field practice area Kalaburagi, Karnataka in 2015, showed that out of the 247 studied population, majority 171(69.23%) knew that malaria is transmitted by mosquito followed by 68(27.53%) Filarial, 22(8.91%) dengue and 37 (14.98 %) Chikungunya. 85.02% participants answered dirty stagnant water as mosquito breeding place. Regarding source of knowledge majority 153(61.94%) was from Television followed by 135(54.66%) from Health care providers.14
Another study conducted in 2015 among students of six secondary schools in Jazan, Saudi Arabia, showed a poor dengue fever (DF) knowledge among the secondary school students. Majority of the respondents were having good attitudes and believed that DF could be controlled and prevented (93.2%), DF control is the responsibility of government and community (83.1%) and they themselves have an important role to play in DF prevention (78.5%).The most common practice to prevent mosquito breeding were found to be the disposing of water from breeding containers (85.5%) and covering of water containers (68.6%). A significant association between the practice of DF, preventive and control measures and the gender of the respondents was found (P<0.005).The top two common sources of DF knowledge were identified as primary health care centers and television 48.1% and 44.5%, respectively.15
A community-based, cross-sectional KAP study conducted in the urban area of Taiz, a hinterland governorate in the southwest of Yemen, in 2015, showed that more than 90.0 % of respondent household heads had correct knowledge about fever, headache and joint pain as common signs and symptoms of dengue fever. Moreover, muscular pain and bleeding were perceived by more than 80.0 % of the respondents as being associated with dengue fever; however, only 65.0 % of the respondents reported skin rash as a sign of dengue fever. More than 95.0 % of respondents agreed about the seriousness and possible transmission of dengue fever; however, negative attitudes regarding the facts of being at risk of the disease and that the infection is preventable were expressed by 15.0 % of respondents. Despite the good level of knowledge and attitudes of the respondent population, poor preventive practices were common. Bivariate analysis identified poor knowledge of dengue signs and symptoms (OR = 2.1, 95 % CI = 1.24–3.68; p = 0.005) and its vector (OR = 2.1, 95 % CI = 1.14–3.84; p = 0.016) as factors significantly associated with poor preventive practices. However, multivariable analysis showed that poor knowledge of the vector is an independent predictor of poor preventive practices of the population (adjusted OR = 2.1, 95 % CI = 1.14–3.84; p = 0.018).16
In a descriptive cross-sectional study conducted in 2015, in Narayan Medical College & Hospital, a rural medical college located in village Jamuhar, District Sasaram, India, showed that out of 223 individuals interviewed, 93% identified fever as important symptom of Dengue fever (DF). The knowledge about other symptoms of DF was low among participants. Only 17.5% knew that DF is transmitted by Aedes mosquitoes. The correct timing of biting time was known by only 14%. Despite low knowledge, the participants had good attitude and most of them reported good preventive practices against dengue prevention and control.17
In a cross sectional study on knowledge, attitude and practice about dengue fever carried out in Gomal in 2015 showed that among 100 respondents 32% were males and 68% were females, 14% were illiterate, 32% attended school, 24% college,30% university,38%, 40% and 22% belonged to poor, middle and high income group. Overall knowledge about dengue disease was 60%, positive attitude was 92% and overall practice was 90%. Among participants 48% were educated till primary school and 24.8% of them till secondary school.5
An interventional study conducted in 2015, during emergence of the chikungunya epidemic and one year prior to the emergence of Zika fever in urban periphery in the city of Machala, Ecuador, showed that households spend a monthly median of US$2.00, or 1.90% (range: 0.00%, 9.21%) of their family income on Aedes. aegypti control interventions. Households reported employing, on average, five different mosquito control and dengue prevention interventions, including aerosols, liquid sprays, repellents, mosquito coils, and unimpregnated bed nets. They found that effectiveness and cost were the most important factors that influence people’s decisions to purchase a mosquito control product.18
A cross-sectional study designed and conducted at Makkah during 2015, showed that knowledge about DF was deficient; 59%, 32.7%, and 8.3% of the students obtained poor, fair, and satisfactory knowledge scores, respectively. Having heard about DF was the strongest predictor for having high knowledge score (t test = 4.47, p < 0.001). This was followed by female gender (t test = 5.81, p < 0.001) and positive family history of DF (t test = 3.18, p < 0.01). The only factor that significantly affected the self-reported practices scores was their level of knowledge about the disease (t test = 3.16, p < 0.01).19
A community based, cross sectional study carried out during 2014, Bhavnagar, showed that there was good knowledge of mosquito Borne Diseases (MBDs) as majority (88.1%) respondents were aware about (MBDs) & 3/4 (76.3 %) were aware about preventive measures against MBDs. In the present study, 68.1% fever cases were found of which 88% consulted government doctor for treatment. Most of (94.8%) respondents were using personal protective measures.20
A cross-sectional study conducted in 2014 in urban area of Jhansi city, showed that the total 100 respondents (59%) were male. When the socio-demographic characteristics of the study population were analyzed, majority were young adults (20-40 years) and were literate. Majority of participants cited mosquito bite as the commonest mode of spread. About 80% of the respondents identified fever as the most common clinical symptom. Nearly half of the respondents had insufficient knowledge about the causative agent of dengue. Television and media were important source of information. Around 60% of respondents correctly reported biting time of mosquito vector. Most prevalent preventive method were coils & liquid vaporisers.21
Another community based cross sectional study conducted in Kannamangala village from in 2014, showed that knowledge and practices regarding dengue fever was not satisfactory 60% of the respondents said dengue is a serious illness and 68.8% said it is transmitted through mosquito bite and only 8% knew the name of the vector. Only 15.3% of the participants changed water in artificial containers every week 49.2% of the respondents got the information from Radio/TV followed by Newspaper/magazine. Only 15.4% of the respondents received information by Health personnel.22
A community based cross-sectional study conducted in 2013, in six selected villages i.e. three in Mewat and three in Rohtak district, showed that about 52% of the respondents in Rohtak region and 42.68% in Mewat region committed that malaria is transmitted by mosquito bite which was directly correlated with the level of education. It was observed that high fever, chills and body pain were considered as the major signs/symptoms of malaria. Television followed by friends and relatives and health care provider’s acts as the major source of information about mosquito borne diseases. Overall (76.2%) individuals from both study areas mentioned that malaria is a serious problem in their area but only 46.3% knew about various Government measures for the protection and treatment of malaria. Mosquito nets, mosquito coil and repellents were commonly used as protective practices by the respondents but the difference was not found significant except for mosquito net (p <0.05) in both the study areas.23
According to a community based cross sectional study conducted in both urban and rural area of Bangalore in 2013, showed that the health workers were main source of information in rural areas. 85% of rural and 59% of urban population were aware that the mosquito transmits dengue. Majority of study population knew that high fever, myalgia and headache are common presenting symptoms, but only 12% of rural and 2% of urban participants were aware of bleeding symptoms of Dengue and 44% of rural and only 9.6% of urban participants were aware that the dengue mosquito bites at day time. 40% of rural and only 5% of urban population said that the mosquito breeds in clean water container. The common self-protective measures used were mosquito coils (75% rural and 68% of urban) followed by mosquito nets (62%) in rural and fans (63%) in urban area.1
In a study on impact of health education on knowledge, attitude and practice related to dengue fever conducted in 2013 at Mysore showed that 60.4% were males and 39.6% were females. Greater part of participants belonged to the age group of 21–40 years. Majority of participants were educated till primary school followed by secondary education. Nearly about half the participants were unemployed. The study revealed that knowledge, attitude and practice score was 24.4
Another study carried on knowledge, attitude and practices regarding Dengue fever in Patiala in 2013 showed that after the monsoon season there was sudden increase in the number of dengue cases diagnosed in Rajindra hospital Patiala with majority of them reported from Tripuri area of Patiala. 87.32% were aware about dengue fever. Fever as presenting symptom was known to 90.5% but very less awareness was seen about other symptoms of dengue fever.6
An study in Pre-University College students of Chitradurga, Karnataka, in 2013, showed that majority of the students (73.9%) had good knowledge about signs, symptoms, and modes of transmission of dengue. Around 70% considered dengue to be a serious illness and 40.52% believed that they are at risk of getting infection. Almost half said dengue is preventable. Very few did not use any effective dengue preventive methods such as spraying of insecticides and mosquito bed nets.8
In a cross-sectional study conducted in 2013, in the cities of Colombia, Arauca and Armenia, showed knowledge, attitude and practice (KAP) indexes to be 56.1%, 79.7%, and 83.2% of the variance, with means of 4.2, 1.4, and 3.2 and values that ranged from 1 to 7, 7 and 11, respectively. The highest values of the index denoted higher levels of knowledge and practices. In the quantile regression, age (0.06; IC: 0.03, 0.09), years of education (0.14; IC: 0.06, 0.22), and history of dengue in the family (0.21; IC: 0.12, 0.31) were positively related to lower levels of knowledge regarding dengue.24
Another cross-sectional survey conducted in five districts of central Nepal between 2012, showed that 77% had heard of Dengue fever (DF). Only 12% of the sample had good knowledge of DF. Those living in the lowlands were five times more likely to possess good knowledge than highlanders (p<0.001). Despite low knowledge levels, 83% of the people had good attitude and 37% reported good practice. They had found a significantly positive correlation among knowledge, attitude and practice (p<0.001). Among the socio-demographic variables, the education level of the participants was an independent predictor of practice level (p<0.05), and education level and interaction between the sex and age group of the participants were independent predictors of attitude level (p<0.05).25
A cross sectional study done in 2012 in Mangalore, showed that data collected by interviewing any adult per household. 136 (90.7%) were aware that mosquitoes transmit diseases. Fourteen (9.3%) were not aware of any potential breeding sources. Only 96 (64%) households used integrated vector control methods. Median cost on permanent mosquito bite prevention methods was more in urban (p=0.011) while the percentage of total family income spent on temporary prevention methods was more in semi urban areas (p<0.001) and among low socio economic families (p<0.001).Breeding sites for mosquitoes like open wells (p=0.026) and open drains (p<0.001) were seen more in semi urban areas. Spraying operations was poor in households of semi urban areas (p=0.02).26
In a cross-sectional study conducted at Sindh, in 2012 showed that overall, 94.6% of participants (43.3% male and 56.7% female, p-value 0.03) had heard about dengue, 58.6% of participants reported‘‘Aedes mosquito’’ as a vector of dengue virus, with gender difference (37.5% male vs 62.5% females with p-value <0.001). The Aedes mosquito is ‘‘A small dark mosquito having white stripes on its leg’’ was reported by 54.8% students. The Aedes mosquito breeds in ‘‘Stagnant clean water’’ was reported by 47.6% (male 40.2% vs female 59.8%, p-value 0.003) and usually bites at ‘‘Dusk’’ by 44.7% and at ‘‘Dawn’’ by 51%. Regarding symptoms of dengue fever, ‘‘Prolonged high fever’’ was reported by 52.6%, ‘‘Muscular pain’’ by 39.6% (p-value 0.009), ‘‘Bleeding’’ by 41.3% (p-value0.001) and ‘‘Headache, nausea and vomiting’’ by 44.7% (p-value 0.001). 27
As per study conducted to evaluate the knowledge and practices regarding dengue infections in Philippines in 2012 showed that among 646 participants more than half of the respondents had good knowledge (61.45%) on causes, signs and symptoms, mode of transmission, and preventive measures about dengue. Almost 52.63% of the respondents used dengue preventive measures such as fans, 70.90% used mosquito coil, and 59.91% used bed nets to reduce mosquitoes while only few utilized insecticides sprays and 36.07% used screen windows and only 22.60% used professional pest control. There was no correlation between knowledge about dengue and preventive practices (p=0.75).7
Another cross-sectional study conducted to assess the knowledge and practices regarding mosquito borne diseases among people of Rajkot, in 2011 showed that 87.96%respondents knew that mosquito transmits malaria and 75.93% respondents did not know how dengue is transmitted. Fever (95.60%) and chills (71.06%) were the most common malaria symptoms told by respondents. 85.65% respondents were not knowing about dengue symptoms. 48.84% told joint pain as chikunguniya symptom. 90.05% respondents associated water collection to be mosquito breeding place. 90.51% respondents knew that mosquito borne diseases can be prevented by using personal protective measures. 23.84% of the respondents did not use anything for prevention against mosquito bites.9
A community based cross sectional study conducted in Feb, 2010 in Pondicherry showed that 1411 (84.29%) of study subjects were using one or the other form of personnel protective (PP) methods against mosquito borne diseases. The use of mosquito repellent coil and liquid vapourizer were commonest among PP methods used. Use of PP methods by females was almost same as compared to males. Respondents living in semi-pucca or kutcha houses were more likely to practice PP methods as compared to respondents living in pucca houses (OR: 1.17; 95% CI: 0.87-1.57). Only 1131 (67.56%) respondents had expressed willingness to cooperate with insecticide spraying operation done by local authority.28
A cross-sectional study carried out in 2010, in Malaysia, showed that the main source of information on dengue was from the television or radio (88.5%). The respondents’ attitude was good and most was supportive of Aedes control measures. There was significant association between knowledge and attitude (P<0.001) with an Odds Ratio of 3.8 (95% CI:2.2, 6.7). Knowledge was associated with age, ethnicity and educational level; attitude was associated with ethnicity and educational level while practice was associated with ethnicity and marital status.29
An household survey conducted in 2009 in Pak-Ngum District – a peri-urban area of Vientiane Capital of Laos showed that a 97% of the participants had heard of dengue, 33% of them did not know that malaria and dengue were different diseases, 32% incorrectly believed that Aedes mosquito transmits malaria, 36% could not correctly report that Aedes mosquitoes bite most frequently at sunrise and sunset; and < 10% of them recognized that indoor water containers could be Aedes mosquito breeding sites. Attitude levels were moderately good with a high proportion (96%) of participants recognizing that dengue was a severe yet preventable disease. The majority (93%) of the interviewees did not believe that they had enough information on dengue. There was an association between good knowledge and better practices, but good knowledge was associated with worse attitudes.30
In a cross-sectional study conducted in a coastal district of west Gujarat in 2007, showed that rural domestic environment was favourable for mosquito breeding. Most of the respondents were unaware about the places where mosquito bred. The knowledge regarding vector, routes and symptoms of malaria were good, while majority were unaware about types of malaria and other mosquito borne diseases. Active malaria surveillance activity were totally lacking in urban area (94%), while it was very poor in rural and slum area. 56% of the respondents were practicing at least one personal protective and larvae control measure, but less efficient one.31
A study assessing the knowledge, attitudes and practices regarding dengue in 2006, showed that about 89.9% of individuals had heard of dengue fever. Sufficient knowledge about dengue was found to be in 38.5% of the sample, with 66% of these in Aga Khan University Hospital and 33% in Civil Hospital Karachi. Literate individuals were relatively more well-informed about dengue fever as compared to the illiterate people. Knowledge based upon preventive measures was found to be predominantly focused towards prevention of mosquito bites (78.3%) rather than eradication of mosquito population (17.3%). Use of anti- mosquito spray was the most prevalent (48.1%) preventive measure. Television was considered as the most important and useful source of information on the disease.32