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 Table of Contents  
ORIGINAL ARTICLE
Year : 2020  |  Volume : 13  |  Issue : 2  |  Page : 112-119

Knowledge, attitude, and practice toward dengue fever among residents in Raichur


1 Navodaya Medical College Hospital and Research Center, Raichur, Karnataka, India
2 Department of Pharmacy Practice, N.E.T. Pharmacy College, Raichur, Karnataka, India

Date of Submission13-Jan-2020
Date of Acceptance04-Mar-2020
Date of Web Publication23-Jun-2020

Correspondence Address:
Dr. Ashok G Mahendraker
Navodaya Medical College Hospital and Research Center, Navodaya Nagar, Raichur - 584 103, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/kleuhsj.kleuhsj_28_20

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  Abstract 


INTRODUCTION: Dengue, which is caused by any one of the four-related viruses transmitted by mosquitoes, is a leading cause of illness and death in the tropics and subtropics.
OBJECTIVE: This study was designed with the objective of assessing knowledge, attitude, and practice (KAP) toward dengue fever.
MATERIALS AND METHODS: The survey questionnaire on the KAP of dengue among the residents of Raichur was completed by 100 respondents.
RESULTS: The average score percentage of knowledge of respondents (84.4%) regarding dengue falls into good response level under the scoring system (59%–77.35%) and that of practice of respondents (22.5%) falls into poor response level under the scoring system (0%–37.5%). Almost all the respondents (96%) had a positive attitude to bring family members who got the symptoms of dengue to see a doctor for immediate treatment-positive correlation was found between KAP of the respondents.
CONCLUSION: The study concluded that the poor practice toward dengue despite good knowledge and attitude level may be due to ignorance. This points out the need for further evaluative studies to assess the reason for poor practice and also to develop strategies to improve the same.

Keywords: Attitude, dengue, knowledge, practice


How to cite this article:
Mahendraker AG, Kovattu AB, Kumar S. Knowledge, attitude, and practice toward dengue fever among residents in Raichur. Indian J Health Sci Biomed Res 2020;13:112-9

How to cite this URL:
Mahendraker AG, Kovattu AB, Kumar S. Knowledge, attitude, and practice toward dengue fever among residents in Raichur. Indian J Health Sci Biomed Res [serial online] 2020 [cited 2020 Aug 11];13:112-9. Available from: http://www.ijournalhs.org/text.asp?2020/13/2/112/287415




  Introduction Top


Dengue is a common and rapidly spreading mosquito-borne viral disease in the world. It is caused by the infection of dengue virus, a Flavivirus in the family of Flaviviridae (single-strand, nonsegmented RNA viruses). There are four antigenically distinct dengue virus serotypes (DEN-1, DEN-2, DEN-3, and DEN-4). The dengue virus is transmitted by bites of Aedes aegypti and Aedes albopictus mosquito.[1] There are two main forms of dengue disease: DF and the more severe dengue hemorrhagic fever (DHF). Infection with dengue virus can produce a broad range of clinical manifestations including asymptomatic infection, mild flu-like symptoms, and the more severe hemorrhagic fever. In severe cases, patients may suddenly deteriorate, develop hypothermia, and go into circulatory shock (dengue shock syndrome). Severe dengue (previously known as DHF) was first recognized in the 1950s during dengue epidemics in the Philippines and Thailand. Today, severe dengue affects most Asian and Latin American countries and has become a leading cause of hospitalization and death among children in these regions.[2]

Dengue, which is caused by any one of the four-related viruses transmitted by mosquitoes, is a leading cause of illness and death in the tropics and subtropics. As many as 400 million people are infected yearly.[3] The transmission of the endemic virus has been reported in more than 100 countries.[4] Since the Second World War, dengue has become a global problem and is endemic in more than 110 countries. Approximately 2.5 billion people, living in tropical and subtropical regions, are estimated to be risk of acquiring dengue infections. Estimates revealed that more than 50–100 million infections with about 500,000 cases of severe dengue are reported annually, which is a leading cause of childhood mortality in several Asian countries.[5]

In India, major epidemics have been reported in the years 1967, 1970, 1982, 1996, and 2003.[6] Dengue fever treatment entails mainly supportive therapy. As there is no vaccine to protect against dengue, great emphasis is placed on control and preventive measures. Thus, the evaluation of people's knowledge, attitude, and practice (KAP) is of great importance to improve integrated control measures.


  Materials and Methods Top


Ethical clearance

The study protocol was reviewed and approved by the Institutional Ethical Board of Navodaya Medical College Hospital and Research Centre, Raichur.

Study design

The study design was a descriptive cross-sectional study concerning KAP of dengue among 100 residents of Raichur who visited Navodaya Medical College Hospital and Research Centre, Raichur. Only one person from the same house was interviewed to represent the house. This was to avoid redundancy and inconsistency of responses. Convenience sampling was applied in this study. The participants were recruited based on their accessibility by the researcher. This sampling method was chosen because of the limitation of time. A face-to-face interview was done through a prepared interviewer-administered questionnaire. The interview was conducted in the local language which is Bahasa Melayu for the ease of communication between the researcher and the participants. Before the interview, explanation about the study was given and written consent was obtained from the participants. Data were collected from 100 residents.

Inclusion criteria

  1. Permanent residents who had been living in Raichur for at least 1 year
  2. Age between 18 and 60 years.


Exclusion criteria

  1. Sick or mentally ill people.


Questionnaire designing

The questionnaire was prepared and designed based on the references to the previous studies by Wan Rozita et al., 2006,[7] and Naing et al., 2011.[8] Then, the questionnaire was prepared in English but was translated into Kannada to be used during the interview with the participants. The questionnaire was divided into five parts: sociodemographic information, knowledge, attitude, practice, and sources of information Annexure 1.

Statistical analysis

The collected data were analyzed using percentages, standard deviation (SD), and averages.


  Results Top


The sociodemographic distribution of the respondents is shown in [Table 1]. Out of the 100 respondents, 54 of them were female (54%). The mean age of the respondents was 39 years (SD = ±8.4). Most of the respondents only had primary education (67%). Respondents of secondary education were found to be only 33%.
Table 1: Sociodemographic characteristics (n=100)

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[Table 2] shows the distribution of knowledge level of dengue among the 100 respondents. The mean score of knowledge of dengue among the respondents was 32.11 (SD = ±5.2). The knowledge score of the respondents ranged between 19 and 41.
Table 2: Knowledge of respondents regarding dengue (n=100)

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Approximately half of the respondents (55%) knew that dengue may cause death, but some of them (6%) mistakenly thought that dengue is not an infectious disease. Only 22% of the respondents correctly noticed that Aedes mosquito has stripes on its body. However, only 8% of the respondents knew that the vector of dengue is the female Aedes mosquito. Majority of the respondents (75%) knew that dengue virus is transmitted by mosquito bites. Almost half of the respondents (40%) answered that water is another mode of transmission of dengue, but there were 49% of the respondents who correctly responded that dengue virus cannot be transmitted by water. Half of the respondents (53%) knew that Aedes mosquito does not breed in dirty water, but only 18% knew that Aedes mosquito can transmit the dengue virus transovarially. Half of the respondents knew that the peak biting periods for Aedes mosquito are early in the morning after dawn (53%). Ninety respondents (81.8%) knew that Aedes mosquito does not bite in the afternoon. However, there were 58 respondents who falsely thought that Aedes mosquito bites at night (40%). Majority of the respondents could correctly tell that rash (60%), high fever (99%), and joint pain (95%) are the common symptoms of dengue fever. Nevertheless, only a few of them (2%) could tell that ocular pain is another common symptom of dengue fever. Majority of the respondents (70%) responded positively that the spreading of dengue virus can be overcome by removing the vector breeding sites. The average score percentage of knowledge of respondents (73%) regarding dengue falls into good response level under the scoring system (59%–77.35%).

[Table 3] shows that majority of the respondents had an excellent attitude toward dengue (84.4%) according to the scoring system. The mean score of attitudes among the respondents was 13.5 (SD = ±1.25). The minimum and maximum attitude scores obtained by the respondents were 8 and 16, respectively.
Table 3: Level of attitude toward dengue among respondents (n=100)

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Majority of the respondents (73%) agreed that their family members should work together during weekends to remove Aedes breeding sites. However, 75% of the respondents actually believed that their families can help in preventing dengue. About 71% of the respondents agreed that their neighbors were also responsible to prevent dengue. Many of them (68%) agreed that they have the responsibility to ensure that there are no Aedes larvae and eggs in their housing areas. Majority of them (83%) agreed that water containers must be covered properly and the inner sides of the containers should be scrubbed and clean regularly (78%). Only 87 respondents (87%) agreed to open their windows and doors when fogging activities were done. Almost all the respondents (96%) had a positive attitude to bring family members who got the symptoms of dengue to see a doctor for immediate treatment.

The distribution of practice level of dengue among the respondents is shown in [Table 4]. The mean score of practice level is 17.98 (SD = ±7.01). The practice score ranged between 3 and 60 among the respondents.
Table 4: Level of practice of dengue among respondents (n=100)

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The percentage of respondents who used aerosol and/or liquid mosquito repellent and/or mosquito coil and/or electrical mosquito mat and/or mosquito bed net everyday was 57%. Only 11 respondents (11%) checked the presence of Aedes larvae and eggs inside and outside the house at least once a week. All the respondents (n = 100) never add larvicide into their water containers used for water storage and never stored water in water containers. Majority of the respondents (92%) closed their windows and doors early in the morning after dawn, but 8 respondents (8%) never closed their windows at that period of time. The situation was quite the same as closing windows and doors in the evening before dusk. Majority of the respondents (86%) closed their windows and doors during dusk, but there were still some respondents (14%) who never close the windows and doors during dusk. The average score percentage of practice of respondents (22.5%) regarding dengue falls into poor response level under the scoring system (0%–37.5%).

As exhibited in [Table 5], there were positive correlations between KAP of dengue among the respondents. Knowledge of dengue had a positive weak correlation with attitude toward dengue (r = +0.21), which means that as the knowledge of dengue increases, the attitude of the respondents toward dengue also increases [Figure 1]. There was a positive very weak correlation between attitude and practice of dengue (r = +0.15). Despite having high attitude toward dengue, the practice score showed a very weak positive correlation [Figure 2]. [Figure 3] demonstrates a positive weak correlation between knowledge and practice of dengue (r = +0.2).
Table 5: Correlation between knowledge, attitude, and practice of dengue

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Figure 1: Correlation between knowledge and attitude of dengue

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Figure 2: Correlation between knowledge and practice of dengue

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Figure 3: Correlation between attitude and practice of dengue

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  Discussion Top


Majority of the respondents were female because it was mostly women who were available during the time of interview. For some men who were available, they asked their wife/mother to give responses as they claimed that women know better about their houses and family health. Mostly, the residents were those who work and have a family in the age range between 36 and 45 years while some respondents were younger in the age range from 26 to 35 years. They were most probably students who were living together with their parents. The rest of the respondents were older people in the age range of a retiree which is between 56 and 60 years. Furthermore, it was mostly housewives who had been interviewed about the KAP of dengue because they were the ones who were available at their houses. They were the ones who were responsible to look after their family and houses everyday. Other females and majority of males were working farmers or with the government or private sectors or construction workers. The rest of them were students and pensioners. Most of the residents had a primary level of education. It is common among the residents as most of them were older people who did not have the same chance to further study at secondary or tertiary level of education as the younger generation.

The results from this study showed that knowledge of the respondents about dengue was good. This might be because the respondents got much information about dengue from various sources including television, newspaper, and radio. Television and radio was the most popular source of information regarding dengue among the study population. This result was similar to the result of the study by Hairi et al.[9] According to the responses of the participants in the questionnaire, the areas where majority of the respondents could answer correctly were the impact of severe dengue infection, the mode of transmission of the virus, the peak biting period of Aedes mosquitoes, the common symptoms of dengue fever, and the method of preventing the spread of dengue. Meanwhile, some of the respondents showed a lack of knowledge regarding the vector which is the Aedes mosquitoes. Most of the respondents did not know which sex of Aedes mosquito bites humans and transmits the dengue virus. Most of them thought that male Aedes mosquitoes were the ones that spread the disease. Most of them also did not know that female Aedes mosquitoes can transmit the virus into their offspring. It was important to know about the transovarial transmission of dengue virus because one of the ways to prevent the disease is by removing or eliminating the Aedes breeding sites around houses. Despite that most of them knew that Aedes mosquito is the vector of dengue, some of them mistakenly thought that dengue virus can also be transmitted by water. They had misconception that dengue is able to spread through water because they were informed to remove stagnant water as a method of prevention. Apparently, there was some confusion among some of the respondents about the transmission of the disease. These findings showed that some of the respondents only followed what they were advised to do to prevent dengue without understanding the significance of this practice. For example, removing any stagnant water does not mean that the water can cause dengue, but the water may contain eggs and larvae of Aedes which had been infected with the virus. Nevertheless, majority of the respondents could correctly answer that dengue virus is transmitted by mosquito bites.

The respondents in this study were found to have excellent attitude toward preventing dengue. This result was supported by previous study conducted by Wan Rozita et al.[7] who found that the urban community in Kuala Lumpur also had good attitude toward dengue. For instance, the community was cooperative during fogging activities that were done in their areas. The respondents agreed to bring their family members who have symptoms of dengue to the hospital immediately for treatment. This finding was similar to the attitude of the villagers in Pakse, Laos, where majority of them will go to see a doctor if they are sick and have any symptoms of dengue infection.[10]

It was found in this study that the residents had poor practice toward dengue. Based on the analysis of the responses, many of them never use larvicides to kill Aedes eggs and larvae, but nearly half of them frequently used mosquito repellents or mosquito coils or mat in order to get rid the adult mosquitoes. In addition, majority of them did not frequently check for the presence of Aedes eggs and larvae and scrub the inner wall of their water storage every week. They did not take the initiative to buy and put the larvicides into their water containers by their own. Although the knowledge and attitude levels were found to be fair, the practice toward prevention measures was found to be poor. Besides ignorance, the exact reason for this was not able to be identified. This points out the need for further evaluative studies to assess the reason for poor practice and also to develop strategies to improve the same.

Interestingly, there were positive correlations between KAP of dengue. Based on the comparison between knowledge and attitude of dengue in the study population, it was found that higher knowledge contributed to better attitude. This result implied that someone who knew more about dengue had better attitude toward dengue. On the other hand, someone who had a lack of knowledge about dengue had lower attitude in preventing dengue. Next, there was a positive very weak correlation between attitude and practice of dengue in this study population. This explained that those who had better attitude would have better practice (but not satisfactory) toward dengue. This may be due to ignorance despite having better knowledge and practice. A positive correlation was also found between knowledge and practice of dengue among the respondents. However, they were weakly correlated with each other. It was consistent with the result of the study by Wan Rozita et al.[7] which also found a weak correlation between knowledge and practice of dengue among the study population.

Summary

  • Out of the 100 respondents, 54 of them were female (54%)
  • The average score percentage of knowledge of respondents (73%) regarding dengue falls into good response level under the scoring system (59%–77.35%)
  • Majority of the respondents had an excellent attitude toward dengue (84.4%)
  • Despite good knowledge, there is a low level of practice (22.5%)
  • The weak positive correlation between the knowledge and practice, and knowledge and attitude, indicates ignorance exhibited by the participants toward the prophylactic practices.



  Conclusion Top


The study concluded that the poor practice toward dengue despite good knowledge and attitude level may be due to ignorance. This points out the need for further evaluative studies to assess the reason for poor practice and also to develop strategies to improve the same.

Limitations of the study

Due to the small sample size of the study, its results and conclusion may not reflect the KAP of whole population in Raichur, Karnataka towards dengue fever. Since the sample size was determined using convenience sampling method instead of random sampling method due to limited time period, there might be overestimation of KAP results of the population under assessment.

Acknowledgment

The authors take it as a privilege to acknowledge Sri S R Reddy, Chairman, Navodaya Educational Trust; Dr. H. Doddayya, Principal, NET Pharmacy College; and head and faculty of different departments of the hospital for their support during the study.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.


  Annexure 1: Top
Tables 1 and 2 show the scoring system adopted for the evaluation of knowledge, attitude, and practice.

Each response for each question in the knowledge, attitude, and practice parts of the questionnaire was given a score. Scores of all the 100 participants are totaled for each section (knowledge, attitude, and practice), and then, the average score for each section is calculated by dividing the latter with 100. Finally, the average percentage score is calculated. Table 2 gives the details of interpretation of average percentage score against excellent, good, adequate, and poor responses.







 
  References Top

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Guha-Sapir D, Schimmer B. Dengue fever: New paradigms for a changing epidemiology. Emerg Themes Epidemiol 2005;2:1-10.  Back to cited text no. 1
    
2.
WHO. Dengue and Severe Dengue. Geneva: WHO; 2012 [cited 2013]; Available from: http://www.who.int/mediacentre/factsheets/fs117/en/index.html. [Last accessed on 2020 Apr 01].  Back to cited text no. 2
    
3.
Mohamed Nur Adli MK, Gnanakkan BD, Fauzi FZ, Hanaf MI, Selvarajah G, Jabar SA, et al. The KAP study on dengue among community in Taman Salak Baiduri, Sepang, Selangor. International Journal of Science & Healthcare Research. 2017; 2:19-25.  Back to cited text no. 3
    
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Kyle JL, Harris E. Global spread and persistence of dengue. Annu Rev Microbiol 2008;62:71-92.  Back to cited text no. 4
    
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Taksande A, Lakhkar B. Knowledge, attitude and practice (KAP) of dengue fever in the rural area of central India. Shiraz E Med J 2012;13:146-57.  Back to cited text no. 5
    
6.
Acharya A, Goswami K, Srinath S, Goswami A. Awareness about dengue syndrome and related preventive practices amongst residents of an urban resettlement colony of South Delhi. J Vector Borne Dis 2005;42:122-7.  Back to cited text no. 6
    
7.
Wan Rozita WM, Yap BW, Veronica S, Muhammad AK, Lim KH, Sumarni MG. Knowledge, attitude and practice (KAP) Survey on dengue fever in an urban Malay residential area in Kuala Lumpur. Malaysian J Public Health Med 2006;6:62-7.  Back to cited text no. 7
    
8.
Naing C, Ren WY, Man CY, Fern KP, Qiqi C, Ning CN, et al. Awareness of dengue and practice of dengue control among the semi-urban community: A cross sectional survey. J Community Health 2011;36:1044-9.  Back to cited text no. 8
    
9.
Hairi F, Ong CH, Suhaimi A, Tsung TW, Bin Anis Ahmad MA, Sundaraj C, et al. A knowledge, attitude and practices (KAP) study on dengue among selected rural communities in the Kuala Kangsar district. Asia Pac J Public Health 2003;15:37-43.  Back to cited text no. 9
    
10.
Nalongsack S, Yoshida Y, Morita S, Sosouphanh K, Sakamoto J. Knowledge, attitude and practice regarding dengue among people in Pakse, Laos. Nagoya J Med Sci 2009;71:29-37.  Back to cited text no. 10
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]



 

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