Dengue Fever Impact of Knowledge On Preventive Practice

Dengue Fever; Impact of Knowledge on Preventive Practice
Atiq ur Rehman et al.
Original Article
Dengue Fever; Impact of Knowledge on

Preventive Practice
Atiq ur Rehman*
Muhammad Asif Mahmood**
Syeda Farhana Kazmi***
Farrukh Munir****
Usman Ghani*****
Objectives: To study the impact of knowledge on preventive practices, rating the * Lecturer, Department of
sources of information about dengue fever and to assess the level of public Psychology, Govt. Postgraduate
College Jaranwala, District
knowledge and preventive practice about dengue fever.
Faisalabad, Punjab, Pakistan.
Study design: Descriptive cross sectional research design.
** Entomologist, Directorate
Place and duration: The data were collected from Faisalabad and Lahore city General Health Services Punjab,
Pakistan
during the months of August, September and October 2015.
Materials and Methods: A structured questionnaire was used to collect the data *** Ph.D., Chairperson, Department
of Psychology, Hazara University,
about dengue fever knowledge, attitude and practices. The sample of the study Manserha, Khyber Puktunkhwa,
consisted of 450 subjects. Descriptive statistics and chi-square test was Pakistan.
****Lecturer, Institute of Education
computed by SPSS 20 version.
Result: In this study it was observed that the major source of information about and Research, University of the
Punjab, Lahore, Pakistan.
dengue fever was television as 74.22% participants got the information about
***** Health Educator, Directorate
dengue from television, 12.67%, from newspaper, 7.78%, from teachers / General Health Services Punjab,
professors and 5.33% participants from other sources health care providers, Pakistan.
radio, friends and Internet. The participants having low knowledge about dengue
was 56.22%, moderate knowledge 30.67% and high knowledge 13.11% as well
as 47.11% participants taking the poor preventive practice about dengue,
44.22% taking the fair preventive practice and 8.67% taking the good preventive Address for Correspondence
practice. The significant association between participants knowledge and Atiq ur Rehman,
Department of Psychology,
2
preventive practice about dengue (4) = 30.19, p < 0.05 was observed.
Govt. Postgraduate College
Conclusion: The fact has been established that knowledge of dengue fever Jaranwala,
having the significant impact on preventive practices. More than half of the public District Faisalabad, Punjab,
having the low knowledge about dengue and nearly half of the public taking the
Pakistan.
E-Mail: atiq0004@yahoo.com
poor preventive practice.
Keywords: Dengue fever, Knowledge, Attitude, Preventive practice.
The first patient of dengue disease was reported from
Jin Dynasty during the period of 265420 AD in the
Dengue is an infection that infects a huge number of
Chinese medical encyclopedia and most of the cases
people each year. Symptoms of dengue disease range
were belonged to the areas where frequent number of
from mild flu like appearance to sever complications.
flying insects and places of stagnant water were
5
The infectious agent (dengue virus) is transmitted from
present, hence the disease was called as water poison.
the diseased person to the healthy ones through female
Laboratory detection of dengue virus was first time
5
Aedes mosquitoes. The Dengue disease is endemic in
confirmed in 1940 during the era of world war II.
1
about 120 countries mainly located in tropical and
Dengue is considered as the main cause of major
2
subtropical regions of the world and outbreaks are
known epidemics of French West Indies , Panama and
1
being reported from many places each year. Globally
Philadelphia occurred during the year of 1635, 1699 and
6
50-100 million people suffer from dengue infection with
1780 respectively. The outbreaks reported from the
500,000 complicated cases and 24,000 deaths
regions of America, Asia and Africa during the year of
3
annually. Epidemiological data indicate that 2.5 billion
1779-80 were also associated with dengue infections,
individuals reside in a dengue risk area out of which 1.8
because of the presentation of dengue like symptoms in
4
7
billion (over 70%) belongs to Asia-Pacific regions.
most of the cases.
First epidemics of Dengue
hemorrhagic fever (DHF) and Dengue Shock Syndrome
Introduction
Ann. Pak. Inst. Med. Sci. 2015; 11(4): 195-201
195

(DSS) were reported from the regions of Southeast Asia
and America during 1950s and 1981 respectively. The
major reason of DHF outbreak in American region was
thought the change of viral serotype DENV2 just after
8
the DENV1outbreak of Cuba. Dengue virus was quickly
spread in the Pacific Islands, Asia and American states
9
during 1970s
and was remained spreading rapidly
during 1980s to 1990s and reached to vast areas of the
10
world through mosquito vectors. During 2012 and
2013 about 22,092 (74 deaths) and 132,046 cases of
dengue disease were reported from Philippine
11
respectively. It is evident that dengue outbreaks
appear in cyclic manner with a gap of three to five
12
years.
Dengue disease is caused by Ribonucleic acid (RNA)
virus that belongs to family flaviridae. The disease
viruses of Yellow fever, Japanese encephalitis, West
Nile virus and Tick-borne encephalitis also belong to the
13
category of flavi-viruses (family flaviridae). So for
scientists have diagnosed four serotypes of dengue
viruses which were named as Denv-I, Denv-II, Denv-III
14
and Denv-IV. Further investigations indicated that the
genome size of dengue virus is 11kb and it is
surrounded by 3 structural and 7non structural
13
proteins. Different clinical presentations have been
observed due to attack of different serotypes of dengue
virus at different areas of the world. In general first
exposure to any single serotype presents mild to
moderate flu like symptoms and provides lifelong
immunity against that specific viral serotype. In routine
10
dengue fever is seldom fatal and its usual symptoms
include austere headache, high grade fever, pain in
muscles, joints and behind eyes, nausea, vomiting and
skin rashes which recover automatically within a weeks
time, but tiredness and weakness may be felt up to
15
many weeks. The further exposure to any other
serotype of dengue virus may presents mild to
complicated (DHF/DSS) symptoms which may be fatal if
not properly managed in time. DHF complications may
result in bleeding from different organs of the body like
gums, nose, ears and bleeding with urine and stool. If
not properly managed these conditions may lead to DSS
15
and even death. DHF disease is frequently observed in
16
young children.
There are some host factors
associated with increased risk of getting complications
of DHF which includes AB blood group, being female,
many leukocyte antigen of class I alleles, Mononucleotide polymorphism in the tumor necrosis factor
gene, and a promoter variant of the DC-SIGN receptor

17
genes. Host related factors which minimize the risk of

getting severe complications of dengue disease due to
secondary infection includes race, Fc receptor genes
18
and polymorphisms in the vitamin D receptor. Dengue
shock syndrome (DSS) is the most complicated form of
dengue infection where the condition of patient quickly
deteriorates and the patient goes to shock. In such
patients the skin may turn into blotchy, cool and
congested condition soon after subsidence of fever.
Other complications of DSS may include restlessness,
circumorally cyanosis, fast and weak pulse, severe
abdominal pain, plasma leakage, shock leading to
19
death.
So for no vaccine and specific treatment are available
20
from prevention and control of dengue. Therefore
standard case management involves supportive care
based on symptoms of the patients, mostly comprised of
bed rest, fluid management and paracetamol as a pain
reliever. Aspirin, Ibrufen and other drugs which help in
21
plasma leakage are strictly avoided.
Female Aedes mosquito gets dengue virus while taking
a blood meal from a dengue patient at the stage of
viremia. Along with the ingested blood, the dengue virus
moves to the area of mid gut where it multiplies in the
epithelial cells of stomach wall. Then the dengue viruses
move back to the salivary glands via heamocoel within
five to seven days. The infected female Aedes
mosquitoes then become able to transfer the dengue
1
virus to new humans during a blood meal. Aedes
aegypti is highly nervous mosquito, which can infect
multiple people during the course of a single blood meal.
Symptoms of dengue disease usually appear after an
22
incubation period of three-to-fourteen days.
Aedes aegypti and Aedes albopictus are the primary
and secondary vectors of dengue disease respectively.
The indoor feeding and resting behavior of Aedes
aegypti is one of the major constraint in the success of
23
any vector control operation. There are black and
white stripes all over the body of Aedes aegypti and is
found in most of the tropical and subtropical regions of
the world. Higher densities of Aedes aegypti and Aedes
albopictus are found in the vicinity of residential
colonies. The female Aedes aegypti prefers to oviposit
in artificial containers like flower vases, water storage
jars, unused toilets bowls and chocked roof gutters
commonly found in or around the houses while Aedes
albopictus can oviposit in both articicial and natural
containers. Both dengue vectors, i.e., Aedes aegypti
and Aedes albopictus are day biting mosquitoes with
196

peak biting activity during the early morning and late
24; 25
afternoon hours.
The most appropriate temperature
for the development and survival of dengue vectors
ranges from 15 to 30C where the minimum mortality of
26
mosquitoes takes place.
Humidity and temperatures are the main factors
affecting the development and longevity of Aedes
mosquitoes. The global warming is one of the major
causes of high precipitation which results in the creation
of many new breeding sites of dengue vectors. On the
other hand, in areas where water supply systems are
not well established, people are used to store drinking
water in artificial containers that provides additional
27
breeding habitats for the vector mosquitoes. Moreover
high environmental temperatures encourage rapid
development of dengue virus within the body of infected
Aedes mosquitoes. This causes the shortening of the
extrinsic incubation period (duration of the virus life
cycle within the mosquito body) thereby enabling
dengue vectors to transmit the disease within reduced
28
time.
The major contributing factors of dengue
outbreaks and other communicable diseases in Pakistan
involves congested cities, insufficient sanitation and lack
29
of safe drinking water supply.
So for the best recommended strategy for prevention
and control of dengue outbreaks are frequent
community awareness campaigns regarding mechanical
elimination of vector breeding sites from their houses
30 ; 31; 32
and surroundings.
A number of investigations declare that public
awareness about dengue disease and vector control
interventions is the one of the best predictor for
33
satisfactory control of dengue outbreaks.
Van
Benthem (2002) proved that the individuals having good
awareness of dengue showed significantly greater
utilization of preventive measures compared to those
34
having little knowledge of dengue disease.
Chusongsang (2005) described that households with
higher knowledge of dengue prevention apply better
preventive activities against dengue than the
households having poor knowledge of dengue
35
disease. Itrat and Colleagues, (2008) also concluded
that utilization of dengue preventive activities were more
consistent with the awareness of the people about such
33
activities.
In contrary to this some other studies
showed that knowledge about preventive measures of
dengue did not certainly results in better application
36
preventive practices. Usually during KAP surveys
researchers try to explore the Knowledge, Attitude and

Practices of the public towards prevention and control of
dengue disease. It helps to determine the awareness
status of the public to cope with any untoward situation
due to dengue. The key purpose of this investigation is
to determine the status of community awareness about
transmission, diagnosis, treatment and prevention of
dengue disease. The findings will be useful for policy
makers and operational programs to design their further
activities in accordance to the awareness status of the
people for better prevention and control of dengue
outbreaks.
Materials and Methods

The current study is based on descriptive cross
sectional research design. A structured questionnaire
was used to collect the data about dengue fever
knowledge, attitude and practices. The sample of the
study
was consisted of 450 subjects taken by
convenience sampling technique. The data were
collected from Faisalabad and Lahore city during the
months of August, September and October 2015.
Descriptive statistics and chi-square test were applied
by using the SPSS version 20 for statistical analysis of
the data.
The questionnaire was designed to assess the
participants' knowledge, attitude and practices about
dengue fever. This questionnaire was consisted of four
sub categories i.e, demographics of the participants,
knowledge, attitude and practices about dengue fever.
Knowledge about dengue fever consists of 14 questions
and every question has to rate on two choices. Correct
choice was awarded a one score and the wrong choice
were awarded the zero score. The range of scores lies
between 0-14 and categorized into three groups. Score
0-8 indicate the lower knowledge about dengue fever, 911 indicate the moderate knowledge about dengue fever
and 12-14 indicate the higher knowledge about dengue
fever.
Attitude about dengue fever consists of twelve
questions, six questions are in a positive sense and six
questions are in a negative sense. Positive questions
are rated on 5 degree rating scales from strongly
disagree to strongly agree, one score is awarded for
strongly disagree and five scores are awarded for
strongly agree. Negative questions are also rated on 5
degree rating scales from strongly agree to strongly
disagree, one score is awarded for strongly agree and
five scores are awarded for strongly disagree. The
range of scores lies between 12- 60 and was
197

categorized into three groups. Score 12-40 indicate the
negative attitude about dengue fever, 41-46 indicate the
neutral attitude about dengue fever and 47-60 indicate
the positive attitude about dengue fever.
Practices about dengue fever consists of eight questions
and every question has to rate on two choices. Yes
choice was awarded a one score and the No choice was
awarded the zero score. The range of scores lies
between 0-8 and is categorized into three groups. Score
0-4 indicate the poor practice about dengue fever, 5-6
indicate the fair practice about dengue fever and 7-8
indicate the good practice about dengue fever.
The Cronbachs alpha coefficient regarding the collected
data was observed as 0.75 for knowledge, 0.70 for
attitude and 0.78 for practice.
Results
The demographic characteristics of the sample,
according to age, educational level, vocation and source
of information about dengue were presented in figure I
and II respectively.
51-60 years
, 64
41-50 years
, 85
M.Phil/
Master , 89 Ph.D, 13
Graduation
, 92
61-70 years
, 19
14-20 years
, 99
21-30 years
31-40 years , 94
, 89
Under
Matric , 17
Intermediat
e , 128
Matric ,
111
Unemployed
, 25
Teachers/
Professors,
Bank
employees,
73
35
House wives,
83
Doctors,
19
Shop
Keepers, 58
Factory
workers, 48
Police
service
employees,
14
Students, 89
Engineers, 6
Figure - I. Demographic Characteristics of the

Sample According to Age, Educational Level and
Vocations
As depicted in figure I, demographic characteristics of
sample were presented according to age, 99 (22.00%)
participants age was 14-20 year, 94 (20.89%) age was
21-30 years, 89 (19.78%) age was 31-40 years, 85
(18.89%) age was 41-50 years, 64 (14.22%) age was
51-60 years and 19 (4.22%) participants age was 61-70
years.
Demographic characteristics of the sample according to
education;17 (3.78%) participants were under Matric,
111 (24.67%) were Matric pass, 128 (28.44%) were
Intermediate, 92 (20.44%) were Graduate, 89 (19.78%)
were Master degree holder and 13 (2.89%) were M.
Phil/ Ph.D. qualified.
Demographic characteristics of sample were presented
according to the vocation, 73 (16.22%) participants were
teachers/professors, 35 (7.78%) were bank employees,
19 (4.22%) were doctors, 6 (1.33%) were engineers, 89
(19.78%) were students, 14 (3.11%) were police service
employees, 48 (10.67%) were factory workers, 58
(12.89%) were shop keepers, 83 (18.44%)
were
housewives and 25 (5.56%) participants were
unemployed.
As depicted in figure II, Source of information of
participants included in the sample was presented as 3
(0.67%) participants got the information about dengue
from health care providers, 334 (74.22%) from
television, 4 (0.89%) from radio, 57 (12.67%) from
newspaper, 35 (7.78%) from teachers / professors, 15
(3.33%) from friends and 2 (0.44%) participants got the
information about dengue from internet.
198
Newspaper
, 57
Radio, 4
Teachers,
35
Friends,
15
Internet,
2
Health
Care
Providers,
3
Television
, 334
Figure - II. Source of Information about Dengue
Fever Knowledge
Table - I. Knowledge, Attitude and Preventive
Practice About dengue (N = 450)
N
%
Level of Knowledge
Low (0-8 scores)
253
56.22
Moderate (9-11scores)
138
30.67
High (12-14 scores)
59
13.11
Level of Attitude
Negative (12-40 scores)
47
10.44
Neutral (41-46 scores)
196
43.56
Positive (47-60 scores)
207
46.00
Level of Prevention
Poor (0-4 scores)
212
47.11
Fair (5-6 scores)
199
44.22
Good (7-8 scores)
39
8.67
As depicted in table I, knowledge about dengue fever
was placed between the scores of 0 to 14, from low
level to high level. Findings indicate that 56.22%
participants having the low knowledge about dengue
and 30.67% having the moderate and 13.11% having
the high knowledge about dengue.
Attitude about dengue fever control was placed between
the scores of 12 to 60, from a negative attitude control to
positive attitude control. Findings of the study depict that
10.44% participants having the negative attitude about
dengue control, 43.56% having the neutral attitude and
46% having the positive attitude about dengue control.
Preventive practice about dengue fever was placed
between the scores of 0 to 8, from a poor preventive
practice to good preventive practice. It was observed
that 47.11% participants having the poor preventive
practice about dengue, 44.22% having the fair

preventive practice and 8.67% having the good
preventive practice about dengue.
Table - II. Association between Knowledge and
Preventive Practice about dengue (N = 450)
Level
Low
Moderate
High
Poor
137
60
15
212 (47.11)
Fair
99
70
30
199 (44.22)
Good
17
14
39 (8.67)
253
(56.22)
138
(30.67)
59
(13.11)
450 (100)
2 = 30.19, df = 4
p =.000
As depicted in table II, chi square test was conducted to

know the association between participants' knowledge
about dengue and preventive practice about dengue
control. In this analysis, we found the significant
association between participants' knowledge and
2
preventive practice about dengue control as (4) =
30.19, p < 0.05.
Discussion
The findings of the study proved that television is the
most frequently observed source of information about
dengue in Pakistan compared to all other available
sources of getting information as 74.22% participants
indicated it as their main source of information about
dengue. This suggests that television is the most
suitable medium for the delivery of public awareness
messages in Pakistan particularly in Faisalabad and
Lahore cities. Newspapers were found the second most
frequent source of getting dengue related information by
the participants as 12.67% indicated it.
37
Radman et al. conducted a study to assess the factors
affecting dengue fever knowledge, attitudes and
practices in Malaysia and they observed that 97.0%
persons got information about dengue fever from
television.
38
Kohli et al.
organized a study in Delhi to
evaluate knowledge and preventive practices about
mosquito exhibited diseases and they noticed that
58.6% urban population and 55.2% rural population got
information about this matter from television.
33
Itrat et al.
conducted a study on knowledge,
awareness and preventive practices about dengue fever
199

and they observed that television was the main source
of information as an average of 62% participants of the
study obtained information from this medium.
The results of this study describe that only 13.11% got
information about dengue fever from health care
providers, radio, teachers, friends and internet. The
contribution of health care providers about dengue fever
knowledge, providing to the public is very minute which
is only 0.67%. It is the need of time that the health care
providers should play more vigorous role in providing
the information to the public so that the effective
campaign might be launched against dengue fever.
Teachers are the important segment of society, they
must play more contribution in providing knowledge
about dengue fever to their students so that we may
overcome this fatal disease.
In our study, we observed that 56.22% participants
having the low knowledge about dengue and 47.11%
having the poor preventive practice about dengue fever.
In the nonexistence of an effective vaccination for
dengue fever, the prevention and control of the disease
principally depend on successful vector control actions
and epidemiological surveillance. It is essential to
enhance health promotion actions via campaigns, social
mobilization and educational platforms to boost
knowledge about dengue fever. This will assist to form
positive attitudes and promote superior preventive
practices among public to control dengue in our country.
We also observed in our study that there is a significant
association between participants knowledge and
2
preventive practice about dengue as (4) = 30.19, p <
0.05. These findings prove that dengue outbreaks can
be best prevented and controlled through enhancing
public awareness about prevention and control
measures of the disease. More community awareness
about preventive measures of the disease results in
development of positive attitudes towards use of
preventive practices at the community level which is
crucial to combat with regularly occurring dengue
outbreaks in the country.
33
Itrat et al.
conducted a study on Knowledge,
awareness and preventive practices about dengue
fever in tertiary care hospitals of Karachi and they
observed that
knowledge about dengue were
associated with the preventive practices.
39
Dhimal et al.
attitude and practice about dengue fever in central
Nepal and observed a significant positive correlation

between knowledge and practices and between attitude
and practices.
40
Mayxay et al.
attitude and practices about dengue in Vientiane capital
of Laos and reported a significant association between
good knowledge and good practices.
Conclusion
In this study it was observed that the major source of
information about dengue fever was television and the
second major source of information about dengue fever
was newspapers. The more than half of the public
having the low knowledge about dengue as well as
nearly half of the public having the poor preventive
practices about dengue. The significant association
between knowledge and preventive practices about
2
dengue (4) = 30.19, p < 0.05 was observed. The fact
has been established that knowledge of dengue fever
having the significant impact on preventive practices.
Recommendations
At the base of the findings of this study, we have framed out the following
recommendations for better prevention and control of dengue disease
through community.
Government organizations and non-government agencies should

launch its programs on a substantial educational campaign to
improve understanding and knowledge about dengue preventive
measures.
Sufficient Informational and educational materials must be made

available to the public at all educational, health care and other
community centers where maximum people can get it for
improvement of their knowledge about dengue.
Information and transmission about dengue, the vector control

practices may be integrated into the school and college syllabus,
particularly in areas where dengue is abundantly prevalent.
Inter coordination seminars should be organized to relate possible

collaborators for public education about dengue control campaigns.
Financial aid should be provided to those programs and activities

that may be helpful for dengue control.
Reorientation coaching of community health workers should be

managed regularly to develop their competence and technical skills
to regulate prevention and dengue control activities.
An effective dengue prevention program requisite full engagement of the
community. vigorous health promotional campaigns and public mobilization
by concerned agencies are required to engage the community
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