Table of Contents  
ORIGINAL ARTICLE
Year : 2013  |  Volume : 6  |  Issue : 4  |  Page : 374-377  

Study of knowledge, attitude and practices regarding dengue in the urban and rural field practice area of a tertiary care teaching hospital in Pune, India


Department of Community Medicine, Smt. Kashibai Navale Medical College, Narhe, Pune, Maharashtra, India

Date of Web Publication17-Sep-2013

Correspondence Address:
Samir Singru
Department of Community Medicine, Smt. Kashibai Navale Medical College, Narhe, Pune - 411 041, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0975-2870.118274

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  Abstract 

Context: Dengue is the most common disease among all the arthropod-borne viral diseases. There is no specific treatment or vaccine available for dengue. The sole method of prevention and control is the knowledge attitude and practices (KAP) for the same. Although, dengue is considered an urban- and semi-urban disease, in recent years, due to water storage practices and large-scale development activities in rural areas, dengue has become endemic in rural areas of India as well. Aims: To assess the KAP regarding dengue. Settings and Design: Urban and rural field practice area of a Tertiary Care Teaching Hospital in Pune, India. Materials and Methods: A pre-tested, semi-structured questionnaire was used to study the knowledge, attitude, and practices regarding dengue. Stratified random sampling technique was used. A modified B. G. Prasad criterion was used for socio-economic classification. Statistical Analysis Used: KAP represented as proportion (%). Chi-square test was used as a test of significance. P value < 0.05 was considered as statistically significant. Results: 68.4% in urban areas and 40.4% in rural area knew that dengue is transmitted by mosquito. 62.6% in urban areas and 48% in rural areas respectively stated fever as a symptom of dengue. The use of anti-adult mosquito measures was 48.05% and 51.42% in urban and rural area respectively Conclusions: There is a definite need to increase the information education communication activities for dengue in the study area.

Keywords: Dengue, information education communication, knowledge attitude and practices


How to cite this article:
Singru S, Debnath D, Bhosale SB, Pandve H, Fernandez K. Study of knowledge, attitude and practices regarding dengue in the urban and rural field practice area of a tertiary care teaching hospital in Pune, India. Med J DY Patil Univ 2013;6:374-7

How to cite this URL:
Singru S, Debnath D, Bhosale SB, Pandve H, Fernandez K. Study of knowledge, attitude and practices regarding dengue in the urban and rural field practice area of a tertiary care teaching hospital in Pune, India. Med J DY Patil Univ [serial online] 2013 [cited 2021 Jun 19];6:374-7. Available from: https://www.mjdrdypu.org/text.asp?2013/6/4/374/118274


  Introduction Top


Dengue is the most common disease among all the arthropod-borne viral diseases. Due to occurrence of remarkable changes in the epidemiology of dengue, currently dengue ranks as the most important mosquito-borne viral disease in the world. [1] It is estimated that nearly 50 million dengue infections occur annually in the world. Although, dengue has a global distribution, the World Health Organization South-East Asia Region (SEAR) together with Western Pacific Region bears nearly 75% of the current global disease burden. [2] Of the total world population of 6.2 billion, countries of the SEAR account for 1.5 billion (24%). On that scale, of the 2.5 billion people (living in the tropics and sub-tropics) at risk of dengue fever/dengue Hemorrhagic fever, 52%, i.e., 1.3 billion population, live in SEAR. [3] In India, dengue is endemic in 23 states/ union territories (UTs). After 1996, outbreak with a total number of 16517 cases and 545 deaths, upsurge of cases were recorded in 2003 with 12754 cases and 215 deaths. Subsequently, in the year 2005 again, 11985 cases along with 157 deaths had been reported respectively. In 2008, total 12561 cases and 80 deaths have been reported. [4] Dengue is endemic in 29 States/UTs. After 1996, outbreak with a total number of 16517 cases and 545 deaths upsurge of cases were recorded in 2003, 2005, and 2008. In 2009 total 15535 cases and 99 deaths have been reported. During 2010, till November 25725 cases and 99 deaths have been reported. [5]

The human habit of storing water in house due to water scarcity leads to breeding of Aedes aegypti mosquito. Furthermore, heavy rainfall leads to artificial collection of water in discarded coconut shells, tires, and other materials. There is no specific treatment or vaccine available for dengue. The sole method of prevention and control is the knowledge attitude and practices (KAP) for the same. Although, dengue is considered an urban- and semi-urban disease, in recent years, due to water storage practices and large-scale development activities in rural areas, dengue has become endemic in rural areas of India as well, increasing the scale of the dengue challenge in the country. [6] We, therefore, decided to conduct a study in the urban and rural field practice area of a Tertiary Care Teaching Hospital in Pune with the objective to assess the KAP regarding dengue, inspect the peridomestic places for artificial collection of water and the presence of Aedes aegypti larvae and to examine various entomological indices to assess the risk of dengue outbreak.


  Materials and Methods Top


The study was approved by the Institutional Ethical Committee. This was a cross-sectional study in the urban and rural field practice area of a Tertiary Care Teaching Hospital in Pune, India. A validated, pre-tested, semi-structured questionnaire was used to study the knowledge, attitude and practices regarding dengue. Stratified random sampling technique was used based on the wards in urban area and villages in rural areas. Sample size calculated was 385 assuming 50% population having knowledge with confidence level of 95% and allowable error of 5%. A sample of 400 was decided to include in the study (200 each from urban and rural area). The house and its surrounding were searched for artificial collection of water and presence of larva for Aedes mosquito and Breateau index container India was calculated. Epi-info statistical software version 3.5.3 and Primer of Biostatistics software version 5.0 by Stanton A Glantz 2002; Mc Graw Hill was used. The study was carried out during the inter-epidemic period (April to June 2011). The investigators comprising of medical officers, sanitary inspectors, and medical social workers were trained in identifying Aedes larvae. The investigators inspected all the artificial containers both inside and outside the house. The larvae found in the process were not investigated for specific species. After the interview, the containers with larvae were made empty and health education was given regarding specific symptoms like fever, severe pain, pain in eyes during eye movement, personal protective measures, maintenance of dry day for the containers. P value < 0.05 was considered as statistically significant. A modified B. G. Prasad criterion was used for socio-economic classification.


  Results Top


The socio-demographic characteristics such as gender, literacy and socioeconomic status of the study sample are shown in [Table 1], [Table 2], [Table 3].

While there was no significant difference in knowledge regarding the prominent symptom of dengue i.e. severe joint pain between urban and rural population, urban population were better aware about the other symptoms such as occurrence of fever in dengue. The urban population was also more aware about the breeding sites of mosquito vector [Table 4].
Table 1: Distribution of study subjects as per gender


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Table 2: Distribution of study subjects as per educational status


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Table 3: Distribution of study subjects as per socio-economic status*


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Table 4: Knowledge regarding dengue


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While urban residents showed significant better attitudes [Table 5], there was no difference in preventive practices for dengue between the urban and rural populations [Table 6]. Perhaps as a result of this there was no significant difference in proportion of Aedes larvae recovered in the vicinity of urban and rural houses [Table 7].
Table 5: Attitude regarding dengue


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Table 6: Practices regarding dengue*


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Table 7: Larvae of Aedes mosquito observed in houses and peridomestic areas


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  Discussion Top


In the present study, 416 subjects were interviewed. There were 206 subjects from urban area and 210 from rural area. The distribution of the subject as per gender, literacy, and socio-economic status is given as per [Table 1], [Table 2], [Table 3] respectively. Fever was stated as a symptom by 62.6% in urban areas and 48% in rural areas respectively. This difference was statistically significant (χ2 = 8.299, P = 0.004). Regarding the mode of spread of dengue 68.4%in urban areas and 40.4% in rural area stated that it was due to mosquito. However, 8 could correctly say Aedes mosquito. This difference was statistically highly significant. (χ2 = 31.670, P = 0.000). Only 36.4% in urban areas and 18.09% in rural areas had correct knowledge regarding the breeding sites of Aedes mosquito. This difference was statistically highly significant. (χ2 = 16.713 P < 0.000).

In another study conducted in urban slums in a metropolitan city of West Bengal, 68.9% had knowledge that fever is the main symptom of the disease, though only 6.2% knew of retro-orbital pain as the pathognomonic symptom of the disease and only 39.1% had knowledge about breeding places of Aedes aegypti. [7] The situation of knowledge regarding dengue is poor in urban study area and still poorer in rural study area. Information Education Communication (IEC) activities needs to be undertaken regarding various aspects such as symptoms, modes of transmission, importance of dry day with respect to dengue, methods for maintaining a dry day. IEC activities should also cover regarding importance of keeping peridomestic areas free from artificial collection of water for preventing Aedes aygypti mosquito breeding. In the present study, only 76.2% in urban area and 66.1% in rural area considered dengue as "serious" and life-threatening disease. This attitude needs to be changed. All fever cases at the patient level should be presumed to be malaria or dengue as these diseases are very common in the study area and should approach the appropriate health authorities in the area. IEC activities should highlight the serious impacts of dengue.

In the present study, only 31.06% in urban areas and 18.09 in rural areas perceived the importance of individual responsibility in the prevention and control of dengue. This urban rural difference was statistically significant. (χ2 = 8.768, P = 0.003). As a part of Individual responsibility in prevention and control, people should spread the knowledge to others, regularly screen their premises for artificial collection of water and remove all discarded materials having potential for water collection.

In the present study, the use of personal protective devices such as mosquito repellant creams, coils, mats, fluids was 48.05% and 51.42% in urban and rural area respectively in all seasons. This is much lower than other study conducted in Pondicherry region where the usage was 99.3% and 73% [8] and 99% and 84% in Orissa. [9] IEC activities need to highlight that the mosquito responsible for dengue is a day-bitter and, therefore, the community should use the above mentioned personal protective devices in day hours also.

In the present study, only 3.39% and 2.38% in urban and rural area respectively knew regarding maintenance of the dry day as a method for breeding control for mosquito. This clearly indicates that there is a definite need of emphasis of this method in IEC regarding dengue prevention. In the present study, only 8.25% and 7.24% in urban and rural area respectively considered spreading the information regarding dengue control in the community as a method. This again denotes lack of community involvement in the dengue control program. Community leaders, Mahila mandal should be involved in this activity. No statistical urban-rural difference was observed in all the three above mentioned practices for dengue control.

In the present study inside the house, Mosquito Larvae were seen in 14 out of the total 1242 containers in urban areas with a House index of 1.1% and 6 out of 1052 containers in rural areas with a house index of 2.85%. Most larvae were seen in the cement tank constructed for water storage in urban areas and discarded pots in rural areas. This finding was also observed by Doke et al. in their study conducted in all districts of Maharashtra where dengue was a major problem. [10] In the present study in peridomestic sites mosquito larvae were seen in 23 out of the 622 containers in urban areas with a premises index of 3.69% and 18 out of the 502 containers with a premises index of 3.58% in rural areas. The container index for urban area was 1.98% and for rural areas was 1.54%. No statistical urban-rural difference was observed. In a study conducted in Narayankere village, near Bangalore where an outbreak of dengue had occurred, the Container index for the village was 6.72% while that for outdoor and indoor containers separately was 17% and 2.4% respectively (P < 0.05). House (Premises) Index was 12% and the Breteau Index was 13.64% for the village. [11] This was much higher than the findings of the present study. Entomological indices as seen in the present study indicate a low-risk of dengue transmission in the study area. In the present study, almost all study subjects from both urban and rural areas stated television and radio as the main source of information regarding dengue. Mass media in the form of television and radio should be used to increase awareness regarding dengue in the government/private run TV/Radio channels. To conclude, there is a definite need to increase the IEC activies for dengue in the study area.


  Acknowledgment Top


We are thankful to Mr. U. K. Sonawane, Mr. Datta Jadhav, Mrs. Archana Shah, Mrs. Surekha Sable, Mr. Amit Nalawade, Mrs. Sheetal Nandedkar, the medical social workers who participated in data collection.

 
  References Top

1.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. 1
    
2.World Health Organization. Regional Office for South East Asia. Situation update of dengue in the SEA Region, 2010 Available from : 0 http://www.searo.who.int/LinkFiles/Dengue_Dengue_update_SEA_2010.pdf. [Last accessed 2012 Dec 10].  Back to cited text no. 2
    
3.World Health Organization. Regional Office for South East Asia. Situation of Dengue/Dengue Haemorrhagic Fever in South-East Asia Region. Available from: http://www.searo.who.int/en/Section10/Section332_1098.htm. [Last accessed 2012 Dec 10].  Back to cited text no. 3
    
4.Annual Report 2009-10. 6.8 Dengue fever/Dengue Haemorrhagic Fever. Ministry of Health & Family Welfare, Government of India: 94-95.  Back to cited text no. 4
    
5.Annual Report 2010-2011. MOHFW. Government of India. Page 85. Available from: http://www.mohfw.nic.in/showfile.php?lid=1091. [Last accessed 2012 Dec 10].  Back to cited text no. 5
    
6.Halasa Yara A, Dogra V, Arora N, Tyagi BK, Deoki Nandan Shepard DS. Overcoming data limitations : d0 esign of a multicomponent study for estimating the economic burden of dengue in India. Dengue Bulletin. Vol. 35. South East Asian region, Western Pacific Region: World Health Organization; 2011. Available from: http://www.searo.who.int/LinkFiles/Dengue_Bulletin_vol-35.pdf. [Last accessed 2012 Dec 10].  Back to cited text no. 6
    
7.Haldar A, Gupta UD, Majumdar KK, Laskar K, Ghosh S, Sen S. Community perception of Dengue in slum areas of metropolitan city of West Bengal. J Commun Dis 2008;40:205-10.  Back to cited text no. 7
    
8.Snehalatha KS, Ramaiah KD, Vijay Kumar KN, Das PK. The mosquito problem and type and costs of personal protection measures used in rural and urban communities in Pondicherry region, South India. Acta Trop 2003;88:3-9.  Back to cited text no. 8
    
9.Babu BV, Mishra S, Mishra S, Swain BK. Personal-protection measures against mosquitoes: A study of practices and costs in a district, in the Indian state of Orissa, where malaria and lymphatic filariasis are co-endemic. Ann Trop Med Parasitol 2007;101:601-9.  Back to cited text no. 9
    
10.Doke PP, Pawar S. Profile of dengue fever outbreaks in Maharashtra. Indian J Community Med 2000;25:170-6.  Back to cited text no. 10
  Medknow Journal  
11.Isaacs N. Measuring inter epidemic risk in a dengue endemic rural area using aedes larval indices. Indian J Community Med 2006;31:187-8.  Back to cited text no. 11
  Medknow Journal  



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7]


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