Comparison of Knowledge, Attitude, and Practice among Communities Living in Hotspot and Non-Hotspot Areas of Dengue in Selangor, Malaysia

Knowledge, attitude, and practice towards dengue fever among medical students in Sudan: A cross-sectional study

Background

Dengue fever, a neglected tropical disease, exhibits a total seroprevalence of 27% in Sudan. During the recent outbreak, medical students actively participated in health education and community outreach programs. This study aims to assess the knowledge, attitude, and practice (KAP) of medical students regarding Dengue Fever (DF) during its current outbreak in Sudan.

Design and methods

We conducted a cross-sectional study involving medical students from more than 15 Sudanese universities, encompassing 11 states. Data collection took place between October 23 and November 10, 2023, utilizing a Google Form questionnaire. A convenient sampling technique was employed to reach students due to its accessibility and feasibility during the ongoing conflict in Sudan. Correlation and regression analyses were used to identify predictors of KAP and establish associations between KAP domains and socio-demographic factors.

Results

Of 694 medical students, 11% reported a previous infection with DF. Among the participants, 58% demonstrated good knowledge, 74.1% exhibited a positive attitude, and less than half (46.7%) demonstrated good preventive practices. There was a positive correlation between knowledge and attitude levels with the practice level (p < 0.001). Gender, age, and previous DF infection emerged as significant predictors (p < 0.05) of the overall KAP level in multiple logistic regression.

Conclusions

Our study revealed a commendable level of knowledge and attitude but a suboptimal level of practice regarding DF among medical students. This inadequacy in practice, particularly among medical students who are expected to set an example, is concerning and warrants further investigation.

Knowledge, attitudes, and practices related to dengue among public school teachers in a Central Luzon Province in the Philippines: an analytic cross-sectional study

BACKGROUND

Dengue has become a major health issue in tropical regions as the numbers of reported cases and estimated infections continuously increase. In the Philippines, many challenges remain in preventing and controlling the disease amidst all the mitigation efforts of the government. This study sought to measure the health literacy of Filipino teachers and determine the associations among teachers' knowledge, attitudes, and selected practices (KAP) against dengue.

METHODS

Elementary and secondary school teachers from the consistently declared dengue hotspots in the City of San Fernando, Pampanga, Philippines, from the years 2017 to 2019 were selected as target participants in this cross-sectional study. A self-administered online survey tool was used in this study for both screening of participants and the KAP survey proper. STATA, descriptive statistics, and multiple logistic regression were used for the data analysis. Odds Ratios (ORs) and 95% confidence intervals (CIs) were reported.

RESULTS

The study comprised 604 participants whose mean age was 38.4 years. Television was determined as the top media source of information, and various health staff were the most trusted and common source of information. Good knowledge on dengue treatment (OR = 1.81; 95% CI 1.18-2.78) and dengue prevention (OR = 1.85; 95% CI 1.26-2.71) were positively associated with having good practices on protection against mosquito bites. Good knowledge on dengue signs and symptoms (OR = 1.56; 95% CI 1.02-2.37) and dengue prevention (OR = 2.38; 95% CI 1.59-3.58) were positively associated with having good practices on preventing breeding sites. Those with positive perceived susceptibility to dengue had lower odds of having good practices on protection against mosquito bites (OR = 0.64; 95% CI 0.41-0.99) and of having good practices on preventing breeding sites (OR = 0.46; 95% CI 0.26-0.81).

CONCLUSION

Even with the existing dengue policies, programs, and strategies, and the high disease literacy rate of Filipinos, dengue remains a struggle with an increasing case rate. Therefore, specific concepts should be emphasized, and interventions should be fine-tuned to better reach and influence the target population to attain a dengue-free Philippines.

Knowledge, attitude, and practices toward dengue fever among the public: a cross-sectional study in the Western region of Saudi Arabia

Background

Dengue fever (DF) is a primary viral disease transmitted to humans by mosquitoes, imposing a significant economic and health burden in numerous regions globally. There is a lack of studies addressing the importance of health education regarding DF in Saudi Arabia. Therefore, this study aimed to assess predictors influencing knowledge, attitude, and practices of the Western region public in Saudi Arabia related to DF.

Methods

This cross-sectional study was conducted as an online self-administered questionnaire collected from July 2023 until August 2023, included 695 participants from the Western region residents aged ≥18 years. Data collected involved sociodemographics, participants' knowledge, attitude, and practices toward DF. We presented the descriptive data as mean ± standard deviations (SD) and medians [interquartile range (IQR)] for continuous variables, while categorical variables were presented as frequencies [percent (%)].

Results

Good participants' knowledge and attitude toward DF were observed among participants [median score 21.0 (interquartile range 16.0-24.0)] out of 35 and [median score 4.00 (interquartile range 3.00-5.00)] out of 5, respectively. Limited practices toward DF were observed among participants [median score 3.0 (interquartile range 0.00-5.00)] out of 8. Participants' knowledge and attitude were not correlated. Participants' education level and employment status predicted participant's knowledge of DF. Participants' age, monthly income, employment status and marital status predicted participants' attitude toward DF. Participants' age, marital status, education levels and income predicted participants' practices toward DF.

Conclusion

Knowledge, attitude, and practices toward DF among adults in Saudi Arabia can be predicted by specific sociodemographic characteristics. Implementing interferences that focus on improving public practices toward DF is imperative.

Fogging to combat dengue: factors influencing stakeholders' attitudes in Malaysia

BACKGROUND

Fogging is a conventional technique used to combat Aedes mosquitoes and prevent dengue disease. It is often implemented in outbreak areas or areas harbouring a high density of Aedes mosquitoes. Currently, studies on stakeholders' attitudes towards fogging are still limited in number. Therefore, this study aims to assess Malaysian attitudes, and identify the predicting factors influencing such attitudes.

METHODS

A validated instrument was used to interview 399 randomly selected respondents from the public (n = 202, 50.6%) and scientists (n = 197, 49.4%) in the Klang Valley region of Malaysia. The data were analysed using PLS-SEM involving Smart-PLS software.

RESULTS

The results confirmed that stakeholder attitudes toward fogging should be viewed in terms of a multi-dimensional association. The stakeholders surveyed were highly positive with regard to the application of fogging to control dengue but professed moderate concerns as to associated risks. The PLS-SEM analyses demonstrated that the perceived benefit was the most important factor influencing attitudes, followed by trust in key players.

CONCLUSIONS

This result provides a good insight from the perspective of education and unravels the underlying fundamentals of stakeholders' attitudes toward the fogging technique. The findings also provide a positive indicator to the responsible parties involved to continue the usage of this technique in conjunction with improvements with regard to its safety aspects, and possibly in combination with other environmental-friendly alternatives in order to achieve a healthy environment without dengue in Malaysia.

Towfiqul Islam AR. Knowledge, Attitude and Practices Towards Dengue Fever Among Slum Dwellers: A Case Study in Dhaka City, Bangladesh

Objectives: This study intends to evaluate Dhaka city slum dwellers' responses to Dengue fever (DF). Methods: 745 individuals participated in a KAP survey that was pre-tested. Face-to-face interviews were performed to obtain data. Python with RStudio was used for data management and analysis. The multiple regression models were applied when applicable. Results: 50% of respondents were aware of the deadly effects of DF, its common symptoms, and its infectious nature. However, many were unaware that DF could be asymptomatic, a previously infected person could have DF again, and the virus could be passed to a fetus. Individuals agreed that their families, communities, and authorities should monitor and maintain their environment to prevent Aedes mosquito breeding. However, overall 60% of the study group had inadequate preventative measures. Many participants lacked necessary practices such as taking additional measures (cleaning and covering the water storage) and monitoring potential breeding places. Education and types of media for DF information were shown to promote DF prevention practices. Conclusion: Slum dwellers lack awareness and preventative activities that put them at risk for DF. Authorities must improve dengue surveillance. The findings suggest efficient knowledge distribution, community stimulation, and ongoing monitoring of preventative efforts to reduce DF. A multidisciplinary approach is needed to alter dwellers' behavior since DF control can be done by raising the population's level of life. People and communities must perform competently to eliminate vector breeding sites.

Dengue-Related Information Needs and Information-Seeking Behavior in Pakistan

This present study aims to examine the information needs and information-seeking behavior of Dengue-affected and non-affected people by exploring their information needs, resources used, and obstacles encountered. A structured questionnaire was used to collect data from 100 Dengue patients and 200 non-patients. The collected data were analyzed by applying descriptive and inferential statistics. The findings revealed that a majority of the respondents had information needs regarding nutritional options, best approaches to treatment, and expected benefits of treatment. They mostly sought information to keep themselves up-to-date and to prevent the disease. Television, Internet search engines, and social media outlets were frequently used information sources along with information-seeking from family and friends. Respondents with higher academic qualifications reported comparatively higher Dengue-related information needs. Moreover, age was a positive predictor of both their information needs and frequency of using health information sources. The findings will be helpful for healthcare providers to tailor Dengue awareness campaigns and prevention strategies according to the public needs and preferences.

Knowledge, Attitudes and Practices toward Dengue Fever, Vector Control, and Vaccine Acceptance Among the General Population in Countries from Latin America and Asia Pacific: A Cross-Sectional Study (GEMKAP)

Dengue represents a major public health concern. With effective vaccines in development, it is important to identify motivational factors to maximize dengue vaccine uptake. A cross-sectional, quantitative, electronic survey was administered to a nationally representative adult population (n = 3800) in Argentina, Brazil, Colombia, Mexico, Indonesia, Malaysia, and Singapore. Willingness to vaccinate against dengue, and Knowledge, Attitudes, and Practices (KAP) toward dengue, vector control, prevention, and vaccination were determined. The Capability, Opportunity, Motivation for Behavior change (COM-B) framework was used to identify factors correlated with dengue vaccine(s) uptake. KAP scores (standardized, 0–100% scale) resulted in a low global score for Knowledge (48%) and Practice (44%), and a moderate score for Attitude (66%); scores were comparable across countries. Of all respondents, 53% had a high willingness (Score: 8–10/10) to vaccinate against dengue, which was higher (59%) in Latin America (Argentina, Brazil, Colombia, Mexico) than in Asia Pacific (40%) (Indonesia, Malaysia, Singapore). Key factors significantly (p < 0.05) associated with increased willingness to vaccinate included accessibility to the public (subsidies and incentives) and trust in the healthcare system and government. A common approach to dengue prevention across endemic countries––with some country-specific customization, including education, vaccination, and vector control (multi-pronged)––may reduce dengue burden and improve outcomes.

Knowledge, Attitudes, and Practices of the Population in Jazan Region, Saudi Arabia Regarding Dengue Fever and Its Prevention Measures: A Community-Based Cross-Sectional Study

In previous studies, there was an apparent lack of health education about dengue fever (DF) among the Saudi population. Therefore, we conducted this study to assess the knowledge, attitude, and practices (KAP) about dengue fever among the Jazan region population, which is one of the most prevalent diseases in the region in Saudi Arabia (KSA). This was a cross-sectional and community-based study. The adult population was divided into governorates according to the regions that were close to each other, and then a convenient stratum was selected from each region. Next, random sampling was applied. Data were collected using a self-administered questionnaire. Exclusion criteria were young people (<18 years old) and health workers. Data analysis was performed using descriptive statistics, the Pearson's correlation coefficient, and multiple linear regression. Of the 392 participants in this cross-sectional study, 59.18% were male, 76.28% were aged 18-35 years, 72.96% had a university degree, and 63% had a monthly income of less than SAR 5000 (USD1 = 3.76). The scores (mean ± SD) for KAP regarding DF among the responders were 22.77 ± 7.9, 22.68 ± 7.24, and 25.62 ± 9.4, respectively. KAP constructs were positively correlated according to the Pearson's coefficient. In multiple linear regression analysis, males were favorably and substantially linked with attitude score (β = 2.76, p = 0.001) and negatively associated with practice score (β = -2.45, p = 0.023). No-degree participants scored lower on knowledge (β = -2.78, p = 0.003). There is potential for more research in Saudi Arabia to increase the generalizability to reduce the impact of dengue epidemics.

Understanding dengue solution and larval indices surveillance system among village health volunteers in high- and low-risk dengue villages in southern Thailand

Background

Successful dengue solutions require community collaboration between agencies engaged in human health, vector control and the environment. In Thailand, village health volunteers emphasize the need for a health working group to interact, collaborate, and coordinate actions. The objectives of this study were to acquire an understanding of dengue solutions, as well as the larval indices surveillance system of village health volunteers in high- and low-risk dengue villages.

Methods

After 12 months of training in dengue prevention and setting larval indices surveillance systems, an analytical cross-sectional survey was conducted. A total of 117 villages were included in the 18 primary care facilities within one district in southern Thailand, and they were divided into 71 high-risk and 46 low-risk dengue villages. Sample size was determined using the G*power formula. The content validity index and reliability values of Cronbach's alpha coefficient for the questionnaires were 0.91 and 0.83, respectively. A random sampling approach was used to acquire data. The chi-square test, t-test, and odds ratio were used to assess the sample's level of understanding.

Results

The study included 1302 village health volunteers, including 895 and 407 from high- and low-risk dengue communities, respectively. In total, 87.9% were female, 51.6% were 20-35 years old, 48.8% had worked as a village health volunteer for 11-20 years, 27.1% had an upper elementary education, and 59.1% had dengue in the previous 12 months. Understanding of the dengue solution and larval indices surveillance system varied across high- and low-risk dengue villages. Village health volunteers with a high level of understanding of the dengue solution and larval indies surveillance system were 1.064 and 1.504 times more likely to stay in high-risk dengue villages, respectively (odds ratio [OR] = 1.064, 95% confidence interval [CI]:0.798-1.419, p = 0.672 and OR = 1.504, 95% CI:1.044-2.167, p = 0.028).

Conclusions

Village health volunteers require ongoing training to understand the prevention and control of dengue and larval indices surveillance systems, promote awareness, and monitor dengue in both high- and low-risk dengue villages.

A Comparative Study on Dengue-related Knowledge, Attitude, and Practice in Hotspot and Non-Hotspot Areas in Selangor

Dengue fever is a deadly vector-borne disease. Prevention strategies without specific drugs or vaccines emphasise community involvement in dengue vector control. Identifying dengue-related knowledge, attitudes, and behaviours is critical to developing more effective intervention strategies. A cross-sectional study compared the knowledge, attitudes, and practices on dengue in selected dengue hotspots and non-hotspot areas in Selangor, Malaysia. A self-administered questionnaire was distributed among 320 randomly selected residents. Data were analysed using an independent t-test and Spearman’s rank-order correlation. Despite having a good understanding of the dengue virus, most respondents (83.1%) from both hotspot and non-hotspot areas were unaware that a person could be infected with the virus more than once in their lifetime, and 62.8% agreed that dengue patients could recover without treatment. Most respondents (76.9%) agreed that buying mosquito repellent is a waste of money, and most reported not sleeping under the insecticide net at night (74.7%). Respondents from dengue hotspot areas had significantly higher attitude scores (32.00±4.60) compared to those of non-hotspot regions (28.78±5.51), t (307) = 5.674, <i>p</i><0.05. There was a significant positive correlation between knowledge and attitude scores (r_s=0.214, p<0.01), between knowledge and practices (r_s=0.563, p<0.01), and attitude and practices (r_s=0.374, p<0.01). In addition to the high levels of knowledge and practice, attitudes toward dengue must be improved to implement proper prevention measures.

Knowledge, attitudes and practices of dengue prevention between dengue sustained hotspots and non-sustained hotspots in Singapore: a cross-sectional study

Dengue sustained hotspots (SHS) have resulted in a significant public health burden. In our study, we aimed to (1) compare knowledge, attitudes and practices (KAP) scores between SHS and non-sustained hotspots (NSHS); and (2) identify and describe gaps and factors associated with KAP of dengue prevention among SHS residents residing in Singapore. A cross-sectional study with convenience sampling was conducted using digital survey in randomly selected SHS and NSHS residential areas, consisting of residents aged 21 or older and who had been residing in their existing housing unit in 2019 and 2020. Chi-square test and T-test were used for comparison analysis of categorical and continuous variables, respectively. A total of 466 respondents completed the self-administered, anonymous survey. There were no significant difference in mean scores for Knowledge [SHS(24.66) vs. NSHS(24.37); P: 0.18], Attitudes [SHS(10.38) vs NSHS(10.16); P: 0.08] and Practices [SHS(9.27) vs NSHS(8.80); P: 0.16] sections. Significant SHS-associated factors identified were age group 41-50 years old [95%CI: 1.25-5.03], Malay (95%CI: 0.17-0.98), up to secondary school education (95%CI: 0.07-0.65), private condominium (95%CI: 1.17-3.39), residing in same household unit for 2-5 years (95%CI: 2.44-6.88), respondents who know that mosquito can breed in open container with stagnant water (95%CI: 0.06-0.98), disagree that reducing Aedes mosquitoes is the only way to prevent dengue: (95%CI: 1.19-3.00) and go to clinic/hospital even without severe symptoms: (95%CI: 0.39-0.95). These independent factors associated with dengue sustained hotspots may influence the risk of dengue transmission in residential areas.

Dengue Fever Responses in Dhaka City, Bangladesh: A Cross-Sectional Survey

Objectives: This study intends to evaluate the Dhaka city residents’ individual views toward DF.

Methods: A cross-sectional survey used google forms for collecting data. Python and RStudio were used for data management and analysis. Kruskal-Wallis or Mann-Whitney U test and logistic regression models were performed, where appropriate.

Results: In total 1008 individuals participated in a pre-tested KAP survey. More than 20% reported being affected by DF before the survey, where they rated their current places as being moderately safe (43%). In terms of DF control, 65% had good knowledge, and 68% reported good practice, whereas they demonstrated an overall good attitude. The increased knowledge of individuals could contribute to behavioral changes regarding DF. Female residents demonstrated better DF attitudes (OR: 0.69; p &lt; 0.05) and practices (OR: 0.66; p &lt; 0.01) compared to male residents. Mixed unit residents had poor KAP levels. Educational attainment can also play an essential role in enhancing the attitude level.

Conclusion: Overall, dengue surveillance activities with sufficient campaigns are required for behavioral change in Dhaka city. This information could be integrated into other DF-affected countries’ strategies against dengue outbreaks.

A cross-sectional study to assess the epidemiological situation and associated risk factors of dengue fever; knowledge, attitudes, and practices about dengue prevention in Khyber Pakhtunkhwa Province, Pakistan

Background

Dengue fever has been responsible for around 12 countrywide large outbreaks in Pakistan, resulting in 286,262 morbidities and 1,108 deaths. Khyber Pakhtunkhwa (KP) is the most recently impacted province. This study aimed to investigate the molecular, epidemiological, and potential elements that contribute to increasing dengue transmission patterns, and knowledge, attitude, and practice (KAP) toward dengue in KP province.

Method

This cross-sectional community-based study was conducted (June-December, 2021) in two phases. Phase I involved the epidemiological (n = 5,242) and molecular analysis of DENV in 500 randomly collected blood samples of the 2021 dengue outbreak in KP. Phase II focused on assessing dengue-KAP levels in healthy communities (n = 14,745, aged >18 years), adopting a cross-sectional clustered multistage sampling in eight districts (dengue-hotspot vs. non-hotspot) of KP. Chi-square tests and logistic regression analysis were applied.

Results

Peshawar district had the highest dengue cases (60.0%) associated with the predominant co-circulation of DENV-2 (45.8%) and DENV-3 (50.4%) serotypes. A rise in cases was reported in October (41.8%) followed by September (27.9%) and August (14.4%; p < 0.001). Males (63.7%, p < 0.001) and individuals aged 16–30 years (37.0%, p < 0.001) were highly affected. General workers (18.0%), families with a monthly income of 10,000–20,000 Pak rupees (50.5%), unmarried (71.0%), uneducated (31%), families with higher human density (>10 individuals per household), and those (29.0%) who faced power outages for more than 7/24 h were the most affected. Moreover, co-morbidities like renal failure and bronchial asthma were associated with disease severity. A community survey on KAP revealed that an average of 74, 60, and 43% of the participants demonstrated good knowledge, attitudes, and dengue preventive practices, respectively.

Conclusion

Multiple poor socioeconomic elements are influencing dengue fever transmission in the province. Higher KAP levels may explain the low frequency of dengue in non-hotspot districts. Our study emphasizes the need for effective and long-term public health education, strengthened vector surveillance, and expanded laboratory capacity for better diagnosis and management of dengue cases to better predict the burden and seasonality of disease in the country.

Dengue Seroprevalence and Factors Associated with Dengue Seropositivity in Petaling District, Malaysia

Dengue virus (DENV) infection is a major public health concern, posing huge economic and disease burdens globally. In Malaysia, the incidence of DENV infections has increased significantly over the years. Nevertheless, the passive surveillance mechanism applied may not capture the actual magnitude of DENV infection. There was also a paucity of community-based studies exploring DENV seroprevalence. This study aimed to determine the DENV seroprevalence and the associated factors among the urban population in Petaling district, Malaysia. A population-based cross-sectional study was conducted from 18 August to 26 October 2018 with 533 participants recruited. Blood samples were collected and analysed for DENV seropositivity using a composite reference standard comprised of three dengue serological tests. Associated factors were identified by fitting Generalised Linear Mixed Models with binomial error structure and logit link function. DENV seroprevalence obtained was 79.0% (95% CI: 75.2–82.4%). The age-specific DENV seroprevalence showed an increasing trend with advancing age, from 22.7% (95% CI: 9.6–45.0%) for those aged below five years old to 94.9% (95% CI: 81.3–98.7%) for those aged ≥60 years old. Only age group and house level were found to be significant factors associated with DENV seropositivity. The odds of being DENV seropositive generally increased with age, from 13.43 (95% CI: 2.77–65.22) for the 5–9 years old age group to 384.77 (95% CI: 39.27–3769.97) for the ≥60 years old age group, as compared to those aged below 5 years old. For house level, those who lived on the first and second floor (OR: 8.98, 95% CI: 3.16–25.12) and the third floor and above (OR: 4.82, 95% CI: 1.89–12.32) had greater odds of being DENV seropositive compared to those living on the ground floor. This study demonstrated the persistently high DENV seroprevalence among the urban population in Petaling district, which could be useful to evaluate dengue control measures taken and estimate more accurate disease incidence. The associated factors with DENV seropositivity identified could also contribute to undertaking more targeted preventive and control measures.

Effects of a serious game on knowledge, attitude and practice in vector control and dengue prevention among adults in primary care: A randomised controlled trial

Objective

Dengue is endemic but vaccination against it is optional in tropical Singapore. Despite vector control measures to curb mosquito breeding, dengue infection continues to be prevalent. A serious game has been developed to raise the community awareness of dengue vector control programme among residents in Singapore. The study aimed to evaluate the effectiveness of this serious game on the knowledge, attitude and practice (KAP) in dengue prevention among adults. It also determined their willingness to be vaccinated against dengue.

Methods

A randomised controlled trial was conducted among volunteer adults who were visiting a regional primary care clinic in Sengkang, Singapore. 400 participants were randomly allocated to receive information regarding dengue prevention from either playing a serious game (intervention) or visiting a dengue prevention website (control). Before and after receiving information on dengue prevention, participants completed a self-administered online questionnaire within a two-week interval to assess the KAP score and their interest to vaccinate against dengue. Participants, who played serious game, evaluated the game with the System Usability Scale (SUS).

Results

A total of 374 participants, comprising of 178 participants (89%) from intervention group and 196 participants (98%) from control group, completed both questionnaires. 157 (78.5%) participants in the intervention group completed playing the serious game. Participants in both groups had increased KAP score from baseline, but the mean difference in score (SD) was greater when assessing participants’ daily practice towards dengue prevention in the serious game group compared to the control group (1.0 (2.8) vs 0.3 (1.9), p = .009). There was a positive correlation (rho = 0.275) between mean change in KAP score and highest achievement attained within serious game ( p = .001). The mean SUS (SD) was 61.8 (19.2) among participants who played the serious game. 84.2% of the study population was willing to undertake the dengue vaccination at baseline. Participants in both groups had increased proportion of participants who showed interest in dengue vaccination from baseline but the difference between serious game group and control group were not significant (5.6% vs 2.6%, p = .131).

Conclusions

Serious game is at least equally effective compared to conventional web-based learning in promoting dengue prevention measures and vaccination intention among adults, and may be considered as a feasible alternative to digitally engage local residents.

Taylor-Robinson A, Wu YS, Aung YN, Low WY, Sim MS, Sekaran SD, Azizan N. Different domains of dengue research in the Philippines: A systematic review and meta-analysis of questionnaire-based studies

Background

Dengue is the most rapidly spreading mosquito-borne viral disease of humans worldwide, including southeast Asia region. This review provides a comprehensive overview of questionnaire-related dengue studies conducted in the Philippines and evaluates their reliability and validity in these surveys.

Methods

A review protocol constructed by a panel of experienced academic reviewers was used to formulate the methodology, research design, search strategy and selection criteria. An extensive literature search was conducted between March–June 2020 in various major electronic biomedical databases including PubMed, EMBASE, MEDLINE and ScienceDirect. A systematic review and meta-analysis (PRISMA) were selected as the preferred item reporting method.

Results

Out of a total of 34 peer-reviewed dengue-related KAP studies that were identified, 15 published from 2000 to April 2020 met the inclusion criteria. Based on the meta-analysis, a poor mean score was obtained for each of knowledge (68.89), attitude (49.86) and preventive practice (64.69). Most respondents were equipped with a good knowledge of the major clinical signs of dengue. Worryingly, 95% of respondents showed several negative attitudes towards dengue prevention, claiming that this was not possible and that enacting preventive practices was not their responsibility. Interestingly, television or radio was claimed as the main source of gaining dengue information (range 50–95%). Lastly, only five articles (33.3%) piloted or pretested their questionnaire before surveying, of which three reported Cronbach’s alpha coefficient (range 0.70 to 0.90).

Conclusion

This review indicates that to combat the growing public health threat of dengue to the Philippines, we need the active participation of resident communities, full engagement of healthcare personnel, promotion of awareness campaigns, and access to safe complementary and alternative medicines. Importantly, the psychometric properties of each questionnaire should be assessed rigorously.

Community Knowledge and Attitudes about the Transmission of Dengue Haemorrhagic Fever and Its Relationship to Prevention Behaviour in Palembang, South Sumatra, Indonesia

BACKGROUND: PSN 3 M Plus is a long-running program in Indonesia for the prevention and control of dengue hemorrhagic fever (DHF). AIM: This study aimed to determine the knowledge, behavior, attitudes, and beliefs of the community toward PSN 3 M Plus in preventing and controlling the spread of DHF. METHODS: A cluster random sampling method was used to recruit 200 respondents in endemic areas and 100 respondents in sporadic locations of Indonesia from August 2020 to February 2021. The respondents were interviewed directly by interviewers and the relationships between demographics and characteristics with the practice of PSN 3M Plus prevention behavior on the incidence of DHF were analyzed. RESULTS: Most respondents had good knowledge regarding the cause of DHF. Although respondents recognized and understood the dangers of and how to control DHF, most did not follow PSN 3 M Plus and believed that fogging was the most effective control measure. There was a significant relationship between the characteristics of the respondents in terms of education, occupation, and attitude on vector control practice. CONCLUSION: Although community environmental modifications can be a cost-effective approach to reduce the incidence of DHF, there is a need to raise public awareness regarding preventive vector control measures as good knowledge does not guarantee good compliance with PSN 3M Plus recommendations.

Evaluating livestock farmers knowledge, beliefs, and management of arboviral diseases in Kenya: A multivariate fractional probit approach

Globally, arthropod-borne virus (arbovirus) infections continue to pose substantial threats to public health and economic development, especially in developing countries. In Kenya, although arboviral diseases (ADs) are largely endemic, little is known about the factors influencing livestock farmers’ knowledge, beliefs, and management (KBM) of the three major ADs: Rift Valley fever (RVF), dengue fever and chikungunya fever. This study evaluates the drivers of livestock farmers’ KBM of ADs from a sample of 629 respondents selected using a three-stage sampling procedure in Kenya’s three hotspot counties of Baringo, Kwale, and Kilifi. A multivariate fractional probit model was used to assess the factors influencing the intensity of KBM. Only a quarter of the farmers had any knowledge of ADs while over four-fifths of them could not manage any of the three diseases. Access to information (experience and awareness), income, education, religion, and distance to a health facility considerably influenced the intensity of farmers’ KBM of ADs in Kenya. Thus, initiatives geared towards improving access to information through massive awareness campaigns are necessary to mitigate behavioral barriers in ADs management among rural communities in Kenya.

Arboviral infection in humans and animals is on the rise globally due to expansion of vector habitats. Despite the economic and social impact of diseases caused by arboviral infection such as chikungunya, dengue, and Rift Valley fever, little is known in terms of community knowledge, beliefs, and management. Evaluating community knowledge, beliefs, and management practices of arboviral diseases is important for better policy guidance and public health investment. We conducted a survey in Kenya’s three hotspot counties of Baringo, Kwale, and Kilifi to understand the factors influencing knowledge, beliefs, and management of arboviral diseases. We found low levels of knowledge and poor managerial skills of arboviral diseases that were largely driven by access to information and asset ownership. Thus, community sensitization through improved access to information is important in increasing awareness and increase the management of arboviral diseases among rural communities in Kenya and other sub-Saharan African countries.

Cat Owners' Perceptions toward Flea Infestation and Flea-borne Diseases: Impact for Public Health and Community Awareness

A structured questionnaire was distributed to a total of 531 cat owners in Peninsular Malaysia to evaluate their perceptions toward fleas and flea-borne diseases (FBD) using a knowledge-attitude-practice (KAP) approach. This study showed that majority of cat owners (50.5%) had a moderate level of knowledge on fleas, while 65.3% of them had a relatively low level of knowledge on FBD. However, most of them had positive attitudes (87.9%) and good practices (94.5%) toward efforts on prevention from flea infestation and FBD. Statistical analysis showed significant associations between knowledge on fleas and FBD toward demographic and pet ownership profiles of the respondents. Educated cat owners from urban area were more likely to have positive attitudes toward prevention of fleas and FBD. Female cat owners with monthly income of RM 5,001-7,000 ($1143-1600) were more likely to have good practices. Middle-aged cat owners showed the highest odds toward both positive attitudes and good practices. Correlation analyses indicated significant linear relationships between both knowledge, which were also associated with attitudes, but not with practices.

Rashid MF, Hod R, Dapari R, Hassan MR. A unique double tango: Construct validation and reliability analysis of risk perception, attitude and practice (RPAP) questionnaire on dengue infection

Introduction/background

Dengue fever remains a public health threat despite being preventable. A solution to the constant problem of dengue infection will require active intervention and a paradigm shift. Assessing perceived risk and correlating it with the attitude and practice of the community will help in designing appropriate measures. However, possible instruments for these assessments come with limitations.

Objective

The aim is to develop and validate a new scoring-based questionnaire, using dual statistical approaches to measure risk perception, attitude, and practices (RPAP) related to dengue in the community.

Methods

The RPAP questionnaire was developed bilingually using the International Society for Pharmacoeconomics and Outcome Research (ISPOR) guidelines. Content analysis was reviewed scrupulously by four expert panels. The initial 35-item scale was tested among 253 Malaysian respondents recruited non-probabilistically via multiple online platforms. Two statistical methods were employed to measure the construct validity: Exploratory Factor Analysis (EFA) as part of the Classical Test Theory (CTT) measurement, while Rasch Measurement Analysis (Rasch) was performed for the Item Response Theory (IRT) measurement. All results were cross-validated with their counterpart to ensure stability. Confirmatory Factor Analysis (CFA) was used to obtain a model fit index.

Results

29 questions were retained after the final analysis. Both EFA and Rasch analysis detect multidimensionality. Nine latent factors were extracted from EFA, while only eight factors remained in the final model following CFA: 1) perceived susceptibility; 2) perceived severity; 3) perceived barrier; 4) perceived benefit; 5) cues to action; 6) self-efficacy; 7) attitude; and 8) practice. All items had adequate factor loadings and showed good internal consistency. The final model after CFA achieved a good fit with an RMSEA value of 0.061, SRMR of 0.068, PNFI of 0.649, and GFI of 0.996.

Conclusion

The RPAP questionnaire contains 29 items and is a reliable and accurate psychometric instrument for measuring the risk perception of dengue fever, attitude, and practice of the community in dengue prevention. The Rasch measurement provides additional rigour to complement the CTT analysis. This RPAP questionnaire is suitable for use in studies related to dengue prevention in the community.

Different Domains of Dengue Research in Malaysia: A Systematic Review and Meta-Analysis of Questionnaire-Based Studies

This review provided a systematic overview of the questionnaire-related dengue studies conducted in Malaysia and evaluated their reliability and validity used in the questionnaires. An extensive literature search was conducted using various electronic databases, including PubMed, EMBASE, Medline, and ScienceDirect. Systematic reviews and meta-analysis (PRISMA) were selected as the preferred item reporting method. Out of 88 identified dengue-related, 57 published from 2000 to April 2020 met the inclusion criteria and were included. Based on the meta-analysis, a poor mean score was obtained for knowledge (49%), attitude (44%), and preventive practice (55%). The study showed that the level of knowledge on cardinal signs and modes of transmission for dengue virus were highest among health care workers, followed by students (international and local) and lastly community residents. In treatment-seeking behaviours, only half of the respondents (50.8%) would send their child to the nearest health clinics or hospitals when a child became restless or lethargic. The acceptance rate for dengue vaccine, bacteria (Wolbachia), as a vector for dengue control and self-test diagnostic kit for dengue showed considerably high (88.4%, 70%, and 44.8%, respectively). Health belief model (HBM) constructs, such as perceived barriers, perceived severity, perceived susceptibility, self-efficacy, and perceived benefit influence prevention practices. Lastly, only 23 articles (40.3%) had piloted or pretested the questionnaire before surveying, in which three reported Cronbach's alpha coefficient (0.70-0.90). A need for active participation of communities and healthcare personnel, promotion of awareness, and safe complementary medicines, as well as assessment of psychometric properties of questionnaire use in dengue surveys in Malaysia, in order for assessing dengue reliably and valid.

Dengue in Dhaka, Bangladesh: Hospital-based cross-sectional KAP assessment at Dhaka North and Dhaka South City Corporation area

Dengue, the most important mosquito-borne viral disease of humans is a recurring global health problem. In Bangladesh, dengue outbreaks are on the increase despite the efforts of government and it is not clear what the understanding of the general Dhaka population towards dengue fever is. Knowledge, attitude and practice (KAP) studies are essential guides in public health interventions. Hence, using KAP, this study aims to assess patient-perspectives with regards to factors associated with dengue, as well as investigate the associated factors between the two corporations in Dhaka. A Hospital-based cross-sectional study of 242 fever patients from two city-corporations in Dhaka (Dhaka North City Corporations, DNCC (n = 91, 37.6%) and Dhaka South City Corporation, DSCC (n = 151, 62.4%) was conducted using pre-tested KAP items. Wilcoxon's Rank Sum was used to determine the KAP by DNCC, DSCC and both corporations and multivariate Poisson regression analyses. The two corporations were analysed separately due to the differences in income distribution, concentration of slums, hospitals and clinics. The study found that more than half of the study population were knowledgeable about dengue (mean percentage scores was 52%), possess an appropriate and acceptable attitude towards the disease (69.2%), and about two thirds of the respondents (71.4%) engaged in practices towards its prevention. After adjusting for the potential cofounders, the factors associated with KAP about dengue fever varied between DNCC and DSCC; with duration of residency and use of mosquito nets were associated with knowledge in the north while income class and age were associated with knowledge and attitude in the south. In the pooled analysis (combining both corporations), knowledge of dengue was associated with good practice towards dengue fever among the respondents. The duration of residence in Dhaka (10+ years), not using mosquito nets and length of time spent in the hospital (7+ days) due to dengue, and decreased knowledge (Adjusted coefficient (β) = -0.01, 95%CI: -0.02, -0.01) were associated with attitude towards dengue in DNCC. On the other hand, middle-high income class, age (40+ years) and increased knowledge were associated with practice towards dengue in DSCC (β = 0.02, 95%CI: 0.01, 0.03). Efforts to increase knowledge about dengue fever through education by the administrations of both corporations would benefit from targeting these high-risk groups for a more sustainable outcome.

Factors Correlated with Practices Regarding Care of Dengue Patients Among Nurses from 94 Primary Care Units in a High- Risk Province in Southern Thailand

Background

In Thailand, primary care units (PCUs) play a part in the health assessment, diagnosis, care, basic treatment and referral of patients suffering from dengue.

Methods

In Nakhon Si Thammarat province in Thailand, we (i) undertook assessment of the personal information, experience, knowledge, attitudes, preparation of equipment and use of medical supplies of nurses in PCUs with regard to dengue patient care (DPC); (ii) analyzed the factors and practices of nurses regarding DPC; (iii) explored nurses’ opinions regarding DPC in PCUs. A cross-sectional mixed methods of collecting data consisted of quantitative and qualitative methods. The study cohort was 94 nurses from 94 PCUs in an area of high risk of dengue outbreaks. The quantitative component involved questionnaires. The qualitative component consisted of nurses’ discussions in focus groups. Spearman’s test was employed to analyze quantitative data, and thematic analyses were employed for qualitative data.

Results

Of 94 nurses from 94 PCUs, 77.7% (n = 73) had a poor knowledge level of DPC and negative attitude, preparation of equipment was carried out by 60.6% (n = 58), and 1 to 6 aspects of DPC were at good practice level: 88.3% (n = 83), 87.2% (n = 82), 85.1% (n = 80), 50.0% (n = 47), 51.1% (n = 48) and 77.7% (n = 73). There was no significant correlation (i) between the knowledge, attitudes and practices with regard to DPC (P > 0.05); (ii) with practice guidelines for dengue prevention (P > 0.05). The quantitative results were related to the four main themes of the qualitative study.

Conclusion

There was a few who had good knowledge and positive attitude levels among participants, and >90% of all nurses had good practices regarding DPC. PCU nurses need training and supporting equipment to carry out a DPC program.

Knowledge, attitudes and practices of COVID-19 among income-poor households in the Philippines: A cross-sectional study

Background

The presence of COVID-19 in low- and middle-income countries (LMICs) is raising important concerns about effective pandemic response and preparedness in the context of fragile health systems and the pervasiveness of misinformation. The objective of this study was to gain an understanding of how COVID-19 was perceived by households experiencing extreme poverty in the Philippines.

Methods

This study was conducted in partnership with International Care Ministries (ICM), a Philippine-based non-governmental organization (NGO) that runs a poverty-alleviation program called Transform targeted towards extreme low-income households. We integrated knowledge, attitudes, and practices (KAP) questions into ICM's cross-sectional program monitoring and evaluation systems from February 20 through March 13, 2020. Frequencies and proportions were calculated to describe the respondents' responses, and the Kruskal-Wallis test and binomial logistic regression were undertaken to determine the socio-demographic characteristics associated with COVID-19 KAPs.

Results

In total, 2224 respondents from 166 communities in rural, urban and coastal settings were surveyed. Although the survey was administered during the earlier stages of the pandemic, 94.0% of respondents had already heard of COVID-19. Traditional media sources such as television (85.5%) and radio (56.1%) were reported as the main sources of information about the virus. Coughing and sneezing were identified as a transmission route by 89.5% of respondents, while indirect hand contact was the least commonly identified transmission route, recognized by 72.6% of respondents. Handwashing was identified by 82.2% of respondents as a preventive measure against the virus, but social distancing and avoiding crowds were only identified by 32.4% and 40.6%, respectively. Handwashing was the most common preventive practice in response to COVID-19, adopted by 89.9% of respondents. A greater number of preventive measures were taken by those with more knowledge of potential transmission routes.

Conclusions

There is a need for targeted health education as a response strategy to COVID-19 in low-income settings, and it is important that strategies are contextually relevant. Understanding KAPs among populations experiencing extreme poverty will be important as tailored guidance for public health response and communication strategies are developed for LMICs.

Survey of Dengue Knowledge and Prevention Practices Associated with Sociodemographic Status: A Cross-Sectional Study Among the Community Living in an Urban Area of Selangor, Malaysia

The present study aimed to explore the current status of knowledge and practices of dengue prevention associated with sociodemographic status among the community living in an urban area of Selangor, Malaysia. A total of 441 participants were interviewed regarding sociodemographic status, knowledge of dengue, and self-reported prevention practices. Participants over 40 years old were more likely (odds ratio [OR] = 4.210, 95% CI = 1.652-10.733, P = 0.003) to have better dengue knowledge. Participants whose average monthly household income was more than MYR3,000 (US$715) were more likely (OR = 1.607, 95% CI = 1.059-2.438, P = 0.026) to have better practices of dengue prevention measures. The finding suggests that both government and community efforts are essential in order to continue to educate about dengue and reduce the frequency of dengue cases nationwide.