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 Table of Contents  
ORIGINAL ARTICLE
Year : 2022  |  Volume : 10  |  Issue : 4  |  Page : 93-98

Knowledge and practice about dengue fever among urban slum dwellers in one district of Andhra Pradesh, India: A study on current status


1 Departments of Community Medicine, GSL Medical College, Rajahmundry, Andhra Pradesh, India
2 Departments of Orthopaedics, GSL Medical College, Rajahmundry, Andhra Pradesh, India

Date of Submission17-Jun-2022
Date of Decision16-Aug-2022
Date of Acceptance17-Aug-2022
Date of Web Publication27-Oct-2022

Correspondence Address:
K M Lavanya
Department of Community Medicine, GSL Medical College, Rajahmundry - 533 296, Andhra Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/mjhs.mjhs_17_22

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  Abstract 


Background: A mosquito-borne disease, dengue is present in many places of India since a long time. Studies have shown that, despite many efforts, the knowledge and practices of people, especially urban slum dwellers remain low. The factors responsible for inadequate knowledge and practices have to be explored and addressed. This study aimed to assess the knowledge and practice about dengue fever among urban slum dwellers of Andhra Pradesh, India.
Materials and Methods: This was a cross-sectional study conducted among the urban slum dwellers (community-based study) in one district of Andhra Pradesh state. Study variables included knowledge about symptoms of dengue, mode of transmission, and complications. Practices to prevent dengue were also studied.
Results: In the present study, males were 85 (30.4%) and females were 195 (69.6%). The awareness about dengue among urban slum dwellers is good (75.4%). Awareness of dengue was significantly higher in females than in males. No significant association of awareness of dengue was found with age, literacy status, socioeconomic status, and occupation. Recognition of symptoms of dengue was significantly better among females compared to males.
Conclusions: The study concludes that the awareness of dengue among urban slum dwellers is good (75.4%). The practices related to mosquito control measures are improving, but, there is still a need to improve knowledge and practice.

Keywords: Dengue, knowledge, practices, urban slum dwellers


How to cite this article:
Lavanya K M, Kumar Andey U V, Mishra SK, Vutharkar NR. Knowledge and practice about dengue fever among urban slum dwellers in one district of Andhra Pradesh, India: A study on current status. MRIMS J Health Sci 2022;10:93-8

How to cite this URL:
Lavanya K M, Kumar Andey U V, Mishra SK, Vutharkar NR. Knowledge and practice about dengue fever among urban slum dwellers in one district of Andhra Pradesh, India: A study on current status. MRIMS J Health Sci [serial online] 2022 [cited 2023 Feb 3];10:93-8. Available from: http://www.mrimsjournal.com/text.asp?2022/10/4/0/359950




  Introduction Top


A single-stranded RNA virus, dengue virus (DENV) belongs to the genus Flavivirus of the family Flaviviridae and consists of four serotypes (DENV: 1–4).[1],[2],[3] Dengue is an arbovirus disease often called breakbone fever due to the presence of joint pains commonly.[4] It is transmitted to humans by the bite of infected Aedes mosquitoes, Aedes aegypti mosquito, and Aedes albopictus.[5] Patients with dengue fever commonly present with complaints of fever which lasts for 5–7 days along with two or more symptoms such as headache, retro-orbital pain, myalgia, arthralgia, rash, hemorrhagic manifestations, or leukopenia.[6]

Fast expanding urbanization, changes happening in the environment, increased migration and mobilization of individuals, growth of population, limited financial and human resources, and neglected (rural and slums) areas are attributed to vector breeding and the rise in dengue outbreaks.[7],[8],[9] DENV infection recognized as one of the world's emerging infectious diseases, is found mainly in tropical and subtropical regions around the world and is still a major public health problem.[10] It was estimated that about 2.5 billion people are at risk for dengue fever according to the World Health Organization and, in recent years, its incidence increased around the world and become an important public health issue, especially in developing countries like India.[11]

The incidence of dengue fever is considerably high, while the awareness and related practices have still not reached expected levels. A 2013 study indicates that 390 million dengue infections occur every year (95% confidence interval 284–528 million), of which 96 million (67–136 million) manifest clinically (with any severity of disease).[12] While a 2012 study, on the prevalence of dengue, estimates that 3.9 billion people in 128 countries are at risk of infection with DENVs.[13]

The Sustainable Development Goal has one of its goals to end the epidemic of neglected tropical diseases like dengue by 2030.[14] Community involvement is very essential for the control of dengue. Community participation helps to share responsibilities and reduces the burden on health-care services. Hence, people should have adequate knowledge of the disease such as basic vector biology, breeding places, and prevention.

One of the studies conducted in South India,[15] reported that, about 86% of the participants ever heard about dengue, while the remaining 14% had not even heard about dengue. However, even people who had heard about the disease lacked knowledge on dengue vector breeding habitat. About 68% of the study participants responded that the breeding places of dengue vectors are drains and garbage, while clean water as the breeding habitat of dengue vectors was known only to 25% of participants. It was found that most of the participants are not aware of the disease symptoms and only 59% of respondents knew that fever was the most common symptom. The authors of the study concluded that in-depth knowledge on dengue epidemiology is lacking among people and it is required for the government as well as community members to do more work for the prevention of vector breeding.

Although the National Vector Borne Disease Control Program (NVBDCP) against dengue and other vector-borne diseases is operational since a long, the lacunae in relation to its awareness and practice still exist. Hence, the present study attempted to assess the current state of knowledge and practices about dengue fever among people residing in urban slums of one district of Andhra Pradesh.


  Materials and Methods Top


This was a community-based cross-sectional study performed in the urban slum dwellers of one district of Andhra Pradesh state for a period of 6 months from July to December 2021, as it is the monsoon season and highly favorable for the breeding of vector mosquitoes. Among a total of 18 urban slum areas, three urban slum areas (Sharadanagar, Andhranagar, and Ambedkar Nagar) were included in the study by random selection. Using the formula, 4pq/L2 sample size was arrived at 266 (P = 52.5%, that is, study participants who knew that dengue are spread by mosquito bite[16] and L = 6). Data could be collected from 280 individuals. Each of the selected slums has 200–220 households having an average family size of five, with about one thousand population. The sampling technique used was systematic random sampling technique. Sampling of households for the study began from East of the urban health center. Sampling interval was 2; so, systematically, every second house was chosen and data were collected from 90 to 100 individuals from each of the three slums. All adults aged 20 years and above, who are available at the time of the visit and have given consent to participate in the study were included in the study, while those who were not available on two consecutive visits to their household and those who could not comprehend for the interview were excluded from the study. The purpose of the study was informed to all the participants in the local language and consent was taken to participate in the study with their voluntary will. The participants did not exert any pressure on the participants to participate in the study. Ethical Clearance was obtained from the Institutional Ethical Committee of GSL Medical College, Rajahmundry, Andhra Pradesh. It was made sure that the study was conducted only after obtaining ethical clearance. Data were collected from 280 adult individuals by face-to-face interview using a predesigned questionnaire which was pilot tested. The questionnaire contained questions related to demographic profile and socioeconomic data, relevant questions to obtain details about knowledge of the study participants along with prevalent practices about dengue. The questionnaire was designed by the principal investigator, and internal validation was done by experts in the subject within the institution, while external validation was done by subject experts working in other medical colleges of three different states. After validation, the questionnaire was pilot tested among 40 urban slum dwellers in the city. The data were analyzed and necessary modifications were made in the questionnaire to meet the requirements of the study. The respondents were free to clarify any doubts they had about the questionnaire or any other related information. Data were entered into an Excel spreadsheet and double-checked for errors and analyzed using IBM® SPSS® Statistics 21 manufactured by IBM. To analyze the relationship between categorical variables, Pearson's Chi-square test was used. P < 0.05 is considered statistically significant. Outcome variables include knowledge and practices of study participants about dengue.


  Results Top


In the present study, males were 85 (30.4%) and females were 195 (69.6%). Among males, most of them (54.5%) had graduation, while among females, most of them (68.1%) had education up to secondary school. [Table 1] shows the sociodemographic profile of the study population.
Table 1: Sociodemographic profile of study participants

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Socioeconomic status was classified using modified Kuppuswamy classification. It was found that the majority of 145 (51.8%) of the study participants belonged to the upper or lower class. Out of 280 study participants, the majority (75.4%) were aware of dengue while only 24.6% were not aware.

Awareness of dengue was found to be significantly higher in females compared to males, although there was no significant association of awareness of dengue with age, literacy status, socioeconomic status, and occupation [Table 2] and [Table 3].
Table 2: Association between knowledge about dengue and study variables

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Table 3: Association between gender and knowledge about dengue

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Regarding the practices related to protective measures used against mosquitoes, about 242 (86.4%) used mosquito nets, 192 (68.6%) used repellents, 173 (61.8%) mesh, 61 (21.8%) creams, and 57 (20.4%) used coils, while 34 (12.1%) did not use any protective measure against mosquitoes [Table 4].
Table 4: Practices related to dengue

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  Discussion Top


This study aimed to assess knowledge and practice about dengue fever among residents of urban slums in a district of Andhra Pradesh. Urban slums are the hot spots for dengue. Rapid urbanization and deficient water management in recent years have led to an increase in mosquito breeding sites and thus, increased the risk of dengue in urban areas.[17]

The present study found that, the mean age of study participants was 47 ± 10.32 years, with the mean age of males being 48 ± 9.41 years and the mean age of females being 43 ± 14.27 years. The majority (68.6%) of them belonged to the age group of 21–40 years, then 41–60 years of age (19.3%), followed by <20 years (10.7%) and >60 years (1.4%). Illiterates were about 40% and among literates, about 25.7% had secondary school education while others had a much lower level of education. Soorya et al.[18] in their study found a higher mean age of the study participants (53.96 ± 13.05 years). They reported that the majority of the study participants had education up to secondary (36.5%), followed by higher secondary (29.9%) and primary (21.2%). None of the participants were illiterate. In a study by Nagoor et al.,[19] there were 57% males and 43% females, study participants had a mean age of 34.5 years, literate individuals were 82%, and the majority (35%) had secondary school education. Senthil Kumar et al.[20] in their study found that study participants had a mean age of 37.47 years. About 61.2% of the subjects were males. About 45.88% had studied below class 10th and the remaining 54.12% had an educational qualification above class 10th. This variation may be due to the varying sociodemographic and environmental conditions prevailing in different regions.

In the current study, out of 280 participants, the majority (75.4%) were aware of dengue. Soorya et al.[18] found that all the respondents had knowledge about mosquito-borne diseases in their study. Dengue was the most commonly known mosquito-borne disease (90.9%). Dengue as a mosquito-borne disease was known to 26.6% of study participants. A statistically significant association between educational level and knowledge about mosquito-borne diseases was derived, while no statistical significance was obtained between literacy status and awareness of dengue in the present study. The possible reason for an increase in awareness in people with higher educational levels may be due to an increase in the understanding capacity of the educated people to the messages and information received from different sources such as television, newspaper, or health educators. Similarly, Sharma et al.[21] found that dengue was perceived as the most common mosquito-borne disease (85.9%). A study conducted by Senthil Kumar et al.[20] showed a higher (88.6%) awareness of dengue among the study population in comparison to the present study, which may be due to a higher number of people having a higher educational level in their study, in which, about 45.88% had studied below class 10th and the remaining 54.12% had an educational qualification above class 10th.

The present study revealed that awareness of dengue was significantly higher in females compared to males, although no significant association of awareness of dengue could be found with age, literacy status, socioeconomic status, and occupation, while in a study by Nagoor et al.,[19] knowledge regarding dengue fever was low in daily wagers (55%) compared to other occupational groups. Recognition of symptoms of dengue was significantly better among females compared to males, while no significant difference was found between males and females in awareness of the cause and complications of disease. Consistent with the present study (75.6%), dengue was transmitted through mosquito bites and was reported by 80.4% of respondents in a study by Senthil Kumar et al.[20] They also revealed a statistically significant difference (P = 0.014) in knowledge scores between subjects who had studied above class 10th and those below class 10th. The difference of knowledge about dengue with regard to the level of education in some of the studies may be because the awareness levels increase as the education level of people increases.

Regarding the protective measures used against mosquitoes in the present study, about 86.4% used mosquito nets, 68.6% used repellents, 61.8% mesh, 21.8% creams, and 20.4% used coils, while 12.1% did not use any protective measure against mosquitoes, while in a study by Nagoor et al.,[19] people used protective measures to a comparatively lesser extent, 33% were commonly using mosquito repellents, 19% were using mosquito coils, 21% of respondents were not using any protective measures, and others are using creams (7%), bed nets (12%), and mesh (8%). About practices to prevent dengue, a study by Senthil Kumar et al.[20] showed that the majority of the study population practiced covering of water containers (63.92%), prevention of blockage of drains (56.86%), and disposal of stagnant water (50.98%). A smaller proportion of subjects used mosquito coils/nets (15.69%) and mosquito repellents (19.21%) to prevent dengue. Mosquito nets were used to prevent dengue by 86.4% of the present study subjects which is higher than the results obtained by Chellaiyan et al. (14.7%).[22] The present study showed increased use of protective measures against dengue compared to other studies done previously. This could be because of increased focus on urban slums and more stringent activities under NVBDCP, increased health education activities by the health-care providers (medical officers, Anganwadi workers, ASHA, etc.), and an increase in the awareness and practice of people in the urban slums. The Village Health Sanitation and Nutrition Committees and their urban equivalents that are a part of local government institutions are a platform that is strengthened and utilized for this purpose. The program is focusing on behavior change efforts at the household level for optimal effect and hence, directing its efforts in this direction.[23]

Limitations

This study being a cross-sectional study, no follow-up was done. Only 3 slums out of 15 slums were included, and the results may not be generalized. Convenience sampling was used to select study respondents in this study. Hence, there is some bias in the representation of our respondents. The possibility of interviewer bias may also be considered.


  Conclusions Top


This study showed that awareness about dengue is more among females (71.1%) when compared to males and also awareness is more among literates (57.3%) when compared to illiterates. This shows education has a positive impact on the awareness of dengue. The study concludes that the awareness of dengue among urban slum dwellers is good (75.4%). The practices related to mosquito control measures are better when compared to previous studies. However, the gap in knowledge and practice is considerably high; 12.1% of people are still not practicing any measures to prevent dengue. Measures to bridge this gap have to be taken to prevent dengue among urban slum dwellers. This gap can be addressed by appropriate health education strategies. People should be motivated with regular health education activities. Although it is being done under the NVBCP, it is probably falling short to motivate people toward healthy practices. Training health workers are required to improve the delivery of health education to the public and hence, their protection. Surveillance activities can be strengthened to keep a watch on disease trends and take necessary measures as and when required. Some of the activities that can be planned at the community level include environmental sanitation in the surroundings, proper water drainage, and disposal of waste. Mosquito control measures such as residual spraying and source reduction can be taken up at the community level. Mass media and community health workers can be engaged to provide active health education to the people just before of the season of mosquito breeding begins in India (July to November), as vector-borne diseases are seasonal diseases.

Acknowledgments

I deeply acknowledge the people in the community who participated in the study and acknowledge the publisher and editor of this journal.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



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



 

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