Knowledge, attitudes, and practices on climate change and dengue in Lao People's Democratic Republic and Thailand

Assessing the knowledge, attitudes, and practices (KAP) of dengue in Thailand: a systematic review and meta-analysis

AIM

Dengue cases are on the rise in Thailand, coinciding with increases in flooding events. Studies pertaining to public knowledge, attitudes, and practices (KAP) of dengue prevention have frequently been used to better understand the public's needs towards dengue. While these studies were conducted in different settings, it is necessary to initiate a systematic review and meta-analysis of relevant studies.

SUBJECTS AND METHOD

We conducted a systematic review and meta-analysis of prior studies in Thailand that assessed the KAP towards dengue. Eligibility criteria were established and independently used by reviewers to select nine studies for the systematic review and three for the meta-analysis. Collectively, the nine studies included 3,058 individuals and 2,519 households.

RESULTS

The overall estimate of the proportion of participants with good knowledge of dengue prevention is 35% (95% CI: 14-59%), suggesting the majority of the population in Thailand had low levels of knowledge towards dengue. The poor levels of practice in Thailand were also observed and confirmed for the majority of the population by meta-analysis, with the pooled estimate of the proportion of participants with good practice of dengue prevention being 25% (95% CI: 22-27%). In contrast, most of the studies included in the systematic review reported positive attitudes towards dengue prevention, and this finding was also affirmed by the meta-analysis, as the pooled estimate of the proportion of positive attitudes towards dengue prevention is 61% (95% CI: 43-77%).

CONCLUSION

Despite good attitudes towards dengue prevention, poor knowledge and poor practices predominate, highlighting the need for enhanced public health campaigns to educate the public on dengue risks and prevention methods.

Knowledge, attitudes and practice questionnaires in dengue, Zika, chikungunya and yellow fever settings: a scoping review protocol

INTRODUCTION

Arboviruses are a broad classification of viral pathogens that require vectors such as mosquitoes for infection transmission. The burden of arboviral diseases worldwide is substantial, affecting millions of people annually, with the Aedes aegypti mosquito responsible for spreading several common arboviruses, including dengue, chikungunya, Zika and yellow fever. One public health strategy to control and prevent these viruses is to influence community members' behaviours related to reducing the breeding sites of Aedes mosquitoes, and knowledge, attitudes and practice (KAP) questionnaires are often used as part of these education campaigns.

OBJECTIVES

To explore the content of KAP questionnaires and methodologies used to evaluate arboviral infections, focusing on dengue, Zika, chikungunya and yellow fever.

METHODS AND ANALYSIS

To identify and describe KAP questionnaires for the selected arboviral infections, a scoping review will be performed and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Scoping Review Extension guidelines. Scientific databases such as MEDLINE, Cochrane, EMBASE, Web of Science, Scielo and LILACS will be searched systematically. Two independent reviewers will screen the title and abstract, followed by a full-text review of the selected articles using the COVIDENCE platform. The extracted information will include citation details, the type of arbovirus, the type of questions in each domain, the scoring system, the theoretical framework and the statistical analysis. The results will be presented comprehensively in tables and figures.

ETHICS AND DISSEMINATION

Ethics approval is not required. Knowledge transfer will be conducted through conference presentations and publications.

Livelihood vulnerability to climate change health impacts among Amhara Sayint district community, northeastern Ethiopia: A composite index approach

Climate change significantly impacts public health, affecting nearly everyone across the globe and contributing to approximately 10% of global mortality. Ethiopia is particularly vulnerable to the changing climate attributed impacts due to economic, and social determinants. While research on climate change is expanding, it often prioritizes its effects on agriculture. The impacts from public health perspective are frequently overlooked. We address this shortcoming by evaluating the vulnerability of the community in the district of Amhara Sayint, Amhara, northeastern Ethiopia, to the health impacts of climate change, and identifying factors involved. Data was collected using a community-based cross-sectional approach, involving 605 randomly selected households between July Twenty and September Five, 2022. The data collection process utilized a validated and pilot-tested questionnaire, which was administered through face-to-face interview with the aid of Kobo Collect toolbox. The community's vulnerability was assessed using the IPCC's framework of vulnerability. Household's Vulnerability status was then classified into three levels according to their Livelihood Vulnerability Index (LVI) score. A partial proportional oddsapproach of ordinal logistic regression model was used to identify factors associated with vulnerability to climate change attributed health impacts. Among the 605 respondents, 48% (95% CI: 44.1, 52.1) were identified as vulnerable, and about 4.6 % (95% CI: 3, 6.6) were classified as highly vulnerable. Wealth status (AOR1 = 1.8; 95 % CI: 1.2, 2.8), educational status (AOR1 = 2.8; 95% CI: 1.1, 7.3), marital status (AOR2 = 4.7, 95% CI: 1.6, 13.4), and home crowdedness (AOR2 = 2.9, 95% CI: 1.1, 8.1) significantly associated with vulnerability. Over half of the residents in the district wereeither being vulnerable or highly vulnerable to climate change attributed health impacts. Therefore, prioritizing prevention and preparedness along with conducting spatial analysis to identify high-risk areas for timely intervention, is essential.

Assessment of knowledge and practices regarding taeniasis and cysticercosis in Pak Chong, Nakhon Ratchasima, Thailand: A cross-sectional study

BACKGROUND

Taeniasis and cysticercosis are parasitic infections caused by Taenia spp., mainly transmitted through the consumption of undercooked pork. Prevention requires increasing knowledge and awareness, improving meat inspection and hygiene, and promoting safe food handling and sanitation. The aim of this study was to evaluate the knowledge and practice (KP) of residents in Pak Chong District, Nakhon Ratchasima, Thailand, regarding taeniasis and cysticercosis.

METHODS

A cross-sectional study was conducted in Pak Chong District, Nakhon Ratchasima, Thailand, and its 11 subdistrict municipalities. Study participants were selected using a stratified random sampling design. A validated questionnaire (Cronbach's alpha = 0.70) was used to collect socio-demographic information and assess knowledge and practices related to taeniasis and cysticercosis. Descriptive statistics and multiple linear regression were used for the analysis.

RESULTS

Of the 360 survey respondents, 65.0% (n = 234) were women, 82.2% (n = 296) were aged under 60 years, 99.2% (n = 357) identified as Buddhist, 87.5% (n = 315) had less than a bachelor's degree education level, 54.2% (n = 195) had monthly family income ≥10,000 Thai baht, 10.6% (n = 38) were unemployed, and 26.1% (n = 93) lived in a town municipality. The survey revealed that 98.3% (n = 354) of participants were categorized as having less accurate knowledge and 83.6% (n = 301) were classified as more frequently engaging in correct prevention practices. Our study revealed that pig farmers (1.7%) occasionally permitted the pigs to forage freely. The results of multiple linear regression analysis revealed that knowledge scores were positively associated with household income ≥10,000 Thai baht (βadj = 1.50, 95% confidence interval [CI] 0.65 to 2.36). Practice scores were negatively associated with age over 60 years (βadj = -1.77, 95% CI -3.14 to -0.40) and living in a subdistrict municipality (βadj = -2.58, 95% CI -3.77 to -1.39). There was no association between KP regarding taeniasis and cysticercosis in the population of Pak Chong.

CONCLUSIONS

Overall, participants' knowledge was lacking. Public education interventions are recommended to improve knowledge among residents with low socioeconomic status. These findings can inform the development of targeted interventions and educational programs in Pak Chong District, especially among elderly people in subdistrict municipalities, to improve practices for the prevention and control of these parasitic infections.

Uncovering the knowledge gap: A web-based survey of healthcare providers' understanding and management of dengue fever in East Azerbaijan, Iran

BACKGROUND

Dengue fever (DF) is increasingly recognized as one of the world's major mosquito-borne diseases and causes significant morbidity and mortality in tropical and subtropical countries. Appropriate and timely diagnosis and risk stratification for severe disease are crucial in the appropriate management of this illness. Healthcare providers (HCPs) play a key role in dengue fever diagnosis, management and prevention. The present study was conducted to determine the knowledge, attitudes and practices (KAP) among HCPs in East Azerbaijan Province, Iran.

METHODS

A cross-sectional survey among 948 HCPs, using a structured questionnaire, was conducted in East Azerbaijan Province from May to July 2022. Data analysis was undertaken using descriptive methods, the Chi-square test or Fisher's exact test, and logistic regression. A P-value <0.05 was considered for statistical significance.

RESULTS

Out of the 948 (68.5% female) respondents, 227 were physicians and 721 were health professionals. The knowledge level of DF was found to be largely inadequate in the present study population (80.4%). The physician vs. health professional were a significant factor in differentiating attitude scores. The mean practice score regarding DF prevention and control measures among respondents was 8.40±1.97.

CONCLUSION

The findings call for urgent continuous education and training courses to increase KAP levels and increased capacity and capability for DF prevention and control. This is of outmost importance for the first point of care of DF patients.

Youth's climate consciousness: unraveling the Dengue-climate connection in Bangladesh

Background

Climate change affects the transmission of vector-borne diseases like dengue, posing a substantial public health threat. Bangladesh, with its favorable conditions for Dengue transmission, has experienced periodic outbreaks. This study explores the relationship between climate change knowledge, perceptions of the Dengue-climate link, and the associated factors among Bangladeshi youth.

Methods

In the Dhaka district of Bangladesh, a cross-sectional study was conducted between September and October 2023, involving face-to-face interviews with 1,358 participants. Convenient (non-probability) sampling was utilized for participant selection. Data collection involved the administration of a semi-structured questionnaire encompassing informed consent, socio-demographic information, and inquiries pertaining to climate change-related knowledge (13 items) and perception (11 items). Data analysis utilized STATA (Version 15.0) and SPSS (Version 26.0).

Results

The mean scores for knowledge and perceptions were determined to be 7.10 ± 3.20 (out of 13) and 26.60 ± 4.12 (out of 33) respectively. Participants had a mean age of 22.02 ± 1.58 years. The study revealed that unmarried status, living in a nuclear family, being a non-smoker, good self-perception of physical health, regular sleep patterns, moderate social media usage, older age, unemployment, and daily media consumption are factors associated with higher knowledge and perception regarding the Dengue-climate change link. Moreover, a positive association was observed between knowledge of climate change and favorable attitudes toward the Dengue-climate connection.

Conclusion

This study underscores the importance of tailored climate change education for youth in Bangladesh and highlights key variables influencing their knowledge and perceptions. Notably, there exists a positive association between climate change knowledge and favorable attitudes toward the Dengue-climate connection. These insights underscore the importance of targeted educational campaigns and policy interventions aimed at enhancing climate consciousness among the youth population, thereby fostering proactive measures to mitigate the impact of Dengue fever in the context of climate change.

Knowledge, Attitudes, and Practices of Rural Communities Regarding Antimicrobial Resistance and Climate Change in Adadle District, Somali Region, Ethiopia: A Mixed-Methods Study

There is an urgent need for interventions in addressing the rapid and disproportionate impact of antimicrobial resistance (AMR) and climate change (CC) on low- and middle-income countries. Within this context, it is important to understand indigenous knowledge in rural communities, which are highly affected. This study examined knowledge, attitude, and practices (KAP) regarding AMR and CC in the Adadle district, Somali region, Ethiopia, utilizing mixed methods, including 362 surveys and 12 focus group discussions among rural communities. Findings showed that 39% and 63% of participants were familiar with AMR and CC, respectively. Of those surveyed, 57% attributed AMR to inappropriate antimicrobial use in animals and humans, while CC was often associated with Allah/God. Multivariable analysis indicated that males exhibited superior knowledge and a positive attitude towards AMR and CC. Additionally, individuals aged 26-35 and 36-45 years showed heightened awareness of AMR and CC, respectively. Moreover, participants who were government employees, pastoralists, and business owners showed better knowledge on CC compared to family caretaker. Religious education and households with more than six members were linked to lower AMR knowledge. This study underlines a greater awareness of CC than AMR and highlights gender-based disparities, recommending integrated educational AMR programs targeting different demographics through a One Health lens, actively involving females, and incorporating local beliefs and practices.

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.

A Germany-wide survey of caregiving professionals on climate change and mental health of children and adolescents - factors influencing their relevance rating of extreme weather event associated mental health impairments

INTRODUCTION

Climate change presents a significant risk for the mental and physical health of young people. In order to identify and properly care for potential mental health impairments from extreme weather events, the relevance of these impairments must be assessed as high by the professional groups providing care for children and adolescents. This raises the question of which factors influence the individual relevance assessment of caretaking professionals?

METHODS

Data was collected creating and conducting a Germany-wide online questionnaire via LimeSurvey. The questionnaire was addressed to professionals providing care for children and adolescents, in this case medical and therapeutic personnel as well as school and pedagogical personnel. Professional associations, chief physicians and school principals were contacted as multipliers and asked to forward the questionnaire to their members and staff. The data was analyzed using the R statistical software, and multiple linear regressions were performed to test the hypotheses.

RESULTS

Overall, 648 questionnaires were taken into analysis. Approximately 70% of the participants considered climate change-induced impacts on the mental health of children and adolescents due to extreme weather events as relevant. Experiencing heat, storm, heavy precipitation, flood/flooding, and/or avalanches/mudflows made a modest yet significant contribution to explaining higher relevance assessments. In contrast, there was no evidence to suggest that an urban working environment increases the relevance assessment.

CONCLUSION

The described influence of experiencing extreme weather events should not be regarded as the sole factor leading to higher relevance ratings. A more comprehensive understanding of the factors influencing relevance assessments is necessary to address key aspects of risk communication and increase risk awareness.

Development of a Pilot Literacy Scale to Assess Knowledge, Attitudes, and Behaviors towards Climate Change and Infectious Disease Dynamics in Suriname

Prior research has shown that climate literacy is sparse among low- and middle-income countries. Additionally, no standardized questionnaire exists for researchers to measure climate literacy among general populations, particularly with regards to climate change effects on vector-borne diseases (VBDs). We developed a comprehensive literacy scale to assess current knowledge, attitudes, and behaviors towards climate change and VBD dynamics among women enrolled in the Caribbean Consortium for Research in Environmental and Occupational Health (CCREOH) cohort in Suriname. Items were generated by our research team and reviewed by a group of six external climate and health experts. After the expert review, a total of 31 climate change and 21 infectious disease items were retained. We estimated our sample size at a 10:1 ratio of participants to items for each scale. In total, 301 women were surveyed. We validated our scales through exploratory (n = 180) and confirmatory factor analyses (n = 121). An exploratory factor analysis for our general Climate Change Scale provided a four-construct solution of 11 items. Our chi-squared value (X2 = 74.32; p = 0.136) indicated that four factors were sufficient. A confirmatory factor analysis reinforced our findings, providing a good model fit (X2 = 39.03; p = 0.23; RMSEA = 0.015). Our Infectious Disease Scale gave a four-construct solution of nine items (X2 = 153.86; p = 0.094). A confirmatory factor analysis confirmed these results, with a chi-squared value of 19.16 (p = 0.575) and an RMSEA of 0.00. This research is vitally important for furthering climate and health education, especially with increases in VBDs spread by Aedes mosquitoes in the Caribbean, South America, and parts of the southern United States.

Assessing the Relationship between Annual Surface Temperature Changes and the Burden of Dengue: Implications for Climate Change and Global Health Outcomes

Dengue fever remains a significant global health concern, imposing a substantial burden on public health systems worldwide. Recent studies have suggested that climate change, specifically the increase in surface temperatures associated with global warming, may impact the transmission dynamics of dengue. This study aimed to assess the relationship between annual surface temperature changes from 1961 to 2019 and the burden of dengue in 185 countries. The dengue burden was evaluated for 2019 using disability-adjusted life years (DALYs) and the annual rate of change (ARC) in DALY rates assessed from 1990 to 2019. A cross-sectional and ecological analysis was conducted using two publicly available datasets. Regression coefficients (β) and 95% confidence intervals (CI) were used to examine the relationship between annual surface temperature changes and the burden of dengue. The results revealed a significant negative relationship between mean surface temperatures and DALY rates in 2019 (β = -16.9, 95% CI -26.9 to -6.8). Similarly, a significant negative relationship was observed between the temperature variable and the ARC (β = -0.99, 95% CI -1.66 to -0.32). These findings suggest that as temperatures continue to rise, the burden of dengue may globally decrease. The ecology of the vector and variations in seasons, precipitation patterns, and humidity levels may partially contribute to this phenomenon. Our study contributes to the expanding body of evidence regarding the potential implications of climate change for dengue dynamics. It emphasizes the critical importance of addressing climate change as a determinant of global health outcomes.

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.

Efficacy Assessment of Autodissemination Using Pyriproxyfen-Treated Ovitraps in the Reduction of Dengue Incidence in Parañaque City, Philippines: A Spatial Analysis

Dengue is one of the most important vector-borne diseases worldwide and is a significant public health problem in the tropics. Mosquito control continues to be the primary approach to reducing the disease burden and spread of dengue virus (DENV). Aside from the traditional larviciding and adulticiding interventions, autodissemination using pyriproxyfen-treated (AD-PPF) ovitraps is one of the promising methods to complement existing vector control strategies. Our paper assessed the efficacy of AD-PPF in reducing DENV infections in two barangays in Parañaque City. Using saliva samples from the participants from both the control and intervention sites, we collected the seroprevalence data for three months in each of the two years. Spatial analysis was conducted to determine hotspot areas and identify DENV infection distributions across the trial periods. The results showed that the intervention site was identified as having a clustering of DENV infections in Month 0 of Year 1 and shifted to a random dispersion of dengue cases at the end of Month 3 in Year 2. The disappearance of the clustering of the intervention site translates to a decrease in the cases of DENV infection relative to the control site. Furthermore, we also identified that DENV transmission occurred at a small-scale level that did not go beyond 86 m. In conclusion, AD-PPF is suggested to be an effective strategy and may be used as an additional vector control approach, albeit based on this short-term implementation.

Knowledge, Attitude, Risk Perception, and Health-Related Adaptive Behavior of Primary School Children towards Climate Change: A Cross-Sectional Study in China

BACKGROUND

Children are disproportionately affected by climate change while evidence regarding their adaptive behavior and relevant influencing factors is limited.

OBJECTIVES

We attempted to investigate health-related adaptive behavior towards climate change for primary school children in China and explore potential influencing factors.

METHODS

We conducted a survey of 8322 primary school children in 12 cities across China. Knowledge, attitude, risk perception, and adaptive behavior scores for children were collected using a designed questionnaire. Weather exposures of cities were collected from 2014 to 2018. We applied a multiple linear regression and mixed-effect regression to assess the influencing factors of adaptive behavior. We also used the structural equation model (SEM) to validate the theoretical framework of adaptive behavior.

RESULTS

Most children (76.1%) were aware of climate change. They mainly get information from television, smartphones, and the Internet. A 1 score increase in knowledge, attitude, and risk perception was associated with 0.210, 0.386, and 0.160 increase in adaptive behavior scores, respectively. Females and children having air conditioners or heating systems at home were positively associated with adaptive behavior. Exposure to cold and rainstorms increased the adaptive behavior scores, while heat exposure had the opposite effects. The SEM showed that knowledge was positively associated with attitude and risk perception. Knowledge, attitude, and risk perception corresponded to 31.6%, 22.8%, and 26.1% changes of adaptive behavior, respectively.

CONCLUSION

Most primary school children in China were aware of climate change. Knowledge, attitude, risk perception, cold, and rainstorm exposure were positively associated with health-related adaptive behavior towards climate change.

Design a protocol to investigate the effects of climate change in vivo

Climate change has a variety of effects on communities and the environment, most of which have been directly addressed, such as floods, droughts, and fires. To date, the impacts of climate change on health in in vivo conditions have not been assessed, and no protocol has been developed in this regard. Therefore, the purpose of the current study is to develop a protocol as well as design and build a pilot to deal with climate change in vivo to show the direct effects of climate change on health. For this purpose, twenty specialists, comprising ten experts active in field climate and 10 experts in field medicine and anatomy, have been consulted to design the proposed exposure protocol using the Delphi method. According to the prepared protocol, an exposure pilot was then designed and built, which provides the climatic conditions for animal exposure with a fully automatic HMI-PLC system. The results showed the average 12:12-h day/night temperature, humidity, and circadian cycle for three consecutive ten-year periods selected for exposure of 1-month-old male rats. The duration of the exposure period is four months, which is equivalent to a ten-year climatic period. This study is a framework and a starting point for examining the effects of climate change on in vivo conditions that have not yet been considered.

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.

Influence of hydroclimatic variability on dengue incidence in a tropical dryland area

Dengue is an endemic disease in more than 100 countries, but there are few studies about the effects of hydroclimatic variability on dengue incidence (DI) in tropical dryland areas. This study investigates the association between hydroclimatic variability and DI (2008-2018) in a large tropical dryland area. The area studied comprehends seven municipalities with populations ranging from 32,879 to 2,545,419 inhabitants. First, the precipitation and temperature impacts on interannual and seasonal DI were investigated. Then, the monthly association between DI and hydroclimatic variables was analyzed using generalized least squares (GLS) regression. The model's capability to reproduce DI given the current hydroclimatic conditions and DI seasonality over the entire time period studied were assessed. No association between the interannual variation of precipitation and DI was found. However, seasonal variation of DI was shaped by precipitation and temperature. February-July was the main dengue season period. A precipitation threshold, usually above 100 mm, triggers the rapid DI rising. Precipitation and minimum air temperature were the main explanatory variables. A two-month-lagged predictor was relevant for modeling, occurring in all regressions, followed by a non-lagged predictor. The climate predictors differed among the regression models, revealing the high spatial DI variability driven by hydroclimatic variability. GLS regressions were able to reproduce the beginning, development, and end of the dengue season, although we found underestimation of DI peaks and overestimation of low DI. These model limitations are not an issue for climate change impact assessment on DI at the municipality scale since historical DI seasonality was well simulated. However, they may not allow seasonal DI forecasting for some municipalities. These findings may help not only public health policies in the studied municipalities but also have the potential to be reproducible for other dryland regions with similar data availability.

Role of artificial intelligence-internet of things (AI-IoT) based emerging technologies in the public health response to infectious diseases in Bangladesh

Digital technologies are the need of today to predict, prevent and control emerging infectious diseases. Bangladesh is one of the world's poorest and most densely populated countries and faces a double burden of two deadly diseases, COVID-19 and dengue. In response to both these diseases, the absence of a digital healthcare system and insufficient preparedness, lack of public awareness pose unique challenges and a large threat to the population, resulting in epidemics of escalating severity. This paper suggests a digital health care and surveillance system based on the internet of things (IoT) and artificial intelligence (AI) for timely identification of COVID-19 and dengue cases and improving the prevention and control strategies in the country.

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.

Mapping the spatial distribution of the dengue vector Aedes aegypti and predicting its abundance in northeastern Thailand using machine-learning approach

BACKGROUND

Mapping the spatial distribution of the dengue vector Aedes (Ae.) aegypti and accurately predicting its abundance are crucial for designing effective vector control strategies and early warning tools for dengue epidemic prevention. Socio-ecological and landscape factors influence Ae. aegypti abundance. Therefore, we aimed to map the spatial distribution of female adult Ae. aegypti and predict its abundance in northeastern Thailand based on socioeconomic, climate change, and dengue knowledge, attitude and practices (KAP) and/or landscape factors using machine learning (ML)-based system.

METHOD

A total of 1066 females adult Ae. aegypti were collected from four villages in northeastern Thailand during January-December 2019. Information on household socioeconomics, KAP regarding climate change and dengue, and satellite-based landscape data were also acquired. Geographic information systems (GIS) were used to map the household-based spatial distribution of female adult Ae. aegypti abundance (high/low). Five popular supervised learning models, logistic regression (LR), support vector machine (SVM), k-nearest neighbor (kNN), artificial neural network (ANN), and random forest (RF), were used to predict females adult Ae. aegypti abundance (high/low). The predictive accuracy of each modeling technique was calculated and evaluated. Important variables for predicting female adult Ae. aegypti abundance were also identified using the best-fitted model.

RESULTS

Urban areas had higher abundance of female adult Ae. aegypti compared to rural areas. Overall, study respondents in both urban and rural areas had inadequate KAP regarding climate change and dengue. The average landscape factors per household in urban areas were rice crop (47.4%), natural tree cover (17.8%), built-up area (13.2%), permanent wetlands (21.2%), and rubber plantation (0%), and the corresponding figures for rural areas were 12.1, 2.0, 38.7, 40.1 and 0.1% respectively. Among all assessed models, RF showed the best prediction performance (socioeconomics: area under curve, AUC = 0.93, classification accuracy, CA = 0.86, F1 score = 0.85; KAP: AUC = 0.95, CA = 0.92, F1 = 0.90; landscape: AUC = 0.96, CA = 0.89, F1 = 0.87) for female adult Ae. aegypti abundance. The combined influences of all factors further improved the predictive accuracy in RF model (socioeconomics + KAP + landscape: AUC = 0.99, CA = 0.96 and F1 = 0.95). Dengue prevention practices were shown to be the most important predictor in the RF model for female adult Ae. aegypti abundance in northeastern Thailand.

CONCLUSION

The RF model is more suitable for the prediction of Ae. aegypti abundance in northeastern Thailand. Our study exemplifies that the application of GIS and machine learning systems has significant potential for understanding the spatial distribution of dengue vectors and predicting its abundance. The study findings might help optimize vector control strategies, future mosquito suppression, prediction and control strategies of epidemic arboviral diseases (dengue, chikungunya, and Zika). Such strategies can be incorporated into One Health approaches applying transdisciplinary approaches considering human-vector and agro-environmental interrelationships.

Assessment of Knowledge, Attitudes, and Practices Regarding Dengue among Physicians: A Web-Based Cross-Sectional Survey

Dengue fever is one of the most important viral infections transmitted by Aedes mosquitoes and a major cause of morbidity and mortality globally. Accurate identification of cases and treatment of dengue patients at the early stages can reduce medical complications and dengue mortality rate. This survey aims to determine the knowledge, attitude, and practices (KAP) among physicians in dengue diagnosis and treatment. This study was conducted among physicians in Turkey as one nonendemic country and Bangladesh, India, and Malaysia as three dengue-endemic countries. The dosing frequencies, maximum doses, and contraindications in dengue fever were examined. The results found that physicians from Bangladesh, India, and Malaysia have higher KAP scores in dengue diagnosis and treatment compared to physicians in Turkey. This may be due to a lack of physician's exposure to a dengue patient as Turkey is considered a nonendemic country. This assessment may help establish a guideline for intervention strategies among physicians to have successful treatment outcomes and reduce dengue mortality.

Ecological, Social, and Other Environmental Determinants of Dengue Vector Abundance in Urban and Rural Areas of Northeastern Thailand

Aedes aegypti is the main vector of dengue globally. The variables that influence the abundance of dengue vectors are numerous and complex. This has generated a need to focus on areas at risk of disease transmission, the spatial-temporal distribution of vectors, and the factors that modulate vector abundance. To help guide and improve vector-control efforts, this study identified the ecological, social, and other environmental risk factors that affect the abundance of adult female and immature Ae. aegypti in households in urban and rural areas of northeastern Thailand. A one-year entomological study was conducted in four villages of northeastern Thailand between January and December 2019. Socio-demographic; self-reported prior dengue infections; housing conditions; durable asset ownership; water management; characteristics of water containers; knowledge, attitudes, and practices (KAP) regarding climate change and dengue; and climate data were collected. Household crowding index (HCI), premise condition index (PCI), socio-economic status (SES), and entomological indices (HI, CI, BI, and PI) were calculated. Negative binomial generalized linear models (GLMs) were fitted to identify the risk factors associated with the abundance of adult females and immature Ae. aegypti. Urban sites had higher entomological indices and numbers of adult Ae. aegypti mosquitoes than rural sites. Overall, participants’ KAP about climate change and dengue were low in both settings. The fitted GLM showed that a higher abundance of adult female Ae. aegypti was significantly (p < 0.05) associated with many factors, such as a low education level of household respondents, crowded households, poor premise conditions, surrounding house density, bathrooms located indoors, unscreened windows, high numbers of wet containers, a lack of adult control, prior dengue infections, poor climate change adaptation, dengue, and vector-related practices. Many of the above were also significantly associated with a high abundance of immature mosquito stages. The GLM model also showed that maximum and mean temperature with four-and one-to-two weeks of lag were significant predictors (p < 0.05) of the abundance of adult and immature mosquitoes, respectively, in northeastern Thailand. The low KAP regarding climate change and dengue highlights the engagement needs for vector-borne disease prevention in this region. The identified risk factors are important for the critical first step toward developing routine Aedes surveillance and reliable early warning systems for effective dengue and other mosquito-borne disease prevention and control strategies at the household and community levels in this region and similar settings elsewhere.