Community perspectives on dengue transmission in the city of Dhaka, Bangladesh

Societal knowledge, attitude, and practices towards dengue and associated factors in epidemic-hit areas: Geoinformation assisted empirical evidence

Dengue is one of Pakistan's major health concerns. In this study, we aimed to advance our understanding of the levels of knowledge, attitudes, and practices (KAPs) in Pakistan's Dengue Fever (DF) hotspots. Initially, at-risk communities were systematically identified via a well-known spatial modeling technique, named, Kernel Density Estimation, which was later targeted for a household-based cross-sectional survey of KAPs. To collect data on sociodemographic and KAPs, random sampling was utilized (n = 385, 5 % margin of error). Later, the association of different demographics (characteristics), knowledge, and attitude factors-potentially related to poor preventive practices was assessed using bivariate (individual) and multivariable (model) logistic regression analyses. Most respondents (>90 %) identified fever as a sign of DF; headache (73.8 %), joint pain (64.4 %), muscular pain (50.9 %), pain behind the eyes (41.8 %), bleeding (34.3 %), and skin rash (36.1 %) were identified relatively less. Regression results showed significant associations of poor knowledge/attitude with poor preventive practices; dengue vector (odds ratio [OR] = 3.733, 95 % confidence interval [CI ] = 2.377-5.861; P < 0.001), DF symptoms (OR = 3.088, 95 % CI = 1.949-4.894; P < 0.001), dengue transmission (OR = 1.933, 95 % CI = 1.265-2.956; P = 0.002), and attitude (OR = 3.813, 95 % CI = 1.548-9.395; P = 0.004). Moreover, education level was stronger in bivariate analysis and the strongest independent factor of poor preventive practices in multivariable analysis (illiterate: adjusted OR = 6.833, 95 % CI = 2.979-15.672; P < 0.001) and primary education (adjusted OR = 4.046, 95 % CI = 1.997-8.199; P < 0.001). This situation highlights knowledge gaps within urban communities, particularly in understanding dengue transmission and signs/symptoms. The level of education in urban communities also plays a substantial role in dengue control, as observed in this study, where poor preventive practices were more prevalent among illiterate and less educated respondents.

Public knowledge, belief, and preventive practices regarding dengue: Findings from a community-based survey in rural Bangladesh

BACKGROUND

Dengue fever, the most prevalent mosquito-borne viral infection, is a recurrent public health threat in Bangladesh. Despite the government's efforts, dengue outbreaks are on the upswing, and people's knowledge, belief, and preventive practices regarding the disease at the rural community level are unclear.

OBJECTIVE

The objective of this study was to assess the level of knowledge, belief and preventive practices regarding dengue and associated factors among community people from rural Bangladesh.

METHODS

A cross-sectional survey was conducted involving 401 people using a convenient sampling technique from three unions of Savar from August to September 2021. Participants' responses were collected through face-to-face interviews using a pre-tested structured questionnaire that included information related to socio-demographics, dengue-related knowledge, preventive practices, and the health belief model (HBM) constructs. Multiple linear regression analysis was performed to determine the factors associated with the knowledge and preventive practices of dengue.

RESULTS

Overall, participants (mean age = 33.47 ± 12.96 years; age range = 18-75 years) correctly answered 66.15% of the knowledge questions regarding dengue. Higher education, travel to dengue-risk regions, and self-efficacy under the HBM construct were all shown to be strongly associated with dengue knowledge. Regarding HBM constructs, about 80% of the participants perceived dengue as dangerous, but less than half (41.4%) believed themselves susceptible to dengue. Considering perceived barriers, 73.07% of the participants believed their residential area was not suitable for Aedes mosquito breeding. Nearly all (93.52%) believed they always kept their surrounding area clean as part of self-efficacy. Moreover, on average participants engaged in 53.69% of all dengue preventive practices. Being older, female, having a higher education, being a service holder, having a good quality of house structure, and perceived susceptibility as well as self-efficacy under the HBM construct were all factors in participants' dengue prevention activities. Participants' dengue preventative practices were shown to be significantly influenced by their knowledge.

CONCLUSIONS

The findings of this study found a moderate level of knowledge regarding dengue among the participants. Regarding dengue prevention, although participants scored highly in several indicators, the overall preventive practices were not satisfactory. This suggests that there is a pressing need for expanded education outreach aimed at increasing public awareness of dengue and encourage preventive practices within rural communities in Bangladesh.

Knowledge, Attitudes, and Practices in Relation to Mosquito-Borne Diseases in Bangladesh

Mosquito-borne diseases (MBDs) such as dengue, malaria, and chikungunya are common in Bangladesh, with frequent outbreaks in the rainy season. Analysis of the knowledge, attitudes, and practices of people toward any crisis is fundamental to addressing any gap. Here, we conducted a cross-sectional study mainly focusing on the northern, southern and central parts of Bangladesh to understand the level of knowledge, attitudes, and practices of people regarding MBDs, mosquito habitats, or control measures. A total of 1720 participants were involved in the study from 33 out of 64 districts of Bangladesh, of which 56.9% were male. While most of them knew about dengue (97.1%), chikungunya (81.4%), and malaria (85.2%), only half of them were aware of filaria (53.3%), which is endemic to the northern region. A knowledge score (0−8, low), (9−16, moderate), (17−24, high), and attitude score (0−4, poor), (5−8, moderate), and (9−13, high) were assigned. While poor and moderate attitudes were considered negative, good attitudes were considered positive. About 45% of the respondents had a moderate knowledge score (50−70); however, about 67.9% of participants showed a good attitude score (>70) towards the control of MBDs. It was found that the knowledge and attitude of the responders were related to their profession (knowledge p < 0.001; attitude, p = 0.002), residential area (knowledge p < 0.001; attitude, p < 0.001), and education level (knowledge p < 0.001; attitude p = 0.004). A mosquito is a kind of nuisance bug, and about 79.8% of responders admitted that they kill mosquitoes as soon as they notice them. They also use bed nets (93.7%) followed by mosquito coils (85.7%) as a preventive method. Interestingly, 73.2% of the responders were reluctant to contact the local government during an increase in mosquito numbers. Overall, the people of Bangladesh have a positive attitude towards the prevention of mosquito-borne diseases. It is highly recommended that the government creates more knowledge regarding this issue and develops collaborative approaches with local people to implement robust preventive measures against mosquito-borne diseases.

Knowledge, awareness and preventive practices of dengue outbreak in Bangladesh: A countrywide study

Background

Dengue, the mosquito borne disease has become a growing public health threat in Bangladesh due to its gradual increasing morbidity and mortality since 2000. In 2019, the country witnessed the worst ever dengue outbreak. The present study was conducted to characterize the socio-economic factors and knowledge, attitude and practice (KAP) status towards dengue among the people of Bangladesh.

Method

A cross-sectional study was conducted with 1,010 randomly selected respondents from nine different administrative regions of Bangladesh between July and November 2019.

A structured questionnaire was used covering socio-demographic characteristics of the participants including their knowledge, awareness, treatment and practices regarding dengue fever. Factors associated with the knowledge and awareness of dengue were investigated separately, using multivariable logistic regression.

Results

Although majority (93.8%) of the respondents had heard about dengue, however, they had still misconceptions about Aedes breeding habitat. Around half of the study population (45.7%) had mistaken belief that Aedes can breed in dirty water and 43.1% knew that Aedes mosquito usually bites around sunrise and sunset. Fever indication was found in 36.6% of people which is the most common symptom of dengue. Among the socio-demographic variables, the level of education of the respondents was identified as an independent predictor for both knowledge (p<0.05) and awareness (p<0.05) of dengue. The preventive practice level was moderately less than the knowledge level though there was a significant association (p<0.05) existed between knowledge and preventive practices. Our study noted that TV/Radio is an effective predominant source of information about dengue fever.

Conclusion

As dengue is emerging in Bangladesh, there is an urgent need to increase health promotion activities through campaigns for eliminating the misconception and considerable knowledge gaps about dengue.

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.

Association among ecological and behavioural attributes, dengue vector and disease control: a cross-sectional study of the city of Dhaka, Bangladesh

BACKGROUND

This study examines vector density, the prevailing knowledge, awareness, attitudes and practice (KAAP) of community members regarding dengue disease and their willingness to pay (WTP) for vector control in Dhaka, Bangladesh.

METHODS

A population-based, cross-sectional study design was followed: (i) an entomological survey was carried out in 727 randomly selected households in 12 wards, representing four urban ecological zones and (ii) a survey of 330 household heads was conducted to study their KAAP. The χ2 test and multinomial logistic regression (MLR) were applied to investigate factors associated with WTP and other variables.

RESULTS

The Stegomyia indices significantly vary among the urban zones, revealing that the paved and built areas with concentrated public/commercial services have the highest mosquito density. Most respondents (93.9%) knew about dengue and its severity (90.3%); however, many of them were unaware (79.3%) about the types of mosquitoes causing dengue. MLR modelling reveals that average spending per month for mosquito control, household income and knowledge about the effects of land use and seasonality on dengue were significantly associated with the WTP for controlling the dengue vector.

CONCLUSIONS

Concerted efforts should be made to increase awareness about dengue transmission and develop community-based sustainable dengue vector control programmes involving both the public and private sectors.

Level of Awareness of Dengue Disease among School Children in Gampaha District, Sri Lanka, and Effect of School-Based Health Education Programmes on Improving Knowledge and Practices

Introduction

Limited awareness and nonsystematized health education programmes have contributed adversely to the increase in dengue incidence at schools due to limited attention which has positively contributed to the increase in vector receptivity. The current study was conducted to evaluate the existing level of awareness of dengue infection among a selected group of school children and to assess the effectiveness of dengue awareness programmes to improve the existing knowledge and preventive practices on dengue.

Methods

A cohort of 2,194 students (13-15 years old) from 10 schools at Kelaniya educational zone, Gampaha District, Western Province of Sri Lanka, was enrolled for the current study, which was conducted during 2015-2016. A self-administered questionnaire, comprising 20 questions, was used to evaluate the present knowledge of the students on various aspects of dengue. A structured awareness programme (2 hours) was conducted for students, followed by a reassessment. General Linear Model (GLM) and chi-square test of independence were used to investigate the variations in knowledge levels.

Results

The majority of students were characterized by "Good" (46.31%, n= 1016) and "Moderate" (42.62%, n= 935) awareness, while only 2.92% (n= 64) of students fell into the "Excellent" (>80%) category prior to the awareness programme. Even though, existing knowledge of students about dengue ranged between "Moderate" and "Good" categories, awareness of "symptoms & patient care" and "control & prevention practices" were limited. After the programme, the awareness level reached the "Excellent" (41.84%, n=918) level indicating a significant increase by 38.92%, according to the chi-square test (p<0.05 at 95% level of confidence).

Conclusion

We recommend implementing school-based educational programmes in order to raise the awareness and to translate knowledge into sound practice to control dengue disease epidemics in these areas.

Risk factors for the presence of dengue vector mosquitoes, and determinants of their prevalence and larval site selection in Dhaka, Bangladesh

Dengue viruses are responsible for over 100 million infections a year worldwide and are a public health concern in Bangladesh. Although risk of transmission is high, data on vector population characteristics are scanty in Bangladesh; therefore, a comprehensive prediction of the patterns of local virus transmission is not possible. Recognizing these gaps, multi-year entomological surveys were carried out in Dhaka, where the disease is most frequently reported. The specific objectives of the present study are threefold: i) to determine the risk factors for the presence of Aedes mosquitoes; ii) to identify the types of most productive and key containers; and iii) to estimate the effects of climatic factors on Aedes abundance in the city of Dhaka, Bangladesh. Entomological surveys were conducted in 12 out of 90 wards in Dhaka. These wards were selected using a probability proportional sampling procedure during the monsoon seasons in 2011, 2012 and 2013 and in the dry season in 2012. All containers inside and around sampled households were inspected for mosquito larvae and pupae, and containers were classified according to their relative size, use pattern, and materials of construction. During the study period (2011-2013), 12,680 larvae and pupae were collected. About 82% of the identified immature mosquitoes were Aedes aegypti, while the remainder were Ae. albopictus and other mosquito species. The largest number of immature mosquitoes was collected from tires and refrigerator trays during 2011 and 2012 monsoon seasons. Conversely, plastic drums were the most productive during the 2012 dry and 2013 monsoon season. Vehicle parts and discarded construction materials were the most efficient producers of Aedes mosquitoes in all surveys. The presence of Aedes mosquitoes was significantly (p < 0.05) higher in low socio-economic zones of Dhaka. Container location, presence of vegetation, and availability of shade for containers were also significantly associated with finding immature Aedes mosquitoes, based on multivariable analysis after confounder adjustment. Rainfall, temperature, and relative humidity also significantly affected the mean abundance of mosquitoes. Proper use, disposal, and recycling of the containers that effectively produce large numbers of Aedes vector mosquitoes may decrease the risk of arboviral transmission.

Dengue seroprevalence, seroconversion and risk factors in Dhaka, Bangladesh

BACKGROUND

Dengue virus (DENV) activity has been reported in Dhaka, Bangladesh since the early 1960s with the greatest burden of dengue fever and dengue hemorrhagic fever cases observed in 2000. Since this time, the intensity of dengue activity has varied from year to year, and its determining factors remained relatively unknown. In light of such gaps in knowledge, the main objectives of this study were to determine the magnitude of seroprevalence and seroconversion among the surveyed population, and establish the individual/household level risk factors for the presence of DENV antibodies among all age groups of target populations in the city of Dhaka.

METHODOLOGY/PRINCIPAL FINDINGS

Considering the lack of fine scale investigations on the factors driving dengue activity in Bangladesh, a prospective cohort study involving serological surveys was undertaken with participant interviews and blood donation across the city of Dhaka in 2012. Study participants were recruited from 12 of 90 wards and blood samples were collected during both the pre-monsoon (n = 1125) and post-monsoon (n = 600) seasons of 2012. The findings revealed that the seroprevalence in all pre-monsoon samples was 80.0% (900/1125) while the seropositivity in the pre-monsoon samples that had paired post-monsoon samples was 83.3% (503/600). Of the 97 paired samples that were negative at the pre-monsoon time point, 56 were positive at the post-monsoon time point. This resulted in a seroprevalence of 93.2% (559/600) among individuals tested during the post-monsoon period. Seroprevalence trended higher with age with children exhibiting a lower seropositivity as compared to adults. Results from this study also indicated that DENV strains were the only flaviviruses circulating in Dhaka in 2012. A multivariate analysis revealed that age, possession of indoor potted plants, and types of mosquito control measures were significant factors associated with DENV seroprevalence; while attendance in public/mass gatherings, and use of mosquito control measures were significantly associated with DENV seroconversion after adjusting for all other variables.

CONCLUSIONS/SIGNIFICANCE

Our study suggests that there is a high level of endemic dengue virus circulation in the city of Dhaka which has resulted in significant DENV seroprevalence among its residents. Seropositivity increased with age, however, a substantial proportion of children are at risk for DENV infections. Our serological analysis also documents considerable DENV seroconversion among study participants which indicates that a large proportion of the population in the city of Dhaka were newly exposed to DENV during the study period (pre-and post-monsoon 2012). High levels of seroconversion suggest that there was an intense circulation of DENV in 2012 and this may have resulted in a significant risk for viral associated illness. Findings of our study further indicated that home-based interventions, such as removing indoor potted plants and increased bed net use, in addition to vector control measures in public parks, would reduce exposure to DENV and further decrease risk of viral associated disease.

Socioeconomic and Ecological Factors Influencing Aedes aegypti Prevalence, Abundance, and Distribution in Dhaka, Bangladesh

This study examined household risk factors and prevalence, abundance, and distribution of immature Aedes aegypti and Aedes albopictus, and their association with socioeconomic and ecological factors at urban zonal and household levels in the city of Dhaka, Bangladesh. During the 2011 monsoon, 826 households in 12 randomly selected administrative wards were surveyed for vector mosquitoes. Results revealed that the abundance and distribution of immature Ae. aegypti and Ae. albopictus, and pupae-per-person indices did not vary significantly among the zones with varied socioeconomic status. Of 35 different types of identified wet containers, 30 were infested, and among the 23 pupae-positive container types, nine were defined as the "most productive" for pupae including: disposable plastic containers (12.2% of 550), sealable plastic barrels (12.0%), tires (10.4%), abandoned plastic buckets (9.6%), flower tub and trays (8.5%), refrigerator trays (6.5%), plastic bottles (6.4%), clay pots (4.9%), and water tanks (1.6%). When the function of the containers was assessed, ornamental, discarded, and household repairing and reconstruction-related container categories were found significantly associated with the number of pupae in the households. The purpose of storing water and income variables were significant predictors of possession of containers that were infested by vector mosquitoes.