Dengue in Brazil and Colombia: a study of knowledge, attitudes, and practices

Acceptability of a hypothetical dengue vaccine and the potential impact of dengue vaccination on personal vector control behavior: a qualitative study in Fortaleza, Brazil

BACKGROUND

Dengue is the most rapidly spreading viral vector-borne disease in the world. Promising new dengue vaccines have contributed to a growing consensus that effective dengue control will require integrated strategies of vaccination and vector control. In this qualitative study, we explored the perspectives of residents of Fortaleza, Brazil on acceptability of a hypothetical safe and effective dengue vaccine, specific drivers of dengue vaccine acceptance or hesitance, and the expected impact of dengue vaccination on their personal vector control practices.

METHODS

A total of 43 in-depth interviews were conducted from April to June 2022 with Fortaleza residents from a diverse range of educational and professional backgrounds, with and without recent personal experiences of symptomatic dengue infections. Data were analyzed using the principles of inductive grounded theory methodology.

RESULTS

Our findings indicate that knowledge of dengue transmission, symptoms, and prevention methods was strong across respondents. Respondents described willingness to accept a hypothetical dengue vaccine for themselves and their children, while emphasizing that the vaccine must be demonstrably safe and effective. Respondents expressed diverse perspectives on how receiving a safe and effective dengue vaccine might influence their personal vector control behaviors, relating these behaviors to their perception of risk from other Aedes mosquito-carried infections and beliefs about the role of vector control in maintaining household cleanliness.

CONCLUSIONS

Our study findings provide community-level perspectives on dengue vaccination and its potential impact on personal vector control behavior for policymakers and program managers in Fortaleza to consider as new dengue vaccines become available. With the introduction of any new dengue vaccine, community perspectives and emerging concerns that may drive vaccine hesitancy should be continuously sought out. Improved urban infrastructure and efforts to engage individuals and communities in vector control may be needed to optimize the impact of future dengue vaccinations and prevent rising cases of other arboviruses such as Zika and chikungunya.

Climate and fertility amid a public health crisis

One line of enquiry in demographic research assesses whether climate affects fertility. We extend this literature by examining the ramifications of climate conditions on fertility over a period of public health crisis in a highly unequal, urban middle-income country. We use monthly data for Brazil's 5,564 municipalities and apply spatial fixed-effects models to account for unobserved municipal heterogeneity and spatial dependence. Findings suggest that increases in temperature and precipitation are associated with declines in births. We also show that changes in response to climate conditions became greater during the Zika epidemic, particularly in urban areas. Combined, findings highlight the value of understanding the intersections between climate and fertility across geographic boundaries and during this public health crisis. Epidemics have become more important in people's lives with the recurring emergence of novel infectious disease threats, such as Zika and Covid-19.

Improving knowledge, attitudes, and practices on dengue and diarrhea in rural primary school students, their parents, and teachers in Colombia: A cluster-randomized controlled trial

BACKGROUND

Improved education on water-related diseases in schools could help to reduce disease burden. This paper presents specific results on knowledge, attitudes and practices (KAP) of a cluster-randomized controlled trial to reduce diarrheal disease and dengue entomological risk factors in rural primary schools in Colombia. The aim was to investigate whether enhanced educational interventions on dengue and diarrheal disease in schools could improve KAP scores related to these diseases in students and teachers in rural primary schools, as well as the students' parents.

METHODOLOGY/PRINCIPAL FINDINGS

A factorial cluster-randomized controlled trial was carried out in 35 rural primary schools in two municipalities in Cundinamarca, central Colombia. Schools were randomized into four arms: interventions related to diarrheal disease (DIA), dengue (DEN), both (DIADEN), or no interventions (control, CON). Both educational and physical interventions to reduce risk factors of dengue and diarrhea were implemented. Comprehensive teachers' manuals were developed and deployed to guide the learning activities. The intervention was carried out over two school years. The knowledge scores of students receiving dengue interventions (DEN, DIADEN) increased by 1.16 point score (0.75-1.56, p<0.001) and those receiving diarrhea interventions (DIA, DIADEN) increased by 1.15 point score (0.67-1.63, p<0.001). The attitude and practice scores of students receiving the diarrhea interventions increased (Attitudes: 0.41 [0.11-0.71, p = 0.01]; Practices: 0.33 [0.01-0.65, p = 0.042]), but not for those receiving the dengue interventions (p = 0.31 and p = 0.08, respectively).

CONCLUSIONS/SIGNIFICANCE

There were increases in knowledge scores among students, their teachers and their parents for both diseases. However, the attitudes and practices components were not affected to the same extent. The hypothesis that the students would disseminate knowledge acquired from the educational interventions to their parents was confirmed for dengue, but not for diarrhea.

TRIAL REGISTRATION

ISRCTN40195031 The trial is registered in the Current Controlled Trials under Infections and Infestations category.

Knowledge, attitudes, and practices about dengue among pupils from rural schools in an endemic area in Colombia

INTRODUCTION

Dengue is a public health problem in tropical and subtropical regions of the world. Studies on dengue in rural areas are scarce since the disease is considered mainly urban.

OBJECTIVE

To determine the knowledge (K), attitudes (A) and practices (P) of dengue in an endemic area in Colombia.

MATERIALS AND METHODS

We conducted a cross-sectional study with 515 pupils (7-16 years old) in 34 rural schools in Anapoima and La Mesa municipalities during 2011. Each KAP category was evaluated independently by a scoring system and then categorized into high, medium or low.

RESULTS

Pupils recognized knowledge variables such as the symptoms (fever, bone pain), transmission route (mosquito bites), and mosquito breeding sites (uncovered water tanks, solid waste). Average scores on attitude were high in both municipalities indicating a well-developed perception of disease severity. Seeking treatment in medical centers and self-medication for fever management and the use of mosquito net and space-spraying of insecticides were the most frequently identified practices.

DISCUSSION

This is the first KAP dengue study performed in a rural area in Colombia and as such it contributes to the understanding of dengue perceptions by the inhabitants of these areas. It showed a medium level of knowledge about dengue and a lower level of preventive practices in pupils from rural schools. It also showed that pupils considered space-spraying as crucial for vector control. The presence of the vector in rural areas of the country underlines the need to improve surveillance and education to more effectively control the vector and promote prevention methods including community participation.

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.

Factors Associated with Dengue Virus Infection and Reinfection in Asymptomatic Children in Two Colombian Municipalities

Dengue is the most important arbovirosis in the world. In this study, we assessed the knowledge, attitudes, and practices (KAP) regarding dengue in parents from two small Colombian municipalities in the Cundinamarca Province. Parents and their healthy children from 4 to 14 years of age were included in some public elementary schools. After a medical examination, blood samples were taken for diagnosis of dengue using enzyme-linked immunosorbent assays (capture immunoglobulin M and capture immunoglobulin G [IgG], indirect IgG and detection non-structural viral protein 1) and detection of viral RNA by reverse transcription polymerase chain reaction. In addition, a KAP survey was applied to the children's parents or tutors. The indirect IgG test determined that of the 347 examined children, 87.9% had a previous infection with the dengue virus (DENV), 12.7% of them were positive for viral RNA (asymptomatic infection), and 32.0% presented reinfections. Risk factors evaluation showed that children aged 8 years and older living in the municipalities for more than 7 years were more likely to be infected or reinfected by DENV. In the same way, poor nutrition, lack of water supply, sewer service, or waste disposal services could raise the likelihood of dengue infections. The surveys indicated that parents have unhealthy practices and a low knowledge about the transmission of the disease, which could result in an increase of mosquito breeding sites, allowing sustained dengue transmission.

Experience and perception of risk associated with knowledge, attitudes and practices regarding dengue in Riohacha, Colombia

Recognition of the determinants of knowledge, attitudes and practices (KAP), which could be conditioned by the experiences and perceptions of the population at risk, is essential for the control of dengue. The scope of this article is to estimate the relationship between the risk perception and dengue diagnosis experiences with KAPs on dengue in an endemic Colombian population. A cross-sectional study with multi-stage random sampling was conducted. Adjusted prevalence ratios (aPR) were estimated using regression models as measures of association. Of the 206 families interviewed, 7% know dengue is caused by a virus and less than 40% recognize other symptoms besides fever. As control strategies, 31% eliminate hatchery sites and 58% use fumigation, though 73% perceive the risk of dengue. The association was identified between the perception of the risk of dengue and knowledge about the vector (aPR = 3.32 CI95% 1.06-10.36), and the experience of diagnosis of dengue with the attitude towards dengue control (aPR = 1.61 CI95% 1.09-2.37). Risk perception and experience with dengue could become determinants of KAPs in relation to this disease.