Knowledge, attitudes, and practices towards dengue prevention among primary school children with and without experience of previous dengue infection in southern Thailand

To develop more effective intervention strategies against dengue, it is necessary to identify determinants of knowledge, attitudes, and practices (KAP), which may be influenced by the dengue experiences of the population at risk. The aim of this study was to assess and compare KAP regarding dengue prevention between Thai primary school children with and without experiences of dengue. A cross-sectional study was conducted among children between ages 8 and 13, attending the 50 public primary schools in Kanchanadit district, between October and November 2019. A 32-item questionnaire was used to collect children's socio-demographic characteristics (4 items), health information (2 items), knowledge (10 items), attitudes (7 items), and practices (9 items) towards dengue prevention, which required 30 min to complete. The KAP between groups was then statistically compared, to identify possible causes of observed differences. Of 1979 children, 15.6% self-reported that they had been infected with dengue, while 84.4% had no history of the disease. Most children indicated that they obtained dengue-related information from primary school teachers (73.6%) and their parents (68.5%). No statistically significant differences in mean KAP scores were observed between children with and without dengue experiences (P > 0.05). When KAP scores were categorized as good or poor levels, based on an 80% cut-off, 12.3% of all children had good dengue-related knowledge, 41.6% had good attitudes, and 25.9% reported good preventive practices. Dengue experience was significantly and positively associated with exercising good preventive practices (odds ratio [OR] = 1.34, 95% confidence interval [CI]: 1.03-1.75, P = 0.031). There were significant positive correlations between attitudes and practices in both children with and without dengue experiences (P < 0.001). To enhance KAP towards dengue prevention, further efforts are needed to increase routine dengue health education programs for primary school students who have and have not experienced dengue, and to improve health education programs within communities, especially to assist guardians with the dissemination of dengue literature.

Developing and using a dengue patient care guideline for patients admitted from households to primary care units and the district hospital: A community participatory approach in Southern Thailand

BACKGROUND

Dengue has been an important health issue in southern Thailand. However, this area has only a surveillance-prevention system, without step-by-step guidelines on dengue treatment for patients admitted from households to primary care units (PCUs) and district hospitals. Therefore, this study were to develop and use a dengue patient care guideline (DPCG), and to evaluate knowledge, attitude, practice (KAP) of dengue patient care.

METHODS

26 health care providers (13 nurses, and 13 public health officials) from eight PCUs and the district hospital developed the DPCG. The study design was based on the community participatory action research that integrated the Iowa model involving the following steps: preparation, guideline development, use and monitoring, evaluation and conclusion, and referring technology. We assessed the improvement between before and after using the DPCG regarding the participants' KAP on patient care and preparedness of equipment. McNamara's test was used to compare the changing results before and after using the DPCG. Qualitative data collection was performed in two meeting discussions with six open-end items. Using a thematic analysis technique, we extracted conclusions and suggested solutions.

RESULTS

The guideline included four steps for patients' care provision at households, PCUs, outpatient departments, emergency rooms, and inpatient departments. After using the DPCG in 39 dengue patients of which 30 patients were admitted to the inpatient department1 and two patients were referred to the tertiary care hospital without mortality. The overall participants' knowledge and attitude, two of six aspects of patients' care, and three of eight types of equipment management were significantly improved (p < 0.05). Eleven themes were evaluated which were associated with the quantitative data.

CONCLUSION

The DPCG instructed dengue patient's care for health care providers from households to the PCUs and district hospital. All participants improved KAP, and equipment management. Step-by-step of DPCG use and participation of all stakeholders are needed.