KNOWLEDGE, ATTITUDE AND PRACTICES ABOUT DENGUE OF HIGH SCHOOL

STUDENTS: BASIS FOR DENGUE PREVENTION PROGRAM

PRINCESS H. BUHAT

MAT- GENERAL SCIENCE

 KNOWLEDGE, ATTITUDE AND PRACTICES ABOUT DENGUE OF HIGH SCHOOL

STUDENTS: BASIS FOR DENGUE PREVENTION PROGRAM

Chapter 1

Introduction to the Study

Chapter 1 includes: (1) Background and

Theoretical Framework of the Study, (2) Statement of Problem and

Hypothesis, (3) Significance of the Study, (4) Definition of

Terms, and (5) Delimitation of the Study.

Part One, Background and Theoretical Framework

of the Study, presents the rationale for selecting the present

problem and the study’s frame of reference that strengthens the

reason for investigation.

Part Two, Statement of the Problem and

Hypotheses, states the general and specific problems addressed

in the study and the hypotheses to be tested.

Part Three, Significance of the Study, describes

the benefits each end-user may derive from and how each can

profit from the results.

 Part Four, Definition of Teams, defines both

conceptually and operationally key terms and variables used in

the study.

Part Five, Delimitation o the Study, specifies

the limits as well as boundaries of the research in terms of the

variables research design, participants, sampling procedure,

data-gathering instruments, and statistical tools used in the

analysis of the Data.

Background and theoretical framework of the study

Dengue fever is caused by a mosquito-borne human viral

pathogen that belongs to the genus Flavivirus of the family

Flaviviridae (single-strand, non-segmented RNA viruses). There

are four dengue serotypes (DEN-1, DEN-2, DEN-3, and DEN-4)

Dengue fever predominantly occurs in Southeast Asia, the

Americas, Africa and the Caribbean Islands. There has been a

gradual global upsurge in the number of dengue cases in the last

decade. Dengue is transmitted in humans by two species

of Aedes mosquitoes namely, Aedes aegypti (principal vector)

and Aedes aldopictus. Although infection with one dengue

serotype confers lifetime immunity against reinfection by the

same serotype, there is no evidence of cross immunity.

Therefore, it is possible for one to be infected with dengue

fever several times during one’s lifetime. There are two main
forms of dengue disease, dengue fever and the more severe dengue

hemorrhagic fever (DHF). Infection with any of the four

serotypes can produce a broad range of clinical manifestations

including asymptomatic infection, mild flu-like symptoms, and

the more severe hemorrhagic fever. The hemorrhagic fever usually

results when someone who had prior infection with a particular

dengue serotype becomes infected with a different serotype. The

cross reaction of antibodies to the dengue antigens is thought

to result in this disease. In severe cases, patients may

suddenly deteriorate, develop hypothermia and go into

circulatory shock, a condition known as dengue shock syndrome.

This syndrome is associated with 40–50% fatality if untreated or

mistreated. When properly treated, the case fatality can be

reduced to 5% or less. Every year, there are more than 100

million cases of dengue worldwide and of these, 2000–3000 cases

(mostly children) result in death. In tropical areas where

dengue fever is endemic, dengue hemorrhagic fever is confined to

children younger than 15 years of age. However, in the Caribbean

and Latin America, all ages are affected with highest incidence

among those under 15 years old. Treatment for dengue fever

entails mainly supportive therapy. Because there is no vaccine

to protect against this disease, great emphasis is placed on

control and preventive measures.

 Statement of the problem and the hypotheses

This study aimed to determine the knowledge, attitude and

practices about dengue of high school students: basis for dengue

prevention program

Specifically aimed to answer the following questions:

1.

Significance of the Study

The study can provide, more information to the knowledge,

Attitude, and Practices about Dengue of High School Students:

Basis for Dengue Prevention Program.

Students.

Knowledge.

Attitude.

Practices.
 Definition of Terms

In order for the reader and viewer to obtain a clear

understanding and knowledge of the study, the following key

terms were defined conceptually and operationally.

Dengue is a mosquito-borne viral infection causing a severe flu-

like illness and, sometimes causing a potentially lethal

complication called severe dengue. The incidence of dengue has

increased 30-fold over the last 50 years.

Knowledge it is facts, information, and skills acquired by a person

through experience or education; the theoretical or practical

understanding of a subject.

Attitude a settled way of thinking or feeling about someone or

something, typically one that is reflected in a person's behavior.

Practices it is the actual application or use of an idea,

belief, or method, as opposed to theories relating to it. "the
principles and practice of teaching"

Students it is primarily a person enrolled in a school or other

educational institution who attends classes in a course to

attain the appropriate level of mastery of a subject

Prevention is the action of stopping something from happening or

arising.
 Scope and Delimitation of the Study

The Study was limit to the 300 respondents in different

schools to determine the Basis for Dengue Prevention Program.

The researchers utilized the descriptive-Correlation survey as

the method of investigation to provide descriptive information.

The gathered data were analyzed and interpreted with the

use of statistical tools such as frequency count, percentage,

means and t-test.

Theoretical Framework

This theory is anchored on practical view of the initiative

that have been taken in this field. Dengue is a disease caused

by four separate but related viruses transmitted by mosquitos.

In this systematic review, we aimed to describe dengue research

in the Philippines, where the disease is of great concern, to

better understand the types of dengue research and the main

findings and important gaps. We identified 135 studies that

described dengue research in the Philippines during the past 60

years. Our review showed that in the early years, dengue studies

were mainly simple descriptive studies and case reports.

Recently the types of investigations have become more complex

and diverse, reflecting advancement in local research capacity

and infrastructure but more research activity would be

beneficial in several areas.

 Dengue is a mosquito-borne, acute febrile illness that is

an important public health problem in tropical countries. In the

early 1950’s, the disease was described in the Philippines as

hemorrhagic fever or infectious acute thrombocytopenic purpura

[1, 2]. Dengue continues to cause considerable concern in the

country because of its widespread endemicity, the minimal

success of vector control strategies, the possibility of severe

disease caused by sequential infection by a different serotype,

the potential for fatal outcomes and the consequent social and

economic burden. The four dengue virus serotypes circulate in

the country where the disease is predominantly reported among

children [3].

Findings from dengue studies could provide policy-makers

with information needed for rational decision-making regarding

dengue preventive and control efforts. The focus of dengue

research may vary widely. This could include basic laboratory

research, the estimation of dengue seroprevalence and incidence;

the assessment of risk factors for severe disease; the

quantification of its economic burden; the elucidation of local

transmission and epidemiology; the development of improved

diagnostic tests or the evaluation of interventions. We reviewed

published studies on dengue research in the Philippines during

the past 60 years. The objective of the review is to better

understand the trends in dengue research and the findings from

 these studies. The results of the review could provide an

impression of local capacity and infrastructure for dengue

research and help determine important knowledge gaps. These gaps

need to be identified since research interest and support for

funding can only be achieved if scientists, decision makers and

other stakeholders are able to understand developments related

to the disease and recognize areas where more information is

needed.

Conceptual Framework

The following conceptual framework illustrated in the Figure 1.

The Knowledge, Attitude, and Practices about Dengue on High

School Students. Basis for Dengue Prevention Program.

Schematic Diagram

Independent Variable Dependent Variable

a. knowledge Dengue Prevention

Program
b. Attitude

c. Practices

Figure 1. Schematic Diagram Showing the relationship between

dependent and independent variable.

 CHAPTER II

REVIEW OF RELATED LITERATURE

This chapter presents the local and foreign related

studies. Related literature was reviewed to point out relevant

of this study to existing knowledge on the problems stated.

Local Literature

To date, there has been no known cure for Dengue Fever

(DF), the world’s fastest spreading mosquito-borne disease which

causes approximately 390 million cases per year and puts an

estimated 3.9 billion people at risk in 128 countries. Since DF

epidemiology and ecology are strongly associated with human

habits and activities, community-based studies have been done to

assess the knowledge, attitude and practices (KAP) of people on

DF.

Several community-based KAP studies have investigated the

correlation among KAP domains. Harapan et al. reported that good

knowledge is positively associated with good practice. This is

parallel to the report by Alyousefi et al. that poor knowledge

on DF has significant positive association with poor preventive

practices. However, other similar studies had different results.

Kumaran et al. and Shuaib et al. reported that knowledge on

causes, signs, symptoms, mode of transmission and preventive

practices against DF is not correlated with the practice of

preventive measures against DF. Aside from these, two case-

control studies reported which preventive practices are

protective factors against DF. Regression models revealed that

removing trash and stagnant water from around the residence,

using mosquito repellent oils, use of mosquito bed nets,

fumigation inside the house, and piped water inside the house

can reduce the risk and vulnerability to DF infection.

Most of the KAP studies have included only community-based

samples and investigation on hospital-based samples with

clinical or serologically-confirmed DF diagnosis has not been

done. Chen et al. interviewed patients who were randomly sampled

from a web-based reporting system through telephone interviews.

However, this method limits the collection to individuals and

households with telephones. It also had 50% response and

completion rate among respondents. On the other hand, face to

face interview with questionnaire would obtain good response and

acceptance rate (99%) and a low refusal rate (1%) among in- and

out-patients. Kenneson et al. also did clinical ascertainment

and community screening to interview households with and without

DF infections by identifying acute or recent DF infections.

However, the data collected among households with acute or

recent DF infections suggested self-report bias, as members of

these households may have already acquired knowledge, changed

their behaviour or attitude towards DF during their

surveillance. Therefore, hospital-based surveillance, compared

with community-based surveillance, would allow us to capture

patients’ knowledge and attitude and their family’s/household’s

practices against DF during hospitalization (acute phase

[febrile-critical] of the infection [2-7 days] from the onset of

fever.) Previous KAP studies have also reported that

sociodemographic data like income, employment, education,

marital status, religion, sex, age, location, socio-economic

status, type of residence and DF history were associated with

KAP. However, to our knowledge, no study has investigated the

association between clinical parameters (e.g. diagnosis,

platelet count), clinical symptoms (e.g. fever, rash, abdominal

pain) and KAP, more so, the difference of determinants of KAP

between paediatric and adult patients with DF. Since adults

exhibit higher incidence of the severe forms of DF compared with

children, clinical presentations of symptoms may also be

significantly different between paediatric and adult patients

with DF. Vomiting and skin rash were more prevalent among

children while myalgia and arthralgia, nausea, thrombocytopenia

were more exhibited by adult patients with DF .

Based on the literatures presented, we hypothesized that

paediatric and adult patients’ knowledge and attitude on DF

would not have significant positive relationship with their

practices against DF, compared with the youth and adult

controls. We also hypothesized that paediatric and adult

patients with DF may have different determinants of KAP by

socio-demographic profile like age, gender and education. In

addition, clinical symptoms as determinants of KAP will be

different between paediatric and adult patients with DF.

Vomiting and skin rash would determine high KAP among paediatric

patients with DF while myalgia and arthralgia, nausea,

thrombocytopenia would de determinants of high KAP among adult

patients with DF. With all these, we hypothesized that

paediatric and adult patients with DF would have lower levels of

KAP domains than the youth and adult controls, which would also

give us hints on which KAP domain have aggravated the

acquisition of the infection. Therefore, this study aimed to

assess and compare the KAP of paediatric patients and adult

patients with DF, paediatric patients with DF and youth control

and adult patients with DF and adult controls. We also sought to

identify the determinants of KAP domains by socio-demographic

profiles, clinical parameters and symptoms, analyse the

relationship among the KAP domains, and identify protective

factors against DF.

According to Begonia C. Yboa, Leodoro J. Labrague.Dengue fever

(DF) is a mosquito-borne viral infection causing a severe flu-

like illness and, sometimes causing a potentially lethal

complication called severe dengue transmitted by bites of

Aedes aegypti and Aedes albopictus mosquito. Dengue fever

(DF) is caused by any of four closely related viruses, or

serotypes: DENV 1, DENV 2, DENV 3, and DENV 4. Symptoms of

infection is characterized by a sudden onset of high

fever (103- 106°F), severe headache, backache, intense pain in

joints and muscles, retro-orbital pain, nausea and vomiting and

a generalized erythematous rash that usually begin 4-7 days

after the mosquito bite and typically last 3-10 days.

However, infection with a dengue virus serotype can also produce

a more complex and severe form of clinical manifestations

like hemorrhage and shock.

In the recent years dengue fever has become international

global public health concern as there has a dramatic

increase of cases of dengue in tropical and subtropical

regions around the world, predominantly in urban and

semi-urban areas. According to the World Health

Organization, dengue fever in its severest form is a leading

cause of serious illness and death among children in some Asian

and Latin American countries - is endemic in more than 100

countries. It is estimated that 50— 500,000 cases of dengue

fever occur worldwide. Out of the 2.5 billion people at risk

globally; about 1.8 billion or more than 70 percent of them live

in the Asia-Pacific region . Emergence of dengue could be

the result of growing levels of urbanization,

international trade and travel which disseminate both vector

and viruses. The first confirmed epidemic of dengue fever

was recorded in the Philippines in 1953-1954. Since then,

several strategies had been formulated to contain the

spread and increasing incidence of dengue . In the

recent years, significant numbers of dengue cases were

recorded in the Philippines. The National Epidemiology

Center of the Philippines' Department of Health reports a total

of 132,046 dengue cases from January to 13 October 2012. This is

24.92% higher compared to the same time period in 2011. Of the

total cases, 20.42% came from the National Capital Region (NCR),

with highest contributors from Quezon City (7 754 cases), Manila

(4 379 cases) and Caloocan City (2 967 cases). Next to NCR,

Region III and Region IV-A registered the highest number

of cases, which are 15.79% and 15.66% respectively, to the

overall figure. The World Health Organization and Centers

for Disease Control and Prevention (CDCP) recommends

extensive community educational campaigns that emphasize

reducing vector breeding sites as an effective way of dengue

prevention

Dengue, a mosquito borne, arboviral disease has become a

major cause of health concern in the recent times throughout the

world. In India, we have been witnessing annual outbreaks for

the past few years and lack of knowledge about prevention and

treatment of dengue among majority of the population leads to

increased mortality. Apart from Delhi, many cases of dengue have

been reported from Punjab. In spite of this fact, very few

studies have been done to know about the knowledge of people

regarding dengue fever and whether proper preventive measures

are being practiced by the community to limit its spread. The

objective of the study is to assess the knowledge, attitude &

practices (KAP) regarding dengue in factory workers in Amritsar,

Punjab.

Practice Essentials

Dengue is the most common and important arthropod-borne

viral (arboviral) illness in humans. It is transmitted by

mosquitoes of the genus Aedes, which are widely distributed in

subtropical and tropical areas of the world (see the image

below). The incidence of dengue has increased dramatically in

recent decades, with estimates of 40%-50% of the world’s

population at risk for the disease in tropical, subtropical,

and, most recently, more temperate areas. Dengue is a disease of

many tropic and subtropics regions that can occur epidemically;

caused by dengue virus, a member of the family Flaviviride.

Dengue is transmitted in humans by two species of Aedes

mosquitoes namely, Aedes aegypti and Aedes albopictus. There are

four distinct serotypes of dengue virus which can all cause a

spectrum of disease, ranging from asymptomatic infection to the

most severe form of the disease Dengue Hemorrhagic Fever (DHF).

The symptoms of dengue infection are high fever, severe

headache, painful joints and muscles, vomiting, nausea, pain

behind the eyes and skin rashes. These symptoms almost last for

about one week, but weakness and tiredness may last for several

weeks. In some patient’s dengue fever leads to development of

DHF and the patient may reflect problems including blood in the

urine or stool, bleeding gums or bloody nose. These symptoms may

lead to death if untreated [1].

Dengue fever, also known as break bone fever, is an

infectious mosquito-borne disease which is caused by the dengue

virus and occurs in tropical and subtropical areas of the world.

The dengue virus belongs to the Flaviviridae family of viruses

that cause diseases in human. Dengue is a self-limiting disease

that clears up by it usually within a couple of weeks. The

incubation period for dengue is five to eight days. Researchers

are working on dengue fever vaccines, but the best prevention

for now is to reduce mosquito habitat in areas where dengue

fever is common.
 Hyperendemicity is the most common risk factor associated

with the emergence of DHF, also becoming a major cause of

hospitalization and death among children in several countries.

Dengue can affect anyone but people having compromised immune

systems are at higher risk of dengue infection. It is possible

to get dengue fever multiple times because dengue virus has four

different serotypes. Infection with one serotype confers long-

term immunity to that serotype but not to the others; therefore

individuals may be infected up to four times. When a mosquito

bites a dengue infected person the virus enters the mosquito and

when it bites another person, the virus enters that person's

bloodstream and the most fatal complication of dengue is when

bleeding started from nose, gums and inside body which can lead

to Dengue Shock Syndrome (DSS), a serious complication of DHF

that can lead to hypotension. Consequently, sudden death of

infected person can occur.

Millions of cases of dengue infection occur worldwide every

year. Dengue fever is the most common in Southeast Asia and the

western Pacific islands, but increasing rapidly in Latin America

and the Caribbean. Dengue fever is a major infectious disease

threat in tropical and subtropical areas, accounting for an

estimated 2.5 billion people at risk of infection and more than

100 million cases, with at least 15,000 deaths annually [6].

 Dengue’s become a public health concern owing to its

detrimental effects on the health of people. Though debates

regarding awareness of people regarding dengue fever continue to

concern researchers, more recently academic research has shown

concern about accessing knowledge of people regarding causes,

signs and symptoms, mode of transmission and preventive measures

of dengue. Several studies recommend that better knowledge of

dengue leads to better prevention techniques adopted by people

to prevent dengue. It is reported that people having high level

of knowledge regarding dengue, use better prevention practices

in order to avoid dengue. Begonia et al. conducted a study to

know knowledge of people about dengue fever. They found that

61.45 percent people had good knowledge about causes and

preventive measures regarding dengue. More than half of the

respondents used dengue preventive measures such as fans,

mosquito coil, and bed nets to avoid mosquitoes while only about

one third utilized insecticides sprays, screen windows and a

little portion used professional pest control. Findings suggest

that better knowledge does not necessarily lead to better

practice of dengue measures.

Situation in Pakistan

In Pakistan dengue fever was first reported in Karachi in 1994.

After that dengue endemic is spreading in Pakistan at faster

rate due to varied contributing factors including

overpopulation, urbanization which in turn leads to lack of

proper water management, lack of effective dengue control

programs and international travel and trade. National Guidelines

for Dengue Vector Control in Pakistan [12] revealed that from

1995 to 2004 only 699 cases of dengue were reported from three

districts of Pakistan.

A sudden rise in cases of dengue fever was witnessed in

year 2005 in Karachi. During the year 2010 16,580 cases of

dengue fever and 257 deaths were reported in Lahore and about

5000 survivors of dengue fever whereas 60 deaths were reported

from rest of the areas of Pakistan. In 2013, 6376 cases of

dengue fever and 23 deaths were reported from Swat, Pakistan.

Despite the efforts to control spread of dengue virus,

recent national survey data indicates that prevalence of dengue

among population is still on the rise and there is a high

mortality rate due to dengue fever in Pakistan. This is evident

that by providing knowledge about dengue and preventive measures

to people dengue infection can be avoided. There is a dire need

to aware people about dengue virus in order to knock back this

epidemic. That’s way awareness campaigns are launched all over

the world including Pakistan to aware people about dengue virus.

The main purpose of this research was to check the level of

awareness about dengue among university student in Azad Kashmir.

It is much important to aware everyone because any one’s

irresponsibility can give chance to grow dengue mosquito, which

can eventually effect the whole area. There are very few studies

aimed at assessing the level of awareness regarding dengue fever

in Pakistan although such information is necessary for better

interventions to control dengue. Notably, in Azad Kashmir study

concerning this issue is never carried out before. Keeping in

view the importance and research gap on the problem the present

study was designed in order to check level of awareness of

people regarding dengue and preventive measures.

Dengue is an important public health problem in the Philippines.

We sought to describe the trends in dengue research in the

country. We searched four databases and identified published

studies on dengue research in the Philippines during the past 60

years. We reviewed 135 eligible studies, of which 33% were

descriptive epidemiologic studies or case series, 16% were

entomologic or vector control studies, 12% were studies on

dengue virology and serologic response, 10% were socio-

behavioral and economics studies, 8% were clinical trials, 7%

were on burden of disease, 7% were investigations on markers of

disease severity, 5% were on dengue diagnostics, and 2% were

modeling studies. During the last decade, dengue research in the

Philippines has increased and evolved from simple descriptive

studies to those with more complex and diverse designs. We

identified several key topics where more research would be

useful.

Dengue is a disease caused by four separate but related

viruses transmitted by mosquitos. In this systematic review, we

aimed to describe dengue research in the Philippines, where the

disease is of great concern, to better understand the types of

dengue research and the main findings and important gaps. We

identified 135 studies that described dengue research in the

Philippines during the past 60 years. Our review showed that in

the early years, dengue studies were mainly simple descriptive

studies and case reports. Recently the types of investigations

have become more complex and diverse, reflecting advancement in

local research capacity and infrastructure but more research

activity would be beneficial in several areas. According to

(Agrupis KA, Ylade M, Aldaba J, Lopez AL, Deen J (2019)

Dengue fever is thought to have circulated in the Caribbean

for more than 200 years, but it was not until 1950s that

virological evidence for this was available. By 1953–54, Den-2

was isolated in Trinidad and Tobago while Den-3 was isolated in

the 1960s from the Greater and Lesser Antilles. Den-1 was first

isolated from Jamaica in 1977 during an epidemic in which 60,000

cases were reported. About 4 years afterwards, Den-4 was

isolated and was partly responsible for the massive outbreak of

dengue which affected nearly half the population of Cuba in

1981. All four serotypes of dengue currently circulate in

Jamaica. More recently, in 1998, there were 1,551 cases of

dengue fever caused by the DEN-1 and DEN-3 strains. Forty-two of

these cases were DHF while 37 were a combination of dengue and

DHF. In 2006, there were 71 confirmed cases of dengue fever in

Jamaica , and there have been recent large outbreaks of the

disease in neighboring Cuba.

Tropical areas such as Jamaica provide a climate that is

conducive to breeding of dengue transmitting mosquitoes. Thus,

seasonal variations in temperature and rainfall correlate with

the levels of dengue infections. Increased numbers of dengue

cases are associated with elevated levels of rainfall and

temperatures. Given that dengue is a vector borne disease, many

initial attempts at curbing the disease were directed at vector

elimination using insecticides. However, chemical vector control

programs have limited feasibility due to insect resistance and

the cost of personnel required to maintain the programs.The WHO

and Centers for Disease Control and Prevention recommends

limited reliance on insecticidal control and emphasis on

community educational campaigns that emphasize residents’

responsibility in reducing vector breeding sites. This view is

supported by prior research showing that community education can

be more effective in reducing dengue vector breeding sites than

chemicals alone. The Jamaican Ministry of health classifies

dengue fever as a class 2 disease. Therefore it is given less

priority than a class 1 disease such as HIV/AIDS. This

prioritization is partly because of budgetary cut backs and

resource constraints. Dengue diagnosis is further hampered by

availability of only one poorly equipped laboratory in the

Island. Thus, samples have to be taken to Trinidad and Tobago

for analysis even during epidemics. This underscores the

reactionary approach towards dengue control in Jamaica.

Nevertheless, Jamaica has a well organized primary health care

system which integrates community based health education about

environmental control of vector with different levels of care.

Attempts have also been made in the past to achieve vector

control over limited geographical areas. These attempts were

however limited by the lack of sufficient funds. To date, only

two published studies have been conducted in the Caribbean to

assess Knowledge, Attitudes and Practices (KAP) related to

dengue fever and neither of these studies was conducted in

Jamaica. One survey study conducted in Grenada in 1996 found

that many people had adequate knowledge of dengue fever and

mosquitoes, but that knowledge of the important relationships

among mosquitoes, human behavior, and disease transmission was

sub-optimal. The other study conducted in Puerto Rico, was a

qualitative assessment of community beliefs and practices about

dengue. Some of the participants had suffered from dengue fever

and were identified through the surveillance system. The

investigators found that participants with previous dengue

diagnosis were more concerned about risk of the disease, had

better knowledge about disease prevention and recommended the

use of insect repellants more than participants who had never

been diagnosed with dengue.

Recent outbreaks of dengue in Jamaica and the paucity of

relevant studies on knowledge, attitudes and practices regarding

dengue transmission and infection necessitated development of

the study. Further, although investments have been made in media

campaigns to increase awareness about dengue by government, non-

governmental and private institutions in Jamaica, no assessment

has been conducted to determine the impact of such interventions

or to identify gaps in knowledge and practice regarding dengue

infection.

Dengue virus is a single-stranded RNA virus with four

serotypes (DENV 1–4) which belong to the genus Flavivirus of the

Flaviviridae family. The arbovirus commonly called break bone

fever4 is transmitted to humans by the Aedes aegyptimosquito

and Aedes albopictus Dengue fever is characterized by fever,

which lasts from 5 to 7 days with two or more symptoms:

headache, retro-orbital pain, myalgia, arthralgia, rash,

hemorrhagic manifestations, or leucopenia. Infection with

additional dengue serotypes increases the risk of hemorrhagic

disease, resulting in severe mucosal and gastrointestinal bleedi

ng, hypovolemia and potentially death. Population growth,

increased movement of individuals, rapid urbanization, limited

financial and human resources, environmental changes and

neglected (rural and slums) areas are attributed to vector

breeding and the rise in dengue outbreaks.

Dengue virus infection is found in tropical and sub-tropical

regions around the world, is increasingly recognized as one of

the world’s emerging infectious diseases and has become a major

international public health concern. The World Health

Organization estimated that about 2.5 billion people are at risk

for dengue fever and, in recent decades, its incidence rate

around the world has increased and become an important public

health issue. The actual numbers of dengue cases have been

underreported and misclassified. One recent estimate indicates

that there are 390 million dengue infections per year, of which

96 million manifest clinically with any severity of World Health

Organization disease classification (Dengue Fever, Dengue

Hemorrhagic Fever and Dengue Shock Syndrome). In the absence of

changes in other determinants, studies suggest that climate

change could expose an additional 2 billion people worldwide to

dengue transmission by the 2080s. An estimated 500,000 people

with severe dengue (DHF/DSS) require hospitalization each year

and about 2.5% of those affected will die. In addition, severe

dengue (DHF/DSS) remains a leading cause of hospitalization and

death of children in at least eight Southeast Asian

countries. In Africa, dengue fever outbreak has been reported

and confirmed in Mauritania, Senegal, and Ethiopia. Dengue is

likely under-recognized and under-reported in Africa due to low

awareness of health-care providers, other prevalent febrile

illnesses, lack of diagnostic testing, and systematic

surveillance.

Most researchers conducted previously were mainly in Asia and

focused on how community members view dengue infections;

however, there have been few attempts to date to better

understand the perspectives of clinicians.18–23 A study

conducted in Taiwan among health professionals towards their

knowledge on mosquito-transmitted diseases (Malaria, yellow

fever and dengue fever) showed significant knowledge

deficits. Similarly, in a study in Karachi, physicians had basic

knowledge but were lacking in clinical diagnosis and management

and needed training. Whereas a study conducted in Pakistan

showed that practitioners had a stronger understanding of dengue

patho-physiology than clinical diagnosis and treatment. Among

primary health-care professionals in Makkah (Saudi Arabia), more

than half of them had an excellent knowledge regarding clinical

presentation of dengue fever (DF) but insufficient knowledge

towards DF diagnosis. A study conducted in Abidjan (Cote

d’Ivore) among health professionals working in public hospitals

showed that one fifth of health professionals had a good

knowledge and good diagnostic practice of DF and three-quarters

of them knew dengue is a series illness. Treatment and

management of dengue with co-morbidities is a major health

problem, because it causes deaths. In major cities of Pakistan,

half of the physicians surveyed were not aware of the management

of dengue patients with liver disease and taking medicines like

metformin. A recent report showed that 60% of dengue cases had

co-morbidities. Hepatitis B and C were major risks to developing

dengue shock syndrome.

One of the HSDP-IV national strategy of Ethiopian is

prevention, control and elimination of malaria.The prevention

and control of dengue outbreak mainly depends on the

epidemiological surveillance of cases and mosquito

vectors. Dengue fever emerged for the first time in the eastern

part of the country and the outbreak continued in this area with

more than 12,000 cases reported to the World Health Organization

since 2013. Also a total of 6,192 new dengue fever cases were

reported from Gode of Somalia region, Hadar of Afar region and

Dire Dawa city administration in May 2014. And it becomes an

ongoing outbreak in Dire Dawa city administration and so far

about 106 cases were reported by the date of study onset in

2017.

Since there is no previous study done regarding the knowledge,

attitude and practice (KAP) of health-care professionals (HCPs)

towards dengue fever prevention and associated factors in

Ethiopia including the study area, this study expected to

provide evidence-based information in order to bridge the gaps

and be used as a milestone for policy makers to improve the

prevention of and control the outbreak of the disease.

Dengue is a viral vector-borne disease spread by the day-

biting mosquitos Aedes aegypti and Aedes albopictus. The global

number of people infected in 2010 was estimated to be 390

million, of which around 14% occurred in the

Americas.1 Venezuela is one of the countries with the highest

burden of dengue in the region,where severe disease and

recurrent epidemics on a background of perennial transmission

are a major public health problem.Maracay city has become one of

the most important endemic urban areas of the country with the

co-circulation of all four dengue serotypes.

No vaccine or specific antiviral treatment against dengue is

widely available yet. Therefore, the most effective way to

prevent and control the spread of dengue continues to be the

reduction or elimination of human–vector contact.Effective

vector control strategies include community-based larvae

control, adult mosquito management, and the use of personal

protection. Community-based larvae control consists of

environmental management, that is, alterations in the

environment to minimize vector breeding, especially in close

proximity with humans, and source reduction by application of

chemical larvicides in possible breeding containers before the

dengue season or during outbreaks in densely populated

areas. Adult mosquito management currently comprises chemical

insecticide spraying in areas where dengue cases are reported,

to reduce transmission by lowering the adult vector

population. In addition, the spread of the disease can be

reduced by using personal protection against mosquito bites, for

example, insect repellents or adult reduction devices, such as

mosquito-repelling vaporizing tablets. Individual and community

contributions to dengue control are of importance for the

success of dengue control programs; studies show that community

involvement in environmental management can reduce

the Aedes larval infestation indices in domestic areas.

However important, social mobilization in dengue control is

often difficult to achieve. It is challenging to motivate people

to prioritize dengue among other acute health and environmental

concerns, especially during interepidemic periods or when vector

breeding continues unabated in neighboring households or other

sites such as informal dumps. By revealing characteristics of

the community knowledge, attitude, and practices (KAP), a KAP

study can offer valuable information for the development of

health promotion approaches and suggest intervention strategies

that are specific to the sociocultural context in which they

have to take place.

Studies on KAP, mosquito breeding sites, and possible

associations between these components related to dengue are not

abundant in the Americas. Although most people in Venezuela are

aware of dengue as a disease, preventive measures to avoid

mosquito breeding sites are not always taken. To our knowledge,

there are no previous studies published on KAP and mosquito

breeding sites for dengue in Venezuela.

To improve dengue control of communities exposed to endemic

dengue transmission, we aimed to 1) describe KAP concerning

dengue, and 2) investigate determinants of a) personal

protection against mosquitoes and b) mosquito breeding site

elimination.
 CHAPTER III

Research design and Methodology

This chapter is categorized into three parts, namely: (1)

Purpose of the study and Research Design, (2) Method, and (3)

Statistical Data Analysis Procedure.

Part one, Purpose of the study and Research Design,

restates the purpose of the study describes the research design

and enumerates the variables used in the study.

Part two, Method, described the participants, the data

gathering instrument and the research procedure employed in the

study.

Part three, Statistical Data Analysis Procedure, discusses

the procedure for scoring and statistical tools used to test the

hypotheses.

Purpose of the study and Research Design

The main purpose of the study was to determine the

knowledge, attitude and practices of high school students about

the dengue of Dao National High School for the School Year 2019-

2020. The survey- correlation method of research was used in the

study. According to Fraenkel & Wallen (2005) survey is used as

descriptive method to further analyze the quality and accuracy

of the study objectives. Surveys can be useful when a researcher

wants to collect data on phenomena that cannot be directly

observed. Surveys are used extensively in library and

information science to assess attitudes and characteristic of a

wide range subjects. On the other hand, correlation research

investigates relationships between two or more sets of data.

This design likewise helps determine the extent to which

different variables are related to each other. David, (2002).

The independent variable in this study was the Knowledge,

attitudes, and practices while the dependent variable was the

Dengue prevention program.

The statistical tools used in the analysis of data were the

Methods