Problem: Dengue Fever in Brgy. Sta.

Cruz

In thus survey, we would like to find out how much you know about Dengue and what to do in case of
dengue outbreak and how confident you feel you can carry behaviours that protect you and your family
from dengue fever.

RESPONDENT BACKGROUND:

NAME: GENDER:

AGE: DATE:

QUESTIONARE:

1. Where did you acquire the Dengue Fever?

Inside the house

School/workplace
Others (please specify) _______________________________________

2. Is this your first time having Dengue Fever?

Yes
No

3. How long did you experience the Dengue Fever?

1-3 days
3-7 days
More than 10 days

4. Which of the symptoms have you experienced during the fever?

Vomiting
High fever
Muscle pain
No idea
Others (please specify) ________________________________________

5. What are the effects of Dengue Fever to you?

Cannot perform daily activities

Cannot go to work/school
Cannot get up form bed
Cannot eat well
Others (please specify)
 6. How often do you clean your house and surroundings?

Everyday
Twice a week
Once a month
Never
Others (please specify) ______________________________________

Below are some recommendations to avoid having dengue fever. Please check (√) your answer of you
Agree, Totally Agree, Disagree and Totally Disagree in the following recommendations in the provided
boxes.

Agre Totally Disagree Totally

RECOMMENDATION e Agree Disagree

1. Educate the residents about the causes, signs and symptoms of

Dengue Fever.

2. Encourage people to clean their surroundings more often.

3. Advise people to avoid having stagnant water to avoid mosquitos.

4. Demonstrate proper cleaning and sanitizing the environment.

5. Brgy. Health Center and medicines should be accessible.