Journal of Infection and Public Health (2015) 8, 466—473

Knowledge, attitudes and preventive

behaviors related to dengue vector
breeding control measures among adults
in communities of Vientiane, capital of
the Lao PDR
Chanthalay Sayavong, Jiraporn Chompikul,
Somsak Wongsawass, Cheerwit Rattanapan ∗

ASEAN Institute for Health Development, Mahidol University, Salaya,

Phutthamonthon, Nakhonpathom 73710, Thailand

Received 2 September 2014 ; received in revised form 16 February 2015; accepted 8 March 2015

KEYWORDS Summary This research aimed to determine the knowledge, attitudes and pre-
Knowledge; ventive behaviors (KAP) of adults in relation to dengue vector control measures in
Attitude; the communities of Vientiane, the capital of the Lao PDR. A total of 207 respon-
Preventive behavior; dents were actively participating in this cross-sectional descriptive study in 2011.
Dengue vector; Representatives of households were interviewed face-to-face by six trained inter-
Community viewers using a structured questionnaire. KAP reliabilities of 0.89, 0.91 and 0.95
were reported in the pilot sample of 30 cases. The associations between each
independent variable and prevention behavior were tested with chi-square tests.
Multiple logistic regression was used to determine the factors that were significantly
associated with preventive behavior while controlling for the other variables. The
results revealed that 51.69% of the respondents had a high level of knowledge. More
than 94% of the respondents knew that dengue fever is a dangerous communicable
disease and that dengue fever is transmitted from person to person via mosquitoes.
More than half (56.52%) of the participants had positive attitudes toward vector

∗ Corresponding author. Tel.: +66 2441 9040 3x62; fax: +66 2441 9014.
E-mail addresses: cheerawit.rat@mahidol.ac.th, cheerawit@hotmail.com (C. Rattanapan).

http://dx.doi.org/10.1016/j.jiph.2015.03.005
1876-0341/© 2015 King Saud Bin Abdulaziz University for Health Sciences. Published by Elsevier Limited. All rights reserved.
Knowledge, attitudes and preventive behaviors among adults 467

control measures, and 52.17% exhibited a high level of preventive behavior in terms of
dengue vector control measures. Preventive behaviors were significantly associated
with information provided from sources that included health personnel (p = 0.038) and
heads of villages (p = 0.031) and with knowledge levels (p < 0.001). This study suggests
that proactive health education through appropriated mass media and community
clean-up campaigns should strengthen and encourage community participation, par-
ticularly in terms of addressing mosquito larvae in overlooked places, such as the
participants’ own homes, for example, in flower vases and ant traps.
© 2015 King Saud Bin Abdulaziz University for Health Sciences. Published by Elsevier
Limited. All rights reserved.

Introduction Methodology

Dengue fever (DF) is a viral infection that is Sampling method

transmitted by the bites of the Aedes aegypti
and Aedes albopictus mosquitos [1—4]. The World
Health Organization (WHO) has declared dengue
fever and dengue hemorrhagic fever endemic in the
Asian sub-continent [5]. Globally, dengue fever is
endemic in 112 countries around the world [6,7].
The estimated annual incidences of 50 million
dengue fever cases and 500,000 dengue hem-
orrhagic fever cases led to 22,000 deaths that
occurred primarily among children [8,9]. Thus far,
there is no promising vaccine in terms of the
prevention of the morbidity and mortality of the
dengue virus that is spread by arthropod vectors
[10,11].
Dengue fever poses potential risks to the popula-
tions of all 16 provinces, including the capital city
of Vientiane. More than 10,000 cases of dengue
fever and 40 deaths were reported in June 2013
in the Lao PDR, which represents 11.3 times more
cases than the number reported for the same
period in the previous year [12]. Urban areas
are particularly affected [13]. The epidemiology
and ecology of dengue fever are strongly associ-
ated with human habits [14,15]. Thus, evaluations
of people’s knowledge, attitudes, and practices
might be of great importance to improving inte-
grated control measures [16]. Moreover, community
knowledge and preventive behaviors regarding the
cause, transmission, prevention and treatment of
dengue fever are significant socio-cultural fac-
tors that have influenced the adoption of dengue
fever control measures [17—19]. However, few
studies have focused on the environmental fac-
tors that are related to people’s KAP regarding
dengue fever vector control and prevention. Hence,
this community-based study aimed to investigate
the knowledge, attitudes and preventive behav-
iors (KAP) toward dengue vector control measures
among adults in Vientiane, the capital of the Lao
PDR.
This cross-sectional survey was conducted among
adults who resided in Vientiane, the capital of the
Lao PDR. Two-stage stratified sampling was applied
to draw a sample that represented the target popu-
lation. Sampling units (households) were allocated
with the proportional to size method. Vientiane
consists of nine districts, which are further divided
into three zones; four center districts are classi-
fied as urban, three districts as semi-urban and two
districts as rural areas. The calculation of the sam-
ple size and a sampling diagram for this study are
presented in Eq. (1) and Fig. 1, respectively.
Z 2 p(1 − p) (1.96)2 (0.59)(1 − 0.59)
n= = = 189
E2 (0.07)2
(1)
where
n = the sample size
E = an acceptance error of 7%
Z = 1.96 (the standard normal score at the 95% con-
fidence interval)
p = 0.59 [7]
The sample size was increased by 10% to allow
for any missing or incomplete data that occurred
during data collection. Consequently, the required
sample size was at least 207 households.
The urban areas are composed of four dis-
tricts (i.e., D1, Chanthabouly; D2, Sikhottabong;
D3, Xaysettha; and D4, Sisattanak), and there are
two districts in rural area (i.e., D1, Packguem;
and D2 Sangthong). The Xaysettha district was
randomly selected from among the urban areas,
and Parkguem was randomly selected from among
the rural areas. Two villages (vs) were randomly
selected from each district, and 207 households
(HH) were then selected from the four villages.
Representatives of the households, including
included mothers, fathers or relatives of the
468
Vientiane Capital City
Urban area
D1 D2 D3 D4
60vs 32 vs 52 vs 40vs
Nongsangthor Nonsavang
102 HH 36 HH
Total 207 households
Figure 1 Sampling diagram of the study.
families were interviewed. Data collection was con-
ducted in Nongsangthor village in which dengue
fever is endemic, and the coverage of the pipe
water supply in Nongsangthor is 100%. Nonsa-
vang village is far from the center of Vientiane
city (approximately 2 km). Twenty percent of the
population uses use pipe water, and 80% use
underground water. These two villages are in dif-
ferent urban areas. Naxa village is off of the
main highway of the Lao PDR approximately 40 km
from Vientiane. All of the households in this vil-
lage use underground water. Maknao village is
situated along the Maekong River approximately
40 km from Vientiane. The people in these two
districts have different lifestyles, behaviors, and
occupations.
Instrument
The survey questionnaire comprised 38 questions
that were as divided into the following 5 parts:
(i) socio-demographic characteristics, such as age,
gender, position in the household, education level
and occupation; (ii) water supply source in the
household and home environment; (iii) sources of
information; (iv) knowledge (11 items rated on a 3-
point Likert scale); (iv) attitudes (14 items rated on
a 3-point Likert scale); and (v) preventive behavior
related to dengue vector breeding control meas-
ures.
Data collection
After acquiring the approval of the National Ethics
Committee for Health Research (No 003/NECHR)
of the Lao PDR, the questionnaire was pre-tested
for reliability by selecting 15 respondents from
an urban area and 15 respondents from a rural
area. The reliabilities for knowledge, attitudes and
C. Sayavong et al.
preventive behaviors were 0.89, 0.91 and 0.95,
respectively. Before collecting data, six research
assistants were standardized with a single-day
Rural area training program. Permission for the data collection
was obtained from the heads of the local pub-
D1 D2 lic health offices, the village chiefs and the Lao
53vs 37vs People’s Democratic Republic Ministry of Health.
Informed written consent was also obtained from
all eligible respondents. The face-to-face inter-
Naxa Maknao view required approximately 30 min. The field
33 HH 36 HH
survey was conducted from January 10th to 31st
of 2011.
Data analyses
The data were verified and entered using Epi
data. MINITAB version 14 was used for the statisti-
cal analysis. The percentages, means or medians,
standard deviations or quartile deviations are
presented as appropriate. Chi-square tests were
used to determine the associations of preven-
tive behaviors related to dengue vector control
measures with socio-demographic characteristics,
sources of information, knowledge and attitudes.
Multiple logistic regressions were used to deter-
mine the associations between the preventive
behaviors and the independent variables while
simultaneously controlling for other confounding
factors.
Results
Socio-demographic characteristics
A total of 207 of respondents were interviewed.
The average age was 41.99 years old. Slightly more
than half (56.04%) were females, and 42.03% of par-
ticipants were mothers. Approximately one-third
(33.82%) of the participants had completed pri-
mary school, and two-thirds had secondary school
level or higher educations. Generally, the primary
occupations were business-related. Approximately
two-third of the respondents were living in urban
area.
Regarding the sources of information, the
participants indicated that they acquired their
information mainly from local television (88.89%)
and radio (65.70%). Moreover, regarding the
sources of information from people (i.e., two-
way communication), the respondents indicated
that the main persons who provided resources
persons were health personnel (31.88%), heads
of villages (23.67%), village health volunteers
(13.35%) and educators in mobile services
(19.32%).
Knowledge, attitudes and preventive behaviors among adults 469

Table 1 Distribution of respondents by knowledge about dengue vector breeding control measures.
Knowledge Correct answer

Number Percent
Dengue fever transmission
High (≥median) 139 67.15
Low (<median) 68 32.85
Minimum = 2, maximum = 6 Median = 5 QD = 0.5
Cycle life of Aedes aegypti mosquito
High (≥median) 127 61.35
Low (<median) 80 38.65
Minimum = 0, maximum = 4 Median = 2 QD = 1
Breeding site control measure
High (≥median) 106 52.21
Low (<median) 101 48.79
Minimum = 1, maximum = 7 Median = 3 QD = 1
Protecting mosquito bite (2 itemsa )
High (≥median) 137 66.50
Low (<median) 70 33.82
Minimum = 1, maximum = 7 Median = 3 QD = 1
Overall knowledge level (11 itemsa )
High (≥median) 107 51.69
Low (<median) 100 48.31
Minimum = 5, maximum = 19 Median = 12 QD = 2
a Some items are multiple correct answers which the interviewers tell them to list all of them.

Note: QD = quartile deviation = (Q3 − Q1)/2.

Knowledge about dengue vector breeding Preventive behaviors related to dengue

control measures vector breeding control measures

Knowledge was assessed with the 4 sub-scales
shown in Table 1. We found that 67.15% of the par-
ticipants were knowledgeable about dengue fever
transmission. Among the participants, 61.35% knew
about the mosquito life cycle, and 66.50% knew
about protecting themselves from mosquito bites.
However, knowledge about how to control the
breeding sites of the disease vectors was fairly
adequate (52.21%). Consequently, regarding overall
knowledge about dengue vector control measures,
approximately half of the respondents (51.69%)
were knowledgeable.
Attitudes toward dengue vector breeding
control measures
More than 64% of the respondents had positive atti-
tudes toward community participation (Table 2).
Only 59.42% of the respondents reported using
insecticides to reduce the mosquito population or
prevent mosquito bites. Among the respondents,
67% had generally positive views of community cam-
paigns and education material support including
sand Abet.
Table 3 illustrates that the breeding site control
behaviors exhibited by the respondents were fair.
Half of the respondents performed only three of
the 8 preventive measures (the median was 3); i.e.,
28.99% of the respondents changed domestic water-
holding containers every week, and 42.03% covered
their domestic water-holding containers. More than
39% changed the water flower vases every week.
Two methods that were reported with lesser fre-
quencies were putting sand Abet® in the containers
(28%) and rearing fish in domestic water-holding
containers (14%). Few reported turning over pails
or buckets when they were not in use (38.65%). The
questionnaire also explored community-involving
behaviors and indicated that half of the respon-
dents performed only one of the activities (median
1) outside houses in areas such as vacant lands or
swamps with rubbish, such as tires, and empty con-
tainers, such as buckets. Approximately 16% turned
and covered such rubbish. Nearly half (46.38%)
cleaned up rubbish around their houses on a weekly
basis. Regarding the overall preventive behaviors
related to dengue vector control measures, 52.17%
exhibited good behaviors.
470 C. Sayavong et al.

Table 2 Distribution of respondents by attitude toward dengue vector breeding control measure.
Attitude Number Percent
Community participation
Positive (≥median) 134 64.73
Negative (<median) 73 35.27
Minimum = 13, maximum = 24 Median = 23 QD = 1.5
Chemical insecticide
Positive (≥median) 123 59.42
Negative (<median) 84 40.58
Minimum = 1, maximum = 9 Median = 7 QD = 1
Social support
Positive (≥median) 138 66.67
Negative (<median) 69 33.33
Minimum = 5, maximum = 10 Median = 9 QD = 0.5
Overall attitude (14 items)
Positive (≥median) 117 56.52
Negative (<median) 90 43.48
Minimum = 20, maximum = 42 Median = 38 QD = 2.5

Associations between knowledge, attitudes
and preventive behaviors
Table 4 indicates that the adults who had good
knowledge of dengue vector control measure were
7.62 times more likely to exhibit good over-
all preventive behavior regarding dengue vector
breeding control measures compared with those
with poor knowledge (95% CI OR = 4.11—14.12), and
this difference was highly significant with a p-
value <0.001. Regarding the overall attitudes about
dengue vector control measures, the adults with
positive attitudes were 1.26 times more likely to
exhibit good preventive behaviors regarding dengue
vector breeding control measures (OR = 1.26, 95%
CI = 0.73—2.19); however, this association was sta-
tistically insignificant.
Table 5 illustrates that the sources of infor-
mation, particularly heads of villages and health
care personnel, played a significant role in pro-
viding knowledge to people in the community.
These influences encouraged high levels of pre-
ventive behaviors among adults in the community
with adjusted odds ratios of 2.30 and 2.54,
respectively. After controlling for the sources of
information, the findings indicated that the adults

Table 3 Distribution of respondents by preventive behavior on dengue vector breeding control measure.
Preventive behavior Number (n) Percentage (%)
Controlling breeding sites
High (≥median) 149 71.98
Low (<median) 58 28.02
Minimum = 0, maximum = 8 Median = 3 QD = 1
Involving community activities
High (≥median) 195 94.20
Low (<median) 12 5.80
Minimum = 0, maximum = 3 Median = 1 QD = 0.5
Preventing from mosquito bite
High (≥median) 162 78.26
Low (<median) 45 21.74
Minimum = 1, maximum = 7 Median = 2 QD = 0.5
Overall preventive behavior
High (≥median) 108 52.17
Low (<median) 99 47.83
Minimum = 1, maximum = 14 Median = 7 QD = 1.5
Knowledge, attitudes and preventive behaviors among adults 471

Table 4 Association between knowledge, attitude and preventive behavior regarding dengue vector breeding
control measure.
Variables Frequency Preventive behavior Crude OR 95% CI for OR p-Value
High (%) (Low %)
Knowledge level
High 107 74.77 25.23 7.62 4.11—14.12 <0.001***
Low 100 28.00 72.00 1
Attitude level
Positive 117 54.17 47.83 1.26 0.73—2.19 0.407
Negative 90 48.89 51.11 1
* p-value <0.05.
** p-value <0.01.
*** p-value <0.001.

with good knowledge were approximately 6 times
more likely to exhibit good preventive behaviors
(95% CI = 3.27—12.01).
Discussion
This community-based study was conducted to
describe the knowledge, attitudes and preven-
tive behaviors related to dengue vector control
measures among adults in Vientiane and to iden-
tify the determinants of preventive behavior.
Regarding knowledge about dengue vector breed-
ing control measures, 67.15% of the adults were
knowledgeable. This finding is consistent with
those of many studies that have been performed
in general population, such as those in Pakistan
[6], Thailand [7,20], Malaysia [21] and Maldives
[22]. Higher proportions of adults provided cor-
rect answers about the cause of dengue being
from the bites of Aedes aegypti mosquitos and
the breeding sites of dengue vectors included
vacant lands, houses and abandoned factories.
However, the knowledge levels of urban and rural
residents were not found to be significantly dif-
ferent in this study. A literature review revealed
that female school students have less knowl-
edge [16] and that high levels of knowledge have

Table 5 Association between factors and preventive behavior on dengue vector breeding control measure by
multiple logistic regression.
Variables Adjusted odds ratio 95% CI of AOR p-Value
Lower Upper
Source of information
Health personnel
No 1
Yes 2.30 1.05 5.04 0.038*
Educators in mobile units
No 1
Yes 1.06 0.34 2.59 0.791
Health volunteers
No 1
Yes 1.04 0.34 3.24 0.940
Heads of villages
No 1
Yes 2.54 1.09 5.94 0.031*
Knowledge level
Low 1
High 6.26 3.27 12.01 <0.001***
AOR = adjusted odds ratio.
* p-value <0.05.
** p-value <0.01.
*** p-value <0.001.
472
been reported among health care professions in
Taiwan [23].
The sources of information about dengue fever
prevention and control that achieved the high-
est levels of coverage among the residents in the
capital city of Laos included mass media, such as
television and radio. Large television or radio cam-
paigns have achieved high levels of coverage in
many countries, such as Malaysia [24], Thailand
[7,20] and Jamaica [25]. There might be direct link
between knowledge and preventive behavior, but
dengue vector breeding site control measures are
probably only used by people who are experienced
with mosquito nuisance problems [26].
Regarding the preventive behaviors, better
water-holding container management has a sub-
stantial effect on the Aedes aegypti population
[7]. Major preventive behaviors are shared among
ASEAN countries such as the Lao PDR [13,27],
Thailand [7,10], and Malaysia [28]. The most used
methods are the installation of window and door
screens and the use of mosquito nets. Less than
half of the respondents covered domestic water-
holding containers with lids. These respondents
were less likely to perform some control meas-
ures, such as changing containers every week, using
Abet® sand and rearing fish to eat mosquito larvae.
However, this study did not investigate the fre-
quency of domestic water use because frequent use
of water might contribute to reducing adult infes-
tation in these containers. The results of this study
revealed that the people were less likely to pay
attention to changing the water in small artificial
containers, such as vases and potted plants, in their
own houses; thus, the personal communications
of health personnel and village health volunteers
might place more emphasis on this issue. The fre-
quency of self-protection from mosquito bites via
the use of repellents in Laos was approximately half
that compared to the frequency among people in
Maldives [22]. However, approximately one-third of
the adults in Maldives use mosquito coils during the
day and night. The risk of dengue infection might
be increased by the use of coils only at night. In the
future, health educators, such as village heads and
volunteers, should also emphasize this point.
In conclusion, closing the gaps between knowl-
edge and preventive behavior will remain an
important challenge for the implementation of
dengue control measures across people with dif-
ferent lifestyles and environment factors, such as
housing and domestic water resources [7,29]. This
study suggests that proactive health education via
appropriated mass media and community clean-
up campaigns should strengthen and encourage
community participation and specifically address
C. Sayavong et al.
mosquito larvae in overlooked places, such as
flower vases and ant traps, in people’s own homes.
Project managers, health planners, policy mak-
ers and local government need to apply greater
effort to implementing dengue fever control meas-
ures in communities to ensure those measures are
proactive and effective. ASEAN Dengue Days have
been held in Indonesia, Myanmar, Vietnam and the
Philippines in 2011, 2012, 2013 and 2014 to increase
public awareness [34], and this practice should be
implemented in other countries.
Conflict of interest
Funding: No funding sources.
Competing interests: None declared.
Ethical approval: Not required.
Acknowledgments
This research was supported by the CDC of
Thailand, the World Bank Laos and the Department
of Public Health Vientiane Capital.
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