Pak J Med Res Original Article

Vol. 52, No. 4, 201

2013

Perceptions and Practices for the Control of Dengue

Fever in Karachi - A School Based Survey
Sultana Habibullah, Junaid Ashraf
PMRC Research Centre, Dow Medical College, Karachi.

Abstract

Objectives: To determine the perceptions and practices for the control of Dengue fever in secondary school children of
Saddar town Karachi.
Study type and duration: Cross-sectional survey based on cluster sampling done over 6 months.
Subjects and Methods: Data was collected from 1320 secondary school children of both gender belonging to public and
private schools (total 14) of Saddar town, Karachi. A structured self administered questionnaire was used which included
variables like age, gender, class pass, knowledge of dengue fever, its control and preventive methods used at their homes.
Data was analyzed on SPSS version 15 and chi square was applied for statistical significance.
Results: Data was analyzed for 1270 students as others had incomplete information. Participation was 650(51%) from
public and 620(49%) from private schools. Majority 517(41%) of the students were 15-16 years old (mean 14.5 STD±1.6)
with male to female ratio of 1.1:1. About 890(70%) students had knowledge about dengue fever and its control methods
mostly received from television (82%). Though 72% knew that mosquito is the causative agent but only 13% were aware
of its biting habits. Almost 66% students believed that dengue infection could be controlled and 33% thought that
mosquito elimination is a good method to the control disease. Majority (90%) students stated that they keep water utensils
covered at their homes. Overall 59% students had good knowledge about dengue fever and its control methods but only
21% were practicing it.
Conclusion: School students had sufficient knowledge about dengue fever and its control but this knowledge did not
change their behavior was not translated into practice.
Policy message: Educational programmes should focus on translating knowledge into practice.
Key words: Dengue fever knowledge, practice, prevention and control methods.

Introduction urbanization and travel to areas having vector where

household water storage in tanks and pots is common and
engue infection is caused by a mosquito (Aedes solid waste disposable services are inadequate4.
D aegypti). It causes high grade fever and body aches
similar to flu but sometimes causes a potentially lethal
In Pakistan the first confirmed epidemic of
dengue fever occurred in Baluchistan in 1994 where
complication called Dengue Hemorrhagic Fever (DHF)1. majority of the cases were IgM positive for multiple
According to WHO, 50 million dengue infections occur dengue serotypes5. A major outbreak occurred in 2011 all
worldwide with disease being more endemic in Africa, over Pakistan with Punjab being maximally affected6.
America, Eastern Mediterranean, South East Asia and The potential mosquito breeding sites are homes and
Western Pacific regions2. During an epidemic of dengue schools and children are its principal targets7. School
infection almost 40% to 50% cases get exposed and this based education is therefore important for community
figure can reach as high as 80% to 90%. Globally almost education because of the presumed transfer of knowledge
500,000 people with DHF require hospitalization each year and practice from classrooms to homes and also because
with majority being children. Mortality occurs in 2.5% cases control measures such as source reduction require
which can be reduced to 1% with easier access to medical ongoing household activities8. The need to know the
care and having knowledge about dengue fever3. The spread perceptions and practice is therefore necessary to better
of dengue is attributed to its wider geographic distribution, address this health issue, therefore this study was design
for school children to find out their perceptions and
Corresponding Author: practices for the control of dengue fever.
Sultana Habibullah
PMRC Research Centre Subjects and Methods
Dow Medical College
Karachi. This cross-sectional survey was conducted in 14
Email: [email protected] secondary schools (7 public and 7 private) of Saddar

Pakistan Journal of Medical Research, 2013 (October - December) 102

 Sultana Habibullah, Junaid Ashraf

town, Karachi, in students of class VII to X. Based on through TV in 728(82%) newspaper 178(20%), family
anticipated population proportion of 50%, at confidence members 139(16%) and friends 99(11%). Other sources of
interval of 95 percent, 4% precision level and inflation dengue information are shown in Table-2.
level of 10% (to account for incomplete data) sample size
of 13209 was calculated, i.e. 660 from each public and Table 2: Source of information about dengue fever.
private schools. All secondary schools of Saddar town
Variables Public Private Total
were listed in two clusters public/private and seven School School n=890(%)
schools were then selected randomly from each cluster. Children Children
A structured self administered questionnaire was n=404 n=486
designed in Urdu which included variables like age, Television 306 422 728(82)
gender, last class passed, school public/private, Newspaper 50 128 178(20)
knowledge of dengue fever including the causative agent, Family members 43 96 139(16)
Friends 25 74 99(11)
breeding and biting habits, symptoms of disease, Radio 15 42 57(6)
methods of prevention and practice for dengue control. Magazine 13 42 55(6)
Permission was obtained from Directors and Principals of Pamphlet 16 23 39(4)
selected schools and consent obtained from students. Govt. awareness programmes 12 24 36(4)
Others 2 21 23(3)
Data collectors explained the objectives of the study to
the students and distributed questionnaire in their
classrooms which were collected after 15-20 minutes. About 913(72%) students knew that mosquito
Scientific Package for Social Sciences (SPSS) was the causative agent for dengue fever, 217(17%) knew
version 15 was used for data analysis, chi square at 0.05 body ache is the commonest symptom of disease,
alpha level used to test significance. 458(36%) stated that it can occur in any age group and
Excluding the background variables scores were 1028(81%) in any person. About mosquito biting and
given to each question on knowledge and practices for breeding sites, 548(43%) knew that the disease spreads in
the control of dengue fever. Maximum overall score for rainy season but only 168(13%) knew that this mosquito
knowledge was 20 and for practice 10. A score of 60% bites in morning and evening only. Clean water (56%)
and above was graded as good and 59 percent and less and flower vase (44%) as the favorite breeding site were
was graded as poor. known. Out of a total of 1270 students 840(66%) students
knew that dengue can be controlled. For the control
Results measures 122(296%) said that stored water should be
kept covered and tank water should be changed after
every seven days. For disease control elimination of
Data of 1320 secondary school children was
mosquitoes was suggested by 420(33%), using mosquito
collected from September to October 2012. There were
nets by 407(32%), using repellent/lotions by 292(23%)
660 students from 7 public and 660 from 7 private
and covering body by 270(21%) (Table-3).
schools. After cleaning the data 1270 record were finally
taken for analysis which included 650(51%) public and Table 3: Knowledge of control methods of dengue fever.
620(49%) private school children.
Out of 1270 students 263(21%) had passed class Variables Public Private Total
VI, 213(17%) class VII, 385(30%) class VIII and School School n=1270(%)
409(32%) class IX. Majority 517(41%) of the students Children Children
n=650(%) n=620(%)
were 15-16 years old with a mean age of 14.5 SD±1.6 and
male to female ratio of 1.1:1. Age and gender is shown in Mosquito elimination 206(32) 214(34) 420(33)
Mosquito nets 180(28) 277(37) 407(32)
Table-1. History of dengue fever in the last two years was Vaccination 107(16) 181(29) 288(23)
present in 15 students and 61 family members. Lotion 135(21) 157(25) 292(23)
Covering body 102(16) 168(27) 270(21)
Table 1: Age and gender distribution among school children. Drug 73(11) 72(12) 145(11)

Variables Male n(%) Female n(%) Total For the control of fever and body aches,
11-12 years 54(8) 100(17) 154(12) 254(20%) students said that ibuprofen was the most
13-14 years 221(32) 230(40) 451(35) effective drug, 1011(80%) students believed a dengue
15-16 years 319(46) 198(34) 517(41)
Above 16 years 96(14) 52(9) 148(12) patient in the family can spread the disease to other family
Total 690(54) 580(46) 1270(100) members. For the control of mosquito breeding sites 52%
said that it is the joint responsibility of the government and
the community.
Almost 890(70%) students had good information
Regarding practices for the prevention and
about dengue fever and its control which were received
control of dengue fever, 90% students said that they keep

103 Pakistan Journal of Medical Research, 2013 (October - December)

 Perceptions and Practices for the Control of Dengue Fever in Karachi - A School Based Survey

household water utensils covered and 62% changed water The study found that 59% students had overall
of flower vase daily. About 43% students used mosquito good knowledge for the control of dengue fever. Male
nets, 40% spray, 34% coils and 31% body lotions to students between 15-16 years who had passed class IX
protect themselves from mosquito bite (Table-4). About and belonged to the private schools had significantly
91% students agreed to co-operate with the government good knowledge about dengue control as compared to
dengue control program in their locality. their other counterparts (Table-5). Overall good practice
for the control of dengue fever was found in only 21%
Table 4: Practice for the control of dengue fever. students (Table-6).
Variables Public Private Total
School School n=1270(%) Discussion
Children Children
n=650(%) n=620(%) The present study showed that though students
Mosquito nets 286(44) 259(42) 545(43) had good knowledge about dengue infection however,
Insecticidal spray 243(37) 265(43) 508((40) they were not practicing what they knew. Control of
Mosquito coils 203(31) 231(37) 434(34)
Lotion 210(32) 185(30) 395(31) dengue fever is primarily based on source reduction.
Cleaning bath water 88(13) 130(21) 218(17) Although knowledge regarding the breeding and
Draining rainy 108(17) 139(22) 247(19) preventive methods is essential but alone it is not enough
water to achieve mosquito control unless it is translated into
Fumigation 68(10) 76(12) 144(11)
Other methods 36(5) 28(4) 64(5) practice or change behaviour10. In the present study 59 %
students had good knowledge about control of dengue
fever, similar findings were reported from South India,
Table-5: Overall good knowledge of dengue fever.
Brazil and Thailand where 90%, 78% and 67%
Variables Subjects % 95% Confidence p value respondents respectively knew about it11-13. Some studies
Interval from Jeddah and Karachi reported deficient knowledge
Age groups about dengue fever in secondary school children and
11-12 years 65 9 1.49-1.65 people of low socio-economic group14,15. In the present
13-14 years 262 35 1.37-1.46 study television and newspapers were found to be
15-16 years 340 44 1.30-1.38 <0.05
important means of information sharing. Though both
Above 16 years 84 12 1.35-1.51
Gender literate and illiterate benefit from television but only
Male 450 60 1.31-1.38 <0.05 literate people read newspaper and same was reported in
Female 301 40 1.44-1.52 other studies11,16. In this study though majority of students
Class passed
had heard about the disease and knew its causative agent
6th class 115 15 1.50-1.62
7th class 112 15 1.40-1.54 but very few knew about its common symptom and its
8th class 249 33 1.30-1.40 <0.05 biting habits indicating a gap in the knowledge and same
9th class 275 37 1.28-1.37 was reported by other worker17. Control of dengue fever
School status
through mosquito nets, repellents sprays etc was reported
Public school 360 48 1.40-1.48 <0.05
Private school 391 52 1.33-1.40 by many students showing a desire towards avoiding a
bite rather than source elimination and same finding was
reported by workers7,18,19.
Table 6: Overall good practices for the control of dengue fever.
The study concludes that sufficient knowledge
Variables Subjects % 95% Confidence p value was found among secondary school children for the
Interval control of dengue fever but this knowledge did not
Age groups change their behavior or was not translated into practice.
11-12 years 30 11 1.74-1.86 The study was conducted in one town only
13-14 years 113 42 1.72-1.80 >0.05 therefore, its results cannot be generalized to all towns or
15-16 years 103 38 1.75-1.82 all students of secondary schools of other towns.
Above 16 years 24 9 1.77-1.89
Gender
Male 153 57 1.74-1.80 >0.05 Acknowledgement
Female 117 43 1.76-1.83
Class passed
6th class 58 21 1.72-1.82
The study was funded by Pakistan Medical
7th class 38 15 1.76-1.87 >0.05 Research Council, Islamabad vide No Grant No-4-23-
8th class 83 31 1.74-1.82 1/1/Dengue/RDC/DMC, Karachi. We acknowledge the
9th class 91 34 1.73-1.81 support and help of all head of the educational instutions,
School status
Public school 128 47 1.77-1.83 >0.05
students and all others who have contributed in
Private school 142 53 1.73-1.80 completing this study.

Pakistan Journal of Medical Research, 2013 (October - December) 104

 Sultana Habibullah, Junaid Ashraf

References 12. Degallier N, Vilarinhos PT, deCarvalho MS, Knox MB,

Caetano J. Jr people knowledge and practice about dengue,
its vector and control means in Brasillia (DF), Brazil:Its
1. WHO. Dengue and dengue hemorrhagic fever. Media
relevance with entomological factors. J Am Mosq Control
Centre Fact Sheet N117; March 2009. Available form,
Assoc 2000; 16:114-23.
URL: http://www.who.int/mediacentre/factsheets/fs117/en/
13. Swaddiwudhipong W, Lerdlukanavonge P, Khumklam P,
index.html.
Koonchote S, Nguntra P, Chaovakiratipong C. A survey of
2. Guzman MG, Kouri G. Dengue: an update. The LANCET
knowledge, attitude and practice of the prevention of
infectious Diseases 2002; 2:33.
dengue hemorrhagic fever in an urban community of
3. WHO. Dengue hemorrhagic fever: diagnosis, treatment,
Thailand. Southeast Asian J Trop Med Pub Heath 1992;
prevention and control. [Geneva]:World Health
23:207-11.
Organization; 1997.
14. Ragab Ibrahim NK, Al-Bar A, Kordey M, Al-Fakeeh A.
4. WHO. Strengthening implementation of the global strategy
Knowledge, attitude and practice relating to Dengue fever
for dengue fever and dengue hemorrhagic fever,
among females in Jeddah high schools. J Infect Public
prevention and control. Report of the informal
Health 2009; 2: 30-40.
consultation; 18-20 October 1999. Geneva: WHO ,1999.
15. Syed M, Syeda UR, Habib M, Zahid R, Bashir A, Rabbani
5. Paul RE, Patel AY, Mirza S, Fisher-Hoch SP, Luby SP.
M, et al. Knowledge, attitude and practice regarding
Expansion of epidemic dengue viral infections to Pakistan.
dengue fever among adults of high and low socio-
Int J Infect Dis 1998; 2:197.
economic groups. J Pak Med Assoc 2010; 60:243.
6. ARY NEWS. 2011dengue outbreak in Pakistan. Available
16. Hairi F, Ong CH, Suhaimi A, Tsung TW, Bin Anis Ahmad
from,
MA, Sundaraj C et al. A knowledge, attitude and practice
URL:http://www.arynews.tv/english/newsdetail.asp?nid11/
(KAP) study on dengue among selected rural communities
5/2011
in the Kuala Kangsar district. Asia Pac J Public Health
7. Lennon JL. Students perceptions about mosquito larval
2003; 15:37-43.
control in a dengue endemic Philippine city. Dengue Bull
17. Van Benthem BH, Khantikul N, Panart K, Kessels PJ,
2004; 28:96-206.
Somboon P, Oskam L. Knowledge and use of preventive
8. Serufo JC, Souza AM, Avares VA. Dengue in the South-
measures related to dengue in northern Thailand. Trop
Eastern Region of Brazil-Historical analysis and
Med Int Health 2002;7:993-1000.
epidemiology. Revista de Saude Publica 1993; 27:157.
18. Itrat A, Khan A, Javaid S, Kamal M, Khan H, Javed S, et
9. Lwanga SK, Lemeshow S. World Health Organization
al. Knowledge, awareness and practices regarding dengue
1991:25.
fever among the adult population of dengue hit
10. Espinoza –Gomez F, Hernandez-Suarez CM, Coll-
cosmopolitan. PLoS One 2008; 3:e2620.
Cardenas R. Educational campaign verses malathion
19. Chiaravalloti Neto F. The population’s knowledge
spraying for the control of Aedes aegypti in Colima,
concerning dengue fever, vectors, and control measures in
Mexico J Epidemiol Community Health 2002;56:148-52.
Sao Jose do Rio Preto, Sao Paulo state. Cad Saude Publica
11. Acharya A, Goswami K, Srinath S, Goswami A. awareness
1997; 13:447-53.
about dengue syndrome and related preventive practices
among residents of an urban resettlement colony of south
Delhi. J Vector Borne Dis 2005; 42:122-7.

105 Pakistan Journal of Medical Research, 2013 (October - December)