KNOWLEDGE AND PRACTICE ON PREVENTION AND CONTROL OF DENGUE FEVER AMONG PEOPLE AT MANGALPUR VDC, CHITWAN DISTRICT OF NEPAL

Background : In many parts of the tropics and subtropics, dengue is endemic especially during rainfall season which is the breeding season of the Aedes mosquito. The knowledge, attitudes and practices (KAP) of the general population are the most critical factors on preventing the infection of dengue virus. Hence this study was aimed to access the knowledge and practice on prevention and control of Dengue among the people of Mangalpur VDC of Chitwan. Methods: A cross-sectional study was done in Mangalpur VDC, Chitwan district of Nepal from Shrawan 2069 to Bhadra, 2069. The sample size of the study was 345 and respondents were the people of Mangalpur VDC. Data is analyzed by using SPSS program version 16.0 for windows. Results: Majority of the respondents 167(48.4%) were between age group 25-39 and minority 9(2.6%) age group >70 years. The mean age of the respondents is 40 years±11. Out of 345 respondents, 176 (51%) were female and 169 (49%) were male. Majority of respondents 218 (63.2) were literate and 127 (36.8%) were illiterate. The level of knowledge regarding dengue fever was statistically significant with age (p=0.002), marital status (p=0.005), education Status (p=0.010), religion (p=0.003) and with occupation (p=0.000). The level of practice regarding dengue fever was statistically significant with marital status(p=0.003), educational status (p=0.000), occupation(p=0.000) and religion(p=0.258). Conclusions: Lack of knowledge and improper practice towards dengue is explicit in this study. Emphasis should be more on creating awareness among people. Education intervention more effective in controlling dengue fever.


INTRODUCTION
Dengue is a mosquito-borne viral disease that has rapidly spread in most of the regions of the world in recent years. Female mosquitoes mainly of the species Aedes aegypti and, to a lesser extent, Ae. albopictus, transmit dengue virus. Up to 100 million cases of Dengue fever (DF) and 500,000 cases of Dengue Hemorrhagic Fever (DHF) and several thousand deaths are estimated to occur annually worldwide. 1 During the past decades, dengue virus emerged in South Asia and DF/DHF epidemics occurred in Bhutan, India, Maldives, Bangladesh and Pakistan. [2][3][4][5][6][7]9,10 The principal vector of dengue virus is the mosquito Aedes aegypti. Dengue virus is maintained in a cycle between humans and Aedes aegypti, domestic day biting mosquitoes. 1 There is limited information available on dengue viral infection in Nepal. In Nepal, the first case of dengue was reported in 2004 from Chitwan district. 20 Sporadic cases were reported since 1990's in a Japanese traveler who visited Nepal and developed DF after returning to Japan. Outbreak of Dengue occurred in Nepal in 2006. From August through November 2006, the number of febrile patients increased in four major hospitals in the Terai region of Nepal: Nepalgunj Medical College, Bheri Zonal Hospital in Nepalgunj, Tribhuvan Hospital in Dang and Narayani subregional hospital in Birgunj.The clinical features in most patients were consistent with the signs of DF. 20 Aedes aegypti was identified in 5 major urban areas of terai region bordering with India, i.e. Biratnagar (Morang), Birganj (Parsa), Bharatpur (Chitwan), Tulsipur (Dang) and Nepalganj (Banke) during the entomological surveillance in Japnese Encephalities endemic district after the Dengue outbreak in 2006 in Nepal. 1 The larvae of Aedes aegypti was also recorded in Kathmandu during June 2009. 20 Hence this study was aimed to access the knowledge and practice on prevention and control of Dengue among the people of Mangalpur VDC of Chitwan.

METHODS
A cross-sectional study was conducted among the residents of Mangalpur VDC, Chitwan, Nepal. The study was conducted from Shawan 2069 to Bhadra 2069. Purposive sampling method was used to collect the data among the respondents. The total sample size taken was 345.
A semi-structured questionnaire was used to collect data from the survey population. Face to face interview was conducted. Some enumerators were hired to collect the data from all wards of Mangalpur VDC. Data was analyzed by using SPSS program, version 16.0. Descriptive statistics (frequency, percentage, mean and standard deviation) and inferential statistics were used to analyze the data.

RESULTS
Majority of the respondents 167(48.4%) were between age group 25-39 and minority 9(2.6%) age group >70 years. The mean age of the respondents is 40 years with 11 years standard deviation. Out of 345 respondents, 176(51%) were female and 169(49%) were male. Majority of respondents 218(63.2) were literate and 127(36.8%) were illiterate. Among literate 98(45.2%) can only read and write, 44(20%) had primary level education and 76(34.8%) had appeared in SLC examination. Concerning the religion of the respondents 241(69.9%) were Hindu and minority 8(2.3%) Islam. As regards to the occupation of the respondents, majority of the respondents 73(21.2%) were farmer and 70(20.3%) were housewife. There were similar percentage of respondents whom were engaged in other occupation like Gov. job in private sector and in business. As far as the number of the children were concern majority 305(88.4%) respondents had 1-3 children 32(9.3%) had no children and 8 (2.3%) respondents had more than 3 children (Table 1).    (Table 3). In regards to the 'yes' majority of the respondent 323(93.6%) change the water of the open container within a week, cover water tank and minority15(4.3%) respondents said they are participated in spraying of insecticide in their community. In regards to No column of statement, the majority 309 (89.6%) of respondent said that they do not clean their roof gutter (Table 5).  (Table 6).  Significance level at 0.05   The level of practice regarding dengue fever was statistically significant with marital status(p=0.003), educational status (p=0.000) and occupation(p=0.000) while it was not statistically significant with religion(p=0.638). High level of knowledge and poor practice have been observed in studies too. [10][11][12][13] Other supported finding was the study done by Naik et al. which revealed that common preventive practices that were prevalent in the community were use of mosquito repellents (46.57%), prevent water stagnation (13.01%), cleaning the house (34.93%). Very few of them practiced weekly emptying of containers (9.58%) and use of mosquito nets (11.64%). 14

CONCLUSION
The respondents' knowledge regarding dengue fever was poor. The level of overall knowledge was statistically significant with age, sex, marital status and education status of the respondents. The half of the respondents knew about prevention of DF and around three fourth of respondents did not know about treatment of DF. Those socio demographic characteristics which are more significant with level of knowledge is seen deficit in preventive practices of dengue fever. More than two third of the respondents had good preventive practices such as use of mosquito net, covering household containers, covering water tank, invert the water holding containers, examine discarded things that can hold water, remove stagnant water around house and clean the bushes, clean roof gutters/ceiling water in rainy season. More two third of the respondents had poor preventive practices such as put kerosene oil in the air cooler water once a week, wear body covering clothing, sleeping under mosquito net at daytime and participate in insecticide spray.