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 Knowledge; Attitude; Preventive behavior; Dengue vector; Community
∗
Summary This research aimed to determine the knowledge, attitudes and preventive behaviors (KAP) of adults in relation to dengue vector control measures in the communities of Vientiane, the capital of the Lao PDR. A total of 207 respondents were actively participating in this cross-sectional descriptive study in 2011. Representatives of households were interviewed face-to-face by six trained interviewers 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: [email protected], [email protected] (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, particularly 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 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 hemorrhagic 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 populations 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 associated with human habits [14,15]. Thus, evaluations of people’s knowledge, attitudes, and practices might be of great importance to improving integrated control measures [16]. Moreover, community knowledge and preventive behaviors regarding the cause, transmission, prevention and treatment of dengue fever are significant socio-cultural factors that have influenced the adoption of dengue fever control measures [17—19]. However, few studies have focused on the environmental factors 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 behaviors (KAP) toward dengue vector control measures among adults in Vientiane, the capital of the Lao PDR.
Sampling method 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 population. 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 classified as urban, three districts as semi-urban and two districts as rural areas. The calculation of the sample size and a sampling diagram for this study are presented in Eq. (1) and Fig. 1, respectively. n=
Z 2 p(1 − p) (1.96)2 (0.59)(1 − 0.59) = = 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% confidence 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 districts (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
C. Sayavong et al. Vientiane Capital City
Rural area
Urban area
D1 60vs
D2 32 vs
Nongsangthor 102 HH
D3 52 vs
D4 40vs
D1 53vs
Naxa 33 HH
Nonsavang 36 HH
D2 37vs
Maknao 36 HH
preventive behaviors were 0.89, 0.91 and 0.95, respectively. Before collecting data, six research assistants were standardized with a single-day training program. Permission for the data collection was obtained from the heads of the local public health offices, the village chiefs and the Lao People’s Democratic Republic Ministry of Health. Informed written consent was also obtained from all eligible respondents. The face-to-face interview required approximately 30 min. The field survey was conducted from January 10th to 31st of 2011.
Total 207 households
Figure 1 Sampling diagram of the study.
families were interviewed. Data collection was conducted in Nongsangthor village in which dengue fever is endemic, and the coverage of the pipe water supply in Nongsangthor is 100%. Nonsavang 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 different 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 village 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 3point Likert scale); (iv) attitudes (14 items rated on a 3-point Likert scale); and (v) preventive behavior related to dengue vector breeding control measures.
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
Data analyses The data were verified and entered using Epi data. MINITAB version 14 was used for the statistical 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 preventive behaviors related to dengue vector control measures with socio-demographic characteristics, sources of information, knowledge and attitudes. Multiple logistic regressions were used to determine 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 participants were mothers. Approximately one-third (33.82%) of the participants had completed primary 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., twoway 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 Table 1
469
Distribution of respondents by knowledge about dengue vector breeding control measures.
Knowledge
Correct answer Number
Percent
Dengue fever transmission High (≥median) Low (
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 Knowledge; Attitude; Preventive behavior; Dengue vector; Community
∗
Summary This research aimed to determine the knowledge, attitudes and preventive behaviors (KAP) of adults in relation to dengue vector control measures in the communities of Vientiane, the capital of the Lao PDR. A total of 207 respondents were actively participating in this cross-sectional descriptive study in 2011. Representatives of households were interviewed face-to-face by six trained interviewers 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: [email protected], [email protected] (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, particularly 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 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 hemorrhagic 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 populations 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 associated with human habits [14,15]. Thus, evaluations of people’s knowledge, attitudes, and practices might be of great importance to improving integrated control measures [16]. Moreover, community knowledge and preventive behaviors regarding the cause, transmission, prevention and treatment of dengue fever are significant socio-cultural factors that have influenced the adoption of dengue fever control measures [17—19]. However, few studies have focused on the environmental factors 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 behaviors (KAP) toward dengue vector control measures among adults in Vientiane, the capital of the Lao PDR.
Sampling method 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 population. 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 classified as urban, three districts as semi-urban and two districts as rural areas. The calculation of the sample size and a sampling diagram for this study are presented in Eq. (1) and Fig. 1, respectively. n=
Z 2 p(1 − p) (1.96)2 (0.59)(1 − 0.59) = = 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% confidence 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 districts (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
C. Sayavong et al. Vientiane Capital City
Rural area
Urban area
D1 60vs
D2 32 vs
Nongsangthor 102 HH
D3 52 vs
D4 40vs
D1 53vs
Naxa 33 HH
Nonsavang 36 HH
D2 37vs
Maknao 36 HH
preventive behaviors were 0.89, 0.91 and 0.95, respectively. Before collecting data, six research assistants were standardized with a single-day training program. Permission for the data collection was obtained from the heads of the local public health offices, the village chiefs and the Lao People’s Democratic Republic Ministry of Health. Informed written consent was also obtained from all eligible respondents. The face-to-face interview required approximately 30 min. The field survey was conducted from January 10th to 31st of 2011.
Total 207 households
Figure 1 Sampling diagram of the study.
families were interviewed. Data collection was conducted in Nongsangthor village in which dengue fever is endemic, and the coverage of the pipe water supply in Nongsangthor is 100%. Nonsavang 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 different 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 village 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 3point Likert scale); (iv) attitudes (14 items rated on a 3-point Likert scale); and (v) preventive behavior related to dengue vector breeding control measures.
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
Data analyses The data were verified and entered using Epi data. MINITAB version 14 was used for the statistical 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 preventive behaviors related to dengue vector control measures with socio-demographic characteristics, sources of information, knowledge and attitudes. Multiple logistic regressions were used to determine 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 participants were mothers. Approximately one-third (33.82%) of the participants had completed primary 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., twoway 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 Table 1
469
Distribution of respondents by knowledge about dengue vector breeding control measures.
Knowledge
Correct answer Number
Percent
Dengue fever transmission High (≥median) Low (
