INTRODUCTION
Dengue is an emerging public health problem in India, incidence of which has increased spatially as well as tem- porally for the last decade. In the year 2001, there were 1452 cases and 35 deaths from dengue in Rajasthan. There is no specific treatment for dengue fever, rather with the com- munity involvement, breeding grounds of Aedes mosquito (dengue vector), can be controlled and prevented. Coun- tries like Singapore and Thailand have become dengue free mainly due to involvement of the community1.
In the State of Rajasthan water storage practices are common due to shortage of portable water and the areas are prone to dengue outbreaks. Most of the studies in Rajasthan have been undertaken on knowledge and behaviour of communities in relation to malaria2–6 while very few studies have been carried out on understanding the knowledge and behaviour of communities in relation
to dengue transmission. Studies on the impact of information, education and communication (IEC) result- ing in behaviour change communication (BCC) in the context of dengue are altogether non-existent in India.
Therefore, with the aim of understanding the knowledge, attitude, behaviour and practices (KABP) prevalent in the communities in relation to dengue transmission, impact of IEC on BCC regarding dengue prevention and control, the present study was undertaken in Jodhpur City of Rajasthan, which is highly endemic for dengue.
MATERIAL & METHODS Study area and sampling
The State of Rajasthan was selected for this study because of its endemicity to dengue and vulnerability to climate change. In the year 2007, the state recorded 540
J Vector Borne Dis 53, September 2016, pp. 279–282
Knowledge, attitude, behaviour and practices (KABP) of the community and resultant IEC leading to behaviour change about dengue in Jodhpur City, Rajasthan
Nivedita
Epidemiology Division, Desert Medicine Research Centre (ICMR), Jodhpur, Rajasthan, India
ABSTRACT
Background & objectives: In recent years dengue has been witnessed as an emerging public health problem.
Therefore, the present study was undertaken in order to assess the knowledge, attitude, behaviour and practices (KABP) adopted by the society for its control and prevention. The changes in behaviour of community after imparting health education were also recorded to determine the effectiveness of information, education and communication (IEC) for dengue prevention and control in Jodhpur City of Rajasthan, India.
Methods: A threefold study was conducted in Jodhpur City regarding KABP about dengue fever amongst the community. Out of 106 cases of dengue reported from Jodhpur City in the year 2008, only 20 households (HHs) could be located. Therefore, nine HHs around one dengue positive household were selected so as to cover the sample size of 200 HHs for eliciting information through structured recorded interview-schedule. Health education as provided through audiovisuals and group discussion etc. and resultant change in KABP was recorded again through interview of respondents from 100 households.
Results: Prevention from dengue mosquito bites through mats and liquid vaporizer was known to 32 and 22%
HHs respectively. Inhabitants of 87% HHs preferred to visit private health facility, 85% of HHs were not aware about the symptoms of dengue, while74% HHs stated that dengue mosquito breeds in dirty water. Awareness about source of mosquito breeding and source reduction was found to be very poor, i.e. 3 and 13% which improved to 78 and 88% respectively after undertaking IEC activities.
Interpretation & conclusion: Being urban area, the economic condition and education level were somewhat similar and satisfactory in Jodhpur City. IEC resulted in significant improvement in knowledge about transmission, breeding habitats of mosquito transmitting dengue, source reduction and health treatment seeking behaviour at government facility. Through such mass awareness programmes in the communities, desired results in prevention and control of dengue transmission can be achieved.
Key words BCC; dengue; IEC; Jodhpur; KABP; Rajasthan; India
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cases and 10 deaths due to dengue as per the epidemio- logical reports (2000–2009) from the office of the Chief Medical Health Officer (CMHO), Jodhpur. The Jodhpur district which experienced dengue epidemic in the year 2000 has become endemic. Because of the pace of urban- ization, and being prone to dengue outbreak, the Jodhpur City was selected for the study. For further selection of study population, epidemiological profile of dengue in Jodhpur district was procured from the office of the CMHO for the year 2000–2009 along with the name and addresses of the patients. The list of reported dengue cases from 2000–2009 was verified from the hospitals in Jodh- pur City, viz. Mathura Das Mathur Hospital and Mahatma Gandhi Hospital. It was found that the names and ad- dresses were inaccurate in most of the cases; and out of the106 cases of dengue reported in the year 2008 only 20 HHs could be located. Therefore, nine HHs around a den- gue positive HH were selected for survey so as to cover 200 HHs in Jodhpur City.
The ethical clearance was obtained from the institute which approved the study. Signed consent was obtained from the respondents, who were respective head in the community. A questionairre based interview-schedule consisting of information on demographic profile of the HHs, basic KABP for prevention from dengue, was de- signed. A preliminary trial of the structured interview- schedule before conducting the survey was carried out in the community, and then the study was conducted in the respective sample size of 200 HHs from December 2009 to January 2010 for assessment of KABP.
Based on the results of KABP study, the inhabitants of HHs were imparted IEC through audio-visuals and focused group discussion. A power point presentation of the respective designed IEC, which was made after ana- lyzing the first hand KABP information from the target community, was arranged in one of the HHs which were reachable to other covered HHs, in the included society.
The IEC activities included the basic knowledge regard- ing transmitting agents of dengue, its symptoms, preven- tive measures for mosquito bites (like use of bednets, applying repellents in evenings on exposed body parts), completely covering the domestic water storage contain- ers, importance of visiting government health care cen- ters for diagnosis and management of dengue fever.
After imparting IEC, 50% of the HHs, i.e. 100 houses were again visited after one year for assessing the change in their KABP in the context of dengue from December 2010 to January 2011. Statistical analysis (t-test) was per- formed to find out the difference in knowledge, behaviour and practices of inhabitants before and after imparting IEC, in MS Excel software.
RESULTS
Knowledge, attitude, behaviour and practices (KABP) of community
About 92% of the inmates of HHs were found liter- ate, of these 5% were above graduate level; 72% of the houses were made of cemented walls followed by stony walls (without plaster); and 49% of the HHs had 3–4 rooms followed by 41% with 1–2 rooms. HHs with 7–8 rooms was rare (3%). Piped water supply was found in 94% of HHs while 97% HHs had electricity supply. Only 1% HHs were having agricultural land holdings; and 62%
of the HHs were having motor cycles followed by bi- cycles (26%).
The results of KABP study are given in Table 1. Re- spondents of 91% HHs were aware about dengue trans- mission through mosquito bites; 32% HHs were using mats, 23% using liquid vaporizer; and 17.5% HHs using bednets. About 85% HHs were not aware about the symp- toms of dengue. As regards source reduction for prevent- ing mosquito breeding, only 13% HHs of the respondents knew that source reduction is important for control of breeding of mosquitoes. About 94% HHs did not under- stand any difference between dengue and malaria. As re- gards the source of knowledge about dengue, 41% of the HHs had learnt from their friends and neighbours, 22%
from schools, 11% through mass media like radio, televi- sion and newspaper, etc. Interestingly, 6% of the HHs responded that they gained information about dengue from banners in the city.
As regards seeking health facilities for diagnosis or treatment for dengue, about 88% of the HHs used to visit private health facilities because they were unsatisfied (60% HHs) and having no faith in public health facility (28% HHs) (Table 2). Target community expressed their preference to wear full sleeved clothes according to sea- son. According to the community, applying oil on body is the best strategy to combat against the mosquito bites.
Around 70% of the HHs were storing water in under- ground tank (UGT) and domestic containers (30%).
Behaviour change communication after IEC
The results of change in knowledge and behavior of the community after imparting IEC are given in Table 1.
After IEC, the knowledge about symptoms of dengue had increased significantly from 7 to 84% HHs. The knowl- edge about breeding of dengue vector in stagnant fresh water also increased from 3 to 78% HHs. Major change was observed in the knowledge about source reduction, i.e. from 13% HHs in pre-IEC to 88% HHs, in post-IEC.
Information, education and communication proved to be
Nivedita: Impact of IEC on KABP against dengue in Jodhpur City 281
Table 1. Impact of IEC on knowledge and attitude of communities in the context of dengue in Jodhpur City
Attribute/Option No. of No. of
pre-IEC post-IEC
(n=200) (n=100)
Awareness of dengue from different sources
Friends/Neighbours 81 (41) 8 (8)
Schools 43 (22) 24 (24)
Radio 22 (11) 21 (21)
Television 15 (8) 11 (11)
Newspapers 15 (8) 12 (12)
Banners 11 (6) 9 (9)
Magazines 7 (4) 7 (7)
Health workers 6 (3) 8 (8)
Awareness about dengue transmitting agent
House flies 12 (6) 2 (2)
Mosquitoes 183 (91.5) 96 (96)
Curse of deity 5 (2.5) 2 (2)
Awareness about the symptoms of dengue
Vomits 5 (2.5) 4 (4)
High fever with chills, rashes 13 (6.5) 84 (84) and headache
Red eyes and body ache 12 (6) 2 (2)
Don't know 170 (85) 10 (10)
Awareness of the main sources of mosquito breeding
Cess pits 1 (0.5) 8 (8)
Stagnant fresh water 6 (3) 78 (78)
Dirty water 148 (74) 12 (12)
Garbage 45 (22.5) 2 (2)
Awareness whether, dengue is dangerous to human life
Yes 178 (89) 96 (96)
Don't know 22 (11) 4 (4)
Awareness about the source reduction
Proper water storage and 26 (13) 88 (88) emptying of containers
No collection of garbage in and 165 (82.5) 10 (10) near the house
Don't know 9 (4.5) 2 (2)
Awareness about the prevention measures from dengue
Bednets 35 (17.5) 12 (12)
Coils 26 (13) 13 (13)
Liquid vaporizers 45 (22.5) 25 (25)
Matts 64 (32) 22 (22)
Repellents 30 (15) 28 (28)
Knowledge whether blood examination is necessary for dengue diagnosis
Yes 102 (51) 99 (99)
Don't know 98 (49) 1 (1)
Difference between malaria and dengue
Yes (Correct knowledge) 12 (6) 76 (76)
No (Incorrect knowledge) 99 (49.5) 14 (14)
Don't know (Unaware) 89 (44.5) 10 (10)
Figures in parentheses indicate percentages.
Table 2. Impact of IEC on behaviour and practices of communities in the context of dengue in Jodhpur City
Attribute/Option No. of pre-IEC No. of post-IEC
(n=200) (n=100)
Practices of communities Practices of water storage
Domestic containers (Covered) 61 (30.5) 51 (51) UGT and domestic containers 139 (69.5) 49 (49)
(Covered)
Health seeking behaviour Visit to health facility
Government/PHC 24 (12) 45 (45)
Private 175 (87.5) 54 (54)
Quack 1 (0.5) 1 (1)
Reason of not visiting to the government health facility
Unsatisfied 120 (60) 31 (31)
No faith 56 (28) 24 (24)
Figures in parentheses indicate percentages.
IEC, about 51% of the HHs started covering the water storage containers as compared to 31% HHs, in the pre- IEC survey while respondents from 45% of the HHs started visiting government health facility against only 12% HHs before IEC.
There was significant difference in the mean of at- tributes, i.e. awareness about symptoms of dengue fever, breeding of mosquito vector, source reduction, difference between dengue and malaria, practices of water storage, behaviour of visiting health facilities, and satisfaction of visit to government health facilities, in pre- and post- IEC at p≤0.05 level [t Stat 4.697766206; P(T≤t) one-tail 0.000422212; t Critical one-tail 1.812461102].
DISCUSSION
The KABP studies related to dengue transmission are rare in India. However, similar studies on malaria have also pointed out poor perception of the community about preventive and intervention measures being undertaken by the public health authorities. In Swaziland, while work- ing on KABP on malaria for its elimination, it was found that despite fair knowledge of malaria, there is a need for improving the availability of information through the pre- ferred community channels, such as Tinkhundlas (dis- tricts), as well as professional health routes7.
In India, Sharma et al8 assessed the impact of IEC campaign on malaria control in Ahmedabad, Dang, Panchmahal and Baroda districts of Gujarat and reported that if IEC activities are undertaken throughout the year, desired level of knowledge of community can be achieved leading to appreciable BCC.
A study conducted in two sub-districts of Kamphaeng Phet province, Thailand, also reported that the correct helpful as 76% of the HHs were able to differentiate be-
tween malaria and dengue in comparison to only 6% prior to IEC.
The impact of IEC on change in behavior of commu- nities in the context of dengue is given in Table 2. After
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knowledge and practice reduce dengue vector popula- tions1. They concluded that there is a direct link between knowledge on dengue prevention and proper water stor- age practices and disposal of solid waste. A study related to the hospitalized patients of dengue in Delhi empha- sized the need of surveillance right from the onset of trans- mission, and the importance of education about the dis- ease in the community9. Singh et al10 in a study carried out in Delhi have reported that poor knowledge of inhab- itants about breeding of dengue vector, its habitats and preventive measures from mosquito bites are the primary reasons behind dengue outbreak and the strategies like minimizing the breeding potential of Ae. aegypti, water management practice by individuals along with imple- mentation of urban bye-laws and IEC activities are nec- essary for its control.
The findings of the present study revealed that the knowledge of communities in Jodhpur City about trans- mission and preventive measures regarding dengue fever was poor and inadequate. However, with IEC, there was tremendous improvement particularly in awareness about symptoms of dengue fever from 6.5% HHs in pre-IEC to 84% HHs post-IEC. Increase in visit to government health facility from 12% HHs in pre-IEC to 45% HHs post-IEC, indicates that behaviour of communities can be changed.
Control of dengue with involvement of community has been demonstrated earlier by Dash et al11 in southern In- dia. The World Health Organization has amply emphasized the importance of social mobilization and communication for behavioural impact in managing dengue disease and provided guidelines for prevention and control of dengue12. In order to provide right message to communities, it is essential to generate latest data on breeding habitats of Aedes, for prioritizing the interventions in most preferred breeding grounds of dengue vectors, as evidenced in a study by Arunachalam et al13, which reported that moni- toring of breeding sites of Aedes mosquito in peridomestic breeding places is very important alongside the coolers.
This study elicited that with mass awareness programme in the communities through group discussion and audio- visual aids, desired results in prevention and control of dengue transmission can be achieved.
ACKNOWLEDGEMENTS
The work is part of thesis for the award of Ph.D.
degree of Jai Narayan Vyas University, Jodhpur. The
author express her grateful thanks to Dr S.P. Yadav, Scientist 'F', Desert Medicine Research Centre (ICMR), Jodhpur for his constant guidance, supervision and en- couragement for the study.
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Correspondence to: Dr Nivedita, Gramin Vikas Vigyan Samiti, 3/437, Milk Men Colony, Pal Road, Jodhpur–342 008, Rajasthan, India.
E-mail: niveditadhi@gmail.com
Received: 29 February 2016 Accepted in revised form: 12 May 2015
