Awareness Regarding Dengue Prevention and Control in Periurban Union Councils of Tehsil Rawalpindi

Dengue infection is a challenging disease to treat, because of its multisystemic, varied, unique, and even life-threatening symptoms. Knowledge of these atypical manifestations aids in early discovery, right diagnosis, prompt intervention, and appropriate treatment. Objectives: To assess the awareness of dengue prevention and control in Periurban union councils of Tehsil Rawalpindi and to nd out the association between awareness regarding dengue prevention and socio-demographic variables through a detailed questionnaire. Methods: A cross-sectional study was designed to assess the awareness levels of 413 respondents and association between dengue prevention and socio-demographic variables for six months duration by applying chi-square. Results: The results showed that the general public had an adequate level of Dengue control knowledge 250 (60.5%), attitudes 261 (63.2%), and practices 138 (66.6%) as well as a willingness to support dengue control efforts. The knowledge of dengue prevention 250 (60.5%) have adequate and 163 (39.5%) respondents have inadequate knowledge. The attitude toward dengue respondents positive are 261 (63.2%) and the attitude toward dengue respondents negative are 152 (36.8%). The practices toward dengue respondents are good are 66.6% and the practices toward dengue respondents poor are 33.4%. The chi-square test shows a signicant relationship between awareness and age, occupation. On the other hand, the relationship between awareness and gender, race, material status, qualication, income, and family are non-signicant. Conclusions: It is concluded that the respondents had a good understanding of Dengue prevention, behaviors, and knowledge. With further campaigns, the general public's technical understanding might develop even more.


A B S T R A C T
by knowledge of these uncommon presentations. Dengue virus infection remains a clinical challenge in every way. To identify patients and prevent outbreaks, complications, and death, ongoing sero-epidemiological surveillance, prompt interventions, vaccine development, and vector control measures are required [1]. Dengue outbreaks are caused by a variety of variables including public ignorance, climate change, insu cient nancing, and poor surveillance. As a result, scienti c research in the Punjab, Sindh interior, and Khyber Pakhtunkhwa provinces of Pakistan, where dengue outbreaks have occurred over the past decade and dengue is also a real risk of non-epidemiology, should be increased [2]. Appropriate dengue preventive actions are signi cantly in uenced by knowledge, danger perception, and self-e cacy. Through television, prevention and control initiatives should focus on raising knowledge about the danger and severity of dengue infection. Individual self-e cacy should be emphasized in health communications [3]. Dengue fever is a severe u-like illness that can a ict babies, toddlers, and adults, although it is seldom fatal. Symptoms usually persist 2-7 days after an incubation period of 4-10 days following a bite from an infected mosquito [4,5]. By taking preventative actions to alleviate hospital overcrowding. This study is signi cant in terms of determining the in uence of dengue activities on dengue prevention. Dengue prevention and control are dependent on successful vector control methods, and continuous community engagement can help to enhance vector control efforts. As a result, this research is critical, as dengue activities can play a critical role in this, and the issue is emphasized. A cross-sectional survey-based study was designed to assess the awareness/attitude, prevention (KAP), and control in Periurban union councils of Tehsil Rawalpindi for six months. The study was aimed to nd out the association between awareness regarding dengue prevention and control and socio-demographic variables through a detailed questionnaire. The goal of a survey by Koonisetty et al. (2021) was to nd out about physicians' knowledge, attitudes, and practices (KAP) when it comes to diagnosing and treating dengue fever. Physicians from Turkey, a nonendemic nation, Bangladesh, India, and Malaysia, three dengue-endemic countries, participated in this study. This study aided in the development of a guideline for clinicians to follow to achieve good treatment results and lower dengue mortality [6]. Itrat et al. (2008) determined the degree of dengue fever knowledge, attitudes, and practices among persons who visited tertiary care facilities in Pakistan. The overall prevalence of su cient knowledge' based on their criteria was found low [7]. We found that there was a su cient prevalence of illness prevention behaviors. Further research into the relationship between knowledge and its e ciency in combating dengue fever will be useful in establishing the impact of public awareness efforts. A cross-sectional study was undertaken in selected rural areas in the Kuala Kangsar district to examine the degree of knowledge, attitude, and behaviors about dengue and its vector, the Aedes mosquito. The community's knowledge was determined to be adequate. 82.0 percent of the 200 respondents said that television/radio was their primary source of dengue information. The attitude of the responders was positive, and the majority of them were in favor of Aedes control efforts. There is a strong link

M E T H O D S
Copyright © 2022. PBMJ, Published by Crosslinks International Publishers 291 between awareness of dengue fever and attitudes toward Aedes management. It was also discovered that having strong knowledge does not always imply having good practice [8]. Syed et al. (2010) sorted data from 400 respondents. About 35% of the people in the survey knew enough about dengue illness and its vector [9]. Education and socioeconomic position exhibited signi cant relationships with knowledge. The group with a higher socioeconomic status had stronger preventative measures. Future health programs should have a stronger emphasis on poor socioeconomic areas. Gul et al. (2014) gathered data from 154 existing Union Councils in Lahore, with a sample size of 800 households [10]. Dengue fever knowledge, attitudes, and behaviors were among the data collected. Dengue fever was known in 98 percent of the individuals. Even though 67 percent of respondents knew enough about dengue, just 3.7 percent were using it. The majority of mosquito bite prevention strategies (70.4 percent) were focused on mosquito coil use rather than the elimination of mosquito breeding areas. The most common source of knowledge regarding dengue fever was television (91 percent). There was a signi cant gap between receiving knowledge and putting it to use, which must be bridged as soon as possible to prevent future illness outbreaks. Qureshi et al. (2014) performed a cross-sectional study in Samanabad Town, Lahore, to examine people's knowledge, attitudes, and practices surrounding dengue illness. Data was collected from 560 respondents using purposeful random sampling. The majority of the responders (90.5%) had a basic understanding of the vector. High-grade fever was the most common and visible symptom, according to 41.4 percent, 97.1 percent recognized the fever was spread by mosquitoes from one person to another, and 72.5 percent thought pots and containers lled with water were the main breeding grounds for the dengue mosquito. Only 34.5 percent thought the Aedes mosquito bites usually in the evening, and 47.5 percent thought the fever isn't communicable [11].
A cross-sectional study was conducted for 6 months. The study was conducted in households of peri-urban union councils of Rawalpindi, Pakistan. All the participants residing in peri-urban areas of Rawalpindi were included with informed consent. The data were collected with the following mandatory requirements: A permission letter from Al-Shifa School of Public Health's review board /committee, and a permission letter from district health authority Rawalpindi. Data on the sociodemographic characteristics and KAPs of the participating household heads were collected using a pre-designed structured questionnaire (via. Google form). Following sources were Akhtar N et al.  Selvarajoo et al. (2020) [12,13]. The questionnaire contained two sections: First section A was related to the information collection on sociodemographic variables such as gender, age, race, marital status, educational status, occupation, income, family structure, and socioeconomic status. The second section B was related to the participant's knowledge, attitudes, and practices (KAPs) about dengue prevention and control activities. The questionnaire of sub-section B1 was comprised of knowledge-related information. The questionnaire of sub-section B2 was comprised of attitudes-related information. The questionnaire of subsection B3 was comprised of practice-related information. All data including qualitative variables, frequencies & percentages, & means, etc. were analyzed using SPSS version 25.

R E S U L T S
were not infected by dengue. People agreed that dengue outbreaks could be controlled if everyone was committed to removing breeding sites for mosquitoes in their area and continuing this exercise even when there is no dengue outbreak. Table 2 shows the detail of the questions related to attitudes on dengue prevention by the 413 respondents. Practices towards dengue prevention: Nearly all (99%) people agreed to safe water usage practices like closing the water container after use, changing water plant/ ower containers in the house weekly and checking for blocked water ow due to garbage/waste, and checking for the cleanliness of drains and gutters on the roofs (94.1%). People used mosquito repellents. The majority (88%) were also part of the dengue prevention campaigns in their area. Table 3 shows the detail of the questions related to the consistency of practice by the 413 respondents. Statistical Analysis: All the bi-responses from the performa were calculated through chi-square to nd out the signi cance or insigni cance between the responses of the respondents (n=413). The p-value indicated that there existed a signi cant difference between Yes/No replies of the respondents of the sections of the questionnaire. B1: Knowledge towards dengue prevention. B2: Attitudes towards dengue prevention and B3: Practices towards dengue prevention.
Total of 413 responses were received through Google form. The majority of people (92.7%) fell in the above 50 years age group, 60.7% were males. 89.1% were Punjabi. Some 57.8% were married individuals. Almost half (50.6%) of the study population were graduates and working (86.6%). The majority 79.1% were earning above 10000 rupees per month. The family structure was joint in 55.6% and socioeconomic status was average in 49.8% of the group. Knowledge towards dengue prevention: Most people had heard of Dengue (98.3%) through Radio or television sources (35.3%). Around 98% of people knew that cause of dengue is mosquito bites. They also knew that little water (5 ml) or so is required for the breeding of mosquitoes and that they bite usually in the morning or late evening. 98% knew Full sleeves & light-colored clothes are best to protect against bites of mosquitoes and that the rainy season is the only outbreak of dengue infection. Above 90% of the population knew about the bene ts of using repellents and coils and larvae removal for controlling the spread of dengue. 74% knew about chemical fogging to prevent dengue. Around 82% of people knew that eggs of dengue mosquitoes can survive dry conditions for up to 6 months. Table 1 shows the detail of the questions related to knowledge of dengue by the 413 respondents. Attitudes towards Dengue Prevention: The general attitude was good. 89.5% of People wanted to help reduce the number of dengue cases in their area, by checking their hotspots and agreeing to take extra precautions if the cases were to rise in their area. 95% agreed to use full sleeves and lightcolored clothes as they prevent mosquito bites. 53.9% of people agreed that it is their responsibility to remove mosquito breeding sites.64% of people reported that they

D I S C U S S I O N
Dengue fever has become a worrisome public health hazard in many parts of the tropics due to rising epidemic activity and challenges in managing the insect vector. The current study was aimed at viewing the level of public awareness about Dengue disease in Rawalpindi. It also gave us an idea about the will and practices of the responders in preventing the spread of Dengue. The majority of people (98.3%) had heard of Dengue through radio or television (35.3 percent). Around 98 percent of respondents were aware that mosquito bites are the cause of dengue fever. They also knew that mosquitoes require only a small amount of water (5 mL) to grow and that they bite most often in the morning or late evening. 98 percent were aware that full sleeves and light-colored clothing are the best ways to avoid mosquito bites and that the rainy season is the only time when dengue fever occurs. More than 90% of the public was aware of the bene ts of utilizing repellents, coils, and larval removal to prevent the spread of dengue fever. Seventyfour percent were aware of the use of chemical fogging to prevent dengue fever. Dengue mosquito eggs may survive dry circumstances for up to 6 months, according to 82 percent of individuals. The prevailing mood was positive. 89.5 percent of respondents intended to assist reduce the number of dengue cases in their region by examining hotspots and agreeing to take extra measures if the number of cases in their area increased. Mosquito bites are prevented by wearing long sleeves and light-colored clothing, according to 95% of respondents. 53.9 percent of respondents believed that removing mosquito breeding locations is their duty. Sixty-four percent of those surveyed said they had not been a icted with dengue fever. People agreed that a dengue outbreak could be contained if everyone committed to eliminating mosquito breeding areas in their region, and to continue doing so even if there was no dengue outbreak. Almost everyone (99%) agreed that safe water consumption habits include sealing the water container after use, replacing water plant/ ower containers in the house weekly, checking for obstructed water ow due to garbage/waste, and inspecting drains and gutters on the roofs for cleanliness (94.1 percent).
Mosquito repellents were employed. The vast majority (88 percent) were also involved in local dengue prevention programs. The general public had a good amount of knowledge, attitude, and practices (KAP) and the will to support Dengue control campaigns. They were inclined to abide by healthy and safe practices as advised by authorities against Dengue. Our KAP survey analysis indicated that the majority of responders have correctly answered the questionnaires. There were very few areas where the public lacked information, for example, that the rainy season accounts for the most spread of the dengue disease where only 64% of responders knew it. Moreover, chemical fogging was not known to approximately 35 % of responders. Such technical information could be delivered to the general public with further campaigns. Nearly half of the responders shared that they did not feel the responsibility of removing the breeding sites in the area which was not very overwhelming. There existed a signi cant difference between the replies of the respondents to the KAP questionnaires. This indicates that the responders were clear about Dengue prevention, practices, and knowledge. Two studies acknowledged the relevance of water container productivity as a metric of vector density; nevertheless, no cluster randomization was attempted, and costs and sustainability were not addressed in any of the investigations. There is no proof that community-based dengue control programs, alone or in conjunction with other control efforts, can improve dengue control e cacy [14]. There is a strong link between awareness of dengue fever and attitudes toward Aedes management. It was also discovered that having strong knowledge does not always imply having good practice. This is most likely owing to rmly rooted behaviors in the community, such as water storage for home consumption [8]. Several researchers have investigated and reported population knowledge, attitudes, and behaviors (KAP) surrounding dengue throughout the previous few decades. The highest scores on the measure indicated a greater level of knowledge and expertise. Because the attitudes measure did not show the same connection, it was excluded from the research. In the quantile regression, age, years of schooling, and a family history of dengue fever were all positively related to lower levels of awareness about the disease. The in uence of such factors gradually waned or eliminated as knowledge grew. Furthermore, the size of the in uence of socioeconomic variables on knowledge scores changes with knowledge level, indicating that additional factors may be in uencing higher levels of knowledge [15]. 521 families in two villages in Yogyakarta, Indonesia, participated in a cross-sectional study. The population's knowledge, attitudes, and practice scores were summed by sex, age, occupation, and education. The average knowledge score was 3.7 out of 8, but both the attitude and practice ratings were excellent. There were numerous notable gaps in understanding of fundamental dengue symptoms, preventative techniques, and the Aedes mosquito's biting and breeding activities. As a result, they developed a vector control card to aid people in their container cleaning approaches. In 2015, the card was tested for eight weeks, using pre-post larvae positive residences and containers as the main result indicators. To raise motivation levels, bottom-up solutions engaging all community members in dengue management, not just those who already follow best practices, are required [16]. In 2001, there was a large dengue epidemic in Chennai, with 737 cases (90 percent) out of a total of 861 cases reported in Tamil Nadu. Only 34.5 percent of the total homes polled recognized what dengue was, and only 3.3 percent knew that the virus is the cause of dengue fever. Water storage was done by the majority of the Households (86.5%), however, just 3% of them kept water for more than 5 days. The majority of Households did not take any precautions to prevent mosquito breeding in their water-holding containers (65 percent). Sixty percent of Households were uninformed of the biting behavior of the dengue vector mosquito. The study's ndings reveal that community knowledge of dengue fever, its transmission, vector breeding places, biting behavior, and preventative techniques is severely lacking. To combat the dengue problem, health education programs regarding the sickness must be developed to improve community awareness and sensitize the people to participate in an integrated vector control effort [17]. A Knowledge, Attitudes, and Practices survey was distributed to 600 randomly selected families in 30 villages in Kampong Cham, one of Cambodia's most populated districts. The majority of participants thought they were in danger and that dengue transmission is avoidable, and they had a high degree of knowledge on dengue transmission, Aedes breeding, and biting prevention strategies. Self-reported vector control behaviors, on the other hand, did not match those found in the surveys [18].
It is concluded that the general population possessed a high level of knowledge, attitudes, and practices as well as a willingness to support Dengue control efforts. They were more likely to follow the authorities' recommendations for healthy and safe Dengue habits. There were just a few areas where the public lacked knowledge. With more dengue control programs and associated campaigns, such technical knowledge could be further improved among the general public. [3] [4] [5] [2] [6] [7] Akhtar N et al.