Knowledge and Preventive Practice of Dengue Fever among Students studying in MMAMC Biratnagar

Introduction: Dengue is a vector-borne viral disease that has rapidly spread in many countries in recent years. Dengue Shock Syndrome have become major public health concern which clearly evident to give attention to follow the healthy behaviors and attitude for its prevention and control. The objective of the study is to assess the knowledge and preventive practice of dengue fever among students studying in MMAMC, Biratnagar. Methods: A descriptive cross-sectional research was conducted in Mahendra Morang Adarsh Multiple Campus in September 2018, among 271 students using non probability purposive sampling technique. Self-administered questionnaire was used for data collection and analyzed by descriptive and inferential statistics. Result: Out of 271 students 55.7% were male and 44.3% were female. The overall mean and standard deviation of the age was 20.65±1.53 years. The study revealed that the respondents had inadequate knowledge (85.6%) and inadequate preventive practice (64.2%) of dengue fever. There was no significant association between level of knowledge and level of preventive practice on dengue fever with p <0.05. Conclusion: This study concluded that majority of the respondents had inadequate knowledge regarding dengue fever and more than half of the respondents had a inadequate preventive practice. Despite the rapid expansion of dengue virus in Nepal, the knowledge and preventive practice of respondents on dengue fever was very low. Educational intervention and awareness program on dengue fever are recommended for its prevention.


INTRODUCTION
Dengue fever and its severe forms Dengue hemorrhagic fever and dengue shock syndrome have become major public health concern, this syndrome can cause 40% to 50% fatality if untreated and with the effective treatment, it can be reduced to 5% or less. 1 Before 1970, Nine countries had suffered with severe dengue epidemics.At present, more than 100 countries in tropical and subtropical regions Africa, Eastern Mediterranean, Americas, South-East Western Pacific region and Asia are affected by dengue.Dengue positive cases were exceeded 1.2 million and 3.2 million in 2008 and 2015 respectively. 2cording to World Health Organization, annually 50-100 million dengue infections occurred whereas over the past 50 years increased with 30-fold in global incidence and at present it assumed a major threat to global public health.Now approximately two-fifth of population of world is at risk of dengue infection. 3systematic review on global epidemiology of Dengue outbreak in 1990-2015 included 243 articles describing 262 dengue outbreaks.In India, the largest numbers of outbreak were observed followed by tropical and subtropical region in China and Brazil. 4he period between 2010-2014, 213 607 cases of dengue fever were found in India. 5e goal of the Global Strategy for Dengue Prevention and Control (2012-2020) is to reduce the burden of Dengue whereas specific objectives are to reduce mortality and morbidity from Dengue by 2020 by at least 50% and 25% respectively using 2010 as the baseline. 6ere were no reported cases of dengue fever found in Nepal till 2004.After 2004, it has been rapidly increases almost all part of country.Many outbreaks were documented in the years 2006, 2010 and 2017 where majority cases were from terai region of Nepal and it has been increased in 2016/2017 in comparison to previous year i.e., 134 cases in 2015/2016 and 1527 cases in 2016/2017. 7The increasing incidences and more severe forms of Dengue fever clearly evident to give attention to follow the healthy behaviors and attitude for the prevention and control of dengue fever among the community.This study aim to assess the Knowledge and preventive practice of dengue fever among students studying at Mahendra Morang Adarsh Multiple Campus, Biratnagar.

METHODS
A Quantitative-descriptive cross-sectional study was conducted to assess the knowledge and preventive practice on Dengue fever among students enrolled in bachelor degree of commerce, science, education and humanities of Mahendra Morang Adarsh Multiple Campus (MMAMC), Biratnagar.Data was collected from September (02-28) 2018 through semi-structured questionnaire.Validity of the questionnaire was maintained by reviewing related literature and consultation with the experts.Data collection tool was translated into Nepali language and then translated it back into English by expert who is fluent in both English and Nepali.Pretesting was done in 10% of the sample in a similar settings and modification of questionnaire was done on the basis of pretest result.Knowledge refers to the theoretical understanding of dengue fever regarding its causes, mode of transmission, sign and symptoms, preventive measures and treatment.Knowledge questionnaire was developed with literature review contained with total score of 36.Result of test was interpreted as follows; 29 -36 score as adequate level of knowledge and 0 -28 as inadequate level of knowledge on dengue fever.Preventive practice refers to the practical use of measure for the prevention of Dengue Fever in terms of knowledge.Questionnaire on the preventive practice of dengue fever was adopted and modified which was in Likert scale. 9There were 10 indicators with a scale of 0-4 points: 0 = never, 1 = seldom, 2 = sometimes, 3 = usually, and 4 = always, giving a score range of 0-40.In determining the level of preventive practice on dengue fever, the following score was used where good practice score contained 32 to 40 and poor practice score range from 0 to 31 of total score of level of practice.Non-probability purposive sampling technique was used to select 271 students.The inclusion criteria of study was students studying at MMAMC in Bachelor level, willing to participate and available at the time of data collection.Ethical approval was taken from Institutional Review Committee of Tribhuvan University Institute of Medicine.Informed written consent was taken prior to data collection.The confidentiality and anonymity were maintained throughout the research process and information is used for research purpose only.Data was collected by the researchers themselves by using semi-structured self-administered questionnaire.The collected data was analyzed by using descriptive (frequency, percentage, mean, standard deviation) and inferential statistics (chi-square test).The p value< 0.05 was considered as significance by using SPSS Version 16.0.

DISCUSSION
The result of the study showed that 97.4% of the respondents had heard about Dengue Fever.This finding is similar to the study conducted in Saudi Arabia whereas 97.5% of students heart about Dengue Fever. 11and also similar to the study conducted in India among students revealed that 94% of the respondents heard about Dengue fever. 12 found, 50.9% of the respondents gained information about Dengue Fever through school/ college and 45.4% from Television which findings is similar to the study conducted in Nepal among health science students revealed that 41.5% of respondents mentioned school/college and 41.2% mentioned Television were the sources of information about Dengue Fever. 13 this study 98.9 percent of the respondents knew that vector for DF is a mosquito which is similar with the study findings conducted in Pakistan showed that 93 percent of the respondents could identify the vector of Dengue Fever. 14ly 28% of the respondent in this study knew transmission for Dengue fever was Aedes whereas this finding is contrast to the study conducted among university students at Pakistan which revealed that 58% of the respondent knew that name of the vector was Aedes and also contradictory to the study conducted among university students in Kashmir. 15,16is study showed that 40.2% of respondents responded that virus is causative agents of Dengue.This finding is inconsistent with the study conducted in Nepal which revealed that 66.5% of the respondent knew that virus is a causative agent of Dengue fever. 13 present study 18.8% respondents reported that Aedes mosquito bites during day time and this finding is similar to the study conducted in Nepal revealed that 15.9% of the respondents knew the biting time of Aedes mosquito. 9In this study 86.7% respondents said that DF was transmitted through infected mosquito bite and same number of respondents also reported the way of transmission of Dengue Fever in study conducted in Nepal. 13 this study only 4.8% of the respondent knew that standing clean water is the breeding sites of Aedes mosquitoes whereas this finding is contrast to the study conducted among university students at Gujrat which revealed that 78% of the respondent knew breeding site of mosquito is standing clean water. 17he findings is difference might be due tolack of awareness.
In current study, the knowledge on preventive measures of Dengue Fever showed that 99.6 percent of respondents knew that it can be prevented through use of bed nets.These finding is similar to the study done in health science students of Nepal which revealed that 100% used mosquito net for prevention of Dengue Fever. 13e overall finding of this study revealed that 14.4 percent of respondents had adequate level of knowledge whereas the study conducted in university of Gujrat revealed similar findings that is 17.4% of respondents had good knowledge on Dengue Fever 17 but contradictory result was found in a study conducted in Malaysia which was 63.2%. 18garding the sign and symptom of Dengue Fever, this study revealed that 99.6% and 90.4% of respondents were able to identify common symptoms like fever Knowledge and Preventive Practice of Dengue Fever among Students studying in MMAMC... and headache respectively.However, this study is supported by a study conducted among highland and lowland communities of central Nepal showed that 99% and 97% of the respondents reported that fever and headache were the common sign and symptom of Dengue Fever respectively. 19is study showed that 35.8% of respondents demonstrated self-reported preventive practice on Dengue Fever.This finding is similar to the previous study conducted among people in Nepal which revealed that 37% of respondents had good practice regarding Dengue Fever. 20 this study 89.3 % of the respondents commonly used bed net and 8.9 % respondents less commonly used insecticides spray for prevention of Dengue Fever.The findings are comparable to the study done in eastern region of Nepal which showed that 100% of the respondents practiced for using bed net and 10.7% of the respondents used insecticides spray as preventive measure of Dengue Fever. 21e findings of this study showed that there was no significant association between level of practicewith selected demographic variable which was contrast to the study conducted among international students in University Putra Malaysia. 22Also contradictory result found in the study conducted in Saudi Arabia among students which showed significant association with level of practice to the demographic variables. 23e of the limitation of this study is the data was collected from only one setting thus the result may not be generalized outside the setting.Preventive Practice of Dengue Fever was measured in terms of knowledge only.
Finding from this study provides basis for development of guidelines and educational material and to conduct awareness program regarding Dengue Fever among students to enhance knowledge.
Similarly, the findings of the study may serve as baseline data for further research in this area.

CONCLUSION
The result of this study concluded that majority of the respondents had inadequate level of knowledge regarding Dengue fever and more than half of the respondents had poor preventive practice.There was no association between level of knowledge and practice on Dengue fever.No association was found between the level of knowledge and practice with selected demographic variables.

Knowledge and Preventive Practice of Dengue Fever among Students studying in MMAMC...Table 5 : Association between level of knowledge and Selected Variables of Respondents on Dengue Fever n=271
2: Pearson's Chi square Test, p value significant at <0.05 level