1

CHAPTER I

INTRODUCTION

Rationale of the study

Dengue is a viral infection caused by four types of viruses DENV-1,

DENV-2, DENV-3, DENV-4 belonging to the Flaviviridae family. Dengue is a

disease inflicted through female Anopheles mosquitoes. They carry the

dengue-causing virus, acting like a vector in spreading the disease. The

mosquitoes inject the virus while they suck the human blood for the

purpose of reproduction, blood acts as a high protein content. It is found

mostly in regions with tropical and sub-tropical climate. Mosquitoes usually

reproduce in stagnant water and this is the main reason dengue is spread

during rainy seasons as the water stays stagnant.

Preventive measures can always save the people from getting

affected by these life-threatening diseases. Reducing the rate of

mosquitoes is the best way to reduce the spread of dengue. People have to

remove the medium in which the mosquitoes reproduce. There is no specific

treatment for dengue but it can be cured if found in the earlier stages.

Ovitraps are now being used to detect and monitor disease carrying

mosquitoes. This research is aimed at finding the dengue management

practices of people in high dengue prone regions and low dengue prone

areas of Cebu City.

 2

Spraying insecticides to kill adult mosquitoes is not effective even

though it is a widely used mosquito control technique. Cleaning up the

larval habitats using larvicides in its larval phases should be given prior

importance. Poor sanitation and poor refuse control provide excellent

condition for mosquito larval to grow. Rubble and garbage caused due to

hurricanes and other natural disasters increase the habitat for mosquito

growth in urban areas.

Eliminating small accumulations of stagnant water around human

habitats ( disposing of old tires, covering water receptacles ) can reduce

the breeding of vector mosquitoes. Now a days biological control agents

like predatory copepods are used in great extent. Increasing heath

surveillance and heightening professional awareness can reduce the spread

of endemic diseases.

In this research, the researchers will bring out the steps and

initiatives taken by the government to eradicate the Dengue virus.

Researchers have also included the statements about the initiatives taken

by the government in the barangays.

 3

Review of Related Literature

Mosquito Aedes aegypti is the primary vector of dengue, which infects

humans by bites during daylight. The control of the virus vector (Mosquito)

should lead to the control of dengue. (Morrison, 2008).

Dengue is a mosquito-borne viral disease that has rapidly spread in

all regions of WHO in recent years. Dengue virus is transmitted by female

mosquitoes mainly of the species Aedes aegypti and, to a lesser extent, Ae.

albopictus. This mosquito also transmits chikungunya, yellow fever and

Zika infection. Dengue is widespread throughout the tropics, with local

variations in risk influenced by rainfall, temperature and unplanned rapid

urbanization (World Health Organisation, 2018).

Every year approximately 50000 individuals are being hospitalized

with dengue haemorrhagic fever. Mainly it’s found in Southeast Asia, the

Pacific and the Americas. The capacity for surveillance and outbreak

response can be increased and the disease burden can be reduced using

the integrated vector management combined with early and accurate

diagnosis has been said. The contribution of antiviral drugs can improve

the control of dengue in the future (Guzman, 2014).

 4

The variation in mosquito vector populations will improve dengue

surveillance and prevention. Aedes aegypti, primary vector can transmit

the virus with remarkable efficiency. As households are expected to be a

primary site the human DENV infection, vector control strategies like

intradomicile vector control strategies should be done. Individual household

can be used as a spatial scale for accessing the entomological risk.

Combined vector control with vaccine delivery will serve as the most

effective intervention strategy for rapid and sustained disease prevention

(Scott, 2010).

In the dengue-endemic countries of Asia and Americas 65% of the

people are at the risk of dengue despite having GAVI (Global Alliance for

Vaccines and Immunisation) support. The demand of the vaccine in the

endemic and non-endemic countries would increase due to the geographic

distribution of dengue (Ananda, 2010).

Several dengue vaccines are in development to address the need for

dengue prevention. Dengue can be prevented by control of vector. Dengue

fever can, in some cases, be life-threatening. Severe dengue causes

abdominal pain and vomiting, breathing difficulties and a decrease in blood

platelets that can lead to internal bleeding. It is the fastest-growing

mosquito-borne viral infection in the world (Mark, 2010).

 5

Clinical management and clinical services states that ,Reducing

dengue mortality requires an organized process that guarantees early

recognition of the disease, and its management and referral when

necessary. The key component of the process is the delivery of good clinical

services at all levels of health care, from primary to tertiary levels. Most

dengue patients recover without requiring hospital admission while some

may progress to severe disease. Simple but effective triage principles and

management decisions applied at the primary and secondary care levels,

where patients are first seen and evaluated, can help in identifying those

at risk of developing severe disease and needing hospital care. This should

be complemented by prompt and appropriate management of severe

dengue in referral centres(World Health Organisation, 2009).

Dengue: Guidelines for Diagnosis, Treatment, Prevention and

Control: New Edition states that, During outbreaks some patients may be

seen presenting with fever with or without rash during the acute illness

stage; some others may present with signs of plasma leakage or shock,

and others with signs of haemorrhages, while still others may be observed

during the convalescent phase. One of the priorities in a suspected outbreak

is to identify the causative agent so that appropriate public health measures

can be taken and physicians can be encouraged to initiate appropriate acute

illness management(World Health Organisation, 2009).

 6

In such cases, the rapidity and specificity of diagnostic tests is more

important than test sensitivity. Samples collected from febrile patients

could be tested by nucleic acid methods in a well-equipped laboratory or a

broader spectrum of laboratories using an ELISA(Enzyme-linked immune

sorbent assay) based dengue antigen detection kit. If specimens are

collected after day 5 of illness, commercial IgM ELISA(Enzyme-linked

immune sorbent assay) or sensitive dengue IgM rapid tests may suggest a

dengue outbreak, but results are preferably confirmed with reliable

serological tests performed in a reference laboratory with broad arbovirus

diagnostic capability. Serological assays may be used to determine the

extent of outbreaks (World Health Organisation, 2009).

According to Department of Medicine, University of Peradeniya, in

the journal Infectious Diseases ,dengue infection ranks highly among new

and newly emerging arthropod-borne viral diseases affecting humans. It

affects a large proportion of the population, mainly in tropical and sub-

tropical countries, causing a high morbidity and mortality due to rising

incidence of dengue haemorrhagic fever. The rapidly expanding global

footprint of dengue is a public health challenge with a high economic

burden. Appropriate management of the burden of dengue is hindered by

several issues, including lack of understanding of the exact pathophysiology

of the disease, failure to control the vector population effectively, lack of

specific treatment for the disease, and technical obstacles in developing a

 7

vaccine. This review provides an overview on the epidemiology, natural

history and management strategies of adult dengue patient. Dengue is a

self-limiting, systemic viral infection transmitted by mosquitoes of genus

aedis. It affects a large proportion of the population in tropical and sub-

tropical countries, causing high morbidity and mortality. The rapidly

expanding global footprint of dengue is a public health challenge with a

high economic burden, that currently remains unchecked due to lack of

licensed vaccines, specific therapeutic agents, or effective vector control

strategies. However, improved care in hospitals has led to a significant drop

of mortality. As such, furthers effort should be taken optimized the

treatment strategies based on proper understanding of the pathophysiology

of the disease(Ralapanawa, 2015).

 8

THE PROBLEM

Statement of the problem

The study would want to determine the possible reasons for the

difference in the dengue rates of Guadalupe, a high dengue case area and

Punta Princessa, a low dengue case area in Cebu City.

Specifically the researchers would like to answer the following question:

1.What measures are taken by the two Barangays in the prevention of

dengue?

2.How the dengue-prevention differ from the two barangays?

Hypothesis

There is no significant difference in the dengue management

procedures taken by the people in Guadalupe, a high dengue case area and

Punta Princessa, a low dengue case area in Cebu City.

 9

Significance of study

This study is significant because this will help the researchers to

know more about dengue management and the researchers can take their

best efforts to prevent the spread of dengue.

The study is beneficial to the following

Student- This will help them understand the need of keeping the

surroundings clean and protected in order for their well-being.

Teachers- This will help them acquire knowledge about the different ways

to reduce the spread of dengue and they can guide students about the

prevention of dengue.

Barangay/City Officials- They can know where to emphasize more

important in providing preventive measures.

DOH (DEPARTMENT OF HEALTH)- They can provide vaccines in regions

of high dengue risk and check for the proper working of the barangays.

Future researchers- They can learn about the efficacy of the

management techniques implied in reducing the dengue rates.

 10

Scope and Limitation

This study is mainly focused on the comparison of dengue

management procedures between Guadalupe, a high dengue case area and

Punta Princessa, a low dengue case area in Cebu City. The research is

focused on the places with same climate.

 11

CHAPTER II

RESEARCH METHODOLOGY

Research Design

In this study, the researchers will be using a random sampling survey

method to select twenty five (25) people from Guadalupe (High dengue

case area) and another twenty five(25) people from Punta Princessa (Low

dengue case area) in Cebu City to gather the data of the dengue

management procedures.

Research Environment

The researchers will be comparing the dengue management

procedures within Guadalupe, a high dengue case area and Punta

Princessa, a low dengue case area in Cebu City.

Research Instrument

In this study, the researchers will use standardize questionnaire to

compare the dengue management procedures within Guadalupe, a high

dengue case area and Punta Princessa, a low dengue case area in Cebu

City.
 12

Research Procedure

First, the researcher will observe twenty five (25) people from

Guadalupe (High dengue case) and another twenty five (25) people from

Punta Princessa (Low dengue case) in Cebu City to gather the data of the

dengue management procedures using standardized questionnaire.

Finally the collected data will be tabulated and analysed using

standard statistical methods.

 13

CHAPTER III

RESULTS AND DISCUSSIONS

The researchers took the survey in the 2 areas using the

questionnaire and computed the data and information using standard

statistic methods. Firstly the age group of the respondents were computed

separately to know which age group of people were correctly following the

dengue management procedures. Then the questions in the questionnaire

was kept as base to do the further research and calculations.

The response of each questions were made into separate tables and

finally all the 10 questions were put under the same table to know the

difference in the responses. The same procedure was followed to compute

the data in area B also.

The choice always was taken into main consideration to make the

analysis in the data recorded.

 14

TABLES BASED ON AGE GROUP

AREA- A (Table 1)

Always Usually Sometimes Seldom Total

16 -25 20 12 21 25 78
26-35 46 33 31 7 117
36-45 11 5 7 31 54
46-55 0 0 1 1
56-65 0
Total 77 50 59 64 250

From this table it is clear that people from age group 16-35 are taking more

preventive measures to control breeding of mosquitoes than the remaining

people from age group 36-65.

AREA- B (Table 2)

Always Usually Sometimes Seldom Total

16-25 25 11 15 9 60
26-35 57 12 29 19 117
36-45 20 0 12 4 36
46-55 19 5 3 1 28
56-65 3 2 1 3 9
Total 124 30 60 36 250

From this table it is clear that people from age group 16-35 are taking more

preventive measures to control breeding of mosquitoes than the remaining

people from age group 36-65.

 15

AREA – A GUADALUPE (TABLE 3)

Always USUALLY SOMETIMES SELDOM TOTAL

1 Uses 9 3 8 5 25
insecticides
sprays
2 Uses 4 3 7 11 25
professional
pest control
3 Uses screen 15 3 5 2 25
windows
4 Uses fans 10 1 6 8 25
5 Uses bed 0 9 6 10 25
nets
6 Eliminates 8 7 2 8 25
standing
water
7 Cut down 9 6 5 5 25
bushes in
yard
8 Uses 8 12 3 2 25
mosquito
coils
9 Covers water 8 6 7 4 25
containers

10 Cleans water 6 0 10 9 25
filled
containers
and ditches
TOTAL 77 50 59 64 250

Table 3 shows that the result for the choice always is just 77 out of 250

that is 30.8% which means only a very few people are taking dengue

prevention methods.

From table 3 it is clear that the people in area -A(GUADALUPE) are not

taking enough measures to control mosquitoes in their area. They are not

having a good dengue management procedure to control the mosquitos

causing dengue in their area.

 16

AREA -B PUNTA PRINCESSA (TABLE 4)

Always Usually Sometimes Seldom Total

1 Uses 5 3 11 6 25
insecticide
sprays
2 Uses 4 1 12 8 25
professional
pest control
3 Uses screen 16 6 3 0 25
windows
4 Uses fans 18 3 3 1 25
5 Uses bed 7 2 6 10 25
nets
6 Eliminates 18 3 3 1 25
standing
water
7 Cut down 9 4 9 3 25
bushes in
yard
8 Uses 5 5 9 6 25
mosquito
coils
9 Covers 22 1 1 1 25
water
containers
10 Cleans 20 2 3 0 25
water filled
containers
and ditches
Total 124 30 60 36 250

Table 4 shows that the result for the choice always is 124 out of 250 that is 49.6%

which means many people are taking dengue prevention methods.

From table 4 it is clear that the people in area B (PUNTA PRINCESSA) are taking

good measures to avoid the breeding of mosquitos. They are habituated for good

dengue management procedure to control mosquitoes causing dengue in their

area.
 17

COMPARITIVE GRAPH

TABLE 3 : PERCENTAGE CALCULATION

AREA A AREA B

Max people using 77 124

preventive methods
to control dengue

In percentage 30.8% 49.6%

 18

According to this research dengue management procedures

like the ones stated above are the best ways to prevent breeding of

mosquitoes. Dengue fever is a dangerous and depleting disease, and it's a

growing threat to global health. Dengue management measures like using

insecticidal sprays , pest control chemicals, screen for windows, bed nets,

cleaning up stagnant water, cutting down the bushes in the yard , using

mosquito coils , covering the water containers and cleaning the water

ditches has been used as the tool to collect data from the two areas.

Using the data collected the researchers found that the people

in area A (GUADALUPE-30.8%) are less habituated in using the above

dengue-prevention measurements compared to the people from area-B

(PUNTA PRINCESSA- 49.6%).

 19

CONCLUSION AND IMPLICATION

Based on the results of the study the researchers concluded

that people from area-a (GUADALUPE) are not properly using the dengue

management prevention methods. So they are highly prone to dengue. On

the other hand people in area-B (PUNTA PRINCESSA) are regularly

following the dengue management prevention method. So they are less

prone to dengue. There fore , if the above mentioned dengue-prevention

methods are followed regularly people can avoid the breeding of

mosquitoes and spread of dengue.

RECOMMENDATION

FUTURE RESEARCHERS – The future researchers working on

this study should know the other factors that affected the efficiency of the

two barangays dengue- prevention measures.

 20

REFERENCES

Online Sources

Scott, TW(2010) Vector dynamics and transmission of dengue virus:

implications for dengue surveillance and prevention strategies: vector

dynamics and dengue prevention. Retrieved from

https://www.ncbi.nlm.nih.gov/pubmed/19802582

Guzman, MG(2010) Dengue: a continuing global threat. Retrieved

from https://www.ncbi.nlm.nih.gov/pubmed/21079655

Amarasinghe, A(2010) Forecasting dengue vaccine demand in

disease endemic and non-endemic countries. Retrieved from

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3056060/

Morission, C(2008) Defining challenges and proposing solutions for

control of the virus vector Aedes aegypti. Retrieved from

https://www.ncbi.nlm.nih.gov/pubmed/18351798

Lan, (1998) Treatment of Dengue Haemorrhagic Fever at Children's

Hospital No. 1, Ho Chi Minh City, Viet Nam, 1991-1996. Retrieved from

http://apps.who.int/iris/handle/10665/148646

Dengue. Retrieved from https://www.doh.gov.ph/Health-

Advisory/Dengue

Dengue and severe dengue. Retrieved from

https://www.who.int/news-room/fact-sheets/detail/dengue-and-severe-

dengue
 21

Campaign for dengue prevention. Retrieved from

http://www.pchrd.dost.gov.ph/index.php/news/library-health-news/258-

campaign-for-dengue-prevention

BOOK SOURCES

World Health Organisation (2009).Dengue: Guidelines for Diagnosis,

Treatment, Prevention and Control: New Edition

Gubler, (1968). Dengue and Dengue haemorrhagic Fever,2nd edition

Origin and expansion of the mosquito Aedes aegypti in Madeira Island

Wilfred, (1870). Campaign for dengue prevention Comparison of

Knowledge, Attitude, and Practice among Communities Living in Hotspot

and Non-Hotspot Areas of Dengue Trop Med Infect Dis. 2019 Feb 15;4(1).
 22

Appendix 1. Questionnaire for the survey …..

Name:_____________________________________________________

Age: ___ Gender: M/F___ Religion:______________________

Civil Status: Married single divorced widow

Monthly income: less than 10,000 11,000-20,000 21,000 and over

Occupation:_________________________________________________

(Abstracted from https://www.researchgate.net/figure/Responses-to-

Dengue-Prevention-Practices-Questionnaire_tbl2_252629649)

1. Uses insecticide sprays to reduce mosquitoes

A. Always C. Sometimes

B. Usually D. Seldom

2. Uses professional pest control to reduce mosquitoes

A. Always C. Sometimes

B. Usually D. Seldom

3. Uses screen windows to reduce mosquitoes

A. Always C. Sometimes

B. Usually D. Seldom

4. Uses fans to reduce mosquitoes

A. Always C. Sometimes

B. Usually D. Seldom
 23

5. Uses bed nets reduce mosquitoes

A. Always C. Sometimes

B. Usually D. Seldom

6. Eliminates standing water around the house to reduce mosquitoes

A. Always C. Sometimes

B. Usually D. Seldom

7. Cuts down bushes in the yard to reduce mosquitoes

A. Always C. Sometimes

B. Usually D. Seldom

8. Uses mosquito coils to reduce mosquitoes

A. Always C. Sometimes

B. Usually D. Seldom

9. Covers water containers in the home

A. Always C. Sometimes

B. Usually D. Seldom

10. Cleans water filled containers and ditches around the house

A. Always C. Sometimes

B. Usually D. Seldom