Dengue in Rural Marang Village : A Study on Knowledge, Attitude

and Practice and Its Association with Socio-demographic Factors

Denggi di Kampung Pedalaman Marang : Kajian Tentang

Pengetahuan, Sikap dan Amalan serta kaitannya dengan Faktor-
faktor Sosiodemografik

by

Year 4, Group 1
Batch 2013/2018
Community Medicine Posting - Research Methodology

UCSI University

Faculty of Medicine and Health Sciences

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STUDENT LIST

1. PAVITHIRAN A/L SELVARAGI (1001026500)

2. TAY RU-FANG (1001130718)

3. WENDY NGU WEN WEN (1001232028)

4. WONG SHIN YIING (1001232821)

5. LEE JUN KEONG (1001334489)

6. ROSHINI PALANISAMY @ PRAMMY SAMMY (1001334850)

7. JANINE TAN SINN LU (1001334862)

8. MERYL LOH WEI CHYI (1001334900)

9. DURGA DEVI GUNESAN (1001334928)

10. LIM JIE YING (1001335448)

11. RENUKA BEULAH A/P KUNALAN (1001335491)

12. SUBASHINI A/P GUNASEGARAN (1001335536)

13. PRITHARANI A/P KARUNAGARAN (1001335558)

14. WAN KHALIL NASRIN BIN WAN MOHD NASIR (1001335726)

15. NUR FARAH NADIA BINTI ZAMRI (1001335969)

16. CHERISH CHONG CHIU WERN (1001026490)

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ACKNOWLEDGEMENT

We express our gratitude to Pejabat Kesihatan Daerah Marang especially the Health
Officers, Dr. Azlihanis bt Abdul Hadi, Dr. Fatimah Suhasliza bt A. Rahman, the Medical
Officer of Klinik Kesihatan Wakaf Tapai and Medical Assistant of Klinik Kesihatan Wakaf
Tapai, Mohd. Nazri bin Mohamad for granting us the permission to do our research in a
village under their district. Besides that, they were also willing to extend a helping hand
when we encountered difficulties during census collection.

This research would not have been a success without the cooperation from the village
head of Kampung Tanah Lot, Mr. Sulong bin Ismail who was very helpful and kind to us
during our time in the village. We extend our sincere thanks to all the villagers of Kampung
Tanah Lot who so willingly participated in our research.

Last but not least, we owe our gratitude to the Vector Team (Alpha, Bravo, Charlie, Delta)
for providing us knowledge and experience on larvae inspection in households.

TABLE OF CONTENT

No. Title Page 1

Student’s Names 2
Acknowledgement 3
Table of content 4-6
Abstract 7-8

CHAPTER 1: INTRODUCTION
1.1 Introduction 9-12

1.2 Rationale 13

1.3 Public Health Significance 13

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1.4 Background information 14

CHAPTER 2: PROBLEM STATEMENT AND LITERATURE REVIEW

2.1 Literature review 15-28
2.2 Problem statement 28

CHAPTER 3: RESEARCH OBJECTIVES, HYPOTHESIS AND CONCEPTUAL

FRAMEWORK
3.1 Research question 28
3.2 Research objectives 29
3.3 Specific objectives 29
3.4 Conceptual framework 30

CHAPTER 4: RESEARCH METHODOLOGY AND OPERATIONAL DEFINITIONS

4.1 Research flow chart 31-32
4.2 Study design 33
4.3 Sampling frame 33
4.4 Sampling method 33
4.5 Study period 34
4.6 Inclusion criteria 34
4.7 Exclusion criteria 34
4.8 Variables 34-35
4.9 Data collection tools 35
4.10 Method of data collection 35
4.11 Questionnaire 35-37
4.12 Pre-testing & Pilot study 37
4.13 Data entry and analysis 37
4.14 Operational Definitions 37-41
4.15 Ethical consideration 41

CHAPTER 5: RESULTS
5.1 Introduction 42
5.2 Sociodemographic profile 42
5.3 Prevalence of Knowledge, Attitude & Practice (KAP) 42-45
5.4 Association between Socio-demographic factors and KAP 45-46

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5.5 Tables and Figures 47-63

CHAPTER 6: DISCUSSION
6.1 Discussion 64-76

CHAPTER 7: LIMITATIONS, RECOMMENDATION AND CONCLUSION

7.1 Limitations 77
7.2 Recommendations 77
7.3 Conclusion 78

CHAPTER 8: REFERENCES
8.1 References 79-92

CHAPTER 9: APPENDICES
9.1 Appendices
A. Interview questionnaire (English) 93-100

B. Interview questionnaire (Malay) 101-109

C. Gantt chart 110

D. Participant information sheet (English) 111-112

E. Participant information sheet (Malay) 113-114

F. Consent form (English) 115

G. Consent form (Malay) 116

H. Map of Kampung Tanah Lot, Wakaf Tapai 117

I. Dean approval letter 118

J. Application for ethical clearance for research 119-130

K. Budget list 131

L. Pictures of community service event 132

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ABSTRACT

The incidence of dengue has grown dramatically around the world and 3.9 billion people,
Malaysia included, are at risk of infection with dengue viruses. Malaysia reported its
highest number of dengue cases, 101,000 cases, in 2015 with 336 deaths despite
increasing allocation of funds for vector control and community education programmes.

Active community participation is crucial for the effectiveness of vector control, with
studies carried out showing that vector control efforts are best achieved when a
community’s knowledge and priorities are taken into account. Knowledge, attitude and
practice (KAP) surveys are focused evaluations that measure changes in human
knowledge, attitudes and practices, and are apt to identify knowledge gaps, cultural beliefs,
or behavioural patterns that may facilitate the implementation of public health initiatives.

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A cross-sectional analytical study was done to assess the level of KAP on dengue of the
rural population, its association with socio-demographic factors and the association
between knowledge, attitude and practice. The study utilised the questionnaire for data
collection of socio-demographic factors, knowledge, attitude and practice concerning
dengue. Data entry and analysis was done using SPSS version 20.0.

This study found that 86.6% of the villagers had high level of knowledge of dengue while
99.2% of them had good attitude towards dengue and 92.1% had good practice
concerning dengue. Of all socio-demographic factors, marital status, occupational status,
educational level and monthly income were found to be significantly associated with
knowledge of dengue. Marital status and occupational status were found to be significantly
associated with the practice towards dengue. There was no association between any of
the socio-demographic factors and the attitude concerning dengue. Besides that, the
findings of this study showed a significant association between knowledge and practice of
dengue. There was no association found between knowledge and attitude of dengue and
no association found between attitude and the practice of dengue.

ABSTRAK

Insiden kes denggi telah meningkat secara drastik di seluruh dunia dimana 3.9 billion
manusia, termasuk rakyat Malaysia, terdedah kepada risiko jangkitan virus denggi.
Bilangan kes denggi tertinggi di Malaysia telah direkodkan pada tahun 2015 dimana
101,000 kes dengan 336 kematian telah dilaporkan. Perkara ini berlaku walaupun
peruntukan untuk kawalan vector dan program kesedaran masyarakat telah ditingkatkan..

Penyertaan aktif masyarakat memainkan peranan penting untuk keberkesanan kawalan

vektor, dimana terdapat satu hasil kajian yang menunjukkan usaha kawalan vektor akan
memberikan hasil yang baik jika tahap pengetahuan dan nilai-nilai masyarakat juga
diambil kira. Kaji selidik pengetahuan, sikap dan amalan (PSA) adalah penilaian tepat
yang mengukur perubahan dalam pengetahuan, sikap dan amalan. Kaji selidik ini akan

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dapat mengenal pasti jurang pengetahuan, adat dan kepercayaan, atau corak amalan
yang akan memudahkan implementasi inisiatif kesihatan awam.

Satu kajian keratan rentas telah dijalankan untuk mengukur tahap PSA terhadap denggi
dalam kalangan penduduk pedalaman, kaitannya dengan faktor-faktor sosio-demografik
serta hubungan antara pengetahuan, sikap dan amalan. Kaji selidik ini telah
menggunakan borang soal selidik untuk mendapatkan maklumat mengenai faktor-faktor
sosio-demografik, pengetahuan, amalan dan sikap terhadap denggi. Kemasukan data dan
analisis telah dilakukan menggunakan SPSS versi 20.0

Hasil kaji selidik ini menunjukkan 86.6% penduduk kampung mempunyai tahap
pengetahuan yang tinggi mengenai denggi, manakala 99.2% mempunyai sikap yang
bagus terhadap denggi, dan 92.1% mempunyai amalan yang bagus terhadap denggi.
Status perkahwinan, pekerjaan, tahap pendidikan dan pendapatan bulanan adalah faktor-
faktor sosio-demografik yang berkait rapat dengan tahap pengetahuan mengenai denggi.
Status perkahwinan dan pekerjaan juga berkait rapat dengan amalan terhadap denggi.
Tiada kaitan telah ditemui antara faktor-faktor sosiodemografik dengan sikap terhadap
denggi. Selain itu, hasil kaji selidik ini telah menunjukkan bahawa tahap pengetahuan dan
amalan terhadap denggi adalah berkait rapat. Manakala tiada hubungan telah ditemui
antara tahap pengetahuan dan sikap, dan juga tiada hubungan antara sikap dan amalan
terhadap denggi.

INTRODUCTION

Dengue, an acute mosquito-borne viral infection transmitted between humans by Aedes

mosquitoes (Simmons et al., 2012) was first reported back in the 1800s. The term Dengue
originated from a Spanish word which means fastidious or careful, possibly in describing
the gait of an individual suffering from the bone pain of a dengue infection (Denggi, 2017).

Due to its wide spectrum of clinical manifestations, dengue infections often go untreated
or undiagnosed. Majority of the patients infected with the Dengue virus experience a mild,
self-limiting form of dengue, with only a handful of them progressing to dengue
haemorrhagic fever or dengue shock syndrome. This syndrome is associated with 40–50%
fatality if untreated or mistreated. When properly treated, the case fatality can be reduced

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to 5% or less (Heyman, 2008). Despite this, no specific therapy for dengue exists to date,
with supportive measures remaining as the mainstay of treatment.

An alarming rise in dengue cases in recent decades have been reported globally with an
estimation of 390 million dengue infections per year (Bhatt et al., 2013) with the World
Health Organization (WHO) calling it the fastest growing mosquito-borne disease in the
world. However, these figures are grossly underestimated, with a large proportion of the
actual dengue cases being under-reported or misclassified. The distribution of dengue has
experienced a rapid geographical expansion with half of the world’s population now living
in more than 100 dengue-endemic countries (WHO, 2017). Distressingly, Malaysia is not
spared from this trend with the rise from 7,200 cases reported in 2000 to 101,000 cases
reported in 2015 (Idengue, 2016).

There are currently four recognized dengue virus serotypes with lifelong immunity
conferred to infection by one serotype. The approval of the world’s first dengue vaccine by
Sanofi-Pasteur in 2015 was shown to be 55-65% effective (Capeding et al., 2014; Villar et
al., 2015). However, the vaccine has yet to be approved by the Ministry of Health,
Malaysia (MOH) due to concerns regarding the safety and efficacy of the vaccine, as the
vaccine was shown to have lower efficacy with the dominant dengue serotypes (DENV-1,
DENV-2) associated with major dengue outbreaks in Malaysia (Villar et al.,2015; Abu
Bakar and Shafee, 2013).

The WHO classifies dengue as a ‘neglected tropical disease’ due to low research attention
and the absence of coordinated efforts to reduce disease burden. As a result, dengue-
endemic countries experience significant health and economic impacts. Outbreaks, in
particular, exert the largest burden on the population and healthcare systems. In South-
East Asia, the disease burden was comparable to meningitis, has surpassed the burden of
hepatitis and is one-third the burden of HIV/AIDS (Shepard et al., 2004). Recent explosive
outbreaks in Brazil saw 158,000 cases reported, with over 9,000 hospital admissions and
230 deaths in a matter of four months (Barreto, 2008). In Malaysia, the cost of dengue
infection amounted to US$102.2 million in 2009 (Shepard et al., 2012).

Given the astounding human and economic costs and with no cure in sight, vector control
with active community participation and active disease surveillance remain as our most

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effective weapon in controlling the spread of dengue (WHO, 2004). These measures aim
to halt the transmission of dengue by reducing Aedes mosquito population. Malaysia’s
passive dengue surveillance system launched in 1973, requires healthcare practitioners
from private and public health facilities to report all suspected dengue cases to the MOH
within 24 hours of encountering such cases (Gubler, 2002). Upon receiving such
notifications, a chain of events is initiated aimed to contain the disease. Vector control
officers from the district health departments of the MOH receive notifications of clinically
suspected dengue cases, investigate them, and initiate chemical fogging in areas
surrounding the suspected index case as a means of destroying adult mosquitoes. On a
global scale, the Global Strategy for Dengue Prevention and Control was launched by the
WHO in an effort to reduce dengue morbidity, mortality and to estimate the true burden of
the disease. Much emphasis is placed on early diagnosis and recognition, surveillance
and outbreak preparedness and sustainable vector control (WHO, 2004). This strategy
has served as a guide for many countries implementing their national vector control
program. Malaysia’s current strategy for dengue prevention and control embodies the core
principles highlighted in the guideline.

Though much success has been achieved with this approach, there are limitations to it.
For one, the assessment of the efficacy and sustainability of vector control and disease
surveillance has proven to be a challenge while sustaining the large, vertically structured
programs, has been a burden to many countries. It has been estimated that the Malaysian
government spent US$17.8 million annually on dengue vector control activities during the
period of 2002 to 2007 (Lim et al., 2010). This is a substantial investment in Malaysia
since this constituted about 0.6% of the annual government health expenditures for those
years.

The biggest contributor to the effectiveness of vector control, however, is active

community involvement. As in with any other communicable disease control, community
participation is the core of the programme, with studies showing that control efforts are
best achieved when a community’s knowledge and priorities are taken into account
(Rosenbaum et al., 1995). The term community participation in vector control activities can
be interpreted in various ways, both in theory and in practice. Commonly, the community
is advised on how to solve health problems caused by the vector or is invited to contribute
to the implementation of centrally designed programs. Rarely, the community is involved
in the process of planning, implementing and evaluating the program (Rifkin, 1996). It is a
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responsibility shared by many, and inter-sectoral cooperation has been proven to be a
strategic approach for successful interventions (Suwanbamrung, 2010). Thus, community-
based source reduction programs have been put forth as the solution for achieving
efficient and sustainable vector control. With mounting evidence that the community plays
a vital role in curbing the spread of the disease, national vector control programs
introduced globally are placing more and more emphasis on community involvement. The
key components of dengue control rely heavily on motivating community and individual
engagement, which highly depends on their perception of the severity of the disease, and
willingness to take responsibility.

Knowledge, attitude and practice (KAP) surveys are focused evaluations that measure
changes in human knowledge, attitudes and practices. The KAP survey was first used in
population studies in the 1950s. KAP survey data are essential for informing public health
work (Hausmann-Muela et al., 2003; Manderson and Aaby, 1992). KAP surveys are very
helpful for identifying knowledge gaps, cultural beliefs, or behavioural patterns that may
facilitate the implementation of public health initiatives. In addition, the data collected from
KAP surveys enable the health ministry to establish baseline levels and to measure any
changes from interventions. In short, KAP surveys enable the government to gauge the
success of healthcare programmes and identify their shortcomings. In the long run,
disease burden, social and economic impacts can be reduced. Large numbers of KAP
studies conducted regarding dengue reported high KAP level among their study
population (Dhimal et al., 2014; Aung et al., 2016). However, studies have found that
knowledge about dengue does not necessarily translate to positive attitudes and improved
preventive measures (Goncalves et al., 2004; Koenraadt et al., 2006). In contrast, findings
in a study done in a rural area of Sao Paulo, Brazil reported strong positive attitude that
was associated with knowledge about dengue fever (Donalisio et al., 2001). With multiple
conflicting reports on how KAP are interlinked, there is an increase need for more studies
to be carried out to determine the extent of their association.

Socio-demographic data is often included in studies. Despite the wealth of information it

provides regarding the research participants, not many studies have studied the
interaction between socio-demographic characteristics and KAP level. Of the few literature
available, majority of them report an association between education level and knowledge.
One particular study by Itrat et al. (2008) demonstrated high level of knowledge about

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dengue with higher educational level. Otherwise, little is known about the association
between socio-demographic characteristics and the level of KAP.

Once thought to be a predominantly urban disease, the WHO has now confirmed that
dengue has spread into rural areas from where it had not been reported previously (Muto,
2000). Today, Thailand has an incidence rate that is higher in rural (102.2 per 100,000)
than urban areas (95.4 per 100,000) (Chareonsook et al., 1999). Similarly, in India,
studies showed a widespread distribution of Aedes aegypti, both in rural and urban areas
during an outbreak in Gujarat (Hayes et al., 1996). With the bulk of KAP studies relating to
dengue in Malaysia concentrated in major towns or cities (Ayyamani et al., 1986;
Rozilawati et al., 2007) and the rapid changing epidemiology of the disease, urgent need
for information is required on the KAP level of the rural population. Thus, this study aims
to assess the level of KAP on dengue of the rural population, its association with socio-
demographic factors and the association between knowledge, attitude and practice.

Rationale

a) The incidence of dengue has grown dramatically around the world and 3.9 billion
people, Malaysia included, are at risk of infection with dengue viruses.

b) Malaysia reported its highest number of dengue cases in 2015 with 336 deaths.

c) Dengue cases in Malaysia continue to rise despite increasing allocation of funds

for vector control and community education programmes.

d) So far, dengue was reported as an urban disease but has since shown to move to
rural settings according to our literature searches.

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 e) To the scope of our literature searches, we find that there is a lack of KAP studies
conducted in a rural setting.

f) Completion of a research project is a partial fulfilment of the requirements of the

Doctor of Medicine programme in UCSI University.

Public Health Significance

It is our hope that the results of this study would be able to contribute to the development
of healthcare programmes tailored to a target population in the control of dengue. The
data provided could be of use to health policy makers in generating a more
comprehensive, integrated strategy to combat the spread of dengue. In addition, since the
dengue cases reported in Malaysia is the third highest among the Western Pacific Region
coupled with the discovery of dengue spread to rural area, our study may be beneficial in
filling knowledge gaps in KAP levels in rural settlements.

Background Information

Our study is conducted in Kampung Tanah Lot, Wakaf Tapai, Marang in the state of
Terengganu. The village extends to an area of four square kilometres and is under the
care and supervision of the Jawatankuasa Kemajuan dan Keselamatan Kampung. The
village is a 30 minute drive to the nearest town, Marang.

Prior to 1980, the land the village sits on was a rubber plantation. The history of the area
dates back to 1910 when a Chinese immigrant was its first settler. The land was then
developed and converted into a village. There are 200 lots for houses but currently, only
76 houses are built with 66 houses having residents. The village has a population of 300

13
with 187 villagers above the age of 18. Majority of the villagers are of Malay ethnicity with
Bahasa Melayu as their main language. The first and current head of the village is Mr.
Sulong bin Ismail.

Majority of the villagers are timber factory workers, business operators and government
officers with their working hours falling between 8 a.m. to 5 p.m. Currently, there are a
number of houses, a playground and a mosque still under construction. The nearest
health facility is ‘Klinik Kesihatan Wakaf Tapai’ which is located approximately one
kilometre away from the village.

According to the village head, there has never been a dengue outbreak in the village.
Nevertheless, he mentioned that there was a suspected dengue case two years back. He
also stated that there has been no fogging or talks on dengue. However, the villagers will
get together once every two to three months to clean up the whole village (gotong-royong).
The latest gotong-royong was done in December 2016 and most of the villagers actively
participated in it.

Literature Review

1. Dengue

Dengue is a fast emerging pandemic-prone viral disease in many parts of the world.
Despite reports stating that dengue, a mosquito-borne viral infection was first reported in
1779 and 1780 (Lanciotti, 1994), a Chinese encyclopaedia has documented dengue as
‘water poison” that involves flying insects associated with water (Gubler, 2006).

In the year 1944, a virus under the flavivirdae virus family was identified by Albert Sabin
and was believed to be responsible for dengue (Lanciotti., 1994). In 1977, a new dengue

14
virus strain DEN-1 was introduced. In 1981, DEN-2 and DEN-4 strain was introduced after
DEN-1. Lastly, in the year 1994, the DEN-3 dengue virus strain was introduced (Gubler,
1998).

Infection with one virus strain provides lifelong immunity to that particular virus strain but
infections by the other virus strain can only provide transient and partial protection. Hence,
people can have more than one dengue infection in their whole lifetime. (MOH, 2005)

Dengue which is described as endemic in many countries especially the tropical and
subtropical countries has caused increasing health and economic burden. (Rahman et al.,
2014) This rapidly increasing disease is identified in 15 countries in Africa from 1960
through 2010. (Amarasinghe A et al., 2011). In 2008, an outbreak which consist of more
than 158 000 reported cases and 230 deaths between January and April in Rio de Janeiro
State. This results in the military being deployed to help out in the healthcare and vector
control operations. (Barreto et al., 2008).

Dengue outbreaks lead to a huge burden on health systems, populations, economies

worldwide. It can trigger similar burdens as other communicable diseases in some of the
common affected areas. (WHO, 2012). In 1990, million population lost to dengue is
consistent to the childhood cluster of diseases (polio, measles, pertussis, diphtheria and
tetanus), meningitis, hepatitis or malaria in Latin America and the Caribbean (Meltzer et al.,
1998).

In 1998, dengue, with 100 million cases and 25,000 deaths reported annually was placed
after malaria as the most important tropical infectious disease (Gubler, 1998). Due to the
significant spread of the virus, dengue emerged as the most important mosquito-borne
viral disease in year 2012 (Murray et al., 2013).

Currently, dengue is one of the most fatal and rapidly spreading mosquito- borne disease
and it is now a worldwide concern (WHO, 2009).At the beginning of 21st century, there
were 50 -100 million cases of dengue fever and several hundred thousand cases of
dengue haemorrhagic fever occurred each year, depending on the epidemic activity.
(Ratageri et al., 2005). Over the last decade the trend has raised much concern where a
study have shown that the number of dengue cases and number of deaths reported has
increased on an average of 14% and 8% per year respectively (Mia et al., 2013). It has
been reported that approximately 5.6 billion of the world’s population exposed to dengue
lives in Asia Pacific and 1.3 billion of those at risk lives in dengue-endemic countries in
South East Asia (Murray et al., 2013).
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In Malaysia, the first case of dengue was reported in the 1900s. The first major outbreak
was identified in our country in the year 1973 and has been increasing ever since.
(Wallace et al., 1980). A significant outbreak happened in Malaysia from the year 1982
with a gradually increasing pattern of incidence and fatality. Since the early 1990s, dengue
became endemic in Malaysia and frequent outbreaks happened thereafter (Hamid et al.,
2014). Its incidence in Malaysia continued to increase from 32 cases per 100,000 in year
2000 to 361 cases per 100,000 population in 2014 (MOH, 2015). Within Asia, Malaysia
ranked third among all the countries in Western Pacific Region in terms of number of
cases reported (Mohd-Zaki et al., 2014).

The primary vector for dengue is the Aedes aegypti mosquito which is commonly found in
urban areas and the secondary vector is Aedes albopictus. The spread of dengue virus is
mainly through human to mosquito to human cycle. Humans will become the carrier after
being bitten by an infected female mosquito before becoming the source of virus for the
uninfected mosquito (WHO, 2016). Ideal range for survival of the Aedes mosquitoes
through all phases of development (88-93%) occurs between the temperatures of 20-30°C.
(Tun-Lin., 2000) Females of this species deposit their eggs in a variety of water-holding
containers, such as jars used for domestic water storage, tires, and disposed items that
have filled with rain water. Because an effective vaccine is not yet available, dengue
control is limited to reduction of the vector population (Reiter P, Gubler DJ, 1997).

Symptoms of dengue can range from mild unrecognised fever to severe disease with
organ involvement (MOH, 2015). Fever, severe headache, pain behind the eyes, muscle
and joint pains, nausea, vomiting, swollen glands or rash is commonly seen after an
incubation period of 4-10 days. When the symptoms associated with warning signs such
as abdominal pain, vomiting, rapid breathing, bleeding gums, fatigue, restlessness and
blood in vomit, dengue should be considered as severe (WHO, 2016).

Until now, there is no specific treatment for dengue. The mainstay of treatment remains
supportive therapy which is by monitoring the intravascular volume replacement therapy
(WHO, 2016).

In the latest WHO weekly epidemiological record, a vaccine for dengue has been
registered in several countries. The vaccine is known as CYD-TDV and it is a prophylactic,
tetravalent, live attenuated viral vaccine. The efficacy of the vaccine in Malaysia is 79.0%
(95% CI 52.3%–91.5%) compared to 31.3% (95% CI 1.3%–51.9%) in Mexico. This may
provide an alternative prevention for dengue besides intervention that includes targeting

16
vectors such as accessing egg-laying habitats, disposing of solid waste properly, covering,
emptying and cleaning of domestic water storage containers on a weekly basis, using
personal and household protection such as window screens and improving community
participation and mobilization for sustained vector control (WHO, 2016).

A paper reported that community participation played a role in order for a vector control
method to success, and for the success of a community–based program, it is important to
assess the community’s perception regarding the disease, its mode of transmission and
breeding sites. (Malhotra.G et al., 2013).

The Malaysian government carried out 7 strategies to strengthen on dengue prevention

and control in terms of surveillance system, integrated vector management, dengue case
management, communication and social mobilization, dengue outbreak response, dengue
research and dengue strategic plan (MOH, 2010).

2. Knowledge

Knowledge of dengue among participants was evaluated based on their knowledge on

signs and symptoms of dengue, transmission of the virus and also their dengue
information sources (Dhimal et al., 2014). In Philippines, 61.45% of the participants had
good knowledge on causes, signs and symptoms, mode of transmission, and preventive
measures on dengue (Yboa and Labrague, 2013). According to a study in Terengganu,
Malaysia, 54.6% of the participants reported to have high level of knowledge (Aung et al.,
2016). In Sri Lanka, even though 98% of participants have heard of dengue, only 58% of
them had adequate knowledge on dengue (Gunasekara et al., 2012). In Nepal, 77% of
participants have heard of dengue but only 12% had good knowledge of dengue (Dhimal
et al., 2014).

In Laos, majority of the participants (80.9%) identified fever as a symptom of dengue,

followed by fewer proportion further mentioning about headache (45.8%) and muscle pain
(31.1%) (Mayxay et al., 2013). This finding is consistent with another study in Pakistan
where 81.5% of participants consistently reported fever as the common symptom of
dengue with only around 20% of them further mentioning headache and muscular pain
(Itrat et al., 2008). In Jamaica, low percentages of respondents were able to correctly
identify typical symptoms of dengue such as fever (49.5%), rashes (34.0%), joint pains
(32.5 %,) and muscle pain (2.1%) (Shuaib et al., 2010). In Thailand, the most commonly

17
mentioned symptom was also fever (59%), followed by nausea/vomiting (32%) and a
general feeling of discomfort (31%) (Koenraadt et al., 2006).

Regarding dengue transmission, a study done in Jeddah reveals that 89.3% knew dengue
is a mosquito-borne disease but only 4.05% of participants identified Aedes as the vector
mosquito (Ibrahim et al., 2009). In Malaysia, 77.5% of participants knew that dengue is an
infectious disease, 88.5% knew that dengue is caused by mosquitoes and 45.5% of
participants were able to identify the type of mosquito (Hairi et al., 2003). Another study in
Malaysia found that majority of participants (97.0%) knew that the vector-borne mosquito,
Aedes aegypti, causes dengue (Al-Dubai et al., 2013). In terms of the biting time of
mosquitoes, most of the participants in Karachi, Pakistan answered either at dusk (57.5%)
or at dawn (44%) (Itrat et al., 2008). In Malaysia, 53.5% said the mosquitoes bite at dusk
and 42% said at dawn while only 29.5% said both ‘at dusk and dawn’ (Hairi et al., 2003).

In North India, 43.4% of participants knew that Aedes mosquitoes breed in stagnant water
(Chinnakali et al., 2012). Another study which was done among rural and slum
communities in North India, shown that 71% of the respondents had the knowledge about
the breeding reported that unclean water-holding containers could be potential breeding
places for the dengue-transmitting vector. The remaining 29% of the respondents reported
that drainage, garbage and stagnant dirty water could be the breeding sites for dengue
vector. (Malhotra.G et al., 2013).In Pakse, Laos, the most common breeding site for
Aedes mosquitoes recognized was water containers (93.9%), followed by stagnant water
reserves like the ponds or rivers (5.6%) (Nalongsack et al., 2009). In Sri Lanka, 90.5% of
them said that dengue mosquitoes breed in clean water (Gunasekara et al., 2012). A
study in Maldives states that 91% of participants knew that the breeding sites of
mosquitoes were empty stagnant water from old tires, trash cans, and flower pots (Ahmed
and Taneepanichskul, 2008). However, a study done in Multan, Pakistan, discovered that
none of the participants knew that Aedes mosquitoes breed in clean water (Naeem-Ullah,
and Akram., 2009).

Regarding treatment options, a study done in Pakistan states that 40% and 34% knew
that no definite treatment or vaccine is available respectively (Qadir et al., 2015). In
Terengganu, majority (70.8%) wrongly believed that there is a specific treatment for
dengue. The study also mentioned that the remedies taken by the participants were
consuming more water (81.7%), getting enough rest (64.3%), taking Panadol (36.2%) or
traditional medications (15.3%) (Aung et al., 2016). In Jamaica, most of them (66.5%)

18
mentioned that they would take aspirin for dengue and 72.3% of participants also said that
they will rest if they contracted dengue (Shuaib et al., 2010).

As for the source of information, in a study done in Malaysia, majority responded that
television was the main source of information followed by printed materials and radio (Al-
Dubai et al., 2013). This finding is also consistent with the findings of a study done in
North India where television was the main source of information (54.9%) followed by
newspapers/magazines (51.7%) and health personnel (26.9%) (Chinnakali et al.,
2012).Another study in North India, reported that health professional and TV/radio was
identified as the major source of public information as 44.87% and 32.75% respectively,
only 5.2% from newspaper; 7-6% from friends/family/schools. (Malhotra.G et al.,
2013).However, in Sindh, Pakistan, the most common source of information was identified
as relatives, friends and family (65.3%) followed by radio and television (22.6%) (Bota et
al., 2014)

Almost three-quarters (74%) of participants in Pakistan study identified that the peak
incidence of dengue fever occurs during the rainy season (Qadir et al., 2015). This finding
is supported by the results from a study done in Laos where almost all (93.3%) mentioned
that Aedes mosquitoes were most prevalent during rainy seasons (Mayxay et al., 2013).
Concerning the law and regulation, 96% of the participants in Kuala Kangsar knew that it
is against the law if Aedes larvae were present in their house or surroundings (Hairi, 2003).
Majority of the participants (91.8%) in Terengganu was also aware that they can be fined if
Aedes larvae were found in their residence (Aung et al., 2016). In the North India study,
more than half of the respondents (56.62%) indicated that the peak biting time of the
mosquitoes is the night time, while about 8 % respondents thought it is at rainy season.
27.37% said mosquito bites any time. Knowledge of dengue vector breeding was
significantly (p=002) more in rural respondents (Malhotra.G et al., 2013).

3. Attitude

A recent study by Aung et al. (2016) among rural population in Terengganu revealed that
18.6% of the participants had good attitude towards dengue. Participants’ attitude were
assessed on how they perceive dengue fever (severity of the illness) together with their
opinion on who are responsible in prevention and control of the disease, the authority or
the public. A study in Sri Lanka shows that 37% of the participants demonstrated
satisfactory attitude (Gunasekara et al., 2012). In Maldives, 42.5% of the participants had
positive attitude, 42.2% had neutral attitude, and 15.2% had negative attitude (Ahmed and

19
Taneepanichskul, 2008). In Thailand, 82.8% of them had good attitude towards dengue
(Makornkan et al., 2015).

In Nepal, the study shows that 91% of participants effectively realize the seriousness of
dengue (Dhimal et al., 2014). In a study done in Thailand, almost all (98%) of participants
considered that dengue is a serious to very serious problem (Koenraadt et al., 2006). A
study done in Jamaica reveals that 63.8% strongly agreed and 23.4% agreed that dengue
is a serious illness (Shuaib et al., 2010). In Laos, 96% of participants believed that dengue
was fatal. However, only 28% will seek medical treatment (Mayxay et al., 2013).

Majority of the participants (77.7%) in Terengganu believed that everyone has a chance in
getting dengue (Aung et al., 2016). A study in Laos found that 94% of participants
believed that dengue is preventable (Mayxay et al., 2013). In Sindh, Pakistan, majority of
the participants (77.6%) said that dengue can be prevented and 55% claimed that dengue
can be cured completely with treatment (Bota et al., 2014).

Regarding responsibility in curbing dengue, 43% of participants in Malaysia felt that it is

the public’s responsibility in curbing dengue while 36.6% said that both community and
authorities should be involved (Ayyamani et al., 1986). In Thailand, 43% mentioned
volunteers of the local public health offices are responsible in controlling mosquito
breeding then followed by community (32%) and government (13%) (Koenraadt et al.,
2006).Studies in Saudi Arabia reveals that 83.1% of participants find that both government
and community are responsible (Binsaeed et al., 2015).

4. Practice

In Sri Lanka, 85% of participants claimed to have good practice towards dengue
(Gunasekara et al., 2012). A study in Maldives states that only 9% of participants have
good practices towards dengue, while 48% had fair practices and 43% had poor practices
(Ahmed and Taneepanichskul, 2008). There are many practices that are practised by the
public in curbing dengue. Some of the practices involve covering all containers used to
store water especially after using them, or wells in their house, frequently checking the
containers, usage of abates, emptying stagnant water in containers or flower pot, usage of
protective bed-nets or mosquito screens on windows, inspecting potential breeding spot
surrounding the house, participation in campaign or communal work or also known as
‘gotong-royong’ activities (Aung et al., 2016).

20
A study done in Punjab, Pakistan, revealed that almost three quarters (72.6%) of
participants predominantly use mosquito mats as a practice in controlling dengue,
followed by chemicals (17%) and bed nets (16%) (Hafeez et al., 2012). Among the
aborigines in Malaysia, the practices followed by most of them are proper disposal of
items that can collect rain water (97.2%), proper disposal of household garbage (94.9%),
and removal of detritus that causes blocked water flow (94.3%) and also involvement in
environmental cleanliness in order to avert dengue (93.9%). However, the use of abate or
chemicals (18.4%) and mosquito repellents (10.7%) were not widely practised among
these community (Chandren et al., 2015). In Philippines, 70.9% used mosquito coils and
59.91% used bed nets to reduce mosquitoes followed by insecticide sprays (31.58%) and
screen windows (36.07%). Environmental control measures were also practised by more
than half of the participants there such as clearing stagnant water around the house
(55.26%), cutting down of bushes in the yard (72.45%), covering of water containers at
home (62.54%) and regular cleaning water-filled containers around the house (64.09%)
(Yboa and Labrague, 2013). Based on a research done in northern Malaysia, it was
disclosed that despite the high level of awareness among the participants (94.2%), the
level of practice in controlling dengue was rather low. The involvement in communal work
and usage of abate was less than 75% and 40% respectively (Danial et al., 2016). A study
done among the military student National Defence University of Malaysia, showed that
both pre-university and university students eliminated stagnant water around the house
(62.9% and 60.6% respectively) and covering water containers (48.6% and 62.1%
respectively). However, the compliance with personal protection measures was lower in
both groups. The practice of using window / door screening was significantly better among
university students. (Lugova H. et al, 2015)

5. Association between KAP and socio-demographic status

In a report done in Malaysia, Kuala Kangsar, socio-demographic characteristics such as

age, gender, level of education, level of literacy, occupation and income shows
association with knowledge, attitude and practice of dengue (Farizah, 2003). A similar
study conducted in Federal Territory, Malaysia states that only ethnicity has association
with knowledge, attitude and practice of dengue (Ayyamani, 1986). Personal history of
dengue is also included as one of the socio-demographic characteristics that were
associated with knowledge, attitude and practice of dengue besides age, sex and gender

21
in a study done in Kuala Lumpur (Rozita et at., 2006). Socio-demographic factors such as
age, ethnicity and educational level was associated to knowledge, while ethnicity and
educational level was associated with attitude, and practice was associated with marital
status and ethnicity as reported in a study done in Negeri Sembilan, Malaysia (TK Leong.,
2014)

A report based in Jamaica states that knowledge, attitude and practice of dengue is
associated with age, sex, marital status, occupation and literacy level (Shuaib, 2010). A
study done in Thailand showed ethnicity and marital status too have associations with
knowledge, attitude and practice of dengue besides age, gender, level of education and
occupation (Takahashi, 2014). Another study done in Thailand by Koenraadt et al. (2006)
reported sex, age and education level was associated with knowledge and practice of
dengue. In Nepal, a similar study also showed that knowledge, attitude and practice was
associated with age, sex, marital status, level of education, income and religion (Dhimal,
2014). A study in Sri Lanka shows that age, sex, occupation and level of education has
association with knowledge, attitude and practice related to dengue (Gunasekara, 2012).
In the city of Havana, a study done by Castro et al. (2010) reported age to be associated
with knowledge and the practice of dengue.

5.1 Age

A study conducted in Malaysia among selected urban, semi-urban and rural communities
has reported strong correlation between awareness of dengue with age group. From this
study, it was shown that among those aged above 41 years old, 96.7% of them are aware
of dengue, followed by age group 31-40, where 89.4% of them are aware and lastly
awareness among those aged between 18-30 was 85.3% (Al-Dubai et al., 2013). Hairi et
al. (2003) did a study among rural communities in Kuala Kangsar District which reported
that people aged below 50 years old showed higher level of knowledge compared to those
aged above 50 years old. Based on a study done in Thailand, it was stated that the
younger people were more knowledgeable than the elderly people (Constantianus et al.,
2006). However, from another study in Thailand, it was reported that no correlation exists
between knowledge on dengue fever and the age of the participants (Takahashi et al.,
2014). In addition, according to a study conducted lately in Kampung Bayam, Kubang
Kerian, Kelantan, the age of a person had no influence on the amount of knowledge on
dengue (Rahman et al., 2015).

22
For attitude on dengue fever, it was shown that those above 50 years old had better
attitude towards dengue as compared to those aged below 50 years old (Hairi et al., 2003).
However, a study done in Central Nepal in 2014 reported that participants aged 15-29
years as having better attitude as compared to those older than 59 (Dhimal et al., 2014).
In Thailand, a study done however reported no association between age and attitude
score (Takahashi et al., 2014).In a study conducted in Perak, it was reported there was no
significant association between age and attitude towards dengue (Farizah et al., 2003).

On practice for dengue fever, a study conducted by Al-Dubai et al. in 2013, reported
significant association between age and practice score of the participants, whereby
participants in 31-40 year age group had higher practice scores as compared to those
who aged 18-30 and those above 41 years old. Based on a study done in Colombo, Sri
Lanka, it was reported that the young (20-35 years old) and old (>46 years old) age group
practiced good preventive measures compared to the 36-45 year old age group
(Charnchudhi et al.,2015).

5.2 Gender

In a study done within rural communities in Kuala Kangsar district, it was reported that
males appeared to be more knowledgeable on dengue fever as compared to females
(Hairi et al., 2003). This finding is supported by a study done among the communities in
Laos that also reported male students being more knowledgeable about dengue than
female students (Sayavong et al., 2015).However, a study conducted in India had
reported a higher knowledge scores among the females (Bhanu et al., 2015). In addition,
according to a study in Thailand in 2006, females had a higher level of knowledge than
males (Constantianus et al.,2006).Gender and knowledge of dengue showed no
significant association in a study conducted in Kelantan in the year of 2015 (Rahman et
al.,2015).

In terms of prevention, a previous study from Perak, Malaysia reported better attitude
among women (Abdullah et al., 2013). Study done by Hairi et al. in Kuala Kangsar in 2003
also revealed females having better attitude towards the preventive measures of dengue.
These findings are further supported by a study done by Bhanu et al. in 2015, which too
reported better attitude among females.

23
A study done by Abdullah et al. 2013 in Perak, Malaysia has shown that for practice
towards dengue fever, it was similar for both genders. Another study conducted in
Thailand reported females having better prevention practices as compared to males
(Koenraadt et al., 2006). This finding is further supported by Bhanu et al. in 2015 that
shows higher practice scores among the females. In Jazan Saudi Arabia, it was reported
that there was a significant association between gender and practice against dengue (A.A.
Al Sheikh et al.,2015).However, in Maldives, a study showed that there was an
association between gender and practice behaviours where females had practiced more
preventive measures against dengue compared to males ( N.Ahmed et al,.2008).

5.3 Ethnic

In a study on factors affecting dengue fever knowledge, attitudes and practices among
selected urban, semi-urban and rural communities in Malaysia, there is strong correlation
found between ethnicity with the awareness of dengue fever. It was shown that 98.2% of
the Chinese are aware of it, followed by 89.4% among the Malays and 81.0% of the
Indians being aware of dengue (Al-Dubai et al., 2013). This finding was however not
replicated in another study done in Cheras, Malaysia that showed absence of association
between ethnicity and the participants’ knowledge on dengue fever (Al-Zurfi et al., 2015).
In addition, one study done in 1986 at Kuala Lumpur, Malaysia had reported Malays being
more knowledgeable about dengue than Chinese.’

Based on a study done among the rural communities in Rembau and Bukit Pelanduk,
Negeri Sembilan, there was a significant association between attitude and ethnicity (TK
Leong., 2014). Better attitude was demonstrated by Malays with at least secondary school
education. Practice was also proven to be significantly associated with ethnicity in this
study.

5.4 Marital status

In a study done in Thailand, results showed that there is no significant correlation between
marital status and level of knowledge towards dengue (Takahashi et al., 2014). Based on
a study done in Kuala Kangsar, Perak, there was no significant association between
marital status and attitude towards dengue (Farizah et al., 2003). Another study conducted
in Malaysia mentioned that the practices towards dengue were higher in singles as
compared to those who are married (Al-Dubai et al., 2013). However, according to a study

24
done among the rural communities in Rembau and Bukit Pelanduk, Negeri Sembilan,
married individuals demonstrated better practice towards dengue (TK Leong., 2014).

5.5 Education

It has been reported in a study done among selected urban, semi-urban and rural
communities in Malaysia, participants who had completed tertiary education (university or
college degree) possess a higher level of knowledge on dengue (Al-Dubai et al., 2013). A
study on knowledge and awareness regarding dengue among the adult population of a
dengue-hit cosmopolitan in Pakistan also reported there was significant associations
between knowledge scores, age and education level (Itrat et al., 2008). This finding is
consistent with a previous study done in Kuala Kangsar (Hairi et al., 2003) and in Mantin
(Aung et al., 2016) that showed the higher the education level, the better the knowledge
on dengue. Furthermore, a study conducted lately in Kampung Bayam, Kubang Kerian,
Kelantan stated that the level of education place a major role in the level of knowledge on
dengue (Rahman et al., 2015). A study in Kamphaeng Phet Province, Thailand reported
that people who attended school were more knowledgeable about dengue than persons
who had never attended school (Constantianus et al., 2006).

Findings of good attitude towards dengue in respondents who have completed higher
education compared to illiterates are found in a study done in Central Nepal (Dhimal et al.,
2014). It was reported that participants who had completed tertiary education (university or
college degree) as having better attitudes towards dengue (Al-Dubai et al., 2013).

For practices against dengue, those who were uneducated had better practices as
compared to the educated ones. This finding is further supported by a study in Thailand
which reported that those who have completed secondary education were likely to have
more knowledge compared to those who have completed primary education (Takahashi et
al., 2014). This finding is yet again replicated in another study done in Honduras, that
stated participants who had completed secondary or higher education had better
knowledge than those who hadn’t (Uematsu et al., 2016). In a study done in Central Nepal,
it was reported that there is an association between the higher education level of the
participants and better preventive practices towards dengue (Dhimal et al., 2014). For
practices regarding dengue among the adult population of a dengue-hit cosmopolitan in
Pakistan, the study also reported that respondents who had completed education up to
secondary school (Grade-6) were more ignorant as compared to those who had
25
completed ten years of schooling (Itrat et al., 2008). Furthermore, a study conducted lately
in Kubang Kerian, Kelantan showed there was a significant association between the level
of education and the practice against dengue (Rahman et al., 2015).

5.6 Occupation and level of income

A study in Malaysia showed that there was an apparent trend between occupation and
income with knowledge. Participants who had occupations with higher income have
shown higher level of knowledge about dengue (Farizah et al., 2003). Similar findings was
seen in another study conducted in Malaysia where higher income groups have higher
levels of knowledge regarding dengue compared to lower income groups (Takahashi et al.,
2014). A different study done in Peninsular Malaysia also reported similar findings, where
skilled workers receiving higher income had higher knowledge about dengue compared to
other jobs (Rebecca et al., 2015). According to a study that was done in Cheras, it was
reported that the level of knowledge and socioeconomic status showed no significant
association (Balsam et al., 2015).

In a study done by Farizah et al. in 2003, results showed that participants with lower levels
of income have better attitude compared to participants with higher levels of income.
However, in a study done in Pakistan, it has been found that those from high
socioeconomic areas had a better attitude and concern towards dengue compared to
those from low socioeconomic areas (M Syed et al., 2010).

In a study done by Wong LP et al. in 2015, preventive measures against dengue were
practiced more by those who were unemployed compared to skilled workers. However,
participants with different levels of income have similar level of practices according to
Farizah et al in 2003. In a study done in Thailand, levels of income are significantly
associated with the practices of using mosquito repellents (Takahashi et al., 2014).

5.7 Personal history of dengue

In a study conducted in Thailand, it has been found that correlation exists between
knowledge level of dengue and family history of dengue. Lower knowledge on dengue
was found among the group in whom no family members had past history of dengue fever
(Takahashi et al., 2014). These findings are in line with a study, conducted among
students in Jeddah that reported those with previous family history of dengue possessed
better knowledge on dengue (Ibrahim et al., 2009).
26
Similarly, a study done in an urban Malay residential area in Kuala Lumpur in 2006,
demonstrated that those with family history or personal history of dengue had shown high
scores in knowledge, attitude and practice on dengue fever (Wan Rozita et al., 2006). In
addition, in a study done by Wong LP et al. in 2015, higher knowledge score was shown
by people with previous history of dengue. Based on a study done in San Juan, Puerto
Rico, it was shown that people with previous history of dengue had a better knowledge
and practiced better preventive measures against dengue compared to those who had no
previous history of dengue (CL Pérez-Guerra et al., 2009).

6. Association between knowledge, attitude and practice

In terms of association, a study conducted in Yemen reported that poor knowledge of

dengue was remarkably associated with poor practice towards dengue (Alyousefi et al.,
2016). In Jeddah, high knowledge was associated with high practice towards dengue
(Ibrahim et al., 2009). However, a previous study done in Maldives found that there was
no association between knowledge and practice (Ahmed and Taneepanichskul, 2008).
This finding is consistent with the results from a study in Jamaica where there was also no
correlation between knowledge of dengue and practice (Shuaib et al., 2010) .Similarly, a
study in Philippines showed that relationship between knowledge and practice on dengue
was insignificant (Begonia C et al,.2013). A study in Punjab has reported that knowledge
had significant impact on practices and attitude (F Hafeez et al., 2012). A significant
association was shown in another study conducted in Thailand between knowledge and
attitude towards dengue(HH Kyu et al.,2005).This finding is consistent with a study
conducted in India which has reported a strong association between knowledge and
attitude (A Taksande et al., 2012). However, another study in India reported a significant
association between good knowledge and poor practice.(S Matta et al.,2016).In terms of
attitude and practice, studies among students of a university in Malaysia found that
significant predictor for poor practices were negative attitude towards practice (Rao et al.,
2016). In Thailand, both knowledge and attitude were positively correlated and there was
statistical significance between them (Makornkan et al., 2015). This finding is consistent
with a study from southern Taiwan which reported a significant association between
knowledge and attitude towards dengue (Ho T.S et al., 2013). In Nepal, there was
significant positive correlation between knowledge-attitude, knowledge-practice and
attitude-practice (Dhimal et al., 2014).In Laos, a study has reported that only knowledge
or attitude does not necessarily lead to a good practice (Nalongsack S et al., 2009).
27
Problem Statement

The lack of knowledge, attitude and practice towards dengue and their association with
socio-demographic characteristics among villagers in Kampung Tanah Lot, Wakaf Tapai,
Marang, Terengganu.

Research Questions

a) What are the socio-demographic characteristics of the villagers?

b) What is the knowledge level of the villagers towards dengue?

c) What is the attitude of villagers towards dengue?

d) What are the practices of the villagers towards dengue?

e) What is the association between socio-demographic characteristics and

knowledge among the villagers towards dengue?

f) What is the association between socio-demographic characteristics and attitude

among villagers towards dengue?

g) What is the association between socio-demographic characteristics and practices

practised by the villagers towards dengue?

h) How is attitude associated with knowledge and practice on dengue?

i) How is knowledge associated with practice on dengue?

Research Objective

General Objective

To assess the level of knowledge, attitude and practices towards dengue and their
association with socio-demographic variables in villagers in Kampung Tanah Lot, Wakaf
Tapai, Marang, Terengganu.

28
Specific Objectives

a) To describe the socio-demographic characteristics of the villagers.

b) To determine the current level of knowledge on dengue among the villagers.

c) To study the villagers’ attitude on dengue.

d) To determine the current practices on dengue among the villagers.

e) To study the association between socio-demographic characteristics and

knowledge on dengue.

f) To study the association between socio-demographic characteristics and attitude

on dengue.

g) To study the association between socio-demographic characteristics and practices

on dengue.

h) To study how attitude affects the knowledge and practice on dengue among
villagers.

i) To study how knowledge affects the villager’s practice on dengue.

Conceptual Framework

Level of
Knowledge on
Dengue among
Villagers of
Socio-demographic Kampung Tanah
Characteristics: Lot

1. Age 29

2. Gender
RESEARCH FLOWCHART

Formulating a research problem

- The level of KAP on dengue

- The association between socio-demographics and KAPP

Construct study design 30

Cross-sectional analytical study

 Writing a research proposal

Methods of data collection

Interviewer administered questionnaire

31

1. Collection of census of the village

METHODOLOGY

Study Design
A cross-sectional analytical study was conducted on villagers aged 18 years and above
from Kampung Tanah Lot, Wakaf Tapai, Marang, Terengganu.

Sampling Frame

32
Villagers above 18 years of age from Kampung Tanah Lot, Wakaf Tapai, Marang,
Terengganu.

Sampling
There were a total of 76 households with 66 of them occupied. Firstly, the houses were
numbered from numbers 1 to 66 by stamping cardboard numbers on all the houses. Then,
census was collected from door to door, covering all the villagers in each household who
were above 18 years of age. The results of the census showed that there were 187
villagers who fell within our inclusion criteria. Later, the census was revised from 187
villagers to 178 villagers because some of them were out of the village when the study
was conducted. Villagers in each house were then numbered according to their ages, from
the youngest to the oldest. Every individual from each household were included in the
sampling unit. Random number generator (Randomizer.org) was used to randomly to
select 30 villagers for the pilot study which was conducted on 14th February 2017.
Universal sampling was done from the sample of 148 villagers. However, 2 of them
rejected to participate and 15 villagers were unavailable due to their unscheduled working
hours after attempting for 3 separate visits .Another 3 villagers were excluded due to their
health problems The remaining 128 villagers were included into the sample and those who
were involved in the pilot study was excluded from the sample.

Sample Size Calculation

The total population of the study was 300 villagers. Based on the sampling frame and
inclusion criteria, there were 178 adults with ages 18 and above. Their information was
entered into the StatCalc Epi Info 7 (CDC, 2017). For a confidence level of 95% and
estimated frequency of 55%, the sample size calculated was 121.

Study Period
The study was conducted from 5th February 2017 to 2nd March 2017.

Inclusion Criteria
a) Villagers from Kampung Tanah Lot aged 18 years and above.

b) Villagers who provides written consent.

c) Villagers who have lived in Kampung Tanah Lot for more than six months.
33
Exclusion Criteria

a) Villagers who were less than 18 years of age.

b) Villagers who were involved in the pilot study.

c) Villagers who refused to participate in the study.

d) Villagers who were absent from their houses at the time of survey on three
separate visits.

e) Villagers who were mentally ill that is under psychiatric clinic follow-up.

Variables
1. Independent Variables: Socio-demographic characteristics

a) Age

b) Gender

c) Race

d) Marital status

e) Level of education attained

f) Occupation

g) Estimated monthly income

h) Duration of stay in village

i) History of dengue of villager

j) History of dengue among acquaintances

2. Dependent Variables

a) Knowledge on dengue

b) Attitude on dengue

34
 c) Practices on dengue

Methods and Data Collection Tools

Data Collection Tools

Interviewer-administered questionnaire

Data Collection Methods

A total of 128 villagers were involved in the study. Information sheets and consent forms
were handed out to the villagers, prior to data collection. A briefing was done to each
respondent before the commencement of the interview. A written informed consent was
obtained from the villagers before their participation. Names were not included in the
questionnaire for anonymity. All the collected and analysed data from the villagers were
maintained confidential at all times.

Questionnaire

The questionnaire was adapted from a study conducted in Terengganu and further
modifications were made to it. (Al-Dubai et al., 2013; Aung et al., 2016)

1. Socio-demographic profile

This section has 10 Questions on socio-demographic characteristics which include age,

gender, race, marital status, level of education attained, occupation, estimated monthly
income, the duration of stay and history of dengue.

2. Knowledge on dengue

A total of 13 questions were prepared to test the knowledge of villagers on dengue.

Among the questions prepared are; clinical features, dengue as an infectious disease,
vector causing the disease, method of transmission, species of the vector, biting time of
the vector, breeding ground of the vector, presence of a specific treatment, type of
treatment, source of information regarding dengue, frequency of cases and rainy season,
fined if larvae found and infected more than once.

35
The sub-item under each question includes 3 choices which are ‘yes’, ‘no’ and ‘not sure’.
For scoring, every single sub-item under each question in section knowledge on dengue
and practices in reducing mosquitoes and larvae 2 scores were given to a correct answer,
1 score for a wrong answer or if the answers were ‘don’t know’. The summed up score for
knowledge ranged from 47-94 and knowledge level was categorized as high level (71-94
score) and low level (47-70 score). (Gunasekaraet al., 2012; Meghnath, 2014; WHO, 2017)

3. Attitude towards prevention of dengue

This section consists of 15 questions. Some of the questions asked include the
seriousness of dengue, whether it is a preventable disease, the most vulnerable age
group, their views on the measures taken by the government and whether they were
actively involved in preventing dengue.

The choices given for this section were ‘strongly agree’, ‘agree’, ‘not sure’, ‘disagree’ and
‘strongly disagree’. Five-level Likert scale was used in statements under the section
attitude towards prevention of dengue. A score of 5 was given for ‘strongly agree’ and a
score of 1 for ‘strongly disagree’. However, in each negative statement reverse score
ratings were given. The scores for attitude ranged from 15-75 and was grouped into good
(45-75 score) and poor (15-44 score). (Gunasekaraet al., 2012)

4. Practices and measures done in reducing mosquitoes and larvae

A total of 17 questions were compiled under this section. The villagers were tested on
their practices, for example, covering water container, inspecting for larvae, mosquito nets,
mosquito screen, disposal of container ,inspection of roof gutter, participation in
campaigns and ‘gotong-royong’,allowing responsible organization to carry out their
activities, practice wearing long sleeve and storing water. For scoring, 2 scores were given
to a correct answer, 1 score for a wrong answer or if the answers were ‘don’t know’.

The questions were given 3 choices which are ‘yes’, ‘no’ and ‘not sure’. (Gunasekaraet al.,
2012; CDC, 2016) The range of total scores for practices and measures in reducing
dengue was from 17-34. The scores were classified into ‘poor’ (17-25 scores) and ‘good’
(26-34 scores).

Pre-testing and Pilot Study

36
Pre-testing of the questionnaire was conducted on Year 4, Group 1 medical students to
test the face validity and content validity. Besides that, pilot study was conducted on 30
villagers from Kampung Tanah Lot. The data collected from the pilot study were entered to
test on the reliability of the questionnaire. Those involved in the pilot study were excluded
from the sample.

Data Entry and Analysis

The data collected was analysed with Statistical Package for the Social Science (SPSS)
version 20.0 (IBM, 2012).Descriptive statistics was applied such as frequency (%) for
categorical data and mean for numerical data. T test and ANOVA test were used to
determine the association between socio-demographic variables and KAP of dengue.

Operational Definitions
Scale of
No. Variables Operational Definition
Measurement

Independent Variables

1 Age The length of time that a person has lived Continuous

or a thing has existed.
(Oxford Dictionary, 2016)

2 Gender Socially constructed characteristics of Nominal

women and men.
(WHO, 2017)
3 Race A category of humankind that shares Nominal
certain distinctive physical traits.
Races in Malaysia:
1. Malay (50.1%)
2. Chinese (22.6%)
3. Indian (6.7%)
4. Others (20.6%)
(Merriam-Webster, 2017)

4 Marital status Personal status of each individual in Nominal

37
 relation to the marriage laws or customs of
the country.
The categories of marital status to be
identified are the following:
(a) single, in other words, never married;
(b) married;
(c) divorced
(e) widowed
A. Marriage
Is the act, ceremony or process by which
the legal relationship of husband and wife
is constituted. The legality of the union may
be established by civil, religious or other
means as recognized by the laws of each
country.
B. Divorce
Is a final legal dissolution of a marriage,
that is, that separation of husband and wife
which confers on the parties the right to
remarriage under civil, religious and/or
other provisions, according to the laws of
each country.
(United Nations, 2017)

C. Widowed
A status a person acquires after the death
of their husband or wife.
(Collins, 2017)
5 Education Primary Education Nominal
level Begins at age 7 and lasts for 6 years,
referred to as Standard 1 to 6. It is
provided by public schools, private schools
and home educators.
Secondary Education

38
 Lasts for 5 years and referred to as Form 1
to Form 5. Students typically enter Form 1
at 13 years of age and complete Form 5 at
17 years old.
Graduate (Tertiary education)
Comprises of certificate and diploma
education at polytechnics or colleges from
the age of 18. At teaching institutes,
education commences from age 18
onwards. Bachelor’s degree programmes
range from age 19 or 20 for three to five
years. Postgraduate studies involve
studying for master’s or PhD studies
following acquisition of a Bachelor’s degree
for one to five years.
(Classbase, 2017)

6 Occupational This category includes Nominal

status Student: a person formally engaged in
learning, especially one enrolled in school
or college. (Dictionary.com, 2017)
Government staff: The public sector
employs workers through the federal, state
or local government. Workers are paid
through a portion of the government’s tax
dollars.
Private Sector: The private sector
employs workers through individual
business owners, corporations or other
non-government agencies. Workers are
paid with part of the company’s profits.
(Investopedia, 2017)
Pensioner: A pensioner is someone who
receives a pension, especially a pension
paid by the state to retired people.
39
 (Collins, 2017)

7 Monthly Gross Monthly Income From Work refers to Ratio

income income earned from employment.
(Ministry of Manpower, 2013)

No income

<RM1000

RM1001 – RM2000

RM2001- RM3000

RM3001-RM5000

>RM5000

8 Duration of The total number of years/months the Discrete

stay villagers have resided in Kampung Tanah
Lot.

Dependent Variables

9 Dengue Dengue is a mosquito-borne viral infection.

Dengue virus is transmitted by female
mosquitoes mainly of the species Aedes
aegypti and, to a lesser extent, Aedes
albopictus. (WHO, 2017)

10 Dengue Enquiry of whether the villagers or their

history acquaintances have contracted dengue in the
past.

11 Knowledge Defined as villager’s awareness or familiarity

on dengue about dengue prevention including possible
cause of dengue recurrence, symptoms,
transmission, treatment and prevention,
necessity of dengue precaution and

40
 recommended/non-recommended practice of
action.
(Mohamad et al., 2013)

12 Attitude on Defined as villager’s opinions or perception

dengue about dengue prevention, awareness, daily
care and socio-cultural perspective.
(Mohamad et al., 2013)

13 Practice Defined as villager’s actions towards dengue

on dengue prevention taken to avoid dengue occurrence.
(Mohamad et al., 2013)

Ethical Consideration

The dean approval letter, research proposal, informed consent form and other relevant
documents were sent to the Research Ethics Committee of UCSI University, Kuala
Lumpur Campus and ethical approval was obtained before commencement of the
study.The interview session begun after the written informed consent was obtained from
them. They were reassured that they were not required to provide their names or could
voluntarily withdraw from the study at any time.

Results

We interviewed 128 out of 148 villagers. One was discarded due to too many missing
values. The ultimate response was 127. So the response rate out of final sample size was
85.8%.

1. Sociodemographic Profile

In this study, 127 villagers aged from 18 years old and above took part in the interview
administered questionnaire. The villagers include 18-20 years old (11.0%), 21-30 years
old (21.3%), 31-40 years old (15.7%), 41-50 years old (19.7%), 51-60 years old (12.6%)

41
and more than 60 years old (19.7%). Among these villagers, 65 (51.2%) of them
were women and 62 (48.8%) of them were men. Villagers were predominantly Malay
(98.4%) but a minority (1.6%) of them were Chinese. Most (55.9%) of them were married,
30.0% were currently single, 3.9% were divorced and 10.2% were widowed. More than
half (58.3%) of the villagers were educated until secondary school level where else
15.7% have only completed their primary schooling. There were 15.0% of graduates
among these 127 villagers, and the rest which had no formal education were 11.0%.Out of
these 127 villagers, 8.7% of them were unemployed, 6.3% were students and
8.7% worked for the government. Those who worked under the private sector were
33.1%, 11.8% were self-employed, 5.5% were pensioners and others account for 25.9%.
In this village, majority of them (30.7%) have a monthly income of less than RM 1000 but
a minority (6.3%) of them have an income of more than RM 3000 per month. There are
29.9% with monthly income of RM 1001 to RM 2000, 12.6% earns RM 2001 to RM
3000 and 20.5% of the villagers have no monthly income when queried. Majority of
them (37.8%) have lived in this village for more than 10 years. Number of villagers staying
here for 2 years to 5 years and more than 10 years are the same which is 37 (29.1%).
Only about 4.0% of them have lived at Kampong Tanah Lot for 6 months to 2 years. At
time of interview, 97.6% of the villagers have not had a history of dengue, however
21.3% of the villagers have had friends/acquaintances/relatives that had been infected by
dengue virus before.

2. Prevalence of Knowledge, Attitude and Practice on Dengue

Based on the classification stated in the methodology, it was found that 86.6% of the
villagers possessed high level of knowledge, 99.2% held good attitude and 92.1% were
practicing good measures against dengue.

2.1 Knowledge

On dengue symptoms, 87.4% of the villagers identified fever and 76.4% identified rashes.
Among the villagers, 74.8% were aware of headache as a dengue symptom. Villagers that
were able to identify rigors were 67.7%, joint pain 63.0%, muscle pain 49.6%, bleeding
55.9%, back pain 30.7% and pain behind the eyes were 39.9%. Less than half of the
villagers (42.5%) were able to distinguish that cough is not a symptom of dengue.

42
Among the villagers, 51.2% were aware that dengue is not an infectious disease and most
of them (96.1%) were able to identify the vector of dengue as a mosquito. Majority (96.9%)
of the villagers were aware that dengue is transmitted from one person to another through
mosquito bites. Villagers who acknowledged that Aedes is the mosquito species that
causes dengue were 88.2%. Majority of them (85.8%) were able to answer biting time of
the Aedes mosquitoes correctly which was during the dawn and dusk.

A large number of villagers were able to identify Aedes mosquito breeding places such as
89.8% of them answered exposed food containers correctly and 95.3% recognized flower
pots and their base plates as one of the breeding grounds for Aedes. Most of the villagers
(96.9%) identified uncovered water containers and those who answered discarded tires
were 96.1%.Four fifth (81.9%) of them reported that wheelbarrow can cause Aedes
mosquitoes to breed. Those who answered stagnant water were 99 of them (78.0%),
puddle 101 (79.5%), roof gutter 105 (82.7%) but for in between trees stems 82 (64.6%).
Those who knew that river is not a breeding ground for Aedes mosquitoes were 85.8%.

Less than quarter (19.7%) of the villagers responded correctly that there is no specific
treatment for dengue. When queried, 69.3% of the villagers answered enough rest
correctly, 83.5% answered consuming more water and less than half of them (37.0%)
answered Panadol as treatment for dengue.

It was reported that radio/television was the major source of information among 96.9% of
the villagers. Majority of the villagers (85.2%) have read about dengue in
books/newspapers/ pamphlets. Villagers who got to know via internet were 58.6% while
85.9% learnt it through health personnel and 77.3% procured information through health
campaigns. Villagers who learnt about dengue through word by mouth were 80.5%.

The villagers who answered that most dengue cases occur often during rainy season were
61.4%, meanwhile 92.9% knew that they can be fined if larvae were found around in their
house compound. Villagers who were aware that they could be infected with dengue virus
more than once were 64.6%.

2.2 Attitude

43
Concerning the villagers’ attitude towards dengue infection, 92.9% of villagers agreed that
dengue is a serious illness and 90.5% agreed that dengue can be prevented. In addition,
81.8% acknowledged that everybody has an equal chance to be infected with dengue
virus. Two-thirds of them, 60% (61.5%) reported that the most vulnerable group to be
engaged with the disease is children.

It was noted that 85.8% agreed that the government has taken enough measures in
preventing dengue .A high percentage of villagers (91.4%) stated that dengue in early
stage can be treated. When asked about elimination of larval breeding sources, 73.3%
disagreed that it is complicated and a waste of time. With respect to attitude towards
prevention and control, more than 30% (33.8%) disagreed that eradicating the vector
mosquitoes is the only measure of controlling and preventing dengue infection. Most
villagers (92.1%) perceived that they play a vital role in eradicating dengue and 70.8%
disagreed that eliminating the vector breeding places is solely the responsibility of the
public health staff and health volunteers. Less than one-third (28.3%) of the villagers
disagreed that controlling and surveying the potential breeding grounds should be done at
least once a year.

On 'Fogging', 22.8% disagreed that ‘Fogging’ can prevent breeding of mosquitoes

completely. Almost all the villagers (96.9%) agreed to seek medical attention if they
developed any symptoms of dengue. More than half of them (54.3%) agreed that the act
of imposing fine helps in controlling dengue. Majority of the villagers (92.1%) agreed that
healthcare personnel should do regular surveillance at residence.

2.3 Practice

Regarding the practice of controlling Aedes population, most villagers performed personal
and environmental control steps against dengue such as storing water in water containers
(56.7%), covering the water storage containers or well in their house with a cover (81.1%),
covering up after using them (85.8%) and regularly inspecting the water containers if the
villagers do not use for a period of more than 5 days (76.4%). Only 38.6% of the villagers
added abate into water storage containers (38.6%).Most villagers (79.5%) also inspected

44
for larvae in the flower pot base plates, 98.4% disposed the stagnant water inside flower
pots or 96.9% disposed any containers that can lead to stagnant water collection and 90.6%
checked the potential breeding places around the house and its vicinity.

Only a minority of villagers used bed-nets while sleeping (7.9%) and installed mosquito
screens on their windows (11.8%). More than 40% of villagers inspected the roof gutters
during the rainy season (42.5%). When asked about campaign, 56.7% of the villagers’
family members have participated in an Aedes prevention community campaign. Everyone
(100%) agreed that eradicating dengue vector is their responsibility together. Majority of
the villagers (92.9%) reported that they would encourage their family members to join
“Gotong-royong” events (Communal activities).When enquired, 96.9% of the villagers will
allow the authorities to conduct dengue preventive measures in their home. Some
villagers (44.9%) stated that they always wear long sleeve when they leave the house
during dusk.

3. Association between knowledge, attitude and practice on dengue and socio-

demographic variables

T test and ANOVA test were used to determine the association between socio-
demographic variables and KAP of dengue.

Marital status, occupational status, educational level and monthly income were
significantly associated with knowledge of dengue (p<0.05). Regarding marital status,
there was a significant difference between widow/widower (69.62 ± 11.08) and married
(80.00± 7.34) for knowledge. On occupational status, there was a significant difference
between others (76.49± 9.65) and students (78.25 ± 3.85) for knowledge. For level of
education, both secondary school (80.53± 6.40) and graduates (81.47 ± 7.11) had
significant association with no formal education (68.93± 10.44).There was a significant
difference between those villagers who earned more than RM 3000 (83.25 ± 4.43) and
those who had no monthly income (75.69 ± 10.16).

There were no significant association between socio-demographic variables and attitude

towards dengue.

Race, marital status and occupational status were significantly associated with practice of
dengue (p<0.05). According to race, there was a statistically significant difference between
45
 Chinese (24.50 ± 2.12) and Malays (28.66 ± 2.02). There was a significant difference
between those who were married (29.10± 1.91) and widow/widower (27.38± 2.02) for
practice. There was a statistically significant difference between the category of other
occupations (28.53 ± 2.05) and students (28.13± 2.70) for practice.

This study showed statistically significant association between knowledge and practice.
No significant association was found between knowledge and attitude towards dengue.
Attitude and practice were also not significantly associated.

Table 1 : Socio-demographic profile of respondents and source of information

about dengue (n= 127)

Characteristics Frequency (%)

Gender

Male 62 (48.8)

46
Female 65 (51.2)

Age group

18-20 years old 14 (11.0)

21-30 years old 27 (21.3)

31-40 years old 20 (15.7)

41-50 years old 25 (19.7)

51-60 years old 16 (12.6)

More than 60 years old 25 (19.7)

Race

Malay 125 (98.4)

Chinese 2 (1.6)

Marital Status

Single 38 (30.0)

Married 71 (55.9)

Divorcee 5 (3.9)

Widow/Widower 13 (10.2)

Education Level

No formal education 14 (11.0)

Primary School 20 (15.7)

Secondary School 74 (58.3)

Graduate 19 (15.0)

Occupational Status

Unemployed 11 (8.7)

47
Student 8 (6.3)

Government Officer 11 (8.7)

Private Worker 42 (33.1)

Self-employed 15 (11.8)

Pensioner 5 (5.5)

Others 35 (25.9)

Monthly Income

No income 26 (20.5)

Less than RM 1000 39 (30.7)

RM 1001 - RM 2000 38 (29.9)

RM 2001 - RM 3000 16 (12.6)

More than RM 3000 8 (6.3)

Duration of stay in village

6 months to 2 years 5 (4.0)

2 years to 5 years 37 (29.1)

5 years to 10 years 48 (37.8)

More than 10 years 37 (29.1)

Dengue History (Personal)

Yes 3 (2.4)

No 124 (97.6)

Dengue History (Acquaintances)

Yes 27 (21.3)

48
No 100 (78.7)

Source of information on dengue

Book/Newspaper/Pamphlet 109 (85.2)

Mass Media 124 (96.9)

Internet 75 (58.6)

Healthcare Personnel 110 (85.9)

Health Campaign 99 (77.3)

Word of mouth 103 (80.5)

FIGURE 1. FREQUENCY OF AGE GROUPS OF THE VILLAGERS

49
 FIGURE 2. FREQUENCY OF THE MARITAL STATUS OF THE VILLAGERS

FIGURE 3. FREQUENCY OF THE LEVEL OF EDUCATION AMONG THE VILLAGERS

50
FIGURE 4. FREQUENCY OF THE ESTIMATED MONTHLY INCOME AMONG THE
VILLAGERS

FIGURE 5. FREQUENCY OF THE OCCUPATION OF THE VILLAGERS

51
 FIGURE 6. FREQUENCY OF SOURCE OF INFORMATION OF DENGUE FOR THE
VILLAGERS

Table 2: Distribution of villagers according to knowledge, attitude and practice

Questions Frequency (%)

52
Knowledge

1. Signs and symptoms

a) Fever (Yes) 111 (87.4)

b) Rigors (Yes) 86 (67.7)

c) Nausea and vomiting (Yes) 89 (70.1)

d) Headache (Yes) 95 (74.8)

e) Joint pain (Yes) 80 (63.0)

f) Muscle pain (Yes) 63 (49.6)

g) Pain behind the eyes (Yes) 43 (39.9)

h) Back pain (Yes) 39 (30.7)

i) Abdominal pain (Yes) 28 (22.0)

j) Bleeding (Yes) 71 (55.9)

k) Rashes (Yes) 97 (76.4)

l) Cough (No) 54 (42.5)

m) Diarrhoea(Yes) 38 (29.9)

2. Is dengue and infectious disease? (No) 65 (51.2)

3. Which of the following is the vector of dengue?

a) Flies (No) 109 (85.8)

b) Ticks/Lice (No) 111 (87.4)

c) Mosquitoes (Yes) 122 (96.1)

4. How is dengue transmitted to a person?

a) Airborne (No)

53
b) Waterborne (No) 93 (73.2)
c) Mosquito bites (Yes) 85 (66.9)
d) Blood transfusion (No) 123 (96.9)
57 (44.9)
5. Which of the species below is the vector of dengue?
a) Culex (No)
64 (50.4)
b) Aedes (Yes)
112 (88.2)
c) Anopheles (No)
66 (52.0)
d) Mansonii (No)
65 (51.2)

6. When is the biting time of the mosquito?

a) Dawn and dusk (Yes)

109 (85.8)
b) Morning and afternoon (No)
92 (72.4)
c) All night (No)
61 (48.0)
d) All day (No)
88 (69.3)

7. Which of the following is the breeding ground of the dengue

vector?
a) Exposed food containers (Yes)
114 (89.8)
b) Discarded tires (Yes)
122 (96.1)
c) Wheelbarrow (Yes)
104 (81.9)
d) Uncovered water containers (Yes)
123 (96.9)
e) Flower pot base plates (Yes)
121 (95.3)
f) Stagnant water (Yes)
99 (78.0)
g) River (No)
109 (85.8)
h) Puddle (Yes)
101 (79.5)
i) Roof gutter (Yes)
105 (82.7)
j) Between tree stems (Yes)
82 (64.6)

8.Is there a specific treatment for dengue? (No)

25 (19.7)

54
9. Which of the following is the treatment for dengue?

a) Enough rest (Yes)

88 (69.3)
b) Consuming more water (Yes)
106 (83.5)
c) Panadol (Yes)
47 (37.0)
d) Traditional medications (No)
69 (54.3)

11. Do dengue cases occur most frequently during rainy season?

(Yes) 78 (61.4)

12. Do you know that you could be fined if larvae is found around
your house compound? (Yes) 118 (92.9)

13. Is it possible to be infected with dengue more than once?

82 (64.6)
(Yes)

Attitude (those who answered in a postive manner)

1. Dengue is a serious illness. 118 (92.9)

2. Dengue can be prevented. 115 (90.5)

3. Everybody has a chance to contract dengue. 104 (81.8)

4. Children are most vulnerable to dengue. 78 (61.5)

5. Government has taken enough measures to prevent dengue. 109 (85.8)

6. Dengue in early stage can be cured. 116 (91.4)

7. Elimination of larval breeding sources is complicated and a 93 (73.3)

waste of time.

8. Combating the vector mosquitoes is the only means of

controlling and preventing dengue. 43 (33.8)

55
9. I play an important role in preventing dengue. 117 (92.1)

10. Eliminating the vector breeding places is solely the

responsibility of the public health staff and health volunteers 90 (70.8)

11. Controlling and surveying potential vector breeding grounds

should be done at least once a year. 36 (28.3)

12. ‘Fogging’ can prevent breeding of dengue vector completely.

29 (22.8)
13. Will you seek medical attention if you have any symptoms of
123 (96.9)
dengue?

14. Fine helps in controlling dengue. 69 (54.3)

15/Healthcare personnel are required to do regular surveillance at 117 (92.1)

residence.

Practice

1. Do you have the habit of storing water in water containers? 72 (56.7)

2. Do the water storage containers/wells have covers in and 103 (81.1)

around your house?

3. Do you keep the water storage containers/wells covered 109 (85.8)

immediately after using it?

4. Do you regularly inspect the water storage containers/wells if it

97 (76.4)
has not been used for more than 5 days?

5. Do you put larvacide (abate) for larvae into the water storage 49 (38.6)
containers in your home?

6. Have you ever done inspection for larvae in the flower pot base 101 (79.5)
plates?

7. If stagnant water is found in flower pot base plate, will you 125 (98.4)
dispose it?

8. Have you ever searched the residence and the area around it to 115 (90.6)
look for vector breeding ground?

56
9. Do you dispose any containers that can lead to stagnant water 123 (96.9)
collection?

10. Do all the people in your house use mosquito nets during
10 (7.9)
sleep each time?

11. Have you installed mosquito screens on windows in your 15 (11.8)

house?

12. Do you check the roof gutters during the rainy season? 54 (42.5)

13. Do your family members participate in Aedes Prevention 72 (56.7)

Community Campaigns?

14. Do you agree that eradicating dengue vector is our

127 (100)
responsible together?

15. Will you encourage your whole family to participate in ‘gotong-

118 (92.9)
royong’ organized at your residence?

16. Will you allow the responsible organization to carry out dengue 123 (96.9)
prevention activities in your community?

17. Do you and your family members always wear long sleeve
57 (44.9)
when you leave the house during dusk.

Table 3: Knowledge, attitude and preventive practice level on dengue among

villagers (n= 127)

57
Based on 50% cut-off

Variables Frequency (%)

Knowledge Level

High (71 - 94 score) 110 (86.6)

Low (47 - 70 score) 17 (13.4)

Attitude

Good (45 - 75 score) 126 (99.2)

Poor (15 - 44 score) 1 (0.8)

Practice

Good (26 - 34 score) 117 (92.1)

Poor (17 - 25 score)
10 (7.9)

Table 4: Association between knowledge, attitude, and practice with socio-

demographic variables.

58
 Knowledge Attitude Practice

Mean (SD) Mean (SD) Mean (SD)

Gender
79.44 (7.18) 56.53 (4.82) 28.48 (1.88)
Male
77.74 (9.03) 55.72 (4.65) 28.71 (2.26)
Female

Age group

18-20 years old 77.07 (5.82) 58.21 (4.76) 28.00 (2.35)

21-30 years old 79.52 (3.57) 56.59 (4.51) 28.19 (1.84)

21-40 years old 80.60 (8.93) 56.60 (4.86) 28.95 (2.56)

41-50 years old 79.72 (7.44) 55.52 (3.56) 29.08 (2.29)

51-60 years old 80.81 (9.31) 55.63 (5.03) 28.88 (1.63)

More than 60 years old 74.16 (10.80) 54.96 (5.58) 28.44 (1.76)

Race
78.64 (8.19) 56.10 (4.77) 28.66 (2.02)
Malay
74.00 (9.90) 57.00 (1.41) 24.50 (2.12) *
Chinese

Marital Status

Married 80.00 (7.34) 55.85 (4.54) 29.10 (1.91)

Single 78.76 (6.88) 57.05 (4.67) 28.21 (2.07)

Divorcee 80.00 (8.00) 57.00 (5.79) 27.60 (2.88)

59
Widow/Widower 69.62 (11.08) * 54.54 (5.49) 27.38 (2.02) *

Education Level

No formal education 68.93 (10.44) 53.79 (5.61) 28.00 (1.36)

Primary School 75.30 (7.86) 55.50 (5.59) 27.95 (2.26)

Secondary School 80.53 (6.40) 56.36 (4.20) 28.77 (2.10)

Graduate 81.47 (7.11) * 57.53 (4.74) 29.05 (2.15)

Occupational Status

Student 78.25 (3.85) 57.38 (4.66) 28.13 (2.70)

Government Officer 81.91 (6.53) 57.64 (4.15) 30.09 (1.58)

Private Worker 81.55 (4.57) 56.12 (4.39) 28.64 (1.78)

Pensioner 73.29 (10.97) 55.86 (2.91) 27.14 (2.97)

Others 76.49 (9.65) * 55.69 (5.26) 28.53 (2.05) *

60
Monthly Income

No income 75.69 (10.16) 56.62 (6.14) 28.62 (1.96)

Less than RM 1000 75.79 (7.94) 55.72 (4.55) 28.28 (2.08)

RM 1001 - RM 2000 80.63 (7.22) 56.29 (4.03) 28.42 (2.11)

RM 2001 - RM 3000 82.75 (4.30) 54.44 (4.27) 29.50 (1.71)

More than RM 3000 83.25 (4.43) * 59.00 (3.59) 29.13 (2.80)

Duration of stay in
village
84.00 (6.60) 59.00 (2.65) 30.40 (1.52)
6 months to 2 years
77.84 (8.03) 57.27 (4.31) 28.05 (1.90)
2 years to 5 years
78.19 (8.48) 56.17 (4.90) 28.71 (2.09)
5 years to 10 years
79.05 (8.16) 54.51 (4.75) 28.76 (2.18)
More than 10years

Dengue History
(Personal)
72.00 (4.36) 60.67 (2.52) 27.67 (4.16)
Yes
No 78.73 (8.21) 56.01 (4.72) 28.62 (2.03)

61
Dengue History
(Acquaintances)
80.44 (5.73) 56.70 (3.92) 28.19 (2.00)
Yes
78.06 (8.70) 55.96 (4.93) 28.71 (2.09)
No

* p< 0.05 (significant), independent samples t-test and one-way Anova

Table 5: Association between knowledge, attitude and practice

Knowledge Attitude

Mean (SD) Mean (SD)

Practice

Good practice 79.01 (9.43) 55.70 (5.54)

Poor practice 73.40 (7.97) 56.15 (4.68)

p-value 0.037 0.772

95% Confidence Interval -10.878, -0.339 -3.551, 2.643

62
 Practice Attitude

Mean (SD) Mean (SD)

Knowledge

Knowledgeable 28.76 (1.9) 56.43 (4.67)

Non-knowledgeable 27.53 (2.67) 54.12 (4.79)

p-value 0.022 0.061

95% Confidence Interval -2.288, -0.180 -4.726, 0.106

Knowledge Practice

Mean (SD) Mean (SD)

Attitude

Good attitude 78.58 (8.22) 28.60 (2.09)

Poor attitude 77.00 (0) 29.00 (0)

p-value 0.849 0.847

63
DISCUSSION

1. KNOWLEDGE

The overall knowledge regarding dengue among the villagers (86.6%) is relatively high.
Similarly, in Philippines, two-third of the participants (61.45%) had good knowledge on
causes, signs and symptoms, mode of transmission, and preventive measures on dengue
(Yboa and Labrague, 2013). This is in contrast with a study in Nepal where only 12% of
participants had good knowledge on dengue (Dhimal et al., 2014). While in a study done
in Sri Lanka, even though 98% of participants have heard of dengue, only 58% of them
had adequate knowledge on dengue (Gunasekara et al., 2012).

Majority of the villagers were able to identify the symptoms of dengue correctly, highest
being 87.4% of the villagers identified fever as a dengue symptom. This finding is
consistent with a study done in Karachi, Pakistan, which had 81.5% participants reported
fever as a symptom (Itrat et al., 2008). Similarly, in a study done in Vientiane, Laos, 80.9%
answered fever as a symptom of dengue, but 14.7% answered skin rash as a dengue
symptom (Mayxay et al., 2013) which is in contrast with the findings of this study, whereby
76.4% reported skin rash as a dengue symptom.

This study also found that other symptoms on dengue identified by villagers are headache
(74.8%) and nausea (70.1%). This is in contrast with a study done in Karachi, Pakistan
where only 22.1% and 19.8% of the respondents answered correctly for both of the
symptoms respectively (Itrat et al., 2008). Another study in Laos also reported less than
half of them, 45.8%, answered the above two symptoms correctly (Mayxay et al., 2013).
Meanwhile in Thailand, 32% of the respondents answered nausea/vomiting as one of the
symptoms in dengue (Koenraadt et al., 2006).

This study reported that 67.7% of the villagers were able to identify rigors and 63.0%
identified joint pain as the symptoms. This is consistent with another study done in
Malaysia with a slightly higher proportion of 95% of respondents answered correctly on
both the above symptoms (Al-Dubai. et al., 2013). However, in Jamaica, low percentages
of respondents (32.5 %,) were able to correctly identify joint pains (Shuaib et al., 2010).

Furthermore, 55.9% of the villagers identified bleeding as a symptom of dengue, in

contrast with two studies done in Pakistan where only 35.1% identified it correctly (Syed et
al., 2010) and 11% identified it correctly in another study (Qadir. et al., 2015). Only small

64
proportion of the villagers answered correctly for muscle pain (49.6%), consistent with a
study done in Laos at 31.1% (Mayxay et al., 2013) and a study done in Jamaica at a
measly 2.1% answering correctly (Shuaib et al., 2010).

Moreover, only 42.5% of the villagers correctly rejected cough as a symptom of dengue.
Less than 40% of the villagers answered correctly for pain behind the eyes (39.9%), back
pain (30.7%), diarrhoea (29.9%) and abdominal pain (22.0%) as symptoms of dengue.
About 51.2% of the respondents were aware that dengue is not contagious; a study in
Pakistan has shown a similar result at 60% (Syed et al., 2010).

In terms of knowledge regarding the vector of dengue, a high number of the villagers
(96.1%) were aware that mosquitoes is the vector of dengue and 88.2% knows that the
species of the vector is Aedes, this is consistent with a study done in Malaysia where 88.5%
knew that dengue is caused by mosquitoes and 45.5% of participants were able to identify
the type of mosquito (Hairi et al., 2003). Similarly, another study in Malaysia also found
that majority of participants (97.0%) knew that the vector-borne mosquito, Aedes aegypti,
causes dengue (Al-Dubai et al., 2013). In contrast, a study in Jeddah reported only 4.05%
of the respondents were able to identify the type of mosquito (Ibrahim et al., 2009). This
probably can be explained by the lower prevalence of dengue in Jeddah.

Similarly, in a study in Jeddah where 89.3% of the respondents were aware of the mode
of transmission (Ibrahim et al., 2009), this study showed that a higher percentage of the
villagers (96.9%) knew that dengue is transmitted through mosquito bites.

As for the biting time of the Aedes mosquitoes, 85.8% were aware that it is during dawn
and dusk, this differs with another study done in Malaysia where only 29.5% answered the
same, while in that same study 53.5% said the mosquitoes bite at dusk and 42% said that
the biting time is at dawn (Hairi et al., 2003). Similarly, most of the participants in Karachi,
Pakistan answered either at dusk (57.5%) or at dawn (44%) (Itrat et al., 2008). This shows
that while there may be some confusion regarding the biting time, most are aware that the
biting time is either at dusk or at dawn.

When it comes to knowledge regarding the breeding ground of Aedes mosquitoes (places
or objects where water may stagnate), the villagers had a very high percentage of correct
answers which include 89.9%: exposed food container, 95.3%: flower pots and their base
plates, 96.1%: discarded tires correctly, 81.9%: wheelbarrow, 82.7%: roof gutter, 79.5%:
puddles while only 64.6% answered correctly between tree stems. All of these findings are
consistent with a study done in Maldives where 91% answered correctly for those places
65
(Ahmed and Taneepanichskul, 2008). Most of the villagers (78%) also answered correctly
that stagnant water could be the breeding ground for Aedes which is in contrast to findings
of a study done in North India where only 43.4% were aware of that fact (Chinnakali et al.,
2012). Most of the villagers, 85.8%, were aware that dengue could not breed in moving
waters such as a river, this is inconsistent with a study done in Laos, where only 5.7% of
the respondents answered incorrectly that dengue could breed in rivers (Nalongsack et al.,
2009). Other than the studies mentioned above, there was a study done among rural and
slum communities in North India, showed that 71% of the respondents had the knowledge
about the breeding reported wrongly that unclean water-holding containers could be
potential breeding places for the dengue-transmitting vector. The remaining 29% of the
respondents reported that drainage, garbage and stagnant dirty water could be the
breeding sites for dengue vector (Malhotra.G et al., 2013).

All of this show that the villagers of this study has a very high knowledge of possible
Aedes breeding ground, which is important as it may affect their practice of discarding the
objects, which may explain the absence of dengue cases in the village.

Regarding the knowledge of dengue treatment, only a small proportion (19.7%) of the
villagers were aware that there is no specific treatment for dengue, which is consistent
with a study done in Pakistan where only 40% knew that there is no definite treatment
(Qadir et al., 2015) and another study done in Malaysia had 29.2% of respondents aware
of it (Aung et al., 2016). However a higher percentage of the villagers answered correctly
that getting enough rest (69.3%), consuming more water (83.5%) and consuming Panadol
(37%) may help in symptomatic treatment. This is consistent with the findings of a similar
study previously done in Terengganu, Malaysia that reported the practices which were
followed by the participants were consuming more water (81.7%), getting enough rest
(64.3%) and taking Panadol (36.2%) (Aung et al., 2016). Other study in Jamaica also had
high percentage (72.3%) of participants said that they will rest if they contracted dengue
(Shuaib et al., 2010).

Most (61.4%) of the villagers answered correctly that dengue cases are related to rainy
season, which is consistent with the findings of a study done in Pakistan whereby 74%
answered correctly (Qadir et al., 2015) and a study done in Laos where 93.3% answered
correctly (Mayxay et al., 2013). However, this is in contrast with a study done in North
India where only 8% respondents thought it is related to rainy season (Malhotra.G et al.,
2013). Concerning the law and regulation, a very high proportion (92.9%) of the villagers
knew that they could be fined if the health officers found larvae within their house
66
compound, which is consistent with another study in Malaysia where 96% of the
participants in Kuala Kangsar knew that it is against the law if Aedes larvae was present in
their house or surroundings (Hairi et al., 2003). 91.8% of the participants in Terengganu
were also aware that they can be fined if Aedes larvae was found in their residence (Aung
et al., 2016). The percentage of villagers that knows that a person can be infected by
dengue fever more than once is 64.6%, this reflects the knowledge towards dengue fever
among the villagers.

As for their source of information, the medium with the highest percentage at 96.9%is
television/radio, which is consistent with another study done in Malaysia. Majority
responded that television was the main source of information followed by printed materials
and radio (Al-Dubai et al., 2013). This finding is also consistent with the findings of a study
done in India that reported television as the main source of information followed by
newspapers, magazines and health personnel (Chinnakali et al., 2012). This is also
supported by another study in North India, where TV/radio was identified as the major
source (32.75%) of public information (Malhotra.G et al., 2013). However, in Sindh,
Pakistan, only 22.6% had the information from radio and television (Bota et al., 2014).

The next media with the highest percentage is books/newspaper/pamphlets at 85.2%.

This is in contrast with a study done by Malhotra.G et al. (2013) which reported only 5.2%
had newspaper as a source of information. Another factor that plays an important role is
the healthcare personnel, as a source of information for 85.9% of the villagers, and 77.3%
said they learnt information regarding dengue from health campaigns. Moreover a large
amount of the villagers (80.5%) acquired dengue information via word of mouth from their
acquaintances, and the medium with the smallest proportion of villagers (58.6%) obtained
information from the internet, all of this are consistent with another study recently done in
Terengganu, Malaysia, the findings of which reported that 81.6% obtained information
from book/newspaper/pamphlet, 90.6% from health campaign, 73.4% from their
acquaintances and 57.9% from the internet (Aung et al., 2016).

Overall, the villagers had very high knowledge regarding dengue, this may very well be
explained by looking at their source of information. A majority of them mentioned mass
media, health campaign and healthcare personnel as their main source of information.
This is probably due to the role played by the Ministry of Health of Malaysia in making
sure that the people, including those in rural areas receive adequate knowledge regarding
dengue which may help in curbing dengue.

67
2. ATTITUDE

On the other hand, this study found that the villagers’ good attitude on dengue was
relatively high (99.2 %).The villagers’ attitude were assessed on how they perceive
dengue fever (severity of the illness) along with their opinion on whether the authority or
the public are responsible in preventing and controlling the disease. Similar findings are
reported in a study in Thailand where 82.8% of participants had good attitude towards
dengue (Makornkan et al., 2015). This is in contrast with a recent study among rural
population in Terengganu where only 18.6% of the participants had good attitude towards
dengue. (Aung et al., 2016)

The current study indicated a good attitude among most of the villagers, particularly in the
fact that 92.9% of the villagers regarded dengue as a serious illness. This finding is
consistent with other studies from different countries. In Nepal, the study showed that 91%
of participants effectively realised the seriousness of dengue (Dhimal et al., 2014). Almost
all (98%) of the participants considered that dengue is a serious to very serious problem in
a study in Thailand (Koenraadt et al., 2006). In Laos, 96% of participants believed that
dengue was fatal (Mayxay et al., 2013).A study done in Jamaica revealed that 63.8%
strongly agreed and 23.4% agreed that dengue is a serious illness (Shuaib et al., 2010).

Majority of villagers (90.5%) acknowledged that dengue can be prevented. Similarly, a

study in Laos revealed that 94% of participants believed that dengue is preventable
(Mayxay et al., 2013). In Sindh, Pakistan, majority of the participants (77.6%) said that
dengue can be prevented and 55% claimed that dengue can be cured completely with
treatment (Bota et al., 2014).

Furthermore, most of the villagers (81.8%) agreed with the idea that everybody has an
equal chance to be infected with dengue virus. This finding is similar to a study in
Terengganu where majority of the participants (77.7%) believed similarly (Aung et al.,
2016). It was noted that two-thirds of the villagers (61.5%) accepted that the most
vulnerable group to be engaged with the disease is children. This is also elicited from a
study in Terengganu where 63.6% of participants agreed that children were the most
vulnerable group (Aung et al., 2016).

A sizeable proportion of villagers (91.4%) stated that dengue in early stage can be treated
and 96.9% of them agreed to seek medical attention if they developed any symptoms of

68
dengue. However, a low rate of attitude was reported in a study done in Laos where only
28% of participants will seek medical treatment (Mayxay et al., 2013).

More than 70% (73.3%) of villagers disagreed that the elimination of larval breeding
sources is complicated and a waste of time. This is consistent with a study in urban, semi-
urban and rural communities in Malaysia stating that about 32.7% of them believed that
elimination of larvae are a complete waste of time (Al-Dubai et al., 2013).

In addition, one-third of villagers (33.8%) disagreed that eradicating the vector mosquitoes
is the only measure of controlling and preventing dengue infection. Previous study also
found that89.3% of the respondents in Klang Valley believed that dengue can be
controlled by combating the breeding of mosquitoes (Al-Dubai et al., 2013).

Less than one-third of the villagers (28.3%) disagreed that controlling and surveying the
potential breeding grounds should be done at least once a year and correspondingly
majority of the villagers (92.1%) stated that healthcare personnel should do regular
surveillance at the residence.

Most of the villagers (92.1%) perceived that they play a vital role in eradicating dengue
and 70.8% of them disagreed that eliminating the vector breeding places is solely the
responsibility of the public health staff and health volunteers. These findings are
consistent with those reported by previous studies. A study in Saudi Arabia reveals that
83.1% of participants agreed that both the government and community are responsible
(Binsaeed et al., 2015). However these findings run contrary to the findings of a study
done in Malaysia regarding the responsibility in curbing dengue, 43% of participants felt
that it is the public’s responsibility in curbing dengue while 36.6% said that both
community and authorities should be involved (Ayyamani et al., 1986).

Moreover, most of the villagers (85.8%) appreciated that the government had taken
enough measures in preventing dengue. More than half of the villagers (54.3%) agreed
that the act of imposing fine helped in controlling dengue. One-fifth of the villagers(22.8%)
disagreed that fogging can prevent the breeding of mosquitoes completely, similar to a
study in Klang Valley where one-third of the respondents (33.7%) disagreed that fogging
by the municipal council is essential enough for prevention of dengue (Al Dubai., 2013).

69
3. PRACTICE

This study also revealed that most of the villagers (92.1%) in Kampung Tanah Lot had
good practice towards dengue. The study in Sri Lanka had shown similar result where
majority of the participants (85%) reported to have had good practice towards dengue
(Gunasekara et al., 2012). This is inconsistent with a study in Maldives, only 9% of
participants had good practices towards dengue, while 48% of them had fair practices and
43% had poor practices (Ahmed and Taneepanichskul, 2008).

Majority of the villagers performed personal and environmental control steps against
dengue. The practices were considered good where 81.1% covered the water storage
containers or well, 85.8% covered the containers immediately after using them, 76.4%
regularly inspect the water containers if they do not use for a period of more than 5 days,
79.5% inspected for larvae in the flower pot base plates, 98.4% disposed the stagnant
water inside flower pots or 96.9% disposed containers that can lead to stagnant water
collection and 90.6% checked the potential breeding place around their house and its
vicinity, except only 56.7% of the villagers stored water in water containers and 38.6% of
them added abate into water storage containers. A recent study among rural population in
Terengganu showed similar rates, where 77% of them agreed to have covered water
storage containers or wells in their houses and also covered the containers immediately
after usage, 69.9% examined the water containers if not used, 93.6% destroyed any
larvae found, 93.7% drained stagnant water in flower pots or water containers (89.7%),
and 86.4% of the respondents checked for potential breeding places around the house
and its vicinity, but only 38.8% of them added abate to water storage containers.(Aung et
al, 2016). Another study which was done among the military student in National Defence
University of Malaysia, showed a similar finding, that both students studying in pre-
university (62.9%) and university (60.6%) claimed that they eliminated stagnant water
around their house, 48.6% and 62.1% respectively also covered water containers. The
university students practiced better on using window / door screening when compared to
the pre-university students, but both groups were poor in compliance with personal
protection measures. (Lugova H. et al, 2015)

Only 7.9% of the villagers used bed-nets while sleeping and only 11.8% of them installed
mosquito screens on their windows. On the contrary, findings of study done in Philippines
found that around 70.9% of their respondents used mosquito coils and 59.91% used bed
nets to reduce mosquitoes followed by insecticide sprays (31.58%) and screen windows
(36.07%) (Yboa and Labrague, 2013). An earlier survey done in North Thailand showed
70
that majority of the respondents claimed that they had mosquito nets in their house (78%),
and this was similar to the finding where reported mosquito net use of 75% (BHB van
Benthem et al, 2002).

This study also found that 42.5% of the villagers will inspect the roof gutters of their house
during the rainy season. More than half of the villagers (56.7%) stated that their family
members have participated in an Aedes prevention community campaign. It was also
noted that 92.9% of the villagers agreed to encourage their family members to join
“Gotong-royong” events (Communal activities). This is similar to the findings with a study
in Kuala Kangsar, that majority of the respondents believed that it was their responsibility
to control Aedes and they agreed to support the health authorities in any campaigns or
activities aimed at eradicating dengue (Hairi et al 2003). Based on a research done in
northern Malaysia, it was disclosed that despite the high level of awareness among the
participants (94.2%), the level of practice in controlling dengue was rather low. The
involvement in communal work and usage of abate was less than 75% and 40%
respectively (Danial et al., 2016). This study also found that all the villagers agreed that
the practice of eradicating dengue vector is their responsibility together (100%). This is in
contrast with the findings of the study in Kuala Kangsar, where only 3.5% of the
participants agreed that it was a shared responsibility, a more than half of the respondents
(57.0%) felt that it was their own responsibility in eradicating Aedes, while the remaining
9.5% of the participants felt it was solely the government’s responsibility (Hairi et al 2003).

It was noted that majority of them agreed to allow the legal authorities to conduct dengue
preventive measures in their house (96.9%). This was similar to the findings of study in
Kuala Kangsar, that 90.5% of the respondents would support any activities organized by
the health authorities to control Aedes and 91.0% of the respondents agreed that
punishing those found to harbour the Aedes larvae in their residence was appropriate in
controlling Aedes. (Hairi et al 2003). Less than half of the villagers (44.9%) stated that
they always wear long sleeve when they leave the house during dusk.

4. ASSOCIATION BETWEEN SOCIO-DEMOGRAPHIC FACTORS AND KNOWLEDGE

There was a statistically significant association between knowledge and monthly income.
It is in line with the previous study done, whereby the results showed that participants who
had occupations with higher income have shown higher level of knowledge about dengue
(Farizah et al., 2003). In monthly income of this study, there were statistically significant
71
mean difference between those who is earning more than RM3000 and those who earns
no monthly income, where those earning more than RM3000 has higher mean (83.25)
compared to those without monthly income (75.69). Similar findings was seen in another
study conducted in Malaysia where the higher income groups have higher levels of
knowledge regarding dengue compared to lower income groups (Takahashi et al., 2014).
Higher level of income means that the villagers have more money to spend on education
compared to those with lesser income; this may be explained by people with higher
income may have more exposure to various sources of information in their workplace.
They may also have a wider range of knowledgeable acquaintances which may help in
obtaining the right knowledge about dengue, also, with higher income, they will be able to
afford more ways of which they might have obtained information about dengue, such as
the television and the internet as compared to the people with lower income, especially in
rural areas such as where this study was conducted. A different study done in Peninsular
Malaysia also reported similar findings, where skilled workers receiving higher income
have higher knowledge about dengue compared to other jobs (Rebecca et al., 2015).
Despite all the literature supporting these study findings, there was one study that was
done in Cheras, reported otherwise whereby the level of knowledge and socioeconomic
status showed no significant association (Balsam et al., 2015).

Another factor found to have a statistically significant mean difference with knowledge is
marital status. In a study done in Thailand, results showed that there is no significant
correlation between marital status and level of knowledge towards dengue (Takahashi et
al., 2014) Same goes to a study done in Kuala Kangsar, Perak (Farizah et al.,2003).
However, in this study, for marital status, there were statistically significant mean
differences between widow and married villagers, with married villagers having higher
mean (80.00) in comparison to widow/widower (69.62). In this study, marital status shows
a significant correlation where widower has significantly lower knowledge scores
compared to other marital status, this may be caused by losing their spouse causes them
to lose motivation in taking care of their surroundings, and they may have lower curiosity
and drive to look up information regarding dengue, some of them may also be living alone
and thus have no one else to take care of.

There is also a statistically significant association between level of education and

knowledge. This is supported by a study conducted lately in Kampung Bayam, Kubang
Kerian, Kelantan stated that the level of education place a major role in the level of
knowledge on dengue (Rahman et al., 2015). For the level of education, there were

72
statistically significant mean difference between both the villagers with the level of
education of secondary school and graduate with those without formal education, where
secondary school and graduate has higher mean at 80.53 and 81.47 respectively in
comparison to without formal education at 68.93. It has been reported in a study done
among selected urban, semi-urban and rural communities in Malaysia, participants who
had completed tertiary education (university or college degree) possess a higher level of
knowledge on dengue (Al-Dubai et al., 2013) Similarly, in this study, villagers with higher
level of education has higher scores in knowledge. This may be seen as self-explanatory,
because they would have had a longer period of studying which may expose them to more
information regarding dengue, and as the education level is higher, they may obtain more
detailed and concise information regarding dengue. Also people with higher level of
education may have more curiosity and the effort to look up information regarding dengue.
This finding is also consistent with a previous study done in Kuala Kangsar (Hairi et al.,
2003) and in Mantin (Aung et al., 2016) that shows the higher the education level, the
better the knowledge on dengue. A study in Kamphaeng Phet Province, Thailand reported
that people who attended school were more knowledgeable about dengue than persons
who had never attended school (Constantianus et al., 2006).

For another component of sociodemographic factor, occupational status, there was

statistically significant finding, whereby in knowledge, private sector workers and ‘others’
showed statistically significant mean difference, with private sectors having higher mean
(81.55%) in comparison to ‘others’ (76.49%). Those who are in ‘others’ had odd jobs such
as manual labour and factory workers which probably imply that their level of education
may be lower than the private sector workers. A different study done in Peninsular
Malaysia also reported skilled workers receiving higher income had higher knowledge
about dengue compared to other jobs (Rebecca et al., 2015). This is consistent with
another study’s findings showing knowledge score was crudely associated with
occupation. The civil servant has the odds of having more knowledge, which is 3.4 times
higher than the factory labourers (Takashi et. al., 2014)

5. ASSOCIATION BETWEEN SOCIO-DEMOGRAPHIC FACTORS WITH ATTITUDE

Attitude towards dengue has no statistically significant association with any other
sociodemographic factors. This is validated by another study done in Thailand, (Takahashi
et al., 2014) where a univariate analysis was done and the finding found that there is no

73
significant association between sociodemographic factors with attitude. Similarly, a study
done in Kuala Kangsar, Malaysia reported no statistical significant association seen
between socio-demographic factors (gender, age, education level, literacy level,
occupation and income) with attitude even though there is a trend seen in the difference of
attitude for gender, age and literacy level (Hairi et al., 2003). Differently, there is another
study done in Malaysia which had one of the sociodemographic factors; gender was
statistically significant associated with attitude (Abdullah et al., 2013). Additionally, TK
Leong (2014) reported ethnicity and education level was associated with attitude in a
study done in Negeri Sembilan, Malaysia.

6. ASSOCIATION BETWEEN SOCIO-DEMOGRAPHIC FACTORS WITH PRACTICE

In view of practice towards preventing dengue, three of the sociodemographic factors

have statistically significant mean difference which is the marital status and occupational
status. Regarding marital status, there was a statistically significant mean difference
between villagers who are widows or widowers with married villagers whereby married
villagers have higher mean (29.10) compared to widows or widowers with lower mean
(27.38). The association between marital status and practice had been supported by
another study where the results stated that singles had more practice scores than married
(Al-Dubai et. al., 2013). However, according to a study done among the rural communities
in Rembau and Bukit Pelanduk, Negeri Sembilan, married individuals demonstrated better
practice towards dengue (TK Leong, 2014).

As for occupational status, it also showed a statistically significant mean difference

between pensioner and government officer where the mean is higher in government
officer (30.09) in comparison with mean of the pensioner (27.14). This is probably due to
the chance that government officers are more exposed to health implementation programs
compared to pensioners. In agreement towards the statistically significant association of
occupation and practice is the study from Chanthaburi, Thailand which mentioned civil
servants has better practice compared to factory labourers (Takahashi et. al., 2014).In
contrast to this, a study done by Wong LP et al. in 2015, preventive measures against
dengue were practiced more by those who were unemployed compared to skilled workers.
However, participants with different levels of income have similar level of practices
according to Farizah et al in 2003.

74
For race, there was statistically significant mean difference between Malays and Chinese,
where Malays had higher mean (28.66) compared to Chinese (24.50), the most plausible
explanation is this may be caused by the significantly small number of Chinese, where
there are only two of them in the village, which is 1.6%, compared to the remaining 98%
which is Malays. That being said, the result is actually consistent with a study done in
Malaysia where there were significant association between ethnicity and practice, and
results also showed that the Malays had better practices compared to other ethnic groups
(TK Leong 2014). However, the result of the present study is not consistent with another
Malaysian study where there were no significant association was found between race and
practice (Al-Dubai et al., 2013).

7. ASSOCIATION BETWEEN KNOWLEDGE, ATTITUDE AND PRACTICE

Knowledge on dengue is one of the most essential parts in the strategy to prevent
dengue, this is supported by a study in Saudi Arabia which found that a low level of
knowledge would lead to difficulty in outlining a dengue prevention strategy (Aziz et al.,
2014). Despite this, community’s good knowledge on dengue does not often translate into
good practice, and this has been a recurring theme in much of the literature. For example,
two studies done in Kuala Kangsar (Hairi et. al., 2003) and Thailand (Koenraadt et. al.,
2006) found that there was little or no significant association between knowledge and
practice. Similarly, a study in Philippines showed that relationship between knowledge and
practice on dengue was insignificant (Begonia C et al,.2013).

On the contrary, the findings of this study showed a significant association between
knowledge and practice. Consistent with this study’s results, studies done in Jeddah
(Ibrahim et. al., 2009) and Laos (Mayxay et. al., 2013) proved good knowledge on dengue
could lead to good practice in preventing dengue. This establishes that knowledge is very
important in moving the community towards good practice in the prevention of dengue.

Despite the association between knowledge and practice in dengue, this study found that
good knowledge, however, did not lead to good attitude. This is in consonance with
Jamaica’s findings suggesting a good level of knowledge, did not commensurate with
attitudes directed at reducing the prevalence of the disease (Shuaib et. al., 2013).
Maldives’ study was also in agreement with the present study stating that there was no
association between knowledge and attitude (Ahmed and Taneepanichskul, 2008). To
75
apprehend the findings, regardless of the level of knowledge, without the will to change
one’s attitude on their own, the attitude will remain the same. Same goes for the
prevention of dengue infection. However, significant association was shown in another
study conducted in Thailand between knowledge and attitude towards dengue (HH Kyu et
al., 2005).This finding is in line with a study conducted in India which has reported a
strong association between knowledge and attitude (A Taksande et al., 2012).

From another perspective, a positive association between attitude and practice has been
validated by other studies such as in Saraburi, Thailand (Makornkan et. al., 2015). On the
other hand, the present study which is in line with studies among students of a university
in Malaysia, found that the significant predictor for poor practices was a negative attitude
(Rao et al., 2016). However, the results of this study reflected that having the right attitude
does not guarantee that the villagers will translate it into practice, and be motivated to act
against dengue infection. Hence, this emphasizes on multi-factorial approach needed for
behavioural change, which also focus on local compliance and perseverance of disease
control programs.

76
Limitations

1. This is a cross-sectional study that does not allow cause-effect relationship.

2. The dialects and accents used by some of the villagers might be different from that of
the interviewer. This would cause the villagers to misunderstand the questions or
provide inaccurate responses. The study could have introduced some systematic error
due to the interview questionnaire where the dialect and accents specific to
Terengganu people could have caused inaccurate responses.
3. The result of the study showed majority of the villagers possessed high level of
knowledge, good attitude and practiced good measures against dengue. This could
probably be due to the villagers who gave socially desirable answers.

Recommendations

1. We would like to recommend that the public health professionals from Klinik Kesihatan
Wakaf Tapai and Pejabat Kesihatan Daerah Marang organize health campaigns and
vector control programs during our community service to have talks concerning
dengue to expand the knowledge of the rural communities as there is an association
seen between knowledge and practice according to this study.
2. We recommend to the district health office and Klinik Kesihatan to sustain their
integration with the village head and the community in continuing and intensifying
dengue education programs to further strengthen and reinforce the knowledge,
attitude and practice component of the rural communities to keep the village dengue-
free.
3. In future studies in Terengganu, interviewers should be selected from Terengganu
and trained to overcome the issue on dialect and accent to be consistent in the
interview process thus reducing systematic errors.

77
Conclusion

A cross-sectional analytical study was conducted on the villagers at Kampung Tanah Lot,
Wakaf Tapai, Marang, Terengganu to assess the level of KAP on dengue of the rural
population, its association with socio-demographic factors and the association between
knowledge, attitude and practice. This study found that 86.6% of the villagers had high
level of knowledge of dengue while 99.2% of them had good attitude towards dengue and
92.1% had good practice concerning dengue. Marital status, occupational status,
educational level and monthly income were found to be significantly associated with
knowledge of dengue. At the same time, marital status and occupational status were
found to be significantly associated with the practice towards dengue. Besides that, the
findings of this study showed a significant association between knowledge and practice of
the villagers regarding dengue.

78
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Oskam, L. (2002) ‘Knowledge and use of prevention measures related to dengue in

northern Thailand’. Tropical Medicine & International Health 7(11), pp. 993-1000.

90
93. Villar, L., Dayan, G., Arredondo-García, J., Rivera, D., Cunha, R., Deseda, C.,

Reynales, H., Costa, M., Morales-Ramírez, J., Carrasquilla, G., Rey, L., Dietze, R.,

Luz, K., Rivas, E., Miranda Montoya, M., Cortés Supelano, M., Zambrano, B.,

Langevin, E., Boaz, M., Tornieporth, N., Saville, M. and Noriega, F. (2015) ‘Efficacy

of a Tetravalent Dengue Vaccine in Children in Latin America’. New England

Journal of Medicine 372(2), pp. 113-123.

94. Wallace HG, Lim TW, Rudnick A, Knudsen AB, Cheong WH, Chew V. (1980)

‘Dengue hemorrhagic fever in Malaysia: the 1973 epidemic’. Southeast Asian

Journal of Tropical Medicine Public Health 11(1), pp. 1-13.

95. Wan Rozita, W.M., Yap, B.W., Veronica, S., Mohammad, A.K. and Lim, K.H. (2006)

‘Knowledge, attitude and practice (KAP) survey on dengue fever in an urban Malay

residential area in Kuala Lumpur’. Malays J Public Health Med 6(2), pp. 62-67.

96. Wong, L.P. and AbuBakar, S. (2013) ‘Health beliefs and practices related to

dengue fever: a focus group study’. PLoS Negl Trop Dis 7(7), pp. e2310.

97. Wong, L.P., Shakir, S.M.M., Atefi, N. and AbuBakar, S. (2015) ‘Factors affecting

dengue prevention practices: nationwide survey of the Malaysian public’. PloS One

10(4), pp. e0122890.

98. World Health Organization. (2004) Global Strategic Framework for Integrated

Vector Management. [Online] Available at : http://whqlibdoc.who.int/hq/2004/WHO

[Accessed 7 February 2017]

99. World Health Organization. (2012) Global Strategy for dengue prevention and

control, 2012–2020. [Online] Available at:

http://apps.who.int/iris/bitstream/10665/75303/1/9789241504034_eng.pdf?ua=1

[Accessed 27 February 2017]

100. World Health Organization. (2009) Dengue guidelines for diagnosis, treatment,

prevention and control: new edition.

91
101. World Health Organization. (2016) Gender. [Online] Available at:

http://www.who.int/gender-equity-rights/understanding/gender-definition/en/

[Accessed 8 February 2017]

102. World Health Organization. (2017) Dengue and severe dengue. Available at:

http://www.who.int/mediacentre/factsheets/fs117/en/ [Accessed 9 February 2017]

103. World Health Organization. (2017) Epidemiology. [Online] Available at:

http://www.who.int/denguecontrol/epidemiology/en/ [Accessed 7 February 2017]

104. World Health Organization. (2017) What is dengue? [Online] Available

at:http://www.who.int/denguecontrol/disease/en/ [Accessed 8 February 2017]

105. Yboa, B.C. and Labrague, L.J. (2013) ‘Dengue knowledge and preventive

practices among rural residents in Samar province, Philippines’. American Journal

of Public Health Research 1(2), pp. 47-52.

92
Appendices

Questionnaire – English version

Serial Number :
Greetings,
Our researchers from the Medical Faculty of the UCSI University is conducting a study on
Knowledge, Attitude And Practice Of Dengue In Kampung Tanah Lot

RESPONDENT’S INFORMATION

Please answer all the questions below by ticking( √ ) one of the answers only.

1. Age

18-20 years old

21-30 years old
31-40 years old
41-50 years old
51-60 years old
>60 years old

2. Gender

Male
Female

3. Race
Malay
Chinese
Indian
Others

93
 4. Marital status
Single
Married
Divorcee
Widow/widower

5.Level of education attained

No formal education
Primary school
Secondary school
Graduate

6. Occupation

Student
Government staff
Private sector
Pensioner
Others

7.What is your estimated monthly income?

No income
<RM1000
RM1001 – RM2000
RM2001- RM3000
RM3001-RM5000
>RM5000

94
8. How long have you been staying here?

Less than 6 months

6 months to 2 years
> 2 years to < 5 years
> 5 years to < 10 years
More than 10 years

9.Have you been infected with dengue previously?

Yes
No

10.Have any of your acquitances been infected by dengue?

Yes
No

SECTION A: GENERAL KNOWLEDGE ON DENGUE

Please answer all the questions below by ticking( √ ) the answers.

1. Among the following,which are the signs and symptoms of dengue?

No Signs & Symptoms Yes No Not sure

1 Fever
2 Rigors
3 Nausea and vomiting
4 Headache
5 Joint pain
6 Muscle pain
7 Pain behind the eyes
8 Back pain
9 Abdominal pain
10 Bleeding from nose,gums and skin
11 Rashes
12 Cough
95
 13 Diarrhea

2. Is dengue an infectious disease?

Yes No Not sure

3. Which of the following is the vector of dengue?

No Vector Yes No Not sure

1 Flies
2 Ticks/lice
3 Mosquitoes

4. How is dengue transmitted to a person?

No Method Yes No Not sure

1 Air Borne
2 Water borne
3 Mosquitoe bite
4 Blood transfusion

5. Which of the species below is the vector of dengue?

No Mosquito species Yes No Not sure

1 Culex
2 Aedes
3 Anopheles
4 Mansonii

6.When is the biting time of the mosquito?

No Time Yes No Not sure

1 Dawn and dusk
2 Morning and afternoon
3 All night
96
 4 All the time

7. Which of the following is the breeding ground of the dengue vector?

No Breeding ground Yes No Not sure
1 Exposed food containers
2 Discarded tyres
3 Wheelbarrow
4 Uncovered water containers
5 Flower pot base plates
6 Stagnant water
7 River
8 Puddle
9 Roof gutter
10 Between tree stems

8. Is there a specific treatment for dengue?

Yes No Not sure

9. Which of the following is the treatment for dengue?

No Treatment Yes No Not sure

1 Enough rest
2 Consuming more water
3 Panadol (Paracetamol)
4 Traditional medicine and herbs

10. What is your source of information regarding dengue?

No Source of information Yes No

1 Books,newspapers,pamphlets
2 Mass media (TV, Radio)
3 Internet
4 Healthcare personnel
5 Health campaign

97
 6 Word of friends/relatives

11. Do dengue cases occur most frequently during rainy season?

Yes No Not sure

12. Do you know that you could be fined if larvae is found around your house
compound?

Yes No Not sure

13. Is it possible to be infected with dengue more than once?

Yes No Not sure

SECTION B: ATTITUDE TOWARDS PREVENTION OF DENGUE

Not Strongly
No Question Strongl Agre sure Disagre disagree
y agree e e
1. Dengue is a serious illness.
2. Dengue cannot be prevented.
3. Everybody has a chance to contract
dengue.
4. Children are most vulnerable to dengue.
5. Government has taken enough measures
to prevent dengue.
6. Dengue in early stage can be cured.
7. Elimination of larval breeding sources is
complicated and a waste of time.
8. Combating the vector mosquitoes is the
only means of controlling and preventing
dengue.
9. I play an important role in preventing
dengue.

98
10. Eliminating the vector breeding places is
solely the responsibility of the public health
staff and health volunteers
11. Controlling and surveying potential vector
breeding grounds should be done at least
once a year.
12. ‘Fogging’ can prevent breeding of dengue
vector completely.
13. Will you seek medical attention if you have
any symptoms of dengue?
14. Fine helps in controlling dengue.
15. Healthcare personnel are not required to do
regular surveillance at residence.

SECTION C:PRACTICES AND MEASURES IN

REDUCING MOSQUITO AND LARVAES
Not
No. Questions Yes No Sure
1. Do you have the habit of storing water in water
containers?
2. Do the water storage containers/wells have covers in and
around your house?
3. Do you keep the water storage containers/wells covered
immediately after using it?
4. Do you regularly inspect the water storage
containers/wells if it has not been used for more than 5
days?
5. Do you put larvacide (abate) for larvae into the water
storage containers in your home?
6. Have you ever done inspection for larvae in the flower pot
base plates?
7. If stagnant water is found in flower pot base plate,will you
dispose it?
8. Have you ever searched the residence and the area
around it to look for vector breeding ground?
9. Do you dispose any containers that can lead to stagnant
water collection?
10. Do all the people in your house use mosquito nets during
sleep each time?
11. Have you installed mosquito screens on windows in your
house?
99
12. Do you check the roof gutters during the rainy season?
13. Do your family members participate in Aedes Prevention
Community Campaigns?
14. Do you agree that eradicating dengue vector is our
responsible together?
15. Will you encourage your whole family to participate in
‘gotong-royong’ organized at your residence?
16. Will you allow the responsible organization to carry out
dengue prevention activities in your community?
17. Do you and your family members always wear long
sleeve when you leave the house during the biting time of
mosquito?

Thank you for your cooperation

~Together we prevent dengue ~

100
Questionnaire – Bahasa Malaysia version

No siri :
Kami penyelidik dari Fakulti Perubatan UCSI University sedang menjalankan kajian
berkenaaan Pengetahuan,Sikap Dan Amalan Terhadap Denggi Di Kampung Tanah
Lot

MAKLUMAT RESPONDEN

Sila JAWAB SEMUA soalan di bawah dengan MENANDA( √ )SATU pilihan jawapan
sahaja.

1.Umur

18-20 tahun
21-30 tahun
31-40 tahun
41-50 tahun
51-60 tahun
>60 tahun

2. Jantina
Lelaki
Perempuan

3. Kaum
Melayu
Cina
India
Lain-lain

4. Status perkahwinan

Bujang
Berkahwin
Bercerai
Kematian suami/isteri

101
4. Tahap tertinggi pendidikan.

Tidak pernah bersekolah

Sekolah rendah
Sekolah menengah
IPTA/IPTS

6. Pekerjaan.

Pelajar
Kakitangan Kerajaan Nyatakan :
Kakitangaan Swasta Nyatakan :

Pesara
Lain-lain (sila Nyatakan :
jelaskan)

7.Pendapatan kasar keluarga sebulan.

Tidak Bergaji
<RM1000
Rm1001 – RM2000
RM2001- RM3000
>RM3000

8. Berapa lamakah anda menduduki kampung ini?

Kurang dari 6 bulan

6 bulan hingga 2 tahun
2 tahun hingga 5 tahun
5 tahun hingga 10 tahun
Lebih daripada 10 tahun

102
9. Adakah anda pernah dijangkiti demam denggi?

Ya
Tidak

10.Adakah kenalan anda (saudara mara/kawan) pernah dijangkiti penyakit

denggi

Ya
Tidak

BAHAGIAN A: PENGETAHUAN MENGENAI DENGGI

Sila JAWAB SEMUA soalan di bawah menggunakan tanda (√).

2. Antara berikut yang manakah merupakan tanda-tanda denggi?

No Tanda-tanda Ya Tidak Tidak Tahu

1 Demam
2 Menggigil
3 Loya dan muntah
4 Sakit kepala
5 Sakit sendi
6 Sakit otot
7 Sakit belakang mata
8 Sakit tulang belakang (sakit
belakang)
9 Sakit perut
10 Pendarahan dari hidung, gusi dan
kulit
11 Ruam / bintik-bintik merah
12 Batuk
13 Cirit-birit

103
2. Adakah denggi merupakan penyakit berjangkit?

Ya Tidak Tidak Tahu

3. Antara berikut yang manakah merupakan pembawa denggi?

No Pembawa Ya Tidak Tidak Tahu

1 Lalat
2 Kutu
3 Nyamuk

4. Bagaimanakah denggi boleh merebak?

No Kaedah Ya Tidak Tidak Tahu

1 Bawaan udara
2 Bawaan air
3 Gigitan nyamuk
4 Transfusi darah

5. Apakah jenis nyamuk yang menjadi pembawa denggi?

No Jenis Nyamuk Ya Tidak Tidak Tahu

1 Culex
2 Aedes
3 Anopheles
4 Mansonii

6. Bilakah waktu paling kerap nyamuk berkenaan mengigit manusia?

No Masa Menghisap Darah Ya Tidak Tidak Tahu

1 Subuh dan lewat petang
2 Pagi dan tengahari

104
 3 Malam dan tengah malam
4 Sepanjang masa

7. Antara berikut, yang manakah merupakan tempat pembiakan pembawa

denggi?

No Tempat Pembiakan Ya Tidak Tidak Tahu

1 Bekas makanan terbiar
2 Tayar terbiar
3 Kereta sorong (kereta tolak)
4 Tempat takungan air yang tidak
bertutup
5 Alas pasu bunga
6 Kolam terbuka
7 Air yang mengalir
8 Lopak air
9 Longkang atap (gutter)
10 Celah-celah dahan pokok

8. Adakah terdapat rawatan yang khusus bagi denggi?

Ya Tidak Tidak Tahu

9. Antara berikut, yang manakah merupakan rawatan bagi penyakit denggi?

No Rawatan Ya Tidak Tidak Tahu

1 Rehat secukupnya
2 Pengambilan air yang banyak
3 Panadol (Paracetamol)
4 Rawatan tradisional (herba)

10. Bagaimanakah anda memperolehi maklumat mengenai denggi?

No Sumber Maklumat Ya Tidak

1 Buku/surat khabar/pamplet

105
 2 Media massa (TV, Radio)
3 Internet
4 Kakitangan kesihatan
5 Kempen kesihatan
6 Orang sekeliling (Saudara
mara/kawan dan sebagainya)

11. Adakah musim hujan merupakan musim yang paling kerap untuk kejadian
kes denggi ?

Ya Tidak Tidak Tahu

12. Tahukah anda bahawa denda boleh dikenakan sekiranya terdapat jentik-
jentik di kawasan rumah anda ?

Ya Tidak Tidak Tahu

13. Bolehkah seseorang dijangkiti denggi lebih daripada sekali?

Ya Tidak Tidak Tahu

BAHAGIAN B: SIKAP TERHADAP PENCEGAHAN DENGGI

Sang
No Soalan Sang Setuj Tidak Tidak at
at u Pasti Setuj Tidak
Setuj u Setuj
u u
1. Denggi merupakan penyakit yang serius
2. Denggi adalah sejenis penyakit yang boleh
dicegah

106
3. Setiap orang mempunyai risiko untuk
dijangkiti denggi
4. Kanak kanak adalah golongan yang mudah
dijangkiti denggi
5. Kerajaan telah melaksanakan tugas yang
mencukupi untuk mengelakkan penyakit
denggi.
6. Denggi peringkat awal mampu dirawat
sepenuhnya
7. Pelupusan sumber jentik-jentik adalah
membuang masa dan menyusahkan
8. Membunuh nyamuk yang membawa
denggi adalah satu-satunya cara untuk
mengawal atau mencegah denggi
9. Saya memainkan peranan yang penting
dalam pencegahan denggi.
10. Membasmi tempat pembiakan nyamuk
adalah tanggungjawab kakitangan
kesihatan dan sukarelawan sahaja
11. Mengawal dan memantau kawasan yang
berupaya untuk pembiakan nyamuk
perlulah dilakukan sekurang-kurangnya
sekali setahun
12. ‘Fogging’ (semburan asap) dapat
menghalang pembiakan nyamuk
sepenuhnya
13. Adakah anda akan pergi berjumpa dengan
doktor sekiranya ada mana-mana tanda
denggi?
14. Adakah denda berkesan dalam
pengawalan denggi.
15. Kakitangan kesihatan perlu melakukan
pemeriksaan di rumah-rumah.

107
 Tidak
No. Soalan Ya Tidak Pasti
1. Adakah anda mempunyai tabiat menyimpan air dalam bekas
penyimpanan air?
2. Adakah bekas penyimpanan air/perigi di kediaman anda
mempunyai penutup?
3. Adakah anda menutup semula bekas penyimpanan air/perigi
sebaik sahaja selesai menggunakannya?
4. Adakah anda selalu memeriksa keadaan air dalam bekas
penyimpanan air/perigi jika tidak menggunakannya untuk
jangka masa lebih daripada 5 hari?
5. Adakah anda meletakkan ubat pencegah jentik-jentik (abate)
ke dalam segala bekas takungan air di kediaman anda? eg
:alas pasu bunga
6. Adakah anda pernah melakukan pemeriksaan jentik-jentik di
dalam bekas pasu bunga kediaman anda?
7. Jika terdapat air bertakung di dalam bekas pasu bunga,
adakah anda akan membuangnya?
8. Adakah anda pernah melakukan pemeriksaan di tempat
kediaman dan kawasan sekitarnya untuk mencari
bekas/tempat yang boleh menjadi tempat pembiakan
nyamuk?
9. Adakah anda menghapuskan bekas yang boleh
menyebabkan air bertakung dengan membuangnya?
10. Adakah kesemua ahli kediaman anda menggunakan
kelambu setiap kali tidur?
11. Adakah kediaman anda menggunakan jaring tingkap?
12. Adakah anda selalu memeriksa longkang atap (gutter) setiap
kali musim hujan?
13. Adakah ahli keluarga anda mengambil bahagian dalam
Kempen Pencegahan Pembiakan Nyamuk Aedes dalam
komuniti anda?
14. Adakah anda bersetuju bahawa membasmi nyamuk Aedes
adalah tanggungjawab bersama?
15. Sekiranya terdapat gotong-royong di kawasan kediaman
anda, adakah anda akan mengalakkan seluruh ahli keluarga
anda untuk menyertainya?

108
16. Adakah anda akan membenarkan pihak berwajib untuk
melakukan aktiviti pencegahan denggi di kediaman anda?

17. Anda dan keluarga sentiasa memakai pakaian lengan

panjang apabila keluar dari tempat kediaman semasa waktu
subuh dan lewat petang.
BAHAGIAN C:AMALAN& KAEDAH
MENGURANGKAN NYAMUK AEDES DEWASA DAN JENTIK-JENTIK

Terima Kasih atas Kerjasama yang diberikan

~BERSAMA BERSATU MENCEGAH DEMAM DENGGI~

109
 GANTT chart

Day
Research Activity 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26
5/2 6/2 7/2 8/2 9/2 10/2 11/2 12/2 13/2 14/2 15/2 16/2 17/2 18/2 19/2 20/2 21/2 22/2 23/2 24/2 25/2 26/2 27/2 28/2 1/3 2/3

Literature Search

Proposal Writing

Proposal Presentation

Preparation for Data

Collection

Ethical Approval

Pilot Study

Data Collection

Data Entry and Cleaning

Data Analysis

Report Writing,
Presentation and
Community Service

Report Submission

110
 PARTICIPANT INFORMATION SHEET

Title of research study:

Dengue in Rural Marang Village : A Study on Knowledge, Attitude and Practice

and Its Association with Socio-demographic Factors

Principle researcher:

Associate Professor Dr.Retneswari Masilamani

The residents of Kampung Tanah Lot, Marang are invited to take part in the research
study on knowledge, attitude and practice on dengue and its association with socio-
demographic Factors in Kampung Tanah Lot, Marang, Terengganu, by UCSI
University Year 4 medical students.

Please read the information sheet before participating in the study. Your participation
is voluntary and you are free to withdraw at any time without giving any reasons,
without your medical care or legal rights being affected. If you agree to take part in
this study, kindly sign the consent form. You are most welcome to contact us if you
require further information.

This document is comprised of 2 pages, please make sure that you have read and
understood all the pages.

Why is this study being done?

Dengue is one of the most important health problems in our country; it is a disease
that can lead to death. Numbers of dengue cases have increased tremendously from
7130 cases in 2000 to 120,836 cases in 2015. This is all happening despite good
vector control and health education programs given to the community.

Hence, the objective of our study is to determine the level of knowledge, attitude and
practice on dengue and associated socio-demographic factors among residents in
Kg. Tanah Lot.

A cross-sectional study will be carried out using a set of questionnaires where the
students will interview you. This study will enable us to obtain information on the
health status and socio-demographic profile among you all.

111
Why have the residents been chosen?

As to the best of our knowledge, there has been only one study done in Kuala
Terengganu and no other study in any other districts including this district.

What do the residents have to do?

You are required to answer the questions from the questionnaires through an
interview. You are requested to answer the question to the best of your ability. The
interview will take less than 30 minutes.

What are the benefits of taking part?

The outcome of this research will give us a clear picture on the status of knowledge,
attitude and practice on dengue among you all. This will enable us to provide
recommendation and carry out community services/ intervention based on the result
of the study.

Confidentiality

Before answering the questions from the questionnaires, an informed consent would
be taken from you to confirm your willingness to participate in this study. Please be
assured that your personal information collected through the study will be considered
highly confidential and privacy shall be maintained.

Contact for further information

For any clarification, feel free to contact +6017 369 7071 (Associate Professor Dr.
Retneswari Masilamani) or +6012 252 3237 (Cherish Chong)

Thank you.

112
 LEMBARAN MAKLUMAT KAJIAN

Tajuk kaji selidik:

Denggi di Kampung Pedalaman Marang : Kajian Tentang

Pengetahuan, Sikap dan Amalan serta kaitannya dengan

Faktor-faktor Sosiodemografik

Penyelia kajian:

Profesor Madya Dr. Retneswari Masilamani

Para penduduk Kg. Tanah Lot, Marang dijemput untuk menyertai kaji selidik kami
yang bertajuk “Kajian tentang Pengetahuan, Sikap Dan Amalan Terhadap Denggi
dan kaitannya dengan faktor sosiodemografik dalam kalangan penduduk Kampung
Tanah Lot, Marang, Terengganu”, yang dijalankan oleh pelajar perubatan tahun 4
UCSI University.

Sila baca lembaran maklumat ini sebelum menyertai kaji selidik ini.Penyertaan
tuan/puan adalah secara sukarela dan tuan/puan bebas untuk menarik diri pada bila-
bila masa tanpa memberi sebarang sebab, tanpa menjejaskan rawatan perubatan
atau sebarang hak undang-undang anda.Sekiranya Tuan/Puan bersetuju untuk
menyertai kaji selidik ini, sila tandatangan borang persetujuan yang
diberi.Tuan/Puan boleh menghubungi kami untuk sebarang maklumat lanjut.

Lembaran ini mempunyai 2 muka surat, sila pastikan anda telah membaca dan
memahami semua muka surat.

Kenapa kajian selidik ini dijalankan?

Denggi merupakan antara masalah perubatan yang paling merisaukan di Malaysia.

Bilangan kes denggi telah meningkat dari 7130 kes pada tahun 2000 ke 120,836 kes
pada tahun 2015. Perkara ini masih berterusan walaupun adanya kawalan vektor
dan program kesedaran masyarakat yang telah dijalankan.

Oleh itu, objektif kaji selidik kami adalah untuk menilai tahap pengetahuan, sikap dan
amalan serta faktor-faktor sosio-demografik yang berkaitan di kalangan anda.

113
Satu kajian akan dijalankan menggunakan satu set soalan kaji selidik, di mana para
pelajar akan menemuduga anda. Melalui kaji selidik ini, kami akan mendapat
maklumat mengenai status kesihatan dan profil sosio-demografik anda semua.

Mengapakah penduduk kampung ini dipilih?

Berdasarkan kajian kami, setakat ini hanya terdapat satu kaji selidik yang telah
dijalankan di Terengganu, dan tiada kaji selidik telah dijalankan di dalam kampung
ini.

Apakah yang perlu dilakukan oleh penduduk ?

Anda perlu menjawab soalan dari lembaran soalan kaji selidik sebaik mungkin. Sesi
soal jawab tidak akan mengambil masa melebihi 30 minit.

Apakah faedah yang diperolehi jika menyertai kajian ini?

Hasil kajian ini akan menunjukkan status pengetahuan, sikap dan amalan di kalangan anda
semua. Ini akan membolehkan kami untuk memberikan cadangan kami kepada pihak
bertanggungjawab dan melakukan khidmat masyarakat berdasarkan hasil kajian kami.

Maklumat Sulit

Sebelum menjawab set soalan yang diberikan, borang persetujuan yang telah diisi
akan dikutip daripada anda untuk memastikan anda bersetuju untuk menyertai kaji
selidik ini. Kami menjamin bahawa segala maklumat peribadi anda adalah sulit dan
dirahsiakan.

Talian untuk sebarang pertanyaan

Untuk sebarang pertanyaan, sila hubungi +6017 369 7071 (Prof Madya Retneswari
Masilamani) atau +6012 252 3237 (Cherish Chong)

Terima kasih .

114
 CONSENT FORM FOR PARTICIPATION
IN RESEARCH STUDY

Title of Study : Dengue in Rural Marang Village: A Study on Knowledge, Attitude and
Practice and Its Association with Socio-demographic Factors
Place of Study : Kampung Tanah Lot, Wakaf Tapai, Marang, Terengganu
Purpose of Study : To assess the level of knowledge, attitude and practices towards dengue and
their association with socio-demographic variables in villagers in Kampung
Tanah Lot, Wakaf Tapai, Marang, Terengganu.
Name of researcher : Associate Professor Dr. Retneswari Masilamani
Name of Supervisor : Associate Professor Dr. Retneswari Masilamani
Please tick in the boxes given below:

I hereby confirm that I have read and understood the information about this
1.
study as stated on the Information Sheet.

I have been given an opportunity to consider all the information given, ask
2. questions on the study or any doubts pertaining to the study, and am
satisfied with the answers given.
I understand that my participation is voluntarily, I can withdraw from this
3. study at any time without giving reasons, and this will not affect my
medical care or legal rights.
I understand that the relevant sections of data collected during the study,
may be looked at by responsible researchers from UCSI Terengganu
4.
Campus and the UCSI University-regulatory authorities, where it is
relevant to the residents of Kg Tanah Lot taking part in this research.

I hereby give the permission for the above officers to access the above
5.
mentioned data/records.

Hereby, I voluntarily agree to participate in the above research study.

______________________ ___________________ ________________

Name of respondent Signature Date

______________________ ___________________ ________________

Name of interviewer Signature Date

115
 BORANG PERSETUJUAN UNTUK
PENYERTAANPROJEK PENYELIDIKAN

Tajuk Penyelidikan :Denggi di Perkampungan Pedalaman Marang : Kajian Tentang Pengetahuan,

Sikap dan Amalan serta Kaitannya dengan Faktor-Faktor Sosiodemografik
Tempat Kajian : Kampung Tanah Lot, Wakaf Tapai, Marang, Terengganu
Objektif Kajian : Untuk menilai tahap pengetahuan, sikap dan amalan terhadap denggi di
Kampung Tanah Lot, Wakaf Tapai, Marang, Terengganu.
Nama Penyelidik : Profesor Madya Dr. Retneswari Masilamani
Nama Penyelia :Profesor Madya Dr. Retneswari Masilamani
Sila tanda dalam kotak di bawah:
Saya sebagai penduduk Kampong Tanah Lot, mengesahkan bahawa saya telah
1. membaca dan memahami maklumat mengenai kajian ini di dalam Lembaran Maklumat
Kajian.
Saya telah diberi peluang untuk mempertimbangkan maklumat yang telah disediakan,
2. bertanya soalan mengenai kajian ini atau apa-apa maklumat yang kurang jelas, dan
saya berpuas hati dengan jawapan yang diberikan.
Saya memahami bahawa penyertaan ini adalah secara sukarela, dan saya boleh menarik
3. diri pada bila-bila masa tanpa memberi sebarang alasan, tanpa menjejaskan rawatan
perubatan serta hak undang-undang saya.
Saya memahami bahawa para penyelidik dari UCSI Kampus Terengganu dan pihak
4. atasan Universiti UCSI akan menilai maklumat/data yang diperolehi sepanjang
penyelidikan ini.

5. Saya memberi keizinan kepada pihak berkenaan untuk mengakses data/rekod saya.

Dengan ini, saya secara sukarela, bersetuju untuk menyertai kajian ini.

______________________ ___________________ ________________

Nama penduduk Tandatangan Tarikh

______________________ ___________________ ________________

Nama penyelidik Tandatangan Tarikh

116
Map of Kampung Tanah Lot

117
 Dean Approval Application Letter

Assoc. Professor Dr. Retneswari Masilamani,

Coordinator of Community Medicine II Programme,

Department of Community Medicine,

Faculty of Medicine and Health Sciences,

UCSI University, Terengganu Campus

21600 Marang, Terengganu.

12 February 2017

Dear Assoc. Prof. Retneswari,

Approval on the Research Proposal by Year 4, Group 1 Medical Students

I hereby refer to the research proposal and the presentation made on the proposal entitled “Dengue
in Rural Marang Village : A Study on Knowledge, Attitude and Practice and Its Association with
Socio-demographic Factors”.

Having reviewed the proposal, I hereby grant approval on the proposal, for the Year 4, Group 1
medical students, to enable them to conduct the study.

Sincerely,

Professor Dr. Zulkifi bin Ahmad,

Dean,

Faculty of Medicine and Health Sciences,

UCSI University, Terengganu Campus.

118
 Ethical Clearance Application Letter

Our reference :

12 February 2017

Head,

Research and Scholarly Activities for FOMHS,

UCSI University, Terengganu Campus,

Bukit Khor,

PT 11065, Mukim Rusila,

21600 Marang,

Terengganu Daru Iman, Malaysia.

Dear Sir,

APPLICATION FOR ETHICAL CLEARANCE FOR RESEARCH STUDY

I, Cherish Chong (Group Leader of Year 4, Group 1 Research Methodology Team), a Year 4
medical student from Faculty of Medicine and Health Sciences of UCSI University am
requesting ethical approval for our study titled “Dengue in Rural Marang Village : A Study
on Knowledge, Attitude and Practice and Its Association with Socio-demographic
Factors” conducted in fulfilment of our research methodology course under the Community
Medicine II programme (MM401).

2. This study is aimed at assessing the level of knowledge, attitude and practice and
their association with socio-demographic characteristics among villagers in Kampung Tanah
Lot, Wakaf Tapai, Marang, Terengganu. While providing us with data regarding the
knowledge, attitude and practice level on dengue among the villagers, the study will offer
valuable information in conducting future health education programmes.

3. We propose to conduct our study on 157 villagers aged 18 and above. In light of this,
we request for ethical approval by the committee prior to the commencement of our study.

119
2. Enclosed, please find the following documents for your reference. (1) Cover letter, (2)
Application for Ethical Clearance for Research, (3) Curriculum Vitae, (4) Consent Form,
(5) Participant Information Sheet, (6) Questionnaire, (7) Research Proposal and (8)
Dean Approval Letter. The information contained in these documents is intended only for
use of this study and would not be used for other purposes.

Thank you for your consideration.

Yours sincerely,

Cherish Chong

Year 4 Medical Student,

Faculty of Medicine and Health Sciences,

UCSI University.

+6 012-2523237

[email protected]

120
 Project Code:

RESEARCH ETHICS COMMITTEE

APPLICATION FOR ETHICAL CLEARANCE FOR RESEARCH

New Submission Resubmission

TITLE OF RESEARCH PROJECT: Dengue in Rural Marang Village : A Study on Knowledge, Attitude
and Practice and Its Association with Socio-demographic Factors

Date: 12 February 2017 Applicant’s status:

Researcher(s) Name*: Faculty, Dept. & Address Phone / Fax E-mail

Assoc. Professor Dr. Faculty of Medicine & Health Sciences +6 017- retneswari@ucsiuni
Retneswari 3697071 versity.edu.my
Masilamani
Principal Investigator

Pn. Aini binti Abu Faculty of Medicine & Health Sciences +6 019- aini@ucsiuniversity.
Bakar 9839455 edu.my
Dr. Fatimah Suhasliza Ministry of Health +6 017- drfsuhasliza@moh.
bt. A. Rahman 3134679 gov.my
Mohd. Nazri bin Ministry of Health [email protected]
Mohamad ov.my
Cherish Chong Faculty of Medicine & Health Sciences +6 012- cherishccw@yahoo.
2523237 com
Pavithiran A/L Selvaragi Faculty of Medicine & Health Sciences +6 014- pavithiranselvaragi
6038614 @yahoo.com
Tay Ru-Fang Faculty of Medicine & Health Sciences +6 017- annabeltay94@gma
7974778 il.com
Wendy Ngu Wen Wen Faculty of Medicine & Health Sciences +6 010- wendyngu94@hot
9676879 mail.com
Wong Shin Yiing Faculty of Medicine & Health Sciences +6 012- [email protected]
9162832 om.my
Lee Jun Keong Faculty of Medicine & Health Sciences +6 016- junkeong_01@hom
9009913 tail.com
Roshini Palanisamy Faculty of Medicine & Health Sciences +6 016- palanisamyroshini
7764077 @gmail.com
Janine Tan Sinn Lu Faculty of Medicine & Health Sciences +6 017- janinetsl07@gmail.
6828415 com
Meryl Loh Wei Chyi Faculty of Medicine & Health Sciences +6 017- meryl_loh@hotmail
5007918 .com
Durga Devi Gunesan Faculty of Medicine & Health Sciences +6 016- durgaived13@gmail
2697003 .com
Lim Jie Ying Faculty of Medicine & Health Sciences +6 016- jasminejy10713@g
3350183 mail.com
Renuka Beulah a/p Faculty of Medicine & Health Sciences +6 010- [email protected]
Kunalan 3963757 m
Subashini a/p Faculty of Medicine & Health Sciences +6 014- subashini_g@yahoo

121
 Gunasegaran 9656983 .com
Pritharani a/p Faculty of Medicine & Health Sciences +6 016- [email protected]
Karunagaran 9967393
Wan Khalil Nasrin bin Faculty of Medicine & Health Sciences +6 014- [email protected]
Wan Nasir 5129426 om
Nur Farah Nadia binti Faculty of Medicine & Health Sciences +6 019- nurfarahnadia.zamr
Zamri 2189115 [email protected]

*state principal researcher

Section A: Human Subject Involvement

No. Item Remarks/ Brief Description

1 Protocol of Research Project
a) Summary of Research Proposal
i. Purpose To assess the level of knowledge, attitude and practices
towards dengue and their association with socio-
demographic variables in villagers in Kampung Tanah Lot,
Wakaf Tapai, Marang, Terengganu.

ii. Background rationale a) The incidence of dengue has grown dramatically

around the world and 3.9 billion people, Malaysia
included, are at risk of infection with dengue viruses.

b) Malaysia reported its highest number of dengue cases

in 2015 with 336 deaths.

c) Dengue cases in Malaysia continue to rise despite

increasing allocation of funds for vector control and
community education programs.

d) To the scope of our literature search we find that there

is lack of KAP studies conducted in a rural setting.

e) There are limited literatures on the association

between socio-demographic characteristics and KAP
levels.

f) Completion of a research project is a partial fulfilment

of the requirements of the Doctor of Medicine

122
 programme in UCSI University.

iii. Hypothesis or problem statement The level of knowledge, attitude and practice and their
association with socio-demographic characteristics among
villagers in Kampung Tanah Lot, Wakaf Tapai, Marang,
Terengganu.

iv. Duration of research project 1 month

b) Methodology/ Procedure
i. Procedures involve invasion of the - Not Applicable-
body (e.g. touching, contact,
attachment of instruments,
withdrawal of specimens)
ii. Description of all procedures 1. Villagers will be briefed and provided the information
involving subjects, in sequential sheet on pilot study and final study.
order (e.g. self-administered 2. A written consent form will be signed by the villagers as
surveys, interviews, questionnaires, proof of consent.
physical measurements)
3. Interviewer-administered questionnaire will be carried
out.
4. A pilot study will be carried out on 30 villagers before
our final study to test the reliability of our
questionnaire.
5. During our final study, the same procedures will be
observed.

iii. A copy of questionnaires Enclosed herein

iv. Venue of research Kampung Tanah Lot, Wakaf Tapai, Marang, Terengganu.
v. A copy of permission/approval letter Dean approval letter enclosed herein
to conduct the research
2 Informed Consent Form
a) Appropriate language Bahasa Malaysia
b) Criteria should include reading and Patient Information Sheet enclosed herein
understanding of subject information sheet
c) Signage from participants or parents/ Villagers above 18 years will be studied. Informed consent
guardians (if subjects are underage) will be obtained from each villager.
3 Study Population
a) Description of criteria for subject Villagers from Kampung Tanah Lot aged 18 years old and
recruitment above who are able to provide written informed consent
and able to understand the purpose of the study.
b) Number of subjects 187 (pilot plus final study)
c) Gender Both males and females

123
 d) Race Malay (No Indian and Chinese villagers in the kampung)
e) Age range 18 years and above
f) Any special characteristics Inclusion Criteria
i. Inclusion criteria
ii. Exclusion criteria 1. Villagers from Kampung Tanah Lot aged above 18 years
old

2. Villagers who have given written consent.

3. Villagers who lived in Kampung Tanah Lot for more than 6

months.

Exclusion Criteria

1. Villagers who are less than 18 years of age.

2. Villagers who will be involved in the pilot study.

3. Villagers who refuse to participate in our research.

4. Villagers who will be absent in their house at the time of

survey on 3 separate visits.

5. Villagers who are mentally ill that is under psychiatric

clinic follow up.
g) Relationship between investigator and None
subjects
h) Remuneration for participation - Not Applicable-
4 Feedback to subjects
a) Provision made for arrangements to inform Community service will be carried out at the end of the study to
subjects of the outcome of the result educate the villagers on dengue based on the results of the
study.
5 Potential benefits of the study
a) Direct benefits to subjects involved in Providing community service to the villagers.
study
b) Potential/ benefits to the scientific 1. Fulfilment of requirement of community medicine II posting as
community/ society that would justify the part of the Doctor of Medicine Programme.
use of human subjects 2. Fulfiment of MPU4 requirement of completion of community
service.
3. Society benefits by community service provided based on the
study and healthcare programmes and policies that may be
introduced based on the study.

6 Competency of Investigators in carrying out

project study/ procedures
a) CVs of all research participants/ Enclosed herein CV of Principal Investigator
supervisors
b) Investigators have conducted a similar - Not Applicable-
research

124
7 Subject information sheet (letter of
information separate from consent form):
describing disease / condition to be
evaluated in the research study
a) Language and proper translations English and Bahasa Malaysia
b) Disease evaluated Dengue
c) Drug evaluated - Not Applicable-
d) Aim of study To assess the level of knowledge, attitude and practices
towards dengue and their association with socio-
demographic variables in villagers in Kampung Tanah Lot,
Wakaf Tapai, Marang, Terengganu.

e) Why the subject is being chosen for They comprise the population that we identified to conduct our
study study, as such, a study has not been done in a village in Marang
district.
f) Expected outcome Knowledge, attitude and practice level varies with socio-
demographic characteristics.

g) Alternative treatment available - Not Applicable-

h) Side effects of participating in the - Not Applicable-
study
i) Organisation and funding of research - Not Applicable-
j) Remuneration of subjects - Not Applicable-
8 Funding of project study and approval status
a) University Part and parcel of curriculum; Applying for ethical approval
through this application

b) Government - Not Applicable-

c) Private/ Company - Not Applicable-
d) Others - Not Applicable-

Section B: Ethical Issues Questionnaire

The following questionnaire is to help alert you to the major types of ethical issues in your research.
Please answer ALL questions.

If you tick (√ ) ‘Yes’ to any of the questions, please include a brief description here and provide full
details and all necessary justifications in your proposal. Please also explain and justify other ethical
issues where applicable.

SUBJECTS’ PROFILE No Yes Brief description

1 Are any of these subjects from a √

125
 particularly vulnerable group? (e.g.
young children, mentally challenged
etc.)
2 Are any of these subjects from a √
minority/ culturally identifiable/
disadvantaged group? (e.g. orang asli
etc.)
3 Are any of these subjects in constant √
requirement of / is highly dependent
on medical care?
4 Are any of these subjects unable to √
give or are incapable of giving
consent?
(i.e. consent will be obtained indirectly
from a legal guardian etc.)
5 Are the subjects given any form of √
payment/ incentive to participate?

PRIVACY AND CONFIDENTIALITY No Yes Brief description

6 Will you be collecting data that will √
potentially disadvantage a subject?
(e.g. handicaps etc.)
7 Does any of the data that is collected √
has the potential to cause discomfort,
embarrassment, or psychological harm
to the subjects?
(e.g. sexual orientation etc.)
8 Does your research involve measures √
undeclared to the subjects?
(e.g. covert observations etc.)
9 Will the collected data be made √
available to other parties not involved
in the research? (e.g. government
agencies)

RISK OF HARM No Yes Brief description

10 Will you be collecting biological √
samples e.g. body fluids?
(if ‘No’, go to Question 13)

11 What type of biological samples? √

(Please indicate amount and
frequency)
12 Is the collection method invasive and √
has the potential to cause harm,
physical pain or discomfort etc.?
13 Will the subjects be subjected to √
physically invasive examinations or
exercise regimens?

126
 14 Is there any form of novel procedure/ √
medication involved?
15 If ‘Yes’ to No.14, and an effective √
treatment is already available, is a
placebo group included and justified?
16 Is there any kind of risk to the subject √
if he/she chose to withdraw?

OTHER ETHICS ISSUES No Yes Brief description

17 Are there any other ethical issues not √
highlighted in this checklist?

Section C: Information on Animal Use in Research: Please fill in the below if it is applicable and
elaborate accordingly.

No. Item Remarks/ Brief Description

1 Details of animal(s) intended to
be used

a) Weight - Not Applicable-

b) Age - Not Applicable-
c) Male - Not Applicable-

Female

d) Species - Not Applicable-

e) Total - Not Applicable-
f) Animal Source - Not Applicable-
2 Explain procedures to be
carried out on the animal

a) Justification of Animal Use - Not Applicable-

in Research (please include
literature review)
b) Procedure to be carried - Not Applicable-
out (including pre, post
and operative care if
applicable)
c) Will the animal be scarified - Not Applicable-
after the research?

d) Method of sacrifice - Not Applicable-

e) List the equipment and - Not Applicable-
drugs that will be used on
the animal

3 Clasification of Project - Not Applicable-

A Experiment involving either no living materials or use of no living materials or use of plants,

127
 bacteria, protozoa, or invertebrate animal species
B Experiment on vertebrate animal species that are expected to produce little of no discomfort

C Experiment that involve some minor stress of pain (short – duration pain) to vertebrate
animal
D Experiment involves significant but unavoidable stress or pain to vertebrate animal species

E Procedures that involve inflicting severe pain near, at, or above the pain tolerance threshold
of un-anesthetized conscious animals

128
Principal Researcher
Signature : Insert Signature
Name : Assoc. Professor Dr. Retneswari Masilamani
Date : 12 February 2017

Section D: Comments at School Level

□ APPROVED □ APPROVE UPON REVISION □ REJECTED

Comments

........................................................................................................................................................................

........................................................................................................................................................................

........................................................................................................................................................................

........................................................................................................................................................................

School Research Representative

Signature :
Name :
Date :

Section E: Comments at Faculty Level

□ APPROVED □ APPROVE UPON REVISION □ REJECTED

Comments

........................................................................................................................................................................

........................................................................................................................................................................

........................................................................................................................................................................

........................................................................................................................................................................

Faculty RSA Committee Dean of Faculty

Signature : Signature :

Name : Name :
Date : Date :
Section F: Approval by UCSI University Research Ethics Committee

Permission to perform the above research is

□ APPROVED □ APPROVE UPON REVISION □ REJECTED

Comments

129
........................................................................................................................................................................

........................................................................................................................................................................

........................................................................................................................................................................

........................................................................................................................................................................

Signature :
Name :
Date :

Section G: Approval by DVC, Academic Affairs & Research

Comments

........................................................................................................................................................................

........................................................................................................................................................................

........................................................................................................................................................................

........................................................................................................................................................................

Signature :
Name :
Date :

130
Budget

No. Item Value

1 Stationery RM 300

2 Transport RM 100

TOTAL RM 400

131
COMMUNITY SERVICE AT KAMPUNG TANAH LOT, WAKAF TAPAI. (28/2/17)

132