Research Article: Factors Affecting Dengue Prevention Practices: Nationwide Survey of the Malaysian Public

Date Published: April 2, 2015

Publisher: Public Library of Science

Author(s): Li Ping Wong, Sharina Mahavera Mohamad Shakir, Narges Atefi, Sazaly AbuBakar, Sheng-Nan Lu.


Efforts to stamp dengue in many dengue endemic countries has met little success. There is a need to re-examine and understand how the public at large view the dengue prevention efforts. This study aimed to examine the demographic factors, theoretical constructs of the Health Belief Model and knowledge about dengue and how these influence the practice of dengue prevention.

A national telephone survey was carried out with 2,512 individuals of the Malaysian public aged 18–60 years.

The majority (73%) of the Malaysian public had a total dengue prevention score of 51–100 (of a possible score of 1–100). Multivariate analysis suggests significant correlates of higher dengue prevention practices with demographic background, perception of susceptibility to dengue, perceived density of mosquitoes in the neighbourhood and knowledge about dengue. Households of lower income of which the majority (40.7%) were from the rural areas, were associated with the highest odds [OR = 1.33; 95%CI = 1.09–1.67; p = 0.004] of dengue prevention. Dengue prevention practices were also less likely to be undertaken in neighbourhoods where the responders perceived there is no and/or low density of mosquitoes. Dengue prevention practices are also less likely to be practiced by skilled workers [OR = 0.78; 95%CI = 0.63–0.95; p = 0.029] compared to those unemployed. Higher perceived susceptibility to dengue was associated with higher dengue prevention practices and participants with higher dengue knowledge were found to have a higher level of involvement in dengue prevention practices.

Results from the study suggest that in formulating approaches to contain dengue, strategies should be developed to cultivate dengue prevention practices among urban population and target areas with low density of mosquitoes where public perceived a less likely chance of getting dengue. Dengue prevention campaigns should focus on messages highlighting the risk of contracting dengue and education to increase knowledge about dengue.

Partial Text

Dengue is a mosquito-borne infection of particular health importance in Asia, the Americas and the Western Pacific. The infection has become endemic with frequent epidemic outbreaks [1] in many parts of the tropics and subtropical regions of the world. The World Health Organization (WHO) currently estimates there may be 50–100 million dengue infections worldwide every year including at least 500,000 dengue cases and 22,000 deaths, mostly among children. In Malaysia, dengue is endemic with frequent major outbreaks notably in urban areas [2]. Dengue is rated the most important communicable disease in Malaysia, superseding tuberculosis, malaria and HIV/AIDS [3]. The number of dengue cases reported was 21,900 in 2012 and 43,346 in 2013, representing an increase of over two fold in a one-year period [4]. As of August 2014, the number of suspected dengue cases has exceeded 60,000 proving to be the biggest outbreak yet of dengue in Malaysia.

Most of the participants of the study were aware that the Aedes spp. mosquitoes transmit dengue and a person with dengue may manifest symptoms including fever, joint and back pains, rashes and chills. However, only about one-third of the participants knew that dengue haemorrhagic fever usually occurs in people who had previous dengue infections. It was also found that less than half of the study participants were aware that there is no specific medication for the treatment of dengue. Therefore, it is recommended that dengue prevention educational programs should add focus on increasing the knowledge on symptoms of dengue including manifestation of severe dengue, unavailability of specific treatment for dengue and the importance of early detection of dengue.

The study revealed that households with lower income, unemployed and unskilled workers carry out more dengue prevention practices. Therefore, households with middle to higher income earners, most of whom live in urban areas, and skilled workers should form the main targets of active dengue prevention and control campaigns. Secondly, from the HBM, higher perceived susceptibility of contracting dengue is associated with higher dengue prevention practices. As perceived susceptibility influences prevention practices, education should be specific about vulnerability to dengue. Thirdly, neighbourhoods with no significant presence or low density of mosquitoes were less likely to practice dengue prevention. Thus, these areas need to be integrated into dengue prevention programs to highlight the importance of mosquito prevention and control despite the perceived low mosquito problems. Lastly, higher dengue knowledge leads to higher dengue prevention practices. Therefore, knowledge-based education campaigns will substantially increase dengue preventive practices in the community. In summary, the study provides useful insights and knowledge that could guide the relevant authorities and government officials in planning, designing and initiating programs and activities aimed at preventing and control of dengue.