CHAPTER IV KAP STUDY ON AEDES BORNE...

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Ph.D Thesis Mosquito fauna

CHAPTER IV

KAP STUDY ON AEDES BORNE

DISEASES

Chapter IV KAP study on Aedes borne diseases

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CONTENT

Chapter IV. KAP STUDY ON AEDES BORNE DISEASES

4.1 INTRODUCTION 169-183

4.1.1 Chikungunya 170

4.1.2 Dengue Fever 176

4.1.3 Vector mosquito 182

4.2 REVIEW OF LITERATURE 184-185

4.3 MATERIALS AND METHODS 186-197

4.4 OBSERVATIONS 198-231

4.4.1 Socio-economic-demographic profile of the respondents 198

4.4.2 Over-all level of Knowledge 204

4.4.3 Over-all level of Attitude and practice 214

4.4.4 Incidence of diseases 220

4.4.5 Association between socio-economic-demographic

profile and Over-all level of Knowledge 221


profile and Over-all level of Attitude and Practice 225

4.4.7 Association between level of Knowledge and

over-all level of Attitude and Practice 228

4.4.8 Association between incidence of disease and

over-all level of Knowledge 230




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4.5 DISCUSSION AND CONCLUSION 232-240

4.5.1 Socio-economic-demographic profile of the respondents 232

4.5.2 Over-all level of Knowledge 233

4.5.3 Over-all level of Attitude and practice 235

4.5.4 Incidence of vector-borne disease in the

study area (CG&DF) 236


profile and Over-all level of Knowledge 236


profile and Over-all level of Attitude and Practice 237

4.5.7 Association between level of Knowledge and



over-all level of Knowledge 239



4.5.9 Conclusions 240

GENERAL SUMMARY AND CONCLUSION OF THE STUDY 241-244


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4.1. INTRODUCTION

For the success of prevention and control of any vector-borne disease, the

most important prerequisite is community participation. Prevention of disease through

better education, knowledge, socio-economic condition and practice is the appropriate

way to keep disease away and remain healthy (Tyagi et al., 2005). Ignorance and

impoverished conditions of people contribute to creating vector breeding source and

spread of diseases and hinder disease control strategy (Wessen, 1972; Yaav et al.,

1999; Collins et al., 1997). Programme implementations need to understand the

disease related knowledge, attitude and practices of the population (Jane et al., 2002).

So the knowledge, attitude and practices of the community should be measured before

the implementation of a control programme. Deficiency, if any, should be

compensated for through proper awareness campaign. Prevention and control become

more effective when community has proper knowledge, attitude and practice

regarding disease and vector.

Knowledge, Attitude and Practice (KAP) study measures the Knowledge,

Attitude and Practices of a community. KAP Study tells us what people know about

certain things, how they feel and also how they behave. The knowledge possessed by a

community refers to their understanding of a given topic. The attitude refers to their

feelings towards this subject as well as any preconceived ideas that they may have had

towards it. The practice refers to the ways in which they demonstrate their knowledge


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and attitude through their actions. Thus KAP study is an educational diagnosis of the

community. Understanding the levels of Knowledge, Attitude and Practice will

expedite a more efficient process of awareness creation, as it will allow the program to

be tailored more appropriately to the needs of the community.

The purpose of KAP study is to assess the community level aspects of

epidemic or vector-borne diseases. Aedes-borne diseases such as DF and CG have

caused serious public health problem in Kerala, especially in rubber plantation belt. In

Kerala Ae.albopictus has been incriminated as the primary vector of DF and CG. In

the present study a sincere attempt has been made to understand the knowledge,

attitude and practice regarding Ae. albopictus mosquito and arboviral diseases such as

DF and CG among adult population of study area.

4.1.1. Chikungunya

CG is a mosquito-borne viral disease. The disease was observed for the first

time in 1952 in Tanzania. (Robinson, 1955; Lumsden, 1955). The name comes from

‘Makonde’ word which means “that which bend up” for walking with a stoop,

reflecting the posture of the person suffering from the disease. This virus has affected

millions of people in Africa, Southeast Asia since it was first reported. Sporadic cases

are regularly reported from different countries in the world. The outbreaks of CG virus

in many countries since 2005 are the most recent example to be cited. The recent

outbreaks appear to be the most severe and the biggest one caused by this virus within

the last 40 years (WHO, 2006 ; Schuffenecker et al., 2006).


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a. Origin

CG is believed to have originated in Africa (Brooks et al., 2004;

Schuffenecker et al., 2006) where it has maintained in sylvatic cycle involving

wild primates and forest dwelling Aedes mosquitoes. It was subsequently

introduced in Asia where it is transmitted from human to human by Aedes aegypti

and Aedes albopictus through an urban transmission cycle (Jupp and McIntosh,

1988).

b. Epidemiology

Since the Tanzanian outbreak in 1952, CG virus has caused outbreak in

different areas of Africa, Asia, and elsewhere. The most recent epidemic re-

emerged in Africa was documented in 1999-2000 in Kinshasa (Pastorino et al.,

2004). In Asia, epidemics have been documented in India, Srilanka, Myanmar,

Thailand, Indonesia, Philippines, Cambodia, Vietnam, Hong Kong and Malaysia.

(Sam and AbuBakar, 2006; Kamath et al., 2006). Since the beginning of 2005, CG

virus has emerged in the islands of the southwestern Indian Ocean. The outbreak

was first reported in Comoros in the beginning of the 2005 (Schuffenecker et al.,

2006; Paquet et al., 2006) . Later in the same year, the virus circulated to the other

islands and countries—Mayotte, Seychelles, Reunion and Mauritius, Madagaskar

and India.


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Fig. 4.1 Chikungunya affected states of India (Source NVBDCP)

India has a long history of CG. There was an outbreak of CG during 1963-

64 in Kolkata (Shah et al.,1964). Since its first isolation in Calcutta in 1963, there

have been several reports of CG virus infection in different parts of India, such as

Vellore, Chennai and Pondicherry in Tamil Nadu (Jadhav et al., 1965; Dandavate

et al.,1965; Thiruvengadam et al.,1965), Visakhapatanam, Rajahmundry and


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Kakinada in Andra Pradesh (Jupp and McIntosh,1988; Ravi, 2006; Yergolkar et

al., 2006). The last epidemic in India was reported from Barsi, Maharashtra in

1973 (Padbidri and Gnaneswar, 1979) when a morbidity of 37.5% was reported

from the whole town. CG virus had almost disappeared from India after 1973

and since then, no case had been reported till end of 2005 (Neogi et al., 1995;

Mourya et al., 2001). Recent reports of large scale outbreaks of fever caused by

CG virus infection in several parts of Southern India have confirmed the re-

emergence of this virus. (Enserink, 2006 ; Ravi,2006) The recent outbreak in

India started at the end of 2005 when cases of suspected fever were reported

from Andhra Pradesh and Karnataka (NICD, 2006; WHO, 2006). The initial

foci of the disease were reported from Hyderabad, Secundrabad and Anantput

district of Andra Pradesh. Several districts of Karnataka state such as Gulbarga,

Tumkur, Bidar, Raichur, Bellary, Chitradurga, Davanagere, Kolar and Bijapur

have also recorded large number of CG virus related fever cases. About 762026

suspected CG cases were reported from Karnataka during 2006. More similar

cases were reported from other states like Tamil Nadu, Kerala, Rajasthan,

Madhya Pradesh and Gujarat.

Since May-June 2006, Kerala has reported outbreaks of CG in some

localities of Kozhikode, Trivandrum, Ernakulam and Alappuzha districts. Soon

it spread to other districts, especially of central Kerala. Kottayam,

Pathanamthitta and Idukki districts showed a high incidence of CG in 2006. By

the end of 2006, all the 14 districts were affected. According to Directorate of


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Health Services Kerala, 70731 suspected cases were reported from Kerala in

2006 and 23052 in 2007. When the epidemic acquired a gigantic proportion, the

army’s medical wing was called in to assist the Kerala government mainly in its

cleanliness drives to tackle the mosquito borne viral disease. The number of

suspected cases reported from 2008 to 2011 was 24683, 11765, 11311 and 183

respectively. No death due to CG was officially reported (DHS Kerala, 2012).

c. Chikungunya Virus

Chikungunya is caused by an arbovirus, belonging to the genus

Alphavirus under the Togoviridae family. The virus is an RNA virus (Brooks et

al., 2004 ; Barrett and Weaver, 2002). The virus alternately affects vertebrates

and Arthropods. The transmission cycle of CG virus is characterized by a

periodicity of 3-4 years (Diallo et al., 1999). This silence is associated with the

development of immunity in animals. Vertical transmission has also been

reported in recent studies.( Schuffenecker et al., 2006; Weaver and Barrett,

2004)

d. Clinical features

Incubation period of disease lies between 1-12 days. Symptoms

generally develop after an incubation period of 4-7 days. The infected person

develop sudden onset of fever, severe headache, vomiting and severe arthalgia.

The symptom is less severe in children than in adults. Patients also have rashes

on the body. The rash is most intense on the trunk and the limbs. Migratory

polyarthritis usually affects the small joints. The joints of the extremities, in


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particular, become swollen and painful to the touch. In most cases the disease is

self-limiting and most symptoms disappear within 5-7 days. Occasionally other

complications may arise (Schuffenecker et al., 2006; Robinson, 1995; Paquet et

al., 2006). Although rare, the infection can result in Meningoencephalitis,

especially in newborns and those with pre-existing medical conditions.

Pregnant women can pass the virus to their fetus. Residual arthritis, with

morning stiffness, swelling and pain on movement may persist for weeks or

months after recovery. A full-fledged disease is most common among adults, in

whom the clinical picture may be dramatic. Severe cases of CG can occur in the

elderly, in the very young (newborns) and in those who are

immunocompromised. (NICD, 2006). Older patients usually continue to suffer

recurrent joint pain for several years. Deaths are very rare but have been

reported due to CG virus (Sarkar, et al., 1964)

e. Diagnosis

Chikungunya should be suspected when epidemic disease occurs with

the characteristic triad of fever, rash and rheumatic manifestations. The

definitive diagnosis can be made by laboratory means. The virus produces

neutralizing and Haemagglutination Inhibition (HI) antibodies and that helps in

making serological diagnosis. HI test is a simple diagnostic test, but it identifies

the group rather than the specific virus. IgM capture ELISA is the most

sensitive serological assay as it is vitally necessary to distinguish the disease

from DF. Virus-specific IgM antibodies may persist even for more than 6


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months. All patients will be positive by 5 to 7 day of illness. Reverse

Transcriptase Polymerase Chain Reaction is confirmatory for the identification

of virus (Brooks et al., 2004; Barrett and Weaver, 2002)

f. Treatment

The disease is self-limiting. There is no specific treatment or vaccine for

CG. Treatment is mostly supportive (bed rest, fluids) and symptoms may be

treated with analgesics and some antipyretics. Movement and mild exercise

tend to reduce stiffness and morning arthralgia, but heavy exercise may

exacerbate symptoms. Some cases may require hospitalization and appropriate

management is done for the complications. (Schuffenecker et al., 2006;

Vanlandingham et al., 2005). People affected by virus should be protected from

further mosquito bites to avoid further transmission.

4.1.2 Dengue Fever

Dengue Fever is a human disease caused by a virus and transmitted

amog human by infected mosquitoes. Dengue Fever (DF) and its severe

forms—Dengue Haemorrhagic Fever (DHF) and Dengue Shock Syndrome

(DSS)—have become major international public health concerns. Over the past

three decades, there has been a dramatic global increase in the frequency of DF,

DHF and DSS and their epidemics, with a concomitant increase in disease

incidence. It occurs commonly in tropical and subtropical regions of the world,

predominantly in urban-suburban areas. It is the most important arboviral

disease of humans, affecting 50-100 million persons annually (Gubler, 2000).


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a. Origin

The first epidemic of dengue was recorded in 1635 in the French West

Indies, although a disease outbreak compatible with dengue had been reported

in China as early as 992 AD (Howe, 1997; Gubler, 1997). During the 18th, 19th

and early 20th centuries, epidemics of dengue-like diseases were reported and

recorded globally, both in tropical as well and temperate regions.

b. Epidemiology

Dengue fever has a wide distribution in the tropical and subtropical

areas of the world, with over 2.5 billion people living in dengue endemic areas

(Halstead, 1980, Rosen, 1982). The currently known geographical distribution

of the various dengue virus serotypes reflects the development of

hyperendemicity in most tropical areas of the world in the past 15-20 years. In

1997, DF/DHF has been the most important arboviral disease of humans, with

an estimated 50 to 100 million cases of DF and several hundred thousand cases

of DHF occurring each year, depending on epidemic activity (Monath, 1994).

Currently, DHF is a leading cause of hospitalization and death among children

in many south-east Asian countries where epidemics first occurred in the 1950s

(WHO, 1986). Epidemic DHF spread to the South Pacific islands in the 1970s,

and reached the Caribbean Basin in the 1980s (Gubler, 1987). The pattern of

severe haemorrhagic disease has evolved in the American region in the 1980s

and 1990s in a manner similar to the way it did in south-east Asia in the 1960s

and 1970s (Gubler, 1987,1993).


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Fig. 4.2 Dengue affected states of India (Source NVBDCP)

Dengue/DHF is an emerging public health problem in India. With the advent

of methods for viral isolation and serological techniques in India all the four serotypes

of dengue virus have been extensively reported since 1956 from various parts of the

country. The major outbreak of DF accompanied by dengue haemorrhagic fever was

reported in Calcutta in 1963. More than sixty outbreaks have been reported since then.

However, the disease became more frequent during the last two decades. These

outbreaks have assumed significance on account of their severity, frequency of

occurrence, clinical profile and mortality. For example, during 1996, a serious

outbreak occurred in Delhi and caused 10252 hospitalization and 423 deaths. At

present almost all the states of the country run the risk of being afflicted with DF.


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Fig. 4.3 Map of Kerala state showing Dengue and Chikungunya prone areas


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In Kerala, DF was first appeared in 1997 when 14 suspected cases with

4 deaths were reported from Kottayam district. This was followed by an

outbreak with 67 cases with 13 deaths in the same district in 1998. By 2001, DF

which was confined to Kottayam district, spread to neighbouring districts like

Ernakulum and Idukki. Sixteen cases were reported from these districts (DHS

Kerala, 2005), followed by 219 cases in 2002 with some death in the state. The

year 2003 experienced a severe epidemic yielding 3546 confirmed cases and a

toll of 68 lives, spread for the first time all over the Kerala’s fourteen districts.

(ICMR, 2006). Since then, DF cases reports became a routine affair in all the

fourteen districts in Kerala.

c. Dengue Virus

Dengue is caused by Dengue virus (DENV). It is a single stranded RNA

positive-strand virus of the family Flaviviridae, genus Flavivirus. Human

dengue can be caused by four distinct serotypes- DEN-1, DEN-2, DEN-3, and

DEN-4. The four dengue serotypes are sufficiently different that infection with

one type does not provide immunity for infection with the others.

d. Clinical features

Dengue virus infection causes a spectrum of illness ranging from

inapparent or mild febrile illness to severe and fatal haemorrhagic disease.

Clinical presentation in both children and adults may vary in severity,

depending on the strain and serotypes of the infecting virus, and the immune

status, age and the genetic background of the patient. However classical DF is


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characterized by a sudden onset of fever and one or more of a number of non-

specific signs and symptoms such as severe headache, backache, joint pains,

nausea and vomiting, eye pain, and rash. (WHO, 1986; Gubler, 1988; Siler et

al., 1926). Generally, younger children are more affected than older children

and adults. Anorexia, queer taste sensation and mild sore throat are not

uncommon. Clinical laboratory findings associated with DF include leukopenia,

and in some patients thrombocytopenia and elevated liver enzymes.

Dengue hemorrhagic fever is characterized by a fever that lasts from 2

to 7 days, with general signs and symptoms that could occur with many other

illnesses (e.g., nausea, vomiting, abdominal pain, and headache). The critical

stage in DHF occurs when the patient develops a capillary-leak syndrome, with

signs of circulatory failure and haemorrhagic manifestations such as skin

haemorrhages, bleeding nose or gums, and possibly internal bleeding.

Thrombocytopenia (<100 000/mm3) and elevated haematocrit are prominent

features. DHF can be a very dramatic disease with the patient’s condition

deteriorating very rapidly with the onset of shock and resulting in death if the

plasma leakage is not detected and corrected with fluid replacement therapy.

Leukopenia, thrombocytopenia and haemoconcentration are constant findings;

hepatomegaly and elevated liver enzymes are common.

e. Diagnosis

The diagnosis of DF is usually made when a patient exhibits the typical

clinical symptoms of headache, fever, eye pain, severe muscle-aches and rash.


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f. Treatment

Because dengue is caused by a virus, there is no specific medicine or

antibiotic to treat it, the only treatment is to treat the symptoms. For typical

dengue, the treatment is purely concerned with relief of the symptoms

(symptomatic). Rest and fluid intake for adequate hydration is important.

4.1.3 Vector Mosquito

a. Characteristics and behaviour

Ae.albopictus acts as the primary vector of DF and CG in Kerala.

Epidemics are sustained by human-mosquito-human transmission.

Characteristics of the vector are detailed in the chapter 3. The species is a peri-

domesticated one and all its biological activities like breeding, resting, feeding,

mating and oviposition are confined around human dwelling, within a radius of

100 meters. These mosquitoes usually breed in clean water collections in

containers, tanks, disposables, tree holes, junk materials in peri-domestic

situations. Rainfall influences the seasonal pattern of the species. Asian tiger

mosquitoes occur in urban, suburban and rural regions. They can also exist in

woodlands, particularly on the outer fringes close to human settlements. The

Asian tiger mosquito bites during the day time, mostly during the morning and

early evening. Depending upon region and biotype there are differing active

peaks (WHO,1999).


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b. Vector Control

Both larval and adult control measures are recommended for reducing

the vector population density. However, breeding source reduction is the best

method for Aedes control. Specific measures for controlling larvae of Aedes

mosquito are detailed in chapter 3. Adult mosquitoes can be controlled by

outdoor chemical spray around the houses; however, larval control is more

economical and provides sustainable control.


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4.2. REVIEW OF LITERATURE

4.2.1. KAP studies

Participation and co-operation of population is essential to the

implementation of control activities. Studies pertaining to knowledge, attitude and

practices showed that direct interaction with community played an important role

in controlling many mosquito borne diseases (Collin et al., 1997; Singh et al.,

1998). Van Benthem et al., (2002) observed that people with knowledge of dengue

had a significantly higher use of preventive practices than people without

knowledge of Dengue.

Abedi et al., (2011) conducted a cross sectional study in Aligarh, India, to

asses knowledge, attitude and preventive practices on dengue. A significant

positive correlation was found between knowledge and practice, but no significant

correlation was found between attitude and knowledge and attitude and practice.

The results have suggested that good attitude does not translates into good

practices, therefore, health promotion activities should be strengthened for

improving knowledge, so as to ensure that people are receptive to the messages

and make it easier for them to adopt desired change of behaviour.

A study from Cameroon showed that poor knowledge of disease

transmission led to incorrect methods of preventive measures. A good percentage

of respondents practised incorrect malaria preventive measures. Prevention of


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disease was consistent with the educational status of the participants (Dickson et

al., 2011)

Itrat et al., (2008) conducted a hospital based study to assess the level of

knowledge, attitudes and practices regarding DF in adult population Karachi,

Pakistan. This study showed that literate individuals were relatively more well-

informed about DF as compared with the illiterate people. However knowledge

based upon preventive measures was found to be predominantly focussed towards

prevention of mosquito bites rather than eradication of mosquito population.

Koenraadt et al., (2006) observed a positive correlation between knowledge

of Dengue prevention and source elimination practice. The study also reported that

no relationship existed between knowledge of DF and adult mosquito reduction

practices.

Matta et al., (2006) conducted a hospital based KAP on DF in Delhi.

Though knowledge regarding dengue transmission, breeding ground, etc was good

among the respondents, practices for the elimination of breeding sites were not

commendable.

Kumar and Gururaj (2005) conducted a KAP study on mosquito borne

diseases in Karnataka and showed that many people were unaware of the breeding

sites of mosquito. Similarly one third of the respondents did not know any

preventive measures against mosquitoes at community level.


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Because of the small number of KAP studies and conflicting results,

relationships among demographic factors, knowledge, practices, and mosquito

infestation are not well understood in countries like India. A better understanding

of how these factors interact to create patterns of behaviour, mosquito infestation,

and disease exposure risk would be valuable in creating more effective awareness

campaigns and source eradication programme. Despite the magnitude of vector-

borne diseases, no documented evidence exists on the KAP of people of Kerala,

especially in respect to Aedes mosquitoes. In the present study an attempt has been

made to understand the knowledge, attitude and practice regarding Aedes mosquito

among the adult population of Kerala.

4.2.2. Objectives

The broad objective of the study was to understand Knowledge, Attitude and

Practice (KAP) of people regarding Ae.albopictus and Ae. albopictus-borne

diseases such as DF and CG. The specific objectives were:-

1. To analyse the socio-economic-demographic profile of the respondents.

2. To study the Over-all Level of Knowledge of respondents about Ae.

albopictus and Ae. albopictus –borne diseases (CG&DF).

3. To study the Over-all Level of Attitude and Practice of respondents

about disease prevention and control

4. To record the extent of incidence of Ae. albopictus –borne diseases in the

study area.


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5. To study the association of socio-economic-demographic status with the

over-all level of knowledge about Ae. albopictus and Ae. albopictus -

borne diseases (CG&DF)..

6. To study the association of socio-ecnomic-demographic status with the

over-all level of attitude and practice about disease prevention and control

7. To study the association between over-all level of knowledge and over-all

level of attitude and practice regarding disease prevention and control.

8. To correlate the association of incidence of disease with the over-all level

of knowledge about Ae. albopictus and Ae. albopictus - borne diseases

(CG&DF)..

9. To correlate the association of incidence of vector-borne disease with the

over-all level of attitude and practice regarding disease prevention and

control.


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4.3. MATERIALS AND METHODS

4.3.1 Study area and population

Mundakayam Panchayat, belonging to Kanjirappally taluk of Kottayam

district was selected for the present Study (Fig 3.1). Selection of study area was

purposive, based on the previous history of vector borne diseases and the

panchayat being a rubber plantation area. Kanjirappally is popularly known as the

capital of rubber production in India. In Kerala Dengue Fever was first reported

from this Panchayat. Heavy incidence of CG was experienced in 2006 and 2007.

Mundakayam panchayat belonging to Kanjirappally taluk of Kottayam

district was selected for the KAP Study. Mundakayam is located 55 kms east of

Kottayam district headquarters and situated on latitude 9°33’ N a longitude 76 °53’

E. Panchayat has an area of 82 sq.km. and divided into 20 wards (at the time of

study). (In 2005 Panchayat was divided and formed Koruthoodu Panchayat). It is

bordered by Kanjirappally, Parathode, Koruthoode and Erumely panchayats. As of

2001 India census, Panchayat has a population of 47987 and has an average

literacy rate of 94 %. There are 12260 households within the panchayat limitan

and population density is 580. Mundakayam is a highland area and is a gateway to

the highrange. Rubber plantation is the main source of income. Besides some

estates (above 20 hectare), rubber plantation in this area is mainly owed by small

scale farmers (mostly below 2 hectare per owner) (Mundakayam Panchayat,2008).


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4.3.2. Study design and Sampling technique

A cross sectional study was conducted between May 2010 and July 2010 in

the selected site. A house was considered as a unit for the survey and every 10th

house was selected for the study. The nearby house was considered in case of any

inconvenience. Thirty houses each were sampled from 7 randomly selected wards.

Thus a total of 210 houses were surveyed during the present study. People above

the age 18 (adults) were considered for the survey. Before the survey a verbal

consent for a face to face interview was sought from the eldest available member

of the family. The purpose of the study was also intimated. The medium of

communication was Malayalam. At the end of the interview each respondent was

given sufficient clarification and other information regarding vector characteristics,

preventive measures, breeding source eradication, etc. The information given by

each respondent was kept confidential.

4.3.3. Research Tool

The survey was based on a self-prepared pre-tested structured questionnaire

consisting of 30 questions, which was intended to collect data regarding basic

demography, knowledge regarding CG and DF, vector characteristics, personal

preventive and source reduction practices (Appendix-III). As no suitable

readymade questionnaire was available, it was prepared based on the literature and

under the supervision of entomologists and epidemiologists of various institutions.

Self prepared questionnaire was pretested among 40 people and made necessary

changes before the administration of the questionnaire.


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Questions in the questionnaire were grouped into 7 categories as follows:

Category 1 – Socioeconomic- demographic profile

This category contained 6 questions (Question 1 to 6), which were intended

to collect data regarding basic demographic profile of the study population, such as

age, sex, education, occupation and financial background. A single question on

source of information was also included in this category.

Category 2 – Knowledge regarding CG

There were 6 questions (Question 7 to 12) in this category and were asked

to assess the knowledge of the respondent regarding various aspects of CG such as

awareness of CG, causative parasite, symptoms, mode of transmission, vector and

possibility of causality due to CG.

Category 3 – Knowledge regarding DF

This category contained 6 questions (Question 13 to 18) and was intended

to gauge the knowledge of respondent regarding awareness of DF, causative

parasite, symptoms, mode of transmission, vector and possibility of causality due

to DF.

Category 4 – Knowledge regarding vector mosquito

This section contained 4 questions (Question 19 to 22). These questions

were framed to collect information regarding vector characteristics such as biting

time, feeding preference, breeding sites and their ability to identify the Aedes.


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Category 5 – Personal preventive practices against vector biting

There were only two questions in this part (Question 23 and 24) and were

designed to know the personal preventive practices of respondents against Aedes

biting.

Category 6 – Attitude and practice towards vector control and treatment

This category included questions related to the attitude and practice of

respondents towards source reduction and diseases treatment. There were 5

questions in this section (Question 25 to 29). The first one asked the respondents to

select the best mosquito control measure. The second and third questions were

included to measure the attitude and participation of respondent towards mosquito

control measures. The fourth question was peculiar and not put to the respondent.

Instead the interviewer observed the premises for positive larval containers. The

fifth question was pertaining to the source of treatment in the case diseases

Category 7 – Incidence of vector borne disease (CG&DF)

The single question of this category (Question 30) asked the respondent

whether there was any incidence of DF/CG in the past or present.

4.3.4. Analysis of Data

Collected data was entered in a computer and analysed by using Statistical

Package for Social Science (SPSS) software version 17. The analysis was done at

3 stages. The objective of the first stage was to summarise the response of


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participants. Descriptive statistics (frequency, percentage) were used to summarize

the responses to each question. Summarised data is presented in suitable tables .

In the second stage the over-all level of knowledge of respondents about

the Ae.albopictus and Ae.albopictus -borne disease and over-all level of attitude

and practice regarding the disease prevention and control was calculated. One

score was assigned to each correct response while zero for inappropriate response

to a question. For multiple response questions the score (one) was equality divided

among the correct choices, wherever appropriate.

A. Calculation of over-all level of knowledge of respondents about the

Ae.albopictus and Ae.albopictus-borne disease

Before calculating the over-all level of knowledge about the Ae.albopictus

and Ae.albopictus-borne disease, knowledge level of respondent regarding CG

(category 2), DF (category 3) and Aedes vector (category 4) was measured

separately. Total score of a respondent in each category was calculated by adding

the score of individual question falling in that category. The minimum possible

score for any respondent was zero while maximum possible score varied with

number of question in each category. Based on the points scored respondents were

divided into three levels- low, moderate and high. Cut off score was determined

arbitrarily by dividing the maximum score by three. Score less than 1/3(upto 33.33

% of the total) of the total score forms the low level, those higher than 2/3 (above

66.66% of the total) of the total score forms the high level and score in between

these two scores (above 33.33 &below 66.66 of the total) forms the moderate level.


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i. Calculation of level of knowledge regarding CG (Category 2 )

The maximum possible score under this category is 6 (sum of the scores of

all the 6 questions). So the score secured by any respondent varied from 0 (possible

minimum) to 6 (possible maximum) points and were grouped into 3 levels as

follows:

Level of knowledge Score range

Low level (upto33.33%) - 0 to 2 score

Moderate level (between l33.33% & 66.66%) - 2.1 to 4 score

High level (above 66.66%) - 4.1 to 6

ii. Calculation of level of knowledge regarding DF (Category 3)

The maximum possible score under this category is 6 (sum of the scores of

all the 6 questions). So the score secured by any respondent varied from 0

(Possible minimum) to 6 (possible maximum) points and were grouped into 3

levels as follows:


Low level(upto33.33%) - 0 to 2 score

Moderate level(between l33.33% & 66.66%)- 2.1 to 4 score

High level(above 66.66%) - 4.1 to 6


194


iii. Calculation of level of knowledge regarding vector mosquito (Category 4)

For multiple response questions the score was equally divided among the

correct choices. The score varied from 0 to 4 points and were grouped into 3 levels

as follows:


Low level(upto33.33%) - 0 to 1.3 score

Moderate level(between l33.33% & 66.66%)- 1.4 to 2.6 score

High level (above 66.66%) - 2.7 to 4 score

Knowledge level of respondents regarding CG and DF was compared.

For the calculation of over-all level of knowledge of respondents about the

Ae.albopictus and Ae.albopictus-borne disease, responses to category 2

(knowledge regarding CC), category 3 (knowledge regarding DF) and category 4

(knowledge regarding vector mosquito) was considered together. The minimum

possible score for any respondent was zero while maximum possible score was 16

(as there were 16 questions under the above 3 categories). Based on the points

scored respondents were divided into three levels- low, moderate and high. Cut off

score was determined arbitrarily by dividing the maximum score (16) by three.

Score less than 1/3 (upto 33.33 % of the total 16) of the total forms the low level,

those higher than 2/3 (above 66.66% of the total 16) of the total score forms the

high level and score in between these two scores (above 33.33 & below 66.66 of

the total 16) forms the moderate level, as follows:


195


Over-all level of knowledge Score range

Low level (upto33.33%) - 0 to 5.30 score

Moderate level (between l33.33% & 66.66%) - 5.31 to 10.6 score


B. Calculation of over-all level of attitude and practice about disease

prevention and control

Over-all level of attitude and practice about disease prevention and control was

calcualated from the responses aginst category five and six.

i. Level of personal preventive practices against vector biting (Category 5 )

First question of this category is multiple response type with two correct

answers. Any one of these responses was sufficient to take protection against

mosquito bite. So score of one was assigned for either or both responses. The total

scores of this category varied from 0 to 2 and were divided into 3 levels as follows:

Level of attitude and practice Score range





196


ii. Level of attitude and practice towards vector control and treatment

(Category 6 )

There were 5 questions in this section. For assessing knowledge level one

score was assigned to each suitable response and zero for inappropriate response to

a question.

Level of attitude and practice Score range




For the calculation of over-all level of attitude and practice of respondents

about the disease prevention and control, responses to category 5 (personal

preventive practices against vector biting), and category 6 (vector control and

treatment) was considered together. The score varied from 0 to 7 points and were

grouped into 3 levels of practice as follows:

Over-all Level of Attitude and Practice Score range .

Poor (upto33.33%) - 0 to 2.3 score

Fair (between l33.33% & 66.66%) - 3.4 to 4.6 score

Healthy (above 66.66%) - 4.7 to 7 score

Mean, Standard Deviation, Minimum and Maximum scores were also

determined for each category.


197


Finally, association between socio-economic-demographic profile and

over-all level of knowledge; association between socio-economic-demographic

profile and over-all level of attitude and practice regarding disease preventive

practices were analysed and presented in a graspable and comprehensible manner.

Similarly association between over-all level of knowledge and over-all level of

preventive practices were analysed. Association between incidences of disease and

over-all level of knowledge; association between incidences of disease and over-all

level of preventive practices were also measure. Chi-squire was used to find out

the significance of association.


198


4.4. OBSERVATIONS

The collected data was processed using suitable statistical tools and

presented in the form of tables and graphs. The data regarding Socio-economic-

demographic profile of the respondents, knowledge on CG, DF and Ae.albopictus,

attitude and practice regarding personal protection and vector control, association

of socio-demographic status with overall level of knowledge and overall

preventive practices, association between overall knowledge and overall preventive

practices and finally association of incidence of diseases with overall level of

knowledge and with overall prevention are provided in the following part of the

chapter.

4.4.1 Socio-economic-demographic profile of the respondents

The present study was conducted among 210 households of Mundakayam

panchayt of Kottayam district. Socio-economic-demographic profile of the

participants is given in the table 4.1. The age of the respondents varied from 18 to

75. The majority of respondents belong to the age group 46-60 (36.7%) and 31-45

(35.2%) (Fig 4.4). Males constituted the major respondents and formed about 66%

of the total (Fig 4.5). Respondents were well-educated - 31% had secondary

education while 23.3 % had higher secondary education (Fig 4.6). The people of

study area were engaged in various occupations. Agriculture/rubber plantation was

the major occupation of the people (23.5%). 20% of the respondents were busy

with house hold activities, especially female. Business men, government


199


employees, private employees, daily wages, students, retired person, self employed

and other categories of peoples come under the survey (Fig 4.7). 72.4 % of

respondents were financially sound and belonged to the Above Poverty Line

(APL).

Table 4.1. Socioeconomic-demographic profile of the respondents

Sl No Variable Number Percentage

4.1.1 Age 18 - 30 39 18.6

31 - 45 74 35.2

46 - 60 77 36.7

60 + 20 9.5

Total 210 100.0

Variable Number Percentage

4.1.2 Sex Male 140 66.7

Female 70 33.3

Total 210 100.0


4.1.3 Education Primary 26 12.4

Middle school 24 11.4

Secondary 65 31.0

Higher secondary 49 23.3

Graduate 36 17.1

Post graduate 10 4.8

Total 210 100.0


200



4.1.5 Financial

background

APL 152 72.4

BPL 58 27.6

Total 210 100.0


4.1.4 Occupation Business 13 6.1

Govt employee 15 7.1

Pvt employee 10 4.8

Plantation/agriculture 49 23.3

Daily wager 24 11.4

House hold 42 20.0

Student 10 4.8

Retired 1 0.5

Self employed 14 6.7

Others 32 15.2

Total 210 100.0


201


Variable Number* Percentage

4.1.6 Source of information TV 184 35.0

News paper 174 33.1

Radio 108 20.5

Journal/magazine 40 7.6

Others 16 3.0

None 4 0.8

Total 526 100

*multiresponses

Among the respondents, over 90% received a good deal of information

from audio-visual and press media. Television and News papers were the most

frequently referred sources of information on vectors and vector-borne diseases

(Fig 4.9).

0

10

20

30

40

50

60

70

80

90

18 - 30 31 - 45 46 - 60 60 +

Per

cent

age

Age group

Fig. 4.4 Age wise distribution of respondents


202


66.7

33.3

Fig. 4.5 Sex wise distribution of respondents

Male

Female

0

5

10

15

20

25

30

35

Primary Middle school

Secondary Higher secondary

Graduate Post graduate

Per

cent

age

Fig 4.6 Education level of respondents

Education


203


0

5

10

15

20

25

Per

cent

age

Fig 4.7 Occupation of respondents

Occupation

72%

28%

Fig 4.8 Financial back ground of respondents

APL

BPL


204


4.4.2. Over-all Level of Knowledge of respondents

Before assessing the over-all level of knowledge about the Ae.albopictus

and Ae.albopictus-borne diseases (CG&DF), knowledge level of respondent

regarding CG (category 2), DF (category 3) and Aedes vector (category 4) was

measured separately.

a. Knowledge of respondents about Chikungunya (CG)

This category comprised 6 questions which were intended to collect

information concerning CG. The details of responses are given in the table 4.2. All

the respondents had heard of a disease called CG. A good proportion of

respondents (38%) knew that virus is the causative agent of CG. The majority were

0

5

10

15

20

25

30

35

40

Per

cent

age

Fig. 4.9 Sources of information


205


aware of the major symptoms of CG. Fever was the most frequently mentioned

symptom, followed by joint pain, rash, vomiting and head ache. 98.1% of

respondents correctly identified mosquito bites as the mode of transmission of CG.

However, majority failed to specify the type of mosquito responsible for CG

transmission. 45% of respondents correctly identified Aedes as the vector for CG.

Over 50% considered CG as a cause of death.

Table4.2 Knowledge of respondents about Chikungunya

Variable Number Percentage 4.2.7 Awareness on

Chikungunya

Yes 210 100.0

Variable Number Percentage 4.2.8 Parasite of CG Virus 80 38.1 Bacteria 6 2.9 Worms 3 1.4 Protozoa 3 1.4 Don’t know 118 56.2 Total 210 100.0


4.2.9 Symptoms CG Fever 144 36.5

Head ache 19 4.8

Joint pain 124 31.0

Rash 52 13.0

Vomiting 34 8.6

Others 4 1.0

Don’t know 17 4.3

Total 394


206



4.2.10 Mode of

transmission of CG

Mosquito bite 206 98.1

Personal contact 1 .5

Air borne 2 1.0

Don’t know 1 .5

Total 210 100.0


4.2.11 Name of the

CG vector

Aedes 95 45.2

Anopheles 4 1.9

Culex 3 1.4

Don’t know 108 51.4

Total 210 100.0


4.2.12 Death by CG Yes 106 50.5

No 92 43.8

Don’t know 12 5.7

Total 210 100.0

Table 4.3 Knowledge Level of respondent regarding CG

Level Number Percentage

Low level (0-2) 4 1.9

Moderate level (2.1-4) 137 65.2

High level (4.1-6) 69 32.9

Total 210 100.0

Mean=3.6 S. D =0.87 Min. 1.4 Max.5.8


207


Level of knowledge of study population was calculated based on the

response of the participants (Table 4.3). About 65% of respondents had moderate

level of knowledge while 32.9% had a high level of knowledge. The mean score of

respondents regarding CG was 3.6 with a standard deviation of 0.87. Minimum

score secured by any respondent was 1.4 and maximum was 5.8.

b. Knowledge of respondents about Dengue Fever (DF)

This section contains 6 questions pertaining to DF. Details of the

knowledge of the participants regarding dengue Fever are given in the table 4.4.

Over 10 % of respondents were unaware of a disease called DF. Similarly the

majority (71%) were unaware of the causative agent of the disease. Fever was

reported as the major symptom. Bleeding, vomiting, body pain, rash etc were the

other symptoms reported in the order. The majority (81%) considered mosquito as

the vector. However, only 25.7% knew that Aedes was the mosquito that spread

the disease. The majority of respondents considered dengue as the prime cause of

death.

Table 4.4 Knowledge of respondents about Dengue Fever

Variable Number Percentage 4.4.13 Awareness of

DF Yes

188 89.5

No 22 10.5 Total 210 100.0


208



4.4.14 Parasite of DF Virus 40 19.0 Bacteria 10 4.8 Worms 9 4.3 Don’t know 151 71.9 Total 210 100.0

Variable Number Percentage 4.4.15 Symptoms of DF

Fever 114 41.9

Bleeding 36 13.2 Body pain 12 4.4 Rash 8 2.9 Vomiting 28 10.3 Don’t know 67 24.6

Others 7 2.6

Total 272

100.0


4.4.16 Mode of transmission of DF

Mosquito bite 149 71.0 Contaminated food 10 4.8 Air borne 13 6.2 Don’t know 38 18.1 Total 210 100.0


4.4.17 DF vector Aedes 54 25.7 Culex 6 2.9 Anopheles 5 2.4 Don’t know 140 66.7 Others 5 2.4 Total 210 100.0


209



4.4.18 Death by DF Yes 119 56.7 No 23 11.0 Don’t know 68 32.4 Total 210 100.0

Table4.5 Knowledge level of respondent regarding Dengue Fever

Level N %

Low level (0-2) 80 38.1

Moderate level (2.1-4) 88 41.9

High level (4.1-6) 42 20.0

Total 210 100.0

Mean=2.7 S. D =1.4 Min. 0.0 Max.5.4

Around 42% of respondents had moderate level of knowledge while 38%

had a low level of knowledge (Table 4.5). The score varied from zero to 5.4. Mean

score was 2.7 with a standard deviation of 1.4. espondents posess some efficiency

in the level of knowlwdge of DF when compaired with CG (Fig 4.10).

c. Knowledge of respondents about vector of CG&DF

A major proportion of respondents (62%) knew that vector mosquito is a

day biter while 28.6% consider them as night biters. Nearly 60% reported that

vector mosquito prefer to bite outdoor. The respondents had a good knowledge of

the breeding habitat of vector mosquito. They considered containers as the major

site of breeding. Latex collecting cup was the most frequently referred habitat,

followed by discarded coconut shells, plastic containers, metallic containers, tyre


210


etc. Nearly 10% responses favoured plant axils as the potential breeding site.

More than half of the respondents could identify the vector mosquito from the

mosquito sample shown to them. Details of the response of the people regarding

vector mosquito are given in the table 4.6

Table 4.6 Knowledge of respondents about vector of CG&DF


4.6.19 Mosquito biting time Day time 131 62.4 Night time 60 28.6 Any time 19 9.0 Total 210 100.0


4.6.20 Preference for feeding

Out door 124 59.0 Indoor 66 31.4 Indoor and out door 20 9.5 Total 210 100.0

Variable Number* Percentage 4.6.21 Aedes breeding site Latex collecting cups 186 35.5 Coconut shell 102 19.5

Drains/canals 42 8.0

Plastic/metallic container 56 10.7

Safety tank 44 8.4

Plant axils/tree hole 20 3.8

Tyre 32 6.1

Cattle shed 41 7.8

Others 1 0.2

Total 524 100.0


211



4.6.22 Ability to identify

the Aedes mosquito

Identified 119 56.7

Not identified 91 43.3

Total 210 100.0

Table 4.7 Knowledge Level of respondents regarding Vector mosquito

Level Number %

Low level (0-1.3) 63 30.0

Moderate level (1.4-2.6) 68 32.4

High level (2.7-4) 79 37.6

Total 210 100.0

Mean=2.15 S. D =1.2 Min. 0.0 Max.3.8

As per the table above (4.7), 37.6 % had a high level of knowledge while

32.4 had a moderate level. The mean score of respondents regarding vector was

2.15 with a standard deviation of 1.2. the minimum score found to be zero and the

maximum was 3.8 (Fig 4.11).

Ph.D Thesis

.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

perc

enta

ge

Fig 4.10 Comparison of level of knowledge of respondents

30.0

.0

5.0

10.0

15.0

20.0

25.0

30.0

35.0

40.0

Low level

Per

cent

age

Fig 4.11 level of knowledge of aedes vector

KAP study on Aedes borne diseases

CG DF


30.032.4

37.6

Low level Moderate level High level

Fig 4.11 level of knowledge of aedes vector


212

Mosquito fauna


Low level

Moderate level

High level

Aedes vector


213


For the calculation of the over-all level of knowledge of respondents about

the Ae.albopictus and Ae.albopictus-borne disease, responses to category 2

(knowledge regarding CC), category 3 (knowledge regarding DF) and category 4

(knowledge regarding vectorof CG&DF) was analysed together (Table 4.8)

Table 4.8 Overall level of knowledge regarding Ae.albpictus and Ae.albopictus-borne diseases(CG&DF)

Level No. %

Low level (0 to 5.30 score) 20 9.5

Moderate level (5.31 to 10.6 score) 148 70.5

High level (10.7 to 16 score) 42 20

9.5

70.5

20

0

10

20

30

40

50

60

70

80

Low level Moderate level High level

perc

enta

ge

Fig 4.12 Over-all level of Knowledge regarding Ae.albpictus and Ae.albopictus-borne diseases (CG&DF)

Knowledge level


214


Less than 10% of respondents had a low level of knowledge as per the

given criteria while over 70% had a moderate level and 20% had a higher level of

knowledge (Fig 4.12)

4.4.3 Over-all Level of Attitude and Practice of respondents

a. Personal protective practices

In the questionnaire, there were two questions related to personal protective

practices against mosquito bite. The table 4.9 gives a clear picture of preventive

practices adopted by the respondents of the study area. Everybody practised one or

more types of preventive measures. Many of these practices were used at night and

indoor situations so they were not suitable against Aedes. Use of fan was the most

frequently referred choice for protection from mosquito bite, followed by mosquito

repellents, closing the doors and windows of houses etc. Some considered that

proper clothing and mosquito creams applied on body would protect against

mosquito bite. The period for which preventive measures were adopted varied. The

majority (46.6%) of the respondents were cautious during outbreak season while

30.5% followed preventive practices throughout the year.

Table 4.9 Personal protective practices

Variable Number* Percentage 4.9.23 Protection from

mosquito bite Mosquito net 49 8.2

Coil/mat/liquid 118 19.8

Proper clothing 8 1.3

Mosquito proof house 5 0.8

Fan 147 24.6


215


Body cream 23 3.9

Close door 117 19.6

Bat 59 9.9

Smoking 68 11.4

Others 3 0.5

Total 597 100.0


4.9.24 Timing of

preventive

measures

Rainy/biting season 42 20.0

Disease outbreak season 100 46.6

Throughout the year 64 30.5

Others 4 1.9

Total 210 100.0

Table 4.10 Level of personal protective practice against mosquito bite

Level No. %

Poor practice (0) 127 60.5

Fair practice (1) 71 33.8

Healthy practice (2) 12 5.7

Total 210 100.0

Mean =0.45 S.D=1.1 Min =0.0 Max 2

Around 60% of respondents followed a poor practice against Aedes bite

whereas 33.8 followed fair practices. Only 5.7 knew the correct preventive

measures against Aedes bite. The mean score for personal preventive practice was

found to be 0.45 with a standard deviation of 1.1. The minimum score was zero

and maximum score was 2.(Table 4.10)


216


b. Vector control and treatment.

Vector control is the most important methods for preventing vector

borne diseases. Positive attitude and good practice of people are crucial in its

success. To understand the attitude and practice of respondents towards

mosquito control measures, four questions were included in this section. A fifth

question related to treatment practice was also included. The responses of

people towards various questions are summarized in the table 4.11. Over 30 %

believed in application of chemicals against adults as the best method. Over 55

% of the respondents knew that source reduction is the best method for

mosquito control. While 54% believed that mosquito control is the primary duty

of the resident himself, 45% deemed it as the duty of local governments and

health department. Though many people knew that mosquito control is the duty

of residents, their involvement is less. Only 35% of respondents gave a positive

response to a question regarding involvement/ participation in control

measures. About 82% of houses were positive for mosquito larval habitat.

Atleast one container with larvae was noted in those houses. The majority of

respondents visited hospital in the event of a disease.


217


Table 4.11 Attitude and practice towards vector control and treatment


4.10.25 Vector control measures

Use of insecticides 97 30.8

Fogging/smoking 25 7.9

Use of larvicidal fish 0 0.0

Source reduction/clean 174 55.2

Others 19 6.0

Total 315 100.0

Variable Number Percentage 4.10.26

Responsibility for mosquito control

Resident 114 54.3

Local Government 63 30.0 Health department 33 15.3

Others 0 0.0 Total 210


4.10.27 Participation

in mosquito

control

measures

Yes 75 35.7

No 129 61.4

No response 6 2.9

Total 210 100.0


4.10.28 Observation for

breeding ground

Present 172 81.9

Absent 38 18.1

Total 210


218


28 Variable Number* Percentage

4.10.29 Treatment Govt hospital 64 28.7

Pvt hospital 109 48.9

Pvt practitioner 46 20.6

Self medication 3 1.3

Others 1 0.4

Total 223 100

Table 4.12 Attitude and Practice of respondent regarding vector control

Level N %

Poor practice (0-1) 13 6.2

Fair practice (2-3) 132 62.8

Healthy practice (4-5) 65 31.0

TOTAL 210 100.0

Mean =2.8 S.D=1.1 Min =0.0 Max 5

Mean score was 2.8 with standard deviation of 1.1. Minimum score was zero

and maximum was 5(Table 4.12).

Ph.D Thesis

6.2

.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

Poor practice

Per

cent

age

Fig 4.13 Level of practice regarding vector control

60.5

0

10

20

30

40

50

60

70

protection from mosquito bite

per

cent

age

of r

esp

ond

ents

Fig 4.14 Level of practice regarding personal protection and

KAP study on Aedes borne diseases

62.8

31.0

Poor practice Fair practice Healthy practice


6.2

33.8

62.8

5.7

31

protection from mosquito bite vector control

Fig 4.14 Level of practice regarding personal protection and vector control


219

Mosquito fauna


level of practice

Fig 4.14 Level of practice regarding personal protection and

poor practice

fair practice

good practice


220


60% of respondents adopted poor practice in taking preventive

measures aginst Aedes biting while only 5.7% adopted healthy

practice (Fig 4.14). 62.8% had a fair practice regarding vector

control while 31% showed good practice.(Fig 4.13).

Table 4.13. Over-all level of attitude and practice regarding disease prevention and

control

Over-all Level of Attitude and Practice No . %

Poor (upto33.33%) - 70 33

Fair (between l33.33% & 66.66%) - 121 57

Healthy (above 66.66%) - 19 09

Only 9% of respondents showed healthy attitude and practice towards disease

prevention and control while 33% showed poor attitude and practice (Table 4.13).

4.4.4. Incidence of disease.

Of the 210 respondent, 75 had a previous history CG and 4 had a history of DF.

Dual infection was not reported. Following table (4.14) gives more details.

Table 4.14. Incidence of disease among the respondents


4.12.30 Any incidence of Dengue

Fever/CG

DF 4 1.9

CG 75 35.7

Neither 131 62.4

Total 210 100.0


221


Though 62% were not inflicted with any disease , 36% had a real

experience of Chikungunya and 2% were infected with Dengue virus (Fig. 4.15)

4.4.5. Association between Socio-economic-demographic profile and Over-all

Level of Knowledge

Association between various socio-economic-demographic parameters with

over-all level of knowledge regarding Ae.albopictus and Ae.albopictus-borne

diseases(CG&DF) was analysed using the SPSS software.

DF2%

CG36%

Neither62%

Fig. 4.15 Incidence of diseases in study population


222


Table 4.15 Association between Age and over-all level of Knowledge

Age Total Level 18-30 31-45 46-60 60+

Low N 1 5 10 4 20

% (2.6) (6.8) (13.0) (20.0) (9.5) Moderate N 26 53 57 12 148

% (66.7) (71.6) (74.0) (60.0) (70.5) High N 12 16 10 4 42

% (30.8) (21.6) (13.0) (20.0) (20.0) Total N 39 74 77 20 210

% (100) (100) (100) (100) (100)

χ 2 10.648 df 6 p 0.100

In the present study age has not been found to be correlated with the over-

all knowledge level of respondents. p-value is higher than .05 and hence there is no

statistically significant association between age and level of knowledge of

respondents ( table 4.15 )

Table 4.16 Association between Sex and over- all level of Knowledge

Sex Total

Level Male Female

Low N 14 6 20

% (10.0) (8.6) (9.5)

Moderate N 93 55 148

% (66.4) (78.6) (70.5)

High N 33 9 42

% (23.6) (12.9) (20.0)

Total N 140 70 210

% (100) (100) (100)

χ 2 3.755 df 2 p 0.153


223


Among the male respondents 66.4% had a moderate level of knowledge

while 23.6% had a high level of knowledge and 10% had a low level of

knowledge. 78.6 % of female respondents had a moderate level of knowledge

while 12.9% had a high level of knowledge (Table 4.16). There was no association

between the level of knowledge and gender of the respondents. Statistical analysis

shows that there is no significant association between sex and level of knowledge.

Table 4.17 shows the details of association between education and

Knowledge. p-vale is lesser than .05 and hence the association is statistically

significant, ie, there is a significant association between education and level of

knowledge. High level of knowledge was observed among highly educated

respondents while relatively low level of knowledge was noted among the less

educated respondents. It highlights the importance of education in acquiring the

knowledge.

Table 4.17 Association between Education and over-all level of Knowledge

Education

Level PR* MS SE HS GR PG Total

Low N 8 3 8 1 0 0 20 % (30.8) (12.5) (12.3) (2.0) (0.0) (0.0) (9.5)

Moderate N 16 19 47 36 23 7 148 % (61.5) (79.2) (72.3) (73.5) (63.9) (70.0) (70.5)

High N 2 2 10 12 13 3 42 % (7.7) (8.3) (15.4) (24.5) (36.1) (30.0) (20.0)

Total N 26 24 65 49 36 10 210 % (100) (100) (100) (100) (100) (100) (100)

χ 2 31.16 df 10 p 0.001

*PR-Pre primary, MS-Middle shool SE- Secondary, HS-Higher Secondary, GR-Graduate, PG- Post Graduate


224


Table 4.18 Association between Occupation and over-all-level of Knowledge

Occupation

Level BU* GO PV PL DW HH ST RT SE OT Low N

0 0 1 6 7 3 0 0 1 2

% (0.0) (0.0) (10.0) (12.2) (29.2) (7.1) (0.0) (0.0) (7.1) (6.3) Moderate

N 11 9 4 32 15 34 7 1 9 26

% (84.6) (60.0) (40.0) (65.3) (62.5) (81.0) (70.0) (100) (64.3) (81.3) High

N 2 6 5 11 2 5 3 0 4 4

% (15.4) (40.0) (50.0) (22.4) (8.3) (11.9) (30.0) (0.0) (28.6) (12.5) Total N 13 15 10 49 24 42 10 1 14 32

% (100) (100) (100) (100) (100) (100) (100) (100) (100) (100)

χ 2 31.127 df 18 p0.028

*BU-business,GO-govt employ,PV-Private employee, PL-Plantation, DW-Daily wager.HH-house wife, ST-students,RT-Retired, SE-Self employed,OT-Others.

Here the p-value is less than 0.05 and hence there is a significant relation

between occupation and level of knowledge (4.18).

Table 4.19 Association between Financial background and over-all-level of

Knowledge

Finance Total

Level APL BPL

Low N 9 11 20

% (5.9) (19.0) (9.5)

Moderate N 105 43 148

% (69.1) (74.1) (70.5)

High N 38 4 42

% (25.0) (6.9) (20.0)

Total N 152 58 210

% (100) (100) (100)

χ 2 14.532 df 2 p 0.001


225


Among the respondents of BPL category only 6.95 had high level of knowledge

while 74.1 % had moderate and 19% had low level of knowledge. Among the

respondents belonging to APL category 25% had high level of knowledge while

69.1 % had moderate level and 5.9% had low level of knowledge (Table 4.19). As

shown in the table there is a significant association between the financial

background and the level of knowledge. Respondents of APL category had a better

knowledge level.

4.4.6. Association between Socioeconomic-demographic profile and Over-all

Level of Attitude and Practice

As shown in the table (4.20) there is no statistically significant association between

age and level of preventive practice. The χ 2 value is 10.35 and p-value is 0.11.

Table 4.20 Association between Age and over-all level of attitude and

practices

Age Total 18-30 31-45 46-60 60+

Poor Practice N 11 32 20 7 70 % (28.2) (43.2) (26.0) (35.0) (33.3) Fair Practice N 21 37 52 11 121

(53.8) (50.0) (67.5) (55.0) (57.6) Healthy Practice N 7 5 5 2 19 % (17.9) (6.8) (6.5) (10.0) (9.0) Total N 39 74 77 20 210

% (100) (100) (100) (100) (100)

χ 2 10.354 df 6 p 0.111


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Table 4.21 Association between Sex and over-all level of attitude and practices

Sex Male Female Total Poor Practice N 42 28 70 % (30.0) (40.0) (33.3) Fair Practice N 85 36 121 % (60.7) (51.4) (57.6) Healthy Practice N 13 6 19 % (9.3) (8.6) (9.0) Total N 140 70 210

% (100) (100) (100)

χ 2 2.125 df 2 p 0.346

As shown in the table (4.21) male respondents had a better practice than

females. However no statistically significant association between sex and level of

preventive practice was observed.

Table 4.22 Association between Education and over-all level of attitude and

practices

Education Total P M P S HS G PG Poor Practice N 11 6 27 22 4 0 70

% (42.3) (25.0) (41.5) (44.9) (11.1) (0.0) (33.3)

Fair Practice N 15 16 33 21 28 8 121 (57.7) (66.7) (50.8) (42.9) (77.8) (80.0) (57.6)

Healthy Practice 0 2 5 6 4 2 19

% (0.0) (8.3) (7.7) (12.2) (11.1) (20.0) (9.0)

Total N 26 24 65 49 36 10 210

% (100) (100) (100) (100) (100) (100) (100)

χ 2 23.752 df 10 p 0.008 *PR-Pre primary, MS-Middle shool SE- Secondary, HS-Higher Secondary, GR-Graduate, PG- Post Graduate


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As shown in the table (4.22) there is a significant association between

education and level of preventive practice. Appropriate practice was observed

among well educated (HS,G, PG) respondents.

Table 4.23 Association between Occupation and over-all level of attitude and

practice

Occupation

BU GO PV PL DW HH ST RT SE OT

Poor Practice N 6 3 1 19 10 17 4 1 0 9

% (46.2) (20.0) (10.0) (38.8) (41.7) (40.5) (40.0) (100) (0.0) (28.1)

Fair Practice N 6 10 7 27 14 23 3 0 12 19

(46.2) (66.7) (70.0) (55.1) (58.3) (54.8) (30.0) (.0) (85.7) (59.4)

Healthy Practice N 1 2 2 3 0 2 3 0 2 4

% (7.7) (13.3) (20.0) (6.1) (.0) (4.8) (30.0) (.0) (14.3) (12.5)

Total N 13 15 10 49 24 42 10 1 14 32

% (100) (100) (100) (100) (100) (100) (100) (100) (100) (100)

χ

2 26.7 df 18 p

0.085

*BU-business,GO-govt employ,PV-Private employee, PL-Plantation, DW-Daily wager.HH-house wife, ST-students,RT-Retired, SE-Self employed,OT-Others.

No significant association was observed between occupation and level of

preventive practice (Table 4.23).


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Table 4.24 Association between Financial background and over-all level of

attitude and practice

Finance Total

APL BPL Poor Practice N 49 21 70 % (32.2) (36.2) (33.3) Fair Practice N 87 34 121 % (57.2) (58.6) (57.6) Healthy Practice N 16 3 19 % (10.5) (5.2) (9.0) Total N 152 58 210

% (100) (100) (100) χ 2 1.542 df 2 p 0.462

As shown in the table (Table 4.24) there is no significant association

between financial background and level of preventive practice. Of the total APL

respondents 32.2% had poor preventive practices, 57.2% had fair practice while

10.5 % had healthy practices. Majority of BPL respondents (58.6%) had fair

preventive practices.

4.4.7. Association between over-all level of Knowledge and over-all level of


As per the table (Table 4.25) there is no association between the over-all level of

Knowledge and the over-all level of attitude and practice. There is no significant

increase in practicing the preventive measures with corresponding increase in

knowledge.


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Table 4.25 Association between over-all level of Knowledge and over-all level of


Level of attitude and practice

Total Level of Knowledge Poor Fair Healthy

Low N 6 13 1 20

% (8.60) (10.70) (5.30) (9.50)

Moderate N 48 85 15 148

% (68.60) (70.20) (78.90) (70.50)

High N 16 23 3 42

% (22.90) (19.00) (15.80) (20.00)

Total N 70 121 19 210

% (100) (100) (100) (100)

χ 2 1.362 df 4 p 0.851

Table 4.26 Association between participation in vector control activity and

observation of larval habitat

Observation of

Breeding Habitat

Participation Yes No Total

No

N 126 9 135

% (73.30) (24.30) (64.60)

Yes

N 46 28 74

% (26.70) (75.70) (35.40)

Total N 172 37 209

% (100) (100) (100)

χ 2 31.878 df 1 p 0.001


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Further analysis showed that participation in source reduction measures

significantly reduces the number of houses positive for larval breeding. As shown

in the table 4.26 there is a highly significant association between source reduction

practice and the occurrence of larval habitat. At the same time many breeding

habitat were observed around the houses of many respondents,where residence

reported source reduction practices.

4.4.8. Association of incidence of disease with over-all level of Knowledge

Table 4.27 Association of over-all level of knowledge and incidence of diseases

Incidence

Total Level of Knowledge

No yes

Low N %

13 7 20

(9.9) (8.9) (9.5)

Moderate N %

91 57 148

(69.5) (72.2) (70.5)

High N %

27 15 42

(20.6) (19.0) (20.0)

Total

131 79 210

(100) (100) (100)

χ 2 0.174 df 2 p 0.917

As shown in the table (4.27) there is no significant association between over-all

level of knowledge and incidence of diseases. Mear acquisition of knowledge is

not sufficient to prevent the incidence of disease.


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4.4.9 Association of incidence of disease with over-all level of attitude and

practice

Table 4.28 Association of the over-all level of attitude and practices with incidence of disease

Incidence of diseases Total

No Yes

Poor Practice N 49 21 70

% (37.4) (26.6) (33.3)

Fair Practice N 74 47 121

% (56.5) (59.5) (57.6)

Healthy Practice N 8 11 19

% (6.1) (13.9) (9.0)

Total N 131 79 210

% (100) (100) (100)

χ 2 5.137 df 2 p 0.077

In the present study no significant association between the preventive

measures and incidence was observed (Table 4.28).


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4.5 DISCUSSION AND CONCLUSION

Many of the previous studies measured the knowledge of vector-borne

diseases in various ways. Some studies determined the knowledge of disease from

the knowledge of the disease alone (Tram et al., 2003; Van et al., 2002), whereas

others included knowledge of the vector and control measure (Rosenbaum et al.,

1995; Lloyd et al., 1992). In the present study both these aspects were included.

Statistical analysis of collected data showed the Knowledge, Attitude and Practice

of respondents regarding various aspects of Aedes albopictus and Aedes albopictus

- borne diseases. Major findings are discussed under the following titles.

4.5.1 Socio-economic-demographic profile of the respondents

Present study showed that people of the study area live in a better

socioeconomic condition (Table 4.1). All the respondents were literate and

majority were well-educated(Fig 4.6). Majority of the respondents of the study area

were financially sound (Fig 4.8). Though agriculture/plantation was the traditional

occupation of the area educated young respondent were found to be attracted to

other occupations. The eldest male member is the head of the family in most of the

households. The household leader has a key role in vector control and disease

prevention. So household leaders be a target group for awareness campaigns.

Various media were available in each household. TV, News papers and Radio were

the major source of information (Fig 4.9).


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4.5.2 Over-all Level of Knowledge

Knowledge of a disease is very essential for its control. The present study

showed that respondents had a better level of knowledge regarding many aspects

of CG, DF and Aedes mosquito.

Several studies have shown that a higher socio-economic status correlates

with better knowledge scores (Kubik et al., 2004; McArthur et al., 2001; Potvin et

al, 2000). Our study also highlighted this conclusion. Every respondent of the

survey was aware of a disease called CG while 89.5% were aware of DF. 98% of

respondents knew that CG was transmitted by infected mosquito bite, 71% knew

the mode of transmission of DF. The respondent of the study had good knowledge

regarding symptoms of CG and DF (Table 4.2, Table 4.4). Respondents had a good

knowledge level regarding CG and DF (Fig 4.10). Knowledge level of respondents

regarding CG was found to be higher than that of Dengue Fever(Table 4.3 and

4.5). The relatively high level of knowledge regarding CG might be due to the

recent outbreak of CG and subsequent reports on various media.

The responses showed that the awareness regarding Aedes was not bad.

The analysis of data indicated that respondent had a good knowledge regarding

breeding ground of Aedes. Majority of the respondent knew that water holding

containers such as latex collecting cups, discarded coconut shells etc were the

dominant breeding sites. However breeding sites such as tree holes and tyres were

rarely referred (Table 4.6). Lack of knowledge of specific breeding habitat

appeared to be a deterrent to the elimination of that source. Respondents were


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almost equally distributed among the three knowledge levels, 37 % had a high

level of knowledge regarding the vector while 32% had moderate level and 30%

had low level of knowledge (Table 4.7).

Over-all knowledge level of respondents regarding Ae.albopictus and

Aedes-borne disease was good. More than 70% of respondents had moderate

knowledge and 20% had high level of knowledge. Only less than 10% had low

level of knowledge (Table 4.8 )

Even though many respondents were aware of many characteristics of

diseases and vector, several misconceptions were identified. One area that

respondent lacked knowledge was that CG causes death. While 50.5 % thought

that CG causes death 11 % thought that DF wouldn’t cause death (table 4.3, table

4.4). Other areas that lacked knowledge were regarding parasites and type of

mosquito responsible for CG and DF. Around 38% give wrong response to the

question on biting time. Similarly 40% were incorrectly, answered the question on

feeding place (out door/indoor) (Table 4.6). Day biting and outdoor biting are the

two important characteristics of Aedes albopictus. Awareness regarding these two

characteristics are essential to plan a specific measures against its bite. Similarly

ability to identify the vector helps to take protection, specifically. These are the

important areas which need to be emphasised more during the awareness

programme.


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4.5.3. Over-all Level of Attitude and Practice of respondents

The over-al level of attitude and practice regarding disease prevention and

control was not satisfactory. Only 30% took personal protective measures

throughout the year. This showed that majority of respondents were unaware that

dengue can occur in all seasons. 46% wait until the outbreak for taking a

preventive measure. This behaviour raises the risk of vector-borne diseases.

Similarly analysis showed that preventive measures are not species specific. A

major proportion of the respondents adopted unsuitable personal preventive

measures. Only a small proportion of the participants were conscious in using cloth

which cover major portion of the body when they go out. Preventive measures

preferred were use of mosquito coils/mat/liquid (Table 4.9). Several studies have

reported these methods to be most common means of prevention (Fradin et al,

2002; Jelinck, 2000). Use of fan was also a very popular method for prevention.

Such finding was reported in some earlier studies (Itrat et al., 2008). Other

preventive measures include the use of mosquito net, electric bat and smoke (Table

4.9). But these methods are effective against night/indoor biting mosquitoes. only

5.7% knew the correct personal preventive practice aginst Aedes biting (Tabe

4.10). It is very important to know the biting time of Aedes mosquito to protect

themselves during day time. As per the present study more than 62% knew the

biting time of Aedes but that knowledge was not put into action.


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Respondents knew that clean surrounding or source reduction is the best

method for controlling the vector density and spread of vector borne

diseases(Table 4.11). However many inappropriate attitude and practice were

observed during the survey. Over 45% of respondents felt that mosquito breeding

source reduction should be the responsibility of local government or health

department (Table 4.11).

A good health seeking behaviour was observed among the respondents.

Half of the respondents visited private hospitals. This may be due to better socio-

economic condition of respondents of the area and availability of numerous private

hospitals.

4.5.4. Incidence of vector-borne disease in the study area (CG&DF)

Ae.albopictus-borne diseases, especially CG have been a serious public health

problem in the study area. 36% of the respondents had a real experience of

Chikungunya and 2% were infected with Dengue virus (Fig. 4.15)

4.5.5. Association between socio-economic-demographic status and Over-all

Level of Knowledge

Many of the previous investigations measured either the knowledge on DF

or on CG. In the present investigation knowledge on both the DF and CG were

measured along with vector characteristics. This approach was useful for

calculating the knowledge on Aedes albopictus and arbovirus spread by it. It was

more relevant and appropriate in area where both the diseases prevalent.


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The socio-demographic characteristics investigated in the present study

were significant associated with the level of Knowledge except for age and sex. In

agreement with other studies, an association of level of knowledge with education,

occupation and financial status was found. High income respondents had better

knowledge level than low income one. Syed et al., (2011) reported a significant

associations of knowledge with education (p= 0.004) and socioeconomic status

(p=0.02). Knowledge of dengue is inadequate in the low socioeconomic class.

4.5.6. Association between Socio-economic-demographic status and Over-all

Level of Attitude and Practice

In the present study a significant association between education and

preventive practices was noted. This observation parallels with that of Dickson et

al (2011). According to Syed et al (2011) high socioeconomic group showed better

preventive practices.

4.5.7. Association between over-all level of knowledge and over-all level of


The knowledge level was unrelated to preventive practice in our study.

Koenraadt et al., (2006) made similar observation in elsewhere, where knowledge

of mosquitoes was not led to source reduction practice. Knowledge alone is greatly

not sufficient to change attitude and practice. Residents may not practice source

reduction because they believe other methods (adult control measures) they use to

reduce mosquitoes are more effective or easier, or because they do not realize the


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presence of breeding ground in their premises (Tuiten et al., 2009). Many

respondents in our survey think that mosquito control is the responsibility of local

government or government departments (Table 4.11). This belief discouraged

residents from practicing source reduction as they felt residents could not

effectively reduce mosquito populations (McNaughton et al., 2010). Other factors

may include lack of motivation, time, social factors, perceived benefits, taboos etc.

On the contrary, significant association between knowledge and attitude towards

vector control were reported (Hairi et al., 2003).

Highly significant correlation was observed between self reported source

reduction practices and occurrence of breeding habitat. Present study showed that

participation in source reduction measures significantly reduces the number of

houses positive for larval breeding (Table 4.26). Similarly, during the survey, it

was also noted that relatively less number of breeding habitats was observed in

households where source reduction was practiced than households from where

source reduction was not practiced. In other words, Numbers of positive water-

holding containers were detected around many households where residents

reported source reduction practice, but these households had lower positive

containers, than those where residents did not report source reduction practice. The

efficacy of source reduction practice is often judged based on the number of water-

holding and mosquito-positive containers in residents’ premises (Koenraadt et al.,

2006; Tuiten et al., 2009). Winch et al., (2002) noted that many mosquitoes

breeding in households where residents had received source reduction education


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were found in “invisible” containers, hidden from superficial inspection. In the

present study it is assumed that residents who practiced source reduction

overlooked containers that were small or hidden from superficial observation.

Many residents were unaware of breeding sites such as tree holes, leaf axils, tyres,

plant pots and other small and uncommon breeding sites (Table 4.6). Time interval

between two successive source reductions is also important especially during rainy

season. Elimination of container is more efficient rather than empting it. In rubber

plantations method of source reduction consists mainly of keeping the latex

collecting containers upside down during rainy days/season, rather than removal of

containers. This measure is usually adopted in simultaneous with the sap

collection, on an expected rain. Farmers usually don’t practice this measure during

non rainy day/season as it causes some latex loss. Unexpected continuous rain will

store water in the container and forms a breeding site for Aedes. Education

campaigns need to emphasize practical ways to get rid of breeding sites (Koenraadt

et al., 2006), provide details on overlooked containers, give tips on how to

thoroughly search a premises of household for water-holding containers (Winch et

al., 2002), and emphasize that source reduction should be practiced at least once a

week.

4.5.8. Association of incidence of disease with over-all level of knowledge

No significant association of incidence of disease with over-all level of

knowledge was observed. This does not mean that knowledge were nothing to do with


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the incidence of diseases but there might be some other important factors that were not

considered here (Table 4.27).

4.5.9. Association of incidence of disease with Over-all Level of Attitude and

Practice

In the present study no significant association of incidence of disease and over-

all level of attitude and practices regarding disease prevention and control was

observed (Table 4.28).

4.5.10 Conclusion

The present survey showed that the participants have sufficient knowledge

regarding Aedes mosquito and Aedes-borne diseases. It may be due to the fact that CG

had been a cause of concern in Kerala recently, and since media was giving enough

awareness. However some deficiencies in their knowledge related to certain aspects

exists. High level of knowledge was not translated into a good practice. It was found

that respondents were more concerned with personal preventive measures mainly

focused towards protection from mosquito bites rather than source reduction. Where

residents practiced source reduction, mosquito sources were significantly reduced or

absent. The observed deficiency should be compensated through proper awareness

programmes and source reduction efforts could be improved by motivating residents

through community-based efforts.


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GENERAL SUMMARY AND CONCLUSION OF THE STUDY

Mosquitoes are probably the most notoriously undesirable Arthropods, with

respect to their ability to transmit various pathogens. More than a hundred species

of mosquitoes are capable of transmitting various diseases to humans and other

animals. They are also known for being irritating biting pests. Sometimes, their

nuisance bites are so severe that they make outdoor activities almost impossible.

The tourism industry is also seriously affected. Mosquitoes are undeniably more

detrimental to human health than any other group of Arthropod vectors.

Today, mosquito control is a vital public-health practice throughout the

world, especially in the tropics because of its profound negative impact on human

progress. Mosquito control in an area is effective only when it is based on the

sound of knowledge of the species- the species diversity, distribution, population

dynamics, breeding ecology, vector status and other aspects of bionomics of

vectors in that particular geographic area. Similarly Knowledge, attitude and

practice of people regarding vectors and vector control should be measured as for

the success of any vector control activity and subsequently the prevention of

vector-borne disease in that area. Ironically, the mosquito composition, diversity,

distribution, ecology and population dynamics of many species of mosquitoes are

not adequately known from Kerala. Therefore, it is highly relevant and appropriate

to investigate the mosquito fauna, especially of central Kerala which is considered

as the epicentre of various mosquito-borne diseases.


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Present study gives a clear idea on the diversity and composition of

mosquito fauna in the study area. A total of 12196 mosquitoes belonging to 10

genera and 38 species were collected during 1728 man-hours of collection.

Collected genera include Aedes, Anopheles, Armigeres, Culex, Coquillettidia,

Heizmannia, Mansonia, Mimomyia, Toxorhynchites and Uranotaenia. Genus

Culex was represented by 16 species, followed by genus Anopheles by seven

species, Aedes by six species, Mansonia by three species and one species each by

genus Armigeres, Coquilletidia, Heizmannia, Mimomyia, Toxorhynchites and

Uranotaenia Among the 10 genera, Culex was the predominant genus and was

represented by 42.5 percentages of the total mosquitoes collected, followed by

Aedes by 26.5 and Armigeres by 19.7 percentages. Armigeres sabalbatus was the

most predominant species with 2404 mosquitoes (19.7%), followed by Aedes

albopictus with 2277 mosquitoes (18.6%) and Culex tritaeniorhynchus with 1509

mosquitoes (12.3%). The remaining 35 species constituted only less than 50 per

cent of the total catches. Of the 38 species studied, 21 species were recognized as

medically important vector mosquitoes. Distribution varied with season, space and

altitude. Species diversity was not varied much with season but most of the species

showed seasonal fluctuation in population density. Spatial distribution varied from

species to species. Ar. sabalbatus showed maximum spatial distribution with 44.4

average number of localities. The average number of localities where

Ae.albopictus found was 34.7. Density and species richness declined from lower

altitude to higher altitude. Larval habitats of 31 species of mosquitoes were


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detected during the study. Ae. albopictus, Ar. sabalbatus and Cx. quinquefasciatus

were found in more than 10 habitats. Latex collecting containers, discarded

coconut shells and tank were the major breeding sites observed in the study area..

Breeding ecology and population dynamics of adult Ae.albopictus have

been explored during the study. Ae. albopictus showed a high degree of plasticity

to various breeding sites and exploited all types of available potential breeding

habitats . The main habitat exploited by Ae.albopictus for breeding was the latex

collecting cup (36.3%), followed by plastic container (10.3%). Other breeding

habitat observed during the study include coconut shells, metallic containers, mud

pot, plant pot, tyre, tank, leaf axils, tree holes and other discards. Relatively high

larval Indices were recorded during the study period. Analysis shows that all larval

indices are well above the threshold levels. Ae.albopictus was present in all

months of study and population density of adult varied from month to month and

season to season. Its monthly total density varied from 0.14 (Feb 2010) to 13.4

(May 2009). Seasonal distribution showed highest seasonal prevalence in pre-

monsoon, followed by monsoon. Monthly landing density varied from 1(Feb 10) to

28 (May2010). Larval indices and adult densities of Aedes albopictus have been

recorded above the critical levels and it implies their potential for future outbreaks.

KAP study measured the Knowledge, Attitude and Practices of residents

regarding Ae. albopictus and Ae. albopictus- borne diseases. Present survey showed

that the participants have sufficient knowledge regarding Ae.albopictus and Ae.

albopictus- borne diseases. However, the relatively higher level of knowledge was not


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translated into a corresponding level of good practice. It was found that respondents

were more concerned with personal preventive measures mainly focused towards

protection from mosquito bites rather than source reduction.

This study provides baseline information on mosquito fauna of Central

Kerala. The study has revealed the presence of many mosquito species, including

vectors of various arboviral diseases. Forest cover, high rainfall, high relative

humidity and moderate temperature along with crops such as rice, rubber, cocoa,

pineapple, coconut and arecanut make suitable conditions for mosquito breeding

and proliferation, especially for Ae.albopictus. Source reduction through

modification or eradication of habitat is essential for the control of mosquitoes and

subsequently the mosquito borne-diseases. Source reduction efforts could be

improved by motivating residents through proper education and community-based

efforts. An integrated vector control program with the participation of the public,

local Governments, various departments of government and public sectors is

advantageous because in addition to reducing the risk of mosquito-borne diseases,

it could also result in an overall reduction in densities of nuisance mosquitoes

making it more acceptable to the surrounding community.

CHAPTER IV KAP STUDY ON AEDES BORNE...

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