Characterization of Selected Barangays with High and Low Incidence of Dengue Fever

CNU Journal of Higher Education, Volume 7 (2013), p 1-18 1 Characterization of Selected Barangays with High and Low Incidence of Dengue Fever Christine Joy J. Bandala and Emilia N. Bustamante Cebu Normal University Date Submitted: August 27, 2013 Originality: 95% Date Revised: November 27, 2013 Plagiarism Detection: Passed ABSTRACT This study looks into the demographic, environmental and socioeconomic factors associated with dengue prevention and control in two barangays of Cebu City as of 2011:Barangay Guadalupe with its high incidence of dengue fever and Barangay Sta. Cruz with a low incidence of dengue fever. The study utilized the descriptive correlational design employing multi-level sampling in selecting respondents. Three (3) standardized research instruments were adopted, as follows: the Cebu Normal University Community Health Assessment, the Department of Health s Green Star Project and the instrument used in the study of Nahida (2008) on the knowledge, attitudes and practices involved in Dengue fever prevention. The Minitab version 13 statistical software was used in data processing. Mode, frequency distribution and percentages were used for demographics, environmental and socioeconomic factors and the chi square to determine the relationship between knowledge, attitudes and practices. Significant factors that contributed to the increased incidence of dengue fever were the drainage system, low socioeconomic status, educational attainment, presence of breeding places and the knowledge, attitudes and practices involved in dengue prevention and control. Keywords: Dengue fever, incidence, knowledge, attitudes, practices, demographics, environmental factors, socioeconomic factors INTRODUCTION Dengue fever (DF) is a viral disease condition produced by dengue viruses. In Asian countries, the disease affected children predominantly during the 80s until the present,when recent reports showed that this disease now highly affects people across all ages (World Health Organization, 1997). Pinheiro and Corber (1997) have seen a remarkable rise in the number of cases affected by Dengue fever in the Philippines and Malaysia among people aged 15 years and above. According to the Department of Health, 29,000 dengue cases were recorded between January and July 2010. This is higher compared to 22,000 cases reported in the same period in 2009.With the alarming increase of dengue cases, the Department of Health intensified its campaign for dengue prevention but still, a significant increase in dengue cases in the Philippines has continued. In fact, in 2011, the Philippines ranked 4th in the list of Association of Southeast Asian

2 CNU Journal of Higher Education, Volume 7 (2013) Nations (ASEAN) member - countries tormented by dengue, (Ibbara Matteo, 2011). Central Visayas, in particular, was reported to have the highest increase, with over 3,600 cases in 2010 compared to 38 during the same period in 2009 (an increase of 1,062%). Cebu City remains the top area with most dengue cases at 1,282, nine (9) of these being fatalities. WHO Regional Director for Southeast Asia Dr Samlee Plianbangchang asserted that dengue fever is a disease condition that cannot be fought by the health sectors alone; it calls for the collaboration of all sectors including the community. Philippine Health Secretary Enrique T. Ona stated that dengue is everybody s concern, and with concerted efforts from the health sector and the public, dengue can be controlled. Studies have shown that there is a link between community characteristics and incidence of dengue (Ma, 2008). Demographic, environmental, economic, behavioral and social factors play an important role in effective communicable disease prevention and the success of public health programs (Debarati and Schimmer, 2005). These studies have considered the threats of acquiring dengue fever in affected communities, including those with deprived living conditions, social disparity and illiteracy. Studies focusing on the knowledge, attitudes and health practices of the community suggested that the government must look into information dissemination programs which can, therefore, enhance the knowledge of the community, improve health practices and adapt to the desired behavioral changes for dengue prevention and control. Recognizing the role of the community as the direct implementers and beneficiaries of dengue prevention and control should be considered. In line with this, the researchers were motivated to conduct a study on barangay characteristics, health practices and the incidence rate of dengue cases in Cebu City. The findings of this study will serve as guide for the policy makers in drafting policies focusing on strengthening health care programs towards dengue prevention and control through recognizing the barangay characteristics including the knowledge, attitudes and practices of the community. Conceptual Framework Figure 1. Conceptual framework of the study. Environment al factors Socioeconomic and Demographic factors Community Knowledge, Attitude and Practices on dengue prevention and control Incidence of Dengue fever

Bandala and Bustamante: Characterization of Selected Barangays 3 In this study, the researchers assessed the three (3) community characteristics that would affect the incidence of dengue fever. These community characteristics include environmental factors, socioeconomic and demographic factors, community knowledge, attitudes and practices involved in dengue prevention and control. REVIEW OF RELATED LITERATURE The occurrence of dengue fever has amplified 30 times between 1960 and 2010. This increase is linked to several factors including rising urbanization, rising population, increase in international travels and global warming (WHO, 2009). Ma (2008) concluded that dengue fever incidence was ecologically associated with some socioeconomic/demographic characteristics of the population. Areas with a high proportion of socioeconomically disadvantaged residents also had a significantly higher incidence. Several researches have considered the threats of acquiring dengue fever in the communities including those with deprived living conditions, social disparity and illiteracy. The identified threats differ greatly depending on the place, population mass, previous contact with definite serotypes and presence of oviposition. Demographic Factors Since dengue fever was discovered in the 1960s, it has become known as a childhood disease. However, in the 1980s, there was a rising incidence of occurrence among older adults. This increasing development of occurrence across population groups has created significant implications for dengue prevention and control. Either these are from a real rise in percentage of dengue fever cases or the result of enhanced categorization and findings of dengue fever (Chareensook, et al. 1999). A study conducted in Thailand concluded that lower birth and death rates reduced the flow of vulnerable individuals in the population and the rise in longevity of protected individuals. The increased percentage of protected populations likewise increases the chances of the dengue carrier mosquito to prey on an immune person, thereby lowering the chances of infection (Guzman, et al. 2002). A study in Maldives found out that females had good practices of dengue fever control and prevention compared to males. This might be because it is believed that females should take care of the households while the kids and males have other responsibilities (Nahida, 2008). This study was not consistent with the study of

4 CNU Journal of Higher Education, Volume 7 (2013) Teetsipat (2005) that found out that the gender of the household leaders had no relationship with preventive behavior involved in dengue hemorrhagic fever. Incidence in the Rural and Urban Areas Dengue has been reported to be common in urban areas where concentrations of dengue-carrying mosquitoes create the desirable situation for the spread of the dengue disease. Yet there are studies that show that transmission may occur in the rural areas. Rising transport contact, movement and expanding periurbanization have been mainly quoted as grounds for the extension of dengue cases to rural areas (DebaratiGuha-Sapir & Schimmer (2005). Environmental Factors A study conducted by Thamapaloet, et al. (2008) in Songkhla, Southern Thailand found out that housing pattern was a major risk factor in the incidence of dengue fever. Houses built with bricks and concrete equipment created a warm interior temperature, which can draw adult mosquitoes to thrive in the area and to feed on the blood of the inhabitants. The open windows and doors are left open throughout the day, allowing mosquitoes to travel freely from house to house. By contrast, the use of window screens had no association with the occurrence of the disease. Garbage dumping in close proximity to a house was correlated with an increased occurrence of dengue fever. Anupong Sujariyakul, et al. (2005) looked into the transmission rates of dengue fever in home and school and found out that those who lived in row houses (connected with a single path) and slum areas, and close neighborhoods with a high population density are at higher risk. These row houses had windows and doors open at daytime and inside it was relatively dark, which was a preferable place for resting mosquitoes. Children who lived in a house with discarded jugs and water tanks had increased chances of acquiring dengue. The existing water containers in schools were seen as an important risk for dengue incidence, for this may cause the dengue carrier mosquitoes to thrive, raising the threat of infection at school even if there were no previous dengue cases found. Researches in Puerto Rico, Taiwan and Australia established that the presence of unused items was correlated with the incidence of dengue fever. The World Health Organization (2009) stated that the potential breeding sites for

Bandala and Bustamante: Characterization of Selected Barangays 5 mosquitoes include flower pots, hard soil on plants, toilet bowl collars, gutters on roof, wayside drainage and any uncovered container that can hold water. In addition, there were also identified unusual breeding sites which included tree holes, plant axils, canvas sheets, discarded receptacles, bamboo stumps, coconut shells. Added to these was the problem of poor garbage management. Socioeconomic factors Social and economic factors have an important part in the occurrence and frequency of dengue fever. It was found out that the use of air conditioners, window screens, and treated water supplies in rich countries aided in the prevention of dengue disease; while enhanced health services decreased or eradicated the death rates due to dengue fever (Ma, 2008). However, there are some irregularities seen in the incidence of dengue fever despite the divisions of rich/ poor categories in countries and despite the intensified programs of rich countries in Southeast Asia such as Singapore, Malaysia and some areas in China. Increased incidence has been seen in Malaysia during epidemics compared to those of other countries in the region. Traditional routines like storing rain water increased the threat of acquiring dengue fever. Although there is an excellent health services standard in rich countries, the complacency of these affected countries without ongoing vigilance geared towards dengue prevention and control may contribute to the rising occurrence of the disease. In the study conducted by Ko, et al. (1992), it was observed that the risk for contracting Dengue fever was 1.8 times higher among individuals who lived in proximity to market areas and open sewers compared to individuals who lived afar. The majority of those who lived in these areas were composed of the poor sector, yet the findings of the study should have looked into the use of screens, which is vital in the prevention of dengue incidence. Community Involvement in the Prevention and Control of Dengue Community participation has been an effective means of dengue prevention and control. The rising awareness of the community has been seen through education drives, yet it still remains uncertain to what degree this newly acquired information has been applied and how extensively this practice has decreased the mosquito populace. Surveys on knowledge, attitudes and practices provide an appropriate plan in assessing programs and the identification of successful methods of community participation and behavioral change.

6 CNU Journal of Higher Education, Volume 7 (2013) A study conducted in Maldives stated that educational attainment had no correlation with the practice of dengue prevention. Yet this finding does not mean that education has no vital role but there might be other factors which affect the practice. Countries must execute national strategies to reduce the breeding places of mosquitoes. The government must also promote more community participation and mobilization programs that stress the need for behavioral change. The success of dengue prevention and control programs is achievable with the contribution and collaboration of individuals, families, communities, support groups, NGOs and local authorities, as stressed by World Health Organization Southeast Asia Regional Director, Dr. Samlee Plianbangchang. METHODOLOGY This research utilized the descriptive-correlational design. This method is intended to decide if two or more variables are correlated with each other and explain the current behaviour or characteristics of a certain group. The researchers determined the relationship between environmental factors, socioeconomic and demographic factors, community knowledge, attitudes and practices in relation to the occurrence of dengue fever. This was conducted in the identified barangays with either high or low incidence of dengue cases within central Cebu City as of 2011. This research utilized the descriptive-correlational design. This method is intended to decide if two or more variables are correlated with each other and to explain the current behaviour or characteristics of a certain group. The researchers utilized the multi-level sampling technique. Wherein the researchers looked into the barangays with high and low incidence of dengue fever as of 2011. After the selection of barangays, the researchers looked into the sitios where dengue cases were reported as either high or low, then households from these sitios were selected as respondents. The research instrument was composed of six parts. Part I involved profiling the socioeconomic and demographic data of the respondents. Part II involved surveying the environment of the respondents. The questions were lifted from the CNU community health assessment and from the DOH green star project. Parts III, IV, V and VI of the questionnaire were lifted from the study of Nahida (2007) entitled Knowledge, Attitudes and [sic] Practices of [sic] Dengue Fever Prevention

Bandala and Bustamante: Characterization of Selected Barangays 7 Among the People of [sic] Maldives which aimed at gaining information regarding the people s knowledge, attitudes and practices related to dengue fever. In treating the variables pertinent to this study, the following descriptions were considered: barangay characteristics referred to the demographic and socioeconomic factors and environmental factors that might affect dengue incidence; dengue incidence referred to the number of dengue cases reported and recorded by the Cebu City Health Office per barangay in the year 2011; environmental factors referred to the ecological features which the researchers looked into, which included source of water, waste disposal practices, drainage, presence of breeding sites and housing of the respondents. Source of water referred to the water that the respondents used for drinking and washing; waste disposal practices referred to the methods used by the respondents in disposing of garbage; presence of breeding sites referred to the areas in the community where wrigglers existed; housing referred to the construction materials used by the respondents in building houses which included light materials (the entire house was made of wood, lumber, and nipa palms for roofing), concrete materials (the entire house was constructed with cement, hollow blocks and galvanized iron for roofing) and mixed materials (the house was constructed with combined light and concrete materials). Demographic and socioeconomic factors referred to characteristics of the respondents expressed in income, educational attainment and population density. Income referred to the sum of individuals wages, salaries, profits and other earnings expressed in monetary terms within one month; educational attainment pertained to the maximum education the person had finished ;community practices referred to the actions done by the respondents for dengue prevention and control; knowledge referred to the familiarity of the respondents regarding dengue fever, which included cause, transmission, clinical manifestations and dengue prevention and control; attitude referred to the feelings and beliefs of the respondents with regard to dengue fever prevention and control. Administrative permits were acquired prior to the conduct of the study. Upon receipt of the permits, the researchers then looked into the surveillance report of dengue cases per sitio from the health centers. The residents of the sitios with either the highest or the lowest incidence of dengue cases were chosen as the respondents of the study. The researchers, together with the research assistants, then conducted interviews per household. The respondents were informed about the goals and objectives of the research. The collected data then were gathered, analyzed and interpreted. To process the environmental factors and demographics of the respondents, mode, frequency distribution and percentages were utilized; and

8 CNU Journal of Higher Education, Volume 7 (2013) to determine the relationship between the knowledge, attitudes and practices, the chi square was used. RESULTS AND DISCUSSIONS Barangay Characteristics It can be gleaned from Table 1 that in terms of environmental characteristics, barangays with high incidence of dengue and those with low incidence differed only in drainage systems. Barangays with high dengue incidence practiced the open drainage system while the low incidence barangays have closed drainage systems. Table 1.Barangay Characteristics. Characteristics High Incidence Low Incidence Environmental factors Source of Water MCWD MCWD Breeding Sites With wrigglers With wrigglers Garbage Disposal With collection system With collection system Drainage Open Drainage Closed Drainage Housing Mixed materials Mixed materials Demographic Factors and Socioeconomic Factors Income Below Minimum wage Below Minimum wage Educational Attainment High School Level College Level Population Density High Density Low Density Knowledge Low Level Moderate level Attitudes Neutral Neutral Practices Fair Level Good Level Drainage System. The Drainage system had a significant effect on the incidence of dengue fever. In the high incidence group, the majority of the respondents had open drainage. This would mean that the standing water served as a reservoir for mosquito larvae; thus, it is a potential breeding site for mosquitoes, thereby giving the residents higher chances of contracting dengue fever (Chartered Institute of Environmental Health, 2009). Table 2: Drainage System. Type of Drainage High (n=305) Low (n=91) Open drainage 262 16 Closed drainage 43 73 p value 0.0000 This finding is supported by the study of Ko et al. (1992) implying that those who lived near markets and open sewers or ditches had 1.8 times higher risk of contracting dengue fever compared to those who did not.

Bandala and Bustamante: Characterization of Selected Barangays 9 In terms of demographic and socioeconomic factors, the barangays differed in educational level, population density, knowledge and practices. In the high incidence group, the majority of the respondents highest educational attainment was high school level while in the low incidence group, it was college level. It was noted that the barangays with high incidence of dengue cases were densely populated. Based on the mean scores of the knowledge of the respondents about dengue prevention and control, the high incidence group was categorized belonging to the low level, while the low incidence group was categorized as belonging to the moderate level. The mean score of the practices of the high incidence group was categorized as fair, while that of the low incidence group was good. Monthly Family Income. Income had a significant bearing on the incidence of dengue fever. It can be gleaned from Table 3 that those who belonged to the low socioeconomic status, usually lived in crowded areas with a high population density, had row houses with poor drainage systems which constituted a favorable site for the Aedes aegypti mosquito to thrive and dengue fever to be transmitted. Table 3: Monthly Family Income. Income (peso) High (n=305) Low (n=91) Below 7,000 127 40 7001-11,000 124 31 11,001-16,000 41 10 16,001-21,000 6 9 Above 21,000 7 1 p-value 0.010 This finding is supported by Ma et al. (2008) that those who were socioeconomically disadvantaged had a significantly higher incidence of dengue fever, especially since they had poor living conditions and were victims of social inequalities and illiteracy. Based on table 1, the majority of the respondents from both the high incidence and low incidence groups were minimum wage earners. According to Thammapalo, et al. (2008) population density would affect the incidence of dengue fever, for the dengue-carrying mosquitoes would not have to travel far to search for victims and transmit the parasites. This is also supported by a study conducted by Bhandari, et al. (n.d.) that higher population density and interconnection of houses could lead to more efficient spread of the dengue virus and higher chances of dengue fever exposure. Educational Attainment. Educational attainment had a significant effect on the incidence of dengue fever (Table 4). Respondents with a higher educational attainment had more access to information about dengue prevention and control. Itrat, et al. (2008) in Pakistan concluded that there was a significant association between educational attainment and knowledge about dengue prevention.

10 CNU Journal of Higher Education, Volume 7 (2013) Table 4: Educational Attainment. Educational Attainment High (n=305) Low (n=91) Elementary level 7 0 Elementary graduate 8 3 High School Level 73 22 High School Graduate 87 15 Vocational 82 2 College Level 16 26 College Graduate 32 23 p-value 0.005 The respondents who had lower educational attainment were more ignorant about dengue cases and prevention compared to those who completed 10 years in school. This is also supported by Stoler, et al. (2011) who stated that the higher the educational attainment, the higher the knowledge about dengue and its prevention. It was observed that during epidemic seasons of dengue, the government created household and multimedia campaigns on dengue prevention to broaden the knowledge of the community of dengue prevention and control, but these information drives must be done year round and not during epidemic seasons only. The actual application of the community of measures for dengue prevention and control must be evaluated. Presence of breeding sites in outdoor containers. The presence of breeding sites in outer containers had a significant effect on the incidence of dengue fever (Table 5). The World Health Organization or WHO (2000) identified potential breeding sites for mosquitoes which included flower pots, flower plates, the hardened soil of potted plants, the collar of toilet bowls, gully traps, roof gutters, roadside drainage and any uncovered container that could hold water. Table 5: Presence of Breeding Sites in Outdoor Containers. Outdoor Containers High Incidence with wrigglers Low Incidence with wrigglers Earthen Jar 5 0 Pitcher 0 0 Drums 20 0 Empty cans 33 0 Empty bottles 39 0 Plants 105 3 Tree holes 17 0 Ground/ rock holes 77 0 Coco shells 13 0 Bamboo stumps 8 0 Used tires 3 0 Cemented water containers 2 0 (pasong) p- value 0.000 In addition, there were also identified unusual breeding sites which included tree holes, plant axils, canvas sheets, discarded receptacles, bamboo stumps,

Bandala and Bustamante: Characterization of Selected Barangays 11 coconut shells, as well as poor garbage management. Natarajan et al. (2010) stated that there was a strong positive association of dengue with the presence of shrubbery areas above the containers. Pupal production was higher in pools of rain water found in outdoor and natural containers. This suggests that Aedes aegypti vectors prefer natural untreated water compared to tap and treated water (Natarajan, et al. 2010). As shown in table 5, respondents from the high incidence group had more outdoor containers with wrigglers compared to the low incidence group. The location of respondents from the high incidence group was near the mountainsides of the city where there was an abundance of natural containers as potential breeding sites of Aedes aegypti compared to the low incidence group. One of the sources of income of the high incidence group was the business of landscaping, and selling of potted plants and flowers for home improvement. These plants created natural containers for breeding sites of mosquitoes. It had been practiced by the high incidence group which ventured into this business to store rain water using cemented containers (pasong), drums and other containers to water the plants. The majority of these containers were left open, thus these were favorable sites for the breeding of mosquitoes. Presence of Breeding Sites in Indoor Containers. As shown in Table 6, the presence of indoor containers had a significant effect on the incidence of dengue fever. Indoor containers, specifically those not covered, are favorable breeding sites. Hamada, et al. (n.d.) concluded that any indoor containers that could hold water was a potential breeding site for mosquitoes. These included flush tanks, toilet bowl collars and drums found within the toilet area and bathrooms. Furthermore, the Hamada, et al.(n.d.) study found out that mosquitoes showed a high preference for drought resistant containers and a toilet environment for breeding wherein ovipositions and egg viability were high. Moisture found in flush tank waters and showers within the toilet environment (Hamada, et al. n.d.) was also high. In the high incidence group, most of the drums containing wrigglers were found within the comfort rooms. These drums were utilized to store water for flushing toilets and for bathing. Flower vases and plates within flower pots and discarded containers such as unused bottles and cans have been favorable sites for mosquitoes (WHO, 2000). These items were also found in the households of the high incidence group.

12 CNU Journal of Higher Education, Volume 7 (2013) Table 6: Presence of Breeding Sites in Indoor Containers. High Incidence Indoor Containers with wrigglers Earthen Jar 1 0 Low Incidence with wrigglers Pitcher 5 4 Drums 30 5 Empty cans 4 0 Empty bottles 25 0 Flower vase 10 3 Pail 0 0 Basin 0 0 Water container 0 0 Water for pets 3 0 Dish rack Around toilet bowls 1 5 0 2 p-value 0.000 Community k nowledge, a ttitudes a nd p ractices t owards d engue prevention and control Knowledge of the respondents can affect the incidence of dengue fever. Based on Table 7 presented above, the mean score of the high incidence group was 8, which is categorized as low level knowledge, compared to the low incidence group, with a mean score of 11, which is categorized as moderate level. Table 7: Community Knowledge, Attitudes and Practices towards Dengue Prevention and Control. High Incidence Low Incidence p-value mean score Mean score Knowledge 8 11 0.000 Attitude 40 41 0.000 Practices on dengue prevention and control 5 8 0.000 Among the respondents of the high incidence group, only 34% knew the principal cause of dengue fever which is the Aedes aegypti mosquito, while 75% of the respondents from the low incidence group knew. The majority of the respondents from the high as well as low incidence groups were well informed about the signs and symptoms of dengue fever and potential sites for mosquito breeding such as old tires, trash cans and flower pots. But in controlling and killing mosquito larvae, only 20% of the respondents from the high incidence group were familiar with the practice of putting abate sand as beneficial in killing larvae and preventing the rise of mosquito breeding sites for three (3) months, while 60%of the respondents from the low incidence group knew this information. This would mean that the majority of the high incidence group had limited knowledge about using chemicals in preventing the occurrence of larvae formation or the respondents were aware of the type of chemicals used in larvicide

Bandala and Bustamante: Characterization of Selected Barangays 13 control, compared to the low incidence group. When the subject of using chemicals in controlling larvae was brought up, the majority of the respondents from the high incidence group verbalized that using chemicals may cause health problems. The educational attainment of the respondents can be taken into account as reflected in Table 4, wherein the majority from the high incidence group were high school graduates while those from the low incidence group belonged to the college level. Attitudes towards dengue prevention and control had a significant effect on the incidence of dengue fever. The respondents from both the high and low incidence groups had a neutral attitude towards dengue prevention and control. In the positively coined statements, the respondents from both the high and low incidence groups agreed with the majority of the questions except that of restricting and checking of the availability of potential breeding sites 1-2 times every year. The majority of the respondents from the low incidence group believed that this activity should be conducted every day. Pertaining to the items in the questionnaire which were negatively stated, the majority of the respondents from both groups generally agreed with the questions except one which stated that the strong and healthy person could get dengue. The majority of the respondents from the low incidence group disagreed; while the majority of the high incidence group agreed. Health education and health promotion must be focused on correcting misconceptions that dengue fever is a disease that can be prevented and there must be a strong participation of the community in eliminating breeding places. Community practices on dengue prevention and control had a significant effect on the incidence of dengue fever. The respondents from the high incidence group had a fair level of practices, while the respondents from the low incidence group had a good level of practices. Only 57% of the respondents from the high incidence group and 70% of the respondents from the low incidence group practiced covering water containers immediately after using. Uncovered water containers are potential breeding sites. Examining plant pots and plates for the presence of larvae and draining pools of water found are crucial activities in preventing dengue fever. This was supported by Nyamah, et al. (2010) who stated that flower pots, vases and tires are the most common potential sites for breeding mosquitoes; therefore it is important to check and drain the pooling of water found in the flower pots to prevent dengue fever. Yet it is observed that a minority or 30% from the high incidence group practiced this activity, whereas 70% of the respondents from the low incidence

14 CNU Journal of Higher Education, Volume 7 (2013) group did. Approximately 20% of the respondents from the high incidence group ventured into the plant and landscaping business and there were numerous flower pots and plants found within the environment; therefore it was challenging to check and drain pools of water from each flower pot, plant and plate. It was observed that areas of the high incidence group consisted of shrubbery; there were natural containers present within the area including plant axils, tree and ground holes, and coco shells. Forty-four percent (44%) of the respondents from the high incidence group and 89% of the respondents from the low incidence group practiced examining water containers in the toilet for mosquito breeding sites. A study conducted by Hamada et al. (n.d.) noted that mosquitoes had a higher chance to breed within the toilet area due to its high humidity and moisture, and the fact that toilet containers were constantly refilled; therefore it is important to regularly check the toilet area. On the other hand, only 31% of the respondents from the high incidence group and 66% of the respondents from the low incidence group practiced checking and cleaning roof gutters during the rainy season. Roof gutters, if not properly cleaned and dried, are potential sites for breeding mosquitoes. As shown in table 1, both the high and low incidence groups scheduled a collection system for garbage disposal; yet, these groups differed in garbage and waste disposal practices. The majority of the high incidence group used sacks, while the low incidence group used plastic and drums for garbage storage. Only 20% of the respondents from the high incidence groups and 86% of the low incidence group practiced covering or tying garbage containers. Uncovered garbage containers or untied sacks and plastic are a potential reservoir for Aedes aegypti mosquitoes. This is also supported by the study conducted by Bhundari et al. (n.d.) that showed that the presence of garbage around the households increases the potential breeding sites for Aedes aegypti. As observed, untied sacks and uncovered garbage containers attract insects and can hold pools of water, thereby increasing the incidence of dengue fever. The majority of the respondents from the high and low incidence groups participated in clean up drives; however, this activity is organized during the rainy season only. The respondents from both the high and low incidence groups strongly agreed that clean-up drives should be done the whole year round.

Bandala and Bustamante: Characterization of Selected Barangays 15 CONCLUSION Socioeconomic and environmental characteristics significantly influenced the escalation of dengue cases in the barangays. Community knowledge, attitudes and practices on dengue prevention and control had a significant bearing on mitigating the life cycle of the dengue vector, consequently eradicating dengue cases. It is recommended that there should be established/organized a strict monitoring and control system that should be jointly participated in by government, non- government and volunteer organizations; campaigns for the prevention and control of dengue through multimedia, regular garbage collection system, proper disposal and drainage system should be intensified. Correction of misconceptions must also be addressed in health education. Strong community participation with regular clean-up drives and finding outdoor and indoor and natural containers that are potential breeding sites for mosquitoes should be encouraged. It is also recommended to conduct further studies on the factors that play an important role in the increasing trend of dengue incidence in the community and to develop appropriate strategies in addressing these factors. REFERENCES Mondini, A. and Chiaravalloti-Neto, F.(2008).Spatial correlation of incidence of Dengue with socioeconomic, demographic and environmental variables in a Brazilian city. Retrieved from http://www.sciencedirect.com/science/article/pii/s0048969708000144 Anker and YuzoArima. (2011). On behalf of emerging diseases surveillance and response, division of health security and emergencies, World Health Organization Regional Office for the Western Pacific. Retrieved from http://www.wpro.who.int/wpsar/archives/archive_2(2)2011_ra_dengue_ Gender_WPR_Arima_Anker.html AnupongSuja, Sa-wangPrateepko, VirasakdiChongsuvivatwong and Suwinch, Thammapalo. (2005). Transmission of Dengue Hemorrhagic Fever: at home or school? Retrieved from http://www.searo.who.int/linkfiles/dengue_bulletins_volumes_29_(200 5)_CHAPTE04.pdf Pérez-Guerra,C L., Seda, H., García-Rivera, E J., and Clark,G G.. (n.d.). Knowledge and attitudes in Puerto Rico concerning dengue prevention. Retrieved from http://journal.paho.org/uploads/1138060077.pdf Chareonsook O, Foy HM, Teeraratkul A, Silarug N. (1999). Changing epidemiology of dengue Hemorrhagic fever in Thailand. Retrieved from http://www.jstor.org/pss/3865249

16 CNU Journal of Higher Education, Volume 7 (2013) ChihWua,C., Jinn-GueyLayb, How-Ran Guoc,Chuan-Yao Lind,Shih-Chun Lungd, Huey-Jen Suc. ( n.d. ).Higher temperature and urbanization affect the spatial patterns of Dengue Fever transmission in subtropical Taiwan. Retrieved from http://ntur.lib.ntu.edu.tw/bitstream/246246/173465/1/26.pdf Debarati- GuhaSapir and Barbara Schimmer. Dengue (2005). Fever: New paradigms for a changing epidemiology. Retrieved at http://www.eteonline.com/content/2/1/1 Derek A. T. Cummings, SoponIamsirithaworn, Lessler,J T., Aidan McDermott, Rungnapa Prasanthong, AnandaNisalak, Richard G. Jarman, Donald S. Burke, Robert V. Gibbons.(2009).The impact of the demographic transition on Dengue in Thailand: insights from a statistical analysis and mathematical modeling. Retrieved from http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.10001 39 Saimlee Plianbangchang. ( 2008 ). Who calls for collaboration on Dengue controlling Dengue has to be everyone s business Retrieved from http://www.searo.who.int/en/section316/section503/section2358_13617.h tm Erum Khan, Mehreen Kisat, Nabil Khan, Amna Nasir, Salma Ayub and RuminaHasan. (2010). Demographic and clinical features of Dengue Fever in Pakistan from 2003 2007: a retrospective cross-sectional study. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/pmc2938342/ Goh,K.T. (2010). Dengue--a re-emerging infectious disease in Singapore. Ann Acad Med Singapore. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/9494676 Guzman, M.G., Kouri, G., Bravo, J., Valdes, L., Vazquez, S., Halstead, S.B. (2002). Effect of age on outcome of secondary Dengue to infections. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/12121599 Hamady Dieng, et al. (n.d.). Unusual developing sites of dengue vectors and potential epidemiological implications. Asian Pacific Journal of Tropical Biomedicine, http://www.apjtb.com/zz/20123/12.pdf Ibarra Mateo.(2011). Philippine ranks 4 th in Asean- Wide Dengue incidence. Retrieved from http://www.gmanetwork.com/news/story/223701/news/nation/philippinesranks-4th-in-asean-wide-dengue-incidence

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18 CNU Journal of Higher Education, Volume 7 (2013) Better environmental management for control of Dengue.(n.d.).Retrieved from. http://www.who.int/heli/risks/vectors/denguecontrol/en/index.html Chartered Institute of Environmental Health. (2009). Distribution pattern of a dengue fever outbreak using GIS. Retrieved from http://www.cieh.org/jehr/distribution_pattern_dengue_fever.html OH Unveils Aksyon Barangay Kontra Dengue As Luzon Braces for Surge Press (2011, August 25). Retrieved from http://www.doh.gov.ph/node/3120 Regional Analysis: Male- female Differences in the Number of Reported Incident Dengue Fever Cases in Six Asian Countries. (n.d.) Retrieved from http://reliefweb.int/sites/reliefweb.int/files/reliefweb_pdf/node- 423175.pdf