Awareness about Mosquito Borne Diseases in Rural and Urban Areas of Delhi

J. Commun. Dis. 45(3&4) 2013 : 201-207 Awareness about Mosquito Borne Diseases in Rural and Urban Areas of Delhi Kohli C*, Kumar R*, Meena GS*, Singh MM*, Ingle GK* (Received for publication Oct 2013) Abstract Mosquito borne diseases have emerged as a serious public health problem in countries of South East Asia Region including India. This study was planned with an objective to study the awareness about mosquito borne diseases in Delhi. A community based cross sectional study among 350 adult individuals selected by systematic sampling method. Data was collected using pretested semi structured questionnaire after taking written informed consent. Data was analyzed using SPSS version 17. Chi-square/Fisher's Exact test were used for qualitative variables and p value < 0.05 was considered significant. 350 adult individuals were selected for interview, 210 (60.0%) belonged to rural area and 140 (40.0%) to urban area. 147 (42%) respondents were males and 203 (58%) were females. 142 (67.6%) subjects in rural and 89 (63.6%) in urban area were able to name atleast one mosquito borne disease. 228 (65.1%) participants were aware of malaria, 218 (62.3%) named dengue, 35 (10.0%) named chikungunya and only 01 (0.3%) each were aware of Japanese encephalitis and yellow fever. Television was most common source of information regarding mosquito borne diseases. It can be concluded that intensive information, education and communication activities are needed to educate people about mosquito borne diseases and their prevention. Key words : Awareness, mosquito borne diseases, Delhi. * Deptt of Community Medicine, Maulana Azad Medical College, New Delhi-110002. Correspondence to: Dr. Charu Kohli, Resident, Department of Community Medicine, Maulana Azad Medical College, New Delhi-110002. Ph: 91-9013566099 ; Email: kohlicdoc17@gmail.com

202 Kohli C et al INTRODUCTION The mosquito borne diseases have emerged as a serious public health problem in countries of South East Asia Region (SEAR) 1 including India. Nearly half of the world's population is at risk of malaria and is among leading causes of mortality especially in Sub 2,3 Saharan Africa. Nearly 80.5% population of India lives in malaria risk areas with a burden 4 of 1.86 million DALYs loss annually. Dengue fever (DF) is another important arthropodborne disease of public health importance in the world and is endemic in 112 countries of 5 the world. The total population at risk of infection of chikungunya is approximately 565.41 million in India. The total annual 6 DALY loss was estimated to be 25,588. Another mosquito borne disease prevalent in India is lymphatic filariasis which is endemic in 18 states and Union Territories with around 420 million people residing in endemic areas 7 and 48.11 million people are infected. In addition of above, Japanese Encephalitis makes the scenario worse with virus active in almost all parts of India and outbreaks have 8 been reported from a number of states. As there is no specific treatment for many diseases like dengue and chikungunya, general public health measures have to be instituted for the prevention and control of mosquito borne diseases. Thus, it is important to understand the current knowledge about mosquito borne diseases and its prevention among people. Keeping the above aspect in view, this study was planned with an objective to study the awareness about mosquito borne diseases in Delhi. MATERIALS AND METHODS Study area: This was a community based cross sectional study conducted in a rural area, Barwala located in northwest district and an urban slum, Balmiki Basti of central district in Delhi. The sampling universe included all adult individuals (more than or equal to 18 years) residing in the above mentioned areas. Sample size was calculated on the basis of results of a previous study where awareness about mosquito borne 9 diseases was present in 69% of subjects. Taking 10% allowable error with 95% confidence interval, sample size came out to be 172. Data collection: The study sample included 210 individuals from rural area and 140 from urban area (total of 350 adults) selected as per proportion to population size selected through systematic random sampling method. Data was collected by interviewing the participants, after getting written informed consent, using a pre-tested semi-structured interview schedule in local language. The schedule contained items on socio-economic and demographic profile of study subjects, awareness about mosquito borne diseases and their prevention. Study was conducted by house to house survey. From each family one individual was selected. Every effort was made to interview the head of the family. In case head of the family was not available, then any family member more than 18 year of age was selected using lottery method. When house was found locked even after three visits, next house was selected without disturbing the overall sampling procedure. Data was analyzed using SPSS software (version 17). Chi square test/fisher's Exact test were used for finding an association between qualitative variables and p value

Awareness about Mosquito Borne Diseases in Rural and Urban Areas of Delhi 203 less than 0.05 was considered significant. Ethical clearance was taken from institutional ethical committee. RESULTS 147 (42%) subjects were males and 203 (58%) were females. 108 (51.4%) subjects in rural and 55 (39.3%) in urban area belonged to 18-29 years of age group, 59 (28.1%) in rural and 41 (29.3%) in urban area belonged to 30-39 years. Approximately equal percentage of subjects in rural (24.3%) and urban area (23.6%) were illiterate. Those educated upto middle school were 46 (21.9%) in rural and 30 (21.4%) in urban area. In rural area, 50 (23.8%) subjects were unskilled workers but in urban area, 39 (27.9%) of subjects were semi skilled workers. Monthly per capita income (in INR) in rural area was Rs. 3824.84 + 2308.41 (SD) and 2846.92 + 1708.12 (SD) in urban area. 142 (67.6%) subjects in rural and 89 (63.6%) in urban area were able to name atleast one mosquito borne diseases but no significant difference was found in two areas ( 2 = 0.61, df=1, p =0.43). 36.3% of subjects were able to tell names of atleast 2 diseases spread by mosquitoes. 21.4% were able to name atleast 1 diseases and 8.3% could name 3 or more diseases spread by mosquitoes. Table 1 shows the responses when study subjects were asked if they had knowledge about diseases which are transmitted by mosquitoes. A total of 228 (65.1%) subjects were aware of malaria, 218 (62.3%) named dengue, 35 (10.0%) named chikungunya. Typhoid and tuberculosis were responded by 25 (7.1%) and 10 (2.8%) subjects respectively. There was no significant difference in knowledge about mosquito borne diseases in rural and urban areas. In analysis for gender wise distribution of knowledge about mosquito borne diseases, it was found that except for disease chikungunya in which females (13.8%) have significantly higher knowledge as compared to males (4.8%) in rural area with 2=7.72, df=1, p =0.01. There was no significant difference among males and females for remaining diseases. Significant difference was seen between education classes for knowledge about mosquito borne diseases. For malaria, percentage of people who could name malaria was 39.3% among illiterates and Table 1: Knowledge about individual mosquito borne diseases in rural and urban areas Disease* Rural Urban Total 2, "p" value No (%) No (%) No (%) (df =1) (N= 210) (N= 140) (N= 350) Malaria 142 (67.6) 86 (61.4) 228 (65.1) 1.41, 0.23 Dengue 129 (61.4) 89 (63.6) 218 (62.3) 0.16, 0.68 Chikungunya 25 (11.9) 10 (7.1) 35 (10.0) 2.11, 0.14 Japanese encephalitis** 01 (0.5) 0 (0.0) 01 (0.3) 0.39 Yellow fever** 01 (0.5) 0 (0.0) 01 (0.3) 0.39 * Figures are not mutually exclusive, ** Fisher's Exact test was used

204 Kohli C et al 90.7% among those who were educated above high school ( 2=48.78, df=4, p =0.01). Similar findings were seen with dengue. Table 2 shows response to the question on knowledge about breeding places of mosquitoes. Responses given were stagnant water collection by 125 (59.5%) rural and 88 (62.9%) urban subjects. 41.4% reported old tyres, broken pots and coconut shells. Except for response blocked drains ( 2=21.87, df=1, p =0.01), no significant difference was found in two areas. No association was seen with gender but there was significant difference between education classes in knowledge about breeding places of mosquitoes. Study subjects were enquired about knowledge regarding symptoms of malaria; maximum number of subjects were aware of fever with chills/rigor in both rural 59 (28.1%) and urban 26 (18.6%) areas and the difference between rural and urban area was significant ( 2=4.14, df=1, p =0.04). Results were significant for response vomiting also ( 2=4.65, df=1, p =0.03). There was no significant difference between males and Table 2: Knowledge about breeding places of mosquitoes in rural and urban areas Breeding places* Rural Urban Total 2, "p" value No (%) No (%) No (%) (df =1) (N= 210) (N= 140) (N= 350) Stagnant Water collection 125 (59.5) 88 (62.9) 213 (60.9) 0.39, 0.53 Old tyres, broken pots, and 84 (40.0) 61 (43.6) 145 (41.4) 0.44, 0.50 coconut shells Blocked drains 105 (50.0) 35 (25.0) 140 (40.0) 21.87, 0.01 Desert coolers 55 (26.2) 37 (26.4) 92 (26.3) 0.01, 0.96 *Figures are not mutually exclusive Table 3: Knowledge about methods of prevention of mosquito borne disease Preventive methods for Rural Urban Total 2, "p" value mosquito borne diseases* No (%) No (%) No (%) (df =1) (N= 210) (N= 140) (N= 350) Prevent stagnation of water 95 (45.2) 79 (56.4) 174 (49.7) 4.20, 0.04 Cover water containers 84 (40.0) 61 (43.6) 145 (41.1) 0.44, 0.50 Cleaning of coolers 42 (20.0) 32 (22.9) 74 (21.1) 0.41, 0.52 Cleaning of the garbage 98 (46.7) 37 (26.4) 135 (38.6) 14.25, 0.01 Putting kerosene oil in coolers 17 (8.1) 25 (17.9) 42 (12.0) 7.58, 0.01 Using PPM 15 (7.1) 05 (3.6) 20 (5.7) 1.98, 0.15 *Figures are not mutually exclusive

Awareness about Mosquito Borne Diseases in Rural and Urban Areas of Delhi 205 females ( p > 0.05) regarding knowledge about symptoms of malaria. Knowledge about symptoms of malaria was significantly different only for symptom fever with chills/rigor with 2 = 20.32, df = 1, p =0.01 in different education classes. Regarding knowledge of study subjects about symptoms of dengue; fever was told by 31 (14.8%) rural and 17 (12.1%) urban participants with no significant difference in two areas ( 2=0.48, df=1, p =0.48). There was no significant difference in knowledge about symptoms of dengue in males and females ( p > 0.05). There was difference in knowledge about fever as symptom of dengue in education classes was significant ( 2=16.60, df=4, p =0.01). Biting time of dengue vector was known to 40 (19.0%) rural and 18 (12.9%) urban area respondents ( 2=2.32, df=1, p =0.12). Table 3 shows results when study subjects were asked if they were aware of how mosquito borne diseases can be prevented. The responses given were; prevention of stagnation of water by 174 (49.7%), covering water containers by 145 (41.1%), use of personal protective measures by 20 (5.7%) subjects etc. Regarding the sources of information about mosquito borne diseases, 116 (55.2%) rural and 82 (58.6%) urban subjects responded Television. 53 (25.2%) rural and 28 (20.0%) urban area respondents mentioned radio. Hoarding and posters/ pamphlets were told by 33 (15.7%) rural and 35 (25.0%) urban and 25 (11.9%) rural and 35 (25.0%) urban area subjects respectively. The findings were significantly different between rural and urban area for hoarding and posters/pamphlets with 2=4.62, df=1, p =0.03 and 2=10.14, df=1, p =0.01. DISCUSSION The study found that 65.1% participants were able to name malaria, 62.3% dengue and 10.0% chikungunya as mosquito borne disease. These findings are consistent with another study conducted by Pandit N et al in Vadodara where it was found that 71.0% of participants knew that mosquito bite causes malaria while 39.0% had knowledge that dengue, chikungunya are transmitted by 10 mosquitoes. The reason of higher awareness about dengue in present study may be because of awareness campaign and frequent occurrence of dengue epidemics in Delhi. Another study by Surendran SN et al reported that 77.0% of study subjects were able to name at least 1 disease transmitted by 11 mosquitoes. The present study shows that knowledge about mosquito borne diseases was significantly associated with education status of the participants. This is consistent with findings of another study by Sharma AK 12 et al. Likewise the study carried out by Van Benthem BH et al, knowledge about mosquito borne diseases was not significantly different 13 by gender and area. Some subjects answered tuberculosis and typhoid, when they were asked about names of diseases spread by mosquitoes. These responses are similar to those given by participants of another study by Matta S et al where 17.0% subjects responded diarrhoea and typhoid in response 14 to question on mosquito borne diseases. This highlights the need of spreading correct knowledge about mosquito borne diseases. 24.3% subjects were aware of fever with chills/rigor as symptom of malaria. The findings were not significantly different in either sex. However the results were significantly different in education classes.

206 Kohli C et al These knowledge about symptoms are comparatively less than the findings reported in another study conducted in Uttar Pradesh (UP) by Sood RD et al where 82.0% of the villagers knew about the symptoms of malaria such as fever, cold and periodic 15 shivering. The higher prevalence of malaria in UP may be a reason for more awareness of its symptoms among study subjects. Although 62.3% subjects knew that dengue spread by mosquito bite, only 13.7% knew fever as a symptom. There is a need to intensify the awareness programs to educate the community about symptoms of dengue and malaria so that they can identify the disease at an early stage and seek medical care. In another study conducted by Aggarwal MK et al, it was also found that low percentage of respondents were able to correctly identify typical symptoms of dengue such as fever (49.5%), rashes (34.0%), joints pain (32.5%) and muscle pain (2.1%) but the figures are still higher than found in the 16 present study. Other studies have reported higher knowledge regarding symptoms of dengue viz. 57.5% awareness of fever as the presenting symptom of dengue while 34.9% of the respondents were not aware of any of 17 the symptoms. Knowledge about dengue and its symptoms was significantly associated with education of subjects as reported 18,19 by other studies as well. REFERENCES 1. WHO. Vector borne diseases in India: Report of a brainstorming session. Geneva: World Health Organization [Internet]. 2006 [cited 2011 Aug 15]. Available from: http://www. searo.who.int/linkfiles/cds_vectorborne_ diseases_ in_india.pdf. 2. WHO. World Malaria Report. Geneva: World Health Organization [Internet]. 2009 [cited 2013 May 11]. Available from: http:// whqlibdoc. who.int/publications/2009/9789241563901_eng. pdf. 3. Lopez AD, Mathers CD. Measuring the global burden of disease and epidemiological transitions: 2002-2030. Ann Trop Med Parasitol 2006; 100(5-6): 481-499. 4. Boratne A, Datta S, Singh Z, Purty A, Jayanti V, Senthilvel V. Attitude and practices regarding mosquito borne diseases and socio demographic determinants for use of personal protection methods among adults in coastal Pondicherry. Ind J Med Specialities 2010; 1(2): 91-96. 5. Guzman MG, Kouri G. Dengue: an update. Lancet Infect Dis 2002; 2(1): 33-42. 6. Krishnamoorthy K, Harichandrakumar KT, Kumari AK, Das LK. Burden of chikungunya in India: estimates of disability adjusted life years (DALY) lost in 2006 epidemic. J Vector Borne Dis 2009; 46: 26-35. 7. Ramaiah KD, Das PK, Michael E, Guyatt H. The economic burden of lymphatic filariasis in India. Parasitol Today 2000; 16: 251-253. 8. Kabilan L, Rajendran R, Arunachalam N, Ramesh S, Srinivasan S, Samuel PP et al. Japanese encephalitis in India: an overview. Indian J Pediatr 2004; 71: 609-615. 9. Snehlata KS, Ramaiah KD, Kumar V, Das P. The mosquito problem and type and cost of personal protection as a measure used in rural and urban communities in Pondicherry region, South India. Acta Trop 2003; 88(1): 3-9. 10. Pandit N, Patel Y, Bhavsar B. Awareness and practice about preventive method against mosquito bite in Gujarat. Healthline 2010; 1(1): 16-20. 11. Surendran SN, Kajatheepan A. Perception and personal protective measures toward mosquito bites by communities in Jaffna district, northern Sri Lanka. J Am Mosq Control Assoc 2007; 23(2): 182 186.

Awareness about Mosquito Borne Diseases in Rural and Urban Areas of Delhi 207 12. Sharma AK, Bhasin S, Chaturvedi S. Predictors of knowledge about malaria in India. J Vector Borne Dis 2007; 44(3): 189-197. 13. Van Benthem BH, Khantikul N, Panart K, Kessels PJ, Somboon P, Oskam L. Knowledge and use of prevention measures related to dengue in northern Thailand. Trop Med Int Health 2002; 7(11): 993-1000. 14. Matta S, Khokhar A, Sachdev TR. Assessment of knowledge about malaria among patients reported with fever: a hospital-based study. J Vector Borne Dis 2004; 41(1-2): 27-31. 15. Sood RD, Mittal PK, Kapoor N, Razdan RK, Dua VK, Dash AP. Community awareness, perceptions, acceptability and preferences for using LLIN against malaria in villages of Uttar Pradesh, India. J Vector Borne Dis 2010; 47(4): 243-248. 16. Aggarwal MK, Dattal U, Tekhre YL. Knowledge, attitudes and practices of community in anti-malaria activities in a Delhi slum. Health Popul Perspect Issues 2004; 27(2): 95-116. 17. Naik PR, Nirgude AS, Prakash GK. Knowledge and preventive practices regarding dengue among adult population of rural area of Nalgonda district, South India. Int J Biol Med Res 2011; 2(3): 652-655. 18. Naing C, Ren WY, Man CY, Fern KP, Qiqi C, Ning CN et al. Awareness of dengue and practice of dengue control among the semiurban community: a cross sectional survey. J Community Health 2011; 36(6): 1044-1049. 19. Syed M, Saleem T, Syeda UR, Habib M, Zahid R, Bashir A et al. Knowledge, attitudes and practices regarding dengue fever among adults of high and low socioeconomic groups. J Pak Med Assoc 2010; 60(3): 243-247.

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