Societal knowledge, attitude, and practices towards dengue and associated factors in epidemic-hit areas: Geoinformation assisted empirical evidence

Abstract

Dengue is one of Pakistan's major health concerns. In this study, we aimed to advance our understanding of the levels of knowledge, attitudes, and practices (KAPs) in Pakistan's Dengue Fever (DF) hotspots. Initially, at-risk communities were systematically identified via a well-known spatial modeling technique, named, Kernel Density Estimation, which was later targeted for a household-based cross-sectional survey of KAPs. To collect data on sociodemographic and KAPs, random sampling was utilized (n = 385, 5 % margin of error). Later, the association of different demographics (characteristics), knowledge, and attitude factors-potentially related to poor preventive practices was assessed using bivariate (individual) and multivariable (model) logistic regression analyses. Most respondents (>90 %) identified fever as a sign of DF; headache (73.8 %), joint pain (64.4 %), muscular pain (50.9 %), pain behind the eyes (41.8 %), bleeding (34.3 %), and skin rash (36.1 %) were identified relatively less. Regression results showed significant associations of poor knowledge/attitude with poor preventive practices; dengue vector (odds ratio [OR] = 3.733, 95 % confidence interval [CI ] = 2.377-5.861; P < 0.001), DF symptoms (OR = 3.088, 95 % CI = 1.949-4.894; P < 0.001), dengue transmission (OR = 1.933, 95 % CI = 1.265-2.956; P = 0.002), and attitude (OR = 3.813, 95 % CI = 1.548-9.395; P = 0.004). Moreover, education level was stronger in bivariate analysis and the strongest independent factor of poor preventive practices in multivariable analysis (illiterate: adjusted OR = 6.833, 95 % CI = 2.979-15.672; P < 0.001) and primary education (adjusted OR = 4.046, 95 % CI = 1.997-8.199; P < 0.001). This situation highlights knowledge gaps within urban communities, particularly in understanding dengue transmission and signs/symptoms. The level of education in urban communities also plays a substantial role in dengue control, as observed in this study, where poor preventive practices were more prevalent among illiterate and less educated respondents.

Keywords: Community awareness; Cross-sectional study; Dengue fever (DF); Epidemiology; KAPs; Rawalpindi; Spatial analysis.

Fig. 1

Study Area Map of District Rawalpindi; the population of 1998 and 2017 is according to “Pakistan Census 2017,” whereas the raster data representing population and built-up is available from “European Commission's Global Human Settlements Data Portal” (https://ghsl.jrc.ec.europa.eu/datasets.php). We have also identified a major urban zone, Rawalpindi City, based on this population and built-up layers.

Fig. 2

KDE illustrating DF (confirmed cases) magnitude per area (2017–2019). (a) Focused 2017, (b) Focused 2018, (c) Focused 2019 and (d) Focused changes

Fig. 3

Map showing KDE-based spatial isolation (criteria) of potential sample sites for KAPs survey in Rawalpindi metropolitan (Imagery Source: Esri, Maxar, GeoEye, Earthstar Geographics, CNES/Airbus DS, USDA, USGS, AeroGRID, IGN, & the GIS User community).

Fig. 4

The hierarchical flow diagram shows knowledge as a causal factor for attitude while knowledge and attitude can change due to variable socio-demographics. Knowledge and attitudes under the mask of socio-demographics can influence certain preventive practices. As categorical covariates, they can be compared to poor preventive practices using the above methodology, where one category (e.g., good knowledge) is used as a reference and others (e.g., poor knowledge) are tested to determine their potential relationship(s).