Effectiveness of the Integrated Dengue Education and Learning (iDEAL) module in improving the knowledge, attitude, practice, environmental cleanliness index, and dengue index among schoolchildren: A randomised controlled trial protocol.

BACKGROUND: Dengue is a mosquito-borne disease caused by four distinct, closely related dengue viruses (DENV). Global dengue incidence has markedly increased in the past decades. The World Health Organization reported that cases increased from 505,430 in 2000 to 5.2 million in 2019. Similarly, the total dengue cases in Malaysia increased from 7,103 in 2000 to a peak of 130,101 in 2019. Knowledge, attitude, and practice (KAP) remain the most effective dengue prevention and control tools. Furthermore, school-based health education is key to enhancing knowledge and raising awareness of the seriousness of dengue among schoolchildren and transferring knowledge and practice from classrooms to homes. Thus, it is necessary to plan an integrated module for the primary prevention of dengue infection, specifically among schoolchildren. AIMS: The present study intends to develop, implement, and evaluate the effectiveness of a theory-based integrated dengue education and learning (iDEAL) module in improving the KAP, environmental cleanliness index, and dengue index among schoolchildren in Selangor and Kuala Lumpur. METHODS: This study is a single-blinded, cluster randomised controlled trial to be conducted from 1 September 2023 to 31 August 2025. The study will involve 20 primary and 20 secondary schools in Selangor and Kuala Lumpur. The 1600 participants will be randomly allocated to intervention and control groups based on selected clusters to avoid contamination. A cluster is a comparable school that fulfils the inclusion and exclusion criteria. The intervention group will receive the iDEAL module, while the control group will receive standard education. The iDEAL module will be developed following a systematic procedure and delivered in-person by trained researchers to the participants. The outcome will be measured using validated, self-administered questionnaires at baseline (T0), immediately (T1), one month (T2), and three months (T3) post-intervention to measure the intervention module effectiveness. The data will be analysed using IBM Statistical Package for Social Science (SPSS) version 28 and descriptive and inferential statistics. Within-group changes over time will be compared using one-way repeated measure analysis of variance for continuous and normally distributed variables. Within-group analysis of categorical data will use Cochran's Q test. The main effect and interaction between and within the intervention and control groups at T0, T1, T2, and T3 will be tested using the generalised linear mixed model (GLMM). Hypothetically, the KAP, environmental cleanliness index, and dengue index among the intervention group will be significantly improved compared to the control group. The hypothesis will be tested using a significance level with a p-value of 0.05 and a confidence interval of 95%. CONCLUSIONS: The study protocol outlines developing and testing an iDEAL module for schoolchildren in Selangor and Kuala Lumpur, with no socio-demographic differences expected. The intervention aims to improve KAP, environmental cleanliness index, and dengue index, potentially reducing dengue risk. Results could inform public health policies, emphasizing school-based interventions' importance in combating diseases like dengue.

Insecticide resistance in dengue vectors from hotspots in Selangor, Malaysia.

BACKGROUND: In Malaysia, dengue remains a top priority disease and usage of insecticides is the main method for dengue vector control. Limited baseline insecticide resistance data in dengue hotspots has prompted us to conduct this study. The present study reports the use of a map on the insecticide susceptibility status of Aedes aegypti and Aedes albopictus to provide a quick visualization and overview of the distribution of insecticide resistance. METHOD AND RESULTS: The insecticide resistance status of Aedes populations collected from 24 dengue hotspot areas from the period of December 2018 until June 2019 was proactively monitored using the World Health Organization standard protocol for adult and larval susceptibility testing was conducted, together with elucidation of the mechanisms involved in observed resistance. For resistance monitoring, susceptibility to three adulticides (permethrin, deltamethrin, and malathion) was tested, as well as susceptibility to the larvicide, temephos. Data showed significant resistance to both deltamethrin and permethrin (pyrethroid insecticides), and to malathion (organophosphate insecticide) in all sampled Aedes aegypti populations, while variable resistance patterns were found in the sampled Aedes albopictus populations. Temephos resistance was observed when larvae were tested using the diagnostic dosage of 0.012mg/L but not at the operational dosage of 1mg/L for both species. CONCLUSION: The present study highlights evidence of a potential threat to the effectiveness of insecticides currently used in dengue vector control, and the urgent requirement for insecticide resistance management to be integrated into the National Dengue Control Program.

Vertical Infestation Profile of Aedes in Selected Urban High-Rise Residences in Malaysia.

Dengue is placing huge burdens on the Malaysian healthcare system as well as the economy. With the expansion in the number of high-rise residential buildings, particularly in the urban centers, the flight range and behavior of Aedes mosquitoes may be altered in this habitat type. In this study, we aimed to expand the understanding of the vertical distribution and dispersal of Aedes in nine selected high-rise residences in Kuala Lumpur, Selangor, and Johor using ovitraps as the sampling method. We discovered that Ae. aegypti is the predominant species in all study sites. Both Ae. aegypti and Ae. albopictus are most abundant within the first three levels and could be found up to level 21 (approximately 61.1-63.0 m). Pearson correlation analyses exhibited negative correlations in eight out of nine study sites between the ovitrap indexes (OIs) within each floor level, suggesting that Aedes density decreased as the building level increased. Our findings provide information to the public health authorities on 'hot spot' floors for effective suppression of dengue transmission.

Semi-field evaluation of the bio-efficacy of two different deltamethrin formulations against Aedes species in an outdoor residual spraying study.

In recent decades, dengue incidence has trended upward worldwide causing urgent needs for new or modified vector control methods. We modified the existing indoor residual spraying (IRS) method by applying insecticide on the outer walls of building structures in an outdoor residual spraying (ORS) study. A semi-field study was conducted to investigate the bio-efficacy of two different deltamethrin formulations: K-Othrine® Polyzone, new polymer-enhanced deltamethrin formulated as a suspension concentrate (SC-PE), and K-Othrine® WG 250, traditional deltamethrin formulated as water dispersible granule (WG). The residual bio-efficacy of deltamethrin SC-PE was compared to deltamethrin WG on finished cement surfaces applied to the outer walls at the Institute for Medical Research (IMR), Malaysia. Standard WHO cone wall bioassays were adapted to evaluate the effective duration of action of these deltamethrin formulations against susceptible laboratory-reared and wild, free-flying Aedes aegypti and Ae. albopictus. Analyses of bioassay results showed that deltamethrin SC-PE 30 mg/m2 has improved longevity in comparison to deltamethrin WG 30 mg/m2. Deltamethrin SC-PE 30 mg/m2 was effective until week 17 (producing > 80% mortality), surpassing deltamethrin WG 30 mg/m2 which only lasted until week 10. This was supported by post-hoc test analyses which demonstrated that deltamethrin SC-PE 30 mg/m2 produced the highest mean of mortality in laboratory-reared Aedes species and the wild Ae. albopictus. However, the effective duration of action of deltamethrin SC-PE (17 weeks) was less than the recommended period by WHO (6 months) but was reasonable given that the spraying was undertaken outdoor. This preliminary data could be of use for the deployment of locally adapted ORS operation in controlling dengue.