Different domains of dengue research in the Philippines: A systematic review and meta-analysis of questionnaire-based studies.

BACKGROUND: Dengue is the most rapidly spreading mosquito-borne viral disease of humans worldwide, including southeast Asia region. This review provides a comprehensive overview of questionnaire-related dengue studies conducted in the Philippines and evaluates their reliability and validity in these surveys. METHODS: A review protocol constructed by a panel of experienced academic reviewers was used to formulate the methodology, research design, search strategy and selection criteria. An extensive literature search was conducted between March-June 2020 in various major electronic biomedical databases including PubMed, EMBASE, MEDLINE and ScienceDirect. A systematic review and meta-analysis (PRISMA) were selected as the preferred item reporting method. RESULTS: Out of a total of 34 peer-reviewed dengue-related KAP studies that were identified, 15 published from 2000 to April 2020 met the inclusion criteria. Based on the meta-analysis, a poor mean score was obtained for each of knowledge (68.89), attitude (49.86) and preventive practice (64.69). Most respondents were equipped with a good knowledge of the major clinical signs of dengue. Worryingly, 95% of respondents showed several negative attitudes towards dengue prevention, claiming that this was not possible and that enacting preventive practices was not their responsibility. Interestingly, television or radio was claimed as the main source of gaining dengue information (range 50-95%). Lastly, only five articles (33.3%) piloted or pretested their questionnaire before surveying, of which three reported Cronbach's alpha coefficient (range 0.70 to 0.90). CONCLUSION: This review indicates that to combat the growing public health threat of dengue to the Philippines, we need the active participation of resident communities, full engagement of healthcare personnel, promotion of awareness campaigns, and access to safe complementary and alternative medicines. Importantly, the psychometric properties of each questionnaire should be assessed rigorously.

Medical practitioner's knowledge on dengue management and clinical practices in Bhutan.

BACKGROUND: Dengue has emerged as a major public health problem in Bhutan, with increasing incidence and widening geographic spread over recent years. This study aimed to investigate the knowledge and clinical management of dengue among medical practitioners in Bhutan. METHODS: We administered a survey questionnaire to all practitioners currently registered under the Bhutan Medical and Health Council. The questionnaire contained items on four domains including transmission, clinical course and presentation, diagnosis and management, and surveillance and prevention of dengue. Participants were able to respond using an online Qualtrics survey, with the invitation and link distributed via email. RESULTS: A total of 97 respondents were included in the study (response rate: 12.7%), of which 61.86% were Health Assistants/Clinical Officers (HAs/COs) and 38.14% were medical doctors. The afternoon feeding behaviour of Aedes mosquito was correctly identified by only 24.7% of the respondents, and ~66.0% of them failed to identify lethargy as a warning sign for severe dengue. Knowledge on diagnosis using NS1 antigen and the clinical significance of elevated haematocrit for initial fluid replacement was strikingly low at 47.4% and 27.8% respectively. Despite dengue being a nationally notifiable disease, ~60% of respondents were not knowledgeable on the timing and type of cases to be reported. Respondent's median score was higher for the surveillance and reporting domain, followed by their knowledge on transmission of dengue. Statistically significant factors associated with higher knowledge included respondents being a medical doctor, working in a hospital and experience of having diagnosed dengue. CONCLUSION: The study revealed major gaps on knowledge and clinical management practices related to dengue in Bhutan. Physicians and health workers working in Basic Health Units need training and regular supervision to improve their knowledge on the care of dengue patients.

The impact of dengue illness on social distancing and caregiving behavior.

BACKGROUND: Human mobility among residential locations can drive dengue virus (DENV) transmission dynamics. Recently, it was shown that individuals with symptomatic DENV infection exhibit significant changes in their mobility patterns, spending more time at home during illness. This change in mobility is predicted to increase the risk of acquiring infection for those living with or visiting the ill individual. It has yet to be considered, however, whether social contacts are also changing their mobility, either by socially distancing themselves from the infectious individual or increasing contact to help care for them. Social, or physical, distancing and caregiving could have diverse yet important impacts on DENV transmission dynamics; therefore, it is necessary to better understand the nature and frequency of these behaviors including their effect on mobility. METHODOLOGY AND PRINCIPAL FINDINGS: Through community-based febrile illness surveillance and RT-PCR infection confirmation, 67 DENV positive (DENV+) residents were identified in the city of Iquitos, Peru. Using retrospective interviews, data were collected on visitors and home-based care received during the illness. While 15% of participants lost visitors during their illness, 22% gained visitors; overall, 32% of all individuals (particularly females) received visitors while symptomatic. Caregiving was common (90%), particularly caring by housemates (91%) and caring for children (98%). Twenty-eight percent of caregivers changed their behavior enough to have their work (and, likely, mobility patterns) affected. This was significantly more likely when caring for individuals with low "health-related quality of well-being" during illness (Fisher's Exact, p = 0.01). CONCLUSIONS/SIGNIFICANCE: Our study demonstrates that social contacts of individuals with dengue modify their patterns of visitation and caregiving. The observed mobility changes could impact a susceptible individual's exposure to virus or a presymptomatic/clinically inapparent individual's contribution to onward transmission. Accounting for changes in social contact mobility is imperative in order to get a more accurate understanding of DENV transmission.

Stakeholders' attitudes to outdoor residual spraying technique for dengue control in Malaysia: A PLS-SEM approach.

Outdoor Residual Spraying (ORS) technique is a complementary preventive measure for dengue. The alarming number of dengue cases in Malaysia requires an alternative method to control dengue besides the traditional method such as fogging. However, the introduction of new technologies depends on social acceptance. Therefore, this study was important to determine the factors that influence stakeholders' attitudes towards the ORS and the moderating factor. A validated instrument was used to randomly interview 399 respondents representing two stakeholder groups which consist of scientists, and the public in Klang Valley, Malaysia. The findings revealed that the stakeholders claimed to have a high degree of religiosity, a high level of trust in the key players, perceived ORS as having high benefits, and displayed highly positive attitudes towards the ORS. The attitudes model towards the ORS model was developed using the SmartPLS software version. The perceived benefit was endorsed as the most important direct predictor of attitudes towards the ORS (ß = 0.618, P<0.001), followed by trust in the key players (ß = 0.151, P<0.001). It is also interesting to note that religiosity served as a moderator for the association between perceived benefit (ß = 0.075, P = 0.024) and perceived risk (ß = 0.114, P = 0.006) with attitudes towards the ORS. The identified predictor factors of stakeholders' attitudes toward the ORS and the moderating factor can serve as indicators for social acceptance of ORS in developing countries. These indicators can help the policymakers in decision making to implement this technique.

Factors associated with the willingness of primary caregivers to avail of a dengue vaccine for their 9 to 14-year-olds in an urban community in the Philippines.

To help address the need for preventive measures against dengue fever, a leading cause of child mortality in the Philippines, vaccine trials are ongoing and a tetravalent vaccine (Dengvaxia™, Sanofi Pasteur) has been developed. It is hypothesized that while acceptability would be high among primary caregivers (i.e., parents/guardians), the willingness to have one's child immunized against dengue would be associated with socio-demographic variables, attitudes and knowledge regarding dengue and vaccination, and past experience with dengue. This study aimed to assess the aforementioned factors' association with primary caregivers' willingness to avail of a dengue vaccine for their 9 to 14-year-old children in an urban community in the Philippines. A cross-sectional study utilizing interviews was conducted to determine which factors were associated with willingness-to-avail assuming a free vaccine, and a case study utilizing a focus group discussion was employed to capture some underlying reasons for their willingness. Data were analyzed using multiple logistic regression and thematic analysis. Among the 202 study participants, 193 (95.54%) were willing to avail of the vaccine. There was a high probability of vaccine acceptance by primary caregivers (95.54%), with good attitude towards vaccination (≥12/15 points) [aOR 10.62, 90% CI (1.73-26.28)] and large household size (>5) [aOR 9.63, 90% CI (2.04-45.58)] being positively associated with willingness-to-avail, and good knowledge regarding dengue fever [aOR 0.10, 90% CI (0.03-0.74)] and older age (>44 years) [aOR 0.14, 90% CI (0.03-0.61)] being negatively associated. Crude analysis showed that household size, knowledge regarding dengue, and attitude towards vaccination were significantly associated with willingness. Multivariate analysis revealed that these factors and the primary caregiver's age were associated with willingness. Thematic analysis showed various perceptions regarding dengue and vaccination. Knowing these factors are associated with willingness-to-avail of the vaccine may help in understanding the audience of health promotion projects aimed at increasing immunization coverage.

Depressive and Anxiety Symptoms among Pediatric In-Patients with Dengue Fever: A Case-Control Study.

BACKGROUND: Psychiatric symptoms have been reported in adult patients with dengue fever (DF); however, information on pediatric patients remains inadequate. We sought to identify the prevalence and predictors of depressive and anxiety symptoms and identify other psychiatric symptoms among pediatric patients with DF. This case-control study involved pediatric in-patients (n = 225) who had clinical or serologic-confirmed DF and healthy school-based controls (n = 260). Participants completed the Revised Child Anxiety and Depression Scale (RCADS). RESULTS: The prevalence of depressive (13.3%) and anxiety (34.2%) symptoms among pediatric patients with DF was significantly (p < 0.001) higher than that among controls (3.5% and 16.2%, respectively). Multiple linear regression analysis found that age, family history of DF, ≤2 days of hospitalization, myalgia, and arthralgia were predictors of increased depressive and anxiety symptoms among the patients. Further, 26.7% of pediatric patients reported irritability, agitation, visual hallucinations, and aggressiveness. CONCLUSION: Pediatric patients present depressive and anxiety symptoms whose levels were associated with social and clinical factors. However, whether these symptoms are present only during the infection or may still persist after recovery or are brought by children's adverse reactions to hospitalization are unknown, and thus, further studies are needed.

Pérdida de calidad de vida y carga económica causada por dengue desde la perspectiva de pacientes y sus familiares / Loss of quality of life and economic burden caused by dengue fever from the perspective of patients and their families

Introducción: En Cuba hay pocos datos disponibles sobre la pérdida de calidad de vida relacionada con la salud y la carga económica para los pacientes de dengue y sus familiares. Objetivo: Describir la pérdida de calidad de vida relacionada con la salud y la carga económica del dengue para los pacientes y sus familiares. Métodos: Se aplicó un cuestionario a 92 pacientes adultos confirmados de dengue y hospitalizados en el Hospital Clínico Quirúrgico Docente Ambrosio Grillo de Santiago de Cuba, entre enero y octubre 2015; también se les aplicó a sus familias. Se calculó la pérdida promedio de calidad de vida a través de una escala analógica (0-100) y de los costos no médicos directos (gastos de bolsillo) e indirectos por paciente. Resultados: la pérdida global de calidad de vida fue de 67,9 por ciento en el peor momento de la enfermedad. El promedio de días autopercibidos hasta la recuperación fue 13,1. El promedio de visitas por paciente a los servicios ambulatorios antes de la hospitalización fue 1,3, y el policlínico resultó el servicio más utilizado. La estadía hospitalaria promedio fue 3,96 noches. Ningún enfermo presentó dengue grave. Los costos no médicos directos para los pacientes y sus familiares, fueron 7,95 USD (CUC). El 44,7 por ciento fue utilizado en transporte y 32,0 por ciento en alimentación, financiados principalmente con los ahorros personales y donaciones de familiares y amigos. Los costos indirectos promedio fueron 4,10 USD (CUC). Conclusión: Hubo una sustancial pérdida de calidad de vida durante la enfermedad. Los costos no médicos directos y los indirectos para los pacientes y familiares fueron bajos. La carga económica asumida por el gobierno es 12 veces mayor que estos(AU)

Introduction: Few data are available in Cuba about the loss of health-related quality of life and the economic burden caused by dengue fever to patients and their families. Objective: Describe the loss of health-related quality of life and the economic burden caused by dengue fever to patients and their families in Santiago de Cuba. Method: A questionnaire was applied to 92 adult patients with confirmed dengue fever admitted to Ambrosio Grillo Clinical Surgical University Hospital in Santiago de Cuba from January to October 2015. The questionnaire was also applied to their relatives. An analog scale (0-100) was used to estimate average loss of quality of life as well as indirect and direct non-medical costs expenses incurred by patients. Results: Global loss of quality of life was 67.9 percent at the worst stage of the condition. Average self-perceived days until recovery were 13.1. Average visits to outpatient services per patient before hospitalization were 1.3. The polyclinic was the most commonly used service. Average hospital stay was 3.96 nights. No patient had severe dengue fever. Direct non-medical expenses incurred by patients and their families were USD 7.95 (CUC), 44.7 percent of which were spent on transportation and 32.0 percent on food. These were mainly covered by personal savings and donations from relatives and friends. Average indirect expenses were USD 4.10 (CUC). Conclusion: There was considerable loss of quality of life during the disease. Patients and their families incurred low non-medical direct and indirect expenses. The economic burden undertaken by the government is 12 times as high(AU)

Public perception and attitude towards dengue prevention activity and response to dengue early warning in Malaysia.

An early warning system for dengue is meant to predict outbreaks and prevent dengue cases by aiding timely decision making and deployment of interventions. However, only a system which is accepted and utilised by the public would be sustainable in the long run. This study aimed to explore the perception and attitude of the Malaysian public towards a dengue early warning system. The sample consisted of 847 individuals who were 18 years and above and living/working in the Petaling District, an area adjacent to Kuala Lumpur, Malaysia. A questionnaire consisting of personal information and three sub-measures of; i) perception, ii) attitude towards dengue early warning and iii) response towards early warning; was distributed to participants. We found that most of the respondents know about dengue fever (97.1%) and its association with climate factors (90.6%). Most of them wanted to help reduce the number of dengue cases in their area (91.5%). A small percentage of the respondents admitted that they were not willing to be involved in public activities, and 64% of them admitted that they did not check dengue situations or hotspots around their area regularly. Despite the high awareness on the relationship between climate and dengue, about 45% of respondents do not know or are not sure how this can be used to predict dengue. Respondents would like to know more about how climate data can be used to predict a dengue outbreak (92.7%). Providing more information on how climate can influence dengue cases would increase public acceptability and improve response towards climate-based warning system. The most preferred way of communicating early warning was through the television (66.4%). This study shows that the public in Petaling District considers it necessary to have a dengue warning system to be necessary, but more education is required.

Impact of a Nonfatal Dengue Episode on Disability-Adjusted Life Years: A Systematic Analysis.

As dengue causes about 4,000 symptomatic nonfatal episodes for every dengue death globally, quantitative disability assessments are critical to assess the burden of dengue and the cost-effectiveness of dengue control interventions. This systematic analysis of disability or quality of life lost from a symptomatic nonfatal dengue episode combined a systematic literature review, statistical modeling, and probabilistic sensitivity analyses. We conceptualized a dengue episode as having two phases: acute and persistent symptoms. Our estimates for the acute phase, consisting of onset and recovery periods and defined as the first 20 days (0.054 year), were based on literature review. We searched PubMed, POPLINE, EconLit, Google Scholar, scientific conferences, and other sources, for "dengue" plus "quality of life" or related terms. From 4,322 initial entries, six met our criteria (original studies with empirical data). The median disability-adjusted life year (DALY) burden for the acute phase was 0.011 (95% certainty interval [CI]: 0.006-0.015) for ambulatory episodes, 0.015 (CI: 0.010-0.020) for hospitalized episodes, and 0.012 (CI: 0.006-0.019) overall. Using literature reviews about persistent dengue, we estimated that 34% of episodes experienced persistent symptoms with a median duration of symptoms of 0.087 (CI: 0.040-0.359) year, which resulted in median DALYs of 0.019 (CI: 0.008-0.082). Thus, the overall median DALY burden was 0.031 (CI: 0.017-0.092) for ambulatory episodes, 0.035 (CI: 0.024-0.096) for hospitalized episodes, and 0.032 (CI: 0.018-0.093) overall. Our dengue-specific burden of a dengue episode was 2.1 times the 2013 Global Burden of Disease estimate. These literature-based estimates provide an empirical summary for policy and cost-effectiveness analyses.

Cost-of-Illness and the Health-Related Quality of Life of Patients in the Dengue Fever Outbreak in Hanoi in 2017.

Dengue fever (DF) outbreaks occur intermittently in Vietnam, and the most recent epidemic happened in 2017. However, attempts to measure the burden of DF in relation to the quality of life and the cost of treatment for patients during an epidemic period are constrained. This study explored the health-related quality of life (HRQOL) and the cost of illness among patients with dengue fever in Vietnam. A cross-sectional study was conducted in Bach Mai Hospital from September to November 2017. The EuroQol-5 dimensions-5 levels (EQ-5D-5L) was used to measure HRQOL. Cost-of illness was measured by collecting data about the direct medical cost, the non-medical cost, and the indirect cost. Among 225 patients, most of the participants experienced problems regarding mobility (62.3%), self-care (71.8%), usual activities (64.6%), and anxiety/depression (64.1%). The mean EQ-5D index was 0.66 (SD = 0.24). The median cost of illness for inpatient and outpatient groups were US $110.10 (IQR = US $4.40⁻1200.00) and US $36.10 (IQR = US $1.80⁻816.30), respectively. Indirect costs accounted for a major proportion in both groups. Lower-skilled workers and those with a higher severity of the disease had significantly lower HRQOL. Meanwhile, people who were inpatients, had comorbidities, had higher incomes, and who experienced a longer disease duration, had a higher cost of treatment. In conclusion, high costs and severe health deterioration, especially in psychological dimensions, were found in patients with DF in Vietnam. Strengthening primary health care services and communication campaigns are necessary to relieve the burden of diseases and could possibly contribute to effective DF control and prevention strategies.

Are Perceived Prevalences of Infection also Biased and How? Lessons from Large Epidemics of Mosquito-Borne Diseases in Tropical Regions.

BACKGROUND: Although people are likely to underestimate the frequencies of risks to health from common diseases and overestimate those from rare diseases, we still do not know much about reasons for this systematic bias, which is also referred to as "primary bias" in the literature. In this study, we take advantage of a series of large epidemics of mosquito-borne diseases to examine the accuracy of judgments of risk frequencies. In this aim, we assessed the perceived v. observed prevalence of infection by Zika, chikungunya or dengue fever during these outbreaks, as well as their variations among different subpopulations and epidemiological settings. METHODS: We used data drawn from 4 telephone surveys, conducted between 2006 and 2016, among representative samples of the adult population in tropical regions (Reunion, Martinique, and French Guiana). The participants were asked to estimate the prevalence of these infections by using a natural frequency scale. RESULTS: The surveys showed that 1) most people greatly overestimated the prevalence of infection by arbovirus, 2) these risk overestimations fell considerably as the actual prevalence of these diseases increased, 3) the better-educated and male participants consistently yielded less inaccurate risk estimates across epidemics, and 4) these biases in the perception of prevalence of these infectious diseases are relatively well predicted by the probability weighting function developed in the field of behavioral decision making. CONCLUSIONS: These findings suggest that the primary bias, which has been found in laboratory experiments to characterize a variety of probabilistic judgments, equally affects perception of prevalence of acute infectious diseases in epidemic settings. They also indicate that numeracy may play a considerable role in people's ability to transform epidemiological observations from their social environment to more accurate risk estimates.

Stress and burnout syndrome in health-care providers treating dengue infection: A cross-sectional study.

INTRODUCTION: Increased prevalence of dengue fever had led to increase stress in providing optimal care for patients. This has been identified as a potential factor that may lead to negative health effects on medical doctors. This study was designed to review the prevalence and associated factors of burnout syndrome (including depression, anxiety, and stress level) among clinicians in the setting of increasing cases of dengue in Malaysia. METHODS: A cross-sectional, multi-centre study was carried out among doctors in contact with patients with dengue infection from four major hospitals in Malaysia in 2015 using Maslach Burnout Inventory and DASS-21 questionnaire. RESULTS: A total of 313 respondents were included in this study with 15.9% of the respondents experiencing high burnout syndrome. Long working hours, depression, anxiety, and stress were significantly associated with high degree of burnout syndrome (p<0.05). However, number of dengue cases reviewed was not significantly associated with the degree of burnout syndrome. Depression and stress were among factors identified as the predictors for burnout syndrome. CONCLUSION: High degree of burnout syndrome among clinicians with significant correlations with symptoms of depression and stress will require early identification to enable early measures to resolve, as well as prevent it. Future studies with more hospitals involvement should be conducted to establish the relationship between the degree of burnout syndrome and prevalence of dengue infection.

Delayed care-seeking and outcome of dengue-infected patients.

A retrospective cohort study was conducted to assess the effect of early (1-4 days after fever onset) and delayed (≥5 days) care-seeking on outcomes of dengue-infected patients. We used data of adult dengue-infected patients treated in Bangkok, Thailand between June 2012 and September 2013. There were 110 patients in the early care-seeking group and 100 in the delayed care-seeking group. There were no deaths. Bleeding complications were not significantly different between the two groups while the latter group had a significantly higher rate of admission compared with the former (98% versus 91.8%, respectively; P = 0.04). Being female was the only factor significantly associated with delayed care-seeking (63.0% versus 45.5%; P = 0.01).

Differences in Perceived Severity of Zika Virus Infection and Dengue Fever and its Influence on Mosquito Control Practices in Malaysia.

The aims of this study were to explore the differences in (1) the perception of severity towards ZIKV infection and dengue fever, and (2) mosquito control practices before and after the ZIKV outbreak were declared a Public Health Emergency of International Concern (PHEIC). Data were collected between Feb to May 2016 using a computer-assisted telephone interviewing system. The median scale score for perceived severity of ZIKV was 3 (interquartile range [IQR] 1-5) versus 4 (IQR 3-5) for dengue (P < 0.001). The scores for mosquito control practices before and after ZIKV was declared a PHEIC were similar, at 4 (IQR 3-5). Multivariate analysis revealed that participants with a higher score for perception of severity of ZIKV were more likely to report greater mosquito control practices after the declaration of the PHEIC (OR 1.822 [95% CI 1.107-2.998]). The emerging ZIKV pandemic requires concerted efforts to enhance mosquito control practices among the Malaysian public. Efforts to improve public mosquito control practices should focus on enhancing the perception of the severity of ZIKV.

Widespread fear of dengue transmission but poor practices of dengue prevention: A study in the slums of Delhi, India.

BACKGROUND: This study has been conducted to throw light on the knowledge and practices related to dengue fever among the poor population living in Delhi's slums. MATERIALS: A household survey was conducted in 2013 among 3,350 households. The households were stratified by a number of variables related to socio-economic status and health events such as hospitalisation. The data collection was completed through face-to-face interviews conducted with the help of 25 field investigators. RESULTS: About 8% of the households had at least one diagnosed dengue case. In comparison to the population surveyed, teenagers (15-19 years) and adults (30-34 years) were more affected whereas children under four years of age were underrepresented. Housewives are more affected by dengue (24%) compared to their share of the population surveyed (17%). Despite the fact that 77% of the respondents are worried about mosquitoes, only 43% of them monitor environment to avoid the presence of breeding sites. CONCLUSION: One cannot exclude the possibility that though young children under the age of four years are exposed to the virus, either their cases were asymptomatic or family members infected during this period had potentially more serious symptoms leading to hospitalisation. This result could thus be explained by budget-related health choices made by this population which do not favour small children. Educational programs should target housewives to improve their impact, as they are the ones mostly responsible for water storage and cleanliness of the house and its neighbourhood. Even with a dengue experience and potentially an acute perception of the risk and its factors, a proper management of environmental conditions is lacking. This along with the fact that word-of-mouth is the main source of information quoted should be a message for municipality health workers to give door-to-door information on how to prevent breeding sites and dengue infection.

Cross-Sectional Survey on the Dengue Knowledge, Attitudes and Preventive Practices Among Students and Staff of a Public University in Malaysia.

Behavioural impact programmes are especially effective for dengue control and prevention. Universities are key settings for health promotion, so understanding factors that influence the practice of dengue prevention within a university community becomes important. This study aimed to examine the factors affecting dengue knowledge, attitude and preventive practices amongst students and staff of a public university. A cross-sectional survey study was conducted in Kuala Lumpur, Malaysia. A total of 372 students and staff of the NDUM were recruited by stratified sampling method. Data were collected via self-administered pre-tested structured questionnaires covering socio-demography and dengue KAP. Data were analysed descriptively. For bivariate analysis, Chi square test was applied. To explore the factors independently associated with the practice of dengue prevention, a logistic regression model was introduced. Overall, the participants had moderate dengue-related knowledge, good attitudes and good preventive practices. The majority had misconceptions about mosquito biting habits (83.8 %), seasonality of dengue epidemics (73.2 %), and mosquito breeding sites (70.3 %). Staff were more likely to have good dengue-related knowledge (p < 0.001) and attitudes (p = 0.008) than students. There was statistically significant positive association between the level of dengue knowledge and monthly average household income (p = 0.008), age (p < 0.001) and education (p < 0.001). Having good attitudes towards dengue was associated with being a non-Malay (p = 0.034), having higher monthly average household income (p = 0.047) and tertiary education (p < 0.001). In regression analysis, only dengue knowledge and dengue attitudes were significantly and positively associated with practice of dengue prevention. Dengue preventive strategies amongst university students and staff should focus on maintaining good dengue-related preventive practices. Educational campaigns should mainly target students, young staff members, and those with lower level of education and income.

Willingness to pay for a dengue vaccine and its associated determinants in Indonesia: A community-based, cross-sectional survey in Aceh.

Vaccination strategies are being considered as a part of dengue prevention programs in endemic countries. To accelerate the introduction of dengue vaccine into the public sector program and private markets, understanding the private economic benefits of a dengue vaccine is therefore essential. The aim of this study was to assess the willingness to pay (WTP) for a dengue vaccine among community members in Indonesia and its associated explanatory variables. A community-based, cross-sectional survey was conducted in nine regencies of Aceh province, Indonesia, from November 2014 to March 2015. A pre-tested validated questionnaire was used to facilitate the interviews. To assess the explanatory variables influencing participants' WTP for a dengue vaccine, a linear regression analysis was employed. We interviewed 677 healthy community members; 476 participants (87.5% of the total) were included in the final analysis. An average individual was willing to pay around US-$ 4 (mean: US-$ 4.04; median: US-$ 3.97) for a dengue vaccine. Our final multivariate model revealed that working as a civil servant, living in the city, and having good knowledge on dengue viruses, a good attitude towards dengue, and good preventive practice against dengue virus infection were associated with a higher WTP (P<0.05). Our model suggests that marketing efforts should be directed to community members who are working in the suburbs especially as farmers. In addition, the results of our study underscore the need for low-cost quality vaccines, public sector subsidies for vaccinations, and intensifying efforts to further educate and encourage households regarding other dengue preventive measures, using trusted individuals as facilitators.

The Self-Regulation Model of Illness: Comparison between Zika and Dengue and Its Application to Predict Mosquito Prevention Behaviours in Malaysia, a Dengue-Endemic Country.

Perceptions about illnesses may influence self-care and preventive health behaviours. Illness perceptions of the Zika virus (ZIKV) infection were investigated under the framework of the Self-Regulation Model of Illness. Illness perception differences between ZIKV and dengue fever were also examined. Lastly, associations between illness perceptions of ZIKV with mosquito prevention practices were studied. Samples were drawn from landline telephone numbers using computer-assisted telephone interviewing in Malaysia. A total of 567 respondents completed the survey between February 2015 and May 2016. The median and interquartile range (IQR) for the total six dimensions of illness perceptions score was higher for dengue (23.0 (IQR 17.0-28.0)) than ZIKV (20.0 (IRQ 11.0-28.0)), p < 0.001. Respondents who planned to have children (OR 1.670, 95% CI 1.035-2.694 vs. no intention to have children) and had friends or acquaintances who died of dengue (OR 2.372, 95% CI 1.300-4.327 vs. no friends who died of dengue) were more likely to have a higher total score for six illness perceptions for ZIKV compared to dengue. Multivariate analysis indicated that the best predictors for mosquito control practices after the ZIKV outbreak was declared a Public Health Emergency of International Concern, in descending order, were causes, control, timeline, and consequences dimensions of illness perception. Understanding the context in which a person perceives ZIKV may contribute to developing interventions that influence prevention behaviours.

Dengue Disease Risk Mental Models in the City of Dhaka, Bangladesh: Juxtapositions and Gaps Between the Public and Experts.

Worldwide, more than 50 million cases of dengue fever are reported every year in at least 124 countries, and it is estimated that approximately 2.5 billion people are at risk for dengue infection. In Bangladesh, the recurrence of dengue has become a growing public health threat. Notably, knowledge and perceptions of dengue disease risk, particularly among the public, are not well understood. Recognizing the importance of assessing risk perception, we adopted a comparative approach to examine a generic methodology to assess diverse sets of beliefs related to dengue disease risk. Our study mapped existing knowledge structures regarding the risk associated with dengue virus, its vector (Aedes mosquitoes), water container use, and human activities in the city of Dhaka, Bangladesh. "Public mental models" were developed from interviews and focus group discussions with diverse community groups; "expert mental models" were formulated based on open-ended discussions with experts in the pertinent fields. A comparative assessment of the public's and experts' knowledge and perception of dengue disease risk has revealed significant gaps in the perception of: (a) disease risk indicators and measurements; (b) disease severity; (c) control of disease spread; and (d) the institutions responsible for intervention. This assessment further identifies misconceptions in public perception regarding: (a) causes of dengue disease; (b) dengue disease symptoms; (c) dengue disease severity; (d) dengue vector ecology; and (e) dengue disease transmission. Based on these results, recommendations are put forward for improving communication of dengue risk and practicing local community engagement and knowledge enhancement in Bangladesh.

Dengue Knowledge and Preventive Practices in Iquitos, Peru.

As part of a cluster-randomized trial to evaluate insecticide-treated curtains for dengue prevention in Iquitos, Peru, we surveyed 1,333 study participants to examine knowledge and reported practices associated with dengue and its prevention. Entomological data from 1,133 of these households were linked to the survey. Most participants knew that dengue was transmitted by mosquito bite (85.6%), but only few (18.6%) knew that dengue vectors bite during daytime. Most commonly recognized dengue symptoms were fever (86.6%), headache (76.4%), and muscle/joint pain (67.9%). Most commonly reported correct practices for mosquito control were cleaning homes (61.6%), using insecticide sprays (23%), and avoiding having standing water at home (12.3%). Higher education was associated with higher knowledge about dengue, including transmission and vector control. Higher socioeconomic status was associated with increased reported use of preventive practices requiring money expenditure. We were less likely to find Aedes aegypti eggs, larvae, or pupae in households that had < 5-year-old children at home. Although dengue has been transmitted in Iquitos since the 1990s and the Regional Health Authority routinely fumigates households, treats domestic water containers with larvicide, and issues health education messages through mass media, knowledge of dengue transmission and household practices for prevention could be improved.