Perception and Practices of Village Health Sanitation and Nutrition Committee (VHSNC) members prevention and control of Dengue

Introduction

Dengue fever (DF) and its severe forms—Dengue Hemorrhagic Fever (DHF) and Dengue Shock Syndrome (DSS)—have become major public health issues of national and internal concern. It is estimated that globally 92 million apparent dengue infections occur every year, of which 70% of the cases belong to the Asian countries. India contributes to around one third of global burden of dengue.¹ . According to World Health Organization annually around 5 lakh people with severe dengue infection require hospitalization, of which 2.5% of the people succumb for it.² India is reporting significant rise in the burden of dengue cases since 2001. Initially dengue was limited to few states in India, but over the years it has become common in almost all the states and union territories.³

Although dengue was considered as urban or semi-urban disease, recently it is becoming endemic in rural areas as well.⁴ Dengue being a disease that is primarily influenced by human behavior, the control of dengue can be achieved only if the communities have adequate knowledge and proper dengue prevention practices.⁵

Government of India had launched National Rural Health Mission (NRHM) which largely envisages the community to take leadership at local level, related to health and related issues. Clearly, it requires involvement of Panchayat Raj Institutions in the management of the health care delivery system. Constitution of Village Health Sanitation and Nutrition Committees (VHSNC) is one of the special initiatives under NRHM to improve the availability and access to quality health care for people residing in rural areas through increased ownership.VHSNC members are expected to take measures to prevent and control the locally endemic diseases through comprehensive community efforts.6 Thus these stake holders are required to have adequate knowledge regarding various communicable diseases like dengue. In this background the present study will be undertaken to assess the perception and practices of VHSNC members on dengue and its prevention in rural areas of Mysuru.

Materials and Methods

After obtaining clearance from Institutional Ethics Committee of JSS Medical College, Mysuru, this cross-sectional study was conducted among VHSNC members of sixteen villages under two randomly selected primary health centers of Mysuru district for a period of six months.

Information regarding socio-demographic characteristics, perception, and practices of VHSNC members about dengue with respect to causes, complications, prevention, and control were done by

Interview method: Using a pre-tested structured Proforma for VHSNC members who could not read and write

Self-administered questionnaire method: Using pre-tested questionnaire for VHSNC members who could read and write

Statistical analysis

The data collected was entered in Microsoft excel-2010 version and analyzed by using SPSSversion 18. Descriptive statistical measures like mean, standard deviation, percentage were applied. Data was represented as tables and figures as relevant. The perception level of study subjects was categorized in the following way:

Correct response to the question asked was given score ‘1’ and wrong answers were given score ‘0’. Total scores per respondent for all the questions were calculated. The scores were further divided into four quartiles. Perception and practice scores of Respondents falling under first quartile (<25% answers are correct) were labeled as poor. Those between first and second and quartile (25-55% answers are correct) were labeled as fair and those between second and third quartile (50-75% answers are correct) were labeled to have satisfactory and above third quartile (>75% answers are correct) were labeled to have good perception and practice.

Results

Among 305 VHSNC members recruited in the study, majority 101 (33.1%) were in the age group of 25-34 years, 254 (83.3%) females, 118 (38.7%) had studied up to high school, 150 (49.3%) were housewives, 296 (97%) were Hindus by religion 227 (74.7%) were from nuclear families and 112 (36.7%) were belonging to lower middle socio economic status according to B G Prasad classification. 160 (53.7%) study participants were representatives of general population in VHSNC followed by 42 (13.8%) Accredited Social Health Activists and Panchayati members, 25 (8.2%) anganwadi workers, 24 (7.9%) school teachers and 8 (2.6%) were junior health assistant females. 164 (53.8%) were having less than three years of experience as members of VHSNC and 230 (75.4%) participants had not received any formal training on their roles and responsibilities and functions of committee. (Table-1)

Among 305 participants, 189 (62.0%) had ever heard of a disease called dengue. Among these participants who had heard of dengue, 99 (52.4%) were aware that dengue is a preventable disease and 75 (39.7%) of them knew that the disease can be fatal if untreated. Among 120 (63.5%) members were aware that dengue is transmitted by bite of mosquito. 36 (30%) of the study participants perceived that the mosquito responsible for transmission of dengue breeds in fresh artificial collection of water. 44 (36.7%) were aware of discarded coconut shells, 42 (35.0%) Waste vehicle tires , 28 (53.3%) thrown plastic cups, 29 (24.2%) unused grinding stone kept outside are the common breeding sites for the mosquitoes. Only 13 (11.0%) members were aware of day biting habit of mosquito and 43 (22.8%) knew about the monsoon and post monsoon season to be the common seasons for dengue transmission. (Table -2)

Among 305 VHSNC members included in the study, 158 (51.9%) of them used to regularly replace water from the containers at least once in a week. When enquired about methods to avoid mosquito bites, majority 165 (54.1%) of participants reported to use bed nets followed by 98 (32.1%) mosquito repellent coils, 60 (19.7%) mosquito repellent creams and oil, wearing full sleeve clothes, 53 (17.7) used to have wire mesh to doors and windows. When enquired about whose responsibility is to control mosquito’s majority 154 (50.5%) of the subjects believed that it is the responsibility of villagers. (Table-3)

Among 189 VHSNC members who had heard of dengue in, majority 105 (55.5%) subjects mentioned that allopathic medicine is most effective in treatment of dengue. 113 (59.8) participants have opted for government health facilities to seek treatment for dengue.

Among 305 VHSNC members included in the, majority 120 (39.3%) were having poor perception regarding dengue followed by 95 (31.1%) fair, 75 (24.6%) satisfactory and 15 (4.9%) good. (Table-4)

Discussion

Dengue is a disease of major public health concern in India. Dengue outbreaks are difficult incidents to manage in rural areas due to lack of availability, accessibility, affordability, and utilization of health care services among rural populace. Thus, prevention of dengue and its outbreaks is a sole strategy that is expected to be effective in these areas. Village health sanitation and nutrition committees are the decision-making bodies at the village level in relation to health, sanitation, and wellbeing. Thus, assessing their perception and practices regarding dengue acts as a key factor for designing educational interventions in prevention and control of the disease in future.

In the present study, 62% of respondents had heard of disease dengue. This finding much lower than the observations made by Itrat A et al,⁷ Nijhawan DM et al⁸ and Bota R et al⁹ where 85% and 89.9% and 94.6% individuals had heard of disease dengue, respectively. Observation of present study is higher compared to the results of study conducted by Heera KC et al¹⁰ in Nepal among people in village development committee at Nepal and Shabadi N et al.¹¹ in rural areas of Mysuru, where 50% and 21% of respondents mentioned that they had heard of disease. This variation in awareness about terminology is attributed to the level of importance the community gives towards the disease, burden of disease in that community and seriousness attached to it.

Only 63.5% of the participants in the present study perceived that dengue is a mosquito borne disease. This is much higher than the observations made by Mohapatra S et al,¹² SinguruS et al4 and Shabadi N et al¹¹ where 17.5%, 40.4% and 42.85% study participants knew about dengue being transmitted by mosquitoes.

Only 30% of the participants in the present study were aware that Aedes aegypti breeds in fresh artificial collection of water. This is in similar lines with the study conducted by JeelaniS et al¹³ in Puducherry where 25% of participants knew that the mosquito breeds in fresh artificial collection of water. Shabadi N et al¹¹ in rural areas of Mysuru reports much lower awareness of 16.6%. This lower knowledge could be attributed to the fact that there is a deep rooted perception that mosquitoes breed in sewage and dirty water and because of which people try to ignore the potential Aedes breeding sites like fresh artificial collections.

In the present study, majority 165 (54.1%) participants reported to use bed nets followed by 98 (32.1%) mosquito repellent coils, 60 (19.7%) mosquito repellent creams and oil, wearing full sleeve clothes, 53 (17.7) used to have wire mesh to doors and windows. In a study conducted by Itrat et al A et al,⁷ and Shaheen S et al, mosquito repellent coils and sprays were the commonly used personal prophylaxis measures. On the other hand, Shabadi N et al¹¹ reports that only 16% and 20% of people using mosquito nets and coils respectively. Personal protection measures against mosquito bites are based on personal preferences and are also determined by sociocultural, economic, and environmental factors. Thus, these measures tend to vary across different localities.

Conclusion

The perception and practices regarding dengue and its prevention were found to be poor among village health sanitation and nutrition committee members in selected primary health center areas of Mysuru. There is a need to undertake focused health education measures to train these community level stakeholders through structured educational interventions.