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Factors Associated with Dengue Prevention Behaviour in Lowokwaru, Malang, Indonesia: a Cross-Sectional Study

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Factors Associated with Dengue Prevention Behaviour in Lowokwaru, Malang, Indonesia: a Cross-Sectional Study Rakhmani et al. BMC Public Health (2018) 18:619 https://doi.org/10.1186/s12889-018-5553-z RESEARCH ARTICLE Open Access Factors associated with dengue prevention behaviour in Lowokwaru, Malang, Indonesia: a cross-sectional study Alidha Nur Rakhmani1,2, Yanin Limpanont1* , Jaranit Kaewkungwal3 and Kamolnetr Okanurak1* Abstract Background: Dengue prevention is important for controlling the spread of dengue infection. Transmission of dengue can be prevented by controlling mosquito breeding sites. Indonesia has dengue a prevention program to minimize mosquito breeding sites known as 3 M Plus. This study aimed to investigate factors associated with dengue prevention behaviour among respondents in the Lowokwaru subdistrict, an urban area in Malang, Indonesia. Methods: This cross-sectional study used a semi-structured questionnaire that was conducted by face-to-face interview. Results: Older respondents (> 60 years and 41–60 years) showed better dengue prevention behaviour than younger respondents (21–40 years and < 21 years) (p value = 0.01). Proportionally more male respondents showed poor dengue prevention behaviour compared with female respondents (p value = 0.007). Respondents who lived in Malang for long durations showed better dengue prevention behaviour compared with those who lived there for a shorter period (p value = 0.016). Those with more family members in their households practiced better dengue prevention behaviour compared with those with fewer family members (p value = 0.004). Perception was associated with dengue prevention behaviour. Respondents who had higher perceived susceptibility showed better dengue prevention behaviour compared with those who had moderate perceptions (p value = 0.000). Conclusions: Age, gender, duration of stay in Malang, number of family members, and perception of dengue susceptibility were associated with dengue prevention behaviour. Keywords: Dengue, Prevention, Behaviour, Urban, Malang, Indonesia Background the rapid movement of infected travellers between popula- Dengue is regarded by the World Health Organization tion centres of the tropics and resulted in an exchange of as “one of the most important arboviral infections in the dengue viruses [5]; and 4) ineffective mosquito control world” [1]. The burden of dengue has grown dramatic- measures for reducing the mosquito population [6, 7]. ally, particularly in Southeast Asia and the Western Pa- The first dengue cases were reported in Jakarta and cific [2]. Several factors influenced this resurgence, Surabaya in 1964. In total, 58 patients were diagnosed including: 1) population growth in urban areas resulting with dengue in Surabaya, 24 of whom subsequently died. in substandard housing and inadequate water and waste Thereafter, dengue spread to all provinces of Indonesia management systems [3]; 2) lack of education, informa- [8, 9]. By 2010, Indonesia ranked the highest for dengue tion and communication concerning vectors of dengue cases among Southeast Asian countries [10]. In 2014, virus [4]; 3) increased air travel, which has allowed for the Ministry of Health reported that the regions with the highest incidence of dengue cases were West, Central and East Java [11]. * Correspondence: [email protected]; [email protected] 1Department of Social and Environmental Medicine, Faculty of Tropical In 1992, the Ministry of Health of Indonesia began Medicine, Mahidol University, Bangkok, Thailand implementing various strategies against dengue, Full list of author information is available at the end of the article © The Author(s). 2018 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Rakhmani et al. BMC Public Health (2018) 18:619 Page 2 of 6 including surveillance systems, case management, vector Methods control and programs aimed at changing people’s behav- Study design and sample iour. The aims of vector control and behavioural change Sample size was calculated by using the formula were combined in a surveillance program known as 3 M ¼ Z2pq n0 e2 [27]. Plus, which required communities to be responsible for 2 Where n0 is the sample size, z was standard value periodically finding and eradicating potential and exist- normal distribution at 95% confidence level (1.96), p ing mosquito nests in their respective vicinities. The (=42.6) was percentage of dengue prevention behaviour “ ’ ” three M s were: menutup (meaning covering water from previous study [28], e2 was acceptable maximum containers), menguras (cleaning water containers), and error (7%). The minimum sample size was 191 and after mengubur/membuang (burying/throwing discarded adding 20% to anticipate for the non-response rate, data “ ” items). Meanwhile, the Plus indicates activities were collected from 220 respondents. aimed at reducing mosquito breeding places, such as This was a cross-sectional study conducted among re- using chemicals to kill larvae or fogging, and activities spondents living in Malang City of East Java during to protect people from mosquito bites, such as using May–June 2016. Malang city has divided area into urban repellent, mosquito coils, insecticide or long sleeves (sub-district) and rural (regency). There are five sub- and trousers [8, 12]. districts in Malang: Lowokwaru, Klojen, Blimbing, Malang is the second largest city in East Java Province, Kedungkandang and Sukun. Lowokwaru sub-district Indonesia. Malang has been an endemic area of dengue with the highest number of dengue cases was selected as since the first time dengue occurred in Indonesia [8, 9]. studied site. In 2015, Lowokwaru sub-district had 50,574 The number of cases of dengue in Malang continues to household with the total population of 166,837 [29]. grow. The worst outbreak of dengue in Indonesia oc- This sub-district consists of 12 villages. This study was curred in 2010 and urban areas like Malang were espe- conducted in Lowokwaru village with the highest preva- cially hard hit. There were 658 dengue cases from lence of dengue in 2015. Lowokwaru village has 104 January to May 2010 in Malang, with 243 cases reported clusters [30]. This study randomly selected 15 clusters in February alone. Moreover, dengue-related mortality from Lowokwaru village. From each cluster, 14–15 re- cases have increased every year; one patient died in spondents were randomly recruited into the study. This – 2014, whereas three patients died in 2015 [13 15]. study enrolled registered residents aged 18 years and Previous studies have revealed that many factors influ- above who had lived more than 6 months in the Lowok- ence dengue prevention practices, including knowledge waru village and who were willing to participate in this and perception. Participants with higher knowledge of study. Residents who were not at home during data col- dengue were reported to adopt dengue prevention tech- lection were excluded from this study. niques more frequently compared with those with low knowledge [16–21]. In addition, studies found that indi- viduals with high perceived susceptibility to dengue Data collection and analysis adopted more dengue prevention measures compared Data collection to explore knowledge, perceptions, and with those with low perceived susceptibility [17]. A study dengue prevention behaviour used a semi-structured in Malaysia showed the prevalence of dengue fever was questionnaire conducted through face-to-face interviews. higher in participants who engaged in high-risk behav- The questionnaire was developed, pre-tested and modi- iours compared with those who exhibited low-risk be- fied according to the pre-tested results. Reliability was haviours [21]. However, several studies revealed that computed using Cronbach’s alpha coefficient and re- good knowledge about dengue fever did not correlate sulted in alpha score 0.736 [31]. Before interviewing, all with good prevention behaviour [22–24]. respondents were informed of the study details and that Regarding socioeconomic factors, such as income, the information they gave would be kept confidential there was an association between family income and and they could stop answering questions at any time. dengue prevention behaviour [25]. Another study re- The maximum score for the knowledge portion was 14 vealed an association between number of family mem- and respondents would be considered as needing im- bers and dengue prevention behaviour [26]. Therefore, provement if they scored 0–8 (< 60%), having moderate this study aimed to investigate factors associated with knowledge if they scored 9–11 (60–80%), and having dengue prevention behaviour among respondents liv- good knowledge with a score of 12–14. The perception ing in high-risk urban areas in Malang. This study portion consisted of 19 statements. Each positive state- would be useful for local health providers in planning ment was given a score of 5 for “strongly agree”, 4 for appropriate interventions to increase community par- “agree”, 3 for “neutral”, 2 for “disagree”, and 1 for ticipation in dengue prevention programs, particularly “strongly disagree”. Conversely,
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