|Year : 2018 | Volume
| Issue : 1 | Page : 30-36
Awareness of treatment options for dengue fever among the patients and their relatives attending a tertiary care hospital in central Kerala
Jency Maria Koshy1, Alice David2, SK Mathew1, Mohan Varughese1, Sony Punnen Thomas1, Jibin John Thomas1
1 Department of Medicine, Believers Church Medical College and Hospital, Thiruvalla, Kerala, India
2 Department of Medical Research, Believers Church Medical College and Hospital, Thiruvalla, Kerala, India
|Date of Submission||27-Nov-2017|
|Date of Acceptance||01-Mar-2018|
|Date of Web Publication||25-May-2018|
Jency Maria Koshy
Department of Medicine, Believers Church Medical College and Hospital, Thiruvalla, Kerala
Source of Support: None, Conflict of Interest: None
Introduction: Dengue virus infection is a major cause of morbidity, mortality, and economic hardship in the tropics and subtropics. We undertook this study to see the level of awareness of symptoms and the treatment options for dengue fever.
Materials and Methods: This was a cross-sectional study done in the Department of Medicine at a tertiary medical care in central Kerala during July 2017. The patients and their attendants visiting outpatient department were interviewed by trained social workers after taking a written consent. The interview was conducted based on a structured questionnaire. Distribution of various aspects of awareness and sociodemographic characteristics are presented. The association of the awareness of treatment options with sociodemographic characteristics was estimated.
Results: Among the 522 subjects interviewed 509 (97.51%) had heard about dengue. Majority of them (89.59%) were aware that this is a preventable disease. Newspaper (80.94%) and television (74.85%) were the main sources of information. Most (85.85%) of them were aware of the infectious nature of the disease and that mosquitoes are the responsible vector. The most common symptoms of this disease which they were aware of were fever (64.83%), body ache (62.48%) and headache (50.68%). Almost half (48.13%) of them incorrectly expressed the need for antibiotics for this viral illness and 46.37% felt the need for platelet transfusion to hasten the recovery. Only education was associated with better awareness regarding antibiotic use (odds ratio [OR] [95% confidence interval [CI]: 1.55 [1.03–2.34]) and platelet transfusion (OR [95% CI]: 2.40 [1.17–4.91]).
Conclusions: They had a reasonably good awareness of the vector that promotes dengue and its breeding sites. However, there were misconceptions regarding the treatment options.
Keywords: Awareness, dengue fever, prevention
|How to cite this article:|
Koshy JM, David A, Mathew S K, Varughese M, Thomas SP, Thomas JJ. Awareness of treatment options for dengue fever among the patients and their relatives attending a tertiary care hospital in central Kerala. J Curr Res Sci Med 2018;4:30-6
|How to cite this URL:|
Koshy JM, David A, Mathew S K, Varughese M, Thomas SP, Thomas JJ. Awareness of treatment options for dengue fever among the patients and their relatives attending a tertiary care hospital in central Kerala. J Curr Res Sci Med [serial online] 2018 [cited 2018 Nov 15];4:30-6. Available from: http://www.jcrsmed.org/text.asp?2018/4/1/30/233203
| Introduction|| |
Dengue virus infection is a major cause of morbidity, mortality, and economic hardship in the tropics and subtropics., Infection occurs when one of four dengue virus serotypes (DENV 1–4) are transmitted to humans by Aedes sp. (primarily Aedes aegypti) mosquitoes.
Over half of the world's population resides in areas potentially at risk for dengue transmission, making dengue one of the most important human viral diseases transmitted by arthropod vectors in terms of morbidity and mortality.
India with its diverse cultural and geographical features, possess an ideal environmental and social conditions for the incidence and spread of this viral infection. The incidence of mosquito-borne epidemics point to environmentally unsustainable and unfriendly waste management protocols that create ambient breeding grounds for infectious agents. The high incidence of a disease such as dengue may also be a reflection of low health literacy. Although Kerala is a state of high literacy, it may be low in health literacy. Understanding the awareness level of the people is the key to improving the health literacy level.
There are many studies done in various parts of India.,,,, However, none of these studies include awareness of treatment options. Since the apprehension among those affected by dengue is high, a clear awareness of the conservative treatment options and removing popular myths regarding treatment options may reduce stress among patients and their relatives. We undertook this study with the objective of assessing the awareness of available treatment options for Dengue fever among patients and their relatives from central Kerala.
| Materials and Methods|| |
One week during the dengue season in July 2017 was chosen at random and all patients and their attendants visiting the outpatient department (OPD) of medicine at a tertiary medical care in central Kerala formed the sample population. All those who were willing to take part in the study were included in the study. They were interviewed by a trained social worker after taking a written consent. The interview was conducted using a structured questionnaire [Annexure 1]. The interview addressed questions related to demographics, experience with dengue, knowledge of vector characteristics, knowledge and attitude about the disease, knowledge of treatment options and practices related to the prevention against this disease. Two of the questions were open-ended questions.
At the end of the interview, the respondents were given an educational pamphlet [Annexures 2 and 3] with information related to dengue fever. This contained information about the vector, its breeding sites, biting time and transmission, symptoms, treatment and preventive aspects of dengue fever.
Distribution of various sociodemographic characteristics and all aspects of awareness of dengue fever are presented using tables and graphs. Univariate logistic regression was used to estimate the association of the awareness of treatment options by sociodemographic characteristics such as age, gender, education and income using odds ratio (OR) and 95% confidence interval (CI).
| Results|| |
There were 522 subjects who were interviewed. Among those 509 (97.51%) had heard about dengue. Those who had not heard of dengue fever were excluded from further analysis. Only 38.8% of the study subjects were males. Most (61.8%) were of the age group of 40–69 years [Figure 1] and belonged to central Kerala (93.87%). About a third (34.0%) were graduates or professionals [Table 1] and another majority (44.6%) had completed secondary school (10th Grade) or higher secondary (intermediate). However, monthly incomes of the majority of the people were <10,000 (71.9%) [Table 2]. Out of the 13 respondents who had not heard about dengue, 6 were graduates and 4 had done up till intermediate.
Newspaper (80.94%) was identified as the major source of public information followed by television (74.85%). Friends (22.59%) were identified as the third most frequent source of information. Among those who had heard about this only 9.63% of them had dengue fever in the past and only 18.07% of them have encountered this illness among their relatives. Most of them (85.85%) believed that the disease was infectious, transmitted through mosquitoes and that they were daytime biters (59.52%).
On questioning about the breeding site of the vector, 22.79% of them responded that breeding was in water, an additional 37.92% specified that they breed in stagnant water including coconut shells, another 12.57% clarified that they breed in freshwater including ponds whereas 7.47% thought that they breed in dirty water. However, poor hygienic conditions were identified as breeding sites by 19.84% of the respondents.
Most (92.14%) were cognizant that this illness is potentially fatal. Majority of them (89.59%) were aware that this is a preventable disease. Almost half of them (46.56%) responded that keeping your surroundings clean and managing waste properly and maintaining good sanitation would be integral to prevention. They also elaborated on various aspects of avoiding mosquito bites, preventing their spread and eradicating them. The measures suggested included fixing mosquito screens on doors and windows, use of mosquito repellents, fogging and avoiding stagnation of water. Few of them (6) felt that health education among public would be a way forward and 2 of them mentioned about immunization as a preventive aspect. Some (14.54%) of them were ignorant about any preventive measures and 29.47% gave irrelevant responses where they elaborated about treatment aspect than preventive aspect [Figure 2].
When asked about the common symptoms of this disease, fever (64.83%), body ache (62.48%) and headache (50.68%) were the most common symptoms which they were aware of followed by bleeding (14.34%), fall in blood pressure (11.79%), rash (9.23%), giddiness (5.3%) and loss of consciousness (1.96%) [Figure 3].
|Figure 3: Distribution of the Signs and symptoms of Dengue patients as expressed by the study group|
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Almost half (48.13%) of them considered antibiotics as a required treatment for this viral illness and 46.37% believed that platelet transfusion would hasten the recovery from this illness. On further analysis, it was noted that age, gender and monthly income were not statistically associated with the awareness that antibiotics have no role in treating dengue infection or that platelet transfusion wouldn't hasten the recovery from dengue infection. However, the association between correct awareness and education was statistically significant: for antibiotic use (OR [95% CI]: 1.55 [1.03–2.34]) [Table 3] and for platelet transfusion (OR [95% CI]: 2.40 [1.17–4.91]) [Table 4].
|Table 3: Association of awareness regarding the role of antibiotics in treating dengue infection with various sociodemographic characteristics|
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|Table 4: Association of awareness regarding the role of platelet transfusion in treating dengue infection with various sociodemographic characteristics|
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| Discussion|| |
The last decade witnessed many epidemics of dengue in India. It is endemic in many states of India including Kerala. The number of dengue cases in Kerala has risen almost threefold from 2597 cases in 2010 to 7204 cases in the year 2016.A. aegypti and Aedes albopictus are the main vectors responsible for the spread of this disease. This vector survives best between 16°C and 30°C and a relative humidity of 60%–80% making climatic conditions in Kerala ideal for this vector to survive.A. aegypti breeds almost entirely in domestic man-made water receptacles found in and around households, water storage containers, water reservoirs, overhead tanks, desert coolers, unused tyres, disposable cups, unused grinding stones, industrial and domestic junk, construction sites, etc. Natural larval habitats are tree holes, latex collecting cups in rubber plantations, leaf axils, bamboo stumps, coconut shells, etc. Frequent intermittent rains facilitates mosquito breeding in the clean water collected in these man-made and natural receptacles, making the control of these vectors nearly impossible without community support. To achieve effective dengue control, larval source reduction with community participation should be carried out. Any community participation would be successful, only if we bring about a behavioral change among the residents of the community. The spread of dengue virus mainly depends on the vector population. Efforts can be put to decrease the breeding sites around the household. However, since breeding grounds like backwaters and paddy fields are beyond the control of common men, stress should be given to the preventive measures to avoid mosquito bites by mosquito-proofing all buildings and using clothes that completely cover the body, when outdoor.
Media has played a major role in bringing awareness regarding certain aspects of the disease as demonstrated in this study. Most study participants had heard about the disease (97.51%), the vector (85.85%), and were even aware of the preventive nature of the disease (89.59%). However, awareness of breeding sites (50.49%) and the biting behavior of the mosquito (59.52%) were to a lesser extent. This awareness is similar to a community-based survey done in Kerala  but much higher than studies done in the rest of India, and other countries.,,
They were made aware mainly through newspapers (80.94%) and TV (74.85%) rather than through personal experience (9.6%) or experience of others (40.67%).
Kerala being a state with a high literacy rate (94.0%) with almost half (47.9%) who have at least matriculated from 10th Grade, may have also contributed to this awareness. Moreover, the respondents of this survey were even more educated than a typical Keralite, with most (78%) having matriculated at least from 10th Grade.
However, there was a lacuna in the awareness of the symptoms and the kind of intervention required. Only 64.83% mentioned fever as a presentation which is much less than studies done among illiterate population. Similarly, only 11.79% were aware of fall in blood pressure as a feature of dengue. This is alarming since hypotension if detected early, can easily be corrected with fluid resuscitation to a large extent, which in turn will prevent the patient from going into dengue shock. Even though they were not well aware of the symptomatology, most (92.14%) of them knew about the potentially fatal nature of this illness. As for treatment options, only 24% were aware that antibiotics have no role in the treatment of this disease unless in case of secondary infections and only 7% were aware that platelet transfusion wouldn't hasten the recovery in this disease.
This study brought out the misconceptions among people regarding the treatment. However, being aware of proper treatment options was not related to being male or female, young or old, or whether they had a low monthly income or not. The only factor that was related to better awareness of the correct treatment options was a level of education more than 10th Grade. National Vector Borne Disease Control Programme guidelines clearly states that prophylactic platelet transfusion may be given only if platelets <10,000 mm3, if there is coagulopathy and or bleeding manifestations. Management of dengue fever is supportive with no antidote available for this disease. The mainstay of management is a close monitoring of the plasma leakage which could happen in these patients, which warrants judicious use of fluids, both oral and intravenous. This is crucial, as lack of monitoring can turn this apparent benign disease to a fatal one.
Most awareness programmes have stressed on the vector and the preventive aspect of the disease. Little has been said about the symptoms and the treatment options. Lack of knowledge in this area has caused lots of unpleasantness and concerns in the doctor-patient relationship. Not prescribing antidote or antibiotics are apparently interpreted as a lack of treatment given by the health professional which agitates the patient and or the patient's family.
Moreover, majority of the respondents were of lower socioeconomic status (73.67%). Although these respondents were not in the OPD in connection with dengue fever, they are representative of the patient group who attend this private hospital. In spite of their economic status, they have sought a private hospital in the hope of getting better treatment options. Therefore the strain in the doctor-patient relationship is even more in this scenario. This can be easily avoided with more awareness of the presentation and treatment options of this illness. Therefore, the media should also make the public aware of the conservative nature of treatment options for Dengue fever which would improve the doctor-patient relationship.
| Conclusions|| |
This study group has a reasonably good awareness of the vector that promotes dengue and its breeding sites. Public media like newspaper and television has played a major role in disseminating this knowledge. However, the awareness that the mosquito bite is to be prevented by all means should be increased. Moreover, the lack of awareness of the symptoms and the misconceptions regarding the treatment options were very high. As we try to combat this illness, the media and health-related organizations have a great responsibility to bring more awareness of the symptoms and the management of dengue fever among the public.
We acknowledge Sneha Elizabeth John, Anu VJ, Liya Augustine and Vishnu Maya NC for helping with conducting the interview and Ansu Stephy Abraham for helping with data entry.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| Annexures|| |
Annexure 1: Dengue Questionnaire
Name .................... Age .................... Gender ....................
- Primary School
- Grade 10
1. Have you heard about Dengue fever? (a) Yes (b) No
(If answer is No, no further questions asked)
2. From where have you heard about this disease?
(a) TV (b) Radio (c) Newspaper (d) Friends (e) Internet
(d) Any other
3) Have you ever had Dengue fever (a) Yes (b) No
4) Have any of your relatives have had Dengue fever? (a) Yes (b) No
5) Is this a transmissible disease? (a) Yes (b) No (c) I don't know
(If the answer to the above question is No, the next question is omitted)
6) How is this transmitted?
(a) Consumption of dirty water (b) Flies (c) Mosquitoes (d) Inhalational route (e) Direct contact with an infected person (f) Any other….. (g) I don't know
(If the answer is mosquito, proceed with the next question)
7) Where is the breeding site of mosquitoes responsible for transmission of Dengue Fever?
8) When does the mosquito which transmits Dengue bite?
(a) Night (b) Daytime (c) Anytime (d) I don't know
9) What are the signs and symptoms of this disease?
(a) Fever (b) Rash (c) Body ache (d) Bleeding (e) Headache (f) Giddiness (g) Loss of consciousness (h) Fall in blood pressure (i) Any other (j) I don't know
10) Are antibiotics needed for the treatment of Dengue fever?
a) Yes (b) No (c) I don't know
11) Does platelet transfusion hasten the recovery of Dengue fever?
(a) Yes (b) No (c) I don't know
12) Can this disease be fatal?
(a) Yes (b) No (c) I don't know
13) Is this disease preventable?
(a) Yes (b) No (c) I don't know
14) If Yes, How can you prevent this disease?
Annexure 2: Dengue educational pamphlet in Malayalam
Annexure 3: Dengue educational pamphlet in English
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[Figure 1], [Figure 2], [Figure 3]
[Table 1], [Table 2], [Table 3], [Table 4]