Community Perception and Risk Reduction Behaviour in Control of Malaria and Dengue: A Study in the Slums of Bengaluru

Introduction Malaria and dengue are major mosquito-borne diseases that constitute a chief public health problem in the country. In the year 2020, there were 1555 cases of malaria and 3384 cases of dengue in Karnataka.¹ These diseases are vector-borne and hence are sensitive to vector biology, changes in weather, and the environment.² The density of the mosquitoes, availability of breeding places, improper drainage of water, and climate change have all led to these diseases being widespread throughout the country.³ The situation is worse in urban areas, where the cases occur in clusters.⁴ In such areas, the problems of improper land use, large construction areas with an unregulated environment, improper sewage and drain facilities, the exponential growth of slums, and poor sanitation practices have paved a way for these diseases. Many national programs aimed at controlling them were rolled out. The combined efforts of the government and the community are required for their effective control.⁵ It requires risk modification behaviors such as proper sanitation facilities constantly and consistently.⁶ Hence, this study was conducted to assess the community perception and risk reduction behavior in the control of malaria and dengue in the slums of Bengaluru.

Materials and Methods

This was a cross-sectional study with mixed methods conducted in urban slums in Bengaluru. The study population included individuals aged 18 years and above residing in urban slums in the field practice area of a medical college in Bengaluru.

Sample size: Based on a previous study conducted by Podder et al. ⁷ , the sample size was calculated to be 90.

Sampling technique: There were a total of 12 slums in the study area. Six slums were selected by simple random sampling using the lottery method. Then following probability proportional to size, sampling was done and the sample size was achieved by systematic random sampling. 

Tools: The quantitative component of the study was measured using a validated semi-structured questionnaire while the qualitative component was conducted using in-depth interviews with household members regarding the factors associated with risk reduction behavior. The data collected included sociodemographic details, overcrowding, ventilation, lighting, water supply, usage and storage, sanitation facilities, and waste disposal. In-depth interviews were conducted according to an in-depth interview guide.

Inclusion criteria: Individuals aged 18 and above residing in Urban slums in the field practice area of a medical college in Bengaluru

Exclusion criteria: Houses that were locked during the visit

Data collected were entered in Microsoft Excel and analyzed with SPSS 20.0 and Atlasti software.

Results

Demographic details: The average age of respondents was 46.5 years and 84% of respondents were female. Participants in the lower socioeconomic class (Kuppuswamy classification) were 87%. All households lived in pucca houses in the current study. Overcrowding was present in 80% of houses. Cross ventilation was absent in 98% of houses. Inadequate lighting was observed in 92%. The Source of water was municipal water supply and 83% with alternate water supply. Community toilets were used by 92% of the individuals and 95% used open dumping near the roads as waste disposal methods. Potential water breeding sites were 60% during the visit. 90% of the subjects knew at least 2 methods to prevent mosquito bites around the house. However, only around 10.3% were aware of at least 2 methods to prevent mosquito breeding around the house. Common answers were washing away the drain water. 43.5% of the individuals were aware of at least 2 symptoms of dengue, whereas only 15% were cognizant of symptoms of malaria. 20.4% of the participants were able to state at least 2 mosquito breeding sites and 55.3% were aware that dengue and malaria were spread by mosquitoes. See figure 1.

All of the participants (100%) agreed that if any symptoms arise, it is important to visit the primary health care (PHC)/clinic to see a doctor. All of the subjects (100%) also agreed that public officials must be allowed to fog and fumigate the houses and inspect the environment for mosquito breeding. 71.2% of the individuals agreed that it is possible to control these diseases efficiently by the community and government holding hands together. 56.7% of the subjects agreed that the community has a responsibility to control these diseases and 6.6% agreed that the community that they live in is at risk of malaria/ dengue. See figure 2.

Among the risk reduction practices, the most common one was covering water containers (100%) followed by the use of mosquito coils/ devices (97.7%) and the use of electric fans (76%). See figure 3.

Figure 4 represents the subthemes identified in the in-depth interview. Among the risk reduction practices, the most commonly identified ones were government responsibility, lack of knowledge, and time constraints.

Discussion

The present study was conducted in a ‘mixed method’ which is a strength in itself. Similar studies were conducted earlier to understand the deeper consideration of the community beliefs and practices about disease transmission.^8,9 Temporal association couldn’t be established owing to the cross-sectional study design. The anonymity of the participants was ensured. Unsatisfactory knowledge scores and unsatisfactory attitude scores were observed in 52% and 56% of the subjects, respectively. Only 49% of the subjects regularly practiced risk reduction practices. The main barriers to practicing risk reduction behavior are a lack of knowledge and the opinion that mosquito control is mainly the responsibility of the government and not the community.^10,11

A similar study conducted by Kohli et al. in Delhi showed a significant association between the educational level of participants and the knowledge mosquito-borne diseases.¹² In their study, 58.6% of urban participants reported that the main source of information was TV. 

A study carried out in Odisha by Das et al. ¹³ showed that even though for protection from mosquito bites, a mosquito net was an effective tool, its reported use was very low and usage was decided by affordability and seasonality. Electric fan usage was reported to be the most common practice. The study also observed a significant positive correlation between knowledge attitude, knowledge practice, and attitude practice scores. 

Conclusion

The knowledge regarding malaria and dengue was unsatisfactory. The attitude regarding community participation in the control of dengue was also unsatisfactory. Among risk reduction practices, covering water containers, use of mosquito coils, and use of electric fans were the most common. The main motivators of risk reduction behavior were maintaining a clean environment, preventing the nuisance of mosquitoes, and advice by Accredited Social Health Activist (ASHAs) whereas the main barriers were lack of knowledge, time constraints, and the belief that government has a bigger role to play. Health education and behavior change communication are recommended. The role of community participation in such diseases must be stressed.

Conflicts of Interest

Nil