Dengue is one of the most important mosquito-borne viral infections affecting populations across tropical and subtropical regions. Its expanding geographic range, rising incidence, recurrent outbreaks, and pressure on health systems have made it a major global public health concern [1-3]. Estimates from global burden analyses indicate that dengue transmission is now widespread, with a substantial share of symptomatic infections occurring in Asia, including India [1,2]. Over recent decades, rapid urbanization, population mobility, climatic variability, inadequate water management, and persistent vector breeding opportunities have collectively sustained transmission in endemic countries [2-5]. India carries a considerable dengue burden and has experienced marked changes in the epidemiology of the disease. Reviews from India have documented increasing frequency of outbreaks, geographic expansion beyond metropolitan areas, circulation of multiple serotypes, and spread from urban centers into peri-urban and rural communities [4,5]. This evolving pattern is particularly relevant for community medicine because prevention still depends heavily on early recognition of symptoms, source reduction, household water management, and timely healthcare seeking [3,6]. Even where government vector control services are active, lasting control cannot be achieved without informed community participation and local behavior change [6-9]. Knowledge, attitude, and practice studies provide a practical framework for understanding how communities perceive dengue and how that perception translates into preventive action. Previous studies from Delhi, Chennai, Tamil Nadu, Haryana, and Delhi slums have shown that communities often recognize dengue as a mosquito-borne illness, yet important gaps persist in knowledge of Aedes breeding sites, daytime biting behavior, warning signs, and effective preventive measures [10-14]. Several reports have also shown a knowledge-practice gap, wherein awareness remains higher than routine adoption of source reduction or community participation activities [10-14]. Such gaps limit the effectiveness of household-level prevention and weaken the impact of broader vector-control programs [6-9]. Local evidence from rural field practice areas is especially valuable because household water storage habits, sanitation conditions, educational profile, and access to health information differ across settings. Data generated from such populations can guide targeted information, education, and communication activities and strengthen primary prevention strategies through field practice outreach. However, published data from the rural field practice area of KIMS & RF, Amalapuram are not readily available. The objectives of this study were to assess the knowledge, attitudes, and practices regarding dengue prevention among households in the rural field practice area of KIMS & RF, Amalapuram, and to examine the association of educational status with knowledge as well as the association between knowledge level and preventive practices.

Study design and setting: This community-based cross-sectional study was conducted in the rural field practice area attached to KIMS & RF, Amalapuram, Andhra Pradesh, India, over a six-month period from January 2022 to June 2022. The study was designed to evaluate household-level knowledge, attitudes, and practices related to dengue prevention in a rural population served through field practice activities. Study population and sampling: The study population comprised households residing in the selected rural field practice villages. One adult respondent from each household was included, preferably the member available at the time of visit who was familiar with household practices related to water storage, sanitation, and health-seeking behavior. A total of 100 households were surveyed during the study period. Households were approached through field visits, and respondents were interviewed after obtaining informed consent. Eligibility criteria: Adults aged 18 years and above who were permanent residents of the study area and willing to participate were included. Visitors, temporary residents, seriously ill individuals, and respondents unable to provide reliable information were excluded from the study. Study tool and data collection: Data were collected using a pretested structured questionnaire administered through house-to-house interviews. The tool was developed after reviewing previously published dengue-related community surveys from India and other endemic settings [11-14]. The questionnaire included sections on sociodemographic details, awareness of dengue, mode of transmission, mosquito breeding sites, symptoms, warning signs, prevention methods, attitudes toward seriousness and community responsibility, and household preventive practices such as covering water containers, checking for stagnant water, disposal of discarded items, use of repellents, and healthcare-seeking behavior for fever. Interviews were conducted in the local language to ensure clarity and consistency. Scoring of knowledge, attitude, and practices: Knowledge was assessed using nine items and categorized as good, moderate, or poor on the basis of the number of correct responses. Attitude was assessed using favorable responses to key statements on disease seriousness, household responsibility, source reduction, and participation in control activities, and categorized as positive, neutral, or negative. Practice was assessed using reported preventive behaviors at the household level and categorized as good, fair, or poor. The same scoring framework was used consistently for all respondents to enable comparison across groups. Statistical analysis: Data were entered in Microsoft Excel and analyzed using standard statistical methods. Categorical variables were summarized as frequencies and percentages, while continuous variables were expressed as mean ± standard deviation. Associations between educational status and good knowledge, and between knowledge level and preventive practices, were examined using the chi-square test. A p value of less than 0.05 was considered statistically significant. Ethical considerations: Participation was voluntary. Informed consent was obtained from all respondents before interview. Confidentiality of participant information was maintained throughout data collection, data entry, and analysis. The study was conducted as a field-based public health assessment relevant to community dengue prevention.

A total of 100 households from the rural field practice area of KIMS & RF, Amalapuram were included in the study. One adult respondent from each household was interviewed. The mean age of the respondents was 38.6 ± 11.4 years. The largest proportion belonged to the 31–40 years age group [34.0%], followed by 41–50 years [24.0%]. Females constituted 58.0% of the respondents, and 34.0% had completed secondary education. The sociodemographic profile of the study participants is presented in Table 1. Table 1. Sociodemographic profile of study participants [N = 100] Variable Category n % Age group [years] 18–30 26 26.0 31–40 34 34.0 41–50 24 24.0 >50 16 16.0 Sex Male 42 42.0 Female 58 58.0 Education Illiterate 14 14.0 Primary school 26 26.0 Secondary school 34 34.0 Graduate and above 26 26.0 Occupation Agriculture 29 29.0 Homemaker 31 31.0 Daily wage laborer 22 22.0 Service/business 18 18.0 With regard to knowledge about dengue prevention, 92.0% of respondents had heard about dengue. Most participants knew that dengue is transmitted by mosquitoes [84.0%] and that fever is a common symptom [88.0%]. However, detailed knowledge was lower for specific aspects such as identification of Aedes mosquito as the vector [52.0%], daytime biting behavior [41.0%], and warning signs of severe dengue [46.0%]. Knowledge that dengue mosquitoes breed in clean stagnant water was present in 68.0% of respondents. Overall, 61.0% of the respondents had good knowledge, 27.0% had moderate knowledge, and 12.0% had poor knowledge, as shown in Tables 2 and 3. Health workers were the most common source of information [38.0%], followed by television or radio [24.0%], friends or relatives [18.0%], social media [12.0%], and doctors [8.0%]. Table 2. Knowledge regarding dengue prevention among study participants [N = 100] Knowledge item Correct response, n % Heard about dengue 92 92.0 Knew dengue is transmitted by mosquitoes 84 84.0 Identified Aedes mosquito as the vector 52 52.0 Knew breeding occurs in clean stagnant water 68 68.0 Knew dengue mosquito bites mainly during daytime 41 41.0 Identified fever as a common symptom 88 88.0 Knew warning signs such as bleeding or severe abdominal pain 46 46.0 Knew dengue can be prevented by source reduction 79 79.0 Knew early medical care reduces complications 82 82.0 Table 3. Overall knowledge score of respondents [N = 100] Knowledge category n % Good 61 61.0 Moderate 27 27.0 Poor 12 12.0 Table 4. Attitude regarding dengue prevention among study participants [N = 100] Attitude statement Agree, n % Dengue is a serious disease 89 89.0 Preventing mosquito breeding is the responsibility of every household 86 86.0 Covering water containers can reduce dengue risk 88 88.0 Cleaning surroundings regularly is necessary to prevent dengue 85 85.0 A person with fever should seek medical care promptly 83 83.0 Community participation is important for dengue prevention 81 81.0 Willing to participate in local dengue awareness/clean-up activities 79 79.0 Attitude toward dengue prevention was generally favorable. A majority of the respondents agreed that dengue is a serious public health problem [89.0%], that mosquito breeding around the house can be controlled by family efforts [86.0%], and that regular cleaning of water storage areas is necessary [85.0%]. Most respondents also felt that immediate hospital consultation is important when a person develops fever during the dengue season [83.0%]. Nearly four-fifths [79.0%] were willing to participate in community-based dengue control activities. On overall attitude scoring, 74.0% had a positive attitude, 18.0% had a neutral attitude, and 8.0% had a negative attitude, as shown in Tables 4 and 5. Table 5. Overall attitude score of respondents [N = 100] Attitude category n % Positive 74 74.0 Neutral 18 18.0 Negative 8 8.0 Despite relatively good awareness and favorable attitudes, preventive practices were less satisfactory. Covering household water storage containers was reported by 63.0% of respondents, while 57.0% cleaned water containers at least once weekly. Only 49.0% checked for stagnant water in coolers, flower pots, tires, or discarded containers on a regular basis. Mosquito repellents or coils were used by 66.0%, and mosquito nets or screens were used by 58.0%. Early healthcare-seeking behavior for fever was reported by 71.0% of households. Participation in community clean-up activities was comparatively low at 44.0%. Based on overall practice scoring, 54.0% had good practices, 31.0% had fair practices, and 15.0% had poor practices, as presented in Tables 6 and 7. Table 6. Practices regarding dengue prevention among study participants [N = 100] Practice item Yes, n % Covered water storage containers 63 63.0 Cleaned water containers weekly 57 57.0 Regularly checked for stagnant water around the house 49 49.0 Properly disposed unused tires, cans, and containers 51 51.0 Used mosquito repellents/coils/liquid vaporizers 66 66.0 Used mosquito nets/screens 58 58.0 Sought medical care early for fever 71 71.0 Allowed anti-larval or indoor spray measures when advised 62 62.0 Participated in community clean-up activities 44 44.0 Table 7. Overall practice score of respondents [N = 100] Practice category n % Good 54 54.0 Fair 31 31.0 Poor 15 15.0 Further analysis showed that educational status was significantly associated with adequate knowledge regarding dengue prevention. Good knowledge was observed among 28.6% of illiterate respondents, 46.2% of those with primary education, 64.7% of those with secondary education, and 88.5% of graduates and above [p < 0.001]. Good preventive practices were also significantly higher among respondents with good knowledge [68.9%] compared with those having moderate or poor knowledge [30.8%; p < 0.001], as shown in Tables 8 and 9. Table 8. Association between educational status and good knowledge regarding dengue prevention [N = 100] Education Good knowledge n [%] Moderate/poor knowledge n [%] p value Illiterate [n = 14] 4 [28.6] 10 [71.4] Primary school [n = 26] 12 [46.2] 14 [53.8] Secondary school [n = 34] 22 [64.7] 12 [35.3] Graduate and above [n = 26] 23 [88.5] 3 [11.5] <0.001 Table 9. Association between knowledge and preventive practices [N = 100] Knowledge level Good practice n [%] Fair/poor practice n [%] p value Good knowledge [n = 61] 42 [68.9] 19 [31.1] Moderate/poor knowledge [n = 39] 12 [30.8] 27 [69.2] <0.001

This community-based cross-sectional study demonstrated that awareness regarding dengue was fairly high among rural households in the field practice area of KIMS & RF, Amalapuram, with 92.0% of respondents having heard about dengue and 84.0% recognizing mosquito transmission. At the same time, more specific entomological and clinical knowledge remained incomplete. Only about half of the respondents identified Aedes as the vector, and even fewer knew its daytime biting behavior or warning signs of severe dengue. This pattern is consistent with earlier Indian studies showing that general awareness is usually better than detailed operational knowledge needed for effective prevention [10-14]. The finding that 61.0% of respondents had good knowledge and 74.0% had a positive attitude is encouraging, particularly in a rural setting. Comparable studies from rural Tamil Nadu and Haryana also reported reasonable awareness of dengue transmission, but weaker understanding of vector behavior, breeding ecology, and symptom severity [12,13]. Earlier studies from Delhi and Chennai similarly documented that communities often know dengue is linked to mosquitoes but remain less informed about indoor breeding, daytime biting, and targeted source reduction [10,11]. Such gaps are important because dengue control depends not only on awareness of the disease but also on accurate recognition of modifiable household risk factors [6-9]. A notable observation in the present study was the gap between knowledge and practice. Although most respondents considered dengue serious and accepted household responsibility for prevention, actual preventive behavior was less consistent. Only 49.0% regularly checked for stagnant water, 57.0% cleaned water containers weekly, and community clean-up participation was limited to 44.0%. Similar discordance between awareness and routine preventive action has been reported in Delhi slums and other Indian communities, where people frequently use personal protective measures such as repellents but participate less in environmental management and collective control activities [12-14]. This has practical significance because systematic reviews suggest that community-based environmental management and water container interventions are more relevant to sustainable dengue prevention than reliance on single reactive measures alone [7-9]. The association between higher educational status and better knowledge in the present study was statistically significant and epidemiologically plausible. Education likely improves access to health information, understanding of disease transmission, and adoption of preventive behavior. More importantly, respondents with good knowledge were significantly more likely to report good preventive practices, indicating that improved understanding can translate into action when messaging is clear and locally meaningful. This relationship has also been observed in community KAP studies and supports the use of focused information, education, and communication campaigns in rural populations [10-14]. Overall, the present findings reinforce the continued importance of community-centered dengue prevention in rural India. As dengue increasingly extends beyond major urban centers, field practice areas and primary care networks have a vital role in promoting early care seeking, safe water storage, routine source reduction, and collective participation in vector control. Strengthening household-level behavior change alongside integrated vector management offers a practical path toward improved dengue prevention in endemic rural settings [4-9]. Limitations This cross-sectional study assessed self-reported practices from 100 households in a single rural field practice area over a defined six-month period. Recall bias and social desirability bias could have influenced some responses. Direct observation of every household practice was limited, and temporal relationships between knowledge, attitudes, and practices cannot be inferred. The findings therefore reflect this local rural context and should be generalized cautiously to other populations.

This study showed that rural households in the field practice area of KIMS & RF, Amalapuram had fairly good overall awareness and favorable attitudes toward dengue prevention, but important deficiencies persisted in vector-specific knowledge and regular preventive behavior. Knowledge about Aedes mosquito identification, daytime biting habit, warning signs, and environmental source reduction was incomplete, and community participation in clean-up activities remained low. Higher education was associated with better knowledge, and better knowledge was strongly linked with better preventive practices. These findings support the need for sustained village-level health education, behavior-focused communication, and community mobilization programs to strengthen household action and improve dengue prevention in rural endemic settings.

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