Dengue fever is a rapidly emerging mosquito-borne viral infection and a major public health challenge in tropical and subtropical countries. Caused by four antigenically distinct serotypes of the dengue virus (DENV-1 to DENV-4), it is transmitted primarily by the bite of infected Aedes aegypti mosquitoes, which are well adapted to urban and semi-urban environments [1]. The World Health Organization (WHO) estimates that over 390 million dengue infections occur annually, with around 96 million manifesting clinically [2]. India is among the countries with the highest dengue burden, with seasonal outbreaks occurring every year, particularly post-monsoon, affecting both urban slums and rural communities [3,4].

Despite its growing significance, dengue continues to be under-recognized in rural settings, where limited access to health education, lack of awareness about the disease, and suboptimal vector control practices contribute to its persistence and spread. Since there is no specific antiviral treatment for dengue, prevention through personal protection and environmental vector control remains the cornerstone of disease management [5]. However, implementation of effective prevention practices at the community level requires that individuals have adequate knowledge about the disease, perceive themselves to be at risk, and adopt appropriate behaviors—components typically assessed through KAP (Knowledge, Attitude, and Practices) studies [6].

Existing literature from various parts of India suggests that there are substantial gaps in public understanding of dengue transmission, symptoms, and prevention, especially in low-literacy rural populations [7,8]. These deficiencies are compounded by reliance on informal sources of information and delayed health-seeking behavior, both of which contribute to increased morbidity and strain on the healthcare system [9]. Understanding local KAP levels is therefore essential to inform targeted health promotion strategies, policy development, and integration into national vector control programs.

In this context, the present study was undertaken to assess the knowledge, attitudes, and practices related to dengue among adults residing in a rural settlement of Gautam Buddha Nagar district in Uttar Pradesh. The objectives of the study were to evaluate the community's understanding of dengue transmission, symptoms, and prevention, and to identify socio-demographic factors associated with poor knowledge, negative attitudes, and inadequate practices. The findings are expected to provide baseline insights for future health education and vector control planning in similar rural settings.

This study was designed as a community-based, cross-sectional descriptive study conducted over a period of 15 months (2019–2020) in eight rural villages under the catchment area of the Rural Health and Training Centre (RHTC) affiliated with the Department of Community Medicine, School of Medical Sciences and Research, Sharda University, Gautam Buddha Nagar, Uttar Pradesh. The study population comprised healthy adults aged between 18 and 60 years residing in the selected villages. Individuals who did not give consent or were unavailable despite two consecutive household visits were excluded. The sample size was calculated using the formula Z²PQ/L², assuming a 52.5% prevalence of good knowledge about dengue from previous literature, with 5% absolute precision, a design effect of 1.5, and 10% non-response rate, yielding a final sample size of 632 participants. A multistage sampling technique was employed. In the first stage, all eight villages under the RHTC were included. In the second stage, a list of households in each village was prepared with assistance from ASHA workers, and households were selected using probability proportional to size sampling. One eligible respondent from each selected household was chosen through a simple random method (lottery). A pre-tested and semi-structured interview schedule was used to collect data, covering five domains: socio-demographic details, knowledge about dengue transmission, symptoms and prevention, prior exposure to dengue or health information, attitude towards disease risk and control (measured on a 5-point Likert scale), and practices related to mosquito control and health-seeking behavior. The tool was developed in English and translated into Hindi for administration. Its content validity was reviewed by experts in Community Medicine, and reliability was assessed using a pilot study conducted in a nearby village not included in the final study. Data collection was carried out through face-to-face interviews at participants’ homes by trained investigators under supervision. All ethical principles were followed, including obtaining written informed consent and ensuring confidentiality. Ethical clearance was obtained from the Institutional Ethics Committee prior to study initiation. Data were entered and analyzed using IBM SPSS version 21.0. Descriptive statistics such as frequencies and percentages were used to summarize variables. Composite scores were created for knowledge, attitude, and practices by assigning scores to correct or appropriate responses. Based on total scores, participants were classified as having good or poor KAP using the sample mean as the cutoff. Bivariate associations between KAP and socio-demographic variables were tested using chi-square tests. Binary logistic regression analysis was used to identify independent predictors of poor knowledge, attitude, and practices. A p-value < 0.05 was considered statistically significant.

A total of 632 adult respondents from eight rural villages of Gautam Buddha Nagar district, Uttar Pradesh, participated in the study. The results are presented in terms of the socio-demographic profile of participants and their knowledge, attitudes, and practices related to dengue fever. The findings also highlight associations between KAP levels and selected socio-demographic variables, providing insights into factors influencing community awareness and preventive behaviors

Table 1: Educational Status of Respondents (N = 632)

Table 1 shows that approximately 25% of participants were illiterate, while only 6.8% had completed graduation or higher education. Most respondents had education levels below intermediate, indicating a potential barrier to health literacy and reinforcing the importance of simple, visual communication in interventions.

Table 2: Perception of Dengue Fever as a Preventable Disease (N = 632)

Table 2 shows that while 53.32% of respondents agreed that dengue is a preventable disease, a significant proportion (30.06%) remained neutral, and 7.59% disagreed or strongly disagreed. This highlights a substantial gap in awareness regarding dengue prevention prior to the intervention.

Table 3: Time to Seek Care after Suspecting Dengue (N = 632)

Table 3 shows that only 40.51% of respondents reported they would seek medical care within 24 hours of suspecting dengue. Half of the participants (50.16%) reported delayed health-seeking behavior (after 24 hours), while nearly 9% would wait more than 2 days. This underscores the need for education on early diagnosis and timely treatment to reduce complications.

Table 4: Protective Measures Used Against Mosquito Bites (N = 632)

Table 4 shows that the most commonly reported protective measure was the use of mosquito nets during the day (87.97%). A much smaller proportion of respondents used chemical repellents (7.44%) or practiced physical barriers like full-sleeve clothing (2.69%). This suggests reliance on a single method and a lack of awareness of complementary protective strategies.

Table 5: Frequency of Checking Mosquito Breeding Sites (N = 632)

Table 5 shows that 72.78% of respondents reported checking water-filled containers and other potential breeding sites every alternate day. While this is encouraging, nearly 9% either checked occasionally or never, indicating the need for sustained behavior change reinforcement to eliminate mosquito habitats effectively.

Table 6: Sources of Dengue Information among Respondents (N = 632)

Table 6 shows that nearly half of the respondents (49.37%) had received dengue-related information from health personnel. Mass media (TV/radio/newspapers) accounted for 14.4%, while schools and community networks contributed to awareness in smaller proportions. Notably, 11.08% of the respondents had never received any information about dengue, indicating a gap in outreach.

Table 7: Experience of Dengue Infection Among Respondents and Family (N = 632)

Table 7 shows that 13.77% of respondents or their family members had experienced dengue in the past year, suggesting a moderately high burden of disease within the community and underscoring the relevance of targeted prevention strategies

.

Table 8: Predictors of Poor Knowledge Regarding Dengue – Unadjusted and Adjusted Odds Ratios (N = 632)

Table 8 shows the unadjusted and adjusted odds ratios (ORs) derived from logistic regression analysis to identify predictors of poor knowledge regarding dengue among adult respondents. In the univariate analysis, being illiterate, having a monthly household income less than ₹5000, and not having received any prior information about dengue were significantly associated with poor knowledge (p < 0.05). After adjusting for confounders, illiteracy remained a strong independent predictor (AOR = 2.87, 95% CI: 1.64–5.02, p < 0.001), as did lack of prior dengue-related information (AOR = 3.88, 95% CI: 2.23–6.73, p < 0.001). Respondents from lower-income households also had higher odds of poor knowledge (AOR = 1.85, p = 0.013). Gender and type of family, although initially appearing significant in the unadjusted model, were not independently associated with knowledge levels after controlling for other variables. These findings underscore the role of education, socioeconomic status, and health communication in determining community knowledge about dengue.

Table 9: Predictors of Poor Dengue Prevention Practices – Unadjusted and Adjusted Odds Ratios (N = 632)

Table 9 shows the results of logistic regression analysis examining socio-demographic and experiential predictors of poor preventive practices against dengue. In the unadjusted model, female gender, illiteracy, lower household income, and lack of prior dengue-related information were significantly associated with poor preventive behavior (p < 0.05). However, after adjusting for all covariates in a multivariate model, only illiteracy (AOR = 2.51; 95% CI: 1.48–4.26; p < 0.001), low income (AOR = 1.67; 95% CI: 1.05–2.65; p = 0.029), and lack of dengue-related information (AOR = 3.12; 95% CI: 1.78–5.47; p < 0.001) remained statistically significant predictors. This suggests that educational and economic empowerment, along with targeted health communication, play a critical role in promoting consistent preventive practices in rural populations.

Table 10: Predictors of Negative Attitude toward Dengue – Unadjusted and Adjusted Odds Ratios (N = 632)

Table 10 shows the predictors of negative attitude toward dengue prevention and control, based on a binary logistic regression model. In the unadjusted analysis, female gender, illiteracy, low income, and lack of prior dengue-related information were significantly associated with negative attitudes (p < 0.05). However, in the adjusted multivariate model, only illiteracy (AOR = 2.65; 95% CI: 1.53–4.57; p < 0.001), low income (AOR = 1.58; 95% CI: 1.00–2.50; p = 0.048), and not having received dengue-related information (AOR = 3.95; 95% CI: 2.20–7.10; p < 0.001) were independently associated with negative attitudes. These findings emphasize the influence of structural and informational inequities in shaping risk perception and willingness to engage in preventive behavior.

This community-based cross-sectional study assessed the knowledge, attitudes, and practices (KAP) regarding dengue fever among adults residing in rural villages of Gautam Buddha Nagar district, Uttar Pradesh. The findings revealed significant gaps in awareness, perception, and preventive behavior, indicating the need for intensified health education efforts in such underserved populations.

The majority of the study participants were male (79.4%), a pattern that may reflect sociocultural factors where male members are more likely to engage with outsiders or be available during household visits. Nearly one-fourth of the respondents were illiterate, and only 6.8% had completed graduation or higher education. These findings are comparable to similar KAP studies conducted in rural Bihar and Tamil Nadu, where lower education levels were strongly associated with poor awareness and practices related to vector-borne diseases [1,2].

Knowledge regarding dengue was found to be inadequate in several areas. Although 53.3% of respondents agreed that dengue is preventable, a considerable proportion remained neutral (30.1%) or disagreed. Misconceptions regarding transmission, symptoms, and vector breeding patterns were also reported. These results are consistent with prior studies conducted in rural and semi-urban regions of India, where knowledge about Aedes mosquito breeding in clean water and daytime biting behavior remains poor [3,4]. In our study, illiteracy, low income, and lack of prior information were significantly associated with poor knowledge scores. Similar associations have been reported by Gupta et al. and Acharya et al., who emphasized the influence of education and access to accurate information on health awareness [5,6].

Attitudinal responses indicated a relatively passive risk perception. Only a modest proportion of participants recognized themselves as being at risk of dengue or strongly agreed that it is a life-threatening disease. This complacency may contribute to delayed health-seeking behavior, as observed in the finding that 50.2% of participants would wait more than 24 hours before seeking care if symptoms occurred. Delay in treatment has been reported as a contributing factor to complications and mortality in dengue cases, particularly in rural India [7].

Preventive practices also showed mixed results. While the majority (88%) reported using mosquito nets during the day, the use of other methods such as repellents (7.4%), protective clothing (2.7%), and environmental vector control (e.g., cleaning water containers) was less frequent. Regular inspection of breeding sites was reported by 72.8%, yet 9% admitted to checking rarely or never. These figures point toward a partial understanding and inconsistent adoption of comprehensive preventive measures—similar to patterns reported in Maharashtra and Karnataka [8,9].

Multivariate logistic regression analysis in our study identified illiteracy, low income, and lack of prior exposure to dengue information as statistically significant independent predictors of poor knowledge, negative attitudes, and poor preventive practices. These findings are in line with national and international literature, where socioeconomic status and access to structured health communication are consistently linked to health-related behavior [10,11].

Unlike intervention-based studies, our study offers a snapshot of real-world community perceptions in the absence of any educational or behavior change reinforcement, thus highlighting the "natural" baseline from which future public health efforts must build. The lack of prior dengue-related information reported by 11.1% of participants further underscores the need for systematic outreach through Accredited Social Health Activists (ASHAs), community educators, and local leaders.

Limitations of the study include its reliance on self-reported data, which may be subject to recall and social desirability bias. The cross-sectional nature limits causal inference. Additionally, although we identified strong associations, the study did not include entomological surveillance or clinical confirmation of past dengue cases, which could have further validated the findings.

In summary, the study reveals considerable deficiencies in community-level knowledge, perception, and preventive practices regarding dengue. These findings underscore the urgent need for sustained, context-specific health education strategies targeting vulnerable groups such as the illiterate and economically disadvantaged in rural India.

This study highlights significant deficiencies in knowledge, attitudes, and preventive practices related to dengue fever among adults in a rural community of Gautam Buddha Nagar district, Uttar Pradesh. Although the majority of respondents reported using mosquito nets, many lacked comprehensive understanding of the modes of transmission, breeding habits of the dengue vector, and the importance of timely health-seeking behavior. The findings also revealed that illiteracy, low household income, and absence of prior dengue-related information were strongly associated with poor KAP outcomes.

These results emphasize the urgent need for targeted health education campaigns that are culturally appropriate and accessible, particularly for low-literacy and economically disadvantaged populations. Strengthening community-level awareness through schools, local health workers, and participatory outreach can play a vital role in improving disease prevention and reducing the burden of dengue. Furthermore, integration of structured KAP assessments into routine public health surveillance may help identify gaps early and guide resource allocation for vector-borne disease control in rural settings.

1. World Health Organization. Dengue: Guidelines for diagnosis, treatment, prevention and control. Geneva: WHO; 2009.
2. World Health Organization. Dengue and severe dengue. https://www.who.int/denguecontrol/disease/en/. Accessed June 2025.
3. National Vector Borne Disease Control Programme. Dengue Guidelines. Directorate General of Health Services, Ministry of Health and Family Welfare, Government of India. https://nvbdcp.gov.in/. Accessed June 2025.
4. Park K. Textbook of Preventive and Social Medicine. 25th ed. Jabalpur: Banarsidas Bhanot; 2019.
5. Acharya A, Goswami K, Srinath S, Goswami A. Awareness about dengue syndrome and related preventive practices amongst residents of an urban resettlement colony of South Delhi. J Vector Borne Dis. 2005;42(3):122–127.
6. Roy E, Mathew T, Purty AJ. Dengue awareness among women in rural Tamil Nadu. Int J Health Sci Res. 2016;6(7):69–76.
7. Mohapatra S, Aslami AN. Knowledge, attitude and practice regarding dengue fever among general patients of a rural tertiary-care hospital in Sasaram, Bihar. Int J Community Med Public Health. 2016;3(3):586–591.
8. Dinesh Kumar, Prabhu GR. Awareness about dengue among urban slum dwellers in Guntur City. J Commun Dis. 2015;47(1):15–20.
9. Singh A, Mishra AK. Delay in health seeking behavior among suspected dengue patients: A cross-sectional study. J Clin Diagn Res. 2017;11(2):LC01–LC04.
10. Mehta SR, Purohit HJ, Sharma M. Knowledge and preventive practices regarding dengue in rural Maharashtra. Indian J Public Health. 2016;60(2):146–149.
11. Gupta P, Patel R, Dey A, Maheshwari A. Community awareness and practices regarding dengue in Delhi. J Family Med Prim Care. 2016;5(1):130–135.
12. Hsan K, et al. Impact of community awareness and behavior change on dengue control in Bangladesh: A cross-sectional study. BMC Public Health. 2019;19:936.
13. International Institute for Population Sciences (IIPS) and MoHFW. National Family Health Survey – 5 (NFHS-5), India Fact Sheet. Mumbai: IIPS; 2021.
14. Abeyewickreme W, Wickremasinghe AR, Karunatilake K, Sommerfeld J, Kroeger A. Community mobilization and household-level waste management for dengue vector control in Gampaha district of Sri Lanka. Pathog Glob Health. 2012;106(8):479–487.