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CHAPTER I
INTRODUCTION
Rationale of the study
Dengue is a viral infection caused by four types of viruses DENV-1,
DENV-2, DENV-3, DENV-4 belonging to the Flaviviridae family. Dengue is a
disease inflicted through female Anopheles mosquitoes. They carry the
dengue-causing virus, acting like a vector in spreading the disease. The
mosquitoes inject the virus while they suck the human blood for the
purpose of reproduction, blood acts as a high protein content. It is found
mostly in regions with tropical and sub-tropical climate. Mosquitoes usually
reproduce in stagnant water and this is the main reason dengue is spread
during rainy seasons as the water stays stagnant.
Preventive measures can always save the people from getting
affected by these life-threatening diseases. Reducing the rate of
mosquitoes is the best way to reduce the spread of dengue. People have to
remove the medium in which the mosquitoes reproduce. There is no specific
treatment for dengue but it can be cured if found in the earlier stages.
Ovitraps are now being used to detect and monitor disease carrying
mosquitoes. This research is aimed at finding the dengue management
practices of people in high dengue prone regions and low dengue prone
areas of Cebu City.
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Spraying insecticides to kill adult mosquitoes is not effective even
though it is a widely used mosquito control technique. Cleaning up the
larval habitats using larvicides in its larval phases should be given prior
importance. Poor sanitation and poor refuse control provide excellent
condition for mosquito larval to grow. Rubble and garbage caused due to
hurricanes and other natural disasters increase the habitat for mosquito
growth in urban areas.
Eliminating small accumulations of stagnant water around human
habitats ( disposing of old tires, covering water receptacles ) can reduce
the breeding of vector mosquitoes. Now a days biological control agents
like predatory copepods are used in great extent. Increasing heath
surveillance and heightening professional awareness can reduce the spread
of endemic diseases.
In this research, the researchers will bring out the steps and
initiatives taken by the government to eradicate the Dengue virus.
Researchers have also included the statements about the initiatives taken
by the government in the barangays.
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Review of Related Literature
Mosquito Aedes aegypti is the primary vector of dengue, which infects
humans by bites during daylight. The control of the virus vector (Mosquito)
should lead to the control of dengue. (Morrison, 2008).
Dengue is a mosquito-borne viral disease that has rapidly spread in
all regions of WHO in recent years. Dengue virus is transmitted by female
mosquitoes mainly of the species Aedes aegypti and, to a lesser extent, Ae.
albopictus. This mosquito also transmits chikungunya, yellow fever and
Zika infection. Dengue is widespread throughout the tropics, with local
variations in risk influenced by rainfall, temperature and unplanned rapid
urbanization (World Health Organisation, 2018).
Every year approximately 50000 individuals are being hospitalized
with dengue haemorrhagic fever. Mainly it’s found in Southeast Asia, the
Pacific and the Americas. The capacity for surveillance and outbreak
response can be increased and the disease burden can be reduced using
the integrated vector management combined with early and accurate
diagnosis has been said. The contribution of antiviral drugs can improve
the control of dengue in the future (Guzman, 2014).
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The variation in mosquito vector populations will improve dengue
surveillance and prevention. Aedes aegypti, primary vector can transmit
the virus with remarkable efficiency. As households are expected to be a
primary site the human DENV infection, vector control strategies like
intradomicile vector control strategies should be done. Individual household
can be used as a spatial scale for accessing the entomological risk.
Combined vector control with vaccine delivery will serve as the most
effective intervention strategy for rapid and sustained disease prevention
(Scott, 2010).
In the dengue-endemic countries of Asia and Americas 65% of the
people are at the risk of dengue despite having GAVI (Global Alliance for
Vaccines and Immunisation) support. The demand of the vaccine in the
endemic and non-endemic countries would increase due to the geographic
distribution of dengue (Ananda, 2010).
Several dengue vaccines are in development to address the need for
dengue prevention. Dengue can be prevented by control of vector. Dengue
fever can, in some cases, be life-threatening. Severe dengue causes
abdominal pain and vomiting, breathing difficulties and a decrease in blood
platelets that can lead to internal bleeding. It is the fastest-growing
mosquito-borne viral infection in the world (Mark, 2010).
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Clinical management and clinical services states that ,Reducing
dengue mortality requires an organized process that guarantees early
recognition of the disease, and its management and referral when
necessary. The key component of the process is the delivery of good clinical
services at all levels of health care, from primary to tertiary levels. Most
dengue patients recover without requiring hospital admission while some
may progress to severe disease. Simple but effective triage principles and
management decisions applied at the primary and secondary care levels,
where patients are first seen and evaluated, can help in identifying those
at risk of developing severe disease and needing hospital care. This should
be complemented by prompt and appropriate management of severe
dengue in referral centres(World Health Organisation, 2009).
Dengue: Guidelines for Diagnosis, Treatment, Prevention and
Control: New Edition states that, During outbreaks some patients may be
seen presenting with fever with or without rash during the acute illness
stage; some others may present with signs of plasma leakage or shock,
and others with signs of haemorrhages, while still others may be observed
during the convalescent phase. One of the priorities in a suspected outbreak
is to identify the causative agent so that appropriate public health measures
can be taken and physicians can be encouraged to initiate appropriate acute
illness management(World Health Organisation, 2009).
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In such cases, the rapidity and specificity of diagnostic tests is more
important than test sensitivity. Samples collected from febrile patients
could be tested by nucleic acid methods in a well-equipped laboratory or a
broader spectrum of laboratories using an ELISA(Enzyme-linked immune
sorbent assay) based dengue antigen detection kit. If specimens are
collected after day 5 of illness, commercial IgM ELISA(Enzyme-linked
immune sorbent assay) or sensitive dengue IgM rapid tests may suggest a
dengue outbreak, but results are preferably confirmed with reliable
serological tests performed in a reference laboratory with broad arbovirus
diagnostic capability. Serological assays may be used to determine the
extent of outbreaks (World Health Organisation, 2009).
According to Department of Medicine, University of Peradeniya, in
the journal Infectious Diseases ,dengue infection ranks highly among new
and newly emerging arthropod-borne viral diseases affecting humans. It
affects a large proportion of the population, mainly in tropical and sub-
tropical countries, causing a high morbidity and mortality due to rising
incidence of dengue haemorrhagic fever. The rapidly expanding global
footprint of dengue is a public health challenge with a high economic
burden. Appropriate management of the burden of dengue is hindered by
several issues, including lack of understanding of the exact pathophysiology
of the disease, failure to control the vector population effectively, lack of
specific treatment for the disease, and technical obstacles in developing a
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vaccine. This review provides an overview on the epidemiology, natural
history and management strategies of adult dengue patient. Dengue is a
self-limiting, systemic viral infection transmitted by mosquitoes of genus
aedis. It affects a large proportion of the population in tropical and sub-
tropical countries, causing high morbidity and mortality. The rapidly
expanding global footprint of dengue is a public health challenge with a
high economic burden, that currently remains unchecked due to lack of
licensed vaccines, specific therapeutic agents, or effective vector control
strategies. However, improved care in hospitals has led to a significant drop
of mortality. As such, furthers effort should be taken optimized the
treatment strategies based on proper understanding of the pathophysiology
of the disease(Ralapanawa, 2015).
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THE PROBLEM
Statement of the problem
The study would want to determine the possible reasons for the
difference in the dengue rates of Guadalupe, a high dengue case area and
Punta Princessa, a low dengue case area in Cebu City.
Specifically the researchers would like to answer the following question:
1.What measures are taken by the two Barangays in the prevention of
dengue?
2.How the dengue-prevention differ from the two barangays?
Hypothesis
There is no significant difference in the dengue management
procedures taken by the people in Guadalupe, a high dengue case area and
Punta Princessa, a low dengue case area in Cebu City.
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Significance of study
This study is significant because this will help the researchers to
know more about dengue management and the researchers can take their
best efforts to prevent the spread of dengue.
The study is beneficial to the following
Student- This will help them understand the need of keeping the
surroundings clean and protected in order for their well-being.
Teachers- This will help them acquire knowledge about the different ways
to reduce the spread of dengue and they can guide students about the
prevention of dengue.
Barangay/City Officials- They can know where to emphasize more
important in providing preventive measures.
DOH (DEPARTMENT OF HEALTH)- They can provide vaccines in regions
of high dengue risk and check for the proper working of the barangays.
Future researchers- They can learn about the efficacy of the
management techniques implied in reducing the dengue rates.
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Scope and Limitation
This study is mainly focused on the comparison of dengue
management procedures between Guadalupe, a high dengue case area and
Punta Princessa, a low dengue case area in Cebu City. The research is
focused on the places with same climate.
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CHAPTER II
RESEARCH METHODOLOGY
Research Design
In this study, the researchers will be using a random sampling survey
method to select twenty five (25) people from Guadalupe (High dengue
case area) and another twenty five(25) people from Punta Princessa (Low
dengue case area) in Cebu City to gather the data of the dengue
management procedures.
Research Environment
The researchers will be comparing the dengue management
procedures within Guadalupe, a high dengue case area and Punta
Princessa, a low dengue case area in Cebu City.
Research Instrument
In this study, the researchers will use standardize questionnaire to
compare the dengue management procedures within Guadalupe, a high
dengue case area and Punta Princessa, a low dengue case area in Cebu
City.
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Research Procedure
First, the researcher will observe twenty five (25) people from
Guadalupe (High dengue case) and another twenty five (25) people from
Punta Princessa (Low dengue case) in Cebu City to gather the data of the
dengue management procedures using standardized questionnaire.
Finally the collected data will be tabulated and analysed using
standard statistical methods.
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CHAPTER III
RESULTS AND DISCUSSIONS
The researchers took the survey in the 2 areas using the
questionnaire and computed the data and information using standard
statistic methods. Firstly the age group of the respondents were computed
separately to know which age group of people were correctly following the
dengue management procedures. Then the questions in the questionnaire
was kept as base to do the further research and calculations.
The response of each questions were made into separate tables and
finally all the 10 questions were put under the same table to know the
difference in the responses. The same procedure was followed to compute
the data in area B also.
The choice always was taken into main consideration to make the
analysis in the data recorded.
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TABLES BASED ON AGE GROUP
AREA- A (Table 1)
Always Usually Sometimes Seldom Total
16 -25 20 12 21 25 78
26-35 46 33 31 7 117
36-45 11 5 7 31 54
46-55 0 0 1 1
56-65 0
Total 77 50 59 64 250
From this table it is clear that people from age group 16-35 are taking more
preventive measures to control breeding of mosquitoes than the remaining
people from age group 36-65.
AREA- B (Table 2)
Always Usually Sometimes Seldom Total
16-25 25 11 15 9 60
26-35 57 12 29 19 117
36-45 20 0 12 4 36
46-55 19 5 3 1 28
56-65 3 2 1 3 9
Total 124 30 60 36 250
From this table it is clear that people from age group 16-35 are taking more
preventive measures to control breeding of mosquitoes than the remaining
people from age group 36-65.
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AREA – A GUADALUPE (TABLE 3)
Always USUALLY SOMETIMES SELDOM TOTAL
1 Uses 9 3 8 5 25
insecticides
sprays
2 Uses 4 3 7 11 25
professional
pest control
3 Uses screen 15 3 5 2 25
windows
4 Uses fans 10 1 6 8 25
5 Uses bed 0 9 6 10 25
nets
6 Eliminates 8 7 2 8 25
standing
water
7 Cut down 9 6 5 5 25
bushes in
yard
8 Uses 8 12 3 2 25
mosquito
coils
9 Covers water 8 6 7 4 25
containers
10 Cleans water 6 0 10 9 25
filled
containers
and ditches
TOTAL 77 50 59 64 250
Table 3 shows that the result for the choice always is just 77 out of 250
that is 30.8% which means only a very few people are taking dengue
prevention methods.
From table 3 it is clear that the people in area -A(GUADALUPE) are not
taking enough measures to control mosquitoes in their area. They are not
having a good dengue management procedure to control the mosquitos
causing dengue in their area.
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AREA -B PUNTA PRINCESSA (TABLE 4)
Always Usually Sometimes Seldom Total
1 Uses 5 3 11 6 25
insecticide
sprays
2 Uses 4 1 12 8 25
professional
pest control
3 Uses screen 16 6 3 0 25
windows
4 Uses fans 18 3 3 1 25
5 Uses bed 7 2 6 10 25
nets
6 Eliminates 18 3 3 1 25
standing
water
7 Cut down 9 4 9 3 25
bushes in
yard
8 Uses 5 5 9 6 25
mosquito
coils
9 Covers 22 1 1 1 25
water
containers
10 Cleans 20 2 3 0 25
water filled
containers
and ditches
Total 124 30 60 36 250
Table 4 shows that the result for the choice always is 124 out of 250 that is 49.6%
which means many people are taking dengue prevention methods.
From table 4 it is clear that the people in area B (PUNTA PRINCESSA) are taking
good measures to avoid the breeding of mosquitos. They are habituated for good
dengue management procedure to control mosquitoes causing dengue in their
area.
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COMPARITIVE GRAPH
TABLE 3 : PERCENTAGE CALCULATION
AREA A AREA B
Max people using 77 124
preventive methods
to control dengue
In percentage 30.8% 49.6%
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According to this research dengue management procedures
like the ones stated above are the best ways to prevent breeding of
mosquitoes. Dengue fever is a dangerous and depleting disease, and it's a
growing threat to global health. Dengue management measures like using
insecticidal sprays , pest control chemicals, screen for windows, bed nets,
cleaning up stagnant water, cutting down the bushes in the yard , using
mosquito coils , covering the water containers and cleaning the water
ditches has been used as the tool to collect data from the two areas.
Using the data collected the researchers found that the people
in area A (GUADALUPE-30.8%) are less habituated in using the above
dengue-prevention measurements compared to the people from area-B
(PUNTA PRINCESSA- 49.6%).
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CONCLUSION AND IMPLICATION
Based on the results of the study the researchers concluded
that people from area-a (GUADALUPE) are not properly using the dengue
management prevention methods. So they are highly prone to dengue. On
the other hand people in area-B (PUNTA PRINCESSA) are regularly
following the dengue management prevention method. So they are less
prone to dengue. There fore , if the above mentioned dengue-prevention
methods are followed regularly people can avoid the breeding of
mosquitoes and spread of dengue.
RECOMMENDATION
FUTURE RESEARCHERS – The future researchers working on
this study should know the other factors that affected the efficiency of the
two barangays dengue- prevention measures.
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REFERENCES
Online Sources
Scott, TW(2010) Vector dynamics and transmission of dengue virus:
implications for dengue surveillance and prevention strategies: vector
dynamics and dengue prevention. Retrieved from
https://www.ncbi.nlm.nih.gov/pubmed/19802582
Guzman, MG(2010) Dengue: a continuing global threat. Retrieved
from https://www.ncbi.nlm.nih.gov/pubmed/21079655
Amarasinghe, A(2010) Forecasting dengue vaccine demand in
disease endemic and non-endemic countries. Retrieved from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3056060/
Morission, C(2008) Defining challenges and proposing solutions for
control of the virus vector Aedes aegypti. Retrieved from
https://www.ncbi.nlm.nih.gov/pubmed/18351798
Lan, (1998) Treatment of Dengue Haemorrhagic Fever at Children's
Hospital No. 1, Ho Chi Minh City, Viet Nam, 1991-1996. Retrieved from
http://apps.who.int/iris/handle/10665/148646
Dengue. Retrieved from https://www.doh.gov.ph/Health-
Advisory/Dengue
Dengue and severe dengue. Retrieved from
https://www.who.int/news-room/fact-sheets/detail/dengue-and-severe-
dengue
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Campaign for dengue prevention. Retrieved from
http://www.pchrd.dost.gov.ph/index.php/news/library-health-news/258-
campaign-for-dengue-prevention
BOOK SOURCES
World Health Organisation (2009).Dengue: Guidelines for Diagnosis,
Treatment, Prevention and Control: New Edition
Gubler, (1968). Dengue and Dengue haemorrhagic Fever,2nd edition
Origin and expansion of the mosquito Aedes aegypti in Madeira Island
Wilfred, (1870). Campaign for dengue prevention Comparison of
Knowledge, Attitude, and Practice among Communities Living in Hotspot
and Non-Hotspot Areas of Dengue Trop Med Infect Dis. 2019 Feb 15;4(1).
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Appendix 1. Questionnaire for the survey …..
Name:_____________________________________________________
Age: ___ Gender: M/F___ Religion:______________________
Civil Status: Married single divorced widow
Monthly income: less than 10,000 11,000-20,000 21,000 and over
Occupation:_________________________________________________
(Abstracted from https://www.researchgate.net/figure/Responses-to-
Dengue-Prevention-Practices-Questionnaire_tbl2_252629649)
1. Uses insecticide sprays to reduce mosquitoes
A. Always C. Sometimes
B. Usually D. Seldom
2. Uses professional pest control to reduce mosquitoes
A. Always C. Sometimes
B. Usually D. Seldom
3. Uses screen windows to reduce mosquitoes
A. Always C. Sometimes
B. Usually D. Seldom
4. Uses fans to reduce mosquitoes
A. Always C. Sometimes
B. Usually D. Seldom
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5. Uses bed nets reduce mosquitoes
A. Always C. Sometimes
B. Usually D. Seldom
6. Eliminates standing water around the house to reduce mosquitoes
A. Always C. Sometimes
B. Usually D. Seldom
7. Cuts down bushes in the yard to reduce mosquitoes
A. Always C. Sometimes
B. Usually D. Seldom
8. Uses mosquito coils to reduce mosquitoes
A. Always C. Sometimes
B. Usually D. Seldom
9. Covers water containers in the home
A. Always C. Sometimes
B. Usually D. Seldom
10. Cleans water filled containers and ditches around the house
A. Always C. Sometimes
B. Usually D. Seldom
