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Dengue in Dhaka, Bangladesh: Hospital-based cross-sectional KAP assessment at Dhaka North and Dhaka South City Corporation area

  • Tanvir Abir ,

    Contributed equally to this work with: Tanvir Abir, O’mezie Ekwudu

    Roles Conceptualization, Data curation, Writing – review & editing

    Affiliation College of Business Administration, International University of Business, Agriculture and Technology, Dhaka, Bangladesh

  • O’mezie Ekwudu ,

    Contributed equally to this work with: Tanvir Abir, O’mezie Ekwudu

    Roles Resources, Writing – original draft, Writing – review & editing

    Affiliation Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia

  • Nazmul Ahsan Kalimullah,

    Roles Conceptualization, Project administration, Resources

    Affiliation Begum Rokeya University, Rangpur, Bangladesh

  • Dewan Muhammad Nur-A Yazdani,

    Roles Investigation, Project administration, Resources

    Affiliation College of Business Administration, International University of Business, Agriculture and Technology, Dhaka, Bangladesh

  • Abdullah Al Mamun,

    Roles Methodology, Resources, Supervision

    Affiliation Faculty of Business and Management, UCSI University, Kuala Lumpur, Malaysia

  • Palash Basak,

    Roles Data curation, Project administration

    Affiliation School of Environment and Life Sciences (Environmental Science and Management), University of Newcastle, Callaghan, Australia

  • Uchechukwu Levi Osuagwu,

    Roles Formal analysis, Methodology, Resources, Writing – review & editing

    Affiliation Diabetes, Obesity, and Translational Research Unit (DOMTRU), School of Medicine, Western Sydney University, Sydney, Australia

  • P. Yukthamarani Permarupan,

    Roles Methodology, Supervision, Visualization

    Affiliation Faculty of Entrepreneurship and Business, Universiti Malaysia Kelantan, Kota Bharu, Malaysia

  • Abdul Hasnat Milton,

    Roles Supervision

    Affiliation Epidemiology Resource Centre, Newcastle, Australia

  • Shamim Hyder Talukder,

    Roles Supervision

    Affiliation Eminence Associates for Social Development, Bangladesh

  • Kingsley E. Agho

    Roles Formal analysis, Methodology, Supervision, Visualization, Writing – review & editing

    Affiliation School of Health Sciences, Western Sydney University, Sydney, Australia


Dengue, the most important mosquito-borne viral disease of humans is a recurring global health problem. In Bangladesh, dengue outbreaks are on the increase despite the efforts of government and it is not clear what the understanding of the general Dhaka population towards dengue fever is. Knowledge, attitude and practice (KAP) studies are essential guides in public health interventions. Hence, using KAP, this study aims to assess patient-perspectives with regards to factors associated with dengue, as well as investigate the associated factors between the two corporations in Dhaka. A Hospital-based cross-sectional study of 242 fever patients from two city-corporations in Dhaka (Dhaka North City Corporations, DNCC (n = 91, 37.6%) and Dhaka South City Corporation, DSCC (n = 151, 62.4%) was conducted using pre-tested KAP items. Wilcoxon’s Rank Sum was used to determine the KAP by DNCC, DSCC and both corporations and multivariate Poisson regression analyses. The two corporations were analysed separately due to the differences in income distribution, concentration of slums, hospitals and clinics. The study found that more than half of the study population were knowledgeable about dengue (mean percentage scores was 52%), possess an appropriate and acceptable attitude towards the disease (69.2%), and about two thirds of the respondents (71.4%) engaged in practices towards its prevention. After adjusting for the potential cofounders, the factors associated with KAP about dengue fever varied between DNCC and DSCC; with duration of residency and use of mosquito nets were associated with knowledge in the north while income class and age were associated with knowledge and attitude in the south. In the pooled analysis (combining both corporations), knowledge of dengue was associated with good practice towards dengue fever among the respondents. The duration of residence in Dhaka (10+ years), not using mosquito nets and length of time spent in the hospital (7+ days) due to dengue, and decreased knowledge (Adjusted coefficient (β) = -0.01, 95%CI: -0.02, -0.01) were associated with attitude towards dengue in DNCC. On the other hand, middle-high income class, age (40+ years) and increased knowledge were associated with practice towards dengue in DSCC (β = 0.02, 95%CI: 0.01, 0.03). Efforts to increase knowledge about dengue fever through education by the administrations of both corporations would benefit from targeting these high-risk groups for a more sustainable outcome.


Dengue is an important public health problem and the leading mosquito-borne viral disease of humans. The disease is caused by dengue viruses (DENV); four genetically related but antigenically distinct ribonucleic acid (RNA) viruses (DENV serotypes 1–4) [1]. DENV belongs to the Flaviviridae family and the most important vectors for viral transmission between humans are blood-feeding females of the mosquito species, Aedes aegypti and Aedes albopictus. In recent decades, the incidence of dengue has grown dramatically around the world with as many as 390 million dengue infections projected to occur annually, with a quarter of these showing clinical manifestations [2, 3]. The ongoing rise in the number of dengue cases is due, in a large part, to the extensive spread of mosquito vectors, rapid and unregulated urbanization, increased international travel, and the absence of effective interventions. According to the World Health Organization; the Americas, Southeast Asia (mostly Thailand, Indonesia and the Philippines) and the Western Pacific are the regions most affected by dengue. Seventy-five percent of the world’s dengue burden is in Asia and there have been significant increases in the number of areas becoming hyperendemic; harbouring multiple DENV serotypes [4, 5].

In Bangladesh, South Asia, dengue fever was first reported in 1964 but became a disease of public health significance from 2000 onwards [6, 7]. Bangladesh has a lower dengue prevalence than most Southeast Asian states [8], but recently has sustained an upsurge in dengue outbreaks; from 2769 cases in 2017 to 10148 cases in 2018. In 2019, the Directorate General of Health Services (DGHS) [9] recorded 87953 cases with 81 deaths, a 9-fold increase in the incidence rate of dengue from the previous year [5, 10]. Previous studies indicate that the number of dengue cases and deaths are highest in the warmer months from July to November, and that men were twice as likely to become infected than women [11]. Many cases of dengue are misclassified because of the wide spectrum of disease signs and symptoms and lack of effective case definitions [12]. Therefore, it is highly probable that dengue cases may be substantially under-reported in Bangladesh given the weak surveillance of a struggling healthcare system. Bangladesh is exposed to a continual risk of dengue virus importations from surrounding endemic neighbours like India and Myanmar [13, 14]. Dhaka, the capital and most populated city in Bangladesh, has a population (approximately 16 million) had the highest number of dengue cases between 2012 and 2019 [13, 15]. Like many other countries, the first dengue vaccine, CYD-TDV, has not been rolled out in Bangladesh due to the risk of more severe disease manifestations in seronegative individuals and children less than 9 years [16, 17]. Even though it is unsustainable, and at times ineffective, vector control with insecticides remains the mainstay of dengue prevention strategies [18].

Research into knowledge, attitude and practice (KAP) provides information about health-related behaviours while sampling the awareness of a disease in a population; and therefore can play a critical role in the prevention of disease [1922]. KAP assessments have been widely ascertained as potent tools in public health intervention research [2325], where information on what participants know, believe and do could be used to promote specific behaviours and conducts that can improve health outcomes. With the rapidly increasing burden of dengue in Bangladesh, and in view of the recent rise in dengue deaths within the most populated city, there is a need for continuous assessment of people’s knowledge, attitude and practice of the residents of Dhaka to devise intervention plans.

Dhaka comprises of Dhaka North City Corporation (DNCC) and Dhaka South City Corporation (DSCC) with the former having a higher density of lower-income communities (>124,000 persons per square kilometre) and slums (1755 vs 1639), and a lower per capita number of hospitals and clinics (193 vs 293) than the latter [26, 27]. A recent quantitative assessment between these corporations suggests different public health policies due to the economic disparity between both corporations [28].

Therefore, this study aimed to assess the knowledge of dengue among fever patients in conjunction with the prevailing attitude and practices associated with the disease across the economic spectrum of the residents of both corporations. Findings of this study will inform intervention strategies for an effective prevention and control of dengue in both corporations, and the wider Bangladesh.


Study design and sampling

The required sample size was calculated by using the statistical formula:

Where n0 is the sample size, z2 was standard value normal distribution at 95% confidence level (1.96), proportion (p) = 0.50 was considered as the average of gender percentage of dengue cases reported in 2019 from previous study [11], d2 was acceptable maximum error (5%). The minimum sample size was 196 and after adding 25% non-response rate yield, the total sample size became 242 respondents. Participants were fever patients presenting with dengue or suspected dengue.

Ethics statement

This study was approved by the Begum Rokeya University Rangpur Human Research Ethics Committee (HREC Approval Number: BRUR/DWRTI/a.n.001).

Study design and sampling method

From August 30 to September 30, 2019, a cross-sectional study was conducted to assess KAP and associated factors related to dengue fever (DF) among a pool of patients who had fever symptoms in the two city-corporations of the Dhaka. Questionnaires (S1 Table) and interviews were administered to ascertain the KAP of 242 dengue fever patients that were randomly selected from multiple hospitals. Fig 1 shows the locations of the study area and hospitals from which survey participants were recruited. In DSCC, there were patients from Dhaka medical college (n = 81) and Sir Salimullah medical college hospitals (n = 70) who had dengue fever and in DNCC, the patients were from Gulshan Ma o Shishu (n = 30), Sohrawardi medical college (n = 31) and Ibne Sinha Medical College, Kallayanpur Branch, Hospitals (n = 30).

Fig 1. The city corporation boundaries and locations of the surveyed hospitals in DSCC and DNCC.

Inclusion criteria and consent

Participants who met the following eligibility criteria were included in the study: (1) Dengue patients in the two Dhaka city-corporations; (2) had dengue fever or dengue symptoms; (3) agreed to participate in this interview by giving written consent; (4) were able to answer the questionnaire. Before interviewing, all respondents were informed of the study details and that the information they gave would be kept confidential and they could stop answering questions at any time.

Data collection

Data was collected to examine knowledge, attitude, practices regarding DF and its prevention using a semi-structured questionnaire conducted through face-to-face interviews and included questions about epidemiological characteristics. The questionnaire was developed, pre-tested and modified according to the pre-testing results. Reliability of the survey items was computed using Cronbach’s alpha coefficient and resulted in an alpha score of 0.73. Each interview lasted between 10–15 minutes. To ensure the confidentiality of the interview, patients were taken to a private area of the clinic to administer questionnaire, and survey sheets stored in a secure location.

Dependent variables

There were 27 items on the questionnaire that assessed the respondent’s knowledge about DF and each question used a binary scale. Binary scores for individual questions were summed to give a knowledge score from 0–27. The knowledge items about DF were assessed by asking participants if they could identify clinical symptoms; the means of transmission; the basic means of preventing the propagation of mosquitoes and their larvae in and around their households. The Cronbach’s alpha coefficients measuring internal consistency among the knowledge scores ranged from 0.68 to 0.71, indicating a satisfactory level of reliability [29, 30].

The attitude towards DF measured feelings about the severity of dengue, including the necessity of hospitalization. The attitude questions consisted of 19 items. Each question used a Likert scale with five levels. Each statement was given a score of 5 for “strongly agree”, 4 for “agree”, 3 for “neutral”, 2 for “disagree”, and 1 for “strongly disagree”. The attitude scores were summed to yield an overall attitude score ranging from 0–95 points. The Cronbach’s alpha coefficient for attitude scores ranged from 0.67 to 0.70, indicating acceptable internal consistency [29, 30].

There were 8 items on the questionnaire that assessed dengue prevention practices and items were based on how the participants controlled mosquitoes and larvae in their house, and whether or not a patient with DF symptoms went to a medical facility immediately. The maximum score for the Practices portion was 8 and ranged from 0–8 points. The Cronbach’s alpha coefficient of DF Prevention Practices ranged from 0.70 to 0.74 indicating an acceptable level of internal consistency [29, 30]. We calculated the mean percentage score by dividing each of the KAP mean scores by their highest possible score and, multiplied them by 100, so as to be able to compare our results with previous findings.

Independent variables

Independent variables used for the study analyses were based on previous studies [11, 31, 32] and independent variable included were gender, age category, employment status, income class, length of stay in hospital, cost of stay in hospital in Taka which had the following options in the survey (<500, 500–3000, 3001–5500, 5501–8000, 8001–10500, 10501–13000, 13,001–15500, 15501–18000, 18001–20,500 and >20500). However, for statistical analysis purpose, the cost of stay in hospital in Taka was categorized into (≥3000 Taka and 3001 Taka) since 54.5% of the participants reported ≥3000 Taka. Other independent variables included: years resident in Dhaka, use of mosquito net (likely to be ineffective at preventing dengue which is transmitted by day-biting Aedes mosquitoes), regular cleaning of drainage system and regular visit to doctors.

Statistical analysis

Preliminary analyses involved frequency counts of all selected independent variables. This was followed by independent t-tests to determine if the KAP scores differed by the two city-corporations (DNCC and DSCC). This was followed by a preliminary analysis on KAP scores that showed that the distribution of KAP scores was skewed towards right. KAP scores were then considered as count variable with non-negative integer values, and therefore Poisson regression was used in the analysis. Multiple Poisson regression was used to determine the adjusted estimate and their 95% confidence intervals (CIs). These were done for each district separately and for both districts in a pooled analysis to identify common factors influencing DF related KAP in Dakar City. All statistical analyses were conducted using STATA/MP Version.14.1 (StataCorp, College Station, Texas, USA). In our analysis, we checked for homogeneity of variance and multicollinearity including Variance Inflation Factors (VIF) using linear regression because collinearity is a property of the independent variables and has nothing to do with the type of regression and the VIF < 4 was considered suitable [33]. Poisson coefficients (Tables 2 and 3) and their 95% confidence intervals (CIs) were obtained from the adjusted regression model and were used to measure the factors associated with the KAP scores in two city-corporations.


Table 1 illustrates the demographic characteristics of respondents from the DNCC and DSCC. Many of the respondents were aged 20-40years (44.2%), half were females, most were employed (65.3%) and were middle to high-income earners (86%). About 62.4% of the respondents lived in the South of Dhaka. Many respondents did not protect themselves from mosquitoes (60%), and a majority (88.5%) failed to maintain good hygiene by not cleaning their drainage systems. About two thirds (71%) of the respondents reported frequent visits to a doctor and almost everyone had spent seven or less nights in hospital. The average scores for the respondents’ knowledge (A), attitude (B) and practice (C) towards dengue in DNCC and SNCC Dhaka (Fig 2) were not significantly different between DNCC and SNCC (unpaired t-test: p = 0.2268, 0.7006 and 0.062 respectively). Overall, the pooled averages (±SD) for both cities were 12.0±4.9, 45.5±9.2, and 5.1±1.7 for knowledge, attitude and practice respectively.

Fig 2.

The average scores for (A) knowledge, (B) attitude (B) and (C) practice towards dengue in both DNCC and SNCC Dhaka.

Table 1. Descriptive statistics of the sociodemographic characteristics of respondents from Bangladesh.

Table 2 illustrates the adjusted odds for factors associated with knowledge, attitude and practice scores in both the north and south of Dhaka. For example, positive odds ratio for knowledge indicate higher scores for knowledge and generally more knowledge about dengue fever than in the reference group. After adjusting for potential confounding variables, respondents with up to 10 years of residency in Dhaka and those that failed to protect themselves from mosquitoes using mosquito nets, had lower odds of Dengue-related knowledge compared to those not resident in Dhaka and respondents that protected themselves from mosquitoes. The use of mosquito net was significantly associated with good attitude towards dengue but the association between income class and attitude towards dengue only approached significance (coefficient (β) = 0.10, 95%CI -0.998,0.20; p = 0.058) among respondents in DNCC. Respondents who spent seven or more days in hospital had lower attitude scores compared with those who spent fewer days in hospital.

Table 2. Adjusted coefficients and 95% confidence intervals of multivariate analysis for factors associated with knowledge, attitude and practice towards dengue in Dhaka North City Corporation (DNCC), Bangladesh.

Table 3 illustrates the factors associated with dengue-related knowledge, attitude and practice, among respondents in DSCC. After adjusting for potential cofounders, respondents’ age was the only factor associated with attitude towards dengue in DSCC, such that older respondents (aged 40 years and above) had a poorer attitude (adjusted coefficient 0.13, 95%CI 0.03, 0.23) towards dengue compared to younger people (aged 20 years and below). Knowledge scores were negatively related to attitude towards dengue (adjusted coefficient -0.01, 95%CI -0.02, -0.01) among DNCC respondents, but showed marginal positive relationship with practice towards dengue (coefficient 0.02, 95%CI 0–0.03) among respondents in DSCC. No other variable showed significant association with the outcome measures.

Table 3. Adjusted coefficients and 95% confidence intervals of multivariate analysis for factors associated with knowledge, attitude and practice towards dengue in Dhaka South City Corporation (DSCC).

In Table 4, the adjusted coefficients for the association between the variables and knowledge, attitude and practice scores are presented for the pooled corporations (DNCC and DSCC combined). The table shows that higher income earners in Dhaka and those who did not clean their drainage system regularly had lower dengue related knowledge compared with lower income earners and respondents who regularly cleaned their drainage system, following adjustment for all potential cofounders. Whereas respondents who failed to use mosquito nets while sleeping had poor attitude towards dengue, good practice towards dengue was marginally associated with dengue related knowledge (adjusted coefficient 0.01, 95% CI 0.00, 0.02) among the respondents in this study.

Table 4. Adjusted coefficients and 95% Confidence Intervals (CI) of multivariate analysis for factors associated with knowledge, attitude and practice towards dengue in Dhaka, Bangladesh.


This study examined KAP regarding dengue among the residents of Dhaka via the two city corporations, Dhaka North City Corporation (DNCC) and Dhaka South City Corporation (DSCC). Our study showed that more than half of the study population were knowledgeable about dengue, possess an appropriate and acceptable attitude towards the disease, and engage in practices towards its prevention. However, the factors associated with KAP regarding dengue varied between both city corporations; with duration of residency and use of mosquito nets found to be correlated with knowledge in the north while income class and age were predictors of knowledge and attitude in the south. In the pooled analysis (combining both cities), knowledge of dengue was a significant predictor of good practice towards dengue fever among the respondents.

We found that the overall mean percentage scores of 52%, 69.2% and 71.4% for KAP was higher than a hospital-based study that examined KAP on dengue fever among paediatric and adult in-patients in Metro Manila, Philippines [34]. This suggests that people in Dhaka were generally more knowledgeable, concerned, and had better practices towards dengue than in the comparison study [34]. The higher mean percentage scores reported in this study could be attributed to the fact that participants examined in this study may have experienced an episode of dengue which could change their perceptions and attitude towards the disease.

As has been previously established [35], the use of mosquito nets in the evenings does not add any value in the prevention of dengue as the virus is transmitted by day-biting mosquitoes. Despite the absence of a direct link between bed net usage and dengue prevention, it is possible that people who use bed nets for the prevention of other mosquito-borne disease (e.g. malaria) may be more aware of the risk posed by mosquito bites and may be more actively preventing mosquito bites through the day. It is not clear why this association was only observed in Dhaka North area.

Most respondents were aware that the mosquitoes that transmit dengue, Aedes aegypti and Aedes albopictus, require stagnant water to propagate and could lay eggs even in clean water containers suggesting an increase in knowledge of dengue transmission when compared to the results from earlier studies in Dhaka [31, 36]. This upward trend in knowledge may be due to the intensified educative campaigns from health authorities owing to the continued outbreaks and exponential increase in the number of dengue cases in the last six years [9]. For example, in 2014, there were about 375 reported dengue cases with no recorded fatalities in Bangladesh. In contrast, more than 87,953 cases and 81 deaths were reported in 2019 [9]. Even though the knowledge of the mosquito’s habit and life-cycle may be lacking [37], people were more likely to have heard about dengue or know someone who has been diagnosed with the disease.

Despite a high level of knowledge about dengue and required preventative measures, there were no corresponding intentional drive to intentionally combat the spread of dengue in either locality (DNCC or DSCC). This survey further revealed that many respondents were cognizant that indiscriminate dumping of plastic containers and bottles could lead to the creation of mosquito larval habitats. However, less than a quarter of the participants inappropriately disposed unused water-holding containers. These containers are potential breeding sites for mosquitoes that may transmit infections, including dengue [38]. The significant association between knowledge and attitude did not yield positive practices that could prevent the spread of dengue. Even though most respondents claimed to appreciate the potential severity of dengue and were inclined to seek medical attention in a hospital during an infection, they did not engage in activities that could get rid of mosquitoes and larvae in their environment. For example, only 16.5% of participants cleaned their drainage system regularly. While this is consistent with many KAP surveys where high levels of awareness of dengue did not expressly translate to practices that can deter disease transmission [3942], some studies showed that good knowledge manifests as acceptable attitude and satisfactory practices to prevent the disease [32, 43].

The exact factor that inhibits the translation of knowledge of dengue to adequate preventive practices remains elusive but may stem from a common belief that it is the not their obligation or that it is the government’s sole responsibility to deploy measures to control mosquito populations and curtail the spread of dengue in the locality [44, 45]. This sense of entitlement which has also been reported elsewhere [46] should be discouraged as it may hinder individual efforts, and promote a nonchalant attitude to vector control measures despite the attendant health benefits [39, 47]. It is expedient that public campaigns against the spread of dengue should emphasize the importance of prevention practices including getting rid of mosquito breeding sites. Small community groups should also channel their efforts at enforcing practical measures like appropriate disposal of containers and bottles that are potential breeding sites for disease vectors. It is the responsibility of every member of the community to ensure their houses or flats are free of breeding sites to protect their own households and those of their neighbours.

The duration of residency in Dhaka North had statistically significant association with knowledge of dengue. However, patients that have lived in Dhaka for more than ten years had lower odds of being able to identify clinical symptoms, describe means of transmission and understand means of preventing propagation of larvae and mosquitoes in this study. It is likely that Dhaka being a capital city with a greater government presence is exposed to more frequent dengue awareness and prevention campaigns compared to outside areas.

In Dhaka South, income class was associated with good knowledge. Some studies on dengue have demonstrated that a direct relationship exists between income class and knowledge [48, 49], and attitude [49, 50]. In this study, we found that respondents in the middle and higher socioeconomic class had lower dengue related knowledge, as they were less likely to correctly identify clinical symptoms of dengue fever and its means of transmission and prevention relative to those in the lower income class. This could be because people with better economic standing have better health facilities [32, 51] and may have little or no experience of the disease compared with those of lower socioeconomic class. As in many other diseases, the ability to identify symptoms of dengue will enable diagnosis and treatment and improve clinical outcomes in dengue as in many other diseases. It is therefore imperative that quality access to health information cut across the socioeconomic strata in any given community.

This study found a significant association between age and attitude of the patients towards dengue in Dhaka South. Participants aged 40 years and above were less likely to appreciate the severity of dengue and the necessity of hospitalization due to dengue than people aged 20 years or less. In contrast to our findings, another study from Bangladesh [44], found that those aged 45–60 years were more likely to report positive attitude towards undertaking precautionary measures to prevent dengue than those aged less than 25 years. Here, it is noteworthy that a present limitation in KAP surveys is the fluid concept of attitude despite scoring systems. While this study defined attitude as the feeling about the severe levels of dengue and the necessity of hospitalization due to dengue; elsewhere [44], attitude refers to the feelings of the community members towards dengue prevention and control. Therefore, it is not surprising that the varying indices in different studies resulted in different measurement outcomes. Nevertheless, it is reasonable that perspectives on dengue transmission are dynamic among young people in Dhaka given the drastic changes in both dengue infections and related fatalities in the last six years.

In this study, the duration of hospital stay was found to be a predictor for attitude towards dengue. Responding residents who were hospitalised for seven or more days reported better attitude towards dengue as compared to people who spent less than seven days in the hospital. This could be explained by the fact that there is no substitute for firsthand experiences since longer hospital stay and increased perceived vulnerability are important drivers of positive attitude and dengue prevention practices [52]. Acknowledging the severity of dengue and the importance of seeking medical attention in a hospital at the onset of symptoms should be deemed necessary and not optional; as it could reduce the duration of hospital stay.

Overall, the significant association between the different outcome variables of KAP are in agreement with previous studies [49, 53]. The association between knowledge and practice is not static with some previous studies reporting significant positive associations [37, 40, 48, 54], and others reported no significant associations [55]. A successful and sustainable approach to translate knowledge into appropriate prevention practices must be one that is community-oriented and people-friendly. Central to the improvement of attitude and practice is behavioural change which though requires basic knowledge but is fuelled by the willingness to change the status quo. Awareness campaign messages should seek to establish the relationship between positive outcomes of good practices in the community and improvements in the health of individuals. As a way of improving the practices of communities, practical approaches in health education should be tailored to discourage negative community habits like indiscriminate refuse disposal and poor maintenance of drains.

Another limitation of this study is that the responses to the questionnaire may not be reflective of actual attitude and practices given that it was a self-reported survey and the respondents may seek to provide socially acceptable responses even though the survey was anonymized. First, the cross-sectional study design limits the causality of the relationship between KAP and associated factors. Second, this study cannot be generalisable to the wider Dhaka population because participants were recruited from the Hospital. Thus, this may limit the generalizability of the study. Third, the reported KAP score might be higher than the general population because the study took place in urban hospitals where participants may have experienced an episode of dengue that may change the participants perceptions and attitude towards the dengue fever. Fourth, this study lacks an appropriate or equivalent comparison group and so does not demonstrate cause. Finally, it is possible the patients will have provided responses that they viewed as favourable to the interviewers, but the use of trained interviewers who could recognise such bias will minimise this bias.


This study found that fever patients in Dhaka had knowledge of dengue, with regards to its clinical symptoms, means of transmission and prevention strategies, and there was a relatively positive attitude towards the severity of the disease and the need for hospitalization. There is need to institute practical and comprehensive public health measures that incorporates behavioural impact assessment at the grassroots level and channelled towards the translation of awareness into preventive practices, since mere awareness is not sufficient on its own. Closing the gap in quality access to accurate health information is key and should be directed equally across all strata of society, especially in developing countries like Bangladesh. Access to information will inform real and tangible intervention strategies for the prevention of dengue. Practical, family-oriented and community-based health education campaigns should be tailored to discourage negative community habits like indiscriminate refuse disposal and lack of drain maintenances and inspire healthy family practices that mitigate the risk of dengue spread.

Supporting information

S1 Table. A study on the cause and current situation the spread of dengue (a mosquito-borne tropical disease caused by the dengue virus) in Bangladesh.



We thank Leon E. Hugo for suggestions during the preparation of the manuscript.


  1. 1. WHO. Dengue and severe dengue. 2017.
  2. 2. Bhatt S, Gething PW, Brady OJ, Messina JP, Farlow AW, Moyes CL, et al. The global distribution and burden of dengue. Nature. 2013;496(7446):504–7. Epub 2013/04/09. pmid:23563266; PubMed Central PMCID: PMC3651993.
  3. 3. WHO. Dengue and severe dengue. 2020 March 2, 2020. Report No.
  4. 4. WHO. Neglected Tropical Diseases: World Health Organization; 2018 [cited 2019 12/02/2019]. Available from:
  5. 5. Wilder-Smith A, Ooi EE, Horstick O, Wills B. Dengue. Lancet. 2019;393(10169):350–63. Epub 2019/01/31. pmid:30696575.
  6. 6. Aziz MA, Gorham JR, Gregg MB. "Dacca fever"-an outbreak of dengue. Pak J Med Res. 1967;6(2):83–92.
  7. 7. Hossain MA, Khatun M, Arjumand F, Nisaluk A, Breiman RF. Serologic evidence of dengue infection before onset of epidemic, Bangladesh. Emerg Infect Dis. 2003;9(11):1411–4. Epub 2004/01/14. pmid:14718084; PubMed Central PMCID: PMC3035545.
  8. 8. Sharmin S, Viennet E, Glass K, Harley D. The emergence of dengue in Bangladesh: epidemiology, challenges and future disease risk. Trans R Soc Trop Med Hyg. 2015;109(10):619–27. Epub 2015/09/04. pmid:26333430.
  9. 9. Directorate DC, editor. Dengue Register. Dhaka Bangladesh.2019.
  10. 10. Hsan K, Hossain MM, Sarwar MS, Wilder-Smith A, Gozal D. Unprecedented rise in dengue outbreaks in Bangladesh. Lancet Infect Dis. 2019;19(12):1287. Epub 2019/11/30. pmid:31782396.
  11. 11. Mamun MA, Misti JM, Griffiths MD, Gozal D. The dengue epidemic in Bangladesh: risk factors and actionable items. The Lancet. 2019;394(10215):2149–50. pmid:31839186
  12. 12. WHO. Global Strategy for Dengue Prevention and Control. Geneva: World Health Organization, 2013.
  13. 13. Sharmin S, Glass K, Viennet E, Harley D. Geostatistical mapping of the seasonal spread of under-reported dengue cases in Bangladesh. PLoS Negl Trop Dis. 2018;12(11):e0006947. pmid:30439942
  14. 14. Murray NEA, Quam MB, Wilder -. Epidemiology of dengue: past, present and future prospects. Clin Epidemiol. 2013;5:299–309. pmid:23990732.
  15. 15. Banu S, Hu W, Hurst C, Guo Y, Islam MZ, Tong S. Space-time clusters of dengue fever in Bangladesh Trop Med Int Health. 2012;17(9):1086–91. Epub 2012/07/20. pmid:22809407
  16. 16. Salje H, Paul KK, Paul R, Rodriguez-Barraquer I, Rahman Z, Alam MS, et al. Nationally-representative serostudy of dengue in Bangladesh allows generalizable disease burden estimates. eLife. 2019;8:e42869. pmid:30958263.
  17. 17. WHO. Revised SAGE recommendation on use of dengue vaccine. 2018. pmid:30424888
  18. 18. Scott TW, Morrison AC. Vector dynamics and transmission of dengue virus: implications for dengue surveillance and prevention strategies: vector dynamics and dengue prevention. Curr Top Microbiol Immunol. 2010;338:115–28. Epub 2009/10/06. pmid:19802582.
  19. 19. Klett-Tammen CJ, Krause G, Seefeld L, Ott JJ. Determinants of tetanus, pneumococcal and influenza vaccination in the elderly: a representative cross-sectional study on knowledge, attitude and practice (KAP). BMC Public Health. 2016;16:121. Epub 2016/02/06. pmid:26846202; PubMed Central PMCID: PMC4743086.
  20. 20. Higuera-Mendieta DR, Cortés-Corrales S, Quintero J, González-Uribe C. KAP Surveys and Dengue Control in Colombia: Disentangling the Effect of Sociodemographic Factors Using Multiple Correspondence Analysis. pmid:27682141 2016;10(9):e0005016. Epub 2016/09/30. PubMed Central PMCID: PMC5040257.
  21. 21. Alyousefi TA, Abdul-Ghani R, Mahdy MA, Al-Eryani SM, Al-Mekhlafi AM, Raja YA, et al. A household-based survey of knowledge, attitudes and practices towards dengue fever among local urban communities in Taiz Governorate, Yemen. BMC Infect Dis. 2016;16(1):543. Epub 2016/10/09. pmid:27717333; PubMed Central PMCID: PMC5054547.
  22. 22. Chandren JR, Wong LP, AbuBakar S. Practices of Dengue Fever Prevention and the Associated Factors among the Orang Asli in Peninsular Malaysia. PLoS Negl Trop Dis. 2015;9(8):e0003954. Epub 2015/08/13. pmid:26267905; PubMed Central PMCID: PMC4534093.
  23. 23. ul Haq N, Hassali MA, Shafie AA, Saleem F, Farooqui M, Haseeb A, et al. A cross-sectional assessment of knowledge, attitude and practice among Hepatitis-B patients in Quetta, Pakistan. BMC Public Health. 2013;13:448. Epub 2013/05/07. pmid:23641704; PubMed Central PMCID: PMC3648389.
  24. 24. Selvarajoo S, Liew JWK, Tan W, Lim XY, Refai WF, Zaki RA, et al. Knowledge, attitude and practice on dengue prevention and dengue seroprevalence in a dengue hotspot in Malaysia: A cross-sectional study. Sci Rep. 2020;10(1):9534. Epub 2020/06/14. pmid:32533017; PubMed Central PMCID: PMC7293214.
  25. 25. Launiala A. How much can a KAP survey tell us about people’s knowledge, attitudes and practices? Some observations from medical anthropology research on malaria in pregnancy in Malawi. Anthropology Matters. 2009;11.
  26. 26. Statistics BBo. Population and housing census: Socio-economic and demographic report. 2011.
  27. 27. Roy S, Sowgat T, Mondal J. City Profile: Dhaka, Bangladesh. Environment and Urbanization ASIA. 2019;10(2):216–32.
  28. 28. Amin N, Rahman M, Raj S, Ali S, Green J, Das S, et al. Quantitative assessment of fecal contamination in multiple environmental sample types in urban communities in Dhaka, Bangladesh using SaniPath microbial approach. PLoS One. 2019;14(12):e0221193–e. pmid:31841549.
  29. 29. Bland JM, Altman DG. Statistics notes: Cronbach’s alpha. Bmj. 1997;314(7080):572. pmid:9055718
  30. 30. Tavakol M, Dennick R. Making sense of Cronbach’s alpha. International journal of medical education. 2011;2:53. pmid:28029643
  31. 31. Dhar-Chowdhury P, Emdad Haque C, Michelle Driedger S, Hossain S. Community perspectives on dengue transmission in the city of Dhaka, Bangladesh. International Health. 2014;6(4):306–16. pmid:24981443
  32. 32. Harapan H, Rajamoorthy Y, Anwar S, Bustamam A, Radiansyah A, Angraini P, et al. Knowledge, attitude, and practice regarding dengue virus infection among inhabitants of Aceh, Indonesia: a cross-sectional study. BMC Infect Dis. 2018;18(1):96. Epub 2018/03/01. pmid:29486714; PubMed Central PMCID: PMC5830327.
  33. 33. Vatcheva KP, Lee M, McCormick JB, Rahbar MH. Multicollinearity in Regression Analyses Conducted in Epidemiologic Studies. Epidemiology (Sunnyvale, Calif). 2016;6(2):227. Epub 03/07. pmid:27274911.
  34. 34. Herbuela VRDM, de Guzman FS, Sobrepeña GD, Claudio ABF, Tomas ACV, Arriola-Delos Reyes CM, et al. Knowledge, Attitude, and Practices Regarding Dengue Fever among Pediatric and Adult In-Patients in Metro Manila, Philippines. Int J Environ Res Public Health. 2019;16(23):4705. pmid:31779171.
  35. 35. WHO. Dengue: guidelines for diagnosis, treatment, prevention and control. World Health O, Special Programme for R, Training in Tropical D, World Health Organization. Department of Control of Neglected Tropical D, World Health Organization E, Pandemic A, et al., editors. Geneva: World Health Organization; 2009.
  36. 36. Islam S, Haque CE, Hossain S, Walker D. Association among ecological and behavioural attributes, dengue vector and disease control: a cross-sectional study of the city of Dhaka, Bangladesh. International Health. 2019. pmid:31782495
  37. 37. Naing C, Ren WY, Man CY, Fern KP, Qiqi C, Ning CN, et al. Awareness of dengue and practice of dengue control among the semi-urban community: a cross sectional survey. J Community Health. 2011;36(6):1044–9. Epub 2011/04/30. pmid:21528416.
  38. 38. WHO. Global Strategy for Dengue Prevention and Control: 2012–2020. Geneva: World Health Organization, 2012.
  39. 39. Koenraadt CJ, Tuiten W, Sithiprasasna R, Kijchalao U, Jones JW, Scott TW. Dengue knowledge and practices and their impact on Aedes aegypti populations in Kamphaeng Phet, Thailand. Am J Trop Med Hyg. 2006;74(4):692–700. Epub 2006/04/12. pmid:16607007.
  40. 40. Mayxay M, Cui W, Thammavong S, Khensakhou K, Vongxay V, Inthasoum L, et al. Dengue in peri-urban Pak-Ngum district, Vientiane capital of Laos: a community survey on knowledge, attitudes and practices. BMC Public Health. 2013;13:434. Epub 2013/05/07. pmid:23641953; PubMed Central PMCID: PMC3645963.
  41. 41. Hairi F, Ong CH, Suhaimi A, Tsung TW, bin Anis Ahmad MA, Sundaraj C, et al. A knowledge, attitude and practices (KAP) study on dengue among selected rural communities in the Kuala Kangsar district. Asia Pac J Public Health. 2003;15(1):37–43. Epub 2003/11/19. pmid:14620496.
  42. 42. Kumaran E, Doum D, Keo V, Sokha L, Sam B, Chan V, et al. Dengue knowledge, attitudes and practices and their impact on community-based vector control in rural Cambodia. PLoS Negl Trop Dis. 2018;12(2):e0006268–e. pmid:29451879.
  43. 43. The PONES. Correction: Knowledge, Attitude and Practice Regarding Dengue Fever among the Healthy Population of Highland and Lowland Communities in Central Nepal. PLoS One. 2014;9(10):e110605.
  44. 44. Dhar-Chowdhury P, Emdad Haque C, Michelle Driedger S, Hossain S. Community perspectives on dengue transmission in the city of Dhaka, Bangladesh. Int Health. 2014;6(4):306–16. Epub 2014/07/02. pmid:24981443.
  45. 45. Zaki R, Roffeei SN, Hii YL, Yahya A, Appannan M, Said MA, et al. Public perception and attitude towards dengue prevention activity and response to dengue early warning in Malaysia. PLoS One. 2019;14(2):e0212497. Epub 2019/03/01. pmid:30818394; PubMed Central PMCID: PMC6394956.
  46. 46. Ramírez G, Álvarez L. Knowledge, Attitudes and Practices Regarding Dengue, Chikungunya, and Zika and their Vector in Villavicencio, Colombia. The Open Public Health Journal. 2017;10:80–9.
  47. 47. de la Cruz AM, Figueroa D, Chacón L, Gómez M, Díaz M, Finlay CM. pmid:10887576. Rev Cubana Med Trop. 1999;51(2):135–7. Epub 2000/07/11.
  48. 48. Castro M, Sánchez L, Pérez D, Sebrango C, Shkedy Z, Van der Stuyft P. The relationship between economic status, knowledge on dengue, risk perceptions and practices. PLoS One. 2013;8(12):e81875. Epub 2013/12/19. pmid:24349145; PubMed Central PMCID: PMC3861357.
  49. 49. Lugova H, Wallis S. Cross-Sectional Survey on the Dengue Knowledge, Attitudes and Preventive Practices Among Students and Staff of a Public University in Malaysia. J Community Health. 2017;42(2):413–20. Epub 2016/10/04. pmid:27696137.
  50. 50. Ghani NA, Shohaimi S, Hee AK, Chee HY, Emmanuel O, Alaba Ajibola LS. Comparison of Knowledge, Attitude, and Practice among Communities Living in Hotspot and Non-Hotspot Areas of Dengue in Selangor, Malaysia. Trop Med Infect Dis. 2019;4(1). Epub 2019/02/20. pmid:30781369; PubMed Central PMCID: PMC6473475.
  51. 51. Itrat A, Khan A, Javaid S, Kamal M, Khan H, Javed S, et al. Knowledge, awareness and practices regarding dengue fever among the adult population of dengue hit cosmopolitan. PLoS One. 2008;3(7):e2620. Epub 2008/07/10. pmid:18612437; PubMed Central PMCID: PMC2440812.
  52. 52. Wong LP, Shakir SM, Atefi N, AbuBakar S. Factors affecting dengue prevention practices: nationwide survey of the Malaysian public. PLoS One. 2015;10(4):e0122890. Epub 2015/04/04. pmid:25836366; PubMed Central PMCID: PMC4383514.
  53. 53. Zamri SNRN A.A and Haque M. Knowledge, attitude and practice regarding dengue among Kuantan medical campus students of International Islamic University of Malaysia. Bangladesh Journal of Medical Sciences. 2020;19(2):245–53.
  54. 54. Wong LP, AbuBakar S, Chinna K. Community knowledge, health beliefs, practices and experiences related to dengue fever and its association with IgG seropositivity. PLoS Negl Trop Dis. 2014;8(5):e2789. Epub 2014/05/24. pmid:24853259; PubMed Central PMCID: PMC4031145.
  55. 55. Mahyiddin NS, Mohamed R, Mohamed J, Ramly N. High knowledge on dengue but low preventive practices among residents in a low cost flat in Ampang Selangor. The Malaysian Nursing Journal. 2016;8:39–48.