Assessment of knowledge, attitudes, and practices towards dengue fever and its vectors among residents of various ecological regions in eastern Nepal

Abstract

Executive Summary: Dengue virus is a single-stranded RNA virus transmitted by Aedes mosquitoes. It belongs to the genus Flavivirus (family Flaviviridae) and includes four serotypes capable of causing disease ranging from self-limiting dengue fever to life-threatening dengue hemorrhagic fever (DHF) and dengue shock syndrome (DSS). Globally, dengue has surged, with an estimated 390 million infections each year; around 96 million of these result in clinically apparent disease, many of which are severe. The Americas, South-East Asia, and Western Pacific regions are the most affected, with Asia accounting for approximately 70% of the global disease burden. Since the first dengue outbreak in 2006, Nepal has faced regular annual dengue outbreaks, from lowland to highland areas, with particularly significant outbreaks in 2022. Understanding people’s perceptions and behaviors is critical to designing effective, context-specific prevention and control strategies. Although several studies have examined dengue in Nepal, little attention has been given to differences across altitudinal regions in eastern Nepal. This study therefore aimed to assess people’s knowledge, attitudes, and practices (KAP) regarding dengue and vector prevention and control at different altitudes in eastern Nepal. In this cross-sectional study conducted in six districts of eastern Nepal, participants were categorized according to residence in highland or lowland areas. Knowledge, attitudes, and preventive practices related to dengue were assessed using a structured questionnaire, and KAP scores were calculated. Sociodemographic characteristics were recorded and analyzed to examine associations with KAP levels, using logistic regression for comparison. Among 662 participants, 31.1% resided in highland areas and 68.9% in lowland regions. Almost all participants (98.3%) had heard of dengue. However, only 6.9% demonstrated good knowledge, 75.4% showed a positive attitude, and 26.7% reported good preventive practices, with no significant differences between highland and lowland residents. Gender, education level, and income were significant predictors of both attitude and practice. There was a negative correlation between knowledge and attitude, and between attitude and practice, while knowledge showed a weak but statistically significant positive correlation with preventive practices. These findings highlight a critical gap: while most participants have heard of dengue and many hold positive attitudes toward prevention, this does not translate into adequate preventive practices. Poor knowledge and limited behavior change directly impede effective dengue prevention at the community level. For policymakers, this underscores the need to:Â Prioritize targeted, evidence-based health education and risk communication strategies tailored to different sociodemographic and altitudinal contexts. Â Strengthen community-based behavior change interventions that go beyond raising awareness to actively support and sustain preventive practices. Â Integrate dengue prevention messages into existing health and social services, schools, and local governance structures, with particular focus on women, lower education groups, and lower-income households. Effective, sustained educational and community engagement strategies are essential to translate awareness and positive attitudes into concrete preventive actions and to reduce the dengue burden in eastern Nepal.