DENGUE KNOWLEDGE AND PRACTICES AND

THEIR IMPACT ON AEDES AEGYPTI

POPULATIONS IN KAMPHAENG PHET,
THAILAND
CONSTANTIANUS J. M. KOENRAADT*, WIETEKE TUITEN, RATANA SITHIPRASASNA,
UDOM KIJCHALAO, JAMES W. JONES and THOMAS W. SCOTT
1. Department of Entomology, University of California, Davis, California;
Department of Entomology, U. S. Medical Component, Armed Forces Research
Institute of Medical Sciences, Bangkok, Thailand

Abstract

A knowledge, attitude, and practice (KAP) survey and an extensive entomologic survey were
conducted in two sub-districts of Kamphaeng Phet province, Thailand, to test the hypothesis
that correct dengue knowledge and practice reduce dengue vector populations. We found a
negative association between respondents knowledge of preventive measures and the
number of unprotected containers in and around their houses. Knowledge of development
sites was positively associated with unprotected containers. No relationships existed between
knowledge of dengue and adult mosquito reduction practices. A higher number of
unprotected containers increased the likelihood of the house being infested with one or more
adult Aedes aegypti. Surprisingly, houses of respondents that used mosquito coils or had
screening on doors and windows were significantly more likely to be infested (odds ratio =2.0)
with adult Ae. aegypti. We conclude that there is a direct link between knowledge on dengue
prevention and container protection practices, whereas measures against adult mosquitoes
are used only when people experience a mosquito nuisance problem.
Previous SectionNext Section

INTRODUCTION

Since the first major outbreak of dengue hemorrhagic fever (DHF) in Thailand in 1958, dengue
has remained a serious health problem in this country, with epidemics occurring every three
to five years.13 The principal vector throughout tropical and sub-tropical areas is the mosquito
Aedes aegypti (L.). Females of this species deposit their eggs in a variety of water-holding
containers, such as jars used for domestic water storage, tires, and disposed items that have
filled with rain water. Because an effective vaccine is not yet available, dengue control is
limited to reduction of the vector population.4 This can be achieved by making water-holding
containers unavailable for immature development (source reduction), by killing adult
mosquitoes with insecticides, or by interfering with mosquito-human contact.
Dengue vector control requires effective participation of the local community. 5 Although
education campaigns have increased peoples awareness of dengue, it remains unclear to
what extent this knowledge is put into practice, and to what extent this practice actually
reduces mosquito populations. Knowledge, attitude, and practice (KAP) surveys provide a
suitable format to evaluate existing programs and to identify effective strategies for behavior
change. Thus far, such studies have been relatively rare in dengue research. 6 Dengue KAP
studies have primarily been used to evaluate the impact of health education and communitybased programs.711 Other KAP studies have been more descriptive, 1216 and a few have
attempted to find statistically significant determinants of knowledge and practices 17 or their
effect on vector populations.18,19 Most of these studies do not include biologic and
socioeconomic determinants in one comprehensive model, making relationships harder to
detect and explain.
For the present cross-sectional study, we used a stepwise approach (Figure 1) in which the
following research questions were addressed: 1) can differences in peoples knowledge of
dengue be explained by their demographic background, 2) do knowledge of Ae. aegypti,
dengue symptoms, and/or preventive measures contribute to better preventive practices, and
3) do these practices have a positive impact on immature and adult populations of Ae.
aegypti? Our KAP study was carried out as part of a larger prospective study that is designed
to examine entomologic risk for human infection with dengue virus. We present the results of
our KAP study and the impact on vector populations of people at risk of infection.

FIGURE 1.
Diagram of relationships between demographics, dengue knowledge, practices, and Aedes
aegypti populations.

MATERIALS AND METHODS

Study area.
The study was conducted in two sub-districts of Kamphaeng Phet Province, Thailand: Kon Tee
(1622& prime; N, 9938 E) and Na Bo Kham (1624 N, 9922 E). Kon Tee is located along
the Ping River, which runs from northwest to southeast. Na Bo Kham is situated 20 km west of
the river. It is surrounded by gently rolling hills that are covered with open forest. Irrigated rice
fields and sugarcane plantations form the main type of land use in both sub-districts. The four
serotypes of dengue virus circulate in the area, and can cause mild to severe manifestations
of dengue fever (DF) and DHF.20,21
All studied households were part of a larger epidemiologic study that encompassed more than
4,000 households from 19 villages in four sub-districts. A geographic information system,
which was developed for our study area, was used to select 611 households for the present
study. Each sub-district was represented by two villages or a part thereof.

Study design.
A KAP questionnaire was designed to collect data on demographic characteristics, peoples
knowledge of dengue, and peoples practices in managing water-holding containers and
reducing mosquitoes in their house. To test the general hypothesis that correct dengue
knowledge and practice reduce dengue vector populations, the results from the KAP survey
were coupled with the results from an extensive entomologic survey during September and
October 2004.

KAP survey
The KAP survey was carried out between July 15 and October 6, 2004. Before the start of the
study, permission was obtained from the head of the local public health office, the village
chief, the Thai Ministry of Health (reference # 53/2546), and the University of California at
Davis Institutional Review Board (Human Subjects Protocol Number 2003114103). Informed
consent was obtained from all human adult participants before the questionnaire was
addressed. The questionnaire was evaluated before the beginning of the actual survey. Two
teams of three persons conducted interviews. Each team consisted of a trained interviewer, a
local public health volunteer, and one of the first two authors (CJMK or WT). The female head
of household was preferably interviewed, but if she was absent, another adult resident was
interviewed. A maximum of two attempts to interview the head of household was made
during the daytime (between 8:00 AM and 11:00 AM). If that failed, a final attempt was made
later in the day (between 5:00 PM and 8:00 PM). A person in 511 of the 611 selected
households was interviewed. Two persons refused to participate, approximately half of the
non-interviewed houses were unoccupied at the time of visit, and the remainder could not be
found at home on all three attempts.
Knowledge of dengue was measured by asking questions related to disease symptoms, the
vector, and preventive measures. In addition, questions were asked about the use of

preventive measures against adult mosquitoes. Questions concerning knowledge and attitude
were open questions and asked before the questions related to preventive measures.

Entomologic surveys.
Between September 10 and November 4, 2004, the interviewed households were surveyed
for the presence of larvae, pupae, and adults of Ae. aegypti as described in detail by Morrison
and others.22 Briefly, seven two-person teams inspected the households between 8:00 AM and
12:30 PM. Two teams were responsible for adult collections, the remaining five teams for
immature collections. Each team consisted of one staff member of the United States Armed
Forces Research Institute of Medical Sciences Entomology Laboratory in Kamphaeng Phet and
one collector was recruited from the village. As a result of residents being absent on at least 3
visits, we collected entomologic data from 492 households that were included in the KAP
study.

Larval and pupal survey.

All water-holding containers on the plot of a household were inspected for larvae or pupae
and described on entomologic survey forms. If pupae were encountered, all pupae were
taken. If only larvae were encountered, a sample of these larvae was taken. Recorded
container variables included cover status (with/without), Abate status (with/without), and
fish status (with/without). Immature surveys lasted an average of 42 minutes per household.
The duration of collection depended on the number of water-holding containers found on each
housing plot (range =10187 minutes). In the laboratory, samples were crosschecked with the
survey forms. Emerged mosquitoes from these samples were killed by freezing and identified
as Ae. aegypti,Ae. albopictus, Culex spp., or Toxorhynchites spp.. Their numbers were
recorded by the individual container, sex, and species. At least one larva or pupa was
identified from 95% of the samples that were positive for immature mosquitoes.

Adult survey.
Adult mosquitoes were collected with battery-powered backpack aspirators (John W. Hock
Company, Gainesville, FL).23 Collections were made from all indoor rooms, if permitted.
Outdoor collections were made in separate collection cups from walls and objects located
within three meters of the edge of the roof, but not from vegetation. For houses elevated on
poles (50.3% of the houses), the outdoor area included the area underneath the house.
Collections were also made from the toilet area. Adult surveys lasted an average of 13
minutes per household, but the duration of collection depended on size and complexity of the
house (range = 639 minutes).
In the laboratory, adult mosquitoes were killed and identified as Ae. aegypti, Ae. albopictus,
Culex spp., Armigeres spp., or Anopheles spp.. Their numbers were recorded on entomologic
survey forms by individual household, location (indoor/outdoor/toilet), and mosquito sex.

Data management.
Entomologic and KAP data were entered twice in Microsoft Office Access 2003 (Microsoft
Corporation, Redmond, WA). The two databases were then synchronized and cleaned by
checking empty cells, extreme values, and variables with inconsistent data when compared
with related variables.
Knowledge of symptoms was defined as the respondent mentioning at least one of the
following symptoms: fever, headache, nausea/vomiting, rash, bleeding, shock, or muscular
pain.24 A person had knowledge of Ae. aegypti development sites if he or she could identify at
least one of the following main container types in Thailand: water storage jars, cement baths,
ant traps, tires, flower pots/vases, and garbage. Similarly, we assumed that a person had
knowledge of preventive measures if he or she mentioned at least one of the following
measures: adding Abate (temephos) (American Cyanamid, Parsippany, NJ) changing stored
water, using a mosquito net, turning containers upside down, insecticide spraying, using
mosquito coils, covering containers, disposing of garbage, and placing fish in stored water.
Overall knowledge of dengue was defined as the sum of knowledge of symptoms, knowledge

of Ae. aegypti development sites, and knowledge of preventive measures. Each respondent
obtained a score between 0 and 3.
Practices to prevent transmission of dengue were divided into two strategies: container
protection and reduction of mosquito populations. Container protection was evaluated at both
the container and the household level. At the household level variables of interest were the
absolute number of containers that was not physically protected by a cover, chemically
protected by Abate or biologically protected by fish and the proportion of protected
containers. Mosquito reduction practice was defined as using at least one of the following
measures to reduce human-mosquito contact and/or the numbers of adult mosquitoes:
repellent, bed net or mosquito coils during the day, and screening on windows/doors.

Statistical analysis.
For analysis of the relationships between demographic background, knowledge, practice, and
mosquito populations, we used binary logistic and ordinal regression procedures, as well as
the general linear model (SPSS version 12.0; SPSS Inc., Chicago, IL). Factors having a
screening significance of P < 0.25 in univariate analysis were included in multivariate
analysis. This analysis also included all possible two-way interactions in the full model. The
final model was selected using a backward procedure. In the first step, all two-way
interactions were excluded from the model. If there was no significant loss of fit as evaluated
by comparing -2 log likelihoods in binary and ordinal regression (chi square distribution) or by
comparing error variance in the general linear model approach (F distribution), the next step
was to exclude the least significant factor until the model lost significant information
compared with the previous model.
Previous SectionNext Section

RESULTS
KAP survey.

Table 1 shows the demographic characteristics of the 511 respondents by sub-district.

Because we intended to interview the female head of household, 82% of the respondents
were women. The age of the respondents ranged between 15 and 82 years, of which 71%
were between 30 and 60 years of age. There were no significant differences in sex and age
distribution between the two sub-districts. Respondents from Na Bo Kham had more formal
education than those from Kon Tee (P = 0.004). Overall, 10% of the respondents were
unschooled, almost 60% of them had education levels of primary school grade four or less,
and the remainder had received secondary schooling. Older persons received less education
than younger ones (P < 0.001). Most of the respondents were farmers (65%), small
tradesmen (14%), or unemployed (8%). However, in Na Bo Kham more respondents were
farmers compared with those in Kon Tee (86% versus 44%). In latter sub-district, more
persons made a living as small tradesmen or were unemployed.
View this table:

In this window
In a new window

TABLE 1
Demographic characteristics of 511 respondents in two sub-districts of Kamphaeng Phet
Province, Thailand*
Of the 473 respondents that had ever heard of the disease dengue, 80% could mention at
least one symptom. The most commonly mentioned symptom was fever (59%), followed by
nausea/vomiting (32%) and a general feeling of discomfort (31%) (Table 2). Muscular pain, a
typical symptom of dengue, was mentioned by only six persons. Numerous respondents
(77%) cited Aedes mosquitoes as the main vector of dengue, and 67% knew that dengue
vectors bite during the day. Water jars (46%) and coconut shells (38%) were the development
sites of mosquitoes that were referenced most often. Knowledge of Abate rag; as a measure

to prevent dengue was cited by 46% and changing stored water frequently by 29%. Twenty
percent did not know any measure to prevent dengue.
View this table:

In this window

In a new window

TABLE 2
Knowledge of dengue symptoms, transmission of the disease, development sites of the Aedes
mosquito and preventive measures against dengue of 473 respondents familiar with dengue*
Almost all respondents (98%) regarded dengue as a serious to very serious problem in their
village and 77% of the respondents thought it would be possible to get rid of the mosquitoes
that cause dengue. Volunteers of the local public health offices (43%) were mentioned most
common as the main person responsible to control mosquito breeding, followed by residents
themselves (32%) and the government (13%).
Determinants of knowledge are shown in Figure 2. Sub-district, sex, age, and education were
significantly related with overall knowledge of dengue in both univariate and multivariate
analysis (Table 3). Persons living in Kon Tee had significantly lower knowledge of dengue
than those in Na Bo Kham and females were more knowledgeable than males. Younger
persons had more knowledge than older ones and people with more formal education knew
more about dengue than persons with less schooling.
View this table:

In this window

In a new window

TABLE 3
Comparing ordinal regression models of demographic characteristics on knowledge of dengue

View larger version:

FIGURE 2.

In this page
In a new window

Determinants of dengue knowledge in Kamphaeng Phet Province, Thailand. P values are

based on univariate ordinal regression and demonstrate the overall significance of differences
in knowledge scores between the categories of each determinant.

Entomologic survey.
Houses and containers in Kon Tee were more likely to be infested with Ae. aegypti larvae or
pupae than those in Na Bo Kham (Table 4). The Breteau index (number of Ae. aegypti
breeding containers per 100 houses) was 289 in Kon Tee and 87 in Na Bo Kham. The number
of Ae. aegypti pupae per house was four times higher in Kon Tee than in Na Bo Kham, whereas
the number of adult Ae. aegypti was about six times higher in Kon Tee.
View this table:
In this window
In a new window

TABLE 4
Entomologic indices of two sub-districts in Kamphaeng Phet Province, Thailand
Of the 911 containers infested with Ae. aegypti larvae or pupae, the four most common
container types were water storage jars (34.0%), ant traps (20.3%), cement baths (12.5%),
and tires (5.5%). These four container types were also identified by KAP survey respondents
(Table 2). Interestingly, coconut shells only contributed 0.2% to the positive containers,
whereas they were mentioned by 38% of the respondents as an important source of Ae.
aegypti.
Covers were the most frequently encountered protection (27% of all containers), followed by
containers with Abate (13%) and fish (5%) (Table 5). Containers that were protected by
Abate , a cover, or fish were much more likely to be free of Ae. aegypti pupae (odds ratio
[OR] = 4.51, P < 0.001). Nevertheless, 1.8% of the protected containers were infested with
pupae.
TABLE 5
Containers with and without protection and infestation status with Aedes aegypti pupae
among 492 households in Kamphaeng Phet Province, Thailand

Impact of knowledge on practices

No knowledge determinants were significantly related to container protection practices in
univariate analysis (P > 0.05; Table 6). However, when knowledge of preventive measures
and development sites were included in a multivariate model together with sub-district, sex,
and occupation (all had screening significance; P < 0.25), respondents with knowledge of at
least one preventive measure had significantly fewer unprotected containers in or around
their house (Table 7). Contrary to our hypothesis, persons that mentioned at least one main
development site of Ae. aegypti had significantly more unprotected containers. Persons with
knowledge of at least one dengue symptom did not protect their containers differently from
persons without such knowledge.
TABLE 6
Effects of demographics and dengue knowledge on the number of unprotected containers at
household level in Kamphaeng Phet Province, Thailand
TABLE 7
Comparing general linear models of knowledge of dengue and demographics on container
practice

With regard to mosquito reduction practices, we did not detect significant relationships with
knowledge of symptoms, knowledge of mosquito development sites, knowledge of preventive
measures, and overall knowledge of dengue in univariate (P > 0.05; Table 8) or multivariate
analyses (Table 9). Sex, sub-district, and education were significantly associated with
mosquito reduction practice (P < 0.05). Females used almost twice as many mosquito
reduction practices as males. In Kon Tee three times more preventive measures were used
than in Na Bo Kham. Persons with more than four years of education used significantly more
mosquito preventive measures than people with less education.
View this table:

In this window
In a new window

TABLE 8
Effect of demographics and dengue knowledge on the use of preventive measures against
adult mosquitoes in Kamphaeng Phet Province, Thailand
View this table:

In this window
In a new window

TABLE 9
Comparing multivariate logistic regression models of knowledge of dengue and demographics
on mosquito prevention practice

Impact of practices on adult vector populations.

A higher number of unprotected containers increased the likelihood of the house being
infested with one or more adult Ae. aegypti (P < 0.001; Figure 3A). Households with a high
proportion of protected containers were less likely to be infested with adult Ae. aegypti (P <
0.001; Figure 3B).

View larger version:

In this page
In a new window

FIGURE 3.

A, Likelihood of adult Aedes aegypti infestation in relation to the number of unprotected

containers (solid line) with 95% confidence limits (dashed lines). B, Likelihood of adult Ae.
aegypti infestation in relation to the proportion of protected containers (solid line) with 95%
confidence limits (dashed lines).
The use of repellent or a bed net during the day did not affect the likelihood of a house being
infested with adult Ae. aegypti (Table 10). In contrast, houses of respondents that used
mosquito coils or had screening on doors and windows were significantly more likely to be
infested (OR = 2.0, 95% confidence interval = 1.193.28 and 1.362.95 for screening and
coils, respectively).
View this table:
In this window
In a new window

TABLE 10
Effect of mosquito preventive measures on the presence of Aedes aegypti in 492 households
in Kamphaeng Phet Province, Thailand
Previous SectionNext Section

DISCUSSION

Although the level of dengue knowledge was high in Kamphaeng Phet Province, Thailand, we
found only little evidence that this knowledge was put into practice. Only knowledge of
preventive measures had a significant and beneficial effect on container protection practice.
Conversely, better container management practice did have a considerable impact on Ae.
aegypti populations. Measures that prevent mosquitoes from developing in water-holding
containers, such as adding Abate to containers, covering containers, and/or placing
larvivorous fish in containers, were effective in reducing Ae. aegypti pupae. One should keep
in mind that the most effective control measure should be compatible with water use
practices.25 Larval control measures also had a considerable impact on the adult populations,
whereas preventive measures against adult mosquitoes had no effect or seemed to have
effects opposite of what was desired.
Compared with studies in other parts of Thailand, knowledge of dengue disease symptoms
was slightly lower. Especially the dengue specific symptoms of bleeding/rash, which were
mentioned by only 29% compared with 77% in Chiang Mai Province 17 and 48% in Mae Sot. 15
This could indicate that people are not always able to distinguish dengue infection from other
diseases. Knowledge of Ae. aegypti development sites was comparable to17 or slightly higher15
than in other Thai studies. Interestingly, in our study coconut shells were mentioned by
roughly half of the respondents as important source for mosquito breeding, whereas they only
accounted for 0.2% of breeding containers in the entomologic survey. This may be explained
by the fact that coconut shells received relatively much attention in recent education
campaigns in Kamphaeng Phet Province. Knowledge of measures to prevent dengue was
similar compared with the other Thai studies.17,26
Previous studies have reported conflicting results regarding the effects of knowledge on
dengue prevention practices. Some studies have shown that dengue knowledge was
associated with an increased use of preventive measures against the disease 15,17 and a
reduced number of development sites for vector larvae.27 Other studies found a significant
reduction in the Ae. aegypti infestation index after community-based prevention
campaigns.8,11,28,29 Consistent with our results, however, were studies in Puerto Rico, 9 Brazil,18
and Trinidad en Tobago19 that found little or no correlation between knowledge of dengue and
levels of Ae. aegypti abundance as measured by larval surveys.
Previous investigators measured knowledge of dengue in various ways. Some determine
knowledge of dengue by knowledge of the disease, 7,12,17 whereas others included knowledge of
the vector and control measures.8,10,11,18,19 A few investigators used a score to measure overall
dengue knowledge.9,30 We used both methods in our study. An overall dengue knowledge score

was calculated to use as an independent variable in ordinal regression and as a dependent

variable in our linear models. Knowledge of symptoms, development sites, and preventive
measures were included as independent variables in our statistical analyses. In this way, we
obtained a robust picture of the various relations between knowledge, practices, and vector
populations.
There were two unexpected results in our study. First, persons with knowledge of Ae. aegypti
development sites had more potential development sites in and around their homes
compared with persons without such knowledge. An explanation could be that people become
more knowledgeable of mosquito development sites when they have a lot of them in and
around their houses. Second, use of mosquito coils and the presence of screening on doors
and windows were associated with a higher risk for houses being infested with adult Ae.
aegypti. We reasoned that the result for screening could have been confounded with
socioeconomic background: well-off families may own larger houses and may be more likely
to invest in screening. The likelihood of collecting at least one Ae. aegypti may simply be
higher in larger houses. We did find that larger houses were more likely to have screening
(P=0.025) and when we controlled for house size, we still found a significant effect of
screening. Perhaps families that have many Aedes mosquitoes in their house are more
bothered by these and, therefore, more likely to invest in anti-mosquito measures.
Apparently, these kinds of protective measures have no measurable impact because the
number of mosquitoes was not reduced. The fact that results were similar for both mosquito
coils and screening supports this notion. Future studies will need to verify if mosquito
prevention measures were used thoroughly and effectively.
In accordance with World Health Organization recommendations, the Thai government
launched a National Dengue Prevention and Control Plan (H.M. The Kings Project) in 1999.
Through an Aedes larvae abatement program and a public education campaign, its main aims
were to reduce case fatality rates below 0.2%, reduce dengue incidence below 50 cases per
100,000 population, and to reduce Aedes development containers to less than 50 per 100
houses.31 The public education campaign may have been the main reason for the high dengue
awareness in our area. However, our entomologic survey demonstrated that vector densities
were well above the defined target, especially for Kon Tee sub-district. Apparently, the
program was successful in increasing peoples awareness of dengue, but it did not result in
practices that led to the desired entomologic targets.
Our results indicate a weak relation between dengue knowledge and practice. Better
knowledge does not necessarily lead to better practice, presumably because it is difficult to
change a persons behavior. In addition, better practice may not necessarily lead to a
reduction of dengue risk because specific, dynamic targets for reduction of Ae. aegypti
populations that will result in desired public health outcomes have not been defined and it is
expected that they will be difficult to obtain. 32 These issues must be addressed before
community-based integrated Ae. aegypti control will provide effective prevention and control
of epidemic DF/DHF. Vertically structured approaches have a well documented history of
achieving immediate results in dengue control, but require the necessary infrastructure and
resources to be sustainable.
Knowledge of preventive measures in our study improved practices by reducing the numbers
of unprotected containers, whereas knowledge of dengue symptoms and development sites
had no effect and opposite effect, respectively, on unprotected containers. This suggests that
more emphasis should be put on practical ways to prevent dengue in educational campaigns,
especially on how to get rid of development sites. Although it was not directly associated with
better practice, knowledge of symptoms is important to recognize the severity of dengue at
an early stage because this can lead to proper case management, which saves lives.
We conclude that there is a direct link between knowledge about dengue preventive
measures and container protection practice, whereas measures against adult mosquitoes are
probably only used when people experience a mosquito nuisance problem. Closing the gap
between knowledge and practice will remain an important challenge for dengue control, as
well as defining dynamic targets for reduction of Ae. aegypti populations.
Previous SectionNext Section

Acknowledgments

Acknowledgments: We thank the residents of Kon Tee and Na Bo Kham, Kamphaeng Phet,
Thailand for participating in the KAP survey and allowing us to collect mosquitoes in their
houses. The collaboration with the staff at the Public Health Offices of Kon Tee and Na Bo
Kham and the local public health volunteers is greatly appreciated. We also thank the staff of
the Kamphaeng Phet Entomology Laboratory of the Armed Forces Research Institute of
Medical Science for their help in our studies. Jared Aldstadt, Arthur Getis, and Birgit van
Benthem are acknowledged for their comments on an earlier version of the manuscript.
Financial support: This study was supported by grant AI-034533 from the National Institutes of
Health.
Previous SectionNext Section

Footnotes

* Address correspondence to Constantianus J. M. Koenraadt, Department of

Entomology, University of California, 1 Shields Avenue, Davis, CA 95616. E-mail:
cjmkoenraadt@ucdavis.edu
Authors addresses: Constantianus J. M. Koenraadt and Thomas W. Scott,
Department of Entomology, University of California, 1 Shields Avenue, Davis, CA
95616,
Telephone:
530-754-4196,
Fax:
530-752-1537,
E-mails:
cjmkoenraadt@ucdavis.edu and twscott@ucdavis.edu. Wieteke Tuiten, Ratana
Sithiprasasna, Udom Kijchalao, and James W. Jones, Department of Entomology,
U.S. Army Medical Component, Armed Forces Research Institute of Medical
Sciences, 315/6 Rajvithi Road, Bangkok 10400, Thailand, Telephone: 66-2-6444888, Fax: 66-2-354-7885, E-mails: ratanas@afrims.org, udomk@afrims.org,
james.jones@afrims.org, and wtuiten@hotmail.com.
Received October 14, 2005.
Accepted November 29, 2005.
Copyright 2006 The American Society of Tropical Medicine
Previous Section

REFERENCES
1.
Chareonsook O, Foy HM, Teeraratkul A, Silarug N, 1999.Changing epidemiology
of dengue hemorrhagic fever in Thailand. Epidemiol Infect 122: 161166.
CrossRefMedline
2. Cummings DA, Irizarry RA, Huang NE, Endy TP, Nisalak A, Ungchusak K, Burke
DS, 2004. Travelling waves in the occurrence of dengue haemorrhagic fever in
Thailand. Nature 427: 344347.
CrossRefMedlineWeb of Science
3.
Nimmannitya S, 1987. Dengue haemorrhagic fever in Thailand. Southeast Asian J
Trop Med Public Health 18: 291294.
Medline
4.
Reiter P, Gubler DJ, 1997. Surveillance and control of urban dengue vectors.
Gubler DJ, Kuno G, eds. Dengue and Dengue Hemorrhagic Fever. New York: CAB
International, 425462.
5.
Winch P, Kendall C, Gubler D, 1992. Effectiveness of community participation in
vector-borne disease control. Health Policy Plann 7: 342351.
Abstract/FREE Full Text
6.
Guha-Sapir D, Schimmer B, 2005. Dengue fever: new paradigms for a changing
epidemiology. Emerg Themes Epidemiol 2: 1.

CrossRefMedline
7.
Tram TT, Anh NT, Hung NT, Lan NT, Cam LT, Chuong NP, Tri L, Fonsmark L, Poulsen
A, Heegaard ED, 2003. The impact of health education on mothers knowledge,
attitude and practice (KAP) of dengue haemorrhagic fever. Dengue Bull 27: 174
180.
8.
Sanchez L, Perez D, Perez T, Sosa T, Cruz G, Kouri G, Boelaert M, van der Stuyft P,
2005. Intersectoral coordination in Aedes aegypti control. A pilot project in
Havana City, Cuba. Trop Med Int Health 10: 8291.
CrossRefMedlineWeb of Science
9.
Winch PJ, Leontsini E, Rigau-Perez JG, Ruiz-Perez M, Clark GG, Gubler DJ, 2002.
Community-based dengue prevention programs in Puerto Rico: impact on
knowledge, behavior, and residential mosquito infestation. Am J Trop Med Hyg
67: 363370.
Abstract
10.
Leontsini E, Gil E, Kendall C, Clark GG, 1993. Effect of a community-based Aedes
aegypti control programme on mosquito larval production sites in El Progreso,
Honduras. Trans R Soc Trop Med Hyg 87: 267271.
Abstract/FREE Full Text
11.
Lloyd LS, Winch P, Ortega-Canto J, Kendall C, 1992. Results of a community-based
Aedes aegypti control program in Merida, Yucatan, Mexico. Am J Trop Med Hyg
46: 635642.
Abstract/FREE Full Text
12.
Kittigul L, Suankeow K, Sujirarat D, Yoksan S, 2003. Dengue hemorrhagic fever:
knowledge, attitude and practice in Ang Thong Province, Thailand. Southeast
Asian J Trop Med Public Health 34: 385392.
Medline
13. Donalisio MR, Alves MJ, Visockas A, 2001. Inqurito sobre con-hecimentos e
atitudes da populao sobre a transmisso do dengue - regio de Campinas So
Paulo, Brasil - 1998. Rev Soc Bras Med Trop 34: 197201.
Medline
14. Dobbins JG, Else JG, 1975. Knowledge, attitudes, and practices related to control
of dengue haemorrhagic fever in an urban Malay kampung. Southeast Asian J
Trop Med Public Health 6:120126.
Medline
15.
Swaddiwudhipong W, Lerdlukanavonge P, Khumklam P, Koonchote S, Nguntra P,
Chaovakiratipong C, 1992. A survey of knowledge, attitude and practice of the
prevention of dengue hemorrhagic fever in an urban community of Thailand.
Southeast Asian J Trop Med Public Health 23: 207211.
Medline
16.
Ayyamani UA, Ying GC, San OG, 1986. A knowledge attitude and practice (KAP)
study on dengue/dengue haemorrhagic fever and the Aedes mosquitoes. Med J
Malaysia 41: 108115.
Medline
17.
Van Benthem BHB, Khantikul N, Panart PJ, Kessels J, Somboon P, Oskam L, 2002.
Knowledge and use of prevention measures related to dengue in nothern
Thailand. Trop Med Int Health 7: 9931000.
CrossRefMedlineWeb of Science
18.
Degallier N, Vilarinhos PT, de Carvalho MS, Knox MB, Caetano J Jr, 2000. Peoples
knowledge and practice about dengue, its vectors, and control means in Brasilia
(DF), Brazil: its relevance with entomological factors. J Am Mosq Control Assoc
16: 114123.
MedlineWeb of Science
19.

20.

21.

22.

23.

24.
25.

26.

27.

28.

29.

30.

31.

Rosenbaum J, Nathan MB, Ragoonanansingh R, Rawlins S, Gayle C, Chadee DD,

Lloyd LS, 1995. Community participation in dengue prevention and control: a
survey of knowledge, attitudes, and practice in Trinidad and Tobago. Am J Trop
Med Hyg 53: 111117.
Abstract/FREE Full Text

Endy TP, Chunsuttiwat S, Nisalak A, Libraty DH, Green S, Rothman AL, Vaughn
DW, Ennis FA, 2002. Epidemiology of inapparent and symptomatic acute dengue
virus infection: a prospective study of primary school children in Kamphaeng
Phet, Thailand. Am J Epidemiol 156: 4051.
Abstract/FREE Full Text

Endy TP, Nisalak A, Chunsuttiwat S, Libraty DH, Green S, Rothman AL, Vaughn
DW, Ennis FA, 2002. Spatial and temporal circulation of dengue virus serotypes: a
prospective study of primary school children in Kamphaeng Phet, Thailand. Am J
Epidemiol 156: 5259.
Abstract/FREE Full Text

Morrison AC, Astete H, Chapilliquen F, Ramirez-Prada C, Diaz G, Getis A, Gray K,

Scott TW, 2004. Evaluation of a sampling methodology for rapid assessment of
Aedes aegypti infestation levels in Iquitos, Peru. J Med Entomol 41: 502510.
Abstract/FREE Full Text

Clark GG, Seda H, Gubler DJ, 1994. Use of the CDC backpack aspirator for
surveillance of Aedes aegypti in San Juan, Puerto Rico. J Am Mosq Control Assoc
10: 119124.
MedlineWeb of Science

WHO, 2002. Dengue and Dengue Haemorrhagic Fever. Fact sheet No. 117,
Geneva: World Health Organization.

Phuanukoonnon S, Mueller I, Bryan JH, 2005. Effectiveness of dengue control

practices in household water containers in Northeast Thailand. Trop Med Int
Health 10: 755763.
CrossRefMedlineWeb of Science

Swaddiwudhipong W, Chaovakiratipong C, Nguntra P, Koonchote S, Khumklam P,

Lerdlukanavonge P, 1992. Effect of health education on community participation
in control of dengue hemorrhagic fever in an urban area of Thailand. Southeast
Asian J Trop Med Public Health 23: 200206.
Medline

Chiaravalloti Neto F, Fiorin AM, Conversani DT, Cesarino MB, Barbosa AA, Dibo
MR, Morais MS, Baglini V, Ferraz AA, Rosa RS, Battigaglia M, Cardoso RP Jr, 2003.
Controle do vetor do dengue e participao da comunidade em Catanduva, So
Paulo, Brasil. Cad Saude Publica 19: 17391749.
Medline

Clark GG, Nieves H, Bonilla L, Seda H, 1992. Community and civic organizations
join for dengue prevention in Mayaguez, Puerto Rico. J Am Mosq Control Assoc 8:
317.

Fernandez E, Lagos I, Sherman C, 1993. Advances in the Aedes aegypti

community-based control project in El Progreso, Honduras. J Am Mosq Control
Assoc 9: 449.

Espinoza-Gmez F, Hernndez-Surez CM, Coll-Crdenas R, 2002. Educational

campaign versus malathion spraying for the control of Aedes aegypti in Colima,
Mexico. J Epidemiol Community Health 56: 148152.
Abstract/FREE Full Text

Kantachuvessiri A, 2002. Dengue hemorrhagic fever in Thai society. Southeast

Asian J Trop Med Public Health 33: 5562.

32.
Scott TW, Morrison AC, 2003. Aedes aegypti density and the risk of dengue-virus
transmission. Takken W, Scott TW, eds. Ecological Aspects for Application of
Genetically Modified Mosquitoes. Dordrecht, The Netherlands: Kluwer Academic
Publishers, 187206.