Knowledge, attitude and practice towards dengue fever prevention and associated factors among public health sector health-care professionals: in Dire Dawa, eastern Ethiopia

Figures & data

Table 1 Socio-demographics of HCPs working in public health facilities (N=300) in Dire Dawa, eastern Ethiopia, 2017

Variables		n (%)
Gender	Male	135 (45)
	Female	165 (55)
Age (years)	21–40	279 (93)
	40–60	21 (7)
Profession	Doctor (GP)	22 (7.3)
	Public health officer	31 (10.3)
	Nurse	247 (82.3)
Education level	MSc degree	3 (1)
	MD	22 (7.3)
	BSc degree	195 (65)
	Diploma	80 (26.7)
Experience	<1 year	24 (8)
	1–4 years	99 (33)
	5–9 years	113 (37.7)
	10–14 years	40 (13.3)
	15–19 years	10 (3.3)
	>19 years	14 (4.7)
Health facility type	Referral hospital	155 (51.7)
	Primary hospital	38 (12.7)
	Health center	107 (35.7)
DF training	Yes	10 (3.3)
	No	290 (96.7)

Abbreviation: HCPs, health care professionals.

Table 2 Knowledge assessment of DF prevention among HCPs (N=300) working in public health facilities in Dire Dawa, eastern Ethiopia, 2017

Characteristics		n (%)
1. Mode of transmission	Aedes aegyptimosquito bite	158 (52.7)
	Anophelesmosquito bite	173 (57.7)
	Dirty water	290 (96.7)
	Bite by lice	297 (99)
	Bite by ticks	298 (99.3)
2. Dengue mosquito bite time/feeding habit	Morning	43 (14.3)
	Afternoon	67 (22.3)
	Evening	136 (45.3)
	Night	64 (21.3)
3. Incubation period	3–14 days	191 (63.7)
	1–12 days	208 (69.3)
	14–28 days	283 (94.3)
4. Advice given to prevent dengue infection	Frequently change the water in flower vases	186 (62)
	Remove containers that accumulate clean water	148 (49.3)
	Eliminate tanks or puddles with stagnant water	267 (89)
	Keep drinking water containers (cisterns, tanks) tightly closed	106 (35.3)
	Take paracetamol	266 (88.6)
5. Patients to be hospitalized	Dengue without warning signs	291 (97)
	Dengue without warning signs but with co-morbidities	38 (12.7)
	Dengue with warning signs	173 (57.7)
	Severe dengue	273 (91)
6. Signs and symptoms of dengue without alarm sign	Headache	293 (97.7)
	Muscle pain	274 (91.3)
	Retro orbital pain	119 (39.7)
	Positive tourniquet test	27 (9)
	Fever/subjective warmth	260 (86.7)
	Petechial rash	76 (25.3)
	Vomit	176 (58.7)
	Ascites	292 (97.3)
	Constipation	295 (98.3)
	Diarrhea	291 (97)
	Edema	297 (99)
	Thrombocytopenia	283 (94.3)
	Dyspnea	292 (97.3)
	Chest pain	292 (97.3)
	Icterus	296 (98.7)
	Dysuria	297 (99)
	Persistent cough	298 (99.3)
	Nasal secretion	279 (93)
	Lymphadenitis	299 (99.7)
7. Treatment for suspected dengue	Intravenous (IV) fluid rehydration	274 (91.3)
	Paracetamol	296 (98.7)
	Anti-bacteria	293 (97.7)
	Anti-viral	295 (98.3)
	Any of the following: Aspirin, NSAIDs/Steroids/Immunosuppressant (methotrexate, cyclosporine, etc.)/Opioids/Platelets/Plasma/Whole blood transfusion	248 (82.7)

Abbreviations: DF, Dengue Fever; HCPs, health care professionals.

Table 3 Opinion about DF prevention among HCPs working in public health facilities (N=300), Dire Dawa, eastern Ethiopia, 2017

	Categorical responses n (%)
Characteristics	Strongly agree	Agree	Neutral	Disagree	Strongly disagree
Do you believe that dengue fever could be prevented and controlled	148 (49.3%)	133 (44.3%)	8 (2.7%)	6 (2%)	5 (1.7%)
Do you think you are fully trained to manage a patient with an infection of dengue without warning signs?	12 (4%)	33 (11%)	14 (4.7%)	168 (56%)	73 (24.3%)
Do you think that eliminating the breeding site of the dengue-causing mosquito is complicated and time consuming?	52 (17.3%)	146 (48.7%)	11 (3.7%)	71 (23.7%)	20 (6.7%)
Do you think that you have an important role in dengue fever prevention?	67 (22.3%)	142 (47.3%)	64 (21.3%)	23 (7.7%)	4 (1.3%)
Do you think that dengue is a major problem for your population?	38 (12.7%)	170 (56.7%)	7 (2.3%)	77 (25.7%)	8 (2.7%)
Do you think that dengue is difficult to detect?	11 (3.7%)	93 (31%)	13 (4.3%)	170 (56.7%)	13 (4.3%)
Do you think that the environment is conducive to disease transmission?	67 (22.3%)	210 (70%)	6 (2%)	12 (4%)	5 (1.7%)
Do you think that dengue has a high morbidity?	44 (14.7%)	133 (44.3%)	17 (5.7%)	99 (33%)	7 (2.3%)
Do you think dengue is considered an alarming diagnosis?	37 (12.3%)	141 (47%)	28 (9.3%)	89 (29.7%)	5 (1.7%)
Do you feel like dengue decreases economic productivity?	107 (35.7%)	171 (57%)	6 (2%)	15 (5%)	1 (0.3%)

Abbreviations: DF,Dengue Fever; HCPs, health care professionals.

Table 4 Practice towards DF prevention among HCPs (N=300) working in public health facilities in Dire Dawa, eastern Ethiopia, 2017

Practice related variables			n (%)
Have you ever seen dengue fever case?	Yes		197 (65.7)
	No		103 (34.3)
Are you familiar with the WHO’s 2010 clinical management of dengue guidelines?	Yes		45 (15)
	No		255 (85)
WHO’s dengue guidelines help in managing dengue fever	Yes		277 (93.3)
	No		23 (7.7)
Are there adequate resources available to treat dengue?	Yes		97 (32.3)
	No		201(67)
What resource lacking to treat patients with dengue?	Sufficient training	Yes	191 (63.7)
		No	14 (4.7)
	Medication needed to treat	Yes	12 (4)
		No	193 (64.3)
	Instruments needed to treat	Yes	9 (3)
		No	196 (65.3)
	Access to laboratory tools	Yes	74 (24.7)
		No	131(43.7)
Do you perform a dengue test if you suspected dengue?	Always		33(11)
	Most of the time		46 (15.3)
	Sometimes		118 (39.3)
	Never		103 (34.3)
Which dengue diagnostic test do you utilize most frequently?	Leukocyte, platelet and hematocrit	Yes	77 (25.7)
		No	2 (0.7)
	Dengue serology (IgM/IgG)	Yes	3 (1)
		No	76 (25.3)
	Dengue RT-PCR	Yes	0 (0)
		No	79 (26.3)
		Do not apply	221 (73.7)
	Viral culture	Yes	0 (0)
		No	79 (26.3)
		Do not apply	221 (73.7)
How frequently do you prescribed paracetamol to dengue patients?	Always		86 (28.7)
	Most of the time		102 (34)
	Sometimes		85 (28.3)
	Never		27 (9)
How frequently do you advise dengue patient to avoid mosquito bite?	Always		78 (26)
	Most of the time		45 (15)
	Sometimes		142 (47.3)
	Never		35 (11.7)
How frequently do you prefer CBC lab investigation to monitor patients with suspected or confirmed dengue?	Always		59 (19.7)
	Most of the time		57 (19)
	Sometimes		82 (27.3)
	Never		102 (34)

Abbreviations: DF,Dengue Fever; HCPs, health care professionals.

Table 5 Bivariate and multinomial logistic regression model showing factors associated with a high level of knowledge of HCPs towards DF prevention in Dire Dawa public health facilities, eastern Ethiopia, 2017 (N=300)

Variables		Knowledge level			COR at 95% CI	AOR at 95% CI
		High	Moderate	Low (Reference category)
Profession	Physician (n=22)	13	7	2	55.500 11.253, 273.720)	38.793 (7.279, 206.734)
	Public health officer (n=31)	5	18	8	5.340 (1.519, 18.746)	6.151 (1.643, 23.026)
	Nurse (n=247)	13	123	111	1	1
Practice settings	Health center (n=107)	5	51	51	0.284 (0.099, 0.816)	0.252 (0.086, 0.737)
	Referral hospital (n=155)	19	81	55	1	1

Abbreviations: DF,Dengue Fever; HCPs, health care professionals.

Table 6 Bivariate and multinomial logistic regression model showing factors associated with a favorable attitude level of HCPs (N=300) towards DF prevention in Dire Dawa public health facilities, eastern Ethiopia, 2017

Variables		Attitude level			COR at 95% CI	AOR at 95% CI
		Favorable	Neutral	Unfavorable (Reference category)
Profession	Physician (n=22)	6	13	3	3.583 0.857, 14.976)	2.6 (0.586, 11.543)
	Public health officer (n=31)	14	14	3	8.361 (2.288, 30.556)	7.011 (1.867, 26.321)
	Nurse (n=247)	48	113	86	1	1
Practice setting	Health center (n=107)	27	41	39	1.274 (0.638, 2.543)	1.84 (0.588, 2.384)
	Primary hospital (n=38)	16	15	7	4.206 (1.527, 11.581)	3.683 (1.284, 10.563)
	Referral hospital (n=155)	25	84	46	1	1

Table 7 Bivariate and multinomial logistic regression model showing factors associated with a neutral attitude level of HCPs towards DF prevention in Dire Dawa public health facilities, eastern Ethiopia, 2017 (N=300)

Variables		Attitude level			COR at 95% CI	AOR at 95% CI
		Favorable	Neutral	Unfavorable (Reference category)
Profession	Physician (n=22)	6	13	3	3.298 (0.911, 11.937)	2.811 0.752, 10.506)
	Public health officer (n=31)	14	14	3	3.552 (0.989, 12.750)	3.452 (1.126, 15.027)
	Nurse (n=247)	48	113	86	1	1

Abbreviations: DF,Dengue Fever; HCPs, health care professionals.

Table 8 Bivariate and multinomial logistic regression model showing factors associated with a high practice level of HCPs (N=300) towards DF prevention in Dire Dawa public health facilities, eastern Ethiopia, 2017

Variables		Practice level			COR at 95% CI	AOR at 95% CI
		High	Moderate	Low (Reference)
Profession	Physician (n=22)	8	13	1	25.532 (3.112, 209.441)	17.618 (2.072, 149.787)
	Public health officer (n=31)	16	10	5	10.213 (3.551, 29.368)	7.650 (2.523, 23.194)
	Nurse (n=247)	47	50	150	1	1
Practice setting	Health center (n=107)	22	27	58	4.231 (0.643, 6.364)	3.582 (0.521, 5.132)
	Primary hospital (n=38)	17	8	13	3.474 (1.517, 7.955)	2.648 (1.076, 6.515)
	Referral hospital (n=155)	32	38	85	1	1
DF training	Received (n=10)	6	3	1	14.308 (1.689, 121.209)	10.231 (1.052, 99.478)
	Not received (n=290)	65	70	155	1	1

Abbreviations: DF,Dengue Fever; HCPs, health care professionals.

Table 9 Bivariate and multinomial logistic regression model showing factors associated with a moderate practice level of HCPs (N=300) towards DF prevention in Dire Dawa public health facilities, eastern Ethiopia, 2017

Variables		Practice level			COR at 95% CI	AOR at 95% CI
		High	Moderate	Low
Profession	Physician (n=22)	8	13	1	39.000 (4.976, 305.681)	28.524 (3.500, 232.436)
	Public health officer (n=31)	16	10	5	6.000 (1.957, 18.393)	4.706 (1.466, 15.108)
	Nurse (n=247)	47	50	150	1	1
Sex	Male (n=135)	30	46	59	2.801 (1.576, 4.977)	2.211 (1.179, 4.146)
	Female (n=165)	41	27	97	1	1
DF training	Received (n=10)	6	3	1	6.643 (0.679, 64.991)	4.741 (0.431, 52.158)
	Not received (n=290)	65	70	155	1	1