Usage of Personal Protective Measures Against Mosquito Bites among Patients Attending Fever Clinic in a Tertiary Care Centre

M Janaki,a D Jaiganesh,a AK Rajendranb

a. Department of Community Medicine, Melmaruvathur, Adhiparasakthi Institute of Medical Sciences (MAPIMS), Tamil Nadu; b. Institute of Community Medicine,  Madras Medical College, Tamil Nadu

Abstract

Introduction: Mosquito borne diseases are very important public health problems affecting both urban and rural areas.  Mosquito borne diseases affect in excess of 40 million people in India every year.  At the Individual level the usage of personal protective measures is an important method to prevent mosquito borne diseases. Mosquito Coils, Repellents, Liquid Vaporizers, Mosquito net. etc are some of the personal protective measures available in the market.

Objectives: 1. To study the pattern of usage of personal protective measures against mosquito bites among the patients attending Fever OPD in Rajiv Gandhi Government General Hospital, Chennai.  2. To identify the reasons for the usage / non usage of personal protective measures against mosquito bites.

Methods: A Hospital based cross sectional study was conducted during October 2011 among 150 patients attending the Fever OPD. A semi structured, pre tested questionnaire was used to collect data.

Results: Among the participants 140 (93%) were using any one of the personal protective measures.  94 (67%) were using the personal protective method daily and 46 (33%) were using once weekly or when mosquito breeding was on the increase.  Mosquito coil was the commonest personal protective method used followed by Liquid Vaporizers, Repellents, Mosquito Nets.  The average Monthly Expenditure for the use of PP measures was 59 Rupees.  Statistically significant association was observed between the pattern of usage (daily usage of personal protective measures) and socio economic status, type of house, mode of disposal of wastes from the house and perceptions regarding prevention of mosquito borne diseases.

Conclusion: This study found that the overall usage was high among the patients attending Fever OPD at Rajiv Gandhi Government General Hospital but many were not using the methods regularly.  Irregularity in use was associated with lower socioeconomic status and poor awareness.

Keywords: , ,

Introduction

Mosquito borne diseases affect in excess of 40 million people in India every year.1  There are a number of diseases borne by mosquitoes.  These include are Malaria, Filariasis, Dengue Fever, Japanese Encephalitis and Chikungunia.  Mosquito borne diseases are one of the most important public health problems affecting both urban and rural areas of India.  Disorganized urbanization, poor sewer systems and challenges in waste management has created new breeding places for the vectors of these diseases.2

In 2003-04, Government of India approved the National Vector Borne Diseases Control Program (NVBDCP), which now comes in the purview of National Rural Health Mission (NRHM). Integrated Vector Control is the chief strategy of this programme.  The components of Integrated Vector Control methods were Source reduction, Chemical and Biological vector control, Personal Protection and Health Education.3                  

Integrated Vector Management (IVM) is an approach that improves the efficacy and cost effectiveness of vector control measures.  The IVM approach is vital to achieving the national targets set for control of vector-borne diseases.4

Personal protection, as the term denotes, is a responsibility vested at the level of the individual and the family.  This is unlike most other strategies in IVM, which are dependent on the public health machinery.  That this machinery falls short of meeting its objectives is a common observation in Indian cities, leading to frequent outbreaks of vector borne diseases.  This is especially true of a city like Chennai, where hygiene and sanitation are long standing issues.  In such scenarios use of personal protective (PP) methods is very often the only line of defense.  However, success of these measures depends on the acceptability and proper usage by the target population. 

Objectives

  1. To study the pattern of usage of personal protective measures against mosquito bites among the patients attending Fever OPD in Rajiv Gandhi Government General Hospital, Chennai.
  2. To identify the reasons for the usage / non usage of personal protective measures against mosquito bites. 

Methods

A Hospital based Cross – sectional study was conducted in the Fever OPD in Rajiv Gandhi Government General hospital, Chennai during October 2011.  The study population was the patients attending fever OPD who belonged to the age 18-60 yrs, both male and female.  Those not willing to participate and severely ill patients were excluded from the study.

Vijay Kumar KN et al1 reported 75% of people were using one or the other forms of PP methods against mosquito borne diseases.  Based on the calculations 95% confidence interval P = 75%, Q = 25% Allowable error d = 10% of 75% = 7.5, the sample size was 129.  Including the 10% non-responsiveness the sample size required for the study was 150.

Systematic Random Sampling Method was used for this study.  The total number of patients attended the fever clinic in the month of October 2011 was 2288 and every 14th patient was included in the study.  Data collection was done after obtaining permission from Institutional Ethical Committee by using a semi structured, pre tested questionnaire from all the study subjects after getting the informed consent.

The Questionnaire includes Socio Demographic variables like age, gender, religion, socio economic status etc., PP methods and the cost spent for the methods.  Personal Protective measures were defined as the methods used by individuals or small groups of people to prevent mosquito contact.10  Some of the methods were Repellents in the form of Mosquito Coils, Liquid Vaporizers, Creams, and Fan at full speed, Mosquito nets, Mosquito bats etc.  Socio Economic status was assessed by Modified Kuppusamy’s Classification.

Statistical Analysis

The data was entered in Excel sheet and analyzed using SPSS version 18.  The results were expressed as proportions and percentages.  Chi square test and Fisher’s Exact test were used to compare the variables and p < 0.05 was considered as statistically significant.

Results

Out of 150 study subjects 66 (44%) belonged to 18 – 35 yrs and 84 (56%) were belonged to 35 – 60 yrs.  Regarding Sex 84 (56%) were male and 66 (44%) were females.  Hindus, Christians, Muslims were 114 (76%), 25 (17%), 11 (7%) respectively.  Only 18 (12%) were illiterate and 132 (88%) were literate.  Among the literates, primary school, high school, higher secondary education and graduates were 14 (9%), 39 (26%), 36 (24%) and 11 (7%) respectively.  According to Modified Kuppuswamy’s classification, 87 (58%) were in the upper lower class and 63 (42%) were in the lower middle class.

Among the study population 49 (33%), 77 (51%), 24 (16%) were living in pucca, semi pucca and katcha house respectively.  Regarding the disposal of waste from houses 86 (57%) were using the public dustbin, 41 ( 27%)  were throwing the daily wastes in front or around their houses and 15% were collecting the wastes in their houses which were taken away by corporation vehicle daily.  The drainage was open method in 63 (42%) houses and underground method in 87 (58%) houses.

Table 1. Usage of Personal Protective Measures

Table 1. Usage of Personal Protective Measures

About the usage of personal protective measures, 140 (93%) study subjects were using one of the methods and 10 (7%) were not using any personal protective measures against mosquito bites.  Among the measures used, Mosquito coils were the leading one followed by Liquid Vaporizers, Repellents, Fan, Mosquito nets and mosquito bats. The percentages are shown in Table 1.

Among the study population the reasons for preference of their own methods were Convenience of the method followed by cost and perception of good control of mosquitoes by the methods. The reasons for not using any method were Economic Problems, allergy to some methods and the attitude that the Mosquito control should be done only by Government agencies (Table 2).  Monthly expenditure to purchase PPM among the users were less than 50 rupees in 51%, 50 – 100 rupees in 45% and 100 – 150 rupees  in 3% and the Mean Expenditure was 59 rupees, Standard Deviation was 29.40 rupees.

Table 2. Reasons for Usage and Non-usage of Personal Protective Measures

Table 2. Reasons for Usage and Non-usage of Personal Protective Measures

Discussion

In this study 140 (93%) were using any one of the personal protective measures which was similar to the studies conducted by Niraj Pandit et al7 in Gujarat, Surendran S et al7 in Sri Lanka and Babu BV et al10 in Orissa.  In another study conducted by Abhijit V Boratne et al5 in Pondicherry, only 84% were using PP methods. The most common methods used in this study was Mosquito coil and Liquid Vaporizers .The similar findings were seen in the studies by Vijay Kumar KN et al,1 Abhijit V Boratne et al5 and  Niraj Pandit et al.8  Babu BVet al10 from Orissa  reported 76% of urban household were using bed net however only 3% were using the bed nets in this study.  Among the users 140 (93%) only 67% of them were using the method regularly which was high compared to Snehalatha et al6 where only 48% used personal-protection measures daily.  In this study the average Expenditure to purchase the PP measures was 59 rupees which was similar to Snehalatha et al6 (62 rupees) but very low compared to Vijaykumar et al.1

Table 3. Socio Demographic Variables and the Pattern of Usage of PP Measures

Table 3. Socio Demographic Variables and the Pattern of Usage of PP Measures

There was a statistical significant association between the pattern of usage (daily usage of personal protective measures) and socio economic status, type of house and mode of disposal of wastes from the house (Table 3).  The usage was regular among those who belonged to lower middle socio economic status, residents of semi pucca house and those who used the public dustbin for disposal of wastes from the house.  The low economic condition of those living in kutcha house may be the cause for the poor usage.  Those who used to throw their wastes in front and around the houses are the one who actually need the PP methods because of increased mosquito breeding. But in this study their usage was low.

Regarding the reasons for non-usage economic problem played an important role.  To overcome this Government may give subsidy to get any form of PP methods in addition to their regular insecticide spray.  Apart from the regular usage of PP measures, the other methods like minor engineering measures, chemical methods etc should also be done for effective control of mosquitoes and mosquito borne diseases.

Since it was a hospital based study the impact of usage of personal protective measures against mosquito borne diseases could not be assessed.  A community based study would give better information on the impact of personal protective measures which might be used to formulate policy actions at the local level.

Conclusion

The overall usage was high among the patients attending Fever OPD in Rajiv Gandhi Government General Hospital, but they were not using the methods regularly.  This attitude should be changed by appropriate health education.  IEC activities should be involved to promote the usage of personal protective measures.  To overcome the economic constraints particularly among the poorer socio economic classes; government can provide personal protective measures through social marketing.  Community participation is an essential component for the reduction of mosquito borne diseases.

References

  1. Vijay Kumar KN, Ramaiah KD.Usage of personal-protection measures against mosquitoes and the low prevalences of Wuchereria bancrofti microfilaraemia in the Indian city of Chennai. Ann Trop Med Parasitol. 2008 Jul;102(5):391-7.
  2. Dr. B.K .Tyagi, The invincible deadly mosquitoes Scientific publishers, Jodhpur India. First Edition, Page no: 84-85.
  3. AH Suryakantha, Text book of Community Medicine with Recent advances JAYPEE Brothers Medical Publishers (P) LTD. 2 nd editions .Page No: 124 – 125
  4. Handbook for Integrated vector management, World Health Organization,    WHO/HTM/NTD/VEM/2012.3
  5. Abhijit V Boratne, Shib Sekhar Datta, Zile Singh, Anil J Purty, V Jayanthi, V Senthilvel Attitude and practices regarding mosquito borne diseases and socio-demographic determinants for use of personal protection methods among adults in coastal Pondicherry Indian journal of medical specialities, 2010;1(2):91-96
  6. Snehalatha KS, Ramaiah KD, Vijay Kumar KN, Das PK. The mosquito problem and type and costs of personal protection measures used in rural and urban communities in Pondicherry region, South India. Acta Trop. 2003;88(1):3-9.
  7. Surendran SN, Kajatheepan. A Perception  and  personal  protective  measures  toward mosquito  bites  by  communities  in  Jaffna  District,  Northern  Sri  Lanka;  J  Am  Mosq Control Assoc. 2007;23(2):182-6.
  8. Niraj Pandit, Yogesh Patel, Bharat Bhavsar Awareness and practice about preventive method against mosquito bite in Gujarat ,Health line 2010 ; 1 (1): 16-20.
  9. Vector borne diseases in India 2006. World Health Organisation. http://www.searo.who.int/LinkFiles/CDS_vector-borne_diseases_in_India.pdf
  10. Babu BV, Mishra S, Mishra S, Swain BK. Personal-protection measures against mosquitoes: a study of practices and costs in a district, in the Indian state of Orissa, where malaria and lymphatic filariasis are co-endemic. Ann Trop Med Parasitol. 2007; 101(7):601-9.
  11. Text Book of Public Health and community Medicine First Edition 2009, Published by   Department of community Medicine Armed Forces Medical College, Pune in collaboration with WHO ,India Office, New Delhi. Page No: 611 – 612.

Author Information

  1. M. Janaki, Assistant Professor of Community Medicine, Melmaruvathur Adhiparasakthi Institute of Medical Sciences (MAPIMS), Tamil Nadu.
  2. D. Jaiganesh, Assistant Professor of Community Medicine, Melmaruvathur Adhiparasakthi Institute of Medical Sciences (MAPIMS), Tamil Nadu.
  3. A. K. Rajendran, Director, Institute of Community Medicine,  Madras Medical College, Tamil Nadu

Conflicts of Interest

None declared

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