research paper about dengue in philippines

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PLoS Neglected Tropical Diseases (Apr 2019)

Trends in dengue research in the Philippines: A systematic review.

• Kristal An Agrupis,
• Michelle Ylade,
• Josephine Aldaba,
• Anna Lena Lopez,
• Jacqueline Deen

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Dengue is an important public health problem in the Philippines. We sought to describe the trends in dengue research in the country. We searched four databases and identified published studies on dengue research in the Philippines during the past 60 years. We reviewed 135 eligible studies, of which 33% were descriptive epidemiologic studies or case series, 16% were entomologic or vector control studies, 12% were studies on dengue virology and serologic response, 10% were socio-behavioral and economics studies, 8% were clinical trials, 7% were on burden of disease, 7% were investigations on markers of disease severity, 5% were on dengue diagnostics, and 2% were modeling studies. During the last decade, dengue research in the Philippines has increased and evolved from simple descriptive studies to those with more complex and diverse designs. We identified several key topics where more research would be useful.

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• Open access
• Published: 15 March 2024

Knowledge, attitudes, and practices related to dengue among public school teachers in a Central Luzon Province in the Philippines: an analytic cross-sectional study

• Ernesto R. Gregorio   ORCID: orcid.org/0000-0003-1931-0458 1 , 10 , 2 ,
• Rie Takeuchi 10 , 11 , 3 ,
• Paul Michael R. Hernandez 4 ,
• John Robert Medina 5 ,
• Shin-ya Kawamura 6 ,
• Mikaela B. Salanguit 1 ,
• Marian Danille C. Santillan 1 ,
• Kimberly Mae S. Ramos 7 ,
• Gideon John Tuliao 1 ,
• Lyndon Morales 8 ,
• Maylin Palatino 9 ,
• Fumiko Shibuya 10 , 11 &
• Jun Kobayashi 1 , 10 , 11  

Tropical Medicine and Health volume  52 , Article number:  25 ( 2024 ) Cite this article

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Dengue has become a major health issue in tropical regions as the numbers of reported cases and estimated infections continuously increase. In the Philippines, many challenges remain in preventing and controlling the disease amidst all the mitigation efforts of the government. This study sought to measure the health literacy of Filipino teachers and determine the associations among teachers’ knowledge, attitudes, and selected practices (KAP) against dengue.

Elementary and secondary school teachers from the consistently declared dengue hotspots in the City of San Fernando, Pampanga, Philippines, from the years 2017 to 2019 were selected as target participants in this cross-sectional study. A self-administered online survey tool was used in this study for both screening of participants and the KAP survey proper. STATA, descriptive statistics, and multiple logistic regression were used for the data analysis. Odds Ratios (ORs) and 95% confidence intervals (CIs) were reported.

The study comprised 604 participants whose mean age was 38.4 years. Television was determined as the top media source of information, and various health staff were the most trusted and common source of information. Good knowledge on dengue treatment (OR = 1.81; 95% CI 1.18–2.78) and dengue prevention (OR = 1.85; 95% CI 1.26–2.71) were positively associated with having good practices on protection against mosquito bites. Good knowledge on dengue signs and symptoms (OR = 1.56; 95% CI 1.02–2.37) and dengue prevention (OR = 2.38; 95% CI 1.59–3.58) were positively associated with having good practices on preventing breeding sites. Those with positive perceived susceptibility to dengue had lower odds of having good practices on protection against mosquito bites (OR = 0.64; 95% CI 0.41–0.99) and of having good practices on preventing breeding sites (OR = 0.46; 95% CI 0.26–0.81).

Even with the existing dengue policies, programs, and strategies, and the high disease literacy rate of Filipinos, dengue remains a struggle with an increasing case rate. Therefore, specific concepts should be emphasized, and interventions should be fine-tuned to better reach and influence the target population to attain a dengue-free Philippines.

Introduction

The majority of low- and middle-income countries are in the tropics where the spread of neglected tropical diseases has become a major public health crisis. Dengue, in particular, has become a global threat due to the increasing number of infected people and endemic areas, which is strongly influenced by global warming. According to the Philippines’ Department of Health, dengue is the fastest-spreading vector-borne disease in the world, being endemic in 100 countries [ 1 ]. In Southeast Asia, the number of reported dengue fever outbreaks has increased dramatically [ 2 ]. About 100 million cases of dengue occur each year along with an estimated 400 million infections. Forty percent of the world’s population, or about 3 million people, live in areas with risk of the disease [ 2 , 3 , 4 ].

Due to the limited resources in low- and middle-income countries, correct diagnosis of dengue has become even more important. Early detection of the disease leads to administration of timely and appropriate medical interventions. This has lowered the fatality rate of severe dengue from 20% to below 1% [ 2 ]. However, the diagnosis of dengue has proved to be challenging due to its nonspecific presentation, especially during its early stages [ 5 ]. With the limited resources available, low accessibility to healthcare, and hesitancy to go to hospitals, compounded by the challenges brought about by the COVID-19 pandemic, differential diagnosis of febrile diseases is expected to be very difficult [ 6 ]. For example, during the early phase of the COVID-19 pandemic, dengue and COVID-19 were incorrectly diagnosed as both patients presented with lymphopenia, leukopenia, thrombocytopenia, and elevated transaminases in laboratory tests. In addition, false information that COVID-19 is transmitted by mosquitoes has become a problem in low- and middle-income tropical countries where mosquito-borne diseases such as dengue are widespread. While this could be protective to a certain extent, the said misinformation still poses a challenge in terms of the diagnosis and treatment of dengue. Therefore, risk communication to convey appropriate information is important in febrile disease control.

Challenges remain in controlling the spread of dengue despite the presence of Philippine government’s prevention policies and an established case reporting system. Contributing to the Philippines’ situation of increased dengue cases is the 2017 dengue vaccine controversy involving Dengvaxia. Yu et al. discovered that after the controversy, there is widespread mistrust and fear in various communities towards the state and health authorities [ 7 ]. The researchers also added that the media played a role in the public's vaccine hesitancy, as well as the altered perceptions towards the government and healthcare. Therefore, it is essential to efficiently implement prevention programs through vector control strategies, appropriate health behavior change, and early diagnosis and appropriate treatment.

Although dengue fever affects all age groups, it is still most common among older children, adolescents and adults [ 8 ]. In a Knowledge, Attitude, and Practice (KAP) study conducted on primary school children in Thailand, it was discovered that the main sources of information on dengue were primary school teachers and guardians and that most of the study participants possessed poor dengue-related knowledge [ 9 ]. The health literacy of school teachers related to dengue must be assessed to see how well they respond to cues important for school-based vector surveillance. Health literacy may then be further enhanced to improve their surveillance responses through appropriate school health education, with a focus on febrile diseases important in the public health context.

In 2022, the Philippine government began to lift the COVID-19 pandemic restrictions, and dengue was expected to become even more widespread. As the number of cases continues to increase, it is important to understand these implications and take appropriate measures. With the resumption of face-to-face classes in the Philippines, health literacy in schools can be an important area for intervention in the Philippines where underreporting of dengue fever cases exists [ 10 ]. Misinformation such as “COVID-19 is transmitted by mosquitoes” should be corrected. To further amplify the current surveillance, prevention, and control measures of dengue cases in the Philippines, knowledge of the factors that affect the rise of dengue cases is vital in implementing appropriate measures.

A study conducted in Lao People’s Democratic Republic found that knowledge about climate change and dengue was significantly associated with one’s level of education and socioeconomic status [ 11 ]. In addition, attitudes toward climate change and dengue were associated with internet use and level of education whereas practices related to dengue were associated with internet use, level of education, socioeconomic status, and previous dengue experience. From this study, it can be seen that one’s knowledge, attitudes, and practices toward dengue are highly dependent on their level of education. In the Philippine context, Labrague and Yboa conducted a study among rural residents in Samar, Philippines [ 12 ]. Despite access to correct information on dengue, the disease remains as a challenge. They found that there are high levels of knowledge and preventive practices regarding dengue. However, higher levels of knowledge do not necessarily lead to better practices of prevention. With this information, it is also important to determine the associations among knowledge, attitudes, and practices to determine which aspects may be the focus of health communication program that can lead to better health outcomes.

This study thus targeted the health literacy of Filipino teachers who serve as one of the sources of health information about dengue. The study aimed to determine the association between the knowledge, attitudes, and selected practices of teachers on dengue and specifically to (1) determine the respondents’ knowledge on the modes of transmission, signs and symptoms, diagnosis, treatment, and methods of preventing dengue; (2) assess the respondents’ attitudes towards dengue prevention and control measures; (3) determine the proportion of respondents who practice health-seeking behaviors and prevention and control measures against dengue; (4) determine the association between the respondents’ prevention and control practices, and their knowledge and attitudes towards dengue and COVID-19; and (5) determine the primary sources of information of the respondents on dengue.

Research design

An analytical cross-sectional design was used to assess the knowledge, attitudes, and practices of public elementary and junior high school teachers regarding dengue. The data were collected from September 2022 to November 2022.

The City of San Fernando, Pampanga, in the Philippines was chosen purposively as the study site. The researchers obtained data on the dengue cases from 2017 to 2019 in the City of San Fernando, Pampanga from their City Health Office  in coordination with their Department of Education Schools Division Office (SDO) to identify the villages (barangays) that had consistently been dengue hotspots, that is, areas with confirmed clustered cases that had increased in number during the past four weeks [ 13 ]. Based on this information, nine public elementary schools and 10 junior high schools in the identified villages were selected.

Study population

The target participants of the study were public elementary and junior high school teachers of the villages that have consistently been dengue hotspots in the City of San Fernando, Pampanga. This study included all eligible teachers in the selected schools. The inclusion criteria were (a) currently employed or on active duty for the school year 2021–2022; (b) teaching staff; and (c) age 18 to 64 years old. A questionnaire that included consent to participation and data inclusion in the study was used for the initial screening. Participants were excluded from the study if they did not provide consent.

Research instrument

The KAP survey instrument was developed based on existing literature and survey tools including a similar study on Zika Virus, which referenced an instrument provided by the World Health Organization (WHO)-Pan American Health Organization [ 14 ].

The self-administered tool consisted of six domains. The first domain contained eight questions that collected the participants’ sociodemographic characteristics. The second domain had four questions relating to any history of exposure to dengue. The third domain had 20 questions about the participant’s knowledge on the dengue virus, which was further categorized into mode of transmission, signs and symptoms, diagnosis, treatment, and prevention. Mode of transmission refers to the participants’ knowledge on how dengue virus is spread from one susceptible host to another, which was measured using seven questions. Signs and symptoms refer to the participants' knowledge of the clinical signs and symptoms of dengue and was measured using two questions. Diagnosis refers to the participants’ knowledge of the correct method of dengue diagnosis, which was measured using five questions. Treatment refers to the participants' knowledge of appropriate treatment for dengue and was measured using four questions. Lastly, prevention refers to the participants' knowledge on how dengue can be prevented. This was measured using two questions. The transmission, diagnosis, and treatment categories in the knowledge domain were measured using true or false statements, with the option to choose “I don’t know.” Meanwhile, the signs and symptoms and prevention categories used multiple-answer questions.

The fourth domain had 15 items that measured the attitudes of the participants towards dengue control, prevention, and treatment. For this, the study utilized the constructs of the health belief model, specifically, perceived benefit, perceived barriers, perceived susceptibility, perceived severity, and external cues to action. All constructs were measured using three questions that were answered through a modified Likert Scale. Perceived benefit refers to the participants' belief in the effectiveness of proper actions to reduce the risks related to dengue. Perceived barriers refer to the participants' belief that tangible and intangible barriers such as costs and safety concerns can prevent the enactment of the advised action. Perceived susceptibility refers to the belief of the participants about their chances of contracting dengue. Perceived severity refers to the belief of the participants about the serious clinical effects of dengue. External cues to action refer to the people or personalities that may possibly influence the participant’s decision to enact the advised action.

The fifth domain contained five questions, four of which could have multiple answers regarding the sources of information and health literacy. The sixth domain measured the participants' practices on dengue prevention and health-seeking behaviors through an item that can have multiple answers. Five questions answered with a four-point Likert scale on their perceptions on the COVID-19 pandemic’s effect on the government’s response in fighting dengue and an open-ended question on the most appropriate strategy for teaching dengue prevention were included in this domain.

To test the reliability of the survey tool, Kuder–Richardson 20 and Cronbach’s Alpha were used with result interpretation considered to be highly reliable.

Data collection, management, and analysis

A letter of request to conduct the study was sent to the SDO Superintendent and to the school heads. Once permission was obtained, assistance from the School Governance and Operations Division was sought to enable the research team to gain access to the teachers. The link to the study questionnaire was sent through an email to the school head of each of the selected schools and was then distributed to the teachers through their group chats. A printed QR code for the questionnaire was also distributed to help facilitate the dissemination of the survey to the teachers. The settings of the online tool used for the study questionnaire ensured that all fields and questions were answered before submission. If the submitted answer was not applicable to the question, the cell was then left blank and was not included in the logistic regression analysis. All individual questionnaire responses were double-checked and verified for completeness and consistency before processing.

The data collected were encoded through Microsoft Excel (Microsoft Corporation, Redmond, WA, USA). Correct answers in the knowledge domain items were coded as 1, 0 otherwise. The percentages of correct answers of the participants for each knowledge domain were computed. A score of more than 75% was considered as having good knowledge, coded as 1, poor knowledge otherwise, coded as 0. For the attitude domain, the responses of 4 and 3 to the Likert scale were coded as being answers with favorable (positive) attitudes towards dengue prevention and control, whereas 2 and 1 were answers indicating less favorable (negative) attitudes towards dengue prevention and control.

STATA 16.1 (STATA Corp., College Station, TX, USA) and descriptive statistics were used for data analysis of the survey, including the sociodemographic profile and knowledge, attitudes, and practices of the participants. For continuous variables such as age of the participants, means and standard deviations were calculated while frequencies and percentages were computed for categorical variables.

Two binary prevention and protection practice outcome variables were defined, namely, (1) practices on protection from mosquito bites; and (2) practices on preventing breeding sites, which included four and five items, respectively. For each outcome, good practice was defined as doing at least 75% of the included items. Binary logistic regression modeling was employed to determine the factors in the knowledge and attitude domains that were associated with the outcome variables, while controlling for confounding of age, sex, educational attainment and subject taught.

Sociodemographic profile

Of the 987 teachers, 618 answered the questionnaire, giving a response rate of 62.6%. Of the 606 teachers who agreed to participate, 604 were eligible for the study and analysis, the two participants who were not part of the teaching staff were excluded from the study. Thus, 604 respondents participated in the study. Their average age was 38.4 (S.D. 10.2; range: 20–62) years. The majority were females (81.6%), had a master’s level or were a master’s graduate (58.8%), and had a family income between PHP 25,200 and PHP 95,299 monthly. About a quarter reported teaching Science or Music, Arts, Physical Education, and Health (Table  1 ).

More than half (65.1%) of the respondents were married individuals. Three-quarters (75.8%) declared themselves to be in the middle-income bracket.

Almost half (48.7%) of the participants were currently taking up their master’s degree, while 34.4% were college graduates. Almost a quarter (24.3%) of the participants taught Science and Music, Arts, Physical Education, and Health.

Sources of information on dengue

The respondents’ commonly used media platforms on obtaining dengue information were television (85.3%), Facebook (79.6%), and Youtube (52.3%), whereas the social media app Viber (3%) and comics (2.7%) were the least preferred.

The respondents’ top three primary sources of data on dengue were Department of Health (DOH) officials (83%), Rural Health Unit staff (64.4%), and members of the Barangay Health Emergency Response Team (56.1%). Other sources (4.1%) and the Department of Education officials (29.8%) were ranked the lowest.

DOH officials (89.1%), Rural Health Unit staff (63.6%), and WHO officials (58.4%) were the top three most trusted sources of information about dengue. The most trusted source of information among non-health officials/employees was family members (34.6%).

Knowledge on dengue

Table 2 shows that the majority of the respondents  knew that skin-to-skin contact (95.5%) and sexual intercourse (90.7%) cannot transmit the disease. Only over half of the respondents (53.5%) knew that dengue can be transmitted through blood transfusion, which is low compared to the other items.

More than half of the participants claimed that abdominal pain, bleeding, diarrhea, headache, and muscle pain are signs and symptoms of dengue, with fever (96.7%) and rashes (89.1%) as the most recognized symptoms linked to dengue (Table  2 ).

Respondents were assessed on their knowledge of preventive measures against dengue, which were divided into (1) prevention and control of the disease; and (2) diagnosis and treatment options. Table 2 shows that the majority of the respondents (> 80%) were able to correctly identify prevention and control methods for dengue, which are the following: removal of standing water at home and school, use of window screens and bed nets to prevent mosquito bites, covering water containers, using mosquito repellent as a self-protection measure, fogging/spraying during a dengue outbreak, with child vaccination identified by the lowest number of participants (56.1%).

Respondents agreed that the diagnosis of dengue is based on blood samples (95.5%), and only a physician can give the final diagnosis of dengue (93.4%), whereas more than half of them (75.3%) either disagreed on the diagnosis of dengue through a PCR test or did not know the answer (Table  2 ).

Attitudes on dengue

Respondents were assessed on their perceptions of dengue, and the responses were categorized into (1) perceived benefits; (2) perceived barriers; (3) perceived severity; (4) perceived susceptibility; and (5) cues to action. Table 3 shows that respondents viewed the use of mosquito coils (62.7%) and application of mosquito repellants (78.5%) as beneficial in the prevention and protection against dengue.

More than half of the respondents in Table  3 agreed that even if the materials that can be used to protect oneself against dengue are expensive (65.1%), health facilities are not accessible (56.1%), and information regarding dengue prevention is not made available (81.8%), they are still willing to avail of these options.

Almost all (98.3%) of the respondents in Table  3 either agreed or strongly agreed that dengue can lead to more severe dengue hemorrhagic fever, and more than half agreed that there is no currently available medicine (54.5%) or effective and safe vaccines (61.3%) against dengue.

Over half (67.1%) of the participants agreed that they feel they are at risk of contracting dengue in the next three months, whereas 69.0% and 97.5% feel that they are more susceptible when the people around them have dengue fever and if there are mosquito breeding sites in their area, respectively (Table  3 ).

Almost all (98.7%) of the respondents feel the need to seek medical attention when they experience flu-like symptoms. They will also protect themselves against the disease when family members or relatives (89.4%) or their doctors (89.6%) recommend it (Table  3 ).

Practices related to dengue prevention

As shown in Table  4 , the most commonly practiced preventive option for dengue done by the respondents in the past three months was the disposal of garbage or trash (88.1%). Although the use of mosquito coils was ranked the lowest, it is still being practiced by more than half of the respondents (57.8%).

Factors associated with dengue-related practices

For this part of the study, a total of 602 participants with complete data were included in the analyses.

Correlates of good practices on protection from mosquito bites

Controlling for age, sex, educational attainment, subject taught, and the other variables, those with good knowledge on the treatment of dengue had 1.81 times the odds of having good practices on protection from mosquito bites compared to those who had poor knowledge (aOR = 1.81; 95% CI 1.18, 2.78). Those with good knowledge on the prevention of dengue had 1.85 times the odds of having good practices on protection from mosquito bites compared to those who had poor knowledge (aOR = 1.85; 95% CI 1.26, 2.71). Those with positive perceived susceptibility to dengue had 36% lower odds of having good practices on preventing mosquito bites than those with negative perceived susceptibility (aOR = 0.64; 95% CI 0.41, 0.99) (Table  5 ).

Correlates of good practices on preventing breeding sites

Controlling for age, sex, educational attainment, subject taught, and the other variables, those with good knowledge on signs and symptoms of dengue and on prevention of dengue had 1.56 (95% CI 1.02, 2.37) and 2.38 (95% CI 1.59, 3.58) times the odds of having good practices on preventing breeding sites, respectively, compared to those with poor knowledge. Those with positive perceived barriers of using personal protective/preventive measures against dengue had 1.58 times the odds of having good practices on preventing breeding sites compared to those with negative attitudes (aOR = 1.58; 95% CI 1.03, 2.44). Finally, those with positive perceived susceptibility to dengue had 54% lower odds of having good practices on preventing breeding sites than those with negative perceived susceptibility (aOR = 0.46; 95% CI 0.26, 0.81) (Table  5 ).

This study evaluated the knowledge, attitudes, and preventive practices regarding dengue among public elementary and secondary school teachers in the City of San Fernando, Pampanga, Philippines. The participants showed good overall knowledge on the modes of dengue transmission, signs and symptoms, prevention and control, and diagnosis and treatment as more than half of the respondents were able to correctly answer most of the items. This could be attributed to the programs and strategies implemented by the Department of Health and the Local Government Unit of Pampanga to achieve its vision of a dengue-free Philippines [ 1 ]. This study result is also consistent with previous investigations reflecting high dengue knowledge levels in Filipino populations [ 12 , 15 ]. However, even with the reported number of individuals knowledgeable about dengue, this study still shows that a certain proportion of the respondents either hold incorrect concepts or are unfamiliar with some facts about the disease.

Only about half of the participants could correctly identify that dengue can be transmitted through blood transfusion. Available information about transfusion-transmitted dengue is limited and could be the reason why this type of transmission is not a common knowledge among the respondents. Relatively, vaccination against dengue scored the lowest among the correct prevention and control measures, which could be attributed to the apprehensions toward vaccines as a result of the former Dengvaxia controversy. Official statistics conveyed the significant increase in vaccine hesitancy supported by individual reports on how immunization coverage rates dropped in the aftermath of the controversy [ 7 ]. On the contrary, the majority of the participants mistakenly believe that getting vaccinated against COVID-19 could lead to protection against dengue. Whether this identifies what the public considers as an alternative to obtaining protection against dengue by mode of vaccination merits further investigation. However, this also points to a significant concern about health communication to the public. In addition, only a low number of the participants correctly believe that a dengue diagnosis can be confirmed through PCR, that there is currently no medicine to cure dengue, and that having a fever for one to seven days without any other symptoms cannot confirm the presence of dengue. To bridge these gaps, emphasis on points regarding modes of dengue transmission, prevention, control, diagnosis, and treatment should be added to the different dengue awareness programs in the province. Specifically, the dengue awareness programs should focus on correcting the misconceptions surrounding vaccination to address vaccine hesitancy.

This study also reports an overall positive attitude towards dengue prevention and control measures, which is consistent on what was found in other Asian countries, although intervention studies have been suggested as points for improvement [ 16 , 17 , 18 ]. This shows that the majority of the respondents have positive perceptions of benefits and barriers to using personal dengue protection and are willing to undertake additional efforts for health safety. In addition, perceived severity and susceptibility show the participants’ awareness of the trends and risks of the disease. Internal and external cues to action against dengue was also found among the majority of the respondents. All of these perceptions could possibly be among the effects of various news reports and articles regarding the continuous and alarming increase of dengue cases from the start of the first half of the year 2022 until the start of the second half in the Philippines [ 19 , 20 ].

A high proportion of respondents also claimed to have practiced, within the past three months, every health-seeking behavior, prevention, and control measures against dengue listed in this study. This could be attributed to the desire to remain vigilant against the disease despite the decrease in reported cases in Central Luzon, Philippines for the first four months of 2022 compared with the records reported for the same period in 2021 [ 21 ]. A similar practice result was seen in KAP investigations regarding dengue among Malaysian populations [ 22 , 23 ]. In contrast, preventive practices against the disease in Singapore for the same year 2022 were reported to be low and could be attributed to the seemingly ineffective prevention regimens imposed on residents, thereby resulting in a reluctance to engage with dengue volunteers and national health officers [ 18 ].

This study likewise found that good knowledge on the treatment and prevention of dengue was associated with good practice of mosquito bite prevention. Moreover, good knowledge on the signs, symptoms, and prevention of dengue were associated with an increased odds of good practice of preventing breeding sites. These findings, however, were not consistent with the results reported from a study in Cebu City and Metro Manila Philippines where the knowledge of participants about dengue fever did not correlate with their practices against the disease [ 15 , 24 ]. Differences in the ways of living between Pampanga, Metro Manila, and Cebu City could be a reason for this discrepancy, with a high dependency on paid workers doing the cleaning and other utility jobs in the latter two areas than the former area.

Finally, a positive association was observed between the respondents’ attitudes and practices on preventing breeding sites, such that a positive perception of barriers increases the likelihood of engaging in good practices. However, participants with a favorable attitude towards the perceived susceptibility to dengue, such as those who feel that they are at risk of contracting dengue, were less likely to practice prevention of dengue breeding sites compared to those with less favorable attitudes. This is in contrast with studies from Central Nepal and Indonesia where strong associations between a good attitude and good preventive practices were reported [ 16 , 25 ]. A possible explanation for this is that while the perceived susceptibility has affected the participants’ intentions, but they did not have the opportunity to implement these practices. Therefore, appropriate programs should be developed to further translate attitudes into practice, such as through consistent garbage collection schedules and regular clean-up drives.

DOH officials, Rural Health Unit staff, barangay health emergency response teams, family members, and WHO officials are the top five primary and most trusted sources of dengue information for the study respondents. From this list, only family members are included among the non-health officials or employees. Empowering these specific people could serve great advantage in increasing good practices, given the reported high associations of good knowledge and preventive actions. In terms of media coverage, television and Facebook are the top sources of dengue information and could be used as means to better reach this particular segment of the population.

While significant statistical associations were observed in some variables, cause and effect relationship was not established as this is one of the limitations of the cross-sectional nature of this study. Moreover, the study results may not be generalized to the study population since a nonrandom sampling method was utilized in the selection of schools.

Second, the online means of survey distribution eliminated interviewer bias that could possibly occur when conducted using face-to-face interviews. However, the use of the digital platform might have introduced information bias as validation of each input from the respondents was difficult. Recall bias could have also occurred as one section of the survey involved remembering the practices done in the past three months and identifying any disease history for self, family, friends, and colleagues, with the latter event as a possible influence on knowledge about dengue. However, a previous study reported no association between having a family member with a history of dengue and obtaining increased knowledge on the disease [ 25 ].

Finally, this study assured the participants of the study’s confidentiality and that their identity will be protected in the survey. This might have reduced the information bias because they knew that their responses will not be traced back to them. This study’s internal validity was strengthened by controlling the effects of the confounding variables during the data analysis. As for the external validity, although the strict inclusion criteria could have limited the generalizability of the findings, a good participation and representation was achieved through a reminder from the SDO superintendents and school heads to ensure a timely and complete response from all of the eligible participants.

Dengue is among the seasonal struggles in a tropical country like the Philippines. Even with its decades-worth of efforts and the high degree of dengue literacy of its citizens, the Philippines still struggles in combating the disease, especially with the emergence of additional challenges influencing the knowledge, attitude, and practices of Filipinos. The findings of this study can serve as baseline health literacy of teachers in the province on dengue, and can be used as a guide in the review and redesign of school-based dengue prevention programs and strategies to fit the status and needs of the teachers who can influence the learners and, to a certain extent, the general population. The in-service training programs for Filipino teachers can include topics on dengue with emphasis on the findings where teachers have low level of knowledge. Based on the findings from this study, learning modules for teachers as well as students can be developed to improve their dengue literacy. Moreover, the significant factors associated with dengue prevention and control derived from this investigation could be used in developing health communication materials with messages that can influence the target population in the province and thereby contributing to the attainment of the vision of a dengue-free Philippines.

Availability of data materials

The datasets generated and/or analyzed during the current study are available from the corresponding author on reasonable request.

Abbreviations

Adjusted odds ratio

Confidence interval

Coronavirus disease-19

Department of Health

Knowledge, attitude, and practice

Polymerase chain reaction

School Division Office

World Health Organization

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Acknowledgements

The authors of this research study would like to thank the schools’ division office and the principals who assisted in study implementation as well as the teachers who participated in this study. We also would like to express our thanks to the technical and ethics reviewers of this research project. The authors are also grateful to the University of the Ryukyus, Okinawa, Japan, for the support they provided to this study.

This work was supported by JSPS KAKENHI Grant Numbers JP20KK0223 and JP21HP2006.

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Department of Health Promotion and Education, College of Public Health, University of the Philippines Manila, 625 Pedro Gil St, Ermita, 1000, Manila, Metro Manila, Philippines

Ernesto R. Gregorio, Mikaela B. Salanguit, Marian Danille C. Santillan, Gideon John Tuliao & Jun Kobayashi

SEAMEO-TROPMED Regional Center for Public Health, Hospital Administration, and Environmental and Occupational Health, Manila, Philippines

Ernesto R. Gregorio

Graduate School of Public Health, International University of Health and Welfare, 4‑3 Kodunomori, Narita, Chiba, 286‑8686, Japan

Rie Takeuchi

Department of Environmental and Occupational Health, College of Public Health, University of the Philippines Manila, Manila, Philippines

Paul Michael R. Hernandez

National Institutes of Health, University of the Philippines Manila, Manila, Philippines

John Robert Medina

Chubu Institute for Advanced Studies, 1200 Matsumoto‑Cho, Kasugai, Aichi, 487‑8501, Japan

Shin-ya Kawamura

College of Medicine, University of the Philippines Manila, Manila, Philippines

Kimberly Mae S. Ramos

Department of Education, Schools Division Office, City of San Fernando, Pampanga, Philippines

Lyndon Morales

School of Medicine, University of Maryland Baltimore, Baltimore, MD, USA

Maylin Palatino

Department of Global Health, Graduate School of Health Sciences, University of the Ryukyus, Nishihara, Japan

Ernesto R. Gregorio, Rie Takeuchi, Fumiko Shibuya & Jun Kobayashi

Japanese Consortium for Global School Health Research, University of the Ryukyus, Nishihara, Japan

Rie Takeuchi, Fumiko Shibuya & Jun Kobayashi

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ERGJ, RT, and JK conceived and developed the study design. ERGJ, MBS, MDCS, and LM conducted the data collection. ERGJ, RT, MCP, and PMRH conducted the data analysis. ERGJ, MDCS, KMSR, GJT, and JK developed the manuscript. ERGJ, PMRH, JRM, SK, FS, and JK reviewed and edited the manuscript. All authors read and approved the final manuscript.

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Correspondence to Ernesto R. Gregorio .

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Permission was sought and received from the study respondents to conduct and publish the results of this study.

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Gregorio, E.R., Takeuchi, R., Hernandez, P.M.R. et al. Knowledge, attitudes, and practices related to dengue among public school teachers in a Central Luzon Province in the Philippines: an analytic cross-sectional study. Trop Med Health 52 , 25 (2024). https://doi.org/10.1186/s41182-024-00591-7

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DOI : https://doi.org/10.1186/s41182-024-00591-7

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Dengue in the Philippines: model and analysis of parameters affecting transmission

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• 1 a Institute of Mathematics , University of the Philippines Diliman , Quezon City , Philippines.
• PMID: 30353774
• DOI: 10.1080/17513758.2018.1535096

Dengue is endemic in the Philippines and poses a substantial economic burden in the country. In this work, a compartmentalized model which includes healthcare-seeking class is developed. The reproduction number is determined to investigate critical parameters influencing transmission. Partial rank correlation coefficient (PRCC) technique is performed to address how the model output is affected by changes in a specific parameter disregarding the uncertainty over the rest of the parameters. Results show that mosquito biting rate, transmission probability from mosquito to human, respectively, from human to mosquito, and fraction of individuals who seek healthcare at the onset of the disease, posted high PRCC values. In order to obtain the values for the desired parameters, the reported dengue cases by morbidity week in the Philippines for the year 2014 and 2015 are used. The reliability of parameters is then verified via parametric bootstrap.

Keywords: Dengue model; basic reproduction number; model identification; parameter estimation; sensitivity analysis.

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Dengue cases in PH rise to 128,824 from Jan to July, says DOH

FILE PHOTO: Dengue cases increased by 33 percent nationwide to more than 128,800 during the first seven months of 2024, according to the Department of Health (DOH). From January to July 27, the DOH said 128,834 people caught dengue – higher than the 97,211 cases logged in the same period last year. INQUIRER FILES

MANILA, Philippines — Dengue cases increased by 33 percent nationwide to more than 128,800 during the first seven months of 2024, the Department of Health (DOH) said Wednesday.

From January to July 27, the DOH said 128,834 people caught dengue – higher than the 97,211 cases logged in the same period last year.

The DOH, however, noted that despite increased cases, dengue-related deaths slightly went down to 337 from 378 in 2023.

READ:  DOH: ‘Siling labuyo’ no cure for dengue

It said the lower death count in the first seven months of this year was due to the public’s initiative to seek early consultation and improved hospital case management.

The health department nevertheless repeated its reminder to the public to comply with the “4S Strategy” against dengue: “Search and Destroy” mosquito breeding places, “Secure Self Protection” from mosquito bite, “Seek Early Consultation” when signs and symptoms of dengue occur, and “Say Yes to Fogging.”

READ:  Store water, avoid dengue, DOH urges public

“We know that more stagnant water means more mosquitoes and more dengue. So let us keep searching and destroying containers that allow mosquitoes to multiply. The good news is [that] seeking consultation early and treating patients properly leads to [fewer] deaths, even [in] more cases. Look at our numbers,” said DOH Secretary Teodoro Herbosa said in a statement.

“Using self-protection measures like clothes that cover the skin, mosquito nets, and repellants will help slow down the rise in cases. Let us also support fogging or spraying in areas identified as local hotspots or outbreak zones,” he added.

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The dengue vaccine is effective and safe: Confirmation from the first global meta-analysis

by University of Bologna

The Dengue vaccine has an efficacy rate of over 50% in reducing disease cases, with lasting effects and a very good safety profile. This is confirmed by the first global meta-analysis on the efficacy of TAK-003, better known as Qdenga: the only vaccine approved to date in Italy and many European countries for fighting Dengue.

Published in the journal Vaccines , the study was conducted by scholars from the University of Bologna and the University of Ferrara.

"This is the first comprehensive global analysis and we are very pleased with the data," says Lamberto Manzoli, director of the School of Specialization in Hygiene and Preventive Medicine at the University of Bologna, who coordinated the study. "It was not a foregone conclusion: it took many years to develop a vaccine with such good results."

The Dengue virus, transmitted by certain species of mosquitoes, infects about 400 million people annually in the warmer regions of the planet, causing more than 3 million deaths. Climate change is also expanding the habitat of the mosquitoes that carry the virus, leading to new Dengue outbreaks in an increasing number of countries. Even in Italy, with the continuous rise in cases, the disease is a major health concern.

Currently, there is no effective therapy against the disease, and environmental remediation actions against mosquitoes cannot eliminate the risk of epidemics. The only prevention strategy is therefore vaccination: approved in Europe in December 2022, the vaccine TAK-003, better known as Qdenga, has shown very promising results. However, until now, a comprehensive estimate of its effectiveness and safety was not available.

Researchers therefore examined and cross-referenced data from the 19 scientific studies conducted so far on the vaccine, to find solid evidence of its ability to combat the disease. Overall, the cases of over 20,000 individuals involved in the various tests were considered, even more than a year after the last administration, both with a single dose and with both doses required for complete vaccination.

The results show that the vaccine reduces the risk of contracting the disease by over 50%, with a high safety profile. Among those who received both doses, more than 90% developed antibodies against Dengue, and the response is very positive even among those who received only one dose: more than 70% of adults and more than 90% of children and adolescents develop antibodies.

"Given the results in terms of safety, immunogenicity, and efficacy, the administration of two doses can undoubtedly be a key tool for Dengue prevention," confirms Maria Elena Flacco, director of the School of Specialization in Public Health at the University of Ferrara and the study's lead author.

"The currently available vaccine can therefore be very useful not only for populations in endemic areas but also for travellers from non-risk areas."

The study authors are Alessandro Bianconi, Matteo Fiore, and Lamberto Manzoli from the University of Bologna (Department of Medical and Surgical Sciences), along with Maria Elena Flacco, Giovanni Cioni, Giovanna Letizia Calò, Gianmarco Imperiali, Vittorio Orazi, Marco Tiseo, Anastasia Troia, and Annalisa Rosso from the University of Ferrara (Department of Environmental and Prevention Sciences).

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Philippine Red Cross ensures sufficient blood supply nationwide amid rising dengue cases

In light of the concerning rise in dengue cases nationwide, the Philippine Red Cross (PRC) announced on Sunday, Aug. 11, that it is intensifying its efforts to ensure that blood and medical assistance are promptly accessible to those in need.

PRC Chairman and Chief Executive Officer (CEO) Richard Gordon, in a statement, assured the public of the organization's preparedness to respond to the crisis. This assurance came after Ormoc City declared a state of calamity due to the health emergency.

"We want to assure everyone that blood for dengue patients—both random platelets and apheresis platelets—is available at the Red Cross," said Gordon.

He added that PRC’s chapters in Iloilo and Ormoc are well-equipped and have the nearby Red Cross blood center in Capiz on standby.

“We have enough blood supplies in our network of chapters across the country to handle the current situation, and we can also deliver blood to areas in need,” Gordon said.

PRC noted that Ormoc City’s declaration of a state of calamity follows a staggering 225 percent surge in dengue cases compared to last year.

In Quezon City, the PRC said the City Health Office also raised the alarm after identifying 12 barangays as dengue hotspots.

PRC reported that the Department of Health (DOH) confirmed dengue cases nationwide have risen by 33 percent this year compared to the same period in 2023.

READ: 

https://mb.com.ph/2024/8/7/dengue-cases-increase-further-but-deaths-lower-compared-to-2023-says-doh

The PRC has been offering blood services since 1947.

Over the years, the organization has enhanced its capabilities, ensuring that its blood centers are fully equipped to meet the needs of patients nationwide.

"Blood supply availability has always been a priority for the PRC, but we have now increased our capacities with modern blood center facilities," Gordon said.

In addition to providing blood, the PRC also emphasized proactive health measures.

"More than the provision of blood, we have health teams who are very active in health promotions all over the country," said PRC Secretary General Gwen Pang. 

These teams are working tirelessly to educate communities about dengue prevention, early detection, and control measures, focusing on high-risk areas such as Iloilo and Quezon City.

The PRC’s comprehensive response—encompassing blood availability, medical assistance, and extensive health education—is vital for managing the current dengue outbreak and ensuring that communities receive the necessary support. More information is available at www.redcross.org.ph.

RELATED STORY: 

https://mb.com.ph/2024/6/16/doh-no-proven-effective-dengue-treatment-yet

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Dengue on the Rise: Get the Facts

What to know.

Dengue is a viral disease that can cause severe illness in some people. Reported dengue cases have doubled in 2024. It's spread by mosquitoes, so protect yourself by preventing insect bites and dumping out standing water where mosquitoes lay eggs.

Dengue is rising at an alarming rate

The World Health Organization (WHO) reports an 8-fold increase in global dengue incidence between 2000 and 2019. In 2023, there were more than 5 million cases reported from 80 countries, with at least 23 countries reporting dengue outbreaks. That number has more than doubled in 2024 so far, with more than more than 10.6 million cases reported in North and South America alone. The true number is likely far greater, highlighting the urgency of addressing this public health crisis. Learn the facts about the virus.

Dengue isn't just found in the tropics.

Dengue outbreaks occur in many countries of the world, including North and South Americas, Africa, the Middle East, Asia, and the Pacific Islands. Almost half of the world's population, about 4 billion people, live in areas where dengue outbreaks could occur. Although dengue is more common in tropical regions, it's not limited to those areas. Recent trends show an expansion of dengue cases into previously unaffected areas, including parts of Europe and the continental United States.

It's spread by mosquitoes ... but not all mosquitoes.

Dengue spreads most often through the bite of an infected mosquito from one of two species, Aedes aegypti or Aedes albopictus. These mosquitoes are the same type that spread Zika and chikungunya viruses. Only Aedes mosquitoes — most commonly Aedes aegypti — are responsible for spreading dengue.

It's having a big year.

Dengue is a global health threat that's currently being fueled by three major drivers. First, a warmer, wetter year means there are more mosquitoes in more places, and these mosquitoes are hard to fight. Second, dengue is cyclical. Large outbreaks tend to occur every few years in areas with mosquitoes and living conditions that make protecting against bites harder. And third, people are traveling more, especially to places where dengue is common. These major drivers have contributed to an alarming rise of dengue cases globally.

Sometimes it can make you severely ill.

Although dengue is sometimes known as "break-bone fever" because of the severe body aches it can cause, most people who get infected with the dengue virus have no symptoms or only mild illness. Most people who do have dengue symptoms recover within a week. However, dengue can also be severe and life-threatening, especially in children, older people, and people with underlying health conditions.

There's no cure, but it is treatable.

Currently, there is no specific cure or medication for dengue. Treatment mainly focuses on relieving symptoms. If you have dengue, you should rest as much as possible, take acetaminophen to control fever and relieve pain, and drink plenty of fluids.

Here's how to prevent it.

The best way to prevent dengue is to avoid mosquito bites. Use EPA-registered insect repellents, wear loose-fitting long shirts and pants, drain standing water where mosquitoes can lay eggs, and make sure your home is protected against mosquitoes .

If you or a family member has dengue, it's important to continue to avoid mosquito bites, especially during the first week of infection so that you do not spread the virus to uninfected mosquitoes and that can then infect others.

There is a dengue vaccine recommended for use in children ages 9–16 years old, who have had a previous laboratory-confirmed dengue infection, and who live in areas where dengue occurs naturally -- which includes some U.S. territories and freely associated Pacific Island states.

Having it once might not protect you.

Because there are four different but closely related dengue viruses that all cause disease, people can get infected with dengue multiple times in their life.

What CDC is doing.

CDC is providing assistance to public health partner agencies that have reported dengue cases. It helps those agencies investigate outbreaks, plan mosquito control programs, train healthcare providers to quickly recognize dengue and manage cases in people who have it. It tests for dengue viruses and uses genetic information to track their spread. And it supports research and training to help prevent and respond to dengue and other mosquito-borne diseases.

Learn about dengue viruses, how dengue spreads, how to prevent dengue, and the areas with risk of dengue.

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Another travel-related dengue case reported on Oahu

July 30, 2024

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The Hawaii Department of Health has reported another travel-related dengue virus case on Oahu, bringing the state’s total to nine so far this year.

DOH said the affected person traveled to a region where dengue is known to be spread, but did not disclose where. Teams were deployed to the affected area of Oahu to conduct an inspection and mosquito control.

Of the nine travel-related dengue cases this year, six have been on Oahu, two on Maui, and one on Kauai.

“Travel exposure identified during these case investigations was spread among various locations around the world,” said DOH in a news release. “Multiple regions around the world are currently experiencing higher-than-normal dengue activity.”

Dengue outbreaks occur in parts of Central and South America; parts of Asia, including the Philippines; the Middle East; Africa; and some Pacific Islands, including American Samoa, the Federated States of Micronesia, the Marshall Islands, Palau; the U.S. Virgin Islands; and parts of the Caribbean including Puerto Rico.

The Centers for Disease Control and Prevention in June issued an alert notifying health care providers and the public of the increased risk of dengue infections in the U.S. this year.

“Dengue cases resurged globally after the COVID-19 pandemic,” said CDC.

Global incidence of dengue has been the highest on record for this calendar year, CDC said, with a higher-than-expected number of cases among U.S. travelers.

Dengue virus is spread from infected person to mosquito to person, according to DOH. While Hawaii is home to the type of mosquitoes that can carry dengue, the disease is not established here.

Symptoms include the sudden onset of fever, nausea, vomiting, rash and body aches, which typically last two to seven days. Although life-threatening illnesses can occur, most people recover after about a week.

Anyone who plans to travel or has traveled to an area with dengue is at risk for infection, said DOH.

Four to six weeks before travel, Hawaii residents should review country-specific travel information for the most up-to-date guidance on dengue risk and prevention measures for that country.

Residents returning from an area with a risk of dengue should take steps to prevent mosquito bites for three weeks. If symptoms develop within two weeks upon return, they should seek medical evaluation.

Health officials also recommend eliminating mosquito-breeding sites in and around homes by pouring out containers of standing water.

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• v.12(2); Apr-Jun 2021

Dengue at the time of COVID-19 in the Philippines

Cases of infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus responsible for coronavirus disease 2019 (COVID-19), have been increasing since the virus emerged in Wuhan, China, in December 2019. As of 13 March 2021, confirmed COVID-19 cases have exceeded 119 million infected individuals across 188 countries, with more than 2.6 million recorded deaths. ( 1 ) National health systems have attempted to contain the pandemic through control measures such as community quarantine and isolation. In the Philippines, an enhanced community quarantine (ECQ) took effect on 15 March 2020 in an effort to flatten the epidemic curve. ( 2 ) ECQ involves placing stringent limitations on people’s mobility and strict regulations on various industry operations, all of which are enforced by uniformed personnel. ( 3 ) In spite of the ECQ, active infections have been steadily increasing in the country, at 611 618 total cases and 12 694 deaths as of 13 March 2021. ( 1 )

In 2020, the Philippines recorded a substantial decrease in the number of dengue cases, with a reduction in notified cases of about 70–90% during the rainy season ( 4 ) specifically from epidemiological weeks 28 to 40. ( 5 ) Apart from existing control and prevention measures implemented in the country – such as the establishment of dengue centres of excellence in tertiary hospitals and the creation of dengue fast lanes – the decrease in the number of cases during the COVID-19 pandemic may be largely due to the reduced mobility of the population. Several studies noted that reduction of localized household movement could lead to a reduction in transmission. ( 6 ) On a larger geographical scale, movement control measures reportedly slow or even prevent the spread of a dengue epidemic from locations with high transmission intensity to suburbs or remote areas. ( 7 ) Conversely, the decrease may have also been a result of reporting hesitancy due to the fear of contracting COVID-19 while visiting a health facility. In Caribbean and Latin American countries, an initial sharp decrease in dengue cases coincided with the start of reporting of COVID-19 cases. ( 8 ) The reduction in dengue trend may be due, in part, to the impact of the pandemic on health-seeking behaviour of the population, driven by fear of being infected. A similar reduction in health facility visits was also purported to be the reason behind the decrease in both infectious diseases and non-infectious diseases during the pandemic. ( 9 ) The Philippines has experienced several clusters of infection in hospitals. COVID-19 hospital transmissions have been widely documented in hospitals in various countries. ( 3 ) The existence of these hospital clusters has decreased medical-seeking behaviour due to the fear of contracting the disease, to the extent that it has impacted the reporting of other diseases and illnesses.

Several other countries in the World Health Organization (WHO) Western Pacific Region also noted a decrease in dengue cases in 2020. ( 5 ) However, this was not the case in Singapore, which has seen a substantial increase in cases, possibly associated with the country’s physical distancing measures implemented in response to COVID-19. ( 10 ) For example, the work-from-home measure implemented may have contributed to the increase in dengue cases, compared with the usual workplace setting. Compared with workplaces, residences have a higher propensity for causing dengue infection, owing to the thriving conditions for mosquito breeding. The rise in dengue cases in Singapore and the reduction in the Philippines and other countries in the region show how different control measures (e.g. mobility restrictions) can vary in their effects on levels of dengue. These variations may be due to the extent and degree of control measures, coupled with prevention and control measures directed to either dengue or COVID-19, and inherent country-specific sociodemographic factors; thus, further investigation of these factors is warranted, subject to the availability of data.

The Philippines and other countries in the WHO Western Pacific Region did not see a similar increase in dengue cases in 2020. However, caution should be exercised, because a trend of increasing dengue cases could still develop in current conditions. The renewed rise of COVID-19 cases and the roll-out of COVID-19 vaccinations may have an impact on dengue cases in the latter part of 2021. The increase in COVID-19 cases may lead to more stringent control measures, but the strength of these measures will depend on the progress of vaccination coverage. According to the Philippines’ current COVID-19 vaccination timeline, the general population will probably start receiving vaccinations in July 2021, after completion of the full master list of people to be vaccinated, which is expected by 30 June 2021. ( 1 ) The dengue season starts a month later, at the end of July.

In summary, although the Philippines has seen a decrease in dengue cases in 2020, a scenario in which cases increase is possible, as has happened in Singapore. Further investigation of countries in the region is needed to ascertain which factors have affected the varying impact on notified dengue cases from COVID-19-related measures, compounded by innate sociodemographic characteristics. Nevertheless, health managers can plan ahead and appraise the current conditions, including the rise in COVID-19 cases and vaccination progress, and consider how these may affect the number of dengue cases in the latter part of 2021.