Microsoft Word - GJPHM-2021-KAP.docx[18].docx 289 GLOBAL JOURNAL OF PUBLIC HEALTH MEDICINE 2021, VOL 3, ISSUE 1 gggggglo Original Article ASSESSMENT OF KNOWLEDGE, ATTITUDES AND PRACTICE TOWARD DENGUE FEVER AMONG UNIVERSITY STUDENTS IN MALAYSIA Mohammed Abdelfatah Alhoot1*, Mohammed A. Abdalqader1, Mustafa Fadil Mohammed1, Mohanad R. Alwan1, Fuzia Elfituri Muftah Eltariki2, Fatehah Munirah Binti Aziz1, Mohd Noorhelmi Bin Bujang1, Nurfitriana Bt Ahmad Munir1, Nur Iwani Binti Abdul Rahim1 1 International Medical School (IMS), Management & Science University (MSU), Shah Alam, 40100, Selangor, Malaysia 2 Post Graduate Centre (PGC), Management & Science University (MSU), Shah Alam, Selangor, Malaysia *Corresponding author: malhoot@hotmail.com ABSTRACT Introduction: Dengue fever is an acute febrile illness with a significant public health concern in tropical and subtropical countries. Population knowledge and practice play an essential role in the transmission and prevention of the disease. This study aims to evaluate the level of knowledge, attitudes, and practice regarding dengue fever among Malaysian university students. Methods: A cross-sectional descriptive study was conducted in twenty-five randomly selected universities across Malaysia. A total of 1520 respondents were approached by simple random sampling method. A previously validated and published questionnaire was used with little modification. The associations between the level of knowledge, Attitudes, and practice with different risk factors were calculated statistically and the significant association was considered with a p-value <0.05. Results: The data were analysed and showed that most of the students (56.3%, 46.2%, and 43.3%) has a moderate level of knowledge, attitude, and practice respectively toward dengue infection among the respondents. The result shows a significant association between the level of practice and knowledge (p-value <0.001) as well as between the level of practice and attitudes (p-value <0.001). Conclusion: The significant association between the practice and knowledge along with attitudes indicates the more knowledge and attitudes lead to better practice. This study highlighted the important role of university students in dengue prevention-based programs. They should be exposed more to improve and transfer their knowledge and attitude to other community population to reduce the incidence of dengue not only in Malaysia but globally. Keywords: Dengue Fever, Malaysia, Knowledge, Attitude, Practice. 290 GLOBAL JOURNAL OF PUBLIC HEALTH MEDICINE 2021, VOL 3, ISSUE 1 gggggglo Introduction Dengue fever (DF) is a disease that is not foreign anymore towards society worldwide nowadays. It is one of the most critical mosquitoes borne illnesses in the world. However, not everyone knows or cares about this disease. DF is a significant cause of morbidity and mortality (Cheah et al., 2014). Clinical manifestations for DF include three phases, which are the febrile phase, critical phase and recovery phase (Kalayanarooj, 2011). Briefly, for febrile phase, it includes dehydration, high fever that may cause neurological disturbances, and febrile seizures in young children. Critical phase includes shock from plasma leakage, severe hemorrhage, and organ impairment. Recovery phase includes hypervolemia that is only if intravenous fluid therapy has been excessive (Kalayanarooj, 2011). In Malaysia, dengue cases were first reported in 1901 in Penang. Since then, the disease became endemic throughout the country. The first case of dengue hemorrhagic fever (DHF) was reported in 1962 in Malaysia. After this, a major outbreak of DHF occurred in 1973 when almost the whole nation was involved (Poovaneswari, 1993). The Destruction of Disease Bearing Insects Act (DDBIA, 1975) was introduced in1975 (Lam, 1994). Recently, it has been estimated that 390 million dengue-infected people yearly, of which 67-136 million show clinically sever infections (World Health Organization, 2020). Currently, over half of the world’s population live in areas potentially at risk for dengue transmission, making dengue one of the most crucial arbovirus disease transmitted to the human in terms of morbidity and mortality. Dengue is endemic in more than 128 countries (Brady et al., 2012) in whereby five out of the six WHO regions were involved compared to only nine countries in 1970 (World Health Organization, 2011b). Approximately, 75% of the global dengue infection burden is in the WHO South-East Asia and Western Pacific regions (World Health Organization, 2011a). The dengue cases in Malaysia increases day by day. This increase gives us a big question mark why there is an increase in the number although the government had conducted many of the preventive measures. According to WHO, many factors lead to the rise in dengue cases nowadays, for example, it can be due to environmental factors that provide places for Aedes mosquito to breed such as the exposed polystyrene and plastic containers and the used tires. The unlimited movement of patients who have been infected with the dengue virus would easily spread the virus to another person. Society’s habit of litter and not well-managed garbage leads to the rise in dengue cases. Lastly, the lack of awareness of the community to implement preventive measures, such as cleaning their surroundings and carry out the activities like "search and destroy" the breeding grounds for mosquitoes every week. It is essential to increase the health promotion activities to strengthen and improve the awareness and practices of dengue control among the Malaysian society. It can form the basis for preventive practices as part of the strategy to control the dengue in the country, thus eliminating them to achieve a zero-dengue country in the future. Preventive strategies are the only means of controlling the disease (Baur, 2013; Low et al., 2006). This study aims to determine the level of knowledge, attitudes, and practice (KAP) regarding DF among Malaysian university students. Furthermore, this study will highlight the role of university students’ as citizens in the collaboration the society together with the government to reduce the dengue transmission cycle. So, in the future, we can focus on those factors to increase awareness among the society. 291 GLOBAL JOURNAL OF PUBLIC HEALTH MEDICINE 2021, VOL 3, ISSUE 1 gggggglo Methods An observational cross-sectional survey was conducted at selected universities in Malaysia. Students at the selected universities were recruited for this survey. The questionnaires were answered by convenience selection of the sample. Simple random sampling was used to select twenty-five universities in the different states of Malaysia to conduct this study. The sample size was calculated by statistical Epi InfoTM version 7.1.3 program (Centre for Disease Control, Atlanta, USA) using 95% confidence level and 2.5 confidence interval with a total population of 1,174,579 local students in both public and private higher education institutions. Accordingly, the sample size calculated was 1518 subjects. The inclusion of this study includes all the students at the selected universities. International students and students aged below 18 years were excluded from this study. A previously validated and published questionnaire was used for this study with little modification (Shuaib et al., 2010). It is a quantitatively designed research whereby a survey was deliberated. The questionnaire has been written in Bilingual (Bahasa Melayu and English) before being used to avoid any difficulty for the students to understand. It is contained a total of 72 questions. The questionnaire comprises four sections, in which Part A, composed of ten questions on personal and demographical information. Part B composed of 25 questions on the knowledge about DF. The response option would be ‘yes’ or ‘no’. Each correct answer was given one point, while no point for the incorrect answer. Part C composed of 15 questions on the attitudes towards DF prevention. The questions were comprised of awareness and responsibility as public in the prevention of DF. The response options for this question will be ‘agree’ or ‘disagree’. A positive attitude will be given one point, and a negative attitude will be given no point. Part D composed of 20 questions on the practice regarding DF prevention. The questions were designed to assess the steps taken in the prevention of DF. Response option included ‘yes’ or ‘no’. If the answer was ‘yes’, one point is given and no points for the answer ‘no’. Amendments have been made to the questionnaires to suit the researchers’ interests excluding the options ‘semirural’, for the ease of data calculation. Ethics and consent The nature of the study was explained briefly to the students and written informed consent was obtained from all the participants. This study was approved by the Ethics Committee of Management and Science University (MSU). The study methodology was reviewed and recommended for ethical approval by the Institute for Health Behavioural Research (IHBR) (NMRR ID NMRR-15-1627-27280 S2 R0). Data collection Data collection began after the Research Committee granted the study approval at Management and Science University (MSU). A cover letter was attached to the questionnaires to ensure the confidentiality of the participants’ information. Patients were given a briefing before distributing the questionnaires. Permission was taken directly from the students after agreed to participate and to fill the consent form. Data were collected by answering a self-administered questionnaire. The questionnaire comprises of 292 GLOBAL JOURNAL OF PUBLIC HEALTH MEDICINE 2021, VOL 3, ISSUE 1 gggggglo close-ended questions. The session ended within half an hour. The study data was stored on the researcher’s personal computer. Data analysis Data were verified and analyzed using the IBM Statistical Package for the Social Sciences (SPSS) version 20.0 software for Windows (IBM Corp., Armonk, NY, USA). Descriptive analysis was used to compute the socio-demographic data (gender, age, residential area, race, monthly family income, relationship status, education level) in which the frequency and percentage of each variable were calculated. The descriptive analysis was also used to find out the prevalence of knowledge, awareness, and practice. For the analysis of the independent variables, the frequency and percentage of the categories were obtained. Inferential analysis was used to analyze the association between the independent and the dependent variables. The Chi-squared test and ANOVA were used to determine the association between KAP with socio-demographic information of the respondents whichever appropriate. The level of KAP was categorized following scoring the right answers. Then, the total score was calculated and converted to a percentage. Finally, The sum score of each outcome was assessed based on Bloom’s cut off point (Bloom, 1956). Based on the sum scores, level of knowledge was classified into low level knowledge (less than 60%), moderate level knowledge (60-80%), and high-level knowledge (80-100%). Results This study was conducted among 1520 respondents with a response rate of 80%, to measure the level of knowledge, attitudes, and practice about DF. Results showed that most of the participants were have a moderate level of knowledge, 56.3%, whereas 24.1% of the study population have a low level of knowledge. For attitudes, 46.2% of the study population showed moderate attitudes than 30.3% with low attitudes. Again 43.3% of the study population showed moderate practice toward Df compared with 25.1% of those with low practice, as shown in Table 1. Table 1: The Level of knowledge, attitudes, and practice about DF among the respondents KAP level Knowledge N (%) Attitude N (%) Practice N (%) Low 367(24.1) 460(30.3) 382(25.1) Moderate 855(56.3) 702(46.2) 658(43.3) High 298(19.6) 298(19.6) 480(31.6) 293 GLOBAL JOURNAL OF PUBLIC HEALTH MEDICINE 2021, VOL 3, ISSUE 1 gggggglo As shown in Table 2, the level of knowledge was significantly associated with gender, females showed a better level of knowledge. The race also showed significant association with knowledge, as the race Malay had the highest level of knowledge. The age showed significant association knowledge, those aged 20-29 years majority under the moderate level of knowledge, while those more than 30 years majority had a higher level of knowledge. Married had a significantly higher level of knowledge as compared to non-married. Monthly family income and living area whether rural or urban did not show significant association with knowledge. Educational level showed a significant association with the level of knowledge with p-value <0.001. Table 2: The association between the level of knowledge and different demographical data Variables Low Moderate High X² P-Value N (%) N (%) N (%) GENDER Male 138(28.3) 263(53.9) 87(17.8) 6.95 0.03 Female 229(22.2) 592(57.4) 211(20.4) Race Malay 309(26.6) 686(59) 167(14.4) 97.05 <0.001 Chinese 25(21.4) 58(49.6) 34(29.1) Indian 22(15.0) 70(47.6) 55(37.4) Others 11(11.7) 41(43.6) 42(44.7) Age Group (Years) <20 44(26.2) 75(44.6) 49(29.2) 85.40 <0.001 20-24 271(24.7) 665(60.7) 159(14.5) 25-29 47(24.6) 86(45.0) 58(30.4) >30 5(7.6) 29(43.9) 32(48.5) Marital Status Single 350(24.4) 817(57.0) 268(18.6) 16.77 0.002 Married 17(20.0) 38(44.7) 30(35.3) Monthly Family Income <3000RM 188(24.6) 435(56.9) 141(18.5) 1.30 0.52 >3000RM 179(23.7) 420(55.6) 157(20.8) Living Area Rural 178(26.0) 384(56.1) 122(17.8) 3.80 0.14 Urban 189(22.6) 471(56.3) 176(21.1) Education Level SPM 62(34.1) 115(63.2) 5(2.7) 50.94 <0.001 DIPLOMA 83(22.5) 188(50.9) 98(26.6) DEGREE 211(23.3) 518(57.2) 177(19.5) MASTER 11(17.5) 34(54.0) 18(28.5) *Level of significant at P value <0.05 Table 3 shows the association with attitude level; males show a higher level of attitudes, p-value <0.001. The race showed a significant association with the level of attitudes with a p-value <0.001. The highest level of attitude was among those aged >30 years, and they showed a significant association. Married showed a significantly higher level of attitude. Those with higher income showed more level of attitude but was not significant. Whether living in rural or urban also does not show a significant association. Master level of education showed a higher level of knowledge. 294 GLOBAL JOURNAL OF PUBLIC HEALTH MEDICINE 2021, VOL 3, ISSUE 1 gggggglo Table 3: The association between the attitude level and different demographical data Variables Level of Attitude Low Moderate High X² P-Value N (%) N (%) N (%) GENDER Male 118(24.2) 257(52.7) 113(23.3) 15.37 <0.001 Female 342(33.1) 445(43.1) 245(23.7) Race Malay 400(34.4) 538(46.3) 224(19.3) 82.72 <0.001 Chinese 27(23.1) 60(51.3) 30(25.6) Indian 16(10.9) 63(42.9) 68(46.3) Others 17(18.1) 41(43.6) 36(38.3) Age Group (Years) <20 43(25.6) 73(43.5) 52(31.0) 57.74 <0.001 20-24 378(34.5) 498(45.5) 219(20.0) 25-29 32(16.8) 100(52.4) 59(30.9) >30 7(10.6) 31(47.0) 28(42.4) Marital Status Single 442(30.8) 667(46.5) 324(22.6) 14.35 0.006 Married 17(20.0) 35(41.2) 33(38.8) Monthly Family Income <3000RM 248(32.5) 348(45.5) 168(22.0) 4.17 0.124 >3000RM 212(28.0) 354(46.8) 190(25.1) Living Area Rural 221(32.3) 300(43.9) 163(23.8) 3.21 0.200 Urban 239(28.6) 402(48.1) 195(23.3) Education Level SPM 69(37.9) 91(50.0) 22(12.1) 36.95 <0.001 Diploma 83(22.5) 189(51.2) 97(26.3) Degree 295(32.6) 397(43.8) 214(23.6) Master 13(20.6) 25(39.7) 25(39.7) *Level of significant at P value <0.05 Table 4 shows no significant association between level of practice and gender, race, age group, marital status, monthly income, and living area. Simultaneously, the relationship with the educational level was significant with p-value <0.001; those master level of education had a higher level of practice. The state where they live and the university, they study at showed significant association with practice toward DF. 295 GLOBAL JOURNAL OF PUBLIC HEALTH MEDICINE 2021, VOL 3, ISSUE 1 gggggglo Table 4: The association of level of practice towards DF with different demographical data Variables Level of Practice Low Moderate High X² P-Value N (%) N (%) N (%) GENDER Male 124(25.4) 208(42.6) 156(32.0) 0.13 0.937 Female 258(25.0) 450(43.6) 324(31.4) Race Malay 289(24.9) 504(43.3) 369(31.8) 2.64 0.851 Chinese 32(27.4) 52(44.4) 33(28.2) Indian 33(22.4) 66(44.9) 48(32.7) Others 28(29.8) 36(38.3) 30(31.9) Age Group (Years) <20 40(23.8) 75(44.6) 53(31.5) 12.34 0.137 20-24 280(25.6) 481(43.9) 334(30.5) 25-29 44(23.0) 85(44.5) 63(32.5) >30 18(27.3) 17(25.8) 31(46.9) Marital Status Single 364(25.4) 624(43.5) 445(31.1) 5.09 0.278 Married 17(20.0) 33(38.8) 35(41.2) Monthly Family Income <3000RM 181(23.7) 334(43.7) 249(32.6) 1.83 0.400 >3000RM 201(26.6) 324(42.9) 231(30.6) Living Area Rural 162(23.7) 299(43.7) 223(32.6) 1.50 0.472 Urban 220(26.3) 359(42.9) 257(30.7) Education Level SPM 67(36.8) 80(44.0) 35(19.2) 25.64 <0.001 DIPLOMA 77(20.9) 165(44.7) 127(34.4) DEGREE 226(24.9) 388(42.8) 292(32.2) MASTER 12(19.0) 25(39.7) 26(41.3) *Level of significant at P value <0.05 296 GLOBAL JOURNAL OF PUBLIC HEALTH MEDICINE 2021, VOL 3, ISSUE 1 gggggglo Table 5 shows the association between the level of practice towards DF and the level of knowledge and attitudes. Table 5: The association of level of practice towards DF with knowledge and attitudes Variables N Mean SD 95% Confidence Interval for Mean Lower Bound Upper Bound Practice Low 367 12.96 3.340 12.62 13.31 Moderate 855 13.70 3.608 13.46 13.94 High 298 14.59 3.616 14.17 15.00 Total 1520 13.70 3.585 13.52 13.88 Attitudes Low 382 9.51 1.985 9.31 9.71 Moderate 658 9.62 2.032 9.47 9.78 High 480 10.25 2.353 10.04 10.46 Total 1520 9.79 2.149 9.68 9.90 Discussion Since the 21st century, DF becomes the most crucial vector-borne disease toward human health that tends to morbidity and mortality, especially for those living in tropical and sub-tropical countries (Wong et al., 2015). Malaysian Ministry of Health reported an incidence rate of 397.71 for dengue in 2019 (Ministry of Health Malaysia, 2020). Yearly the incidence rate has been increased over the population and over the government target for DF incidence, which is less than 50. There is no apparent reason to justify this increase. It could be due to climate changes, hot and humid weather; alternatively, the unplanned urbanization and community population behaviours make the environment very suitable for mosquitos breeding and growth. Malaysia Health Technology Assessment Section (MaHTAS) published in 2015 that the dengue incidence rate is higher in the age group of 15 and above. Most of the dengue cases reported were from urban areas (70% - 80%). Many factors such as high-density population, and rapid development favour dengue transmission could be involved (Ministry of Health Malaysia & Academy of Medicine Malaysia, 2015). With this sharp surge of dengue cases in Malaysia, it is a must for the respondents to possess the right information, attitudes, and practice. Therefore, this cross-sectional study was run to determine the knowledge, attitudes, and practice regarding DF, especially among Malaysian university students. Our result shows that respondents were moderately knowledgeable in various aspects which are more or less corresponding with previous studies conducted in Malaysia (Al-Zurfi et al., 2015; Alhoot et al., 2017; Hairi et al., 2003; Leong, 2014; Wong et al., 2015), Laos (Mayxay et al., 2013; Nalongsack et al., 2009), Nepal (Dhimal et al., 2014), Pakistan (Itrat et al., 2008), Philippines (Yboa & Labrague, 2013), Sri Lanka (Gunasekara et al., 2015), Jamaica (Shuaib et al., 2010) and Saudi Arabia (Ibrahim et al., 2009). In contrast, another study, that has been done in urban, semi-urban and rural communities in Malaysia demonstrated a higher rate of knowledge (89.7%) towards DF (Al-Dubai et al., 2013). This variation could be attributed to that different regions could have a different experience and the diverse 297 GLOBAL JOURNAL OF PUBLIC HEALTH MEDICINE 2021, VOL 3, ISSUE 1 gggggglo target population. Interestingly, another study in the Perak state in Malaysia showed the highest rate (96.8%) of the public having a good knowledge of DF (Abdullah et al., 2013). This level of good knowledge was referred to the intensive education and awareness campaigns carried out by the government and various institutions to control the spread of the disease effectively. This can be shown clearly when we look at the significant association between practice and knowledge level (p-value < 0.001). The finding from this study is supporting the data obtained in 2015 by Wong et al. where the student from the tertiary education level possessed a high level of knowledge related to dengue transmission (Wong et al., 2015). The results show a good Knowledge of preventing mosquitoes breeding by removing standing water, reducing the mosquitoes by cutting down bushes and killing mosquito larvae by pouring chemicals in standing water. This result similar to previous results showing blocked drains is the most suitable place for the mosquito breeding (Rozita et al., 2006) and stagnant water is top mosquito breeding sites (Al-Dubai et al., 2013; Alhoot et al., 2016; Leong, 2014). When the students' attitudes are analysed, this study finds that university students have moderate positive attitudes, which should be reflected in their practice in preventing dengue. However, it is not reflected based on the data obtained. For example, there should be a significant association between the degrees of susceptibility for those previously affected or knew someone with their practice, since being infected with dengue virus for the second time will be much-severed reaction than the first one. Thus, this study found that there was no significant association between those two. There should be a concern with their perception of susceptibility based on Wong et al. findings (Wong et al., 2015) Some of the respondents state substantial body system decrease the chance of being infected. The most common practices used by respondents to prevent the dengue were the covering of water containers, cleaning water containers, and ditches around their homes. This finding was constant with previous results (Abdullah et al., 2013; Al-Dubai et al., 2013; Alhoot et al., 2017; Leong, 2014). This study shows a significant association between the knowledge and the education level in which the Master or higher education level has a higher level of knowledge than respondents with other educational levels. Al-Dubai et al. (2013) found a significant association between attitudes and both levels of education and employment status. It is like other study done by Leong et al. (2014) where education level and ethnicity have a significant association with respondents. Rozita et al. (2006) also found higher education level has positive attitudes towards DF. Finally, the result shows a significant association between knowledge and practice, unlike the earlier studies (Abdullah et al., 2013; Al-Dubai et al., 2013; Alhoot et al., 2017; Leong, 2014). It indicates that people with good knowledge tend to act and be involved in preventing their surroundings from breeding mosquitoes and spread DF. 298 GLOBAL JOURNAL OF PUBLIC HEALTH MEDICINE 2021, VOL 3, ISSUE 1 gggggglo Conclusion This study highlighted university students' vital role in dengue prevention-based programs such as dengue campaigns, talks, school health programs, community collaboration activities. Generally, they have a moderate knowledge of and attitude toward DF. They should be exposed more to improve and transfer this knowledge to other community members. Furthermore, it is essential to pollinate the seed of the right attitude and practice regarding dengue and its impact on the public. These programs should be started first at school levels to educate children at an early age. Even though these activities established for some time ago, overall results could be achieved by the cooperation of individuals, community, government, and mass media. Finally, everyone should play a role in eradicating dengue outbreak not only in Malaysia but worldwide. Acknowledgements Thanks, are addressed to the different universities whom their students recruited to respond to the study questionnaire to achieve this study. Conflicts of Interest: The authors declare no conflicts of interest. Funding This study was supported by Management and Science University (MSU) Seed Grant Number: SG- 379-0216-IMS. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. REFERENCES • Abdullah, M., Azib, W., Harun, M., & Burhanuddin, M. (2013). Reliability and construct validity of knowledge, attitude and practice on dengue fever prevention questionnaire. Am Int J Contemp Res, 3, 69-75. • Al-Dubai, S. A., Ganasegeran, K., Mohanad Rahman, A., Alshagga, M. A., & Saif-Ali, R. (2013). Factors affecting dengue fever knowledge, attitudes and practices among selected urban, semi-urban and rural communities in Malaysia. Southeast Asian J Trop Med Public Health, 44(1), 37-49. http://www.ncbi.nlm.nih.gov/pubmed/23682436 • Al-Zurfi, B. M. N., Fuad, M. D. F., Abdelqader, M. A., Baobaid, M. F., Elnajeh, M., Ghazi, H. F., Ibrahim, M. H., & Abdullah, M. R. (2015). Knowledge, attitude and practice of dengue fever and heath education programme among students of Alam Shah science school, Cheras, Malaysia. Practice, 129, 63.62. • Alhoot, M. A., Baobaid, M. F., Al-Maleki, A. R., Abdelqader, M. A., Lavannya A/P Rangas Paran, B. A. P. K., Kavitha A/P Balasingam, Mathuri A/P Appanu, Paveetran A/L Bathmanathan, & Maniam, M. A. L. (2017). Knowledge, attitude, and practice towards dengue fever among patients in Hospital Taiping. Malaysian Journal of Public Health Medicine, 17(3), 15:13. • Alhoot, M. A., Tong, W. T., Low, W. Y., & Sekaran, S. D. (2016). Climate Change and Health: The Malaysia Scenario. In Climate Change and Human Health Scenario in South and Southeast Asia (pp. 243-268). Springer. • Baur, X. (2013). Berufskrankheiten der 3er-Gruppe der BKV-Anlage (Augenzittern). In Arbeitsmedizin (pp. 119-121). Springer. 299 GLOBAL JOURNAL OF PUBLIC HEALTH MEDICINE 2021, VOL 3, ISSUE 1 gggggglo • Bloom, B. S. (1956). Taxonomy of educational objectives. Vol. 1: Cognitive domain. New York: McKay, 20, 24. • Brady, O. J., Gething, P. W., Bhatt, S., Messina, J. P., Brownstein, J. S., Hoen, A. G., Moyes, C. L., Farlow, A. W., Scott, T. W., & Hay, S. I. (2012). Refining the global spatial limits of dengue virus transmission by evidence-based consensus. PLoS Negl Trop Dis, 6(8), e1760. https://doi.org/10.1371/journal.pntd.0001760 • Cheah, W. K., Ng, K. S., Marzilawati, A. R., & Lum, L. C. (2014). A review of dengue research in malaysia. Med J Malaysia, 69 Suppl A, 59-67. http://www.ncbi.nlm.nih.gov/pubmed/25417953 • Dhimal, M., Aryal, K. K., Dhimal, M. L., Gautam, I., Singh, S. P., Bhusal, C. L., & Kuch, U. (2014). Knowledge, attitude and practice regarding dengue fever among the healthy population of highland and lowland communities in central Nepal. PloS one, 9(7), e102028. • Gunasekara, T., Velathanthiri, V., Weerasekara, M., Fernando, S., Peelawattage, M., Guruge, D., & Fernando, S. (2015). Knowledge, attitudes and practices regarding dengue fever in a suburban community in Sri Lanka. • Hairi, F., Ong, C. H., Suhaimi, A., Tsung, T. W., bin Anis Ahmad, M. A., Sundaraj, C., & Soe, M. M. (2003). A knowledge, attitude and practices (KAP) study on dengue among selected rural communities in the Kuala Kangsar district. Asia Pac J Public Health, 15(1), 37-43. https://doi.org/10.1177/101053950301500107 • Ibrahim, N. K. R., Al-Bar, A., Kordey, M., & Al-Fakeeh, A. (2009). Knowledge, attitudes, and practices relating to Dengue fever among females in Jeddah high schools. J Infect Public Health, 2(1), 30-40. • Itrat, A., Khan, A., Javaid, S., Kamal, M., Khan, H., Javed, S., Kalia, S., Khan, A. H., Sethi, M. I., & Jehan, I. (2008). Knowledge, awareness and practices regarding dengue fever among the adult population of dengue hit cosmopolitan. PloS one, 3(7), e2620. • Kalayanarooj, S. (2011). Dengue classification: current WHO vs. the newly suggested classification for better clinical application? J Med Assoc Thai, 94 Suppl 3, S74-84. http://www.ncbi.nlm.nih.gov/pubmed/22043757 • Lam, S. (1994). Strategies for dengue control in Malaysia. Tropical medicine, 35(4), 303-307. • Leong, T. K. (2014). Knowledge, attitude and practice on dengue among rural communities in Rembau and Bukit Pelanduk, Negeri Sembilan, Malaysia. International Journal of Tropical Disease & Health, 4(7), 841-848. • Low, J. G., Ooi, E. E., Tolfvenstam, T., Leo, Y. S., Hibberd, M. L., Ng, L. C., Lai, Y. L., Yap, G. S., Li, C. S., Vasudevan, S. G., & Ong, A. (2006). Early Dengue infection and outcome study (EDEN) - study design and preliminary findings. Ann Acad Med Singapore, 35(11), 783-789. http://www.ncbi.nlm.nih.gov/pubmed/17160194 • Mayxay, M., Cui, W., Thammavong, S., Khensakhou, K., Vongxay, V., Inthasoum, L., Sychareun, V., & Armstrong, G. (2013). Dengue in peri-urban Pak-Ngum district, Vientiane capital of Laos: a community survey on knowledge, attitudes and practices. BMC Public Health, 13(1), 434. • Ministry of Health Malaysia. (2020). Health Facts 2020. • Ministry of Health Malaysia & Academy of Medicine Malaysia. (2015). Clinical Practice Guidelines - Management of Dengue Infection in Adults (3rd edition ed.). Malaysia Health Technology Assessment Section (MaHTAS) http://www.moh.gov.my & http://www.acadmed.org.my • Nalongsack, S., Yoshida, Y., Morita, S., Sosouphanh, K., & Sakamoto, J. (2009). Knowledge, attitude and practice regarding dengue among people in Pakse, Laos. Nagoya J Med Sci, 71(1- 2), 29-37. • Poovaneswari, S. (1993). Dengue situation in Malaysia. Malays J Pathol, 15(1), 3-7. http://www.ncbi.nlm.nih.gov/pubmed/8277787 • Rozita, W., Yap, B., Veronica, S., Muhammad, A., Lim, K., & Sumarni, M. (2006). Knowledge, attitude and practice (KAP) survey on dengue fever in an urban Malay residential area in Kuala Lumpur. Malays J Public Health Med, 6(2), 62-67. • Shuaib, F., Todd, D., Campbell-Stennett, D., Ehiri, J., & Jolly, P. E. (2010). Knowledge, attitudes and practices regarding dengue infection in Westmoreland, Jamaica. West Indian Med J, 59(2), 139-146. http://www.ncbi.nlm.nih.gov/pubmed/21132094 • Wong, L. P., Shakir, S. M., Atefi, N., & AbuBakar, S. (2015). Factors affecting dengue prevention practices: nationwide survey of the Malaysian public. PloS one, 10(4), e0122890. https://doi.org/10.1371/journal.pone.0122890 300 GLOBAL JOURNAL OF PUBLIC HEALTH MEDICINE 2021, VOL 3, ISSUE 1 gggggglo • World Health Organization. (2011a). Comprehensive guideline for prevention and control of dengue and dengue haemorrhagic fever. • World Health Organization. (2011b). Dengue: Call for urgent interventions for a rapidly expanding emerging disease. • World Health Organization. (2020). Dengue and severe dengue. https://www.who.int/news- room/fact-sheets/detail/dengue-and-severe-dengue • Yboa, B. C., & Labrague, L. J. (2013). Dengue knowledge and preventive practices among rural residents in Samar province, Philippines. American Journal of Public Health Research, 1(2), 47-52.