臺灣博碩士論文加值系統

Background: Dengue is a mosquito-borne viral infection that now is endemic in most tropical countries. In Costa Rica since the 1990’s dengue has become the most important vector-borne disease, causing outbreaks almost every year, leaving thousands of people affected since its resurgence.
Objective: To analyze the individual knowledge, attitude and practice towards Dengue control and preventive measures among the Orotina inhabitants in the Central-Pacific region of Costa Rica.
Methods: From August 15th to November 15th 2007 we conducted a cross-sectional study among 409 persons living in the Orotina Canton, in the Central-Pacific region of Costa Rica. Demographic characteristics, knowledge, attitudes and practices of dengue were measured by means of a structured questionnaire, and an environmental survey of the premises was conducted to determine household features including the presence of Aedes aegypti potential breeding sites (PBS) and mosquito larva. Differences between the different variables were calculated by chi-square test. Logistic regression was used to identify determinants of knowledge, attitudes and practices of dengue disease, and to find associations between individual characteristics and dengue related KAP with presence of PBS and mosquito larva.
Results: Of the 409 persons, 343 (84%) participants answered correctly the mode of dengue transmission (through a mosquito bite), 79% had adequate knowledge of dengue symptoms, 61% had adequate knowledge of Aedes aegypti breeding sites and 66 % had adequate knowledge of dengue control/preventive measures. In multivariate analyses, the people residing in the rural area and the people who do not know a person who had dengue before were associated of having inadequate knowledge in the 4 categories of knowledge. In terms of practices of dengue control/preventive measures, 87% of people claimed to practice and 13% not to practice. In multivariate analyses, the determinants associated with the people who do NOT practice were: residing the in rural area (aOR: 2.88, 95% CI: 1.07-7.77), having negative attitude towards the effectiveness of recommended control/preventive measures (aOR: 3.58, 95% CI: 1.66-7.70) and inadequate knowledge of breeding sites and mode of transmission. Environmental survey: 77% of people had in their premises the presence of potential breeding sites, and 21% out of the total had mosquito larva in their premises. Just one association was found: less educated people were associated with presence of mosquito larva in urban premises. No other personal characteristics or dengue related KAP factors were associated with neither of the outcome variables.
Conclusion: Although the overall knowledge and control/preventive practices were high, the presence of potential breeding sites and mosquito larva was also high, meaning that people had sufficient awareness about the characteristics of dengue disease, but showed lack of action towards preventing and controlling the disease. Therefore an integrated vector control program supported by legislative measures is recommended to encourage householders compliance in this matter.

1 INTRODUCTION 1
1.1 Background and Significance 1
1.2 Situation Analysis in Costa Rica. 6
1.2.1 Country Profile 6
1.2.2 Health Care System 7
1.2.3 Dengue Situation in Costa Rica 9
1.3 Main Objective and Research Questions 11
2 LITERATURE REVIEW 12
2.1 Etiology 12
2.2 Transmission 12
2.3 Epidemiology / Disease Burden and Global Situation 14
2.4 Epidemiological Trend in the Americas 16
2.5 Epidemiological Trend in Costa Rica 16
2.6 Clinical picture 18
2.6.1 Dengue Fever 18
2.6.2 Dengue Haemorrhagic Fever (DHF) 18
2.6.3 Dengue Shock Syndrome (DSS) 19
2.7 Resurgence of Epidemic Dengue in Latin America 20
2.8 Dengue Control 22
2.9 Overview of Dengue Control in Costa Rica 23
2.10 Community Campaigns and KAP 24
3 METHODOLOGY 29
3.1 Diagram of Relationships 29
3.2 Setting 30
3.3 Target Population 31
3.4 Measurement 32
3.4.1 KAP Survey 33
3.5 Human Subjects Protection 38
3.6 Statistical Analysis 38

4 RESULTS 40
4.1 Demographic Characteristics 40
4.2 Knowledge 43
4.2.1 Knowledge of Dengue Disease Symptoms 44
4.2.2 Knowledge of Dengue Vector Breeding Sites 48
4.2.3 Knowledge of Dengue Disease Control/Preventive Measures 51
4.2.4 Association of Demographics with Knowledge of Dengue Fever Mode of Transmission 55
4.3 Attitudes 56
4.3.1 Association of Different Determinants with Dengue Related Attitudes 57
4.4 Practices 60
4.4.1 Association of Different Determinants with Practice of Dengue Fever Control/Prevention Measures 61
4.5 Environmental Survey 63
4.5.1 Potential Breeding Sites (PBS) 63
4.5.2 Mosquito Larva Survey 68
5 DISCUSSION 74
5.1 Study design and Bias 75
5.2 Comparison with Previous Studies 77
5.2.1 Knowledge 77
5.2.2 Attitudes 80
5.2.3 Practices 81
5.2.4 Environmental Survey 82
5.3 Study Strengths and Limitations 86
6 CONCLUSION AND POLICY IMPLICATIONS 88
7 REFERENCES 90
8 APPENDICES 104

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