A total of 23 papers focusing on knowledge, attitude, and practices regarding dengue in the household were found in the systematic review. The 23 articles that qualified for this study were then assessed in terms of (i) dengue-related knowledge, (ii) dengue-related attitude, and (iii) dengue-related preventive practices.
4.1 Dengue-related knowledge
Dengue fever is a preventable infection, and the success of dengue control is largely determined by household dengue-related knowledge. Dengue-related knowledge assesses people’s understanding of dengue and provides an overview of the level of knowledge a specific population has about dengue. The analysis of the 23 papers revealed that the households’ knowledge of dengue varies. Some of the studies demonstrated households with a high level of dengue-related knowledge [38, 39, 40, 41], while some with adequate dengue-related knowledge [42, 43]. Analyses of the 23 papers found that the vast majority of the respondents about 66.3–97.4% had heard of dengue and dengue fever [38, 40, 42, 43, 44, 45, 46, 47, 48]. However, Phuyal et al. (2022) discovered that only 40.6% of respondents had previously heard of dengue fever [49]. Regarding the danger of the disease, 73.9% were aware that dengue fever is an infectious disease [40] and a viral disease (82.2%) [4], with multiple infections possible [41]. Findings from Rahman et al. (2021) revealed that less than 50% of the respondents knew about dengue virus serotypes and vectors [50], and less than 20% correctly answer the number of days required by the vector mosquitoes to complete their life cycle [4]. Majority of the respondents (more than 91%) were able to identify that dengue is caused by mosquito bites [38, 51, 52]. But findings from Khalil et al. (2016) revealed that only 39.8% knew that dengue is transmitted by mosquito bite [44].
Aside from fever, knowledge of dengue signs and symptoms was much less prevalent among households. Although more than 80% of the respondents knew that fever is an important dengue symptom [4, 39, 40, 41, 42, 45, 49, 50, 52, 53, 54, 55, 56], only 42.7% could name three or more dengue symptoms [52]. Less than 50% of the respondents recognized headache, bleeding, body aches, skin rash, muscle pain, abdominal pain, pain behind the eyes, and nausea as signs of dengue infection [42, 44, 47, 54]. However, some of the past studies found that the majority of the respondents (more than 90%) can recognize headache, muscle pain, vomiting blood, and joint pain as common dengue fever symptoms [4, 39, 50 53, 54, 56]. Furthermore, while restlessness and rapid breathing were less identified as being associated with dengue symptoms [4] more than 70% of respondents were aware of it. Unfortunately, some of the studies revealed that less than 40% of the respondents knew fever is the most important dengue fever symptom [44, 46].
In terms of Aedes mosquito breeding sites, approximately 94.6% of respondents were aware of it [40] and 78% were aware that Aedes mosquitoes can breed both indoors and outdoors [41]. According to the findings from Kumaran et al. (2018), 95.5% of the households correctly identify at least one breeding site [52]. The majority of respondents (94.2%) identified outdoor containers as Aedes mosquito breeding sites [42]. More than 75% of respondents were aware that mosquitoes breed in clean-standing water [47, 49]. Furthermore, the majority of the respondents were aware that Aedes mosquitos breed in stagnant clean water found in trash cans, water jars, house drains, old or discarded tires, and flowerpots, to name a few [38, 47, 52, 54, 57]. On the other hand, according to Rahman et al., (2022), 47.72% of respondents did not know where the vectors Aedes mosquito breed [41], and 45.7% believed that unclean water-holding containers could be potential breeding places for Aedes mosquito [46]. Less than 20% of the respondents recognized indoor water containers or water storage as common Aedes mosquito breeding sites [42, 44]. Furthermore, only a small number of respondents incorrectly believed that areas with running water could be Aedes mosquito breeding ground [42].
In terms of mosquito biting time, unfortunately, 93% of households are unaware of the peak biting of dengue mosquitoes [40]. According to Basra et al. (2019) and Dhimal et al. (2014), less than 13% of the households knew that dengue mosquitoes mostly bite during the day [45, 55], whereas Potdar (2018) found that 38% of the households had no idea that dengue mosquitoes bite during the day [48]. According to the findings of Khalil et al. (2016), 32.6% of respondents believed mosquitoes bite most frequently at night [44]. Phuyal et al. (2022), on the other hand, demonstrated that respondents were aware that Aedes mosquitoes bite during the early morning hours [49]. More than 60% of those polled were aware that Aedes mosquitoes bite during the day [42, 52]. Meanwhile, results from Aung et al. (2016) and Rahman et al., (2022) revealed that more than 75% of the respondents were aware of two periods of Aedes mosquito biting activity, namely early morning and late evening [41, 54].
In terms of dengue mode of transmission, more than 90% of respondents knew that dengue was transmitted by mosquitoes’ bites [4, 42, 46, 47, 48, 54, 58], and the majority of them (more than 60%) knew that Aedes was the specific mosquitoes that transmit dengue virus [42, 46, 53, 54, 57]. About 60% knew that female Aedes mosquitoes is the agent, responsible for dengue transmission [41, 51, 57]. However, research from Basra et al. (2019), Dhimal et al. (2014), and Phuyal et al. (2022) revealed that more than 80% of respondents were unaware that Aedes mosquitoes transmit the dengue virus [45, 49, 55]. More than half of the respondents were aware of the fact that ticks and flies do not transmit dengue [45, 49, 55].
In terms of the availability of dengue treatment and cure, more than 75% of respondents were unsure about the cure for dengue fever [40, 53], while less than 40% were aware of the availability of the dengue treatment [43]. In terms of mosquito prevention methods, the majority of respondents were aware of at least one mosquito breeding and mosquito-bite prevention method [52]. More than 80% of the respondents used insecticides like Ridsect to kill adult mosquitoes [51, 57]. According to Sayavong et al. (2015), the majority of respondents we aware of how to avoid mosquito bites [58]. The most frequently mentioned mosquito bites method was the use of nets during the day [52].
4.2 Dengue-related attitudes
People’s attitudes towards dengue are accessed through attitude. People are asked about how they feel about dengue and how they would react if they or someone they know became infected with dengue. Respondents showed a good attitude (86%) [41]. 97% of the respondents had a good attitude toward dengue and dengue prevention [51]. Dengue is a serious problem, according to more than 87% of respondents [38, 39, 45, 49, 54, 55] and it is a potentially fatal disease [42, 56].
In terms of the risk of contracting dengue, more than 75% of respondents believed that everyone is at risk of contracting the disease [40, 48, 51, 52, 53, 54, 57], while 44% disagreed [44]. The vast majority of respondents (more than 80%) were terrified of being diagnosed with dengue [51, 53]. More than 90% of respondents believed that dengue could be prevented [42, 45, 52], but surprisingly, more than 41% agreed that dengue could not be prevented or was unsure [56].
Around 75% of the respondents believed it is critical to combat dengue transmission [53], and more than 70% believe all dengue patients have a chance of full recovery [51, 54, 57]. In terms of dengue treatment, more than 80% of the respondents agreed that seeking immediate treatment or seeing a doctor if have dengue signs and symptoms is critical [40, 41, 51, 57], but only 28% would seek medical help or treatment within the first 24 hours [42].
The majority of respondents (more than 70%) agreed that eliminating and controlling Aedes mosquito breeding sites is one of the best ways to control and prevent dengue [45, 51, 54, 55, 57]. Cleaning potential breeding sites for Aedes mosquitoes and ensuring no mosquitoes eggs and larvae are present around respondents’ homes should be done regularly [41], with more than 75% of respondents agreed to it [4, 41]. One to three times a week, the majority of respondents’ family members and neighbours should clean Aedes mosquito breeding sites such as water containers, plant pots, and storage tanks [41]. Unfortunately, Ramli et al. (2022) discovered that 90% are unaware of this responsibility [40]. Furthermore, approximately 71.6% of respondents believed that eliminating larval breeding sources was difficult and time-consuming [54]. Some respondents believe that the task of preventing dengue, such as dengue controlling or removing mosquito breeding sites, is solely the responsibility of the government, while others believe that everyone should participate. More than 67% of the respondents agreed that the government including health authority staff and health volunteers responsible for preventing dengue [44, 48, 54]. Meanwhile, more than 75% of respondents agreed that communities should actively participate in controlling dengue [41, 42, 45, 51, 55, 57], indicating a positive community attitude toward dengue prevention activities [41].
In addition to chemical fogging, approximately 93.06% of respondents agreed that authorities should demolish potential breeding sites [41]. Meanwhile, more than half of those polled believed that chemical fogging by health authorities was sufficient for dengue prevention [4, 54]. 89.5% are unaware of the time fogging activities, and 66.5% do not want to open windows or doors during this time [40].
4.3 Dengue-related practices
Dengue practices are inquiries about respondents’ daily routines for avoiding dengue. Previous studies have discovered both poor and effective dengue prevention practices. Despite the respondents’ high level of knowledge and attitudes, poor preventive practices were common [39]. The majority of respondents have unsatisfactory dengue prevention practices [4], such as no communication with the local authority for fogging activity [41], they took no precautions to prevent mosquito breeding [48, 50], did not monitor potential Aedes mosquito breeding sites inside or outside the house [40, 41], less participation in any dengue campaign or programs in their neighbourhood [51, 54, 57] and worse, some respondents had never heard of the dengue campaign or programs [57]. In contrast, Selvarajoo et al. (2020) discovered that the majority of respondents search for and destroy mosquito breeding sites [4].
The majority of the respondents recognized water containers as a major breeding site for Aedes mosquitoes [42]. The most common good preventive practice among household respondents was covering water containers [39, 41, 45, 51, 53, 54, 55, 57, 58], clean water containers, change water container once a week, and keep plant pots clear and excess water drained [4, 41, 42, 53, 57, 58]. Meanwhile, the majority of respondents took action to remove mosquito larvae from the water tank or container if they discovered them, and they cleaned the drains or gutter roofs every time it rained [4, 51, 54, 57]. Furthermore, they dry water collection around houses (72.1%) [39] and look for any garbage or rubbish that could clog the drainage system around their house [51, 53].
Dengue fever can be avoided by taking precautions. Almost all respondents agreed that the best strategy for the prevention of dengue fever is to avoid mosquito-man contact [45, 50, 55]. Previous research also found that the majority of respondents used mosquito nets to protect themselves from Aedes mosquito bites [39, 42, 49, 53, 54, 55, 56], used mosquito control methods such as mosquito coils, mosquito repellent, mosquito spray or killing appliances and solutions [4, 41, 44, 43, 45, 46, 47, 49, 50, 55, 56]. Furthermore, when it comes to treatment, the majority of the respondents visited a hospital or health facility or sought medical assistance for dengue fever testing and treatment [43, 56]. In the meantime, some respondents believe in traditional dengue-fighting medicine [53].