A study of the effectiveness of school health education programs on selected mosquito borne diseases: school based cross-sectional study

Abstract

Background: School health education programs provide a convenient platform for engaging the students in health promotion activities. Public health problems like mosquito borne diseases cannot be controlled without active participation of the community and students are a resourceful component of the community who can be encouraged to take up activities to control mosquito borne diseases in the community.
Methods: School-based cross-sectional study was conducted in December 2010 to March 2011 among 508 school students selected at random from students studying in the eighth to tenth standard. P < 0.05 was considered as statistically significant.
Results: Totally 508 students were included in this study. The number of students unaware of the stages in the
mosquito life cycle and the mosquito’s resting habits reduced from 420 (82.68%) to 19 (3.74%) and 103 (20.28%) to 13 (2.56%) respectively. The number of students with correct knowledge of the biting habits of the female mosquito and personal protection (PP) measures increased from 31.69% to 97.05% with statistically highly significant (p<0.0001) and 52.95% to 74.21% respectively.
Conclusions: The present study suggested that the school health education program is effective in creating awareness and increasing the knowledge regarding mosquito borne diseases among school children and possibilities of successfully engaging the community at large in the fight against mosquito borne diseases. The need would be to sustain this activity and implement it in schools as part of the vector borne disease control programme.
Keywords: Cross sectional study, Mosquito borne Diseases, School going children, School health education program

Full text

International Journal of Research in Medical Sciences | June 2017 | Vol 5 | Issue 6 Page 2728
International Journal of Research in Medical Sciences
Jayanthi S et al. Int J Res Med Sci. 2017 Jun;5(6):2728-2733
www.msjonline.org
pISSN 2320-6071 | eISSN 2320-6012
Original Research Article
A study of the effectiveness of school health education programs on
selected mosquito borne diseases: school based
cross-sectional study
Jayanthi Sureshbabu1, Senthilvel Vasudevan2*, Priyanka Raj3
INTRODUCTION
Vector borne diseases are a significant cause of morbidity
and mortality globally. Dengue Fever (DF) and
Chikungunya are the systemic viral infections transmitted
among humans by infected Aedes mosquitoes.1 DF ranks
as the most important arboviral disease with almost half
the world’s population now at risk. Outbreaks exert a
huge burden on the populations, health related systems
and the economics of the most tropical countries in the
present world. DF is caused by the infection of flavi virus
in tropical and subtropical regions of Asia, Pacific and
the Caribbean islands, Central America and South
America whereas Chikungunya, caused by an alpha virus
is endemic to Africa and Asia.2,3 Severe and life
threatening forms of DF is Dengue hemorrhagic fever
1Department of Community Medicine, Pondicherry Institute of Medical Sciences, Kalapet- 605014, Pondicherry, India
2Department of Biostatistics, Amrita Institute of Medical Sciences and Research Centre, Ponekkara, Kochi- 682041,
Kerala, India
3Department of Public Health and Epidemiology, Oman Medical College, Sohar, Sultanate of Oman, Oman
Received: 12 April 2017
Accepted: 08 May 2017
*Correspondence:
Dr. Senthilvel Vasudevan,
E-mail: senthilvel@aims.amrita.edu
Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under
the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial
use, distribution, and reproduction in any medium, provided the original work is properly cited.
ABSTRACT
Background: School health education programs provide a convenient platform for engaging the students in health
promotion activities. Public health problems like mosquito borne diseases cannot be controlled without active
participation of the community and students are a resourceful component of the community who can be encouraged to
take up activities to control mosquito borne diseases in the community.
Methods: School-based cross-sectional study was conducted in December 2010 to March 2011 among 508 school
students selected at random from students studying in the eighth to tenth standard. P < 0.05 was considered as
statistically significant.
Results: Totally 508 students were included in this study. The number of students unaware of the stages in the
mosquito life cycle and the mosquito’s resting habits reduced from 420 (82.68%) to 19 (3.74%) and 103 (20.28%) to
13 (2.56%) respectively. The number of students with correct knowledge of the biting habits of the female mosquito
and personal protection (PP) measures increased from 31.69% to 97.05% with statistically highly significant (p
<0.0001) and 52.95% to 74.21% respectively.
Conclusions: The present study suggested that the school health education program is effective in creating awareness
and increasing the knowledge regarding mosquito borne diseases among school children and possibilities of
successfully engaging the community at large in the fight against mosquito borne diseases. The need would be to
sustain this activity and implement it in schools as part of the vector borne disease control programme.
Keywords: Cross sectional study, Mosquito borne Diseases, School going children, School health education program
DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20172478

Jayanthi S et al. Int J Res Med Sci. 2017 Jun;5(6):2728-2733
International Journal of Research in Medical Sciences | June 2017 | Vol 5 | Issue 6 Page 2729
(DHF) and Dengue shock syndrome (DSS). DHF tends to
affect children under 15 years of age and DSS causes
dangerously low blood pressure.4,5 Typically, the people
infected with dengue virus were asymptomatic DF (80%),
some others have DHF (5%), and a small proportion of
people have DSS.6,7 Aedesmosquitoes bite during the
daytime, particularly in the early morning and in the
evening, and thus spread infection at any time of day
throughout the year.8 An infection can be acquired from a
single bite of the Aedes mosquito, which has a limited
flight range.
The global incidence of dengue is 390 million per year,
of which 96 million manifest apparently.1 The latest
studies estimate and stated that 3.6 billion population
were living in areas of risk, more than 230 million people
were having the infections, millions cases of DF, over 2
million cases of the severe disease and 21,000 deaths.9 In
2013, Chikungunya was confirmed on the Caribbean
island of St. Martin with 66 confirmed cases and around
181 suspected cases.9
In India, more than 32,000 dengue cases and 100 deaths
of the month of September 2013 have been reported. The
highest incidence of DF was in Kerala, which had 7,000
cases.10 Early detection of DF suspected cases, access to
proper medical care and proper disease management can
help in drastically lowering the rate of fatal cases.11 There
are currently no licensed vaccines or specific therapeutics
for DF and Chikungunya.12,13
At present, various vaccines are used to treat the patients
at the preclinical and clinical stages of development of
dengue.14 So, great emphasis is placed on control and
preventive measures. Prevention can be achieved by
reducing the habitat and the density of mosquitoes and
limiting exposure to bites. The objective of the study was
to assess the effectiveness of a school health education
programs on mosquito borne diseases. To creating
awareness about vector borne diseases like dengue and
Chikungunya, their control and urging students to adopt
better practices in the community and help in the control
of mosquito borne diseases (MBDs).
METHODS
Sample selection
Students from 8th to 10th standard from two Government
and two private schools were selected and included in our
present study. The schools were located in and around the
practice area of Anaichikuppam Rural Health Centre,
Department of Community Medicine, Pondicherry
Institute of Medical Sciences, Puducherry, South India.
Student selection, their training and method of data
collection
A questionnaire was designed to assess the level of
knowledge about selected MBDs among students and the
different factors that influenced the degree of awareness.
The study period was December 2010 to March 2011. A
total of 508 students were enrolled from four different
schools. Data was collected by trained final year medical
students, interns and post graduate students under the
direct supervision of the author and co-investigators. The
questionnaires had five main sections; under each section
were various subdivisions to collect different types of
data. The subdivisions included demography, economic
factors, education, general knowledge and awareness.
The pre-test was conducted from 10th to 12th, December
2010, and this was followed by imparting health
education. After a period of three months, post-test was
conducted from 15th to 17th, March 2011 in the same
schools. Health education included 40 minutes of a power
point presentation and videos covering the topics listed
earlier. Prior permission was obtained from the school
authorities before starting the study. Briefed about the
nature of the study to the participants and oral consent
was obtained from them. Pre-designed and pre-tested
structured questionnaire was administered in the present
study. Necessary prior permissions were obtained from
the school authorities. Data was entered in Microsoft
Excel and used to construct the tables. SPSS, version 16.0
was used for statistical analysis.
Statistical analysis
For comparing the Mean and Standard Deviation,
proportions, for association chi-square test was used and
p- value less than 0.05 was considered as statistically
significant.
RESULTS
A total of 508 students studying in 8th to 10th standards
(Table 1) participated.
Table 1: Distribution of gender and standard among
the school students.
School
standard
Gender
Total N (%)
Boys
Girls
n (%)
n (%)
VIII
85 (36.64)
85 (30.80)
170 (33.47)
IX
79 (34.05)
111(40.22)
190 (37.40)
X
68 (29.31)
80 (28.99)
148 (29.13)
Total
232 (45.67)
276 (54.33)
508 (100.0)
Out 508 students, 232 (45.67%) were boys and 276
(54.33%) girls. The overall mean age of the school
students was found as 13.95±1.21 (Mean±SD) years. In
the present study, 161 (31.7%) were aware that only the
female mosquito bites/feeds on the host, but this number
rose to 493 (97.1%) at the end of the programme. In the
pre-test, more particularly, the number of students, who
did not know about the life stages by 420 (82.9%) and
resting habits of mosquitoes by 103 (20.3%), reduced
significantly to 19 (3.7%) and 13 (2.6%) respectively

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International Journal of Research in Medical Sciences | June 2017 | Vol 5 | Issue 6 Page 2730
(Table 2). It was observed that 268 (52.8%) and 232
(45.7%) students, knew that DF and Chikungunya were
MBDs, the number increased to 371 (73%) and 392
(77.2%), respectively, post-test. In the pre-test 257
(50.6%) students knew that these viral diseases were
transmitted ‘only by Aedes mosquitoes’ and 431 (84.8%)
had gained the knowledge as per the post-test. Three
fourth (382; 75.2%) of the students were aware about the
causes of getting MBDs through ‘mosquito bite’ and the
number increased to 404 (79.5%) after the programme
(Table 3).
Table 2: Knowledge of students about mosquito bionomics (N= 508).
Knowledge
Pre test n (%)
Post test n (%)
Chi- square value
p- value
Which mosquito bite/ feed the host?
Male mosquito
122 (24.01)
9 (1.77)
468.29
<0.001 HS
Female mosquito
161 (31.69)
493 (97.05))
Both
93 (18.31)
5 (0.98)
Don’t know
132 (25.98)
3 (0.59)
Biting time of Aedes mosquito*
Morning
50 (9.84)
18 (3.54)
596.85
<0.001 HS
Night
246 (48.42)
93 (18.31)
Evening
73 (14.37)
20 (3.94)
Day time
11 (2.17)
430 (84.65)
All time
37 (7.28)
46 (9.06)
Don’t know
111 (21.85)
9 (1.77)
Breeding places of mosquitoes*
Rice field
51 (10.04)
36 (7.09)
559.02
<0.001 HS
Ditches
184 (36.22)
78 (15.35)
Ponds
26 (5.12)
118 (23.23)
Tree holes
39 (7.68)
117 (23.03)
Plastic cups
26 (5.12)
231 (45.47)
Tyres
10 (1.97)
160 (31.50)
Stagnant water
147 (28.94)
37 (7.28)
Water containers
41 (8.07)
142 (27.95)
Coconut shells
19 (3.74)
128 (25.20)
Tins
4 (0.79)
173 (34.06)
All of the above
9 (1.77)
0
Don’t know
35 (6.89)
0
Others**
4 (0.79)
4(0.79)
Stages in mosquito lifecycle*
Egg
26 (5.12)
127 (25)
700.99
<0.001 HS
Larva
20 (3.94)
183 (36.02)
Pupa
6 (1.18)
49 (9.65)
Adult
15 (2.95)
25 (4.92)
All of the above
10 (1.97)
118 (23.23)
None of the above
15 (2.95)
2 (0.39)
Don’t know
420 (82.68)
19 (3.74)
Resting habit of mosquitoes
Indoor
93 (18.31)
102 (20.08)
193.64
<0.001 HS
Out door
225 (44.29)
114 (22.44)
Both
67 (13.19)
228 (44.88)
Don’t know
103 (20.28)
13 (2.56)
*Multiple responses possible; **Garbage and Bushes; HS- Highly Significant.
A total of 269 (53%) and 377 (74.2%) students were
expressed the opinion that personal protection measures
were the most effective way of preventing MBDs. A very
low number of students (34; 6.7%) were aware about the
role of ‘fish in mosquito control’, and this number
increased to 450 (88.6%). Only 29 (5.7%) of students

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International Journal of Research in Medical Sciences | June 2017 | Vol 5 | Issue 6 Page 2731
knew about National vector borne disease control
programmes in the pre-test and but the number increased
to 390 (76.8%) in post-test (Table 4). The difference in
knowledge about mosquito bionomics, knowledge of DF
and Chickungunya and prevention and control of MBDs
among students in pre and post-test was highly
statistically significant (p<0.001).
Table 3: Knowledge and belief of students about DF and chikungunya (N= 508).
Knowledge
Pre test n (%)
Post test n (%)
Chi- square value
p- value
Names of MBDs*
Malaria
374 (73.62)
418 (82.28)
87.76
<0.001 HS
Dengue
268 (52.75)
371 (73.03)
Chikungunya
232 (45.67)
392 (77.17)
Filariasis
59 (11.61)
186 (36.61)
Others**
34 (6.69)
2 (0.39)
Source of information*
TV
114 (22.44)
224 (44.09)
170.25
<0.001 HS
Relatives
75 (14.76)
99 (19.49)
News paper
41 (8.07)
172 (33.86)
Radio
9 (1.77)
70 (13.78)
Doctor
39 (7.68)
287 (56.50)
Para medical staff
15 (2.95)
70 (13.78)
School study
238 (46.85)
361 (71.06)
Don’t know
23 (4.53)
2 (0.39)
Is all genus of mosquitoes responsible for DF and chikungunya?
Yes
251 (49.50)
77 (15.16)
136.31
<0.001 HS
No
257 (50.59)
431 (84.84)
High mosquito density season*
Pre-monsoon
55 (10.83)
13 (2.56)
258.38
<0.001 HS
Monsoon
377 (74.21)
256 (50.39)
Post monsoon
44 (8.66)
300 (59.06)
Don’t know
32 (6.30)
4 (0.79)
Perceived causes of getting MBDs*
Mosquito bite
382 (75.20)
404 (79.53)
119.36
<0.001 HS
Drinking dirty water
182 (35.83)
37 (7.28)
Over work
24 (4.72)
14 (2.76)
Eating sweet or sour or cold
food
28 (5.51)
5 (0.98)
Too much exposure under sun
33 (6.50)
7 (1.38)
Irregularity in taking meals
29 (5.71)
2 (0.39)
Don’t know
15 (2.95)
4 (0.79)
* Multiple responses possible; **Swine flu and Cancer; HS- Highly Significant.
DISCUSSION
This study aims to raise awareness about MBDs among
and provide guidance to the students on the prevention
and management of MBDs.15 Health education is
generally accepted as an important, cost effective,
primary level of preventive measure.16 During pretest, the
students knew more about Malaria than about DF and
Chikungunya. Even though Pondicherry is endemic to
filariasis only 59 (11.6%) students knew about filariasis
and this number increased to 186 (36.6%), after they
attended the health education session, and the level of
students’ knowledge improved on other MBDs also.
First, students didn’t know enough about container
breeding sites and couldn’t associate plastic cups, tins,
tyres, tree holes, water containers and coconut shells with
breeding sites. 19 (3.74%) students, who were aware that
coconut shells could serve as breeding sites for Aedes
mosquitoes.
A study was conducted in Pondicherry among 1674
respondents, and 71 (4.24%) of them knew that coconut
shells could serve as breeding sites for mosquitoes.17

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International Journal of Research in Medical Sciences | June 2017 | Vol 5 | Issue 6 Page 2732
Even though Pondicherry is a coastal area, people are not
aware of containers serving as breeding sites. To educate
the school students about Mosquito Born Diseases
(MBDs), mosquito bionomics, modes of disease
transmission and control measures should be taught even
at the school age. In the present study, only 11 (2.17%)
students were aware about the day biting habit of the
Aedes mosquitoes. A similar result was found in a study
which was conducted in Jamaica among 188 residents, in
that 5 (2.7%) were knew about the day biting nature of
Aedes mosquito. However, awareness about the biting
time of these mosquitoes was found as same as with the
previous study.
Table: 4: Prevention and control against MBDs (N=508).
Two hundred and thirty-eight (46.85%) students were
indicated that ‘school study’ is the predominant source of
information about MBDs. In a study conducted in Brazil,
172 (61.6%) control group students were replied that
their main source of information was school teaching.20
Indeed the awareness created by school teaching there
was lower than in the earlier study. However, the
students’ exposure in the school is high because the
students spend much of their time in the school
environment rather than outside. 50.39% and 59.06% of
students were aware about the high mosquito density
during monsoon and post monsoon periods,
respectively.21 One hundred and eighty-two (35.8%)
students believed that drinking dirty water can cause DF
and Chikungunya and the number was reduced to 37
(7.3%) during posttest. Only 6% of students knew about
the involvement of fish in mosquito control, which is
similar to the findings of Muninarayana et al among
adults in Kolar.22
Study revealed that school health education programs
utilizing interactive lecture methods and Audio visual
aids (videos, etc.) helped students to improve their
knowledge regarding selected mosquito borne diseases.
Students showed interest in learning about vectors and
their role in disease transmission. Health Education could
be an effective medium in promoting health and possibly
behavioral changes in the community because imparting
health education to school students is the starting point
for ensuring community participation. The need now
would be to sustain this activity and implement it in
schools as part of the vector borne disease control
program. Schools and teachers should give preference to
community-oriented problems and educate the students
about them with the involvement of all stake holders. IEC
(Information, Education and Communication) materials
may be provided among the school’s students, thereby
making it more accessible about the community.
Information about Dengue, vectors and modes of disease
transmission may be incorporated into the school
curriculum, especially in areas where dengue is highly
prevalent.
ACKNOWLEDGEMENTS
Authors would like to acknowledge the study
participants, final year medical students and interns for
their active participation. The authors are also thankful to
the Director-Principal of Pondicherry Institute of Medical
Sciences, Puducherry for his constant support, guidance,
logistics and permission for publishing this study.
Funding: No funding sources
Conflict of interest: None declared
Ethical approval: The study was approved by the
Institutional Ethics Committee
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Pre test n (%)
Post test n (%)
Chi- square value
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Personal protection measures
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105.16
<0.001 HS
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All of the above
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Cite this article as: Jayanthi S, Senthilvel V,
Priyanka R. A Study of the effectiveness of school
health education programs on selected mosquito
borne diseases: School Based Cross-Sectional Study.
Int J Res Med Sci 2017;5:2728-33.