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 PDF Version
Students’ Perceptions about Mosquito
Larval Control in a Dengue-Endemic
Philippine City
Jeffrey L. Lennon#
FoundationUniversity, School of Education, DumagueteCity, Negros
Oriental, The Philippines
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Abstract
A study was carried out among university students to find out their
perceptions about mosquito larval control in a dengue-endemic Philippine
city. This formative research was conducted to obtain information for
formulating future school-related dengue control strategies. The study was
carried out in-class through a semi-structured, open-ended question format.
The study yielded information on students’ perceptions about the most
important measures for mosquito larval control and perceived reasons why
people did not implement them. The study also explored the opinions of the
students by gender. The study yielded students’ knowledge on the types of
mosquito larval habitats. Little was expressed about
specific indoor mosquito larval control nor about the frequency of
conducting source-reduction activities. Perceived barriers to constructing
mosquito larval control centred on themes such as
apathy, laziness and lack of time. Further studies are necessary to
follow-up on these themes in depth.
Keywords: Dengue, formative research, mosquito
larval control, students, open-ended questionnaire, Philippines.
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Introduction
The control of Aedes aegypti mosquito
larvae is essential for the control of dengue fever (DF) and dengue haemorrhagic fever (DHF)[1]. The need to know the
perceptions of key informants is necessary in order to better address the
dengue-related control issues in a specific area or community[2-5]. Schools are
potential mosquito breeding sites[6-8].
Also, primary, secondary and tertiary school-age students are principal targets of the Aedes mosquitoes[9-11].
Dengue has become a steadily increasing health problem in the Philippines[9].
Consequently, it has become endemic in Dumaguete
city, Philippines[12].
Aedes control is largely based on source
reduction. Therefore, knowledge of the types of mosquito breeding sites is a
prerequisite for health personnel, schoolteachers and children and the
community at large for the control of dengue. Various types of containers
have been identified as potential mosquito breeding sites. These include
plastic and metal containers, animal-feeding dishes, tyres,
flower vases, coconut shells and water storage drums[3,4,13,14].
The knowledge about the types of breeding containers alone is not enough to
achieve mosquito control. Attitudes and beliefs impact a person’s knowledge
about mosquito control. For example, the belief that dengue is not a fatal or
serious problem impairs a person from carrying out adequate mosquito control
practices. Some people believe that mosquitoes within the home and outside
are different. So it is believed that mosquitoes inside the house do not
carry disease[15].
Gender-related responsibilities for control of certain mosquito breeding
containers might also exist. There may be different responsibilities for one
gender inside the residence compared to the outside surroundings. Or, there
may be a distribution of clean-up activities depending upon ownership of
specific items such as tyres[15].
One study in Mexico
indicates that informants devalued the use of screens in dengue prevention
and believed that the screens were not effective in keeping out mosquitoes[2].
Since dengue is already endemic in this study city in the Philippines,
it was presupposed that there would already be a high level of awareness
about dengue in general. So, this study sought to explore the more specific
topic related to dengue control, through source reduction. Therefore, this
objective of the study was to explore the opinions of Philippine university
education students about the mosquito larvae control in a dengue endemic
city.
Materials and methods
Subjects
The subjects consisted of 43 university major students at Foundation
University, College
of Education, Dumaguete
city, Philippines.
There were 36 female and 7 male subjects. All subjects were Filipinos. The
participants were students in a college-based “personal and community
hygiene” course. This study took place prior to any course coverage or
discussions about dengue fever or any of the mosquito-borne diseases. The
participation was voluntary and no student in the class declined it. The results
and data were confidentially held. All results were tabulated and reconciled
so that the responses would be anonymous.
Procedure
Two open-ended semi-structured questions were administered to the subjects on
January 16, 2003. The
students’ instruction was the facilitation of the questionnaire.
The two questions were as follows:
1. What
is the best way to control mosquito larvae?
2. Why
don’t some people use the measure you suggest for question No. 1?
The questions were given verbally. The students were also told that they were
allowed to give more than one response per question. The students gave
written responses to the questions. The responses were classified by gender.
There were no predetermined categories. Categories of responses were created
from post-survey results. As categories emerged, sub-categories were created
according to their relationship to the broader response categories. The time
allotted for the whole process of issuing instructions to the students and
completion of response-writing was approximately 15 minutes.
Results
On the responses to Question 1, the principal categories that emerged
concerning mosquito larvae control activities were as follows: outside
activities, inside activities, activities not specified as inside or outside,
activities related to specific types of containers, use of insecticide,
unrelated activities, and not familiar with mosquito larvae (Table 1).
Table 1. Responses to
Question 1
|
Category
|
Male
|
Female
|
Total
|
|
I. Outside activities
A. General outside activities
A.1. Clean
surroundings or yard
A.2. Clean surroundings daily
B. Specific water-containing items
outside
B.1. Turn
over coconuts
B.2. Dispose of water in coconut
shells
B.3. Put tyres
in a safe place
B.4. Dispose of tyres
B.5. Dispose of stagnant water in
drums
C. Other
environmental activities
C.1. Clean
canals
C.2. Burn grass
C.3. Put trash cans in a safe place (to avoid rain-water entry)
C.4. Throw garbage
properly
D. Activities involving other
participants
D.1. Clean-up
drive participation
|
5
1
1
0
0
1
0
1
0
0
0
0
|
22
1
0
1
2
0
1
5
1
1
5
1
|
27
2
1
1
2
1
1
6
1
1
5
1
|
|
II. Inside
activities
A. Clean
house (No specific activities mentioned)
|
0
|
4
|
4
|
|
III.
Activities not specified as
inside or outside
A. Non-specific cleaning
A.1. Clean
things with stagnant water
A.2. Clean or eliminate stagnant
water
A.3. Empty all stagnant water
A.4. Avoid or prevent stagnant
water
A.5. Dispose of anything where
mosquito eggs are laid
A.6. Kill mosquito larvae in
stagnant water (not specified)
A.7. Clean things where mosquito
larvae are laid
(non-specific item)
|
1
1
0
0
0
0
0
|
0
5
2
4
1
2
2
|
1
6
2
4
1
2
2
|
|
B. Activities related to non-specific
types of containers
B.1. Prevent
water from entering open containers
B.2. Cover any water container
B.3. Clean water containers
B.4. Dry water containers
B.5. Empty containers
|
0
0
0
0
0
|
1
8
1
1
1
|
1
8
1
1
1
|
|
|
C. Clothes-hanging arrangement
|
0
|
1
|
1
|
|
|
IV.
Activities related to specific
types of containers
A. Avoid
open cans
B. Cover water containers such
as gallon containers
C. Cover water barrels and
tanks
D. Put open cans in a safe
place
E. Dispose of cans
F. Cover jars
G. Cover basins
H. Clean bottles
I. Replace
flower vase water (no time mentioned)
J. Replace flower vase water
daily
K. Replace flower vase water
weekly
L. Cover garbage
M. Put garbage in a can (No
mention of placing over)
|
0
0
0
0
1
0
0
0
1
1
0
0
0
|
1
1
2
3
0
1
1
1
0
1
1
2
1
|
1
1
2
3
1
1
1
1
1
2
1
2
1
|
|
|
V. Other
control-related activities
A. Spraying
insecticide
|
0
|
4
|
4
|
|
|
VI. Unrelated
activity
A. Remove
an injured person
|
0
|
1
|
1
|
|
|
VII. Not
familiar with mosquito larvae
|
0
|
1
|
1
|
|
|
Total
|
14
|
94
|
108
|
|
|
n
|
7
|
36
|
43
|
|
|
No. of students with multiple responses
|
5
|
29
|
34
|
|
Table 2. Responses to Question 2
|
Category
|
Male
|
Female
|
Total
|
|
I. Knowledge-related
categories
A. Lack
of education
B. Lack
of knowledge
C. Lack
of consciousness of surroundings or environment
D. Lack
of consciousness of health
E. Specific
responses related to knowledge
E.1. Do not know that the
suggested method of larval control is
effective
E.2. Do not know the cause and
effect of the mosquito to dengue
E.3. They think that they know
everything about mosquito control
already
E.4. Not aware of the
consequences
E.5. Do not know that the
mosquito is dangerous
|
1
0
0
0
–
1
0
1
0
0
|
1
5
3
3
–
1
1
0
2
2
|
2
5
3
3
–
2
1
1
2
2
|
|
II.
Attitude-related categories
A. Don’t
care – apathy
B. Don’t
care because they have enough money to pay hospital
bill
C. Lazy
D. Busy
E. Since
people are busy, they only use mosquito sprays to kill adult mosquitoes instead of mosquito larvae
F.1. No
time
F.2. Insufficient
time or little time
G. No
money especially to pay for insecticide spray
H. Tired
|
1
0
3
2
1
0
0
0
1
|
9
1
7
6
0
6
1
1
1
|
10
1
10
8
1
6
1
1
2
|
|
III.
Practice-related categories
A. Lack
of cooperation with others
B. They
just use insecticide spray instead of source restriction environment control
|
0
0
|
2
1
|
2
1
|
|
IV.
Invalid or unrelated responses
A. Misunderstood the question (Answered in the
affirmative)
B. Either
answered Question 1 incorrectly or unfamiliar with the term “mosquito larvae”
|
1
0
|
8
2
|
9
2
|
|
V.
No response
|
1
|
0
|
1
|
|
Total
|
13
|
63
|
76
|
|
n
|
7
|
36
|
43
|
|
Students with multiple responses
|
4
|
20
|
24
|
For the responses to Question 2, the principal categories that emerged
concerning reasons why people do not undertake mosquito larvae control were
as follows: knowledge-related categories, attitude-related categories,
practice-related categories, invalid or unrelated responses and no response
(Table 2).
Discussion
In response to Question 1, both female and male students rated “clean
surroundings” (Table 1, Category I A.2) with the largest number of responses.
This reflects the need for emphasis on specific mosquito control efforts
while developing training and health education strategies[5,14].
The higher rating of outside activities compared to inside activities
reflects the perceived importance of outside clean-up, and conversely, the
relative lack of importance of inside clean-up and control of inside mosquito
breeding sites. This may follow the perception as recorded in literature that
“house mosquitoes” do not transmit dengue[2,5]. Perhaps students
believe that the Aedes
mosquitoes do not live inside houses or other living quarters.
No male subject gave any response related to indoor mosquito control measures
(Table 1, Category II). Besides the perception that the indoors lack
importance in mosquito control, the males may have deemed the indoors as the
domain of females. The role of women as homemakers needs to be considered in
vector control programmes. This was reviewed in a
number of international settings[15].
Female subjects responded to all but one response, “activities not specified
as inside or outside” (Table 1, Category III). Perhaps, the male respondents
were not carrying out these activities. The male response emphasis on general
response items Table 1 A, “General outside
activities” may suggest their lack of specificity in the details necessary to
conduct proper dengue-related mosquito control. The largest response in Table
1, Category III, was on the section “cover any water container” (Category III
B.2). This practice is consistent with recommendations throughout the literature[4,6,7,13,14]. However,
these responses in Table 1, Category III B.2, are less than one-third the number of the responses given in Table 1, Category I A.1.
The training of students in environmental surveys and in the environmental
action plan known as “4 o’clock
habit”, has previously been successful[6].
It is suggested that this be projected on a larger scale to include other
members of the community.
The responses in “activities related to specific types of containers” Table
1, Category IV, were scattered across the item sub-categories by the respondents.
Many of these response items could be used as inside containers. Not only is
it necessary to cover, empty, and clean containers, but also to indicate the
frequency of the activity in order to conduct adequate mosquito control. Only
the responses in Table 1, Category IV J, and Category IV K, both dealing with
flower-water replacement, and Category I A.2 “clean surroundings daily”
mentioned the frequency and timing of activities. This amounted to four
responses out of a total of 108 responses in Table 1. Perhaps, programmes need to stress health education on the
mosquito life-cycle and include emphasis on the time interval to conduct
successive mosquito control clean-ups. The lack of responses on the frequency
of environmental clean-up is in agreement with previous literature on the
incomplete understanding about the mosquito life-cycle, and thus, the need to
include this topic in future health education programmes[2,5].
Only four female respondents and no male respondent in Table 1, Category V A,
indicated that insecticide spraying was the most important mosquito control
measure. The overwhelming majority of the respondents discussed general or
specific environmental clean-up activities. Source reduction of mosquito
breeding sites without the use of adult insecticides has been stressed in
dengue-related health education programmes in Honduras[3], Mexico[4], and the Philippines[6,13,16]. Since larvicides are not currently being used or promoted in
this Philippine study site, the respondents most likely were referring to the
use of adult insecticides. In contrast, dengue control programmes
in Puerto Rico utilized both source reduction of
mosquito breeding sites and insecticide use[14]. However, for
developing countries, regular adult aerosol insecticides were deemed to be
too expensive for regular home use, and thus not recommended for routine control[13].
Only one respondent as seen in Table 1, Category VI, gave a response to an
activity unrelated to mosquito control. Also, there was only one respondent as
seen in Table 1, Category VII, who responded to the category, “Not familiar
with mosquito larvae”. These responses validated that the respondents in
general had awareness about mosquito larvae. However, only a minority gave
specific details either in types of control measures or in the timing of
control activities.
For Question 2, the greatest number of responses among the knowledge-related
category was the general category, “Lack of knowledge”, Table 2, Category I
B. There was no concentration of specific knowledge-related responses. There
were nearly twice as many attitude-related responses as knowledge-related
responses. Attitude responses were greater than knowledge responses for both
male and female subjects (Table 2). Since dengue is endemic in Dumaguete City[12], and various health
education programmes have continued for years, it
is reasonable to agree that there is a high general awareness about dengue.
However, knowledge alone is generally not sufficient to change attitudes and behaviour[17]. Health education to
increase only knowledge without addressing health behaviours
has also been ineffective in the dengue control experience[5].
The greatest numbers of responses were in the attitude-related categories of
“Don’t care – apathy”, Table 2, Category II A, and “Lazy”, Table 2, Category
II C. The responses of apathy or laziness could have been a result of a weak
belief in the effectiveness of the proposed measures from Table 1 to control
mosquitoes and dengue. The health belief model may help to explain these
responses. Two key components of the health belief model are “perceived
benefits” and “perceived barriers.” A lower perception of benefits coupled
with elevated barriers may result in a lower possibility for change[18]. Likewise, people
having low self-efficacy (a construct of the Social Cognitive Theory and also
the Health Belief Model), or, in other words, confidence in doing something[18,19] could have
resulted in their lack of interest to carry out the suggested mosquito
control tasks.
The large number of responses found in Table 2, Categories II D, II E, II F1
and II F2, related to the factors of insufficient time to perform clean-up
tasks is also suggested in the literature[15]. While people may know
about various individual mosquito breeding sites source reduction tasks, they
may lack the self-confidence necessary to perform a regular, comprehensive
environmental clean-up task. Thus, skill development on how to conduct the
steps of an environmental action plan for dengue control should be emphasized
in order to increase self-efficacy and mosquito control behaviours.
This promotion of skill development may, in turn, increase personal
efficiency to perform source reduction tasks and thus, decrease the
perception of time as a limitation to perform mosquito control activities.
There were only two responses to Table 2, Category III A, “Lack of
cooperation with others”. This low number may have been due to a high value
placed on the important relational imperative or supportive Filipino norm of
“bayanihan”
or cooperation[20]. Yet, there were still
responses to perceived lack of cooperation as a cause for lower rate of
mosquito larval control activities. Addressing this norm through various
communications and other health promotion means may help in increasing
mosquito larvae control activity.
Increasing the self-efficacy of individuals in the community may help in
increasing the collective efficacy for the desired behavioural
change activities. High levels of perceived collective efficacy may increase
the likelihood of a group carrying out desired behavioural
change activities[21].
Therefore, promoting strategies to increase collective efficacy may enhance
the likelihood that community mosquito control activities will be carried out
and sustained.
Asking the questions orally, rather than in a written form, had some
limitations. This may have contributed to the nine respondents who
misunderstood Question 2. They answered Question 2 by explaining their reason
of choice for the best mosquito larval control, rather than explain why
people were not using the best mosquito larval control method. See these
responses in Table 2, Category IV A.
This form of questioning was also limited in the lack of in-depth follow-up.
The procedure in this study did not allow for follow-up of such responses as
the reason for “apathy” as a response to Question 2. Unlike other studies
that used interviews[2-5,14] or focus groups[4,5], the facilitator of
the questions did not interact with the respondents , nor probe for follow-up
responses.
The method and procedure also had its strengths. In spite of utilizing
open-ended questions, the procedure was very efficient in time and in
organization. Unlike a previous study where interviews lasted for an hour per
respondent, and at home[5], respondents in this
study were able to complete the questions in a matter of minutes, and in one
sitting.
All questions were completed at the same time, reducing potential biases that
could result from interaction with others in the outside environment. Also,
having the students complete the questions individually, without interaction
with fellow students and reduced biased or blended responses.
The procedure also demonstrated the strength of producing a large variety of
response categories, multiple responses and overall total responses in a very
short period of time. This was evident for both sexes and in response to both
questions.
Summary and recommendations
 The study is suggestive that there was an
understanding by most students of the term “larvae”, and its general
relationship to mosquito and dengue control. This was exemplified by the low
number of incorrect responses to content unrelated to mosquito larval control
as indicated in Table 1, Categories VI and VII, and Table 2, Categories III
B, IV B and V.
There were no male responses for indoor
control measures to Question 1. Also, there were almost no specific mosquito
control measures mentioned by the male respondents. Further studies should
explore the possible gender relationship to mosquito control practices.
The majority of male and female respondents
did not mention indoor mosquito larval control. Therefore, future mosquito
control programmes should stress the importance of
indoor mosquito larval control measures.
Efforts are needed to create awareness
regarding frequency of mosquito activities.
There should be an in-depth exploration of the
reasons behind the perceived causes of non-participation in mosquito larval
control. Especially, the reasons behind “apathy” and “laziness” as perceived
causes for non-participation in mosquito larval control should be further
explored.
Activities such as an environmental control
action plan and creation of a mosquito control “checklist” and implementation
for houses and schools as a means to increase self-efficacy should be
promoted.
The determinants of collective efficacy in
mosquito larval control and dengue control should be explored.
Teachers play an important role in facilitating of health promotion in dengue
endemic areas. Students and teachers should be properly oriented to carry out
personal, school and community mosquito and dengue control measures.
Antecedent to this is an understanding of students’ perceptions about
mosquito-related dengue control. The in-class semi-structured question method
is one tool to carry out this type of formative research.
Acknowledgement
The author is associated with the International Technical Assistance Group
(ITAG), Seattle, WA, USA.
ITAG’s support is gratefully acknowledged. Also,
thanks to Chona F. Lennon and Fernando N. Florendo for their assistance.
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