Dengue knowledge, attitudes and practices and their impact on community-based vector control in rural Cambodia

Background: Globally there are an estimated 390 million dengue infections per year, of which 96 million are clinically apparent. In Cambodia, estimates suggest as many as 185,850 cases annually. The World Health Organization global strategy for dengue prevention aims to reduce mortality rates by 50% and morbidity by 25% by 2020. The adoption of integrated vector management approach using community-based methods tailored to the local context is one of the recommended strategies to achieve these objectives. Understanding local knowledge, attitudes and practices is therefore essential to designing suitable strategies to fit each local context. Methods and findings: A Knowledge, Attitudes and Practices survey in 600 randomly chosen households was administered in 30 villages in Kampong Cham which is one of the most populated provinces of Cambodia. KAP surveys were administered to a sub-sample of households where an entomology survey was conducted (1200 households), during which Aedes larval/pupae and adult female Aedes mosquito densities were recorded. Participants had high levels of knowledge regarding the transmission of dengue, Aedes breeding, and biting prevention methods; the majority of participants believed they were at risk and that dengue transmission is preventable. However, self-reported vector control practices did not match observed practices recorded in our surveys. No correlation was found between knowledge and observed practices either. Conclusion: An education campaign regarding dengue prevention in this setting with high knowledge levels is unlikely to have any significant effect on practices unless it is incorporated in a more comprehensive strategy for behavioural change, such a COMBI method, which includes behavioural models as well as communication and marketing theory and practice. Trial registration: ISRCTN85307778. Author summary: The global incidence of dengue has grown dramatically over the last few decades and has become the most rapidly spreading mosquito-borne disease. To date, there is no specific treatment. A vaccine came on the market in 2015, but it will be several years before it becomes widely available and its efficacy is limited. Therefore vector control is the most important means of dengue prevention at the current time. The World Health Organization recommends the adoption of an integrated vector management approach using community-based methods tailored to the local context. In order to design appropriate strategies, it is essential to understand local knowledge, attitudes and practices regarding dengue vector control. We conducted a survey in the Cambodian province of Kampong Cham, to investigate the local knowledge levels as well as self-reported vector control practices and observed practices. We found a high knowledge of dengue transmission, and Aedes breeding and biting prevention methods. However, no correlation was found between self-reported vector control practices and observed practices. Additionally, knowledge levels did not correlate with actual vector control practices.