Knowledge, attitudes, and practices regarding dengue infection among public sector healthcare providers in Machala, Ecuador

Abstract

BackgroundDengue fever is a rapidly emerging infection throughout the tropics and subtropics with extensive public health burden. Adequate training of healthcare providers is crucial to reducing infection incidence through patient education and collaboration with public health authorities. We examined how public sector healthcare providers in a dengue-endemic region of Ecuador view and manage dengue infections, with a focus on the 2009 World Health Organization (WHO) Dengue Guidelines.MethodsA 37-item questionnaire of dengue knowledge, attitudes, and practices was developed and administered to dengue healthcare providers in Machala, Ecuador. Survey focus areas included: “Demographics,” “Infection and Prevention of Dengue,” “Dengue Diagnosis and the WHO Dengue Guide,” “Laboratory Testing,” “Treatment of Dengue,” and “Opinions Regarding Dengue.”ResultsA total of 76 healthcare providers participated in this study, of which 82 % were medical doctors and 14 % were nurses. Fifty-eight percent of healthcare professionals practiced in ambulatory clinics and 34 % worked in a hospital. Eighty-nine percent of respondents were familiar with the 2009 WHO Dengue Guidelines, and, within that group, 97 % reported that the WHO Dengue Guide was helpful in dengue diagnosis and clinical management. Knowledge gaps identified included Aedes aegypti mosquito feeding habits and dengue epidemiology. Individuals with greater dengue-related knowledge were more likely to consider dengue a major health problem. Only 22 % of respondents correctly reported that patients with comorbidities and dengue without warning signs require hospital admission, and 25 % of providers reported never admitting patients with dengue to the hospital. Twenty percent of providers reported rarely (≤25 % of cases) obtaining laboratory confirmation of dengue infection. Providers reported patient presumptive self-medication as an ongoing problem. Thirty-one percent of healthcare providers reported inadequate access to resources needed to diagnose and treat dengue.ConclusionParticipants demonstrated a high level of knowledge of dengue symptoms and treatment, but additional training regarding prevention, diagnosis, and admission criteria is needed. Interventions should not only focus on increasing knowledge, but also encourage review of the WHO Dengue Guidelines, avoidance of presumptive self-medication, and recognition of dengue as a major health problem. This study provided an assessment tool that effectively captured healthcare providers’ knowledge and identified critical gaps in practice.Electronic supplementary materialThe online version of this article (doi:10.1186/s40794-016-0024-y) contains supplementary material, which is available to authorized users.

The burden of dengue fever and chikungunya in southern coastal Ecuador: Epidemiology, clinical presentation, and phylogenetics from the first two years of a prospective study

“…In prior studies in Machala, community members and healthcare professionals indicated that there was low health care seeking behavior in certain populations, such as working men in the urban periphery, and self-medicating was common practice. 18,71 Another explanation is that our definition of symptomatic DENV infections included mildly symptomatic infections that did not require medical attention. These findings highlight the importance of active surveillance protocols that capture inapparent infections and infections in demographic groups who are less likely to seek health care or who have limited access to health care.…”

“…This is especially important in places and in subgroups with low healthcare seeking behavior, which result in underreporting and continued disease transmission. 18,71 Enhanced surveillance systems have been shown to detect an increase in infections earlier than passive surveillance systems, 25 providing a warning of an escalating outbreak. These data are currently being used to parameterize and calibrate local epidemic forecast models.…”

Social-ecological factors and preventive actions decrease the risk of dengue infection at the household-level: results from a prospective dengue surveillance study in Machala, Ecuador

“…Demographic differences between symptomatic and asymptomatic cases may have introduced bias in earlier studies. In Machala, community members reported that working men in the urban periphery are the group least likely to seek healthcare [25], and health care providers [63] supported this notion; therefore, prior studies based on MOH case reports would have underestimated their risk of infection. Also, this study focused on data from individual households rather than neighborhood-level data, and may have therefore been better suited to tease out factors related to the spread of DENV between households.…”

Low to medium-low risk perception for dengue, chikungunya and Zika outbreaks by infectious diseases physicians in France, Western Europe

“…This is the first study on the perception of the present and future risk of vector-borne diseases (i.e., dengue, [33][34][35][36], H1N1pdm flu [37][38][39] and H5N1 avian flu [40][41][42]; others have focused on general practitioners in France [43][44][45], both general population and practitioners [46], French pharmacists [47] or risk perception in Europe and other countries worldwide [48][49][50]. The appearance of various emerging infectious diseases during the last two decades (e.g., chikungunya, SARS-CoV, MERS-CoV, Ebola virus, Zika), as well as that of antibiotic-resistant bacteria, has stimulated research on risk perception in the general public and policy-makers [51][52][53][54][55].…”