|Year : 2022 | Volume
| Issue : 5 | Page : 56-59
Knowledge, attitude, and practice regarding mosquito-borne diseases among migrant laborers from a migrant settlement in Ponekkara, Ernakulam Kerala
Rohini Bhardwaj1, K Sreelakshmi Mohandas2, Minu Maria Mathew3
1 MPH Scholar, Department of Community Medicine and Public Health, Amrita Institute of Medical Sciences, Kochi, Kerala, India
2 Assistant Professor, Department of Community Medicine, Amrita Institute of Medical Sciences, Kochi, Kerala, India
3 Lecturer (Biostatistics), Department of Community Medicine, Amrita Institute of Medical Sciences, Kochi, Kerala, India
|Date of Submission||11-Aug-2022|
|Date of Decision||15-Aug-2022|
|Date of Acceptance||19-Aug-2022|
|Date of Web Publication||11-Nov-2022|
K Sreelakshmi Mohandas
Department of Community Medicine, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Ponekkara, Kochi, Kerala
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Background: Mosquito-borne diseases (MBDs) such as Malaria, Dengue, Chikungunya, lymphatic filariasis, and Japanese Encephalitis are important public health problems in India. Ernakulam in Kerala being a hub of construction activities has a large influx of migrants from Odisha, West Bengal, Bihar, Assam, U. P., Jharkhand, T. N., and Karnataka. Hence, the objective of this study was to assess the knowledge, attitude, and practice related to MBDs and the associated factors among the migrant laborers from a migrant settlement in Ponekkara, Ernakulam Kerala. Materials and Methods: A cross-sectional study was done among 179 migrant laborers from a migrant settlement in Ponekkara, Kerala, from September 2021 to November 2021 using a pretested semi-structured questionnaire to collect information regarding socio-demographic details and their knowledge, attitude, and practice regarding mosquito borne diseases. After taking verbal consent, the questionnaire was administered by the investigator. Descriptive and univariate analysis was done using SPSS Version 20. Results: It was found that 58.4% of the migrant laborers had poor knowledge, 55.9% had poor attitude, and 61.5% of them had poor practice regarding MBDs. On univariate analysis, a statistically significant association was observed between attitude score and the level of education. Conclusion: The findings showed that migrant laborers had an overall poor knowledge, attitude, and practices regarding MBDs. Consequently, there is a need to plan an awareness program among the migrant settlements regarding MBDs.
Keywords: Attitude, knowledge, migrants, mosquito-borne diseases, practice
|How to cite this article:|
Bhardwaj R, Mohandas K S, Mathew MM. Knowledge, attitude, and practice regarding mosquito-borne diseases among migrant laborers from a migrant settlement in Ponekkara, Ernakulam Kerala. Indian J Public Health 2022;66, Suppl S1:56-9
|How to cite this URL:|
Bhardwaj R, Mohandas K S, Mathew MM. Knowledge, attitude, and practice regarding mosquito-borne diseases among migrant laborers from a migrant settlement in Ponekkara, Ernakulam Kerala. Indian J Public Health [serial online] 2022 [cited 2022 Nov 29];66, Suppl S1:56-9. Available from: https://www.ijph.in/text.asp?2022/66/5/56/360652
| Introduction|| |
Vector-borne diseases (VBDs) account for more than 17% of all infectious diseases, causing more than 700,000 deaths annually. Majority of the VBDs are transmitted by mosquitoes, the most important diseases being Malaria, Dengue, Yellow Fever, Japanese encephalitis (JE), Chikungunya, Lymphatic Filariasis (LF), West Nile virus, and Zika. Mosquito-borne diseases (MBDs) are an important public health problem in countries of the Southeast Asia Region including India. MBDs have claimed lives and overwhelmed health systems in many countries; additionally, diseases such as LF cause chronic suffering, life-long morbidity, disability, and stigmatization.
In India, states of Odisha, Chhattisgarh, Jharkhand, Meghalaya, and Madhya Pradesh disproportionately accounted for nearly 45.47% of malaria cases and 70.54% of falciparum malaria cases in 2019. In 2016, 64,057 cases of Chikungunya were reported from India only. Moreover, India accounts for 34% of the global cases of dengue and 40% of the global burden of lymphatic filariasis.
Kerala has evolved as an attractive destination for migrant workers from the rest of India. As of 2018, it was estimated that 3.5 million migrant workers hailed from all over India to Kerala. The increasing demand for workers, coupled with the high wage rates compared to other states, regular availability of employment and minimal avenues for employment in states which are experiencing a demographic dividend coincided by lack of employment opportunities, has resulted in the evolution of some of the longest labor migration corridors in India connecting Kerala with Assam, West Bengal, Odisha, Jharkhand, Bihar, and U. P. in addition to Tamil Nadu and Karnataka.
The migrant population is quite contrasting from native population in terms of health and socioeconomic status. Kerala has a tropical climate with an average annual rainfall of 3055 mm which is favorable for mosquito breeding. Consequently, migration along with environment plays an important role in the spread of MBDs. Hence, the objective of this study was to assess the knowledge, attitude, and practice related to MBDs and the associated factors among the migrant laborers from a migrant settlement in Ponekkara, Ernakulam Kerala.
| Materials and Methods|| |
This is a cross-sectional study conducted among migrant laborers between September and November 2021 in a migrant settlement in Ponekkara division of Ernakulam district. Any person who has migrated to Kerala from any state of India for employment and stayed for a period not <1 year was considered as a migrant. The migrant settlement for the study had laborers who were employed in construction work and housekeeping. Migrant laborers who were <18 years of age and who were unable to understand Hindi/Tamil/Telugu were not included in the study. Due to dearth of adequate literature, a pilot study was carried out among 30 migrant laborers to know the prevalence of good knowledge, attitude, and practice and it was found to be 40%, 42.9%, and 44.7%, respectively. With 95% confidence interval, 20% relative precision, P = 40% with 20% nonresponse rate, a sample size of 174 was calculated.
A total sample of 179 was achieved using convenient sampling technique. A pretested semi-structured questionnaire was used to collect details regarding the socio-demographic profile and the knowledge, attitude, and practice assessment. The questionnaire was prepared in English and was conveyed in Hindi, Tamil, and Telugu based on the state of origin of the migrants. The questions relating to the assessment of knowledge, attitude, and practice were scored 0 and 1 each for incorrect response and correct response, respectively.
The knowledge, attitude, and practice scores were divided into two categories based on the median score. The knowledge, attitude, and practice scores were 11, 3, and 6, respectively. A score less than the median value was considered as poor knowledge/practice and poor attitude, respectively.
After taking a verbal consent, the questionnaire was administered to the migrants by the investigator. Institutional ethical clearance was obtained (reference number: ECASM-AIMS-2021–383). Collected data were entered into MS Excel for Windows 7 and analyzed using IBM SPSS Statistics for Windows, version 20 (IBM Corp., Armonk, N.Y., USA). Continuous variables are expressed in mean ± standard deviation and categorical variables are expressed in frequency and percentage. Chi-square test was done to determine the factors associated with knowledge, attitude, and practice.
| Results|| |
Of the 179 participants, the median age was 26 (22, 34) years. A vast majority, 176 (98%), of them were male. Approximately, 49.2% of the migrants were from West Bengal, 29.1% of were from Odisha, 13.9% from Bihar and a smaller group from Assam, Maharashtra, Tamil Nadu, and Uttar Pradesh. Around one-third of the study participants (39.1%) had only primary school education (Class I-VIII), one-third (38.5%) had secondary education (Class IX-XII), less than one-third (21.8%) of the study participants were illiterate and one participant was a B. A. graduate. A majority, 67.6%, of them had been staying in Kerala for 1–7 years while 32.4% have been staying in Kerala for more than 7 years. More than half of the study participants (52.5%) were married.
The knowledge, attitude, and practice scores regarding MBDs are described in [Table 1].
|Table 1: Distribution of study participants based on knowledge, attitude, and practice score|
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Mosquitoes were perceived as a problem by 41.9% of the participants. A total of 149 (83.3%) participants knew that mosquitoes cause diseases. These participants (n = 149) were asked further questions regarding knowledge. Approximately half of the study participants were able to name at least 2 MBDs. It was seen that 48.6% were able to name malaria and dengue, while 13.4% were able to name malaria alone as a mosquito-borne disease. Around 15.1% of the study participants were not able to name any disease caused by mosquitoes. “Fever” or “Fever with chills and rigors” or “Fever with head and body ache” as a symptom of MBDs was mentioned by 56.9% of migrants and only 15.1% participants were able to mention three or more than three symptoms.
About 55% participants mentioned they have heard about mosquito-borne diseases from family members and acquaintances or other sources such as T. V., mobile phone, and newspaper. Drains, garbage, and artificial water collections were the most common answer in combination with other mosquito breeding places. About, 55.3% of participants were able to mention more than two mosquito breeding places while 13.4% were unaware about mosquito breeding places.
Most participants mentioned mosquito bite only during night (67%) while 26.3% responded both day and night. A significant number of participants (86%) were bitten by mosquitoes at home when compared to workplace. A total of 149 (83.3%) participants who knew mosquitoes' causes diseases were taken for assessing the knowledge score.
Most of the migrants (96.6%) slept indoors. Mosquitoes caused both health risk and nuisance for 35.2% of the participants, and it caused no problem for 22.9% of the participants. Illness in family due to mosquito bites in the past 5 years was seen among 15% of the participants and 15% took treatment for the same. Government hospital was the place of treatment for 11.7% of the study participants. In addition, 2.8% participants opted private hospital for treatment.
Information regarding insecticidal sprays was mentioned by only 58.1% (n = 104). Furthermore, 93.26% (n = 97) out of them were aware of the frequency of insecticidal sprays. General cleanliness of surroundings as preventive measures against mosquito-borne disease was mentioned by 37.4% of the participants. The ability of the participants to mention two or more preventive measures against mosquitoes breeding places was low (34.7%). Mosquito nets were the common answer when asked about the personal protective measures against mosquito bites. About 44% of the study participants were able to mention at least two personal protective measures against mosquito bites.
On univariate analysis using Chi-square test, the level of education was found to be statistically significant with attitude score [Table 2].
|Table 2: Univariate analysis for the association of poor knowledge, attitude, and practice score with sociodemographic variables|
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| Discussion|| |
This cross-sectional study conducted to assess knowledge, attitude, and practice related to MBDs among the migrant laborers showed that 58.4% had poor knowledge, 55.9% had poor attitude, and 61.5% had poor practice. The level of education was found to be statistically significant for the attitude scores. Most migrants were males (98%), 49.2% belonged to West Bengal and more than half of them were married (52.5%). In another study conducted on migrant labor settlement in Kerala, 60.8% belonged to Odisha and all of them were males and only 40% of the participants were married. A higher number of migrants are married in the current study and this may be due to the difference in the age structure of migrants as younger population tend to migrate more from the rural areas for labor work.
The proportion of illiterates in our study is comparable to the findings from a similar study done in Delhi. This may be because people with no formal education leave their state of origin looking for jobs in the informal sector. As per our study, 41.9% perceived mosquitoes as a problem and 83.3% knew mosquitoes cause disease. Higher awareness may be due to the endemicity of MBDs in native states of these migrants. Many of the participants (85%) were able to name at least one MBD. In a study conducted in Surat city, the ability to name at least one MBD among migrants was 67%. Around 56.9% of the migrants knew “Fever” or “Fever with chills and rigors” or “Fever with head and body ache” as a symptom of MBDs while 31.8% did not know any of the symptoms. The study in Surat city suggests that only 41% of migrants mentioned fever with chills as the symptom of malaria. These differences may be due to the awareness programs conducted by the authorities in Ernakulam or their increased access to information sources.
In the current study, the most known MBD was malaria. Similar results were seen in a Karnataka-based study. This may be due to the incomplete knowledge regarding MBDs such as dengue, JE, and LF, which are also hazardous, cause morbidity, mortality and are preventable. Most participants responded mosquitoes bite in the nighttime only (67%). Similar results were seen in the study done in Karnataka. As most of the migrant workers are involved in jobs requiring hard physical labor, they may be unaware of the mosquito bites during daytime. It was seen that a higher number of migrants (39.5%) had outdoor sleeping habits in Surat city. In our study, only 3.4% of migrants slept outdoors. The reason for this may be that migrants were provided with accommodation near the construction sites.
Around 58.1% knew about regular insecticidal spraying done in and around the place. Majority of the participants also knew about the frequency of spraying. This means that more than half of the migrants were aware of preventive measures at community level. The ability of the participants to mention at least two preventive measures against mosquito breeding places was low (34.7%). This indicates that migrants were not fully aware about the potential breeding places which is an important factor for controlling the disease transmission. They should be made aware of the source reduction, especially for the control of Aedes and Anopheles mosquitoes which may also breed indoors in clean water storage containers. Most of the migrant workers used mosquito nets against mosquito bites and this might be because mosquito nets are effective, long-lasting, and cheaper than other personal protective creams and repellents.
| Conclusion|| |
This research has brought certain facets of knowledge, attitude, and practices among the migrants about MBDs that may help in planning an awareness program. The program should encompass the wide variety of diseases transmitted by mosquitoes that cause morbidity as well as mortality while touching on the segments of source reduction, especially for control of mosquitoes which may also breed indoors in clean water storage containers. More thrust has to be given to observing dry day once a week at the construction sites as well as in and around migrant accommodations. In addition, they should be made aware of the day-biting habits of mosquitoes.
We would like to thank Mr. Vijaya Kumar Swami Ji, Head of Constructions, Amrita Institute of Medical Sciences, Kochi, Mr. Hardik, HOD, Department of Housekeeping, Amrita Institute of Medical Sciences, Kochi.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2]