Kaneda Eiko

Pongvongsa Tiengkham

Nippon Sport Science University

日本体育大学紀要（Bull. of Nippon Sport Sci. Univ.），40 (1)，1–4，2010Basic knowledge of dengue fever and malaria in school teachers in a rural area of Lao PDREiko KANEDA1,2) and Tiengkham PONGVONGSA3)1) Nippon Sport Science University, 2) Toyo University, 3) Savannakhet Malaria Centre, Lao PDRAbstract: Mosquito-borne diseases such as dengue fever and malaria are one of the most serious infectious diseases in Lao PDR. It is necessary to understand the causes, symptoms, and preventive measures to avoid contracting these diseases, and school health education plays an important role in this respect. It is also necessary for teachers to have correct knowledge of dengue fever and malaria. This paper assesses the teachers’ knowledge of dengue fever and malaria, especially the causes, symptoms, and preventive methods, in the Lahanam area of Lao PDR and compares the level of knowledge with teachers’ age and teaching experience. We found that all teachers understood the symptoms and preventive methods of dengue fever but did not have an equally thorough understanding of malaria. No correlation was found between knowledge and age or teaching experience. With regard to the cause of infection with dengue fever and malaria, most teachers understood these diseases to be transmitt ed by mosquitoes. These fi ndings suggested that because local teachers are not transferred, eﬀ orts to improve knowledge, such as the training of the teachers, may be needed.(Received: June 25, 2010 Accepted: July 28, 2010)Key words: dengue fever, malaria, teachers’ knowledge, Lao PDR【Original】???????tional teaching materials but also basic knowledge of teachers about infectious diseases, especially symp-toms, causes, and prevention methods related tomosquito-borne infections. In rural areas of Lao PDR,almost no teachers are transferred from the villagewhere they live when seeking employment. Moreover,they have few opportunities to absorb new knowledgeand may need to take part in programs such as thetraining of teachers (TOTs) for health education.The purpose of this study is to assess the teachers’ knowledge of mosquito-borne infections in rural areasand investigate the relationship between knowledgelevel and teachers’ age and teaching experience.2. Methods1) Study site and subjectsThe Lahanam area is located in the countryside of Songkhone district, Savannakhet province. This studyarea comprises six villages and fi ve primary schools,including two branch schools. The region is made upprimarily of rice fi elds, and the remainder is coveredby forest. Three of the six villages are located near theBanghiang River, which is a tributary of the MekongRiver. The total population of the region was 44131. BackgroundDengue virus is spread by the mosquito vector Aedes aegypti and causes signifi cant morbidity and mortality worldwide. The World Health Organization estimates 50 million annual worldwide cases of dengue fever1).Malaria is also increasingly becoming a serious bur-den in most tropical countries and a major cause of death in children in sub-Saharan Africa. Approximate-ly 300 million people worldwide are aﬀ ected by malaria, and 1–1.5 million people die every year due to malaria2). The disease burden is increasing in almost all the tropical countries because malaria creates socioeconomic problems and leads to many deaths, particularly among young children3).In Laos, there were more than 200 cases of dengue fever in Saravane Province and 73 cases in Sekong Province in 20084). Malaria is also a public health problem in Lao PDR, with approximately 300,000 suspected cases reported each year5).Health education in the schools is one of the eﬀ ec-tive methods to prevent these infectious diseases. En-hancement of health education in the schools would require not only the availability of appropriate educa-2Basic knowledge of dengue fever and malaria in school teachers in a rural area of Lao PDRsigned an identifi cation code that was used in place of their names during data analysis.3. ResultsThe number of enrolled teachers in this area was 24.The average age was 39 years (range, 25–57 years) andaverage teaching experience was 18 years (range, 4–34years). All teachers except one were residents of thisarea.Table 1 shows the teachers’ knowledge of denguefever and malaria, especially the symptoms and pre-ventive methods. All teachers knew the symptoms of dengue fever; in contrast, 4 of 24 teachers were notfamiliar with the symptoms of malaria. With regardto understanding the prevention of dengue fever, 3teachers gave wrong answers, while for malaria, 4teachers gave wrong answers. No correlation wasfound between the points for the answers to thesequestions and teacher age (r=0.071, n=23) or teachingexperience (r=−0.105, n=23).Table 2 gives more detail about responses withregard to symptoms and prevention. Fever, a typicalsymptom, was the most well-recognized symptom of both dengue fever (n=24/24) and malaria (n=18/24).Overall, the typical symptoms of each disease, such asrash in dengue fever (n=17/24) and chills in malaria(n=16/24), were understood. Furthermore, the use of mosquito net was recognised as a preventive methodfor dengue fever (n=24/24) and malaria (n=18/24).Methods related to destroying the mosquito’s sourceranked from second to fourth for the prevention of both dengue fever and malaria. Half or less than half of teachers know that the house must be cleaned toprevent mosquito breeding; three teachers believe thatdrinking boiled water leads to prevention of malaria.Table 3 shows the teachers’ knowledge of infectionroutes for dengue fever and malaria. For dengue fever,23 of 24 teachers answered correctly, that is, mosqui-to’s bite spread the infection in humans. However,only three-quarters of teachers gave the correct answerregarding the spread of malaria (n=18/24). One teacheranswered that dengue fever and malaria are caused bythe bombs that were dropped by the United Statesduring the Vietnam War. Two teachers believed thatinfection was caused by ingesting mosquito larvaefrom unboiled drinking water. Four of 24 teachersanswered that they did not know the cause of malaria infection.people, and the number of households was 713 fami-lies6). Malaria has not recently been reported in this area, and only a few cases of dengue fever are reported each year.2) Data collectionAll primary-school teachers in this area were inter-viewed in person in September 2005. The interview was conducted in the Lao language, and the answers were writt en in the notebook in English by a Laotian parasitologist.The questions asked were about symptoms, causes, and preventive methods for dengue fever and malaria. Detailed knowledge of the teachers about dengue fe-ver and malaria was recorded. The number of correct answers and mistakes was tallied to yield individual scores for knowledge of symptoms and preventive methods. Teachers were given one point for each cor-rect answer, and a point was subtracted for each mis-take. To make clear the relationship between these points, the teachers’ knowledge was compared with their age and teaching experience. Aft er the results of interview were determined, the fi ve highly ranked symptoms and preventive methods of dengue fever and malaria were summarised. Finally, all data were consolidated with regard to the cause of dengue fever and malaria.3) Statistical analysisTo analyse teachers’ knowledge of symptoms and disease prevention and the relationship with age and teaching experience, the data were entered into a computer with the Microsoft  Excel program. Pearson correlation analyses were performed by SPSS 11.5 soft ware (SPSS Inc., Chicago, IL).4) Ethical considerationsThe Ministry of Health, Savannakhet province, approved the project at the district level; it was also approved by the Health Development Study Project team and the ethical committ ee of the Institute of Tropical Medicine, Nagasaki University.Before the survey was started, a meeting was held in each school, and informed consent was obtained from all the teachers. Confi dentiality was guaranteed for respondents’ information. If the participants did not agree to participate, we did not include them. The data were stored securely, and participants were as-3KANEDA・PONGVONGSAWith regard to symptoms and prevention of infec-tion, no correlation was found between teachers’ knowledge and teachers’ age or educational experi-ence. This fi nding suggests that when the opportunity4. DiscussionWe investigated school teachers’ basic knowledge of dengue fever and malaria in Lahanam. All teachers had a general understanding about the symptoms of dengue fever; however, some were unaware about the cause of malaria. The rate of correct answers for malar-ia was low because of no occurrence of malaria in this area; thus, the teachers did not have a reason to edu-cate themselves about the cause and symptoms of this disease. In Lao PDR, however, many endemic areas of malaria infection exist, especially in the rural areas of Att apu, Khammouan, and Savannakhet province7–9); thus, health education in the schools is very important.Table 1. Teacher’s knowledge of dengue fever and malaria*: 1=primary, 2=secondary, **: 1=primary level, 2=middle level, 3=teacher trainig college, ***: ( )=the number of wrong answerTable 2. The teacher’s answer of symptom and preventive of dengue fever and malaria (fi ve high-ranking items)Table 3. Cause of dengue fever and malaria(n=24)4Basic knowledge of dengue fever and malaria in school teachers in a rural area of Lao PDRmalaria. Lancet Infect Dis. 2(4), 209–218, 2002. 4) International Society for infectious Diseases,ProMED-mail 22 June 2008, Archive Number20080802.2367, 2008. 5) Phetsouvanh, R., Inthakone, S., Naphayving, P.,Hongvanthong, B., Phompida, S., Sidavong, B.,Vanisaveth, V., Sengsavath, V., Luangphengsouk, K.The current malaria situation in Lao PDR. MekongMalaria Forum 5, 14–22, 2000. 6) Kaneda, E. Result of Health examination in primaryschool at Lahanam zone in Lao P.D.R. Jpn J SchoolHealth (Japanese) 47, 322–323, 2005. 7) Vythilingam, I., Sidavong, B., Chan, S.T., Phonemixay,T., Vanisaveth, V., Sisoulad, P., Phetsouvanh, R.,Hakim, S.L., Phompida, S. Epidemiology of malariain Att apeu Province, Lao PDR in relation to entomo-logical parameters. Trans R Soc Trop Med Hyg99(11), 833–839, 2005. 8) Kobayashi, J., Somboon, P., Keomanila, H., In-thavongsa, S., Nambanya S. Inthakone S., Sato, Y.,Miyagi, I. Malaria prevalence and a brief entomolog-ical survey in a village surrounded by rice fi elds inKhammouan province, Lao PDR. Trop Med IntHealth 5(1), 17–21, 2000. 9) Anothay, O., Pongvongsa, T., Maharat, N.,Sirivichayakul, C., Chantavanich, P., Silachamroon, U., Looareesuwan, S. Clinical presentation of childhoodmalaria in Savannakhet province, Lao PDR. South-east Asian J Trop Med Public Health 31, Suppl 1, 85–90, 2000.10) Lindsay, S.W., Alonso, P.L., Armstrong Schellenberg,J.R., Hemingway, J., Adiamah, J.H., Shenton, F.C.,Jawara, M., Greenwood, B.M. A malaria control trialusing insecticide-treated bed nets and targetedchemoprophylaxis in a rural area of The Gambia,west Africa. 7. Impact of permethrin-impregnatedbed nets on malaria vectors. Trans R Soc Trop MedHyg., 87, suppl 2, 45–51, 1993.11) Killeen, G.F., Kihonda, J., Lyimo, E., Oketch, F.R.,Kotas, M.E., Mathenge, E., Schellenberg, J.A.,Lengeler, C., Smith, T.A., Drakeley, C.J. Quantifyingbehavioural interactions between humans andmosquitoes: evaluating the protective eﬃ  cacy of insecticidal nets against malaria transmission inrural Tanzania. BMC Infect Dis. 10(6), 161, 2006.12) Gu, W., Novak, R.J. Predicting the impact of insecti-cide-treated bed nets on malaria transmission: thedevil is in the detail. Malar J. 16(8), 256, 2009.13) Tsuyuoka, R., Wagatsuma, Y., Makunike, B. Theknowledge and practice on malaria among commu-nity members in Zimbabwe. Cent Afr J Med. 47(1),14–17, 2001.〈連絡先〉 著者名：金田英子住　所：東京都世田谷区深沢 7–1–1所　属：日本体育大学衛生学・公衆衛生学研究室E-mailアドレス：e-kaneda@nitt ai.ac.jpto the participant of the TOTs not have to consider the age and the teaching experience in these schools espe-cially. Since the number of teachers is limited in rural areas, classes are oft en interrupted for the TOTs, which interfere with the children’s education. There-fore, it is desirable that the teacher, who is not infl u-ence in the class, should att end the TOT and deliver the knowledge gained from training to the school children through appropriate educational programs.The use of mosquito net and destruction of the mosquito’s source were well-recognized prevention methods in this study. Many reports have shown these methods to be most eﬀ ective10–12).The belief that one can acquire infection from drink-ing water has also been seen in other countries13). Some teachers also believed that dengue fever oc-curred as a result of the bombs dropped during the Vietnam War because dengue fever fi rst appeared in this area aft er the Vietnam War.While it is important for children in rural areas to have access to education, the lack of a system of trans-fer of teachers in this country sometimes leads to the educational method gett ing into a rut. Improvement of teacher quality is an important step in avoiding this downfall.Acknowledgements: We gratefully acknowledge Professor Kazuhiko Moji (the Research Institute for Humanity and Nature, Kyoto, Japan) and Professor Boungnong Bupha (National Institute of Public Health, Lao PDR). We are also thankful to Dr. Panom Phongmany (Savannakhet Province, Ministry of Health, Lao PDR) and the teachers in Lahanam. This research was undertaken with joint fi nancial assistance from the Research Institute for Humanity and Nature, Kyoto, Japan (Professor Tomoya AKIMICHI), through the health development study of the Lao PDR project.5. References1) World Health Organization. Dengue and dengue hem-orrhagic fever, accessed March 04, 2006. (Available from: http://www.who.int/mediacentre/factsheets/fs117/en/)2) Winstanley, P., Ward, S., Snow, R., Breckenridge, A. Therapy of falciparum malaria in sub-saharan Africa: from molecule to policy. Clin Microbiol Rev. 17(3), 612–37, 2004.3) Wongsrichanalai, C., Pickard, A.L., Wernsdorfer, W.H., Meshnick, S.R. Epidemiology of drug-resistant 

Basic knowledge of dengue fever and malaria in school teachers in a rural area of Lao PDR

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