Dengue Survey Questionnaire

1. Can you identify the aedes mosquito?

Yes/No
2. Do you know where aedes mosquito come from ?
Yes/No
3. Do you know how is the aedes mosquito reproduction ?
Yes/No
4. Do you know what is the symptoms of dengue?
Yes / No
5.Do you know Dengue can cause serious/critical sick even killing a life ?
Yes/No
Tick a correct if you agree or disagree the statement below.
No
Statement
6
7
8
9

Agree

Disagree

To empty stagnant water from old tires, trash cans, and

flower pots helps to prevent reproduction of aedes
mosquito.
To wear long pants and long sleeves helps to prevent bite
from mosquito.
Use mosquito repellant sprays that contain DEET when
visiting places where dengue is endemic helps to protect
being bite from mosquito.
Avoiding standing water and staying indoors for two
hours after sunrise and before sunset will decrease the
persentage being bite from mosquito.

10. Have you experience dengue fever before ?

Yes/No
11. Is there any members of your family had experience dengue fever before ?
Yes/No If yes, how many members ? ___________
12. How long is the duration of your members or yourself take to recover from dengue
fever?
A. Less than a week
B. More than a week
C. No one of my members or myself experience dengue fever before
13. If there is a talk or workshop about prevention of dengue will you attend ?
Yes/No

14. If there is a Gotong-Royong event going to launch in your staying area will you
participate ?
Yes/No
15. Will you try to get more information about dengue fever just to protect and remind
your family & friends serious of dengue ?
Yes/No