AN ANALYSIS OF THE FACTORS CONTRIBUTING TO THE

INCIDENCE OF DENGUE FEVER, KNOWLEDGE AND

PREVENTION: INPUT TO REDUCTION OF CASES

A Thesis Presented to the Faculty of the Graduate School of

St. Bernadette of Lourdes College

Fairview, Quezon City

In Partial Fulfillment of the Requirements for the Degree

MASTER OF ARTS IN NURSING

By

VIRGINIA C. BACOLOD,RN

MAY 2017

0
 APPROVAL SHEET

AN ANALYSIS OF THE FACTORS CONTRIBUTING TO THE

INCIDENCE OF DENGUE FEVER, KNOWLEDGE AND

PREVENTION: INPUT TO REDUCTION OF CASES

By

VIRGINIA C. BACOLOD,RN, 2017

In partial fulfillment of the requirements for the degree of

Master of Arts in Nursing, this thesis has been reviewed and is
recommended for approval in oral examination.

JOCELYN L. OLAIVAR,RN,MAN,PhD
Adviser
APPROVED by the committee for Oral Examination with a
grade of PASSED.

MARILYN D. YAP,RN,MAN,PhDEd.,FPCHA
Chair

GERMELINA D. CONSUL,RN,MAN,PhD
Member

RAMONA F. CARAAN,RN,MAN,PhD
Member
CERTIFIED that the author passed the Comprehensive
Examination on March 2017 and this thesis is ACCEPTED in partial
fulfillment of the requirements for the degree of Master of Arts in
Nursing this April 2017.

MARILYN D. YAP,RN,MAN,PhDEd.,FPCHA
Chair, Graduate School

1
 ACKNOWLEDGEMENTS

First and foremost, the researcher would like to express an utmost

thanks to the Almighty Father for giving the researcher strength and

courage to pursue this study.

Ms. Jocelyn L. Olaivar, the research adviser for her patience,

guidance, encouragement and practical advice, throughout this

study.

Dr. Marilyn D. Yap, Dr. Germelina D. Consul and Dr. Ramona F.

Caraan, the panel of examiners for their guidance, comments and

suggestions for the improvement of the study.

I am indebted to Mr. Kenneth F. Ferol, Mr. Carmelito Mantong, Dr.

CharlsTrugillo, Ms. Fema D. Bayana and Ms. Rosana M. Enano

for their ideas and suggestions.

It is a pleasure to thank the Rural Health Units Staff of Claver,

Mainit, Placer, Taganaan, Socorro and Gigaquit and the

community who made this thesis possible for their supports and

cooperation during the conduct of the study.

2
To her family Mama Nena, Papa Virgil, Mama Hermie, Papa Ric,

Ivy, Bernard, Rick, Richer, Jodie, Erich, Carlfor their moral

support and encouragement.

Lastly, she offer her regards and blessings to her beloved husband

Boyen, daughter Rica Angelica and son Carl Angelou who

supported her in any respect during the completion of the project, for

their patience moral support and love.

VIRGINIA C. BACOLOD,RN

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 DEDICATION

To Ricardo,

My ever supportive and loving husband,

whose sacrificial care for me and our children

made it possible to me to complete this work,

and to our daughter Rica Angelica and son Carl Angelou

who are indeed a treasure from the Lord.

4
 ABSTRACT

This study aims to analyze the factors contributing to the incidence of

dengue fever, knowledge and prevention: input to reduction of cases.

Specifically, the study sought to answer the following questions. How

are the following factors contributing to the incidence of dengue in

terms of economic, social, environmental . What is the level of

knowledge and prevention of dengue? Is there a significant

relationship on factors contributing to the incidence of dengue and

level of knowledge and prevention of dengue? A qualitative design

was utilized there are selected municipalities were involved. The

data were analyzed using weighted mean, standard deviation and

Multiple Regression.

. Findings revealed that respondents economic factors

contributing to the incidence of dengue. That statement numbers 5

The patient submit himself for check up to the local health clinics

after 2 days of successive fever got the lowest mean of 1.87 with a

verbal interpretation of Disagree. On the other way around,

statement 2 The patient can buy mosquito net for sleeping to

prevent mosquito bite that can cause dengue fever got the highest

mean of 3.46 with a verbal interpretation of Agree. As to the social

5
factor contribute to the incidence of dengue. The highest mean of

3.57 was got by statement number 7 Residents have the access to

dengue awareness reading materials for dengue awareness

purpose with a verbal interpretation of Strongly Agree. In opposite

lowest mean of 2.01 was with statement 9 Local health office

conduct evaluation of dengue prevention program activities they

implemented in their locality. and has a verbal interpretation of

Disagree. With regards to the environmental factor contributing to

the incidence of Dengue in Surigaodel Norte. It was revealed that

statement number 5Resident cover water containers to prevent the

possible breeding ground of mosquito. got the highest mean of 3.53

with a verbal interpretation of Strongly Agree. On the other way

around the lowest mean of 1.48 and with a verbal interpretation of

Strongly Disagree was garnered by statement 6 Local health office

conducts weekly fogging the area which is rampant in dengue fever

cases. On the Factors contributing to the Incidence of Dengue and

Level of knowledge as Dependent Variableit was significantly

predicted the level of knowledge in dengue fever of the respondents.

The results of the regression indicated that one predictor explained

17.72% of the variance (R2 = 0.03, F(3,146) = 1.58, p<0.05). It was

found that economic factor significantly predicted the level of

knowledge ( = 0.148, p = 0.046). With regards to Factors

6
Contributing to the Incidence of Dengue and Level of Prevention as

Dependent Variable it was significantly predicted the level of

prevention in dengue fever of the respondents. The results of the

regression indicated that one predictor explained 13.95% of the

variance (R2 = 0.019, F(3,146) = 0.966 p<0.05). It was found that

environmental factor significantly predicted the level of knowledge (

= -0.129, p = 0.038). There is a significant relationship in terms of the

Analysis on Factors Contributing to the Incidence of Dengue and

Level of Knowledge as Dependent Variable. It was found that

economic factor significantly predicted the level of knowledge. There

is also significant relationship on the Analysis on Factors

Contributing to the Incidence of Dengue and Level of prevention as

Dependent Variable. It was resulted that environmental factor

significantly predicted the level of prevention.

Based on the above mentioned findings, the following

conclusions are drawn: Economic factor, respondent refuse their

selves to submit for check due to the financial consideration, with

regards to social factor evaluation of dengue program activities has

an important role in the enhance and upgrading for public benefit, on

the environmental factor the conduct of fogging in the area is the less

thing that notice by the participant conducted in the area. Participant

has a less knowledge that one of the symptoms of dengue fever is

7
severe eye pain, on the prevention they notice that organizing a

dengue brigade is not inviting to minimize dengue. There is a

significant relationship on the analysis on factors contributing to

Incidence of dengue as dependent variable both knowledge and

prevention. Dengue preventive measure that they implemented such

as dengue awareness information drive, organizing of dengue

brigade committee which spearhead socio-civic activities like fun run

and weekly cleaning especially in the dengue prone area.

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 LIST OF TABLES

Table 1 Economic Factors Contributing to the

Incidence of Dengue ----------------------------------60

Table 2 Social Factors contributing to the Incidence of Dengue-

---------------------------------- 61

Table 3 Environmental Factors Contributing to theIncidence of

Dengue --------------------------------- 63

Table 4 Level of Knowledge Contributing to the Incidence of

Dengue---------------------------------- 66

Table 5 Levels of Prevention Contributing to theIncidence of

Dengue--------------------------------- 68

Table 6 Regression Analysis on Factors Contributing

to the Incidence of Dengue and Level ofKnowledge as
Dependent Variable---------------- 70

Table 7 Regression Analysis on Factors Contributing

to the Incidence of Dengue and Level of Prevention as
Dependent Variable---------------- 71

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 TABLE OF CONTENTS

Acknowledgement ---------------------------------------- 2

Dedication ---------------------------------------- 4

Abstract --------------------------------------- 5

List of Table --------------------------------------- 9

CHAPTER I: THE PROBLEM:ITS BACKGROUND AND

RATIONALE

Introduction ------------------------------------------- 11

Research Impediments ---------------------------- 16

Statement of the Problem ------------------------ 17

Hypothesis ------------------------------------------ 18

Theoretical Framework ---------------------------- 18

Research Simulacrum------------------------------ 19

Significance of the Study-------------------------- 20

Definition of Terms --------------------------------- 22

CHAPTER II: REVIEW OF RELATED LITERATURE AND STUDIES

Conceptual Framework--------------------------- 23

Research Literature ------------------------------- 31

Synthesis ---------------------------------------- 49

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CHAPTER III: METHODOLOGY AND RESEARCH DESIGN

Research Method ------------------------------- 52

Sampling Procedure------------------------------- 52

Setting of the Study ------------------------------- 53

Ethical Consideration----------------------------- 54

Research Instruments---------------------------- 55

Data Collection Procedure --------------------- 56

Statistical Treatment of Data ----------------- 57

CHAPTER IV: PRESENTATION, ANALYSIS AND

INTERPRETATION OF DATA---------------- 59

CHAPTER V: SUMMARY OF FINDINGS, CONCLUSION AND

RECOMMENDATION

Summary of Findings------------------------------- 73

Conclusion ----------------------------------------- 77

Recommendations -------------------------------- 77

Bibliography ---------------------------------------- 79

Appendix A (Letter) ------------------------------- 82

Appendix B (Questionnaire) -------------------- 83

Curriculum Vitae ------------------------------ 87

11
 CHAPTER 1

THE PROBLEM: ITS BACKGROUND AND RATIONALE

Introduction

World Health Organization declares the outbreaks of dengue

fever in many countries in Asia that causes serious public health

concern. The dengue viruses are members of the genus Flavivirus

and family Flaviviridae which have been associated with epidemics

of dengue fever with varying degree of severity. The incidence of

dengue fever is known as the fastest growing viral infection spread

by Aedesaegypti mosquito which half a million people suffer that

requires hospitalization each year (Dengue Bulletin, 2012).

Dengue is a viral infection caused by four types of viruses

such as (DENV-1, DENV-2, DENV-3, DENV-4) belonging to

the Flavivirdae family. The viruses are transmitted through the bite of

infected Aedesaegypti and Aedes albopictus female mosquitoes that

feed both indoors and outdoors during the daytime (from dawn to

dusk). These mosquitoes thrive in areas with standing water,

including puddles, water tanks, containers and old tires. Lack of

reliable sanitation and regular garbage collection also contribute to

the spread of the mosquitoes. Risk of dengue exists in tropical and

subtropical areas of Central America, South America, Africa, Asia,

12
and Oceania. All travelers are at risk during outbreaks. Long-term

travelers and humanitarian workers going to areas where Dengue is

endemic are at higher risk. Dengue occurs in urban and suburban

settings with higher transmission rates happening during the rainy

season.

In some cases, dengue infection is asymptomatic persons

do not exhibit symptoms. Those with symptoms get ill between 4 to 7

days after the bite. The infection is characterized by flu-like

symptoms which include a sudden high fever coming in separate

waves, pain behind the eyes, muscle, joint, and bone pain, severe

headache, and a skin rash with red spots. Treatment includes

supportive care of symptoms. Many dengue patients develop

fever after infection. According to WHO, in infants and youths, they

often have undifferentiated febrile disease accompanied by rash that

can be depend on severity of cases and day of post-infection as

shown in figure 4, while older children and adults may have a mild

febrile condition but other normally have high fever, throbbing

headache, pain behind the eye, myalgia and arthralgia as well as

rash. Mild bleeding such as nose or gum bleed and easy bruising

also may occur during DF (CDC, 2011).

Some patients may report itching and abnormalities in the

sense of taste, normally metallic taste. Moreover, in certain cases,

13
encephalitic and encephalopathic manifestation also may occur,

including lethargy, confusion, seizure, nuchal rigidity and paresis.

The illness may progress to Dengue Hemorrhagic Fever

(DHF). Symptoms include severe abdominal pain, vomiting, diarrhea,

convulsions, bruising, and uncontrolled bleeding. High fever can last

from 2 to 7 days. Complications can lead to circulatory system failure

and shock, and can be fatal (also known as Dengue Shock

Syndrome).If patient is infected with the same Dengue virus serotype

then it will become immune to future infections. However, if infected

subsequently with a different serotype, immunity wanes over time

which increases the risk of developing Dengue Hemorrhagic Fever.

Dengue fever can vary from mild to severe. The more severe

forms include dengue shock syndrome and dengue hemorrhagic

fever (DHF). Patients who develop the more serious forms of dengue

fever usually need to be hospitalized. The best way to prevent the

disease is to avoid being bitten by mosquito. Although there is no

certain treatment for dengue, it can be treated as long as it is caught

before developing into dengue shock syndrome or dengue

hemorrhagic fever.

According to Harley (2014) the process begins with the

transmission of virus from an infected mosquito to human. One type

of dengue virus can infect only once. The high risk areas for catching

14
dengue fever are urban areas where the population density is high

and sanitation is poor and in rural areas. Dengue fever can occur if

the environment is friendly for mosquito breeding which means

stagnant water which is their breeding ground.

Knowledge of the geographical distribution and burden of

dengue is essential for understanding its contribution to global

morbidity and mortality burdens, in determining how to allocate

optimally the limited resources available for dengue control, and in

evaluating the impact of such activities internationally. Additionally,

estimates of both apparent and inapparent infection distributions

form a key requirement for assessing clinical surveillance and for

scoping reliably future vaccine demand and delivery strategies.

Furthermore, no studies have used a continuous global risk map as

the foundation for dengue burden estimation.

Climate and population spread were important factors for

predicting the current risk of dengue around the world. With

globalization and the constant march of urbanization, it can be

anticipate that there could be dramatic shifts in the distribution of the

disease in the future. The virus may be introduced to areas that

previously were not at risk, and those that are currently affected may

experience increases in the number of infections. For instance,

15
dengue fever strikes Surigaodel Norte a number of months ago with

a massive impact on their health situation.

Taking into account the above realities the research is opted

to conduct the study on factors contributing to the incidence of

dengue fever in Surigaodel Norte. This could be of great help in

sustaining efforts of preventing dengue fever and other forms of

diseases.

Research Impediments

The researcher during the conduct of the study experiences

quite a lot of difficulties. The following are as follows;

Financial since the study needs appropriate budgetary

requirements use for paper and printing of hardcopy. Transportation

budget since the researcher needs to ride a vehicle or any private

transport. The researcher allocates an amount of money to

reproduce an reprint, and also for transportation matters from its

personal savings.

Time Availability since the researcher is working in a

government sector, there is a need for her to sacrifice several days,

in order to personally send letter of communication to the selected

Municipal Health Offices to ask permission in conducting the study.

Since the researcher believes the necessity of investing more focus

and sincerity to the continuous professional growth of individuals.

16
 Distance as to how far the location from each municipality,

since Surigaodel Norte is subdivided into two Congressional

Districts. District 1 composes the 9 Island Municipality where the

famous Siargao Island is located. District 2 compose 11 mainland

municipality and 1 Component City. It made the researcher more

challenging to pursue the studies regardless of the distance since it

develop more her role as a government employee in the health

sector.

Statement of the Problem

The study aims to determine an analysis of factors

contributing to the incidence of dengue fever, knowledge and

prevention: input to reduction of cases. Specifically, the study sought

to answer the following questions.

1. How are the following factors contributing to the incidence of

dengue in terms of:

1.1. economic,

1.2. social

1.3 environmental

2. What is the level of knowledge and prevention of dengue?

3. Is there a significant relationship on factors contributing to the

incidence of dengue and level of knowledge and prevention of

dengue?

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4. What Intervention Program may be proposed to reduced dengue?

Hypothesis

At0.05 level of significance it is hypothesized that there is no

significant relationship on the contributing factors when they are

grouped according to their profile.

Theoretical Framework

This study is anchored in Morels theory stating that the need

for a thorough understanding of behaviors related to management of

the larval habitats of the main dengue vector, knowledge, prevention

as well as treatment-seeking behavior which are very crucial.

Dengue is a disease caused by a virus. It can be acquired if an

infected mosquito bites a person. It is common in warm, wet areas in

the world. Outbreaks occur in the rainy season. Dengue is very

common in warm areas. Symptoms include high fever, headaches,

joint and muscle pain, vomiting, and a rash. Most people with

dengue recover within two weeks. Until then, drinking lots of fluids,

resting, and taking non-aspirin fever reducing medicines might help.

Sometimes dengue turns into dengue hemorrhagic fever, which

causes bleeding from your nose, gums or under your skin. It can also

become dengue shock syndrome, which causes massive bleeding

and shock. These forms of dengue are life-threatening (National

18
Institute of Allergy and Infectious Diseases, 2012). WHO stated that

the burden of dengue has grown dramatically in recent decades, and

it is currently classified as an emerging or re-emerging infectious

disease. Dengue fever and dengue hemorrhagic fever or dengue

shock syndrome occur in over 100 countries, with more than 2.5

billion people at risk and an estimated 50 million infections per year

(World Health Organization, 2015).

RESEARCH SIMULACRUM

INPUT PROCESS OUTPUT

How are the

following factors
contributing to the
incidence of Level of
dengue in terms knowledge and
Proposed
of: prevention
Intervention
1. economic Program

2. social

3. environmental

Figure1. An Analysis of the Factors Contributing to the Incidence of

Dengue Fever, Knowledge and Prevention: Input to Reduction of
cases

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The first box comprises the first variables of which are the factors

contributing to the incidence of dengue in terms of economic, social

and environmental

The second box delves on the level of knowledge and

prevention on dengue cases. This factors serves as an important

determinants as to the prevailing problems exist as to the incidence

of dengue fever.

Third box shows the proposed intervention program to reduce

dengue cases.

SIGNIFICANCE OF THE STUDY

Future Researchers. This study enables the researchers to

apply the theories learned in nursing research thus helping them to

hone their skills. In relation to their quest for continuous studies in

relation to health and safety

Nursing Students. They will be given more knowledge on the

proper stress coping mechanisms. They will be able to learn some

alternative techniques or actions on how to at least alleviate the

stress they are facing in their everyday lives. Nursing students will

somehow be ready in handling everyday stressors that might come.

They will be competent and be effective nurses someday.

To the Clinical Instructors. This study will give them

knowledge on the levels of stress felt by their students. The clinical

20
instructors then will be able to plan and balance the different

academic and clinical requirements to be done by the students by

mentoring their students into practical situations that leads to the

development of practical skills.

Rural Health Unit. This study will serve as their bases in

conducting activities and programs that help local people to be

aware about dengue transfusion and prevention. This will help them

to the to identify potential areas in their locality that is prone to

dengue cases.

Provincial Health Office. This study will be useful to further

improve current programs and advocacy with regards to dengue

disease in the whole province. It also gives more awareness to

personnel of provincial health office about the current status of

dengue cases in the province basis for budgeting and legislation.

Nurses.This study will help nurses to do perform their care

and service especially to the dengue patients, since they know the

physical and health risk of an individual as to their recovery and

medication.

Patients.This study will inform patients to act necessarily in

time of dengue fever, to submit themselves for check up and

confinement if recommended by the physician. This study also gives

them more knowledge how risky and danger fever brought about by

21
various mosquito which is commonly located in their respective

household.

DEFINITION OF TERMS

Economic relating or affecting material goods and financial

resources. Capacity of an individual to purchase something in

relation to his/her need.

Social allowing people to meet and interact with others for the

purpose of deliberating or having a conversation of a certain issue

that can affect their day to day life

Environmental relating to, or caused by, a persons or animals

surroundings. The activities we perform in order our environment to

be clean and safe for our living.

Knowledge showing great knowledge or awareness with regards

to a certain situation. Knowing of something or someone

Prevention actions that make it very difficult for something to

happen. To do activities and actions which lead to you not to be safe

and secure.

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 CHAPTER II

REVIEW OF RELATED LITERATURE AND STUDIES

Conceptual literature

Dengue viruses are transmitted by Aedes mosquitoes, which

are highly sensitive to environmental conditions. This disease used

to be called break bone fever because it sometimes causes severe

joint and muscle pain. Dengue fever is quite dangerous febrile

(Feverish) disease can be found in the tropics Asia and Africa.

Dengue fever is transmitted by AedesAegypti mosquito, which

transmits diseases as yellow fever. Health experts have known about

dengue fever from more than 200 years (Gomez, 2010).

Dengue virus infection is an escalating health problem

throughout the world. It is one of the fastest re-emerging arboviral

disease in the world, imposes a heavy economic and health burden

on countries, families and individual patients. In the absence of an

effective drug or vaccine, the only strategic options presently

available are case management to prevent death and vector control

to reduce viral transmission (Horstick,Heiman,Welthiem,

2010).However, large dengue outbreaks continue to occur every

year and the disease is extending to new geographical areas.

Integrated vector management can reduce vector densities

considerably, but the results of vector control programmes are often

23
far from ideal. Routine interventions against the immature stages of

the vector have proved ineffective for a long time, while the results of

vertical interventions are often transient. Several user-friendly

dengue vector control tools and approaches have become available

but questions remain as to their effectiveness, alone or in

combination, and their cost-effective delivery by public health

services and the private health sector (Welthiem, 2010).

Furthermore, dengue which uses arthropods and other

mosquitoes as vectors is common in tropical and sub-tropical

climates, and is often associated with other diseases such as

malaria, chikungunya, yellow fever, St. Louis encephalitis, West Nile

virus, Japanese encephalitis, and Tick-borne encephalitis.

Commonly transmitted by the mosquitoes Aedesaegypti and

Aedesalbopictus which is considered one of the fastest growing

hemorrhagic viruses worldwide. It is less well-known due to the

localization of the disease, which is uncommon outside of tropical

and sub-tropical regions. Recently, increased travelling to and from

endemic countries has resulted in the spread of dengue in new

regions. From 2010 up to present, dengue outbreaks have been

reported and believed to be imported via travelers that visited

endemic regions such as the Caribbean, Asia, and Latin America.

(No author and Year)

24
 Factors such as rapid population growth and the ease of

migration also compound the problems of endemic nations. Close

contact between human and vectors coupled with an increased size

of the host population often increases the chances of contracting

dengue. The widespread occurrences of such population networks

plays significant roles in distributing the disease, and pathologically,

this condition often provide excellent room for disease to continue

developing and growing. Additionally, global economic trade from

endemic countries such as the shipment of used tires and changing

weather patterns also contributes to the expansion of dengue

infections beyond the vectors niche as emphasized by Bhatt (2013).

According to May 2015 update, the World Health Organization

(WHO) estimated that over 3.9 billion people worldwide are at risk of

contracting dengue and there are roughly 284 - 528 million infections

every year. 500,000 people are hospitalized with severe dengue

annually and 2.5% of them succumb to the infection. Of all reported

cases, most of the patients with severe infection of dengue are

children. With high numbers of infections and mortality rates, the

dengue endemic can no longer be ignored.

Several combative measures across all endemic countries

have been applied and tested to suppress the prevalence of dengue

25
over the years and most common one is the heavy use of

Aedeslarvicide. Others include education on dengue pathogenesis

and pathology for public and active extermination of mosquito

breeding sites, which include all bodies of stagnant water. Current

research on the use of vaccines are discussed and evaluated in

terms of their functionality, confidence, and application in endemic

areas. In addition, problems that may arise upon the application of

both measures once they are introduced indefinitely will be

evaluated. The pathogenesis and pathology of dengue provides

strong arguments to support the use of vaccines and biological

control in preventing dengue infection as pointed out by Plennevaux

(2016) .

Beatty (2011) made mentioned about current trends in

dengue vaccines and drugs to maximize potential cure if not

prevention. Dengue vaccine introduction should be a part of a

comprehensive dengue control strategy, including well executed and

sustained vector control, evidence-based best practices for clinical

care for all patients with dengue illness, and strong dengue

surveillance. Vaccine introduction must be accompanied by a

targeted communication strategy. Decisions about introduction

require careful assessment at the country level, including

consideration of local priorities, national and sub-national dengue

26
epidemiology, predicted impact and cost-effectiveness with country-

specific inputs, affordability and budget impact. At the time of

introduction, countries are encouraged to have a functional

pharmacovigilance system with at least minimal capacity to monitor

and manage adverse events following immunization. Countries

considering vaccination should also have a dengue surveillance

system able to detect and report hospitalized and severe dengue

cases consistently over time.

However, dengue vaccines which are currently in

development and policymakers need appropriate economic studies

to determine their potential financial and public health impact.

Although dengue is an important vector-borne disease, the economic

literature is relatively sparse and results have often been conflicting

because of use of inconsistent assumptions. Health economic

research specific to dengue is urgently needed to ensure informed

decision making on the various options for controlling and preventing

this disease. Other aspects Due to the partial efficacy of the vaccine

against dengue of any severity, careful communication is needed to

inform vaccinees that they may still be at risk of dengue and of the

importance of receiving all three doses and of adhering to other

disease preventive measures. Hence, assessment of vaccine

effectiveness, and the durability of that effectiveness, is a priority.

27
Current data suggest substantially lower benefit of vaccination in

seronegative individuals 9-45 years of age (Villar, 2015).

In the Philippines there are many cases of dengue fever

arising because of environmental changes that may be caused by

human activities and geographical conditions. It is considered as one

of the tropical country and so disease can spread throughout the

country. Temperature, precipitation, and humidity are critical to

mosquito survival, reproduction, and development and can influence

mosquito presence and abundance. Additionally, higher

temperatures reduce the time required for the virus to replicate and

disseminate in the mosquito. This process, referred to as the

"extrinsic incubation period", must occur before the virus can reach

the mosquitoes salivary glands and be transmitted to humans

(Tjaden, 2013). If the mosquito becomes infectious faster because

temperatures are warmer, it has a greater chance of infecting a

human before it dies.

According to WHO (2015), although environmental factors are

important they are not the only factors critical to dengue

transmission. Virus must be present, there must be sufficient

numbers of humans still susceptible, or non-immune, to the virus,

and there must be contact between those susceptible humans and

the mosquito vectors. In countries where transmission does routinely

28
occur, short-term changes in weather, particularly temperature,

precipitation, and humidity, are often correlated with dengue

incidence. These associations, however, do not describe the

occurrence every few years of major epidemics in these areas,

suggesting that long-term climate variability does not regulate long-

term patterns in transmission. A more important regulator of

epidemics might be the interplay of the four different dengue

serotypes. The level of prior exposure of a human population to each

of the dengue serotypes may be a more critical determinant of

whether a large epidemic occurs than climatic cycles.

Globally, the reported incidence of dengue has been

increasing. Although climate may play a role in changing dengue

incidence and distribution, it is one of many factors; given its poor

correlation with historical changes in incidence, its role may be

minor. Other important factors potentially contributing to global

changes in dengue incidence and distribution include population

growth, urbanization, lack of sanitation, increased long-distance

Ushiroda, (2015) travel, ineffective mosquito control, and increased

reporting capacity as stated by Johnston (2015).

As emphasize by symptoms of dengue fever are severe

headache, pain in the muscles and joints, and rash that can be

described as small red spots. Some patients experience gastritis,

29
diarrhea, vomiting and abdominal pain. Dengue fever usually starts

suddenly with a high fever, headache, pain behind eyes and pain in

the muscles and joint. A rash usually appears 3 to 4 days after the

start of the fever.As stated byReiter (2010), symptoms like nausea,

vomiting and loss of appetite are common. Each type of the dengue

virus is re-emerging worldwide. Researchers have shown that

several factors are contributing to the resurgence dengue fever such

as controlled urbanization, increased international travel,

substandard socio-economic condition and finally global warming.

The Department of Health (DOH) (No Date) launches its,

Barangay Dengue Nationwide Campaign-Puksain Enemy Numebr

One Dengue which demonstrates the governments determination to

combat this disease and protect the health and well-being of the

people. In the statement that was given by Health Secretary Paulyn

Jean B. Rosell-Ubial, said that that DOH is closely coordinating with

local government officials to help stop the spread of dengue

diseases.

Fortunately, the local government of Surigaodel Norte

positively responding on the threat that the dengue has bought over

the years. They have implemented different programs actively

preventing and controlling the spread of the disease. The local

officials are undertaking necessary measures such as implementing

30
information campaign like radio programs, press release and

Bandello. Moreover, surveillance activity which includes larvae

collection, container identification and hospital monitoring were

closely inspected. Environmental campaigns are actively executed

such as fogging operation and massive clean-up drive. They have

also future plans on school-based approach by a school sanitation

campaign. With these, preventive measures that are being

implemented, the people are expected to render an effective

response to help prevent the spread of the disease.

Research literature

In one of the paper titled Dengue and Dengue Hemorrhagic

Fever: It's History and Resurgence As a Global Public Health

Problem by Gubler (2011), both DENV and its primary vector, the

Aedesaegypti originated in either Africa or Asia continent. During the

17th, 18th and 19th centuries, Aedesaegypti migrate from Africa in

water container on slave ships during African slave trade (Lee,

2014). However, due to long journey time, epidemics of disease

were less reported. Numbers of tropical countries with active

shipping ports experienced outbreak of dengue by 1800.

Dengue is a serious public-health concern in the Philippines. It

can affect anyone, no matter what the age or social status. It is an

illness caused by a mosquito bite. Dengue is normally not fatal, but it

31
could be. In the last five decades, dengue has spread from a handful

of countries to over 128. The incidence has increased thirtyfold in

this period. This has been blamed on factors such as unprecedented

urbanization and globalization, which has resulted in large mosquito

populations living in places with big human populations. This has led

to an increased transmission and geographic spread of the virus.

Other factors, such as inadequate housing, water, sewage and

waste-management systems, have contributed to an increase in the

populations of the Aedesaegypti mosquito, which is responsible for

dengue.(No date and Year)

According to the World Health Organization (WHO), over 3.2

million cases were reported in 2015 across the Americas, Southeast

Asia and Western Pacific. In 2015 the Philippines reported over

169,000. This represented a 59.5-percent increase from the previous

year. The Philippines was seventh in the world and fourth overall in

Asia Pacific for incidence of dengue from 2004 to 2010.

Moreover, dengue is a mosquito-borne flavivirus found in

tropical and sub-tropical regions of the world, mostly in urban and

semi-urban settings. Day-biting Aedes mosquitos spread

disease. It is the fastest spreading vector-borne viral disease and

is now endemic in over 100 countries, resulting in 40% of the

32
worlds population living in an area at risk for dengue. Indeed, it is

a public health problem in the tropical and sub-tropical world.

Dengue cases have grown dramatically in recent years as well as

dengue mortality. It is named as complex disease and its

transmission depends on multiple factors involved at different

levels. Global population growth and unplanned urbanization

result in substandard housing and inadequate water supply and

waste management services, which promote dengue

transmission.

Understanding the social determinants of dengue mortality

is a necessary step in order to define interventions before taking

actions to prevent the related avoidable deaths. Developing a tool

that is able to identify the social determinants of dengue mortality

could be a useful method, asked and needed by fieldworkers, to

provide information that wouldnt be able to find

elsewhere.Dengue is an emerging disease, and the distribution of

the mosquito vector is partially mediated by environmental

conditions.

Today, the World Health Organization (WHO) published in

the Weekly Epidemiological Record its first Position Paper on a

dengue vaccine, based on the available evidence of CYD-TDV or

Dengvaxia, the only dengue vaccine to have received

33
regulatory approval. A dengue vaccine was recommend by the

WHO as introduction as part of a comprehensive dengue control

strategy, including well-executed and sustained vector control,

evidence-based best practices for clinical care for all patients with

dengue illness and strong dengue surveillance.

Dengue vaccines have been under development since the

1940s, but due to the limited appreciation of the global burden of

dengue, interest languished for much of the 20th century.

However, recent years have seen a dramatic increase in dengue

vaccine progress. Today several vaccine candidates are

undergoing clinical development, some of which are in advanced

stages. The dengue vaccine CYD-TDV was first registered in

December 2015 and since then, it has been licensed in several

countries. The development of a safe and effective dengue

vaccine has been a high priority and WHO supports this effort

through technical guidance and advice. The registration of the

vaccine represents a landmark event in tackling dengue.

According to a study by the University of the Philippines

National Institute of Health, the vaccine is expected to reduce

dengue cases in the country by over 24 percent in a span of five

years. The dengue vaccination needs to be taken in three doses at

zero-six-12 months interval, can protect the individual from all four

34
strains of the dengue virus. This can be administered to people age

9 to 45. Dengvaxia was created by Sanofi Pasteur, a leading

multinational pharmaceutical company and an expert in the

development of vaccinations. It took more than 20 years to develop

and has been thoroughly tested based on WHO guidelines. Studies

of the vaccine included more than 41,000 people and were carried

out in 15 countries, including the Philippines. The results were fully

reviewed by a committee of independent experts, and the vaccine

has also been recommended by the WHO. In the Philippines the

DOH, together with the DepEd, launched the much-awaited

administration of the dengue vaccine via a school-based

immunization approach.

For a dengue vaccine to be effective, it must give protection

against all homotypic and heterotypic infecting serotypes.

Development of safe and cost-effective tetravalent dengue vaccine

has been on the top agenda of the public health stakeholders since

the last decade.

Dengue prevention and control will depend upon effective, long-term

management of the Aedes vector. To be cost-effective and

sustainable, dengue control needs to be achieved through integrated

community-based action. As the Aedes vector dwells in domestic

and peri-domestic settings and lays eggs in artificial water containers

35
that have been created because of daily living activities undertaken

by the communities themselves, the communities need to be

educated about this specific behavior of the vector and the corrective

environmental modification (permanent and long-lasting) and

environmental manipulation (temporary and short lived) measures

that they need to take to reverse Aedes breeding. School-based

dengue control programmes are also needed to educate generations

for the future and bring about a sense of social responsibility. The

role of information, education and communication material in dengue

control cannot be over-emphasized. As India has a diverse culture,

the attitude and practices of all the major ethnic, social, linguistic and

cultural groups should be studied and analyzed, and health

education material should be developed targeting all such groups.

Moreover, dengue viruses are members of the Flaviviridae,

transmitted principally in a cycle involving humans and mosquito

vectors. In the last 20 years the incidence of dengue fever epidemics

has increased and hyper-endemic transmission has been

established over a geographically expanding area. A severe form,

dengue hemorrhagic fever (DHF), is an immune pathologic disease

occurring in persons who experience sequential dengue infections.

The risk of sequential infections, and consequently the incidence of

DHF, has risen dramatically, first in Asia and now in the Americas. At

36
the root of the emergence of dengue as a major health problem are

changes in human demography and behavior, leading to unchecked

populations of and increased exposure to the principal domestic

mosquito vector, Aedesaegypti. Virus-specified factors also influence

the epidemiology of dengue. Speculations on future events in the

epidemiology, evolution, and biological expression of dengue are

presented.

Environmental management is generally considered to be an

essential component of dengue prevention and control, particularly

when targeting the most productive container habitats of the vector.

Source reduction, 'clean-up' campaigns, regular container emptying

and cleaning (targeting not only households but also public spaces

such as cemeteries, green areas and schools), installation of water

supply systems, solid waste management and urban planning all fall

under the rubric of environmental management. However, huge

investments in infrastructure are needed to increase access to safe

and reliable water supplies and solid waste disposal systems. In

addition to overall health gains, such provision would clearly have a

major impact on vector ecology, although the relationship is complex.

For instance, cost recovery mechanisms, such as the introduction of

metered water, might actually encourage the household collection

and storage of roof catchment rainwater, which can be harvested at

37
no cost. Although not studied carefully, the construction of

community water distribution services to rural townships and villages

might be contributing to the rural spread of dengue in Southeast Asia

and elsewhere by facilitating domestic water storage. When

decisions on such infrastructure development are being made, the

views of Ministers of Public Health and municipal health departments

are seldom voiced loudly, even when the economic and public health

burden of diseases linked to water and sanitation are recognized,

including those associated with dengue.

The epidemiologic picture of dengue has been worsening, with

rebound of its principal mosquito vector, Aedesaegypti, in many

areas and the rapid global expansion of a secondary

vector, Aedesalbopictus. Dengue prevention by vector control has

proven difficult, and there is as yet no vaccine or specific therapy.

The pathogenesis of DHF/DSS is unknown; however, 6 decades of

increasing cocirculation of multiple dengue virus (DENV) serotypes

(DENV-1, -2, -3, and -4) has been associated with progressive global

expansion of DHF/DSS. Impending shock can be prevented with

fluid and electrolyte therapy; however, early identification of severe

cases is difficult. Preventable deaths continue to occur, particularly in

areas with few trained healthcare workers. Thus, dengue remains an

38
important potentially fatal epidemic disease that challenges public

health, clinical, and research systems at many levels.

Dengue fever, dengue haemorrhagic fever and dengue shock

syndrome (DF/DHF/DSS) are a group of tropical disease states that

cause significant humanitarian and economic hardship.

DF/DHF/DSS are caused by the dengue virus, which belongs to the

flavivirus genus of the family Flaviviridae. The flavivirus genus

includes approximately 70 viruses of which there are 3 antigenic

complexes; the Japanese encephalitis virus, tick-borne encephalitis,

and the dengue virus complexes. There are four distinct serotypes of

dengue virus (i.e., dengue virus serotypes 14) which all cause

clinical disease. It is estimated that more than 2.5 billion people are

at risk of infection and more than 100 countries have endemic

dengue virus transmission. While exact numbers of dengue virus

cases are not available, for the period 20002004, the annual

average was 925,896 cases, which was almost double when

compared to the 479,848 cases that were reported for the period

19901999. About 250,000 to 500,000 cases of DHF are reported

annually although the true incidence is not really known. In dengue

endemic regions which include countries in Asia and the Americas,

the burden of dengue is approximately 1,300 disability-adjusted life

years (DALYs) per million population, which is similar to the disease

39
burden of other childhood and tropical diseases, including

tuberculosis, in these regions (Stuart D. Blacksell,2012).

Laboratory tests are essential to provide an accurate

diagnosis of acute dengue virus infection at patient presentation to a

clinical setting so that appropriate treatment and patient

management may be administered. In many dengue endemic

settings, laboratory diagnostic resources are limited and simple rapid

diagnostic tests (RDTs) provide opportunities for point-of-care

diagnosis. The characteristics of the ideal diagnostic test are said to

be defined by the ASSURED criteria: (1) Affordable by those at risk

of infection; (2) Sensitive (few false-negatives); (3) Specific (few

false-positives); (4) User-friendly (simple to perform and requiring

minimal training); (5) Rapid (to enable treatment at first visit) and

Robust (does not require refrigerated storage); (6) Equipment-free;

(7) Delivered to those who need it. (R. W. Peeling ,2010).

Transmission of dengue viruses (DENV), the leading cause of

arboviral disease worldwide, is known to vary through time and

space, likely owing to a combination of factors related to the human

host, virus, mosquito vector, and environment. An improved

understanding of variation in transmission patterns is fundamental to

conducting surveillance and implementing disease prevention

strategies. The study reveaedl the remarkably focal nature of DENV

40
transmission within a hyperendemic rural area of Thailand. These

data suggest that active school-based dengue case detection

prompting local spraying could contain recent virus introductions and

reduce the longitudinal risk of virus spread within rural areas. The

results should prompt future cluster studies to explore how host

immune and behavioral aspects may impact DENV transmission and

prevention strategies. Cluster methodology could serve as a useful

research tool for investigation of other temporally and spatially

clustered infectious diseases (Mammen P MammenJr. ,2011).

Many observations suggest that immune responses to dengue

are determinants of disease severity. Epidemiological studies have

shown that most DHF/DSS cases occur either during second dengue

infections with different dengue serotypes, or in infants born with

maternal anti-dengue immunoglobulin G that has declined to

subneutralizing levels. There are 2 main theories to explain the

mechanism of dengue immunopathogenesis. The first is that

antibodies raised against the primary infection do not neutralize the

virus causing the second heterologous infection, but instead promote

viral replication by antibody-dependent enhancement (ADE). In ADE,

nonneutralizing antibody complexed to virus increases viral uptake

by Fc receptorbearing cells. ADE has been recapitulated for

dengue both in tissue culture and in mouse and monkey models .

41
Another theory of dengue immunopathogenesis proposes that

memory T cells reactivated by second heterologous infections

express altered cytokine levels contributing to plasma leakage and

increased disease severity. This theory is consistent with clinical

studies and animal research, although it does not easily explain

DHF/DSS in infants. Both phenomena, as well as other factors

including virus virulence, and genetic/nutritional host factors, may

play a role to differing degrees in the development of severe dengue.

DENV-specific antiviral antibody responses are directed mainly

against E, and NS. Nonneutralizing antibodies raised against are

highly cross-reactive against all DENV serotypes, and potently

promote ADE in tissue culture. The antibodies are increased in

symptomatic secondary dengue infections and constitute a large

fraction of the total antibody repertoire in DHF. Normally,

noninfectious immature virus particles can become highly infectious

in the presence ofantibodies , consistent with the possibility that

during secondary infection preexisting, cross-reacting antibodies that

bind both virions and immature virus particles might increase disease

severity by increasing the viral load. The therapeutic option of

monoclonal antibodies might logically be discarded due to fear of

eliciting ADE. However, mutations in antibody regions totally

eliminate ADE in mice, indicating that it may be possible to design

42
safe and effective treatment with neutralizing monoclonal antibodies.

Mutations in antibody regions eliminate ADE in mice, indicating that

single specificities or cocktails of neutralizing monoclonal

antibodies might be therapeutically useful. A better understanding of

the immune pathogenic mechanisms underlying dengue is crucial for

developing safe vaccines and therapeutics that will not potentiate

severe disease following natural infection. (Catherine A.

Laughlin,2012).

There are many promising areas for future research and approaches

that seem to offer the greatest promise of return on investment.

Interdisciplinary studies of the interface between DENV and its

human and mosquito hosts are urgently needed, as this research

information is essential to the design and development of safe and

effective vaccines and treatments. It is also important both for the

development and evaluation of accurate diagnostic assays for both

individual patient care and epidemiologic endeavors to control vector

populations and disease outbreaks. (NO Author and Date)

The importance of integration of clinical with basic research,

enhanced collaborations across seemingly unrelated disciplines, and

the inclusion of studies involving genomics and bioinformatic tools is

an important area of emphasis. Building on the several ongoing

global collections of viruses, viral sequences, and clinical specimens

43
(www.viprbrc.org, accessed 15 June 2012), efforts should be

strengthened to correlate viral genome sequences with geographic

sources, host antibody status, disease severity, and host genetic

elements that influence replication and pathogenesis. International

collaborations on the identification and preparation of field sites for

studies of new diagnostics, vaccines, and therapeutics are also

needed. Similarly, cross-disciplinary collaborations for the study of

vector control measures, both behavioral and chemical, may be as

essential to disease control as the development of vaccines and

drugs. Thus, the ultimate control of dengue will require collaborative

research programs undertaken by investigators representing many

disciplines and an integrated multidisciplinary and multinational

research program.(Zaitseva,2010).

Dengue is an increasingly incident disease across many parts

of the world. In response, an evidence-based handbook to translate

research into policy and practice was developed. A handbook that

facilitates contingency planning as well as the development and use

of early warning and response systems for dengue fever epidemics,

by identifying decision-making processes that contribute to the

success or failure of dengue surveillance, as well as triggers that

initiate effective responses to incipient outbreaks. An evidence-

based handbook was generated to facilitate deployment of dengue

44
surveillance and response systems for timely and effective

management of outbreaks, and to identify the factors required for

success. Evidence was evaluated using literature reviews,

policymaker and stakeholder interviews, assessment of dengue

contingency planning and outbreak management in ten endemic

countries, and a statistical analysis to identify outbreak early warning

signs in five countries. Best practices for managing dengue

outbreaks included timely and context-specific dengue contingency

plans that distinguished between routine practices and outbreak

interventions, surveillance systems, outbreak definitions, alert

algorithms, and managerial, clinical and vector control capacity. A

computer-assisted early warning system was developed to enable

each locality to develop its own context-specific scheme. Today,

most countries do not have comprehensive, detailed contingency

plans for dengue outbreaks, responding simply by intensifying vector

control, with minimal focus on integrated management of clinical

care, epidemiological, laboratory and vector surveillance, and risk

communication(Han, 2015).

In addition, successful outbreak detection (the term outbreak

is used here synonymously with epidemic) and response is reliant

on a representative and timely surveillance system reflecting the

transmission of disease; that is, an effective alert mechanism linking

45
surveillance data to the best possible evidence-based and cost-

effective response strategies. The main purposes of a surveillance

system are to a) monitor and document disease trends and b) detect

outbreaks at an early stage. A contingency plan links these elements

together and describes additionally the timing and response actions

to be taken when an outbreak is imminent or has begun. In the

following sections, we highlight different aspects of contingency

planning and provide detailed information on each

component(George,2015)

The World Health Organization (2014) classifies dengue as a

disease important in public health. The epidemiology and ecology of

dengue infections are strongly associated with human habits and

activities. The study evaluates the knowledge and practices

regarding dengue infections among rural residents in Samar

Province, Philippines. A cross sectional design was adopted for the

investigation. Convenience samples of six hundred forty six (646)

residents who were visiting the rural health units in different

municipalities of Samar, Philippines were taken as participants in

study. More than half of the respondents had good knowledge

(61.45%) on causes, signs and symptoms, mode of transmission,

and preventive measures about dengue. More than half of the

respondents used dengue preventive measures such as fans (n =

46
340, 52.63%), mosquito coil (n = 458, 70.90%), and bed nets (n =

387, 59.91%) to reduce mosquitoes while only about one third

utilized insecticides sprays (n = 204, 31.58%) and screen windows (n

= 233, 36.07%) and a little portion used professional pest control (n =

146, 22.60%). There was no correlation between knowledge about

dengue and preventive practices (p=0.75). Television/Radio was

cited as the main source of information on dengue infections.

Findings suggest that better knowledge does not necessarily lead to

better practice of dengue measures. Educational campaigns should

give more emphasis dengue transmissions and on cost effective

ways of reducing mosquito and preventing dengue such as

environmental measures and control. Furthermore, wide range of

information, skills and support must be provided by the government

to increase dengue awareness among residents.(Leodoro J.

Labrague,2013).

It is essential to note that while majority of the respondents

were highly informed of the causes, symptoms, and dengue

preventive measures, still quite significant proportion of the

respondents hold wrong notions about dengue transmissions. For

instance, most of the respondents were aware that dengue is caused

by mosquito bite and a person with dengue may manifests

symptoms like fever, headache, joint and muscle pains, rashes, and

47
abdominal pain. However, about half of the respondents believed

that flies, ticks, and all types of mosquitoes transmit dengue while

only one fourth of the respondents knew that pain behind is also a

symptom of dengue. In a Jamaican study, most participants were

aware that flies and ticks do not transmit dengue fever (66.5% and

71.8% respectively). Good knowledge on the mosquito vector and

signs and symptoms of dengue is essential in identifying the disease

and in seeking early and appropriate medical treatment to save lives

(Shuaib F,2012).

It could be inferred from this investigation that the level of

knowledge about dengue and preventive practices among the study

population is rather high. However, they face challenges such as

greater access to correct information on dengue. In view of this

result, government agencies and other non-government

organizations should strengthen its programs on massive

educational campaign to increase awareness and knowledge

regarding dengue and preventive measures to reduce mosquito and

prevent dengue. Information, education and communication (IECs)

materials maybe provided in areas like schools and health centers

making it more accessible for the residents to obtain. Knowledge of

dengue, the vectors and transmission of disease may be

incorporated into the school curriculum especially in areas where

48
dengue is highly prevalent. Intersectoral coordination meetings

should be conducted to identify possible partners for public

education dengue control campaigns to help finance the

program/activities. Reorientation training of community health

workers should be conducted regularly to improve their technical

skills and capability, and their ability to supervise prevention and

control activities

(Centers for Disease Control and prevention,2013).

Synthesis

The present study investigates the analysis of the factors

contributing to the incidence of dengue fever, knowledge and

prevention. Consistent findings reported in literature, the present

study also established a positive ideas, inputs, and insights with

respect to the study. This research came into realization when the

research noticed the spread of infectious dengue fever. The

abovementioned authors provide significant information and basis to

the worldwide spread of dengue. Healthy mind and body is a part of

quality life and in fact, is essential to human interaction, adaptation,

and survival. Indeed the researcher found out interesting and

informative to have a basic knowledge of potential risk of dengue

spread all over the globe.

49
 Results, findings and recommendation from different author of

various studies contribute significantly to the realm of the present

study. Indeed, it is of great help to the researcher understanding the

complexity of dengue fever. Characterizing the global variation of

dengue viruses will be important for understanding where current

vaccines will be formulated. In the future, it may assist us in

determining which strain to include in vaccination programmes and

to follow the virus as it evolves.

50
 CHAPTER III

METHODOLOGY AND RESEARCH DESIGN

Research Method

The researcher will use the descriptive research design and

employs survey method in the gathering of data. Descriptive

research design typically ascertains respondents perspectives or

experiences on a specified subject in a predetermined structured

manner (Kowalczyk, 2015).On the other hand, survey method allows

researchers to collect a large amount of data in a relatively short

period of time that can be created quickly and administered easily.

The researcher believes that that the designs to be used is

appropriate for this kind of study to obtain first hand data from the

respondents so as to formulate rational conclusions and

recommendation pertains to the study on factors contributing to the

incidence of dengue fever in Surigao del Norte.

Sampling Procedure

The researcher will make use of the following steps are to be

made in consolidate the needed data for the study. Primarily, a letter

of request to be sent to the selected Municipalities in Surigao del

Norte to allow the researcher to conduct an interview and survey

relevant information about the incidence of dengue cases in their

51
municipality. Respondents will be selected through purposive

sampling method is very useful in situations when you need to reach

targeted sample quickly (Crossman, 2017) will be ask to answer the

questionnaire for more relevant information needed in the study. A

letter of request attached in the questionnaires addressing the

purpose of conducting the study for respondents concern.

Respondent were selected dengue patients and nurses in the rural

health unit of the selected municipalities of Surigao del Norte.

Patients under 12 or over 70 years old, patients who did not yet

infected with dengue are excluded to participate in the study.

A 2017 report by the Philippine News Agency estimated that

there are a total of 78 reported dengue cases in Surigao del Norte

and an estimated number of 150 nurses and health workers in the

province. In choosing the participants, stratified sampling technique

is used. A total of 150 participants, nurses or dengue patients were

included in this study.

Setting of the Study

Surigao del Norte is a province in the Philippines located in

the Caragaregion of Mindanao. Its capital is Surigao City. The

province comprises two major islands Siargao and Bucas Grande in

the Philippine Sea, and a small region at the northeastern tip of

52
Mindanao. This mainland portion borders Agusandel Norte, and

Surigao del Sur to the south. Surigaodel Norte is the second

northernmost of the Mindanao provinces and is an important

transportation hub between Visayas and Mindanao. Numerous

ferries cross the Surigao Strait between Surigao and the island of

Leyte carrying vehicles and passengers between Liloan in Southern

Leyte and Surigao City.

The area of Surigao del Norte was once part of an ancient

district referred to as "Caraga" during the Spanish colonial period

named after its chief inhabitants, the Caraga tribe or Caragans who

were largely concentrated in a settlement called Caraga. The ancient

district of Caraga, which was established in 1609 comprised all of the

present day provinces of Surigao del Norte, Surigao del Sur, the

northern part of Davao Oriental and eastern Misamis Oriental. The

seat of government was at Tandag until it was transferred to the

town of Surigao in 1848. Six Spanish military districts were

established in Mindanao in 1860 and the areas of present day

Surigao del Norte, Surigao del Sur, Agusan del Norte, Agusan del

Sur (collectively called Agusan back then), including the territory

lying between present day Butuan and Caraga bays, formed the third

district called the "East District" which was changed in 1870 to

"Distrito de Surigao". By the end of the Spanish rule in 1897, Agusan

53
had been organized as a single politico-military comandancia named

"Butuan", within the administrative jurisdiction of Distrito de Surigao

Surigaodel Norte is an archipelago province situated at the

rim of the Asian continental shelf. It is located at the northeastern tip

of Mindanao and faces the Philippine Trench. The province is

bounded by the Dinagat Islands on the north, east by the Philippine

Sea, south by the provinces of Agusandel Norte and Surigao del Sur,

and on the west by the Surigao Strait. The province, with an area of

1,972.93 square kilometers (761.75 sq mi), comprises the mainland

situated at the northeastern tip of Mindanao and several offshore

islands, the largest of which include Siargao and Bucas Grande. The

mainland is generally mountainous. The province has many caves

and tunnels in its islands. Some are half-submerged in water most of

the time and could be accessed only during low tides like the

Sohoton Cove at Bucas Grande Island. Its biggest islands are

usually mountainous and rich in minerals. Nonoc Island has one of

the world's largest deposits of nickel. The smaller ones either rest on

sand and gravel or have a limestone base bonded by boulders, reefs

and sandbars. Some islets which include those in Del Carmen in

Siargao Island are a cluster of rock formations jutting out from the

sea covered with shrubs and coconut trees.

54
Ethical Consideration

The researcher will guided by the ethical principles in the

conduct of the study. Ethical aspects have been considered to help

researcher to determine the roles and responsibilities in nursing

research. It is also important for protection of human from harm,

coercion, and invasion of privacy (Talbot 2011)

During the conduct of the study, the researcher will consider and

implement following principles :(Beuchamp and Childress, 2010)

The subjects are not allowed to choose to participate in the

research study freely, without coercion of threat or harm from others.

They were also free to withdraw from the study anytime without

penalty or loss of benefit. They were made to design an informed

consent prior to participation in the study. The researcher will ensure

that no harm will come to the subject from participating in the

research study.

The nurse researcher will balance the associated benefits and

risks of the subjects participation in the study

The rights of the respondents will be respected. The subject

will be informed of the purpose of the study. Any information

obtained in the study will be kept anonymous and this will facilitated

by using code numbers. Access to the raw data in the study is limited

to the principal investigation to decrease threat loss of confidentiality.

55
Questionnaires are coded and no names are visible in the

questionnaire. The researcher study conducted as outlined in the

informed consent.

(No author, how to implement ang survey, ethics and confidentiality), Commented [m1]: Waya ako kasabot unay ija ipabutang
diri.

Research Instruments

The data is going to be obtained through a researcher-made

questionnaire that comprises of two parts. The first part is

contributing factors of dengue fever in Surigaodel Norte in terms of

economic, social and environmental The second part was the level of

knowledge and prevention. The respondents will ask to check or

specify the answers being requested with all honesty as well as

sincerity. . A letter of request was sent to the experts to validate the

instrument with regards to the content and construct validity. After

which, data were analyzed, followed by the revision of the

questionnaire and its present administration. For reliability, items of

the questionnaire were subject to Cronbach Alpha of .973814

described as standard. Furthermore, the following mean interval is

devised for interpretation for the mean score scale.

56
 Part 1 of the questionnaire looks at the three factors

associated with dengue. These are Economic, Social and

Environment factors.

Part 2 evaluates the level of knowledge and prevention of the

respondents as to the prevalence of dengue in the locality.

Data Collection Procedure

Before the survey will be administered, the researcher will

performed a pilot study to test the affectivity and completeness of the

questionnaire to be used. The pilot study conducted among the

among the patient and nurses of Municipality of Claver, Surigaodel

Norte, utilizing the methods and questionnaire.

The researcher will be submitting a letter of permission

addressing the Municipal Health Officer of the rural Health Unit of

Mainit, Surigaodel Norte for the proposed pilot study of the research.

Afterwards, the researcher will be having a records review to identify

the target population where the study will be conducted. They used a

Pagoso et al formula to determine the sample size. After identifying

the result, a stratified sampling method will be using because it gives

the population equal/proportion chance of inclusion through dividing

the identified population into different subgroups or strata. Likewise,

57
it can ensure the researcher will obtain sufficient sample points to

support a separate analysis group.

Subsequently, the researcher will be going t identified

barangays and will be able to submit a letter of permission to the

barangay captains. After that another letter of permission will be

given to respondents prior to the conduct of the survey proper. A

guided response type, of recall and dichotomous type of

questionnaire will be using. After gathering the necessary

information, the researcher will tabulate process and analyze the

data manually. The data gathered will be organized using the

Talligram (Tabulation) and Frequency Distribution Table System

Analysis. (paano ginather ang data). Commented [m2]: Na answer na man ni sa paragraph
above.

STATISTICAL TREATMENT OF DATA

The data gathered in this study will be analyze and interpret

as follows;

1. To determine the factors contribute to the incidence of dengue

fever, knowledge and prevention. The researcher will be using

the descriptive bio statistical tools such as mean and standard

deviation.

58
2. To determine the level of knowledge and prevention on the

factors contributing to the high incidence of dengue fever. The

statistical tool to be used in the test of the relationship

specifically the Multiple Regression.

59
 Chapter IV

Presentation, Analysis and Interpretation of Data

Table 1. (Highest mean- justify & support according to author and

year, Lowest citation according to author and year)

Economic Factor Contributing to the Incidence of Dengue

INDICATORS MEAN INTERPRE

TATION

1. The patient buy an insect repellant 2.11 Disagree

lotion in commercial store for dengue
prevention purposes.
2. The patient buy Mosquito net for 3.46 Agree
sleeping to prevent mosquito bite that can
cause dengue fever.
3. The patient have a door screen in their 1.94 Disagree
house to prevent the access of mosquito
of going inside.
4. The patient prefer to use Commercial 1.89 Disagree
Medicine during the time of dengue fever.
5. The patient submit himself for check up 1.87 Disagree
to the local health clinicsafter 2 days of
successive fever.

60
6. The patient prefer to use herbal 3.44 Agree
medicine during fever as an alternative for
commercial medicine.
7. Patient submit himself for confinement 2.46 Disagree
after checkup as recommended by the
doctor.
8. Patient able to have insect repellant in 2.05 Disagree
their household to protect their selves
from mosquito bite.
9. The patient have a window screen in 2.43 Disagree
their house to prevent the access of
mosquito going inside.
10. The patient have an electric mosquito 2.39 Disagree
killer in their house to eliminate
mosquitoes.
Average Mean 2.41 Disagree

Ratio Scale Verbal Interpretation

4 3.50 4.00 Strongly Agree
3 2.50 3.49 Agree
2 1.50 2.49 Disagree
1 1.0 1.49 Strongly Disagree

The table above shows that the respondents economic factors

contributing to the incidence of dengue. The statement 2 The

patient can buy mosquito net for sleeping to prevent mosquito bite

that can cause dengue fever got the highest mean of 3.46 with a

verbal interpretation of Agree. This result is related to the idea of

Sarah Berthe, (2014) that some people who favored the use of

mosquito nets appeared to be more aware of health and dengue

prevention. On the other way around, That statement numbers 5

The patient submit himself for check up to the local health clinics

61
after 2 days of successive fever got the lowest mean of 1.87 with a

verbal interpretation of Disagree as supported by the idea of Brian

Palmer (2015) that some patients minimize their symptoms and

ignore the warning signs of serious illness. Most of the time, however

it forces the physician to investigate and treat a problem would have

gone on its own way.

In conclusion, the average mean 2.41 with the verbal

interpretation of disagree it is understood that majority of the

respondent have the difficulty in terms economic conditions where in,

they disagree on the majority of the items cause it requires financial

appropriation. They assumed that by the time they visit the doctor,

they need to have that money as payment for check-up and for

medication. It clearly manifest also that respondents fall on the mass

group where in their income is just enough for daily survival.

Table 2.

Social Factor Contributing to the Incidence of Dengue

INDICATORS MEAN INTERPR

ETATION

1. The patient have an access on dengue 3.54 Strongly

prevention program implemented by the
local health office Agree

2. The patient participates in the conduct 2.48 Agree

of dengue prevention activities in the

62
area.
3. Local health Office Personnel 2.54 Agree
conducts a home to home visitation in the
dengue prone areas.
4. The residents have an access to 2.93 Agree
dengue fliers for dengue awareness
purposes.
5. Local health office conducts monitoring 2.50 Agree
of dengue prevention program activities
they implemented in their locality.
6. Local health office conducts inspection 3.50 Strongly
of dengue prone areas in their locality
Agree

7. Residents have the access to dengue 3.57 Strongly

awareness reading materials for dengue
awareness purpose. Agree

8. Local health office organizes a 3.51 Strongly

community symposium to areas which are
highly prone in dengue fever. Agree

9. Local health office conduct evaluation 2.01 Disagree

of dengue prevention program activities
they implemented in their locality.

10. Local health office coordinates local 2.49 Disagree

media in dengue awareness program
conducted in the area.
Average Mean 2.91 Agree

Ratio Scale Verbal Interpretation

4 3.50 4.00 Strongly Agree
3 2.50 3.49 Agree
2 1.50 2.49 Disagree
1 1.0 1.49 Strongly Disagree

63
 Table 2 shows the social factor contributing to the incidence of

dengue. The highest mean of 3.57 was got by statement number 7

Residents have the access to dengue awareness reading materials

for dengue awareness purpose with a verbal interpretation of

Strongly Agree. The health department under local government unit

spearheads the production of reading materials in relation to dengue

down to Barangay Health Workers up to their constituents. In

opposite lowest mean of 2.01 was with statement 9 Local health

office conduct evaluation of dengue prevention program activities

they implemented in their locality. and has a verbal interpretation of

Disagree. As stipulate by the idea of SokrinKhun (2013) that the

need for sustained routine education dengue prevention and control

and the need for approaches to ensure the translation of knowledge

into practice.

In summary, having average mean of 2.91 having a verbal

interpretation of agree respondents understand that social factors

contributes on the incidence since through the awareness and

prevention activities conducted by the local health office it can made

them more conscious and knowledgeable in the prevention and

proper medication of dengue fever. The result also reveals that

respondents are aware of the dengue prevention program. They are

64
also conscious that they need to participate and be involved since

they are part of the community.

Table 3.

Environmental Factors Contributing to the Incidence of Dengue

INDICATORS MEAN INTERPRE

TATION

1. Residents conducts daily cleaning of 3.51 Strongly

surroundings of their respective
community household. Agree

2. Residents remove all the object in their 2.54 Agree

household that stagnates water which can
be the breeding ground of mosquito.
3. Residents conducts daily changes of 2.44 Disagree
water in flower vases which can be
possively the breeding ground of
mosquito.
4. Residents remove water in canals and 1.97 Disagree
open tanks to prevent possible the
breeding ground of mosquito
5. Resident cover water containers to 3.55 Strongly
prevent the possible breeding ground of
mosquito. Agree

6. Local health office conducts weekly 1.48 Strongly

fogging the area which is rampant in
dengue fever cases. Disagree

7. Residents conducts daily changing of 2.47 Disagree

water in flower pots in their household to
prevent the possible breeding ground of
mosquito
8. Residents cover all water galloon to 3.53 Strongly
prevent the possible breeding ground of
mosquito. Agree

65
9. Residents remove flower that stocks 2.46 Disagree
water in their leaves and stem to prevent
the possible breeding ground of mosquito.
10. Resident check their surrounding daily 3.43 Agree
as to the cleanliness to remove all the
objects that can be possibly the breeding
ground of mosquito
Average Mean 2.74 Agree

Ratio Scale Verbal Interpretation

4 3.50 4.00 Strongly Agree
3 2.50 3.49 Agree
2 1.50 2.49 Disagree
1 1.0 1.49 Strongly Disagree

Table 3 above presents the environmental factor contributing

to the incidence of Dengue in Surigaodel Norte. It was revealed that

statement number 5Resident cover water containers to prevent the

possible breeding ground of mosquito. got the highest mean of 3.53

with a verbal interpretation of Strongly Agree. Wherein, water

storage container should be covered with tight fitting lids or screen;

care being taken to replace them after used as pointed out by the

Disaster Management information System, A Global Initiative for

Preparing Civil Society to Meet Emergencies (2012). On the other

way around the lowest mean of 1.48 and with a verbal interpretation

of Strongly Disagree was garnered by statement 6 Local health

office conducts weekly fogging the area which is rampant in dengue

fever cases. According to the Guidelines for Integrated Vector

66
Management for Control of Dengue/Dengue Hemorrhagic Fever

(2011) the need for chemical control measures are recommended in

permanent big water containers where water has to be conserve or

stored.

In conclusion as to the environmental factors respondent

agree as clearly manifested by the average mean of 2.74 that

environmental management and consciousness has really an impact

to the incidence of dengue in a certain area since dengue fever can

be found in area having a poor hygiene and cleaning. Respondents

have a clear understanding that they need to maintain a clean and

hygienic environment so that they can prevent dengue. Their

knowledge on proper environmental management helps them to

learn basic activities that leads them to establish a dengue free

community.

Table 4.

Level of Knowledge Contributing to the Incidence of Dengue

INDICATORS MEAN INTERPRE

TATION

1. The patient experience severe headache 3.49 Agree

as part of dengue fever symptoms.
2. The patient experience severe eye pain 1.57 Strongly
as part of dengue fever symptoms
Disagree

67
3. The patient experience joint pain as part 2.50 Agree
of dengue fever symptoms
4. The patient experience muscle pain as 3.49 Agree
part of dengue fever symptoms
5. The patient experience rashes as part of 3.59 Strongly
dengue fever symptoms
Agree

Average Mean 2.93 Agree

Ratio Scale Verbal Interpretation

4 3.50 4.00 Strongly Agree
3 2.50 3.49 Agree
2 1.50 2.49 Disagree
1 1.0 1.49 Strongly Disagree

Table 4 above implies the level of knowledge contributing to

the incidence of Dengue. It shows that the highest mean of 3.59 with

a verbal interpretation of Strongly Agree got by statement 5 The

patient experience severe eye pain as part of dengue fever

symptoms. It is supported by the statement of Vanessa Ngan, 2011

that in most cases rash was generalized widespread and over any

part of the body. Most patient develop skin rash between the 3rd day

and 5th day after the onset of Fever. Hence, the statement 2 The

patient experience severe eye pain as part of dengue fever

symptoms got the lowest mean of 1.57, having a verbal

interpretation of Strongly Disagree as proven by the idea of

Healthkart (2012) that along the with fever, sere headache also

68
occurs in the initial phase of dengue with re-orbital (behind the eye)

pain.

In summary the respondent level of knowledge on dengue

prevention having the average mean of 2.93 with a verbal

interpretation of agree respondent affirmed on the basic symptoms

of dengue wherein immediate action must be taken so that it will not

be going into a worse scenario. It shows also that they are now more

conscious on the necessity of giving more serious treatment on

dengue and consider dengue as a serious health risk.

Table 5

Level of Prevention Contributing to the Incidence of Dengue

INDICATORS MEAN INTERPRE

TATION

1. Local health office conduct dengue 3.05 Agree

awareness symposium in dengue prone
areas.
2. Local health office distributes of leaflets 2.91 Agree
and reading materials in dengue prone
areas.
3. Local health office Post tarpaulin and 3.48 Agree
Public Announcement Materials in public
places for dengue awareness purposes.
4. Local health office coordinate with the 1.49 Strongly
local media in disseminating dengue
preventive measures to the residents Disagree

5. Local health office organize of a dengue 1.48 Strongly

Brigade Campaign that spearhead
activities and program for dengue

69
prevention. Disagree

Average Mean 2.49 Disagree

Ratio Scale Verbal Interpretation

4 3.50 4.00 Strongly Agree
3 2.50 3.49 Agree
2 1.50 2.49 Disagree
1 1.0 1.49 Strongly Disagree

The Table above shows the level of prevention contributing to

the incidence of Dengue in Surigaodel Norte. It was revealed that the

highest mean of 3.05, having a verbal interpretation of Agree got by

the statement 1 Local health office conduct dengue awareness

symposium in dengue prone areas. which is one of the important

things to do this as stated by Edith R. Regalado (2015) that rich or

poor, whatever is ones status in life, a disease like a viral mosquito-

borne dengue, is everyones business. On the other side statement 4

Local health office coordinate with the local media in disseminating

dengue preventive measures to the residents got the lowest mean

of 1.48 with a verbal interpretation of Strongly Disagree. In which

the organization of the Dengue Barangay Brigade conduct such

activities including decloging of canals; mobilization of residents of

affected communities in clean-up campaign with the help of Dengue

Brigade (Editorial Page, Catanduanes Tribune, August 2014)

70
 On the level of prevention that contributes to the incidence of

dengue respondents notice the need of a more strong preventive

measure that the local health office conducted beyond awareness

program and integrated approach to dengue prevention it was

proven with the average mean of 2.9 having a verbal interpretation of

disagree. Respondents notice that there is a need for the local

health office to continue and more persistent in their dengue

prevention program and activities. The emphasis on the adverse

threat and effect to health of dengue fever must be clearly explained

and presented to the respondent so that they would feel that its a

necessity to learn preventive measures to dengue fever concern.

Table 6

Regression Analysis on Factors Contributing to the Incidence

of Dengue and Level of Knowledge as Dependent Variable

Std. of Std.
Err. Of of
INDICATORS Beta Beta B Err. t(146) p-level
Of B
Economic 0.148 0.082 0.134 0.074 1.812 0.045986
Social -0.095 0.082 -0.105 0.090 - 0.245914
1.165
Environment 0.005 0.082 0.007 0.119 0.062 0.950937

71
 The table above reveals the multiple regression analysis

which was used to test if the three factors (economic, social and

environment) significantly predicted the level of knowledge in dengue

fever of the respondents. The results of the regression indicated that

one predictor explained 17.72% of the variance (R2 = 0.03, F(3,146)

= 1.58, p<0.05). It was found that economic factor significantly

predicted the level of knowledge ( = 0.148, p = 0.046).

This result suggests that respondent who have the capacity in

terms of financial matters have more knowledge in terms of dengue

prevention as cited by Guha Sapir and Schimmer,(2011) intheir

study Dengue Fever: New Paradigm for a Changing epidemiology

that air conditioning, screens and safe water supplies in wealthier

countries help prevention and better health services reduce or

eliminate mortality from dengue fever. This also means that

respondents points was that ability to purchase or buy something

that could prevent mosquito or dengue fever in general matters a lot

on the vulnerability of dengue fever to an individual or community.

Table 7

Regression Analysis on Factors Contributing to the Incidence

of Dengue and Level of Prevention as Dependent Variable

72
INDICATOR Beta Std. B Std. of t(146) p-level
of Err. Of
S Err. B
Of
Beta
Economic -0.064 0.082 -0.071 0.092 -0.773 0.440980
Social 0.007 0.082 0.009 0.112 0.086 0.930990
Environment -0.129 0.082 -0.234 0.148 -1.572 0.038011

The table above reveals the multiple regression analysis which was

used to test if the three factors (economic, social and environment)

significantly predicted the level of prevention in dengue fever of the

respondents. The results of the regression indicated that one

predictor explained 13.95% of the variance (R2 = 0.019, F(3,146) =

0.966 p<0.05). It was found that environmental factor significantly

predicted the level of knowledge ( = -0.129, p = 0.038).

This result suggests that respondent who are environmental

conscious are less in risk to be affected by dengue fever as

environment play an important role in dengue prevention. In which

environmental management seeks to change the environment in

order to present or minimize vector propagation and human contact

with the vector-pathogen by destroying, altering, removing or

recycling non essential containers that provide egg/larval/pupal

habitat, such actions should be mainstay of dengue vector control.

Three types of environmental management are defined:

environmental modification, environmental manipulation and change

73
to human habitation or behavior according to Environmental

Management, World Health Organization (2012). Respondent tells

that more environmental conscious individual is more advantage as

part of dengue prevention. The reason is that they are more aware

on what things to be eliminated and thrown away since those object

can be a possibly breeding ground of mosquito. The constant

hygienic and cleaning activities also prevent mosquito staying in a

place since they cant found a breeding area for them to stay.

Chapter V

SUMMARY OF FINDINGS CONCLUSION AND

RECOMMENDATION

Summary of Findings

After thorough and careful analysis of the data, an answer to

problems posited in the study, the following were the results.

1. Respondents economic factors contributing to the incidence of

dengue. That statement numbers 5 The patient submit himself for

check up to the local health clinicsafter 2 days of successive fever

got the lowest mean of 1.87 with a verbal interpretation of

Disagree. On the other way around, statement 2 The patient can

74
buy mosquito net for sleeping to prevent mosquito bite that can

cause dengue fever got the highest mean of 3.46 with a verbal

interpretation of Agree. As to the social factor contribute to the

incidence of dengue. The highest mean of 3.57 was got by

statement number 7 Residents have the access to dengue

awareness reading materials for dengue awareness purpose with a

verbal interpretation of Strongly Agree. In opposite lowest mean of

2.01 was with statement 9 Local health office conduct evaluation of

dengue prevention program activities they implemented in their

locality. and has a verbal interpretation of Disagree. With regards

to the environmental factor contributing to the incidence of Dengue in

Surigaodel Norte. It was revealed that statement number 5Resident

cover water containers to prevent the possible breeding ground of

mosquito. got the highest mean of 3.53 with a verbal interpretation

of Strongly Agree. On the other way around the lowest mean of

1.48 and with a verbal interpretation of Strongly Disagree was

garnered by statement 6 Local health office conducts weekly

fogging the area which is rampant in dengue fever cases.

2. On the Factors Contributing to the Incidence of Dengue and Level

of knowledge as Dependent Variableit was significantly predicted the

level of knowledge in dengue fever of the respondents. The results of

75
the regression indicated that one predictor explained 17.72% of the

variance (R2 = 0.03, F(3,146) = 1.58, p<0.05). It was found that

economic factor significantly predicted the level of knowledge ( =

0.148, p = 0.046). With regards to Factors Contributing to the

Incidence of Dengue and Level of Prevention as Dependent Variable

it was significantly predicted the level of prevention in dengue fever

of the respondents. The results of the regression indicated that one

predictor explained 13.95% of the variance (R2 = 0.019, F(3,146) =

0.966 p<0.05). It was found that environmental factor significantly

predicted the level of knowledge ( = -0.129, p = 0.038).

3. There is a significant relationship in terms of the Analysis on

Factors Contributing to the Incidence of Dengue and Level of

Knowledge as Dependent Variable. It was found that economic

factor significantly predicted the level of knowledge. There is also

significant relationship on the Analysis on Factors Contributing to the

Incidence of Dengue and Level of prevention as Dependent Variable.

It was resulted that environmental factor significantly predicted the

level of prevention.

4. The following Intervention Program is being proposed to reduce

dengue;

76
a. Conduct Entomological Survey to the Municipality of the Province

of Surigao del Norte with high dengue cases.

b. Conduct a Multi-Sectoral Advocacy and Awareness Campaign

Against Dengue in Areas of the province which is High in Dengue

Cases.

c. Strengthen/improve dengue surveillance response to dengue

cases. A data base that can be continuously updated to share

current & historical data on dengue cases. A standardize reporting of

dengue cases to improve preparedness of public health officials by

providing early warning prior to epidemics which can help reduce

fatality rates.

d. Vector surveillance to control mosquito populations & limit dengue

transmission.

e. Biological control of Dengue includes use of organisms that prey

or interrupt the life cycle of the mosquitoes resulting to reducing the

mosquito population. Examples of predatory organisms are the fish

Poeciliareticulata and the copepodacyclopoidea that kill by eating

the eggs, larvae and pupa of the mosquitoes

f. The ovicidal and larvicidal traps interrupt the life cycle of the

mosquitoes by attracting the female mosquito to lay eggs on the

trap. The trap contains substances that kills the eggs.

77
g.Massive anti-dengue campaigns using media campaigns in such

flyers and posters were distributed. Flyers and education materials

show how to help eradicate the mosquitoes by removing water

sources that can be a breeding ground for mosquitoes. These

campaigns are geared towards raising awareness to the

communities about the threat of Dengue, to call the public to action

and do their share in eliminating the mosquitoes.

h. Daily advocacy & implementation of clean up drive 4 o Clock

habitto ensure the absence of breeding sites of dengue mosquitoes.

i. Suggest to the local officials to initiate and allocate budget for

Purok competition Search for cleanest and greenest Purok to

maintain and sustain cleanliness and prevent diseases.

Conclusion

Based on the above mentioned findings, the following

conclusions are drawn:

1. Economic factor, respondent refuse their selves to submit for

check due to the financial consideration, with regards to social factor

evaluation of dengue program activities has an important role in the

enhance and upgrading for public benefit, on the environmental

factor the conduct of fogging in the area is the less thing that notice

by the participant conducted in the area.

78
2. Participant has a less knowledge that one of the symptoms of

dengue fever is severe eye pain, on the prevention they notice that

organizing a dengue brigade is not inviting to minimize dengue.

3. There is a significant relationship on the analysis on factors

contributing to Incidence of dengue as dependent variable both

knowledge and prevention.

Recommendations

Premised on the findings and deduced insights from the

study, the following are recommended for actions.

Residents. They should have to be more vigilant and conscious in

establishing clean and safe surroundings in their area of residence,

by removal of object that stagnates water through information

dissemination activity like information drive and symposium with

regards to dengue fever prevention.

Patients.They should have to be more alert in dealing with common

symptoms of dengue so that immediate medication will be applied by

the local health authority, by submitting their selves for check up

confinement if necessary.

Nurses. They are requested to make use of the findings in this study

and to serve the bases in decision in performing their jobs in the

hospital especially to the dengue fever patients.

79
Local Health Office.As the local government agency which has a

direct access in the different community, they should have to

improve, maintain and evaluate the current dengue preventive

measure that they implemented such as dengue awareness

information drive, organizing of dengue brigade committee which

spearhead socio-civic activities like fun run and weekly cleaning

especially in the dengue prone area.

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Appendices A

ST. BERNADETTE OF LOURDES COLLEGE

GRADUATE SCHOOL
West Fairview, Quezon City

March 3, 2016

DR. GERMELINA D. CONSUL

Professor
Graduate School
St. Bernadette of Lourdes College
West Fairview, Quezon City

Madam:

Greetings of Peace!

83
 I am conducting a study entitled An Analysis of the Factors
Constributing to the Incidence of Dengue Fever, Knowledge and
Prevention: Input to Reduction of Cases in partial fulfillment of
the requirements for the degree of Master of Arts in Nursing, Major in
Nursing Administration.
In this connection, I would like to ask you to please validate
my questionnaire as to its content; I firmly believe that your expertise
will help much to the improvement of my questionnaire
I hope for your affirmative response to this request.
Thank you very much and God bless you always.

Respectfully yours,

VIRGINIA C. BACOLOD
Researcher

Appendices B

AN ANALYSIS OF THE FACTORS CONTRIBUTING TO THE

INCIDENCE OF DENGUE FEVER, KNOWLEDGE AND

PREVENTION: INPUT TO REDUCTION OF CASES

Instruction: Supply necessary information on the following

questions.

Part I. Contributing factors to the incidence of dengue fever in

Surigaodel Norte.

84
Economic 4 3 2 1

1. The patient buy an insect repellant

lotion in commercial store for dengue
prevention purposes.
2. The patient buy Mosquito net for
sleeping to prevent mosquito bite that can
cause dengue fever.
3. The patient have a door screen in their
house to prevent the access of mosquito
of going inside.
4. The patient prefer to use Commercial
Medicine during the time of dengue fever.
5. The patient submit himself for check up
to the local health clinicsafter 2 days of
successive fever.

6. The patient prefer to use herbal

medicine during fever as an alternative for
commercial medicine.
7. Patient submit himself for confinement
after check up as recommended by the
doctor.
8. Patient able to have insect repellant in
their household to protect their selves from
mosquito bite.
9. The patient have a window screen in
their house to prevent the access of
mosquito going inside.
10. The patient have an electric mosquito
killer in their house to eliminate
mosquitoes.

Social 4 3 2 1

1. The patient have an access on dengue

prevention program implemented by the
local health office
2. The patient participates in the conduct
of dengue prevention activities in the area.
3. Local health Office Personnel conducts
a home to home visitation in the dengue

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prone areas.
4. The residents have an access to
dengue fliers for dengue awareness
purposes.
5. Local health office conducts monitoring
of dengue prevention program activities
they implemented in their locality.
6. Local health office conducts inspection
of dengue prone areas in their locality
7. Residents have the access to dengue
awareness reading materials for dengue
awareness purpose.
8. Local health office organizes a
community symposium to areas which are
highly prone in dengue fever.
9. Local health office conduct evaluation of
dengue prevention program activities they
implemented in their locality.
10. Local health office coordinates local
media in dengue awareness program
conducted in the area.

Environment 4 3 2 1

1. Residents conducts daily cleaning of

surroundings of their respective
community household.
2. Residents remove all the object in their
household that stagnates water which can
be the breeding ground of mosquito.
3. Residents conducts daily changes of
water in flower vases which can be
possively the breeding ground of
mosquito.
4. Residents remove water in canals and
open tanks to prevent possible the
breeding ground of mosquito
5. Resident cover water containers to
prevent the possible breeding ground of
mosquito.
6. Local health office conducts weekly
fogging the area which is rampant in

86
dengue fever cases.
7. Residents conducts daily changing of
water in flower pots in their household to
prevent the possible breeding ground of
mosquito
8. Residents cover all water galloon to
prevent the possible breeding ground of
mosquito.
9. Residents remove flower that stocks
water in their leaves and stem to prevent
the possible breeding ground of mosquito.
10. Resident check their surrounding daily
as to the cleanliness to remove all the
objects that can be possibly the breeding
ground of mosquito

Part II. Level of Knowledge and Prevention of dengue

Knowledge 4 3 2 1

1. The patient experience severe

headache as part of dengue fever
symptoms.
2. The patient experience severe eye pain
as part of dengue fever symptoms
3. The patient experience joint pain as part
of dengue fever symptoms
4. The patient experience muscle pain as
part of dengue fever symptoms
5. The patient experience rashes as part of
dengue fever symptoms
Prevention 4 3 2 1

1. Local health office conduct dengue

awareness symposium in dengue prone
areas.
2. Local health office distributes of leaflets
and reading materials in dengue prone
areas.
3. Local health office Post tarpaulin and
Public Announcement Materials in public
places for dengue awareness purposes.

87
4. Local health office coordinate with the
local media in disseminating dengue
preventive measures to the residents
5. Local health office organize of a dengue
Brigade Campaign that spearhead
activities and program for dengue
prevention.

Ratio Scale Verbal Interpretation

4 3.50 4.00 Strongly Agree
3 2.50 3.49 Agree
2 1.50 2.49 Disagree
1 1.0 1.49 Strongly Disagree

Thank you for your cooperation

CURRICULUM VITAE

VIRGINIA C. BACOLOD
Blk. 4 Lot 18, Purok 9, Navalca
San Juan, Surigao City
Philippines
Mobile No.: 0947-317-0497
Email Add: giebacolod_75@yahoo.com
PERSONAL DATA
Age : 42 years old
Date of Birth : August 19, 1975
Gender : Female
Civil Status : Married
Height : 5' 1"

88
Weight 58 kgs.
Nationality Filipino
Religion Catholic
: Blk 4 Lot 18, Purok 9, Navalca, San Juan, Surigao
Permanent Address City
EDUCATIONAL BACKGROUND
Tertiary Level Bachelor of Science in Nursing
School Butuan Doctors' Collegre
Location AD Curato St., Butuan City
School Year 1992-1996
Secondary Level Albor National High School
Location Libjo, Surigao del Norte
School Year 1987-1991
Elementary Level Albor Central Elementary School
Location Libjo, Surigao del Norte
School Year 1981-1986
LICENSE/CERTIFICATIONS
Phil. Nurses' Licensure Date release :
License No. 0308251
Examination 12/13/1996

WORK EXPERIENCE
Inclusive Dates DEPARTMENT/OFFICE POSITION
Albor District Hospital
March 1999-June 2009 Nurse I (Permanent)
Libjo, Surigao del Norte
Provincial Heal Office
July 2009-Present Nurse I (Permanent)
Washington, Surigao City
TRAININGS/SEMINARS
Mental Health and Psychosocial Support Service
November 15-17,2016 Training
TOT on Matrix Intensive Outpatient (MIOP) for people
affected with substance use and dependence: A
October 10-14,2016 community-based approach

May 11-13, 2016 Regional Strategic planning/workshop on EREID

program among LGU's and Hospitals Coordinator
April 12-14, 2016 Basic water sanitation and hygiene training in
Emergencies and Disaster
3 Months Training on Intensive and critical Care
Nursing @ Vicente Sotto Memorial Medical Center,
July 9- Octobe 9, 2014 Cebu City

89
 Enhancing Teamwork Capabilities for effective
May 13-15, 2014 Emergency & Disaster response
Training on Comprehensive Vaccine Preventable
June 18-20, 2013 Disease surveillance and Response
REFERENCES
Maria Rosana M. Enano Chief Technical Division
Provincial Health Office, SC
Fema D. Bayana Nurse II
Provincial Health Office, SC

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