Dengue Knowledge, Attitudes, and Prevention Practices Among Urban Communities in Peninsular Malaysia

Published: Malaysian Journal of Public Health Medicine, 2006; Vol. 6(1): 44–50

Original URL: MJPHM Volume 6, Issue 1, 2006

Last reviewed: March 2026

Background and Public Health Context

Dengue fever has been a defining public health challenge for Malaysia throughout the modern era. The country experienced cyclical epidemic waves throughout the 1990s and 2000s, with each successive cycle tending to produce higher case numbers and more widespread geographic distribution. By the mid-2000s, Malaysia was recording tens of thousands of notified dengue cases annually, with the majority concentrated in densely populated urban and peri-urban areas of states such as Selangor, the Federal Territory of Kuala Lumpur, Johor, and Penang.

The Aedes aegypti mosquito, the primary vector for dengue virus in Malaysia, is an urban-adapted species that breeds in clean, stagnant water found in artificial containers around human dwellings. Discarded tyres, water storage containers, flower vases, clogged roof gutters, and even upturned bottle caps can serve as breeding sites. This intimate association between vector breeding and human domestic environments means that dengue control depends critically on community participation in source reduction — the systematic elimination of potential breeding habitats.

The Malaysian Ministry of Health invested substantial resources in dengue prevention through a multi-pronged approach comprising vector surveillance, insecticidal fogging during outbreaks, larval control, health education campaigns, and legislative measures including the Destruction of Disease-Bearing Insects Act 1975. The effectiveness of these programmes, however, depended heavily on public cooperation and sustained community engagement, making knowledge, attitude, and practice (KAP) studies essential for programme planning and evaluation.

The Knowledge-Attitude-Practice Framework in Dengue Prevention

KAP studies became a cornerstone of dengue research in Malaysia and across the Southeast Asian region during the 2000s. The underlying rationale was that effective vector control requires not only government-led interventions but also individual and community-level behaviour change. Understanding what people know about dengue, how they perceive its threat, and what preventive actions they actually take provides essential intelligence for designing more effective communication strategies and community mobilisation programmes.

Research published in MJPHM during this period consistently revealed a paradoxical pattern: Malaysian urban communities demonstrated reasonably good knowledge about dengue but much lower levels of consistent preventive behaviour. This knowledge-practice gap became a central concern for public health authorities and researchers alike.

Knowledge Levels and Patterns

Studies conducted in the mid-2000s found that the vast majority of urban Malaysian adults — typically over 80% — could correctly identify that dengue was transmitted through mosquito bites. Most respondents were also aware that Aedes mosquitoes bite primarily during daytime hours, a distinguishing feature from malaria-carrying Anopheles species. Knowledge about common symptoms of dengue (high fever, severe headache, body aches, skin rash) was also generally good, likely reflecting the cumulative impact of years of health education campaigns through mass media, community health talks, and school-based programmes.

However, more nuanced knowledge showed greater variability. Understanding of the role of the four dengue virus serotypes, the concept of sequential infection increasing the risk of severe dengue haemorrhagic fever, and the importance of early medical consultation for warning signs were less well established in the general population. Some respondents held misconceptions, such as believing that dengue could be spread through direct person-to-person contact or that insecticidal fogging alone was sufficient to eliminate the disease.

Attitudes Toward Dengue Prevention

Attitudes toward dengue prevention were generally positive in the abstract. Most respondents acknowledged that dengue was a serious disease, agreed that prevention was a shared responsibility between the government and the community, and expressed willingness to participate in vector control activities. These favourable attitudes, however, did not reliably translate into sustained behavioural engagement.

Several attitudinal barriers were identified. Some respondents exhibited a fatalistic perspective, believing that dengue was inevitable and that individual prevention efforts were futile. Others expressed frustration that their neighbours’ lack of compliance undermined their own efforts — a classic collective action problem. Still others perceived dengue prevention activities as primarily the government’s responsibility, viewing their own role as passive recipients of fogging operations and public health announcements rather than active participants in source reduction.

Prevention Practices and the Knowledge-Practice Gap

The critical finding across multiple Malaysian KAP studies from this era was the substantial gap between knowledge and practice. While most respondents knew that eliminating stagnant water was important, only about 40–60% reported regularly inspecting and clearing potential breeding sites around their homes on a weekly basis. Specific practices and their adoption rates varied:

Several factors predicted higher levels of preventive practice adoption. Education level showed a consistent positive association: individuals with secondary or tertiary education were more likely to engage in regular source reduction activities. Prior personal or household experience with dengue illness was a powerful motivator, with families that had been directly affected showing significantly higher rates of preventive behaviour. Socioeconomic status also played a role, as households with greater resources could more easily install screens, purchase repellents, and maintain their domestic environments.

Implications for Public Health Communication

The persistent knowledge-practice gap documented in these studies carried important implications for dengue communication strategies. The findings suggested that information-only approaches — such as mass media campaigns and educational brochures — were necessary but insufficient. While they could build knowledge and favourable attitudes, they did not reliably produce the sustained behavioural changes needed for effective community-based vector control.

Researchers recommended a shift toward more participatory, community-centred approaches that addressed the motivational and structural barriers to prevention behaviour. This included empowering community leaders to organise regular neighbourhood clean-up activities, establishing neighbourhood-level surveillance and response systems, providing practical tools and resources (such as larvicide tablets and inspection guides) rather than just information, and using social pressure and peer accountability as motivational levers.

Malaysia’s Evolving Dengue Control Landscape

The KAP research published in MJPHM during this period contributed to the evidence base that informed subsequent evolution of Malaysia’s dengue control strategy. By the 2010s, the country had moved toward a more integrated approach combining environmental management, community mobilisation, innovative vector control technologies (including sterile insect techniques and Wolbachia-based approaches), improved surveillance through real-time reporting systems, and legislative enforcement of breeding site elimination.

Despite these advances, dengue remains a major public health concern in Malaysia, with the country recording significant outbreaks periodically. The fundamental insight from mid-2000s KAP research — that knowledge alone is insufficient and that community engagement must address motivation, social norms, and structural barriers — continues to be relevant for current and future dengue prevention programmes.

Limitations

Studies from this period typically employed cross-sectional survey designs, which capture a single point in time and cannot determine the direction of causation between variables. Self-reported practices may overestimate actual behaviour due to social desirability bias. Most studies were conducted in urban settings and may not reflect the knowledge and practices of rural or semi-urban populations. The variety of questionnaire instruments used across different studies limited the comparability of findings. Additionally, the studies generally did not measure the actual impact of reported practices on Aedes breeding indices or dengue incidence, leaving the link between KAP findings and epidemiological outcomes partly inferential.