Knowledge, Attitude and Practice of Dengue Fever and Health Education Programme Among Students of Alam Shah Science School, Cheras, Malaysia

Background and Context

Dengue fever remains one of Malaysia’s most pressing public health challenges. The country has experienced a dramatic escalation in dengue cases over the past two decades, with annual case counts increasing from 7,103 in the year 2000 to over 100,000 cases per year in the mid-2010s. The annual incidence rate increased more than elevenfold during this period, from approximately 31.6 to over 361 cases per 100,000 population. Selangor and Kuala Lumpur have consistently recorded the highest number of cases and the greatest incidence rates nationally, making urban and peri-urban areas in the Klang Valley — including Cheras — focal points for dengue prevention efforts.

Dengue is caused by four serotypes of the dengue virus (DENV-1 through DENV-4) transmitted by Aedes mosquitoes, primarily Aedes aegypti and Aedes albopictus. In the absence of widely available vaccines or specific antiviral treatments at the time of this study, disease prevention relied almost entirely on vector control — reducing mosquito breeding sites — and on community behaviour change. The knowledge, attitude, and practice (KAP) framework has been widely employed in public health research to assess communities’ understanding of diseases, their emotional and cognitive responses, and the extent to which they translate knowledge into protective behaviour.

Study Design and Methodology

This study employed a two-phase design. The first phase was a cross-sectional survey assessing baseline KAP regarding dengue fever among 204 students at Alam Shah Science School, a residential upper secondary school established in 2003 in Cheras, Kuala Lumpur. The second phase was an interventional (pre-post) study evaluating the effectiveness of a structured health education programme in improving knowledge scores.

A self-administered questionnaire was used to collect data on socio-demographic characteristics, knowledge about dengue fever (transmission, symptoms, prevention), attitudes towards dengue prevention, and reported preventive practices. The knowledge component assessed understanding of the vector, disease signs and symptoms, and prevention methods. Attitude was measured through items assessing the perceived seriousness of dengue, personal responsibility for prevention, and willingness to participate in community control efforts. Practice questions addressed actual behaviours such as covering water storage containers, eliminating stagnant water, and participating in community fogging or gotong-royong (communal cleaning) activities.

Socio-Demographic Profile

The study population was predominantly Malay (96.6%), reflecting the composition of the residential science school. Approximately 64.6% of respondents reported a monthly family income exceeding RM 3,000, and 64.6% resided in urban areas during school holidays. The age range of participants corresponded to upper secondary school students (Form 4 and Form 5), typically aged 16 to 17 years.

The Knowledge-Practice Gap

Perhaps the most striking finding of this study was the substantial gap between knowledge and attitudes on one hand, and preventive practices on the other. While nearly two-thirds of students possessed good knowledge about dengue and approximately four-fifths held positive attitudes, nearly three-quarters reported poor preventive practices. This knowledge-practice gap — sometimes termed the “KAP gap” — is a well-documented phenomenon in health behaviour research and is particularly relevant in the context of vector-borne disease prevention.

Several factors may explain this disconnect. First, knowledge of disease facts does not automatically translate into the practical skills and motivation needed to sustain daily preventive behaviours such as routine inspection and elimination of water-collecting containers. Second, environmental and structural barriers — including limited personal agency over shared community spaces, reliance on municipal services for drain maintenance, and the residential school setting itself — may constrain students’ ability to implement prevention practices regardless of their knowledge level. Third, the residential school environment may limit students’ engagement with household and community-level mosquito control activities that are typically assessed in KAP studies.

Health Education Programme Effectiveness

The health education intervention consisted of structured educational sessions addressing dengue transmission, recognition of symptoms, first aid measures, and practical prevention strategies. Pre- and post-intervention knowledge assessments demonstrated a statistically significant improvement in knowledge scores following the educational programme (p < 0.001). This finding is consistent with the broader literature demonstrating that school-based health education interventions can effectively improve dengue knowledge among adolescents.

However, the study’s design did not include a follow-up assessment to determine whether the knowledge gains were sustained over time or translated into improved preventive practices. This is an important limitation, as the sustainability and behavioural impact of one-time educational interventions have been questioned in the health promotion literature. More intensive, multi-session programmes that incorporate practical skills training, peer education, and environmental management activities may be needed to bridge the knowledge-practice gap.

Implications for Dengue Prevention in Malaysia

The findings of this study support the need for comprehensive, multi-strategy approaches to dengue prevention that go beyond information dissemination. While health education remains an important component of dengue control, it must be complemented by environmental management interventions, community mobilisation efforts, and structural changes that make preventive practices easier and more accessible. School-based programmes offer an important channel for reaching young people, who can serve as agents of change within their families and communities.

The Ministry of Health Malaysia’s ongoing dengue prevention campaigns, including the comms4Dev (communications for development) programme and the Destroy Aedes Mosquito-Breeding Sites (DAMS) initiative, recognise the importance of community engagement alongside vector surveillance and control. Integrating KAP assessment into the monitoring and evaluation frameworks of these programmes can help identify knowledge deficits and behavioural barriers that need to be addressed through targeted interventions.

Limitations

This study was conducted in a single residential science school with a predominantly Malay student population, limiting the generalisability of findings to other demographic groups and settings. The use of self-reported practice measures may be subject to social desirability bias. The absence of a control group and the short follow-up period limit the ability to attribute observed knowledge changes solely to the educational intervention. Future studies should employ randomised controlled designs with longer follow-up periods and objective measures of preventive behaviour.

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