Although DF is prevalent in Ataq, we discovered that only 53.5% of people have a good level of knowledge about DF, which is slightly less than what was reported in Westmoreland, Jamaica, in 2010 [9] and in a tertiary hospital in Sri Lanka in 2019 [10]. Our findings surpass those of previous studies conducted in Pakistan in 2010 [11], Malaysia in 2020 [12], and Indonesia in 2015 [13].
Although most respondents indicated that fever, headache, and joint pain are obvious symptoms of DF, and only two-thirds of respondents reported that muscle pain and retro-orbital pain are symptoms of DF, most respondents were unable to identify skin rash and bleeding as symptoms of DF. In comparable studies conducted in Taiz (Yemen) [6], Jamaica [9], Malaysia [7], and Cambodia [14], fever was also reported as the primary symptom of DF. This could be explained by educational messages in the mass media citing fever as dengue’s primary symptom [15] or by the participants’ personal experience with the disease or witnessing a close friend or relative’s case. Thus, raising awareness of these signs and symptoms could aid in distinguishing DF from other febrile infectious diseases, particularly in developing nations where DF is endemic.
More than half of the participants (57.9%) were aware that not all mosquitoes can transmit DF, three-fourths (75%) were aware that Aedes mosquitoes (black mosquitoes) can transmit the disease, and the majority (56%) were aware that dengue mosquitoes are most likely to feed/bite during the day. These results are lower than those of other studies conducted in Taiz, Yemen, which found that 82.2% of respondents believed that Aedes mosquitoes transmit DF, and that approximately two-thirds of respondents knew that these mosquitoes transmit DF primarily during the day [6]. In addition, in rural Cambodia, 96.7% of individuals were able to identify mosquitoes as the dengue vector, and 74% of participants believed that the dengue vector bites during the day [14]. Moreover, our findings demonstrated that respondents had greater knowledge than rural communities in Hodeidah, where approximately one-third of respondents perceived the daytime transmission of DF [16]. The high illiteracy rate (30.3%) of the Shabwah community in this study may be one of the reasons for the community’s lack of knowledge regarding the mosquito species that can transmit DF.
The study revealed that members of the Shabwah community had misconceptions regarding the transmission of DF, as they reported that the disease is transmitted by flies (50.3%), direct contact with an infected person (43.2%), drinking contaminated water, or eating contaminated food (46.5%). These misconceptions are higher than in previous studies conducted in Taiz; 80.7%, 85.1%, and 68% of participants correctly believed that flies contact with infected individuals, eating contaminated food, and drinking contaminated water played no role in the transmission respectively. In addition, a previous study conducted in Hodeidah revealed that most participants believed that the disease could be transmitted from an infected person to a healthy person via direct contact. A study in Bangladesh reported that only 6% of respondents believed that DF is transmitted through human-to-human contact [6, 16, 17].
Most participants in the current study recognized that stagnant water and keeping water in uncovered containers play a significant role in the transmission of DF by mosquitoes. These findings are comparable to those of previous research conducted in Taiz [6], Southern Thailand [18], and highland and lowland communities in Central Nepal [19]. The strengthening of mass media messages and educational campaigns in recent years [20] may have contributed to improved identification of risk factors.
This study revealed that the Shabwah community comprehensively understood dengue preventive measures and diverse breeding habitats. Likewise, several studies conducted in Taiz and rural Cambodia have found knowledge levels comparable to those of this study population [6, 14].
Despite proper knowledge of DF prevention, there is a gap in the perception of the transmission, necessitating intensive education campaigns to correct misconceptions and change behavior to reflect good knowledge in the practical life of the community, which may be crucial for maintaining the health status of families and communities.
Most participants in our study (64.1%) had a positive outlook in their attitude toward DF with no statistically significant correlation to socioeconomic factors. Similar to previous research conducted in Yemen’s Taiz and Hodeidah governorates, our study revealed a positive attitude regarding the severity and transmissibility of DF, as well as its prevention and community participation [6, 16].
In addition to covering the body with clothing, using creams to repel mosquitoes, and using insecticide sprays to reduce mosquito populations, the respondents adopted additional preventive DF measures. Contrary to previous studies conducted in Yemen, which reported low levels of community practice [6, 16], our study reveals a high level of community practice. This is likely because the practices in the community are primarily influenced by local tradition, culture, education, and exposure to other governorates in recent history.
We found a significant correlation between the practice of preventing DENV transmission and education level. The practice scores of those with university education, followed by those with secondary education, were higher than those with primary education and those who were illiterate.
Spearman correlations reveal a weak relationship between the KAP domains of respondents in this study. Although there was a significant correlation, the positive linear relationship between the three domains was weak; the correlation coefficients for each domain were less than 0.20. The most popular source of information about DF was television (34.2%), followed by education campaigns (31.5%), and radio. Unprecedented research in Central Nepal revealed that radio was the primary source of [19] information. Several studies conducted in Taiz, KSA, and Indonesia have reported similar primary sources [5, 6, 15].
Limitations of the study
Due to the current internal conflicts and war, it is extremely difficult to travel between Yemen’s governorates to collect data, so this study has some limitations, such as a lack of generalizability. Another limitation is the use of the interview method for data collection which may be the reason for high score of the local community KAP toward DF.