WORLD

Churi et al. JOURNAL OFWorld

PHARMACY AND PHARMACEUTICAL
Journal of Pharmacy SCIENCES
and Pharmaceutical Sciences
SJIF Impact Factor 5.210

Volume 4, Issue 10, 748-761. Research Article ISSN 2278 – 4357

STUDY OF IMPACT OF HEALTH EDUCATION ON KNOWLEDGE,

ATTITUDE AND PRACTICE RELATED TO DENGUE FEVER

Bhanu Vaishnavi G1, Shobha Churi*1, Narahari M G2, Justin Kurian1, Lalremruata B1,
Esther Laldinpuii1 and Frency Susan Baby1

1
Department of Pharmacy Practice, JSS College of Pharmacy, JSS University, Mysore,
Karnataka, India.
2
Department of Emergency Medicine, JSS Medical College and Hospital, JSS University,
Mysore, Karnataka, India.

ABSTRACT
Article Received on
03 Aug 2015, Dengue fever caused by viral pathogen belongs to the family
Revised on 25 Aug 2015, Flaviviridae that infects 80 million people with 30,000 fatality (Dengue
Accepted on 18 Sep 2015
hemorrhagic fever) cases in the world yearly. World Health
Organization (WHO) ranks dengue, as the most major mosquito-borne
*Correspondence for viral disease in the world. The objective of the study to measure the
Author
influence of education on knowledge, attitude and practice about
Dr. Shobha Churi
Department of Pharmacy
dengue fever and its association with patients demographic, socio-
Practice, JSS College of economic and literacy pattern. This was a prospective, educational
Pharmacy, JSS University, interventional study conducted over a period of six months in the
Mysore, Karnataka, India.
medicine unit of JSS Medical College Hospital. Patients enrolled in the
study were administered with a validated knowledge, attitude, practice
(KAP) questionnaire as a pre-assessment (prior to education). Then all the patients were
provided education with a pre-designed educational material and re-administering the KAP
questionnaire (post-education) and the overall scores were calculated. Pre and post-education
KAP scores were compared using paired t-test method. A total of 177 patients were enrolled
in the study majority of patients were males (60.4%) compared to females (39.6%). Study
results revealed a significant improvement in the mean KAP score from pre (24) to post-
education KAP questionnaire score (72.5). KAP score of both pre (27.9) and post (73.8)
education was high for females when compared to male participants (Pre-education KAP
score-24.11, Post-education KAP score-69.2). Analysis of study also exhibited significant (P
<0.05) improvement in the total KAP score of pre-education to post-education for all the

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participants. The study concludes that pharmacist mediated education has improved the
patient‟s knowledge, attitude and practice towards disease and this in turn can lead to better
adoption of measurements for prevention of dengue fever.

KEYWORDS: Dengue Fever, Patient Education, Knowledge, Attitude, Practice (KAP).

INTRODUCTION
Dengue fever is caused by a mosquito-borne human viral pathogen belonging to the genus
Flavivirus of the family Flaviviridae (single-strand, non-segmented RNA viruses),
transmitted in humans by two species of Aedes mosquitoes namely, Aedes aegypti (principal
vector) and Aedes aldopictus.[1] There are four dengue serotypes (DEN-1, DEN-2, DEN-3,
and DEN-4) disseminate disease in two main forms, dengue fever and dengue hemorrhagic
fever (DHF).[2]

Dengue virus transmission follows two general patterns epidemic and hyperendemic
transmission. Epidemic transmission occurs when dengue virus is introduced into a region as
an isolated event that involves a single viral strain. If the number of vectors and vulnerable
human hosts are adequate, explosive transmission can occur, with an incidence rate of 25-
50%. Hyperendemic transmission is characterized by the continuous circulation of multiple
viral serotypes in an area where a large pool of susceptible hosts and a competent vector
(with or without seasonal variation) are persistently present and is the leading pattern of
global transmission. Hyperendemic transmission appears to be a major risk for dengue
hemorrhagic fever.[2, 3]

In India, the virus was first isolated in fifties. Occurrences have been reported from different
parts of the country, largely, from metropolitan regions. The outburst of dengue in Delhi
reported 423 deaths during 1996.[3] In its nationwide prevalence, it affected nearly 16,531
people causing 545 deaths. In 1997, 5,726 cases and 10 deaths were reported.[4] From then
the incidence of dengue cases has been increasing by 2% each year.[3] The situation in our
country is reflected by the occurrence of major dengue outbreaks over the preceding few
years. No consistent data is available on hand to assess the exact magnitude of the disease in
our country. In reality, several of the smaller outbreaks go unreported.[3, 4] Although dengue
fever is not constantly fatal, it is a troublesome and devastating disease with no effective
cure. Six percent of dengue fever cases end up in dengue hemorrhagic fever, which can
progress into a critical condition called dengue shock syndrome and it is associated with 40–

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50% fatality if untreated or wrongly treated. When properly treated, the fatality rate can be
reduced to 5% or less.[4] The loss caused by dengue fever is not only accounted in terms of
pain and suffering of individuals affected, but the management and prevention of dengue also
imposes an enormous economic burden upon governments and communities. Globally there
is a vague estimation of 50 million cases of dengue yearly, equal to 527,000 disability
adjusted life years (DALYs). Another economic cost of dengue fever which is difficult to
quantify is the impact on tourism. This happened in India and Thailand after cases rose from
166 in 2009 to 406 in 2010. This could have a serious impact for a country in which the
tourism sector contributes 6% to national Gross Domestic Products (GDP).[5]

Mysore is an endemic area for dengue, recording more number of confirmed cases in the state
since January 2013.[2] The number of suspected cases visiting major hospitals has also gone
up, which make it difficult for the healthcare team to cope with the sudden rise in dengue
fever cases. More than 40 suspected patients have been reported in a day from various
hospitals in Mysore out of which at least 23 patients were positive to dengue test.[6]

Providing education or awareness about dengue fever is critical for the prevention or control
of dengue fever especially in areas having high incidence of the disease like India. Since
there are no vaccines for this disease, the only way to exterminate dengue virus is to provide
education towards the disease.[7] Providing education and awareness will increase the
patient‟s knowledge, attitude and practice of preventive measures towards the disease which
can lead to more desirable outcome.[8] Till date there are a few interventional studies done on
knowledge, attitude, practice (KAP) related to dengue in India. Thus, the present study was
carried out with the aim of assessing the impact of education on KAP about dengue fever
among patients. This study was conducted at JSS Medical College Hospital, a tertiary care
teaching hospital, covering the patients coming from rural, semi-urban and urban areas.

MATERIALS AND METHODS

This study was a prospective educational interventional study conducted from October 2013
to March 2014 in the inpatient medicine units of JSS Medical College Hospital Mysore. The
medicine ward consists of six units, on an average around 110 to 120 patients are admitted
per week in these units. The study was approved by the Institutional Human Ethics
Committee of JSS College of Pharmacy, Mysore. The patients aged ≥18 years of either
gender admitted to medicine wards with the diagnosis of dengue fever with or without co-
morbidities were included in the study. Patients who are not co-operative and not willing to

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participate in the study were excluded. Data about the patient‟s age, gender, educational
level, marital status, diagnosis, treatment were obtained from the various sources like,
inpatient case records, treatment charts and laboratory investigations, interview with patients
and patient care takers, interview with health care professionals.

A suitable data collection form was designed for use in the study. The data collection form
contains parameters like patient name, age, weight, gender, in-patient number, occupation,
education qualification, allergies, diagnosis, past medical history, social history, duration of
illness, treatment chart and KAP score. The data collected was documented in both hardcopy
and in electronic database created in Microsoft access 2007 for easy retrieval of the data.

Development of KAP questionnaire: Validated KAP questionnaire was used in the study.
These questionnaires had shown significant results in the study conducted by A.J. Abedi et
al.[9] The English version of KAP questionnaire was translated to Kannada version by
linguistic experts at Central Institute of Indian Languages. Both the English and Kannada
questionnaires were validated by administering the questionnaire to 20 persons. After 15 days
both questionnaires were once again administered to the same 20 people. It was found that
understanding of the questions at different point of time was same.

Designing and validation of educational material: The educational material was designed
by the project team and it includes the basic introduction about the dengue fever, information
regarding how it is transmitted, the major signs and symptoms, the diagnosis procedure,
complication of dengue fever, treatment available and the prevention and control measures
against dengue fever. The English version of educational material was translated to Kannada
and translation was done by linguistic experts at Central Institute of Indian Languages. The
concurrent validation of English and Kannada educational material was done by a clinical
pharmacist and a physician.

Study procedure: Patients who met the inclusion criteria were enrolled in the study after
obtaining a signed informed consent form, from the patients or patient‟s caretaker. A
validated KAP questionnaire was administered to all the patients as a pre-assessment (prior to
education) to assess the knowledge, attitude and practice about disease. Then all the patients
were provided education with the pre-designed educational material about 10-15 minutes.
After 5 days, the KAP questionnaire was re-administered (post-education) to assess the
knowledge, attitude and practice about dengue fever and the overall scores were calculated

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again. Pre and post-education KAP scores were compared to assess the impact of health
education. Association of dengue fever with demographics, socio-economic and literacy
pattern was also assessed.

The questionnaire was divided into 4 core categories and they are as follows.
Part I (Socio-demographic)
There were 11 questions in this part which include all the demographic details of the patient,
education level, employment status, income, any previous exposure to the disease, and source
of information about dengue fever.

Part II (Knowledge regarding dengue fever)

There were 14 questions in this section that focus on the knowledge of dengue fever which
included signs and symptoms, cause, treatment and prevention. Each question had two
choices. A correct answer was given 1 score and 0 score for a wrong answer. The score
varied from 0 – 14 points and was classified into 3 levels, high level with score 12-14 (80-
100%), moderate level had score from 9-11 (60-70%) and low level score was 0-8 (less than
59%). Bloom‟s cut-off point scoring procedure is used in which cut off score/points are
determined to the particular questionnaire and these points are then converted into
percentages.[10]

Part III (Attitudes regarding dengue fever)

This part includes attitude questionnaire like, the aspect of prevention and it was assessed by
using Likert‟s scale. Likert (1932) developed a procedure for measuring attitudinal scales.
The original Likert scale used a series of questions with five response alternatives: strongly
approve (1), approve (2), undecided (3), disapprove (4), and strongly disapprove (5). Hence,
Likert scales are often called summative scales. In a “good” Likert scale, the scale is balanced
on both sides of a neutral option, creating a less biased measurement.[11] There were 12
statements which included both positive and negative. The rating scale was measured as
follows positive statement choice and score were; (strongly agree - 5, agree - 4, neither agree
nor disagree – 3, disagree – 2 and strongly disagree – 1). For negative statement scores were
opposite (strongly agree - 1, agree - 2, neither agree nor disagree – 3, disagree – 4 and
strongly disagree – 5).

The scores varied from 12 to 60 and all individual answers were summed up for total scores
and calculated for means. The scores were classified into 3 levels; Positive Attitude (47-60

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scores), Neutral Attitude (41-46 scores) and Negative Attitude (12-40 scores).

Part IV (Practices regarding dengue fever)

The score in practices regarding dengue prevention of the participants varied from 0 to 8,
and were classified into 3 levels. These variables were given value zero for “no” and value
one for “yes” and were categorized as good practice having score from 07 – 08 (76-100%),
fair practice with score 05 – 06 (51-75%) and poor practice score was 00 – 04 (less than 50%)
(Bloom‟s cut off point, 60-80%).[10]

Data Analysis: Data analysis was done using SPSS version 20 Program and windows excel
2013. All the collected data was analyzed in order to assess the impact of patient education
on knowledge, attitude and practice of the dengue fever towards the patients. During the
study, influence of co variables like association of dengue fever with demographic, socio-
economic and literacy pattern was also assessed. Descriptive statistics (percentage, mean and
standard deviation) were used primarily to summarize and describe the data. For analytical
statistic “paired t-test method” was used for the comparison between pre-education and post-
education data. P<0.05 is considered as significant. Later the association of demographics,
socio-economic and education on pre-education KAP score was assessed through descriptive
statistics (percentage).

RESULTS
The study involved a total of 177 participants who successfully answered all the baseline and
follow up questionnaire. Among the enrolled, 107 (60.4%) were male and 70 (39.6%) were
female with a male: female ratio of 1.5:1. Greater part of participants belong to the age group
of 21–40 years (77(43.7%)).Majority participants were educated till primary school
(85(48%)) followed by secondary education (44(24.8)%). Nearly about half the participants
were unemployed (85(48%)), it includes all the three category patients like housewife‟s,
students and aged population followed by economically active participants (74(42%)) and
least was employed population (18(10%)). Table 1 illustrates demographic details of the
participants.

Knowledge on dengue fever: Participants answered a total of 14 close ended, multiple

choice questions about dengue fever. Each correct response was given one mark with a total
of 14 marks. At pre-education, majority of participants (153(87%)) had “low knowledge”
followed by 24(13%) participants had “moderate knowledge” where as majority of

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participants (123(68.9%)) had “high knowledge” followed by (54(1.0%)) participants had

“moderate knowledge” at post-education. The details are shown in table 2. The mean ± sd
knowledge score for the participants was 2.5±1.5 at pre-education level out of possible 14
points. There was significant (P<0.05) improvement in knowledge score from pre (2.5±1.5)
to post (12.5±1.8) education (Table 3). In the study only about 19(11%) of the participants
knew about vector behaviour, the time period when a mosquito bites and symptoms of
disease. Of the total participants 161(91.4%) knew that empty stagnant water from old tyres,
trash cans, and flower pots can be breeding places for mosquitoes a pre-education . Only 4%
of participants correctly answered questions regarding the use of abate sand for the
prevention of mosquito‟s larvae at pre education. At pre-education only 11% and at post-
education 99% of participants answered correctly for questions like; principle vector to cause
dengue, symptoms and time of mosquito bit.

Attitude on dengue fever: Participants were interviewed with 12 questions which had a total
score of 60. There were only 3(1.6%) of participants who had “positive attitude”, 40(22.5%)
of them had “neutral attitude”, and while majority of the participants 134(75.7%) had
“negative attitude”. After education the 143(80.7%) participants found to have “positive
attitude” and 34(19.2%) had “neutral attitude. The mean ± sd score for attitude of all
participants were 38.4±8.7 out of a possible 60 points at pre-education. There was significant
improvement in attitude score from pre (38.4±8.7) to post-education (52±7). Distribution of
scores of attitudes on dengue fever of the participants is shown in table 3. Study results
reveals that at pre-education, 116(66%) participants “strongly agree” and at post-education,
44(25.4%) participants “agree” that dengue is serious disease and precautions should be taken
against it.

Practice on dengue fever: Range of the respondent‟s practice scores was 1 to 8. Out of 8
possible points for practice questionnaire mean ± sd was found to be 2.0±1.8 at pre-
education. Majority of the participant (127(71.7%)) had “poor practice” followed by
46(25.4%) participants had “fair practice”, and only 4(2.8%) of the participant had “good
practice” at pre-education level. About 25.4% participants scored 80% in practice regarding
dengue fever at pre-education. Only 48 (26.8%) participants do not have the habit of
checking stored water container, stagnant water pools nor have the responsibility of disposing
the waste at pre-education. Ninety eight percent of the participants cover the water jars after
using it immediately which is a very good practice at pre-education.

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Majority of the participants (75.3%) use mosquito nets and coils as preventive practice
against mosquito bite at pre-education. Total 124 (70%) of the participants found to have
“good practice” and 53 (30%) participants had “fair practice” at post-education. There was
improvement in the practice of preventive measures after counselling the participants with
education leaflet. The practice mean ± sd score was found to be 7.0±1 after education. There
was a significant (P<0.05) improvement in the mean ± sd practice score from pre-education
score (2±1.8) to post-education score (7±1) table 3.

Knowledge, attitude and practice (KAP): The pre-education mean ± sd of total KAP was
24±11.3 and the mean ± sd after post-education was 72.5±6.8 with P value of <0.05 at 95%
confidence interval. Study showed a positive impact of education on the KAP of the dengue
fever and significant improvement in aspects of knowledge, attitude and practice [figure 1
and table 3].

Association of demographics with the score of KAP: Results of pre-education KAP test
states that, female participants (KAP score percentage:34.10%) are having better knowledge,
attitude and practice towards dengue fever when compared to male participants (KAP score
percentage: 29.2%). However, there was no significant statistical difference observed
between males and females. The pre and post-education KAP score was found to be highest
in the participants who are less than 20 years of age (34 (42.40%)). This could be because
most of the people from this age group are college students who had prior knowledge about
dengue fever through education. Percentage of pre-education KAP scores among various age
groups is shown in the table 3.

Influence of education on the score of KAP: A significant difference was observed among
the various educational groups where a higher education correlates to a higher pre and post-
education KAP score (P<0.05). Graduates were having 44.5% of pre-education KAP and
93.1% of post-education KAP which is highest among the other groups. Least pre-education
score was found in illiterate group. The details are shown in table 3.

Influence of socio-economic status on the pre-education KAP scores: There was no

significant (P>0.05) association between socio-economic status and pre or post-education
KAP score.

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Table 1: Distribution of participants based on demographic details.

Parameters Categories Number of Patients n (%)
Male 107 (60.4)
Gender Female 70 (39.6)
<20 19 (10.7)
Age 21-40 77 (43.7)
41-60 63 (35.5)
>61 18 (10.1)
Primary 85 (48)
Education Secondary 44 (24.8)
Graduation 29 (16.5)
Illiterate 19 (10.7)
Employee 18 (10)
Socio-economic
Economically active 74 (42)
status
Unemployed 85 (48)

Table 2: Distribution of participants based on knowledge, attitude and practice scores.

Number of patient’s Number of patient’s
Parameters
Pre–education (%) Post–education (%)
Knowledge
High knowledge (12-14) 0(0%) 123(68.9%)
Moderate knowledge (9-11) 24(13%) 54(31.0%)
Low knowledge (0-8) 153(87%) 0(0%)
Attitude
Positive attitude (47 – 60) 3(1.6%) 143(80.7%)
Neutral attitude (41 – 46) 40(22.5%) 34(19.2%)
Negative attitude (12 – 40) 134(75.7%) 0(0%)
Practice
Good practice (7 – 8 ) 4(2.8%) 124(70.0%)
Fair practice (5 – 6) 46(25.4%) 53(29.9%)
Poor practice (0 – 4) 127(71.7%) 0(0%)

Table 3: Knowledge, attitude and practice scores at pre-education and post- education
level based on demographics of participants.
KAP/Demographics KAP Score [Mean ± sd (%)] P value
data (n=177) Pre-education Post-education
Overall KAP score 24 ± 11.3 (29) 72.5 ± 6.8 (88.6)
Knowledge 2.5 ± 1.5 (17.5) 12.5 ± 1.8 (89.2) < 0.05
Attitude 38.4 ± 8.7 (64) 52 ± 7 (86.6)
Practice 2 ± 1.8 (25) 7 ± 1 (87.5)
Age (years)
<20 (n= 19) 34.8 ± 6.3 (42.4) 73.2 ± 5.4 (90)
21-40 (n=77) 29.8 ± 5.2 (35.2) 71.1 ± 6.9 (86.7)
41-60 (n=63) 24.5 ± 8.9 (29.7) 70.9 ± 8.3 (86.4) < 0.05
>60 (n=18) 22.9 ± 9.2 (26.8) 70.6 ± 4.9 (86)
Education

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Illiterate (n=19) 23.7 ± 9.2 (28.9) 71.1 ± 8.4 (86.7)

Primary (n=85) 24.2 ± 11.8 (29.5) 70.3 ± 9.2 (86.2)
Secondary (n=44) 24.3 ± 12.7 (29.4) 72.19 ± 5.5 (87.3) < 0.05
Graduate (n=29) 36.4 ± 9.2 (44.5) 75.11 ± 6.8 (93.1)

Figure 1: Knowledge, attitude and practice mean scores at pre and post education level

DISCUSSION
The objective of health education on dengue fever was to inform people the available
scientific knowledge of the disease, so that it could be used to bring changes in attitudes and
practices for better health. The distribution of male and female participants ratio in our study
was similar to a study conducted by Madiha syed et al where 61% were males and 39% were
females.[12] Also gender distribution pattern of our study is similar to studies conducted by
Ahmed Itrat et al and Begonia C et al.[13,14] Socio-economic status of the participants
included, were in contrast to the results of the study conducted by Madiha Syed et al in
Karachi, and Soodsada Nalongsack et al where only 4.5% were unemployed and 71% were
employed.[12, 15]

It emphasizes the need to conduct of awareness programs regarding community infections

like dengue. The results of our study have demonstrated that participants were knowledgeable
(91.4%) at pre-education KAP, which was not similar in studies by Madiha Syed et al and
Faisal Shuaib et al where in 54.9% and 62.2% had knowledge about identifying breeding
place of mosquito respectively.[12,16] Stratification of education level from our study was
similar to a study conducted by Tran Tan Tram et al, where in 6% were illiterate, majority
(52%) had primary schooling, remaining 35% had secondary schooling.17 In the current study
11% of the participants knew signs and symptoms, vector that causes the disease at pre-

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education KAP, which was similar to Tran Tan Tram et al study where only small proportion
12.5% of participants knew about dengue symptoms.[17] Though only 4% participants in our
study have knowledge about use of abate sand, when evaluated against Soodsada Nalongsack
et al study where 41.7% sample sizes identified abate sand.[15] In post-education KAP test
68.9% participants had high knowledge in our study, which was similar to Tran Tan Tram et
al study where (68%) participants had high knowledge.[17] About 66% participants strongly
agree to the statement that dengue is a serious disease and precautions should be taken
against it, and similar observation was found in the study of Madiha Syed et al, Faisal Shuaib
et al, and Amar Taksande et al, however only little proportion of subjects knew the symptoms
of disease.[12,16,18] Thus bridging the gap in knowledge is essential in the design of programs
to educate participants on personal protection against mosquitoes.[16] The outcome of practice
score in pre-education KAP test had only 25.4% of participants with fair knowledge, that
was similar to the findings in Faisal Shuaib et al study (28.5%).[16] It was necessary to note
that although majority of participants (91.4%) knew that stagnant water is breeding place for
mosquitoes, yet a significant proportion of participants followed poor practice measures. This
inconsistency between knowledge and practice implies that „good knowledge does not
necessarily lead to good practice’ which was similar to the observation of other studies
conducted by Madiha Syed et al, Begonia C. Yboa et al, Soodsada Nalongsack et al and S.
Matta et al.[12,13,15,19]

Most of the participants (75.3%) make use of mosquito nets and coils as preventive practice,
which was consistent with study results conducted by Soodsada Nalongsack et al (79.1%) and
S. Matta et al (77.21%).[15, 19] The overall pre and post-education KAP outcome in this study
was similar to Tran Tan Tram et al study where in there was a significant difference between
pre and post-education (P<0.05).[17] In the present study female participants have more KAP
score percentage (34.10) when compared to male participants (29.2) which was similar to the
results stated in Wan Rozita et al with evidence that females (46.8%) have more knowledge,
attitude and practice when compared to male population (32.1%).[20] This could be due to
confounding factor of health seeking behavior among the members of society. Age factor also
had an significant (P<0.05) association in pre-education KAP sore, where patients with less
than 20 years of age have high KAP score percentage (42.4%) among all the other age
groups. Probably this could be due to the effect of education factor along with age where
most of patients with less than 20 years of age were college students. Thus pre-education
KAP scores also found to have significant associations with education groups (P<0.05)

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stating higher education have higher KAP score. Other study by Madiha Syed et al also have
shown a significant association among the literates and illiterates regarding the KAP of
dengue fever (P<0.05).[12] In present study socioeconomic status doesn‟t show significant
(P>0.05) association with pre-education KAP score and economic status (P>0.05). The
studies conducted by by Madiha Syed et al and Wan Rozita et al. reveals that there is no
significant association with KAP scores and economic status.[12, 20] Most of the participants
came to know their individual responsibility in practicing preventive measures with regard to
dengue fever. Analysis of this study advocates the use of health education program by health
care professionals in improving the knowledge, attitude and practice of public. Health
education provided to a patient, increased their understanding of the problem and encouraged
their participation in prevention and control measures against the disease.[17]

Our results must be construed with several potential limitations the most of which may be,
less proportion of sample size that limits our ability to detect associations and yielded
estimates that lacked precision. Secondly, since the study was interviewer-based use of
questionnaires, some participants would provide socially desirable responses to some
questions.

CONCLUSION
The purpose of health education on dengue fever was to raise awareness about the disease
that could be prevented. There was significant improvement with educational intervention
regarding knowledge, attitude and practice among the participants. Participants demonstrated
gaps in knowledge and poor attitude which may affect the level and frequency of preventive
practices. By the end of the study the intervention with aid of clinical pharmacist and also
education material showed improvement in patient‟s knowledge, attitude and practice
regarding dengue fever. Study highlights that educating patients is the need of the hour in
improving the knowledge, attitude and practice of preventive measures for the complete
control over the endemic disease.

ACKNOWLEGEMENTS
The Authors thank JSS University, all the health-care professionals at the hospital, the Head
of the Department of Pharmacy Practice, and the Principal of the JSS College of Pharmacy
for providing us support in the conduct of this study.

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