Community Willingness to Participate in A Mosquito Breeding Site Eradication Program : A Study in Bandung , West Java , Indonesia

Despite many efforts to prevent dengue, vector control still promising specially through integrated vector management. This effort requires community participation. Therefore, it is crucial to understand the factors that are associated with the willingness of communities in high prevalence areas to participate in mosquito breeding eradication program. This study explored factors associated with the willingness of community members in Bandung to participate in the mosquito breeding eradication program initiated by Indonesian's government, called One House One Larvae Monitor. A communitybased cross-sectional study was carried randomly at sub-district level in Bandung from JanuaryNovember 2018. Interviews using a set of validated questionnaires were conducted to collect data on demography, socioeconomic status, knowledge, attitude and practice regarding implementation of the program. Among 210 participants, the proportion of low-to-middle knowledge, attitude, and practice (KAP) index is more prevalent. Yet, for attaining high-score on KAP, there are three main predictors observed; by being female, at least had attend undergraduate level of education, and being an entrepreneur. A good score in the attitude section does not necessarily translate to good score in the practice section. The results reflect the need for better tools for changing the behavior of society, and it should not be limited to enhancement of society’s knowledge.


INTRODUCTION
Dengue virus infection is one of the most important vector-borne disease in the world (Huntington MK, Allison J, 2016).Bhatt et al. estimated about 390 million DENV infections occurring each year, of which 96 million were seemingly evident (Bhatt et al., 2013).[In Indonesia, the first dengue reports in Jakarta and Surabaya were in 1968.Since then, it has been expanding in incidence and geography, and is likely hyperendemic nationwide (Suwandono et al., 2006)); (Karyanti et al., 2014), including Bandung (Respati & Ardini Raksanagara, Henni Djuhaeni, 2017).The disease results in loss of productivity, school absenteeism, and aggravation of poverty, high costs for health care and a burden on public health services (Elsinga et al., 2017).
As neither effective medication nor vaccines are available for DENV, vector control remains pivotal (Matthews, Dobson, Nkot, Wiles, & Birchmore, 2009).Vector control is crucial to reduce the burden of the disease.Vector control has a long-standing, proven record of preventing, reducing and eliminating vector-borne diseases (Townson et al., 2005).This strategy has been developed into chemical, biological, and physical controls (DeRoeck, Deen, & Clemens, 2003).
In implementation of vector-borne disease control, the term community participation has been broadly interpreted.Community-based vector control projects have been described as having both active and passive components (Ralph T. Bryan, Fanor Balderrama, Robert J. Tonn, 1994).National policy for vector control program is conducted by a combination of malathion fogging, temephos larviciding and source reduction.
The mass fogging is carried out during an epidemic under the supervision of Health Officers.The focal fogging is applied in an area within a radius of 100 m from DHF case happened.This is carried out by volunteers under the supervision of health workers.Mass larviciding during an epidemic and in highly endemic areas is considered as the complementary measure.The source reduction is conducted by community participation.Mass fogging have been expensive in terms of the chemicals and equipment used.They consume much time and labor if used as the primary methods of prevention, not to mention that it caused mosquito resistance problem (Soedarmo, 1994).
More priority should be given to the source reduction through community participation in order to prevent DENV [11].Unfortunately, it remains challenging to achieve community participation in this program, as previous study showed the lack of community participation in Bandung City (Lia Faridah, Titik Respati, Sunarjati Sudigdoadi, 2017).As crucial as it is, community participation in vector control for dengue remains a neglected topic in scientific literature (Elsinga et al., 2017).This strategy is driven by many social, economic and psychological factors, which need to be addressed for forging and implementing the effective health policy (Gunn et al., 2018), (Glanz & Bishop, 2010), (World Health Organization, 2012)).In Indonesia, several strategies have been done to strengthen community participation including a new program called "one house one larvae monitor".There is a gap on factors that influence the engagement of community participation to implement the new program.This study intends to know the knowledge, attitude and practice of community participants in implementing new strategy in Bandung City.

Sampling locations
This is a cross-sectional survey on communities and volunteers at 16 villages in Bandung City who had always supported government's programs.The sixteen villages were chosen with stratified random sampling based on 4 parameters: dengue incidence, population density, altitude and socio-economic condition.

Sampling method
Sampling units (households) were allocated proportionally to the sample size.The inclusion criteria for respondents which represented each household were: (1) female, (2) age above 16 years-old, (3) permanent resident in the area, (4)  n = The sample size E = Acceptance error of 10% Z = 1.96 (the standard normal score at the 95% confidence interval) P = 0.50 (P value of prevalent knowledge regarding mosquito is taken as 50%) (Dhaduk et al., 2013) The sample size was increased by 10% to allow for any missing or incomplete data that might occurred during the data collection (Sayavong, Chompikul, Wongsawass, & Rattanapan, 2015).Consequently, the required sample size was at least 106 households, minimal 7 houses for each village.Each household was represented by a mother or adult woman who was in charge of their house daily.

Ethics
This study approved by the ethics committee of Universitas Padjajaran with the ethical clearance registration number 071711.

Data collection
The questionnaire was tested for its validity and reliability by randomly selecting 30 respondents in Bandung.Three research assistants were standardized before collecting data.The interviews were done face to face and it required at least 10 minutes of time to completely fill the questionnaire.Permission for data collection was obtained from Bandung City Government and Bandung Health Institution, under the umbrella of our university's Dengue Project.Inform consent of the participants were taken after explaining the purpose of the study and noting their willingness to share the information.All data were recorded in Microsoft Excel 2007 sheet for further analysis.

Data analysis
The response from questionnaire were transformed into binary array, then each respondent was scored as the sum of its positive answers.Participants who have scored below and equal to first quartile; between first and third quartile; and equal and above third quartile were classified as low, middle, and high-scoring participants, respectively.Each question was assessed for its 95% confidence interval of, and its margin of error, as displayed on the tables below (Table 1-4).Demographic factors were evaluated to see its impact on the odds of having high score, calculated through multivariate logistic regression, performed on R Studio, and rounded to two decimal places.

Demography
This study used 210 participants from across Bandung City, with the age ranged from 20 to 72 years old.The most prevalent ages were between 35-49 years old, while there were only 6.7% participants who were above 65 years old.Female made a large portion of respondents (63.3%).Almost half of the participant had attained at least undergraduate level of education (41.9%), while the least fractions of respondents only received secondary education (3.3%).Interestingly, almost half of the participants were identified as housewives/unemployed (49.1%), followed by employee (25.7%, either as civil servants or in private sector).From the employed ones, only 3.3% (of total respondents) were health workers or related occupation (such as the volunteers in the Indonesian health care system).Only 5.7% of the respondents has been retired, showing that most of our respondents were economically in the productive stage.
Knowledge, attitude, and practice  Delving more deeply into the questions of the KAP assessment, there are four questions that significantly have more positive answers than the rest.This include (1) 'Know one of the sign of dengue infection is 2-7 days of fever', (2) 'Agree that you are responsible for regularly reporting to health workers', (3) 'Prevented dengue by draining, closing, recycling, cleaning mosquito breeding sites', and (4) 'Checked the presence of mosquito larvae in water reservoirs to prevent dengue'.Questions (1) is obtained from Knowledge section, questions (2) from Attitude section, and questions (3) and ( 4) obtained from Practice section (table 2, 3, Nevertheless, there are some questions that signify low positive results.Two questions from Knowledge section only answered positively by 46.7%, which is 'Know that fever sufferers should be in a cool room', and 'Know that fever sufferers should drink a lot'.Moreover, there are five questions in the Attitude sections that answered positively by less than 50% of the respondents.Those are 'Sprinkled Abate Powder which is done every two or three months at a rate of 10 grams Abate…', 'Sowed Abate powder to kill mosquito larvae', 'Used mosquito net during sleep and socialized it to prevent Dengue', 'Checked an empty and uninhabited house to check mosquito larvae', and 'Trained to become Jumantik cadre'.Yet, in the Indicators section, generally there are no low-scoring questions. This study was carried out to assess the knowledge, attitude, and practice of community participants in Bandung City.There is need to evaluate the gap on factors that influence the engagement of community participation to implement new "One House One Larvae Monitor" program.In short, what is observed from the results is there are certainly low overall score of KAP assessment from study participants (figure 1).
Low overall KAP score obtained from study participants also reflected by other previous studies.In Peri-Urban of Vientiane, the depth of their knowledge on Dengue was still low (Mayxay et al., 2013).Moreover, in semi-urban town in Malaysia, knowledge about Dengue transmission and control also deemed insufficient (Cho Naing, 2011).This shows that there is urgent need to improve the depth of understanding in society about the Dengue and close the gaps so that people have better collective participation in new programs.'Good attitude does not translate into good practice' phenomenon is a recurring pattern that emerges in this variety of study.
As shown in this study, there is no low-scoring questions (below 50% positive) in the attitude section, yet there are 4 low-scoring questions in the Practice section.A cross-sectional survey in Kuala Kangsar, Malaysia found that good knowledge does not necessarily lead to good practice (Hairi et al., 2003).A similar study conducted in Aligarh, India, showed typical results too, where society that receptive to the messages and adopted a change of behaviour is expected (Abedi, Khan, Ansari, & Amir, 2011).This shows that there is need for other means in translating and changing the behaviour of society in terms of Dengue programs, where not only knowledge is enhanced.
Main predictors of high indexes in this assessment is by being female, which is shown also in previous studies such as in Cambodia.This reflects on the social role of women in Indonesia as a caretaker, which imply higher odds of knowing and practically doing measures to prevent Dengue directly.The second one is education, where the longer of education duration is correlated to the higher odds of attaining overall higher score of this study KAP assessment.This pattern also found on previous studies where education level is correlated with higher understanding of Dengue (Shuaib, Todd, Campbell-Stennett, Ehiri, & Jolly, 2010), and that family's knowledge positively correlated with dengue prevention program (Hadriyati, A., Marisdayana, R., & Ajizah, 2016), for example the Indonesian 3M Plus program (AWALUDDIN, 2017).
The last predictor for high level of knowledge discovered in this study is by being an entrepreneur.This is one of the unique findings since health workers even does not make it to the top predictor of having high level of Dengue knowledge.This could be resulted from the inadequate sampling problem, which randomly selects large portion of high knowledge entrepreneur, while also include lowknowledge health workers.

CONCLUSION
To conclude, study participants in Bandung generally have low-to-medium knowledge regarding knowledge, attitude, and practice of Dengue prevention.The main predictor of high level of knowledge is by being female, attend undergraduate level of education, and being an entrepreneur.Another major finding is that good score in the attitude section does not necessarily translate to good score in the practice section.This imply a need to increase not only Dengue knowledge of the society, but also its practical behaviour so that the program implemented will have better success.

ACKNOWLEDGEMENT
Appreciation from authors to all participants who support and joint the survey.The authors thank all the research assistants, for this survey could not be done without their help.This study was supported by internal grant in the scheme of Academic Leadership Grant and Basic Competency Research (HIU ALG and HIU RFU).Bandung,West Java,

REFERENCE
Lia Faridah et.al  | Community Willingness to Participate in A Mosquito Breeding Site Eradication Program : A Study in Bandung, West Java,

Table 1 . Survey participant demographic information and its odds ratio for level of knowledge, attitude and practice
As shown in Figure1, most of the respondents scored low to middle level on KAP (Knowledge, Attitude and Practice) assessment.It is should be noted that the low, medium, and high indicator are designated to participants who scored less than or equal to1 st quartile, between first and third quartile, and equal & higher than third quartile, respectively.Further analysis showed that several predictors could affect the odds of high score with the KAP assessment, as shown in Table1.Being female, having at least undergraduate education, and being an entrepreneur are the main predictors of attaining high score.

Table 4 . Practice towards dengue prevention
Distribution of knowledge, attitude, and practice level regarding dengue symptoms and first aid.The low, medium, high indicator are designated as participants having score less and equal than 1st quartile, between first and third quartile, and equal and higher than third quartile, respectively.
Abedi, A. J., Khan, Z., Ansari, A., & Amir, A. (2011).SP5-23 Is knowledge and attitude correlating with practices?A KAP study on dengue fever.Lia Faridah et.al | Community Willingness to Participate in A Mosquito Breeding Site Eradication Program : A Study in