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\begin{document}


\def\RunningAuthor{Rajaseger~Nirmal~Kumar\space\textit{et al.}}
\firstPage{6612}
\articleType{Original Article}
\receivedDate{16 Aug 2020}
\acceptedDate{21 Sep 2020}
\revisedDate{16 Sep 2020}
\journalVolume{2020, 11}
\journalIssue{4}
\journalDoi{ijrps.v11i4.3568}
\copyrightYear{2020}
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\title{\textbf{Environmental Risk Mapping for Dengue Fever Transmission in a Rural Area, Tamil Nadu} \textbf{\space }}
\author{Rajaseger~Nirmal~Kumar,  
            Anantha~Eashwar~V~M,  
            Ruma~Dutta\textsuperscript{*},  
            Nisha~B,  
            Gomathy~Parasuraman,  
            Yogesh~Mohan, 
            Timsi~Jain~\\[5pt]{Department of Community Medicine, Saveetha Medical College Hospital, Thandalam, Tamil Nadu, India}}

\begin{abstract}
Dengue is a systemic viral infection transmitted between humans by Aedes mosquitoes. Dengue is a viral infection which originates from mosquitoes. Dengue is caused by a virus called the dengue virus (DENV). Most notably, there are four major DENV serotypes. Therefore it is possible to be diseased by either four or all four of them. As seen in most cases, DENV infections usually cause a mild infection, but it can also lead to an acute flu-like illness. Occasionally this proliferates into a possibly deadly problem, called severe dengue. The Detection and mapping of Dengue risk areas is a multifaceted, tiring, complicated and extended task requiring evaluation of many criteria. It is not sure that always one single factor is liable for Dengue Fever transmission in all areas, but it differs with changing geographical location. The main objective of the present study is to prepare an environmental risk mapping for dengue transmission in a rural area, Tamil Nadu and access the level of risk the people of that area are in and how susceptible they are to dengue. A total of 40 houses were observed for risks of dengue using a questionnaire and by looking around the house for possible hotspots after screening for inclusion and exclusion criteria. There is hence a need for educational programs to facilitate awareness and promote sensible practices to avoid dengue. Every individual should also follow precautionary guidelines taking into consideration the risk dengue. This study serves to spotlight the possible current risk in contracting dengue due to poor household habits and lack of awareness in a rural area. 
\end{abstract}\def\keywordstitle{Keywords}

\begin{keywords}mosquito,\newline ecological factors,\newline vector transmission,\newline rural area
\end{keywords}
\twocolumn[ \maketitle {\printKwdAbsBox}]
\makeatletter{\raggedright\textsuperscript{*}Corresponding Author\par Name:\ Ruma~Dutta~\\ Phone:\ 9952885332~\\  Email:\ rumadr14@gmail.com
        \par}\vspace*{-11pt}\hrulefill\par{\fontsize{12}{14}\selectfont ISSN: 0975-7538}\par% 
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        \makeatother
        
    
\section{Introduction}
One of the most common arboviral diseases passed to human beings from mosquito vectors is Dengue fever (DF) belonging to the genus Aedes \unskip~\citep{901982:20488545}; the key factors affecting the spread of this virus include mixing virus serotypes, the vulnerability of human populations and mosquito density \unskip~\citep{901982:20488544}.

The only manner to control this deadly virus is to impose vector control as there is no vaccine or precis treatment; this invariably places greater importance on prediction and identification of possible risk areas to assist in dengue prevention \unskip~\citep{901982:20488549}.

There are many parameters and reasons to determine the reasons for the expansive rise of dengue. These include growth of human population, nature of vectors, the biology of population, the natural course of the history of the virus, human actions against nature and many more. In terms of environmental factors, rainfall, temperature, humidity are well-known determinants that can affect various developmental phases of dengue vector thereby limiting the occurrence of DF \unskip~\citep{901982:20488540,901982:20488541,901982:20488539}. 

The goal of effective and efficient risk assessment can be achieved by a broader-scale and prognostic point of view which asses risk that is not only about the already sampled areas but also expanded to new, unsampled areas analytically and logically \unskip~\citep{901982:20488551}. The study of risk mapping is one of the components used to evaluate the risk patterns of health care practitioners as well as recommends necessary changes in the living conditions to provide the best environment to the patient. Thereby risk mapping studies are an essential indicator to judge the quality and standard of living among individuals of a specific area. The current study is aimed to analyze the living conditions of people of a rural area and evaluate the risks of dengue in that region. This will help us gain knowledge on the prevalence of dengue in that locality and finally assessing the trend of dengue cases. 

\textbf{Aims and Objectives}

To determine the household and environmental risk factors for dengue transmission in a rural area, Chennai.

\textbf{Methodology}

\textbf{Study Design}

Cross-sectional Study.

\textbf{Study Duration}

The study was conducted for a period of 3 months, starting from Jan 2020 to March 2020.

\textbf{Study Participants}

 Adult above 18yrs who will be available at the household

\textbf{Study Area}

The study was conducted in Mappedu, Tamilnadu

\textbf{Sample size}

All the 40 houses from the three different streets near the rural health Centre were included in the study.

\textbf{Study Tool and Data Collection}

A Pre-tested, validated, structured and self - administered questionnaire consisting of their socio-demographic details, assessment of environmental factors of household and assessment of potential breeding sources.\textbf{\space }Data were obtained from each house after rigorous scrutiny and careful examination, accessible areas were thoroughly covered. Epicollect 5 was used to collect relevant data.

\textbf{Informed consent}

It was obtained from all the study participants before eliciting the desired information. 

\textbf{Inclusion criteria}

All houses in a particular location were included in the study.

\textbf{Exclusion criteria}

The study participants who didn't give proper responses to specific questions.

\textbf{Ethical clearance}

The study was carried out after getting approval from the Institutional Ethics Committee. Permission to carry out the study was also obtained from the Head of Community Medicine Department before starting the study.
    
\section{Results}
\textbf{Socio-demographic details of study participants}

Totally 40 houses were included in this study after screening for inclusion and exclusion criteria. Majority of the study participants were female (82.5\%) and between the age of 41-50 (22.5\%) or 51-60 (27.5\%). The educational qualifications of the personnel surveyed are as follows, 2 (5\%) have no formal schooling, 9 (22.5\%) have primary schooling, 22 (55\%) people have a high school education, 5 (12.5\%) have completed higher secondary, and 2 (5\%) have completed graduate or higher.

The distribution of monthly income of the interviewed personnel are as follows most people have an income range between 5000-9999 being 24 (60\%), 6 (15\%) have an income range of 10000-14999, 1 (2.5\%) has an income range of 15000-19999, 5 (12.5\%) have an income range of 20000-24999 and 4 (10\%) have an income of more than 24999. The number of family members is hugely varied three families (7.5\%) have one person in the family, 13 families (32.5\%) have two people, 13 families (32.5\%) have three people, four families have (10\%) have four people and seven families (17.5\%) have more than four people. The per capita income of the households are as follows, 23 (57.5\%) of households fall between 1000-2500, 12 (30\%) of households belong to 2501-5000, 3 (7.5\%) households fall between 5001-10000 and 2 (5\%) households have a per capita of greater than 10000 (Table~\ref{tw-524418086b61}).


\bgroup
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\caption{\boldmath {Distribution of breeding spots}}
\label{f-687c057aaced}
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\caption{\boldmath {Distribution of breeding spots}}
\label{f-00248ca11b8a}
\end{graph}
\egroup

\begin{table*}[!htbp]
\caption{\boldmath {Distribution of socio-demographic details of study participants} }
\label{tw-524418086b61}
\def\arraystretch{1.1}
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\begin{tabulary}{\linewidth}{p{\dimexpr.3376\linewidth-2\tabcolsep}p{\dimexpr.3588\linewidth-2\tabcolsep}p{\dimexpr.3036\linewidth-2\tabcolsep}}
\tbltoprule \rowcolor{kwdboxcolor}\multicolumn{2}{p{\dimexpr(.6964\linewidth-2\tabcolsep)}}{Variables} & Assessment of demographic details\\
\tblmidrule 
Gender &
  Male : Female ratio &
  1:1.43\\
Age &
  21-30 \mbox{}\protect\newline 31-40 \mbox{}\protect\newline 41-50 \mbox{}\protect\newline 51-60 \mbox{}\protect\newline 61-70 \mbox{}\protect\newline {\textgreater}70 &
  1 (2.5\%) \mbox{}\protect\newline 7 (17.5\%) \mbox{}\protect\newline 9 (22.5\%) \mbox{}\protect\newline 11 (27.5\%) \mbox{}\protect\newline 8 (20\%) \mbox{}\protect\newline 4 (10\%)\\
Educational qualifications \mbox{}\protect\newline  &
  No formal education \mbox{}\protect\newline Primary schooling \mbox{}\protect\newline High school \mbox{}\protect\newline Higher secondary school \mbox{}\protect\newline Graduate and above &
  2 (5\%) \mbox{}\protect\newline 9 (22.5\%) \mbox{}\protect\newline 22 (55\%) \mbox{}\protect\newline 5 (12.5\%) \mbox{}\protect\newline 2 (5\%)\\
Monthly income &
  5000-9999 \mbox{}\protect\newline 10000-14999 \mbox{}\protect\newline 15000-19999 \mbox{}\protect\newline 20000-24999 \mbox{}\protect\newline {\textgreater}25000 &
  24 (60\%) \mbox{}\protect\newline 6 (15\%) \mbox{}\protect\newline 1 (2.5\%) \mbox{}\protect\newline 5 (12.5\%) \mbox{}\protect\newline 4 (10\%)\\
Number of family members &
  1 \mbox{}\protect\newline 2 \mbox{}\protect\newline 3 \mbox{}\protect\newline 4 \mbox{}\protect\newline {\textgreater}4 &
  3 (7.5\%) \mbox{}\protect\newline 13 (32.5\%) \mbox{}\protect\newline 13 (32.5\%) \mbox{}\protect\newline 4 (10\%) \mbox{}\protect\newline 7 (17.5\%)\\
Per capita income &
  1000-2500 \mbox{}\protect\newline 2501-5000 \mbox{}\protect\newline 5001-10000 \mbox{}\protect\newline {\textgreater}10000 &
  23 (57.5\%) \mbox{}\protect\newline 12 (30\%) \mbox{}\protect\newline 3 (7.5\%) \mbox{}\protect\newline 2 (5\%)\\
\tblbottomrule 
\end{tabulary}\par 
\end{table*}

\begin{table*}[!htbp]
\caption{\boldmath {Assessment of environmental characteristics of study participants} }
\label{tw-f0afd6e2102d}
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\begin{tabulary}{\linewidth}{p{\dimexpr.4503\linewidth-2\tabcolsep}p{\dimexpr.3823\linewidth-2\tabcolsep}p{\dimexpr.16740000000000002\linewidth-2\tabcolsep}}
\tbltoprule \rowcolor{kwdboxcolor}\multicolumn{2}{p{\dimexpr(.8325999999999999\linewidth-2\tabcolsep)}}{Variables} & Assessment of Ecological factors\\
\tblmidrule 
Type of floor \mbox{}\protect\newline  &
  Hard floor  \mbox{}\protect\newline Earth floor &
  22 (55\%) \mbox{}\protect\newline 18 (45\%)\\
Type of wall &
  Cement brick &
  40 (100\%)\\
The floor of the principal living \mbox{}\protect\newline  &
  Ground floor &
  40 (100\%)\\
Yard/open space \mbox{}\protect\newline  &
  Yes  \mbox{}\protect\newline No &
  33 (82.5\%) \mbox{}\protect\newline 7 (17.5\%)\\
Bushes in yard \mbox{}\protect\newline  &
  Yes  \mbox{}\protect\newline No &
  29 (72.5\%) \mbox{}\protect\newline 11 (17.5\%)\\
No. of windows \mbox{}\protect\newline  &
  1 \mbox{}\protect\newline 2 \mbox{}\protect\newline 3 \mbox{}\protect\newline 4 &
  15 (37.5\%) \mbox{}\protect\newline 18 (45\%) \mbox{}\protect\newline 5 (12.5\%) \mbox{}\protect\newline 2 (5\%)\\
Source of your drinking water \mbox{}\protect\newline  &
  Pond/stream  \mbox{}\protect\newline Public stand pipe \mbox{}\protect\newline Tube well/bore hole &
  1 (2.5\%) \mbox{}\protect\newline 22 (55\%) \mbox{}\protect\newline 17 (42.5\%)\\
Source of water for domestic usage \mbox{}\protect\newline  &
  Pond/stream  \mbox{}\protect\newline Public stand pipe \mbox{}\protect\newline Tube well/bore hole &
  1 (2.5\%) \mbox{}\protect\newline 22 (55\%) \mbox{}\protect\newline 17 (42.5\%)\\
Type of toilet facilities with or without a septic tank  &
  With septic tank \mbox{}\protect\newline  &
  40 (100\%)\\
Method of disposal of liquid waste  &
  Let to the garden \mbox{}\protect\newline Open ground \mbox{}\protect\newline A closed pipe drainage system \mbox{}\protect\newline Underground drainage &
  17 (42.5\%) \mbox{}\protect\newline 18 (45\%) \mbox{}\protect\newline 1 (2.5\%) \mbox{}\protect\newline 4 (10\%)\\
Method of water storage \mbox{}\protect\newline  &
  Open tank  \mbox{}\protect\newline Closed tank &
  14 (35\%) \mbox{}\protect\newline 26 (65\%)\\
Method of disposal of solid waste \mbox{}\protect\newline  &
  Dumped in open ground Burnt in the open area \mbox{}\protect\newline Collected and disposed of by municipality/panchayat &
  22 (55\%) \mbox{}\protect\newline 3 (7.5\%) \mbox{}\protect\newline 15 (37.5\%)\\
Availability of Cattle \mbox{}\protect\newline  &
  Yes \mbox{}\protect\newline No &
  7 (17.5\%) \mbox{}\protect\newline 33 (82.5\%)\\
\tblbottomrule 
\end{tabulary}\par 
\end{table*}

\begin{table*}[!htbp]
\caption{\boldmath {Assessment of potential breeding sources} }
\label{tw-23d9baaf8264}
\def\arraystretch{1.1}
\ignorespaces 
\centering 
\begin{tabulary}{\linewidth}{p{\dimexpr.3794\linewidth-2\tabcolsep}p{\dimexpr.19550000000000004\linewidth-2\tabcolsep}p{\dimexpr.2021\linewidth-2\tabcolsep}p{\dimexpr.223\linewidth-2\tabcolsep}}
\tbltoprule \rowcolor{kwdboxcolor} Variables & \multicolumn{3}{p{\dimexpr(.6206\linewidth-2\tabcolsep)}}{\cAlignHack Assessment of potential breeding sources }\\
\rowcolor{kwdboxcolor} & Mosquito absent,  \mbox{}\protect\newline Larva absent & Mosquito present, Larva absent & Mosquito present, \mbox{}\protect\newline  Larva present\\
\tblmidrule 
 &
  N (\%) &
  N (\%) &
  N (\%)\\
Water storage tank &
  40 (100\%) &
  0 (0\%) &
  0(0\%)\\
Drum &
  39 (97.5\%) &
  1 (2.5\%) &
  0 (0\%)\\
Air cooler &
  28 (70\%) &
  5 (12.5\%) &
  7 (17.5\%) \\
Used tires &
  40 (100\%) &
  0 (0\%) &
  0(0\%)\\
Flower vase with water &
  40 (100\%) &
  0 (0\%) &
  0(0\%)\\
Roof gutter/sun shades &
  29 (72.5\%) &
  3 (7.5\%) &
  8 (20\%)\\
Potted plants with saucer &
  40 (100\%) &
  0 (0\%) &
  0(0\%)\\
Ornamental pool/fountain &
  40 (100\%) &
  0 (0\%) &
  0(0\%)\\
Animal water container &
  40 (100\%) &
  0 (0\%) &
  0(0\%)\\
Discarded junks &
  25 (62.5\%) &
  7 (17.5\%) &
  8 (20\%)\\
Discarded food \& drink containers &
  23 (57.5\%) &
  13 (32.5\%) &
  4(10\%)\\
Disposable cups/glasses &
  17 (42.5\%) &
  23 (57.5\%) &
  0(0\%)\\
Tree holes &
  38 (95\%) &
  2 (5\%) &
  0(0\%)\\
Rock holes &
  39 (97.5\%) &
  1 (2.5\%) &
  0(0\%)\\
Fruit shell &
  38 (95\%) &
  2 (5\%) &
  0(0\%)\\
Shoot off palm/ coconut leaves &
  40 (100\%) &
  0 (0\%) &
  0(0\%)\\
\tblbottomrule 
\end{tabulary}\par 
\end{table*}
\textbf{Assessment of environmental factors of household}

The type of floor in most houses is mostly divided into Hard floor and Earth floor. There are 18 (45\%) living on a hard floor and 22 (55\%) living on Earth floor. All families involved in the study are living on the ground floor. There are some houses with a second floor mainly used a roof to keep water tanks. The source of water is a tube well/bore pipe for 17 (42.5\%) families, 1 (2.5\%) using pond/stream and a large majority using public standpipe being 22 (55\%). 33(82.5\%) of the houses have an open yard, and seven families (17.5\%) lack an open yard. 29 (72.5\%) of houses have bushes in the vicinity, and 11 (27.5\%) do not have bushes in the area. The number of windows varies in the area. 15 (37.5\%) of houses have one window, 18 (45\%) of houses have two windows, 5 (12.5\%) of houses have three windows, and a small percentage 2 (5\%) of houses have four windows or more. All houses in the area have flush to a piped sewage system. The method of disposal of liquid waste differs significantly. Eighteen families (45\%) dispose of in open gardens, 17 families (42.5\%) just let it into the garden, one family (2.5\%) use open pipe drainage system/closed pipe drainage system and four families (10\%) use underground drainage system. The method for water storage was found to be open tanks in 26 (65\%) and 14 (35\%) in closed tanks. The method of solid waste disposal is dived into three categories dumped in open ground, burnt in the open area and collected and disposed of by municipality or panchayat. 22 (55\%) families dumped solid waste in open ground, 15 (37.5\%) families solid waste was collected and disposed of by municipality or panchayat and 3 (7.5\%) families of solid waste was burnt. All households consist of a toilet with a septic tank. 7 (17.5\%) of households have cattle such as cows, chickens, etc. 33 (82.5\%) of households do not have any cattle (Table~\ref{tw-f0afd6e2102d}).

\textbf{Assessment of potential breeding sources} \textit{\space }

Next, the results of the breeding sites and mosquito infestation was compiled. In-water storage tanks, there was neither mosquito nor larva breeding (0\%) found. The same holds for the air cooler except for a small one family (2.5\%) found a mosquito in the area, but there was still no larva breeding (0\%). Drum had a wide range of results. 28 (70\%) of drums were found not to have larva or mosquitos. 12 (30\%) of drums were found to have mosquitos, of which 7 (58.3\%) were found to have larva and 5 (41.7\%) did not have larva. Used tires did not give any significant data as there was neither mosquito nor larva breeding 0 (0\%) found. The same situation was found in potted plants as there was neither mosquito nor larva breeding 0 (0\%) found. The same issue was found in animal food container as there was neither mosquito nor larva breeding 0 (0\%) found. In discarded junk, the mosquito absent is found to be 25 (62.5\%) and 15 (37.5\%) found to have mosquito. Of the 15 (37.5\%), 8 (53.3\%) had larva present and 7 (46.7\%) had larva absent. In discarded food and drink containers, 57.5\% were found to be absent of mosquito. 42.5\% were found have mosquito infestation, of which 76.5\% were found to devoid of the larva and 23.5\% were found to have larva. In disposable cups/glasses, 57.5\% were absent of mosquito, and 42.5\% were found to have mosquito and larva breeding (0\%) found. In tree holes, 2 (5\%) were found to have mosquitos, and 38 (95\%) were absent of mosquitos and larva breeding 0 (0\%) found. The same was found in fruit shells, 2 (5\%) were found to have mosquitos, and 38 (95\%) were absent of mosquitos and larva breeding 0 (0\%) found. In rock holes, only 1 (2.5\%) were found to have mosquitos, and 39 (97.5\%) were absent of mosquitos, and larva breeding 0 (0\%) found. In shoot of palm/ coconut leaves, there was neither mosquito nor larva breeding 0 (0\%) found. (Table~\ref{tw-23d9baaf8264})

\textbf{Distribution of breeding spots}

The map depicts the number of households where breeding spots are present or absent. The red dots represent the households with breeding spots present, and the green spots represent the households without any breeding spots (Figure~\ref{f-687c057aaced}). There are 11 (27.5\%) of households without any breeding spots and 29 (72.5\%) of households with breeding spots.

\textbf{Distribution of breeding spots}

The graph depicts the distribution of the various breeding spots. Air cooler, tree holes, fruit shells and rock holes are seen only in 1 (2.5\%) household. The most commonly seen breeding spot is disposable cups which is seen in 23 (57.5\%) households. The next most common is discarded food containers which are seen in 17 (42.5\%) households, followed by discarded junk which is seen in 15 (37.5\%) households (Graph~\ref{f-00248ca11b8a}).
    
\section{Discussion}
As mentioned by \unskip~\cite{901982:20488551}, artificial containers are a significant breeding spot for dengue mosquitos. This is similar to the data obtained by us as there is a clear majority of households where artificial containers such as discarded junk (37.5\%), Discarded food containers (42.5\%) and disposable cups (57.5\%) account for most of the breeding spots. This can be attributed to the low socio-economic status and education background of the individuals in the vicinity. They lack the proper knowledge and practices to prevent the breeding of mosquito in their households. A proper campaigning and knowledge sharing session will benefit the people of the area by decreasing the possibility of mosquito infestation and in turn, decrease the cases of dengue in that area. \unskip~\citet{901982:20488542}  further emphasize on the storage of water in containers such as the drum is due to the irregular supply and stockpiling of water for future use. When this water is left unattended for long periods leads to potential mosquito breeding as seen in our study where there is a good number of households (30\%) where mosquito breeding was seen in the drums. As mentioned by \unskip~\citet{901982:20488546} who associated insufficient rainfall and long-term storage of water in containers, it further proves evidence to the fact that stockpiling water over a long period can be attributed to an elevated risk of dengue infestation.

\unskip~\citet{901982:20488550} and \unskip~\citet{901982:20488546} stress the importance of removing water-filled containers kept over a while as a manner to eliminate mosquito breeding. \unskip~\citet{901982:20488543,901982:20488548} suggest that the proper coving of water-holding containers is a very good practice to prevent stagnant water retention and mosquito breeding. \unskip~\citet{901982:20488550,901982:20488546,901982:20488547} greatly emphasis on the need of both awareness and knowledge of the residents on dengue mosquito breeding. This can be implemented by conducting a public health education to increase awareness and highlight the seriousness of mosquito breeding and diseases associated with it. By slowly reducing various ecological and household factors associated with mosquito breeding, we can reduce the risk of dengue infection ultimately.
    
\section{Conclusions}
In the area of Mappedu, we can identify the potential mosquito breeding in various households. The lack of knowledge and awareness is a crucial factor that has contributed to the identification of potential breeding spots. Prolonged water storage without proper covers can also be attributed as a critical factor in the potential breeding spots. We have mapped out the potential risky households with a variety of factors indicating the danger that these households could face. These breeding spots are not only potential risky spots for dengue but also other mosquito-borne diseases such as malaria. A detailed and simple awareness and health program can help in the long run in the fight against dengue.
\section*{Acknowledgement}We are thankful to the faculty members of Community Medicine for permitting us and for their guidance throughout the study. We also express our heartfelt thankfulness to the volunteers who participated and co-operated to help us complete the study.

\textbf{Conflict of interest}

The authors declare that they have no conflict of interest for this study.

\textbf{Funding support}

The authors declare that they have no funding support for this study.
    

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