PAKISTAN BIOMEDICAL JOURNAL

Sustainable Development Agenda is gaining importance, acknowledging its importance right adaptation of interventions for housing regarding vector-borne disease prevention as suggested by “Keeping the Vector Out” can make cities and human settlements vector-proof and sustainable. Objective: To assess community perceptions regarding chikungunya vector-proof housing for sustainable development. Methods: Descriptive cross-sectional study included 400 households of Aziz Bhatti Town, Lahore. A semi-structured questionnaire administered by personal interview method to the available and willing adult member of the household by Researcher with the environmental inspector and lady sanitary patrol of Dengue and Polio survey teams of DDO o�ce Aziz Bhatti Town Lahore, using simple random sampling technique after consent and ethical approval. The questionnaire was pre-tested (Pilot). Data analyzed using SPSS 20.0. Results: Among 400 households interviewed, the majority 69.7% were living in houses that were built >9 years ago, 86.8 % were concrete. Climatic change and global warming can increase disease carried by mosquito Aedes Aegypti believed by 90.2 % and their impact can be mitigated by improved housing reported by 91.5%. Regarding community perceptions about vector-proof housing, 74.6% believed that improved house design can prevent entry and breeding of mosquitoes therefore, 86.3% screened windows doors and eaves, 83.0% believed that they always checked cracks and crevices in the wall, �oor and roof and cemented them. But 58.7% believed that they do not consider mosquito prevention housing interventions as one of the important factors when constructing their house as among barriers 73.5% could not afford modern building materials, 73.5% lack detailed knowledge and 13.8% thought screening as an obstruction to ventilation. Dengue, Chikungunya, and Zika disease are spread by Aedes mosquito species believed by 78% who (agreed and strongly agreed) still 81.8% urged for health education regarding chikungunya vector proof housing. Conclusion: Housing improvement can mitigate the impacts of climatic change and vector-borne disease. But health program planners need to identify and facilitate the removal of barriers for adoption of Vector proof housing.

PBMJ Vol. 5, Issue. 2 Jul-Dec 2022 and living conditions as a barrier against vector-borne diseases like Dengue and Chikungunya; "Keeping the vector out" is at the core of effective housing interventions to p r eve n t ve c to r -b o r n e d i s e a s e w h i c h c a n b e accomplished by Vector proof housing strategy.[1,2] The growing population is expected to triple to 1.23 billion by 2050, needs an estimated 144 million new houses by 2030 in rural areas alone.For a little additional cost, new infrastructure and housing projects can be planned, designed, and developed with vector control in mind, making urban settlements and cities intrinsically vectorproof and healthy.
According to World Health [3] Organization, vector-borne diseases are causing more than 700'000 deaths annually.Chikungunya is becoming a global problem and has been identi ed in nearly 40 countries.Pakistan continues to respond to an outbreak that started in 2016.
Pakistani strains shared high [4,5] similarity with East/Central/South African, Indian Ocean Lineage(ECSA.IOL), and strains were closely related to those derived in India which suggests the possibility of their migration from India to Pakistan.[6,7,8] Climate change impacted the transmission of vectorborne diseases which account for 17% of the global burden of communicable diseases.(9,10,11)Climate change and Global warming are one of the greatest environmental and health equity challenges of our times.Third-world countries are least prepared for their impacts and are most at risk.El-Nino Southern Oscillation (ENSO) event in 2014-16 caused climatic changes making the world a heaven for pathogens such as Aeaegypti and Ae.Albopictus and their vectors to emerge and propagate clusters of disease activity.(12,13) Among Asian countries Pakistan's precipitation is also under its in uence.[14,15,16] Mosquito proof houses and hospital acts as a shield in transmitting infection from an immobilized person.Field experiments are now needed to determine whether an investment in mosquito proo ng cause an evolutionary reduction in pathogen virulence.[17] To reduce the burden of mosquito-borne disease and keeping in view the low awareness practices, a study on "Community perceptions regarding Chikunguniya Vector Proof Housing in Lahore, Pakistan for Sustainable development."was carried out to help policymakers understand the need of the community regarding vector proof housing infrastructure in light of World Health Organization guidelines and prevent vector borne diseases.

METHODS:
A Community based cross-sectional observational study was conducted after Institutional Ethical committee and the Deputy District o ce Lahore approval in 13 Union Councils of Aziz Bhatti town an administrative town (tehsil) in Lahore Pakistan.The town is located 18.4 km next to Wahga Border having 705311 population chosen as the area of interest due to the positive prevalence of genus Aedes mosquito and the least studied by the researchers.A total of 400 houses-holds were enrolled for the study using Simple Random Sampling Technique and Computerize generated random list of households, data was collected from October 2019 to January 2020.A semi-structured questionnaire was administered by personal interview method to the one available and willing adult member of the household.If the household member refused to participate, the member of the next household was interviewed until reaching the sample size required.The interviews were conducted by the researcher with the environmental Inspector and lady sanitary patrol of Dengue and Polio survey teams of Deputy District O ce Aziz Bhatti Town Lahore.The questionnaire-based on World Health Organization guidelines "Keeping the Vector Out, 2017" translated into Urdu language and was pre-tested (Pilot) before conducting the main survey to check its precision on 10% of the study population i.e 40 respondents who were households residing in the same area but were not the part of the study sample.After the pilot study, necessary amendments were made, then the main survey was conducted.The questionnaire covered the following areas: (I) Socio-demographic information; (II) Knowledge about climatic change link to Chikunguniya vector proof housing; (III) Perceptions about practices regarding Chikunguniya vector proof housing using (Likert's 5-point scale); (IV) Chikunguniya vector proof housing practice barriers (V) Health education regarding Chikungunya vector proof housing.Data was analyzed using SPSS version 20.0.Frequency and percentage tables were generated for all possible variables related to categorical data.Bar and pie diagrams were used in the same context.

RESULTS
The present study shows the observations based upon responses received from 400 Households.As shown in Table-1 most of the respondents 69.0% were up to 34 years old, and the remaining proportion 31.0%more than 34 years old.Among households, 53.5% of the respondents were males while 46.5% were females.Regarding the family size of our study, the majority had >5 family members in the house.The literacy level was high 98.2% of respondents were literate and 70.2% respondents employed while only 1.8% were illiterate and 29.8% were unemployed.Questions on housing type and whether those who own their homes were asked, and we found that more than half of the respondents were owners 53.0% and most of the houses 86.8% were made of concrete, 13.2% mix material (Bricked bricks i.e.Brick masonry-style /Concrete).About the age of houses in town the households reported, 17.5% were Taj S et al.,

Table 1: Community Perceptions Regarding Chikungunya Vector Proof Housing
Table 2 provides information regarding household perceptions about Chikungunya vector proof housing practice using Likert's 5-point scale adapted questionnaire scale of 1 to 5given to each perception, varying from: SA = Strongly Agree, A = Agree, UN = Undecided, D = Disagree, SD = Strongly Disagree.Among 400 respondents, when asked about screening house, (47.5%) were strongly agreed that as "Necessary Intervention" against mosquito they have screened windows and eaves so that their house becomes Chikungunya vector proof, (38.8%) were agreed, (4.8%) were undecided, (4.8%) were disagreed and (4.2%) were strongly disagreed.When asked about do they think/believe, it is possible that house design can prevent entry and breeding of mosquito, (53.8%) respondents strongly agreed, while (20.8%) were agreed.(7.5%) were undecided, (16.8%) disagreed and (1.2%) were strongly disagreed with the statement.Regarding checking of cracks and crevices in wall, oor and roof and cementing them (47.0%) were strongly agreed, and (36.0%) agreed.When information about piped water supply was inquired, (57.0%) were strongly agreed that they have a reliable supply of piped water at their home, (31.0%) were agreed, (6.8%) were undecided, (1.8%) were disagreed and (3.5%) were strongly disagreed.Table 2, 3 and Figure   I think/believe that as "Necessary Intervention" against mosquito I have screened windows, doors and eaves so that my house becomes chikungunya vector proof.
I have well tted the ceiling of my house to prevent mosquito entry.
We frequently check that gutters in and around house are completely covered.
I do have time so that I dispose off rubbish regularly from my house.
Removal of stagnant water from water infrastructure lid is necessary.My piped water supply had leaks and I have sealed them.
I always check cracks and crevices in wall, oor and roof and cement them.
We completely cover water storage container.
The environment surrounding house can in uence mosquito density therefore house owners are responsible for mosquito management surrounding house.
Mosquito management surrounding the house is the responsibility of government.signi cant factor when constructing their house.The ndings of our research indicated that nancial issues, lack of house ownership, and knowledge about detailed mosquito preventive measures are the leading factors that affected vector-proof housing practice.These were the associated barriers that disrupted chikungunya vector-proof housing.Kaindoa etal.19 also reported nancial issues as the major problem among respondents and they were compelled to reside in the poorly constructed house that had gaps on walls, eaves, and doors.Health organizations needs to revise the building codes and create institutions of vocational training that teach the necessary skills to enable homeowners, local businesses, and architects to deliver the interventions, keeping in view the cost-bene t of the project and solution to the adverse effects of screening such as reduction of indoor ventilation.This not only helps to reduce the costs of interventions, but it involves and sensitizes the community while strengthens the local economy.A crucial element in the prevention of vector-borne diseases is behavioral change.Health education can improve awareness among people so that they know how to protect themselves and their communities from mosquitoes.In our study, 93.8% of respondents were aware that mosquitoes enter their house through open doors and windows, and mainstream of the respondents adopted preventive practices such as 86.3% of respondents believed that as "Necessary Intervention" against mosquito they have screened windows and eaves so that their home becomes chikungunya vector proof, 95.3% respondents well tted the ceiling of their house to avoid mosquito entry.A large number of respondents had leakage in their piped water supply and they sealed them, 83.0% always checked cracks and crevices in the wall, oor and roof and cemented them, and 99.0% completely covered water storage container.Continue studying mosquito breeding preventive measures adopted by households.It is pertinent to mention that majority of participants checked frequently that gutters in and around their house are completely covered, about 85.8% of the households had time to dispose of rubbish from their house, 93.7% of respondents believed that removal of stagnant water from water infrastructure lid is necessar y and 91.4% of the respondents were aware that frequent emptying and cleaning of essential containers such as air cooler can prevent chikungunya disease.Kaindoa etal.19 showed quite similar results that 61.5% of respondents employed strategies such as netting on the window, blocking eaves, using bricks on the wall, using cement on the wall to make their homes vector proof.Sharma etal.18 reported only 25.7% of the households had time to dispose of garbage regularly from their house.Despite adopting most of the preventive measures against mosquito, 81.8% of households desired that health education regarding Chikungunya mosquito-proof housing is necessary for their area, this shows that the community was previously sensitized by Dengue and Malaria disease therefore they adopted preventive practices, But still, they need to know and get detail knowledge about Chikungunya vector proof housing interventions.As in our study, 64.0% of the population was undecided about their belief that "Dengue, Chikungunya and Zika disease is spread by Aedes mosquito species."Health communication and education is an art that requires combined efforts of mass media and health personal knowing the principles of health promotion or behavioral change for changes in behavior and not just for changes in knowledge or attitudes.In our study of households, we found that majority of respondents had the concept of changing house design and its impact on their protection against climatic change and vector-borne diseases but due to lack of detailed knowledge and other multiple reasons they were not adopting the mosquito-proof interventions.Therefore, they urged the need for a health communication channel for appropriate knowledge regarding Chikungunya mosquito prevention.Among the respondents, 90.8% believed that the most effective way of transmitting health information regarding Chikungunya vector proof housing is health worker home visit, followed by television/radio 81.8%, social media 74.2%, newspaper 73.0%, online information, and free brochure from health authorities 69.0% and community events 60.5%.Rashid etal.20 observed that effective mode of communication among 23.2% respondents was social media, followed by t e l e v i s i o n 2 1 .0 % , n e w s p a p e r 1 4 .6 % , f a m i l y members/friends 12.6%, school teachers 12.4%, doctors 9.5% and radio 6.0% while 0.5% respondents had no knowledge.This shows a progressive change in the trend of Respondents believed that climatic change and global warming increase the Chikungunya disease carried by mosquito Aedesaegypti and Albopictus and its impact can be mitigated by vector-proof housing, but the practice of vector-proof housing intervention was given less priority by respondents when it came to house construction.Health program planners need to identify and facilitate the removal of barriers such as household's nancial issues, lack of detailed information about vector proof house, and cost-bene t of the project for change.

E F E R E N C E S :
[ [10] [11] PBMJ Vol. 5, Issue. 2 Jul-Dec 2022 society getting more inclined towards the use of electronic m e d i a a n d l a d y s a n i t a r y p a t r o l h o m e v i s i t s .A communication specialist on mass media is not an e p i d e m i o l o g i s t .T h e r e fo r e, t h e r e i s a n e e d fo r epidemiologists and medical personnel on mass media to address accurate and useful information with the broader community through the media for behavior change and to reduce the chance to sensationalize or misinterpret the content.Also, information, education, and communication (IEC) intervention programs may need to be reviewed so that health workers can maximize the opportunity to educate the community.Vector-proof housing inter vention only without surrounding environmental control is of no worth.Our 87.8% of respondents believed that the environment surrounding the house can in uence mosquito density, therefore, they are responsible for mosquito management surrounding the house while 83.2% of the respondents believed that mosquito management surrounding the house is the responsibility of the government or we can say that they considered government and households as equally responsible for maintaining the cleanliness of e n v i r o n m e n t s u r r o u n d i n g t h e h o u s e .A l o b u i a etal.21showedquite similar behavior exhibited by households 54.7 % who believed that both government and households are responsible for maintaining the vectorproof environment outside the houses.Such results are primarily because the population was mostly educated belonging to urban background already sensitized by Malaria and Dengue, if a similar study was conducted at an area having a rural background or unsensitized population, we may have found different results.Some of the limitations of our study include study was conducted only in one town of Lahore having a small sample size.Further studies, with or without housing intervention on large scale are needed to fully assess the bene ts of vector-proof housing in light of vector-borne disease prevention.

Frequent
reliable supply of piped water at my house.
that were up to 4 years old, 12.8% were living in 5-8 years old houses, and 69.7% of respondents living in houses that were built 9 years before or more.

Table - 3
: Chikunguniya vector proof housing practice barriers, health education and it's link to climatic change among 400 households of Azizbhatti town Lahore, Pakistan.
mosquito-borne disease and climatic change impact can be mitigated by improving housing, and 74.6% (strongly agreed and agreed) that house design can prevent entry and breeding of mosquito but only 27.3% considered PBMJ Vol. 5, Issue. 2 Jul-Dec 2022