Knowledge, Attitudes, and Practices of Health Officials on Dengue Prevention in Sri Lanka: Ethical, Equity, and Social Implications

Abstract

Dengue remains one of the most important mosquito borne diseases in Sri Lanka, causing recurrent outbreaks despite the availability of national prevention policies. This indicates a persistent gap between policy formulation and field level implementation. Such gaps are not only technical public health concerns but also raise ethical, equity, and social implications, as vulnerable communities may experience a disproportionate disease burden when prevention systems are weak. This mixed method study assessed the knowledge, attitudes, and practices of health officials involved in dengue prevention in Sri Lanka and explored system level barriers affecting implementation. A descriptive cross sectional design was used. Quantitative data were collected from 80 health officials representing Medical Officers, Public Health Inspectors/Public Health Officials, Field Workers, and Administrative Staff using a WHO adapted, translated, and pre tested questionnaire. Qualitative data were obtained through 10 key informant interviews. Quantitative data were analysed using descriptive statistics, ANOVA, and Chi square tests, while qualitative data were analysed thematically. Only 27.5% of participants had satisfactory knowledge of dengue prevention policy and national targets. Although attitudes were moderately positive, reported prevention practices were weak, with only 11.3% demonstrating good practices. Knowledge and practice scores differed significantly across professional groups, indicating unequal training and capacity within the workforce. Qualitative findings identified barriers such as staff and resource shortages, funding delays, weak intersectoral coordination, limited enforcement authority, training gaps, and underuse of surveillance tools. The findings highlight the need to strengthen workforce capacity, governance support, intersectoral coordination, and field level implementation. Improving dengue prevention is essential not only to reduce disease burden but also to promote fairness, public trust, and social well being.