Risk Factors Associated With Dengue in District Khyber, Khyber Pakhtunkhwa, Pakistan, From September 2 to November 24, 2019: Case-Control Study (Preprint)

BACKGROUND Dengue is a vector-borne disease endemic to Pakistan as well as to Khyber Pakhtunkhwa. A total of 300 confirmed cases of dengue were reported in District Khyber in 2019, where a prompt response was initiated by the Disease Surveillance and Response Unit. Subsequently, a study was planned to identify the risk factors associated with dengue and to propose recommendations for containment of the disease. OBJECTIVE This study aimed to assess the risk factors associated with dengue in District Khyber and to provide recommendations for improving the existing system and preventing dengue. METHODS A case-control study was conducted in District Khyber from September 2 to November 24, 2019. Cases were enrolled from health care facilities based on predefined criteria, which included the presence of clinical signs and symptoms as well as laboratory confirmation of dengue NS1 antigen. Controls were enrolled from the community at a case-control ratio of 1:2. Data were collected using a pretested questionnaire in face-to-face interviews. RESULTS A total of 300 cases were enrolled; 87% (263) of cases were men. This study found that 45% (269/601; odds ratio [OR] 15, 95% CI 9.9-24.07; <i>P</i>&lt;.001) of enrolled participants did not use bed nets and 39% (236/601; OR 1.7, 95% CI 1.1-2.4; <i>P</i>&lt;.001) did not use mosquito repellents. A total of 39% (233/601; OR 16.6, 95% CI 11.11-24.93; <i>P</i>&lt;.001) of enrolled participants who tested positive for dengue were neighbors, 35% (213/601; OR 1.47, 95% CI 1.04-2.0; <i>P</i>&lt;.001) lived in a joint family, and 40% (241/601; OR 3.32, 95% CI 2.3-4.7; <i>P</i>&lt;.001) slept outdoors; these factors were significantly associated with dengue. CONCLUSIONS Dengue is a preventable disease and can be controlled by the proper use of bed nets and mosquito repellents, modification of sleeping habits, and improvement in family structure. Dengue management training for health care personnel and community awareness are recommended.