Introduction

Dengue fever is a global arboviral disease that affects humans and has become a significant public health concern. The dengue virus (DENV) is transmitted to humans by infected Aedes aegypti mosquitoes. These daytime-biting species reproduce in natural and artificial water-holding containers and thrive in various environments, including rural, urban, and semi-urban areas (Khan et al., (2018); WHO, 2022). Infection with any of the four DENV serotypes (DENV-1 to DENV-4) can lead to illnesses ranging from mild febrile syndromes to severe forms such as dengue haemorrhagic fever (DHF) and dengue shock syndrome (DSS), which may result in fatality. The severity of the disease often depends on the individual’s immune response to the viral infection (Rothman, 2011).

Dengue is the fastest-spreading vector-borne disease worldwide (Selvarajoo et al., 2020). The reported cases have increased dramatically, from 0.51 million in 2000 to 4.2 million in 2019. Approximately 70% of the global dengue disease burden is in Asia (WHO, 2022). This region, particularly Southeast Asia, reports high annual dengue cases, mortality, and morbidity rates (Harapan et al., 2016). The disease is endemic in over 100 countries and is associated with significant socio-economic burdens (Junior et al., 2022; Abubakar et al., 2022), potentially impeding national development and public health capacity (Franklinos et al., 2019). For example, Malaysia’s annual dengue prevention and treatment cost is estimated at USD 175.5 million in the 2009/2010 fiscal year (Packierisamy et al., 2015). Previous studies have demonstrated that Malaysians generally hold a positive attitude toward alternative dengue control methods, such as Outdoor Residual Spraying (Arham et al., 2021a), the use of Wolbachia-infected Aedes mosquitoes for dengue management (Arham et al., 2020; 2021b), and the dengue vaccine (Arham et al., 2022). However, fogging remains a traditional approach used to combat Aedes mosquitoes and prevent the spread of dengue (Arham et al., 2023). While strong support exists for these alternative strategies and fogging techniques, providing accurate information, empowering positive attitudes, and promoting best practices in dengue prevention remains crucial.

Dengue transmission on a global scale is intricately linked to various social factors, including education, household characteristics, human behaviour, and the proliferation of Aedes mosquitoes (Gurevitz et al., 2021; Selvarajoo et al., 2020). Behavioural factors are crucial in creating environments that foster vector proliferation. Consequently, public education on effective prevention strategies emerges as a cornerstone of sustainable disease control efforts. Empirical research indicates that elevated levels of dengue-related knowledge, combined with positive attitudes and proactive preventive practices within communities, significantly enhance these efforts (Selvarajoo et al., 2020; Ghani et al., 2019). For instance, in regions like Selangor, Malaysia, human behaviour has been demonstrably influential in shaping dengue transmission patterns (Ghani et al., 2019). Moreover, the findings presented by Arham et al., (2021c) will serve as a crucial benchmark for evaluating stakeholder engagement and understanding their active participation in implementing dengue control strategies. Such robust involvement promotes effective governance and plays a vital role in fostering a healthier society free from the threat of dengue fever. By harnessing collective action and informed engagement, communities can work towards a future where dengue is not an inevitable consequence of the environment but a preventable disease.

The recurring annual outbreaks across Asian countries amplify the urgency to understand community behaviour. KAP studies examine how individuals perceive a disease, their emotional and intellectual responses, and their preventive actions. Knowledge assessments indicate awareness levels, attitude components evaluate personal beliefs and willingness to act, and practice components measure actual behaviours. Such assessments help evaluate the effectiveness of existing health programs and motivate greater community involvement in prevention efforts (Van Benthem et al., 2002). KAP frameworks provide a basis for sustained community-level vector control, which remains the cornerstone of dengue prevention strategies (Selvarajoo et al., 2020; Ghani et al., 2019).

While numerous studies have explored dengue’s biomedical and epidemiological dimensions, there remains a lack of consolidated insights into how human behaviour at the household level contributes to the persistence and control of the disease in Asia. In contrast to prior systematic reviews that focused primarily on vector biology, cost-effectiveness, or surveillance tools, this study uniquely synthesises literature centred on behavioural responses, which have received comparatively limited attention.

Theoretically, this paper advances the current body of knowledge by integrating public health and behavioural sciences perspectives to explore the role of community engagement in dengue prevention. Practically, it provides public health authorities with an evidence-based reference on the prevailing knowledge, attitudes, and practices among households. These insights are essential for refining outreach and intervention strategies tailored to different Asian socio-cultural contexts. Understanding household behaviour becomes increasingly critical as the global fight against dengue shifts towards more participatory and community-driven strategies. This review is therefore timely and essential, as it identifies key behavioural trends and knowledge gaps that could hinder the effectiveness of future health campaigns.

A thorough review of existing systematic literature establishes a solid foundation for understanding the limitations of previous research and effectively positioning the current study. Previous systematic reviews on dengue can be categorised into four key domains. Firstly, comprehensive epidemiological trend analyses have been conducted across various countries, including Brazil (Teixeira et al., 2013), Thailand (Limkittikul et al., 2014), Malaysia (Mohd-Zaki et al., 2014), the Philippines (Bravo et al., 2014), Mexico (Dantés et al., 2014), France (L’Azou et al., 2014), Colombia (Villar et al., 2015), and Pakistan (Khan et al., (2018)). Secondly, research on the economic burden and cost-effectiveness has been conducted, including studies by Beatty et al. (2011), as well as more recent work by Junior et al. (2022) and Abubakar et al. (2022), who specifically examined the epidemiological and economic impacts of dengue in Brazil and Malaysia, respectively.

Thirdly, research focused on vector control and surveillance encompasses community-based interventions (George et al., 2015), outbreak monitoring tools (Runge-Ranzinger et al., 2014), and biological control agents such as Bacillus thuringiensis israelensis (Boyce et al., 2013). Horstick et al. (2010) reviewed the operations of dengue vector-control services, while Ward et al. (2017) examined dengue data and surveillance systems in Tanzania. Lastly, in recent years, there has been a rise in modelling and predictive studies, including reviews on diagnostic and intervention modelling (Hoyos et al., 2021) and perspectives on dengue haemorrhagic fever (Wang et al., 2020).

While these reviews have contributed substantially to understanding dengue prevention and management, they predominantly address biomedical, entomological, or surveillance-related aspects. To date, no systematic review has comprehensively synthesised behavioural responses at the household level, particularly regarding knowledge, attitudes, and practices (KAP) in the Asian context. This remains a critical gap, especially given the central role that household behaviour plays in the transmission and prevention of dengue.

This study addresses the aforementioned research gap by systematically reviewing existing literature on dengue-related knowledge, attitudes, and practices among Asian households. Data were collected using the PRISMA approach and analysed through descriptive and content analyses to offer a holistic view of behavioural responses to dengue.

The novelty of this study lies in its comprehensive synthesis of KAP findings across Asia, with a specific focus on the household unit, which has been underrepresented in prior reviews. In line with recent cross-disciplinary reviews in energy and environmental studies, which have successfully integrated multi-country behavioural and policy analyses (Shah et al., 2024a; 2022a; Yao et al., 2021), this study adopts a similar systematic structure in the context of public health, focusing on Asian households’ dengue-related knowledge, attitudes, and practices. For instance, studies in the energy efficiency domain have demonstrated the significance of institutional quality, public behaviour, and regional strategies in shaping outcomes (Shah et al., 2024b; 2022b). Drawing on these frameworks, this paper employs a similar analytical lens in dengue research by linking regional behaviours to public health impact, particularly in the highly affected Asian region.

Ultimately, this study aims to enhance existing understanding of how knowledge, attitudes, and practices influence dengue prevention at the household level across Asia. The findings are expected to help stakeholders develop targeted and context-sensitive interventions for dengue control. To the best of the authors’ knowledge, this is the first systematic review specifically dedicated to dengue-related knowledge, attitudes, and practices (KAP) among Asian households. The structure of the remainder of this paper is outlined as follows. “Methodology” details the methodology employed, while “Descriptive Analysis” presents the descriptive findings. “Content Analysis” encompasses the content analysis, and “Discussion” concludes with a summary of the findings, limitations, and recommendations for future research.

Methodology

This section describes the methodology adopted in conducting the systematic review of dengue, including retrieving and analysing literature. The review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) framework, which was widely used in studies of infectious diseases (Swaan et al., 2018; Steele et al., 2016; Charles-Smith et al., 2015) to guide the data collection process.

The PRISMA method ensures transparency and replicability in reviewing and synthesising the literature. This method is particularly suitable for research questions involving the synthesis of behavioural evidence, as it provides a structured framework for identifying, screening, and including studies that meet clearly defined eligibility criteria. In this study, the PRISMA framework is supplemented by an integrative systematic review (ISR), which accommodates quantitative and qualitative research, allowing for broader inclusion and more nuanced insights. This dual approach is aligned with recent trends in health behaviour literature that emphasise methodological integration for complex issues such as disease prevention and household behaviour. The PRISMA method enables researchers to justify their research challenges and provide reasonable recommendations for future studies (Jamaluddin & Saibani, 2021). According to Sierra-Correa and Cantera Kintz (2015), among the benefits of the PRISMA statement are i) clearly defined research questions; ii) classification of literature inclusion and exclusion criteria, and iii) the ability to conduct extensive database literature searches within a specific time frame. Therefore, the PRISMA statement facilitates a comprehensive literature search on the knowledge, attitudes, and practices (KAP) levels among Asian households regarding dengue. Manuscripts using quantitative, qualitative, and mixed methods were included in the integrative systematic review (ISR).

According to Jackson et al. (2019)The ISR technique is the right choice, enabling a thorough manuscript overview using multiple research approaches. The ISR was conducted in June 2022, utilising two significant databases: Scopus and Web of Science (WoS). The ISR technique consists of four key phases: identification, screening, eligibility, and data extraction and synthesis (Jamaluddin & Saibani, 2021).

Identification strategy

The identification process began with developing specific search terms informed by expert consultations and previous reviews. Keywords such as “dengue,” “knowledge,” “attitudes,” “practice,” and “Asia” were refined and tested across various databases. Boolean operators and truncations were utilised to ensure comprehensive retrieval. These search strings were applied to both databases’ abstract, title, and keyword fields, yielding 6762 records (see Table 1).

Table 1 Search strings used in Scopus and Web of Science.
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Screening and inclusion criteria

For the screening stage, only manuscripts that met the specific inclusion criteria outlined in Table 2 were accepted for review. These criteria included the following: (i) only journal articles were considered, as they provide comprehensive reports and established research (González-albo & Bordons, 2011); (ii) only manuscripts written in English were accepted to facilitate data retrieval and analysis; (iii) only peer-reviewed journal articles published between 2010 and 2022 were selected, as this timeframe sufficiently captures the evolution of the research topic; and (iv) only studies focusing on knowledge, attitudes, and practices related to dengue among households in Asian countries were included. As a result of these criteria, 2085 duplicate records were excluded, and 2209 were removed during the initial screening (see Table 2).

Table 2 Inclusion and exclusion criteria.
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Eligibility assessment

Full texts of potentially relevant articles were assessed using a standardised checklist adapted from PRISMA guidelines. The 2445 manuscripts were rejected during the eligibility stage because they were unrelated studies on the dengue knowledge, attitude, and practices level among Asian households. Finally, only 23 papers were included in the final analysis for data abstraction and analysis. The PRISMA flow diagram used in this study is depicted in Fig. 1, which was adapted from the sources (Liberati et al., 2009). A descriptive analysis provided an overview of the 23 papers, while content analysis addressed the research questions.

Fig. 1: PRISMA flow diagram of article selection process.
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The diagram outlines the systematic process of identifying, screening, and selecting articles for the review, including the number of records identified, screened, excluded, and included in the final synthesis.

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Data extraction and synthesis

The final 23 articles were analysed in two stages. First, a descriptive analysis was conducted to map the number of publications over time, journal sources, and geographical distribution. Second, a manual content analysis was performed to identify and categorise key behavioural themes related to knowledge, attitudes, and practices (KAP). Each article was read in full, and thematic elements were coded manually based on recurring patterns and conceptual categories. The results from this thematic coding were then organised into summary tables to provide a structured synthesis aligned with the research objectives.

Based on the literature reviewed and the thematic findings, a conceptual framework was developed to illustrate the behavioural linkages between knowledge, attitudes, and practices (KAP) about dengue prevention among Asian households (see Fig. 2). This framework provides a theoretical foundation for understanding how household-level behavioural factors contribute to the effectiveness of dengue control strategies.

Fig. 2: Conceptual framework of dengue: KAP (knowledge, attitudes, practices) behavioural linkages.
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This framework illustrates the relationships between knowledge, attitudes, and practices (KAP) in dengue prevention. External factors such as public health campaigns, education, media exposure, and socioeconomic conditions influence knowledge, which shapes attitudes and drives preventive practices, ultimately leading to enhanced household-level dengue prevention.

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As shown in Fig. 2, the framework positions knowledge as a precursor to attitude formation, which influences actual preventive practices. These three elements are interrelated and reinforced by contextual factors such as community awareness campaigns, socio-economic status, and perceived disease severity. By understanding these interlinkages, policymakers and health practitioners can design more compelling, behaviourally informed interventions at the household level.

Descriptive analysis

Figure 2 illustrates the distribution of 23 papers related to dengue knowledge, attitudes, and practices (KAP) levels among Asian households from 2010 to 2022. Most papers were published in 2022, with four articles, followed by 2016, 2018, and 2021, each with three articles. Two papers were published in 2015, 2019, and 2020; one was published in 2010, 2013, 2014, and 2017. As shown in Fig. 2, the number of selected papers increased in 2022, indicating that researchers and educators are interested in the topic and the importance of investigating the issue of dengue knowledge, attitudes, and practices (KAP) levels among Asian households.

As shown in Fig. 3, the distribution of 23 identified papers across 20 journals indicates that a broad range of journals discuss the topic of dengue knowledge, attitudes, and practices (KAP) levels among Asian households. PLOS ONE, the Malaysian Journal of Medicine and Health Sciences, and BMC Infectious Diseases published two papers, while 17 other journals published one. The 23 selected papers were distributed across nine Asian countries, as shown in Fig. 4. Malaysia had the most papers (6), followed by Bangladesh, India, Laos, and Pakistan, each with three. Nepal and Yemen had two, and Cambodia and Thailand had one. Malaysia had several papers addressing the dengue-KAP level among households, which is unsurprising given that dengue fever is Malaysia’s most common infectious disease (Mashudi et al., 2022).

Fig. 3: Publication trends of dengue KAP studies over time.
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This figure shows the annual distribution of dengue KAP (knowledge, attitudes, practices) studies from 2008 to 2024, highlighting the increasing research interest in this area, with noticeable peaks in 2018 and 2022.

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Fig. 4: Distribution of published papers across multiple journals.
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This figure presents the distribution of the 23 selected papers on dengue KAP across various academic journals, indicating the diversity of publication sources and the multidisciplinary nature of this research area.

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Content analysis

Content analysis is a qualitative research method that interprets and systematically categorises textual data based on recurring themes, concepts, or patterns (Elo & Kyngäs, 2008). This study used content analysis to explore how prior empirical research has described households’ knowledge, attitudes, and practices (KAP) regarding dengue prevention. This approach facilitated a structured synthesis of behavioural insights by coding and thematically organising relevant findings from the 23 selected articles, allowing for direct alignment with the study’s research objectives. The results are presented thematically across three subsections: (i) dengue-related knowledge, (ii) dengue-related attitudes, and (iii) dengue-related preventive practices Fig. 5.

Fig. 5: Geographical distribution of selected papers by Asian country.
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This map shows the geographical distribution of the 23 selected studies on dengue KAP (knowledge, attitudes, practices) among Asian households, highlighting the countries where research on this topic has been conducted, including Malaysia, India, Bangladesh, Pakistan, Laos, and others.

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Dengue-related knowledge

Dengue fever is a preventable infection, and the success of dengue control is primarily determined by household knowledge related to dengue prevention. Dengue-related knowledge assesses people’s understanding of dengue and provides an overview of the level of knowledge a specific population has about dengue. The analysis of the 23 papers revealed that the households’ knowledge of dengue varies. Some studies have demonstrated that households possess a high level of knowledge about dengue (Khan et al., (2022a); Ramli et al., 2022), while others have shown that they possess adequate knowledge about dengue (Krishnamoorthy et al., 2018). Analyses of the 23 papers revealed that the vast majority of respondents, ranging from 66.3% to 97.4%, had heard of dengue and dengue fever (Khan et al., (2022a); Ramli et al., 2022; Hossain et al., 2021; Krishnamoorthy et al., 2018; Potdar, 2018; Khalil et al., 2016; Dhimal et al., 2014; Mayxay et al., 2013; Syed et al., 2010). However, Phuyal et al. (2022) found that only 40.6% of respondents had previously heard of dengue fever. Regarding the danger of the disease, 73.9% of respondents were aware that dengue fever is an infectious disease (Ramli et al., 2022) and a viral disease (Selvarajoo et al., 2020), with the potential for multiple infections (Rahman et al., 2022). Findings from Rahman et al. (2021) revealed that less than 50% of the respondents were aware of dengue virus serotypes and vectors, and fewer than 20% correctly answered the number of days required by vector mosquitoes to complete their life cycle (Selvarajoo et al., 2020). Most respondents (more than 91%) correctly identified that dengue is caused by mosquito bites (Khan et al., (2022a); Rahman et al., 2020; Kumaran et al., 2018). Nevertheless, Khalil et al. (2016) revealed that only 39.8% knew that a mosquito bite transmits dengue.

Aside from fever, knowledge of dengue signs and symptoms was much less prevalent among households. Although more than 80% of the respondents knew that fever is an important dengue symptom (Phuyal et al., 2022; Ramli et al., 2022; Rahman et al., 2021; Mohd Khairi et al., 2021; Selvarajoo et al., 2020; Basra et al., 2019; Kumaran et al., 2018; Aung et al., 2016; Alyousefi et al., 2016; Saied et al., 2015; Dhimal et al., 2014; Mayxay et al., 2013), only 42.7% could name three or more dengue symptoms (Kumaran et al., 2018). Less than 50% of the respondents recognised headache, bleeding, body aches, skin rash, muscle pain, abdominal pain, pain behind the eyes, and nausea as signs of dengue infection (Khalil et al., 2016; Aung et al., 2016; Mayxay et al., 2013; Syed et al., 2010). However, some past studies have found that the majority of respondents (more than 90%) can recognise headache, muscle pain, vomiting blood, and joint pain as common symptoms of dengue fever (Mohd Khairi et al., 2021; Selvarajoo et al., 2020; Rahman et al., 2020; Alyousefi et al., 2016; Aung et al., 2016; Saied et al., 2015). Furthermore, while restlessness and rapid breathing were less commonly identified as symptoms associated with dengue (Selvarajoo et al., 2020), more than 70% of respondents reported being aware of these symptoms. Unfortunately, some studies have revealed that fewer than 40% of respondents know that fever is the most common symptom of dengue fever (Hossain et al., 2021; Khalil et al., 2016).

Approximately 94.6% of respondents were aware of Aedes mosquito breeding sites (Ramli et al., 2022), and 78% knew that Aedes mosquitoes can breed indoors and outdoors (Rahman et al., 2022). According to Kumaran et al. (2018), 95.5% of households correctly identified at least one breeding site. Most respondents (94.2%) identified outdoor containers as breeding sites for Aedes mosquitoes (Mayxay et al., 2013). More than 75% of respondents were aware that mosquitoes breed in clean standing water (Phuyal et al., 2022; Syed et al., 2010). Furthermore, the majority of respondents were aware that Aedes mosquitoes breed in stagnant, clean water found in trash cans, water jars, house drains, old or discarded tires, and flowerpots, among other locations (Khan et al., (2022a); Kumaran et al., 2018; Karimah Hanim et al., 2017; Aung et al., 2016; Syed et al., 2010). On the other hand, according to 2022, 47.72% of respondents were unaware of where Aedes mosquitoes breed, and 45.7% believed that unclean water-holding containers could be potential breeding grounds for Aedes mosquitoes (Hossain et al., 2021). Less than 20% of the respondents recognised indoor water containers or water storage as common breeding sites for Aedes mosquitoes (Khalil et al., 2016; Mayxay et al., 2013). Furthermore, only a small number of respondents incorrectly believed that areas with running water could be breeding grounds for Aedes mosquitoes (Mayxay et al., 2013).

In terms of mosquito biting time, unfortunately, 93% of households are unaware of the peak biting time of dengue mosquitoes (Ramli et al., 2022). According to Basra et al. (2019) and Dhimal et al. (2014), less than 13% of the households knew that dengue mosquitoes mainly bite during the day, whereas Potdar (2018) It was found that 38% of households were unaware that dengue mosquitoes bite during the day (Potdar, 2018). According to the findings of Khalil et al. (2016), 32.6% of respondents believed mosquitoes bite most frequently at night. Phuyal et al. (2022) respondents were aware that Aedes mosquitoes bite early in the morning (Phuyal et al., 2022). More than 60% of those polled were aware that Aedes mosquitoes bite during the day (Kumaran et al., 2018; Mayxay et al., 2013). Meanwhile, results from Aung et al. (2016) and Rahman et al. (2022) revealed that more than 75% of the respondents were aware of two periods of Aedes mosquito biting activity, namely early morning and late evening (Rahman et al., 2022; Aung et al., 2016).

Regarding the mode of transmission of dengue, more than 90% of respondents were aware that it is transmitted by mosquito bites (Hossain et al., 2021; Selvarajoo et al., 2020; Potdar, 2018; Sayavong et al., 2015; Syed et al., 2010). The majority of them (more than 60%) knew that Aedes was the specific mosquito that transmits the dengue virus (Hossain et al., 2021; Rahman et al., 2020; Karimah Hanim et al., 2017; Aung et al., 2016; Mayxay et al., 2013). Approximately 60% of respondents knew that female Aedes mosquitoes are the primary agents responsible for dengue transmission (Rahman et al., 2022). However, research from Phuyal et al. (2022), Basra et al. (2019), and Dhimal et al. (2014) revealed that more than 80% of respondents were unaware that Aedes mosquitoes transmit the dengue virus. More than half of the respondents knew that ticks and flies do not transmit dengue (Phuyal et al., 2022; Basra et al., 2019; Dhimal et al., 2014).

Regarding the availability of dengue treatment and cure, more than 75% of respondents were unsure about the cure for dengue fever (Ramli et al., 2022; Rahman et al., 2020). In comparison, fewer than 40% were aware of the availability of dengue treatment (Krishnamoorthy et al., 2018). Regarding mosquito prevention methods, most respondents were aware of at least one mosquito breeding and mosquito-bite prevention method (Kumaran et al., 2018). Over 80% of the respondents used insecticides, such as Ridsect, to kill adult mosquitoes (Mohd Khairi et al., 2021; Karimah Hanim et al., 2017). According to Sayavong et al. (2015), the majority of respondents were aware of how to avoid mosquito bites. The most frequently mentioned mosquito bite method was using nets during the day (Kumaran et al., 2018).

Overall, while most households demonstrated a basic awareness of dengue, their knowledge remained fragmented, particularly regarding transmission vectors, symptoms, and mosquito breeding cycles. These findings reinforce the argument that knowledge alone does not guarantee effective prevention, a view echoed in earlier literature (Selvarajoo et al., 2020; Khalil et al., 2016). This supports the study’s central proposition that comprehensive behavioural interventions must address gaps in awareness and depth of understanding. The variability in knowledge across regions and countries also aligns with the broader epidemiological diversity noted in past reviews (Mohd-Zaki et al., 2014; Khan et al., (2018)), further justifying the need for localised, household-specific public health strategies.

Dengue-related attitudes

People’s attitudes towards dengue are assessed through attitude. People are asked about their feelings regarding dengue and how they would react if they or someone they know were to contract dengue. Respondents showed a good attitude (86%) (Rahman et al., 2022). Ninety-seven per cent of the respondents had a positive attitude toward dengue and dengue prevention (Mohd Khairi et al., 2021). Dengue is a serious problem, according to more than 87% of respondents (Khan et al., (2022a); Phuyal et al., 2022; Basra et al., 2019; Aung et al., 2016; Alyousefi et al., 2016; Dhimal et al., 2014), and it is a potentially fatal disease (Saied et al., 2015; Mayzay et al., 2013).

In terms of the risk of contracting dengue, more than 75% of respondents believed that everyone is at risk of contracting the disease (Ramli et al., 2022; Mohd Khairi et al., 2021; Rahman et al., 2020; Kumaran et al., 2018; Potdar, 2018; Aung et al., 2016), while 44% disagreed (Khalil et al., 2016). Most respondents (more than 80%) were terrified of being diagnosed with dengue (Mohd Khairi et al., 2021; Rahman et al., 2020). More than 90% of respondents believed that dengue could be prevented (Kumaran et al., 2018; Dhimal et al., 2014; Mayxay et al., 2013), but surprisingly, more than 41% agreed that dengue could not be prevented or were unsure (Saied et al., 2015).

Around 75% of respondents believed it is critical to combat dengue transmission (Rahman et al., 2020), and more than 70% believed that all dengue patients have a chance of full recovery (Karimah Hanim et al., 2017; Aung et al., 2016). In terms of dengue treatment, more than 80% of respondents agreed that seeking immediate treatment or consulting a doctor if they exhibit dengue signs and symptoms is crucial (Ramli et al., 2022; Rahman et al., 2022; Mohd Khairi et al., 2021; Karimah Hanim et al., 2017). However, only 28% would seek medical help or treatment within the first 24 h (Mayxay et al., 2013).

The majority of respondents (more than 70%) agreed that eliminating and controlling Aedes mosquito breeding sites is one of the best ways to control and prevent dengue (Mohd Khairi et al., 2021; Basra et al., 2019; Aung et al., 2016; Dhimal et al., 2014). Cleaning potential breeding sites for Aedes mosquitoes and ensuring that no mosquito eggs or larvae are present around respondents’ homes should be done regularly (Selvarajoo et al., 2020), with more than 75% of respondents agreeing to this practice (Rahman et al., 2022). One to three times a week, most respondents’ family members and neighbours should clean Aedes mosquito breeding sites such as water containers, plant pots, and storage tanks (Rahman et al., 2022). Unfortunately, Ramli et al. (2022) found that 90% of individuals are unaware of this responsibility.

Furthermore, approximately 71.6% of respondents believed eliminating larval breeding sources was difficult and time-consuming (Aung et al., 2016). Some respondents believe that the task of preventing dengue, such as controlling dengue or removing mosquito breeding sites, is solely the government’s responsibility. In contrast, others believe that everyone should be allowed to participate. More than 67% of the respondents agreed that the government, including health authority staff and health volunteers, is responsible for preventing dengue (Potdar, 2018; Aung et al., 2016; Khalil et al., 2016). Meanwhile, more than 75% of respondents agreed that communities should actively participate in controlling dengue (Rahman et al., 2022; Mohd Khairi et al., 2021; Basra et al., 2019; Karimah Hanim et al., 2017; Khalil et al., 2016; Mayxay et al., 2013), indicating a positive community attitude toward dengue prevention activities (Rahman et al., 2022).

In addition to chemical fogging, approximately 93.06% of respondents agreed that authorities should demolish potential breeding sites (Rahman et al., 2022). Meanwhile, more than half of those polled believed that chemical fogging by health authorities was sufficient for dengue prevention (Selvarajoo et al., 2020; Aung et al., 2016). 89.5% of respondents are unaware of the time fogging activities, and 66.5% do not want to open windows or doors during this period (Ramli et al., 2022).

The findings indicate a generally positive attitude among households, although there are inconsistent perceptions regarding personal responsibility and the government’s role. These results reinforce prior research suggesting that behavioural change often hinges on how communities perceive disease severity and their accountability for prevention. Previous systematic reviews, such as those by George et al. (2015) and Horstick et al. (2010), tend to overlook this nuanced behaviour, further validating the current study’s emphasis on community-level engagement and empowerment. Understanding attitudes, particularly about personal versus government responsibility, is essential for designing effective, community-driven dengue control programs. This aligns with earlier modelling studies (Hoyos et al., 2021) that highlight the importance of perception and trust in shaping public health behaviour. The identified gaps in proactive treatment-seeking and the belief in the efficacy of prevention underscore the need for targeted campaigns to shape attitudes effectively.

Dengue-related practices

Dengue practices are inquiries about respondents’ daily routines for avoiding dengue. Previous studies have discovered both poor and effective dengue prevention practices. Despite the respondents’ high level of knowledge and attitudes, poor preventive practices were standard (Alyousefi et al., 2016). The majority of respondents have unsatisfactory dengue prevention practices (Selvarajoo et al., 2020), such as no communication with the local authority for fogging activity (Rahman et al., 2022), they took no precautions to prevent mosquito breeding (Potdar, 2018; Rahman et al., 2021), did not monitor potential Aedes mosquito breeding sites inside or outside the house (Ramli et al., 2022; Rahman et al., 2022), less participation in any dengue campaign or programs in their neighbourhood (Mohd Khairi et al., 2021; Aung et al., 2016)and worse, some respondents had never heard of the dengue campaign or programs (Karimah Hanim et al., 2017). In contrast, Selvarajoo et al. (2020) It was discovered that the majority of respondents search for and destroy mosquito breeding sites.

The majority of the respondents recognised water containers as a major breeding site for Aedes mosquitoes (Mayxay et al., 2013). The most common good preventive practice among household respondents was covering water containers (Mohd Khairi et al., 2021; Rahman et al., 2020; Basra et al., 2019; Karimah Hanim et al., 2017; Aung et al., 2016; Alyousefi et al., 2016; Sayavong et al., 2015; Dhimal et al., 2014), clean water containers, change water container once a week, and keep plant pots clear and excess water drained (Rahman et al., 2022; Selvarajoo et al., 2020; Karimah Hanim et al., 2017; Sayavong et al., 2015; Mayxay et al., 2013). Meanwhile, the majority of respondents took action to remove mosquito larvae from the water tank or container if they discovered them, and they cleaned the drains or gutter roofs every time it rained (Mohd Khairi et al., 2021; Selvarajoo et al., 2020; Karimah Hanim et al., 2017; Aung et al., 2016). Furthermore, they dry water collection around houses (72.1%) (Alyousefi et al., 2016) and look for any garbage or rubbish that could clog the drainage system around their house (Mohd Khairi et al., 2021; Rahman et al., 2020).

Dengue fever can be avoided by taking precautions. Almost all respondents agreed that the best strategy for preventing dengue fever is to avoid mosquito bites (Rahman et al., 2021; Basra et al., 2019; Dhimal et al., 2014). Previous research also found that the majority of respondents used mosquito nets to protect themselves from Aedes mosquito bites (Phuyal et al., 2022; Rahman et al., 2020; Basra et al., 2019; Aung et al., 2016; Alyousefi et al., 2016; Saied et al., 2015; Mayxay et al., 2013), used mosquito control methods such as mosquito coils, mosquito repellent, mosquito spray or killing appliances and solutions (Rahman et al., 2022; Phuyal et al., 2022; Rahman et al., 2021; Hossain et al., 2021; Selvarajoo et al., 2020; Basra et al., 2019; Krishnamoorthy et al., 2018; Khalil et al., 2016; Saied et al., 2015; Dhimal et al., 2014; Syed et al., 2010). Furthermore, when it comes to treatment, the majority of respondents visited a hospital or health facility to seek medical assistance for dengue fever testing and treatment (Krishnamoorthy et al., 2018; Saied et al., 2015). In the meantime, some respondents believe in traditional dengue-fighting medicine (Rahman et al., 2020).

While many households demonstrated good knowledge and concern regarding dengue, their preventive practices were often lacking or applied inconsistently. This observation aligns with the well-documented KAP (Knowledge, Attitude, Practice) gap identified in earlier studies related to dengue behaviour (Selvarajoo et al., 2020; Harapan et al., 2016). The findings indicate that structural barriers, such as inadequate coordination of fogging efforts and limited awareness of breeding sites, continue to impede effective practices despite positive attitudes. This KAP gap underscores a broader behavioural challenge in dengue control, echoing patterns found in community-based intervention reviews (e.g., George et al., 2015). Practices such as monitoring breeding sites and engaging in community fogging are not uniformly adopted, highlighting the need to close the intention-action gap through behavioural nudges and enhanced community involvement. These implications are crucial for policymakers aiming to turn awareness into practical household actions. The disconnect between knowledge, attitude, and actual practice reinforces the KAP behavioural inconsistency illustrated in the conceptual framework (Fig. 2). It supports the broader assertion that health education alone is inadequate without structural support and community mobilisation (Runge-Ranzinger et al., 2014).

Discussion

The present study aimed to systematically review the existing literature on the knowledge, attitudes, and practices related to dengue among Asian households. Household participation in controlling and preventing dengue is critical at the ground level, and successful participation is heavily dependent on household knowledge, attitudes, and prevention practices. A systematic search of the existing literature using electronic keywords through two well-known databases, Scopus and WoS, yielded 23 relevant papers for analysis. The highest number of selected publications from Malaysia can be attributed to the country’s hyperendemic status for dengue due to major dengue outbreaks in a cyclical pattern of approximately every 4–8 years. The cyclical pattern of major dengue outbreaks in Malaysia involves all four serotypes of the dengue virus, and each successive change in the dominant serotype is associated with an increase in severe dengue cases (Abubakar, Shafee (2002)). As a developed country in Asia, Malaysia benefits from a more developed research infrastructure and government support for dengue research, which contributes to the high number of publications on the topic (Guad et al., 2021).

Information availability versus awareness uncertainty

The collective findings of all 23 related papers provide valuable insights into dengue-related knowledge. While a significant proportion of respondents knew that a mosquito bite causes dengue (Khan et al., (2022a)), one study found that only 39.8% knew that dengue is transmitted by a mosquito bite (Khalil et al., 2016). Although knowledge of dengue signs and symptoms was widespread among households, several studies have reported contradictory findings regarding the most common symptoms of dengue. While some studies found that the majority of respondents recognised fever as the most common symptom of dengue (Ramli et al., 2022; Rahman et al., 2022; Phuyal et al., 2022), others reported contradictory findings (Hossain et al., 2021; Khalil et al., 2016). The availability of information on dengue manifestation and symptoms varied by education level, with studies indicating that respondents with higher education levels and access to education had a better understanding of dengue symptoms. Similarly, studies conducted in urban areas have shown a higher level of prior knowledge of dengue symptoms than those conducted in rural areas. This can be observed in the studies by Ramli et al. (2022), Rahman et al. (2022) and Phuyal et al. (2022), which involved respondents who had attained at least a secondary education level and above, 90% of them having tertiary education or higher, and 84% having access to education, respectively. Conversely, studies by Khalil et al. (2016) and Hossain et al. (2021) involved more than 50% of respondents with a lower education level than class 12, and 55% with a secondary education level or below, respectively. These findings suggest a relationship between access to education and awareness of dengue symptoms. Studies conducted in the city (Ramli et al., 2022; Rahman et al., 2022; Phuyal et al., 2022) demonstrated a higher level of prior knowledge about dengue symptoms compared to those conducted in rural areas [44, 46], suggesting an association between geographical location and access to healthcare infrastructure and educational resources.

Education versus misconception

Ramli et al. (2022) found that many respondents in their study were unaware of the peak dengue mosquito biting seasons, with fewer than 13% aware that Aedes mosquitoes primarily bite during the day (Basra et al., 2019; Dhimal et al., 2014). This finding may be attributed to the misconception that some species of mosquitoes, such as the Anopheles mosquito, which transmits malaria, are more active at night (Bedasso et al., 2022). In contrast, the Aedes mosquito is active during the day, especially in the early morning and late afternoon. It is essential to note that different species of mosquitoes have different biting habits and preferences, and the diseases they transmit also vary. Although previous research found that the majority of respondents were aware that dengue was transmitted by mosquito bites (Hossain et al., 2021; Selvarajoo et al., 2020), research by Basra et al. (2019) and Phuyal et al. (2022) revealed that more than 80% were unaware. The high percentage of respondents unaware of the transmission method of dengue may be due to various factors, including differences in education levels, access to information, and public health campaigns, which may have contributed to the disparity in awareness levels. These findings underscore the significance of public health campaigns in raising awareness about dengue, particularly in rural areas. Improving knowledge and awareness about dengue can lead to more effective prevention and control measures, ultimately reducing the burden of dengue on affected communities. However, previous studies have shown that dengue is a serious problem and a potentially fatal disease (Phuyal et al., 2022; Khan et al., (2022a); Saied et al., 2015). In one study, 44% of respondents believed that not everyone is at risk of contracting the disease (Khalil et al., 2016). This misconception may be attributed to a lack of understanding of the development of dengue disease. It is essential to address this issue since it may lead to complacency and a false sense of security among individuals who believe they are not at risk. Moreover, it can also lead to a lack of urgency in implementing preventive measures at the community level.

Negative reactions to vector control and preventive measures

Regarding dengue-related attitudes, Kumaran et al. (2018) most respondents believed dengue could be prevented, while more than 41% disagreed (Saied et al., 2015). This disagreement may stem from a lack of understanding about vector control measures. Additionally, some may believe that preventing dengue is beyond their control, or that the responsibility falls solely on the government and other organisations. Negative experiences with dengue prevention methods in the past may also contribute to the belief that dengue cannot be prevented. Despite many respondents agreeing that cleaning potential Aedes mosquito breeding sites is one of the most effective ways to control dengue (Mohd Khairi et al., 2021; Rahman et al., 2020; Brasa et al., 2019; Kumaran et al., 2018; Aung et al., 2016), 71.6% of respondents believed that eliminating Aedes mosquito larval breeding sources is a complicated and time-consuming process (Aung et al., 2016). This perception can be attributed to a lack of awareness about effective vector control measures and inadequate community engagement in mosquito control efforts. In addition, findings revealed that the majority of respondents are unaware of the timing of fogging activities for dengue prevention (Ramli et al., 2022), and half of the respondents believed these activities were sufficient for dengue prevention (Selvarajoo et al., 2020). The lack of awareness regarding the timing of fogging activities may be due to inadequate communication by relevant authorities. Local health departments or municipal authorities typically conduct fogging activities, and they may not have adequately informed the public about the schedule of these activities or the importance of taking additional preventive measures. Additionally, misconceptions about the effectiveness of fogging activities may contribute to the belief that they are sufficient for dengue prevention. These misconceptions could also be due to inadequate education campaigns and a lack of understanding about the limitations of fogging activities in controlling dengue. These misconceptions and knowledge gaps highlight the need for targeted and effective communication and education campaigns to improve understanding of dengue, its prevention, and effective vector control measures. Such campaigns should also aim to dispel common misconceptions, increase awareness of the importance of preventive measures at the community level, and promote community engagement in mosquito control efforts.

The mixture of good and poor practices

The analysis of 23 studies on dengue-related practices in Asia revealed that households employ both effective and ineffective practices for dengue prevention. Poor practices include failing to communicate with local authorities regarding fogging activities (Rahman et al., 2022), a lack of precautionary measures (Rahman et al., 2021), insufficient monitoring of Aedes mosquito breeding sites (Ramli et al., 2022), and low participation in dengue programs or campaigns (Mohd Khairi et al., 2021). On the other hand, effective dengue prevention practices commonly observed in Asian households include frequent cleaning, covering, and changing water containers (Rahman et al., 2022; Karimah Hanim et al., 2017; Alyousefi et al., 2016), removing mosquito larvae from water container (Mohd Khairi et al., 2021; Selvarajoo et al., 2020), avoiding mosquito-man contact Basra et al. (2019), using mosquito nets and mosquito control tools (Phuyal et al., 2022; Krishnamoorthy et al., 2018), and seeking medical care in a hospital for dengue treatment (Rahman et al., 2022). The combination of ineffective and effective dengue prevention practices in Asian households can be attributed to several factors. One reason is a lack of knowledge or awareness about dengue prevention and control measures. Misconceptions about the effectiveness of specific preventive measures, a lack of resources or access to practical preventive tools, and social and cultural factors that may influence the adoption of specific practices may also contribute to this. Additionally, inadequate communication and education campaigns and a lack of support from local authorities or health departments could also contribute to the mix of poor and good practices.

Strengths, limitations of the review and future research

The main strength of this review lies in its comprehensive and systematic search of multiple sources, which enables a more comprehensive overview of dengue-related knowledge, attitudes, and practices among Asian households. Furthermore, to the best of our knowledge, this is the first systematic review to examine dengue-related knowledge, attitudes, and practices (KAP) among households in Asia. Nonetheless, several limitations should be noted. First, within the study’s time frame, no previous research has examined dengue-related KAP among households in Vietnam, Indonesia, and the Philippines. These countries are among the top five with the highest number of dengue cases reported, according to the European Centre for Disease Prevention and Control (ECDC, 2022), highlighting the need for further research in these areas. Second, while electronic keyword searches are universally recognised as the most common and effective method for conducting systematic analyses, researchers should also employ supplementary search techniques to locate existing research papers (Tsafnat et al., 2014; Horsley et al., 2011). Reference checking, citation searching, and consulting an expert are all recommended supplementary search techniques (Briscoe et al., 2020; Gøtzsche & Ioannidis, 2012; Horsley et al., 2011).

Conclusion

This study employed a systematic review guided by the PRISMA methodology to investigate household-level knowledge, attitudes, and practices (KAP) related to dengue prevention across various Asian countries. A total of 23 empirical studies published between 2010 and 2022 were analysed using descriptive and content analysis techniques. The objective was synthesising behavioural responses that influence dengue transmission and control at the community level. This review contributes significantly to public health scholarship by providing a region-specific behavioural synthesis, which has been largely lacking in previous systematic reviews that have focused primarily on biomedical, epidemiological, and surveillance-related aspects. The analysis revealed considerable heterogeneity in household knowledge of dengue signs and symptoms, mosquito breeding sites, and the transmission process. While many respondents were aware that mosquito bites cause dengue, detailed knowledge of vector behaviour and peak biting times was often lacking. Attitudinal assessments revealed positive perceptions of dengue prevention; however, some communities relied on government fogging and external control measures. Most critically, despite moderate to high knowledge and attitude scores in many studies, actual preventive practices were frequently insufficient, revealing a “knowledge–practice” gap that continues to hinder effective dengue control at the household level. These findings highlight an urgent need for health education campaigns beyond awareness, focusing instead on behaviour change strategies tailored to household contexts. National and local health authorities should develop integrated communication programs that utilise culturally sensitive messaging to enhance knowledge of mosquito biting times, dispel misconceptions about breeding sites, and promote routine preventive measures. Training community health workers, mobilising local leaders, and integrating dengue prevention into school curricula could also help strengthen household and community engagement. Furthermore, incorporating real-time data collection and behavioural feedback tools into public health outreach may enhance the responsiveness and effectiveness of dengue interventions. From a policy perspective, this study supports a shift from top-down fogging campaigns to participatory, household-empowered strategies that address dengue control’s social and behavioural dimensions.