1.Dengue Fever is characterized by sudden onset fever with intense headache, joint and muscle pain and a rash.

True / False

. The haemorrhagic form of Dengue Fever is more serious and it can lead to shoc!, bleeding and can be fatal

True / False

". #os$uitoes transmitting dengue infection bite mostly during a. daytime b. night time

%. The mos$uito that transmits Dengue Fever lays its eggs in a. dirty sewage water b. river water c. clean and clear water

&. 'mpty stagnant water from old tires, trash cans, and flower pots, coconut shells can be breeding places for mos$uitoes. True / False

(. The best preventive measure is the elimination of the places where the mos$uito lays its eggs

True / False

) . The treatment for Dengue Fever is a. *ntibiotics are treatment of choice b. +accine c. There is no specific treatment

,. -tored water containers/tan!s for drin!ing water without being covered should be cleaned every )days.

True / False

..The vector of Dengue Fever / Dengue /aemorrhagic Fever is 0 a.1ule2 b.*nopheles c.*edes d.3 don4t !now

15. 3 am afraid of getting Dengue Fever if one of my family members has dengue fever as dengue spreads directly from person to person. a. 6es b. 7o

Strongly agree

Agree

Neither Agree Nor Disagree

Disagree

Strongly Disagree

01. Eliminating the breeding places is the responsibility of only public health staff and Municipality.

02. Only method of controlling or pre enting Dengue is to combat the ector mos!uitoes.

0". #ou are one of the important people in pre ention

0$. Strong and healthy person %ill not get dengue infection.

0&. Only fogging is enough to pre ent mos!uito and no need for other %ays.

0'. E erybody has a ris( of being infected %ith dengue irus.

0). *t is possible to reco er completely from dengue infection.

0+. Elimination of lar al breeding sources is a %aste of time and ery complicated.

1.

Do you co er %ater containers immediately,

#es- No

2. Do you ha e %ater tan( at home.*f yes. /o% often do you clean it, #es- No Once a %ee( - once a month - once e ery " months " Do you ha e indoor plants - flo%er pots at home,*f yes. /o% often do you change %ater, Ne er -0ee(ly- daily $.0hich of the follo%ing do you use for mos!uito control, 1oils- bednets - rac(et- electric machine - cream - all of the abo e &.Do you discard empty cans. coconut shells.etc around your home, #es -No #es- No

'.Do you cooperate %hen Municipality %or(er is fogging or spraying disinfectant, #es - No ).Do you participate in any campaign of Dengue pre ention in community, #es-No

8here did you get information on Dengue Fever9 a.Family, Friends, 7eighbors b.Television c./ospital/clinics d.7ewspaper e.:osters/leaflets by govt/#unicipality f.#agazine g.;adio h.-chool / 1ollege #our age2 a. 1& to 2&yrs b. 2& to "& yrs Name 2 Signature2