Public knowledge, practices and perceptions on typhus fevers in Southern Sri Lanka

Objective: To assess public knowledge, practices and perceptions on typhus fevers in Sri Lanka. Methods: A descriptive study was done in four selected typhusprone areas in Southern Sri Lanka. A mixed-method was employed using face-to-face interviews and questionnaire-based surveys among confirmed cases of typhus and at-risk populations, respectively. Frequencies, percentages, and means were used to characterize socio-demography and evaluate disease awareness. Results: The lay terms for typhus fevers reported in the studied region were "peacock fever", "tick fever" and "bird fever". A total of 499 subjects participated [mean +/- SD, (45 +/- 16) years] in the questionnaire-based survey, and 13.6% (n=68) reported past experience of typhus fever, 1.2% (n=6) identified the disease as "typhus" while 58.7% (n=293) and 11.8% (n=59) knew it as 'peacock fever' and 'tick fever', respectively. The etiological agent was unknown to 95.2% (n=475), but 53.5% ((n=267) were aware that it was vector-borne. Fever (57.3%, n=286), eschar (35.7%, n=178), headache (22.0%, n=267) and myalgia (19.2%, n=96) were identified as key symptoms. Past disease experience was significantly associated with higher awareness of the main disease symptoms (fever: chi(2)=15.713, P<0.001; headache: chi(2)=19.447, P<0.001; lymphadenopathy: Fisher's exact test, P=0.023; eschar: chi(2)=12.049, P<0.001). None knew of any disease prevention methods. Participants with a past history of typhus fever had sought treatment at state hospitals (55.9%, 38/68) and private sector hospitals (5.9%, 4/68). Conclusions: Public awareness on preventive practices for typhus fevers was rare among the participants though vector-borne aspect was known to many. Clinical disease awareness was deficient among those without past experience of typhus fever. Community sensitization on vector avoidance strategies is highly recommended.