CHAPTER 1

INTRODUCTION

This chapter presents the background of the study, statement of the problem, objectives

of the study, significance of the study, scope & limitations, and the terms used in the study.

Background of the Study

Studies conducted by Akinsulie and Idris (2024) have found that dengue fever virus

(DENV) is a mosquito-borne virus, mostly spread by Aedes aegypti. According to the World

Health Organization, DENV is found primarily in urban and semi-urban areas in tropical and

subtropical climates globally, putting approximately half of the world’s population at risk,

where about 100-400 million cases of the disease occur annually. In 2023 alone, there were

over five million cases of dengue fever reported in more than 80 countries and territories

worldwide. This is due to an ongoing outbreak of the disease potentiated by unanticipated spike

in cases. It is crucial to understand DENV transmission patterns to manage public health

effectively.

Additionally, according to Jaenisch et al. (2016) the burden of dengue continuous to

Increase globally, with an estimated 100 million clinically apparent infections occurring each

year. Although most dengue infections are asymptomatic, patients can present with a wide

spectrum of clinical symptoms ranging from mild febrile illness through to severe

manifestations of bleeding, organ impairment, and hypovolaemic shock due to a systematic

vascular leak syndrome. Clinical diagnosis of dengue and identification of which patients are

likely to develop severe disease remain challenging.

The purpose of this qualitative study is to investigate symptoms of dengue fever and

suggest possible solutions on how can we deal with it, to analyze the factors influencing the

emotional responses of dengue patients and the subsequent coping strategies they employ
following diagnosis, to identify factors influencing patient perceptions of treatment

effectiveness and actual treatment outcomes.

Statement of the Problem

This study aims to investigate the experiences of dengue patients regarding their possessed

physical symptoms, emotional reactions and coping mechanisms throughout their journey, from

diagnosis to recovery. Specifically, this paper will seek to answer the following:

1. What are the experiences of dengue patients regarding their perceived physical

symptoms, emotional reactions and coping mechanism during their journey?

2. How does the initial diagnosis of dengue fever impact patients emotional

responses and subsequent coping strategies?

3. What are the perceptions of dengue patients regarding the effectiveness of the

treatment they received?

Objectives of the Study

• To explore the personal experiences of dengue patients in their physical and

emotional aspects throughout their journey.

• To determine the coping strategies employed by patients following their

diagnosis and how these strategies, vary based on initial emotional responses.

• To determine the perceptions of dengue patients with the treatment received.

To the Dengue Patients. This study provides insights into the emotional and psychological

aspects of living with dengue, helping patients understand that their experience are shared. It

can empower them with coping strategies and foster a sense of community and support during

their recovery journey.

To the Hospitals. Findings can inform hospital practices and patient care protocols by

highlighting the importance of addressing not only the physical but also the emotional needs of

dengue patients. This can lead to improved patient satisfaction and better health outcomes.

To the Healthcare Facilities. The study emphasizes the need for comprehensive care

approaches that incorporate mental health support for dengue patients. It can guide healthcare

facilities in developing programs and resources that enhance patient education and emotional

well-being.

To the Future Researchers. This research lays the groundwork for further studies on the lived

experiences of dengue patients, encouraging exploration of related topics such as long-term

psychological effects and the effectiveness of various coping strategies. It can also inspire

comparative studies with other infectious diseases.

Scope and Limitation

This study is a qualitative research. Its main purpose is to investigate the experiences of dengue

patients regarding their possessed physical symptoms, emotional reactions and coping

mechanisms throughout their journey, from diagnosis to recovery.

examining their physical symptoms, emotional reactions, and coping mechanisms from the

moment of diagnosis through their recovery process. By utilizing in depth interviews and

personal narratives, the research aims to capture the multifaceted experiences of patients,

providing insights into how they navigate the challenges posed by the disease. This study to

highlight the interplay between physical health and emotional well-being, shedding light on the

support system and coping strategies employed by patients. However, the limitation of this

research include a potentially small and non-representative sample size, which may restrict the

generalizability of the findings. Furthermore, the study may not account for variations in

healthcare access or socio-economic factors that could influence patients experiences, thereby

narrowing the contextual understanding of dengue’s impact on diverse population.

This study will not go further beyond what it seek to explore and will not ask questions

or discuss anything more personal to participants.

Definition of Terms

To understand better the contents of the study, he following terms were operationally defined.

Coping Mechanism. strategies used to cope-up, adopt and accept the situation.

Diagnosis. the time when the patient already know that they have dengue.

Emotional Reaction. responses that occur in mind that affects body when encountering

something that affects emotionally

Physical Symptoms. observable or measurable signs that indicates a health condition or illness

Recovery. a return to a normal state of health, mind or strength.

REVIEW OF RELATED LITERATURE AND STUDIES

This includes the review of related literature and studies which the researchers have to shed

light the topic under study.

Review Of Related Literature

FOREIGN

In a literature review, Niyati K. et al. (2016) found that dengue fever is a major global

health problem, spreading rapidly over the past 50 years. It’s found in 128 countries, mostly in

developing nations, threatening nearly 4 billion people yearly. Studies estimate 390 million

dengue infections annually, with 96 million confirmed cases. It’s spread by Aedes mosquitoes,

mainly in tropical and subtropical areas, risking infection for about a third of the world’s

population. Dengue causes various illnesses, from mild fever to severe, sometimes fatal,

hemorrhagic fever. Its spread is linked to urbanization, travel, poor mosquito control, and

globalization. While there’s no cure, a vaccine is now licensed in some countries. Aedes

mosquitoes, primarily Ae. Aegypti, spread dengue; others like Ae. Albopictus also transmit it.

The mosquito life cycle takes about 8-10 days.

There is an urgent need to identify correlates of both vaccine protection and disease

enhancement (Wilde-Smith et al., 2018). Mortality from severe dengue is low, but the economic

and resource burden on health services remains substantial in endemic settings. Unfortunately,

progress towards development of effective therapeutics has been slow, despite notable advances

in the understanding of disease pathogenesis and considerable investment in antiviral drug

discovery. For decades antibody-dependent enhancement has been the prevalent model to

explain dengue pathogenesis, but it was only recently demonstrated in vivo and in clinical

studies. At present, the current mainstay of management for most symptomatic dengue patients

remains careful observation and prompt but judicious use of intravenous hydration therapy for

those with substantial vascular leakage.

of Health (MoH) establishes national guidelines for the 32 state health departments, while daily

operations remain the responsibility of state and local health services. Federal-level vector

control and dengue surveillance guidelines, developed by the MoH, involve collaboration with

the 32 state health services and organizations such as IMSS, ISSSTE, PEMEX and the Armed

Forces medical services. A public health laboratory network diagnoses a sample of suspected

dengue patients—all probable cases in areas without recent dengue or during low transmission,

and approximately 30% during transmission or outbreaks—using confirmatory assays (NS1,

IgM, or IgG ELISA). A subset (10%) of positive samples undergoes virus isolation analysis.

Weekly reporting is mandated for probable and confirmed dengue cases, while probable or

confirmed dengue hemorrhagic fever (DHF) cases and dengue-related deaths require 24-hour

reporting. The MoH estimates dengue cases in two phases: first, multiplying probable cases

by the positive case proportion from the lab-diagnosed sample (yielding possible cases), and

then adding the total lab-confirmed cases.

Local

Dengvaxia, a chimeric yellow fever tetravalent dengue vaccine developed by

SanofiPasteur is widely licensed in dengue-endemic countries. In a large cohort study

Dengvaxia was found to partially protect children who had prior dengue virus (DENV)

infections but sensitized seronegative children to breakthrough DENV disease of enhanced

severity. In 2019, the European Medicines Agency and the US FDA issued licenses that

reconciled safety issues by restricting vaccine to individuals with prior dengue infections.

Haltstead et al., (2020) proposed recommendations concerning continued use of this dengue

vaccine.(1) obtain a better definition of vaccine efficacy and safety through enhanced phase 4

surveillance, (2) obtain a valid, accessible, sensitive, specific and affordable serological test

that identifies past wild-type dengue virus infection and (3) clarify safety and efficacy of

Dengvaxia in flavivirus immunes. In the absence of an acceptable serological screening test

consent.

While prior research has illuminated the seasonal genetic structure and expansion of

*Aedes aegypti* mosquito vectors, and the connectivity among populations across various

island seaports [28, 29], understanding of genetic structuring within highly urbanized, dengue-

endemic regions remains limited (Carvajal, T.M et al., 2020). This study focuses on

Metropolitan Manila, a location ideal for investigating the influence of urbanization on the

current genetic structure of *Ae. Aegypti*. Previous research in this area has primarily

examined the relationship between dengue epidemiology and climate [5, 30, 31], or employed

wing geometric morphometrics to analyze population structure [32], providing insufficient

information regarding genetic structure and relatedness. To address this gap, the study collected

adult *Ae. Aegypti* samples from multiple sites within Metropolitan Manila to characterize

the population genetic structure and inter-population relationships.

Review Of Related Studies

FOREIGN

The outpatient study revealed that the highest levels of depression and stress were

observed immediately following dengue infection. A Pakistani study reported high anxiety and

depression levels in 60% of hospitalized dengue patients, with a correlation to symptom

severity [10]. The researchers suggest that the lower depression scores in the outpatient study

may be due to the later assessment timing, after the acute phase of the illness had passed

(Buenaño et al., 2024). The study compared the mental health and certain cognitive functions

of individuals with dengue (IgM-positive) and healthy controls during the 2021 dengue

outbreak in Esmeraldas, Ecuador.

The World Health Organization (WHO) identified dengue fever as a top ten global

health threat in 2019. A significant portion of the world’s population—an estimated 3.9 billion
people, or 40-50%—are at risk of infection, with 128 countries facing dengue risk, and 70% of

the global burden concentrated in Asia (Brady et al., unspecified). A global outbreak was

marked by a surge in reported dengue cases, rising from under 0.5 million in 2000 to over 3.34

million in 2016. Although global case numbers declined in 2017, a substantial increase to 4.3

million cases occurred in 2019. That year, the highest numbers of cases were reported in Brazil,

the Philippines, Vietnam, Mexico, Nicaragua, Malaysia, and India, with Sri Lanka ranking

eighth globally and fifth in Asia (Jaywickreme, K.P et al., 2021). Sri Lanka experienced a major

dengue epidemic in 2017 (186,101 cases, >320 deaths), the largest in three decades. Despite

control measures, cases resurged in 2019, reaching 102,746—double the 2018 total—

concentrated primarily in the western province, with 20% in Colombo (Jaywickreme, K.P et

al., 2021). While dengue deaths increased from 58 in 2018 to 90 in 2019, the mortality rate per

case decreased. Dengue fever mortality is generally below 1%, while dengue hemorrhagic

fever mortality ranges from 2-5% with prompt treatment but can reach 20% if left untreated.

LOCAL

Comparing DENV genetic material from both mosquitoes and people could improve

our understanding of how different dengue viruses are related (Saito et al., 2020). Most studies

only focus on people who have symptoms, ignoring those without symptoms, who are

increasingly important in the spread of dengue. A previous study showed that people without

symptoms can still infect mosquitoes, even with lower virus levels in their blood [24],

suggesting they might act as hidden sources of infection for mosquitoes [25,26], spreading the

virus. Therefore, dengue surveillance needs methods that consider these undetected infections.

Mosquito-based viral testing can help find these asymptomatic infections [15]. A one-month

study in Tarlac City, Philippines, during the 2015 dengue peak season examined mosquitoes

collected near homes of people suspected of having dengue to determine the different types of

dengue viruses in the local mosquito population.

Studies conducted by Ylade et al., (2021) have found that a single dose of CYD-TDV

(Dengvaxia, Sanofi Pasteur) given to nine to fourteen-year-old children through a community-

severe dengue but were unable to conclude on protection against milder illness. These studies

emphasize the importance of prevention through vaccination.

Dengue fever diagnosis relies on both clinical symptoms and blood tests, such as NS1

tests, for confirmation. The timing of testing is critical, as the virus may persist for several days

after infection. Patients may experience a critical period, typically between days five and seven,

where their condition could deteriorate. Treatment options vary depending on the severity of

the illness, ranging from home care for mild cases to hospitalization for more severe cases. The

involvement of family members in the patient’s care is often beneficial. Dengue poses

significant health risks, including internal bleeding and the potential for severe dehydration,

necessitating careful fluid management. While blood transfusions may be necessary in some

instances, they are not a routine treatment for all dengue patients. continues to inform best

practices for diagnosis and treatment. (Dr. Lee S. et al., 2015)

References:

(Wilder-Smith et al., 2018)

[Link]

hl=en&as_sdt=0,5#d=gs_qabs&t=1737877708809&u=%23p%3DHxGRVmJcW7YJ

(Saito et al., 2020)

[Link]

Aedes_aegypti_mosquitoes_collected_concurrently_with_suspected_patients_in_Tarlac_

City_Philippines

(Niyati K. et al., 2016)

engue+patients+in+other+countries+&btnG=#d=gs_qabs&t=1737630794916&u=%23p

%3DJYVri0-k6j4J

(Carvajal, T.M et al., 2020)

[Link]

+fever&qst=br#d=gs_qabs&t=1738107119650&u=%23p%3DeBwygPOuw3UJ

(Ylade et al., 2021)

[Link]

eness+of+treatment+of+dengue+in+the+Philippines+&btnG=#d=gs_qabs&t=173787965

1267&u=%23p%3D_jh1KeGDSSAJ

(Haltstead et al., 2020)

[Link]

eness+of+treatment+of+dengue+in+the+Philippines+&btnG=#d=gs_qabs&t=173787971

1622&u=%23p%3DfXee5Yme5YMJ

(Buenaño et al., 2024)

[Link]

(Jaywickreme, K.P et al., 2021)

[Link]

+fever&qst=br#d=gs_qabs&t=1737970052004&u=%23p%3DeBwygPOuw3UJ

(Undurraga, E.A et al., 2015)

[Link]

hl=tl&as_sdt=0,5#d=gs_qabs&t=1737969323572&u=%23p%3DXwLPUoUbh5QJ

(Dr. Lee S. et al.,)

RESEARCH METHODOLOGY

This chapter explains methodologies that were used in gathering data and analysis which are

relevant to the research. The methodologies will include areas such as research design,

respondents of the study, locale of the study, data gathering procedure, data gathering

method/instrument and data analysis.

Research Design

The researchers will use phenomenological research design as the study is attempting

to know the lived experiences of dengue patients. In the context of investigating the dengue

patients, this approach seeks to explore the subjective experiences of patients from the moment

of diagnosis through their recovery. Specifically, a semi-structured interview with open-ended

questions will be conducted so that the researchers can ask additional questions during the

interviews if clarifications and further explanations will be needed.

Respondents of the Study

The respondents of the study will be consisted of 15 participants in Gerona, Tarlac

(researcher’s community).

Participant selection employed a non-probability sampling incorporating purposive

sampling and snowball sampling. Purposive sampling was strategically used to select

participants possessing specific characteristics relevant to the research questions, such as

particular demographics, experiences, or knowledge. This targeted approach enriched the data

by focusing on individuals who could provide valuable insights related to the study’s objectives.

Snowball sampling expanded the sample by leveraging the networks of initially recruited

participants. Participants were asked to refer other individuals who met the inclusion criteria,

facilitating access to a wider range of perspectives and experiences within the community.
 The researchers believe that these participants would be enough to provide sufficient

and essential information to answer the questions raised in this society.

Locale of the Study

The study will be conducted in the researcher’s community, Gerona, Tarlac.

Data Gathering Procedure

A consent form will be given to each of them before the interview and will serve as a

document providing that they have given their permission for them to be interviewed by the

researchers. After the consent from have been signed by the respondents, the interviewer will

inform them when the interview proper starts and so as the recording.

When all the respondents have already been interviewed, the recorded answers will be

transcribed into texts for analyzation.

Since this study is descriptive in nature, the use of a semi-structured interview will

allow the researchers some flexibility in the way they worded the questions for each individual

respondent. It will also give the researchers the opportunity to probe for more information and

clarification when necessary. The researchers need to have a skill to match the interview

questions to an appropriate techniques (Neuman, 2000)

Data Gathering Instrument

In conducting the interview, the researchers will be writing down notes of the

respondents’ answers. The researchers will also use smartphones as their audio/video recording

material in order to be accurately documenting the answers in the interview to avoid

misinterpretation.

Data Analysis

When the answers of the respondents have already been transcribed into texts, which

was referred by Mthembu (2000) as raw data that need to be converted into refined data for
better analysis by the researcher, these would be translated into English as part of data

refinement. The refined data will be analyzed using thematic analysis. Braun and Clarke (2006)

state that thematic analysis is a foundational method of analysis that needed to be defined and

described to solidify its place in qualitative research. It is a method for identifying, analyzing,

organizing, describing, and reporting themes found within a data set (Braun & Clarke, 2006).

The respondents' answers to each questions will be evaluated Into codes and these

codes will be simplified into categories, and from the categories, the researchers will generate

a theme which will represent the answer that prevailed for each questions raised in this study.