Republic of the Philippines

University of Northern Philippines

Tamag, Vigan City
College of Nursing

A Case Study on Dengue Fever

Presented
To the College of Nursing
University of Northern Philippines

In partial Fulfillment of the Requirements for the

ISDH-GS Duty Nursery

Presented to:
Ms. Theressa Tejada

Presented by:
Rey T. Gabia

September 3, 2023

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 Table of Contents

Title Page …………………………………………………………………………… 1

Table of Contents …………………………………………………………………… 2

I. Introduction and Objectives ………………………………………………… 3 - 4

II. Personal data ……………………………………………………………....... 5 - 6

III. Nursing History of Past and Present Health Illness ………………………… 7 - 8

IV. PEARSON Assessment ……………………………………………………... 9 - 12

V. Diagnostic Procedures (Ideal and Actual).…………...…………………… 13 - 17

VI. Anatomy and Physiology …………………………………………………... 18 – 22

VII. Pathophysiology

a. Algorithm …………………………………………………………… 23

b. Explanation …………………………………………………………. 24

VIII. Management

a. Medical and Surgical (Ideal and Actual) …………………………… 25 - 26

b. Nursing Care Plan (NCP) …………………………………………...

c. Promotive and Preventive Management …………………………….

IX. Drug Study …………………………………………………………………...

X. Discharge Plan ………………………………………………………………

XI. Updates and Organization ...…………………………………………………

XII. Bibliography …………………………………………………………………

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I. Introduction and Objectives

INTRODUCTION

Dengue is a mosquito-borne viral disease that has rapidly spread to all regions of

WHO in recent years. Dengue virus is transmitted by female mosquitoes mainly of the

species Aedes aegypti and, to a lesser extent, Ae. albopictus. These mosquitoes are also

vectors of chikungunya, yellow fever and Zika viruses. Dengue is widespread throughout the

tropics, with local variations in risk influenced by climate parameters as well as social and

environmental factors.

Dengue causes a wide spectrum of disease. This can range from subclinical disease

(people may not know they are even infected) to severe flu-like symptoms in those infected.

Although less common, some people develop severe dengue, which can be any number of

complications associated with severe bleeding, organ impairment and/or plasma leakage.

Severe dengue has a higher risk of death when not managed appropriately. Severe dengue

was first recognized in the 1950s during dengue epidemics in the Philippines and Thailand.

Today, severe dengue affects most Asian and Latin American countries and has become a

leading cause of hospitalization and death among children and adults in these regions.

Dengue is caused by a virus of the Flaviviridae family and there are four distinct, but

closely related, serotypes of the virus that cause dengue (DENV-1, DENV-2, DENV-3 and

DENV-4). Recovery from infection is believed to provide lifelong immunity against that

serotype. However, cross-immunity to the other serotypes after recovery is only partial, and

temporary. Subsequent infections (secondary infection) by other serotypes increase the risk of

developing severe dengue.

Dengue has distinct epidemiological patterns, associated with the four serotypes of the

virus. These can co-circulate within a region, and indeed many countries are hyper-endemic

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for all four serotypes. Dengue has an alarming impact on both human health and the global

and national economies. DENV is frequently transported from one place to another by

infected travelers; when susceptible vectors are present in these new areas, there is the

potential for local transmission to be established.

OBJECTIVES

General Objective

It analyzes the issue and examines how the patient's condition is treated. To provide

sufficient information on the illness or condition and its nursing implications. The student

will also gain a firm understand of how to help the patient with the essential intervention by

the time the presentation is through, in addition to the sickness process and clinical

indications.

Specific Objectives

Student-Centered Objectives:

 To establish a trustworthy and nonjudgmental connection with the patient.

 To evaluate the sickness using the PEARSON scale, as well as the present history.

 Giving knowledge about the disease of the patient.

Patient-Centered Objectives:

 To treat and alleviate the patient’s disease.

 To establish rapport.

Family-Centered Objectives:

 The family will be able to gain knowledge and understanding on the risk factors in

acquiring dengue fever.

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II. PERSONAL DATA

A. Biographic Profile

Name: Jubileen Martinete

Age: 23-year-old

Sex: Female

Occupation: Call Center Agent

Address: San Antonio, Narvacan, Ilocos Sur

Date of Birth: August 12, 2000

Place of Birth: Iloilo

Civil Status: Single

Religion: Roman Catholic

Nationality: Filipino

B. Clinical Profile

Institution: Metro Vigan Hospital

Room/Ward: 314

Case Number: 252934

Date of Admission: July 15, 2023

Vital Signs upon admission

 Heart Rate: 110 bpm

 Respiratory Rate: 26 bpm

 Body Temperature: 38.4° Celsius

 O2 Sat: 96%

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  Blood Pressure: 140/880 mmHg

Admitting Physician: Dr. Romias, Dr. Manuel

Attending Physician: Dr. Guerero

Chief Complaint: Fever and headache with neck

muss

Admitting Diagnosis: Dengue Fever r/o Typhoid Fever

Final Diagnosis: Dengue Fever

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III. Nursing History of Past and Present Health Illnesses

A. BIOGRAPHIC DATA

This is the case of Jubileen Martinete, 23 years old call center agent, a resident of San

Antonio, Narvacan, Ilocos Sur. She lives with her parents and she was born on March 25,

2000 in Iloilo via normal delivery. A Filipino citizen and a Roman Catholic.

B. CHIEF COMPLAINTS

Fever and headache with neck muss

C. MEDICAL DIAGNOSES

Dengue Fever.

D. HISTORY OF PRESENT ILLNESS

Her condition started 10 days PTA as intermittent fever, consulted private MD

manager as dengue fever given meds of cefixime and probiotics.

E. PAST HEALTH HISTORY

Nothing significant.

F. HISTORY OF HOSPITALIZATION

She was admitted in Metro Vigan hospital for complaining that she has headache,

cough and fever, she also claimed that she is in pain in her upper part of abdomen.

G. FAMILY HEALTH HISTORY

Nothing significant.

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IV. PEARSON Assessment

Assessment Hospital Date: December 12 - 14

Physiological December 12 - 13, 2022

 For the general appearance, the patient can walk,

stand, awake, and can eat alone.

 The skin has no signs of discoloration. There was no

bad odor, and there were no lesions or bleeding. The

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 turgor and capillary of the skin are poor. No rushes

are noted.

 Eyes are symmetrical. The presence of the sclera is

good. The shape and size of the eyeball are normal.

Sunken eyeballs are noted. There are no fluid

secretions. The eye-muscle coordination is normal.

 The nose is symmetrical. There are no obvious

lesions, edema, or bleeding. There are no fluid

discharges and no tenderness in the sinuses.

 The lips are dry and rosy. There are no apparent

lesions, swelling, or bleeding on the lips. The tongue

is normal in color.

 The body of the patient is normal color. There is no

bulge in the body. And no unwanted movement.

 No discolorations in both upper and lower extremities.

The size of the upper and lower extremities is normal.

 December 12: Temperature is 38.9° Celsius, above

normal.

 December 13: 36.6° Celsius, normal.

December 14, 2022

 Temperature is 36.1° Celsius, normal.

 The patient is discharged.

Elimination December 12, 2022

 2x of urination in 4hrs.

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  No bowel movement in 4hrs.

December 13, 2022

 1x of urination in 4hrs.

 1x bowel movement in 4hrs.

December 14, 2022

 No bowel movement and urine noted.

Activity and Rest December 12, 2022

 Patient was being reminded to note fluid intake.

 DAT-EDCF

 Patient sleeps normally.

December 13, 2022

 Patient was monitored for signs and symptoms for

bleeding.

 DAT-EDCF

 Patient sleeps normally.

December 14, 2022

 Patient was ready to go home.

Safety and Security December 12, 2022

 D5LR 1L is a fluid inserted in the IV tube to run for

8hrs.

 No known allergies to food and medicines.

 No presence of swelling on IV insertion site.

 The patient was routinely monitored.

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  All vital signs were recorded.

 Patient’s room is tidy, safe, and air conditioned. The

room has own comfort room.

December 13, 2022

 PLR 1L is a fluid inserted in the IV tube to run for

12hrs.

 No known allergies to food and medicines.

 No presence of swelling on IV insertion site.

 The patient was routinely monitored.

 All vital signs were recorded.

 Patient’s room is tidy, safe, and air conditioned. The

room has own comfort room.

December 14, 2022

 Patient is discharged, safe and sound.

Oxygenation December 12, 2022

 No difficulty of breathing.

 O2 Saturation: 98%

December 13, 2022

 No recorded for difficulty of breathing.

 O2 Saturation: 99%

December 14, 2022

 O2 Saturation: 99%

Nutrition December 12, 2022

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  Insert IVF: D5LR 1L x 8hrs

 DAT-EDCF

December 13, 2022

 Insert IVF: PLR 1L x 12hrs

 DAT-EDCF

December 14, 2022

 Insert IVF: PLR 1L x 12hrs

 DAT-EDCF

V. DIAGNOSTIC PROCEDURE (Ideal and Actual)

IDEAL

Name and Purpose of the Procedure Importance

Blood Test

SGOT/AST

An AST blood test helps determine Doctors primarily use the AST blood

test to check for and assess liver problems,

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how well the liver is functioning by usually alongside other liver tests. The AST

measuring levels of aspartate protein mainly occurs in the liver and heart.

aminotransferase (AST) in the blood. Too

much of this enzyme can indicate a

problem, such as liver damage. Another

name for the test is a serum glutamic-

oxaloacetic transaminase (SGOT) test.

SGPT/ALT ALT blood tests are often part of liver

ALT is an enzyme found in many parts function testing. The main reason to take an

of the body, but the liver contains the ALT test is if you or your doctor identify

highest concentration. This enzyme, signs of liver damage or failure. It can also

formerly known by the name serum be taken to monitor the progression of liver

glutamic-pyruvic transaminase, or SGPT, is diseases or to evaluate the effectiveness of

used by the body to break down food into treatment.

energy.

An ALT test measures the amount of

ALT in the blood to assess if the liver is

damaged. The most common reason to take

an ALT test is to detect liver injury and to

screen for/or help diagnose liver disease, as

it is considered to be one of the best

methods to identify liver issues.

Urinalysis Test (UA)

A urinalysis involves checking the To check for a disease or infection of

appearance, concentration and content of the urinary tract. The urinary tract includes

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urine. It's used to detect and manage a wide the kidneys, the tubes that carry urine from

range of disorders, such as urinary tract the kidneys to the bladder (ureters), and the

infections, kidney disease and diabetes. bladder. It also includes the tube that carries

urine from the bladder to outside the body

(urethra).

Complete Blood Count (CBC)

A complete blood count (CBC) is a A complete blood count is a common blood

blood test used to evaluate your overall test that's done for a variety of reasons; to

health and detect a wide range of disorders, review your overall health, to diagnose a

including anemia, infection and leukemia. medical condition, to monitor a medical

A complete blood count test measures condition, and to monitor medical treatment.

several components and features of your

blood, including:

 Red blood cells (RBCs), which carry

oxygen.

 White blood cells (WBCs), which

fight infection.

 Hemoglobin, the oxygen-carrying

protein in red blood cells.

 Hematocrit, the proportion of red

blood cells to the fluid component,

or plasma, in your blood.

 Platelets, which help with blood

clotting.

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 Actual

Name of the Normal Value Actual Implication Nursing

Procedure Value Responsibilities
Blood test SGOT/AST: 111 High, but does  Monitor vital
8.000 – 50.000
u/L not necessarily signs

indicate liver especially

damage. blood

pressure.
SGPT/ALT:
78 High, may  Promote rest.
0.000 – 35.000
u/L indicate any  Provide

form of injury adequate

or damage in nutrition.

the liver.  Reducing risk

for injury.

Urinalysis Test  Label

(UA) specimen for

Microscopic analysis to

Examination ensure their

 Transparency  Slightly delivery to the

Turbid lab.
 Color
 Yellow  Should
Chemical
collected in a
Examination
1.016 – 1.022 1.005 Normal clean, dry
 Specific

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 Gravity 6.000 – 8.000 6.5 Normal container.

 pH Negative

 Albumin Negative

 Nitrates

 Blood Negative

(Hemoglobin) Negative

 Sugar

Complete Blood  Monitor

Count (CBC) patient’s vital

 RBCs 39 – 47% 40 Normal signs.

 Hematocrit 120 – 160 g/L 128 Normal  Instruct to

 Hemoglobin 4.200 – 5.400 4.60 Normal resume

150.000 – 92 Low normal

 Platelet
450.000 x10
activities and
g/L
4.5 – 11.0 x diet.
9
2.0 Low
10 / L
 WBCs

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VI. ANATOMY AND PHYSIOLOGY

The body has a highly developed immune system

that detects and eliminates foreign chemicals and organisms

that enter the body as a second line of defense. The immune

system is able to discriminate between foreign chemicals

called antigens and the body's own tissues. As a result,

immune army cells may recognize and eliminate just those

enemy antigens. The immune system also consists of other

proteins and chemicals that help antibodies and T cells in

their work. Among them are chemicals that alert

phagocytes to the site of the infection. The immune system

also includes other proteins and chemicals that the body can use to mount a better and faster

immune response the next time any of these antigens appear. Normally floating freely in the

circulation, the complement system is a collection of proteins that travels to illnesses and

joins forces with other proteins to help eradicate germs and foreign particles. By altering the

surface of bacteria or other microbes, they achieve this and cause their demise.

Two types of immune system:

The innate immune system is the body's first line of defense against germs entering

the body. It responds in the same way to all germs and foreign substances, which is why it is

sometimes referred to as the "nonspecific" immune system. It acts very quickly: For instance,

it makes sure that bacteria that have entered the skin through a small wound are detected and

destroyed on the spot within a few hours. The innate immune system has only limited power

to stop germs from spreading, though.

The adaptive immune system takes over if the innate immune system is not able to

destroy the germs. It specifically targets the type of germ that is causing the infection. But to

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do that it first needs to identify the germ. This means that it is slower to respond than the

innate immune system, but when it does it is more accurate. It also has the advantage of being

able to "remember" germs, so the next time a known germ is encountered, the adaptive

immune system can respond faster. This memory is also the reason why there are some

illnesses you can only get once in your life, because afterwards your body becomes

“immune.” It may take a few days for the adaptive immune system to respond the first time it

comes into contact with the germ, but the next time the body can react immediately. The

second infection is then usually not even noticed, or is at least milder.

Parts of Immune System:

 White blood cells are the key players in your immune system. They are made in your

bone marrow and are part of the lymphatic system. White blood cells move through

blood and tissue throughout your body, looking for foreign invaders (microbes) such

as bacteria, viruses, parasites and fungi. When they find them, they launch an immune

attack. White blood cells include lymphocytes (such as B-cells, T-cells and natural

killer cells), and many other types of immune cells.

 Antibodies help the body to fight microbes or the toxins (poisons) they produce. They

do this by recognising substances called antigens on the surface of the microbe, or in

the chemicals they produce, which mark the microbe or toxin as being foreign. The

antibodies then mark these antigens for destruction. There are many cells, proteins

and chemicals involved in this attack.

 Complement system is made up of proteins whose actions complement the work

done by antibodies.

 The lymphatic system is a network of delicate tubes throughout the body. The main

roles of the lymphatic system are to: manage the fluid levels in the body, react to

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 bacteria, deal with cancer cells, deal with cell products that otherwise would result in

disease or disorders, and absorb some of the fats in our diet from the intestine.

The lymphatic system is made up of:

o lymph nodes (also called lymph glands) – which trap microbes

o lymph vessels – tubes that carry lymph, the colourless fluid that bathes your

body's tissues and contains infection-fighting white blood cells

o white blood cells (lymphocytes).

 The spleen is a blood-filtering organ that removes microbes and destroys old or

damaged red blood cells. It also makes disease-fighting components of the immune

system (including antibodies and lymphocytes).

 Bone marrow is the spongy tissue found inside your bones. It produces the red blood

cells our bodies need to carry oxygen, the white blood cells we use to fight infection,

and the platelets we need to help our blood clot.

 The thymus filters and monitors your blood content. It produces the white blood cells

called T-lymphocytes.

Three types of Immunity:

1. Innate immunity: Everyone is born with innate (or natural) immunity, a type of

general protection. For example, the skin acts as a barrier to block germs from

entering the body. And the immune system recognizes when certain invaders are

foreign and could be dangerous.

2. Adaptive immunity: Adaptive (or active) immunity develops throughout our lives.

We develop adaptive immunity when we're exposed to diseases or when we're

immunized against them with vaccines.

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 3. Passive immunity: Passive immunity is "borrowed" from another source and it lasts

for a short time. For example, antibodies in a mother's breast milk give a baby

temporary immunity to diseases the mother has been exposed to.

Two types of blood vessels that carry blood throughout the body:

The artery is the blood vessels which carry the blood away from the heart towards

the body parts. The arteries form smaller and thinner capillaries which supply blood to the

different organs in the body. The vein carry blood from body parts to heart.

The three types of blood cells in whole blood that travels through the system of arteries

and veins:

 Red blood cells, or erythrocytes, are specialized cells that circulate through the body

and deliver oxygen to tissues. In humans, red blood cells are small and biconcave

(thinnest in the center, just 7 - 8 μm in size), and do not contain mitochondria or a

nucleus when mature. In the lungs, red blood cells take up oxygen, and as they

circulate through the rest the body, they release the oxygen to the surrounding tissues.

Red blood cells also play an important role in transport of carbon dioxide, a waste

product, from the tissues back to the lungs. Some of the carbon dioxide binds directly

to hemoglobin, and red blood cells also carry an enzyme that converts carbon dioxide

into bicarbonate. The bicarbonate dissolves in plasma and is transported to the lungs,

where it's converted back into carbon dioxide and released.

 Platelets, also called thrombocytes, are cell fragments involved in blood clotting.

They are produced when large cells called megakaryocytes break into pieces, each

one making 2000 – 3000 platelets as it comes apart. When the lining of a blood vessel

is damaged (for instance, if you cut your finger deeply enough for it to bleed),

platelets are attracted to the wound site, where they form a sticky plug. The platelets

release signals, which not only attract other platelets and make them become sticky,

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 but also activate a signaling cascade that ultimately converts fibrinogen, a water-

soluble protein present in blood plasma, into fibrin (a non-water soluble protein). The

fibrin forms threads that reinforce the platelet plug, making a clot that prevents further

loss of blood.

 White blood cells, also called leukocytes, are much less common than red blood

cells and make up less than 1\%1%1, percent of the cells in blood. Their role is also

very different from that of red blood cells: they are primarily involved in immune

responses, recognizing and neutralizing invaders such as bacteria and viruses. White

blood cells are larger than red blood cells, and unlike red blood cells, they have a

normal nucleus and mitochondria.

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VII. PATHOPHYSIOLOGY

Algorithm

Bite of Aedes Aegypti

The virus enters under the skin.

Inside the Langerhans cell, the virus infects and reproduces (immunity of the skin)

Interferons are released by Langerhans cells (to limit the spread of infections)

The lymphatic system receives infected Langerhans cells, which alerts the immune system.

Then goes circulation.

Results in Viremia – high levels of virus in the bloodstream.

Activation of Immune response – increase lymphocyte

Decreases neutrophils and white blood cells

Releases of Pyrogen causes fever

Dengue

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Explanation

Dengue virus is spread primarily by Aedes mosquitoes, in particular Aedes aegypti.

Human beings are the primary hosts of this virus, arousing even nonhuman primates. An

infection may be obtained through a single bite. A female mosquito that consumes an

infected person’s blood (within a febrile, viremic span of 2 to 12 days) becomes infected with

the virus in its intestine. When an infected mosquito bites person's skin, the victim contracts

the dengue virus. A kind of dendritic cell in the skin called Langerhans cells is infected by the

dengue virus. Interferons are made by the infected Langerhans cells to assist stop the

infection from spreading further. Viruses carried by further infected Langerhans cells reach

the lymph nodes where they infect more cells. Viremia, a high concentration of the dengue

virus in the circulation, is brought on by the transmission of the virus. The immune system

creates antibodies to destroy the dengue virus particles that boost lymphocytes in order to

combat the illness. Dengue fever can result in a drop of white blood cells and neutrophils;

this happens because it damages the bone marrow and affects the blood cells and damage the

platelets. Pyrogens can raise the thermostat and elevate body temperature because they

release viruses or dead body cells, both of which have the ability to produce fever which

turns to dengue fever.

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VIII. MANAGEMENT

This part presents the Medical and Surgical Interventions (Ideal and Actual) that

provides direction for the care of the patient to adequately address the needs, the nursing care

plans, and the promotive and preventive management of the overall health and well-being of

the patient.

a. Medical and Surgical (Ideal and Actual)

Medical (Ideal and Actual)

IV Fluids

 D5LR can be given when additional fluids can be given.

 PLR will serve as a management and a treatment for dehydration.

Medications

Clinical Tests

 Complete Blood Counts (CBC) - to look for low platelet count typical of

the later stages of the illness and to detect the decrease in hemoglobin,

hematocrit, and red blood cell (RBC) count (evidence of anemia) that

would occur with blood loss associated with severe dengue fever.

 Urinalysis Test (UA) –

 Blood Test –

Surgical (Ideal and Actual)

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 The majority of surgical symptoms may be treated non-operatively or with

minimally invasive techniques. Surgical manifestations are relatively uncommon.

Acute acalculous cholecystitis, acute pancreatitis, acute appendicitis, splenic rupture,

bowel perforation, gastrointestinal hemorrhage, and hematomas are a few common

surgical symptoms. When a patient from a dengue-endemic location arrives with an

acute abdomen or bleeding symptoms, a high degree of suspicion of dengue fever is

required. Poor results are caused by incorrect diagnoses and needless surgical

treatments. Evaluation using fundamental hematological testing, early dengue antigen

tests/serology, and imaging might help avoid such misdiagnoses. 

25
26
 NURSING CARE PLAN

Cues Nursing Diagnosis Scientific Nursing Objectives Intervention Rationale Evaluation

Background
Subjective: Acute pain r/t to Aedes Aeggypti Short Term: INDEPENDENT INDEPENDENT Short Term:
“sumasakit ang abdominal pain, (dengue virus 6:00am-5:00pm * Monitored v/s * For baseline data 6:00am-5:00pm
tyan, ulo at sever headache, carrier)8-12 days of July 17, 2023 * Assessed the *To know patients’ July 17, 2023
kasukasuhan ko sa and joint pain as viral replication on After 1 hour of patients’ perception of pain After 1 hour of
kanang binti” as evidence by the mosquito salivary nursing description of pain nursing
verbalized by the patient scaling pain glands intervention * Promoted bed * To limit the pain intervention
patient right leg (6. /10) patient will rest Patient
Objective: Headache (5/10) implement a pain * Encouraged * Prevents joint implemented a
+ facial grimace abdominal pain Bites from management plan frequent changes in stiffness pain management
Pain scale joint pain (7/10) mosquito (portal of that includes position plan that includes
right leg (6/10), entry in the skin) pharmacological * Applied warm or * To promote pharmacological
headache (5/10) and non- moist compress on muscle relaxation and non-
abdominal pain pharmacological the affected area pharmacological
(7/10) measures * Encourage to do * To promote measures.
Allowing dengue deep breathing relaxation
virus to be Long Term: exercise Long Term:
inoculated towards 6:00am-5:00pm *Encourage small * To prevent 6:00am-5:00pm
the circulatory July 17, 2023 frequent meals stomach pain July 17, 2023
blood (incubation After 8 hours of After 8 hours of
period 3-14 days) nursing DEPENDENT DEPENDENT nursing
intervention * Paracetamol * To relieve pain intervention
Antibodies Patient will report 500mg PO Doctor’s Patient reported
pain at a decrease order decreased level of
level. pain as evidenced
by pain scale of
joint pain right leg
attached to the 3/10 from 6/10,
viral antigens headache 2/10

27
 Recognition to from 5/10,
dengue viral abdominal pain
antigen on 4/10 from 7/10
infection monocyte GOAL MET.

Release of
cytokines which
consists of
vasoactive agents

Dengue fever

ACUTE PAIN

28
29
30
c. Promotive and Preventive

Promotive

a. Public awareness should be promoted for prevention and control the dengue fever.

This should involve cooperation between private and public sectors.

b. Health education strategies should educate the people to break the mosquito life

cycle by destroying the possible mosquito breeding sites such as concrete pools,

water tanks, aquaria, irrigation ditches and drainages as well as air-conditioners

and disposable tires.

c. The immediate-action principle should be activated associated with effective

communication and cooperation between different government sectors. Positive

dengue cases should be followed by intensive management of the vector in the

possible breeding sites where the case came from.

d. Enhancing self-awareness among the people through health education programs.

Different activities should be organized including practicing self-protection and

regular workshops on the larvae and adults control strategies. It is important to

educate people about the adverse effects of the arbitrary application of insecticides

without prior knowledge on dose, resistance and side effects of these chemicals.

e. Regular education programs should be conducted out at different levels to

highlight the importance of personal sanitation in preventing dengue.

f. The residents should be aware not merely to control activities carried out by the

control personnel but also interacting with health education organized by the

respective authorities and government bodies.

31