Dengue is an infectious disease transmitted by mosquitoes of the Aedes genus. It is a public health problem due to its severity, particularly in the case of dengue hemorrhagic fever, but also because of its increasing incidence [1][2]. This increase in the incidence of dengue is partly due to the rapid and often poorly controlled urbanization of cities [3]. This places it among the so-called “re-emerging” diseases. There are 390 million cases per year worldwide, of which 96 million are symptomatic [4]. In Côte d’Ivoire, in the Cocody-Bingerville health district, the dengue test positivity rate is 11% [5]. Dengue affects all types of population, including pregnant women.

Dengue fever is poorly understood and often mistakenly confused with malaria by both healthcare professionals and the general public. Indeed, it has no specific clinical signs, and its progression is unpredictable. Dengue fever in pregnant women has particular characteristics. These include the risk of teratogenicity [6] as well as the risk of developing a severe hemorrhagic form that can be life-threatening for the mother [7]. Several studies have been conducted among healthcare professionals [8][9]. However, few studies have been carried out on pregnant women regarding dengue fever.

In this context, what might be the educational needs of pregnant women regarding dengue fever? To this end, we assessed the knowledge, attitudes, and practices of pregnant women regarding dengue fever in order to improve their care, particularly prevention.

This was a cross-sectional, descriptive study of knowledge, attitudes, and practices. It took place over a period of 9 months, from January 1, 2025, to September 30, 2025. Data collection occurred from January 9 to March 28, 2025 (3 months). The study population consisted of all pregnant women who consulted at the Angré University Hospital Center. Pregnant women with a gestational age of ≥11 weeks of amenorrhea who had actually begun their prenatal care were included in the study. That is, those who had undergone a dating ultrasound (11th - 13th weeks of gestation). Among these pregnant women, some were randomly selected each week for inclusion in the study. Pregnant women selected according to the inclusion criteria who declined to participate in the study (those who closed the questionnaire without answering the questions) were not included. Data were collected using a questionnaire created from Google Forms and sent via an internal messaging system (WhatsApp) to the pregnant women included in the study.

The questionnaire comprised four groups of questions. The first group concerned sociodemographic data. The second group of questions related to pregnant women’s knowledge of dengue fever. The third group of questions concerned pregnant women’s attitudes toward dengue fever. The fourth group of questions related to pregnant women’s behavior in the face of dengue fever. For each question in the second through fourth groups, there were five possible answers according to the Likert scale.

We focused on the following variables:

- Quantitative variables: maternal age, parity.

- Qualitative variables: occupation, education level, municipality of residence, knowledge about dengue (mode of transmission, signs, complications of dengue in the mother-child dyad), attitudes towards dengue (willingness to sleep under insecticide-treated bed nets, environmental maintenance practices), practices related to dengue (self-medication, use of traditional medicines, routine use of antimalarial drugs).

The threshold was set at 60% for each correct answer. A threshold of 60% - 90% correct answers was considered good. Above 90% correct answers were considered excellent.

Anonymity and informed consent were respected according to the Helsinki Protocol.

The study’s limitations are represented by a selection bias. In fact, the exclusive selection of pregnant women who underwent ultrasound dating between 11 and 13 weeks of amenorrhea may exclude some patients with limited access to prenatal care.

The frequency found was 29.04% of all consultations and 43.38% of gynecological consultations. This frequency is close to 50%. We were thus able to recruit nearly half of the pregnant women during this study period.

The pregnant women included in the study were young, with a mean age of 34.49 years (±4.027). This age of full reproductive activity corresponds to the age at which conception is planned and is directly related to the low parity observed in this study. The young age of our pregnant women certainly reflects that of the general population of Côte d’Ivoire, where nearly half the population is under 60 years old [10]. Most of the pregnant women lived in the Cocody district, which is home to the Angré University Hospital. In this municipality, sanitation is fairly well maintained, as it is one of the more affluent areas of Abidjan. However, the problem arises from the presence of certain plants (traveler’s tree, banana tree) in households. These hollow-trunked plants can retain rainwater, creating stagnant water conducive to the development of mosquito larvae. It is also in this relatively upscale area of Abidjan that many residents have flowerpots with domes that can collect stagnant water, creating ideal breeding grounds for parasites. This municipality is prone to dengue fever epidemics, as demonstrated by Beugré’s study on certain entomological parameters of mosquitoes in the Cocody-Bingerville health district [11]. The majority of pregnant women had a secondary education. A well-informed pregnant woman can better understand the consequences of dengue fever for both the pregnant woman and the fetus.

The vast majority of pregnant women included in the study had already heard about dengue fever through television. The Ministry of Health, Public Hygiene, and Universal Health Coverage has frequently conducted both mass and community-based awareness campaigns about dengue. Those using television appear to be the most effective. It is a reliable channel, especially when informational spots are broadcast during prime time, from 7 p.m. to 11 p.m. The pregnant women had a good understanding of the human-to-human transmission of dengue, which occurs via a vector: the Aedes mosquito. However, most of them were unaware that in utero transmission of dengue is possible. This lack of knowledge is a factor that could contribute to the absence of effective prevention measures, such as sleeping under insecticide-treated bed nets. This ignorance exposes the fetus to complications such as abortion, acute fetal distress, low birth weight, prematurity, intrauterine growth retardation, malformations and fetal death in utero [6].

Knowledge was insufficient regarding the complications of dengue. Pregnant women’s awareness of these maternal and fetal complications prevents trivializing this re-emerging disease, which is directly linked to climate change. Indeed, dengue can be responsible for maternal and fetal mortality and morbidity [12]-[14].

The only positive behavior among pregnant women above the 60% threshold was the willingness to eliminate standing water. This preventative measure protects against dengue fever, as well as other mosquito-borne diseases. Just over half of the pregnant women favored sleeping under a mosquito net. This measure is particularly effective if one sleeps under it even during naps. Indeed, the Aedes mosquito is diurnal and feeds on human blood both day and night.

Knowledge influences attitudes to some extent. Both, in turn, influence practices to some extent. Thus, more than half of the pregnant women surveyed admitted to self-medicating primarily for flu-like symptoms. This reflects the trivialization of flu-like symptoms, which are present in several illnesses. The danger of self-medication is that it will often alleviate certain signs, such as joint pain, without actually treating the disease, especially when the patient is using non-steroidal anti-inflammatory drugs. These anti-inflammatory drugs are responsible for a higher risk of hemorrhage when dengue fever and pregnancy are combined, especially in the third trimester. While it is true that dengue fever has no specific treatment, consulting a healthcare professional for a health check-up or dengue test can help ensure more appropriate care. This is especially important because dengue fever during pregnancy is associated with adverse outcomes (miscarriage, prematurity, intrauterine growth restriction, fetal death). This is highlighted in a meta-analysis by Paixão [15].

This study involved nearly half of the pregnant women attending antenatal care (ANC) during the data collection period. It focused on a young population, most often with few children, and with a secondary education. It appears that pregnant women have a good general knowledge of dengue fever. However, their knowledge is limited regarding the effects of dengue on pregnancy. This lack of awareness of the complications of dengue probably contributes to the finding that attitudes and practices remain unchanged.

This highlights the need for dengue education for pregnant women. Therefore, pregnancy, which leads women to attend health facilities monthly, should be an opportunity for healthcare professionals to address this educational gap regarding dengue through community-based awareness sessions during ANC visits, especially during the rainy season. This can be arranged while waiting in the common room.