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 Table of Contents  
ORIGINAL ARTICLE
Year : 2022  |  Volume : 8  |  Issue : 1  |  Page : 32-37

A cross-sectional study to assess knowledge, attitude, and practices regarding Zika virus among nursing students in a tertiary care center of central India


1 Department of Community Medicine, Bundelkhand Medical College, Sagar, Madhya Pradesh, India
2 Department of Community Medicine, Government Medical College, Shahdol, India
3 Department of Pediatric Medicine, Tagore Medical College, Rathinamangalam, India
4 Department of Pediatric Medicine, Sri Ramachandra Medical College, Porur, Chennai, Tamilnadu, India

Date of Submission02-Jan-2021
Date of Acceptance14-Oct-2021
Date of Web Publication30-Mar-2022

Correspondence Address:
Dr. Vikas Gupta
Department of Community Medicine, Government Medical College, Shahdol, Madhya Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/IJAM.IJAM_135_20

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  Abstract 


Introduction: Recently, the Zika virus (ZIKV) has become a major concern across the world. ZIKV can primarily spread through the bite of infected Aedes aegypti mosquitoes. Till now, ZIKV is considered an incurable infectious disease. As Zika is an emerging disease of an international concern with the ongoing speculation about a potential outbreak in India in the future, the present study was conducted with an aim to assess knowledge, attitude, and practices regarding ZIKV among nursing students.
Materials and Methods: This hospital-based cross-sectional study was conducted among 240 nursing students during 2019, and data were collected using a pretested, predesigned, standardized, and self-administered questionnaire. The ethical approval was obtained from the Institutional Ethical committee before the conduct of the study. All tests were performed at 5% level of significance.
Results: The present study has included 240 nursing students (228 female students and 12 male students). The most common source of information related to ZIKV was social media among 75.6% of the students and 46.7% of the participants has low knowledge regarding ZIKV. Surprisingly, about one-tenth of the participants (14.2%) made an attempt to gain more knowledge about ZIKV, and nearly one-fifth of the participants were not using any method at all (17.1%) to prevent mosquito bites.
Conclusion: This study showed inadequate knowledge among nursing students which will be future health care providers about ZIKV infection. The awareness about ZIKV infection should be ensured and maintained among health care providers to face any possible emergence in the region.
The following core competencies are addressed in this article: Medical knowledge, Patient care, Practice-based learning, and Systems-based practice.

Keywords: Aedes, arthralgia, microcephaly, nursing students, Zika virus


How to cite this article:
Kumar RM, Gupta V, Kumar RP, Palaniyandi S, Palaniyandi A. A cross-sectional study to assess knowledge, attitude, and practices regarding Zika virus among nursing students in a tertiary care center of central India. Int J Acad Med 2022;8:32-7

How to cite this URL:
Kumar RM, Gupta V, Kumar RP, Palaniyandi S, Palaniyandi A. A cross-sectional study to assess knowledge, attitude, and practices regarding Zika virus among nursing students in a tertiary care center of central India. Int J Acad Med [serial online] 2022 [cited 2022 May 18];8:32-7. Available from: https://www.ijam-web.org/text.asp?2022/8/1/32/341183




  Introduction Top


A short time ago, the Zika virus (ZIKV) has become a paramount concern across the world. It is a virus which belongs to the Flaviviridae family.[1] It was first isolated from a monkey in 1947, in the Zika forest of Uganda, and the first isolation of the virus from a human was on top found to be in Uganda in the 1960s.[2] Over the time, ZIKV was discovered in the human populations in many countries including Sierra Leone, the Philippines, and Indonesia; however, it was not a major public concern at that time. Attention to ZIKV reached a global level after an outbreak in Latin America in 2015.[3],[4] ZIKV can primarily spread through the bite of infected mosquitoes, especially the Aedes aegypti type. In addition, this virus can be transmitted through sexual contact or by an infected pregnant woman to her fetus, which may lead to microcephaly, a serious birth defect of the brain.[1],[5] Lately, cases involving ZIKV were reported in more than 10 countries in the “Americas region,” which indicated the rapid spread of the virus.[6],[7] More than 2 million km2 area of India is climatically at high risk of Zika. In vector population, Aedes aegypti and Aedes albopictus present in densities capable of transmitting Zika in case the virus reaches India. The susceptible population and high volume of international travel make Zika a potential candidate for a forthcoming outbreak. As a precautionary measure, the Indian Council of Medical Research has started monitoring ZIKV in India wherein samples negative for Dengue and Chikungunya are being tested for Zika.[8],[9] As Zika is an emerging disease of international concern with the ongoing speculation about a potential outbreak in India in the future,[8] the current nursing students will be future health care providers, and they need to possess the sufficient knowledge about the widespread infectious diseases, their symptoms, modes of transmission, and methods of prevention and treatment. Keeping this in mind, the present study was conducted with the aim to assess knowledge, attitude, and practices regarding ZIKV among nursing students of a tertiary hospital in Central India.


  Materials and Methods Top


Study setting and design

This hospital-based cross-sectional study was conducted at Bundelkhand Government Medical College, Sagar, Madhya Pradesh from January to February 2019. It is a tertiary care hospital with a daily out-patient of around 1275/day and an average inpatient of 95/day.

Study population and sample size

The study participants included all 240 nursing students (Bachelor of Science) studying in government medical college and hospital from the 1st year to 4th year. The purpose of the study was explained and informed written consent was obtained from all the study participants and anonymity and confidentiality of the participants were maintained.

The sample size was calculated (n = 236) considering the proportion of nursing students having adequate knowledge regarding ZIKV as 50% (studies not found in Madhya Pradesh) with confidence level of 95% and 6.5% absolute allowable error by applying the following formula: N = (Z1 − a/2)2 × p (1 − p)/d2; where Z = Standard normal variate for the level of significance (at 5% Type I error [P < 0.05], Z = 1.96 for 2-sided test), a = Level of significance (0.05), p = Prevalence (proportion-50%), d = Absolute Allowable error (6.5%), n = Sample Size. Although the calculated sample size came out to be 236, a sample of 240 study participants was included in the study.

Study tool

A pretested, predesigned, and standardized questionnaire containing objective and multiple-choice questions in English language was used for the study. The questions regarding the knowledge, attitude, and practices related to ZIKV were compiled from the existing literature.[10],[11],[12] The questionnaire was divided into three parts. The first part consisted of eight questions to assess the knowledge and each correct response was given a score of 1, whereas an incorrect response or no response was given a score of 0 and the total score could lie anywhere in the range of 0–8. The scoring for classifying high and low knowledge was based on the median of the total score. The second part consisted of 10 questions to assess the attitude, the questions were answered on a 3-point Likert scale (agree, neutral, and disagree) and the third part consist of 10 questions to assess the practice.

Data collection

Everyday activity included briefing of the study through face-to-face interaction among nursing students of different classes. After that questionnaire was self-administered by the participants under the direct supervision of an investigator, and also care was taken that no consultations were made with the fellow nursing students by strict vigilance with the help of nursing staff. The participants took part in the batches of 12–15 counts per session so that day-to-day academic activities of nursing college and hospital is not hampered. In this way, all nursing students were covered in the study during the defined period. The questionnaire required 30–45 min per batch to be completed. The completed questionnaires were then collected and checked for the completeness. Appropriate approval was obtained from the Institutional Ethics Committee (number IEC/BMCH/2018-12 dated February 12, 2018).

Data analysis

Collected data were entered into the MS Excel spreadsheet, coded appropriately, and later cleaned for any possible errors. Analysis was carried out using the IBM SPSS Statistics for Windows, Version 22.0 (IBM Corp. Armonk, NY, USA). During data cleaning, more variables were created to facilitate the association of variables. Clear values for various outcomes were determined before running frequency tests. Categorical data were presented as percentages (%), whereas continuous data were presented as median. Pearson's Chi-square test was used to evaluate differences between the groups for categorized variables. All tests were performed at a 5% level of significance; thus, an association was significant if the P < 0.05.


  Results Top


The present study has included 240 nursing students (228 female students and 12 male students). [Table 1] shows that 92.1% of the participants have ever heard of ZIKV, and among 75.6% of such participants, the most common source of information related to ZIKV was social media such as Facebook, WhatsApp, Instagram, and Telegram. Nearly four-fifth of the study participants (84.2%) were aware that the ZIKV is most commonly transmitted through mosquitoes, but when asked specifically about the type of the mosquito around half of the participants (55.0%) responded as Aedes mosquito. On a similar account, around half of the participants were aware of the breeding place, i.e., clean water (46.7%) and biting time, i.e., day time (49.6%) of Aedes mosquito. About two-fifth of the study participants were aware of the most common symptoms (43.8%) and commonly occurring newborn-related complications (40.4%) of ZIKV disease. The median score for knowledge obtained was five and; 112 participants were having a median score below five, which reflects that 46.7% of the participants have low knowledge regarding ZIKV.
Table 1: Distribution of the study participants according to their knowledge about Zika Virus (n=240)

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[Table 2] shows that two-fifth of nursing students (40.0%) agree on the fact that the ZIKV disease is a serious disease, around two-third of the participants (60.4%) agree on that the individual contribution could prevent the ZIKV outbreak/epidemic. Surprisingly, about one-tenth of the participants (14.2%) made an attempt to gain more knowledge about ZIKV while on the contrary to that more than three-fourth of the participants (77.9%) agreed that often ZIKV disease makes them worry about their family.
Table 2: Distribution of the study participants according to their attitude toward Zika Virus (n=240)

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[Table 3] shows that when study participants were investigated about the preventive measures being practiced specifically to prevent mosquito bite and breeding, it was observed that nearly three-fourth of the participants were using methods such as mosquito repellent equipment (78.3%), 82.1% of the participants were using a fan to drive away mosquitoes, 74.2% was wearing full sleeves clothes/covering the body with clothes to avoid mosquito bites and nearly one-fifth of the participants were not using any method at all (17.1%).
Table 3: Distribution of the study participants according to practices toward prevention and control of the Zika Virus in case of outbreak (n=240)

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[Table 4] shows that the association of the knowledge score and year of the study of nursing students, and it has revealed that as such no statistically significant difference was observed for the low knowledge score and year of the study among nursing students (P > 0.05).
Table 4: Association between knowledge score and year of study among nursing students (n=240)

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  Discussion Top


After an extensive literature search and to the best of our knowledge, this may be the first study conducted in Madhya Pradesh, India, for assessing the knowledge, attitudes, and practices of nursing students toward ZIKV. The present study showed that nearly half of the nursing students (46.7%) had low level of knowledge about ZIKV. This finding agrees with the results of Gupta et al., who conducted a similar study but among dental practitioners, and in that study, the majority of the participants (61.8%) had inadequate knowledge about ZIKV infection.[10] In another study conducted by Cheema et al., among Middle Eastern practitioners in Qatar found that among 446 participants, 66% reported poor knowledge regarding ZIKV.[11] Moreover, a study by Moore surveyed practitioners from different countries revealed that the majority of the participants have an inadequate knowledge regarding ZIKV.[12]

The cause behind such poor knowledge among the target populations may be due to no cases of ZIKV cases at the time of conduction of studies; as the threats of the ZIKV were concentrated mainly in the Americas. Furthermore, this could be due to the lack of resources in terms of very few nursing journals and limited availability of continuing education for them to update their knowledge in India.[13] Therefore, it can be presumed that the lack of sufficient knowledge can result in possible transmission of the disease.[14],[15],[16],[17],[18]

The study by Gupta et al. showed that nearly two-fifth of their participants obtained their knowledge about ZIKV from the internet.[10] Similarly, the current study revealed that social media were among the most common sources of participant's information. This result is expected due to the availability of technology and smartphones which are frequently used in the medical field. These findings indicate the importance of using such tools for spreading health information and educational messages about ZIKV.

A recent cross-sectional study done by Bedoya-Arias et al. in Pereira and Cartagena cities of Colombia, showed that most of the respondents (97% and 92.5% in both cities) correctly identified the routes of ZIKV transmission.[19] The cause of their high level of knowledge may be due to the extensive spread of ZIKV epidemic during 2016 in the most Latin American countries, including Colombia. In such countries, many educational programs were done about ZIKV, and these results in increasing their knowledge about it. Our results illustrated that less than half of the nursing students correctly identified the symptoms of ZIKV, and the corresponding rate from the Gupta et al., a study was 40.4%.[10] Lack of resources and inability to regularly upgrade their knowledge makes them less interested in the recent updates of pandemic diseases (ZIKV).[18]

Congenital anomalies and Guillain–Barré Syndrome associated with ZIKV made the circumstances to become worse.[20],[21] In the current study, about two-fifth of the participants correctly identified that microcephaly is the most dangerous complication of ZIKV and similar findings were revealed by Betancourt-Trejos et al., and Sabogal-Roman et al.[22],[23] However, a study by Harapan et al. conducted among general practitioners in Indonesia showed that 66.5% of them had a good knowledge of pregnancy-related issues of ZIKV.[24]

Concerning student's attitude, less than one-fifth of the study participants made an attempt to gain more knowledge about ZIKV. Furthermore, almost two-third of the students believed that individual contribution could prevent Zika epidemic or outbreak. Similar level of attitude was reflected in the studies by Ibrahim et al., Sulania and Khokhar, and Katler et al.[25],[26],[27] In recent studies by Sharma et al., and Maharajan et al., have shown that educational intervention has significantly improved attitude levels regarding ZIKV among students.[28],[29]

Limitations

As the present study was conducted in a single center in Madhya Pradesh, India, and most of the respondents were nursing students and the information obtained cannot be generalized across all hospitals, which can be considered a limitation of the study.


  Conclusion Top


ZIKV epidemic is the latest in the recent series of emerging viral infection with the global health repercussion. It is the need of the hour to urgently address this public health emergency. This study showed inadequate knowledge of nursing students which will be future health care providers about ZIKV infection. The knowledge about ZIKV should be improved in terms of route of the transmission, clinical manifestations, and diagnostic criteria, its potential complications, as well as the infection prevention and control because ZIKV and other emerging infectious diseases are considered big threats to India, due to international tourism. The awareness about ZIKV infection should be ensured and maintained among health care providers to face any possible emergence in the region.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

Research quality and ethics statement

The authors of this manuscript declared that this scientific work complies with reporting the quality, formatting and reproducibility guidelines set forth by the EQUATOR Network. Appropriate approval was obtained from institutional ethics committee (number IEC/BMCH/2018-12 dated February 12, 2018).



 
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  [Table 1], [Table 2], [Table 3], [Table 4]



 

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