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 Table of Contents  
ORIGINAL ARTICLE
Year : 2019  |  Volume : 24  |  Issue : 1  |  Page : 39-43

Knowledge and attitude regarding Zika virus disease among junior residents of a tertiary care hospital in Delhi, India


1 Department of Community Medicine, Dr. BSA Medical College, Delhi, India
2 Department of Community Medicine, VMMC and SJH, New Delhi, India

Date of Web Publication14-Mar-2019

Correspondence Address:
Dr. Anika Sulania
Department of Community Medicine, Dr. BSA Medical College, Sector-6, Rohini, Delhi
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jmgims.jmgims_46_17

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  Abstract 


Introduction: Zika virus disease (ZVD) is a mosquito-borne arbovirus infection caused by Zika virus, a Flavivirus from the Flaviviridae family spread via a type of mosquito called Aedes mosquito, namely Aedes aegypti and Aedes albopictus which is also responsible for spreading diseases such as dengue, chikungunya, and yellow fever. Outbreaks of ZVD have been recorded in Africa, the Americas, Asia, and the Pacific. Materials and Methods: A cross-sectional study with complete enumeration was carried out among non-PG junior residents (JRs) of a tertiary care hospital of Delhi. Those who agreed to fill the questionnaire were included in the study after written consent. A self-administered, pretested, semistructured questionnaire, consisted of three sections, is used. Results: 125 (72.7%) participants had heard about ZVD, and almost 61% of participants believed A. aegypti to be the vector for transmission of ZVD. More than 80% of participants believed that ZVD outbreak is possible in India. The various reasons they quoted for the outbreak were environmental factors (50%), travel and immigration (16.3%), unawareness and unpreparedness (11.5%), host factors (9.6%), agent factors (6.4%), and easy transmission (4.7%). Approximately 90% of the study participants who have heard of ZVD knew that travel to the endemic area should be postponed. Participants with high level of knowledge according to knowledge score think that ZVD outbreak is possible in India in the future and they tried to gain more knowledge about ZVD. The results were found to be statistically significant. Conclusion: It can be concluded that the low knowledge among JR area is worrisome and a great deal of importance needs to be paid because health-care providers should be able to identify and screen potential patients to prevent further progression of this disease.

Keywords: Aedes, birth defects, epidemics, microcephaly, Zika virus disease


How to cite this article:
Sulania A, Khokhar A. Knowledge and attitude regarding Zika virus disease among junior residents of a tertiary care hospital in Delhi, India. J Mahatma Gandhi Inst Med Sci 2019;24:39-43

How to cite this URL:
Sulania A, Khokhar A. Knowledge and attitude regarding Zika virus disease among junior residents of a tertiary care hospital in Delhi, India. J Mahatma Gandhi Inst Med Sci [serial online] 2019 [cited 2019 May 25];24:39-43. Available from: http://www.jmgims.co.in/text.asp?2019/24/1/39/254130




  Introduction Top


Zika virus disease (ZVD) is a mosquito-borne arbovirus infection caused by Zika virus (ZIKV), a Flavivirus from the Flaviviridae family spread via a type of mosquito called Aedes mosquito, namely Aedes aegypti and Aedes albopictus which is also responsible for spreading diseases such as dengue, chikungunya, and yellow fever.[1] It was first reported from monkeys of Zika forest, Uganda, in 1947.[2] Outbreaks of ZVD have been recorded in Africa, the Americas, Asia, and the Pacific.[2] The first large outbreak of disease caused by Zika infection was reported from the Island of Yap (Federated States of Micronesia) in 2007.[2] In July 2015, a spatiotemporal relationship between cases of Guillain–Barré syndrome (GBS) and Zika infection was found.[3] In October 2015, a similar link was found between microcephaly and Zika infection when Brazil reported a staggering 4783 cases of microcephaly and/or central nervous system malformation, suggestive of congenital infection in contrast to an average of 163 microcephaly cases per year recorded in Brazil during 2001–2014.[2],[3] The WHO emergency committee reported possible causation and declared the disease as a public health emergency of international concern.[4] Human ZIKV infection appears to have changed in characteristic while expanding its geographical range. The change is from an endemic, mosquito-borne infection causing mild illness to an infection causing, from 2007 onward, large outbreaks, and from 2013 onward, outbreaks linked with neurological disorders including GBS and microcephaly. Seroprevalent in the Indian population though no locally acquired cases or viral isolation has been detected.[2],[5] More than 2 million km2 area of India is climatically at high risk of Zika.[6] In vector population, A. aegypti and A. albopictus present in densities capable of transmitting Zika in case the virus reaches India.[6] Susceptible population and high volume of international travel make Zika a potential candidate for a future 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.[7]

As Zika is an emerging disease of international concern with ongoing speculation about a potential outbreak in India in the future,[5] health-care providers need to be aware about this. Keeping this in mind, this study was conducted to assess the knowledge, attitude, and preparedness of the junior residents (JRs) toward managing Zika. The objectives of the study were (1) to evaluate knowledge regarding ZIKV among JRs of a tertiary care hospital; (2) to assess attitude of JRs toward Zika; and (3) to assess preparedness of the JRs toward managing ZVD.


  Materials and Methods Top


A cross-sectional study was carried out among non-PG JRs of a tertiary care hospital of Delhi. Data were collected within a span of 1 month. All those who agreed to fill the questionnaire were included in the study after written consent. For sampling purpose, complete enumeration of non-PG JRs was done. The hospital has 189 non-PG JRs. All the junior doctors who were available on duty during the period of data collection in their respective ward, outpatient department, or operation theater were included in the study. Those who refused to participate and those who could not be reached even after three visits were excluded. A self-administered, pretested, semistructured, and printed questionnaire in English language was given to the study participants, which consisted of three sections: (a) demographic profile – age, gender, and department; (b) knowledge – 23 multiple-choice questions which included questions regarding viral characteristics, transmission, symptomatology, diagnosis, prevention, and treatment of ZIKV; and (c) few questions regarding the attitude of the participants about ZVD. Confidentiality of the study participants was ensured.

The questionnaire was divided into the following sections:

Scoring for classifying high and low knowledge: Each correct response was given a score of 1 whereas an incorrect response or no response was given a score of 0. The knowledge scores of the practitioners were categorized as high and low based on the mean of the total score, which served as a cutoff point. The questionnaire contained 15 questions which could be scored, and the total score could lie anywhere in the range of 0–37.

Data entry and statistical analysis were performed using MS Excel (Office 2013) and SPSS version 21.0 (IBM Corp, Armonk, NY, USA). Descriptive statistics were used for characteristics of the 110 participants. Significant differences between the two groups were determined using the Chi-square test.


  Results Top


The total number of participants of the study was 172 with 135 (78.5%) males and 37 (21.5%) females, giving the response rate of 94.7%. The study population had a mean age of 26.1 ± 1.9 years. Most of the non-PG JRs were working in clinical department (88.4%) and 11.6% were working in para- or preclinical departments. In assessing the knowledge of the study, 125 (72.7%) participants had heard about ZVD, and almost 61% believed A. aegypti to be the vector for transmission of ZVD; roughly 23% of participants thought it to be A. albopictus and 16% believed that the vector can be both. More than 80% of participants believed that ZVD outbreak is possible in India. The various reasons they quoted for the outbreak were environmental factors (50%), travel and immigration (16.3%), unawareness and unpreparedness (11.5%), host factors (9.6%), agent factors (6.4%), and easy transmission (4.7%). The reasons quoted by participants about impossibility of an outbreak were agents not present and no favorable climate 66.7% and 33.3%, respectively, as shown in [Table 1].
Table 1: Distribution of the study subjects according to knowledge about ZIKA virus disease (ZVD)

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Regarding the knowledge of mode of transmission, more than 70% knew about transmission through mosquito bites, followed by blood transfusion (42.4%), sexual intercourse (41.6%), mother-to-child transmission (40.8%), transmission via air (20.8%), and food and water (7.2%). 13.6% did not know about disease transmission as shown in [Table 2]. However, 81.6% of participants agreed that climate change can aggravate the transmission of ZIKV.
Table 2: Distribution of the study participants according to their knowledge about mode of transmission (n=125)

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Regarding the knowledge about symptoms of ZVD, only 6.4% of participants were not aware of symptoms of ZVD whereas the rest of the participants knew about it. Fever (87.2%) was the most common symptoms they knew followed by headaches (80.2%) [Table 3]. On asking about the risk of maternal ZIKV infection, study participants knew microcephaly (61.6%), miscarriage (56.8%), impaired growth (45.6%), prematurity (36.8%), and still birth (29.6%). 72 (57.6%) JRs knew that pregnant women are at special risk of harm from Zika, of these only 4 (5.5%) knew about all the risks of maternal Zika infection to the fetus [Table 4]. 7 (5.6%) JRs knew about all the criteria to suspect ZIKV in new-born whereas 29 (13.2%) did not know of any criteria [Table 5].
Table 3: Knowledge about symptoms of ZVD (n=125)

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Table 4: Distribution of the participants according to their knowledge about risks of maternal Zika virus infection to fetus (n=125)

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Table 5: Reasons for suspecting ZVD in a newborn (n=125)

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[Figure 1] describes the various mode of prevention of transmission of ZIKV. Approximately 90% of the study participants who have heard of ZVD knew that travel to the endemic area should be postponed. Other modes of prevention quoted were prevent mosquito exposure during day (64.8%), prevent mosquito exposure during day (53.6%), avoid unprotected sexual intercourse (36.8%), wear masks (16.8%), and avoid ingesting contaminated food and water (5.6%). Participants with high level of knowledge according to knowledge score think that ZVD outbreak is possible in India in the future and they tried to gain more knowledge about ZVD. The results were found to be statistically significant for both with P = 0.003 and 0.012, respectively, as shown in [Table 6]. The various methods used to gain knowledge about ZVD were Internet and social media (79.4%), discussing with medical colleagues and seniors (43.8%), newspapers (26%), medical journals (15%), TV documentaries (4.1%), and attending conferences and lectures (2.1%) as shown in [Figure 2].
Figure 1: Bar chart describing the mode of prevention of Zika virus transmission (n=125).

31 (24.8%) JRs knew about all the ways to prevent infection from Zika, 46% people knew about some of the ways to prevent infection and 36.5% people didn't know about even a single method to prevent infection


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Table 6: Impact of level of knowledge on attitude (n=125)

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Figure 2: Methods used to gain more knowledge about ZVD (n=73). 151 (87.77%) JRs out of 172 JRs claimed that they would like to attend workshops/ seminars regarding ZIKA

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  Discussion Top


ZIKV, a recently declared global public health concern, has been spreading at an alarming pace. Therefore, it becomes important for the entire health-care personnel to constantly update their knowledge, so that they are able to potentially screen such patients for prevention of possible spread of the disease. Our study found that 58 (46.4%) JRs had low knowledge of Zika. In a similar study among private dental practitioners, 67.8% of clinicians were found to have low knowledge.[8] Low knowledge scores have been demonstrated when ebola and chikungunya outbreaks recently emerged and caused considerable distress among health-care workers. Therefore, it can be assumed that lack of knowledge can result in possible transmission of the disease, and it becomes important that doctors be acquainted with recent medical happenings from time to time.[9],[10] Most JRs had heard about Zika fairly recently, that is, in the past 6 months. This reflects that with the increasing global concern for Zika (mainly in 2015 and 2016), the WHO initiative to aware people was reasonably effective. Internet was the most popularly used source of information, that is, 58 (46.4%) JRs used it compared to 37.8% private dental practitioners.[9] 102 (81.6%) JRs agreed that climate change can aggravate the transmission of Zika and hence aware about climate change. 89 (71.2%) JRs knew that Zika can spread through mosquito bite. However, in an American poll, it was found that 90% of Americans were aware about the same. Similarly, 52 (41.6%) JRs knew about the sexual route of transmission as compared to 57% of Americans and only 7.8% of private dental practitioners. The higher awareness in Americans could have to do with the fact that the USA has been recently reporting a lot of cases and the public is concerned.[10] 76 (60.8%) JRs knew about A. aegypti as the vector compared to 66.3% dental practitioners who were aware about the same.[8] 59 (34.3%) JRs believed that Zika cases have been reported in India and this reflects unawareness. More than that, it shows a poor attitude toward gaining knowledge. JRs with better knowledge scores (high knowledge) were found to more significantly believe that Zika could cause an outbreak in the near future as compared to those with low knowledge. The result was statistically significant with P < 0.05 (P = 0.003); this means good knowledge is vital for a positive attitude. JRs who claimed to have tried to gather more information about Zika were found to have higher knowledge than their counterparts. The result was statistically significant with P < 0.05 (P = 0.012).


  Conclusion Top


It can be concluded that the low knowledge among JR area is worrisome and a great deal of importance needs to be paid because health-care providers should be able to identify and screen potential patients to prevent further progression of this disease.

Limitation

The study was restricted to only junior doctors and senior doctors and nursing staff were not. The information obtained cannot be generalized across all hospitals. An extensive questionnaire preferably employing open-ended questions can be used for documenting more specific responses.

Recommendations

The present highlights the gap and need for awareness campaigns about ZVD. Studies based on a larger sample population having such a constitution so that the results can be extrapolated considerably and accurately to the general population. Because junior doctors are the first contact to patients availing health care in tertiary hospitals, it is imperative to sensitize them to the clinical features of ebola virus disease, so that they can institute proper personal protective measures for their own safety and for the safety of other patients. It is advised that regular continuing medical educations or workshops and conferences should be organized and they are motivated to attend.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Sulania A. ZIKA virus disease: An update. MAMC J Med Sci 2016;2:122-30.  Back to cited text no. 1
  [Full text]  
2.
World Health Organization. Zika Virus Fact Sheet. World Health Organization; 02 June, 2016. Available from: http://www.who.int/mediacentre/factsheets/zika/en/. [Last accessed on 2018 Jun 17].  Back to cited text no. 2
    
3.
Pan American Health Organization. Reported Increase of Congenital Microcephaly and other Central Nervous System Symptoms. Pan American Health Organization; February, 2016. Available from: http://www.paho.org/hq/index.php?option=com_content&view=article&id=11675&Itemid=41711&lang=en. [Last accessed on 2018 Jun 17].  Back to cited text no. 3
    
4.
World Health Organization. Zika Virus Outbreak Global Response. World Health Organization; 15 July, 2016. Available from: http://www.who.int/emergencies/zika-virus/response/en/. [Last accessed on 2018 Jun 19].  Back to cited text no. 4
    
5.
Smithburn KC, Kerr JA, Gatne PB. Neutralizing antibodies against certain viruses in the sera of residents of India. J Immunol 1954;72:248-57.  Back to cited text no. 5
    
6.
Messina JP, Kraemer MU, Brady OJ, Pigott DM, Shearer FM, Weiss DJ, et al. Mapping global environmental suitability for Zika virus. Elife 2016;5. pii: e15272.  Back to cited text no. 6
    
7.
Government of India. Ministry of Health and Family Welfare. Directorate General of Health Services. Guidelines on Zika Virus Disease following Epidemic in Brazil and Other Countries of America; 2016. Available from: http://www.mohfw.nic.in/showfile.php?lid=3705. [Last accessed on 2018 Jun 29].  Back to cited text no. 7
    
8.
Gupta N, Randhawa RK, Thakar S, Bansal M, Gupta P, Arora V, et al. Knowledge regarding Zika virus infection among dental practitioners of Tricity area (Chandigarh, Panchkula and Mohali), India. Niger Postgrad Med J 2016;23:33-7.  Back to cited text no. 8
[PUBMED]  [Full text]  
9.
Fazekas B, Fazekas J, Moledina M, Fazekas B, Karolyhazy K. Ebola virus disease: Awareness among junior doctors in England. J Hosp Infect 2015;90:260-2.  Back to cited text no. 9
    
10.
Lisk C, Snell L, Haji-Coll M, Ellis J, Sufi S, Raj R, et al. Doctors' knowledge of viral haemorrhagic fevers. Acute Med 2015;14:47-52.  Back to cited text no. 10
    


    Figures

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    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]



 

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