Original Research Article Uprety S et al
PERCEPTION REGARDING SWINE FLU AMONG SCHOOL TEACHER IN INARUWA MUNICIPALITY OF EASTERN NEPAL
Uprety S1*, Limbu NPM2, Poudel M3, Ghimire A4, Khanal VK1, Baral DD5
ABSTRACT Affiliation 1. Associate Professor, School of Public Health and Community Introduc on Medicine, BPKIHS, Dharan Swine flu is an acute respiratory viral disease, caused by a 2. Lecturer, Department of Community Health, Patan Academy strain of the influenza type A virus known as H1N1. Currently of Health Sciences, Lalitpur swine flu is spreading rapidly in India with a regular threat of it 3. Additional Professor, Department of General Practice and Emergency Medicine, BPKIHS, Dharan being spread to Nepal owing to the open borders. 4. Professor, School of Public Health and Community Medicine, Objec ve BPKIHS, Dharan The objec ve of this study was to assess the knowledge, 5. Assistant Professor, School of Public Health and Community Medicine, BPKIHS, Dharan a tude and prac ce on different aspects of Swine Flu. Methodology This is cross-sec onal study conducted in Inaruwa municipality A R T I C L E I N F O of Sunsari district from 1 March to 10 April, 2015. A total of Article History 31 schools (21 private and 10 public) were iden fied in the Received : 06 February, 2017 municipality out of which 16 were randomly chosen for the Accepted : 18 July, 2017 study. Published : 30 August, 2017 Results © Authors retain copyright and grant the journal right of first Total sample size was 260 school teachers. Majority of the publication with the work simultaneously licensed under Creative Commons Attribution License CC - BY 4.0 that allows respondents belong to the age group 30-39 years, about 72 % others to share the work with an acknowledgment of the were male and 86% thought that it is a preventable disease. It work's authorship and initial publication in this journal. was observed that females had a be er a tude towards preven ve measures of swine flu as compared to the males (p<0.023), but males had be er prac ces as compared to the females (p<0.001).
ORA 22 Conclusion The preven on prac ce for swine flu was not adequate. * Corresponding Author Despite having acceptable knowledge and a tude, posi ve Dr Samyog Uprety prac ces needs to be encouraged. The teachers should be Associate Professor well informed about the earliest appearing symptoms of School of Public Health and Community Medicine swine flu. So that they can closely monitor the students and B. P. Koirala Institute of Health Sciences, Dharan, Nepal Email: [email protected] can recommend the students for medical checkup on appearance of the symptoms.
Citation KEYWORDS Uprety S, Limbu NPM, Poudel M, Ghimire A, Khanal VK, Baral DD. A tude, Nepal, Sunsari, swine flu Perception Regarding Swine Flu Among School Teacher in Inaruwa Municipality of Eastern Nepal. BJHS 2017;2 (2)3 : 150-155
Birat Journal of Health Sciences ISSN: 2542-2758 (Print) 2542-2804 (Online) Vol.2/No.2/Issue 3/ May-August 2017 150 Original Research Article Uprety S et al
INTRODUCTION combat it, ways of preven on were also studied. Each Swine flu is an acute respiratory viral disease, caused by a par cipant was asked to report the precau onary measures strain of the influenza type A virus known as H1N1, where H that s/he has been using during the epidemic to prevent 1 and N stand for two surface proteins of the virus. The illness infec on, maintaining personal hygiene extra care be taken is generally mild except in people in high risk groups as for suspected case. Data collec on was done via direct face- pregnant women and people with medical condi ons like to-face interview using semi-structured ques onnaire at 2 infec on with other influenza viruses. Swine flu was school premises a er taking permission from the head- reported in Mexico and spread over the world. The union teacher and obtaining informed consent with respec ve agency reported more than 15,000 cases of swine flu in the teachers (All the school teachers were included in the study 3 globe. The Mexico had second highest number of infec ons ll the sample size was fulfill), prior study pretes ng was nearly 5000 behind the united states of America with nearly done in 10% sample in Dharan, reliability test was performed 3 8000 cases. Worldwide there was more than 375, 000 and 60% cut off value was establish, using ques ons directed laboratory confirmed cases of pandemic influenza H1N1 in at accessing knowledge, a tude, prac ces, and demographic 2009 and thousands deaths reported to world health variables. Regarding knowledge, a tude and prac ces 41, 4 organisa on (WHO). 11 and 62 score was made respec vely and 60% cut of value According to Rubin GJ et al regarding public percep ons was taken for acceptable limit so 25 (24.6 in knowledge); 7 about swine flu, respondents have percep on that swine flu (6.6 in a tude) and 38 (37.2 in prac ces) were the lower is severe, that the risk of catching is high, that the outbreak value considered respec vely. Data was entered in Microso 5 will con nue for a long me. In another study by Joseph TF Excel 2007 and analysed using SPSS 11.5 version. Descrip ve et al about widespread public misconcep on in the early sta s cs as percentage, propor on, mean, standard phase of the H1N1 influenza epidemic done in Hongkong devia on, were calculated along with graphical and tabular China, it was seen that public did not perceive a high presenta on. As a part of inferen al sta s cs, correla on likelihood of having a local H1N1 outbreak, nor did they 6 between the demographic variables and knowledge, a tude regard H1N1 as a threatening diseases. A study done by and prac ces, and one-way ANOVA test for the group Akan H et al in Turkey about the knowledge and a tudes variables was applied to find out the significant associa on at among the university students toward pandemic influenza 95% confidence interval. showed that the par cipants had enough knowledge about H1N1 pandemic, about the disease there were s ll gaps and RESULTS confusion in some areas and main informa on source was Table 1 shows the socio-demographic profile of the study 7 mass media. Nepal has open borders with neighboring popula on, in which majority were from 30-39 years of age countries specially with India so has always threat of followed by 20-29 years, male popula on were predominant spreading Swine flu. Out of the 300 samples collected from than female and majority were Hindu by religion. Similarly, suspected cases across the country, a total of 42 pa ents st 8 while observing by ethnicity most of them were Brahmin have been tested posi ve for H1N1, as of 1 March 2015. (38%) and Madhesi (31%), and about 51% were working in Thus, awareness is needed for its effec ve preven on. This study was conducted, keeping school teachers as our target Table 1: Socio-demographic profile of study popula on (n = 260) popula on, as they are the foci for knowledge and can give Characteris cs Category Number Percentage the informa on regarding swine flu to the children. Age (Years) <20 14 5.4 METHODOLOGY 20 – 29 72 27.7 30 – 39 74 28.5 A cross-sec onal study was conducted in Inaruwa 40 – 49 57 21.9 Municipality, Eastern Nepal among school teachers of both 50+ 43 16.5 government and private schools from 1 March to 10 April Gender Male 187 71.9 2015. A total of 31 schools, including 21 private and 10 public Female 73 28.1 were iden fied in the municipality, out of which 16 were Religion Hindu 213 81.5 randomly chosen for the study. Among 16 schools, 8 were Muslim 47 18.1 public schools and 8 were private. For the sample size Occupa on dura on <10 133 51.2 calcula on, the informa on of a study conducted by Singh in years 10 -19 72 27.7 AB et al in India was considered where the propor on of 20 and above 55 21.2 knowledge of swine flu among school teachers was about Ethnicity Brahman/Chhetri 99 38.1 60% with 95% confidence interval and 80% power, total Madhesi 81 31.2 sample size was 260 school teachers.9 Knowledge about the Muslim 46 17.7 disease, mode of transmission, source of infec on, routes of Janja –terai 16 6.2 transmission, a tudes and percep ons of the disease were Janja – hill 15 5.8 asked and its communicability, governmental efforts to Dalit – hill 3 1.5
Birat Journal of Health Sciences 151 Vol.2/No.2/Issue 3/ May-August 2017 ISSN: 2542-2758 (Print) 2542-2804 (Online) Original Research Article Uprety S et al
According to table 2, while most teachers were well aware of When we asked about the source of transmission of swine flu basic aspects of swine flu but only 37% could tell swine flu is (Figure 2), most of them expressed that it can be transmi ed also known as H1N1, 65% could tell that swine flu is viral in by infected person (77%) and consuming pork meat (34%) origin, 86% thought that it is a preventable disease and 93% and some also told that vector like mosquitoes (14%) can agreed that face mask could help in the preven on. transmit the swine flu.
Table 2: Knowledge about swine flu in the study popula on (n = 260)
Characteris cs Op ons/answers Number Percentage Heard about swine flu? Yes 260 100 What is the other name of swine flu? Bird flu/H5N1 34 13 H1N1 97 37.3 H2N2 2 0.8 SARS 1 0.4 Don't know 126 48.1 What is the Causa ve agent for swine flu? Bacteria 20 7.7 Parasites 10 3.8 Viruses 170 65.4 Don't know 60 23.1 Is breast-feeding protec ve against swine flu? Yes 110 42.3 No 70 26.9 Don't know 103 39.6 Availability of vaccine against swine flu? Yes 87 33.3 No 70 26.9 Don't know 103 39.6 Is Preven on possible? Yes 224 86.2 No 20 7.7 Don't know 16 6.2 Any role of facemask in controlling infec on Yes 242 93.1 No 11 4.2 Don't know 7 2.7 Is isola on necessary? Yes 215 82.7 No 45 17.3
Most of them received informa on from Radio/TV (84%) Figure 2: Distribu on of respondents according to source of followed by newspapers (63%). The only 7% had received infec on (Mul ple op ons) (n = 260) informa on from health centre (Figure 1). Don't know 6.50% Figure 1: Distribu on of respondents according to source of informa on (Mul ple op ons)(n = 260) Others 6.92%
Ca le 8.07% Radio/tv 84.23%
Mosquito bite 14.60% Newspaper 63.46%
Consuming park 34.23% Friends 14.23%
Infected person 77.30% Health Centre 7.30%
0.% 10.% 20.% 30.% 40.% 50.% 60.% 70.% 80.% 90.% Health Volunteers 3.07%
Brochures/posters 2.30% Figure 3 shows the knowledge about routes of transmission of H1N1, majority expressed that sneezing (90%), touching Others 1.15% contaminated surfaces (41%) are major route of transmission, and some said the consuming pork meat is also one of the 0.% 10.% 20.% 30.% 40.% 50.% 60.% 70.% 80.% 90.% route of transmission.
Birat Journal of Health Sciences ISSN: 2542-2758 (Print) 2542-2804 (Online) Vol.2/No.2/Issue 3/ May-August 2017 152 Original Research Article Uprety S et al
Figure 3: Distribu on of respondents accordig to the towards preven ve measures of swine flu as compared to knowledge about routes of transmission the males, but males had be er prac ces (p<0.001)as (Mul ple op ons) (n = 260) compared to the females, however there was no sta s cally significant difference between gender regarding the 100% 90.30% knowledge of swine flu (p=0.121). Likewise, Hindu were 90% 80% observed to have be er knowledge (p<0.001), a tude 70% (p<0.008) and prac ce (p<0.001) regarding the swine flu as 60% compared to Muslims 50% 41.92% 38.07% 40% 30% 20% 17.30% Table 5: Comparison between variables with knowledge, 10% 5% a tude and prac ce 0% Touching Sneezing contaminated Kissing and Consuming Don't Know surface handshake Pork About 99% of the respondents thought that swine flu is communicable, and 95% thought that it is a life threatening disease (Table 3). Table 3: A tude about swine flu in the study popula on (n = 260)
A er calcula ng the total score for knowledge, a tude and prac ces, in this research we have found that (Figure 4), most of the respondents (77.30%) had good knowledge about About 94% of the respondents believed that maintaining swine flu. Similarly, 95% were found to have a good a tude, good personal hygiene helps in preven on of swine flu; however only 59% were prac cing measures and similarly, 95% thought that avoiding crowded places and precau ons to prevent it. physical contact also helped in preven on of transmission (Table 4). Figure 4: Percep on about swine flu among study Table 4: Awareness of prac ces regarding swine flu in popula on (n = 260) study popula on (n = 260)
100% 94.60% 90% 80% 77.30% 70% 59.20% 60% 50% 40% 30% 20% We try to compare between demographic variables with Knowledge, A tude and Prac ce (Table 5), which shows that 10% as the work experience increases, the knowledge increases, 0% it was observed that females had be er a tude (p < 0.023), Knowledge A utude Prac ce Birat Journal of Health Sciences 153 Vol.2/No.2/Issue 3/ May-August 2017 ISSN: 2542-2758 (Print) 2542-2804 (Online) Original Research Article Uprety S et al
DISCUSSION regarding the knowledge of swine flu. Likewise, Hindu were School teachers are ac ve and important person of our observed to have be er knowledge, a tude and prac ce society, they can influence popula on at large scale, as they regarding the swine flu as compared to Muslims. A study are responsible for educa on and enlightenment of a large done by Balkhy HH et al 2010,12 reveal that educa on was the number of children and their parents and society. In spite of only significant predictor of concern, and the level of educa on the rising incidence of swine flu amongst exposed popula on, was inversely related to the degree of concern (p < 0.001). only limited informa on is available for the knowledge, a tude and prac ces of school teachers. Good knowledge regarding swine flu amongst teachers will prove to be CONCLUSION immensely helpful. Teachers good Knowledge, A tude and Most of the respondents had good knowledge about swine Prac ce will not only benefit them but also translate into flu with good a tude but not good prac ce for preven on of dissemina ng the same to students and their families swine flu. Majority expressed that sneezing was routes of 10 resul ng in maximum benefit to society. transmission of swine flu. So concerned authori es should Knowledge of School Teachers: Majority of respondents had encourage them to prac ce proper measures to prevent the correct knowledge about basic aspects of H1N1 (causa ve spread of disease. agent, route of transmission and availability of vaccine) which was consistent with similar a study done in Pune, India.9 All the teachers were aware about swine flu but RECOMMENDATIONS almost four out of ten could cited the scien fic name of Although there was good knowledge about swine flu and H1N1, most could cited that it is viral in origin, also, most of a tude but regarding prac ce there was not much concern them thought that it is a preventable disease and 93% agreed for preven on of swine like hand washing as a preven ve that face mask could help in the preven on which was measure. So health educa on for behavioural changes a consistent with a study done in Hongkong.11 corner stone for a healthy life style that could be maintained A tudes of School Teachers:Almost all of the respondents through the future genera ons. A comprehensive health thought that swine flu is communicable and is a life educa on program should be properly planned and threatening, however, in another study respondents didn't 6 implemented in schools using different approaches. regard it as life threatening. Ninety-one percent of the respondents had their daily life disturbed by the rising Properly planned interven ons for cost-effec ve posi ve incidence of swine flu in the country, and 74% were worried achievements should be maintained through regular about suffering from the disease themselves. About 70% of monitoring, supervision and periodic evalua on and the people thought that the protec ve measures are not highlights the poten al of school as a promising venue for sufficient to protect the society from spread of the disease. hand-washing promo on ac vi es and lay founda ons for Almost 93% were willing to take the vaccine against swine flu, behaviour change in long-term. had it been present. Almost 85% felt that the informa on that is made available to the public is not sufficient, and thought that government isn't doing enough to ensure LIMITATION OF THE STUDY protec on and knowledge of the people. The study included that the observa ons were based on Prac ces of School Teachers: Majority of the respondents percep on about swine flu among school teachers; the believed that maintaining good personal hygiene helps in findings of the study were for school teachers of government preven on of swine flu which was consistent with findings and private school and the study design did not include any that 61% people perceived the efficacy of hand washing as controls. The study has not large sample size, so the results 11 very good. However, only 2.1% believed in hand washing as cannot be generalized. mode of preven on.12 Similarly, 95% thought that avoiding crowded places and physical contact also helped in ACKNOWLEDGEMENT preven on of transmission similar to the findings of 60% believed avoiding crowded places.9 About 72% of the I would like to express my gra tude towards School of Public respondents believed that closing the schools during Health and Community Medicine, BPKIHS, Inaruwa seasonal flu outbreaks is a good idea and 99% thought that Municipality, the school principals and teachers for giving us extra care should be taken for the suspected cases. the consent for conduc ng our study. I would like to When compare with knowledge, a tude and prac ce which acknowledge my colleagues and MBBS batch 2012 for their shows that with increase in work experience, the knowledge never-ending support. of swine flu were increased among respondents, it was observed that females had a be er a tude towards preven ve CONFLICT OF INTEREST measures of swine flu as compared to the males, but males We declare that no compe ng interest. had be er prac ces as compared to the females, however there is no sta s cally significant difference between gender Birat Journal of Health Sciences ISSN: 2542-2758 (Print) 2542-2804 (Online) Vol.2/No.2/Issue 3/ May-August 2017 154 Original Research Article Uprety S et al
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