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Knowledge, attitude and practice towards SARS

Identifieur interne : 000073 ( Istex/Corpus ); précédent : 000072; suivant : 000074

Knowledge, attitude and practice towards SARS

Auteurs : Abdulbari Bener ; Abdullatif Al-Khal

Source :

RBID : ISTEX:359E46C049F1F2B060D16452B4206E62C30F0ABE

English descriptors

Abstract

The objective of the study was to explore the knowledge, attitude and practice of the population of Qatar towards severe acute respiratory syndrome (SARS). The study took the form of a cross-sectional community-based survey in Doha International Airport and primary health care centres situated in urban and semi-urban areas of Qatar. The survey was conducted among travellers arriving at Doha International Airport and community residents visiting health centres from April to September 2003. A total of 1,800 subjects were approached for the study of which 1,386 (77.0%) responded to the questionnaire. The study showed that although 79.4% of the total subjects claimed to know about SARS, only 8.0% had accurate knowledge about all of the symptoms of SARS. The respondents’ satisfaction with the preventive measures taken by the health authorities was only 66.6%. Overall, 73.0% of the total subjects knew that SARS was highly infectious; 69.9% knew that it could spread through close contact;67.4% were aware that high fever was the early symptom; and 60.8% thought SARS could be cured. Half of the subjects said they had gained most of their knowledge on SARS through television and radio programmes (52.2%). Three-fifths (60.1%) were afraid to travel for fear of being affected by SARS. The level of awareness of SARS among Qataris was poor (31.7%) compared to that among non-Qataris(68.3%). The level of knowledge about SARS was better among educated subjects. The survey found a high level of stress and fear among the respondents. Health authorities should be on the alert and re-examine their capacity to manage an outbreak like SARS in the event that such a mishap should recur in the future.

Url:
DOI: 10.1177/146642400412400408

Links to Exploration step

ISTEX:359E46C049F1F2B060D16452B4206E62C30F0ABE

Le document en format XML

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<year>2004</year>
</pub-date>
<volume>124</volume>
<issue>4</issue>
<fpage>167</fpage>
<lpage>170</lpage>
<abstract>
<p>The objective of the study was to explore the knowledge, attitude and practice of the population of Qatar towards severe acute respiratory syndrome (SARS). The study took the form of a cross-sectional community-based survey in Doha International Airport and primary health care centres situated in urban and semi-urban areas of Qatar. The survey was conducted among travellers arriving at Doha International Airport and community residents visiting health centres from April to September 2003. A total of 1,800 subjects were approached for the study of which 1,386 (77.0%) responded to the questionnaire.</p>
<p>The study showed that although 79.4% of the total subjects claimed to know about SARS, only 8.0% had accurate knowledge about all of the symptoms of SARS. The respondents’ satisfaction with the preventive measures taken by the health authorities was only 66.6%. Overall, 73.0% of the total subjects knew that SARS was highly infectious; 69.9% knew that it could spread through close contact;67.4% were aware that high fever was the early symptom; and 60.8% thought SARS could be cured. Half of the subjects said they had gained most of their knowledge on SARS through television and radio programmes (52.2%). Three-fifths (60.1%) were afraid to travel for fear of being affected by SARS. The level of awareness of SARS among Qataris was poor (31.7%) compared to that among non-Qataris(68.3%). The level of knowledge about SARS was better among educated subjects. The survey found a high level of stress and fear among the respondents.</p>
<p>Health authorities should be on the alert and re-examine their capacity to manage an outbreak like SARS in the event that such a mishap should recur in the future.</p>
</abstract>
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<meta-value> July 2004 Vol 124 No 4 The Journal of The Royal Society for the Promotion of Health JRSH JRSH 2004;124(4):167-170 Authors AAbbdduullbbaarrii BBeenneerr,, PPhhDD,, IITTMMAA,, MMFFPPHHMM,, FFRRSSSS,, Consultant and Head, Department of Medical Statistics and Epidemiology, Hamad General Hospital, Hamad Medical Corporation, PO Box 3050, Doha, State of Qatar AAbbdduullllaattiiff AAll--KKhhaall,, MMDD,, PPhhDD,, Department of Medicine, Hamad General Hospital, as above CCoorrrreessppoonnddiinngg aauutthhoorr:: Abdulbari Bener, address as above Tel: +974 439 3765 or +974 439 3766 Fax: +974 439 3769 Email: abener@hmc.org.qa FFuullll ttiittllee:: A knowledge, attitude and practice towards SARS awareness: a community-based study Received 4 December 2003, revised and accepted 4 May 2004 Key words Communicable diseases; epi- demiology; public health; severe acute respiratory syndrome INTRODUCTION During the autumn of 2002, the world experienced the first new epidemic of the 21st century with the emergence of a readily transmissible disease, severe acute respiratory syndrome (SARS). Because SARS has the potential of becoming the first pandemic of the new millennium, the World Health Organization issued a global warning on 12 March 2003.1 SARS is a newly recognised illness associated with infection from a novel coronavirus.1-3 The outbreak of SARS gave every community an oppor- tunity to study the use and efficiency of public health information systems and population health technology to detect and fight this epidemic. SARS hit the world on 16 November 2002 when the first cases of atypical pneumonia appeared in the Guangdong province in southern China.1 The disease quickly spread to Vietnam and Hong Kong and from there made its way around the globe. By 11 July 2003 there were 8,437 cases of SARS world- wide leading to 813 deaths.1 The western hemisphere was not spared; in Canada, about 37 people had died by the end of June 2003.4 SARS was introduced to Canada by a visitor returning to Toronto in February 2002 after visiting Hong Kong. He transmitted the disease to a family member who was later admitted to a community hospital. This infection then led to a large nosocomial outbreak in Canada.5-12 More recently, a knowledge, attitude and practice study8 was performed in the district of Pinggu in Beijing, China, to determine the awareness of SARS. The results showed that 97.7% of participants knew SARS was an infectious disease and 74.0% knew it spread through saliva. The social and economic impact of SARS is noticeable. SARS is an infectious disease that fright- ens the population, makes fear a part of every human encounter, and disrupts community mental health. It has threatened the political, economic and social stability of countries throughout the world, especially affecting Asian cities such as Beijing, Hong Kong, Singapore and Taipei.1, 4 , 8 In these areas, the economic growth, sense of security, health care system, trade, tourism, employment and global harmony were severely affected by the recent Knowledge, attitude and practice towards SARS Abstract The objective of the study was to explore the knowledge, attitude and practice of the population of Qatar towards severe acute respiratory syndrome (SARS). The study took the form of a cross-sectional community-based survey in Doha International Airport and primary health care centres situated in urban and semi-urban areas of Qatar. The survey was conducted among travellers arriving at Doha International Airport and community residents visiting health centres from April to September 2003. A total of 1,800 subjects were approached for the study of which 1,386 (77.0%) responded to the ques- tionnaire. The study showed that although 79.4% of the total subjects claimed to know about SARS, only 8.0% had accurate knowledge about all of the symptoms of SARS. The respondents' satisfaction with the preventive measures taken by the health authorities was only 66.6%. Overall, 73.0% of the total subjects knew that SARS was highly infectious; 69.9% knew that it could spread through close contact; 67.4% were aware that high fever was the early symptom; and 60.8% thought SARS could be cured. Half of the subjects said they had gained most of their knowledge on SARS through television and radio programmes (52.2%). Three-fifths (60.1%) were afraid to travel for fear of being affected by SARS. The level of awareness of SARS among Qataris was poor (31.7%) compared to that among non-Qataris (68.3%). The level of knowledge about SARS was better among educated subjects. The survey found a high level of stress and fear among the respondents. Health authorities should be on the alert and re-examine their capacity to manage an outbreak like SARS in the event that such a mishap should recur in the future. SARS awareness RESEARCH 167 167-170 SARS.qxd 7/7/04 5:26 pm Page 167 JRSH The Journal of The Royal Society for the Promotion of Health July 2004 Vol 124 No 4 outbreak of SARS. This study of SARS awareness was conducted among the population of Qatar. The main objectives of the study were to determine the knowledge, attitude and behaviour of the population above 15 years of age towards SARS; to study the impact of health education through various media in increasing public aware- ness; and to identify the association between various socio-demographic factors and knowledge about SARS. METHOD This study was conducted in the State of Qatar, which is located halfway up the western coast of the Arabian Gulf. The country is a peninsula extending towards the north of the Gulf, with a set of islands having a total area of 11,427 square kilo- meters. Doha is the capital and commer- cial centre of the country. The estimated population of the State of Qatar for the year 2002 was 616,151. Approximately 30% of the population are Qatari nationals and the rest are expatriates, mostly from the Middle East, South Asia and Southeast Asia. As SARS was continuing to spread around the world, and the health authori- ties found two suspected cases of SARS in Qatar, the authors felt it was necessary to educate the community on SARS as well as to gauge the level of awareness amongst the Qatari population. A cross-sectional survey was therefore conducted between April and September 2003 among trav- ellers arriving at Doha International Airport and residents attending primary health care centres. Of the 21 primary health care centres in Qatar, 11 were select- ed for the study (eight in an urban setting and three in a semi-urban setting) from across the whole country. The subjects were selected at random from the patients visiting the health centres and passengers arriving and departing from Doha International Airport. The sample size was computed by using the Epi-Info version 2000 Computer Programme. Allowing an error of 2.5%, level of significance of 5%, and 95% confi- dence interval, the computer programme indicated that a sample size of 1,800 subjects would be needed to achieve the objectives of our study. Data on the level of awareness of SARS were collected through specially designed questionnaires. These were distributed among travellers at the airport and the residents visiting the health centres. Face- to-face interviews were conducted to gauge the knowledge about SARS and people's attitude and behaviour towards the disease. The questionnaire was made up of four major parts: the first part comprised questions regarding socio-demographic status and employment; the second contained questions relating to general knowledge about SARS; the third asked subjects about their attitudes and behav- iour towards SARS; and the fourth concerned practices among travellers. A representative sample of 1,800 Qatari and non-Qatari subjects were approached from the daily visits of primary health care centres and airport travellers, but only 1,386 gave consent to take part in the study. The Statistical Packages for Social 168 RESEARCH SARS awareness Table 1 Demographic data of participants (total sample 1,386) Recognised SARS? Yes No n (%) n (%) 1,100 (79.4) 286 (20.6) Age group <30 261 (23.7) 52 (18.2) 30-39 487 (44.3) 132 (46.1) 40-49 258 (23.5) 74 (25.9) >50 94 (8.5) 28 (9.8) Gender*** Male 534 (48.5) 186 (65.0) Female 566 (51.5) 100 (35.0) Nationality* Qatari 349 (31.7) 112 (39.2) Non-Qatari 751 (68.3) 174 (60.8) Marital status* Single 379 (34.5) 116 (40.6) Married 663 (60.2) 149 (52.1) Divorced/widowed 58 (5.3) 21 (7.3) Level of education*** Illiterate 26 (2.4) 7 (2.4) Primary 43 (3.9) 25 (8.8) Preparatory 105 (9.5) 47 (16.4) Secondary 421 (38.3) 116 (40.6) University graduate 505 (45.9) 91 (31.8) Occupation** Sedentary 275 (25.0) 89 (31.1) Businessman 135 (12.3) 19 (6.6) Manual labour 243 (22.1) 80 (28.0) Student 79 (7.2) 15 (5.3) Housewife 140 (12.7) 27 (9.4) Police or military 131 (11.9) 41 (14.3) Professional 97 (8.8) 15 (5.3) Monthly income (QR+)** <3,000 266 (24.1) 101 (35.3) 3,000-5,000 403 (36.7) 93 (32.5) 5,001-10,000 294 (26.8) 70 (24.5) >10,000 137 (12.4) 22 (7.7) Place of residence Urban 829 (75.4) 221 (77.3) Semi-urban 271 (24.6) 65 (22.7) Type of residence*** Villa 543 (49.4) 103 (36.0) Flat/apartment 387 (35.2) 129 (45.1) Traditional/mud house 170 (15.4) 54 (18.9) * p = 0.05 ** p = 0.01 *** p = 0.001 + 1$ = 3.65 QR 167-170 SARS.qxd 7/7/04 5:26 pm Page 168 July 2004 Vol 124 No 4 The Journal of The Royal Society for the Promotion of Health JRSH Sciences (SPSS)9 were used for statistical analysis. Student's t-test was used to ascer- tain the significance of differences between mean values of two continuous variables, and the non-parametric Mann-Whitney test was used. Chi-square analysis was performed to test for differences in proportions of categorical variables between two or more groups. In 2 x 2 tables, the Fisher exact test (two-tailed) was used instead of chi-square. The level p<0.05 was considered as the cut-off value for significance. The limitations of this study are that it has been undertaken in a relatively small population and that the random selection of subjects may not be perfect. Finally, this is self-reported information based on questionnaires. RESULTS Table 1 shows the demographic character- istics of the participants and whether or not they recognised the term 'SARS'. Although 79.4% of the total subjects claimed they recognised the term, detailed screening by questionnaires on their knowledge of the signs and symptoms of SARS proved their lack of knowledge on this matter. Among those who recognised the term SARS, 44.3% were in the 30 to 39 years of age group. The level of awareness among Qataris was poor (31.7%) compared to that among non-Qataris (68.3%). The percentage of men and women who recog- nised the term SARS was fairly similar, 48.5% in males and 51.5% in females. Also, the common level of knowledge regarding SARS was greater among those with higher levels of education. Table 2 reveals the respondents' knowl- edge on the signs and symptoms of SARS. Among the symptoms of SARS, most of the subjects were aware of the high fever (67.4%), breathing difficulties (58.7%), dry cough (57.4%) and headache and discomfort (52.4%). Of the seven signs and symptoms for SARS, 26.6% of the total subjects correctly identified four and 18.2% correctly identi- fied five. Of the total subjects, 73% were aware that SARS was a highly infectious disease, although only 45.3% thought it could be prevented. Most of the participants obtained their knowledge from television and radio programmes (52%), followed by newspa- per and magazine articles (44%), advice from health professionals (42%), internet (34%), books (28%) and relatives (22%). This shows that the reporting in the mass media failed to provide detailed informa- tion on SARS, its background, symptoms and possible routes of infection. With regard to participants' attitude and behaviour, 60% were afraid to travel due to SARS, 69% were afraid of contacting people affected by SARS, and a similar proportion (63%) avoided unnecessary travel to endemic areas. The present study reveals that the psychological impacts of anxiety and fear were common among the subjects who participated in this study. DISCUSSION Throughout recorded history, epidemics have relentlessly descended on societies, disturbing their previous harmony. By July 2003 SARS had infected at least 8,437 people in 30 countries.1 In its wake, the healthcare and economic systems of some of the countries affected have been seri- ously disrupted. Despite the fact that cancer, stroke, trauma and poisoning are the leading causes of death globally, these are of less concern to the public as the affected do not pass their conditions on to others. Our study showed that respondents had a fair knowledge about SARS (79.4%). None of the respondents were totally igno- rant about the disease because of the role of information technology during the SARS epidemic. However, the level of awareness among Qataris was poor (31.7%) compared to that among non- Qataris (68.3%). This might be because most of the mass media presenting the relevant information was in English. A recent report by Gerberding states that the "use of internet has sped information exchange and helped overcome the prob- lems."10 But our study evaluated the level or accuracy of their knowledge, finding that 26.6% of the subjects could only iden- tify four of the seven signs and symptoms of SARS, and only 8% could identify all of them. This suggests that the health authorities should have been more alert in producing television documentaries, radio programmes, books, journal articles and newspaper reports on this deadly virus to educate the community. From 1 November 2002 to 11 July 2003, a total of 8,437 probable SARS cases were reported to the World Health Organization from 30 countries; 813 deaths have been reported although none in the United States.11 As of 15 July 2003, a total of 418 SARS cases were reported in the United States, with 344 (82.3%) classified as suspected SARS and 74 (17.7%) classified as probable SARS.12 SARS awareness RESEARCH 169 Table 2 General knowledge about SARS (total sample 1,386) Recognised SARS n (%) Knowledge of signs and symptoms* Fever over 38°C 934 (67.4) Headache and discomfort 726 (52.4) Dry cough after two to seven days 796 (57.4) Breathing difficulties 814 (58.7) Severe back pain 360 (26.0) Vomiting 446 (32.2) Dizziness 510 (36.8) Specific knowledge of SARS* SARS can be prevented 628 (45.3) SARS can be reduced by education 909 (65.6) SARS can spread by close person-to-person contact 969 (69.9) SARS is highly infectious 1,012 (73.0) SARS can be cured 843 (60.8) * Multiple choice questionnaire, thus percentages do not add up to 100% 167-170 SARS.qxd 7/7/04 5:26 pm Page 169 JRSH The Journal of The Royal Society for the Promotion of Health July 2004 Vol 124 No 4 SARS themselves and dying of the illness. The survey revealed that anxiety and fear had a common psychological impact among the subjects. Health authorities should pause briefly to re-examine their capacity to manage an outbreak of conta- gious respiratory infections like SARS. ACKNOWLEDGEMENTS This study was funded and supported by the World Health Organization. This work would not have been possible without the cooperation of the study participants, airport clinic physicians and primary health care staff. The authors would like to thank Mrs S Samson and Mr A Farooq of the Medical Statistics and Epidemiology Department for their help in data entry and analysis. 170 RESEARCH SARS awareness The World Health Organization has encouraged each country to enforce stricter SARS preventive measures.13 Accordingly, the health authorities of Qatar swung into action to protect the community and travellers arriving from affected areas. Suspected cases were isolat- ed to break the chain of transmission from infected to healthy persons. The National Epidemic Preparedness Committee of the State of Qatar met regularly to take control and institute preventive measures for early detection. Of the respondents to our ques- tionnaire, 33.4% were not happy with the preventive measures taken by the health authorities of Qatar. SARS clinically presents with high-grade fever, chills and rigors, myalgia, headache and cough with or without sputum.11 In the present study, 67.4% of the subjects recognised high-grade fever as a sign and symptom of SARS, 58.7% recognised breathing difficulties, 57.4% recognised dry cough and 52.4% recognised headache and discomfort. With its highly infectious and fatal nature, the SARS virus has been described as a possible biological weapon.14, 15 The virus can be transmitted by contact with an infected person. It is estimated that a single person infected with SARS can infect three others in a population that has not yet insti- tuted control measures. The health author- ities of Qatar were highly alert to this potential threat to public health during the SARS outbreak. In our survey, 73.0% of the total subjects knew that SARS was highly infectious and 55% thought that the disease could not be prevented, which is consistent with the previous study reported from Beijing, China.8, 16 Most of the residents believed SARS has an influence on regular life, stability of society, development of economy and international communica- tions. Nevertheless, SARS severely tested the capacity of the global public health community to respond rapidly. Moreover, it tested each country's integrity in report- ing data as well as the emergency response plans of each country. In Middle East and Arabian Gulf countries, our study was the first population-based survey on SARS. CONCLUSION The study revealed that although 79.4% of the total subjects claimed that they recog- nised the term 'SARS', only 8% were able to correctly identify all seven signs and symptoms associated with the disease. Over 60% of the subjects experienced fear of infection and worried about catching References 1 World Health Organization. Severe Acute Respiratory Syndrome (SARS). Available online at www.who.int/csr/sars/en (accessed on 10 October 2003) 2 Peiris JS, Lai ST, Poon LL, Guan Y, Yam LY, Lim W, et al. Coronavirus as a possible case of severe acute respiratory syndrome. Lancet 2003;361:1319-25 3 Ksiaziek TG, Erdman D, Goldsmith CS, Zaki SR, Peret T, Emery S, et al. A novel coron- avirus associated with severe acute respiratory syndrome. N Engl J Med 2003;348:1953-66 4 Eysenbach G. SARS and population health technology. J Med Intern Res 2003;5:14 5 Varia M, Wilson S, Sarwal S, McGeer A, Gournis E, Galanis E, et al. 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<namePart type="family">Bener</namePart>
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<affiliation>Department of Medical Statistics and Epidemiology, Hamad General Hospital, Hamad Medical Corporation, PO Box 3050, Doha, State of Qatar,</affiliation>
<affiliation>E-mail: abener@hmc.org.qa</affiliation>
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<name type="personal">
<namePart type="given">Abdullatif</namePart>
<namePart type="family">Al-Khal</namePart>
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<affiliation>Department of Medicine, Hamad General Hospital, Hamad Medical Corporation, PO Box 3050, Doha, State of Qatar</affiliation>
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<abstract lang="en">The objective of the study was to explore the knowledge, attitude and practice of the population of Qatar towards severe acute respiratory syndrome (SARS). The study took the form of a cross-sectional community-based survey in Doha International Airport and primary health care centres situated in urban and semi-urban areas of Qatar. The survey was conducted among travellers arriving at Doha International Airport and community residents visiting health centres from April to September 2003. A total of 1,800 subjects were approached for the study of which 1,386 (77.0%) responded to the questionnaire. The study showed that although 79.4% of the total subjects claimed to know about SARS, only 8.0% had accurate knowledge about all of the symptoms of SARS. The respondents’ satisfaction with the preventive measures taken by the health authorities was only 66.6%. Overall, 73.0% of the total subjects knew that SARS was highly infectious; 69.9% knew that it could spread through close contact;67.4% were aware that high fever was the early symptom; and 60.8% thought SARS could be cured. Half of the subjects said they had gained most of their knowledge on SARS through television and radio programmes (52.2%). Three-fifths (60.1%) were afraid to travel for fear of being affected by SARS. The level of awareness of SARS among Qataris was poor (31.7%) compared to that among non-Qataris(68.3%). The level of knowledge about SARS was better among educated subjects. The survey found a high level of stress and fear among the respondents. Health authorities should be on the alert and re-examine their capacity to manage an outbreak like SARS in the event that such a mishap should recur in the future.</abstract>
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<topic>Communicable diseases</topic>
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<topic>public health</topic>
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