|Year : 2016 | Volume
| Issue : 1 | Page : 33-37
Knowledge regarding Zika virus infection among dental practitioners of tricity area (Chandigarh, Panchkula and Mohali), India
Nidhi Gupta, Ravneet Kaur Randhawa, Sahil Thakar, Mohit Bansal, Preety Gupta, Vikram Arora
Department of Public Health Dentistry, Swami Devi Dyal Hospital and Dental College, Barwala, Panchkula, Haryana, India
|Date of Web Publication||13-Apr-2016|
Ravneet Kaur Randhawa
Department of Public Health Dentistry, Swami Devi Dyal Hospital and Dental College, Barwala, Panchkula, Haryana
Source of Support: None, Conflict of Interest: None
Background: Zika virus (ZIKV), a vector-borne virus affecting a large number of people, has today become a major public health concern in the developed and developing countries worldwide.
Aim: The purpose of this study was to assess the knowledge of ZIKV among dental practitioners residing in Tricity area (Chandigarh, Panchkula and Mohali), India.
Subjects and Methods: A total of 412 private dental practitioners were randomly sampled of whom 254 (61.6%) responded to participate in this cross-sectional survey. A self-structured, closed-ended questionnaire was administered to each participant to record demographic and professional characteristics followed by their knowledge regarding ZIKV. Statistical analysis was performed using SPSS Version 20 (IBM Corp, Armonk, NY). The results were expressed in percentages. Multivariable linear regression analysis was carried out to assess the association of participant's demographics and professional characteristics with knowledge.
Results: The sample consisted of 152 (59.9%) male and 102 (40.1%) female practitioners. Majority of the practitioners belonged to the age group of 25-34 years (66.1%). High knowledge was reported by only 38.2% of the practitioners. A statistically significant difference was seen when mean knowledge scores were compared with the qualification of the participants (P = 0.04), with postgraduates having more knowledge than graduates regarding ZIKV. Most of the knowledge of the practitioners came from television (37.8%) while journals only represented 4.7% of the total information gained.
Conclusion : ZIKV infection, a new public health emergency, needs to be addressed urgently. All health care professionals should have adequate knowledge of the virus and be conversant with necessary precautionary measures to be taken making it imperative that dental practitioners strive to continually update their knowledge from time to time.
Keywords: Infectious disease, knowledge, Tricity area, Zika virus
|How to cite this article:|
Gupta N, Randhawa RK, Thakar S, Bansal M, Gupta P, Arora V. Knowledge regarding Zika virus infection among dental practitioners of tricity area (Chandigarh, Panchkula and Mohali), India. Niger Postgrad Med J 2016;23:33-7
|How to cite this URL:|
Gupta N, Randhawa RK, Thakar S, Bansal M, Gupta P, Arora V. Knowledge regarding Zika virus infection among dental practitioners of tricity area (Chandigarh, Panchkula and Mohali), India. Niger Postgrad Med J [serial online] 2016 [cited 2019 Mar 26];23:33-7. Available from: http://www.npmj.org/text.asp?2016/23/1/33/180179
| Introduction|| |
Zika virus (ZIKV) is an emerging pandemic disease that has been recently declared as a Public Health Emergency by the World Health Organization (WHO) and is catching the attention of people across the globe.  It is a mosquito-borne virus that was first identified in Uganda in 1947 in rhesus monkeys through a monitoring network of sylvatic yellow fever and was first described by Dick et al. in two separate papers. ,
ZIKV was isolated from humans in Nigeria during studies conducted in 1968 and during 1971-1975. , However, from 1951 to 1981, various authors documented serologic evidence of human ZIKV infection from other African countries such as Uganda, Tanzania, Egypt, Central African Republic, Sierra Leone, Gabon and parts of Asia including India, Malaysia, the Philippines, Thailand, Vietnam and Indonesia, but owing to its low prevalence, were not of much Public Health Concern. ,,,,
Attention to ZIKV was first brought to the global platform when it manifested itself in the form of outbreaks, which were reported for the first time from the Pacific in 2007 and 2013 (Yap and French Polynesia) and in 2015 from the Americas (Brazil and Colombia) and Africa (Cape Verde). Quite recently, more than 13 countries in the Americas have reported sporadic ZIKV infections indicating its rapid geographic expansion which necessitates the need for prompt attention towards proper management of this communicable disease. ,
Although ZIKV has been isolated from Aedes africanus, Aedes apicoargenteus, Aedes luteocephalus, Aedes aegypti, Aedes vittatus and Aedes furcifer mosquitoes, researchers were unable to identify any link of transmission between these breeds and animals, until Boorman and Porterfield in 1956 subsequently demonstrated the transmission of ZIKV to mice and monkeys by A. aegypti in a laboratory making it the main mosquito breed responsible for the transmission of this disease. ,,, Among humans, the first well-documented report of ZIKV disease was described by Simpson of his own occupationally acquired ZIKV illness in 1964, when he was 28 years of age.  The clinical symptoms of ZIKV are similar to those of dengue and chikungunya; diseases spread through the same mosquitoes which include fever, skin rashes, conjunctivitis, joint and muscle pain, malaise and headache and are usually mild in nature. The incubation period (the time from exposure to symptoms) of this virus is not clear but is likely to be a few days (~10 days). 
Till date, there is no definite cure for this disease; however, recently, an Indian Pharmaceutical company has claimed to manufacture a vaccine to combat this deadly disease and is currently undergoing preclinical trials and shall be available in an inactivated form in approximately 2 years. ,
With ZIKV rapidly manifesting itself as a pandemic concern, it is important for dentist to also have sufficient knowledge so as to screen potential carriers in their clinical setting, and hence, this study aims to assess the knowledge of dental practitioners on ZIKV in Tricity, India.
| Subjects and Methods|| |
A cross-sectional study was conducted among private dental practitioners in Tricity (Chandigarh, Panchkula and Mohali) area from December 2015 to January 2016. The list of private dental practitioners was obtained from the respective Indian Dental Association branches across Chandigarh, Panchkula and Mohali. From the list, a total of 412 private dental practitioners were randomly selected, and only those who agreed to participate were included in the survey. The protocol of the study was approved by the Institutional Ethical Review Board of Swami Devi Dyal Hospital and Dental College, Panchkula. A written, informed consent was obtained from the study subjects after explaining them about the aim and objectives of the study, as well as the fact that participation was a voluntary and completely anonymous.
The questionnaire used was in English, and its respective psychometric properties (validity) were assessed. Content validity was assessed by a panel of experts consisting of staff members of the Swami Devi Dyal Hospital and Dental College, Panchkula. The purpose was to depict those items with a high degree of agreement among experts.
A pilot study (pretest) was performed on 30 subjects to determine the test-retest reliability of survey question. The respondents were also asked for feedback on clarity and whether there was any difficulty in answering the questions or ambiguity to what sort of answer was required. A few modifications were made based on the response given by the participants to improve the understanding of the questionnaire. The face validity was also assessed and it was observed that 92% of the participants found the questionnaire to be easy.
The final questionnaire was divided into two sections. Section A included questions regarding demographic profile such as age, gender, years and area of practice while Section B included questions related to knowledge regarding ZIKV using a two-page, self-structured, closed-ended questionnaire which contained 14 multiple-choice questions which included questions regarding communicability, symptomatology and diagnostics, virus characteristics and treatment of ZIKV. The responses to the questions had only one correct answer and including the option of "do not know" in some questions. The knowledge scores of the practitioners were categorised as high and low based on the mean of the total score which served as a cut-off point. The questionnaire contained 13 questions which could be scored, and the highest score achieved by any participant could be 13 as a correct response was awarded score of 1 while an incorrect response was given a score of 0. The participants of the pilot study (pretest) were not included in the final analysis.
Statistical analysis was performed using SPSS version 20 (IBM Corp, Armonk, NY). The results were expressed in percentages. Multivariable linear regression analysis was carried out to assess the association of participants' demographics and professional characteristics with the knowledge scores. Cronbach's alpha (α) of the questionnaire was found to be good (0.82).
| Results|| |
Of the 412 dental practitioners contacted to participate in the study, a total of 254 (61.6%) dental practitioners responded. The demographic variables are described in [Table 1]. The sample consisted of 152 (59.9%) male and 102 (40.1%) female practitioners. Majority of the practitioners belonged to the age group of 25-34 years (66.1%).
It was found that only 97 (38.2%) of the clinicians had high knowledge regarding ZIKV [Table 2]. [Table 3] depicts the responses provided by the clinicians which have been expressed in percentage. It revealed that 86.6% of the clinicians knew the viral origin of ZIKV although 9.4% classified it of bacterial origin (question 1). The correct incubation period (7-14 days) was only marked by 40.6% of the respondents (question 4), and only 66.3% knew about the correct vector associated with this disease (question 7). About 97% of the practitioners did not know about the diagnostic test available for ZIKV. The above responses indicate a low knowledge among the dental practitioners regarding ZIKV.
|Table 3: Various responses provided by the practitioners regarding Zika virus|
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The total knowledge scores of the respondents were analysed with the various variables used in the study using a multiple linear regression, and it revealed that qualification yielded a significant difference (P = 0.04) as compared to other variables indicating a difference between the knowledge of graduates and postgraduates [Table 4].
|Table 4: Association between the demographic and participants' variables assessed with the knowledge scores using multivariate linear regression analysis|
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[Table 5] reveals the sources of knowledge regarding ZIKV among the dental practitioners. It revealed that most of their knowledge came from television (37.8%) while the internet consisted of 10.2% of their knowledge. The least information was gained through journals which only represented 4.7% of the total information gained.
|Table 5: Source of knowledge regarding Zika virus among the dental practitioners|
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| Discussion|| |
ZIKV, a recently declared global public health concern, has been spreading at an alarming pace. Therefore, it becomes important for the entire healthcare personnel to constantly update their knowledge  so that they are able to potentially screen such patients for prevention of possible spread of the disease. At present, with the boom in dental tourism in India, it becomes important that the dentists are able to identify and screen potential carriers for such diseases. 
As per the CDC's information sheet on recent outbreaks and health incidents across the globe,  the Ebola outbreaks in West Africa (March 2014 - present) and chikungunya in the Americas (June 2014 - present) have been of much concern like the recently emerging ZIKV disease. Our study revealed that as many as 61.8% of the dental practitioners of Tricity area had low knowledge regarding ZIKV, and similarly, low knowledge scores had also been demonstrated by them when Ebola and chikungunya outbreaks recently emerged and caused considerable distress healthcare workers. Therefore, it can be assumed that lack of knowledge can result in possible transmission of the disease, and it becomes important that doctors can be acquainted with recent medical happenings from time to time regarding these recent outbreaks. ,,,, However, in contrast to our results, Aung et al. reported that 54.7% of their respondents which included nursing students in Yangon had good knowledge regarding Ebola virus disease during its outbreak. 
It was observed that majority of the dental practitioners (37.8%) gained their knowledge from internet as social networking sites have become a part of our daily lives, and 33.9% of the practitioners got their knowledge regarding ZIKV from television which is in agreement with various authors , who also reported a majority of their respondents (dental practitioners) gaining their knowledge from audio-visual aids (100%). This could be attributed to the fact that television nowadays is being watched by a majority of people as it is the most easily accessible source available to gain knowledge regarding current events.
Alarmingly, only 40.4% of dental practitioners responded correctly to the incubation period of ZIKV.  It is of concern that only a few people have sufficient knowledge regarding the onset of this disease and this highlights that private dental practitioners in the Tricity area do little to increase their knowledge to combat recent threats and mainly focus on dental practice only. The study also revealed that knowledge of both genders regarding ZIKV did not yield any statistical significance and these findings are in accordance with the study conducted by Gupta et al. 
The present study is also prone to limitations. The first was the inadvertent creeping in of social desirability bias. Second, due to the cross-sectional nature and random selection of the participants, a selection bias could have occurred; however, to compensate for the same, the researchers did try to incorporate as much sample as possible. Another limitation is that data presented here are only representative of practitioners residing in Tricity area, and knowledge among dental health care professionals can vary geographically.
| Conclusion|| |
It can be concluded that the low knowledge present among dental practitioners of Tricity area is actually worrisome and a great deal of importance need to be paid to such outbreaks as dentists can help identify and screen potential patients to prevent further progression of this disease. It is advised that regular continuing medical educations and continuing dental educations be attended and the internet be used to read articles related to such outbreaks to constantly update their knowledge and safeguarding the interests of the people.
We would like to thank all the dental professionals of Tricity who have contributed towards this survey and have given their valuable opinion.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Dick GW, Kitchen SF, Haddow AJ. Zika virus. I. Isolations and serological specificity. Trans R Soc Trop Med Hyg 1952;46:509-20.
Dick GW. Zika virus. II. Pathogenicity and physical properties. Trans R Soc Trop Med Hyg 1952;46:521-34.
Moore DL, Causey OR, Carey DE, Reddy S, Cooke AR, Akinkugbe FM, et al.
Arthropod-borne viral infections of man in Nigeria, 1964-1970. Ann Trop Med Parasitol 1975;69:49-64.
Fagbami AH. Zika virus infections in Nigeria: Virological and seroepidemiological investigations in Oyo State. J Hyg (Lond) 1979;83:213-9.
Robin Y, Mouchet J. Serological and entomological study on yellow fever in Sierra Leone. Bull Soc Pathol Exot Filiales 1975;68:249-58.
Saluzzo JF, Ivanoff B, Languillat G, Georges AJ. Serological survey for arbovirus antibodies in the human and simian populations of the South-East of Gabon (author′s transl). Bull Soc Pathol Exot Filiales 1982;75:262-6.
Jan C, Languillat G, Renaudet J, Robin Y. A serological survey of arboviruses in Gabon. Bull Soc Pathol Exot Filiales 1978;71:140-6.
Saluzzo JF, Gonzalez JP, Hervé JP, Georges AJ. Serological survey for the prevalence of certain arboviruses in the human population of the south-east area of Central African Republic (author′s transl). Bull Soc Pathol Exot Filiales 1981;74:490-9.
Hayes EB. Zika virus outside Africa. Emerg Infect Dis 2009;15:1347-50.
Lanciotti RS, Kosoy OL, Laven JJ, Velez JO, Lambert AJ, Johnson AJ, et al.
Genetic and serologic properties of Zika virus associated with an epidemic, Yap State, Micronesia, 2007. Emerg Infect Dis 2008;14:1232-9.
Duffy MR, Chen TH, Hancock WT, Powers AM, Kool JL, Lanciotti RS, et al.
Zika virus outbreak on Yap Island, Federated States of Micronesia. N Engl J Med 2009;360:2536-43.
Marchette NJ, Garcia R, Rudnick A. Isolation of Zika virus from Aedes aegypti
mosquitoes in Malaysia. Am J Trop Med Hyg 1969;18:411-5.
McCrae AW, Kirya BG. Yellow fever and Zika virus epizootics and enzootics in Uganda. Trans R Soc Trop Med Hyg 1982;76:552-62.
Boorman JP, Porterfield JS. A simple technique for infection of mosquitoes with viruses; transmission of Zika virus. Trans R Soc Trop Med Hyg 1956;50:238-42.
Simpson DI. Zika virus infection in man. Trans R Soc Trop Med Hyg 1964;58:335-8.
Mazmanian PE, Davis DA, Galbraith R; American College of Chest Physicians Health and Science Policy Committee. Continuing medical education effect on clinical outcomes: Effectiveness of continuing medical education: American College of Chest Physicians Evidence-Based Educational Guidelines. Chest 2009;135 3 Suppl:49S-55S.
Ratnapalan S, Uleryk E. Organizational learning in health care organizations. Systems 2014;2:24-33.
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.
Lisk C, Snell L, Haji-Coll M, Ellis J, Sufi S, Raj R, et al.
Doctors′ knowledge of viral hemorrhagic fevers. Acute Med 2015;14:47-52.
Valerio L. When information does not translate into knowledge. Ebola and hemorrhagic fevers knowledge among primary care physicians and nurses. Open J Prev Med 2015;5:122-7.
Gupta N, Mehta N, Gupta P, Arora V, Setia P. Knowledge regarding Ebola hemorrhagic fever among private dental practitioners in Tricity, India: A cross-sectional questionnaire study. Niger Med J 2015;56:138-42.
Aung MH, Oo WM, Lynn KK, Mya KM. Knowledge and perception towards Ebola virus disease among nursing students in the University of Nursing, Yangon. Myanmar Med J 2015;57:8-14.
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]
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