July06, 2022,UK

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Knowledge, Attitude and Practices of Indian Dentists during COVID-19

Dr Ridhi Narang 1, Dr. Astha Doshi 2*, Dr. Shashank Kumar Mishra3, Dr. Shruti Dabi4,
Dr. Kirti Siroya5, Dr. Swarnendra Nag 6

1. MDS, Associate Professor, Department of Public Health Dentistry, Adesh Institute of Dental Sciences and Research Centre, Bathinda, Punjab

2*. MDS, Senior Lecturer, Department of Public Health Dentistry, Darshan Dental College and Hospital, Udaipur, Rajasthan, India.

3. MDS, Senior Lecturer, Department of Conservative Dentistry and Endodontics, Chhattisgarh Dental College and Research Institute, Rajnangaon, Chhattisgarh, India.

4. MDS, Department of Periodontology, Private Practitioner, Ajmer, Rajasthan, India.

5. BDS, Darshan Dental College and Hospital, Udaipur, Rajasthan, India.

6. Intern Student, Darshan Dental College and Hospital, Udaipur, Rajasthan, India.


Corresponding Author: Dr. Astha Doshi, MDS, Senior Lecturer, Department of Public Health Dentistry, Darshan Dental College and Hospital, Udaipur, Rajasthan, India.

Copy Right: © 2022 Dr. Astha Doshi, this is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Received Date: February 25, 2022

Published Date: March 07, 2022
 

Abstract

Objectives: The cross-sectional study aims to evaluate the Knowledge, attitude and Practices (KAP) of 1394 Indian dental fraternity towards COVID-19.

Methods: Data was collected using E survey form which comprised of 2 parts. The first part pertained to information like general demographic details (gender, qualification and place of college/practice). Part two comprised of knowledge (9), attitude questions (13) eliciting what the students and dentist feels regarding current situation and strategies recommended and practice-based questions (12) to judge whether they incorporate these preventive strategies in their daily practices. Descriptive statistics were used to summarize the demographic information. Difference between the groups was analysed using chi square test. Pearson correlation test was used to find out the correlation between knowledge, attitude and practice-based questions.

Results: Difference in adequate knowledge regarding incubation period of the diseases (p=0.04), disposal of medical waste generated by treatment of suspected or confirmed 2019-nCoV patient (p=0.04), attitude towards worrying about suffering from the disease (p=0.006), afraid of disease even after vaccination (p=0.003) and postponing of appointments of patients not requiring immediate care should be postponed (p<0.01) varied significantly among different education levels of dental fraternity.

Conclusions: The results revealed a significant positive correlation between knowledge, attitude and practice response given by the study subjects. Extensive educational programs must be done as there were lacunae in the knowledge, attitude and practices towards COVID-19 among the dentists.

Keywords- Dental Education, Dental Public Health, Virology, Transmission, Prevention

Knowledge, Attitude and Practices of Indian Dentists during COVID-19

Introduction

Chinese Centre for Disease Control and Prevention publically declared Novel Corona virus as the causal pathogen of Covid-19 (1). On 30th January 2020 (2), WHO declared its as a public health emergency. Covid-19 has been recognized in 192 countries and territories around the world and 1 International conveyance i.e. the Diamond Princess Cruise ship harboured in Yokohama, Japan (3) till March 22nd 2020. Due to the contagious nature of virus, there are rapidly increasing number of cases (4,5). Till now, a large number of infections in medical staff have been reported too (6,7). Due to the peculiar features of dental setting, the cross-infection risk will be high between dental practitioners and patients.

To formulate and implement effective prevention and control strategies of Covid-19 within the dental field, comprehensive knowledge of the same is needed. Due to lack of any previous study and a relevant questionnaire, the present study was one of its own kind to formulate the same. Hence the main aim of the study was to evaluate the knowledge, attitude and practices of BDS third year, final year and interns along with graduates, post graduates and practicing dental professionals towards Covid-19. The hypothesis for the present study was that there will be no difference in knowledge, attitude and practices of different categories of Indian dentist.


Materials and Methods

A descriptive cross-sectional study in the form of e-survey (Google Forms) was conducted among BDS Third year, Final year students, interns along with graduates, postgraduates and practicing dental professionals in India, using a 34 item, self-administered close ended pre structured questionnaire during the months of February-March 2020. The subjects were recruited according to the following inclusion and exclusion criteria.


Inclusion Criteria:

1. As in the Indian scenario patient exposure in dental college starts with BDS third year, so dental students of BDS Third year, Final year students, interns, graduates, postgraduates and practicing dental professionals were included in the study.

2. Participants with Android phones.


Exclusion Criteria:

1. Those who did not give consent.

2. BDS first and second year students.

The study protocol was reviewed by the Ethical Committee of Adesh Institute of Dental Science and Research, Bathinda and was granted ethical clearance. An official permission was taken before conducting the study from the Principal of Adesh Dental College. The purpose of the study was fully explained to the participants and the informed consent was obtained.

 

Sample

Out of total 2000 links send, 1573 students and dentist responded to that questionnaire with three rounds of follow-ups. Out of 1573, 179 participant’s proformas were excluded due to incomplete questionnaire. Hence the final sample consisted of 1394 subjects. 


Questionnaire

The questionnaire was designed to obtain dental participant’s responses about knowledge, attitude and practices towards nCoV-19. The first part assessed the general demographic details of the respondents like gender, qualification and place of college/practice. Part two comprised of knowledge (12), attitude (14) and practice-based questions (15). Knowledge and attitude-based questions elicited what the students and dentist feel regarding current situation while practice-based questions judged whether they incorporate these preventive strategies in their daily practices.

The survey questionnaire was pretested (pilot-survey) by giving it to 50 respondents. The comprehensiveness of the instrument was tested by asking about difficulties in understanding items or frequencies, in order to optimize the face and content validity before the main study. The reliability was assessed using Cronbach’s coefficient. Reproducibility was evaluated by measuring test-retest reliability. It was calculated using intraclass correlation coefficient. The overall value of Cronbach’s alpha (α) coefficient of the questionnaire was estimated to be 0.83, indicating good internal consistency. These questions were excluded from the main study. The homogeneity of the questionnaire was evaluated on the basis of the corrected item and total correlation coefficients. These analyses computed the correlation between each question in the questionnaire. The corrected correlation coefficients values were above 0.23 that has been recommended for including a question in the questionnaire. However, three knowledge, one attitude and three practice based questions Cronbach’s alpha was <0.60. Hence the final questionnaire comprised of 9 knowledge, 13 attitude and 12 practice based questions.


Statistical Analysis

The data was transferred from prefilled proforma to excel sheet for the purpose of data analysis. 95% confidence interval was used to find significance of proportion of KAP’s. Descriptive statistics were used to summarize the demographic information. Data was analyzed using Statistical Package for Social Sciences (SPSS) software program (version 24). Difference between the groups was analysed using chi square test. Pearson correlation test was used to find out the correlation between knowledge, attitude and practice-based questions. The level of significance (p) was set at <0.05.

 

Results

A total of 1394 dental health professionals answered the questionnaire providing the response rate of 69.7%. Majority of them were females (71.8%) and belonged to undergraduate category (66.47%) followed by private practitioners (13.37%) as shown in table 1.

The present situation of CoVID-19 knowledge among dental fraternity is displayed in table 2. Overall participants exhibited good knowledge regarding zoonotic emergence of Covid-19 (66.21%), virus as a causative agent (99.14%), source of infection (87.37%), incubation period of COVID 19 (82.42%), ways of control in dental settings (95.91%) and transmission of n-CoV 2019 in dental clinics (85.44%). Maximum knowledge regarding WHO declaration of COVID-19 as a health emergency on 30-01-2020 was exhibited by postgraduate students (49.57%) followed by academicians (42.25%) and minimum by practitioners (16.89%) followed by undergraduate students (6.59%) with statistically significant difference (p<0.01). Difference in adequate knowledge regarding incubation period of the diseases (p=0.04) and disposal of medical waste generated by treatment of suspected or confirmed 2019-nCoV patient (p=0.04) was also found to vary statistically among the groups.

Table 3 shows attitude regarding Covid-19 according to level of education. Majority of the respondents believed COVID-19 to be dangerous (89.74%) and was hindering their daily activities (75.65%). More than 50% respondents believed that the measures taken by government are not enough to contain the disease.

Around 76.83% believed that media updates create panic rather than awareness also at the same time, majorities i.e. 97.06% wish to remain updated and surprisingly 76.83% believed that China is responsible for this disease. Attitude towards worrying about suffering from the disease (p=0.006), afraid of disease even after vaccination (p=0.003) and postponing of appointments of patients not requiring immediate care should be postponed (p<0.01) varied significantly among different education levels of dental fraternity.

Table 4 shows practices regarding containment of Covid-19 according to level of education. As much as 73.89% respondents covered their mouth and nose with face mask, 95.27% were maintaining 1 meter distance between themselves and anyone who is coughing or sneezing and 93.9% covered their mouth and nose with their bent elbow or tissue whi1le coughing or sneezing. Majority of them avoided visiting crowded places (90.17%), avoided physical contact while greeting (90.24%) and if hand shaked, avoid touching their eyes, nose and mouth (89.60%). The difference among groups according to level of education was also found to be statistically significant (p<0.05).

Pearson correlation analysis revealed a significant positive correlation between knowledge, attitude and practice response given by the study subjects (table 5)

 

Discussion

Novel Corona Virus or Covid-19 cases in India have now crossed the 40,000 mark (8). Current observations suggest it affects people of all ages. However, higher risk is posed on those who are in close contact with symptomatic and asymptomatic Covid-19 case including health care team and other patients in the hospital (9). To the best of our understanding there are no cases of Covid-19 among Dentists reported until now. Dental care settings invariably carry the risk of 2019-nCoV infection still the large number of emergency patients goes to Dental clinics and Hospitals for treatment (10). Hence, the present study explored the knowledge, attitude and practices of dental health students and professionals towards Covid- 19 in India. KAP survey was conducted as it is a quantitative method (predefined questions formatted in standardized questionnaires) that provides access to quantitative and qualitative information. KAP surveys will reveal misconceptions or misunderstandings regarding Covid- 19 that may represent obstacles to the activities that we would like to implement and potential barriers to behavior change. This KAP survey reveals what was said, but there may be considerable gaps between what is said and what is done.

Present study results showed that respondents exhibited good knowledge regarding zoonotic emergence of Covid 19 (66.21%). According to recent research conducted by Chan et al 2020 and Lu et al 2020, SARS CoV is zoonotic and the most probable origin being Chinese horse shoe bats (4,11).

Present results showed that 99.14% knew virus is responsible for COVID 19. Coronavirus belong to the family of Coronaviridae, of the order Nidovirales, comprising large, single, plus stranded RNA as their genome [12,13]. Researchers suggest Human to human spread is via direct transmission (Cough, sneeze and droplet inhalation transmission) and contact transmission i.e. contact with oral, nasal and eye mucous membrane [14]. During dental procedures before aerosols settle on environmental surfaces or enter in respiratory track they stay airborne for an extended period. Thus, poses a threat via spread through droplets and aerosols from infected individuals in dental clinic and hospitals (10,15).

Present study showed that COVID-19 was hindering dentist’s daily activities (75.65%). This might be due to the fact that the Centre governments have declared completely lockdown in India from 26 March to 17 May. It has made dental professionals anxious about their study, job and practice.

Positive attitude towards postponing of appointments of patients not requiring immediate care (p<0.01) varied significantly among different education levels of dental fraternity. It might suggest of time required for preparedness of future prevention of Covid-19 spread, appropriate training of health care workers and arrangement of adequate armamentarium required.

As currently no evidence for any specific treatment against Covid-19 has been suggested, therefore controlling the source of infection, lowering the risk of transmission, using preventive measures, providing early diagnosis, isolation and supportive care for affected patients must be followed (16). Majority of the respondents in the present study showed healthy practices for containment of Covid 19 in their general life and dental practice. WHO also suggested interim guidance on infection prevention and control during healthcare when Covid-19 infection is suspected (17). IDA and Dental Council of India have also issued guidelines for the same.

Poor knowledge was more obvious in questions related to WHO declaration of COVID-19 as a health emergency on 30-01-2020 (83.36%) and disposal of medical waste generated by treatment of suspected or confirmed 2019-nCoV patient (65.35%). This discrepancy could be due to the fact that various informational sources in India focussed on its containment and not how to deal with a patient if he/she happens to visit the clinic. Thus there are lacunae in the information provided by educational programmes regarding the management of such patients. It is recommended that that on line continuing dental educational programmes should be made available for dental health professionals to deal with such patients recognize their clinical symptoms and later dispose of the medical waste appropriately. Also, it is advisable for the dental fraternity to access the ministry of health website to gain updated knowledge and educational content on Covid 19.

The main strength of this study is that it reports important health issue that threaten dental profession in India, especially during the times of outbreak of Covid-19. This study has featured an area where no information is yet available with regard to Knowledge, Attitude and Practices (KAP) towards Covid- 19 among dental fraternity. However, some of the limitations of the study include low response rate and cross sectional nature of the study. Further studies with larger sample size with many categories of dental health professionals would be needed to identify their KAP towards Covid-19. As this is the first study of its type so many of the results were not prepared with past literature. Based on the results of present study, hypothesis was rejected that there was no difference in knowledge, attitude and practices of different categories of Indian dentist.

Clinical Significance: Epidemic of COVID-19 has become a major public health issue for the world and could threaten dental profession in India. This study presented KAP towards COVID- 19 among Indian dentist where no information is yet available with this regard and could help them to formulate and implement effective preventive strategies.


Conclusion

It can be concluded that dental students and professionals had good knowledge, positive attitude and healthy practices towards containment of Covid-189.  Still there are few lacunae requiring improvement. Large scale educational programmes for Covid-19 must be initiated from professional bodies to reinforce the knowledge to influence their behaviour positively.

 

References

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2. Mahase, Elisabeth. “China Coronavirus: WHO Declares International Emergency as Death Toll Exceeds 200.” BMJ, 2020, p. m408.

3. World Health Organization. 2020b. Coronavirus disease 2019 (COVID-19): situation report-36. [accessed 2020 Feb 26]. https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200225-sitrep-36-covid-19.pdf?sfvrsn=2791b4e0_2.

4. Chan, Jasper Fuk-Woo, et al. “A Familial Cluster of Pneumonia Associated with the 2019 Novel Coronavirus Indicating Person-to-Person Transmission: A Study of a Family Cluster.” The Lancet, vol. 395, no. 10223, 2020, pp. 514–23.

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8. Ministry of Health and Family Welfare, Government of India, 2020; Coronavirus disease 2019 (COVID-19): situation report. [accessed 2020 April 1]. https://www.mohfw.gov.in.

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11. Lu, Roujian, et al. “Genomic Characterisation and Epidemiology of 2019 Novel Coronavirus: Implications for Virus Origins and Receptor Binding.” The Lancet, vol. 395, no. 10224, 2020, pp. 565–74.

12. Chen, Yu, et al. “Emerging Coronaviruses: Genome Structure, Replication, and Pathogenesis.” Journal of Medical Virology, vol. 92, no. 10, 2020, p. 2249.

13. Gorbalenya, Alexander E., et al. “Nidovirales: Evolving the Largest RNA Virus Genome.” Virus Research, vol. 117, no. 1, 2006, pp. 17–37.

14. Lu, Cheng-wei, et al. “2019-nCoV Transmission through the Ocular Surface Must Not Be Ignored.” The Lancet, vol. 395, no. 10224, 2020, p. e39.

15. Wei, Jianjian, and Yuguo Li. “Airborne Spread of Infectious Agents in the Indoor Environment.” American Journal of Infection Control, vol. 44, no. 9, 2016, pp. S102–08.

16. Wang, Dawei, et al. “Clinical Characteristics of 138 Hospitalized Patients with 2019 Novel Coronavirus–Infected Pneumonia in Wuhan, China.” JAMA, vol. 323, no. 11, 2020, p. 1061.

17. World Health Organization. 2020a. Clinical management of severe acute respiratory infection when novel coronavirus (2019-nCoV) infection is suspected: interim guidance [accessed 2020 Feb 17]. https://www.who.int/ publications-detail/clinical-management-of-severe-acute-respiratory-infection-when-novel-coronavirus-(ncov)-infection-is suspected.

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