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Knowledge, attitudes and practices (KAP) of the population regarding severe fever with thrombocytopenia syndrome (SFTS) in endemic areas of Lu'an in China were assessed before and after an intervention programme. The pre-intervention phase was conducted using a sample of 425 participants from the 12 selected villages with the highest rates of endem...
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... the knowledge acquired from the intervention programme to their guardians since the majority of their guardians had no formal education. Healthcare staff including doctors and nurses was not included as their special occupations. The calculation of the sample size and sampling diagram for the present study is pre- sented in Eq. (1) [14] and Fig. 1, ...
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Citations
... For questions on attitudes and practices, we used a three-point Likert scale [25,26]. For each question on satisfactory attitudes, a "yes" answer was given a score of 2, "maybe" a score of 1, and "no" was given 0 score. ...
... For all participants, scores for each dimension of KAP were analyzed as the number of points obtained as a proportion of the maximum possible score [12,26]. We combined KAP data with previously collected data on serostatus for leptospirosis, demographic, socioeconomic, and environmental/exposure factors [7,20]. ...
Several studies have identified socioeconomic and environmental risk factors for infectious disease, but the relationship between these and knowledge, attitudes, and practices (KAP), and more importantly their web of effects on individual infection risk, have not previously been evaluated. We conducted a cross-sectional KAP survey in an urban disadvantaged community in Salvador, Brazil, leveraging on simultaneously collected fine-scale environmental and epidemiological data on leptospirosis transmission. Residents’ knowledge influenced their attitudes which influenced their practices. However, different KAP variables were driven by different socioeconomic and environmental factors; and while improved KAP variables reduced risk, there were additional effects of socioeconomic and environmental factors on risk. For example, males and those of lower socioeconomic status were at greater risk, but once we controlled for KAP, male gender and lower socioeconomic status themselves were not direct drivers of seropositivity. Employment was linked to better knowledge and a less contaminated environment, and hence lower risk, but being employed was independently associated with a higher, not lower risk of leptospirosis transmission, suggesting travel to work as a high risk activity. Our results show how such complex webs of influence can be disentangled. They indicate that public health messaging and interventions should take into account this complexity and prioritize factors that limit exposure and support appropriate prevention practices.
... Although the case fatality rate has decreased, its epidemic area has continued to expand. 23 provinces in China reported SFTS cases, and the absolute number of infections increased from 2010 to 2016 [3]. Even in 2017, more than 90% of SFTS cases reported in China and the World Health Organization once listed SFTS as one of the nine major infectious diseases in the key list, which is one of the most serious public health problems in recent years [4,5]. ...
Background
This study aimed to explore whether the transmission routes of severe fever with thrombocytopenia syndrome (SFTS) will be affected by tick density and meteorological factors, and to explore the factors that affect the transmission of SFTS. We used the transmission dynamics model to calculate the transmission rate coefficients of different transmission routes of SFTS, and used the generalized additive model to uncover how meteorological factors and tick density affect the spread of SFTS.
Methods
In this study, the time-varying infection rate coefficients of different transmission routes of SFTS in Jiangsu Province from 2017 to 2020 were calculated based on the previous multi-population multi-route dynamic model (MMDM) of SFTS. The changes in transmission routes were summarized by collecting questionnaires from 537 SFTS cases in 2018–2020 in Jiangsu Province. The incidence rate of SFTS and the infection rate coefficients of different transmission routes were dependent variables, and month, meteorological factors and tick density were independent variables to establish a generalized additive model (GAM). The optimal GAM was selected using the generalized cross-validation score (GCV), and the model was validated by the 2016 data of Zhejiang Province and 2020 data of Jiangsu Province. The validated GAMs were used to predict the incidence and infection rate coefficients of SFTS in Jiangsu province in 2021, and also to predict the effect of extreme weather on SFTS.
Results
The number and proportion of infections by different transmission routes for each year and found that tick-to-human and human-to-human infections decreased yearly, but infections through animal and environmental transmission were gradually increasing. MMDM fitted well with the three-year SFTS incidence data ( P <0.05). The best intervention to reduce the incidence of SFTS is to reduce the effective exposure of the population to the surroundings. Based on correlation tests, tick density was positively correlated with air temperature, wind speed, and sunshine duration. The best GAM was a model with tick transmissibility to humans as the dependent variable, without considering lagged effects (GCV = 5.9247E-22, R ² = 96%). Reported incidence increased when sunshine duration was higher than 11 h per day and decreased when temperatures were too high (>28°C). Sunshine duration and temperature had the greatest effect on transmission from host animals to humans. The effect of extreme weather conditions on SFTS was short-term, but there was no effect on SFTS after high temperature and sunshine hours.
Conclusions
Different factors affect the infection rate coefficients of different transmission routes. Sunshine duration, relative humidity, temperature and tick density are important factors affecting the occurrence of SFTS. Hurricanes reduce the incidence of SFTS in the short term, but have little effect in the long term. The most effective intervention to reduce the incidence of SFTS is to reduce population exposure to high-risk environments.
... Several studies have identified socioeconomic and environmental risk factors for infectious 23 disease, but the relationship between these and knowledge, attitudes, and practices (KAP), and 24 more importantly their web of effects on individual infection risk, have not previously been 25 evaluated. We conducted a cross-sectional KAP survey in an urban disadvantaged community 26 in Salvador, Brazil, leveraging on simultaneously collected fine-scale environmental and 27 epidemiological data on leptospirosis transmission. Residents' knowledge influenced their 28 attitudes which influenced their practices. ...
... For answers given by participants to questions based on statements that 124 were true, each "correct" answer was assigned a score of 2, a "do not know" answer was 125 assigned 1, and an "incorrect" answer was assigned 0; for false statements the scales were 126 reversed [25]. 127 For questions on attitudes and practices, we used a three-point Likert scale [25,26]. For each 128 question on satisfactory attitudes, a "yes" answer was given a score of 2, "maybe" a score of 129 1, and "no" was given 0 score. ...
Several studies have identified socioeconomic and environmental risk factors for infectious disease, but the relationship between these and knowledge, attitudes, and practices (KAP), and more importantly their web of effects on individual infection risk, have not previously been evaluated. We conducted a cross-sectional KAP survey in an urban disadvantaged community in Salvador, Brazil, leveraging on simultaneously collected fine-scale environmental and epidemiological data on leptospirosis transmission. Residents’ knowledge influenced their attitudes which influenced their practices. However, different KAP variables were driven by different socioeconomic and environmental factors; and while improved KAP variables reduced risk, there were additional effects of socioeconomic and environmental factors on risk. For example, males and those of lower socioeconomic status were at greater risk, but once we controlled for KAP, male gender and lower socioeconomic status themselves were not direct drivers of seropositivity. Employment was linked to better knowledge and a less contaminated environment, and hence lower risk, but being employed was independently associated with a higher, not lower risk of leptospirosis transmission, suggesting travel to work as a high risk activity. Our results show how such complex webs of influence can be disentangled. They indicate that public health messaging and interventions should take into account this complexity and prioritize factors that limit exposure and support appropriate prevention practices.
... In the future, we should intervene in key populations before active tea picking begins (Lyu et al., 2018). Our findings have also shown that the cases we discovered might only be "the tip of the iceberg." ...
Objective
On May 2, 2017, an outbreak of unexplained fever with rashes was reported in Lu'an, China. In this study, we aimed to identify the possible pathogens, epidemiological characteristics, and risk factors of this outbreak.
Methods
We conducted descriptive field epidemiological studies. Blood samples were tested using an indirect immunofluorescence assay for Rickettsia rickettsii antibody, and nested polymerase chain reaction and gene sequencing assays were performed.
Results
We recruited 39 cases who had symptomatic onset from April 20 to June 8, 2017. Among these, 9 were suspected cases, 18 were probable cases, and 12 were confirmed cases. No one died. The main clinical manifestations were fever (100%), rash (100%), fatigue (97.3%), myalgia (83.8%), and anorexia (83.8%). None of the patients died. Thirty-seven patients who were treated with antibiotics during hospitalization showed significant improvement. The cases were distributed across 14 townships in 2 counties. The median age was 59 (43.0–81.0) years, of which 93.3% had a history of tea picking (28/30), and 77.3% (17/22) had a history of tick bites. The mean incubation period was 5.0 days (2.0–13.0 days). Serum IgG titers were higher in convalescent patients than in the general population (p = 0.016). Phylogenetic analysis revealed that the ompA sequences of Rickettsia sp. Lu'an-2018 had an 86.8%–99.0% sequence identity with the 23 strains of Rickettsia found worldwide.
Conclusions
This was the first reported outbreak of an undetermined species of a human infection with the spotted fever group of Rickettsia in China, which might be caused by ticks biting local residents when picking tea.
... This study has some limitations. Our survey combined widely used questions on knowledge, attitudes, and practices studies and health belief model studies [44,45]. Some questions were rephrased to ensure their fitness in Hong Kong and have only undergone face validity by our expert panel. ...
BACKGROUND
The Public Private Interface-electronic Patient Record (PPI-ePR) system was implemented as a new electronic platform to facilitate collaboration between the public and private sectors in Hong Kong. However, its barriers to participate and benefits have not hitherto been comprehensively assessed.
OBJECTIVE
This study aims to evaluate the awareness, acceptance, perceived benefits, and obstacles to participation among private doctors and general public.
METHODS
From December 2012 to January 2013, 2,435 telephone interviews were performed by trained interviewers to survey random-selected patients who were enrolled or not enrolled in the PPI-ePR system. At the meantime, self-administered surveys were sent by post to 10,285 registered doctors in Hong Kong. The questionnaires for both patients and doctors contain questions on subjects’ awareness, acceptance and perceptions to PPI-ePR, perceived benefits and obstacles of participating in the programme, reasons for not using the system after enrolling, as well as perceived areas for service improvement of the system.
RESULTS
Over 53% of enrolled patients believed that the PPI-ePR system would improve healthcare quality by “reducing duplicate tests and treatments”, while over 76% of enrolled doctors emphasized “timely access to patients’ medical records” as the biggest benefit of their enrolment. Among non-enrolled patients, unawareness of the project was among the most popular obstacle of enrolling the PPI-ePR system (40%). Regarding non-enrolled doctors, the complicated registration process hinder them from participating in the programme the most (48%). Establishing of user-friendly interface (71.5%), and open rights for patients to access their own medical records (63.7%) were among the most widely underlined factors to attract non-enrollees’ participation of the programme.
CONCLUSIONS
This study comprehensively assessed the popularity, perceived benefits and hindering factors of enrolling the PPI-ePR system in Hong Kong. Lack of awareness, as well as fear of the complex registration procedures, was the most common reason of individuals’ absence in the program, calling for more frequent and effective promotions of the program. Even for enrolled users, simplified and user-friendly interface with more functions must be developed to improve their activity.
... This study has some limitations. Our survey combined widely used questions on knowledge, attitudes, and practices studies and health belief model studies [44,45]. Some questions were rephrased to ensure their fitness in Hong Kong and have only undergone face validity by our expert panel. ...
Background:
The Public Private Interface-Electronic Patient Record (PPI-ePR) system was implemented as a new electronic platform to facilitate collaboration between the public and private sectors in Hong Kong. However, its barriers to participate and benefits have not been comprehensively assessed.
Objective:
This study aimed to evaluate the awareness, acceptance, perceived benefits, and obstacles to participation among private doctors and the general public.
Methods:
From December 2012 to January 2013, 2435 telephone interviews were performed by trained interviewers to survey randomly selected patients who were enrolled or not enrolled in the PPI-ePR system. In addition, self-administered surveys were sent by postal mail to 4229 registered doctors in Hong Kong. The questionnaires for both patients and doctors contained questions on subjects' awareness, acceptance, and perceptions of the PPI-ePR, perceived benefits and obstacles of participating in the program, reasons for not using the system after enrolling, and perceived areas for service improvement of the system.
Results:
More than 53.1% (266/501) of enrolled patients believed that the PPI-ePR system would improve health care quality by reducing duplicate tests and treatments, while more than 76.8% (314/409) of enrolled doctors emphasized timely access to patients' medical records as the biggest benefit of their enrollment. Among nonenrolled patients, unawareness of the project was the most popular obstacle to enrolling in the PPI-ePR system (483/1200, 40.3%). Regarding nonenrolled doctors, the complicated registration process hindered them from participating in the program the most (95/198, 48.0%). Television, newspaper, and magazine advertisements and medical profession newsletters or journals were suggested as the most effective means to encourage participation in the program among surveyed patients (1297/1701, 76.2%) and doctors (428/610, 70.2%), respectively. Lack of clinical indication requiring data extraction from other hospitals was the main reason for low level of PPI-ePR use.
Conclusions:
This study comprehensively assessed the popularity, perceived benefits, and hindering factors of enrolling in the PPI-ePR system in Hong Kong. Low levels of awareness, few privacy concerns, and inactive use of the PPI-ePR system were among the key features for patients and physicians. Public promotions, simplified logistics, and a user-friendly online interface were suggested to improve the coverage and effectiveness of health information exchange between private and public health care sectors.
... The SFTS knowledge level reported in this study was 37.4%, which is lower than the 56.2% reported in another KAP study conducted in Lu'an city, another area of Anhui Province in which SFTS is prevalent. 21 This low SFTS knowledge level may be due to the lack of regular health education programs in our study settings and limited information sources regarding SFTS. In our study, we further demonstrated that even though participants had heard about SFTS, knowledge of the symptoms and signs was lacking. ...
... Most respondents expressed the appropriate attitude of visiting a doctor immediately when bitten by a tick, a finding which is similar to that of a previous KAP study on zoonotic disease. 21 Participants with lower knowledge levels have been shown to be more likely to have a right attitude toward the disease. 23 In this study, more than 80.0% of participants desired consultation and nearly 70.0% were willing to attend the free detection. ...
This study aimed to assess baseline knowledge, attitudes, and practices about severe fever with thrombocytopenia syndrome (SFTS) and identify the target population for health education programs in endemic areas of Anhui, China. This cross-sectional study was conducted from May to June 2017. Of 752 participants, 383 (50.9%) were from Nanqiao District, 397 (52.8%) were female, and 430 (57.2%) were farmers; 37.4% had heard about SFTS, but knowledge of symptoms and signs including fever (34.2%), leukopenia (8.0%), and thrombocytopenia (10.1%) was low. Only 12.1% knew that SFTS virus is transmitted by ticks, 9.4% realized that the blood and body fluid of SFTS are infectious, and only 38.2% thought that the tick should be paralyzed using medical alcohol or iodine. Meanwhile, 61.3% wore long-sleeve clothes, whereas 20.2% used repellents. Median scores for knowledge, attitudes, and practices, and the total score were 4.0, 6.0, 5.0, and 16.0, respectively. Knowledge was influenced by region (OR = 0.632, 95% CI: 0.399-0.999), education (OR = 0.516, 95% CI: 0.434-0.612), gender (OR = 1.865, 95% CI: 1.165-2.987), and age (OR = 3.406, 95% CI: 2.345-4.947). Education was a predictor of lack of appreciation of infection risk (OR = 0.519, 95% CI: 0.449-0.599) and practice (OR = 0.481, 95% CI: 0.396-0.584). Our findings indicate that SFTS-related health education programs are required for females; participants from Qianshan Prefecture; those with an occupation of farmer, retiree, houseworker, or unemployed; elderly participants; and those with low education. Large-scale sustainable health education programs focusing on the target populations are urgently needed in endemic areas.
Tick-borne rickettsial disease (TBRD) is a perilous acute infection that often eludes diagnosis in its early stages. The triad of knowledge, attitudes, and practices (KAPs) among medical professionals is key to reducing missed diagnosis rates. Therefore, a meticulous evaluation of KAPs is imperative. This study aimed to delve into the understanding of TBRD and explore the beliefs and practices related to personal prevention methods among individuals in Lu’an, a hotspot for TBRD. During the summer months of 2023, convenience sampling was employed by circulating a confidential questionnaire to 1,206 participants in the endemic regions of China. This questionnaire painted a comprehensive picture of the participants’ sociodemographic profiles and their KAPs levels vis-à-vis TBRD. The findings revealed that participants scored a mere 55.78% in knowledge, while their attitudes and practices garnered impressive scores of 90.09% and 90.83%, respectively. Upon further analysis using multiple linear regression, several intriguing patterns emerged. Male participants, employed in the Infectious Disease Department, held vice-senior or higher titles, or had prior medical training demonstrated superior knowledge scores. On the other hand, medical personnel who were younger than 30, possessed graduate degrees or higher qualifications, and had training excelled in attitudes and practices. Notably, when employing the Boston Consulting Group (BCG) matrix, a significant distribution of medical personnel was observed across the four quadrants. Specifically, 37.43%, 13.19%, 19.61%, and 29.77% fell into the first, second, third, and fourth quadrants. This survey underscores the commendable attitudes and practices of medical staff towards TBRD in endemic regions of China. However, their knowledge level remains wanting and demands urgent improvement.
O objetivo do estudo é realizar um programa de treinamento e formação nutricional, direcionado aos educadores infantis de uma Rede Municipal de Educação Infantil, quanto às práticas alimentares e alimentação escolar, avaliando sua eficácia e verificando possíveis associações com a escolaridade destes educadores infantis. Trata-se de um estudo pré-experimental, do tipo pré-teste e pós-teste, realizado sem grupo de controlo. A amostra foi composta por 224 educadores infantis provenientes de 15 Centros Municipais de Educação Infantil, os quais participaram de um Curso de Promoção da Saúde e Prática Pedagógica na Educação Infantil, composto por dois módulos. Dados sociodemográficos, realização de atividade física e dados antropométricos foram informados via aplicação de questionário. Utilizou-se um Questionário de Conhecimento Nutricional para a mensuração do conhecimento em nutrição dos indivíduos e para a avaliação de aquisição de conhecimento, após Intervenção Nutricional, um questionário em escala Likert. Os dados foram analisados, considerando p < 0,05. O escore médio de conhecimento nutricional pré-intervenção educativa foi de 8,1±2,0 pontos, observando predominância de moderado conhecimento nutricional entre os educadores infantis (68%). Por meio do teste t pareado, observou-se diferença (p < 0,001) entre as notas médias após (5,07) e antes (3,4) do programa de intervenção nutricional, sem, contudo, haver diferença entre a estratificação escolar dos participantes (valor-p = 0,26). O programa de intervenção alimentar e nutricional proposto demonstrou-se simples e eficaz para a melhoria do conhecimento sobre alimentação e nutrição dos educadores infantis.
