Knowledge, attitudes, and practices of women of childbearing age testing negative for Zika virus in Kentucky, 2016

Knowledge, Attitudes and Practices About Zika Virus Infection Among Women of Reproductive Age in Central Brooklyn, New York City, USA

Zika virus (ZIKV) is spread by mosquitos, sexual intercourse and vertically during pregnancy. The 2015-2016 ZIKV epidemic infected millions in the Americas and resulted in thousands of infants born with malformations. Though the clusters of severe birth defects have subsided since 2017, ZIKV transmission remains a concern throughout Latin America and the Caribbean. Travel-associated and sexually-transmitted Zika, therefore, remain potential routes of transmission for women of reproductive age and their partners. This is particularly true for communities with high immigrant and foreign-born populations in Central Brooklyn, New York. Limited information has been collected on the perception by this population of ZIKV and how high-risk women engage in preventive practices. Using a survey adapted from the WHO, we assessed engagement in mosquito-related preventive practices while traveling. Data from 483 respondents on knowledge and perceived ZIKV concern, along with demographics as correlates of engagement in preventive practices were collected using a convenience sample between September 2020 and January 2021. Data were collected via a multipronged approach using social media in REDCap. Our findings show that being white/not Hispanic, pregnant, knowledgeable and concerned about ZIKV, and having enough information about ZIKV were all significantly associated with an increased likelihood of engaging in preventive practices while traveling. Multivariable logistic modeling revealed that knowledge was significantly associated with an increased likelihood of engaging in preventive practices while traveling (AOR = 1.90, 95% CI [1.28-2.83]). These findings underscore the importance of directing tailored health education efforts to vulnerable populations.

Zika virus knowledge and vaccine acceptance among undergraduate students in Guayaquil, Ecuador

Purpose

Zika virus (ZIKV) was declared a Public Health Emergency of International Concern (PHEIC) in 2016. Concerns surrounding the effects of ZIKV persist today and several vaccine candidates are currently in various stages of development worldwide. There is limited research on ZIKV vaccine acceptability worldwide, and little research specific to Latin American countries. This research aims to identify the general beliefs and acceptance of a potential ZIKV vaccine in the undergraduate population at Escuela Superior Politécnica del Litoral (ESPOL) in Guayaquil, Ecuador.

Methods

Between January and November 2019, 429 undergraduate students at ESPOL responded anonymously to a ZIKV vaccine survey. Frequencies, percentages, simple correspondence analysis, and bivariate inferential analyses were conducted using Kendall's tau-b test. Tests explored associations between likelihood of receiving a ZIKV vaccine and demographic, ZIKV information seeking, ZIKV psychosocial variables, and ZIKV information source variables.

Results

Among the eligible participants, 241 (56.2%) were willing to receive a ZIKV vaccine if one was made commercially available. Most students were male (61.5%), age 20-25 (63.3%), and of mixed (Mestizo) race (95.3%). Results provided insight into student's knowledge on ZIKV, revealed television as the most common information source, and found most students were willing to receive a ZIKV vaccine were one to become available. Bivariate results revealed most respondents reported feeling neutral or likely to receive a ZIKV vaccine regardless of their agreeability with ZIKV information seeking behavior and psychosocial variables.

Conclusions

This study provides insight into ZIKV knowledge among ESPOL university students and reveals most respondents obtained ZIKV related information from television. The most common reason for not wanting to receive a hypothetical ZIKV vaccine was vaccine hesitancy. Likelihood of receiving a ZIKV vaccine was associated with several information seeking behavior and psychosocial variables. Public health campaigns should focus on comprehensive ZIKV education efforts in this population.

Knowledge of Emerging and Reemerging Infectious Diseases in the Public of Guangzhou, Southern China

Objective

The objective of this study is to get the overall picture about the knowledge of emerging and reemerging infectious diseases in public in Guangzhou and provide a scientific basis for developing health information strategies.

Methods

We used the structured questionnaire to interview 1,000 Guangzhou residents by health enquiry hotline. Descriptive analysis was presented to evaluate the knowledge of the participants. Multiple logistic regression model was performed to determine the influence factors for knowledge of emerging and reemerging infectious diseases

Results

A total of 801 individuals completed the survey. About one-third had heard of Middle East respiratory syndrome (MERS) and Zika, whereas Ebola and plague about 50%. A total of 32.08% participants had never heard of any of the four diseases. Only 2.08% knew the sexual transmission of Zika and 90.17% had no idea about the epidemic region of plague. No more than 15% knew they should check their health status after returning from the epidemic region. Education level and income were the key factors that influenced knowledge rate.

Conclusions

The low-level knowledge called for the improvement in health information to the public, especially those with low level of education and income. Effective and precise health information was urged to carry out to improve the prevention for the emerging and reemerging infectious diseases.

Taking the Bite out of Mosquito Bites: The Role of Perceived Risk

The present study examined how dimensions of perceived risk contributed to mosquito avoidance behaviors in a flood-prone area. Mosquito avoidance behaviors were classified into proactive (i.e. used repellant sources) and withdrawal/reactive (i.e. reduced outside activities) behaviors. After controlling for level of mosquito bites, increased scores for above normal perceived risk were associated with withdrawal/reactive avoidance behaviors; whereas, increased scores for normal perceived risk were associated with proactive avoidance behaviors. Efforts to improve mosquito avoidance behaviors should distinguish the type of perceived risk and the type of avoidance behavior. Greater congruence between perceived risk (i.e. normal risk of mosquito-borne illnesses) and avoidance behaviors (i.e. planning avoidance behaviors) will increase the effectiveness of education programs for disease prevention.

The Association Between Active Transportation and Serum Total 25-Hydroxyvitamin D Levels Among US Childbearing-Aged Women

BACKGROUND

Serum total 25-hydroxyvitamin D (25[OH]D) and physical activity (PA) both play important roles in maternal-fetal health. However, a high prevalence of vitamin D and PA insufficiency has been observed in women of childbearing age. Active transportation may increase overall PA levels and potentially boost serum 25(OH)D levels.

METHODS

Data from the National Health and Nutrition Examination Survey between 2007 and 2014 were used. A total of 5601 women aged 18-49 years were included. Transportation PA (TPA) was quantified as metabolic equivalents of task and serum 25(OH)D levels was measured. Multivariable logistic regression models adjusted for potential confounders were conducted.

RESULTS

The corresponding adjusted odds ratios associated with vitamin D insufficiency (<50 nmol/L) were 1.09 (95% confidence interval, 0.87-1.37) for 1 to 499 MET minutes per week of TPA, 0.69 (0.52-0.91) for 500 to 1000 MET minutes per week of TPA, and 0.95 (0.72-1.26) for >1000 MET minutes per week of TPA, respectively, compared with no TPA. Using vitamin D deficiency (<30 nmol/L) as the outcome led to similar results. The association between TPA and serum 25(OH)D levels was more robust in high sedentary time.

CONCLUSIONS

A moderate level of TPA is related to lower odds of suboptimal vitamin D status among women of childbearing age.

Knowledge of Sexual Transmission of Zika Virus Among Women Who Are Pregnant or Intend to Become Pregnant, Arizona, 2017

OBJECTIVES

Levels of knowledge about the sexual transmission of Zika virus are consistently low in populations at risk of a mosquito-borne outbreak, including among women of childbearing age and women who are pregnant or intend to become pregnant. We investigated the effectiveness of sources of public health messaging about sexual transmission to women who are pregnant or intend to become pregnant in Arizona.

METHODS

In 2017, we conducted an Arizona-statewide survey 15 months after the initial release of US guidelines on sexual transmission of Zika virus. We used Poisson regression, adjusting for demographic factors, to estimate the likelihood among women who were pregnant or intended to become pregnant of knowing that Zika virus is sexually transmitted relative to other women of childbearing age. We used multinomial logistic regression models to explore associations with most used health information sources, either in person (eg, medical providers) or online (eg, Facebook), categorized by extent of dependability.

RESULTS

Women who were pregnant or intended to become pregnant had similarly poor knowledge of the sexual transmission of Zika virus as compared with other women of childbearing age (adjusted prevalence ratio = 1.14 [95% CI, 0.83-1.55]). Only about one-third of all respondents reported knowledge of sexual transmission. Reliance on high- vs low-dependability information sources, whether in person or online, did not predict the extent of Zika virus knowledge among women who were pregnant or intended to become pregnant.

CONCLUSION

As late as the second year of local Zika virus transmission in the United States, in 2017, women in Arizona were not receiving sufficient information about sexual transmission, even though it was available. To prepare for possible future outbreaks, research should explore which aspects of Zika information campaigns were ineffective or inefficient.

Assessment of knowledge, attitudes, and practices towards Zika virus among healthcare workers in St. Kitts

Background

Healthcare workers are usually the first responders during outbreaks and are instrumental in educating the populace about the prevention of different diseases and illnesses. The aim of this study was to assess the association between healthcare workers’ characteristics and knowledge, attitudes and practices toward Zika virus.

Methods

This was a cross-sectional study that collected data from healthcare workers at 3 medical facilities using a validated self-administered questionnaire between July 2017 – September 2017. Logistic regression models were used to examine the association between sociodemographic and knowledge, attitudes, and practices.

Results

A total of 190 healthcare workers were analyzed. Of these, 60, 72.6 and 64.7% had good knowledge, positive attitudes, and good practices toward Zika virus, respectively. Healthcare workers without a formal degree were less likely to have good knowledge of Zika virus (adjusted odds ratio (AOR) = 0:49; 95% confidence interval (CI) = 0.24–0.99) compared to those with a formal degree. Reduced odds for positive attitude towards Zika virus were observed in healthcare workers with low income as compared to those with high income (AOR = 0.31; 95% CI =0.13–0.75). Being younger than 40 years old was associated with poor Zika virus practices (AOR = 0:34; 95% CI = 0.15–0.79).

Conclusions

Significant association between healthcare workers’ sociodemographic characteristics and Zika virus knowledge, attitudes and practices were observed. Public health interventions that seek to increase Zika virus awareness should aim to train healthcare workers who are younger, without formal degree and those earning low income.

"Too Much to Ask, Too Much to Handle": Women's Coping in Times of Zika

Zika virus infection during pregnancy is a cause of congenital brain abnormalities. Its consequences for pregnancies have made governments and both national and international agencies issue advice and recommendations to women. This study was designed to understand the impacts of Zika on women who were less directly affected and less vulnerable to Zika. Women were recruited from various locations in Brazil, Puerto Rico, and the United States. Data were collected through semi-structured interviews and analyzed using thematic analysis. Women perceived that public health systems placed an unfair responsibility for preventing health complications from Zika onto women who had limited ability to do so. They also stated that the measures recommended to them were invasive, while creating the perception that women were the sole determinant of whether they contracted Zika. The results indicate that women with higher levels of education understood the limitations of the information, government actions, and medical care they received, which ended up producing higher levels of anguish and worry. Gender inequality and discrimination must be recognized and rendered visible in the public health emergency response. The social effects of the epidemic affected women more than had been thought before and at deeper emotional levels.

Knowledge of the Sexual Transmission of Zika Virus and Preventive Practices Against Zika Virus Among U.S. Travelers

Individuals are often at increased risk of acquiring infectious disease while traveling. We sought to understand knowledge, attitudes and practices (KAP) regarding Zika virus among travelers from the United States. A total of 1043 study participants were recruited from a probability-based internet panel. Participants self-reported their knowledge of Zika infection and modes of transmission, and identified actions they had taken to prevent Zika infection and transmission including actions to prevent unintentional pregnancy since becoming aware of the Zika virus. Logistic regression was used to model the odds of taking preventive actions against Zika infection with adjustment for potential confounding factors. Knowledge of the sexual transmissibility of Zika virus significantly increased the odds of taking a preventive action against Zika infection, especially condom use or sexual abstention. Participants reported preferences for receiving information about Zika from private doctors and from the Internet. Discrepancies between where travelers seek information about Zika and how they would like to receive information regarding Zika were also found. These findings suggest that improving targeted messaging through online media may increase awareness of the sexual transmissibility of Zika as well as improve health communications with U.S. travelers. Travelers who are unaware of potential disease risks are less likely to adopt personal protective measures to protect themselves and reduce disease spread. Thus, future work should focus on improving communication and providing education to adopt effective prevention strategies while traveling.

An investigation into the knowledge, perceptions and role of personal protective technologies in Zika prevention in Colombia

Background

Arboviruses transmitted by day-biting Aedes mosquitoes are a major public health concern. With the challenges inherent in arbovirus vaccine and therapeutics development, vector control and bite prevention strategies are among the limited options available for immediate intervention. Bite prevention through personal protective technologies (PPT), such as topical mosquito repellents or repellent-impregnated clothing, may help to decrease biting rates and, therefore, the risk of disease in groups most susceptible to adverse outcomes from Zika virus. However, achieving high uptake and compliance with PPT can be challenging.

Methodology/Principal findings

To gain an insight into the knowledge and concerns of pregnant women surrounding Zika and their opinions regarding PPT, particularly repellent clothing, a focus group study was carried out with pregnant women, women of reproductive age, and semi-structured interviews with their male partners in two cities in Colombia. The discussions revealed shortfalls in basic knowledge of Zika virus, with several pregnant participants reporting being unaware of the potential for Zika-related congenital malformations. Although participants generally considered Zika to be a significant personal threat, most rated it as less of a concern than dengue or diarrheal diseases. Overall, repellent clothing and other forms of PPT were viewed as effective, although some participants expressed concerns over the high costs of repellents, and safety fears of regular contact with repellent chemicals, which they perceived as potentially harmful. Plant-derived repellents were considered to be safer than synthetic chemical repellents. Discussions also highlighted that health centers were the preferred source of information on bite-reduction.

Conclusions/Significance

Achieving high uptake and compliance with PPT in populations most at risk of adverse outcomes from Zika infection requires engaging key users in open dialogue to identify and address any practical issues regarding PPT use, and concerns over safety. The findings presented here suggest that educational campaigns should strongly emphasize the risks associated with Zika during pregnancy, and discuss safety profiles of approved synthetic repellents and the availability of EPA-approved plant-based repellents. In addition, the economic and political context should be a major consideration when evaluating personal mosquito-repellent strategies.

Although mosquito personal protective technologies (PPT), such as topical DEET or permethrin impregnated clothing, show high efficacy in laboratory studies, they frequently achieve poor population uptake. This is likely due to numerous factors, including high costs, dislike of the feel or smell of the product, and safety fears over the repellent chemicals. The targeted use of PPT to those at elevated risk of severe disease, such as pregnant women in Zika endemic regions, may help mitigate adverse outcomes from Zika virus infection. To explore ways of increasing the appeal of PPT, a focus group study was performed with pregnant women and women of reproductive age in two cities in Colombia. Although almost all participants had heard of Zika, not all pregnant women were aware of the potential for Zika-related birth defects. PPT products were generally viewed as effective, although many expressed fears that repeated exposure to chemicals may affect fetal development. There was limited trust over repellent-manufacturer claims of safety, and women from low socioeconomic groups believed PPT products to be unaffordable. Participants identified health centers as trusted sources of bite-prevention education, suggesting health workers should emphasize safety and efficacy of approved repellents.

knowledge, perceptions and practices regarding zika virus of university students in northern Colombia (Santa Marta, 2016)

This study focuses on 171 university students’ level of knowledge, perceptions and practices regarding Zika virus and its vector in Santa Marta (Colombia) in 2016. A survey was conducted and answers about causative agent and mode of transmission were classified into three levels of knowledge. 32.1% of the students stated that they had suffered from Zika. A 60% stated that they knew what the disease was, however, only 29.2% knew what the causative agent was and 45.6% knew the mode of transmission. Regarding the level of knowledge, only 14.6% knew the causative agent and the mode of transmission (Level 2). In general, the students recognize Zika’s symptoms, and 53.8% consider Zika to be very serious and more than half consider that they, the community and the government are responsible for controlling the vector. Even though more than half the students know the most important strategies as regards on how to control the vector, they do not practice them; this may be explained by the characteristics of their daily live dynamics, the lack of community organization, deficiency in the system of public health and climate change. It is recommended to implement permanent vector control strategies that consider the sociocultural characteristics of at-risk populations.

Knowledge, attitudes, and practices of public secondary school teachers on Zika Virus Disease: A basis for the development of evidence-based Zika educational materials for schools in the Philippines

The Philippines is at risk in developing a Zika Virus (ZIKV) Disease Outbreak. One of the possible interventions is health education because students are potential health advocates and influencers to their communities through the knowledge transfers from their teachers. The competency of Filipino teachers on ZIKV Disease is yet to be described. This study aimed to assess the knowledge, attitudes, and practices of public secondary school teachers on ZIKV Disease. A modified version of the Knowledge, Attitudes, and Practices Survey Tool on Zika Virus Disease from the World Health Organization—Pan American Health Organization (WHO-PAHO) was used to assess the knowledge, attitudes, and practices of teachers of eight public secondary schools in five villages in Quezon City, Philippines. Out of the 609 respondents, 87.3% reported that their main source of information about ZIKV is tri-media, which includes television, print, and radio. Majority of the respondents mentioned that ZIKV is transmitted through a mosquito bite (80.3%). However, only half of the participants identified vector control as a preventive strategy. Moreover, only 54% admitted to have cleaned their water containers or water sources within the last week. Only a few identified mother-to-child (23%) and sexual intercourse (8%) as other means of transmission. Half (49.8%) of the respondents felt that it is possible to acquire ZIKV in their community, while 90% perceived that a private doctor (90%) or a public hospital (88%) can effectively treat the disease. Perceived stigma is high at 50%. This study showed there was good knowledge among teachers on vector transmission of ZIKV but poor knowledge on other aspects of the disease. Also, there was a low level of perceived susceptibility and severity of ZIKV which can be explained by the absence of a personal encounter with a Zika patient and the low number of cases in the Philippines. Half of the respondents said that they cleaned the possible mosquito breeding sites within the last week, followed by those who cleaned their water source more than a week ago (19%). None of the socio-demographic characteristics is significantly associated with respondents’ knowledge on Zika. Only income and location of residence were found to be significantly associated with attitudes towards Zika. These findings call for a comprehensive training program that includes development of teaching materials for public secondary school teachers on ZIKV Disease based from this study.

Knowledge, Attitude, and Practice Regarding Zika Among Travelers to Brazil: Qatar's Airport Study 2017

Background The Zika virus has become an international health issue and poses a systematic risk for a growing number of travelers. Qatar is no exception to this status, where its Hamad International Airport (HIA) has become an important hub for many travelers to and from affected countries. Thus, it is a national necessity to determine the knowledge, attitude, and practice of travelers' regarding this emerging disease in the State of Qatar. Methods This was a cross-sectional study that employed a self-administered questionnaire (n=100) and was conducted at Hamad International Airport. Descriptive and inferential statistical tests were applied to analyze the data using the Statistical Package for the Social Sciences (SPSS) (IBM SPSS Statistics 21, IBM Corporation, Armonk, NY, USA, 2014). Results The majority of travelers (75%) reported hearing about the Zika disease prior to their current flight, mainly from the media (73%) and the internet (46%). The majority of participants (69%) knew about the vector-borne transmission and symptomatology of a Zika infection while more than half (54%) correctly identified effective methods to prevent infection. Regarding their attitude, less than two-thirds (58%) of the participants agreed that pregnant women must postpone their travel to any Zika-affected area. Regarding their practice, only a quarter of the sampled travelers (24%) sought pre-travel medical advice before going to Brazil. Comparing the knowledge score among different education levels, we found that high-school students scored significantly better than those with diplomas and bachelors, p=0.042 and p=0.012, respectively. Conclusion The survey findings revealed that the knowledge of Zika infection is low among travelers to Brazil. Thus, stronger efforts to educate travelers about Zika are recommended. It is also vital that travelers be encouraged to seek proper medical advice prior to travel.