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Crosato V, Formenti B, Gulletta M, Odolini S, Compostella S, Tomasoni LR, Matteelli A, Castelli F. Perception and Awareness about Monkeypox and Vaccination Acceptance in an At-Risk Population in Brescia, Italy: An Investigative Survey. AIDS Behav 2024; 28:1594-1600. [PMID: 38240947 PMCID: PMC11069468 DOI: 10.1007/s10461-024-04271-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/07/2024] [Indexed: 05/05/2024]
Abstract
Before 2022, monkeypox virus (Mpox) infection in humans was seldom reported outside Africa. During the May 2022 outbreak, most cases were detected among men who have sex with men (MSM). Since Mpox is largely unknown to the general population, through a self-completion questionnaire, we investigated the behaviours and knowledge of our at-risk population belonging to the sexually transmitted infection (STI) outpatient clinic of the Infectious Diseases Unit of the ASST Spedali Civili of Brescia, Italy, between August and October 2022. Most patients that took part in the compilation are HIV positive MSM. The other participants were HIV-seronegative patients with other STIs. Overall, 144 questionnaires were compiled. Most of the participants were Italians (130;90%) and males (139;96.5%) between 30 and 60 years (118;82%). Almost all (136;94%) reported having heard about Mpox and more than half (80;56%) received information about the transmission. Twenty-four respondents (16%) received information from health professionals and 14 (10%) believed that the information received was complete. Although 41% of respondents thought they were at risk of getting the infection and 62% were afraid to get it, the majority (56%) did not increase the precautions taken. When asked if they would accept a vaccine to prevent the disease, more than a third (32%) of respondents expressed hesitation or complete refusal to be vaccinated. Based on our results, what emerges is that there is still a lack of knowledge and awareness about Mpox. To address this issue, targeted health promotion and education strategies that provide the necessary resources to reduce risk behaviours and enhance connections with healthcare professionals are needed.
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Affiliation(s)
- Verena Crosato
- Division of Infectious and Tropical Diseases, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.
| | - Beatrice Formenti
- Division of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili Hospital, Brescia, Italy
- UNESCO Chair in Training and empowering human resources for health development in resource-limited countries, University of Brescia, Brescia, Italy
| | - Maurizio Gulletta
- Division of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili Hospital, Brescia, Italy
| | - Silvia Odolini
- Division of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili Hospital, Brescia, Italy
| | - Silvia Compostella
- Division of Clinical Psicology, ASST Spedali Civili Hospital, Brescia, Italy
| | - Lina Rachele Tomasoni
- Division of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili Hospital, Brescia, Italy
| | - Alberto Matteelli
- Division of Infectious and Tropical Diseases, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Francesco Castelli
- Division of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili Hospital, Brescia, Italy
- UNESCO Chair in Training and empowering human resources for health development in resource-limited countries, University of Brescia, Brescia, Italy
- Division of Infectious and Tropical Diseases, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
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Aynalem ZB, Abate MD, Meseret F, Muhamed AN, Abebe GK, Adal AB, Wondmieneh A, Andualem A, Ademe S, Workye H, Bewket B, Beyene GA, Alene T, Tsega TD. Knowledge, Attitude and Associated Factors of Monkeypox Infection Among Healthcare Workers in Injibara General Hospital, Northwest Ethiopia. J Multidiscip Healthc 2024; 17:1159-1173. [PMID: 38505654 PMCID: PMC10950085 DOI: 10.2147/jmdh.s454828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 03/01/2024] [Indexed: 03/21/2024] Open
Abstract
Background Fighting health threats, especially the rise of new infectious diseases, is one of the main responsibilities of healthcare workers. However, their knowledge and attitudes toward monkeypox have not yet been assessed. Therefore, this study aimed to assess the knowledge, attitude, and factors associated with monkeypox infection among healthcare workers at Injibara General Hospital, Northwest Ethiopia. Methods Institution-based cross-sectional study was conducted from December 1-30, 2022. Data were collected using a structured self-administered questionnaire. A simple random sampling technique was used to select study participants. Descriptive statistics and multivariable logistic regression analyses were computed. The degree of association was interpreted using an odds ratio with a 95% confidence interval and a p-value < 0.05. Results Among the 200 healthcare workers who participated, 38.5% (95% CI: 32.5%-45%) and 62% (95% CI: 55-68.5%) had good knowledge and positive attitudes regarding monkeypox respectively. Having a master's degree or above (AOR = 11.25: 95% CI: 2.03-62.33), being vaccinated against COVID-19 (AOR = 2.60: 95% CI: 1.37-4.94), and having access to information about monkeypox (AOR = 3.37: 95% CI: 1.33-8.50) were the factors associated with good knowledge. Furthermore, a positive attitude was significantly associated with being 30 years of age or older (AOR = 2.95: 95% CI: 1.55-5.60) and having access to information about monkeypox (AOR = 4.14: 95% CI: 2.06, 8.30). Conclusion Both good knowledge and positive attitudes were relatively low among healthcare workers. Factors such as age, education level, COVID-19 vaccination status, and access to information about monkeypox were significantly associated with the knowledge and attitude of healthcare workers. To enhance the knowledge and attitude of healthcare workers, hospitals should consider offering educational upgrades, hosting educational events like seminars, conferences, webinars, and campaigns, and ensuring comprehensive coverage of the topic in medical curricula.
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Affiliation(s)
- Zewdu Bishaw Aynalem
- Department of Nursing, College of Medicine and Health Sciences, Injibara University, Injibara, Ethiopia
| | - Melsew Dagne Abate
- Department of Nursing, College of Medicine and Health Sciences, Injibara University, Injibara, Ethiopia
| | - Fentahun Meseret
- Department of Pediatrics and Child Health Nursing, School of Nursing and Midwifery, College of Health and Medical Science, Haramaya University, Harar, Ethiopia
| | - Ahmed Nuru Muhamed
- Department of Nursing, College of Medicine and Health Science, Wolkite University, Wolkite, Ethiopia
| | - Gebremeskel Kibret Abebe
- Department of Emergency and Critical Care Nursing, School of Nursing, College of Health Sciences, Woldia University, Woldia, Ethiopia
| | - Abebaw Bires Adal
- Department of Nursing, College of Medicine and Health Sciences, Injibara University, Injibara, Ethiopia
| | - Adam Wondmieneh
- Department of Nursing, College of Medicine and Health Sciences, Injibara University, Injibara, Ethiopia
| | - Atsedemariam Andualem
- Department of Nursing, College of Medicine and Health Sciences, Injibara University, Injibara, Ethiopia
| | - Sewunet Ademe
- Department of Nursing, College of Medicine and Health Sciences, Injibara University, Injibara, Ethiopia
| | - Haile Workye
- Department of Nursing, College of Medicine and Health Sciences, Injibara University, Injibara, Ethiopia
| | - Bekalu Bewket
- Department of Nursing, College of Medicine and Health Sciences, Injibara University, Injibara, Ethiopia
| | - Getachew Amare Beyene
- Department of Midwifery, College of Medicine and Health Sciences, Injibara University, Injibara, Ethiopia
| | - Tamiru Alene
- Department of Pediatrics and Child Health Nursing, College of Medicine and Health Sciences, Injibara University, Injibara, Ethiopia
| | - Tilahun Degu Tsega
- Department of Public Health, College of Medicine and Health Sciences, Injibara University, Injibara, Ethiopia
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Nka AD, Bouba Y, Fokam J, Ka'e AC, Gabisa JE, Mandeng N, Mfonkou DJT, Ambe CC, Mballa Mpouel ML, Djikeussi T, Tchounga BK, Ayuk Ngwese DT, Njume D, Mbala Nomo SE, Ngoufack Jagni Semengue E, Tiotsia Tsapi A, Fokou BB, Simo Kamdem IK, Tommo Tchouaket MC, Takou D, Pabo W, Sosso SM, Tandi E, Esso L, Etoundi Mballa GA, Zoung-Kanyi Bissek AC, Gregory Edie HE, Ndembi N, Colizzi V, Perno CF, Ndjolo A. Current knowledge of human Mpox viral infection among healthcare workers in Cameroon calls for capacity-strengthening for pandemic preparedness. Front Public Health 2024; 12:1288139. [PMID: 38532968 PMCID: PMC10963399 DOI: 10.3389/fpubh.2024.1288139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Accepted: 02/16/2024] [Indexed: 03/28/2024] Open
Abstract
Introduction An increased incidence of human Monkeypox (Mpox) cases was recently observed worldwide, including in Cameroon. To ensure efficient preparedness and interventions in the health system, we sought to assess the knowledge of Mpox's transmission, prevention, and response among healthcare workers (HCWs) in Cameroon. Methods A cross-sectional online survey was conducted among HCWs in Cameroon using 21-item questions adapted from the United States Centers for Disease Control and Prevention (US-CDC) standard questionnaire on Mpox. The overall knowledge of Mpox was assessed by cumulative score and categorized as excellent (≥80%, 17/21) or good (≥70%, ≥15/21) knowledge. The regression analysis was used to identify the predictors of Mpox knowledge. Results The survey enrolled 377 participants, but only responses from 342 participants were analyzed. Overall, 50.6% were female participants, and 59.6% aged 30 years or younger. The majority of the participants were medical doctors (50.3%); most worked in central-level hospitals (25.1%) and had 1-5 years of experience (70.7%). A total of up to 92.7% were aware of Mpox, with social media (58.7%) and radio/television (49.2%) as the main sources. The mean knowledge score was 14.0 ± 3.0 (4 to 20), with only 12.9% having excellent knowledge (≥80%) and 42.1% having good knowledge of Mpox. Younger age (26-30 years old) was associated with good knowledge, while workplace type was associated with excellent knowledge of Mpox (aOR [95% CI]: 4.01 [1.43-11.24]). Knowledge of treatment/management of Mpox was generally poor across the different professional categories. Conclusion Knowledge of Mpox among HCWs is substandard across different professionals. Thus, for optimal preparedness and immediate interventions for Mpox and similar emerging pathogens, capacity-strengthening programs should be organized for HCWs while encouraging scientific literature and organizational social media websites.
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Affiliation(s)
- Alex Durand Nka
- Chantal BIYA International Reference Centre for Research on HIV/AIDS Prevention and Management (CIRCB) Yaoundé, Cameroon
- Faculty of Medicine and Surgery, University of Rome “Tor Vergata”, Rome, Italy
- Faculty of Sciences and Technologies, Evangelical University of Cameroon, Bandjoun, Cameroon
| | - Yagai Bouba
- Chantal BIYA International Reference Centre for Research on HIV/AIDS Prevention and Management (CIRCB) Yaoundé, Cameroon
- Faculty of Medicine, UniCamillus - Saint Camillus International University of Health Sciences, Rome, Italy
- National AIDS Control Committee, Central Technical Group, Ministry of Public Health, Yaoundé, Cameroon
| | - Joseph Fokam
- Chantal BIYA International Reference Centre for Research on HIV/AIDS Prevention and Management (CIRCB) Yaoundé, Cameroon
- Faculty of Health Sciences, University of Buea, Buea, Cameroon
- National Public Health Emergency Operations Coordination Centre, Ministry of Public Health, Yaoundé, Cameroon
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | - Aude Christelle Ka'e
- Chantal BIYA International Reference Centre for Research on HIV/AIDS Prevention and Management (CIRCB) Yaoundé, Cameroon
- Faculty of Medicine and Surgery, University of Rome “Tor Vergata”, Rome, Italy
| | - Jeremiah Efakika Gabisa
- Chantal BIYA International Reference Centre for Research on HIV/AIDS Prevention and Management (CIRCB) Yaoundé, Cameroon
- Department of Health Biotechnology, Fobang Institutes for Innovations in Science and Technology, Yaoundé, Cameroon
| | - Nadia Mandeng
- National Public Health Emergency Operations Coordination Centre, Ministry of Public Health, Yaoundé, Cameroon
- Faculty of Health Sciences, University of Bamenda, Bamenda, Cameroon
| | | | - Chenwi Collins Ambe
- Chantal BIYA International Reference Centre for Research on HIV/AIDS Prevention and Management (CIRCB) Yaoundé, Cameroon
- Faculty of Medicine and Surgery, University of Rome “Tor Vergata”, Rome, Italy
| | - Marie-Laure Mballa Mpouel
- Chantal BIYA International Reference Centre for Research on HIV/AIDS Prevention and Management (CIRCB) Yaoundé, Cameroon
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | - Tatiana Djikeussi
- Elisabeth Glaser Peadiatric AIDS Foundation (EGPAF), Douala, Cameroon
| | | | - Derrick Tambe Ayuk Ngwese
- Chantal BIYA International Reference Centre for Research on HIV/AIDS Prevention and Management (CIRCB) Yaoundé, Cameroon
- Department of Health Biotechnology, Fobang Institutes for Innovations in Science and Technology, Yaoundé, Cameroon
| | - Debimeh Njume
- Chantal BIYA International Reference Centre for Research on HIV/AIDS Prevention and Management (CIRCB) Yaoundé, Cameroon
| | | | - Ezechiel Ngoufack Jagni Semengue
- Chantal BIYA International Reference Centre for Research on HIV/AIDS Prevention and Management (CIRCB) Yaoundé, Cameroon
- Faculty of Medicine and Surgery, University of Rome “Tor Vergata”, Rome, Italy
- Faculty of Sciences and Technologies, Evangelical University of Cameroon, Bandjoun, Cameroon
| | - Armand Tiotsia Tsapi
- Faculty of Sciences and Technologies, Evangelical University of Cameroon, Bandjoun, Cameroon
| | | | | | - Michel Carlos Tommo Tchouaket
- Chantal BIYA International Reference Centre for Research on HIV/AIDS Prevention and Management (CIRCB) Yaoundé, Cameroon
- School of Health Sciences, Catholic University of Central Africa, Yaoundé, Cameroon
| | - Désiré Takou
- Chantal BIYA International Reference Centre for Research on HIV/AIDS Prevention and Management (CIRCB) Yaoundé, Cameroon
| | - Willy Pabo
- Chantal BIYA International Reference Centre for Research on HIV/AIDS Prevention and Management (CIRCB) Yaoundé, Cameroon
- Faculty of Sciences, University of Buea, Buea, Cameroon
- Faculty of Medicine, University of Antwerp, Antwerp, Belgium
| | - Samuel Martin Sosso
- Chantal BIYA International Reference Centre for Research on HIV/AIDS Prevention and Management (CIRCB) Yaoundé, Cameroon
| | - Erick Tandi
- National Public Health Emergency Operations Coordination Centre, Ministry of Public Health, Yaoundé, Cameroon
- Department of Disease, Epidemics, and Pandemics Control, Ministry of Public Health, Yaoundé, Cameroon
| | - Linda Esso
- National Public Health Emergency Operations Coordination Centre, Ministry of Public Health, Yaoundé, Cameroon
- Department of Disease, Epidemics, and Pandemics Control, Ministry of Public Health, Yaoundé, Cameroon
| | - Georges Alain Etoundi Mballa
- National Public Health Emergency Operations Coordination Centre, Ministry of Public Health, Yaoundé, Cameroon
- Department of Disease, Epidemics, and Pandemics Control, Ministry of Public Health, Yaoundé, Cameroon
| | | | | | - Nicaise Ndembi
- Africa Centres for Disease Control and Prevention, Addis Ababa, Ethiopia
| | - Vittorio Colizzi
- Chantal BIYA International Reference Centre for Research on HIV/AIDS Prevention and Management (CIRCB) Yaoundé, Cameroon
- Faculty of Medicine and Surgery, University of Rome “Tor Vergata”, Rome, Italy
- Faculty of Sciences and Technologies, Evangelical University of Cameroon, Bandjoun, Cameroon
| | - Carlo-Federico Perno
- Chantal BIYA International Reference Centre for Research on HIV/AIDS Prevention and Management (CIRCB) Yaoundé, Cameroon
- Microbiology, IRCSS Bambino Gesu' Pediatric Hospital, Rome, Italy
| | - Alexis Ndjolo
- Chantal BIYA International Reference Centre for Research on HIV/AIDS Prevention and Management (CIRCB) Yaoundé, Cameroon
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
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Yang Y, Zhang W, Han B, Meng H, Wang J, Wu K, Fu L, Wang B, Jiang X, Li Q, Xu Z, Zhang Y, Qi X, Zou H. Mpox knowledge and vaccination hesitancy among healthcare workers in Beijing, China: A cross-sectional survey. Vaccine X 2024; 16:100434. [PMID: 38304877 PMCID: PMC10831242 DOI: 10.1016/j.jvacx.2024.100434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 01/03/2024] [Accepted: 01/08/2024] [Indexed: 02/03/2024] Open
Abstract
Background Mpox, one of the most serious threats to global health, is now being seen in small but rising numbers in Beijing, China. Our study aimed to investigate healthcare workers' (HCWs) knowledge of Mpox and to explore reasons associated with their hesitancy to vaccinate against Mpox in Beijing, China. Methods A cross-sectional study was conducted among HCWs in Beijing from July 24 to August 2, 2023, through an online questionnaire. Participants answered questions about sociodemographic characteristics, Mpox information sources, Mpox knowledge, perception of vaccines, and attitudes toward Mpox vaccination. We used Chi-squared test to compare difference in Mpox vaccination hesitancy between different groups. Multivariable logistic regression models were applied to analyze correlates of vaccination hesitancy among HCWs. Results A total of 2331 HCWs completed the questionnaire, with an effective response rate of 92.45 % (2155/2331). Most of the HCWs in this study worked at tertiary hospitals (89.65 %), with a mean age of 36.69 ± 9.08 years. Among the 2155 participants, 52.99 % had over ten years of working experience, and 16.66 % were from high-risk departments relevant to Mpox treatment. Approximately 84.41 % knew about Mpox before this study, 80.79 % exhibited a high level of knowledge about Mpox, whereas 42.37 % were hesitant to be vaccinated against Mpox. Moreover, the hesitancy rate of HCWs in high-risk departments (47.91 %) was higher than in lower-risk departments (41.26 %). Higher educational level (aOR = 1.75, 95 %CI: 1.17-2.62), longer working years (1.71, 1.32-2.22), working at high-risk departments (1.34, 1.05-1.71), and lower level of knowledge about Mpox (1.78, 1.13-2.85) appeared as the most significant determinants of Mpox vaccination hesitancy among HCWs who knew about Mpox. For the HCWs who did not know about Mpox, longer working years (1.96, 1.02-3.78) were significant factors associated with their hesitancy. The predominant reason for hesitancy toward Mpox vaccination among HCWs encompassed apprehensions about vaccine side effects. Conclusion HCWs had good knowledge of Mpox, whereas their Mpox vaccination hesitancy was also relatively high in Beijing, China. Increasing HCWs' vaccination confidence and knowledge level about Mpox, especially for those working in high-risk departments, may be an essential way of reducing their hesitancy.
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Affiliation(s)
- Yuan Yang
- Beijing Chaoyang District Center for Disease Prevention and Control, Beiijng, China
| | - Weijie Zhang
- School of Public Health (Shenzhen), Sun Yat‐sen University, Shenzhen, China
| | - Baihui Han
- Beijing Chaoyang District Center for Disease Prevention and Control, Beiijng, China
| | - Han Meng
- Beijing Chaoyang District Center for Disease Prevention and Control, Beiijng, China
| | - Jiaqi Wang
- Beijing Chaoyang District Center for Disease Prevention and Control, Beiijng, China
| | - Ke Wu
- Beijing Chaoyang District Center for Disease Prevention and Control, Beiijng, China
| | - Leiwen Fu
- School of Public Health (Shenzhen), Sun Yat‐sen University, Shenzhen, China
| | - Bingyi Wang
- School of Public Health (Shenzhen), Sun Yat‐sen University, Shenzhen, China
| | - Xiaohong Jiang
- Beijing Chaoyang District Center for Disease Prevention and Control, Beiijng, China
| | - Qian Li
- Beijing Chaoyang District Center for Disease Prevention and Control, Beiijng, China
| | - Zhiyuan Xu
- Beijing Chaoyang District Center for Disease Prevention and Control, Beiijng, China
| | - Ye Zhang
- Beijing Chaoyang District Center for Disease Prevention and Control, Beiijng, China
| | - Xiao Qi
- Beijing Chaoyang District Center for Disease Prevention and Control, Beiijng, China
- Department of Global Health, School of Public Health, Peking University, Beiijng, China
| | - Huachun Zou
- School of Public Health, Fudan University, Shanghai, China
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Scarinci S, Padovan M, Cosci B, Petillo A, Gattini V, Cosentino F, Mignani A, Foddis R, Guglielmi G. Evaluation of Smallpox Vaccination Coverage and Attitude towards Monkeypox Vaccination among Healthcare Workers in an Italian University Hospital. Vaccines (Basel) 2023; 11:1741. [PMID: 38140146 PMCID: PMC10747083 DOI: 10.3390/vaccines11121741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 09/28/2023] [Accepted: 10/09/2023] [Indexed: 12/24/2023] Open
Abstract
(1) Background: In 2022, monkeypox (Mpox) was declared a public health emergency. The European Medicines Agency has authorized the use of Imvanex/Jynneos, a smallpox vaccine, for coverage against pox. Healthcare workers (HCWs) are all considered by the European Centre for Disease Prevention and Control to be at risk, but in Italy, vaccination was offered only to laboratory personnel. The present study aims to investigate smallpox vaccination coverage (VC) that provides protection against Mpox among HCWs in an Italian university hospital and to assess HCWs' attitudes towards the possibility of getting vaccinated against Mpox. (2) Methods: We conducted a cross-sectional survey. 336 HCWs from selected wards were asked to fill out a self-declaration to collect their sex, profession, ward, vaccination status, and attitude toward Mpox vaccination. (3) Results: 60.71% of HCWs involved provided the requested data; 38.7% of them were previously vaccinated against smallpox, which corresponds to 23.5% of the total HCWs in the wards considered. Considering those born before 1979 as vaccinated, VC increases from 23.5% to 41.7%; the percentage of HCWs who adhered to vaccination is 23%; laboratory technicians showed a lower willingness to be vaccinated. The ward with the highest willingness to vaccinate is proctological surgery. (4) Conclusions: Based on our experience, a variability in smallpox VC and in willingness to vaccination has emerged both among different job titles and age categories and across the wards analyzed. Additionally, our survey reveals that vaccination attitudes are higher among HCWs from wards that currently do not have free access to such vaccinations.
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Affiliation(s)
- Sergio Scarinci
- Occupational Preventive Medicine Ward, Azienda Ospedaliero-Universitaria Pisana, 56124 Pisa, Italy; (S.S.); (M.P.); (B.C.); (A.P.); (V.G.); (F.C.); (A.M.)
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy;
| | - Martina Padovan
- Occupational Preventive Medicine Ward, Azienda Ospedaliero-Universitaria Pisana, 56124 Pisa, Italy; (S.S.); (M.P.); (B.C.); (A.P.); (V.G.); (F.C.); (A.M.)
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy;
| | - Bianca Cosci
- Occupational Preventive Medicine Ward, Azienda Ospedaliero-Universitaria Pisana, 56124 Pisa, Italy; (S.S.); (M.P.); (B.C.); (A.P.); (V.G.); (F.C.); (A.M.)
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy;
| | - Armando Petillo
- Occupational Preventive Medicine Ward, Azienda Ospedaliero-Universitaria Pisana, 56124 Pisa, Italy; (S.S.); (M.P.); (B.C.); (A.P.); (V.G.); (F.C.); (A.M.)
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy;
| | - Vittorio Gattini
- Occupational Preventive Medicine Ward, Azienda Ospedaliero-Universitaria Pisana, 56124 Pisa, Italy; (S.S.); (M.P.); (B.C.); (A.P.); (V.G.); (F.C.); (A.M.)
| | - Francesca Cosentino
- Occupational Preventive Medicine Ward, Azienda Ospedaliero-Universitaria Pisana, 56124 Pisa, Italy; (S.S.); (M.P.); (B.C.); (A.P.); (V.G.); (F.C.); (A.M.)
| | - Aldo Mignani
- Occupational Preventive Medicine Ward, Azienda Ospedaliero-Universitaria Pisana, 56124 Pisa, Italy; (S.S.); (M.P.); (B.C.); (A.P.); (V.G.); (F.C.); (A.M.)
| | - Rudy Foddis
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy;
| | - Giovanni Guglielmi
- Occupational Preventive Medicine Ward, Azienda Ospedaliero-Universitaria Pisana, 56124 Pisa, Italy; (S.S.); (M.P.); (B.C.); (A.P.); (V.G.); (F.C.); (A.M.)
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Ahmed SK, Abdulqadir SO, Omar RM, Hussein S, Qurbani K, Mohamed MG, Abubaker Blbas HT, Fahrni ML, Lazzarino AI. Knowledge, Attitudes, and Willingness of Healthcare Workers in Iraq's Kurdistan Region to Vaccinate against Human Monkeypox: A Nationwide Cross-Sectional Study. Vaccines (Basel) 2023; 11:1734. [PMID: 38140139 PMCID: PMC10747727 DOI: 10.3390/vaccines11121734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 11/15/2023] [Accepted: 11/16/2023] [Indexed: 12/24/2023] Open
Abstract
Although human monkeypox infections had not been recorded in the Kurdistan region of Iraq as of August 2023, the rapid growth of cases worldwide and the detection of monkeypox in neighboring Middle Eastern nations call for careful planning and timely response measures. Educating and empowering frontline healthcare workers (HCWs) so that they can act to curb the spread of monkeypox infections are core elements of primary prevention and protecting public health. Therefore, this study aimed to assess HCWs' knowledge and attitudes about monkeypox and their willingness to vaccinate against monkeypox. By employing a convenience sampling method, an online survey was disseminated via Google Forms between 1 November 2022 and 15 January 2023. The researchers utilized regression analyses to ascertain the factors associated with the three parameters: knowledge, attitude, and the willingness to vaccinate. A total of 637 HCWs were included in the analysis (ages ranged between 21 and 51 years). The mean overall scores were 8.18 of a max score of 16 (SD 3.37), 3.4 of 5 (SD 1.37), and 2.41 of 5 (SD 1.25) for knowledge, attitude, and willingness to vaccinate, respectively. A multivariate logistic regression analysis demonstrated that HCWs who had heard about monkeypox before 2022 rather than later had a higher level of knowledge (AOR: 4.85; 95% CI: 2.81-8.36; p < 0.001). In addition, those who had newly joined the workforce or had less than 1 year experience in practice had more positive attitudes about curbing monkeypox (AOR: 0.35; 95% CI: 0.20-0.59; p < 0.01) than those who practiced for longer. No significant predictors of willingness to vaccinate against monkeypox were identified. The research revealed that HCWs exhibited a relatively low level of monkeypox knowledge. They also had poor attitudes towards monkeypox vaccination and were therefore reluctant to receive the vaccines. Imparting knowledge about the infectious disease can cultivate better awareness and attitudes among HCWs as to their roles in mitigating the spread of an epidemic in the foreseeable future.
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Affiliation(s)
- Sirwan Khalid Ahmed
- Department of Adult Nursing, College of Nursing, University of Raparin, Rania, Sulaymaniyah 46012, Iraq;
- Ministry of Health, General Directorate of Health-Raparin, Rania, Sulaymaniyah 46012, Iraq
| | - Salar Omer Abdulqadir
- Department of Psychiatric and Mental Health Nursing, College of Nursing, University of Raparin, Rania, Sulaymaniyah 46012, Iraq
| | - Rukhsar Muhammad Omar
- Department of Kindergarten, College of Basic Education, University of Raparin, Rania, Sulaymaniyah 46012, Iraq
| | - Safin Hussein
- Department of Biology, College of Science, University of Raparin, Rania, Sulaymaniyah 46012, Iraq
| | - Karzan Qurbani
- Department of Biology, College of Science, University of Raparin, Rania, Sulaymaniyah 46012, Iraq
| | - Mona Gamal Mohamed
- Department of Adult Nursing, RAK College of Nursing, RAK Medical and Health Sciences University, Ras Al Khaimah 72603, United Arab Emirates
| | | | - Mathumalar Loganathan Fahrni
- Faculty of Pharmacy, Universiti Teknologi MARA (UiTM), Puncak Alam Campus, Selangor Branch, Puncak Alam 42300, Malaysia
| | - Antonio Ivan Lazzarino
- Department of Epidemiology and Biostatistics, Imperial College London, Norfolk Place, London W2 1PG, UK
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7
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Jahromi AS, Jokar M, Sharifi N, Kashkooli S, Rahmanian K, Rahmanian V. Global knowledge and attitudes towards mpox (monkeypox) among healthcare workers: a systematic review and meta-analysis. Int Health 2023:ihad094. [PMID: 37861417 DOI: 10.1093/inthealth/ihad094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 09/04/2023] [Accepted: 10/18/2023] [Indexed: 10/21/2023] Open
Abstract
BACKGROUND The recent increase in human mpox (monkeypox) cases emphasizes the importance of early detection, prompt response and preventive management to control the spread of the disease. Healthcare workers (HCWs) play a crucial role in this process. This study aimed to determine the global knowledge and attitudes towards mpox among HCWs. METHODS This study searched multiple databases, including Google Scholar, Scopus, PubMed/MEDLINE, Science Direct, Web of Science, Embase, Springer and ProQuest, to locate various publications. The search was limited to English-language articles published between May 2022 (when the increase in mpox incidence was reported) and August 2023. The Joanna Briggs Institute (JBI) quality checklist was utilized to evaluate the quality of the included studies. Data were obtained using a Microsoft Excel spreadsheet and subsequently scrutinized through STATA software, version 14. The heterogeneity of the studies was assessed using the inverse variance and Cochran Q statistics based on the I2 test statistics. The Dersimonian and Liard random effects models were used where heterogeneity existed. Subgroup analysis and univariate and multivariable metaregression techniques were used to examine the causes of heterogeneity. RESULTS A total of 22 studies, including 22 studies for knowledge (27 731 HCWs) and 6 studies for attitudes (14 388 HCWs), were included in the meta-analysis. The pooled estimates for good knowledge and positive attitudes among HCWs were 26.0% (95% confidence interval [CI] 17.8 to 34.2) and 34.6% (95% CI 19.0 to 50.2), respectively. Moreover, the knowledge was 34.8% (95% CI 24.1 to 45.6) among HCWs with <5 y of work experience and 41.6% (95% CI 33.1 to 50) among individuals possessing >5 y of professional background. CONCLUSIONS Good knowledge of HCWs is at a low level. It is suggested that training sessions should be tailored towards younger HCWs with less healthcare experience. Additionally, it is essential to identify strategies on how to improve the knowledge and attitudes for better practice about the disease in HCWs worldwide.
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Affiliation(s)
| | - Mohammad Jokar
- Faculty of Veterinary Medicine, Karaj Branch, Islamic Azad University, Karaj, Iran
| | - Nader Sharifi
- Department of Public Health, Khomein University of Medical Sciences, Khomein, Iran
| | - Sirus Kashkooli
- Research Center for Social Determinants of Health, Jahrom University of Medical Sciences, Jahrom, Iran
| | - Karamatollah Rahmanian
- Research Center for Social Determinants of Health, Jahrom University of Medical Sciences, Jahrom, Iran
| | - Vahid Rahmanian
- Department of Public Health, Torbat Jam Faculty of Medical Sciences, Torbat Jam, Iran
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Masood S, Alkubaisi NA, Aslam M, Salman M, Baraka MA, Mustafa ZU, Mallhi TH, Khan YH, Meyer JC, Godman B. Knowledge of Human Monkeypox Infection among Final Year Medical, Pharmacy, and Nursing Students: A Multicenter, Cross-Sectional Analysis from Pakistan. Healthcare (Basel) 2023; 11:2777. [PMID: 37893851 PMCID: PMC10606159 DOI: 10.3390/healthcare11202777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 09/22/2023] [Accepted: 09/26/2023] [Indexed: 10/29/2023] Open
Abstract
The World Health Organization (WHO) declared the monkeypox outbreak a public health emergency in June 2022. In Pakistan, positive cases of monkeypox were reported in April 2023. Healthcare workers (HCWs) are considered as a front-line force to combat such outbreaks. A questionnaire-based cross-sectional study was conducted among 11 public sector educational institutions in Punjab, Pakistan, during May and June 2023 among final year medical, pharmacy, and nursing students concerning their knowledge of monkeypox. This included the signs/symptoms of monkeypox. Healthcare students were chosen as they are the HCWs of tomorrow. A total of 389 healthcare students participated in the study, with a mean age of 23.17 ± 1.72 years, and the majority were female. The mean knowledge score was 17.69 ± 4.55 (95% CI 17.24-18.14) out of a maximum total knowledge score of 26 (each correct answer was given a score of 1). The proportion of students with good, moderate, and poor knowledge was 21.6%, 43.2%, and 35.2%, respectively. Age (p = 0.017), gender (p < 0.001), and education (p < 0.001) had a significant impact on the knowledge score. In the multivariate linear regression model, education was the only significant factor linked to knowledge scores. Overall, the majority of future HCWs had moderate knowledge of monkeypox. Consequently, educational activities are needed to improve monkeypox-related knowledge among future HCWs. Furthermore, emerging infectious diseases should be routinely incorporated into HCW curricula.
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Affiliation(s)
- Sahabia Masood
- Department of Medicine, University Medical and Dental College Faisalabad, Faisalabad 38000, Pakistan
| | - Noorah A Alkubaisi
- Department of Botany and Microbiology, College of Science, King Saud University, Riyadh 11451, Saudi Arabia
| | - Maryam Aslam
- Basic Health Unit (BHU), 554GB, Tehsil Tandlianwala, Faisalabad 38000, Pakistan
| | - Muhammad Salman
- Institute of Pharmacy, Faculty of Pharmaceutical and Allied Health Sciences, Lahore College for Women University, Lahore 54000, Pakistan
| | - Mohamed A Baraka
- Department of Pharmacy, Fatima College of Health Sciences, Abu Dhabi P.O. Box 3798, United Arab Emirates
- Clinical Pharmacy Department, Faculty of Pharmacy, Al-Azhar University, Cairo 11651, Egypt
| | - Zia Ul Mustafa
- Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Gelugor 11800, Penang, Malaysia
- Department of Pharmacy Services, District Headquarter (DHQ) Hospital, Pakpattan 57400, Pakistan
| | - Tauqeer Hussain Mallhi
- Department of Clinical Pharmacy, College of Pharmacy, Jouf University, Sakaka 72388, Saudi Arabia
| | - Yusra Habib Khan
- Department of Clinical Pharmacy, College of Pharmacy, Jouf University, Sakaka 72388, Saudi Arabia
| | - Johanna C Meyer
- Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria 0208, South Africa
| | - Brian Godman
- Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria 0208, South Africa
- Strathclyde Institute of Pharmacy and Biomedical Science (SIPBS), University of Strathclyde, Glasgow G4 0RE, UK
- Centre of Medical and Bio-Allied Health Sciences Research, Ajman University, Ajman P.O. Box 346, United Arab Emirates
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Das SK, Bhattarai A, KC S, Shah S, Paudel K, Timsina S, Tharu S, Rawal L, Leon-Figueroa DA, Rodriguez-Morales AJ, Barboza JJ, Sah R. Socio-demographic determinants of the knowledge and attitude of Nepalese healthcare workers toward human monkeypox: a cross-sectional study. Front Public Health 2023; 11:1161234. [PMID: 37293610 PMCID: PMC10244767 DOI: 10.3389/fpubh.2023.1161234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 05/08/2023] [Indexed: 06/10/2023] Open
Abstract
Human monkeypox is an infectious zoonotic disease and since May 2022, there has been a spike in cases worldwide. In this regard, a global health emergency has been declared by the World Health Organization (WHO) on July 23rd, 2022. Although there have been no confirmed human monkeypox cases in Nepal yet, the nation is undeniably at risk of an outbreak. Despite all preventive efforts and preparedness for monkeypox, there still remain several challenges including the literacy and knowledge of our healthcare workers regarding monkeypox. The aim of this study was to assess the level of knowledge and attitude of Nepalese healthcare workers regarding monkeypox. A cross-sectional study was performed on different healthcare workers at Tribhuvan University Teaching Hospital on the month of October 2022 using a set of validated questionnaires used previously in a Saudi Arabian study. An in-person survey was conducted where a total of 220 questionnaires were distributed. The response rate was 93%. Knowledge was categorized into high or low based on the mean knowledge score. The attitude was assessed using a 3-point Likert scale. The association of the knowledge and attitude of the respondents in accordance with their socio-demographics was statistically evaluated using Pearson's Chi-square test. The mean knowledge score was 13. A larger proportion of the respondents (60.4%) demonstrated a high knowledge and 51.1% demonstrated a positive attitude. Studying monkeypox during medical education possessed a significant difference in the attitude (p = 0.025). Knowledge did not vary based on socio-demographic characteristics. Despite almost half a year into the monkeypox outbreak, Nepalese healthcare workers still have an unsatisfying degree of knowledge and a negative attitude regarding its control which shows the need for education and awareness.
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Affiliation(s)
- Santa Kumar Das
- Tribhuvan University Teaching Hospital, Institute of Medicine, Tribhuvan University, Tribhuvan, Nepal
| | - Abhinav Bhattarai
- Tribhuvan University Teaching Hospital, Institute of Medicine, Tribhuvan University, Tribhuvan, Nepal
| | - Simran KC
- Central Department of Public Health, Institute of Medicine, Tribhuvan University, Tribhuvan, Nepal
| | - Sangam Shah
- Tribhuvan University Teaching Hospital, Institute of Medicine, Tribhuvan University, Tribhuvan, Nepal
| | - Kiran Paudel
- Tribhuvan University Teaching Hospital, Institute of Medicine, Tribhuvan University, Tribhuvan, Nepal
- Grupo de Investigación Biomedicina, Faculty of Medicine, Fundación Universitaria Autónoma de las Américas - Institución Universitaria Visión de las Américas, Pereira, Risaralda, Colombia
| | - Sakchhyam Timsina
- Tribhuvan University Teaching Hospital, Institute of Medicine, Tribhuvan University, Tribhuvan, Nepal
| | - Sunraj Tharu
- Tribhuvan University Teaching Hospital, Institute of Medicine, Tribhuvan University, Tribhuvan, Nepal
| | - Laba Rawal
- Tribhuvan University Teaching Hospital, Institute of Medicine, Tribhuvan University, Tribhuvan, Nepal
| | | | - Alfonso J. Rodriguez-Morales
- Facultad de Medicina Humana, Universidad San Martín de Porres, Chiclayo, Peru
- Grupo de Investigación Biomedicina, Faculty of Medicine, Fundación Universitaria Autónoma de las Américas - Institución Universitaria Visión de las Américas, Pereira, Risaralda, Colombia
- Master's Program in Clinical Epidemiology and Biostatistics, Universidad Cientifica del Sur, Lima, Peru
| | | | - Ranjit Sah
- Tribhuvan University Teaching Hospital, Institute of Medicine, Tribhuvan University, Tribhuvan, Nepal
- Grupo de Investigación Biomedicina, Faculty of Medicine, Fundación Universitaria Autónoma de las Américas - Institución Universitaria Visión de las Américas, Pereira, Risaralda, Colombia
- Master's Program in Clinical Epidemiology and Biostatistics, Universidad Cientifica del Sur, Lima, Peru
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Mahameed H, Al-Mahzoum K, AlRaie LA, Aburumman R, Al-Naimat H, Alhiary S, Barakat M, Al-Tammemi AB, Salim NA, Sallam M. Previous Vaccination History and Psychological Factors as Significant Predictors of Willingness to Receive Mpox Vaccination and a Favorable Attitude towards Compulsory Vaccination. Vaccines (Basel) 2023; 11:vaccines11050897. [PMID: 37243001 DOI: 10.3390/vaccines11050897] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Revised: 04/17/2023] [Accepted: 04/24/2023] [Indexed: 05/28/2023] Open
Abstract
During the ongoing multi-country monkeypox (Mpox) outbreak, healthcare workers (HCWs) have represented a key group in mitigating disease spread. The current study aimed to evaluate the attitude of nurses and physicians in Jordan towards Mpox vaccination, as well as their attitude towards compulsory vaccination against coronavirus disease 2019 (COVID-19), influenza, and Mpox. An online survey was distributed in January 2023 based on the previously validated 5C scale for psychological determinants of vaccination. Previous vaccination behavior was assessed by inquiring about the history of getting the primary and booster COVID-19 vaccination, influenza vaccine uptake during COVID-19, and any history of influenza vaccine uptake. The study sample consisted of 495 respondents: nurses (n = 302, 61.0%) and physicians (n = 193, 39.0%). Four hundred and thirty respondents (86.9%) had heard of Mpox before the study, and formed the final sample considered for Mpox knowledge analysis. Deficiencies in Mpox knowledge were reflected in a mean knowledge score of 13.3 ± 2.7 (out of 20.0 as the maximum score), with significantly lower knowledge among nurses and females. The intention to receive Mpox vaccination was reported by 28.9% of the participants (n = 143), while 33.3% were hesitant (n = 165), and 37.8% were resistant (n = 187). In multivariate analysis, Mpox vaccine acceptance was significantly associated with previous vaccination behavior, reflected in higher vaccine uptake and with higher 5C scores, while Mpox knowledge was not correlated with Mpox vaccination intention. The overall attitude towards compulsory vaccination was neutral, while a favorable attitude towards compulsory vaccination was associated with higher 5C scores and a history of previous vaccination uptake. The current study showed a low intention to get Mpox vaccination in a sample of nurses and physicians practicing in Jordan. The psychological factors and previous vaccination behavior appeared as the most significant determinants of Mpox vaccine acceptance and of attitudes towards compulsory vaccination. The consideration of these factors is central to policies and strategies aiming to promote vaccination among health professionals in efforts to prepare for future infectious disease epidemics.
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Affiliation(s)
- Haneen Mahameed
- Department of Pathology, Microbiology and Forensic Medicine, School of Medicine, The University of Jordan, Amman 11942, Jordan
| | | | | | | | - Hala Al-Naimat
- School of Medicine, The University of Jordan, Amman 11942, Jordan
| | - Sakher Alhiary
- Nursing Department, Jordan University Hospital, Amman 11942, Jordan
| | - Muna Barakat
- Department of Clinical Pharmacy and Therapeutics, Faculty of Pharmacy, Applied Science Private University, Amman 11931, Jordan
- MEU Research Unit, Middle East University, Amman 11831, Jordan
| | - Ala'a B Al-Tammemi
- Migration Health Division, International Organization for Migration (IOM), The UN Migration Agency, Amman 11953, Jordan
| | - Nesreen A Salim
- Prosthodontic Department, School of Dentistry, The University of Jordan, Amman 11942, Jordan
- Prosthodontic Department, Jordan University Hospital, Amman 11942, Jordan
| | - Malik Sallam
- Department of Pathology, Microbiology and Forensic Medicine, School of Medicine, The University of Jordan, Amman 11942, Jordan
- Department of Clinical Laboratories and Forensic Medicine, Jordan University Hospital, Amman 11942, Jordan
- Department of Translational Medicine, Faculty of Medicine, Lund University, 22184 Malmö, Sweden
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Rony MKK, Sharmi PD, Akter D, Parvin MR, Alamgir HM. Knowledge and Attitude Regarding Human Monkeypox Virus Infection among Nurses: A Cross-Sectional Study. SAGE Open Nurs 2023; 9:23779608231216619. [PMID: 38020319 PMCID: PMC10676072 DOI: 10.1177/23779608231216619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 09/27/2023] [Accepted: 11/04/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction Monkeypox (Mpox) is an infectious illness that can spread to humans through infected humans, animals, or contaminated objects. In 2022, the monkeypox virus spread to over 60 countries, raising significant public health concerns. Nurses play a vital role in patient care and have critical responsibilities in managing infected patients and being aware of the potential impact on the general population. Objective This study aimed to investigate the knowledge and attitudes (KAs) of Bangladeshi nurses regarding monkeypox infectious disease. Methods A cross-sectional study was conducted between October 2022 and March 2023 to evaluate the KA of nurses. Semi-structured and self-administered questionnaires were used, distributed via Google Form, and a convenient sampling technique was implemented. The dataset was analyzed using the Chi-square test, multivariable logistic regression, and Pearson correlation coefficient. Results A total of 1047 datasets were included in the final analysis. Overall, 57.97% of the participants demonstrated good knowledge, and 93.12% of the respondents had a positive attitude towards monkeypox disease. Female nurses exhibited better knowledge (adjusted odds ratio (AOR) 1.36; 95% confidence interval (CI) 0.88-1.98) and a more positive attitude (AOR 1.64; 95% CI 1.12-3.00) than male nurses. Furthermore, a strong correlation was observed between good knowledge of monkeypox disease and a positive attitude (r = 0.76, p < 0.001), while poor knowledge moderately correlated with a negative attitude (r = 0.53, p < 0.001). Conclusions Given the need for further improvement in KA, we recommend implementing additional training programs to enhance the abilities and motivation of nurses in effectively managing patients affected by monkeypox.
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Affiliation(s)
- Moustaq Karim Khan Rony
- Master of Public Health, Bangladesh Open University, Gazipur, Bangladesh
- Directorate General of Nursing and Midwifery, Dhaka, Bangladesh
| | - Priyanka Das Sharmi
- International University of Business Agriculture and Technology, Dhaka, Bangladesh
| | | | - Mst. Rina Parvin
- Red Crescent Nursing College, Sylhet, Bangladesh
- Major at Bangladesh Army, Combined Military Hospital, Dhaka, Bangladesh
| | - Hasnat M. Alamgir
- Professor and Head, Department of Public Health, State University of Bangladesh, Dhaka, Bangladesh
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