Akram Ahmad

Knowledge and attitude of healthcare workers about middle east respiratory syndrome in multispecialty hospitals of Qassim, Saudi Arabia

BackgroundWith the increase in prevalence of Middle East Respiratory Syndrome (MERS), healthcare workers (HCWs) are at risk of acquiring and subsequently transmitting this lethal virus. In view of this, HCWs were evaluated for their knowledge of and attitude towards MERS in Saudi Arabia.MethodsA cross sectional study was performed in two hospitals of Qassim region in Saudi Arabia. A total of 280 healthcare workers were selected to participate in this study. Knowledge and attitude were assessed by using self-administered and pretested questionnaire. Descriptive statistics were carried out to express participants’ demographic information, mean knowledge score and mean attitude score of HCWs. Inferential statistics (Mann–Whitney U test and Kruskal Wallis tests, p < 0.05) were used to examine differences between study variables. Chi squares tests were used to assess the association between study variables and attitude questions. Spearman’s rho correlation was used to identify the association between the knowledge, attitude scores.ResultParticipants demonstrated good knowledge and positive attitude towards MERS. The mean scores of knowledge and attitude were 9.45 ± 1.69 (based on 13 knowledge questions) and 1.82 ± 0.72 (based on 7 attitude questions). The correlation between knowledge and attitude was significant (correlation coefficient: 0.12; P <0.001). HCWs were less educated about the management (42.4%), source (66%) and consequences of MERS (67.3%), while a majority of them were well aware of the hallmark symptoms (96%), precautionary measures (96%) and hygiene issues (94%). Although the majority of respondents showed positive attitude towards the use of protective measures (1.52 ± 0.84), their attitude was negative towards their active participation in infection control program (2.03 ± 0.97). Gender and experience were significantly associated with knowledge and attitude (P < 0.05).ConclusionsThe findings of this study showed that healthcare workers in Qassim region of Saudi Arabia have good knowledge and positive attitude towards MERS. Yet there are areas where low knowledge and negative attitude of HCWs was observed. However, studies are required to assess the knowledge and attitude of HCWs at national level so that effective interventions could be designed as surveillance and infection control measures are critical to global public health.

Effect of Religious Beliefs on the Smoking Behaviour of University Students: Quantitative Findings From Malaysia

The Malaysian official Islamic authorities have issued a “fatwa” (Islamic ruling) regarding smoking practice which prohibits Muslims from smoking because of its potential harm to health. Since the prevalence of smoking among Malaysian students is high, this study was designed to explore the perceptions and opinions of Malaysian Muslim students towards smoking in International Islamic University of Malaysia. A prospective, cross-sectional study was conducted among School of Science students in International Islamic University Malaysia. Convenience sampling approach was used to recruit 323 students based on sample size calculation. A content- and face-validated questionnaire was used to collect the data from the participants. Non-smokers highly supported the fatwa on smoking forbiddance than smokers (94 vs 64.3xa0%, pxa0=xa00.001). A significant proportion of non-smokers believed that Islam prohibits smoking because of its potential harm (94.9 vs 71.4xa0%, pxa0=xa00.001). Majority of smokers agreed that addiction is the main barrier towards smoking cessation (78.6 vs 61.5xa0%, pxa0=xa00.019). The results showed positive influences of Islamic beliefs on the non-smokers. Further studies are required to validate these findings by surveying other universities of Malaysia.

Polio vaccination in Pakistan.

Syed Hussain and colleagues (April 18, p 1509) praised the Pakistani Government for arresting parents who refused poliovirus vaccination for their children, calling it a bold move to address the serious issue of polio in Pakistan. This statement gives the impression that parental refusal of child vaccination is the main reason for the failure of polio campaigns in Pakistan; however, this is not the case. Of 34·7 million children targeted for vaccination in March, 2015, only 33 695 (<1%) children were missed because of their parents’ refusal. Roughly 33·6 million (79%) children were vaccinated, whereas the remaining children (20%) were missed mainly because of security issues, such as death threats from militant groups who perceive polio vaccination campaigns as a cover to serve the intelligence purposes of the Central Intelligence Agency. We believe that Hussain and colleagues ignored important considerations. First, most of the parental refusal is because of their religious misconceptions about vaccination and distrust in government offi cials. Moreover, with the arrest of citizens, no evidence exists to confi rm that parents’ beliefs about vaccination can be changed and their trust in the governent regained. Second, some of the people arrested for refusal of polio vaccination were still single and had no children, and some people did not refuse polio vaccines for their children. We believe that arresting people for refusal will not help them to understand the gravity of the issue, rather thoughts against the state will breed in arrested parents and might further strengthen their misconceptions towards polio vaccination. Third, the security of the general population and polio vaccine workers seems to be a much bigger problem. Lastly, the eff ectiveness of used vaccines is also a concern because in February, 2015, a Federal Investigation Agency sealed 11 800 vials of spoiled polio vaccines in the National Institute of Health, Pakistan. The Pakistani Government should provide security to the public and the polio vaccine workers. Evidence-based approaches should be adapted to change the misconceptions of parents. Government officials should launch the campaign with full dedication and honesty, since previous campaigns have been dented by political corruption and mismanagement. These are the bold moves that are needed to liberate Pakistan from polio.

Are healthcare workers ready for Ebola? An assessment of their knowledge and attitude in a referral hospital in South India

INTRODUCTIONnThe World Health Organization (WHO) declared the Ebola virus disease (EVD) epidemic to be a public health emergency of international concern. Healthcare workers (HCWs) are at the highest risk of infection, as they may come into contact with patients blood or fluids. This study was conducted to assess knowledge and attitudes of HCWs towards EVD in India.nnnMETHODOLOGYnA descriptive, cross-sectional study was conducted in a multispecialty public sector referral hospital of Telangana, India. Knowledge and attitude of HCWs were evaluated using a pre-validated questionnaire. A sample of 278 participants was selected to participate in this study. The Chi-squared test was used to assess the relationship between attitudes and demographic characteristics. Logistic regression was used examine the association between knowledge and study variables.nnnRESULTSnOf 257 participants who responded (92.4% response rate), 157 (61.1%) were females. The majority of the respondents were physicians (n = 117, 45.5%). Radio and television were the major sources of information about EVD reported by participants (89%). Overall knowledge of HCWs was poor (mean knowledge score: 6.57 ± 2.57). Knowledge of physicians and experienced workers (≥ 10 years) was significantly higher than their respective groups. The overall attitude of the participants was positive (mean attitude score: 1.62 ± 0.57). Significant positive correlations between knowledge and attitude were observed.nnnCONCLUSIONSnThe findings indicate that participants lack basic understanding of EVD. We recommend future studies be conducted across India to identify and subsequently bridge the knowledge gaps among HCWs.

A cross-sectional survey on the attitudes and interests of rural population towards expanded pharmacist prescribing in India

Background Shortage of qualified medical doctors and little or no access to basic medicines and medical facilities are the major rural health concerns in India. Expanding the role of pharmacists to provide prescribing services could improve rural health outcomes. Objective To assess the attitudes of rural population towards pharmacist prescribing and their interest in using expanded pharmacist prescribing services. Setting Rural population of Assam, India. Methods A descriptive, cross-sectional survey was conducted for a period of 2xa0months from March to April 2016 in the State of Assam, India. A multi-stage sampling was used to recruit (nxa0=xa0410) eligible participants. Main outcome measure Rural population attitudes towards, and interests in using, pharmacist prescribing services. Results The attitudes of participants were generally positive towards pharmacist prescribing. A large proportion of participants (81.5%) agreed that pharmacists should have a prescribing role in rural India. Participants indicated their interest in using expanded pharmacist prescribing services, with greater interests in receiving medications in emergency situations (79.7%) and getting a treatment plan for their medical problem (75.6%). Participants with low income and tertiary education had better attitudes and showed more interest towards expanded pharmacist prescribing services (pxa0<xa00.05). Conclusions Most participants had positive attitudes towards pharmacist prescribing and were interested in using expanded pharmacist prescribing services.

Fixed-dose combination antibiotics in India: global perspectives.

On March 10, 2016, the Indian Government banned around 3 3 0 “ i r r a t i o n a l ” f i xe d d o s e combination drugs (FDCs) with immediate eff ect. FDCs are products that contain two or more active drugs in a fixed-dose ratio, and are useful for minimising pill burden and lowering cost. However, FDCs should ideally contain constituents that act via diff erent mechanisms and do not cause additive toxic effects. An FDC is described as irrational if these conditions are not met. The government’s decision was infl uenced by reports expressing concern about the safety and efficacy of FDCs manufactured in India. In view of the substantial fi nancial loss to industry, some pharmaceutical companies have taken legal action to exempt their FDCs from the ban. However, we believe the government’s action was necessary to safeguard public health. 63 (19%) of the 330 banned FDCs are antibiotics. Antibiotic resistance is of increasing concern worldwide, but initiatives to curtail inappropriate use have had little success. Studies of several antibiotic combinations, such as meropenem and sulbactam, have reported no additional advantage over their individual constituents, and have been reported to cause toxic reactions and promote resistance. Despite repeated investigations into the shortcomings of some FDCs, such drugs are still being manufactured and promoted on the Indian drug market. 118 antibiotic FDCs are available on the Indian market, 80 (68%) of which are not registered with the Central Drugs Standard Control Organisation. The regulation of FDCs of antimicrobials in India is important from a global perspective. The growth of worldwide trade and travel has allowed resistant microorganisms to spread rapidly to distant countries and continents. New Delhi metalloβ-lactamase, an enzyme that causes bacteria to be resistant to antibiotics, was fi rst reported in India in 2008 and is now found worldwide. Moreover, FDCs that have been banned in India have been reported to be exported to other African and Asian countries. Such exports are a setback for the individuals or organisations trying to implement antimicrobial stewardship initiatives in these settings. Inadequate knowledge of physicians about FDCs is also an exacerbating factor in antibiotic resistance. The Indian Government has taken a much-needed step to restrict antibiotic resistance by banning irrational FDCs. Since implementation of the ban is still pending, we urge the international community to support the Indian Government’s initiative to ensure full implementation of the ban on irrational FDCs, because controlling antibiotic resistance in India is key for controlling antibiotic resistance worldwide.

Exploring the intentions of pharmacy students towards pharmacy ownership by using theory of planned behaviour

ObjectiveThe objective of this study was to assess the association of the constructs of theory of planned behaviour (behavioural beliefs, normative beliefs, control beliefs) and demographic variables with the intentions of pharmacy students to become pharmacy owner.MethodsA cross sectional study was conducted between October and November, 2014, using a pretested, self-administered questionnaire delivered to a sample of 350 pharmacy students at a private university of Pakistan. Behavioural beliefs, normative beliefs and control beliefs were assessed on four point Likert scale of agreement. The scores were summed and dichotomized based on an arbitrary 50xa0% cut-off score to assess positive and negative beliefs. Binary logistic regression was used to analyse the data.ResultsA total of 313 participants (89.4xa0%) responded to the questionnaire. Participants’ behavioural beliefs, normative beliefs and control beliefs were negative towards pharmacy ownership with the mean scores of 13.90u2009xa0±xa00.41 (score range: 6–24), 9.66xa0±xa00.49 (score range: 4–16) and 16.88xa0±xa00.40 (score range: 7–28) respectively. Professional year and family business were significantly associated with intentions of pharmacy students to own a pharmacy (pxa0<xa00.05).ConclusionBehavioural beliefs, normative beliefs and control beliefs were negative towards pharmacy ownership. Implementation of entrepreneurship course in pharmacy school may transform the beliefs of pharmacy students towards pharmacy ownership.

Polio and cross-border management

A substantial gain was made towards polio eradication in 2015, with a 79% reduction in polio cases worldwide (n=74) compared with 350 cases reported in 2014. As of Dec 14, 2016, 34 cases of wild poliovirus have been reported worldwide in 2016. Despite the gradual reduction in the reported cases, wild poliovirus still poses a huge threat to global public health because it has not yet been eradicated. Security issues, religious beliefs, and parental refusal are cited as major barriers potentially thwarting successful eradication of polio. How ever, the exportation of poliovirus is the biggest challenge that authorities are facing in attempts to curb the continued transmission of wild poliovirus. Given the high risk of exportation of wild poliovirus, the International Health Regulations Emergency Committee declared the situation as a public health emergency of international concern and vaccination for international travellers was recommended in 2014. Pakistan and Afghanistan are regarded as the biggest exporters of wild poliovirus. These two countries form a single epidemiological block with a regular cross-border movement of people, which maintains the fl ow of virus in both directions. The movement of people crossing the border has largely been unchecked or uncontrolled. In 2015, most reported cases of polio in Afghanistan were from Nangarhar province, which borders Pakistan, and were genetically linked to cases in Pakistan. All cases of polio in these border areas are reported in the mobile population, especially the returning displaced population. Eff orts are being made to imple ment the WHO temporary recom mendations for international travellers in Pakistan and Afghanistan. However, in view of the outbreak in border areas, faster progress is urgently needed. Both countries should intensify cross-border eff orts to enhance the surveillance of borders for prompt detection of wild poliovirus and increase vaccination coverage of travellers and refugees crossing the border. More personnel should be employed on all the illegal crossing points on the Pakistan–Afghan border. Both countries should devise a mechanism to screen the authenticity of vaccination documents in the wake of reports of fake polio vaccination certificates. Talks between the two countries in which representatives agreed to improve the cross-border coordination mechanism were reported to have taken place. However, in view of relations between the two countries, the task of improving cross-border coordination for the control of polio will remain unfi nished if polio is not depoliticised. Investment in regional mechanisms to form a joint polio task force at the borders is just as important as organisation of public health campaigns and immunisation activities.

Muslim scholars' knowledge, attitudes and perceived barriers towards polio immunization in Pakistan.

Pakistan is one of the two countries where polio remains endemic. Among multiple reasons of polio prevalence, false religious beliefs are accounted as major barriers towards polio immunization in Pakistan. Within this context, religious scholars are now engaged in polio immunization campaigns to dismantle the myths and battle the resurgence of polio in Pakistan. The objective of this study was to assess knowledge, attitudes and perceived barriers of Muslim scholars towards polio immunization in Pakistan. A descriptive, cross-sectional survey of Muslim scholars was conducted in Quetta and Peshawar divisions of Pakistan. From October to December 2015, a convenience sample of 770 Muslim scholars was recruited from the local mosques and religious institutions to participate in this study. Knowledge, attitudes, and perceived barriers were assessed by using self-administered, anonymous and pretested questionnaire. Descriptive and regression analyses were used to express the results with pxa0<xa00.05 taken as significant. Three hundred and forty-eight (45.2xa0%) participants exhibited good knowledge about polio with a mean score of 7.16xa0±xa02.12 (based on 14 questions). Knowledge gaps were identified about the transmission (32.6xa0%) and consequences of poliovirus (39.9xa0%). Overall, 527 (68.4xa0%) participants showed positive attitudes towards polio immunization with a mean attitude score of 27.35xa0±xa02.68 (based on nine statements). The majority of participants agreed on the need of depoliticizing polio immunization issues (87.1xa0%), while reservations were noted about their willingness to participate in future polio immunization programs (44.6xa0%). Security (75.8xa0%) and vaccine management issues (64xa0%) were reported by the participants as the major barriers towards polio immunization in Pakistan. The findings showed poor knowledge of Muslim scholars towards polio; however, their attitudes were positive towards polio immunization. More studies are required to assess the knowledge and attitudes of Muslim scholars at the national level to validate the findings of this study.

Beliefs, attitudes and self-use of Ayurveda, Yoga and Naturopathy, Unani, Siddha, and Homeopathy medicines among senior pharmacy students: An exploratory insight from Andhra Pradesh, India.

Objectives: To assess the beliefs, attitudes and self-use of Ayurveda, Yoga and Naturopathy, Unani, Siddha, and Homeopathy (AYUSH) medicines among senior pharmacy students. Methodology: This was a descriptive cross-sectional study conducted among pharmacy students in four pharmacy schools located in Andhra Pradesh in South India. This study was conducted from the August to September 2014. The study population included all pharmacy students enrolled in Doctor of Pharmacy, Bachelor of Pharmacy and Diploma in Pharmacy programs in studied pharmacy schools. The pretested AYUSH survey had 8 questions on AYUSH related beliefs and 8 question on AYUSH related attitudes. The survey also asked participants about AYUSH related knowledge, frequency of use of AYUSH and the reason for using AYUSH. The data analysis was performed using SPSS Version 20. Chi-square test and Mann-Whitney U-test were employed to study the association between the independent and dependent variables. Results: A total of 428 pharmacy students participated in the survey. 32.2% of the study population was females and 32.5% of the population resided in rural areas. Males were more likely to have positive beliefs about AYUSH when compared to females (odd ratio [OR] = 4.62, confidence interval [CI] = 2.37−8.99, P < 0.001). Similarly, students living in hostels were more positive in their beliefs about AYUSH compared with students living at home (OR = 2.14, CI = 1.12−4.07, P < 0.05). Students living in hostel also had a positive attitude about AYUSH use (OR = 1.74, CI = 1.03−2.93, P < 0.05). Conclusion: Pharmacy students held favorable attitude and beliefs about AYUSH use. This baseline survey provides important information about the pharmacy student′s perception about AYUSH. Further research is needed to explore the reasons that shape the pharmacy student′s beliefs and attitudes about AYUSH.