DOI: 10.7860/JCDR/2016/17519.7790

Original Article

Dentistry Section

Knowledge and Apprehension of Dental Patients about MERS-A Questionnaire Survey Nipun Ashok1, Jean Clare Rodrigues2, Khalid Azouni3, Shorouk Darwish4 Abdulwahab abuderman5, Abdul aziz fahad alkaabba6, Bassel tarakji7

ABSTRACT Introduction: Middle East Respiratory Syndrome (MERS) is a disease caused by beta corona virus. From April 11th to 9th June 2014, World Health Organization (WHO) reported a total of 402 laboratory confirmed cases of MERS from KSA, out of which 132 cases were reported from Riyadh alone. Aim: The aim of this study was to assess the knowledge and apprehension of patients about MERS visiting Al Farabi College of Dentistry, Riyadh, Saudi Arabia. Materials and Methods: A cross-sectional questionnaire based survey was conducted which consisted of 10 self-prepared questions. A total of 404 patients participated in this study. Results: Three hundred and forty patients had heard about MERS. Nearly a quarter of the patients (25.74%) were

apprehensive about undergoing dental treatment because of MERS. A little more than half of the patients (50.99%) knew that camel is a source of Middle East Respiratory Syndrome-Corona virus. Most of the patients (80.72%) were aware of the infection control measures to be followed by dentist and 138 patients claimed they took some precaution when present inside the dental college. Conclusion: Majority of the patients had heard about MERS and was aware of the infection control measures. However, some patients were apprehensive about undergoing dental treatment because of MERS. Further steps need to be taken to educate the patient's about transmission of MERS and infection control measures in a dental hospital.

Keywords: Aerosol infection, Coronavirus, Respiratory infection

Introduction

Middle East Respiratory Syndrome (MERS) was first reported from a patient in Saudi Arabia who died of pneumonia due to a novel beta corona virus in September 2012 [1]. WHO has reported a total of 699 laboratory confirmed cases of MERS and 209 deaths due to MERS as in June 2014. Most of the cases were reported in Middle East countries Jordan, Kuwait, Oman, Qatar, Saudi Arabia (KSA), United Arab Emirates (UAE) and Yemen [2]. All the cases of MERS reported outside the Middle East were people who recently travelled from countries inside of the Middle East. Most of the cases reported were males and the median age was 49-year-old [3]. Corona viruses are a group of viruses which primarily infect the upper respiratory and gastrointestinal tract of birds and mammals [4]. Scientists identified a new type of corona virus belonging to the lineage C betacorona viruses, which was initially called novel coronavirus 2012 and now termed as Middle East Respiratory Syndrome Corona Virus (MERS-CoV) [1,5,6]. Research has confirmed that dromedary camels throughout the Arabian Peninsula and in parts of north and east Africa carry these viruses and further analysis concluded that camels can be infected with MERS-CoV [7]. Dipeptidyl peptidase4 (DPP4, CD26) has been recognized as the cellular receptors for MERS-CoV , which is distributed regularly in mammal’s kidney and lung [8,9]. Clinical features of MERS closely resemble to those seen in Severe Acute Respiratory Syndrome (SARS). Most common symptoms are cough, fever and dyspnea. Apart from these, other symptoms seen are chills, headache, rigors, myalgia and malaise. Major complication of MERS is respiratory failure. It was also seen that more than half of the cases in KSA have had some underlying conditions [10]. A 75% of the reported cases are likely to acquire infection through human-human transmission (secondary cases) and 25% of the cases are likely to be acquired from animals (primary cases) 58

[11]. Most common mode of transmission of MERS in KSA was through human to human transmission in health care settings. Epidemiologic investigations are in progress to understand the transmission pattern of this virus and risk of transmission between animals and humans [2]. According to WHO, MERS seems to follow a seasonal pattern with a sudden spurt in the incidence of new cases from MarchApril onwards. From 11th April to 9th June 2014, WHO reported a total of 402 laboratory confirmed cases of MERS from KSA, out of which 132 cases were reported from Riyadh alone and 114 cases of confirmed death were reported from KSA during the same period. Majority of the secondary cases were healthcare workers who were infected within the hospital and patients who had been to hospital for other reasons and were considered to have been infected with MERS‐CoV in the hospital [2,11].

aim The aim of this survey was to analyze the knowledge and apprehension about MERS among the dental patients visiting Al Farabi College of Dentistry, Riyadh, KSA.

Materials and Methods

A cross-sectional questionnaire based survey was conducted from 2nd April 2014 to 25th May 2014. Ethical clearance was obtained from the institutional review board of Al Farabi College of Dentistry. A pilot study was conducted on 38 patients at Al Farabi College of Dentistry. Based on the response, appropriate adjustments were made. The findings of pilot study revealed that 81.5% of the patients were aware of MERS. Based on this, sample size was calculated at 99% confidence level with a margin of error of 5% Sample size= Z α2*(P)*(1-P)

C2

Z= Z value (2.576 for 99% confidence level) P=percentage of picking a choice, expressed as a decimal (0.815). Journal of Clinical and Diagnostic Research. 2016 May, Vol-10(5): ZC58-ZC62

www.jcdr.net

Nipun Ashok et al., Knowledge of Dental Patients About Mers-A Questionnaire Survey

C= confidence interval or margin of error expressed as decimal. (.05) (2.576)2* (0.815)*(1-0.815) = 400.20

(.05)2

Sample size required was calculated as 400.20. In the present study, we included a total of 404 dental patients, who were selected randomly from the general outpatient Department of Al Farabi College of dentistry, Riyadh. Informed consent was obtained from the patients before the interview. Questionnaire Design: The questionnaire consisted of 10 selfprepared questions and had two parts. The first part gathered personal information (four questions): age, sex, nationality, and education. According to nationality, patients were categorized as Saudi citizen or non-Saudi. Based on age, patients were categorized into three groups; 50 years. Based on education level, patients were categorized as below primary, primary, secondary and graduate. The second part had six questions. Of these, five questions (four closed ended and one open ended) were used to assess the patient’s knowledge and apprehension about MERS and one question was used to assess patient’s knowledge about infection control. An option of ‘yes’ or ‘no’ was given to answer these questions.

Statistical analysis

Factors

Yes (%)

No (%)

Male

214 (79.85)

54 (20.15)

Female

126 (92.64)

10 (7.36)

Chi-square

p-value

11.081

0.0010*

31.030

0.0001*

20.67

0.0001*

44.274

0.0001*

Sex

Citizen Saudi

182 (94.79)

10 (5.21)

Non-Saudi

158 (74.53)

54 (25.47)

Age group (years) 50

46 (67.64)

22 (32.36)

Primary

45(64.29)

25 (35.71)

Secondary

132 (79.52)

34 (20.48)

Graduate

163 (97.02)

5 (2.98)

Total

340 (84.16)

64 (15.84)

Education

[Table/Fig-2]: Response of the patients when asked whether they heard about MERS. * Statistically significant (p

Knowledge and Apprehension of Dental Patients about MERS-A Questionnaire Survey.

Middle East Respiratory Syndrome (MERS) is a disease caused by beta corona virus. From April 11(th) to 9(th) June 2014, World Health Organization (WHO...
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