|Year : 2017 | Volume
| Issue : 1 | Page : 57-60
Assessment of Knowledge and Attitude of Dentists Toward Bioterrorism Awareness in Dhule (Maharashtra, India): A Cross-sectional Survey
Minal M Kshirsagar1, Arun S Dodamani2, Prashanth Y Vishwakarma3, Girija A Dodamani4, Harish C Jadhav5, Rahul C Bhandari1
1 Department of Public Health Dentistry, ACPM Dental College, Dhule, India
2 Principal, Professor and Head, Department of Public Health Dentistry, ACPM Dental College, Dhule, India
3 Reader, Department of Public Health Dentistry, ACPM Dental College, Dhule, India
4 Senior Lecturer, Department of Prosthodontics, ACPM Dental College, Dhule, India
5 Senior Lecturer, Department of Public Health Dentistry, ACPM Dental College, Dhule, India
|Date of Web Publication||14-Mar-2017|
Minal M Kshirsagar
A-8/72 Suyojit Lawns, Near Rathi Industries, Satpur, Nashik 422 007
Source of Support: None, Conflict of Interest: None
Introduction: Bioterrorism, as a major health problem, has received lots of attention in the recent years. It is the intentional use of microorganisms and toxins to produce disease and death in humans, livestock, and crops; their attraction in war and their use in terrorist attacks are attributed to various unique features. Aim: To assess the knowledge and attitude of graduate dentists and postgraduate dentists toward bioterrorism in Dhule city, Maharashtra (India). Materials and Methods: A cross-sectional study included graduate dentists and postgraduate dentists in Dhule, Maharashtra, India. The list of dentists of Dhule city was obtained from the Indian Dental Association office, Dhule branch. Among 110 dentists practicing in Dhule city, 97 responded. A structured, self-administered questionnaire consisting of 15 closed-ended questions was employed. The information regarding age, gender, and profession (specialty branch) was collected. The data were tabulated and subjected to analysis using Pearson’s chi-square test. Results: Statistically significant difference was seen when knowledge and attitude of dentists and dentists with postgraduate qualification toward bioterrorism were compared (P < 0.05). Conclusion: Dentists with postgraduate qualification have better knowledge and attitude toward bioterrorism as compared to graduate dentists. Most of the dentists felt the need to educate the public regarding suspected bioterrorist attack, and they were willing to do so and had the confidence that it was preventable.
Keywords: Bioterrorism, dentists, terrorism
|How to cite this article:|
Kshirsagar MM, Dodamani AS, Vishwakarma PY, Dodamani GA, Jadhav HC, Bhandari RC. Assessment of Knowledge and Attitude of Dentists Toward Bioterrorism Awareness in Dhule (Maharashtra, India): A Cross-sectional Survey. J Indian Assoc Public Health Dent 2017;15:57-60
|How to cite this URL:|
Kshirsagar MM, Dodamani AS, Vishwakarma PY, Dodamani GA, Jadhav HC, Bhandari RC. Assessment of Knowledge and Attitude of Dentists Toward Bioterrorism Awareness in Dhule (Maharashtra, India): A Cross-sectional Survey. J Indian Assoc Public Health Dent [serial online] 2017 [cited 2018 Dec 12];15:57-60. Available from: http://www.jiaphd.org/text.asp?2017/15/1/57/201934
| Introduction|| |
Mass disasters can arise at any time from natural or manmade circumstances such as bioterrorism. “Terror” or “terrorism” is not a new term to the world nowadays. The term “terrorism” comes from the French word “terrorisme,” which is based on the Latin verb “terrere” (to cause to tremble). Terrorism can be defined as a strategy to use violence, social threats, or coordinated attacks to generate fear, cause disruption, and ultimately leading to compliance with specified political, religious, or ideological demands. Bioterrorism is a terrorism that involves the release or dissemination of biological agents intentionally. These agents (bacteria, viruses, or toxins) may be in a naturally occurring form or in a human modified form. In its simplest sense, bioterrorism means direction of bioweapons against civilians. In a bioterrorism attack, there is a deliberate release of viruses, bacteria, toxins, and other harmful agents, which are used to cause illness or death in people, animals, or plants.
Terrorists may choose to use biological weapons to achieve their goals, because biological agents are relatively cheaper than conventional weapons, and many of these agents would be relatively easy to prepare and easy to hide or disseminate. Their use would also allow bioterrorists in protecting themselves and escaping before any illness is detected. In India, there has been no documented case of bioterrorism so far. For this reason, it is necessary to know and learn about this form of terror before it arises and becomes a formidable challenge to our public health system and the society.
Disasters are inevitable, and it is almost impossible to fully recoup the damage caused by them; however, it is possible to minimize the potential risk. The risk can be minimized by developing early disaster warning strategies, preparing and implementing developmental plans to provide resilience, and helping in rehabilitation. Dental professionals are an integral part of the healthcare community who may provide care to the general public by playing various healthcare roles in response to bioterrorist attacks when it strikes, which may include identification of humans, biosurveillance and notification, diagnosis and monitoring, triage, referrals of patients, immunizations, decontamination, and infection control would be considered to provide oral healthcare there is need of awareness regarding bioterrorism among dentists. Therefore, an attempt was made through this study to assess the knowledge and attitude of dentists of Dhule city, Maharashtra (India) toward bioterrorism.
| Materials and Methods|| |
This was a cross-sectional study directed at dentists (BDS and MDS) across Dhule city, Maharashtra (India) over a period of 1 month. The protocol of the intended study was submitted to the Institutional Review Committee, and ethical clearance was obtained. The purpose of the study was explained to every participant, and written informed consent was obtained.
A structured, self-administered questionnaire consisting of 15 closed-ended questions was prepared and tested by a pilot study on 20 subjects. The validity and reliability of the questionnaire was obtained by giving it to the subject matter experts (content validity). The reliability of the questionnaire was subjected to Cronbach’s alpha analysis, and the internal consistency of the questionnaire was found to be 0.8. The required changes were made; then, the questionnaire was finalized.
The list of dentists of Dhule city was obtained from the Indian Dental Association, Dhule branch. All the dentists (n = 110) practicing in Dhule were considered. The information regarding age, gender, and profession (specialty branch) was collected (response rate 88.18%).
The collected data were tabulated in Microsoft Excel and subjected to statistical analysis using the Statistical Package for the Social Sciences version 16 software (SPSS Inc., Chicago, IL, United States). The data were analyzed using Pearson’s chi-square test, and P < 0.05 was considered statistically significant.
| Results|| |
Out of 110 dentists, 97 responded (response rate 88.18%).
Most of the dentists were <40 years of age (81.4%). Majority of them were males (62.8%) and graduate dentists (56.7%) [Table 1].
Less than 60% of the dentists were unaware of the commonly used biologic agents, such as plague, small pox, anthrax, and botulism, employed in an attack [Table 2].
On comparison of graduate dentists and dentists with postgraduate qualification regarding the knowledge of bioterrorism [Table 2], the following were observed:
- There was no statistically significant (P < 0.05) difference of recognition of signs and symptoms of bioterrorism-related diseases, awareness of the commonly used agents, and awareness of dental clinics as a source to spread bioterrorism between them.
- There was a statistically significant (P < 0.05) difference of knowledge regarding where to report during such an attack, with most dentists with postgraduate qualification having the correct knowledge than graduate dentists.
All the dentists felt the need to educate the public regarding bioterrorism, whereas none of them had attended any continuing dental education (CDE) program related to it [Table 3].
It was found that there was a statistically significant (P < 0.05) difference between the graduate dentists and dentists with postgraduate qualification regarding attitude toward bioterrorism as a serious threat to international peace and India as well, and dental professionals can take part in mitigation of the same [Table 3].
| Discussion|| |
Bioterrorism has become a significant threat to the world and a challenge to public health if not diagnosed early. Exposure of civilians to bioterrorism agents may result in severe health problems if not treated within sufficient time, and the effects may last longer or can be transferred to the next generation.
The results of this study show that 75.2% of the dentists were confident regarding recognition of signs and symptoms of bioterrorism-related diseases, and 78.3% were aware about the commonly used agents related to it. About 57.7% of the dentists were aware about the agents that caused plague, small pox, anthrax, and botulism, 58.7% of the dentists knew where to report during bioterrorism attack, and 78.3% of the dentists thought that dental clinics could be a source to spread bioterrorism. A study conducted by Katz et al. showed that only 64% of the dentists were aware about highest priority pathogens, whereas a study conducted by Chaudhari et al. showed that 25% of the medical interns and 40.84% of the dental interns were aware about bioterrorism.
Majority of the dentists (92.7%) had an attitude that bioterrorism is a threat to international peace, and it was preventable (90.7%). About 81.4% of the dentists were confident that they could manage the bioterrorism case. Most of the dentists felt the need to educate the public regarding bioterrorism, and they were willing to do so. They even wanted to acquire more knowledge about the same. None of them had attended any CDE program related to it, and they felt this topic should be added to the curriculum. In Hawaii, dentists have optional training sessions on bioterrorism preparedness.
In India, there is no such training available regarding bioterrorism. Robyn et al. showed that after following 3.5 h educational program, the participants reported increased confidence in recognizing symptoms of bioterrorism-related diseases, in addressing patients’ bioterrorism concerns, and ability to treat bioterrorism victims.
Aghaei and Nesami showed that education had a positive effect on nurses’ knowledge and attitudes, and it could be a guideline for administrators of the Ministry of Health and Medicine for planning to achieve the goals of preventive and defense against bioterrorism. Bhoopathi et al. found no difference regarding knowledge, opinion, and perceived need for bioterrorism education of dental professionals from those regions.
When we compared knowledge and attitude of dentists, there was a statistically significant difference regarding where to call during an attack. Dental professionals can take part in mitigation of bioterrorism, and bioterrorism can be a serious threat to international peace and India as well. Dentists with postgraduate qualification had more knowledge and attitude toward it compared with graduate dentists, and this might be due to the fact that dentists with postgraduate qualification attend more conferences or programs related to their field and can update their knowledge about the things that are going around or the problems that are faced by the public. We have a scope for expansion of preparedness against bioterrorism by including bioterrorism in the curriculum. According to Chmar et al., basic knowledge and training should be seamlessly implemented into the current curriculum without the addition of a new course.
This study has its own limitations. This study was limited to Dhule city only, and the data were collected without giving any educational program before or after. Hence, we recommend that further research is necessary to check the effectiveness of such educational programs on people and healthcare professional or workers regarding bioterrorism. Further cross-sectional studies are also necessary to compare knowledge, attitude, and practices of every healthcare professional or worker among various cities, because if they are prepared or have efficient knowledge, then they can save people by spreading awareness regarding the same. It can be assessed before and after giving a health educational program directed toward bioterrorism. We also recommend inclusion of training and education in the medical, dental, and dental hygiene curricula and developing continuing education (CE) courses for practicing dental professionals and mandating their attendance to better prepare the dental community to respond during a bioterrorism event.
| Conclusion|| |
This study showed that dentists with postgraduate qualification had better knowledge and attitude toward bioterrorism compared to graduate dentists. Most of the dentists felt the need to educate the public regarding bioterrorism, and they were willing to do so and had the confidence that it was preventable. They also agreed that bioterrorism is a global threat.
The authors would like to thank all the participants who gave their valuable time and consent to this study. They would also like to thank Dr. Mahesh Khairnar for his help in statistical analysis.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Chaudhari A, Shetiya SH, Kakodkar P, Shirahatti R. Knowledge, attitude and practice regarding bioterrorism amongst the medical and dental interns in Dr. D.Y. Patil deemed university − A questionnaire study. J Indian Assoc Public Health Dent 2011;9:94-9.
Bhargava D, Bhargava K, Sabri I, Siddharth M, Dave A, Jagadeesh HG et al.
Bioterrorism − “my role as a dentist”. J Indian Acad Forensic Med 2011;33:254-7.
Hilleman MR. Overview: Cause and prevention in biowarfare and bioterrorism. Vaccine 2002;20:3055-67.
Das CS, Kataria VK. Bioterrorism: A public health perspective. Med J Armed Forces India 2010;66:255-60.
Pandita V, Basavaraj P, Singla A, Gupta R, Kaur R, Vashishtha V et al.
Recasting disaster recovery strategy at dental workplace in combating crisis − A questionnaire study. J Clin Diagn Res 2016;10:39-44.
Bhoopathi V, Mashabi SO, Scott TE, Mascarenhas AK. Dental professionals’ knowledge and perceived need for education in bioterrorism preparedness. J Dent Educ 2010;74:1319-26.
Nathan MD, Sakthi DS. Dentistry and mass disaster − A review. J Clin Diagn 2014;8:ZE01-3.
Tanielian T, Stein BD, Eisenman D, Keyser DJ, Olmsted SS, Pincus HA. Understanding and Preparing for the Psychological Consequences of Bioterrorism; 2003. p. 1-7. Available from: http://www.rand.org
. Public service of the RAND Corporation. [Last accessed on 2016 Jul 12].
Robyn RM et al.
Clinicians’ knowledge, attitudes, and concerns regarding bioterrorism after a brief educational program. JOEM 2004;46:77-83.
Aghaei N, Nesami MB. Bioterrorism education effect on knowledge and attitudes of nurses. J Emerg Trauma Shock 2013;6:78-82.
] [Full text]
Chmar JE, Ranney RR, Guay AH, Haden NK, Valachovic RW. Incorporating bioterrorism training into dental education: Report of ADA-ADEA terrorism and mass casualty curriculum development workshop. J Dent Educ 2004;68:1196-9.
[Table 1], [Table 2], [Table 3]