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ORIGINAL ARTICLE
Year : 2022  |  Volume : 20  |  Issue : 3  |  Page : 298-303

COVID-19 outbreak: Knowledge, attitude, and practice among dental students in a tertiary care hospital: A cross-sectional study


1 Department of Public Health Dentistry, Vinayaka Mission's Sankarachariyar Dental College, Vinayaka Mission's Research Foundation (Deemed to be University), Salem, Tamil Nadu, India
2 Department of Public Health Dentistry, Vydehi Institute of Dental Sciences and Research Centre, Bengaluru, Karnataka, India

Date of Submission03-Apr-2021
Date of Decision18-Dec-2021
Date of Acceptance24-Jun-2022
Date of Web Publication12-Sep-2022

Correspondence Address:
C Bharath
Department of Public Health Dentistry, Vinayaka Mission's Sankarachariyar Dental College, Vinayaka Mission's Research Foundation (Deemed to be University), Salem - 636 308, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jiaphd.jiaphd_55_21

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  Abstract 


Background: Dental care settings have the risk of COVID-19 infection due to the aerosols generated during procedures, handling of sharps, and proximity of the dentist to the patient's oropharyngeal region. Materials and Methods: This descriptive cross-sectional online survey among undergraduate and postgraduate dental students studying in a tertiary care hospital employed a convenient snowball sampling technique. The survey instrument consisted of pretested and prevalidated questionnaire comprising demographic characteristics, 14 items on knowledge domain, 6 items on attitude domain, and 4 items on practice domain modified from a previously published questionnaire on COVID-19. Statistical Analysis: Statistical analysis was done using SPSS version 20.0 to perform the Chi-square test, MannWhitney, KruskalWallis, Spearman's correlation, and linear regression analysis. Results: The study population comprised 79 (28.9%) males and 194 (71.1%) females, with approximately 53% belonging to the age group of <20 years. Based on our results, the majority of the general population had inadequate (42.1%) knowledge about the disease with a mean knowledge score was 22.82 ± 1.98. Conclusion: This study showed that the dental students had an inadequate level of knowledge and negative attitude in their outlook on overcoming the COVID-19 pandemic. Various health education programs are necessary, particularly targeting students with lower knowledge regarding COVID-19 are essential for encouraging adequate knowledge, positive attitude, and maintain safe dental practices.

Keywords: COVID-19, dental students, knowledge, pandemic


How to cite this article:
Bharath C, Lakshmi K P, Lakshmi S V, Saravanan N. COVID-19 outbreak: Knowledge, attitude, and practice among dental students in a tertiary care hospital: A cross-sectional study. J Indian Assoc Public Health Dent 2022;20:298-303

How to cite this URL:
Bharath C, Lakshmi K P, Lakshmi S V, Saravanan N. COVID-19 outbreak: Knowledge, attitude, and practice among dental students in a tertiary care hospital: A cross-sectional study. J Indian Assoc Public Health Dent [serial online] 2022 [cited 2022 Sep 25];20:298-303. Available from: https://www.jiaphd.org/text.asp?2022/20/3/298/355892




  Introduction Top


The novel coronavirus (2019-nCoV, officially known as SARS-CoV-2 or COVID-19) was first reported in December 2019, as a cluster of acute respiratory illness in Wuhan, Hubei Province, China, from where it spread rapidly to over 198 countries. It was declared as a global pandemic by WHO on March 12, 2020.[1],[2] Coronaviruses are a large group of viruses that are rather common throughout the community.[3] In terms of symptoms, the WHO reported that more than 80% of COVID-19 patients showed mild symptoms and recovered without any medical intervention, approximately 20% of infected cases had a severe illness such as shortness of breath, septic shock, and multi-organ failure, and it has been reported that an estimated 2% of cases can be fatal.[4],[5] With regard to SARS-CoV-2, researchers have confirmed its nosocomial transmission, although very little is known about its mode of transmission and the extent of environmental contamination.[6] In the event of an COVID-19 outbreak, the dentist can be the first person to come in contact with an infected person; they can either unknowingly become a carrier and infect others or by following proper guidelines can prevent the possible spread of the disease and save the entire community from its disastrous consequences.[7] Dental care settings have the risk of 2019-nCoV infection due to the aerosols generated during procedures, handling of sharps, and proximity of the dentist to the patient's oropharyngeal region. If adequate precautions are not taken, the dental treatments can potentially lead to cross-contamination.[8] Apart from reducing the transmission rate, considering an individual's fear is a vital aspect for their psychological well-being and may also largely influence the manner in which an individual may adhere to preventive measures and thereby determine the clinical outcome of COVID-19.[9] The speed with which COVID-19 is spreading across the world calls for rapid assessments of the population's knowledge and perceptions of this infection.[10] Assessing the knowledge, attitude, and practices (KAPs) related to COVID-19 among the general public would be helpful to provide better insight to address poor knowledge about the disease and the development of preventive strategies and health promotion programs.[11] Dentists are now an important member of the primary health-care team and hold great potential to expand their role in preventing infectious diseases like COVID-19. In the event of outbreak like COVID-19, dental students should have an in-depth knowledge and attitude to have a better understanding and should be updated with the practices that have to be adopted in preventing strategies in the dental settings. The KAP of dental students have potential role in the preventive practices with regard to COVID-19 infection. Hence, the present study was undertaken with the aim to assess the KAP regarding COVID-19 outbreak among dental students in a tertiary care hospital in Salem, India.


  Materials and Methods Top


This cross-sectional online survey employed a convenient snowball sampling technique. Using Google Forms, a questionnaire gathering demographic data and KAP of dental students regarding the COVID-19 pandemic were prepared and distributed through e-mail and WhatsApp among undergraduate and postgraduate dental students aged 18–35 years for a duration of 1 month from May 1, 2020, to May 31, 2020. The cover page of the questionnaire included a short introduction regarding the objectives and the voluntary nature of participation and declarations of confidentiality and anonymity. Ethical approval for this study was obtained from the institutional ethical committee before the start of the study. Participation was voluntary, and informed consent was obtained from the participants. The eligibility criteria followed for the participants was that all those students (first, second, third, final year students, interns, and postgraduate students) in dental college who are willing to participate in the study and participants who give informed consent were included in the study. A pretested, prevalidated, 31-item self-administered structured closed-ended online questionnaire was formulated. Out of the 24 items in the questionnaire, 14 items comprised knowledge domain, 6 items comprised attitude domain, and 4 items comprised practice domain. The internal validity of the questionnaire was assessed by a panel of subject experts. The purpose was to depict those items with a high degree of agreement among experts. The panel of experts recommended modifying the wording of the questions. To check the reliability and internal consistency of the questionnaire, Cronbach's alpha was calculated and was found to be 0.8697. Before the commencement of the main study, a pilot study was performed in the month of April 2020, on 10% of the sample size. It served as a preliminary study to identify any organizational problems, calculate sample size, and to have prior idea regarding estimate of the time taken for each participant. Modifications in the methodology and questionnaire were made wherever necessary, and the final study was planned and carried out. According to the result of the pilot study, the final questionnaire was determined by the authors. The results of the pilot study were not used for the final sample of the study. Each correct answer in relation to the knowledge of COVID-19 was given one point. For each item, scoring was done as 1 for correct answer and 0 for incorrect answer. Overall score was computed by summing the correct answer scores and a cutoff level of <10 was evaluated as inadequate knowledge and >11 indicated adequate knowledge. Attitude score of >4 indicated a positive attitude and a score of 1–3 indicated a negative attitude. Correct answers in practice were given a score of 1, whereas incorrect answer was given a score of 0. A score of 3 or higher were thought of as having good practice.

Statistical analysis

Data were analyzed using the statistical package for the social sciences (SPSS Inc., Chicago, Illinois, USA) version 20. Descriptive statistics were used to calculate the frequencies and comparison of mean KAP score between the genders was done using Mann–Whitney test, age group was done by Chi-square test and mean KAP scores and year of a study was done by KruskalWallis test. Spearman's correlation and regression analysis was used to assess the relationship between KAP scores. Statistical significance was set at P < 0.05.


  Results Top


The study population comprised 79 (28.9%) males and 194 (71.1%) females, with approximately 53% belonging to the age group of <20 years [Table 1]. Among the study population, 273 eligible subjects who completed and returned the questionnaire had a mean age of (22.3 ± 6.1) years, most of them were female (71.1%), the highest percentage of respondents were 1st year undergraduate students (26.4%). Based on our results, the study population had inadequate knowledge (42.1%) about the disease with a mean knowledge score of 22.82 ± 1.98. Based on the gender, significant difference for knowledge about COVID-19 was noted for questions on the first city to get affected with COVID-19 (P = 0.000), modes of transmission (P = 0.000), symptoms (P = 0.045), percentage of deaths reported (P = 0.008), availability of vaccine (P = 0.000), recommended drug (P = 0.000), source of information (P = 0.000), and type of contact (P = 0.000). Comparison of the attitude responses based on gender, the difference was significant (P = 0.035) for questions 16 and 20. When practice responses were measured and compared according to gender, a significant difference was observed for all the questions. When practice responses regarding COVID-19 were compared according to gender, a significantly higher positive response was shown for questions Q 21, Q 22, Q 23, and Q 24 [Table 2]. The highest mean knowledge score was observed among 21–25 years of age group students (23.02 ± 1.77), followed by (23.00 ± 1.34) for >31 years of age group and this was statistically significant (P = 0.046). However, comparison based on age groups in the mean of attitude scores did not reveal any significant difference (P = 0.117). A significant difference was observed for practice score based on age group (P = 0.039). Comparison based on year of study revealed higher mean attitude score among 3rd year postgraduate students and this difference was statistically significant (P = 0.002) [Table 3]. Spearman's correlation depicts positive linear relationship between knowledge–attitude (r = 0.048) (P = 0.039). The result showed a significant correlation between practice score and age (r = 0.138) (P = 0.023), practice and gender (r = 0.130) (P = 0.032), and practice and year of study (r = 0.214) (P = 0.000) [Table 4]. The multiple linear regression model to analyze the knowledge score in relation to demographic variables revealed that adequate knowledge scores were significantly associated with age (P = 0.012) and year of study (P = 0.004) [Table 5]. Adequate knowledge, positive attitude, and good practice scores were seen in 34.1%, 42.1%, and 96.7% of the study participants, respectively [Table 6].
Table 1: Demographic characteristics of the study participants

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Table 2: Comparison of responses of study participants based on gender and age

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Table 3: Knowledge, attitude, and practice scores of the study participants

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Table 4: Correlation of knowledge, attitude, and practice scores with age, gender, and year of study

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Table 5: Multiple regression analysis of knowledge score with age, gender, and year of study

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Table 6: Knowledge and practice scores of the participants regarding coronavirus disease 2019

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  Discussion Top


COVID-19 is a novel viral disease which has caused devastating impact on the health care and psychological well-being of the population throughout the world. Health-care workers, especially dentists, are at increased risk of developing COVID-19 infection due to their close contact with aerosol droplets when performing various dental treatments. The distance between the working field and the dentist is approximately 35–40 cm, and certain procedures can be very time-consuming, which puts the dentist at a higher risk of contracting COVID-19.[12],[13] It is, therefore, of at most importance that the KAP of the dental students be studied which will help in adopting better strategies for the prevention of the disease. This study showed that the knowledge and awareness of this sample of dental students was inadequate regarding COVID-19 infection during the current outbreak. More than half of the population had inadequate knowledge about COVID-19 disease (66%) which is in contrast to study conducted in other Asian countries which indicated high levels of COVID-19 knowledge among the health-care workers.[14],[15],[16] In addition, 82% felt that washing hands with soap and water could help to prevent COVID-19 transmission; 89% knew that incubation period of COVID-19 is 2–14 days; 66% felt that aerosol contact has increased risk of COVID-19 disease which is in line with study done by Singh et al.[17] The main source of information about coronavirus among the study population was television (60%), followed by Internet (30%). Among the study population, 93% felt that informing the health-care professionals about recent travel history is important in controlling the disease. Substantial proportion of participants (84%) believed that N 95 masks are highly effective in protecting the wearer from infection with COVID-19. Majority of the population (90%) had adequate attitude related to importance of hand hygiene in controlling the spread of the disease, which is in line with study done by Lee et al.[18] Data analysis on the practice section revealed that 96% of the participants practiced routine hand hygiene and 90% of the population wore mask to prevent disease transmission. The present study found that the majority of the participants were aware of the COVID-19 mode of spread and transmission which is essential during dental practice. It is crucial for the dental professionals to follow the procedures and guidelines focusing on reducing the amount of aerosol generated and deal with it effectively. It is also important for the dental students to follow the current guidelines given by the government to minimize the risk of infection in dental practice. The fear that dentists have regarding getting infected from COVID-19 could be greatly curtailed if dentists and dental health-care workers meticulously follow the relevant recommendations issued by the regulatory authorities. These include the universal cross-infection control protocols along with some additional precautions in cases where patients present with any suspicious symptoms.[19] In the current study, the participants had good practice scores though they showed inadequate knowledge and negative attitude toward COVID-19. Around 68% of the subjects were aware of preventive procedures used to prevent the spread of coronavirus which is in line to study by Singh et al.[20] This might be due to regulatory rules made by the government toward creating awareness and prevention of COVID-19 infection toward the public. This lack of knowledge and attitude among dental student's calls for attention as it is necessary to improve their KAP as they come across patients in day-to-day life in primary health-care setup.

Limitations

This study is limited to only dental students of a university, the sample size is relatively small, and therefore, results cannot be generalized to a larger population, hence, it is recommended to conduct further studies using larger samples at various institutions in India and abroad.


  Conclusion Top


This study presents a comprehensive assessment of KAP related to COVID-19 among dental students. This study showed that the dental students have an inadequate level of knowledge and negative attitude in their outlook on overcoming the COVID-19 pandemic. Various health education programs are necessary, particularly targeting students with lower knowledge regarding COVID-19 are essential for encouraging good knowledge, positive attitude, and maintain safe dental practices.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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