- Email: [email protected]
H1N1 influenza – Awareness among newly employed healthcare workers in Lagos State, Nigeria
Research
CSIRO PUBLISHING
www.publish.csiro.au/journals/hi
Healthcare Infection, 2011, 16, 30–32
H1N1 influenza – Awareness among newly employed healthcare workers in Lagos State, Nigeria K. O. Wright A,B MB CHB, MPH, FMCPH C. E. Enabulele A MD, MPH, FWACP M. Akinyinka A MBBS A
Department of Community Health and Primary Health Care, Lagos State University Teaching Hospital, 1-5, Oba Akinjobi Street, GRA Lagos, Nigeria. B Corresponding author. Email: [email protected]
Abstract. Background: The 2009 H1N1 influenza pandemic accounted for numerous hospitalisations and deaths in various parts of the world with lingering effects. An assessment of awareness about H1N1 influenza was conducted among newly employed healthcare workers undertaking pre-placement medical examinations in Lagos, Nigeria. Methods: A cross-sectional study was carried out between June and August 2010 at the Staff Welfare Clinic of a tertiary health institution using a self-administered questionnaire. Consenting participants were recruited consecutively within the study period and ethical clearance was obtained from the ethics committee of the Lagos State University Teaching Hospital (LASUTH). Results: The majority (81.7%) of all respondents had heard about H1N1 influenza. The most commonly known symptoms included cough, catarrh and breathing difficulty; the main source of information was the mass media. About three-quarters (75.9%) of the respondents expressed willingness to be vaccinated if vaccines were readily available. Conclusion: Further research could provide insights to the benefits of utilising educational strategies for preventing influenza in developing countries. Additional keywords: H1N1 influenza, vaccine, prevention.
Background The World Health Organisation’s (WHO) description of an influenza pandemic is one in which a new influenza virus appears, against which the human population has no immunity, resulting in several simultaneous epidemics worldwide, with enormous numbers of deaths and illnesses.1 The current H1N1 influenza (formerly called swine influenza) was first reported in March 2009 in Mexico.2 By June, the WHO pandemic level was raised to level 6 on account of widespread infection beyond North America (Mexico) to other parts of the world, such as Australia, the UK, Chile, Spain and Japan.2 In September 2009, nearly 9000 hospitalisations and over 550 deaths had occurred in the USA from H1N1 influenza.2 WHO reported that H1N1 had been confirmed in 200 000 people in more than 100 countries with at least 2185 deaths.2 According to WHO, 214 countries reported laboratoryconfirmed cases of H1N1 influenza.3 Between April 2009 and April 2010, the Centres for Disease Control (CDC) reported ~61 million cases of H1N1 pandemic influenza, ~274 000 hospitalisations and 12 470 Australian Infection Control Association 2011
deaths.4 In Nigeria, by November 2009, there were 11 laboratory-confirmed cases of H1N1 pandemic influenza with two deaths recorded.5 In a study of 1088 probable or confirmed cases of pandemic H1N1 influenza A in California, 31% of patients were admitted to intensive care units and 11% died.6 Healthcare workers play a key role in the prevention and control of diseases. Given the potential global impact of H1N1 influenza, this study was conducted to assess awareness of the pandemic H1N1 influenza by newly employed government health workers (doctors, nurses, laboratory scientists) in Lagos State, Nigeria. Method The Lagos State University Teaching Hospital (LASUTH) is a multi-speciality hospital situated at Ikeja in Lagos State which serves the Lagos area and its environs. The health and wellbeing of members of staff of LASUTH and the Lagos State University College of Medicine (LASUCOM) are catered for at the staff clinic of LASUTH where the study was conducted. 10.1071/HI10033
1835-5617/11/010030
H1N1 influenza awareness in Lagos State, Nigeria
Study design The study is descriptive and cross-sectional in design.
Healthcare Infection
31
Table 1. Sociodemographic details Variable
Frequency (n = 333)
Percentage
9 184 99 21 7 13
2.7 55.3 29.7 6.3 2.1 3.9
202 131
60.7 39.3
4 5 61 261 2
1.2 1.5 18.3 78.4 0.6
A
Selection of subjects All newly employed healthcare workers enrolling for preplacement medical examination between June and August, 2010 of LASUTH, LASUCOM or other Lagos State hospitals were invited to participate. Study instrument A quantitative method of data collection was applied using an 18-item self-administered structured questionnaire in seeking information on socio-demographic details, awareness and attitude regarding H1N1 influenza. Analysis Data analysis was done with the aid of EPI-INFO statistical software (Epi 3.5.1 version: CDC, Atlanta GA,US: http:// wwwn.cdc.gov/epiinfo/). Differences in proportions were compared using the Chi-square test and the significance level was set at P < 0.05 Ethical consideration Ethical clearance for the study was obtained from the LASUTH ethical committee, and verbal consent was obtained at point of data collection. Participation was voluntary and participants were assured of strict confidentiality. Results A total of 333 respondents were recruited and consented within the study period. About three-quarters of the respondents were between 21 and 40 years of age; the mean age being 30 6.8 (range 15–58). There was a female preponderance and the majority (78.4%) of respondents were highly educated at the tertiary level (Table 1). A great majority (81.7%) had heard of H1N1 influenza and equally high proportions of 76.8% and 77.2% were adequately informed that H1N1 is caused by a virus and that it is airborne, respectively. The mass media (television and radio; 90.8%) were the respondents’ main sources of information regarding H1N1 influenza (Table 2). The common symptoms of H1N1influenza known to the respondents included cough (50.2%), catarrh (44.4%) and breathing difficulty (33.9%). Respondents with tertiary education were most knowledgeable regarding preventive practices for H1N1 infection such as hand-washing, use of face-masks, medications and vaccines. However, there was no statistically significant relationship between the level of education and understanding prevention of H1N1 (P > 0.05). Awareness about H1N1 influenza was highest in respondents between the ages of 21 and 30 years (P < 0.05). About a quarter of the total respondents interviewed were hesitant and responded in the negative regarding willingness to be vaccinated against H1N1 influenza (Table 3).
Age group (years) 20 21–30 31–40 41–50 >50 No response Sex Female Male Highest educational level attained No formal Primary Secondary Tertiary No response A
Mean age was 30 6.8.
Table 2.
Awareness about H1N1
Awareness of H1N1 Heard about H1N1 Yes No Source of informationA Friend Radio/TV Hospital Posters Healthcare provider Others Cause of N1H1 Bacterial Fungal Viral Don’t know Transmission Blood-borne Airborne Skin contact Food-borne Water-borne SymptomsA Cough Catarrh (watery nasal discharge) Chest pain Vomiting Diarrhea Abdominal pain Breathing difficulty Headache A
No. (n = 333)
Percentage
272 61
81.7 18.3
27 247 39 33 29 9 (n = 727) 24 3 209 36
9.9 90.8 14.3 12.1 10.7 3.3 8.8 1.1 76.8 13.2
16 210 27 4 15
5.9 77.2 9.9 1.5 5.5
167 148 65 55 43 26 113 57
50.2 44.4 19.5 16.5 12.9 7.8 33.9 17.1
Multiple responses.
Discussion The high awareness level (81.7%) observed in this study is similar to findings by Kamate et al. in India in which 83.1% of respondents had heard about H1N1 influenza; however, less
32
Healthcare Infection
K. O. Wright et al.
Table 3. Willingness to be vaccinated against H1N1 influenza Willing to be vaccinated
No.
%
Yes No Don’t know Total
253 7 40 333
75.9 2.1 12.0 100.0
than 20% of participants in that study understood it is caused by a virus.7 This varies from our study in which 76.8% of the respondents knew the causative agent was a virus. Another Indian study in Chandigarh conducted on healthcare workers to assess knowledge, attitude and practices on the novel H1N1 swine-origin influenza virus, revealed that 90% of the study participants were familiar with clinical symptoms of H1N1 influenza.8 The internet was the most popular (84%) means of information in that study.8 This proportion greatly exceeds those of the present study in which awareness about common symptoms was ~50% and less for symptoms such as cough, breathing difficulty and running nose (catarrh). This could be due to the similarity of these symptoms with other conditions, such as the common cold and chest infections. The mass media (television and radio) were the most popular means of information about H1N1 influenza among the respondents, which varies from the internet being the most prevalent (84.0%) source for participants in the Chandigarh study, which was alleged to be due to the quest for knowledge by healthcare workers.8 Hand-washing, use of face masks and vaccines were the most commonly known methods of prevention. Park et al. in a Korean study on prevention of H1N1 influenza transmission among university students observed that over 90% of participants perceived hand-washing as an effective measure to prevent H1N1 influenza transmission.9 Similarly, Akhan et al. reported that most participants in a Turkish study were of the opinion that hand-washing, face masks and quarantine are effective measures for preventing H1N1 influenza.10 Kamate et al. also reported a statistically significant association between age and awareness about H1N1 influenza. With our study, awareness was significantly greater with increasing age (P < 0.05). Most (75.9%) respondents in this study were prepared to uptake vaccine if made available. This may be due to the high level of awareness about the H1N1 influenza pandemic and possibly the importance of vaccination as a protective measure. This differs from a Hong Kong survey on willingness to accept the H1N1 influenza vaccine among nurses, where a low proportion (27%) indicated willingness as a result of fear of side-effects and efficacy of the vaccine.11
This study demonstrates a high level of awareness of the H1N1 influenza pandemic which may account for the acceptance of vaccination as a feasible preventative strategy. Further education and research regarding vaccination access, vaccination uptake and actual use of recognised prevention strategies may be of benefit in the future in Nigeria. References 1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
Ives J, Greenfield S, Parry JM, Draper H, Gratus C, Petts JI, et al. Healthcare Workers’ Attitudes to Working during Pandemic Influenza: A Qualitative Study. BioMed Central, Public Health; posted 2009 October 19. Bronze MS. H1N1 Influenza (swine flu). E-medicine Specialties, 2009 Available at: http://emedicine.medscape.com/article/1807048overview (Last accessed February 2011). World Health Organization. Pandemic (H1N1) 2009 – update 104. Available at: http://www.who.int/csr/don/2010_06_11/en/index.html (Accessed June 16, 2010) US Centers for Disease Control and Prevention. Updated CDC estimates of 2009 H1N1 influenza cases, hospitalizations and deaths in the United States, April 2009 – April 10, 2010. Available at: http:// www.cdov/h1n1flu/estimates_2009_h1n1.htm (Accessed June 7, 2010). Pandemic (H1N1) 2009 in the African Region. Available at: http://en. wikipedia.org/wiki/Template:2009-2010_flu_pandemic_table (Last accessed February 2011). Louie JK, Acosta M, Winter K, Jean C, Gavali S, Schechter R, et al. Factors associated with death or hospitalization due to pandemic 2009 influenza A (H1N1) infection in California. JAMA 2009; 302(17): 1896–902. doi:10.1001/jama.2009.1583 Kamate SK, Agarwal A, Agrawal A, Chaudhary H, Singh K, Mishra P, Asawa K. Public knowledge, attitude and behavioural changes in an Indian population during the Influenza A (H1N1) outbreak. J Infect Dev Ctries 2009; 4: 7–14. Mahajan V, Saini SS. Knowledge, attitude and practices regarding Novel H1N1 (Swine) flu among paediatricians in Chandigarh. Indian Pediatr 2010; 47: 101–4. doi:10.1007/s13312-010-0001-x Park JH, Cheong HK, Son DY, Kim SU, Ha CM. Perceptions and behaviours related to hand hygiene for the prevention of H1N1 Influenza transmission among Korean University students during the peak pandemic period. BMC Infect Dis 2010; 10. doi:10.1186/14712334-10-222 Akan H, Gurol Y, Izbirak G, Ozdatii S, Yilmaz G, Vitrinal A, Hayran D. Knowledge and attitudes of university students towards pandemic influenza: a cross-sectional study from Turkey. BMC Public Health 2010; 10: 413. doi:10.1186/1471-2458-10-413 Wong SYS, Wong ELY, Chor J, Kung K, Chan PKS, Wong C, et al. Willingness to accept H1N1 pandemic influenza vaccine: A crosssectional study of Hong Kong community nurses. BMC Infect Dis 2010; 10: 316. doi:10.1186/1471-2334-10-316
Manuscript received 24 November 2010, accepted 17 February 2011
http://www.publish.csiro.au/journals/hi
CSIRO PUBLISHING
www.publish.csiro.au/journals/hi
Healthcare Infection, 2011, 16, 30–32
H1N1 influenza – Awareness among newly employed healthcare workers in Lagos State, Nigeria K. O. Wright A,B MB CHB, MPH, FMCPH C. E. Enabulele A MD, MPH, FWACP M. Akinyinka A MBBS A
Department of Community Health and Primary Health Care, Lagos State University Teaching Hospital, 1-5, Oba Akinjobi Street, GRA Lagos, Nigeria. B Corresponding author. Email: [email protected]
Abstract. Background: The 2009 H1N1 influenza pandemic accounted for numerous hospitalisations and deaths in various parts of the world with lingering effects. An assessment of awareness about H1N1 influenza was conducted among newly employed healthcare workers undertaking pre-placement medical examinations in Lagos, Nigeria. Methods: A cross-sectional study was carried out between June and August 2010 at the Staff Welfare Clinic of a tertiary health institution using a self-administered questionnaire. Consenting participants were recruited consecutively within the study period and ethical clearance was obtained from the ethics committee of the Lagos State University Teaching Hospital (LASUTH). Results: The majority (81.7%) of all respondents had heard about H1N1 influenza. The most commonly known symptoms included cough, catarrh and breathing difficulty; the main source of information was the mass media. About three-quarters (75.9%) of the respondents expressed willingness to be vaccinated if vaccines were readily available. Conclusion: Further research could provide insights to the benefits of utilising educational strategies for preventing influenza in developing countries. Additional keywords: H1N1 influenza, vaccine, prevention.
Background The World Health Organisation’s (WHO) description of an influenza pandemic is one in which a new influenza virus appears, against which the human population has no immunity, resulting in several simultaneous epidemics worldwide, with enormous numbers of deaths and illnesses.1 The current H1N1 influenza (formerly called swine influenza) was first reported in March 2009 in Mexico.2 By June, the WHO pandemic level was raised to level 6 on account of widespread infection beyond North America (Mexico) to other parts of the world, such as Australia, the UK, Chile, Spain and Japan.2 In September 2009, nearly 9000 hospitalisations and over 550 deaths had occurred in the USA from H1N1 influenza.2 WHO reported that H1N1 had been confirmed in 200 000 people in more than 100 countries with at least 2185 deaths.2 According to WHO, 214 countries reported laboratoryconfirmed cases of H1N1 influenza.3 Between April 2009 and April 2010, the Centres for Disease Control (CDC) reported ~61 million cases of H1N1 pandemic influenza, ~274 000 hospitalisations and 12 470 Australian Infection Control Association 2011
deaths.4 In Nigeria, by November 2009, there were 11 laboratory-confirmed cases of H1N1 pandemic influenza with two deaths recorded.5 In a study of 1088 probable or confirmed cases of pandemic H1N1 influenza A in California, 31% of patients were admitted to intensive care units and 11% died.6 Healthcare workers play a key role in the prevention and control of diseases. Given the potential global impact of H1N1 influenza, this study was conducted to assess awareness of the pandemic H1N1 influenza by newly employed government health workers (doctors, nurses, laboratory scientists) in Lagos State, Nigeria. Method The Lagos State University Teaching Hospital (LASUTH) is a multi-speciality hospital situated at Ikeja in Lagos State which serves the Lagos area and its environs. The health and wellbeing of members of staff of LASUTH and the Lagos State University College of Medicine (LASUCOM) are catered for at the staff clinic of LASUTH where the study was conducted. 10.1071/HI10033
1835-5617/11/010030
H1N1 influenza awareness in Lagos State, Nigeria
Study design The study is descriptive and cross-sectional in design.
Healthcare Infection
31
Table 1. Sociodemographic details Variable
Frequency (n = 333)
Percentage
9 184 99 21 7 13
2.7 55.3 29.7 6.3 2.1 3.9
202 131
60.7 39.3
4 5 61 261 2
1.2 1.5 18.3 78.4 0.6
A
Selection of subjects All newly employed healthcare workers enrolling for preplacement medical examination between June and August, 2010 of LASUTH, LASUCOM or other Lagos State hospitals were invited to participate. Study instrument A quantitative method of data collection was applied using an 18-item self-administered structured questionnaire in seeking information on socio-demographic details, awareness and attitude regarding H1N1 influenza. Analysis Data analysis was done with the aid of EPI-INFO statistical software (Epi 3.5.1 version: CDC, Atlanta GA,US: http:// wwwn.cdc.gov/epiinfo/). Differences in proportions were compared using the Chi-square test and the significance level was set at P < 0.05 Ethical consideration Ethical clearance for the study was obtained from the LASUTH ethical committee, and verbal consent was obtained at point of data collection. Participation was voluntary and participants were assured of strict confidentiality. Results A total of 333 respondents were recruited and consented within the study period. About three-quarters of the respondents were between 21 and 40 years of age; the mean age being 30 6.8 (range 15–58). There was a female preponderance and the majority (78.4%) of respondents were highly educated at the tertiary level (Table 1). A great majority (81.7%) had heard of H1N1 influenza and equally high proportions of 76.8% and 77.2% were adequately informed that H1N1 is caused by a virus and that it is airborne, respectively. The mass media (television and radio; 90.8%) were the respondents’ main sources of information regarding H1N1 influenza (Table 2). The common symptoms of H1N1influenza known to the respondents included cough (50.2%), catarrh (44.4%) and breathing difficulty (33.9%). Respondents with tertiary education were most knowledgeable regarding preventive practices for H1N1 infection such as hand-washing, use of face-masks, medications and vaccines. However, there was no statistically significant relationship between the level of education and understanding prevention of H1N1 (P > 0.05). Awareness about H1N1 influenza was highest in respondents between the ages of 21 and 30 years (P < 0.05). About a quarter of the total respondents interviewed were hesitant and responded in the negative regarding willingness to be vaccinated against H1N1 influenza (Table 3).
Age group (years) 20 21–30 31–40 41–50 >50 No response Sex Female Male Highest educational level attained No formal Primary Secondary Tertiary No response A
Mean age was 30 6.8.
Table 2.
Awareness about H1N1
Awareness of H1N1 Heard about H1N1 Yes No Source of informationA Friend Radio/TV Hospital Posters Healthcare provider Others Cause of N1H1 Bacterial Fungal Viral Don’t know Transmission Blood-borne Airborne Skin contact Food-borne Water-borne SymptomsA Cough Catarrh (watery nasal discharge) Chest pain Vomiting Diarrhea Abdominal pain Breathing difficulty Headache A
No. (n = 333)
Percentage
272 61
81.7 18.3
27 247 39 33 29 9 (n = 727) 24 3 209 36
9.9 90.8 14.3 12.1 10.7 3.3 8.8 1.1 76.8 13.2
16 210 27 4 15
5.9 77.2 9.9 1.5 5.5
167 148 65 55 43 26 113 57
50.2 44.4 19.5 16.5 12.9 7.8 33.9 17.1
Multiple responses.
Discussion The high awareness level (81.7%) observed in this study is similar to findings by Kamate et al. in India in which 83.1% of respondents had heard about H1N1 influenza; however, less
32
Healthcare Infection
K. O. Wright et al.
Table 3. Willingness to be vaccinated against H1N1 influenza Willing to be vaccinated
No.
%
Yes No Don’t know Total
253 7 40 333
75.9 2.1 12.0 100.0
than 20% of participants in that study understood it is caused by a virus.7 This varies from our study in which 76.8% of the respondents knew the causative agent was a virus. Another Indian study in Chandigarh conducted on healthcare workers to assess knowledge, attitude and practices on the novel H1N1 swine-origin influenza virus, revealed that 90% of the study participants were familiar with clinical symptoms of H1N1 influenza.8 The internet was the most popular (84%) means of information in that study.8 This proportion greatly exceeds those of the present study in which awareness about common symptoms was ~50% and less for symptoms such as cough, breathing difficulty and running nose (catarrh). This could be due to the similarity of these symptoms with other conditions, such as the common cold and chest infections. The mass media (television and radio) were the most popular means of information about H1N1 influenza among the respondents, which varies from the internet being the most prevalent (84.0%) source for participants in the Chandigarh study, which was alleged to be due to the quest for knowledge by healthcare workers.8 Hand-washing, use of face masks and vaccines were the most commonly known methods of prevention. Park et al. in a Korean study on prevention of H1N1 influenza transmission among university students observed that over 90% of participants perceived hand-washing as an effective measure to prevent H1N1 influenza transmission.9 Similarly, Akhan et al. reported that most participants in a Turkish study were of the opinion that hand-washing, face masks and quarantine are effective measures for preventing H1N1 influenza.10 Kamate et al. also reported a statistically significant association between age and awareness about H1N1 influenza. With our study, awareness was significantly greater with increasing age (P < 0.05). Most (75.9%) respondents in this study were prepared to uptake vaccine if made available. This may be due to the high level of awareness about the H1N1 influenza pandemic and possibly the importance of vaccination as a protective measure. This differs from a Hong Kong survey on willingness to accept the H1N1 influenza vaccine among nurses, where a low proportion (27%) indicated willingness as a result of fear of side-effects and efficacy of the vaccine.11
This study demonstrates a high level of awareness of the H1N1 influenza pandemic which may account for the acceptance of vaccination as a feasible preventative strategy. Further education and research regarding vaccination access, vaccination uptake and actual use of recognised prevention strategies may be of benefit in the future in Nigeria. References 1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
Ives J, Greenfield S, Parry JM, Draper H, Gratus C, Petts JI, et al. Healthcare Workers’ Attitudes to Working during Pandemic Influenza: A Qualitative Study. BioMed Central, Public Health; posted 2009 October 19. Bronze MS. H1N1 Influenza (swine flu). E-medicine Specialties, 2009 Available at: http://emedicine.medscape.com/article/1807048overview (Last accessed February 2011). World Health Organization. Pandemic (H1N1) 2009 – update 104. Available at: http://www.who.int/csr/don/2010_06_11/en/index.html (Accessed June 16, 2010) US Centers for Disease Control and Prevention. Updated CDC estimates of 2009 H1N1 influenza cases, hospitalizations and deaths in the United States, April 2009 – April 10, 2010. Available at: http:// www.cdov/h1n1flu/estimates_2009_h1n1.htm (Accessed June 7, 2010). Pandemic (H1N1) 2009 in the African Region. Available at: http://en. wikipedia.org/wiki/Template:2009-2010_flu_pandemic_table (Last accessed February 2011). Louie JK, Acosta M, Winter K, Jean C, Gavali S, Schechter R, et al. Factors associated with death or hospitalization due to pandemic 2009 influenza A (H1N1) infection in California. JAMA 2009; 302(17): 1896–902. doi:10.1001/jama.2009.1583 Kamate SK, Agarwal A, Agrawal A, Chaudhary H, Singh K, Mishra P, Asawa K. Public knowledge, attitude and behavioural changes in an Indian population during the Influenza A (H1N1) outbreak. J Infect Dev Ctries 2009; 4: 7–14. Mahajan V, Saini SS. Knowledge, attitude and practices regarding Novel H1N1 (Swine) flu among paediatricians in Chandigarh. Indian Pediatr 2010; 47: 101–4. doi:10.1007/s13312-010-0001-x Park JH, Cheong HK, Son DY, Kim SU, Ha CM. Perceptions and behaviours related to hand hygiene for the prevention of H1N1 Influenza transmission among Korean University students during the peak pandemic period. BMC Infect Dis 2010; 10. doi:10.1186/14712334-10-222 Akan H, Gurol Y, Izbirak G, Ozdatii S, Yilmaz G, Vitrinal A, Hayran D. Knowledge and attitudes of university students towards pandemic influenza: a cross-sectional study from Turkey. BMC Public Health 2010; 10: 413. doi:10.1186/1471-2458-10-413 Wong SYS, Wong ELY, Chor J, Kung K, Chan PKS, Wong C, et al. Willingness to accept H1N1 pandemic influenza vaccine: A crosssectional study of Hong Kong community nurses. BMC Infect Dis 2010; 10: 316. doi:10.1186/1471-2334-10-316
Manuscript received 24 November 2010, accepted 17 February 2011
http://www.publish.csiro.au/journals/hi