Site Map
Research Article
Preliminary Knowledge, Attitudes, and Practice of Students: Zika Virus and Maternal Health
Nikki Keene Woods1*, Amy K Chesser1, Jennifer Mattar2 and Lamin Barrow1
1Department of Public Health Sciences, Wichita State University, Wichita, USA
2Department of Biomedical Engineering, Wichita State University, Wichita, USA

ABSTRACT
Purpose
To assess student Zika virus knowledge, attitudes, and practice related to maternal health. In 2007 widespread human infection from the Zika virus became more widespread. As a result there has been increased public health concern worldwide. The Zika virus is associated with health problems and also economic losses.

Design, setting and subjects
A preliminary survey of Zika knowledge, attitudes, and practice was administered to a convenience sample of college students.

Measures
A twenty-four question survey was modified from the World Health Organization.

Analysis
Descriptive statistics were used.

Results
Sixty-one (61) students completed the survey. The majority of respondents were female (85.7%, n=43), mean age of 27 years. No student responses were 100% accurate for signs/symptoms of Zika but most students could identify the majority of the symptoms. Over half (63.6%, n=21) supported access to abortions. The majority supported testing all pregnant women for Zika (75.0%, n=36), the development of a vaccine (89.4%, n=42) and most would get a Zika vaccine (68.1%, n=32).

Conclusion
In an era of abundant information, the lack of consistent Zika health knowledge among students further highlights the importance of accurate and timely health information to improve maternal and child health.
KEYWORDS
Health communication; Health promotion; Health protective behavior; International health; Maternal and child health

Abbreviations
FMH: Fetomaternal Hemorrhage;
KB: Kleihauer-Betke
Introduction
The Zika virus was first discovered in the Zika forest area of Uganda in 1947 in a sentinel rhesus monkey. In Nigeria in 1954 there were about a dozen reports of human infections. However it wasn’t until 2007 that widespread human infection from the Zika virus became more widespread, moving from the small island of Yap to French Polynesia, to the millions infected in South America [1]. As a result there has been an increased public health concern worldwide [2-5]. The virus is transmitted by a mosquito vector and is transmitted through blood, from mother to fetus and sexual intercourse [6,7]. Common symptoms frequently reported are fever, rash, joint pain, red eyes, muscle pain and headache and an infected person can be contagious for three to twelve days. Additionally the two main health risks associated with Zika are Guillain-Barre Syndrome, which affects the nervous system and microcephaly, a birth defect that causes inadequate development or growth of the brain revealed upon birth. Zika symptoms commonly present for one week duration, showing similarities to infections like dengue and chikungunya [1,7,8].

The Zika virus is associated with health problems and also economic losses. In 2016, the World Bank projected that Zika-related economic losses in Latin America alone would reach $3.5 million [2]. Despite the health and economic burden of Zika, an online poll reported 77% of the general population in the United States public was “not very worried” about Zika virus. Additionally, epidemiological reports of Zika infection in the United States reported inequalities in low-income regions [1].

Due to the perceived lack of concern among the general population, there remains an increased interest in understanding Zika knowledge, attitudes, and practice in relation to public health communication [1]. Although Zika has been headline news in national and international settings, little research has been done to understand the knowledge and attitudes for this issue. One study which examined Zika and vaccine interest concluded more than half of university students surveyed were interested in a Zika vaccine, but further research evaluating Zika attitudes is critical [9]. These findings supported an interest for a Zika vaccine, but did not investigate health attitudes related to Zika. The objective of this study was to assess student knowledge, attitudes, and practice related to Zika.
Methods
Study design
This preliminary survey was nested in a larger investigation involving Zika knowledge and the media [10] and used similar methodology as a previous study which examined Ebola perceptions [11]. The survey was administered to a convenience sample of health profession and communication college students using the online Qualitrics® data collection software. The online survey was open for eight weeks during the spring 2017 semester. Participants were recruited via email invitations in health profession and communication courses. Consent was obtained before the survey began and it was self-administered through the online software. Participants could complete the survey on both mobile and desktop devices. This study was approved by a university Institutional Review Board.
Measures
The survey included twenty-four questions including demographic and Zika-related questions. Demographic questions were used to describe the population characteristics (i.e., gender, age, family income). Questions about student Zika knowledge, attitudes, and practice were included from the World Health Organization’s Zika survey [12]. Example questions include: (a) If a pregnant woman has Zika, what are the risks she faces (check all that apply), (b) If a pregnant woman has Zika, what are the risks for the fetus/baby (check all that apply) and (c) Why should a woman avoid getting pregnant because of Zika (check all risks).
Data analysis
All data were analyzed using IBM SPSS statistics version 19. Descriptive statistics were used to describe the population and responses to Zika questions.
Results
Sixty-one (61) students completed the survey. The majority of respondents were female (85.7%, n=43) with a mean age of 27 (SD=10.11). The highest percentage of respondents reported parental income between $20,000-59,999 (44%, n=21) and reported educational status as 4th year college student (53%, n=26),) and 3rd year college student (18%, n=9). None of the participants were pregnant at the time of the survey (Table 1).
Zika knowledge
Seventy one percent (71.1%, n=37) of the study participants reported there is no cure for Zika. No student responses were 100% accurate for signs/symptoms of Zika. The majority of participants (84.3%, n=43) correctly identified Zika mosquito transmission, 60.8% (n=31) indicated Zika is transmitted congenitally from mother-child, 51.0% (n=26) reported Zika to be transmitted through sexual contact and 51.0% (n=26) of the study participants self-reported Zika is transmitted through blood transfusion. Participants incorrectly identified Zika transmission through the air (13.7%, n=7) and kissing/sneezing (13.7%, n=7).

When participant’s knowledge about the symptoms of Zika was assessed, 94.1% (n=48) correctly identified fever, 76.5% (n=39) joint pain, 64.7% (n=33) muscle pain, 56.9% (n=29) headache and 51.0% (n=26) red eyes. Just under half of participants (49.0%, n=25) incorrectly identified stomach pain and loss of appetite as a symptom of Zika and 31.4% (n=16) incorrectly identified cough/sore throat as a symptom.
Zika attitudes and practice
The majority of respondents (63.6%, n=21) supported access to safe, legal abortions for women who are infected with Zika during pregnancy. Less than half reported taking action to prevent unintended pregnancy since hearing about Zika (41.9%, n=13). The majority supported testing all pregnant women for Zika (75.0%, n=36). The majority also supported the development of a vaccine, at any cost, to protect against Zika (89.4%, n=42), and most would get a Zika vaccine immediately if it was available (68.1%, n=32).
Discussion
Survey respondents reported a higher-level of education than average in the United States, yet reported marginal knowledge of Zika symptoms and transmission. The gap between expected and actual Zika knowledge among a higher educated and mostly health-related college student population highlights the importance of accurate information disseminated in a timely and effective manner [13]. The student respondents had easy access to high-quality and reliable health information, yet still reported gaps in Zika health knowledge. The gap between expected and actual Zika knowledge likely grows as income and education levels decrease further emphasizing the importance of systematic health dissemination [1,14]. The lack of consistent Zika health knowledge among students further highlights the importance of accurate and timely health information. The health education community needs to improve health information dissemination strategies, specifically regarding health epidemics, which require rapid action and health behavior changes from the general population [15]. Broader public health programs to support knowledge dissemination could include an emphasis on mobile health technologies (e.g., cellular phone educational programs) [16] and train the trainer models using lay health workers [17].

Over half of respondents (64%) reported supporting access to safe, legal abortions, yet almost all (89%) supported screening all pregnant women for Zika virus. The varying levels of support between public health surveillance and Zika treatment options could be attributed to a number of population characteristics including religious affiliations and political ideologies of the setting. Interestingly, despite a large proportion of support for a Zika vaccine, fewer respondents reported the desire to actually receive the vaccine once developed (89% versus 68%). Reported differences could be due to stages of life differences and desire to have children. Neither question was included in the survey and is a limitation of the findings.

This study fills an important gap in describing Zika knowledge, attitudes, and practice among college students who may be some of the first to desire a Zika vaccine, however, the study is not without limitations. The small sample size from college students is not representative of the community, region or country and results should be interpreted as such. Response bias may have been present as respondents were students and may have answered questions from a more socially acceptable standpoint. This preliminary survey has not been tested with larger sample sizes and responses could be subject to high variability. Finally, the online format may have discouraged some participants from completing the study for a variety of reasons including accessibility and confidentiality.
Conclusion
In an era of abundant information that is rapidly available through social media and other online sources, the lack of consistent Zika health knowledge among students further highlights the importance of accurate and timely health information. The health education community populations to support population-level behavior changes. Strategies for the future should include increased participation on social media sites to improve the quality of health-related information available online. There should also be an increased focus on improving health communication mediums and strategies among vulnerable populations to reduce health disparities. Broader public health programs to support knowledge dissemination should include emerging technologies and strategies such as mobile health and train the trainer models.

References
  1. Teng Y, Bi D, Xie G, Jin Y, Huang Y, et al. (2017) Dynamic forecasting of Zika epidemics using Google trends. PLoS One 12: 0165085.
  2. Fellner C (2016) Zika in America: The year in review. P T 41: 778-791.
  3. Gostin LO, Hodge JG Jr (2016) Zika virus and global health security. Lancet Infect Dis 16: 1099-1100.
  4. Gyawali N, Bradbury RS, Taylor-Robinson AW (2016) The global spread of Zika virus: is public and media concern justified in regions currently unaffected? Infect Dis Poverty 5: 37.
  5. Sikka V, Chattu VK, Popli RK, Galwankar SC, Kelkar D (2016) The emergence of Zika virus as a global health security threat: A review and a consensus statement of the INDUSEM Joint Working Group (JWG). J Glob Infect Dis 8: 3-15.
  6. Lee CT, Vora NM, Bajwa W, Boyd L, Harper S, et al. (2016) Zika virus surveillance and preparedness-New York City, 2015-2016. Morb Mortal Wkly (MMWR) Rep 65: 629-635.
  7. Paixao ES, Barreto F, Teixeira Mda G, Costa Mda C, Rodrigues LC (2016) History, epidemiology, and clinical manifestations of Zika: A systematic review. Am J Public Health 106: 606-612.
  8. Centers for Disease Control and Prevention (2014) Zika virus. Centers for Disease Control and Prevention, Georgia, USA.
  9. Painter JE, Plaster AN, Tjersland DH, Jacobsen KH (2017) Zika virus knowledge, attitudes, and vaccine interest among university students. Vaccine 35: 960-965.
  10. Chesser AK, Keene Woods N, Mattar J, Barrow L (2017) Assessment of student perceptions and opinions of information about Zika from the media. Journal of Family Medicine and Disease Prevention.
  11. Chesser AK, Keene Woods N, Mattar J, Craig T (2016) Promoting health for all Kansans through mass media: Lessons learned from a pilot assessment of student Ebola perceptions. Disaster Med Public Health Prep 10: 641-643.
  12. World Health Organization (2016) Knowledge, attitudes and practice surveys: Zika virus disease and potential complications: Resource pack. World Health Organization, Geneva, Switzerland.
  13. Sharma M, Yadav K, Yadav N, Ferdinand KC (2017) Zika virus pandemic-analysis of Facebook as a social media health information platform. Am J Infect Control 45: 301-302.
  14. Burkle FM Jr (2016) Zika: Defining the public health and exposing its vulnerabilities. Disaster Med Public Health Prep 10: 296-297.
  15. Dredze M, Broniatowski DA, Hilyard KM (2016) Zika vaccine misconceptions: A social media analysis. Vaccine 34: 3441-3442.
  16. Kahn JG, Yang JS, Kahn JS (2010) ‘Mobile’ health needs and opportunities in developing countries. Health Aff (Millwood) 29: 252-258.
  17. Lewin S, Munabi-Babigumira S, Glenton C, Daniels K, Bosch-Capblanch X (2010) Lay health workers in primary and community health care for maternal and child health and the management of infectious diseases. Cochrane Database Syst Rev 17: 004015.

Figures


Figure 1: (a) Chemical structures of PAMPS48-PEG227-PAMPS48 (AEA) and PEG47-PMAPTACm (EMm, m = 27,53, and 106).
[M]0 and [M] represent the concentrations of the monomer at polymerization time = 0 and the corresponding time, respectively.



Figure 2: Time-conversion (?) and the first-order kinetic plots (?) for the polymerization of AMPS in the presence of CPD-PEG-CPD in water at 70oC.
[M]0 and [M] represent the concentrations of the monomer at polymerization time = 0 and the corresponding time, respectively.



Figure 3: GPC elution curves for a sample of HO-PEG-OH (Mn = 9.40 ? 103; Mw/Mn = 1.06) (----) and triblock copolymer of PAMPS48-PEG227-PAMPS48 (AEA, Mn = 2.32 × 104; Mw/Mn = 1.42) (--).
[M]0 and [M] represent the concentrations of the monomer at polymerization time = 0 and the corresponding time, respectively.



Figure 4: 1H NMR spectra for (a) EM53, (b) AEA, and (c) AEA/EM53 micelle in D2O containing 0.1 M NaCl at 20°C. Assignments are indicated for the resonance peaks.
[M]0 and [M] represent the concentrations of the monomer at polymerization time = 0 and the corresponding time, respectively.



Figure 5: (a) Light scattering intensities and (b) Rh for PIC micelles of AEA/EM106 (?), AEA/EM53 (?), and AEA/M27 (?) as a function of fAMPS (= [AMPS]/([AMPS] + [MAPTAC])) in 0.1 M NaCl aqueous solutions. [AMPS] and [MAPTAC] represent the concentrations of the AMPS and MAPTAC units, respectively. The total polymer concentration was kept constant at 1 g/L.
[M]0 and [M] represent the concentrations of the monomer at polymerization time = 0 and the corresponding time, respectively.



Figure 6: (a) Distributions of Rh for the PIC micelles of AEA/EM106 (?), AEA/EM53 (?), and AEA/EM27 (?) in 0.1 M NaCl aqueous solutions. (b) Relationship between relaxation rate (G) and square of the magnitude of the scattering vector (q2). (c) Plots of Rh as a function of Cp.
[M]0 and [M] represent the concentrations of the monomer at polymerization time = 0 and the corresponding time, respectively.



Figure 7: A typical example of Zimm plots for AEA/EM106 micelle in 0.1 M NaCl aqueous solution.
[M]0 and [M] represent the concentrations of the monomer at polymerization time = 0 and the corresponding time, respectively.



Figure 8: TEM images for (a) AEA/EM27, (b) AEA/EM53, and (c) AEA/EM106 micelles.
[M]0 and [M] represent the concentrations of the monomer at polymerization time = 0 and the corresponding time, respectively.

Tables
 

n

(%)

Sex (n=59)*

Male

6

12.24

Female

43

87.76

Age (n=43)*

Maximum

64

 

Mean

27.19

 

Standard deviation

9.99

 

Variance

99.87

 

Parents/caregivers annual income range (n=48)*

Below $20,000

16

33.33

$20,000-59,999

21

43.75

$60,000-$89,999

5

10.42

$90,000 or more

6

12.5

Year in college (n=49)*

Year 1

1

2.04

Year 2

4

8.16

Year 3

9

18.37

Year 4

26

53.06

Graduate school

9

18.37

Table 1: Participant characteristics (N=61).
*Not all participants reported demographics

Citation: Woods NK, Chesser AK, Mattar J, Barrow L (2018) Preliminary Knowledge, Attitudes, and Practice of Students: Zika Virus and Maternal Health. J Community Med Public Health Care 5: 035.