IJCRR

DOI URL: http://dx.doi.org/10.31782/IJCRR.2021.131121

A cross-sectional study was carried out in tertiary care hospital at Pimpri, Pune, Maharashtra from April 2018 to October 2018. Study participants were physicians working in various departments above the rank of first year junior residents in the same hospital. From previous study it was found that 40.4% participants exhibited good knowledge of JE⁷considering same proportion calculated Sample size using formula for proportionate sample size with 10% allowable error at 95% confidence interval was 93(Open epi software). A total of 103 study participants were included. A convenience sampling, method was applied, and participants were approached on a continuous basis until the required sample size achieved. Intern doctors, visiting doctors, and doctors not willing to participate were excluded from the study.

Knowledge and perception about JE were assessed with the help of preformed self-assessment questionnaire from existing literature.⁷ Knowledge assessment: there were total 17 questions to assess knowledge of study participants. Each correct response were given 1 score and wrong response zero score.  Knowledge scores ranged from 0–17 and cut off level of <12 considered as poor knowledge and ≥12 as good knowledge. Perception questions consisted of 4-point Likert scale of agreement. A score of 1 was given to strongly disagree, 2 to disagree, 3 agree and 4 to strongly agree. The scale measuredperception from maximum 52 to minimum 13. Scores of <40 were taken as negative perception, > 40 as positive perception.

Ethical clearance (Ref No. I.E.S.C/C-10/18) was obtained from Institutional Ethical Review Board before the start of the study. Verbal informed consent was obtained from the study participants and confidentiality was maintained.

Data Analysis

Data was entered in Microsoft Excel 2007. The responses of the participants were statistically analyzed using SPSS v.20. Descriptive analysis for categorical and continuous variable was performed. Categorical variable results expressed in frequency (percentages) and continuous variable results expressed in mean & standard deviation (SD) or Median and quartile depending on distribution of variable. Chi-square test was used to check any difference in knowledge and perception in relation to gender, department, designation, and years of experience after MBBS. P-value of less than 0.05 was reported as statistically significant at 95% Confidence interval.

Results

Out of total 103 health care professional interviewed, 57.3% were male and 42.7% female participants. More than half (57.3%) were from clinical departments, and 64.1% were of junior resident of 2^nd & 3^rd year [Table 1]. Mean years of experience among professionals was 4.17yrs and range 1-40yrs. Based on the total score for knowledge, 68% had good knowledge about disease. About perception scoring 53.4% had positive perception toward disease concerned [table 1]. Surprisingly 25.2% professional responded antibiotics as a first line of treatment for JE and 43.7% responded antiviral drugs are highly effective against JE. Most of them (94.3%) said that precautions need to be taken when dealing with JE patients [Table 2].

Proportionately faculty (75%) had good knowledge of disease compared to resident doctors (60.6%). However, there was no statistically significant difference for knowledge and perception towards JE in relation to gender, designation, years of experience and working department (P>0.05) [Table 4].

Discussion

To the best of our knowledge, this is the first study that has evaluated the knowledge and perceptions of medical practitioners about JE in Maharashtra and India.The results of the study found that the overall knowledge and perception of participants in this study was good, but their knowledge about incubation period, role of antiviral in treating JE and role of antibiotics in treating JE, risk of JE for health worker were not satisfactory. Their knowledge was relatively better for disease transmission, symptoms of JE and vaccines. Similar findings were found when knowledge about JE was evaluated among health caregivers in a study at Shaanxi Province, China and One Indian study.^7,8 Though Present study includes only medical practioner many were uncertain about disease epidemiology as they use to handle very few JE cases in the study area.

Regarding JE case management-in spite of fact that JE is a viral disease and there is no role of antibiotics; also, there is no specific antiviral medication available in the treatment of JE⁹ participants showed unsatisfactory knowledge about pharmacotherapy, as one fourth of participants (25.2%) felt that antibiotics are the first line of treatment. These findings indicate the need to take essential measures to bridge this knowledge gap by implementing effective interventions such as intensifying educational programs in the form of continuous medical education activities and webinars, etc., as JE is a life-threatening disease. In educational Programme, there should be a focus on the case management aspect. These strategies were also supported by previous researchers in their report on the knowledge of Ebola virus disease (EVD) among HCWS in 2014.¹⁰

One fifth of participants (19.4%) in this study wrongly answered that JE is not seasonal in its occurrence. This possibly conclude that there was lack of literature reading habit or participation in workshops or symposia by health care professionals.¹¹ Such health care professionals will mislead diagnosis of Acute encephalitic syndrome (AES) and that will be life-threatening to patients and reduced notification of disease burden. Efforts should be made to address this issue by encouraging health professionals to attend and participate in continuous medical education Programme. Impact of continuous medical education Programme results were helpful to improve case management when a research was carried out at the time of swine flu epidemic in Saudi Arabia.¹²

It is noteworthy to mention that experienced senior doctors (faculty) were more knowledgeable as compared to junior ones. The results are in line with another study.¹⁴The possible reason for these findings could be due to administrative positions held by faculty, which allow them to participate in different educational forums, conferences, and discussion panels which may increase the overall knowledge of workers about healthcare issues associated with current epidemics. Our study findings are similar to a report which suggested that experienced workers are more effective in dealing with patients in healthcare settings.¹⁵ Our study suggests that junior doctors should also focus while conducting training and other educational programs to increase their knowledge about JE. There was no difference in relation to gender, pre and paraclinical department and years of experience for perception towards JE. Even perceptions of the resident doctors and faculty didn’t show much difference towards JE. Study in north India found that the perceptions of the physicians were more positive as compared to nurses, while older participants also showed positive perceptions towards JE.⁷

In the present study perception concerning management part of disease like serious illness, its risk of transmission among health care workers, intensive and emergency treatment suggests a wide gap between theory and practical knowledge of managing JE. This gap in practice could be due to no disease burden and management experience by health care professional in the study area. Also, literature showed that the there is no occurrence or outbreak of JE or acute encephalitis syndrome since more than a decade in the study area.⁵ As of current training pattern of health care professionals in India, they are graduated differently in different parts of the country about managing various health problems depending on local health needs and resources availability so perception about Japanese encephalitis as a serious problem may not be uniform among them all over country.

Perception towards acknowledgingthemselves with the information about disease, interventions like mosquito breeding place reduction, community participation, vaccination, and universal standard precaution while handling JE cases was also not satisfactory. These findings suggest that healthcare professionals being pillars of the society should equip uniformly throughout the country to combat future outbreaks of JE, which may be an important public health problem due to lack of intervention or manmade activities.⁶ Healthcare professionals are also important source of information to general public to provide counselling, education and prevention measures for diseases so it is need of time to strengthen preventive and curative knowledge of post graduate doctors irrespective of disease burden they are handing in particular geographical area during their training. This finding suggests that there is a need to in cult habit of conducting uniform training of health care professionals through seminar/webinar during disease outbreak in different geographical area. Also, there is a need to promote health research uniformly in India as it may provide important information about disease trends, risk factors, and required public health interventions. Arranging research seminars on outbreak of diseases and other health issues on a regular basis may aid in improving perception. Literature found that participation in research activities may change perception of healthcare workers regarding different disease conditions.¹³

Conclusion

Health care professionals have optimized knowledge but not up to the mark. Today’s resident doctors are future health care manager, so they should uniformly empower through medical education Programmes like conferences, seminar, and workshop on Japanese encephalitis, epidemiology, management and epidemiological shift in disease patterns. The study has explored an area where much research needs to be done. Additionally, study findings will help the stakeholders in India to design customized interventions to optimize the knowledge and perceptions of Health care professionals towards JE. The present study has some limitations like small sample size, convenience sampling approach and single-center study, which may not be generalizable to the whole state or country. Our findings address one of the major healthcare problems that may confront India in future. Further studies large size multicentric studies are required to establish these results by including other major referrals hospitals of the affected states of India. Our findings could be a basis for further development of educational campaigns by targeting less knowledgeable areas as highlighted in this study.

Conflict of Interest: No

Source of Funding: Indian Council of Medical Research (ICMR)

Acknowledgement: Authors acknowledge the immense help received from the scholars whose articles are cited and included in references of this manuscript. The authors are also grateful to authors / editors / publishers of all those articles, journals and books from where the literature for this article has been reviewed and discussed.