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Global Advanced Research Journal of Medicine and Medical Sciences (ISSN: 2315-5159) Vol. 7(4) pp. 090-097, April, 2018
Available online http://garj.org/garjmms
Copyright © 2018 Global Advanced Research Journals
Full Length Research Article
Middle East Respiratory Syndrome-Corona virus:
Knowledge and attitude of Qassim University students,
KSA
Hanan M. M. Tork, RN, MSN, PhD and Fathia Ahmed Mersal, RN,MSN, PhD
College of Nursing, Qassim University, Saudi Arabia
Accepted 05 May, 2018
Globally, since September 2012, 1626 laboratory-confirmed infected cases with MERS including at least
668 related deaths have been reported to WHO from 26 countries. Approximately 80% of human cases
have been reported by Saudi Arabia and the numbers of infected cases increase gradually. Effective
infection prevention and control depends on awareness of people at all levels. The current study aim to
assess the knowledge and attitude of QassimUniversity students in Saudi Arabia towards Middle East
Respiratory Syndrome Coronavirus (MERS-CoV). A cross-sectional study was conducted among 733
undergraduate students at Qassim University. Knowledge and attitude were assessed by using self
administered questionnaire. Data were analyzed using SPSS version 16. Descriptive statistics were
used for data summarization and presentation. The findings of this study showed that the main
sourcesof information regarding Corona among students were internet followed by television and radio.
Lessthan three quarters of students had satisfactory knowledge and majority of them had positive
attitude.Whereas majority of students think that University did not provide awareness campaigns about
Corona.Furthermore, the findings explained that female had better knowledge than male and medical
studentsaremore knowledgeable than non-medical students with p> (0.000). The current study
findingsconcluded that the studied sample had good knowledge score as well as positive attitude
toward MERSCoV. Future research should recruit students from different regions of the country in order
to better assessment of students’ knowledge about MERS-CoV.
Keywords: Corona virus, Knowledge, attitude, University students, KSA
INTRODUCTION
Middle East respiratory syndrome (MERS) is a recent
infectious disease caused by a coronavirus that
contributes increase to respiratory infection (Choi and
Kim, 2016). It has been an emerging worldwide health
problem that is mainly identified in Kingdom of Saudi
Arabia (KSA) with progressive growth in cases and
*Corresponding Author E-mail: 3239@qu.edu.sa
deaths (Nour et al., 2015). The virus is a new, evolving
infectious disease that was primary identified in 2012 in
Saudi Arabia (Al-Hazmi et al., 2016). Saudi Arabia
showed the first case of MERS and recorded the highest
level of infection and mortalities around the world.
According to the last statement from WorldHealth
Organization (WHO), more than1626 cases of MERS
have been reported in 26 countries worldwide, 668 of
them died and the numbers of infected cases increase
gradually (WHO, 2017).However, 85% of reported cases
were detected in Saudi Arabia, mostly in the cities of
Riyadh and Jeddah (Meyer et al., 2015; Saudi Ministry of
Health, 2014). The infection route has not been
clarifiedevidently, although its transmission through
Arabian camels was documented in Saudi Arabia. Most
patients originally suffer from a severe acute lower
respiratory illness, but others are asymptomatic or
indicate a mild acute upper respiratory illness (Centers
for Disease Control and Prevention, 2015).
Effective infection prevention and control depending on
awareness and compliance of healthcare workers at all
levels (WHO, 2017). A survey of healthcare workers in
South Korea found a poor level of knowledge of the
modes of transmission, which was implicated in the rapid
spread of the infection in hospitals (Kim, 2015).Level of
the community's awareness and knowledge about the
MERS-CoV and their attitudes toward infected persons
play a critical role in controlling the disease (Kim and
Choi, 2016). Community compliance with preventive
measures is as important as well-organized outbreak
response and failure to comply with preventive measures
in emergency situations may expose public health to risk.
Public attitude and knowledge have a serious impact on
the spread of infections (Akan et al., 2010). Universities
with their large concentrations of young persons have the
potential to be a focus of serious outbreak. Consequently;
thissecondarily may have a negative effect in the
community (Akan et al., 2010). Owing to the serious
threat posed by MERS-CoV to public health, it is
essential to evaluate the knowledge, attitudes and
behavior of the public and students towards important
and spread of infectious diseases. This information
provides baseline statistics for the prevention and control
of infectious diseases through estimation of the influence
of previous prevention efforts made by the government
and guiding the need for further interventions (Al-
Mohaissen., 2017).
Available studies about awareness and attitude among
the Saudi Arabian community toward this infection are
little and limited by the small number of participants.
Public awareness of MERS-CoV helps significantly in
infection control whereas a lack of necessaryinformation
leads to low detection rates,delayed treatment,generate
fear and prejudice towards those who are infected,
discrimination and stigma (Zaini, 2016; Al-Mohaissen,
2017).
The Saudi Ministry of Health (MOH) has performed a
series of preventive measures, including strategies to
control the spread of MERS-CoV andto enhance public
health awareness through social media, and distribution
of educational materials in shopping malls, schools and
mosques. However MOH has reported a positive relation
between MERS-CoV infection and direct contact with
infected family members. So, it is obvious that people in
Saudi Arabia still lack the reasonable awareness
regarding the MERS-CoV mode of transmission, and
accessible protective measures to decrease exposure
Tork and Mersal 091
(Jradi, 2016).
In Saudi Arabia, several studies addressed the
awareness of healthcare worker and medical students
about MERS. The studies showed that awareness among
healthcare workers vary between institutions, gender and
among different professions (Khan et al., 2014; Kharma
et al., 2015; Al-Mohrej and Agha, 2016; Alsahafi and
Cheng, 2016). The knowledge of healthcare workers in
Mecca, Medina and Jeddah about MERS was poor and
there is need for further education and training programs
specially in using personal protective equipments and
infection control measures (Alsahafi and Cheng, 2016). In
Jeddah, a study addressing the awareness of all
procedures concerning prevention and protection from
MERS among students of dental college which revealed
that more information needs to be provided (Kharma et
al., 2015). In Riyadh undergraduate students of Health
colleges' in King Saud Bin Abdul-Aziz University were
knowledgeable regarding the clinical aspects of MERS
but were lacking background awareness in the basic
sciences (Al-Mohrej and Agha, 2016). In Qassim-our
setting-a study showed that healthcare workers have
good knowledge and positive attitude towards MERS but
no data available regarding University students (Khan et
al., 2014). Therefore, the current study was designed to
assess the knowledge and attitude of QassimUniversity
students towards Middle East Respiratory Syndrome
Coronavirus to provide a baseline data regarding
knowledge and attitude of University students in Qassim.
STUDY METHODOLOGY
Study design, Setting and participants
A cross-sectional study was conducted for the period
offour months at Qassim University in Qassim region,
Saudi Arabia. A total of 733 University students who
studied at different colleges (Nursing, computer sciences,
Preparatory Year Program ‘PYP’, Medicine, Medical
Applied Sciences, Business, Dentstry, Pharmacy) were
invited voluntarily to participate in this study. The
generated sample size was adequately powered to
estimate the process parameters. A convenience
sampling approach was adopted in which the
respondents were recruited on ease of accessibility.
Measures
The data was collected through a self-administered
questionnaire. The study questionnaire was designed by
Memish et al., (2014) and its validity and reliability were
tested in different studies (Al-Tawfiq and Memish, 2014;
Memish et al., 2014). The questionnaire was divided into
three parts. The first part includes demographic data of
the participants; the second part assessed the knowledge
of participants regarding MERS in which Yes or No option
092 Glo. Adv. Res. J. Med. Med. Sci.
was given against each set of question. The third part
determined the attitude of respondents towards MERS in
which their response were evaluated through 5 point
Likert scale of agreement. The study instrument
assessed the knowledge of University students by asking
questions about the nature, etiology, symptoms, risk
group, consequences, source of transmission, prevention
and treatment of MERS-CoV. Knowledge scores ranged
from 0-36 and cut off level of <22 were set for satisfactory
knowledge and ≥22 for good knowledge. Assessment of
attitude was carried out through 13 item questions in
which the responses were recorded on 5 point Likert
scale. A score of 1 was given to strongly agree, 2 to
agree, 3 to undecided, 4 to disagree and 5 to strongly
disagree. A score of ≥ 48 was considered as positive
attitude while score of < 48 was taken as negative
attitude.
Data Collection Procedure
Permission was obtained from the University Studies
Center at Qassim University as required by its policy.
With the help of the responsible administrator at each
college, the researcher obtained consent from the
students who invited to voluntarily participate in the study.
The investigator asked the professors of general studies
courses for permission to administer the survey in their
classes. The self-administrated questionnaire, which was
filled in by participants has a cover letter stating the
purpose of the study. The investigators ensured students
that data provided would be kept confidential where no
names or other identification was collected. After
collecting questionnaires from the study sample, the
questionnaires with considerable missing data were
excluded.
Data analysis
The data collected from the survey was coded and
entered into the mainframe computing system using
SPSS version 16 (Chicago, IL, USA). Data were
analyzed using frequency and percentage statistics,
appropriate statistical methods were applied as
correlation coefficient (r).Regarding P value, it was
considered that: non-significant (NS) if P> 0.05,
Significant (S) if P< 0.05, Highly Significant (HS) if P<
0.01.
Ethical Issues
Participation in the study was voluntary and the purpose
of the study was explained to students prior to distribution
of the questionnaires.Written consent was obtained from
each study participant by attaching a statement of
consent to each questionnaire. However, identification of
the students was not recorded anywhere on the
questionnaire and confidentiality was assured by
analyzing the data in aggregate.
RESULTS
A total of 733 undergraduate University students were
participated in the present study, majority of them
(88.5%) were female and more than half of students
(55.1%) their age ranged between 18 to 21 years
old.Additionally majority (93.6% ) of them live in urban
and 96.6% live with their family, whereas more than two
thirds (69.4%) of them study in health colleges (table 1).
Table 1. Number and Percent Distribution of Studied Sample
Regarding Their Personal Characteristics
Parameter N=733 %
Age
18-21 404 55.1
22-25 325 44.3
> 25 4 0.5
Gender
Male 84 11.5
Female 649 88.5
Residence
Urban 686 93.6
Rural 47 6.4
Living with
Family 708 96.6
Relatives 11 1.5
Students home 5 0.7
Alone 9 1.2
Specialty of college
Medical 509 69.4
Non-Medical 224 30.6
26.9
6.3
6.4
3.8
11.7
17.5
9.3
18.1
Nursing Medicine
dentistry
Computer sciences Applied medical sciences
Business
PYP Pharmacy
Figure 1. Percentage Distribution of studied sample regarding their
Colleges
Figure (1) shows that most (26.9%) of students were in
nursing college followed by pharmacy and business
students (18.1% and 17.5%) respectively.
Tork and Mersal 093
0
10
20
30
40
50
60
70
Friends and
relatives
Internet College TV and
radio
Journals and
magazines
32.3
66.4
27
55.3
16.2
Figure 2. Percent Distribution of Studied Sample Regarding Their Source of Information about
Corona
Figure (2) indicates that the main sources of information regarding Corona among students (66.4% and 55.3%) were
internet followed by television and radio. Whereas college, journals and magazines (27% and 16.2%) were the scarce
sources of information.
Table 2. Number and Percent Distribution of Studied Sample Regarding Their General Knowledge of Corona
Parameter Yes No
N % N %
1. Have you ever heard of Corona's disease? 722 98.5 11 1.5
2. Are you interested in learning about Corona’s disease? 588 80.2 145 19.8
3. Is it a disease that affects the Middle East only? 365 49.8 368 50.2
4. Is an old disease disappeared and returned during these years? 77 10.5 656 89.5
5. Do you know that Corona is a new disease that does not know
much of its characteristics?
502 68.5 231 31.5
6. Do you think that the disease will increase the severity and
widespread in the near future?
267 36.4 466 63.6
7. Is it a seasonal disease? 344 46.9 389 53.1
8. The cause of Corona's disease is virus? 632 86.2 101 13.8
9. Is Corona infectious disease? 691 94.3 42 5.7
10. Do you think Corona is a hereditary disease? 19 2.6 714 97.4
11. Do you know someone who is infected with Corona? 34 4.6 699 95.4
12. Is there a vaccine against Corona? 265 36.2 468 63.8
Regarding general knowledge of Corona table (2) indicates that majority (98.5%) of students heard about Corona and
97.4% of them known that Corona is not a hereditary and 94.3% reported that Corona is infectious disease. In addition,
86.2% of them agree that virus is the cause of Corona and 80.2% are interested in acquiring information about the
disease. Whereas 63.8% known that Corona had not a vaccination and 63.6% of participants think that Corona severity
and widespread will increase in the future. Small percentage of them (4.6%) who know someone infected with Corona.
094 Glo. Adv. Res. J. Med. Med. Sci.
Table 3. Number and Percent Distribution of Studied Sample Regarding Their Knowledge about Symptoms and Methods of
Transmission of Corona
Parameter Correct Wrong incomplete
No % No % No %
1. Do you think Corona has obvious symptoms? 448 61.1 285 38.9
2. Can you identify the person with the disease? 194 26.5 539 73.5
3. What are the initial symptoms of the disease? 94 12.8 48 6.5 591 80.6
4. What are the advanced symptoms of this disease? 482 65.8 251 34.2
5. What are the methods of transmission of corona? 145 19.8 9 1.2 579 79
6. Is Corona disease transmitted by sexual relationship? 390 53.2 343 46.8
7. Is Corona disease transmitted during childbirth? 474 64.7 259 35.3
8. Corona disease is transmitted among animals? 77 19.8 656 89.5
9. The source of this disease is camels? 417 56.9 316 43.1
Table (3) reflects that students had poor knowledge regarding symptoms and methods of transmission regarding
Corona. Whereas (26.5% and 12.8%) of them can identify person with the disease and know the initial symptoms of the
disease. Furthermore (19.8%) known the methods of transmission of corona and disease is transmitted among animals.
Meanwhile nearly two thirds (61.1%, 65.8%) agree that Corona has obvious symptoms and known its complications,
additionally more than half (53.2% and 56.9%) agree that Corona disease transmitted by sexual relationship and source
of this disease is camels respectively.
Table 4. Number and Percent Distribution of Studied Sample Regarding Their Knowledge about Treatment and Prevention of Corona
Parameter Correct wrong incomplete
No % No % No %
1. Is there an effective treatment against the disease? 295 40.2 438 59.8
2. Do you think that alternative medicine (herbs) can treat the disease? 362 49.4 371 50.6
3. What are the methods of prevention of Corona? 280 38.2 12 1.6 441 60.2
4. Do you comply with methods of prevention? 483 65.9 250 34.1
Regarding knowledge about treatment and prevention of Corona table 4 shows that nearly half (59.8% and 50.6%) of
students think that there is an effective treatment against the disease and alternative medicine (herbs) can treat the
disease. In addition (38.2% and 65.9%) had good information about the methods of prevention of Corona and comply
with methods of prevention.
22.1
40.8
37.1
Do you think that the University has provided sufficient
awareness campaigns about Corona disease?
yes
no
insuffecient
Figure 3. Percent Distribution of Studied Sample Regarding Their Opinion about
Awareness Campaign Presented by University
Figure (3) shows that majority of students (40.8% and 37.1%) think that university did not provide awareness
campaigns about Corona or the awareness campaigns were insufficient respectively.
Tork and Mersal 095
Table 5. Number and Percent Distribution of Studied Sample Regarding their attitude toward Corona
Parameter
N=733
N=733
SA &A I don’t know D & SD
N
%
N
%
N
%
1. Transmission of MERS-CoV infection can be prevented by
us
ing universal precautions given by WHO and CDC
695 94.8 26 3.5 12 1.6
2. Prevalence of MERS can be reduced by active participation of
health care worker in hospital infection control program
665 90.7 56 7.6 12 1.6
3. Any related information about MERS should be disseminated
among peers and other healthcare workers c
709 96.7 19 2.6 5 0.7
4. MERS patients should be kept in isolation 656 89.5 66 9 11 1.5
5. Intensive and emergency treatment should be given to
diagnosed patients
706 96.3 23 3.1 4 0.5
6. Gowns, gloves, mask and goggles must be used when
dealing with MERS patients
690 94.1 35 4.8 8 1.1
7. Healthcare workers must acknowledge themselves with all
the information about MERS
716 97.7 12 1.6 5 0.7
8. Healthcare workers should constantly update their knowledge
of t
he disease
712 97.1 14 1.9 7 1
9. Health professionals should carefully deal with, before, during
and after communicating with a Corona patient
713 97.3 17 2.3 3 0.4
10. You must follow preventive measures at home 687 93.7 34 4.6 12 1.6
11. Owning a hand sanitizer lotion in a pocket or bag is important 670 91.4 43 5.9 20 2.7
12. The mask should be used in gatherings, markets and park 554 75.6 94 12.8 85 11.6
13. I will not sit next to an infected student or a member of her family
who is infected
560 76.4 122 16.6 51 7
N.B: SA &A mean strongly agree and agree- SD &D mean strongly disagree and disagree
Regarding attitude toward Corona, table (5) describes that general positive attitude among majority of students.
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
knowledge
attitude
70.7
96.3
29.3
3.4
unsatisfactory
satisfactory
Positive
Negative
Figure 4. Percent Distribution of Studied Sample Regarding Their Total Knowledge and Attitude
about Corona
Regarding total knowledge and attitude about Corona figure (4) describes that more than two thirds (70.7%) of
students had satisfactory knowledge and majority (96.3%) of them had positive attitude.
096 Glo. Adv. Res. J. Med. Med. Sci.
Table 6. Correlation between Total Knowledge, Total Attitude about
Corona and Personal Characteristics of Studied Sample
Items Total knowledge Total attitude
R p-value R p-value
Age 0.066 0.074 -0.081 0.029
Gender 0.183 0.000** -0.008 0.826
College specialty
-0.235 0.000** -0.051 0.164
Table (6) shows that strongly positive correlation
between gender and total knowledge regarding Corona
which means that female had better knowledge than
male p> (0.000). Additionally it shows that strongly
negative correlation between college specialty and total
knowledge regarding Corona which means that health
colleges’ students had better knowledge than non-health
colleges’ students p> (0.000). Whereas it shows than
there are no relations among personal characteristics and
attitude toward Corona p≤ (0.05).
DISSCUSSION
Levels of knowledge about a particular infectious illness
can be influenced by the seriousness of the illness,
spread of the disease and methods for sharing and
distribution of knowledge. In the case of MERS, the
localized spread of the disease in Saudi Arabia and the
number of fatalities associated with it might have
increased public interest in understanding how to
maintain proper precautionary measures both on the
community and on the individual level (Al-Hazmi et al.,
2016).
The current study aimed to assess the knowledge and
attitude of Qassim University students in Saudi Arabia
towards Middle East Respiratory Syndrome Coronavirus
(MERS-CoV). The distribution of the demographic
variables of the respondents showed a high percentage
of medical colleges students, urban dwellers and female.
This may be justified by the fact that male and females
studying in separate campuses due to cultural norms in
Saudi Arabia and if the data collectors are females, male
will have a little opportunity to participate due to difficulty
in contacting them. Regarding the age of participants, the
majority of studied sample was less than or equal to 25
years old; which consistent with many previous studies
among University students (Al-Hazmi et al., 2016;
Elnagar et al., 2017; Alshammari et al., 2018).
Regarding to the students’ source of information about
corona virus, most of students depending on internet
(66.4%) followed by TV and Radio (55.3%) as asource of
information. This is alogical finding due to recently
widespread of internet, where most of the colleges’
students become internet users and considering it as a
main source of information. This finding more or less is
similar to the findings from previous studies in which
knowledge about emerging infectious diseases was
obtained by internet and watching TV (Hassan, 2016;
Kim and Choi, 2016). The current study confirmed the
fact that students of health colleges are more
knowledgeable compared to other specialties and this
result is in accordance with Amatya et al. (2013). This
difference in the level of knowledge between health
colleges and non-health colleges could be obtained from
study subjects and experience of practice. The present
study showed good knowledge and positive attitude
among students in Qassim University about the disease
and the majority of them believed that the disease could
be prevented by using universal precautions given by
WHO. These results are consistent with a study
conducted in the same region and revealed good
knowledge and positive attitude among healthcare
workers towards MERS (Khan et al., 2014) and also
consistent with other study which done by Alqahtani
(2017) in Najran city among 418 health colleges’
students. In spite of that, the current results are
inconsistent with previous research which done among
nursing students in Hail University and repoted negative
attitude about the disease (Alshammari et al., 2018). The
main limitations of this study were that the study exhibits
results froma single University within a specific regionand
the number of male subjects in this study was small;
therefore, results cannot be generalized in Saudi Arabia
and additional cross-sectional multi-intuitional studies
with convergent sample of both sexes that reflect cultural
characteristics from other Saudi Arabian Universities are
needed. Future research should recruit students from
different regions of the country in order to better
assessment of students’ knowledge about MERS-CoV.
ACKNOWLEDGEMENTS
The Authors extends their appreciation and thanks to the
Deanship of Scientific Research at Qassim University for
funding this work. The authors gratefully thanks as well to
all participants from undergraduate students in Qassim
University and the administrative authorities of the
participated colleges for their time, enthusiasm and
willingness to take part in the study.
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