Knowledge and awareness regarding cholera epidemic among Syrian private university students (non-medical colleges)

doi:10.21203/rs.3.rs-5209297/v1

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Knowledge and awareness regarding cholera epidemic among Syrian private university students (non-medical colleges)

https://doi.org/10.21203/rs.3.rs-5209297/v1

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Background: Cholera is defined as an acute bacterial infection caused by Vibrio cholerae, and the main clinical feature of cholera is watery diarrhea, therefore cholera represents a global threat to public health and a sign of underdevelopment in a country. An important factor contributing to the spread of cholera is the lack of public knowledge and awareness of its transmission methods and early measures to diagnose and treat cholera symptoms, therefore it is important to understand the public knowledge and awareness of this disease to reduce its transmission.

Methods: A cross-sectional descriptive study was conducted at the Syrian Private University, during the period from 12/6/2024 to 27/8/2024. The number of participating students was 208 male and female students, from non-medical colleges at the university. This was done through a questionnaire distributed electronically and in paper form.

Results: Our study included 208 students from the Syrian Private University, males (51%) and females (49%). The most participating age group was "21-25" (52.9%). The most participating students were "Information Engineering" students (43.8%). They answered that the causative agent of cholera is "bacteria" (51.4%). The most important symptoms of cholera were answered "acute watery diarrhea" (54.3%). They answered about the spread of cholera: contaminated water (93.8%). Contaminated food (88%).

Conclusion: We found that the level of knowledge of the participating students at the Syrian Private University is average to weak, and the attitudes and practices of students in some of the points raised are unsatisfactory. We recommend conducting awareness campaigns about the cholera epidemic and further studies at the population level.

Infectious Diseases

Knowledge and awareness

cholera

epidemic

university students.

Cholera is defined as an acute bacterial infection caused by the bacterium Vibrio cholerae. The main clinical feature of cholera is watery diarrhea.[1] Although the causative bacteria have more than 200 serotypes, only two serotypes are prevalent in poor sanitary and hygienic conditions, namely O1 and O139.[2] These two particular strains have been associated with cholera outbreaks worldwide. Cholera infection is usually severe and highly virulent.[3] In addition, cholera outbreaks usually occur in areas where water or food has been contaminated due to poor sanitation.[4] The bacteria are transmitted along the gastrointestinal tract through contaminated food or water. Vibrio cholerae produces cholera toxins, which cause the clinical symptoms of infection.[5] In addition to watery diarrhea, other symptoms include vomiting and abdominal cramps. Furthermore, the infection affects all age groups.[6] The diagnosis of cholera is primarily based on culturing the causative bacteria from a patient’s stool sample.[7] Rapid testing can also provide an initial result to initiate a targeted treatment plan.[8] Management of cholera consists of antibiotics, rehydration measures for vomiting and diarrhea through the administration of electrolytes and fluids.[9] However, the key to preventing cholera outbreaks is through improving hygiene, sanitation and drainage systems. In addition, cholera vaccine can play an important role in controlling and preventing the infection. [10,11] Recent reports have shown that annual estimates of cholera cases worldwide are as high as 4 million, with up to 143,000 annual deaths.[12] Thus, cholera represents a global public health threat and a sign of a country’s lack of development. Cholera outbreaks have affected many countries over the past years, mainly in Asia and Africa, such as India, Sudan, Pakistan and Bangladesh.[13] Another factor contributing to the spread of cholera is the lack of public knowledge and awareness about its transmission methods and early measures to diagnose and treat cholera symptoms. Therefore, it is important to understand public knowledge and awareness about the disease to reduce its transmission.[14]

Aim of the study:

study the knowledge and awareness regarding the cholera epidemic among students of the Syrian Private University (non-medical colleges).

Sample collection tool:

Patient data was collected via a paper/electronic form, which included questions about: patient demographic information, habits, symptoms, type of infarction and its complications.

A cross-sectional descriptive study was conducted at the Syrian Private University, during the period from 12/6/2024 to 27/8/2024.

The number of participating students was 208 male and female students, from non-medical colleges at the university (Information Engineering, Petroleum Engineering, Business Administration). This was done through a questionnaire, containing a set of questions that serve the research objective (causes and symptoms of cholera, knowledge about cholera infection, attitude towards cholera infection).

The approval of the Syrian Private University was obtained to publish the questionnaire in paper and electronic form at the university among students.

Statistical analysis:

Patient data were tabulated and entered into the computer. The questionnaires prepared by the students were collected and filled out and entered into the Excel program. Then, the Statistical Package for the Social Sciences (SPSS) program, version (26), was used to analyze this data. The following statistical methods were used in the analysis: Descriptive analysis: This consists of finding the relative frequency distributions of the categorical study variables (gender, place of residence, financial status, etc.) and adding graphic forms to enrich the results. Inferential analysis: This part of the analysis aims to present and interpret the results and infer from them in order to reach the study objective, by conducting the Chi Square test of independence to study whether there is a relationship between two descriptive variables by applying the Chi Square statistic.

Socio-demographic characteristics of students

Our study included 208 students from the Syrian Private University, 106 (51%) males and 102 (49%) females. The most participating age group was "21–25" 110 (52.9%), followed by "18–20" 58 (27.9%). "Information Engineering" students were the most participating with 91 (43.8%), followed by "Business Administration" 72 (34.6%), and then "Petroleum Engineering" 45 (21.6%). (Table 1)

Table 1
		N	%
Sex	Male	106	51
Sex	Female	102	49
Total		208	100
		N	%
Age groups	18–20	58	27.9
	21–25	110	52.9
	27–35	28	13.5
	36–45	12	5.8
Total		208	100
		N	%
Specialization	Information Engineering	91	43.8
	Petroleum Engineering	45	21.6
	Business Administration	72	34.6
Total		208	100

Causes and symptoms of cholera: Table 2 shows the students' answers about the causes and symptoms of cholera. When asked about the causative agent of cholera, almost half of them answered that it was a "bacterium" 107 (51.4%). When asked about the symptoms of cholera, more than half of them answered that it was "acute watery diarrhea" 113 (54.3%). Regarding the early symptoms indicating fluid loss, a large percentage answered "thirst" 105 (50.5%). When asked about the pulse in cholera, a large percentage answered that it was "slow" 87 (41.8%). They were also asked: Can fluids be replaced orally to manage watery diarrhea? More than half of them answered "yes" 112 (53.8%).

Table 2
		N	%
What causes cholera?	virus	63	30.3
	bacterium	107	51.4
	Fungi	12	5.8
	parasite	26	12.5
Total		208	100
		N	%
Cholera symptoms	Blood in stool, chest pain, sprained hand and foot	46	22.1
	blood in mouth, bleeding in stomach	27	13
	frequent loose stools	22	10.6
	acute watery diarrhea	113	54.3
Total		208	100
		N	%
Early symptoms of fluid loss	thirst	105	50.5
	oliguria	61	29.3
	Low blood pressure	42	20.2
Total		208	100
		N	%
Pulse is usually in cholera.	slow	87	41.8
	fast	71	34.1
	natural	37	17.8
	absent	13	6.3
Total		208	100
		N	%
Do you think that in watery diarrhea fluids can be replaced orally?	Yes	112	53.8
	No	96	46.2
Total		208	100

Knowledge about cholera infection: Table 3 shows students’ answers on the topic “Knowledge about cholera infection”. When asked about the spread of cholera through: Contaminated water; most of them answered “yes” with a percentage of 195 (93.8%). Contaminated food; they answered “yes” with a large percentage of 183 (88%). Flies and mosquitoes; they answered “yes” with a percentage of 157 (75.5%). Poor hygiene; they answered “yes” with a percentage of 184 (88.5%). Sanitation; they answered “yes” with a percentage of 183 (88%).

Table 3
		N	%
Is cholera spread through contaminated water?	Yes	195	93.8
Is cholera spread through contaminated water?	No	13	6.3
Total		208	100
		N	%
Is cholera spread through contaminated food?	Yes	183	88
Is cholera spread through contaminated food?	No	25	12
Total		208	100
		N	%
Is cholera spread by flies and mosquitoes?	Yes	157	75.5
Is cholera spread by flies and mosquitoes?	No	51	24.5
Total		208	100
		N	%
Is cholera spread by poor hygiene?	Yes	184	88.5
Is cholera spread by poor hygiene?	No	24	11.5
Total		208	100
		N	%
Is cholera spread by poor sanitation?	Yes	183	88
Is cholera spread by poor sanitation?	No	25	12
Total		208	100

Attitude towards cholera infection: Table 4 shows the students’ responses on the axis “Attitude towards cholera infection”. Their answers to the questions asked were as follows: “Do you think cholera can be contagious?” 175 (84.1%) answered “Yes”. “Do you think that the spread of cholera can be prevented?” 185 (88.9%) answered “Yes”. “Do you think that traveling to an area where cholera is prevalent can make you get sick?” 185 (88.9%) answered “Yes”. “Do you think that your cultural practice may encourage or influence the spread of cholera?” 176 (84.6%) answered “Yes”. “Do you think that eating in groups may promote the spread of cholera?” 171 (82.2%) answered “Yes”. “Do you think that poor hand washing habits in restaurants will promote the spread of cholera?” A large percentage of 176 (84.6%) answered “yes.” “Do you think that the unsanitary conditions surrounding the city will encourage the spread of cholera?” A large percentage of 195 (93.8%) answered “yes.” “Do you think that the improper use of toilets will encourage the spread of cholera?” A large percentage of 187 (89.9%) answered “yes.” “Do you think that vaccination can prevent cholera?” A large percentage of 153 (73.6%) answered “yes.”

Table 4
		N	%
Do you think cholera can be contagious?	Yes	175	84.1
Do you think cholera can be contagious?	No	33	15.9
Total		208	100
		N	%
Do you think cholera can be prevented?	Yes	185	88.9
Do you think cholera can be prevented?	No	23	11.1
Total		208	100
		N	%
Do you think traveling to an area where cholera is common could make you sick?	Yes	185	88.9
	No	23	11.1
Total		208	100
		N	%
Do you think your cultural practice may encourage or influence the spread of cholera?	Yes	176	84.6
	No	32	15.4
Total		208	100
		N	%
Do you think that eating in groups may promote the spread of cholera?	Yes	171	82.2
	No	37	17.8
Total		208	100
		N	%
Do you think poor hand washing habits in restaurants will promote the spread of cholera?	Yes	176	84.6
	No	32	15.4
Total		208	100
		N	%
Do you think the unsanitary conditions surrounding the city will encourage the spread of cholera?	Yes	195	93.8
	No	13	6.3
Total		208	100
		N	%
Do you think improper use of toilets will encourage the spread of cholera?	Yes	187	89.9
	No	21	10.1
Total		208	100
		N	%
Do you think a vaccine can prevent cholera?	Yes	153	73.6
Do you think a vaccine can prevent cholera?	No	55	26.4
Total		208	100

Practices on cholera infection: Table 5 shows students’ responses to questions related to practices on cholera infection. They were as follows: “Would you go to the hospital to treat yourself if you suspected cholera?” Most of the students answered “yes” with a percentage of 189 (90.9%). “Would you resort to traditional medicine to treat yourself if you suspected cholera?” Most of the students answered “no” with a percentage of 107 (51.4%). “Would you consume a prescription to treat yourself if you suspected cholera?” 153 (73.6%). “Would you always wash your hands with soap?” Most of the students answered “yes” with a percentage of 194 (93.3%).

Table 5
		N		%
Would you go to the hospital to treat yourself if you suspected cholera?	Yes		189	90.9
	No		19	9.1
Total		208		100
		N		%
Would you turn to traditional medicine to treat yourself if you suspected cholera?	Yes		101	48.6
	No		107	51.4
Total		208		100
		N		%
Would you take a prescription to treat yourself if you suspected you had cholera?	Yes		153	73.6
	No		55	26.4
Total		208		100
		N		%
Will you always wash your hands with soap?	Yes		194	93.3
Will you always wash your hands with soap?	No		14	6.7
Total		208		100

Cholera is an infectious disease that can lead to an epidemic outbreak. This type of infection is more common in areas that suffer from a lack of adequate health facilities and hygiene measures. Therefore, it is necessary to improve the public's knowledge and awareness of cholera infection and the necessary measures to prevent cholera infection.

The current study aimed to investigate the level of knowledge, practice and attitude of Syrian Private University students towards the causes, manifestations and attitudes of cholera infection.

The study revealed an average general awareness among university students about cholera infection, as almost half of the participating students (51%) answered correctly that the causative agent is a "bacterium", and there was a slight preponderance of males (26%) compared to females (25%) in answering correctly, but there was no statistically significant difference (P-Value > 0.05). Students of the Faculty of Information Engineering answered correctly at a higher rate than the Faculties of Business Administration and Petroleum Engineering, but there was also no statistically significant difference (P-Value > 0.05).

The percentage of those who answered correctly about the main symptom of cholera infection was (54%), and the percentage of females was greater (28.6%) compared to males (26%) by answering correctly that the main symptom is "acute watery diarrhea". The students of the College of Information Engineering also answered correctly at a higher rate than the Colleges of Business Administration and Petroleum Engineering, but there was also no statistically significant difference (P-Value > 0.05).

By studying the students' knowledge about the methods of spreading cholera infection, we found a good level of awareness, as (93%) answered correctly that the main method of transmission is contaminated water, and at rates exceeding (80%) that contaminated food, poor hygiene and poor sanitation are among the methods that cause the spread of infection.

By studying the students' attitude towards cholera infection, we found good percentages exceeding (80%) of the participating students who answered well because: cholera is a contagious infection, and the spread of cholera can be reduced, traveling to an infected area is a factor in contracting the disease, some cultural practices and eating habits contribute to the spread of cholera, and insufficient hand washing and inappropriate use of toilets are factors that cause the spread of infection and thus modifying them has a role in reducing the spread of infection.

Finally, by studying the practices regarding infection that students will carry out, where most students (90%) reported that they would go to a hospital in the event of infection, and less than half of them (48%) would resort to treatment with traditional medicine.

The current study had some limitations; it included participants in only one university and non-medical colleges at the Syrian Private University, which may affect the realism of these results.

These results represent an inference for primary care physicians such as general practitioners and family medicine physicians during their practice, especially in developing countries. They can provide them with an understanding of the community's perception of the risks and method of transmission of cholera.

This understanding could improve physicians’ communication with patients and provide them with important information that patients may not know. Furthermore, it could guide public health decision-makers in developing national public awareness campaigns to improve their knowledge and reduce the spread of the disease, especially in epidemics.

We found that the level of knowledge of the participating students at the Syrian Private University was average to weak, and that the students’ attitudes and practices were considered unsatisfactory in some of the points raised.

Declarations Ethical statement:

The ethical consent was obtained from Syrian private university ethical committee Competing Interest: the authors declare no competing of interests.

Availability of data and materials:

All data are available from the corresponding author on reasonable request.

Funding:

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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The authors declare no competing interests.

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Knowledge and awareness regarding cholera epidemic among Syrian private university students (non-medical colleges)

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