|Year : 2014 | Volume
| Issue : 6 | Page : 732-737
A study on awareness regarding swine flu (influenza A H1N1) pandemic in an urban community of Karnataka
K Shilpa1, BA Praveen Kumar2, S Yogesh Kumar3, Amit R Ugargol4, Vijaya A Naik3, MD Mallapur3
1 Department of Community Medicine, Azeezia Institute of Medical Sciences, Kerala, India
2 Department of Community Medicine, PESIMSR, Kuppam, Andhra Pradesh, India
3 Department of Community Medicine, Jawaharlal Nehru Medical College, KLE University Belgaum, Karnataka, India
4 Department of Microbiology, Azeezia Institute of Medical Sciences, Kerala, India
|Date of Web Publication||18-Nov-2014|
B A Praveen Kumar
Department of Community Medicine, PESIMSR, Kuppam, Andhra Pradesh
Source of Support: None, Conflict of Interest: None
Background: Globally, India was one among the most affected countries for cases and deaths of swine flu (influenza A H1N1) during 2009 influenza pandemic with lot of public hype and panic. Aims: This study was designed to assess the awareness, attitude, myths and practices regarding Swine flu among urban population of Belgaum district, Karnataka. Subjects and Methods: This study was conducted in an urban community of Belgaum, Karnataka during 2009. A total of 250 households were interviewed using a pretested questionnaire by systematic random sampling. One person from each household preferably head of the family was asked regarding knowledge, attitude and practice during swine flu pandemic. Results: Among the study population, 73.6% had previously heard of swine flu. More than half of the participants said mass media communication was found to be the major source of information. Around 82.6% of the participants said fever was the most common symptom and using facemask was accepted as the important mode of prevention by 81.5% participants. Only 19.0% were willing to leave their locality temporarily if any cases were seen around. Majority of the participants selected government hospital for treatment facilities if they get any symptoms of swine flu. Hand washing, as a mode of prevention was known to 92.4% of the respondents. Around 33.4% of the populations were ready to share knowledge to others if they were given health education regarding swine flu. Conclusions: Knowledge regarding swine flu pandemic was low among study participants. Most of the participants had health seeking behavior. Majority of the respondents were practicing hand washing. Strategies to create more awareness about pandemic through effective mass media are vital for containing the pandemic.
Keywords: H1N1 flu, pandemic, swine flu, urban community
|How to cite this article:|
Shilpa K, Praveen Kumar B A, Kumar S Y, Ugargol AR, Naik VA, Mallapur M D. A study on awareness regarding swine flu (influenza A H1N1) pandemic in an urban community of Karnataka. Med J DY Patil Univ 2014;7:732-7
|How to cite this URL:|
Shilpa K, Praveen Kumar B A, Kumar S Y, Ugargol AR, Naik VA, Mallapur M D. A study on awareness regarding swine flu (influenza A H1N1) pandemic in an urban community of Karnataka. Med J DY Patil Univ [serial online] 2014 [cited 2017 Apr 26];7:732-7. Available from: http://www.mjdrdypu.org/text.asp?2014/7/6/732/144862
| Introduction|| |
Swine flu is an acute respiratory disease, caused by a strain of the influenza type A virus known as H1N1, officially referred as novel A/H1N1.  The virus is a mixture of four known strains of influenza A virus: One endemic in humans, one endemic in birds and two endemic in pigs (swine). Swine influenza was first proposed to be a disease related to human influenza during the 1918 flu pandemic, which was known as Spanish flu, (infected about 500 million people and caused approximately 50 million deaths).  At the end of March 2009, an outbreak of novel influenza A/H1N1 infection occurred in Mexico, followed by ongoing spread to all over the world in a short period.  On 11 June 2009, the World Health Organization (WHO) raised its pandemic alert to the highest level, phase 6,  meaning that, the A/H1N1 flu had spread in more than two continents. On June 2010, it had caused over 18,172 deaths in more than 214 countries and overseas territories or communities.  Most illnesses, especially the severe ones and deaths had occurred among healthy young adults. ,
Transmission of the new strain is human-to-human. Its symptoms are similar to those of influenza in general. It includes fever, cough, sore throat, body aches, headache, chills and fatigue. The flu can make chronic health problems worse. Vaccines are available for different kinds of swine flu. However, vaccines against the new strain are developed, with safety profile like seasonal flu vaccine. Knowledge, attitude and practice (KAP) of people regarding swine flu are a cornerstone in prevention of virus spread and outbreak. 
India is ranked 3 rd among the most affected countries for cases and deaths of swine flu globally.  The highest number of cases were reported in 2009 (27,236), followed by 2010 (20,604) and 2012 (5,054 cases). The highest number of swine flu deaths took place in 2011 (1,763), followed by 2009 (981) and 2012 (405).  Sheer volume of cases could easily overstretch already fragile and overburdened health services, especially in the developing countries and cause considerable suffering in human populations around the world. 
Swine flu has killed 261 people in India in the first 3 months of 2013, with most deaths reported from Rajasthan and Gujarat. A total of 2,329 people tested positive for the Influenza A (H1N1) virus, in 35 states and union territories.  In a northern state of India, Punjab, total number of confirmed cases was 182 and 42 deaths.  These deaths initiated chain of media reports and local physician's articles on measures to prevent Swine flu being published in the newspaper dailies. When levels of worry are generally low, acting to increase the volume of mass media and advertising coverage is likely to increase the perceived efficacy of recommended behaviors, which in turn is likely to increase their uptake.  Trust in government/media information was more strongly associated with greater self-efficacy and hand washing; whereas trust in informal information was strongly associated with perceived health threat and avoidance behavior. 
"The Government has been successful in providing information to people on swine flu. Even television channels have played a major role in educating people by inviting doctors and experts in their studios every day to provide information about the deadly virus," Information and Broadcasting minister, Government of India said. 
The best we citizens can do is to keep ourselves informed about the happenings and the steps we can take to prevent the spread of the flu.  Adequate amounts of vaccine and antivirals are unlikely to be available early on in a pandemic and latter could become ineffective because of resistance. These factors have focused attention on the use of non-pharmaceutical public health interventions to inhibit human to human transmission and fuelled interest in answering important questions about influenza epidemiology and transmission. 
Keeping all this in view the study was designed to assess the awareness, practices, their attitude and myths regarding Swine flu among urban population of Khasbag, Belgaum district, Karnataka, South India.
| Subjects and Methods|| |
The present cross-sectional study was carried out in the month of November and December 2009 just after an epidemic situation in the study area. According to guidelines for conducting KAP study, minimum sample size required for KAP study is 200,  for sample to be more representative of population, a total of 250 participants were included in the study.
Study participants were the residents of Khasbhag having a population of 7000, which was a field practice area of the department of Community Medicine, Jawaharlal Nehru Medical College; Belgaum district, Karnataka, South India. The study subjects were selected from 1250 households using systematic random sampling. Participants aged 15 years and above were included in the study.
All the selected participants were interviewed personally through pre-tested and pre-designed questionnaire. This pre-designed instrument consists of socio-demographic characteristics (age, sex, education and occupation), knowledge and awareness about the disease (nature, mode of spread/transmission, clinical features and preventive measures) and even the practices followed.
After taking the written consent, participants were interviewed. There were no refusals, as complete anonymity was ensured.
The information thus collected was computerized and analyzed by using Statistical Package for Social Science (SPSS 16.0) software program for Windows. Data was presented as proportions and Chi-square test was used as to find out the association.
| Results|| |
Study population constituted 132 (52.8%) males and 118 (47.2%) females. Among the participants 73.6% (184) had previously heard of Swine flu and were aware of it as a disease entity. Socio demographic profile of the participants has been described in [Table 1]. Hence, further analysis was performed on 184 participants.
Tele media was the most common source of information in 52.2% of the participants [Table 2]. A common symptom of Swine flu such as fever was known to 82.6% while 72.3% and 55.4% of the respondents knew cough and cold as a symptom respectively [Table 3]. Only 2.7% of them had myth regarding spread of swine flu by eating pork, while 56.0% of the respondents said it was by inhalation and close contact with the infected. Half of the participants 50.5% knew there was treatment available for swine flu, while only 10.3% of them had heard about the drug Tamiflu.
When asked, 59.2% of the participants were happy with the measures taken by the government to control the disease and nearly half of them, i.e., 50.5% were aware of free treatment and testing facilities by Government. Use of mask/handkerchief as a preventive measure against swine flu was known to 81.5%, others said it could be prevented by maintaining personal hygiene 37.0%, avoiding crowded places 32.1% etc., as shown in [Table 4].
About 60.3% of them were aware of the tests being done to detect swine flu and majority of them named government hospital as the testing and treatment center near to their locality.
Only few, i.e., 15.8% of them were aware of swine flu vaccine and 16.3% among them were willing to take it. Majority of the participants were scared of the disease, i.e., 63.0% and the reasons given were as shown in [Table 5].
Willingness to leave the place temporarily was seen in 19.0% of the participants. There was a significant association between socio-economic status and the participants willing to leave the place if anybody near to them had experienced the symptoms (P = 0.01). Majority 97.8% of them were ready to take their friends, family members and sufferers to the nearby hospital.
Nearly 53.3% participants preferred government hospital if they had any symptoms of swine flu [Table 6]. Different preventive measures followed by the participants are shown in [Table 7]. Washing hands and avoiding crowded places during an outbreak was significantly associated with socio-economic status (P = 0.000). Sharing knowledge about swine flu was seen in only 33.2% of the participants, which was significant with socio-economic status and occupation of the participants (P = 0.000).
| Discussion|| |
The results of the present study depict a range of knowledge; attitudes and self-reported behavioral patterns concerning H1N1 influenza pandemic among a sample of urban population of Belgaum District, Karnataka.
In our study, 73.6% of the participants had previously heard about swine flu, which was lesser in comparison to other studies, ,,, which may be due to lack of awareness and interest regarding health issues in our study population area. Present study constituted more of male participants, which were similar to a study done in Patiala  while female participants were more in a study done by Latiff et al. in Kuala Lumpur, Malaysia  and Lin et al.  of China. Tele media was the most common source of information in our study which was similar to other studies as well. ,, Health care providers as a source of information were very minimal as they were not well-trained and were not having good knowledge regarding the disease. They should take this opportunity and maximize their efforts in providing health education as they are nearer to the community. A regular training program needs to be designed and implemented with the aim of capacity building of the peripheral health workers, so as to make them competent and to update their knowledge, thus enabling them to teach the various updates.
Fever was the most common symptom known to majority of the participants in our study, as was observed in other studies. , Only 2.7% of the population in our study had a misconception that eating pork can spread swine flu, contradicting the observation made by Singh et al.  which was 40.6%. Use of face mask as a preventive measure was known to 81.5% of the study population while it was low in studies done by Singh et al. 56%  and Farahat et al. 14.3%.  This may be because of good telemedia facilities available in urban areas.
Hand washing as a preventive measure was followed by 92.4% of the participants which concurred with the findings of Farahat et al.,  Balkhy et al.  and Kamate et al.  In our study, 32.1% of the participants avoided crowded places, while it was 52.6% with the findings of the study done by Kamate et al.  and in another study which was conducted by Kumar et al. in Haryana during 2010 pandemic 40.0% of the participants avoided contact with people who appeared sick.  This may be because of the fear they had for swine flu. As prevention is the most appropriate measure to control H1N1 flu pandemic and awareness of H1N1 flu is ranked very high in preventive measures, the distribution of proper information to the public on the status of the H1N1 virus pandemic would have been important to achieve awareness of the potential risks and the optimum code of behavior during the pandemic.
In our study, 81.5% of population knew that the use of mask as a way of prevention from swine flu, whereas hand washing as a personal hygiene, which is a very effective way to prevent swine flu transmission, was known only to 37.0%. In contrast to our study, Rubin et al. in their study  reported higher percentage 87.8% of the interviewers believing hand washing role in reducing swine flu transmission and less respondent 24.3% in favor of use of mask in preventing swine flu spread. The study done by Farahat et al.  demonstrated that, 31.9% of participants believe that, staying at home when infected until cured is better, while in our study only few around 2.7% stayed at home.
In this study, 33.2% were ready to share their knowledge when given health education, which is an important tool of motivation. Furthermore, Whitley and Monto  stated that, health education is an important tool to reduce prevalence of the disease. In addition, Al-Shehri et al.,  demonstrated that, the role of health education in modern world is increased with the goal to provide the individuals with information, skills and motivation necessary to make intelligent decisions concerning life-style and personal health behavior.
The triad of knowledge, attitudes and practices in combination governs all aspects of life in human societies and all three pillars together make up the dynamic system of life itself. Therefore, they were linked all together in a way so that any increase in knowledge, changes in attitudes toward prevention of influenza A H1N1 as well as changes in the kinds of practices that were followed regarding prevention of H1N1 influenza. 
| Conclusion|| |
Knowledge regarding swine flu pandemic was low among study participants. Most of the participants had health seeking behavior, as many of them practiced hand washing. Creating awareness about pandemic through effective mass media is vital for containing the pandemic.
This study investigated the levels of knowledge, attitudes and practices regarding H1N1 influenza pandemic and may help to provide scientific support to assist health sector authorities in developing strategies and health education campaigns to prevent transmission of H1N1 influenza and related pandemics. Guidelines and recommendations have been developed to prevent and control the spread of H1N1 during pandemic threat (WHO, 2009). However, successful containment or control of pandemic influenza will rely on early recognition of sustained human-to-human transmission, which requires an effective system for outbreak detection, rapid data collection, analysis, assessment and timely reporting especially in resource poor settings.
Lack of laboratory facilities, pooling of cases, lack of manpower, vaccine and investigation and a poor health information management system are the important areas, which need immediate attention. Government should focus on providing scientific and effective information through the prime medias. We recommend in the light of study findings that, although people are aware of Swine flu and risk associated with it but they lack in correct knowledge in spite of study has been conducted just after so much hype and this topic being in news and on the tongues of the people.
| Acknowledgment|| |
Our sincere thanks to the residents of Khasbhag, which is the field practice area of Jawaharlal Nehru Medical College, Belgaum, Karnataka.
| References|| |
Girard MP, Tam JS, Assossou OM, Kieny MP. The 2009 A (H1N1) influenza virus pandemic: A review. Vaccine 2010;28:4895-902.
World Health Organization (WHO). Pandemic (H1N1) 2009 - Update. Disease Outbreak News (WHO); 2010 May 14.
Novel Swine-Origin Influenza A (H1N1) Virus Investigation Team, Dawood FS, Jain S, Finelli L, Shaw MW, Lindstrom S, et al
. Emergence of a novel swine-origin influenza A (H1N1) virus in humans. N Engl J Med 2009;360:2605-15.
Center for Disease Control and Prevention (CDC). CDC advisors make recommendations for use of vaccine against novel H1N1. Press Release. Retrieved 2009.
Al-Twab AA. Family socio-economic status scale. Revised ed. MD. Thesis in Educational Basics, Faculty of Education. Egypt: Assiut University; 2004.
Sinha NK, Roy A, Das B, Das S, Basak S. Evolutionary complexities of swine flu H1N1 gene sequences of 2009. Biochem Biophys Res Commun 2009;390:349-51.
Article based on data provide by Union Health Ministry. Available from http://www.articles.timesofindia.indiatimes.com/2013-02-28/india/37351071_1_swine-flu-deaths-highest-number. [Last cited on 2013 May 05].
Narain JP, Bhatia R. Influenza A (H1N1): Responding to a pandemic threat. Indian J Med Res 2009;129:465-7.
IDSP database. Available from: http://www.idsp.nic.in/idsp/userLogs/loginUsers.jsp. [Last cited on 2013 May 05].
Rubin GJ, Potts HW, Michie S. The impact of communications about swine flu (influenza A H1N1v) on public responses to the outbreak: Results from 36 national telephone surveys in the UK. Health Technol Assess 2010;14:183-266.
Liao Q, Cowling B, Lam WT, Ng MW, Fielding R. Situational awareness and health protective responses to pandemic influenza A (H1N1) in Hong Kong: A cross-sectional study. PLoS One 2010;5:E13350.
Available from: http://www.hindustantimes.com/Indianews/%20NewDelhi/Govt-efforts-media-role check-swine-flu-spread-Soni/Article1-448296.aspx. [Last cited on 2013 May 05].
Swine flu India, A fight against pandemic. Available from: http://www.swinefluindia.com/. [Last cited on 2013 May 05].
Kaliyaperumal K, (I.E.C.Expert), Diabetic Retinopathy Project. Guidelines for conducting a knowledge, attitude and practice study. Community Ophthalmol 2004;4:8.
Singh S, Kaur P, Singh G. Study to assess the awareness, perception and myths regarding swine flu among educated common public in Patiala District. Int J Res Dev Health 2013;12:54-60.
Rathi S, Gandhi H, Francis M. Knowledge and awareness about H1N1 flu in urban adult population of Vadodara, India. Available from: http://www.academia.edu/2848942/Knowledge_and_Awareness_about_H1N1_Flu_in_Urban_Adult_Population_of _Vadodara_India. [Last accessed on 2013 May 06].
Chaudhary V, Singh RK, Agrawal VK, Agarwal A, Kumar R, Sharma M. Awareness, perception and myths towards swine flu in school children of Bareilly, Uttar Pradesh. Indian J Public Health 2010;54:161-4.
Farahat T, Al-Kot M, Al-Fath AO, Noh A, Diab N. Promotion of knowledge, attitude and practice towards swine flu A/H1N1; (An intervention study on secondary school children of Menofia Governorate, Egypt. Menofia Med J 2010;23:83-94.
Latiff LA, Parhizkar S, Zainuddin H, Chun GM, Rahiman MA, Ramli NL, et al
. Pandemic influenza A (H1N1) and its prevention: A cross sectional study on patients' knowledge, attitude and practice among patients attending primary health care clinic in Kuala Lumpur, Malaysia. Glob J Health Sci 2012;4:95-102.
Lin Y, Huang L, Nie S, Liu Z, Yu H, Yan W, et al
. Knowledge, attitudes and practices (KAP) related to the pandemic (H1N1) 2009 among Chinese general population: A telephone survey. BMC Infect Dis 2011;11:128.
Balkhy HH, Abolfotouh MA, Al-Hathlool RH, Al-Jumah MA. Awareness, attitudes, and practices related to the swine influenza pandemic among the Saudi public. BMC Infect Dis 2010;10:42.
Kamate SK, 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.
Kumar N, Sood S, Singh M, Kumar M, Makkar B, Singh M. Knowledge of swine flu among healthcare workers and general population of Haryana India during (2009) pandmic. Australas Med J 2010;3:614-7.
Whitley RJ, Monto AS. Prevention and treatment of influenza in high-risk groups: Children, pregnant women, immunocompromised hosts, and nursing home residents. J Infect Dis 2006;194 Suppl 2:S133-8.
Al-Shehri AS, Abdel-Fattah M, Hifnawy T. Knowledge and concern about avian influenza among secondary school students in Taif, Saudi Arabia. East Mediterr Health J 2006;12 Suppl 2:S178-88.
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7]