Knowledge and attitude of teachers and school nurses about upper respiratory tract infections among primary school students

Introduction

Schools inherently foster the transmission of infections from person to person because they are a group setting in which students are in close contact and share supplies and equipment. The spread of infection does not just stop at the school, the children pass it to their siblings, friends and family – out into the wider community as they go from place to place^(1).

Infectious diseases account for millions of school days lost each year for school students in the United State in ( 2014) 40% of children aged 5–17 years missed 3 or more school days because of illness or injury. Nearly 22 million school days are lost each year due to colds alone and  38 million school days are lost each year due to the influenza virus ⁽²⁾.

In Egypt according to the WHO, the number of reported cases of mumps was (20390, 7626 and 5143 cases) in 2013, 2014and 2015 respectively. In 2014 the number of reported cases of chickenpox was 1075 cases, the number of reported cases of measles was (1314 and 5432 cases) in 2014 and 2015 respectively. In 2015 number of reported cases of the seasonal influenza was 9769 cases, and German measles was 53 cases ^(3).

In Minia Governorate, the ministry of health and population reported that; the number of reported cases of measles was (4, 27, 175 and 18cases) respectively in 2013, 2014, 2015and 2016. Mumps cases was (1686, 175 and 59 cases) respectively in 2013, 2014 and 2015. Seasonal influenza cases was (225, 242 and283 cases) respectively in 2014, 2015and 2016. Chickenpox cases were (34 and 198 cases) respectively in 2015and 2016. And  12 cases of  meningitis  in 2016⁽⁴⁾.

Teachers have a variety of responsibilities for the health of their students such as motivating them in the development of healthy habits, encouraging student's responsibility for health and observing them for signs of health problems. Also have a responsibility to model healthy behavior and provide health instruction. Other responsibility includes assisting with screening efforts and measures to control spread of disease. Teachers may counsel students with health problems and may make referral for assistance as appropriate ^(5). 

The school nurse's responsibility in infectious disease control is to determine student at risk, students or staff with close contact, determine who will provide the required intervention, and develop strategy for early identification of additional cases and an exclusion policy.  Also she should be knowledgeable  about  current  infectious  diseases regulations  and  control,  current  reportable  diseases, collaborate with health care providers on limitations for the child upon return to school, promote prevention and control through health education, serving  as  a  resource  person  to  staff,  provide  health counseling  to  parents  and  guardians  regarding appropriate treatment and follow-up. School nurses need to be physically present in schools to address these responsibilities appropriately .Improved student outcomes result where schools have a full-time school nurse ^(6).

Significance of the study

Respiratory infectious diseases aren't new disease but spreading and identified from thousand years. It can be a major cause of death among school children and affect child's schooling by causing absenteeism and delay school achievement ⁽⁷⁾ .Worldwide nearly 22 million school days are lost each year due to colds alone and 38 million due to the influenza virus ^(8).At Minia governorate upper respiratory tract infections are common among school children and rise in prevalence especially in winter and spring. So this study was conducted to assess the knowledge and attitudes of teachers and school nurses because they are the main responsible for the health of these pupils who haven't developed good personal habits or immunity to various diseases.

Aim of the Study

This study aimed to assess knowledge and attitudes of school teachers and school nurses about upper respiratory tract infections among primary school students.

Research questions

1-       What are the knowledge and attitudes of school teachers and nurses about upper respiratory tract infections among primary school students?

2-       What are the relations between knowledge and attitudes of school teachers and school nurses and the prevention of upper respiratory tract infections?

Subject and Methods

Research design:

                A descriptive design was used to achieve the aims of the current study.

Setting:

           The setting was chosen by Multistage Random Sample. The study was conducted in six governmental primary schools out of three districts in Minia governorate were chosen and from each district a rural and an urban primary school were selected randomly.

Sample

           Convenient sample was used in this study. The total sample size was 234 teachers and school nurses.

Tools of data collection:

Tool one: It was developed by the researcher and it was a structured questionnaire which was consisted of the following parts:

v  Part I: Personal and socio-demographic data: such as (age, sex, address, qualifications, etc….).

v  Part II: it include knowledge of school teachers and school nurses about upper respiratory tract infections e.g. (sign and symptoms, mode of transmission, etc….).

Tool two: It includes the attitudes of school teachers and school nurses when they find a case of upper respiratory tract infections.

Scoring system: 

The researcher determined 26 questions about knowledge of upper respiratory tract infections, every question equal one degree and total score equal 26 degrees. After the calculation of each person's scores the participant who had:

• ≥60 % = Satisfying knowledge.
• < 60% = Unsatisfying knowledge.

The attitudes will be measured by using Likert's scale ^(9). Its questions were being recorded into, agree with a score 3, to some extent 2 disagree with score 1. The participant who had:

• 60 % and more = positive attitude.
• Less than 60% = negative attitude.

Validity

The tools were tested for content validity by three experts of academic medical and nursing staff from faculty medicine and faculty of nursing at Minia University. Modifications were done accordingly.

Reliability

The tools were designed in its final format and tested for reliability by using internal consistency using Cronbach test, the tools proved to be reliable (0.73).

Pilot study

          A pilot study was conducted on 10% of the study sample in the selected setting to evaluate the applicability & clarity of the tools. No modification was done in the study tool based on the pilot study. This sample was included into study sample.

Ethical consideration:

        An official letter of the study approval was obtained from the dean of the faculty of nursing at Minia University to undersecretary of the ministry of education, then to the chairman of the previously mentioned setting. A written initial approval obtained from the research ethical committee of the faculty of nursing, Minia University. An oral permission for voluntary participation was obtained from teachers and school nurses and purpose of the study was explained.

Study procedure

The researcher initially introduced herself to all participants and they were assured that the collected data would be absolutely confidential. Persons were informed that participation is voluntary. Data were collected within 3 months from February to April 2016, two days/week at official school time from 8 Am: 12 pm. The investigator met the subjects in their work place and they were interviewed at times that were convenient to them. The time spent to fill the questionnaire ranged between 15 to 20 minutes according to the needed explanation. Measures were taken to protect ethical rights of subjects.

Statistical design:

        Data collected and analyzed by computer program SPSS" ver. 20" Chicago, USA. Data expressed as mean, Standard Deviation, number, and Percentage. Using t.test to determine significant for the numeric variable. Using Chi-square to determine significant for the non-parametric variable.

Results

Table (1): Distribution of the study sample according to their personal and demographical data (n= 234)

*According to school teachers’ view

Table (1): the above table show that distribution of socio-demographic data of teachers and school nurses, regarding to their age, the table showed that 41% of them were ranged between 35- 46 years, 76.1% of them were female, 52.1% school place in urban area and near to half (47%) of them have university qualification,  regarding to the economic status of the study sample more than half (51.3%) mentioned that their economic status were somehow sufficient according to their point of view, about one third (35%) of them have experience less than 10 years. It also the vast majority of teachers’ (89.7%) married with children.

Fig (1): Concerning the school teachers and school nurses opinion toward best methods of health education for primary school students

Figure (1): this figure highlighted that, concerning the school teachers and school nurses opinions toward best methods of health education for primary school students; third fourth (76.5%) of them said that combination between posters, pictures, lectures and handout are best methods of health education. Other sources were posters and pictures, lectures only, and handout only (17.9 %, 4.7%, & 0.9 % respectively).

Table (2): Distribution attitudes of teachers regarding upper respiratory tract infections among students (n = 231)

Table (2) revealed attitudes of teachers regarding upper respiratory tract infections among students where the majority of respondents agreement were in referring of ill students with respiratory infections to the school nurse, it’s important to observe students contact after the isolation of the infectious case, should observe the diseased student with infectious disease when returning to school after cure, it’s necessary to follow up the absences and ask about the cause of absence, must report the members of the school after the return of the student, should guide students to follow positive health behaviors, and it’s necessary to obtain health education for respiratory infectious diseases (90.1%, 96.5%, 93.9%, 97.4%, 89.6%, 99.6%, & 99.6% respectively)

Table (3): Distribution total knowledge & attitudes scores of school teachers and school nurses regarding upper respiratory tract infection (n = 234).

       Table (3): showed that, in relation to total knowledge & attitudes scores of teachers and school nurses’ regarding upper respiratory tract infection, (52.6 %) of them had unsatisfactory level of knowledge while (47.4%) had satisfactory level of knowledge about upper respiratory tract infection but, the majority of sample subject (99.6%) had positive attitude toward action must done before, during and after upper respiratory tract infection occur.

Table (4): Correlation between demographic data and school teachers and school nurses knowledge and attitudes regarding upper respiratory tract infection (n = 234)

*Correlation is significant at the 0.05 level ** Correlation is significant at the 0.01 level

Table (4): this table mentioned that as regard to correlation between demographic data teachers and school nurses knowledge regarding upper respiratory tract infection, there were weak positive association between total knowledge regarding upper respiratory tract infection and qualification and sources of getting information (r = .200**, .139* respectively) also, between total attitude scores and sources of getting information (r = .141*), but there were fair negative association between age, years of experiences and total knowledge scores (r = -.299**, -.278** respectively).

Table (5): Correlation between prevention of spread of upper respiratory infections and school teachers and school nurses knowledge and attitudes regarding upper respiratory tract infection (n = 234)

         *Correlation is significant at the 0.05 level   ** Correlation is significant at the 0.01 level

Table (5): illustrated correlation between prevention of spread of upper respiratory infections and school teachers and school nurses knowledge regarding upper respiratory tract infection. There were significant relation between prevention spread of respiratory infectious diseases and teachers’ knowledge and attitude regarding upper respiratory tract infection (r = .166*& .297** respectively).