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View of Knowledge and Attitude of Parents toward Children on COVID 19 Disease- A Qualitative Studies

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Knowledge and Attitude of Parents toward Children on COVID 19 Disease- A Qualitative Studies

Dr.Amruta.C. Naik1, Dr.Rajnish Kumar Verma2, Dr.Chandana Namburi3, Dr.Eklavya Sharma4, Dr.Mudita Sharma5, Dr. Abhimanyu Singh6, Dr.Heena Tiwari7

1MDS, Consultant Pediatric and Preventive Dentist, Pune, Maharashtra, India.

[email protected]

2 MDS, Senior Lecturer, Department of Pediatric& Preventive Dentistry, Kalinga Institute Of Dental Sciences, Campus 5, KIIT University ,Patia, Bhubaneswar, Odisha,India.

[email protected]

3BDS MPH, Epidemiologist, Mississippi State Department of Health, Jackson, MS-39216, United States. [email protected]

4MDS, Consultant Oral & Maxillofacial Surgeon,Tonk ENT Dental & General Hospital, B- 61, Sahkar Marg near ICICI Bank, Jaipur. [email protected]

5MDS, Consultant Oral & Maxillofacial Pathologist, Tonk ENT Dental & General Hospital, B-61, Sahkar Marg near ICICI Bank, Jaipur. [email protected]

6P.G student, Department of Pediatric and Preventive Dentistry, Saraswati Dental College, Lucknow. [email protected]

7BDS, PGDHHM, MPH Student, ParulUniveristy, Limda, Waghodia, Vadodara, Gujrat, India. [email protected]

Corresponding Author:

Dr.Amruta.C. Naik, MDS, Consultant Pediatric and Preventive Dentist, Pune, Maharashtra, India. [email protected]

ABSTRACT:

Background-Coronavirus disease 2019 or COVID-19 had a rapid global spread. COVID-19 is highly infectious and capable to infect the individuals of all age. The aim of the present study is to describe the knowledge and attitude ofparents regarding the COVID-19 infection in children, comprising of the mode of transmission, protection measures and clinical signs of the disease.

Materials & Method- A cross-section study among parents was conducted. The size of the sample was 650. The information regarding the clinical signs of the disease, modes of transmission, protection measuresagainst COVID-19 were collected.

Results- The results of the study indicate that the parents had good understanding of the mode of transmission, protection measures and clinical signs of the disease. Based on the parents’ responses, it was observed that the resources they used the most about COVID-19 was social media (76%),followed by news channels. Most of the parents correctly mentioned that fever was the most common clinical sign, followed by cough. Mostly, parents have an appropriate attitude towards susceptibility to infection in children withincrowds.

Conclusions- It was concluded that reported findings are important in order to understand the clinicalcharacteristics as well as the transmission potential of COVID-19 infection in children from the parents’ perspective. In this study, the knowledge of most of the parents about COVID-19 in children was considered good. Thereby this knowledge helps to create educational programs in order to increase theawareness in areas that had less awareness.

KEYWORDS: COVID-19, children, parents, protection measure, transmission

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INTRODUCTION:

Coronavirus disease- 19, also known as COVID-19 is a new pandemic which has spread from Wuhan, China to the numerous countries.1 So far, most of the severely affected COVID-19 patients have suffered from pneumonia.2 COVID-19 is highly contagious. The current reports from Chinese Centres for Diseases Control and Prevention indicate that the COVID-19 rarely attacks children.3, 4 It is still unclear that why children have a higher resistance to some quite infectious diseases. Healthy respiratory system as compared to adults, a very active innate immune system in children and lesser hidden abnormalities in children may play a role.5,6 The other possible explanations for the lower cases of COVID-19 infections in children may be due to minimum participation of children in the various outdoor activities and they also have little international travel, which further lowers their possibility of getting infected.6,7 It is necessary to explain the primary method that can help in managing COVID-19 in children.8 Presently, the parents are role models and promoter in their children's health. Thereby good parenting skills are very much essential when the children are restrained within their home.

Besides observing the behaviour and performance of the child, parents must also regard their children's needs and protect them against any danger. Thereby, it is necessary to survey the knowledge, attitude and also the beliefs of parents about COVID-19. Since very less research has been performed yet in this area, thereby in the present study, the researchers conducted a cross-sectional survey in order to describe the knowledge and attitude of parents regarding COVID-19 in children, including the protection measures, modes of transmission and clinical signs of the disease.

MATERIALS & METHODS:

A cross-sectional study was designed in which 650 parents participated in an online survey.

All the parents were qualified for this research. This survey consisted of 25 statements categorised as a) measures to protect children against COVID-19 by the parents- 9 statements, b) modes of transmission of COVID-19- 4 statements, c) clinical symptoms -12 statements. Each answer was given one point for the right answer and zero points for the wrong answer. This questionnaire was found reliable and valid. Online surveys were used to collect the data for this research. The objective of this online survey was to collect the responses about the knowledge and the attitude of parents towards the COVID-19 in children.

The parents participating in the study received an email with an agreement form and an online survey for submission, which anonymously and electronically collected data. Around 800 surveys were sent to the parents by e-mail, generating a response rate of approximately 81%. Therefore, out of a total of parents participated in this research of whom 137 (21.0%) were male and 514 (79.0%) were female. The mean age of the participants was 34 years. For their information about COVID 19, mostly parents depended on news channels (n = 530) and social media (n = 480) (Table 1). The statistical package SPSS version 25 was used for the analysis of all statistical data.

RESULTS:

The information was gathered about the knowledge and attitude of parents regarding the home measures, frequent hand washing for childrenand themselves (n = 532), routinely cleaning and disinfecting surfaces that had been in connection with known or suspected patients (n = 554) and placing known or suspected patients in well-ventilated individual rooms (n = 534) (Table-2). Handshaking (n = 459), gathering in crowded places and contacting surfaces like doorknobs and tables (n = 568) were reported as modes of transmission. The information was collected regarding the clinical symptoms of COVID-19 in children and mode of transmission. Most of the parents listed fever as first most common clinical symptom (n = 530) and secondly cough (n = 540) and shortness of breath (n = 572).

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Parents also reported skin rash (n = 59) and heavy sneezing and coughing (n = 558) as symptoms of COVID-19 (Table-3). Furthermore, 61% of parents believe that the children may be infected, but remain asymptomatic (n=490).

TABLE 1:SOURCE OF INFORMATION REGARDING COVID-19 AS PER PARENTS’ RESPONSES

Source of information Number (n)

Social media 480

Google and search engines 279 Family, friends, neighbours 350

News channels 530

Ministry of Health website 69 Scientific articles and research 156 Other, such as newspapers 200 Table 2: Prevention measure as per the parents’ responses

Prevention measures Number (n)

Wash hand frequently 532

Eat boiled and cooked food 375

Apply mask to known or suspected patient 550 Place known or suspected patients in well-ventilated

individual rooms

534 All health workers must wear protective clothing 560 All health workers must wear protective clothing 489 Routinely cleaning and disinfecting surfaces in

connection with known or suspected patients

554

Table 3: Clinical signs of COVID-19 in children as per the parents’ responses

Clinical Signs Number (n)

Fever 530

Cough 540

Shortness of Breath 572

Skin Rash 59

Sneezing and Coughing 558

Sore Throat 324

Joint/Muscle Pain 200

Diarrhoea 150

Vomiting 210

Asymptomatic 490

DISCUSSION:

Results of the present study show that parents in this study depend mainly on the news channels and social media for their information on COVID-19. The results also show that according to the parents’ response, the main reported symptom of a COVID-19 infection in children is fever and also shortness of breath. The results were not completely consistent with the previous studies regarding the main clinical manifestation that include fever and shortness of breath, which found that children and adult patients have the same clinical manifestation, such as cough and fever.9, 10 However, these studies also found that some children just have mild overall symptoms such as diarrhoea and runny nose. Thirteen paediatric patients that

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had tested positive of COVID-19 were in close contact with a family member who also tested positive. The patients included three neonates.10The children underwent a COVID-19 RNA test. The present study shows that approximately 60% of parents believe that children may be infected but remain asymptomatic. This is consistent with the previous studies that mentioned that an infected person does not need to show any symptoms in order to transmit the virus to another person. The study shows that almost 89% of the parents participated in the study agree that the major route of COVID-19 transmission is by respiratory droplet. This finding is also consistent with the finding of other studies. Mostly, people are more susceptible to the virus within the crowds. Many parents were in favour of prevention and mentioned that there are several ways to prevent COVID-19. These methods include frequent washing the children’ hands, giving boiled and cooked food to children, apply masks to known or suspected patients, place known or suspected patients in well-ventilated individual rooms far away from children, wearing protective clothing specially when contacted the sick people, also avoid transporting the patients unless necessary. More than 95% mentioned not to accompany any of their children to a crowded place. Many previous literatures suggested that asymptomatic individuals can also transmit the virus, thereby measures should emphasise on the social distancing like avoiding mass gatherings and also school closures.11-14To determine whether children are important sources of transmission, it is essential to evaluate whether the risk posed by the school closures to the well-being and education of the children is justified.

Identifying and isolating the individuals at early stages is critical in order to control COVID- 19. While being in isolation, the infected children should not have any visitors and the treatment should depend on the basis of clinical experience of adult patients, since there are few cases in children.15

CONCLUSION:

To summarize, it is believed that the findings reported here are important in order to understand the clinical characteristics and also the transmission potential of the COVID-19 infection in children, from the perspective of parents. The knowledge of parents about COVID- 19 in children was considered good. The parents have a good background knowledge on the protection measures against the disease, modes of transmission of the virus and clinical signs of the disease.

REFERENCES:

1. Rothan HA, Byrareddy SN. The epidemiology and pathogenesis of coronavirus disease (COVID- 19) outbreak. Journal of autoimmunity. 2020 Feb 26:102433.

2. Abuhammad S. Parents’ knowledge and attitude towards COVID-19 in children: A Jordanian Study. Int J ClinPract. 2021;75: e13671

3. Le HT, Nguyen DN, Beydoun AS, Le XTT, Nguyen TT, Pham QT, Ta NTK, Nguyen QT, Nguyen AN, Hoang MT, Vu LG, Tran BX, Latkin CA, Ho CSH, Ho RCM. Demand for Health Information on COVID-19 among Vietnamese. Int J Environ Res Public Health. 2020 Jun 18;17(12)

4. Lee P.I., Hsueh P.R. Emerging threats from zoonotic coronaviruses-from SARS and MERS to 2019-nCoV. J MicrobiolImmunol Infect. 2020 Feb 4;(20):30011–30016. pii:

S1684-1182

5. Wang D., Hu B., Hu C., Zhu F., Liu X., Zhang J.1. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China.

J Am Med Assoc. 2020 Feb 7

6. Wang C, Pan R, Wan X, Tan Y, Xu L, McIntyre RS, Choo FN, Tran B, Ho R, Sharma VK, Ho C. A longitudinal study on the mental health of general population during the COVID-19 epidemic in China. Brain, behavior, and immunity. 2020 Apr 13

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7. Li Q., Guan X., Wu P., Wang X., Zhou L., Tong Y. Early transmission dynamics in Wuhan, China, of novel coronavirus-infected pneumonia. N Engl J Med. 2020

8. Wang C, Pan R, Wan X, Tan Y, Xu L, McIntyre RS, Choo FN, Tran B, Ho R, Sharma VK, Ho C. A longitudinal study on the mental health of general population during the COVID-19 epidemic in China. Brain, behavior, and immunity. 2020 Apr 13

9. Depoux A, Martin S, Karafillakis E, Preet R, Wilder-Smith A, Larson H. The pandemic of social media panic travels faster than the COVID-19 outbreak. Journal of Travel Medicine, 2020 Mar 3.

10. Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y, Qiu Y, Wang J, Liu Y, Wei Y, Yu T.Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. The Lancet. 2020 Feb 15;395(10223):507-13

11. Adalja AA, Toner E, Inglesby TV. Priorities for the US health community responding to COVID- 19. Jama. 2020 Mar 3. 24.

12. Chinazzi M, Davis JT, Ajelli M, Gioannini C, Litvinova M, Merler S, y Piontti AP, Mu K, Rossi L, Sun K, Viboud C. The effect of travel restrictions on the spread of the 2019 novel coronavirus (COVID-19) outbreak. Science. 2020 Mar 6

13. Wu Z, McGoogan JM. Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: summary of a report of 72 314 cases from the Chinese Center for Disease Control and Prevention. Jama. 2020 Feb 24.

14. Aman F, Masood S. How Nutrition can help to fight against COVID-19 Pandemic.

Pakistan Journal of Medical Sciences. 2020 May 9;36

15. World Health Organization. Coronavirus disease 2019 (COVID-19): situation report, 72

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