Knowledge, attitude and practices towards Crimean Congo hemorrhagic fever of residents of Kyankwanzi and Kakumiro districts, Uganda

Abstract

Crimean Congo Hemorrhagic Fever(CCHF) is characterized by a sudden onset of high fever, chills, severe headache and gastrointestinal disorders, such as nausea, vomiting, and diarrhea. Hemorrhagic manifestations occur during severe cases and often present as large areas of ecchymosis, but not frank bleeding. Exposure to ticks, most notably those in the genus Hyalomma or direct contact with body fluids of virus-infected animals or humans are considered the critical risk factors. The virus is highly infectious and its transmission can be minimized by having clear knowledge, right attitude and practices about it. Proper and timely infection-control measures, universal precautions like restricted engagement with suspected patients, careful management of infected patients and public awareness are suitable interventions. We conducted a study to determine the knowledge, attitude and practices of people towards CCHF in Kakumiro and Kyankwanzi Districts of Uganda. The study followed a mixed-method design to collect quantitative data (400 participants) and qualitative data (40 participants) systematically and purposively respectively from sampled community members in Kyankwanzi and Kakumiro Districts. Quantitative data was collected using a pre-tested interviewer-administered questionnaire while qualitative data was collected using an audio recorder and focus group discussion guide. Categorical and numerical variables were summarized into frequencies and means respectively. Overall knowledge was determined by obtaining the lowest score on the five asked questions whereas overall attitude was determined by averaging the scores of strongly agreeing and agreeing on each attitude variable. Associations were explored using a binary logistic regression model. A P-value < 0.05 was considered statistically significant. Qualitative analysis was done using thematic analysis in Atlas ti software. The proportion of those who were found to have knowledge on CCHF was 30% (95% CI 25.55 – 34.75). Participants who had a primary level of education were 2.44 times more likely to be knowledgeable about CCHF as compared to those who had no education [Odds Ratio (OR) = 2.44, P-value = 0.021]. Participants from Kakumiro were almost 3 times more likely to be knowledgeable about CCHF as compared to those from Kyankwanzi (OR = 3, P value<0.001). Females were 39%more knowledgeable as compared to the males but this difference was not statistically significant. The overall attitude on CCHF was good (72.3%) with most of the participants agreeing to CCHF as being a serious health problem (92.8%). As part of the practices, majority of the participants owned animals and they were in contact with the animals (91.6%). From the qualitative study, majority of the participants reported to have heard of a similar disease like MarburgvirusandEbolavirusandtheyhadknowledgeonhowthediseasesweretransmitted. Conclusively, the overall level of knowledge about CCHF in this study population was low whereas the overall attitude was good. Specific health education should be conducted by health care providers to high-risk communities to empower them to recognize early symptoms of CCHF and also to include the disease in their initial differential diagnosis, thereby ensuring early detection of the disease. Barrier nursing should also be practiced. Occupation, level of education and district of residence were significantly associated with knowledge.