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Republic of Iraq F

Ministry of Higher Education


& scientific Research
Karbala University
College of medicine

Knowledge and Attitude and Practice (KAP) of health workers in Holy


Karbala governor ate about HIV/AIDS

A dissertation

Submitted to the scientific researches in ministry of Higher Education as


partial fulfillment for the degree of Diploma in family medicine

By

Fawzia Hussein Al-Rubee

M.B.Ch.B

Supervised by

Assistant Professor Dr. Ali Al Mousawi Dr. Riyadh Rasheed Toma


MBChB, MSc in Community Medicine Iraqi board of urology FICMS

European board of urology EBU.

2018 1440
‫جمهورية العراق‬

‫وزارة التعليم العالي والبحث العلمي‬

‫جامعة كربالء‬

‫كلية الطب‬

‫معـارف وإتجاهات وممارسات العاملين في مجـال الرعايـة الصحيـة في محافظة كربالء‬


‫المقدسة عن متالزمة العوز المتاعي المكتسب‬

‫أطروحة‬

‫مقدمة الى وزارة التعليم العالي والبحث العلمي – جامعة كربالء – كلية الطب كجزء من متطلبات نيل‬
‫شهادة الدبلوم في طب االسرة‬

‫اعداد‬

‫فوزية حسين الربيعي‬

‫بكالوريوس طب وجراحة عامة‬

‫بأشراف‬

‫أ‪.‬م‪.‬د‪ .‬علي موسى الموسوي‬

‫د ‪ .‬رياض رشيد طعمة‬ ‫جامعة كربالء ‪/‬كلية الطب‬

‫جامعة كربالء ‪/‬كلية الطب‬


‫‪2018/1440‬‬
‫بسم هللا الرحمن الرحيم‬
‫ين﴾‬ ‫ت فَ ُه َو يَ ْ‬
‫ش ِف ِ‬ ‫﴿ َو ِإذَا َم ِر ْ‬
‫ض ُ‬
‫صدق هللا العظيم‬

‫] الشعراء ‪[ 80 :‬‬
Dedication

To my dear family, especially my husband, my daughters and


my son.
To my parents.
To my brothers and sisters.

i
Acknowledgements

I want to express my great thanks and regards to my supervisor Dr. Ali


Mousa -Al Mousawi for his help and support .

My great thanks and regards are to Dr. Rhiyadh Rasheed for his support.

My great thanks are to all medical members at family and community


department.

My great thanks to all health worker staff especially the staff nurses in Al-
Imam Al-Hussein medical city, Obstetrics and Gynecology hospital for
participating in the study.

Great thanks to all staff nurses at primary health care centers at Al-Hurr
and Kerbala center sectors for helping me. Thanks go to all people who
participate in the study.

ii
Supervisor Certification
I certify that this thesis (Knowledge and Attitude and Practice (KAP)
of health workers in Holy Karbala governorate about HIV/AIDS) was
prepared under my supervision in the department of family community
medicine as a partial fulfillment of the degree of Diploma of family
medicine.

Signature:
Supervisor: Assist. Prof. Dr Ali Al Mousawi
College of Medicine/ Karbala University
/ /2018

Signature:
Supervisor: Dr. Riyadh Rasheed Toma
College of Medicine/ Karbala University
/ /2018

In review of the available recommendation, I forward this thesis for


debate by examining committee.

Signature:
Name: Dr. Ali Abutiheen
College of Medicine / Karbala University
/ /2018

iii
Abstract
A descriptive analytical study was conducted to assess HIV/AIDS-related
knowledge attitude, and practice (KAP) among health care workers at
Governmental hospitals included (Al-Imam Hussein medical city, Gynecology
and Obstetrics hospital) and primary health care centers at Al-Hurr and Kerbala
Centers primary health sectors at Karbala Government for the period from
January 1st, 2018 to June 30th, 2018. In order to prevent HIV\AIDS infection and
further spread of infection among community as they are playing an important
role in the prevention of further infection.
The study sample included (403) healthcare workers (185 medical assistants, 199
nurses, 7 retired workers, and 12 of other description) who were purposively
recruited from the aforementioned health agencies in Karbala Government. The
study instrument includes the sociodemographic sheet, AIDS knowledge,
Attitudes toward HIV/AIDS, and practices related to AIDS. Data were collected
by using a self-reported questionnaire. Data were analyzed by using the statistical
package for social sciences (SPSS 21) at significance level of P < 0.05
The study results revealed that the participants mean age was 34.42 ± 11.16; more
than a third are within the age group of (19-27) years-old (n = 144; 35.7%), most
are females (n = 242; 60.0%) compared to males (n = 161; 40.0%). Furthermore,
participants reported better knowledge in the items of “Did you hear about
AIDS?”, “Is AIDS dangerous?”, “What is the cause of AIDS? Is it a virus?”, “Do
you think that AIDS can be transmitted from one person to another?” and “Do
you know if there is a vaccine for AIDS prevention?”. On the other hand, they
have poor knowledge about method of transmissions “Via insect bite, via
coughing ?”respectively. Regarding participants' attitudes toward AIDS, they
reported the highest positive reported attitudes toward AIDS were for the items
“Do you agree with taking care of a family member with AIDS?”, and “Do you
agree with making a voluntary test for the virus causing AIDS?”.

iv
On the other hand, they reported the highest negative attitudes for the items “Do
you agree with having food in a restaurant with a person with AIDS?”, “Do you
agree that children with AIDS be in schools with healthy children?” , “Ending the
relationship with your friend if you knew that he/she has AIDS” and “If you are
asked to take a blood sample form a person with AIDS, do you agree”?
With respect to participants' practices related to AIDS, the clear majority reported
that the most used syringe type is the disposable one, the most reported method
of sterilizing the surgical tools used in surgical procedures and dressing is boiling
them to a 100℃ after washing and sterilization. The majority reported that it is
important to wear gloves and masks on contact with the patient (n = 332; 82.4%),
dealing with blood and its products, especially in labs. Most of the participants
reported that they would be afraid from getting infection if they helped an infected
person during their duty. Ultimately, for risk groups identification, the highest
category reported to be advised for performing the test were those who intend to
get married, tattoo workers, nurses, laboratory staff, and travelers entering the
country.
Females, and those who hold a bachelor's degree, have better knowledge about
AIDS than males. Females who are single, perform clinical job, and those who
work in hospitals have better attitudes toward AIDS than males.
Male participants who reported that their economic state was poor, those who
work in hospital, performed clinical job have better practice for AIDS.

v
List of Contents

Title Page
List of the contents
List of tables vii, viii
List of abbreviations X
Chapter one: Introduction
1.1.background 12
1.2.Epidemiology 13,14,15
1.3. Symptoms and Sign of HIV/AIDS 15,16
1.4. Diagnosis of HIV/AIDS and Screening tests 17,18
1.5.Treatment 18,19
1.6. Prevention and ART for Prophylaxis 19,20
1.7. Mother to Child Transmission (MTCT) 20
1.8. Health care Workers 21
1.9. Previous studies on KAP 21-26
1.10. Objectives of Study 27
Chapter Two 28
Material and Methods 29-31
Chapter Three 32
Results 33-57
Chapter Four 58
Discussion 59-71
Chapter Five
Conclusions and Recommendations 72,73
References of the study 74-78
Appendices 80-91

vi
vii
List of Tables

Table No. Table Title Page

The distribution of the participants' socio-


Table 1 demographic and employment characteristics (n = 1
403)
Table 2 The participants’ Knowledge about AIDS (n = 403) 2
The participants’ Knowledge about AIDS Prevention
Table 3 3
Methods (n = 403)
Table 4 The participants’ Attitudes toward AIDS (n = 403)
The participants’ Sources of Information about
Table 5
AIDS (n=403)
Table 6 The participants’ practice s related to AIDS (n = 403)
The distribution of knowledge, attitude and
Table 7 practice scores according to the participants
answers (n=403)
The difference in Participants’ Knowledge among
Table 8
Age Groups
Table 9 The gender distribution of Participants’ Knowledge
The difference in Participants’ Knowledge among
Table 10
different occupations
The difference in Participants' Knowledge among
Table 11
different education levels
The difference in Participants' Knowledge among
Table 12
Marital State Groups
The difference in Participants' Knowledge among
Table 13
Workplace Groups

viii
Difference in Participants' Knowledge among
Table 14
different Economic state
The difference in Participants' Attitudes toward
Table 15
AIDS among Age Groups
The difference in Participants' Attitudes toward
Table 16
AIDS between Gender Groups
Difference in Participants' Attitudes toward AIDS
Table 17
among different Occupations
The difference in Participants' Attitudes toward AIDS
Table 18
among different Educational levels
Difference in Participants' Attitudes toward AIDS
Table 19
among Marital Status Groups
Difference in Participants' Attitudes toward AIDS
Table 20
among Workplace Place
The difference in Participants' Attitudes toward
Table 21
AIDS among economic State
The difference in Participants' Practice for AIDS
Table 22
among Age Groups
The Gender distribution of Participants' Practice for
Table 23
AIDS
The difference in Participants' Practice for AIDS
Table 24
among different Educational level
Difference in Participants' Practice for AIDS among
Table 25
Marital states
The difference in Participants' Practice for AIDS
Table 26
among Workplace groups
Difference in Participants' Practice for AIDS among
Table 27
different Occupations

ix
The difference in Participants' Practice for AIDS
Table 28
among Economic Status Groups
The Frequency of HIV Cases and Mortality Rates Per
10.000 Population in Karbala governorate between
Table 29
2012 -2016.

x
Abbreviations
Abbreviation Full text
ART Antiretroviral therapy
AIDS Auto Immune Deficiency syndromes
CDC Centers of disease Control and Prevention
HIV Human Immunodeficiency virus
PHC Primary health care.
HCWs Health Care Workers
KAP Knowledge, Attitudes, Practice
MTCT. Mother Transmission to Child Transmission
NATs Nucleic Acid test
No. Number
PEP Post- Exposure prophylaxis
Pre-EP Pre-Exposure prophylaxis
PLWHA People lived with HIV/AIDS.
WHO World health organization.

xi
Chapter One
Introduction

12
Chapter one …………………………………..……………….Introduction

Introduction

Back ground:

Human Immune Deficiency virus (HIV/AIDS) is considered one of the most


important public health problems of the late twentieth and early twenty-first
centuries and one of the leading causes of mortality and morbidity all over the
world (1). The virus can infect people at any age and gender, but younger ages
from (15-25) years are more susceptible to the infection than other age-group (2).
It is also, considered one of the communicable diseases that can be prevented (3),
and the second cause of death among the youths (22-45 year) globally,(4) while
it was the fourth most common cause of death among people of all ages (2)
Human Immune Deficiency virus is a retro virus which is considered as a blood-
borne virus that is present in most body fluids such as breast milk, vaginal
secretion and seminal fluid secretion (4). The virus has a strong ability to destroy
human body immune system specifically T-lymphocyte cells named as Cluster of
Differentiation-4 (CD4cells, also called T-helper cells or T4 cells), leaving the
person liable for more life -threatened opportunistic infection, neurological
disorders and malignancies. In normal healthy adults, the number of CD4 cells,
range from (500-1500) cells/cubic millimeter (19). AS the infection progresses,
the number of these cells declines (15). When the CD4 count drops below 200
cells/cubic millimeter, the infected person become severely ill, and susceptible to
many opportunistic infections (5).

13
Chapter one …………………………………..……………….Introduction

Epidemiology

The report of the World Health Organization (WHO) about HIV/AIDS all over
words in 2018, reported that HIV/AIDS is still a major public health problem (9).
It causes one million deaths from AIDS related illnesses. Total number of people
who have died from AIDS related illnesses since the beginning of epidemics
reached to 35.0 million in 2016(17). There were19.4 million diseased people and
more than 35 million people lives with HIV/AIDS. The annual incidence is nearly
1.0 million newly infected cases in 2018 all over the world. The African Region
accounts for two thirds of global total new HIV infections. In mid- 2017, 20.9
million people lived with HIV were receiving the ART all over the world. At the
same year an estimated 47% of the newly infected cases with HIV were related
to Key populations and their partners (those supposed to be at higher risk for
transmitting HIV infection). Men who have sex with men and sex workers are
among the high-risk groups (4). These groups are at increased chance of infection

14
Chapter one …………………………………..……………….Introduction

with HIV and reduced access to HIV testing and antiretroviral therapy programs
(9). Between 2000 -2016, new HIV infection was dropped by 39%. During this
period, HIV-related deaths fall by one-third with 13.1million lives saved due to
ART intake. So, number of people living with HIV /AIDS in 2016, according to
WHO report were ( 19.4million, 53%) in eastern and Southern Africa , (6.1
million, 17%) in western and central Africa, in Asia and the Pacific were (
5.1million, 14%), and in Western and Central Europe and North Canada were
(2.1million, 6%) (17). Iraq is considered as a country with low level of HIV/AIDS
prevalence. According to the WHO estimates in 2018, the prevalence of
HIV/AIDS is less than 0.1% of population, most of these cases between age of
(15-59) years(17). In Iraq 1st case was registered in 1986 among hemophiliac
patients due to receiving contaminated blood with virus. From 1986-2011, the
HIV/ AIDS accumulative number of reported cases were 306 (22). The last
registration of total number of infection in Iraq by annual report of ministry of
health in 2016 was 241 cases. In Karbala govern orate, Number of recorded cases
from 2012-2016, by annual reports of ministry of health was shown in (Table 29).
However, there is a high chance for increased incidence due to multiple risk
factors that contributed to HIV infection spread including: liberalized trade
relations and increasing substance use disorder, especially among youth (6).
Since 2003, no case was reported due to injecting drugs or homosexual behavior,
and Only 5-7% of infected cases occurred through contaminated blood and blood
products, this was due to the adoption of strict measures by Ministry of health in
Iraq (22). As, so far, there is no cure for HIV/AIDS, greater efforts all over the
world is being paid to the control and prevention of HIV pandemic. The pandemic
characteristics of the HIV/AIDS makes this type of infection different from the
other communicable diseases including the STDs, which includes rate of the
spread of the virus, reaching epidemic proportions in some parts of the word,
long incubation period before appearance of symptoms, absence of preventive
vaccine and curative therapy(8).

15
Chapter one …………………………………..……………….Introduction

Symptom and signs of HIV/AIDS:

HIV/AIDS infection divided into three stages:

1- The early or Acute stage of HIV infection: that is defined as HIV infection
in the past six months. During this stage some people do not feel any
symptom at all, while other 40%-90% of them have flu -like symptoms
within 2-4 weeks after infection. These symptoms include fever, rash,
chills, night sweat, muscle ache, mouth ulcer, sore throat and generalized
fatigue. These symptoms can last from days to several weeks. During this
time the patient will become highly infectious and can spread the infection
to others. The infection may not be detected on some types of HIV test that
look for antibodies against HIV. The tests that can be used for acute
infection look for HIV-RNA or P24 antigen. Antibodies production takes
few weeks or more to be produced by the patient’s immune system. If the
test is positive, the patient is at high risk of transmission of infection to
16
Chapter one …………………………………..……………….Introduction

others. If it is negative, Pre -Exposure prophylaxis Antiretroviral (ART)


drugs are needed to stay negative (3).

2- Clinical latency stage: The second stage is called the clinical latency stage or
Chronic HIV infection. During this stage, the patient may be a symptomatic or
have only mild symptoms related to HIV infection. The virus still active but
reproduces at very low levels. When infected people take ART as recommended,
they may stay in the same stage for several decades as the therapy helps in
keeping the HIV virus at low level. While, in other patients who are not taking
treatment, this period is shorter. However, the clinical latency period usually last
10-years or more, but in some patients the symptoms may progress faster during
this stage. Asymptomatic patient during this stage can transmit the infection into
others. However, patients who are on ART therapy and having very low level of
HIV virus in their blood, or other body fluid are less likely to transmit the
infection than those who do not take ART (9).

3- Late stage of HIV infection (AIDS): It is considered the most sever phase
of HIV infection. When the virus will attack the body’s immune system
causes a sharp dropping in CD4-T cells number. When the count declines
below 200 cells /cubic millimeter, opportunistic illnesses develop, and that
patient’s health is severely compromised(24). Patients with AIDS
complain from fever, chill, sweats, swollen lymph glands, weakness and
weight loss. If the patients left with-out ART treatment, they will survive
for about 3-years only. Also, these patients are susceptible for more
dangerous infections and more severe illnesses such as tuberculosis, sever
bacterial infection, cryptococcal meningitis, and cancers such as sarcoma
and lymphoma (6).

Opportunistic Infections: when pathogens that are usually suppressed by the


immune system take the opportunity to transform into sever clinical infections
including: Cytomegalovirus: viral infection mostly affects the eyes; Kaposi’s

17
Chapter one …………………………………..……………….Introduction

sarcoma: type of skin cancer; Pneumocystis Carinii pneumonia; Candidiasis that


can cause thrush in the mouth or infections of throat or Vagina (6).

Diagnosis of HIV (Tests for Screening and Diagnosis):

There are three tests available for HIV detection but no test available to detect the
virus immediately after infection. These tests are very accurate. Detection of viral
infection depend on various factors. These factors including type of test used for
HIV detection. So, these tests include: Nucleic acid tests (NATs), antigen
/antibody tests, and antibody tests. NATs, searching for presence of actual virus
in blood. This test is used for person recently exposed to HIV infection or possible
exposure with sign and symptoms of HIV infection. The test is expensive and not
use for routine screening for HIV. Antigen/antibody tests: These tests search for
both antigens and antibodies. This antigen called P24 is form before antibodies
forming, causes activation of body immune system. In United states, these tests
preferable as it can detect both antigen and antibodies. Also, tests can be done at
labs so commonly used in United States. Another rapid antigen /antibody test
available and can used easily. Antibody tests use to detect presence of antibodies,
proteins in infected person. These antibodies produced by individual immune
system against HIV. The antibodies tests considered rapidly and commonly uses
home tests. The initial test use for HIV detection either antigen tests or
antigen/antibody test. if the initial test is positive, so person will be sent to health
care provider for follow the result up. If initial test is positive and it is a laboratory
test, then the laboratory will follow up the test on similar sample as initial test.
The follow-up of tests by health care provider permitting in correct diagnosis
(18). So, HIV can be detected by serological tests as Rapid diagnostic test (RDT)
and Enzyme Immune Assays test (EISA) for detection the presence or absence of
antibodies to HIV -1/2 and or HIV P24antigen. These tests are used in
combination as no single HIV test can give an HIV positive diagnosis (6). These
serological tests detect anti bodies produced by the immune system of infected

18
Chapter one …………………………………..……………….Introduction

person, when it is attacked by the virus, not by direct detection of virus. These
antibodies can be detected within 28 days of infection and not in earlier (this
period is called the window period). It represents a period of high infectivity;
even viral transmission can occur during all stages of infection (6). Virology test
can be used in infants and children less than 18-months. This test is used for
person recently exposed to HIV infection.

Treatment

WHO allows ART for all people living with HIV infected patient during whole
their lives in 2017, regardless the stages of disease or CD4 cells counts. Those
included lactating, pregnant women, adults, adolescents and children. Also, it is
estimated in 2017, that 80% of infected pregnant women (total number were 1.1
million) all over the world should receive ART treatment to prevent viral
transmission to their children. Some countries have supported the elimination of
MTCT as in Armenia, Cuba, Thailand and Belarus. And considered MTCT as a
public health problem. Other countries with a high prevalence of HIV infection
also announced for HIV elimination programs. The suppression of HIV infection
can be done by using combination of three or more ART drugs. This therapy
suppresses the viral replication within an individual body, improves the body
immune system and return the ability of it to fight off the infection, but does not
cure it. The guidelines released by WHO in 2016, consolidated on the use of ART
for prevention and treatment of HIV. By mid-2018, this recommendation has
been implemented by 163 countries, which covers98%of all PLHIV globally. The
guidelines of WHO in 2016, contain new alternative ART treatment with high
efficiency and less side effects, more tolerated by patient and with less treatment
discontinuation rate when compare with recently used treatment includes,
dolutegravir and low-dose efavirenz for first-line therapy, and raltegravir and
darunavir/ritonavir for second-line therapy. Change to dolutegravir has already
used in twenty fours low and middle-income countries. This new medicine is

19
Chapter one …………………………………..……………….Introduction

expected to improve the treatment duration and type of care of people living with
HIV. But used with limitation in infants and young children. So, WHO and
partners for this cause, are working with efforts for introduction of more effective
medicine against HIV with less side effects and introducing age-suitable pediatric
types of antiretroviral therapy. To reduce risk of serious illnesses with advanced
disease and death, WHO recommended that these infected people should receive
a "Package of care" that contains testing for and prevention of danger infections
that can lead to death. These serious infections include, cryptococcal meningitis
and tuberculosis infection.

In addition to Antiretroviral therapy now, new recommendations introduced by


WHO, focused on treatment of all people living with HIV(the number of people
has increased from 28 million to 36.9 million PLWHA). Those people uses
treatment eligible. Globally, 21.7million people living with infected individuals
were receiving antiretroviral medicines in 2017. The coverage of antiretroviral
therapy for adults and children living with HIV/AIDS was reached to 59% all
over worlds in 2017. Only 52% of children and adolescents were receiving
antiretroviral therapy at the end of 2017. So, WHO for this reason, is supporting
countries to accelerate their efforts to diagnose the HIV at the same time and treat
these populations. The expanding in improvement of treatment against HIV,
given a hope to bring the world on track to end the epidemic of HIV/AIDS by
2030 (17).

Antiretroviral therapy uses for prevention:

Now a day, more than one methods are available for the prevention of HIV
infections. These methods include using condoms at correct way during sexual
inter-course, abstinence (not having sex), limitation number of sexual partners
and never sharing syringes. Also using newer HIV prevention therapy (ART),
such as post and pre-exposure prophylaxis ART (18). In developing countries,
unsafe practices like handling of contaminated needles without care, uses
20
Chapter one …………………………………..……………….Introduction

injections without demands, in adequately sterilized needles with uses of more


than one time, and improper disposal of harmful and dangers waste are considered
a major problem. All these can easily increase the potential risk of transmission
of HIV/AIDS among health care workers (8). In Iraq, strict measures adopted by
Ministry of health to prevent spread of HIV infection as the blood contaminated
products and the heterosexual route considered as a common route of viral
transmission (21).

Pre-Exposure Prophylaxis and Post-Exposure Prophylaxis:

Pre-Exposure Prophylaxis (Pre-EP): In 2011(6), a trail has confirmed that using


ART therapy for infected person can reduce transmission of infection to their
uninfected sexual partner by 96%. So, according to this result the WHO
announced to give ART to all people living with HIV positive persons (17).
Second types of prophylaxis are used by HIV negative people is post-exposure
prophylaxis (PEP) by using oral ART drug by HIV negative people which is
effective in reducing transmission among range of population (as partner with
positive HIV and other HIV negative, highly-risk heterosexual couples, men who
have sex with men, people inject drug) (9). Prophylactic therapy can be given for
pregnant women or breast-feeding women with HIV negative child (17).
Alternatively, this PEP means that ART therapy is used by the HIV negative
person within 72 hours of exposure to HIV, to prevent HIV infection (9). The
PEP included counseling, first aid, HIV test and giving of 28 days course of ART
drug with follow-up. This PEP is used for both adult and children (occupation
and non-occupation exposure) (9).

Mother to Child (MTCT) Transmission: Transmission of HIV from an


HIV-positive woman to her child may occur during pregnancy, delivery or
breastfeeding. The term is used because the mother is immediate source of the
infection(9).

21
Chapter one …………………………………..……………….Introduction

Health Care Workers

Health Care Workers (HCWs) are important and fundamental domain in HIV
transmission and prevention. Firstly, the HCW; especially the nursing staff forms
an important and major bulk of health staff in all over the world. Secondly,
because of the nature of their job which brings them in close contact with patients’
blood and other risky body fluids, so they are at high risk of direct exposure to
HIV/AIDS and other infections. About 2.5% of people infected with HIV /AIDS
all over the words are among HCW(6). Furthermore, health care workers also
carry significant risk to the patients under their care and their families (7). As, so
far, there is no cure for HIV/AIDS, greater efforts all over the world is being paid
to the control and prevention of HIV pandemic. On focusing on these groups
found in developing countries, they are more seriously exposed to infection
because of increased prevalence of HIV/AIDS and increasing exposure to risk
factors during practicing their jobs. In addition to that, this infectious agent can
be easily transmitted via specific body fluids ,blood and medical instruments to
healthy uninfected one (10). So the study of knowledge among HCWs is very
important since they are essential in the prevention of diseases and create a
positive attitude toward HIV/AIDS (13). Also, they should know how to protect
themselves from contracting the infection. KAP study also, of important values
in formulating strategy for the development of compliance to treatment, control
and prevention of HIV infection(14).

Results of previous studies on KAP among health care workers on


HIV/AIDS:

Many studies done on knowledge, attitude and practice on HIV/AIDS among


health care workers (HCWs) all over the world, with clear variations. In Egypt
22
Chapter one …………………………………..……………….Introduction

at Cairo hospital in 2011(20), a similar study was done among post graduated
nurses (number = 67) and under graduated nurses (number=73), total number was
140. The study reported that general knowledge about the disease was good
among the study participants. More than three quarters of them (88.6%), knew
that HIA/AIDS is caused by virus that attacks immune system. Most of them
(81%) incorrectly believed that there is a cure for AIDS. All the participants knew
the correct ways of HIV transmission, through infected blood, sharing syringes
and sharps (100%). More than (26.9%) of them did not know about sexual mode
of transmissions. Also, more than one half of them (63%) did not know that a
woman with HIV positive was transmit infection through lactation to her baby.
However, other wrong expectation among participants that HIV infection was
absent in Egypt and detected as 92.1%of of all participants. The score of mode of
transmission over all knowledge was 6.99_+ 0.9 in post graduated nurses and
6.99_+0.7 in under graduated nurses So both under and post graduated reported
same and good knowledges. Another study was done in Iraq, at Baquba Teaching
Hospital in 2017(22), to assess the knowledge among health care workers on
HIV/AIDS. A total respondent included in this study were200 health care
workers, only(22, 10.5%) of them were nurses, and (21,10.5%) were medical
assistant. Knowledge regarding the cause of HIV/AIDS among nursing staff was
98% answered correctly when they were asked about the cause, while all medical
assistant answered correctly about cause of HIV infection. Regarding the
prevalence method of transmission of HIV in Iraq, the staff nurses were answered
correctly with(63.6%)While (42.9%) of medical assistants correctly answered is
blood transfusion. Knowledge regarding vertical transmission of HIV from
mother to her child that, 81.8% of staff nurses answered correctly while 88%of
medical assistant answered correctly. Regarding the AIDS is curable disease or
no. More than one half of nursing staff(63%) answered correctly in that
HIV/AIDS is incurable disease. While (71.4%) of medical assistant answered
correctly. Regarding the information about controlling AIDS by ART, nursing

23
Chapter one …………………………………..……………….Introduction

staff answered correctly with 34.6%, while 47.6% of medical assistants were
answered correctly. Their Knowledges on transmission of AIDS by shaking
were81.8% in nursing staff and 85.7% in medical assistants. Despite good
knowledge of participants, there was wrong thought about the commonest
method of transmission in Iraq which had been blood transfusion. However, the
rate of HIV infection is still high in Iraq due to blood transfusion (22). Another
study was done on the knowledge of health care workers at South east Nigeria in
2017 about HIV/AIDS (31). Number of participants were 240 nursing staff. Over
all participants, the knowledge was good. Related to method of transmission
(188,78%) of them answered correctly that the HIV transmit through unprotected
sexual intercourse. Three quarters of them(185,77.1%) agree that it is transmit
through blood transfusion. Most of them (225, 78.3%) knew that AIDS caused
by virus. Similarly, (128, 53.3%) of them strongly agreed that ART does not cure
HIV/AIDS but treat it (31 ). Similar study done among staff nurses at medical
college and hospital at Kolkata, India in 2015(15). Number of participants were
290 nurses, only 250 answered their questionnaire completely. The study reported
on knowledge about the causation of HIV, 79.6% of the respondents were know
that AIDS is caused by HIV virus, 65% of respondents answered that later stage
of HIV is known as AIDS. Regarding the modes of transmission of HIV, it was
observed that most of them knew about spread of HIV infection via different
modes of sexual contact such as vaginal sex (94%) and anal sex (86%). Also,
most of them was known that AIDS can be transmitted through blood in different
ways, as donating blood from HIV-positive patients (86%) and when taking care
of patients (86.8%) with exposure to his blood. Mother to child transmission of
HIV/AIDS was also well known to the participants, as ( 76.8% )of them knew it
can be spread via breastfeeding while (96%) of them knew that it can be
transmitted during delivery of the different aspects of HIV. Only( 50.4%) of total
participants correctly knew that exclusive breastfeeding by HIV positive mother
can be occurred to her baby. Regarding incorrect infant feeding practices via

24
Chapter one …………………………………..……………….Introduction

formula feeding was 56.8%, exclusive breast feeding for 1st six months then
change to mixed feeding was 57.6% of them incorrectly knowledge. Regarding
risk perception during casual contact, 45.2% of them had the wrong ideas. That
working every day with infected person with HIV is of a higher risk. Also( 64%
) of them incorrectly answered that shaking hands with AIDS patients with
generalized body rash was very risky. While 25.5% thought that touching HIV
positive patients is of some risk. So, the study showed good knowledge on
transmission of virus to infant by breast feeding, with poor knowledge reported
on casual transmission of virus (15). Another study was done at maternity
hospital, in Bangalore, India in May- 2015, Number of participating paramedical
staffs and staff nurse) were 60. Their knowledge regarding the inhibition of
vertical transmission of HIV, about( 52 ,86.7%) of them had Moderately adequate
knowledge, (6,10.0%) of them had Inadequate knowledge and (2, 3.3%) have
adequate knowledge. So, the study reported that more than half of HCP have
inadequate knowledge about the inhibition of vertical transmission of HIV(23),
from infected mother to her child. Similar study done among Jordanian HCPs at
Hashemite university, Zarqa, Jordan in 2011. The total number of respondents
who completed their questions and participated in the survey were 922 out of
1260 nursing staff. The study showed that knowledge about HIV/AIDS among
Jordanian nurses was weak. This week result was recorded in the following
subsections, as course of disease, manifestation, transmission, immunology,
incidence, precaution and prevention. While nurses showed good level of
knowledge about HIV/AIDS in one subsection (risk group). Most of the
knowledge of nursing staff about sources of current information on HIV/AIDS
were inadequate. They answered that the major source of information was
internet web sites (52.7%). No one pointed to journal as a source of HIV/AIDS
information (21). Another study done at Tehran, Iran in 2010 (3), on the
knowledge of nurses of paramedical staff on HIV/AIDS at Imam Khomeini
Clinical and Hospital Complexion. Number of participants were 196 staff nurses.

25
Chapter one …………………………………..……………….Introduction

The study showed ( 96.3 %) of nurses had good knowledge regarding HIV/AIDS
and methods of it is transmission.

Attitude: Many studies done to determine the attitudes of health care workers
towards HIV/AIDS. One study was at Hashemite university, Zarqa, Jordan in
2011(21). The study showed that three quarters (75.2%) of the staff nurses had
negative attitude towards caring for people with HIV/AIDS because of fear of
contagion. In addition to the facts, that HIV/AIDS is considered fatal. Also,
Social stigma related to HIV/AIDS, makes it difficult for staff nurses to establish
therapeutic relation with HIV/AIDS patient. Also, the study showed that (58.8%)
of Jordanian nurses in this study had a negative attitude towards HIV/AIDS
because of recognized fatal outcome of disease. Only 3% of nurses had positive
attitude towards introducing of direct care to HIV/AIDS patient. More than two
thirds of nursing staffs (84 %) disagree to provide care to people with HIV/AIDS
positive. Another study in Egypt (20) on attitudes of nursing staff, shown
negative attitudes towards people with HIV positive. More than half of the
participants nurses refused to deal with HIV positive people who were seen in
work place or in public. Another study done at Tehran, Iran, in 2010 (3) about
attitude of health care workers including nurses. Majority of them (169, 86.22%),
answered on that patient should have civil rights like other people. Others
answered that patients should be isolated from other people (49,25%). Most of
them answered that patients should be protected and treated( 172,87.75%). The
study also, shown that( 17, 8.67%) of participants had negative attitudes, they
answered on prevention of patient with HIV from continuing education and
working in the community. So, study had shown highly positive attitudes towards
HIV/AIDS patients with mild negative attitudes.

Practice: Several studies were done about the practice of HCWs , towards
people with HIV positive. One of studies was in 2015, among nursing staff
regarding care with HIV positive patients, at Kolkata, India (15). The results

26
Chapter one …………………………………..……………….Introduction

showed that only 4% of nurses answered that they never used gloves during
taking care of HIV-positive patients, others 1.2% of nurses said ,that they never
wash their hands between surgical interference and patients. Some of them
(15.6%) reported that they never use eye protective device. Also, 9.6% of
respondent were recapping needle after withdrawing blood from HIV-positive
patient, 11.6% of them were removing or inserting canola without care, 10.4%
of them, were administering an injection with -out care and considered all these
practices of no risk at all.

27
Chapter one …………………………………..……………….Introduction

Study objectives:
This study was performed to assess HIV/AIDS-related knowledge attitude, and
practice (KAP) among health care workers at the governmental hospitals
including (Al-Imam Hussein Medical City, Gynecology and Obstetrics hospital)
and Primary Health Care centers at Holy Karbala govern orate from 1st January
2018 to the 30th June 2018, In order to assess the program of HIV\AIDS
prevention and control in regards the health care workers who play an important
role in the prevention and control of the infection. Determining weaknesses in
KAP disciplines will help to bridge the gaps and cover areas of weakness to
prevent HIV/AIDS spread in the community.

28
Chapter Two
Material and
Methods

29
Chapter tow ……………………………………………………Material and Methods

Material and Methods:


The ethical approval for conducting the study was obtained from the ethical
committee at the College of Medicine / Karbala University and from the ethical
committee of health in Karbala health Directorate.

Type of study used in the survey was descriptive cross-sectional study. The
survey included health care personals working in the following premises, which
were the main health care providing premises in Karbala city center:

1. Al Husseini Teaching Hospital at Imam Hussein Medical City.

2. Gynecology and Obstetrics hospital.

3. Al -Hurr Primary health sector including 5 Primary Health Centers.

4. Karbala center primary health sector including 7 Primary Health Centers.

The survey was conducted in six months Duration between the1 st January 2018
to the 30th June 2018. The purpose was to assess the health care personals
knowledge, attitude and practice about H.IV/AIDS.

The needed sample size was calculated according to the total number of health
care personals in the selected premises, to be representative of the total population
in these premises. A total of 350 health staff was needed to be survived and
additional participants were added to compensate for non-response, so a total of
403 of health care personals were survived. The distribution of the participants in
the selected health premises and the total health care personals in them was as
follows:

The health care personals from Al Husseini Teaching Hospital at Imam Hussein
Medical city were selected from the different sectors in the hospital including Al
Zehra Centre (main medical unit), surgical units (public and private sections, burn
and plastic surgery units), Radiotherapy department, emergency unit and out-
patient consultation clinic.
30
Chapter tow ……………………………………………………Material and Methods

The included sections in Al- Zahra center which includes the Coronary Care Unit,
Intensive Care Unit, Gastro-intestinal Center, neurology units and at admission
rooms units.

In the Gynecology and obstetrics hospital health care personals were selected
from different parts of the hospital including emergency unit, labor unit, neonatal
care unit, post-delivery care unit, Intensive Care Unit, theatre unit, admission
room units and from private sector of the hospital.

On visiting these health care premises all available health care personals were
asked to fill in the self-administered questionnaire.

Pilot study: a selective sample was chosen from the health care personals for pilot
study before conducting the definitive study. The pilot survey was stared in the
form of self-administered questionnaires, to ensure understanding and clearance
of the questions for the health care personals.

The survey Questionnaire: a specially designed questionnaire was selected after


reviewing the related literature from the World Health Organization
questionnaires and other researches. The found questionnaires were translated
into Arabic language and some questions were changed according to the accepted
local culture and customs in Karbala.

According to the statistical records of Karbala health directorate in July 2018,


there were 3476 health care personals (nursing staff) in all the government
hospitals and primary health care Sectors. At Imam-Al-Hussein teaching hospital
there were 506 medical personals, while at the Gynecology-Obstetrics hospital
there were 181 health care personals. Al-hurr sector there were 164 health care
personals and at Karbala center health sector there were 279 health care personals.

The survey questionnaire included 11questions related to the socio-demographic


characteristics of the participants that included (age, gender, qualification, social

31
Chapter tow ……………………………………………………Material and Methods

state, numbers of children, type of job, educational level, evening work, type and
place of work and economic level of the participants.

The main body of the survey questionnaire included related to the participants’
knowledge Attitude and Practice (KAP) about HIV/AIDS. Knowledge about
AIDS/ HIV included 32 questions that included general information about HIV
methods of transmission and prevention using yes, no or I do not know on
answers. Attitude questions included 13 questions that assessed the attitudes and
beliefs of health care personals staff on HIV used on answers on Likert scale of
‘’strongly do not agree, do not agree, in between, agree and strongly agree.
Questions about practice of health care personals consisted of 10 questions related
to their behaviors towards HIV/AIDS infection during their practice. They chose
many answers depending on their information and education about HIV/AIDS.
After finishing the data collections, data were entered an Excel data base and then
it was analyzed by using the Statistical Package for Social Sciences version
21(SPSS- 21) and Excel soft wares at a significance level of P < 0.05.

32
Chapter Three
Results

33
Chapter three ……………………………………. Results
Results
Table 1: The distribution of the participants' socio-demographic and employment
characteristics (n = 403)
Variables Frequency Percent
Age (Years): Mean (SD): 34.42 ± 11.16
19-27 144 35.7
28-36 95 23.6
37-45 83 20.6
46-54 64 15.9
≥ 55 17 4.2
Gender
Female 242 60.0
Male 161 40.0
Occupation
Medical Assistant 185 45.9
Nurse 199 49.4
Retired 7 1.7
Others 12 3.0
Job Type
Administrative 75 18.6
Clinical job 284 70.5
Epidemiologist Surveillance 4 1.0
Others 40 9.9
Education
Primary 10 2.5
Nursing High School 200 49.6
Associate degree (Diploma,2years after secondary 174 43.2
school 19 4.7

34
Chapter three ……………………………………. Results
Bachelor's degree
Table 1: (Continued)
Variables Frequency Percent
Marital Status
Married 288 71.5
Divorced 50 12.4
Single 65 16.1
Workplace
PHC 209 51.9
Hospital 189 46.9
Private (Al-Ka feel Privet hospital) 5 1.2
Do you have an evening job?
Yes 296 73.4
No 107 26.6
Accommodation
Independent 208 51.6
Shared 195 48.4
Property
Rented 87 21.6
Owned 300 74.4
Other 16 4.0
Economic Status
Poor 30 7.4
Moderate 296 73.5
Good 77 19.1

The mean age) was 34.42 ± 11.16-year (Not years); more than one third of
the participants was within the age group of (19-27) year-old (n = 144; 35.7%),
and the least were those who were 55-year or older (n = 17; 4.2%). Most were
females (n = 242; 60.0%) compared to males (n = 161; 40.0%).

Concerning the occupation, around a half were nurses (n = 199; 49.4%),


followed by medical assistants (n = 185; 45.9%), others (n = 12; 3.0%), while
only a minority were retired (n = 7; 1.7%). Regarding job type, most reported
doing clinical duties (n = 284; 70.5%).
35
Chapter three ……………………………………. Results
With respect to the educational qualification, around one half were
graduates of high nursing school (n = 200; 49.6%), followed by those who hold
an associate degree (n = 174; 43.2%), while only a minority hold a bachelor's
degree (n = 19; 4.7%), or were primary school graduates (n = 10; 2.5%).

Regarding marital state, most are married (n = 288; 71.5%), followed by


those who were single (n = 65; 16.1%), and those who were divorced (n = 50;
12.4%).

Concerning the place, they work in, more than a half work in PHC centers
(n = 209; 51.9%), followed by those who work in hospitals (n = 189; 46.9%). As
rules in Iraq permit combining official and private work; about three quarters of
the participants reported that they have an evening job (n = 296; 73.4%

The socioeconomic state in Iraq has no clear demarcation; for this reason,
few questions were included to give a hint about the socioeconomic state,
including number of children, the type of living accommodation, house
ownership, estimated economic state. With respect to the living accommodations,
more than a half reported that they live independently (n = 208; 51.6%) compared
to those who share living with others (n = 195; 48.4%), most reported that they
have their own houses (n = 300; 74.4%), followed by those who live in rented
houses (n = 87; 21.6%), and those who live in other form houses (n = 16; 4.0%).
Lastly, most reported that they have a moderate economic state (n = 296; 73.5%),
followed by those who have a good economic state (n = 77; 19.1%), while only
a minority reported to have a poor economic state (n = 30; 7.4%).

Table 2: The participants’ Knowledge about AIDS (n = 403)

36
Chapter three ……………………………………. Results
Yes No
Item
f (%) f (%)
Did you hear about AIDS? 391 (97.0) 12 (3.0)
369
Is AIDS dangerous? 34 (8.4)
(91.6%
What is the cause of AIDS? Is it a virus? 376 (93.3) 27 (6.7)
Do you think that AIDS can be transmitted from one person to
347 (92.8) 29 (7.2)
another?
Do you know if there is a vaccine for AIDS prevention? 114 (28.3) 289 (71.7)
Do you think that AIDS can be completely prevented? 268 (66.5) 135 (33.5)
Do you think that AIDS signs appear on the infected person? 178 (44.2) 225 (55.8)
Do you think it is possible to be completely cured from AIDS? 101 (25.1) 302 (74.9)
Causes of Disease Transmission
Via intercourse 381 (94.5) 22 (5.5)
Via blood transfusion or organ donation from an infected person 383 (95) 20 (5.0)
From the mother to her fetus 352 (87.3) 51 (12.7)
Drug use by using the syringe for intravenous injection 386 (95.8) 17 (4.2)
Drug use by using the syringe for intramuscular injection 339 (84.1) 64 (15.9)
Through cough 200 (49.6) 203 (50.4)
Via breastfeeding 244 (65.5) 159 (39.5)
Using the same shaving tools 347 (86.1) 56 (13.9)
Sharing drink and/or food 18 (44.7) 223 (55.3)
Contacting an infected person 130 (32.3) 273 (67.7)
Insect bite 224 (55.6) 179 (44.4)
Tattooing supplies 364 (90.3) 39 (9.7)

The participants reported better knowledge in the items of “Did you hear
about AIDS?”, “Is AIDS dangerous?”, “What is the cause of AIDS? Is it a virus?”
and “Do you think that AIDS can be transmitted from one person to another?”
(97.0%, 93.3%, 92.8%, 91.6%) respectively, Table 2). Also, better knowledge
in items “Do you know if there is a vaccine for AIDS prevention?” and “Do you

37
Chapter three ……………………………………. Results
think it is possible to be completely cured from AIDS?” (289,71.7%)and (302,
74.9%) respectively, table 2).

table 2).

Concerning participants’ knowledge about the etiology of AIDS


transmission, they reported better knowledge for the items “Via intercourse”,
“Via blood transfusion or organ donation from an infected person”, “From the
mother to her fetus”, and “Drug use by using the syringe for intravenous
injection” (95.8%, 95.0%, 94.5%, 87.3%, respectively, this is shown in table 2).

Table 3: The participants’ Knowledge about HIV/AIDS Prevention Methods (n =


403)
Strongly Do not Not Strongly
Agree
Item Disagree agree decided agree
f (%) f (%) f (%) f (%) f (%)
Prevention Methods
Completely isolating the
22 (5.5) 15 (3.7) 49 (12.2) 225 (55.8) 92 (22.8)
infected person from others
Avoid sharing shaving tools 6 (1.5) 2 (0.5) 12 (3.0) 256 (63.5) 127 (31.5)
Using condom 3 (0.7) 6 (1.5) 10 (2.5) 221 (54.8) 163 (40.4)
Blood examination before its
13 (3.2) 8 (2.0) 18 (4.5) 199 (49.4) 165 (40.9)
transfusion
Using syringe for one time only 11 (2.7) 1 (0.2) 20 (5.0) 223 (55.3) 148 (36.7)
Avoid adultery 23 (5.7) 6 (1.5) 11 (2.7) 197 (48.9) 166 (41.2)
Avoid public swimming pools
13 (3.2) 54 (13.4) 31 (7.7) 212 (52.6) 93 (23.1)
and W.C.
Making voluntary AIDS tests
for individuals with multiple 1 (0.2) 16 (4.0) 10 (2.5) 188 (46.7) 188 (46.7)
sexual relationships
Disseminating health education
about the AIDS among the 7 (1.7) 9 (2.2) 3 (0.7) 191 (47.4) 193 (47.9)
public

The participants reported more agreement about the items “Disseminating


health education about the AIDS among the public”, “Using condom”, “Avoid

38
Chapter three ……………………………………. Results
sharing shaving tools”, “Making voluntary AIDS tests for individuals with
multiple sexual relationships” (95.3%, 95.2, 95.0, 93.4, respectively as shown in
table 3).(193,47.9%), ( 221 54.8%), (256, 63.5%), (188, 46.7%) respectively,

Table 4: The participants’ Attitudes toward AIDS (n = 403)


What is your attitude toward AIDS?
Yes No
Item
f (%) f (%)
Ending the relationship with your friend if you knew that he/she
210 (52.1) 193 (47.9)
has AIDS
Do you agree to live in the same house with a person with AIDS? 96 (23.8) 307 (76.2)
Do you agree to eat and drink with a person with AIDS? 80 (19.9) 323 (80.1)
Do you agree to be with a person with AIDS? 66 (16.4) 337 (83.6)
Do you agree to taking care for a family member with AIDS? 198 (49.1) 205 (50.9)
Do you agree to buy fresh fruits and vegetables from a person
54 (13.4) 349 (86.6)
with AIDS?
Do you agree to play sports with a person with AIDS? 60 (14.9) 343 (85.1)
Do you agree to having food in a restaurant with a person with
30 (7.4) 373 (92.6)
AIDS?
Do you agree to make a voluntary test for the virus causing
225 (63.3) 148 (36.7)
AIDS?
Do you agree that children with AIDS be in schools with healthy
52 (12.9) 351 (87.1)
children?
If you are asked to take a blood sample from a person with AIDS,
177 (43.9) 226 (56.1)
do you agree?

The participants highest positive reported attitudes toward AIDS were for
the items “Ending the relationship with your friend if you knew that he/she has
AIDS”, “Do you agree to take care for a family member with AIDS?”, and “Do
you agree to make a voluntary test for the virus causing AIDS?” (63.3%, 52.1%,
49.1%, respectively, table 4).

39
Chapter three ……………………………………. Results
On the other hand, they reported the highest negative attitudes for the items
“Do you agree to having food in a restaurant with a person with AIDS?”, “Do
you agree that children with AIDS be in schools with healthy children?”, “Do you
agree to buy fresh fruits and vegetables from a person with AIDS?”, “Do you
agree to be with a person with AIDS?”, and “Do you agree to play sports with a
person with AIDS?” (92.6%, 87.1%, 86.6%, 85.1%, 83.6%, table 4).

Table 5: The participants’ Sources of Information about AIDS (n=403)


Item Frequency Percent
What is your source of information about AIDS?
Family 78 19.4
Friend 112 27.8
Magazines 78 19.4
Internet 223 55.3
Radio 47 11.7
TV 90 22.3
Others 142 35.2
Did you find a client with AIDS on your career?
Yes 131 32.5
No 272 67.5
If you found a client with AIDS on your career, what will you
do?
Offering counseling 121 30.0
Refer him/her to a specialized health agency 329 81.6
Leave him/her 12 3.0
Calling a health agency 146 36.2
Making AIDS test for his/her family members 169 41.9
Did you attend a training course related to AIDS?
Yes 76 18.9
No 327 81.1
In case of offering new courses about AIDS, would you like
to join them?
Yes 312 77.4
No 91 22.6
Are there any preparations in the health agencies to receive
clients with AIDS?
Yes 170 42.2
No 233 57.8
Is there a treatment for AIDS?

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Chapter three ……………………………………. Results
Yes 66 16.4
No 337 83.6

The most reported source of information about AIDS were the internet,
other sources, friends, TV, family members and magazines & radio (55.3%,
35.2%, 27.8%. 22.3%, 19.4%, 19.4%, 11.7%) respectively.

More than two thirds of the participants reported that they did not meet a
client with AIDS throughout their career (n = 272; 67.5%), the majority reported
that they would refer him/her to a specialized health agency when they find
him/her (n = 329; 81.6%), followed by making AIDS test for his/her family
members (n = 169; 41.9%).

The majority of the participants reported that they did not attend any
training courses about AIDS (n = 327; 81.1%), most reported that they will join
such courses when they are available(n = 312; 77.4%), more than a half reported
that there were no preparations in their health agencies to receive clients with
AIDS (n = 233; 57.8%), and the majority reported that there is no medication for
treating AIDS (n = 337; 83.6%).

41
Chapter three ……………………………………. Results
Table 6: The participants’ practice s related to AIDS (n = 403)
Item Frequency Percent
What is the syringe type used in I.M. or I.V.
injection?
371 98.5
Disposable syringe
8 2.0
Multiple use syringe
3 0.7
Using boiler to sterilize syringe
What is the method of sterilizing the surgical tools
used in surgical procedures and dressing?
Washing them with water and a disinfectant 92 22.8
It is preferable to boil them to a 100℃ after their 222 55.1
washing and sterilization
Using the oven 197 48.9
Using autoclave 188 46.7
It is important to wear gloves and masks on:
Contact with the patient
332 82.4
Dealing with blood and its products, especially in labs
249 61.8
On surgical operation, dialysis, deliveries, and
210 52.1
gynecological acts
203 50.4
On wound suturing and dressing
If an infected woman asks about breastfeeding, what
would you advise her?
Avoid breastfeeding definitely 241 59.6
Give bottle feeding 227 56.3
Give breastfeeding for 6 months then starting 15 3.7
supplementary food 79 19.6
Take ART along with breastfeeding

42
Chapter three ……………………………………. Results

Table 6: (Continued)

Items Frequency Percent


If you help an infected person during your duty, do
you become afraid from:
Getting infection 331 82.1
The patient could not come back again 259 64.3
What groups you advise to make to make AIDS test
for them?
268 66.5
Arrived persons
290 72.0
Coming back passengers
321 79.7
Those who intend to get married
259 64.3
Individuals with venereal disease
272 67.5
Barbers
313 77.7
Tattoo workers
241 59.8
Surgeons
251 62.3
Dentists
273 67.7
Midwives
306 75.9
Nurses
294 73.0
Laboratory staff
199 49.4
Retailers

The clear majority reported that the most used syringe type is the
disposable one (n = 371; 98.5%), the most reported method of sterilizing the
surgical tools used in surgical procedures and dressing is boiling them to a 100℃
after their washing and sterilization (n = 222; 55.1%), followed by using the oven
(n = 197; 48.9%), and the autoclave (n = 188; 46.7%, table 6).

43
Chapter three ……………………………………. Results
The majority reported that it is important to wear gloves and masks on
contact with the patient (n = 332; 82.4%), dealing with blood and its products,
especially in labs (n = 249; 61.8%), on surgical operation, dialysis, deliveries,
and gynecological acts (n = 210; 52.1%), and on wound suturing and dressing (n
= 203; 50.4%, table 6).
The majority reported that if an infected mother asked about pregnancy,
they will advice her it necessary to avoid pregnancy (n = 359; 89.1%), and if she
insists to be pregnant, I’ll explain to her the AIDS consequences n = 150; 37.2%,
table 6).
More than one half of the participants reported that if an infected woman
asks about breastfeeding, they would advise her to avoid breastfeeding (n = 240;
59.6%), followed by advising her to give bottle feeding (n = 227; 56.3%), and
taking ART along with breastfeeding (n = 79; 19.6%, table 6).
Most of the participants reported that they would be afraid from getting
infection if they helped an infected person during their duty (n = 331; 82.1%).
For risk groups identification, the highest category reported to be advised for
performing the test were those who intend to get married (n = 321; 79.7%), tattoo
workers (n = 313; 77.7%), nurses (n = 306; 75.9%), laboratory staff (n = 394;
73.0%), and travelers entering the country (national or foreigners, n = 290;
72.0%) as shown in Table 6.

44
Chapter three ……………………………………. Results
Table 7: The distribution of knowledge, attitude and practice scores according to
the participants answers (n=403)
Knowledge score Attitude score Practice score
Group Frequenc Percen Frequenc Percen Frequenc Percen
y t y t y t
Negative
191 47.5% 246 61% 291 75.6%
(below mean)
Positive (Mean
211 52.5% 157 39% 94 24.4%
or above)
Total 402* 100 403* 100 385* 100.0

* The total is different because of missing answers


A total score was calculated for knowledge, attitude and practice through
summation of related questions answers after correcting the direction of positivity
where acceptable answers were given the highest score compared to the wrong or
unacceptable answers.
The means were 21.83, 2.45 and 4.03 for knowledge, attitude and practice,
respectively. The participants were divided into negative answers for those below
the mean and positive answers for those equal to the mean or above. The
proportions of positive answers % were for knowledge, attitude and practice,
respectively (table 7).

45
Chapter three ……………………………………. Results
Table 8: The difference in Participants’ Knowledge among Age Groups
Age Groups Negative (below Positive (Mean
Total
mean) or above)
19-27 66 (46.2%) 77 (53.8%) 143 (100.0%)
28-36 46 (48.4%) 49 (51.6%) 95 (100.0%)
37-45 47 (56.6%) 36 (43.4%) 83 (100.0%)
46-54 25 (39.1%) 39 (60.9%) 64 (100.0%)
≥ 55 7 (41.2%) 10 (58.8%) 17 (100.0%)
Total 191 (47.5%) 211 (52.5%) 402 (100.0%)
Chi-square= 5.01, p=0.289

Participants who were within the age group of (46-54) years-old reported
better knowledge, while the least were those who were within the age group of
37-45-year group. However, the difference was not statistically significant (table
8).
Table 9: The gender distribution of Participants’ Knowledge
Gender Negative (below Positive (Mean
Total
mean) or above)
Female 109 (45.2%) 132 (54.8%) 241 (100.0%)
Male 82 (50.9%) 79 (49.1%) 161 (100.0%)
Total 191 (47.5%) 211 (52.5%) 402 (100.0%)
Chi-square= 1.26, p=0.262

Females have better knowledge about AIDS than males. However, there is
no statistically significant difference in participants’ knowledge about AIDS
between the age groups (table 9).

46
Chapter three ……………………………………. Results
Table 10: The difference in Participants’ Knowledge among different
occupations

Occupation Negative (below Positive (Mean


Total
mean) or above)
Med. Assistant 80 (43.5%) 104 (56.5%) 184 (100.0%)
Nurse 100 (50.3%) 99 (49.7%) 199 (100.0%)
Retired 6 (85.7%) 1 (14.3%) 7 (100.0%)
Others 5 (41.7%) 7 (58.3%) 12 (100.0%)
Total 191 (0.0%) 211 (52.5%) 402 (100.0%)
Chi-square= 6.06, p=0.109

Medical assistants and nurses have better knowledge about HIV/AIDS


(56.5%, 49.7%) respectively, However, there was no statistically significant
difference in participants' knowledge about AIDS among occupation groups
(table 10).

Table 11: The difference in Participants' Knowledge among different education


levels

Education Negative (below Positive (Mean


Total
mean) or above)
Primary School 4 (40.0%) 6 (60.0%) 10 (100.0%)
Secondary School 98 (49.0%) 102 (51.0%) 200 (100.0%)
Institute 80 (46.2%) 93 (53.8%) 173 (100.0%)
College 9 (47.4%) 10 (52.6%) 19 (100.0%)
Total 191 (47.5%) 211 (52.5%) 402 (100.0%)
Chi-square= 5.16, p=0.916

47
Chapter three ……………………………………. Results
On comparison between educational level of participants, all of them reported
that they have better knowledge about AIDS(53.8%, 52.6%, 51%) respectively.
However, there is no statistically significant difference in participants' knowledge
about AIDS among education groups (table 11).

Table 12: The difference in Participants' Knowledge among Marital State Groups

Marital Negative (below Positive (Mean or


Total
state mean) above)
Married 140 (48.6%) 148 (51.4%) 288 (100.0%)
Divorced 16 (32.0%) 34 (68.0%) 50 (100.0%)
Single 35 (54.7%) 29 (45.3%) 64 (100.0%)
Total 191 (47.5%) 211 (52.5%) 402 (100.0%)
Chi-square= 6.29, p=0.043

Divorced participants have better knowledge than married participants and


single participants and the difference was statistically significant difference in
participants' knowledge among marital state group (table 12).

Table 13: The difference in Participants' Knowledge among Workplace Groups

Work place Positive


Negative (below
(Mean or Total
mean)
above)
PHC 96 (45.9%) 113 (54.1%) 209 (100.0%)
Hospital 93 (49.5%) 95 (50.5%) 188 (100.0%)
Private 2 (40.0%) 3 (60.0%) 5 (100.0%)

Total 191 (47.5%) 211 (52.5%) 402 (100.0%)


Chi-square= 1.84, p=0.609

48
Chapter three ……………………………………. Results
Participants who work in PHC centers have better knowledge about AIDS
than those who work in hospitals. However, there was no statistically significant
difference in participants' knowledge about AIDS among workplace groups (table
13).

Table 14: Difference in Participants' Knowledge among different Economic state

Positive
Negative
Economic state (Mean or Total
(below mean)
above)
Poor 17 (56.7%) 13 (43.3%) 30 (100.0%)
Medium 142 (48.0%) 154 (52.0%) 296 (100.0%)
Good 32 (42.1%) 44 (57.9%) 76 (100.0%)
Total 191 (47.5%) 211 (52.5%) 402 (100.0%)
Chi-square= 1.92, p=0.382

Participants who reported that economic state was good have better
knowledge about AIDS than those whose economic state was moderate and those
whose economic state was poor(44,57.9%). However, there was no statistically
significant difference in participants' knowledge about AIDS among the
economic state groups (table 14).

Table 15: The difference in Participants' Attitudes toward AIDS among Age
Groups

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Chapter three ……………………………………. Results
Age group Negative (below Positive (Mean or
Total
mean) above)
19-27 91 (63.2%) 53 (36.8%) 144 (100.0%)
28-36 51 (53.7%) 44 (46.3%) 95 (100.0%)
37-45 56 (67.5%) 27 (32.5%) 83 (100.0%)
46-54 36 (56.3%) 28 (43.8%) 64 (100.0%)
≥ 55 12 (70.6%) 5 (29.4%) 17 (100.0%)
Total 246 (61.0%) 157 (39.0%) 403 (100.0%)
Chi-square= 5.16, p=0.272

Participants aged (28-36) years-old have better attitudes toward AIDS than
those who were within other age groups, while the least were those who were 55-
year-old or older and the difference was significant (table 15).

Table 16: The difference in Participants' Attitudes toward AIDS between Gender
Groups
Gender Negative (below Positive (Mean or
Total
mean) above)
Female 139 (57.4%) 103 (42.6%) 242 (100.0%)
Male 107 (66.5%) 54 (33.5%) 161 (100.0%)
Total 246 (61.0%) 157 (39.0%) 403 (100.0%)
Chi-square= 3.31, p=0.069

Females have better attitudes toward AIDS than males. However, there was
no statistically significant difference in participants' attitudes toward AIDS
between gender groups as shown in (Table 16).

Table 17: Difference in Participants' Attitudes toward AIDS among different


Occupations

50
Chapter three ……………………………………. Results
Type of job Negative (below Positive (Mean
Total
mean) or above)
Administrative 53 (70.7%) 22 (29.3%) 75 (100.0%)
Clinical job 166 (58.5%) 118 (41.5%) 284 (100.0%)
Epidemiological
3 (75.0%) 1 (25.0%) 4 (100.0%)
Surveillance
Others 24 (60.0%) 16 (40.0%) 40 (100.0%)
Total 246 (61.0%) 157 (39.0%) 403 (100.0%)
Chi-square= 4.07, p=0.244

Participants who perform clinical job have better attitudes toward AIDS
than other occupations. However, there was no statistically significant difference
in participants' attitudes toward AIDS among occupation groups (table 17).

Table 18: The difference in Participants' Attitudes toward AIDS among


different Educational levels

Negative (below Positive (Mean


Education Total
mean) or above)
Primary School 8 (80.0%) 2 (20.0%) 10 (100.0%)
Secondary School 112 (56.0%) 88 (44.0%) 200 (100.0%)
Institute 112 (64.4%) 62 (35.6%) 174 (100.0%)
College 14 (73.7%) 5 (26.3%) 19 (100.0%)
Total 246 (61.0%) 157 (39.0%) 403 (100.0%)
Chi-square= 5.74, p=0.125

Participants who hold Secondary school level have better attitudes toward
AIDS than those who were primary school graduates, those who hold an associate
degree, and those who were secondary school graduates. However, there was no
statistically significant difference in participants' attitudes toward AIDS among
the education groups (table 18).

51
Chapter three ……………………………………. Results
Table 19: Difference in Participants' Attitudes toward AIDS among Marital
Status Groups
Attitude score
Marital state Positive (Mean or Total
Negative (below mean)
above)
Married 177 (61.5%) 111 (38.5%) 288 (100.0%)
Divorced 31 (62.0%) 19 (38.0%) 50 (100.0%)
Single 38 (58.5%) 27 (41.5%) 65 (100.0%)
Total 246 (61.0%) 157 (39.0%) 403 (100.0%)
Chi-square= 0.22, p=0.895

Participants who were single have better attitudes toward AIDS than those
who were divorced, and those who were married. However, there was no
statistically significant difference in participants' attitudes toward AIDS among
marital state groups (table 19).

Table 20: Difference in Participants' Attitudes toward AIDS among Workplace


Place
Attitude score
Marital state Negative (below Positive (Mean or Total
mean) above)
PHC 134 (64.1%) 75 (35.9%) 209 (100.0%)
Hospital 109 (57.7%) 80 (42.3%) 189 (100.0%)
Private 3 (60.0%) 2 (40.0%) 5 (100.0%)
Total 246 (61.0%) 157 (39.0%) 403 (100.0%)
Chi-square= 1.74, p=0.420

Participants who work in hospitals have better attitudes toward AIDS than
those who work in PHC centers, However, there was no statistically significant

52
Chapter three ……………………………………. Results
difference in participants' attitudes toward AIDS among workplace groups (table
20).

Table 21: The difference in Participants' Attitudes toward AIDS among economic
State
Negative (below Positive (Mean
Economic state Total
mean) or above)
Poor 15 (50.0%) 15 (50.0%) 30 (100.0%)
Medium 178 (60.1%) 118 (39.9%) 296 (100.0%)
Good 53 (68.8%) 24 (31.2%) 77 (100.0%)
Total 246 (61.0%) 157 (39.0%) 403 (100.0%)
Chi-square= 3.61, p=0.165

Participants who reported that their economic state was poor have better
practice for AIDS than those whose economic state was good, and those whose
economic state was moderate. However, there was no statistically significant
difference in participants' practice for AIDS among economic state groups (table
21).

Table 22: The difference in Participants' Practice for AIDS among Age Groups
Negative (below Positive (Mean or
Age group Total
mean) above)
19-27 105 (76.1%) 33 (23.9%) 138 (100.0%)
28-36 70 (76.1%) 22 (23.9%) 92 (100.0%)
37-45 69 (86.3%) 11 (13.8%) 80 (100.0%)
46-54 36 (61.0%) 23 (39.0%) 59 (100.0%)
≥ 55 11 (68.8%) 5 (31.3%) 16 (100.0%)
Total 291 (75.6%) 94 (24.4%) 385 (100.0%)
Chi-square= 12.15, p=0.016

53
Chapter three ……………………………………. Results
Participants aged 46-54 years-old have better practice for AIDS than those
who were within other age groups, while the least were those who were 37-45-
year-old or older and the difference was significant (table 22),

Table 23: The Gender distribution of Participants' Practice for AIDS

Gender Negative (below Positive (Mean or Total


mean) above)
Female 176 (76.2%) 55 (23.8%) 231 (100.0%)
Male 115 (74.7%) 39 (25.3%) 154 (100.0%)
Total 291 (75.6%) 94 (24.4%) 385 (100.0%)
Chi-square= 0.12, p=0.735

Males have better practice for AIDS than males. However, there was no
statistically significant difference in participants' practice for AIDS between
gender groups (table 23).

Table 24: The difference in Participants' Practice for AIDS among different
Educational level

Education Negative (below Positive (Mean Total


mean) or above)
Primary School 9 (90.0%) 1 (10.0%) 10 (100.0%)
Secondary School 145 (77.1%) 43 (22.9%) 188 (100.0%)
Institute 124 (73.8%) 44 (26.2%) 168 (100.0%)
College 13 (68.4%) 6 (31.6%) 19 (100.0%)
Total 291 (75.6%) 94 (24.4%) 385 (101.0%)
Chi-square= 2.18, p=0.535

54
Chapter three ……………………………………. Results
Participants who hold College degree have better practice for AIDS than
those who hold other degrees. However, there was no statistically significant
difference in participants’ practice for AIDS among the education groups (table
24).

Table 25: Difference in Participants' Practice for AIDS among Marital states
Attitude score
Marital state Negative (below Positive (Mean or Total
mean) above)
Married 208 (75.6%) 67 (24.4%) 275 (100.0%)
Divorced 34 (73.9%) 12 (26.1%) 46 (100.0%)
Single 49 (76.6%) 15 (23.4%) 64 (100.0%)
Total 291 (75.6%) 94 (24.4%) 385 (100.0%)
Chi-square= 0.10, p=0.950

Participants who were divorced have better Practice for AIDS than those
who were married, and those who were single. However, there was no statistically
significant difference in participants' practice for AIDS among marital state
groups (table 25).

Table 26: The difference in Participants' Practice for AIDS among Workplace
groups
Practice for AIDS
Work Place Negative (below Positive (Mean or Total
mean) above)
PHC 145 (73.6%) 52 (26.4%) 197 (100.0%)
Hospital 144 (78.3%) 40 (21.7%) 184 (100.0%)
Total 289(75.95%) 92 (24.05%) 381(100.0%)
Chi-square= 2.55, p=0.279

55
Chapter three ……………………………………. Results
Participants who work in PHCce have better Practice for AIDS than those
who work in the hospital. However, there was no statistically significant
difference in participants’ practice for AIDS among workplace groups (table 26).

Table 27: Difference in Participants' Practice for AIDS among different


Occupations

Occupation Negative (below Positive (Mean


Total
mean) or above)
Administrative 60 (84.5%) 11 (15.5%) 71 (100.0%)
Clinical job 197 (73.0%) 73 (27.0%) 270 (100.0%)
Epidemiological
3 (75.0%) 1 (25.0%) 4 (100.0%)
Surveillance
Others 31 (77.5%) 9 (22.5%) 40 (100.0%)
Total 291 (77.5%) 94 (22.5%) 385(100.0%)
Chi-square= 4.15, p=0.239

Participants who perform clinical job have better Practice for AIDS than
among other occupations. However, there was no statistically significant
difference in participants’ practice for AIDS among occupation groups (table 27).

56
Chapter three ……………………………………. Results
Table 28: The difference in Participants' Practice for AIDS among Economic
Status Groups

Negative (below Positive (Mean


Economic state Total
mean) or above)
Poor 20 (69.0%) 9 (31.0%) 29 (100.0%)
Medium 212 (74.9%) 71 (25.1%) 283 (100.0%)
Good 59 (80.8%) 14 (19.2%) 73 (100.0%)
Total 291 (75.6%) 94 (24.4%) 385 (100.0%)
Chi-square= 1.84, p=0.398

Participants who reported that their economic state was poor have better
practice for AIDS than those whose economic state was good, and those whose
economic state was moderate. However, there was no statistically significant
difference in participants’ practice for AIDS among economic state groups as
shown in( Table 28).

A total knowledge, attitudes and practice scores were formulated through summation and showed
that 52.5% of the participants have positive knowledge scores (more than mean score). For attitudes
and practice the proportions were (39.0% and 24.4%). Higher knowledge scores were significantly
associated with higher positive attitudes. The proportion of the mean score positive attitudes among
those with knowledge scores higher than those with lower knowledge scores (59.24% vs, 48.16%,
p=0.033). Similarly, marital state of the participants was significantly associated with knowledge
scores (p=0.043). Divorced participants had the highest score followed by single participants and the
least were the married participants (68.0%, 51.4% and 5.3%, respectively). While, no such association
was found between knowledge scores with other participants characteristics such as age group
(p=0.286), gender (p=0.262), place of work (p=0.737), educational level (p=0.914), job type (p= 0.607)
and occupation (p=0.109). This was similar to attitudes score as it was not significantly associated with
and predictors.

The vast majority (99%) reported using disposable syringe and they mostly reported using boiling
surgical tools to a 100℃ after their washing and sterilization. Similarly, a great majority (82.4%)
reported that it is important to wear gloves and masks on contact with AIDS patient (table 6). The
practice score was only significantly positively associated with age category (p=0.016)

57
Chapter three ……………………………………. Results
Table 29: The Frequency of HIV Cases and Mortality Rates Per 10.000 of
Population in Karbala governorate between 2012 -2016.

Cases Morbidity Mortality Mortality


Year
Male Female Total Rate Male Female Total Rate
2012 0 0 0 0.0 0 0 0 0.0
2013 1 1 2 0.02 0 0 0 0.0
2014 0 0 0 0.0 2 1 3 0.03
2015 1 1 2 0.02 1 0 1 0.01
2016 2 0 2 0.02 0 0 0 0.0
Total 4 2 6 0.06 3 1 4 0.04

58
Chapter Four
Discussion of Study Finding

59
Chapter four ………………………………. Discussion of Study Finding

Discussion of Study Finding


The mean age of all the participants was 34.42 ± 11.16 year. More than one-third of

the sample in the present study was within the age group of (19-27) year-old and the least

were those who were 55-year or old. This might reflect that Iraqi youths are welling to be

more engaged in health care services which may resent a shift in a cultural taboo, resulting

possibly from the high rates of unemployment in Iraq. Female constituted three-fifth of the

study subjects compared to males who constituted two-fifth (Table1). This could be

explained as that the larger number of study subjects are high nursing school graduates where

such schools in Iraq accept only females. This finding is consistent with that obtained by

Hassan and Wahsheh (2011) who found that more than half of the study subjects were

females (59%)(21) and here again, this might indicate an improved sociocultural viewpoint

about female HCP. Concerning the occupation, around one half of the participants were

nurses, followed by medical assistants. The reason for such distribution might be related to

the above-mentioned note, as the larger portion of study subjects were nursing school

graduates (Table 1). Regarding job type, most reported doing clinical duties. This finding

could be attributed to the reality that most of study subjects were of low educational

qualification, so they would be required to undertake clinical duties rather than administrative

duties which usually require higher educational qualifications. An important critique to the

Iraqi Health care service, is that people with low educational level are ascertained for clinical

duties while those with higher education are named for administrative responsibilities; which

need to be reversed and highly professionals been engaged in clinical jobs.

With respect to the educational qualification, around one half were graduates of high

nursing school, followed by those who hold an associate degree (Diploma – 2-years after

high school), while a small proportion hold a bachelor's degree, or were primary school

graduates. This finding reflects the reality of education in Iraq where the number of nursing

60
Chapter four ………………………………. Discussion of Study Finding

high school noticeably outweighs that of institutes and colleges of nursing respectively. This

finding is inconsistent with that of Hassan and Wahsheh (2011) who found that more than

two thirds of the respondents (82.4%) held a bachelor's degree in nursing. The low

educational level of HCP might represent a call for health policy makers to plan for

improving such defect and reach the global standards or at least neighboring countries

standard.

Regarding marital state, most participants were married, and this is an expected finding for

such HCP in this age group. On sixth of the sample were single. And this finding seems to be

consistent with subjects' age; where around one-third of them were within the age group of

(19-27) years-old. Further cross-tabulation analysis demonstrates that around one-third of

those who were within the age group of (19-27) years-old were single. Concerning the place

of work, more than one half were working in PHC centers, followed by those who work in

hospitals. This finding could be explained as that working as bed-side care provider requires

better knowledge and skills which can be obtained through higher educational qualification;

the majority of nurses who hold a bachelor's degree and medical assistants were employed in

hospitals rather than PHC centers (Table1). The socioeconomic state in Iraq has no clear

demarcation. For this reason, few questions were included to give a hint about the

socioeconomic state including the number of children they have, type of living

accommodation, house ownership and estimated economic state. With respect to the living

accommodations, more than three quarters reported that they live in shared house while only

one fifth live independently, and less than one half reported that they own a house, and the

remaining live in a rented house. In addition, most of the participants reported that they have

a moderate economic state, this finding could reflect the economic status of the Iraqi HCP.

Mostly, it is impossible for employees who rely only on their monthly salary to have owned

houses. Participants reported good knowledge in the items of “Did you hear about

61
Chapter four ………………………………. Discussion of Study Finding

HIV/AIDS?”, “Is HIV/AIDS dangerous?”, “What is the cause of HIV/AIDS? Is it a virus?”

and “Do you think that AIDS/HIV can be transmitted from one person to another?”. On the

other hand, more than one quarter of participants recorded poor knowledge for the items

“Do you know if there is a vaccine for AIDS prevention?” and other one quarter of them also

thought that it is possible to be completely cured from AIDS (Table 2). These findings reflect

that some of the study participants do not seek to update their information about advancement

in different aspects of AIDS. These findings in present study are almost congruent with that

obtained by (Chen and Holzemer, 2004)(25) who found that all nurses had heard about AIDS,

but a small proportion did not know what causes AIDS. Most knew that HIV can be

transmitted from person to other (97.1%). But participants were not very sure how HIV/AIDS

can be transmitted. Also, present study congruent with other study done by (Abdelhai, R,

Taher, 2011) at Egypt (20). In that, general knowledge about the disease was good among

study participants. More than three quarters of them knew that HIV/AIDS is caused by virus.

More than one quarter of them did not know about sexual mode of transmissions and this in

congruent with present study in that majority of participants recorded good knowledge about

transmission of disease via sexual mode and less than one tenth of them didn’t know about

sexual mode of transmission as one half of them finished nursing high school and less than

one-half finished diploma degree. Also, less than one fifth of them( was attended a training

course related to AIDS throughout their job. Three quarters of participants in present study

correctly answered in that it is impossible to cure from HIV/AIDS in comparison to what

obtained by Taher (20), who found that more than three quarters of participant believed that

there is complete cure from AIDS. Concerning participants’ knowledge about the etiology of

AIDS transmission, they reported better knowledge for the items “Via intercourse”, “Via

blood transfusion or organ donation from an infected person”, “From the mother to her

fetus”, and “Drug use by using the syringe for intravenous injection” respectively (Table 2).

62
Chapter four ………………………………. Discussion of Study Finding

These findings could reflect participants' knowledge deficit in that insect bites can transfer

the AIDS infection from an infected person to an uninfected one (55.6%). These findings are

consistent with the study that was conducted in Egypt study (20) which reported that all

participants correctly answered that method of transmissions were infected blood and sharing

syringe and sharps. These findings are higher than that reported in South East Nigeria in

2017 (31), which reported that three-quarters of participants answered correctly "AIDS is

transmitted through blood transfusion" (n = 185; 77.1%). Furthermore, these findings are

congruent with that obtained by Som, Bhattacherjee, Guha, Basu, Datta , 2015)(15), who

reported that the participant had good knowledge on methods of transmission, around 90%

answered correctly in that AIDS is transmitted via blood in various ways also from donating

blood from HIV positive patient (86%) and exposure to blood when taken care of patient was

(86.8%). About (76.8%) of them knew that it is transmitted via breast feeding. This finding is

congruent with that study done in south east of Nigeria,2017, among health care

workers(31).The study showed that three quarters of them(185,77.1%) agree that HIVis

transmit through blood transfusion. While(188, 78%)of them correctly answered via

unprotected sexual intercourse. The participants reported more agreement about the items

“Disseminating health education about the AIDS among the public”, “Using condom”,

“Avoid sharing shaving tools”, “Making voluntary AIDS tests for individuals with multiple

sexual relationships” respectively (Table 3).The most reported source of information about

AIDS/HIV was the internet web sites, other sources included friends, Television, family

members and magazines and radio respectively (Table 5). These findings indicated that the

study participants do not seek to look for information in the scientific textbooks. Internet is

more accessible to them compared to scientific textbooks which could be expensive for them

or they find difficulty in accessing such textbooks in libraries or at their health premises.

These finding are consistent with that obtained by Hassan and Wahsheh (2011), who reported

63
Chapter four ………………………………. Discussion of Study Finding

that the participants' main source of HIV/AIDS/HIV information was Internet web sites

(52.7%). On the other hand, these findings are inconsistent with that of Chen and Holzemer

(2004), who reported that nurses' sources of knowledge in China about HIV and AIDS/HIV

were watching television programs (88.9%) talking to experts (60.2%) and reading books or

newspapers (59.6%). On the other hand, Macfarlane (2014) reported that most of the nurses

in Havering and Redbridge University Hospitals had acquired most of their HIV knowledge

on the job, through their own reading or the media (27). Most of the participants in present

study (337, 83.6%) reported that there is no medical treatment for HIV/AIDS. This reflect

bad knowledge on development of drugs against HIV/AIDS. This finding incongruent with

study of (Alsalihi, Sh, 2017) in Baquba Teaching Hospital, who found that 34.6% of nursing

staff and 47.6% of medical assistants in the study were answered correctly about effect of

Antiretroviral therapy (ART) in controlling HIV infection(20). Siebert compare this with

attitudes, concerns and practices of (60) medical laboratory technologists in Fiji related to

handling HIV positive biological specimens. They reported that HIV/AIDS knowledge

deficits are represented in HIV falling into diverse biological specimens, the destruction of

HIV outside the body, and the risk categories of HIV transmission. Participants who were

within the age group of (46-54) years-old have poorer knowledge about HIV/AIDS (39,

60.9), while the least were those who were within the age group of 37-54-year group (36,

43.4%). However, the difference was not statistically significant (Table 8). This finding goes

in line with that of Suominen and others (2010) who concluded that nurses’ age correlated

negatively with their knowledge score. Females have better knowledge about AIDS/HIV

than males. However, there is no statistically significant difference in participants’

knowledge about AIDS/HIV between the age groups (Table 9). This finding in inconsistent

with that obtained by Siebert, Lynch, and Singh (1995) who found that males demonstrating

higher knowledge than females. However, there was no statistically significant difference in

64
Chapter four ………………………………. Discussion of Study Finding

participants' knowledge about AIDS/HIV among gender groups (Table 9). Also present

study showed Participants who hold a bachelor's degree have better knowledge about

AIDS/HIV than those who were secondary school graduates, those who hold an associate

degree, and those who were primary school graduates. However, there is no statistically

significant difference in participants' knowledge about AIDS/HIV among education groups

(Table 11). This finding is congruent with that of Suominen and others (2010) who concluded

that staff nurses’ length of education correlated positively with their knowledge score and

inconsistent with that of (Abdelhai, R, Taher) that shown no statistically significance

difference between post graduates and undergraduate nurses in knowledge on HIV/AIDS..

Divorced participants reported better knowledge than married participants and single

participants and the difference was statistically significant difference in participants'

knowledge among marital state group (Table 12). The participants in present study, who

work in PHCs also have better knowledge about HIV/AIDS than those who work in

hospitals (Table 13). However, there was no statistically significant difference in participants'

knowledge about AIDS/HIV among workplace groups. Suominen and others (2010)

concluded that nurses’ years in work correlated negatively with their knowledge scores. This

is incongruent with that obtained by Som, Bhattacherjee and others (2015) who concluded

that nurses at age group>25 years with work experience of 6-10 years were found to have

better knowledge (P< 0.05). The participants highest positive reported attitudes toward

HIV/AIDS were for the items “Do you agree to make a voluntary test for the virus causing

HIV/AIDS?”, “Do you agree to taking care for a family member with HIV/AIDS?” as shown

in (Table 4). On the other hand, they reported the highest negative attitudes for the items “Do

you agree to having food in a restaurant with a person with HIV/AIDS?”, “Do you agree that

children with AIDS/HIV be in schools with healthy children?”, “Do you agree to buy fresh

fruits and vegeTables from a person with HIV/AIDS “Do you agree to be with a person with

65
Chapter four ………………………………. Discussion of Study Finding

HIV/AIDS?”, and “Do you agree to play sports with a person with AIDS/HIV?” respectively

(Table 4). These findings could be culturally-originated as the study participants are part of

the Iraqi population who look at individuals with HIV/AIDS negatively as HIV/AIDS is

mainly attributed to acts that involve unacceptable behaviors. These findings are congruent

with that obtained by Tsai and Keller (1995) who found that Taiwanese nurses’ attitudes

about giving care to HIV-positive patients generally was negative and that they lacked

knowledge regarding prevention of HIV infection in the workplace (26). Consistently, these

findings go in line with that of Chen and Holzemer (2004). who reported that nurses were

prone to have positive attitude toward people living with HIV Positive patients (25). On the

other hand, these findings are incongruent with that of Doda, Negi, Gaur, and Harsh (2018)

who found that nurses had more positive attitudes toward people living with HIV/AIDS

(PLWHA) than the other groups (postgraduate residents, undergraduate medical students,

laboratory technicians)(2). More than two thirds of the participants (81.6%) reported that they

did not meet a client with AIDS/HIV throughout their career; and this is consistent with the

low incidence of AIDS/HIV in Iraq. The majority reported that they would refer him/her to a

specialized health agency when they find him/her, followed by making HIV/AIDS test for

his/her family members. These findings could be explained as that most of HIV/AIDS cases

might not be reported or underreported (because of social stigma), where the infected persons

may hesitate to visit health agencies to seek medical care because of the social stigma related

to HIV/AIDS. The may not declare their state on visiting private or governmental health

facilities, and this problem represents a real danger for the public and need an extensive

health education programs covering patients, HCP and general public. Legislations and

guideline are also urgently needed. These findings are consistent with that of Chen and

Holzemer (2004) who found that around half of the nurses reported that they avoided contact

with HIV-positive patients, however, more than one half of these nurses sympathized with

66
Chapter four ………………………………. Discussion of Study Finding

and had concerns about these patients. Also congruent with that of Hassan and Wahsheh, who

found that three quarters of participants had negative attitude towards HIV/AIDS because

fear of contagion and social stigma. Poor knowledge perception, attitude, and practice about

how the disease is spread and how it can be prevented are considered as key factors

increasing the spread of HIV/AIDS in developing countries (Doda, Negi, Gaur, & Harsh,

2018). The majority of the participants reported that they did not attend any training courses

about HIV/AIDS. Furthermore, most reported that they would join such courses when they

are offered. This finding could reflect the study participants sensitized the seriousness of

AIDS/HIV. By joining such courses, they will be more prepared to prevent and manage

HIV/AIDS. This finding is congruent with that of Hassan and Wahsheh (2011) who reported

that majority of respondents were interested in support groups for staff nurses and attending

in-service programs about HIV/AIDS/HIV. More than one half of the participants reported

that there were no preparations in their health premises to receive clients with AIDS/HIV.

This finding could be explained by the low-reported HIV/AIDS cases and does not urge

health officials in Iraq to think about establishing such preparations. On the other hand,

planning for training courses is usually decided in a proportionate extent with the size of a

given health condition. The majority reported in present study that if an infected mother asks

about pregnancy, they ‘would advise her it necessary to avoid pregnancy (89.1%), and if she

insists to be pregnant, I’ll explain to her the AIDS/HIV consequences’ (Table 6). These

findings reflect the participants' sound awareness related to HIV/AIDS prevention. This

finding is consistent with study of Som, Bhattacherjee, Guha, Basu, & Datta) who reported

that 96% of the participants knew that HIV can be spread from mother to child during

pregnancy, delivery. More than one half of the participants reported that if an infected woman

asks about breastfeeding, they would advise her to avoid breastfeeding, followed by advising

her to give bottle feeding only, and taking ART along with breastfeeding (Table 6). Also,

67
Chapter four ………………………………. Discussion of Study Finding

these finding are congruent with that of Som, Bhattacherjee, Guha, Basu, and Datta) in that

56.8% of participants advice infant feeding practices via formula only and 57.6% of them

advised breast feeding for six months and then change to mixed feeding. These findings in

present study reflect participants' good level of knowledge about Mother-To-Child (MTC)

transmission as HIV can pass from the mother to her child through breastfeeding and delivery

of the different aspects of HIV/AIDS. Social stigma, fear of contagion, and education and

counseling represent important issues in AIDS/HIV control program for HCP. The majority

of the participants reported that they would be afraid from getting infection if they help an

infected person during their duty. This finding is consistent with that obtained by Hassan and

Wahsheh (2011), who reported that more than two-thirds of Jordanian nurses had a negative

attitude towards HIV/AIDS/HIV patient under their direct care. This finding was also

consistent with that of Chen and Holzemer (2004) and Macfarlane (2014) who concluded that

most of the participants worried about getting AIDS/HIV Participants aged (28-36) years-old

have better attitudes toward HIV/AIDS than those who were within other age groups, while

the least were those who were 55-year-old or older and the difference was significant (Table

15). This finding is consistent with that of Suominen and others (2010) who found that length

of work experience (in years) correlated negatively with attitude. Females have better

attitudes toward HIV/AIDS than males. However, there was no statistically significant

difference in participants' attitudes toward HIV/AIDS between gender groups (Table 16).

Participants who perform clinical job have better attitudes toward HIV/AIDS than other

occupations. However, there was no statistically significant difference in participants'

attitudes toward AIDS/HIV among occupation groups (Table 17).

Participants who hold secondary school level have better attitudes toward AIDS/HIV than

those who were primary school graduates, those who hold an associate degree as most of

participants (49.6) were finished secondary nursing school and most of them were worked in

68
Chapter four ………………………………. Discussion of Study Finding

the major hospitals. Also, they were in direct contact with HIV/AIDS patients. Lectures and

seminars provided for health care workers mostly at hospital. So, they were taken more

information on AIDS easily. Some of them attended course for AIDS which can improve

their attitudes, However, there was no statistically significant difference in participants'

attitudes toward AIDS/HIV among the education groups (Table 18). This finding is

inconsistent with that of Suominen and others (2010) who found that nurses’ length of

education (in years) had a positive influence on attitude scores. Participants who were single

have better attitudes toward AIDS/HIV than those who were divorced, and those who were

married. However, there was no statistically significant difference in participants' attitudes

toward AIDS/HIV among marital state groups (Table 19). This finding is incongruent with

that obtained by Suominen and others (2010) who found that single nurses had higher attitude

levels than others. Participants who work in hospitals have better attitudes toward AIDS/HIV

than those who work in PHC centers. However, there was no statistically significant

difference in participants' attitudes toward AIDS/HIV among workplace groups (Table 20).

This could be explained as that nurses who work in hospitals could receive more cases of

AIDS/HIV than those who work in PHC centers and those who work in private hospitals.

This implies that dealing with more AIDS/HIV cases can positively influence nurses'

attitudes toward persons with ADS.. Almost all participants (98.5%) reported using

disposable syringes for injecting drugs or for other purposes (Table 6). This finding could be

explained as that the disposable syringe is the most available type of syringes in Iraq.

Furthermore, since most of study participants are considered as young, they did not deal with

the older generations of syringe that were used in the past decades in Iraq. The most reported

method of sterilizing the surgical tools used in surgical procedures and dressing is boiling

them to a 100 0 C. after their washing and sterilization, followed by using dry heating by

oven and autoclaving methods. (Table 6). These findings could reflect the absence of well-

69
Chapter four ………………………………. Discussion of Study Finding

determined, agreed-upon sterilizing policy among the health agencies in Iraq. This

incongruent with studies carried out in Nigeria by Sofola , 2003), that reported the most

common methods of sterilization of surgical instruments is autoclaving.(84%). Furthermore,

Deeks, Lewin, and Havlir (2013) stated that concerns are growing that the multi-morbidity

associated with HIV disease could affect healthy aging and overwhelm some health-care

systems, particularly those in resource-limited regions that have yet to develop a chronic care

model fully. Other concerns include infection fear, becoming infected through partner

betrayal, the economic consequences of infection, society's response to the HIV/AIDS crisis,

testing concerns, worries about becoming infected through casual contact (Bell, Molitor, and

Flynn, 1999; Hassan and Wahsheh, 2011), the safety of medical procedures, For risk groups

identification, the highest category reported to be advised for performing the test were those

who intended to get married (321,79.7%), tattoo worker (241, 59.8), nurses (306,75.9%),

laboratory staff (306,75.9%) and travelers entering the country (national or foreigners ,

290,72.0%,268,66.5%) respectively as shown in (Table 6). This could be explained as that

the only condition in which HIV-testing is mandatory in Iraq is for those who intend to get

married. Participants who reported that their socioeconomic status was poor have better

practice for AIDS/HIV than those whose economic state was good, and those whose

economic state was moderate. However, there was no statistically significant difference in

participants' practice for AIDS/HIV among economic state groups (Table 21). This finding

could be explained as those participants with poor socioeconomic status can be more

empathetic with individuals with AIDS/HIV. Participants aged 46-54 years-old have better

practice for AIDS/HIV than those who were within other age groups, while the least were

those who were 37-45-year-old or older and the difference was significant (Table 22). This

finding could be explained as that the longer years of career, the better the practice. Males

have better practice for AIDS/HIV than males. However, there was no statistically significant

70
Chapter four ………………………………. Discussion of Study Finding

difference in participants' practice for AIDS/HIV between gender groups (Table 23). This

finding could be explained as that in the light of the societal norms in Iraq, male nurses have;

to some extent, less restriction in dealing with HIV/AIDS cases than female health care

workers. Participants who hold College degree have better practice for HIV/AIDS than those

who hold other degrees. However, there was no statistically significant difference in

participants’ practice for AIDS/HIV among the education groups (Table 24). This could be

attributed to the reality that the higher the academic curriculum, the more the qualified

graduates. Participants who were divorced have better Practice for HIV/AIDS than those

who were married, and those who were single. However, there was no statistically significant

difference in participants' practice for HIV/AIDS among marital state groups (Table 25). This

could be explained as that divorced participants could feel less worried of contracting

AIDS/HIV and they could have no partners to whom they subsequently can transfer the

AIDS/HIV compared to married participants. Participants who work in hospitals have better

Practice for AIDS/HIV than those who work in PHC centers. However, there was no

statistically significant difference in participants’ practice for AIDS/HIV among workplace

groups (Table 26). As we mentioned earlier, participants who work in hospitals could receive

more cases of AIDS/HIV than those who work in PHC centers or in private sector.

Participants who perform clinical job have better practice for AIDS/HIV than among other

occupations. However, there was no statistically significant difference in participants’

practice for AIDS/HIV among occupation groups (Table 27). This finding could be explained

as that performing a clinical job could acquire health care workers broader body of

knowledge and practice compared to other occupation that lack the direct care for persons

with AIDS/HIV. Participants who reported that their economic state was poor have better

practice for AIDS/HIV than those whose economic state was good, and that economic state

was moderate. However, there was no statistically significant difference in participants’

71
Chapter four ………………………………. Discussion of Study Finding

practice for AIDS/HIV among economic state groups (Table 28). As we mentioned earlier,

participants with poor socioeconomic status can be more empathetic with individuals with

AIDS/HIV which in turn provoke them to care for persons with HIV/AIDS better.

72
Conclusions and Recommendations

Conclusions:

The participants reported better knowledge in the items of the definition, severity,

etiology, prevention methods, and transmission of HIV /AIDS, the availability

of a vaccine for HIV infection and curability of disease. Also, the participants

had positive attitudes toward HIV/AIDS seemed to outweigh their negative

attitudes. The study participants demonstrated correct practices related to tackling

HIV /AIDS condition in ways that can prevent its transmission. The majority

reported appropriate advising for mothers infected with AIDS, with the goal of

avoiding its transmission to their babies. Most of the participants reported

noticeable fear of contracting HIV/AIDS throughout their caregiving for persons

with HIV/AIDS. Females have better knowledge and attitudes toward AIDS than

males. Participants who hold a bachelor's degree have better knowledge and

attitudes toward AIDS compared to lower educational levels. Divorced

participants have better knowledge and attitudes toward AIDS compared to

married and single participants. Participants who work in PHC centers have better

knowledge and attitudes toward AIDS compared to those who work in hospitals.

Recommendations:

1- It is necessary to conduct further studies on larger samples of nurses across

Iraq with the goal of increasing their knowledge, enhancing their attitudes

and practices related to AIDS.

73
2- There is a need to initiate continuous medical education activities that

should target nursing staffs with lower educational levels with the goal of

enhancing their knowledge, attitudes, and practices related to HIV/AIDS.

3- It is necessary to incorporate materials related to different aspects of

HIV/AIDS into the curriculum of nursing programs; particularly nursing

institutes and schools.

74
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14. Siddiqi S, Khan MS, Majeed SA. Knowledge, attitude and practice survey

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21. Hassan, Z. M., & Wahsheh, M. A. (2011). Knowledge and Attitudes of

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79
Appendices

80
Study Instrument

Age: ……….. Year

Gender: Female [ ] Male [ ]

Results

Occupation: Medical Assistant [ ] Nurse [ ] Retired [ ] Other [ ]

Job Type: Administrative [ ] Clinical [ ] Epidemiologist Surveillance [ ]

Other [ ]

Education: Primary [ ] Nursing High School [ ] Diploma [ ] Bachelor's degree [

Marital Status: Married [ ] Divorced [ ] Single [ ]

Workplace: PHC [ ] Hospital [ ] Private [ ]

Do you have an evening job? Yes [ ] No [ ]

Accommodation: Independent [ ] Shared [ ]

Property: Rented [ ] Owned [ ] Other [ ]

Economic Status: Poor [ ] Moderate [ ] Good [ ]

81
The participants’ Knowledge about AIDS

Item Yes No
Did you hear about AIDS?
Is AIDS dangerous?
What is the cause of AIDS? Is it a virus?
Do you think that AIDS can be transmitted from one person to
another?
Do you know if there is a vaccine for AIDS prevention?
Do you think that AIDS can be completely prevented?
Do you think that AIDS signs appear on the infected person?
Do you think it is possible to be completely cured from AIDS?
Causes of Disease Transmission
Via intercourse
Via blood transfusion or organ donation from an infected person
From the mother to her fetus
Drug use by using the syringe for intravenous injection
Drug use by using the syringe for intramuscular injection
Through cough
Via breastfeeding
Using the same shaving tools
Sharing drink and/or food
Contacting an infected person
Insect bite
Tattooing supplies

82
The participants’ Knowledge about AIDS Prevention Methods

Strongly Do not Not Strongly


Item Agree
Disagree agree decided agree
Prevention Methods
Completely isolating the infected
person from others
Avoid sharing shaving tools
Using condom
Blood examination before its
transfusion
Using syringe for one time only 92.0
Avoid adultery
Avoid public swimming pools and
W.C.
Making voluntary AIDS tests for
individuals with multiple sexual
relationships
Disseminating health education
about the AIDS among the public

83
4: The participants’ Attitudes toward AIDS (n = 403)
What is your attitude toward AIDS?

Item Yes No
Ending the relationship with your friend if you knew that he/she has AIDS
Do you agree to live in the same house with a person with AIDS?
Do you agree to eat and drink with a person with AIDS?
Do you agree to be with a person with AIDS?
Do you agree to taking care for a family member with AIDS?
Do you agree to buy fresh fruits and vegetables from a person with AIDS?
Do you agree to play sports with a person with AIDS?
Do you agree to having food in a restaurant with a person with AIDS?
Do you agree to make a voluntary test for the virus causing AIDS?
Do you agree that children with AIDS be in schools with healthy children?
If you are asked to take a blood sample from a person with AIDS, do you
agree?

84
The participants’ Sources of Information about AIDS

What is your source of information about AIDS?

Family [ ] Friend [ ] Magazines [ ] Internet [ ]

Radio [ ] TV [ ] Others [ ]

Did you find a client with AIDS on your career? Yes [ ] No [ ]

If you found a client with AIDS on your career, what will you do?

Offering counseling [ ] Refer him/her to a specialized health agency [ ]

Leave him/her [ ] Calling a health agency [ ]

Making AIDS test for his/her family members [ ]

Did you attend a training course related to AIDS? Yes [ ] No [ ]

In case of offering new courses about AIDS, would you like to join them? Yes [ ] No
[ ]

Are there any preparations in the health agencies to receive clients with AIDS?

Yes [ ] No [ ]

Is there a treatment for AIDS? Yes [ ] No [ ]

85
The participants’ Practices related to AIDS

What is the syringe type used in I.M. or I.V. injection?

Disposable syringe [ ] Multiple use syringe [ ]

Using boiler to sterilize syringe [ ]

What is the method of sterilizing the surgical tools used in surgical procedures and

dressing?

Washing them with water and a disinfectant [ ]

It is preferable to boil them to a 100℃ after their washing and sterilization [ ]

Using the oven [ ] Using autoclave [ ]

It is important to wear gloves and masks on:

Contact with the patient [ ]

Dealing with blood and its products, especially in labs [ ]

On surgical operation, dialysis, deliveries, and gynecological acts [ ]

On wound suturing and dressing [ ]

If an infected mother asks about pregnancy, what will you do?

It is necessary to avoid pregnancy [ ]

I would agree with her since AIDS doesn’t transmitted to the fetus [ ]

Advise her to take ART [ ]

If she insists to be pregnant, I’ll explain to her the AIDS Consequences [ ]

If an infected woman asks about breastfeeding, what would you advise her?

Avoid breastfeeding definitely [ ]

Give bottle feeding [ ]

Give breastfeeding for 6 months then starting supplementary food [ ]

Take ART along with breastfeeding [ ]

86
If you help an infected person during your duty, do you become afraid from:

Getting infection [ ]

The patient could not come back again [ ]

What groups you advise to make to make AIDS test for them?

Arrived persons [ ] Coming back passengers [ ]

Those who intend to get married [ ] Individuals with venereal disease [ ]

Barbers [ ] Tattoo workers [ ]

Surgeons [ ] Dentists [ ]

Midwives [ ] Nurses [ ]

Laboratory staff [ ] Retailers

87
‫ااستبيان عن االيدز‬
‫العمر‪ .......... :‬السنة‬
‫]‬ ‫ذكر [‬ ‫الجنس ‪:‬أنثى‬
‫ا المهنه معاون طبي [] ممرض [] متقاعد [] أاخرى ‪:‬‬
‫التعليم‪ :‬االبتدائي [] مدرسة ثانوية التمريض [] دبلوم [] درجة البكالوريوس []‬
‫الحالة االجتماعية‪ :‬متزوج [] مطلق [] أعزب []‬
‫مكان العمل‪ :‬مستشفى[] مراكزالرعاية الصحية األولية [] خاص []‬
‫ال [ ]‬ ‫هل لديك وظيفة مسائية؟ نعم‬
‫االقامة‪ :‬مستقل [] مشترك []‬
‫العقار‪ :‬مؤجر [] مملوك [] آخر []‬

‫الوضع االقتصادي‪ :‬ضعيف [] معتدل [] جيد []‬

‫معرفة المشاركين حول مرض اإليدز‬

‫البند نعم ال‬

‫هل سمعت عن اإليدز؟‬

‫هل االيدز خطير؟‬

‫ما هو سبب اإليدز؟ هل هو فيروس؟‬

‫هل تعتقد أن اإليدز يمكن أن ينتقل من شخص إلى آخر؟‬

‫هل تعرف ما إذا كان هناك لقاح للوقاية من اإليدز؟‬

‫هل تعتقد أن اإليدز يمكن منعه بالكامل؟‬

‫هل تعتقد أن عالمات اإليدز تظهر على الشخص المصاب؟‬

‫هل تعتقد أنه من الممكن الشفاء التام من اإليدز؟‬

‫أسباب انتقال المرض‬

‫عن طريق الجماع‬

‫عن طريق نقل الدم أو التبرع باألعضاء من شخص مصاب‬

‫من األم إلى جنينها‬

‫‪88‬‬
‫استخدام المخدرات عن طريق استخدام حقنة الحقن في الوريد‬

‫استخدام المخدرات عن طريق استخدام حقنة للحقن العضلي‬

‫من خالل السعال‬

‫عن طريق الرضاعة الطبيعية‬

‫باستخدام نفس أدوات الحالقة‬

‫تقاسم الشراب و ‪ /‬أو الطعام‬

‫االتصال بشخص مصاب‬

‫لدغة حشرة‬

‫لوازم الوشم‬

‫معرفة المشاركين حول طرق الوقاية من االيدز‬

‫اإلجابة ب ال أوافق بشدة ال أوافق لم يقرر موافق موافق بشدة‬

‫طرق الوقاية‬

‫عزل الشخص المصاب تما ًما عن اآلخرين‬

‫تجنب مشاركة أدوات الحالقة‬

‫استخدام الواقي الذكري‬

‫فحص الدم قبل نقل الدم‬

‫باستخدام حقنة لمرة واحدة فقط ‪92.0‬‬

‫تجنب الزنا‬

‫تجنب حمامات السباحة العامة و ‪W.C.‬‬

‫إجراء اختبارات طوعية لمكافحة اإليدز لألفراد ذوي العالقات الجنسية المتعددة‬

‫نشر التعليم الصحي حول مرض اإليدز بين العامة ‪:‬‬

‫مواقف المشاركين تجاه اإليدز (ن = ‪)403‬‬

‫‪89‬‬
‫ما هو موقفك تجاه اإليدز؟‬

‫البند نعم ال‬

‫إنهاء العالقة مع صديقك إذا كنت تعرف أنه مصاب باإليدز‬

‫هل توافق على العيش في نفس المنزل مع شخص مصاب بمرض اإليدز؟‬

‫هل توافق على األكل والشرب مع شخص مصاب باإليدز؟‬

‫هل توافق على أن تكون مع شخص مصاب بمرض اإليدز؟‬

‫هل توافق على االهتمام بأحد أفراد األسرة المصابين باإليدز؟‬

‫هل توافق على شراء فواكه وخضروات طازجة من شخص مصاب بمرض اإليدز؟‬

‫هل توافق على ممارسة الرياضة مع شخص مصاب بمرض اإليدز؟‬

‫هل توافق على تناول الطعام في مطعم مع شخص مصاب بمرض اإليدز؟‬

‫هل توافق على إجراء اختبار طوعي لفيروس اإليدز؟‬

‫هل توافق على أن األطفال المصابين باإليدز يكونون في المدارس مع أطفال أصحاء؟‬

‫إذا ُ‬
‫طلب منك أخذ عينة دم من شخص مصاب باإليدز ‪ ،‬فهل توافق على ذلك؟‬

‫مصادر معلومات المشاركين حول مرض اإليدز‬

‫ما هو مصدر معلوماتك عن مرض اإليدز؟‬

‫][ ‪Family [] Friend‬مجالت [] اإلنترنت []‬

‫راديو [] تلفزيون [] آخرون []‬

‫هل وجدت عميالً مصابًا بمرض اإليدز في حياتك المهنية؟ نعم ال [ ]‬

‫إذا عثرت على عميل يعاني من مرض اإليدز في حياتك المهنية ‪ ،‬فما الذي ستفعله؟‬

‫تقديم المشورة [] إحالته ‪ /‬ها إلى وكالة صحية متخصصة []‬

‫دعه ‪ /‬ها [] االتصالل بالمووءسسة صحية []‬

‫اءجراء اختبار اإليدز ألفراد أسرته []‬

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‫هل حضرت دورة تدريبية متعلقة باإليدز؟ نعم ال [ ]‬

‫في حالة تقديم دورات جديدة حول اإليدز ‪ ،‬هل ترغب في االنضمام إليهم؟ نعم ال [ ]‬

‫هل هناك أي استعدادات في الوكاالت الصحية الستقبال مرضى اإليدز؟‬

‫نعم ال [ ]‬

‫هل يوجد عالج لمرض اإليدز؟ نعم ال [ ]‬

‫ممارسات المشاركين المتعلقة باإليدز‬

‫ما هو نوع الحقن المستخدم في العالج‬

‫حقنة يمكن التخلص منها [] حقنة متعددة االستخدامات []‬

‫استخدام المرجل لتعقيم حقنة []‬

‫ما هي طريقة تعقيم األدوات الجراحية المستخدمة في العمليات الجراحية وارتداء المالبس؟‬

‫غسلها بالماء ومطهر []‬

‫من األفضل أن تغليهم إلى ‪ ℃ 100‬بعد غسلها وتعقيمها []‬

‫استخدام الفرن [] باستخدام األوتوكالف []‬

‫من المهم ارتداء القفازات واألقنعة على‪:‬‬

‫االتصال مع المريض []‬

‫التعامل مع الدم ومنتجاته ‪ ،‬وخاصة في المختبرات []‬

‫على العمليات الجراحية ‪ ،‬غسيل الكلى ‪ ،‬الوالدات ‪ ،‬وأعمال أمراض النساء []‬

‫على خياطة الجرح وارتداء المالبس []‬

‫إذا سألت أم مصابة عن الحمل ‪ ،‬ماذا ستفعل؟‬

‫من الضروري تجنب الحمل []‬

‫‪91‬‬
‫أتفق معها ألن اإليدز ال ينتقل إلى الجنين []‬

‫تقديم المشورة لها التخاذ ][ ‪ART‬‬

‫إذا أصرت على أن تكون حامالً ‪ ،‬فسأشرح لها عواقب اإليدز []‬

‫إذا سألت امرأة مصابة عن الرضاعة الطبيعية ‪ ،‬فماذا تنصحها؟‬

‫تجنب الرضاعة الطبيعية بالتأكيد []‬

‫يعطي الرضاعة الصناعية []‬

‫إعطاء الرضاعة الطبيعية لمدة ‪ 6‬أشهر ثم البدء في الغذاء التكميلي‬

‫تناول العالج ‪ART‬مع الرضاعة الطبيعية‬ ‫تناول العالج ‪ART‬مع الرضاعة الطبيعية‬

‫‪ :‬إذا قمت بمساعدة شخص مصاب أثناء عملك ‪ ،‬هل تخاف من‪:‬‬

‫الحصول على العدوى []‬

‫لم يتمكن المريض من العودة مرة أخرى []‬

‫ما هي المجموعات التي تنصح بها لجعل اختبار اإليدز بالنسبة لهم؟‬

‫األشخاص العائدون من السفر [] المسافرون []‬

‫أولئك الذين ينوون الزواج [] األفراد المصابين بمرض تناسلي []‬

‫الحالقون [] عمال الوشم []‬

‫الجراحون [] أطباء األسنان []‬

‫القابالت [] الممرضات []‬

‫موظفو المختبر [] الباعة المتجولين []‬

‫‪92‬‬
‫الخالصة‬
‫أجريت دراسة وصفية تحليلية عن مدى معارف ومواقف الكادر التمريضي المتعلقة بفيروس نقص المناعة‬
‫المكتسب ‪ /‬االيدز وتمت الدراسة بين الكادر التمريضي في المستشفيات الحكومية في (مدينة االمام الحسين‬
‫الطبية ومستشفى أمراض النساء والتوليد) ومراكز الرعاية الصحية األولية في قطاع الحر وقطاع المركز‬
‫في محافظة كربالء ‪.‬‬
‫‪.‬للفترة من ‪ 1‬يناير ‪ 2018‬إلى ‪ 30‬يونيو ‪ 2018‬من أجل الوقاية من اإلصابة بفيروس نقص المناعة البشرية‬
‫اإليدز ومنع انتشار العدوى بين أفراد المجتمع حيث أنهم يلعبون دورا ً مهما ً في الوقاية من العدوى‪.‬‬
‫شملت عينة الدراسة (‪ )403‬ممرض ومرضه من العاملين في مراكز الرعاية الصحيه االوليه والمستشفيات‬
‫الحكومية حيث شمل العدد (‪ 185‬مساعدا ً طبيا ً ‪ 199 ،‬ممرضة ‪ 7 ،‬عمال متقاعدين ‪ 12 ،‬ممرض يقومون‬
‫بمهام اخرى ) تم توظيفهم من قبل دائرة الصحة في محافظة كربالء‪ .‬تشمل أداة الدراسة الورقة االجتماعية‬
‫الديموغرافية و المعرفة عن االيدز ‪ ،‬واالتجاهات تجاه اإليدز ‪ ،‬والممارسات المتعلقة باإليدز‪ .‬تم جمع‬
‫البيانات باستخدام االستبيان المبلغ عنه ذاتيا‪ .‬تم تحليل البيانات باستخدام الحزمة اإلحصائية للعلوم‬
‫االجتماعية( ‪ (SPSS) windows‬اإلصدار ‪21.‬‬
‫أظهرت نتائج الدراسة أن متوسط عمر المشاركين كان ‪ .11.16 ± 34.42‬أكثر من الثلث هم ضمن الفئة‬
‫العمرية (‪ )19-27‬سنة (ن = ‪ 144‬؛ ‪ ، )٪35.7‬معظمهم من اإلناث (ن = ‪ 242‬؛ ‪ )٪60.0‬مقارنة بالذكور‬
‫(العدد = ‪ 161‬؛ ‪ .)٪40.0‬وعالوة على ذلك ‪ ،‬أبلغ المشاركون عن معرفة أفضل في بنود "هل سمعت عن‬
‫اإليدز؟" ‪" ،‬هل اإليدز خطير؟" ‪" ،‬ما هو سبب اإليدز؟ هل هو فيروس؟ "و" هل تعتقد أن اإليدز يمكن أن‬
‫ينتقل من شخص إلى آخر؟ "على التوالي‪ .‬من ناحية أخرى كان لديهم أيضا معرفة جبدة للبنود "هل تعرفون‬
‫ما إذا كان هناك لقاح للوقاية من اإليدز؟" و "هل تعتقد أنه من الممكن الشفاء التام من اإليدز؟" على التوالي‪.‬‬
‫فيما يتعلق بمواقف المشاركين تجاه اإليدز ‪ ،‬فقد أفادوا بأن أعلى المواقف اإليجابية التي تم اإلبالغ عنها‬
‫تجاه اإليدز كانت بالنسبة للبنود "إنهاء العالقة مع صديقك إذا كنت تعرف أنه مصاب باإليدز" ‪" ،‬هل توافق‬
‫على رعاية أحد أفراد األسرة المصابين باإليدز "‪ ،‬و" هل توافق على إجراء اختبار طوعي للفيروس يسبب‬
‫اإليدز؟ "‪ .‬من ناحية أخرى ‪ ،‬أبلغوا عن اعلى نسبة بخصوص المواقف السلبية عن البنود "هل توافق على‬
‫تناول الطعام في مطعم مع شخص مصاب باإليدز؟" ‪" ،‬هل توافق على أن األطفال المصابين باإليدز‬
‫يكونون في المدارس ‪.‬‬
‫فيما يتعلق بممارسات المشاركين فيما يتعلق باإليدز ‪ ،‬ذكرت الغالبية العظمى أن أكثر أنواع المحاقن‬
‫استخدا ًما هي النوع القابل للتصرف ‪ ،‬وهي أكثر الطرق التي يتم اإلبالغ عنها لتعقيم األدوات الجراحية‬
‫المستخدمة في العمليات الجراحية وتغليهم بالمالبس إلى ‪ ℃ 100‬بعد غسلها والتعقيم ‪،‬كما ذكرت األغلبية‬
‫أنه من المهم ارتداء القفازات واألقنعة عند التعامل مع المريض (ن = ‪ 332‬؛ ‪ ، )٪ 82.4‬والتعامل مع الدم‬

‫‪93‬‬
‫ومنتجاته ‪ ،‬وخاصة في المختبرات‪ .‬أفاد غالبية المشاركين أنهم سيخافون من اإلصابة إذا ساعدوا شخص‬
‫مصاب أثناء القيام بواجبهم‪ .‬في نهاية المطاف ‪ ،‬بالنسبة لتحديد هوية المجموعات المعرضة للخطر ‪ ،‬كانت‬
‫أعلى فئة تم إبالغها إلجراء االختبار هي أولئك الذين ينوون الزواج ‪ ،‬وعمال الوشم ‪ ،‬والممرضات ‪،‬‬
‫وموظفي المختبرات ‪ ،‬والمسافرين الذين يدخلون إلى البالد‪ .‬كما بينت الدراسة ان اإلناث اللواتي يحملن‬
‫درجة البكالوريوس ‪ ،‬لديهم معرفة أفضل عن اإليدز من الذكور‪ .‬النساء اللواتي يعشن بمفردهن ‪ ،‬يؤدين‬
‫العمل السريري بصورة افضل من المتزوجات وأولئك الذين يعملون في المستشفيات لديهم مواقف أفضل‬
‫عن اإليدز من الذكور‪.‬‬
‫المشاركون الذكور أولئك الذين أفادوا بأن وضعهم االقتصادي ضعيف ‪ ،‬والذين يعملون في المستشفيات ‪،‬‬
‫و الذين يقومون بالعمل السريري لديهم ممارسة أفضل لمرض اإليدز‪.‬‬

‫‪94‬‬

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