RJHS 11(3).cdr Knowledge, Attitudes and Practices of Disease Prevention among Health Talk-Giving Healthcare Workers in Primary Health Centres at Osogbo 3 2 3 3 3 *Tajudeen, W.A. , Adesina, K.A. , Fakorede, J.I. , Muraina, O.A. , Ikotun, B.M. , 3 3 1 Adesiyan, H.J. , Olayinka, A.O. , Omisore, A.G. ABSTRACT Background: Disease prevention measures such as creating public awareness are needed to protect the vulnerable populace from acquiring diseases. Knowledgeable health care workers are pivotal to this, and it therefore becomes imperative to assess health workers in this regard. The objective of this study was to ascertain the level of knowledge, the kind of attitude towards and practices of disease prevention among health-talk giving primary health care workers in Osogbo, south western Nigeria. Methods: A descriptive cross-sectional study done among 204 respondents from 13 primary health care centres in Osogbo selected using multi-stage sampling technique. The research instrument used was a self-administered questionnaire analysed with SPSS 23.0. Univariate, bivariate, and multivariate analyses were done as appropriate and a p-value of <0.05 was taken as statistically significant. Results: The results of this study revealed that at least nine out of ten respondents had good knowledge (90.2%) and positive attitude (94.1%) towards disease prevention. A greater proportion of doctors (100%) had good knowledge of disease prevention compared to other health workers while nurses took the lead in having a positive attitude (97.4%). Respondents had varying responses in their practices towards disease prevention, but generally speaking, most respondents who had good knowledge and positive attitudes also exhibited good practices. The only identifiable predictor of respondent's knowledge was level of education, (p=0.024 OR=0.157). Conclusion: The fact that about a tenth of respondents had poor knowledge and about 5% had negative attitude towards disease prevention is a major cause for concern. Since health talk-giving health workers interact directly with the populace, the potentially huge negative effects that this minority can have cannot be underestimated. Therefore, there is a need for close-monitoring and regular review of the kind of information given to clients as well as training and re-training of health workers. Keywords: Knowledge, Attitudes, Practices, Disease, prevention, Healthcare workers. *Corresponding author Tajudeen WA. Email: tajudeenwaliu85@gmail.com 1 Department of Community Medicine, College of Health Sciences, Osun State University, Osogbo, Nigeria 2 Department of Nursing Science, College of Health Science, Osun State University, Osogbo, Nigeria 3 Public Health programme, College of Health Sciences, Osun State University, Osogbo, Nigeria Received: June 26, 2022 Accepted: April 21, 2023 Published: September 30, 2023 Original Article Research Journal of Health Sciences Res. J. Health Sci. Vol 11(3), September 2023 224 Research Journal of Health Sciences subscribed to terms and conditions of Open Access publication. Articles are distributed under the terms of Creative Commons Licence (CC BY-NC-ND 4.0). (http://creativecommons.org/licences/by-nc-nd/4.0). http://dx.doi.org/10.4314/rejhs.v11i3.5 Connaissances, attitudes et pratiques de prévention des maladies chez les agents de santé qui parlent de santé dans les centres de santé primaires d'Osogbo 3 2 3 3 3 *Tajudeen, W.A. , Adesina, K.A. , Fakorede, J.I. , Muraina, O.A. , Ikotun, B.M. , 3 3 1 Adesiyan, H.J. , Olayinka, A.O. , Omisore, A.G. Résumé Contexte général de l'étude : Des mesures de prévention des maladies telles que la sensibilisation du public sont nécessaires pour protéger la population vulnérable contre l'acquisition de maladies. Des travailleurs de la santé compétents sont essentiel à cet égard, et il devient donc impératif d'évaluer les agents de santé à cet égard. Objectif de l'étude: Connaître le niveau de connaissance, le type d'attitude envers et les pratiques des prévention des maladies parmi les professionnels de la santé qui parlent de la santé à Osogbo , dans le sud l'ouest du Nigéria. Méthode de l'étude: Une étude transversale descriptive réalisée auprès de 204 répondants de 13 écoles primaires centres de soins de santé d'Oshogbo sélectionnés à l'aide d'une technique d'échantillonnage à plusieurs degrés. La recherche L'instrument utilisé était un questionnaire auto-administré analysé avec SPSS 23.0. Uni varié, des analyses bi variées et multi variées ont été effectuées selon les besoins et une valeur de p <0,05 a été prise comme statistiquement significatif. Résultat de l'étude: Les résultats de cette étude ont révélé qu'au moins neuf répondants sur dix avaient de bonnes connaissances (90,2 %) et attitude positive (94,1 %) envers la prévention des maladies. Une meilleure proportion de médecins (100 %) avaient une bonne connaissance de la prévention des maladies par rapport aux autres les infirmières étaient en tête pour avoir une attitude positive (97,4 %). Les répondants avaient des réponses dans leurs pratiques en matière de prévention des maladies, mais de manière générale, la plupart des répondants qui avaient de bonnes connaissances et des attitudes positives ont également fait preuve de bonnes pratiques. Le seul identifiable des connaissances du répondant était le niveau d'éducation, ( p = 0,024 OR = 0,157). Conclusion : Le fait qu'environ un dixième des répondants aient une faible connaissance et environ 5 % négative à l'égard de la prévention des maladies est une cause majeure de préoccupation. Depuis les discours sur la santé les agents de santé interagissent directement avec la population, les effets négatifs potentiellement énormes que cela la minorité peut avoir ne peut pas être sous-estimée. Par conséquent, il est nécessaire de surveiller de près et de un examen régulier du type d'informations données aux clients ainsi que la formation et le recyclage des de santé. Mots-clés: Connaissances, attitudes, pratiques, maladie, prévention, personnel de santé *Corresponding author Tajudeen WA. Email: tajudeenwaliu85@gmail.com 1 Department of Community Medicine, College of Health Sciences, Osun State University, Osogbo, Nigeria 2 Department of Nursing Science, College of Health Science, Osun State University, Osogbo, Nigeria 3 Public Health programme, College of Health Sciences, Osun State University, Osogbo, Nigeria Received: June 26, 2022 Accepted: April 21, 2023 Published: September 30, 2023 Article Original Research Journal of Health Sciences Res. J. Health Sci. Vol 11(3), September 2023 225 Research Journal of Health Sciences subscribed to terms and conditions of Open Access publication. Articles are distributed under the terms of Creative Commons Licence (CC BY-NC-ND 4.0). (http://creativecommons.org/licences/by-nc-nd/4.0). http://dx.doi.org/10.4314/rejhs.v11i3.5 INTRODUCTION Health workers are people whose job is to protect and improve the health of their communities. Health workers include Doctors, Nurses, Pharmacists, Dentists, Laboratory scientists, Health assistants, Public health practitioners, Community Health Officers (CHO), Physiotherapists, Community health extension workers (CHEWs), Community health attendants etc. Community health workers are essential personnel in resource-limited settings; they focused on infectious diseases and maternal and child health. However, their skills could potentially be utilized in national efforts to reduce the growing burden of non-communicable diseases (1). A disease is a particular abnormal condition that negatively affects the structure or function of part or all of an organism, and that it is not due to any external injury, it may be caused by external factors such as pathogens or by internal dysfunction. Preventable communicable or infectious diseases like malaria and HIV/AIDs account for millions of deaths globally especially in middle and low-income countries including Nigeria (2). Many developing countries are facing an enormous burden of infectious diseases. Nigeria is faced with a high burden of both communicable and non-communicable diseases, creating significant challenges among key health indicators (3). N o n - c o m m u n i c a b l e d i s e a s e s a r e increasingly becoming the leading causes of morbidity and mortality worldwide. They encompass a cluster of illness which includes: Diabetes mellitus, cancers, chronic respiratory d i s e a s e s , c a r d i o v a s c u l a r d i s e a s e a n d musculoskeletal disorders with greater impact on the poor countries of sub-Saharan African of which Nigeria occupy a significant position (4). Similarly, many chronic diseases are caused by preventable risky behaviours such as tobacco use and exposure to second-hand smoking, poor nutrition including diets low in fruits and vegetables and high in sodium and saturated fats, lack of physical activity, excessive alcohol use, etc (5). Stronger health systems underpinned by primary health care are crucial to effectively manage NCDs and risk factors for them. Primary health care is often the first gateway to health services for people and plays a central and co-coordinating role in the p r e v e n t i o n , d i a g n o s i s a n d l o n g - t e r m management of chronic diseases (2). Thus, both communicable and non-communicable diseases can be prevented through health education. The major way through which individuals receive health information in Nigeria is through health talks given by health workers. This is especially so as Primary health care (PHC) is the first level of health care with which the general populace comes in contact, so it is not an insignificant number of the population that is taken care of at the PHC level. Although one author reported a significant decrease in the proportion of clients visiting primary health centres in a developed country (6), the situation arguably is not the same in developing countries. In previous studies, health workers have demonstrated varying d e g r e e s o f k n o w l e d g e r e g a r d i n g b o t h communicable and non-communicable diseases (7,8). Since health workers are traditionally the custodians of knowledge in this part of the world responsible for the dissemination of health information to clients, it is expected that the level of their knowledge should be high but this is not always the case. For instance, only 37.9% of primary healthcare workers in southwest Nigeria had good knowledge of the nature and care of sickle cell disease (9). Similarly, only 34.7% of primary health care workers have positive attitude regarding tuberculosis disease in Minna, Niger State Nigeria (10). It is generally assumed that health workers by virtue of their 'job' should have adequate knowledge about diseases and other health conditions this assumption can possibly be true for both tertiary and secondary levels but there is often inadequate knowledge among primary health care workers (11). Health care workers serve as the main asset of the health care system in achieving its goals especially those who give health talk, however, it is crucial to examine their level of knowledge, attitude and practices on disease prevention. This study, therefore, sets out to examine the knowledge, attitude and practices of health talk-giving health care workers in primary health facilities in Osun State, Nigeria towards disease prevention. MATERIALS AND METHODS A descriptive cross-sectional study was carried out among 204 healthcare workers in primary health centres in Osogbo, Osun State Nigeria. There are numerous Primary Health Care centres and private hospitals providing primary care services in the state. The sample size for the study was 204, 2 calculated using Leslie Fischer's formula (n= (Z - 2 pq)/d ) for the descriptive study of populations less than 10,000 with p as 84.2.0%, being the Res. J. Health Sci. Vol 11(3), September 2023 226 KAP of disease prevention among healthcare workers in PHC Tajudeen et al. proportion of healthcare workers with good knowledge on infection prevention from a previous study , Z as 1.96 representing a 95% confidence interval. A multi-stage sampling technique was used to select study participants across local governments, wards and categories of hospital workers. A purposely designed self - administered questionnaire was used to obtain data from study participants after a pre-test done outside of the study area. Involvement in risky sexual behaviour was defined as those who had casual sexual intercourse and do not use condoms. Approval for the conduct of the study was obtained from the Ethics and research committee of Osun State University. Permission was also obtained from the State Primary Health Care Board and consent was taken from each participant while participants were assured of confidentiality. Data collected were analyzed using IBM SPSS version 23.0 software. Results were presented using tables and charts, chi-square and logistic regression analyses were generated with confidence level set at 95% and a P-value <0.05 was considered significant. There were a total of 29 questions for knowledge related statements, correct responses were scored as one and incorrect responses were scored as zero. The scores were summed up to obtain an overall score for each respondent, with a range of 0 to 29. Attitude had a total of 14 questions, correct responses were assigned one, and wrong responses assigned zero, with a total summed up scores ranging from 0 to 14. Knowledge and attitude were further categorized using the median or 50% score as the cut-off point. This was done to assess and grade the respondent's knowledge (good or poor knowledge), attitude (positive and negative attitude) towards disease prevention. Good knowledge and positive attitude were adjudged as those who scored equal or above 50% and poor knowledge and negative attitude as those that scored below it. There were 20 questions on preventive practice, correct/good response were scored as one while incorrect/poor responses were scored as zero, using the mean (9.80) as the cut-off point, good practice was adjudged as those scores who scored or above the mean and poor practice as those who scored below it. RESULTS A total of 204 respondents comprising of 41(20.1%) males and 163 (79.9%) females participated in this study. The mean age was 35.6 ± 8.9 years. Almost a fifth of the respondents were nurses/ midwives while 6.4% were doctors and the remaining 75% of the respondents were CHEWs, CHO, Pharmacists, Lab scientists etc. Majority of the respondents (44.6%) had 1-5 years of working experience, 22.5% had 6-10 years of practice while 32.9% had been practising for more than 11 years. In general, majority (90.2%) of the respondents have good knowledge of disease prevention. similarly, for attitude, 94.1% of the respondents had positive attitude towards disease prevention (Figure ). In Table 2, more respondents who had a university degree and higher qualifications had good knowledge (97.6%) compared to those with diploma (85.1%) as their qualification p=0.003. Of the 204 participants, thirteen were doctors and all (100%) of them had good knowledge of disease prevention compared to 94.7% of nurses/midwives and 88.2% of other health workers. More of the respondents with one to five years and those with eleven years and above of working experience had good knowledge on disease prevention (91.2% and 91.0% respectively) compared to those with six to ten years working experience (87.0%). Respondents whose qualifications were university degrees and higher (96.4%) had positive attitude compared to those whose qualifications were diplomas (92.6%). In terms of their designation, more Nurses/Midwives (97.4%) were found to have positive attitude compared to Doctors (92.3%) and other health workers (93.5%). Respondents who have been working for 1 to 5 years as health workers had more (96.7%) positive attitude compared to (91.3%) of those working for 6-10years and (92.5%) of those working for 11 years and above. In table 3a, of all the 204 respondents 184 (90.2%) always washes their hands before eating and after using the toilet, about three quarters (70.6%) exercise regularly, only 40 (19.6%) eats junk foods every day. About two-thirds (63.2%) take sugary drinks sometimes or few times a week, more than three-quarters (76.0%) take vegetables regularly. Only less than half (45.1%) of the respondents were found to have been involved in risky sexual behaviour i.e. have had casual sex and does not use condoms). Similarly, majority (90.7%) washed their vegetables thoroughly when cooking. Only 7.8% take alcohol, while only 2.0% smokes. In the last year, only (24.0%) have not had a blood pressure check. Only 27.0% of the respondent shares personal things like towel, combs and slippers, Res. J. Health Sci. Vol 11(3), September 2023 227 KAP of disease prevention among healthcare workers in PHC Tajudeen et al. about a sixth (17.2%) of the respondents said their superior insisted they come to work even when sick. Only (12.7%) of the respondents said they rarely do a medical check-up, less than one- sixth (14.2%) had contracted hospital-acquired infections before (Table 3a). Out of the 41 male respondents, only 13 (31.7%) had done prostate cancer screening before (Table 3b), Among 163 female participants, more than two-thirds (71.8%) do Breast Self-Examination while only 24.5% had done cervical cancer screening using pap smear before (Table 3c). Overall, there were good practices towards disease prevention among health talk giving primary healthcare workers at Osogbo. When relating the preventive practices of respondents against their knowledge and attitude towards disease prevention, respondents who regularly washed their hands regularly before eating and after using the toilet were found to have 167(90.8%), 167(90.8) good knowledge and 172(93.5%), 173(94.0) positive attitude respectively. Those who exercise regularly have more good knowledge (91.0%) and positive attitude (93.8%). Similarly, respondents that rarely eat junk have more good knowledge (95.7%) p=0.004 and 100.0% positive attitude towards disease prevention p=0.032. majority of the respondents take sugary drinks and fruits few times a week and were found to have more good knowledge 118(91.5%) and 123(93.9%) and 125(96.9%) and 123(93.9%) positive attitude towards disease prevention respectively. More of the respondents that sometimes takes vegetable was found to have 140(90.3%) good knowledge and 145(93.5%) favourable attitude, Likewise, majority of the respondents who do not involve in risky sexual behaviour were found to have good knowledge (92.0%) and attitude (96.4%) towards disease prevention. In terms of the preventive practice of washing vegetables thoroughly when cooking at home, more of the respondents that normally washed vegetables thoroughly had good knowledge 166 (89.7%) and positive attitude 173(93.5%). Most of the respondents does not or had never taken alcohol and have more good knowledge (91.4%) and (98.9%) positive attitude p=0.0007, correspondingly, majority of the respondents had never smoked before and were found to have more good knowledge and positive attitude (92.0%) and (96.4%) respectively. Regarding the practice of blood pressure, most of those that have checked their blood pressure in the past year also have more of good knowledge (91.0%) and a significant (96.8%) positive attitude p=0.012. Although most of the health workers does share personal things, those who share had more good knowledge (90.9%) compared to those who does not, while more of the respondents that do not share their personal things had more of favourable attitude (96.6%) p=0.029. those who cultivated the habit of always covering their mouth and nostrils when sneezing or coughing had more good knowledge (91.3%) and positive attitude (94.4%) towards disease prevention. Respondents that do not go to work and those who sometimes do as insisted by their superior had more good knowledge on disease prevention, while those who rarely go when sick have a significant positive attitude (100.0%) towards disease prevention. p<0.001. Health workers that do regular medical check-up have more good knowledge (95.8) while those who do it sometimes were found to have more of positive attitude (96.3%). This finding shows a significant-good knowledge (93.5%) p=0.008 and positive attitude (97.6%) p<0.001 among those who had never contracted hospital-acquired infection (Table 4a). In table 4b: Male respondents who have done prostate cancer screening have 100.0% good knowledge while those who have never done it have 100.0% positive attitude. (Table 4b) Female health workers that normally do Breast Self-Examination have significant-good knowledge (91.5%) on disease prevention p= 0.048 and positive attitude (95.7%). Likewise, those who had done cervical cancer screening had more good knowledge (95.0%) while more of those who had never done the screening have a more favourable attitude (94.3%) towards disease prevention (Table 4c). Overall, more than four-fifths (88.7%) had good practices of diseases prevention. DISCUSSION Although many studies had previously looked into the knowledge, attitude and practices of health workers related to the prevention of specific diseases, this study is distinctive because it examined the knowledge, attitude and practices of diseases prevention generally among health talk-giving primary health care workers. In this study, quantitative data were collected from 204 primary health workers in selected PHCs in Osogbo, Osun State and significant findings which will contribute to evidence-based knowledge and interventions on diseases prevention are hereby discussed. This study revealed that the majority of the health workers had good knowledge, about Res. J. Health Sci. Vol 11(3), September 2023 228 KAP of disease prevention among healthcare workers in PHC Tajudeen et al. nine out of ten of the respondents had good knowledge, and this finding is similar to a previous study on rabies where the majority of the respondents had good knowledge (14). The overall knowledge of this study is however slightly lower than that of another study on infection prevention (12) but contrary to another study where only 20.3% of the respondents had good knowledge (15). It is actually not unexpected that health workers, in general, should demonstrate a good knowledge regarding diseases and their prevention and/or control, since it is their domain. Theoretically and practically, they often have been 'exposed' to various disease conditions because they are often involved in the management of such, even at the primary care level. So the norm is to expect virtually all health workers to be knowledgeable about diseases, thus, it is however surprising that about a tenth of health workers were classified as having poor knowledge. The proportion with poor knowledge may appear small however the potential negative effects are quite significant, especially in terms of the misinformation this set of health workers can pass to the general populace when they give health talks during health education sessions. Such misinformation is not likely to be limited to the primary contacts of the health workers as these recipients can be secondary transmitters of the false information received from the health workers to others within and outside of their neighbourhoods. In this environment, information received from health workers are usually considered as factual and sacrosanct and clients (patients and patients' relatives) are likely to take such hook, line and sinker and act based on the information received from such health workers. More of the males' respondents had good knowledge compared to females regarding diseases and their prevention and control which is in tandem with a study on Lassa fever (11) but against another Nigerian study on tuberculosis where more females had good knowledge (16). A possible lesson to draw from these varying scenarios is that the level of knowledge is independent of sex, and is perhaps a reflection of individual learning abilities and capacities. The higher number of males having good knowledge here may also be explained by the fact that most health workers at the primary health care level are females and a dilution effect may take place between females who are on the extreme sides of good and poor knowledge, with the larger number of females possibly contributing to the fact that more females will be at the 'negative' end of poor knowledge. More respondents who have a university degree and higher qualifications had good knowledge on disease prevention and this was statistically significant, (p<0.05), this should probably be expected, as they are likely to have more knowledge and experience during the course of their study than those who have diploma qualification. More doctors had good knowledge than others and this finding is similar to that of another study on Lassa fever (17) and could be attributed to experience in their course of study and with higher training and exposure related to their qualification though this was not statistically significant. In this study, the overall attitude of the health workers towards disease prevention was favourable as 94.1% have positive attitude towards disease prevention, this is similar to other studies (18) and (19) which showed that a greater percentage of primary care workers had a positive attitude towards infectious disease prevention and another study on health promotion and prevention (20) but contrary to another Nigerian study where many primary health care workers had negative attitude regarding the management of an infectious disease (10). The positive attitude of respondents in this study is higher compared to another study on infection prevention among healthcare workers where the overall attitude was poor (15). However, the study conducted in Guinea on Ebola virus Disease reported low attitude compared to this study (21). Workers attitudes are vital indicators to the willingness to learn and consequently improve themselves, thus the high level of positive attitude seen among health workers is commendable and shows the willingness of workers to further understand disease processes and prevention. Although not statistically significant, younger respondents, those with higher education and in terms of profession, nurses made up the larger number of those with positive attitude when compared to their counterparts. This may be due to the enterprising nature of the young and their readiness to learn and those with higher qualifications have possibly being placed at an advantageous position in terms of an attitude than those who have diploma qualification by virtue of detailed academic processes they went through. More nurses/midwives had a positive attitude towards disease prevention than others including medical doctors. It is possible that some doctors who are more knowledgeable as shown in this study exercised a high degree of contentment with their level of knowledge and their attitudes towards Res. J. Health Sci. Vol 11(3), September 2023 229 KAP of disease prevention among healthcare workers in PHC Tajudeen et al. disease prevention may be compromised because of their high level of knowledge, as they may feel that there is nothing new to learn about disease prevention. This study revealed that there was no gap between knowledge and practices which is in line with the study on Tuberculosis (16) and another Ethiopian study on infection prevention among health care workers (12). However, slightly more than one-sixth of the respondents who were involved in the preventive practice of regular exercise have poor knowledge of disease prevention. The overall good practices could be ascribed to the respondents' better knowledge reciprocated on their preventive practices. This study revealed that the majority of the respondents who had practised a healthy diet has significant good knowledge and a positive attitude towards the prevention of diseases p=0.004 and p=0.032 respectively. This could be attributed to the fact that the more one practices an act, the more knowledge acquired., respondents who rarely do medical check-up were found to have a greater proportion of poor knowledge on diseases prevention compared to those who do it sometimes and regularly. This could be attributed to the frequent check-up and therefore greater comprehension of diseases preventive practices. Respondents who have done various screening/tests and check-up before such as males that had done prostate cancer and females that have done BSE and cervical cancer screening were found to have good knowledge and a positive attitude towards disease prevention this might be due to awareness and health education. The majority of the respondents practices preventive measure including a thorough washing of vegetables, hand washing before and after eating and after using the toilet, abstinence from risky sexual behaviour, covering of nostril when sneezing or coughing and were found to have good knowledge and positive attitude towards disease prevention. The result of this study revealed that there is a significant positive association between attitude and preventive practice of diseases prevention, the better knowledge and favourable attitude could be attributed to their consistent preventive practices which may be due to their awareness of the associated health risks of poor practices and thereby having better knowledge on diseases prevention. However, more than three quarters of respondents who do not share personal things have positive attitude towards disease prevention and was statistically significant P=0.029. Similarly, respondents who rarely go to work when sick was found to have more positive attitudes compared to others and also statistically significant p<0.001. A significant positive attitude was shown towards the preventive practices of Alcohol consumption, as well as blood pressure check p=0.007 and p=0.129 respectively. Although a good number of respondents had good knowledge and positive attitudes, the few workers who do not have cannot be said to be negligible because of the nature of work that health workers do, wrong information can be easily disseminated to the populace causing adverse effects. This thus emphasizes the reason why primary health care workers should have adequate diseases prevention knowledge coupled with a favourable attitude as well as practices. Further studies may look at this research topic at state, geopolitical zone or on rural and urban comparison context. Similarly, further study may assess this topic on communicable and non- communicable context. CONCLUSION This study revealed that the majority of the respondents had good knowledge of disease prevention. Similarly, about nine out of ten of the respondents have positive attitude towards disease prevention. A number of factors were associated with knowledge on diseases prevention in this study including the level of education, there was no significant identifiable predictor of respondents' attitude towards disease prevention. This study also revealed that both the knowledge and attitude of the respondents were found to influence their practices towards disease prevention. When respondents' knowledge and attitude were related to their practices towards diseases prevention, most respondents who had good knowledge and positive attitudes also exhibited overall good practices. The findings of this study which although revealed a distinctively high level of k n o w l e d g e a n d p o s i t i v e a t t i t u d e a l s o demonstrated a significant relationship between knowledge and attitude of health workers towards their diseases preventive practices. Training and retraining of primary health care workers especially those whose qualifications were below university degree on disease prevention and health promotion generally, sufficient training of new intakes among primary health care workers as well as periodic re-training after few years of practices, for instance at four to five years' intervals to enhance good knowledge and positive attitudes are recommended. Res. J. Health Sci. Vol 11(3), September 2023 230 KAP of disease prevention among healthcare workers in PHC Tajudeen et al. Res. J. Health Sci. 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Knowledge , attitude and behavior of primary health care workers regarding health care-associated infections in Kuwait . Greener J Med Sci. 2012;2(4):92–8. 19. Ekuma AE, Oridota ES. Knowledge , attitude and tuberculosis infection control practice among healthcare workers in DOTS centres in Lagos , Nigeria. Int J Infect Control. 2016;12(4):1–9. 20. Raffy R L, Harold L P. Attitude About and Practices of Health Promotion and Prevention Among Primary Care Providers. Sage Journals. 2014;(12):11. 21. Touré A, Traoré FA, Sako FB, Delamou A, Tonguino FS, Sylla D, et al. Knowledge , attitudes , and practices of health care workers on Ebola virus disease in Conakry , Guinea?: A cross- sectional study Demographic characteristics. J Public Heal Epidemiol. 2016;8(2): 12-6 KAP of disease prevention among healthcare workers in PHC Tajudeen et al. Table 1: Frequency distribution of socio-demographic characteristics (n=204) Variable Frequency Percentage Age Group [Mean age 35.6 (8.9) years, Minimum=20, Maximum=59] 20-39 years (Young Adults) 121 59.3 40-59 years (Middle-aged) 83 40.7 Sex Male 41 20.1 Female 163 79.9 Marital Status Currently Married 133 65.2 Not Currently Married 71 34.8 Religion Christianity 125 61.3 Islam 79 38.7 Ethnicity Yoruba 195 95.6 Non-Yoruba 9 4.4 Level Of Education Diploma 121 59.3 University degree and higher 83 40.7 Profession Doctor 13 6.4 Nurse/midwife 38 18.6 Other health workers* 153 75.0 Years Of Practice 1-5 years 91 44.6 6-10 years 46 22.5 11 years and above. 67 32.9 Other Health Workers *CHEW (40.9%), CHO (40.9%), Health Assistant (3.9%) Pharmacist (10.3%), Lab scientist/technician (5.4%), Physiotherapists (0.5%) Medical Record (0.5%) KAP of disease prevention among healthcare workers in PHC Tajudeen et al. Res. J. Health Sci. Vol 11(3), September 2023 232 Table 2: Knowledge and Attitude of respondents on disease prevention related to their socio- demographic characteristics Socio-demographic variables and their categories Knowledge of diseases prevention (n=204) Statistics Attitude towards diseases prevention (n=204) Statistics Poor (%) N=20 Good (%) N=184 Negative (%) N=12 Positive (%) N=192 Sex Male 1(2.4) 4(97.6) x2=2.191 p= 0.139 2 (4.9) 39 (95.1) x2< 0.001 p= 1.000 Female 19(11.7) 114(88.3) 10 (6.1) 153 (93.9) Marital status Currently Married 13 (9.8) 120 (90.2) x2< 0.001 p= 0.985 7 (5.3) 126 (94.7) x2= 0.041 p=0.840 Not currently married 7 (9.9) 64 (90.1) 5 (7.0) 66 (93.0) Age Young Adult 11(9.1) 110(90.9) x2=0.171 p=0.679 6 (5.0) 115 (95.0) x2= 0.140 p= 0.708 Middle aged 9 (10.8) 74 (89.2) 6 (7.2) 77 (92.8) Religion Christianity 13 (10.4) 112(89.6) x2=0.130 p=0.719 6 (4.8) 119 (95.2) x2= 0.271 p= 0.602 Islam 7(8.9) 72(91.1) 6 (7.6) 73 (92.4) Ethnicity Yoruba 18(9.2) 117(90.8) x2=0.501 p=0.479 11 (5.6) 184 (94.4) x2< 0.001 p= 1.000 Non-Yoruba 2(22.2) 7(77.8) 1 (11.1) 8 (88.9) Level of education Diploma 18 (14.9) 103(85.1) x2=8.652 p=0.003* 9 (7.4) 112 (92.6) x2= 0.701 p= 0.402 University Degree and Higher 2(2.4) 81(97.6) 3 (3.6) 80 (96.4) Profession Doctor 0(0.0) 13(100.0) x2=4.360 p=0.113# 1 (7.7) 12 (92.3) x2= 1.089# p= 0.580 Midwife 2(5.3) 36(94.7) 1 (2.6) 37 (97.4) Other health workers 18(11.8) 135(88.2) 10 (6.5) 143 (93.5) Duration of practice 1-5 years 8 (8.8) 83(91.2) x2=0.665 p=0.717# 3 (3.3) 88 (96.7) x2= 2.153 p= 0.341 6-10 years 6 (13.0) 40 (87.0) 4 (8.7) 42 (91.3) 11 & above 6(9.0) 61(91.0) 5 (7.5) 62 (92.5) #= Likelihood Ratio * Statistically Significant KAP of disease prevention among healthcare workers in PHC Tajudeen et al. Res. J. Health Sci. Vol 11(3), September 2023 233 Table 3a: Frequency distribution of respondents’ practices on disease prevention (n=204) Variable Sub-Categories Frequency Percentage Do you wash your hands before eating Always 184 90.2 Sometimes 18 8.8 Rarely/Not at all 2 1.0 Hand washing after using the toilet Always 184 90.2 Sometimes 16 7.8 Rarely/Not at all 4 2.0 Exercise at least thirty minutes at least five days a week. Yes 144 70.6 No 60 29.4 Eating of junks in the past 7 days None/Rarely 47 23.0 Sometimes/Few times a week 117 57.4 Once Daily 40 19.6 Taking of Sugary drinks None/Rarely 31 15.2 Sometimes/Few times a week 129 63.2 Once Daily 44 21.6 Taking of fruit None/Rarely 18 8.8 Sometimes/Few times a week 131 64.2 Once Daily 55 27.0 Involvement in risky behaviour No 112 54.9 Yes 92 45.1 Thorough washing of vegetables when cooking at home Yes 185 90.7 No 9 4.4 Not sure 10 4.9 Do you still take alcohol? Yes 16 7.8 No 95 46.6 Never taken 93 45.6 Do you still smoke? Yes 4 2.0 No 63 30.9 Never taken 137 67.2 Do you share personal things like combs, towel etc.? Yes 55 27.0 No 149 73.0 Do you cover your nostrils/mouth with tissue or handkerchief when sneezing or coughing? Yes, Always 161 78.9 Sometimes 25 12.3 Rarely 18 8.8 When you are sick, do you or your boss/superior usually insist that you come to work instead of staying at home? Yes, Always 35 17.2 Sometimes 52 25.5 Rarely 117 57.4 Frequency of medical check-up Regularly 71 34.8 Sometimes 107 52.5 Rarely 26 12.7 Have ever had a hospital-acquired infection? Yes 29 14.2 No 168 82.4 I don’t know 7 3.4 Table 3b: Frequency distribution of female respondents’ practices on disease prevention (n=163) Breast cancer self-examination Yes 117 71.8 No 46 28.2 Cervical cancer screening using pap smear Yes 40 24.5 No 123 75.5 Table 3c: Frequency distribution of male respondents’ practices on disease prevention (n=41) Prostatic cancer screening using PSA Yes 13 31.7 No 28 68.3 KAP of disease prevention among healthcare workers in PHC Tajudeen et al. Res. J. Health Sci. Vol 11(3), September 2023 234 Table 4a: Respondents’ preventive practices against the development of diseases related to their level of knowledge and Attitude towards disease prevention. Preventive Practices Against the Development of Diseases Knowledge On Disease Prevention N= 204 Statistics Attitude Towards Diseases Prevention (N=204) Statistics Poor (%) N=20 Good (%) N=184 Negativ e (%) N=12 Positive (%) N=192 Do you wash your hands before eating Always 17 (9.2) 167 (90.8) x2= 1.290# p= 0.525 12(6.5) 172(93.5) x2=2.556# p=0.279 Sometimes 3 (16.7) 15 (83.3) 0(0.0) 18(100.0) Rarely/Not at all 0 (0.0) 2 (100.0) 0(0.0) 2(100.0) Exercise at least thirty minutes for at least five days in a week. Yes 13 (9.0) 131 (91.0) x2= 0.334 p= 0.564 9(6.3) 135(93.8) x2<0.001 p= 0.985 No 7 (11.7) 53 (88.3) 3(5.0) 57(95.0) Eating of junks in the past 7 days None/Rarely 2 (4.3) 45 (95.7) x2=10.975# p= 0.004* 0(0.0) 47(100.0) x2=6.907# p=0.032* Sometimes/F ew times a week 8 (6.8) 109 (93.2) 8(6.8) 109(93.2) Once Daily 10 (25.0) 30 (75.0) 4(10.0) 38(90.0) Involvement in risky behaviour No 9 (8.0) 103 (92.0) x2= 0.878 p= 0.349 4(3.6) 108(96.4) x2=2.396 p= 0.122 Yes 11 (12.0) 81 (88.0) 8(8.7) 84(91.3) Do you still take alcohol? Yes 2 (12.5) 14 (87.5) x2 = 0.335 p= 0.846 3(18.8) 13(81.3) x2= 9.883# p=0.007* No 10 (10.5) 85 (89.5) 8(8.4) 87(91.6) Never taken 8 (8.6) 85 (91.4) 1(1.1) 92(98.9) Had blood pressure check in the last one year Yes 14 (9.0) 141(91.0) x2= 0.147 p= 0.701 5(3.2) 150(96.8) x2= 6.349 p= 0.012* No 6 (12.2) 43 (87.8) 7(14.3) 42(85.7) Do you share personal things like combs, towel etc.? Yes 5 (9.1) 50 (90.9) x2= 0.043 p= 0.835 7(12.7) 48(87.3) x2=4.792 p=0.029* No 15 (10.1) 134 (89.9) 5(3.4) 144(96.6) #: Likelihood Ratio * Statistically Significant. Table 4b: Male respondents’ preventive practice of prostate cancer screening against their knowledge and Attitude towards disease prevention Preventive practices against the development of diseases Knowledge of disease prevention N= 204 Statistics Attitude towards diseases prevention (n=163) Statistics Poor (%) (n=20) Good (%) (n=184) Negative n=2 Positive (n=39) Prostatic cancer screening using PSA (n=41) Yes 0 (0.0) 13 (100.0) x2< 0.001 p= 1.000 2(15.4) 11(84.6) x2=1.820 p=0.177 No 1 (3.6) 27 (96.4) 0(0.0) 28(100.0) #: Likelihood Ratio * Statistically Significant KAP of disease prevention among healthcare workers in PHC Tajudeen et al. Res. J. Health Sci. Vol 11(3), September 2023 235 Table 4c: Female respondents’ preventive practices of breast self-examination for breast cancer and cervical cancer screening against their knowledge and Attitude towards disease prevention Preventive Practices Against the Development of Diseases Knowledge of Disease Prevention N= 204 Statistics Attitude Towards Diseases Prevention (N=163) Statistics Poor (%) N=20 Good (%) N=184 Negative N=10 Positive N=153 Breast Cancer Self- Examination (n=163) Yes 10 (8.5) 107 (91.5) x2=3.893 P= 0.048* 5(4.3) 112(95.7) x2=1.481 P= 0.224 No 9 (19.6) 37 (80.4) 5(10.9) 41(89.1) Cervical Cancer Screening Using Pap Smear (n=163) Yes 2 (5.0) 38 (95.0) x2=1.505 p= 0.220 3(7.5) 37(92.5) x2=0.001 p=0.972 No 17 (13.8) 106 (86.2) 7(5.7) 116(94.3) #: Likelihood Ratio * Statistically Significant Table 5: Knowledge and Attitude of respondents on disease prevention related to their disease preventive practice. Categorized Preventive Practices Against the Development of Diseases Knowledge of Disease Prevention N= 204 Statistics Attitude Towards Diseases Prevention (N=163) Statistics Poor (%) N=20 Good (%) N=184 Negative N=10 Positive N=153 Poor Practice 5 (21.7) 18 (78.3) x2=2.077* p = 0.149 3 (13.0) 20 (87.0) x2=1.165* p = 0.281 Good Practice 17 (9.4) 164 (90.6) 9 (5.0) 172 (95.0) * Continuity correction. Table 6: Binary logistic regression of the outcome variable “Respondents' level of knowledge on diseases prevention” and selected l socio-demographic predictors Predictor Variable Categories Variable P-Value Odds Ratio 95% Confidence Interval Lower Upper Sex Female (Reference) 0.100 5.763 0.714 46.481 Marital Status Not Currently Married (Reference) 0.977 1.019 0.290 3.582 Age Middle Aged (Reference) 0.265 2.202 0.549 8.838 Religion Islam (Reference) 0.614 0.765 0.270 2.167 Ethnicity Non-Yoruba (Reference) 0.167 4.058 0.556 29.640 Level of Education University Degree and Higher (Reference) 0.024* 0.157 0.031 0.781 Years of Practice as Health Workers 11years And Above (Reference) 0.642 6-10 YEARS 0. 776 0.772 0.129 4.611 1-5 YEARS 0.381 0.525 0.124 2.217 KAP of disease prevention among healthcare workers in PHC Tajudeen et al. Res. J. Health Sci. Vol 11(3), September 2023 236 Table 7: Binary logistic regression of the outcome variable “Respondents' Attitude towards diseases prevention” and selected socio-demographic predictors Predictor Variable Categories Variable P Value Odds Ratio 95% Confidence Interval Lower Upper Sex Female (Reference) 0.416 1.981 0.382 10.289 Marital Status Not Currently Married (Reference) 0.119 3.516 0.725 17.050 Age Middle Aged (Reference) 0.770 1.273 0.253 6.406 Religion Islam (Reference) 0.437 1.629 0.475 5.586 Ethnicity Non-Yoruba (Reference) 0.247 4.173 0.372 46.794 Level Of Education University Degree and Higher (Reference) 0.458 0.569 0.128 2.522 Profession Other Health Workers (Reference) 0.453 Midwife/Nurse 0.383 0.346 0.032 3.756 Doctors 0.425 2.502 0.262 23.867 Years Of Practice as Health Workers 11 And Above (Reference) 0.173 6-10 YEARS 0.101 6.249 0.698 55.944 1-5 YEARS 0.807 1.230 0.234 6.456 Figure 2: Knowledge and Attitudes of the Respondents towards Disease Prevention KAP of disease prevention among healthcare workers in PHC Tajudeen et al. 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