Addis Ababa University School of Graduate Studies School of Medicine Department of Emergency Medicine and Critical Care Assessment of KAP towards BLS among dental medicine interns in selected health colleges, Addis Ababa Ethiopia A thesis submitted to school of graduate studies of Addis Ababa University, Department of Emergency Medicine and Critical Care in partial fulfillment of the requirements for degree of masters in Emergency medicine and critical care nursing June 2017, Addis a APPROVED BY THE BOARD OF EXAMINERS This thesis by Abubeker Hussen is accepted in its present form by the board of examiners as satisfying thesis requirement for the degree of Masters of Science in Emergency medicine and critical care nursing Examiner: _ Full name Rank Signature and Date Advisors: _ Full name Rank Signature and Date _ Full name Rank Signature and Date b c Table of contents Contents Table of contents i Acknowledgment i Acronyms i List of tables i List of figures i Abstract i Introduction i 1.1 Background of the study i 1.2 Statement of the Problem i 1.3 Significance of the Study i Literature Review i 2.1 BLS Knowledge i 2.2 Attitude towards BLS i 2.3 Practices towards BLS i 2.4 Conceptual framework i Objectives i 3.1 General Objective i 3.2 Specific objectives i Methods and Materials i 4.1 Study Setting i 4.2 Study design i 4.3 Source Population i 4.4 Study population i 4.5 Inclusion and exclusion Criteria i 4.5.1 Inclusion Criteria i 4.5.2 Exclusion Criteria i 4.6 Sample size determination i 4.7 Sampling Technique i i 4.8 Study Variables ii 4.8.1 Dependent Variables ii 4.8.2 Independent Variables ii 4.9 Data Collection and Quality Control procedures ii 4.10 Operational definition of terms ii 4.11 Data processing and analysis ii 4.12 Ethical consideration ii 4.13 Dissemination and utilization of results ii Results ii 5.1 Introduction ii 5.2 Demographic characteristics of the study participants ii 5.3 Knowledge of Basic Life Support among the study participants ii 5.4 The study participant’s attitude towards Basic Life Support ii 5.5 The study participant’s practice regarding Basic Life Support ii 5.6 Association of knowledge with independent variables ii 5.7 Association of attitude of dental internes towards BLS with independent variables ii Discussion ii 7: Conclusion, Recommendation and Limitations of the study ii 7.1: Conclusion and Recommendations ii 7.2: Limitations ii References ii Annex ii Annex I Information Sheet ii Annex II Consent sheet ii Annex III: Questionnaire ii ii Acknowledgment I am extremely grateful to the efforts exerted by my colleagues who facilitated the successful completion of this research proposal I would also like to extend my deepest gratitude to my advisors; for their time, effort and valuable comments and directions they gave in the preparation of this thesis I also thank AAU for the chance given to me to pursue my master’s study And I am grateful for Atlas Health Science College and AAU School of Dental Medicine for letting me conduct my study in their premises iii Acronyms AED Automated External Defibrillator AHA American Heart Association BLS Basic Life Support CPR Cardio Pulmonary Resuscitation EMS Emergency Medical Service KAP Knowledge Attitude Practice MMV Mouth to Mouth Ventilation SCA Sudden Cardiac Arrest iv List of tables Table 1: Name of the Dental Medicine School at which the dental interns attending…… …15 Table 2: Demographic characteristics of study participants in the study assessment of KAP regarding BLS among dental interns at selected health science colleges Addis Ababa Ethiopia, 2017…………………………………………………………………………………………….16 Table 3: Knowledge of the study participants towards Basic Life Support in the study assessment of KAP regarding BLS among Dental internes at selected health science colleges Addis Ababa, Ethiopia 2017…………………………………………………………………17 Table 4: Opinions of participants towards Basic Life Support in the study of assessment of KAP regarding BLS among Dental internes at selected health science colleges Addis Ababa, Ethiopia 2017………………………………………………………………………….19 Table 5: Study participants practice of Basic Life Support in the study assessment of KAP regarding BLS among dental internes at selected health science colleges, Addis Ababa, Ethiopia 2017………………………………………………………………………………… 20 Table 6: Bivariate and multivariate logistic regression analysis of Knowledge status and the independent Variables…………………………………………………………………………21 Table 7: Bivariate and multivariate logistic regression analysis of Attitude and the independent Variables………………………………………………………….22 v List of figures Figure Conceptual frame work for assessment of knowledge, attitude and practice among dental internes regarding BLS, developed from literatures Figure Study participants' BLS workshop attendance .17 Figure Study participants’ attitude towards BLS 20 vi Abstract Background of the study: Life-threatening emergencies can occur at anytime, anywhere and to anyone Such emergencies are somewhat more likely to occur within the confined dental office due to the increased level of stress which is often present Basic life support (BLS) is the foundation for saving life following cardiac arrest Fundamental aspects of BLS include recognition of Sudden Cardiac Arrest (SCA) and activation of the emergency response system, early Cardiopulmonary Resuscitation (CPR), and rapid defibrillation with an Automated External Defibrillator (AED) Objective of the study: To determine KAP of internes studying dental medicine towards BLS at Atlas Health Science College and Addis Ababa University School of Dental Medicine, Addis Ababa, Ethiopia 2017 Methods and Materials: Institution based prospective study was conducted at selected health science colleges in Addis Ababa, in titled ‘assessment of KAP among internes studying dental medicine towards BLS’ from January to June 2017 The study sample was selected using convenience non random sampling since the interns studying Dental Medicine at Atlas Health Science College and AAU School of Dental Medicine were limited in number Data analysis of the study was conducted using SPSS version 20; descriptive and analytical statistics were done Results: Most of the participants 76 (66.7%) know the adult chest compression depth Whereas 57 (50%) of the participants have reported their reluctance to perform resuscitation It was found that sex of the dental interns is significantly associated with their knowledge regarding BLS; female study participants were likely to have times more knowledge regarding BLS than their male counter parts with AOR= 5.3299, at 95% CI (2,373, 12,282) As well those dental internes with less than years clinical experience are more likely to have positive attitude towards BLS; with AOR=0.157 at 95 CI (0.062,0.399) Conclusion: Knowledge and Practice skills of BLS were found to be poor among the dental internes in the study A significant portion of the study participants have shown negative attitude towards providing BLS An organized curriculum for BLS should be part of the dental medicine curriculum with much higher emphasis vii Category Attitude Negative n(%) 75(65.79%) OR 95%CI Positive n(%) 39(34.21%) COR AOR School AAU AHSC Clinical experience None Less than years Between and 10 years 15 60 35 25 37 12 13 27 457(.141, 1.486) 1 156(.062,.395) 157(.062, 399) 000 24 Discussion This study emphasized on assessing the Knowledge, attitude, practice and skill of BLS of dental interns Health professionals should have sound knowledge and skills regarding BLS Response rate of the study were found to be consistently poor when compared with other studies, still in our study many knowledge gaps were found among dental interns regarding BLS/CPR Certain domains where majority of study subjects gave incorrect answer were: Have you ever had any prior training in BLS, Chest compression: Ventilation in infants is 30:2; Location for chest compression in infants is one finger Breadth below the nipple line, depth of chest compression in adults is 2-3 inches, compression depth in infant is about 1and 1/2 inches, and ARD stands for Emergency Medical Services Most of the participants 89 (78.1%) thought that BLS/CPR should be included in the undergraduate dental medicine curriculum Results were consistent with other studies which were done in similar population Pillow et al (2014) and Roshana et al (2012) Moreover, Zaheer and Haque (2009) showed that a large number of participants (79%) were of the opinion that training of BLS should be a part of the curriculum Similarly in the study by Ohoud A et al most of the participants 425 (93.6 %) thought that dentists and dental students should know about BLS and that it should be included in the undergraduate dental curriculum (30) This study revealed that 56 (49.1%) of the participants have answered ≥ 50% of the knowledge questions correctly in which they are classified as having sufficient knowledge whereas 58 (50.88%) have answered < 50% of the knowledge questions correctly These findings were consistent with those of the study conducted by Raghav et al (26) This study also suggested that those with prior training in BLS had better knowledge, which is consistent with a study conducted by Sudeep et al (8) which demonstrated the improvement of knowledge and skills of CPR after BLS training 25 Female dental medicine internes were found to have times more knowledge than male dental medicine internes in this study; which is consistent with a similar study conducted by Ohoud A et al in Saudi Arabia in which significantly higher knowledge score was observed among females than males (30) In this study 75 (65.79%) of the study participants were found to have negative attitude towards BLS, whereas 39 (34.21%) were found to have positive attitude towards BLS This is in contrary to a study conducted in India, the attitude of interns, 69 (67.6%) had positive attitude towards BLS and 33 (32.4%) had negative attitude towards BLS (16) This might be related to lack of BLS training and practice at the dental schools In contrary to a study conducted by Varma L et al (25) in which 50.5% of the dentists were confident in managing any emergency condition at their dental offices, which was also similar to the findings in other study done by Muller and Broadbent (22) In this study only 26 (22.8 %) of the dental medicine internes reported as being confident to provide chest compression and the majority 38 (33.3%) reported as likely when rating their level of confidence The remaining 50 (43.2 %) of the study participants have said they aren’t confident This is related to the lack of practice and inadequacy of BLS training Similar to the study conducted by Ohoud A et al which showed that 63.2 % reluctance of the study participants to perform resuscitation; this study also revealed that 50 % of the study participants reported as being reluctant to perform resuscitation In this study all of the dental medicine interns 100 % never have performed MMV on a doll or actual patient or have done CPR; which is in contrast to a study conducted to assess the preparedness of dental practitioners toward medical emergencies by enquiring about the key start points such as medical history, drug history, vital signs of the patients, and availability of emergency drug kits at their dental office 94.02% of the total practitioners enquired about medical and drug history, but only 67.11% of them obtained filled Performa and about 83.06% recorded vital signs All the above findings were high when compared to a similar study conducted by Kumarswami et al which was mainly due to increase in the awareness regarding medical emergencies among dentists (25) 26 7: Conclusion, Recommendation and Limitations of the study 7.1: Conclusion and Recommendations Knowledge and Practice skills of BLS were found to be poor among the dental internes in the study A significant portion of the study participants have shown negative attitude towards providing BLS An organized curriculum for BLS should be part of the dental medicine curriculum with much higher emphasis Workshops on a regular basis should be focused on skills of BLS for dental students Trainees might not acquire adequate knowledge in a single session of training Repeated training, hands-on practice and practical demonstrations are equally necessary for acquiring practical knowledge 7.2: Limitations As the sample size for the study is small only (120) the results might lack representativeness Since the data was collected by using a structured questionnaire; there might be a chance of getting a false response So to overcome this problem and to objectively assess the practice of dental interns towards BLS in future it will be good to employ observational study The other limitation was the time given for the study is short Other than the above mentioned limitations; to the best of our knowledge the study have assessed the KAP of dental internes regarding 27 BLS in Addis Ababa, Ethiopia References Marsden AK Guidelines for Cardiopulmonary Resuscitation Basic Life Support Revised recommendations of the Resuscitation Council (UK) BMJ 1989;299: 442–445 Shanta Chandrasekaran, Sathish Kumar, Shamim Ahamed Bhat, Saravana Kumar, P Mohammed Shabbir, VP Chandrasekaran Awareness of basic life support among medical, dental, nursing students and doctors India Journal of Anesthesia 2010; 54:1216 AJ Handley Guidelines for basic life support BMJ; 1993; 306:1587-9 H Sarin, D Kapoor Adult basic life support Indian J Crit Care Med 2006; 10:95-104 HT Srinivas, Nalini Kotekar, Sindhu R Rao A survey of basic life support awareness among final year undergraduate medical, dental, and nursing students International Journal of Health and Allied Sciences 2014; 3:91-94 Ji Ung Na, Min Seob Sim, Ik Joon Jo, Hyoung Gon Song, Keun Jeong Song Basic life support skill retention of medical interns and the effect of clinical experience of cardiopulmonary resuscitation Emergency Medical Journal 2012; 29:833-837 Neha Baduni, Prem Prakash, Dhirendra Srivastava, Manoj Kumar Sanwal, Bijender Pal Singh Awareness of Basic life Support among Dental Practitioners National Journal of Maxillofacial Surgery 2014; 5:19-22 S Elanchezhiyan, Awareness of Dental Office Medical Emergencies Among Dental Interns in Southern India: An Analytical Study Journal of Dent Educ March 2013; 77(3): 364-69 Carvalho RM, Costa LR, Marcelo VC Brazilian dental students’ perceptions about medical emergencies: a qualitative explorative study Journal of Dent Educ 2008; 72(11): 1343-49 10 Gonzaga HF, Buso L, Jorge MA, Gonzaga LH, Chaves MD, Almedia OP Evaluation of knowledge and experience of dentists of São Paulo State, Brazil about cardiopulmonary resuscitation Brazil Dent Journal 2003; 14: 220-22.) 28 11 Owais Khalid Durrani BDS, FCPS, MOrth RCSEd, FFD RCSI, Associate Professor, Department of Orthodontics, Islamic International Dental College and Hospital, Riphah International University) 12 Zamir Q, Nadeem A, Rizvi AH Awareness of cardiopulmonary resuscitation in medicalstudents and doctors in Rawalpindi- Islamabad, Pakistan J Pak Med Assoc 2012; 62: 1361–1364 13 Kandray DP, Pieren JA, Benner RW Attitudes of Ohio dentists and dental hygienists on the use of automated external defi brillators Jornal of Dental Educ 2007; 71: 480–486 14 Marsden AK Guidelines for Cardiopulmonary Resuscitation Basic Life Support Revised recommendations of the Resuscitation Council (UK) BMJ 1989; 299: 442–445 15 Steen P A, Kramer-Johansen J Improving cardiopulmonary resuscitation quality to ensure survival CurrOpinCrit Care 2008; 14:299-304 16 Dhage Pundalika Rao Narayan, S N Biradar, Mayurnath T Reddy & Sinjatha BK Assessment of knowledge and attitude about basic life support among dental interns and postgraduate students in Bangalore city, India Adapted from World Journal of Emergency Medicine, 2015 17 M P Müller, M Hänsel, S N Stehr, S Weber, T Koch A state-wide survey of medical emergency management in dental practices: incidence of emergencies and training experience Emerg Med J 2008;25:296-300 doi:10.1136/emj.2007.052936 18 Chandrasekaran S, Kumar S, Bhat SA, Saravanakumar Shabbir PM, Chandrasekaran V Awareness of basic life support among medical, dental, nursing students and doctors Indian J Anaesth 2010;54:121–126 [PMC free article] [PubMed] 19 Atherton GJ, McCaul JA, Williams SA Medical emergencies in general dental practice in Great Britain Part 3: Perceptions of training and competence of GDPs in their management Br Dent J.1999; 186: 234-7 20 Sopka S, Biermann H, Druener S, Skorning M, Knops A, Fitzner C, et al Practical skills training influences knowledge and attitude of dental students towards emergency medical care Eur J Dent Educ 2012;16:179-86 29 21 Jodalli PS, Ankola AV Evaluation of knowledge, experience and perceptions about medical emergencies amongst dental graduates (Interns) of Belgaum city, India J Clin Exp Dent 2012;4:e14- http://www.medicinaoral.com/odo/volumenes/v4i1/jcedv4i1p14.pdf 22 Morrison AD, Goodday RH Preparing for medical emergencies in the dental office J Can Dent.Assoc.1999;65:2846 23 Broadbent JM, Thomson WM The readiness of New Zealand general dental practitioners for medical emergencies N Z Dent J 2001;97:82-6 24 Varma L S, Pratap K, Padma T M, Kalyan V S, Vineela P Evaluation of preparedness for medical emergencies among dental practitioners in Khammam town: A crosssectional study J Indian Assoc Public Health Dent [serial online] 2015 [cited 2017 Jan 18]; 13:422-8 Available from: http://www.jiaphd.org/text.asp?2015/13/4/422/171178 25 Gbotolorun OM, Babatunde LB, Osisanya O, Omokhuale E Preparedness of government owned dental clinics for the management of medical emergencies: A survey of government dental clinics in Lagos Nig Q J Hosp Med 2012; 22:263-7 26 Shrestha Roshana, Batajoo KH, Piryani RM, Sharma MW.Basic life support: knowledge and attitude of medical/paramedical professionals World J Emerg Med 2012; 3(2): 141– 145 27 Osinaike BB, Aderinto DA, Oyebamiji EO, Dairo MD, Diya KS Evaluation of knowledge of doctors in Nigerian tertiary hospital about CPR Nigerian Medical Practitioner 2007;52: 16–18 28 Elif AA, Zeynep K Knowledge of basic life support: a pilot study of the Turkish population by Baskent University in Ankara Resuscitation 2003;58: 187–192 [PubMed] 29 Laurent F, Augustin P Managing a cardiac arrest: evaluation of final year predoctoral dental students J Dent Educ 2009; 73: 211-8 30 30 Ohoud Alotaibi , Faizah Alamri, Laila Almufleh, Wedad Alsougi Basic life support: Knowledge and attitude among dental students and Staff in the College of Dentistry, King Saud University The Saudi Journal for Dental Research (2016) 7, 51–56 Annex Annex I Information Sheet Research Topic: Assessment of KAP towards BLS among dental medicine interns in selected Health Science Colleges, Addis Ababa Ethiopia, 2017 Investigator: Abubeker Hussen Dear Respondent: I am a Masters student at AAU, School of Medicine, Department of Emergency Medicine and Critical Care I kind heartedly request you to participate in a study that is aimed at assessing the knowledge, Attitude and Practice of Dental interns towards BLS in Selected Health Science Colleges in Addis Ababa Participation in this study is voluntary; you can also withdraw at any time from the study if you feel uncomfortable Refusal to participate will not affect your work or care you shall seek at any of the health facilities in any way Confidentiality will be ensured by not using your name or address on the questionnaire There are no risks involved in participating in this study The study has no immediate benefits to the respondents, but will have benefits later in improving the knowledge of schools in long runs by implementation of study findings at time of training in higher institutions 31 I welcome any question if you have any about the study and your participation Should you have any questions about the research or any related matters, please contact the researcher at Phone no: +251-911616512 Email:Sweetabuki@gmail.com 32 Annex II Consent sheet I understand the nature of the study, benefits, and my right to voluntary participation, confidentiality and withdrawal from the study without any oppression I have had the opportunity to ask questions and answered to my satisfaction To express my agreement I have signed below I hereby freely consent to take part in this study Signature of the participant _ Date _ Supervisor Name _ signature _ Date _/ _/ E.C Name of interviewer Date / _/ E.C signature Yours Faithfully, 33 Annex III: Questionnaire Basic life support questionnaire to the participants Part I Socio-demographic questions Sex _ Age _ Clinical experience Done/seen BLS (CPR)** done on a patient Yes No Clinical experience None ( 0) Less than years Between and 10 years More than 10 years The last attended BLS# workshop None (0) within the last years More than years Done/seen BLS (CPR)** done on a patient Yes No Part II: Knowledge questions What is the abbreviation “BLS” stands for? a) Basic Life Support b) Best Life Services c) Basic Lung Support d) Basic Life Standards 34 What will be your first step? When you find an adult person unresponsive on the road? (Note: If you are alone at that place) a) Maintain airway b) Start chest compression c) Ask for help d) Start giving breathings If an adult person after accident is not responding to you even after shaking and shouting at him, what will be your immediate action plan? (Note – If multiple rescuers are present) a) Rapid defibrillation b) Immediate recognition of cardiac arrest and activation of emergency response system c) Put him in recovery position d) Observe If an adult person after accident is not responding to you even after shaking and shouting at him, for how much time you will try to feel for pulse before moving to start chest compressions? a) Minimum5 sec andMaximum10 seconds b) Minimum10 sec andMaximum15 seconds c) Minimum15 sec andMaximum20 seconds d) Any of the above What is the location for chest compression in adults? a) Right side of the chest b) Left side of the chest c) Centre of the chest on breastbone d) Anywhere on chest region What is the location for chest compression in infants following 2- finger technique? a) Two finger in the center of infant's chest just below the nipple line b) Two finger breadth above the nipple line c) Two fingers at the intermammary line d) Two fingers at Xiphisternum Technique to give breaths in infants? (Note- Preferred method) a) Mouth-to-mouth only b) Mouth-to-Mouth and- nose c) Mouth-to-nose only 35 d) Mouth-to-mouth without nose pinched Technique to give breaths in infants? (Note- If you are not able to apply preferred method) a) Make a Mouth-to-mouth seal only b) Use of some instruments c) Make a Mouth-to-nose seal d) None of the above What is Depth of compression in adults during CPR? a) At least inches b) 2½– inches c) Less than inches d) According to your comfortable level 10 What is Depth of compression in Children during CPR? a) About inches b) 2½– inches c) One - fourth to one-half depth of chest d) About1 inches 11 Depth of compression in infants during CPR? a) More than 1½– inches b) About 1and 1/2 inches c) About½– CM d) One-half to one-third depth of chest 12 Rate of chest compression in adult and Children during CPR? a) At least 100 /min b) At least 90 /min c) At least 80 /min d) At least 70 /min 13 Compression-Ventilation ratio in adult? (Note- If single rescuer) a) 30:1 b) 15:2 c) 30:2 d) 15:1 14 Compression-Ventilation ratio in adult? (Note- If double rescuer) a) 30:2 b) 15:2 c) 30:1 d) 15:1 15 In a child, chest compression and ventilation ratio is? (Note- If single rescuer) a) 15:2 b) 5:1 c) 30:2 d) 3:1 16 In a child, chest compression and ventilation ratio is? (Note- If double rescuer) 36 a) 15:2 b) 5:1 c) 30:2 d) 3:1 17 Abbreviation AED stands for? a) Automated External Defibrillator b) Automated Electrical Defibrillator c) Advanced Electrical Defibrillator d) Advanced External Defibrillator 18 What does abbreviation EMS stands for? a) Effective Medical Support b) Emergency Management Services c) Emergency Medical Services d) External Medical Services 19 If you and your colleague are eating food and suddenly your colleague starts symptoms of choking and is confirmed by talking to him, what will be your first response on the spot? a) Give back blows b) Give chest compression c) Give abdominal thrusts d) Any of the above 20 If you and your colleague are eating food and suddenly your colleague starts symptoms of choking and is confirmed by talking to him/her, what will be your first response? (Note- If your colleague is pregnant /obese) a) Give abdominal thrusts b) Give back blows c) Give chest thrusts d) None of the above Part III Attitude questions BLS training should be part of the dental medicine curriculum? Yes No Reluctance to perform resuscitation Not reluctant 37 Reluctant Reasons for reluctance Fear of causing further harm to patient Fear of acquiring infection Fear of taking responsibilities Not confident The reason for lack of knowledge about BLS Busy curriculum Lack of interest No professional training available The need for regular update of BLS knowledge of dentists Incomprehension of the importance of BLS Medical emergencies are not commonly encountered Other causes Mouth to mouth ventilation Willing to perform without any hesitancy Prefer to us some type of barrier Would stay back and let someone else to volunteer Refuse to perform 5 Please rate yourself on BLS knowledge? Poor Below average Average Good Excellent Is it useful to know about BLS? Yes No Thank you for your participation!!! 38 ... Objective of the study: To determine KAP of internes studying dental medicine towards BLS at Atlas Health Science College and Addis Ababa University School of Dental Medicine, Addis Ababa, Ethiopia. .. Objective  To determine KAP of internes studying dental medicine towards BLS in Atlas Health Science College and Addis Ababa University School of Dental Medicine Addis Ababa, Ethiopia, November... conducted in Dental Medicine Schools found in Addis Ababa In 2017 a total of eight dental medicine institutes were present in the country, of which four were found in Addis, of the four dental medicine