|Year : 2020 | Volume
| Issue : 2 | Page : 73-77
Methicillin-resistant Staphylococcus aureus: Knowledge, attitude and perception among medical students in a private institution in Ogun State, Nigeria
Tinuade Adesola Ajani1, Charles John Elikwu1, Chinenye Gloria Anaedobe2, Chika Celen Okangba1, Babatunde Tayo1
1 Department of Medical Microbiology and Parasitology, Benjamin Carson (Snr) School of Medicine, Babcock University, Illisan-Remo, Nigeria
2 Department of Medical Microbiology and Parasitology, College of Health Sciences, University of Abuja, Abuja, Nigeria
|Date of Submission||10-Mar-2020|
|Date of Acceptance||14-Jul-2020|
|Date of Web Publication||07-Sep-2020|
Tinuade Adesola Ajani
Department of Medical Microbiology and Parasitology Benjamin Carson (Snr) School of Medicine, Babcock University, Illisan-Remo
Source of Support: None, Conflict of Interest: None
Background: Methicillin-resistant Staphylococcus aureus(MRSA) spread is of concern in the hospital and community. Clinical medical students can serve as vectors for the transmission of the pathogen. This study was aimed to determine the level of knowledge, attitude and perception of MRSA among clinical medical students in Babcock University, Ilishan-Remo, Ogun State, Nigeria.
Methods: This was a descriptive cross-sectional study that involved 100 clinical medical students in Babcock University from March 2018 to March 2019. A structured self-administered questionnaire was used to assess the knowledge, attitude and perception of MRSA among the participants. Data were analysed using IBM SPSS version 23. The mean ± standard deviation (SD) of the correct answers to knowledge, attitude and perception of MRSA was analysed, respectively. Respondents who scored more than the mean ± SD were considered to have adequate knowledge, attitude and perception.
Results: Majority (59%) had respectively poor knowledge, attitude (51%) and perception (51%) about MRSA. Among the 41% who have heard about MRSA, 30/41 (73.2%) had their source of information from classroom lectures. Fifty-seven per cent of the participants did not know the drug of choice for MRSA, whereas 32% were not sure of the importance of handwashing in the prevention of MRSA. Good knowledge and perception were significantly associated with clinical year of study (P < 0.05), whereas good knowledge was significantly associated with marital status (P = 0.029) and clinical year of study (P < 0.05).
Conclusion: The level of knowledge, attitude and perception of the study participants to MRSA was inadequate.
Keywords: Attitude, clinical students, knowledge, methicillin-resistant Staphylococcus aureus, perception
|How to cite this article:|
Ajani TA, Elikwu CJ, Anaedobe CG, Okangba CC, Tayo B. Methicillin-resistant Staphylococcus aureus: Knowledge, attitude and perception among medical students in a private institution in Ogun State, Nigeria. Port Harcourt Med J 2020;14:73-7
|How to cite this URL:|
Ajani TA, Elikwu CJ, Anaedobe CG, Okangba CC, Tayo B. Methicillin-resistant Staphylococcus aureus: Knowledge, attitude and perception among medical students in a private institution in Ogun State, Nigeria. Port Harcourt Med J [serial online] 2020 [cited 2020 Oct 24];14:73-7. Available from: https://www.phmj.org/text.asp?2020/14/2/73/294458
| Introduction|| |
Methicillin-resistant Staphylococcus aureus (MRSA) is a public health emergency both in the hospital and community settings because infections caused by these bacteria lead to increased morbidity and mortality among patients.,, Patients with MRSA infections are 64% more likely to die than those with methicillin-susceptible S. aureus strains. MRSA accounts for 44% of healthcare-acquired infections in Europe., MRSA infections also lead to longer duration of illness, hospital stays, use of expensive drugs and additional expenses for the same illness. The prevalence of MRSA varies with countries depending on the infection control practices. In Nigeria, different studies have reported different prevalence depending on the zones of the country where the study took place.,,
MRSA is the most important cause of antibiotic-resistant healthcare-associated infections worldwide. Healthcare workers and medical students are likely to be important in the transmission of the infection because of their increased exposure to the bacteria in the hospital., MRSA accounted for 44% of S. aureus isolated from healthcare workers in the United Kingdom, whereas in Taiwan and Saudi Arabia, the prevalence of MRSA among medical students was 2.2% and 6.7%, respectively.,, Many studies have been done on the assessment of the knowledge of health workers about MRSA,,, but since medical students are also important in the transmission of MRSA, it is important to evaluate their knowledge on MRSA because knowledge is an important factor for the prevention of this pathogen. There is a dearth of data on the knowledge, attitude and perception of medical students about MRSA in Nigeria. Therefore, the aim of this study is to assess the knowledge, attitude and perception of MRSA among clinical students of Ben Carson School of Medicine, Babcock University in Ilishan-Remo, Ogun State, Nigeria.
| Methods|| |
This was a descriptive cross-sectional study that was conducted among clinical medical students in Ben Carson School of Medicine, Babcock University, Ilishan-Remo, Ogun State, Nigeria. The study took place over 12 month's period between March 2018 and March 2019. A sample size of 100 was calculated based on 6.7% prevalence of MRSA among medical students in Saudi Arabia to give a 95% confidence level and margin of error of ±5%. The participants were recruited by simple random sampling technique based on their clinical year of study in ratio 4:2: 1. Inclusion criteria were medical students in clinical year who were ready to fill the questionnaire, whereas exclusion criteria were pre-clinical students.
Ethical approval was obtained from the Babcock University Health Research Ethics Committee before the commencement of the study, and a written informed consent was obtained from the participants before inclusion in the study.
A structured self-administered questionnaire was used to obtain data to assess the knowledge, attitude and perception of MRSA among the medical students. Data were analysed by SPSS Version 23 (IBM Inc., Chicago, Illinois, USA). For knowledge, the correct answers were scored 1, whereas the wrong answers were scored 0. The respondents who scored greater or equal to the mean ± standard deviation (SD) were considered to have adequate knowledge. For attitude, the answers were graded from 1 to 4, the mean of the total answers was analysed and the respondents with scores greater than the mean ± SD were considered as having good attitude. The answers to perception were graded 1 to 5, the mean of the answers was analysed and the participants with scores greater than the mean were considered to have good perception of MRSA. The association between variables was determined using Chi-square test at statistical significance level of 5%.
| Results|| |
The mean age of the participants was 18.0 1 ± 0.5 years, majority 69% were aged 21–25, 66% were females and 58% were in clinical year 1 [Table 1].
Forty-one per cent of the participants had heard about MRSA and 30% heard about it from the lectures. The mean ± SD of the knowledge score of the participants was 4.59 ± 4.0. Forty-one per cent of the participants scored above the mean and were considered to have adequate knowledge about MRSA, whereas 59% had poor knowledge. Majority (33/59 [55.9%]) of the participants with poor knowledge were from clinical one, whereas out of the 41% with adequate knowledge, 19% were from clinical two [Table 2].
The mean ± SD of the attitude of the participants was 17.54 ± 4.9. Forty-nine per cent had good attitude, whereas 51% had poor attitude. Out of the 15 clinical year 3 students involved in this study, 14/15 (93.3%) had good attitude towards MRSA. Majority of the participants (42%) with poor attitude were from clinical year 1 [Table 3].
Among the participants, 38% strongly agree that standard precautions can prevent MRSA, 30% strongly agree that all healthcare workers and medical students should have the knowledge of MRSA although 17% agree strongly that surveillance can reduce MRSA. The mean ± SD score on perception was 28.99 ± 6.4. Forty-nine per cent had good perception [Table 4].
[Table 5] shows the association between good knowledge, attitude and perception, respectively, with age, gender, marital status and clinical year of study.
|Table 5: Sociodemographic factors associated with good knowledge, attitude and perception|
Click here to view
| Discussion|| |
Knowledge and awareness of MRSA is important among medical students because of their exposure to hospital environment, patients and healthcare workers. The study observed that majority of our participants had poor general knowledge about MRSA. This observation is in consonant with the deficient knowledge (37%) of MRSA reported among medical students in Central China by Yang et al. Jennings-Sanders and Jury and Jayamaha and Nagahawatte reported inadequate knowledge of MRSA among some sets of students in the US and India, respectively., Among the 41% of the participants who have heard about MRSA, 30/41 (73.2%) had their knowledge from classroom lectures. This finding is in contrast to that of a study in India in which a higher percentage (86.7%) of students' knowledge was from their courses in the lecture room and with another study from Central China where only 25% of the students recalled being taught in the class about MRSA.,,, These variances might be due to the diversity and contents of medical education in various medical schools.
Many of the students with inadequate knowledge were from clinical year 1, and this might be because they have less clinical exposure to medical training than those in clinical years 2 and 3. Out of the total participants, the highest percentage of students with adequate knowledge about MRSA were from clinical year 2, but when compared based on the number of students recruited from each of the two classes, more students, i.e., 13/15 (86.7%), from clinical year 3 had adequate knowledge. Gupta et al. reported a similar finding.
A higher percentage of students did not know the drug of choice for MRSA, and this finding is similar to that of previous studies., A proportion of the students (32%) were not sure of the importance of handwashing in the reduction of MRSA, and this finding is similar to a previous report by Dyar et al. in Europe. A percentage of students were not sure of what happens in their training institutions in terms of MRSA screening and outbreak investigation. These observations from our study show that a proportion of the students do not understand the importance of clinical practice such as handwashing and outbreak investigation that can reduce or prevent MRSA. Maybe more students mentoring and good clinical practice by the trainers in front of the students can help solve the problem of the poor attitude and perception observed from this study.
Clinical year of study was significantly associated with good knowledge, attitude and perception in this study. This observation is similar to what has been reported by previous studies from Huang et al. and Gupta et al., respectively.,,, Further area of research is to conduct this type of study in many of our medical schools in Nigeria.
This study is not without limitations; the level of clinical exposure of the students varies based on their clinical year of study, and this might have affected the answers that were given to some questions.
| Conclusion|| |
We found that the level of knowledge, attitude and perception of the study participants about MRSA was not adequate. The medical students will soon progress in their carrier to become medical doctors, without adequate knowledge, they will not be able to prevent and manage MRSA very well and this might cause a gradual increase in the burden of infection caused by this pathogen. Therefore, proper guidelines that incorporate more clinical practices that can prevent or reduce MRSA in the medical school curriculum are advocated. Furthermore, larger studies with large sample size are needed to explore this area.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Hidron AI, Kourbatova EV, Halvosa JS, Terrell BJ, McDougal LK, Tenover FC, et al
. Risk factors for colonization with methicillin resistant Staphylococcus aureus
(MRSA) in patients admitted to an urban hospital: Emergence of community asssociated MRSA nasal carriage. Clin Infect Dis 2005;41:159-66.
Taiwo SS, Onlie BA, Akanbie AA 2nd
. Methicillin resistant Staphylococcus aureus
isolates in Ilorin, Nigeria. Afr J Clin Exp Microbiol 2004;5:189-97.
Raygada JL, Levine DP. Methicillin-Resistant Staphylococcus aureus: A Growing Risk in the Hospital and in the Community. Am Health Drug Benefits 2009;2:86-95.
Köck R, Becker K, Cookson B, van Gemert-Pijnen JE, Harbarth S, Kluytmans J, et al
. Methicillin-resistant Staphylococcus aureus
(MRSA): Burden of disease and control challenges in Europe. Euro Surveill 2010;15:01-09.
Elward AM, McAndrews JM, Young VL. Methicillin-sensitive and methicillin-resistant Staphylococcus aureus
: Preventing surgical site infections following plastic surgery. Aesthet Surg J 2009;29:232-44.
Nwankwo BO, Abdulhadi S, Magagi A, Ihesiulor G. Methicillin resistant S. aureus
(MRSA) and their antibiotic sensitivity pattern in Kano, Nigeria. Afr J Clin Exp Microbiol 2010;11:129-36.
Udobi CE, Obajuluwa AF, Onaolapo JA. Prevalence and antibiotic resistance pattern of methicillin-resistant Staphylococcus aureus
from an orthopaedic hospital in Nigeria. Biomed Res Int 2013;2013:01-04.
Agricola J, Sabrina J M, Lillian N, Mtebe M, Sima R, Elizabeth GM, et al
. Nasal carriage of methicillin-resistant Staphylococcus aureus
among health care workers in tertiary and regional hospitals in Dares Salam, Tanzania. Int J Microbiol 2018;2018:01-07.
Peters C, Dulon M, Kleinmuller O, Nienhaus A, Schablon A. MRSA Prevalence and risk factors among health personnel's and residents in nursing homes in Hamburg, Germany A cross-sectional study. PLoS One 2017;12:e0169425.
Fraise AP, Mitchell K, O'Brien SJ, Oldfield K, Wise R. Methicillin-resistant Staphylococcus aureus
(MRSA) in nursing homes in a major UK city: An anonymized point prevalence survey. Epidemiol Infect 1997;118:1-5.
Chen CS, Chen CY, Huang YC. Nasal carriage rate and molecular epidemiology of methicillin-resistant Staphylococcus aureus
among medical students at a Taiwanese university. Int J Infect Dis 2012;16:e799-803.
Zakai SA. Prevalence of methicillin-resistant Staphylococcus aureus
nasal colonization among medical students in Jeddah, Saudi Arabia. Saudi Med J 2015;36:807-12.
Seibert DJ, Speroni KG, Oh KM, DeVoe MC, Jacobsen KH. Knowledge, perceptions, and practices of methicillin-resistant Staphylococcus aureus
transmission prevention among health care workers in acute-care settings. Am J Infect Control 2014;42:254-9.
Trigg D, Timmons S, Pynegar C. An audit of healthcare workers' knowledge of methicillin resistant Staphylococcus aureus
(MRSA) against current infection control standards. J Infect Prev 2008;9:30-3.
De Giusti M, La Torre G, Aurigemma C, Solimini K, Mannocci A, Marinelli L, et al
. Knowledge, attitude and behaviour toward MRSA: Results from a survey among biomedical students and the general population. Int J Public Health 2011;19:527-34.
Yang K, Wu D, Tan F, Shi S, Guo X, Min Q, et al
. Attitudes and perceptions regarding antimicrobial use and resistance among medical students in Central China. Springerplus 2016;5:1779.
Jennings-Sanders A, Jury L. Assessing methicillin-resistant Staphylococcusaureus knowledge among nursing students. Nurse Educ Today 2010;30:789-93.
Gupta MK, Vohra C, Raghav P. Assessment of knowledge, attitudes, and practices about antibiotic resistance among medical students in India. J Family Med Prim Care 2019;8:2864-9.
] [Full text]
Wasserman S, Potgieter S, Shoul E, Constant D, Stewart A, Mendelson M, et al
. South African medical students' perceptions and knowledge about antibiotic resistance and appropriate prescribing: Are we providing adequate training to future prescribers? S Afr Med J 2017;107:405-10.
Dyar OJ, Pulcini C, Howard P, Nathwani D; ESGAP (ESCMID Study Group for Antibiotic Policies). European medical students: A first multicentre study of knowledge, attitudes and perceptions of antibiotic prescribing and antibiotic resistance. J Antimicrob Chemother 2014;69:842-6.
Huang Y, Gu J, Zhang M, Ren Z, Yang W, Chen Y, et al
. Knowledge, attitude and practice of antibiotics: A questionnaire study among 2500 Chinese students. BMC Med Educ 2013;13:163.
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]