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2021
Antimicrobial resistance poses a growing threat to public health, as infections from resistant strains of microbial become increasingly difficult and expensive to treat, resulting in prolonged illness and greater risk of death. A cross-sectional descriptive study was done among 471 higher secondary level students of private schools in Kathmandu Valley. Data were collected from Grade 11 and 12 non-science faculty students through self-administered questionnaires. Half (50.5%) of the students gave correct response by saying that antibiotic kills bacteria and 49.1% said that it is for fever. Majority (93.0%) of them said that it should be taken with water. Regarding the response on when to stop taking antibiotic, 46.9% said correctly by saying when all prescribed medicines are taken whereas and 40.8% said that after feeling better. More than half (58.8%) of the students had not heard about antibiotic resistance, whereas those who have heard among them 24% of students said that they had...
Journal of Institute of Medicine, 2019
Introduction The lack of awareness on the appropriate use of antibiotics, its dose and duration is one of the leading causes of global antimicrobial resistance (AMR). AMR poses a growing threat to public health, as infections from resistant strains of microbes become increasingly difficult to treat, resulting in prolonged illness and greater risk of death. Hence, this study would be an important reference for determining the scope of the problem which will be essential for formulating and monitoring an effective response to antibiotic use and its problem of resistance. Methods A descriptive cross-sectional study was done among higher secondary level students from selected schools in Kathmandu valley. Baseline data was collected after a tutorial session through semi-structured questionnaires which was based on past researches and verified using expert consultation. Ethical consideration was maintained throughout the study. Descriptive statistics was used to find out the KAP level including knowledge score and attitude-practice score of the selected population. Results Among 465 participants conducted in our research, the overall average knowledge score of the participants was found to be 73.3% while the attitude-practice score was 60.53%. It was found that 80.86% of the participants had heard the term "antibiotic resistance". The knowledge score percentage among the students of grade 10 and 11 had no significant difference (p value= 0.592). Conclusion Our study concludes that if topics like antibiotics and their judicial use is well covered in school curriculum, it can produce measurable change in knowledge, attitude and practice level of the students.
Introduction: Antibiotic resistance has been described by World Health Organisation as a major global health problem that threats our ability to treat common infectious diseases and needs urgent action. Among many other factors, knowledge and behaviour of community members that lead to inappropriate use of antibiotic highly contributes to development and spread of antimicrobial resistance. Hence this study has been undertaken with the aim to assess the knowledge and attitude related to antibiotic use among high school students. Methods: A cross-sectional questionnaire based survey was conducted at a Kathmandu based highschool. The data were collected via self-administered questionnaire after verbal consent for voluntary participation. There were nine questions related to knowledge and five questions related to attitude. Data were aggregated to compile frequency distribution tables and the percentages of responses were calculated. Result: A total of 232 students participated in the study. In the questions related to knowledge, nearly 62% of the students agreed to the statement "Antibiotics are needed to cure most coughs and cold". About 19% students were not sure whether antibiotics can kill the useful bacteria in our body. In the attitude part, 53.87% students responded that they stop taking antibiotics when they start to feel better and 59.91% students responded that they buy antibiotics on their own from a pharmacist when needed. Conclusions: The deficiencies in basic understanding about the nature and use of antibiotics and casual attitude in their use among high school students is a matter of great concern as it poses many serious problems including promotion of antibiotic resistance
BioMed Research International, 2024
Background: Antimicrobial resistance (AMR) is a global health problem contributing to increasing rates of morbidity and mortality throughout the world. Inadequate knowledge and misconceptions surrounding antibiotics and their overuse can significantly contribute to the growth and spread of AMR. This study aimed to assess knowledge, attitudes, and practices (KAP) regarding antibiotic use and resistance among undergraduates in Pokhara, Nepal, and examine associations of knowledge and attitudes with demographic factors and specific antibiotic use practices. Methods: A cross-sectional survey was conducted from April to September 2023 among 461 undergraduate students in Pokhara Metropolitan City. Frequency distributions were used to describe participants' KAP regarding antibiotics. Chi-square tests were applied to identify factors significantly associated with knowledge and attitudes toward antibiotics, with a significance level of 5%. Result: Among the total participants, 155 (33.6%, 95% CI: 29.6-38.3) had a lower level of knowledge regarding antibiotics, while a moderate and higher level of knowledge was observed among 208 (45.1%, 95% CI: 40.1-49.5) and 98 (21.3%, 95% CI: 17.5-24.7) students, respectively. Nearly half (53.6%, 95% CI: 48.9-58.2; 50.1%, 95% CI: 45.8-54.4) of the students illustrated positive attitudes and good practices. Factors such as gender, academic discipline, and previous education on antibiotics were associated with students' knowledge regarding antibiotics, at 5% level of significance (p < 0 05). Similarly, a statistically significant relationship existed between students' academic discipline, past courses, and their attitudes toward antibiotics. The knowledge of the participants on the antibiotic use was found to have a statistical relationship with practice-related attributes such as finishing the antibiotic course even after feeling well, giving less preference to antibiotic for cold (p < 0 05). The attitude of the participants toward antibiotics was found to have a statistical relation with practices such as consulting a doctor for antibiotics and finishing the course of antibiotic (p < 0 05). Conclusion:A large proportion of undergraduates have moderate to high knowledge regarding antibiotic use, while only half had a positive attitude and good practice toward antibiotic use, suggesting a large gap existing in awareness of antibiotic resistance and rational use.
Journal of Nepal Medical Association
Introduction: Self-medication among adolescents has become a serious global problem that plays an important role in irrational use of medication and tends to increase with the age of adolescents. Limited research has been done in Nepal regarding antibiotic knowledge among non-medical students. Hence, this study aims to assess the knowledge of higher secondary non-science students regarding antibiotic use, resistance and its consequences. Methods: A cross-sectional descriptive study was done during antibiotic awareness week 2017 among 471 grade 11 and 12 non-science students of private schools in Kathmandu. Convenience sampling technique was used. Data was collected through self-administered questionnaires. Descriptive statistics was utilised to find out the knowledge level of the students. Results: The mean age of the students 245 (52%) male, 226 (48%) female) was 17.19 years and 335 (71.1%) were from grade 12. Approximately all 462 (98.1%) the participants had inadequate knowledge ...
International Journal of Basic & Clinical Pharmacology
Background: The growing concern about antibiotic resistance, of late, led World Health Organization to declare it as World Health Day theme in 2011. Knowledge spreads awareness and understanding by melting the barriers of ignorance while attitudes and practices have a bearing on the health related behaviour. The present study aims at evaluating the knowledge, attitudes and practices of medical students towards antibiotic usage.Methods: The present cross-sectional study was conducted among the Pre-final medical students (6th / 7th semester) who participated in the questionnaire survey on knowledge, attitude and practice towards antibiotics usage. The data was analysed and Chi-square was used as test of significance.Results: Overall, 132 students were interviewed. Majority (96.2%) had heard of antibiotic resistance. About 22% of the sample stated that antibiotics can cure viral infections, among them female being in the higher proportion (p<0.05). Majority (>90%) agreed that ant...
Medical Journal of Shree Birendra Hospital
Introduction: Antibiotic resistance has been described by World Health Organisation as a major global health problem that threats our ability to treat common infectious diseases and needs urgent action. Among many other factors, knowledge and behaviour of community members that lead to inappropriate use of antibiotic highly contributes to development and spread of antimicrobial resistance. Hence this study has been undertaken with the aim to assess the knowledge and attitude related to antibiotic use among high school students. Methods: A cross-sectional questionnaire based survey was conducted at a Kathmandu based high-school. The data were collected via self-administered questionnaire after verbal consent for voluntary participation. There were nine questions related to knowledge and five questions related to attitude. Data were aggregated to compile frequency distribution tables and the percentages of responses were calculated. Result: A total of 232 students participated in th...
Infection and Drug Resistance
Background: Antibiotics are lifesaving drugs, and inappropriate uses lead to the resistance that renders them ineffective. This study aims to understand knowledge, attitude, and practice (KAP) concerning antibiotic use and resistance among university students in Bangladesh. Methods: A cross-sectional study was performed from January to April 2020 among students at Jahangirnagar University (JU), Bangladesh. Purposive sampling was conducted through an in-person interview using a structured questionnaire. Students from the faculties of biological sciences and non-biology background were included. The univariate ordinal regression technique was used to analyze the relationship between predictors and good knowledge about the antibiotics. A two-tailed p-value was calculated to determine statistical association. Results: Out of 205 study participants, 92 and 113 responders were from biological science faculty and non-biology disciplines, respectively. Less than half of the students (42.4%) showed a good knowledge level (scores higher than 80%). Biology-background students possess better knowledge than non-biology students [odds ratio (OR) = 4.44, 95% confidence level (CL) (2.56, 7.70), p < 0.001]. A better attitude was noticed among all students. The self-medication rate was quite low, and more than 90% of students were found to consume antibiotics according to the physician's prescription. Lack of treatment adherence was recorded, and students admitted to stoptaking antibiotics when symptoms disappeared (48.67% biology and 36.26% non-biology). Multivariate regression analysis was unable to detect any significant association between selfmedication and gender, student category or the level of knowledge about antibiotics. Conclusion: Students of biological science background possessed better knowledge indicating the importance of appropriate curriculum imparted in knowledge buildup. Introducing a short course about the risk and development of antibiotic resistance will grow the students' awareness to avoid the resistance phenomenon.
Journal of Kathmandu Medical College, 2018
Background: Antibiotics are considered to be among the most commonly sold drug classes globally. Antibiotic resistance is a recognized public health issue at the local, national and global levels.Objectives: The aim of this study was to identify awareness of general public regarding the use and resistance of antibiotics.Methodology: A descriptive cross-sectional study was conducted in Kathmandu in November 2016 using a quantitative questionnaire among 120 adult people aged 20–60 years. Convenience sampling method was used and information on use of antibiotics and resistance was obtained using semi-structured questionnaire through interview method. Descriptive statistics was done to describe the respondent’s level of awareness regarding use of antibiotics and resistance.Results: Among the total respondents, majority had incorrect awareness as regards to action, reasons for using antibiotics, possible side effects of the antibiotic. Seventy one percent of the respondents had not heard...
INTRODUCTION Physicians formally learn about antimicrobials and also AR during the 5-6 year of the undergraduate medical program. MS in Bangladesh and in many other countries usually undertake a course of Pharmacology in Year-III and IV, in which they start acquiring knowledge about drugs and medication including antimicrobials and AR. Their knowledge regarding medicine prepares them to prescribe rationally when they eventually graduate. MS are not allowed to prescribe drugs independently. AR is an important growing global health concern and needs serious intervention. Awareness about AR is an essential concern for undergraduate students, as they are the future practitioners. 1 A doctor must possess the knowledge to correctly select an antibiotic or other drug for a particular disease. This issue is not currently being addressed in the undergraduate course curriculum; which may leads to irrational prescribing and promotes AR. 2 Therefore, it is essential to have a comprehensive knowledge regarding drugs, including antimicrobials during their undergraduate level to improve the judicious use of antimicrobials. 3 Consequently, it is important for the MS to have the KAP study on anti-microbials and AR to help policy makers to develop an adequate education program prescribers. 4 WHO states that all healthcare workers and MS should be educated on rational antimicrobial prescribing or ' Antimicrobial stewardship' and this is an integral part of AR containment activities. 5,6 Very few studies have been conducted to find the MS' perception about their education and knowledge of antibiotic use in Bangladesh. A study reported that only ≤25% of their study participants could answer questions relating to treating urinary tract infection, cellulites, or Neisseria gonorrhea correctly. 7 Even senior MS did not choose antimicrobials appropriately in various clinical settings. 8 MS will enter soon in the global health workforce and should be the target group for intervention to decrease AR. 9 They should be motivated and reinforced to take action about the ongoing problem. 10 Although, MS have received much theoretical teaching in their coursework for antimicrobials and AR but suffers from the lack of practical and clinical knowledge. 2 Most of the young graduates select antimicrobials by copying older colleagues rather from official guidelines. 2 It is dangerous to learn from older members whose knowledge is not up to date. Hence, it is essential to give emphasis to the medical curriculum to improve knowledge regarding antimicrobials and AR. Over three-quarters of MS suggested more training programs on anti-microbial selection. There was no definitive resource for antimicrobial selection, and most of the MS have depended on 'Epocrates' software. 2 ABSTRACT Background: Physicians formally receive education regarding antimicrobi-als and microbial resistance during a 5-6 year curriculum of the undergraduate medical program. However, the once magical bullet of antibiotics is now threatened by AR, which has become a significant hazard to global health. Thus, a doctor must possess the adequate knowledge to select an antibiotic or other drug for use in a particular disease. This issue is not currently being addressed in the undergraduate curriculum resulting in irrational prescribing. Therefore, it is essential to possess a comprehensive knowledge regarding drugs, including antimicrobials at an undergraduate level. Currently, there is no comprehensive evaluation of medical students' perception of AR in Bangladesh. This was the driving force to conduct this study and to identify gaps in KAP of medical students about AR, as well as to enrich the medical curriculum. Methods: This is a cross-sectional, ran-domized, questionnaire-based study. Data were collected using a validated instrument. Results: 107 students were selected using a quota sampling technique. A total of 107 participants (32.71% male and 67.29% female) attended the study. The response rate was 100%. Out of the cohort; 37.38%, 30.84%, and 31.78% were from the Year-III, Year-IV, and Year-V respectively. The participants felt more confident in 'Making an accurate diagnosis of infection/ sepsis.' Conclusion: Our study population found to be suffering from a lack of confidence partially due to a gap in their knowledge about the proper selection of antimicrobials.
Universal Journal of Pharmaceutical Research
Aim and objective: The study attempts to investigate the knowledge and actual condition of antibiotic uses among university students to get rid from different infectious diseases. Methods: The study was conducted in a residential dormitory of a public university of Bangladesh. About 145 (n=145) students took part in the study which was conducted in January, 2020. Data were collected on the basis of a questionnaire made of basic questions about antibiotics and its resistance. Results: Among 145 students, 94.5% previously known about antibiotic which is impressive but a vast majority (46.4%) had no idea about antibiotic resistance and 51% did not know anything what will happen if bacteria become resistant to antibiotics which is alarming. It was found that the most used antibiotic was Azithromycin (46.4%), whereas amoxicillin (40%) was second highest. Those antibiotics were used to treat mostly fever (63.4%), various infections (31%), cold cough(25.4%),diarrhea(15.5%) irritable bowel ...
Journal of Chitwan Medical College, 2020
Background:Antibiotic resistance is a global crisis posing a considerable threat, especially, to developing countries and can cause 10 million deaths by 2050. Medical students as future doctors play an essential role in promoting the rational use of antibiotics. The objectives of this study were to evaluate the respondents’ knowledge, attitude and practice (KAP) regarding antibiotic use, antibiotic self-medication, and antibiotic resistance and compare the KAP among different subgroups of respondents at KIST Medical College, Lalitpur, Nepal. Methods: A cross-sectional study was done among final year medical students and interns from September to October 2019. A structured questionnaire with 22 statements for assessing knowledge, 13 statements for attitude and 12 statements for practice was used as a data collection tool. Differences in the KAP scores among different subgroups were studied using appropriate statistical tests. Results: A total of 131 respondents participated, and ...
Background: Antibiotic is a wonder drug used in the treatment and control of microbial infections and resistance to such drug is a major global health issue because of its extensive and improper use. Health professional students being easy to mould should be made aware to focus on the social aspects of antibiotic management especially the knowledge, attitudes, and practices so that they can aware and help the general population regarding the judicious use of antibiotics in future.
International Journal of Environmental Research and Public Health, 2019
The purpose of this study was to conduct a preliminary study to assess knowledge, attitude, and practice (KAP) associated with antibiotic use among medical students (MS) and non-medical students (NMS) at Kathmandu University, Nepal. A self-administered questionnaire was distributed to 1223 students for a cross-sectional study. In total, 1222 questionnaires collected from 609 MS and 613 NMS were regarded as effective. A t-test and Chi-square test were applied to analyze the data. A total of 25 out of 39 questions in the KAP survey were found to have statistical significance. The MS showed higher levels of knowledge/attitude/practice associated with antibiotic use than the NMS. Significant gaps were found in and between the MS and NMS in the first and final years of study. Interventions, such as lectures, courses, workshops, and seminars on antibiotic use, along with internet and media campaigns, etc., are needed to improve the awareness and change the behavior of both the MS and the ...
Journal of Drug Delivery and Therapeutics, 2017
Antibiotic resistance is a worldwide public health concern now and only proper knowledge and practices can solve the problem. This study was aimed to evaluate the knowledge, attitudes, and practices regarding antibiotic use among the University students who study Microbiology. In January-February 2017, a cross-sectional study was conducted amongst 266 students of the Microbiology department at the Noakhali Science and Technology University in Bangladesh. Students of all the academic years (first year to masters) took part in this study. A self-administered questionnaire was provided during regular lectures. The questionnaire included demographic characteristics of participants and 25 questions about their knowledge, attitudes and actual practices about antibiotic use. Collected data was analyzed using Microsoft Excel and Statistical package for social sciences (SPSS). In a case of knowledge, 23.7% of the respondents stated that antibiotics are appropriate for viral infections, 48.9% think that antibiotics can speed up the recovery of cold and cough and 45.9% provided a positive response regarding the better efficacy of newer and costly antibiotics. Overall attitude towards antibiotic resistance is good among total students (87.6%-100%). Student's practices regarding proper antibiotic use (63.5%-84.6%) is poor than their knowledge and attitudes. About half (52.26%) of the students took antibiotic last year and of them, 75.5% took those antibiotics through the professional doctor's prescription. A high proportion of the study participants (36.5%) mentioned that they usually take antibiotic for fever and 31.6% said they started an antibiotic therapy after a simple doctor call or without a proper medical examination. Students of the Microbiology department in Noakhali Science and Technology University have a fair knowledge and attitude about antibiotic usage but their practices of antibiotic usage need to be improved. As these Students are the future contributor of the health sector in Bangladesh, their proper knowledge and practices are highly expected.
International Journal of Pharmacy and Pharmaceutical Sciences, 2024
Objective: To study the knowledge, attitude and practice of antibiotic usage and resistance among undergraduate medical students at Gauhati Medical College and Hospital. Methods: It was a questionnaire-based, cross-sectional and observational study. A structured validated questionnaire was used as a study tool consisting of 22 questions. A Google form was then developed and circulated. 3rd Professional Part-I and Part-II MBBS students were included in the study. Results: A total of 268 students participated in the study. Data were analysed using a Microsoft Excel Sheet and Student's t-test. The majority gave correct responses regarding the meaning of antibiotic resistance and agreed that improper use of antibiotics leads to the development of antibiotic resistance. The majority (86.57%) feel that a combination of factors gives rise to antibiotic resistance. Overall, 259 (96.64%) of students think all healthcare providers should have a good knowledge of the rational use of antibiotics and that the use of antibiotics should be guided by culture and sensitivity reports. However, it was seen that only about 33% of students in both groups had attended an educational programme or training on the topic. Conclusion: Most students in both groups have good knowledge and attitudes regarding antibiotic usage and resistance. However, they must attend more educational programs and training to improve practice.
Journal of Chitwan Medical College, 2020
Background:Antibiotic resistance is a global crisis posing a considerable threat, especially, to developing countries and can cause 10 million deaths by 2050. Medical students as future doctors play an essential role in promoting the rational use of antibiotics. The objectives of this study were to evaluate the respondents' knowledge, attitude and practice (KAP) regarding antibiotic use, antibiotic self-medication, and antibiotic resistance and compare the KAP among different subgroups of respondents at KIST Medical College, Lalitpur, Nepal. Methods: A cross-sectional study was done among final year medical students and interns from September to October 2019. A structured questionnaire with 22 statements for assessing knowledge, 13 statements for attitude and 12 statements for practice was used as a data collection tool. Differences in the KAP scores among different subgroups were studied using appropriate statistical tests. Results: A total of 131 respondents participated, and 76(58%) were female. Most were from the Brahmin ethnic group 54(41.2%) while 82(62.6%) had relatives in the medical field. Ninety-three (71%) were final year medical students and 38(29%) were medical interns. The knowledge scores were high (76) among most subgroups of respondents. The attitude score was 58 out of 65 and practice score was 6 out of 12. Knowledge scores were higher among female respondents, and practice scores were higher among interns (p=0.002). Conclusions: The study showed good knowledge and attitude regarding antibiotics among the final year medical students and the interns. Interns were found to have a better practice than the final year students for using antibiotics rationally.
Journal of Drug Delivery and Therapeutics
Background: Assessment of knowledge, attitudes and practices (KAP) of antibiotic prescription among doctors may help in developing guidelines to improve antibiotics use and decrease resistance. Aims and objectives: Our aim was to evaluate KAP regarding antibiotic use and its resistance among doctors. Materials and Methods: A cross sectional, questionnaire based study was conducted among the doctors of B.P. Koirala Institute of Health Sciences, Dharan, Nepal between January-March 2016 and their KAP regarding antibiotic use and resistance was assessed by using a five point Likert scale. The data were analyzed by calculating percentage and frequency. Results: Almost half of the doctors (50.2%) used to prescribe antibiotics more than once daily. Nearly two thirds of the doctors (65.3%) received antibiotic education at a formal lecture on ward rounds. Most of the doctors (87.4%) agreed that antimicrobials are overused. One hundred thirty four doctors (42.3%) agreed that patients' demands for antibiotics contribute to its overuse. Nearly two third doctors (70.7%) believed that locally developed antimicrobial guidelines would be more useful. Most of the respondents (89.9%) wanted more ongoing education on antibiotic use and its resistance. Conclusions: Our study reveals that antibiotics are overused and patients' demand contributes to this. Locally developed antimicrobial guidelines would be more useful. More CME on antibiotic use and its resistance should be conducted to enhance the awareness among doctors.
Background To reduce the magnitude of antimicrobial resistance, there is a need to change the knowledge and behavior of future prescribers regarding use and prescription of antibiotics. This can be ensured through the appropriate training of next generation doctors and medical students. But, before planning or strengthening any teaching or training program for any group, it is required to have a conclusive evidence about knowledge, attitude and practices of that group. With this background this study was conducted to assess the knowledge, attitudes and the practices of medical students in India with respect to antibiotic resistance and usage Methods It was a cross-sectional study which was done online through google forms. A semi-structured questionnaire containing a five point Likert scale was used for the data collection. The questionnaire was sent to medical students across India by sharing link through contacts of Medical Students Association of India. Respondent-driven sampling...
International Journal of Basic & Clinical Pharmacology, 2018
Background: Antimicrobials are agents used to kill or inhibit growth of microorganisms. Now they are most commonly used as well as misused medicine too. Misuse of these agents lead to development of resistance which is now a global concern. Public awareness about antimicrobial resistance is a key factor in combating the situation which includes educating doctors and health care professionals. So the current study is undertaken to assess the knowledge, attitude and practices (KAP) related to antibiotic resistance and usage and among the MBBS students and doctors. Methods: A pre-formed duly validated questionnaire was distributed among the study group and their KAP regarding antimicrobial usage and resistance was assessed by Likert scale whose responses ranges from strongly agree to strongly disagree and always to never. Some questions were of true/false type. One question was choosing the correct answer. In this study, questionnaires were distributed among 270 participants out of which 188 were MBBS students and 82 were doctors. After collection, data were entered in Microsoft excel and simple descriptive statistics were used to generate frequencies, percentage and proportions. Wherever possible the chi-square test or fisher exact test was done to find out any association. * p<0.05 was taken as significant. Results: Response rate was 100% among the study populations. Out of 270 study population, 91% (245) had the knowledge that indiscriminate use of antibiotics cause ineffective treatment with a considerable difference in knowledge between undergraduates and doctors (p<0.05). Also it causes bacterial resistance (96.3%). Around 89% of the total participants agreed that bacteria do not cause common cold and influenza. Conclusions: This study revealed that most of the study population, both undergraduates and doctors were well aware about the emerging problem of antimicrobial resistance. However, responses related to their practices were quite varied. Hence, further educational interventions are needed to improve their practices towards antibiotics use in both the study groups.
Journal of Advances in Medical and Pharmaceutical Sciences, 2020
Background and Objectives: Antibiotic resistance has become a global encumbrance in the field of medicine. Various factors like antibiotic abuse, overuse or irrational usage of antibiotics, over the counter availability of antibiotics etc., have been put forth as accused leading to antibiotic resistance. The present study aims at evaluating the knowledge, attitude and practice of antibiotic usage and antibiotic resistance among undergraduate students in private universities in Dhaka, Bangladesh. Original Research Article Chowdhury et al.; JAMPS, 22(8): 6-18, 2020; Article no.JAMPS.61731 7 Methodology: A cross-sectional, questionnaire-based quantitative survey conducted among undergraduate students in private universities in Dhaka, Bangladesh including 1 st year to 4 th year from different academic background. The questionnaire comprised of: Demographic data; Knowledge including 17 questions; Attitudes including 16 questions and practices consisting of 8 questions. Majority of the qu...
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