an interventional study on the knowledge, attitude and practice on ...

AN INTERVENTIONAL STUDY ON THE KNOWLEDGE ATTITUDE AND PRACTICE ON HAND FOOT AND MOUTH DISEASE AMONG THE

PARENTS OR CAREGIVERS OF CHILDREN AGED 10 AND BELOW AT NANGA SEKUAU RESETTLEMENT SCHEME

FROM 26TH MARCH TO 10TH JUNE 2012

4th Year Medical Students Community Medicine and Public Health Posting MDP40210

Group 1 (Rotation 1)

Posting Coordinators

Prof Dr Mohd Raili Suhaili Dr Cliffton Akoi

Group Members

Abu Zarin bin Zahari Kiu Kuong Lung Nurul Shahirah binti Abdul Shukor Adrian Loo Wei Nam Ling Kho Lee Rachel Kamea Aqilah binti Zaidan Ling Kok Yung Rebecca anak Tuloi Bong Pao Yub Muhammad Rifai bin Ishak Sim Joo Ching (hIm Hock Peng Muna Fahima binti Zainuddin Sumayyah binti Hashim

ihing Nor Izziatie Eliany binti Alias Tee Jie Xi QR )evi alp R Sivarajah Nur Inani binti Ahmad Tarmizi Teh Thian Ping

46 zhar bin Kiprawi Nuraishah binti Md Nor Yoganantham all Kodiesarn 161 Theng Nurul Fadlin binti Rosli 2012

d

FACULTY OF MEDICINE AND HEALTH SCIENCES

An Interventional Study on the Knowledge Attitude and Practice on Hand Foot and

Mouth Disease among the Parents or Caregivers of Children Aged 10 and Below at Nanga

Sekuau Resettlement Scheme from 26th of March to 10th June 2012

4th Year Medical Students

Community Medicine and Public Health Posting MDP 40210



Prof Dr Mohd Raili Suhaili

Dr Cliffton Akoi

Abu Zarin bin Zahari Kiu Kuong Lung Nurul Shahirah binti Abdul Shukor

Adrian Loo Wei Nam Ling Kho Lee Rachel Kamea

Aqilah binti Zaidan Ling Kok Yung Rebecca anak Tuloi

Bong Pao Yub Muhammad Rifai bin Ishak Sim Joo Ching

Chan Hock Peng Muna Fahima binti Zainuddin Sumayyah binti Hashim

HoWei Shing Nor lzziatie Eliany binti Alias Tee Jie Xi

Kamini Devi alp RSi varajah Nur lnani binti Ahmad Tarmizi Teh Thian Ping

Khairul Azhar bin Kiprawi Nuraishah binti Md Nor Yoganantham all Kodiesarn

Khoo Ee Theng Nurul Fadlin binti Rosli

DECLARATION

We declare that this research originates from our own effort except for certain facts and citations

with which the sources have been clearly listed in the bibliography

Abu Zarin Bin Zahari 23028

Adrian Loo Wei N am 23040

Aqilah Binti Zaidan 23155

BongPaoYub 20726

Chan Hock Peng 23259

Ho Wei Shing 23607

Kamini Devi NP RSivarajah 23714

Khairul Azhar Bin Kiprawi 21206

Khoo Ee Theng 23757

Kiu Kuong Lung 18723

Ling Kho Lee 23882

Ling Kok Yung 23883

Muhammad Rifai Bin Ishak 24223

Muna Fahima Binti Zainuddin 24241

Nor Izziatie Eliany Binti Alias 21789

Nur Inani Binti Ahmad Tarmizi 24596

Nuraishah Binti Md Nor 24654

Nurul Fadlin Binti Rosli 19611

Nurul Shahirah Binti Abdul Shukor 24767

Rachel Kamea 24855

Rebecca Anak Tuloi 22164

Sim Joo Ching 25024

Sumayyah Binti Hashim 25182

Tee Jie Xi 20116

Teh Thian Ping 25269

Yoganantham AIL Kodiesaren 25426

ii

ACKNOWLEDGEMENT

First and foremost we are deeply indebted to our posting coordinator Dr CJiffton Akoi

and aU the lecturers of the Department of Community Medicine and Public Health for their

professional supervision and guidance throughout this posting We would also like to extend our

gratitude to our supervisors Prof Dr Mohd Raili Suhaili Dr Cliffton Akoi Dr Mohd Mizanur

Rahman and Dr Helmy Hazrni for their assistance and support in this study In addition much

appreciation goes to the Faculty of Medicine and Health Sciences University Malaysia Sarawak

(UNIMAS) for providing us a chance to do this study and to interact with the local long house

community During this study we have learned to appreciate this new culture and realized the

value of working together as a team We would also like to extend our deepest appreciation to

Mr Sukran Kana Community Development Officer and a special thank you to the Tuai-tuai

Rumah and Sekuau Community for their endless cooperation Last but not least we would also

like to thank the medical team from Lanang and Oya Clinic as well as the UNIMAS drivers

They have worked hard and provided a huge contribution to making this study a success

111

1

ABSTRACT

Hand Foot and Mouth Disease (HFMD) is now considered an emerging infectious disease that

affects the population worldwide In order to cope with the high prevalence of HFMD in

Malaysia level of knowledge and awareness among the population should be assessed so that

appropriate interventions can be carried out The objective of this study was to study the

knowledge attitude and practice on HFMD among the parents or caregivers of children aged 10

years and below at Nanga Sekuau Resettlement Scheme from 26th of March to 10th of June 2012

The results obtained were then using as the baseline data to conduct an intervention beneficial to

the community to enhance their level of knowledge attitude and practice towards HFMD Data

collection was done by face to face interview using interview-based questionnaire Data analysis

was done using SPSS software version 200 Results showed that 611 of the respondents had

good knowledge 522 had good attitude while 558 had good preventive practice towards

HFMD Analysis found a significant association between total knowledge score and the level of

education (plt005) Similar significant association was found between total attitude score and

leveJ of education (plt005) and marital status (plt005) However no significant association was

found between total practice score and socio-demographic characteristics A positive correlation

was found between the knowledge and attitude (pltOOI) as well as attitude and practice

(pltOOOl) Post-intervention study showed significant improvement in the knowledge on mode

of spread of HFMD (plt005) but no significant increase in the t~tal level of knowledge attitude

and practice (pgt005) In conclusion there is a great need for intensive intervention in order to

enhance their awareness on HFMD among the respondents

iv

ABSTRAK

Penyakit Tangan Kaki dan Mulut (HFMD) kini dianggap penyakit berjangkit yang baru muncul

yang memberi kesan terhadap penduduk di seluruh dunia Bagi menghadapi HFMD ynag kerap

berlaku di Malaysia tahap pengetahuan dan kesedaran dalam kalangan penduduk perlu dinilai

supaya campur tangan yang sesuai boleh dijalankan Objektif kajian ini adalah untuk mengkaji

pengetahuan sikap dan amalan mengenai HFMD dalam kalangan ibu bapa atau penjaga

kanak-kanak berusia 10 tahun dan ke bawah di Skim Penempatan Semula Nanga Sekuau dari 26

Mac hingga 10 Jun 2012 Keputusan yang diperoleh digunakan sebagai data asas untuk

menjalankan campur tang an yang dapat memberi manfaat kepada masyarakat bagi

meningkatkan tahap pengetahuan sikap dan amalan ke arah HFMD Pengumpulan data telah

dilakukan melalui temuduga secara bersemuka dengan menggunakan soal selidik berasaskan

temubual Analisis data dilakukan dengan menggunakan perisian SPSS versi 200 Hasil kajian

menunjukkan bahawa 611 responden mempunyai pengetahuan yang baik 522 mempunyai

sikap yang baik manakala 558 mempunyai amalan pencegahan yang baik ke arah HFMD

Analisis mendapati terdapat hubungan yang signifikan antara skor pengetahuan jumlah dan

tahap pendidikan (p lt005) dan antara jumlah skor sikap dan tahap pendidikan (p lt005) dan

status perkahwinan (p lt005) Walau bagaimanapun tiada hubungan yang signifikan antara

jumlah skor amalan dan ciri-ciri sosio-demografi Terdapat hubungan positif yang ditemui

antara pengetahuan dan sikap (p lt001) serta sikap dan amalan (p lt0001) Kajian pascashy

campur tangan menunjukkan peningkatan yang ketara dalam pengetahuan tentang cara

penularan HFMD (p lt005) tetapi tidak ada peningkatan yang ketara dalam jumlah tahap

pengetahuan skap dan amalan (pgt 005) Kesimpulannya campur tangan intensif amat

diperlukan untuk meningkatkan kesedaran terhadap HFMD dalam kalangan responden

v

1

ue t Khidmat ~u UUla

tT VERSm MALAYSIA

TABLE OF CONTENTS

PAGE

Declaration ii

Abstract lV

List of Abbreviations XVl

Acknowledgements iii

Abstrak v

Table of Contents vi

List of Appendices middot xi

List of Tables xii

List of Figures xiv

CHAPTER 1 INTRODUCTION AND LITERATURE REVIEW

11 Introduction

12 Background information 2

13 Statement of problem 3

14 Significance of the study 4

15 Literature review 5

151 Epidemiology 5

152 Risk factors 7

153 Symptoms and signs 8

154 Causative agent 11

155 Mode of spread 11

156 Complications 12

157 Diagnosis and investigations 13

158 M anagement 13

159 Preventive measures 14

1510 Knowledge attitude and practice 15

vi

16

1

I

Research objectives 17

161 General objective 17

162 Specific objectives 17

17 Hypotheses 18

18 Operational definition 19

19 Conceptual framework 21

CHAPTER 2 METHODOLOGY

21 Research design and setting 22

22 Population and sampling 22

221 Inclusion criteria 23

222 Exclusion criteria 23

23 Variable 23

24 Data collection 24

241 Study instruments 24

242 Procedures 24

243 Ethical issues 25

25 Data entry analysis and interpretation 26

26 Re earch timeline 27

CHAPTER 3 HEALTH INTERVENTION REPORT

31 Introduction 29

32 Objectives 29

33 Health intervention activities 29

331 A day with community ice breaking 30

332 Health intervention programme Prevent HFMD You Can Make A Change 31

333 Mini health intervention programme 38

34 Evaluation of intervention programme 39

35 Awareness of health intervention programme 39

36 Attendance of respondents 39

vii

I

Satisfactory rating of the programme 37

Benefit from the health intervention programme 38

CHAPTER 4 RESULTS

Introduction41

Socio-demographic characteristics 42

421 Age

422 Gender

423 Race

424 Marital status

425 Educational level

426 Employment status

427 Relationship with children

43 Knowledge on HFMD

431 Source of information on HFMD

432 Level of knowledge (Mode of spread)

433 Level of knowledge (Signs and symptoms)

434 Level of knowledge (Treatment)

435 Level of knowledge (Prevention)

436 Total score of knowledge

437 As ociation between level of knowledge and each socio-demographic

characteristic

44 Level of attitude

441 Total level of attitude

442 Association between level of attitude and eac~ socio-demographic

characteristic

viii

39

40

43

44

44

45

45

46

46

47

47

48

48

51

52

53

54

55

58

60

60

63

--1

45 Level of practice 65

451 Total score of practice 65

452 Association between level of practice and each socio-demographic 67

characteristic

453 Choice of seeking medical advice for treatment of HFMD symptoms 69

46 Relationship between level of knowledge level of attitude and level of 70

practice (KAP) concerning HFMD before intervention

461 Relationship between knowledge and attitude 70

462 Relationship between knowledge and practice 70

463 Relationship between attitude and practice 70

47 Post-intervention results 71

471 Introduction 71

472 Level of knowledge 71

4721 Level ofknowledge (Mode of spread) 72

4722 Level of knowledge (Signs and symptoms) 73

4723 Level of knowledge (Treatment) 74

4724 Level of knowledge (Prevention) 75

4725 Post intervention total level of knowledge 76

4726 Relationship between changes in knowledge on HFMD and socio- 79

demographic characteristics

4727 Comparing the means of knowledge score before and after intervention 81

473 Level of attitude 82

4731 Post intervention total level of attitude 82

4732 Relationship between changes in attitude on HFMD and socio-demographic 85

characteri tics

4733 Comparing the means of total attitude score Defore and after intervention 87


4741 Post intervention total level of practice 88

4742 Relationship between changes in practice on HFMD and socio-demographic 90

characteristics

4743 Comparing the means of total practice score before and after intervention 92

ix

J

CHAPTERS DISCUSSION

50 Introduction 93

51 Health intervention 93

511 Source of knowledge 93


513 Association between level of knowledge and socio-demographic factors 96


515 Association between level of attitude and socio-demographic factors 98


517 Association between level of practice and socio-demographic factors 101

518 Choice of place of treatment if the child shows signs and symptoms of HFMD 102



52 Po t-intervention discussion 104

521 Post intervention changes in knowledge on HFMD 104

522 Post intervention changes in attitude on HFMD 105

523 Post intervention changes in practice on HFMD 105

524 Relationship between the changes of knowledge attitude and practice on 106

HFMD and socio-demographic characteristics of respondents

525 Comparison between pre- and post-intervention knowledge attitude and 106

practice score

53 Limitation 107

x

CHAPTER 6 CONCLUSIONS AND RECOMMENDATIONS

10961 Conclusions

11062 Recommendations

111REFERENCES 118APPENDIX 1 124APPENDIX 2 130APPENDIX 3

xi

LIST OF TABLES

TABLE PAGE

21 Population and sampling of the respondents 22

22 Research timeline pre-intervention activities 27

23 Research timeline for post-intervention activities 28

31 Schedule of a day with community Ice breaking 31

32 Schedule of health intervention programme 35

41 Distribution of the respondents by age 44

42 Distribution of the respondents by race 45

43 Distribution of the respondents by marital status 46

44 Distribution of the respondents by educational level 46

45 Distribution of the respondents by employment status 47

46 Relationship of the respondents with the children 47

47 Source of knowledge on HFMD 49

48 Percentage distribution of the respondents by the level of knowledge on 50

HFMD

49 Total level of knowledge for each subsection 57

410 Percentage distribution of respondents by socio-demographic characteristics 58

and level of knowledge

411 Respondents attitude towards HFMD 60

412 Percentage di tribution of respondents by socio-demographic characteristics 63

and level of attitude

xii


and level of practice

414 Distribution of the choice of seeking medical advice for treatment of HFMD

symptoms among the respondents

69

415 Relationship between knowledge and attitude knowledge and practice

attitude and practice among the respondents

70


417 Relationship between changes in knowledge on HFMD and socioshy


79

418 Means of knowledge score before and after intervention 81

419 Respondents attitude towards HFMD (Post-intervention) 82

420 Relationship between changes in attitude on HFMD and socio-demographic

characteristics

85

421 Means of total attitude score before and after intervention 87

422 Relationship between changes in practice on HFMD and socio-demographic

characteristics

90

423 Means of total practice score before and after intervention 92

xiii

LIST OF FIGURES

PAGE

11 The algorithm of classification on severity of children with HFMD 10


31 Source about awareness of health intervention program 40


33 Rea ons for not coming to the health intervention program by the respondents 41

34 Program that benefits the respondents 42

35 Evaluation of activities done on health intervention program 42

41 Distribution of the respondents according to gender 45

42 Distribution of respondents who had heard of HFMD 48

43 The level of knowledge on mode of spread of HFMD among respondents 51

44 The level of respondents knowledge on signs and symptoms of HFMD 52

45 The level of respondents knowledge on treatment of HFMD 53

46 The level of respondents knowledge on prevention of HFMD 54

47 Histogram on the score of knowledge 55

Level of knowledge of the respondents 56

Level of knowledge of the respondents for each subsection 57

Histogram on the score on attitude 61

Level of attitude of the respondents 62

xiv

412 Histogram showing the score on practice 65

413 Level of practice of the respondents 66


(Post-intervention)

415 The level of respondents knowledge on signs and symptoms of HFMD (Postshy 73

intervention)

416 The level of respondents knowledge on treatment of HFMD (Postshy 74

intervention)

417 The level of respondents knowledge on prevention of HFMD (Postshy 75

intervention)

418 Level of knowledge of the respondents (Post-intervention) 76

419 Level of knowledge of the respondents for each subsection (Post-intervention) 77

420 Post-intervention changes in knowledge on HFMD 78

421 Level of attitude of the respondents (Post-intervention) 83

422 Post-intervention changes in attitude on HFMD 84

423 Level of practice of the respondents (Post-intervention) 88

424 Post-intervention changes in practice on HFMD 89

xv

LIST OF ABBREVIATIONS

eNS Central Nervous System

CSF Cerebrospinal Auid

CV-AI6 Coxsackievirus A 16

CVS Cardiovascular System

EV 71 Enterovirus 71

HFMD Hand Foot and Mouth Disease

KAP Knowledge Attitude and Practice

xvi

CHAPTER 1

INTRODUCTION

Introduction

Hand foot and mouth disease (HFMD) is an acute viral illness that affects children and

infants which may occur in cluster or outbreaks This disease occurs around the world but

particularly affect East and Southeast Asia the most This disease can lead to death if

mplications develop This viral illness is caused by the group of human enterovirus including

genus of family Picornaviridae Polioviruses Echoviruses Coxsackie virus groups A and B

and Bandenteroviruses 68-71 are the members of the enterovirus genus which harm human

(Zeichhardt amp Grunert 2004) The viruses mainly transmit through direct contact with discharge

infected person such as saliva blisters fluid or stool of the infected person A child with

-_LI usually presents with mild fever accompanied by headache sore throat and general

malaise Eventually the sign of blister-like sore develops on the hands feet and buttocks of the

child Most of the children with this disease also suffer from ulcers in the mouth throat and

_IDe leading to loss of appetite HFMD is closely related to poor hygiene and close contact

iofected persons This disease can be severe when it can cause neurological complications

buman being (Chang et a1 1999)

In the year 1998 the worlds largest outbreak of HFMD had occurred in Taiwan where

00000 cases were reported Out of these numbers 400 of the cases involved neurological

~ati4ons and 78 of them died (Ho et al 1999) In the following year HFMD caused

__liiea in Western Australia and Perth In the subsequent year outbreak of this disease had

reported in Korea Taiwan Singapore Japan and Peninsular Malaysia (Podin et aI 2006)

In Malaysia this contagious disease had become endemic causing outbreak and death

6 children (Ministry of Health of Malaysia 2010) About 2628 cases were reported in the

ear 1997 with 31 cases of death involving mostly children and infants In the year 2010 the

JlUI~1I of cases spiked up to 8769 cases but decreased in the subsequent year to 2919 cases

According to the Sarawak Health Department (2006) there was an increase in the

Dumber of cases in Sarawak from April to June 1997 There were 29 cases of death due to

RFMD involving children less than 6 years old due to progressive cardiorespiratory failure

About 100 of cases were characterized by presence of fever 66 had ora ulcer and 62 with

on their extremities Furthermore 24 children presented with cardiopulmonary symptoms

Therefore health promotion and education especially on hygiene should be conducted in

bull __sil This is very important in order to prevent the prevalence of HFMD not only in

IftDlaYBiia but also worldwide

Background information

enga Sekuau Resettlement Scheme is one of the four major Rajang Security Command

COM) areas in Sibu Division Sarawak This resettlement is located in Selangau District

is approximately 45 kiiometres from Sibu town Nanga Sekuau Resettlement Scheme was

to be set up in 1972 Currently it has a total of 2q relocated longhouses with a recorded

pqPJlllw(lln of 3677 in which 95 are Than while 5 is shared by other ethnics Clean water to

supplied by Public Works Department (PWD) while 24 hour electrical supply is

IiIIKnWlbe Sarawak Electrical Supply Company (SESCO) The rubbish collection is catered

Rural District Council There is also a Sekuau Health Clinic which provides health

2

I ces to the community including Rural Curative Service (RCS) Outpatient Department

(OPO) Maternal and Child Health Care (MCHC) Village Health Service (VHS) and School

Health Service (SHS) The clinic also has the expanded scope of services such as Special Needs

Ciildren Early Intervention Program and Program Warga Emas The area is accessible by road

also by river Majority of the residents are farmers and a minority are government servants

or working in private sectors

13 Statement of the problem

Due to human population growth all over the world frequent international traveling

crowded habitats urbanization and alteration of microbial properties outbreaks of certain

infectious diseases are frequently heard HFMD is also now considered an emerging infectious

disease that affects the population worldwide

Lou and Lin (2006) stated that the primary risk factor for the transmission of HFMD is

Ibrough household transmission Thus the more the children in a family the higher the risk of

household transmission Kampung Sekuau resettlement scheme is a village consisting of several

houses which can accommodate on average more than hundred residents per house Thus in

_i~(3IOW~tIed living environment the risk of the children getting HFMD is high If the parents or

iClilease the incidence in the village will be remarkably high Thus through this research we

like to identify the ocio-demographic characteristics and to study the knowledge attitude

10 years and

that we can assess the KAP status of the parents on the disease

3

The social impact of HFMD to the health care providers family members and chBdren

also of much concern in this research For the health care providers the social cost of HFMD

IS quite substantial Lou and Lin (2006) stated that the direct cost which includes hospitalization

Woratory tests diagnostic test on children infected with HFMD in United States is around $ 69 shy

111 while the indirect cost for a hired caretaker and patient worker consumed about $ 63 - 442

Furthermore a family with a child infected with HFMD will have a negative impact on their

daily livings and work The childs academic performance wil1 be affected as well Thus it is

important for us to conduct a study to assess the KAP on HFMD among the parents so that

intervention can be done to improve their KAP

Our target populations in this research are the parents or caregiver of any child aged 10

years and below This is because a study has proven that children aged 10 years and below are

_epable to HFMD (Nervi 2012)

Significance of the study

The findings made through this interventional study will be useful as a baseline data for

professionals and researchers who are interested in a similar study Besides it will give

_lIt information to parents or caregiver of the children concerning the necessary care and

liIrilV8IlIti(]in of the disease

4

luUI Khidmal Maklumllt AkadtbullbullHmiddot UNIVERSm l1ALA)SIA SARAWAJ(

Literature review

Epidemiology

The virus EV71 which causes HFMD was first discovered in 1969 when it was isolated

child with aseptic meningitis Since then the virus had spread to many parts of the world

HFMD due to EV71 infection involved two patterns of outbreak The first pattern was sporadic

or small outbreak which has occurred in the United States Sweden Japan and Australia The

__ pattern was an epidemic outbreak which involved high mortality and had occurred in

countries such as Bulgaria in 1975 (44 deaths) Hungary in 1978 (47 deaths) Malaysia in

1J7 (at least 31 deaths) and Taiwan in 1998 involving 78 deaths (Chan et aI 2011) Their

deges showed that the outbreaks in Vietnam Malaysia Taiwan and China had claimed more

large outbreak of HFMD due to the neurovirulent strain of EV71 emerged in Malaysia

997 and caused a high mortality of at least thirty-one cases of death among young children

IDIjority of deaths were from Sibu with eleven reported cases while Sarikei had seven death

years later in 2000 there was another recurrent outbreak of the disease in Malaysia

deggilt cases of death in Peninsular Malaysia There was another outbreak in the year

Malaysia but the cases and mortality rate were not recorded well Then there was

two recorded cases of death in Peninsular Malaysia during late 2005 followed by a larger

in Sarawak with six deaths Nevertheless the ongoing outbreak continued in year 2010

Malaysia (Chua amp Abdul 2011) Their studies showed that recurrence of HFMD

m~_curred every 24 years

5

On the 23rd February 2006 there were 923 reported HFMD cases in Sarawak as

-1P1IecI to 73 cases in 2005 Sibu division 436 cases were reported from 1 st January 2006 to

February 2006 However there were only 80 reported cases over the previous years There

41 registered cases reported in Kuching in 2005 followed by 118 cases the following year

Bintulu the number of cases reported were 13 in 2005 and increased to 211 cases in 2006

(Sarawak Health Department 2006)

In the year 2007 the number of HFMD cases in Sarawak was 6571 In the year 2008

INlftP1IIfIII1P a high number of HFMD cases in Sarawak which recorded 10505 cases which is a

iDcrease from the previous year (The Star Online 2009) In the year 2009 HFMD records

~Idll~ the epidemic level in Sarawak with a total number of 9655 cases reported (The Star

~~_ 2012) In the year 2010 there were 8769 cases of HFMD in Malaysia (Bernamacom

In 2011 HFMD in Malaysia recorded a total number of 2919 cases Sarawak recorded

_~IU_ number of HFMD in the country which is 914 cases followed by Selangor which had

~ - The other reported cases were Johor and Perlis with identical 300 cases and Penang

RII)IJUIIIIC There was no reported death case in year 2011 (Bernamacom 2011)

Since the HFMD outbreak in Malaysia in 1997 was found to be due to human enterovirus

I) a surveillance programme was set up in March 1998 to study the patterns and

Iiiisti~cs of the disease in Sarawak as well as to understand the dynamics of EV71

IIpln as a measure to provide early warning of impending outbreaks Based on their

et aI 2006) they showed that EV71 outbreaks have occurred every three years in

as the outbreak in year 1997 2000 2003 and 2006 Besides it was shown that the

6

epidemiological curves were influenced by social factors such as the media influence or

movements during big public holidays especially during Hari Gawai which is a local

unique to people in Sarawak In these studies EY71 was proven as not the only virus

_lied with HFMD as other subgenus or serotype of enterovirus such as Coxsackievlirus A 16

AIO can cause the disease as well However it is known that EY71 is the

virus that causes very large outbreaks The transmission of virus can be rapid as many

-PICstart travelling or moving about the state especially during festive season such as Hari

ben the outbreaks has not reached baseline

According to the Sarawak Health Department (2006) children below 10 years old are

w lnerable to get this disease However the disease is more severe with higher number of

aJiPli(atilons in children under 5 years old There is no difference in number between males and

There are several areas in Sarawak which have been identified as hotspots of HFMD

IIklilldllldes Sibu Miri Kuching and Bintulu (Sarawak Health Department 2006)

~tIimiddotng to Chang et al (2002) the risk factors of HFMD are children previous contact

disease or herpangina cases attendance at kindergarten or child care centers large

of children in a family and residence in a rural area Poor hygienic and sanitary

rIIr also found to be one of the risk factors for HFMD (Chinese CDC 2008)

_lren less than J0 years of age are the group that is susceptible to HFMD (Nervi

outEll there is still lack of evidence to support this the relative immaturity of the

7

FACULTY OF MEDICINE AND HEALTH SCIENCES

An Interventional Study on the Knowledge Attitude and Practice on Hand Foot and

Mouth Disease among the Parents or Caregivers of Children Aged 10 and Below at Nanga

Sekuau Resettlement Scheme from 26th of March to 10th June 2012

4th Year Medical Students

Community Medicine and Public Health Posting MDP 40210



Prof Dr Mohd Raili Suhaili

Dr Cliffton Akoi

Abu Zarin bin Zahari Kiu Kuong Lung Nurul Shahirah binti Abdul Shukor

Adrian Loo Wei Nam Ling Kho Lee Rachel Kamea

Aqilah binti Zaidan Ling Kok Yung Rebecca anak Tuloi

Bong Pao Yub Muhammad Rifai bin Ishak Sim Joo Ching

Chan Hock Peng Muna Fahima binti Zainuddin Sumayyah binti Hashim

HoWei Shing Nor lzziatie Eliany binti Alias Tee Jie Xi

Kamini Devi alp RSi varajah Nur lnani binti Ahmad Tarmizi Teh Thian Ping

Khairul Azhar bin Kiprawi Nuraishah binti Md Nor Yoganantham all Kodiesarn

Khoo Ee Theng Nurul Fadlin binti Rosli

DECLARATION






BongPaoYub 20726


Ho Wei Shing 23607



Khoo Ee Theng 23757


Ling Kho Lee 23882

Ling Kok Yung 23883








Rachel Kamea 24855


Sim Joo Ching 25024


Tee Jie Xi 20116



ii

ACKNOWLEDGEMENT














111

1

ABSTRACT





















iv

ABSTRAK























v

1


tT VERSm MALAYSIA

TABLE OF CONTENTS

PAGE

Declaration ii

Abstract lV



Abstrak v



List of Tables xii

List of Figures xiv


11 Introduction





151 Epidemiology 5

152 Risk factors 7






158 M anagement 13



vi

16

1

I




17 Hypotheses 18








23 Variable 23



242 Procedures 24





31 Introduction 29

32 Objectives 29








vii

I



CHAPTER 4 RESULTS

Introduction41


421 Age

422 Gender

423 Race

424 Marital status












characteristic




characteristic

viii

39

40

43

44

44

45

45

46

46

47

47

48

48

51

52

53

54

55

58

60

60

63

--1




characteristic








471 Introduction 71













characteri tics





characteristics


ix

J

CHAPTERS DISCUSSION

50 Introduction 93



















practice score

53 Limitation 107

x


10961 Conclusions



xi

LIST OF TABLES

TABLE PAGE














HFMD







xii





69



70




79




characteristics

85



characteristics

90


xiii

LIST OF FIGURES

PAGE



















xiv




(Post-intervention)


intervention)


intervention)


intervention)








xv









xvi

CHAPTER 1

INTRODUCTION

Introduction









































2



















10 years and


3


















4


Literature review

Epidemiology



















5






















6




















7

DECLARATION






BongPaoYub 20726


Ho Wei Shing 23607



Khoo Ee Theng 23757


Ling Kho Lee 23882

Ling Kok Yung 23883








Rachel Kamea 24855


Sim Joo Ching 25024


Tee Jie Xi 20116



ii

ACKNOWLEDGEMENT














111

1

ABSTRACT





















iv

ABSTRAK























v

1


tT VERSm MALAYSIA

TABLE OF CONTENTS

PAGE

Declaration ii

Abstract lV



Abstrak v



List of Tables xii

List of Figures xiv


11 Introduction





151 Epidemiology 5

152 Risk factors 7






158 M anagement 13



vi

16

1

I




17 Hypotheses 18








23 Variable 23



242 Procedures 24





31 Introduction 29

32 Objectives 29








vii

I



CHAPTER 4 RESULTS

Introduction41


421 Age

422 Gender

423 Race

424 Marital status












characteristic




characteristic

viii

39

40

43

44

44

45

45

46

46

47

47

48

48

51

52

53

54

55

58

60

60

63

--1




characteristic








471 Introduction 71













characteri tics





characteristics


ix

J

CHAPTERS DISCUSSION

50 Introduction 93



















practice score

53 Limitation 107

x


10961 Conclusions



xi

LIST OF TABLES

TABLE PAGE














HFMD







xii





69



70




79




characteristics

85



characteristics

90


xiii

LIST OF FIGURES

PAGE



















xiv




(Post-intervention)


intervention)


intervention)


intervention)








xv









xvi

CHAPTER 1

INTRODUCTION

Introduction









































2



















10 years and


3


















4


Literature review

Epidemiology



















5






















6




















7

ACKNOWLEDGEMENT














111

1

ABSTRACT





















iv

ABSTRAK























v

1


tT VERSm MALAYSIA

TABLE OF CONTENTS

PAGE

Declaration ii

Abstract lV



Abstrak v



List of Tables xii

List of Figures xiv


11 Introduction





151 Epidemiology 5

152 Risk factors 7






158 M anagement 13



vi

16

1

I




17 Hypotheses 18








23 Variable 23



242 Procedures 24





31 Introduction 29

32 Objectives 29








vii

I



CHAPTER 4 RESULTS

Introduction41


421 Age

422 Gender

423 Race

424 Marital status












characteristic




characteristic

viii

39

40

43

44

44

45

45

46

46

47

47

48

48

51

52

53

54

55

58

60

60

63

--1




characteristic








471 Introduction 71













characteri tics





characteristics


ix

J

CHAPTERS DISCUSSION

50 Introduction 93



















practice score

53 Limitation 107

x


10961 Conclusions



xi

LIST OF TABLES

TABLE PAGE














HFMD







xii





69



70




79




characteristics

85



characteristics

90


xiii

LIST OF FIGURES

PAGE



















xiv




(Post-intervention)


intervention)


intervention)


intervention)








xv









xvi

CHAPTER 1

INTRODUCTION

Introduction









































2



















10 years and


3


















4


Literature review

Epidemiology



















5






















6




















7

ABSTRACT





















iv

ABSTRAK























v

1


tT VERSm MALAYSIA

TABLE OF CONTENTS

PAGE

Declaration ii

Abstract lV



Abstrak v



List of Tables xii

List of Figures xiv


11 Introduction





151 Epidemiology 5

152 Risk factors 7






158 M anagement 13



vi

16

1

I




17 Hypotheses 18








23 Variable 23



242 Procedures 24





31 Introduction 29

32 Objectives 29








vii

I



CHAPTER 4 RESULTS

Introduction41


421 Age

422 Gender

423 Race

424 Marital status












characteristic




characteristic

viii

39

40

43

44

44

45

45

46

46

47

47

48

48

51

52

53

54

55

58

60

60

63

--1




characteristic








471 Introduction 71













characteri tics





characteristics


ix

J

CHAPTERS DISCUSSION

50 Introduction 93



















practice score

53 Limitation 107

x


10961 Conclusions



xi

LIST OF TABLES

TABLE PAGE














HFMD







xii





69



70




79




characteristics

85



characteristics

90


xiii

LIST OF FIGURES

PAGE



















xiv




(Post-intervention)


intervention)


intervention)


intervention)








xv









xvi

CHAPTER 1

INTRODUCTION

Introduction









































2



















10 years and


3


















4


Literature review

Epidemiology



















5






















6




















7

ABSTRAK























v

1


tT VERSm MALAYSIA

TABLE OF CONTENTS

PAGE

Declaration ii

Abstract lV



Abstrak v



List of Tables xii

List of Figures xiv


11 Introduction





151 Epidemiology 5

152 Risk factors 7






158 M anagement 13



vi

16

1

I




17 Hypotheses 18








23 Variable 23



242 Procedures 24





31 Introduction 29

32 Objectives 29








vii

I



CHAPTER 4 RESULTS

Introduction41


421 Age

422 Gender

423 Race

424 Marital status












characteristic




characteristic

viii

39

40

43

44

44

45

45

46

46

47

47

48

48

51

52

53

54

55

58

60

60

63

--1




characteristic








471 Introduction 71













characteri tics





characteristics


ix

J

CHAPTERS DISCUSSION

50 Introduction 93



















practice score

53 Limitation 107

x


10961 Conclusions



xi

LIST OF TABLES

TABLE PAGE














HFMD







xii





69



70




79




characteristics

85



characteristics

90


xiii

LIST OF FIGURES

PAGE



















xiv




(Post-intervention)


intervention)


intervention)


intervention)








xv









xvi

CHAPTER 1

INTRODUCTION

Introduction









































2



















10 years and


3


















4


Literature review

Epidemiology



















5






















6




















7


tT VERSm MALAYSIA

TABLE OF CONTENTS

PAGE

Declaration ii

Abstract lV



Abstrak v



List of Tables xii

List of Figures xiv


11 Introduction





151 Epidemiology 5

152 Risk factors 7






158 M anagement 13



vi

16

1

I




17 Hypotheses 18








23 Variable 23



242 Procedures 24





31 Introduction 29

32 Objectives 29








vii

I



CHAPTER 4 RESULTS

Introduction41


421 Age

422 Gender

423 Race

424 Marital status












characteristic




characteristic

viii

39

40

43

44

44

45

45

46

46

47

47

48

48

51

52

53

54

55

58

60

60

63

--1




characteristic








471 Introduction 71













characteri tics





characteristics


ix

J

CHAPTERS DISCUSSION

50 Introduction 93



















practice score

53 Limitation 107

x


10961 Conclusions



xi

LIST OF TABLES

TABLE PAGE














HFMD







xii





69



70




79




characteristics

85



characteristics

90


xiii

LIST OF FIGURES

PAGE



















xiv




(Post-intervention)


intervention)


intervention)


intervention)








xv









xvi

CHAPTER 1

INTRODUCTION

Introduction









































2



















10 years and


3


















4


Literature review

Epidemiology



















5






















6




















7

16

1

I




17 Hypotheses 18








23 Variable 23



242 Procedures 24





31 Introduction 29

32 Objectives 29








vii

I



CHAPTER 4 RESULTS

Introduction41


421 Age

422 Gender

423 Race

424 Marital status












characteristic




characteristic

viii

39

40

43

44

44

45

45

46

46

47

47

48

48

51

52

53

54

55

58

60

60

63

--1




characteristic








471 Introduction 71













characteri tics





characteristics


ix

J

CHAPTERS DISCUSSION

50 Introduction 93



















practice score

53 Limitation 107

x


10961 Conclusions



xi

LIST OF TABLES

TABLE PAGE














HFMD







xii





69



70




79




characteristics

85



characteristics

90


xiii

LIST OF FIGURES

PAGE



















xiv




(Post-intervention)


intervention)


intervention)


intervention)








xv









xvi

CHAPTER 1

INTRODUCTION

Introduction









































2



















10 years and


3


















4


Literature review

Epidemiology



















5






















6




















7



CHAPTER 4 RESULTS

Introduction41


421 Age

422 Gender

423 Race

424 Marital status












characteristic




characteristic

viii

39

40

43

44

44

45

45

46

46

47

47

48

48

51

52

53

54

55

58

60

60

63

--1




characteristic








471 Introduction 71













characteri tics





characteristics


ix

J

CHAPTERS DISCUSSION

50 Introduction 93



















practice score

53 Limitation 107

x


10961 Conclusions



xi

LIST OF TABLES

TABLE PAGE














HFMD







xii





69



70




79




characteristics

85



characteristics

90


xiii

LIST OF FIGURES

PAGE



















xiv




(Post-intervention)


intervention)


intervention)


intervention)








xv









xvi

CHAPTER 1

INTRODUCTION

Introduction









































2



















10 years and


3


















4


Literature review

Epidemiology



















5






















6




















7




characteristic








471 Introduction 71













characteri tics





characteristics


ix

J

CHAPTERS DISCUSSION

50 Introduction 93



















practice score

53 Limitation 107

x


10961 Conclusions



xi

LIST OF TABLES

TABLE PAGE














HFMD







xii





69



70




79




characteristics

85



characteristics

90


xiii

LIST OF FIGURES

PAGE



















xiv




(Post-intervention)


intervention)


intervention)


intervention)








xv









xvi

CHAPTER 1

INTRODUCTION

Introduction









































2



















10 years and


3


















4


Literature review

Epidemiology



















5






















6




















7

CHAPTERS DISCUSSION

50 Introduction 93



















practice score

53 Limitation 107

x


10961 Conclusions



xi

LIST OF TABLES

TABLE PAGE














HFMD







xii





69



70




79




characteristics

85



characteristics

90


xiii

LIST OF FIGURES

PAGE



















xiv




(Post-intervention)


intervention)


intervention)


intervention)








xv









xvi

CHAPTER 1

INTRODUCTION

Introduction









































2



















10 years and


3


















4


Literature review

Epidemiology



















5






















6




















7


10961 Conclusions



xi

LIST OF TABLES

TABLE PAGE














HFMD







xii





69



70




79




characteristics

85



characteristics

90


xiii

LIST OF FIGURES

PAGE



















xiv




(Post-intervention)


intervention)


intervention)


intervention)








xv









xvi

CHAPTER 1

INTRODUCTION

Introduction









































2



















10 years and


3


















4


Literature review

Epidemiology



















5






















6




















7

LIST OF TABLES

TABLE PAGE














HFMD







xii





69



70




79




characteristics

85



characteristics

90


xiii

LIST OF FIGURES

PAGE



















xiv




(Post-intervention)


intervention)


intervention)


intervention)








xv









xvi

CHAPTER 1

INTRODUCTION

Introduction









































2



















10 years and


3


















4


Literature review

Epidemiology



















5






















6




















7





69



70




79




characteristics

85



characteristics

90


xiii

LIST OF FIGURES

PAGE



















xiv




(Post-intervention)


intervention)


intervention)


intervention)








xv









xvi

CHAPTER 1

INTRODUCTION

Introduction









































2



















10 years and


3


















4


Literature review

Epidemiology



















5






















6




















7

LIST OF FIGURES

PAGE



















xiv




(Post-intervention)


intervention)


intervention)


intervention)








xv









xvi

CHAPTER 1

INTRODUCTION

Introduction









































2



















10 years and


3


















4


Literature review

Epidemiology



















5






















6




















7




(Post-intervention)


intervention)


intervention)


intervention)








xv









xvi

CHAPTER 1

INTRODUCTION

Introduction









































2



















10 years and


3


















4


Literature review

Epidemiology



















5






















6




















7









xvi

CHAPTER 1

INTRODUCTION

Introduction









































2



















10 years and


3


















4


Literature review

Epidemiology



















5






















6




















7

CHAPTER 1

INTRODUCTION

Introduction









































2



















10 years and


3


















4


Literature review

Epidemiology



















5






















6




















7






















2



















10 years and


3


















4


Literature review

Epidemiology



















5






















6




















7



















10 years and


3


















4


Literature review

Epidemiology



















5






















6




















7


















4


Literature review

Epidemiology



















5






















6




















7


Literature review

Epidemiology



















5






















6




















7






















6




















7




















7

an interventional study on the knowledge, attitude and practice on ...

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