YoungScien+stsAwards2016

Assessmentofzoono+cdiseaseawarenessamongprimaryandsecondaryschools

studentsinMalaysia

MokrishAjat

FacultyofVeterinaryMedicineUniversi+PutraMalaysia

FinalReport

ThisreportwassubmiHedtoMABUNESCOYoungScien+stsAwardscommiHee.TheauthorwouldliketoacknowledgethecommiHeeforselec+nghimasoneoftherecipientforthe2016award.

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Contents1 Summary 42 Introduction 53 Methodology 6 3.1 Questionnaires 6 3.2 Schoolzoonoticdiseasesawarenessprogram 6 3.2.1 Module1 7 3.2.2 Module2 7 3.2.3 Module3 7 3.2.4 Module4 9 3.2.5 Module5 10 3.2.6 Module6 10 3.2.7 Module7 10 3.2.8 Module8 10 3.3 Samplinganddatacollection 10 3.4 DataAnalysis 114 Resultsanddiscussion 115 Conclusion 136 Futureplans 137 References 138 Appendix 15

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1 SummaryMalaysiaislocatedinSouthEastAsia,demographicallydividedintoPeninsularMalaysiaand the island of Borneo. There are two biosphere reserves under UNESCO at themoment, which is Tasik Chini and Crocker Range.Malaysia is rich in biodiversity andmajority of the population are constantly in close contact with animals. Humans arepronetobe infectedwithzoonoticdiseasesfromwildlifeordomesticanimalsandtheenvironment. Progressive economy, rapid urbanization and the flourishing of eco-tourismindustryareoneofthefewkeyfactorsthatincreasethepossibilitiesofhumansinteractingmorewiththeecosysytem.Thisstudywasconductedtodesignanddevelopan awareness program among school students inMalaysia on zoonotic diseases. It isimportantforpublicespeciallyschoolstudentstobeawareofzoonoticdiseasesinorderto prevent zoonotic disease transmissionwhen handling animals for example pets. ApilotstudywasconductedusingthemodulesdevelopedtodeterminetheawarenessonzoonoticdiseasesamongprimaryschoolstudentsofSekolahKebangsaanSeriSelangorUSJ4, Subang Jaya, Selangor before and after the school zoonotic diseases awarenessprogramandaswellastoassesstheeffectivenessoftheprogramineducatingstudentsonzoonoticdiseases.Theawarenessprogramconductedconsistsofeightmodulesandeachmodule comprises of a few activities related to zoonotic diseases education forschoolstudents.Theprogramwasdivided intotwophases, firstphasewasconductedon the 5th October 2016 at the school followed by the second phase on the 10thOctober 2016 in UPM. A set of questionnaires on zoonotic diseaseswas designed toassess the awareness and knowledge of students on zoonotic diseases. Thequestionnaires(pre-surveyforms)weredistributedamongthestudentstobeansweredbeforethestudentswere introducedto thezoonoticdiseases topics in theawarenessprogram and the questionnaires (post-survey forms) which consist of the samequestions as inpre-survey formsweredistributedagain after the the school zoonoticdiseases awareness program and activities finished. A total of 40 respondents wereobtained. Mann Whitney U-Test was used to analyze the data by each question.Significantdifference(P<0.05)inawarenessonzoonoticdiseasesbyeachquestionwasobserved among primary school students of Sekolah Kebangsaan Seri Selangor, USJ4betweenbeforeandafter theawarenessprogram. (89.1%) from35 totalofquestionshad significantdifference (P<0.05) in awarenesson zoonoticdiseasesbetweenbeforeand after the programwas conducted. Thus, we can conclude that the programwaseffectiveandthestudentsacquiredbasicknowledgeonzoonosesandwaystopreventtransmission after participating in the school zoonotic diseases awareness program.Modules developed under this project will be used for future zoonotic diseasesawareness program in more schools in the near future, hopefully with collaborationwithrespectiveministriesornon-governmentalagencies.

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2 IntroductionZoonosesarediseasesthatarenaturallytransmittedbetweenanimalsandhumans. InTanzania,researchhasshownthatseveralzoonoses,includingbrucellosis,leptospirosis,andQfever,arecommon,butunder-diagnosed,causesofhumanillness(Zhangetal.,2016). Zoonoses constitute a diverse group of viral, bacterial, rickettsial, fungal,parasitic, and prion diseases with a variety of animals reservoirs, including wildlifes,livestocks,petanimals,andbirds (Nkuchiaetal.,2007). Inmostcases,animalsplayanessentialroleinmaintainingtheinfectioninnatureandcontributeinvaryingdegreestothedistributionandactualtransmissionof infectioninhumanandanimalpopulations.Thesediseaseshaveavarietyoftransmissionmechanismsthatmaybedirectsuchasinrabiesandanthrax,orindirect,viavectors,food,waterandtheenvironment,asinthecase of bovine tuberculosis and cysticercosis. Many, such as brucellosis, also havemultiple routes of infection.With the constant and inevitable interaction ofman andanimals, zoonotic diseases remain a genuine threat to health and survival for people,theirlivestock,companionanimalsandwildlife(WHO,2005).AmongthemanyzoonoticdiseasesprevalentinMalaysiaareleptospirosis,rabies,influenza,Japaneseencephalitis,toxoplasmosis,ornithosis,QfeverandmonkeypoxwhichhavebeeninvestigatedattheDivisionofVirusResearch,lnstituteforMedicalResearch,KualaLumpur(Tan,1981).Theperceptionofthecommunitytowardszoonoticdiseasesplaysanimportantroleforthemaintenanceoflifecycleandtransmissionofthesediseasestothedifferentarraysoftheirhosts.Studyingtheperceptionofthecommunityontheriskfactors,routesoftransmission and life cycle of zoonotic diseases is a crucial step towards thedevelopment and implementation of appropriate disease prevention and controlstrategies(Tesfayeetal.,2013).Majorityelementaryandhighschoolstudentsreceiveinformationsonzoonoticdiseasesfromtheirfamiliesintheformofadvicewhilemosthealthprofessionalsreceivetheirinformationsfrommedicalschoolstheyhaveattendedwhich justifies that health professionals have better awareness about zoonoticdiseases. It is shown thathealthprofessionalshavebetter knowhowas compared tonon health professionals and students’ response is used to access information aboutwhatfamiliesofschoolagedchildren(Girmaetal.,2012).Few studies have been done on zoonotic diseases in Malaysia. Studies includesleptospirosis, an emerging zoonotic disease in Malaysia (Thaya et al., 2013), somezoonotic diseases prevalent inMalaysia (Tan, 1981) and zoonoticmalaria inMalaysia(Lim,2013).However,therewasnopublishedstudyonzoonoticdiseasesawarenessinMalaysia especially among school students. Thus, this studywas conducted to assessawarenessonzoonoticdiseaseamongprimaryschoolstudentsofSekolahKebangsaanSeriSelangorUSJ4,SubangJaya,Selangorbyfocusingonthedevelopmentofthebestmethodstoeducatethestudentsaboutthezoonoticdiseasessothattheyhavebetterunderstanding on the preventation of exposure to zoonotic diseases through schoolzoonotic diseases awareness program that comprise of few modules that studentswouldbeinvolvedin.

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3 MethodologyIn thisproject,a setofquestionnaireandmodulesweredeveloped inorder toassessthe awareness of school students on zoonotic diseases. Program conducted in therespectiveschoolwasdividedintotwophases.3.1 QuestionnairesAsetofquestionnaireswasdevelopedtoassesstheawarenessandknowledgeofschoolstudentsonzoonoticdiseases.Thequestionswerepresentedinafive-pointLikertscaleranging from “Strongly disagree = 1” to “Strongly agree = 5” An example of thequestionnairesisintheappendixsection.Questionnairesaredividedintosixsectionsasstatedbelow:SectionA:HealthanddiseasesSectionB:PetsSectionC:Pettingfarm,zoosandstrayanimalsSectionD:Feelings,interactionsandperceptionstowardanimalsSectionE:FoodsafetyandpersonalhygieneSectionF:General3.2 SchoolzoonoticdiseasesawarenessprogramIn this pilot study, school students from Sekolah Kebangsaan Seri Selangor wereselected. This school is located in amodern sub-urban residential area approximately20km away from the capital city of Malaysia, Kuala Lumpur. A total number of 40standard 6 students from Sekolah Kebangsaan Seri Selangorwere assessed. Studentsarewithintheagerangeof11to12yearsold.Theyconsistof22femaleand18malefromamultiracialbackgrounds.Theschool zoonoticdiseasesawarenessprogramwasdivided into two phases, first phase was conducted on the 5th October 2016 at theschoolasinappendix2followedbythesecondphaseonthe10thOctober2016inUPMas inappendix3.Theprogramconductedconsistsofeightmodulesandeachmodulecomprises of a few activities related zoonotic diseases education for school students.ActivitiesconductedattheschoolwereModule1tillModule4,followedbyModule5tillModule 8 inUPM.A set of questionnaires on zoonotic diseaseswasdeveloped toassess the awareness and knowledge of students on zoonotic diseases. Thequestionnaires(pre-surveyforms)weredistributedamongthestudentstobeanswered

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beforethestudentswere introducedto thezoonoticdiseases topics in theawarenessprogramandthequestionnaires(post-surveyforms)thatconsistofthesamequestionsas in pre-survey forms were distributed again after the awareness program finished.Samerespondentswereusedforpreandpostsurvey.Tentativeoftheprogramforbothdayscanbeseenintheappendixsection.3.2.1Module1:IntroductionToUPM-VETAndWhatIsAVetDoctorTheobjectiveofModule1was to introduce FacultyofVeterinaryMedicineUPMandalso the veterinarian profession. UPM corporate video was showed to the studentsfollowed by a short talk to introduce the veterinary medicine profession by slidepresentation.FromModule1,studentswouldbeabletounderstandbettertheroleandfunctionofaveterinarian.3.2.2Module2:IcebreakingsessionModule2wasconductedtodividethestudents intosmallergroupsothattheygettoknowmembersof thegroupandalso to introduce the facilitator to them.Theyweredividedintoeightgroupscomprisingof4-5studentsforeachgroup.Onefacilitatorwasassigned for each group. Facilitators are volunteers that consist of lecturers andpostgraduatestudentsfromUPM.Pre-assessmentquestionnairewasdistributedamongthe students in this session and facilitators would assist or clarify the questions toensuretheyunderstoodquestionsthatwereasked.3.2.3Module3:Whatisapathogen?In Module 3, students were introduced to different terms and types of pathogensavailable around such as bacteria, virus andparasites.Module 3was loosely adaptedfrom “What is a Pathogen” module fromMichigan State University. The activities inModule 3 consist of 3 sections; bacteria section, virus section and parasites section.Facilitatorsexplainedanddescribedthesepathogensusingan informationcardto thestudents. Students need to construct different types of bacteria, virus and parasitesbased on the information given to them by their respective facilitators. Studentswillhavetoobserveanddeterminethedifferencesbetweenthethreemaintypesofdiseaseagentsbyusingmaterialsgivenaslistedbelow:Bacteriasection:Modelingclay,artwire,cottonballs,writingutensilsorsticks,double-sidedtape.Virussection:Balloons,beans,cottonballs,coffeestirstraws,double-sidedtape/photosquares.Parasitessection:Modelingclay.

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3.2.5Module5:DairyfarmvisitModule5takesplaceonthesecondphaseoftheprogram.StudentsassembledatthedairyfarmintheearlymorningatLadang16,UPM.Inthisvisit,students listenedtoashorttalkbytheattendingveterinarianofficeratthefarmonfoodsafetyinparticularlydrinking freshmilk. The term pasteurisation and personal hygiene after touching theanimalswerealsoemphasizedinthismodule.3.2.6Module6:Flashbackactivity–WordsearchIn thismodule, studentswill have to recall differentwords and terms that they haveheard frompreviousactivitiesconducted inphaseone.Theactivitywasawordsearchthatincludesalltermsrelatedtozoonoses.Aninvitedspeakeralsogaveashortflasbackdiscussionwith the students.Anexampleof thewordsearchused in thismodule is inappendix6.3.2.7Module7:BeazoonoticdiseasedetectiveModule7wasdeveloped to introduce thediferent types zoonotic parasites and theirmodeoftranssmission, lifecyclesanddiagnosistechniqueinparasitedetection.Therewere4activitiesinModule4.Firstactivitywastheashortintroductionofparasitesandzoonotic parasites and what samples to collect for diagnosis of parasites by slidepresentation.Secondactivitywasademonstrationoffecalandbloodexaminationsuchby fecal floatation technique for intestinalparasitesand thewetmount technique forblood parasite (trypanosome). The third activitywas examination and drawing of theparasites that they observed under the microscope. In this activity, students weredivided into eight groups and each group was allocated one set of parasites (sixspecimens) and one volunteer (postgraduate students or lecturers). Students wereaskedtodrawandlabelthemorphologyofparasitesandtheyweregiventenminutesfor each specimen. In this activity, volunteer explained the life cycle and mode oftransmissionofeachparasitespecimenswhilethestudentsdrawingtheparasites.Lastsessionwasadiscussionwithstudentsonwhattheyhadlearned.Ashortdemonstrationonproperhandwashingtechniquewasalsointroduced.3.2.8Module8:MypetandIModule8was a talkonhavingpets andprecaution steps tobe takenwhenhandlinganimals.A small animalpracticeveterinarianconducted thisactivitywithaguideofaslidepresentationandresidencecatsfromtheUniversityVeterinaryHospital,UPM.3.3SamplinganddatacollectionAtotalof40standard6studentsfromSekolahKebangsaanSeriSelangorwasassessedinthisstudy.Theyconsistof22femaleand18malefromamultiracialbackgrounds.The

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school zoonoticdiseasesawarenessprogramwasdivided into twophases, firstphasewasconductedonthe5thOctober2016attheschoolfollowedbythesecondphaseonthe10thOctober2016inUPM.Theprogramconductedconsistsofeightmodulesandeachmodulecomprisesofafewactivitiesrelatedzoonoticdiseaseseducationforschoolstudents. Basically the activities conducted at the school were based on Module 1,Module2,Module3andModule4whileinUPM,activitiesconductedbasedonModule5,Module6,Module7andModule8.Asetofquestionnairesonzoonoticdiseaseswasdesignedtoassesstheawarenessandknowledgeofstudentsonzoonoticdiseases.Thequestionnaires(pre-surveyforms)weredistributedamongthestudentstobeansweredbeforethestudentswere introducedto thezoonoticdiseases topics in theawarenessprogram and the questionnaires (post-survey forms) which consist of the samequestions as inpre-survey formsweredistributedagain after the awarenessprogramfinished.Thesamerespondentswereusedforpreandpostprogram.3.4DataanalysisMicrosoftExcel®wasusedtoeditthecollecteddataandtoconstructgraphicdata.DatawasanalyzedusingtheIBMStatisticalPackageofSocialScience(SPSS)version22.MannWhitneyUTestwasusedtocomparepreandpost-programonawarenessofzoonoticdiseasesamongthestudentsforeachquestion.4 ResultsanddiscussionA total of 40 respondents participated in this survey. They were from standard 6studentsofSekolahKebangsaanSeriSelangorconsistof55%offemaleand45%ofmalefrom a multiracial backgrounds. 92.5% of students reside in the city while 7.5% ofstudentsstaysoutsideofthecity.Thesamestudentswereassessedforbeforeandaftertheprograminthissurvey.Agegroupofthesestudentsarefrom11to12yearsold.A totalof36questionswereassessed in thesurvey.Therewere31questions in totalthathadsignificantdifferent (P<0.05) inawarenessscorebetweenbeforeandafterthe programwas conducted. Therewere increases inmean rank in post-program foreach question. The higher mean rank in post program indicates that there was anincrease in level of awareness among the students for these 31 questions after theawareness program was conducted. Four questions had no significant different inawareness score between before and after the awareness program. Below are twoexamplesofquestionsthatshowedsignificantincreasedinawareness.

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Figure 1. The percentage of students who answered “strongly agree”, “agree” and“unsure”basedonquestion3:“animalsdiseasescanspreadtohuman”.

Figure 2. The percentage of students who answered “strongly agree”, “agree” and“unsure”basedonquestion26:“Ihaveheardthetermofpasteurisation”.

15.4%

56.4%

28.20%

67.50%

30.00%

2.5%0%

10%

20%

30%

40%

50%

60%

70%

80%

stronglyagree agree unsure

Q3.Animaldiseasescanspreadtohuman

%ofstudents

Response

%OFSTUDENTSPRE-PROGRAM

%OFSTUDENTSPOST-PROGRAM

8.3%

44.40% 47.20%

73.70%

21%

5.3%

0%

10%

20%

30%

40%

50%

60%

70%

80%

stronglyagree agree unsure

Q.26Ihaveheardtheterm'pasteurisation'

%ofstudents

Response

%OFSTUDENTSPRE-PROGRAM

%OFSTUDENTSPOST-PROGRAM

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Atotalof35questionsor89.1%hadsignificant(P<0.05)inawarenessscorebetweenbeforeandaftertheprogramwasconductedwhile(11.4%)from35totalofquestionshadnosignificantdifferent(P>0.05)onawarenessscorebetweenbeforeandaftertheprogram was conducted. The percentage of total of questions that had significantdifferent(P<0.05)inawarenessscoremorethanthepercentageoftotalofquestionsthathadnosignificantdifferent(P>0.05)onawarenessscorebetweenbeforeandafterthe program was conducted. Thus, there was a significant different in the level ofawarenessamongthestudentsbetweenbeforeandaftertheprogramwasconducted.We can also conclude that the school zonotic diseases awareness program waseffective.5 ConclusionThisstudyrevealedthatschoolstudentshadacquiredbasicknowledgeonzoonosesandways to prevent transmission after participating in the school zoonotic diseasesawareness program with the overall total of 89.1% of questions that had significantdifferent (P < 0.05) in awareness score between before and after the programwasconducted. Thus, therewas significant different in the level of awareness among thestudentsbetweenbeforeandaftertheawarenessprogramwasconductedandwecanalsoconcludethattheprogramwaseffective.6 FutureplansModules developed from this project will be adapted and applied for awarenessprogram on zoonotic diseases among school students in Malaysia together withMalaysia One Health University Network (MyOHUN). This module is to be publishedonlineunderMyOHUN.7 References

1. Babu, A. J., Ramya, P., & Rao, L. V. (2015). A study on the awareness andknowledgeofzoonoticdiseasesamongthepublic inandaroundProddatur-YSRKadapaDistrict,AndhraPradesh,India.InternationalJournalofRecentScientificResearch,6 (7), 5131–5138. Retrieved fromhttps://www.researchgate.net/publication/291696239_A_study_on_the_awareness_and_knowledge_of_zoonotic_diseases_among_the_public_in_and_around_Proddatur-YSR_Kadapa_District_Andhra_Pradesh_India.

2. Durga,A.(2016).MostCommonZoonoticDiseases:TransmittedfromAnimalstoHumans Aparna Durga .Research and Reviews Journal of ZoologicalSciences,(SpecialIssue-S1|),7-9.Retrieved,fromhttps://www.rroij.com/open-access/most-common-zoonotic-diseases-transmitted-from-animals-to-humans-.pdf.

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3. Girma,S.,Zewde,G.,Tafess,K.andJilbat,T(2012).Assessmentofawarenessonfood borne zoonosis and its relation with Veterinary Public Health Services inandaroundAddisAbaba,Ethiopia.EthiopianVeterinaryJournal,2012;16(1):15-22.Retrievedfrom:

https://www.researchgate.net/publication/256497770_Assessment_of_awareness_on_food_borne_zoonosis_and_its_relation_with_Veterinary_Public_Health_Services_in_and_around_Addis_Ababa_Ethiopia.

4. Lim,K.G. (2013).ZoonoticMalaria inMalaysia.Medical JournalofMalaysia,68(No1),4–5.Retrievedfromhttp://www.e-mjm.org/2013/v68n1/malaria.pdf.

5. Masavkar, S.P., & Naikwadi, A.M. (2016). Awareness and attitude regardingcommonzoonoticdiseasesamong farmers.Scholars JournalofAppliedMedicalSciences (SJAMS) ,(ISSN 2320-6691 ), 1052-1060. Retrieved , fromhttp://saspublisher.com/wp-content/uploads/2016/03/SJAMS-43F-1056-1060.pdf.

6. NkuchiaMM,RuthL,ChrisAB,HenrietteV(2007).Infectiousdisease

surveillance.BlackwellPublishingInc.Malden,Massachusetts02148-5020USA.pp.246-248.

7. Tan,D.S.K(1981).SomeZoonoticDiseasesPrevalentInMalaysia.TheMalaysianjournal of pathology, 4, 19–27. Retrieved fromhttp://www.mjpath.org.my/past_issue/MJP1981/zoonotic-diseases-prevalent-in-malaysia.pdf.

8. Tesfaye,D.,Fekede,D.,Tigre,W.,Regassa,A.,&Fekadu,A.(2013).Perceptionofthepublicon thecommonzoonoticdiseases in Jimma,SouthwesternEthiopia.InternationalJournalofMedicineandMedicalSciences,5(6),pp.279-285,280–285.doi:10.5897/IJMMS2013.0931

9. Thaya.S, T., Ian D, R., Fairuz, A., &MT, A. (2013). Leptospirosis, an emergingzoonoticdiseaseinMalaysia.TheMalaysianjournalofpathology.35(2):123-32

10. “WhatIsAPathogen".MachiganStateUniversityExtension.N.p.,2017.Web.8Mar.2017

11. WHO (2005). The Control of Neglected Zoonotic Diseases. Report of a JointWHO/DFID-AHP Meeting with the participation of FAO and OIE. Geneva,September2005.Available:http://whqlibdoc.who.int/publications/2006/9789241594301_eng.pdf.AccessedinJanuary,2017.

12. WHO. (2013,April 25). Zoonosesand theHuman-Animal-Ecosystems interface.Retrieved January 19, 2017, from World Health Organization,http://www.who.int/zoonoses/en/

13. Zhang, H. L., Mnzava, K. W., Mitchell, S. T., Melubo, M. L., Kibona, T. J.,Cleaveland, S., … Halliday, J. E. B. (2016). Mixed methods survey of Zoonoticdiseaseawarenessandpracticeamonganimalandhumanhealthcareprovidersin Moshi, Tanzania. PLOS Neglected Tropical Diseases, 10(3), e0004476.doi:10.1371/journal.pntd.0004476

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8 Appendix(i) Exampleofsurveyforms

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(ii) Exampleofprogramschedule

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(iii) Exampleofmodulefortheprogram

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(iv) PicturesfromPhase1

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(v) PicturesfromPhase2

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(vi) Localmediacoverageonprogram

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