Assessment of Precautionary Measures Medical Students & Doctors Practiced at Eid-ul-Adha during COVID-19

 

 

Usama Saeed1
Javaria Saeed2
Nabiha Farasat Khan3            BSc, M.Phil, MHPE, CME
Muhammad Saeed4                BDS

 

 

OBJECTIVE: To analyze the precautionary measures that medical students and clinicians practiced during Eid-ul-Adha' 2020."
METHODOLOGY: An online cross-sectional survey was conducted on medical students and doctors/clinicians/faculty in
Balochistan, where the questionnaire (10 items) was posted on google platforms after Eid-ul-Adha between 10th to 31st
December 2020. Inclusion criteria consisted of first to third year medical students and clinicians whereas fourth and final year,
house officers and postgraduate students were excluded. Pilot study demonstrated reliability of questionnaire Cronbach's alpha
0.624. SPSS version 23 was used for analysis.
RESULTS: In current study majority (n=82/126) of the study participants were males, more than half of them were medical
students (n=73/126). Eighty percent (80%) participants (n=66/82) offered Eid's congregational prayer in masjids, 11/82 prayed
at home only five (n=5/82) of them didn't perform prayer at all; majority (64%) of them practiced SOPs at the time of prayer
in Masjid. In family gatherings, 73% followed all precautionary measures whereas 10% avoided SOP's. At the time of ritual
livestock sacrifice, 62% participants followed whereas only 10% didn't follow to any precautions. During meat distribution,
68.5% study participants practiced all precautionary measures and just 2.7% did not follow SOP's during meat distribution.
No significant difference was found between medical students and doctors in practicing precautionary measures, except during
meat distribution (p-0.009).
CONCLUSION: Medical students and doctors practiced precautionary measures well. However, statistically significant relation
was found between medical students and doctors praying in masjids and maintaining a safe distance in Eid gatherings during
this pandemic.
KEYWORDS: COVID-19, Eid-ul-Adha, Precautionary Measures, Medical Students, Doctors.
HOW TO CITE: Saeed U, Saeed J, Khan NF, Saeed M. Assessment of precautionary measures medical students & doctors
practiced at Eid-ul-Adha during COVID-19. J Pak Dent Assoc 2022;31(1):32-37.
DOI: https://doi.org/10.25301/JPDA.311.32
Received: 13 June 2021, Accepted: 01 Ocotber 2021

INTRODUCTION
Eid-ul-Adha, one out of the two Islamic festivals, is celebrated with great zeal and enthusiasm annually on 10th of Dul-Al-Hajj, the last month of Islamic Calendar. Muslims gather with their families and friends to pray, sacrifice animals and distribute meat to the needy and destitute in order to please Allah Almighty. This Islamic celebration holds a symbolic value as well; it honors the willingness of Ibrahim (AS) to sacrifice his son, Ismael (AS), as an act of obedience to Allah’s command. 1 However, amid COVID-19 pandemic having already affected around 16 million individuals worldwide in the month of July’2020 and a further risk of its spread, social gatherings. 2 This
Eid-ul-Adha in August’2020 was considered problematic due to the overcrowding of people amongst the hustle and
bustle of the great event; animal transportation from rural to urban areas for sale, Eid Congregational Prayer, sacrifice in public areas and/or during social gatherings in amusement parks, restaurants, picnic points or homes.
3 All Muslims including Pakistanis celebrated Eid-Ul-Adha during the first week of August’2020 in this pandemic. Muslims sacrificed animals including goats, cows, sheep and camels. Eid celebration and sacrifices made it quite challenging for the Ministry of Health not only in Pakistan but also in the entire Muslim world to control the situation, as the chances of a drastic rise of COVID-19 infection were very high.3,4 COVID-19 is a viral infection, primarily affecting the respiratory system, transmitted directly or indirectly when a healthy person contacts the saliva, respiratory secretions or respiratory droplets of an infected individual.5 The index case was first recognized in China’s Wuhan city in December’20195 , and was declared a Global Health Emergency in January’2020 by WHO due to its worldwide spread and regulations were asked to be administered.6 The SOPs advised by health care workers included wearing face mask and gloves, physical and social isolation, washing hands for 20sec with soap, monitoring and controlling religious and social gatherings. During Eid-ul-Adha, animal sacrifice was also confined to specific areas with strict regulations to contain the disease transmission.2,3,7
Pakistan is a low-middle income country with a population of 207.8 million, predominantly Muslim population of over 95% residing in five different provinces i.e. Gilgit-Baltistan, Punjab, Sindh, Khyber Pakhtunkhwa (KPK), and Baluchistan.8 To overcome the consequences of COVID-19, the government had opted smart lockdown to arrest risk of infection spread towards individuals, families and communities. To promote and encourage adoption of key measures to prevent and minimize the spread of the infection, government officials directed the observation of SOPs. The commitment of Pakistanis to these control measures was a key factor in deciding the fate of battle against COVID-19.9 The purpose of this survey was to analyze precautionary measures adopted during social and religious practices by medical students and doctors during COVID-19 pandemic during Eid al Adha’2020.

METHODOLOGY
After taking IRB from Bolan University of Medical and Health Sciences Quetta (No.00009/BUMHS/IRB/2020),
quantitative survey was designed and conducted on previous research reports and WHO guidelines for COVID-19.2
Due to pandemic, it was difficult to conduct a community-based survey and collect data so we opted for online Google platform survey. On-line questionnaire included gender, qualification, occupation and designation for background information of the participants and to analyze practice of precautionary measures among 126 medical students of four medical colleges (Makran Medical College in Turbat, Jahalawan Medical College in Khuzdar, Loralai Medical College in Loralai and Bolan Medical College in Quetta) and doctors of Balochistan during Eid-ul-Adha in this pandemic. As the newly inaugurated medical colleges of Makran, Jhalawan and Loralai comprise only three batches each, with neither house job nor post-graduation started so far, we included just first to third year medical students from Bolan Medical College to correspond data with that of the other three medical colleges. Data was collected during 10th to 20th December 2020.
After completing conceptualization of this survey, two medical educationists tested the face and content validity
of the instrument. The approved version of the instrument had 10 items only and had two parts. The first part contained questions related to the demographic information of the participants such as gender, occupation, designation and qualification (in case of clinicians/physicians) while the second part consisted of questions affiliated to precautionary measures including wearing face masks and gloves, keeping a distance of 6-feet, washing hands with soap for 20 sec and avoid touching the face with unwashed hands to prevent virus entry into mouth or nose. Participants were asked to answer in yes and no.
Prior to its official release, pilot testing was done on a small group of people having same characteristics as the
study group through a messaging and voice-over service, WhatsApp to check if the questions were clear and
unambiguous. Questionnaire was acceptable as its reliability was Cronbach’s alpha 6.24%. After this pilot survey, the
questionnaire was distributed to participants through internet into WhatsApp groups of author We used purposive and snowball sampling to recruit participants. The valid response rate was 90% after excluding invalid responses. Informed consent was obtained from all respondents. A brief introduction to the study was provided in the questionnaire on study objectives, questionnaire filling duration, as well as the names and contact information of the investigators. Participation in the survey was voluntary. All respondents were informed that they were free to continue or quit at any time, and the submission of the questionnaire would be regarded as consent to participate.
Second part of the questionnaire consists of six questions that assisted in assessing precautionary measures medical students and doctors were practicing during this pandemic in Eid-ul-Adha. One of these questions have two options: “yes”, and “no”. Whereas others have practiced-based questions focused on the attitude toward COVID-19 and Eid prayers, which precautionary measures did participants practice during family gatherings questions related to precautionary measures participants practice during sacrifice and during meat distribution including wear facemask and gloves, wash hands before and after sacrifice, make a distance of 6-feet, didn’t touch face with unwashed hands

ANALYSIS
The data was analyzed by using SPSS version 23. Frequency and percentage were given for gender, occupation
and responses pertaining to precautionary measures practices overall during Eid-ul-Adha. Chi-square was used to
determine the association of occupation and precautionary measures practiced overall during Eid-ul-Adha. A p-value
< 0.05 was taken as significant.

RESULTS
    One hundred and fifty participants from Makran Medical College, Jahalawan Medical College, Loralai Medical
College and Bolan Medical College across Balochistan responded to our research questionnaire. After scrutiny,
completed questionnaires (n = 126) were included in the study.
Out of 126 participants, majority (65.1%, n=82/126) were males whereas 58% (n=73/126) were medical students. Table 1 demonstrates demographic details. Table 2 presents details about the male participant’s response about precautionary measures during performing prayer, family gathering, practiced on SOP’s advised by local health authorities, observing sacrifice of the animal/s and meat distribution to neighbors and family members. Correlation
between occupations and precautionary measures practiced while meat distribution to family and friends is displayed in Table 3.

DISCUSSION
Overall results of participants following precautionary measures in COVID-19 pandemic were satisfactory. Almost
half of them followed all the precautionary measures in all items; giving an average of 73% during social gatherings,
64% during Eid-ul-Adha Prayers at Masjid, 62% during sacrifice while 68% during meat distribution. In comparison
with the results of other studies in which medical students and doctors demonstrated an overall better response towards SOPs, Hayat I from Punjab detected 81.22%6 while 92% students from Soltan’s study in Egypt practiced precautionary measures to avoid COVID-19 infection.10 The highest ratio (95%) was observed among study participants of Noreen et al research paper.11 In case of washing hands time and again, illiterate background and lack of childhood training serve as contributing factors to its low score.12 Basically majority of the population in Balochistan faces poverty13 which may be a cause of why participants (especially medical students) did not follow the precaution of wearing face masks and gloves attentively (average result 18%); whereas ignorance adds to this point as well. The result of participants maintaining a distance of 6 feet is poor as well; this may be due to the fact that this region of Pakistan has a tradition of shaking hands as well embracing each other especially on Eid Festivals; the younger ones even have to kiss the hands of the elderly as a sign of respect. These cultural norms not observed by any member create social stigma in society.
Medical students demonstrated interest to participate in the current study. More than half (58%) population of our research work (n=73/126) were medical students, remaining 42.1% (n=53/82) were doctors, 18/126 were Assistant  Professors, eight Associate Professors and nine Professors. Remaining 18 participants were also doctors but they were serving on administrative posts (MS, DHO, and registrar). We observed very low percentage of professors who participated in the study, which authenticates their busy schedule and short time for extra clinical activities. On the other hand only 49.7% Lebanese Physicians practiced precautionary measures.
During sacrifice, 42.7% (n=35/82) participants seems to have practiced precautionary measures, 23.2% (n=19/82)
avoided touching their face with unwashed hands, 21% (n=17/82) wore facemasks, whereas 12.2% (n=10/82) maintained a distance of 6feet. During meat distribution, 37.8% (n=31/82) practiced all precautionary measures, 22% (n=18/82) washed their hands with soap for 20sec before and after meat distribution, 17.1% (n=14/82) did not touch their face with unwashed hands, whereas only 7.3% (n=6/82) wore masks, whereas 9.8% participants (n=8/82) did not follow precautionary measures. Athough not on Eid-ul-Adha but other studies carried out on COVID-19 discuss percentage of participants on the basis of gender who wash their hands regularly. A study consisted of 1257 study samples out of which 632 (90.3%) females washed their hands in comparison 85.6% males for 20sec with soap.6
Only 8.2% of our study participants washed their hands for 20 sec during social gathering, however 31% (n=16/52) medical students washed their hands before and after meat distribution. When comparing practices of precautionary measures among undergraduates, majority of the study participants of Hayat K, Khasawneh et al, Soltan and Noreen K washed their hands regularly for 20 sec with resulting percentages of 87%, 88.1%, 90% and 91% respectively.9-11,15 This observation points towards the lazy nature, lack of time and/or non-serious attitude of medical students of Balochistan towards COVID-19.
Possibly the reasons responsible in maintaining low mortality in doctors and medical students would be performing prayers in home. As we found a statistically significant association when we compared Eid-ul-Adha prayer in masjid and /or in home among medical students and doctors (p-0.003). Medical students exhibited lack of time and extra burden of their studies that hinder all sorts of physical activities, and deficit social interactions that in-turn impeded them for performing prayers.16 When comparing responses there was no significant difference between medical students and doctors in wearing facemask, gloves, washing hands for 20 seconds and touching the face, statistically significant difference was observed between occupation of study participants and meat distribution after sacrifice (p-0.09). It may also be worth mentioning that despite of being blamed of fundamentalism, majority of the population in this region willingly reduced the religious rituals to a bare minimum level.17,18,19,20,21 Strict adherence to local, cultural and religious practices which include ablution almost five times in a day, use of face covering by the adult females and maintaining social distances as between genders at gatherings and educational institutions may have been the major contributory factors.22-24,25,26,27
Majority (80.5%, n=66/82) participants of current study offered Eid prayers in masjids; 39% wore facemasks (n=32/66), 22% (n=18/66) observed sufficient gap between namazis in masjid whereas 21% (n=17/66) follow all
precautionary measures. As they all were educated, they were aware of the severity and complications associated with COVID-19, so majority of the medical students and doctors practiced precautionary measures.
Balochistan is primarily a male predominating society and this aspect is confirmed in our study as 65% (n=82/126) study participants were males.28 Though various components work as contributing factors in low female literacy rate in Balochistan as compared to the other parts of the country including remote educational institutes, financial constraints, social problems and cultural barriers.28,29 However, in the current research work, the percentage of females was low as they offer prayers at home, and/or sacrifice ritual and
meat distribution during Eid-ul-Adha is related to men. In contrast, studies conducted by Hayat I, Hayat K, Soltan ,
Dhahri et al and Noreen K during this pandemic related to the adaptation of hygienic and precautionary measures
demonstrated female predominance (73.77%, 55. 7%, 61.1%, 65.9%, 71.4% respectively)6,9,11,30 and were not linked to a specific event.
This type of study had not been conducted before so the author was unable to discuss and compare results of current study with others research work.

STRENGTH OF STUDY
Medical students were keener to participate in online surveys and knew about their practices during this pandemic.
Doctors, being more mature, practice precautionary measures carefully and strictly to avoid any infection. This is the first ever study to analyze medical students and doctors about the precautionary measures they practice. It was a small-scale study. To assess the perceptions, attitude and knowledge it should be done on a larger scale
among medical students and doctors. As it was an online survey, there is a chance of questionnaire bias. There may
be sampling bias, as survey may be restricted to those participants who were more active on social media. However
to reduce sampling bias, questionnaire was distributed to different online channels to improve its visibility among
respondents. There may also be response bias, which the respondents consciously or subconsciously did. As still, no
work was done on this forum to check and analyze which precautionary measures medical students and doctors were practicing, so it was impossible to compare our results with any other survey or study.

CONCLUSION
Doctors demonstrate more responsible behavior towards precautionary measures advised by healthcare workers as
compared to medical students.

ACKNOWLEDGEMENT
Author offers her thanks to all volunteer participants of
this online survey.

AUTHOR CONTRIBUTION
Usama Saeed and Javaria Saeed: data collection (students), literature search
Muhammad Saeed: data collection (doctors), analysis
Nabiha Farasat Khan: manuscript writing, methodology
Attia Bari: review and final approval of manuscript

FUNDING RESOURCES
None

CONFLICT OF INTEREST
None

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