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Original Article

Zika virus disease knowledge among the future

health‑care providers of the United Arab Emirates
Syed Arman Rabbani,
Farhan Mustafa1,
Tasneem Shouqair1, Itaf Mohamad1,
Nada Tahsin1
Department of Clinical Pharmacy and
Pharmacology, RAK Medical and Health
Sciences University, 1RAK College of
Pharmaceutical Sciences, RAK Medical
and Health Sciences University,
Ras Al Khaimah, United Arab Emirates
J. Adv. Pharm. Technol. Res.
Abstract
Zika virus (ZIKV) disease has become a major public health concern. Although there are
no reported cases of ZIKV disease in the United Arab Emirates (UAE), there is a potential
risk of transmission due to large expatriate population and high influx of international
travelers. This cross-sectional study was conducted to assess the knowledge of ZIKV
disease among the students of a medical and health sciences university in the UAE.
Their knowledge of ZIKV disease was assessed using a specially designed, pretested,
and validated questionnaire. Of the 500 respondents included in the final analysis,
314 (62.8%) respondents presented with poor knowledge of ZIKV disease. The mean
knowledge score of the study population was 10.48 ± 2.48 out of a maximum of 17.
Gender, college and year of study, nationality and attendance in lecture/conference/
workshop on Zika were significantly associated with the level of knowledge. The males
possessed significantly (P = 0.046) better knowledge as compared to the females.
Students of medical college had significantly (P = 0.005) better knowledge as compared
to students of other colleges. The level of knowledge improved significantly (P = 0.026)
as the year of study progressed. There is a need for medical and paramedical students to
update their knowledge of ZIKV disease as they are the future health‑care providers who
will be responsible for creating awareness about such outbreaks and their preventive
measures.

Key words: Health‑care providers, knowledge, United Arab Emirates, Zika virus disease

INTRODUCTION There is a drop in the number of ZIKV disease cases but

As per the latest World Health Organization  (WHO)
situation report on Zika, there are 84 countries, territories
or subnational areas with evidence of vector‑borne Zika
virus (ZIKV) transmission.[1] Although the WHO has ended
the Public Health Emergency of International Concern on
ZIKV the global risk assessment remains unchanged.[2]
Address for correspondence:
Dr. Syed Arman Rabbani,
Department of Clinical Pharmacy and Pharmacology, RAK
College of Pharmaceutical Sciences, RAK Medical and Health
Sciences University, Ras Al Khaimah, United Arab Emirates.
E‑mail: arman@rakmhsu.ac.ae
Access this article online
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there is a need for the countries worldwide[3] to be vigilant
toward this epidemic and associated complications.
ZIKV disease is a mosquito‑borne infection which is usually
mild but because of its associated serious complications
such as microcephaly and Guillain–Barre disease,[4] it poses
a significant threat. The United Arab Emirates (UAE) has
a high influx of international travelers, and additionally,
it has a large expatriate population[5] coming from regions
where other flavivirus infections have been reported. This
increases the potential risk of transmission of ZIKV disease
in the region.
This is an open access article distributed under the terms of the Creative
Commons Attribution‑NonCommercial‑ShareAlike 3.0 License, which allows
others to remix, tweak, and build upon the work non‑commercially, as long as
the author is credited and the new creations are licensed under the identical
terms.
For reprints contact: reprints@medknow.com

How to cite this article: Rabbani SA, Mustafa F, Shouqair T,

DOI: Mohamad I, Tahsin N. Zika virus disease knowledge among the
10.4103/japtr.JAPTR_239_17 future health-care providers of the United Arab Emirates. J Adv
Pharm Technol Res 2017;9:20-5.

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Rabbani, et al.: Zika virus disease knowledge

The WHO recommends enhanced public awareness and
engagement, better reporting, use of vector control, and
personal protective measures. [6] Well‑informed future
health‑care providers can play a crucial role in spreading
awareness regarding such diseases.
A number of recent studies have been published evaluating
the awareness regarding ZIKV disease in different
populations,[7‑12] but there are very few studies on the
awareness of ZIKV disease among medical and health
sciences university students.[13,14] The paucity in research
data on awareness of ZIKV disease in the UAE has led to
this study.
METHODS
Study design
This cross‑sectional study was carried out to assess the ZIKV
disease knowledge of students of RAK Medical and Health
Sciences University, UAE.
Study population
Students of medical, pharmacy, dental, and nursing
colleges of the university were considered for the study.
Only those respondents who were available for data
collection and who gave written informed consent were
included in the study.
Sample size
A convenience sampling technique was used for sample
size. Five hundred fifty‑eight students agreed to participate
in the study and signed the informed consent form.
Study instrument
A specially designed, pretested, and validated questionnaire
was used to record responses of the students. The questions
of knowledge domain were based on knowledge, attitudes,
and practices resource pack of WHO. The content validity
of the questionnaire was determined by a panel of experts.
The questionnaire was pretested on 30 students before the
conduct of the study. This field testing of the questionnaire
yielded a Cronbach’s alpha reliability score of 0.80,
indicating high‑internal reliability.
marital status, college of study, year of study, attending any
recent lecture, conference, or training workshop related to
ZIKV disease.
Data analysis
The level of knowledge was analyzed as a two‑category
variable: “good” or “poor”  (on the basis of 70% cutoff
point). The association of demographic characteristics
of study respondents with the level of knowledge was
assessed using the Pearson 2. P < 0.05 was considered to
be statistically significant. Data were analyzed using SPSS
22.0 for Windows (SPSS Inc., Chicago, IL, USA).
Ethical consideration
The study was approved by RAK Medical and Health
Sciences University Research and Ethics Committee.
RESULTS
Sociodemographic characteristics
Out of the total 558 study respondents, 58 were excluded
from the analysis as the questionnaires returned by them
were incomplete. Data from 500 study respondents were
analyzed. The sociodemographic characteristics of the
respondents are shown in Table 1.
Knowledge of Zika virus disease
The mean knowledge score of the study population was
10.48 ± 2.48 out of a maximum of 17. The mean knowledge score
of medical students was the highest (11.25 ± 2.30) followed
by pharmacy, dental, and nursing students [Figure 1].
Out of the 500 study participants, 314 (62.8%) participants
presented with poor knowledge of ZIKV disease whereas
only 186 (37.2%) possessed good knowledge of the disease.
Majority of respondents knew about prevention  (78.2%)
and transmission (62.2%) of ZIKV disease. Three hundred
17.00
16.00
15.00
14.00
13.00
12.00
Knowledge Score

11.00
Research variables 10.00
9.00
Response variable 8.00
To assess knowledge regarding ZIKV disease, knowledge 7.00
domain of questionnaire was divided into 6 parts consisting 6.00
10.43 10.54 11.25
5.00 10.21
of 17 questions. For each question, “I know” response was 4.00
scored one, and “I don’t know” was scored as zero, for a 3.00
2.00
total possible score of 0–17, with higher scores indicating 1.00
better knowledge. 0.00
Nursing Pharmacy Dental Medical
College of study
Explanatory variables
The demographic domain of questionnaire consisted of Figure 1: Mean (±standard deviation) knowledge score of the study
seven questions pertaining to age, gender, nationality, respondents

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Rabbani, et al.: Zika virus disease knowledge

Table 1: Distribution of sociodemographic 100

characteristics (n=500) 95
90
85
Frequency (%) 95% CI 80
75
Age 70
18-19 104 (20.8) 17.2-24.2 65
60

Percent
20-21 212 (42.4) 37.8-46.8 55
50
22-23 131 (26.2) 22.2-30.0 45
40 78.2
24-25 35 (7.0) 4.8-9.4 35
30 62.2 57.7 57.6
>25 18 (3.6) 2.0-5.2 25 52.7 53.8
20
Gender 15
10
Male 243 (48.6) 44.4-52.8 5
Female 257 (51.4) 47.2-55.6 0
General Transmission Signs and Treatment Diagnosis Prevention
College Knowledge Knowledge Symptoms Knowledge Knowledge
Knowledge
Knowledge

Pharmacy 174 (34.8) 30.6-39.0 Knowledge Domains

Medical 257 (51.4) 46.8-56.0
Dental 43 (8.6) 6.2-11.2 Figure 2: Knowledge of study respondents regarding Zika virus
Nursing 26 (5.2) 3.2-7.4 disease by different domains
Year of study
Year 1 136 (27.2) 23.4-31.2 level of knowledge regarding ZIKV disease improved
Year 2 208 (41.6) 37.2-46.0 significantly (P = 0.026) as the year of study progressed.
Year 3 102 (20.4) 16.8-24.2
Year 4 50 (10.0) 7.4-12.8 DISCUSSION
Year 5 4 (0.8) 0.2-1.6
Marital status The present study was undertaken to assess the level of
Single 490 (98.0) 96.8-99.2 knowledge regarding ZIKV disease  –  a new emerging
Married 10 (2.0) 0.8-3.2 infectious disease in students of a medical and health
Nationality sciences university in the UAE. Medical and health sciences
Syrian 129 (25.8) 22.2-29.8 students are the future health‑care providers and their
Iraqi 118 (23.6) 20.0-27.2 understanding of this potentially serious disease is very
Emirati 64 (12.8) 9.8-15.8 important. UAE has a high influx of international travelers,
Egyptian 63 (12.6) 9.8-15.8 and there is a potential risk of transmission of ZIKV disease.
Irani 47 (9.4) 6.8-12.2 Public awareness about this disease is warranted, and
Yemeni 41 (8.2) 6.0-10.8 well‑informed health‑care providers play a very crucial role
Others 38 (7.6) 5.4-10.0 in spreading awareness regarding such diseases.
CI: Confidence interval

Our results revealed that the majority of the participants

seventy‑seven  (75.4%) of respondents knew that ZIKV
disease is transmitted by mosquito bite. Furthermore,
321  (64.2%) respondents recognized that ZIKV can be
passed by a pregnant woman to her fetus during pregnancy.
Majority of study participants (84.2%) acknowledged the
fact that they should avoid travel to places where ZIKV
outbreaks are going on. Table 2 and Figure 2 represent the
knowledge of study respondents on different aspects of
ZIKV disease.
The association of sociodemographic characteristics
and level of knowledge is presented in Table  3. Gender,
college and year of study, nationality, and attendance in
lecture/conference/workshop on Zika were significantly
associated with the level of knowledge. The males possessed
significantly (P = 0.046) better knowledge regarding ZIKV
disease as compared to the females. Students of medical
college had significantly  (P  =  0.005) better knowledge of
the disease as compared to students of other colleges. The
presented with poor overall knowledge of ZIKV disease.
These results are in line with recent studies conducted
in different populations; medical students in Saudi,[14]
health‑care workers in Indonesia,[8] and dental practitioners
in India.[7] In contrast, a study conducted in India among
dental students [13] reported that the majority of the
participants good possessed knowledge about ZIKV disease.
The poor knowledge of our study respondents can
be attributed to the fact that ZIKV disease is a recent
phenomenon and still not been included in the medical and
health sciences curriculum.
We reported that the mean knowledge score of the medical
students was the highest followed by the pharmacy, dental,
and nursing students. The mean knowledge score of the
study population was 10.48 ± 2.48. This result is in line with
a study conducted in a dental institute in India[13] where the
mean knowledge score of the participants was 11.73 ± 4.158.

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Table 2: Knowledge of respondents regarding Zika virus disease

Questions Frequency (%) 95% CI
General knowledge of Zika virus disease
As of early 2016, a widespread outbreak of Zika is ongoing, primarily in the Americas
I know 288 (57.6) 53.4-61.6
I don’t know 212 (42.4) 38.4-46.6
Knowledge of transmission of Zika virus disease
Zika virus is transmitted to people through the bite of an infected Aedes species
mosquito
I know 377 (75.4) 71.2-79.0
I don’t know 123 (24.6) 21.0-28.8
A pregnant woman can pass Zika virus to her fetus during pregnancy
I know 321 (64.2) 60.0-68.4
I don’t know 179 (35.8) 31.6-40.0
Zika can be passed through sex from a person who has Zika to his or her partners
I know 288 (57.6) 53.2-61.4
I don’t know 212 (42.4) 38.6-46.8
Zika can also be transmitted through blood transfusion
I know 319 (63.8) 59.8-68.0
I don’t know 181 (36.2) 32.0-40.2
Knowledge of signs and symptoms of Zika virus disease
The most common symptoms of Zika are fever, rash, joint pain, conjunctivitis
I know 287 (57.4) 52.8-61.4
I don’t know 212 (42.4) 38.4-47.0
Zika is mild with symptoms lasting for several days to a week
I know 238 (47.6) 42.8-51.8
I don’t know 262 (52.4) 48.2-57.2
Zika Infection during pregnancy can cause microcephaly and other birth defects
I know 282 (56.4) 52.0-60.6
I don’t know 218 (43.6) 39.4-48.0
Knowledge of treatment of Zika virus disease
There is no vaccine or medicine for Zika virus disease
I know 282 (56.4) 52.4-60.8
I don’t know 218 (43.6) 39.2-47.6
Only symptomatic treatment can be given
I know 295 (59.0) 54.8-63.4
I don’t know 203 (40.6) 36.2-44.8
Knowledge of diagnosis of Zika virus disease
Diagnosis of Zika is based on a person’s recent travel history, symptoms, and blood or urine
test results
I know 288 (57.6) 53.4-62.0
I don’t know 211 (42.2) 37.8-46.6
Knowledge of prevention of Zika virus disease
Avoid travel to places where Zika outbreaks are there
I know 421 (84.2) 81.2-87.4
I don’t know 79 (15.8) 12.6-18.8
Protect from mosquito bites by using insect repellent, wearing full sleeve clothes
I know 411 (82.2) 78.8-85.4
I don’t know 89 (17.8) 14.6-21.2
Condoms can reduce the chance of getting Zika from sexual intercourse
I know 341 (68.2) 64.2-72.4
I don’t know 159 (31.8) 27.6-35.8
CI: Confidence interval

Majority of the participants (75.4%) were aware of the fact findings were reported by studies conducted among mixed
the ZIKV disease is transmitted by mosquito bite. Similar population of students and faculty in the Middle East

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Table 3: Association of sociodemographic Our findings revealed that half of the participants had
characteristics and level of knowledge knowledge regarding ZIKV disease signs and symptoms
Variable n Good Poor P which is slightly higher than reported by a study among
knowledge knowledge medical students of a Saudi university[14] (41.8%) but lower
Age (%) than the studies conducted in India.[7,13]
18-19 500 48.1 51.9 0.114
20-21 34.0 66.0 In our study, males possessed significantly better knowledge
22-23 32.8 67.2 of the disease as compared to females. Similar findings were
24-25 34.3 65.7 reported in the study conducted in a Middle East country.[10]
>25 38.9 61.1 Singh et al. reported contrasting results where females had
Gender (%) a better awareness of the disease as compared to males.[13]
Male 500 40.7 59.3 0.046
Female 33.1 66.9 Our study demonstrated that the level of knowledge
College (%) regarding ZIKV disease improved significantly as the year
Pharmacy 500 29.3 70.7 0.005 of study progressed. This can be attributed to the fact that
Medical 44.4 55.6 as year of study advances students get more exposure and
Dental 27.9 72.1 become more aware of new emerging disorders.
Nursing 26.9 73.1
Year of study (%) The main strength of the study is that it takes up
Year 1 500 31.6 68.4 0.026 knowledge assessment of a potentially serious emerging
Year 2 39.9 60.1 viral disease of the future health‑care providers of UAE.
Year 3 45.1 54.9
Another strength of the study is the high‑response rate
Year 4 40.0 60.0
of the survey (89%). An important strength of the study
Year 5 95.2 4.8
is its multiethnic sample. The present study has some
Nationality (%)
limitations also. A selection bias may have been there due
Syrian 500 40.3 59.7 0.048
to the cross‑sectional nature of the study and random
Iraqi 45.8 54.2
sampling. Another limitation is that it may not be the only
representative of the students studying in UAE. The level
Emirati 32.8 67.2
of knowledge may vary with universities.
Egyptian 33.3 66.7
Irani 38.3 61.7
Yemeni 24.4 75.6 CONCLUSION
Others 21.1 78.9
Attended lecture/
Overall, the study participants presented with poor
conference/workshop knowledge of ZIKV disease  –  new potentially serious
on Zika (%) mosquito‑borne disease. Although there are no reported
Yes 500 85.6 14.4 <0.001 cases of ZIKV disease in the UAE, there is a potential risk
No 44.2 55.8 of transmission due to high influx of international travelers.
Statistically significant values are in bold There is a need for the medical and paramedical students
to update their knowledge of ZIKV disease as they are
country[10]  (73.3%), dental students in India[13]  (88%) and the future health‑care providers who will be responsible
general public in Malaysia[9] (85.8%). for creating awareness about such outbreaks and their
preventive measures.
Our study demonstrated that a large proportion (64.2%) of
study respondents knew that ZIKV can be passed by a pregnant Acknowledgments
woman to her fetus during pregnancy. These findings are The authors would like to thank students of RAK Medical
consistent with the studies conducted in Saudi[14] and Malaysia.[9] and Health Sciences University for participating in the
study. The authors also thank Dr. S. Gurumadhva Rao, Vice
Majority of our study participants agreed to the fact that Chancellor; Dr. B. G. Nagavi, Dean; Dr. Padma G. M. Rao,
they should avoid travel to places where ZIKV outbreaks are Associate Dean, RAK Medical and Health Sciences University
going on. The general population of the Malaysian study[9] for their support and encouragement.
on ZIKV also acknowledged this fact.
Financial support and sponsorship
The findings related to knowledge of prevention and Nil.
transmission of ZIKV among our study respondents is
encouraging as prevention is the best approach for such Conflicts of interest
outbreaks. There are no conflicts of interest.

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Rabbani, et al.: Zika virus disease knowledge
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