AbstractAbstract

Although outbreaks of infectious diseases are uncommon, specifically in sports settings, effective information distribution may aid in managing difficult conditions and enhance preparedness for future pandemics. Hence, the study assessed the knowledge, attitude, and preventive practices of infectious diseases among student-athletes in selected senior high schools (SHS) in Ghana. The descriptive cross-sectional study recruited 405 SHS student-athletes (160 males, 245 females) with a mean age of 17.86 ± 2.19. A modified and re-validated knowledge, attitude, and practice questionnaire was administered. Sixty three percent had adequate knowledge about infectious diseases, 54.1% had a positive attitude towards infectious disease prevention, and 59.5% had good practices regarding infectious diseases. Sixty-two percent opined that viruses, 27.2% bacteria, 6.9% parasites, and 4.0% fungus cause infectious diseases. Participants’ knowledge significantly correlated with attitudes and prevention practices (p = .001). Attitudes positively correlated significantly with knowledge and preventive practice (p = .001). Age classification, class, household size, and type of sports positively correlated with knowledge, attitude, and preventive practices of infectious diseases. Younger student–athletes more often had adequate knowledge, a positive attitude, and good preventive practices regarding infectious diseases compared to older colleague-athletes. Student-athletes from lesser household sizes, dormitory sizes, and class sizes more often had adequate knowledge, positive attitudes, and good preventive practices for infectious diseases. Student-athletes’ knowledge positively influences their attitudes and preventive practices regarding infectious diseases. Teachers should be exposed to sustainable infection preventive knowledge to foster, promote and monitor infectious diseases among the students.

Keywords:Keywords:

infectious disease, knowledge, attitude, preventive practice, senior high schools, student-athletes

IntroductionIntroduction

Infectious diseases are transmitted through direct contact between individuals or indirectly through other mediums, such as contaminated food, water, faeces, bodily fluids, or animal items (Nash et al., 2015; Steffan et al., 2020). These diseases were responsible for the most terrifying plagues throughout history, with new ones always appearing (Foege, 2020). As influenza epidemics have demonstrated, a novel pathogen that first manifests locally somewhere in the world might spread over entire continents in days or weeks (Ford, 2020).

Infectious diseases continue to devastate human health, negatively affecting various aspects of life, including education and sports (Palmer et al., 2020). Infectious diseases are a prominent factor contributing to mortality globally, especially in less developed nations like Ghana, and they tend to be widespread among various populations, including school students, particularly young children (Ohene et al., 2011).

Schools are a major avenue for infectious disease transmission due to the close proximity of young people, some of whom may not practice basic personal hygiene or have sufficient immunity to certain diseases (World Health Organization, 1999). Diseases can also be transmitted through airborne means, where agents have a higher potential to infect more individuals compared to those transmitted via direct contact (Jones & Brosseau, 2015).

Athletes participate in sports, often engaging in direct skin-to-skin contact, which can facilitate the spread of infections (Nowicka et al., 2020). As a result, there is growing concern surrounding infectious disease outbreaks among athletes participating in sports. These outbreaks can impact coaches, support personnel, spectators, and the entire school community, potentially leading to severe health issues (Nowicka et al., 2020; Peterson et al., 2019; Raji et al., 2023). Therefore, it is vital to explore athletes' knowledge of infectious diseases, attitudes towards infection prevention, and potential preventive measures, especially in developing countries with limited healthcare resources.

MethodsMethods

EthicsEthics

The Committee on Human Research Publications and Ethics reviewed and approved the study (CHRPE/AP/498/23). Permission was taken from the various school heads to conduct the study. Participants were briefed on the study's objectives and the various sections of the questionnaire and assured of the confidentiality of the information they provided. Their consent was sought, and after gaining a personal understanding of the study, they were made to sign a consent form of participation. The study posed no harm or physical risk to the study participants.

The study employed a descriptive cross-sectional study design. The study employed both convenience and purposive sampling methods.

ParticipantsParticipants

The study recruited 450 student-athletes from 10 different selected senior high schools in Ghana and the number of athletes selected in each school was 45. Four hundred and five questionnaires were retrieved for data analysis, while 45 (10%) were not returned and could not be recovered despite follow-up. The study included students who were not sick, on any medication for health issues, available during data collection, participated in sporting activities, were able to read and write in English and were not living with any disability.

InstrumentationInstrumentation

The study adopted, modified and re-validated a pretested face-to-face Knowledge, Attitude and Preventive Practices structured questionnaire originally designed by Feleke et al. (Feleke, Adane, et al., 2022; Feleke, Gebrehiwot, et al., 2022). The initial reliability value of the instrument was 0.79. After modifications and re-validation, the Cronbach's Alpha reliability value for all variables tested was 0.76, and the Cronbach's Alpha based on Standardized Items was 0.77, signifying strong reliability. The questionnaire was divided into four main sections: Section A encompassed demographic details with nine questions, Section B covered infectious disease knowledge, Section C delved into attitudes toward infectious disease prevention, and Section D explored infectious disease preventive practices, all with 15 questions each. Personal identifiers were not collected during data collection to ensure participant confidentiality.

Prior to collecting data, all participants received a comprehensive explanation of the research objectives. Participants were informed about their right to withdraw from the study at any point and were assured that their responses would remain anonymous and confidential. Informed consent was obtained through a consent form, indicating their approval for participating in the research. Upon granting consent, participants proceeded to answer questions related to the variables assessed in the study.

Statistical AnalysisStatistical Analysis

Statistical Package for Social Sciences (SPSS) version 27.0 was used for data entry and analysis. Descriptive statistics presenting means with standard deviations were used for continuous variables and frequencies and percentages for categorical variables to gauge student-athletes' overall understanding of infectious diseases, their attitudes toward disease prevention, and the variety of preventive approaches adopted by senior high school student-athletes in Ghana. Chi-square tests and Pearson correlation coefficient values (p-values) were utilized to examine the relationship between demographics and knowledge, attitude, and preventive practices of infectious diseases among student-athletes. Respondents scoring above or equal to the mean value [mathematically straightforward and commonly understood (Habibzadeh et al., 2017)] were categorized as having adequate knowledge, positive attitude and good preventive practices toward infectious disease prevention. Conversely, those scoring below the mean value were classified as having inadequate knowledge, a negative attitude, or poor practices toward infectious disease prevention. The significance level was set at α = 0.05.

ResultsResults

Table tbl. 1 reveals that 60.5% of the study participants were female and 39.5% were male. There were 61.5%, 27.4%, and 11.1% participants in forms 3, 2 and 1, respectively. Most participants were Christians 91.6%, Muslims were 7.7%, and the remaining 0.7% belonged to other religions. The mean age of the study participants was 17.86 ± 2.19, with a household size average of 7.00 ± 5.64, an average of 44.24 ± 16.17 of students in a class, and an average of 29.04 ± 21.53 of students in a dormitory. 67.4% of the participants fall between the ages of 17-19 years, 63.2% are found in household sizes of about 3-6 members, 88.1% stay in dormitories of less than 50 people and 67.4% are in classes of less than 50 people. 40.5% of the participants participated in athletics (track and field events), 22.0% in football, and 14.6% in basketball.

Table tbl. 2 reveals that 42.2% of the study participants stated that the minimum time needed for hand washing was one (1) minute, 34.8% said that the minimum time required for hand washing was twenty (20) seconds, 16.0% stated that the minimum time needed for hand washing was ten (10) seconds, and the remaining 6.9% said that the minimum time required for hand washing was 5 seconds.

Table tbl. 3 revealed that HIV/AIDS, with 17.8% is the most common infectious disease known by the participants, followed by COVID-19 with 17.3%. Diseases less known are Hepatitis B, Ringworm and Candidiasis (2% or less).

Table tbl. 4 showed that most of the study participants (31.9%) stated that their source of information about infectious diseases was from their teachers, 24.9% found out about infectious diseases on the internet, and 18.8% got information from hospital workers.

According to table tbl. 5, majority of the participants (63.0%) had adequate knowledge about infectious diseases, with a mean knowledge score of 9.67 ± 1.72, 54.1% had a positive attitude towards infectious disease prevention, with a mean attitude score of 11.52 ± 1.91 and a mean preventive practice score of 10.80 ± 3.31, 59.5% of the study participants had good practices regarding the acquisition of infectious diseases.

From table tbl. 6, the correlation coefficient (0.363) of attitude towards infectious diseases and preventive practices of infectious diseases indicates a moderate to strong positive relationship, while the correlation coefficient (0.313) of knowledge of infectious diseases and attitude towards infectious diseases indicates a moderate positive relationship, and the correlation coefficient (0.216) of knowledge of infectious diseases and preventive practice indicates a weak to moderate positive relationship; however, the relationship is not as strong as that between attitude and practice.

Table tbl. 7 reveals that all the demographics positively correlated with knowledge, but the type of sport played by each participant correlated significantly.

Table tbl. 8 reveals that all the demographics positively correlated with attitude, but the class/form of each participant correlated significantly.

Table tbl. 9 reveals that all the demographics positively correlated with attitude, but age and household size correlated significantly.

DiscussionDiscussion

The main objective of the study was to investigate the knowledge, attitude, and preventive practices of infectious diseases among senior high school student-athletes in Ghana, which is novel in this sense.

According to the study, a sizeable portion of the study subjects (more than half) disclosed that they adhered to the advised practice of washing their hands for at least twenty seconds, a good habit for maintaining hygiene and preventing the spread of infections (germs and illnesses) as shown in table tbl. 2. This finding aligns with earlier studies (Feleke, Adane, et al., 2022; Feleke, Gebrehiwot, et al., 2022; Jackson et al., 2021).

Table tbl. 3 revealed that the most common examples of infectious diseases known by the respondents were HIV/AIDS and COVID-19, as earlier reported (Aliyu et al., 2013). This may be due to the prevalence of HIV/AIDS in Ghana over the decade, as well as the current outbreak of the COVID-19 pandemic. Also, it implies effective public health campaigns, media influence, and the global significance of the diseases mentioned above. It also raises questions about the extent of awareness regarding other infectious diseases [Hepatitis B (1.2%), Candidiasis & Ringworm (2.0%), Ebola & Whooping Cough (2.5%)] and underscores the importance of well-rounded health education.

Table tbl. 4 indicates that the participants largely depended on their teachers as their primary source of infectious disease knowledge, followed by the Internet, consistent with a study among Secondary School Youth in Zaria, Nigeria (Aliyu et al., 2013). This emphasizes the importance of education and the digital world in changing people's awareness of health-related issues.

Results from Table tbl. 5 showed that infectious disease health education initiatives among student-athletes have been successful, as more than half of the participants showed adequate knowledge, positive attitudes, and good preventative practices. This demonstrates recommendable behaviour, increased health literacy, and decreased infection risks in the setting of sports. The findings from the current study correlate with a study (Alrasheedy et al., 2021) which discovered that students had good knowledge, as well as positive attitudes and good practices towards infectious diseases like COVID-19.

Table tbl. 6 suggests that knowledge, attitude, and preventive practice of infectious diseases among student-athletes are interconnected. The results revealed a positive correlation between knowledge and attitude; attitude and practice, as well as knowledge and preventive practice among students-athletes, as earlier submitted (Adli et al., 2022). Improving knowledge about infectious diseases can lead to positive attitudes, encouraging individuals to adopt and maintain the desired preventive practices. This insight is valuable for designing educational campaigns or interventions promoting specific behaviours, such as health-related preventive practices.

Student-athletes in Ghana senior high schools have adequate knowledge, positive attitudes, and good preventive practices toward infectious disease prevention, whereby their level of knowledge influences their attitude and preventive practice of infectious disease. With respect to age and gender, younger and female student-athletes have adequate knowledge, positive attitudes, and good preventive practices compared to their older and male counterparts. These findings could imply that the younger and female populations were smart, more adaptable, and had better access to technology (Bello et al., 2021).

SHS sports teachers should be exposed to sustainable infection preventive programmes to foster, promote and monitor existing infectious disease levels among the student-athletes. Seminars should be organized for the second cycle schools’ sports officials to enlighten them on infectious diseases, their causes, transmission mode, treatment and management. The study is limited by a small sample size that might not speak for all student–athletes in Ghana's various senior high schools.

ReferencesReferences