INTRODUCTION

f-limited disease New Zealand, USA, Canada) with good sanitary which results in fulminate hepatitis and death in and hygienic conditions, infection rates are only a small proportion of patients. However, it generally low. In countries with very low is a significant cause of morbidity and sociohepatitis ‘‘A’’ viral (HAV) infection rates, economic losses in many parts of the world disease may occur among specific risk groups (WHO, 2000). Geographic areas can be such as travelers (WHO, 2009). characterized by high, intermediate, or low levels Daycare and school staff have a key role in endemicity patterns of Hepatitis viral in preventing the transmission of diseases in infection. The levels of endemicity correlate day-care and school environment (Australian with hygienic and sanitary conditions of each Department of Health, 2010). Any program geographic area (WHO, 2010). In developing provides advice for teachers can help to countries with very poor sanitary and hygienic minimize the spread of infection in schools conditions (parts of Africa, Asia and Central and (Baxter, 2005).The risk of transmission of most South America), infection is usually acquired communicable diseases can be reduced during early childhood as an asymptomatic or significantly by routine attention to basic mild infection. Reported disease rates in this hygiene. All staff and children should be areas are therefore low and outbreaks of disease encouraged to maintain control spread of are rare, while in countries with transitional communicable disease and straightforward basic economies and some regions of industrialized good practices. Infections can be passed on countries where sanitary conditions are variable before a person is knowingly unwell (Health (Southern and Eastern Europe, some regions in protection agency, 2005). This study objected to the Middle East), children escape infection in construct an educational program in respect to early childhood. Paradoxically, these improved Hepatitis "A" for primary teachers in Kirkuk economic and sanitary conditions may lead to a governorate. higher disease incidence, as infections in older

MATERIALS AND METHOD

To achieve the objective of the present study a quasHepatitis "A", one of the oldest diseases (Northern and Western Europe, Japan, Australia, known to humankind, is a seli-experimental design was depended on the period (1/7/2011 through 20/4/2012). A probable (stratified) sample of (80) teachers has participated voluntarily from (80) primary schools in Kirkuk governorate (who gave their approval). The method of sampling followed was by dividing the governorate to districts (inside and outside Kirkuk city), then selected reasonably one school from each district and one teacher from each school appointed. The sample was divided into two equal groups of (40) teachers, one group was exposed to an educational program (study group), while the second did not expose to the program (control group). To construct the educational program, five steps were undertaken: Depending on reviewing diseases profile of Health Directorate in Kirkuk, and consulting many professional physicians in the directorate, it was obvious that (Hepatitis A) had high prevalence rates among primary school pupils, so, the researchers selected the disease to construct an educational program regarding it and applicated it on the primary school teachers.

A special questionnaire was developed after reviewing many related kinds of literature, it composed of two parts, part-1; Sociodemographic data as age, gender, years of service, part-2; fourteen items about hepatitis ‘‘A’’ (seven for knowledge, five for practice and two for attitudes), the questionnaire was exposed to twenty-one experts for validation,  their comments were undertaken in the final draft of the tool, while the reliability of the tool was measured through a technique of test-retest after application on ten teachers out of the study sample, it was (r.= 0.83).

RESULTS

The pre-test for the subjects was carried out to indicate their levels of knowledge, practice, and attitude about the selected disease for study and control groups. The educational program was constructed regarding the disease taking into consideration the subjects' knowledge, attitudes, and practices with respect to the disease. It was applied as three lectures for three days in-between on the study group in a special hole in one of the schools inside the city. The researchers used audio-visuals related to posters, videos in addition to discussions between the subjects and the researchers, each lecture took between (1 – 1.5) hour. Post-test for the subjects in the study group was carried out to indicate the acquisition of knowledge, practice, and attitude with respect to the disease after three weeks of carrying out the program. All items had two options (correct=1) while (incorrect=zero). SPSS version-18 computer software was used for the analysis of data. The statistical measures used were; mean and standard deviation as a descriptive statistic, and test for paired samples as an inferential statistic. The probability value depended to indicate the significance was (p. ≤0.05).

 Table (1): Socio-demographic Characteristics of the Subjects in Study and Control Groups:

Table (2): Comparison between Pre-test Scores for Study and Control Groups regarding Hepatitis "A" by using t-test.

 Table (3): Comparison between Post-test Scores for Study and Control Groups regarding Hepatitis "A" by using t-test.

 Table (4): Association between Post-test of KAP scores in regard to Hepatitis "A" with Gender of the Study Group by using t-test.

Table (5) Analysis of Variance of Teachers' Knowledge, Attitudes and Practices for Post-test scores regarding the age of the study group;

Table (6) Analysis of Variance of Teachers' Knowledge, Attitudes and Practices for Post-test Scores regarding Years of Work for Study Group;

DISCUSSION

 Children, especially those at school age are at increased risk of infectious diseases due to their increased activity, poor knowledge, and inappropriate personal health practices. Nurses' role as counseling or adviser impedes on them the responsibility of health teaching to prevent these diseases. To achieve that, constructing an educational program about infectious disease is necessary to help teachers developing their knowledge, practices, and attitudes to ensure the safety of children. The important limitation the researches faced was that there is no related literature about such health programs regarding communicable diseases among teachers. In this study, the researchers assessed knowledge, attitudes, and practices with respect to Hepatitis "A" as one of the common childhood communicable diseases as a trial to determine the weak points they had with respect to the disease, also to construct and implement such educational program regarding that. Throughout the course of data analysis, it depicted that more than two-thirds of the study sample were males (62.5, 72.5%) in study and control groups respectively (table-1). This result is in agreement with a study done by Mushtaq and colleagues (2011). Relative to age, the age group of (25-34) years of the study and control groups accounted highest proportions (40%, 45%) respectively (Table- 1). This result is in agreement with the findings of a previous study done by Girgis and colleagues (2011). Regarding years of employment, more than one-quarter of the study group had less than five years of employment in addition to the same percentage of the category of (5-9) years, also, 1/3 of the control group were from the category of fewer than five years of employment as (27.5%, 32%) respectively (Table- 1). Prior to the implementation of the educational program, a pre-test was carried out on both groups (study and control). It was found that there were no significant differences between the two groups at all topics related to the disease. It means that teachers had the same knowledge, attitudes, and practices about the disease (Table2). After completion of the educational program, a comparison of post-test scores- that was administered for both groups three weeks later was carried out. Results indicated that there were significant differences among all topics related to the disease (Table- 3). This means that teachers had got improvement in their knowledge, attitudes, and practices regarding the disease. This was agreed with the findings of a previous study (Wu, 2007). Results of teachers' KAP scores with respect to the demographic characteristics did not show any significant differences in all topics regarding the disease (Tables- 4,5,6). These results can be due to many factors; smallness of the sample, importance of the program topics to the community that imposes liability on teachers to pay more attention to prevent any health problem related, the simplicity of the presentation of the information accompanies with the actuality of the explanation of the disease, commitment in attendance all sessions for the suitability of the time of sessions and number of it, stay far from the routine style in presenting information and dependence on discussion and feedback for each information, in addition, to use different audiovisuals, and the strong desire of teachers to enroll and attend all sessions of the program. Children, especially those at school age are at increased risk of infectious diseases due to their increased activity, poor knowledge, and inappropriate personal health practices. Nurses' role as counseling or adviser impedes them the responsibility of health teaching to prevent these diseases. To achieve that, constructing an educational program about infectious disease is necessary to help teachers developing their knowledge, practices, and attitudes to ensure the safety of children. The important limitation the researches faced was that there is no related literature about such health programs regarding communicable diseases among teachers. In this study, the researchers assessed knowledge, attitudes, and practices in respect to Hepatitis "A" as one of the common childhood communicable diseases as a trial to determine the weak points, they had in respect to the disease, also to construct and implement such educational program regarding that. Throughout the course of data analysis, it depicted that more than two-thirds of the study sample were males (62.5, 72.5%) in study and control groups respectively (table-1). This result is in agreement with a study done by Mushtaq and colleagues (2011). Relative to age, the age group of (25-34) years of the study and control groups accounted highest proportions (40%, 45%) respectively (Table- 1). This result is in agreement with the findings of a previous study done by Girgis and colleagues (2011). Regarding years of employment, more than one-quarter of the study group had less than five years of employment in addition to the same percentage of the category of (5-9) years, also, 1/3 of the control group were from the category of fewer than five years of employment as (27.5%, 32%) respectively (Table- 1). Prior to the implementation of the educational program, a pre-test was carried out on both groups (study and control). It was found that there were no significant differences between the two groups at all topics related to the disease. It means that teachers had the same knowledge, attitudes, and practices about the disease (Table2). After completion of the educational program, a comparison of post-test scores- that was administered for both groups three weeks later was carried out. Results indicated that there were significant differences among all topics related to the disease (Table- 3). This means that teachers had got improvement in their knowledge, attitudes, and practices regarding the disease. This was agreed with the findings of a previous study (Wu, 2007). Results of teachers' KAP scores with respect to the demographic characteristics did not show any significant differences in all topics regarding the disease (Tables- 4,5,6). These results can be due to many factors; smallness of the sample, importance of the program topics to the community that imposes liability on teachers to pay more attention to prevent any health problem related, the simplicity of the presentation of the information accompanies with the actuality of the explanation of the disease, commitment in attendance all sessions for the suitability of the time of sessions and number of it, stay far from the routine style in presenting information and dependence on discussion and feedback for each information, in addition to using different audiovisuals, and the strong desire of teachers to enroll and attend all sessions of the program.

CONCLUSIONS

The study concludes that there is a lack of teachers' knowledge, attitudes, and practices in regard to the disease before the implementation of the educational program. Good acquisition of knowledge, attitudes, and practices after implementation of the educational program. In addition, Demographic characteristics of teachers had not indicated an obvious association with knowledge, attitudes, and practices regarding the disease after the implementation of the educational program.

RECOMMENDATIONS

Construct of an Infectious Disease Control Guidelines for schools by the Ministry of Health about childhood communicable disease to help teachers to prevent and control such disease among pupils. In addition, the present study recommends that applying for such educational health programs in all Iraqi governorate primary schools to increase awareness about communicable disease controls among teachers. Inclusiveness other communicable diseases in such educational health programs.

REFERENCES

Australian Department of Health, Government of Western Australia. (2010). Communicable Disease Guidelines for teachers, childcare workers, local government authorities, and medical practitioners. Prevention and control program, Department of Health. Australia. p 2.

Baxter, D. (2005). Infection control and cross infection guidelines for school, control of infection unite. (6thed.)Stockport NHS. p13. Girgis, N., Elbahnasawy, H., and Omer, T. (2011). Changing Mothers' Behavior to prevent Viral Infectious Diseases among their Children by using the Health Belief Model. Canadian Journal of Medicine.2(2)p29-33.

Health protection agency. (2005). The control of communicable diseases in schools and nurseries. p 5.

Mushtaq, M., Shahid, U., Abdullah, H., Saeed, A., Omer, F., Siddiqui, A. (2011). UrbanRural Inequities in Knowledge, Attitude, and practices regarding tuberculosis in two Districts of Pakistan's Punjab province. International Journal for Equity in Health. 10 (8). p 2-6.

World Health Organization (WHO). (2000). Hepatitis A - An Introduction, Hepatitis A, Department of Communicable Disease Surveillance, and Response. p 4.

World Health Organization (WHO). (2010). Postgraduate Programs School of Public Health and Community Medicine, Communicable Diseases Humanitarian Emergencies. p 3.

World Health Organization d (WHO). (2009). Hepatitis A Virus, The Global Prevalence of Hepatitis A Virus Infection and Susceptibility: A Systematic Review, Department of Immunization, Vaccines, and Biologicals (IVB). Switzerland, WHO.p4-6.

Wu, C. (2007). Effectiveness of a Specific Infection Control Education Program for Taiwanese Nursing Students, Queensland University of Technology. Institute of Health and Biomedical Innovation, School of Nursing. p 115-138.

([1]) Assist. Lecturer / College of Nursing / University of Mosul/ narynurse@yahoo.com.

([2]) Assist. Prof./ Mosul Technical Institute