Graduation Thesis

Defense

Department of dentistry

Aug 19 ,2024
Knowledge and Attitudes towards Management of
Medical Emergencies among Undergraduate
Dental Students at Atlas College of Health Science,
Addis Ababa, Ethiopia

Investigator- Sebah Mohammed

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Advisor- Sisay Dejene (MPH)
Contents

Introduction
Objective
Materials and Methods
Results and discussion
Conclusions
recommendation
Limitation of the study
References
Acknowledgment
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 Introduction
 Dentistry is a branch of medical sciences that involves active clinical practices that could be
invasive involving injections, surgeries, extractions, and some long-standing procedures. In
the event of these procedures, there are possibilities that some complications leading to a
medical emergency.[1]

 Various medical emergencies  Most dental students lacks

Include
 syncope,  enough knowledge,
 foreign-body airway obstruction,  confidence, and
 heart attack,  preparedness in managing such
 anaphylactic reaction, emergencies.
convulsions, asthmatic attack, and
in rare instances sudden cardiac
death.

 Over all
This research dives into the knowledge and attitude of undergraduate dental
students at Atlas College of Health Science in Addis Ababa, Ethiopia, regarding
medical emergency management.
 Statement of the Problem
Management of medical emergencies is a critical skill for
all healthcare professionals, including dental students who
will soon be providing patient care.
Worldwide studies previous studies
show that the level of training Data from previous studies
and level of knowledge on suggest that more than 3
management of medical million sudden cardiac death
emergencies of the studied occur worldwide every year
dental students is below and survival is lower than 8%.
desirable standard. [12]
. .

The lack of robust data on the knowledge and attitude of Atlas College students
towards medical emergencies further hinders meaningful interventions.
Without understanding their current standing, it is difficult to tailor educational
resources, training programs, and support systems to address their specific needs
and optimize their preparation for real-world scenarios.
 At the end this research paper answer for
What is the level of knowledge and attitude of undergraduate dental students at
Atlas College of Health Science in Addis Ababa, Ethiopia, regarding the
management of medical emergencies
 Significance of the Study
Understanding the knowledge and attitude of undergraduate dental students towards
medical emergency management holds significant value for multiple stakeholders,
including the students themselves, Atlas College of Health Science, and the wider
Ethiopian healthcare system.

For ACHS
Firstly, this study's findings will be crucial for Atlas College in refining its
curriculum and training programs.

For Ethiopia
Secondly, the insights gained from this research extend beyond the
college, impacting the broader Ethiopian healthcare system.
 Objective
General Objective
 To assess knowledge and attitude of undergraduate dental students at
Atlas College of Health Science in Addis Ababa, Ethiopia, regarding the
management of medical emergencies.

Specific objective

To determine level of knowledge among undergraduate dental

students on the medical emergencies.

To determine the attitude of students towards handling medical

emergencies.
.
Material and Method
1 Study area
 conducted in Atlas College of health science which is located in kirkos sub
city, Addis Ababa.
 established around 2003 G.C.
 The college has three departments ,doctor of dental medicine, dental therapy
and bachelor of dental science.
 The first dental graduate was in 2010 G.C, with 25 DDM. Currently the
college has a total of 684 students, which are 303 doctor of dental medicine,
248 bachelor of dental surgery, 133 dental therapies.

2 Study period

The study was conducted from Feb 10 to March 15, 2024

Study design
3
Institutional based descriptive, cross-sectional survey used.
 Population
Source Population
includes students at Atlas College of Health Science who are final year
BDS and Dental Therapy students, as well as DDM students in their fourth
year and above.

Study population
The study population was selected from the college students list that fulfill
the inclusion criteria during the data collection period was considered as
study participants.

Inclusion and exclusion criteria

Inclusion Exclusion
Dental students above fourth year Students who were
department of DDM and BDS in Atlas in internship.
college of health science Students who are
Last year of Dental therapy students in unwilling
Atlas College of health science were
included.
 Sample size determination
Sample size was determined by using single population proportion formula with 95% confidence
interval (CI) and 5% margin of error. Since there is no previous finding reported sample proportion of
50% will be used for sample size calculation.
Formula: n = z^2 * p (1 - p) / d^2

Where:
n = sample size z = confidence level (e.g., 1.96 for 95%) p = estimated proportion of students with
desired knowledge/attitude (e.g., 0.5 if you expect 50%) d = margin of error
(e.g., 0.05 for +/- 5% accuracy n = 1.96^2 * 0.5 * (1 - 0.5) / 0.05^2 ≈ 384
Since the study population is relatively small (321), by applying the finite population correction for
greater accuracy.
Formula: Correction factor = N / (N + n - 1) where:
N = total population size (321) n = calculated sample size (384)
Correction factor = N / (N + n - 1)
= 321/ (321 + 384 - 1) ≈ 0.46
Adjusted sample size: n adjusted = n * correction factor ≈ 321* 0.46= ≈148
Adjustment for non-response rate of (10%) = 148+14.8= ≈162.8
Sampling Procedure and technique study variable
 The research conducted using
simple random sampling Dependent variable Independent variable
technique.  Age
 Occupation
 Knowledge of students
 Income
 By obtaining sampling frame for  Attitude of students  Educational status
the students above fourth year for  Employment status
DDM, and final year for BDS and  Sex
DT of student from the register
office of Atlas College.
 Then by using random selection 163
was obtained from sampling frame.
Data collection tool and procedures
The data collected using a self-structured questionnaire. The
questionnaire was supplied English language.
From a total of 163 students will be selected randomly from
the sampling frame of dental students that obtained from
registrar office of Atlas College.
.
1 The questionnaire contains
 socio demographic
information
 18 knowledge based
 9 attitude concerning

2 The questionnaire includes

 BLS,  drugs used in emergencies

 CPR in dental practice.
 assessment and resuscitation  management of epileptic
techniques regarding airway, patient, [16, 17]
breathing, circulation ,
Data quality assurance and management
 The questioners are adopted from the other studies. Finally,
the collected data was checked for completeness during the
data collection, entry, and analysis process.

Data Analysis
 After data collection, the data was checked for completeness.
 Then coded and entered into SPSS for analysis.
 Descriptive statistics is used to summarize the study findings.
 Finally the data is presented using tables as well as in statements.

Dissemination of the result

The result will be disseminated in soft and hard copy to Atlas
College of Health Sciences Department of Dental Medicine, and will
be available for any research in the future that desires to take any
background data from the results of the current one.
 Ethical Consideration
 Ethical clearance letter was obtained from Atlas
College and forwarded to the concerned party.
 Permission was secured from the local authorities of
the study area.
 Permission and written consent from dental students
(DDM, BDS, Therapy) was requested before data
collection begins, and only volunteers and students in
inclusion criteria.
 Privacy and confidentiality was maintained
throughout the process of the study.

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 Operational definition
Knowledge: in this study knowledge means the fact or condition
of being aware of managing medical emergency. OR the range of
one's information or understanding regarding management of
medical emergency.
Attitude: in this study Attitude means a settled way of thinking or
feeling about management of medical emergency.
Good Knowledge: refers to respondents who correctly answer
>60% of the total knowledge question. [18]
Poor Knowledge: refers to respondents who correctly answer
<60% of the total knowledge question. [18]
Positive attitudes: refers to respondents who score greater than
the mean score. [18]
Negative attitudes: refers to respondents who score less than the
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mean score. [18]

 5. Result
 Sociodemographic data

Category Frequency Percentage

Characteristics

20-25 90 55.2
26-30 35 21.5
>30 38 23.3
Age
male 77 47.2
female 86 52.8
Gender
DDM 64 39.3
BDS 48 29.4
DT 51 31.3
Department
4th 57 35.0
5th 35 21.5
>5th 20 12.3
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3rd 51 31.3
Educational level
employed 43 26.4
unemployed 120 73.6

Employment in health care unit

Knowledge about medical emergency management

About management of breathing difficulty 37(27.7%)

have good knowledge , 27(16.6%) have fair
knowledge ,69(42.3%) have poor knowledge ,3(1.8%)
have very poor knowledge .

About Dental treatment due to aspiration of foreign

body, about 43(26.4%) response was they examine
mouth and local area , 33(20.2%) will Ask patient to
cough , 71(43.6%) attempt Heimlich maneuver and
16(9.8%) response was they will do all the listed above .

Respiratory distress patient can be managed by oxygen

inhalation or not, 32(19.6%) respond was no and 18
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(11%) are uncertain.

About the immediate management for a patient having a hypoglycemic attack,
10 (6.1%) IV atropine, 86 (52.8) gives IV Glucose, 56(34.4%) gives Oral
Glucose, and 11(6.7%) respond as Saline Infusion.

Students asked about whether the transfusion of blood manages patient

develops sever oral bleeding after extraction or not, 76(46.6%) respond as yes
and 67(41.1%) respond no, the rest 20 (12.3%) are uncertain.

About CPR 31(19%) respond 30 chest compressions and 2 rescue breaths at a

rate of 100-120 compressions per minute ,104 (63.8%) 15 compression to 2
breathing

About recommended chair position for a patient having a syncope attack

20(12.3%) prefer 45-degree position , 13(8%) make chair at supine position ,
93(79.8%) Supine position with feet slightly elevated (Trendelenburg position).
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 perc
Category Frequency Present Category frequency enta
Question ge
Question
Excellent 27 16.6
10 chest compressions and 1
28 17.2
rescue breaths
Good 37 22.7
Fair 27 16.6
rate your overall 30 chest compressions and 2
knowledge of managing Poor 69 42.3 rescue breaths at a rate of 100- 104 63.8
breathing difficulty very poor 3 1.8 120 compressions per minute
CPR ratio
Examine mouth and local
43 26.4
area 15 compression to 2 breathing 31 19
airway obstruction Ask patient to cough 33 20.2
during Dental treatment Yes 58 35.6
due to aspiration of Attempt Heimlich no 61 37.4
71 43.6
foreign body, what maneuver Do CPR indicated for hypotensive patient
would you do All 16 9.8 Uncertain 44 27
Yes 87 53.4 Yes 47 28.8
No 15 9.2 no 73 44.8
Respiratory distress Do CPR indicated for patient with profuse bleeding
patient can be managed Uncertain 61 37.4 uncertain 43 26.4
by salbutamol
Yes 113 69.3 yes 45 27.6
No 32 19.6 no 70 42.9
Respiratory distress Do CPR indicated for patient with anaphylactic reaction
patient can be managed Uncertain 18 11 uncertain 48 29.4
by oxygen inhalation
Yes 90 55.2 Yes 62 38
Respiratory distress No 50 30.7
patient can be managed
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by mouth to mouth Uncertain 23 14.1 No 67 41.1
breath

Uncertain 34 20.9
Do CPR indicated for patient with syncope
 Altitude
yes 150 92

Do you think that obtaining the vital signs (blood pressure, pulse, respiratory rate, temperature) of a patient no 13 8
before starting any treatment is of any importance
very satisfied 18 11
satisfied 53 32.5
dissatisfied 87 53.4

How satisfied are you with the training and education you have received on managing breathing difficulty very dissatisfied 5 3.1
during your dental studies
very satisfied 17 10.4
satisfied 35 21.5
dissatisfied 103 63.2

How satisfied are you with the training and education you have received on managing a heart attack very dissatisfied 8 4.9
during your dental studies
yes 59 36.2
Do you feel confident in your ability to respond appropriately to a patient experiencing a seizure in a
dental setting? no 104 63.8

Strongly Agree 73 44.8

Agree 65 39.9

disagree 24 14.7

Strongly disagree 1 0.6

Effective management of seizures is a critical skill for dental practitioners."
Very Familiar 4 2.5
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Familiar 51 31.3

How familiar are you with the use of emergency medications in managing seizures in a dental office Not Familiar 108 66.3

Very Important 134 82.2

Important 27 16.6

How do you perceive the importance of effective bleeding management in dental practice not important 2 1.2
 Discussion
 The findings reveal significant gaps in both knowledge and attitude among
students.
 This is consistent with findings from similar studies conducted globally,
For instance, in Saudi Arabia, only 37% of dental students felt confident
managing medical emergencies. (5)

 About BLS and CPR, only a fraction of students could correctly identify
the steps involved in performing in the present study .
 Comparatively, a study in India reported that only 33.7% of dental
students had knowledge about BLS, primarily due to the lack of
professional training. (1)

 The knowledge of CPR among dental students at Atlas College of Health

was found to be poor. This aligns with findings from similar studies
conducted in various regions.
 For example, a study in Nepal reported that 59.3% of dental students had
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poor knowledge of CPR. Similarly, research from India highlighted that

only 33.7% of dental students possessed good knowledge of basic life
support (BLS). (1)
 primarily due to the lack of professional training.
 In the present study students generally have poor knowledge of
managing respiratory difficulties.
 Among the participants, only a small proportion (16.6%) rated
their knowledge as excellent, while a significant number (42.3%)
considered their poor knowledge ​.
 Many students reported they had not received hands-on training in
managing medical emergencies, greatly affecting their confidence
levels.
 This aligns with research from Jordan, where dental students' self-
reported proficiency in emergency management was sub-optimal
due to inadequate practical experience.
 Practical training is essential for building confidence and
competence in real-world scenarios.
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When compared to other studies, the findings at Atlas College are
consistent with global trends but show certain regional variances.
For instance, in a study conducted in Saudi Arabia, only 37% of dental
students felt confident in handling any medical emergency, including
respiratory difficulties.(5)

Similarly, a survey in India indicated that dental students had poor

knowledge of basic life support, which encompasses managing
respiratory emergencies, with only 33.7% of participants demonstrating
good knowledge. (1)

The differences observed in the level knowledge can be due to various

factors, including the

 Intensity and frequency of training programs,

 The integration of practical sessions in the curriculum, and
 The availability of simulation-based learning
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 CONCLUSION
The findings reveal significant gaps in both
knowledge and altitude among students,
highlighting a critical area for educational
intervention.

Furthermore, continuous professional

development should be encouraged, allowing
students to stay updated with the latest
guidelines and techniques in emergency care.

Establishing partnerships with local hospitals

and emergency services for practical training
could also provide invaluable experience for the
students .
 Recommendation

For ACHS
CPD
The results suggest an urgent
need to revise the current dental Continuous professional
curriculum at Atlas College to development (CPD) should be
include comprehensive training encouraged to allow students to
on medical emergency stay updated with the latest
guidelines and techniques in
management.
emergency care.
.

National Educational Policies

 The insights gained from this research extend beyond the college,
impacting the broader Ethiopian healthcare system.

 The study can inform national educational policies and

guidelines for medical emergency training within dental schools
throughout.
 Limitation of the study

This study while aiming to shed light on the knowledge and

attitude of undergraduate dental students in managing medical
emergencies, acknowledges inherent limitations that should be
considered when interpreting the findings.

The research solely focuses on students at Atlas College of

Health Science in Addis Ababa, limiting the generalizability of
the results to other institutions or broader dental student
populations..

The specific curriculum, student demographics, and training

practices at Atlas might differ from other settings, potentially
influencing the knowledge and attitude levels captured in this
study.
.
 Reference
1,Fernandes AL, Malik JB, Ansari SR, Murali S, Thirupathii J. Knowledge, attitude,
and practice of dentists in the management of medical emergencies in India: A cross-
sectional study. Journal of Oral Biology and Craniofacial Research. 2023 Nov
1;13(6):758-63.
2, Gupta S, Mishra S, Behl S, Srikant N, Mascarenhas R. Knowledge of handling
medical emergencies among general dental practitioners pan India: a cross-sectional
survery. BMC Research Notes. 2023 Sep 14;16(1):221.
5,Ilyas, M., ul Momina, A., Saleem, A., Shaikh, G. and Tariq, A., 2020. Knowledge
and Attitude of Dental professionals towards Basic life support. Saudi J Oral Dent
Res, pp.291-294.
9, Raffee L, Khader Y, Oteir A, Alawneh K, Saqan RS, Beovich B, Williams B. Final
year dental students‟ perception of knowledge, training and competence in medical
emergency management. Global Journal of Health Science. 2018 Apr 23;10(6):1.
16, Pun DB, Thapa B, Shrestha P, Chaudhary S, Pandey N, Chaurasia L. Knowledge
and Attitude towards Cardiopulmonary Resuscitation among Students of a Dental
College. Janaki Medical College Journal of Medical Science. 2020 Dec 31;8(2):18-
24.
18, Tadesse M, Seid SA, Getachew H, Ali SA. Knowledge, attitude, and practice
towards basic life support among graduating class health science and medical
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students at Dilla University; a cross sectional study. Annals of Medicine and Surgery.
2022 Oct 1;82:104588.
ACKNOWLEDGEMENT

First and foremost, I want to express my profound gratitude

to Allah for supporting me during my studies and every
other stage of my lives. I want to thank my family for
their support.
My thankfulness is extended to [Link] Dejene (MPH),
my advisor, for his understanding and helpful counsel
during the proposal preparation process.
In addition, I want to thank Atlas College of Health
Science for this opportunity and for their support.

SM
 THANK YOU

SM