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Clinical s uden s' pe cep ion o acu e heuma ic e e and
knowledge o accine de elopmen in he u u e: A c oss-
sec ional s udy
Awoe e Tamunosiki Chinawa 1, Jude Tony Onyia 2, Edmund Ndudi Ossai 3, Ikenna Chidiebele
Nwokoye 4, Ogonna Obidi Nwankwo 5, Chiesonu Demphy Nzeduba 5, Josepha Maduabuchi
Chinawa 2*
1Depa men o Communi y Medicine, College o medicine ESUT, Enugu, Enugu S a e, Nige ia
2Depa men o Paedia ics, College o medicine UNEC, Enugu, Enugu S a e, Nige ia
3Depa men o Communi y Medicine, Ebonyi S a e Uni e si y, Abakiliki, Ebonyi s a e, Nige ia
4Alex Ekwueme Fede al Uni e si y Teaching Hospi al Abakaliki, Ebonyi s a e, Nige ia
5Depa men o Paedia ics, College o medicine ESUT, Enugu, Enugu S a e, Nige ia
A icle in o Abs ac
In oduc ion
The incidence o ca dio ascula diseases in child en is
inc easing [1-4]. Acu e Rheuma ic Fe e (ARF) is one o
he acqui ed hea diseases wi h a global bu den in Sub-
Saha an A ica [1, 2]. Accu a e documen a ion o he
epidemiology o ARF and i s clinical ea u es in A ica
will help o imp o e diagnosis and enhance seconda y
p e en ion [3, 4]. The p e alence o ARF has shown
luc ua ions o e ime [5-9]. Fo ins ance, o e he las 2
decades, he global p e alence a e has inc eased, and i
is p ojec ed ha by 2030, he a e may inc ease o 559.88
pe 100,000 people [5]. In No h-Cen al Nige ia, ARF
p e alence is 21.6 pe 1000, wi h a male p eponde ance
[6]. The mo bidi y and mo ali y associa ed wi h ARF in
2015 we e es ima ed a 319,400 cases [6]. Some s udies
ha e documen ed ha he e ec i e implemen a ion o
A icle his o y:
Recei ed 9 No . 2024
Accep ed 21 Aug. 2025
Published 13 Jul. 2025
Chinawa e al. J Med Edu De . 2025; 18(2): 86-95 Jou nal o Medical Educa ion De elopmen
Backg ound & Objec i e: Acu e heuma ic e e (ARF) is a majo public heal h issue among
child en wi h inc eased mo bidi y and mo ali y. This s udy aimed o explo e clinical medical
s uden s' pe cep ions and awa eness o ARF and he po en ial o de eloping a u u e accine,
as well as o documen he ac o s associa ed wi h hese iews.
Ma e ials & Me hods: This c oss-sec ional s udy was conduc ed in wo medical schools in he
Enugu me opolis om July 2024 o Oc obe 2024. The s udy en olled 341 clinical medical
s uden s om wo medical schools in Sou heas Nige ia. Da a we e collec ed using a alida ed
in e iewe -adminis e ed ques ionnai e. The ques ionnai e included 11 a iables o assess he
s uden s' ARF knowledge. The maximum ob ainable ma k o each esponden was 29.
Knowledge o ARF accina ion was assessed using eigh a iables.
Resul s: Mos esponden s (93.0 %) demons a ed awa eness o ARF. Jus o e hal (50.7 %)
ecognized so e h oa as a symp om o ARF. Fi y-one poin - h ee pe cen o esponden s
demons a ed good knowledge o ARF. Mos esponden s (86.8%) knew accina ion could be
an e ec i e p e en i e measu e agains he disease i a ailable. Fou h-yea esponden s we e
i e imes less likely o possess good knowledge o ARF compa ed o hei six h-yea
coun e pa s, wi h an Adjus ed Odds Ra io (AOR) o 0.2 (95% Con idence In e al [CI]: 0.1-
0.5). Responden s unde 25 yea s old we e h ee imes less likely o in end o ecei e he ARF
accine compa ed o hose 25 yea s old and abo e (AOR = 0.3; 95%, CI: 0.1-0.9).
Conclusion: A conside able numbe o medical s uden s we e awa e o he de elopmen o he
ARF accine. This se es as a s ong call o inco po a e he eaching o ARF in o he cu iculum
a all le els o medical educa ion.
Keywo ds: medical s uden s, acu e heuma ic e e , pe cep ion, cu iculum, knowledge,
medical school, accina ion.
*Co esponding au ho :
Josepha Maduabuchi Chinawa,
Depa men o Paedia ics, College o
medicine UNEC, Enugu, Enugu S a e,
Nige ia.
Email: josepha [email protected]
O iginal A icle
How o ci e his a icle:
Chinawa AT, Onyia JT, Ossai EN,
Nwokoye Ich, Nwankwo OO,
Nzeduba ChD, Chinawa JM. Clinical
s uden s' pe cep ion o acu e
heuma ic e e and knowledge o
accine de elopmen in he u u e: A
c oss-sec ional s udy among medical
s uden s in Enugu S a e, Nige ia. J
Med Edu De . 2025; 18(2): 86-95.
[ DOI: 10.61882/edcj.18.2.86 ] [ Downloaded om edujou nal.zums.ac.i on 2025-10-03 ]
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Chinawa e al
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Jou nal o Medical Educa ion De elopmen ¦ Volume 18 ¦ Issue 2 ¦ 2025 87
su eillance and ad ocacy p og ams in he con ol o
ARF is cons ained by limi ed access o p ima y heal h
ca e. This is caused by he high cos o mic obiological
diagnosis o ARF using An i-S ep olysin O (ASO) i e
and h oa swabs and he low index o suspicion by
physicians coupled wi h a lack o awa eness in he
communi y [10-12]. I is impo an o no e ha since
G oup A S ep ococcus (GAS) in ec ions can be
p e en ed wi h a accine de eloped agains o ganisms
ha cause sepsis, a h i is, o pyode ma, he e is a
possibili y ha such a accine could also p e en all
mani es a ions o GAS- ela ed diseases [13].
Vaccina ion is conside ed he mos e ec i e s a egy o
educing he incidence o ARF and cu bing he ising
p e alence o GAS- ela ed diseases [14]. Howe e , he e
has been no b eak h ough in he clinical ial and
de elopmen o accines. Sheel e al. [14] ou lined a
amewo k o accine de elopmen , emphasizing
clinical ial design op imiza ion, phase-speci ic
de elopmen s a egies and egula o y equi emen s o
accine egis a ion [14]. Poo pe cep ion and pauci y o
awa eness o he cause, cou se, mo bidi y and mo ali y
o ARF among clinical medical s uden s could also
con ibu e o he sp ead o he disease. A ho ough
assessmen o he le el o pe cep ion o ARF among
clinical s uden s is c ucial in educing he sp ead o he
disease among his popula ion. This s udy, he e o e,
aimed o documen clinical s uden s' pe cep ions o ARF
and iden i y associa ed ac o s. Fu he mo e, he s udy
in es iga ed medical s uden s' knowledge and
pe spec i es on he po en ial o u u e accine
de elopmen agains ARF.
Ma e ials & Me hods
Design and se ing(s)
This was a c oss-sec ional s udy conduc ed in wo
medical schools in Sou heas Nige ia om 14 Ma ch
2024 o 24 Oc obe 2024. I in ol ed clinical medical
s uden s in hei ou h o six h yea o s udy d awn om
wo Sou h-eas e n Nige ian medical schools: Ebonyi
S a e Uni e si y, Abakaliki, and Enugu S a e Uni e si y
o Science and Technology, Enugu.
Pa icipan s and sampling
Th ee hund ed o y-one clinical medical s uden s om
wo medical schools in Sou heas Nige ia we e en olled
consecu i ely in he s udy. The s uden s we e ec ui ed
consecu i ely un il he sample size was eached. Medical
s uden s in he clinical class who p o ided in o med
consen we e included in he s udy. In con as , medical
s uden s in he p e-clinical class and hose wi hou
consen we e excluded om his s udy. A wo-s age
sampling echnique was used o selec he medical
s uden s o inclusion in he s udy. Six acc edi ed
medical schools in sou heas Nige ia ha e clinical
medical s uden s. Two medical s uden s we e selec ed
ou o he six using a simple andom sampling echnique
o ballo ing. In he second s age, a lis o all medical
s uden s in he clinical classes ( ou h yea o six h yea )
was made. On each day o da a collec ion, he numbe o
medical s uden s in he h ee classes in each o he wo
selec ed schools who we e p esen se ed as he
sampling ame. The sampling in e al was de e mined
by di iding he o al numbe by he sample size o 170,
which ep esen ed he es ima ed numbe o s uden s om
each selec ed school who would pa icipa e in he s udy.
The e o e, e e y medical s uden was ec ui ed o he
s udy based on he sea ing a angemen o he s uden s in
he h ee classes on each day o da a collec ion. On each
occasion, he index s uden was selec ed using a simple
andom sampling echnique o ballo ing. The o mula
ob ained he sample size: n = Z2pq ÷ d2 [15].
A minimum sample size o 347 s uden s was ob ained
using he o mula abo e.
Tools/Ins umen s
The s udy used a alida ed in e iewe -adminis e ed
ques ionnai e. Ray e al. [16] adap ed his ques ionnai e
using a g oup o s uden s aged 10-16 andomly selec ed
om di e en schools. The ques ionnai e co e s
ques ions on knowledge o ARF and willingness o be
accina ed, de ined as he p epa edness o eadiness o
ecei e a accine a e conside ing he e icacy, bene i s,
ad e se e ec s, and ba ie s associa ed wi h ecei ing
such a accine [17]. Knowledge o ARF was assessed
using 11 a iables.
Fi e i ems ocused on symp oms, wi h each co ec
esponse sco ing one and inco ec esponse sco ing 0.
The o he six a iables o he ARF assessmen ocused
on he disease's p e alence, he age g oup mos likely o
be a ec ed, impac , diagnosis, ea men op ions and
p e en ion o he disease. Fo hese six a iables, a
co ec answe by any esponden a ac ed ou ma ks,
while an inco ec answe was sco ed ze o. Thus, he
maximum ob ainable ma k o each esponden was
29. Knowledge o heuma ic e e accina ion was
assessed using eigh a iables. Each co ec esponse
om he esponden s a ac ed a sco e o one, while
inco ec esponses we e sco ed ze o. The maximum
sco e each esponden could ob ain is eigh .
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88 Jou nal o Medical Educa ion De elopmen ¦ Volume 18 ¦ Issue 2 ¦ 2025
The ques ionnai e componen s ela ed o socioeconomic
s a us we e de eloped using P incipal Componen
Analysis (PCA) in STATA s a is ical so wa e e sion
12. The ele en a iables lis ed abo e se ed as inpu s o
he PCA. Fo he calcula ion o dis ibu ion cu poin s,
qua iles we e used. Each esponden was assigned he
weal h index sco e o hei amily.
The qua iles we e Q1 = Poo es , Q2 = The Ve y Poo ,
Q3 = The Poo , and Q4 = The Leas Poo . The qua iles
we e u he dicho omized in o low socioeconomic class,
comp ising he poo es and e y poo , and high
socioeconomic class, comp ising he poo es and leas
poo g oups.
C onbach's α was employed o assess he in e nal
consis ency o he ques ionnai e adap ed om Ray e al.
[18]. A sco e o 0.8 was achie ed, indica ing a
sa is ac o y le el o eliabili y. Addi ionally, Pea son's
co ela ion coe icien was u ilized o de e mine he es -
e es eliabili y, wi h a sco e o 0.5 indica ing a highe
eliabili y.
Da a collec ion me hods
The ques ionnai es we e dis ibu ed o he medical
s uden s du ing he didac ic lec u e pe iod in he i s and
second semes e s o he yea o s udy.
Da a analysis
Da a en y and analysis we e done using he S a is ical
P oduc and Se ice Solu ions (IMB-SPSS) s a is ical
so wa e e sion 25. Con inuous a iables we e
ep esen ed using mean and s anda d de ia ion, while
ca ego ical a iables we e p esen ed using equencies
and p opo ions. The mean knowledge sco e o ARF
among he ca ego ies o independen a iables was
compa ed using he S uden - es when he g oups we e
wo and wi h analysis o a iance i he g oups we e
mo e han wo.
The mean knowledge sco e o ARF accina ion among
he ca ego ies o independen a iables was compa ed
using he S uden - es when he g oups we e wo and
wi h analysis o a iance i he g oups we e mo e han
wo.
A p- alue o <0.05 de e mined he le el o s a is ical
signi icance. A chi-squa e es and mul i a ia e analysis
h ough bina y logis ic eg ession we e employed.
Responden s who achie ed a sco e o 50% o highe o
he o al possible sco e we e conside ed o ha e good
knowledge.
Resul s
Table 1 shows he socio-demog aphic cha ac e is ics o
he esponden s.
The mean ± SD o he age o he esponden s was 24.3 ±
2.9 yea s. The highes p opo ion o he esponden s,
67.2%, we e unde 25 yea s old, while he leas
p opo ion, 3.8%, we e 30 yea s and abo e. A highe
p opo ion o he esponden s, 51.0%, we e male. The
majo i y o he esponden s, 96.5%, we e single. The
highes p opo ion o he esponden s, 64.2%, we e in he
i h yea o s udy, while he leas p opo ion, 8.2%, we e
in he six h yea .
Table 1. Socio-demog aphic cha ac e is ics o esponden s (n
= 341)
Va iable
F equency
Pe cen
Gende
Male
174
51.02
Female
167
48.97
Ma i al s a us
Single
329
96.48
Ma ied
12
3.52
Class o s udy
Fou h yea
94
27.57
Fi h yea
219
64.22
Six h yea
28
8.21
Educa ional a ainmen o a he
No o mal educa ion
11
3.23
P ima y educa ion
26
7.63
Seconda y educa ion
50
14.66
Te ia y educa ion
254
74.49
Educa ional a ainmen o mo he
No o mal educa ion
12
3.52
P ima y educa ion
17
4.99
Seconda y educa ion
56
16.42
Te ia y educa ion
256
75.07
Employmen s a us o a he
Unemployed
13
3.81
Sel -employed
181
53.08
Paid employmen
147
43.11
Employmen s a us o mo he
Unemployed
10
2.93
Sel -employed
149
43.70
Paid employmen
182
53.37
Family socio-economic s a us
Low socio-economic class
176
51.61
High socio-economic class
165
48.39
Age o esponden s in yea s
Mean ± SD
4.26 ± 2.94
Abb e ia ion: SD, s anda d de ia ion.
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Jou nal o Medical Educa ion De elopmen ¦ Volume 18 ¦ Issue 2 ¦ 2025 89
Table 2 shows awa eness o ARF and heuma ic e e
accine among he esponden s. The majo i y o he
esponden s, 93.0%, we e awa e o ARF. The majo
sou ces o in o ma ion included heal h wo ke s (82.3%),
in e ne /social media (61.8%), and iends (42.3%). Less
han one- i h o he esponden s, 17.9%, we e awa e o
he ARF accine. The majo sou ces o in o ma ion on
he ARF accine included heal h wo ke s, 77.0%;
in e ne /social media, 50.8%; and iends, 39.3%.
Table 2. Awa eness o ARF and heuma ic e e accine
among he esponden s (n = 341)
Va iable
F equency
Pe cen
Awa eness o ARF
Yes
317
92.96
No
24
7.04
Awa eness o heuma ic e e
accine
Yes
61
17.89
No
280
82.11
No e: Mul iple esponses encou aged.
Table 3 shows he esponden s' knowledge o ARF and
heuma ic e e accina ion. A highe p opo ion o he
esponden s, 88.9%, knew ha sho ness o b ea h is a
symp om o heuma ic e e and heuma ic hea disease.
A highe p opo ion o he esponden s, 50.7%, knew
ha so e h oa is a symp om o heuma ic e e . Mos
esponden s, 56.0%, knew he age g oup 5-15 yea s we e
mo e likely o ha e heuma ic e e . A highe p opo ion
o he esponden s, 81.5%, knew ha diagnosis is by
his o y aking and pas medical his o y o so e h oa .
The mean knowledge o ARF sco e was 14.8 ± 5.8. Mos
86.8% o esponden s knew accina ion could be a good
measu e o p e en diseases. The mean knowledge o
ARF accina ion sco e was 4.5 ± 1.4. Less han hal o
he esponden s, 45.7%, knew hey we e no in Nige ia's
high-p io i y g oup o heuma ic e e accina ion. Less
han one- en h o he esponden s, 8.5%, we e awa e o
anyone who died om heuma ic e e . A mino
p opo ion o he esponden s, 5.6%, in end o ecei e
accina ion o heuma ic e e when a ailable. Table 4
shows he co ela ion ma ix o a iables, including he
age o esponden s, knowledge o ARF and knowledge
o ARF accina ion. A e y weak posi i e co ela ion
exis ed be ween knowledge o ARF and heuma ic e e
accina ion. Inc eases in ARF knowledge we e
associa ed wi h inc eases in ARF accina ion
knowledge, and his ela ionship was s a is ically
signi ican (n = 341, = 0.141, p = 0.009). Table 5 and
6 compa ed mean sco es o knowledge o ARF and
knowledge o ARF accina ion. The mean knowledge
sco e o ARF was highes among he six h-yea s uden s,
16.5 ± 5.9, and leas among hose in he ou h yea , 11.6
± 4.9, and he mean di e ence was s a is ically
signi ican (F = 21.836, p < 0.001). The mean knowledge
sco e o ARF was signi ican ly highe among he
esponden s whose mo he s had e ia y educa ion, 15.1
± 5.9 compa ed o hose whose mo he s had seconda y
educa ion and below, 13.8 ± 5.1 (S uden = 1.990, p =
0.048). The mean knowledge sco e o ARF was highe
among he esponden s whose amilies we e in he high
socioeconomic class, 15.5 ± 5.6 compa ed o hose in he
low socioeconomic class. The mean di e ence was
s a is ically signi ican (S uden = 2.374, p = 0.018).
The mean knowledge sco e o heuma ic e e
accina ion was signi ican ly highe among esponden s
who pe cei ed hemsel es as suscep ible o ARF, wi h a
sco e o 4.9 ± 1.2, compa ed o hose who did no
pe cei e hemsel es as suscep ible, whose sco e was 4.4
± 1.5 (S uden = 3.161, p = 0.002). The mean
knowledge sco e o heuma ic e e accina ion was
highe among he esponden s who in end o ecei e
heuma ic e e accina ion, 5.0 ± 1.3 when compa ed o
hose who did no in end o ecei e he accine, 4.4 ± 1.4
and he mean di e ence was ound o be s a is ically
signi ican , (S uden = 3.718, p < 0.001).
Discussion
This s udy aimed o explo e he pe cep ion and
awa eness o ARF among clinical medical s uden s and
o documen associa ed ac o s. A high le el o
awa eness (93.3%) was no ed among medical s uden s.
This may be a ibu ed o he ac ha mos in o ma ion
on ARF was de i ed om heal h p o essionals. The le el
o awa eness o ARF among medical s uden s was
signi ican ly highe han ha epo ed by Alnema i e al.
[18] in Saudi A abia, whe e a le el o awa eness o 55.2
% was epo ed in s uden s in he College o Medicine
and 33.3% in he College o Den is y, 44.8% in he
College o Pha macy, 21.4% in he college o applied
Medical sciences and 45.9% among college o nu sing
s uden s. The p esen s udy's indings we e highe han
hose o Nkoke e al. [19] and Chelo e al. [20]. The
a ia ion in awa eness o ARF may be a ibu ed o he
di e ing medical cu icula employed by he pa icipa ing
medical schools, he yea o s udy o he medical s uden s
in ol ed, and po en ially he me hodologies used by he
au ho s. The s udy also showed ha 56% o medical
s uden s know ha ARF commonly a ec s child en
be ween he ages o 5 and 15 yea s. Simila ly, only
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41.6% no ed ha skin ash could igge ARF. This was
also simila o he s udy o Fakieha e al. [21], whe e
54.8% o he subjec s knew ha child en aged 5 o 15
yea s old a e suscep ible o ARF. The associa ion
be ween skin ash (bac e ial de ma i is) and ARF was
no ed in 46.1% o he epo age o Fakieha e al. [21]
Table 3. Knowledge o ARF and heuma ic e e accina ion among he esponden s (n = 341)
Va iable
Co ec esponse
F equency (Pe cen )
P e alence o heuma ic e e has dec eased o e ime
Yes
63 (18.47)
Sho ness o b ea h is a symp om o heuma ic e e and heuma ic hea disease
Yes
303 (88.86)
Join pain/swelling is a symp om o heuma ic e e
Yes
149 (43.70)
Leg swelling is a symp om o heuma ic e e
Yes
93 (27.27)
Skin ash is a symp om o heuma ic e e
Yes
142 (41.64)
So e h oa is a symp om o heuma ic e e
Yes
173 (50.73)
T ea men o so e h oa and p ima y p ophylaxis is ideal p e en i e measu e
Yes
199 (58.36)
Age g oup (5-15 yea s) mo e likely o ha e heuma ic e e
Yes
191 (56.01)
T ea men is by use o non-s e oidal an i-in lamma o y d ugs, an ibio ics and s e oids
Yes
185 (54.25)
Impac o he disease is in poo socio-economic g oups
Yes
129 (37.83)
Diagnosis is by his o y aking and pas his o y o so e h oa
Yes
278 (81.52)
Vaccina ion could be a good measu e o p e en diseases
Yes
296 (86.80)
Rheuma ic e e accine may be o immense help in he igh agains he disease
Yes
273 (80.05)
One could be expec ed o wea a ace mask e en a e ecei ing heuma ic e e accine
Yes
55 (16.13)
The e is no disease called heuma ic e e hence heuma ic e e accine is alse
No
265 (77.71)
The e is no heuma ic e e in Nige ia hence no need o heuma ic e e accine
No
250 (73.31)
Side e ec s o heuma ic e e accine may be epo ed a e adminis e ing he accine
Yes
43 (12.61)
The e has been no accine de eloped o he p e en ion o heuma ic e e
Yes
258 (75.66)
Nige ia is no in e es ed in heuma ic e e accina ion
No
103 (30.21)
In en ion o ecei e heuma ic e e accina ion
I could be in ec ed wi h Rheuma ic e e
Yes
87
25.51
No
254
74.49
Ha e been es ed o heuma ic e e
Yes
8
2.3
No
333
97.7
Awa e o anyone ha was es ed o heuma ic e e
Yes
32
9.38
No
309
90.62
Awa e o anyone in ec ed wi h heuma ic e e
Yes
50
14.66
No
291
85.34
Awa e o anyone ha died om heuma ic e e
Yes
29
8.50
No
312
91.50
In end o ecei e accina ion o heuma ic e e when a ailable
Yes
19
5.57
No
322
94.43
Knowledge o heuma ic e e / heuma ic hea disease
Mean ± SD
14.8 ± 5.8
Knowledge o heuma ic e e accina ion
Mean ± SD
4.5 ± 1.4
Abb e ia ion: SD, s anda d de ia ion.
Table 4. Co ela ion ma ix o a iables including age o esponden s, knowledge o ARF and knowledge o heuma ic e e
accina ion (n = 341)
Va iable
Co ela ion co-e icien , p- alue
Age o esponden s in yea s
Knowledge o ARF
( o al sco e)
Knowledge o heuma ic e e
accina ion
( o al sco e)
Age o esponden s in yea s
1
Knowledge o ARF ( o al sco e)
= 0.001
p = 0.984
1
Knowledge o heuma ic e e
accina ion ( o al sco e)
= 0.062
p = 0.256
= 0.141
p = 0.009
1
Abb e ia ions: , co ela ion co-e icien ; p- alue, p obabili y alue.
[ DOI: 10.61882/edcj.18.2.86 ] [ Downloaded om edujou nal.zums.ac.i on 2025-10-03 ]
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Table 5. Compa ison o mean sco es o knowledge o ARF and knowledge o heuma ic e e accina ion (n = 341)
Va iable
n
Mean ± SD
Sig.
Age o esponden s in g oups
< 25 yea s
229
14.8 ± 5.8
= 0.007, p = 0.994
≥ 25 yea s
112
14.8 ± 5.7
Gende
Male
174
14.5 ± 5.7
= 0.973, p = 0.331
Female
167
15.1 ± 5.8
Ma i al s a us
Single
329
14.7 ± 5.8
= 0.747, p = 0.456
Ma ied
12
16.0 ± 4.2
Yea o s udy
Fou h yea
94
11.6 ± 4.9
F = 21.836, p <0.001
Fi h yea
219
15.9 ± 5.6
Six h yea
28
16.5 ± 5.9
Educa ional a ainmen o a he
Te ia y educa ion
254
14.7 ± 5.8
= 0.218, p = 0.827
Seconda y educa ion and below
87
14.9 ± 5.8
Educa ional a ainmen o mo he
Te ia y educa ion
256
15.1 ± 5.9
= 1.990, p = 0.048
Seconda y educa ion and below
85
13.8 ± 5.1
Employmen s a us o a he
Unemployed
13
13.8 ± 4.6
F = 0.446, p = 0.640
Sel -employed
181
15.0 ± 6.0
Paid employmen
147
14.6 ± 5.6
Employmen s a us o mo he
Unemployed
10
14.5 ± 5.9
F = 0.089, p = 0.915
Sel -employed
149
14.7 ± 5.6
Paid employmen
182
14.9 ± 5.9
Family socio-economic s a us
Low socio-economic class
176
14.1 ± 5.9
= 2.374, p = 0.018
High socio-economic class
165
15.5 ± 5.6
In end o ecei e heuma ic e e accine
Yes
90
14.0 ± 5.1
= 1.647, p = 0.101
No
251
15.1 ± 6.0
Compa ison o mean sco es o knowledge o heuma ic e e accina ion
n
Mean ± SD
Sig.
Age o esponden s in g oups
< 25 yea s
229
4.5 ± 1.4
= 1.150, p = 0.251
≥ 25 yea s
112
4.7 ± 1.4
Gende
Male
174
4.5 ± 1.5
= 0.278, p = 0.781
Female
167
4.5 ± 1.4
Abb e ia ions: , - es s a is ic; F, analysis o a iance s a is ic; SD, s anda d de ia ion; n, numbe o pa icipan s; Sig., Signi icance; p, p obabili y alue.
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92 Jou nal o Medical Educa ion De elopmen ¦ Volume 18 ¦ Issue 2 ¦ 2025
Table 6. Compa ison o mean sco es o knowledge o ARF and knowledge o heuma ic e e accina ion (n = 341)
Va iable
n
Mean ± SD
Sig.
Ma i al s a us
Single
329
4.5 ± 1.4
= 2.130, p = 0.053
Ma ied
12
5.1 ± 0.9
Yea o s udy
Fou h yea
94
4.3 ± 1.7
F = 2.881, p = 0.057
Fi h yea
219
4.7 ± 1.3
Six h yea
28
4.3 ± 1.7
Educa ional a ainmen o a he
Te ia y educa ion
254
4.5 ± 1.4
= 0.029, p = 0.977
Seconda y educa ion and less
87
4.5 ± 1.6
Educa ional a ainmen o mo he
Te ia y educa ion
256
4.5 ± 1.3
= 1.352, p = 0.177
Seconda y educa ion and less
85
4.7 ± 1.6
Employmen s a us o a he
Unemployed
13
4.9 ± 1.6
F = 0.556, p = 0.574
Sel -employed
181
4.5 ± 1.4
Paid employmen
147
4.5 ± 1.4
Employmen s a us o mo he
Unemployed
10
4.6 ± 2.1
F = 0.591, p = 0.554
Sel -employed
149
4.4 ± 1.5
Paid employmen
182
4.6 ± 1.3
Family socio-economic s a us
Low socio-economic class
176
4.4 ± 1.5
= 1.253, p = 0.211
High socio-economic class
165
4.6 ± 1.3
Pe cei ed suscep ibili y o heuma ic e e
Yes
87
4.9 ± 1.2
= 3.161, p = 0.002
No
254
4.4 ± 1.5
Ha e been es ed o heuma ic e e
Yes
8
4.0 ± 1.3
= 1.054, p = 0.293
No
333
4.5 ± 1.4
Awa e o someone es ed o heuma ic e e
Yes
32
4.9 ± 1.3
= 1.725, p = 0.085
No
309
4.5 ± 1.4
Awa e o someone in ec ed wi h heuma ic e e
Yes
50
4.8 ± 1.4
= 1.371, p = 0.171
No
291
4.5 ± 1.4
Awa e o someone ha died om heuma ic e e
Yes
29
4.6 ± 1.4
= 0.378, p = 0.706
No
312
4.5 ± 1.4
In end o ecei e heuma ic e e accina ion
Yes
90
5.0 ± 1.3
= 3.718, p < 0.001
No
251
4.4 ± 1.4
Abb e ia ions: , - es s a is ic; F, analysis o a iance s a is ic; SD, s anda d de ia ion; n, numbe o pa icipan s; Sig., Signi icance; p, p obabili y alue.
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The cu en s udy no ed no associa ion be ween gende
and he pe cep ion o ARF. Howe e , Fakieha e al. [21]
no ed gende as he only impo an ac o a ec ing
knowledge o ARF in hei s udy. O he s udies no ed
ha emales ha e be e knowledge han males [22-29].
The s udy no ed ha ewe medical s uden s (50.7%)
knew ha so e h oa was a symp om o ARF.
Conce ning he associa ion be ween bac e ial so e h oa
and ARF, Kulik e al. [25] no ed ha o e 79.5% o hei
subjec s we e awa e o he link be ween a so e h oa and
ARF, which was also simila o he s udy o Manase e
al. [26] whe e 73.1% o heal h wo ke s we e awa e o
his ela ionship be ween so e h oa and ARF [25]. This
poo awa eness o he associa ion be ween so e h oa
and ARF highligh s he need o speci ic aining and
po en ial cu iculum e isions.
Though 93.0% o he clinical medical s uden s we e
awa e o ARF, only a mino popula ion had good
knowledge o ARF in e ms o epidemiology, sp ead and
managemen . This indica es a se ious and u gen need o
in ensi y he dissemina ion o in o ma ion on he
epidemiology and sp ead o he diseases, especially
among clinical medical s uden s. This in o ma ion
should also be in oduced o p e-clinical medical
s uden s o cu b he mili a ing e ec s o his disease.
Besides, in o ma ion on p ima y and seconda y
p e en ion and disease awa eness should be p o ided in
he ea ly yea s o medical school [30].
I is no ed in his s udy ha s uden s who we e in he 6 h
yea o s udy had mo e knowledge o ARF han hose in
a lowe class. I is expedien o in oduce he lec u e on
he awa eness and p e en ion o ARF in he in oduc o y
class o he medical school. This inding con as s wi h
hose o o he s udies [28–30]. Fu he mo e, s uden s
om high socioeconomic classes had a highe
knowledge o ARF han hose om a lowe economic
class. This inding was a a iance wi h Machlu e al.
[31], who documen ed he associa ion o ARF wi h lowe
socioeconomic classes. The s udy showed ha a majo
p opo ion o medical s uden s (81.5%) we e well-
in o med abou he ising p e alence o ARF. Some
s udies ha e documen ed a ising p e alence o ARF,
wi h 300,000–500,000 new cases diagnosed annually
and app oxima ely 230,000 ela ed dea hs [31].
Abou hal (54.3%) o he medical s uden s in he cu en
s udy no ed ha he managemen o ARF includes using
non-s e oidal an i-in lamma o y d ugs, an ibio ics and
s e oids. Fakieha e al. [21] co obo a ed he same esul s
when hey no ed ha 56.5% o hei subjec s we e awa e
o using an ibio ics o manage so e h oa . In e es ingly,
he cu en s udy ound ha 75.7% o he medical
s uden s ecognized he non-a ailabili y o heuma ic
e e accine, ye 78.9% we e awa e o he ongoing
e o o de elop such a accine. This good le el o
awa eness could be explained by he co ela ional
ma ix, which showed a posi i e co ela ion be ween
knowledge o ARF and knowledge o heuma ic e e
accina ion.
Conclusion
The e is a poo pe cep ion o ARF's clinical co ela es
and managemen among clinical medical s uden s. Many
medical s uden s a e awa e o he de elopmen o an
ARF accine. This is a cla ion call o add he eaching o
ARF o he cu iculum a all le els in he medical school.
This could educe he bu den and complica ions
associa ed wi h he disease. Vigo ous campaigns and
changes in medical cu icula, which should include
lec u es on ARF ac oss all le els o medical school, may
signi ican ly inc ease he pe cep ion and managemen o
ARF among medical s uden s [45].
E hical conside a ions
This was ob ained om he Resea ch and E hics
Commi ee o Enugu S a e Uni e si y Teaching Hospi al
(Pa klane) Enugu, Nige ia. Addi ionally, e bal
in o med consen was ob ained om he pa icipa ing
medical s uden s o he s udied medical schools. The
s udy adhe ed o es ablished e hical p inciples and
ins i u ional guidelines h oughou . The code o he
app o ed wo k was ESUTHP/C-MAC/RA/034/158.
A i icial in elligence u iliza ion o a icle
w i ing
No applicable..
Acknowledgmen
We a e g a e ul o he esea ch assis an , Nnamdi, who
helped in da a en y.
Con lic o in e es s a emen
The au ho s decla e ha hey ha e no compe ing
in e es s.
Au ho con ibu ions
MC, ATC, OCN, ENO, ICN, JTO, NOO, and CNO
concei ed and designed his s udy, while JMC helped
wi h he c i ical e ision o he a icle. JMC and ENO
[ DOI: 10.61882/edcj.18.2.86 ] [ Downloaded om edujou nal.zums.ac.i on 2025-10-03 ]
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Chinawa e al
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: Clinical s uden s’ pe cep ion o acu e heuma ic e e
94 Jou nal o Medical Educa ion De elopmen ¦ Volume 18 ¦ Issue 2 ¦ 2025
also did he Da a analysis/in e p e a ion. All au ho s ha e
ead and app o ed he manusc ip .
Funding
No o ganiza ion unded his s udy. The au ho s
pe sonally co e ed all expenses incu ed du ing he
s udy.
Da a a ailabili y s a emen
Da a a e, howe e , a ailable om he au ho s upon
easonable eques and wi h pe mission o he
co esponding au ho .
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