THE STUDY OF COMMUNITY AWARENESS ABOUT MULTIPLESCLEROSIS

Maram M Alharbi, Raneem A Alrouji, Alanound Z Alsamari, Razan M almufarriji, Bayan A Alrabah, Ghaida S Alsuhaibani, Shatha S Alghamdi, Yara M Falata, Bayan S Aldebas and Rafif Z Othman. Medical students,college of medicine, Al Maarefa colleges for science & technology, Riyadh, Saudi Arabia. ...................................................................................................................... Manuscript Info Abstract ......................... ........................................................................ Manuscript History


ISSN: 2320-5407
Int. J. Adv. Res. 4 (12), 15-22 16 It affects 2.5 million people worldwide. It isthe most commondisabling neurological disease of young adults, appearing mostly at 20 to 40 years old. However, it can also affect children and older people. It also occurs in various regions of the world and in different proportions. It usually occurs in cold more than tropical regions. 2 Although it is a common neurological disease, few people know about it.
The exact cause of MS is unknown but it is considered as an autoimmune disease that affect multiple sections of the brain and spinal cord and this disease has 3 main features: Destruction of myelin, a fatty insulation covering the nerve fibers, is the main characteristic of MS. The end results of this process "demyelination" are multiple patches of hard, scarred tissue called plaques or lesions. Sclerosis comes from the Greek word skleros, which means hard. Damage of axons; the fibers that carry electric impulses away from a nerve cell, is also a major factor in the permanent disability that occurs with MS. As well asinflammation that is caused by permeability of blood brain barrier to T cell which attacks myelin. 3 The signs and symptoms of MS can be mild or sever, ranging from disturbance of sensation in the limbs to paralysis and loss of muscle control, vision and balance.

Objectives:-
To assess the awareness and knowledge of the community about types, signs and symptoms of MS.

Literature review:-
In a research studying the relation between MS and environmental factors, gender and ethnicity, prevalence of MS; indicates that the rate of the disease has increased steadily during the twentieth century. As with most autoimmune disorders, twice as many women are affected by MS as men. MS is more common in colder climates. People of Northern European descent appear to be at the highest risk for the disease, regardless of where they live. Native American of North and South America, as well as Asian American population, have relatively low rate of MS. 2 A study done by the Division of Neurology, King Khalid University Hospital, Riyadh, Saudi Arabia. Showed that there are indications of increasing incidence of MS in Saudi Arabia. The symptomatology and site of lesions are similar to that seen in the West, but the course and evolution might be different. The main course was remissions and relapses but without transformation to chronic progressive disease, and the main disability was partial or complete bilateral visual loss. 1 A study about the relationship of UV exposure to prevalence of MS in England concluded that the regression of MS against UVB intensity for all seasons, while the interaction between IM and UVB seasonal rose. 4 A study about the relationship of ultraviolet B radiation (UVB) and Epstein-Barr virus (EBV) exposure in explaining the period prevalence of multiple sclerosis (MS) in England, concluded that UVB exposure and IM together can explain a substantial proportion of the variance of MS. The effect of UVB on generating vitamin D seems the most likely candidate for explaining its relationship with MS.
A study about the prevalence of MS in Qatar showed that a positive family history was found in MS patients and Qatar is now a medium-to-high risk area for MS. 5 Imaging research from Western University (London, Canada) by Ravi Menon, PhD, of the Robarts Research Institute.They found iron deposits in deep gray matter, suggesting that the accumulation occurs very early in the disease course.The scientists found iron deposits in the clinically isolated syndrome (CIS) group were well above the amounts found in the control group. The MRIs also revealed for the first time, subtle damage to the brain's white matter even at this early stage. 6 The Global Advisory Committee on Vaccine Safety (GACVS) has concluded that there is no association between administration of the hepatitis B vaccine and MS. By 2001, more than 700 cases of central demyelinating diseases with a close match to the natural epidemiologic distribution of MS had been reported to the French authorities, the majority were adult females. No cases were reported among children less than 25 months despite vaccination of 1.8 million babies. The analysis of data from spontaneous reports and results of epidemiological studies do not support a 17 causal relationship between MS and hepatitis B vaccination. The most likely explanation is a coincidental association. 7 A study was done about the relationship between headaches and MS concluded that MS patients had tension headaches or vascular headaches of the migraine type; there was no distinctive "MS headache". Headaches did not correlate with any clinical features of MS. The study concludes that an association between headaches and MS may exist. 8 A study about the high and low risk profile for the development of MS within 10 years after optic neuritis showed that the 10-year risk ofMS following an initial episode of acute optic neuritis is significantly higher if there is a single brain MRI lesion; higher numbers of lesions do not appreciably increase that risk. However, even when brain lesions are seen on MRI, more than 40% of the patients will not develop clinical MS after 10 years. In the absence of MRI lesions, certain demographic and clinical features seem to predict a very low likelihood of developing MS. This natural history information is a critical input for estimating a patient's 10-year MS risk and for weighing the benefit of initiating prophylactic treatment at the time of optic neuritis or other initial demyelinating events in the central nervous system. 9 A study conducted in Norway determined the relationship between tobacco smoking and the risk of developing MS in a general population of 22,312 individuals. A total of 87 individuals reported having developed MS. The study concluded that the risk of MS was higher among smokers than among never-smokers. 10 Studies in Canada have provided strong evidence that environmental factors act at a population level to influence the unusual geographical distribution of MS. However, the available data accommodate more than one type of environmental effect. Migration studies show that changes to early environment can greatly affect risk, and there are recent indications that risk can be altered in situ. The rising incidence rates of MS in Canada implied by longitudinal increases in sex ratio place this effect in temporal context and narrow the candidates for mediating the effect of environment. Similarly, geographical patterns in Australia imply that modifiable environmental factors hold the key to prevent 80% of cases. Genetic epidemiology provides overwhelming evidence that genetic background has an important complementary role. If genetic factors are held constant, the environment sets the disease threshold. Although these could be independent additive risk factors, it seems more likely that susceptibility is mediated by direct interactions between the environment and genes. 11

Methodology:-
We searched the following databases from three hundred and nineteen visitors and workers of the malls, both males and females. The study areas were Granada Center, Panorama Mall, Alqasr Mall and Hayat Mall in Riyadh, Saudi Arabia. The Study design is Cross sectional community based study. The study population was selected by simple random sampling. Data collection tool was a self-administered questionnaire, which contains questions measuring community awareness. After gathering the information; clearance, coding, entry and analysis was done. On Ethical considerations, a verbal consent was obtained from all participants, and all participants answered anonymously.

Discussion:-
In this study of public awareness regarding MS, the majority has no knowledge about the disease; this is a clear evidence of low awareness in the community. Where the majority emphasized that they did not attend any awareness campaigns aboutMS.
The majority of the sample has a good knowledge about the causes of the disease, as they mentioned the correct answer which is genetic and viral. Genetic cause of MS is supported by a study in Qatar that showed a positive family history in MS patients, and by another study in the United Statesshowed that almost all patients with MS have a viral antigen. 5,12 This study also suggests that the majority of the sample has no knowledge about MS types. But one third of the sample know that there are types of MS which is correct as there are four types of theDisease according to a study was done about MS types (All About MS) in America, 2002. 13 The study also indicates that the majority of the sample has low knowledge of how to deal with MS patients. A survey of MS perceived cognitive problems and compensatory strategy use in Canada, showed that there was a high prevalence of spontaneous utilization of strategies to deal with cognitive difficulties. The most common strategy was the use of an external memory aid (e.g., note pad). This low knowledge might be due to the low awareness in signs, symptoms and causes of the disease. 14 One third of the study's target populationhas medium level knowledge about the signs and symptoms of MS. A study in the United States about the worst symptoms, showed that it mostly was fatigue then pain and the least being dizziness.Another study said that the signs and symptoms range from those that command the immediate attention of patient and doctor to those that escape the attention of patient and family over the course of a lifetime. 15 About quarter of population chose the correct answer that MS can be prevented, when a geographical pattern in Australia imply that modifiable environmental factors hold the key to prevent 80% of cases. 11 In the study almost half of the sample did not know the answer that MS is rarely fatal. 19 The majority of the sample support that TV is the best way to raise awareness about MS and clearly about any other medical issue. This finding support the result of a study was done about (Mass media and smoking cessation) which concluded that media awareness campaigns and programs produced a change in the awareness. 20 This study resultsshowed that the majority of people trust counseling a doctor about any information they need in regard to MS or other medical issues. This result supports the one of a study titled (Exploration of the relationship between continuity, trust in regular doctors and patient satisfaction with consultations with family doctors) that concluded that the majority of people council their doctors about any health issue, with the trust being the strongest influence. 21

Conclusion:-
In regard to measuring knowledge of people about MS it was found that the majority of people have no idea about what is MS disease, and the level of knowledge in general was average. Specifying the knowledge about the cause of multiple sclerosis, the majority of people think it is genetic in nature. Regarding the knowledge if MS has types or not, the greatest proportion of people agrees that MS have different types. As to having information about dealing with MS patients, the majority was found to lack any knowledge about this aspect. Coming to the sign and symptoms of MS and the extent of people knowledge about them, the majority of people were average. Regarding the cure and the prevention approach of MS, the majority of people do not know if it is curable or preventable. Asking about the knowledge of whether MS is fatal or not, the greatest number of people answered with no.
In respect to the awareness of people about MS, the majority of people mentioned that they did not attend or see MS awareness campaigns. The majority of people prefer television awareness campaigns and doctors as a source of information.
Finally, almost all people in this study have the desire to know more about MS.
Recommendations:-1. According to the discussion, we recommend increasing awareness media campaigns regarding MS, recruiting in it some of the specialized doctors. 2. Increase the public awareness by activating the awareness programs using different methods, such as social media, TV, published brochures, and newspapers. 3. Increase the number of researches about MS around the world. 4. Develop support groups for MS patients, so they can benefit from each other's experiences.