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Medicine
DOI: 10.21070/acopen.10.2025.11323
Published: 2025-06-09

Moderate Knowledge and Attitudes Toward Tonsillitis Among Nursing Students


Community Health Nursing Department, College of Nursing, University of Basrah, Basrah
Iraq
Al-Kawther Primary Health Care Center, Basrah Health Directorate, Basrah
Iraq
Fundamentals of Nursing Department, College of Nursing, University of Basrah, Basrah
Iraq
AL-Hadi University College, Department of Radiology Techniques, Baghdad
Iraq
College of Nursing, University of Basrah, Basrah
Iraq
College of Nursing, University of Basrah, Basrah
Iraq

(*) Corresponding Author

Knowledge Attitude Tonsillitis Children Nursing Students

Abstract

General Background: Tonsillitis, a common pediatric illness, is typically self-limiting and primarily viral in origin, though bacterial forms—especially those caused by group A streptococcus—can result in serious complications. Specific Background: Nursing students, as future frontline healthcare providers, require foundational understanding and attitudes toward pediatric infections like tonsillitis to promote effective patient education and clinical decision-making. Knowledge Gap: Limited studies have assessed the adequacy of nursing students’ knowledge and attitudes regarding tonsillitis in children, particularly in Middle Eastern academic contexts. Aim: This study aimed to evaluate the knowledge and attitudes of nursing students at the University of Basrah regarding pediatric tonsillitis. Results: Among 150 students surveyed, most demonstrated moderate knowledge and attitudes toward the condition, with significant gaps in understanding its infectious nature and complications. Novelty: This study highlights underexplored misconceptions among nursing students—such as low awareness of the infectious potential and complications of tonsillitis—despite relatively high awareness of its immunological and symptomatic aspects. Implications: Targeted educational interventions are necessary to address specific knowledge deficiencies and reinforce accurate clinical perspectives, thereby improving early detection, appropriate referral, and rational antibiotic use in pediatric tonsillitis care.

HIghlight :

  • Moderate Understanding: Most nursing students demonstrated moderate knowledge and attitudes regarding tonsillitis in children.

  • Gender Distribution: A higher percentage of female students (66%) participated compared to males (34%).

  • Misconceptions Noted: Only 17.3% correctly identified tonsillitis as infectious, highlighting a crucial gap in understanding.

Keywords: Knowledge, Attitude, Tonsillitis, Children, Nursing Students

 

Introduction

An infection of the tonsils is called tonsillitis. Although it may also strike adults and teens, it is a prevalent childhood ailment. The most frequent cause of it is a viral infection. Occasionally, a bacterial infection (group A streptococcus infection, which is also responsible for scarlet fever) may also be the reason. Close physical contact with another person or airborne droplets from coughing or sneezing can also spread the virus. Like with colds, flu, coughs, and other illnesses of a similar kind, you run the risk of spreading the bacterium or virus that has caused A prevalent illness, Tonsillitis accounts for around 1.3% of outpatient visits [1-5]. Tonsillitis is thought to account for 3.7% of all visits and is the sixth most frequent illness treated by general practitioners (GPs) for children ages 0 to 14 [6-10]. The majority of tonsillitis bouts are caused by viruses, resolve on their own, and don't need medication. [11-15]. When antibiotics are prescribed inappropriately for suspected or acute tonsillitis, it can lead to preventable adverse medication events and exacerbate the growing issue of antibiotic resistance [16-20]. However, if bacterial tonsillitis is not well-treated, it can lead to uncommon but dangerous side effects such as glomerulonephritis, rheumatic fever, and peritonsillar abscesses [21-24]. It is thus advised that those patients who are at high risk or who are vulnerable, such as individuals who are Indigenous, sick patients, or patients whose clinical characteristics are especially severe and indicative of a streptococcal infection, receive antibiotic therapy [25-30]. To treat tonsillitis and the more general problem of identifying and treating respiratory tract and pharyngeal infections, clinical practice guidelines, or CPGs, have been produced. [25, 31]. Additionally, many Australian initiatives have been created to support the promotion of prudent antibiotic usage. [32-34]. The majority (89%) of children under the age of five who have confirmed or suspected tonsillitis episodes are prescribed antibiotics, which is more than what is advised in the current Australian therapeutic guidelines, despite these initiatives and the active promotion of guidelines. Only a minority (14%) receive the suggested counseling and advice. [11].

Methods

A cross-sectional study has been carried out to assess the level of knowledge and attitudes of nursing students about tonsillitis in children in the period from the beginning of November 2023 to the beginning of April 2024. The sample was collected using a questionnaire by interviewing randomly at the College of Nursing, University of Basrah. The researcher adopted an assessment tool to assess the knowledge and attitudes of nursing college students. A questionnaire was conducted to study their knowledge and attitudes. After completing this, the questionnaire was distributed and presented to a panel of experts, and data was collected by interviewing nursing students on the subject of the study. Research study tool (questionnaire): The questionnaire consists of Part One: The first section is a social and demographic characteristics sheet consisting of (5) items: age, gender, educational stage, marital status, and type of study. In the second part, there were some questions to evaluate the knowledge of nursing students. It contained 10 questions, including questions related to the definition of the disease, the causes of the disease, common signs and symptoms, and 10 questions related to the attitudes of nursing students regarding the subject of the study. The project was carried out in Basrah city. The study, which started from December 2023 to the beginning of April 2024 carried out on nursing students. The study involved a sample of 51 males and 99 females, Nursing students. A non-probability (purposive) sampling method was used when selecting the sample to be used to collect data.

Results

Age 18 - 20 55 36.6%
21 - 23 61 40.6%
24 and above 34 22.7%
Gender Male 51 34%
Female 99 66%
Stage Stage 2 54 36%
Stage 3 46 30.7%
Stage 4 50 33.3%
Type of study Morning study 72 48%
Evening study 78 52%
Table 1.The demographic features of the students

The table shows the demographic features of the sample. The table showed that 36.6% of the sample were in the age interval from 18- 20 years, 40.6 % were from 21-23 years and 22.7% were 24 years and above. About the sex of the participants: 34 % were males and 66% were females. Regarding the stages, 36% were in the second stage, 30.7% were in the third stage, and 33.3% were in the fourth stage. Regarding the type of study: 48% were in the morning study and 52% in the evening study.

No. Questions Yes Not Sure No Mean
F % F % F %
1. Tonsils are part of the lymphatic system 129 86.0% 9 6.0% 12 8.0% 2.78
2. Tonsils play an important role in the body’s immunity 134 89.3% 12 8.0% 4 2.7% 2.87
3. Tonsillitis only occurs in children 15 10.0% 7 4.7% 128 85.3% 2.75
4. Tonsillitis is an infectious disease 26 17.3% 34 22.7% 90 60.0% 1.57
5. Tonsillitis is an acute disease 104 69.3% 29 19.3% 17 11.3% 2.58
6. The most common causes are bacterial 97 64.7% 43 28.7% 10 6.7% 1.42
7. Diagnosis is usually made by clinical examination 95 63.3% 36 24.0% 19 12.7% 2.50
8. Surgical tonsillectomy is the treatment of choice 87 58.0% 14 9.3% 49 32.7% 2.25
9. Antibiotics are necessary to treat all infections 88 58.7% 25 16.7% 37 24.7% 1.66
10. The most common signs of tonsillitis
Fever 121 80.7% 14 9.3% 15 10.0% 2.7
Headache 107 71.3% 22 14.7% 21 14.0% 2.57
Pharyngeal pain 138 92.0% 9 6.0% 3 2.0% 2.9
Bad breath 121 80.6% 22 14.6% 7 4.6% 1.24
Snoring during sleeping 91 60.7% 32 21.3% 27 18.0% 1.57
Difficulty eating and drinking 134 89.3% 13 8.6% 3 2.0% 2.87
Table 2.Knowledge of nursing students about tonsillitis in children

The table shows the distribution of the answers to the questionnaire and the mean scores for each question (knowledge) students know significantly that Tonsils are part of the lymphatic system (86%). 89.3% of the students know that Tonsils play an important role in the body’s immunity, and 85.3% know that tonsillitis can occur at any age and not merely for children. Only 17.3% knew that Tonsillitis is an infectious disease, which is incredible .96.3% considered Tonsillitis an acute disease, 64.7% agreed that the most common causes are bacterial, 63.3 % agreed that Diagnosis is usually made by clinical examination, 58% consider Surgical tonsillectomy is the treatment of choice. 58.7% agree that Antibiotics are necessary to treat all infections. Pharyngeal pain, Difficulty eating and drinking, Bad breath, and Fever high grade are signs of acute tonsillitis respectively. Total mean = 2.28 moderate.

No. Questions Yes Not Sure No Mean
F % F % F %
1. Do you think tonsillitis is a serious disease 46 30.6% 28 18.6% 76 50,6% 1.8
2. Do you think the infection can occur more than three times a year 91 60.7% 44 29.3% 15 10.0% 2.50
3. Do you think laboratory tests are necessary for all patient 95 63.3% 27 18.0% 28 18.6% 2.44
4. Do you think drug treatment is more necessary than surgical intervention 85 56.6% 37 24.6% 28 18.7% 2.38
5. Do think recovery is possible without any treatment 58 38.7% 32 21.3% 60 40.0% 1.98
6. Do you think has a serious complication 79 52.6% 43 28.6% 28 18.6% 2.34
7. Do you think tonsillectomy is beneficial for health 67 44.6% 32 21.3% 51 34.0% 2.10
8. Do you think that enlarged tonsils indicate tonsillitis 108 72.0% 32 21.3% 10 6.6% 1.34
9. Do you think mouthwash has a role in preventing tonsillitis 96 64.0% 33 22.0% 21 14.0% 2.50
10. Do you think that constantly eating ice cream can lead to tonsillitis 110 73.3% 21 14.0% 19 12.6% 2.60
Table 3. Attitudes of nursing students about tonsillitis in children

The table shows the responses of the students to the second part of the questionnaire: Only 30.6% think that tonsillitis is a serious disease, and 60.7 % think that the infection can occur more than three times a year. 63.3% think that a laboratory test is necessary for all patients. 56.6% Think that drug treatment is more necessary than surgical intervention. 38.7% think that recovery is possible without any treatment. 52.6%think that the disease has a serious complication. 44.6% think that tonsillectomy is beneficial for health. 72% think that enlarged tonsils indicate tonsillitis. 64% think that mouthwash has a role in preventing tonsillitis 73.3% think that constantly eating ice cream can lead to tonsillitis. Total mean =2.19 moderate.

Discussion

A study conducted at the College of Nursing, University of Basra, using a cross-sectional method, where the results in the first table showed that the largest number of polytheists are between the ages of 21 - 23, and the vast majority are women. The table shows the responses of the students to the questionnaire, by measuring the mean of scores, we found that the students had the significant right answer for all the questions except for, table (2) showed question 4 tonsillitis infection disease (17% answer) the viruses and bacteria that because tonsillitis can sometimes be spread to other people. To avoid spreading infection, it's important to: keep away from people while unwell. Wash your hands. According to the present study, most of the students are female (66%), and the results of this study agree with a study (10) which stated that most of the sample is female, with a percentage of 72.9%. Also, question 6, the most common causes are bacteria only (6% answer). A viral infection is the most common cause of tonsillitis. The most common types of viruses that infect the tonsils include adenovirus, which is a possible cause of the common cold and sore throat, rhinovirus, which is the most common cause of the common cold and influenza, or flu, and others. Table (3) shows that Q1 in the attitude only (30% answer). If tonsillitis is left untreated, a complication called a peritonsillar abscess. This is an area around the tonsils that is filled with bacteria, and it can cause these symptoms: Severe throat pain. And also showed that Q6 attitude, do you think tonsillitis has a serious complication only (18% answer). It's important to treat tonsillitis, especially if it is caused by the strep bacteria, because strep can lead to rare and life-threatening diseases like rheumatic fever.

Conclusion

The majority of participants were aged 21 to 23 years, with more female participants than males. Most of the participating students have moderate knowledge regarding tonsillitis in children, and most of the participating students have moderate attitudes regarding tonsillitis in children.

Recommendations

Providing educational programs for students to improve their knowledge about tonsillitis. Training courses must be provided to students to increase their knowledge of the complications of tonsillitis and common signs and causes of tonsillitis. Due to the importance of tonsils, we recommend increasing health awareness among all university students.

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