Aya Jabbar Hussein¹, Faraed D Salman²*, Manar Jabbar Hussein³, Marwa Jabbar Hussein⁴, Ahmed Jabbar Hussein⁵ and Jabbar Hussein Kamel⁶

¹BSc Pharmacy (Iraq), MSc Cosmetic Science Student (USA/OH), MBA (USA/LA), Iraq
²Professor in Dental Assistant Department Medical Technical Institute, Erbil Polytechnique University, Erbil/Iraq
³PhD Iraqi Board Degree OBG, Masters in Aesthetic Gynecology (UK), Masters in STEM Cell and Regenerative Medicine, Iraq
⁴Mosul University - College of Medicine, FKBMS - Medical Oncology/Erbil-Iraq, ESMO/ASCO Certified, Iraq
⁵Baghdad University - Dentistry College, Baird British Academy Conservative Dentistry (Certificate), Iraq
⁶Professor in Conservative Dentistry, Head of Conservative Department, TISHK University, Erbil, Iraq

*Corresponding Author: Faraed D Salman, Professor in Dental Assistant Department Medical Technical Institute, Erbil Polytechnique University, Erbil/Iraq.

Received: February 08, 2023; Published: February 27, 2023

Abstract

Assessing the principles, knowledge, attitude, and compliance of the Iraqi population group with regard to mask use; raising awareness and accountability, counseling them on the value of wearing masks, and researching the most common negative effects of mask use among them.

Materials and Methods: 1205 responses to an online survey with a cross-sectional design were gathered from healthy Iraqi backgrounds, ranging in age from 11 to 65 and with varying levels of education. The survey was divided into 5 components that were relevant to the major goals and objectives of the research. Gender differences were expressed as frequencies and percentages using the chi-squared fisher exact test, with statistical significance set at p < 0.05. Data were analyzed using SPSS between various variables.

Results: Among the 1205 people enrolled in the study, females comprised of (723,60%), and males (482,40%) with age range (11-65 years old).

Concerning adherence to wearing mask: The majority of the sample (73% female, 68% male) were adherent to wearing masks, whereas (25%-28%) were non-adherent, with no significant difference between them owing to uncomfortability, with social stigma being the predominant source of this uncomfortability; the overall sample was 30.80% female and 43% male.

Concerning association between health problems side effects of wearing mask: More than half sample (54% females) and (59.7% males) didn’t suffer from any health conditions, while (44.40% females, 36.30% males) suffered from health conditions with highly significant difference at p 0.001 sequentially: respiratory problems, psychological problems, and others with non-significant difference between these problems at p 0.18.

For children, nearly half of the sample (50% girls and 47.90% boys) had the same health problems as in adults, following the same order; respiratory, psychological, and others with a non-significant difference at p 0.096.

Concerning knowledge and attitude: A relatively good percentage of total sample (61.90% females, 54% males) change their mask daily in comparison with (22.10% females, 23.90% males) who wore the mask more than 2 days with highly significant difference at p 0.001, also a good knowledge and attitude percentage concerning disposing mask after frequent use (75.30% females, 72.30% males) with significant difference at p 0.03.

Concerning knowledge and attitude of general population regarding the best type of mask to wear: Less than half of the total sample (47.90% females, 47.70% males) responded that N-95 is the best type with non-significant difference at p 0.2 and (53.50% females 44.30% males) use regular, medical or non-medical mask with highly significant difference at p 0.006.

Concerning the need to wear double masks during the Delta variant: One third of the sample (36.50% females, 28.80% males) felt the urge to wear a mask, while the other third (32% females, 37% males) felt it was not required to wear a mask with a highly significant difference at p 0.008.

Concerning advocating for people to wear masks: More than half of the sample (56.90% females, 56.70% males) advice other people to wear masks more frequently in public places with non-significant difference at p 0.051.

Conclusion: The study revealed good knowledge and attitude level of participants towards; adherence, principles, disposing masks, and promoting the necessity of mask-wearing, with fair level toward the best type of mask to wear; the type they utilize the most, unsatisfactory low level toward hand washing, sanitizing after wearing mask, and for the need to wear double masks during the delta variant with approximately half of the total sample (adults and children) suffered from health issues due to the side effects (respiratory, psychological etc…) it’s imperative to identify solutions to manage these adverse effects.

 Keywords: Mask-wearing; Practice; Iraqi Population; Side Effect

References

1. Chan KH and Yuen KY. “COVID-19 epidemic: disentangling the re-emerging controversy about medical facemasks from an epidemiological perspective”. International Journal of Epidemiology 49 (2020): dyaa044.
2. World Health Organization. Advice on the Use of Masks in the Context of COVID-19, Interim guidance. WHO (2020).
3. Chu DK., et al. “Physical distancing, face masks, and eye protection to prevent person-to-person transmission of SARS-CoV-2 and COVID-19: a systematic review and meta-analysis”. Lancet 395 (2020): 1973-1987.
4. Eikenberry SE., et al. “To mask or not to mask: modelling the potential for face mask use by the general public to curtail the COVID-19 pandemic”. Infectious Disease Modelling (2020) 5:293-308.
5. Howard J., et al. “Face masks against COVID-19: an evidence review”. Preprints (2020) 2020040203.
6. Kai D., et al. “Universal masking is urgent in the covid-19 pandemic: seir and agent based models, empirical validation, policy recommendations”. arXiv:2004.13553. arXiv (2020).
7. Viola IM., et al. “Face coverings, aerosol dispersion and mitigation of virus transmission risk”. arXiv:2005.10720. arXiv (2020).
8. Greenhalgh T., et al. “Face masks for the public during the covid-19 crisis”. BMJ 369 (2020): m1435.
9. Leung CC., et al. “Mass masking in the COVID-19 epidemic: people need guidance”. Lancet 395 (2020): 945.
10. Lyu W and Wehby GL. “Community use of face masks and COVID-19: evidence from a natural experiment of state mandates in the US”. Health Affair 39 (2020): 1419-1425.
11. Liu X and Zhang S. “COVID-19: face masks and human-to-human transmission”. Influenza Other Respir Viruses 14 (2020): 472-473.
12. Bavel JJV., et al. “Using social and behavioural science to support COVID-19 pandemic response”. Nature Human Behaviour 4 (2020): 460-471.
13. Colorafi KJ and Evans B. “Qualitative descriptive methods in health science research”. HERD 9 (2016): 16-25.
14. Lee's A., et al. “Respiratory performance offered by N-95 respirators and surgical masks: Human subject Evaluation With NaCl aerosol representing Bacteria and virus particle size range”. Annals of Occupational Hygiene 52 (2008): 177-185.
15. Gissel Olivas. “Daily use of face masks causing a variety of health issues For Some Amarillo residents”. 4 (2020): 24.
16. Lim ECH., et al. “Headaches and the N95 face-mask amongst healthcare providers”. Acta Neurologica Scandinavica 113 (2006): 199-202.
17. “Expert advice for nurses on minimising the effects of prolonged use of masks and visors”. Erin Dean Posted 14 January (2022).
18. CDA websites (the dentists insurance company 1996-2022, CDA foundation. 1996-2022 California Dental Association (2021).
19. Sawicki JG., et al. “Coronavirus patients safety network sawicki JG, Nystrom DT, Purtell R., et al”. Hospital Practice (2021).
20. Das S., et al. “A comprehensive review of various categories of face masks resistant to COVID-19”. Clinical Epidemiology and Global Health (2021).
21. “Science brief: Community use of masks to control the spread of SARS-CoV-2”. Centers for Disease Control and Prevention (2022).
22. Government of Canada. "Non-medical masks and face coverings: about”. Ottawa, ON: Government of Canada (2020).
23. "Ministry of Health. Face coverings and face masks”. Toronto, ON: Queen's Printer for Ontario (2020).
24. New York Times (2021).
25. https://www.cdc.gov/csels/dls/locs/2021/12-10-2021-Lab-Update-covid-19-response-call-on-12-13.html. (1-3)
26. Kai Kisielinskis., et al. “Is a Mask that covers the mouth &Nose from undesirable Side effects in Everyday Use and free of potentia)”. Hazard s.
27. Palmer CL., et al. “Toxic mask-ulinity: The link between masculine toughness and effective reactions to mask wearing in the COVID-19 era”. Politics and Gender (2020): 1-14.
28. Canini L., et al. “Surgical mask to prevent influenza transmission in household: a cluster randomized trial”. Plos One 5 (2010): e13998.
29. Macintyre CR., et al. “Face mask use and control of respiratory virus transmission in household”. Emerging Infectious Diseases 15 (2009): 233-241.
30. Macintyre CR., et al. “A cluster of randomized trial of cloth masks compared with medical masks in health care workers”. BMJ open 5 (2015): e006577.
31. Macintyre CR., et al. “A cluster randomized clinical trial comparing fit-tested and non-fit tested N-95 respirators to medical masks to prevent respiratory virus infection in healthcare workers”. Influenza Other Respiratory Viruses 5 (2011): 170-179.
32. Suess T., et al. “The role of face masks and hand hygiene in the prevention of influenza transmission in households: results from a cluster randomized trial; Berlin, Germany, 2009 – 2011”. BMC Infectious Diseases 12 (2012): 26.
33. Shenal BV., et al. “Discomfort and Exertion associated with prolonged wear of respiratory protection in a health care setting”. Journal of Occupational and Environmental Hygiene 9 (2011): 59-64.
34. Cohen S. “Social relationships and health”. American Psychology 59 (2004): 676-684
35. Lei-Hunt N., et al. “An overview of systematic reviews on the Public Health Consequences of social isolation and loneliness”. Public Health 152 (2017): 157-171.
36. Holt-Lunstad J., et al. “Social relationships and mortality risk: a metal-analytic review”. Plos Medicine 7 (2010).
37. Shor E and Roelfs DJ. “Social contact frequency and all-cause mortality: a metal-analysis and meta regression”. Social Science and Medicine 128 (2015): 76-86.
38. Rains SA. “The nature of psychological reactance revisited: A meta-analytic review”. Human Communication Research 39 (2013): 47-73.
39. Matusiak L., et al. “Inconveniences due to the use of face masks during the COVID-19 pandemic. A survey study of 876 young people”. Dermatology Therapy 33 (2020): e 13567.
40. Palmiero AJ., et al. “Speech intelligibility assessment of protective facemasks and air-purifying respirations”. Journal of Occupational and Environmental Hygiene 13 (2016): 960-968.
41. Spitzer M. “Masked education? The benefits and burdens of wearing face masks in schools during the current corona pandemic”. Trends in Neuroscience and Education 20 (2020): 100138.
42. World Health Organization. “COVID-19: Physical distancing” (2020).
43. Shuntaroo Kazaki., et al. “Mask increases eye involvement during smiling: a facial EMG study”. Scientific Reports 1 (2021): 20370.
44. Roberge RJ., et al. “Absence of consequential changes in physiological, thermal and subjective responses from wearing a surgical mask”. Respiratory Physiology and Neurobiology 181 (2012): 29-35.
45. Roberge RJ., et al. “Physiological Impact of the N95 filtering facepiece respirator on healthcare workers”. Respiratory Care 55 (2010): 569-577.
46. Rehmann T., et al. “Physiologic and other effects and compliance with long-term respirator use among medical intensive care unit nurses”. American Journal of Infection Control 41 (2013): 1218-1223.
47. Johnson AT. “Respirator masks protect health but impact performance. A review”. Journal of Biological Engineering 10 (2016): 4.
48. Rosner E. “Adverse effects of prolonged mask use among healthcare professionals during covid-19”. Infectious Diseases and Epidemiology (2020).
49. Heider CA., et al. “Prevalence of voice disorders in healthcare workers in the universal masking covid-19 era”. Laryngoscope (2020).
50. Roberge RJ., et al. “Protective face mask impact on human thermoregulation: an overview”. Annals of Occupational Hygiene 56 (2012): 102-112.
51. American college of sports medicine. Sixth ed. Lippincott Williams and Wilkins; Baltimore: 2010. ACSM’S Resource Manual for guidelines for excessive testing and prescription (2010).
52. Farrelk PA., et al. Second edition. Lippncott Williams and Wilkins; Baltimore: 2012. ACSM’S Advanced excessive physiology (2012).
53. Kenney WL., et al. 5^th Human kinetics; champaign, IL: 2012. Physiology of sport and exercise (2021).
54. Kao TW., et al. “The physiological impact of wearing an N95 mask during hemodia-lysis as a precaution against SARS in patients with end-stage renal disease”. Journal of the Formosan Medical Association 103 (2004): 624-628.
55. United States Department of labr. “Occupational safety and health administration”. Respiratory Protection Standards 29 CFR (2007): 1910.134.
56. World Health Organization. “WHO – Advice on the use of masks in the context of covid-19:Interim Guidance”. 6 April 2020. World Health Organization; Geneva, Switzerland (2020).
57. World Health Organization. WHO – Advice on the use of masks in the context of covid-19:Interim Guidance, 5 June 2020. World Health Organization; Geneva, Switzerland (2020).
58. Rebmann T., et al. “Physiologic and other effects and compliance with long-term respirator use among medical intensive care unit nurses”. American Journal of Infection Control 41 (2013): 12181223.
59. Gohn DYT., et al. “Randomised clinical trial to evaluate the safety, fit, comfort of a novel N95 mask in children”. Scientific Report 9 (2019): 18952.
60. Liv Y., et al. “Effects of wearing N95 and surgical facemasks on heartrate, thermal stress and subjective sensation”. International Archives of Occupational and Environmental Health 78 (2005): 501-509.
61. Johnson AT. “Respirator masks protect health but impact performance: a review”. Journal of Biological Engineering 19 (2016): 4.
62. Kyung SY., et al. “Risks of N95 face masks in subjects with COPD”. Respiratory Care 65 (2020): 658-664.
63. Johnson AT., et al. “Effect of external dead volume on performance while wearing a respirator”. AIHAJ-61 (2000): 678-684.
64. Rosner E. “Adverse effects of prolonged mask use among health care professionals during covid-19”. Journal of Infectious Diseases and Epidemiology (2020).
65. Azuma K., et al. “Effects of low-level inhalation exposure to carbon dioxide in indoor environments. A short review on human”. Environment International 121 (2018): 51-56.
66. Drechsler M and Morris J. Stat Pearls. Stat pearls publishing; treasure island, FL, USA: 2020. Carbon dioxide narcosis (2020).
67. Ong JJY., et al. “Headaches associated with personal protective equipment-across-sectional study among frontline healthcare workers during covid-19”. Headache 60 (2020): 864-877.
68. Ramiraz-Moreno JM., et al. “Mas associated de novoheadache in healthcare workers during the covid-19 pandemic”. medRxiv (2020): 2020.08.0720167957.
69. Johnson AT. “Respirator masks protect health but impact performance: a review”. Journal of Biological Engineering 10 (2016): 4.
70. Kumar Shubhanshu and Avaneesh Sing. “Prolonged use of N-95 mask a boon or bane to healthcare workers during covid-19 pandemic”. Indian Journal of Otolaryngology and Head and Neck Surgery 25 (2011): 1-4.
71. Elisheva Rosner., et al. “Adverse effects of prolong use of masks among health care professionals during covid-19”. Journal of Infectious Diseases and Epidemiology 6 (2020): 130.
72. Cansu Koseoglu Toksoy., et al. “Headache related to mask use of health care workers in covid-19 pandemic”. Korean Journal of Pain2 (2021): 241-245.
73. Tayler Green: Dental trends, dentistry, advice and comments October 12th, (2020).
74. https://www.Dentistryiq.com/dentalhygiene/clinical-hygiene/article/14180247/theimpactofcovid-19-ppe-on-dental-professionals-and-dehydration
75. Lan J., et al. “Skin damage among health care workers managing coronavirus disease 2019”. Journal of the American Academy of Dermatology 82 (2020): 1215-1216.
76. Foo C., et al. “Adverse skin reactions to personal protective equipment against severe acute respiratory syndrome – descriptive study in Singapore”. Contact Dermatitis 55 (2006): 291-294.
77. Badri FM. “Surgical mask contact dermatitis and epidemiology of contact dermatitis in health care workers”. Current Allergy and Clinical Immunology 30 (2017): 183-188.
78. Brlayneh Fentahun Shibesh. “Community’s wearing practice and its associated factors for covid-19 prevention in metropolitan city, northwest, Ethiopia”. Primary Health Care: Open Access7 (2021): 391.
79. Adela Ngwe Wondo L., et al. “Knowledge, attributes, practices of/towards covid-19 preventive measures and symptoms: A cross-sectional study during the exponential rise of the outbreak in Cameroon”. Plos Neglected Tropical Diseases (2020).
80. Eddy BsaPB. “Assessment of KAP (knowledge, attitude, and practice) of university students toward prevention of covid-19”. IJBI2 (2020): 117-125.
81. Tirhas Tadese TT., et al. “Health care workers’ knowledge, attitude, and practice of proper face mask utilization, and associated factors in police health facilities of Addis Ababa, Ethiopia”. Journal of Multiscript Health (2020).
82. Azlan, AA., et al. “Public knowledge, attitudes, and practices towards covid-19: A cross-sectional study in Malaysia”. MedRxiv preprint (2020): 20085563.
83. Escombe AR., et al. “Improving natural ventilation in hospital waiting and consulting rooms to reduce nosocomial tuberculosis transmission risk in a low resource setting”. BMC Infectious Disease 19 (2019): 88.
84. Xuyu Chen LR., et al. “Hand hygiene, mask-wearing behaviours and its associated factors during the covid-19 epidemic: across-sectional study among primary school students in Wuhan, China”. International Journal of Environmental Research and Public Health 17 (2020): 2893.
85. Yazew BJ., et al. “Knowledge, attitude, and practice of healthcare workers towards covid-19 epidemic: Across-sectional study among primary school students in Wuhan, China”. International Journal of Environmental Research and Public Health 17 (2020): 2893.
86. Robinson Ssebuufu FKS., et al. “Awareness, knowledge, attitude and practice towards measures for prevention of the spread of covid-19 in the Ugandans”. (2020).
87. Lee LYK., et al. “Practice and technique of using face mask amongst adults in the community: Across-sectional descriptive study”. BMC Public Health1 (2020): 1-11.
88. Gralton J and Mclaws ML. “Protecting health care workers from pandemic influenza; N95 or surgical masks?” Critical Care Medicine 38 (2010): 657-667.
89. Van der Sande M., et al. “Professional and home made masks reduce exposure to respiratory infections among the general population”. PLOS One7 (2008): e2618.
90. Uchida M., et al. “Effectiveness of vaccination and wearing masks on seasonal influenza in Matsumoto city, Japan, in the 2014/2015 season: An observational study among all elementary school children”. Preventive Medicine Reports 5 (2017): 86-91.
91. Chen C., et al. “Hand hygiene, mask-wearing behaviors and its associated factors during the covid-19 epidemic: A cross-sectional study among primary school students in Wuhan, China”. International Journal of Environmental Research and Public Health 8 (2020).
92. Allison MA., et al. “Feasibility of elementary school children’s use of hand gel and face masks during influenza season”. Influenza and Other Respiratory Viruses 4 (2010): 223-229.
93. Stebbins S., et al. “Using non pharmaceutical interventions to prevent influenza transmission in elementary school children: parent and teacher perspectives”. Journal of Public Health Management and Practice 2 (2009): 112-117.
94. Smart NR., et al. “Assessment of the wear ability of face masks against air pollution in primary school-aged children in London”. International Journal of Environmental Research and Public Health11 (2020).
95. Center for disease control and prevention. NIOSH – approved N95 filtering face piece respirators: Ancillary respirator information (2020).
96. Labortest-Schutz masken im Hartesest: Die Melsten Filtern Ungenugend (2020).
97. MacIntyre CR., et al. “A cluster randomized trial of cloth masks compared with medical masks in health care workers”. BMJ Open 5 (2015): e006577.
98. MacIntyre CR., et al. “Face masks for the prevention of infection in health care and community settings”. BMJ 350 (2015): h694.
99. Smith JD., et al. “Effectiveness of N95 respirators versus surgical masks in protecting health care workers from acute respiratory infection: A systematic review and meta-analysis”. CMAJ 188 (2016): 567-574.
100. Manish Garg., et al. “Double masking during covid-19 pandemic”. International Journal of Recent Scientific Research9 (2021): 43084-43087.
101. Brooks JT., et al. “Maximizing Fit for cloth and medical procedure masks to improve performance and reduce SARS-CoV-2 Transmission and exposure, 2021”. MMWR Morbidity and Mortality Weekly Report 70 (2021): 254-257.
102. Mueller J., et al. “Double masking: does science coincide with common sense?” Infection Control and Hospital Epidemiology (2021): 1-2.
103. Unnikrishnnan S. “Double masking or N95 mask must to keep mutant variants at bay”. The New Indian Express (2021).
104. Varyhese AS. “Beat covid with double masking”. The New Indian Express (2021).
105. Sickbert – Bennett EE., et al. “Fitted filtration Efficiency of Double Masking during the covid-19 pandemic”. JAMA Internal Medicine8 (2021): 1126-1128.
106. Rawand Essam., et al. “Clinical features of B.1.617.2 (Delta) variant concern (voc): case report: first case in Iraq”. Research Square (2021).
107. Abishek Singh., et al. “Social perception and practices of households regarding mask use in public places during covid-19 post quarantine period. 2020”. BLDE University Journal of Health Sciences / Published by Wolters-Kluwer-Med Know (2020).
108. Rieger MO. “To wear or not to wear? Factors influencing wearing face masks in Germany during the covid-19 pandemic”. Journal of Health and Social Behavior 3 (2020): 50-54.
109. Nepal R., et al. “Knowledge attitude, and practice regarding covid-19 among healthcare workers in Chitwan”. Nepal. Research. Square (2020).
110. Gunasekaran GH., et al. “Prevalence of face mask use among general public when visiting wet market during covid-19 pandemic: An observational study 110”. med Rxiv 1 (2020): 20105023.

Citation

Citation: Faraed D Salman., et al. “Community’s Mask Wearing Practice and its associated Undesirable Side Effects Among Iraqi Population Group in COVID-19 Era”.Acta Scientific Medical Sciences 7.3 (2023): 172-189.

Copyright

Copyright: © 2022 Faraed D Salman., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.