Qom University of Medical Sciences Journal

Introduction
Scorpion sting is the most important venomous bites in Iran with average annual case of about 50,000 and 20 related deaths. More than 80% of scorpion sting cases are related to the southern Iran. The study aims to investigate the knowledge, attitude and practice (KAP) of people in south of Kerman province, Iran regarding scorpion sting and the factors affecting its prevalence.
Methods
This cross-sectional study was conducted from February to May 2020 in southern areas of Kerman province. The sample size was determined 384 using the formula and considering P=0.5 and 95% confidence interval. The samples were 44 people from Faryab county (Population: 34,600 people), 130 from Roodbar county (Population 105,600 people), 112 from Kahnooj county (Population: 91300 people) and 98 from Ghaleh Ganj county (Population: 79500 people) in Kerman. Samples were selected by multi-stage and random sampling method from health centers, nursing houses, and households. Inclusion criteria were being an adult (a woman or head of household) and resident in rural areas. The exclusion criteria were the inability to communicate normally and lack of cooperation.
The KAP of people experienced scorpion stings as well as environmental and human factors involved in this experience were examined in the rural areas of these counties using a researcher-made questionnaire. The questionnaires were completed by face-to-face interviews. The collected data entered into SPSS v. 20 software and Microsoft Excel 2010. Data were described using mean and standard deviation for quantitative data and frequency and percentage for qualitative data.
Results
The results showed a high level of knowledge (87.9%) of scorpion shelters. The most common reported scorpion shelters were as following: under the bricks/stones/blocks, under carpet, cracks in walls, under  leaf litter, inside of ants’ nest, trunk of trees, and in agricultural lands and gardens. The most important names that local people used for calling scorpions in the southern regions of Kerman province were Zoom, Kazhdom, Almas, Gadim, Hashtbog, Dom Posht, Gunuk and Zartos. The most common strategy in dealing with scorpion stings were hospitalization, use of cold compresses, moving away from the scene, covering the sting area with a cloth, washing the sting site, and applying pressure over the sting site.
Most of participants (81.6%) suggested that spraying insecticides and the use of petroleum products were the main methods for getting rid of scorpions. Most of households were hanging the wet clothes to dry indoor (92.6%), and were aware of shaking out the clothes before using (83.6%). Some households were putting the shoes in the shoe rack, but most of them (63.5%) were leaving their shoes at the door, although most of them were shaking out their shoes before wearing (86.1%). Their beds were mostly on the floor, but they were not shaking out them before using. Moreover, 31% of participants had belief in traditional medicine including the use of opium juice or the leaves/juice of milkweed (Calotropis procera) or eggplant on the sting site, slashing the sting with a blade, and praying. Most of households (73.5%) had found scorpions in their houses and 36.7% of them reported a history of scorpion sting in the family members. Most of them (64%) had got stung indoors. In assessing the safety of the place of residence, it was reported that most of houses (74.8%) had no walls or had very unfavorable fencing such that they not only could not prevent the scorpions from entering the house, but also their cracks and gaps were a safe place for sheltering of scorpions. In addition, most of houses (78.3%) were not safe in terms of scorpions entering due to using Korsi (A stool-like frame of wood covered by blankets under which a fire is placed for heating) indoor in low height, existence of cracks and gaps in walls and windows, not installing nets on windows, and existence of an open space around the location of the cooling system. Most of participants (70.2%) answered “No” to the question about whether they have ever been taught what to do in case of exposure to scorpion stings, and 72.7% answered “No” to the question about whether they have been given education about the characteristics of dangerous scorpions.
Discussion
To our knowledge, this the first study in Iran that assess the environmental and human factors of scorpion sting in the southern region of Kerman province. The results indicate the necessity of planning, designing and implementing preventive measures. In this regard, the negotiation and consulting with regional officials for finding solutions as well as designing a comprehensive educational program can help reduce the incidence of scorpion stings and their complications in the study area. Moreover, training programs in this field should be provided to the physicians, nurses, pre-hospital emergency personnel, and health workers. The distribution of educational pamphlets (with pictures and brief information about the types of dangerous scorpions and how to control them) among people and medical centers and continuous assessments for encouraging people to improve their environmental health can be helpful.
Ethical Considerations
Compliance with ethical guidelines
This article is based on the research grant and support of Jiroft University of Medical Sciences with code of ethics IR.JMU.REC.1399.020.
Funding
The sponsor of this research is Jiroft University of Medical Sciences.
Authors contributions
Project supervisor: Mehran Shahi; The initial idea, development of working methods, conducting research, writing and preparing the main draft: Hossein Dehghan and Ismail Amiri Qanat Saman; Editing of the original draft, criticism and editing of the original version of the article: Tahira Rahimi, Mehran Shahi, Nasser Nasiri, Seyed Hassan Nikokar and Reza Faryabi; Editing of the article, analysis section and entering data into the software: Salman Danshi and Sediq Ahmadzadeh; Data analysis: Tahira Rahimi.
Conflicts of interest
The authors declared no conflict of interest.
Acknowledgements
The authors of the article consider it necessary to thank the former vice president of health and respected supervisor of Jiroft University of Medical Sciences, Dr. Ali Asghar Kheyrkhah, and the caring colleagues of the vice president of health and health networks of Jiroft, Kohnouj, Qaleh-Ganj, Faryab, and Roodbar, especially Mrs. Sarwar Senjari, Asieh Nazari, Habibeh Mirzadeh, Nasrin Selajegheh, as well as Mr. Islam Babrbayan and Ghasem Falah expressed their gratitude. Also, we are appreciated of Mr. Moslem Adeli. We are grateful to the people of the southern regions of Kerman province, who patiently and carefully provided their time to our research team.