Qom University of Medical Sciences Journal

Introduction
Recently, the outbreak of monkeypox virus in May 2022 has caused a new global health concern such that the World Health Organization (WHO) later announced that the monkeypox is a global health emergency. Monkeypox, as a zoonotic disease transmitted from animals to humans, has been predominantly observed in several regions in the world particularly in West and Central Africa [1]. This virus was officially identified as an independent human infection transmitted from one animal to another and subsequently to humans [2]. Monkeypox cases have been reported in 75 countries across five continents [3]. The monkeypox virus is a member of the Orthopoxvirus genus of the Poxviridae family that was first discovered in monkeys in 1958 [4]. Vulnerable groups, for instance, immunocompromised individuals, children, and pregnant women are at risk of this infection [7]. Information regarding the impact of monkeypox infection on pregnant women is limited; however, it has been shown that monkeypox virus transmission to expectant mothers can result in fetal death or congenital infection [8]. The findings of a study by Jacobson et al. [9] showed that attitudes towards fertility and childbearing are influenced by anxiety caused by monkeypox. Dong et al. [10] found that with the outbreak of monkeypox, women’s attitudes towards childbearing have changed and anxiety and fear among women planning pregnancy have increased. The present study aims to predict the anxiety caused by monkeypox based on the attitude towards fertility/childbearing and the attitude towards death in pregnant women from south of Iran.
Method
This is a descriptive-correlational study. The study population consists of all pregnant women who visited the health centers in Zabul city from September to December 2022 (n=5321). Based on the inclusion criteria, 368 people were selected. The data collection tools included the Persian version of attitudes toward fertility and childbearing scale with 23 items and four subscales, Wong et al.’s [19] death attitude profile-revised with 32 items and five subscales (approach acceptance, death avoidance, fear of death, escape acceptance, and natural acceptance), and a researcher-made monkeypox anxiety scale with 18 items and two subscales of physical and psychological symptoms. The obtained data were analyzed in SPSS software, version 26 using Pearson’s correlation test and step-by-step linear regression analysis. The significance level was set at 0.05.
Results
Most of the participants (32.6%) had a marriage duration of 5-10 years. All components of death attitude including escape acceptance (β=0.283), neutral acceptance (β=0.280), approach acceptance (β=0.312), death avoidance (β=-0.168) and fear of death (β=-0.158), as well the components of childbearing attitude including childbearing as a hindrance (β=0.198), fertility for the future (β=0.127), children as a pillar of life (β=0.143) and fertility after the fulfillment of prerequisites (β=0.099) could predict the anxiety caused by monkeypox. They explained 55% of the changes in anxiety caused by the outbreak of monkeypox in pregnant women. All components had a significant and positive relationship with monkeypox-related anxiety, except for the “death avoidance” and “fear of death” components, which had a negative significant relationship. Also, the effect of the “approach acceptance” component on the anxiety caused by the outbreak of monkeypox with a standard beta coefficient of 0.31 was higher than other components in the regression model.
Conclusion
The attitude towards death and fertility/childbearing can predict the anxiety caused by monkeypox in pregnant women. Therefore, cognitive interventions should be conducted to improve these attitudes in pregnant women.
Ethical Considerations
Compliance with ethical guidelines
In this study, all ethical principles were considered. The study was approved by the Ethics Committee of Islamic Azad University, Zabol Branch (IR.IAU.ethics.REc.1402.21799).
Funding
This study was extracted from a research project and financially supported by Islamic Azad University, Zabol Branch and Zabol University of Medical Sciences (Code: 21799).
Conflicts of interest
The author declared no conflict of interest.