Teachers Knowledge towards Autism Spectrum Disorder and its Associated Factor in Addis Ababa public schools, Ethiopia, 2024 Multicenter cross sectional study

Teachers Knowledge towards Autism Spectrum Disorder and its Associated Factor in Addis Ababa public schools, Ethiopia, 2024 Multicenter cross sectional study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Teachers Knowledge towards Autism Spectrum Disorder and its Associated Factor in Addis Ababa public schools, Ethiopia, 2024 Multicenter cross sectional study Mizan Tsegaye, Fasil Menbere, Yohannes Godie, Fikirte Kassaye, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4258035/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 25 You are reading this latest preprint version Abstract Background Autism spectrum disorder (ASD) is a neurodevelopmental disorder primarily impacting social communication and behavior. Preschool and primary school teachers have a vital role in identifying and supporting these children. However, the extent of teachers' knowledge about the disorder and their knowledge towards including children with ASD in their classrooms remains uncertain. The aim of this study was to evaluate the knowledge towards including children with autism spectrum disorders in their classrooms, and associated factors among preschool and primary school teachers in public schools in Addis Ababa. Methods and Materials Data from preschool and primary school teachers were collected using a self-administered questionnaire between September 2023 and December 2023. The collected data were analyzed utilizing SPSS version 27. Descriptive statistics were employed to summarize the findings, while bivariate binary logistic regression was utilized to examine associations between variables. Results The study findings revealed that only 35.5% of teachers had adequate knowledge, and the mean attitude score was 3.4, indicating a slight positive inclination towards inclusive education. Teachers between the ages of 20 and 25 had 90% lower knowledge compared to those above 40 years (AOR = 0.1, 95% CI = 0.48–0.7) with a p-value of 0.014. First to sixth-grade class teachers were 2.4 times more likely to have adequate knowledge (AOR = 2.4, 95% CI = 1.2–4.5) with a p-value of 0.007. Those who relied on social media as a knowledge source were 60% more likely to have knowledge compared to those who did not (AOR = 0.4, 95% CI = 0.2–0.8) with a p-value of 0.013. Previous experience with a child who has special needs increased the likelihood of having adequate knowledge by 44% (AOR = 0.54, 95% CI = 0.2–0.9) with a p-value of 0.04. Conclusion and recommendation The overall level of knowledge regarding ASD is inadequate; however, there is a positive tendency towards including students with ASD in regular classes. It is recommended to provide professional development programs, as well as develop guidelines and curriculum, to enhance teachers' knowledge. Autism spectrum disorder Knowledge Preschool teacher Inclusive education Figures Figure 1 Figure 2 INTRODUCTION Autism spectrum disorder (ASD) poses a significant global financial burden due to various factors, including healthcare services, therapeutic interventions, educational expenses, as well as the costs associated with the loss of productivity among caregivers and adults with ASD. The combined impact of these costs contributes to the economic challenges faced by individuals, families, and societies affected by ASD ( 1 ). ASD is a significant public health concern. Studies have shown a rapid increase in its prevalence in recent years. According to a comprehensive systematic review and meta-analysis, the global prevalence of ASD was found to be 0.6% ( 2 ). The Centers for Disease Control in the USA indicates that ASD affects 1 in 36 children of the age of 8 years ( 3 ). A number of general education teachers practices interventions found to be successful in improving academic outcomes across individuals with ASD ( 4 ). Social, behavioral, and academic teaching strategies can be implemented to improve the educational experiences of students with ASD ( 5 ). Teachers who are supposed to work with student with ASD are expected to have knowledge about specific characteristics, individual learning differences, social interactions and treatments ( 6 ). Poor knowledge of teachers regarding ASD can lead to delayed diagnosis by attributing problematic behavior associated with ASD to disobedience or personality disorder ( 7 ) in addition to recommending ineffective treatment and stigma ( 6 ). In China, it has been observed that a lack of knowledge about autism often leads to teachers being hesitant to accept autistic children into their classrooms. This limited understanding can result in behaviors associated with autism being misinterpreted as intentional misbehavior or a reflection of a disordered personality, rather than being recognized as manifestations of the condition. Moreover, this lack of awareness hinders the recognition and understanding of autism among teachers ( 7 , 8 ). Data are scarce on the prevalence of ASD in Africa compared to other regions of the world. However, four studies conducted in African communities (Uganda, Nigeria, Somalia, and Libya) were assessed, revealing an overall prevalence rate of 1% ( 2 ). In Uganda a prevalence of 0.68% was recorded ( 9 ) In a population-based survey of autistic traits in Kenyan adolescents and young adults 0.63% were estimated as having high autistic traits while 14.9% had borderline autism traits ( 10 ). The prevalence of ASD in Ethiopia, as in many developing nations, lacks official documentation. Nonetheless, it appears ASD is an unaddressed problem given the overcrowding and lengthy waiting lists at existing autism centers in Addis Ababa ( 11 ). There is a significant lack of knowledge about ASD in Ethiopia among the general public, and educational and social sectors, including teachers, health professionals, and government officials ( 12 ). School system support for children with ASD is also very underdeveloped at both government and public facilities ( 11 ). According to a previous study on the lived experiences of parents with children with autism, one of the most significant challenges they faced was accessing schools that could provide professional services for their children. These parents expressed constant worry about the limited availability of facilities such as schools, autism centers, and therapeutic centers, particularly those that offered speech therapy. The lack of resources, services, and trained professionals posed obstacles to parents in supporting their children's academic and social progress effectively. Moreover, the mainstream schools that were accessible to them were ill-equipped to meet the specific needs of children with special needs. These schools lacked proper equipment, professional staff, and adherence to ethical standards. As a result, parents had to navigate through inadequate school systems that had unfair admission rules and where their children received unprofessional treatment from staff members ( 13 ). In Ethiopia, a study was conducted to assess the knowledge among nurses working in governmental hospitals in Addis Ababa, and the findings indicated that nurses had a good level of knowledge about ASD ( 14 ). Previous researches, done in Addis Ababa, has examined the learning difficulties experienced by children with autism and the challenges encountered in teaching processes within autism centers. Studies have also explored the challenges faced by families raising children with ASD, focusing on the perspectives of mothers. However, to the best of the researcher's knowledge, there is no publication available specifically regarding the knowledge of teachers regarding ASD in Ethiopia or Addis Ababa. Considering the extent of awareness gaps observed in developed countries, it is reasonable to assume that similar or even greater knowledge gaps may exist in less developed countries like Ethiopia. METHODS AND MATERIALS Study design, area and Period An institutional-based cross-sectional study design was conducted. The study was conducted in Addis Ababa, the capital and largest city of Ethiopia, which is divided into 11 sub-cities. The focus of the study was on preschools and primary schools in Addis Ababa, specifically within the public school system. Out of the total 903 preschools in Addis Ababa, 227 of them are public schools. The study took place from September 2023 to December 2023, encompassing a four-month period. The target population for the study was the teachers working in public preschools in Addis Ababa, which amounted to a total of 12,019 teachers. Population The source population was all Addis Ababa public preschool and primary school teachers. The study population was randomly selected preschool and primary school teachers working in selected Addis Ababa public schools during the study period and was willing to participate in the study. An inclusion criterion was preschool and primary school teachers in Addis Ababa public schools who were giving service at the time of the study. Exclusion criteria were those who were on sick leave and maternity leave at the time of data collection. Sample size determination The sample size in this cross-sectional study was determined using a single population Proportion formula. Considering the following assumptions Formula: n= \(\frac{{\left(\frac{Z\alpha }{2}\right)}^{2}\times p(1-p)}{{d}^{2}}\) Where, n = the required sample size (Zα/2 = 1.96 = (standard score corresponding to 95% confidence interval) P = 80% taken from South African study done on knowledge and associated factors of ASD ( 15 ). However, the researcher could not find a similar study on attitude and associated factors for attitude. d = 5% (maximum margin of error the researcher is willing to allow) Therefore n = (1.96) 2 (0.8x0.2)/ (0.05) 2 = 245 for knowledge. n = (1.96) 2 (0.5x0.5)/ (0.05) 2 = 384 for attitude. n = (1.96) 2 (0.8x0.2)/ (0.05) 2 = 245 for associated factors for knowledge. n = (1.96) 2 (0.5x0.5)/ (0.05) 2 = 384 for associated factors for attitude. 384 was taken because it is the highest possible sample size Then, considering 10% of non-respondent rate the final desired sample size was calculated as 384 + 38 (10% non-response rate). Then, the final sample size was 423. Data collection and instrument A validated self-administered questionnaire was chosen as the appropriate method for data collection in this study due to its advantages in terms of standardization and efficiency. The Autism Stigma and Knowledge Questionnaire (ASK-Q) was chosen as it is a validated tool with robust psychometric support and cross-cultural applicability in measuring knowledge. The ASK-Q draws upon published research conducted in 11 countries, including the US, UK, Iran, India, Saudi Arabia, Malaysia, Tanzania, Senegal, Cape Verde, Zambia, and Burkina Faso. The questionnaire includes four domains that assess different aspects of knowledge. The first domain focuses on symptoms and diagnosis of ASD. The second domain explores the etiology and nature of the disorder. The third domain examines knowledge about the treatment of ASD. Lastly, the fourth domain delves into the topic of stigma associated with ASD. To assess the reliability of the ASK-Q, a test-retest method using a reliability metric developed for Dichotomous Classification Models (DCMs) was employed. The findings revealed high-reliability coefficients for the classifications of the four subscales, namely 0.982, 0.954, 0.984, and 0.933. Additionally, the ASK-Q exhibited strong internal consistency, as indicated by a Cronbach's Alpha coefficient of 0.88 ( 16 ). For this study, a total of 19 items were selected from the original 49 items of the ASK-Q, representing all four subscales. Proportional cut-off values were calculated to determine inadequate knowledge. The Autism Attitudes Scale for Teachers (AAST) is used in this study. It is a Likert-type scale used to measure school teachers' attitudes towards children with ASD. It consists of two alternate forms, each containing seven items, and offers five response options: strongly disagree, disagree, uncertain, agree, and strongly agree. The correlation between Forms A and B is reported to be 0.84. The reliability coefficients for Forms A and B are 0.85 and 0.78, respectively. The combined 14-item scale has an alpha reliability coefficient of 0.91. Accordingly, attitude scores are obtained by summing the scores of individual items. Notably, Questions 1, 2, 4, 6, 7, 8, 9, 11, 13, and 14 are reverse graded. A higher total score on the scale indicates a more positive attitude towards children with ASD ( 17 ). Both of the form was used in this study. A one-day training session was conducted for both data collectors and supervisors. The training covered various aspects, including the objective and relevance of the study, the importance of maintaining confidentiality of information, the rights of the respondents, obtaining informed consent, and the methods of data collection. Following the training, data collection was started. At the end of each day, the supervisors and principal investigator reviewed and examined the collected questionnaires for completeness and relevance. Feedback and guidance were provided to the data collectors as necessary, ensuring the quality and accuracy of the data collection process. Operational Definition Preschool teachers – teachers who were teaching students in kindergarten class at the time of study Primary school teachers - teachers who were teaching students from 1st grade to 8th grade at the time of study Autism spectrum disorder disorder which meet the ASD criteria of DSM-5TR. Regular classroom General education classroom that follows the standard curriculum for the given grade level. Adequate Knowledge - Respondents who score above or equal to the cut-off score of knowledge-related questions ( 16 ). Inadequate knowledge - Respondents who scored below the cut-off score of knowledge-related questions ( 16 ). Positive attitude - Respondents who scored the mean and above score of attitude-related Questions ( 18 ). Negative attitude -Respondents who scored below the mean score of attitude-related questions ( 18 ). Methods Data Analysis and Interpretation Data collection was carried out using the Kobo Tool software. Subsequently, the collected data underwent a cleaning process and was exported to the SPSS Version 27 software for analysis. Descriptive analyses were conducted for all variables after ensuring the data's distribution, and any outliers, missing values, or inconsistencies were identified and addressed. Continuous variables were reported as mean ± standard deviation, while categorical variables were presented as numbers (percentages). Adequate knowledge was coded as "1" and inadequate knowledge as "0" for the knowledge outcome. Similarly, a positive attitude was coded as "1" and a negative attitude as "0" for the attitude outcome. Univariate and bivariate regression analyses were conducted to examine the association between dependent and independent variables. Statistical significance was determined at a 95% confidence interval, with a p-value threshold of less than 0.05. The study's results were presented using text, tables, and pie charts to enhance comprehension RESULTS Socio-demographic characteristics of study participant In this study, a total of 416 teachers participated, resulting in a response rate of 98.3%. However, data from 3 participants had missing values exceeding 50%, so the final sample size used for analysis was 413.The mean age of the participants was 32.5 years, with a standard deviation of 7.3. Of the participants, 52% (214) were female and 48% (197) were male. The majority of teachers had a work experience ranging from 5 to 10 years, which accounted for 30% of the sample. Regarding monthly income, the mean was reported as 7795 birr, with a range of 2799 to 19030 birr (Table 1). Response of participants regarding previous training, formal education, and experience related to ASD In response to questions regarding previous training, formal education, and experience related to ASD, Only 6 out of the 413 teachers (1.5%) reported that they had not heard about autism before. The majority of teachers (80.9%) reported teaching in inclusive schools. Approximately 57.1% of the teachers reported having come across an autistic child in their previous work experience. About 54% of the teachers reported knowing an autistic person closely. When it comes to sources of information about autism, the majority of teachers (63.2%) reported social media as a common source (Table 2). Knowledge based characteristics of the study participant on ASD The overall knowledge of study participants on ASD was measured using the mean value, and the score of the mean value was 9.5 ± 4.2 out of 19. Adequate knowledge was demonstrated by 35.6% of the teachers based on their scores. The knowledge based characteristics is expressed in the figure below (Figure 1). The mean scores for the subdomains of the knowledge questionnaire were as follows: Etiology of ASD: 3.35 ± 2 out of 8, Symptoms of ASD: 4.42 ± 2.3 out of 7, Treatment of ASD: 1.69 ± 1.1 out of 4, and Endorsement of stigma; 1.5 ± 1 out of 3 (Table 3). Attitude-based characteristics of study Participants on inclusion of student with ASD to regular schools The overall attitude of study participants towards the inclusion of autistic students in regular schools, based on the mean value score, is 3.34±0.49, indicating a mildly positive attitude. Out of the total participants, 77.5% (320 individuals) had a positive attitude where as 22.5% (93 individuals) had a negative attitude towards inclusion. The mean value score for the question "Such a good teacher can do a lot to help an autistic child" was higher at 3.95±1.1. On the other hand, the mean value score for the question "Regular schools are too advanced for autistic children" was lower at 2.66±1.2 (Figure 2). Determinant of participant’s knowledge about autism spectrum disorder The strength of the variables was assessed using odds ratios (OR) and 95% confidence intervals (CI) through a binary logistic regression model. In the bivariate binary logistic regression analysis, several variables were found to be associated with the adequacy of knowledge at a p-value of 0.25. These variables included age, work experience, source of knowledge from formal education, social media, TV and radio, previous teaching experience in inclusive classrooms, previous experience with a child with special needs, and attitudes of teachers toward inclusive education. However, in the multivariate binary logistic regression analysis, after accounting for other variables, only certain factors remained significant at a p-value of 0.05. These significant factors were age, level of classroom teaching, social media as a source of information, and participant's experience with a child having special needs and attitude of teachers towards inclusive education of students with ASD. Accordingly, after adjusting for other covariates: Participants in the age range of 20-25 years had a 90% lower chance of having adequate knowledge compared to those aged above 40 years (adjusted odds ratio [AOR] = 0.1, 95% confidence interval [CI] = 0.48-0.7). Participants who had no experience with children having special needs had a 46% lower chance of having adequate knowledge compared to participants who had experience (AOR = 0.54, 95% CI = 0.2-0.9). First to sixth grade teachers had 2.4 times greater chance of having adequate knowledge compared to teachers who teach in the 7th and 8th grades (AOR = 2.4, 95% CI = 1.2-4.5). Participants who did not acquire their knowledge from social media had a 60% lower chance of having adequate knowledge (AOR = 0.4, 95% CI = 0.2-0.8). Participants who had negative attitudes toward teaching students with ASD in regular classrooms have 80% lower chance of having adequate knowledge (AOR = 0.2, 95% CI = 0.1-0.6) (Table 4). DISCUSSION The findings of the present study indicate that participants had a relatively low level of knowledge, with only 35.6% achieving an "Adequate" knowledge score. This is concerning, especially considering the current prevalence of ASD. In comparison to similar studies conducted in South Africa, where a higher proportion (80%) of participants demonstrated better knowledge about ASD, the results suggest a notable disparity in knowledge levels between the two regions ( 15 ). On average participants responded 50% of total scores obtainable which is lower than results from Nigeria where participants correctly answered 67.9% of total scores obtainable ( 19 ). A higher proportion of nurses (54.35%) working in governmental hospitals in Addis Ababa demonstrated good knowledge about ASD compared to the teachers in this study ( 14 ). Similar to the study participants in South Africa, this study showed a higher proficiency in recognizing ASD symptoms (68%), but their understanding of the ethology, nature of the disease, and treatment of ASD was relatively limited (15% and 22% respectively)( 15 ). It is important to note that possessing adequate knowledge about the nature and treatment of ASD is crucial for teachers, as it enables them to provide appropriate advice to parents and recommend timely specialist intervention for their children. The findings of the study indicate several factors that were positively associated with possessing adequate knowledge about autism. These factors include older age, teaching from 1st to 6th grade, obtaining information about autism from social media, and having experience with special needs students. Specifically, teachers who taught in the 1st to 6th grade had 2.4 times higher knowledge compared to teachers who taught in the 7th and 8th grade (2.4; 95% CI: 1.2–4.5). This difference in knowledge levels may be attributed to 72% of the special need students are attending lower grades of 1 to 4 (and 28% enrolling grades 5 to 8), which indicates that many special need students are not progressing through the education system and that there is a high dropout and repetition rate within this group of students ( 20 ) so 1st to 6th grade teachers' greater exposure to a larger number of special needs students, particularly those with more severe forms of autism. Some students may drop out or repeat grades before reaching the 7th and 8th grade. The finding that participants who did not acquire their knowledge from social media had a 60% lower chance of having adequate knowledge (AOR = 0.4, 95% CI = 0.2–0.8) suggests that obtaining information about autism from social media platforms may have a positive impact on teachers' knowledge levels. On the other hand, unlike findings from other studies ( 21 ) the finding that receiving formal education or training did not show any significance in relation to knowledge about autism raises concerns about the effectiveness of current teaching materials and guidelines. The superior performance of teachers with hands-on experience in working with special needs students, which was found to be 40% higher (AOR = 0.6, 95% CI = 0.2–0.8), is consistent with the findings of a study conducted in Singapore. The study in Singapore also reported that teachers with prior work experience with children with special needs had higher knowledge about ASD (OR = 1.716 CI 1.128–2.610) ( 22 ). This suggests that direct, in-person interactions with special needs children may enhance teachers' overall comprehension of child development, enabling them to more effectively discern distinctions between typically developing children and those with special needs and that practical experience is a more effective means of imparting knowledge about autism to teachers, compared to formal education and training programs ( 21 ). The findings of the present study indicate a concerning inadequacy in the knowledge of preschool and primary teachers regarding ASD. Approximately 65% of the participants demonstrated a lack of knowledge in this area. Although teachers displayed a generally positive knowledge towards ASD, about the disorder was found to be insufficient. Such interventions are crucial for promoting the appropriate identification and education of children with autism. The cross-sectional method employed in this study has a limitation. The sample size could have been increased with design effect to increase the strength of the finding. Another limitation pertains to the wording of the knowledge assessment questionnaire. The possibility of leading or suggestive wording in the questionnaire could have influenced participants to provide responses that aligned with the expected correct answers.. Additionally, a limitation of the study is the lack of comparison of findings between different schools. Each school may have a different inclusive culture, which could potentially influence the knowledge and attitudes of teachers towards ASD. It is crucial to acknowledge and address these limitations in future studies to enhance the validity and reliability of the research findings. Acronyms and Abbreviations ASD = Autism spectrum disorders, DSM = Diagnostic and Statistical Manual of Mental Disorders, AAST = Autism Attitude Scale for teachers, ASKQ = Autism stigma and knowledge questionnaire, AOR = Adjusted Odds Ratio, COR = Crudes Odds Ratio, CI = Confidence Interval, OR = Odds Ratio, SPSS = Statistical Package for Social Science, MOH = Ministry of Health, MOE = Ministry of Education, and WHO = World Health Organization Declarations Ethical approval Before commencing the research, ethical clearance was obtained from the Ethical Committee of SPHMMC (name of the institution) with additional support in the form of a letter from the Pediatrics Department and the City Government of Addis Ababa Education Bureau. Before their involvement in the study, all participating school teachers were provided with a written informed consent document. This document assured them of the confidentiality and anonymity of their responses. It was clearly stated in the consent form that the participants had the right to withdraw from the study at any stage if they wished to do so. Furthermore, the questionnaire did not collect any personally identifiable information, and all data collected were treated as strictly confidential, and solely used for research purposes. Participation in the study was entirely voluntary. Availability of Data and materials: The data and other documents used in this study are available from the corresponding author. Competing interests: All authors confirmed that they have no conflict of interest. However, some parts of the paper Funding This research did not receive any specific grant from fund agencies Authors Contribution: MT and FM conceptualized and designed the study; collected, analyzed and interpreted the data; and drafted the manuscript. YG, DB, FK , and TA were involved in data analysis, drafting of the manuscript and advising the entire research paper. They were also involved in the interpretation of the data and contributed to manuscript preparation. All authors have read and approved the final manuscript. Acknowledgement We have special thanks for study subjects, institutions, data collectors, leaders and staff of each study area. We would like to express thanks to Dr. Surafel Worku for his expertise and support. References Association AP. Diagnostic and Statistical Manual of Mental Disorders, DSM-5. 5th ed: American Psychiatric Publishing;. 2018. Salari N, Rasoulpoor S, Rasoulpoor S, Shohaimi S, Jafarpour S, Abdoli N, et al. The global prevalence of autism spectrum disorder: a comprehensive systematic review and meta-analysis. Ital J Pediatr. 2022;48(1):112. Rochelle P. Walensky M, MPH, Director, Debra Houry M, MPH, Chief Medical Officer and Deputy Director for Program and Science Rebecca Bunnell, PhD, MEd, Director, Office of Science. 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Tables Table 1: Socio-demographic characteristics among preschool and primary school teachers (n=413) Variable Frequency Percentage (%) Age 20 – 25 years 26 – 30 years 31 – 40 years Above 40 years 65 124 166 49 16.1 30.7 41.1 12.1 Sex Female Male 214 197 51.8 47.7 Marital statues Married Single Divorced Widowed 236 155 14 7 57.7 37.5 3.4 1.7 Level of education Certificate Diploma Degree Masters 10 158 228 17 2.4 38.3 55.2 4.1 Work Experience < 1 year 1 – 5 years 5 -10 years 10 – 20 years 20 – 30 years 30 – 40 years 17 92 124 104 27 9 4.1 22 30 25.2 6.5 2.2 Level of classroom teachers teach Preschool 1 st – 6 th Grade 7 th – 8 th Grade 65 204 130 15.7 49.4 31.5 Sub-city of school teachers teaches Arada Addis Ketema Gulelea 90 175 148 21.7 42.3 35.8 Table 2: Participant Responses to questions regarding previous training, formal education and experience related to ASD (n=413) Variable Response Frequency % Have you heard about autism before Yes No 392 6 97.8 1.5 Have you come across autistic child during your work experience as teacher? Yes No 236 175 57.1 42.4 Have you had any form of formal Education about autism? Yes No 121 291 29.3 70.5 Do you know a close person with autism? Yes No 224 187 54.2 45.3 If the answer to the above question is yes how frequently do you meet this child Daily Weekly Monthly Sometimes Never 71 28 17 97 12 17.2 6.8 4.1 23.5 2.9 Have you had Training on early childhood development? Yes No 145 265 35.1 64.2 Are you teaching in inclusive school Yes No I don’t know 334 50 27 80.9 12.1 6.5 Have had teaching experience In a special need or inclusive classroom? Yes No 261 147 63.2 35.6 Have you had Previous experience of children with special need? Yes No 178 413 43.1 55.7 Table 3: The knowledge characteristics of study participants in the subdomain of symptoms, ethology, treatment and endorsement of stigma Subdomains Adequate knowledge Inadequate knowledge Frequency Percent % Frequency Percent % Symptoms 280 67.8 133 32.2 Etiology 65 15.7 348 84.3 Treatment 98 23.7 315 76.3 Endorse stigma Do not Endorse stigma Stigma 179 43.3 234 56.7 Table 4: Determinant of having adequate knowledge with regards to ASD among teachers Variables Knowledge COR(95%CI) AOR (95%CI) P -value Adequate Knowledge Inadequate knowledge Age 20-25 11 54 0.2 (0.0-0.5) 0.1 (0.48-0.7) 40 24 25 1 1 Work experience 1-10year 73 143 0.6 (0.2-1.4) 1.1 (0.3-3.9) 0.81 11-20year 48 56 1.5 (0.5-2.5) 1.48 (0.48-4.5) 0.48 21-30 year 12 15 1 1 Level of class of teaching Preschool 25 40 4.3 (1.3-13) 1.6 (0.69-4.0) 0.249 1 st -6 th grade 75 129 1.5 (0.8-2.8) 2.4 (1.2-4.5) 0.007 7 th and 8 th grade 38 92 1 1 Source of knowledge formal education Yes 49 70 1 1 No 97 191 1.3 (0.8-2.1) 1.0 (0.5-1.9) 0.99 Books Yes 56 71 1 1 No 90 190 0.2 (0.2-2.2) 1.0 (0.5-1.9) 0.96 Social media Yes 108 153 1 1 No 38 108 2.0 (1.2-3.1) 0.4 (0.2-0.8) 0.013 TV and radio Yes 81 126 1 1 No 65 135 1.3 (0.8-2.0) 0.6 (0.3-1.0) 0.07 Teaching experience in special need or inclusive class Yes 110 151 1 1 No 37 110 2.1 (1.3-3.3) 0.6 (0.3-1.1) 0.13 Previous experience of children with special need child Yes 82 96 1 1 No 64 166 2.2 (1.4-3.3) 0.54 (0.2-0.9) 0.04 Attitude Positive attitude 117 172 1 Negative 22 23 0.4 (0.2-0.7) 0.2 (0.1-0.6) 0.001 Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4258035","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":291562113,"identity":"944a7d29-2d7e-4627-b208-3a48411c50bf","order_by":0,"name":"Mizan Tsegaye","email":"","orcid":"","institution":"Saint Paul’s hospital Millennium Medical College","correspondingAuthor":false,"prefix":"","firstName":"Mizan","middleName":"","lastName":"Tsegaye","suffix":""},{"id":291562114,"identity":"cd7d9a73-fb02-414a-bc92-197a0211de81","order_by":1,"name":"Fasil Menbere","email":"","orcid":"","institution":"Saint Paul’s hospital Millennium Medical College","correspondingAuthor":false,"prefix":"","firstName":"Fasil","middleName":"","lastName":"Menbere","suffix":""},{"id":291562115,"identity":"b3586737-3bee-41ee-b583-4799b2fd0e04","order_by":2,"name":"Yohannes Godie","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA80lEQVRIiWNgGAWjYFACHjjL4ABDBZBiZm4gRcsZkBZGErQwMLaBaAJaDI73HvxcuMPGXj4ieeOBj/Nqo/nbgVp+VGzDreXMuWTpmWfSEjfeSCs4OHPb8dwZhxkbGHvO3Mat5UaOgTRv2+EEwxk5Bod5tx3LbQBqYWZsw6vF+Ddv2397sJa/c47lzidCixnQlgOM8yWAWhgbanI3ENIieeaMmTVvW3LiBp5nBQd7jh3I3QjUchCfX/iO9xjf5m2zs5dvT9784UdNXe6884cPPvhRgVuLwgGYCyGMw2DyADalMCDfgMqow6d4FIyCUTAKRigAANZiY0N+NIDMAAAAAElFTkSuQmCC","orcid":"","institution":"Menelik II Medical and Health science college","correspondingAuthor":true,"prefix":"","firstName":"Yohannes","middleName":"","lastName":"Godie","suffix":""},{"id":291562116,"identity":"a2c6fd00-e6f0-49ab-adbf-39e9f054560f","order_by":3,"name":"Fikirte Kassaye","email":"","orcid":"","institution":"Menelik II Medical and Health science college","correspondingAuthor":false,"prefix":"","firstName":"Fikirte","middleName":"","lastName":"Kassaye","suffix":""},{"id":291562117,"identity":"da82733a-f056-45e3-a75e-6a69acecd324","order_by":4,"name":"Dires Birhanu","email":"","orcid":"","institution":"Dila University","correspondingAuthor":false,"prefix":"","firstName":"Dires","middleName":"","lastName":"Birhanu","suffix":""},{"id":291562118,"identity":"32c1a26b-fcac-432f-aa03-8c208a5dfed4","order_by":5,"name":"Teklu Assefa","email":"","orcid":"","institution":"Menelik II Medical and Health science college","correspondingAuthor":false,"prefix":"","firstName":"Teklu","middleName":"","lastName":"Assefa","suffix":""}],"badges":[],"createdAt":"2024-04-12 13:22:45","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4258035/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4258035/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":55006462,"identity":"9d88bffa-05e0-4d0c-a77a-d4bd8152b44b","added_by":"auto","created_at":"2024-04-19 18:58:01","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":6665,"visible":true,"origin":"","legend":"\u003cp\u003eKnowledge based characteristics of the study participant on ASD\u003c/p\u003e","description":"","filename":"Onlinedrawingimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-4258035/v1/07c9547856f7c9eedd24212e.png"},{"id":55005494,"identity":"f30ff3f0-26a7-45a7-9bc7-733e20efeaa0","added_by":"auto","created_at":"2024-04-19 18:50:01","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":5766,"visible":true,"origin":"","legend":"\u003cp\u003eThe overall attitude of study participants on ASD\u003c/p\u003e","description":"","filename":"Onlinedrawingimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-4258035/v1/58dc56a66e0354b436e38198.png"},{"id":55008614,"identity":"4c93888b-3db1-4d24-b59f-7bbb51942535","added_by":"auto","created_at":"2024-04-19 19:06:02","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":466329,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4258035/v1/b0c75751-d2e4-4851-a5c9-da1e24a741a5.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Teachers Knowledge towards Autism Spectrum Disorder and its Associated Factor in Addis Ababa public schools, Ethiopia, 2024 Multicenter cross sectional study","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eAutism spectrum disorder (ASD) poses a significant global financial burden due to various factors, including healthcare services, therapeutic interventions, educational expenses, as well as the costs associated with the loss of productivity among caregivers and adults with ASD. The combined impact of these costs contributes to the economic challenges faced by individuals, families, and societies affected by ASD (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eASD is a significant public health concern. Studies have shown a rapid increase in its prevalence in recent years. According to a comprehensive systematic review and meta-analysis, the global prevalence of ASD was found to be 0.6% (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). The Centers for Disease Control in the USA indicates that ASD affects 1 in 36 children of the age of 8 years (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). A number of general education teachers practices interventions found to be successful in improving academic outcomes across individuals with ASD (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). Social, behavioral, and academic teaching strategies can be implemented to improve the educational experiences of students with ASD (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). Teachers who are supposed to work with student with ASD are expected to have knowledge about specific characteristics, individual learning differences, social interactions and treatments (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). Poor knowledge of teachers regarding ASD can lead to delayed diagnosis by attributing problematic behavior associated with ASD to disobedience or personality disorder (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e) in addition to recommending ineffective treatment and stigma (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn China, it has been observed that a lack of knowledge about autism often leads to teachers being hesitant to accept autistic children into their classrooms. This limited understanding can result in behaviors associated with autism being misinterpreted as intentional misbehavior or a reflection of a disordered personality, rather than being recognized as manifestations of the condition. Moreover, this lack of awareness hinders the recognition and understanding of autism among teachers (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). Data are scarce on the prevalence of ASD in Africa compared to other regions of the world. However, four studies conducted in African communities (Uganda, Nigeria, Somalia, and Libya) were assessed, revealing an overall prevalence rate of 1% (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). In Uganda a prevalence of 0.68% was recorded (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e) In a population-based survey of autistic traits in Kenyan adolescents and young adults 0.63% were estimated as having high autistic traits while 14.9% had borderline autism traits (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). The prevalence of ASD in Ethiopia, as in many developing nations, lacks official documentation. Nonetheless, it appears ASD is an unaddressed problem given the overcrowding and lengthy waiting lists at existing autism centers in Addis Ababa (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThere is a significant lack of knowledge about ASD in Ethiopia among the general public, and educational and social sectors, including teachers, health professionals, and government officials (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). School system support for children with ASD is also very underdeveloped at both government and public facilities (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). According to a previous study on the lived experiences of parents with children with autism, one of the most significant challenges they faced was accessing schools that could provide professional services for their children. These parents expressed constant worry about the limited availability of facilities such as schools, autism centers, and therapeutic centers, particularly those that offered speech therapy. The lack of resources, services, and trained professionals posed obstacles to parents in supporting their children's academic and social progress effectively. Moreover, the mainstream schools that were accessible to them were ill-equipped to meet the specific needs of children with special needs. These schools lacked proper equipment, professional staff, and adherence to ethical standards. As a result, parents had to navigate through inadequate school systems that had unfair admission rules and where their children received unprofessional treatment from staff members (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn Ethiopia, a study was conducted to assess the knowledge among nurses working in governmental hospitals in Addis Ababa, and the findings indicated that nurses had a good level of knowledge about ASD (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). Previous researches, done in Addis Ababa, has examined the learning difficulties experienced by children with autism and the challenges encountered in teaching processes within autism centers. Studies have also explored the challenges faced by families raising children with ASD, focusing on the perspectives of mothers. However, to the best of the researcher's knowledge, there is no publication available specifically regarding the knowledge of teachers regarding ASD in Ethiopia or Addis Ababa. Considering the extent of awareness gaps observed in developed countries, it is reasonable to assume that similar or even greater knowledge gaps may exist in less developed countries like Ethiopia.\u003c/p\u003e"},{"header":"METHODS AND MATERIALS","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy design, area and Period\u003c/h2\u003e \u003cp\u003eAn institutional-based cross-sectional study design was conducted. The study was conducted in Addis Ababa, the capital and largest city of Ethiopia, which is divided into 11 sub-cities. The focus of the study was on preschools and primary schools in Addis Ababa, specifically within the public school system. Out of the total 903 preschools in Addis Ababa, 227 of them are public schools. The study took place from September 2023 to December 2023, encompassing a four-month period. The target population for the study was the teachers working in public preschools in Addis Ababa, which amounted to a total of 12,019 teachers.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003ePopulation\u003c/h2\u003e \u003cp\u003eThe source population was all Addis Ababa public preschool and primary school teachers. The study population was randomly selected preschool and primary school teachers working in selected Addis Ababa public schools during the study period and was willing to participate in the study. An inclusion criterion was preschool and primary school teachers in Addis Ababa public schools who were giving service at the time of the study. Exclusion criteria were those who were on sick leave and maternity leave at the time of data collection.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eSample size determination\u003c/h2\u003e \u003cp\u003eThe sample size in this cross-sectional study was determined using a single population Proportion formula.\u003c/p\u003e \u003cp\u003eConsidering the following assumptions\u003c/p\u003e \u003cp\u003eFormula: n= \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\frac{{\\left(\\frac{Z\\alpha }{2}\\right)}^{2}\\times p(1-p)}{{d}^{2}}\\)\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e \u003cp\u003eWhere, n\u0026thinsp;=\u0026thinsp;the required sample size\u003c/p\u003e \u003cp\u003e(Zα/2\u0026thinsp;=\u0026thinsp;1.96 = (standard score corresponding to 95% confidence interval)\u003c/p\u003e \u003cp\u003eP\u0026thinsp;=\u0026thinsp;80% taken from South African study done on knowledge and associated factors of ASD (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). However, the researcher could not find a similar study on attitude and associated factors for attitude.\u003c/p\u003e \u003cp\u003ed\u0026thinsp;=\u0026thinsp;5% (maximum margin of error the researcher is willing to allow)\u003c/p\u003e \u003cp\u003eTherefore\u003c/p\u003e \u003cp\u003en = (1.96)\u003csup\u003e2\u003c/sup\u003e (0.8x0.2)/ (0.05)\u003csup\u003e2\u003c/sup\u003e= 245 for knowledge.\u003c/p\u003e \u003cp\u003en = (1.96)\u003csup\u003e2\u003c/sup\u003e (0.5x0.5)/ (0.05)\u003csup\u003e2\u003c/sup\u003e= 384 for attitude.\u003c/p\u003e \u003cp\u003en = (1.96)\u003csup\u003e2\u003c/sup\u003e (0.8x0.2)/ (0.05)\u003csup\u003e2\u003c/sup\u003e= 245 for associated factors for knowledge.\u003c/p\u003e \u003cp\u003en = (1.96)\u003csup\u003e2\u003c/sup\u003e (0.5x0.5)/ (0.05)\u003csup\u003e2\u003c/sup\u003e= 384 for associated factors for attitude.\u003c/p\u003e \u003cp\u003e384 was taken because it is the highest possible sample size Then, considering 10% of non-respondent rate the final desired sample size was calculated as 384\u0026thinsp;+\u0026thinsp;38 (10% non-response rate).\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eThen, the final sample size was 423.\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eData collection and instrument\u003c/h2\u003e \u003cp\u003eA validated self-administered questionnaire was chosen as the appropriate method for data collection in this study due to its advantages in terms of standardization and efficiency. The Autism Stigma and Knowledge Questionnaire (ASK-Q) was chosen as it is a validated tool with robust psychometric support and cross-cultural applicability in measuring knowledge. The ASK-Q draws upon published research conducted in 11 countries, including the US, UK, Iran, India, Saudi Arabia, Malaysia, Tanzania, Senegal, Cape Verde, Zambia, and Burkina Faso. The questionnaire includes four domains that assess different aspects of knowledge. The first domain focuses on symptoms and diagnosis of ASD. The second domain explores the etiology and nature of the disorder. The third domain examines knowledge about the treatment of ASD. Lastly, the fourth domain delves into the topic of stigma associated with ASD. To assess the reliability of the ASK-Q, a test-retest method using a reliability metric developed for Dichotomous Classification Models (DCMs) was employed. The findings revealed high-reliability coefficients for the classifications of the four subscales, namely 0.982, 0.954, 0.984, and 0.933. Additionally, the ASK-Q exhibited strong internal consistency, as indicated by a Cronbach's Alpha coefficient of 0.88 (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). For this study, a total of 19 items were selected from the original 49 items of the ASK-Q, representing all four subscales. Proportional cut-off values were calculated to determine inadequate knowledge. The Autism Attitudes Scale for Teachers (AAST) is used in this study. It is a Likert-type scale used to measure school teachers' attitudes towards children with ASD. It consists of two alternate forms, each containing seven items, and offers five response options: strongly disagree, disagree, uncertain, agree, and strongly agree. The correlation between Forms A and B is reported to be 0.84. The reliability coefficients for Forms A and B are 0.85 and 0.78, respectively. The combined 14-item scale has an alpha reliability coefficient of 0.91. Accordingly, attitude scores are obtained by summing the scores of individual items. Notably, Questions 1, 2, 4, 6, 7, 8, 9, 11, 13, and 14 are reverse graded. A higher total score on the scale indicates a more positive attitude towards children with ASD (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). Both of the form was used in this study.\u003c/p\u003e \u003cp\u003eA one-day training session was conducted for both data collectors and supervisors. The training covered various aspects, including the objective and relevance of the study, the importance of maintaining confidentiality of information, the rights of the respondents, obtaining informed consent, and the methods of data collection. Following the training, data collection was started. At the end of each day, the supervisors and principal investigator reviewed and examined the collected questionnaires for completeness and relevance. Feedback and guidance were provided to the data collectors as necessary, ensuring the quality and accuracy of the data collection process.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eOperational Definition\u003c/h2\u003e \u003cp\u003e \u003cb\u003ePreschool teachers \u0026ndash;\u003c/b\u003e teachers who were teaching students in kindergarten class at the time of study\u003c/p\u003e \u003cp\u003e \u003cb\u003ePrimary school teachers\u003c/b\u003e - teachers who were teaching students from 1st grade to 8th grade at the time of study\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eAutism spectrum disorder\u003c/strong\u003e \u003cp\u003edisorder which meet the ASD criteria of DSM-5TR.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eRegular classroom\u003c/strong\u003e \u003cp\u003eGeneral education classroom that follows the standard curriculum for the given grade level.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eAdequate Knowledge\u003c/b\u003e - Respondents who score above or equal to the cut-off score of knowledge-related questions (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cb\u003eInadequate knowledge\u003c/b\u003e - Respondents who scored below the cut-off score of knowledge-related questions (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cb\u003ePositive attitude\u003c/b\u003e - Respondents who scored the mean and above score of attitude-related\u003c/p\u003e \u003cp\u003eQuestions (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cb\u003eNegative attitude\u003c/b\u003e -Respondents who scored below the mean score of attitude-related questions (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eMethods Data Analysis and Interpretation\u003c/h2\u003e \u003cp\u003eData collection was carried out using the Kobo Tool software. Subsequently, the collected data underwent a cleaning process and was exported to the SPSS Version 27 software for analysis. Descriptive analyses were conducted for all variables after ensuring the data's distribution, and any outliers, missing values, or inconsistencies were identified and addressed. Continuous variables were reported as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation, while categorical variables were presented as numbers (percentages). Adequate knowledge was coded as \"1\" and inadequate knowledge as \"0\" for the knowledge outcome. Similarly, a positive attitude was coded as \"1\" and a negative attitude as \"0\" for the attitude outcome. Univariate and bivariate regression analyses were conducted to examine the association between dependent and independent variables. Statistical significance was determined at a 95% confidence interval, with a p-value threshold of less than 0.05. The study's results were presented using text, tables, and pie charts to enhance comprehension\u003c/p\u003e \u003c/div\u003e"},{"header":"RESULTS","content":"\u003ch2\u003e\u003cstrong\u003eSocio-demographic characteristics of study participant\u0026nbsp;\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eIn this study, a total of 416 teachers participated, resulting in a response rate of 98.3%. However, data from 3 participants had missing values exceeding 50%, so the final sample size used for analysis was 413.The mean age of the participants was 32.5 years, with a standard deviation of 7.3. Of the participants, 52% (214) were female and 48% (197) were male. The majority of teachers had a work experience ranging from 5 to 10 years, which accounted for 30% of the sample. Regarding monthly income, the mean was reported as 7795 birr, with a range of 2799 to 19030 birr (Table 1).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResponse of participants regarding previous training, formal education, and experience related to ASD \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn response to questions regarding previous training, formal education, and experience related to ASD, Only 6 out of the 413 teachers (1.5%) reported that they had not heard about autism before. The majority of teachers (80.9%) reported teaching in inclusive schools. Approximately 57.1% of the teachers reported having come across an autistic child in their previous work experience. About 54% of the teachers reported knowing an autistic person closely.\u0026nbsp;When it comes to sources of information about autism, the majority of teachers (63.2%) reported social media as a common source (Table 2).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eKnowledge based characteristics of the study participant on ASD\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe overall knowledge of study participants on ASD was measured using the mean value, and the score of the mean value was 9.5 \u0026plusmn; 4.2 out of 19. Adequate knowledge was demonstrated by 35.6% of the teachers based on their scores. The knowledge based characteristics is expressed in the figure below (Figure 1).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe mean scores for the subdomains of the knowledge questionnaire were as follows: Etiology of ASD: 3.35 \u0026plusmn; 2 out of 8, Symptoms of ASD: 4.42 \u0026plusmn; 2.3 out of 7, Treatment of ASD: 1.69 \u0026plusmn; 1.1 out of 4, and Endorsement of stigma; 1.5 \u0026plusmn; 1 out of 3 (Table 3).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAttitude-based characteristics of study Participants on inclusion of student with ASD to regular schools\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe overall attitude of study participants towards the inclusion of autistic students in regular schools, based on the mean value score, is 3.34\u0026plusmn;0.49, indicating a mildly positive attitude. Out of the total participants, 77.5% (320 individuals) had a positive attitude where as 22.5% (93 individuals) had a negative attitude towards inclusion. The mean value score for the question \u0026quot;Such a good teacher can do a lot to help an autistic child\u0026quot; was higher at 3.95\u0026plusmn;1.1. On the other hand, the mean value score for the question \u0026quot;Regular schools are too advanced for autistic children\u0026quot; was lower at 2.66\u0026plusmn;1.2 (Figure 2).\u0026nbsp; \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDeterminant of participant\u0026rsquo;s knowledge about autism spectrum disorder\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe strength of the variables was assessed using odds ratios (OR) and 95% confidence intervals (CI) through a binary logistic regression model. In the bivariate binary logistic regression analysis, several variables were found to be associated with the adequacy of knowledge at a p-value of 0.25. These variables included age, work experience, source of knowledge from formal education, social media, TV and radio, previous teaching experience in inclusive classrooms, previous experience with a child with special needs, and attitudes of teachers toward inclusive education.\u0026nbsp;However, in the multivariate binary logistic regression analysis, after accounting for other variables, only certain factors remained significant at a p-value of 0.05. These significant factors were age, level of classroom teaching, social media as a source of information, and participant\u0026apos;s experience with a child having special needs and attitude of teachers towards inclusive education of students with ASD. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAccordingly, after adjusting for other covariates: Participants in the age range of 20-25 years had a 90% lower chance of having adequate knowledge compared to those aged above 40 years (adjusted odds ratio [AOR] = 0.1, 95% confidence interval [CI] = 0.48-0.7). \u0026nbsp;Participants who had no experience with children having special needs had a 46% lower chance of having adequate knowledge compared to participants who had experience (AOR = 0.54, 95% CI = 0.2-0.9). First to sixth grade teachers had 2.4 times greater chance of having adequate knowledge compared to teachers who teach in the 7th and 8th grades (AOR = 2.4, 95% CI = 1.2-4.5). \u0026nbsp;Participants who did not acquire their knowledge from social media had a 60% lower chance of having adequate knowledge (AOR = 0.4, 95% CI = 0.2-0.8). Participants who had negative attitudes toward teaching students with ASD in regular classrooms have 80% lower chance of having adequate knowledge (AOR = 0.2, 95% CI = 0.1-0.6) (Table 4).\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThe findings of the present study indicate that participants had a relatively low level of knowledge, with only 35.6% achieving an \"Adequate\" knowledge score. This is concerning, especially considering the current prevalence of ASD. In comparison to similar studies conducted in South Africa, where a higher proportion (80%) of participants demonstrated better knowledge about ASD, the results suggest a notable disparity in knowledge levels between the two regions (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). On average participants responded 50% of total scores obtainable which is lower than results from Nigeria where participants correctly answered 67.9% of total scores obtainable (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). A higher proportion of nurses (54.35%) working in governmental hospitals in Addis Ababa demonstrated good knowledge about ASD compared to the teachers in this study (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eSimilar to the study participants in South Africa, this study showed a higher proficiency in recognizing ASD symptoms (68%), but their understanding of the ethology, nature of the disease, and treatment of ASD was relatively limited (15% and 22% respectively)(\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). It is important to note that possessing adequate knowledge about the nature and treatment of ASD is crucial for teachers, as it enables them to provide appropriate advice to parents and recommend timely specialist intervention for their children. The findings of the study indicate several factors that were positively associated with possessing adequate knowledge about autism. These factors include older age, teaching from 1st to 6th grade, obtaining information about autism from social media, and having experience with special needs students.\u003c/p\u003e \u003cp\u003eSpecifically, teachers who taught in the 1st to 6th grade had 2.4 times higher knowledge compared to teachers who taught in the 7th and 8th grade (2.4; 95% CI: 1.2–4.5). This difference in knowledge levels may be attributed to 72% of the special need students are attending lower grades of 1 to 4 (and 28% enrolling grades 5 to 8), which indicates that many special need students are not progressing through the education system and that there is a high dropout and repetition rate within this group of students (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e) so 1st to 6th grade teachers' greater exposure to a larger number of special needs students, particularly those with more severe forms of autism. Some students may drop out or repeat grades before reaching the 7th and 8th grade.\u003c/p\u003e \u003cp\u003eThe finding that participants who did not acquire their knowledge from social media had a 60% lower chance of having adequate knowledge (AOR = 0.4, 95% CI = 0.2–0.8) suggests that obtaining information about autism from social media platforms may have a positive impact on teachers' knowledge levels. On the other hand, unlike findings from other studies (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e) the finding that receiving formal education or training did not show any significance in relation to knowledge about autism raises concerns about the effectiveness of current teaching materials and guidelines. The superior performance of teachers with hands-on experience in working with special needs students, which was found to be 40% higher (AOR = 0.6, 95% CI = 0.2–0.8), is consistent with the findings of a study conducted in Singapore. The study in Singapore also reported that teachers with prior work experience with children with special needs had higher knowledge about ASD (OR = 1.716 CI 1.128–2.610) (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). This suggests that direct, in-person interactions with special needs children may enhance teachers' overall comprehension of child development, enabling them to more effectively discern distinctions between typically developing children and those with special needs and that practical experience is a more effective means of imparting knowledge about autism to teachers, compared to formal education and training programs (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe findings of the present study indicate a concerning inadequacy in the knowledge of preschool and primary teachers regarding ASD. Approximately 65% of the participants demonstrated a lack of knowledge in this area. Although teachers displayed a generally positive knowledge towards ASD, about the disorder was found to be insufficient. Such interventions are crucial for promoting the appropriate identification and education of children with autism.\u003c/p\u003e \u003cp\u003eThe cross-sectional method employed in this study has a limitation. The sample size could have been increased with design effect to increase the strength of the finding. Another limitation pertains to the wording of the knowledge assessment questionnaire. The possibility of leading or suggestive wording in the questionnaire could have influenced participants to provide responses that aligned with the expected correct answers.. Additionally, a limitation of the study is the lack of comparison of findings between different schools. Each school may have a different inclusive culture, which could potentially influence the knowledge and attitudes of teachers towards ASD. It is crucial to acknowledge and address these limitations in future studies to enhance the validity and reliability of the research findings.\u003c/p\u003e "},{"header":"Acronyms and Abbreviations","content":"\u003cp\u003eASD = Autism spectrum disorders, DSM = Diagnostic and Statistical Manual of Mental Disorders, AAST = Autism Attitude Scale for teachers, ASKQ = Autism stigma and knowledge questionnaire, AOR = Adjusted Odds Ratio, COR = Crudes Odds Ratio, CI = Confidence Interval, OR = Odds Ratio, SPSS = Statistical Package for Social Science, MOH = Ministry of Health, MOE = Ministry of Education, and WHO = World Health Organization\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthical approval\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eBefore commencing the research, ethical clearance was obtained from the Ethical Committee of SPHMMC (name of the institution) with additional support in the form of a letter from the Pediatrics Department and the City Government of Addis Ababa Education Bureau. Before their involvement in the study, all participating school teachers were provided with a written informed consent document. This document assured them of the confidentiality and anonymity of their responses. It was clearly stated in the consent form that the participants had the right to withdraw from the study at any stage if they wished to do so. Furthermore, the questionnaire did not collect any personally identifiable information, and all data collected were treated as strictly confidential, and solely used for research purposes. Participation in the study was entirely voluntary.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of Data and materials:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data and other documents used in this study are available from the corresponding author.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors confirmed that they have no conflict of interest. However, some parts of the paper\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research did not receive any specific grant from fund agencies\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors Contribution:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMT\u003c/strong\u003e and \u003cstrong\u003eFM\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003econceptualized and designed the study; collected, analyzed and\u0026nbsp;interpreted the data; and drafted the manuscript. \u003cstrong\u003eYG, DB, FK\u003c/strong\u003e, and \u003cstrong\u003eTA\u003c/strong\u003e were involved in data analysis, drafting of the manuscript and advising the entire research paper. They were also involved in the interpretation of the data and contributed to manuscript preparation. All authors have read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe have special thanks for study subjects, institutions, data collectors, leaders and staff of each study area. We would like to express thanks to Dr. Surafel Worku for his expertise and support. \u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eAssociation AP. Diagnostic and Statistical Manual of Mental Disorders, DSM-5. 5th ed: American Psychiatric Publishing;. 2018.\u003c/li\u003e\n\u003cli\u003eSalari N, Rasoulpoor S, Rasoulpoor S, Shohaimi S, Jafarpour S, Abdoli N, et al. The global prevalence of autism spectrum disorder: a comprehensive systematic review and meta-analysis. Ital J Pediatr. 2022;48(1):112.\u003c/li\u003e\n\u003cli\u003eRochelle P. Walensky M, MPH, Director, Debra Houry M, MPH, Chief Medical Officer and Deputy Director for Program and Science Rebecca Bunnell, PhD, MEd, Director, Office of Science. Prevalence and Characteristics of Autism Spectrum Disorder Among Children Aged 8 Years \u0026mdash;Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2020. Centers for Disease Control and Prevention. March 24, 2023;72(2).\u003c/li\u003e\n\u003cli\u003eFleury VP, Hedges S, Hume K, Browder DM, Thompson JL, Fallin K, et al. Addressing the Academic Needs of Adolescents With Autism Spectrum Disorder in Secondary Education. Remedial and Special Education. 2014;35(2):68-79.\u003c/li\u003e\n\u003cli\u003eMurray J. Practical Teaching Strategies for Students with Autism Spectrum Disorder. BU Journal of Graduate Studies in Education. 2015;7(2).\u003c/li\u003e\n\u003cli\u003eLow HM, Wong TP, Lee LW, Makesavanh S, Vongsouangtham B, Phannalath V, et al. A grassroots investigation of ASD knowledge and stigma among teachers in Luang Prabang, Lao PDR. Research in Autism Spectrum Disorders. 2021;80.\u003c/li\u003e\n\u003cli\u003eHuang AX, Jia M, Wheeler JJ. Children with autism in the People\u0026apos;s Republic of China: diagnosis, legal issues, and educational services. J Autism Dev Disord. 2013;43(9):1991-2001.\u003c/li\u003e\n\u003cli\u003eWang J, Zhou X, Xia W, Sun C, Wu L, Wang J. Autism awareness and attitudes towards treatment in caregivers of children aged 3-6 years in Harbin, China. Soc Psychiatry Psychiatr Epidemiol. 2012;47(8):1301-8.\u003c/li\u003e\n\u003cli\u003eKakooza-Mwesige A, Ssebyala K, Karamagi C, Kiguli S, Smith K, Anderson MC, et al. Adaptation of the \u0026ldquo;ten questions\u0026rdquo; to screen for autism and other neurodevelopmental disorders in Uganda. Autism. 2013;18(4):447-57.\u003c/li\u003e\n\u003cli\u003eNdetei2 DMVMIGATDM. A population-based survey of autistic traits in Kenyan adolescents and young adults South African Journal of Psychiatry. 2022.\u003c/li\u003e\n\u003cli\u003eZeleke WA, Chitiyo M, Hughes TL. Autism service providers report: Behavioral and educational interventions used in Ethiopia. International Journal of School \u0026amp; Educational Psychology. 2017;6(3):176-87.\u003c/li\u003e\n\u003cli\u003eZeleke WA, Hughes TL, Kanyongo G. Assessing the Effectiveness of Professional Development Training on Autism and Culturally Responsive Practice for Educators and Practitioners in Ethiopia. Front Psychiatry. 2020;11:583674.\u003c/li\u003e\n\u003cli\u003eBIRHANU B. The Lived Experiences of Mothers Raising Children Diagnosed with Autism Spectrum Disorder in Ethiopia: Perceptions and Challenges. University of Stavanger, Norway. 2020.\u003c/li\u003e\n\u003cli\u003eTasew S, Mekonnen H, Goshu AT. Knowledge of childhood autism among nurses working in governmental hospitals of Addis Ababa, Ethiopia. SAGE Open Med. 2021;9:20503121211049121.\u003c/li\u003e\n\u003cli\u003eHutton NK, Mitchell C, van der Riet M. Assessing an isiZulu questionnaire with educators in primary schools in Pietermaritzburg to establish a baseline of knowledge of Autism Spectrum Disorder. BMC Pediatr. 2016;16(1):185.\u003c/li\u003e\n\u003cli\u003eAshley J. Harrison1 LPBNCNMLPJMC. Development and Psychometric Evaluation of the Autism Stigma and Knowledge Questionnaire (ASK-Q). J Autism Dev Disord. 2017.\u003c/li\u003e\n\u003cli\u003eCullen JP, Gregory, J.L., \u0026amp; Noto, L.A. The teacher attitudes toward inclusion scale (TATIS) technical report. Savannah, Georgia: Appalachian state university , University of bridgeport 2010.\u003c/li\u003e\n\u003cli\u003eOlley JG, Devellis RF, Devellis BM, Wall AJ, Long CE. The Autism Attitude Scale for Teachers. Exceptional Children. 2016;47(5):371-2.\u003c/li\u003e\n\u003cli\u003eUwaoluetan2 ONAaO. Primary School Teachers\u0026rsquo; Knowledge of Autism Spectrum Disorders and Their Attitudes Towards Inclusive Education. Journal of Teaching and Teacher Education. 2022;10(1).\u003c/li\u003e\n\u003cli\u003eeducation Mo. A Master Plan for Special Needs Education/Inclusive Education in Ethiopia 2016-2025. In: Education FDRoEMo, editor. 2016.\u003c/li\u003e\n\u003cli\u003eG\u0026oacute;mez-Mar\u0026iacute; I, Sanz-Cervera P, T\u0026aacute;rraga-M\u0026iacute;nguez R. Teachers\u0026rsquo; Knowledge Regarding Autism Spectrum Disorder (ASD): A Systematic Review. Sustainability. 2021;13(9).\u003c/li\u003e\n\u003cli\u003eLian WB, Ying SH, Tean SC, Lin DC, Lian YC, Yun HL. Pre-school teachers\u0026apos; knowledge, attitudes and practices on childhood developmental and behavioural disorders in Singapore. J Paediatr Child Health. 2008;44(4):187-94.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTable\u0026nbsp;1:\u0026nbsp;Socio-demographic characteristics among preschool and primary school teachers (n=413)\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.33901192504259%\" valign=\"top\"\u003e\n \u003cp\u003eVariable\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.55366269165247%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.55366269165247%\" valign=\"top\"\u003e\n \u003cp\u003eFrequency\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.55366269165247%\" valign=\"top\"\u003e\n \u003cp\u003ePercentage (%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.33901192504259%\" valign=\"top\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.55366269165247%\" valign=\"top\"\u003e\n \u003cp\u003e20 \u0026ndash; 25 years\u003c/p\u003e\n \u003cp\u003e26 \u0026ndash; 30 years\u003c/p\u003e\n \u003cp\u003e31 \u0026ndash; 40 years\u003c/p\u003e\n \u003cp\u003eAbove 40 years\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.55366269165247%\" valign=\"top\"\u003e\n \u003cp\u003e65\u003c/p\u003e\n \u003cp\u003e124\u003c/p\u003e\n \u003cp\u003e166\u003c/p\u003e\n \u003cp\u003e49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.55366269165247%\" valign=\"top\"\u003e\n \u003cp\u003e16.1\u003c/p\u003e\n \u003cp\u003e30.7\u003c/p\u003e\n \u003cp\u003e41.1\u003c/p\u003e\n \u003cp\u003e12.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.33901192504259%\" valign=\"top\"\u003e\n \u003cp\u003eSex\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.55366269165247%\" valign=\"top\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003cp\u003eMale\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.55366269165247%\" valign=\"top\"\u003e\n \u003cp\u003e214\u003c/p\u003e\n \u003cp\u003e197\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.55366269165247%\" valign=\"top\"\u003e\n \u003cp\u003e51.8\u003c/p\u003e\n \u003cp\u003e47.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.33901192504259%\" valign=\"top\"\u003e\n \u003cp\u003eMarital statues\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.55366269165247%\" valign=\"top\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003cp\u003eSingle\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eDivorced\u003c/p\u003e\n \u003cp\u003eWidowed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.55366269165247%\" valign=\"top\"\u003e\n \u003cp\u003e236\u003c/p\u003e\n \u003cp\u003e155\u003c/p\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.55366269165247%\" valign=\"top\"\u003e\n \u003cp\u003e57.7\u003c/p\u003e\n \u003cp\u003e37.5\u003c/p\u003e\n \u003cp\u003e3.4\u003c/p\u003e\n \u003cp\u003e1.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.33901192504259%\" valign=\"top\"\u003e\n \u003cp\u003eLevel of education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.55366269165247%\" valign=\"top\"\u003e\n \u003cp\u003eCertificate\u003c/p\u003e\n \u003cp\u003eDiploma\u003c/p\u003e\n \u003cp\u003eDegree\u003c/p\u003e\n \u003cp\u003eMasters\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.55366269165247%\" valign=\"top\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003cp\u003e158\u003c/p\u003e\n \u003cp\u003e228\u003c/p\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.55366269165247%\" valign=\"top\"\u003e\n \u003cp\u003e2.4\u003c/p\u003e\n \u003cp\u003e38.3\u003c/p\u003e\n \u003cp\u003e55.2\u003c/p\u003e\n \u003cp\u003e4.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.33901192504259%\" valign=\"top\"\u003e\n \u003cp\u003eWork Experience\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.55366269165247%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt; 1 year\u003c/p\u003e\n \u003cp\u003e1 \u0026ndash; 5 years\u003c/p\u003e\n \u003cp\u003e5 -10 years\u003c/p\u003e\n \u003cp\u003e10 \u0026ndash; 20 years\u003c/p\u003e\n \u003cp\u003e20 \u0026ndash; 30 years\u003c/p\u003e\n \u003cp\u003e30 \u0026ndash; 40 years\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.55366269165247%\" valign=\"top\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e92\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e124\u003c/p\u003e\n \u003cp\u003e104\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.55366269165247%\" valign=\"top\"\u003e\n \u003cp\u003e4.1\u003c/p\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003cp\u003e25.2\u003c/p\u003e\n \u003cp\u003e6.5\u003c/p\u003e\n \u003cp\u003e2.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.33901192504259%\" valign=\"top\"\u003e\n \u003cp\u003eLevel of classroom teachers teach\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.55366269165247%\" valign=\"top\"\u003e\n \u003cp\u003ePreschool\u003c/p\u003e\n \u003cp\u003e1\u003csup\u003est\u003c/sup\u003e \u0026ndash; 6\u003csup\u003eth\u003c/sup\u003e Grade\u003c/p\u003e\n \u003cp\u003e7\u003csup\u003eth\u0026nbsp;\u003c/sup\u003e\u0026ndash; 8\u003csup\u003eth\u003c/sup\u003e Grade\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.55366269165247%\" valign=\"top\"\u003e\n \u003cp\u003e65\u003c/p\u003e\n \u003cp\u003e204\u003c/p\u003e\n \u003cp\u003e130\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.55366269165247%\" valign=\"top\"\u003e\n \u003cp\u003e15.7\u003c/p\u003e\n \u003cp\u003e49.4\u003c/p\u003e\n \u003cp\u003e31.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.33901192504259%\" valign=\"top\"\u003e\n \u003cp\u003eSub-city of school teachers teaches \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.55366269165247%\" valign=\"top\"\u003e\n \u003cp\u003eArada\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eAddis Ketema\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eGulelea\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.55366269165247%\" valign=\"top\"\u003e\n \u003cp\u003e90\u003c/p\u003e\n \u003cp\u003e175\u003c/p\u003e\n \u003cp\u003e148\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.55366269165247%\" valign=\"top\"\u003e\n \u003cp\u003e21.7\u003c/p\u003e\n \u003cp\u003e42.3\u003c/p\u003e\n \u003cp\u003e35.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable\u0026nbsp;2:\u0026nbsp;Participant Responses to questions regarding previous training, formal education and experience related to ASD (n=413)\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"588\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"48.55195911413969%\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.724020442930154%\"\u003e\n \u003cp\u003e\u003cstrong\u003eResponse\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.013628620102214%\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrequency\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.710391822827939%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"48.55195911413969%\"\u003e\n \u003cp\u003eHave you heard about autism before\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.724020442930154%\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003cp\u003eNo\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.013628620102214%\"\u003e\n \u003cp\u003e392\u003c/p\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.710391822827939%\" valign=\"top\"\u003e\n \u003cp\u003e97.8\u003c/p\u003e\n \u003cp\u003e1.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"48.55195911413969%\"\u003e\n \u003cp\u003eHave you come across autistic child during your work experience as teacher?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.724020442930154%\"\u003e\n \u003cp\u003eYes \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.013628620102214%\"\u003e\n \u003cp\u003e236\u003c/p\u003e\n \u003cp\u003e175\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.710391822827939%\" valign=\"top\"\u003e\n \u003cp\u003e57.1\u003c/p\u003e\n \u003cp\u003e42.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"48.55195911413969%\"\u003e\n \u003cp\u003eHave you had any form of formal Education about autism?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.724020442930154%\"\u003e\n \u003cp\u003eYes \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.013628620102214%\"\u003e\n \u003cp\u003e121\u003c/p\u003e\n \u003cp\u003e291\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.710391822827939%\" valign=\"top\"\u003e\n \u003cp\u003e29.3\u003c/p\u003e\n \u003cp\u003e70.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"48.55195911413969%\"\u003e\n \u003cp\u003eDo you know a close person with autism? \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.724020442930154%\"\u003e\n \u003cp\u003eYes \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.013628620102214%\"\u003e\n \u003cp\u003e224\u003c/p\u003e\n \u003cp\u003e187\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.710391822827939%\" valign=\"top\"\u003e\n \u003cp\u003e54.2\u003c/p\u003e\n \u003cp\u003e45.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"48.55195911413969%\"\u003e\n \u003cp\u003eIf the answer to the above question is yes how frequently do you meet this child\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.724020442930154%\"\u003e\n \u003cp\u003eDaily\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eWeekly\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eMonthly\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eSometimes\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eNever\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.013628620102214%\"\u003e\n \u003cp\u003e71\u003c/p\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003cp\u003e97\u003c/p\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.710391822827939%\" valign=\"top\"\u003e\n \u003cp\u003e17.2\u003c/p\u003e\n \u003cp\u003e6.8\u003c/p\u003e\n \u003cp\u003e4.1\u003c/p\u003e\n \u003cp\u003e23.5\u003c/p\u003e\n \u003cp\u003e2.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"48.55195911413969%\"\u003e\n \u003cp\u003eHave you had Training on early childhood development?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.724020442930154%\"\u003e\n \u003cp\u003eYes\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.013628620102214%\"\u003e\n \u003cp\u003e145\u003c/p\u003e\n \u003cp\u003e265\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.710391822827939%\" valign=\"top\"\u003e\n \u003cp\u003e35.1\u003c/p\u003e\n \u003cp\u003e64.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"48.55195911413969%\"\u003e\n \u003cp\u003eAre you teaching in inclusive school\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.724020442930154%\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003cp\u003eI don\u0026rsquo;t know\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.013628620102214%\"\u003e\n \u003cp\u003e334\u003c/p\u003e\n \u003cp\u003e50\u003c/p\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.710391822827939%\" valign=\"top\"\u003e\n \u003cp\u003e80.9\u003c/p\u003e\n \u003cp\u003e12.1\u003c/p\u003e\n \u003cp\u003e6.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"48.55195911413969%\"\u003e\n \u003cp\u003eHave had teaching experience In a special need or inclusive classroom?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.724020442930154%\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.013628620102214%\"\u003e\n \u003cp\u003e261\u003c/p\u003e\n \u003cp\u003e147\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.710391822827939%\" valign=\"top\"\u003e\n \u003cp\u003e63.2\u003c/p\u003e\n \u003cp\u003e35.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"48.55195911413969%\"\u003e\n \u003cp\u003eHave you had Previous experience of children with special need?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.724020442930154%\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.013628620102214%\"\u003e\n \u003cp\u003e178\u003c/p\u003e\n \u003cp\u003e413\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.710391822827939%\" valign=\"top\"\u003e\n \u003cp\u003e43.1\u003c/p\u003e\n \u003cp\u003e55.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 3: The knowledge characteristics of study participants in the subdomain of symptoms, ethology, treatment and endorsement of stigma\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"25.85034013605442%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eSubdomains\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"35.54421768707483%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eAdequate knowledge\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"38.605442176870746%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eInadequate knowledge\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.04597701149425%\" valign=\"top\"\u003e\n \u003cp\u003eFrequency\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003ePercent %\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.60919540229885%\" valign=\"top\" style=\"width: 15.8145%;\"\u003e\n \u003cp\u003eFrequency\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.344827586206897%\" valign=\"top\" style=\"width: 11.5605%;\"\u003e\n \u003cp\u003ePercent %\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25.894378194207835%\" valign=\"top\"\u003e\n \u003cp\u003eSymptoms\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.783645655877343%\" valign=\"top\"\u003e\n \u003cp\u003e280\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.821124361158432%\" valign=\"top\"\u003e\n \u003cp\u003e67.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.013628620102214%\" valign=\"top\" style=\"width: 15.8145%;\"\u003e\n \u003cp\u003e133\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.487223168654175%\" valign=\"top\" style=\"width: 11.5605%;\"\u003e\n \u003cp\u003e32.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25.894378194207835%\" valign=\"top\"\u003e\n \u003cp\u003eEtiology\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.783645655877343%\" valign=\"top\"\u003e\n \u003cp\u003e65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.821124361158432%\" valign=\"top\"\u003e\n \u003cp\u003e15.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.013628620102214%\" valign=\"top\" style=\"width: 15.8145%;\"\u003e\n \u003cp\u003e348\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.487223168654175%\" valign=\"top\" style=\"width: 11.5605%;\"\u003e\n \u003cp\u003e84.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25.894378194207835%\" valign=\"top\"\u003e\n \u003cp\u003eTreatment\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.783645655877343%\" valign=\"top\"\u003e\n \u003cp\u003e98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.821124361158432%\" valign=\"top\"\u003e\n \u003cp\u003e23.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.013628620102214%\" valign=\"top\" style=\"width: 15.8145%;\"\u003e\n \u003cp\u003e315\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.487223168654175%\" valign=\"top\" style=\"width: 11.5605%;\"\u003e\n \u003cp\u003e76.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25.85034013605442%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"35.54421768707483%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eEndorse stigma\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"38.605442176870746%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eDo not Endorse stigma\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25.894378194207835%\" valign=\"top\"\u003e\n \u003cp\u003eStigma\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.783645655877343%\" valign=\"top\"\u003e\n \u003cp\u003e179\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.821124361158432%\" valign=\"top\"\u003e\n \u003cp\u003e43.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.013628620102214%\" valign=\"top\" style=\"width: 15.8145%;\"\u003e\n \u003cp\u003e234\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.487223168654175%\" valign=\"top\" style=\"width: 11.5605%;\"\u003e\n \u003cp\u003e56.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 4: Determinant of having adequate knowledge with regards to ASD among teachers\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.649484536082475%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"39.175257731958766%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eKnowledge\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.43298969072165%\" valign=\"top\"\u003e\n \u003cp\u003eCOR(95%CI)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.463917525773196%\" valign=\"top\"\u003e\n \u003cp\u003eAOR (95%CI)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.278350515463918%\" valign=\"top\"\u003e\n \u003cp\u003eP -value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.649484536082475%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.556701030927837%\" valign=\"top\"\u003e\n \u003cp\u003eAdequate \u0026nbsp;Knowledge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.61855670103093%\" valign=\"top\"\u003e\n \u003cp\u003eInadequate knowledge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.43298969072165%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.463917525773196%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.278350515463918%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.649484536082475%\" valign=\"top\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.556701030927837%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.61855670103093%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.43298969072165%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.463917525773196%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.278350515463918%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.649484536082475%\" valign=\"top\"\u003e\n \u003cp\u003e20-25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.556701030927837%\" valign=\"top\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.61855670103093%\" valign=\"top\"\u003e\n \u003cp\u003e54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.43298969072165%\" valign=\"top\"\u003e\n \u003cp\u003e0.2 (0.0-0.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.463917525773196%\" valign=\"top\"\u003e\n \u003cp\u003e0.1 (0.48-0.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.278350515463918%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.024\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.649484536082475%\" valign=\"top\"\u003e\n \u003cp\u003e26-30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.556701030927837%\" valign=\"top\"\u003e\n \u003cp\u003e49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.61855670103093%\" valign=\"top\"\u003e\n \u003cp\u003e75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.43298969072165%\" valign=\"top\"\u003e\n \u003cp\u003e0.6 (0.3-1.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.463917525773196%\" valign=\"top\"\u003e\n \u003cp\u003e0.6 (0.2-2.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.278350515463918%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.014\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.649484536082475%\" valign=\"top\"\u003e\n \u003cp\u003e31-40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.556701030927837%\" valign=\"top\"\u003e\n \u003cp\u003e59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.61855670103093%\" valign=\"top\"\u003e\n \u003cp\u003e107\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.43298969072165%\" valign=\"top\"\u003e\n \u003cp\u003e0.43 (0.3-1.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.463917525773196%\" valign=\"top\"\u003e\n \u003cp\u003e0.4 (0.1-1.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.278350515463918%\" valign=\"top\"\u003e\n \u003cp\u003e0.49\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.649484536082475%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026gt;40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.556701030927837%\" valign=\"top\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.61855670103093%\" valign=\"top\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.43298969072165%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.463917525773196%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.278350515463918%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.649484536082475%\" valign=\"top\"\u003e\n \u003cp\u003eWork experience\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.556701030927837%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.61855670103093%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.43298969072165%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.463917525773196%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.278350515463918%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.649484536082475%\" valign=\"top\"\u003e\n \u003cp\u003e1-10year\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.556701030927837%\" valign=\"top\"\u003e\n \u003cp\u003e73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.61855670103093%\" valign=\"top\"\u003e\n \u003cp\u003e143\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.43298969072165%\" valign=\"top\"\u003e\n \u003cp\u003e0.6 (0.2-1.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.463917525773196%\" valign=\"top\"\u003e\n \u003cp\u003e1.1 (0.3-3.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.278350515463918%\" valign=\"top\"\u003e\n \u003cp\u003e0.81\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.649484536082475%\" valign=\"top\"\u003e\n \u003cp\u003e11-20year\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.556701030927837%\" valign=\"top\"\u003e\n \u003cp\u003e48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.61855670103093%\" valign=\"top\"\u003e\n \u003cp\u003e56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.43298969072165%\" valign=\"top\"\u003e\n \u003cp\u003e1.5 (0.5-2.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.463917525773196%\" valign=\"top\"\u003e\n \u003cp\u003e1.48 (0.48-4.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.278350515463918%\" valign=\"top\"\u003e\n \u003cp\u003e0.48\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.649484536082475%\" valign=\"top\"\u003e\n \u003cp\u003e21-30 year\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.556701030927837%\" valign=\"top\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.61855670103093%\" valign=\"top\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.43298969072165%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.463917525773196%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.278350515463918%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.649484536082475%\" valign=\"top\"\u003e\n \u003cp\u003eLevel of class of teaching\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.556701030927837%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.61855670103093%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.43298969072165%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.463917525773196%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.278350515463918%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.649484536082475%\" valign=\"top\"\u003e\n \u003cp\u003ePreschool\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.556701030927837%\" valign=\"top\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.61855670103093%\" valign=\"top\"\u003e\n \u003cp\u003e40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.43298969072165%\" valign=\"top\"\u003e\n \u003cp\u003e4.3 (1.3-13)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.463917525773196%\" valign=\"top\"\u003e\n \u003cp\u003e1.6 (0.69-4.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.278350515463918%\" valign=\"top\"\u003e\n \u003cp\u003e0.249\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.649484536082475%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003csup\u003est\u003c/sup\u003e -6\u003csup\u003eth\u003c/sup\u003e grade\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.556701030927837%\" valign=\"top\"\u003e\n \u003cp\u003e75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.61855670103093%\" valign=\"top\"\u003e\n \u003cp\u003e129\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.43298969072165%\" valign=\"top\"\u003e\n \u003cp\u003e1.5 (0.8-2.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.463917525773196%\" valign=\"top\"\u003e\n \u003cp\u003e2.4 (1.2-4.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.278350515463918%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.007\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.649484536082475%\" valign=\"top\"\u003e\n \u003cp\u003e7\u003csup\u003eth\u003c/sup\u003e and 8\u003csup\u003eth\u003c/sup\u003e grade\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.556701030927837%\" valign=\"top\"\u003e\n \u003cp\u003e38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.61855670103093%\" valign=\"top\"\u003e\n \u003cp\u003e92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.43298969072165%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.463917525773196%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.278350515463918%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.649484536082475%\" valign=\"top\"\u003e\n \u003cp\u003eSource of knowledge\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eformal education\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.556701030927837%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.61855670103093%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.43298969072165%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.463917525773196%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.278350515463918%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.649484536082475%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.556701030927837%\" valign=\"top\"\u003e\n \u003cp\u003e49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.61855670103093%\" valign=\"top\"\u003e\n \u003cp\u003e70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.43298969072165%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.463917525773196%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.278350515463918%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.649484536082475%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.556701030927837%\" valign=\"top\"\u003e\n \u003cp\u003e97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.61855670103093%\" valign=\"top\"\u003e\n \u003cp\u003e191\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.43298969072165%\" valign=\"top\"\u003e\n \u003cp\u003e1.3 (0.8-2.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.463917525773196%\" valign=\"top\"\u003e\n \u003cp\u003e1.0 (0.5-1.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.278350515463918%\" valign=\"top\"\u003e\n \u003cp\u003e0.99\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.649484536082475%\" valign=\"top\"\u003e\n \u003cp\u003eBooks\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.556701030927837%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.61855670103093%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.43298969072165%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.463917525773196%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.278350515463918%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.649484536082475%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.556701030927837%\" valign=\"top\"\u003e\n \u003cp\u003e56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.61855670103093%\" valign=\"top\"\u003e\n \u003cp\u003e71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.43298969072165%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.463917525773196%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.278350515463918%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.649484536082475%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.556701030927837%\" valign=\"top\"\u003e\n \u003cp\u003e90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.61855670103093%\" valign=\"top\"\u003e\n \u003cp\u003e190\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.43298969072165%\" valign=\"top\"\u003e\n \u003cp\u003e0.2 (0.2-2.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.463917525773196%\" valign=\"top\"\u003e\n \u003cp\u003e1.0 (0.5-1.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.278350515463918%\" valign=\"top\"\u003e\n \u003cp\u003e0.96\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.649484536082475%\" valign=\"top\"\u003e\n \u003cp\u003eSocial media\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.556701030927837%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.61855670103093%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.43298969072165%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.463917525773196%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.278350515463918%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.649484536082475%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.556701030927837%\" valign=\"top\"\u003e\n \u003cp\u003e108\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.61855670103093%\" valign=\"top\"\u003e\n \u003cp\u003e153\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.43298969072165%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.463917525773196%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.278350515463918%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.649484536082475%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.556701030927837%\" valign=\"top\"\u003e\n \u003cp\u003e38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.61855670103093%\" valign=\"top\"\u003e\n \u003cp\u003e108\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.43298969072165%\" valign=\"top\"\u003e\n \u003cp\u003e2.0 (1.2-3.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.463917525773196%\" valign=\"top\"\u003e\n \u003cp\u003e0.4 (0.2-0.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.278350515463918%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.013\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.649484536082475%\" valign=\"top\"\u003e\n \u003cp\u003eTV and radio\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.556701030927837%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.61855670103093%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.43298969072165%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.463917525773196%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.278350515463918%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.649484536082475%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.556701030927837%\" valign=\"top\"\u003e\n \u003cp\u003e81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.61855670103093%\" valign=\"top\"\u003e\n \u003cp\u003e126\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.43298969072165%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.463917525773196%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.278350515463918%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.649484536082475%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.556701030927837%\" valign=\"top\"\u003e\n \u003cp\u003e65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.61855670103093%\" valign=\"top\"\u003e\n \u003cp\u003e135\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.43298969072165%\" valign=\"top\"\u003e\n \u003cp\u003e1.3 (0.8-2.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.463917525773196%\" valign=\"top\"\u003e\n \u003cp\u003e0.6 (0.3-1.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.278350515463918%\" valign=\"top\"\u003e\n \u003cp\u003e0.07\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.649484536082475%\" valign=\"top\"\u003e\n \u003cp\u003eTeaching experience in special need or inclusive class\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.556701030927837%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.61855670103093%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.43298969072165%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.463917525773196%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.278350515463918%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.649484536082475%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.556701030927837%\" valign=\"top\"\u003e\n \u003cp\u003e110\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.61855670103093%\" valign=\"top\"\u003e\n \u003cp\u003e151\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.43298969072165%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.463917525773196%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.278350515463918%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.649484536082475%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.556701030927837%\" valign=\"top\"\u003e\n \u003cp\u003e37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.61855670103093%\" valign=\"top\"\u003e\n \u003cp\u003e110\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.43298969072165%\" valign=\"top\"\u003e\n \u003cp\u003e2.1 (1.3-3.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.463917525773196%\" valign=\"top\"\u003e\n \u003cp\u003e0.6 (0.3-1.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.278350515463918%\" valign=\"top\"\u003e\n \u003cp\u003e0.13\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.649484536082475%\" valign=\"top\"\u003e\n \u003cp\u003ePrevious experience of children with special need child\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.556701030927837%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.61855670103093%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.43298969072165%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.463917525773196%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.278350515463918%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.649484536082475%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.556701030927837%\" valign=\"top\"\u003e\n \u003cp\u003e82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.61855670103093%\" valign=\"top\"\u003e\n \u003cp\u003e96\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.43298969072165%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.463917525773196%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.278350515463918%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.649484536082475%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.556701030927837%\" valign=\"top\"\u003e\n \u003cp\u003e64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.61855670103093%\" valign=\"top\"\u003e\n \u003cp\u003e166\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.43298969072165%\" valign=\"top\"\u003e\n \u003cp\u003e2.2 (1.4-3.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.463917525773196%\" valign=\"top\"\u003e\n \u003cp\u003e0.54 (0.2-0.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.278350515463918%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.04\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.649484536082475%\" valign=\"top\"\u003e\n \u003cp\u003eAttitude\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.556701030927837%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.61855670103093%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.43298969072165%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.463917525773196%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.278350515463918%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.649484536082475%\" valign=\"top\"\u003e\n \u003cp\u003ePositive attitude\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.556701030927837%\" valign=\"top\"\u003e\n \u003cp\u003e117\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.61855670103093%\" valign=\"top\"\u003e\n \u003cp\u003e172\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.43298969072165%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.463917525773196%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.278350515463918%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.649484536082475%\" valign=\"top\"\u003e\n \u003cp\u003eNegative\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.556701030927837%\" valign=\"top\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.61855670103093%\" valign=\"top\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.43298969072165%\" valign=\"top\"\u003e\n \u003cp\u003e0.4 (0.2-0.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.463917525773196%\" valign=\"top\"\u003e\n \u003cp\u003e0.2 (0.1-0.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.278350515463918%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-pediatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bped","sideBox":"Learn more about [BMC Pediatrics](http://bmcpediatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bped/default.aspx","title":"BMC Pediatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Autism spectrum disorder, Knowledge, Preschool teacher, Inclusive education","lastPublishedDoi":"10.21203/rs.3.rs-4258035/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4258035/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAutism spectrum disorder (ASD) is a neurodevelopmental disorder primarily impacting social communication and behavior. Preschool and primary school teachers have a vital role in identifying and supporting these children. However, the extent of teachers' knowledge about the disorder and their knowledge towards including children with ASD in their classrooms remains uncertain. The aim of this study was to evaluate the knowledge towards including children with autism spectrum disorders in their classrooms, and associated factors among preschool and primary school teachers in public schools in Addis Ababa.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods and Materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData from preschool and primary school teachers were collected using a self-administered questionnaire between September 2023 and December 2023. The collected data were analyzed utilizing SPSS version 27. Descriptive statistics were employed to summarize the findings, while bivariate binary logistic regression was utilized to examine associations between variables.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study findings revealed that only 35.5% of teachers had adequate knowledge, and the mean attitude score was 3.4, indicating a slight positive inclination towards inclusive education. Teachers between the ages of 20 and 25 had 90% lower knowledge compared to those above 40 years (AOR = 0.1, 95% CI = 0.48–0.7) with a p-value of 0.014. First to sixth-grade class teachers were 2.4 times more likely to have adequate knowledge (AOR = 2.4, 95% CI = 1.2–4.5) with a p-value of 0.007. Those who relied on social media as a knowledge source were 60% more likely to have knowledge compared to those who did not (AOR = 0.4, 95% CI = 0.2–0.8) with a p-value of 0.013. Previous experience with a child who has special needs increased the likelihood of having adequate knowledge by 44% (AOR = 0.54, 95% CI = 0.2–0.9) with a p-value of 0.04.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion and recommendation\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe overall level of knowledge regarding ASD is inadequate; however, there is a positive tendency towards including students with ASD in regular classes. It is recommended to provide professional development programs, as well as develop guidelines and curriculum, to enhance teachers' knowledge.\u003c/p\u003e","manuscriptTitle":"Teachers Knowledge towards Autism Spectrum Disorder and its Associated Factor in Addis Ababa public schools, Ethiopia, 2024 Multicenter cross sectional study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-04-19 18:49:56","doi":"10.21203/rs.3.rs-4258035/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision 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