Attitudes and Stigma toward Dementia Among Medical and Environmental Health Students at the School of Health and Sciences Alliances at the State University of Zanzibar 

ABSTRACT:
 Introduction: Public stigma involves negative stereotypes of dementia patients as burdensome, leading to social distancing, while self-stigma refers to individuals with dementia internalizing these views, affecting their mental well-being. Structural stigma encompasses systemic barriers, including insufficient healthcare policies and resources. The role of medical students in shaping attitudes toward dementia is noteworthy, as they may hold negative perceptions that can impact the quality of patient care. 
Objective: To assess attitudes and stigma about dementia among medical and environmental health students at the State University of Zanzibar.
Methodology: A descriptive cross-sectional design was used to assess dementia-related knowledge, attitudes, and stigma among 150 students. 
Results: Revealed that while most students demonstrated positive attitudes (e.g., 76.7% would live with a family member with dementia and 86.0% disagreed with feeling ashamed if a family member had dementia.), a significant proportion exhibited high levels of stigma (Notably, 64.7% strongly agreed they would not want their family to know if they had dementia), particularly regarding social distancing and family shame. This suggests a discrepancy between positive attitudes and harmful societal behaviours, such as avoidance and isolation.
Conclusion: The majority of participants in this study displayed a good level of knowledge and a positive attitude toward dementia. However, negative behaviours, including discrimination and social isolation, remain prevalent. These behaviours, such as avoidance, may hinder early diagnosis and impede access to adequate treatment for individuals with dementia.
Key words: dementia, attitudes, stigma, students, Zanzibar, Tanzania
Introduction
Stigma is a deeply rooted societal issue that has significant implications for individuals and groups, particularly when it comes to health conditions like dementia. It refers to the negative perception or disapproval attached to individuals or groups who possess specific characteristics or engage in behaviours that are perceived as deviant or undesirable.[1] Stigma towards people with dementia can have profound effects on their mental health, treatment outcomes, and quality of life, as well as the overall societal response to the disease. The stigmatization of dementia is compounded by widespread misconceptions, lack of understanding, and societal attitudes towards ageing and cognitive decline, which continue to persist across cultures, regions, and communities. [2]
There are different types of stigma, each with its unique manifestations and consequences. Public stigma refers to the general societal perception of individuals with dementia and the prejudices they face. This often includes negative stereotypes that those with dementia are incapable, dependent, or burdensome; public stigma can produce social distance from people living with dementia. [3] Self-stigma, on the other hand, occurs when individuals with dementia internalize these societal beliefs and develop negative feelings about themselves, often leading to social withdrawal and reduced engagement in care or treatment. [4][5] Another form of stigma, structural stigma, pertains to the institutional and systemic barriers that exist in society, such as a lack of adequate healthcare policies or resources to support those with dementia.[6] [7]
In addition to stigma, attitudes towards dementia play a crucial role in determining how individuals with dementia are treated. Attitudes are defined as the evaluative judgments that individuals make about people, objects, or events based on their beliefs, feelings, and behaviours. In the case of dementia, attitudes can range from positive and empathetic to negative and discriminatory, depending on individual and societal perceptions of the condition. Medical students, as future healthcare providers, play a critical role in shaping attitudes towards dementia in healthcare settings. However, research suggests that medical students may hold negative attitudes towards dementia, which can impact their clinical practices and the quality of care they provide to individuals living with the condition.
The impact of stigma towards dementia is significant and far-reaching, both for individuals with dementia and the broader community. Stigmatization can contribute to social isolation, delay in diagnosis, and reduced access to healthcare services for those with dementia. Furthermore, stigma can deter people from seeking early diagnosis and treatment, resulting in poorer outcomes and diminished quality of life. This can be particularly problematic in low-income countries, where stigma and misinformation about dementia may be more pervasive, and the availability of healthcare services and educational programs may be limited.[8][9][10] 
Globally, stigma related to dementia is prevalent in both developed and developing countries. In Western countries, such as the United States and the United Kingdom, there is a growing awareness of dementia, but stigma remains a significant barrier to care. Research has shown that people in these countries often associate dementia with a loss of personhood. As a result, individuals with dementia may be treated as invisible or disregarded by society. In contrast, in many low-resource settings, stigma surrounding dementia is exacerbated by cultural beliefs that associate cognitive decline with witchcraft, divine punishment, or simply as a natural part of aging.[11]
In Africa, where dementia remains under-researched, stigma is often intertwined with misconceptions about the disease. In many African societies, dementia is not widely recognized as a medical condition but is instead perceived as a regular part of ageing or an outcome of mystical forces [11]. This contributes to a lack of adequate diagnostic services, education, and support systems for people living with dementia. However, recent efforts to raise awareness and improve understanding about dementia have started to challenge these negative attitudes, but stigma remains pervasive in many African countries [12].
In Tanzania, the situation is similar. Although dementia is a growing concern due to the ageing population, there is still a significant lack of awareness and understanding about the disease. A study by S. L.[13] found that there is widespread stigma associated with dementia in Tanzania, with many individuals perceiving it as a natural and inevitable aspect of ageing or associating it with spiritual causes. Furthermore, healthcare workers, including medical students, may lack adequate training in dementia care and management, contributing to negative attitudes toward the condition.[14] This lack of awareness and stigma may delay the diagnosis of dementia, impair caregiving, and limit the resources available to support individuals with dementia and their families in Tanzania.[15]
The stigma surrounding dementia has far-reaching consequences, especially among healthcare providers. Medical students, who are at the forefront of future healthcare delivery, may develop negative attitudes towards individuals with dementia due to a lack of exposure, inadequate training, and societal beliefs. These attitudes can have a detrimental effect on the quality of care provided to dementia patients, leading to poor communication, neglect, and inadequate treatment. Therefore, addressing stigma and improving attitudes toward dementia among medical students is a critical step in enhancing dementia care and support services in both developed and developing countries. Educational interventions targeting medical students are essential for fostering empathy, understanding, and respect for people with dementia, which in turn can lead to better clinical outcomes for those living with the condition [16]
Stigma surrounding dementia is a global issue that affects individuals, healthcare systems, and society at large. Medical students, as future healthcare providers, play a crucial role in addressing this stigma. Understanding the types of stigma, the impact on individuals with dementia, and the importance of cultivating positive attitudes toward dementia is essential in improving care and support for people with dementia. This paper will explore the prevalence and impact of stigma and attitudes towards dementia among medical students, with a specific focus on Zanzibar, and highlight the importance of addressing these issues through education and intervention.
Broad objective
•	To assess attitudes and stigma about dementia among medical and environmental health students at the State University of Zanzibar.

Specific objectives
•	To identify the socio-demographic characteristics of the participants, including age, gender, course, academic year, health services practice, and presence of a relative with dementia.
•	To identify attitudes towards dementia among medical and environmental health students.
•	To assess stigma about dementia among medical and environmental health students.

Research Methodology
Study Design
A descriptive cross-sectional design was employed to assess knowledge, attitudes, and stigma related to dementia among medical and environmental health students at the State University of Zanzibar. The study was conducted from March to April 2024.
Study Area
The research was conducted at the School of Health and Medical Sciences (SHMS) at the State University of Zanzibar from March to April 2024.
Target Population
The target population consisted of Doctor of Medicine (MD) and Environmental Health students at the State University of Zanzibar.
Study Population
The study population consisted of first- and second-year students pursuing a Doctor of Medicine and an Environmental Health degree.
Study Variables
•	Dependent Variables
o	Attitudes towards dementia
o	Variables related to stigma, including beliefs, feelings, isolation, and expectations
•	Independent Variables
o	Demographic characteristics, including age, sex, educational status, religion, and occupational status
Sampling Technique
A simple random sampling (SRS) method was used to select the study participants.
Inclusion and Exclusion Criteria
•	Inclusion Criteria
o	First- and second-year Environmental Health and Medical degree students who agreed to participate after providing informed consent.
•	Exclusion Criteria
o	Students who chose to withdraw from the study.
Sample Size Determination
The sample size was calculated using the following formula:
N=Z2×P×(1−P)E2N = \frac{Z^2 \times P \times (1-P)}{E^2} 
Where:
•	NN = minimum desired sample size
•	ZZ = standard normal deviation (1.96) corresponding to a 95% confidence interval
•	PP = estimated proportion of the target population (7.4% or 0.074), based on a study conducted in India (Lee, J. et al., 2023)[17]
•	
•	EE = expected margin of error (5%)
•	q=1−Pq = 1 - P
Substituting the values into the formula:
N=(1.96)2×(0.074)×(1−0.074)(0.05)2=105N = \frac{(1.96)^2 \times (0.074) \times (1-0.074)}{(0.05)^2} = 105 
Therefore, the minimum required sample size is 105. However, to enhance the feasibility of the study, a sample size of 150 was used.
Data Collection Technique
Data was collected using a researcher-administered questionnaire. The questionnaire was developed in English and adapted from existing tools, including:
•	The Dementia Knowledge Assessment Scale (DKAS) (25 items) (Annear, MJ et al., 2017)[18]
•	An Attitude Assessment Scale (8 items) (Musoke Phillip, M et al., 2021)[19]
•	A Stigma Assessment Scale (6 items) (Zhang Qiwen Z et al., 2023) [20]

Data Processing and Analysis
The collected data were described, categorised by different variables, tabulated, and interpreted using graphical representations. The data were analyzed using the Statistical Package for Social Sciences (SPSS) version 23. Statistical techniques, including the chi-square test, analysis of variance (ANOVA), and odds ratios, were employed to examine the relationships between variables.
Ethical Considerations
Ethical approval was obtained from the Zanzibar Health Research Ethics Committee (ZAHREC). Permission to conduct the study was granted by the School of Health and Medical Sciences (SHMS) at the State University of Zanzibar. Informed consent was obtained from all participants, who signed a consent form before participating in the study.

Results

Table 1: Socio-Demographic Data of MD and BENVH Students at SHMS (SUZA), Zanzibar – 2024
VARIABLES	FREQUENCY	PERCENTAGE (%)	
Age	
16-20
21-25
26-30
31-35
36-40	33
72
35
8
2	22.0%
48.0%
23.3%
5.3%
1.3%	
Gender	
Male
Female	56
94	37.3%
62.7%	
Course	
MD
BENVH	100
50	66.7%
33.3%	
Academic year	
First
Second	85
65	56.7%
43.3%	
Practice health services	
Yes
No	67
83	44.7%
55.3%	
Relative with dementia	
Yes
No	22
128	14.7%
85.3%	
Have you read any research about dementia	
Yes
No	30
120	20.0%
80.0%	
Have you heard about dementia or Alzheimer’s diseases	
Yes
No	124
26	82.7%
17.3%	

Table 2: Attitudes toward Dementia among MD and BENVH Students at SHMS, Zanzibar – 2024

VARIABLE	FREQUENCY	PERCENTAGE (%)	
Would you share a house with a family member who had dementia? (Yes)	
Yes
No 	115
35	76.7%
23.3%	
Do you believe that people with dementia are responsible for their problem? (No)	
Yes
No 	31
119	20.7%
79.3%	
Do you see people with dementia as violent and dangerous people to be avoided? (No)	
Yes
No 	31
119	20.7%
79.3%	
Would you feel ashamed if people knew someone in your family had dementia? (No)	
Yes
No 	21
129	14.0%
86.0%	
Would you be afraid to have a conversation with someone who has dementia? (No)
	
Yes
No 	31
119	20.7%
79.3%	
Would you be scared of having someone with dementia as a neighbour? (No)	
Yes
No 	22
128	14.7%
85.3%	
Do you think people with dementia can live in the community? (Yes)
	
Yes
No 	141
9	94.0%
6.0%	
Do you think people with dementia should live in a nursing home? (Yes)
	
Yes
No 	85
65	56.7%
43.3%	

Table 3: Attitude Responses among MD and BENVH Students at SHMS (SUZA), Zanzibar – 2024
ATTITUDE	                       COURSE	TOTAL	
	MD	BENVH 		
Poor attitude	4 (4%)	0 (0%)	4 (2.7%)	
Moderate attitude	18 (18%)	16 (32%)	34(22.7%)	
Good attitude	78 (78%)	34(68%)	112 (74.6%)	
Total	100	50	150 (100%)	
Chi-square	5.329	Sig. 0.070	
ANOVA	F=4.66	Sig. 0.496	

Table 4: Response of stigma among MD and BENVH students at SHMS, Zanzibar-2024
VARIABLE	FREQUENCY	PERCENTAGE (%)	
If I have dementia, I will not want my family to know.
	
Strongly agree 
 Agree 
 Neutral  
 Disagree
 Strongly disagree	97
28
7
9
9	64.7%
18.7%
4.7%
6.0%
6.0%	
 If I have dementia, I will feel humiliated.	
Strongly agree 
 Agree 
 Neutral  
 Disagree
 Strongly disagree	51
38
23
20
18	34.0%
25.3%
15.3%
13.3%
12.0%	
It is best that people with dementia live where they won't bother anyone.	
Strongly agree 
 Agree 
 Neutral  
 Disagree
 Strongly disagree	51
37
24
25
13	34.0%
24.7%
16.0%
16.7%
8.7%	
I would personally not like to spend much time with a person with dementia.	
Strongly agree 
 Agree 
 Neutral  
 Disagree
 Strongly disagree	61
52
21
11
5	40.7%
34.7%
14.0%
7.3%
3.3%	
The company of most people with dementia is quite enjoyable.
	
Strongly agree 
 Agree 
 Neutral  
 Disagree
 Strongly disagree	19
21
37
50
23	12.7%
14.0%
24.7%
33.3%
15.3%	
People with dementia live mostly independently.
	
Strongly agree 
 Agree 
 Neutral  
 Disagree
 Strongly disagree	44
36
27
29
14	29.3%
24.0%
18.0%
19.3%
9.3%	

Table 5: Stigma responses among MD and BENVH students, SHMS, Zanzibar- 2024
Stigma according to the questionnaire	Course		Total 	
	MD	BENVH		
No stigma	3(3%)	1(2%)	4(2.7%)	
Moderate stigma	40 (40%)	21 (42%)	61 (26.7%)	
High stigma	57 (57%)	28 (56%)	85(56.6%)	
Total	100	50	150	
Pearson Chi square0.164 sig0.921    Anova F.000 sig1.000	

Characteristics of the participants
A total of 150 students participated, with 100 MD students and 50 BENVH students. The highest age group was 21-25 years, comprising 72 students (48.0% of the total participants), with ages ranging from 16 to 40 years. The majority (62.7%) were female. Additionally, 56.7% were in their first academic year, and 55.3% had not previously practised health services. Most students (85.3%) did not have relatives with dementia, and 80.0% had not read dementia research, despite 82.7% having heard of dementia or Alzheimer’s disease. (Table 1)
Attitudes toward Dementia
In assessing attitudes based on the questionnaire (Table 2), the students answered:
o	Would you share a house with a family member who had dementia? (Yes): A significant majority (76.7%) of students are open to living with a family member who has dementia. 
o	Do you believe that people with dementia are responsible for their problem? (No): A substantial majority (79.3%) of students do not believe that people with dementia are responsible for their condition. 
o	 Do you see people with dementia as violent and dangerous people to be avoided? (No): Again, a large majority (79.3%) do not view people with dementia as violent or dangerous. 
o	Would you feel ashamed if people knew someone in your family has dementia? (No): A large majority (86%) do not feel ashamed if someone in their family has dementia. However, 14% still express shame, 
o	 Would you be afraid to have a conversation with someone who has dementia? (No) A substantial majority (79.3%) are not afraid to engage in conversation with someone who has dementia. However, the rest are still apprehensive, which might reflect concerns about communication difficulties or social discomfort.
o	Would you be scared of having someone with dementia as a neighbour? (No)The majority (85.3%) of students would not be scared to have a person with dementia as a neighbour. However, 14.7% would still feel uneasy, reflecting a modest level of stigma and fear in the community.
o	 Do you think people with dementia can live in the community? (Yes)A very high percentage (94%) believe that people with dementia can live in the community, with independence and social roles, despite their condition.
o	 Do you think people with dementia should live in a nursing home? (Yes): While more than half (56.7%) believe that people with dementia should live in a nursing home, a significant portion (43.3%) feels that this may not be necessary. 

  Distribution of Attitudes by Course:
•	Good Attitude: A majority of participants in both groups have a good attitude toward dementia, with 78% of MD students and 68% of BENVH students reporting this. This suggests that, overall, both groups tend to have a positive perspective on dementia.
•	Moderate Attitude: 18% of MD students and 32% of BENVH students have a moderate attitude toward dementia. This indicates that a larger proportion of BENVH students hold a more neutral or less favourable view compared to MD students, although this remains a sizable minority.
•	Poor Attitude: The percentage of participants with a poor attitude is low overall, with only 4% of MD students and none from BENVH students. This suggests that, while stigma and negative attitudes may exist, they are not widespread across either group. (Table 3)

Stigma Toward Dementia
In assessing stigma based on the questionnaire, the students answered:
•	If I have dementia, I will not want my family to know: A significant majority (64.7%) of respondents strongly agree that they would not want their family to see if they were diagnosed with dementia.
•	If I have dementia, I will feel humiliated: Over half of respondents (59.3% combined) either strongly agree or agree that they would feel humiliated if they had dementia. About 15.3% are neutral, indicating a varying perspective on how individuals may think in the hypothetical scenario of a dementia diagnosis. Only a smaller percentage (25.3%) of people disagree with the notion of feeling humiliated, which could suggest that some individuals may not feel a sense of shame in the context of dementia.
•	It is best that people with dementia live where they won't bother anyone: This statement shows a moderate level of stigmatization toward people with dementia, with 58.7% agreeing (combined strongly agree and agree) that individuals with dementia should live in a way that does not "bother" others. On the other hand, approximately 25.4% disagree or strongly disagree with this statement, suggesting that some participants view dementia differently, perhaps with more empathy.
•	I would personally not like to spend much time with a person with dementia: A substantial portion of participants (75.4% combined) either strongly agree or agree that they would not like to spend much time with a person with dementia, The neutral and disagreement responses (14.0% and 10.6%, respectively) are considerably lower, pointing to a clear trend of hesitation or reluctance to engage with people diagnosed with dementia.
•	The company of most people with dementia is quite enjoyable: The results for this statement show a general lack of positivity toward the company of individuals with dementia, with 48.6% disagreeing or strongly disagreeing that it is enjoyable to be with people with dementia. A larger portion (37.2%) is neutral or somewhat favourable, indicating that there might be a range of experiences or varying levels of understanding about the quality of life and emotional connection with people with dementia.
•	People with dementia live mostly independently: A total of 53.3% (strongly agree and agree) of participants believe that individuals with dementia can live independently, On the other hand, 28.6% disagree or strongly disagree, suggesting that some participants recognize the limitations on independence caused by dementia. (Table 4)
The stigma assessment consisted of 6 items, with responses categorized into low, moderate, or high stigma based on a 3-point Likert scale. The results revealed that 56.6% of participants exhibited high levels of stigma. Notably, 64.7% strongly agreed they would not want their family to know if they had dementia, and 40.7% disagreed with the notion that spending time with a person with dementia is unpleasant. (Table 5)

Discussion
This study examined 150 students, consisting of 100 Doctor of Medicine (MD) students and 50 Bachelor of Environmental Health (BENVH) students. The largest age group was 21-25 years, with a majority of female participants. Most of the students were in their first academic year, and over half had no prior experience in practicing health services. While nearly three-quarters did not have a relative with dementia, had not read any research about dementia, despite having heard of dementia or Alzheimer's disease.
The results of this study indicate that the majority of students demonstrated a positive attitude toward individuals with dementia. For instance, more than two-thirds of participants expressed a willingness to share a house with a family member who had dementia, and 86% showed high acceptance of caring for a loved one with dementia. This reflects a relatively high level of acceptance and readiness to provide care for a family member with dementia. Our results compare with a research study in Australia, which found that attitudes towards dementia in elderly people with dementia were neutral [21]. However, Wang in China reported that attitudes towards dementia among medical students were positive [22], in line with Khatiwada's findings in Nepal [23]. In contrast, a study conducted in Palestine showed that students had a low level of positive attitudes towards dementia. [24] The different sociocultural characteristics and levels of knowledge about dementia could explain these differences.
A large majority of students reported that they would not feel ashamed if someone in their family had dementia. These findings align with previous research, suggesting a positive correlation between knowledge and attitude toward dementia. This emphasizes the importance of raising awareness and providing health education, as such initiatives can foster a more inclusive community for individuals with dementia.[25]
Additionally, the majority of students do not view people with dementia as violent or dangerous individuals to be avoided, which demonstrates that most students do not hold the negative stereotypes that individuals with dementia are aggressive or unapproachable—stereotypes that often contribute to stigma. Moreover, a large majority of students do not feel embarrassed if others know that someone in their family has dementia, reflecting a relatively high level of social acceptance of dementia within this population.
Approximately 80% of students are not afraid to engage in conversations with someone who has dementia, indicating that many students view individuals with dementia as capable of having meaningful interactions. However, the remaining 20% remain apprehensive, which may reflect concerns about communication difficulties or social discomfort. More than three-quarters of respondents expressed that they would not be scared to have someone with dementia as a neighbour, indicating openness and a lack of fear regarding living near someone with dementia. Furthermore, over 90% of students believe that people with dementia can live in the community, highlighting a positive attitude toward the integration of dementia patients into society.
However, more than half of the participants believe that people with dementia should live in a nursing home. This reflects the ongoing debate between institutional care and community-based care, with many students recognizing the importance of offering care options beyond institutional settings. Overall, students exhibited positive attitudes toward dementia. 
In contrast, the study revealed a high level of stigma associated with dementia, both on a personal and societal level. A significant number of participants strongly agreed with statements such as, "If I have dementia, I will not want my family to know." This response could reflect a broader societal perception that dementia is shameful or taboo. More than half of the students agreed with the statement, "If I have dementia, I will feel humiliated." This finding aligns with the general fear of embarrassment or humiliation, which is common in societies where dementia is not widely understood. A substantial portion of participants also agreed with the statement, "I would personally not like to spend much time with a person with dementia." Additionally, while the majority of students believed that "people with dementia live mostly independently," a significant portion disagreed with this view. These mixed opinions suggest a lack of consensus regarding the capabilities of individuals with dementia.
Research on medical students’ attitudes toward dementia often reveals similar findings. Studies consistently show that medical students hold stigmatizing views about dementia, frequently associating it with embarrassment and humiliation[26]. Another study found that medical students often view dementia as a condition that leads to a loss of dignity and autonomy, mirroring the sentiments expressed by participants in your study. Furthermore, participants’ reluctance to spend time with individuals with dementia aligns with findings from Mariani, which highlighted the discomfort and avoidance behaviours observed among healthcare students when interacting with patients with dementia.[27][28]
However, it is also important to note the mixed opinions about the independence of individuals with dementia. Research suggests that while some students perceive dementia as a condition that strips away independence, others believe that, with the right support, individuals can maintain a degree of autonomy. This reflects a broader need for education and training in dementia care, as well as a more nuanced understanding of the condition.[29][30][31]
Here’s a rewritten version of your paragraph with the percentages replaced by descriptive language, along with grammar and spelling checks:

Comparison Between MD and BENVH Students on Stigma Toward Dementia
Attitudes Toward Disclosure: Medical students tend to be more reluctant than BENVH students to share a diagnosis of dementia with their family members. A significantly larger proportion of MD students strongly agree with not wanting their family to know, which could be attributed to their more profound understanding of the condition. This increased awareness may lead to a stronger association of dementia with stigma.
Humiliation: A greater percentage of MD students express that they would feel humiliated by a dementia diagnosis compared to BENVH students. This indicates a notable difference in the emotional responses between the two groups, which may stem from their distinct levels of knowledge and personal experiences.
Spending Time with People with Dementia: Both MD and BENVH students show some hesitation when it comes to spending time with individuals living with dementia. However, medical students appear to be more reluctant. This could suggest that despite their medical training, MD students may still harbour negative perceptions or reservations about the condition.
Our study aligns with others that have evaluated the knowledge and attitudes of final-year medical students toward dementia. While the study primarily focused on improving knowledge through a sensitisation program, it also highlighted areas where students felt less confident, such as identifying risk factors, signs and symptoms, and caregiving. These gaps in knowledge could potentially contribute to feelings of discomfort or humiliation when dealing with dementia patients. Other results showed significant positive changes in attitudes toward people with dementia following the workshop, highlighting the effectiveness of targeted education in enhancing students' willingness to engage with individuals affected by dementia.[32][33][34] Collectively, these studies underscore the importance of integrating comprehensive dementia education into medical curricula. Such initiatives can enhance students' knowledge, improve attitudes, and reduce stigma associated with dementia, ultimately fostering a more empathetic and competent healthcare workforce.

Limitations of the Research
 The limitations were acknowledged in the study. First, since the questionnaire was self-administered, there was a possibility that participants might provide answers without a complete understanding of dementia. The interpretation of specific questions could have also introduced bias in the responses. Additionally, the use of arbitrary knowledge and attitude scores may not fully capture the depth of participants’ actual knowledge or their proper attitudes toward dementia.
Conclusion
The majority of participants in this study displayed a good level of knowledge and a positive attitude toward dementia. However, negative behaviours, including discrimination and social isolation, remain prevalent. These behaviours, such as avoidance, may hinder early diagnosis and impede access to adequate treatment for individuals with dementia.
Recommendations
To address these issues, it is crucial to integrate health education on dementia into the academic curriculum for university students, particularly those in health-related fields. Additionally, healthcare workers should receive continuous training and education to reduce stigma and improve understanding. Promoting positive attitudes and increasing awareness will contribute to the creation of a more supportive and inclusive community that is dementia-friendly.

ETHICAL APPROVAL

In this study, ethics were considered by obtaining permission to conduct the study from the School of Health and Medical Science (SHMS). Ethical approval was obtained from Zanzibar’s Health Research Ethics             Committee (ZAHREC) with No: ZAHREC/02/ST/MAR/2024/51.

COMPETING INTERESTS DISCLAIMER:
Authors have declared that they have no known competing financial interests OR non-financial interests OR personal relationships that could have appeared to influence the work reported in this paper.

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