|Year : 2021 | Volume
| Issue : 2 | Page : 80-87
Knowledge and adherence to coronavirus disease 2019 preventive measures: A bi-national web-based survey
Olabode E Omotoso1, Precious-Paul Awoyemi2, Victor James Wahab3, Mahmoud Ragab4, John Oluwafemi Teibo5, Opeyemi Akinfe1, Amira Matareek6
1 Department of Biochemistry, College of Medicine, University of Ibadan, Ibadan, Nigeria
2 Department of Sociology, Faculty of Education, University of Ibadan, Ibadan, Nigeria
3 Department of Microbiology, University of Benin, Nigeria
4 Department of Biotechnology, Benha University, Benha, Egypt
5 Department of Biochemistry, College of Medicine, University of Ibadan, Ibadan, Nigeria; Department of Biochemistry and Immunology, University of São Paulo, São Paulo, Brazil
6 Faculty of Pharmacy, Mansoura University, Mansoura, Egypt
|Date of Submission||31-Dec-2020|
|Date of Acceptance||09-Jul-2021|
|Date of Web Publication||16-Aug-2021|
Olabode E Omotoso
Department of Biochemistry, College of Medicine, University of Ibadan, Ibadan
Source of Support: None, Conflict of Interest: None
Background: Within few months of its outbreak, coronavirus disease 2019 (COVID-19) has ravaged over 200 countries, resulting in over a million deaths. As the disease curve flattens in most countries, the instituted guidelines were receded to mitigate the effect on citizens and the national economy. Aims: To assess the knowledge and level of adherence of Nigerians and Egyptians to the COVID-19 preventive measures. Settings and Design: A validated web-based cross-sectional questionnaire was utilized to obtain 915 respondents via a convenient sampling technique. Materials and Methods: Data were obtained from Egyptians and Nigerians who gave consent for participation and are above 18 years of age. Statistical Analysis Used: Data obtained were analyzed using the Statistical Package for the Social Sciences, v. 20. Chi-square test, correlation and one-way analysis of variance were performed to test for relationships between variables. Statistically significant results (P < 0.05) were subjected to further test. Results: Most Egyptians (87%) had satisfactory COVID-19 knowledge compared to Nigerians (40%). Age (18–30 years), tertiary education and educational background were factors that influenced respondents' knowledge. Although majority (73%) believe that the prevention measures are required to curtail the menace of COVID-19, the adherence of most respondents (59.1%) to the measures was unsatisfactory. The pandemic and the regulatory policies negatively affected respondents' education, school or job (90.3%), finance (87.9%) and social interaction (87.5%). Conclusion: Both countries showed a good knowledge of the disease but poor adherence to the preventive measures. The pandemic negatively affected people's finance, education, job, and social interaction.
Keywords: Adherence, coronavirus disease 2019, effect, knowledge, preventive measures
|How to cite this article:|
Omotoso OE, Awoyemi PP, Wahab VJ, Ragab M, Teibo JO, Akinfe O, Matareek A. Knowledge and adherence to coronavirus disease 2019 preventive measures: A bi-national web-based survey. Saudi J Health Sci 2021;10:80-7
|How to cite this URL:|
Omotoso OE, Awoyemi PP, Wahab VJ, Ragab M, Teibo JO, Akinfe O, Matareek A. Knowledge and adherence to coronavirus disease 2019 preventive measures: A bi-national web-based survey. Saudi J Health Sci [serial online] 2021 [cited 2021 Dec 8];10:80-7. Available from: https://www.saudijhealthsci.org/text.asp?2021/10/2/80/323877
| Introduction|| |
The novel coronavirus disease (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been a threat to public health and human co-existence since its outbreak in December 2019. Within few months of its outbreak, COVID-19 has resulted in over a million deaths globally with an increasing daily burden. Globally, as of 15:06 GMT, 01 December 2020, there have been 63,756,626 confirmed cases of COVID-19 infection, including 1,477,422 deaths. Africa accounts for 2,188,092 (3.43%) of the confirmed cases and 52,096 (3.53%) reported deaths due to COVID-19 infection globally.
Coronaviruses are single-stranded RNA viruses and are causative pathogen of pathogenic respiratory infections like the SARS, middle east respiratory syndrome and SARS-CoV-2. According to World Health Organization (WHO), most infected persons will experience mild to moderate respiratory illness, while most will recover without requiring keen medical intervention. People with comorbidities (diabetes, cardiovascular disease, other respiratory infections, and immune-compromising ailments) and older people are more prone to develop more severe symptoms and disease outcome. Common symptoms of coronavirus infection include but are not limited to; fever, dry cough, difficulty in breathing or shortness of breath, loss of speech, sore throat, diarrhea, and body weakness.
During the first few months of its outbreak, it was predicted that the virus would have a debilitating effect in Africa due to the poor health infrastructure and a large number of immune-compromised population. Surprisingly, high-income countries have been the worst hit by the pandemic, despite the advanced healthcare system in place. During the peak of the disease transmission, most countries enforced regulatory policies and preventive measures in line with WHO recommendations to curtail the spread of the disease. However, these regulations, most especially lockdown and ban on public gatherings had a negative toll on citizens in most low- and mid-income countries that could not provide palliatives and/or reliefs for their citizens. As the disease curve begins to flatten in most countries, most of the regulatory guidelines were subsided to mitigate the effect on citizens, the national economy, and social interaction.
Adherence to preventive guidelines (the use of alcohol-based hand sanitisers, washing of hands, respiratory etiquettes, and other regulatory policies) is important in protecting oneself and inhibiting the spread of COVID-19. With increasing daily human transmission across the world, knowledge about the disease, how it spreads, and adherence to preventive measures is essential. The present Study assessed public knowledge and level of adherence to the instituted guidelines against COVID-19 infection in Egypt and Nigeria. The information acquired will assist in understanding predictive factors that influence Nigerians and Egyptians knowledge about the pandemic which will promotes adherence to preventive measures and contribute immensely to the ongoing fight against COVID-19.
| Materials and Methods|| |
The research instrument administered was designed as a cross-sectional questionnaire in Arabic and English which are the official languages of Egypt and Nigeria respectively. At the end of the total lockdown, the questionnaire was released online via social media platforms (WhatsApp and Facebook) on October 18, 2020 and collated on November 20, 2020. Nigeria and Egypt had one of the highest burdens of COVID-19 in Africa. Thus the choice of both African countries. [7,8] The COVID-19 index cases in Africa were also first reported in Egypt and Nigeria.
Study participants, sample size, and sampling
The inclusion criteria were nationals living in the two countries (Egypt and Nigeria) who gave consent for participation and are >18 years of age. Nonconsenting and those <18 years of age were not included. For sample size calculation: We anticipated that 50% of the study participants would have sufficient knowledge of COVID-19 and adherence to the preventive guidelines at 99% confidence level. Using the Open Source Epidemiologic Statistics for Public health web interface, v. 3.01, the required sample size was 664. We added a 35% contingency to make the minimum sample size 897 respondents from both countries. To ensure adherence to the social distance guidelines, a paper-based questionnaire format was not feasible; we, therefore, opted for a web-based questionnaire. Due to the differing internet penetration rate in Nigeria (61.2%) and Egypt (48.1%), the respondents were sampled in a ratio of (Nigeria) 2:1 (Egypt) using a convenience sampling method to reach the participants via social media platforms (WhatsApp and Facebook). Respondents were recruited from major cities, Oyo and Lagos state (Nigeria) and Egypt; Cairo, and Qalyubia Governorate.
This study strictly adhered to the World Medical Association Declaration of Helsinki's ethical principles. Although a low-risk study, we did not recruit any vulnerable (below 18 years) or nonconsenting individuals. The study had a short introduction clearly stating the purpose of the study and the average time to complete the questionnaire. Also, anonymity was upheld, and voluntary participation was allowed before filling the questionnaire. Informed consent was sought and the email of the principal investigator was supplied for any clarification or withdrawal of data from the study.
The administered questionnaires (Arabic and English) were designed using Google forms (Alphabet Inc., California, USA) and prevalidated by two independent subject experts. The questionnaire in Arabic was initially translated to English to ensure items in the questionnaires are communicating the same thing both in English and Arabic and then back translated. The approved questionnaire can be assessed online (Arabic - https://forms.gle/YNcosp8pYbBYKgzx7 and English - https://bit.ly/2HzpSCR). The questionnaires were pretested on 20 respondents which were not included in the analysis. The instrument (designed as a questionnaire) consists of 5 major parts:
- Sociodemographic information of respondents
- Respondent's knowledge of the novel coronavirus infection
- Adherence to COVID-19 preventive measures
- Role of media, government and social groups (religious bodies, medical association, peers, and social societies) in creating awareness and ensuring adherence to the guidelines
- Effect of the pandemic on respondent's finance, school, education or job, and social interaction.
Responses were imported from Google form as a Microsoft Excel spreadsheet. Collated data from Egypt in Arabic was translated to English. All data were then analyzed using the Statistical Package for the Social Sciences (SPSS) for Windows, Version 20.0. Armonk, NY: IBM Corp. Descriptive statistics were used to summarize respondents' socio-demographic information. Knowledge and adherence were assessed using a numbered scoring pattern. The dependent variables were computed and then binned into an equal percentile (50%) based on mean scores to categorize the knowledge and adherence level. Respondents with numeric scores greater than the mean scores were classified as satisfactory (satisfactory knowledge or adherence level) and vice-versa. The association between the demographics (independent variables) and the dependent variables were tested using cross-tabs. Preliminary analyses were performed to ensure no violation of the assumptions of normality, linearity, and homoscedasticity. Where required, correlation analysis was performed to test for relationships between variables. Chi-square test and one-way analysis of variance (ANOVA) were used to test for differences in the knowledge and adherence score across the independent variables. Statistically significant results (P < 0.05) were subjected to further significant tests.
| Results|| |
Comparison of sociodemographic data about respondents' coronavirus disease 2019 knowledge and adherence to preventive measures
A total of 915 respondents (Nigeria – 610 and Egypt – 305) were included in this study [Table 1] shows the proportion of respondents across the sociodemographics. Satisfactory COVID-19 knowledge was observed in most Egyptians (265, 87%) compared to Nigerians (246, 40%). Females (349, 61%) had satisfactory COVID-19 knowledge compared to males (162, 47%). Respondents within the age group 18–30 years had a better COVID-19 knowledge compared to other age groups. Respondents who had tertiary education (bachelors – 311, 59% and postgraduate – 126, 53%) had more satisfactory knowledge than those with lower educational levels. Respondents with medical background (124, 65%) had more satisfactory knowledge of COVID-19 compared to those with scientific (277, 63%) and others with nonmedical or nonscientific background (110, 39%). Despite the satisfactory COVID-19 knowledge of respondents, the respondents' level of adherence to the COVID-19 preventive guidelines was poor as only (132, 43%) Egyptians and (242, 40%) Nigerians had satisfactory scores. This was a similar trend across all sociodemographics [Table 2].
|Table 1: Comparison of respondents' demographics in the present study (n=915)|
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|Table 2: Relationship between sociodemographic data and the dependent variables|
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Knowledge of coronavirus disease 2019 and adherence to preventive measures among respondents
From a maximum obtainable score of 5, most respondents (511, 55.9%) had satisfactory knowledge of COVID-19. Although majority of the respondents (825, 90.2%) believed that coronavirus is a real global pandemic, many Nigerians (298, 48.9%) and very few Egyptians (44, 14.4%) thought that the coronavirus is a hoax. Likewise, only very few respondents (321, 35.1%) knew anyone who has ever been infected with the virus. Most of the respondents (805, 88%) identified that there was no approved drug or vaccine as of when data were collected to prevent the novel COVID-19.
From a maximum obtainable score of 11, most respondents (n = 541/915, 59.1%) had an unsatisfactory level of adherence to COVID-19 preventive measures. Even though majority of respondents (668, 73%) believe that preventive measures are required to curtail the menace of COVID-19. Although most respondents (589, 64.4%) wash their hands with soap and water frequently, only a few avoided touching their eyes or mouth with unwashed hands (413, 45.1%), avoided nonessential travel (333, 36.4%), go out only for essential reasons (258, 28.2%), and keep at least 2 m distance (248, 27.1%). Similarly, although most respondents (747, 81.6%) identified that the use of face masks is effective as a preventive measure, only few (523, 57.2%) used a face mask in public.
Most respondents (467, 51%) do not know the coronavirus symptoms. Meanwhile, (n = 491/805, 53.7%) identified to have experienced COVID-19 symptom (s) since the outbreak. From those (n = 437) who responded to action taken after COVID-19 symptoms manifestation, the majority did nothing (220, 50.34%), some took drugs or herbs (110, 25.17%), and others self-isolated or quarantined (30, 6.86%).
The role of media and social groups and effect of COVID-19 pandemic
Only a few (433, 47.3%) of the respondents are confident that the media are presenting proper news on the COVID-19 preventive measures. A good number of the respondents believed the role of the following; medical associations (854, 93.3%), media (791, 86.4%), religious bodies (760, 83.1%), peers (706, 77.2%), government (697, 76.2%), and social society groups (654, 71.5%) are helpful in their contribution to promoting knowledge and adherence to COVID-19 preventive measures. Meanwhile only 485 (53%) respondents rated the government's effort in combatting the pandemic as satisfactory. The coronavirus pandemic had a negative effect on respondents' education, school or job (826, 90.3%), finance (804, 87.9%), and social interaction (801, 87.5%). Very few respondents (341, 37.3%) are likely to communicate with others on the need for adherence to the COVID-19 preventive measures [Supplementary Table 1]. Respondents' education, school or job (290, 95%), followed by social interaction (265, 87%) and finances (259, 85%) was the most affected by the COVID-19 pandemic for most Egyptians. Most Nigerians reported a severe effect of the pandemic on their finances (543, 89%), followed by education, school or job (537, 88%), and social interaction (537, 88%).
Influence of Sociodemographic factors on coronavirus disease 2019 knowledge and adherence to preventive measures
Using the Chi-square test, the difference in the knowledge of female (568, 6%) and male respondents (347, 38%) about COVID-19 [as shown in [Table 2]] was statistically significant (P = 0.023). Meanwhile, there was no significant difference (P = 0.329) in the level of adherence across gender as shown in [Table 2] to COVID-19 preventive measures. The difference in the knowledge of respondents who are never married or single (757, 58 82.7 %) and married (158, 44 17.3 %) about COVID-19 was statistically significant (P = 0.034). Meanwhile, there was no significant difference (P = 0.217) in the level of adherence of respondents across marital status to COVID-19 preventive measures. There was also no significant difference (P = 0.076) across educational status in both respondents' knowledge and level of adherence to COVID-19 preventive measures.
The impact of the educational background on knowledge of COVID-19 was explored using one-way between-groups ANOVA. Levene's test significance value of 0.086 depicts non-violation of the homogeneity of variance assumption. There was a statistically significant difference in COVID-19 knowledge scores for the three educational background groups (F (2, 912) =33.59, P = 0.005). The post hoc comparisons using the Tukey Honestly Significant Difference (HSD) test indicated that the mean score for respondents with medical (mean = 3.74 ± 1.2 standard deviation [SD]) and scientific background (mean = 3.75 ± 1.05 SD) was significantly different from those with nonmedical or non-scientific background (mean = 3.07 ± 1.25 SD); the effect size (0.069), calculated using eta squared depicts a large effect size. As shown in [Table 2], respondents with either medical or scientific background have satisfactory knowledge of COVID-19 (401, 78.47%) compared to other respondents with nonmedical or nonscientific backgrounds (110, 21.53%).
The impact of the educational background was likewise explored on the level of adherence to COVID-19 preventive measures. Levene's test significance value of 0.538 depicts nonviolation of the homogeneity of variance assumption. There was a statistically significant difference in adherence level scores for the three educational background groups (F [2, 912)= 7.429, P < 0.001). The post hoc comparisons using the Tukey HSD test indicated that the mean score for respondents with medical (mean = 6.26 ± 2.8 SD) and scientific background (mean = 5.78 ± 2.8) was significantly different from those with nonmedical or nonscientific background (mean = 5.25 ± 2.9); using eta squared; there was a small effect size (0.02).
The impact of age on adherence to COVID-19 preventive measures was explored. Levene's test significance value of 0.12 depicts nonviolation of the homogeneity of variance assumption. There was a statistically significant difference in adherence to COVID-19 preventive measures scores for the age groups (F [3, 911) = 2.632, P = 0.034). The post hoc comparisons using the Tukey HSD test indicated that the mean score for respondents between 21–30 years (mean = 5.77 ± 2.86 SD) and 31–40 years (mean = 5.88 ± 3.01) was significantly different from 18–20 years (mean = 5.71 ± 2.69) to >41 years (mean = 4.49 ± 2.55); the effect size (0.01), calculated using eta squared depicts a small effect size. Meanwhile, there was no significant difference in the COVID-19 knowledge score across all age groups.
The relationship between knowledge of COVID-19 and adherence to preventive measures was investigated using Pearson product-moment correlation coefficient. There was a low positive correlation between the two variables (r = 0.251**, n = 915, P = 0.01), with the high knowledge level of COVID-19 associated with a higher level of adherence to preventive measures.
| Discussion|| |
The index case of coronavirus infection in Africa was reported in Egypt and then Nigeria., As of December 23, 2020, 18:04 GMT, there have been 127,061 and 79,789 confirmed cases of coronavirus infection with 7167 and 1231 reported deaths due to COVID-19 from Egypt and Nigeria respectively. Due to the low testing rate in African countries,, it is widespread speculation that the COVID-19 burden is under-reported in Africa. To curtail the spread of the coronavirus infection, most nations enforced regulatory policies and preventive measures [Figure 1]; restrictions on public gathering and international flight, self-isolation or quarantine, total lockdown or curfew on movement, as well as proper hand-washing and social distancing. Most low- and mid-income countries could not sustain most of these regulatory policies, due to the adverse effect on the national economy and lives of its citizens where the majority are living below the poverty threshold. Hence, the need to relax some of the restrictions put in place to curtail COVID-19 transmission.
In the light of increasing daily incidence, the present study helps to understand the knowledge and level of adherence of respondents to the COVID-19 preventive measures. Most Egyptians (87%) had satisfactory knowledge of COVID-19 compared to Nigerians (40%). The poor knowledge of Nigerians might be because most (80%) do not know anyone who has been infected, that about half (49%) think that COVID-19 is a hoax in Nigeria and some (29%) do not believe the virus is in Nigeria. This supports an earlier study in Nigeria where most of the respondents live in denial of the existence of the disease. In contrast, most Egyptians (66%) have either been infected or know someone who has been infected with the virus, only a few (14%) feel COVID-19 is a hoax as well as very few (6%) do not believe the virus is in Egypt. Our finding corroborates earlier reports,, where most Egyptians had satisfactory knowledge of the disease. Despite the satisfactory knowledge of the disease, the respondents' adherence to the COVID-19 preventive measures was poor as only (43%) Egyptians and (40%) Nigerians had satisfactory level of adherence to the preventive measures. This corroborates other reports in Nigeria and Egypt where the level of adherence was poor. A study of 1022 Nigerians identified the inability to afford alcohol-based hand sanitizers or their scarcity as major reasons for poor adherence. This gap in knowledge about COVID-19 and its preventive measures creates a gap between respondents' understanding of the aetiology and epidemiology of the infection and makes them a significant source of transmission for the virus.
Though not surprising, respondents who had a medical background, followed by scientific have more satisfactory knowledge and level of adherence to the COVID-19 preventive measures compared to those with no- medical or scientific background.
While the public health challenges associated with COVID-19 is of importance, the socioeconomic challenges it poses must not be ignored. Most Nigerians studied identified a severe effect of the pandemic on their finance (89%), education, school or job (88%), and social interaction (88%). Likewise, most Egyptians identified a severe effect of the pandemic on their education, school or job (95%), social interaction (87%), and finance (85%). Government and policymakers are encouraged to provide palliatives and appropriate measures to cushion these effects on their citizens. In line with our study, most respondents from a previous study in Nigeria also identified low income as the major effect of COVID-19. While most dental students in Turkey (74.5%) identified that the pandemic negatively affected their psychology.
Earlier reports have identified the social media and the Internet as major sources of information about COVID-19.,,,, Most Nigerians (94%) and Egyptians (71%) in the present study opine that the media help to gain knowledge and influenced adherence to COVID-19 preventive measures. Surprisingly, only 338 (55%) Nigerians and 95 (31%) Egyptians are confident that the media are presenting the proper news on COVID-19 preventive measures. Hence, extreme caution must therefore be taking because of unverified information and conspiracy theories about COVID-19 propagated on social media channels. Being the major source of information, regulatory bodies should put in more measures to ensure verification of information on social media channels about COVID-19 and other infectious diseases.
In contrast to a high level of adherence in a study on respondents in Arab countries, our study showed a very low level of adherence to COVID-19 preventive measures as only 182 (30%) Nigerians and 66 (22%) Egyptians observe the social distancing of at least 2 m, 162 (27%) Nigerians and 171 (56%) Egyptians avoided non-essential travels, 407 (67%) Nigerians and 182 (60%) Egyptians always wash their hands as required and 162 (27%) Nigerians and 96 (31%) Egyptians only go out for essential reasons. To ensure Africa does not become the next epicentre for coronavirus infection, strict compliance to the regulatory policies should be encouraged and proper dissemination of verified information on COVID-19 should be prioritized.
It is disheartening that only 190 (31%) Nigerians and 151 (50%) Egyptians are likely to speak to others about best practices on adherence to COVID-19 preventive measures. The major limitation of our study was the use of a web-based questionnaire. In as much we tried to uphold the preventive measures by employing a web-based survey; those without internet access could not be sampled. Our result also cannot be generalized for both countries as our respondents mostly (65.25%) are young population (18–30 years), those with medical/scientific background (69.2%), and those with a University degree (83%) who are the major internet users in both countries.
| Conclusion|| |
The COVID-19 outbreak has claimed many lives, stretching the global economy, public health, and social interaction. Assessing the knowledge and level of adherence to COVID-19 social and public health guidelines can prove effective in identifying and modifying measures in place to reduce the COVID-19 burden. Information on social media platforms on COVID-19 must be monitored and verified to ensure the right information is disseminated. Both countries showed a good knowledge of the disease but adherence to the preventive measures is unsatisfactory. We, therefore, solicit for increased adherence to the guidelines to avoid an unnecessary second wave of the disease. Similarly, with the adverse effect of the pandemic on people's finance, education, job and social interaction, support should be made available to cushion these effects on the populace. Most fear on the low COVID-19 burden in Africa has been hinged on the low testing rate; we, therefore, encourage a scale-up of both countries' testing capacity to ensure the disease burden is not under-reported.
We acknowledge our friends and colleagues who helped in sharing the web-based questionnaire to reach a wider audience.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2]