Knowledge, attitudes, and practices related to the COVID-19 pandemic among Bangladeshi youth: a web-based cross-sectional analysis

Healthcare workers' willingness to receive COVID-19 booster dose and associated factors in the Democratic Republic of the Congo

The COVID-19 booster dose is considered an important adjunct for the control of the COVID-19 pandemic due to reports of reduced immunity in fully vaccinated individuals. The aims of this study were to assess healthcare workers' intention to receive the booster dose of COVID-19 vaccine and to identify predictive factors among healthcare workers. A cross-sectional study was conducted among healthcare workers selected in two provinces, Kasai Oriental, and Haut-Lomami. Data were collected using a questionnaire administered through structured face-to-face interviews, with respondents using a pre-tested questionnaire set up on the Open Data Kit (ODK Collect). All data were analyzed using SPSS v26.0 (IBM Corporation, Armonk, NY, USA). Vaccination coverage for COVID-19, considering declarations by health workers, is around 85.9% for the province of Kasai Oriental and 85.8% for Haut-Lomami. A total of 975 responses were collected, 71.4% of health workers at Kasai Oriental and 66.4% from Haut-Lomami declared a definite willingness to receive a COVID-19 vaccine booster. The duration of protection was the main reason for accepting a booster COVID-19 dose for 64.6% of the respondents. Logistic regression analysis showed that having chronic diseases (aOR = 2.95 [1.65-5.28]), having already received one of the COVID-19 vaccines (aOR = 2.72 [1.43-5. 19]); the belief that only high-risk individuals, such as healthcare professionals and elderly people suffering from other illnesses, needed a booster dose (aOR = 1.75 [1.10-2.81]). Considering the burden of COVID-19, a high acceptance rate for booster doses could be essential to control the pandemic. Our results are novel and could help policymakers design and implement specific COVID-19 vaccination programs to reduce reluctance to seek booster vaccination.

Factors affecting knowledge, attitude, and practice of COVID-19: A study among undergraduate university students in Bangladesh

The global expansion of the COVID-19 outbreak is one of the worst disasters the world has faced in recent decades. This study explored various factors of knowledge, attitude, and practice regarding COVID-19 among Bangladeshi undergraduate university students. In addition, we also look at how COVID-19 based knowledge, attitude, and practice influence each other. Using a random sampling technique and a self-administered structured questionnaire survey, this study collected data from 167 private university students in Bangladesh from 1st October to 30th October 2020. Data were analyzed using descriptive statistics (including frequencies, percentages, and means), binary logistic regression, bivariate regression analysis, and factor analysis. The findings suggest that most of the students learned about COVID-19 from various sources, including news media (TV, radio, newspapers, etc.), international organizations (WHO, UN, etc.), various government programs, or from their friends, family members, or neighbors. Most of the students were concerned about becoming sick, keeping social distance, and family members' job insecurity, followed by the university shutdown and the subsequent quarantine. Many students believe Bangladesh's media, government, medical sector, and religious organizations played a significant role during COVID-19. Binary logistic regression demonstrates that students' gender, department, and residency significantly explained their COVID-19 knowledge. In addition, students' attitudes significantly vary with their religion and place of residence. Students' departments and semesters found significant in explaining their practice regarding COVID-19. Moreover, factor analysis results also identified several crucial factors in explaining students' overall knowledge, attitude, and practice of COVID-19. Finally, we found a statistically significant relationship between knowledge, attitude, and practice.

Modelling the mass consumption potential of organic food: Evidence from an emerging economy

The deterioration of the environment, shortage of resources, and frequent occurrence of food safety issues have made people increasingly concerned about themselves while maintaining their health and protecting the environment through food. Organic food, as a healthy and eco-friendly option, is gradually gaining attention. Based on the value-belief-norm theory, this study explores why individuals consume organic food and the range of factors that lead to this consumer behavior. This study adopted a cross-sectional design and collected quantitative data from conveniently selected 300 youth participants in Bangladesh using an online survey. The findings revealed that health values and motivation have a significant positive effect on healthy eating beliefs, which, together with the awareness of the consequences, affect personal norms toward organic food consumption. Personal norms also have a significant positive effect on organic food consumption behavior among Bangladeshi youth. Finally, trust on organic food positively moderates the effect of personal norms on organic food consumption. The findings of this study are expected to foster the development of a comprehensive framework to promote programs and policies focused on organic and healthy food consumption culture among youth in developing nations.

Knowledge, attitudes and practices (KAP) on COVID-19 among the general population in most affected districts of Nepal

The COVID-19 pandemic has become one of the global health challenges in the current context. In Nepal, the first confirmed case was reported on 23 January 2020, and since then, it has resulted in several negative impacts, including economic disruption and deterioration of physical and mental health. In such a pandemic, it is indispensable to understand the knowledge and behavioral patterns of the general population regarding COVID-19. Therefore, our study aimed to assess the knowledge, attitudes and practices on COVID-19 among the general population in most affected districts and its relationship with socio-demographic conditions. The cross-sectional study was conducted among the general population above the age of 18 years from eight districts of Nepal including Kathmandu, Bhaktapur, Lalitpur, Morang, Sunsari, Rupandehi, Chitwan, and Kaski. A convenient non-probability sampling method was considered with total sample size of 702. The questionnaire survey was conducted to collect data. Descriptive statistics, non-parametric statistical tests, and a logistic regression model were used for analysis. The study showed that 93.3% of respondents had knowledge of overall preventive practices, whereas only 32% had knowledge of overall symptoms of COVID-19. Regarding attitudes, only 14.3% strongly believed that the COVID-19 pandemic would end soon. The preventive practice was reduced after the lockdown compared to that of during the lockdown. The respondents with white-collar occupations, high-income, and unmarried were good at KAP. Similarly, highly educated and those residing in urban areas had good knowledge and practice. The study findings will help in the development of targeted programs to improve the general population's knowledge, attitudes and practices on COVID-19, which is paramount to dealing with the existing pandemic and also such possible future waves of the pandemic.

Assessment of knowledge, attitudes and practices towards COVID-19 among rural adolescents in Thakurgaon district, Bangladesh: an interview-based study

OBJECTIVES

To evaluate the understanding, opinions and actions concerning COVID-19, referred to as knowledge, attitudes and practices (KAP), among rural adolescents in Bangladesh. Additionally, the study aimed to identify the determinants that may influence adolescents' KAP.

DESIGN

An interview-based cross-sectional study.

SETTING

The study area was the Thakurgaon district, which was located in the northwestern region of Bangladesh.

PARTICIPANTS

A total of 266 rural adolescents were selected using a non-probability (convenience sampling) technique.

MAIN OUTCOME MEASURES

Sociodemographic characteristics, source of information, COVID-19-related KAP, and their associated factors.

RESULTS

The majority of the respondents were females and reported that mass media (eg, television channels and papers) was the main source of information to learn about COVID-19. The mean score for knowledge was 7.15±3, whereas the scores were 10.5±2.8, and 8.78±2.66 for attitude and practice, respectively. Among the adolescents, only 11% had adequate knowledge, a positive attitude (27%) and good practices (31%). The predictive factors related to adolescents' knowledge and attitude were their religion, educational level and family income. Adolescents who were from the Islamic religion and who had secondary education were more knowledgeable and encompassed more positive attitudes. Besides, poor KAP towards COVID-19 was significantly higher among the participants with the lowest family income (less than 10 000 BDT). Moreover, their knowledge was significantly associated with their attitudes and practices.

CONCLUSION

The study found that adolescents in rural areas lacked sufficient knowledge of COVID-19 and engaged in unsatisfactory preventative behaviour. Therefore, the development of effective health education programmes that incorporate consideration of KAP-modifying factors is needed. In addition, the result would be helpful for other similar types of pandemics.

Attitude and Acceptance towards COVID-19 Booster Doses among Literacy Advantaged Population in Pakistan: A Cross-Sectional Study

Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has affected billions of lives and is expected to impose a significant burden on the economy worldwide. Vaccination is the only way to prevent the infection. However, convincing people to get themselves vaccinated is challenging in developing countries such as Pakistan. Therefore, a cross-sectional questionnaire-based study was conducted (n = 982 participants) all over Pakistan to evaluate the perception, knowledge, attitude, and acceptance of the general public towards the SARS-CoV-2 vaccine, in general, and a booster dose of SARS-CoV-2, in particular. The highest number of participants were from the province of Punjab (84.5%), followed by Islamabad (3.8%), Sindh (3.7%), Khyber Pakhtunkhwa (2.7%), Baluchistan (2.6%), Gilgit Baltistan (1.4%), and Azad Jammu and Kashmir (1.4%). A total of 915 participants were vaccinated against COVID-19, out of which 62.2% received one booster dose, followed by double booster doses (25.5%) and single vaccine shots (12.3%). The highest number of vaccinated participants were from Punjab (85.8%), followed by Islamabad (3.9%), Sindh (2.8%); Khyber Pakhtunkhwa (2.6%); Baluchistan (2.3%); Gilgit-Baltistan (1.3%); and Azad, Jammu, and Kashmir (1.2%). Among the vaccinated individuals, 71.4% were unemployed, 27.4% were employed (653), and 1.2% were retired from service. However, no significant association was observed among genders and educational levels in regard to acceptance of the booster vaccine. The outcomes of the study revealed that the increased acceptance of booster doses of the SARS-CoV-2 vaccines among the public was associated with the intent of personal and family protection. Moreover, individuals with low socioeconomic status and pregnant females showed the least acceptance towards the vaccine inoculation. The study also revealed a decline trend of accepting SARS-CoV-2 vaccine among children.

COVID-19 Vaccine Acceptance, Attitude, Hesitancy, and Its Associated Factors among Wolaita Sodo University Students: A Mixed-Method Study

Background

Countries in the world have been experiencing the ongoing impact and spread of the coronavirus disease (COVID-19) virus pandemic. The health and financial burden of the pandemic has prompted the need for timely and effective vaccination to be considered as the best strategy for controlling disease transmission. However, vaccine acceptability remains an area of concern in developing countries like Ethiopia.

Objective

To assess attitude, hesitancy in the COVID-19 vaccine acceptance, and associated factors among health science students at Wolaita Sodo University.

Methods

A triangulated mixed-method study was conducted. Quantitative data were entered into SPSS Windows version 25 for analysis, and the qualitative data were transcribed using open code version 4.3. A binary logistic regression model was used to establish the association between dependent and independent variables. Adjusted odds ratio (AOR) with a 95% confidence interval (CI) was used to measure the strengths of the association. Thematic approach was used for qualitative data analysis.

Results

A total of 352 students participated in this study. Having family members who were infected with COVID-19, information about COVID-19 vaccine, the need for a vaccine with the level of concern, intention to take COVID-19 vaccine, and academic year were strongly associated with vaccine acceptability. Graduating class and other senior students were about 4 and 2 times more likely to accept vaccination as compared to freshman-year students (AOR = 4.128; 95% CI: 1.351-12.610;P = 0.012) and (AOR = 2.195; 95% CI: 1.182-4.077; P value = 0.013), respectively. Even if 67% of students had a good attitude towards the vaccine, 56% of the students hesitated to take the vaccine.

Conclusion

The majority of respondents had a constructive attitude towards the COVID-19 vaccine, and only a few of them were vaccinated against the COVID-19 virus. It is of utmost importance to design an evidence-based strategy to increase the uptake of vaccination for healthcare students and other nonhealth science students in universities.

Hand Hygiene, Face Mask Use, and Associated Factors during the COVID-19 Pandemic among the Students of Mongar Higher Secondary School, Bhutan: A Cross-Sectional Study

Non-pharmacological measures, such as hand hygiene and face mask use, continue to play an important role in the fight against the COVID-19 pandemic. However, there is a paucity of studies on the adherence to these measures among students in Bhutan. Therefore, we aimed to investigate hand hygiene and face mask-wearing behaviours, as well as their associated factors, among the students of Mongar Higher Secondary School, Bhutan. We conducted a cross-sectional study amongst the students of Mongar Higher Secondary School in Bhutan. The students self-answered the questionnaire on web-based Google Forms. Multivariable logistic regression for good hand washing and face mask use was conducted in order to identify statistically significant socio-demographic covariates. The correlation between hand hygiene and mask use was investigated using Pearson’s correlation coefficient. A total of 533 students completed the survey questionnaire, 52.9% (282) of whom were female students. Facebook (44.3%, 236) and TV (35.5%, 189) were the two most popular sources of information on COVID-19 prevention and control. Good (scores of ≥80% of total scores) hand hygiene and face mask use were reported in 33.6% (179) and 22.1% (118) of students. In multivariable logistic regression, male students presented 79% (adjusted odds ratio [AOR] = 1.79, 95% confidence interval [CI] = 1.23−2.613) odds of engaging in good hand hygiene, compared to female students. Compared to grade 9, those in grade 10 were 60% (AOR = 0.4, 95% CI 0.158−0.998) less likely to engage in good hand hygiene. Boarding students presented 68% (AOR = 1.68, 95% CI 1.001, 2.813) higher odds of wearing a face mask compared to day students. There was a significant positive correlation between good hand hygiene and face mask use (r = 0.3671, p-value < 0.001). Good hand hygiene and face mask use were reported in less than one-third of the study participants. It is recommended to continue educating students on good hand hygiene and face mask use through popular information sources.

Knowledge, Attitudes, and Practices towards COVID-19 among Pregnant Women in Northern Bangladesh: A Community-Based Cross-Sectional Study

Background: COVID-19, caused by SARS-CoV-2, remains a global public health concern despite the availability of effective antiviral treatment against multiple strains. Studies have shown that pregnant women are more susceptible to COVID-19 due to altered physiology and immunological features. Therefore, this study was designed to investigate pregnant women’s knowledge, attitudes, and practice (KAP) to prevent COVID-19 and determine the factors associated with KAP. Methods: A community-based cross-sectional study was conducted among 425 pregnant women in Northern Bangladesh. The samples were obtained using a simple random sampling technique from 5 April to 15 June 2020. The data were collected by face-to-face survey with a structured and pre-tested questionnaire and analyzed using SPSS version 25. Bivariable and multivariable logistic regression analyses were performed, and p-values < 0.05 at 95% CI were considered statistically significant. Results: Overall, the score of KAP among the respondents was 47.76%, 49.41%, and 56.24%, respectively. Participants’ area of residence, educational status of the husband, and antenatal care (ANC) visit were significantly associated with the level of knowledge, whereas age, educational status of the husband, number of living children, and knowledge were significant predictors of attitude. The knowledge of COVID-19 was the only predictor associated with the practice. Conclusion: Our study shows that almost half of the participants had poor knowledge, a negative attitude, and poor practices regarding COVID-19. Additional health education programs by healthcare professionals and different media, coordinated and combined efforts of government and individuals’ participation will be required to fight the spread of the infection.

COVID-19 preventive practices and associated factors among high school and preparatory school students in Dessie City, Ethiopia

Background

As the COVID-19 pandemic continues to ravage the world, the most pretentious sector besides the economy is the education system. Ethiopia is not equipped with the infrastructure and facilities to provide online classes for students at all levels. Hence, all institutions were re-opened with mandatory infection prevention and control (IPC) protocols such as the use of face masks, physical distancing, shifts in classes, and routine hand washing practices with soap and water to restrict the spread of the virus. Nevertheless, there has been no monitoring and follow- up and there is no data on IPC compliance among school children in the country. The purpose of this study was to examine the COVID-19 preventive practices and their associated factors among high and preparatory school students in Dessie City, Ethiopia.

Methods

A cross-sectional study was carried out by using a pre-tested face-to-face applied structured questionnaire and direct observations from March 8 to March 20, 2021, in five high and preparatory schools in Dessie City. The sample size was proportionally allocated in each school based on the students' total number registered in the first academic semester, then stratified by grade level, and proportionally allocated to each grade and section. Finally, a simple random sampling method was used to select study participants. Variables with p-values < 0.25 in the bivariate logistic regression analysis were entered into the multivariate logistic regression model.

Results

This study involved 422 students with a response rate of 98.8%. The level of good preventive practices was 43.7%. After adjusting for covariates, female, positive attitudes, received IPC training and clear accessible sharing of information and feedback with parents, students and teachers were identified as predictors of good precaution practices.

Conclusion

The prevalence of good prevention practices for COVID-19 among students was relatively very low. Therefore, the Department of Health and Education of Dessie City and each school should implement environmental health programs and promote prevention practices in high schools and preparatory schools.

Knowledge, attitudes and practices of healthcare professionals toward the novel coronavirus during the early stage of COVID-19 in a lower-and-middle income country, Bangladesh

Healthcare workers (HCWs) are at an increased risk of COVID-19 infection because of their direct exposure to suspected and confirmed coronavirus patients in healthcare facilities. This condition is even more acute in low-and lower-middle-income countries (LMICs). Given the poor healthcare settings of Bangladesh, it is challenging to halt the spread of infection without proper knowledge, attitudes, and good behavioral practices (KAPs). Therefore, this study conducted a cross-sectional study from May 5 to 31, 2020, with 203 healthcare professionals to determine the knowledge, attitudes, and practices (KAP) toward COVID-19. Participants were doctors, nurses, dentists, and allied health professionals. A self-administered questionnaire including several KAP-related items aligned with the World Health Organization (WHO) guidelines was distributed over various online platforms to collect data. Bivariate and multivariable logistic regression analyses were conducted to determine the factors influencing KAP levels. The majority of participants were male (52.22%). The prevalence of high knowledge levels, positive attitudes, and good practices were 51.23, 45.81, and 49.75%, respectively. Social media was the most common source for seeking coronavirus information. Workers at private institutions were less likely (OR = 0.56, 95% CI = 0.30-0.95, p < 0.05) to be knowledgeable than workers at public institutions. Doctors had more positive attitudes than other healthcare professionals. Older participants showed high rates of good behavioral practices (OR = 1.05, 95% CI = 1.06-1.32, p < 0.05) than younger ones. Workers at private institutions had a better practice level toward COVID-19 (OR = 2.11, 95% CI = 1.17-3.83) than those at public institutions. These results point to the necessity for proper training programs for medical professionals that help them gain confidence to deliver the correct treatment to their patients and the need to implement preventative steps during pandemics.

Knowledge, Attitude and Practices of rabies during an outbreak in Samtse Municipality, Bhutan: A cross-sectional study

Background

A rabies outbreak in dogs occurred on February 22, 2021, in the Samtse Municipality, Bhutan. A rapid response team (RRT) was activated comprising of human and animal health teams to investigate and contain this outbreak. An assessment of the knowledge, attitude, and practice (KAP) on rabies was elicited during this period to develop evidence-based education material.

Methods

A face-to-face KAP questionnaire was administered to a volunteer member of 55 households in two communities (Norbuling and Xing Workshop areas) following the rabies outbreak in the Samtse Municipality from March 15 to 22, 2021. Descriptive statistics were used to describe the demographic characteristics. The associations between the KAP scores were assessed using the Pearson correlation coefficient.

Results

Of the 55 respondents, 63.6% (35) had poor knowledge, 90.9% (50) and 63.6% (35) reported good attitude and practice toward rabies. Three (5.5%) participants had not heard about rabies. The other misconceptions were that rabies can be prevented with antibiotics (67.3%, 37), dressing the bite wounds (20.0%, 11), and seeking treatment from the local healer (5.5%, 3). Correct knowledge was reported on excessive salivation as the sign of the rabid animal (58.2% 32), rabies prevention through vaccination (81.8%, 45), and seeking medical care on the same day (94.5%, 52). Eighty-nine percent (49) vaccinated their dogs and domestic animals annually, 100% received post-exposure prophylaxis (PEP) after an animal bite, 78.2% (43) washed the animal bite wounds with soap and water, and 9.1% (5) would consult the local healer for animal bites. A majority (78.2%, 43) of them agreed that rabies is a serious public health problem in the Samtse Municipality and 49.1% (27) agreed that the public was adequately informed about rabies. A positive correlation was observed between the knowledge-practice scores (r = 0.3983, P value = 0.0026), and attitude-practice scores (r = 0.4684, P value < 0.001).

Conclusion

The poor knowledge of rabies in this study needs to be addressed urgently. The main misconceptions included were that rabies is not fatal, dressing animal bite wounds, and seeking dog and animal bite care from local healers. Health education should focus on these misconceptions.

Food handler's level of COVID-19 prevention practice and preparedness of food and drinking establishments to combat the pandemic in Eastern Ethiopia

Background

Food and drinking establishments are potential hotspots for the spread of coronavirus. Food handler's have a higher risk of contracting the disease and transmitting it to others. The aim of this study was to assess the food handler's level of preventive practices toward COVID-19 and the preparedness of food and drinking establishments to tackle the pandemic in Eastern Ethiopia.

Methods

The cross-sectional study design was conducted from September 1 to 30, 2020. A stratified sampling technique was used to select 276 licensed public food and drinking establishments and a simple random sampling technique was employed to select 422 food handlers from the selected establishments. A face-to-face interview and checklist-based observation were used to collect data. The collected data were entered into Epidata 3.1 and exported to STATA version 16 for analysis. Binary logistic regression analysis were conducted to identify factors associated with COVID-19 preventive practice. Statistical significance was declared at p < 0.05.

Results

About 406 food handler's participated in this study, making the response rate 96.2%. The study showed that 38.4% of study participants (95% CI: 33.5, 43.1) had good preventive practices for COVID-19. Only 10.5% of food and drinking establishments fulfilled all requirements to prevent COVID-19 transmission. Being male [AOR = 0.61, 95% CI(0.61, (0.39, 0.93)], attending secondary education [AOR = 2.20, (95% CI: 1.37, 3.53)], having a favorable attitude toward COVID-19 [AOR = 1.89, (95% CI: 1.22, 2.95)], and having good knowledge about COVID-19 [AOR = 1.78, (95% CI: 1.13, 2.81)] were significantly associated with the level of COVID-19 preventive practices.

Conclusion

The level of good COVID-19 preventive practice was found to be low among the food handler's. Only one in ten food and drink establishments fulfilled the national guideline for preventing COVID-19 transmission. Being male, attending secondary education, having knowledge about COVID-19, and having a favorable attitude toward COVID-19 were significantly associated with good COVID-19 preventive practices. A vibrant guideline on prevention practices should be in place at all establishments, and compliance should be monitored. Local health office experts should take comprehensive measures to make all food and drinking establishments accountable for practicing all preventive measures.

Knowledge, Attitudes, and Practices concerning Black Fungus during COVID-19 Pandemic among Students of Bangladesh: An Online-Based Cross-Sectional Survey

Background: Infection with COVID-19 and its control entailing steroids and immunomodulatory medications disrupted normal immune function. The ensuing immunological disorder led to the rise of another infection—Black Fungus (Mucormycosis). However, the spread of Black Fungus can be minimized through proper knowledge, informed attitude, and conscious preventive practice. This study aimed to assess students’ knowledge, attitude, and practice (KAP) regarding Black Fungus amid the COVID-19 pandemic in Bangladesh. Methods: This cross-sectional study was carried out among Bangladeshi students from June to July 2021. Using Google Forms, an e-questionnaire was developed for this web-based survey, and the participants were selected through a snowball sampling approach. Results: Out of the 2009 participants, more than half were female (53.5%), and the majority were at an age between 18 and 25 years (31.5%) and had received higher secondary (HSC) schooling (77.8%), while around 61% resided in urban areas. Findings revealed that most of the students (63.8%) spent around 2 h on electronic and social media to become informed about COVID-19 and Black Fungus. Approximately 33% of the students showed low KAP scores (32.9%), whereas around 26% had high KAP scores. Our results show a significant association between KAP and sex, schooling, living status, residence, and media exposure. Conclusion: The knowledge of Black Fungus considerably varies among Bangladeshi students considering the place of residence, age, sex, living arrangement, and media exposure. Policymakers should emphasize awareness among people focusing on the results of this study to increase deterrent attitudes and protective practices to minimize the risks of being infected.

Do Vaccination Attitudes Mediate the Link between Critical Consciousness and COVID-19 Vaccination Behaviour? A Cross-Sectional Study

Critical consciousness development represents a building block in the formation of health-related attitudes and behaviours. One of the most studied health-related behaviours in the previous year is COVID-19 vaccination behaviour. The present study examines critical consciousness, COVID-19 vaccination attitudes and vaccination behaviour in a consistent sample of young adults (N = 1185). Participants were residents of Romania, aged 18 to 41 years. The Critical Consciousness Scale—Short Form (CCS-S) and the Vaccination Attitudes Examination (VAX) Scale were used. The results demonstrate the mediating role of two types of vaccination attitude—lack of confidence in the promoted vaccine benefits and worries about unforeseen effects—in the relationship between critical reflection and vaccination behaviour. Communication is fundamental in an initiative aimed at changing behaviour. When shaping a health-related campaign, communication and dialogue must be horizontal and characterised by empathy and mutual recognition to determine favourable health-related behaviour.

Knowledge, Attitude and Practices Toward Coronavirus Disease (COVID- 19) in Southeast and South Asia: A Mixed Study Design Approach

Background

Coronavirus has spread to almost every country since its emergence in Wuhan, China and countries have been adopted an array of measures to control the rapid spread of the epidemic. Here, we aimed to assess the person's knowledge, attitude and practices (KAP) toward the COVID-19 epidemic in Southeast and South Asia applying the mixed study design (cross-sectional and systematic review).

Methods

In the cross-sectional study, 743 respondents' socio-demographic and KAP-related information was collected through an online population-based survey from the Malaysian population. In the systematic review, the database PubMed, Web of Science and Google Scholar search engine were searched and related published articles from South and Southeast Asia were included. Frequency distribution, Chi-square association test and binary logistic regression were fitted using cross-sectional data whereas random effect model and study bias were performed in meta-analysis. We used 95% confidence interval and P <0.05 as statistical significances.

Results

The prevalence of good knowledge, positive attitude and frequent practice toward COVID-19 epidemic were 52.6%, 51.8% and 57.1%, respectively, obtained by cross-sectional data analysis. The KAP prevalence were ranged from 26.53% (Thailand) to 95.4% (Nepal); 59.3% (Turkey) to 92.5% (Pakistan); and 50.2 (Turkey) to 97% (Afghanistan), respectively, obtained by 18 studies included in the meta-analysis. The prevalence of KAP was higher [84% vs. 79%, P_{heterogeneity} <0.001; 83% vs. 80%, P_{heterogeneity} <0.001; 85% vs. 83%, P_{heterogeneity} <0.001] in South Asia compared to Southeast Asia, obtained by subgroup analysis. Some studies reported mean level instead of the proportion of the KAP where the score varied from 8.15–13.14; 2.33–33.0; and 1.97–31.03, respectively. Having more knowledge and attitude were encouraged more likely to practice toward COVID-19. Study suggests age, gender, education, place of residence and occupation as the most frequent significant risk factors of KAP toward COVID-19.

Conclusion

The study sufficiently informs how other countries in Southeast and South Asia enriches their KAP behaviors during the pandemic which may help health professionals and policymakers to develop targeted interventions and effective practices.

Knowledge, Attitudes, and Misconceptions About COVID-19 Prevention Practices Among High and Preparatory School Students in Dessie City, Ethiopia

Background

Knowledge, attitudes, and misconceptions of students about COVID-19 (coronavirus disease) prevention have been examined in relatively few studies. This study aimed to assess the knowledge, attitudes and misconceptions about COVID-19 prevention practices among high and preparatory school (grades 9 to 12) students in Dessie City, Ethiopia.

Methods

This school-based cross-sectional study used a pre-tested structured questionnaire and direct observations from March 1 to 30, 2021 in 5 high and preparatory school students in Dessie City, Ethiopia. The sample size was proportionally allocated in each school based on the number of students registered in the first semester, stratified by grade level, and section. Data analysis employed 3 binary logistic regression models (Models I, II and III) with 95% CI (confidence interval). Bivariate analysis (crude odds ratio [COR]) and multivariable analysis (adjusted odds ratio [AOR]) were used. Variables with P-values <0.3 in the bivariate analysis were retained in the multivariable logistic regression analysis for each model. Variables with significance levels P<0.05 in the multivariable analysis of each model was identified as significant factors.

Results

The levels of good knowledge, positive attitudes, and low misconceptions were 74.8%, 60.2%, and 56.1%, respectively. After adjusting for the covariates, grade 12, positive attitude and living in households with more than 5 members were identified as factors significantly associated with good knowledge about COVID-19 prevention practices. Good knowledge of COVID-19 prevention practices, household size >5, infection prevention and control (IPC) training, and low level of misconceptions were factors significantly associated with positive attitudes, whereas students age ≥18 years, positive attitude, and IPC training were factors significantly associated with less misconceptions about COVID-19 prevention measures.

Conclusion

The prevalence of good knowledge, positive attitude, and low level of misconceptions of prevention practices for COVID-19 among students was relatively low. Therefore, Dessie City Health and Education Department and each high and preparatory school should implement continuous monitoring programs to ensure high prevention awareness and promote preventive behavior towards COVID-19.

COVID-19 Incidence Prediction Model Based on Community Behavior With Neural Networks

Abstract BACKGROUNDS : The COVID-19 pandemic has created a global health emergency that requires a public health response to prevent the spread of the virus. AIM: The purpose of this study was to determine the prediction model for the incidence of COVID-19 based on community behavior. METHODS: This study used a cross-sectional study design. The study population was all people aged >18 years in Medan City and obtained a sample of 395 people with stratified random sampling technique. The research instrument used a questionnaire in google form, then, using Microsoft Office Excel, we transferred the data from the survey to a computer program. Furthermore, the data was analyzed using the neural networks method. Then the features importance will be calculated using the Random Forest with Mean Decrease Impurity (RF-MDI) method. RESULT: The results showed that based on the confusion matrix, the prediction value for those who did not suffer from COVID-19 was correct from negative data = 8, the correct prediction value for COVID-19 from positive data = 8. While the incorrect prediction value for machines that predicted negative results but the actual data was positive = 2, and predicts a positive result but the actual data is negative = 4. Thus, based on the neural net classification method, the accuracy value is 72%. The results of this study indicate that poor preventive behavior by the community greatly affects the spread of COVID-19 cases. CONCLUSION: Poor community behavior, such as not limiting their interaction/contact with other people, not exercising frequently, leaving the house without keeping a safe distance, and not washing hands regularly, can all impact COVID-19 transmission in the community Keywords: Behavior Prediction Model, COVID-19 Incidence, Neural Network

Risk perception and preventive behaviours of COVID-19 among university students, Gondar, Ethiopia: a cross-sectional study

OBJECTIVE

This study aimed to assess COVID-19 preventive behaviours and their associated factors among university students.

METHODS

An institution-based cross-sectional study was employed among 405 university students and the study participants were chosen using a stratified simple random selection procedure. A pretested self-administered questionnaire was used to assess participants' perception of and preventive behaviour towards COVID-19. A multivariable logistic regression analysis was employed to identify factors associated with COVID-19 preventive behaviour.

RESULT

A total of 405 students participated in this study with a response rate of 97.4%. The mean age of the participants was 23.6 (SD ±2.4, range 19-30) years. Two hundred and twenty of the participants (45.7% with 95% CI 41.0% to 51.0%) had good preventive behaviour towards COVID-19. COVID-19 preventive behaviour was significantly associated with age (adjusted OR (AOR)=1.1, 95% CI 1.00 to 1.2), female sex (AOR=1.6, 95% CI 1.02 to 2.60), knowing anyone infected with COVID-19 (AOR=4.05, 95% CI 1.9 to 8.8), participants who had high perceived susceptibility (AOR=2.14, 95% CI 1.44 to 3.35) and participants who were enrolled in health programmes (AOR=4.23, 95% CI 2.6 to 7.0).

CONCLUSION AND RECOMMENDATION

The overall COVID-19 preventive behaviour among university students is unsatisfactory. Students' COVID-19 preventive behaviour was influenced by age, sex, knowing a COVID-19 infected person, perceived susceptibility and the sort of programme in which they had enrolled. The findings revealed that health communication interventions aimed at changing people's perceptions of COVID-19 and related prevention strategies are urgently needed to improve this population's COVID-19 preventive behaviour.

Assessing public knowledge, attitudes and determinants of third COVID-19 vaccine booster dose acceptance: current scenario and future perspectives

Background

People with weakened immune systems may not develop adequate protection after taking two doses of the mRNA-combined COVID-19 vaccine. The additional dose may improve the level of protection against Covid-19.

Objectives

Current study aimed to evaluate the knowledge, attitude and determents of third COVID-19 vaccine booster dose acceptance among population in the UAE.

Methods and materials

This is online descriptive cross-sectional community-based study conducted among the students and faculty of Ajman University from 25 August to 20 October 2021. The questionnaire, which was in the English language, encompassed two sections containing 22 items. Section one gathered the demographic details of the respondents, while Section two used 13 questions to evaluate the respondents’ knowledge of and attitude to the third COVID-19 vaccine booster dose.

Results

614 respondents participated in this study. The average knowledge score was 44.6% with a 95% confidence interval (CI) of [41%, 49%]. Better knowledge scores were observed in postgraduates (OR 4.29; 95% CI 2.28–8.11), employees in the healthcare sector (OR 1.62; 95% CI 1.05–2.51), participants who had relatives infected with the Covid-19 (OR 1.46; 95% CI 1.05–2.02), participants who had infected with Covid-19 (OR 2.21; 95% CI 1.43–3.43) and participants who had received first two doses of the COVID-19 vaccine (OR 2.08; 95% CI 1.40–3.11). The average attitude score was 70.2% with a 95% confidence interval (CI) of [69.2%, 71.2%].

Conclusion

Necessary steps should be taken by the government and public health authorities, in line with the local culture, to increase vaccination acceptance and foster positive attitudes towards the vaccine. A suitable approach to this would be to develop an educational framework that could demonstrate the risks of vaccine avoidance or delay to the general population. Moreover, health authorities should pay more attention to the false information being disseminated across the internet, especially social media. Also, healthcare workers should be trained in vaccinology and virology to make sure that they are able to understand important developments in these fields and convey the findings to their patients.

Knowledge, Attitudes, and Practices Toward Coronavirus and Associated Anxiety Symptoms Among University Students: A Cross-Sectional Study During the Early Stages of the COVID-19 Pandemic in Bangladesh

BACKGROUND

University students' knowledge, attitude, and practice (KAP) toward COVID-19 are vital to prevent the spread of the virus, especially in the context of developing countries. Consequently, the present study aimed to determine the KAP levels of university students and associated anxiety during the earlier stage of the pandemic in Bangladesh.

METHODS

A cross-sectional, online study with 544 university students was conducted during April 17-May 1, 2020. The questionnaire incorporated several KAP-related test items aligned with the World Health Organization (WHO) guidelines. Anxiety was measured with the 2-item Generalized Anxiety Disorder scale (GAD-2). Multivariable logistic regression analysis was performed to determine the association between KAP levels and anxiety adjusting for sociodemographic variables. Subgroup analyses included rerunning models stratified by gender and quarantine status.

RESULTS

Approximately 50% of students showed high levels of knowledge about COVID-19 guidelines, 59% reported behavioral practices that aligned with COVID-19 guidelines, and 39% had negative attitudes toward COVID-19 guidelines. Attitudes differed by anxiety (χ² = 23.55, p < 0.001); specifically, negative attitudes were associated with higher anxiety (OR: 2.40, 95% CI = 1.66-3.46, p < 0.001). Associations were significant for male (OR = 2.36; 95% CI = 1.45-3.84, p < 0.001) and female (OR = 2.45; 95% CI = 1.3-4.34; p < 0.001) students. Stratified analyses found non-quarantined students with negative attitudes had three times the chance of experiencing anxiety (OR = 3.14, 95% CI: 1.98-4.98, p < 0.001). Non-quarantined students with low levels of knowledge had half the chance of developing anxiety (OR = 0.49, 95% CI: 0.31-0.78, p < 0.01).

CONCLUSION

Based on these findings, it is recommended that university authorities continue to prioritize proactive and effective measures to develop higher levels of knowledge, more positive attitudes and better behavioral practices regarding COVID-19 for the mental health of their students.

Determinant Factors of COVID-19 Vaccine Hesitancy Among Adult and Elderly Population in Central Java, Indonesia

PURPOSE

The Coronavirus disease (COVID-19) vaccination program has been rolled out to address the pandemic. However, the COVID-19 vaccination coverage rate in Indonesia, especially in Central Java, is low. The study aimed to identify COVID-19 vaccine acceptance and to determine the factors associated with COVID-19 vaccine hesitancy.

PARTICIPANTS AND METHODS

A cross-sectional study was conducted from September to October 2021. A self-reported questionnaire was distributed to participants aged ≥ 18 years and living permanently in the area of study by the multistage sampling technique. Bivariate and multivariate analyses were performed to determine the association. All statistical tests were significantly considered if the p-value <0.05 at 95% confidence interval (CI).

RESULTS

A total of 500 participants were eligible, with the age ranging from 18 to 76 years old. COVID-19 vaccine acceptance rate was 93.6%. In the multivariate logistic regression analysis, we found that the elderly (aOR=5.231; 95% CI=1.891-14.468), having comorbidity (aOR=4.808; 95% CI=1.975-11.706), not being exposed to information (aOR=7.039; 95% CI=2.072-23.908), not believing in the vaccine halalness (OR=3.802; 95% CI=1.272-11.364), not believing that vaccines could prevent the COVID-19 infection (OR=4.964; 95% CI=1.970-12.507), and having vaccination-related mild-moderate anxiety (OR=14.169; 95% CI=2.405-83.474) were more likely to have vaccine hesitancy (p<0.05). Place of residence, education level, belief that the vaccine could prevent the severe symptoms of COVID-19, and knowledge were significantly related to the vaccine acceptance in the bivariate analysis (p<0.05), but they were no longer significant in the multivariate (p>0.05).

CONCLUSION

A high acceptance rate of the COVID-19 vaccine was found in this study. However, vaccine hesitancy is a major public health concern for attaining herd immunity and reducing the risk of case mortality. These findings could be the strategic focus for the government to improve COVID-19 vaccination coverage.

The need for a holistic approach toward pandemic control: lessons from a cross-sectional study on COVID-19 in Meghalaya, India

We conducted a community-based cross-sectional survey of 416 participants from Meghalaya, India to assess knowledge, perceptions, and practices toward recommended COVID-19 preventive measures, and to explore health-seeking behavior and stigma during early phase of the pandemic. Most participants had knowledge of the signs and symptoms of COVID-19 (94%) and its spread (96%), and reported positive behavior change such as handwashing ≥ 6 times/day (41% pre-COVID-19 vs. 81% during COVID-19, P < 0.001), sneezing or coughing into sleeves (65% pre-COVID-19 vs. 89% during COVID-19, P < 0.001) and staying home if having flu-like symptoms (44% pre-COVID-19 vs. 94% during COVID-19, P < 0.001). We found delayed healthcare seeking for non-COVID-19 illnesses (16%). Fear of losing life was reported by 26% participants, as was discrimination toward migrant returnees, with 35% blaming returnees for the spread of COVID-19. We highlight the need for a holistic approach toward pandemic control, including social and mental health interventions, in public health strategies.

Knowledge, Attitude, and Practice Toward COVID-19 Among Sherubtse College Students in Bhutan: A Web-Based Cross-Sectional Study

Bhutan has reopened schools and colleges after an initial closure to contain coronavirus disease 2019 (COVID-19) transmission. However, the risk of transmissions is higher in the schools and colleges due to crowding. Therefore, this study aimed to assess the level of knowledge, attitude, and practice (KAP) toward COVID-19 among the students of Sherubtse College in Bhutan. A cross-sectional study using a questionnaire was conducted in September 2020 among the students of Sherubtse College, Bhutan. The questionnaire was made in the Google Forms and administered through a social forum WeChat app. The KAP scores were calculated that include mean scores. The association between the KAP was assessed using the Pearson's correlation coefficient. A total of 613 students participated in the survey. The majority of the participants (57%) were female and 56% were from the third year. The mean knowledge score was 10.7 (SD = 1.7; range 0–14), mean attitude score of 3.67 (SD = 1.0; range: 0–5), and mean practice score of 5.19 (SD = range: 0–6). A majority of the students had good knowledge (98%) and practice (93.5%) scores, and a positive attitude (86.6%) toward COVID-19. A positive but weak correlation between good knowledge and practice (r = 0.1, p = 0.0126) was observed. Having a positive attitude led to practicing appropriately most of the time (r = 0.1866, p < 0.001). The students had good KAP scores and followed the COVID-19 prevention protocols advocated by the government. Good knowledge and a positive attitude were translated into good practice. Therefore, the education campaign of the Bhutan government seems to be effective in the students.

Poultry farming and farmers perception towards the farming condition during COVID-19 pandemic in Bangladesh

Coronavirus disease 2019 (COVID-19) is threating global public health and has declared as a pandemic crisis around the world. An attempt was made to ascertain the effect of COVID-19 on practices in poultry farming (PPF), problem faced for poultry farming (PFPF) and poultry farmer's perception on COVID-19. A questionnaire based cross-sectional study was conducted among 397 poultry farmers during the period of October to December 2020 in selected area of Bangladesh. The PPF score at just prior and during of the COVID-19 was 7.11 ± 3.25 and 6.53 ± 3.12 having significant difference (p < 0.01). But, the training on poultry farming can improve the PPF score at just prior (7.57 ± 3.20) and during (6.91 ± 3.13) of the COVID-19. Additionally, the mean PFPF score was found of 10.67 ± 6.15. In logistic regression analysis, the farmers of ≥18-29 years aged and had no training were 0.42 (95% CI:0.20-0.88; p < 0.01) and 0.58 (95% CI:0.35-0.98; p < 0.05) times respectively less likely to have satisfactory score on PPF. Similarly, the farmers of ≥18 to 29 and ≥ 40-49 years aged were 2.52 (95% CI:1.36-4.69; p < 0.01) and 2.08 (95% CI:1.12-3.87; p < 0.05) times respectively more likely to have considerable score on PFPF than the farmers of other age group. Interestingly, the internet users had 2.51 (95% CI:0.95-6.57; p < 0.05) times higher to have more satisfactory PPF score (≥60%). Moreover, the farmers of ≥18-29 years aged, masters level education and had training, significantly (p < 0.01) thought the COVID-19 is more dangerous indicated by the higher median (median = 8). In conclusion, the PPF and PFPF score was significantly varied by demographical characteristics of farmers. Therefore, the farmers had the concept about COVID-19 and more than 75% of them believe that COVID-19 doesn't transmit from poultry.

Awareness, Views, and Expectations about COVID-19 Vaccinations: A Cross-Sectional Study of Dental Clinic Patients in India

INTRODUCTION

Several vaccines against coronavirus disease 2019 (COVID-19) have been licensed and are being administered worldwide in various countries. However, the awareness, behaviors, and expectations of COVID-19 vaccines among dental clinic patients are poorly understood.

METHODS

An e-survey was carried out among 1800 patients who visited dental clinics in India. The survey was carried out using a questionnaire of four parts and informed consent (i.e. sociodemographics, knowledge, attitudes, and perceptions). The investigators used Internet methods for data collection during the pandemic.

RESULTS

The mean awareness score was significantly higher among participants who reported having a university/higher level of schooling, being in the upper socioeconomic status community, living in cities, and having previously received all required vaccines. The mean attitude score was slightly higher for participants who reported being female and had a history of getting all required vaccinations. Just over half (52%) of participants felt everyone should be vaccinated. This interpretation was slightly higher among females than males (56.9% vs. 47.9%, P = 0.004).

CONCLUSIONS

The results indicate that patients attending dental clinics in India have insufficient awareness but more optimistic attitudes about the COVID-19 vaccine. Immediate health promotion campaigns must be implemented before vaccine schedules in order to increase awareness.

Knowledge, attitudes and perceptions towards COVID-19 vaccinations: a cross-sectional community survey in Bangladesh

BACKGROUND

Several vaccines have been approved for use against coronavirus disease (COVID-19) and distributed globally in different regions. However, general community knowledge, attitudes and perceptions towards COVID-19 vaccinations are poorly understood. Thus, the study aimed to investigate community knowledge, attitudes and perceptions towards COVID-19 vaccinations in Bangladesh.

METHODS

An exploratory and anonymous population-based e-survey was conducted among 1658 general individuals (55.6% male; mean age = 23.17 ± 6.05 years; age range = 18-65 years). The survey was conducted using a semi-structured and self-reported questionnaire containing informed consent along with four sections (i.e., socio-demographics, knowledge, attitudes, and perceptions). Multiple linear regression was performed to determine the variables predicting knowledge, and attitudes towards COVID-19 vaccinations.

RESULTS

The mean scores of knowledge and attitudes were 2.83 ± 1.48 (out of 5) and 9.34 ± 2.39 (out of 12) respectively. About a quarter of participants thought that the COVID-19 vaccination available in Bangladesh is safe, only 60% will have the vaccination and about two-thirds will recommend it to family and friends. In the multiple regression model, higher SES, having university/ higher levels of education, having nuclear families and having previous history of essential vaccines uptake were associated with knowledge; whilst attitudes were significantly associated with being female and having previous history of essential vaccines uptake. Just over half of the participants thought that everyone should be vaccinated and 61% responded that health workers should be vaccinated first on priority basis. 95% of respondents believed the vaccine should be administered free of charge in Bangladesh and almost 90% believed that the COVID-19 vaccine used in Bangladesh may have side effects.

CONCLUSIONS

The findings reflect inadequate knowledge but more positive attitudes towards COVID-19 vaccine among the general population in Bangladesh. In order to improve knowledge, immediate health education programs need to be initiated before mass vaccination are scheduled.

Analysis of change in knowledge, attitude, and practices about COVID-19 following and awareness session in rural population of Western India

BACKGROUND

Beginning of the pandemic showed our limitations in our understanding of the spread of the dreaded coronavirus-19 that had sprung from China and spread through thick and thin across the world. The measures to contain the spread of virus in the absence of specific treatment protocol had everyone grope for the solutions in a very short time frame. One such is the knowledge, attitude, and practice in the rural setup.

AIM

The aim of the study is to measure the change in knowledge, attitude, and practices (KAP) regarding COVID-19 following an awareness session in rural population.

MATERIALS AND METHODS

A cross-section interventional study was carried out in January 2021. An interactive awareness session was conducted with the help of audiovisual aids following MOHFW guidelines for COVID-19, and the change in KAP about COVID-19 was measured by pre- and posttest standardized questionnaire.

RESULTS

Of all the participants, statistically significant change in knowledge was seen from 43% to 52%. The villagers were educated about preventive steps and a positive change was measured in the practice of changing masks regularly (84%-100%), maintaining social distancing (44%-64%), frequent handwashing (52%-64%). No change was seen in wearing of masks (92%) and negative change was seen in avoiding handshakes (32%-28%). The preventive practices regarding COVID-19 pandemic changed significantly from 50% to 58%. Our study measured positive attitude change toward getting vaccinated from 64% to 72%.

CONCLUSION

A single, short awareness session led to significant change in KAP about COVID-19 in rural population.

Knowledge, Attitudes, and Practices Regarding COVID-19 Among Health Care Workers in Public Health Facilities in Eastern Ethiopia: Cross-sectional Survey Study

Background

On March 13, 2020, Ethiopia reported the first confirmed case of COVID-19 in Addis Ababa. COVID-19 is likely to overwhelm an already-fragile health care delivery system and reduce the availability of essential health services. This analysis of data from the Somali Region of Eastern Ethiopia on health care workers’ (HCWs) knowledge, attitudes, and practices regarding the prevention and control of COVID-19 may be used in planning health education programs about the emerging viral disease.

Objective

This study aimed to investigate the knowledge, attitudes, and practices of HCWs regarding COVID-19 infection.

Methods

This cross-sectional study was conducted among HCWs in three public health facilities in the Somali Region, Eastern Ethiopia. A self-administered questionnaire was shared with all HCWs working at the public health facilities. A total of 15 knowledge questions were scored as 1 or 0 for correct or incorrect responses, respectively. A total of 14 practice questions were scored on a 3-point scale from 1 (“always”) to 3 (“never”). A total of six attitude questions were rated on a 5-point Likert scale, in a negative dimension, as follows: 1 (“strongly agree”), 2 (“agree”), 3 (“neutral”), 4 (“disagree”), and 5 (“strongly disagree”). Mean scores were calculated and used as a cut point to dichotomize the outcome variables (>13.7 indicated good knowledge, <18.8 indicated good practices, and ≤10.5 indicated favorable attitudes). We used t tests and analyses of variance (ie, F tests) to analyze the mean score differences of knowledge, attitudes, and practices between the independent variables. Spearman correlation was used to assess the relationship between mean knowledge and attitude scores.

Results

Of the 686 HCWs approached, a total of 434 HCWs responded (63.3% response rate). The mean age of the participants was 27.6 (SD 5.3) years, and the majority of the participants were male (293/434, 67.5%). The mean knowledge score was 13.7 (SD 2.6), and 73.3% (318/434) of participants had sufficient knowledge. The mean attitude score was 10.5 (SD 4.1), and 54.8% (238/434) of the participants had a good attitude toward COVID-19. The mean practice score was 18.8 (SD 5.8), and 61.5% (267/434) of the participants practiced precautionary measures to prevent COVID-19. There was a negative correlation between knowledge and attitude scores (r=–0.295, P<.001) and between knowledge and practice scores (r=–0.298, P<.001).

Conclusions

The overall levels of knowledge and practice were relatively better than the attitude level. This highlights the need to implement strategies that enhance the positive attitudes and safe practices of the HCWs for better containment of the pandemic and supporting of essential health care services.

Global epidemiology of COVID-19 knowledge, attitude and practice: a systematic review and meta-analysis

OBJECTIVE

To assess the knowledge, attitude and practice (KAP) of the global general population regarding COVID-19.

DESIGN

Systematic review and meta-analysis.

METHODS

MEDLINE, Embase, CINAHL and PsycINFO were used to identify articles published between 1 January and 30 June 2021 assessing KAP regarding COVID-19 in the global general population. The quality of eligible studies was assessed. Random effects model was used to obtain the pooled proportion of each component of KAP of COVID-19. Heterogeneity (I2) was tested, and subgroup and correlation analyses were performed.

RESULTS

Out of 3099 records, 84 studies from 45 countries across all continents assessing 215 731 participants' COVID-19 KAP were included in this study. The estimated overall correct answers for knowledge, good attitude and good practice in this review were 75% (95% CI 72% to 77%), 74% (95% CI 71% to 77%) and 70% (95% CI 66% to 74%), respectively. Low-income countries, men, people aged below 30 years and people with 12 years of education or less had the lowest practice scores. Practice scores were below 60% in Africa and Europe/Oceania. Overall heterogeneity was high (I2 ≥98%), and publication bias was present (Egger's regression test, p<0.01). A positive significant correlation between knowledge and practice (r=0.314, p=0.006), and attitude and practice (r=0.348, p=0.004) was observed.

CONCLUSIONS

This study's findings call for community-based awareness programmes to provide a simple, clear and understandable message to reinforce knowledge especially regarding efficacy of the preventive measures in low and lower middle-income countries, and in Africa and Europe/Oceania, which will translate into good practice. Targeted intervention for men, people with low education, unemployed people and people aged below 30 years should be recommended. As most of the included studies were online surveys, underprivileged and remote rural people may have been missed out. Additional studies are needed to cover heterogeneous populations.

PROSPERO REGISTRATION NUMBER

CRD42020203476.

Understanding the determinants of COVID-19 vaccination intention and willingness to pay: findings from a population-based survey in Bangladesh

BACKGROUND

Several coronavirus disease (COVID-19) vaccines have already been authorized and distributed in different countries all over the world, including Bangladesh. Understanding public acceptance of such a novel vaccine is vital, but little is known about the topic.

OBJECTIVES

This study aimed to investigate the determinants of intention to receive a COVID-19 vaccine and willingness to pay (WTP) among people in Bangladesh.

METHODS

An anonymous and online-based survey of Bangladeshi people (mean age = 29.96 ± 9.15 years; age range = 18-60 years) was conducted using a self-reported questionnaire consisting of socio-demographics, COVID-19 experience, and vaccination-related information as well as the health belief model (HBM). Multivariable logistic regression was performed to determine the factors influencing COVID-19 vaccination intent and WTP.

RESULTS

Of the 894 participants, 38.5% reported a definite intention to receive a COVID-19 vaccine, whereas 27% had a probable intention, and among this intent group, 42.8% wanted to get vaccinated as soon as possible. Older age, feeling optimistic about the effectiveness of COVID-19 vaccination, believing that vaccination decreases worries and risk of COVID-19 infection, and being less concerned about side effects and safety of COVID-19 vaccination under the HBM construct were found to be significant factors in COVID-19 vaccination intention. Most of the participants (72.9%) were willing to pay for a COVID-19 vaccine, with a median (interquartile range [IQR]) amount of BDT 400/US$ 4.72 (IQR; BDT 200-600/US$ 2.36-7.07) per dose. Factors associated with higher WTP were younger age, being male, having higher education, residing in an urban area, having good self-rated health status, positivity towards COVID-19 vaccination's effectiveness, and being worried about the likelihood of getting infected with COVID-19. Participants who were COVID-19 vaccination intent preferred an imported vaccine over a domestically-made vaccine (22.9% vs. 14.8%), while 28.2% preferred a routine immunization schedule.

CONCLUSION

The findings indicate a considerable proportion of Bangladeshi people intended to get vaccinated and had WTP for the COVID-19 vaccine. However, urgent education and awareness programs are warranted to alleviate public skepticism regarding the COVID-19 vaccination.

Financial and Mental Health Concerns of Impoverished Urban-Dwelling Bangladeshi People During COVID-19

Background: The COVID-19 pandemic has impacted the physical, mental and financial health of many individuals. Individuals living in impoverished crowded settings may be particularly vulnerable to COVID-19-related stressors. How substantially marginalized groups like impoverished urban-dwelling individuals have been impacted during this pandemic is poorly understood. The present study aimed to investigate the associated factors of financial concerns and symptoms of depression and posttraumatic stress disorder (PTSD) during the COVID-19 pandemic among impoverished urban-dwelling individuals residing in Dhaka, Bangladesh. Methods: A cross-sectional survey was conducted between August and September 2020 using face-to-face interviews in six disadvantaged neighborhoods ("slums") in Dhaka. Individuals were interviewed using a semi-structured questionnaire consisting of questions assessing socio-demographics, lifestyle, financial well-being relating to the COVID-19 pandemic, depression, and PTSD. Results: Four-hundred-and-thirty-five individuals (male = 54.7%; mean age = 45.0 ± 12.0 years; age range = 18-85 years) participated. Most (96.3%) reported that their household income decreased due to the COVID-19 pandemic. Factors associated with decreased household incomes included female gender, primary education, joblessness, food scarcity and depression. Depression symptoms were linked to female gender, joblessness, divorce, living in a joint family, excessive sleep and smoking. Low incomes, excessive sleep, joblessness and food scarcity were positively associated with PTSD symptoms. In contrast, less sleep appeared protective against PTSD. Conclusions: Public health initiatives, in particular mental health services that target stress and biocentric approaches that consider how humans interact with multiple facets of nature, should be introduced to mitigate against potential financial and psychological effects of the pandemic on impoverished urban-dwelling individuals in Bangladesh.

Perception and experiences regarding COVID-19 pandemic among urban young adults in Bangladesh: a mixed-method study

Aim

This study aimed at exploring the perception and experiences with regard to the COVID-19 pandemic among Bangladeshi urban young adults.

Subject and methods

Using a mixed-method approach, an online cross-sectional survey among 315 participants and in-depth interviews (IDI) among 20 young adults were conducted from May 1 to May 25, 2020. Descriptive statistics and chi-square tests were performed for quantitative data, along with the thematic analysis for qualitative data.

Results

The mean (± SD) age of the participants was 26.54 (± 3.05), and the majority were male (54.9%). About 81.6% of the participants reported COVID-19 as a viral disease, transmitted through droplets of sneezing and coughing, and close contact with another person (90.8%). Nearly 40% of participants reported news channels as a reliable source of information for COVID-19. Participants who were male were less likely to be aware than females in terms of mode of transmission of COVID-19 such as going outside of the home (82.7% male vs 90.8% female; p < 0.05). Male participants thought they were perfectly healthy and more reluctant to agree with maintaining social distance compared to female participants (72.8% male vs 90.1% female; p < 0.001). Participant's satisfaction level with services provided by the government was also significantly different and higher among females than male participants (39.9% male vs 53.5% female; p < 0.05). The majority of the participants reported suffering due to financial uncertainty, psychological distress, and inadequate health facilities. Dissatisfaction was reported with the existing health services as creating several misconceptions, lacking testing facilities, and debasement by the health professionals.

Conclusion

This study found a better perception regarding COVID-19 among the young adults, but they had poor preventive practices. Health education intervention with the rapid response should be implemented targeting this vulnerable group to improve their preventive practices.

Knowledge and preventive behaviors regarding COVID-19 in Bangladesh: A nationwide distribution

Assessing individuals' knowledge and preventive behaviors towards the Coronavirus Disease of 2019 (COVID-19) is essential for the related public health surveillance strategies. Although some of the studies were conducted in Bangladesh, none of these studies considered the geographical distribution of knowledge and preventive behaviors towards COVID-19. Therefore, the present nationwide cross-sectional study with 10,067 samples for the first-time aims to assess the knowledge gap by presenting the geographical distribution of the COVID-19 knowledge and preventive behaviors across all administrative districts of Bangladesh. The measures included socio-demographics and questions about knowledge and preventive behaviors related to COVID-19. One-way ANOVA, independent t-test, and multiple linear regression were used to analyze the data. In addition, GIS-based mapping identified district-wise distribution of the outcomes. Results indicated that the overall mean score of knowledge related to COVID-19 was 14.363 ± 3.073, whereas 16.95 ± 2.89 was for preventive behaviors. Participants' being male, being divorced or widowed, consuming alcohol, smoking cigarettes, living in villages, and having no formal education reported lower performing preventive COVID-19 behaviors. Those participants with higher knowledge scores reported higher preventive COVID-19 behaviors (β = 0.053, p<0.001). However, the model predicted only 13.2% of the variation in preventive COVID-19 behaviors while the overall model being significant. The findings suggest that the Bangladeshi government should initiate appropriate far-reaching program of health education focusing on knowledge and preventive behaviors towards COVID-19 at a community level. After all, the strategies to combat COVID-19 will require individuals' involvement to control and prevent the disease outbreak, for which education is essential.

Willingness to vaccinate against COVID-19 among Bangladeshi adults: Understanding the strategies to optimize vaccination coverage

BACKGROUND

Although the approved COVID-19 vaccine has been shown to be safe and effective, mass vaccination in Bangladeshi people remains a challenge. As a vaccination effort, the study provided an empirical evidence on willingness to vaccinate by sociodemographic, clinical and regional differences in Bangladeshi adults.

METHODS

This cross-sectional analysis from a household survey of 3646 adults aged 18 years or older was conducted in 8 districts of Bangladesh, from December 12, 2020, to January 7, 2021. Multinomial regression examined the impact of socio-demographic, clinical and healthcare-releated factors on hesitancy and reluctance of vaccination for COVID-19.

RESULTS

Of the 3646 respondents (2212 men [60.7%]; mean [sd] age, 37.4 [13.9] years), 74.6% reported their willingness to vaccinate against COVID-19 when a safe and effective vaccine is available without a fee, while 8.5% were reluctant to vaccinate. With a minimum fee, 46.5% of the respondents showed intent to vaccinate. Among the respondents, 16.8% reported adequate adherence to health safety regulations, and 35.5% reported high confidence in the country's healthcare system. The COVID-19 vaccine refusal was significantly high in elderly, rural, semi-urban, and slum communities, farmers, day-laborers, homemakers, low-educated group, and those who had low confidence in the country's healthcare system. Also, the prevalence of vaccine hesitancy was high in the elderly population, low-educated group, day-laborers, people with chronic diseases, and people with low confidence in the country's healthcare system.

CONCLUSION

A high prevalence of vaccine refusal and hesitancy was observed in rural people and slum dwellers in Bangladesh. The rural community and slum dwellers had a low literacy level, low adherence to health safety regulations and low confidence in healthcare system. The ongoing app-based registration for vaccination increased hesitancy and reluctancy in low-educated group. For rural, semi-urban, and slum people, outreach centers for vaccination can be established to ensure the vaccine's nearby availability and limit associated travel costs. In rural areas, community health workers, valued community-leaders, and non-governmental organizations can be utilized to motivate and educate people for vaccination against COVID-19. Further, emphasis should be given to the elderly and diseased people with tailored health messages and assurance from healthcare professionals. The media may play a responsible role with the vaccine education program and eliminate the social stigma about the vaccination. Finally, vaccination should be continued without a fee and thus Bangladesh's COVID vaccination program can become a model for other low and middle-income countries.

Knowledge, Attitude, and Practice of Indonesian Residents toward COVID-19: A Cross-Sectional Survey

Coronavirus disease 2019 (COVID-19) has become a pandemic. We examined the KAP's relationship with factors associated with practice toward the COVID-19 pandemic in Indonesia. This cross-sectional survey study was conducted between March and April 2020 and included 1033 participants. Knowledge scores of COVID-19 were positively associated with wearing a mask when leaving home (odds ratio (OR): 1.22, p < 0.05). Although men had a lower knowledge score, they were less likely to go to a crowded place compared with women (OR: 0.79, p < 0.05). However, women (OR: 1.25, p < 0.05) were more likely than men to wear a mask when leaving home. Furthermore, men (OR: 3.32, p < 0.05) were more likely than women to have a positive attitude toward COVID-19. Indonesian residents had satisfactory knowledge, demonstrated a positive attitude, and followed appropriate practices toward the pandemic. More educated individuals had a more positive attitude. Men and women differed with respect to their knowledge-based practices. Men were less likely to go to crowded places, and women were more likely to wear a mask when leaving home. Furthermore, men were more likely to wear a mask when leaving home than women when men had the attitude that Indonesia can win against COVID-19.