A Cross-Sectional Study of Knowledge, Attitudes, and Practices concerning COVID-19 Outbreaks in the General Population in Malang District, Indonesia

Survey of public knowledge, attitudes, and practices regarding personal protection against COVID-19 in the post-pandemic era

In the emerging post-pandemic era (the 'wavelet' era), humans must coexist with viruses for the foreseeable future, and personal protective behaviors will largely replace national-level preventive measures. In this new normal, encouraging the public to implement proper personal protective behaviors against the coronavirus disease (COVID-19) is vital to the sustainable development of cities and communities. This knowledge-attitude-practice (KAP) survey conducted in Chengdu (N = 900) narrowed the knowledge gap regarding post-pandemic public practices of protective behavior. Findings show that:(1) approximately 1/3 of the respondents are currently not concerned about COVID-19 at all; (2) respondents with different demographics and individual COVID-19-related factors showed significant differences in practice behaviors indoors and outdoors; (3) vulnerable groups performed better in practice behavior indoors/outdoors; (4) because the public may relax their vigilance outdoors, public places may become a transmission threat in the next outbreak; (5) attitudes are important, but limited incentives for practice; and (6) when knowledge increases beyond a threshold (68.75-75% in this study), protective behaviors decrease. Our results suggest that authorities must continue to educate and motivate the public, extending measures to cover personal protective practices, and have targeted policies for specific demographics to ensure equity in healthcare in the event of another pandemic (COVID-19 and alike crisis). Besides, comparing the results of the current study with similar studies conducted in other parts of the world can provide insights into how different populations respond to and adopt COVID-19 protective behaviors. The epidemiologists can use the data collected by this and other KAP surveys to refine epidemiologic models, which can help predict the spread of the virus and the impact of interventions in different settings.

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.

Perception and attitudes of street food vendors toward the healthiness of meals prepared and sold in Dodoma

Consumption of street meals among urban dwellers has become inevitable, especially in low- and middle-income countries. It has been linked to higher incidence of dietary-related diseases. Vendors' perceptions and attitudes toward the healthiness of meals can influence nutritional quality of the offered meals. Therefore, the study aimed to assess perceptions and attitudes of vendors toward healthy and unhealthy meals as well as the healthiness of meals they prepare and sell. A cross-sectional study was carried out among 384 street food vendors. Face-to-face interviews were conducted using semistructured questionnaire. Pearson Chi-square test and logistic regression analysis were used in comparing and testing for the association of perceptions and attitudes to vendors' characteristics. Street food vendors that took part in this study demonstrated good perceptions based on what they perceived to be healthy meals (58.33%) and positive attitudes (95.57%) toward preparation and provision of healthy meals. Perceptions were associated with sex (p = .007), education level (p = .002), and investment cost (p = .000). Results from logistic regression showed that better perceptions of healthy meals were associated with being female (OR = 2.46, p-value < .031), having higher education (OR = 11.88, p-value < .042), and vending experience of 1-5 years and more than 5 years (OR = 3.17, 2.95, p-value < .019, .039, respectively) while having moderate investment cost showed significant lower chances of having better perceptions (OR = 0.33, p-value < .001). Attitudes were associated with sex (p = .002), age (p = .002), marital status (p = .013), education (p = .009), and vending experience (p = .008). Female vendors, having 25 years of age and above, living with partners, with tertiary education, and having vending experience of more than 1 year had shown to have more positive attitudes toward healthy meals. Generally, street food vendors had good perceptions and attitudes toward healthy meals. This implies possible room for change and adoption of better ways of preparing meals. These findings could be used as a stepping stone in improving nutritional and healthy quality of street meals. Increased efforts are needed on the inclusion of nutritional aspects of healthy meals as they were merely considered by vendors. Future interventions on these vendors should focus more on male vendors, vendors with little vending experience, and little education as they had shown to have relatively poorer attitudes and perceptions compared to other groups.

Is knowledge about COVID-19 associated with willingness to receive vaccine, vaccine uptake, and vaccine booster uptake in rural Malang, Indonesia?

Background

Lack of knowledge regarding the coronavirus disease (COVID-19) and COVID-19 vaccines is a key barrier to COVID-19 vaccine uptake in low- and middle-income countries (LMICs).

Aims

To examine factors associated with knowledge about COVID-19 and the association between knowledge of COVID-19, willingness to receive a COVID-19 vaccine, and vaccine uptake in Malang, East Java, Indonesia.

Method

A cross-sectional study among individuals aged 15-99 years was conducted in Malang, Java Timur, Indonesia between November 2022 and January 2023. Of 10,050 potential respondents, 10,007 were able to complete the survey. The main independent variable was knowledge about COVID-19, which was assessed using a six-item questionnaire. The dependent variables were COVID-19 vaccine uptake and COVID-19 booster vaccine uptake. The mediating variable was respondent's willingness to receive a COVID-19 vaccine. Linear regression was used to examine factors associated with knowledge about COVID-19. Logistic regression was employed to examine the association of knowledge about COVID-19 with vaccine uptake. Generalized structural equation modeling (GSEM) was performed to examine whether willingness to receive a vaccine mediated the association between knowledge about COVID-19 and vaccination uptake.

Findings

The percentage of respondents who reported having received at least one dose of a COVID-19 vaccine was 94.8%, while the percentage of those who reported having received at least three doses was 88.5%. These numbers are higher than the national average for COVID-19 vaccine and booster vaccine uptake. Most respondents answered about four of six knowledge items correctly (M = 4.60, SD = 1.1). Among respondents who had not received a vaccine, 83.1% expressed willingness to receive a vaccine when it became available to them. Older, more educated, employed respondents, and those with higher economic status, demonstrated more accurate knowledge about COVID-19 than younger, less educated, unemployed respondents and those with lower economic status. Respondents who demonstrated more accurate knowledge about COVID-19 were more likely to have received a vaccine (OR = 1.528, 95% CI = 1.428-1.634) and a booster vaccine (OR = 1.260, 95% CI = 1.196-1.328). Willingness to receive a vaccine mediated the association between knowledge about COVID-19 and vaccine uptake (coef. = 0.426, 95% CI = 0.379-0.473).

Implications

Interventions and public health programs aiming to improve knowledge about COVID-19 can be implemented to improve individual willingness to receive COVID-19 vaccination and to improve COVID-19 vaccine uptake among the general population.

Covid-19 related factors to food security and dietary diversity among urban households in western Oromia, Ethiopia

Background

This study aims to assess factors associated with food security and dietary diversity among poor urban households of western Oromia, Ethiopia, after the outbreak of the Covid-19 pandemic.

Method

A cross-sectional, community-based study was conducted in May to June 2021 with 361 poor urban households in the Horo Guduru Wollega zone, western Oromia, Ethiopia. A pre-tested structured questionnaire was used to collect primary data. Twenty-four hour reminder points were used to assess household dietary diversity, and household food security was assessed using the Household Food Insecurity Access Scale tool. Data were evaluated using the statistical software SPSS version 25.0.

Results

This study showed a prevalence of food insecurity in households of 59.6%. The mean and standard deviation of household dietary diversity values were 4.19 ± 1.844. Family size (AOR = 8.5; 95% CI:3.295-21.92), monthly income (AOR = 3.52; 95% CI; 1.771-6.986), dietary diversity (AOR = 8.5; 95% CI; 3.92-18.59), knowledge (AOR = 3.0, 95% CI = 1.08-)8.347), attitude (AOR = 8.35, 95% CI:3.112-22.39) and practices against Covid-19 (AOR = 2.12; 95% CI:1.299-11.4) were factors significantly associated with food insecurity. Variables like educational status (AOR = 3.46; 95% CI:1.44-8.312), increased family size after the Covid-19 pandemic (AOR = 2.26; 95% CI:1.02-5.04), food security (AOR = 6.7; 95% CI:4.01-19.01), knowledge (AOR = 3.96; 95% CI:1.57-10.0), attitude (AOR = 3.9; 95% CI:1.75-8.82) and practices toward coronavirus (AOR = 2.23; 95% CI:2.18-23.95) were predictors significantly associated with dietary diversity.

Conclusion

This study concluded that family size, monthly income, and dietary diversity were factors contributed to household food security. On the other hand, variables such as educational status, family size, and food security were highly relevant factors for dietary diversity after the outbreak of the Covid-19 pandemic. Knowledge, attitudes, and practices were also variables related to both household food security and dietary diversity. Therefore, immediate interventions such as nutrition-specific interventions can be suggested to address food insecurity and problems of inadequate food intake in poor urban households. In addition, governmental and non-governmental organizations should raise awareness and policies to support those at higher risk by developing affordable, sustainable and targeted social protection systems that ensure food security and adequate dietary intake at the household level.