Knowledge and Preventive Practice during COVID-19 Pandemic in Bagmati Province, Nepal ()
1. Introduction
On 31st December 2019, the world witnessed an outbreak of pneumonia of unknown origin in Wuhan, China [1] . Later, on 11th February 2020, World Health Organization (WHO) named it as coronavirus disease 2019 (COVID-19), which is caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) [2] . Coronaviruses belong to the Coronaviridae family and represent crown-like spikes on the outer surface of the virus; thus, it was named as corona virus [3] . The subfamily includes alpha, beta, gamma, delta and omicron coronaviruses [4] . As an emerging acute respiratory infectious disease (ARIs), COVID-19 primarily spreads through the respiratory tract by droplets, respiratory secretions and direct contact [5] . The most common symptoms at onset of COVID-19 illnesses are fever, cough, fatigue, shortness of breath, while other symptoms include sputum production, headache, hemoptysis, diarrhea, etc [6] [7] . However, in immune-compromised patients, there is a chance that the virus could cause a lower respiratory illness like pneumonia and bronchitis [8] . Incubation periods range from 2 days to 14 days from the day of exposure [9] .
The first case in Nepal was confirmed on 23rd January 2020, on a 31-year-old student, who had returned from Wuhan, China on 9th January, 2020 [10] . It was the first recorded case of COVID-19 in South Asia. On April 4, first case of local transmission was detected in Kailali district. A country-wide lockdown came into effect on March 24, 2020 and ended on July 21, 2020 [11] . As of 29th August, 2022; the Ministry of Health and Population (MoPH) has confirmed a total of 996,834 cases, 981,521 recoveries and 12,000 deaths across the country [12] . The coronavirus has been detected in all provinces and districts of the country, with Bagmati province and Kathmandu district being the most affected. Total vaccine doses given was 53,747,378 among them 69.6% have been fully vaccinated and only 24.8% people have booster dose [13] until the end of August 2022.
Prevention and control measures for COVID-19 are the only way to contain the disease. The effective preventive measures for COVID-19 are non-pharmaceutical interventions such as wearing masks, washing hands with soap and water, using sanitizer, social distancing, and avoiding close contacts, etc. However, safe and effective vaccines against Corona viruses are considered a game-changing tool [14] [15] . Many studies have shown that high level of education is positively related on COVID-19 [16] [17] [18] [19] . Similarly, a study in Saudi Arabia reported that health education programs were helpful to improve knowledge and preventive practices of the community people [20] . To control the outbreak of the disease in Nepal, it is necessary to understand the knowledge and practices of the population. Therefore, the aim of this study was to determine knowledge and practices about COVID-19.
2. Methods
This was an online-based cross-sectional study conducted from August 1, 2021, to August 30, 2021, among the general population of Bagmati Province, Nepal. A convenience sampling method was used in which the link to the Google Form questionnaire was shared with participants via Messenger and Facebook groups. In addition, Facebook friends were asked to share the link with their circle of friends.
The age group of 15 to 60, who can use social media were included. On the other hand, the age groups below 15 and above 61, as well as illiterates and those who do not have access to social media, were excluded. According to the 2011 census, the total population of Bagmati province was 5,433,818. The sample size was obtained 301 participants, which was calculated using the sample size calculator-relief application 2018 with a margin of error of ± 5%, a confidence level of 90%, a 50% response rate, and a population size of 5,433,818.
The survey was conducted online using a self-reported questionnaire developed according to Centers for Disease Control and Prevention (CDC) guidelines for communities. The Nepali version was reviewed by experienced public health professionals and corrected as needed. The questionnaire consisted of three main sections. The first section collected information on the independent variables of respondents’ sociodemographic characteristics, including age, sex, marital status, education level, work status, residence, and income level. The second section obtained information on participants’ knowledge of COVID-19. This section included questions about modes of transmission, incubation periods, risk groups, prevention, and control. The last section of the questionnaire assessed respondents’ practices. This section consisted of questions on practices and behaviors such as attending social events and busy places, social distance, hand washing after sneezing, coughing, and blowing, and hand washing practices.
2.1. Ethical Considerations
Approval was obtained from Kobe University Graduate School of Health Sciences, Reg No. 1007, and the Nepal Health Research Council, NHRC, Reg No. 231/2021MT. On the first page of the online questionnaire, respondents were clearly informed about the background and objectives of the study. Online consent was obtained before proceeding with the rest of the questionnaire. Privacy, confidentiality, and anonymity were maintained.
2.2. Statistical Analysis
The basic description of the participants was simply tabulated frequencies, proportions, and means. Multivariable logistic regression analysis was performed to identify factors significantly related to participants’ knowledge and practice of COVID. The Cronbach’s alpha obtained was 0.7.
3. Results
The total number of participants who completed the questionnaire was 296, all living in Bagmati province. They comprised of 152 were male (51.40%) and 144 were female (46.60%). Table 1 shows the social and demographic characteristics of the respondents. Most participants (57.80%) were in the 15 - 29 age group and the Janajati ethnic group (39.50%). More than half of the participants (51.40%) were unmarried and lived in urban areas (61.50%). Almost one-third of the participants had a bachelor’s degree (30.70%) and a master’s degree (31.40%). However,
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Table 1. Social and demographic characteristics of the participants (N = 296).
about 43% of the respondents were students, 8% in the private sector and 12% in the government institutions. Only 20.90% of the respondents had medical background. The mean COVID-19 knowledge score was 7.62 (SD = 2.06, range: 0 - 10), and the overall accuracy of the knowledge test was 76% (7.62/10 * 100). The mean practice score was 11 (SD = 1.91, range: 0 - 13), indicating good practice.
Table 2 shows the knowledge of the participants on COVID-19. The knowledge on WHO recommended time to wash hands was (42.90%) compared to the knowledge on the other questions posed to the participants. Nearly 97.5% of participants indicated that clean water is necessary for hand washing. About half of the participants agreed that vaccines are effective against COVID-19, and that travelling is one of the main reasons for the spread of COVID-19. Less than half agreed that the disease could pose a serious threat to public health.
The change to preventive practices towards the COVID-19 pandemic is shown in Table 3. Only 57.3% of the respondents use a handkerchief or tissue when coughing or sneezing. Most of them, about 90%, wore masks when they went outside. Almost 80.7% informed their friends and family members about the preventive measures towards COVID-19. While 84.5% of the participants washed their hands more frequently than before the pandemic, and 85.5% changed their handwashing behavior due to the COVID-19 pandemic.
For knowledge and practice in relation to several independent variables, including gender, age, education, occupation, marital status, residence, house type, and medical background. Multiple logistic regression analysis was conducted. Table 4 shows that education, medical background, and occupation were significantly
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Table 2. COVID-19 Knowledge response of the participants (N = 296).
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Table 3. Participants’ practice behavior related to COVID-19 (N = 296).
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Table 4. Regression results of knowledge about COVID-19 and its association with other factors (N = 296).
Note: The model is adjusted for ethnicity and income of the participants.
associated with knowledge. Similarly, Table 5 shows that area of residence, house type, and age were significantly associated with practice. Both the Table 4 and Table 5 were adjusted for ethnicity and income of the participants. There was no statistically significant relationship between knowledge and practice.
Figure 1 shows that 35% of the participants used social media, such as Facebook,
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Table 5. Regression results of practice during COVID-19 and its association with other factors (N = 296).
Note: The model is adjusted for ethnicity and income of the participants.
Twitter, and other sites, to know about COVID-19. Television, newspapers, and government daily reporting MOHP accounted for 17%, 10%, and 15%, respectively. 10% listen to radio, while 11% obtain their information from mobile ringtones and SMS. According to this study, Figure 2 shows that the main triggering factors that lead people to wash their hands during COVID-19 are fear of contracting COVID-19 infection, and self-consciousness.
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Figure 1. Medium of information for the participants about COVID-19.
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Figure 2. Triggering factors for hand washing during COVID-19.
4. Discussions
This study has shown that most participants were knowledgeable about COVID-19 with a mean achievement of 76.2% (7.62/10 * 100) in knowledge and a practice score of 84.6% (11/13 * 100). Participants’ education, medical background, and occupation were significantly associated with knowledge. While living area, type of house, and age were significant factors in practice, rural residents had a comparatively better practice score than urban residents. It might be because most of the participants were young adults with easy access to social media who resided in cities for jobs and education but returned to their respective villages during lockdown.
According to this survey, men demonstrated a better level of knowledge than women. Similar findings were made in the Riyadh, Saudi Arabia KAP study [21] . The medical background was positively significant with high knowledge and good practice. A similar outcome was seen among Ugandans [22] . Most of the participants were under 30 years old, single, and had higher education levels. The findings indicated that elderly people have more experience than younger people. This may be brought on by how diseases are perceived to affect older people. In the study of Cameroonian [23] residents, age > 20 years was associated with high knowledge of COVID-19. Women scored lower in practice than men. This research found no significant relationship between knowledge and practice towards COVID-19 pandemic. It was evident that few individuals who were aware of COVID-19 and were not taking it seriously.
Many studies conducted in China [24] , USA [25] , Egypt [26] , Saudi Arabia [27] and Nepal [28] found that people with higher educational levels knew more about COVID-19. According to a study from China [29] , unmarried people have higher knowledge; however, our research was unable to identify any evidence linking COVID-19 knowledge and marital status. Furthermore, few individuals were avoiding crowded areas. Similar findings were obtained in Philippines [30] , [30] and a previous study from Nepal [28] . Non-pharmaceutical interventions (NPIS), which seek to prevent transmission by lowering contact rates in the general population, include social distance and avoiding large crowds. These practices were not fully adhered to, in Nepal.
5. Limitations of the Study
There were some limitations to this investigation. This study used an online cross-sectional survey for data collection. It used a convenient sampling strategy that could lead to selection bias. To participate, participants must have access to the internet.
6. Recommendation for Further Studies
There were significant gaps in the knowledge of how often to wash hands and how to prevent touching the face, eyes, and nose with the hands. This research indicates that health education should be targeted at females, those with lower levels of education, people who are older, and people without medical backgrounds.
7. Conclusion
Education level and occupation were associated with their knowledge, whereas their living conditions, type of house, and age were significant factors in their preventive practices towards COVID-19 pandemic. Moreover, men and women both possess knowledge levels that are higher than average, and people with higher education levels have knowledge that is superior to that of those with lower education levels. It is noteworthy that knowledge and preventive practices towards COVID-19 are not related. It demonstrates that having information does not guarantee sound behavior.
Acknowledgements
Associate Professor Yuko Uesugi;
Mr. Rabin Karki;
Ms. Moeno Sakai;
Mr. Naresh Kumar Shrestha.
Legends
COVID-19: Coronavirus disease of 2019;
SARS-CoV-2: Severe Acute Respiratory Syndrome Coronavirus 2;
WHO: World Health Organization;
CDC: Centers for Disease Control and Prevention;
ARIs: Acute Respiratory Infectious Disease;
KAP: Knowledge Attitude and Practice;
MOHP: Ministry of Health and Population;
NHRC: Nepal Health Research Council;
MERS: Middle East Respiratory Syndrome;
NPIs: Non-pharmaceutical Interventions.