Journal of Preventive Medicine

Keywords

Knowledge; Awareness; COVID-19; SARS-CoV-2; Nepalese residents

Introduction

The virus that is the root cause of the highly pestilent global pandemic has been designated as novel coronavirus and was subsequently denominated as Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) causing the coronavirus disease (COVID-19) [1-2]. As stated and recorded by experts, SARS-CoV-2 leaped humans at one of the wet markets of Wuhan which dreamed from the bats with its first case recorded in Wuhan, Hubei province of China [3]. By the 31st December of the Wuhan Municipal Health Commission had given out its alert. Soon this disease enshrouded the whole world and was declared as a pandemic by the World Health Organization on the 11th of March, 2020 [4]. The Coronavirus is not something of a sudden or accidental origin, it is a well-recorded family of single-stranded, spherical, or pleomorphic enveloped RNA viruses which have club-shaped protrusions covering them like a crown/halo-like appearance and also the reason for its naming [5-6]. SARS turned up in 2002 in Southern China while MERS flared up in 2012 in Jordan of Saudi Arabia, COVID-19 causing the SARS-Cov-2 is the 3rd coronavirus and is seeming to have great pandemic potential with its case fatality ratio ranging from 1.38% to 3.4% [7-8]. This virus is usually transmitted to nasal mucosa via airborne droplets produced by sneezing, cough, and talking with a mean incubation period of about 5 days and its key symptoms include fever, dry cough and shortness of breath. It may cause pneumonia in the lung, Gastroenteritis in the gastrointestinal tract, and rarely encephalitis in CNS [9-11]. The first positive case of COVID-19 in Nepal was confirmed on the 13th of January, 2020. The diseased person was a Nepalese student at Wuhan Institute of Technology, Wuhan, China, and had no history of co-morbidities. The person was discharged soon with the instructions for self-quarantine at home.

The only ray of light coming through this dark time is the vaccine which can end the pandemic. As the Centre for Disease Control and Prevention (CDC) does not put forward one vaccine over another, the best COVID-19 vaccine is the one that is accessible to people them. Currently approved COVID-19 vaccines are safe, effective, and reduce the risk of severe illness [12]. The vaccines might prevent people from getting infected with COVID-19 or from becoming gravely sick or passing away due to COVID-19. It averts the person from spreading the COVID-19 virus to others and making it difficult for the disease to escalate, contributing to herd immunity [13]. COVID-19 vaccine, Covishield (brand name), manufactured by India was launched in Nepal on the 27th of January. This project was initiated by India provided under grant aid with the 1 million doses [14]. The precedence was given to frontline workers including medical professionals, supporting staff of health facilities, FCHVs, sentinels, executors of diplomatic mission, garbage men, and detainees. After that, the journalists and diplomatic staff were included in the vaccination program [15]. The second phase started from March 7 to March 15. The feedback of the public was also supportive.

Like any other country, Nepal is sticking to the method of imposing lockdowns to curb the spread of this highly infectious disease [16]. Nepal is a country with limited resources and a restricted number of vaccine doses are making it available to the people based on immediate requirements. Such a time requires the cooperation of all the citizens and in this time of crisis the health workers, bankers, and the other frontline workers who are on their duty outside their homes even when we have an option to stay at home and continue our work while being safe from the pandemic, definitely need safety for themselves as well as for others so that they do not bring back home any disease from their workplaces.

Good knowledge and practice are the need of the hour for the prevention of the spread of this pandemic [17]. Awareness and knowledge play a vital role in defining one’s attitude towards the current problem and their way of responding to it which this study aims to access. The limited availability of vaccines and the necessity to follow an order of preference are all interrelated and cooperation and understanding for this will build a healthy system where this disease can be successfully fought off. Awareness and right knowledge about the magnitude of damage this infectious disease can cause, the methods of its spread, and the necessary safety precautions will surely help enlighten people, make them conscious about their day to day behavior, and prevent its spread saving theirs and others life at this period when the vaccine is not available to all the public.

Materials and methods

Study design

A descriptive web-based cross-sectional survey was conducted among the general population of Nepal, a country in Asia, lying along the southern slopes of the Himalayan mountain ranges. The study was conducted from 1^st November to 30th November for one month in 2020. The online survey was preferred because of the ongoing pandemic crisis and the urgency for data collection considering the situation.

Sampling and data collection

An unrestricted self-selected, convenient sampling method was adopted to generate a heterogeneous sample [18]. A total of 469 people responded to the survey. Among them, 5 persons failed to give ethical consent and they were excluded making the final sample of 464.

Inclusion and exclusion Criteria

All Nepali residents approachable online who responded to the web-based survey in November 2020 were included in the study. Those who were not approachable online and failed to give ethical consent were excluded.

Study tools and ethical consent

A google form poll was designed. The questionnaire was prepared by lecturers of Nepalgunj Medical College, Chisapani, Banke, Nepal analyzing what people should know about COVID-19 from the website of the World Health Organization (WHO), Center for Disease Control and Prevention (CDC), and the Ministry of Health and Population, Nepal (MoHP) to protect them from this hazard [19-21]. The questionnaire was validated by pretesting in 10% of the students. The initial page of the form contained the background, objectives of the study, and consent, followed by a questionnaire only after voluntary agreement by the participants. The questionnaire had two sections. The first section collected socio-demographic information while the second section consisted of information related to knowledge and awareness about COVID-19. The participants responded to questions with “yes” or “no” and in multiple answers questions [22].

Results

A total of 469 subjects participated in this web-based survey. Out of these 469 participants, 464 gave ethical consent and provided the information required for this study. Thus, the participation percentage was 98.93%. Among the 464 participants involved in the study, 273 were males and 191 were females. The male to the female ratio obtained was 91:57, among the total participants, 407 belonged to the age group 18-30 years, belonged were in the age group 30-60 years, 28 were of 60 years and above while 8 participants were below 18 years of age. There was a huge participation from the young adults between 18 and 30 years of age, which was around 87.5% of the total. Very low participation of people below 18 years was seen about 1.7% only. 229 participants were graduates, 145 of them had completed their secondary education, 63 had achieved higher education, 10 were post-graduates, and 17 were illiterate.

Gender vs. knowledge table compared the mean average knowledge between males and females. The average knowledge observed in females was 75.4% whereas in the male was 73.2% (Table 1).

Table 1: Gender vs. knowlede table.

The age vs. knowledge table compared the average knowledge of different age groups. The average knowledge was found to be highest in the age groups 18 to 30 years (75.39%) (Table 2).

Table 2: Age vs. knowledge table.

Qualification status vs. knowledge table (Table 3) compared the variance of knowledge level based on the educational qualification of individuals. Illiterates had the least average knowledge while those with secondary education had greater average knowledge.

Table 3: Qualification vs. knowledge table.

Discussion

This study is an attempt to make a reliable comparison between the mean knowledge score among the different sexes, people within different age groups, and with different educational qualifications. Based on the scores acquired by the participants, the average knowledge score was found to be 74.3%. Meanwhile, the average knowledge score ranged from 45.83% to 78.71% while comparing different parameters. Comparing to a similar study conducted in China, the average knowledge was higher with a score of 90%. In the meantime, another study in the same country China revealed about 91.2% of average knowledge among the participants involved in the survey. The study carried out in Bangladesh for assessing knowledge, attitude, and practice in their public in March and April showed an average knowledge score of 48.3% which is far less than that of people of Nepal. A cross-sectional study conducted among 2,083 undergraduate or postgraduate students from different government and private universities during the initial stage of the disease in Jordan showed an average knowledge score of 56.5%.

However, in our study which was conducted some months later after the outbreak of COVID-19, the general population of Nepal has been found to have much higher knowledge than undergraduate and postgraduate students of Jordan. A cross-sectional bi-national survey that assessed knowledge, attitude, and perceptions of Egyptians and Nigerians in Africa during the pandemic revealed they also had less knowledge and awareness than the Nepalese residents with a score of only 61.6%.

The average knowledge among the females was found to be 75.4% while that of the male was 73.2%. Admittedly, this finding of our study was similar to the finding in a cross-sectional study conducted in Bangladesh in which a higher knowledge score was reported among females than males. In a study conducted on knowledge, attitude, and practice towards COVID-19 among young adults with Type 1 Diabetes Mellitus in India, the average knowledge was 74% which was similar to what we found out about the knowledge and awareness about COVID-19 in young adults.28 Our study reported an average of 74.3% of knowledge score which is higher in context to the literacy rate of Nepal which is around 65.9%. In contrast to the study performed among the University students in Mizan Tepi University with an average knowledge score of 47%, general citizens of Nepal were found to be much knowledgeable.

Various studies had been conducted to find at which level the Nepalese population is regarding knowledge of this pandemic. The common population consists mainly of school-going students, household women, working professionals from different fields, students from different disciplines, etc. A study conducted in eastern Nepal revealed that the people had a fair idea about the pandemic as around 89.6% of the participants correctly answered the questions related to the disease rightly, seeing based on gender the percentage was found to be higher in females than in the males similar to our study.

Conclusion

The knowledge level was found to be directly proportional to the educational status of the participants. Females and young adults had more knowledge about COVID-19 in comparison to others. The average knowledge scores, attitude, and practices have improved significantly these days than that during the first wave of COVID-19. Social media, mobile phones, television, radios, etc do have a powerful impact on improving knowledge on different aspects of COVID-19. So, if the messages spreading through them are made more comprehensive, they will make a remarkable difference in knowledge and awareness of people, thus enhancing their attitudes and practice towards COVID-19 which will help to check the transmission of this disease in the countries where the availability of vaccines is very less at present.

References

1. World Health Organization (WHO). Naming the coronavirus disease (COVID-19) and the virus that causes it.
2. World Health Organization (WHO). Archived: WHO Timeline-COVID-19.
3. Health E, Disease H, Disease L, Management P, Conditions S, et al. (2021) Coronavirus History: Origin and Evolution. WebMD.
4. World Health Organization (WHO). The World Health Organization Just Declares COVID-19 a Pandemic.
5. World Health Organization ( WHO). Coronavirus disease 2019.
6. Zhu Z, Lian X, Su X, Wu W, Marraro G, et al. (2020) From SARS and MERS to COVID-19: a brief summary and comparison of severe acute respiratory infections caused by three highly pathogenic human coronaviruses. Respir Res 21:1-4

   [Crossref] [Google Scholar] [Indexed]

7. Hu T, Liu Y, Zhao M, Zhuang Q, Xu L, et al. (2020) A comparison of COVID-19 SARS and MERS. PeerJ 8:e9725

   [Crossref] [Google Scholar] [Indexed]

8. Bastola A, Sah R, Rodriguez-Morales A, Lal B, Jha R et al. (2020) The first 2019 novel coronavirus case in Nepal. Lancet Infect Dis 20:279-280

   [Crossref] [Google Scholar] [Indexed]

9. Poudel K, Subedi P (2020) Impact of COVID-19 pandemic on socioeconomic and mental health aspects in Nepal. Int J Soc Psychiatry 66:748-755

   [Crossref] [Google Scholar] [Indexed]

10. Gebretsadik D, Gebremichael S, Belete M (2021) Knowledge, Attitude and Practice Toward COVID-19 Pandemic Among Population Visiting Dessie Health Center for COVID-19 Screening, Northeast Ethiopia. Infect Drug Resist 14:905-915

    [Crossref] [Google Scholar] [Indexed]

11. Fielding N, Lee R, Blank G (2012) The SAGE Handbook of Online Research Method. SAGE Publications Ltd,
12. Khatiwada B, Ministry of health and population. Government of Nepal, Nepal.
13. Zhong B-L, Luo W, Li H-M, Zhang Q-Q, Liu X-G, et al. (2020) Knowledge, attitudes, and practices towards COVID-19 among Chinese residents during the rapid rise period of the COVID-19 outbreak: a quick online cross-sectional survey. Int J Biol Sci 16(10):1745-1752

    [Crossref] [Google Scholar] [Indexed]

14. Gao H, Hu R, Yin L, Yuan X, Tang H, et al. Knowledge, attitudes and practices of the Chinese public with respect to coronavirus disease (COVID-19): an online cross-sectional survey. BMC Public Health 20:1816

    [Crossref] [Google Scholar] [Indexed]

15. Ferdous MZ, Islam MS, Sikder MT, Mosaddek ASM, Zegarra-Valdivia J, et al. (2020) Knowledge, attitude, and practice regarding COVID-19 outbreak in Bangladesh: an online-based cross-sectional study. PLoS One 15:e0239254

    [Crossref] [Google Scholar] [Indexed]

16. Olaimat AN, Aolymat I, Shahbaz HM, Holley RA (2020) Knowledge and Information Sources About COVID-19 Among University Students in Jordan. Front Public Health

    [Crossref] [Google Scholar] [Indexed]

17. Elnadi H, Odetokun IA, Bolarinwa O, Ahmed Z, Okechukwu O, et al. (2020) Correction: Knowledge, attitude, and perceptions towards the 2019 Coronavirus Pandemic: A bi-national survey in Africa. PloS one 16: e0247351

    [Crossref] [Google Scholar]

18. Anwar S, Araf Y, Newaz Khan A, Ullah MA, Hoque N, et al. (2020) Women's Knowledge, Attitude, and Perceptions Toward COVID-19 in Lower-Middle-Income Countries: A Representative Cross-Sectional Study in Bangladesh. Front Public Health 8:571689

    [Crossref] [Google Scholar] [Indexed]

19. Pal R, Yadav U, Grover S, Saboo B, Verma A, et al. (2020) Knowledge, attitudes and practices towards COVID-19 among young adults with Type 1 Diabetes Mellitus amid the nationwide lockdown in India: A cross-sectional survey. Diabetes Res Clin Pract 166:108344

    [Crossref] [Google Scholar] [Indexed]

20. Durbar S, Kathmandu (2021) Multidimensional Poverty Index 2018 of NPC& OPHDI: Nepal Human Development Report 2014 of NPC & UNDP. Government of Nepal National Planning Commission cite, Nepal
21. Angelo AT, Alemayehu DS, Dacho AM (2020) Knowledge, Attitudes, and Practices toward Covid-19 and Associated Factors among University Students in Mizan Tepi University. Infect Drug Resist 14:349-360

    [Crossref] [Google Scholar] [Indexed]

22. Chapagain K, Rauniyar GP, Pokharel R, Bhattarai A (2020) Information about COVID-19 among selected population of Eastern Nepal: A descriptive Cross-sectional Study. JNMA J Nepal Med Assoc 58:770-774

    [Crossref] [Google Scholar] [Indexed]