key: cord-0252298-r74c7axk
authors: Dahiru, T.; Bello-Manga, H.; Hamza, K.L.; Muhammad-Idris, Z.K.; Zakari, A.M.; Ayodeji, O.T.; Joseph, S.; Yahaya, A.; Ishaku, S.G.; Ejembi, J.; Sani, H.; Garry, E.; Mohammed, B.; Emmanuel, D.S.; Unung, P.; Tijjani, B.; Tijani, Z.O.; Kase, S.; Bello, H.; Usman, A.T.; John, A.
title: KNOWLEDGE, RISK PERCEPTION AND PREVENTIVE PRACTICES OF COVID-19 AMONG STAFF OF PRIMARY AND SECONDARY SCHOOLS IN KADUNA STATE, NIGERIA
date: 2021-06-03
journal: Ann Ib Postgrad Med
DOI: nan
sha: e1da8bd168a9c071838feac08873ac84871e81fe
doc_id: 252298
cord_uid: r74c7axk

INTRODUCTION: Kaduna State is among the three States with the highest number of confirmed COVID-19 cases. The objective of this study was to assess the knowledge, risk perception and practices of staff towards prevention and control of COVID-19 infection in schools to provide policy makers, education and health managers required information to manage the epidemic as the schools prepare to re-open. METHODS : This was a school-based survey conducted using purposive sampling of 55 schools located in nine LGAs with the highest number of reported COVID-19 cases as at October 2020. Five schools with the highest students'/pupils' enrollment in each of the LGA were selected and all staff were interviewed. Information on knowledge, risk perception and practices of prevention was collected. Descriptive statistics were generated using Stata v14 software. RESULTS: A total of 1065 staff in 55 schools completed the interview. Major sources of information are television (73%), radio (61%), and social media (57%); and 76% indicated that a virus is the causative agent of COVID-19. Overall, 70%, 19%, 7%, 9.3% and 0% respectively had adequate knowledge of cause, preventive measures, respiratory hygiene, modes of transmission and symptoms of COVID-19; however only 14% ever attended a workshop on COVID-19. Eighty-two percent and 89% respectively believed in the efficacy of face masks and handwashing as means of prevention; 39% thought that they are likely to contract COVID-19. Ninety-nine percent and 90% have ever used face mask and hand sanitizer to prevent COVID-19; 96% and 85% respectively have use these methods in previous 24hours. Between 42% and 73% of schools needed additional commodities/requirements/supplies to comply fully with COVID-19 prevention protocols. CONCLUSION : While knowledge of COVID-19 is suboptimal, perception is positive and practice is high. Thus, teachers need to be well informed and encouraged to sustain current levels of preventive measures. Government needs to provide schools with adequate preventive commodities to ensure compliance.

China. By February 2020, the virus reached the African continent when the first case was reported in Egypt, and the first suspected case in Nigeria was reported on February 27 in Lagos. As at June 10, 2021, Nigeria has tested 2,180,444 samples out of which 166,982 confirmed cases and 2117 deaths. In Kaduna State, there are 9103 confirmed cases with 65 deaths. 2 To respond to this epidemic, the government instituted control measures with establishment of the Presidential Task Force on COVID-19 (PTF) to coordinate all the response activity of the country. Various specific measures were implemented at different times by the PTF and respective State Governments. These included the travel restriction within the country and with the outside world that began early, case identification, contact tracing and isolation, handwashing and hand hygiene, use of face masks, and several social distancing and stay-at-home measures with, in some cases, lockdowns of exceedingly high-risk areas which later involved large parts of the country as announced by various state governments. Additionally, all religious, social and cultural gatherings were banned; official government services and activities were also suspended indefinitely except essential services such medical, security and transportation of essential goods. 3 By the middle of March 2020, it is estimated that 107 countries had implemented national school closures related to COVID-19, affecting 862 million children and young people, roughly half the global student population. [4] [5] [6] [7] In Kaduna State, the school closure due to COVID-19 pandemic affected 2,450,547 school pupils/students. Recent literature has argued both for and against reopening of educational institutions in the midst of surging COVID-19 cases across the globe 4, 7, [8] [9] [10] [11] [12] [13] . While the Nigeria Center for Disease Control and Prevention has issued a guideline on school re-opening, this document is not based on locally-generated empirical data. Therefore, in view of scarce information and pressure on countries to consider re-opening schools in the context of COVID-19 pandemic, there is the urgent need to conduct a research, albeit rapid to guide policy makers on course actions for school to re-open. The Kaduna State Government was quick to impose several restrictions on all forms of gatherings early during the pandemic: schools, markets, churches and mosques were closed indefinitely. However, after 6-7months of schools' closure, schools were re-opened in a step-wise manner between October and November while strictly complying with COVID-19 prevention protocols such as temperature check at entrance for all staff and students/pupils, compulsory wearing of face masks, handwashing with soap and water and/or regular use of hand sanitizer as well as all other guidelines against COVID-19 infection as stated by the NCDC and the Kaduna State COVID-19 Task Force 14 .

As the pandemic soars in Nigeria in general and Kaduna State in particular, and with mounting pressure from parents and students to re-open schools, there is urgent need to assess the readiness and willingness of school teachers, school administrators, parents and students alike towards re-opening schools. This readiness is in terms of knowledge, risk perception and practices of staff towards prevention and control of COVID-19 as well as what needed to be provided by the schools to implement COVID-19 prevention protocol such as availability of hand sanitizers, face masks, adequate water supply and hand washing equipment. Across the world, it has been documented that pupils and students alike have suffered psychologically from lock-down including sexual violence such as rape or attempted rape and domestic violence beside loosing vital period of their education due to the COVID-19 lockdown 15, 16 . Parents are equally overwhelmed by increased household chores from continuous presence of children at home. Thus, the need to guide policy-makers on strategies/options available for school resumption necessitated the conduct of this study.

The study area is Kaduna State, northwestern Nigeria. Kaduna is a trade center and a major transportation hub for the surrounding agricultural areas, with its rail and road junction. The 2020 population estimates as used for planning in the state population is projected as 8,252,400 17 

We conducted a school-based cross-sectional descriptive study.

All the teachers, school administrators and other staff (office assistants, account staff, security, matrons etc.) At the end, there were 5 schools selected in each LGA: 1. One Public Secondary in Urban Area (preferably located at LGA headquarters) 2. One Public Secondary in Rural Area (preferably in the second biggest town/village in the LGA) 3. One Private Secondary in Urban Area (preferably located at LGA headquarters) 4. One Public Primary (preferably located at LGA headquarters) 5. One Public Primary in Rural Area (preferably in the second biggest town/village in the LGA)

We developed two set of questionnaires: one was administered to all teachers and other staff to assess their knowledge, risk perception and level of practice of prevention of COVID-19. This questionnaire was developed from various COVID-19 questionnaires used in Saudi Arabia, Pakistan, Iran, Ethiopia and Egypt that interviewed general population to a large extent and the questions were further contextualized for the Nigerian settings. [19] [20] [21] [22] [23] The questionnaire was divided into the following sections: i) knowledge; questions about knowledge included knowledge of the nature of the causative agent, transmission modes, symptoms of the disease, prevention, respiratory hygiene and source of information on the knowledge; ii) perception; perception about efficacy of preventive measures such as use of face of face masks, handwashing, use of hand sanitizers, level of risk of contracting the disease, self-perception of severity of disease if one contacts the disease; iii) practice of prevention; frequency of complying with preventive measures such face mask, complying with physical distancing, social/religious gatherings. The second questionnaire was developed to assess the schools' readiness to provide facilities to implement anti-COVID-19 measures. This questionnaire was administered to schools' administrators and information collected included their demographics, availability of regular supply of water, sanitation facilities, other materials/supplies such face masks, soap and water, hand sanitizers, handwashing points for students/pupils and staff.

The two sets questionnaires were administered as a verbal structured interview using a field-adapted electronic data collection tool, Kobo Toolbox. 24 Each interviewer downloaded the scripted questionnaire onto his/her android mobile and/or electronic device.

The collected data were collated and analyzed using Stata 14. 15 

The results are presented in Tables 1-5 . In all, 1065 staff comprising of teachers (75.8%), school administrators (4.8%), nurse/midwife (0.6%), security guards, matrons/hall wardens (5.5%), account officers (1.2%) and other categories of staff (6.1%) were interviewed in 55 schools across the nine selected local government areas (LGAs) of the State. Seven hundred and thirty-nine (or 59%) of the respondents are aged 30-49 years with average age of 40 years. Five hundred and eighty-four (or 55%) are female; 86% are either currently married (84%) or previously married (2%) and 90% have higher degrees. Four hundred and eleven (38.6%) are in public primary schools followed by those in public senior secondary schools (28.5%) then those in public junior secondary schools (13.0%). is equally a symptom. Other symptoms were mentioned by less than 10% of respondents (Table 2) . Overall, 1013 (95%) knew how to prevent the infection. Specifically, as shown in Figure 1, Approximately, 83% (880) perceived that face masks are effective in preventing COVID-19 transmission while 89% (952) indicated that handwashing is efficacious. About 39% (414) indicate that their level of self-perceived risk of contracting COVID-19 is likely/very likely. Further, 23% believed that it will be severe/very severe infection if they contract the disease. Table 5 is about practice of prevention in which 97% (1031) have ever used soap and water to wash hands; 90% (954) have ever used hand sanitizer; 99% (1063) have ever use face mask; 96% (1019) have used face mask in previous 24 hours and 906 (85%) have ever hand sanitizer in previous 24 hours. In the previous 24hours, 39% (423) have attended a mass gathering out of which 91% (375) used face mask. Nine hundred and forty-seven (89%) of the respondents declared that face masks are available in the schools but only 147 (14%) have ever attended workshop/seminar on COVID-19.

We conducted this study at the peak of the showed that the internet (social media platforms) and television are the two commonest sources of information with 84% and 44% of the participants utilizing them as sources. 30 Similar results of preponderance of internet (social media platforms) as sources of COVID-19 information are reported by Abdelhafiz and Chen. 31, 29 Attitudes and risk perceptions serve as mediators between knowledge and practices; the two have important role in adoption of healthy practices in preventing diseases. They also serve as facilitators of health behaviour change. 32, 33 Our study shows that about 83% and 89% believed that use of face mask and proper and regular handwashing are efficacious in preventing the infection while up to 39% believed that they are likely to contract the disease respectively; and that 23% perceived that the infection would be severe in them. In a Thai study, as much as 70% considered the disease to be serious and dangerous and a further 75% considered themselves at risk of contracting the disease 34 while less than half (44 %) considered themselves at risk of contracting the disease in another study. 21 Our study further showed that as much 89% are confident in adopting preventing measures against COVID-19. This is much higher than the levels reported by Honarvar and Sirchan. 21, 34 These researchers reported 75% and 15% being responsible or confident in abiding with COVID-19 prevention protocols.

Our study reported on use of soap and water to wash hands, hand sanitizers, face masks, and avoidance of mass gathering/social gathering. We also reported knowledge of the following preventive measures: social distancing, physical distancing, regular hand washing, use of face mask, facial and respiratory hygiene, avoidance handshakes etc. (Table 2) . From literature, COVID-19 prevention practices vary widely between geographic areas and demographic groups. For instance, in our study, we reported that approximately 97%, 90% and 100% had ever used soap and water to wash hands, hand sanitizers and face mask respectively. Furthermore, in the previous 24hours, we reported that 96% of our respondents had used face mask while 85% had used hand sanitizer; 39% had attended mass gathering in previous 24hours of which 91% had used face masks. Among the Chinese, 98% used face masks when going for outdoor activities compared to 24% of US population. 35, 36 Similarly, from North Central of Nigeria, Reuben and colleagues reported 93%, 96% and 82% practice of social distancing, personal hygiene and face masks respectively. 37

While knowledge of COVID-19 is suboptimal, perception is positive and practice is high. Thus, teachers/staff need to be well informed through targeted and tailored-made education and encouraged to sustain current levels of preventive measures. Schools need to be provided with adequate preventive commodities to ensure compliance to COVID-19 prevention protocols.

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