key: cord-0328369-psl83v0v authors: Ripon, M. K. H.; Khan, N. M.; Khan, A. E. M. A.; Ahmed, R.; Afrin, S.; Sayed, M. A.; Moghal, D. M. M. R. title: A Comparative Study on the knowledge and attitude of COVID-19 among Urban and Rural populations of Bangladesh. date: 2021-08-11 journal: nan DOI: 10.1101/2021.08.10.21261843 sha: e37e9f8c0f1499d72a2037aea9dbf8f02f3370a1 doc_id: 328369 cord_uid: psl83v0v Aim: This study is aimed to identify the awareness and behavioral perspective on COVID-19 between urban and rural people of Bangladesh during the period of outbreak. Methods: A community-based cross-sectional study was conducted in 30 districts of Bangladesh, where 322 participants from urban and 312 from rural area. Participants were selected through convenience sampling. Results: Rural people are found to be much more inter connected to receive information from neighbor. Regarding the incubation periods and the general symptoms, knowledge differs significantly from urban to rural. Even their precautionary and transmission knowledge is found to associate in most of the cases. During this outbreak, urban people significantly increase their religious habits and also believe that there will some major change of life after outbreak. Discussion: The study reflected that health education program needed to aware about COVID-19 in both urban and rural in Bangladesh that helps in formulating and executing communication and outbreak management. Coronavirus2' (SARS-CoV-2) respectively [5] . It is now a pandemic and an international emergency of public health for all over the countries, should step forward to prevent COVID-19 spread called by World Health Organization (WHO) on January 30 [6, 7] . The COVID-19 was confirmed to spread in Bangladesh on March 2020. The first three known cases were reported by the country's Institute of Epidemiology, Disease Control and Research (IEDCR) on 8 March 2020 [8] . Within 4 May, there are a total of 10143 confirmed cases, 182 deaths and Case Fatality Rate (1.79%) in the country [9] . Bangladesh first imposed nationwide lockdown from March 26 and extended several times for the consequence the Ministry of Public Administration again issued a notification on 4 May, 2020 to extend the general holiday and close all schools, colleges and universities until 14 May, followed by a weekend [15] [16] May except all emergency services to resist the spreading of COVID-19 [10] .Government of Bangladesh bound to withdraw lockdown due to the economic distress related to suicidal incidences around that time [11, 12] . Within the last two weeks of march, 2021, the number of infection and death is tremendously increases and high-risk zone gave a hyper jump from 10 to 38 which is more than half country's 64 districts, according to IEDCR data [13] . From June, 2021, both the number of infection and death dramatically increases and government reimposed a strict lockdown nationwide from July 1-13 and ease the lockdown from July 15-22 for the biggest festival Eid al-Adha and again resume the strict lockdown from July 23 to next two weeks [14] [15] [16] . July, 2021 [18] .During the period of outbreaks, general people need instant information, a group of population is experience fear, discrimination and stigmatization required special care [19, 20] .Furthermore, after the outbreak of severe acute respiratory syndrome (SARS), Middle East respiratory syndrome (MERS), and Ebola, it was recommended that the knowledge and attitudes is connected with the intensity of panic emotion regarding the infectious diseases which make further difficulties to prevent the spread of the diseases [21] [22] [23] [24] [25] [26] . While the illness and death are significant, general public or specific communities suffer from fear which make them delay asking help and remain undetected that is very hazardous for controlling transmission during the outbreak of infectious diseases [25] . After the outbreak, the prevalence of post-traumatic stress disorder (PTSD) and major depression of general people increased up to 41% and 7% respectively [27] . At this critical situation, it is vital need to understand the public's awareness of COVID-19 in Bangladesh to facilitate the management of outbreak. In this study, we investigate the knowledge and attitude towards COVID-19 of both urban and rural residents of Bangladesh during this rise period of outbreak to provide the legislators actual field-based data and to support them in the management of this pandemic. To capture the attitude toward COVID-19 among the people of Bangladesh, a community-based cross-sectional study was conducted over a short period (March 2020 to April 2020) during the rise period of outbreak of COVID-19. We have collected the data from 30 convenient districts out of 64 districts. Due to lockdown situation in Bangladesh, it was very hard to collect the data from all the districts. Total 634 participants are encountered in the survey, where we tried to make equal representation of urban and rural people. Respondents were also selected from each district based on their availability to us. In a ward, we have used convenience sampling, a nonprobability sampling technique, in selecting the respondents from the people of Bangladesh. This sampling technique is also known as accidental sampling in many literatures. Convenience sampling involves the sample being drawn from that part of the population that is close to hand. Though it increases the selection bias, it was the only efficient way of collecting data from the people of Bangladesh in lockdown days. One of the uses of the 2 statistic is in contingency (dependence) testing where n randomly selected items are classified according to two different criteria, such as when data are classified on the basis of two factors (row factor and column factor), where the row factor has r levels and the column factor has levels. We use chi square test ( 2 )in our research to test the hypothesis that the two or more factors are independent. P values of the chi square test are presented in the table. Table 1 summarizes the participants according to their demographic characteristics. There is almost equal representation of urban and rural people in our data set, where female participants are found to slightly more convenient than male. We have collected the data from those people who have age 13 or above. Among them, 94% are found to be educated as they have completed their secondary school certificate. Majority of our respondents are from the middle-class family or higher which ensures that they have the sufficient resources to gather knowledge about COVID-19. Unfortunately, we didn't find any survivor respondents. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. All rights reserved. No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. All rights reserved. No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted August 11, 2021. ; https://doi.org/10.1101/2021.08.10.21261843 doi: medRxiv preprint All rights reserved. No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. Knowledge of urban and rural people about these mediums are associated at 5% level of All rights reserved. No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted August 11, 2021. ; https://doi.org/10.1101/2021.08.10.21261843 doi: medRxiv preprint significance except the sneezing and the surface they have recently touched. Their knowledge on food including refrigerated or frozen food, whether COVID-19 spread through food or not, also associated. This result is found to be statistically significant at 1% level of significance. The opinion of warm weather can stop the outbreak of spreading of this virus is now talk of the town. We have found a significant association between the knowledge of urban and rural people about this opinion. Some people are agreed about the opinion of transmission from pet or another animal, where some others are disagreed. Urban and rural people's knowledge about this transmission is found to be significant. Most of the people in urban area believes that someone can spread the virus without being sick, where most of the rural people bear reverse belief on their mind. This result is also found to be statistically significant at 1% level of significance. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. generally looking like pneumonia insignificantly varies from urban to rural people. We haven't found any significant association between the knowledge of urban and rural people on Adults All rights reserved. No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted August 11, 2021. ; https://doi.org/10.1101/2021.08.10.21261843 doi: medRxiv preprint and Older Persons, that they are at higher risk of COVID-19. A small portion of people in both areas, more specifically 0.93% and 0.32%, believes that they could mixed with mass people even if they are the positive cases of COVID-19. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted August 11, 2021. ; girlfriend or wife Self-isolate for 14 (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted August 11, 2021 (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted August 11, 2021 (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted August 11, 2021 Our study shows that urban people are more knowledgeable than rural people regarding causes of COVID-19. This is because, the people in urban and rural area in Bangladesh doesn't have the similar access to gather knowledge on various issues. Though mass media is the largest source of knowing about COVID-19 here, rural people are mostly dependent on the broadcast media and their neighbors. However, urban people are found to be more aware about this virus than the All rights reserved. No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted August 11, 2021. ; https://doi.org/10.1101/2021.08.10.21261843 doi: medRxiv preprint rural one. They are mostly dependent on internet, especially social sites, scientific journals, broadcast media etc. These areas are the sources of knowledge about COVID-19 to them. Urban and rural residents of the China, where the first COVID-19 patient was reported, have the moderate level of COVID-19 knowledge and they show a positive attitude toward the disease [30] .The urban respondents of Pakistan, a nearby country of Bangladesh, had higher knowledge about COVID-19 disease as compared to rural respondents. Their hygienic behavior was better than rural respondents [31] . However, our data also represents that rural people significantly carry lack of knowledge about transmission as well as precautions. On the other hand, both urban and rural people know that there is no treatment of this disease but rural people are not taking much precautions, our thinking this may be due to the lack knowledge and awareness. Choi and Kim also described in their studies infection-control knowledge directly related with attitudes and practice [21].Ajzen and Fishbein revealed a significant correlation among knowledge, attitudes and practice [28] . Other studies also support this finding where they mentioned lack of awareness in Anhui province of China [29] . Impact of this pandemic on the global health and mental health is reported in recent studies [28] . Our study also shows that both urban and rural people are worried about getting the corona virus and believe that after outbreak life will be changed in a major way. Some researchers tried to identify the root cause of panic in the community, where they reported that the Muslim communities in the rural area facing the COVID-19 Pandemic attempts to find refuge from the plague and hope for survival [32] . However urban people significantly increased their religious habit during this outbreak. So far, we know, previously population-based studies regarding COVID-19 either field based or online based were conducted in the city area only. In our country, internet is not easily accessible, especially in rural area. Moreover, the people in the rural area are not habituated All rights reserved. No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted August 11, 2021. ; regarding this on-line survey. Face to face survey is highly recommended here to find out the exact scenario. In contrast we conducted our study in both urban and rural areas following heath guidelines strictly and also covered a good number of participants in both areas. On the other hand, the limitation of our study, we can't include survivor in this study because survivor wasn't available at that time. Our recommendation to conduct similar studies in different developing countries in the world for more evidence for the management of pandemic because rural people is less advanced in different perspectives than urban people. COVID-19 is now a pandemic and the situation are like time bomb as no medical treatment is too much effective and no proper vaccine yet discovered. Bangladesh become a highest worse condition regarding this infectious disease in the world due to overpopulated and lack of awareness. In this circumstance only people's awareness in Bangladesh can help to protect us. This cross-sectional study was carried out to identify the awareness and behavioral perspective on COVID-19 between urban and rural people. Awareness regarding COVID-19 was unsatisfactory in rural residents as compared to urban. Based on the results of our study, we can conclude that improvement of COVID-19 knowledge, attitudes and promotion of awareness among residents by effective health education programs is needed especial care needed in rural areas. Our belief this survey will provide valuable information to the legislators regarding the perceptions of urban and rural population for the management of pandemic. 1. Centers for Disease Control and Prevention (CDC). Update: Outbreak of severe acute All rights reserved. No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted August 11, 2021. ; https://doi.org/10.1101/2021.08.10.21261843 doi: medRxiv preprint WHO | Update 31 -Coronavirus never before seen in humans is the cause of SARS The history and epidemiology of Middle East respiratory syndrome corona virus Clinical features of patients infected with 2019 novel coronavirus in Wuhan The reproductive number of COVID-19 is higher compared to SARS coronavirus Mathematical model of infection kinetics and its analysis for COVID-19, SARS and MERS among Chinese residents during the rapid rise period of the COVID-19 outbreak: a quick online cross-sectional survey update/coronavirus-disease-(covid-2019)-bangladesh-situation-reports COVID-19: Bangladesh to extend lockdown until No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. 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(which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity Knowledge, Attitudes and Practices of COVID-19 Among Urban and Rural Residents in China: A Cross-sectional Study Knowledge, behavior and precautionary measures related to COVID-19 pandemic among the general public of Punjab province Turning religion from cause to reducer of panic during the COVID-19 pandemic There was no financial and material support in this study.