key: cord-0703990-kxiuhu5m authors: rugarabamu, s.; Byanaku, A.; Ibrahim, M. title: Knowledge, attitudes, and practices (KAP) towards COVID-19: A quick online cross-sectional survey among Tanzanian residents. date: 2020-05-01 journal: nan DOI: 10.1101/2020.04.26.20080820 sha: bcbee2c092b43738b2504034db8246acb059d4c5 doc_id: 703990 cord_uid: kxiuhu5m In Tanzania, Unprecedented measures have been adopted to control the rapid spread of the ongoing COVID-19 epidemic. Residents adherence to control measures is affected by their knowledge, attitudes, and practices (KAP) towards COVID-19. In this study, we investigated Tanzanian residents KAP towards COVID-19 during the rapid rise period of the outbreak.This was a cross sectional study that involved sample of online Tanzanian residents who was recruited via authors networks with residents and social media. A self-developed online KAP questionnaire using Survey Monkey tool was used to collect data from participants. The questionnaire assessed demographic and had 12 questions on COVID Knowledge and 5 questions on attitude and practice. Descriptive and inferential analysis was carried out using SPSS 17.Four hundred residents completed a survey. The mean age of study participants was 28 years, and majorities were females 216 (54.0%). There were no significant different in relation to demographic variables (p>0.3). Those who held a bachelor degree or above (60.3%) had more correct score. The overall, (84.4%) of participants had good knowledge level and the good knowledge was associated with education level (p=0.001). Nearly all of the participants (96.0%) had confidence that Tanzania can win the battle against COVID-19. The majority of the respondents (77%) did not do to the crowded place in recent says. Multiple linear regression analysis showed that male gender, age-group of 16-29 years and education of secondary or lower were significantly associated with lower knowledge score.Our findings suggest that residents of a relatively high level of socioeconomic status, have had good knowledge, optimistic attitudes, and appropriate practices towards COVID-19 during the rapid rise period of the COVID-19 outbreak. Suggesting that health education programs aimed at improving COVID-19 knowledge are helpful for encouraging an optimistic attitudes and maintaining safe practices. Due to the limitation in representativeness of the sample, more studies are warranted to investigate the KAP towards COVID-19 among Tanzania residents of a low socioeconomic status. Coronavirus disease 2019 (COVID- 19) is an emerging respiratory disease that is caused by a novel coronavirus and was first detected in December 2019 in Wuhan, China. The disease is infectious, and its main clinical symptoms include fever, fatigue dry cough, myalgia, and dyspnea. It is reported that 10-20% of the patients with COVID-19 develop to the severe stage, which is characterized by acute respiratory distress syndrome, septic shock, difficultto-tackle metabolic acidosis, and bleeding and coagulation dysfunction [1, 2] . Empirical clinical data have shown that the overall case fatality rate of COVID-19 ranges 2 -5% worldwide, much lower than those of SARS (9.5%), MERS (34.4%), and H7N9 (39.0%) [1] [2] [3] . The ongoing COVID-19 epidemic has spread very quickly, and by April 23, 2020, the virus had reached over 30 countries altogether, resulting in 2 544 792 laboratory-confirmed infections and 175 694 deaths, with nearly most infections and deaths occurring in European Region and region of the Americas [4] . Responding to this serious outbreak, the World All rights reserved. No reuse allowed without permission. was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. Health Organization (WHO) declared it a public health emergency of international concern on January 30 and called for collaborative efforts to prevent the rapid spread of COVID-19 [5] . Tanzania, in particular is among African countries that has been hit by the COVID-19 epidemic [6] . Until April 24, Government authorities announced 284 cases of Cocid-19, among them 256 are in stable condition, seven in special care, 37 recovery and 10 deaths [7] . including prohibition of mass gathering, close management of communities, and isolation and care for infected people and suspected cases.Moreover,Tanzania residents were obliged to perform hand washing using soap and running water and/or alcohol based hand sanitizer and were encouraged to wear face masks outside of their home. The battle against COVID-19 is still continuing in Tanzania. To guarantee control success, people's adherence to these control measures are essential [9] [10] . Lessons learned from other outbreaks suggest that knowledge and attitudes towards infectious diseases are associated with level of panic emotion among the population, which can further complicate attempts to prevent the spread of the disease [9] [10] [11] [12] . To facilitate outbreak management of COVID-19 in Tanzania, there is an urgent need to understand the public's awareness of COVID-19 at this critical moment. In this study, we All rights reserved. No reuse allowed without permission. 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 (which this version posted May 1, 2020. . https://doi.org/10.1101/2020.04.26.20080820 doi: medRxiv preprint investigated the KAP towards COVID-19 among online Tanzania residents during the rapid rise period of the COVID-19 outbreak. Tanzania is grouped into five ecological zones comprising of 30 regions. 8 (27%) of the total include its largest populated region of Dar-es-salaam reported at least a COVID -19 case. This cross-sectional survey took place from 15 th -28 th of April 2020. Because it was during outbreak it was not feasible to do a community-based national sampling survey hence we use online survey forms to collect the data. Starting with author's network a one-page recruitment website link was circulated to their media connections, group of their WhatsApp and other social media accounts. A total of 5000 residents were assumed to actively use media connections. Calculation using statistical software gave a minimum sample of 384 [13] . Adjusting for non-responders 400 eligible residents received an email and WhatsApp invitation and could access the questionnaire online through Survey Monkey Questionnaire [14] . The questionnaire consisting of 20 questions was based on a KAP survey template (Appendices 1 & 2). This template was modified and adapted to the Swahili language and According to guidelines for clinical and community management of COVID-19 by Ministry of Health Tanzania and then validated by experts. Finally, the questionnaire was piloted among medical officers in the target area. The questionnaire consisted of demographics and KAP parts. Demographic variables included age, gender and education Level. The questionnaire had 17 questions regarding clinical presentations, transmission routes, and prevention and control of COVID-19 (Appendix 1). These questions were answered on a Yes/No, true/false basis with an additional "I don't know" option. A correct answer was assigned 1 point and an All rights reserved. No reuse allowed without permission. was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. incorrect/unknown answer was assigned 0 points. The total knowledge score ranged from 0 to 12, with a higher score denoting a better knowledge of COVID-19. The online survey settings restricted the participants from providing additional responses. Data analysis Response data on the questionnaire provided in Survey Monkey was imported into SPSS 17 and recoded. The knowledge score was calculated from a total of 12 points. The mean score was compared and a score above the median value was considered good knowledge [15, 16] . Chi--squared analysis was used to compare proportions of good COVID-19 knowledge between the democratic variables. Analysis of variance (ANOVA) was used to identify differences. Significance was considered at a p--value <0.05. Descriptive statistics were described for the questions related to attitudes and practices. A total of 400 participants completed the survey questionnaire. The average age was 32.0 years (standard deviation [SD]: 10.1 range: 16-72), Women represented 54% of the participants. A majority of the participants (60.3%) held a bachelor's degree or above. There were no significant differences in demographic variables (Table 1) . 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 (which this version posted May 1, 2020. Overall, the participants answered 84.4% of the questions correctly. Out of the highest possible score of 12 points, the mean knowledge score was 9.3 ± 2.0. The median knowledge score was 9 ranging from 2 to 10. A score above 8 was considered good COVID-19 knowledge. 60.5% of the degree older had a score of 9 or higher on the 12 selected questions related to knowledge (Figure 1 ). 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 (which this version posted May 1, 2020. The correct answer rates of the 12 questions on the COVID-19 knowledge questionnaire were 70.2-98.6% (Table2). The mean COVID-19 knowledge score was 8.7 (SD: 1.6, range: 0-12), suggesting an overall 72% (9.7/12) correct rate on this knowledge test. Knowledge scores significantly differed across genders, age-groups, and education levels (P<0.001). Multiple linear regression analysis showed that male gender (β: -0.284, P<0.001), age-group of 16-29 years (β: -0.302, P<0.001), and education of bachelor's degree or lower (β: -0.191 ~ -1.346, P<0.001), were significantly associated with lower knowledge score (Table (Table 2) . The majority of the respondents agreed that COVID-19 will finally be successfully controlled (96%). The attitude towards the final success in controlling COVID-19 had no significant differences across genders and education levels (P<0.71). The majority of the participants had not visited any crowded place (77%) and wore masks when going out (80.0%) in recent days. All rights reserved. No reuse allowed without permission. 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 (which this version posted May 1, 2020. . https://doi.org/10.1101/2020.04.26.20080820 doi: medRxiv preprint On questions related to transmission, almost all participants (98%) correctly identified that COVID-19 is transmitted by respiratory droplets and also factors such as chronic illnesses and obesity can lead to serious case (Figure 1 ). To the best of our knowledge, this is the first online cross section study to examining the KAP towards COVID-19 among Tanzania residents. In this study, 84.4% of the participant had a score above 8 out of a total of 12 points and considered as good knowledge of COVID-19, which is a concern during the rapid rise period of the COVID-19 outbreak. Previous studies from different part of the world have identified good knowledge in infection control as a predictor of good practice [17, 18] , in addition other studies have highlighted that major gaps in COVID-19 knowledge could result in uncertainties and non-stringent control measures [19] . The vast majority of the participants also held an optimistic attitude towards the COVID-19 epidemic believing that COVID-19 will finally be successfully controlled, and had confidence that we can win the battle against the virus. This is likely to have influence cautions with majority avoid visiting crowded places and wore mask. In addition, nearly all reported adhere to preventive measures as instructed by their national health care authority. This study have identified demographic factors associated with KAP. The findings are useful for public health policy-makers to quickly recognize the need for a group specific target populations for COVID-19 prevention and health education programmes. The finding of a high correct rate of COVID-19 knowledge in period with high increase of cases is good predictor of positive impact initiative to involve community in a fight for COVID-19 however the result might have bed affected by sampling characteristics where by majority held degree or higher. These are the privilege group who would actively learn knowledge of this infectious disease from various channels of information, the official All rights reserved. No reuse allowed without permission. was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. This was the first cross-sectional online survey assessing KAP on COVID-19 among Tanzania residents and will add to the limited numbers of studies performed in Tanzania. Our findings suggest that residents of a relatively mid to high level of socioeconomic status, have had good knowledge, optimistic attitudes, and appropriate practices towards COVID-19 during the rapid rise period of the COVID-19 outbreak. Suggesting that health education programs aimed at improving COVID-19 knowledge are helpful for encouraging an optimistic attitudes and maintaining safe practices. Due to the limitation in representativeness All rights reserved. No reuse allowed without permission. 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 (which this version posted May 1, 2020. . https://doi.org/10.1101/2020.04.26.20080820 doi: medRxiv preprint of the sample, more studies are warranted to investigate the KAP towards COVID-19 among Tanzania residents of a low socioeconomic status. The authors declare absence of any competing interests. 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