key: cord-0911773-cx6smyxt authors: Anikwe, Chidebe C.; Ogah, Christian O.; Anikwe, Ifeyinwa H.; Okorochukwu, Bartholomew C.; Ikeoha, Cyril C. title: Coronavirus disease 2019: Knowledge, attitude, and practice of pregnant women in a tertiary hospital in Abakaliki, southeast Nigeria date: 2020-07-24 journal: Int J Gynaecol Obstet DOI: 10.1002/ijgo.13293 sha: 26e4251f9b5e94072825f4d59b7664bf9d239b44 doc_id: 911773 cord_uid: cx6smyxt OBJECTIVE: To determine the knowledge, attitude, and practice of antenatal attendees towards COVID‐19 in Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Nigeria. METHODS: A cross‐sectional survey was carried out among 430 consenting pregnant women attending antenatal clinics between March 1 and May 30, 2020, using pretested questionnaires. RESULTS: The mean age and mean gestational age of the respondents were 30.04 years (95% confidence interval [CI] 28.9–31.1) and 26.3 weeks (95% CI 23.3–29.3), respectively. More than four‐fifths (82%) of the women believed that COVID‐19 is real and their main source of information was mass media. The majority had adequate knowledge of COVID‐19. More than half of the respondents said COVID‐19 is a curable disease and that chloroquine can be used. The majority showed a good attitude and preventive practice of COVID‐19 disease; however, one‐fourth (24%) thought that infected individuals should be killed to prevent the spread of the virus. CONCLUSION: The study population has good knowledge, attitude, and practice of COVID‐19 disease. However, it is worrisome that some respondents thought that infected individuals should be killed. Proper education must be given to the populace to avert these negative attitudes while promoting a positive preventive attitude. The study population has adequate knowledge, good attitude, and preventive practice of COVID‐19; however, community education is needed to reduce anxiety among the populace. its curtailment. 5, 6 Currently, therapeutic management is mainly supportive with great emphasis being placed on the prevention of transmission of the virus. 1 To this end, WHO has recommended a series of preventive measures to halt the spread of the disease 7 and which has been adopted by the Nigerian government. The success of these measures is largely dependent on the populace having a good knowledge of them. 8 Everybody is at risk of becoming infected 9 ; however, an immunocompromised state, as seen in pregnancy with its physiological changes, could predispose a pregnant woman to increased risk of SARS-COV-2 infection 9,10 compared to the general population. The cytokine storm that occurs in COVID-19 infection is likely to predispose a pregnant woman with COVID-19 to increased morbidity and even mortality. 9, 11 The cumulative effect of the disease on the woman is likely to have a detrimental effect on her and the developing fetus. It could predispose a developing fetus to intrauterine growth restriction (IUGR), preterm delivery with immediate and long-term sequelae, abortion, and stillbirth. 12 Even though vertical transmission is yet to be confirmed, 12, 13 fear and anxiety associated with infection could lead to increased demand for abortion and operative deliveries. 12, 14 With the above background, it becomes imperative that great efforts should be made to prevent pregnant women and their fetuses from the scourge of COVID-19. This can only be achieved if a woman is knowledgeable about how to prevent contracting the virus and its transmission to her family and others. This becomes very obvious in the study setting that lacks the enabling social and medical infrastructures needed to properly manage a case of COVID-19. 4 The aim of the present study is to determine the knowledge, attitudes, and preventive practice of pregnant women towards COVID-19 in Alex Ekwueme Teaching Hospital Abakalliki, Nigeria. The findings from the study will help to modify policies and guidelines towards the successful prevention of COVID-19 among an obstetric population in Nigeria. The present study is a cross-sectional study that assessed the knowledge, attitudes, and preventive practice of COVID-19 infection among antenatal attendees in Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi State. The study was carried out in the Department of Obstetrics and Other health issues, such as hypertension, diabetes mellitus, malaria, anemia, HIV/AIDS, family planning, and contemporary health issues, were also discussed. Routine services ater the health talk included measuring weight and height, estimation of blood pressure, urinalysis, and estimation of hemoglobin. Folic acid, ferrous sulfate, intermittent prophylactic treatment (IPT), and multivitamin supplementation are prescribed. Antiretroviral therapy and Septrin were also given to HIVpositive pregnant women. Ethical approval for the study was obtained from the Research and Ethics Committee of the hospital. The study instrument was a pretested structured interviewer questionnaire which was divided into sections: socio-demographic and obstetric characteristics; knowledge; attitude; and practice of COVID-19 infection. A 4-point Likert scale (Strongly disagree, Disagree, Agree, Strongly agree) was used to assess the adequacy of attitudes among the respondents. A respondent was judged as having an adequate attitude if her response to a question was "Agree" or "Strongly agree" while those with a response of "Strongly disagree" or "Disagree" were assessed as having inadequate knowledge. Each questionnaire took 5-10 minutes to complete. The sample size was calculated using the formula for cross-sectional study (N=Z 2 PQ/D 2 ) where N is the required sample size, Z is 1.96 at 95% confidence interval (CI), P is estimated patient satisfaction from similar studies of 50% (0.5), D is the margin of error at 5% (standard deviation of 0.05), and Q is 1 − P. A minimum sample size of 423 patients was obtained and, ater the addition of a 10% attrition rate, was increased to 430. The study population comprised women that attended their routine visit to the antenatal clinic. The study population was recruited by using a ballot method of simple random sampling method ater verbal consent was obtained. Women who consented were asked to pick a piece of a white card marked "Yes" (include) or "No" (exclude) with replacements from a black polythene bag in which an equal number of "Yes" and "No" cards were added. Women that picked a card marked "Yes" were recruited to the study population. They were interviewed by resident doctors in the Department of Obstetrics and Gynaecology who were trained to administer the questionnaire. Face masks were provided to the study population during the process of data collection and each of the researchers also wore a face mask. Translation into native languages was done in cases where the respondents had lower levels of education. The data obtained were analyzed using SPSS version 20 (IBM Corp., Armonk, NY, USA). The results were presented with frequency tables/ | 199 Anikwe eT AL. percentages and bar charts (Tables 1-3 and Fig. 1 ). Categorical variables were compared with odds ratios (OR) and x 2 test. The level of significance was set at P<0.05. A total of 450 questionnaires were distributed among antenatal attendees, of which 430 were correctly filled and used for analysis. This gave a response rate of 95.6%. The mean age and mean gestational age of the respondents were 30.0 4years (95% CI 28.9-31. (14) Not sure 17 (10) Sources of information TV 91 (16) Radio 62 (11) Newspaper 37 (7) Friends 69 (12) Health worker 91 (16) Social media 75 (13) Internet 65 (12) Churches/mosque 50 (9) Town criers 9 (2) Antibiotics 32 (7) Drink hot water 90 (21) Drink hot gin 23 (5) Drink saltwater 40 (9) a Values are given as number (percentage). COVID-19 infection is a public health problem and adequate knowledge among the populace is essential for its management. 1, 7 It has been demonstrated that adequate knowledge is a prerequisite for the establishment of preventive belief, forming a positive attitude, and promoting of positive practice to disease. 15, 16 The present study shows that the majority of respondents had adequate knowledge about COVID-19 infection. Of the respondents, 353 (82%) believed that the disease is real while more than four-fiths (88%) of respondents thought that the disease is Opinion about the source of the infection is diverse among the respondents as 32%, 38%, and 30% of the antenatal women studied believed that the sources of infection are from an animal, human, and clubs, places of work, and markets. This is a cause for concern as sleep disorders and other stress occurring in pregnant women might lead to unfavourable pregnancy outcomes and interventions. 12, 19 It is also worrisome that 24% of the women think that individuals infected with This high level of practice is expected from healthcare workers, prob- COVID-19) Dashboard https:// covid 19.who.int/?gclid =Cj0KC Qjww_f2BRC -ARIsA P3zar Gxeg_ Tx4IC 3YW_sBhh-Q9RNu -hIg-KMu9I Op_YSL-bUclV F8HcH DoaAt mmEALw_wcB Early transmission dynamics in Wuhan, China, of novel coronavirus-infected pneumonia Outbreak of pneumonia of unknown etiology in Wuhan, China: The mystery and the miracle Africa prepares for coronavirus COVID-19 vaccine development pipeline gears up Remdesivir for the treatment of Covid-19 preliminary report World Health Organization. Country & Technical Guidance -Coronavirus disease (COVID-19) 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 Analysis of the susceptibility to COVID-19 in pregnancy and recommendations on potential drug screening Why are pregnant women susceptible to COVID-19? An immunological viewpoint Maternal death due to COVID-19 The novel coronavirus (2019-nCoV) in pregnancy: What we need to know Management of pregnant women infected with COVID-19 Clinical characteristics of pregnant women with Covid-19 in Wuhan. China Breakthrough: Chlrorquine phosphate has shown apparent efficacy in treatment of COVID-19 associated pneumonia in clinical trials Pharmaceutical care of chloroquine phosphate in elderly patients with coronavirus pneumonia (COVID-19) Knowledge, attitude and practice regarding COVID-19 among health care workers in Henan Knowledge regarding prevention of Novel Coronavirus (COVID-19): An electronic cross-sectional survey among selected rural community Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: A descriptive study Knowledge and risk perception towards Lassa fever infection among residents of affected communities in Ebonyi State, Nigeria: Implications for risk communication Features Evaluation and Treatment Coronavirus (COVID-19). StatPearls [Internet Health anxiety and behavioural changes of pregnant women during the COVID-19 pandemic COVID-19 and mental health: A review of the existing literature Pregnant women's knowledge and practice of preventive measures against COVID-19 in a low-resource African setting Coronavirus Disease-2019: Knowledge, attitude, and practices of health care workers at Makerere University Teaching Hospitals, Uganda. Front Public Health CCA: participated in the study design, data collection/analysis, and interpretation of findings and drating of the manuscript. COO: participated in study design, interpretation of findings, and drating of the manuscript. CCI: participated in the data analysis and the interpretation of findings. BCO: participated in the interpretation of findings and drating of the manuscript. All authors participated in the review of the final manuscript. All authors approved the manuscript. Funding for the study was borne by the authors. The authors have no conflicts of interest.