key: cord-1050715-48zwvm2t authors: Feleke, Alelgne; Adane, Metadel; Embrandiri, Asha; Berihun, Gete; Walle, Zebader; Keleb, Awoke; Kloos, Helmut title: Knowledge, Attitudes, and Misconceptions About COVID-19 Prevention Practices Among High and Preparatory School Students in Dessie City, Ethiopia date: 2022-05-10 journal: J Multidiscip Healthc DOI: 10.2147/jmdh.s325636 sha: f150b9ee06122bab7862cbc09859425cb0128aaa doc_id: 1050715 cord_uid: 48zwvm2t BACKGROUND: Knowledge, attitudes, and misconceptions of students about COVID-19 (coronavirus disease) prevention have been examined in relatively few studies. This study aimed to assess the knowledge, attitudes and misconceptions about COVID-19 prevention practices among high and preparatory school (grades 9 to 12) students in Dessie City, Ethiopia. METHODS: This school-based cross-sectional study used a pre-tested structured questionnaire and direct observations from March 1 to 30, 2021 in 5 high and preparatory school students in Dessie City, Ethiopia. The sample size was proportionally allocated in each school based on the number of students registered in the first semester, stratified by grade level, and section. Data analysis employed 3 binary logistic regression models (Models I, II and III) with 95% CI (confidence interval). Bivariate analysis (crude odds ratio [COR]) and multivariable analysis (adjusted odds ratio [AOR]) were used. Variables with P-values <0.3 in the bivariate analysis were retained in the multivariable logistic regression analysis for each model. Variables with significance levels P<0.05 in the multivariable analysis of each model was identified as significant factors. RESULTS: The levels of good knowledge, positive attitudes, and low misconceptions were 74.8%, 60.2%, and 56.1%, respectively. After adjusting for the covariates, grade 12, positive attitude and living in households with more than 5 members were identified as factors significantly associated with good knowledge about COVID-19 prevention practices. Good knowledge of COVID-19 prevention practices, household size >5, infection prevention and control (IPC) training, and low level of misconceptions were factors significantly associated with positive attitudes, whereas students age ≥18 years, positive attitude, and IPC training were factors significantly associated with less misconceptions about COVID-19 prevention measures. CONCLUSION: The prevalence of good knowledge, positive attitude, and low level of misconceptions of prevention practices for COVID-19 among students was relatively low. Therefore, Dessie City Health and Education Department and each high and preparatory school should implement continuous monitoring programs to ensure high prevention awareness and promote preventive behavior towards COVID-19. using simple random sampling (lottery method) based on classroom attendance at the time of the survey as the sampling frame. The interviewer-administered, structured questionnaire was adapted from WHO COVID-19 guidelines and various reports. [12] [13] [14] [15] [16] The questionnaire includes selected socio-demographic, knowledge, attitude, and misconception variables. The data collectors were 3 BSc. in environmental health professionals and 3 BSc. holders in nursing. One data collector was recruited for each of the 4 schools and 2 data collectors for one school, which was the largest. The questionnaire was prepared in English and then translated to Amharic (the local language) and back to English by different translators to check its consistency. The principal investigator trained the data collectors for 2 days about the contents of data collection tool, data collection procedures and ethical issues. The questionnaire was pre-tested in 1 high and preparatory school in Kombolcha town with a 5% sample (21 students) to establish the validity and reliability of the questionnaire and the questionnaire was amended based on the findings of the pre-test. Inter-observer reliability was ensured by providing clear definitions about knowledge, attitudes, misconceptions and prevention practices regarding COVD-19. The content validity of the questionnaire was improved by using a literature review to identify relevant items; the tool was evaluated by experts in the same research field and questions that were not relevant at the critical level were eliminated. One supervisor and principal investigator supervised data collection and supported the data collectors. Each questionnaire was checked daily for completeness and consistency was checked before data were entered. The outcome variables were knowledge (good or poor), attitudes (positive or negative), and misconceptions (less or more) about COVID-19 prevention practices. Explanatory variables were socio-demographic status and source of information on COVID-19. regression analysis. Variables with significant levels of p-values less than 0.05 in the multivariable analysis of each model were identified as factors significantly associated with good knowledge, positive attitude, and less misperception toward COVID-19 prevention practices. The occurrence of multicollinearity within independent variables was investigated using standard error at a cut-off value of 2 and a maximum standard error less than 2. The Hosmer-Lemeshow test 17 was used to assess model fitness for models I, II, and III, and the p-values were 0.897, 0.834, and 0.949, respectively, suggesting that all models fit. The Ethical Review Committee of the College of Medicine and Health Sciences of Wollo University gave ethical clearance for the study (Protocol number: WU/CMHS/146/03/2021). Official support letters were obtained from Wollo University for Dessie City Education Department in order to obtain support during data collection from each school. Prior to data collection, the purpose of the study was explained to each participant and informed written consent was obtained from study participants 18 years and older. For study participants below the age of 18 years, written consent was obtained from their families. Participants were informed that participation was voluntary and that they could decline to answer any of the questions during the interview and opt out of the study. They were also assured of the confidentiality of the information they provided. All study methods were performed in accordance with the ethical principles of the Declaration of Helsinki. Of the selected 422 students, 417 were included in the study (98.8% response rate). Two-thirds of the participants were females (256, 61.4%) and 60.9% were less than 18 years old. The mean (±SD) age of the students was 16.97 (±1. 27) years. Almost all of the respondents (402, 96.4%) were single. Nearly half (204, 48.9%) of the participants' mothers were housewives and 141 (33.8%) of the fathers were government employees (Table 1) . Nearly all (94.7%) participants received updated COVID-19 information from family/friends, television (90.4%), Facebook (89.2%), and other internet sources (90.6%) ( Figure 1 ). Three-fourths (74.8%, 95% CI: 70.3-78.9) of the students had good knowledge and 25.2% (95% CI: 21.1-29.5) had poor knowledge of COVID-19 prevention measures. The great majority (378, 90%) of the students knew that proper washing of hands for 20 seconds or more with soap and water can prevent the transmission of COVID-19 and 383 (90.8%) stated that rubbing hands with alcohol-based sanitizer can prevent transmission. The great majority of respondents (392, 94%) knew that maintaining a 2-meter social distance can protect against COVID-19 infection; 391 (93.8%) of them knew that face masks or face coverings can reduce the transmission of the virus (Table 2) . About 60.2% (95% CI: 55.6-65.2) of the students had a positive attitude and 39.8% (95% CI: 34.8-44.4) had a negative attitude towards COVID-19 prevention practices. Of the 351 students who thought COVID-19 can be controlled in Dessie, 335 (80.3%) stated that the virus can be controlled if people follow all guidelines of the Ministry of Health, and 215 (51.6%) stated that the administration of drugs can control the epidemic. Two-fifths (39.1%) of the students thought infections were socially stigmatized. Almost three-fifths (246, 59.0%) of the participants worried about contracting COVID-19 (Table 3) . All variables with P-values < 0.3 in the bivariate analysis were entered into multivariable logistic regression analysis ( Table 5 ). The final analysis showed that the odds of developing good knowledge about COVID-19 prevention practices among students in grades 11 and 12 were 5.45 times (AOR = 5.42, 95% CI: 2.55-11.67) higher than for lower-grade students. Similarly, the odds of developing good knowledge about COVID-19 prevention practices among students living in households with 5 or more members were 3.30 times (AOR = 3.30, 95% CI: 1.99-5.45) higher than for those who lived in smaller households. The odds of good knowledge among students who had a positive attitude were 2.69 times (AOR = 2.69, 95% CI: 1.63-4.44) higher than of those who had a negative attitude ( Table 7 shows the results of the bivariate analysis of socio-demographic characteristics and source of information, knowledge, and misconceptions regarding COVID-19 with attitudes among high school and preparatory school students in Dessie City, Ethiopia, March 2021. The multivariable analysis showed that the odds of developing a positive attitude about COVID-19 prevention practices were 2.55 times higher (AOR = 2.55, 95% CI: 1.58-4.12) among students who had good knowledge about prevention programs than among those who had poor knowledge. The odds of developing a (Table 10 ). The focus of this study was on determining the prevalence of knowledge, attitudes, and misconceptions and associated factors in regard to COVID-19 prevention practices among high and preparatory school students in Dessie City. We found tha the prevalence of good knowledge was 74.8% (95% CI: 70.3-79.1), positive atitude was 60.2% (95% CI: 55.6-65.2) and less misconceptions was 56.1% (95% CI: 51.6-60.4). The rate of good knowledge in our study was lower than that reported by the only other COVID-19 study of preparatory students in Ethiopia, 18 which was also carried out in March 2021. This difference is consistent with the lower knowledge, attitude and misconception levels of the high school students in our study. Our findings reveal that the determinant factors for good knowledge were directly related to education level, household size, and positive attitude. The prevalence of good knowledge of prevention measures (74.8%) in our study was similar to prevalence levels reported from studies in Saudi Arabia (68.1%) 4 and Bangladesh (61.2%) 19 as well as in Amhara Region (69.6%) 9 and Awi Zone (76.6%) 20 in Ethiopia. Variations may be the result of socio-demographic differences, the effectiveness of local COVID-19 programs, and the dates of the studies. Students in grades 11 and 12 in our study were 5.45 times more knowledgeable about COVID-19 than those in grades 9 and 10; this finding is similar to results from a study of students in 4 private and public universities in Amhara Region, 9 general populations in China 21 and Syria, 22 university students in Japan, 18 and health care workers in Bangladesh. 23 Students who had a positive attitude had 2.74 times more knowledge than those with a negative attitude, corroborating a study in Nepal 24 and a study among health care workers in hospitals in Nigeria. 25 This study showed that students living with 5 or more family members had 3.30 times better knowledge of the COVID-19 pandemic than those living in smaller families. This finding differs from results of studies of college students in Amhara Region 9 and Debre Tabor Town in Ethiopia. 26 The great majority (378, 90.6%) of participants knew that proper hand washing procedures (for at least 20 seconds with soap and water) can prevent COVID-19, a result similar to findings in studies in southwestern Ethiopia (92.7%), 27 South Wollo, Ethiopia (93.83%), 28 in Bangladesh (93.5%), 29 Egypt (94%), 30 and Nepal (97%), 31 but higher than in Addis Zemen Hospital, (78.5%), 32 Gondar City (53%) 33 and Amhara Region (79%, 34 all in Ethiopia. These discrepancies may be due to differences in the socio-demographic characteristics of the study populations and the effectiveness of national and local COVID-19 prevention programs. In our study, 391 (93.8%) of the students knew that wearing a face mask decreases the risk of transmission of COVID-19. This rate was similar to those reported from southern Ethiopia (87.3%) 35 but higher than in South Wollo Zone (79.0%); 28 Addis Ababa (46.1%) 36 and Amhara Region (60%) 34 in Ethiopia, in Malaysia (76.7%), 37 Nigeria (86%), 38 Bangladesh (89.4%); 19 China (2.8%), 21 Philippines (49% 39 and India (36.5%). 40 These discrepancies may be due to variations in the effectiveness of prevention programs and socio-demographic characteristics of the study populations. Three fifths (60.2%, 95% CI: 55.5-64.5) of the participants had a positive attitude towards COVID-19 prevention measures. Studies in 8 teaching hospitals in Ethiopia (94.7%); 41 among health care workers in Pakistan (86.5%), 42 among residents in Malaysia (86.5%), 37 in 10 universities in China (73.8%), 43 in Uganda (72.4%), 44 and in India (97.3%) 45 and in Bangladesh (78.9%) 19 reported higher rates. These rates are similar to those in Addis Ababa (60.7%) 36 but higher than in Pakistan (44%) 46 and Makerere University Teaching Hospital in Uganda (21%). 47 These discrepancies may be due to variations in study populations and the commencement dates and effectiveness of prevention programs. In this study, the odds of having a positive attitude among students who had good knowledge about COVID-19 prevention measures were 2.69 times higher than for those with poor knowledge. Similar results were reported from Addis Ababa, 36 Sidama Region in southern Ethiopia 48 and Bangladesh. 19 The odds of having a positive attitude among students living in households larger than 5 persons were 1.56 times higher than among those in households smaller than 5 persons, a finding in line with a study in Gondar, Ethiopia. 49 Students in Dessie schools who received training about COVID-19 prevention measures had a 1.64 times higher positive attitude score than those who did not receive training, similar results in studies in South Gondar Zone hospitals. 50 The great majority (351, 84.2%) of participants believed COVID-19 can be controlled in Dessie City. Similarly high levels of confidence in the success of control programs were reported in Malaysia (95.9%), 37 Nigeria (85%), 38 Bangladesh (86.8%), 20 and the United Arab Emirates (89.0%) 51 but our levels were higher than in Iran (47.1%), 52 Syria (60.1%), 21 Tigray Region (74.3%), 53 and Ataye District Hospital in Ethiopia (7.2%). 54 These variations may be due to differences in the effectiveness of control programs and attitudes toward government programs. More than half (246, 59.0%) of the students worried about contracting COVID-19, a figure similar to those in studies in Nepal (70.9%), 24 India (72%), 55 and Nigeria (56.37%). 56 More than half (234, 56.1%) (95% CI; 51.3-60.9%) of the students had less misconceptions about prevention measures of COVID-19 disease, this finding is similar to that from a study in Saudi Arabia (56.2%) 4 but lower than from a research in China (98%). 57 These discrepancies could be due to differences in data collection methods and socio-demographic characteristics of study populations and the effectiveness of prevention programs. A small proportion (74, 17.7%) of the participants believed that females are more vulnerable to COVID-19 infection than males. This proportion was lower than in a study in Saudi Arabia (56.2%). 4 This study reveals that students who had a positive attitude about COVID-19 prevention and control measures had 1.56 times fewer misconceptions than those who had a negative attitude, corroborating results from a study in Saudi Arabia. 58 Due to the fear of being called uninformed, study participants may have provided socially acceptable answers to the knowledge and attitude questions. Another limitation is the cross-sectional study design, which did not allow assessment of the causality of the associations between knowledge, attitudes, misconceptions and preventive practices. We recommend longitudinal studies that examine the dynamics of knowledge and preventive behavior in the changing COVID-19 risk, intervention and socioeconomic environment in Ethiopia. Another limitation is that our study was not a comparative study of the 2 groups of students (high school and preparatory school); differences in knowledge, attitudes and misconceptions between these 2 groups may be relevant in understanding age-linked and education-linked differences in COVID-19 prevention, as our study indicated, and thus may guide curriculum development. The prevalence of good knowledge about COVID-19, positive attitudes, and less misconception towards preventive and control measures of COVID-19 among students in Dessie City were relatively low. After adjusting for covariates, we found positive attitude and large household size to be associated with good knowledge of COVID-19. Having good knowledge of COVID-19 prevention, living in large families, having IPC training, and having a low level of misconceptions were associated with a positive attitude. Similarly, age above 18 years, positive attitude, and IPC training were independent indicators of low misconception. Therefore, the Health and Education Department and each school in Dessie City should promote awareness and prevention practices in high schools and preparatory schools through appropriate health education programs, especially among younger students, to reduce misconceptions about and exposure risk to COVID-19. The COVID-19 pandemic: diverse contexts; different epidemics-how and why? Facemask wearing to prevent COVID-19 transmission and associated factors among taxi drivers in Dessie City and Kombolcha Town COVID-19 coronovirus pandemic Predictors of misconceptions, knowledge, attitudes, and practices of COVID-19 pandemic among a sample of Saudi population Knowledge, attitudes, and practices toward covid-19 and associated factors among university students in Mizan Tepi University The pandemic of coronavirus: misconceptions from the land of Mesopotamia Knowledge and perceptions of COVID-19 among the general public in the United States and the United Kingdom: a cross-sectional online survey Coronavirus disease (COVID-19) advice for the public: myth busters Preventive practice and associated factors towards COVID-19 among college students in Amhara Region, Ethiopia: a cross-sectional study Knowledge, attitude, prevention practice, and associated factors toward COVID-19 among preparatory school students in Southwest Ethiopia Survey tool and guidance: rapid, simple, flexible behavioural insights on COVID-19 Community perception survey-COVID 19 knowledge, attitude and practice survey in Kabul, Kunduz and Khost Province. The Johannitter International Assistance National Institute of Environmental Health Science. COVID-19_BSSR_Research_Tools.pdf Myths, misconceptions, othering and stigmatizing resources to COVID-19 in South Africa: aA rapid qualitative assessment COVID-19: infection prevention and control checklist for long-term care and retirement homes Goodness of fit tests for the multiple logistic regression model Knowledge, attitudes, and practices toward COVID-19 among university students in Japan and associated factors: an online cross-sectional survey Knowledge, attitudes, and practices related to the COVID-19 pandemic among Bangladeshi youth: a web-based cross-sectional analysis Level of community readiness for the prevention of COVID-19 pandemic and associated factors among residents of Awi Zone, Ethiopia: a community-based cross-sectional study Knowledge, attitudes and practices of COVID-19 among urban and rural residents in China: a cross-sectional study attitudes and practices (KAP) towards pandemic COVID-19 among Syrians. Res Sq Healthcare workers' knowledge, attitude, and practice regarding personal protective equipment for the prevention of COVID-19 Healthcare workers' knowledge, attitude and practices during the COVID-19 pandemic response in a tertiary care hospital of Nepal The COVID-19 crisis in Sub-Saharan Africa: knowledge, attitudes, and practices of the Nigerian public Assessment of knowledge, practice and associated factors towards prevention of novel vorona virus among clients attending at Debre Tabor General Hospital Debre Tabor Town, North West Ethiopia, 2020: institutional based cross-sectional study Knowledge and preventive practices towards Covid-19 and associated factors among healthcare workers in selected health facilities of Illu Aba Bor and Buno Bedelle Zones, Southwest Ethiopia. Res Sq Knowledge and practice of clients on preventive measures of COVID-19 pandemic among governmental health facilities in South Wollo, Ethiopia: a facility-based cross-sectional study Knowledge, attitude, and practice regarding COVID-19 outbreak in Bangladesh: an online-based cross-sectional study Knowledge, attitude and practices (KAP) of rural population about COVID-19: a community-based study in Talkha District Evaluation of knowledge, attitude, practice and hospital experience regarding COVID-19 amongpost-partum mothers at a tertiary care center: a cross-sectional study Knowledge, attitude and practice towards COVID-19 among chronic disease patients at Addis Zemen Hospital, Northwest Ethiopia Knowledge, attitude, and precautionary measures towards COVID-19 among medical visitors at the University of Gondar comprehensive specialized hospital Northwest Ethiopia Factors determining the knowledge and prevention practice of healthcare workers towards COVID-19 in Amhara region, Ethiopia: a cross-sectional survey Adherence with COVID-19 preventive measures and associated factors among residents of Dirashe district, Southern Ethiopia COVID-19 and the public response: knowledge, attitude and practice of the public in mitigating the pandemic in Addis Ababa Public knowledge, attitudes and practices towards COVID-19: a cross-sectional study in Malaysia Corona virus disease 2019 (COVID-19): knowledge, attitudes, practices (KAP) and misconceptions in the general population of Katsina State Knowledge, attitudes and practices of COVID-19 among income-poor households in the Philippines: a cross-sectional study Knowledge and understanding among medical imaging professionals in India during the rapid rise of the covid-19 pandemic Knowledge, attitude and practice of healthcare workers towards COVID-19 and its prevention in Ethiopia: a multicentre study Knowledge, attitude and preventive practices related to COVID-19 among health professionals of Punjab province of Pakistan A cross-sectional survey of knowledge, attitude and practice associated with COVID-19 among undergraduate students in China Awareness, knowledge, attitude and practice towards measures for prevention of the spread of COVID-19 in the Ugandans: a nationwide online cross-sectional survey. Front Public Health Indian community´s knowledge, attitude & practice towards COVID-19 Knowledge, attitude, and practices of Community pharmacists about COVID-19: a cross-sectional survey in two provinces of Pakistan Coronavirus disease-2019: knowledge, attitude, and practices of health care workers at Makerere university teaching hospitals Knowledge, attitudes, and practices related to COVID-19 pandemic among adult populations in Sidama Regional State, Southern Ethiopia: a community based cross-sectional study Knowledge and attitude of the communities towards COVID-19 and associated factors among Gondar City residents, northwest Ethiopia: a community based cross-sectional study Knowledge, attitude, and preventive practices towards COVID-19 and associated factors among adult hospital visitors in South Gondar Zone Hospitals, Northwest Ethiopia COVID-19 knowledge, attitudes, and practices of United Arab Emirates medical and health sciences students: a cross sectional study Public knowledge, attitude, and practice towards COVID-19 in Iran. Res Sq Knowledge, attitudes, and practices towards COVID-19 pandemic among quarantined adults in Tigrai Region Knowledge, attitude, practice towards COVID-19 pandemic and its prevalence among hospital visitors at Ataye district hospital, Northeast Ethiopia Study of knowledge, attitude, anxiety & perceived mental healthcare need in Indian population during COVID-19 pandemic Survey data of COVID-19-related knowledge, risk perceptions and precautionary behavior among Knowledge, attitudes, and preventative practices (KAPs) towards COVID-19 among international students in China community practice of using face masks for the prevention of COVID-19 in Saudi Arabia This includes studies and reviews conducted by multidisciplinary teams as well as research which evaluates the results or conduct of such teams or healthcare processes in general. The journal covers a very wide range of areas and welcomes submissions from practitioners at all levels, from all over the world. The manuscript management system is completely online and includes a very quick and fair peer-review system We gratefully acknowledge the Wollo University College of Medicine and Health Science Ethical Review Committee for providing the ethical clearance letter, that allowed us to do this research. We also acknowledge Dessie City Education Department and the school administrations for their cooperation during this study by providing essential information and support. Moreover, we would also like to extend our special thanks to the data collectors, supervisors, and study participants for their valuable contributions and cooperation. The authors report no conflicts of interest in this work. AOR, adjusted odds ratio; COR, crude odds ratio; COVID-19, coronavirus disease; IPC, infection prevention and control.