Assessment of Novel Coronavirus (COVID-19) Knowledge and Perceptions in Nigeria
Chapter One
Objectives Of The Study
The study aimed at investigating the knowledge, prevalence and perception of coronavirus epidemic in Nigeria.
- To examine the knowledge of Covid 19 among Nigerians.
- To investigate the prevalence of Covid 19 in Abuja.
- To ascertain the perception of Covid 19 spread and steps to curb the pandemic.
CHAPTER TWO
LITERATURE REVIEW
Overview of Coronavirus Disease
Coronavirus Disease is a contagious disease that first emerged in Wuhan, China in 2019. It was later coded “COVID-19” by the W.H.O which stands for Coronavirus Disease 2019. The Coronavirus outbreak remains one of the worst global pandemics for decades. The mortality rate soared and the easy of spread was upsetting. Research shows that older people and those with underlying medical problems like cardiovascular diseases, diabetes, chronic respiratory disease, and cancer were more likely to develop serious illnesses from coronavirus (W.H.O, 2020). Some of the symptoms of Coronavirus include; Sore throat, runny nose, constant coughing/sneezing, breathing difficulty and fatigue.
Illustration of the Morphology of Coronaviruses; the club-shaped viral spike pelomers, coloured red, create the look of a corona surrounding the virion when observed with an electron (Wikipedia,2020a-SARS- CoV-2 without background.png).
As at the time of this study, there were no reliable treatments for Coronavirus, but a series of researches were in the pipeline across the world towards finding a clinical vaccine for the contagion. However, recent events shows that behavioural change can help contain the spread of coronavirus. Some of the suggested measures to halt the coronavirus pandemic include; improved individual habits such as personal hygiene, including constant washing of hands with alcohol-based sanitizers, good respiratory attitude (close coughing and sneezing), and other personal protection practices like wearing of face mask, social distancing, avoiding touching of the face, and reducing contacts with people through self-isolation at home or avoiding nonessential travels or gatherings. Coronavirus is a global problem that requires more action coordination and global cooperation to successfully contain the outbreak and to deal with its aftermath effects. Consequently, the United Nations appealed for 2 billion dollars to support global response efforts towards tackling the coronavirus pandemic. The consequences of COVID-19 could be more severe; if people do not comply or adhere strictly to public health regulations and advice.
Global Responses to Coronavirus Pandemic
A proactive response is critical to the containment of any disease outbreak, but the coronavirus took the world by surprise and most countries were not prepared initially for the pandemic, including the world powers. Shortly after the outbreak of COVID-19, the World Health Organization (W.H.O) issued guidelines and updates on how to mitigate the spread of the pandemic, and thereafter, many countries adopted different measures in addition to the W.H.O guidelines to contain the spread of the disease. There were lockdowns in most parts of the world, and people were asked to work from home. Some countries even deployed their military to enforce coronavirus restrictions, and to reduce the number of covidiots. There were increased demands for health equipment including, protective gowns, sanitizers, face masks and hand gloves. Countries like the United States and the U.K also opened their visitation doors for medical professionals such as doctors and nurses who were working or willing to treat the effects of COVID-19. Also, large gatherings and sporting activities were suspended at both local and international levels. Big sporting events like the prestigious European Champions League games were played behind closed doors before they were suspended. Global responses to Coronavirus pandemic were varied from country to country, but most countries endorsed the closure of school strategy as a means to contain the spread of COVID-19. Some selected COVID-19 responses across the world particularly as it relates to the closure of schools due to Coronavirus are highlighted below:
CHAPTER THREE
RESEARCH METHODOLOGY
Introduction
This section presents Methodology used in the study. It is presented under; Research Design, Target population, Sample Size, Sampling Technique and, Research Instruments, Validity of Research instruments, Reliability of Research instruments, Data collection procedures and Data Analysis Techniques.
Research Design
This study used a descriptive survey research design. In using this design, data collection was carried out in a structured process. Kumar (2005) argues that the goal of descriptive research is to describe the characteristics of a selected phenomenon and involves the collection of data without manipulation of variables. The sole purpose of descriptive research is to provide an accurate and valid representation of the factors or variables that are relevant to the research question. Descriptive survey research is helpful in indicating trends in attitudes and behaviors, and enables generalization of the findings of the research study to be done.
Neuman, (2000). This design is appropriate for this study because it will enhance the amount of quality information.
Sources of Data
The data for this study were generated from two main sources; Primary sources and secondary sources. The primary sources include questionnaire, interviews and observation. The secondary sources include journals, bulletins, textbooks and the internet.
Population of the study
A study population is a group of elements or individuals as the case may be, who share similar characteristics. These similar features can include location, gender, age, sex or specific interest. The emphasis on study population is that it constitutes of individuals or elements that are homogeneous in description (Prince Udoyen: 2019). Target population is finite in size, exists within a given time frame, and is accessible. Patton (2002) argues that for a target population to be plainly defined there is need to clearly define the properties that the researcher anticipates to investigate by use of a working definition.
The study targeted the residents in Abuja because it is one of the biggest corona virus hit zone in Nigeria. A population sample of 500 residents was selected for the study.
CHAPTER FOUR
DATA ANALYSIS AND RESULTS PRESENTATION
A total of 589 respondents participated in this online survey. Majority of the study population were male 59.6% (351), 80.6% (475) were between ages 18–39 years, 90.4% (522) had a college (Bachelor) degree or above and 56.2% (331) reside in urban areas respectively. The majority of the respondents 58.7% (346) and 56.5% (333) live in residences arranged in linear (straight) street patterns and houses with a maximum of 5 inhabitants (Table 1).
The current findings showed that almost all the respond- ents 99.5% (586) had knowledge of COVID-19 with the majority of the respondents 55.7% (328) and 27.5% (162) stating the internet/social media and Television (TV) as their major source of knowledge. Although 91.9% (541) of the respondents agreed that COVID-19 is caused by a virus, only 55.3% (326) believed that it is similar to SARS. Knowledge regarding the transmission of COVID-19 showed 99.2% (584) and 92.2% (543) believed everyone is at risk of infection and COVID-19 virus have between 1 and 14 days incubation period while 93.0% (548) and 88.5% (521) of the respondents knew that COVID-19 virus can be transmitted through Air droplets (from patients’ sneezing/coughing) and Close contact with infected persons. Also, majority of the respondents mentioned breathing difficulty 94.6% (557), dry cough 89.6% (528) and high fever 86.9% (512) as COVID-19 symptoms. However, 76.2% (449) of the respondents believed that it is possible to be infected without showing any symptom, and also 94.7% (558), 81.7% (481) and 58.6% (345) of the respondents opined that alcohol-based sanitizers, soap/detergents and cleaning of surfaces with diluted chlorine could kill COVID-19 virus (Table 2).
CHAPTER FIVE
DISCUSSION OF FINDINGS AND CONCLUSION
Discussion
The emergence of COVID-19 from the city of Wuhan, China in December 2019 and its rapid global spread across over 215 countries and territories has become one of the largest pandemics in recent times with several devastat- ing and significant public health challenges [3]. Being the most populous African nation and the 7th most populated country in the world, Nigeria’s population could undoubt- edly be associated with a higher risk of increased morbid- ity and mortality due to COVID-19. With the infection prevention and control (IPC) strategies adopted by the NCDC and Nigerian government to curtail COVID-19, the adherence of the citizenry depends largely on their level of awareness and knowledge regarding the pandemic [5]. Unconcerned attitudes and adherence to false and super- stitious beliefs by the public often arise due to inadequate awareness, which further affects the level of preparedness and the proper implementation of IPC measures at the national or subnational levels.
This study is the first epidemiological survey aimed at assessing the KAP of individuals within north-central Nigeria towards the COVID-19 pandemic as well as iden- tifying key areas of concerns and needs for optimal sub- national and community intervention. Collating such infor- mation is necessary for the promotion of major preventive behaviors including personal hygiene, social distancing as well as appraising the challenges emanating as a result of prolonged lockdown and restrictions. With the novelty of COVID-19 and its pathological and epidemiological uncertainties, the study of the population levels of KAP becomes critical for efficient health planning, implementa- tion and management of the public.
This survey was dominated by male (59.6%) and single (60.1%) respondents who are mostly educated up to college (Bachelor) degree or above (90.4%) with an overall 99.5% perception of Covid-19 thus, depicting that the respondents are knowledgeable about COVID-19 pan- demic. In agreement with our findings, previous studies conducted in different Asian countries [5, 19–21], Egypt, Kenya and Nigeria [1, 22, 23] indicated high COVID- 19 knowledge among the population. The high level of COVID-19 knowledge recorded in this study could be attributed to the caliber of respondents who participated in the survey. In the study area, only the educated use social media and the internet since they understand the use of the English Language. Those with college (Bachelor) degree or higher educational qualifications, and less than 40 years old constituted the vast majority of the respond- ents in this study (Table 1). Although the high level of COVID-19 awareness among the respondents signifies a positive predictor in curtailing COVID-19 pandemic within north-central Nigeria, the result however excluded the underprivileged (uneducated and vulnerable) individuals. The use of social media (55.7%) and TV (27.5%) con- stitute the major sources of information about COVID-19. This is consistent with other findings that reported the use of social media as the major tool for COVID-19 informa- tion [1, 5, 21]. In Nigeria, the use of the social media especially WhatsApp, Facebook and the internet constitute the main sources of information with about 85.49 million users recorded within the first quarter of 2020 of which more than 70% are youth [24] (who constitute the major- ity of the respondents in this study). Right from the WHO declaration of COVID-19 as pandemic, several guidelines and information on COVID-19 have been uploaded online by WHO and NCDC which are easily accessible by inter- net users. Access to such reliable information could help dispel the pandemic of misinformation, misconception and citizenry ignorance about COVID-19.
Although 91.7% of the respondents believed that COVID-19 is caused by a virus, only 55.5% agreed that it is similar to SARS. The transmission routes, incubation period and symptoms of COVID-19 are well recognized by the respond- ents. Also, 99.2% of the respondents believed that every- one is at risk of getting infected with the COVID-19 virus. This further reflects the effectiveness of the social media and internet in the creation of awareness about COVID-19 pandemic within the Nigerian population however, some media platforms often exaggerate the risk associated with COVID-19 pandemic [1].
Our findings on respondents’ knowledge on the transmission, incubation period and symptoms of COVID-19 aligns with the findings of Saqlain et al. [21] and Giao et al. [20] who reported good knowledge (93.2% and 89.51%) of par- ticipants regarding COVID-19 transmission and symptoms. Nevertheless, in another study conducted among the Ira- nian population, a lower proportion of the study population (56.5%) had sufficient knowledge of COVID-19 transmis- sion and symptoms [25] when compared with the current study.
The majority of the respondents in this study reportedly took different precautionary measures including social dis- tancing, improved personal hygiene and use of face mask during the lockdown period. This generally indicates the optimism and willingness of the Nigerian population in effecting attitudinal and behavioral changes relevant in the fight against the COVID-19 pandemic. The awareness and sensitization campaigns by the Federal Ministry of Health (FMOH) and the NCDC have significantly reflected in the attitude of the respondents as 94.7% are aware of the pre- ventive guidelines laid down by the government and 79.5% reportedly follow those guidelines accordingly. Though 90.3% of the respondents agreed that all crowded places should be avoided during the COVID-19 pandemic, however, 27.5% sometimes visited crowded places during the period of the survey. The inability of the various states and local governments within the Nigerian north-central region to implement very strict IPC measures including total lockdown, banning of all public gatherings, social distancing and the compulsory use of face mask becomes noticeable risk behaviors among the study population. The higher risk of visiting crowded places as recorded in this study is attrib- uted to the age brackets of the respondents, as most of them (80.1%) are below 40 years of age. More so, most of the young people within the study area still live on menial jobs for their daily survival even during the pandemic and lock- down as government palliatives were not provided during the time of the survey. Furthermore, due to fewer number of COVID-19 positive cases within north-central Nigeria dur- ing the study period [26], residents believed they are at lower risk of contracting COVID-19 virus as similarly reported in a study conducted among residents in non-Hubei districts of China [5]. This study showed a significant (p < 0.05) rela- tionship existing between good knowledge of COVID-19 amongst residents of north-central Nigeria and positive atti- tude towards COVID-19.
As part of the protective measures against COVID-19, 45.3% of the respondents believed prayer is also effectual in COVID-19 prevention. This agrees with the previous findings of a KAP survey on COVID-19 within a Nigerian population [23]. This finding is consistent with the strict religious adherence and beliefs among Nigerians which foster increasing carefree and lackadaisical attitudes of the populace, making the majority of the population to resort to only prayers and religious rituals during disease outbreaks without recourse to laid down IPC measures [27]. The direct involvement of religious leaders and clerics by the Nigerian government in the fight against COVID-19 would immeasurably aid in the dissemination of factual information about COVID-19 among their followers.
The major adaptive activities resorted to by the major- ity of the respondents during the implementation of strict lockdown policy were spending time on social media (Facebook and WhatsApp), watching TV/movies and read- ing books/magazines. However, although 50.6 and 40.6% of the respondents were bored and nervous, 38.7, 34.1 and 7.5% were fearful/paranoid, stressed and having insomnia while only 1.2% were happy regarding the COVID-19 pandemic situation. Our findings are similar to the report recently recorded from an Indian population in response to the COVID-19 pandemic [8]. Once a larger proportion of the population becomes anxious and paranoid during epidemics/ pandemics, panic buying, stress, rumors and exhaustion of available resources become the resultant effects. The drastic change in dietary needs, food consumption, lifestyle, behaviors and daily routines are usually observed [8]. Also, various measures including social distancing policies, lockdown, travel ban, self- isolation and quarantine among others and the wild misconceptions in the media might have further contributed adversely to the mental health and psyche of the respondents [28]. This indicates that despite possessing significant knowledge about COVID-19 by the majority of the respondents as earlier reported, the respondents are still largely influenced by media misinformation and misconcep- tion, rumors, superstitious and religious beliefs. The media especially social media, TV and the internet negatively influ- ence mental wellbeing with an attendant increase in anxiety level [8].
The perception of the study population regarding governments’ efforts in mitigating the COVID-19 pandemic in Nigeria showed that only 25.3% of the respondents were satisfied with government efforts. Despite public outcry especially by the Trade Union Congress (TUC) of Nigeria and Nigerian Medical Association (NMA) opposing govern- ment plan to invite Chinese doctors to fight COVID-19 in Nigeria, the government proceeded with their plan prior to this survey. However, majority of the respondents (68.1%) have no faith in Chinese doctors’ intervention in Nigeria. The NMA vehemently argues that spike in COVID-19 cases and death in Italy coincided with the arrival of Chinese med- ical experts, moreover Chinese doctors are not licensure to practice in Nigeria [29]. Should COVID-19 vaccines be developed and made available, only 29.0% of the respondents would accept to be vaccinated. The increased rejection and indecisiveness of accepting COVID-19 vaccines when available may be attributed to the fear and misconceptions trending on the media about COVID-19 vaccines and associ- ated health dangers.
Most of the respondents (90.2%) believed that community spread of COVID-19 within the study area could be reduced through adherence to all the FMOH and NCDC IPC guide- lines. Additionally, 70.5% of the respondents were optimistic about the possible prevention of future pandemics as 82.5% opined that the establishment of early alerts and global warning are key in preventing the occurrence of a global pandemic in the future. The majority of the study popu- lation (93.7%) were willing to read and share with others the right information about COVID-19. Based on the data analyzed, community response to COVID-19 pandemic will significantly (p < 0.05) decrease community transmission of COVID-19 virus in north-central Nigeria.
Due to limited accesses to phones and internet, the under- privileged and vulnerable Nigerian population especially the older adults, unemployed, illiterates, farmers, rural and semi-urban dwellers (who constitute a significant number of the population with the study area) are more probably to have limited and/or poor knowledge about COVID-19. Undoubtedly, this would result in negative KAP towards COVID-19 hence, negating all efforts geared towards COVID-19 mitigation. Therefore, conducting KAP regarding COVID-19 among the underprivileged and vulnerable Nigerian pop- ulation deserves immense and urgent attention especially with the daily increase in COVID-19 cases. Further stud- ies could use open-ended questions, in-depth interviews or focus group discussion for adequate assessment of attitudes and practices of the population towards COVID-19. With the current government plans to initiate gradual easing of the lockdown, public health experts could visit households to assess adequate KAP regarding COVID-19 and associated public health, socio-economic and psychological burdens.
For the last few couple of months, COVID-19 has risen into a major global public health challenge with no known pharmaceutical treatment or vaccines, as such different treatment options are currently been explored. The identification of national, sub-national or community levels of KAP towards COVID-19 will enable the prompt identi- fication and adequate design of cost-effective and viable public health campaigns. The present study reveals the need for intensified and comprehensive health education programs focused on the dissemination of consistent and harmonized information to the public. The Nigerian government and NCDC should urgently take proactive meas- ures in counteracting and dispelling different trending mis- conceptions, misinformation, tales and conflicting medical opinions about COVID-19. With the increasing usage of the media, internet and telecommunication amongst the Nigerian population [24], the government would undoubt- edly benefit immensely in the utilization of both the telecommunication, social and traditional media in massive dissemination of adequate information.
Conclusion
This study provides a comprehensive assessment of the KAP of residents of north-central Nigeria towards COVID-19 during the second and third weeks of the strict lockdown enforced by the government. The findings sug- gest that Nigerians who participated in this study have good level of knowledge on COVID-19 with a positive attitude and compliance with the necessary IPC measures outlined by the government, which are necessary for mitigating the spread of COVID-19. Despite their demerits, social media and the internet contributed significantly to the acquisition of the needed knowledge. There was no remarkable satisfaction in the government efforts in cur- tailing COVID-19 especially the involvement of Chinese doctors. Efforts toward assessing the KAP of the under- privileged and vulnerable population and the dissemina- tion of health education via indigenous languages among these groups should be intensified. Efforts targeting every group of the Nigerian population would constitute holistic and viable approach in curtailing COVID-19.
Acknowledgements All authors have interest on public health, emerg- ing infectious diseases and disease control. They have over the years worked on Ebola, Lassa, rabies among other infections. They are trained public health microbiologists, clinical psychologists and fac- ulty members.
Compliance with Ethical Standards
Conflict of interests The authors declare that they have no conflict of interest.
Ethical Approval The approval for this research was given by the Research and Ethics Committee (REC) of Plateau State University, Bokkos, Nigeria. Furthermore, data obtained from each respondent were anonymous and confidentially treated.
Informed Consent Participation in this survey was anonymous, con- sensual and voluntary with informed consent given by all prospective respondents.
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