key: cord-0722940-k5883w6s authors: Nwafor, J. I.; Aniukwu, J. K.; Anozie, B. O.; Ikeotuonye, A. C. title: Knowledge and practice of preventive measures against COVID-19 infection among pregnant women in a low-resource African setting date: 2020-04-20 journal: nan DOI: 10.1101/2020.04.15.20066894 sha: 3bf1b66287bec879c20d05998acaad085963287b doc_id: 722940 cord_uid: k5883w6s Background: Coronavirus disease pandemic has resulted in death of thousands of people across several countries. Several preventive measures have been recommended to halt the spread of the disease and its associated mortality. However, the level knowledge and practice of these preventive measures against COVID-19 infection among pregnant women, which constitute vulnerable groups, are yet to be evaluated. Aim: To determine the knowledge and practice of preventive measures against COVID-19 infection among pregnant women in Abakaliki. Materials and Methods: This was a self-administered questionnaire-based cross-sectional study conducted from February 1, 2020 to March 31, 2020 among 284 antenatal clinic attendees at Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi State. A pretested and validated questionnaire was used to collect the data. Data analysis was done using SPSS version 22. Results: Of 284 participants, 60.9% (n=173) had adequate knowledge of the preventive measures against COVID-19 infection. However, the overall practice of these preventive measures among the participants were poor as 69.7% of the participants were not practicing the preventive measures against the coronavirus. The determinants of poor practice of the preventive measures among the participants were being in age group 31-40 years (AOR=2.04, 95%CI: 1.26 - 5.37, p=0.022), married (AOR=2.99, 95%CI: 1.40 - 6.33, p=0.035) grandmultiparous (AOR=3.11, 95%CI: 1.32 - 6.56, p=0.021), residing in rural area (AOR=2.08, 95%CI: 1.32 - 4.05, p=0.031), and having no formal education (AOR=6.73, 95%CI: 2.66 - 18.34, p=0.002). Conclusion: The study showed that most of the participants had adequate knowledge of preventive measures against COVID-19 infection but the practice of these preventive measures were poor among the participants. Emerging infections have been shown to have adverse impact on pregnant women and their fetuses as shown by recent pandemic caused by 2009 pandemic H1N1 influenza virus and the severe fetal effects of Zika virus. 1 In December, 2019, a series of pneumonia cases of unknown cause emerged in Wuhan (Hubei, China), with clinical presentations resembling viral pneumonia. Deep sequencing analysis from lower respiratory tract samples indicated a novel coronavirus that was later named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). 2 The infection has spread to over 110 countries including Nigeria prompting World health organization to declare it a pandemic on March 11, 2020. 3 Globally, as of April 15, 2020, there have been 1,914,916 confirmed cases of COVID-19, including 123,010 deaths, reported by WHO. 3 Nigeria Centre for Disease Control announced the first confirmed case of coronavirus disease in Nigeria on February 27, 2020 and since then many confirmed cases have been reported in many States across the country. 4 Early efforts have focused on describing the clinical characteristics and outcomes of Covid-19 in the general population. 5 However, the disease appears to be particularly impactful in special populations that include those older than 65 years of age. 6 Pregnant women are also considered to be a special population group because of the unique 'immune suppression' caused by pregnancy. 7 The immunologic and physiologic changes of pregnancy might make pregnant women at higher risk of severe illness or mortality with Covid-19, compared with the general public. 6, 7 However, there is little information on Covid-19 infection during pregnancy. [7] [8] [9] There are limited case series reporting the impact on women affected by coronaviruses (CoV) during pregnancy. 1, 2, 6 In women affected by other coronavirus infections such as . CC-BY-NC-ND 4.0 International license It is made available under a 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 April 20, 2020. . https://doi.org /10.1101 /10. /2020 Middle East Respiratory Syndrome (MERS-CoV) and Severe Acute Respiratory Syndrome (SARS-CoV), the case fatality rate appeared higher in women affected in pregnancy compared with non-pregnant women. 10 To curtail the continued spread of the coronavirus disease and its associated mortality, World Health Organisation has recommended series of preventive measures including regular hand washing with water and soap, social distancing, covering hand and mouth while coughing and avoiding touching eyes, nose and mouth. 11 In Nigeria, this preventive measures have been adopted to prevent further spread of the virus in the country. The government of Nigeria has also engaged in media campaigns to disseminate information on these preventive measures to the general public. However, the level of knowledge and practice of these preventive measures against COVID-19 infection among pregnant women, which constitute vulnerable groups, are yet to be evaluated. Therefore, this study aimed to determine the knowledge and practice of the preventive measures of coronavirus infection among pregnant women attending antenatal care at a tertiary hospital in Abakaliki, South-east, Nigeria. . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted April 20, 2020. Study design, period and area: This is a cross-sectional study that was conducted among pregnant women attending antenatal care at Alex Ekwueme Federal University Teaching Hospital, Abakaliki from February 1, 2020 to March 31, 2020. Ebonyi state is one of the five states in the South-east geopolitical zone of Nigeria. 12 Abakaliki is a semi-urban area and the capital of Ebonyi State, Nigeria. The population comprises mainly of subsistence farmers and petty traders. Christianity forms their major religion and the inhabitants are predominantly Igbo speaking. All consenting eligible pregnant women who attended antenatal care during the study period. Study criteria: All women who gave informed consent to participate in the study were included in the study. Participants who had a verbal communication problem and complete loss of hearing were excluded. The sample size was calculated by taking variability of proportion of 18% from the average of 450 pregnant women who attend antenatal clinic per month in the hospital. 13 Using Open Epi software package for the determination of sample size and design effect of 1.5 at error margin of 5%, the final minimum sample size was calculated as 227. After considering 10% non-response rate for any unpredictable events, the final required sample size was 249.7. However, 284 women were recruited for the study. The study participants were selected by using simple random sampling method and the first participant was selected by using lottery method. The dependent (outcome) variables for this study were the level of knowledge and practice of preventive measures against COVID-19 infection. The . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted April 20, 2020. CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted April 20, 2020. The questionnaire has 12-item scale (6-item for knowledge questions and 6-item for practice questions). The scoring system of women's knowledge and practice of preventive measures was either 2 (for correct answer) or 0 (for incorrect answer). The minimum score was 0 whereas the maximum score was 12 each for both knowledge and practice component of the questionnaire. The reliability of the questionnaire was checked by conducting a pretest among pregnant women in the antenatal clinic, by taking 5% of the sample size. From the pretest, understandability, clarity, and organization of the questionnaire were checked. From the reliability test of knowledge and practice questions, 0.898 Cronbach's alpha value was found. The questionnaire was prepared in English language and then translated to Igbo (local language in Abakaliki) that was used for data collection and re-translated back to English to check its consistencies. The questionnaire was then refined accordingly for final use. Two trained house officers participated in data collection. The data collector were trained for one day on the techniques of data collections. The training also included the importance of disclosing the possible benefit and purpose of the study to the study participants before the start of data collection. . CC-BY-NC-ND 4.0 International license It is made available under a 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 April 20, 2020. were expressed as adjusted odds ratio (AOR) at 95% confidence interval, with level of significance set at p < 0.05. Committee (REC) of the Alex Ekwueme Federal University Teaching Hospital, Abakaliki. Informed consent was taken from the study participants after informing the study subjects on study objectives, expected outcomes, and benefits associated with it. Confidentiality of responses was maintained throughout the study. . CC-BY-NC-ND 4.0 International license It is made available under a 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 April 20, 2020. Only 30.3% of the participants' practices to prevent human-to-human transmission of the virus were within good practice scores. The sources of information on coronavirus infection pandemic for the study participants is shown in Table 2 . The commonest source of information for the participants was the television (82.7%), followed by friends and relatives (78.5%). Health workers and internet accounted for 39.8% and 44.7% of sources of information for the participants respectively. Participants' responses of knowledge of coronavirus infection and its preventive measures are shown in Table 3 . Cough (75.7%) and difficult breathing (82.4%) were most common symptoms known by participants. Just over half (53.9%) of the . CC-BY-NC-ND 4.0 International license It is made available under a 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 April 20, 2020. were less likely to have adequate knowledge when compared with younger age groups. On the other hand, women who were above para 5 were less likely to have inadequate . CC-BY-NC-ND 4.0 International license It is made available under a 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 April 20, 2020. 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 April 20, 2020. . CC-BY-NC-ND 4.0 International license It is made available under a 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 April 20, 2020. Because COVID-19 is an emerging infectious disease, the optimal treatment for affected individuals has not yet been established. 1, 2, 6 Currently, the effect of coronavirus infection in pregnancy is not well described. 14 It is important that . CC-BY-NC-ND 4.0 International license It is made available under a 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 April 20, 2020. Although, case reports from advanced countries about the outcome of coronavirus disease in pregnancy appear to be good 8 and and these outcomes were achieved with intensive, active management that might be absent in most developing countries due to poor healthcare system prevalent in resource-constrained settings. Therefore, pregnant women require special attention in relation to prevention, diagnosis, and management. In order to effectively contain the spread of the coronavirus infection to Nigerian population and to protect vulnerable populations such as pregnant women, this current media campaign should be extended to rural areas where access to electronic media is limited. In addition, provision of economic palliative support to families who depend on daily income for survival would likely encourage women, who in some cases are . CC-BY-NC-ND 4.0 International license It is made available under a 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 April 20, 2020. . https://doi.org/10.1101/2020.04.15.20066894 doi: medRxiv preprint the breadwinners in many households, to adopt preventive measures to halt the spread of this virus in Nigeria. The strength of this study is that it is the first study to evaluate the knowledge, practice and sociodemographic variables associated with poor knowledge and practice of preventive measures against coronavirus infection among pregnant mothers in a low-resource setting. These associated factors of poor practice were determined using bivariate and multivariate logistic regression analysis. These statistical methods are appropriate and efficient method for determining associations between dependent and independent variables. Despite these strengths, this study has a limitation. It is a single centre study which limits the generalization of the study findings to the study area. A multicentre study would have been ideal. In conclusion, this study showed that most of the participants had adequate knowledge of preventive measures against COVID-19 infection. However, the practice of these preventive measures were poor among the participants. Multiparity, rural residence, low level of educational attainment and occupations (such as farming, trading and artisan) were factors significantly associated with poor practice of the preventive measures against coronavirus -19 infection among pregnant women. The authors declare no conflict of interest . CC-BY-NC-ND 4.0 International license It is made available under a 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 April 20, 2020. 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 April 20, 2020. . CC-BY-NC-ND 4.0 International license It is made available under a 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 April 20, 2020. . CC-BY-NC-ND 4.0 International license It is made available under a 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 April 20, 2020. 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 April 20, 2020. . CC-BY-NC-ND 4.0 International license It is made available under a 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 April 20, 2020. . CC-BY-NC-ND 4.0 International license It is made available under a 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 April 20, 2020. . CC-BY-NC-ND 4.0 International license It is made available under a 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 April 20, 2020. . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted April 20, 2020. . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted April 20, 2020. . https://doi.org/10.1101/2020.04.15.20066894 doi: medRxiv preprint Coronavirus Disease 2019 (COVID-2019) and Pregnancy: What obstetricians need to know Global interim guidance on coronavirus disease 2019 (COVID-19) during pregnancy and puerperium from FIGO and allied partners: Information for healthcare professionals Nigeria Centre for Disease Control. COVID-19 outbreak in Nigeria situation report Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study Royal college of obstetricians and gynaecologists. Coronavirus (COVID-19) infection in pregnancy information for healthcare professionals 2020. 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(which was not certified by peer review) The copyright holder for this preprint this version posted