key: cord-0947509-5csu1xzm
authors: Aronu, Ann E; Chinawa, Awoere T; Ossai, Edmund N; Onukwuli, Vivian O; Chinawa, Josephat M
title: COVID-19: Knowledge of Mode of Spread and Preventive Practices among College Adolescents in Nigeria
date: 2021-02-05
journal: J Trop Pediatr
DOI: 10.1093/tropej/fmab002
sha: a078a82c2fad59a0b601b760d9f6470041abcbff
doc_id: 947509
cord_uid: 5csu1xzm

BACKGROUND: Corona virus pandemic (COVID 19) has emerged as the single most important topical issue and poses a challenge to medicine. Adolescent school children are exposed to a varying degree. OBJECTIVES: The study is aimed to determine the knowledge of the mode of spread and preventive practices among college adolescents attending six secondary schools in Enugu metropolis. METHODOLOGY: This was a cross-sectional study carried out in 6 secondary schools among 500 college adolescents. A pretested, interviewer-administered questionnaire was used for data collection. RESULTS: Majority of the respondents, 98.4% were aware of COVID-19. Although, a higher proportion of the respondents, 52.0% were aware COVID-19 could be transmitted through contact with infected persons, only a minor proportion of them, 42.4% had a good knowledge of the mode of spread of COVID-19. However, a high proportion of the respondents, 69.2% practiced good preventive measures against COVID-19. Also, respondents whose parents were self-employed were 1.4 times more likely to have good knowledge of the mode of spread of COVID-19 when compared with those whose parents were on paid employment [adjusted odd ratio (AOR) = 1.4, 95% confidence interval (CI): 0.9–2.0]. The respondents whose fathers have attained tertiary education were 1.6 times more likely to have good preventive practices against COVID-19 when compared with those who had secondary school and below (AOR = 1.6, 95% CI: 1.04–2.5). CONCLUSION: Though college adolescents were aware of COVID-19, not a significant proportion practiced good preventive measures against COVID-19. Knowledge of mode of spread and preventive practices were significantly enhanced by fathers’ educational status and being a female adolescent child.

COVID-19 is caused by the severe acute respiratory syndrome corona virus 2 (SARS-CoV-2). This has now become a pandemic with significant morbidity and mortality [1] . Since the 31st day of December 2019 and up to 19 September 2020, the time of this report; thirty million, five hundred and forty thousand, four hundred and forty-six cases of COVID- 19 have been reported, including 952 724 deaths [2] . Fever, dry cough, fatigue, myalgia, shortness of breath and dyspnea are noted symptoms of COVID-19 [3, 4] .

Some studies have shown good knowledge of COVID 19. For instance, Al-Hanawi et al. [5] noted a high knowledge score of 17.96 in a scale of 22 in their subjects. Several studies have shown satisfactory levels of knowledge but all these studies are among the adult population [6, 7] .

A study has shown that 98% of people also are aware of the clinical symptoms of COVID 19, but only half of the respondents knew this disease could spread from person-to-person in close contact [7, 8] .

Similarly, 56% of their study population had no knowledge of masking as a means of preventing infection [7] .

There are three major prongs in the prevention of COVID 19. These include wearing of face mask, hand washing and social distancing. Wearing of face mask is noted as one of the preventive measures against COVID 19 and has been seen to be very protective. A study has reported that face masks were 79% effective in preventing transmission [9] . Although it is noted that wearing masks after illness onset does not protect against the infection, a study noted that the use of face mask has shown reduction of infection among families living with someone in isolation or quarantine [10] .

Moreover, the use of face masks has been recommended in the community in the USA [10] . They opined that universal face mask use has the potential to reduce outward transmission from infected but asymptomatic people, as well as protect children from becoming infected.

The use of face mask in this locale is not really imbibed as people are seen either not wearing the mask or hanging it in their chin while going about their business. Strict adherence to the three prong measures of prevention may not be followed by the college adolescents. This could cause surge in number of cases and deaths among these students. The study is thus aimed to determine the knowledge of the mode of spread and preventive practices among college adolescents. The study will help to make policies in secondary schools especially now that preparations are being made for school reopening.

The study was carried out in six different secondary schools located in Enugu metropolis. The schools were drawn from urban and semi urban areas.

A descriptive cross-sectional study among college adolescents attending secondary schools in Enugu Metropolis.

A total of 500 college adolescents from 6 secondary schools were consecutively enrolled into the study. The objectives of the study were explained to the students and information in the proforma of study was described to the adolescents.

Adolescents present at the time of study in the selected secondary schools and who gave consent were enrolled into the study.

Adolescents who did not give consent were excluded from the study.

The sample size of 500 college adolescents was estimated using the formula [11] :

Sampling technique Adolescent students who were included in the study were selected by a two-stage sampling technique. Number of students in the colleges in Enugu metropolis were drawn from a list comprising three local government areas in the metropolis. This was ranked in terms of number of students in the schools. This was done separately for public and private secondary schools in each of the three local government areas. Based on this ranking, the first six schools in the three local government areas were selected. Using a simple random sampling technique of balloting, one private and one public secondary school was selected from each of the three local government areas in the metropolis. This served as the first stage.

List of all students in senior secondary class three and junior secondary class three was made in the second stage. (These are the two classes allowed by the Government of Nigeria to return to school to complete their terminal exams in the wake of COVID-19 pandemic). Nine thousand, nine hundred and sixty-three students in the two classes from the six selected schools were selected. This is the sampling frame. Sampling interval was obtained by dividing the sampling frame by the sample size of 500, hence a sampling interval of 4 was used. In this regard, every 4th student was recruited for the study, based on the sitting arrangement of the students on each day of data collection. The index student for any day data collection was selected using a simple random sampling technique of balloting.

A pretested and validated interviewer administered questionnaire was used in the study. Information obtained included: biodata, occupation and educational level of both parents, class of the adolescent, and perception of and prevention of COVID 19.

Ethical clearance was sought and obtained from the ethics committee of UNTH Ituku-Ozalla Enugu on 12th October 2020. Approval for the study was obtained from the principals of the six secondary schools. Verbal consent was also sought and obtained from the parents or guardians of the students. Verbal consent was also obtained from the students.

Data entry and analysis were done using IBM Statistical Package for Social Sciences (SPSS) statistical software version 25. Continuous variables were summarized using mean and SD, while categorical variables were summarized using frequencies and proportions. Chi-square test and multivariate analysis using binary logistic regression were used in the analysis and the level of statistical significance was determined using a p-value of < 0.05.

The outcome measures of the study included good knowledge of mode of spread of COVID-19 and good preventive practices against COVID-19. Knowledge of mode of spread of COVID-19 was assessed using five variables. For each respondent, a correct answer was assigned a score of one while an incorrect answer was given a score of zero. Respondents that correctly answered 60% of the five variables were regarded as having good knowledge of spread of COVID-19 while those that scored less than 60% were classified as having poor knowledge.

Preventive practices against COVID-19 was assessed using 10 variables. For each of the variables, a correct answer was given a score of one and an incorrect answer a score of zero. Respondents that correctly answered 60% of the 10 variables used to assess preventive practices against COVID-19 were regarded as having good preventive practice while those that scored less than 60% were classified as having poor preventive practice.

In determining the predictors of good knowledge of spread of COVID-19 and good preventive practices against COVID-19, variables that had a p value of <0.2 on bivariate analysis were entered into the logistic regression model. The result of the logistic regression analysis was presented using adjusted odds ratios and 95% confidence intervals (CI) and level of statistical significance was determined by a p value of <0.05. Table 1 shows the socio-demographic characteristics of the respondents. The mean age of the respondents was 15.1 6 1.7 years and a higher proportion of the respondents, 57.8% were 15 years and above. A higher proportion of the respondents, 56.4% were females. Majority of the students, 64.8% were in junior secondary three class. The highest proportion of the parents of the respondents, 35.0% were in the upper socio-economic class. Table 2 shows the awareness of COVID-19 among the respondents. Majority of the respondents, 98.4% were aware of COVID-19. The major sources of information on COVID-19 include local television channels, 33.3%, foreign television channels, 28.3% and newspapers, 23.2%. The major symptoms of COVID-19 as identified by the respondents included cough, 68.8%. Fever 62.4% and difficulty in breathing, 57.8%. Table 3 shows the knowledge of mode of spread of COVID-19 among the respondents. A higher proportion of the respondents, 52.0% were aware COVID-19 could be transmitted through contact with infected persons. A minor proportion of the respondents, 42.6% were aware that COVID-19 could be transmitted through sneezing, while a higher proportion, 62.6% believed that COVID-19 is not air borne. A minor proportion of the respondents, 42.4% had good knowledge of the mode of spread of COVID-19. Table 4 shows preventive practices against COVID 19 among the respondents. Majority of the students, 77.0% used a personal, alcohol-based hand sanitizer. Similarly, a higher proportion of the respondents, 71.4% washed their hands regularly with soap and water. More than half of the respondents, 55.4% always stood 6 feet apart from others in public space. Overall, a higher proportion of respondents, 69.2% practiced good preventive measures against COVID-19. Table 5 shows factors affecting good knowledge of the mode of spread of COVID-19 among the respondents. The respondents who were males were Also, respondents whose parents were self-employed were 1.4 times more likely to have good knowledge of spread of COVID-19 when compared with those who were on paid employment. (AOR ¼ 1.4, 95% CI: 0.9-2.0). Table 6 shows factors affecting good preventive practices against COVID-19 among the respondents. The respondents who fathers have attained tertiary education were 1.6 times more likely to have good preventive practices against COVID-19 when compared with those who had secondary school education and below (AOR ¼ 1.6, 95% CI: 1.04-2.5). Also, the respondents who had good knowledge of the mode of spread of COVID-19 were 7.2 times more likely to have good preventive practices of COVID-19 when compared with those who had poor knowledge. (AOR ¼ 7.2, 95% CI: 4.4-11.9). these measures did not curb the rate of infection as the success or failure of these efforts are largely dependent on every one's knowledge of the preventive practices. Majority of college adolescents in this study; 98.4% were aware of COVID-19. The finding in this study is higher than previous studies who had prevalence of 69.6%, 73.8% and 88.2% in Ethiopia, 80.8% seen in a study in eight countries of five continents and 78.2% seen in Sudan respectively [12] [13] [14] . The variation in prevalence could be due to the sample size used in our study. Secondly it could be due to discrepancy in cut-off values used to categorize the knowledge levels.

Majority of the respondents heard about COVID 19 from the local television channels and foreign television channels, while a few got their information from the internet. This is also similar to a study in an urban slum where majority of adolescents reported that television was a major source of information on COVID-19 [15, 16] . It is important to note that adolescents with internet access could be prone to misinformation on COVID 19 and this could lead to fear and wrong preventive measures towards the infection [16, 17] .

A higher proportion of respondents, 69.2% practiced good preventive measures against COVID-19. This is, however, lower than reports from studies done in Syria, Pakistan and Sudan where proportions of 73.8% [18] 80.5% [19] and 89.9% [20] were obtained respectively. The discrepancy in prevalence of preventive measures could be due to variation in the cut-off values for the assessment of preventive practices. While this study used a cut-off point of 60%, previous studies used above 80% scores to classify adequate preventive practice. Socio-cultural differences could also account for this.

Majority of the adolescents noted that COVID-19 can be prevented through social distancing, use of hand sanitizer and masking.

A study of mask wearing during influenza pandemic in Japan showed that the use of masks was more effective in adolescents than children [21] . The World Health Organization also stated that the 'do no harm' phenomenon on masking in children and adolescents should be observed. The guidelines state that masking in adolescents who are more than 12 years should be same as that of adults [22] . The use of face mask in developing and resource poor countries is very necessary especially when they can make their cloth mask. Cloth mask has been found to be effective with a low cost benefit ratio [23, 24] .

Granted that the adolescents, who had good knowledge of spread of COVID-19 were 7.2 times more likely to have good preventive practices of COVID-19 when compared with those who had poor knowledge, there still exists a huge gap between knowledge of preventive methods and actual practice among the college adolescents. For instance, a high knowledge level of 98.4% and a preventive practice of 69.2% was obtained in this study, showing a gap of 29.2%. A study [25] has reported that only 77.3% of their subjects showed Similarly, those who reported that they had not been going to crowded places were 33.2%, but the knowledge that avoidance of crowded places prevents infection by novel-coronavirus was 90.3% [26] . Similarly, Zhong et al. [27] noted that a higher COVID-19 knowledge scores were found to be significantly associated with a lower likelihood of practices toward COVID-19 epidemic. The reason for this gap between knowledge and preventive practice could be that adolescents showed more commitment to adhere to protective measures in the early phase of the pandemic but now that lockdown is easing off and people are resuming their normal lifestyles, they deemed it inexpedient to burden themselves with hand washing, social distancing and masking [17] . These findings clearly underscore the urgent need to improve and sustain adolescents' COVID-19 knowledge via health education, which may also result in improvement in their practices towards COVID-19 prevention. Though a minor proportion of adolescents, 42.4% had a good knowledge of the mode of spread of COVID-19, 52.0% were aware COVID-19 could be transmitted through contact with infected persons while a higher proportion, 62.6% believed that COVID-19 is not air borne. In keeping with this study, Mohammed et al. [14] also noted that approximately half of their respondents were unaware that SARS-CoV-2 could spread from person-toperson. This poor knowledge on mode of spread could be due to inaccessibility of information. Furthermore, a good number of college adolescents have good knowledge of symptoms of COVID 19. A study in Saudi Arabia also documented a high proportion of respondents who were aware of the clinical symptoms of COVID-19 [5] .

It was observed in this study that male adolescents were 1.4 times less likely to have good knowledge of mode of spread of COVID-19. In the same vein, adolescents whose parents were self-employed were 1.4 times more likely to have good knowledge of mode of spread of COVID-19 when compared with those who were on paid employment. This study also revealed that older adolescents were more knowledgeable regarding COVID 19 compared to younger ones. This finding is in tandem with studies from China [27] and India [28] which showed that female adolescents were very curious and wanted to know every new or trending event, including the new novel virus (COVID-19) [29] . In addition, female adolescents need to know more on COVID 19 because they are more vulnerable and at risk of child labor, sexual abuse and gender based violence.

Adolescents whose parents are self-employed are likely to spend more time with their parents who may have more time of their own and may stay at home to gather information about spread of COVID 19 while those on salary employment are always away from home and very busy in their station. This could offer them little time to listen to any information on COVID 19 [30] .

Adolescents whose fathers attained tertiary education were noted to be 1.6 times more likely to have good preventive practices against COVID-19 when compared with those who had secondary school education and below. Zhong et al. [26] also noted in their study that the male gender, lower educational level and unemployment were significantly associated with lower knowledge score. The finding from this study is corroborated by a study from Wuhan, China with high mortality rates following the pandemic. The authors reported that the university graduates seriously sought information from various information channels such as CCTV, the official website of the national Health commission of China and the Wechat official account of the Wuhan Health Commission. The significant positive association between levels of education and COVID-19 knowledge scores supports this speculation [17] .

It is noted in this study that older adolescents are more knowledgeable on the perception of COVID 19 and its preventive practices. Older college adolescents were also more active in searching information on this virus from all possible sources, but the younger ones may not be opportuned, but will rather learn about COVID-19 from parents or other family members [17] .

This study also showed that adolescents commended government efforts in prevention of COVID 19. This was also similar to the findings in Palestine where adolescents, especially the older ones were noted, to commend the promptness of the government's response and that of Ministry of Health (MOH). In fact, a 15-year-old, girl with a disability once commented 'The MOH performs well, as much as it can to face the epidemic' [17] .

C O N C L U S I O N Though college adolescents were aware of COVID-19, only a small proportion practiced good preventive measures against COVID-19. Knowledge of mode of spread and preventive practices were significantly enhanced by fathers' educational status and being a female adolescent child.

The authors declare no conflict of interest.

C O N S E N T Ethical clearance was sought and obtained from the ethics committee of University of Nigeria Teaching Hospital. Permission and consent were also obtained from the principals/teachers and adolescents from the schools of study respectively as well as the parents/guardians. The participation in the study was voluntary. Respondents' anonymity and confidentiality were maintained.

We are grateful to Miss Carol for helping in entering the raw data.

A novel coronavirus from patients with pneumonia in China

Situation Update Worldwide, as of

Pattern of early human-to-human transmission of Wuhan

A familial cluster of pneumonia associated with the 2019 novel coronavirus indicating person-to-person transmission: a study of a family cluster

Knowledge, attitude and practice toward COVID-19 among the public in the Kingdom of Saudi Arabia: a cross-sectional study

CDC. Centers for Disease Control and Prevention: Coronavirus (COVID-19) 2020

Is the Saudi public aware of Middle East respiratory syndrome?

Attitude and Practice (KAP) Study about Middle East Respiratory Syndrome Coronavirus (MERS-CoV) among population in Saudi Arabia

An investigation of transmission control measures during the first 50 days of the COVID-19 epidemic in China

Recommendation Regarding the Use of Cloth Face Coverings, Especially in Areas of Significant Community-Based Transmission

Explaining socioeconomic-related inequality in knowledge about HIV in Malawi

Socio-economic inequality in comprehensive knowledge about HIV in Malawi

Knowledge, attitudes, and practices of Sudanese residents towards COVID-19

Public knowledge, attitudes and practices towards COVID-19: a crosssectional study in Malaysia

Attitudes and Practices Towards COVID-19: An Epidemiological Survey in North-Central Nigeria

Exploring the Impacts of Covid-19 on Adolescents

Public Knowledge and Practices regarding COVID-19: A Cross-Sectional Survey from Pakistan

Racial disparities in knowledge, attitudes and practices related to COVID-19 in the USA

Face masks for the public during the COVID-19 crisis

Clinical characteristics of coronavirus disease 2019 in China

Advice on the Use of Masks in the Context of COVID-19. Geneva: World Health Organization

Are you Happy or Sad? How Wearing Face Masks Can Impact

COVID-19: How Much Protection do Face Masks Offer? -Mayo

Mon-Adolescents-in-Urban-Slums-in-Dhaka-Bangladesh.pdf

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

Beliefs/Attitudes and Practices of Rural Residents in

Survey data of COVID-19-related knowledge, attitude, and practices among indonesian undergraduate students

COVID-19 knowledge, attitudes and practices in a conflict affected area of the South West Region of Cameroon

How will COVID-19 affect girls and young women? j Plan