AWARENESS OF COVID-19 AMONG GENERAL POPULATION OF NORTHEAST INDIA: A WEB BASED CROSS-SECTIONAL STUDY

assess the level of awareness among Materials and Methods : A web based survey was conducted among 185 people of deferent states of northeast during the of April and May 2020. A self-structured validated questionnaire used for collecting information. Descriptive analysis was performed to represent the study characteristics. Awareness among the study population was categories into 3 Levels i.e Adequate, Moderately Adequate and Inadequate. Level of Adequate awareness considered as > (Mean + SD, Moderately Adequate as (Mean-SD)-(Mean

The virus is primarily spread between people during close contact, most often via small droplets produced by coughing, sneezing, and talking. The droplets usually fall to the ground or onto surfaces rather than travelling through air over long distances. It is most contagious during the first three days after the onset of symptoms, although spread is possible before symptoms appear, and from people who do not show symptoms. 4 The standard method of diagnosis is by real-time reverse transcription polymerase chain reaction (rRT-PCR) from a nasopharyngeal swab. Chest CT imaging may also be helpful for diagnosis in individuals where there is a high suspicion of infection based on symptoms and risk factors. 5 Recommended measures to prevent infection include frequent hand washing, maintaining physical distance from others (especially from those with symptoms), quarantine (especially for those with symptoms), covering coughs, and keeping unwashed hands away from the face. 6 The use of cloth face coverings such as a scarf or a bandana is recommended in public settings to minimise the risk of transmissions, with some authorities requiring their use. Medical grade facemasks such as N95 masks should only be used by healthcare workers, first responders and those who care for infected individuals. 7 According to the World Health Organization (WHO), there are no vaccines nor specific antiviral treatments for COVID-19. 6 On 1 May 2020, the United States gave emergency use authorization to the antiviral remdesivir for people hospitalized with severe COVID-19. 8 Management involves the treatment of symptoms, supportive care, isolation and experimental measures. 9 The World Health Organization (WHO) declared the COVID-19 outbreak a public health emergency of international concern (PHEIC) on 30 January 2020 and a pandemic on 11 March 2020. Local transmission of the disease has occurred in most countries across all six WHO regions. 10 Awareness is the key factor for prevention of spread of COVID-19 among general people. Although very few study conducted in our country, a study reported that despite many awareness programs conducted by the governments and other agencies, there are certain false beliefs among the general public of India towards the transmission, prevention, and treatment of COVID-19. 11 As per my knowledge concern, till now there is no study on awareness of COVID-19 in the northeast region. Furthermore, in the northeast region, especially in Assam COVID-19 positive cases increases every day. In view of these contexts, the present study was undertaken to assess the awareness among the general population of Northeast region of India

Materials and Methods:-
A web-based cross-sectional survey was conducted among the general population of Northeast region of India during the period of April and May 2020.
A self-structured validated questionnaire used for collecting information. The questionnaire was conveniently distributed among the people using Google forms through social media networks. Participants who gave consent to willingly participate in the survey would click the "Continue" button and would then be directed to complete the self-administered questionnaire.
Complete data was collected from 185 numbers of respondents from different states of northeast India. Questionnaire survey was based on two parts-one is Socio-demographic variables of respondents it consist of 6 items ie. Age, Sex, Educational status, Occupation and Place of residence. Another is related to awareness of COVID-19 i.e General information about the COVID-19, Risk factors and sign and symptoms of COVID-19, and preventive measures. Descriptive analysis was performed to represent the study characteristics. Awareness among the study population was categories into 3 Levels i.e Adequate, Moderately Adequate and Inadequate. Level of Adequate awareness considered as > (Mean + SD, Moderately Adequate as (Mean-SD)-(Mean + SD) and Inadequate as < (Mean-SD).

Results and Discussions:-
In regards of socio-demographic variables, it has been observed that a total of 185 participants from different states of Northeast India responded to the survey. Out of total respondents, 81(43.8%) from Manipur, 42(22.7%) from Assam, 42(22.7%) from Meghalaya and 20(10.8%) from Nagaland. The highest number of respondents, 67(36.2%) belongs to age group 26 to 30 years of age which was followed by 54(29.1%) at the age of >30 years, 34(18.4%) at the age of 21 to 25 years and 30(16.2 %) respondents below 20 years of age. Majority of respondents 134(72.4%) were female and male respondents were 51(27.6%). Majority of respondents, 122(65.9%) their educational status was graduate level and above. 37(20 %) of respondents were primary level and 26(14.1%) were secondary level of education. In regards of religions, majority of respondents, 92(49.7%) were Hindu as compared to 79(42.7%) were Christian, 10(05.4%) Islam and 6(03.24%) were others. Majority of respondents, 59(49.7%) were students which was followed by 53(28.6%) were private employees, (17.8%) were Govt employees. 177(63.2%) of respondents belong to urban and 67(36.2%) were in rural community. (Table-1 (Table-3) More than half, 102(67.45%) respondents were aware about the general information of COVID-19. Only 75(40.5%) and 124(67%) respondents could answer the question of what is corona virus and which virus can causes COVID-19 respectively. Average (80.82%) respondents were aware about the disease process of COVID-19, whereas out of that 119(64.3%) respondents were aware about the risk factors of COVID-19, i.e. Responded correctly as older person and person with pre-existing medical conditions like hypertension, diabetes Mellitus and heart diseases etc. Regarding the mode of transmission, 176(95.1%) of total respondents were reported correctly. Majority of people, 135(72.9%) were aware about the meaning of community transmission like spreading infection through community people. In regards of common sign and symptoms, 154 (83.2%) of total respondents could correctly answered. Majority of respondents 164(88.6%) were aware about correct incubation periods of COVID-19. (Table-3) An average of 154 (83.24%) respondents out of total were aware regarding prevention of COVID-19. 150(81.1%) of respondents were aware the meaning of "Quarantine" as isolating the person but less than half of respondents were aware about the treatment of Covid-19. Regarding frequency and duration of hand washing, 167(90.3%) and 134(72.4%) of respondents have correct concept respectively. 160(89.2%) of total respondents reported correct answer regarding the minimum distance between one person to another person to prevent Covid-19. Majority of people 165(89.2%) were aware about the step to do when any person is suspected of COVID-19 near their home. 173(93.5%) respondents have the knowledge of increasing body immunity which is the important concern of prevention of COVID-19. 180(97.3%) of respondents have given correct answer regarding the body parts that should be avoided to touch for prevention of COVID-19. Regarding the measures to be taken for prevention of COVID-19, majority of respondents 176(95.1%) were aware about the wearing mask and gloves, maintaining social distancing and cover nose and mouth while sneezing. (Table-4) In regards of age, it was observed that majority of respondents i.c. 21(31.3 %) were adequately aware at the age of 26-30 years and at the age group of 21-25 years 25(73.5 %). had highest moderately adequate awareness. Highest inadequate awareness was found in the age group of <20 years. Regarding gender, male and female both were almost same in all levels of awareness although slightly female were higher than male in adequate, 36(26.8%) and male were higher than female in moderately adequate awareness, 13(25.4%). Highest percentage of adequate awareness, 35(28.7%) found at graduate level or above and otherwise highest percentage of moderately adequate awareness have seen among the respondents of primary and high school level of education, 23(62.2%). In regards of religions, it was found that majority of Hindu respondents were adequately aware compared to other religions 37(40.2%) and highest inadequate awareness found among Christian religions 24(40.4%). Private employees were more aware adequately compared to others 18(33.9%) and highest inadequate awareness found among daily workers 5(100%). In place of residence, it was found that urban people were more adequately aware 38(32.5%) compared to rural people and rural people were more in moderately adequate awareness, 42(62.7%) ( Table-5)    in the northeast region. Although no similar studies found in northeast region, a study in Maharashtra, conducted on awareness of COVID-19 among the general people, suggested that though the overall knowledge on COVID-19 was good enough among the general public of India, still there is a need for education to avoid false beliefs especially among the people who are elderly, having a low level of education, and non-professional workers. 12 (Table-3) More than half, 102(67.45%) respondents were aware about the general information of COVID-19. The present study showed that majority of respondents were aware about the risk factors, mode of transmission, community transmission, common symptoms of Covid-19, and about incubation periods of Covid-19. This findings are supported by a study which was conducted by Puvvada R K et al., 11 reported similar awareness level regarding the risk factors of COVID-19, common sign and symptoms and mode of transmission. In contrast we have seen in a study among US adults, nearly one third people (28.3%) could not correctly answered about the sign and symptoms of COVID-19 and One in 4 adults (24.6%) believed that they were "not at all likely" to get the virus, and 21.9% reported that COVID-19 had little or no effect on their daily routine. 16 An average of 154 (83.24%) respondents out of total were aware regarding prevention of COVID-19. 150(81.1%) of respondents were aware the meaning of "Quarantine". Regarding frequency and duration of hand washing, 167(90.3%) and 134(72.4%) of respondents have correct concept respectively. 160(89.2%) of total respondents reported correct answer regarding the minimum distance. 176(95.1%) were aware about the wearing mask and gloves, maintaining social distancing and cover nose and mouth while sneezing.
In regards of age, it was observed that majority of respondents i.c. 21(31.3 %) were adequately aware at the age of 26-30 years and at the age group of 21-25 years 25(73.5 %). had highest moderately adequate awareness. Highest inadequate awareness was found in the age group of <20 years. The findings showed that awareness level was different in different age group which is supported by the studies of Paul, A(2020) 15 and Puvvada R K et al. 11 Regarding gender, male and female both were almost same in all levels of awareness although slightly female were higher than male in adequate, 36(26.8%) and male were higher than female in moderately adequate awareness, 13(25.4%). This finding is consistent by a study in Malaysia reported similar level of awareness in both male (91%) and female (87%). 17 Highest percentage of adequate awareness, 35(28.7%) found at graduate level or above and otherwise highest percentage of moderately adequate awareness have seen among the respondents of primary and high school level of education, 23(62.2%). This finding is supported by Azlan AA et. al 17 and Labban L et. al 18 which reported that the level of awareness increased with the higher level of education.
This study is the first to assess the awareness of COVID-19 among general people of northeast so that it will provide baseline for further study. We believe that the findings of the study will be provided as a pillar of formulating strategies for prevention of community transmission of COVID-19 by increasing awareness among general population.
We acknowledge that the study has some limitations, including depending on technology for collecting information instead of direct contract with respondents. Another limitation is that the small sample size within a short period of time which limits the generalization of the results.

Conclusion:-
The findings of this study revealed that overall awareness of northeast people was not satisfactory, though aspects wise awareness was good. People were more aware in aspect of preventive measures compared to other aspects. Awareness was high in higher educational level. Male and female were almost equally aware about COVID-19. The awareness of general public regarding COVID-19 plays a major role in preventing of community transmission. This study would be helpful to provide baseline information to determine the type of intervention that may be required to increase the level of awareness in order to prevent further COVID-19 pandemic.
their support and encouragement. All subjects who participated in the study despite of panic stage of pandemic would gratefully acknowledged.