Knowledge, attitude and practices regarding COVID-19 outbreak among people in Basrah city

Background: The World Health Organization (WHO) declared COVID-19 an international public health emergency on January 30th and demanded coordinated action from all countries to contain its rapid spread, and a pandemic on March 11th due to its continued spread across countries and continents. During a pandemic, the information gap can have negative consequences by increasing stress and instability. Furthermore, unfavorable attitudes and practices, as well as other misconceptions and beliefs, can intensify the disaster's devastating effects. Aims : 1. To determine the knowledge, attitude and practices of people in Basrah about COVID-19 pandemic. 2. To know the main source of peoples , information. Method: This study is a cross-sectional study conducted on a sample of persons selected throughout the period from 25 th April to 1 st August 2021. The study involved 402 individuals who attended primary health care centers in Basah city center. Results: In this study, 25.6% of the participants aged 30-39 years and 34.6% of them had secondary school education, 51.7% were females. Majority of the study sample (71.6%) were married. More than half (62.4%) showed self or family history of COVID-19. Half of the participants in this study had moderate level of knowledge, social media was the source of information for 54.2% of the participants, 67.4% of the participants didn’t know the correct symptoms of COVID-19 disease, and also 82% didn’t know the incubation period, while 90.8% know the mode of transmission. Highest percentage (40.5%) had poor attitude, and 59%had poor practice level. Conclusions: The highest percentage of the participants had moderate knowledge, poor attitude and poor practices. Social media is the main source of information about COVID-19 among the studied sample. Recommendation: This study recommends enhancing awareness of people about the importance of control and preventive measures against COVID-19 virus in decreasing the prevalence of the disease.


Introduction
he world has seen severe changes in the fatal virus's unprecedented development, specifically Novel Coronavirus (nCOVID- 19).Since the report of the first cluster of Coronavirus infections on 31 st December 2019 in Wuhan, a metropolitan metropolis of China, it has showed a rapid spread over a short period. 1 The World Health Organization (WHO) declared COVID-19 as an international public health emergency on January 30th and demanded coordinated action from all countries to contain its rapid spread, and a pandemic on March 11 th due to its continued spread across countries and continents. 2,3Low pathogenicity and high transmissibility are two alarming T

RESEARCH PAPER
The Medical Journal of Basrah University (2022); 40(1): 68-80 CONID-19 Pandemic KAP characteristics of this virus, which have resulted in an extremely high prevalence and mortality when compared to its predecessors. 4The disease causes respiratory disease (similar to the flu) with key clinical symptoms such as a dry cough, fever, and, in more severe cases, breathing problems.COVID19 is a highly contagious disease with a high fatality rate that has been classed as a class B disease and managed as a class A infectious disease in China in January 2020.SARS-COV-2 spread from person to person through inhalation of infected person's aerosols. 3,5It also spread directly from person to person when a COVID-19 case coughs or exhales, causing droplets to enter another person's nose, mouth, or eyes.Other people contract the virus by handling fomites and then touching their faces, 6 Patients with pre-existing illnesses (such as hypertension, cardiomyopathy, lung disease, cancer, or diabetes) have been identified as possible risk factors for severe disease and mortality. 7,8The WHO upgraded the COVID-19 emergency from a public health international emergency (30 January 2020) to a pandemic on March 11, 2020. 9Social media is a primary source of disseminating various fallacies about disease prevention and resistance. 10Previous epidemics, such as MERS and SARS, have shown that evaluation of knowledge, attitudes, and practices aids in the identification of myths, taboos, and disinformation about the epidemic, as well as the development of effective methods to minimize its negative consequences. 10he study aims to determine the knowledge, attitude and practices of people in Basrah about COVID-19 pandemic and to know the main source of peoples , information.

Methodology
This study is a cross-sectional study conducted in the city center of Basrah governorate, in the south of Iraq during the period from 25th of April to the 1st of August 2021 on a sample of 402 adults attended the six randomly selected primary health care centers during the study period.Verbal agreement to contribute in the study was acquired for each participant.Information were obtained by interviewing the participants, a directly-administered questionnaire specially designed for the study purpose was used, the questionnaire had been constructed after verifying various similar previous studies.To measure the knowledge of each participant, we assigned a true response for each question in the questionnaire as correct, and false answers as incorrect ones.For questions with multiple choices, answers of participants who assigned half or more than half of the correct choices were considered correct, while those who assigned less than half of the correct choices were considered incorrect.The same was carried out regarding attitude and practices.People who scored 75% or more in the area of the knowledge assessment section are considered with good knowledge about Covid-19.Those with a score of 50-75%, and those score less than 50%, are those with moderate and poor knowledge respectively, the same is applied for attitude and practices.Data of the studied sample were entered, managed and analyzed using the statistical package for social sciences (SPSS) version 26.

Results
In this study the highest percent (25.6%) of the sample aged between 30-39, and only 1% of them aged 70 years and more, people who had secondary school education showed the highest percentage (34.6%)and only 12.2% of them had university and postgraduate education, 48.3% of the sample were males and 51.7% were females.Majority of the study participants (71.6%) were married, and only 2.7% were divorced, 40.8% had 1-4 children and 27.9% had no children.This study showed that 60.45% had average monthly income and 3.7% had very good income.The highest percent (41.8%) were governmental employees.(Table -

Discussion
In the near future, living with COVID-19 appears to be unavoidable.Thus, the enforcement of personal protective measures should be followed by a reduction in incident cases. 11The findings of the current study demonstrated that half of the studied people had moderate knowledge.Studies, such as a research conducted in Addis Ababa, Ethiopia in 2020, indicated that 58.6 percent of the population possessed moderate knowledge. 12A study conducted in various continents (Asia, Americas -North and South, Europe, Africa, and other -Australia and Antarctica) and another one in Nepal showed that the respondents demonstrated good knowledge constituted 93.2% and 84.25% respectively. 10,13 study in Mosul showed that 86% of the participants had high level of knowledge. 14The moderate level of knowledge among the participants in this study may be because most participants had secondary school education, which education could be owing to the high level of media coverage, which included all media outlets, and the influence of the pandemic on social life, which forced people to follow.The present study revealed that almost all the participants 99.5% had heard about COVID-19 or knew the name of the disease, similarly the same was reported by a study in Jordan. 15One probable explanation is that, in comparison to the traditional media sources, social media apps have grown in popularity and accessibility, hastening the distribution of information.Majority of the study sample (90.8%) knew that mode of the transmission can be by respiratory droplets or by direct contact.In a research in Pakistan, only 70.5 % of the participants agreed that the virus spreads through air droplets and touch. 16While the study in Asian developing countries showed that 93.1% were knowledgeable regarding transmission mode. 17And in Lebanon study, 61.5% of participants know the correct modes of transmission. 18In this study around 79.6% of all the participants, correctly identified the elderly and those with comorbidities as highrisk groups for COVID-19 disease; however, only about 20.4% incorrectly identified adults, adolescents, and children as high-risk groups.
Similar to a study in Lebanese population in which about 62.7% of the participants correctly identified the elderly and those with comorbidities as high-risk groups for COVID-19. 18In a study which was done in Mosul, majority of the respondents confirmed that COVID-19 disease is more dangerous in patients with chronic diseases and the elderly, 14 the fatal outcomes are predicted by severity, older age, and presence of co-morbidity according to a study about the pandemic of COVID-19 in Eastern Mediterranean Region. 19n this study, the percent of accurate knowledge regarding symptoms of COVID-19 was 32.6%, which is much lower than those reported in Pakistan and Saudi Arabia in whom 93% and 98% were well-aware about COVID-19 symptoms respectively. 18,20And also lower than that estimated in Lebanese study which revealed that 54.7% of the participants were aware about the clinical symptoms. 21This study showed that only 17.9% of the study sample, knew the correct incubation period.In another study conducted by Zegarra et al., 86.2% of the participants knew the correct incubation period. 22In Asian developing countries study, 93.8% of the participants knew the correct incubation period, 17 while only 15.4% of the participants knew the correct incubation period in Lebanon study. 18This study showed that the opinion of 44% of the participants was that there was no useful treatment for the disease caused by the virus but only preventive measures, in a study done in Pakistan around 79% said that there is only supportive treatment available for the virus. 16Bangladesh is a country, where only 18.3 percent of the participants thought that COVID-19 had no treatment, while 47.3 percent thought it was a treatable disease. 23In this study, evaluation of the information obtained from the participants to ascertain about COVID-19 disclosed substantial dependence on the social media of 54.2%, this result agreed with the results of a study conducted during this pandemic in which more information in Venezuela had been shared through social media and on the internet compared to the national radio and television broadcast media. 24Another study in Asian developing countries (China, India, and Pakistan), suggested financial and media related difficulties as the reasons that prevent their people from obtaining accurate information. 17The World Health Organization defined the present situation of excessive correct and incorrect information about the COVID-19 pandemic posted on social media as an infodemic. 25Social media platforms provide direct access, they may amplify rumors and present problematic information depending on users' interests and attitudes assessed by algorithms to mediate and encourage content promotion, but they may also amplify rumors and present questionable information. 26By the present study, 40.5% of the participants had poor attitude toward COVID-19.Findings of this study showed that more than half of the participants (57%) stated they would go to a health facility if they had symptoms in contrast to a study in Iran in which 75% of the sample stated they would go to a health facility if they had a fever. 27This study showed that 61.7% of the participants were following news about the virus progression in another countries, and 73.9% of the participants were following news about the virus progression in Iraq.According to a study in China, 97.1 percent of the participants monitored COVID-19 closely. 28his study showed that 35.1% of the studied sample said the situation will be for better, while in Pakistan despite the less faith in government 67.3% were optimistic that COVID-19 would be successfully controlled, 29 this is relatively low as compared to that in China and Malaysia.A study in china 2020, showed that 90.8% of the participants believed that COVID-19 will finally be successfully controlled. 30,31A study in Sudan showed that 99.1% of the participants agreed that COVID-19 will finally be successfully controlled. 32his study shows that 59% of the participants had poor practices.Level of practice was good for both of the Malaysian population and Chinese residents. 30,31The majority of Venezuelans self-reported that they were following recommended practices. 33A study in Sudanese population revealed that only 48.5% had a good practice toward the COVID-19. 32he present study found that 84.1% of the participants were wearing mask when going outside and 70.4% were washing their hands frequently and 40.3% avoid crowded places.This is in stark contrast to a recent study of Chinese citizens, in which nearly all (98.0%) of study population reported using masks while leaving their houses and nearly all (96.4%) avoided busy venues and wore masks when leaving the house 98.0%. 30In Saudi Arabia 2020, 94% avoided crowded locations, and 88% avoided shaking hands. 34In Jordan precautionary measures such as hand washing was practiced by 87.0% and only 9.7% wear a face mask often. 35In the Sudanese research 2020, 49.2 percent of the participants said they had not visited any crowded area recently, 32 while in India 2020, more than 95% of the participants had avoided crowded places recently. 36These variations could be attributed to the disparities in state-enforced rules, cultural experience with previous pandemics, and the two subpopulations' educational levels.
In conclusion, the highest percentage of the participants had moderate Knowledge, poor attitude, and poor practice.Social media is the main source of information about COVID-19 among the studied sample.This study recommended enhancing awareness of people

Table 4 . Sources of information about COVID-19 Answers of the participants about the knowledge, attitude and practice questions
All the participants knew name of the epidemic, 81.8% of them classified it as a viral one, and 77.6% identify it as an infectious one, while 22.4% thought that COVID-19 is a political conspiracy or an issue between countries, 67.4% were not able to determine at least half of the disease correct symptoms, and also 82% didn't know the correct incubation period, 90.8% know the disease mode of transmission, 5% of the participants said that they will not take the vaccine, the main reasons for them were fear from vaccine side effects (47.9%) or from the manufacturing country (19.2%) and 39.1% think that the vaccine is useless.(table-5)