Journal of Women's Health Care
Open Access

Level of Knowledge and Preventive Practices against Covid-19 Pandemic Infection among Pregnant Women Visiting Serbo Health Center, Jimma Town South West Ethiopia

Daniel Aboma^1* and Solomon Gurmu^{2 *}Correspondence: Daniel Aboma, Obstetrics and Gynaecology Department, Shenen Gibe General Hospital, Jimma, Ethiopia, Tel: +251904336151, Email:

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Introduction

Formerly novel-corona virus disease is currently a global health threat and public health emergency of international concern [1]. The severe acute respiratory syndrome outbreak that was linked to Novel corona virus was first reported in 2003 [2]. Sixteen years later, a closely similar outbreak, which first received the name novel corona virus, was detected. The outbreak was first reported in late December 2019, when clusters of pneumonia cases of unknown etiology were found to be associated with epidemiologically linked exposure to the seafood market and untraced exposures in the city of Wuhan in China province [3].

It was by far the largest outbreak of atypical pneumonia since the SARS outbreak. In the initial stage of the outbreak, the total number of cases and deaths exceeded those of SARS [2]. Subsequently, the spread of the virus has shown exponential growth and spread to all continents and received a unique name from the World Health Organization (WHO) [4]. On January 30, 2020, the WHO declared that the virus was a pandemic disease [1-7]. As of December 2019 until May 7, 2020, the pandemics registered 8,862,301,425 cases and 268, 908 deaths in the world.

Ethiopia has become among affected countries as of March 15, the date on which one imported case was first detected. On May 7, 2020, there were 191 total notified cases and four deaths. The effects in pregnancy were initially based upon previous experience with Middle East Respiratory Syndrome-related coronavirus (MERS) [8, 9]. However, virus turns out to be far more infectious, albeit with lower mortality and similar morbidity to women of reproductive age [10-13]. Hospital recommendations on infection control, screening and isolation protocols change rapidly in accordance with the latest evidence. The physiological and immunological changes in pregnancy make women more susceptible to severe illness from respiratory infections [14,15]. A recent Centre for Disease Control and Prevention report demonstrated that pregnant women with more likely to be hospitalized, admitted to the intensive-care unit and receive mechanical ventilation albeit with similar risk of mortality compared to non-pregnant women [16]. Pregnancy itself poses logistical challenges and conundrums for obstetricians managing pregnant women with suspecting or diagnosed with. The ROG suggests that the pandemic increases the risk of perinatal anxiety, depression and domestic violence in pregnant women [11]. Hence, pregnant women deserve a more sensitive approach and mutual understanding during this global pandemic among clinicians and their partners.

Therefore, this study aimed to determine the level of knowledge and preventive practices against Covid-19 pandemic infection among pregnant women visiting Serbo health center, Jimma town south west Ethiopia. There are limited studies on the subject matter since the pandemic was recently recognized [17,18]. Consequently, this will enable clinicians to provide appropriate counselling to reassure and clarify doubts of pregnant women during the antenatal, intrapar tum and post-partum period.

Materials and Methods

Study setting and period

This study was conducted in Serbo health centre during October 22-28, 2020, i.e. after eight months of the first case in Ethiopia. Serbo health centre is located in Jimma town, the capital of the Jimma zone in Oromia National Regional State. Serbo health centre provides diagnostic and treatment services.

Study design

A facility-based cross-sectional study design was conducted to rapidly assess knowledge and preventive practices on Covid-19 infections among pregnant women who visited the health centre.

Population and sample

• 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.

• Participant who had a verbal communication problem and complete loss of hearing were excluding

Sample size determination and sampling

The single population formula was used to determine the sample size. Accordingly, the formula for sample size determination uses is: n=(Zα,2)2 *[(p1q1),(d)2], where n denotes the sample size, Zα,2 is the reliability coefficient of standard error at 5% level of significance=1.96, p=proportion of pregnant mother who visit health centre who is knowledgeable about (50%, no previous study found), and d refers to the level of standard error tolerated (5%). Hence, the calculation yielded a sample size of 232 visitors after adjusting for the total visitors’ population that was expected to visit the hospital in a one-week period. Finally, consecutive sampling was applied until the allocated sample size was filled.

Study variable

Dependent (outcome) variable

• Level of knowledge and practice of preventive measures against Covid-19 pandemic infection.

Independent variable

• Socio demographic characteristics

• Educational status

Instrument and measurement

The survey was conducted using tools that were adapted from WHO resources and similar studies [14-16,19]. The knowledge questions had 14 items covering issues such as symptoms, risk conditions, prognosis, and modes of transmission, safety, and precautions in Covid-19 infection.

Data collection, management, and analysis

The data were collected through an exit interview at clinics, wards in Serbo health centre by trained and experienced enumerators. A minimum of one-meter distance was kept between interviewers and interviewees. A pretested translated version of the instrument was used for data collection. Data analysis was managed using software for the statistical package for social science package version 23.0. Before further data analysis, reverse scoring for negatively worded items, normality curve, and tests of homogeneity of variances were checked.

Ethical clearance

The study was ethically approved by the institutional review board of Jimma University. The ethical clearance letter was obtained. Verbal informed consent was sought from every respondent. Data collectors were observed for 14 days after the completion of the survey. The interviewers wore protective face masks. Reasonable physical distance was kept between the involved individuals during data collection. The potential risk was minimal at the time of the study. The data were collected in a private condition and kept confidential.

Results

Socio-demographic characteristics of the respondents

A total sample of 232 pregnant mothers’ visiting health centre was approached. The respondents’ mean age was 30.5 ± 10.2 years. A higher proportion of respondents were married (84.6%), Muslims (59.9%), and farmers (67.7%). 71.1% were unable to read or write (Table 1).

Table 1: Socio-demographic characteristics of Serbo health center visitors, Jimma, October 2020 (n=232).

Knowledge of virus infection among the pregnant mother visiting health centre

One hundred ninety-eight (83.0%) of pregnant mothers visiting the centre knew the main clinical symptoms as fever, fatigue, dry cough, and myalgia. 42.7 % of the respondents mentioned other symptoms such as the stuffy nose, runny nose, and sneezing, which distinguishes from common cold or the flu. Table 2 presents the details of knowledge of pregnant mothers visiting health centre about Covid-19. A high proportion (73.3%) of pregnant mothers visiting health centre knew that the virus spread via respiratory droplets of infected people. However, 27.6% of the respondents reported that asymptomatic transmission was possible.

Table 2: Knowledge of COVID-19 among Serbo health center visitors, Jimma, Ethiopia, October 2020 (N=232).

Properly washing hands with soap and water 82.3%, not touching the eye, nose and mouth with unwashed hands (79.3%), and avoiding crowded places (76.7%) were commonly known methods of preventing virus transmission. However, 78.4 % of respondents, Isolation and treatment of people who are infected with the virus are effective ways to reduce the spread of the virus.

One hundred fifty-six (67.2%) of mothers responded people who have contact with someone infected with the virus should be immediately isolated in a proper place. One hundred fifty-nine (68.5%) of pregnant mothers visiting health centre knew that elderly people who have chronic illnesses and obesity are at higher risk of developing a severe form. Around 61.6% of respondents knew that the virus had no effective cure yet early seeking of treatment increases the chance of recovery.

One hundred seventy-one (73.7%) of pregnant mothers visiting health centre were predominantly engaged in frequent hand washing with water and soap, stopped shaking hands while giving greeting (53.0%), avoiding physical proximity (78.9%) and going to crowed places (43.9%), to protect themselves from (Table 3).

Table 3: Pregnant mothers visiting Serbo health centre on COVID-19 preventive practices, Jimma, Ethiopia, October 2020 (n=232).

Discussion

Despite a significant proportion (83.0%) Of, health centre visitors knew the main clinical symptoms. Only 42.7% of them were able to identify symptoms like (stuffy nose, runny nose, and sneezing) that, distinguish it from common cold, flu. Moreover, confusion can intensify bias and social stigma related to disease infection.

Concerning knowledge of risk factors, good proportions (68.5%) of the health centre visitors knew that elderly people who have chronic illnesses and obesity are at high risk of developing a severe form. Moreover, 61.6% knew that early seeking of treatment increases the chance of recovery, despite the lack of effective cure developed till the moment. A study in Wuhan, China, revealed that deaths are can reach up to 16.7% (9.4-23.9%) for patients in an intensive-care unit [20,21]. The provisional case fatality rate by WHO is approximately 3.4% [4]. Although this level of knowledge is promising to safeguarding the most at-risk population segment, it could divert the attention of the young, adult public to adopt preventive measures. The misperception that young, children are at low risk of contracting infection is found under the WHO’s list of rumours that could grant false assurances [14,22]. The findings from the current study support this idea, as only 55(23.7%) of the respondents perceived that children and young adults must take measures to prevent infection by the virus.

The study found out that the knowledge about the major mode of transmission was as high as 73.3% i.e. the visitors knew that the virus spreads via contamination with respiratory droplets of infected people. Although the current study did not investigate potential sources where infections can be acquired, a study conducted in Wuhan, China, presented 10(9.8%) of humanto- human transmission of as familial clustering of cases, and 34(33.3%) nosocomial infections [22]. Concerning the knowledge about methods of preventing infection by, Health centre visitors dominantly mentioned proper washing of hands (82.3%), not touching before washing hands (79.3%), and avoiding crowded places (76.7%). If the above knowledge is executed in self-care practices by individuals and the public at large, it can help prevent the spread of the virus in the country.

Nevertheless, there were huge gaps between the magnitude of knowledge of preventive methods and the practices. For example, only 82.3% of visitors had reportedly frequently washed their hands with water and soap, although the knowledge was as high as 95.5%. In the same manner, those who reported that they had not been going to crowded places were 76.7%, although the knowledge that avoidance of crowded places prevents infection by novel-coronavirus was 90.3%. Perhaps, in resource-limited settings, several reasons can be mentioned as to why people cannot frequently and properly wash their hands and easily avoid crowded places. For instance, to mention some, Ethiopia is known by modest coverage and intermittent continuity of water supply and hand washing facilities, a high rate of overcrowded living conditions, frequent social and religious ceremonies, and high unemployment rate calling for urgent efforts to bridge the gap between knowledge and practices [20,22]. This study found out that hand washing and avoidance of shaking hands for greeting as two dominantly practiced methods of preventing infection. Still, avoidance of non-careful touching of face parts that are used for the entrance of the virus, wearing masks, cover while coughing, sneezing, use of sanitizers, and stay at home was very low (1.6-11.3%). The entire practices were not as high in contrast to the contagiousness natures of the virus. In the absence of adaptation to these practices as packages, the entire public is at a high to contract the infection [8-10].

Conclusion

The magnitude of the visitors’ knowledge and preventive practices such as hand washing, avoidance of handshaking, and physical distancing were modest to protect themselves from this highly contagious virus. Notably, some knowledge about the virus was very low and needs an urgent improvement: “children, young adults must take measures to prevent the infection (23.7%)”, “symptoms that distinguished it from the common cold (61.6%)”.There were huge discrepancies between knowledge of prevention methods and actual practices, especially hand washing. In such highly contagious viruses with no effective cure, high-level knowledge must be achieved in the population to stop the spread of the virus.

Therefore, community engagement efforts for combat should emphasize addressing key preventive methods, use dissonant messages to close the gaps between existing knowledge and actual behaviour’s, and keep advancing knowledge status based on the contexts of significant socio-demographic characteristics for designing effective and tailored communication strategies. The finding also suggests interventions on the pandemic should simultaneously address the issue of social stigma and discrimination before it gets out of control.

References

1. https://www.who.int/news/item/30-01-2020-statement-on-the-second-meeting-of-the-international-health-regulations-(2005)-emergency-committee-regarding-the-outbreak-of-novel-coronavirus-(2019-ncov)
2. Huang C. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395:497-506.
3. Nishiura H. The extent of transmission of novel coronavirus in Wuhan, China, 2020. J Clin Med. 2020;9:330.
4. Wang C, Horby PW, Hayden FG, Gao GF. A novel coronavirus outbreak of global health concern. Lancet. 2020;395(10223):470-473.
5. Paules CI, Marston HD, Fauci AS. Coronavirus infections-more than just the common cold. Jama. 2020;323(8):707-708.
6. Hawryluck L, Gold WL, Robinson S, Pogorski S, Galea S, Styra R. SARS control and psychological effects of quarantine, Toronto, Canada. Emerging infectious diseases. 2004;10(7):1206.
7. Chan JF, Yuan S, Kok KH, To KK, Chu H, Yang J, et al. A familial cluster of pneumonia associated with the 2019 novel coronavirus indicating person-to-person transmission: A study of a family cluster. Lancet. 2020;395(10223):514-523.
8. Cao Z, Zhang Q, Lu X, Pfeiffer D, Jia Z, Song H, et al. Estimating the elective reproduction number of 2019-nCoV in China. medRxiv 2020;20018952.
9. Li Q, Guan X, Wu P, Wang X, Zhou L, Tong Y, et al. Early transmission dynamics in Wuhan, China, of novel coronavirus–infected pneumonia. N Engl J Med. 2020;82:1199-1207.
10. Rothe C. Transmission of 2019-nCoV Infection from an asymptomatic contact in Germany. N Engl J Med. 2020;382:1199-1207.
11. Ryu S, Chun BC, Korean Society of Epidemiology 2019-nCoV Task Force Team. An interim review of the epidemiological characteristics of 2019 novel coronavirus. Epidemiol Health. 2020;42:e2020006.
12. Chen N. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: A descriptive study. Lancet. 2020;395:507-513.
13. Holshue ML. First case of 2019 novel Coronavirus in the United States. N Engl J Med. 2020;382:929-936.
14. https://www.who.int/docs/default-source/coronaviruse/covid19-rcce-guidance-final-brand.pdf
15. Zhong BL, Luo W, Li HM, Zhang QQ, Liu XG, Li WT, et al. 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. International journal of biological sciences. 2020;16(10):1745-1752.
16. Geldsetzer P. Knowledge and Perceptions of COVID-19 Among the General Public in the United States and the United Kingdom: A Cross-sectional Online Survey. Ann Intern Med. 2020.
17. Person B, Sy F, Holton K, Govert B, Liang A, the NCID, SARS Community Outreach Team. Fear and stigma: The epidemic within the SARS outbreak. Emerg Infect Dis. 2004;10:358-363.
18. Paget J. The influenza pandemic and Europe: The social impact and public health response. Ital J Public Health 2009;6(3):257-259.
19. https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public/myth-busters
20. Cao J, Tu WJ, Cheng W, Yu L, Hu X, Liu Q, et al. Clinical features and short-term outcomes of 102 Patients with corona virus disease 2019 in Wuhan, China. Clin Infect Dis. 2020:243.
21. Cao J, Hu X, Cheng W , Tu WJ, Yu L, Liu Q. Clinical features and short-term outcomes of 18 patients with Corona Virus Disease 2019 in the intensive care unit. Intensive Care Med. 2020;46(5):851-853.
22. https://www.unicef.org/documents/social-stigmaassociated-coronavirus-disease-covid-19