Introduction: COVID-19 has become a global public health concern. In Nepal, the government has imposed lockdown, school closures, non-pharmacological interventions, isolation, and quarantine. People were asked to accept self-care interventions. However, the effectiveness of these preventive measures depends on the knowledge and practice of an individual. Therefore, this study aimed to investigate the association between knowledge and practice among Bagmati province residents during the COVID-19 pandemic.
Methods: A cross-sectional study was conducted using an online Google Form questionnaire. A total of 296 participants completed the surveys on social media, particularly Facebook. To assess the factors associated with knowledge and practices toward COVID-19, logistic regression analysis was applied.
Results: The total scores of knowledge and practice were 7.62 ± 2.06 and 11 ± 1.91, respectively. Results showed that education, people having a medical background, and occupation were significantly associated with knowledge. While urban residence, older age, and living in a rental with a shared room were significantly associated with practice.
Conclusions: People with higher education, medical backgrounds, and household workers had high knowledge about COVID-19; however, knowledge was not associated with practice. There was a gap between knowledge and practice.
On 31st December 2019, the world witnessed an outbreak of pneumonia of unknown origin in Wuhan, China [1] . Later, on 11th February 2020, World Health Organization (WHO) named it as coronavirus disease 2019 (COVID-19), which is caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) [2] . Coronaviruses belong to the Coronaviridae family and represent crown-like spikes on the outer surface of the virus; thus, it was named as corona virus [3] . The subfamily includes alpha, beta, gamma, delta and omicron coronaviruses [4] . As an emerging acute respiratory infectious disease (ARIs), COVID-19 primarily spreads through the respiratory tract by droplets, respiratory secretions and direct contact [5] . The most common symptoms at onset of COVID-19 illnesses are fever, cough, fatigue, shortness of breath, while other symptoms include sputum production, headache, hemoptysis, diarrhea, etc [6] [7] . However, in immune-compromised patients, there is a chance that the virus could cause a lower respiratory illness like pneumonia and bronchitis [8] . Incubation periods range from 2 days to 14 days from the day of exposure [9] .
The first case in Nepal was confirmed on 23rd January 2020, on a 31-year-old student, who had returned from Wuhan, China on 9th January, 2020 [10] . It was the first recorded case of COVID-19 in South Asia. On April 4, first case of local transmission was detected in Kailali district. A country-wide lockdown came into effect on March 24, 2020 and ended on July 21, 2020 [11] . As of 29th August, 2022; the Ministry of Health and Population (MoPH) has confirmed a total of 996,834 cases, 981,521 recoveries and 12,000 deaths across the country [12] . The coronavirus has been detected in all provinces and districts of the country, with Bagmati province and Kathmandu district being the most affected. Total vaccine doses given was 53,747,378 among them 69.6% have been fully vaccinated and only 24.8% people have booster dose [13] until the end of August 2022.
Prevention and control measures for COVID-19 are the only way to contain the disease. The effective preventive measures for COVID-19 are non-pharmaceutical interventions such as wearing masks, washing hands with soap and water, using sanitizer, social distancing, and avoiding close contacts, etc. However, safe and effective vaccines against Corona viruses are considered a game-changing tool [14] [15] . Many studies have shown that high level of education is positively related on COVID-19 [16] [17] [18] [19] . Similarly, a study in Saudi Arabia reported that health education programs were helpful to improve knowledge and preventive practices of the community people [20] . To control the outbreak of the disease in Nepal, it is necessary to understand the knowledge and practices of the population. Therefore, the aim of this study was to determine knowledge and practices about COVID-19.
2. Methods
This was an online-based cross-sectional study conducted from August 1, 2021, to August 30, 2021, among the general population of Bagmati Province, Nepal. A convenience sampling method was used in which the link to the Google Form questionnaire was shared with participants via Messenger and Facebook groups. In addition, Facebook friends were asked to share the link with their circle of friends.
The age group of 15 to 60, who can use social media were included. On the other hand, the age groups below 15 and above 61, as well as illiterates and those who do not have access to social media, were excluded. According to the 2011 census, the total population of Bagmati province was 5,433,818. The sample size was obtained 301 participants, which was calculated using the sample size calculator-relief application 2018 with a margin of error of ± 5%, a confidence level of 90%, a 50% response rate, and a population size of 5,433,818.
The survey was conducted online using a self-reported questionnaire developed according to Centers for Disease Control and Prevention (CDC) guidelines for communities. The Nepali version was reviewed by experienced public health professionals and corrected as needed. The questionnaire consisted of three main sections. The first section collected information on the independent variables of respondents’ sociodemographic characteristics, including age, sex, marital status, education level, work status, residence, and income level. The second section obtained information on participants’ knowledge of COVID-19. This section included questions about modes of transmission, incubation periods, risk groups, prevention, and control. The last section of the questionnaire assessed respondents’ practices. This section consisted of questions on practices and behaviors such as attending social events and busy places, social distance, hand washing after sneezing, coughing, and blowing, and hand washing practices.
2.1. Ethical Considerations
Approval was obtained from Kobe University Graduate School of Health Sciences, Reg No. 1007, and the Nepal Health Research Council, NHRC, Reg No. 231/2021MT. On the first page of the online questionnaire, respondents were clearly informed about the background and objectives of the study. Online consent was obtained before proceeding with the rest of the questionnaire. Privacy, confidentiality, and anonymity were maintained.
2.2. Statistical Analysis
The basic description of the participants was simply tabulated frequencies, proportions, and means. Multivariable logistic regression analysis was performed to identify factors significantly related to participants’ knowledge and practice of COVID. The Cronbach’s alpha obtained was 0.7.
3. Results
The total number of participants who completed the questionnaire was 296, all living in Bagmati province. They comprised of 152 were male (51.40%) and 144 were female (46.60%). Table 1 shows the social and demographic characteristics of the respondents. Most participants (57.80%) were in the 15 - 29 age group and the Janajati ethnic group (39.50%). More than half of the participants (51.40%) were unmarried and lived in urban areas (61.50%). Almost one-third of the participants had a bachelor’s degree (30.70%) and a master’s degree (31.40%). However,
Social and demographic characteristics of the participants (N = 296)
Variables
N
%
Sex
Female
144
46.60%
Male
152
51.40%
Age
15 - 29
171
57.80%
30 - 44
88
29.70%
45 - 60
37
12.50%
Ethnicity
Brahmin
73
24.70%
Chhetri
80
27.00%
Janajati
117
39.50%
Others
26
8.80%
Marital Status
Married
139
47.00%
Unmarried
152
51.40%
Others
5
1.70%
Area of Residence
Urban
182
61.50%
Rural
114
38.50%
Type of living house
Single family home
174
58.80%
Shared house
66
22.30%
Shared rental room
56
18.90%
Education
Primary
12
4.10%
Secondary
30
10.10%
Higher Secondary
64
21.60%
Bachelor
91
30.70%
Master and above
93
31.40%
Others
6
2.00%
Occupation
Government
38
12.80%
Private
84
28.40%
Unemployed
19
6.40%
Daily wages
8
2.70%
Household/farming
17
5.70%
Student
130
43.90%
Income
<10,000
35
11.80%
10,000 - 20,000
34
11.50%
20,000 - 30,000
33
11.10%
30,000 - 50,000
48
16.20%
>50,000
38
12.80%
Don’t know
108
36.50%
Medical background
No
234
79.10%
Yes
62
20.90%
Knowledge score (Mean, SD)
7.62
2.06
Practice score (Mean, SD)
11.00
1.91
about 43% of the respondents were students, 8% in the private sector and 12% in the government institutions. Only 20.90% of the respondents had medical background. The mean COVID-19 knowledge score was 7.62 (SD = 2.06, range: 0 - 10), and the overall accuracy of the knowledge test was 76% (7.62/10 * 100). The mean practice score was 11 (SD = 1.91, range: 0 - 13), indicating good practice.
Table 2 shows the knowledge of the participants on COVID-19. The knowledge on WHO recommended time to wash hands was (42.90%) compared to the knowledge on the other questions posed to the participants. Nearly 97.5% of participants indicated that clean water is necessary for hand washing. About half of the participants agreed that vaccines are effective against COVID-19, and that travelling is one of the main reasons for the spread of COVID-19. Less than half agreed that the disease could pose a serious threat to public health.
The change to preventive practices towards the COVID-19 pandemic is shown in Table 3. Only 57.3% of the respondents use a handkerchief or tissue when coughing or sneezing. Most of them, about 90%, wore masks when they went outside. Almost 80.7% informed their friends and family members about the preventive measures towards COVID-19. While 84.5% of the participants washed their hands more frequently than before the pandemic, and 85.5% changed their handwashing behavior due to the COVID-19 pandemic.
For knowledge and practice in relation to several independent variables, including gender, age, education, occupation, marital status, residence, house type, and medical background. Multiple logistic regression analysis was conducted. Table 4 shows that education, medical background, and occupation were significantly
COVID-19 Knowledge response of the participants (N = 296)
Statement
Correct
Incorrect answer %
COVID-19 is a viral disease
91.70%
8.30%
Antibiotics are effective for COVID-19
75.70%
24.30%
Contains of hand sanitizer
81.00%
19.00%
Term isolation, quarantine and social Distancing are same
69.20%
29.80%
COVID-19 is a preventable disease
68.30%
31.70%
Medium of COVID-19 spreading
76.20%
23.80%
Close contact with pet animals causes COVID-19
82.20%
17.80%
Incubation time of COVID-19
81.00%
19.00%
Main symptoms of COVID-19
87.60%
12.40%
Best preventive measures for COVID-19
94.80%
5.20%
Appropriate length for social distancing
62.00%
38.00%
WHO recommended length of time to wash hands
42.90%
57.10%
Clean water necessity during hand washing
97.50%
2.50%
Participants’ practice behavior related to COVID-19 (N = 296)
Statement
Yes
No
Tissues or handkerchief use during coughing or sneezing
57.30%
42.70%
Regular mask use when going outside
90.30%
9.70%
Maintain social distance of at least 1 meter while going outside or in the crowd
75.60%
24.40%
Discuss about COVID-19 prevention with your family and friends
80.70%
19.30%
Avoiding crowded places (public vehicles, parties, family functions,
59.10%
40.90%
Avoid touching face, eyes and nose with hands
46.30%
53.70%
Wash hands with soap and water more often than before the pandemic
84.50%
15.50%
Wash hands with soap and water more than 7 times a day
50.10%
49.90%
Carry hand sanitizer along with you while you go outside and use it frequently
68.00%
32.00%
Do you change the behavior of hand washing with the situation of COVID-19
85.50%
14.50%
Sleeping pattern changed during COVID-19
43.90%
56.10%
Eat nutritious diet and practice regular physical activity during COVID-19
67.00%
33.00%
Practice regular physical activity during COVID-19
36.70%
63.30%
Do you have got vaccinated
31.70%
68.30%
Regression results of knowledge about COVID-19 and its association with other factors (N = 296)
Odd ratio
95.0% C.I.
P-value
Lower
Upper
Living area
Urban
Rural
0.7
0.39
1.37
0.331
Type of House
Single family home
Shared house
1.6
0.80
3.10
0.188
Shared room in rent
1.0
0.50
2.12
0.931
Gender
Female
Male
1.8
0.96
3.39
0.066
Marital status
Married
Unmarried
0.8
0.32
1.87
0.572
Age
15 - 29
30 - 44
0.9
0.36
2.09
0.749
45 - 60
0.5
0.17
1.60
0.254
Education Level
Primary
Secondary
6.5
1.07
38.89
0.042
Higher Secondary
2.9
0.51
16.12
0.232
Bachelor
4.9
0.89
26.61
0.069
Master and above
6.8
1.17
39.06
0.032
Medical Background
No
Yes
3.9
1.87
8.16
0.000
Occupation
Government service
Private office
1.2
0.48
3.02
0.694
Unemployed
0.5
0.10
2.32
0.362
Households
8.5
1.66
43.86
0.010
Students
3.2
1.01
10.00
0.048
Note: The model is adjusted for ethnicity and income of the participants.
associated with knowledge. Similarly, Table 5 shows that area of residence, house type, and age were significantly associated with practice. Both the Table 4 and Table 5 were adjusted for ethnicity and income of the participants. There was no statistically significant relationship between knowledge and practice.
Figure 1 shows that 35% of the participants used social media, such as Facebook,
Regression results of practice during COVID-19 and its association with other factors (N = 296)
Factors
Odd ratio
95.0% C.I.
P-value
Lower
Upper
Living area
Urban
Rural
0.4
0.21
0.67
0.001
Type of House
Single family home
Shared house
0.7
0.38
1.41
0.358
Shared room in rent
0.3
0.16
0.64
0.001
Gender
Female
Male
1.0
0.58
1.84
0.907
Marital status
Married
Unmarried
0.7
0.31
1.74
0.487
Age
15 - 29
30 - 44
0.4
0.16
0.90
0.027
45 - 60
0.2
0.07
0.63
0.005
Education level
Primary
Secondary
0.5
0.14
2.05
0.364
Higher Secondary
1.6
0.48
5.18
0.447
Bachelor
1.8
0.56
5.61
0.328
Master and above
1.3
0.38
4.47
0.673
Medical Background
No
Yes
1.3
0.65
2.53
0.474
Occupation
Government service
Private office
1.7
0.67
4.23
0.271
Unemployed
1.5
0.41
5.74
0.527
Households
1.9
0.43
8.28
0.402
Students
1.3
0.46
3.95
0.592
Note: The model is adjusted for ethnicity and income of the participants.
Twitter, and other sites, to know about COVID-19. Television, newspapers, and government daily reporting MOHP accounted for 17%, 10%, and 15%, respectively. 10% listen to radio, while 11% obtain their information from mobile ringtones and SMS. According to this study, Figure 2 shows that the main triggering factors that lead people to wash their hands during COVID-19 are fear of contracting COVID-19 infection, and self-consciousness.
4. Discussions
This study has shown that most participants were knowledgeable about COVID-19 with a mean achievement of 76.2% (7.62/10 * 100) in knowledge and a practice score of 84.6% (11/13 * 100). Participants’ education, medical background, and occupation were significantly associated with knowledge. While living area, type of house, and age were significant factors in practice, rural residents had a comparatively better practice score than urban residents. It might be because most of the participants were young adults with easy access to social media who resided in cities for jobs and education but returned to their respective villages during lockdown.
According to this survey, men demonstrated a better level of knowledge than women. Similar findings were made in the Riyadh, Saudi Arabia KAP study [21] . The medical background was positively significant with high knowledge and good practice. A similar outcome was seen among Ugandans [22] . Most of the participants were under 30 years old, single, and had higher education levels. The findings indicated that elderly people have more experience than younger people. This may be brought on by how diseases are perceived to affect older people. In the study of Cameroonian [23] residents, age > 20 years was associated with high knowledge of COVID-19. Women scored lower in practice than men. This research found no significant relationship between knowledge and practice towards COVID-19 pandemic. It was evident that few individuals who were aware of COVID-19 and were not taking it seriously.
Many studies conducted in China [24] , USA [25] , Egypt [26] , Saudi Arabia [27] and Nepal [28] found that people with higher educational levels knew more about COVID-19. According to a study from China [29] , unmarried people have higher knowledge; however, our research was unable to identify any evidence linking COVID-19 knowledge and marital status. Furthermore, few individuals were avoiding crowded areas. Similar findings were obtained in Philippines [30] , [30] and a previous study from Nepal [28] . Non-pharmaceutical interventions (NPIS), which seek to prevent transmission by lowering contact rates in the general population, include social distance and avoiding large crowds. These practices were not fully adhered to, in Nepal.
5. Limitations of the Study
There were some limitations to this investigation. This study used an online cross-sectional survey for data collection. It used a convenient sampling strategy that could lead to selection bias. To participate, participants must have access to the internet.
6. Recommendation for Further Studies
There were significant gaps in the knowledge of how often to wash hands and how to prevent touching the face, eyes, and nose with the hands. This research indicates that health education should be targeted at females, those with lower levels of education, people who are older, and people without medical backgrounds.
7. Conclusion
Education level and occupation were associated with their knowledge, whereas their living conditions, type of house, and age were significant factors in their preventive practices towards COVID-19 pandemic. Moreover, men and women both possess knowledge levels that are higher than average, and people with higher education levels have knowledge that is superior to that of those with lower education levels. It is noteworthy that knowledge and preventive practices towards COVID-19 are not related. It demonstrates that having information does not guarantee sound behavior.
Acknowledgements
Associate Professor Yuko Uesugi;
Mr. Rabin Karki;
Ms. Moeno Sakai;
Mr. Naresh Kumar Shrestha.
Conflicts of Interest
The authors declare no conflicts of interest regarding the publication of this paper.
Cite this paper
Shrestha, G., Negi, B. and Nakazawa, M. (2023) Knowledge and Preventive Practice during COVID-19 Pandemic in Bagmati Province, Nepal. Journal of Biosciences and Medicines, 11, 112-124. https://doi.org/10.4236/jbm.2023.117010
Legends
COVID-19: Coronavirus disease of 2019;
SARS-CoV-2: Severe Acute Respiratory Syndrome Coronavirus 2;
WHO: World Health Organization;
CDC: Centers for Disease Control and Prevention;
ARIs: Acute Respiratory Infectious Disease;
KAP: Knowledge Attitude and Practice;
MOHP: Ministry of Health and Population;
NHRC: Nepal Health Research Council;
MERS: Middle East Respiratory Syndrome;
NPIs: Non-pharmaceutical Interventions.
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