COVID-19: Knowledge of mode of spread and preventive practices among mothers attending a tertiary health institution

Ann E Aronu; Awoere T Chinawa; Obinna C Nduagubam; Edmund N Ossai; Josephat M Chinawa

doi:10.4103/ijmh.IJMH_54_20

ORIGINAL ARTICLE

Year : 2021 | Volume : 26 | Issue : 1 | Page : 56-63

COVID-19: Knowledge of mode of spread and preventive practices among mothers attending a tertiary health institution

Ann E Aronu¹, Awoere T Chinawa², Obinna C Nduagubam³, Edmund N Ossai⁴, Josephat M Chinawa¹
¹ Department of Paediatrics, College of Medicine, University of Nigeria Enugu Campus, Enugu, Nigeria
² Department of Community Medicine, Enugu State University College of Medicine, Enugu, Nigeria
³ Department of Paediatrics, Enugu State University College of Medicine, Enugu, Nigeria
⁴ Department of Community Medicine, College of Health Sciences, Ebonyi State University Abakaliki, Ebonyi State, Nigeria

Date of Submission	08-Aug-2020
Date of Decision	24-Aug-2020
Date of Acceptance	29-Aug-2020
Date of Web Publication	21-Oct-2020

Correspondence Address:
Josephat M Chinawa
Department of Paediatrics, College of Medicine, University of Nigeria Enugu Campus, Enugu
Nigeria

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijmh.IJMH_54_20

Abstract

Background: COVID-19 pandemic is a very common menace in the world. Knowledge on mode of spread and prevention of COVID-19 remains blurred among mothers who visit children clinics. Objectives: This work is aimed to determine the knowledge of mode of spread and preventive practices among mothers presenting in a health institution. Materials and Methods: This is a cross-sectional observational study undertaken in a health institution in South East Nigeria using a structured self-administered questionnaire. Data entry and analysis were done using IBM Statistical Package for Social Sciences (SPSS) statistical software version 25.0. Results: All the respondents (100.0%) have heard of COVID-19. A minor proportion of the respondents, 31.9%, had good knowledge of the mode of spread of COVID-19. Majority of the respondents, 93.3%, knew that COVID-19 could be prevented through good use of personal hand sanitizer. A high proportion of the respondents, 75.5%, were aware that COVID-19 could be prevented by avoiding crowded places and 76.7% by wearing of face mask. The respondents who were in the age group 30–39 years were twice more likely to have good knowledge of spread of COVID-19 when compared with those who were 50 years and above. (AOR = 2.2, 95%CI: 1.2–3.9). The respondents who attained tertiary education were 1.3 times less likely to have good knowledge of spread of COVID-19 when compared with those who attained secondary education. (AOR = 0.8, 95%CI: 0.5–1.2). Respondents who were married were about five times more likely to have good preventive practices against COVID-19 than those who were single parents. (AOR = 4.9, 95%CI: 2.8–8.4). Conclusion: Education is predictive of knowledge of mode of spread while being married is predictive of knowledge of preventive practices.

Keywords: Children, knowledge, mothers, prevention

How to cite this article:
Aronu AE, Chinawa AT, Nduagubam OC, Ossai EN, Chinawa JM. COVID-19: Knowledge of mode of spread and preventive practices among mothers attending a tertiary health institution. Int J Med Health Dev 2021;26:56-63

How to cite this URL:
Aronu AE, Chinawa AT, Nduagubam OC, Ossai EN, Chinawa JM. COVID-19: Knowledge of mode of spread and preventive practices among mothers attending a tertiary health institution. Int J Med Health Dev [serial online] 2021 [cited 2023 Jun 5];26:56-63. Available from: https://www.ijmhdev.com/text.asp?2021/26/1/56/298788

Introduction

As at July 27, 2020, coronavirus disease-2019 (COVID-19) has spread to the six continents, and about 16,264,048 cases have been detected worldwide, with 648,966 deaths and 9,407,977 recoveries.^[1] It is noted that approximately 215 countries and territories worldwide have been affected by the COVID-19 pandemic.^[1] In the African terrain, South Africa ranks highest with 445,433 cases and 6,796 deaths. This is followed by Egypt with documented 92,062 cases and 4,606 deaths and Nigeria with 40,532 cases and 858 deaths.^[2],[3] Children of all ages are prone and vulnerable to COVID-19, and many cases have been reported in infants and younger children.^[4] However, children with COVID-19 present with milder symptoms than their adult counterparts.[5] In China, several cases of COVID-19 have been reported in families. In fact, a study has shown a secondary attack rate of 3%–10% in one household.^[4] Nevertheless, direct transmission from a child to an adult has not been documented but children have the potential to spread the disease in the community.^{[5],[6],[7],[8]}

COVID-19 menace is indeed a serious global health emergency. This is because many countries are confronted with an unprecedented crisis the world has not witnessed before. It is known that coronavirus has affected 213 countries, areas, and territories resulting in 3,139,000 cases and 218,020 deaths globally.^[9] Although there are strong initiatives and recognition of the public health menace posed by coronavirus SARS CoV-2 infection, with several measures being recommended, the level of knowledge and perception of these preventive measures among mothers are yet to be evaluated. Mothers are important agents of change and so a good knowledge of the mode of spread and preventive measures of COVID-19 among them will impact the family and the community, and thereby reduce spread. There is a call to to reinforce community awareness of practices to stop the nationwide spread of the virus.

Strict adherence to health-specific three-prong measures, such as wearing masks, washing of hands, and social distancing which are known to limit spread, are not strictly followed resulting in a skyrocketed increase in morbidity and mortality. Knowledge of the mode of spread and preventive practices of COVID-19 among mothers attending the Paediatric section of the hospital is a rare topic in this locale and very few literatures have discussed this topical issue. This work thus aimed to determine the knowledge of the mode of spread and preventive practices among mothers presenting in a health institution.

Materials and Methods

Study area

The hospital under study is a referral hospital for majority of health facilities in south eastern Nigeria. An average of 1186 clients presented to the three paediatric clinics and wards in the health facility, which includes the children outpatient clinics, children emergency room/wards and immunization clinics on a monthly basis within the study period.

Study population

This study involved 404 mothers who attended children emergency room, the pediatric wards, and children outpatient and immunization clinics with their children, within the period of study.

Study design

This was a cross-sectional observational study that assessed the knowledge of the mode of spread and preventive practices among mothers attending the pediatric section of a tertiary institution.

Study population

This was an observational and prospective study, carried out in ESUT Teaching Hospital Enugu over a 3-month period. A total of four hundred and four participants were consecutively enrolled. The aim of the study was explained in clear terms using vernacular to the mothers and information contained in the proforma of study was described in detail to the mothers.

Inclusion/exclusion criteria

Mothers who understood the details in the questionnaire and who gave consent were included and those that did not give consent or who did not have a good grasp on the questionnaire were excluded.

Data collection

Data on mode of spread and preventive measures were collected from the mothers. This was done using a structured self-administered questionnaire.

Sampling technique

Systematic random sampling technique using facility register was used to select clients as they present on each day of data collection. An average of 1186 clients presented in the Paediatric clinics in the health facility on a monthly basis within this COVID-19 period. This number, 1186 served as sampling frame. Sampling interval was determined by dividing sampling frame (1186) by sample size (404), hence a sampling interval of 3 was used. Every third client was recruited for the study based on the order of registration of clients on each of the clinics on each day of data collection. The index client was selected by a simple random sampling method through balloting. The clients coming for the various clinics on the five working days of the week were included in the study.

Ethical approval

The approval of the Ethics and Research Committee of the Enugu State University Teaching Hospital was obtained before commencing the study (Reference number: IRB00002323).

Consent

A verbal informed consent was obtained from the respondents to participate in this study.

Sample size estimation

The minimum sample size used in this study was calculated using the formula:

where Z = 1.96, that is, the level of significance,

P = proportion of mothers who have knowledge of child wearing of face mask (taken as 0.5 being a new study), and

D = tolerable error (0.05).

Using the above formula, the minimum sample size with 5% attrition rate was approximately 404.

Data analysis

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 standard deviation while categorical variables were summarized using frequencies and proportions. Frequency tables and cross-tabulation were generated. Chi-square test of statistical significance and multivariate analysis using binary logistic regression were used in the analysis and the level of statistical significance was determined by a P value of <0.05.

Outcome variables included knowledge of mode of spread and knowledge of preventive practices against COVID-19. Knowledge of mode of spread of COVID-19 was assessed using six variables. For each correct response to the variables, the respondent was given a score of one while an incorrect answer was given a score of zero. Respondents who scored ≥60% of total score was regarded as having good knowledge of spread of COVID-19 while those whose <60% of the total score was regarded as having poor knowledge.

Knowledge of preventive practices against COVID-19 was assessed using nine variables. Each correct answer was awarded a score of one while an incorrect one was scored zero. Respondents who scored ≥60% of total score were regarded as having good knowledge of preventive practices against COVID-19 while those whose <60% of the total score was regarded as having poor knowledge of preventive practices.^[10] In determining the predictors of good knowledge of spread and good knowledge of preventive practices against COVID-19, variables that had a P value of <0.2 on bivariate analysis were entered into the logistic regression model for that purpose.^[10] The results were reported using adjusted odds ratios (AOR) and 95% confidence interval and the level of statistical significance was determined by a P value of <0.05.

Results

[Table 1] shows the sociodemographic characteristics of the respondents. The mean age of the respondents was 40.1 ± 12.3 years. The highest proportion of respondents were in the age group, 30–39 years (33.2%), while the least proportion, 20.3%, were less than 30 years old. Majority of the respondents, 78.5%, were married. Majority, 56.2%, were self-employed.

Table 1: Sociodemographic characteristics of the respondents

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[Table 2] shows awareness of COVID-19 among the respondents. All the respondents (100.0%) have heard of COVID-19. The important sources of information of COVID-19 included text messages from Nigeria Center for Disease Control, 91.1%; newspapers, 87.1%; WhatsApp messages, 75.0%, and Facebook, 73.0%. The symptoms of COVID-19 as identified by the respondents included dry cough, 86.6%; difficulty in breathing, 85.9%, and sneezing, 77.2%.

Table 2: Awareness of COVID-9 among the respondents

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[Table 3] shows the knowledge of mode of spread of COVID-19 among the respondents. Majority of the respondents were aware that COVI-19 could be spread through contact with infected persons. A higher proportion of the respondents, 51.0% knew that COVID-19 could be spread via droplet infection. A minor proportion of the respondents, 31.9% had good knowledge of the mode of spread of COVID-19.

Table 3: Knowledge of mode of spread of COVID-19 among the respondents

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[Table 4] shows the knowledge of preventive practices of COVID-19 among the respondents. Majority of the respondents, 93.3% knew that COVID-19 could be prevented through good use of personal hand sanitizer. A higher proportion of the respondents, 75.5% were aware that COVID-19 could be prevented by avoiding crowded places and 76.7% by wearing of face mask. A minor proportion of the respondents, 6.9% were aware that one could not prevent COVID-19 by taking medicines that are not prescribed. Majority of the respondents, 68.3% had good knowledge of the preventive practices against COVID-19.

Table 4: Knowledge of preventive practices against COVID-19 among the respondents

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[Table 5] shows the predictors of good knowledge of spread of COVID-19 among the respondents. The respondents who were in the age group 30–39 years have twice higher odds of having a good knowledge of spread of COVID-19 when compared with those who were 50 years and above. (AOR = 2.2, 95%CI: 1.2–3.9). The respondents who attained tertiary education have 1.3 lower odds of having good knowledge of spread of COVID-19 when compared with those who attained secondary education and less. (AOR=0.8, 95%CI: 0.5–1.2).

Table 5: Factors associated with good knowledge of COVID-19 among the respondents

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[Table 6] shows the factors associated with good knowledge of preventive practices against COVID-19 among the respondents. The respondents who were in the age group, 30–39 years have four times higher odds of having good knowledge of preventive practices against COVID-19 when compared with those were 50 years and above, (AOR=3.5, 955CI: 1.9–6.6). Similarly, the respondents who were married have five times higher odds of having good preventive practices against COVID-19 when compared with those who were single. (AOR=4.9, 95%CI: 2.8–8.4). The respondents who were unemployed have four times higher odds to have good preventive practices against COVID-19 when compared with those who were on salaried employment. (AOR=3.6, 95%CI: 1.2–11.4).

Table 6: Factors associated with good preventive practices against COVID-19 among the respondents

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Discussion

This study has shown that all the mothers who brought their children to hospital have heard of the symptoms of COVID-19. The most import important source of information on COVID-19 was from text messages from Nigeria Centre for Disease Control (NCDC). This finding is in tandem with other studies.^[11],[12] This source of information from text messages could be due to the fact that most of these mothers attained high level of education and always listen to or read the daily information from NCDC. Apart from information from NCDC, majority of the respondents also got the information about COVID-19 through WhatsApp massages, and Facebook. This finding agrees with that of Dorcas et al.^[13] Bhagavathula et al.,^[14] and Zhong et al.^[15] Though these results may be gratifying; however, information on social media concerning COVID-19 could be false and misleading and can put fear on individuals.

Mothers were noted to have a very high knowledge of symptoms of COVID-19 in this study. Most of the participants in the study by Mohammed et al.^[16] also showed a high level of knowledge of symptoms associated with COVID-19.^[17] This high knowledge of mothers on COVID-19 symptoms could be explained by the high level of information dissemination by various government and non-governmental agencies on the mode of spread and prevention of COVID-19.

We noted in this study that about a third of mothers had a good knowledge of mode of spread of COVID-19. This is also corroborated by the study of Mohammed et al.^[16] noted that about half of the respondents were unaware of the mode of spread of COVID-19. This surprising assertion of mothers having enough information on COVID-19 but are unaware of the mode of spread could be explained by the fact that information on COVID-19 focuses so much on number of infections, number of deaths and preventive measures with less emphasis on mode of spread. In the corollary, Hadil et al.^[17] noted poor knowledge in various aspects related to the virus’ way of transmission.

The use of hand sanitizers noted as a major preventive method against COVID-19 in this study has been corroborated by several studies.^{[15],[16],[17],[18]} High level of education and information on prevention of COVID-19 could explain this finding.

Wearing of face mask is noted as one of the preventive measures against COVID-19 and has been seen to protect children when their mothers wear it frequently. A study has noted that face masks were 79% effective in preventing transmission.^[18] Though it is noted that wearing masks after illness onset does not protect against the infection, nonetheless, the use of face mask has shown reduction of infection among families living with someone in isolation or quarantine.^[19]

Moreover, the use of face masks has been recommended in the community in the US.^[19] They opined that universal face mask has the potential to reduce outward transmission from asymptomatically infected people as well as protect children from becoming infected. Studies have suggested that the use of face mask should be encouraged since it does no harm and poses no threat to life.^[20] However, it has been pointed out that as mothers cover their faces with mask, reading of facial expressions by their children becomes very difficult. Children are emotionally inclined and this makes them not to be able to interpret any emotional cues as children rely on facial expressions and tone of voice of their caregiver’s to avoid danger. The use of face mask by mothers 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.^[21],[22]

Though the good knowledge on preventive measures against COVID-19 could help mothers to prepare for the rainy day, the present study has shown a lapse of 2.6% with regards mothers’ knowledge of preventive practices and 6.7% and 23.3% on the use of sanitizers and face masks, respectively. This could be the proverbial “break the hedge and the serpent will bites.”

We noted in this study that mothers who were in the age group 30–39 years have higher odds of having good knowledge of spread of COVID-19 when compared with those who were 50 years and above. Furthermore, mothers who attained tertiary education have lower odds of having good knowledge of spread of COVID-19 when compared with those who attained secondary education and less. Mothers with tertiary education status may be gainfully employed and could be very busy with their white-collar jobs without having much time to listen to information on spread of COVID when compared with their secondary school counterpart who are less likely to be in offices but rather at homes or doing menial jobs and who will always have time to fetch information regarding spread of COVID.

It is also interesting to note that mothers who were married have five times higher odds of having good preventive practices against COVID-19 when compared with those who were single. The fact that married mothers are settled, focused with a stable home could explain this difference and additional information could also come from a spouse. Again, respondents who were unemployed have four times higher odds to have good preventive practices against COVID-19 when compared with those who were on salaried employment. Al-Mohrej et al.,^[11] Bawazir et al.,^[23] and Beieret^[24] in keeping with this study have also noted age, gender, educational and income level as significant predictors of respondents’ knowledge of COVID-19 prevention. The fact that unemployed respondents are noted to have higher odds of having better knowledge of preventive practices than salaried respondents could be explained by the fact that the unemployed mothers stay at home most of the time and possibly get tuned to all sources of information and communication gadgets compared to their salaried counterpart who could be very busy with the demands of their profession or office jobs. Blustien et al.^[25] have also corroborated these findings on the impact of COVID-19 on the unemployed.

Granted that mothers had high knowledge of COVID-19 and its preventive measures, most mothers in this study did not have knowledge on mode of spread. This creates a yearning gap and can further worsen the spread of the infection. Sensitization and health promotion on the mode of spread of COVID-19 are very expedient so as to avert any impending danger this pandemic could cause in the nearest future.

Conclusion

Though mothers have information about prevention of COVID-19, a minor proportion of them know about the mode of spread. However, a good number of mothers noted the use of sanitizers and face mask as preventive measures against COVID-19. Being married and level of education enhanced knowledge on prevention of COVID-19.

Recommendation

There should be a clarion call on government to intensify effort on policies on public health promotion and on nongovernment agencies to provide accurate information on the use of facemasks in children.

Limitation

This paper is limited by the fact that it was carried out in one institution. A nationwide study will be worthwhile.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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