Around 1.2 billion COVID-19 infections and 3.3 million deaths have been projected for Africa if containment measures fail, nevertheless, stringent adherence to social distancing measures is envisaged to reduce the contact rate and curtail the transmission multifold [30, 31]. The message is clear, Ethiopians must comprehend and sternly abide by the recommendations and handling strategy vis-à-vis the control and prevention of COVID-19. On the precincts of limited scientific information on COVID-19, the WHO had suggested improving knowledge, prevention and control measures in health care and community settings . The novelty of this virus, along with its uncertainties, makes it indispensable for health authorities to plan appropriate stratagems. It is therefore of paramount pertinence that the KAP of the population be studied to guide these efforts. To the best of our knowledge, this is the first study in Ethiopia regarding general public’s KAP and assessment of risk of infection towards COVID-19 among Ethiopians, albeit, some studies have been done with limited sample sizes including higher education communities , undergraduate students in Debre Berhan University , nurses in Northern Ethiopia  and visitors in Jimma University Medical Center .
In our survey, with respondents, being predominantly male and educated (68 % holding undergraduate degree or higher), we found that the average knowledge score of Ethiopians was moderate at 11.2 ± 2.2, with an overall correct-response rating of 74.7 % about COVID-19. This is in lines parallel to the results (73.8 %) observed among undergraduate students from Debre Berhan University  and hospital visitors in Jimma University Medical center . The rating ranged widely among demographic variables indicating that some participants had satisfactory knowledge (29 %) about the disease while a poor knowledge score rating was documented for others (8 %). Ethiopians in the age-group of 30-49 recorded higher knowledge scores, plausibly due to a greater access to information intertwined strongly with the implications of higher education. Based on the limited information available to date, the risk of pets spreading the virus that causes COVID-19 in people is considered to be low. At this time, there is no evidence that animals play a significant role in spreading the virus that causes COVID-19  however, ~60.9% answered the other way due to lack of information about the fact. On the other hand, social distancing has been projected as the key to prevent the current pandemic [30, 31]. Remarkably, 45.4 % had responded as 2 feet, instead of the recommended 6 feet, which could be bracketed together with the failure of the mass to retrieve correct information. On a surprising note, equipped with the correct information about its genesis in China, 4 in 10 participants wrongly expanded ‘COVID-19’ as ‘China originated Virus disease-2019’. By the same token, those with low education status possibly attributable to restricted access to credible and timely information about the disease in the rural regions. This variation in levels of knowledge may be reflective of the current COVID-19 information landscape in the country. Although the government and health authorities have been consistently disseminating COVID-19 information since the disease was first detected in Ethiopia , there has also been a surge in false and inaccurate information . This demands dissemination of correct knowledge in a timely manner to the various strata of the society.
Several surveys, conducted in other countries have indicated differences in levels of COVID-19 knowledge-score and correct response rating among the general population. A similar correct response rating (~74 %) of the general public of Ethiopia (this study) and undergraduate Ethiopian university students  have been documented as against higher values of 84.7 % in Sudan  and 80 % in Nigeria . Differences have been observed in the studies conducted in other countries such as Egypt , Tanzania , Nepal , Malaysia , and Indonesia . The dissimilarities in the knowledge-appraisal questionnaires do not make it possible for accurate comparisons of knowledge levels across these studies. Moreover, barring Bangladesh and our study, all the previous surveys embraced female participants as the major respondents. Interestingly, knowledge score significantly differed with respect to gender of the respondents in other countries, while such trend was not evident for Ethiopia and Egypt.
In general, Ethiopians (63 %) showed moderate attitude towards the current pandemic in our survey. Notably, 35% respondents expressed reassuring/good attitude as against a mere 2%, displaying poor attitude towards COVID-19. For instance, 9 out of 10 participants agreed to isolate themselves if symptomatic while three out of four appreciated the disease containment endeavors of the government. By the same token, Aynalam et al.,  reported that more than 80 % of the respondents in their study were upbeat about Ethiopia’s triumph against the COVID-19 fiasco. At this juncture, drastic measures of the Ethiopian government in mitigating the spread of the virus, including the declaration and enforcement of a SoE for five months, door to door temperature check by health personnel, and closure of education institutes and worship places merit special mention. Our study evinced that a low fraction (11.5 %) of respondents was unconvinced with the government’s efforts in fighting against COVID-19. To talk about other African nations, pertinently, 71 % and 60.9 % of Nigerians and Sudanese respectively are buoyant about the win against COVID-19 through their respective governmental actions [22, 23]. Augmented attitude scores bore a direct correspondence with the age and education level in our study. Correlational analysis also augments the findings of present study as knowledge was positively correlated with the attitudes significantly and the same was observed in Indonesia . Nine out of ten were of the view that COVID-19 is posing serious public health threat, owing to its highly contagious nature and global status, however, only 6 out 10 seemed to be panic-stricken. This may be explained in the light of the current observation that Ethiopia is one of the least affected country in the world with a low mortality. However, probability of asymptomatic individuals and low rate of detection in the country need to be addressed as well. On the other hand, around 3 out of 10 respondents averred the virus to be a potential bioweapon, while, corresponding results were 1 out of 4 in Egypt  and nearly 1 out of 2 (50 %) in Nigeria . In the context of the current dearth of scientific evidence, there is enormous heated discussion globally on the synthetic versus natural origin of SARS-CoV-2, responsible for COVID-19. Around 22 % of the Ethiopian respondents in our study vouched for its synthetic genesis as against 36 % Nigerians .
Needless to state that the possession of adequate knowledge and apt attitude towards the disease may not suffice, the requisite is to employ and engage in appropriate practices to prevent and combat the viral assault. 36.2 %, 52.4 %, 56.3 %, and 67.6 % of the respondents asserted the use of nose mask, maintenance of social distancing, avoidance of crowded places and regular washing of hands respectively as against a quarter of the participants who continued to resort to the unique Ethiopian style of greeting, involving bodily contact. This was suggestive of a low willingness of the participants to make behavioral changes towards COVID-19 with respect to some of the day to day practices. A number of factors associated for the poor practices, such cost of the mask, sanitizer, and low availability of the protection materials, and culture (greetings, eating together). Another survey in Ethiopia showed 56 % of undergraduate students and 66 % hospital visitors not maintained social distance [27, 29] during March 18-24. During this period 8 out of 10 people not wearing nose mask when leaving home , but it has improved to 1 out 5 in this study during May. The similar percentage of people wearing mask was observed in neighboring country of Egypt . Whereas, another African peoples of Tanzanians shows 80 %, Sudanese at 49.3 %, and Nigerians at 65 % [25, 21, 22]. In case of Chinese study almost all used face masks when they go out during the current pandemic , that may be the reason they got succeeded in the disease spread.
Most importantly, a considerable fraction of the participants (17.6 %) seems to be least bothered and consequently non-adherence to these precautionary measures. Specifically, this encompassed females, young aged responders, unmarried, those with lower education status, self-employed and unemployed, and participants with poor knowledge and those hailing from Somali and Afar region. Previous studies in other countries have attested the correspondence of higher risk taking behavior with younger age, low education levels and lifestyle in rural areas [10, 39]. In contrast with our results, Zhong et al., (2020) found a greater correlation of non-recommended/dangerous practices to the male participants in China . On the other hand, lockdown was imposed in many countries for certain number of days. However, no lockdown protocol has been enforced in Ethiopia till the date of drafting this manuscript. Although, the number of confirmed cases and deaths are considerably low in Ethiopia in contrast to rest of African countries, there seems to be a gradual increase in recent weeks (9,503 on 19th July, 2020) . In this regard, less than half of the participants (~41 %) in our survey stood in support of a lockdown in Ethiopia. There was a positive correlation between attitudes and practices while no correlation between knowledge and practices. This might be explained as government strict action on prevention practices and peoples willingness towards the action. While previous studies in other countries found positive correlation between knowledge and practices [10, 40].
With regard to risk of infection, around 18 % people could be bracketed under high risk category, it means around 19.5 million peoples are in high risk in Ethiopia. Considering the limited representation of various sections of the population and the fact that >95% of the participants in our survey had college education, the numbers in the high risk category could be plausibly much more in the real scenario. Among gender, we found women’s are at high risk than man. In many settings, women and girls are highly vulnerable and at increased risk during an epidemic or crisis, because they are responsible not only for caring for the elderly and children, but because they often make up more than half of the healthcare workforce . Surprisingly, healthcare workers were in higher risk (18.3 %) than the students (14.6 %), even though the former group exhibited adequate/good knowledge (55 %) than the latter counter parts with 26 % and 20 % knowledge score, respectively. At this juncture, it would be relevant to mention that healthcare workers in Ethiopia had demonstrated an insufficient knowledge and perception but positive attitude during Ebola outbreak in 2015, thereby, vouching for an intense training for the healthcare professionals . These findings clearly evince the significance of improving the various practices of the Ethiopian citizens towards COVID-19 through timely health education and dissemination of correct information in various nook and crannies of the country, which are also envisaged to contribute in improving the attitude, knowledge and perception of the mass towards COVID-19.
Limitation of the study
The authors had solely relied on their online/social media networks (Telegram, Facebook, WhatsApp and email accounts) for circulation of the survey link. As a result, considerable fraction of the population could not participate in the survey. Moreover, when compared to current population in Ethiopia, the survey-samples were over representative of male respondents, below the age of 50, those with university level education and mostly employed in the public sector. A more systematic, community based, inclusive sampling method with local language is recommended to improve representativeness and generalizability of the findings. The survey questions were generally used and modified based on previously published KAP assessment carried out on COVID-19 in Ethiopia. Despite these limitations, our findings provide valuable information about the KAP of Ethiopians during a peak period of the COVID-19 outbreak.