During the survey period, 452 eligible individuals completed the survey. About 77 percent of the respondents were in the age group 26–45 followed by the age group 46–59 at about 15 percent. Respondents were from 14 urban and rural governorates (out of 26 governorates in Egypt) including Cairo, Giza, Alexandria, the Delta, and Upper Egypt. About 66 percent were from Cairo, while about 9% were from Giza Governorate. About 67 percent of participants have a college degree, about 15% have a master’s level education, and 13% have a doctoral level education. About 29% of participants work in the healthcare field in different capacities.
Nearly three-quarters of respondents (73.9 percent) reported increased frequency of household cleaning during the COVID-19 lockdown, of whom 88.1 percent increased their use of disinfectants. Furthermore, about 79.4 percent used bleach and 14.2 percent of them mixed bleach with other products rather than water.
Most individuals (about 91 percent) obtained information about how to use disinfectants from multiple sources. The most common sources of information were social media (79.7 percent) followed by CDC or WHO websites (63.5 percent), and TV/satellite (58.9 percent) (see Fig. 1). When we asked about why respondents chose this source as the primary source of information, 46 percent of the respondents answered that the main reason was the ease of getting information from that source, followed by 44 percent whose main reason was the trust in that source of information. Although respondents used different sources to get information about the use of disinfectants, the CDC or WHO websites were reported to be the most trusted source (62 percent) whereas 56 percent of those who consulted with a physician, pharmacist or nurse trusted the information. Fifty two percent of the respondents who used social media (Facebook, WhatsApp) trusted these sources versus 48 percent who used Arabic TV and satellite Programs. Consulting a relative or a friend showed the lowest level of trust.
Among the type of symptoms, respiratory symptoms were most frequently reported, followed by skin, eye, and digestive symptoms. Some individuals reported multiple symptoms. The order of frequency of symptoms were consistent across sources of information (Fig. 2). The primary symptom type for each system was shortage of breath (6.9 percent) and nasal burning sensation (6.9 percent) for respiratory, dryness for skin (6.6 percent), burning sensation for eyes (4.0 percent), and hiccup for digestive (1.1 percent) (Fig. 3).
We found that more individuals developed respiratory symptoms of bleach toxicity when social media was their main source of information to learn about cleaning and disinfection practices (correlation coefficient = 0.10, p-value = 0.03) followed by a relative or a friend (correlation coefficient = 0.10, p-value = 0.02). In addition, individuals were more likely to develop any symptom (i.e., eye, skin, respiratory, or digest) when they obtained information from a relative and a friend (correlation coefficient = 0.10, p-value = 0.04). Obtaining information from more reputable public-facing health sources, such as CDC or WHO website, TV and satellite, or a health professional were not associated with development of symptoms (Table 1).
Among respondents who increased the frequency of the use of bleach in household cleaning (n = 365), 42.2 percent did not use any PPE. The most frequently used PPE were disposable gloves (35.1 percent), face mask (31.8 percent), and rubber/latex gloves (23.3 percent) (Fig. 4).
When we examined the correlation between source of information and other variables (e.g., the use of personal protective equipment while disinfecting the household, whether the respondent or any other family member in the same household experienced any adverse effects to bleach, the age of the respondent, the level of education, and the occupation of the person completing the survey), we found several significant correlations. Although most respondents used social media as their primary source of information, individuals with higher education levels and individuals with medical background were less likely to trust information from social media (p-value 0.07, 0.001 respectively). Although 40 percent of respondents used friends and relatives as a source of information, older people, people with higher education levels, and individuals with medical background were less likely to trust their information (p-value 0.06, < 0.0001, 0.0001 respectively).