Risk of Transmission and Knowledge Gap for Novel Coronavirus Disease 2019 (Covid-19) in Addis Ababa: Risk Estimation and Control Strategies

Background: A novel coronavirus disease 2019 is pandemic infectious disease. It is neither SARS nor influenza; rather it is a zoonotic virus that can be transmitted to humans. COVID-19 was emerged at the end of 2019 in China in Wuhan, the capital of Hubei China. Physical contact and respiratory routs are the two most important well established routs of transmission of the virus. This study is aimed to evaluate knowledge gap and risk activities against Covid-19 in Addis Ababa. Methods: The study used a primary data collected from 431 individuals with analysis of descriptive statistics and multivariate binary logistic regression. Explanatory variables practicing health care service, age, sex, family size, working place, lock down, safe working environment, use transportation, contacting density population, health status and flight history; and knowledge gap and carefulness is response variable at 5% level of significance. Results: In this work practicing health care service & physical distance, safe working environment and Contacting density population are statistically significant predictors in describing risk transmission of Covid-19. Intercept (OR=1.429, 95% CI: 1.199, 1.659), Practicing health care service & Physical Distance (OR=6.885, 95% CI: 6.765, 7.005), Working Place (OR=1.206, 95% CI: 0.961, 1.451) and Safe working environment (OR=4.013, 95% CI: 3.768, 4.258) were factors significantly associated with increased risk of Covid-19 transmission. Conclusions: To control disease transmission in Addis Ababa we need to encourage inhabitants to practice health care service & physical distance, to work their jobs at home and preparing national guidelines to safe working environment and usage transportation.


Background
Novel Coronavirus disease 2019 (COVID-19) is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) [1]. COVID-19 is accidental global health burden especially for developing countries in terms of death and economic cost. The disease was first identified in 2019 in Wuhan, the capital of Hubei China, and has since spread globally, resulting in the 2019-20 coronavirus pandemic [2]. The virus is transmitted from infected person to susceptible human via respiratory system droplet, contact, and fomites. According to CDC, 2020 report infected humans shows disease symptoms like fever, breathlessness, cough, it may take 2-14 days for a person to notice symptoms after infection, but muscle pain, sputum production, diarrhea, and sore throat are less common [3], [16].
COVID-19 infection has four distinct stages [4]. The first stage is importing by test positive person who have a travel history aboard to virus infected countries the second stage is when the local transmission of virus from infected persons to susceptible person. The third stage is stage of virus transmission across community to a person who hasn't travel history or exposed to infected person. The fourth stage is stage of the infection where it takes on the form of an epidemic. [13] While according to the WHO report more than 80% of Covid-19 positive patients can recover, around 14% get severe disease, causing breathlessness and pneumonia and about 5% critical disease and the failure of more than one organ 2% will get in fatal death. COVID-19 virus have four life cycle steps such as; attachment and entry, replicas protein expression, replication and transcription, and assembly and release [5]. Until the preparation of this article (21 April 2020), more than 2,501,920 cases of COVID-19 have been reported in more than two hundred ten countries and territories, resulting in over 171,741 deaths but more than 658,956 people have recovered from this deadly virus [6].
The COVID-19 infection has created an enormous health challenge worldwide. The major continents affected by this disease were Europe, America and Asia. Until April 28, 2020 Africa confirmed 33,627 new cases, 10,226 recovered and 1,476 death against Covid-19. Ethiopia is the second most populous nation in Africa, next to Nigeria. According to WHO alert Ethiopia will be one of the seriously affected countries in Africa. Since first evidence of the COVID-19 pandemic was reported in Ethiopia in March 14, 2020 in Addis Ababa COVID-19 has claimed the lives of 124 (Apr 27, 2020) [6].
COVID-19 is transmitted from infected human to susceptible human through fluids in the respiratory system, fomites, physical contact, uncontrolled sneezing and cough such as mucus.
Less aligned emphasis has been given to the COVID-19 in Ethiopia. Citizens have unique social attachment (greeting, work place, religious culture and holidays, transportation, etc) are serious risk for transmission of COVID-19 [7], [8], [12].
In order to reduce the number of deaths caused by COVID-19, it is better to supply free awareness creation schedule and close physical contact. Closing physical contact is controlling strategy help to block the replication of disease to community. Poor hand hygiene practice, overcrowding, and close physical contacts like hand shaking contributes for the fast spread of the virus with in very short period of time. Restricting mobility of individuals within the border and across borders is believed to be key in preventing transmission [8].

Statement of the Problem
Ethiopia shares land borders with 5 countries (highly attacked by COVID-19) Sudan, Somalia, Djibouti, Eritrea and Kenya. Proportions of tested individuals are near zero compared to the total population of Ethiopia. This is an indication the current number of Covid-19 positives in the country could be a lot more had all the population been tested. A limited diagnostic center and quarantine places will leads to increase this number. Since Addis Ababa is capital city number of foreigners, tourists, national meeting and transportations are centralized. Inhabitants have a wide range of variability across economical, educational and consciousness in capital Addis Ababa.
Although most of the residents in the capital are considered to have access to awareness programs, knowledge of the infection, better access to health care and opportunity to obtain sanitary materials such as detergents, currently Addis Ababa is reeling from unprecedented spread of the virus. Recently in Addis Ababa the number of bars and restaurants (averagely in 150 feet (45 meters) and counted at least 30 bars; one after another on both sides.), hotels, khat and addiction house, commercial sex workers, proletariat, transportation, radically increases throughout the capital city. Students play football and others in community. The population density is estimated to be near 5,165 individuals per square kilometer available. It is critical to protect health care workers and the community from virus transmission and create a safe working environment. However, individuals comeback to their home after higher rate of unsafe physical contact. This all discovers Covid-19 positive patients will be extremely increased (outbreak). Hereof, this article was considering the above research gap into account and evaluates the risk activities and knowledge gap of community in Addis Ababa, Ethiopia about Covid-19.

General Objective
The main objective of this study was to analyze Risk Transmission and Knowledge Gap for Novel Coronavirus Disease 2019 (Covid-19) in Addis Ababa, Ethiopia.

Specific Objective
This study is aimed to address the following specific objectives: • To identify social and economy emergency problems associated with covid-19 in community.
• To evaluate the knowledge gap and carelessness action taken by community regarding to covid-19.
• To assess the attitudes of actions that can save lives now and avert large scale crisis from Covid-19.
• To assess the prevention measures followed by the people.

Method
The COVID-19 pandemic has impact of both social and economic. It remains one of the leading causes of mortality around the world. Nigeria confirms first case in Sub-Saharan Africa Jan 28, 2020 and the disease has been spread throughout the continent including Ethiopia.

Data Source and Study Area
The data used in this study is obtained from community live in Addis Ababa. There are more than 116 Woreda in 10 Kifle Ketema. The population of Addis Ababa is estimated to be 6 million. The data is taken from peoples living in selected Woreda. Data was collected by face to face interview with the selected 431 respondents with the help of questionnaire.

Study Population
All COVID-19 positive patients are illegible (fulfill inclusive criteria) for this study. The study sample will be selected by using stratified random sampling technique. All susceptible groups including both male and female will be target population (more than four million).  , 1, … … … . , are parameters (coefficients).

Model Assumption
Assumption of the Logistic Model 1. Logistic regression model does not assume linear relationship between dependent and independent variables.
2. The dependent variables not normally distributed but assume its distribution is within the range of exponential family of distribution such as normal, Poisson, binomial and gammas.

The dependent variables is not homoscedasticity for each level of in dependent variable,
which is there is no homogeneity of variance of assumption.
4. Normally distributed error terms are not assumed 5. Logistic regression does not negative that independent continuous variable.
6. Both dependent and independent variables are dichotomous

Parameter Estimation for Logistic Regression
Consider the logistic regression model where u=0,1,2,3, …and Ŵ is a diagonal matrix with its diagonal elements )

Assessment of Model Adequacy
After the model is fitted the next important step is checking the model adequacy. There are several steps involved in assessing the appropriateness, adequacy and usefulness of the model. First, the overall goodness of fit of the model is tested. Second, the importance of each of the explanatory variables is assessed by carrying out statistical tests of the significance of the coefficients.  This discovers novel coronavirus disease 2019 will be increased in future. Therefore    between an infector and infectee [12]. Based on the above findings human mobility restrictions and social distancing is highly recommended. Therefore encouraging physical distancing measures within the workspace, increased use of email and teleconferences to reduce close contacts, reduced contact between employees and customers, reduced contact between employees, adoption of flexible leave policies and promoting the use of other personal protective countermeasures [9]. By decreasing the frequency and length of social interactions and the physical contacts between individuals leads transmission may therefore be eradicated.

Results of Binary Logistic Regression Analysis
Furthermore; extending festivals holidays, protecting community hygiene, washing hand for every 20 seconds, and always covering mouth and nose with tissues or elbow when sneezing or coughing is critical action.
Working Place: Flexible working schedules/ shifts for employees, encourage distance working, working at home, communication behaviors (teleworking, increased use of email and teleconferences) to reduce close contacts, reduce contacts between employees and customers also critical solution against reducing physical contact for transmission of Covid-19 and door-to-door screening [10], [15].
Working Environment: In order to create a safe working environment Use sanitary materials frequently, contact tracing between customers and works, force all customers to wear face mask as well as washing their hand before entering working place, opening window and others are critical [11].
Usage of Transportation: Novel coronavirus disease 2019 infections haven't any vaccination or drug with proven clinical efficacy, although there are several candidates that might be effective in prevention or treatment. Therefore, another critical to eradicate transmission of Covid-19 is traffic schedules/ shifts for drivers, and the control of transportation capacity to reduce the passengers; canceling mass meeting practices. Force all in transportation to wear face mask and sanitizers frequently, getting enough air, reform payment system (mobile and internet banking) [1], [14].
Robust and sufficient awareness, truths about daily disease prevalence and guidance documents (easy controlling method) are frequently adverting to peoples increase their consciousness. Based on the finding we scrutinize and recommend practicing health care service, keeping physical distance, safe working environment, and transportation need critical concern in Addis Ababa.
They help us to delay and eradicate outbreaks of Covid-19 for save live of other regions in Ethiopia. Behind this, no need to take time to mobilize individuals and institution for volunteer action (helping poor community members). Another focusing area is door-to-door screening, increasing diagnostic centers and hospital equipment also and need concern by ministry of health.