Assessment on Awareness Towards Preventive Measures of COVID-19 in Sheka, South Nation Nationalities and Peoples of Region, Southwestern Ethiopia: Community Based Cross-Sectional Study

Background: The coronavirus disease2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and it is the most important public health problem worldwide. A critical element in tackling the COVID-19 crisis is personal behavioral change. However, there is a paucity of evidence that shows peoples ‘on awareness towards COVID-19 pandemic. Thus, this study aimed to assess the awareness level towards COVID-19 in Sheka, South nation nationalities, and peoples of the region (SNNPR), Southwestern Ethiopia. Methods: A community-based cross-sectional study was employed 10 th to 21 th of April 2020. A total of 419, study participants included in this study. Both univariable and multivariable logistic regression analyses used to identify signicant factors of awareness level. Variables with p-value<0.05 were considered signicant inuences of the awareness. Results: Of all respondents in the study, nearly half(49.4 %) of participants had an awareness of COVID-19.Sex, education level, religion, symptom, and knowing prevention methods were factors signicantly associated with an understanding of COVID-19. Respondents who know all prevention methods (AOR: 8.1, 95%CI: 1.3-51.9) are more likely to aware of COVID-19 than its counterpart. Conclusion: In this study, a low awareness level towards COVID-19 observed, and programs to improve awareness towards COVID-19 are essential to prevent and control the pandemic.

universities. The virus affects over 1.5 billion students worldwide, accounting for 87% of enrolled learners [11].
To date, there is no speci c vaccine or treatment recommended to prevent COVID-19. Though messages related to COVID-19 transferred from health professionals and the concerned body frequently, still the utilization of preventive measures is low in our observation. A critical element in tackling the COVID-19 crisis is public behavior change. Behavior change requires that the public understands, accepts, and implement the recommended prevention methods. There is a paucity of evidence that shows the levels of individual awareness towards COVID-19 in Ethiopia. Thus, this study aimed to assess the awareness level towards COVID-19 in Sheka Zone, South nation nationalities and peoples of region, Southwestern Ethiopia.

Study area and design
The current study was conducted in Sheka Zone, South Nation Nationalities and Peoples of Region, Southwestern Ethiopia. The capital of the Zone, Masha, is located 951 Km to North West of Awassa, the capital of SNNPR and 676 km to Southwest of Addis Ababa. Sheka is bordered on the south by Benchi-Sheko, on the west by the Gambela Region, on the north by the Oromiya Region, and on the east by Kaffa. Administratively, the Zone is structured into three Woreda and two city administrations. A communitybased cross-sectional study was employed 10 th to 21 th of April 2020.The study populations are all populations who are living in the study area, South Nation Nationalities peoples of Region, Southwestern Ethiopia Sampling Procedure The sample size calculated using a single population proportion formula considered con dence level, the margin of error, and expected maximum proportion [12]. The required sample size computed as is at 95% con dence level for normal distribution, which is 1.96,is a margin of error (5%). And 10 % none response rate considered. Thus, considering (a maximum proportion for the awareness of individuals about COVID-19 pandemic), the sample size for this study becomes 384.5+38.5~424.

Data collection tools and procedure
The data were collected using a structured interviewer-administered questionnaire that was prepared based on the study objectives and conducted in the study area, South Nation Nationalities, and Peoples of Region, southwestern part of Ethiopia. The questionnaires translated into the local language that is Amharic. Six health extension workers involved for twelve days on the 10 th to 21 th , April 2020 G.c for data collectors. One-day training has given for data collectors and selected participants by the investigators to control the quality of data.

The study variables
The outcome variable was the awareness status of participants dichotomized as aware and not aware (measured from the knowledge of participants towards . Aware when the participants showed knowhow about COVID-19 spreading on prevention and control mechanism and not aware when the participants showed poor understanding in the direction of COVID-19 spreading on prevention and control mechanism related questions.
The explanatory variables include socio-demographic factors such as age, sex, level of education, religion, source of income, prevention method used, knowing symptoms, use of quarantine, treatment, source of information, level of implementing of government and health professionals' declaration, and pre-existing health condition of participants measured from structural administered questionnaires.

Data analysis
Data were analyzed using the SPSS software package (version 20) [13]. Frequency distribution, percentage, and plots used to provide sound results. The chi-square test and binary logistic regression model were applied to examine the association between factors and the dependent variable. The logistic regression model used when the dependent variable or the response variable qualitatively expressed [14].
Binary logistic regression is the form of regression, which used when the dependent variable is dichotomous and the independent variables are any type. A binary variable has only two possible values, such as presence or absence of a particular event, in our study (the participants has awareness towards preventive measure of COVID-19 pandemic or not).
The odds are simply the ratio of the probabilities for the two possible outcomes [15]. If is the probability that an event will occur, and then 1 -p i is the probability that an event will not occur.
Let in 2 × 2 tables, within row the odds of success are and within row the odds of success equal The ratio of the odds from the two rows (odd ratio) given by The Wald test is the most computing parameter estimation method used in tting logistic regression method. After the model is tted, the next important step is checking the model adequacy, therefore, the study used the Hosmer-Lemeshow test [16].

Results
The socio-demographic characteristics of the study participants illustrated in Table 1. Four hundrednineteen respondents participated in the survey. Among the respondents, 207 (49.4%) had awareness, and 212 (50.6%) did not have an understanding of COVID-19 pandemics, which was an almost equal proportion of awareness. Of the total respondents, males accounting, 97(46.9%), and females accounting, 110 (53.3%) had awareness towards COVID-19 pandemics whereas 68 (32.1%) of males and 144 (67.9%) of females did not have awareness about COVID-19. Table 1 also shows the distribution of age on awareness status. The majority of the respondents in the age group between 20 to 29 had awareness.   (Table 2).  (Table 3). The rst two rows in Table 3 stand for the two possible outcomes, and the two columns under the heading predicted are for high and low probabilities. The observation also held in the sensitivity (71. 5%) as compared to that of speci city (76.4%). Sensitivity measured the correct proportion of classi ed events (the awareness of individuals towards COVID-19). Speci city measures the true proportion of classi ed non-events (those not suggested for awareness of individuals towards COVID-19). Both false positive and false negative rates are a little more than 25%.
The false positive and false-negative rate respectively measure the proportion of observing misclassi ed as events and miss classi ed as non-events. Thus, the overall correction prediction was 74% on the progress over the chance level to aware of the COVID-19 pandemic.
The results from multivariable analysis revealed that gender, religion, education level, understanding prevention methods were factors associated with awareness level of COVID-19. (Table 4).

Discussion
Now a day, the COVID-19 is spreading in the world dramatically. The Ethiopia government takes many measurements to tackle the impact of COVID-19 on any business sector and the wellbeing of individuals.
It is, therefore, mandatory to explore the effects of COVID-19 in Ethiopia and to set out immediate priorities and longer-term strategies for appropriate interventions. Culturally, in Ethiopia, it is hard to apply all COVID-19 prevention strategies since the individual is a highly sociable, culturally indispensable one for each other, and the marketing system is traditional.
The COVID-19 is a current language spoken by almost all media all over the world. However, society still does not aware of the risk of COVID-19 pandemic. The study showed that 50.6% of participants did not have awareness about the COVID-19 disease. The overall correction prediction value was 74%. It is an improvement over the chance level to aware of the COVID-19 pandemic, and 26% chances did not aware of COVID-19. The current study is consistent with the study done in the awareness of the individual towards COVID-19 disease [17].
Hence, much effort needed to create awareness for the individual about COVID-19 by assessing sociodemographic factors and the individual's perception towards COVD-19 pandemic management. Quarantine is one mechanism to control the coronavirus pandemic. The study about ninety-nine percent of the societies have awareness about quarantine and expected to report the disease. The current study is consistent with the study done in Middle East Respiratory Syndrome Coronavirus epidemic impact on healthcare workers' risk perceptions, work and personal lives [18] and also consistent with the study conducted in Vietnam were 97.9% of the participants agree to quarantine [19].
According to the world health organization (WHO) advice, the individual expected to be high risk by COVID-19 pandemic if their current health status is pregnancy, seizure, hypertension, diabetic Miletus, addiction, HIV, chronic pulmonary and chronic rental disease. The study showed that seventy-seven percent of participants are healthy, and twenty-three percent of participants are at risk. Thus, special attention should be given to the high susceptive society in the town city administration by creating awareness about the COVID-19 pandemic (Fig. 1). According to this study, 0.48% of participants never implemented the government, and health professions taught how to prevent coronavirus pandemic prevention strategies (Fig. 2).
Currently, there is no vaccine to treat coronavirus pandemic. However, still, the individual believed that there is a vaccine to treat the disease. In the study, 8.2% of individuals assumed that there is a vaccine, and these results show it very risks to manage the pandemic. The level of implementation of government and health professional declaration regarding COVID-19 pandemic overall prevention strategies are questionable since some individual was not still implementing the government declaration.
The awareness may be depending on religious aspects. Some religions may preach that the disease becomes from God and so that it is so hard to stop by government declaration and health profession.
The model may tell us some religions are less aware (religion concern) than other religions even if we cannot recommend which religion is better. As is known, the Ethiopian religious association agreed to announce declaration for one month to pray to tackle the hidden war, which is an unseen enemy that attacks all individuals regardless of the religion in the World.
The study found that mass media and public health care workers were the most important sources of information for Sheka Zone, Tepi Town city administration individual's awareness towards COVID-19. These ndings were similar to Myanmar adults study the familiar sources were social media and mass media [20]. Also in Hong Kong study in which their common sources were social platform and mass media but different with health care workers study in which their primary sources were not only social media but also o cial government websites [21], [22] and in Pakistan healthcare professionals study [23].
The multivariable binary logistic regression used to identify the factors in uencing society's awareness of COVID-19. The results showed that gender, educational level, and preventive strategies are signi cant factors in the understanding of individuals. These ndings were similar to the study conducted in Myanmar adults on awareness, perceived risk, and protective behaviors to COVID-19 and in Saudi Arabia [20], [24].

Conclusion
The nd out about highlights the awareness status in Sheka, South Nation Nationalities' Peoples of Region, Tepi city administration, Southwestern part of Ethiopia and individuals presently practising concerning COVID-19 pandemic. The study assessed individuals' awareness and exercise in the direction of COVID-19 spreading prevention. According to our nding, the main factors for being aware are gender being female, education level being secondary and above level, religion, knowing symptoms of COVID-19 and prevention strategies. The study found that below half of the respondents (49.4%) agreed on the essential role of individuals in the prevention of COVID-19 spreading and they decided to inform suspected instances to any involved health care workers and follow the directions of the ministry of health authorities and the establishment policies to forestall the expansion. Also, the nding con rmed that more than half (50.6%) of the individual has no su cient awareness and insu cient protecting exercise to prevent COVID-19 infection. The study found 54. 18    Level of implementation the government declaration regarding COVID-19 by individuals. Figure 3 Predicted probability of individual towards COVID-19

Supplementary Files
This is a list of supplementary les associated with this preprint. Click to download. Questionnare.docx