This study was performed in a time of a quickly changing evidence and rapid spread of the coronavirus. The study was performed among the Sudanese population using smartphones and social media that explain why the majority of the population were young, living in Khartoum state and were university or highly educated. This was also the case in previous t quick online surveys on COVID-19 (6,14,16–18)
The high awareness in this study can be explained by the explosive flow of information on all platforms especially after the appearance of the first case of the disease in the country similar to what happened in China(6). The sources of knowledge were mainly official websites (internet) and social media. The Sudanese Federal Ministry of Health has a well-established with thousands of flowers, continuously updated social media page and an official website. The wide access to the social media carries the risk of infodemics which the authorities should mitigate by proper risk communication(17,18). Similar to what happened in Egypt, hydroxychloroquine ran out of the stocks in Sudan after rumors of its promising effect on COVID-19(17)
The knowledge of the population was high and this may be attributed to the characteristics of the study population, it is also a feature found in other countries in the region (17–20). However, another multinational study indicated lower knowledge in countries in the region ( Jordan, Kuwait and Saudi Arabia) (21). The data revealed that well-educated and older persons had better knowledge about the COVI-19; this can be used to direct the health education efforts towards younger and less educated groups.
It’s worth noting that 98%, 95% and 77% of the population had knowledge about the main preventive measures of the disease spread (handwashing, social distancing, and masks) if this knowledge has been transferred into practice it would make significant difference in the control of the disease.
The attitude of the participants was generally good, with positive significant difference among older and educated groups this was consistent with their knowledge and is consistent with other studies (6,14)
The attitude about wearing face masks was low (49%) compared to 77% of the population mentioned it as a mean for controlling the disease. This could be attributed to several factors: inconsistency in the information between different sources such as WHO, CDC, and MoH which was the same case in Egypt (16,17). There was no law enforcement of the masks use unlike the situation in China and Saudi Arabia (6,14). Other possible factors include the high prices of masks and their availability in the Sudanese market, the latter factor has been a global issue(16).
The mean practices score was relatively low compared to high knowledge and good attitude of the participants. This finding brings the importance of improving the accessibility to preventive measures such as availability of handwashing facilities, facemasks, and enforcing social distancing in different facilities.
The Sudanese community is a sociable active community which influenced the avoidance handshaking (27%) and social distancing unlike the situation in other countries like Saudi Arabia where 88% avoided handshaking(14).
This study demonstrated that the area of residence affects the practices related to the preventive measures especially in those outside Sudan despite the lack of the significant effect on the knowledge and attitude; this might be explained by accessibility to hygiene materials and strict regulations.
It is known that hand hygiene is a major element in the prevention of COVID-19 and other infectious disease. Poor hand washing practice is more linked with male gender, younger age and residence outside Khartoum. This might be due to several factors such as males and young people tend to take more risky behavior as shown in different studies(6). Beside that in the states, the social networks are more active with less available services
The good knowledge and attitude has not been translated to satisfactory practices. Which will affect the combating of this virus as the action is mainly based on the community engagement and behavioral changes (14)
Implication of the findings on the health system
The weak infrastructure, under-resourced health system, widespread of the illiteracy and social practices will negatively influence the spread of the COVID-19 and response towards its prevention.
The study population may not represent the diverse Sudanese communities but it gives an insight to what is happening in Sudan. It is expected that the situation to be worse in more remote and underprivileged areas.