Socio-demographic characteristics of respondents
In the quantitative component of this study, a total of 661 study participants were included. About 37.5% of study participants were males. Nearly two-third (433(65.5%)) of respondents are residing in the rural area. Of the total study participants, majority (534 (80.8%)) were married. About half (51.4%) of individuals are without formal education, and only 13.3% of respondents had secondary and above education level.
Table 1
Descriptive results of socio-demographic and economic characteristics of respondents in east Gojjam Zone, 2020
Variables
|
Total (%)
|
Variables
|
Total (%)
|
Gender
Male
female
|
248 (37.5)
413 (62.5)
|
Education
No formal education
Primary school
Secondary and above
|
340 (51.4)
233 (35.2)
88 (13.3)
|
Residence
Rural
Urban
|
433 (65.5)
228 (34.5)
|
Occupation
Government employee
Farmer
Merchant
House wife
|
84(12.7)
396(59.9)
65 (9.8)
116 (17.5)
|
Marital status
Unmarried
Married
Divorced
Widowed
|
52 (7.9)
534 (80.8)
50 (7.6)
25 (3.8)
|
Family size
≤ 3
≥ 4
|
292 (44.2)
369 (55.8)
|
Age
≤ 25
26–35
35–45
≥ 46
|
75 (11.3)
269 (40.7)
198 (30)
119 (18)
|
Comorbidity
Yes
No
Unknown
|
139 (21.0)
460 (69.6)
62 9.4)
|
Level of knowledge, attitude and preventive practice towards COVID-19 pandemic
The result of this study revealed that only 59.6% (95%CI: 56, 63.4) of respondents had better understanding of COVID-19 pandemic. These include recognizing ways of transmission, preventive measures and symptoms. Similarly, only 14.5% (95%CI: 11.6, 17.1) of individuals had favorable attitude towards COVID-19. More specifically, about 30% of individuals believed that COVID-19 comes for sinners. In addition, nearly 16.3% of respondents think that the government used COVID-19 for political issue. Moreover, this study showed that only one-fifth (20.9%) of study participants had good preventive practices. About 31% of individuals are wearing mask in crowded area. Of the total interviewed study participants, about 41% of them maintain physical distancing.
Factors associated with the level of knowledge towards COVID-19 pandemic
Multivariable binary logistic regression analysis was conducted to identify the determinant factors associated with the level knowledge (Table 2). Accordingly; residence, age of respondent, educational level, and occupation were factors significantly associated with the level of knowledge towards COVID-19. Respondent’s residing in urban area had better knowledge (AOR: 0.1, 95%CI: 0.08, 0.2) than individuals living in rural area. The level of knowledge among study participants who had age between 35 and 45 are more-likely (AOR: 0.4, 95%CI: 0.2, 0.8) than respondents who had age less-than25 years.
The odds of knowledge towards COVID-19 is more-likely (AOR: 0.2, 95%CI: 0.1, 0.5) among respondents who had secondary and above educational level than individuals without formal education. Furthermore, housewife respondents had low level of knowledge (AOR: 5.1, 95%CI: 1.7, 15.5) than government employee.
Table 2
Univariable and multivariable binary logistic regression analysis on factors associated with the level knowledge towards COVID-19 in east Gojjam Zone, 2020.
Variables
|
Level of knowledge
|
COR(95%CI)
|
AOR(95%CI)
|
Poor knowledge
|
Good knowledge
|
Gender
Male
female
|
109
158
|
139
255
|
Ref.
1.2(0.9, 1.7)
|
Ref.
0.7(0.5, 1.0)
|
Residence
Rural
Urban
|
237
30
|
196
198
|
Ref.
0.1(0.01, 0.2)
|
Ref.
0.1(0.08, 0.2)
|
Marital status
Unmarried
Married
Divorced
Widowed
|
21
213
23
10
|
31
321
27
15
|
Ref.
0.9(0.5, 1.8)
1.3(0.6, 2.8)
0.9(0.4, 2.6)
|
Ref.
0.9 (0.5, 1.7)
1.1 (0.4, 2.5)
0.1 (0.08, 0.2)
|
Age
≤ 25
26–35
35–45
≥ 46
|
41
95
91
40
|
34
174
107
79
|
Ref.
0.5(0.3, 0.8)
0.7(0.4, 1.2)
0.4(0.2, 0.8)
|
Ref.
0.3(0.2, 0.6)
0.4(0.2, 0.8)
0.2(0.1, 0.4)
|
Education
No education
Primary school
Secondary+
|
188
72
7
|
152
161
81
|
Ref.
0.4(0.3, 0.5)
0.1(0.03, 0.2)
|
Ref.
0.4(0.3, 0.6)
0.2(0.1, 0.5)
|
Occupation
Gov.employee
Farmer
Merchant
House wife
|
5
208
14
40
|
79
188
51
76
|
Ref.
17.5(6.9, 44.1)
4.3(1.5, 12.8)
8.3(3.1, 22.2)
|
Ref.
8.8(2.9, 24.9)
2.9(0.9, 9.4)
5.1(1.7, 15.5)
|
Family size
≤ 3
≥ 4
|
105
162
|
187
207
|
Ref.
1.4(1.0, 1.9)
|
Ref.
1.3(0.9, 1.9)
|
Comorbidity
Yes
No
Unknown
|
60
182
25
|
79
278
37
|
Ref.
0.9(0.6, 1.3)
0.8(0.5, 1.6)
|
Ref.
0.8(0.5, 1.2)
0.9(0.4, 1.7)
|
Factors associated with the level of attitude towards COVID-19 pandemic
In the multivariable logistic regression analysis, residence, level of knowledge, occupation, and having confirmed comorbidity were factors associated the level of attitude towards COVID-19 (Table 3). Respondents residing in urban area had favorable attitude (AOR: 0.5, 95%CI: 0.3, 0.8)) towards COVID-19 than study participants living in rural area. The result of this study revealed that study participants who had better awareness are more-likely (AOR: 3.0, 95%CI: 1.7, 5.5) to have favorable awareness.
Table 3
Univariable and multivariable binary logistic regression analysis on factors associated with the level Attitude towards COVID-19 in east Gojjam Zone, 2020
Variables
|
Level of Attitude
|
COR(95%CI)
|
AOR(95%CI)
|
Unfavorable attitude
|
Favorable attitude
|
Gender
Male
female
|
222
343
|
26
70
|
Ref.
0.6(0.4, 0.9)
|
Ref.
0.6(0.4, 1.01)
|
Residence
Rural
Urban
|
384
181
|
49
47
|
Ref.
0.5(0.3, 0.8)
|
Ref.
0.5(0.3, 0.8)
|
Marital status
Unmarried
Married
Divorced
Widowed
|
42
459
41
23
|
10
75
9
2
|
Ref.
1.4(0.7, 3.0)
1.01(0.4, 2.9)
2.7(0.6, 13.6)
|
Ref.
1.4(0.7, 3.0)
1.0(0.4, 2.8)
0.5(0.3, 0.8)
|
Age
≤ 25
26–35
35–45
≥ 46
|
57
219
181
108
|
18
50
17
11
|
Ref.
1.4(0.8, 2.6)
3.4(1.6, 6.9)
3.1(1.4,7.0)
|
Ref.
1.5(0.7, 2.9)
3.0(1.3, 7.2)
1.8(0.7, 4.9)
|
Education
No education
Primary school
Secondary +
|
300
200
65
|
40
33
23
|
Ref.
0.8(0.5, 1.3)
0.4(0.2, 0.7)
|
Ref.
1.1(0.6, 1.9)
0.5(0.2, 1.2)
|
knowledge
Good
Poor
|
318
247
|
76
20
|
Ref.
2.9(1.8, 4.9)
|
Ref.
3.0(1.7, 5.5)
|
Occupation
Gov.employee
Farmer
Merchant
House wife
|
69
353
59
84
|
15
43
6
32
|
Ref.
1.8(0.9, 3.4)
2.1(0.8, 5.9)
0.6(0.3, 1.1)
|
Ref.
0.5(0.2, 1.4)
1.2(0.4, 3.7)
0.2(0.1, 0.6)
|
Family size
≤ 3
≥ 4
|
240
325
|
52
44
|
Ref.
1.6(1.0, 2.5)
|
Ref.
0.9(0.6, 1.6)
|
Comorbidity
Yes
No
Unknown
|
131
372
62
|
8
88
0
|
Ref.
0.3(0.1, 0.5)
------------
|
Ref.
0.3(0.1, 0.6)
------
|
Factors associated with the level of preventive practice towards COVID-19 pandemic
The result of this study revealed that residence of study participants, occupation, and having confirmed comorbidity were factors associated with the level of preventive practice. Respondents residing in urban area had better preventive practice (AOR: 0.2, 95%CI: 0.1, 0.3) than study participants living in rural area.
Table 4
Univariable and multivariable binary logistic regression analysis on factors associated with the level preventive practice towards COVID-19 in east Gojjam Zone, 2020
Variables
|
Level of practice
|
COR(95%CI)
|
AOR(95%CI)
|
Poor practice
|
Good practice
|
Gender
Male
female
|
191
332
|
57
81
|
Ref.
1.2(0.8, 1.8)
|
Ref.
1.2(0.8, 1.9)
|
Residence
Rural
Urban
|
383
140
|
50
88
|
Ref.
0.2(0.1, 0.3)
|
Ref.
0.2(0.1, 0.3)
|
Marital status
Unmarried
Married
Divorced
Widowed
|
45
406
47
25
|
7
128
3
0
|
Ref.
0.5(0.2, 1.1)
2.4(0.6, 10.0)
-----------
|
Ref.
0.4(0.2, 1.0)
2.1(0.5, 9.0)
-----------
|
Age
≤ 25
26–35
35–45
≥ 46
|
59
201
168
95
|
16
68
30
24
|
Ref.
0.8(0.4, 1.5)
1.5(0.8, 2.9)
1.1(0.5, 2.2)
|
Ref.
0.8(0.4, 1.5)
1.3(0.6, 2.8)
0.7(0.3, 1.6)
|
Education
No education
Primary school
Secondary +
|
271
196
56
|
69
37
32
|
Ref.
1.3(0.9, 2.1)
0.4(0.3, 0.7)
|
Ref.
1.6(1.0, 2.7)
0.8(0.4, 1.8)
|
knowledge
Good
Poor
|
311
212
|
83
55
|
Ref.
1.1(0.7, 1.5)
|
Ref.
0.6(0.4, 1.1)
|
Attitude
Favorable
Unfavorable
|
77
446
|
19
119
|
Ref.
0.9(0.5, 1.6)
|
Ref.
0.8(0.4, 1.5)
|
Occupation
Gov.employee
Farmer
Merchant
House wife
|
53
337
40
93
|
31
59
25
23
|
Ref.
3.3(1.9, 5.6)
0.9(0.5, 1.8)
2.4(1.3, 4.5)
|
Ref.
2.9(1.3, 6.2)
0.6(0.3, 1.4)
1.7(0.8, 1.8)
|
Family size
≤ 3
≥ 4
|
225
298
|
67
71
|
Ref.
1.3(0.9, 1.8)
|
Ref.
1.0(0.7, 1.6)
|
Comorbidity
Yes
No
Unknown
|
112
352
59
|
27
108
3
|
Ref.
0.8(0.5, 1.3)
4.7(1.4, 16.3)
|
Ref.
0.8(0.5, 1.4)
3.9(1.1, 13.8)
|
Risk perception and challenges of COVID-19 prevention and control in east Gojjam Zone
A total of 9 individuals were participated in the study for an in-depth interview with median age of 32 years, ranging from 19 to 50 years.
Table 5
Showed Distribution of the Socio-demographic Characteristics of respondents, East Gojjam Zone community; Northwest Ethiopia. Sep, 2020.
S. No
|
Variable
|
|
Frequency
|
%
|
1
|
Sex
|
female
|
2
|
22.2
|
Male
|
7
|
77.3
|
2
|
Marital Status
|
married
|
6
|
66.7
|
single
|
3
|
33.3
|
3
|
Educational Level
|
illiterate
|
4
|
44.4
|
primary education
|
2
|
22.2
|
secondary and above
|
3
|
33.3
|
4
|
Occupation
|
Merchant
|
3
|
33.3
|
Government employee
|
4
|
44.4
|
Farmer
|
2
|
22.2
|
|
|
Total
|
9
|
100.0
|
After analysis and reviewing articles, in this study both emerged (psychosocial and perceived behavior) and predefined (perception of susceptibility to a health threat, the perception of its severity, and the perception of the benefits, costs and barriers) themes were identified.
In this finding, the higher portion of the respondents had awareness on the occurrence of the virus. Some understood that it is originated from animals whereas a few of them believed the virus as a result of God punishment to humans and other say it is a man-made virus. Contrarily, some respondents still had doubt about the existence of the virus they are ignorant. The level of ignorance could create a problem as this set of individuals about spreading the disease.
Almost all respondents were highly understood the disease prevention strategies; but nearly all were not practicing all. This is because they believed /denied as the occurrence of the case in the study settings. In the study area, some claimed that if the case is why measures were not taken in market pleases; but the state tried to implement in the religion/faith based organization. This made a question for respondents to believe the occurrence of the disease. A few respondents believed that the only solution to prevent the virus is praying for our Lord/God. Most respondents do their job for the sake of living. Respondents have strong spiritual feelings and sense of right and wrong have made them to perform their duties as usual. The respondents’ being trustful/abide for God and will not make anything to them and some perceived as it (COVID-19) is because of sin.
Theme 1: Psychosocial Emotions
A. Negative Emotions in the Early Stage
All study subjects experienced a significant amount of negative emotions in the first week, especially in the period when officials providing acquaint to the first time about the occurrence of the disease. As stated by a few respondents, as the first case notified in the country the concern about everything continued to rise. When normal work hours changed and proclamations declared; warries increased and the community were conserve many things necessary for survival for them as well their family. Some respondents failing to meet physical and psychological needs brought a sense of helplessness. Most of the respondents felt different levels of anxiety. All most all expressed concern about the impact of the outbreak on the health of their families. They also said that their families were worried about it too.
“Firstly, at the occurrence of the disease and at the time of the officials notifying about the disease; I was very nervous, the overall activity was very troublesome, made frustrations…. Even I was not confident to be out of home, to perform my routine activities and … All conditions were upsetting me.” (Respondent 6, male43 year’s old daily laborer)
B. Physical Distancing perceived as a Loss for intimacy
Many participants felt that the physical distancing and isolation polices had had significant social and psychological impacts on individuals lives, many of the respondents explained physical distancing is in accordance with the lives of this community. Every activity performed together with others (significant others, friends, families…). Being distance physically, some experience sense of loss, in-person (social interaction) and loss of routine. These in turn led to ‘losses’ to emotion, motivation, and self-worth. This is central to loss of social interaction. The lack of face-to-face contact had, leaving participants upset in their feeling. This was stated by a respondent as,
“ No one has performed/or live alone. The nature of our family is extended type so what? It is very embracing for someone to be said kept your distance from me. … if someone /intimates/ said/ ordered me to be sand far …. I don’t have any word to state my filling. ” (Respondent 1, male24 years old trader).
Participants explained how impacts like physical distancing and not being able to socialize with friends, meant they experienced a general loss of meaning in life. Some respondents felt that direction on physical distancing had been generally unclear, and that information about the problem had conveyed ‘mixed messages’ and a few participants described a lack of trust, who were seen to be politicizing the case. A few participants explained that being physically distant, inability to socialize, and the loss of social support led to them feeling a loss of ‘self-worth’.
“I tried to know about the situation, seen professionals to advocate and tried to message about distancing in the straight, market please and on media too. They/professionals/ advised the community to …, the government set a strategy to be far from my intimates, but in my opinion noting is said about marketing. This is a paradox for me to accept the message and implement distancing. This feel me something…. Ohhh….” Respondent 7, 28 year’s old lady).
Theme 2: Perceived susceptibility
Regarding respondents’ individual susceptibility for the disease, a few individuals are susceptible for the disease and a few of them may claim they may have the virus unless they are tested and know their status. A participant perceived the disease is belonging to common cold family. A few respondents experience a mild flu like symptoms and they claim this situation as it happens for the virus.
“In my opinion the virus is a common cold one. Everyone may be infected with common cold. If so every one may be prone to the virus and develop the disease. As of I am too.” (Respondent 1, male24 year’s old trader)
Theme 3: Perceived severity of the disease threat
As all respondents stated that they have no experience for the case/the disease. Theoretical all have the information about the severity of the disease. All claim about pain especially head ache and death cause by the virus/disease. Some respondents pursue experiences stated by real individuals from a media about the severity of the disease. The current COVID-19 Socio-economic impacts are challenging the delivery of essential services to the most affected segments of the population. These consequences (social and economic) of the disease were well explained by all respondents and stated by a respondent as:
“…. Of course, it is difficult and painful for an individual to see professionals who wear protective clothes and equipment as we see via media. It makes something wrong in your feeling, emotion…... this show how it needs a caution and sever is. This causes a person to be in a dilemma of being how much the case is too sever … and the rumors in our locality.” (Respondent 1, male24 year’s old trader)
Theme 4: Perceived Barriers to COVID-19 Prevention
1. Information Overload, but Lack of Trusted Sources
Respondents’ reported being assaulted with information about COVID-19, including from social media, mostly (TV), and as well radio, government announcements, and through face-to-face conversations with neighbors during kettle ceremonies. Despite that, individuals still have many uncertainties regarding the existence of the case:
“ I still feel like people have so many questions, they want answers in a clear way about the mechanisms of transmission, and the exact time to be stop, the current situation how it continues….? ” (Respondent 1, male24 year’s old trader)
As explained by some respondents, even government information was perceived to be unreliable with the understanding that it was aimed at maintaining government interests. The information and rumors spread in part cause fear and emotion. Media played a very big role in creating awareness and also make panic to many individuals. This led to individuals to perceived as COVID-19 was more dangerous, which create fear and anxiety within the communities. However, the information and rumors also created wrong perceptions to the situation, individuals perceived differences among the black and white race in immunity towards the virus/disease with suggestions given by a respondent that:
“… in my perception the virus cannot affect more us; we have /among the blacks and white/ a difference during our development. We/blacks are prone for many cases. We lived in most circumstances … these may help us to resist conditions. Also our/communities in the setting/ feeding habits help us too. Thanks to our herbals, I always use hot drinks by adding garlic, lemon, ጤና አዳም, ዳማ ከሴ, ginger …” (Respondent 1, male24 years old trader)
About the spread of COVID-19, respondents’ experiences during the early days of the spread of COVID-19 due to its novel dimensions, they/some participants/ were feel helpless and frustrated, and feel sense of loss their love and made ambiguity on the help of their family if it happened on either side and they had to do many unusual activities. One of the respondents described as:
“I remember the day when our prime said something about the disease… I was become …... something which made me uncomfortable and less effortful to do something in my way. I was tried to know many about the disease; but nothing I found…. walking here and there… aggressive even for my kids… I was not correct on that occasion.” (Respondent 7, 28 years old lady).
2. Social barriers
Social barriers were the other challenge to individuals to practice the prevention measures for COVID-19. Individuals in the area have had strong social interaction and there is extended family structure. Lack of attention paid to COVID-19 by the community, customs and common beliefs, and community resistance against messages delivered by different means for prevention behaviors had fell manifest in today’s individual’s life style in the society, and failed to talks about health, rather living manner. One of the respondents reiterated this as:
“One part of this problem is rooted in the structure of the society. I mean, there are very strict norms as barriers. Customs and common beliefs have become barriers. If laws are passed and everything is based on religion, the society resists against these correcting behaviors.” (Respondent 4, 36 years old man)
Battle for independence and striving for living as well as lack of interactions with individuals who have a better understanding regarding COVID-19 and officials and negligence were among other barriers for strategy implementation. A respondent restated this as:
“Individuals want to be independent. Someone never listen to their parents or colleagues. There have been talk and discuss about the situation/outbreak in their family and/or groups about the outbreak together with their family/colleagues. Young adolescents and some individuals do not communicate/ignore the discussion with their families/colleagues at all and they do whatever they like. They/some individuals have the information about COVID-19; but nothing they do.” (Respondent 8, male 50 years old)
3. Information and Communication Weaknesses
Lack of asking questions and getting appropriate information about an issue among the community, incomplete and inaccurate information and rumors about COVID-19 among individuals, and irrational shame about practicing some prevention strategies were some important barriers stated by the respondents’. A Participant said that:
“I honestly do not ask any questions about these issues from my family. I really feel embarrassed. I try to find my answers for myself mostly using my phone from Facebook. I do not know the answers retrieved are right or wrong, but I usually get the information from the Internet. Until now, I have had no interest to talk to my parents and with those who have a better understanding about the situation.” (Respondent 1, male24 years old trader)
Family inadequacy on information about COVID-19 is one of the perceived barriers in the study setting for COVID-19 prevention strategy. Low parental awareness regarding COVID-19 transmission, passiveness of family concerning COVID-19 health information, belief of family toward COVID-19 prevention behavior, individual refusal (shame) to practice, and denial on the existence of the virus at the community could all slow down to practice the recommended prevention mechanisms in the study setting. A participant stated that:
“This is my opinion, “I can’t believe on the use of mask…. He smiles and he observe me diagonally; … አይ ሞኞ ሰው እንዴት በጨርቅ ከሞት ይድናል? /how will individuals survive using protecting themselves by using clothes…. I am not confident enough to use it (the mask) … because I am not believing about the purpose.” (Respondent 2, male50 years old urban resident)
4. Individuals’ Concerns About Being Judged by Others
As few respondents stated, uncertainty of confidentiality of information, and fear of losing social interaction among individuals, and finally individuals’ concerns about being judged by others were among barriers to COVID-19 prevention mechanisms’ in the study community. In this regard, one of the respondents stated this as:
“In the first weeks of the occurrence of the disease; I was doing what it was said. Mostly I tried to stay to my home together with my family. I was feared and worried about many issues for my living. Later I left from my house and tried to practice what officials and professionals said to prevent myself and my family from the case. ... was wash my hands frequently, use mask in market areas as well when I work my duties. Always my friends were laughing with me about what I was done and at one day my fried said “… እስቲ እኛ ሞተን አንተ እና ቤተሰቦችህ ብቻ ስትኖሩ እናያለን አለኝ፡፡” Really I was upsetting with this notion. After a while I …… everything what it was expected.” (Respondent 6, male43 years old daily laborer).