To the best of our knowledge, this is the first comprehensive report in Nigeria that considered the knowledge about the spread, symptoms, disease progression, risk factors, treatment and preventive measures against COVID-19. In addition, our study assessed perceptions about COVID-19 and adherence to preventive measures among the Nigerian population. We also determined the predictors of self-perceived risk of contracting COVID-19.
A common source of information about COVID-19 in this study was the internet. This is similar to what was reported in a recent study from Egypt which also identified internet as the most common source of information about COVID-19 [5]. Coronavirus disease 2019 information from the Ministry of Health channeled through television and radio stations are often regulated and are always in line with the World Health Organization (WHO) and Nigeria Centre for Disease Control (NCDC) guidelines. To reach more people, bulk sms and online outlets through the use of social media like Facebook, twitter and so on are now also widely adopted by the Ministry of Health and NCDC, in addition to television and radio, to disseminate COVID-19-related information. The use of internet however, has also increased the influx of fake and unauthenticated news. Caution should therefore be exercised in the use of online outlets as the major source of information by individuals. Doubtful online information should be verified from other reliable sources.
The knowledge about the spread, symptoms, disease progression, risk factors, treatment and preventive measures against COVID-19 in this study was generally good. This can be attributable to the high level of education of our respondents as corroborated by a study among educated people in China which also revealed good knowledge about COVID-19 [7]. Despite the general good knowledge displayed in virtually all the domains of knowledge assessed, the responses to some specific knowledge questions are disturbing and need to be clarified by more public enlightenment. For example, the finding that some respondents either did not know or did not believe that asymptomatic individuals can transmit the virus is quite worrisome. Such persons may be tempted not to adhere to the prevention guidelines for COVID-19 where there are apparently healthy individuals and this can undermine the preventive efforts of COVID-19 transmission from person to person.
Also, quite a number of our study participants clearly misconstrued sneezing as a symptom of COVID-19. Although unprotected sneezing is one of the effective ways of transmitting the novel coronavirus from an infected individual, sneezing is not part of the community case definitions for COVID-19 according to NCDC guideline. More public enlightenment on the community case definitions of COVID-19 is needed to avoid the stigma associated with sneezing in public places which is increasingly becoming high in Nigeria.
Another area where Nigerians need further enlightenment is knowledge about the at-risk population for severe COVID-19. Although knowledge about the risk factors for severe COVID- 19 appeared good, approximately 20% of individuals still either did not know or did not believe that severe COVID-19 is associated with chronic illnesses. Similarly, approximately half of our study participants did not know or did not believe there was a relationship between obesity and severity of COVID-19. These findings are disturbing as there are documented evidences that older individuals, people with chronic illnesses and obesity needs to take extra precaution to prevent themselves from contracting COVID-19 as they are more at risk of progressing to the severe form of the disease [13,14]. There is therefore a need for serious public enlightenment if the desired reduction in morbidity and mortality associated with COVID-19 in this population is to be attained. Another call for concern is the reasonable number of respondents who believed that antibiotics can be used for managing COVID-19 and those who did not know that antibiotics cannot be used for managing COVID-19. These two groups of individuals could become victims of inappropriate use of antibiotics and its subsequent complications as the sale of drugs is generally unregulated in Nigeria with many medicine stores not requesting for doctors’ prescriptions before drugs are sold to patients. Another implication of the inappropriate use of antibiotics, especially in Nigeria, where the use of antibiotics has been grossly abused, is that it poses serious public health threat in relation to antimicrobial resistance. Stressing the fact that the World Health Organization disapproves the use of antibiotics for the treatment of COVID-19 can therefore not be overemphasized [15].
Coronavirus disease 2019 infection in Nigeria started among international travelers, many political office holders and elites at the early stage. This made a number of people to believe that it was a disease of the rich from anecdotal evidence. Currently however, COVID-19 transmission is in the community transmission phase in Nigeria where everybody is now at risk of contracting the disease. The fact that some few individuals in our study still believed that COVID-19 is a disease of the rich is therefore disheartening and disturbing. These set of individuals are not likely to adhere to the COVID-19 prevention guidelines and may jeopardize the current efforts in the fight against this highly contagious disease. Hence, more public education is needed if the fight against COVID-19 is to be won.
Findings from this study revealed that our study participants are quite optimistic that the Nigerian government can win the current battle against COVID-19. Study participants from a recent study among the Chinese population also had similar optimism [16]. Previous Government outbreak response (Ebola outbreak in Nigeria and Severe Acute Respiratory Syndrome outbreak in China) in these two countries may be a possible reason why the populace are confident that their Government can handle the current COVID-19 outbreak.
In this study, a total lockdown of the nation was perceived as a measure that can help to curtail the current COVID-19 pandemic. This should however be interpreted with caution because most of our respondents are highly educated persons and civil servants who may be on salaries and hence are not representative of the entire population. Anecdotal evidence suggests that a total lockdown may not be appropriate for Nigeria as quite a number of her citizens are not salary earners and therefore have to fend for themselves, especially when the provision of palliatives is not effective. Further studies addressing the perception of the self-employed and those who work with private establishment about the total lockdown policy as well as discussion involving all relevant stakeholders about possible ways to adapt the lock down policy to the Nigerian context is urgently recommended.
The self-perceived risk of contracting SARS-CoV-2 among our study population was high when the proportions are converted to absolute numbers. Among those that perceived themselves as not being at risk of contracting the virus in this study, reasons adduced for their self-perceived risk include the fact that they adhere to some preventive measures such as avoidance of crowded places and regular washing of their hands with soap under running tap. This assertiveness is quite true as these measures are highly effective in breaking the chain of transmission of the disease and they should be highly encouraged.
Some of the good preventive measures adopted, as reported by our participants, included avoidance of crowded places; frequent hand washing with soap and running water; and use of hand sanitizers. Even though our respondents reported adherence to some precautionary measures to prevent the spread of COVID-19, the adherence in our study was low compared to the measures taken in other countries like China and Egypt [5,7]. Reasons why people are not adhering to this preventive measures in Nigeria should be addressed urgently. For example, some of our study participants rarely or do not use hand sanitizers because they cannot afford it, feel it is scarce or feel its use is not necessary. Recommended ways of increasing the adherence to COVID-19 prevention guidelines among the Nigerian population include providing public education on clear explanation on why the adherence to COVID-19 prevention measures needs to be observed, disabusing peoples’ minds about COVID-19 myths, providing facts and correct information about COVID-19, and addressing obstacles hindering the full adherence to the prevention guidelines among other recommendations.
Only a few of our respondents used face mask as at the time data were collected. Majority of the people believed it was not necessary to use face mask. A significant number of the respondents could not also use face mask because of hike in price. There is currently no consensus on the use of face mask by healthy people in public places. However, the Centres for Disease Control and Prevention (CDC) has recommended the use of face mask in areas where there is significant community-based transmission [16]. The WHO also recommends the use of face masks to population at risk of exposure and the vulnerable groups [17]. In Nigeria, where there is no efficient public health alert system, reliable disinfection programme, and increase in the transmission rates in many major cities, the government and the local public health agencies of the country have made the right decision in making the wearing of face mask compulsory in public places.
The use of vitamins was the most common preventive chemotherapy used by our respondents. Although an earlier study supported the use of vitamins for the management of COVID-19 [19], a more recent review of the evidence on the use of vitamin D for treatment or prevention in COVID-19 rebuffed this [18].
Older adults and those who visited crowded places were more likely to have a self- perceived risk of contracting COVID-19 from our study. These are not surprising results because documented risk factors for transmission of COVID-19 include older age and overcrowding. These results therefore underscores the importance of physical and social distancing across all age groups with additional focus on the older population. Females and married persons were less likely to have a self-perceived risk of contracting COVID-19. Reasons why this was so is not so clear and more research may need to be conducted to determine the reason for this.
One of the limitations of this study was that the uneducated people and those living in rural areas who are likely to be more vulnerable due to poor knowledge and poor preventive measures practices were not represented in this study. It is therefore very important to conduct similar study among the uneducated and rural dwellers in Nigeria. Also, the online nature of the study did not permit us to conduct a focus group discussion and in-depth interview which could have further provided us with more details on the participants’ responses. Despite these limitations, this study was able to add to the existing body of knowledge on COVID-19 in Nigeria.
Currently, COVID-19 is being transmitted actively in Nigeria. To effectively break the chain of transmission of the current outbreak, there is an urgent need for a robust public enlightenment about the disease. Also, physical and social distancing should be emphasized across all age groups with additional focus on the older population.