A Cross-sectional Analysis of Kogi State Residents' Knowledge and Perceptions on COVID-19 Pandemic

Coupled with the outbreak of Covid-19 in Nigeria, there has been a controversial trailing of the Covid-19 incidence in Kogi State involving the state authorities and the Nigeria Centre for Disease Control (NCDC). Giving the importance of appropriate awareness and the perceptions to curbing the spread of the disease, this study aimed at assessing the knowledge, perception and precautionary measures of Kogi state residents in response to the outbreak of Covid-19. An online cross-sectional survey was conducted among 401 residents in Kogi State Nigeria, with a structured questionnaire. Data collected were analyzed using descriptive statistics of frequencies and Simple percentage in tables. Findings revealed that all the participants were aware of and had basic knowledge about Covid-19. The study participants had ample knowledge about the required preventive measures and how to protect themselves from Covid-19. It was also revealed that 45.2% of the respondents were conversant with the practice of three to more of the precautionary guidelines for preventing Covid-19. The study also found that a signicant number of the respondents held a very low risk perception of Covid-19 by expressing an unlikely probability of getting infected by the virus. As regards skepticism and belief on coronavirus, 45.9% believed that Covid-19 is a hoax which was invented by interest groups for nancial gains; 46.1% opined that the number of people reported by the NCDC as infected by the coronavirus in Nigeria is exaggerated. Again, 33.7% of the respondents believed that the second wave of the Covid-19 in Nigeria was a scam. The main source of Covid-19 information utilized by majority of the respondents was from Television programmes (34.2%) and Whatsapp (31.9%) platforms. The study concluded that while there was a high level of awareness of Covid-19 among residents of Kogi State and a remarkable level of precautionary practices against the spread of the Covid-19 virus, there are however, indications of misconceptions and misinformation that breeds skepticism and belief that may be detrimental to curbing effectively, the spread of the Covid-19 virus within the state


Introduction
Nigeria like other countries of the world has not been spared by the outbreak of the Coronavirus Disease  and the challenges which it has brought to bear (Valeriani, Vukovic, & Mollica, 2020;Mazzoleni, Turchetti, & Ambrosino,.2020;Ajisegiri, Odusanya, & Joshi,.2020). The number of cases recorded in the country has continued to be on the increase, spreading across several states and suggestively by an ongoing community transmission (Ajisegiri etal,.2020;Ogundokun, Lukman, Kibria, Awotunde, & Aladeitan,. 2020;Ohia, Bakarey, & Ahmad,. 2020). As it is widely publicized, Covid-19 is an infectious respiratory disease caused by a new coronavirus called SAR-CoV-2 with signs and symptoms that include sore throat, cough, runny nose, tiredness, aches, fever and shortness of breath (Velavan & Meyer,.2020;World Health Organization [WHO], 2020). In some cases, infected persons could be asymptomatic (Lee, 2020). Studies have also shown that the incubation period of Covid-19 from publicly reported con rmed cases is estimated to develop symptoms after 14days (Lauer, Grantz, Bi, Jones, & Lessler, 2020). Covid-19 has also proved very deadly as it has claimed over 2,009,781 deaths worldwide and 1435 deaths in Nigeria. (NCDC, 2021) While the origin and the cause of Covid-19 is riddled with a lot of debates, controversies and misconceptions from socio-economic, political and religious perspectives (Ndinojuo, 2020;Gharib, 2020;Tariq, et al., 2020;Catalin & Umbres,.2020), the World Health Organization seems to be clear in establishing that the transmission of the disease is primarily from person-to-person via respiratory droplets bred by talking, coughing, sneezing or also by contact with contaminated surfaces (WHO, 2021). Unfortunately, since there is no de nite established cure for the virus, basic measures are geared towards its prevention (Tingbo, et al., 2020;Cirrincione, et al., 2020). To prevent the spread of the virus requires public health and personal respiratory hygiene (Kakemam, et al., 2020). The Nigeria Center for Disease Control and Prevention (NCDC) maintains that the way to prevent the illness is to avoid the virus by ensuring washing of hands often with soap and water for at least 20 seconds; avoid touching eyes, nose or mouth, especial with unwashed hands; maintaining social distance; use of disinfectants; use of facial mask in public places or avoiding public gatherings (NCDC, 2020). Isolation and treatment of people who are infected with Covid-19 virus has also been proved to be an effective way to reduce the spread of the virus (Lima, 2020;CDC, 2021).
The role of the individual and the public in the prevention and control of the spread of diseases as suggested by some health behavior literatures are anchored on how much knowledge they have regarding the disease, its perceived susceptibility and severity (Radley, 2004;Tripathi, et al., 2020). This detail often determines the level of individual responses and provides information that can be used for appropriate interventions. Hochbaum and Rosenstock developed the Health Belief Model (HBM) in the early 1950s -a theoretical guideline to explain how four basic constructs namely; Perceived susceptibility, Perceived severity, Perceived bene ts and perceived barriers can be used to in uence behavioral change in the control and prevention of diseases (Baum, Newman, Weinman, West, & McManus, 1997). This theory was later updated to include the in uence of cues to action and self-e cacy to help identify speci c actions to trigger appropriate responses and improve the belief among individuals to persistently undertake the appropriate responses (Glanz, Rimer, & Viswanath, 2008) towards the control and prevention of a disease. Regrettably, since the outbreak and increasing number of recorded cases of COVID-19 in Nigeria by the Nigeria Center for Disease Control (NCDC), there has been a controversial trailing of the COVID-19 incidence in Kogi State involving the state authorities and the NCDC coupled with the political, religious and economic points of views which has seemingly promote misconceptions about COVID-19 and affect perceptions (Onwughalu, 2020;Afoke, 2020;Onyeji, 2020;Abu, 2020) Giving the importance of appropriate awareness and the perceptions in the Health Belief Model, this study was therefore carried out with the aim of assessing the knowledge, perception and precautionary measures of Kogi State residents in response to the outbreak of Covid-19. The results extracted from this study could be of great importance at providing information that can help in appropriate interventions as regard covid-19 in Kogi State.

Methods
Study Design and Population.
The design of this study was basically an online cross-sectional survey conducted from 28th December, 2020 to 28th January, 2021 with the intent of obtaining responses regarding the Knowledge, Perception, belief and Precautionary Practices towards covid-19 among residents of Kogi State, Nigeria. The study population comprised of individuals who basically had access to phones, laptops and the internet services; that were at least 15 years old and had at least a basic school education. Respondents were sort from across the three senatorial districts of the state and participation in the survey was voluntary.

Sample Size
Using the Raosoft sample size calculator (http://www.raosoft.com/samplesize.html), a minimum of 385 participants was the estimated sample size for this study. The calculation was done using the projected population size of 4,473,490 given by the National Bureau of Statistics (NBS, 2018) with a response distribution of 50%, 5% margin of error and 95% con dence level.

Measures
The survey questionnaire used in this study was designed using some recommendations while adopting questions from the WHO Survey Tool and Guidelines on rapid, simple, exible behavioral insight on Covid-19 (WHO, 2020) and also NCDC guidelines for awareness and prevention of COVID-19 (NCDC, 2020). The study questions included six socio-demographic related questions. Other domains of the questionnaire included awareness and risk perception of coronavirus; Knowledge about the causes, symptoms and prevention of coronavirus; precautionary practices toward coronavirus, Skepticism and belief regarding coronavirus and nally community preparedness and susceptibility to coronavirus.

Method of Data Collection.
A structured online questionnaire designed using Google forms was sent through social media platforms to prospective respondents residing within Kogi state. Whatsapp and Facebook groups were mainly used to disseminate the link. However, due to the inability to meet the required minimum sample size within the time frame for conducting the survey online, a number of the structured questionnaire was printed and administered to individuals directly using the convenience sampling technique also across the three senatorial districts of the state. The introductory note to the questionnaire stated that participation is voluntary and responses of in the survey will be recorded anonymously. The questionnaire copies were administered and collected between 28th December, 2020 and 28th January, 2021

Data Analysis
All data collected from the questionnaire of this study were collated on Microsoft-excel spreadsheet, transferred into and analyzed using IBM SPSS V.18 software. Descriptive statistics using frequencies and simple percentages in tables were generated for the analysis.

Ethical Considerations.
Basic ethical principles were adhered to. A statement of informed consent and voluntary participation was made clear at the introductory note of the questionnaire. Data were recorded anonymously and treated con dentially. Results 3.1. Sociodemographic pro le of the study participants.
A total of 401 persons responded to the survey questionnaire. As shown in Table 1, the study sample consisted largely of 272 Male (67.8%). Most of the respondents were between the ages of 24-44 (61.4%).
Fifty-six point 9 percent were married, 87.5% had at least a tertiary education and 61.1% were mostly Christians. 143(35.7%) of respondents are from Kogi west senatorial district, 129 (32.2%) from Kogi central and 129 (33.2%) from Kogi east.   Consequently upon the above data, it was necessary to nd out exclusively the percentages of the combinations of the stated precautionary measures often practiced by respondents in avoidance of the Covid-19 infection.   As shown in Table 7, the main source of knowledge about coronavirus for the respondents is via Television news which constitutes 34.2% of the respondents, followed by Whatsapp chats which had 31.9%. Newspaper was the least with 1.0%.

Discussion Of Findings
This study aimed at assessing the knowledge, perception and precautionary measures of Kogi State residents' in response to the outbreak of Covid-19 pandemic. It also highlighted the perceived susceptibility of contracting the coronavirus and the popular skepticism concerning the virus.
From the result of the study we observed that the awareness of the existence of Covid-19 and the knowledge about the causes, clinical symptoms and incubations period from contracting the disease till showing symptoms were reasonably very high among the respondents. So also was their knowledge about the required preventive measures and how to protect them from Covid-19 was also very high. This nding is consistent with similar studies done in iran and india where majority of the respondents showed high awareness to Covid-19 (Kakeman etal.,2020;and (Sai, et al., 2020) Likewise, as demonstrated from the result 45.2% of the respondents were conversant with the practice of three to more of the precautionary guidelines for preventing Covid-19. Among the most combined precautionary measures were (1) frequent washing of the hands with soap at least for 20 seconds (2) avoidance of social events and crowd (3) avoidance of touching one's eyes, nose and mouth with unwashed hands (4) the use of face mask (5) the use of disinfectants or hand sanitizers. The single most practice precautionary measure by the respondents was the use of facial mask.
The study also found that a signi cant number of the respondents held a very low risk perception of Covid-19 by expressing an unlikely probability of getting infected by the virus and also ranked their community susceptibility level to be very low to spread the virus. Although, while we hold that the tendency that the perceived risk perception as acknowledge by respondent may not re ect the reality of the situation it may also account for why the day to day activities of residents seems to be carried out with some level of con dence.
An area for concern as revealed by the study is on the skepticism and beliefs held by respondents regarding covid-19. Among such skepticism was that they are no hard evidence that coronavirus really exist, this was view was held by 65.3% of the respondents. In spite of the remarkable responses as to providing accurate answers that were used to test respondents general knowledge about covid-19 a signi cant number of the respondents amounting to 45.9% believed that Covid-19 is a hoax invented by interest groups for nancial gains.46.1% also believed that the number of people reported by the NCDC as infected by the coronavirus in Nigeria is exaggerated. Again, 33.7% of the respondents believed the said second wave of the covid-19 in Nigeria is a scam. The result as shown calls for concern as it can be deduced that the reasons for the low perceived risk perceptions may not be farfetched from the Skepticism and believes most respondents hold about the coronavirus and its effects. To buttress this Catalin and Radu (2020) in their study con rms that in the onset of the COVID19 crisis, local media featured extensively the opinions of various pundits, politicians, and 'experts' who either minimized the pandemic or deemed it a hoax.
The main source of information about covid-19 for most of the respondents was rst, via Television programs and secondly from whatsapp platforms. While it can be deduced that Television and whatsapp seems to be the most reliable means of gaining information by the respondents, we posit that as much as respondents may have gained valuable information as regards the awareness and general knowledge about Covid-19 via the aforementioned means it also suggestively account for the propagated misconceptions and misinformation that account for their existing believes and Skepticism held by respondents concerning Covid-19.

Strength and limitation
As at the time of conducting this studies, there has been no serious research conducted to provide an insight into the knowledge and risk-perception of Kogi state residents about covid-19 so much as to explore their awareness and perceived susceptibility, we however consider that since this study was a cross-sectional survey mostly conducted online, it may aptly represent people of the average class with access to network and computer gadgets thus it may not be suitable to generalize this ndings to the entire Kogi State.

Conclusion And Recommendation
This study has presented valuable information regarding the assessment of KOGI state residents' knowledge, risk perception, prevention practices and Skepticism about the Covid-19. The study concluded that while there is a high level of awareness of Covid-19 among residents and a remarkable level of precautionary practices against the spread of the Covid-19 virus, there are also indications of misconceptions and misinformation that breeds Skepticism and belief that may be detrimental to curbing effectively the spread of the Covid-19 virus within the state In the light of the above we wish to make the following recommendations; First, public health authorities and all stakeholders involved in curbing the spread of the Covid-19 virus within and outside the state should strive to provide reliable and up-to-date information on the disease and as well make attempt to condemn wide spread ideas and notions that may instigate misinformation and misconceptions capable of promoting beliefs and Skepticism that are detrimental to downplay effective and expected responses from the general public.
Secondly, all public health authorities and stakeholders involved in curbing the spread of the virus should take more advantage of Television programmes and whatapps platforms to provide accurate, precise and timely information to the public. They should also watch out within these communication platforms to discourage contradicting information and provide counter information to discourage Skepticism concerning covid-19.
Finally, we suggest that the NCDC needs to develop strategies that provide evidence in their reports as a means of restoring con dence in the mind of the general public especially residents of Kogi state to believing that Covid-19 is real. Declarations