Socio-demographic characteristics
A sum of 475 participants took an interest in this survey; majority, 135/475 (28.5%) were within 18-24 years and more were female 252/475 (53.2%). We had a representation for major ethnicities in Ghana. The Majority (268/475, 56.4%) of the participants were residing in the southern sector (region) of Ghana. About two-thirds (382/475, 80.4%) of the participants had at least a university-level education. With regards to occupation, 130/475 (27.4%) of the participants were students. Table1 illustrates the socio-demographic characteristics of the sampled Ghanaian participants in the study.
Table 1 Demographics of study participants (N=475)
Characteristics
|
Number of participants (%)
|
Gender, n (%)
|
Male
|
223 (46.8)
|
|
|
Female
|
252 (53.2)
|
|
Age cohort (years), n (%)
|
18-24
|
136 (28.6)
|
|
|
25-34
|
185 (31.7)
|
|
|
35-44
|
102 (18.1)
|
|
|
45+
|
52 (11.6)
|
|
Education, n (%)
|
High school and below
|
52 (11.0)
|
|
|
Associate's degree
|
101 (22.3)
|
|
|
Bachelor's degree
|
207(43.6)
|
|
|
Master's degree and above
|
115 (24.2)
|
|
Occupation, n (%)
|
Student
|
130 (27.4)
|
|
|
Employed
|
206 (43.4)
|
|
|
Unemployed
|
71 (15.0)
|
|
|
Other
|
68 (14.3)
|
|
Marital status, n (%)
|
Married
|
241 (50.7)
|
|
|
Single
|
162 (34.1)
|
|
|
Others
|
72 (15.2)
|
|
Religion
|
Christian
|
251 (52.8)
|
|
|
Muslim
|
152 (32.0)
|
|
|
Other
|
72 (15.2)
|
|
Region of current residence, n (%)
|
Southern sector
|
208 (43.8)
|
|
|
Middle sector
|
167 (35.2)
|
|
|
Northern sector
|
100 (21.1)
|
|
“Others” comprised of re-married, cohabiting, divorced, separated, and widowed; African traditional religion, Eckankar, Hari Krishna, Buddhism
Knowledge scores of participants about COVID-19 pandemic
Table 2 exhibits the results of a comparison between the knowledge scores obtained by participants and their demographic characteristics. The mean score (m=10.6, SD=1.14, 88.3%, range 0-12) obtained by the participants on the COVID-19 knowledge items suggests that the participants had all-inclusive knowledge of issues regarding the pandemic. The overall mean score (M=10.6/12, 88.3%) for this study, in the region of 4 months into the pandemic, was between the correct percentage rates reported by Clement [20] and Zhong [21] in their sample of United State and Chinese citizens respectively. The data also showed statistically significant differences between the correct knowledge score and the demographics (independent variables) of participants (p<0.05): “Age group”, “Education”, “Participant’s Occupation”, and “Region of current residence”. However, “Gender”, “Marital Status” and “Religion” were not statistically significant (p>0.05).
Table 2 COVID-19 Knowledge score by demographic characteristics (N=475)
Characteristics
|
Correct Knowledge score
(mean, standard deviation)
|
t/F
|
p
|
Gender
|
Male
|
10.5 (1.14)
|
1.04
|
0.299
|
|
Female
|
10.6(1.14)
|
|
|
Age cohort (years)
|
18-24
|
10.4(1.7)
|
4.15
|
<0.001
|
|
25-34
|
11.35(1.2)
|
|
|
|
35-44
|
11.10(1.9)
|
|
|
|
45+
|
10.7(1.5)
|
|
|
Education
|
High school and below
|
9.5 (2.1)
|
3.34
|
<0.001
|
|
Associate's degree
|
10.3 (1.9)
|
|
|
|
Bachelor's degree
|
11.0 (1.7)
|
|
|
|
Master's degree and above
|
11.3 (1.3)
|
|
|
Occupation
|
Student
|
10.8 (1.8)
|
4.98
|
0.008
|
|
Employed
|
10.6 (1.3)
|
|
|
|
Unemployed
|
10.7 (1.3)
|
|
|
Marital Status
|
Married
|
10.5 (1.8)
|
2.26
|
0.107
|
|
Single
|
10.7 (1.9)
|
|
|
|
Other
|
10.5 (1.4)
|
|
|
Religion
|
Christian
|
10.9(1.1)
|
2.12
|
0.158
|
|
Muslim
|
10.3(1.6)
|
|
|
|
Other
|
9.7 (2.1)
|
|
|
Region of current residence
|
Southern sector
|
11.5 (1.6)
|
5.17
|
<0.001
|
|
Middle sector
|
10.7 (1.8)
|
|
|
|
Northern sector
|
10.9 (1.8)
|
|
|
Others” comprised of re-married, cohabiting, divorced, separated, and widowed; African traditional religion, Eckankar, Hari Krishna, Buddhism
Causes, Status Quo, and Subsequent Occurrences of the COVID-19 pandemic in Ghana
The data revealed an interesting result concerning what Ghanaians believed could potentially be the cause (on a 7-point Likert scale) of the COVID-19 pandemic. The majority of the participants (85%, 95% CI 71.2%-91.5%) selected "extremely unlikely" and "moderately unlikely" which implies that they did not believe the infection could be a bioweapon. This result goes contrary to the finding of [19] were 23% (95% CI 22.4%-25.5%) of US and 18% (95% CI 17.1%-19.9%) of UK participants believed the infection was a bioweapon when they were asked the same question. The participants estimated a range of 10,000 to 13,000 infections in Ghana. The estimate by the participants corresponds to a median of 11,000 infections. The participant also thought that the rate of COVID-19 infection in Ghana is likely to extend beyond 20,000 cases by the end of 2020.
COVID-19 Infection and mortality rate among Ghanaians
With regards to the rate of infection and associated risk, 10.5% (50/474, 95%CI 7.0%-21.0%) of participants thought persons infected with the COVID-19 are likely to develop a lethal illness and possibly die. Besides, 91.7% (95% CI, 88.6% -97.7%) of the participants thought that older adults (60 and above) are more susceptible to the COVID-19 infection than children and young adults. When asked "Are those with other health problems more likely to die from an infection with the new coronavirus disease than those without any other health problems?'',94.8% (95% CI 92.8%-97.0%) of the participants acknowledged that the mortality of individuals (adults) with health complications are higher than those without any other health complications [19].
Awareness of COVID-19 Symptoms, and attitude toward Health Care and Information Seeking among Ghanaians
Most of the participants (86.9%, 413/475) acknowledged COVID-19 as a viral infection and also originated from China (97.7%, 464/475). More than half of the participants (54.4%, 259/475) of the participants responded that the incubation period of the COVID-19 infection ranges between 2-14 days. Fever (80.6%, 383/475), difficulty in breathing (74%, 351/475), dry cough (71.8%, 341/475) and sore throat (67.5%, 321/475) are the four most-cited symptoms of COVID-19 among the participants.
When asked, “if you exhibit any of the above symptoms and recently visited a COVID-19 hotspot, or spent time with an individual who did, what would be the appropriate steps to take?” 34.2% (95% CI 32.9%-36.5%) of the participants acknowledged the recommended healthcare-seeking protocol of self-isolation and contacting the emergency health care team. However, 31.1% (95% CI, 27.3%-33.3%) of the participants responded that the COVID-19 infection was treatable. Furthermore, 66.5% (95% CI, 63%-69%) of the participants recognized that there was no vaccine for immunization against the COVID-19 infection.
With regards to COVID-19 information seeking among participants, the majority (73.4%, 349/475) received information through the Television; 28.8% (95%CI, 24%-32%) indicated that the information received was not adequate to make decisions vis-à-vis the COVID-19 infection [28]. The participants (59.5%, 283/475) recognized the sources of information on the COVID-19 infection as reliable. Besides, the majority (55.7%, 95% CI, 53.4%-58.1%) responded to knowing COVID-19 emergency contacts and isolate facilities in Ghana.
Etiquettes for preventing the spread of COVID-19 Infection
The results showed that the participants are well acquainted with the COVID-19 prevention etiquettes. Majority of the participants (95%, 95% CI, 92%-97%) acknowledged that wearing of facial or nose mask; washing of hands with medicated soap more than 3 times per day; the use of sanitizers to disinfect hands regularly, and avoiding touching of the face with unwashed hands are the influential etiquette for preventing COVID-19 infection.
Even though the majority of the participants recognized the good practices towards the prevention of COVID-19, a large percentage of the participants had disinformation about the infection. The participants also thought that being highly religious or spiritual (53.4%, 95% CI 47.9%-56.1%), living in hot and humid climates (49%, 95% CI 44.5%-52.8%), taking a hot bath (37%, 95% CI 35.4%-39.1%), drinking hard liquor (“Akpeteshi”) (36% 95% CI 34.5%-39.3%), smoking cannabis (“Wee”) (31%, 95% CI 28.6%-35.7%), and drinking herbal concoctions - Neem Tree leaves - (29%, 95% CI 25.7%-33.4%) were equally good practices for preventing the COVID-19 infection.
Majority of the participants (91%, 95% CI, 89.3%-93.4%) acknowledged that the main mode of COVID-19 transmission is when infected individual coughs or sneezes and the droplet settles on a surface or suspends in the air for an amount of time. When asked, "Older adults are the only individuals that can be infected with the COVID-19." with options "True" or "False", 99% (470/475) of the participants selected "False" showing their variance with the statement. All of the participants (100%) thought that Ghana's borders should remain closed to all countries; however, Ghanaians who want to return from abroad should be made to self-isolate for the 14 days as stipulated by the World Health Organization (WHO).
Attitudes of participants towards the COVID-19 pandemic
Generally, the attitude of the participants towards the success in the cases management and reliance on eradicating COVID-19 showed significant associations. The majority of the participants (81.5%, 387/475) acknowledged that the protocols implemented by the Government of Ghana can ultimately assist in successfully managing the COVID-19 pandemic 18.5% (88/475) of the participants reported otherwise. The results also showed a statistically significant difference with genders, education levels, occupation categories, marital status and region of current residence (P<0.05) with regards to participants' attitude towards the successful management of COVID-19 pandemic. In Table 3, the participants who responded "I Disagree" had significantly lower COVID-19 knowledge scores than those who responded "I Agree" (OR: 0.79, p<0.001).
In the context of gender, the female participants had 100% (2.00, 0.046) increased odds compared to the male participants of success in managing the COVID-19 pandemic in Ghana. Participants from the Northern sector had 31% (0.69, 0.001) decreased odds of success in managing the COVID-19 pandemic in Ghana juxtaposed with Southern and Middle sector participants. The smallest effect of all the analyses illustrated that participants within the 18-24 years cohort had 60% (0.40, 0.013) decreased odds of success in managing the COVID-19 pandemic in Ghana juxtaposed with the other age categories. Finally, for every unit of COVID-19 knowledge scores, the odds of the government of Ghana successfully managing the pandemic decreased by 21% (0.79, 0.001).
The majority of the participants (77.13%, 366/475) had the reliance that Ghana can defeat the COVID-19 pandemic while 22.9% (109/475) were pessimistic. With regards to the reliance of eradicating COVID-19, there was statistical significance (P<0.05) across all the demographic variables. Significantly, participants who scored lower COVID-19 knowledge scores expressed less reliance on winning than those who had higher scores (P<0.001). For every COVID-19 knowledge score, the odds of participants’ reliance that the pandemic would be eradicated from Ghana decreased by 26% (0.74, 0.001).
Table 3: Multiple binary logistic regression attitude outcomes of participants (N=475)
Characteristics
|
Success in Managing,
OR (95% CI), p-value
|
Reliance of eradicating,
OR (95% CI), p-value
|
Gender
|
Male
|
1.61 (1.11, 1.78), <0.001
|
1.67 (1.19, 2.49), <0.001
|
|
Female
|
2.00 (1.01, 3.96), 0.046
|
2.15 (0.21, 4.11), 0.036
|
Age cohort (reference: 18-24)
|
25-34
|
1.13 (0.99, 2.37), 0.048
|
1.55 (1.01, 2.37), 0.003
|
|
35-44
|
1.45 (0.73, 1.99), <0.001
|
1.55 (1.01, 2.37) <0.001
|
|
45+
|
1.23 (0.51, 2.31), 0.006
|
1.55 (1.01, 2.37) 0.014
|
Education (reference: High school and below)
|
Associate's degree
|
1.99 (1.31, 3.01), <0.001
|
4.89 (2.63, 8.91), <0.001
|
|
Bachelor's degree
|
1.56 (1.03, 3.17), 0.009
|
3.55 (1.69, 6.10), <0.001
|
|
Master's degree and above
|
1.25 (0.63, 2.31), 0.005
|
2.56 (1.13, 4.14), <0.001
|
Occupation (reference: Student)
|
Employed
|
1.73 (1.41, 2.21), 0.032
|
1.95 (1.62, 2.59), 0.004
|
|
Unemployed
|
0.78 (0.57, 1.03), 0.039
|
0.73 (0.53, 0.99), 0.043
|
Marital Status (reference: other)
|
Married
|
1.91 (1.01, 3.96), 0.047
|
1.78 (0.54-3.12), 0.003
|
|
Single
|
1.31 (0.20-3.63), 0.009
|
1.87 (0.58-3.21), 0.041
|
Religion (reference: Other)
|
Christian
|
2.21 (0.81, 4.73), <0.001
|
1.79 (1.00, 3.53), 0.015
|
|
Muslim
|
1.45 (0.71, 2.67), 0.003
|
1.56 (0.77, 4.11), 0.006
|
Region of current residence (reference: Northern sector)
|
Southern sector
|
2.46 (0.99, 4.65), 0.001
|
2.06 (1.10, 3.65), 0.001
|
|
Middle sector
|
1.75 (1.49, 3.11), 0.003
|
2.35 (1.62, 4.67), 0.00
|
Knowledge score
|
|
0.79 (0.75, 0.90), 0.001
|
0.74 (0.69, 0.86), <0.001
|
“Others” comprised of re-married, cohabiting, divorced, separated, and widowed; African traditional religion, Eckankar, Hari Krishna, Buddhism
Behaviour of participants with regards to the COVID-19 pandemic
In Table 4, the results indicate the predictors of each of the 3 behavioural outcomes. The binary logistic regression analysis results indicated a significant association between participants buying more goods and COVID-19 knowledge scores (OR: 0.69, <0.001). This implied that the odds of reporting unusual buying behaviour decreased by 31% for a unit increase in knowledge scores. Participants' responses to purchasing behaviour increased by 65, 54% and 68% for the cohorts of 25-34 years, 35-44 years, and 45 and above years, respectively, juxtaposed with the 18-24 years cohort. In the context of education, participants with high school and below qualification were associated with increased buying behaviours. Moreover, the odds of reporting unusual buying behaviour decreased by 22% (0.78, 0.039) among participants in the unemployed category. Finally, those who reside in the Northern sector had decreased odds of uncommon purchasing behaviour.
In the context of participants attending a public gathering, the odds decreased by 9% (0.91, 0.001) for every unit increase in COVID-19 knowledge scores. The female gender had 58% (1.58, 0.038) increased odds of attending a public event than their male counterparts. Finally, participants with a Master's degree and above had higher (1.63, 0.003) odds of attending a public gathering than others in the education category.
The results also show that for every unit increase in COVID-19 knowledge scores, the odds of a participant wearing a nose or facial mask outside the home decreased by 35% (0.65, 0.001). In the context of education, the participant with Master's degree and above and Bachelor's degree reported 441% (5.41, 0.001) and 276% (3.76, 0.001), respectively, increased odds of wearing a nose or facial mask outside the home juxtaposed with the other education categories (Table 4). Besides, participants who reside in the Northern sector reported 2% lower odds compared to participants in the Southern sector (336%) and the Middle sector (252%). Moreover, the lowest effect of all the analysis showed that the male gender had 50% (0.50, 0.001) decrease odds of wearing a nose or facial mask outside the home juxtaposed with 53% (1.53, 0.001) increase odds for the female gender.
Table 4: behaviour outcomes of participants (N=475)
Characteristics
|
Purchase more goods, OR (95% CI), p-value
|
Crowd of more than 100 people, OR (95% CI), p-value
|
Wore mask, OR (95% CI), p-value
|
Gender
|
Male
|
1.00 (0.65, 2.33), <0.001
|
1.41 (1.10, 1.85),
0.023
|
0.50 (0.39, 2.59), <0.001
|
|
Female
|
1.58 (0.76-1.58), 0.038
|
0.71 (0.49-1.12), <0.001
|
1.53 (0.99-2.67), <0.001
|
Age cohort (reference:
18-24)
|
25-34
|
1.65 (1.10-2.61),
<0.001
|
1.23 (0.72-2.42), <0.001
|
1.25 (0.61-2.46), 0.015
|
|
35-44
|
1.54 (1.05-2.77), <0.001
|
1.66 (0.56-2.99), 0.045
|
1.38 (0.28-2.42), 0.031
|
|
45+
|
1.68 (1.45-4.15), <0.001
|
0.76 (0.55-1.21), <0.001
|
1.31 (0.88-1.98), <0.001
|
Education (reference: High school and below)
|
Associate's degree
|
1.76 (1.08-2.77), <0.001
|
1.48 (0.85-2.53), <0.001
|
1.34 (1.01-5.97), <0.001
|
|
Bachelor's degree
|
1.54 (1.01-2.36), 0.048
|
1.22(0.78-1.90), 0.008
|
3.76 (1.42-5.39), <0.001
|
|
Master's degree and above
|
2.21 (1.19-3.44), 0.001
|
1.63(1.34-3.99), 0.003
|
5.41 (1.71-11.02), <0.001
|
Occupation (reference: Student)
|
Employed
|
1.41 (0.97-2.14), <0.001
|
1.04 (0.68-1.59), <0.001
|
1.21 (0.69-2.11), <0.001
|
|
Unemployed
|
1.45 (1.03-2.36), <0.001
|
1.22 (0.78-1.90), 0.001
|
0.76 (0.42-1.39), 0.014
|
Marital Status (reference: Other)
|
Married
|
2.97 (1.46, 6.08), 0.003
|
0.81 (0.50-1.46), 0.003
|
1.35 (0.39-1.83), <0.001
|
Religion (reference: Other)
|
Christian
|
1.01 (0.63, 3.33), 0.045
|
1.09 (0.44, 2.91), <0.001
|
2.23 (0.71, 4.05), <0.001
|
|
Muslim
|
1.20 (0.76, 2.81), 0.008
|
0.99 (0.47, 1.88), <0.001
|
1.50 (0.91, 3.11), <0.001
|
Region of current residence (reference: Northern sector)
|
Southern sector
|
1.32 (0.91-2.42), 0.008
|
1.51 (0.68-2.11), 0.013
|
4.36 (1.52-6.07), 0.048
|
|
Middle sector
|
1.54 (0.91-2.77), <0.001
|
0.93 (0.53-1.64), <0.001
|
3.52 (1.15-5.34), <0.001
|
Knowledge score
|
|
0.69 (0.46-1.00), <0.001
|
0.91 (0.85-2.13), <0.001
|
0.65 (0.50-0.83), <0.001
|
“Others” comprised of re-married, cohabiting, divorced, separated, and widowed; African traditional religion, Eckankar, Hari Krishna, Buddhism
Approval of participants vis-à-vis the easing of COVID-19 restrictions
The participants had a diverse opinion about the easing of the COVID-19 restriction in Ghana. The majority of the participant (81.9%, 389/475) were gratified with the government of Ghana’s decision to ease the COVID-19 restriction for life to return to normalcy. The findings from a binary logistic regression analysis indicated the major predictors of participants approval towards the ease of COVID-19 restrictions. Participants' self-reports of approval toward ease of restrictions had a negative association with COVID-19 knowledge. For every unit of increase in COVID-19 knowledge score, the odds of the participants’ approval of the government of Ghana's decision to ease the COVID-19 restriction increased by 220% (Table 5). In the context of the age cohort, the odds of reporting approval towards the easing of COVID-19 restrictions increased by 238% and 453% for “25-34 year” cohort and “35-44 year” cohort respectively, compared to “18-24 year” cohort. Moreover, the odds of approval towards the easing of the restrictions increased by 78%, 245% and 571% for participants with associate's degree, bachelor's degree and master's and above respectively, compared to participants with high school and below qualifications. In the context of religion, the odds of participants reporting approval towards the easing of COVID-19 restrictions 598% and 176% for Christians and Muslims respectively, compared to the other regions. Finally, participants residing in the southern sector and middle sector of Ghana reported increased odds of approval towards the easing of COVID-19 restrictions.
Table 5 Determinants of approval toward easing COVID-19 restrictions (N=475)
Characteristics
|
Easing COVID-19 restrictions, OR (95% CI)
|
p-value
|
Gender
|
Male
|
2.56 (1.00, 4.78)
|
0.002
|
|
Female
|
1.03 (0.67, 3.01)
|
<0.001
|
Age cohort (reference: 18-24)
|
25-34
|
3.38 (1.50, 7.21)
|
<0.001
|
|
35-44
|
5.53 (2.59, 10.67)
|
<0.001
|
|
45+
|
0.74 (0.59, 3.98)
|
0.039
|
Education (reference: High school and below)
|
Associate's degree
|
1.78 (1.00, 3.06)
|
<0.001
|
|
Bachelor's degree
|
3.45 (1.89, 9.01)
|
<0.001
|
|
Master's degree and above
|
6.71 (3.39, 11.53)
|
<0.001
|
Occupation (reference: Student)
|
Employed
|
3.78 (1.08, 7.67)
|
<0.001
|
|
Unemployed
|
5.98 (2.19, 9.77)
|
0.003
|
Marital Status (reference: Single)
|
Married
|
2.26 (0.89, 4.73)
|
0.001
|
|
Other
|
1.08 (0.56, 2.78)
|
<0.001
|
Religion (reference: other)
|
Christian
|
6.98 (2.90, 9.45)
|
<0.001
|
|
Muslim
|
2.76 (1.00, 3.66)
|
0.008
|
Region of current residence (reference: Northern sector)
|
Southern sector
|
5.17 (1.34, 7.39)
|
<0.001
|
|
Middle sector
|
4.12 (2.00, 8.23)
|
<0.001
|
Knowledge score
|
|
3.20 (1.01, 7.92)
|
<0.001
|