The on-going COVID-19 pandemic is still a global puzzling jeopardy whose fate has remained unknown yet. The overwhelming patient numbers at most health facilities accompanied by the still much fear for stigma from the public among those infected [24–27] have forced many to adopt home-based isolation and management of their mild to moderate symptoms, accepting hospital admissions only after progressing to severe symptoms. Sufficient knowledge and strict implementation of the recommended safe home-based COVID-19 patient care and dead body management guidelines in the general population are therefore key to minimise chances of further spread of the disease among family members and the community.
To our knowledge, little data exists globally concerning the knowledge and readiness for COVID-19 home-based care and dead body management. In this study, we were able to reveal that the knowledge level about both home-based COVID-19 patient care and dead bodies’ management was below 50%, and that over 90% of the residents were not ready to undertake those two initiatives.
This study found out that the mean knowledge about home-based covid-19 patient care among participants was at 49.5%, which is a low score. It could be because by the time the study was done, no awareness communications specifically about home-based Covid-19 patient care had been extended to communities in the country. This finding was congruent with that reported among patients at a public hospital in Uganda by Twinamasiko and others which showed a general knowledge about COVID-19 at only 50% . However, it is in contrast to the study done by Zhong and colleagues among Chinese residents whose covid-19 knowledge score was as high as 90%  and the study by Geldsetzer P among United States (US) and United Kingdom (UK) residents, which showed a generally good knowledge . The reason for this big difference in the knowledge between Ugandan residents and those of UK, US, and China could possibly be due to the relatively very big number of covid-19 cases received by the latter nations which could have triggered more self-responsibility and curiosity among their residents to know more about the virus as everyone sensed being a potential candidate for the disease compared to Uganda with comparably lower covid-19 cases. It could also be due to the differences in the extent and forms of awareness strategies employed by the respective countries.
In this study, the very low average knowledge (18.28%) expressed about the early warning signs of severe COVID-19 puts many home-cared covid-19 patients at a high risk of progressing from mild-moderate to severe and critical conditions without the care takers’ notice, hence delayed transfer to hospital for advanced management, increasing chances of dying from homes. This low knowledge could possibly be due to the COVID-19 public sensitization message in the country whose content is generally richer in mild to moderate COVID-19 symptoms such as cough, sneezing, body weakness, among others and less emphasis put on severe disease symptoms such as blue lips, confusion. In addition, the message is usually conveyed in English which may not be easily understood as effective as local languages and is via televisions and radios which may not be owned by all the people in communities. This score is however higher than the 5% reported on knowledge about signs of severe pneumonia among care takers in Ghana in 2011 but lower than that reported (84%) in the same country later after employing some two community-based strategies  Similarly, a small portion (45%) of participants who knew all the clear definitions of a covid-19 contact is worrying because failure to quickly identify such people can spread the virus among family members and the community. We recommend more education emphasis along those lines by the MOH and the covid-19 task force. On the other hand, the good knowledge expressed by majority of participants (> 74%) regarding patient isolation principles such as limitation to only one room, assigning only one care taker, no hosting visitors and a must use of personal protective equipment when handling a patient’s body fluids shows some significant positive impact of the Covid-19 awareness campaign done so far. It is in agreement with a study by Olum and colleagues among Ugandan health care workers . We recommend continuous delivery of public messages containing such content to act as reminders for their actual implementation.
The mean knowledge score concerning safe COVID-19 dead body management among study participants was 36.5%. Though the possibility of transmission of the virus from a covid-19 copse to living humans is still unclear [1, 5, 17–19], this was a low knowledge level characterised by very few participants capable of identifying the most effective PPE to use under different moments of corpse handling such as protection against the dead body’s fluids, and the recommended number of people to prepare the body. In the event that covid-19 dead bodies are infectious, it puts a big infectivity risk in the current settings where families have to directly involve in COVID-19 dead body management and burials of their relatives without any assistance by the MOH personnel. This is still mostly due to insufficient communication messages specific to safe COVID-19 dead body handling by families.
This study also found out that 96.6% of the residents were not ready to undertake both home-based COVID-19 patient care as well as family-centred COVID-19 dead body burial arrangements. 84% of these reported insufficient knowledge regarding the proper conduction of such activities as the major block. This shows that despite the little knowledge they have so far, they are not confident enough to perform such activities as families alone. Of the 3.4% (n = 7) respondents who were ready to perform such activities, 3 were health care workers who reported to have undertaken a special training in doing so. This could imply that if such similar training is provided to the general public at large, the percentage of those ready to take on this proposed new involvement would increase, with reduced fear and chances of viral transmissions among people in homes. This is congruent with an observation by Sharma et al in India where family members of a covid-19 deceased refused to even have a look at the dead body due to fear .
In this study, there was no association between the residents’ knowledge on home-based patient care, dead body management or preparedness with age, sex, or education level. This could possibly be due to the fact that COVID-19 is a new issue which came with almost uniform sensitization to the public regardless of one’s sex, age or education level hence uniform exposure to covid-19 information and roughly equal knowledge acquisition by all groups of people.
This study has some limitations. Firstly, no standardised tool had been previously validated for assessment of knowledge on COVID-19 home-based care, dead body management or their preparedness. However, the questions have been formulated based on the WHO guidelines for home-based COVID-19 patient care and dead body management [5, 12]. Secondly, only residents in one district were surveyed and the results of this study may not reflect the knowledge and preparedness for the entire country. However, being the first study about this in the country, these results can be used to formulate countrywide public education schedules related to covid-19 home-based patient care and dead body management. A similar study may be extended to other districts and countries.