Research Article - (2022) Volume 10, Issue 6

Prevention Practice and Associated Factors towards COVID-19 among Childbearing Age Women of Debre Tabor Town, Northwest Ethiopia: Community-based Cross-Sectional Study
Bekalu Getnet Kassa1*, Habtamu Gebrehana Belay1, Alemu Degu Ayele1, Gedefaye Nibret Mihiretie1, Adanech Getie Tefera1 and Mastewal Belayineh Akilil2
 
1Department of Midwifery, Debre Tabor University, Debre Tabor, P. Box; 272, Amhara, Ethiopia
2Department of Midwifery, University of Gondar, Gondar, P. Box; 196, Amhara, Ethiopia
 
*Correspondence: Bekalu Getnet Kassa, Department of Midwifery, Debre Tabor University, Debre Tabor, P. Box; 272, Amhara, Ethiopia, Email:

Received: 25-Jun-2022, Manuscript No. JTD-22-17242; Editor assigned: 28-Jun-2022, Pre QC No. JTD-22-17242 (PQ); Reviewed: 12-Jul-2022, QC No. JTD-22-17242; Revised: 19-Jul-2022, Manuscript No. JTD-22-17242 (R); Published: 26-Jul-2022, DOI: 10.35241/2329-891X .22.10.331

Abstract

Background: Middle East Respiratory Syndrome a novel corona virus, Wuhan China have raised great public health concern globally. The virus is zoonotic which has a tendency to be transmitted between animal to human and human to human. The major route of transmission of COVID-19 is droplet and close contact. To date, no antiviral treatment or vaccine has been explicitly recommended for COVID-19. So, applying preventive measures to control COVID-19 infection is the most critical intervention. Therefore, the aim of this study was to asses practice of COVID-19 prevention and its associated factors.

Methods: This cross-sectional study was conducted from May 10 to June 25, 2020. A total of 660 women in Debre Tabor Town were included. The study participants were selected using simple random sampling technique. The collected data were checked for completeness. The data were entered and cleaned using Epi-Data version 4.2 then exported to SPSS version 23 for analysis. Crude odd ratio and probability value were identified for each independent variable and independent variables with probability value of less than 0.2 were entered into multivariable logistic regression. Statistically significant associated factors were identified based on probability value (p-value) less than 0.05 and adjusted odd ratio with 95% confidence interval.

Results: The prevalence of prevention practice of COVID-19 was 493 (74.7%) with a mean age of 31.3 (SD ± 6.241) years. Women attend higher education (AOR=2.3, CI=1.05-5.02), Husband attend secondary education (AOR=1.52, CI=1.3-2.88), had radio or television (AOR=0.55, CI=0.32-0.97), knowledge (AOR=1.68, CI=1.46-5.46) and didn’t perceive COVID-19 is a result of ours sin (AOR=2.31, CI=1.76-4.95) are better practiced for preventive measures of COVID-19.

Conclusions: The prevalence of prevention practice of COVID-19 in the study area is low. Education, had radio or television, knowledge and perceived COVID-19 is a result of ours sin were significantly associated factors of prevention practice of COVID-19.

Keywords

Prevention; Practice; Associated factors; COVID-19

Abbrevations

AOR: Adjusted Odd Ratio; CI: Confidence Interval; RNA: Ribino Nucleic Acid; SPSS: Stastical Package for Social Science; WHO: World Health Organization

Introduction

Corona viruses are enveloped non-segmented positive sense RNA viruses belonging to the family Corona viridae and the order Nido virales and broadly distributed in humans and other mammals [1]. It is zoonotic viruses and have raised great public health concern globally [2]. The World Health Organization (WHO) declared the novel coronavirus “2019-nCoV” outbreak as a global public health emergency [3].

In December,2019, Wuhan, Hubei province, China, became the center of an outbreak of pneumonia of unknown cause, which raised intense attention not only within China but also internationally [4].

COVID-19 is spread due to close person-to-person contact via coughing or sneezing, similar to the transmission of influenza and other respiratory pathogens [5]. People with cardio-pulmonary complaints, weakened immune systems, infants and older adults are more prone to COVID-19. Symptoms of COVID-19 include sneezing, cough, sore throat, fever, headache and feeling of being unwell, which may appear in a few as 2 days, or as long as 14 days, after exposure to the virus [4,6].

The 2019-2020 corona viruses pandemic was confirmed to have spread to Africa on 14 February, 2020. The first confirmed case on the continent was in Egypt [7,8], and the first confirmed case in sub-Saharan Africa was in Nigeria [9].

Globally on June 28, there were 10, 097, 334 corona virus cases and 501, 585 deaths recorded, five million cases recovered and more than half million cases and 10,480 deaths in Africa and 5846 cases and 103 deaths in Ethiopia were reported [10].

Experts have worried about COVID spreading to Africa, because many of the healthcare systems on the continent are inadequate, having problems such as lack of equipment, lack of funding, insufficient training of healthcare workers, and inefficient data transmission [11,12].

COVID-19 will also greatly affect the economy and delay achieving development goals given that most countries in sub Saharan Africa depend on foreign aid [13]. With nearly broken public health systems, deprived public health sectors and a very small number of specialized hospitals, there is little capacity for tracing, testing, confirmation, isolation and treatment of those infected [14].

The WHO has developed standard recommendations for the reduction of exposure and transmission include: regular cleaning of hands; covering the mouth and nose with tissue while coughing and sneezing, then immediately throwing the tissue away and washing hands; avoiding close contact with infected persons; seeking medical care in case of fever and cough; sharing past travel history with healthcare providers; avoiding direct unprotected contact with live animals and surfaces in areas with current reported cases of novel corona virus infections; avoiding the consumption of raw or undercooked animal products; and handling raw meat, milk or animal organs with care to prevent cross-contamination [15,16].

According to currently available information regarding COVID-19, the WHO advises that essential precautions and actions should be implemented to minimize the risk of exportation or importation of the disease [17]. To date, no antiviral treatment or vaccine has been explicitly recommended for COVID-19. So, applying preventive measures to control COVID-19 infection is the most critical intervention. In the study area there is no study have been conducted on this issue.

The findings of this study will help programme managers, stakeholders and health service providers to design appropriate intervention to increase practice of prevention of COVID-19. Therefore, the aim of this study was to determine practice and associated factors towards prevention of COVID-19 among childbearing age in Debre Tabor Town, Northwest Ethiopia.

Methodology

Study design and setting

This cross- sectional study was conducted from May 10 to June 25, 2018 among childbearing age in the community of Debre Tabor Town. Debre Tabor is the capital city of South Gondar Administrative Zone of Amhara Region, Ethiopia. There were 14,614 childbearing age women in the community. The town has divided in to six small administrative units called kebeles. Women from in each kebeles were taken as study population.

Sample size determination and sampling procedures

Sample size was calculated using single population proportion formula and the required sample size for this study was determined using the following assumptions; desired precision (d)=4%, Confidence level=95% (Zα/2=1.96 value) and 50% of the prevalence of prevention practice of COVID-19. Hence, the calculated sample size by considering 10% non- response rate was 660. To collect the data, initially the number of households with childbearing age women in each kebele was found from the kebele registration book. Then, the study households were selected through simple random sampling technique based on the proportion of the number of households in each kebeles and the first household was selected using lottery method. In cases where two or more eligible women were found in one household only one is interviewed by using lottery method.

Data collection instrument and procedures

Data collection tool comprised of structured questionnaires that were prepared after thorough literature review and the local situation of the study area and purpose of the study were considered to prepare the questionnaire. Questionnaires were prepared first in English then translated to Amharic which is the vernacular language of the respondents by language expert for ease of understanding of the respondents. Data were collected via face-to-face interview technique using structured questionnaires.

Twelve and two midwives who have BSc degree were selected and trained for data collection and supervision respectively. They had previous exposure in data collection. Data were collected on sociodemographic, knowledge, perception and practice of towards of COVID-19. Questionnaires were pretested on 33(5%) of women of Woreta Town in South Gondar Zone before final data were collected. The investigators and research assistants were involved to incorporate changes in questionnaires after pretest. To guarantee internal validity, only completed questionnaires were adopted.

Measurement

Face-to-face interview questionnaires were used as data collection tool. The knowledge of the respondents was assessed by using 12 questions and the correct responses of each respondent for all questions were added to decide whether the respondent was poor or good knowledge. Questionnaires related to perception contain 6 questions with answered yes or no. Practice of prevention of COVID-19 questionnaires also contains 8 questions with answered yes or no. Therefore, the mean value of each variable for each respondent and the overall mean were identified to determine knowledge, perception and practice of prevention of COVID-19.

Operational definitions

Good practice: Those who were score at or above the mean value of practice measuring questions.

Poor practice: Those who were score below the mean value of practice measuring questions.

Good knowledge: Those who were score at or above the mean value of knowledge measuring questions.

Poor knowledge: Those who were score below the mean value of knowledge measuring questions.

Positive perception: Those who were score at or above the mean value of perception measuring questions.

Negative perception: Those who were score below the mean value of perception measuring questions.

Statistical analysis

The collected data were checked for completeness. The data were entered and cleaned using Epi-Data version 4.2 then exported to SPSS version 23 for analysis. Descriptive analysis was employed to summarize the data. Crude Odd Ratio (OR) and probability value (P-value) were identified for each independent variable and all independent variables with probability value of less than 0.2 were entered into multivariables logistic regression. Statistically significant associated factors were identified based on probability value (P-value) less than 0.05 and Adjusted Odd Ratio (AOR) with 95% Confidence Interval (CI).

Results

Socio-demographic characteristics

A total of 660 women participated in this study, yielding a response rate of 100%. The mean age of the respondents was 31.3 (SD ± 6.241) with a range of 15-49 years. Almost three-fourth of respondents were Orthodox (74.1%) and 107 (16.2%) of participants were Muslim. Among participants, 436 (66.1%) were married and 129 (19.5%) were single (Table 1).

Variable Frequency (n=660) Percent (%)
      Age
        <20 yrs 35 5.3
         20-30 yrs 452 68.5
        >35 yrs 173 26.2
        Ethnicity
       Amhara 548 83
       Oromo 90 13.6
        Tigrie 8 1.2
        Others 14 2.1
         Religion
       Orthodox 489 74.1
         Muslim 107 16.2
       Protestant 37 5.6
       Catholic 27 4.1
        Education
Unable to read and write 197 29.8
Able to read and write 305 46.2
    Primary (1-8) 68 10.3
   Secondary (9-12) 57 8.6
  Higher education 33 5
        Occupation
  Gov’t employee 441 66.8
 Non-Gov’t
employee
180 27.3
      Student 19 2.9
      Merchant 20 3
      Marital status
        Single 129 19.5
        Married 436 66.1
        Divorced 6 0.9
       Widowed 89 13.5
        Husband education
Unable to read and write 158 23.9
Able to read and write 126 19.1
    Primary (1-8) 166 25.2
   Secondary (9-12) 136 20.6
  Higher education 74 11.2
          Husband occupation
   Gov’t employee 279 42.3
Their own business 138 20.9
    Private worker 162 24.5
     Daily laborer 81 12.3
        Family size
<four 261 39.5
>=four 399 60.5
         Had radio and TV
Yes 601 91.1
No 59 8.9

Table 1: Socio-demographic characteristics of the participants (n=660) in Debre Tabor Town, Northwest, Ethiopia, 2020.

Knowledge about COVID-19

Half of the study participants (51.2%) had good knowledge about COVID-19. Regarding to clinical symptoms of COVID-19; three mostly mentioned by respondents were fever (27.4%), headache (21.4%) and dry cough (18.6%) respectively. Nearly, 90% of the respondents (88.2%) said that the main route of transmission was respiratory droplet and close contact (Table 2).

Variable Frequency (n=660) Percent (%)
                       Do you have information (know) about COVID-19?
Yes 660 100.0
No 0 0.00
   If yes, Source of Information
Mass media 130 19.7
              Health professional 192 9.1
Social media 187 28.3
Others 151 22.9
                                               What are causative agents of COVID-19?
Virus 291 44.1
Bacteria 134 20.3
Protozoa 80 12.1
                       I don’t know 155 23.5
                               What are the main routes of transmission for COVID-19?
Close contact and respiratory droplet 582 88.2
Water 20 3.0
Food 19 2.9
                   I don’t know 39 5.9
                                      How long is Incubation period of COVID-19?
2-14 days 406 61.5
3-7 days 95 14.4
>14 days 45 6.8
                I don’t know 114 17.3
                                              Who are susceptible for COVID-19?
             Children and elderly 107 16.2
               General population 343 52.0
Adult 55 8.3
People with pre-existing diseases 141 21.4
          I don’t know 14 2.1
                                    What is the clinical Symptom of COVID-19?
Fever 181 27.4
Dry cough 123 18.6
Headache 141 21.4
             Stuff and runny nose 67 10.2
        Difficulty of breathing 120 18.2
           I don’t know 28 4.2
                         Which measures taken after showing S/SX of COVID-19?
              Stay at home 269 40.8
            Use facemask 206 31.4
      Inform for health worker 141 21.4
           Call to 8335 43 6.5
                            Who is more danger for death after confirmed COVID-19?
Adults 18 2.7
Children 79 12.0
People with pre-existing disease 137 20.8
                            Age >60years 146 22.1
Pregnant mother 124 18.8
Smokers 117 17.7
                   I don’t know 39 5.9
                                       People with S/SX can transmit COVID-19?
Yes 163 24.7
No 237 35.9
                  I don’t know 260 39.4
                                          Mother with COVID-19 can transmit to fetus?
Yes 240 36.4
No 195 29.5
                I don’t know 225 34.1
                                         Mother with COVID-19 can breastfeed?
Yes 206 31.2
No 220 33.3
                I don’t know 234 35.5
                                                               Overall knowledge
                Poor knowledge 338 51.2
              Good knowledge 322 48.8

Table 2: Knowledge about COVID-19 among childbearing age in Debre Tabor Town, Northwest, Ethiopia, 2020.

Perception about COVID-19

More than half of the respondents (60.7%) had perceived that COVID -19 was as a result of ours sin. And also, more than threefourth of the respondents (77.1%) had perceived that COVID-19 is occurs when the weather condition is cold. Likewise, nearly half of participants (47.9%) had negative perception; while 52.1% had positive perception towards prevention practice of COVID-19 (Table 3).

Variables Frequency (n=660) Percent (%)
                                  Did you believe that COVID-19 comes due to ours sin?
Yes 402 60.9
No 258 39.1
                                   Did you believe that COVID-19 is a disease of white?
Yes 439 66.5
No 221 33.5
                   Did you believe that eating uncommon animals a cause of COVID-19?
Yes 161 24.4
No 499 75.6
                    Did you believe that COVID-19 occurs when the weather is cold?
Yes 399 60.5
No 261 39.5
                                 Did you believe that COVID-19 attack only elderly?
Yes 509 77.1
No 151 22.9
           Did you believe that apply prevention measure antagonize to religious practice?
Yes 142 21.5
No 518 78.5
                                                        Overall Perception
     Negative perception 256 38.8
      Positive perception 404 61.2

Table 3: Perception about COVID-19 among childbearing age in Debre Tabor Town, Northwest, Ethiopia, 2020.

Prevention practice of COVID-19

The overall all prevalence of prevention practice of COVID-19 among participants were 493 (74.7%) with 95% CI (71.2-78.3). Onethirds (30%) of the respondents had good COVID-19 preventive practice. About 66.5% of respondents reported that they were washing their hands with water and soap or use sanitizer’s. Nearly three-forth (69.2%) respondents reported that they have avoided touching their eyes, nose, and mouth with unwashed hands. Only 68.8% of respondents reported that they practiced social distancing (Table 4).

Variable Frequency (n=660) Percent (%)
                                      Did you have practiced prevention of COVID-19 methods?
Yes 493 74.7
No 167 25.3
                                   Did you repeated hand wash with water and soap or use sanitizer?
Yes 328 66.5
No 165 33.5
                               Avoid touching eye, nose and mouth with unwashed hands?
Yes 341 69.2
No 152 30.8
                              Cover your mouse and nose when you are coughing and sneezing?
Yes 365 74.0
No                                                                                    165 26.0
                                                   Uses facemask when you are outside home?
Yes 339 68.8
No 154 31.2
                                                If yes; after using facemask where to avoid it?
Anywhere                                                         142 28.8
Garbage 351 71.2
                                                                  Are stayed at home?
Yes 376 76.3
No 117 23.7
                                                                    Social distance
Yes 351 71.2
No 142 28.8
                                                                     Overall practice
Poor 345 70.0
Good 148 30.0

Table 4: Prevention practice of COVID-19 among childbearing age in Debre Tabor Town, Northwest Ethiopia, 2020.

Reasons for not practice of prevention of COVID-19

Major reasons for not practice of prevention of COVID-19 claimed by the study participants were 88 (52.7) of negligence, 33 (19.8%) of hopeless, 32 (19.2%) of believe in God and 14 (8.4%) of can’t afford it.

Factors associated with prevention practice of COVID-19

Variables with P<0.2 in binary logistic regression model were entered in to multiple logistic regression. Those variables were marital status, education, occupation, family size, had a radio or television, knowledge, COVID-19 comes due to the results of sin, eating uncommon animals and cold weather condition.

In multiple logistic regression; education (maternal and husband), had radio or television, knowledge about COVID-19 and COVID-19 comes due to the result of ours sin were significantly associated with prevention practice of COVID-19.

The odds of practicing prevention of COVID-19 among maternal versus husband were 2.3 and 1.52 times higher among secondary and above education compared to those who are low grade and not attended formal education (AOR=2.30, 95% CI=1.05- 5.02) and (AOR=1.52, 95% CI=1.30-2.88) respectively. Those individuals didn’t’ have radio or television was 44.9% lowering practice prevention of COVID-19 than those having radio or television (AOR=0.55, 95% CI=0.32-0.97). Respondents had good knowledge more likely practiced prevention of COVID-19 than those had poor knowledge (AOR=1.68, 95% CI=1.46-5.46). Those respondents didn’t perceive COVID-19 comes due to the result ours sin more likely practice of prevention of COVID-19 than their counterparts (AOR=2.31, 95% CI=1.76-4.95) (Table 5).

Variable Practice of COVID-19 Crude or (95% CI) Adjusted or (95% CI)
Poor Good
                                                                    Maternal education
Unable to read and write 136 61 1  
     Able to read and write 198 107 1.2(0.82-1.76) 1.22(0.82-1.82)
Primary (1-8) 40 28 1.56(0.88-2.75) 1.43(0.79-2.61)
Secondary (9-12) 32 25 1.74(0.95-3.18) 1.68(0.89-3.15)
Higher education 16 17 2.36(1.12-4.99) 2.3(1.05-5.02)*
                                                              Husband education
   Unable to read and write 92 66 1  
        Able to read and write 77 49 0.88(0.55-1.43) 0.83(0.51-1.37)
Primary (1-8) 112 54 0.67(0.42-1.05) 0.82(0.49-1.35)
Secondary (9-12) 102 34 1.93(2.28-4.76) 1.52(1.3-2.88)*
Higher education 39 35 1.25(0.71-2.17) 1.37(0.77-2.44)
                                                           Had radio or TV
No  28 31 0.47(0.27-0.81) 0.55(0.31-0.97)*
Yes  394 207 1  
                                                                  Knowledge
Poor 225 113 1  
Good 197 125 1.26(3.12-4.57) 1.68(1.46-5.46)
                                                            COVID-19 due to ours sin?
No 170 88 1.15(1.82-6.97) 2.31(1.76-4.95)**
Yes  252 150 1  

Table 5: Multivariable logistics regression of factors associated with prevention practice of C0VID-19 among childbearing age (n=493) in Debre Tabor Town, Northwest Ethiopia, 2020.

Discussion

To the best of our understanding, this is the first study investigating prevention practice towards COVID-19 among childbearing age women in Ethiopia. This study was conducted to fill the gap in the literature and providing a reference on prevalence and prevention practice among childbearing age women. We found that almost one- thirds of the participant (30%) had good practice about COVID-19 prevention related issues. This finding was lower than the studies done a population-based survey and among health worker in Iran and Ethiopia respectively [18,19]. The underlying reason for these differences could be the period, study participants and place in which the studies were conducted.

This study showed that overall prevalence of prevention practice of COVID-19 in the study area were 493 (74.7%) with 95% of CI (71.2- 78.3%) which is lower than the study done a population-based survey in Iran [18,19]. The possible reason for this difference might be due to the shortage of infrastructure and inadequate trained provider show that the frontline prevention methods COVID-19. This suggests further implementation and encouragement from the government is required for the application of good practice towards COVID-19 and its prevention methods.

In addition to estimating the prevalence of preventive practice; this study was tried to determined factors associated with prevention practice of COVID-19. The finding of the current study revealed that respondents who were secondary and higher education had better practiced prevention practice of COVID-19 compared to low grades or non-attendant of formal education ((AOR=2.3, 95% CI=1.05-5.02) and (AOR=1.52, 95% CI=1.3-2.8)) respectively. The likely explanation could be increased levels of education are more aware of the importance of health education messages and act on them. In addition, a person with increased levels of education has high self-confidence and feels comfortable so it is easily accessing the information that regarding to COVID-19 [20-23].

Conclusion

In this study those individuals didn’t’ have radio or television was 44.9% lowering practice prevention of COVID-19 than compared to those having radio or television (AOR=0.55, 95% CI=0.32- 0.97); which is supported by a study done in China, Saudi Arabia and Ethiopia. This is the reason due to there is no exposure to information since its global topic of discussion in the media and public that leads to less chance of aware of about COVID-19. Another reason could be the effort of government and media in providing information starting from the time of the outbreak so the person practicing well to prevent him from the diseases.

The finding of this study shows that respondents had good knowledge on COVID-19 had better practiced in prevention practice of COVID-19 compared to those had poor knowledge (AOR=1.68, 95% CI=1.46-5.46); which is supported by a study done in China, Iran and Ethiopia. These in fact that if an individual has general knowledge regarding COVID-19 it is better to practice or which, in turn their knowledge in to action would enhance their practice regarding to the prevention of COVID-19.

Respondents didn’t perceive that COVID-19 comes from due to the result of ours sin had 2.31 times more likely practiced for preventive measures of COVID-19 compared to those perceived it (AOR=2.31, 95% CI=1.76-4.95). The reason of this might be the women think that the main prevention method of COVID 19 is praying to God rather than practicing WHO recommended preventive measures.

This study has some limitations. One of the limitations is bias occurred as a result of study design (cross-sectional) since the study took information at specified time-points and cause and effect association cannot be studied. The other limitation was lack of sufficient similar study; which limit comparison with other studies.

The prevalence of prevention practice of COVID-19 in the study area is low. Factors like education (maternal and husband), had radio or television, knowledge and perceived COVID-19 is a result of ours sin were significantly associated factors of prevention practice of COVID-19.

Declaration

Ethics approval and consent to participate

Ethical clearance was obtained from Institutional Review Committee of Debre Tabor University. Formal letter of cooperation was written for Debre Tabor Town administrative office. We stated for the participants that they had the right of unwilling to participate in the study and they had also the right to quit their participation at any stage without any restriction. Moreover, we informed the purpose, procedures, advantage and disadvantage of the study to the participants. Finally, written informed consent was obtained from a parents or guardian for participants under 18 years old.

Availability of data and materials

The datasets collected and analyzed for the current study is available from the corresponding author and can be obtained on a reasonable request.

Competing interests

The authors declare that they have no competing interests.

Funding

The author did not receive funding for this study.

Acknowledgment

We are thankful to data collectors and all participants in Debre Tabor Town for their willingness to participate in the study and we would also like to thank Debre Tabor Town administrative office for giving us information on the study population and the support during data collection.

REFERENCES

Citation: Kassa BG, Belay HG, Ayele AD, Mihiretie GN, Tefera AG, Akilil MB (2022) Prevention Practice and Associated Factors towards COVID-19 among Childbearing Age Women of Debre Tabor Town, Northwest Ethiopia: Community-based Cross-Sectional Study. J Trop Dis. 10:331.

Copyright: © 2022 Kassa BG, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.