ABSTRACT
Background: The novel Coronavirus was first detected in Wuhan, China in December 2019. In Ethiopia, The COVID-19 pandemic was expanding geopgraphically overtime. Understanding the spatial variation of the pandemic and the level of compliances towards COVID-19 prevention strategies is important to guide focused prevention and control efforts. Aim: This study aimed to explore the level of compliance and spatial variation in COVID-19 prevention strategies in major cities and towns in the Amhara region, Ethiopia. Methods: A community based observational survey was conducted from June 25 to August 10, 2020, in 16 selected cities and towns of the Amhara region. The level of compliance with hand hygiene, physical distancing and mask utilization as per the WHO recommendations were observed from 6,002 individuals and 346 transport services. Getis-Ord Gi* statistics were used to identify hot spot areas with a low level of compliance with COVID-19 preventive strategies. Spatial interpolation was performed to predict the level of compliance for un-sampled areas in the region. Results: The practice of hand hygiene, physical distancing and mask utilization were 12.0%, 13% and 26%, respectively. COVID-19 prevention strategies were found to be spacially non-random in Amhara region (Global Moran's I = 0.23, z-score = 9.5, P-value < 0.001). Poor (Hot Spot Areas) COVID-19 Prevention practices were spatially clustered at Northern Amhara (Metema, Gondar, and Woghemira town) and Western Amhara (Moarkos, Enjibara, And Bahir Dar town).Southern (Shewa Robit, and Kemissie Twon) and Eastern (Dessie, Kombolcha, Wolidiya, and Kobo) parts of the Amhara region were spatially clustered as cold spots (better practice) for COVID-19 prevention strategies. With regards to the practice of COVID19 prevention strategies, practices were low in northern and northwestern parts of the region (5%), whereas this was found to be much higher in the southern part of the region (41%). Conclusion: The level of compliance with regards to hand hygiene, physical distancing and mask utilization exhibit spatial variation across the region. Continuous community-based education using different modalities are necessary to increase the practice of hand hygiene, physical distancing and mask utilization.