Knowledge and Practice of Personal Protective Measures Against COVID-19 in Africa: Systematic Review.

BACKGROUND: With COVID-19 being a newly evolving disease, its response measures largely depend on the practice of and compliance with personal protective measures (PPMs). OBJECTIVE: This systematic review aimed to examine the knowledge and practice of COVID-19 PPMs in African countries as documented in the published literature. METHODS: A systematic search was conducted on the Scopus, PubMed, and Web of Science databases using appropriate keywords and predefined eligibility criteria for the selection of relevant studies. Only population-based original research studies (including qualitative, quantitative, and mixed methods studies) conducted in Africa and published in the English language were included. The screening process and data extraction were performed according to a preregistered protocol in PROSPERO (CRD42022355101) and followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The quality of the included studies was assessed using the Mixed Methods Appraisal Tool. Thematic analysis was used to systematically summarize the studies into 4 predefined domains: knowledge and perception of PPMs, mask use, social and physical distancing, and handwashing and hand hygiene, including their respective levels and associated factors. RESULTS: A total of 58 studies across 12 African countries were included, published between 2019 and 2022. African communities, including various population groups, had varying levels of knowledge and practice of COVID-19 PPMs, with the lack of personal protective equipment (mainly face masks) and side effects (among health care workers) being the major reasons for poor compliance. Lower rates of handwashing and hand hygiene were particularly noted in several African countries, especially among low-income urban and slum dwellers, with the main barrier being the lack of safe and clean water. Various cognitive (knowledge and perception), sociodemographic, and economic factors were associated with the practice of COVID-19 PPMs. Moreover, there were evident research inequalities at the regional level, with East Africa contributing 36% (21/58) of the studies, West Africa contributing 21% (12/58), North Africa contributing 17% (10/58), Southern Africa contributing 7% (4/58), and no single-country study from Central Africa. Nonetheless, the overall quality of the included studies was generally good as they satisfied most of the quality assessment criteria. CONCLUSIONS: There is a need to enhance local capacity to produce and supply personal protective equipment. Consideration of various cognitive, demographic, and socioeconomic differences, with extra focus on the most vulnerable, is crucial for inclusive and more effective strategies against the pandemic. Moreover, more focus and involvement in community behavioral research are needed to fully understand and address the dynamics of the current pandemic in Africa. TRIAL REGISTRATION: PROSPERO International Prospective Register of Systematic Reviews CRD42022355101; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022355101.

Social Factors Associated With Adherence to Preventive Behaviors Related to COVID-19 Among Rural and Semi-urban Communities in Western Maharashtra, India.

Background: To control the transmission of the coronavirus disease 2019 (COVID-19) infection, the Government of India (GoI) had taken stringent precautionary measures during the lockdown period. This study aimed to explore determinants affecting adherence to protective measures against COVID-19 infection among rural and semi-urban settings of Maharashtra, India. Methods: A cross-sectional telephonic survey among 1,016 adults from randomly selected households was conducted between June 5 and July 16, 2020. The data were explored for knowledge, awareness, practices related to protective measures, and self-risk perception. Socio-demographic and attitudinal correlates of failure to use protective measures against COVID-19 were measured. Results: In the survey, 72% of the participants were men. The mean age was 46 years (SD: 13.8). The main source of information was television (91%); however, information from healthcare providers (65%) and mass media announcements (49%) was trustworthy. Washing hands immediately with soap after returning from outdoors was reported by 95% of the respondents, always using a mask while outdoors by 94%, never attended social gatherings by 91%, always using hand sanitizer while outside by 77%, and 68% of the respondents followed all protective measures. The knowledge score [mean score 20.3 (SD: 2.4) out of 24] was independently associated with the risk of not using protective measures, with each unit increase in knowledge score, the risk of not using protective measures reduced by 16%. No source of income was independently associated with not using protective measures [AOR 1.5 95% CI (1.01-2.3)]. Conclusions: The COVID-19 public health interventions and behavior change communication strategies should be specifically directed towards the low socio-economic populations through trusted sources. The association between knowledge and practices demonstrates the importance of accurate public health communication to optimally follow preventive measures, such as structural interventions to address poverty and employment policies to address the unemployment crisis are required. Surveillance activity is needed to understand the actual behavior change among the population.

Survey on usage and concerns of a COVID-19 contact tracing application in Japan.

OBJECTIVES: We aimed to identify the concerns, current implementation status and correct usage, and factors inhibiting implementation and correct use of a COVID-19 contact tracing application among the ordinary citizens in Japan. STUDY DESIGN: This was a cross-sectional study based on an internet survey completed by 2013 participants who were selected among registrants of an Internet research company between September 8 and 13, 2020. METHODS: Participants completed an online survey that included thoughts and concerns about the application, status of use, and questions about whether the application was being used correctly. We performed multiple logistic regression analysis to clarify the association between the use of the app and sociodemographic factors and user concerns. RESULTS: Of the 2013 respondents, 429 (21.3%) participants reported using this application, but only 60.8% of them used it correctly. The percentage of those having some concerns about the application ranged from 45.9% to 75.5%, with the highest percentage being 'doubts about effectiveness of apps for preventing spread of infection'. Multiple logistic regression analysis revealed, the main concerns inhibiting application use were insufficient knowledge of how to use it, privacy concerns, doubts about the effectiveness of the app, and concerns about battery consumption and communication costs. Additionally, the prevalence of the application was lower for lower-income individuals. CONCLUSIONS: The findings suggest that income may create inequalities in the efficacy and effectiveness of COVID-19 contact tracing applications. Awareness activity strategies to dispel such concerns and support low-income individuals may be needed.

Public Trust and Policy Compliance during the COVID-19 Pandemic: The Role of Professional Trust.

Previous research has shown that public trust is vital for promoting policy compliance, particularly in times of crisis. However, the literature supporting this notion remains scarce, especially in countries which have successfully contained a pandemic despite showing a generally low level of public trust in the government. To address this topic, we conducted a cross-sectional study between February and March of 2020 to examine the relationship between public trust and the compliance of the general public in adopting personal protective measures introduced during the early phase of the coronavirus disease 2019 (COVID-19) outbreak in Thailand. We report our result from a hierarchical regression. We find a positive and significant relationship between public trust in the government and the likelihood of respondents adopting these precautions, more importantly, this relationship was fully mediated by the professional trust as the effect of public trust in the government on policy compliance was reduced by 0.118, namely from (ß = 0.133, p < 0.001) to (ß = 0.015, p > 0.05). Married respondents residing in the capital city, with a higher degree of worry were also more likely to comply with these safety measures. In conclusion, the finding sheds light on the dynamic relationship between public trust and policy compliance and offers some implications in times of a global health crisis.

Social Distancing among Medical Students during the 2019 Coronavirus Disease Pandemic in China: Disease Awareness, Anxiety Disorder, Depression, and Behavioral Activities.

BACKGROUND: During the coronavirus disease (COVID-19) pandemic, harsh social distancing measures were taken in China to contain viral spread. We examined their impact on the lives of medical students. METHODS: A nation-wide cross-sectional survey of college students was conducted from 4-12 February 2020. We enrolled medical students studying public health in Beijing and Wuhan to assess their COVID-19 awareness and to evaluate their mental health status/behaviors using a self-administered questionnaire. We used the Patient Generalized Anxiety Disorder-7 and Health Questionnaire-9 to measure anxiety disorders and depression. We used multivariable logistic regression and path analysis to assess the associations between covariates and anxiety disorder/depression. RESULTS: Of 933 students, 898 (96.2%) reported wearing masks frequently when going out, 723 (77.5%) reported daily handwashing with soap, 676 (72.5%) washed hands immediately after arriving home, and 914 (98.0%) reported staying home as much as possible. Prevalence of anxiety disorder was 17.1% and depression was 25.3%. Multivariable logistic regression showed anxiety to be associated with graduate student status (odds ratio (aOR) = 2.0; 95% confidence interval (CI): 1.2-3.5), negative thoughts or actions (aOR = 1.6; 95% CI: 1.4-1.7), and feeling depressed (aOR = 6.8; 95% CI: 4.0-11.7). Beijing students were significantly less likely to have anxiety than those in the Wuhan epicenter (aOR = 0.9; 95% CI: 0.8-1.0), but depression did not differ. Depression was associated with female students (aOR = 2.0; 95% CI: 1.2-3.3), negative thoughts or actions (aOR = 1.7; 95% CI: 1.5-1.9), and anxiety disorder (aOR = 5.8; 95% CI: 3.4-9.9). Path analysis validated these same predictors. CONCLUSIONS: Despite medical students' knowledge of disease control and prevention, their lives were greatly affected by social distancing, especially in the Wuhan epicenter. Even well-informed students needed psychological support during these extraordinarily stressful times.