Knowledge of COVID-19 Symptoms, Transmission, and Prevention: Evidence from Health and Demographic Surveillance in Southern Mozambique (preprint)

ABSTRACT

Background: Over 230,000 COVID-19 cases and over 2,200 deaths have been reported in Mozambique though March 2023. Understanding community members' knowledge and perception of SARS-CoV-2 transmission and prevention is essential for directing public health interventions to reduce disease spread and improve vaccination coverage. Here, we aimed to describe knowledge of COVID-19 transmission, prevention, and symptoms among community residents in Mozambique. Methods: We conducted a cross-sectional survey among 33,087 of 40,636 households (81.4%) in a Health and Demographic Surveillance System in Manhica, Mozambique, at the tail end of the Delta variant wave in September 2021 to the peak of Omicron cases in January 2022. Principal components analysis was used to create scores representing knowledge of COVID-19 symptoms, transmission, and prevention. Multiple imputation and quasi-Poisson regression were used to examine associations between demographic characteristics and sources of COVID-19 information, and knowledge of COVID-19 symptoms, transmission, and prevention. We examined whether sources of COVID-19 information mediated the relationship between educational attainment and knowledge of symptoms, transmission, and prevention. Results: Across this rural community, 98.2%, 97.0%, and 85.1% of household respondents reported knowing how COVID-19 could be prevented, that SARS-CoV-2 can cause disease, and how SARS-CoV-2 is transmitted, respectively. Most recognized symptoms were cough (51.2%), headaches (44.9%), and fever (44.5%). Most cited transmission mechanisms were droplets (50.5%) or aerosol (<5 micrometer diameter) (46.9%) from an infected person. Most cited prevention measures were handwashing (91.9%) and mask-wearing (91.8%). Characteristics associated with greater knowledge of symptoms, transmission, and prevention included having at least primary education, older age, employment, higher wealth, and Christian religion. Respondents who had had COVID-19 symptoms were also more likely to have knowledge of symptoms, transmission, and prevention. Gathering information from TV, WhatsApp, radio, and hospital mediated the relationship between educational attainment and knowledge scores. Conclusions: Community public health measures to reduce infectious disease transmission are contingent upon perceptions of risk and knowledge. These findings support the need for outreach and for community-engaged messaging to promote prevention measures, particularly among people with low education.