Journal of Clinical Immunology

Open Access
and Microbiology Review Article

Knowledge, Attitude and Risk Perception of COVID-19 in Rural

Ghana: A Viewpoint
Shadrack O Frimpong1,2*, Sam Kris Hilton1*, Moro Seidu1, Sharon Dorcoo-Attipoe1,3, Yusuf Ransome4,
Elijah Paintsil5,6, Carol Brayne2
1
Research Department, Cocoa360, Accra, Ghana
2
Department of Public Health and Primary Care, University of Cambridge, UK
3
Tersha LLC, Alpharetta, GA, USA
4
Department of Social and Behavioural Science, Yale School of Public Health, Yale University, USA
5
Department of Pediatrics, Yale School of Medicine, Yale University, USA
6
Departmemt of Epidemiology of Microbial Diseases, Yale School of Public Health, Yale University, USA
*
Corresponding Author: Shadrack O Frimpong, Research Department, Cocoa360, Accra, Ghana and
Department of Public Health and Primary Care, University of Cambridge, UK;
Email: sof20@cam.ac.uk

Received Date: 11-10-2021; Accepted Date: 05-11-2021; Published Date: 12-11-2021

Copyright© 2021 by Hilton KS, et al. All rights reserved. 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.

Abstract
Many studies have been carried on COVID-19 exploring knowledge, risk perceptions, and
attitudes to the infection and pandemic without examining the relationship between these
constructs. This viewpoint suggests that risk perception may be a pathway between knowledge
about COVID-19 and attitudes in rural Ghana. Thus, evaluating risk perceptions of diseases is
imperative for community-based health interventions.

Keywords
COVID-19; Knowledge; Risk Perception; Attitudes

Frimpong SO | Volume 2; Issue 3 (2021) | JCIM-2(3)-039 | Review Article

Citation: Frimpong SO, et al. Knowledge, Attitude and Risk Perception of COVID-19 in Rural Ghana:
A Viewpoint. J Clin Immunol Microbiol. 2021;2(3):1-6.

DOI: http://dx.doi.org/10.46889/JCIM.2021.2307
 2

Abbreviations
WHO: World Health Organization; GHS: Ghana Health Service; SARS: Severe Acute
Respiratory Syndrome; SARS COV-2: Severe Acute Respiratory Syndrome Corona Virus

Introduction
COVID-19 is an infectious disease that has adversely affected the global economy, claiming
millions of lives worldwide [1]. COVID-19 was first reported in Wuhan city, the capital of
Hubei province in Central China, in December 2019. It was declared a pandemic by the World
Health Organization (WHO) on March 11, 2020, as it has spread throughout the world [2].
Ghana Health Service (GHS) reported that from March 12, 2020, to October 24, 2021, Ghana
had confirmed 130,077 COVID-19 cases with 1,175 deaths (Table 1 and 2, Fig. 1) [3]. Despite
the Ghanaian Government’s effort to fight the virus in urban areas, little attention has been paid
to the response in rural areas.

With the absence of vaccination, precaution and attitude will be recommended, particularly in
rural areas where there has been little or no support from the Government [4]. However, people
have no information about the virus, and precaution has not been considered; therefore, little
is known about these. Individuals' general culture plays a substantial role in the fight against
the virus, but attitudinal change may depend on the virus severity level [5]. Many studies have
been carried on COVID-19 exploring knowledge, risk perceptions, and attitudes to the
infection and pandemic. Nevertheless, these studies have not examined the relationship among
these constructs. This paper provides us with how risk perception could mediate the
relationship between knowledge and attitudes in rural Ghana, where there is currently a dearth
of research on COVID-19.

Frimpong SO | Volume 2; Issue 3 (2021) | JCIM-2(3)-039 | Review Article

Citation: Frimpong SO, et al. Knowledge, Attitude and Risk Perception of COVID-19 in Rural Ghana:
A Viewpoint. J Clin Immunol Microbiol. 2021;2(3):1-6.

DOI: http://dx.doi.org/10.46889/JCIM.2021.2307
 3

Figure 1: COVID-19 positive rate in Ghana by date of report taken, 01 Aug 2020-24-Oct-
2021.

Knowledge about COVID-19

Knowledge about COVID-19 is vital for its management and control. Literature show that
knowledge about COVID-19 can be obtained through awareness creation, insights on mode of
transmission, awareness of symptoms and preventive measures, and access to information
sources [6]. Here, we review these indicators of knowledge concerning public attitude and risk
perception.

Frimpong SO | Volume 2; Issue 3 (2021) | JCIM-2(3)-039 | Review Article

Citation: Frimpong SO, et al. Knowledge, Attitude and Risk Perception of COVID-19 in Rural Ghana:
A Viewpoint. J Clin Immunol Microbiol. 2021;2(3):1-6.

DOI: http://dx.doi.org/10.46889/JCIM.2021.2307
 4

• Awareness: The consciousness of the destructive effect of COVID-19 disease aids one to
make informed decisions to elude the effect of the disease. It follows that having accurate and
timely access to information is an effective tool to guard against pandemics [7]

• Transmission: Studies show that the primary source of the COVID-19 is unnamed as
researchers agree that the possible host of this virus is bats, pangolins, or seafood [1]. WHO
posits that the causative agent of COVID-19, SARS-CoV-2 is reputed to be transmitted
primarily through respiratory droplets and close contact with an infected person. It can also be
transmitted through having indirect contact with surfaces within immediate surroundings or
objects used on an infected person [8]
• Symptoms: COVID-19 manifestations are generally evident in an infected person after the
virus incubation period (usually between 1-14 days), ranging from asymptomatic, mild, and
moderate to severe [1]. The symptoms are mainly fever, cough, and fatigue and others include
sputum production, headache, hemoptysis, diarrhea, breathlessness and pneumonia [9-11].
These conditions are manifested by symptomatic patients, but asymptomatic patients do not
typically manifest them [12]

• Prevention: The WHO submits that education, isolation, control, and treatment of infected
patients are crucial steps in preventing the spread of the virus [11]. The Centers for Disease
Prevention and Control notes that the leading preventive measures against the spread of the
virus include: (1) wearing a mask; (2) observing social distancing by staying at least 6 feet
from others; (3) avoiding crowded and poorly ventilated places; (4) washing your hands often
or disinfect using sanitizers with at least 60% alcohol concentration; (5) covering sneeze and
cough; (6) cleaning and disinfecting high touch surfaces; (7) monitoring your health daily; and
(8) getting vaccinated [13]

• Information sources: COVID-19 related information from the inception of the outbreak was
obtained from the internet (including electronic news websites and social media such as
Twitter, Facebook, YouTube, Instagram, and Whatsapp) and traditional media (television,
newspaper, magazine and radio), family, friends, health workers, and information professionals
[7,14]

Knowledge, Risk Perception and Attitude

The success or failure to combat this pandemic highly depends on the behaviour or attitude of
the public [15]. It follows that human attitudes are crucial to helping stop or minimize the
spread of the virus but the determinant of attitude during pandemics is knowledge about the
pandemic [15-17]. Knowledge of the symptoms influences public attitudes towards the virus
[18]. Undaunted behaviours towards the virus is due to unawareness of the ramifications of
being infected by the virus [17]. These all suggest it is essential to motivate behavioural change
Frimpong SO | Volume 2; Issue 3 (2021) | JCIM-2(3)-039 | Review Article

Citation: Frimpong SO, et al. Knowledge, Attitude and Risk Perception of COVID-19 in Rural Ghana:
A Viewpoint. J Clin Immunol Microbiol. 2021;2(3):1-6.

DOI: http://dx.doi.org/10.46889/JCIM.2021.2307
 5

intentionally. Nonetheless, the people may resist such change depending on their risk
perception level about the virus. People’s perception these symptoms as real, including the
possibility of being infected, can equally influence attitudes towards the virus. It is anticipated
that knowledge of the symptoms will influence the people's risk perception, which in turn will
affect attitudes.

Literature on similar SARS outbreaks indicated that the involvement in precautionary

behaviour and compliance to control measures was due to a perceived higher risk of SARS
infection [19]. For instance, when Ghana recorded its first COVID-19 case with the limited
knowledge, citizens assumed immunity to the virus, because they thought the virus could not
withstand the temperatures in Africa till the number of cases began to increase [20].
Particularly, the perception and attitude of rural folks in the northern part of Ghana,
demonstrated a low level of awareness of COVID-19. Most of them believed that it was a (1)
punishment from God, (2) disease from Satan/ witches, (3) disease for the rich, and (4) disease
that cannot affect rural people [20]. Furthermore, compared to the urban areas, the rural folks
are most likely not to have quick, accurate, and reliable dissemination of COVID-19 related
information, perhaps due to poor internet connectivity in rural areas [20]. Therefore, the risk
perceptions of populace in the rural communities are probably affected, thereby making them
behave negatively towards the preventive measures [13].

Conclusion
Research submits that the attitudes of the people play a role in the fight against this virus, but
attitudinal change may vary depending on the level of risk perception of the virus. The paper
proposes that knowledge may have more substantial influence on attitudes through risk
perception in a rural setting of a developing country, particularly Ghana. Thus, risk perception
of the people must be keenly considered in rolling out any intervention to stop the spread of
the virus and mitigate its negative impacts.

Conflicts of Interest
The authors declare that have no competing interest and not any conflict of interest.

References
1. Mustapha T, Daskum AM, Gana AH, Unyah NZ. An emergent infectious disease, Severe Acute Respiratory
Syndrome Corona Virus (SARS COV-2): A Mini Review. Int J Res. 2020;7:287-93.

Frimpong SO | Volume 2; Issue 3 (2021) | JCIM-2(3)-039 | Review Article

Citation: Frimpong SO, et al. Knowledge, Attitude and Risk Perception of COVID-19 in Rural Ghana:
A Viewpoint. J Clin Immunol Microbiol. 2021;2(3):1-6.

DOI: http://dx.doi.org/10.46889/JCIM.2021.2307
 6

2. World Health Organization. WHO Director-General’s opening remarks at the media briefing on COVID-19,
2020. [Last accessed 05 November,2021] https://www.who.int/dg/speeches/detail/who-director-general-s-
opening-remarks-at-the-media-briefing-on-covid-19---11-march-2020
3. Ghana Health Service. Situation Update, Covid-19 outbreak In Ghana as at 24 October 2021. [Last accessed
05 November,2021] https://www.ghs.gov.gh/covid19/
4. Iorfa SK, Ottu IF, Oguntayo R, Ayandele O, Kolawole SO, Gandi JC, et al. COVID-19 knowledge, risk
perception, and precautionary behavior among nigerians: a moderated mediation approach. Front Psychol.
2020;11:3292.
5. Cori L, Bianchi F, Cadum E. Risk perception and COVID-19. Int J Environ Res Public Health. 2020;17:3114.
6. Wolf MS, Serper M, Opsasnick L, O'Conor RM, Curtis L, Benavente JY, et al. Awareness, attitudes and
actions related to COVID-19 among adults with chronic conditions at the onset of the US outbreak: a cross-
sectional survey. Ann Internal Med. 2020;173(2):100-9.
7. Ali MY, Bhatti R. COVID-19 (Coronavirus) pandemic: information sources channels for the public health
awareness. Asia Pacific J Public Health. 2020;32(4):168-9.
8. World Health Organization. WHO Coronavirus Disease (COVID‐19) Dashboard, 2020. [Last accessed 05
November,2021] https://covid19.who.int/
9. Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel
coronavirus in Wuhan, China. The Lancet. 2020;395(10223):497-506..
10. Nature. Stop the Wuhan virus. Nature. 2020;577(7791):450.
11. World Health Organization. Coronavirus disease 2019 (COVID-19) situation report-73, 2020. [Last accessed
05 November,2021] https://www.who.int/health-topics/coronavirus#tab=tab_3
12. World Health Organization. WHO Coronavirus (COVID-19) dashboard, 2020. [Last accessed 05
November,2021] https://covid19.who.int/region/afro/country/gh
13. Centers for Disease Control and Prevention. COVID-19: How to Protect Yourself & Others. [Last accessed
05 November,2021] https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/prevention.html
14. Olaimat AN, Aolymat I, Shahbaz HM, Holley RA. Knowledge and information sources about COVID-19
among university students in Jordan: a cross-sectional study. Front Public Health. 2020;8:254.
15. Perrotta D, Grow A, Rampazzo F, Cimentada J, Del Fava E, et al. Behaviours and attitudes in response to the
COVID-19 pandemic: insights from a cross-national Facebook survey. EPJ Data Sci. 2021.
16. Verelst F, Willem L, Beutels P. Behavioural change models for infectious disease transmission: a systematic
review (2010-2015). J Royal Society Interface. 2016;13(125):20160820.
17. Roy D, Tripathy S, Kar SK, Sharma N, Verma SK, Kaushal V. Study of knowledge, attitude, anxiety &
perceived mental healthcare need in Indian population during COVID-19 pandemic. Asian J Psychiatry.
2020;51:102083.
18. Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel
coronavirus in Wuhan, China. Lancet 2020;395:497-506.
19. Smith RD. Responding to global infectious disease outbreaks: lessons from SARS on the role of risk
perception, communication and management. Social Sci Med. 2006;63(12):3113-23.
20. Saba CK, Nzeh J, Addy F, Karikari AB. COVID-19: Knowledge, perceptions and attitudes of residents in the
Northern Region of Ghana, West Africa. 2020.

Frimpong SO | Volume 2; Issue 3 (2021) | JCIM-2(3)-039 | Review Article

Citation: Frimpong SO, et al. Knowledge, Attitude and Risk Perception of COVID-19 in Rural Ghana:
A Viewpoint. J Clin Immunol Microbiol. 2021;2(3):1-6.

DOI: http://dx.doi.org/10.46889/JCIM.2021.2307