REVIEW OF THE RELATED LITERATURE

The COVID-19 pandemic has become a major concern worldwide, regardless of whether the
country is developed or developing; it is one of the world's most dominant challenges.
Countries all over the world have taken, and continue to take, unprecedented infection
prevention and control measures in order to stop the spread of COVID-19. As previously stated,
COVID-19 was first reported by WHO on December 31, 2019, and a global pandemic was
declared on March 11, 2020.

Despite the effects on society, the global environment, and the economy, some studies have
looked into people's knowledge, attitudes, and practices about COVID-19. Honarvar et al.
investigated an adult's knowledge, attitude, risk perception, and practices regarding COVID-19.
Similarly, Reuben et al. (16) assessed people's knowledge, attitudes, and practices regarding
COVID-19 in North-Central Nigeria. They discovered that people with good knowledge have a
positive attitude and have taken steps to reduce the spread of COVID-19.

Preventive Measures towards COVID-19

According to GERMS, 2020, as the world races against time to find a standard cure for COVID-
19, prevention for now is the only mitigation method to subdue the spread of infection globally.
The COVID-19 mitigated measures include hand hygiene, respiratory hygiene, self-isolation, and
social distancing by the general public. Hand washing is a thorough hand wash that helps to
abate the spread of COVID-19 as this method helps to eliminate SARS-CoV-2 and other germs
on the hands. In Nigeria, alcohol-based gel (sanitizer) ought to be used to rub the hands as it is
applied in Nigeria.

Kampf G, Todt D, Pfaender S, Steinmann E J Hosp Infect, 2020, frequent surface cleaning is
necessary because SARS-CoV-2 has been confirmed to remain on surfaces for several days;
hence, infected surfaces may be a major transmission route. The decontamination of infected
surfaces is highly effective through the use of chemical solutions such as ethanol (62–71%),
isopropanol (50–100% quantity), sodium hypochlorite (0.1% quantity), hydrogen peroxide
(0.5% quantity), and povidone-iodine (0.2–7.5% quantity). If cases of COVID-19 are confirmed in
a particular place or location, it is advised that all areas and surfaces be thoroughly
decontaminated to ensure that SARS-CoV-2 is eliminated in order to prevent the wide spread of
community transmission. Furthermore, all handy machineries, equipment, and materials used
or handled by a patient with COVID-19 ought to be decontaminated to kill off germs and SARS-
CoV-2 before being handled by other people.
Strict adherence to social distancing in any form of reduced contact between people is termed
"social distancing." There are usually two types of social distancing: public and individual social
distancing. Public social distancing comprises a set of various measures put in place to ensure
that large gatherings of people are prohibited during the COVID-19 pandemic. Such measures
include quarantines, travel bans, closures of schools, closures of workplaces, closures of
stadiums, markets, theatres, and shopping malls. Individual social distancing comprises
measures put in place by individuals to reduce contact with other people. Such measures
include: avoidance of unnecessary travel, sitting at home, avoiding crowded places, avoiding
handshakes and hugging, etc. Presently, many health authorities in nations globally are advising
public and individual social distancing to abate the spread of COVID-19. For instance, Germany,
the USA, Italy, Nigeria, Spain, the United Kingdom, France, and many other countries have put
up various social distancing measures in their respective countries. Importantly, social
distancing would only be effective as a mitigation measure against the spread of COVID-19 if
strictly enforced and strictly followed by the public. Furthermore, elderly people, especially
those with underlying medical conditions, ought to adhere strictly to all social distancing
measures in COVID-19 pandemic hotspot areas. Respiratory hygiene refers to measures taken
by individuals to reduce the rate of transmission of highly infectious respiratory diseases like
influenza, Middle East respiratory syndrome (MERS), and the present COVID-19.
Ayenigbara IOCent Asian J Glob Health. 2020, stated that respiratory hygiene measures include:
covering the mouth with a tissue paper or a handkerchief when coughing and sneezing;
disposing of used tissue paper and handkerchiefs immediately after coughing and sneezing; and
covering the mouth and nose with a bent elbow when coughing and sneezing, after which the
hands and elbow should be thoroughly washed with an antiseptic soap and clean running
water.
In their study Personal protective equipment during the coronavirus disease (COVID) 2019
pandemic - a narrative review (Anaesthesia. 2020) stated that The wearing of protective face
masks is to cover the nose and the mouth in order to prevent the spread of highly infectious
respiratory diseases like influenza, MERS, and COVID-19. SARS-CoV-2 is primarily transmitted by
droplet and contact routes. Droplet transmission, for example, occurs through larger
respiratory particles, typically larger than 5 m in diameter and subject to gravitational forces;
these droplets and particles tend to travel no more than 1 meter; thus, a 2-meter contact limit
is recommended to prevent transmission. Importantly, face mask usage is strongly advised for
patients infected with COVID-19 to reduce the transmission of SARS-CoV-2 through sneezes,
coughs, and talking. Also, wearing masks by uninfected individuals can help reduce the rate and
chances of touching the face with infected and unwashed hands and prevent inhaling SARS-
CoV-2 under certain conditions in COVID-19 hotspot areas. Furthermore, wearing a mask is
strongly advised for the health personnel treating COVID-19 patients. Hence, the proper use of
PPE will diminish the risk of SARS-CoV-2 transmission. Importantly, any PPE ought to be
matched to the potential mode of viral transmission: contact, droplet, or
airborne. Furthermore, overuse of PPE is a form of misuse, and the misuse of PPE depletes
limited stocks, leads to avoidable shortages, and increases the risk of SARS-CoV-2 infection to
staff. As a precautionary measure, many countries, such as Nigeria, China, Hong Kong, Thailand,
Czech Republic, Slovakia, Vietnam, Austria, Israel, Taiwan, Panama, Japan, South Korea,
Malaysia, and Singapore, have encouraged their citizens to wear masks that cover their nose
and mouth when going to public places (World Health Organization, 2020).
In study Only strict quarantine measures can curb the coronavirus disease (COVID-19) outbreak
in Italy, 2020, testing, self-isolation, quarantine, and contract tracing are quick tests that are
required for the early diagnosis of COVID-19 among the general public in order to begin
treatment, prevent condition worsening, and prevent the spread of SARS-CoV-2 to other people
and the community at large. For a higher prevention strategy, rapid COVID-19 testing ought to
be scaled up across all nations of the world, especially in COVID-19 hotspot zones. Self-isolation
is the process of keeping oneself away from public contact in order to reduce the spread of
highly contagious infections. In Anderson RM, Heesterbeek H, Klinkenberg D, Hollingsworth TD
Lancet, 2020, self-isolation is advised for individuals with confirmed COVID-19, and also for
individuals who have traveled to COVID-19 hotspot areas. Furthermore, self-isolation is
necessary for individuals who have come into contact with COVID-19 patients, for individuals
who are expecting their test results and for individuals who have had contact with people who
have returned from COVID-19 hotspots areas. Also, self-quarantine is advised for elderly people
and the entire people in COVID-19 hotspot areas. For instance, some countries have mandated
a self-isolation, or quarantine for the duration of 14 days for incoming travelers, while some
countries have also mandated a compulsory COVID-19 testing for incoming travelers at the
respective entry points with the aims to reduce transmission rates and prevent a second wave
of mass transmission. Also, rigorous contact tracing ought to be performed to identify
individuals who might have come into contact with confirmed COVID-19 patients in other to
further reduce the spread of infection. Generally, after contacts have been identified, some
countries recommend self-isolation, or quarantine for the duration of 14 days, or testing of
contacts, and different recommendations have been in place during different steps of
containment or mitigation of the COVID-19 pandemic.

Level of Knowledge towards COVID-19

In their thesis Knowledge, Attitude, and Practice During the COVID-19 Pandemic: A Review. A
research conducted by Hiroshi Koyama, et al., 1357 health workers including doctors, nurses,
and paramedics in China showed that medical doctors obtained higher knowledge scores
compared with nurses and paramedics. Compared with frontline health workers who have
direct contact with confirmed and suspected patients, non- frontline workers displayed low
levels of confidence to fight the virus. In Italy, respondents from 2046 hospital staff showed
that in general, healthcare workers possessed good knowledge. A research on medical students
from Iran indicated that such students have an average of 96% correct answers with 79.60%,
13.8%, and 6.7% of students holding high, moderate, and low levels of knowledge, respectively.
In Jordan, medical and non-medical students obtained an average score, where 90% of the
participants had good knowledge of COVID-19 symptoms and more than 80% are aware of the
lack of vaccine and treatment for COVID-19. No significant differences were observed regarding
knowledge between medical and non- medical students. The cited sources of knowledge about
COVID-19 are social media (34%), the WHO (19.9%), TV (17.6%), the Internet (13%), the
Ministry of Health (10.1%), and colleagues (5.4%) research conducted in the US and the UK
revealed considerable knowledge among respondents about the transmission, spread, and
symptoms of COVID-19. However, a portion of the populations cited misconceptions about the
prevention of the disease. Nevertheless, the difference in knowledge and misperception
between the US and the UK participants is non-significant. Another study in China on 6910
residents argued that the level of knowledge of the residents was positive with a score of 10.8.

In Government Doon Medical College Dehradun, Uttarakhand India, student’s awareness about
preventive measures against COVID-19 was assessed and it was found that 96% of students
were aware about importance of home quarantine. Majority (88%) of students were aware that
hand hygiene, cough etiquettes, and avoiding contacts with sick person can help in the
prevention of its transmission. However only 79% of students were aware that early
symptomatic and supportive treatment for COVID-19 can help to recover from infection. Best
observation of the study was that 99% of students were aware that hand washing and
sanitization are very important practices for COVID-19 prevention.

Attitudes towards COVID-19

Research conducted by (Hiroshi Koyama, et al., 2020) health workers in China indicated that
knowledge directly influenced attitudes. Approximately 85% of health workers were afraid of
being infected while working, whereas 60% experienced anxiety when working in isolation
rooms and intensive care units. The study on hospital staff from Italy proposes that more than
41% of the respondents avoid crowded places as a precautionary measure. Furthermore,
healthcare workers generally were more aware of COVID- 19 compared with the public.
Furthermore, the research on 368 dentists in Jordan revealed that more than half of the
participants deemed that the symptoms of COVID-19 can be resolved over time and thus do not
require special treatment. A total of 275 dentists (74.7%) agreed that implementing social
distancing among patients in the clinic, wearing a mask in the waiting room, and hand-washing
before entering the treatment room can prevent the spread of the virus during dentist
appointments. However, 80 respondents (21.7%) believe that such measures are not important
and do not cause excessive panic. A total of 304 dentists (82.6%) reported that they refrain
from handling patients that display COVID-19 symptoms, whereas 161 dentists (43.8%)
mentioned that they preferred that patients with symptoms visit the hospital instead of their
clinics. Furthermore, 17 dentists (4.6%) expressed that they will refuse to treat patients with
COVID-19 symptoms and advise them to leave the clinic. In contrast, 182 dentists (49.5%)
confirmed that they will treat the patient, but advise them to visit the hospital afterward. A
study on health and non-health students from Jordan indicated that such students possessed
high levels of attitude. The study showed that nearly all participants (99.7%) agreed that hands
should be regularly washed for personal hygiene. In terms of avoidance, approximately 68.4%
of the participants expressed that using masks can prevent viral infections, 81.8% and 79.4%
agreed that smoking and antibiotics cannot prevent infection, 94.6% cited that they will divulge
if they are infected, and 93.6% will visit hospitals if infected. The study in China on residents as
respondents found that residents in general hold an optimistic attitude toward the COVID-19
pandemic. As many as 90.8% are hopeful that COVID-19 will be successfully controlled, and
97.1% are confident that China will win against the virus.

Research conducted in Mizan Tepi University, (Angelo AT, et al., 2020) stated that about half of
the students agreed that they are worried for might getting Covid-19, 182 (45.3%) agree
for preventive measures should be only applied by risk groups and older adults. Two
hundred sixty-eight (66.7%) agree for visiting the health facility when they develop
symptoms, 275 (68.4%) agreed that limit of movement by individuals decreases the
disease transmission, and 158 (39.3%) agreed that students living in the campus are
vulnerable for Covid-19. Two hundred five (51.0%) agreed that the outbreak has impacted
their study, and 184 (45.8%) had agreed that eating raw vegetables and wild animals do
not impact the transmission. Overall 217 (54.0%) of the study participants had scored
attitude score greater than the mean attitude score (7.4) and had a positive attitude
towards Covid-19 prevention.

Palak Sharma et al., student’s attitude was explored towards COVID-19 and it was found that
98% of students were ready to share the COVID-19 related information with others. 79% of
students were satisfied regarding media coverage of COVID-19 in India and were willing for
their vaccination against COVID-19, if provided. Maximum number (97%) of students were
following stay at home order given by government. One of the major finding was that only 56%
of students were ready to allow recovered patients in their community which means stigma and
fear exists against those previously infected. Approximately all 99% of students were confident
that India will win battle against COVID-19. Student’s preventive practices were assessed and it
was found that 98% students carried hand sanitizer during outbreak, and 92% students practice
sanitizing their hand after coughing & sneezing and wash hands after returning from public
places. Majority (94%) of students practice changing their clothes after outside visit wears face
mask outside. Only 15% students have visited crowded places recently which shows that
students were following stay at home orders.

References:

Angelo AT, et al., Knowledge, Attitudes, and Practices Toward Covid-19 and Associated Factors
Among University Students in Mizan Tepi University, 2020. Retrieved from
https://www.dovepress.com/knowledge-attitudes-and-practices-toward-covid-19-and-
associated-facto-peer-reviewed-fulltext-article-IDR#

Hiroshima Koyama, et al., Knowledge, Attitude, and Practice During the COVID-19 Pandemic: A
Review, 2020. Retrieved from chrome-
extension://oemmndcbldboiebfnladdacbdfmadadm/https://www.researchgate.net/publication
/343316431_Knowledge_Attitude_and_Practice_During_the_COVID-
19_Pandemic_A_Review/fulltext/5f414008a6fdcccc43e78105/Knowledge-Attitude-and-
Practice-During-the-COVID-19-Pandemic-A-Review.pdf?%20origin=publication_detail#T0002

Palak Sharma, (2020). Knowledge, attitude and practices regarding COVID-19 among school
students of North India. Retrieved from https://www.ijfcm.org/html-article/13595

Germs, 2020. COVID-19 (SARS-CoV-2) pandemic: fears, facts and preventive measures.
Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7572217/

World Health Organization. Coronavirus disease (COVID-19) advice for the public. 2020.

Retrieved from  https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-
for-public.
Cook TM. Personal protective equipment during the coronavirus disease (COVID) 2019
pandemic - a narrative review. Retrieved from Anaesthesia. 2020;75:920–7.
doi: 10.1111/anae.15071.

jödin H, Wilder-Smith A, Osman S, Farooq Z, Rocklöv J. Only strict quarantine measures can curb
the coronavirus disease (COVID-19) outbreak in Italy, 2020. Retrieved from Euro
Surveill. 2020;25:2000280. doi: 10.2807/1560-7917.ES.2020.25.13.2000280.