DECLARATION

We, Dzamalala Rabecca, Mwalubunju Victoria, Lyton Jacqueline and Chabwera

Sylvester, declare that this research project report represents our own work and that it has
never been presented elsewhere for any degree. All sources of information have been
rightfully acknowledged.

NAME SIGNATURE DATE

Dzamalala Rabecca ……………… …………………

Mwalubunju Victoria ……………… …………………

Lyton Jacqueline ……………… …………………

Chabwera Sylvester ……………… …………………

i
 APPROVAL

We hereby certify that this has been submitted to Lilongwe University of Agriculture and
Natural Resources with our approval in partial fulfillment of the requirements for the
Bachelor of Science Degree in Nutrition and Food Science.

DATE

DR. GETRUDE MPHWANTHE, RD.

RESEARCH PROJECT SUPERVISOR

DATE

ASSOCIATE PROFESSOR, ALEXANDER KALIMBIRA, PhD.

HEAD, DEPARTMENT OF HUMAN NUTRITION AND HEALTH

DATE

ASSOCIATE PROFESSOR, TINNA MANANI, PhD.

DEAN, FACULTY OF FOOD AND HUMAN SCIENCE

ii
 DEDICATION.

We dedicate this to our parents, Mr and Mrs Dzamalala, Mr and Mrs Mwalubunju, Mr
and Mrs Lyton and Mr and Mrs Chabwera, for their tireless effort in supporting us, and
for their day to day prayers that made this a success.

iii
 ACKNOWLEDGEMENTS

Special thanks should go to the following for the valuable efforts during the entire study
period:

 Getrude Mphwanthe PhD, RD, our study supervisor, for her tireless guidance,
support and mentorship which has led to the success of this paper. May God
continue blessing her.
 To our classmates for their support, advice and assistance as they were always
there for us when we needed them.
 Lilongwe University of Agriculture and Natural Resources for the opportunity
rendered to have this experience, it is priceless.
 Lastly, we sincerely appreciate all the respondents for their participation in the
study.

iv
 ABSTRACT

Coronavirus (COVID-19) is a respiratory infection caused by the Severe Acute

Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). Malawi recorded its first COVID-
19 case on 2nd April 2020. According to Ministry of Health statistics, as of 30 thApril 2022,
Malawi had reported a total number of 85,788 confirmed cases, of which three active
cases, 82,066 patients have recovered with 14 new cases, 2,634 deaths reported and total
of 1,107,875 fully vaccinated.

The objective of the research was to assess nutrition perceptions and practices related to
COVID-19 among adults residing in rural and urban areas with unknown COVID-19
status. A cross- sectional study was conducted in rural (Chiseka village) and urban (Area
36), Lilongwe with a sample size of 183. Data was analyzed using Excel and IBM SPSS
version 20.0. The differences in perceptions and practices between urban and rural was
determined using Pearson Chi-Square test.

The findings of the study showed that nutrition practices include consumption of ginger,
lemon and dietary supplements, they also practiced mask, sanitizing and vaccination. The
use of dietary supplements such as zinc (26.5%), vitamin C (39) and zinc and vitamin C
(27) was observed only in urban area. there were significant differences (P = 0.004: X 2
=36.68) in nutrition perception and practices (P= 0.000: X2 = 17.62). No significant
differences were observed in COVID-19 related knowledge between the urban and rural
areas.

In conclusion the study has shown that there is limited nutrition information related to
COVID-19 among the participants based on the nutrition practices and perceptions
observed during the study. Therefore, the Malawi government through Ministry of
healthy should set nutrition guidelines on prevention and control of COVID-19.

v
 TABLE CONTENT

APPROVAL.................................................................................................................................II

DEDICATION............................................................................................................................III

ACKNOWLEDGEMENTS.......................................................................................................IV

ABSTRACT..................................................................................................................................V

1.0 INTRODUCTION...................................................................................................................1

1.1 Background..............................................................................................................................1

1.2 Problem Statement..................................................................................................................2

1.3 Significance..............................................................................................................................3

1.4 OBJECTIVES.........................................................................................................................3
1.4.1 Main objectives..................................................................................................................3
1.4.2 Specific objectives..............................................................................................................4

1.5 Research questions..................................................................................................................4

2.0 LITERATURE REVIEW.......................................................................................................5

3.0 MATERIALS AND METHODS..........................................................................................10

3.1 Study area..............................................................................................................................10

3.2 Study design...........................................................................................................................10

3.3 Sampling method and target population.............................................................................10

3.4 Sample size.............................................................................................................................10

3.5 Data collection methods........................................................................................................11

3.6 Data analysis..........................................................................................................................11

3.7 Ethical consideration.............................................................................................................11

3.8 Dissemination of the results..................................................................................................12

4.0 RESULTS..............................................................................................................................13

vi
4.1 Demographic characteristics................................................................................................13

4.2 Knowledge, attitude and practices.......................................................................................15

4.2.1 Knowledge related to COVID-19.....................................................................................15
4.2.2 Definition of COVID-19..................................................................................................16
4.2.3 Causes of COVID-19.......................................................................................................16
4.2.4 Signs of COVID-19..........................................................................................................17

4.3 Practices related to COVID-19.............................................................................................18

4.3.1 Food practices related to COVID-19................................................................................18
4.3.2 Non-food practices related to COVID-19.........................................................................19
4.3.3 Dietary Supplements........................................................................................................20
4.3.4 Reasons for following food practices...............................................................................21
4.3.5 Nutrition practices related to COVID-19 among adults residing in rural and urban areas.
..................................................................................................................................................22

4.4 Perception related to food and non-food practices.............................................................24

4.4.1 Perceptions of food practices............................................................................................24
4.4.2 Perceptions of non-food practices....................................................................................25
4.4.3 Nutrition perceptions related COVID-19 categorized according to the health belief model
..................................................................................................................................................26

4.5 Differences between rural and urban..................................................................................27

4.6 Sources of information related to COVID-19......................................................................28

5.0 DISCUSSION........................................................................................................................29

5.1 knowledge, attitude and practices........................................................................................29

5.1.1 Knowledge related to COVID-19.....................................................................................29
5.1.2 Practices related to COVID-19.........................................................................................30
5.1.3 Perceptions related to COVID-19.....................................................................................31
5.1.4 Differences between urban and rural residents.................................................................31

6.0 CONCLUSION......................................................................................................................33

6.1 LIMITATIONS OF THE STUDY.......................................................................................33

6.2. RECOMMENDATIONS.....................................................................................................33

7.0 REFERENCE........................................................................................................................34

8.0 APPENDIX............................................................................................................................38

vii
 LIST OF FIGURES

Figure 1 : Knowledge of COVID-19

Figure 2 : Signs of COVID-19

Figure 3 : Food practices

Figure 4 : Non-food practices

Figure 5 : Dietary supplements

Figure 6 : Effects of the practices

Figure 7 : Recommended practices

Figure 8 : Non-recommended practices

Figure 9 : Perceptions of food practices

Figure 10 : Perceptions of non-food practices

Figure11 : Information source

viii
 LIST OF TABLES

Table 1 : Demographic characteristics

Table 2 : Health Belief Model

Table 3 : Differences between rural and urban areas

ix
 ABBREVIATIONS

AU : African Union

COVID-19 : Corona Virus Disease

FAO : Food and Agriculture Organization

KAP : Knowledge, attitude and practices

MoH : Ministry of Health

NHSRC : National Health Sciences Research Committee

SARS-CoV-2 : Severe Acute Respiratory Syndrome Coronavirus2

UNICEF : United Nations International Children’s Emergency Fund

WHO : World Health Organization

x
 1.0 INTRODUCTION

1.1 Background
Coronavirus (COVID-19) is a respiratory infection caused by the Severe Acute
Respiratory Syndrome Coronavirus (SARS-CoV-2). It began in Wuhan the capital city of
Hubei province China (Chen, 2020). The disease has spread worldwide, including
Malawi. The first African country to record COVID -19 case was Egypt on the 14 th of
February 2020, followed by Algeria on the 25th of February 2020. Malawi recorded its
first COVID-19 case on 2nd April 2020 and is currently experiencing a third wave of the
pandemic. According to Ministry of Health statistics, by 31 st January 2021, a total of
20,830 COVID-19 cases were confirmed, of which 13,075 were active cases, 7,005 had
recovered, 843 were new cases and a total of 540 deaths were reported national wide. As
of February 28th 2021, total confirmed cases reported were 31,798, of which 11,893 were
active cases, 18,874 patients had recovered, 150 new cases and a total of 1,044 deaths
were reported. By 31st march 2021, total confirmed cases had reached 33,551, of which
2,028 were active cases, 30,272 patients had recovered, 26 new cases and a total of 1,117
deaths had been reported by that day. As of 28thApril 2021, Malawi had reported a total of
34,052 confirmed cases, of which 799 were active cases, 31,972 patients had recovered,
five new cases and a total of 1,147 deaths had been reported (MoH,2021). On 10 thOctober
2021, Malawi had reported a total number of 61,676 confirmed cases, of which 2,724
were active cases, 56,430 patients had recovered with four new cases, 2,290 deaths
reported and total of 508,367 fully vaccinated. According to MoH statistics, by 30 th April
2022, a total of 85,788 COVID-19 cases were confirmed, with 2,634 deaths and 82,066
recovered cases.

Since the outbreak of COVID-19, eating habits have changed, either for the worst or the
best, different types of food have been used with belief that the foods will help to
prevent, contain, or relieve the symptoms of the COVID-19 (Kaso et al., 2021). This has
led to the rise in both healthy and unhealthy eating practices. Unhealthy practices, for
example excessive consumption of lemon, ginger or vitamin C supplements has increased

1
(Kaso et al., 2021). Levine et. tal, 1992 indicated that excessive intake of vitamin C lead
to diarrhoea, heartburn and vitamin toxicity (in extreme circumstances but rare). Vitamin
C toxicity has negative effects like digestive stress (for example, acid reflux and nausea)
or kidney stones (Levine et. tal, 1992). However healthy practices like increased physical
exercise and good eating habits show positive effects with relieved COVID-19 symptoms,
improved immune system and healthy outcomes.

Poor eating habits and lack of exercise can lead to diet related chronic diseases like
cardiovascular diseases, type 2 diabetes and obesity. People with chronic conditions are at
increased risk of COVID-19 (Morais et al, 2020). A study by Shaoting et.al (2020),
shows that diet related diseases have increased during the pandemic. The nutrition
perceptions that have arised due to COVID-19 are different from one country to another
because of knowledge and attitudes on COVID-19, availability of different types of food,
different sources of information and severity of the COVID-19. The practices and
nutrition perceptions also differ among those practiced in rural and those practiced and
believed in urban area.

1.2 Problem Statement

COVID-19 has led to different changes in social, economic, nutrition and dietary intake.
In attempts to prevent and contain the pandemic has led to a rise in misinformation about
ways of preventing and treating COVID-19. One of the ways is consumption of particular
types of food for example lemons, which are consumed in an inappropriate quantity, due
to invalidated information from different sources (Hua and Shaw, 2020).

World Health Organization guidelines for containing the pandemic includes maintaining
distance between individuals, enhancing hand hygiene and limiting mass gatherings and
wearing facial masks (Government of Malawi, 2020). General guidance for nutrition
management of COVID-19 include; supplementation with vitamin C, B6, zinc, vitamin
A, iron and folate. limiting intake of food rich in trans-fat and saturated fats, taking

2
tea(warm), ginger or turmeric to relieve sore throat, taking enough sleep and many more
(WHO, 2020).

Nutrition misinformation during the pandemic can lead to long term health complications,
which may include gastric problems as a result of vitamin c toxicity, diarrhea and nausea.
Health problems like cardiovascular diseases, diabetes and overweight may escalate due
to reduced physical activity levels and poor eating habits during the pandemic (Brooks et
al., 2020).

Morais et al., (2020) states that healthy dietary practices have shown a positive protective
effect on the immune system and healthy outcomes during the COVID- 19, although
unhealthy eating behaviors can lead to a negative effect on the immune system (Calder et
al., 2020). Reduced immunity in the body can lead to increased susceptibility to
infections.

In Malawi there is no much information regarding nutritional perceptions or practices in

relation to COVID-19. This study was conducted to elucidate practices related to
COVID-19, among adults with unknown COVID-19 status.

1.3 Significance
This study was conducted to help understand nutrition related perceptions that had risen
with the coming of COVID-19 and if these perceptions were different between people
living in rural and urban residents. It also helped to identify the changes in eating
behavior which can help nutritionists develop strategies that can improve people’s eating
behaviors, their ability to access, understand and apply the health information found on
internet, radio or other media sources during the COVID-19 pandemic. The study also
helped to explore the level of knowledge, attitude and practices related to COVID-19

3
among the population to provide a scientific basis for preventing and controlling this
deadly pandemic.

1.4 Objectives
1.4.1 Main objectives
To assess nutrition perceptions and practices related to COVID-19 among adults residing
in rural and urban areas with unknown COVID-19 status.

1.4.2 Specific objectives

1. To assess the nutrition perceptions related to COVID-19 among adults residing in
rural and urban areas with unknown COVID-19 status.
2. To find out the nutrition practices related COVID-19 among adults residing in rural
and urban areas with unknown COVID-19 status.
3. To determine the difference in nutrition perceptions and practices among rural and
urban adults with unknown COVID-19 status.

1.5 Research questions

 What are the nutrition perceptions in urban and rural areas related to COVID-19?
 What are the nutrition practices in urban and rural area related to COVID-19?
 Are the perceptions in rural area different from those in urban area?

4
 2.0 LITERATURE REVIEW

A study conducted by Husain and Ashkanani 2020,which assessed the changes in dietary
habits and lifestyle behaviour in Kuwait during COVID-19. The study targeted 415 adults
of 18-73 years of age. The study found that there was an increase in the percentage of
participants consuming four or more meals a day. A great reduction in physical activity
and an increase in screen time and sedentary activity(Husain and Ashkanani, 2020).

Shaoting 2020 carried out a study on the knowledge, attitudes and practices of COVID-
19 among urban and rural residents in China, found that the COVID-19 knowledge level
was significantly different among different regions. The study also found that educational
level, sex, marital status and health care workers status impacted COVID-19 knowledge.
In addition, urban area was associated with higher score; COVID-19 knowledge, attitude
toward preventive measures and willingness to visit clinic for check up(Shaoting, 2020).

A cross sectional study by Laura et al. (2020)in Italy among respondents of 12 of ages 12-
86 years, (n= 3,533). Results showed a positive change in lifestyle and eating habits with
3.3% of smokers who quit and an increased physical activity level of 38.3% and 15% of
consuming of organic food and fruits and vegetables. A noticable abrupt weight gain in
48.6% of the respondents (Laura et al.,2020).

5
Another study by Tuyen and Shwa-huey, (2020) in Vietnam on digital healthy diet
literacy and self perceived eating behaviour change during COVID-19 pandemic among
undergraduate nursing and medical students (n=7,616) aged 19-27 years was used. They
found that 42.8% of students reported healthier eating behaviour during the pandemic,
digital diet literacy scale was associated with 18%, 23% and 17% increased livelihood of
healthier eating behaviour during the the pandemic for the overall sample, (Tuyen and
Shw-huey, 2020).

A descriptive study in Nigeria (n=360 ), the results showed that 89 (26%) of the
respondents knew they could contact the virus and 41(12)% of respondents perceived it as
an exagerated event. The most reported practice for mitigating COVID-19 was the use of
face masks with 224 respondents and social distancing with 164 respondents (Ilesanmi
and alfolabi, 2020).

Another study by Dimaano et al.,(2021) conducted in Philippines among respondents18

years and above (n=178). Results showed117 respondents (65.73%) took both mineral
and multivitamin supplements. On the other hand, 61 (34.27%) respondents took
vitamins,
while 120 (67.42%) respondents took both mineral and vitamin supplements during the
pandemic. In addition, the intake of these supplements increased during pandemic. Self-
willingness (28.65%) was the most common response to factors linked with mineral and
vitamin consumption prior to the pandemic, whereas doctor's prescription was the most
common response during the pandemic (44.94%). The level of micronutrient
supplementation practiced by the respondents was also applied because they knew and
believed that it could reduce the risk of COVID-19 infection (Dimaano et al, 2021)

A cross sectional study by Kutyauripo et al., (2021) in Zimbabwe among respondents 18

years and above (n=400). Results showed majority of the respondents (80.5%) consumed
natural functional foods to prevent or relieve COVID-19 symptoms. Lemon was the most
consumed functional food and 80% of the respondents consumed more than one

6
functional food. The majority of the respondents (72%) consumed the functional foods in
tea or as tea. More than half of the respondents (50.3%) rarely consumed functional foods
before COVID-19 period but after the outbreak of COVID-19, only 16.3% were rarely
consuming functional foods. Women, the aged, and the educated had a significant (p ≤
0.05) association with consumption of natural functional foods for the purpose of COVID
19 prevention or remedy (Kutyauripo et al., 2021).

Cross-sectional study in general population in India by Poddar et al., (2022) among

respondent 20 years and above (n=2193). Most of our participants were well educated and
were either postgraduates or graduates 1913 (87.23%). The mean knowledge score of the
participants was 10.36 (standard deviation: 1.27, median: 11.00). Most of the participants
avoided crowded places, washed hands repeatedly, did not shake hands with any one.
Majority of the participants were not taking any prophylaxis medications (Poddar et al.,
2022).

A study by Faour-Klingbeil et al.,2021 in selected countries from the Lebanon, Jordan,

and Tunisia respondents 19 years and above (n=1074). Seventy percent of the
respondents were concerned that COVID-19 may be transmitted through food. The
perception of risk from touching contaminated surfaces and food packaging and being
exposed to infected people during food shopping was even higher. For only less than half
of the respondents, the information from local authorities was considered trustworthy and
the associated risk communication and response to false rumors were timely, effective,
and clear. But the satisfaction level among the Jordanians was remarkably stronger than
for the Lebanese and Tunisian respondents. The demographic factors, trust in
information, and attitudes towards authorities’ performance in risk communication did
not influence risk perceptions. Respondents’ knowledge was limited based on their chief
sources of information, such as social media, local news media broadcasts, and
announcements by the World Health Organization (Faour-Klingbeil et al., 2021).

7
A study conducted by Shahnazi et al., 2020 among respondents of ages 15-77 and n=750
and it was found that a vast majority of the participants were aware of the main symptoms
of COVID-19, the study, using health belief model constructs found that self-efficacy
beliefs, barrier beliefs, benefits, fatalism and cues to action had significant effects on
preventive behaviors fromCOVID-19 (Shahnazi et al., 2020).

As one of preventive precaution the then president of the republic of Malawi Peter
Mutharika declared a state of national disaster on 20th March 2020 even though by that
time Malawi had not yet register any COVID-19 case, which led to immediate closure of
schools, colleges, both public and private universities which was effective Monday, 23rd
March,2020. And by the time of the declaration, there had already begun propagation and
spread of myths regarding COVID-19 that black people are immune to the disease and
that the warm climate of Africa is protective against the virus, in which the president
with the necessary advise from health personnel’s was quick to deem force. Apart from
education, other dimensions of the nation are also affected by COVID-19 for example,
economy, health system and agriculture (FAO, 2020).

Malawi is one of the world’s poorest countries, with a population of 18.6 million (NSO,
2019). Health care funding in Malawi is low, heavily relying on donor resources, and an
effective and efficient delivery of health care services is lacking (Thula et al, 2020). Thus
making people turn to local methods of preventing COVID-19. Examples of these
methods are consumption of lemons, boiled blue gum leaves, boiled pawpaw leaves and
face steaming. Despite all the attempts made by the government and the people to contain
and stop the spread of the virus, there are still new COVID-19 cases each day (Thula et
al, 2020).

A study by Banda et al. (2020) was conducted in the Karonga Health and Demographic
Surveillance Site in Malawi among respondents aged 18 and older (n630). Results
showed 33.2% of respondents believe that the novel coronavirus is waterborne and 50.6%

8
believe that it is blood borne. A large percentage of respondents perceive that there was
no risk, or only a small risk, that they would become infected (44.4%), but 72% of
respondents expected to be severely ill if they became infected. Increased hand washing
and avoiding crowds are the most reported strategies to prevent the spread of COVID-19.
Use of face masks was more common among urban residents (22.5%) than among rural
residents (5.0%), (Banda et al., 2020)

As the country was facing a second wave of COVID-19 pandemic it received its first
shipment of COVID-19 vaccines (Oxford-AstraZeneca vaccine) via COVAX Facility
(WHO Africa,2021), which was constituted with 360,000 doses and an addition of
100,000 doses from AU and 50,000 from the Government of India (UNICEF, 2021b)
making a total of 510,000 doses of AstraZeneca COVID-19 vaccine. The vaccine was
launched in Malawi on 11 March 2021 in Zomba and Mzuzu districts concurrently,
presided over by the State President Lazarus Chakwera and Vice President Saulosi
Chilima respectively and by 15 March, 890 health workers and other frontline workers
had already been vaccinated (UNICEF,2021). As of the 6th April 2021, 164,733 people
had been vaccinated against 3,800,000 people which Malawi aims to immunize by end
2021 (UNICEF, 2021b). By 30th April 2022 a total of 1,107,875 had been fully
vaccinated.

The COVID-19 pandemic has put significant pressure on health systems all around the
world. The drastic measures established to contain its spread are creating serious
impediments to economic activity (including agrifood systems), to livelihoods, food
security and nutrition (FAO. 2020).

9
 3.0 MATERIALS AND METHODS

3.1 Study area

The study was conducted in Lilongwe rural (Chiseka village) and urban (Area 36). The
study area was selected based on ease of access by the primary researchers.

3.2 Study design

The study was a cross- sectional study which was conducted over a period of one month
(February, 2022).

3.3 Sampling method and target population

Convenient sampling method was used. The study targeted adults from 19 years and
above who consented to participate in the study.

3.4 Sample size

The sample was derived by computing minimum sample formula:

n=Z [ ( 1− p ) p ] /e
2 2

Where p was the estimate percentage

And e was the level of sampling error

Z was the desired level of confidence

2 2
n=2.58 (0.5 ×0.5)/0.1

10
=166+10% (non-response error)

¿ 182.6

=183

Proportional probability sampling from each study are

Chiseka population = 73,302 (NSO, 2019)

Area 36 population = 50,666 (NSO, 2019)

Sample size (n) = 183

n 183 183
Sampling fraction =/ = =
N 73302+50666 123968

183
Chiseka = 73302× = 108
123968

183
Area 36 = 50666× = 75
123968

3.5 Data collection methods

Face to face interviews were conducted with eligible respondents using a semi-structured
questionnaire (attached in appendix). The data collected included demographic
information, COVID-19 related practices and nutritional practices. Food and Agriculture
Organization (FAO) knowledge, altitudes and practices (KAP) survey guidelines (2014)
was used to evaluate the level of knowledge about COVID-19; where scores taken from
respondents on knowledge of COVID-19, causes of COVID-19 and signs and symptoms
of COVID-19). Knowledge was graded in this manner; ≤ 70% is categorized as having
inadequate knowledge, 71%-89% as having moderate knowledge with need of assistance
and 90% upwards is graded as knowledgeable.

3.6 Data analysis

11
Collected data was entered and analyzed using IBM SPSS statistics version 20.0 and
Excel. Descriptive statistics such as means and percentages were used to analyze the data.
The differences in perceptions and practices between urban and rural was analyzed using
Chi-Square test. Health belief model was used to analyze perceptions related to COVID-
19.

3.7 Ethical consideration

The study protocol was approved by the National Health Sciences Research Committee
(NHSRC) in the Ministry of Health (letter of approval attached in appendix). Permission
to conduct the study was sought from local traditional leaders in the areas and written
informed consent was obtained from the study participants.
3.8 Dissemination of the results
The findings of the study were presented to the faculty members and students at the
Department of Human nutrition and health at LUANAR, NHSRC and to Bunda College
Library.

12
 4.0 RESULTS

4.1 Socio-demographic and economic characteristics

Presented in table 1 are the results of socio-demographic and economic characteristics.
The mean age of participants was 32±11 years with 54.6% within 19-30 years. The
majority of the participants were married (65%), 22.4% farmers, 23% attained up to
secondary school education, 90.7% christians, about 59.6% of the participants were from
rural area (Chiseka) and 40.4% the urban (Area 36).

13
Table 1: Demographic Characteristics

n(%
Demographics ) Mean±SD
Sample (total) 183
Age ranges
(years) 19-30 100 (54.6) 32.12±11.46
31-45 62 (33.87)
45 and above 21 (11.47)
Gender Male 88 (48.08)
Female 88 (48.08)
Location Urban 74 (40.43)
Rural 109 (59.56)
Religion Christianity 166 (90.71)
Islam 14 (7.65)
Other 3 (1.63)
Marital status Married 119(65.02)
Widowed 7(3.82)
Single 43(23.49)
Separated 3(1.63)
Divorce 11(6.01)
Occupation Farmer 41(22.40)
Full time formal employment 34(18.57)
Self-employment 16(8.74)

14
 Casual employment
Business
Domestic
Other (specify)
None
Level of
education Standard 1-4
Standard 5-8
Form 1-2
Form 3-4
Non-university with a certificate/diploma
University with diploma/degree
Other
None

4.2 Knowledge, attitude and practices

4.2.1 Knowledge related to COVID-19
About 84.7% of respondents knew what COVID-19 is, with 43.9% of these residing in
urban and 56.2% in rural area. As such 84% of respondents had good knowledge of
COVID-19 and 14.3% had poor to no knowledge. The 92% of urban respondents had
good knowledge of COVID-19, with 8% of the respondents having poor or no knowledge
of COVID-19. Among rural respondents 80% had good knowledge of COVID-19 and
20% of the respondents having poor to no knowledge.

Results of the study shows that 84.7% of respondents knew what COVID-19 is, this
shows that participants have high level of knowledge according to the Food and
Agriculture organization knowledge, attitude and practices (FAO KAP) survey
guidelines. The results showed that 91.9% of urban residents and 81.3% of rural residents
knew what COVID-19 is. This shows that both areas have knowledge of COVID-19,
however, Rural residents were categorized as knowledgeable but need more information
on COVID-19 while the urban residents are categorized as knowledgeable on COVID-19.

15
4.2.2 Definition of COVID-19
With reference to figure 1; about 16% indicated that COVID-19 is a viral disease ,14%
airborne disease, 4.5% disease caused by microorganisms, 12% communicable disease,
16% pandemic that started in 2019, 12% respiratory disease, 0.6% the beginning of
malaria and 22.6% indicated that it is just a disease.

16
 25 22.6
20
16 16
15 14
12 12
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Figure 1: Definition COVID-19 by respondents

4.2.3 Causes of COVID-19

It was observed that among the participants who ever heard of COVID-19, 60% knew
what causes COVID-19. After probing, most respondents (40.6%) explained that
COVID-19 is caused by poor hygiene, 37.6% said it is caused by corona, some of them
(21.3%) responded that it is caused by close contact with people, and 3 participants
(0.5%) said it is caused by the devil.

4.2.4 Signs of COVID-19

Figure 2, shows signs of COVID-19. It was found that majority of people knew the signs
of COVID-19. The signs that the respondents gave were; fever, headache, flue,
pneumonia, difficulty in breathing, joint pains, general body weakness and cough.

17
 70 66.3
60
49.7
50
40 38

30 25 22.5
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20
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ea
ea

dy
eu

in
br
H

Jo

bo
Pn

in

al
lty

er
icu

en
G
iff
D

Figure 2: Signs of COVID-19

4.3 Practices related to COVID -19

4.3.1 Food practices related to COVID-19
As shown in figure 3; food practices related to COVID-19 include: consumption of ginger
(92%) lemons with (88%) and garlic (57%). Other food practices were alcohol intake
(39%), herbs usage (43%). There was a minimal consumption of local vegetables, onions,
soda and Janus sweet.

18
 100 92 88
90
80
Percentage

70
60 57
50
39 43
40
30 20
16 17
20 11 9
10
0
r lic t s le bs t da l
ge on ar ee ion ab er en o ho
n m sw et o
G
i
L e G s O
n
eg
H atm S lc
nu lv r tre A
Ja c a ate
Lo w
ot
H

Figure 3: Food practices during COVID-19

4.3.2 Non-food practices related to COVID-19

Wearing of masks was the common practice (88%), washing hands (71%), use of hand
sanitizer (69%), social distance (58%) with other practices such as praying, coughing on
elbow, exercise, steaming. Furthermore, about 43% got the COVID-19 vaccine to prevent
the disease.

19
 100
90 88
80
71 69
70
60 58
50
Percentage

43 40
40
30
20
11 11
10 6 5
0
e g k s e g its w er e
ccin ayin
M
as and tanc m
in
fru lbo itiz rcis
a h s a e n e
V Pr ng l di St
e of on Sa Ex
shi cia ir ety g
a o a in
W S
av ugh
ta in
g Co
E

Figure 4: Non-food practices during COVID-19

4.3.3 Dietary supplements during COVID-19

Presented in figure 5 are the results of dietary supplements. The findings showed that
there was a high consumption of vitamin C (39%), combination of zinc and vitamin C
(27%) and zinc (26%). Supplement consumption was observed only in urban.

20
 45
40 39

35
30 26.5 27
Percentage

25
20
15
10
5
0
Zinc Vitamn C Zinc and Vitamin C

Figure 5: Dietary supplements

4.3.4 Reasons for following food practices

Figure 6 indicates reasons for following food and non-food practices during COVID -19.
These were prevention from contracting the virus (19%), to reduce severity (17.7%),
relieve cough and flue (16.2%), 12% relief in breathing. The other effects include;
relieving constipation, masking symptoms of COVID-19, relieving stomach irritation and

21
body relief. About 13% of the respondents were uncertain if what they were practicing
had any effects on their health in regards to COVID-19.

20 19
18
18 16.2
16
14 13
12
12 11
10
8
Percentage

6 3.8 4
4 2
2 1
0

f
s

e
y

n
ng

on

h
g

lie
om

flu
rit

tai
ac

tio
in
cti

ati

re
ve

er
ita
th

pt

d
ra

tip

sto

nc
ea

se

an

dy
m

irr
nt

ns
br

sy

Bo
ce
co

ng

h
co

ug

ac
in

du

ng

ni
m

m
co
ve
f

Re

ki

n
fro

lie

sto
ru
lie

as

ve
Re
t

ve
Re
en

ve
lie

lie
ev

Re

lie
Re
Pr

Re
Figure 6: Reasons for following food and non- food practices during COVID-19

4.3.5 Recommended and non-recommended practices related to COVID-19

The findings show that respondents take different actions in response to COVID-19
pandemic, which include food and non-food practices but not all the practices were
recommended in the WHO relief guidelines. The figure 7 and 8 shows food and non- food

22
practices and supplements that are recommended and those that are not recommended
respectively.

92 87 88
100
71 69
80 57 58
60 43 43.5
39 39 40
40 26.527.9
percentages

20 11 11 5 11
0

Figure 7: The recommended practices followed by the respondents

45 39
40
35
30
percentage

25
20
20 16 17
15
10 9
6
5
0
Onion Janus sweet Herbs Alcohol Praying Soda

Figure 8: The non-recommended practices followed by respondents

4.4 Perception related to food and non-food practices during COVID-19

4.4.1 Perceptions of food practices related to COVID-19

23
Figure 9 indicates responses on the food perceptions which were; prevention (42%),
protection (18%), good health and boosting immunity (12%). Only two percent of
respondents did not know why they were following the food practices.

45 42
40
35
30
25
20 18
Percentage

15 12 12
10 8
6
5 2
0
g h s n
lin no
w alt ted ru tio ity
a k e ec vi n un
H
e t d
h ot ng ev
e m
no oo Pr eni P r im
o G k g
D ea stin
W o
Bo

Figure 9: Perceptions for food practices during COVID-19

4.4.2 Perceptions of non-food practices related to COVID-19

Presented in figure 10 are the responses on the non-food perceptions such as; preventing
from contracting (31%), reducing severity (19%), 4% of respondents were doing it to

24
avoid getting arrested and Only 3% of respondents did not know why they were following
the non-food practices.

35
31
30
25
20 19

15 12
9 10
10
Percentage

7
5 4
5 3
0

s
n

ng
ity

d
w

ice
rit

alt

ste
io

in
no

cti
un
iss

dy
ve

he

rv
re
tk

tra
m
m

se

ar

se
d

m
no

on
oi
ns

oo
ce

ng

ic
ti
av
tra

tc
o

bl
G
du

os

tti
D

pu
en
To

ge
t

Bo
Re
en

ev

o
d
ev

st
Pr

oi
Pr

es
av

cc
To

ta
ge
To
Figure 10: Perceptions of non-food practices followed during COVID-19

4.4.3 Nutrition perceptions related COVID-19 categorized according to the health belief
model

25
The results showed nutrition perceptions respondents had, the perceptions are categorized
following the health belief model (FAO KAP manual, 2014).

Table 2: Perceptions categorized according to the Health Belief Model.

Attitudes Perceptions
Perceived susceptibility to problem Protection
Prevent from contracting
Perceived seriousness of consequences Reduce severity
Prevent from dying
Prevent transmission
Perceived benefits of actions Boost immunity
Good health
Prevent transmission
Weakening virus
Good health
Healing
Perceived barriers to action To avoid getting arrested
To get access to services

The health belief model is a theoretical model used to explain and help understand health
behaviors, the model states that people’s beliefs influence their health related actions and
behavior. The model categorizes the perceptions based on perceived susceptibility,
seriousness, benefits and barriers to action.

It is believed that respondents followed the practices based on perceived susceptibility

based on responses of protection and preventing from contracting the virus. Other
responses showed the respondents undertook such practices based on perceived
seriousness of the consequences of COVID-19, shown by the following responses; reduce
severity, prevent from dying and preventing transmission. Most of the respondents shown

26
to adopt behavior change based on perceived benefits of actions shown by responses that
include boosting immunity, good health, weakening virus and healing. Perceptions like;
to avoid getting arrested and to get access to services reflected behavior change based on
perceived barriers to action

4.5 Differences between rural and urban residents in COVID-19 related knowledge
perceptions and practices
Table 3: Urban and rural differences in Knowledge Perceptions and Practices related to
COVID-19

Indicator Percent Chi-square test p-value

Knowledge of Rural (59.6%) 3.98 0.46

COVID-19 Urban (40.4%)

Perceptions of food Rural (59.6%) 36.68 0.004

practices Urban (40.4%)
Perceptions of non- Rural (59.6%) 23.6 0.001
food practices Urban (40.4%)
Food practices Rural (59.6%) 17.62 0.000
Urban (40.4%)
Non-food practices Rural (59.6%) 35.84 0.032
Urban (40.4%)

Table 3 above shows that there is no difference in knowledge of COVID-19 among adult
residents of rural and urban areas. This is shown by a Chi-Square test of 3.98 with a p-
value of 0.46.

The chi square test also shows that there is a difference in nutrition perceptions among
adult residents of rural and urban areas. This is shown by a Chi-Square test of 36.68 with
a p-value of 0.004.

27
There is a difference in food practices among adult residents of rural and urban areas.
This is shown by a Chi-Square test significant of 17.62 with a p-value 0.000 as shown on
the table 3. There is also a difference in non-food practices among adult residents of rural
and urban areas. This is shown by a chi-square test significant at 35.84 with a p-value of
0.032.

4.6 Sources of information related to COVID-19

About 66.8% of respondents get their information from radio stations, televisions and
newspapers and newspapers. With 11.8% from family and friends, 8.6% from
hospital/medical personnel and 11.8% from social media.

12.8%

8.6%

66.8%
11.8%

Radio, television and newspaper Family and friends

Hospital or medical personel social media

Figure 8: Information sources

28
 5.0 DISCUSSION

5.1 Knowledge, attitude and practices

5.1.1 Knowledge related to COVID-19
No significant difference in knowledge related COVID-19 among rural and urban
residents is a clear indication that knowledge did not vary based on location. A similar
study by Fatmi et al., 2020 found a significant difference in knowledge of COVID-19
among adults of rural and urban residents, they attributed the higher knowledge scores of
urban residents to better educational qualifications (Fatmi et al., 2020). Another study
conducted in the bordered population of northern Thailand revealed poor knowledge
about COVID-19, especially among participants with characteristics such as rural, poor,
and less educated people (Srichan et al., 2020). The differences in knowledge in the
different studies may be due to differences in source and dissemination of information in
different regions of the world.

Most of the respondents (86%) recognized common signs of the disease of COVID-19,
this could be attributed to effective dissemination of COVID-19 related information. This
corresponds to a study conducted in the United States and the United Kingdom where a
majority of the United States (79.8%) and United Kingdom (84.6%) participants
recognized the symptoms of COVID-19 (Geldsetzer, 2020).

The study has found that 60% of respondents knew about signs of COVID-19. The signs
included fever, headache, flue, pneumonia and difficulty in breathing. This is in line with
findings by Kaso et al. (2021) who reported that respondents knew the signs and
symptoms of COVID-19, such as dry cough, fatigue, headache, sore throat, shortness of
breath and fever.

29
5.1.2 Practices related to COVID-19
The practices of our respondents were that majority consumed ginger, lemon, garlic,
onions and local vegetables. A study by Kutyauripo et al, (2021) states that the practices
followed during COVID-19 in Zimbabwe residents were consumption of functional foods
like garlic, ginger, lemon and moringa oleifera (Kutyauripo et al,2021). Preference for
these natural foods and herbs is mainly influenced by health claims that are made (Zafar
and Ping, 2020). Although no conclusive evidence exists to back up the claims of these
particular foods and herbs in preventing COVID-19 (Subbarao et al., 2020), this shift in
dietary choice was perceived by respondents as positive health behavior.

Dietary supplements intake such as vitamin C and zinc was common among urban
residents. Another study by Dimaano, (2021) also found that there was increased mineral
and vitamin supplementation during the pandemic, the supplements consumed include
both mineral (zinc, copper, selenium and magnesium), vitamin (vitamin C, A, B6, D and
E) and multi vitamin supplements. The consumption of foods and supplements for
prevention of COVID-19 might have been influenced by information disseminated via
family and friends and social media.

The results also highlight that the respondents practiced social distance, wore masks,
washed hands frequently, sneezed or coughed on elbow, praying and got vaccinated. A
similar study conducted by Kaso et al., (2021) also found that non-food practices during
COVID-19 include wearing face masks, frequent hand washing, social distance, staying
home, avoiding handshakes and using hand sanitizer. The non-food practices were mainly
influenced by information dissemination through radio, television screens and billboards,
government enforced restrictions access to social services for people without masks and
limitation in number of gatherings.

30
5.1.3 Perceptions related to COVID-19
Results of the study has revealed that nutrition perceptions of the majority of respondents
include good health, healing, protection, boosting immunity, to avoid dying, get access to
public and social services and to reduce severity. This is in line with a study conducted in
2020 by Dimaano, 2021 which states that behavior change during COVID-19 pandemic
was due to perceptions that include decreasing the susceptibility, severity of an infection,
strengthening the body's immune system, reduction in resistance to infections, lower risk
of infection, help in boosting immune response.

The rise in different food and non-food practices might be attributed to; perceptions that
failure to practice protective measures resulted in an individual’s increasing risk of being
infected (perceived susceptibility), the effects of contracting the virus are severe
(perceived seriousness), following the practices will be beneficial to preventing or
management of the virus (perceived benefits to actions), healing and weakening the virus
and benefits of the actions outweigh the costs (perceived barriers to action) . This is in
line with a study conducted by Shahnazi et al., 2020 which states that the practices
followed by respondents indicated that most respondents had relatively high perceived
susceptibility, perceived severity, perceived self-efficacy, but lower perceived barriers
and fatalistic beliefs.

5.1.4 Differences between urban and rural residents

The differences observed in this study on food and non-food practices are similar to a
study by Callaghan et al., which found that rural residents were less likely to practice
preventive measures against COVID-19 as compared to Urban residents.

31
 6.0 CONCLUSION

It can be concluded that, the nutrition perceptions followed included prevention, to be

protected and boosting immunity among others. The nutrition practices observed include
consumption of ginger, lemon and dietary supplements, they also practiced mask,
sanitizing and vaccination. The study has shown an existence of a significant difference in
nutrition perceptions and practices among adults residing in rural and urban areas.

6.1 Limitations of the study

 It was difficult to collect data since data collection was done during a rainy season
hence people were busy in their farms.
 Data collection was done when COVID-19 was phasing out hence most people
had already stopped practices.
 Poor cooperation from participants as they were asking for COVID-19 relief
funds.

6.2. Recommendation
 The Malawi government through the ministry of health should set nutritional
guidelines on prevention and management of COVID-19.

32
 7.0 REFERENCES

1. Al-Sabbagh, M. Q., Al-Ani, A., Mafrachi, B., Siyam, A., isleem, U., Massad, F. I.,
Abufaraj, M. (2022). Prediction of adherence with home quarantine during
COVID-19 crisis: the case of health belief model. Psychology, Health and
Medicine, 7-10.

2. Bhuiyan, N., Puzia, M., stecher, C., & Huberty, J. (2021). Association between
rural or urban status, health outcomes and behaviours and COVID-19 perceptions
among meditation app users: Longitudinal survey study. JMIR Mhealth Uhealth,
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3. Brooks, S., Webster, R., Smitth, L., Woodland, L., Wessely, S., Greenberg, N., &
Rubin, G. (2020). The psychological impact of quarantine and how to reduce it:
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4. Callaghan, T., Lueck, J., Trujillo, K., & Ferdinand, A. (2021). Rural and Urban
Differences in COVID-19 prevention behaviour. The journal of Rural Health, 11.

5. Calder, P., Carr, A., Gombart, A., & Eggersdolfer, M. (2020). Optimal nutritional
status for a wel-functioning immune system is an important factor to protect
against viral infections. Nutrients, 1181.

6. Embassy of the Peoples Republic of China in the Republic of Malawi. (2021).

Embassy announcements. Lilongwe, Malawi. Retrieved may 1, 2021, from
https://mw.china-embassy.org/chn/zygg/t1759264.htm

7. FAO. (2020). National Agrifood systems and COVID-19 in Malawi. Effects,

policy responses and long term implications. Rome, 1- 10.

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8. Fatmi Zafar, S. M. (2020). Knowledge, attitude and practices towards COVID-19
among Pakistani residents: information access and low literacy vulnerabilities.
Pakistani: East Mediterr Health j.

9. Francesca Dimaano, M. A. (2021). Consumer awareness and perception on

mineral and vitamin supplements to boost immunity against COVID-19. Indag
Cavite: Cavite State University.

10. Government of Malawi. (2020). On additional measures on the Coronavirus,

statement by the minister of health Jappie Chancy Mtuwa Mhango. 3-8. Malawi:
Ministry of Health.

11. Hau, J., & Shaw, R. (2022). Corona Virus (COVID-19) 'Infordemic' and
Emerging Issues through the a Data Lens: The Case of China. Public Health(17),
2309.

12. Hassan H, S. A. (2020). Purchasing functional foods to stay fit. Journal of

Humanities and Applied Social Sciences, 12,13.

13. Immune system is an Important Factor To Protect against Viral Infections. (2020).
Nutrients(12), 1181.

14. Innocent Kutyauripo, J. C. (2021). Food behaviour towards natural functional

foods during the COVID-19 pandemic. Hirare: Zimlabs.

15. Kaso, A. W., Hareru, H. E., Agero, G., & Ashuro., Z. (2021). Assessiment of
practice of COVID-19 preventive measures and associated factors among
residents in Southern Ethiopia. PLOS ONE, 5-8.

16. Levine, M., Rumsey, S., Daruwala, R., Park, J., & Wang, Y. (1999). Creteria and
recommendations for Vitamin C intake. 281(15), 1415-1423.

17. llias, M., Russell, K., Aziz, R. M., Angi-Alradie, M., Vinnakota, D., & Al-
Mohaimeed, A. (2021). The Health Belief Model Predicts Intention to Recieve the
COVID-19 Vaccine in Saudi Arabia: Results from a Cross Section Survay.
Vaccines, 4-10.

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18. Morais, A., Aquino, J., Silva-Maria, J., Vale, S., Maciel, B., & Passos, T. (2020).
Nutritional status, diet and viral respiratory infections: Perspectives for SARS-
CoV-2. Br. J. Nutri, 1-20.

19. NHSRC. (2021). Retrieved May 1, 2021, from https://malawi.un.org/en/46778-

declaration-state-disaster-malawi-president-peter-mutharika

20. P., G. (2020). Knowledge and percptions of COVID-19 among the general public
in the United staes and the United Kingdom: A cross-sectional online survey.
Philladephia: American College of Physicians .

21. Pike, K., & Dunne, P. (2015). The rise of eating disorders in Asia: A review. J.
Eat. Disorder, 3-33.

22. Public Health Institute of Malawi. (2021). Republic of Malawi Ministry of Health
COVID-19 info. update, Health Education Service, Ministry of Health.

23. Retrieved from https://www..afro..who.int/news/malawi-receive-first-shipment-

covid-19-vaccine-covax (accessed on 5 march,2021 at 09:07)

24. Retrieved from https://www.unicef.org/media/95416/file/UNICEF-Malawi-covid-

19-sitiuation-report-for-1-15-March-2021.pdf16-april(5 may, 2021, at 07:31)

25. Retrieved from https://www.unicef.org/malawi/report/unicef-malawi-covid-19-

situation-report-16(10 May-2021, 12:48)b

26. Shanazi, M., Ahmadi-Livan, M., Pahlavazadeh, B., Rajabi, A., Hamrah, M., &
Charkazi, A. (2022). Assessing Preventive Health Behaviors from COVID-19
Based on Health Belief Model (HBM) among People in Colestan Province: a
Cross-Sectional Study in the Northen Iran. research square, 5-7.

27. Shaoting, J. Y. (2020). Knowledge, altitudes and practices of COVID-1 among

urban and rural residents in China.Henam. Springer.

28. SubbaRao, M., Gavaravarapu, Seal, A., Banerjee, P., Reddy, T., & Pittla, N.
(2022). Impact of Infodemic Pandemic on Food and Nutrition Related Perceptions
and Practices of India Internet User. PLOS ONE, 4-9.

35
 29. Tuyen, K. D. (2020). Digital health diet literacy and self perceived eating behavior
change during COVID-19 pandemic among undergraduate nursing and medical
students; A rapid online survey. Switzerland. International Journal of
Envirnmental and Public Health.

8.0 APPENDIX

Table 4 shows the data for new, confirmed, active, recovered and death cases in Malawi
0n every last day of the month from April 2020 – April 2022.

Total Total Total New deaths Total Total tests

confirmed active recovered cases vaccinated conducted
cases cases
2020
April 37 27 7 1 3 744
May 284 238 42 5 4 4,590
June 1265 989 260 41 16 14,173
July 4078 2089 1875 97 114 30,267
August 5566 2231 3160 30 175 31,261
September 5773 1331 4263 1 179 53,057
October 5930 423 5323 7 184 62,600
November 6025 287 5454 0 185 73,674
December 6,583 505 5,075 11 189 84,509
2021
January 20,830 13,075 7,005 843 540 132,915
February 31,945 11,893 18,874 150 1,044 197,924
March 33,551 2,028 30,372 26 1,117 134,289 218,468
April 34,052 799 31,972 5 1,147 296,127 232,358
May 34,338 335 32,616 3 1,155 355,118 246,232
June 36,126 1,529 33,169 229 1,196 401,406 268,117
July 52,347 12,475 38,005 538 1,635 591,863 339,084
August 60,494 10,279 47806 108 2177 410,484 386,738

36
 September 61,580 3,729 55,337 28 2,282` 496,875 409,387
October 61,796 1,950 53,313 2 2,301 556,336 426,102
November 61,916 571 58,807 15 2,306 601,650 442,053
December 75,075 12,334 60,145 874 2,364 705,769 487,334
2022
January 84,475 12,350 69,332 55 2,561 775,726 528,593
February 85,339 6,892 75,600 11 2,615 811,834 546,965
March 85,640 2,407 80,330 9 2,626 892,414 562,051
April 85,781 804 82,066 14 2,634 1,107,875 574,139

QUESTIONNAIRE

Knowledge,  Innovation,  Excellence

LILONGWE UNIVERSITY OF AGRICULTURE AND NATURAL RESOURCES
FACULTY OF FOOD AND HUMAN SCIENCES
DEPARTMENT OF HUMAN NUTRITION AND HEALTH

NUTRITION PERCEPTIONS AND PRACTICES RELATED TO COVID-19 AMONG ADULTS IN RURAL

AND URBAN RESIDENTS OF LILONGWE.

Introduction and informed consent

ERSITY OF AGRICULTURE AND NATURAL

RESOURCES
My name is-------------------------------a student at Lilongwe University of Agriculture and Natural
Resources(LUANAR), Bunda campus doing an academic study on Nutrition Perceptions and
Practices Related to Covid-19 Among Adults in Rural and Urban Residents Of Lilongwe.

37
I would like to ask you some questions about Nutrition Perceptions and Practices Related to
Covid-19. The provided information will help to determine whether the coming of COVID-19 has
any bearing on current nutrition perceptions and practices among adults residing both in rural
and urban. All the issues discussed here will remain confidential. Your participation is voluntary;
you may choose to participate or not. However, your participation in this study will be highly
appreciated. The data collected will be used for the purpose of the study only without
identifying your name. Our interview will last no more than 15 minutes.

Are you willing to take part in this study? Yes No

Signature___________ Fingerprint_________________

Are there any questions about what has been explained? Yes No

Section 1

Socio-demographic questionnaire for adults (> 19 years)

1. Gender of the respondent

Male ___________
Female ___________

Age ___________
Geographical location ___________
2. What is the highest level of education you have completed??

Standard 1-4 --------------------------------------1

Standard 5-8 --------------------------------------2
Form 1-2 --------------------------------------3
Form 3-4 ---------------------4
Non-university with certificate/diploma -------------------5
University with diploma/Degree --------------------6
Other (specify) ----------------------7
None --------------------8

3. What is your marital status?

Married -----------------------1

Divorced ------------------------2

38
 Widowed ------------------------3

Single --------------------------4

Separated/cohabit -----------------------5

4. What is your religion?

Christianity --------------------------------------1

Islam --------------------------------------2

Others (specify) --------------------------------------3

5. Respondent’s main occupation?

Farmer ----------------------------------------
1
Full time formal employment -----------------------------------------2
Self-employed (specify) -----------------------------------------3
Casual employment -----------------------------------------
4
Business (specify) -----------------------------------------
5
Domestic/housework -----------------------------------------
6
Retired -----------------------------------------
7
Other (specify) -----------------------------------------
8
None -----------------------------------------9

Section 2
Knowledge of COVID-19

1. Do you know what COVID-19 is?

Yes------------1
No-------------2

If yes, can you tell me what it is?

_____________________________________________________________________
39
 _____________________________________________________________________
______

What are the causes of COVID-19?

Knows--------------------1

Does not know----------2

If yes, explain

_____________________________________________________

_____________________________________________________

2. Can you describe the signs of COVID-19?

Yes--------1

No---------2

If yes, describe them

A____________________________________________________________

B_____________________________________________________________

C_____________________________________________________________

Section 3

Nutrition practices related to COVID-19

1. Have you consumed any food in an attempt to prevent or manage COVID-19?

Yes-------1

No--------2

2. If yes, what foods did you consume?

a. ____________________________

b.____________________________

40
 c.____________________________

d.____________________________

e.____________________________

3. How many times do you consume the mentioned foods?

3. two
Food 1. once 2. more to 4. >three
item a day than three times
once times a week
a
per
week
day

4. what other practices have you done in attempt to prevent or manage COVID-19

___________________________________________________

___________________________________________________

___________________________________________________

41
 Section 4

Perceptions related to COVID-19

1. What outcomes do you anticipate after consumption of the mentioned foods?

_______________________________________________________________
_______________________________________________________________
_______________________________________________________________
_____________

2. What are your anticipated outcomes from other non-food related practices to
prevent /contain COVID-19?
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________
________________________

3. Does the consumed food bring any effects?

Yes--------1

No---------2

If yes, explain

_______________________________________________________________
_______________________________________________________________
_______________________________________________________________
_________________________

Section 5

Source of information related to COVID-19

42
1. Where do u get the information related to COVID-19?

a. Social media----------------------------------1

b. Friends-----------------------------------------2

c. Hospital/ medical personnel----------------3

d. Radio/ television/ newspaper--------------4

e. Others-----------------------------------------5

2. Do you know the validity of the information related to COVID-19 you obtain
from different sources?

Yes___ 1

No ___ 2

3. Do you know the credibility of your information source you used to obtain
information related to COVID-19?

Yes ----------1

No------------2

Thank you for your participation.

43
Letter of approval from National Health Science Research Committee

44
45