Perception of the community in Kerala on COVID-19 infection and its preventive measures

Aarati Santhosh Nair; Roshni Mylath; Neha Susan Jacob; Asmita Anilkumar Mehta; AS Ambily; Anusree M

doi:10.4103/AMJM.AMJM_10_22

ORIGINAL ARTICLES

Year : 2022 | Volume : 18 | Issue : 2 | Page : 56-61

Perception of the community in Kerala on COVID-19 infection and its preventive measures

Aarati Santhosh Nair¹, Roshni Mylath¹, Neha Susan Jacob¹, Asmita Anilkumar Mehta², AS Ambily³, Anusree M⁴
¹ Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeethem, Ponekara, Kochi 682041, Kerala, India
² Department of Respiratory Medicine, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeethem, Ponekara, Kochi 682041, Kerala, India
³ Department of Commerce and Management, Amrita School of Arts and Sciences, Kochi, India
⁴ Amrita School of Arts and Sciences, Kochi, Amrita Vishwa Vidyapeethem, Coimbatore, India

Date of Submission	22-Jan-2022
Date of Acceptance	18-Mar-2022
Date of Web Publication	30-Jun-2022

Correspondence Address:
Asmita Anilkumar Mehta
Amrita Institute of Medical Sciences, Ponekkara, Kochi, Kerala
India

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/AMJM.AMJM_10_22

Abstract

Background: COVID-19 pandemic was started in December 2019. It has variable presentation from mild sore throat to severe respiratory distress. As we had seen there are no signs of it ending soon. Role of medical management in treatment is limited and so prevention of infection is the best mode to control the spread. It is important to identify people’s awareness about the infection. Aims: The aim of this study was to assess the awareness and their perception among people of kerala regarding outbreak, symptoms, preventive measures and treatment of covid-19. Objective: The primary objective was to evaluate the perception of the community in kerala on COVID-19 infection and its preventive measures. The secondary objective was to assess the factors affecting the awareness of COVID-19 among the community. Materials and Methods: An online survey was conducted from November 2020 to January 2021 among kerala community in relation to their perception towards Covid 19 infection and its preventive measures. Results: Total number of responses received were 610. Total 58.2% of the people agreed that the disease was contagious and spread by droplet, 84.1% of the people knew about asymptomatic carriers, 71.6% of the people believed that infection was curable while 18.5% were not sure about it. 6.1% thought that infection was incurable. Uni-variate analysis showed that neither gender, nor the socioeconomic or education status of the responder affected their level of knowledge about COVID-19. Conclusion: The study showed that the respondents had adequate awareness about COVID-19 outbreak and its preventive measures. People were aware of the virus, its common symptoms, prevention, lab tests and medical facilities. People understood the importance of preventive measures prescribed by the government like social distancing, hand washing, usage of face masks.

Keywords: Awareness, COVID-19, knowledge, preventive measures

How to cite this article:
Nair AS, Mylath R, Jacob NS, Mehta AA, Ambily A S, Anusree. Perception of the community in Kerala on COVID-19 infection and its preventive measures. Amrita J Med 2022;18:56-61

How to cite this URL:
Nair AS, Mylath R, Jacob NS, Mehta AA, Ambily A S, Anusree. Perception of the community in Kerala on COVID-19 infection and its preventive measures. Amrita J Med [serial online] 2022 [cited 2023 Mar 30];18:56-61. Available from: https://ajmonline.org.in/text.asp?2022/18/2/56/349258

Introduction

The novel SARS corona virus disease 2019 (COVID-19) has affected the public across the globe and continue to be an important and urgent threat to global health. Since the outbreak in early December 2019 in the Hubei province of the People’s Republic of China, the number of patients confirmed to have the disease has exceeded 5,507,376 in more than 160 countries, and the number of people infected is 308,034,154 as of 10-1-22.^[1] Efficient diagnosis and better predictors of prognosis in COVID-19 are needed to mitigate the burden on the healthcare system.^[2] Prediction models comprising of clinical features or laboratory parameters that can estimate the risk of people poor outcome from the COVID-19 infection could assist medical staff in triaging patients when allocating limited healthcare resources.^[3]

To prevent the infection socially, a series of lockdowns were implemented by the Kerala government which resulted in the halt of all economic and social activities.^[4] COVID-19 causes a variety of symptoms and not all people infected with COVID-19 will have the same symptoms. Fever, dry cough, shortness of breath, fatigue or body aches are some of the most common symptoms appearing 2–14 days after the exposure, however, some people had experienced headache, abdominal pain, diarrhea and sore throat as well, although some patients might not develop symptoms until later. Asymptomatic cases were also found which can be a major issue of concern with respect to being extension into transmission chain of virus.^[5] Covid-19 has affected the entire globe and all sects of society in one or other way. In India also people have reacted differently with some having fear for life, others emotionally fragile and few worried about their livelihood and future. Many are even unaware about facilities provided by the government, regarding reliable news sources, symptoms of covid-19 and its prevention.^[2]

The present study was based on an extensive survey to understand the extent of public awareness in study population. It was aimed at awareness of community on importance in preventing the spread of COVID-19 at community level. An online questionnaire survey was conducted. It was mainly based on the essential parameters about modes of transmission, importance of personal hygiene and social distancing in the prevention of disease, available medicines and methods they are using to boost their immunity.^[5] Hence, it is very crucial to study the following factors in the population and their effects in society.^[2]

Materials and Methods

It was a questionnaire based cross-sectional study. The study population was those who were willing to answer the questionnaire. The IRB of the institute approved the study. All the participants were informed that their answers will be analyzed and published. It was digital questionnaire and was disseminated through mail or social media. This mode was safest in the era of social distancing. This technique of convenience sampling, which is a non-probability sampling technique, allows researchers to select respondents directly from the population as per their convenience. The technique was cost-effective and time-saving. Our sample comprised of people who use digital equipment and social media and it may not represent general public of Kerala. A semi structured questionnaire was prepared in straightforward, understandable English by using Google form on the basis of two previously published articles.^[5],[6] The questionnaire consisted of 19 questions divided into 3 sections. The study questionnaire is attached as annexure 1. It was also informed to the participant that their opinion will be shared on scientific platform without disclosing their identity.

In the first section, the following socioeconomic variables were included: gender, age, occupation, marital status, employment status and educational level. The second and third sections consisted of a set of multiple choice questions relating to the study population’s knowledge of covid-19 and the questions in the third section were designed to measure the extent of community awareness on the preventive measures and proper procedures in relation to covid-19 virus.^[2]

Once the data was collected, all questionnaires were exported to Microsoft excel. Double entry verification was performed on a randomly selected questionnaire (n = 50). The data from each of the returned questionnaires were coded and entered in a statistical package for social sciences (SPSS, version 21, Chicago, IL, USA) software, which was used for statistical analysis. A descriptive statistic, including percentages and frequency distribution, were calculated for each of the questions. A descriptive and univariate correlation analysis with the Pearson correlation coefficient [r] was used to find the correlation at the 5% significance level. A p-value of <0.05 represented a significant difference.

Results

Base line demographics of the study sample:

Six hundred ten participants took part in the survey, of which 59.5% were females, and 39.8 while 0.7% people preferred not to say their gender. Majority of the respondents belonged to the age group of 18–35 (61.6%) followed by 36- 58 (30.5%) [Table 1].

Table 1: Base line and social demographics of the participants

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Majority of the respondents had UG degree (51.3%), followed by PG (21.3%), while (20.7%) of the respondents had matriculation as their educational qualifications and (6.6%) of the respondents were Doctorates and had professional degree.

Out of 610 respondents 62.6% respondents were professionals, followed by semi- professionals (17.9%) and 9.3% skilled workers while 10.2% respondents were unemployed. Other details about the marital status, monthly family income and residence are shown in [Table 1].

Participants’ knowledge

Interestingly, 29.7% and 25.6% of the people disagreed and strongly disagreed respectively that the source of the virus was bat. There was 15.1% of the people who believed that the source of was bats, while 3.1% of them strongly believed so! Almost more than half the population (58.2%) and 36.4 of the people strongly believed and agreed respectively that COVID-19 is a droplet infection, while 4.1% of them took a neutral stand on that. Forty one percent of study was aware that people with co-morbidities like diabetes were more prone to the infection and strongly agreed to it, whereas 40.1% agreed to it. A total of 12.3%of them were neutral about this, and 5.1% disagreed with this statement.

When it came to the source of information, 42% of the sample depended on the news, while 31.8% received information from health professionals, and 25.2% received it from social media. It was enlightening to know that 34.6% of the people believed that the lifespan of the virus was 2–3 days on plastic and stainless steel, 24hours on cardboard, 4 hours on copper and five days on paper and glass. 58% of the sample was not sure about this fact, and the other 5.7% disagreed. A good 71.6% of the study population believed that the infection was curable, and 18.5% were unsure about it. 6.1% of them thought the infection was incurable. It was indeed a good thing that 84.1% of the population knew about asymptomatic carriers of infection while 13.8% took a neutral stand, and 1.8% of them were sadly unaware of it.

Community awareness of the preventive measures and proper procedures

Majority of study population (54.6%) were aware of preventive measures of avoiding infection e.g. practice of hand washing, usage of masks and sanitizers and maintenance of social distancing. Out of them 41.8% believed that along with the above-mentioned measures, prophylactic antibiotics, Vitamin C tablets and alternative medicines also played a role in prevention. Only 8.5% of the sample believed that the best way to prevent infection spread was by using masks and regularly washing hands with sanitizers. Social distancing was perceived as the main solution to control spread by 3.6% while following strict quarantine guidelines were seen as the right way by 3.3% of the people. A considerable fraction of 84.4% of the study sample believed all the above-mentioned methods and practices could help to prevent the spread of the infection. A good 67% of the sample thought that sanitizer (alcohol) is an adequate sterilizing agent to remove the virus from surfaces. In comparison, 15.1% of them opted for fumigation, 10.3% of them opted for bleach /chlorine, and 5.9% of them opted for UV rays.

Mindset of the public towards the progression of the pandemic

It was interesting to note that 45.6% of the sample was optimistic that the pandemic would end after the introduction of the vaccine and 28.2% of them were not sure when the pandemic end would. There was 15.6% who were pessimistic enough to state that it will not end anytime soon while 9.2% were optimistic about things taking a turn for the better by 2022.

When enquired about how worried or anxious they were regarding this pandemic on a scale of one to 10 with the one indicating “not worried” at all and ten indicating “very worried” 18.5% of them were neutral regarding it and opted for 5. In contrast, 15 .9% opted for 8, 14.4% opted for 7, 12.6% opted for 10, and 11.1% opted for 6, indicating that the vast majority of them are worried about the course this pandemic has taken and are emotionally affected by it.

Univariate analysis of age, gender and educational qualification was done with that of awareness, knowledge and preventive measures which is shown [Table 2].

Table 2: Univariate analyses of age, gender and educational status with awareness, knowledge and preventive measures of COVID-19 infection

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As the P value was greater than 0.05, there was no significant association was found between age, gender or education and awareness, knowledge and preventive measures to be taken for COVID 19.

Discussion

The first positive case of covid-19 in India was confirmed on 30^th January 2020 in Kerala and by March 10, all mass gatherings were banned. The next day, WHO declared the COVID-19 as a pandemic on March 14^th, following which Kerala ordered a complete lockdown till March 31^st.^[7] A series of lockdowns were put up on public since then and is still continued in some or other form of restrictions. This was a cross-sectional online survey conducted to assess the perception of COVID-19 in Kerala public. The survey used a questionnaire written in English.

The study found that approximately 54% of the participants thought that COVID-19 resulted from the genetic modification of a virus in a laboratory, which contradicts studies that have found COVID-19 to be 96% the same at the whole-genome level to a COVID-19 detected in bats from Yuhan province in China.^[8] Most participants agreed that healthy people could be carriers of the virus. In addition, more than three-quarters of participants thought that the elderly and people with underlying health conditions (low immunity, diabetes and/or heart problems) were at an especially high risk of death from COVID-19 and that children were at low risk of death from COVID-19; these views correspond to accepted guidelines by WHO about mortality risks from COVID-19.^{[8],[9],[10],[11]}

In current study most of the people believed that the pandemic would end after introducing vaccination to the general public even though they were optimistic about the infection being curable. More than half of the respondents were worried about their health due to COVID-19 outbreak, even though the case fatality rate was 1–2% among positive cases.^{[3],[12],[13]} This figure might be substantially lower if there were unreported and/or missed cases^[9],[14] Fortunately, the fatality rate of COVID-19 appears to be lower than that of other recent infectious disease outbreaks, such as Ebola^[11] severe acute respiratory syndrome corona virus (SARS-CoV);^[1] and Middle East respiratory syndrome corona virus (MERS-CoV);^[1],[15] The available data has suggested that more than 80% of patients with COVID-19 had “mild disease and recovered” and only 2% died from COVID-19. It is also important to note that while the general public appeared to be well informed regarding the common symptoms of COVID-19 and only 2% of the respondents^{[1],[15],[16]} excluded the role of wearing masks as a preventive method to protect them from catching a COVID19 infection.

Participants’ responses indicated a good awareness of how the virus was transmitted. Approximately 94% of them confirmed that COVID-19 could be transmitted via droplets from sneezing or coughing and from contaminated surfaces. Moreover, more than half of the participants believed that COVID-19 could survive outside the body for days, which matched with the findings of a recent study.^[17] Participants also felt that using chlorine and alcohol can be appropriate for sterilizing and eliminating the virus from contaminated surfaces. Indeed, this awareness of using chlorine and alcohol to reduce the spread of the disease was in line with the recommendation of the Center for Disease Control and Prevention (CDC) to use chlorine and alcohol on different surfaces for sterilization purposes.^[18] Moreover, most participants believed in domestic isolation, followed by sterilization and safety procedures as the best way to suppress the spread of the disease. Importantly, in cases where symptoms worsened, there was a satisfactory awareness of the need to seek help from professional caregivers by going to the nearest hospital. More than half of the respondents believed that the crisis would be over in Kerala by the beginning of 2022 or after a new treatment or vaccine had been developed.

A comparison of the results of the present study on the level of awareness and knowledge on preventive methods for COVID-19 were done with previously published study and are shown in [Table 3]. It shows that perception of COVID-10 in the current study was comparable to the other study population conducted in Northern parts of India.

Table 3: Comparison of variables and awareness, knowledge and preventive measures of current study with that of previously published study

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Limitations

The study was based on digital questionnaire in English. The socio-economic analysis suggested that this was mainly a group of professionals, well placed and well educated people and may not represent the general population of Kerala. We understand that the study population may represent very small proportion of the Kerala population. The questionnaire was not validated and it needs further validation studies.

Conclusion

In this study, we had investigated the extent of the perception of the study population toward COVID-19. The study showed that study population had reasonably good information about COVID-19. More than half of the study sample had accurate knowledge and awareness regarding the virus, its virulence and the necessary preventive measures. As we have discovered by now that COVID-19 is not going to end any time soon, the only way to avoid infection is to get vaccinated and follow COVID appropriate behavior. The government and the general public should take actions and measurements to reduce the transmission of COVID-19 and save many lives.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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