CHAPTER ONE
1.0 Background of the study
In December 2019, an outbreak of unusual pneumonia cases was reported in Wuhan, China. By January 11,
2020, the etiologic agent was identified as SARS-CoV-2 and the clinical syndrome was named COVID-19.
Two months later, on March 11, 2020, the WHO declared COVID-19 a pandemic that had already reached
114 countries, affecting 118,000 people and causing 4291 deaths. On February 14, 2020, the first African
case was reported in Egypt. By April 2020, COVID-19 had already affected 10,000 people in 52 African
countries. Dr. Matshidiso Moeti, the WHO Regional Director for Africa, asked then for “a decentralized
response, which is tailored to the local context". (Zhu N, Zhang DY, Wang WL, et al. 2019)
Since then, Sub-Saharan countries have struggled to respond to the pandemic, taking into account the
particularities of their context. On the one hand, the following factors may be considered positive and may
have worked in their favor: A lower risk of importation and transmission due to a lower flow of transport
and trade; a younger demographic distribution, which is associated with lower mortality rates; the
experience accumulated from other recent epidemic outbreaks; and other less obvious factors such as
specific genetic variations and the continent's climatic characteristics. On the other hand, many other
factors suggested greater vulnerability in African countries, namely: Packed unregulated urban areas along
with cultural practices that value social cohesion and social gatherings; higher levels of respiratory
diseases; concomitance with immune-compromising conditions such as AIDS, diabetes or malnutrition;
weak healthcare structures that are too dependent on private or external financing; low human resources
capacity, lack of critical equipment and vulnerable supply chains; and other factors such as weak public
administration, infrastructure patchiness, political instability and armed conflicts, less educated populations
who are more permeable to potentially harmful misinformation, among others. (WHO)
Given these particularities, it seems necessary to carry out tailored actions that consider the specific context
of different countries. In this regard, an evaluation of the knowledge, attitudes and practices (KAPs)
regarding COVID-19 prevention has proven useful to identify the most vulnerable communities to which
health promoters should pay special attention.
To the best of our knowledge, no study of COVID-19 related KAPs has been conducted in the Republic of
Ghana. With an estimated population of 27 million, Ghana is among the most vulnerable countries when it
comes to coping with COVID-19. It has an understaffed, fragmented, and uncoordinated health system.
The country is characterized by a high rate of poverty and mortality, a high burden of infectious diseases,
insufficient epidemiological surveillance and underdeveloped infrastructure. Like other countries in the
region, Ghana declared a state of health emergency and adopted public health measures that included the
mandatory use of masks, contact tracing, self-isolation or quarantine, closures of worship spaces, the
prohibition of gatherings of more than 50 people, closures of airports and public transport limitations.
Authorities also made public health recommendations, such as hand washing, breathing practices, and
social distancing, while preparing the health systems for specific diagnoses and treatments.
By December 11, 2020, Ghana counted 52,738 confirmed cases and 326 deaths. These relatively low
figures need to be interpreted in the light of a low testing capacity and a fatality rate that goes over 6.1%.
Additionally, one must consider the social and economic impact, along with other long-standing health
issues such as malaria, AIDS and tuberculosis, hypertension and diabetes e.t.c that has affected the country.
(GHS, 2020)
1.1
STATEMENT OF THE PROBLEM
Currently, the world is experiencing the novel severe acute respiratory syndrome coronavirus disease
2019(SARSCoV-2) pandemic, commonly known as COVID-19, which was first reported by the World
Health Organization (WHO) on December 31, 2019, as a viral pneumonia outbreak of unknown etiology in
the Hubei Province of China. To date, at least eight million people are infected by COVID-19 and over
400,000 have died, with most counties in Europe worst hit by the pandemic. COVID-19 is rapidly
spreading across Africa, and current data indicates 54 countries are affected, with close to 200,000 people
infected and deaths exceeding 4,000. (WHO, 2020).
The COVID-19 pandemic in Ghana is part of the worldwide pandemic of coronavirus disease
2019(COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). In the
month of March 2020 there were earliest confirmed cases and initial response from the Government of
Ghana. Joint meetings among major stakeholders were conducted as well as training sessions organized for
teachers and other professionals on how to handle suspected cases of novel COVID-19. Measures instituted
by the President of Ghana on 15 March 2020 included bans on school activities, bans on all social
gatherings, and a temporary lockdown and restrictions of the movements of people in the Greater Accra
and Ashanti Regions of Ghana. (GHS, 2021)
Greater Accra, Ashanti and Upper West regions recorded cases in March. At an emergency press briefing
on 12 March 2020 Health Minister Kwaku Agyemang-Manu announced Ghana's first two confirmed cases
(in Accra). The two cases were people who returned to the country from Norway and Turkey which made
them the first actual cases of COVID-19 in Ghana. These two cases initiated the first contact tracing
process in Ghana. Of the first two cases reported in Ghana, one case was a senior officer at the Norwegian
Embassy in Ghana who had returned from Norway; while the other was a staff member at the United
Nations (UN) offices in Ghana who had returned from Turkey.
By the end of the month of March there had been 152 confirmed cases, 5 deaths, and 22 recovered patients,
leaving 125 active cases going into April.
Ghana's president Nana Akufo-Addo began delivering a series of state of the nation addresses concerning
COVID-19 in March by announcing that the cedi equivalent of US$100 million would be made available to
enhance Ghana's coronavirus preparedness and response plan. Parliament passed the Novel Coronavirus
(COVID-19) National Trust Fund Act, 2020 (Act 1013) which setup a fund to receive and manage
contributions and donations from individuals, groups and corporate bodies to support in the fight against
the virus.
Initially the Government of Ghana banned all public gatherings including conferences, workshops,
funerals, festivals, political rallies, church activities and other related events to reduce the spread of the
virus. Beaches were also closed. Basic schools, senior high schools and universities, both public and
private, were also closed. Only Basic Education Certificate Examination and West African Senior School
Certificate Examination candidates were permitted to remain in school under social distancing protocols.
Traveling to Ghana from countries which had recorded over 200 positive COVID-19 cases was strongly
discouraged with non-admittance of such travellers; this restriction did not however apply to Ghanaian
citizens and people with resident permits. All of the country's borders were later closed for two weeks from
midnight of Sunday 22 March 2020. Passport services were also suspended.
On 30 March, 2020 the partial lock down of Accra and Kumasi took effect. Members of the Executive,
Legislature and the Judiciary; and some services such as those that were involved in the production,
distribution and marketing of food, beverages, pharmaceuticals, medicine, paper and plastic packages,
media and telecommunications were exempted from the restrictions.
On 26 March, 64 new cases were recorded increasing Ghana's case count to 132. On the same day, a letter
written and signed by the Director General of the Ghana Health Service Dr. Patrick Kuma-Aboagye
recalled all staff on study-leave into active service. This was to help accommodate the workload on health
centers. A special life insurance cover for the professionals at the frontline dealing with the pandemic was
announced by the Ghana Health Ministry. The workers were insured under Group Life cover, with an
assured sum of GHC 350,000 on each life. (GHS, 2021).
Coronavirus is transmitted from person-to-person through droplets of saliva or discharge from the nose
when an infected person coughs or sneezes. Infected persons present with mild to moderate symptoms but
are able to recover even without treatment. The common symptoms include fever, tiredness, dry cough,
shortness of breath, body aches and pains, and sore throat, and very few people present with diarrhea,
nausea, and running nose. Factors like old age and comorbidities, namely, cardiovascular diseases, diabetes
mellitus, chronic respiratory diseases, and cancer, are associated with poor prognosis. Without effective
treatment and vaccine, the world is left with a single option thus strict adherence to public health
preventive measures: regular hand-washing using soap and water or alcohol-based hand rub, social
distancing (maintaining a distance of at least two meters), not touching the face, covering the nose and
mouth with tissue when coughing or sneezing, staying at home if feeling unwell, wearing of face masks,
and prompt seeking of medical care when one has suggestive symptoms .These measures have been
popularized and supported by the WHO, governments, and Ministries of Health globally. To that effect,
guidance and policies and presidential directives have been issued. In Ghana, several communication
channels are used to reach the population with preventive messages about COVID-19, including
presidential directives. This is aimed at improving people’s knowledge about COVID-19, changing their
attitudes towards adopting public health preventive measures, and improving their adherence to practicing
public health preventive measures. However, data are limited regarding people’s knowledge about COVID19, attitudes towards presidential directives and Ministry of Health (MoH) guidelines, and practices of
public health preventive measures (KAP). Second, anecdotal observations indicate that people in the rural
areas is less adherent to practicing public health preventive measures about COVID-19 compared to those
in the urban areas, suggesting possible deficiency in knowledge about COVID-19 and perhaps negative
attitudes towards presidential directives and MoH guidelines. However, evidence to support this
observation is non-existent. This study therefore seeks to assess the knowledge, attitude and practice of
COVID-19 prevention among residents of Bolgatanga East District in the Upper East Region of Ghana.
Our findings will inform the design of effective public health preventive measures so as to halt the spread
of COVID-19.
1.2
PURPOSE OF THE STUDY
The purpose of the study is to assess the knowledge, attitude and practice of COVID-19 prevention among
residents of Bolgatanga East District in the Upper East Region of Ghana.
1.3
OBJECTIVES OF THE STUDY
The specific objectives of this study are to:
1. Assess the knowledge about COVID-19 prevention among residents in the Bolgatanga East District.
2. Determine the attitudes towards COVID-19 prevention among residents in the Bolgatanga East District.
3. Ascertain the adherence to practicing COVID-19 preventive measures among residents in the
Bolgatanga East District.
1.4
RESEARCH QUESTIONS
1. What is the knowledge level of the residents in the Bolgatanga East District on COVID-19 prevention?
2. What is the attitude of residents in the Bolgatanga East District towards COVID-19 prevention?
3. To what extent do residents in the Bolgatanga East District adhere to practicing the COVID-19
preventive measures?
1.5
SIGNIFICANCE OF THE STUDY
The findings of this study would lead the researchers to assist the population under study to gain adequate
knowledge on COVID-19 prevention, assist them to develop a positive attitude towards COVID-19
prevention and strict adherence to practicing public health preventive measures of the Novel COVID-19. It
would also serve as a source of information to the nurses’ trainees, nurse practitioners and policy makers to
use for research. Finally the document will serve as a reference point for any future research on COVID-19
prevention in Ghana.
1.6
DELIMITATIONS OF THE STUDY
The study was confined to only residents in the Bolgatanga East District, a suburb of the Bolgatanga
Municipality. The study could not be extended to everybody within the district but to only 68 respondents
of the Daborin community in the Bolgatanga East District, both male and females who falls within the age
groups of 15-80 years, those who had both formal and informal education and those who have not had any
form of educational background.
1.7
LIMITATIONS OF THE STUDY
Financial constraints and the fact that the researchers were to complete the study within a limited time
frame and to continue with other aspects of their course of study challenged the study.
1.8
OPERATIONAL DEFINITIONS
Definition of terms
1. Pandemic; its defined as “an epidemic occurring worldwide, or over a very wide area, crossing
international boundaries and usually affecting a large number of people”.
2. Syndrome; a group of symptoms which consistently occur together, or a condition characterized by a set
of associated symptoms.
3. Knowledge; level of understanding about salient aspects of COVID-19 prevention
4. Attitude; the view, opinions, impressions and values attached to COVID-19 prevention
5. Practice; the extent to which residents adhere to laid down protocols on COVID-19 prevention.
CHAPTER TWO
LITERATURE REVIEW ON CORONA VIRUS (COVID’19)
2.0 Introduction
This chapter contains a review of current and past research finding relevant to the topic under study. This
literature review was organized into four sections as follows; the concept of COVID-19, the knowledge of
the public on COVID-19, attitude of the public towards COVID-19 and the practice of COVID-19
prevention among the public.
2.1 THE CONCEPT OF CORONA VIRUS DISEASE
Corona virus is an illness that affects the respiratory system caused by a novel corona virus called severe
acute respiratory syndrome (SARS-CoV-2). It was discovered in the year December, 2019 at Wuhun city,
Hubei china. COVID-19 was declared as a public health emergency of international concern by the world
health organization (WHO) on January 30, 2020. (WHO)
CAUSATIVE ORGANISM
This infection was said to be transmitted through animal such as bat, but the causative agent is known as
novel corona virus (SARS-CoV-2)
Mode of Transmission
Since this infection has affinity on the respiratory system its mode of transmission is droplet of an infected
persons and contact route. According to current evidence on covid’19, the virus is primarily transmitted
between people through respiratory droplets and contact route.
Droplet transmission occurs when a person is in close contact (within 1m) with who has respiratory
symptoms (coughing or sneezing) and is therefore at risks having his/her mucosae (mouth and nose)
expose to potentially infective respiratory droplets. Transmission may also occur through fomite in
immediate environment around infected person. Therefore transmission of covid’19 virus can occur by
direct contact with infected people and indirect contact with surfaces with the immediate environment or
object used on the infected person (e.g. stethoscope and thermometer).
Risk group of covid’19
Corona virus has affinity to any type of person but these groups of persons are more prone to this infection.
1. The aged and children
2. People with lungs problems such us chronic obstructive pulmonary disease (COPD) and asthma
3. Cardiac disease e.g. Coronary arterial disease, pulmonary hypertension and heart failure
4. People with diabetes and obesity
5. People with weakened immune system (immune-compromised). A healthy immune system fights
the germs that cause disease, but condition like organ transplant, cancer treatment and HIV/ AIDS
make you prone to this infection
6. Chronic liver disease.
7. People in Overcrowded areas
Pathophysiology/pathogenesis
The pathogenesis of SARS-CoV-2 is still not widely known, but it is thought to be not much different from
SARS-CoV which is more widely known. In humans, SARS-CoV-2 mainly infects cells in the airways that
line the alveoli. SARS-CoV-2 will bind to the receptors and make their way into the cell. The glycoprotein
contained in the envelope spike virus will bind to the cellular receptor in the form of ACE2 in SARS-CoV2. In cells, SARS-CoV-2 duplicates genetic material and synthesizes the proteins needed, then forms new
virions that appear on the cell surface.
Similar to SARS-CoV, in SARS-CoV-2 it is suspected that after the virus enters the cell, the viral RNA
genome will be released into the cytoplasm of the cell and translated into two polyproteins and a structural
protein. Next, the viral genome will begin to replicate. The glycoprotein in the newly formed virus
envelope enters the endoplasmic reticulum membrane or Golgi cells. Nucleocapsid formation occurs
consisting of RNA genomes and nucleocapsid proteins. Viral particles will grow into the endoplasmic
reticulum and Golgi cells. In the final stage, vesicles containing virus particles will join the plasma
membrane to release new viral components.
The transmission of the infection is mainly person to person through respiratory droplet. Faecal-oral route
is possible. The presence of the virus has been confirmed in sputum, pharyngeal swab and faeces.
Vertical transmissions of SARS-Cov-2 has been reported and confirmed by positive nasopharyngeal swab
for covid’19. The incubation period of corona virus is 5-15days. Therefore, it has been recommended to
quarantine those exposed to the infection for 14days.
For most people, the symptoms end with cough and fever. After 5 to 8 days of infection the following signs
and symptom may be shown; Shortness of breath, acute respiratory distress syndrome, dizziness and
sweating. (WHO, 2019)
Diagnoses
There are series of conducted on the issue of corona virus.
Some of these include;
1. Sputum test
2. X-ray
3. Nasopharyngeal swab
4. Blood sample for screening and contact tracing
5. Polymerase chain reaction test (PCR Test)
Medical Treatment
Before the numerous efforts of the scientist to provide the world with vaccine to combat the deadly disease,
medical partitionist also start to use some of the corticosteroid and some combination of antibiotic to safe
people who are infected.
The following are the drug used
1. Dexamethasone and other corticosteroid like prednisone and methylprednisolone
2. Tocilizumab
3. Remdesivir in combination with baricitinib
4. Anticoagulation drug were given to prevent blood clot e.g. Heparin
Nursing Management
1. Easing anxiety, which is relatively common covid’19, with combination of anxiolytic medication
and psychotherapy that include relaxation techniques, breathing exercise and encouragement.
2. Reduce fever by serving prescribe antipyretic’s
3. Improve breathing pattern by elevating head end of bed
4. Educate patient on condition
5. Check vital signs
Prevention of Corona Virus
1. Maintain a safe distance from others, even if they don’t appear to be sick
2. Wear a nose mask in public, especially indoors or when physical distancing is not possible
3. Wash and clean hand with soap under running water and use alcohol base sanitizer
4. Stay home (self-quarantine) when you feel unwell
5. Cover your nose with your elbow or tissue when coughing or sneezing
6. Avoid crowd and poorly ventilated spaces
7. Get vaccinated when is your turn
Complications of Corona Virus
Although most people with covid’19 have mild to moderate symptom, the disease can cause severe
medical complication and lead to death in some people. Older adults or people with existing medical
are at a greater risk of becoming seriously ill with covid’19.
The following are the complication of corona virus:
1. Pneumonia
2. Organ failure
3. Heart problems (cardiomyopathy)
4. Acute kidney injury
5. Additional viral and bacterial infection
2.2 Knowledge on Covid’19
a research conducted on 1357 health workers including doctors, nurses, and paramedics in china showed
that medical doctors obtained higher knowledge scores compared with nurses and paramedics
(doctors=38.56±3.31; nurse=37.85±2.63; paramedics 36.72±4.82). Compared with frontline health workers
who have direct contact with confirmed and suspected patient, non-frontline workers displayed low levels
of confidence to fight the virus. In Italy, respondent from 2046 hospital staff showed that, in general, health
care workers possessed good knowledge.
A research on medical student from Iran indicated that such student has an average of 96% correct answers
with 76.60%, 13.8 and 6.7 of students holding high, moderate, and low level of knowledge respectively
Research conducted in US and UK revealed that considerable knowledge among the respondent about the
transmission, spread, and symptom of covid’19. However, a portion of the populations cited a
misconception about the prevention of the disease. Another student in china on 6910 residents argued that
the level of knowledge of the resident was positive with a score of 10.8 (SD: 1.6; range: 0-12). (Zhong et.
al. China, KAP of covid’19)
2.3 Attitude Towards Covid’19 Prevention
The study on health care 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 room and intensive care units.
The study on hospital staff from Italy proposes that more than 41% of the respondent avoid crowded places
as a precautionary measure. Furthermore, healthcare workers were more aware of covid’19 compared with
the public. Furthermore, the research on 368 dentists in Jordan revealed that more half of the participant
(n=203; 55.2%) deemed that the symptom of covid’19 can be revolved over time and thus do not require
any special treatment
A total of 275 dentist (74.7%) agreed that implementing social distancing among patient in the clinic,
wearing of nose mask, in the waiting room and washing of entering the treatment room can prevent the
spread of the virus during dentist appointment. however, 80 respondents (21.7%) believes that such
measures are not important and do not cause excessive panic.
A total of 304 dentists (82.6%) reported that they refrain from patient with covid’19 symptom, whereas 161
dentist 43.8% mentioned that they prefer that patient with symptom visit the hospital instead the clinics.
Furthermore, 17 dentist 4.6% confirm that they will refuse to treat patient with a symptom of covid’19 and
advise them to live the clinic. In contrast, 182 dentists (49.6%) confirmed that they will treat the patient,
but will advise them to visit the hospital afterward. (Olum et. al, 2019. China)
2.4 Practice/adherence to covid’19 prevention
The Jordan study on health and non-health workers student obtained an average of 0.78±0.2 (SD) in terms
of practice. In other words, student displayed the favorable practice towards covid’19 preventions, such as
hand washing, refraining from shaking hands and following the etiquette of coughing and sneezing.
(Christy et. al, China)
CHAPTER THREE
METHODS
3.0. Introduction
This chapter highlights the methods and techniques that were employed in the study. It describes the study
design, study setting, the study population, sample size determination, sampling method and procedure,
data collection methods, pre-testing, data processing and analysis, and ethical considerations.
3.1. Study design
The study will use a descriptive cross sectional study design to assess the knowledge, attitude and practice
of COVID-19 prevention among residents of the Bolgatanga East District of the Upper East Region of
Ghana.
The cross sectional design will be employed for this study because, according to Levin (2006), the
approach provides a “snap-shot” of the outcome and the characteristics associated with it at any specific
point in time. Thus it allows the data to be collected on individual characteristics associated at the time of
the study alongside information about the outcome, as well as associations between these characteristics
and the outcome of interest.
3.2. The study setting
The study was carried out in Zuarungu, a community in the Bolgatanga East District of the Upper East
Region of Ghana. The Daborin community is located along the Bolga- Bawku highway. The community
was selected out of the seven communities by randomly picking the name out of the names of the seven
communities written on separate papers.
3.3. Study population
The study population from which the sample will be drawn consisting of all age groups ranging from
children aged 15years to adults in the Zuarungu community. The inclusion criterion will be all residents
including educated and non-educated, men and women, young and old in the community who will be
willing to participate in the study, and exclusion criterion will be all residents who will not be willing to
participate in the study.
3.4. Sampling Technique
Participants for the study will be obtained using convenience sampling, a non- probability sampling
technique where subjects are selected because of their easy accessibility and proximity. Convenience
sampling will be used over other sampling techniques because it is less time consuming, thus will be a
suitable approach since the researchers have a limited time frame to conduct the study.
3.5. Data collection instrument and procedure
A structured questionnaire consisting of four parts will be used to collect data for this study. The first part
of it is to obtain information on the respondent’s biographic data (demographic data), the second part is to
assess the knowledge level on COVID-19 among residents, the third part is to examine the attitude of
residents on COVID-19 prevention and the last part is to assess the practices of COVID-19 prevention
among residents. Questionnaires will then be administered to the residents who met the inclusion criteria
and will be willing to participate in the study.
3.6. Pre-testing
In order to resolve possible glitches in wording, lack of clarity in instructions etc, pre-testing of the
questionnaires will be Toah community using 10 respondents. Toah community will be selected because it
shares similar social and economics characteristics as that of the Zuarungu community.
3.7. Data processing and analysis
Data obtained for the study will be checked for completeness first, after which properly completed data will
be coded and analyzed using Microsoft excel.
The findings will be summarized using descriptive statistics (mean, median and standard deviation) and
presented in tables and figures. Figures were exported to Microsoft excel to allow clearer presentation
3.8. Ethical consideration
In order to maintain confidentiality, respondents in the study will not be required to give their names or
provide any leading information that may predict their identity.
Participation in this study will strictly be voluntary, after a careful explanation of questionnaire to
respondents.
CHAPTER FOUR
DATA ANALYSIS AND PRESENTATION OF FINDINGS
4.0 Introduction
This chapter deals with the analysis of data and presentation of results. Microsoft Excel was used to
analyze the data and the results presented using frequency distribution tables, figures and graphs. Results
were organized under major headings as follows demographic profile of respondents, knowledge on Covid19, attitude towards Covid-19 and practices of Covid-19 prevention among residents.
4.1 Demographical Characteristics of Respondents
Out of the 68 respondents that participated in the study, majority (35.3%) were within the age group 21-64
years while an equal number of respondents (32.4%) were within the age bracket of 15-20 years and above
65 years as shown in the table 1.1a below
Also out of the 68 respondents, majority were females (67.7%) and the remaining were males (32.4%) as
shown in the table 1.1a below
Table 1.1a Age Distribution of Respondents
Age Group (Years)
Frequency (N)
Percent (%)
15-20
22
32.4
21-64
24
35.3
Over 65
22
32.4
68
100.0
Male
22
32.4
Female
46
67.7
68
100.0
Total
Gender
Total
With regards to
the religious affiliation of the respondents, table 1.1b demonstrates that most respondents (79.4%) in the
study were Traditional African Worshipers, about 14.7% were Christians while the remaining 5.9% were
muslims. There was however no respondent belonging to a religion other than those captured in the study.
Table 1.1b Religious Affiliation of Respondents
Religion
Frequency (N)
Percent (%)
Christianity
10
14.7
Traditional African Worshipers
54
79.4
Islam
4
5.9
Total
68
100.0
Figure 1.1b Educational Level of Respondents
60
50
40
30
20
10
0
Non Formal (13.2%)
Primary (32.4%)
Secondary (51.5%)
Tertiary (2.9%)
Figure 1.1b above indicates that most of the respondents (51.5%) in the study had completed at least
secondary education, a significant number (32.4%) had at least primary education and about 2.9% had
tertiary education. The remaining 13.2% had no form of formal education at all.
40
35
30
25
20
15
10
5
0
House Wife (16)
Trader (40)
Farmer (6)
Figure 1.1c: Distribution of Respondents by Occupational Type
Formal Job (6)
As illustrated in figure 1.1c above, most respondents (40) in the study were traders, 16 respondents were
house wives while an equal number of respondents (6) were either farmers or employed in the formal
sector.
4.2 Knowledge of Respondents on Covid-19
As shown in figure 1.2a below, awareness on Covid-19 was almost universal among respondents sampled
for the study. About 94.1% of the respondents were fully aware about the existence of covid-19, with only
5.9% indicating that they have never heard of covid-19 or believed it does not exist.
6%
Aware (94.1%)
Not Aware (5.9%)
94%
Figure 1.2a: Awareness level of respondents on covid-19
Young people and the aged between the ages of 15-20 and above 65 years respectively were less likely to
hear of covid-19 as compared to their other counterparts. However other demographic characteristics such
as religion, gender and occupation had no significant association with a respondent’s awareness on covid19.
Table 1.2a: Relationship between Respondents Demographic Characteristics and Their Awareness on
Covid-19.
Awareness on Covid-19
Yes
Age
No
Total
of 15-20
18
4
22
21-64
22
0
22
>65
24
0
24
64
4
68
10
0
10
Affiliation of Christianity
50
4
54
Respondents
4
0
4
64
4
68
Respondents
Total
Religious
Islam
T.A.Religion
Total
Educational
Non Formal
9
0
9
Level
Basic
20
2
22
Secondary
33
2
35
Tertiary
2
0
2
64
4
68
House Wife
16
0
16
Trader
36
4
40
Farmer
6
0
6
Formal Job
6
0
6
64
4
68
Total
Occupation
Total
As demonstrated in the table 1.2b below, the radio was the major source of information on covid-19 in the
Daborin community. Out of the 66 respondents who reported being aware of covid-19, about 58.8% of
them stated that the radio was their main source of information on covid-19, 17.6% of them stated that the
television was their source of information while 4.4% stated that social media, seminars/workshops,
newspapers/magazines and senior colleagues was their source of information, the remaining 2.9% stated
posters/pamphlets as their source of information on covid-19.
Table 1.2b: Source of information on covid-19
Response
Frequency
Percent(%)
Valid Percent(%)
Radio
40
58.8
60.6
Social media
3
4.4
4.5
Television
12
17.6
18.2
Seminars or Workshops
3
4.4
4.5
Posters/pamphlets
2
2.9
3.0
Newspapers/magazines
3
4.4
4.5
Senior colleagues
3
4.4
4.5
Total
66
97.1
100.0
Missing Data
2
2.9
Total
68
100.0
Valid
Most respondents out of the 68 respondents answered about four of six knowledge items correctly as
shown in table 1.2c below. Respondents appeared to be knowledgeable about transmission through
respiratory droplets of infected people (97.1% answered correctly (Yes), 1.5% incorrectly (No), and 1.5%
reported that they did not know). The high prevalence of misunderstanding was discovered in a knowledge
item, with participants believing that infection could occur through eating or having contact with wild
animals. Only 26.5% correctly answered the statement was false, 42.6% believed it was true, and 30.9%
said they were not sure. About half of the respondents (48.5%) replied that wearing general medical mask
helps prevention was correct (Yes), but 39.7% answered incorrectly (No), and 11.8% did not know.
There was an adequate knowledge among respondents as 66.9% answered yes of six covid-19 items as in
table 1.2c
KNOWLEDGE
YES
Percent
NO
Percent(%) DO NOT Percent(
(%)
The main clinical symptoms of COVID-19 59
KNOW
%)
86.8
7
10.3
2
2.9
73.5
10
14.7
8
11.8
69.1
20
29.4
1
1.5
26.5
29
42.6
21
30.9
97.1
1
1.5
1
1.5
48.5
27
39.7
8
11.8
66.9
94
23
41
10
are fever, fatigue, dry cough and myalgia
There is currently no effective treatment 50
for COVID-19 but early symptomatic and
supportive
treatment
can
help
most
patients recover from infection
Not all persons with COVID-2019 will 47
develop severe cases. Only those who are
elderly have chronic illnesses are more
likely to be in severe cases.
Eating or contacting wild animals would 18
result in infection by the COVID-19 virus.
The
COVID-19
virus
spreads
via 66
respiratory droplets of infected individuals.
Ordinary residents can wear general 33
medical masks to prevent infection by the
COVID-19 virus.
Total
273
Table 1.2c: Knowledge of Respondents on Covid-19
4.3 Attitude Towards Covid-19
From table 1.2d below, respondents answered two attitude items correctly, out of the 68 respondents, when
asked “What do you think is the possibility of you getting COVID-19 infection?” 35.3% believed there is a
higher possibility of been infected while 23.5% believed very high possibility, 19.1% believed moderate
possibility, 14.7% believed low possibility and 7.4% believed very low possibility of been infected with
covid-19.
When asked “What do you think will be the severity if COVID-19 infects you?” 54.4% believed high in
severity, 14.7% believed very high in severity, 17.6% believed moderate severity, 7.4% believed low
severity and 5.9% believed very low in severity when infected with covid-19.
It is obvious the respondents had positive attitude towards covid-19 as 82.4% of the respondents had
between moderate to very high of two covid-19 items. This implies that the respondents had a positive
attitude towards COVID-19 infection.
Table 1.2d: Attitude of respondents towards covid-19
ATTITUDE
Very Percent
Lo
Percen
Moderat
Percen
low
w
t
e
t
(%)
(%)
1
What do you think
High
Percent
Very Percent
(%)
high
(%)
(%)
5
7.4
10
14.7
13
19.1
24
35.3
16
23.5
4
5.9
5
7.4
12
17.6
37
54.4
10
14.7
9
6.6
15
11
25
18.4
61
44.9
26
19.1
is the possibility of
you getting
COVID-19
infection?”
2
“What do you think
will be the severity
if COVID-19
infects you?
3
Total
4.4 Practices of Covid-19 Preventive Measures
From table 1.2e below, most of the respondents (51.5%) adhere to the covid-19 preventive measures and
are said to often wear facial masks, 16.2% always wear facial masks 29.4% will sometimes wear facial
masks and 2.9% has never worn facial masks.
Similarly, about half of the respondents 50% are said to sometimes practice hand hygiene, 36.8% often
practice hand hygiene and 13.2% as always practicing hand hygiene.
On the other hand, 44.1% will often practice social distancing by avoiding crowded places, 39.7% will
sometimes avoid crowded places 8.8% will always avoid crowded places and about 7.4% has never
avoided crowded places or practiced social distancing.
The respondents practice covid-19 preventive measures as 96.5% of the respondents answered between
sometimes to always of three covid-19 items.
Table 1.2e: Practices of Covid-19 Preventive Measures by Respondents.
S/N PRACTICE
Never
Percent
Sometimes
(%)
1
Wearing
Percent
Often Percent
(%)
Always
(%)
Percent
(%)
2
2.9
20
29.4
35
51.5
11
16.2
0
0
34
50.0
25
36.8
9
13.2
5
7.4
27
39.7
30
44.1
6
8.8
7
3.4
81
39.7
90
44.1
26
12.7
facial masks
2
Practicing
hand hygiene
3
social
distancing
(avoiding
crowded
places)
4
Total
CHAPTER FIVE
DISCUSSION AND SUMMARY OF FINDINGS, CONCLUSION AND RECOMMENDATIONS
5.0. INTRODUCTION
In this chapter the results of this study has been discussed by relating the major findings to the available
literature presented in chapter two earlier. Pertinent among the issues is the extent to which the findings of
this study agreed with or were in variance with the available literature. Issues that were raised and
responded to are presented holistically
5.1. DISCUSSIONS
Our findings demonstrated that the respondents have adequate knowledge about COVID-19, as 66.9% of
the respondents answered yes to six covid-19 items, including the transmission of the virus through
respiratory droplets of infected people and clinical symptoms of the disease. The perceived risk for
infection susceptibility was relatively lower than the disease’s perceived severity as 82.4% of the
respondents had between moderate to very high of two covid-19 items regarding attitudes towards covid19. The impact of efficacy beliefs on preventive measures was high as 96.5% of the respondents answered
between sometimes to always of three covid-19 items in both personal hygiene and social distancing. Most
respondents complied with the recommended practices such as wearing facial masks (16.2%), practicing
hand hygiene (13.2%), and social distancing to prevent COVID-19 infections.
Several findings on the associations among KAP factors provided valuable insights into how public health
initiatives can better protect the population’s health during public health emergencies, such as emerging
infectious disease pandemics, by establishing strategic behavioral interventions. First, knowledge can play
a crucial role in enhancing the practice of public preventive behavior, as our findings showed that
knowledge was associated with attitudes and preventive behaviors. Minjung Lee. et al, 2021 have
previously reported similar associations when performing KAP surveys toward COVID-19.This result
implies that information disseminated through health interventions to prevent and control epidemics must
be based on scientific evidence and delivered in understandable language to heighten public knowledge of
the issues. Although it is difficult to say how much knowledge is sufficient enough for achieving desirable
changes in health outcomes, the impact of knowledge on health behaviors has been validated in many
public health areas based on the premise that the public can make ‘informed decisions’ about health
behaviors by leveraging their knowledge about relevant health issues. While there are numerous definitions
of informed decision-making, they commonly agree that informed decisions are based on sufficient
knowledge of scientific evidence about the relevant aspects of the available alternatives.
In addition to providing sufficient and precise information, efforts to correct inaccurate and misguided
information are needed. The “infodemic” phenomenon refers to an overabundance of
Information-potentially invalid or harmful information—spread on the internet or through other media. The
infodemic is a tremendous and ongoing challenge during the COVID-19 pandemic. Information production
and consumption have increased significantly since the start of the pandemic, meaning the public is more
easily exposed to misinformation. During health crises, engaging the public with behavior change
initiatives may be profoundly limited when disseminated health information conflicts with existing beliefs
stemming from culture and system, and rumors or misinformation are rampant across communication
sources. We recommend that public health practitioners and policymakers promote knowledge and
understanding while addressing contextual factors that may hinder the public’s learning processes
concerning health information. Notably, this study found a high prevalence of misunderstanding regarding
the source of infection through eating or contact with wild animals, as only 26.5% of respondents correctly
answered the information was false. Our study did not delve into the contexts behind this misinformation.
Thus, we suggest that future research identify and monitor such misconceptions about COVID-19
dispersed across communication platforms to provide accurate and evidence-based information about the
disease and prevention measures.
Second, attitudes, especially efficacy beliefs, had a significant and robust impact on practicing preventive
behaviors, implying that promoting preventive behaviors toward COVID-19 would require promoting both
knowledge and efficacy beliefs among the public. Consistent with evidence that efficacy beliefs serve as
significant predictors of preventive behaviors (Minjung Lee et al. 2021), this study also displayed that for
the public to perform precautionary behaviors after acquiring information, they then need to believe that
such practices would be effective. For example, people need to believe that washing hands would keep
them from being infected, beyond merely informed so, to perform and sustain the behavior. While
knowledge itself is at the root of learning, a discrepancy between information delivered and received is
expected, given individual characteristics. Public health experts need to acknowledge that health
communication is a dynamic process shaped mainly by individual cognitive and psychological factors. Our
findings imply that a particular emphasis should be placed on bolstering efficacy; thus, COVID-19
behavior programs may integrate messaging strategies that stress the effectiveness of target behaviors (e.g.,
estimated reduced risks after the uptake of practicing hand hygiene) promoted by the programs. We also
recommend that the efforts prioritize populations who displayed low efficacy beliefs, particularly those
who are younger and have less knowledge of COVID-19.
Third, our study results showed that COVID-19 knowledge, attitudes, and practices differed by
Socio-demographics factors. Specifically, males and less educated individuals had less knowledge about
COVID-19, rendering them particularly vulnerable to the epidemic. This result is similar to prior research
investigating the association between socio-demographic factors and knowledge level during the COVID-
19 pandemic in China and Hong Kong. Many health communications studies have examined the
phenomena of knowledge inequality. Such studies have emerged, particularly since the knowledge gap
hypothesis postulated that people would acquire knowledge at different paces, widening the knowledge gap
over time, depending on their socioeconomic status, cognitive capabilities, and prior knowledge.
This study did not explore the temporal trend of inequalities; nevertheless, it identified the gaps in all
factors within a causal link. Substantial differences among the respondents were evident in knowledge,
attitudes, and behaviors. Thus, reducing gaps in health behaviors and outcomes may be achieved by
decreasing knowledge inequalities and prioritizing them with scant health knowledge.
Several limitations of this study should be acknowledged. First, we used the average score of knowledge in
the analysis, so each knowledge item’s effect was not examined. Second, our study did not extensively
explore other attitudinal factors associated with COVID-19 behaviors, such as perceived barriers or other
communication factors that may have influenced the public’s knowledge, including seeking information,
using the media, or processing information. Third, while efficacy beliefs can be conceptualized to include
both response efficacy and self-efficacy, our study only adopted and examined the former, providing
limited perspectives on the concept’s inherently composite nature.
5.2 CONCLUSSIONS
During health crises and emergencies, the public needs to practice precautionary behaviors at all times, as
the novelty and unpredictability of epidemics may exceed a health system’s capability to a significant
degree. This study provides evidence that knowledge is an essential predictor of attitudes and behaviors,
contributing to advancing intervention strategies to promote and sustain the public’s precautionary
behaviors in the context of the COVID-19 pandemic. Meanwhile, our study’s findings suggest that some
people may be disadvantaged from performing health behaviors due to the unequal distribution of
knowledge, attitudes, and behaviors, possibly in combination with a lack of access to health care and preexisting health conditions. Finally, this study provides critical and timely insights into how the government
and public health organizations establish and implement appropriate policies and interventions that do not
overlook and deprioritize those in urgent need.
5.3 RECOMMENDATIONS
1. Attention must be paid to those who showed particularly low levels of COVID-19 knowledge, as
they are less likely to have proper attitudes and perform preventive behaviors. When all behavioral
aspects are disproportionately distributed across different social groups, future policies and
interventions should not be one-size-fits-all, as shown in this study. We suggest public health
authorities should attempt a ‘person-centered’ approach rather than a ‘disease-centered’ approach to
investigate vulnerable subpopulations and prioritize policies and communication efforts to
accommodate the underserved’s needs.
2. It’s recommended that authorities of the various health facilities within the district should
collaborate with the National Commission for Civic Education to embark on outreach programs
targeting the rural areas within their catchment areas to provide adequate information on the need to
practice covid-19 preventive measures.
3. The Ministry of Health and the Ghana Health Service should collaborate with the Ghana Media
Commission and the Ghana Journalist Association to promote the practice of covid-19 preventive
measures since the media such as radio and televisions are the major source of information for most
people.
4. Further studies should be conducted on the role and influence of knowledge on the practices of
covid-19, since adequate knowledge has direct influence on the practice of preventive measures.
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APPENDIX
RESEARCH QUESTIONAIRE
QUESTIONAIRE DESIGNED BY
1. AYAABA ABDUL RASHEED
2. AWINI DAVID
3. AYEBILLA ALICE
4. AWUAH MARY
STUDY QUESTIONNAIRE
NURSING AND MIDWIFERY TRAINING COLLEGE-ZUARUNGU
COVID-19 IN GHANA: ASSESSING THE KNOWLEDGE, ATTITUDE AND PRACTICE OF
COVID-19 PREVENTION AMONG RESIDENTS IN THE BOLGATANGA EAST DISTRICT
This questionnaire is about a study titled; Assessing the Knowledge, Attitude and Practice of COVID-19
Prevention among residents in the Bolgatanga East District. We will be grateful if you could give truthful
and honest response to the questions. You are allowed to stop answering the questions if you feel very
uncomfortable. Please bear with us if some questions provokes your emotions. However, we would
encourage you to try and respond to all the questions. Kindly give your consent or otherwise before
proceeding.
A.I CONSENT TO PARTAKE IN THIS STUDY [ ]
B.I DO NOT CONSENT TO TAKE PART IN THIS STUDY [ ]
SECTION A: DEMOGRAPHIC CHARACTERISTICS
1 What is your age (years) at your last birthday……………………
2 What is your Gender Male 1[ ] Female 2[ ]
3 What is your Religion Christian 1[ ] Muslim 2[ ] Traditionalist 3[ ] Others 4[ ]
5 Level of education Basic 1[ ] Secondary 2 [ ] Tertiary 3 [ ] None 4 [ ]
6 What is your Ethnicity, Please Specify………………………….……
7 Have you heard of COVID-19? Yes 1[ ] No 2 [ ]
Sources of Information on COVID-19 please tick (√) where applicable:
8 What is your source of information on COVID-19 Radio [ ] Social Media [ ] Television [ ] Seminars or
Workshop [ ] Posters or Pamphlets [ ] Newspapers or Magazines [ ] Senior Colleagues [ ]
Other Sources, Please Specify………………………………….…………
Instruction: from statement 9-14, indicate by circling from 1-3 your response on your knowledge on covid19 infection (where 1 = Yes, 2 = No and 3 = Do not know )
S/N KNOWLEDGE
YES
NO
DO NOT
KNOW
9
The main clinical symptoms of COVID-19 are fever, fatigue, dry 1
2
3
2
3
1
2
3
1
2
3
1
2
3
1
2
3
cough and myalgia
10
There is currently no effective treatment for COVID-19 but early 1
symptomatic and supportive treatment can help most patients
recover from infection
11
Not all persons with COVID-2019 will develop severe cases.
Only those who are elderly have chronic illnesses are more likely
to be in severe cases.
12
Eating or contacting wild animals would result in infection by
the COVID-19 virus.
13
The COVID-19 virus spreads via respiratory droplets of infected
individuals.
14
Ordinary residents can wear general medical masks to prevent
infection by the COVID-19 virus.
From statement 15 and 16, indicate by circling on a 5-point Liked scale the extent to which the following
statement below show your attitude toward COVID-19 infection “1 = very low,2 = low 3 = moderate, 4 =
high and 5 = very high”
ATTITUDE
Very
Low
Moderate High
low
15
What do you think is the possibility of you getting
Very
high
1
2
3
4
5
1
2
3
4
5
COVID-19 infection?”
16
“What do you think will be the severity if COVID19 infects you?
From statement 17-19, indicate by circling on a 4-point Liked scale the extent to which the following
statement below on your pactice of COVID-19 infection prevention (where 1 = never, 2 = sometimes, 3 =
often, and 4 = always).
S/N
PRACTICE
Never
Sometimes Often
Always
17
Wearing facial masks
1
2
3
4
18
Practicing hand hygiene
1
2
3
4
19
social distancing (avoiding crowded places)
1
2
3
4