Knowledge, Attitude and Practice Towards COVID-19 Among Chronic Disease Patients at Addis Zemen Hospital, Northwest Ethiopia

Figures & data

Table 1 Sociodemographic and Clinical Characteristics of Chronic Disease Patients, Addis Zemen, Northwest Ethiopia, 2020 (N=404)

Variables	Category	Frequency	%
Sex	Male	246	60.9
	Female	158	39.1
Age (in years)^c		56.5± 13.5
Marital status	Married	305	75.5
	Unmarried	32	7.9
	Divorced	24	5.9
	Widowed	43	10.6
Educational status	Unable to read and write	150	37.1
	Read and write	105	26.0
	Elementary	59	14.6
	Secondary and above	90	22.2
Residence	Urban	254	62.9
	Rural	150	37.1
Monthly income (ETB)^c		7252.7 (±3650.3)
Occupation	Merchant	97	24.0
	Governmental employee	83	20.5
	Private-employee	73	18.1
	Farmer	81	20.1
	Housewife	58	14.4
	Other^a	12	3.0
Type of chronic disease	Diabetes mellitus	101	25.0
	Hypertension	99	24.5
	Heart Disease	104	25.7
	Chronic lung disease	51	12.6
	Hypertension and DM	84	20.8
	Other^b	4	1.00
Heard about COVID-19	Yes	401	99.2
	No	3	0.7
High-risk group for developing severe illness (more than one response possible)	Old age(elderly)	302	74.8
	DM or HTN or Heart disease comorbidity	229	56.7
	Suppressed immunity	159	39.4
	Chronic lung diseases	153	37.9
	Children	142	35.1
	Pregnant	107	26.5

Notes: ^aDaily laborer. ^bRheumatoid arthritis, gout. ^cContinuous variables expressed as mean ± SD.

Abbreviation: ETB, Ethiopian birr.

Figure 1 Awareness of COVID-19 symptoms reported by chronic disease patients, Addis Zemen, Northwest Ethiopia, 2020 (n=404).

Table 2 Frequency of Responses by the Study Participants for Knowledge Questions, Addis Zemen, Northwest Ethiopia, 2020 (N=404)

S. No.	Knowledge Questions	Frequency (%)
		Yes (N, %)	No (N, %)	I Do Not Know (N, %)
1	Main clinical symptoms of COVID-19 are fever, cough, shortness of breath, and fatigue	376 (93.1)	10 (2.4)	18 (4.5)
2	Unlike the common cold, stuffy nose, runny nose, and sneezing are less common in persons infected with the COVID-19 virus	126 (31.2)	76 (43.6)	102 (25.3)
3	COVID-19 symptoms appear within 2–14 days	95 (23.5)	12 (3.0)	297 (73.5)
4	Currently, there is no effective treatment or vaccine for COVID-2019, but early symptomatic and supportive treatment can help most patients to recover from the infection	293 (72.5)	2 (0.5)	109 (26.98)
5	Not all persons with COVID-19 will develop severe cases. Those who are elderly, have chronic illnesses, and with suppressed immunity are more likely to be severe cases	322 (79.7)	12 (3.0)	70 (17.3)
6	Touching or shaking hands of an infected person would result in the infection by the COVID-19 virus	283 (70.1)	41 (10.2)	80 (19.8)
7	Touching an object or surface with the virus on it, then touching your mouth, nose, or eyes with the unwashed hand would result in the infection by the COVID-19 virus	217 (53.7)	81 (20.1)	106 (26.2)
8	The COVID-19 virus spreads via respiratory droplets of infected individuals through the air during sneezing or coughing of infected patients	337 (83.4)	10 (2.3)	57 (14.1)
9	Persons with COVID-19 cannot infect the virus to others if he has no any symptom of COVID-19	228 (56.4)	76 (18)	100 (24.8)
10	Wearing masks when moving out of home is important to prevent the infection with COVID-19 virus	306 (75.7)	23 (5.7)	75 (18.5)
11	Children and young adults do not need to take measures to prevent the infection by the COVID-19 virus	123 (30.5)	193 (47.7)	88 (21.8)
12	To prevent the COVID-19 infection, individuals should avoid going to crowded places such as public transportations, religious places, Hospitals and Workplaces	345 (85.4)	10 (2.3)	49 (12.1)
13	Washing hands frequently with soap and water for at least 20 seconds or use an alcohol-based hand sanitizer (60%) is important to prevent infection with COVD-19	317 (78.5)	35 (8.7)	52 (12.9)
14	Traveling to an infectious area or having contact with someone traveled to an area where the infection present is a risk for developing an infection	395 (97.8)	2 (0.5)	7 (1.7)
15	Isolation and treatment of people who are infected with the COVID-19 virus are effective ways to reduce the spread of the virus	329 (81.4)	16 (4.0)	59 (14.6)
16	People who have contact with someone infected with the COVID-19 virus should be immediately isolated in a proper place.	245 (60.6)	43 (10.6)	116 (28.7)
	The overall level of knowledge
	Good	137 (33.9)
	Moderate	116 (28.7)
	Poor	151 (37.4)

Note: Numerical values written in bold indicate the frequency of correct responses.

Table 3 Factors Associated with Poor Knowledge Among Chronic Disease Patients in Bivariable and Multivariable Logistic Regression Analyses, Addis Zemen, Northwest Ethiopia, 2020 (N=404)

Variables	Poor Knowledge		OR (95% CI)
	Yes (n=137)	No(=267)	COR	AOR
Age (in years)^a	63.2±11.8	53.1± 13.1	1.06 (1.04–1.08)**	1.05 (1.01–1.08)**
Sex
Male	87(35.4)	159 (64.6)	1
Female	50 (31.7)	108 (68.4)	1.2 (0.78–1.80)
Marital status
Married	97 (31.8)	208 (68.2)	1	1
Unmarried	2 (6.3)	30 (93.8)	0.1 (0.03–0.61)	2.2 (0.32–14.78)
Divorced	11 (45.8)	13 (54.2)	1.8 (0.78–4.19)	1.4 (0.43–4.49)
Widowed	27 (62.8)	16 (37.2)	3.6 (1.86–7.02)	2.7 (0.92–8.11)
Educational status
Cannot read and write	103 (68.7)	47 (31.3)	63.5 (19.11–211.32)	7.1 (1.58–31.93)*
Read and write	28 (26.7)	77 (73.3)	10.5 (3.08–36.06)	2.5 (0.55–11.36)
Elementary	3 (5.0)	56 (95.0)	1.6 (0.30–7.97)	0.6 (0.08–4.40)
Secondary and above	3 (3.3)	87 (96.7)	1	1
Residence
Urban	25 (9.8)	229 (90.2)	1	1
Rural	112 (74.7)	38 (25.3)	26.9 (15.52–46.93)	19.0 (6.87–52.66)**
Occupation
Merchant	4 (4.2)	93 (95.8)	0.4 (0.11–1.39)	0.46 (0.09–2.16)
Governmental employee	8 (9.6)	75 (90.4)	1	1
Private-employee	25 (34.2)	48 (65.8)	4.9 (2.03–11.70)	1.7 (0.46–5.86)
Farmer	55 (67.9)	26 (32.1)	19.8 (8.34–47.12)	0.5 (0.12–2.24)
Housewife	41 (70.7)	17 (29.3)	22.6 (8.98–56.87)	1.0 (0.24–4.20)
Others^b	4 (33.3)	8 (66.7)	4.7 (1.15–19.08)	0.2 (0.02–1.93)
Monthly income (in ETB)^a	5177.3±2265.7	8317.6±3769.0	0.9(0.89–0.99)	0.8 (0.79–0.89)**

Notes: *Statistically significant (p-value < 0.05); **Statistically highly significant (p-value < 0.01). ^aContinuous variables expressed as mean ± SD. ^bDaily laborer.

Abbreviations: AOR, adjusted odds ratio; CI, confidence interval; COR, crude odds ratio.

Table 4 Attitude/Perception of Chronic Disease Patients Towards COVID-19, Addis Zemen, Northwest Ethiopia, 2020 (N=404)

S.n	Questions	High	Moderate	Low	Very Low
1	Your level of risk of infection with COVD-19	80(19.8)	146(36.1)	115(28.5)	83(20.5)
2	How much you protect yourself from the disease/care to yourself	116(28.7)	133(32.9)	99(24.5)	56 (13.8)
		Highly threatening	Moderately threatening	Easy	Not annoying at all
3	Being infected with COVD 19 to you is	212(52.5)	83(20.5)	53(13.1)	56(13.9)
		Very easy	Easy	Difficult	Very difficult
4	Washing hands frequently for 20 seconds with soap or using sanitizer is	296(73.2)	74(18.3)	32(7.9)	2(0.5)
5	Avoiding touching face with unwashed hands	222(54.9)	105(26.0)	60(14.9)	17(4.2)
6	Avoiding shaking others	198(49.0)	85(21.0)	101(25.0)	20(4.95)
7	Avoiding attending in a crowded population	71(17.6)	53(13.1)	114(28.2)	166(41.0)
8	Practicing physical distancing	43(10.6)	30(7.4)	122(30.2)	209(51.7)
9	Covering mouth or nose during a cough or sneeze with elbow/a tissue	307(75.9)	46(11.4)	39(9.7)	12(3.0)
10	Avoiding close contact with sick people	148(36.6)	158(39.1)	84(20.8)	14(3.5)
11	Using a mask when leaving home	129(31.9)	182(45.1)	80(19.8)	13(3.2)
12	Listening and following the direction of state and local authorities	110(27.2)	179(44.3)	102(25.3)	13(3.2)
13	Isolating oneself, if get sick to avoid the spread	65(16.1)	107(26.5)	111(27.5)	121(30.0)
14	Staying at home to minimize the risk of infection	160(39.6)	138(34.2)	67(16.6)	39(9.7)

Table 5 Frequency of Response by Chronic Disease Patients for Practice Questions, Addis Zemen, Northwest Ethiopia, 2020 (N=404)

S.no	Questions	Frequency
		Yes (N, %)	No (N, %)
1	Do you participate in meetings, religious activities, events, and other social gatherings or any crowded place in areas with ongoing community transmission?	250(61.8)	154(38.1)
2	In recent days, have you worn a mask when leaving home?	148(36.)	(63.4%)
3	If yes, do you touch the front of the mask when taking it off?	97(65.5)	51(34.5)
4	Do you reuse a mask?	116(78.4)	33(21.6)
5	Do you wash your hands with soap and water frequently for at least 20seconds or use sanitizer/60% alcohol	265(65.5)	139(34.4)
6	Do you touch your eyes, nose, and mouth frequently with unwashed hands?	105(26)	299(74.0)
7	Do you clean and disinfect frequently touched objects and surfaces	224(55.4)	180(44.6)
8	Do you practice “physical distancing” by remaining 6 feet/2 meters away from others at all times?	121(29.9)	283(70.1)
9	Do you use other workers’ phones, desks, offices, or other work tools and equipment?	58(14.4)	346(85.6)
10	Do you limit contact (such as handshakes)	290(71.7)	114(28.3)
11	Do you eat or drink in bars and restaurants?	56(13.9)	348(86.1)
12	Do you cover your nose and mouth during coughing or sneezing with the elbow or a tissue, then throw the tissue in the trash	295(73.1)	109(26.9)
13	Do you prefer to stay at home, in a room with the window open during the transmission period	292(72.2)	112(27.7)
14	Do you stay home when you were sick due to common cold-like infection during the transmission period	280(69.3)	124(30.7)
15	Do you listen and follow the direction of your state and local authorities?	259(64.1)	145(35.9)

Note: Frequency of correct/acceptable practices is written in bold.

Table 6 Factors Associated with Poor Practice on COVID-19 Among Chronic Disease Patients in Bivariable and Multivariable Logistic Regression Analyses, Addis Zemen, Northwest Ethiopia, 2020 (N=404)

Variables	Poor Practice		OR (95% CI)
	Yes (n= 191)	No (=213)	COR	AOR
Age (in years)^a	58.4±13.9	54.8±12.9	1.02(1.01–1.03)	0.9(0.96–1.01)
Sex
Male	122(49.6)	124(50.4)	1
Female	69(43.7)	89(56.3)	0.78(0.52–1.18)
Marital status
Married	136(44.6)	169(55.4)	1	1
Unmarried	17(53.1)	15(46.9)	1.4(0.68–2.92)	3.9(1.47–10.58)**
Divorced	16(66.7)	8(33.3)	2.5(1.03–5.98)	1.5(0.44–5.04)
Widowed	22(51.2)	21(48.8)	1.3(0.69–2.46)	0.5(0.17–1.25)
Educational status
Unable to read and write	107(71.3)	43(28.7)	10.7(5.66–20.17)	2.7(1.03–7.29)*
Read and write	53(50.5)	52(49.5)	4.4(2.28–8.39)	3.5(1.48–8.38)**
Elementary	14(23.7)	45(76.3)	1.3(0.60–2.97)	2.0(0.76–5.43)
Secondary and above	17(18.9)	73(81.1)	1	1
Residence
Urban	69(27.2)	185(72.8)	1	1
Rural	122(81.3)	28(18.7)	11.7(7.12–19.16)	2.7(1.09–6.70)*
Occupation
Merchant	19(19.6)	78(80.47)	0.6(0.30–1.194)	0.8(0.33–1.81)
Governmental Employee	24(28.9)	59(71.1)	1	1
Private-employee	35(48.0)	38(52.0)	2.3(1.16–4.38)	1.0(0.44–2.37)
Farmer	70(86.4)	11(13.6)	15.6(7.07–34.5)	2.1(0.64–6.79)
Housewife	37(63.8)	21(36.2)	4.3(2.11–8.85)	0.5(0.18–1.74)
Others^b	4(33.3)	8(66.6)	2.5(0.72–8.38)	0.7(0.14–3.36)
Monthly income (ETB)
<7252 (mean)	146(66.1)	75(33.9)	5.9(3.86–9.23)	2.3(1.20–4.15)*
≥7252	45(24.6)	138(75.4)	1	1
Poor knowledge
Yes	118(86.1)	19(13.9)	16.5(9.48–28.72)	8.6(3.81–19.45)**
No	73(27.3)	194(72.7)	1

Notes: *Significant at p< 0.05; **Significant at p< 0.01. ^aContinuous variables expressed as mean ± SD. ^bDaily laborer.

Abbreviations: AOR, adjusted odds ratio; CI, confidence interval; COR, crude odds ratio; ETB, Ethiopian birr.