Knowledge, Attitudes and Practices Toward Prevention and Early Detection of COVID-19 and Associated Factors Among Religious Clerics and Traditional Healers in Gondar Town, Northwest Ethiopia: A Community-Based Study

Figures & data

Table 1 Socio-Demographic Characteristics of the Religious Clerics and Traditional Healers in Gondar Town

Variables	Categories	Frequency(n)	Percentage (%)
Age	18–30 years	76	18.5
	31–45 years	122	29.8
	46–60 years	110	26.8
	> 60 years	102	24.9
Sex	Male	379	92.4
	Female	31	7.6
Marital status	Married	260	63.4
	Widowed/separated	37	10
	Single/unmarried	113	27.6
Educational level	Unable to read and write	86	21.0
	Able to read and write without formal education	117	28.5
	Primary school	99	24.1
	Secondary school	83	20.2
	College/university and above	25	6.1
Study subjects	Orthodox clerics	218	53.2
	Muslim clerics	105	25.6
	Dual traditional healers	65	15.9
	Sole traditional healers	22	5.4
Number of family members	No family member	116	28.3
	More than 2 family members	294	71.7
Underlying disease	Chronic lung disease	15	3.7
	Neuromuscular disease	5	1.2
	Allergy	5	1.2
	Diabetes mellitus	25	6.1
	Hypertension	33	8.0
	Cardiovascular disease	12	2.9
	Cancer	1	0.2
	None	315	76.8

Table 2 Knowledge Items Toward COVID-19 Among Religious Cleric and Traditional Healers in Gondar, 2020

Knowledge Items	Correct Response n (%)	Incorrect Response n (%)
Ever heard of COVID-19	404(98.5)	6 (1.5)
Causative agent of COVID-19	148 (36.1)	262 (63.9)
COVID-19 infection can be prevented	334 (81.5)	76 (18.5)
Main transmission routes of COVID-19	321 (78.3)	89 (21.7)
Impact of early detection and visit to health institution on COVID-19	238 (58.0)	172 (42.0)
Current WHO recommended quarantine or isolation period of COVID-19	246 (60.0)	164 (40.0)
Effect of unauthorized traditional treatment and religious practices on COVID-19	122 (29.8)	288 (70.2)
Individuals with underline diseases and/or weaken immunity are at higher risk to COVID-19	232 (56.6)	178 (43.4)
Older age groups are higher risk to COVID-19	273 (66.6)	137 (33.4)
COVID-19 can be diagnosed	261 (63.7)	149 (36.3)
Mentioned at least one sign and symptomof COVID-19	369 (90)	41 (10)
Proper hand washing can prevent COVID-19	308 (75.1)	102 (24.9)
Appropriate facemask use can prevent COVID-19	214(52.2)	196 (47.8)
Effect of physical distancing or avoiding mass gatherings for COVID-19 prevention	262(63.9)	148(36.1)
Quarantine or self-isolation prevents COVID-19 transmission	209(51)	201(49)
COVID-19 is a fatal disease	249 (60.7)	161 (39.3)

Abbreviation: COVID-19, Coronavirus Disease 2019.

Table 3 Bivariate and Multivariate Analysis of Factors Associated with Knowledge Toward COVID-19

Variables	Poor Knowledge n (%)	COR (95% CI)	AOR (95% CI)	P value
	Total (39.3%)
Age (Years)
18–30	9 (2.2)	8.37(3.77–18.58)	7.33(2.76–19.49)	<0.001*
31–45	41 (10)	2.22(1.29–3.81)	1.65 (0.89–3.05)	0.107^#
46–60	57 (13.9)	1.04(0.61–1.79)	1.23 (0.67–2.27)	0.491^#
>60	54 (13.2)	1.00	1.00
Sex
Female	18 (4.4)	1.00	1.00
Male	143(34.9)	2.28(1.08–4.80)	1.16 (0.45–2.97)	0.753^#
Educational status
Unable to read and write	62 (15.1)	1.00	1.00
Able read and write	54 (13.2)	3.01(1.66–5.46)	2.94 (1.56–5.51)	0.001*
Primary school	26 (6.3)	7.25(3.78–13.89)	5.97 (2.94–12.10)	<0.001*
Secondary school	14 (3.4)	12.7(6.05–26.76)	8.59 (3.84–19.19)	<0.001*
University/college	5(1.2)	10.3(3.48–30.65)	6.57(2.00–21.52)	0.002*
Marital status
Married	103(25.1)	4.11(1.91–8.86)	2.82(1.13–7.03)	0.026*
Single	31 (7.6)	7.14(3.09–16.46)	1.17(0.39–3.45)	0.776^#
Widowed/separated	27 (6.6)	1.00	1.00
Presence of underlying disease
No known underlying disease	202(49.3)	1.00	1.00
Known underlying disease	47 (11.5)	1.88(1.18–2.98)	0.58(0.34–1.00)	0.05^#

Notes: *P<0.05 statistically significant association, ^#P>0.05 statistically non-significant association.

Abbreviations: AOR, adjusted odds ratio; COR, crude odds ratio; CI, confidence interval; cut off point, 60%.

Table 4 Attitude Items Toward COVID-19 Among Religious Cleric and Traditional Healers in Gondar Town, 2020

Attitude Items	Positive Response n (%)	Negative Response n (%)
Early detection and or report is effective on the COVID-19 outcome	179 (43.7)	231 (56.3)
Will go to or call for consultation to a healthcare provider if you have signs and symptoms of COVID-19	177 (43.2)	233 (56.8)
Avoiding mass gatherings is necessary for COVID-19 prevention	189(46.1)	221 (53.9)
Perceived risk of infection	155 (37.8)	255 (62.2)
Avoiding touching eyes, mouth and noses with unclean hand is necessary for COVID-19 prevention	175 (42.7)	235 (57.3)
Covering the mouth and nose while coughing and sneezing could prevent the transmission of COVID-19	220 (53.7)	190 (46.3)
Physical distancing is necessary for COVID-19 prevention	181 (44.1)	229 (55.9)
Self-isolation and/or quarantine can prevent COVID-19	212 (51.7)	198 (48.3)
Facemask is necessary for COVID-19 prevention	209 (51.0)	201 (49.0)
Patients with COVID-19 infection can recover	273 (66.6)	137 (33.4)
Information updates and its relationship with COVID-19 prevention	254 (62)	156 (38)
COVID-19 is a result of punishment of God	54(13.2)	356(86.8)
TH/religious cleric were better to manage COVID-19 than physicians	132(32.2)	278(67.8)
Patients with COVID-19 symptoms can be kept in TH or religious places for traditional and or spiritual healing	270(65.9)	140(34.1)

Abbreviations: COVID-19, Coronavirus Disease 2019; TH, traditional healer.

Table 5 Bivariate and Multivariate Analysis of Factors Associated with Attitude Toward COVID-19

Variables	Negative Attitude n (%)	COR (95% CI)	AOR (95% CI)	P- value
	Total (65.9%)
Age (Years)
18–30	37 (9)	2.65(1.42–4.94)	3.01(1.38–6.59)	0.006*
31–45	72 (17.6)	1.74(0.99–3.06)	1.82(1.02–3.27)	0.042*
46–60	88 (21.5)	0.62(0.33–1.19)	0.71(0.37–1.37)	0.314^#
>60	73 (17.8)	1.00	1.00
Sex
Female	28 (6.8)	1.00	1.00
Male	242(59)	5.28(1.57–17.70)	3.45(0.96–12.37)	0.057^#
Marital status
Married	171(41.7)	9.1(2.14–38.74)	5.65(1.28–24.83)	0.022*
Single	64 (15.6)	13.4(3.07–58.43)	4.25(0.88–20.52)	0.072^#
Separated/Widowed	35 (8.5)	1.00	1.00
Presence of underlying disease
No known underlying disease	205 (50)	1.00	1.00
Known underlying disease	65 (15.9)	1.11(0.68–1.81)	1.04(0.96–12.37)	0.883^#

Notes: *P<0.05 Significant association, ^#P>0.05 statistically non-significant association.

Abbreviations: AOR, adjusted odds ratio; COR, crude odds ratio; CI, confidence interval; cut off point, 60%.

Table 6 Practice Items Toward COVID-19 Among Religious Clerics and THs at Gondar Town, 2020

Practice Items	Correct Practice n (%)	Incorrect Practice n (%)
Extremely scared about COVID-19	134 (32.7)	338 (82.4)
Keep dietary balance and food or drink hygiene	72 (17.6)	402 (92.6)
Perform regular exercise	8 (2)	402 (98)
Avoid mass gatherings in the weeks before	105 (25.6)	305 (74.4)
Check sign and symptoms of COVID-19 regularly	56 (13.7)	354 (86.3)
Cover the mouth and nose while coughing and or sneezing	189 (46.1)	221 (53.9)
Avoiding touching eyes, ears and noses	163 (39.8)	247 (60.2)
Practice physical distancing	115 (28.0)	295 (72)
Proper hand washing	196 (47.8)	214 (52.2)
Appropriate facemask uses in the weeks before	73(17.8)	337(82.2)
Follow COVID-19 information updates from trusted sources	135(32.9)	275(67.1)
Responsible to report COVID-19 symptoms from customers/followers to responsible body?	384(93.7)	26 (6.3)
Use and prescribe unauthorized traditional medicine for COVID-19	77 (18.8)	333(81.2)
Provide traditional treatments/or spiritual healing (holy water or prayer) for the customers with COVID-19 symptoms in the same area with other customers/followers?	37 (9)	373(91)
Preventive measures taken if you had close contact with COVID-19 confirmed or suspected cases?	71 (17.3)	339(82.7)
Counsel customers/followers to safety practices about COVID-19?	114(27.8)	296(72.2)

Abbreviation: COVID-19, Coronavirus Disease 2019.

Table 7 Bivariate and Multivariate Analysis of Factors Associated with Practice Toward COVID-19

Variables	Poor Practice n (%)	COR (95% CI)	AOR (95% CI)	P value
	Total =84.4%
Age (years)
18–30	66 (16.1)	1.13(0.96, 2.78)	4.75(2.04–11.08)	<0.001*
31–45	89 (21.7)	2.78(1.35–5.73)	4.37(1.33–14.33)	0.015*
46–60	101(24.6)	0.66(0.27–1.66)	0.94 (0.35–2.49)	0.902^#
>60	90 (22)	1.00	1.00
Educational status
Unable to read and write	81 (19.8)	1.00	1.00
Able read and write	94 (22.9)	3.96(1.44–10.90)	4.03 (1.35–12.04)	0.012*
Primary school	85 (20.7)	2.66(0.92–7.74)	1.80 (0.56–5.81)	0.322^#
Secondary school	67 (16.3)	3.86(1.34–11.11)	4.15 (1.28–13.42)	0.018*
University/college and above	19(4.6)	5.11(1.41–18.54)	5.42(1.24–23.76)	0.025*
Marital status
Married	207(50.5)	4.48(1.04–19.22)	2.56(0.52–12.60)	0.246^#
Single	104 (25.4)	1.51(0.31–7.34)	0.94(0.14–6.28)	0.952^#
Separated/widowed	35(8.5)	1.00	1.00
Number of family members
No family member	107 (26.1)	1.00	1.00
≥2 family members	239(58.3)	2.73(1.30–5.73)	2.31 (0.80–6.66)	0.120^#
Presence of underlying disease
No known underlying disease	279(68)	1.00	1.00
Known underlying disease	67 (16.3)	3.45(1.97–6.04)	4.74(2.43–9.27)	<0.001*

Notes: *P<0.05 statistically significant association, ^#P>0.05 statistically non-significant association.

Abbreviations: AOR, adjusted odds ratio; COR, crude odds ratio; CI, confidence interval; cut off point, 60%.