Journal of Multidisciplinary Healthcare
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ORIGINAL RESEARCH
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Open Access Full Text Article
COVID-19 Prevention Practices and Associated
Factors Among Farmers in Peri-Urban Areas of
Northeastern Ethiopia
Leykun Berhanu
Gete Berihun
Zebader Walle
Daniel Teshome
Adinew Gizeyatu
Masresha Abebe
Seada Hassen
Ayechew Ademas
Birhanu Wagaye
Metadel Adane
1
Department of Environmental Health
Science, College of Medicine and Health
Sciences, Wollo University, Dessie,
Ethiopia; 2Department of Social and
Public Health, College of Health Sciences,
Debre Tabor University, Debre Tabor,
Ethiopia; 3Department of Anatomy,
College of Medicine and Health Sciences,
Wollo University, Dessie, Ethiopia;
4
Department of Public Health Nutrition,
School of Public Health, College of
Medicine and Health Sciences, Wollo
University, Dessie, Ethiopia
Background: COVID-19 is a global health threat due to its rapid spread and ability to kill
millions of people. The majority of pandemic-fighting approaches rely on prevention activities, which can be influenced by a variety of factors. Farmers are more vulnerable to
COVID-19, so evaluating existing prevention practices and associated factors is critical to
prevent the COVID-19 pandemic.
Objective: To assess COVID-19 prevention practices and associated factors among farmers
in peri-urban areas of Northeastern Ethiopia.
Methods: A community-based cross-sectional study design was conducted among 409
selected farmers. Data were collected using face-to-face interviews and on-the-spot-observational checklist. Data were analyzed using bivariable logistic regression model at 95% CI
(confidence interval). During the bivariable analysis (crude odds ratio [COR]), varibales
having a p-value of less than 0.250 were included into the multivariable analysis (adjsuted
odds ratio [AOR]). Factors associated with COVID-19 preventive practices were determined
using a multivariable analysis at a p-value of 0.050.
Results: Of 409 participants, 206 (63.6%), 157 (38.4%), and 117 (28.6%) of them had
satisfactory knowledge, positive attitude, and good prevention practices about COVID-19,
respectively. Age of the farmers with greater than or equal to 45 years (AOR: 3.2; 95% CI:
1.7–6.1), educational status of secondary school and above (AOR: 3.1; 95% CI: 1.4–6.6), and
income level of having greater than or equal to 2,001.00 Ethiopian birr (ETB) (AOR: 1.9;
95% CI: 1.1–3.4) were all found to be significantly associated with the COVID-19 prevention practices.
Conclusion: Even though the majority of farmers had satisfactory knowledge,
a considerable proportion of them had a negative attitude and poor COVID-19 prevention
practices. Age, educational status, and income level are factors associated with COVID-19
prevention practices. Hence, health education should be given to improve the farmers’
knowledge, attitudes and prevention practices to minimize the risk of COVID-19 among
farmers in semi-urban areas of northestern Ethiopia.
Keywords: COVID-19, Dawa Chefa District, Peri-urban Areas, Farmers, Northeast Ethiopia
Introduction
COVID-19 is a virus that originated in Wuhan, China, and is more infectious than the
Coronavirus that causes Severe Acute Respiratory Syndrome (SARS) and Middle
Correspondence: Leykun Berhanu
Email leyberhanuwu.edu.et@gmail.com
East Respiratory Syndrome (MERS).1 Evidence indicate that the virus is carried by
birds and mammals, with humans being particularly vulnerable to infection and
Journal of Multidisciplinary Healthcare 2021:14 1843–1852
Received: 25 May 2021
Accepted: 11 June 2021
Published: 12 July 2021
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Berhanu et al
transmission.2,3 COVID-19 is transferred largely by droplets from infected people coughing, sneezing, or speaking,
as well as by touching a contaminated surface and then
contacting the eyes, nose, or mouth without washing
hands.4,5
COVID-19 manifests itself as cough, fever, malaise,
weakness, and shortness of breath. The new virus has
sparked widespread alarm around the world because of its
great potential for quick spread and the fact that it can be
deadly.6,7 COVID-19 in its later stage resulted in respiratory distress syndrome, septic shock, hemorrhage, and
coagulation malfunction.8
Hand washing, wearing a face mask, maintaining a safe
physical distance, keeping the space ventilated, avoiding
crowded areas, covering the nose and mouth while coughing or sneezing, avoiding direct contact with animals and
suspected areas of coronavirus infections, and avoiding the
intake and handling of raw meat to prevent cross-contamination are among the COVID-19 prevention practices
suggested by the World Health Organization (WHO).9
COVID-19 prevention efforts are said to be influenced
by group awareness and mindset, according to
researchers.10,11 For example, the SARS outbreak in
China demonstrated how a lack of information and mindset can make disease prevention more difficult.12 People’s
desire to support government attempts to combat the pandemic is also substantially influenced by their level of
awareness, and having more knowledge is highly associated to a good attitude regarding COVID-19 prevention
methods.13
Despite taking a number of prevention measures,
numerous countries, including Ethiopia, are still unable
to contain the pandemic. Many African continents, including Ethiopia, are seeing an increase in infection rates. As
of March 23, 2021, the WHO reported that more than
120 million individuals had been infected and more than
2.7 million had perished. In Africa, more than 3 million
people have been affected. Since March 23, 2021, when
the first incidence of COVID-19 was discovered in
Ethiopia on March 13, 2020, more than 190,000 people
have been infected and over 2500 people have died.14
Effective infection prevention and control practices
must be implemented at the global, national, and individual levels to combat the COVID-19 pandemic, which
necessitates sufficient knowledge of the etiology, transmission, and various community responses to the pandemic,
as well as a positive mindset, to correctly implement the
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prevention practices.13,15,16 The best example was during
the Ebola pandemic, when research on awareness, attitude,
and practice (KAP) helped to establish preventive techniques. The data support the theory that a lack of understanding about the diseases contributes to an increase in
the number of cases. This means that community awareness, thinking, and prevention activities helps in containing the outbreak and minimizing its impact on public
health, social, economic, and political issues.17
Several studies have focused on COVID-19 prevention practices in the general population, healthcare workers, and those with chronic illnesses. However, as per our
knowledge, so far no research has been done to determine the prevention practices and related factors among
vulnerable populations in peri-urban areas such as farmers, who are the backbone of society in low- and middleincome countries, including Ethiopia. Agriculture provides food through harvesting crops including wheat,
sugar cane, rice, and a variety of other crops. Farmers
are important for the establishment of a good crop with
a fair yield, which they can only supply, thus none of this
would be possible without them. The COVID-19 pandemic has had a profound impact on humanity’s lifestyle
and activities, including agriculture. Food demand and
hence food security are significantly impacted as
a result of mobility restrictions, reduced purchasing
power, and a disproportionate impact on the most vulnerable population groups. According to the Food and
Agriculture Organization, COVID-19 has a substantial
impact on agriculture in two areas: food supply and
demand. These two factors are inextricably linked to
food security.18
As a result, protecting farmer’s health from the
COVID-19 pandemic entails enhancing the public’s
health. Therefore, this study aimed to assess COVID-19
prevention practices and associated factors among farmers
in peri-urban areas of Dawa Chefa District, Northeastern
Ethiopia.
Methods
Study Area Description
The study was conducted in the peri-urban areas of Dawa
Chefa District, which consists of four Kebeles (the smallest administrative unit in Ethiopia) of Oromia Special
Zone in Amhara region, Northeastern Ethiopia. The district is 326 km far from Addis Ababa, the capital city of
Ethiopia, to Northern Ethiopia. According to the Central
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Berhanu et al
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Statistical Agency (CSA), the population projection of
Dawa Chefa district was 150,165 populations composed
of 74,687 (49.7%) male and the remaining 75,478 (50.3%)
female.19 Dawa Chefa District is located at a latitude and
longitude of 10°43′N and 39°52′E, respectively. The altitude of the area ranges from 1500 to 2300 meters above
sea level. Based on the climatic classification, the area is
classified under semiarid climatic conditions. The rainfall
distribution of the study area has highly seasonal and
temporal variations. The predominant production system
in this area is mixed crop-livestock farming in which cattle
are the most important livestock species.20
Study Design and Populations
A community-based cross-sectional study design was conducted from January 1 to February 15, 2021. The source
populations were all farmers in the peri-urban areas of
Dawa Chefa District whose age 18 years and above,
whereas the study population was all farmers living in
the selected peri-urban Kebeles of Dawa Chefa District.
Sample Size Determination and Sampling
Procedure
The sample size was determined using a single population
proportion formula.21
ðza=2 Þ2 � pð1
n¼
d2
pÞ
Using the assumptions of:
Zα/2 is the standard normal variable value at (1–α) %
confidence level (α is 0.05 with 95% CI [confidence interval], Zα/2 = 1.96), p is an estimate of the expected prevention practices for COVID-19 in Dawa Chefa District taken
as a good prevention practice of 50.0%. A proportion of
50.0% was considered since there had been no previous
study conducted in the study area or other similar setting,
and d margin of error (5.0%). Adjusting for a 10% nonresponse rate, the final sample size was determined to be
422. Of the total four peri-urban Kebeles, two Kebeles
were selected randomly. Households with residents aged
18 years and above were selected from each Kebele and
study participants were allocated proportionally.
A sampling frame was made within households that had
at least one resident aged 18 years and above. Households
with study participants aged 18 years or above were
selected using a systematic sampling technique. When
there is more than one eligible participant with the selected
household, a simple random sampling technique was used.
Journal of Multidisciplinary Healthcare 2021:14
From the selected household, if there was no eligible study
participant during the first visit, another visit was done on
the same day or the next day.
Dependent and Independent Variable
Measurement
The dependent variable of this study was the prevention
practices of COVID-19, measured as good or poor and the
independent variables were socio-demographic characteristics, presence of training about COVID-19, source of
information about COVID-19, knowledge about COVID19 (satisfactory or unsatisfactory), and attitude towards
COVID-19 (positive or negative). The outcome variable
of good or poor prevention practices was measured using
11 close-ended questions having aresponse of “often,
sometimes, and never” with ascore of 2, 1, and 0 points,
respectively. The total score ranged from 0 to 22. Then, the
respondents were classified as having good COVID-19
prevention practices if they had amean score of 80% and
above, whereas poor preventive practice for amean score
of below 80%.10,22 The independent variables of sociodemographic factors of the study participants and source
of information, knowledge, and attitude about COVID-19
were measured by self-reporting of the study participants.
Knowledge about COVID-19
To examine knowledge about COVID-19: 18 close-ended
questions were used which had a “Yes, No, and do not
know” response. A score of “1” mark was assigned for
a correct response and a value of “0” to an incorrect and
do not know the response. The total score ranged from 0 to
18. If the respondents correctly answered 80% and above,
they classified as having satisfactory knowledge otherwise
they classified as having unsatisfactory knowledge.10,16
Attitude towards COVID-19
The attitude of the respondents was assessed using 17
close-ended questions, which had a response of “agree,
undecided, and disagree” with a score of 2, 1, and 0,
respectively. The total score ranged from 0 to 34. Then,
participants were classified as having a positive attitude if
they score 80% and above otherwise classified as having
a negative attitude towards COVID-19.10,16,22
Data Collection and Data Quality
Assurance
A structured close-ended questionnaire was prepared in
English language, translated to the local language Amharic,
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Berhanu et al
and re-translated back to English. The questionnaire had four
parts. Part I contains socio-demographic information of the
respondents; Part II contains questions prepared to assess the
knowledge about COVID-19. Part III comprises questions
designed to assess the attitude towards COVID-19 and Part
IV includes questions prepared to assess the prevention practices applied by households. Before the beginning of the actual
data collection, the questionnaire was pre-tested on 5% of the
sample size. Based on the finding obtained, the necessary
correction such as the ordering of the questions, addition of
the missed question, removing less important questions, and
language editions were done accordingly. The primary investigator gave one-day training for both data collectors and
supervisors about the objective of the study, data collection
tool, ethical issues and other consideration that has to be clear
before the beginning of the actual data collection. The data
were collected by five environmental health professionals
using face-to-face interviews and observational checklist.
During data collection, three master holder public health professionals carried out daily supervision.
Table 1 Socio-Demographic Characteristics of Farmers in PeriUrban Areas of Dawa Chefa District, Northeastern Ethiopia,
January 1 to February 15, 2021 (N = 409)
Variables
Responses
Frequency
(%)
Sex
Male
Female
194(47.4)
215(52.6)
Age (years)
18 to 24
25 to 34
126(30.8)
97(23.7)
35 to 44
≥ 45
110(26.9)
76(18.6)
Cannot read and write
Can read and write
135(33.0)
157(38.4)
Primary school (1–8
grade)
60(14.7)
Secondary school (9–12
57(13.9)
Educational status
grade)
Marital status
Religion
Data Processing and Analysis
The data were entered into EpiData version 4.6 and exported
to SPSS version 25.0 software for data cleaning and analysis.
Descriptive statistics such as frequency and percentage were
calculated to examine the overall distribution of the variables.
A binary logistic regression model was used to determine the
association between the dependent and the independent variables. All the independent variables, which had a p-value of
less than 0.250 from the bi-variable analysis, were entered for
multivariable analysis. In the multivariable analysis, a p-value
of < 0.05 and AOR (adjusted odds ratio) with 95% CI was
used to measure associations, and variables with p-value <
0.05 were assumed statistically significant and associated factors of prevention practices against COVID-19 pandemic. The
presence of multicollinearity among independent variables
was checked using standard error at the cutoff value of 2 and
we found that a maximum standard error of 0.380, which
indicate no multicollinearity. Model fitness was checked
using the Hosmer and Lemeshow test and we found
a p-value of 0.485.
Results
Socio-Demographic Characteristics of
the Respondents
The survey was completed by 409 of the 422 respondents, for a response rate of 96.9%. Around half 215
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Monthly income level
(ETB)
Family size
Single
Married
120(29.3)
243(59.4)
Divorced
46(11.3)
Muslim
Orthodox
258 (63.1)
121(29.6)
Protestant
30(7.3)
≤ 499.00
500.00 to 2,000.00
158(38.6)
143(35.0)
≥ 2,001.00
108(26.4)
≤5
>5
215(52.6)
194(47.4)
Abbreviation: ETB, Ethiopian Birr.
(52.6%) of the respondents were female, and more than
one-third 135 (33.0%) of them could not read or write.
Less than one-third 108 (26.4%) of the respondents, had
a monthly income of more than or equal to 2,000.00 ETB
(Average exchange rate of United States Dollars (USD)
to Ethiopia birr was 39.6237 during the study period),
and nearly half 194 (47.4%) of them had a family size of
more than five (Table 1).
Presence of Training and Source of
Information about COVID-19
Of 409 study participants, about half 228 (55.7%) of them
received training about COVID-19. About half 199 (48.7%),
108 (26.4%), and 198 (48.4%) of the respondents received
information about COVID-19 from their family or friends,
social media, and radio or television outlets, respectively
(Table 2).
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Table 2 Presence of Training and Source of Information About
COVID-19 Among Farmers in Peri-Urban Areas of Dawa Chefa
District, Northeastern Ethiopia, January 1 to February 15, 2021
(N = 409)
Variables
Responses
Frequency (%)
Presence of training about
COVID-19
Yes
No
228(55.7)
181(44.3)
Receiving information through
family/friends
Yes
No
199(48.7)
210(51.3)
Receiving information through
social media
Receiving information through
radio/TV
Yes
No
108(26.4)
301(73.6)
Yes
No
198(48.4)
211(51.6)
Table 3 Knowledge of farmers about COVID-19 in Peri-Urban
Areas of Dawa Chefa District, Northeastern Ethiopia, January 1
to February 15, 2021 (N = 409)
Variables
Responses
The majority 338 (82.6) of respondents were aware of the cause
of the COVID-19 pandemic. The majority 354 (86.6%) of
respondents said there is no cure for COVID-19, but that supportive care might help them recover, and most 359 (87.8%) of
them were aware of the presence of an effective vaccine. The
respondents’ average knowledge score was 82.3±9.6%.
According to the mean score value, 63.6% of the respondents
had satisfactory knowledge about COVID-19 (Table 3).
The Attitude of the Respondents towards
COVID-19
About two-thirds 255 (62.3%) of the respondents agreed that
avoiding touching the eyes, nose, and mouth would reduce the
risk of exposure to COVID-19. Almost similar percentage 253
(61.9%) of them agreed that coughing and sneezing into the
elbow or within the cloth is a good practice to prevent the
spread of COVID-19. About three fourth 294 (71.9%) of
them agreed that proper mask usage should include covering
nose, mouth, and chin and almost similar proportion 291
(71.4%) of them agreed that staying at home play
a significant role in preventing the spread of the pandemic.
The overall mean attitude score of the respondents was 77.3
±9.3%. Nearly two-fifth 38.4% of the respondents had
a positive attitude towards COVID-19 (Table 4).
COVID-19 Prevention Practices of the
Respondents
Nearly half 188 (46.0%) of the respondents often went to
a crowded place. About two-thirds 253 (61.9%) of the
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Incorrect
(n[%])
(n[%])
COVID-19 is a bacterial borne diseases
338(82.6)
71(17.4)
Fever is one of the clinical symptoms of
331(80.9)
78(19.1)
354(86.6)
55(13.4)
COVID-19
Fatigue is one of the clinical symptoms of
COVID-19
Dry cough is a common feature of COVID-19
355(86.8)
54(13.2)
An individual infected/suspected with
323(79.0)
86(21.0)
351(85.8)
58(14.2)
342(83.6)
67(16.4)
COVID-19 can show myalgia
The disease is more dangerous in people
Knowledge of the Respondents about
COVID-19
Correct
with cancer, diabetes, and chronic
respiratory diseases
The disease can be transmitted directly
through the consumption of uncooked dairy
and meat products
There is effective vaccine for COVID-19
359(87.8)
50(12.2)
There is no cure for COVID-19, but
354(86.6)
55(13.4)
346(84.6)
63(15.4)
301(73.6)
108(26.4)
346(84.6)
63(15.4)
293(71.6)
116(28.4)
336(82.2)
73(17.8)
324(79.2)
85(20.8)
308(75.3)
101(24.7)
334(81.7)
75(18.3)
338(82.6)
71(17.4)
supportive treatment helps to recover
Eating or contacting animal would result in
COVID-19 infection
Persons with COVID-19 cannot infect the
virus to others when fever is not present
The COVID-19 can spreads via respiratory
droplets of infected individuals
Young adults and children are not
responsible to prevent COVID-19, as they
are child
Avoid going to crowded places can help to
reduce exposure to COVID-19
Washing hands regularly using water and
soap can help to prevent COVID-19
Physical distancing can reduce the risk of
COVID-19 if it is maintained less than two
meter
The COVID-19 can spreads through
touching coins and bankbooks
The ideal length of time to wash hands in
preventing the spread of COVID-19 is 20
seconds
Overall mean knowledge score = 82.3±9.6%
Knowledge
Satisfactory
about
63.6%
(95%CI:
COVID-19
58.7-67.7)
Unsatisfactory
36.4%
(95%CI:
32.3-41.3)
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Table 4 Attitude of Farmers towards COVID-19 in Peri-Urban Areas of Dawa Chefa District Northeastern Ethiopia, January 1 to
February 15, 2021 (N = 409)
Variables
Responses
Disagree
Undecided (n[%])
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(n[%])
(n[%])
Avoiding placing fingers into the eyes, nose, and mouth would prevent the spread of COVID-19
100(24.4)
54(13.2)
255(62.4)
Coughing and sneezing into the elbow or within the clothing is a good practice in preventing the
105(25.7)
51(12.5)
253(61.8)
spread of COVID-19
Daily temperature monitoring is useful to prevent the risk of contracting the virus
117(28.6)
30(7.3)
262(64.1)
It is my opinion that early detection of COVID-19 can improve treatment outcome
132(32.3)
44(10.7)
233(57.0)
Strictly following physical distancing measures and avoiding crowded places would limit the
spread of COVID-19
145(35.4)
44(10.8)
220(53.8)
It is my opinion that health education can help prevent COVID-19
102(25.0)
41(10)
266(65.0)
It is my opinion that COVID-19 is a curable disease
It is my opinion that authorities should quarantine COVID-19 patients in special hospitals
307(75.0)
51(12.5)
58(14.2)
34(8.3)
44(10.8)
324(79.2)
Proper usage of face mask should include covering nose, mouth, and chin
82(20.0)
33(8.1)
294(71.9)
Staying at home would play a significant role in preventing the spread of COVID-19
I will report to the immediate health institution or call 8335/994 If I suspect myself for COVID-
91(22.2)
34(8.3)
26(6.4)
46(11.3)
292(71.4)
329(80.4)
If there is an available vaccine for the virus, I am willing to get it
I usually follow the updates about the spread of the virus in my country
36(8.8)
33(8.0)
71(17.4)
53(13.0)
302(73.8)
323(79.0)
I usually follow the updates about the spread of the virus worldwide
25(6.1)
58(14.2)
326(79.7)
If a lecture about the virus is organized near me, I will attend it
If flyers or brochures that include information about the disease are distributed, I will read them
22(5.4)
13(3.2)
60(14.7)
64(15.6)
327(79.9)
332(81.2)
32(7.8)
61(14.9)
316(77.3)
19
and follow the instructions mentioned in them
If protective measures and equipment are available at an affordable price, I will buy them
Overall mean attitude score (Mean± SD) = 77.3±9.3
Attitude towards COVID-19
Positive = 38.4% (95%CI: 33.8-43.0)
Negative = 61.6% (95%CI: 57.0-66.2)
respondents often wash their hands with soap for at least 20
seconds. Almost similar percentages of the respondents use
a face mask and avoid kissing and contacting others. About
half of them often go to the health institution if they get a fever,
headache, and breathing problems. The overall mean practice
score of the respondents was 70.6±13.2%. Less than one-third
117 (28.6%) of the respondents had good COVID-19 prevention practices (Table 5).
Factors Affecting COVID-19 Prevention
Practices
From the bi-variable analysis, we found that age, educational status, income level, family size, receiving
COVID-19 information from family or friends, receiving
COVID-19 information from TV or radio, and
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receiving COVID-19 information from social media were
the candidate variables for the multivariable logistic regression analysis. Multivariable logistic regression analysis
revealed that respondents’ age, educational level, and
monthly income were all significantly associated (p<0.05)
with COVID-19 prevention practices. The analysis indicated that respondents aged greater than or equal to 45
years old were 3.2 times more likely to apply good
COVID-19 prevention practices compared to those whose
ages ranged from 18 to 24 years. Those who completed
secondary school were 3.1 times more likely to have good
COVID-19 prevention practices than those who cannot read
and write. Respondents who had a monthly income greater
than or equal to 2,001.00 ETB were 1.9 times more likely to
apply better COVID-19 prevention practices than those
who had less than or equal to 499.00 ETB (Table 6).
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Table 5 COVID-19 Prevention Practices Among Farmers in Peri-Urban Areas of Dawa Chefa District Northeastern Ethiopia, January
1 to February 15, 2021 (N = 409)
Variables
Responses
Often
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(n[%])
Sometimes
Never
(n[%])
(n[%])
Do you go to a crowded place?
188(46.0)
62(15.1)
159(38.9)
To prevent contracting and spreading COVID-19, I avoid consuming outdoor food.
233(57.0)
97(23.7)
79(19.3)
To prevent contracting and spreading COVID-19, I avoid public transportations (taxi, bus … etc.)
Do you wash your hands with soap for at least 20 seconds?
290(70.9)
253(61.8)
60(14.7)
107(26.2)
59(14.4)
49(12.0)
To prevent contracting and spreading COVID-19, I pay more attention to my hygiene than usual
267(65.3)
79(19.3)
63(15.4)
To prevent contracting and spreading COVID-19, I use facemasks
To prevent contracting and spreading COVID-19, I avoid kissing/contacting others
276(67.5)
278(68.0)
82(20.0)
89(21.8)
51(12.5)
42(10.2)
Do you use alcohol-based hand sanitizer, if water is not available?
267(65.3)
92(22.5)
50(12.2)
Do you participate in COVID-19 voluntary service in your community?
Do you go to a health institution, if you get a fever, headache, and breathing problem?
233(57.0)
217(53.1)
84(20.5)
136(33.2)
92(22.5)
56(13.7)
To prevent contracting and spreading COVID-19, I avoid going out of my home.
198(48.4)
121(29.6)
90(22.0)
Overall mean practice score = 70.6±13.2%
COVID-19 prevention practices
Discussion
Good = 28.6% (95% CI: 24.2-33.0)
Poor = 71.4% (95% CI: 67.0-75.8)
Despite repeated attempts to prevent and control COVID19, the problem persists, harming the lives and economic
progress of millions of people across worldwide, including
Ethiopia. Lack of studies to identify the status of COVID19 prevention practices and assoicated factors in periurban areas in northeastern Ethiopia hinders the efforts
of the prevention programs towards COVID-19.3
Having sufficient knowledge of COVID-19 is beneficial in gaining a clear understanding of the disease burden,
which allows a person to take appropriate prevention
practices.22 The current study found that 63.6% (95% CI;
58.7–67.7) of the respondents had satisfactory knowledge,
which is almost similar to a study conducted in Africa,
which found that 61.6% of the study participants had a
satisfactory knowledge.14 The majority of those who took
part in this study were aware of the main COVID-19
transmission routes as well as the fact that there is no
effective COVID-19 cure. The current figure, however, is
lower than that of an Indian survey, which indicated that
around 70% of respondents possessed satisfactory
knowledge.23 This can be credited to India’s health ministry’s concerted attempts to inform the people about the
pandemic’s scope and severity, as well as its transmission,
prevention, and control techniques. In addition, the average mean knowledge score of the respondents was 82.3%,
Journal of Multidisciplinary Healthcare 2021:14
which is consistent with a survey conducted in Saudi
Arabia,24, and Vietnam,3 where the mean knowledge
score of the respondents was found to be 81.6% and
81.7%, respectively. Measures such as mass education
and providing training programs for those who are in
need should be taken to improve the level of knowledge
among respondents. However, the higher result was
reported in Pakistan and India where the mean knowledge
score of the respondents was 90% and 88.9%, respectively.6,8 A slightly lower results was reported in
China in which the overall mean knowledge score of the
respondents was 80%.25
People’s attitude affect their decision to do or not do
something, and having a positive attitude means that they
are eager, capable, and committed to taking various prevention steps to avoid contracting COVID-19 infection.
According to the findings, 38.4% (95% CI: 33.8–43.0) of
the respondents had a positive attitude towards COVID19, which was almost a half lower than the study done in
Pakistan where 80–90% of the respondents had a positive
attitude towards COVID-198 and consistent with the study
done in China.11 In addition, the respondents’ overall
mean attitude score was 77.3%, which is consistent with
the study conducted in India,6 where the mean attitude
score of the respondents was 73.3%. The higher result
was reported in China25 and Saudi Arabia,24 where the
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Table 6 Factors Affecting COVID-19 Prevention Practices Among Farmers in Peri-Urban Areas of Dawa Chefa District,
Northeastern, Ethiopia, January 1 to February 15, 2021 (N = 409)
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Variables
COR (95% CI)
AOR (95% CI)
P-value
Good (n[%])
Poor (n[%])
18–24
33(28.2)
93(31.8)
1
25–34
35–44
13(11.1)
32(27.4)
84(28.8)
78(26.7)
0.4 (0.2–0.9)
1.2(0.7–2.0)
0.5 (0.2–0.9)
1.2(0.7–2.3)
0.037
0.527
≥ 45
39(33.3)
37(12.7)
3.0(1.6–5.4)
3.2(1.7–6.1)
≤ 0.001
Cannot read and write
35(29.9)
100(34.2)
1
Can read and write
Primary (1–8 grade)
31(26.5)
18(15.4)
126(43.2)
42(14.4)`
0.7(0.4–1.2)
1.2(0.6–2.4)
0.7(0.4–1.2)
1.0 (0.5–2.2)
0.166
0.914
Secondary (9–12)
33(28.2)
24(8.2)
3.9(2.0–7.5)
3.1(1.4–6.6)
0.004
≤ 499.00
39(33.3)
119(40.7)
1
500–2,000.00
≥ 2,001.00
33(28.2)
45(38.5)
110(37.7)
63(21.6)
0.9(0.5–1.6)
2.2(1.3–3.7)
Age
≤ 0.001*
Educational status
0.001*
Monthly income level (ETB)
Family size
≤5
0.008*
68(58.1)
147(50.3)
1
49(41.9)
145(49.7)
0.7 (0.5–1.1)
53(45.3)
64(54.7)
157(53.8)
135(46.2)
1
0.1(0.5–1.1)
81(69.2)
220(75.3)
1
36(30.8)
72(24.7)
0.7(0.5–1.2)
No
54(46.2)
157(53.8)
1
Yes
63(53.8)
135(46.2)
0.7(0.5–1.1)
>5
0.7(0.4–1.3)
1.9(1.1–3.4)
0.319
0.031
1.6(1.1–2.5)
0.072
Receiving information through family/friends
No
Yes
Receiving information through social media
No
Yes
0.195
0.7 (0.5–1.2)
0.836
0.9(0.5–1.7)
Receiving information through TV/radio
0.150
0.7 (0.4–1.1)
Notes: *Significance difference at p < 0.05.
Abbreviation: ETB, Ethiopian Birr.
mean attitude score of the respondents is reported to be
85.4% and 94.1% respectively. Without a positive mindset,
learning about the transmission and mitigation methods is
useless for any interventions aimed at reducing the pandemic’s health and economic effects. As a result, a strategy
should be devised to shift the respondent’s thinking and
prepare them to correctly implement the numerous prevention measures in order to protect themselves and their
families from the risk of COVID-19 exposure.
Due to a shortage of effective treatment procedures and an
enough budget to deliver vaccines for all people, especially in
poor countries like Ethiopia; more effort is needed to focus on
the holistic preventive strategy. In this survey, less than a third,
28.6% (95% CI: 24.2–33.0) of the respondents had a good
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Prevention Practices of COVID-19
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COVID-19 prevention practice. This figure was lower than
the study conducted in Pakistan, where nearly all participants
perform the basic prevention practices.8 In Jordan, 87.5% of
respondents had good COVID-19 prevention practices, which
included hand washing with soap or alcohol, wearing personal
protective equipment, and wearing a mask.1
Lower COVID-19 prevention practices found in this study
may be attributed to a lack of sufficient public education,
community carelessness in implementing various prevention
practices, a negative attitude toward the pandemic, and most
importantly, the absence of clear legal issues that suggest what
to do and what not to do in terms of pandemic control.
Furthermore, the respondents’ overall mean practice score
was 70.6%, which is lower than a study done in Saudi
Journal of Multidisciplinary Healthcare 2021:14
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Arabia, where the respondents’ mean practice score was
86.8%.24 A higher result was also reported in India,6 where
the mean practice score of the respondents was 93.0%, and
China in which about 90% of the study subjects had a good
COVID-19 prevention practices.25 Appropriate preventive
initiatives will help to save millions of people’s lives and reduce
the cost of medicine and supportive care.
The current study also found that individuals aged 45 and
up were 3.2 times more likely to apply good COVID-19 prevention practice than those aged 18 to 24 years (AOR: 3.2; 95%
CI; 1.7–6.1). The current result is in line with the research
conducted in Egypt, India, Jordan, Bangladesh, Gondar, and
Dire Dawa City administration.5,6,9,10,13,26 Because the elderly
have a larger chance of contracting and developing complications from the diseases, they used better preventative
strategies.15
The survey also found that people with a secondary
education or higher were 3.1 times more likely to apply
good prevention practices than those who could not read
or write (AOR: 3.1; 95% CI: 1.4–6.6). This finding is
supported by the study done in Jordan5 and
Bangladeshi,16 where higher education is associated with
good COVID-19 prevention practices.
Moreover, the study found that respondents having
a monthly income of greater than or equal to 2,001.00 ETB
were 1.9 times more likely to employ better COVID-19 prevention practices than those who had a monthly income of less
than or equal to 499 ETB (AOR: 1.9; 95% CI; 1.1–3.4). The
present finding is consistent with the study done in Egypt10 and
Bangladeshi,16 where poor income was associated with poor
COVID-19 prevention practices. This suggests that a lack of
sufficient income to carry out various prevention practices is an
obstacle to lowering the risk of infection.15
Conclusion
Even though the majority of farmers had satisfactory knowledge, the survey found that a considerable proportion of them
had a negative attitude and poor COVID-19 prevention practices. Age, educational status, and monthly income of the
respondents were significantly associated (p<0.05) with
COVID-19 prevention practices. As a result, steps should be
taken to improve the attitudes, educational status, and income
level of the farmers to minimize the risk of COVID-19 exposure. This can be achieved by informing the vulnerable population, which may be at risk of contracting COVID-19, about the
pandemic’s seriousness and political, social, economic, and
health consequences on a regular and timely basis. For those
Journal of Multidisciplinary Healthcare 2021:14
who cannot afford it, hand sanitizer and a face mask should be
given. Vaccines should also be available for the elderly.
Ethical Consideration
All of the methods used in this study were done following the
Helsinki declaration. As a result, ethical clearance was obtained
from the ethical review board of Wollo University College of
Medicine and Health Science. A formal letter of cooperation
was also written to the town administration. Because not all of
the study participants were educated, obtaining written consent
from them was difficult. As a result, after receiving ethical
review board permission, verbal consent was received from
study participants. Before starting the interview, the data collector explained the purpose of the study for all the participants,
and verbal consent was obtained from the study participants.
During data collection, individuals with COVID-19 symptoms
were linked to the surrounding health institution for screening
and further treatment. All the information obtained from each
study participant was kept confidential.
Acknowledgment
First, the authors wish to express their gratitude to Wollo
University’s College of Medicine and Health Sciences for
providing the funds necessary to duplicate the data collection
tool. The authors would like to express their gratitude to the
Dawa Chefa District Administration for providing the necessary information required to conduct the study. Finally, the
authors would like to express their gratitude to the data
collectors, supervisors, and participants in the research.
Author's Contributions
All authors made a significant contribution to the work
reported, whether that is in the conception, study design, execution, acquisition of data, analysis, and interpretation, or in all
these areas; took part in drafting, revising, or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been
submitted; and agree to be accountable for all aspects of the
work.
Disclosure
The authors report no conflicts of interest in this work.
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