KNOWLEDGE ON MINIMIZING THE SPREAD OF COVID- 19 AMONG THE ATTENDING OPD PATIENTS OF SELECTED HOSPITAL OF DHAKA CITY-SANNI JAISWAL

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Author-

SANNI JAISWAL

(RN), BSc in nursing,
UNIVERSITY OF DHAKA.

MPH,
STATE UNIVERSITY OF BANGLADESH.

CMed,
BIRDEM Academy.

MPhil (1st Part),
UNIVERSITY OF DHAKA

 

1.  Introduction:

  1. Background

According to the World Health Organization (WHO), viral diseases continue to emerge and represent a serious issue to public health. In the last twenty years, several viral epidemics such as the severe acute respiratory syndrome coronavirus (SARS-CoV) from 2002 to 2003, and H1N1 influenza in 2009, have been recorded. Most recently, the Middle East respiratory syndrome coronavirus (MERS-CoV) was first identified in Saudi Arabia in 2012.

 

An epidemic of cases with unexplained low respiratory infections detected in Wuhan, the largest metropolitan area in China’s Hubei province, was first reported to the WHO Country Office in China, on December 31, 2019. Published literature can trace the beginning of symptomatic individuals back to the beginning of December 2019. As they were unable to identify the causative agent, these first cases (n=29) were classified as “pneumonia of unknown etiology.” The Chinese Center for Disease Control and Prevention (CDC) and local CDCs organized an intensive outbreak investigation program. The etiology of this illness was attributed to a novel virus belonging to the coronavirus (CoV) family. [1]

 

On February 11, 2020, the WHO Director-General, Dr. Tedros Adhanom Ghebreyesus, announced that the disease caused by this new CoV was a “COVID-19,” which is the acronym of “coronavirus disease 2019”. In the past twenty years, two additional CoVs epidemics have occurred. SARS-CoV provoked a large-scale epidemic beginning in China and involving two dozen countries with approximately 8000 cases and 800 deaths (fatality rate of 9,6%) and the MERS-CoV that began in Saudi Arabia and has approximately 2,500 cases and 800 deaths (fatality rate of 35%) and still causes as sporadic cases.

 

This new virus is very contagious and has quickly spread globally. In a meeting on January 30, 2020, per the International Health Regulations (IHR, 2005), the outbreak was declared by the WHO a Public Health Emergency of International Concern (PHEIC) as it had spread to

18 countries with four countries reporting human-to-human transmission. An additional landmark occurred on February 26, 2020, as the first case of the disease, not imported from China, was recorded in the United States (US). [2]

The CoVs have become the major pathogens of emerging respiratory disease outbreaks. They are a large family of single-stranded RNA viruses (+ssRNA) that can be isolated in different animal species. For reasons yet to be explained, these viruses can cross species barriers and can cause, in humans, illness ranging from the common cold to more severe diseases such as MERS and SARS. The dynamics of SARS-Cov-2 are currently unknown, but there is speculation that it also has an animal origin. [3]

 

 

The potential for these viruses to grow to become a pandemic worldwide represents a serious public health risk. Concerning COVID-19, the WHO raised the threat to the CoV epidemic to the “very high” level, on February 28, 2020. On March 11, as the number of COVID-19 cases outside China has increased 13 times and the number of countries involved has tripled with more than 118,000 cases in 114 countries and over 4,000 deaths, WHO declared the COVID- 19 a pandemic. [4]

Throughout its history, the world has been plagued by a number of pandemic outbreaks like the Spanish flu of 1918 and the Asian flu of 1957. [5] The most recent and perhaps, one of the most widespread outbreaks, is the COVID-19 pandemic, which has continued to debilitate the entire global system. Tracing the roots of the COVID-19 pandemic, on 31st December 2019, an outbreak of pneumonia of unknown reason was identified and reported from the Wuhan City in Hubei Province of China to the World Health Organization [WHO] Country Office for China. On7 th January 2020, this was diagnosed as the ‘Novel Corona Virus’. While on 30th January, the outbreak of the virus was declared a Public Health Emergency of International Concern [PHIEC] by the WHO, on 11th March 2020 it was recognized as a pandemic. [6]

Etiology

CoVs are positive-stranded RNA viruses with a crown-like appearance under an electron microscope (coronam is the Latin term for crown) due to the presence of spike glycoproteins on the envelope. The subfamily Orthocoronavirinae of the Coronaviridae family (order Nidovirales) classifies into four genera of CoVs: Alphacoronavirus (alphaCoV), Betacoronavirus (betaCoV), Deltacoronavirus (deltaCoV), and Gammacoronavirus (gammaCoV). Furthermore, the betaCoV genus divides into five sub-genera or lineages. Thus, SARS-CoV-2 belongs to the betaCoVs category. It has round or elliptic and often pleomorphic form, and a diameter of approximately 60–140 nm. Like other CoVs, it is

 

sensitive to ultraviolet rays and heat. In this regard, although high temperature decreases the replication of any species of virus. Currently, the inactivation temperature of SARS-CoV-2 must be well elucidated. It seems that this virus can be inactivated at about 27° C. On the contrary, it may resist the cold even below 0°C. Furthermore, these viruses can be effectively inactivated by lipid solvents including ether (75%), ethanol, chlorine-containing disinfectant, peroxyacetic acid, and chloroform except for chlorhexidine. [7]

 

Epidemiologic Characteristics Mode of Transmission:

The person-to-person spread of SARS-CoV-2 is thought to occur mainly via respiratory droplets, resembling the spread of influenza. With droplet transmission, virus released in the respiratory secretions when a person with infection coughs, sneezes, or talks can infect another person if it makes direct contact with the mucous membranes. The infection can also occur if a person touches an infected surface and then touches his or her eyes, nose, or mouth. Droplets typically do not travel more than six feet (about two meters) and do not linger in the air however, SARS-CoV-2 remained viable in aerosols under experimental conditions for at least three hours.

 

Source of Transmission:

The study in Wuhan shows that the Covid-19 outbreak was associated with a seafood market that sold live animals, where most patients had worked or visited and which was  subsequently closed for disinfection. However, as the outbreak progressed, person-to person spread became the main mode of transmission. Although patients with symptomatic COVID- 19 have been the main source of transmission, recent study suggests that asymptomatic patients and patients in their incubation period are also carriers of SARS-CoV-2. This epidemiologic feature of COVID-19 has made its control extremely challenging, as it is difficult to identify and quarantine these patients in time, which can result in an accumulation of SARS-CoV-2 in communities.

 

Incubation period: The incubation period for COVID-19 is thought to be within 14 days following exposure, with most cases occurring approximately four to five days after exposure. [8]

Because the first cases of the COVID-19 disease were linked to direct exposure to the Huanan Seafood Wholesale Market of Wuhan, the animal-to-human transmission was presumed as the main mechanism. Nevertheless, subsequent cases were not associated with this exposure mechanism. Therefore, it was concluded that the virus is transmitted from human-to-human, and symptomatic people are the most frequent source of COVID-19 spread. Because of the possibility of transmission before symptoms, and thus individuals who remain asymptomatic could transmit the virus, isolation is the best way to contain this epidemic.

 

Analysis of data related to the spread of SARS-CoV-2 in China seems to indicate that close contact between individuals is necessary. Of note, pre- and asymptomatic individuals may contribute to up 80% of COVID-19 transmission. The spread, in fact, is primarily limited to family members, healthcare professionals, and other close contacts (6 feet, 1.8 meters). Concerning the duration of contamination on objects and surfaces, a study showed that SARS-CoV-2 can be found on plastic for up to 2-3 days, stainless steel for up to 2-3 days, cardboard for up to 1 day, copper for up to 4 hours. Moreover, it seems that contamination is higher in intensive care units (ICUs) than general wards and SARS-Cov-2 can be found on floors, computer mice, trash cans, and sickbed handrails as well as in air up to 4 meters from patients. [9]

 

Epidemiology

Data provided by the WHO Health Emergency Dashboard report 8,525,042 confirmed cases of COVID-19, including 456,973 deaths (as of 1:38 pm CEST, 20 June 2020).

To date, there are cases in 215 Countries. Considering case comparison, in Europe there are 2,509,750 confirmed cases; Americas 4,163,813; Eastern Mediterranean 878,428; Western Pacific 203,490; South EastAsia 206,200; Africa 208,000. The highest fatal cases have been recorded in the US (121,130) followed by Brasil (49,156), and UK (42,589). [10]

 

Treatment / Management

There is no specific antiviral treatment recommended for COVID-19, and no vaccine is currently available. The treatment is symptomatic, and oxygen therapy represents the first step for addressing respiratory impairment. Non-invasive (NIV) and invasive mechanical ventilation (IMV) may be necessary in cases of respiratory failure refractory to oxygen therapy. Again, intensive care is needed to deal with complicated forms of the disease. [11]

 

 

Prevention

Preventive measures are the current strategy to limit the spread of cases. Preventive strategies are focused on the isolation of patients and careful infection control, including appropriate measures to be adopted during the diagnosis and the provision of clinical care to an infected patient. For instance, droplet, contact, and airborne precautions should be adopted during specimen collection, and sputum induction should be avoided.

The WHO and other organizations have issued the following general recommendations:

  • Avoid close contact with subjects suffering from acute respiratory
  • Wash your hands frequently, especially after contact with infected people or their environment.
  • Avoid unprotected contact with farm or wild
  • People with symptoms of acute airway infection should keep their distance, cover coughs or sneezes with disposable tissues or clothes and wash their
  • Strengthen, in particular, in emergency medicine departments, the application of strict hygiene measures for the prevention and control of
  • Individuals that are immunocompromised should avoid public
  • Healthcare workers caring for infected individuals should utilize contact and airborne precautions to include PPE such as N95 or FFP3 masks, eye protection, gowns, and gloves to prevent transmission of the

The most important strategy is to frequently wash the hands and use portable hand sanitizer and avoid contact with their face and mouth after interacting with a possibly contaminated environment. [12]

The Vaccine

Meanwhile, scientific research is growing to develop a Sars-CoV-2 vaccine. There are more than 100 candidate vaccines in development worldwide, of those 8-10 under clinical investigation. In this ‘vaccine gaming’, Chinese researchers appear to be ahead, having completed a phase I investigation. Nevertheless, several studies are ongoing, especially in the US, and the UK. [13]

 

 

 

 

1.1.  Problem Statement:

 

In South Asia, despite implementing various public health measures, the overall situation of the COVID-19 pandemic has been worsening and there is no sign of expected epidemic growth curve to be flattened. As of 12 July 2020, over one million cases and 31,688 deaths have been reported in the South Asia, and hence created an alarming situation as one-third of the world’s population (~1.7 billion) with similar socio-economic characteristics live in these densely populated and resource limited regions. In this regard, Bangladesh could be an interesting setting to understand the characteristic of the COVID-19 pandemic from the South Asian perspective. With a population of over 160 million, Bangladesh is one of the most densely populated (1265 per square km) countries in the world. About 60% of its population is between 15 to 64 years and only 4.7% is above 65 years of age. [14]

 

Because of economic prosperity, the country has been experiencing an increasing trend of unplanned urbanization, and currently, more than 32% of people live in urban areas. Bangladesh is also undergoing nutrition and epidemiologic transition with a higher burden of non-communicable diseases (NCDs). A recent meta-analysis has shown that overall prevalence for metabolic syndrome (a cluster of health problems including high blood pressure, abdominal fat, high triglycerides, high blood sugar, and low HDL cholesterol) is higher in Bangladesh compared to the estimated world prevalence (30% versus 20-25%).[15] Besides, approximately 34% of adults are overweight and NCDs account for 67% of deaths  in Bangladesh.[16] [17]

 

The capital Dhaka city has a population of nearly 20 million, and currently it is the epicenter of COVID- 19 outbreak in Bangladesh. The first three official COVID-19 cases were reported on March 8, 2020, which included two men returning from Italy. Amid the upsurges of unofficial deaths of people with COVID-19 like symptoms, the first official death was confirmed on 18 March 2020. The city hosts more than 1 million slum dwellers and marginal communities who live in close proximity and are deprived of adequate facilities for maintaining personal hygiene as bathroom/toilets and water reservoirs are shared between several families. [18] [19]

Figure 1 represents an overall timeline of COVID-19 related major events in the first four months in Bangladesh.

Bangladesh officially started imposing intervention measures to tackle COVID-19 in

 

March 2020. After the first case was reported, flights were limited, educational institutions were closed, and health screening was imposed at all the port of entries. Two weeks after the first confirmed case, the government imposed a nation-wide lockdown (ref). During this period, all offices remain closed, public transportation was shut, gatherings and all sorts of inter-district travels were suspended, prayers in places of worship were suspended, and mandatory stay at home order was imposed. The lockdown was relaxed after 66 days at which point the total COVID-19 cases reached 47,153 with a death toll of 650. Within a week, reporting of new cases increased by roughly 50%. After three months into the pandemic, the total cases reached 68,508; among them, 14,560 (21.25%) were recovered and 930 (1.36%) were deceased.

Figure 1: Major events and public health measures in COVID-19 outbreak in Bangladesh. Deaths over time are represented in the secondary axis. [20]

  • Justification

The novel coronavirus disease 2019 (COVID-19) has triggered a public health emergency of international concern. Within a period of six months, the Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) has spread to more than 200 countries/territories, infected more than ten million people worldwide, and claimed over half a million lives. The COVID- 19 causes a plethora of clinical manifestations, and the severity and outcomes may vary depending on the underlying comorbidities (diabetes, heart diseases, hypertension, COPD), age, sex, and geographic locations. [21]

 

The present scenario of increasing Covid-19 patients and number of deaths per day shows that the global population seems to be susceptible to this virus. As the animal origin of the COVID-19 virus is unknown at present, the risk of reintroduction into previously infected areas is also high.

 

This study helps to assess the knowledge of OPD patients towards the Covid-19 disease. And this information might help to find out the knowledge gaps among the people regarding the Covid-19 and the misconceptions prevailing in the society about it.

 

  • Justification

The novel coronavirus disease 2019 (COVID-19) has triggered a public health emergency of international concern. Within a period of six months, the Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) has spread to more than 200 countries/territories, infected more than ten million people worldwide, and claimed over half a million lives. The COVID- 19 causes a plethora of clinical manifestations, and the severity and outcomes may vary depending on the underlying comorbidities (diabetes, heart diseases, hypertension, COPD), age, sex, and geographic locations. [21]

 

The present scenario of increasing Covid-19 patients and number of deaths per day shows that the global population seems to be susceptible to this virus. As the animal origin of the COVID-19 virus is unknown at present, the risk of reintroduction into previously infected areas is also high.

 

This study helps to assess the knowledge of OPD patients towards the Covid-19 disease. And this information might help to find out the knowledge gaps among the people regarding the Covid-19 and the misconceptions prevailing in the society about it.

 

 

  • Objectives:

 

  • General objectives:

To determine the level of knowledge on minimizing the spread of COVID-19 among the attending OPD patients of selected Hospital of Dhaka city.

 

  • Specific objectives:

 

  • To identify the level of knowledge on minimizing the spread of COVID-19
  • To determine source of information related on COVID-19
  • To identify the socio-demographic characteristics of OPD

 

 

 

 

  1. Review of Literature:

Until the 3 April 2020 more than 1,010,000 cases of COVID-19 have been reported in more than two hundred countries and territories, resulting in over 53,000 deaths but more than 211,000 people have recovered from this deadly virus.

On February 20, 2020, a young man in the Lombardy region of Italy was admitted with an atypical pneumonia that later proved to be COVID-19. In the next 24 hours there were 36 more cases, none of whom had contact with the first patient or with anyone known to have COVID-19. This was the beginning of one of the largest and most serious clusters of COVID-19 in the world. [31] Despite aggressive effort, the disease continues to spread and the number of affected patients is rising in Italy and it has also becomes higher than that of China. Italy has recorded higher number of cases per day and new deaths per day (>900, highest daily figure in the outbreak so far) than China. [22] Till present date (2020 March 29) the coronavirus COVID-19 has affected 199 countries and territories around the world with a total 664,590 cases, 30,890 deaths and 1,42,368 recovered cases.  [23]

Since the start of the COVID-19 outbreak, there have been extensive attempts to better understand the virus and the disease in China. It is remarkable how much knowledge about a new virus has been gained in such a short time. However, as with all new diseases, and only 7 weeks after this outbreak began, key knowledge gaps remain. The people are unknown about the source of infection, pathogenesis and virulence of the virus, transmissibility, risk factors for infection and disease progression, diagnostics, clinical management of severe and critically ill patients, and the effectiveness of prevention and control measures. The timely filling of these knowledge gaps is necessary to keep oneself safe and away from the disease and to enhance control strategies. [24]

 

The report of COVID-19 cases in the United States that occurred during February 12–March 16, 2020 and severity of disease (hospitalization, admission to intensive care unit [ICU], and death) were analyzed by age group. As of March 16, a total of 4,226 COVID-19 cases in the United States had been reported to CDC, with multiple cases reported among older adults living in long-term care facilities (4). Overall, 31% of cases, 45% of hospitalizations, 53% of ICU admissions, and 80% of deaths associated with COVID-19 were among adults aged ≥65 years with the highest percentage of severe outcomes among persons aged ≥85 years. In contrast, no ICU admissions or deaths were reported among persons aged ≤19 years. [25]

 

The trends of incidence and mortality in Bangladesh were compared with some South Asian and other countries with significant COVID-19 infections. In Figure 2, we found that Bangladesh had a similar trend of incidence during the initial phase of the pandemic (first 30 days or so). After that, the incidence in Bangladesh and other South Asian countries slowed down compared to Brazil, the USA, and European countries. As for mortality, the South Asian countries had significantly fewer deaths over time compared to the other countries in

 

 

  1. Research Methodology

 

  • Study Method & Design:

 

Quantitative study method and Descriptive types of cross sectional study were conducted during the study.

  • Study Population:

 

The study populations were the attending OPD patients of selected Hospital of Dhaka city.

 

  • Study Period:

 

The study period were conducted for six months.

  • Sampling technique:

 

Non probability purposive sampling techniques were applied for this study.

 

  • Data collection tools:

A pre-tested and modified questionnaire were used to collect the data.

Reliability of questionnaires

  • Reliability was maintained by
  • Strong emphasis was given to make questionnaire and guidelines
  • Clear and simple questions are prepared according to the educational level of the respondents
  • Data collection technique/method:

Data were collected by face to face interview with the help of structured questionnaire.

  1. RESULT

 

Table-1: Distribution of the respondents by gender (n=30).

 

 

 

Variable Frequency Percent
Male 22 73.52%
Female 8 26.67%
Total 30 100%

 

 

Table-1: The table shows that among 30 respondents, 73.52% (n=22) respondents were male and 26.67% (n=8) respondents were female.

Figure1: Distribution of the respondents by age (n=30).

Figure-1: The figure shows that among 30 respondents, 46.69% (n=16) respondents were 20- 40 age, 33.34% (n=10) respondents were 40-60 age and 20% (n=6) respondents were 60-80 age.

Figure-2: Distribution of the respondents by educational level (n=30).

Figure-2: The figure shows that among 30 respondents, 43.33% (n=13) respondents were Bachelor/Masters with educational background, 40.00% (n=12) respondents were illiterate and 16.67% (n=5) respondents were SSC passed.

 

Figure-3: Distribution of the respondents by their job (n=30).

Figure-3: The figure shows that among 30 respondents, 40.00% (n=12) respondents were working as service holder, 33.33% (n=10) respondents were unemployed, 16.67% (n=5) respondents were businessman/maid/servants/driver, and 10.00% (n=3) respondents were garments worker.

Figure 4: Distribution of the respondents according to heard about COVID-19 (n=30).

Figure-4: Regarding the heard about COVID-19, study result showed that 100.00% (n=30) respondents opined that they heard.

 

Figure-5: Distribution of the respondents by getting the sources of information related COVID-19. (n=30).

Figure-5: The figure shows that among 30 respondents, 40.00% (n=12) respondents got information regarding COVID-19d by Doctors/Nurses/Hospitals, 26.67% (n=8) respondents got from relatives / friends, 20.00% (n=6) respondents got from newspaper & 13.33% (n=4) respondents got from media.

Figure -6: Distribution of the respondent by mode of transmission for COVID-19 (n=30) (n=30).

Figure-6: The figure shows that among 30 respondents, 83.33% (n=25) respondents said that COVD-19 is a communicable disease and only 16.67% (n=5) respondents sad non – communicable disease.

Table-2: Distribution of the respondents by group peoples were been more affected in first wave of COVID-19 pandemic situation (n=30).

Variable Frequency Percent
Child 0-16years 2 6.66%
Young Adults 17-30 years 8 26.66%
Middle-aged Adults 31-45 years 15 50.00%
Elderly people Above 45 years 3 10.00%
Pregnant/lactating mother 2 6.66%
Total 30 100%

 

Table-2: The table shows that among 30 respondents, 50.00% (n=15) respondents said Middle-aged adults (31-45years) were been more affected in first wave of COVID-19 pandemic situation, 26.66% (n=8) respondents said Young adults (17-30 years), 10.00% (n=3) respondents said Elderly people (Above 45 year) and with 6.66% (n=2) respondents said Child (0-16years) & Pregnant/lactating mother simultaneously.

Figure -7: Distribution of the respondent by which genders being more infected in first wave of COVID-19 pandemic situation (n=30).

Figure-7: The figure shows that among 30 respondents, 73.33% (n=22) respondents said male were more infected in first wave of COVID-19 pandemic situation than female with 26.67% (n=8).

 

Table-3: Distribution of the respondents by groups of peoples were been more likely to risk for death in first wave of COVID-19 pandemic situation (n=30).

 

Variable Frequency Percent
Age 0-16years 0 0.00%
17-30years 3 10.00%
31-45years 5 16.67%
Above 60years 22 73.00%
Total 30 100%

 

Table-3: The table shows that among 30 respondents, 73.00% (n= 22) respondents said above 60years old were more likely to risk for death in first wave of COVID-19 situation, 16.67% (n=5) respondents said 31-45years old and 10.00% (n=3) respondents said 17- 30years old.

 

Figure 8 -: Distribution to the respondents by which genders had being died more due to COVID-19 in first wave of pandemic situation (n=30).

Figure 8-: The figure shows that among 30 respondents, 76.67% (n=23) respondents said that men were being died more due to COVID-19 rather than female with 23.33% (n=7).

Table-4: Distribution of the respondents by the sign & symptoms forCOVID-19 (n=30).

 

 

Variable Frequency Percent
Fever 5 16.67%
Sore throat 3 10.00%
Cough 2 6.67%
Whole body ache 3 10.00%
Breathlessness 5 16.67%
All of above 12 40.00%
Total 30 100%

 

Table-4: The table shows that among 30 respondents, 40.00% (n=12) respondents said all of above sign & symptoms are of COVID-19, with 16.67% (n=5) respondents said fever, 16.67% (n=5) said breathlessness, 10.00% (n=3) respondents said sore throat and 6.67% (n=2) respondents said cough.

Figure –9: Distribution of the respondents by measures to be taken for minimizing the spread of COVID-19 (n=30).

Figure-9: The figure shows that among 30 respondents, 60% (n=18) answered wearing mask measures can be taken to minimizing the spread of COVID-19, 20% (n=6) answered All of above 16.67% (n=5) answered frequent hand washing, and 3.33% (n=1) answered avoiding crowded place.

Section – C:-

Figure-10: Distribution of the respondents by scoring of knowledge on COVID-19 (n=30).

Figure-10: The figure shows scored number of knowledge on Covid-19 among the 30 respondent’s which were assessed by categorizing it into three levels of knowledge which were ‘good’ by saying ‘Yes’ (n=28), ‘average’ by saying ‘No’ (n=2) and ‘poor’ by saying ‘possibly’ (n=0). Most (93.33%) of the respondents had good knowledge regarding Covid-19. Rest possesses either average (6.67%) level of knowledge and none was poor.

 

  1. DISCUSSION

This descriptive type of cross sectional study examined knowledge regarding minimizing the spread of COVID-19 among the attending OPD patients of selected Hospital of Dhaka city with a sample size of 30.

 

In this study, the result of socio demographic factor revealed that among 30 respondents, 73.52% respondents were male and 26.67% respondents were female where 46.69% respondents were aged between 20-40years old, 33.34% were 40-60years old and 20% respondents were with 60-80years old. Among, which 43.33% respondents were Bachelor/Masters with educational background, 40.00% were illiterate and 16.67% were only SSC passed. And by their job 40.00% respondents were working as service holder, 33.33% were unemployed, 16.67% were businessman/maid/servants/driver, and 10.00% respondents were garments worker.

 

Regarding the heard for COVID-19, study revealed that 100.00% respondents had heard COVID-19 and got the information regarding COVID-19 by Doctors/Nurses/Hospitals with 40.00%, 26.67% from relatives / friends, 20.00% from newspaper & 13.33% got from media. 50.00% respondents said Middle-aged adults (31-45years) were been more affected in first wave of COVID-19 pandemic situation, 26.66% respondents said Young adults (17-30 years), 10.00% respondents said Elderly people (Above 45 year) and with only 6.66% said Child (0-16years) & Pregnant/lactating mother respectively. Among which 73.33% respondents said male were more infected in first wave of COVID-19 pandemic situation than female with 26.67%.

 

In result it was also revealed that 73.00% respondents said above 60years old were more likely to risk for death in first wave of COVID-19 situation, 16.67% (n=5) respondents said 31-45years old and 10.00% (n=3) respondents said 17-30years old & from which 76.67% respondents said that men were being died more due to COVID-19 rather than female with 23.33%.

 

More than 50% of patients infected with SARS-CoV-2 were aged between 21 and 40 years Children and elderly people belong to the least infected group. Deaths due to COVID-19 in Bangladesh increased with the age of patients. About 40% of cases aged over 60 years were four times more likely to die than the age group of 31–40 years. Males were infected (71%) and died (77%) in a higher proportion than females. [21]

 

In Bangladesh, the proportion of men catching the virus was 2.5 times more than women, although studies around the world suggest that both men and women are equally susceptible to the virus. [28] [29] a similar observation was noted in India and Pakistan where men comprised about 65% and 70% of confirmed cases, respectively. [30] [31]

 

This disparity in susceptibility might be due to cultural aspects since men dominate the outdoor activities and are less careful towards keeping up with personal hygiene. Also, the percentage of susceptibility might vary since COVID-19 is more fatal for men, causing them to seek medical care and subject to testing. [32] The death rate among males was found higher in various studies around the world. In South Asia, males died in a higher proportion: India (64%), Pakistan (74%), and Bangladesh (77%). Studies showed that men over 60 years of age are twice as likely to die of COVID-19 as women. [32] [38] This could partly be explained by the presence of higher comorbidity and the smoking habit in men, although the exact reason remains to be elucidated. [39] However, women in India had a higher case fatality rate compared to males (CFR: 2.9% versus 3.3%) which contrasts the scenario of Bangladesh (CFR: 1.4% versus 1.01%). [29] [30] Future studies should be warranted to understand the disparity in sex-specific mortality risk in South Asia.

A successful and sustainable approach to translate knowledge into appropriate prevention practices must be one that is community-oriented and people-friendly. Central to the improvement of attitude and practice is behavioral change which though requires basic knowledge but is fueled by the willingness to change the status quo. Awareness campaign messages should seek to establish the relationship between positive outcomes of good practices in the community and improvements in the health of individuals. As a way of improving the practices of communities, practical approaches in health education should be tailored to discourage negative community habits like not wearing mask & washing hand properly before eating.

 

 

 

 

 

  • Conclusion

This study concentrated only on the knowledge of OPD patients in aspects of COVID-19 related in terms of its sign and symptoms, preventive measures, knowledge related etc. This study found that attending patients in OPD hospitals had knowledge of COVID-19, with regards to its clinical symptoms, means of transmission and prevention strategies, and there was a relatively positive attitude towards the severity of the disease and the need for hospitalization.

 

There is need to institute practical and comprehensive public health measures that incorporates behavioral impact assessment at the grassroots level and channelled towards the translation of awareness into preventive practices, since mere awareness is not sufficient on its own. Closing the gap in quality access to accurate health information is key and should be directed equally across all strata of society, especially in developing countries like Bangladesh. Access to information will inform real and tangible intervention strategies for the prevention of COVID-19. Practical, family-oriented and community-based health education campaigns should be tailored to discourage negative community habits like not wearing mask & washing hand properly before eating and inspire healthy family practices that mitigate the risk of COVID-19.

Moreover, this study revealed that more than half of OPD patients had a good knowledge of COVID-19.

 

  • Recommendation

Coronavirus disease 2019 (COVID-19) has resulted in considerable morbidity and mortality worldwide since December 2019. In order to explore the preventing measures for minimizing the spread of COVID-19, a study was conducted to assess the knowledge among attending OPD patients. The recommendations that can be given are as follows:-

COVID-19 can result in more severe disease, including hospitalization, admission to an intensive care unit, and death, especially among older adults. Everyone can take actions, such as wearing mask properly, social distancing, to help slow the spread of COVID-19 and protect the population from severe illness.

Persons of all ages and communities can take actions to help slow the spread of COVID-19 and protect each other by staying away from those who are sick, avoiding crowds as much as possible, avoiding cruise travel and nonessential air travel, and staying home as much as possible to further reduce the risk of being exposed.

Individuals at the extreme of ages and those that are immunocompromised are at the most significant risk. All health care workers should understand the presentation of the disease, workup, and supportive care. Further, health professionals should be aware of the precautions necessary to avoid the contraction and spread of the disease.

As well as, maintaining good social distance is mandatory for preventing the spread of the disease.

Strict personal hygiene measures (hands wash) are necessary for the prevention and control of this infection.

Avoid close contact with subjects suffering from acute respiratory infections.

People with symptoms of acute airway infection should keep their distance, cover coughs or sneezes with disposable tissues or clothes, and wash their hands.

Immunocompromised patients should avoid public exposure and public gatherings.

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