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 Table of Contents  
ORIGINAL ARTICLE
Year : 2021  |  Volume : 9  |  Issue : 2  |  Page : 61-66

Knowledge, attitude, and practices toward COVID-19 of people staying in night shelters during lockdown in Kakinada, Andhra Pradesh


Department of Community Medicine, Rangaraya Medical College, Kakinada, Andhra Pradesh, India

Date of Submission07-Jan-2021
Date of Decision16-Jan-2021
Date of Acceptance22-Mar-2021
Date of Web Publication11-Jun-2021

Correspondence Address:
Dr. Jeevanapriya Pala
Flat No: 201, V. V. R. Towers, D. No. 7-9-36/1, Ramaraopeta, Kakinada - 533 004, Andhra Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/mjhs.mjhs_3_21

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  Abstract 


Background: Coronavirus disease-2019 (COVID-19) has emerged as a serious public health problem worldwide. Appropriate knowledge, attitude, and practices like wearing a mask always and in a proper manner, following social distancing and handwashing frequently are some measures required to protect oneself from COVID-19. Government of India and State Governments have created the lot of awareness.
Objectives: To assess and determine the factors responsible for knowledge, attitude, and practices of people staying in night shelters toward COVID-19 in Kakinada.
Materials and Methods: A cross-sectional study was conducted among 131 members staying in night shelters. The present study was carried out using the semi-structured questionnaire. Study participants were contacted and interviewed to assess the knowledge, attitude, and practices.
Results: Majority were males (89.3%); 40.4% were married; 63.4% were from rural areas; 70.9% were migrant laborer; 55.7% were Hindu; 41.2% belonged to backward class; 37.4% were educated up to primary class; and 67.2% had income <400 INR per day. Mean knowledge, attitude, and practice scores were 7.4 ± 2.78, 6.36 ± 2.59, and 4.36 ± 1.43, respectively. Multiple linear regression analysis showed that age group >50 years (vs. <50 years), location urban (vs. rural), marital status married (vs. separate, others), education primary (vs. illiterate, secondary, inter) were significantly associated with high knowledge score (P < 0.05). Age group <50 years, gender female (vs. males), and education illiterate (vs. primary and secondary) were significantly associated with positive attitude toward COVID-19 (P < 0.05). There was no statistically significant correlation between practice and the sociodemographic variable.
Conclusion: The overall knowledge, attitude among night shelters in Kakinada was just above average but with poor practices.

Keywords: Attitude, knowledge, night shelters, practice


How to cite this article:
Pala J, Babu GK, Babji K. Knowledge, attitude, and practices toward COVID-19 of people staying in night shelters during lockdown in Kakinada, Andhra Pradesh. MRIMS J Health Sci 2021;9:61-6

How to cite this URL:
Pala J, Babu GK, Babji K. Knowledge, attitude, and practices toward COVID-19 of people staying in night shelters during lockdown in Kakinada, Andhra Pradesh. MRIMS J Health Sci [serial online] 2021 [cited 2021 Oct 21];9:61-6. Available from: http://www.mrimsjournal.com/text.asp?2021/9/2/61/318152




  Introduction Top


Wuhan, China was the center of emergence for the coronavirus disease 2019 (COVID-19) in December 2019. It has rapidly spread to >200 countries and territories. On January 30, 2020, COVID-19 was declared as “public health emergency of international concern” by the World Health Organization (WHO). It was the highest level alarm given by the WHO in recent years.[1] As on September 30, 2020, there were 34 million cases and 1.02 million deaths worldwide.[2] The first case from India was confirmed in Thrissur district of Kerala on January 30, was a student come for vacation from Wuhan University, China. As of September 30, 2020, India has recorded >6.3 million cases and 98,708 deaths.[3]

The Prime Minister enforced national lockdown on March 24, 2020 as a “Preventive measure to reduce community spread and the overburdening of the country's health system.” The lockdown has severely impacted migrants, several of whom lost their jobs and shelter. Most of the migrants began walking to their native place as there was no means of transport but stranded outside in their native places due to restrictions made by state governments. Wanting to get back, the migrants were trapped as the borders not only between the two states but also between the two districts were sealed. To ensure that there is no movement of migrants during lockdown, to prevent the spread of coronavirus, the state governments were instructed to use the National Disaster Response Fund so that these migrants will be provided with shelter and food.[4] Kerala was the first state in India to open relief camps for over one lakh migrant workers on March 27, followed by Delhi on March 28, 2020. Government of Andhra Pradesh provided food and shelter for migrant labors and homeless right from March 31, 2020. District Collector or Municipal Commissioner appointed individual “Nodal Officer” to take care of these arrangements for migrants and other needy people. “Auxiliary Nurse Mid-Wife (ANM) of Primary Health and Surveillance Team” was appointed to carry out health checkup of all the people in the state.

Migrants reacted in panic and confusion toward pandemic. They often denied adequate healthcare, nutrition, housing, and sanitation.[5] As they are working in informal sector, belongs to low socioeconomic status and most of them not aware of social media, raises questions regarding the level of understanding and attitudes toward COVID-19 among them. Most of the studies were online studies that lead to less coverage of migrant people.

COVID-19 is a new virus causing devastating effect on global health by affecting all sectors. There have been limited published data on knowledge, attitudes, and practices toward COVID-19 among migrant workers. Due to uncertainty of origin, clinical features and transmission of COVID-19, health authorities have no definitive strategies to manage the public, even worst situation in case of migrant workers. Migrant workers were most affected group during national wide lockdown as they neither have any work to do nor they able to travel back to native places.[5] It is therefore of utmost importance to study knowledge, attitudes, and practices of migrant workers to guide health authorities in planning measures to prevent the spread of COVID-19. The present study was done in night shelters established for migrant people in Kakinada during the pandemic to study their knowledge, attitude, and practices related to COVID-19.

Objectives

  1. To assess knowledge, attitude and practices of people staying in night shelters toward COVID-19
  2. To determine the factors responsible for knowledge, attitude, and practices among study participants.



  Materials and Methods Top


Study design

It was a cross-sectional study.

Study period

The study was conducted from April 1 to May 17, 2020.

Settings

The study was conducted in night shelters of Kakinada.

Sample size

All 131 members who were staying in two night shelters in Kakinada were included in the study.

Ethical approval

Institutional Ethics Committee approval was taken. Informed consent was obtained from study participants. They were given health education at the end of the data collection.

Inclusion criteria

  1. All persons aged above 18 years of either gender staying in the night shelters in Kakinada during the study period
  2. Willing to respond and participate in the present study.


Exclusion criteria

  1. Persons in the night shelters with severe comorbidities, ill health, or not willing to participate.


Study tool

The study was carried out by using predesigned semi-structured questionnaire. Internal consistency reliability of questionnaire was calculated using Kuder and Richardson Formula 20 (KR-20).[6] The reliability values for knowledge – 0.74, attitude – 0.84, and practice – 0.67. The questionnaire had four components: Demographics, knowledge, attitude, and practice. Demographic variables included age, gender, religion, caste, education level, occupation, and residence. Knowledge had 12 questions, about symptoms, risk factors, transmission, preventive measures of COVID-19. These questions were answered on a Yes/No/I don't know measures. Total score ranged from 0 to 12. To measure attitude of the participants, 12 questions were asked with yes/no options and attitude range from 0 to 12. Practices were assessed using eight questions with yes/no options and score ranged from 0 to 8. “Modified Blooms cutoff of 80% was used to determine sufficient knowledge (≥80%), positive attitude (>10), and good practice (>6).”[7]

Likely biases and its control

As the study was interview based, recall bias is natural. However, as the situation is recent one and there is continuous awareness program going on, recall bias is likely to be very limited in this study. Length of interview was kept constant for all the study participants to overcome the interviewer's bias.

Data analysis

Data were entered in the MS Excel 2019. Analyses were performed using the IBM SPSS Statistics for Windows, Version 20.0. Armonk, New York, USA. At the time of interview, only it was ascertained that there should not be any missing data. Descriptive statistics and relevant tables were used to summarize the information. Associations between the independent variables and dependent variables were assessed using multiple regression analysis.


  Results Top


A total of 131 members participated in the study with an average age was 50.25 ± 11.91 years. Majority of patients were males 117 (89.3%). 40.4% were married; 63.4% were from rural areas; 70.9% were migrant laborer; 55.7% were Hindu; 41.2% belonged to backward class; 37.4% were educated up to primary class and 32.8% were illiterate; 67.2% had income <400 INR per day [Table 1].
Table 1: Sociodemographic characteristics of study subjects (n=131)

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Mean knowledge score was 7.4 ± 2.78. Overall correct answer rate of the knowledge questionnaire was 61.6%. 35.9% (47) of the participants scored 80% or more and were considered to have sufficient knowledge [Figure 1]. Major source of information was from health care providers 94 (71.8%), followed by hostel staff 88 (67.2%) [Figure 2]. Most participants knew that COVID-19 is a contagious disease 104 (79.4%). Seventy-four percent of participants believed that disease spreads through droplets. About preventive measures against COVID-19, 83.2% (109) participants were aware of wearing mask, 71% (93) were aware of washing hands followed by avoiding crowded places 65.6% (86), social distancing 56.5% (74) [Figure 3].
Figure 1: Distribution of study participants based on knowledge, attitude, and knowledge score (n = 131)

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Figure 2: Percentage distribution of source of information regarding coronavirus disease-2019 (n = 131)

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Figure 3: Percentage distribution of preventive measures toward coronavirus disease-2019 (n = 131)

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Mean attitude score was 6.36 ± 2.59 and correct answer rate was 61.6%. Only 24.4% (32) have positive attitude toward COVID-19 [Figure 1]. Majority of participants 74.8% (98) were believed that wearing mask can prevent COVID-19. Only 45.8% (60) have positive attitude toward hand washing. Study participants expressed being bored 62 (47.3%), angry 39 (29.7%), stressed 28 (21.3%), happy 72 (54.9%) about staying in night shelters during national lockdown due to pandemic. 60.3% (79) participants were refer themselves to stay in shelter.

Mean practice score was 4.36 ± 1.43 and correct answer rate was 54.5%.24.4% (32) of study participants were following good practices [Figure 1]. 24.4% (32) of study participants were following good practices. Only 67.2% (88) of participants were wearing the mask continuously and 60.3% (79) were washing mask once a day. 33.6% (44) were following hand washing measures correctly. 52.7% (69) were maintaining social distance of three feet inside the shelter. Fifty-six (42.7%) of the participants approached health care persons visiting the shelter for the symptoms of fever, cough, cold gastritis, knee pains, and body pains.

Median knowledge score was slightly better among people <50 years (8.1 ± 2.79) when compared to >50 years (7.4 ± 2.77). Median attitude and practice scores were similar in both age groups with less variation of attitude scores among <50 years age group [Figure 4]. Median scores of knowledge, attitude, and practice were little higher among females than male participants [Figure 5]. Migrant laborers have high median knowledge scores (7.8 ± 2.79) than destitute (7.4 ± 2.8). Most of the destitute have positive attitude (toward COVID-19 and following good practices (6.7 ± 2.61) when compared to migrant laborers (6.2 ± 2.61), respectively [Figure 6].
Figure 4: Level of knowledge, attitude, and practices of study participants stratified by age group

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Figure 5: Level of knowledge, attitude and practices of study participants stratified by gender

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Figure 6: Level of knowledge, attitude and practices of study participants stratified by occupation

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Multiple linear regression analysis showed that age group >50 years (vs. <50 years), location urban (vs. rural), marital status married (vs. separate, others), education primary (vs. illiterate, secondary, inter) were significantly associated with high knowledge score (P < 0.05). Age group <50 years, gender female (vs. males), education illiterate (vs. primary, secondary) were significantly associated with positive attitude toward COVID-19 (P < 0.05). There was no statistically significant correlation between practice and the sociodemographic variable at P < 0.05 [Table 1].


  Discussion Top


Majority were males (89.3%); 40.4% were married; 63.4% were from rural areas; 70.9% were migrant laborer; 55.7% were Hindu; 41.2% belonged to backward class; 37.4% were educated up-to primary class; 67.2% had income <400 INR per day. Mean knowledge, attitude, and practice score was 7.4 ± 2.78; 6.36 ± 2.59; 4.36 ± 1.43, respectively. Multiple linear regression analysis showed that age group >50 years (vs. <50 years), location urban (vs. rural), marital status married (vs. separate, others), education primary (vs. illiterate, secondary, inter) were significantly associated with high knowledge score (P < 0.05). Age group <50 years, gender female (vs. males), and education illiterate (vs. primary, secondary) were significantly associated with positive attitude toward COVID-19 (P < 0.05). There was no statistically significant correlation between practice and the sociodemographic variable.

From our study, only 35.9% of study participants were found to have sufficient knowledge. This score is much lower than that reported in the Chinese general population (90%) by Wang et al.,[8] among the general population of Andhra Pradesh (90%) Narayana et al.[9] in Andhra Pradesh and 77.2% in a study done in Malaysian public by Azlan et al.[10]

Moderate knowledge score was 37.4% and 26.7% had poor knowledge scores. Participants with no income, illiterates scored lowest knowledge scores. This indicates limitations in disseminating information to all the sectors of the community. 24.4% of participants have positive attitude toward COVID-19, whereas in an online study conducted by Kartheek et al.[11] in India, it was found that 87.2% of study participants showed positive attitude toward COVID-19, and Wang et al. noted this one as 46% among the Chinese population.[8]

Majority of them were neutral (50.4%) toward COVID-19 in the present study. Negative attitude was shown by 25.2% which was proportionately more among separated and divorced; those belong to scheduled caste and illiterates. Even though they were under constant supervision by staff, only 24.4% were following good practices, whereas it was >90% in studies conducted by Narayana et al.,[9] Kartheek et al.[11] in India, and >80% among Malaysian public.[11] 62.6% were following moderate practices and 13% were following poorly.


  Conclusion Top


The knowledge and attitude related to COVID-19 prevention and care among people living in the night shelters was just above the average, but practices were poor. They were well informed about the disease and its prevention. There is need to develop innovative ideas so that practices can be improved.

Acknowledgment

The authors acknowledged great fully the efforts of the volunteers, ANMs, and the respondents who participated in the study.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

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World Health Organization. Listing of WHO Response to COVID-19. Available from: https://www.who.int/news/item/29-06-2020-covidtimeline. [Last accessed on 2020 Apr 05].  Back to cited text no. 1
    
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Worldometer. Corona Virus Update (Live): Cases and Deaths from COVID-19 Virus Pandemic. Worldometers; 2020 p. 1 Available from: https://www.worldometers.info/coronavirus/%0Ahttps://www.worldometers.info/coronavirus/? [Last accessed on 2020 Apr 05].  Back to cited text no. 2
    
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Covid19India. Corona Virus Outbreak in India - Covid19india.org; 2020. p. 3-7. Available from: https://www.covid19india.org/. [Last accessed on 2020 Apr 05].  Back to cited text no. 3
    
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Chevalerie S. Indian Migrant Workers during the COVID-19 Pandemic. Wikipedia; 2020. p. 1-17. Available from: https://en.wikipedia.org/wiki/Indian_migrant_workers_during_the_COVID-19_pandemic. [Last accessed on 2020 Apr 05].  Back to cited text no. 4
    
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Elsevier. Novel Corona Virus Information Centre. Elsevier's Free Health and Medical Research on the Novel Corona Virus (SARS-CoV-2) and COVID-19. Available from: https://www.elsevier.com/connect/coronavirus-information-center. [Last accessed on 2020 Apr 05].  Back to cited text no. 5
    
6.
Bolarinwa OA. Principles and methods of validity and reliability testing of questionnaires used in social and health science researches. Niger Postgrad Med J 2015;22:195-201.  Back to cited text no. 6
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7.
Anderson LW, Krathwohl DR, Bloom BS. A Taxonomy for Learning, Teaching, and Assessing: A Revision of Bloom's Taxonomy of Educational Objectives (Complete Edition). New York: Longman; 2001.  Back to cited text no. 7
    
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Wang C, Tian Q, Zhao P, Xiong M, Latkin CA, Gan Y, et al. Disease knowledge and attitudes during the COVID-19 epidemic among international migrants in China: A national cross-sectional study. Int J Biol Sci 2020;16:2895-905.  Back to cited text no. 8
    
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Narayana G, Pradeepkumar B, Ramaiah JD, Jayasree T, Yadav DL, Kumar BK. Knowledge, perception, and practices towards COVID-19 pandemic among general public of India: A cross-sectional online survey. Curr Med Res Pract 2020;10:153-9.  Back to cited text no. 9
    
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Azlan AA, Hamzah MR, Sern TJ, Ayub SH, Mohamad E. Public knowledge, attitudes and practices towards COVID-19: A cross-sectional study in Malaysia. PLoS One 2020;15:e0233668.  Back to cited text no. 10
    
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Kartheek AS, Gara KH, Vanamali DR. Knowledge, attitude and practices towards COVID-19 among Indian residents during the pandemic: A cross-sectional online survey. J NTR Univ Health Sci 2020;9:107-15.  Back to cited text no. 11
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