Introduction
Coronavirus disease 2019 (COVID-19) is an emerging respiratory infection caused by a novel coronavirus called Severe Acute Respiratory Syndrome coronavirus 2 (SARS-CoV- 2). The virus is a member of the coronavirus family that are zoonotic pathogens, i.e., the viruses cause and transmit illnesses between human and several animals species such as cattle, camels, cats, and bats.2, 3 The SARS-CoV-2 virus is similar to Middle East Respiratory Syndrome coronavirus (MERS-CoV) and Severe Acute Respiratory Syndrome coronavirus (SARS- CoV), which have their origins inbats.
A novel coronavirus (2019-nCoV) was identified as the causative virus by Chinese authorities on January 7. The outbreak was declared a Public Health Emergency of International Concern on January 30, 2020. The WHO has now characterized the outbreak as a pandemic.1 This disease causes severe acute respiratory syndrome (SARS CoV- 2), which presents with symptoms like fever, cough, shortness of breath, muscle pain, sputum production, sore throat, diarrhea, abdominal pain, loss of smell, and in severe conditions leading to viral pneumonia and multi-organ failure.4, 5, 6, 7 This virus spreads through respiratory droplets and by close contact from people to people.8 From the time of exposure to onset, the symptoms show between 2-14 days, with an average of 5 days.9, 10 Elderly persons and those suffering from co-morbidities like heart disease, lung disease and diabetes, are at higher risk of developing severe COVID-19 illness.11
The standard test to be conducted for the detection of the virus is reverse transcription polymerase chain reaction (rRT-PCR) from a nasopharyngeal swab.12, 13 The health ministry has also advised observing good personal hygiene, regular monitoring of health, frequent hand washing with soap and water or use of alcohol-based hand sanitizer, to follow respiratory etiquettes, to wear a mask and to contact a doctor immediately if cough, fever or problem in breathing arises. The infection rate of COVID-19 in India is reported to be 1.7%, significantly lower than the worst affected countries, as the report on 29 March 2020.8 India announced the implementation of a nation-wide complete lockdown for 21 d (i.e. up to 14th April 2020), which only allowed essential services to operate over the entire 130 million population of India which was later extended.14
A person’s adherence to the prevention measures is essential for controlling the spread of COVID-19, which can be explain by their knowledge, attitudes, and practices (KAP) on COVID-19. Thus, we conducted a survey to investigate the KAP on COVID-19 among the medical students of a Rama Medical College during the rapid rise of the COVID-19 outbreak.
Materials and Methods
This cross-sectional survey was conducted among the medical students from Rama medical college, in Kanpur (U.P), from 30th June to 20th July 2020, the 3 weeks the 2nd unlock period of India. As we all know, social- distancing is the best way of prevention from COVID-19, therefore instead of conducting a community-based survey, present study collected the data by means of an online survey. Ethical clearance was taken from ethical committee. The survey questionnaire formwhichwas adapted from a Chinese study by Bao-Liang Zhong et al15 was posted and circulated using various social media platforms like Whatsapp Group and e-mail address of the students. The study participants were informed about the details of the study objectives for filling the questionnaire and confidentiality at the beginning of the survey, and informed consent was obtained from each participant. It has been disclosed to all the participants that their identity will keep confidential and the results will be used only for research purposes. Among the 300 students responses of 7were incomplete and 12 were not responded therefore our final sample for present study was 281.
Questionnaire
A self-designed questionnaire was prepared, which comprised two parts to collect details of the participants profile along with KAP towards COVID-19. The questions were established on the basis of some published literature and the authors’ experience of KAP. After the preparation of the questionnaire, it was sent to some experts to consult their opinions regarding the validity of the questionnaire followed by a small pilot study to test its simplicity and difficulty. However, the results of the pilot study were not included in the actual samples used for the study.
The first part of the questionnaire covered information of the participants profile and the second part contained questions for KAP assessment. Participants profile variables included age, gender and MBBS Batch (as per year of admission in Institution). The self-designed questionnaire comprised 11 questions regarding knowledge, 4 for attitude, and 8 for practice.
Knowledge questions mainly dealt with the participants’ knowledge regarding clinical symptoms, transmission routes, prevention, and control of COVID-19. These questions were responded on a true/false basis with an additional “I don’t know” option. The true answer was assigned with 1 point and false/I don’t know answers were assigned with 0 point. Higher scores represented a better knowledge of COVID-19. Similar options were assigned for the questions related to attitude while only two options namely ‘Yes’ and ‘No’ were assigned for the questions related to practice towards COVID-19.
Statistical analysis
Statistical analyses were performed using SPSS, version 22. Knowledge, attitude, and practice Measurement data were expressed as mean ± SD and categorical data were expressed as frequency and percentage. Parametric test (independent samples t-test) was used for comparison between different subgroups of the participants. Comparisons of KAP scores among the students with respect to gender and age group are done using independent samples t-test, as appropriate. The statistical significance level of the test was expressed as (α=0.05).
Results
Study participants profile
Frequency and percentage of all the participants characteristics like gender, age, and MBBS Batch (year in which they joined) are represented in ? Table 1. Out of the 281 participants, 50.2% were males while the rest were female (49.8%); the majority of them 63.3% were ≥21 years old while only 36.7% were 17-20 years old. Almost equal number of participants from 2018 Batch 33.8% and 2019 bath 33.5% rest 32.7% from 2017 MBBS Batch.
Knowledge
The results of the knowledge survey are presented in Table 2. Most of the participants (79.7%) had correct information about the main clinical symptoms of COVID-19. About 83.6% of the study subjects were aware symptomatic supportive treatment is helpful in most patients to recover from the infection.
Majority of the participants knew about the transmission of the virus, but only 42.7% of the total participants agreed that general population can wear ordinary triple layered cloth mask for protection against infection from COVID-19 virus. Level of knowledge about prevention and treatment was high among the students, (88.3%) knew that they should avoid crowded places i.e., public places and limit public transport to minimum in order to prevent COVI-19 virus infection. Majority (94.3%) knew that immediate isolation of people with h/o contact with someone infected with the COVID-19 Virus generally for 14 days is necessary.
Table 2
Knowledge
Attitude
Table 3 shows that about 79.7% participants said that Mass media (eg, newspapers, internet, and television news channels etc.) are the major source of information about COVID-19 virus. Majority had a positive attitude towards the lockdown and curfews in containment, could possibly control the spread of virus.73.3% had an optimistic view that the pandemic would be successfully controlled in the future.
Table 3
Attitude
Practice
Table 4 presents preventive practices of the participants during the COVID-19 pandemic. Majority reported that there was a considerable increase in hand washing and use of hand sanitizer during this period. About 91.5% agreed that they use gloves and masks more frequently now. Majority (92.5%) now carry a sanitizer with them. Social distancing and respiratory etiquettes were followed by 94.3% and 94% respectively. 96.8% avoided unnecessary travel after the COVID-19 pandemic. While only 56.9% participants had saved any helpline number for COVID-19 in case of any queries or information was required.
Table 4
Practice
Awareness, attitude and practices scores
Table 5 describes the scores of knowledge, attitude, and practices towards COVID-19 with respect to demographic variables such as gender, age, and religion. The knowledge scores of the male were slightly higher than that of females, although the difference was not significant(P>0.05). Higher scores of males were observed in the attitude and practice as compared with that of females. In addition, the difference in practice score was significant between different genders (P<0.05), therefore, it is recommended that Females should pay more attention to practice towardsCOVID-19. Secondly, the KAP score for the age-category of 17-20 was higher than the other category, with no significant difference among groups (P>0.05).
Table 5
Awareness, attitude and practices scores (Independent Sample t-test)
Discussion
An increasing role of medical students in spearheading a voluntary task force while gaining skills and experience has been proposed in recent times.16 In the midst of this crisis, the Indian health ministry has proposed to provisionally permit medical undergraduates of senior grades to treat COVID-19 patients.17 COVID-19 is a global pandemic and all the countries are fighting with this disease. Many accept that medical students can be considered in a portion of the emergency and non-emergency clinical based jobs and should be prearranged for health care workers shortage.18 This approach would not only help to reduce the doctor population ratio and provide care to a large number of people in need. Hence, medical students were included in our study. Since COVID 19 is a new disease there is a limited information around, so it is all the more essential to provide the medical students with authentic and relevant information.
In the present study 50.2% were males while the rest were female (49.8%); the majority of them 63.3% were ≥21 years old while only 36.7% were 17-20 years old. Almost equal number of participants from 2018 33.8% and 2019 batch 33.5% rest 32.7% from 2017 MBBS Batch (Table 1). Similarly in a study by Vishwesh Agarwal et al19 done in April 2020 out of 616 undergraduates (age 21.5 years, 46.1% males) had recently completed (16.7%) or in the final year of their undergraduate training program (54.1%). Demographic factors, especially the association between gender and KAP towards COVID-19 are consistent with previous studies on COVID-19 and SARS in 2003 in general.15, 20, 21
Regarding the knowledge about COVID 19, majority of the participants in this study (79.7%) had correct knowledge about the main symptoms of COVID-19. These findings were comparable to studies done by Taghrir et al22 and Alzoubi et al.23 83.6% of the participants aware of about that early symptomatic and supportive treatment can help most patients recovering from the infection. Similarly in the study by Modi et al24 in Mumbai, the overall percentage of correct answers from study participants was 71.2% with the highest percentage of correct responses from medical undergraduate students (74.10%) and lowest from the non-clinical/administrative staff (53.64%). In our study majority of the students had correct knowledge about the transmission routes of the virus which were comparable with the study by Ambika Sharma25 done in April 2020 where almost all knew the mode of transmission of infection and common preventive measures. In the present study most of them believed that washing hands and wearing mask are important for prevention. Consciousness about the prevention and treatment was high.(88.7%) knew that COVID-19 can be prevented by avoiding crowded places such as train stations and avoiding public transportation. Similarly in a study by Modi et al24 more than 75% of the responders were aware of the various infection control measures like rapid triage, respiratory hygiene, and cough etiquette and having a separate, well-ventilated waiting area for suspected COVID-19 patients. 94.3% of participants in our study knew that people who have contacted with someone infected with the COVID-19 virus should be immediately isolated in a proper place. In general, the observation period is 14 day. 88.5% of students correctly answered about incubation period of disease as 1-14 days in the study done by Taghrir et al.22 and Ambika Sharma25 Results were similar in study by Giao et al26 from Vietnam, only 60-70% of the HCWs were aware of the incubation period, treatment options and route of transmission. In our study 79.7% of the students agreed that media coverage (e.g. newspaper, television, online) give much exposure to news about COVID-19 virus are consistent with results by Ambika Sharma25 where common source of information was internet, television, and social media. Similarly study by M. Saqlain et al.27 87.68% of HCWs used social media as their main source of information, followed by radio and television (45.89%) and seniors/other colleagues (42.51%). In the present study 96.8% of the participants avoided unnecessary travel or outing during the outbreak. Maintaining social distance during the outbreak was the second most prevalent behavior reported by the participants. A high percentage of were following all the preventive practices Similarly 94.47% medical students answered yes for practicing preventive behavior in a study done on Iranian medical students by Taghrir et al.22 In the present study the knowledge scores of the male were slightly higher than that of females. Higher scores of males were observed in the attitude and practice as compared with that of females, difference in practice score was significant between different genders (P<0.05).KAP score for the age-category of 17-20 was higher than the other category, with no significant difference among groups (P>0.05). Similarly in the study by Taghrir et al.22 difference between males and females was significant in risk perception at level of P< 0.01 Females had lower risk perception.
Conclusion
Positive results were seen in the study but there is constant need of updating knowledge of the health force since concepts about COVID-19 are evolving on an everyday basis. Implementing Periodic educational interventions, training programs and conducting webinars on infection control practices for COVID-19 for all health care workers and students can be very useful for improving awareness. Updates by the World Health Organization and government websites are best and authentic sources for health care workers to review their knowledge.
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