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 Table of Contents  
ORIGINAL ARTICLE
Year : 2021  |  Volume : 28  |  Issue : 3  |  Page : 149-159

Perception and practices towards Covid-19 amongst residents in Southern Nigeria


1 Department of Community Medicine, University of Uyo; Institute of Health Research and Development, University of Uyo Teaching Hospital; Health Systems Research Hub, University of Uyo, Uyo, Akwa Ibom State, Nigeria
2 Institute of Health Research and Development, University of Uyo Teaching Hospital; Department of Anaesthesia, College of Health Sciences, University of Uyo, Uyo, Akwa Ibom State, Nigeria
3 Institute of Health Research and Development, University of Uyo Teaching Hospital; Department of Internal Medicine, Faculty of Clinical Sciences, College of Health Sciences, University of Uyo, Uyo, Akwa Ibom State, Nigeria
4 Health Systems Research Hub, University of Uyo, Uyo, Akwa Ibom State, Nigeria
5 Department of Community Medicine, College of Health Sciences, University of Uyo, Uyo, Akwa Ibom State, Nigeria

Date of Submission11-May-2021
Date of Decision01-Sep-2021
Date of Acceptance10-Sep-2021
Date of Web Publication22-Oct-2021

Correspondence Address:
Dr. Christie Divine Akwaowo
Department of Community Medicine, University of Uyo Teaching Hospital, Uyo, Akwa Ibom State
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/npmj.npmj_554_21

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  Abstract 


Background: Within a short duration, coronavirus disease 2019 (COVID-19) spread globally, affecting all facets of life and causing widespread panic. This study set out to assess the perception and practices towards COVID-19 of urban and rural residents in Akwa Ibom State, Nigeria. Materials and Methods: A cross-sectional study design and multistaged sampling technique were used. Data were collected using an interviewer-administered questionnaire between October and December 2020. Scores assessing perception and practices were allocated and graded based on specific stratified demarcations. P < 0.05 was considered statistically significant. Results: A total of 822 individuals from the selected households were interviewed (urban: 401, 48.8%; rural: 421, 51.2%). Majority of respondents urban (99.8%) and rural (97.9%) were aware of COVID-19. Most respondents had low risk-perception of COVID-19 (62.4%), with significantly more rural respondents having low-risk perception (70.6% rural vs. 54.0% urban). The general perception of COVID-19 amongst the respondents was good (79.2%) with no statistically significant difference between urban and rural residents. Most of the participants had good practices towards COVID-19, with significantly higher proportion of urban respondents having good practice (93.8%) compared to their rural counterparts (83.1%). Amongst rural residents, high-risk perception was associated with higher proportion of good practice (93.4%) compared to 84.5% of low-risk perception (P = 0.015). Conclusions: The participants had high level of awareness, low risk perception, good general perception and good practices toward COVID-19. However, urban respondents showed better practices towards COVID-19. More attention should be directed towards improving COVID-19 perception and practices particularly amongst rural residents.

Keywords: Coronavirus disease 2019, Nigeria, perception, practice, rural, urban


How to cite this article:
Akwaowo CD, Eyo CS, Umoh IO, Ekpin VI, Esubok NU. Perception and practices towards Covid-19 amongst residents in Southern Nigeria. Niger Postgrad Med J 2021;28:149-59

How to cite this URL:
Akwaowo CD, Eyo CS, Umoh IO, Ekpin VI, Esubok NU. Perception and practices towards Covid-19 amongst residents in Southern Nigeria. Niger Postgrad Med J [serial online] 2021 [cited 2021 Nov 28];28:149-59. Available from: https://www.npmj.org/text.asp?2021/28/3/149/328774




  Introduction Top


The novel coronavirus disease 2019 (COVID-19) has rapidly spread around the globe since its discovery in December 2019, leaving in its wake a global health crisis, as well as an economic one.[1] In February 2020, the World Health Organisation (WHO) declared it a pandemic, as it had spread to 114 countries at the time.[2] Globally, as of 27 December 2020, there have been over 79 million COVID-19 cases including 1,754,493 deaths due to the disease.[3] In Nigeria, there have been 83,576 cases with 1247 deaths.[3] Although the African region has been the least affected by the disease so far, the number of new cases appear to be rising in recent times.[3],[4] The WHO has stated that the African region is not carrying out enough testing, warning that COVID-19 will turn into a 'silent epidemic' unless more testing is done.[5],[6]

Due to the lower impact of COVID-19 in Africa, and in Nigeria specifically, lockdowns have been eased, and people have gone back to their everyday life.[7] This may be responsible for the recent rise in COVID-19 cases. The newly approved COVID-19 vaccine appears very promising; however, it may take several months or years for these vaccines to get to most countries in the African continent,[8],[9] hence, the practice of precautionary measures against COVID-19 is still very much necessary. The WHO recommends the prevention of person-to-person transmission by frequent hand washing, social distancing and respiratory hygiene (covering mouth and nose while coughing or sneezing).[10] Previous studies have unveiled rural/urban health disparities in the practice of preventive behaviours such as wearing sunscreen,[11] cancer screening[12] and influenza vaccinations.[13] A recent study in China reported that compared with urban residents, rural residents performed less preventive behaviours and had negative attitude, even after controlling for demographic characteristics.[14]

The battle against COVID-19 is still ongoing in Nigeria and to ensure favourable outcomes, people's adherence to control measures is essential. This is largely affected by their knowledge, attitudes and perception towards COVID-19.[15] To our knowledge, no study has been done in Akwa Ibom State to assess the perception and practice towards COVID-19. Hence, the aim of this study is to assess and compare the perception of urban and rural respondents and their practices towards COVID-19 in Akwa Ibom State, Nigeria.


  Materials and Methods Top


Data collection for this study took place between 09 October 2021 and 14 October 2021 amongst rural residents and 02 December 2020 and 05 December 2020 amongst urban residents.

Ethical considerations

Ethical approval was obtained from the University of Uyo Teaching Hospital Institutional Health Research and Ethics Committee (Ethical approval Reference: UUTH/AD/S/96/Vol XXI/472) on the 06 November 2020. Informed written consent was obtained from respondents before questionnaires were administered. Data collectors observed strict COVID-19 protocols by wearing face masks throughout the survey and also gifting a facemask to each respondent in the study. The respondents were required to wear the masks during the interview.

Study location

The study was conducted in Akwa Ibom State, located in southern Nigeria. The State has an estimated population of 5.48 million people.[16] It is an oil-rich state comprising 31 local government areas (LGAs), stratified into urban, semi-urban and rural. The state is predominantly populated by the Ibibios, Annangs and the Oron. However, a lot of foreign citizens from all over Nigeria reside in the State Capital City, Uyo.

The state has 31 LGAs and three senatorial districts (North-East/Uyo, North-West/Ikot Ekpene and South/Eket senatorial districts).

Study design and study population

An analytical cross-sectional study was conducted in three rural communities and in Uyo, the capital city. The communities surveyed included Efoi, Adiasim and Ikot Akpamba. For the urban setting, the communities studied were Akapasak Estate, Silver Jubilee and Idoro Estate all in the capital city. The study population comprised individuals 18 years and older, who gave consent to participate in the study. All adults who did not consent or were too sick to respond were excluded from the survey.

Sampling technique

A multistaged sampling method was employed in the study. Simple random sampling was used to select one LGA stratified by senatorial district. From the list of villages in the LGA, one village was selected from each local government. Adiasim was selected for Ikot Ekpene Senatorial District, Ikot Akpamba for Uyo senatorial district and Effoi for Eket senatorial district. Each of the villages comprised approximately 600 households. A systematic random sampling method was then used to select approximately 200 households in each community. Every second household in each of the selected communities was selected for the survey.

Sample size determination

Using the formula for the comparison of independent proportions,[17] the sample size was calculated as follows:

n = (u + v)2× (P1q1 + P2q2)/P1P2

n = minimum sample size per group

u = 1.28 the standard normal deviate at power of 90%

v = 1.96 (standard normal deviates at 95% confidence interval)

P1 = prevalence of good practice in previous study (41.6%).[18]

q1 = 1 − P = 1 − 0.416 = 0.584

The expected difference in prevalence of good practice between urban and rural (p1 − p2) is within 10%,

n = 360

Adding 10% of non-response rate makes a total of 400.

A total of 401 and 421 respondents participated in this study from urban and rural areas, respectively.

Study instruments

An interviewer-administered, semi-structured questionnaire was used in this study. The questionnaire was adapted from the WHO and NCDC guidelines for COVID-19. Already available literature was explored in-depth and synchronized into a framework which grouped various questions under the different themes including knowledge, attitudes, perception and practices. The questionnaire was validated by pre-testing and analysing on thirty participants resident in Uyo. The questionnaire comprised four sections: section A obtained information on the sociodemographic characteristics, Section B elicited information on awareness and sources of information of COVID-19, Section C elicited perception of COVID-19 and Section D elicited practice of respondents towards COVID-19.

Data management

Data obtained were analysed using Statistical Package for the Social Sciences version 22 (IBM SPSS statistics for windows version 22.0. Armonk, NY, USA: IBM Corp.). The categorical data were summarized with frequency and percentages. Pearson's Chi-square was applied to assess the relationship between respondents' sociodemographic characteristics and their knowledge and attitude towards COVID-19. Statistical significance was set at P < 0.05.

Outcomes

Perception

Eight questions assessed the respondents' perception of COVID-19. This section was divided into risk perception and general perception. Risk perception was assessed by 2 questions with scores ranging from 2 to 6. High risk perception was taken as a score of 4 and above, while low risk, <4. General perception was assessed by 6 questions, with scores ranging from 5 to 16. A score of 11 and above was considered good, while a score below 11 was considered poor.

Practice

Ten questions assessed respondents' practice towards COVID-19, with scores ranging from 10 to 50. Good practice was taken as a score of 30 and above and poor <30.


  Results Top


Sociodemographic characteristics of respondents

A total of 822 respondents participated in this study, with 401 (48.8%) urban and 421 (51.2%) rural. Majority were aged 25–39 years (48.7%), female (52.4%), married (59.0%) and had secondary education (41.5%). Business was the most prevalent occupation (29.4%) and most were of the Ibibio tribe (49.6%). There was statistically significant difference in the age, gender, marital status, level of education, occupation and tribe of urban and rural respondents [Table 1].
Table 1: Socio-demographic characteristics of respondents

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Respondents' awareness of coronavirus disease 2019

Nearly all respondents were aware of COVID-19, however, 9 (2.1%) of urban respondents were not aware of COVID-19, compared to 1 (0.2%) of urban respondents.

Respondents' perception of coronavirus disease 2019

As shown in [Table 2], a higher proportion of rural respondents perceived their risk of contracting COVID-19 as low (68.0%), compared to 44.8% of urban respondents. Most rural respondents also considered the risk of their friends and family being infected with the virus as low (68.7%), compared to 50.7% of urban respondents. These were significant at P = 0.000. Concerning their general perception, most respondents felt that COVID-19 was highly contagious (73.3%) that face mask was very effective in preventing the virus (54.4%) and that handwashing is very effective in preventing the virus (65.0%). Majority also felt that COVID-19 was very dangerous (56.5%), however, less than half (43.5%) were worried about the virus, and only 40.9% thought the mandatory lockdown and movement restriction were necessary. There were significant differences in responses to all perception questions between urban and rural participants.
Table 2: Respondents' responses to perception questions by their location

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Most respondents had low risk perception of COVID-19, with significantly more rural respondents having this (70.6% rural vs. 54.0% urban) at P = 0.000. Concerning the general perception, most had good perception (79.2%) and there was no statistical difference between the two locations [Table 3].
Table 3: Respondents' perception of coronavirus disease-2019 by their location

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As shown in [Table 4], no statistically significant association was seen between the respondents' risk perception and their sociodemographic characteristics, while their general perception was significantly associated with their level of education (P = 0.029). A majority of respondents with tertiary education had good general perception of COVID-19 (83.7%). For rural respondents, however, as seen in [Table 5], their risk perception was significantly different across the tribes (P = 0.022), where respondents from Annang tribe had the highest proportion of low-risk perception (77.4%).
Table 4: Urban respondents' perception of coronavirus disease-2019 by their socio-demographic characteristics

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Table 5: Rural respondents' perception of coronavirus disease-2019 by their sociodemographic characteristics

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Practice towards coronavirus disease 2019

Most participants washed their hands often (43.0%), disinfected their hands with alcohol-based sanitizer sometimes (27.5%), used nose mask sometimes (36.6%), avoided touching their hands and mouth sometimes (33.7%) and kept social distance in public places sometimes (44.2%). Majority also shook hands with others sometimes (33.6%), rarely gave hugs (34.0%) and sometimes attended social gatherings (42.3%). A high proportion said they never took antibiotics (67.1%) and garlic, ginger and turmeric (57.0%) for the purpose of preventing the virus. There was statistically significant difference in respondents' responses to all practice questions between urban and rural respondents [Table 6].
Table 6: Respondents' responses to questions on practice towards coronavirus disease-2019 by their location

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Majority of both urban and rural respondents had good practice towards COVID-19 (93.8% of urban and 87.1% of rural). The difference between them was statistically significant [χ2 = 10.225; P = 0.001; [Figure 1]. [Table 7] and [Table 8] show the association between urban and rural respondents' practice towards COVID-19 and their sociodemographic characteristics, respectively. While no statistically significant association was seen amongst the urban respondents, gender had a significant relationship with practice of rural respondents (P = 0.035). A higher proportion of females had good practice (90.2%) compared to males (83.1%).
Figure 1: Respondents practice towards coronavirus disease 2019 by their location

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Table 7: Urban respondents' practice towards coronavirus disease-2019 by their sociodemographic characteristics

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Table 8: Rural respondents' practice towards coronavirus disease-2019 by their socio-demographic characteristics

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Relationship between respondents' perception of coronavirus disease 2019 and their practices

There was no statistically significant association between urban respondents' practices towards COVID-19 and their perception. However, for rural respondents, high-risk perception was associated with a higher proportion of good practice (93.4%) compared to 84.5% of low-risk perception (P = 0.015). This is shown in [Table 9].
Table 9: Respondents' practice towards coronavirus disease-2019 by their knowledge, attitude and risk perception

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  Discussion Top


This study set out to assess and compare the perception and practice towards COVID-19 of urban and rural residents in Akwa Ibom State, Nigeria. We found that significantly higher proportion of urban residents had high-risk perception of COVID-19 compared to their rural counterparts, and a higher proportion of urban resident also had good practice towards COVID-19 compared to their rural counterparts. These findings are in congruence with previous studies.[14],[19] A survey in 12 African countries revealed a contrasting report in Nigeria, where rural residents had higher risk perceptions compared to their urban counterparts, however, it reported that a higher proportion of Nigerians resident in urban areas practiced self-quarantine and handwashing compared to rural respondents.[20] We did not find any significant difference in the general perception of COVID-19 between urban and rural respondents.

Previous literature suggests that disease risk perceptions are a key determinant of health behaviour, although the nature of this varies between diseases.[21] It has also been found that individuals generally tend to underestimate their likelihood of experiencing negative occurrences when compared to the average person, an effect known as optimism bias.[22] This may be why only 37.6% of all the respondents in this study had high-risk perception of COVID-19 despite its rapid spread. Similar to this, a study in Ibadan, Nigeria reported that only 26% of their respondents thought they were at risk of contracting the virus, while others thought it was either an attack by the Western world, an intention for corruption or it was grossly exaggerated.[23] A study on risk perception of influenza in Italy during the immediate post-pandemic period also found a low perceived susceptibility to the disease.[24] Our study also found a significant disparity between the risk perception of urban and rural residents, where nearly half of urban residents had high-risk perception, while less than a third of rural respondents did. Similar finding was reported in a survey in China.[14]

In our study, the belief that proper use of face masks and handwashing were very effective in preventing infection with the virus was held by a significantly higher proportion of rural respondents; however, a higher proportion of urban residents thought the mandatory lockdown was very necessary. This is probably because a many of rural respondents were involved in jobs that require daily movement such as artisan, trading and farming and may therefore have had their livelihoods disproportionately impacted by the lockdown. Even though rural residents perceived hand hygiene and use of facemask to be effective, this did not translate to practice. Urban respondents were seen to practice good hand hygiene, and use face mask more frequently than rural respondents. They were also seen to practice all the correct preventive measures assessed in this study more than their rural counterparts. However, consideration should be given to the fact that strict measures were put in place by the authorities to ensure residents followed rules regarding COVID-19 such as movement restriction, returning those without masks home, provision of wash hand basins and running water at strategic points, as well as arraigning those who held social gatherings to mobile courts, and these measures were mainly enforced in urban areas, neglecting the rural areas. This may explain the observed differences in the practice of preventive measures towards COVID-19. It is worthy of note that handwashing was generally practiced more often than other preventive measures, as was seen in a similar study.[25] Good hand hygiene has been identified as one of the most important tools in breaking the transmission of infections.

This study also showed that majority of rural residents did not abuse antibiotics in a bid to prevent infection, while over half of urban residents had done so. This may be due to the fact that urban residents have better access to these antibiotics. COVID-19 has been found to foster antibiotic misuse which may in turn lead to increased antimicrobial resistance.[26] In Nigeria, prescription monitoring is very poor and prescription drugs including antimicrobials are sold over-the-counter in pharmacies and by patent medicines vendors,[27] further worsening antibiotic misuse.

Despite the widespread concerns about the use of natural home remedies such as garlic, ginger and turmeric, majority of rural respondents had never taken it to prevent contracting the virus. In contrast, about 70% of their urban counterparts had taken these home remedies. Before the COVID-19 vaccine was manufactured, there was no ideal anti-COVID-19 medication, hence people turned to various home remedies. These home remedies are typically safe and contain antioxidant properties.[28] However, their role in the prevention of COVID-19 has not yet been established. Despite this, information on the potency of these home remedies was widely discussed on social media sites, the radio and on television.[28] This may explain why more urban residents used home remedies compared to rural respondents.

Several studies have reported that sociodemographic characteristics of individuals predict their perception and practice towards COVID-19.[23],[29],[30] A study in Iran reported that respondents who were male, older, well-educated and married had significantly higher perceptions of susceptibility.[29] This is in contrast to our findings that no significant relationships were seen the risk perception between urban and rural residents. However, educational level showed a significant relationship with the general perception of urban residents. Our study found a significant gender disparity in practices towards COVID-19 amongst rural residents, where significantly more females had good practices. This is in contrast to what was seen amongst urban residents where an equal proportion of both genders had good practices towards COVID-19. Our findings in the rural areas suggest that more men should be targeted during awareness and knowledge creation concerning preventive practices against COVID-19.

Even though a higher proportion of respondents with high-risk perception had good practices towards COVID-19, amongst both urban and rural respondents, only rural residence had a statistically significant relationship. Findings in a similar study agreed with ours.[23] This is in congruence with the health-belief model which posits that perceived susceptibility will lead action to prevent an illness. However, this is not always true as other factors come into play such as perceived benefits of their actions, perceived barriers to the health action and self-efficacy – the belief that an individual can successfully carry out the health action, despite the barriers.[31]

The limitations of this study design as with any cross-sectional study design is that it does not establish causality, though an association is seen in perceptions and practices towards COVID-19. There is also risk of responder bias and recall bias. Besides, there was no standardized set of questions to assess the perception and practice of respondents towards COVID-19, however, we adapted questions from similar studies as well as using the WHO and NCDC guidelines on the prevention of COVID-19 to develop our questionnaire.


  Conclusions Top


This study assessed the perception and practice of urban and rural residents towards COVID-19. We found that there was high awareness of COVID-19 amongst urban and rural residents in Akwa Ibom state. Majority of the respondents had low-risk perception of COVID-19, with urban residents having significantly higher proportion of high-risk perception. There was no significant difference in urban and rural residents' general perception of COVID-19. The practices towards COVID-19 were generally good, however significantly higher proportion of urban residents had good practices. Risk-perception had significant association with practices towards COVID-19 among rural residents.

This study has demonstrated that risk perception is associated with practices towards COVID-19. We recommend that rural areas be preferentially targeted for awareness on COVID-19 to improve and enhance risk perception towards the disease.

Acknowledgements

We acknowledge the Health Systems Research Hub, University of Uyo for providing the platform for this research. We thank Ama Akpanudo and Treasure Akwaowo for supporting the literature search.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8], [Table 9]



 

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