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 Table of Contents  
ORIGINAL ARTICLE
Year : 2021  |  Volume : 28  |  Issue : 4  |  Page : 240-246

Determinants of correct knowledge of coronavirus infection and COVID-19 disease pandemic among pregnant women in South-West Nigeria


1 Department of Obstetrics and Gynaecology, Faculty of Clinical Sciences, College of Medicine, University College Hospital, University of Ibadan, Ibadan, Oyo State, Nigeria
2 Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Oyo State, Nigeria
3 Department of Obstetrics and Gynaecology, University College Hospital, Ibadan, Oyo State, Nigeria
4 Department of Obstetrics and Gynaecology, Lagos State University Teaching Hospital, Ikeja, Lagos State, Nigeria

Date of Submission23-Aug-2021
Date of Decision13-Oct-2021
Date of Acceptance09-Nov-2021
Date of Web Publication29-Nov-2021

Correspondence Address:
Dr. Rukiyat Adeola Abdus-Salam
Department of Obstetrics and Gynaecology, Faculty of Clinical Sciences, College of Medicine, University of Ibadan, Ibadan, Oyo State
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/npmj.npmj_650_21

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  Abstract 


Background: As the spread of COVID-19 continues, the disease and its sequels affect antenatal, intrapartum and post-partum care, thus making pregnant women and their babies vulnerable. This study assessed the knowledge of COVID-19 disease and determinants of correct knowledge among pregnant women at the University College Hospital, Ibadan, Nigeria. Methods: A cross-sectional study was conducted among pregnant women. Data collected were analysed with STATA 16.0 software. Descriptive, bivariate and multinomial regression analyses were performed. The primary outcomes were awareness of COVID-19 (yes/no), correct knowledge, and determinants. Results: Three hundred and eighty participants were interviewed. The mean age was 32 years (±4.78). A little over a third (37%) were aged 30-34 years, married (97.1%), Yoruba (86.6%), had tertiary education (89.0), in skilled occupation (54.6%) and not well-exposed to media (56.7%). The knowledge of COVID-19 was good (15%), fair (79%), and poor (6%). About 19.6%, 66.7% and 13.7% of participants who had poor, fair and good knowledge, respectively, believed that COVID-19 exists (P = 0.007). The factors associated with good knowledge include occupation, income, level of education and exposure to media (P value <0.05). On multinomial logistic regression, occupation was significantly associated with good knowledge, while being less exposed to media was significantly associated with having poor knowledge. Conclusion: Pregnant women had fair knowledge of COVID-19 disease; occupation, level of education, exposure to media and income are associated with having correct knowledge. Misinformation and misconception about COVID-19 disease may affect maternal health utilization and pregnancy outcomes. Antenatal care presents an opportunity to provide health education and increase the knowledge of COVID-19 among pregnant women.

Keywords: COVID-19 disease, COVID-19 pandemic, COVID-19 pregnancy, SARS-CoV-2 infection


How to cite this article:
Abdus-Salam RA, Lawal TV, Lawal OO, Akinlusi FM, Bello OO, Morhason-Bello IO. Determinants of correct knowledge of coronavirus infection and COVID-19 disease pandemic among pregnant women in South-West Nigeria. Niger Postgrad Med J 2021;28:240-6

How to cite this URL:
Abdus-Salam RA, Lawal TV, Lawal OO, Akinlusi FM, Bello OO, Morhason-Bello IO. Determinants of correct knowledge of coronavirus infection and COVID-19 disease pandemic among pregnant women in South-West Nigeria. Niger Postgrad Med J [serial online] 2021 [cited 2022 Jan 24];28:240-6. Available from: https://www.npmj.org/text.asp?2021/28/4/240/331535




  Introduction Top


COVID-19 disease pandemic is caused by the novel virus SARS-CoV-2. It is an RNA virus in the coronavirus family of viruses that cause acute respiratory illnesses. Since the outbreak of the pandemic in 2019 in Wuhan, China, the infection has spread across the world, affecting all categories of humans beings including the pregnant women and unborn babies.[1] The infection is characterised by mild-to-moderate airway infection in the majority of cases and may involve severe symptoms such as respiratory failure and multiple end-organ damage. In general, the presenting symptoms of SARS-CoV-2 infection include fever, dry cough, tiredness, aches, sore throat, shortness of breath and difficulty breathing. Some of the risk factors of COVID-19 are history of recent travel to high-risk infection areas, contact with coronavirus carriers, health-care workers in contact with infected people and contact with infected surfaces.[2] According to the World Health Organisation, as of 5th August, 2021, there were 200,174,883 confirmed cases of COVID-19 with 4,255,892 deaths globally.[3]

The following public health strategies have been found effective for preventing the spread of COVID-19 disease: Good personal hygiene including handwashing or use of 70% alcohol-based hand sanitiser, social distance or spatial distance[4] or physical distance and the use of a face mask. There is currently no known treatment for COVID-19 disease, but there are several approved COVID-19 vaccines that are being deployed.

In low-resource settings, antenatal care clinics are usually crowded with a large number of clients within a limited space. Antenatal clinic appointments are not timed based on the number of pregnant women or available infrastructure in Nigeria. Rather, pregnant clients are seen based on requests or medical indications. The large congregation of pregnant women waiting for antenatal consultation is a potential source of transmission and acquisition of coronavirus infection from asymptomatic carriers due to the lack of social distancing in most cases.[5],[6] The current design of most antenatal clinics in Nigeria where pregnant patients sit closely in a row is a potential risk factor for transmitting coronavirus from asymptomatic carriers. Appropriate knowledge and practice of preventive strategies among pregnant women at all times including during the antenatal care sessions are important and will curb the spread of infection through this means.

In general, access to information shapes peoples' behaviour towards health-related issues; this could be through media, discussions/lectures, health talks and social media platforms. There is enormous information concerning the pandemic in the media, especially the social media. This information combines facts and evidence, myths and misconceptions and misinformation. The correct knowledge, awareness and attitude of pregnant women to COVID-19 disease are important in the prevention and treatment of COVID-19. Both patients and health-care providers have key roles to play to stop the spread of SARS-CoV-2 infection, as their behaviours can be easily influenced by the quality of the information in their possession.

Zhong et al. investigated the knowledge, attitude and practice towards COVID-19 among Chinese residents of Hubei, China, during the rapid rise period of the outbreak. The study reported that 90% of the participants had correct knowledge of COVID-19, and nearly 98% wore masks when going out. The knowledge score was associated with the lower likelihood of negative attitudes and preventive practices towards COVID-19.[7] The study also reported a positive association between correct knowledge of COVID-19, socioeconomic status and attitude and preventive practices among Chinese residents.[7] A few studies from Nigeria have assessed the knowledge and attitude of pregnant women towards COVID-19 and found high awareness and good knowledge of common symptoms;[8],[9] however, some of these studies reported inappropriate findings such as poor practice of preventive measures, some women believed that infected individuals should be killed to control the spread of the disease and misconceptions among the pregnant women.[9],[10] The factors associated with inadequate knowledge include older age >40 years, high parity, lower education, rural residence and occupation.[10]

As the battle against the spread of COVID-19 continues, the appropriate awareness and knowledge of the disease will enhance the understanding, attitude and practice of evidence-based interventions among pregnant women. This study aims to assess the awareness, knowledge and factors associated with correct knowledge of pregnant women on COVID-19.


  Methods Top


Ethical approval was obtained from the institutional ethics review committee – UI/UCH Ethics Committee with Ethical approval number UI/UCH/20/0264. Ethical approval was granted on the 10th June 2020. The study was conducted between August and November 2020.

Study design

This was a cross-sectional study of women receiving antenatal and delivery care in the obstetric section of the University College Hospital, Ibadan, Ibadan, Nigeria (Antenatal Clinic complex).

Study area/site

The study was conducted in Ibadan, at a tertiary health-care facility in Southwest Nigeria. The hospital is a 950-bed tertiary health institution; a major referral hospital in South-West Nigeria and has a dedicated unit for the care of SARS-CoV-2 suspected and infected patients.

Study population

Participants were consenting pregnant women receiving antenatal and delivery care at the University College Hospital, Ibadan. We excluded women that declined participation and those that presented with emergencies or had serious medical complications that cannot respond or comprehend information.

A sample size of 380 participants was calculated using the following formula: n = Zα2/pq/d2; assuming a prevalence of awareness of coronavirus and COVID-19 disease of 50%. About 30–40 pregnant women were scheduled for antenatal clinic to avoid large assemblies and to comply with the social distance policy between patients. On average, 100 pregnant women were seen weekly at the antenatal clinic. A probability sampling technique – simple random sampling technique was used; a target of about 50%–70% of the pregnant women is sampled at each clinic during the study period. Pregnant women were assessed for eligibility and enrolled after adequate counselling. Data were collected using a pretested semi-structured interviewer-administered questionnaire. The information obtained were sociodemographic characteristics; awareness, knowledge of the causes, prevention and misconceptions about COVID-19. Data collected were entered into Statistical product and service solution (IBM SPSS® Statistics version 23), Armonk (N.Y., USA). Data were exported and analysed using STATA software version 16. The primary outcomes were awareness of COVID-19 and correct knowledge of SARS-CoV-2 infection and COVID-19 disease and prevention. A knowledge score of the causes, symptoms and prevention of COVID-19 was computed. The score was stratified into poor (0–41), fair (42–49) and good (50–55) knowledge. In this study, exposure to media was defined by exposure to radio/television, newspaper, posters, Internet and social media. 'Well-exposed to media' was defined by exposure to four–five forms of media while 'less exposed to media' is exposure to <3 forms of media.

Descriptive, bivariate and multinomial regression analyses were conducted. A linear regression model was used to explore the potential explanatory variables for possible multicollinearity (all predictor variables were dichotomized). Explanatory variables with variance inflation factor <10 were dropped from the model. The multinomial logistic regression was fitted to know the factors that predict knowledge of COVID-19 disease among the participants. A likelihood ratio test (LRT) was used to select the variables that were significant at 10%. The level of significance was set at P < 0.05.


  Results Top


Three hundred and eighty pregnant women were recruited and interviewed. All participants were aware of COVID-19 disease. Majority had a fair knowledge of COVID-19 (79%) while 15% and 6% demonstrated good and poor knowledge, respectively [Figure 1]. The mean age of participants was 32 years (±4.78), a little over a third (37%) were aged 30–34 years. The participants were mostly married (97.1%), Yoruba (86.6%), of tertiary level of education (89.0), skilled occupation (54.6%) and only 41.3% were well exposed to media information on COVID-19. In the obstetric characteristics, the participants were mostly booked patients (84.5%) receiving antenatal care at the study site and currently primiparous women (33.7%) [Table 1].
Figure 1: The distribution of COVID-19 knowledge among participants

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Table 1: Sociodemographic and obstetric characteristics of participants (n=380)

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In [Table 2], good knowledge of COVID-19 disease was the highest (19.1%) among women >40 years, but lowest (8.7%) among women aged 18–24 years. Similarly, poor knowledge of COVID-19 was the highest (26%) among women aged 18–24 years and lowest in the age group 30–34 years. Among the participants, poor knowledge of COVID-19 was seen in 16.8% of booked and 20% of unbooked women. Concerning exposure to media, 17.2% women who were well exposed to the media had good knowledge while 72.6% had fair knowledge. About 89.8% of those who were well exposed to media had fair to good knowledge of COVID-19 compared to about 77.7% of participants less exposed to media. There was a significant association between occupation, income, level of education, belief that COVID-19 exists, exposure to media and COVID-19 knowledge (P < 0.05).
Table 2: Cross tabulation of respondents' knowledge score and demographics

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About 19.6%, 66.7% and 13.7% of participants with poor, fair and good knowledge, respectively, believed that COVID-19 exists, and it is real. In contrast, 13.8%, 68.9% and 17.4% of participants with poor, fair and good knowledge, respectively, considered themselves to be at risk of contracting COVID-19. Furthermore, 55.0% of participants desired to have COVID-19 screening tests done during pregnancy while 52% desired testing during labour/delivery. Of the women who had an interest in COVID-19 test during pregnancy, 85.6% had good/fair knowledge of COVID-19 and 84.3% of participants interested in the screening test in labour/delivery had good/fair knowledge.

[Table 3] presents the results of multinomial logistic regression to assess association between the knowledge of COVID-19 and selected explanatory variables. In the final model, factors that were significantly associated with the knowledge of COVID-19 include education, occupation, income and exposure to media.
Table 3: Multinomial logistics regression of the selected predictors

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In comparison of poor knowledge with fair knowledge, unskilled occupation and less exposure to media information were associated with having poor knowledge of COVID-19. Women that were unskilled or unemployed (designated as 'other occupation') had a higher odds (adjusted odds ratio = 1.755; 95% confidence interval [CI], 0.975–3.161) of having poor knowledge of COVID-19 relative to professionals or skilled workers. Women that were less exposed to media had 2.129 (95% CI, 1.130–4.010) odds of having poor knowledge than professionals or skilled workers. The factor significantly associated with having good knowledge of COVID-19 compared to fair knowledge was occupation. The odds of participants whose occupation was categorized as 'others' was 0.35 (95% CI, 0.143–0.878) less likely to have good knowledge of COVID-19 compared to those with professional/skilled occupation.


  Discussion Top


This study assessed the awareness and correct knowledge of clinical features and preventive measures of COVID-19 disease among pregnant women at a tertiary health-care facility. The main finding of this study is that all participants were aware of coronavirus infection (SARS-CoV-2 infection) and COVID-19 disease, the majority had fair knowledge of clinical features and prevention of spread of the infection, less than a fifth had good knowledge. Despite the high level of awareness, the relatively high proportion of participants with inadequate knowledge suggests that appropriate information and knowledge of the disease are lacking among pregnant women.

The participants in this study were mostly aged 30–34 years, married, Yoruba, of tertiary level of education and skilled occupation. More than half of the participants were not well exposed to media and there were no participants who were not exposed to the media at all. Exposure to the media was determined using exposure to radio, television, newspapers, social media and internet. Exposure to media was most commonly to social media and this constitutes the most common source of information among the participants.

Awareness in this study was high and may be associated with the high level of campaigns, mass enlightenment programs and jingles in the media – radio, television intended to create awareness and sensitize individuals about the disease and prevention strategies. This study was also conducted around the period of lockdown; the effect of lockdown may have contributed to the increased awareness. The high awareness in this study is similar to the study by Allagoa and colleagues in Nigeria who found 80% awareness of main symptoms but fewer participants were conversant with less classical symptoms.[8] Our findings was also similar to another study by Anikwe et al. where 82% of pregnant women believed that COVID-19 is real and mass media was the major source of information.[9]

More than three-quarters of the women had fair knowledge, while less than a fifth had good knowledge. In assessing correct knowledge of COVID-19, fair to good knowledge of COVID-19 was associated with occupation, level of education, income, belief that COVID-19 exists and exposure to the media, but only media and occupation remained significantly associated in the final model. Hoque et al. in South Africa reported that knowledge and attitude toward COVID-19 was low, but there was high compliance with preventive practices. This study recruited pregnant women that were mostly single, unemployed and of lower educational level.[11] Although some studies documented high awareness and knowledge of COVID-19, low compliance with preventive practices such as wearing of facemask and social distance.[9],[10] Occupation was associated with good knowledge of COVID-19, while occupation and access to media were associated with poor knowledge. The factors associated with good knowledge include age, educational status, place or location of residence, monthly income, profession, gender, marital status and exposure to news media. While, age, occupation, educational level, residence, monthly income, profession, gender, marital status and knowledge were associated with attitude and practice.[12]

The emergence of SARS-CoV-2 infection, COVID-19 disease – novel disease, and its other effects (including social and economic) in the year 2019, was associated with a lot of uncertainties, fear, anxiety, panic, misinformation, misconceptions; unsubstantiated and unproven interventions. It was associated with exposure to a large pool of uncensored information in the media.

Poor awareness, knowledge and belief may be associated with poor compliance with recommended preventive strategies such as correct use of face masks, social distance which are supposed to help control and curtail the spread of the disease in the absence of a proven treatment. Poor knowledge may lead to self-medication as well as using unproven medications and interventions such as steam inhalation and other home remedies which may be harmful to the pregnant woman and foetus. A study in Nigeria has reported similar finding. In that study, over half of pregnant women believed that COVID-19 was curable and chloroquine can be used to treat COVID-19.[9] Another similar Nigerian study observed misinformation that malaria chemoprophylaxis is effective for the treatment of COVID-19 disease.[13]

The participants in this study were women in the reproductive age group, pregnant women, and some of them having older children. They are key members of the household and have major roles to play in the care of the family and prevention of the spread of coronavirus infection in the household by educating others, teaching and imbibing the recommended positive hygiene practices. It is therefore important for women to be aware and have the correct knowledge to ensure prevention of the spread of SARS-CoV-2 infection and disease. There is a positive correlation between good knowledge and positive preventive practices; risky behaviors are common with poor knowledge and lower education.[8],[11],[14],[15] Poor knowledge, wrong beliefs and information dissemination among pregnant women will have negative implications on women and their unborn babies. About two-thirds of pregnant women with poor knowledge believed that COVID-19 disease did not exist. A similar study in South-East Nigeria reported that some participants thought COVID-19 disease was possibly 'a scam' and believed that infected individuals should be killed to prevent the spread of the virus despite recording adequate knowledge and attitudes among the same population.[9] A qualitative study reported that participants believed that COVID-19 was not a reality and as such they did not comply with the recommended preventive practices.[15]

In this study, there were a few limitations. We used cross-sectional design, which make it impossible to draw causality between the factors. A prior history of COVID-19 disease or exposure among participants or their relatives was not ascertained and affected pregnant women were not excluded from the study. This may affect the findings; thus, participants with prior exposure to the disease will have higher knowledge of COVID-19 disease. The knowledge of pregnant women that were previously exposed to COVID-19 disease or who might have had or managed relatives with COVID-19 disease could have influenced their knowledge.

One of the strengths of this study was using a composite scoring system with a high cut off for good knowledge of COVID among pregnant women. We also asked questions on the risk perception for COVID-19 disease among pregnant women including their desire to undergo routine testing during antenatal clinic and delivery in the labour ward. This information on health-care perception among women provides some insight on the impact of COVID-19 on antenatal care services and its implications on maternal health and safety.


  Conclusion Top


Correct knowledge of COVID-19 disease and preventive measures are imperative for the effective control of the spread of coronavirus infection. Investments in health education to disseminate correct knowledge including minimising misinformation are important and will be highly productive in the immediate, short and long-term management of the disease. Moreover, factors associated with good knowledge and attitudes such as level of education, income, occupation, exposure to correct knowledge in the media and scrutiny of the information being disseminated are some long-term measures that should be emphasised and improved upon to enhance peoples' awareness, knowledge, attitudes and health practices in general.

Financial support and sponsorship

Self-sponsored.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
World Health Organization. Novel Coronavirus (2019-nCoV) Situation report – 1. January 2020. Available at: https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200121-sitrep-1-2019-ncov.pdf. [Last accessed 2021 Nov 21].  Back to cited text no. 1
    
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World Health Organisation. Coronavirus – Symptoms, Overview Prevention. World Health Organization (WHO); 2020. Available from: https://www.who.int/health-topics/coronavirus#tab_3. [Last accessed on 2020 Apr 11].  Back to cited text no. 2
    
3.
World Health Organisation. WHO Coronavirus (COVID-19) Dashboard. World Health Organisation; 2021. Available from: https://covid19.who.int/. [Last accessed on 2021 May 09].  Back to cited text no. 3
    
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Abel T, McQueen D. The COVID-19 pandemic calls for spatial distancing and social closeness: Not for social distancing! Int J Public Health 2020;65:231.  Back to cited text no. 4
    
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Bai Y, Yao L, Wei T, Tian F, Jin DY, Chen L, et al. Presumed asymptomatic carrier transmission of COVID-19. JAMA 2020;323:1406-7.  Back to cited text no. 5
    
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Chan JF, Yuan S, Kok KH, To KK, Chu H, Yang J, et al. A familial cluster of pneumonia associated with the 2019 novel coronavirus indicating person-to-person transmission: A study of a family cluster. Lancet 2020;395:514-23.  Back to cited text no. 6
    
7.
Zhong BL, Luo W, Li HM, Zhang QQ, Liu XG, Li WT, et al. Knowledge, attitudes, and practices towards COVID-19 among Chinese residents during the rapid rise period of the COVID-19 outbreak: A quick online cross-sectional survey. Int J Biol Sci 2020;16:1745-52.  Back to cited text no. 7
    
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Allagoa DO, Oriji PC, Obagah L, Tekenah ES, Dambo N, Atemie G. Knowledge, attitudes and practices towards COVID- 19 among pregnant women in a tertiary hospital in. Int J Res Reports Gynaecol 2020;3:35-41.  Back to cited text no. 8
    
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Anikwe CC, Ogah CO, Anikwe IH, Okorochukwu BC, Ikeoha CC. Coronavirus disease 2019: Knowledge, attitude, and practice of pregnant women in a tertiary hospital in Abakaliki, southeast Nigeria. Int J Gynecol Obstet 2020;151:197-202.  Back to cited text no. 9
    
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Nwafor JI, Aniukwu JK, Anozie BO, Ikeotuonye AC, Okedo-Alex IN. Pregnant women's knowledge and practice of preventive measures against COVID-19 in a low-resource African setting. Int J Gynaecol Obstet 2020;150:121-3.  Back to cited text no. 10
    
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Hoque AM, Alam AM, Hoque M, Hoque ME, Van Hal G. Knowledge, attitudes, and practices towards COVID-19 of pregnant women at a primary health care facility in South Africa. Eur J Med Heal Sci 2021;3:50-5.  Back to cited text no. 11
    
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Wake AD. Knowledge, attitude, practice, and associated factors regarding the novel coronavirus disease 2019 (COVID-19) pandemic. Infect Drug Resist 2020;13:3817-32.  Back to cited text no. 12
    
13.
Richardson S, Ibinaiye T, Nikau J, Oresanya O, Marasciulo M, Roca-Feltrer A, et al. COVID-19 knowledge, beliefs, prevention behaviours and misinformation in the context of an adapted seasonal malaria chemoprevention campaign in six northern Nigerian States. Trop Med Health 2020;48:101.  Back to cited text no. 13
    
14.
West BA, Aitafo JE, Genesis D, Kalio B. Knowledge, attitudes and practices of pregnant women attending the antenatal clinic of rivers state university teaching hospital, Nigeria towards the coronavirus (COVID-19) pandemic. Int J Health Sci Res 2021;11:21-33.  Back to cited text no. 14
    
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Nnama-Okechukwu CU, Chukwu NE, Nkechukwu CN. COVID-19 in Nigeria: Knowledge and compliance with preventive measures. Soc Work Public Health 2020;35:590-602.  Back to cited text no. 15
    


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