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Epidemiological Assessment of Knowledge and Perceptions towards Corona Virus Disease-19 among Gyadi-Gyadi Communities in Kano, Nigeria

Background: Worldwide coronavirus disease 2019 (COVID-19) is a major public health problem. Coronavirus (CoV) is a zoonotic pathogen that can be transmitted via animal-to-human and human-to-human interactions. It was found to be originated from Wuhan, Hubei, China, in December 2019, and was recognized as a pandemic by the World Health Organization, spreading to more than 190 countries and territories, resulting near 74,816 deaths and 1,349,660 affected cases as on 7 April 2020. Poor knowledge and perceptions towards COVID-19 contributed to the prolonged transmission of diseases in the community. The aim of this study was to assess knowledge and perceptions towards COVID-19 among Gyadi-Gyadi communities in Kano, Nigeria. Methodology: A community based cross-sectional study was conducted in Gyadi-Gyadi from April, 2020 to May, 2020 . Data was collected using a pretested structured questionnaire. Descriptive analysis was performed to obtain the frequency distribution of the variables . Results: The result shows that 300 participants responded to the questionnaire. 165(55%) respondents were male and the remaining 135 (45%) were female. Regarding sign and symptom 162 (54%) of the respondents have answered headache, fever, cough, sore throat, and flu are symptoms of COVID-19.Concerning perceptions, 145 (48.3%) perceived that lack of hand washing practice contribute to COVID-19. Conclusion: The study revealed that the respondents have low knowledge towards COVID-19. However, the perception status of the respondents towards COVID-19 was poor. Supportive supervision for health extension workers in order to strengthen effective health education to the community on the causes, sign and symptoms of the diseases and possible preventives measures are urgently needed.


INTRODUCTION
The novel Coronavirus Disease 2019 or COVID 19 is a respiratory illness that can spread from person to person causing flu like symptoms and in severe cases death. It was found to be originated from Wuhan, Hubei, China, in December 2019, and was recognized as a pandemic by the World Health Organization [WHO, 2020, CDC, 2020], spreading to more than 190 countries and territories, resulting near 74,816 deaths and 1,349,660 affected cases as on 7 April 2020. Since there is no vaccine or specific antiviral treatment for COVID-19 there are a number of suggested strategies in the control like social distancing and personal hygiene practices. Even then, the pandemic has led to severe global socioeconomic disruption, [WHO, 2020] and discrimination to foreigners [Zhai and Du, 2020]. Coronavirus (CoV) infections are emerging respiratory viruses that are known to cause illness ranging from the common cold to severe acute respiratory syndrome (SARS) [Yin and Wunderink, 2018]. CoV is a zoonotic pathogen that can be transmitted via animal-to-human and human-to-human interactions . Multiple epidemic outbreaks occurred in 2002 (SARS), with approximately 800 deaths, and in 2012 (Middle East respiratory syndrome coronavirus, MERS-CoV), with 860 deaths [Li et al, 2020, Bhagavathula andShehab, 2020]. About 8 years after the MERS-CoV epidemic, the current outbreak of coronavirus disease 2019  in Wuhan City, Hubei Province, China, has emerged as a global outbreak and significant public health issue [Lai et al, 2020].
The coronavirus belongs to a family of viruses that may cause various symptoms such as pneumonia, fever, breathing difficulty, and lung infection [WMHC, 2020]. COVID-19 is spread by human-to-human transmission through droplet, feco-oral, and direct contact and has an incubation period of 2-14 days [Backer et al, 2020]. Patients with COVID-19 present with pyrexia in 85% of cases during their illness course, but only 45% are febrile on early presentation . Moreover, cough is seen in 67.7% of patients and sputum is produced in 33.4%. Respiratory symptoms such as dyspnea, sore throat, and nasal congestion present in 18.6%, 13.9%, and 4.8% of cases, respectively . Constitutional symptoms such as muscle or bone aches, chills, and headache are seen in 14.8%, 11.4% and 13.6% of the cases, respectively . Gastrointestinal (GI) symptoms such as nausea or vomiting and diarrhea are seen in 5% and 3.7% of the cases, respectively.
These viruses are common in animals worldwide, but very few cases have been known to affect humans.  In January 2020, the etiologic agent responsible for a cluster of severe pneumonia cases in Wuhan, China was identified as being a novel Betacoronavirus, but it is distinct from SARS---CoV and MERS---CoV [WHO, 2020, GISAID, 2020]. The complete genome sequence of this new agent has been released and different detection protocols have been developed but not fully validated yet. However, in light of the possible introduction of a suspected case related to 2019---nCoV in the America region, the Pan American Health Organization / World Health Organization (PAHO/WHO) recommends to Member States to ensure their timely identification, the shipping of samples to National and reference laboratories and the implementation of the molecular detection protocol for 2019---nCoV, according to the laboratory capacity.
There are different types of Corona viruses reported over the years. Tissue tropism varies with the type of corona virus i.e., alpha and beta corona viruses infect mammals; in contrast, gamma and delta corona viruses infect birds and fish, but some of them can also infect mammals . The new 2019 novel Corona virus-2 or SARS-CoV-2 is identified as beta corona virus [Velavan and Meyer, 2020]. Virus virulence is basically due to its genes responsible for viral replication, genes which help to escape from host immune system, those which are involved in the transmissibility and genes coding toxic products in host cells. The current virus seems to be very contagious and has quickly spread globally [Cascella et al, 2020]. People with underlying health conditions like high Blood Pressure, diabetes, stroke, cardiac or kidney diseases, aged individuals, and people with weakened immune system face higher risks if COVID 19 like infections happens to them , Raghupathi, 2019. If people are challenged with COVID 19 after a recent viral infection, their defenses are already down and that could result in increasingly poor prognosis for them from this virus [Young et al, 2020]. This is mainly because of low levels of immune cells and high cytokine levels in body fluids. Cytokine release syndrome (CRS) is an acute systemic inflammatory syndrome characterized by fever and multiple organ dysfunctions. In some cases viral infections can illicit excessive immune reactions like "cytokine storm" leading to tissue damage. This is mainly mediated by a chemical interleukin 6 (IL-6) produced by our immune cells. It was observed that other than viral infections, IL-6 level will also increases during cardiovascular diseases, infections, some forms of cancers, inflammatory and autoimmune disorders [Mehta et al, 2020]. COVID 19 often leads to CRS if other systemic health complications were previously present in a patient, a major cause of death. That is the reason why the people with underlying diseases are requested to stay safe otherwise they may not be able to cope with the excess IL-6 levels upon infection which can lead to cytokine release syndrome (CRS) and even death [WHO, 2020].
Since the current pandemic can be spread by aerosol transmission from person to person, with direct or indirect contact [Riou and Althaus, 2020], intentional and thoughtful acts are the necessity of the time as Governments, communities, citizens, media, and other key influencers have an important role to play in preventing and stopping the pandemic which is highly influenced by host travel and other host behaviours leading to direct contact and spread of COVID 19 [ECDC, 2020]. The WHO guidelines restricting international travel from affected areas, clinical or home isolations and other advices and recommendations are having prime importance as they are meant to be strictly followed to reduce number of direct contacts and the general risk of transmission of this acute respiratory infection [WHO, 2020]. In addition to this, behavioral differences like restricted stay in indoors during winter can also have an effect on Corona viral spread . Hand washing for at least 20 seconds after visiting public spaces. Soap or hand sanitizer with at least 60% of ethanol is recommended [IPAC, 2020]. It is also recommended to avoid touching the denoted facial T-zone (eyes, nose, and mouth) as this is the access point for virions into the upper respiratory tract [IPAC, 2020]. Avoiding contact with people who are already presenting with symptoms, as well as avoiding gathering or crowded places. Travel to outbreak areas must be prohibited. A healthy individual must maintain at least six feet distance from individuals presenting with symptoms [IPAC, 2020]. The sterilization of frequently handled surfaces is beneficial.
All healthcare workers managing COVID-19 patients require full personal protective equipment (PPE) containing surgical masks, double gloves, full-sleeved procedural gowns, and eye shield [IPAC, 2020]. The N95 masks which prevent 95% of the droplets from entering the mask must be exclusively dawned prior to performing procedures associated with a higher risk for aerosol exposure such as tracheostomy, tracheal intubation, bronchoscopy, cardiopulmonary resuscitation (CPR), and noninvasive ventilation (NIV) [IPAC, 2020]. These procedures have the potential to aerosolize the virus. Containment of community transmissions is achieved by the closure of educational institutions, businesses, airspace, and sports events. High-risk individuals such as those older than 65 or having chronic comorbidities without any symptoms are also required to self-quarantine to decrease the likelihood of COVID-19 contraction [IPAC, 2020].
The higher case-fatality rate of COVID-19 reported in different countries suggests that it is more fatal in older patients [Onder et al, 2020]. Statistical reports states that the case fatality rate in Italy and China appear very similar for age groups 0-69 years, but rates are higher in Italy among individuals aged 70-80 years or older [WHO, 2020]. The reasons for this susceptibility can be either physical or social or both. Not only old ages compromise immunity and self defense making them more vulnerable to infectious diseases and acute respiratory distress syndrome but also more likely to have health conditions such as coronary, lung or kidney diseases, diabetes which can contribute to their low immunity levels. Stress can also cause people dying from heart attacks who have COVID-19 [Wu Z and McGowan, 2020]. Social isolation or mobility challenges are faced by the elderly in many societies, which may worsen the scene more than their weak immunity. In many countries, elderly are more likely to be in nursing or retirement home, or living with family in a more crowded situation where there"s a greater risk of infection [Kane, 1980]. On 12th January 2020, the China CDC shared the genetic sequence of the SARS-CoV-2. This enabled countries to develop primers against the SARS-CoV-2 genome and utilize reverse transcriptase polymerase chain reaction (RT-PCR) assays to make a diagnosis of COVID-19. Therefore, RT-PCR has become the gold standard for the diagnosis of COVID-19, but it is only 66-80% sensitive [Ai et al, 2020]. Essentially, this means that 20-34% of patients with COVID-19 out of 100 would test negative despite being infected. This variance in the sensitivity can be attributed to the patients being tested early in the disease course wherein the viral load is beneath detection level or due to lack of automation in sample preparation for RT-PCR. Furthermore, a single negative RT-PCR does not rule out COVID-19, hence a repeat RT-PCR must be performed. The concern rises regarding the timeframe of the repeat RT-PCR, the ideal window lies between 24 to 72 hours of the negative test. The management of viral pneumonia is predominantly supportive amidst the absence of validated antiviral drugs. The most primary symptoms managed in COVID-19 are fever and non-productive cough, therefore the first-line antipyretic agent is Paracetamol and antitussive of choice is guaifenesin . Supplementary oxygen at 5 L/min must be administered for patients that require management of severe respiratory distress and the oxygen saturation (SaO2) target must be ≥92-95% in pregnant patients and ≥90% in all other patients ].
In the majority of the cases, public health measures are vital for the management of the spread of COVID-19. If public health measures for containment are not adequate, then there will be a patient burden that supersedes the capacity of available ICU beds and mechanical ventilation, as seen in the crisis taking place in Italy. Therefore, the entire objective of the COVID-19 management rests on the premise of social distancing to suppress the rapid emergence influx of new cases in a short time frame. This epidemiological concept is referred to as the "flattening of the curve". The mainstay of public health must be to identify the infective cases, isolate these cases, attain contact tracing and isolate contacts that present with symptoms .
.On 28 January 2020, the Federal government of Nigeria assured citizens of the country of its readiness to strengthen surveillance at five international airports in the country to prevent the spread of coronavirus. The government announced the airports as Enugu, Lagos, Rivers, Kano and the FCT. [CoV, 2020]. The Nigeria Centre for Disease Control also announced same day that they had already set up coronavirus group and was ready to activate its incident system if any case emerged in Nigeria [Odunsi, 2020]. deaths. State authorities have acknowledged the unusually high number of deaths, and while they initially denied they were related to coronavirus they are now conducting "verbal" autopsies. Considering Kano"s low literacy rate, the authorities should ensure that public health information is accessible to all and available in relevant languages. They should also act swiftly to identify, isolate, and treat Covid-19 cases as well as trace contacts, in order to curb the virus" spread. At this time of crisis, the government should work with trusted community-based groups, religious leaders, and community radio stations to protect citizens by equipping them with the right information (KMOH, 2020). Poor knowledge and perceptions towards COVID-19 contributed to the prolonged transmission of diseases in the community. Therefore the aim of this study was to assess knowledge and perceptions towards COVID-19 among Gyadi-Gyadi communities in Kano, Nigeria.

Study Area and Study Design
The study was conducted in Gyadi-Gyadi which is one of the towns found in Tarauni local government Kano state.
The estimated population of the Gyadi-Gyadi communities was 664147. A community-based cross-sectional study was conducted using intervieweradministered questionnaire from April, 2020 to May, 2020.

Sample Size Determination
In this study, manual calculation of the sample size using Morgan and Krejcie (1970) formula was used for sample size determination as stated below: S= X 2 NP (1-P) ÷d 2 (N-1) +X 2 P (1-P) Where: S = Required sample size X 2 = The table value of the chi-square at desired confidence

Inclusion And Exclusion Criteria
Resident individuals aged 18 years and above and willing to participate were included in the study. Individuals who stayed as guests in the selected households, those who were <18 years of age and who had chronic illnesses were excluded from the study.

Data Collection
Data was collected from eligible and willing participants using a pre-tested, structured questionnaire. Socio-demographic information including age, gender, occupation, education and socio-economic status were collected. The knowledge of the participants on symptoms suggestive of COVID-19 causes of COVID-19, treatment and preventive measures, regarding COVID-19 was also collected.

Data Analysis
Data were analyzed using Statistical Package for Social Science (SPSS) software version 16.0 at that time with the help of the Statistician. The descriptive statistical method was used to analyze frequencies and percentages.

Ethical Considerations
This study was conducted only after obtaining approval from Gyadi-Gyadi District Head.

RESULTS
A total of 300 respondents were interviewed, giving 100% response rate. The majority, 165 (55%) of the respondents were males. Among all, 115(38.3%) of respondents were 31-35 years of age. Of the study subjects, 195 (65%), were married. The socio-economic characteristics of the study showed that, among all respondents, 180(60%) of respondents attended formal education, among this 145(48.3%) of respondents were secondary school completed, 35(11.7%) of respondents were primary school completed, while 120(40%) of respondents reported that they were took informal education (were illiterate and only read and write). Similarly, results of occupational status of respondents indicated, 150 (50%) of respondents were civil servants, 70(23.3%) were company employee, 45(15%) were Merchants and 35 (11.7%) were House wives (Table 1).

Knowledge of The Respondents towards COVID-19
From a total of three hundred (300) (Table 3).

DISCUSSION
At present, COVID-19 is a global topic of discussion in the media and among the public.
With the currently mounting COVID-19 transmission raising tensions for everyone, including for health officials and health systems, an important question arises regarding how we manage information to help frontline Health Care Workers (HCWs) in times of public health crisis. For this reason, we investigated communities" knowledge and perceptions of the prevention and control of COVID-19 at the pandemic level Knowledge and perceptions of COVID-19 varied across different categories of respondents. Our study revealed that respondents have low knowledge about COVID-19 but showed negative perceptions of COVID-19 transmission prevention. We also found that 95(31.7%) of respondents used family and friends as a primary source of information about COVID-19.
This indicates obtaining information from authentic sources is pivotal for disseminating unbiased and reliable data about the emerging COVID-19 infection and is essential for respondents" preparedness and response. However, a finding of considerable concern is that 118 (39.3%) of respondents used social media as a source of information. Currently, there is a vast diversity of information available through the internet, including unverified malicious information that can spread quickly and misguide respondents. In particular, health authorities and scientists have warned that widespread misinformation about COVID-19 is a serious concern causing xenophobia worldwide [Lai et al, 2020, Thomas, 2020, Shimizu, 2020, Mejova and Kalimeri, 2020]. In this regard, respondents should carefully evaluate COVID-19-related information and should use scientific and authentic content as information sources. The findings of this study suggest a significant gap between the amount of information available on COVID-19 and the depth of knowledge among respondents, particularly about the mode of transmission and the incubation period of COVID-19.

CONCLUSION
The study revealed that, the respondents has low knowledge towards COVID-19. However, majority have poor perceptions towards COVID-19. Therefore, according to this research education has its own contribution for perceptions. In general, according to the study the perceptions level of the community is poor. Since knowledge and perceptions are the key factor for the control and prevention of COVID-19, strengthen the awareness of the community towards COVID-19 is mandatory. As the global threat of COVID-19 continues to emerge, greater efforts through educational campaigns and Supportive supervision for health extension workers in order to strengthen effective health education to the community on the causes, sign and symptoms of the diseases and possible preventives measures are urgently needed. ACKNOWLEDGMENTS I am grateful to thank the study participants and acknowledge the team of research assistants.