A Comparative Study on the knowledge and attitude of COVID-19 among Urban and Rural populations of Bangladesh.

TL;DR: In this article, a community-based cross-sectional study was conducted in 30 districts of Bangladesh, where 322 participants from urban and 312 from rural area were selected through convenience sampling.

Abstract: Aim This study is aimed to identify the awareness and behavioral perspective on COVID-19 between urban and rural people of Bangladesh during the period of outbreak. Methods A community-based cross-sectional study was conducted in 30 districts of Bangladesh, where 322 participants from urban and 312 from rural area. Participants were selected through convenience sampling. Results Rural people are found to be much more inter connected to receive information from neighbor. Regarding the incubation periods and the general symptoms, knowledge differs significantly from urban to rural. Even their precautionary and transmission knowledge is found to associate in most of the cases. During this outbreak, urban people significantly increase their religious habits and also believe that there will some major change of life after outbreak. Discussion The study reflected that health education program needed to aware about COVID-19 in both urban and rural in Bangladesh that helps in formulating and executing communication and outbreak management.

Summary

Introduction

• In 1960, corona virus was first appeared and until 2002, the world considered it as a nonfatal and relatively simple virus.
• An unknown case of pneumonia was reported which clinical symptoms were similar to usual viral pneumonia in Hubei province, China, in December 2019 [4].
• Within the last two weeks of march, 2021, the number of infection and death is tremendously increases and high-risk zone gave a hyper jump from 10 to 38 which is more than half country’s 64 districts, according to IEDCR data [13].
• During the period of outbreaks, general people need instant information, a group of population is experience fear, discrimination and stigmatization required special care [19, 20].

Methods

• To capture the attitude toward COVID-19 among the people of Bangladesh, a community-based cross-sectional study was conducted over a short period (March 2020 to April 2020) during the rise period of outbreak of COVID-19.
• In a ward, the authors have used convenience sampling, a nonprobability sampling technique, in selecting the respondents from the people of Bangladesh.
• This sampling technique is also known as accidental sampling in many literatures.
• The questionnaire was developed based on the knowledge about COVID-19.
• P values of the chi square test are presented in the table.

Results

• Table 1 summarizes the participants according to their demographic characteristics.
• People in urban and rural bear similar general information about COVID-19 on their mind except the cases, where urban people are more knowledgeable about the causes of this novel virus than the rural people.
• The authors have conducted Chi Square test to check the association between the knowledge of urban and rural people in Bangladesh.

Discussion

• The authors study shows that urban people are more knowledgeable than rural people regarding causes of COVID-19.
• This is because, the people in urban and rural area in Bangladesh doesn’t have the similar access to gather knowledge on various issues.
• Urban people are found to be more aware about this virus than the rural one.
• These areas are the sources of knowledge about COVID-19 to them.
• This cross-sectional study was carried out to identify the awareness and behavioral perspective on COVID-19 between urban and rural people.

Figures

Table 6: Population according to their knowledge on TREATMENT

Table 2: Distribution of knowledge level and its source about COVID-19 in urban and rural.

Table 3: Population according to their knowledge on TRANSMISSION

Table 5: Population according to their knowledge on PRECAUTIONS

Table 4: Population according to their knowledge on SIGN & SYMPTOMS

Figure 1: Distribution of urban and rural people according their general knowledge about COVID-19.

Table 7: Population according to effect on MENTAL HEALTH

Full text

A Comparative Study on the knowledge and attitude of COVID-19 among Urban and
Rural populations of Bangladesh
Md. Kamal Hossain Ripon,
1
Noor Muhammad Khan,
2
A E M Adnan Khan,
1
Rana Ahmed,
1
Safia
Afrin,
1
Md. Abu Sayed,
1
and Md. Mizanur Rahman Moghal,
1, *
1
Department of Pharmacy, Mawlana Bhashani Science and Technology University, Tangail-
1902, Bangladesh
2
Department of Statistics, Mawlana Bhashani Science and Technology University, Tangail-
1902, Bangladesh
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(which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.
The copyright holder for this preprintthis version posted August 11, 2021. ; https://doi.org/10.1101/2021.08.10.21261843doi: medRxiv preprint
NOTE: This preprint reports new research that has not been certified by peer review and should not be used to guide clinical practice.

Abstract
Aim: This study is aimed to identify the awareness and behavioral perspective on COVID-19
between urban and rural people of Bangladesh during the period of outbreak.
Methods: A community-based cross-sectional study was conducted in 30 districts of
Bangladesh, where 322 participants from urban and 312 from rural area. Participants were
selected through convenience sampling.
Results: Rural people are found to be much more inter connected to receive information from
neighbor. Regarding the incubation periods and the general symptoms, knowledge differs
significantly from urban to rural. Even their precautionary and transmission knowledge is found
to associate in most of the cases. During this outbreak, urban people significantly increase their
religious habits and also believe that there will some major change of life after outbreak.
Discussion: The study reflected that health education program needed to aware about COVID-19
in both urban and rural in Bangladesh that helps in formulating and executing communication
and outbreak management.
Key words: COVID-19, outbreak, SARS-CoV-2, awareness, Bangladesh
All rights reserved. No reuse allowed without permission.
(which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.
The copyright holder for this preprintthis version posted August 11, 2021. ; https://doi.org/10.1101/2021.08.10.21261843doi: medRxiv preprint

Introduction
In 1960, corona virus was first appeared and until 2002, the world considered it as a nonfatal and
relatively simple virus. The outbreak of 2002-2003 in China later spread many other countries
including United States of America with high mortality rates. After massive fatality, Centers for
Disease Control and Prevention and World Health Organization (WHO) declared a state of
emergency in 2004 [1-3].An unknown case of pneumonia was reported which clinical symptoms
were similar to usual viral pneumonia in Hubei province, China, in December 2019 [4]. The
pneumonia was named by the World Health Organization (WHO) and the International
Committee on Taxonomy of Viruses as “COVID-19” and ‘Severe Acute Respiratory Syndrome
Coronavirus2’ (SARS-CoV-2) respectively [5]. It is now a pandemic and an international
emergency of public health for all over the countries, should step forward to prevent COVID-19
spread called by World Health Organization (WHO) on January 30 [6, 7].
The COVID-19 was confirmed to spread in Bangladesh on March 2020. The first three known
cases were reported by the country's Institute of Epidemiology, Disease Control and Research
(IEDCR) on 8 March 2020 [8]. Within 4 May, there are a total of 10143 confirmed cases, 182
deaths and Case Fatality Rate (1.79%) in the country [9].
Bangladesh first imposed nationwide lockdown from March 26 and extended several times for
the consequence the Ministry of Public Administration again issued a notification on 4 May,
2020 to extend the general holiday and close all schools, colleges and universities until 14 May,
followed by a weekend 15-16 May except all emergency services to resist the spreading of
COVID-19 [10].Government of Bangladesh bound to withdraw lockdown due to the economic
distress related to suicidal incidences around that time [11, 12].
All rights reserved. No reuse allowed without permission.
(which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.
The copyright holder for this preprintthis version posted August 11, 2021. ; https://doi.org/10.1101/2021.08.10.21261843doi: medRxiv preprint

Within the last two weeks of march, 2021, the number of infection and death is tremendously
increases and high-risk zone gave a hyper jump from 10 to 38 which is more than half country’s
64 districts, according to IEDCR data [13]. From June, 2021, both the number of infection and
death dramatically increases and government reimposed a strict lockdown nationwide from July
1-13 and ease the lockdown from July 15-22 for the biggest festival Eid al-Adha and again
resume the strict lockdown from July 23 to next two weeks [14-16].
Overall, 1,994,752 infected cases and 19,779 deaths reported in Bangladesh [17] and globally
more than 196,002,202 people was infected and 4,193,301 confirm death by COVID 19 on 28th
July, 2021 [18].During the period of outbreaks, general people need instant information, a group
of population is experience fear, discrimination and stigmatization required special care [19,
20].Furthermore, after the outbreak of severe acute respiratory syndrome (SARS), Middle East
respiratory syndrome (MERS), and Ebola, it was recommended that the knowledge and attitudes
is connected with the intensity of panic emotion regarding the infectious diseases which make
further difficulties to prevent the spread of the diseases [21-26]. While the illness and death are
significant, general public or specific communities suffer from fear which make them delay
asking help and remain undetected that is very hazardous for controlling transmission during the
outbreak of infectious diseases [25]. After the outbreak, the prevalence of post-traumatic stress
disorder (PTSD) and major depression of general people increased up to 41% and 7%
respectively [27].
At this critical situation, it is vital need to understand the public’s awareness of COVID-19 in
Bangladesh to facilitate the management of outbreak. In this study, we investigate the
knowledge and attitude towards COVID-19 of both urban and rural residents of Bangladesh
All rights reserved. No reuse allowed without permission.
(which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.
The copyright holder for this preprintthis version posted August 11, 2021. ; https://doi.org/10.1101/2021.08.10.21261843doi: medRxiv preprint

during this rise period of outbreak to provide the legislators actual field-based data and to
support them in the management of this pandemic.
Methods
To capture the attitude toward COVID-19 among the people of Bangladesh, a community-based
cross-sectional study was conducted over a short period (March 2020 to April 2020) during the
rise period of outbreak of COVID-19. We have collected the data from 30 convenient districts
out of 64 districts. Due to lockdown situation in Bangladesh, it was very hard to collect the data
from all the districts. Total 634 participants are encountered in the survey, where we tried to
make equal representation of urban and rural people. Respondents were also selected from each
district based on their availability to us. In a ward, we have used convenience sampling, a non-
probability sampling technique, in selecting the respondents from the people of Bangladesh. This
sampling technique is also known as accidental sampling in many literatures. Convenience
sampling involves the sample being drawn from that part of the population that is close to hand.
Though it increases the selection bias, it was the only efficient way of collecting data from the
people of Bangladesh in lockdown days.
The questionnaire was developed based on the knowledge about COVID-19. We designed the
questionnaire into several sections including Transmission, Sign & Symptoms, Precautions,
Treatment, Mental Health, and socio-demographic status of the respondents. Each part is a
mirror image of the knowledge about COVID-19 except first and the last part which contains the
demographic characteristics and mental health of the participants respectively. In the second
section, the questions were designed to reflect the basic knowledge about COVID-19 among
rural and urban populations. Knowledge about the transmission is most important part to resist
the COVID-19, which was measured through the questions in section three. Similarly, questions
All rights reserved. No reuse allowed without permission.
(which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.
The copyright holder for this preprintthis version posted August 11, 2021. ; https://doi.org/10.1101/2021.08.10.21261843doi: medRxiv preprint