Knowledge, attitude and perception towards COVID-19 among representative educated sub-Saharan Africans: A cross-sectional study during the exponential phase of the pandemic

Abstract

Coronavirus disease 2019 (COVID-19) pandemic, caused by the Severe Acute Coronavirus 2 (SARS-CoV-2), is a global health threat with extensive misinformation and conspiracy theories. Therefore, this study investigated the knowledge, attitude and perception of sub-Saharan Africans (SSA) on COVID-19 during the exponential phase of the pandemic. In this cross-sectional survey, self-administered web-based questionnaires were distributed through several online platforms. A total of 1046 respondents from 35 SSA countries completed the survey. The median age was 33 years (18-76 years) and about half (50.5%) of them were males. More than 40% across all socio-demographic categories except the Central African region (21.2%), vocational/secondary education (28.6%), student/unemployed (35.5%), had high COVID-19 knowledge score. Socio-demographic factors and access to information were associated with COVID-19 knowledge. Bivariate analysis revealed that independent variables, including the region of origin, age, gender, education and occupation, were significantly (p < 0.05) associated with COVID-19 knowledge. Multivariate analysis showed that residing in East (odds ratio [OR]: 7.9, 95% confidence interval (CI): 4.7-14, p<0.001), Southern (OR: 3.7, 95% CI: 2.1-6.5, p<0.001) and West (OR: 3.9, 95% CI: 2.9-5.2, p<0.001) Africa was associated with high COVID-19 knowledge level. Apart from East Africa (54.7%), willingness for vaccine acceptance across the other SSA regions was <40%. About 52%, across all socio-demographic categories, were undecided. Knowledge level, region of origin, age, gender, marital status and religion were significantly (p < 0.05) associated with COVID-19 vaccine acceptance. About 67.4% were worried about contracting SARS-CoV-2, while 65.9% indicated they would consult a health professional if exposed. More than one-third of the respondents reported that their governments had taken prompt measures to tackle the pandemic. Despite high COVID-19 knowledge in our study population, most participants were still undecided regarding vaccination, which is critical in eliminating the pandemic. Therefore, extensive, accurate, dynamic and timely education in this aspect is of ultimate priority.

Fig 1. Respondents’ knowledge of COVID-19.

A: Participants’ knowledge score, the horizontal lines across the violin plot represent the median knowledge scores whereas the dotted lines depict the 25^th and 75^th percentiles B: Participants identified COVID-19 main symptoms C: Participants Sources of COVID-19 information.

Fig 2. Responses on ways of preventing infection or spread of SARS-CoV-2.

A chart showing the actions that respondents thought would help prevent getting infected with or spreading COVID-19. Respondents could pick multiple responses.

Fig 3. Attitude towards COVID-19 vaccine acceptance and SARS-CoV-2 infection.

(A): Respondents’ willingness to accept the COVID-19 vaccine. (B): Respondents’ attitude if they or their relatives contracted SARS-CoV-2. (C): Respondents’ level of concern towards contracting SARS-CoV-2.

Fig 4. Perception of respondents on the measures employed by their governments to manage the COVID-19 pandemic.

Respondents gave their perceptions on a scale ranging from bad to excellent. (A) Responses on how well governments managed the COVID-19 pandemic (according to region of residence). (B) General responses on government management of the pandemic.

Fig 5. Respondents’ perception on where they are likely to contract SARS-CoV-2.