Knowledge, Attitude and Practice Associated with COVID-19 ‎among‏ ‏Egyptian House Officers: Online Cross-Sectional Survey‎ ‎

METHODS

The study was approved by the Ethics Committee and a cross-sectional questionnaire- as online survey by Google Forms, to cover a wide range of house officers in different Egyptian universities and easy access, was conducted over three months between March 2020 and May 2020.

Participants: The target group was Egyptian house officers.

Pilot testing: The questionnaire was pilot tested on a random sample of house officers, the time to fill in the questionnaire was not limited. Answers to all questionnaire items were obligatory, and submission was not allowed till all questions were answered.

Questionnaire Development: We have developed a questionnaire formed as an online survey by Google Forms to cover a wide range of doctors with easy access.

Each questionnaire consists of two main parts:

1. PPersonal information (name, age)
2. KKnowledge, attitude, and practice towards COVID-19 pandemic (Diagnosis, lines of treatment and others).

Score grading:

A grading method was used for each variable in this questionnaire as following. A correct option was assigned one point, zero for the wrong answer in the knowledge section; one for positive, 0 for a negative answer in the attitude section; one for proactive, and 0 for a passive answer in the practice part.

Questionnaire distribution:

A summary of the study, including its aims were shared via email, WhatsApp, and Facebook. We asked the participant to share the questioner within their networks.

Statistical Analyses:

Data were analyzed using Version 16.0 of SPSS. We used descriptive and analytical statistics. Categorical variables were compared using Chi-square or Fisher exact test, while the numeric variables were analyzed using the 'Mann–Whitney U test. Data are expressed as mean (standard deviation [SD]) or number (%) as appropriate. A P-value of

RESULTS

One hundred five online-based questionnaires were received via google ‎form. Response results show that 64.7% of females and 35.3% of males ‎participated in the study (Figure 1).‎

Table 1 showed that 46.1% knew that Coronavirus could be prevented ‎by following the precautions. Considering all these measurements, such as ‎staying at home, social distancing, avoid mass gatherings, repeated hand ‎washing, and wearing PPE. ‎

According to the precautions, 61.7% of the participants mentioned that, the use ‎of PPE and physical isolation for two weeks must be observed by health ‎care workers who had contact with COVID-19 patients.‎

‎According to COVID-19 spread, 91.2% of house officers accepted that ‎traveling is a significant risk factor for disease transmission. 55.9% of ‎house officers knew that the highest risk groups for COVID-19 were ‎patients with comorbidities like cardiovascular disease, hypertension, ‎and immunocompromised patients 39.2% (Table 1).‎

According to the house office's knowledge, the most crucial suspicion is ‎fever, more than 38℃ as 71.5% accepted this answer. According to the ‎imaging study, 70.6% of house officers accepted that radiological study ‎is a cornerstone for the diagnosis of COVID-19.‎

About 69.6% of house officers accepted that treatment is only ‎symptomatic and supportive treatment, while only 39.2% mentioned ‎that oral anticoagulant treatment must be considered for all COVID-19 ‎cases.‎

The total score for house officers Knowledge was 6/7.

Items about COVID-19 attitude of house officers, including six single ‎choice questions. Each question with a collected score for house officers’ ‎attitude as shown in Table 2.‎

About 71% of house officers mentioned that they are happy to be a ‎physician despite this; only 31.4% accepted that the physician takes ‎considerable respect from the community and the government. 63.7% ‎said that they could share the responsibility to fight the COVID-19 ‎pandemic with the health care providers. About 61.8% think this ‎outbreak has impacted their training course in the hospital (Figure 2).  ‎According to the world fighting against COVID-19 pandemic, 84.3% ‎accepted that the world could eliminate this pandemic. Anxiety ‎symptoms for getting the infection by COVID-19 developed in 68.6% ‎of house officers. Sleep disorder symptoms related to COVID-19 ‎developed in 44.1%. ‎

The total score for house officers' attitude was 4 /7‎.

We used three single-choice questions for assessing the practice—the ‎total score for proactive practice is shown in Table 3. COVID-19 local or ‎international guidelines are read by 97.1% of house officers.‎

Precautions during the training courses at the hospital were observed in ‎‎81.4% of house officers. 14.7% of the house officers who participated ‎in the study also followed COVID-19 precautions for the general ‎population. About 15.2% only accepted visiting COVID-19 patients ‎who had been cured. The overall score for the house officers practice ‎was 2/4. ‎

DISCUSSION

Novel Coronavirus 2019 has become the primary global concern; the ‎physicians are the front lines for virus-fighting. This is the first study in ‎Egypt examining the KAP towards COVID-19 among Egyptian house ‎officers to the best of our knowledge. This online cross-sectional survey ‎on 105 House officers who accepted to contribute from different ‎Egyptian Universities.‎

We found that the female had a significantly higher contribution to our ‎study than male (64.7% females and 35.3% males). Other studies by ‎ Al-Hazmi et al. and Abdelhafiz et al. ‎reported that females had more contribution and knowledge than males ‎‎[10 & 11].‎

Our results revealed that the overwhelming majority of Egyptian house ‎officers had the basic knowledge and attitude toward this pandemic. ‎However, their practice not proactive varied towards COVID-19 was ‎significantly different.‎

According to Infection Control measurements. ‎Our study showed that 46.1% reported that the prevention of COVID-‎‎19 infection could be achieved by following precautions considering all ‎these measurements. Stay at home, social distance, avoid mass ‎gatherings, repeated hand washing, and wearing PPE. These findings ‎agree with another KAP study done by Yaling Peng and his colleague ‎on Chinese university students who took higher scores for knowledge ‎about the infection control measures [12].‎

Participants' knowledge regarding COVID-19 spread and the risk ‎group:‎

Acceptance of 91.2% of house officers that traveling is a significant ‎risk factor for disease transmission concordant with the modelling study ‎by Drake and his colleagues [13] also showed that transportation obstacles ‎could considerably reduce the transmission.

Liang et al. demonstrated associations of chronic diseases like diabetes ‎with severe COVID-19. Our study noticed that 55.9% of house ‎officers knew that the highest risk group for COVID-19 are cardiovascular ‎diseases and hypertension followed by immunocompromised patients ‎‎39.2% [14].‎

Participants' knowledge regarding COVID-19 Diagnosis and ‎treatment :‎

According to the house officer's knowledge, the most important ‎symptom is the fever that is more than 38℃ as 71.5% accepted this ‎answer and this concordant with another study by Zhu J and his ‎colleagues reported that fever present in about  78.4% of patients [15].‎

According to the imaging study, 70.6% of house officers accepted that ‎radiological studies is a cornerstone for diagnosis of COVID-19, and this ‎in agreement with Sun and his colleagues who mentioned that ‎abnormal MSCT lesions had been found in about to 97% of ‎hospitalized patients [16]. Another study by Shi et al. ‎reported that CT findings might be present even with minimal or no ‎symptoms [17].‎

The WHO approved the Solidarity trial, a ‎large international study to various treatments (local standard of care plus ‎remdesivir, lopinavir/ritonavir, lopinavir/ritonavir plus interferon beta, ‎or hydroxychloroquine/chloroquine) compared with the local standard ‎of care alone. In our study, 69.6% of house officers accepted that COVID-19 ‎ treatments are only symptomatic and supportive. Only 39.2% mentioned ‎that oral anticoagulant treatment must be considered to treat all cases ‎‎[18].‎

The total score for house officers' knowledge was 6/7. Their training ‎can further explain the significantly higher knowledge gained by house ‎officers. A study by Ejeh and his colleagues showed similar good ‎knowledge among house officers [19].‎

House Officers Practice attitude towards COVID-19 : ‎

Participants of our study had some excellent attitude towards their job ‎and could fight the virus pandemic.  This was also concordant with ‎another study by  Zhong  and his colleagues, who did KAP ‎for residents as front lines. Most of them took precautions to fight ‎against virus spread as they did not go to crowded areas. Vigorous ‎infection control measures could explain this by the government [20].‎

Zhou X et al, Liu Z et al and Chen S et al mentioned that 70.1-‎‎88.9% of the Chinese believed that successful control of the epidemic is ‎possible during the previous corona epidemic. In our study, 84.3% ‎accepted that the world could get rid of the COVID-19 pandemic [21-‎‎23].‎

Unfortunately, we noticed that some Egyptian house officers might have ‎unfavorable attitude as they thought that the physician, in general, did ‎not take their considerable respect from the community and the ‎government. Also, anxiety symptoms started to develop in 68.6% of ‎participating house officers. This is in agreement with Zhou et al, who showed that about 35.6% of healthcare workers ‎showed anxiety features [24]. Another study by Ejeh and his ‎colleagues demonstrated that anxiety disorders were prevalent among ‎healthcare workers especially at age group (40-50) with odds ratio ‎‎8.933 [25]‎.

House Officers Practice related to COVID-19: ‎

To do good practice, you have to study relevant guidelines of COVID-‎‎19 diagnosis and management and this practice among the Chinese ‎University Students was reported by Peng et al. [12], according to our ‎study, local and international are read by 97.1% of house officers.‎

Precautions during the training course at the hospital were done by ‎‎81.4% of house officers. This also mentioned by Imai T et al, Quah ‎ et al and Khan et al [26-28]. Our findings are consistent with ‎outcomes of other studies in which healthcare workers showed positive ‎practice and proper use of personal protective equipment and other ‎infection control measures.‎

We noticed that some of the house officers need to improve on their ‎practice as only 14.7% mentioned the Precautions that must be done ‎toward COVID-19 for the general population, and  15.2% only ‎accepted the visit of COVID-19 patients that had been cured. This also ‎reported by Peng and his colleagues [12].‎

Funding :    None.

Conflict of interest:    None.

Ethical Considerations: According to the Helsinki Declaration principles, the study was approved by the Research Unit, Faculty of Medicine,