A Review on Knowledge, Attitude, and Practice During the COVID-19 Pandemic in Ethiopia

The 2019 novel coronavirus (2019-nCoV) or the severe acute respiratory syndrome corona virus 2 (SARS-CoV-2) as it is now called, is rapidly spreading from its origin in Wuhan City of Hubei Province of China to the rest of the world [1]. Novel coronavirus (pandemic) was named as ‘‘Corona Virus Disease 2019’’ (2019nCoV) by World Health Organization (WHO) in Geneva, Switzerland [2,3]. So this virus is deadly third-generation virus in Corona family apart from Middle East Respiratory Syndrome (MERS) in 2012 and Severe Acute Respiratory Syndrome (SARS) in 2003. The diameter of corona virus is 65-125 nm, and contains a single strand of RNA with lengths ranging from 26 to 32 kb and it is under Corona viridae family. Coronaviruses comprise several types, such as alpha, beta, gamma, delta, SARS CoV, H5N1 influenza A, H1N1 2009, and MERS-CoV [4]. World Health Organization declared the novel corona virus as a global public health emergency (pandemic) on January 30, 2020 [5]. Novel coronavirus disease is a highly infectious disease, and the ongoing outbreak has affected a huge part of populations around the world. There are four levels of COVID-19 transmission according to World Health Organization, such as, no cases reported, sporadic cases, Clusters of cases, or Community transmission [6]. Public health and social measures play a crucial role in reducing the number of infections and reduce death until the vaccine is ready [1].


Introduction
The 2019 novel coronavirus (2019-nCoV) or the severe acute respiratory syndrome corona virus 2 (SARS-CoV-2) as it is now called, is rapidly spreading from its origin in Wuhan City of Hubei Province of China to the rest of the world [1]. Novel coronavirus (pandemic) was named as ''Corona Virus Disease 2019'' (2019-nCoV) by World Health Organization (WHO) in Geneva, Switzerland [2,3]. So this virus is deadly third-generation virus in Corona family apart from Middle East Respiratory Syndrome (MERS) in 2012 and Severe Acute Respiratory Syndrome (SARS) in 2003. The diameter of corona virus is 65-125 nm, and contains a single strand of RNA with lengths ranging from 26 to 32 kb and it is under Corona viridae family. Coronaviruses comprise several types, such as alpha, beta, gamma, delta, SARS CoV, H5N1 influenza A, H1N1 2009, and MERS-CoV [4].
World Health Organization declared the novel corona virus as a global public health emergency (pandemic) on January 30, 2020 [5]. Novel coronavirus disease is a highly infectious disease, and the ongoing outbreak has affected a huge part of populations around the world. There are four levels of COVID-19 transmission according to World Health Organization, such as, no cases reported, sporadic cases, Clusters of cases, or Community transmission [6]. Public health and social measures play a crucial role in reducing the number of infections and reduce death until the vaccine is ready [1].
The novel corona virus is transmitted through large droplets generated during coughing and sneezing by symptomatic and sometimes from asymptomatic patients [7]. Therefore, frequent hand-washing with soap and water and using sanitizer or alcohol is crucial. The common clinical features include fever (not in all), cough, sore throat, headache, fatigue, headache, myalgia and breathlessness [8].
COVID-19 has infected more than 17,660,523 people worldwide, with more than 680,894 deaths in different regions and countries. The USA, the major hit country alone, recorded more than 359,180 deaths on early August 2020. Based on the World Health Organization (WHO) Africa report, as of 02 August, 2020, a cumulative total of 802,792 confirmed COVID-19 cases with 13,779 deaths have been reported across all African countries in the region [9]. In Ethiopia the virus spreads alarmingly because the community didn't practice the information given by ministry of health and the government; as of August 2, 2020, 17,999 cases and 284 deaths have been reported [9].
Subsequently, Ethiopia has also commenced monitoring the disease and has implemented the COVID-19 prevention and containment interventions recommended by World Health Organization [10]. Health system of Ethiopia is not as developed as other countries so if the virus is not contained it will cost the country many things. Knowledge, attitude, and practice (KAP) research is important to collect information on what is known, believed, and done by a specific population [11]; But in Ethiopia those types of research is not available like other countries. It is vital to know the level of knowledge, attitude, and practice of the population towards COVID-19 to contain the virus in countries like Ethiopia. Therefore, this review aimed to assess the knowledge, attitude and perception of COVID-19 pandemic in Ethiopia.
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Literature Review
A literature search was conducted in August 1-2, 2020 using the keywords Practice, Attitude, Knowledge, Ethiopia, and COVID-19 on PubMed and Google Scholar databases and the reference list of all identified reports and articles were searched manually in Google. The search yields a total of 13 articles.

KAP studies on COVID-19
Thirteen articles on KAP during COVID-19 in Ethiopia ( Table 1). The articles used questionnaires and interview (including face to face and telephone) for data collection and the number of respondents ranging from 247 to 1570 for a total of 7,335. The respondents consisted of health workers, population, health students and patients from different corners of the country.

Knowledge
Thirteen articles on knowledge about COVID-19 among health workers, hospital staff, students, and sample populations. All articles reported substantial levels of knowledge about COVID-19 in Ethiopia. A research on 422 health workers showed that nurses obtained higher knowledge scores which are very important to tackle the virus because nurses are one of the frontline workers.
In a study by [12,13] the majority (70.1%) of the study participants reported that shaking hands of infected individuals result in the spread of infection. 217 (53.7%) knew touching an object or surface with the virus on it, then touching the mouth, nose, or eye transmits the virus and 337 (83.4%) knew respiratory droplets of infected individuals through the air during sneezing or coughing spreads the virus.
In other study, from 546 participants, 71.4% correctly responded that the main clinical symptoms of COVID-19 are fever, fatigue, dry cough, and shortness of breath, and the majority (95%) said currently there is no cure for COVID-19 and more than 73.6% of the participants used social media as their main source of information about COVID-19 [14].
A study by showed that 276 (67.6%) of the students said that air droplets from the infected persons can transmit the infection of COVID-19 to healthy individuals. Similarly, 375 (91.9%), 343 (84.1%), and 324 (79.4%) of the participants said that patients with COVID-19 can present with fever, dry cough, and shortness of breath respectively and 293 (71.8%) of the students have gotten information about COVID-19 from mass media (TV, magazines, newspaper, radio) and nearly fifty percent (54.2%) of the participants have gotten information from social media (face book, Instagram, what's app and telegram). According to [13][14][15][16] Knowledge is a prerequisite for establishing prevention beliefs, forming positive attitudes, and promoting positive behaviors, and individuals' cognition and attitudes towards disease affect the effectiveness of their coping strategies and behaviors to a certain extent. A study by showed (72%) of the study participants had favorable attitude towards the COVID-19 and 85.3% of the nurses had disturbed psychological responses towards the COVID-19 ( Table 2). The vast majority of the participants also held an optimistic attitude towards the COVID-19 epidemic according to [13]: 81.8% believed that COVID-19 will finally be successfully controlled, and 77.3% had confidence that world leader/WHO can win the battle against the virus

Discussion and Conclusion
In those thirteen studies on Knowledge, Attitude and Practice towards COVID-19 in Ethiopia; there is a gap between knowledge, attitude and practice; some had good knowledge about the virus but their practice was very poor that is why COVID-19 is increase alarmingly in Ethiopia. The review also revealed that knowledge directly influenced attitudes. Good KAP is a tool that can be used to assess the current conditions and if it is used properly it plays a pivotal role to control the spread of COVID-19. Therefore the following recommendations are given.
Government and ministry of health must give information to the society through TV, radio and social media repeatedly.
Address peoples live in rural area through health professional about what is at stake Wearing mask must be mandatory Follow people's day to day activities when they are in the shop/malls, taxi, work etc.

Data Availability
All the datasets used to support the findings of this study are all in the text.