https://doi.org/10.47108/jidhealth.Vol3.IssSpecial2.59 Ali Jadoo SA, et al., Journal of Ideas in Health 2020;3(Special 2):258-265 © The Author(s). 2020 This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (https://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. e ISSN: 2645-9248 Journal homepage: www.jidhealth.com Open Access Knowledge, attitude, and practice toward COVID-19 among Iraqi people: a web-based cross-sectional study Saad Ahmed Ali Jadoo1*, Adil Hassan Alhusseiny2, Shukur Mahmood Yaseen3, Mustafa Ali Mustafa Al-Samarrai4, Ru’ya Abdulhadi Al-Rawi4, Ahmed K. Al-Delaimy4, Mohammed Waheeb Abed5, Hanan Raheem Hassooni6 Abstract Background: Iraq was among the first countries invaded by the novel human coronavirus (SARS-COV-2) after China. This study aimed to assess the Iraqi people's knowledge, attitudes, and practices toward COVID-19 during the pandemic. Methods: A cross-sectional study recruiting an online self-reported survey conducted from 17-31 July 2020. Data of 877 participants have undergone descriptive, univariate, and multivariable regression analyses, respectively, to assess the differences in mean scores and identify factors associated with knowledge, attitudes, and practices (KAP) toward COVID-19. Results: Most of the respondents (78.8%) from the urban region, highly educated (69.7%), aged less than 45 years (61.2%), females (58.3%), married (51.9%), and 74.0% self-ranked health as good. Less than half (45.4%) were employed; however, the average monthly income was USD 400 or more in about 66.8% of them. The mean knowledge, attitude and practice score was 15.57 ± 2.46 (range: 0-20), 38.88 (SD = 3.57, (range: 11-55), and 5.13 (SD = 1.14, range: 0–6), respectively. Findings of regression analysis showed that higher educated (p< 0.001), urban residents (P <0.001), employed (P =0.040), and having an income level of USD 400 or more (P <0.001) were significantly associated with upper knowledge score. Female gender and employed respondents are significantly associated with positive attitude scores, but inversely respondents with an income of USD 400 or more are significantly associated with a negative attitude. Regarding practice score, the female gender and those living in an urban region had better practice, but the young age group (0-44 years) was significantly associated with the weak practice. Conclusion: Although Iraq has adopted a preventive and precautionary plan to control the spread of coronavirus. However, the public's knowledge and attitude toward COVID-19, coupled with the unstable political and security situation, have greatly affected the commitment to preventive measures. Keywords: COVID-19, Knowledge, Attitude, Practice, public, preventive measures, Iraq Background Iraq was among the countries that were early hit by the first wave of the COVID-19 pandemic. Since the appearance of the first case at the end of February 2020, Iraq has taken a series of measures to contain the pandemic [1]. However, the response to the escalating emergencies was not well planned. The decisions made by the Iraqi Higher Committee for Health and National Safety (IHCHNS) did not consider the social and economic situation in Iraq [2]. For example, the imposition of a total lockdown and its extension several times without providing livelihood alternatives to many groups of society increased the population's suffering and non-compliance [3]. Reports indicate that a small percentage of the population understood the country's serious health situation and respected the lockdown measures. Most of the educational campaigns that were led by the Iraqi government and the non-government organizations (NGOs) at the local and international levels were broken in front of the rock of stubbornness and indifference of many citizens. On the contrary, a high percentage of the population in Iraq followed the statements of the party and religious leaderships that deliberately weakened the central state's decisions and allowed their followers to mix and practice party ___________________________________________________ drsaadalezzi@gmail.com 1Department of Public Health, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey Full list of author information is available at the end of the article https://doi.org/10.47108/jidhealth.Vol3.IssSpecial2.59 http://www.jidhealth.com/ Ali Jadoo SA, et al., Journal of Ideas in Health (2020); 3(Special 2):258-265 259 and religious rites despite the spread of the pandemic throughout the country [4]. Unfortunately, people did not realize the seriousness of the situation until the pandemic reached their homes. Lack of health awareness was a prominent characteristic of the Iraqi people. Many infected people have avoided treatment due to the social stigma associated with coronavirus and the prevailing belief that health institutions have become a host for transmission. Others believed that the Coronavirus pandemic was a conspiracy and a political game. Therefore, many cases come late to the hospital with severe respiratory distress [5]. People began to realize how bad the situation was when they or a loved one were brought to a hospital, and they saw patients quickly die every day [6]. Iraq witnessed an alarming increase in the number of cases in the summer, especially in July, August, and September 2020. According to the world meter statistics [Worldometer], the number of confirmed cases in Iraq exceeded 387,121, at a rate of 3,500 new cases per day during the past six weeks [7]. Despite the continuing spread of the pandemic, the IHCHNS decided to ease restrictions on combating the coronavirus by allowing the movement of people between provinces and reopening the borders and crossings in addition to tourism facilities and sporting events [8]. There is no doubt that it is protecting the individuals and preserving society's health among the duties of the central government. Nevertheless, people have an essential role in implementing plans and strategies to prevent diseases and epidemics. This study aimed to assess the knowledge, attitude, and practice (KAP) towards the COVID- 19 pandemic among the Iraqi people. Methods Study Design and Sample A cross-sectional study was conducted from 17 July 2020 to 31 July 2020 among Iraq's general population. Given the lockdowns and the restricted movement, data was collected via an online self-reported questionnaire using Google Docs Forms. The researchers distributed the survey link to the participants via Twitter, WhatsApp, and Viber groups. Inclusion and exclusion criteria All Iraqi people living in Iraq understood the questionnaire's content and agreed to participate are included in the study. However, the study excluded the participants from outside Iraq. Sample size The researchers sought to improve the generalizability of the study by maximizing the target sample size. According to world bank data, Iraq's total population was estimated at 39,309.78 in 2019 [9]. The sample size calculator [10] arrived at 1,037 participants, using a margin of error of ± 4.0%, a confidence level of 99%, a 50% response distribution, and 39,309.78 people. Study tool The authors developed the self-reported questionnaire following the guidelines of the Centers for Disease Control and Prevention (CDC) [11]. Moreover, several published articles related to knowledge, attitude, and practice towards the COVID-19 pandemic have been considered [12-23]. Initially, the questionnaire was written in the English language, and then it was translated into the Arabic language. The questionnaire test piloted among 20 respondents not included in the study. Content validation was performed using the content validity rate [24-26]. The online questionnaire's first page contained an assurance of the freedom to participate or withdraw and that all information and opinions submitted would be anonymous and confidential. The questionnaire contains four main sections. The first section is devoted to information on the participants' sociodemographic characteristics, including age, gender, marital status, level of education, employment, place of residency, income level, and self-rated health status. The second section of the questionnaire is dedicated to assessing participants' knowledge of COVID-19. This section contained 20 items focusing on the ways of transmitting the Coronavirus, the clinical symptoms that appear on the infected person, the treatment protocol, and what groups are most at risk of infection, in addition to information on the strategies of isolation, prevention, and control of the pandemic. The third section of the questionnaire included 11 items to assess participants 'attitudes towards COVID-19, using a five-point Likert scale to determine the level of participants' agreement ranging from "1" 'Strongly disagree' to "5" 'Strongly agree'. The fourth section of the questionnaire has six questions recruited to evaluate respondents' practices and behaviors toward COVID- 19. Independent variables For sociodemographic variables, gender was coded as one for females and zero for males. The age variable was reported in six groups: "<18","18-24", "25–34", "35-44", "45-54", "55-64", "65-74" and ">74" years old. Moreover, the age was categorized into two categorize codded zero for more than 44 years and coded one for 44 years and below. Marital status was captured as binary, and a value of one was used for married and zero for otherwise. Education was categorized and coded into one (high educated) for college/university degree, and postgraduate degree and zero (low educated) for high school or below. Work status categorized and the value of zero given to unemployed and value of one given to employed. Place of residency coded as zero for rural and one for urban. Monthly income (Iraqi Dinar (IQD)1 = United State Dollar (USD) 0.0008, exchange rate on 10 July 2020) was divided into four categories: 75 57 6.5 Marital status Married 455 51.9 Single 422 48.1 Education High education 611 30.3 Low education 266 69.7 Residency Urban 691 78.8 Rural 186 21.2 Employment Unemployed 479 54.6 Employed 398 45.4 Level of income <$200 73 8.3 $200-399 218 24.9 $400-1000 320 36.5 >$1000 266 30.3 Self-ranked health status Very poor 22 2.5 Poor 47 5.4 Acceptable 159 18.1 Good 360 41.0 Very good 289 33.0 Regression results of KAP-related factors Regression analysis showed that higher educated (P-value = 0.000, <0.05), urban residents (P-value=0.000, <0.05), employed (P-value=0.040, <0.05), and having income level of USD 400 or more (P-value=0.000, <0.05) were significantly associated with upper knowledge score. Female gender and employed respondents are significantly associated with positive attitude scores, but inversely, respondents with an income of USD 400 or more are significantly associated with a negative attitude. Regarding practice score, the female gender and those living in the urban region had better practice, but the young age group (0-44 years) was significantly associated with weak practice (Table 4). As presented in Table 5, more than 90% of the total sample had accurate knowledge related to "washing hands, wearing medical masks, avoiding touching their eyes, nose, and mouth with the unwashed hand ", "clinical symptoms and its importance", "spreads through cough and sneeze by infected people", "elderly people, people with chronic diseases in higher risk" and "the importance of healthy food and drinking water and isolation". However, 34.8% had a misconception that afebrile patients will not transmit the virus to others. Moreover, 49.8% have insufficient knowledge about antibiotics' effectiveness, and 38.7% do not have accurate knowledge about children affected by COVID-19. 31.4% had difficulty distinguishing coronavirus from influenza. Furthermore, there was a lack of information among the participants regarding pregnant women, and the possibility of infection with Coronavirus (63.4%), contact with wild animals (59.4%), and the importance of wearing a face mask when infected or being close to an infected person (51.4%). Ali Jadoo SA, et al., Journal of Ideas in Health (2020); 3(Special 2):258-265 261 More than 95% of "Maintaining a reasonable distance" and "washing hands" protect individuals and society from coronavirus. 86.2% reported that they do not believe in staying at home as an effective preventive measure. About 50% of them thought coronavirus would be controlled, and 54.9% feel that it was too late for the implication of lockdown at the beginning of the epidemic. Just 50.6% of them thought the Iraqi government's strict measures were enough to win the battle against coronavirus. Also, 72.3% of participants thought complying with the National Safety Committee of the Ministry of Health's instructions will prevent the spread of coronavirus. 25.4% thought the announced number related to infected and dead persons due to coronavirus are exaggerated, 54.9% of them have a growing concern about the second peak of coronavirus cases (Table 6). In terms of practice towards COVID-19 that are presented in Table 7 in Annex, 15.7% of participants had attended a social event involving many people, 28.3% were in a crowded place, 84.5% did not avoid social behavior such as shake hands or kiss people, 9.1% did not think seriously about social distancing, 6.6% were not interested about washing hands after going to a public place, or after blowing your nose, coughing, or sneezing, 11.9% were not interested about washing things from outside the home. Table 2 Number of questions, range, scores, and levels of knowledge, attitude, and practice Variables Number of questions Range of score Total scores (mean ± SD) Accuracy rate (%) Knowledge 20 0-20 15.57 ± 2.46 77.85 Attitude 11 11-55 38.88 ± 3.57 70.69 Practice 6 0-6 5.13 ± 1.14 85.50 Table 3 KAP scores by socio-demographic and economic characteristics Variables Categories Total (%) Knowledge score (mean ± SD) p-value Attitude score (mean ± SD) p-value Practice score (mean ± SD) p-value Gender Female 511(58.3) 15.64 ±2.35 0.348 39.01 ±3.57 0.228 5.18±1.13 0.102 Male 366(41.7) 15.49±2.61 38.71 ±3.57 5.05±1.14 Age 0-44 years 537(61.2) 15.68±2.49 0.126 38.77 ±3.63 0.312 5.10±1.16 0.388 >40 years 340(38.8) 15.41±2.42 39.04 ±3.47 5.17±1.11 Marital status Married 455(51.9) 15.77±2.45 0.016 38.94 ±3.49 0.645 5.16±1.13 0.427 Unmarried 422(48.1) 15.37±2.47 38.83 ±3.66 5.10±1.15 Education High education 611(69.7) 15.94±2.33 0.000 39.87 ±3.61 0.733 5.17±1.12 0.117 Low education 266(30.3) 14.73±2.56 38.94 ±3.50 5.04±1.18 Residency Urban 691(78.8) 15.83±2.37 0.000 38.83 ±3.47 0.375 5.18±1.12 0.020 Rural 186(21.2) 14.61±2.62 39.09 ±3.98 4.96±1.18 Employment Employed 398(45.4) 15.93±2.30 0.000 38.97 ±3.44 0.521 5.14±1.12 0.825 Unemployed 479(54.6) 15.28±2.56 38.81 ±3.68 5.12±1.15 income level > USD 400 586(66.8) 15.90±2.76 0.000 38.72 ±3.50 0.053 5.16±1.09 0.329 < USD 400 291(33.2) 14.91±2.23 39.22 ±3.70 5.08±1.23 Self-ranked Good health 649(74.0) 15.74±2.39 0.000 38.90 ±3.65 0.885 5.12±1.17 0.807 health status Poor health 228(26.0) 15.10±2.60 38.86 ±3.34 5.14±1.05 Table 4 Regression results of KAP-related factors for COVID-19 Variable B SE Beta t P-value 95% CI Tolerance VIF lower-Upper Knowledge (Durbin-Watson= 1.865) Higher educated (VS low educated) 0.801 0.189 0.149 4.246 0.000 (0.431,1.171) 0.840 1.191 Urban (VS Rural) 0.830 0.203 0.138 4.089 0.000 (0.432,1.229) 0.916 1.091 Employed (VS unemployed) 0.285 0.168 0.058 1.696 0.040 (0.045,0.615) 0.902 1.109 > USD 400(VS < USD400) 0.645 0.175 0.123 3.682 0.000 (0.301,0.988) 0.929 1.076 Attitude (Durbin-Watson= 1.757) Female (VS male) 0.447 0.263 0.062 1.696 0.040 (-0.070,0.963) 0.859 1.165 > USD 400(VS < USD400) -0.559 0.259 -0.047 -2.161 0.031 (0.051,1.067) 0.976 1.025 Employed (VS unemployed) 0.395 0.263 0.055 1.498 0.013 (-1.123,0.912) 0.841 1.188 Practice (Durbin-Watson= 1.754) Urban (VS rural) 0.195 0.097 0.070 2.006 0.030 (0.075,0.315) 0.911 1.097 Female (VS Male) 0.156 0.081 0.068 1.919 0.045 (0.044,0.386) 0.925 1.081 0-44 years (vs >44 years) -1.122 0.081 -0.052 -1.510 0.021 (-0.036,0.280) 0.951 1.051 Ali Jadoo SA, et al., Journal of Ideas in Health (2020); 3(Special 2):258-265 262 Discussion To our knowledge, this study is the first national study to explore the knowledge, attitude, and practice of the Iraqis towards the Novel Coronavirus in 2020. The Iraqis scored 77.85% correct rate of knowledge about the COVID-19 pandemic. The results of this study did not differ from a previous study conducted in Sudan (78.20%) [12], and higher than rates reported in studies from Egypt and Nigeria (61.6%) [13], and Bangladesh (48.3%) [14], however, the rate was lower than the rates recorded in other countries such as China (90.0%) [15], Cameroon (84.19%) [16], Saudi Arabi (81.64%) [17], Malaysia (80.5%) [18]. Like other studies conducted in Bangladesh [14], China [19], India [20], and Egypt [21], the higher rates of knowledge correlated with a higher level of education among the respondents with a numerical advantage for the youth population. The youth component of high schools and the undergraduate students represent the group that most social media users, which reinforces the hypothesis of having more access to news and information about the COVID-19 pandemic than the elderly. Moreover, the linear regression analysis showed that knowledge was affected by a high percentage of respondents in urban areas. Similar findings were seen in India [20] and Ethiopia [22]. Iraq suffers from a chronic shortage in the supply of electricity and low internet services, especially in rural areas, which significantly contributed to depriving rural residents of regular access to confidential information and the up to date data about the COVOID-19. Furthermore, having a job with a salary is significantly associated with good knowledge about COVID-19. Similar findings were reported in Malaysia [18], Egypt [21]. COVID-19 caused a deterioration in the global economic situation, which negatively affected the population's physical and psychological health state in general [28,29]. Coronavirus's impact was more severe on countries that already suffer from an unstable political and economic situation, such as Iraq. There was a limitation to access information among the unemployed and low-income families. Lack of essential services coupled with the deteriorating economic situation in Iraq has made most people interested in securing an income to meet the family's needs rather than improving the knowledge about the Corona epidemic. Similar to findings reported in China [19], Bangladesh [14], Egypt, and Nigeria [13], the vast majority of Iraqis agree that leaving a social distance (95.7%), washing hands (97.6%), and staying at home (86.2%) are the best ways to control the epidemic. Unlike previous studies [17, 20, 23], the Iraqis expressed a pessimistic attitude towards the COVID- 19 epidemic: 45.5% of respondents believed that the coronavirus pandemic would not be successfully controlled, and 45.4% of respondents do not have confidence in the Iraqi government's measures to win the battle against the virus. Nevertheless, 72.3% of the respondents emphasized the need to adhere to the National Safety Committee's instructions at the Ministry of Health to prevent the spread of coronavirus. Although 89.3% of respondents believed that the complete lockdown was an effective measure to prevent the coronavirus spread, it harmed the family's economic situation, and 49.3% felt that the implementation was too late. Our survey showed that females were significantly associated with a positive attitude to COVID-19 (P=0.040) than counterpart men. Our survey results coincide with the results of a study conducted in Spain [30], which confirmed that women take the epidemic seriously and are more committed to the standards of protection against the coronavirus with more responsibility than men. Not surprisingly, employed respondents (P=0.013) were significantly associated with a positive attitude toward the COVID- pandemic compared to unemployed people. Although this study did not distinguish between government and self or private employment, getting a job with a sufficient income was a challenge in Iraq. The worldwide lockdown led to massive unemployment; therefore, maintaining or getting a job has dramatically mitigated the economic impact of the COVID-19 pandemic and improved the attitude towards pandemic. However, respondents with high incomes had a negative attitude towards Coronavirus, perhaps because they believe that the pandemic would be prolonged, which could reduce their salaries or lose their jobs later. Similar results have been reported in Vietnam. Dang et al. [31] found that the Coronavirus pandemic-related decline in income was at an average of 61.6% among two-thirds of the study participants and that more than a quarter of them had a salary deficit at forty percent or more. Although the pessimistic attitude prevailed among the respondents, they reacted positively, and the majority of them adhered to the necessary precautions to prevent infection with the COVID-19 virus. More than 84.0% avoided social events and social behavior, such as shaking hands or kissing. Moreover, over 90.0% become interested in practicing social distancing and washing hands or things brought from outside the home. On the other hand, 28.3% of the respondents reported that they went to crowded places and 15.0% of them attended meetings and social events, explaining the emergence of recurrent infection hotspots in different regions of Iraq, which causes delays or failure of the plans of the competent authorities to combat the coronavirus. Findings of the regression analysis showed that urban residents (P= 0.030), female sex (P= 0.045), and those aged more than 44 years (P= 0.021) were significantly more likely to practice protective measures against the spread of the coronavirus than their counterparts. Similarly, Yue et al. [19] found that urban area was "associated with a higher practice score" toward COVID-19 than the rural area. Moreover, it is known that urban residents are more concerned with their rights to health services and generally tend to adhere to health instructions compared to rural residents [32]. Brooks DJ and Saad L [33] found that males are less interested in the Coronavirus than females. Therefore, the mortality rate due to Coronavirus was higher among male patients than females. Galasso et al. [34] found that most women considered coronavirus as a severe health problem. Women were keener to know about the Coronavirus pandemic, listen to the instructions, committed to safety measures, and comply with policies than men. Although there is no definitive evidence to exclude a particular age group from infection with Coronavirus, however, published reports from the World Health Organization [35] indicated that young people are at a lower risk of contracting coronavirus based on less severe physical and clinical signs and symptoms associated with COVID-19 than the old age group. Like other studies [17, 35], our study found that young people are less committed to health prevention measures and have less practice. Moreover, older people are Ali Jadoo SA, et al., Journal of Ideas in Health (2020); 3(Special 2):258-265 263 distinguished by knowledge, wisdom, and responsibility, reflected in better practices than the young age group. Unfortunately, since 2003, political, financial, and administrative corruption in Iraq has created an environment for a dilapidated health system [36]. Most of the bright medical professionals have emigrated. More than half of already in workplace have the intention to leave on both the graduate and undergraduate levels [36,37], because there is no clear law to protect them from of the recurrent exposure to different types of violation [38]. Faced with all these aforementioned challenges, the central government in Iraq is unable to implement very restrictive measures including complete national lockdown, banning all public gatherings, encouraging social distancing, and the compulsory use of face masks, becomes risky behaviors among the study population. Table 5 Correct responses to knowledge statements regarding COVID-19 (N=877). No. Statement Number (%) 1 Corona is a viral disease that spreads from person to person at a distance of up to two meters (6 feet) 630(71.8) 2 Corona spreads through respiratory droplets that occur when infected people cough and sneeze. 834(95.1) 3 Corona infection may occur by touching or kissing the contaminated surfaces or objects and then touching the mouth, nose, or possibly the eyes. 834(95.1) 4 Eating or touching wild animals can lead to infection with the Coronavirus. 355(40.5) 5 People infected with COVID-19 cannot transmit the virus to others when a fever is not present. 572(65.2) 6 The main clinical symptoms of COVID-19 are fever, fatigue, dry cough, myalgia, and shortness of breath. 849(96.8) 7 Unlike the common cold, congestion, runny nose, and sneezing are less common in people infected with COVID-19. 602(68.6) 8 Antibiotics are effective in treating COVID-19. 440(50.2) 9 Currently, there is no effective cure for COVID-19, but early symptomatic and supportive treatment can help most patients recover from the diseases. 764(87.1) 10 The elderly and people who suffer from severe chronic diseases such as heart or lung disease and diabetes have a doubled risk of developing severe complications from developing a COVID-19. 840(95.8) 11 Pregnant women are more susceptible to infections than non-pregnant women. 318(36.6) 12 Children are less likely to be infected with COVID- 19 than adults. 538(61.3) 13 It is not necessary for children or young people to take protective measures against COVID-19 transmission. 754(86.0) 14 people must wash their hands with soap and water or use a hand sanitizer containing at least 60% alcohol for at least 20 seconds. After being in a public place, after nose-blowing, coughing, or sneezing, 788(89.9) 15 As a precaution, people should avoid touching their eyes, nose, and mouth with unwashed hands. 858(97.8) 16 Wearing medical masks is very important to prevent corona infection. 840(95.8) 17 People should only wear a mask if they are infected with the virus or if they are caring for someone with suspected COVID-19 infection. 426(48.6) 18 Healthy food and drinking water strengthen the body's immunity and resistance against COVID-19. 765(87.2) 19 Isolation and treatment of people infected with the COVID-19 are effective ways to reduce the spread of coronavirus. 855(97.5) 20 People being in contact with someone infected with COVID-19 should be immediately quarantined, in an appropriate location, for a general observation period of 14 days. 797(90.9) Table 6 Responses to attitudinal statements regarding COVID-19 (N=877). No. Statements Strongly agree Agree Do not know Disagree Strongly disagree 1 Maintaining a reasonable distance from others is very important to avoid the spread of coronavirus 441(50.3) 398(45.4) 23(2.6) 7(0.8) 8(0.9) 2 Hand washing is necessary to protect individuals and society from coronavirus. 496(56.6) 360(41.0) 13(1.5) 1 (0.1) 7(0.8) 3 Staying at home is an effective preventive measure to protect individuals and society from exposure to CORONA 318(36.3) 438(49.9) 41(4.7) 69(7.9) 11(1.3) 4 I think the Corona epidemic can be successfully controlled. 94 (10.7) 349(39.8) 286(32.6) 116(13.2) 32(3.6) 5 The strict measures taken by the Iraqi government are sufficient to win the battle against coronavirus. 90(10.3) 353(40.3) 184(21.0) 160(18.2) 90(10.3) 6 Complying with the National Safety Committee of the Ministry of Health instructions will prevent the spread of corona. 162(18.5) 472(53.8) 172(19.6) 55(6.3) 16(1.8) 7 The complete lockdown was an effective measure to prevent the spread of coronavirus, but it negatively affected the family's economic situation. 334(38.1) 449(51.2) 38(4.3) 48(5.5) 8(0.9) 8 I think the figures that announced the number of infected people and the number of deaths due to coronavirus are exaggerated. 60(6.8) 163(18.6) 297(33.9) 238(27.1) 119(13.6) 9 I still think that Corona Virus is a hoax, and there is no need to take precautions. 7(0.8) 14(1.6) 74(8.4) 311(35.5) 471(53.7) 10 I have a growing concern about the second peak of coronavirus cases 101(11.5) 381(43.4) 255(29.1) 119(13.6) 21(2.4) 11 When the lockdown introduced at the beginning of the epidemic, I felt it was implemented too late 123(14.0) 310(35.3) 178(20.3) 244(27.8) 22(2.5) Conclusion In conclusion, this study found that the level of knowledge, attitude, and practice of the Iraqis towards COVID-19 was acceptable. Several factors, including gender, educational level, employment, place of residence, and income, were among KAP determinants towards COVID-19. Likewise, previous studies indicated that the level of KAP is positively and negatively affected by the extent to which the awareness of the population develops and the community's ability to contain diseases and pandemics. In light of the Coronavirus pandemic, many researchers have made valuable efforts to study the KAP of people toward the COVID-19. Often the results were positive, recording reassuring proportions of how well people knew about the new pandemic. Nevertheless, the spread of the pandemic at such a rapid speed in different and distant societies raises questions about the extent to which people are serious about adhering to health institutions' instructions. Ali Jadoo SA, et al., Journal of Ideas in Health (2020); 3(Special 2):258-265 264 Table 7 Practices related to COVID-19 (N=877). No. Statement Yes No 1 Have you recently attended a social event (such as a wedding party, funeral parlor, etc.) involving many people? 138(15.7) 739(84.3) 2 Have you recently been in a crowded place? 248(28.3) 629(71.7) 3 Have you recently avoided shaking hands or kissing or any social behavior that calls for meeting and closeness? 136(15.5) 741(84.5) 4 Have you seriously thought about practicing social distancing and leaving a distance when talking to people? 797 (90.9) 80(9.1) 5 Have you recently become more interested in washing your hands with soap and water frequently for at least 20 seconds, especially after going to a public place or after blowing your nose, coughing, or sneezing? 819(93.4) 58(6.6) 6 Have you recently become more interested in washing things that you bring from outside the home, including fruits and vegetables? 773(88.1) 104(11.9) Abbreviation COVID-19: Coronavirus; IHCHNS: Iraqi Higher Committee for Health and National Safety; NGOs: Non-Government Organizations; CDC: Centers for Disease Control and Prevention; KAP: Knowledge, Attitude, Practice; IQD: Iraqi Dinar; USD: United State Dollar Declaration Acknowledgment We would like to thank Mr. Anmar Shukur Mahmood for his great efforts in helping to prepare the questionnaires and the necessary links and distribution through the social networking sites. We also extend our thanks to all respondents to the survey during the Coronavirus pandemic. Funding The authors received no financial support for their research, authorship, and/or publication of this article. Availability of data and materials Data will be available by emailing drsaadalezzi@gmail.com Authors’ contributions Saad Ahmed Ali Jadoo (SAAJ) is the principal investigator of this manuscript (Original manuscript) who designed the study and coordinated all aspects of the research including the study design, analysis, and interpretation of data, drafting the work, writing the manuscript, and reviewed and approved the manuscript. SAAJ, MAMA, SMY contributed to the study concept, design, writing, reviewing, editing, and approving the manuscript in its final form. MWA contributed to data collection. RAA, and AKA contributed to drafting the manuscript. All authors have read and approved the final manuscript. Ethics approval and consent to participate We conducted the research following the Declaration of Helsinki, and the protocol was approved by the Ethics Committee of the Scientific Issues and Postgraduate Studies Unit (PSU), College of Medicine, University of Anbar (Ref: SR/368 at 19-July-2020); the Ethics Committee of the College of Medicine, Diyala University (Ref: 1250 at 15-July-2020); National Cancer Institute, Misrata, Libya (Ref: 0000 at 91-August-2020). Moreover, web-based informed consent obtained from each participant after explanation of the study objectives and the guarantee of secrecy. Consent for publication Not applicable Competing interest The authors declare that they have no competing interests. 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Author details 1Department of Public Health, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey.2 Department of Internal Medicine, Faculty of Medicine, Diyala University, Iraq. 3Department of Anatomy, Molecular Genetics, Faculty of Medicine, University of Diyala, Diyala, Iraq. 4Ddepartment of family and community medicine, Faculty of Medicine, Anbar University, Anbar, Iraq. 5Department of Physiology, Faculty of Medicine, Diyala University, Diyala, Iraq.6Department of Biology, Faculty of Education for Pure Science, Diyala University, Iraq. Article Info Received: 13 August 2020 Accepted: 01 October 2020 Published: 19 December 2020 References 1. World Health Organization, Early COVID-19 preparation saved lives in Iraq. Available from: http://www.emro.who.int/irq/iraq- news/early-covid-19-preparation-saved-lives-in-iraq.html [Accessed on 25 October 2020] 2. Government of Iraq, Covid-19: Higher Committee for Health and National Safety announces new measures. 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