key: cord-279395-qfb06csa
authors: Khan, Samea; Khan, Mahjabeen; Maqsood, Khizra; Hussain, Tanveer; Noor‐ul‐Huda,; Zeeshan, Muhammad
title: Is Pakistan prepared for the COVID‐19 epidemic? A questionnaire‐based survey
date: 2020-04-10
journal: J Med Virol
DOI: 10.1002/jmv.25814
sha: 
doc_id: 279395
cord_uid: qfb06csa

COVID‐19 is a pandemic that began in China in December 2019. World health organization (WHO) has expressed fears that Pakistan might emerge as the next epicenter of this pandemic. We hypothesize that at present the Pakistani masses are not prepared to face any threat of a looming epidemic. The main aim of this study was to evaluate the basic knowledge of educational and health care workers (HCWs) regarding COVID‐19, its control, and prevention. Knowledge about origin, symptoms, and spread of viral infection was assessed. In this cross‐sectional survey, a self‐designed questionnaire was distributed among 302 HCWs including physicians (10.9%), nurses (1.32%), lab staff (1.65%), and academic individuals including faculty and students (86.42%) of different organizations. Results were analyzed using the χ (2) test. Obtained results validate our null hypothesis that Pakistani masses are not well aware of the COVID‐19 and strategies for the prevention and control of infection. The study concluded that individuals belonging to the front‐line workers and high literacy groups are not prepared for the alarming situation in the country. Effectual implementation of infection control programs should be practiced, and it depends on awareness, training, and cooperation of individuals.

COVID-19 has been first reported as a cluster of pneumonia cases of unknown etiology from Wuhan, Hubei, Mainland China on 8th

December 2019. 1 This novel coronavirus outbreak is believed to be originated from an animal source in individuals who visited the local seafood and animal market in Wuhan, after which community transmission led to the initial endemic turning into a pandemic. 2, 3 Travel associated cases of COVID-19 infection have been reported by different countries. [4] [5] [6] At present as the world health organization (WHO) has declared the COVID-19 as a pandemic, Pakistan is facing a critical situation and strict measures need to be taken to avert the threat of a national health crisis. WHO has expressed its fears that Pakistan is facing a major COVID-19 challenge. They mentioned that if effective measurements are not taken Pakistan might emerge as the next epicenter of this pandemic. [7] [8] [9] It is believed that insufficient consideration is given to the basic infection control protocols including hand washing and personal protective equipment use in the educational and health care institutes of the country. The Ministry of Health, Pakistan has declared new guidelines for infection control which are based on the WHO recommendations. 10 However, the implementation of the basic infection control protocols is possible only when people and employees are made aware of the introduced policies by giving them clear guidelines. Awareness level and compliance of the educational and healthcare workers play an important role in the effective and timely prevention and control of a public health crisis. 11 To formulate a healthy policy, the multi-disciplinary teams including key front-line workers should be a part of the policy planning to ensure that these policies function effectively. 12 Pakistan faces many specific challenges about infection control that must be met by devising national policies.

Our null hypothesis states that "Pakistani masses are not prepared to face a looming threat of a COVID-19 epidemic."

The main aim of the present questionnaire-based analysis was to check the awareness level among the employees at educational institutes and the health care workers (HCWs) in various organizations across Pakistan. Questionnaires were filled by diverse groups of faculty, students, HCWs (physicians, nurses and lab staff).

These questionnaires addressed access to information, training, confidence in the ability of faculty and HCWs to implement the introduced policies at their workplaces and asses the main threats which could lead to a possible public health crisis. These forms also evaluated the level of preparedness that any institute had to deal with a COVID-19 outbreak.

A total of 303 individuals were included in this study. These include students and faculty (261) and HCWs (41) of which 32 physicians, 4 nurses and 5 laboratory staff in public and private sector educational and health institutes across Pakistan filled a questionnaire.

View of students, faculty and HCWs from educational and health institutes regarding the recent public health emergency of the pandemic COVID-19 was collected by filling in a standardized questionnaire. Questionnaires were distributed using the quick mode of communications including Facebook, emails, and WhatsApp. Anonymous responses were recorded and no ethical approval was required for this survey. Feedback was taken based on their knowledge about COVID-19, its spread, and prevention and control measures implemented at their organizations. The questionnaire contained 21 different questions on basic knowledge of the infection, personal attitudes, and common practices during infection outbreak, control programs and policies, training and orientation conducted to bring awareness on origin, a common mode of transmission, signs, and symptoms. The participants were asked to either choose from given options or write their own opinion. Please access the manuscript at: https://forms.gle/r2SmQa4BEsb3QnJQ6.

All the data were analyzed with computer software SPSS version 21. The χ 2 test was applied and P value .1 or less was considered significant. Level of significance was measured to evaluate the difference in proportion among different respondent groups (HCW and professionals from educational institutes).

In total 303 individuals including students and faculty (86.42%) and

HCWs (13.56%) of which 10.59% physicians, 1.32% nurses and 1.65% laboratory staff in public and private sector educational and health institutes across Pakistan submitted their responses to the questionnaire. Figure 1 summarizes the characteristics of the study groups in terms of age, gender and organization (educational and health care). Out of these respondents, 50.99% were aged less than 25 years, 48.66% between 25 and 50 years, and 0.33% above 50 years comprising of 28.47% males and 71.52% females. A total of 12.58% of the respondents were from government hospitals, 7.61% were from private hospitals and 79.8% were from the educational institutes.

Responses to questions were compared among subjects from educational institutes, physicians, nurses, and lab staff. Response percentage in each group and their P values which were obtained using the χ 2 test are summarized in Table 1 . The responses to questions regarding basic knowledge, that is name, origin, common signs and symptoms, sources of infection of COVID-19 and awareness of any other pandemic viral infection in the past varied greatly.

In response to a query regarding the name of the virus 95.36%, individuals responded that they were aware and 2.32% responded that they did not know the name of the virus. A P value of .85 suggests that results were insignificant and the variables (profession and awareness regarding the name of the virus were not related).

The second question posed was regarding the origin of COVID-19, 82.45% of respondents said that they were aware of its origin, while 8.94% said that they did not know its origin, 8.61% of respondents were not sure whether they knew or not the origin of COVID-19. The highest uncertainty (50) about the origin of COVID-19 was found among the nurses. Based on professional awareness it was seen that 93.75% of physicians, 25% nurses, 100% lab technicians, and 81.61% F I G U R E 1 Visual representation of demographic characteristics of study group. A total of 28.74% (blue males and 71.52% (red) females participated in the study. A total of 50.99% of participants were below the age of 25 years, 48.66% were between ages 25 to 50 years and 0.33% belonged to the age group above 50 years. A total of 86.42% of participants belonged to the educational institutes, and 13.56% were health care workers. A total of 79.8% of respondents belonged to the educational institutes and 20.19% belonged to the health care workers (HCWs) For the query about sources of information regarding COVID-19, the internet, and social media remained at the highest level while the newspaper is considered as the third source of information in all professions however most prominent trend was noticed in academic subjects ( Figure 2 ).

Organization wise distribution of the responses is shown in Table 2 . Results are presented in terms of several respondents and percentages; the P value is also recorded for each response. The Table 3 about the previous pandemics, a high level of awareness was found in all organizations.

A similar pattern of responses was noticed in a query about the spread of infection in Pakistan. It is clear from the data presented in When we look at the response of people about the latest update about COVID-19, most people rely on getting information from the internet followed by social media (Figure 3 ).

Male and female distribution across different professions was significantly varied ( χ 2 9.818; P value .001; Table 2 ). Physicians, nursing and laboratory staff were less likely to be male and female than expected, while the other was significantly more likely to be female and less likely to be male as compared to the expected. According to the profession, the distribution of responses to the questions was varied, so we checked whether gender has any impact on responses. However, both male and female response distribution is very much similar. (Table 2) . Also, concerning the organization, there is a significant variation in the distribution of age groups ( χ 2 33.036; P value .001). It was mainly observed that in Government and private hospital participants were more likely falling in 25-to 50-year group that is below 25 years were lesser than expected, whereas educational institute participants were more likely to be falling in below 25 years than expected as compared to the 25-to 50-year group where the ratio of expected is higher than the observed.

The outcome of this questionnaire suggests that Pakistan faces a unique challenge related to public health, which majorly is the peo- 

To avert the threat of an epidemic, it is significant that public knowledge, attitude, and behavior towards COVID-19 response is prompt. However, the results of our study reveal that the masses of Pakistan are not aware of the gravity of the situation. Moreover, front-line workers are not prepared to face the challenge. It is a matter of urgency that awareness at all levels is promoted.

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Pakistan Facing Major Covid-19 Challenge. WHO; 2020. 8. 52 new coronavirus cases push Pakistan's tally to 237

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Ministry of Health P. National Action Plan for Corona virus disease (COVID-19) Pakistan

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Is Pakistan prepared for the COVID-19 epidemic? A questionnaire-based survey

The authors declare that there are no conflict of interests.

SK and MZ designed the study and compiled the manuscript, MK and KM performed the statistical analysis, NH compiled the statistical results, TH carried out the final formatting and manuscript proofread.All authors have read the manuscript and agree to the submission.

http://orcid.org/0000-0002-9909-4726 F I G U R E 3 Bar chart for distribution of responses according to organization. This figure represents the various sources used by the people to gather knowledge about COVID-19. Light blue bar represents all organizations, orange bar stands for educational institutes, gray bar represents government institute, the yellow bar represents private institute
