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

World Health Organization declared the novel coronavirus as a global public health emergency on January 30, 2020. COVID-19 has infected more than 17,660,523 people worldwide, with more than 680,894 deaths in different regions and countries. 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. 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. The level of panic in peoples is associated with knowledge and attitude according to Researchers. Good Knowledge, Attitude and Practice 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. So, the aim paper was to assess/review the knowledge, attitude and perception of the population towards COVID-19 pandemic in Ethiopia. This review paper revealed that there is a gap between knowledge, attitude and practice. Therefore, the government and ministry of health must give information to the society through TV, radio and social media repeatedly because Differences in media consumption have important implications for risk perceptions and compliance with social distancing.


Introduction
COVID-19 pneumonia was first reported in Wuhan, Hubei Province, China, in December, 2019, followed by an outbreak across Hubei Province and other parts of the country [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 contain a single strand of RNA with lengths ranging from 26 to 32 kb and it is under Coronaviridae 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 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.

Literature Search
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 is very important to tackle the virus because nurses are one of the frontline workers.   [12].
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 in Amhara region showed that 276 (67.6%) college students said 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 (Facebook, Instagram, whatsup and telegram) [18].

Attitude Toward COVID-19
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 [13]. 72% of the study participants had satisfactory attitude towards the COVID-19 and 85.3% of the nurses had disturbed psychological responses towards the COVID-19 [19]. The vast majority of the participants also held an optimistic attitude towards the COVID-19 epidemic and 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 [13].

Practice Toward COVID-19
Articles on the practice of COVID-19 pandemic in Ethiopia is presented in table 4. Two hundred sixty-five (65.5%) study participants reported that they washed their hands with soap frequently, 71.7% of the respondents had avoided handshaking, 36.6% of the study participants used face mask, 154 (38.1%) attending overcrowded place, 224 (55.2%) didn't clean frequently touched surfaces and objects and 121 (29.9%) didn't Practice physical distance [12]. Two hundred sixteen (40.9%) of participants gone crowded place and 336 (63.3%) were didn't used face-mask when leaving their home. Three hundred ninety-six (75.0%) respondents were used sterilizers before and after touching inanimate object [13].

Conclusion and Recommendation
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 increases alarmingly in Ethiopia. Religion in Ethiopia consists of a number of faiths and more than 96% of the population have a religion due to this the majority of people in Ethiopia believed that the cause of COVID-19 pandemic is spiritual, and it emerged due to sin. This might be one of the main reason why people didn't practice the preventive measures. 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; a) Government and ministry of health must give information to the society through TV, radio and social media repeatedly because Differences in media consumption have important implications for risk perceptions and compliance with social distancing. b) Use of health extension workers with assignment of specific catchment population to regularly monitor the health of the community at household level. c) Wearing mask in public and crowded places must be mandatory.