The novel Coronavirus (COVID-19) pandemic is a major global health threat of the twenty-first century and was first detected on 31 December 2019 in Wuhan, China [1
]. WHO declared COVID-19 a global emergency on 30 January 2020, and labelled it a pandemic on 11 March 2020. This new virus is structurally similar to severe acute respiratory syndrome (SARS) and the Middle East respiratory syndrome (MERS) [3
], but does not seem to be as deadly as other coronaviruses including SARS and MERS [5
]. During the 2002–2003 SARS outbreak, a total of 8098 infected cases and 774 deaths were reported [5
]. In the later outbreak of MERS and since 2012, a total of 2494 infected cases and 858 deaths were reported [3
]. COVID-19 has, however, surpassed the earlier outbreaks of coronaviruses and is more transmissible than both SARS and MERS [7
]. As of 16 December 2020, 190 countries, including Bangladesh, have confirmed more than 73.5 million COVID-19 cases and 1.64 million deaths globally [8
COVID-19 has exposed large gaps in public health preparedness and response for infectious disease threats and outbreaks in South Asia, including Bangladesh. The lack of resilient public health surveillance system is particularly evident [9
]. Bangladesh is one of the poorest and most densely populated countries in the world, with over 160 million inhabitants [10
]. The first COVID-19 case in Bangladesh was identified by the Institute of Epidemiology, Disease Control and Research (IEDCR), on 7 March 2020 [11
]. The number of infected cases began to rise on 9 March 2020, and as of 16 December 2020, there were 494,209 infected cases and 7129 deaths reported in Bangladesh [8
]. According to the COVID-19 risk and vulnerability index, Bangladesh ranked 30th in the globe in the number of individuals affected [12
]. The COVID-19 outbreak has already spread across all 64 districts in the respective nation (IEDCR, 2020). However, questions remain regarding the actual number of reported cases and shortage of testing facilities [13
]. Bangladesh is facing an unprecedented challenge to protect against COVID-19 because of its high population density and fragile healthcare system.
With vaccines starting to become available in several countries to select residents such as the elderly and health workers, positive individual and communal actions continue to be major ways by which to minimize the transmission of the virus and potentially save lives [14
]. WHO has outlined public health and social measures that are useful for slowing or stopping the spread of COVID-19 at local, regional, national, and international level. These include, but are not limited to, practicing social distance, regular hand wash, avoid touching one’s face, smoking cessation, and avoiding other activities that weaken the lungs (WHO 2020). A limited number of knowledge, attitudes, and practices (KAP) studies have been conducted in Bangladesh during previous epidemics. For instance, a study conducted in Bangladesh during the dengue epidemic in 2019 found that good knowledge and attitudes were significantly associated with good dengue prevention practices [15
]. Battling the COVID-19 pandemic is a lengthy process and measures to raise the general population’s knowledge and implementation of recommended health practices are some of the best approaches to combat COVID- 19 [13
]. Adopting individual level prevention strategies depends on people’s KAPs regarding the health threat, especially in infectious disease contexts [17
A KAP survey is an effective tool for the management of infectious disease during outbreak and recovery stages [15
]. This survey among at-risk populations is useful to provide critical information to guide response and recovery efforts, health education, and social mobilization during epidemics [15
]. Bangladesh fears a coronavirus crisis as cases could be increasing due to higher testing rates, testing equipment becoming more available (whereby earlier in the pandemic testing was not readily available), infections increasing, or a combination thereof. Thus, there is a growing concern about the importance of health behaviors and attitudes towards the virus, and studies that address KAP in Bangladesh can contribute to prevention of further spread. Densely populated and overcrowded countries such as Bangladesh have the potential to become disease hotspots with active transmission of agents to large communities [13
Under such an alarming situation, little is known about the status regarding COVID-19 KAP among Bangladeshi residents. To facilitate outbreak management of COVID-19, an understanding of the public’s awareness related to COVID-19 signs and symptoms, and transmission modes and treatments/prevention/control strategies towards COVID-19 is urgently needed. Therefore, this study aimed to investigate KAP and determinants of preventive practices related to COVID-19 outbreak among rural and urban residents in Bangladesh. This study provides a glimpse of the overall public health preparedness and a scientific basis for preventing and controlling the epidemic in Bangladesh and other endemic countries around the world. The following research questions were addressed in this study: (1) Can differences in people’s KAP towards COVID-19 be explained by their socio-demographic characteristics? (2) Do participants’ demographics, knowledge, and attitudes about COVID-19 signs and symptoms, transmission, and/or preventive measures contribute to better preventive practices?
This study was conducted during the onset of COVID-19 pandemic in Bangladesh and elsewhere. Overall, 70% of the respondents surveyed in Bangladesh had poor knowledge and preventive practices regarding COVID-19, even though most of the respondents (more than 60%) reported good attitude towards COVID-19. This latter finding is encouraging and offers opportunity for intervention. Male and less educated respondents who also have poor knowledge on signs and symptoms and transmission regarding COVID-19 reported poor prevention practices towards COVID-19. Several studies also found that in Bangladesh more than half of the respondents reported “good knowledge” of COVID-19, with age and education having a significant impact on knowledge and prevention practices of COVID-19 [13
]. Another study in China found that age, gender, and education were influencing factors of COVID-19 knowledge [25
]. In contrast, a study conducted by Zhong et al. showed that the overall correct rate of COVID-19 knowledge was 90% [1
], which was much higher than that of our study; the difference might be due to the higher education levels of the sample compared to our study. Therefore, relevant health education can help improve KAP level of the public, especially those with lower educational background.
Urban respondents reported comparatively better KAP than rural respondents; the difference may be due to better access to education, internet facilities, communication strategies, and health facilities which was reflected in the respondents’ level of KAP. For example, we found that more than 90% of the urban participants had higher than secondary school level of education compared to rural participants (66.1%). Higher socio-economic conditions and internet usage was also higher among urban participants (Table 1
). Low literacy rate, internet facilities, and poor socioeconomic conditions were likely key factors resulting in insufficient KAP regarding COVID-19 among rural participants [25
]. This study also identified significant determinants of prevention practices towards the pandemic in Bangladesh. These findings are useful for public health policymakers and health workers to identify target populations for COVID-19 prevention and health education. KAP surveys are a useful tool to determine effective evidence-based prevention and control strategies through changing poor KAP [26
We found that most respondents knew that COVID-19 is a global pandemic and social media was found to be the most popular and frequently used source of information among both urban and rural communities. These findings suggest that people are more interested in receiving news and information about COVID-19 through social media. This finding can be used by the Bangladesh Ministry of Health to promote population-based awareness regarding COVID-19 through social media. As there are currently no completely effective vaccines against COVID-19, prevention and management remain the best and only way to tackle this deadly disease. Public awareness of COVID-19 through social media and mass media is a crucial factor in protecting against this disease. At the same time, however, it is important to ensure that correct information on COVID-19 is spread via both social and mass media, provided that misinformation about COVID-19 continues to dominate social media [27
]. Consuming credible and heterogeneous rather than polarized and siloed health information and news via social media is particularly important because it has a significant effect on one’s healthcare decisions and outcomes.
Online-based mental health intervention programs are strongly recommended as a way of promoting more reliable and authentic information about COVID-19, as well as making available possible telemedicine care, as suggested in related research papers [28
]. Both government and non-government agencies need to educate local communities about the protection and safety measures against COVID-19. Early and quick detection measures using emerging technologies can be applied to stop the transmission of COVID-19 [31
]. The diagnostic facilities of Bangladesh should be improved across the country, particularly among vulnerable communities, such as older adults, the poor, minorities, the homeless, and those with pre-existing mental health disorders [32
]. Further specific to Bangladesh, vulnerable communities include those who live in remote rural areas, the poor, children, and adolescents. As suggested by Rajkumar (2020), cases such as these require “close collaboration between psychiatrists and specialties from other branch of medicine, as well as with local authorities and health workers in the community” [32
6. Conclusions and Recommendations
Above all, the attitude of Bangladeshi urban and rural residents is positive, but the knowledge and preventive practices related to COVID-19 need to be improved. There is an urgent need for building awareness programs targeting the unhealthy behaviors of rural and urban residents in Bangladesh. For this, social mobilization and communication programs should be developed. Since most of the respondents use social media and electronic media, rigorous and targeted campaigns by public health authorities through social, electronic, and print media can ultimately play a role in improving knowledge and control measures regarding COVID-19 by disseminating validated health information. As the global threat of COVID-19 continues to escalate, greater efforts through an interdisciplinary approach involving community participation, media, government, and educational programs regarding COVID-19 should be advocated to control the pandemic. This study provides useful information for COVID-19 control and prevention which is specific to Bangladesh, and suggests that routine KAP investigation can be an effective monitoring tool to control the spread of COVID-19.