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BMJ Open: first published as 10.1136/bmjopen-2020-043971 on 23 February 2021. Downloaded from BMJ Open is committed to open peer review. As part of this commitment we make the peer review history of every article we publish publicly available. When an article is published we post the peer reviewers’ comments and the authors’ responses online. We also post the versions of the paper that were used during peer review. These are the versions that the peer review comments apply to. The versions of the paper that follow are the versions that were submitted during the peer review process. They are not the versions of record or the final published versions. They should not be cited or distributed as the published version of this manuscript. BMJ Open is an open access journal and the full, final, typeset and author-corrected version of record of the manuscript is available on our site with no access controls, subscription charges or pay-per-view fees (http://bmjopen.bmj.com). If you have any questions on BMJ Open’s open peer review process please email [email protected] http://bmjopen.bmj.com/ on October 4, 2021 by guest. Protected copyright. BMJ Open BMJ Open: first published as 10.1136/bmjopen-2020-043971 on 23 February 2021. Downloaded from KAP-COVIDGLOBAL: A Multinational Survey of the Levels and Determinants of Public Knowledge, Attitudes, and Practices towards COVID-19 ForJournal: peerBMJ Open review only Manuscript ID bmjopen-2020-043971 Article Type: Original research Date Submitted by the 19-Aug-2020 Author: Complete List of Authors: Masoud, Ahmed; Fayoum University Faculty of Medicine Zaazouee, Mohamed; Al-Azhar University - Assiut Branch Elsayed, Sara; October 6 University Faculty of Medicine Ragab, Khaled; Minia University Faculty of Medicine Kamal, Esraa; Fayoum University Faculty of Medicine Alnasser, Yusra; Damascus University Faculty of Medicine Assar, Ahmed ; Menoufia University Faculty of Medicine Noreldin, Anas; Al-Azhar University Faculty of Medicine Istatiah, Loai; Fayoum University Faculty of Medicine Abd-Elgawad, Mohamed; Fayoum University Faculty of Medicine Abdelsattar, Ahmed; Fayoum University Faculty of Medicine Sofy, Ahmed; Fayoum University Faculty of Medicine Hegazy, Doaa; Harvard Medical School Femía, Vistor; Universidade do Vale do Sapucai http://bmjopen.bmj.com/ Mendonça, Adriana; Universidade do Vale do Sapucai Sayed, Fatma; Fayoum University Faculty of Medicine Elmoursi, Ahmed; University of Kentucky College of Medicine Alareidi, Alaa; Rutgers University Abd-Eltawab, Ahmed; Fayoum University Faculty of Medicine Abdelmonem, Mohamed; Fayoum University Faculty of Medicine Mohammed, Omar; Fayoum University Faculty of Medicine Derballa, EzzEldeen ; Fayoum University Faculty of Medicine Elfass, Kareem; King Faisal University on October 4, 2021 by guest. Protected copyright. Abdel-Daim, Mohamed; Suez Canal University Faculty of Veterinary Medicine; King Saud University College of Science Abushouk, Abdelrahman ; Ain Shams University, Keywords: PUBLIC HEALTH, EPIDEMIOLOGY, VIROLOGY For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml Page 1 of 41 BMJ Open 1 2 3 4 BMJ Open: first published as 10.1136/bmjopen-2020-043971 on 23 February 2021. Downloaded from 5 6 7 8 9 I, the Submitting Author has the right to grant and does grant on behalf of all authors of the Work (as defined 10 in the below author licence), an exclusive licence and/or a non-exclusive licence for contributions from authors 11 who are: i) UK Crown employees; ii) where BMJ has agreed a CC-BY licence shall apply, and/or iii) in accordance 12 with the terms applicable for US Federal Government officers or employees acting as part of their official 13 duties; on a worldwide, perpetual, irrevocable, royalty-free basis to BMJ Publishing Group Ltd (“BMJ”) its 14 licensees and where the relevant Journal is co-owned by BMJ to the co-owners of the Journal, to publish the 15 Work in this journal and any other BMJ products and to exploit all rights, as set out in our licence. 16 17 The Submitting Author accepts and understands that any supply made under these terms is made by BMJ to 18 the Submitting Author Forunless you peer are acting as review an employee on behalf only of your employer or a postgraduate 19 student of an affiliated institution which is paying any applicable article publishing charge (“APC”) for Open 20 Access articles. Where the Submitting Author wishes to make the Work available on an Open Access basis (and 21 intends to pay the relevant APC), the terms of reuse of such Open Access shall be governed by a Creative 22 Commons licence – details of these licences and which Creative Commons licence will apply to this Work are set 23 out in our licence referred to above. 24 25 Other than as permitted in any relevant BMJ Author’s Self Archiving Policies, I confirm this Work has not been 26 accepted for publication elsewhere, is not being considered for publication elsewhere and does not duplicate 27 material already published. I confirm all authors consent to publication of this Work and authorise the granting 28 of this licence. 29 30 31 32 33 34 35 36 37 38 http://bmjopen.bmj.com/ 39 40 41 42 43 44 45 46 on October 4, 2021 by guest. Protected copyright. 47 48 49 50 51 52 53 54 55 56 57 58 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml BMJ Open Page 2 of 41 BMJ Open: first published as 10.1136/bmjopen-2020-043971 on 23 February 2021. Downloaded from 1 2 3 4 KAP-COVIDGLOBAL: A Multinational Survey of the Levels and Determinants of 5 Public Knowledge, Attitudes, and Practices towards COVID-19 6 7 Ahmed Taher Masoud1, Mohamed S. Zaazouee2, Sarah M. Elsayed3, Khaled M. Ragab4, Esraa M. Kamal1, 8 Yusra T. Alnasser5, Ahmed Assar6, Anas Z. Nourelden7, Loai J. Istatiah1, Mohamed M. Abd-Elgawad1, 9 Ahmed T. Abdelsattar1, Ahmed A. Sofy1, Doaa G. Hegazy8, MD, Victor Z. Femía9, Adriana R. Mendonça9, 10 1 10 11 1 1 11 Fatma M. Sayed , Ahmed Elmoursi , Alaa Alareidi , Ahmed K. Abd-Eltawab , Mohamed Abdelmonem , 12 Omar M. Mohammed1, EzzEldeen A. Derballa1, Kareem A. El-Fas12, PharmD, Mohamed Abdel-Daim13, ‡ 14 ‡ * 13 PhD , Abdelrahman I. Abushouk , MD for the KAP-COVIDGLOBAL Investigators 14 15 16 1 Faculty of Medicine, FayoumFor University, peer Fayoum, review Egypt only 17 2 18 Faculty of Medicine, Al-Azhar University, Assiut, Egypt 19 3 th 20 Faculty of Medicine, 6 of October University, Giza, Egypt 21 4 Faculty of Medicine, Minia University, Minia, Egypt 22 23 5 Faculty of Pharmacy, Damascus University, Damascus, Syria 24 25 6 Faculty of Medicine, Menoufia University, Menoufia, Egypt 26 27 7 Faculty of Medicine, Al-Azhar University of Cairo, Cairo, Egypt 28 8 29 Department of Ophthalmology, Harvard Medical School, Boston, MA 30 9 Universidade do Vale do Sapucaí, Pouso Alegre, Minas Gerais, Brazil 31 32 10 Division of Gastroenterology, Department of Internal Medicine, University of Kentucky, Lexington, KY 33 34 11 School of Environmental and Biological Sciences, Rutgers University, New Brunswick, NJ http://bmjopen.bmj.com/ 35 36 12 College of Clinical Pharmacy, King Faisal University, Hofuf, Saudi Arabia 37 13 38 Department of Zoology, College of Science, King Saud University, Riyadh, Saudi Arabia & Pharmacology 39 Department, Faculty of Veterinary Medicine, Suez Canal University, Ismailia, Egypt 40 14 41 Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 42 on October 4, 2021 by guest. Protected copyright. 43 * All collaborators are listed in Appendix file 1. 44 ‡ Both authors contributed equally and are considered conjoined senior authors. 45 46 47 Correspondence: Abdelrahman I. Abushouk, MD; 330 Brookline Ave, Boston, 02115, MA 48 49 Tel: +1 6173978718; Email: [email protected] & [email protected] 50 51 OR Mohamed Abdel-Daim; College of Science, King Saud University, Riyadh, 11362, Saudi Arabia 52 Tel: +2 01014295780; Email: [email protected] 53 54 Manuscript Word Count: 3357 55 56 57 58 1 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml Page 3 of 41 BMJ Open BMJ Open: first published as 10.1136/bmjopen-2020-043971 on 23 February 2021. Downloaded from 1 2 3 4 Abstract 5 6 Objective: The adherence to public health recommendations to control COVID-19 spread is influenced by 7 8 public knowledge, attitudes, and practices (KAP). We performed this cross-sectional study to assess the 9 10 levels and determinants of public KAP towards COVID-19 in a large, multinational sample. 11 12 Design: Cross-sectional study (survey). 13 14 15 Setting: The questionnaire was distributed to potential respondents via online platforms 16 For peer review only 17 Participants: 71,890 individuals from 22 countries. 18 19 Methods: We formulated a four-section questionnaire in English, followed by validation and translation 20 21 into seven languages. The questionnaire was distributed (May-June 2020) and each participant received 22 23 a score for each KAP section. 24 25 26 Results: Overall, the participants had fair knowledge (mean score: 19.24±3.59) and attitudes (3.72±2.31) 27 28 and good practices (12.12±1.83) regarding COVID-19. About 92% reported moderate-to-high compliance 29 30 with national lockdown. However, significant gaps were observed: only 68.2% knew that infected 31 32 individuals may be asymptomatic; 45.4% believed that antibiotics are effective treatments; and 55.4% 33 34 http://bmjopen.bmj.com/ 35 stated that a vaccine has been developed. However, 71.9% believed or were uncertain that COVID-19 is a 36 37 global conspiracy; 36.8% and 51% were afraid of contacting doctors and Chinese people, respectively. 38 39 Further, 66.4% reported the pandemic had moderate-to-high negative effects on their mental health.
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