Knowledge and Attitude on Prevention of Novel COVID-19 Among Community Health Workers in Nepal. Amul Shrestha ( [email protected] ) IFHR (Innovative foundation for health and research) https://orcid.org/0000-0001-7892-4279 Tek Bahadur Thapa IFHR (Innovative Foundation for Health and Research) Mahendra Giri IFHR, Nepal Sanjiv Kumar IFHR, Nepal Sakil Dhobi IFHR, Nepal Harikali Thapa IFHR, Nepal Pawan Prakash Dhami IFHR, Nepal Arun Shahi IFHR, Nepal Ajita Ghimire IFHR, Nepal Research article Keywords: Knowledge and attitude, community health care workers (HCW’s), enabling factors, palika (Rural/ Urban Municipalities and Metropolitan city) Posted Date: February 1st, 2021 DOI: https://doi.org/10.21203/rs.3.rs-192110/v1 License: This work is licensed under a Creative Commons Attribution 4.0 International License. Read Full License Page 1/28 Version of Record: A version of this preprint was published at BMC Public Health on July 19th, 2021. See the published version at https://doi.org/10.1186/s12889-021-11400-9. Page 2/28 Abstract 1. Background: Emerging and reemerging pathogens are global challenges for public health and the pandemic of Coronavirus disease 2019 is a reemerging case of an infectious disease caused by Severe Acute Respiratory Syndrome-Corornavirus-2 . Health care worker worldwide are at higher risk worldwide and the situation is the same in Nepal. The knowledge and attitude of health workers will certainly mark the outcome towards this pandemic. So, this study aims to assess the knowledge and attitude of community health workers towards the prevention of COVID-19 virus. 2. Methods: A descriptive cross-sectional study was carried out among the community health workers of various provinces of Nepal. A semi-structured, self-administered questionnaire was prepared in google form and circulated to the sampled health workers through various social media platforms like Facebook, messenger, Instagram, g-mails and messengers. Responses containing anonymized data was collected analyzed in using SPSS-version-20. The results were interpreted and was checked with various demographic and enabling factors using chi-square test and logistic regression model. Also, ethical approval was taken from NHRC (ERB protocol registration number: 360/2020P) prior to the conduction of study. 3. Results: Out the total sample size of 450, we took 399 responses taking into consideration all the inclusion criteria. So, from 399 valid response, 230 (47.6%) were males and 169 (42.4%) were females. 380 (95.2%) employed participants thought that wearing PPE will reduce the chances of getting COVID- 19, majority of the participants 80.5%(321) responded that COVID-19 will successfully be controlled and staffs receiving excellent support from palika had high knowledge level. Knowledge level was signicantly associated with the enabling factor “support from palika” (P=0.045). 4. Conclusions: Proper and adequate knowledge and attitude towards COVID-19 is a paramount in the prevention and control of SARS-COV2 for everyone and especially the HCW’s who are the frontline workers. There is a need to orient more HCW’s regarding COVID-19, preventive measures. 45.9% of the respondents had no availability of COVID-19 response medical items for prevention of COVID-19 at their respective health facilities which is a serious issue which need to address very quickly to ght against the pandemic. Introduction Emerging and reemerging pathogens are global challenges for public health [1]. Corona viruses are enveloped RNA viruses that are distributed broadly among humans, other mammals, and birds and causes respiratory, enteric, hepatic, and neurologic diseases [2, 3]. Six coronavirus species are known to cause human disease [4]. Four viruses 229E, OC43, NL63, and HKU1 are prevalent and typically cause common cold symptoms in immunocompetent individuals [4]. The two other strains, severe acute respiratory syndrome coronavirus (SARS-CoV) and Middle East respiratory syndrome (MERS) coronavirus (MERS-CoV) are zoonotic in origin and have been linked to sometimes fatal illness [5]. Corona virus Page 3/28 disease 2019 (COVID-19) is an infectious respiratory disease which is caused by newly recognized corona virus [6]. Given the high prevalence and wide distribution of corona viruses, the large genetic diversity and frequent recombination of their genomes, and increasing human–animal interface activities, novel corona viruses are likely to emerge periodically in humans owing to frequent cross- species infections and occasional spillover events [5, 11]. In late December 2019, several local health facilities reported clusters of patients with pneumonia of unknown cause that were epidemiologically linked to a seafood and wet animal wholesale market in Wuhan, Hubei Province, China [12]. In January 2020, the outbreak of the 2019 novel coronavirus (2019- nCoV) in China spread progressively to other countries [13, 14], with WHO declaring it a Public Health Emergency of International Concern [15]. Among the affected 200 countries globally (where 2,074,529 conrm cases and 139,378 deaths were reported as of April; and 23,560 conrm cases and 586 deaths South East Asia region including Nepal [16]. On 23rd January 2020, the rst case was reported for COVID- 19 in Nepal and now (21st Sept 2020), the data hiked at 64,122 cases with 46,233 recovered and 411 deaths [17]. Health workers are at the front line of the COVID-19 outbreak response and as such are exposed to hazards that put them at risk of infection [18]. Community health workers are one of the apex part of the health system of Nepal. After the decentralization, local government health system purely depends on community health workers. They are the pioneer for the prevention, promotion, and curative activities at the community level. So, their knowledge and attitude play a pivotal role for preventing COVID-19 at the community level and this study aims to nd out the knowledge and attitude on prevention of novel coronavirus among community health workers in Nepal Methods A descriptive cross-sectional study design was carried out to nd out the status of knowledge and attitude of community health care workers towards the prevention of novel corona virus-2019. The study was conducted among the community health workers who are working at Health post and Primary Health Care level health institutions during the pandemic of COVID-19 in all the seven provinces of Nepal. A semi-structured, self-administered questionnaire was prepared in google form and circulated to the sampled health workers of all 7 provinces. The online forms were disseminated via various social media platforms like Facebook, messenger, Instagram, g-mails, messengers, WhatsApp, and Viber. The informed consent was also attached along with the google forms before the beginning of the survey. Informed consent was taken from each respondent before the data collection and they were provided full rights to withdraw the study at any instance of time they wish. Also, ethical approval was taken from NHRC (ERB protocol registration number: 360/2020 P) prior to the conduction of study. The sample size was calculated using the formula for the descriptive cross-sectional study, i.e. N= (Z α/2) 2 2 p*q / d ) at 95% CI and 4% allowable error limit. With p = 75%, our sample size was calculated to be 450. Page 4/28 The sampling of the respondents was carried out via convenience sampling technique (non-probability sampling method). For maintaining quality control and quality assurance of this study, designed questionnaires was pre-tested for content validity and tools were modied after pre-test and from observation eld note. After the distribution of the questionnaire, 420 responses were obtained from the health care workers out of which 399 met the inclusion criteria which was 95% of the total response and 88% of the total sample size. After the data collection, it was checked for completeness. The information will automatically be transferred to excel sheet and then transferred to SPSS. Responses containing anonymized data was collected and analyzed using SPSS-version 20. The results were interpreted in terms of percentage response, knowledge and attitude score and chi-square test and logistic regression was adopted to nd the association between knowledge and attitude with various demographic and enabling factors. Results Out the total sample size of 450, we took 399 responses taking into consideration all the inclusion criteria. Responses from health workers other than HP, PHC of Government of Nepal, not residing in Nepal, not working at the time of COVID-19 pandemic, were excluded. So, from 399 valid response, 230 (47.6%) were males and 169 (42.4%) were females. So, the gender of the participants was almost evenly distributed. Regarding the marital status of the respondents, more than half of them were married (61.7%) followed by unmarried (37.6%). Among the total respondents participated, nearly 1/3rd was HA (Health Assistant) (29.6%) and the least were ANM and staff nurses, both 4.8%. Majority of the respondent (61.2%) said that Television and radio was the media through which they rstly got the information about COVID-19. Nearly 2/5 (40.1%) of the respondents were working at Bagmati province while the least (3%) respondents were from Sudurpaschim province. Regarding the education level, 41.4% of the respondents had completed PCL (Prociency Certicate level) and only 11.3% had completed their master level study. Nearly half (46.1%) of the respondents responded that their monthly