Knowledge, attitudes and practices of COVID-19 among income-poor households in the Philippines: A cross-sectional study

Lincoln Leehang Lau; Natalee Hung; Daryn Joy Go; Jansel Ferma; Mia Choi; Warren Dodd; Xiaolin Wei

摘要

BackgroundThe presence of COVID-19 in low- and middle-income countries (LMICs) is raising important concerns about effective pandemic response and preparedness in the context of fragile health systems and the pervasiveness of misinformation. The objective of this study was to gain an understanding of how COVID-19 was perceived by households experiencing extreme poverty in the Philippines.MethodsThis study was conducted in partnership with International Care Ministries (ICM), a Philippine-based non-governmental organization (NGO) that runs a poverty-alleviation program called Transform targeted towards extreme low-income households. We integrated knowledge, attitudes, and practices (KAP) questions into ICM’s cross-sectional program monitoring and evaluation systems from February 20 through March 13, 2020. Frequencies and proportions were calculated to describe the respondents’ responses, and the Kruskal-Wallis test and binomial logistic regression were undertaken to determine the socio-demographic characteristics associated with COVID-19 KAPs.ResultsIn total, 2224 respondents from 166 communities in rural, urban and coastal settings were surveyed. Although the survey was administered during the earlier stages of the pandemic, 94.0% of respondents had already heard of COVID-19. Traditional media sources such as television (85.5%) and radio (56.1%) were reported as the main sources of information about the virus. Coughing and sneezing were identified as a transmission route by 89.5% of respondents, while indirect hand contact was the least commonly identified transmission route, recognized by 72.6% of respondents. Handwashing was identified by 82.2% of respondents as a preventive measure against the virus, but social distancing and avoiding crowds were only identified by 32.4% and 40.6%, respectively. Handwashing was the most common preventive practice in response to COVID-19, adopted by 89.9% of respondents. A greater number of preventive measures were taken by those with more knowledge of potential transmission routes.ConclusionsThere is a need for targeted health education as a response strategy to COVID-19 in low-income settings, and it is important that strategies are contextually relevant. Understanding KAPs among populations experiencing extreme poverty will be important as tailored guidance for public health response and communication strategies are developed for LMICs.The presence of the COVID-19 pandemic in low- and middle-income countries (LMICs) is raising important concerns about the preparedness of health systems within these countries to address the disease as it continues to spread. With health care facilities that were already overburdened before the pandemic, it is becoming increasingly clear that adopting the measures employed by high-income countries in LMICs may not be feasible [1,2]. Current recommendations focus heavily on hospital-based interventions, but in the context of severe resource limitations, addressing shortages of hospital beds, oxygen, ventilators and personal protective equipment as primary response initiatives may not be realistic. Moreover, there is a need within LMICs to provide emergency support to vulnerable populations, including individuals and households experiencing poverty.There are also concerns around misinformation that may impede public health responses. As the WHO Director-General Dr Tedros Adhanom Ghebreyesus said, “we’re not just fighting an epidemic; we’re fighting an infodemic” [3]. The reach of the pandemic on a global scale has led to a flood of information surrounding the virus, and despite the merits of rapid information dissemination through mass and social media for public health action, misinformation can also easily be propagated through the same channels [4-6]. Both exaggerated and understated pandemic estimates [7] can either fuel panic or a false sense of security among the general public. Additionally, confusion surrounding basic information on how to reduce transmission and exposure to the virus puts people at risk of infection [8,9]. In the context of LMICs, households in resource-poor settings might not have access to regular and reliable sources of information about disease etiology, leaving them ill-equipped to minimize the risk of infection during emerging outbreaks [10-12]. Understanding public perceptions and their responses to COVID-19 is therefore critical in the ongoing planning and implementation of effective pandemic responses in LMICs, particularly by evaluating current public health messaging and communication strategies.In the Philippines, although the speed of transmission was initially limited, public health measures have not been sufficient to curtail the spread of the virus. On January 30, 2020, its Department of Health confirmed the first case in the country [13], and in an attempt to contain further transmission, the Philippine government enforced sweeping preventive measures such as an enhanced community quarantine in r

机译：背景技术在低收入和中等收入国家（LMIC）的COVID-19的存在是对脆弱卫生系统背景下的有效大流行反应和准备的重要担忧以及错误信息的普遍性。本研究的目的是了解Covid-19在菲律宾经历极端贫困的家庭如何了解。方法是与菲律宾的非政府组织（非政府组织）的国际护理部门（ICM）的合作伙伴研究）经营着贫困的减轻计划，称为变革，目标是极端的低收入家庭。从2月20日至3月13日，我们将知识，态度和实践（KAP）问题纳入ICM横断面程监测和评估系统。计算频率和比例以描述受访者的反应以及Kruskal-Wallis测试和对二项式逻辑回归进行了调查与Covid-19 KAPS相关的社会人口统计特征。评估来自农村，城市和沿海环境的166个社区的2224名受访者。虽然在大流行的早期阶段进行了调查，但是94.0％的受访者已经听说过Covid-19。传统的媒体来源，如电视（85.5％）和收音机（56.1％）被报告为病毒信息的主要信息来源。咳嗽和打喷嚏被确定为89.5％的受访者的传输路线，而间接手接触是最少识别的传输路线，占72.6％的受访者。用82.2％的受访者确定了一种防止病毒的预防措施，但社会偏差和避免人群分别仅被32.4％和40.6％鉴定。洗手是响应Covid-19的最常见的预防实践，通过89.9％的受访者采用。具有更多潜在传输路线知识的人采取了更多的预防措施。坚决的是需要有针对性的健康教育作为Covid-19在低收入环境中的反应策略，并且重要的是，策略在上下文相关。了解遇到极端贫困的人口中的KAP将是重要的，因为为公共卫生反应和通信策略的量身定制指导是为LMICS制定的。Covid-19在低收入和中等收入国家（LMIC）的存在是对此的重要担忧在这些国家的健康系统准备，以解决疾病，因为它继续传播。通过在大流行前已经负担过重负重的医疗保健设施，越来越明显，采用LMIC中的高收入国家雇用的措施可能是不可行的[1,2]。目前的建议在大量上侧重于医院的干预措施，而是在严重资源限制的背景下，寻址医院病床，氧气，呼吸机和个人防护设备的短缺，因为主要反应举措可能无法逼真。此外，在LMIC中需要提供对弱势群体的紧急支持，包括体验贫困的个人和家庭。涉及可能阻碍公共卫生反应的错误信息。作为世卫组织总干事博德罗斯·亚汉·彭雷森斯博士说，“我们不只是对流行病斗争;我们正在争夺一个infodemy“[3]。大流行对全球范围的范围导致了围绕病毒的信息，尽管通过对公共卫生行动的群众和社交媒体快速信息传播的优点，但误导也可以通过相同的渠道容易地传播[4 -6]。夸大和低调的大流行估计都可以燃料恐慌或普通公众之间的虚假安全感。此外，围绕关于如何减少传播和暴露于病毒的基本信息的困惑使人们有感染风险[8,9]。在LMIC的背景下，资源差的环境中的家庭可能无法获得常规可靠的有关疾病病因的信息来源，使其能够减少出现爆发期间感染风险[10-12]。因此，了解对Covid-19的公众看法及其对Covid-19的答复在持续的计划和实施LMIC中的有效大流行反应中，特别是通过评估当前的公共卫生消息和沟通策略。菲律宾，尽管传播速度最初是有限的，但公共卫生措施并没有足以减少病毒的传播。 2020年1月30日，其健康部确认了该国的第一个案例[13]，并试图遏制进一步传播，菲律宾政府强制加强综合综合措施，如r

Knowledge, attitudes and practices of COVID-19 among income-poor households in the Philippines: A cross-sectional study

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