1. INTRODUCTION
The Novel Coronavirus Disease (COVID-19) has caused acute respiratory infections in humans that was first identified in late December 2019 in Wuhan China, thereafter it spread worldwide with expediential growth in over 216 countries. In March 2020, the World Health Organization (WHO) declared COVID-19 a pandemic [1]. Data was updated on 31 August 2020, there were 25,085,685 confirmed cases and 843,927 deaths, with the majority occurring in Europe and the Americas [2]. Most people with mild or moderate symptoms of COVID-19 can recover without medical interventions or specific treatment at a hospital [3-5]. Brad Spellberg, reported that about 5% of COVID-19 cases among people experienced mild influenza-like illness without epidemiological risk factors [6]. Also, some studies recently found that infected individuals may report as asymptoms [1, 7, 8], which makes them potential sources of transmission within the community [3, 6]. Almost 20% of COVID-19 patients who had severe symptoms including dyspnea, the shock of sepsis, and multi-organ failure, needed hospitalization and about 2% of COVID-19 cases resulted in death [4]. Patients equal to or older than 65 years old, and people with underlying health conditions such as chronic diseases of the lungs, liver, and kidneys, heart failure, diabetes, hypertension, severe obesity, as well as immunocompromised patients were at a higher risk of serious illness and death from COVID-19 [3]. There has been evidence of the virus spreading from person to person through inhalation of saliva droplets or secretions of the nose behaviors for infectious diseases are inadequate [14-16]. The aim of this study was to determine factors relating to preventive practice to reduce infection in these students.
2. MATERIALS AND METHOD
All students that are currently studying at the University of Medicine and Pharmacy at Ho Chi Minh City (UMP) in 2020 were eligible. A cross-sectional study was performed in February and March 2020. A total of 6 classes were chosen from the first to sixth-year students, using the strategy of from people with COVID-19 [9-11]. At this time, a vaccine or specific treatment for COVID-19 is not yet available [8]. Containment measures in the community are important including washing hands with soap or alcohol hand sanitizers regularly, practicing social distancing (2.0m gap), using personal protective equipment (PPE), and wearing face masks in public [1, 8]. Vietnam has recorded over 1,040 confirmed infections, and some hospital had to be isolated because of the spread within the facilities, plus there were 32 deaths recorded [12, 13]. During this time the Government instructed the community to wear face masks whilst in any public area, and wash hands frequently with soap and water [12, 13]. The lack of healthcare workers is noted as a major challenge in responding to this pandemic. Students of health sciences have been requested to assist if needed, but the previous studies have shown that knowledge and attitudes about preventive simple random sampling. After that, convenience sampling was used to select participants. Finally, only 56.8% of students finished and returned the questionnaire (Figure 1).
A structured self-administered questionnaire was set up according to our previous study toward COVID-19 among healthcare workers with a focus on Knowledge, Attitude, and Practices (KAP) [15]. A pilot study also was completed using 10 students to give their opinions regarding its simplicity and comprehensibility. The questionnaire was completed in approximately 10 minutes. The subjects that took part in the pilot study were not included in this study. The questionnaire consisted of four sections including the characteristics of demographics, 11-items relating to COVID-19 knowledge, 7-items for assessing attitudes, and 3-items for evaluating practices relating to prevention. The collection of the data was completed in the lecture hall of the UMP. Notification of the study aims and the informed consent were completed with participants before completing the questionnaire, and their opinions were anonymous.
The knowledge items were categorized into correct and incorrect. Good overall knowledge was defined as a correct response in all of knowledge items. The attitudes were collected by using 5 point Likert scales with answers ranging from strongly agree to strongly disagree. To each attitude item, the answer to strongly agree or agree was marked into a positive attitude, and the answer to strongly disagree or disagree or undecided was considered a negative attitude. The positive overall attitude was defined as a positive response in all of the attitude items.
Practices were the main outcome variables that consisted of 3-items toward “wearing face masks in crowded places”, “washing hands frequently with soap and water or with alcohol hand sanitizers”, and “the average time for washing hands 20 seconds”. A good overall preventive practice was defined as a “yes” response in all practice items.
Data was analyzed using Stata 13.0 software. Frequencies and percentages were used to describe data. To establish an association of factors with practices, Odds ratio (OR) and 95% confidence interval (95% CI) were estimated. All factors which have a significance level <0.2 in the univariable analysis were included in the multivariable analysis by the logistic regression model. Based on the hypothesis, literature, and P-value criteria, stepwise backward procedures were performed to reach a complete model that has P-value <0.05 of all of the variables.
3. RESULTS
A total of 551 eligible students from first to sixth-year classes submitted completed questionnaires, with a majority of them being female (59.2%) and they had a mean age of 21.6 ± 1.9. COVID-19 information was recorded as being obtained mainly via social media (95.8%). The field of education of participants included general medicine, preventive medicine, traditional medicine, and public health, in which the highest percentage was preventive medicine students (48.5%), and the highest percentage of participants were from the second year (33.4%) (Table 1).
The results, as shown in Table 2, indicated that the good knowledge ranged from 66.6% to 99.3%, and 53.2% to 98.6% of participants reported positive attitudes. The overall rate of good knowledge and positive attitude was 49.0% and 26.1% respectively. The majority of the participants reported wearing face masks in crowded places (89.5%), and cleaning hands frequently with soap and water or with alcohol hand sanitizers (89.5%). When the participants were asked about the average time for washing hands, just half of them commented at least 20 seconds (50.5%). The overall result of the survey reporting good practice was recorded as 41.0%. When adjusted for all other variables in the logistic regression model, only a good overall attitude was associated with the good overall preventive practices (p<0.05), AOR = 1.72 (95% CI: 1.16 – 2.55) (Table 4).
4. DISCUSSION
Results indicated that the overall rate of good knowledge and positive attitude was low, and the students reported having insufficient knowledge and negative attitudes. COVID-19 was an emerging viral respiratory infection and our study was conducted in the early stages of the pandemic. Therefore, most students may not have learned much about this virus, so the results reported may be logical. The results will help education facilities prepare appropriate educational interventions and training for students who may be requested to assist if needed. For assessing practices toward prevention, a high proportion of participants reported wearing face masks in crowded places (89.5%) and cleaning hands frequently with soap and water or with alcohol hand sanitizers (89.5%). However, one unanticipated finding was that around half the students reported that they did not wash their hands for a minimum of 20 seconds (50.5%). This may be due to bad hygiene habits, and related to popular culture in Vietnam, which may need to change. According to WHO, cleaning hands is one of the measures to prevent COVID-19 transmission. Nevertheless, the length of time must be long enough to entirely remove all microbes on a person’s hands [4, 17]. Previous research suggested that washing hands for between 15-30 seconds decreases more microorganisms than cleaning for a shorter period [18, 19]. Preventive practice should be evaluated by direct observation, while our result showed the assessment based only on the questionnaire, that might have an information bias. The findings have important implications for developing medical and personal hygiene messages in the media in the future. The results showed that participants with a positive attitude toward COVID-19 were more likely to report good practices. The findings were similar to an Australian study where students who agreed with the importance of vaccinations were significantly more likely to have received the influenza vaccination [20]. There was a high rate of students that received COVID-19 information via social media (95.8%), which was reported in our previous study amongst healthcare workers [15]. Also, it was recorded by Chu JN et al, that mass media messages directly correlated to the increase of hepatitis B screening among Vietnamese Americans [21]. This might be due to the ability of social media to deliver faster updating of information. Therefore, efforts to improve correct practices should include mass media messages.
The limitations of this study included the fact that sampling was collected during a short period at the UMP in Ho Chi Minh City. However, the results did reflect, in part, the knowledge, attitude, and practices of students in the country. The Vietnamese Authorities need to develop strategies to regularly support the students through applicable and relevant health education programs.
Conclusion
There were only 41.0% recorded responses indicating good practices toward prevention measures. Besides, knowledge and attitudes about COVID-19 among students were inadequate. Further health education interventions should be focused to change bad hand-washing habits via mass media messages.
