Knowledge of COVID-19 and perception regarding isolation, quarantine, social distancing, and community containment during COVID-19 pandemic among people with diabetes

Asher Fawwad; Nida Mustafa; Nazish Waris; Saima Askari; Abdul Basit

doi:10.4103/jod.jod_80_21

ORIGINAL ARTICLE

Year : 2021 | Volume : 12 | Issue : 4 | Page : 500-507

Knowledge of COVID-19 and perception regarding isolation, quarantine, social distancing, and community containment during COVID-19 pandemic among people with diabetes

Asher Fawwad¹, Nida Mustafa¹, Nazish Waris², Saima Askari¹, Abdul Basit¹
¹ Baqai Institute of Diabetology and Endocrinology, Baqai Medical University, Karachi, Pakistan
² Clinical Biochemistry and Psychopharmacology Research Unit, Department of Biochemistry, University of Karachi, Karachi, Pakistan

Date of Submission	24-Jun-2021
Date of Acceptance	08-Sep-2021
Date of Web Publication	12-Jan-2022

Correspondence Address:
Prof. Asher Fawwad
Biochemistry Department, Baqai Institute of Diabetology and Endocrinology, Baqai Medical University, Plot No. 1-2, II-B, Nazimabad No. 2, Karachi 74600.
Pakistan

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jod.jod_80_21

Abstract

Aim: The aim of this article is to determine knowledge level and perception about coronavirus disease 2019 (COVID-19) among people with diabetes. Materials and Methods: A cross-sectional study was conducted among 268 diabetic subjects from April 2020 to October 2020 at the outpatient department of Baqai Institute of Diabetology and Endocrinology, Karachi, Pakistan. A series of questions regarding knowledge and perception about COVID-19 were asked, and participants’ demographic characteristics and source of information regarding COVID-19 were recorded and analyzed. Results: Among 268 participants, 59.7% had diabetes for more than 5 years. More than half of the subjects had heard about COVID-19 on television (63.8%). The majority of subjects had information about symptoms of COVID-19, including fever (92.2%), dry cough (79.9%), flu (78%), and shortness of breath (52.6%). Most of the participants had knowledge about preventive measures for COVID-19 such as wearing a face mask (77.6%), washing hands frequently with soap (72.8%), using hand sanitizer (72%), social distancing (47.4%), isolation and hygiene (38.8%), and quarantining (32.1%). However, less than half of the participants knew the correct meanings of social distancing (40.3%), isolation (29.1%), and quarantine (22.4%). Conclusion: Overall, most of the participants had information about common symptoms of COVID-19 including fever, dry cough, flu, and shortness of breath as they had heard about COVID-19 on television, at office, radio, and their living area. The government has taken effective measures in the prevention of COVID-19. Still, there remains a need for public awareness campaigns to combat the spread of disease.

Keywords: COVID-19, diabetes, knowledge and perception, Pakistan

How to cite this article:
Fawwad A, Mustafa N, Waris N, Askari S, Basit A. Knowledge of COVID-19 and perception regarding isolation, quarantine, social distancing, and community containment during COVID-19 pandemic among people with diabetes. J Diabetol 2021;12:500-7

How to cite this URL:
Fawwad A, Mustafa N, Waris N, Askari S, Basit A. Knowledge of COVID-19 and perception regarding isolation, quarantine, social distancing, and community containment during COVID-19 pandemic among people with diabetes. J Diabetol [serial online] 2021 [cited 2023 Feb 4];12:500-7. Available from: https://www.journalofdiabetology.org/text.asp?2021/12/4/500/335599

Introduction

The novel coronavirus (COVID-19) has arisen spontaneously since December 2019 and has emerged as a major health issue worldwide.^[1] The infection caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is termed novel because the respective virus behaved differently from its peers. It is highly contagious and was seen to affect a subset of people more severely causing a high death toll.^[2] It was first reported in Wuhan, a city of Central Hubei Province of China, and now around 219 countries and territories are affected by this infection.^[3] It has also reached Pakistan and the number of confirmed cases of COVID-19 is rising every day.^[4] Transmission of COVID-19 has been reported to occur from human to human, and when an individual coughs or sneezes, the virus is conjecture to spread through respiratory droplets. Tiredness, fever, cough, sore throat, and shortness of breath are the most common symptoms. Other rare symptoms include headache, runny nose, aches, and diarrhea. Also, a loss of smell and taste has been experienced by some people.^[5] To control and prevent the spread of COVID-19, many countries have taken drastic measures including quarantining, isolation, social distancing, traveling restriction, and community containment.^[6]

COVID-19 appears to be severe among subjects with advancing age and underlying comorbidities. Similarly, diabetes mellitus has emerged as a distinctive comorbidity leading to severe disease, acute respiratory distress syndrome, and increased COVID-19 fatalities.^[7] According to the National Institutes of Health in Italy, 35.5% of people who died from SARS-CoV-2 infection had diabetes.^[8] Another study reported that people with diabetes have a three-fold increased risk of severe outcomes (classified as hospitalization, intensive care unit admission, intubation, or death) compared with people without diabetes.^[9]

Type 2 diabetes has been discovered to increase the production of angiotensin-converting enzyme 2 (ACE2) in the lungs. ACE2 promotes the novel coronavirus pneumonia as a binding site for COVID-19, although decreased ACE2 expression may result in severe lung injury after infection. Serious diseases and glucocorticoids can impair insulin sensitivity; hence, infectious diseases are associated with high mortality of diabetic people.^[10] It is imperative that people with diabetes are required to take extra care, strictly compliant with social distancing and hygiene, and maintain good glycemic control during COVID-19.^[7] However, the compliance of people to these safety measures will be strongly affected by their knowledge of COVID-19. Therefore, knowledge of people with diabetes is expected to be the key element in their fight against this infection. Thus, this study aimed to determine diabetic people’s knowledge level and perceptions about COVID-19.

Materials and Methods

This cross-sectional study was carried out in the outpatient department of Baqai Institute of Diabetology and Endocrinology (BIDE), a tertiary care diabetes center in Karachi, Pakistan. Type 1 and type 2 diabetic subjects of age ≥15 years attending the diabetic clinic from April 2020 to October 2020 were included in the study. Ethical approval was obtained with ref no. BIDE/IRB/AFAWWAD/10/28/20/0284 from the Ethical Review Board of BIDE before the start of this study. Consent was received from all the participants via a consent form to allow for inclusion of their non-identifiable information in the study. The sample size was calculated using a single proportion sample size formula, with a precision of 5% and a confidence interval of 90%. The percentage of diabetic subjects with significant knowledge of COVID-19 was assumed to be 50%. A systematic random sampling technique was used to collect data from study participants. The data were collected by trained volunteers by using proper protective materials such as wearing gloves and surgical face mask, using hand sanitizer, and standing around 2 m away from the participant.

The self-structured questionnaire was developed for data collection by reviewing the published related literature. It was divided into two sections. The first section covered the participants’ demographic and other information. In this section, questions were related to age, gender, education level, marital status, occupation, language, type of diabetes, duration of diabetes, and other comorbidities. The second section comprised 32 questions that covered the knowledge of COVID-19 including sources of information, knowledge about coronavirus, behavioral intentions, and prevention practices. After the preliminary draft questionnaire was composed, it was reviewed by senior researchers of BIDE. Necessary modifications were done in the preparation of final draft on the basis of expert’s suggestions. The questionnaire was also validated through Cronbach’s α. The value of Cronbach’s α of 0.881 indicated that the questionnaire was reliable and fit to conduct the study.

Statistical analysis

After the data collection, all questionnaires were entered into a customized Excel-based system. All data were subsequently imported into and analyzed via Statistical Package for the Social Sciences version 20.0. Descriptive statistics were then generated and reported as numbers (percentages) as well as mean ± standard deviation, where appropriate.

Results

A total of 268 diabetic subjects participated in this study, out of which 130 (48.5%) were males and 138 (51.5%) were females. The mean age of the participants was 46.37±12.57. The majority of the subjects had type 2 diabetes (89.6%), whereas only 10.4% had type 1 diabetes. One hundred and eight (40.3%) subjects had diabetes for less than 5 years, whereas 160 (59.7%) subjects had diabetes for more than 5 years. Most of them were married (79.1%), employed (41.8%), and Urdu speaking (59.3%). Around 39% of subjects had hypertension followed by other diseases (18.7%) [Table 1].

Table 1: Characteristics of studied subjects

Click here to view

[Table 2] demonstrated the knowledge about COVID-19 among diabetic subjects. More than half of the subjects had heard about COVID-19 on television (63.8%), whereas very few of them had heard at office (6.7%) and radio (1.9%). Around 14% of subjects had known COVID-19 patients in their living area and 8.6% had known COVID-19 patients in their family. The majority of subjects had information about symptoms of COVID-19 including fever (92.2%), dry cough (79.9%), flu (78%), and shortness of breath (52.6%). About 9% of the respondents reported that COVID-19 cannot be prevented, whereas 23% were not sure about it. The remaining respondents recognized the following preventive measures for COVID-19: wearing a face mask (77.6%), washing hands frequently with soap (72.8%), using hand sanitizer (72%), social distancing (47.4%), isolation and hygiene (38.8%), quarantining (32.1%), increasing vitamin C intake (26.9%), drinking clean water (20.2%), removing stagnant water (6%), avoiding meat, poultry, and eggs (5.2%), and using mosquito repellent (0.4%).

Table 2: Knowledge about COVID-19 among diabetic subjects

Click here to view

The respondents identified major vulnerable groups to get infected as older population with comorbidity (67.9%), children (33.6%), and diabetic people (26.9%). A very large number of subjects reported that the vaccine for COVID-19 is not available in Pakistan. More than half of the subjects agreed that stopping themselves from watching news will help in decreasing the fear (57.8%), and COVID-19 will be successfully controlled (51.1%). Some subjects (29.1%) had misconception that the virus will die at high temperatures. However, notably, confusion was found among participants when asked if touching the dead body of COVID-19 patient could result in infection (52.2% agreed vs. 47.8% disagreed) [Table 2].

Some people (24.3%) reported that they did not hear the word “quarantine,” whereas only 22.4% of people know the correct meaning of quarantine, that is, to separate and restrict the movement of healthy people who are exposed to disease to see if they have no symptoms. Moreover, only 3.4% disagreed that quarantining oneself will prevent from getting COVID-19 and spreading it to others. The majority of the subjects (76.1%) had heard about the term “isolation,” but only a few (29.1%) knew the correct meaning of it, that is, to separate healthy people from people with communicable disease. Similarly, most of the subjects (85.4%) had heard about the term “social distancing,” but only half of them understand the correct meaning of it (40.3%) and knew that at least 6 feet distance should be maintained between two people (45.9%). Likewise, only 35.6% had heard the word “community containment,” but most of them were not sure about its meaning [Table 3].

Table 3: Knowledge and perception of quarantine, isolation, community containment, and social distancing

Click here to view

Discussion

The majority of our study participants had information about symptoms of COVID-19. Most of the participants had knowledge about preventive measures for COVID-19, such as wearing face mask, washing hands frequently with soap, using hand sanitizer, social distancing, isolation and hygiene, quarantining, increasing vitamin C intake, drinking clean water, removing stagnant water, avoiding meat, poultry, and eggs, and using mosquito repellent. Subjects also had misconceptions and confusion regarding infection spreading, term quarantine, social distancing, etc. In our study, although participants had misconceptions, most of the study participants displayed correct answers similar to the study carried out by Zhong and co-workers.^[11] In an online survey, Geldsetzer^[12] assessed similar KAP findings among the US and UK people. Most of our study population were being graduate, postgraduate, or intermediate. The majority of people heard about COVID-19 on television in our study. We are also in line with recent findings by Ahmed et al.^[13]; a study from Pakistan that carried out during the exponential spread of cases in Pakistan with strict lockdown reported that social media such as Facebook, WhatsApp, Twitter, etc. and television to be the most common sources of acquiring information regarding this disease. We also found a positive attitude following practical measures to prevent its spread while being optimistic about the future course of this pandemic in our country is consistent with Mahmood et al.’s study.^[14] Our data supported Rubin et al.’s^[15] study for the swine flu epidemic, showing that people respond appropriately if they have basic knowledge about modes of transmission and availability of vaccines during an outbreak. Although social media is fast, misconceptions and lack of knowledge were also found in our study participants such as the term quarantine and isolation difference.

In Pakistan, a low resource country with poor health infrastructure, people are feeling the negative psychological impacts of the lockdown, closure of economic activity, and uncertainty about what the future holds similar to Alrasheedy et al.’s study.^[16] Ornell et al.^[17] published effective strategies that provide a framework for clinicians to educate people to cope with the mental stress of this pandemic more accurately. Our study proposes that urgent measures are needed to educate people to mitigate the current situation. However, the Pakistan government and health ministry play an imperative role in this act and have proposed the guidelines regarding COVID-19 prevention for the general population as avoiding crowded places or social distancing, wearing masks when going outside, washing hands regularly for at least 20 s, seeking regular medical care, etc.^[18]

The strength of our study lies in the fact that this provides a “real-time” assessment of the KAP segment of the diabetic population during this critical period when it is needed to plan public health strategies. General population, small sample size, and unstandardized assessment of the practices of respondents toward COVID-19, which should be ideally assessed using in-depth interviews and expert opinions to ensure validity, are our limitations.

Conclusion

Overall, most of the participants had information about common symptoms of COVID-19 including fever, dry cough, flu, and shortness of breath, as they had heard about COVID-19 on television, at office, radio, and their living area. The government has taken effective measure in the prevention of COVID-19. Still, there remains a need for public awareness campaigns to combat the spread of disease.

Authors’ contribution

AF: Concept and design, edited, and approved the final manuscript.

NM: Literature search, data analysis, interpretation of data, and wrote the manuscript.

NW: Literature search and wrote the manuscript.

SA: Edited and approved the final manuscript.

AB: Concept and design and approved the final manuscript.

Financial support and sponsorship

Nil.

Conflicts of interest

The authors declare that they have no conflicts of interest.

References

1.	Khalid A, Ali S. COVID-19 and its challenges for the healthcare system in Pakistan. Asian Bioeth Rev 2020;12:551-64.
2.	Munjal M, Das S, Chatterjee N, Setra AE, Govil D. Systemic involvement of novel coronavirus (COVID-19): A review of literature. Indian J Crit Care Med 2020;24:565-9.
3.	Malviya R, Sharma A, Gupta R, Awasthi R. Treatment and prevention of osteoporosis during COVID-19 outbreak: Management and adherence to treatment guidelines. Open Public Health J 2020;31:13.
4.	Ministry of National Health Services, Regulation and Coordination (MoNHSRC). https://covid.gov.pk. [Last accessed on 2021 Jun 23].
5.	Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020;15:497-506.
6.	Shah JN, Shah J, Shah J. Quarantine, isolation and lockdown: In context of COVID-19. J Patan Acad Health Sci 2020;8:48-57.
7.	Pal R, Yadav U, Grover S, Saboo B, Verma A, Bhadada SK. Knowledge, attitudes and practices towards COVID-19 among young adults with type 1 diabetes mellitus amid the nationwide lockdown in India: A cross-sectional survey. Diabetes Res Clin Pract 2020;166:108344.
8.	Fadini GP, Morieri ML, Longato E, Avogaro A. Prevalence and impact of diabetes among people infected with SARS-CoV-2. J Endocrinol Invest 2020;43:867-9.
9.	Ko JY, Danielson ML, Town M, Derado G, Greenlund KJ, Kirley PD, et al. Risk factors for coronavirus disease 2019 (COVID-19)-associated hospitalization: COVID-19-associated hospitalization surveillance network and behavioral risk factor surveillance system. Clin Infect Dis 2021;72:e695-703.
10.	Zhong BL, Luo W, Li HM, Zhang QQ, Liu XG, Li WT, et al. Knowledge, attitudes, and practices towards COVID-19 among Chinese residents during the rapid rise period of the COVID-19 outbreak: A quick online cross-sectional survey. Int J Biol Sci 2020;16:1745-52.
11.	Yang Y, Zhong W, Tian Y, Xie C, Fu X, Zhou H. The effect of diabetes on mortality of COVID-19: A protocol for systematic review and meta-analysis. Medicine 2020;99:e20913.
12.	Geldsetzer P. Knowledge and perceptions of COVID-19 among the general public in the United States and the United Kingdom: A cross-sectional online survey. Ann Intern Med 2020;173: 157-60.
13.	Ahmed N, Hassan W, Rasool R, Fahim U, Shakil A, Khan KS. Knowledge, attitude and practices regarding Covid-19 among a cross-sectional sample from Karachi, Pakistan: Descriptive data. J Infect Dis Epidemiol 2020;6:164.
14.	Mahmood S, Hussain T, Mahmood F, Ahmad M, Majeed A, Beg BM, et al. Attitude, perception, and knowledge of COVID-19 among general public in Pakistan. Front Public Health 2020;8:602434.
15.	Rubin GJ, Amlôt R, Page L, Wessely S. Public perceptions, anxiety, and behaviour change in relation to the swine flu outbreak: Cross sectional telephone survey. Br Med J 2009;339:b2651.
16.	Alrasheedy AA, Abdulsalim S, Farooqui M, Alsahali S, Godman B. Knowledge, attitude and practice about coronavirus disease (COVID-19) pandemic and its psychological impact on students and their studies: A cross-sectional study among pharmacy students in Saudi Arabia. Risk Manag Healthc Policy 2021;14:729-41.
17.	Ornell F, Schuch JB, Sordi AO, Kessler FHP. “Pandemic fear” and COVID-19: Mental health burden and strategies. Braz J Psychiatry 2020;42:232-5.
18.	Government of Pakistan. Prevention of COVID-19. COVID-19 Health Advisory Platform. 2020. covid.gov.pk [Last accessed on 2021 Jun 23].