Knowledge, attitudes and practices of adult patients seen in ENT consultation facing COVID-19 in Lomé, Togo.

Winga Foma^1,&, Essobozou Pegbessou¹, Warou Dolou², Aboudourazak Amadou³, Stephen Lionel Antoine Lawson², Bathokedeou Amana¹, Essohanam Boko⁴, Eyawèlohn Kpemissi¹

 

¹Department of ENT, Sylvanus Olympio University Hospital of Lomé, Togo, ²Department of ENT, Kara University Hospital, Togo, ³Biostatistician, health insurance consultant, Equimed Group of Lomé, Togo, ⁴Department of ENT, Campus University Hospital of Lomé, Togo

 

 

^&Corresponding author
Dr Winga Foma, Department of ENT, Sylvanus Olympio University Hospital of Lomé08BP : 80787, Lomé, Togo, E-mail : adrienfoma@yahoo.fr

 

 

 

 

Reported for the first time in China on December 31, 2019, infection with the new coronavirus (SARS-CoV-2) was reported first on the African continent on February 15, 2020 in Egypt. Named COVID-19 by WHO on February 11, 2020 [1], this new pandemic reached Togo on March 6, 2020 [2]. The infection is characterized by a variety of symptoms: dry cough, fever, myalgia, asthenia, pharyngeal pain and dyspnea mainly, but also vomiting, diarrhea, abdominal pain and anorexia in some cases. In addition, COVID-19 can cause severe lower respiratory tract infection marked by pneumonia and acute respiratory distress syndrome [3]. Through international media, social networks and scientific publications, information concerning this new respiratory infection has reached the four corners of the world, specifying the routes of transmission and calling for compliance with preventive measures. These measures are social distancing, essentially wearing masks and hand hygiene. As part of the information and reports of suspected cases of COVID-19 infection, several countries have made their numbers available to their populations; in Togo, this number is 111 [2]. Transmission of COVID-19, whether community or nosocomial, occurs by air, oral or by contact of hands and contaminated objects with the ENT and ocular mucous membranes. Given the implication of the ENT sphere in the transmission of the disease, it seemed appropriate to verify the knowledge, attitudes and practices of the patients received in an ENT consultation in Lomé in front of it in order to better orient the campaigns, education and communication. Far from wanting to establish a scale of knowledge levels, it was specifically to question the general knowledge of patients about this new pandemic and to describe their behavior in light of the information received.

 

 

Scheme and study framework

 

This was a descriptive and analytical cross-sectional study that took place from May 4 to June 5, 2020, in the ENT department of the Sylvanus Olympio University Hospital in Lomé, the country's leading referral center.

 

Study population

 

The target population was patients aged at least 15 years who had come for an outpatient visit to the ENT department of the Sylvanus Olympio University Hospital in Lomé. Only patients aged 15 and over who gave their written consent (on the form) were included in the study. The study did not include patients under 15 years of age, patients who did not give their consent and those with a cognitive impairment who did not allow the survey to be conducted. The consent of patients aged 15 to 18 was confirmed by their parent or guardian accompanying them.

 

Data collection

 

An anonymous questionnaire in French on a survey sheet was given during the first 5 to 10 minutes of a regulatory ENT consultation, Mondays, Wednesdays and Fridays and consisted of 3 parts: socio-demographic data, knowledge of COVID-19, the attitudes and practices of the respondent during this period of the beginning of the epidemic in our country.

 

These 3 parts included questions divided as follows:

 

• Six questions on socio-demographic characteristics: age, sex, nationality, level of education, occupation and number of people living under the same roof with the patient.
• Nine general knowledge questions on COVID-19 based on information provided so far by WHO, scientific literature and the Togolese government. Questions related to the fact of having already heard of the disease, sources of information, the country of first reports of the disease, its presence or not in Togolese territory, the routes of transmission, the prevention measures, the symptoms, lethality or not, the need for information or not.
• Seven to eight questions on the apprehensions and behavior of patients in the face of this new disease. They dealt with the notion of fear, the reaction to a suspected COVID-19 infection, compliance with barrier measures, self-medication, and whether or not to accept a possible screening or a possible vaccination.

 

The questionnaire was given in the confidence of the consultation room by doctors and medical assistants previously briefed on the items to standardize their understanding and facilitate translations into mother tongues for patients if necessary. The questionnaire included open and closed questions; open ones were marked with an asterisk in the results.

 

Data analysis

 

The data collected on a survey form were entered and analyzed using the Epi-Info 7 software. The frequencies of the categorical variables were compared using the Pearson Chi-square test and the test exact Fischer taking into account the conditions of validity and performance of the various tests. The decisions were made with a 5% risk.

 

 

Results     

Socio-demographic data

 

A total of 166 patients were enrolled in the study during the month of the survey and all were aware of the existence of the new pandemic. The sex ratio was 0.43. The mean age was 38.93 ± 15.24 years. The extreme ages were 15 and 87. The 35 to 45 age group was the most represented with 42 cases (25.30%). Socio-demographic characteristics are presented in Table 1

 

Knowledge of respondents to COVID-19

 

One interviewee was not aware of the presence of COVID-19 on Togolese territory. Radio / TV broadcasts and newspapers were the most used source of information on COVID-19 by the patients surveyed (86.14%). The top three symptoms most reported by patients as suggestive of COVID-19 were cough, fever and pharyngeal pain. Table 2 presents the knowledge of the patients investigated on the disease.

 

Attitudes and practices of respondents

 

One hundred and thirty-two patients (79.52%) admitted to being afraid of the COVID-19 disease and 28 (16.87%) took preventive self-medication for it. This self-medication was essentially made of preparations made from African peach, spices or lemon. A refusal of a possible mass screening or possible vaccination against COVID-19 was noted in 21.69% of patients. More information about the attitudes and practices of the respondents is presented in Table 3.

 

The analysis of the attitudes and practices of the respondents (Table 4) shows, among other things, that the respondents who thought they had been infected tended to take preventive self-medication. Low education has been associated with fear of COVID-19. A tendency of people over 25 and informed respondents outside social networks to accept mass screening for COVID-19 was noted. People on social networks were therefore less likely to accept mass screening.

 

 

Discussion     

This study allowed us to verify the knowledge, the practices and some attitudes of the patients with whom we interact in our practice in this period of pandemic, considering the risk of transmission by ENT route. The objective of this work was not to determine levels of knowledge in patients. Given the great variability of the data in the scientific literature on this new disease, given the target population and given the final objective which is to improve awareness campaigns in our country, no scale of level of knowledge, even arbitrary, was judged useful. Given the high rates of correct responses, we consider that patients' overall knowledge of COVID-19 is good in terms of symptoms, transmission routes and barrier measures. However, it is important to note the misunderstanding of contact transmission by patients. In fact, contact with a contaminated person or surface is often interpreted as a transcutaneous transmission by patients, which could give rise to stigmatization of people suffering from COVID-19. It is therefore necessary to explain the contact carried to the ENT or ocular mucosa during awareness campaigns. As advised by authors, ENT medical staff, as high-risk professionals, should improve protection awareness [4].

 

More than 79% of respondents reported being afraid of COVID-19. The attitudes and practices of those surveyed were diverse and varied, although they seemed to reflect the measures decreed by the health authorities in terms of barrier measures and in case of suspected disease. The increase in public concerns and apprehensions about COVID-19 infection has already been reported, calling for the mental health of populations to be taken into account in awareness campaigns [5]. It should be noted that there was an increasing trend in feelings of fear among respondents with low educational attainment in our series; which could be linked to difficulties in understanding certain information and recognizing misinformation on COVID-19. The intense media coverage of the COVID-19 pandemic means that information spreads faster and more widely than during the SARS epidemic in 2003, the H1N1 flu in 2009, or the MERS-CoV epidemic in 2013-2015, exacerbating public perceptions of personal health, fear, panic and stress [6]. Others fear that SARS-CoV-2 may be due to its novelty and uncertainty about the severity of the current epidemic [7]. In addition, during the COVID-19 epidemic, negative emotions such as fear can lead to somatic symptoms which in turn cause physical and mental discomfort [8]; this could explain the fact that nearly 17% of the respondents in our series thought they were infected at some point. The rapid sharing of scientific information is an effective way to reduce public panic about COVID-19 [9]. Roy et al [5] reported that most educated people are more aware of this infection, of the importance of measures and government initiatives taken to limit its spread.

 

We noted a significant proportion of preventive self-medication among our respondents. In this period of the beginning of the epidemic where the antiviral therapeutics and the vaccine are at the experimental stage or poorly defined, we are witnessing a reconversion of molecules already used for other pathologies for the management of COVID-19. Nauclea latifolia, a plant known and used for centuries in febrile, painful, digestive and metabolic pathologies in sub-Saharan Africa [10, 11], has often been used alone or in combination with other preparations during the self-medication of some investigated. Thus, patients who, for a symptom or other, think they have COVID-19 tend to resort to self-medication (p-value = 0.0003). This attitude could have several explanations: fear of stigma and the risk of isolation, the absence of conventional treatment and disinformation campaigns. Raising awareness by all possible means remains fundamental with knowledge and behaviour checks to avoid misunderstandings and misinformation on the routes of disease transmission, on therapeutic management and on the possible discovery of a vaccine.

 

 

Conclusion     

This survey of patients seen in an ENT consultation during this period of the onset of the COVID -19 epidemic shows a good level of overall knowledge of the disease in terms of symptoms, routes of transmission and barrier measures. Radio and TV programs and newspapers were the main source of information for the respondents. Their attitudes and practices were diverse and varied, although dominated by the measures decreed by the health authorities. Continued awareness-raising, and above all with the right explanations, is still necessary to guarantee what has been learned and avoid fear, stigma and bad practice. National studies are still needed to assess the levels of knowledge, practices and impact of COVID-19 in the population.

What is known about this topic

• Knowledge surveys of different population groups on COVID-19 generally show an acceptable level testifying to the effectiveness of awareness campaigns.
• The attitudes and practices of populations towards COVID-19 are diverse and varied depending on several factors including the magnitude of the epidemic, media coverage and government measures.

What this study adds

• In addition to the good basic knowledge of patients on COVID-19, this investigation in an environment at high risk of contamination shows misunderstandings on the modes of transmission; which could lead to stigmatization.
• With almost one in two being very afraid of the disease, an increasing trend in the feeling of fear was noted among those with a low level of education.
• This survey on COVID-19, which is one of the first on an essentially secular population in a risk environment, draws attention to self-medication, the possibility of mass screening and vaccination.

 

 

Competing interests     

The author(s) declare(s) that they have no competing interests

 

Funding: None

 

Ethical considerations

 

All participants in the present study provided written informed consent (on the form). The consent of patients aged 15 to 18 was confirmed by their parent or guardian accompanying them. An investigation authorization has been obtained from the administrative and health authorities of the Sylvanus Olympio University hospital. The approval number for this study is 0921/2020 / MSHP / CHU-SO / DIR / DRH / SERV.PERS. During the analysis, the confidentiality and anonymity of all participants were preserved. A number was assigned to each interviewee to safeguard the transcripts of the interviews.

 

 

Authors' contributions     

All of the first three authors participated in data collection and bibliographic research. The data processing was coordinated by the fourth author and the writing of the article was done by the first three authors. The last four authors read and edited the article.

 

 

Tables     

Table 1: Socio-demographic characteristics of respondents

Table 2: Respondents Knowledge of COVID-19

Table 3: Attitudes and practices of respondents towards COVID-19

Table 4: Analysis of the attitudes and practices of the respondents towards COVID-19

 

 

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