Background:
In December 2019, a series of pneumonia cases of unknown cause were detected in Wuhan City, Hubei Province of China. The pathogen identified was named as novel coronavirus (2019-nCoV), currently called, severe acute respiratory syndrome corona virus-2 (SARS-CoV-2), an enveloped and single stranded RNA virus [4] which has phylogenetic resemblance to SARS-COV-1 [5]. COVID-19 is the name that has been given to a new severe acute respiratory syndrome caused by coronavirus 2 (SARS-CoV-2). The disease was notified to the World Health Organization (WHO) on December 31, 2019 [1] and it was declared as public health emergency of international concern (PHEIC) by WHO on January 30, 2020. Due to the rapid spread of the virus, the severity of illness and reported fatalities, COVID-19 was further labelled as a global pandemic on March 11, 2020 [2]. By June 2020 COVID-19 has spread to over 210 countries and territories, caused 6,313,662 laboratory confirmed cases and 376,282 deaths [3]. Till date (June 2020), no medicine has demonstrated efficacy in preventing, treating or curing COVID-19.
Pakistan’s first COVID-19 case was reported on 26 February 2020 [7]. As of June 9, 2020, Pakistan has 108,317 laboratory confirmed cases and 2,172 COVID-19 associated deaths. Punjab (n=40,815) has highest number of cases followed by Sindh (n=39,555), Khyber Pakhtunkhwa KP (n=14,006), Baluchistan (n=6,788), Gilgit Baltistan (952), Islamabad (n=5,785) and Azad Jammu Kashmir (n=412) [8]. First systematic response emerged on March 13, when the government convened an emergency meeting of the National Security Committee, an apex civil-military coordination body, and made the decisions to seal the border with Iran, prohibit large-scale public gatherings, institute social distancing to limit infections, and close down educational institutions across the country. The COVID-19 Pakistan Preparedness and Response Plan (PPRP), prepared with the support of the UN and is guided by the WHO Strategic Preparedness and Response Plan (SPRP) [9], outlines the international assistance required by the Government of Pakistan (GoP) to stop the transmission of the pandemic and respond to the emerging public health needs in Pakistan. It is
Accordingly, the Government of the province Khyber Pakhtunkhwa (KPK) has taken all the necessary actions to cope with the situation of COVID-19 in the province [10]. Communication campaign under the title ‘RCCE’ (Risk Communication and Community Engagement) is under implementation across the province and its review reveals that false public perception due to easing of lockdown by Government has resulted in escalation of COVID-19 cases in Pakistan that needs to be addressed through a nationwide enforcement intervention to increase compliance with COVID-19 preventative actions [11].
Ex FATA, now known as Newly Merged Districts (NMDs) is the poorest region of Pakistan. 73% of its 5 million population lives in poverty compared to a national average of 39% [12]. Adult literacy stands at 28% (8% for women) compared to a national average of 57% (43% for women) [13]. One million, out of 1.8 million children (aged 5-16), are out of school. Many families do not send their girls to school, particularly as they reach puberty. Livelihoods and economic opportunities are limited. Many people live in barren, dry, mountainous areas vulnerable to climate change. Only 10% of land is fertile and only 7% currently suitable for farming [14].
This area is inaccessible for online and digital surveys due to security and logistical reasons [18]. Therefore, to tailor the response for this isolated area, this face to face survey was direly needed to assess their knowledge and perceptions regarding the COVID 19 pandemic. Fortunately, Khyber Pakhtunkhwa Merged Districts (KPMD) Support Program is implementing outreach activities under DFID support and the staff and resources being well positioned were utilized for the survey. This survey aimed at assessing the knowledge of residents of Newly merged districts, NMDs, about COVID-19.