Discussion
Our results reveal that mean knowledge score was similar amongst adults and adolescents. However, adult males on average scored better than the adult females. Overall, 98 % of the study participants knew about COVID 19 and 92% participants acknowledged COVID- 19 as a preventable infection. Formal school education and belonging to district NWTD and SWTD (vs. the reference district Khyber) were significantly associated with higher knowledge score amongst both adults and adolescents. In addition, formal school education and adults belonging to district Kurram, Orakzai and SWTD (vs. the reference district Khyber) had greater odds of believing that COVID 19 is preventable.
The higher mean score amongst adult males that adult females in our study can be explained by the fact that these districts are culturally rigid with little opportunity for females to come out. They also have little opportunities for education and remain confined to homes. Overall, however, a high proportion of participants was aware of COVID19 and related information. Finding of similar online surveys conducted on same topic in same time zone are supportive of these findings, although those research studies reached to settled KP and not NMDs due to connectivity issues and security reasons.
Ipsos tracker and snap poll conducted in April through Random Digit Dialer (RDD) with 1000 plus interviews and 73% males, found 93% respondents aware of COVID19 (18). 12% respondents of this survey were from Khyber Pakhthunkhwa. Similarly, a web-based survey conducted by AKU (n= 403) with 30% respondents from Khyber Pakhthunkhwa and 41% males, found 99.5 % awareness (19).
Online survey conducted in Hubei, China with 6910 respondents, found 90% respondents with correct knowledge of which 66% were women and 64% had Bachler degree (20). A cross sectional survey conducted in Malaysia with 4850 respondents found 80.5% respondents with correct knowledge (21). Similarly, a population-based survey of 8591 participants conducted in Iran found 90% respondents knowledgeable (22).
Our findings further revealed that formal school education and belonging to particular districts may have a positive association with knowledge and attitude related to COVID 19. These findings are in line with literacy rates and the educational opportunities available in these districts [13]. Another important factor, that may explain the lower knowledge amongst some districts, is the protracted emergency that affected these districts intensely and for longer period. Most population remained displaced (TDPs) due to conflict situation.
Two third of the respondents knew about symptoms of fever and cough, and handshake as major reason for spread of disease. Three fourth respondents agreed to consult doctors for sickness. Nearly all respondents termed it preventable out of which two third identified hand wash and home stay as means for prevention. Four out of five respondents knew about test to diagnose the disease.
These findings support the theory of concurrent multisource information dissemination for a global pandemic. Though Government of Pakistan and Government of Khyber Pakhthunkhwa launched Risk Communication and Community Engagement (RCCE) very early but global media played much role in spreading the knowledge as radio and television were identified major source of information. This was followed by relatives and health worker. Displayed material was the least identified source.