Results
A total of 1227 participants (including 758 adults and 469 adolescents)
completed the survey questionnaire. Among this sample, the average age
was 34(12) years and 15(2) years for adults and adolescents
respectively. There was almost an equal proportion of males and females
(adults: [376 male and 382 females]; adolescents: [233 boys and
236 girls]). Similarly, a comparable number of adults and adolescents
participated in the survey from each of the 5 districts (Table
1 ).
Comparison of Mean Knowledge score by demographic characteristics of
participants are presented in Table 1 . Overall there was no
significant difference in Mean score between adults and adolescents
(13.78 (4.00), 13.55 (3.72) respectively, p = 0.3). Comparisons within
the subgroups of adults showed that the Mean score of males 14.42 (3.89)
was significantly higher than that of the females 13.16 (4.00) p
<0.001. Adult participants with any formal education had more
knowledge compared to those who had no formal education 14.92 (3.84) and
13.04 (3.93) respectively, p <0.001). In contrast, both male
and female adolescents had similar mean knowledge score (p=0.06).
However, adolescents who had any formal education had significantly
better knowledge score than the counterparts (p<0.001).
A one way between groups ANOVA was performed to compare the impact of
‘district of residence’ on ‘Mean Knowledge score’ (Table 1 ).
Participants were divided into 5 groups according to the district where
the participants lived. There was statistically significant difference
in the knowledge score amongst the districts in both adults
(p<0.001) and adolescents (p=0.001). The magnitude of the
difference in the mean score was, however, small. Amongst adults, post
hoc comparisons using the Tukey HSD test indicated that the mean score
for districts NWTD 15.08 (3.26) and SWTD 15.03 (3.64) were not
statistically different from each other, though, these were
significantly higher than the mean score of districts Khyber 13.03
(3.46) Kurram 12.36 (4.59) and Orakzai 13.67 (4.18). The mean scores of
districts Khyber, Kurram and Orakzai were alike. Amongst adolescents,
participants from district NWTD had significantly higher score 13.86
(3.64) compared to all other 4 districts, which had similar scores 12.73
(3.05), 13.05 (4.68), 13 (3.78), 13.86 (3.64) for district Khyber,
Kurram, Orakzai and SWTD respectively.
Table 2, 3 and 4 present the gender stratified response of
participants (adults and adolescents) for various questions used for
assessing the knowledge for COVID 19. Overall, 98 % of the study
participants knew about COVID 19. Most of the adult and adolescent
participants identified fever (63%) and cough (65%) as the symptoms of
COVID 19 (Table 2 ). Another 44% of participants identified
sore throat while headache and difficulty in breathing was identified by
32% and 25% of the participants, respectively. Around 8% of
participants knew about other symptoms, like gastrointestinal tract
symptoms, loss of taste and loss of smell. On average around 71% of the
total participants recognized handshake as a mode of transmission
(Table 2 ) of COVID19 while the proportion of participants who
knew about cough, air borne transmission and overcrowding were 49%,
30% and 18% respectively. When asked about the treatment options for
COVID 19, 68% opted for consulting a doctor, 26% for self-cure, 23%
for home remedies while 7% for spiritual healers. Around 7% of
participants did not know about the treatment (Table 3 ).
Typically, 92% participants acknowledged COVID 19 as a preventable
infection while 8% thought otherwise. Of those who knew it is
preventable, 64% identified hand washing as a method for preventing the
infection, 57% identified home stay whereas social distancing and
avoiding handshake was identified by 37% of participants as an approach
for preventing COVID 19. Approximately, 14% were of view that eating
healthy can prevent the infection (Table 3 ). 79% respondents
knew that test is available for its diagnosis. Among those who knew,
55% were adults and 45% adolescents, 51% males and 49% females.
Amongst both adults and adolescents, main source of information was
radio (54%). The proportion of participants who recognized television,
health workers, relatives, social media and newspaper as sources of
information about COVID 19 were 30%, 29%, 26%, 18% and 7%
respectively. Only 4% referred to displayed material (Table
4 ). Knowledge of participants significantly differed across genders
amongst both adults and adolescents (Tables 2, 3 and 4 ).
Multiple linear regression analysis, adjusted for demographic variables
with Knowledge score as the outcome (Table 5 ), showed that age
(β[SE]: 0.03[0.01], P=0.001), formal school education (vs. no
education, β[SE]: 1.90[0.27], P<0.001) and belonging
to district NWTD and SWTD (vs. the reference district Khyber β[SE]:
2.00 [0.42], p<0.001 and 2.13 [0.42],
p<0.001, respectively), were significantly associated with
higher knowledge score. Similar results were obtained amongst both
adults and adolescents. However, the relationship between age and
knowledge score was not significant in adults after adjusting for other
demographic variables (Table 5 ).
Multiple logistic regression analysis (Table 6 ) found that
female gender (vs. male, OR[95% CI]: 0.43[0.25-0.73], p =
0.002), formal school education (vs. no education, OR[95% CI]:
2.99[1.68-5.30],p<0.001), and belonging to district
Kurram, Orakzai and SWTD (vs. the reference district Khyber, OR[95%
CI]: 0.04[0.01-0.17, p<0.001; 0.08[0.02-0.36],
p=0.001; 0.64[0.01-0.27], p<0.001, respectively) had
greater odds of believing that COVID 19 is preventable. Analysis
stratified for adults and adolescents showed similar results. Though,
there was no significant association between the attitude regarding the
preventable nature of COVID 19 and gender in adults and with place of
residence in adolescents (Table 6 ).