Knowledge, attitudes and practices towards COVID-19 in Ethiopia, 2021

Introduction: COVID-19, caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is a highly contagious respiratory disease that has posed major global and national public health challenges. In Ethiopia, effective prevention and control efforts largely depend on the population’s knowledge, attitudes, and practices (KAP) towards the disease. Assessing these factors provides valuable insights into public awareness, perception, and behavioural responses, which are essential for guiding health education and policy interventions. This study aimed to assess the level of knowledge, attitudes, practices, and psychological responses towards COVID-19 among the Ethiopian population in 2021. Methods: A cross-sectional study using a convenient sampling technique was conducted, with an online survey administered from June 2020 to July 2021 via the EPHI (Ethiopian Public Health Institute) and FMOH (Federal Ministry of Health) websites. The target population consisted of adult (18+ years) participants residing in Ethiopia. Results: Of the 1,214 study participants, 84.3% were male, and 15.7% were female. The average scores of knowledge, attitude, practice and psychological response towards COVID-19 were 43.9%, 49.0%, 52.6%, and 53.8% respectively. No significant association was found between knowledge and education, gender, age group, or marital status. However, knowledge and attitude were found to be significantly associated with lower monthly income (<15,000 ETB). In addition, knowledge showed a significant association with employment status (non-students, p<0.05) and urban residency (p=0.003). Psychological responses were significantly related to being employed (p<0.05) and being married (p=0.016). Furthermore, participants’ practices demonstrated significant associations with male gender (p<0.05) and marital status (married, p=0.032). Participants’ practices, including regular use of personal protective equipment (PPE), handwashing, and avoiding contaminated surfaces, were strongly linked to their psychological responses and perceived attitudes. Notably, 88.7% of participants expressed scepticism about the existence of COVID-19 in Ethiopia, as they had not witnessed any cases during the study period, and 88.0% were pessimistic about following preventive measures. There was no significant association between time (over the course of the study) and knowledge, practices, and psychological responses. There was a decrease in participants practising recommended COVID-19 preventive measures over time (β = -0.052). While time had a statistically significant positive effect on attitudes (β =0.107, P=0.001), revealing that individuals` attitudes improved over time Conclusion: The study revealed generally low levels of knowledge, attitude, practice, and psychological response towards COVID-19 among participants, with socioeconomic and demographic factors influencing these aspects. Although attitudes improved over time, adherence to preventive measures declined, highlighting the need for sustained public health education and behavioural reinforcement.