Discussion

This study is the first survey in the eastern part of Ethiopia, Harari Region State, as far as our knowledge, that aimed to assess the public’s level of knowledge, attitude, and practice towards the COVID-19 recommended preventive measure as well as to assess the determinant factors among the general population. The comparison of our study with the findings reported from Sidama, Southern Ethiopia; Washing a hand, using a face mask, avoiding touching the face, and staying at home were 68.7%, 82.2%, 55.4%, and 46%, respectively. Whereas the findings in Sidama reported that washing their hands, using a face mask, avoiding touching their faces, and staying at home were 96%, 67.1%, 29.6%, and 80.9%, respectively[15]. This discrepancy might be due to the difference in sample population and sample size.
In our finding the level of knowledge toward Covid-19 prevention measure among Harar population was 75.1% of them had a good knowledge. This is higher than the studies conducted in different parts of Ethiopia; 70.7% in Dire Dawa [16], 60.7% in Gondar[17], 60.5% in southern Ethiopia[18], 45.89% in North East Ethiopia[19], but this is lower than the studies conducted in Uganda[20] and China[21], 83.9% and 85.2%, respectively. The reason for this discrepancy could be due to a difference in the source population, sample population, and access to technologies.
Our study revealed that, only 43.7% of the participants had positive attitude toward Covid-19 prevention measure. This is higher than 34.1%, study conducted in Gondar, Norther Ethiopia, but lower than studies conducted in Tigray, Ethiopia[22], Uganda[20], and China[21] which reported 55.6%, 72.4% and 92.9%, respectively. The reason for this discrepancy could be due to differences in source population, sample population, measurement variation, and access to information and technologies.
Of the total participants, nearly half, 52.8%, of them had a good level of practice toward Covid-19 Prevention. This is higher than studies reported from different parts of Ethiopia, 15.6%, 40.7%, and 47.5%, in Gondar, Dire Dawa, and Tigray, respectively. but lower than the reports from studies conducted in Ethiopia, Sidama[15] and Addis Ababa[23]; China[21], and Uganda[20], 55.4%, 59.8%, 84.4%, and 85.3%, respectively. The reason for this discrepancy could be due to differences in source population, sample population, measurement variation, and access to information and technologies.
Occupational status of the participants was significantly associated with level of knowledge toward Covid-19 prevention. House wife were 8 time more likely to have a good knowledge level toward Covid-19 prevention measure as compared with drivers. This is consistent with the study conducted in Uganda[24]
Participant educational level was significantly associated with level of knowledge toward Covid-19 prevention measure. Those participants who are unable to read and write and those with primary education were 9 and 2 times more likely to have good knowledge towards Covid-19 prevention measures than participants who attended above secondary school, respectively. This is consistent with other similar study conducted in Dessie, South East Ethiopian[19], but our finding was contradictory to the study conducted in Tigray which indicated having no formal education was significantly associated with lower knowledge toward Covid-19 prevention measures[25]. This difference could be due to differences in sample size, sample populations, and measurement tools.
This study revealed novel determinants of attitude toward the Covid-19 prevention measure. That is, individuals unable to read and write and those with primary education were 5 and 1.7 times more likely to have a positive attitude toward the measure than those who attended above secondary school, respectively. This might be due to the overconfidence developed by educated people in the study area. Civil servants were 2 times more likely to have a positive attitude toward COVID-19 prevention measures than drivers. Individuals living in < 5 family size were 83% less likely to a have positive attitude than those who live in ≥10 family size. Individuals with < 5000 ETB average monthly income were 3 times more likely to have positive attitude toward Covid-19 prevention measure than those who had ≥ 15000 ETB average monthly income. These factors, which have shown a significant association with the level of attitude toward Covid-19 prevention measure in our study, have not been reported in other similar studies.
In this study, married individuals were 5 times more likely to have good practice than those who are separated. This is consistent with study conducted in Dire Dawa[16]. This could be due to married individuals may feel more responsible to have good prevention practice in order to protect their families.
In our study, people who are unable to read and write were 3 times more likely to have good practice toward Covid-19 prevention than those who are above secondary school. This finding was inconsistent with studies from Gondar[17] and Tigray[22], which reported that people with above secondary school are more likely to have good practice than those who are unable to read and write. This difference could be due to difference in the sample population and sample size. The other possible reason could be that people with higher education even though they have better knowledge about Covid-19 infection, may feel inappropriately overconfident and neglect to apply recommended Covid-19 prevention practices.
In this study, family size was found to be significantly associated with Covid-19 prevention measures, which has not been reported in other similar studies. People with ≥ 10 family members were 8 times more likely to have good practice towards Covid-19 prevention than those with < 5 family members. This could be due to the fact that the more family members the more they feel responsible for protecting their family from the Covid-19 infection and compelled to adhere to recommended Covid-19 prevention practices.