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Review Article

A Review on Knowledge, Attitude, and Practice during the COVID-19 Pandemic in Ethiopia

Samuel Chane Teferi*

Department of Biology, Selale University, Ethiopia

*Address for Correspondence: Samuel Chane Teferi, Department of Biology, Selale University, Ethiopia, ORCID ID: orcid.org/0000-0002-5805-7857; E-mail: Samuelchane19@gmail.com

Submitted: 08 August 2020; Approved: 22 August 2020; Published: 24 August 2020

Citation this article: Teferi SC. A Review on Knowledge, Attitude, and Practice during the COVID-19 Pandemic in Ethiopia. Sci J Immunol Immunother. 2020;4(1): 010-015.

Copyright: © 2020 Teferi SC. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited

Keywords: Ethiopia; Practice; COVID-19; Pandemic

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The novel coronavirus has been declared by World Health Organization as a global public health emergency of International concern on January 30, 2020. COVID-19 has infected more than 17,660,523 people worldwide, with more than 680,894 deaths in different regions and countries. Based on the World Health Organization (WHO) Africa report, as of 02 August, 2020, a cumulative total of 802,792 confirmed COVID-19 cases with 13,779 deaths have been reported across all African countries in the region. In Ethiopia the virus spreads alarmingly because the community didn’t practice the information given by Ministry of Health and the Government; as of August 2, 2020, 17,999 cases and 284 deaths. Researchers have suggested that the level of panic is correlated with knowledge and attitude among the population. Good Knowledge, Attitude and Practice are a tool that can hopefully be used to control the spread of COVID-19. Therefore, the Ethiopian government must give information to the society through TV, radio and social media repeatedly. So, the current study aimed to assess/review the knowledge, attitude and perception of COVID-19 pandemic in Ethiopia.


The 2019 novel coronavirus (2019-nCoV) or the severe acute respiratory syndrome corona virus 2 (SARS-CoV-2) as it is now called, is rapidly spreading from its origin in Wuhan City of Hubei Province of China to the rest of the world [1]. Coronavirus (CoV) is clustered under the viral family group that causes disease in mammals and birds. A pandemic novel coronavirus was named as ‘‘Corona Virus Disease 2019’’ (2019-nCoV) by World Health Organization (WHO) in Geneva, Switzerland [2,3]. This is the deadly third-generation virus in Corona family preceded by Middle East Respiratory Syndrome (MERS) in 2012 and Severe Acute Respiratory Syndrome (SARS) in 2003. Coronaviruses belong to the Coronaviridae family, have a diameter of 65–125 nm, and contain a single strand of RNA with lengths ranging from 26 to 32 kb. Coronaviruses comprise several types, such as alpha, beta, gamma, delta, SARSCoV, H5N1 influenza A, H1N1 2009, and MERS-CoV [4].

The current novel coronavirus disease 2019 (COVID-19) that causes pneumonia is a highly infectious disease, and the ongoing outbreak has affected a huge part of populations around the world. It has been declared by World Health Organization as a global public health emergency of international concern on January 30, 2020 [5]. WHO has described four levels of COVID-19 transmission which are countries or local areas with: No cases reported, Sporadic cases, Clusters of cases (grouped in place and time), or Community transmission [6]. While vaccines and specific medications are not yet available for COVID-19, other public health and social measures play an essential role in reducing the number of infections and saving lives [1].

All ages are susceptible. Infection is transmitted through large droplets generated during coughing and sneezing by symptomatic patients but can also occurs from asymptomatic people and before onset of symptoms [7]. Therefore, health experts advise frequent hand-washing with soap and water. The clinical features of COVID-19 are varied, ranging from asymptomatic state to acute respiratory distress syndrome and multi organ dysfunction. The common clinical features include fever (not in all), cough, sore throat, headache, fatigue, headache, myalgia and breathlessness [8].

COVID-19 has infected more than 17,660,523 people worldwide, with more than 680,894 deaths in different regions and countries. The USA, the major hit country alone, recorded more than 359,180 deaths on early August 2020. Based on the World Health Organization (WHO) Africa report, as of 02 August, 2020, a cumulative total of 802,792 confirmed COVID-19 cases with 13,779 deaths have been reported across all African countries in the region [9]. In Ethiopia the virus spreads alarmingly because the community didn’t practice the information given by ministry of health and the government; as of August 2, 2020, 17,999 cases and 284 deaths [9].

Subsequently, Ethiopia has also commenced monitoring the disease and has implemented the COVID-19 prevention and containment interventions recommended by World Health Organization [10]. Health system of Ethiopia is not as developed as other countries so if the virus is not contained it will cost the country many things. Therefore, community engagement supported by local evidence with strict implementation of social and physical distancing measures is mandatory. Moreover, Knowledge, attitude, and practice (KAP) research can collect information on what is known, believed, and done by a specific population [11]. Understanding the public’s level of awareness about the knowledge, attitude, and practice toward COVID-19 is vital to stop the spread of the virus in countries like Ethiopia. Therefore, the current study aimed to assess/review the knowledge, attitude and perception of COVID-19 pandemic in Ethiopia.

Literature Search

A literature search was conducted in August 1-2 2020 on PubMed and Google Scholar databases using the keywords “knowledge,” “attitude,” “practice,” and “COVID-19, Ethiopia” and the reference list of all identified reports and articles were searched. The search yields a total of 13 articles.

KAP Studies on COVID-19

Thirteen selected articles on KAP during COVID-19 in Ethiopia (Table 1). The articles used questionnaires and interview (including face to face and telephone) as instruments with the number of respondents ranging from 247 to 1570 for a total of 7,335. The respondents consisted of health workers, population, health students and patients from different corners of the country.


Thirteen articles on knowledge about COVID- 19 among health workers, hospital staff, students, and sample populations. In general, all articles reported considerable levels of knowledge about COVID-19. A research conducted on 422 health workers showed that nurses obtained higher knowledge scores which is very important to tackle the virus because nurses are one of the frontline workers (Table 1,2).

The majority (70.1%) of the study participants reported that shaking hands of infected individuals result in the spread of infection. Touching an object or surface with the virus on it, then touching the mouth, nose, or eye, and respiratory droplets of infected individuals through the air during sneezing or coughing were reported as means of COVID-19 transmission by 217 (53.7%) and 337 (83.4%) of the study participants, respectively [12, 13]. In other study among the 546 participants, 71.4% correctly responded that the main clinical symptoms of COVID-19 are fever, fatigue, dry cough, and shortness of breath, and the majority (95%) said currently there is no cure for COVID-19 and more than 73.6% of the participants used social media as their main source of information about COVID-19 [14].

Nearly three-fourth (73.6%) of the respondents has heard about COVID-19 but only 42.4% and 37.8% knew COVID-19 transmission and clinical manifestations, respectively. Only 14% of the respondents knew that the asymptomatic transmission of COVID-19. Respondents from the two most populous regions, Amhara (AOR=0.497 (95%CI: 0.2990-0.6542) and Oromia (AOR= 0.4512; 95%CI: 216 0.3218-0.8026) regional states had poor level of knowledge compared with respondents from Addis Ababa [15]. A study by [16,17] revealed that 350 (88.2%) of participants had good knowledge about COVID-19. The respondents’ correct answer rates on the manifestation of COVID-19 were 66.5%. About 75.5% and 82.6% of participants said, that COVID-19 has no specific treatment and vaccine respectively and the majority of healthcare workers gathered information regarding COVID-19 from social media (73.6%) and television (71.5%). However, sources of knowledge about COVID-19 are TV/Radio has a role of 424(80.3%) and followed by a social-media 372(70.5%) according to [13].

A study by [18] showed that 276 (67.6%) of the students said that air droplets from the infected persons can transmit the infection of COVID-19 to healthy individuals. Similarly, 375 (91.9%), 343 (84.1%), and 324 (79.4%) of the participants said that patients with COVID-19 can present with fever, dry cough, and shortness of breath respectively and 293 (71.8%) of the students have gotten information about COVID-19 from mass media (TV, magazines, newspaper, radio) and nearly fifty percent (54.2%) of the participants have gotten information from social media (facebook, Instagram, whatsup and telegram).

Attitude toward COVID-19

Knowledge is a prerequisite for establishing prevention beliefs, forming positive attitudes, and promoting positive behaviours, and individuals’ cognition and attitudes towards disease affect the effectiveness of their coping strategies and behaviours to a certain extent [13]. A study showed 72% (CI, 67.8 to 76.4) of the study participants had favorable attitude towards the COVID–19 and 85.3% (CI, 82.2 to 88.7) of the nurses had disturbed psychological responses towards the COVID–19 [19-24]. The vast majority of the participants also held an optimistic attitude towards the COVID-19 epidemic: 81.8% believed that COVID-19 will finally be successfully controlled, and 77.3% had confidence that world leader/WHO can win the battle against the virus [13] (Table 3).

Practice toward COVID-19

Table 4 presents articles on the practice of COVID- 19. Two hundred sixty-five (65.5%) study participants reported that they washed their hands with soap frequently. The majority (71.7%) of the respondents had avoided handshaking. Only one third (36.6%) of the study participants used face mask during leaving their home. The other less frequently practiced preventive measures were avoiding of attending overcrowded place 154 (38.1%) and cleaning and disinfecting of frequently touched objects and surfaces 224 (55.2%). Practicing physical distancing was the least 121 (29.9%) practiced preventive measure [12]. Moreover, 33.3% of respondents had at least one risk behaviors related to COVID-19 infection. Two hundred sixteen (40.9%) of participants gone crowded place and 336(63.3%) were didn’t used face-mask when leaving their home. Three hundred ninety-six (75.0%) respondents were used sterilizers before and after touching inanimate object [13] (Table 4).


In those thirteen studies in KAP toward COVID-19; there is a gap between knowledge, attitude and practice that is why COVID-19 is increasingly fast in Ethiopia. The findings also indicated that knowledge directly influenced attitudes. Good KAP is a tool that can hopefully be used to control the spread of COVID-19. Therefore, the Ethiopian government must give information to the society through TV, radio and social media repeatedly.

Data Availability

All the datasets used to support the findings of this study are all in the text.


I am deeply grateful to all sources of materials used for this review article and it is duly acknowledged.

  1. Wang J, Wang Z. Strengths, Weaknesses, Opportunities and Threats (SWOT)
    Analysis of China’s Prevention and Control Strategy for the COVID-19 Epidemic. 2019.
  2. Log S. Understanding SARS-CoV-2. 2020: 1-9.
  3. Zhang C, Zheng W, Huang X, Bell EW, Zhou X. Protein structure and sequence re-analysis of 2019-nCoV genome does not indicate snakes as its intermediate host or the unique similarity between its spike protein insertions and HIV-1. J Proteome Res. 2020. DOI: 10.1021/acs.jproteome.0c00129.
  4. Shereen MA, Khan S, Kazmi A, Bashir N, Siddique R. COVID-19 infection: origin, transmission, and characteristics of human coronaviruses. J Adv Res. 2020; 24: 91-98. DOI:10.1016/j.jare.2020.03.005.
  5. Chen H, Guo J, Wang C, Luo F, Yu X, Zhang W, et al. Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: a retrospective review of medical records. Lancet. 2020.
  6. Search G. Coronavirus COVID-19 situation reports-World Health Organization. 2020: 5-7.
  7. Rothe C, Schunk M, Sothmann P. Transmission of 2019-nCoV infection from an asymptomatic contact in Germany. N Engl J Med. 2020. DOI: 10.1056/NEJMc200146.
  8. Huang C, Wang Y, Li X. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020; 395:  497–506.
  9. WHO. Coronavirus disease 2019 (COVID-19) Situation Report-195. WHO, 2020.
  10. Ethiopian Public Health Institute. COVID-19_Interim containment strategies-ETH. Addis Ababa, March, 2020.
  11. Haq N, Hassali MA, Shafe AA, Saleem F, Farooqui M, Aljadhey H, et al. A cross sectional assessment of knowledge, attitude and practice towards Hepatitis B among healthy population of Quetta, Pakistan. BMC Public Health. 2012; 12: 1. DOI: 10.1186/1471-2458-12-692.
  12. Akalu Y, Ayelign B, Derbew Molla M. Knowledge, Attitude and Practice towards COVID-19 among Chronic Disease Patients at Addis Zemen Hospital, Northwest Ethiopia. Infection and Drug Resistance. 2020: 13.
  13. Fantaye Nigussie T, Nassir Azmach N. Knowledge, attitude and practice towards covid-19 among Arba Minch town, southern Ethiopia. Global scientific journal. 2020: 8.
  14. Asmare Aynalem Y, Yirga Akalu T, Gebresellassie B, Tadesse Sharew N, Shibabaw Shiferaw W. Assessment of undergraduate student knowledge, practices, and attitude towards COVID-19 in Debre Berhan University, Ethiopia. 2020. DOI: 10.21203/rs.3.rs-28556/v1.
  15. Negera E, Moti Demissie T, Tafess K. Inadequate level of knowledge, mixed outlook and poor adherence to COVID-19 prevention guideline among Ethiopians. 2020. DOI: 10.1101/2020.07.22.215590.
  16. Jemal B, Aweke Ferede Z, Mola S, Hailu S. Knowledge, attitude and practice of healthcare workers towards COVID-19 and its prevention in Ethiopia: a multicenter study. 2020. DOI: 10.21203/rs.3.rs-29437/v1.
  17. Geda NR, Legesse B, Kebede SW, Fekadu B. Knowledge and attitude towards covid-19 in Ethiopia. Frontieri 2020.
  18. Woday Tadesse A, Melese N, Eshetie S, Chanie M, Ali A. Knowledge, Attitude, and Practice and Associated Factors towards COVID-19 among College Students in Amhara Region, Ethiopia; a Cross-Sectional Study. 2020.
  19. Bahrey D, Tukue G, Teklemariam G. Knowledge, Attitude, Practice and Psychological response toward COVID-19 among Nurses during the COVID-19 outbreak in Northern Ethiopia. 2020. DOI: 10.21203/rs.3.rs-26236/v1.
  20. Kebede Y, Yitayih Y, Birhanu Z, Mekonen S, Ambelu A. Knowledge, perceptions and preventive practices towards COVID-19 early in the outbreak among Jimma university medical center visitors, Southwest Ethiopia. PLoS ONE 15: e0233744. DOI: 10.1371/journal.
  21. Bekele D, Tolossa T, Tsegaye R, Teshome W. The knowledge and practice towards COVID-19 pandemic prevention among residents of Ethiopia: An Online Cross-Sectional Study. BioRxiv preprint. 2020. DOI: 10.1101/2020.06.01.127381.
  22. Henok Dagne, Kassahun Alemu, Baye Dagnew. Prevention Practice and Associated Factors of Coronavirus disease 2019 (COVID-19) Outbreak among Educated Ethiopians: An online Based Cross-sectional Survey. 2020. DOI: 10.21203/rs.3.rs-34504/v1.
  23. Mola S, AwekeZ, Jemal B, Hussein R, Hailu S, Neme D, et al. Magnitude and associated factors for attitude and practice of Southern Ethiopian residents toward COVID-19 and its preventions: A community based cross sectional study. 2020. DOI: 10.21203/rs.3.rs-36120/v1.
  24. Wogayehu B, Taye, Yilma W,  Kahssay Faraja C. Knowledge regarding 2019 novel coronavirus (2019-nCoV) infection among final year health science students at Arbaminch College of Health Sciences, Southern Ethiopia: a cross-sectional study. 2020.