|Year : 2021 | Volume
| Issue : 1 | Page : 360-366
Assessment of hygienic practices at the beginning of coronavirus disease-19 and after 3 months of its appearance in Egypt
Shaimaa Y Abd elRaouf, Shaimaa S Soliman, Nehad B Abd Elaty
Department of Public Health and Community Medicine, Faculty of Medicine, Menoufia University, Menoufia, Egypt
|Date of Submission||18-Aug-2020|
|Date of Decision||06-Oct-2020|
|Date of Acceptance||20-Oct-2020|
|Date of Web Publication||27-Mar-2021|
Shaimaa Y Abd elRaouf
Shebien El-Kom, Menoufia 32511
Source of Support: None, Conflict of Interest: None
To assess the hygienic practices and preventive measures of individuals at the beginning of coronavirus disease-19 (COVID-19) pandemic and after 3 months of its appearance in Egypt.
As there is still no definitive vaccine or treatment for COVID-19, personal hygienic practices and avoidance of exposure remain the gold standard for its prevention and control.
Patients and methods
A cross-sectional study included 391 participants who were asked to fill in a questionnaire to assess their hygienic practices and preventive measures of COVID-19 at the beginning and after 3 months of the pandemic in Egypt. The questionnaire consisted of 20 questions based on the WHO hygienic guidelines and was delivered through online Google form, and the higher the score, the better the practices. The validity and reliability of the questionnaire were shown to be satisfactory.
The mean age of the studied group was 31.7 years (18–58 years), 72.4% were females, 81.8% were highly educated, 74.4% were living in urban areas, and 58.1% were married. The mean total score of the hygienic practices was significantly higher after 3 months of COVID-19 pandemic (49.1±7.82) than at the beginning (47.8±6.88), with P value less than 0.001. Participants who were aged more than 30 years (P=0.001), married (P=0.026), or currently working (P=0.001) maintained better practices than participants who were younger, single, or not working.
Most participants applied most of the hygienic practices to avoid COVID-19 infection. Some of the practices were improved after 3 months of COVID-19 appearance in Egypt.
Keywords: coronavirus disease-19, Egypt, epidemic, hygiene
|How to cite this article:|
Abd elRaouf SY, Soliman SS, Abd Elaty NB. Assessment of hygienic practices at the beginning of coronavirus disease-19 and after 3 months of its appearance in Egypt. Menoufia Med J 2021;34:360-6
|How to cite this URL:|
Abd elRaouf SY, Soliman SS, Abd Elaty NB. Assessment of hygienic practices at the beginning of coronavirus disease-19 and after 3 months of its appearance in Egypt. Menoufia Med J [serial online] 2021 [cited 2021 May 8];34:360-6. Available from: http://www.mmj.eg.net/text.asp?2021/34/1/360/312049
| Introduction|| |
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and the resultant coronavirus disease-2019 (COVID-19) have evolved into a pandemic, requiring persons around the world to attend to rapidly changing messages about public health and take immediate actions to minimize their risk of infection and the spread of the virus . Like SARS-CoV and Middle East respiratory syndrome coronavirus (MERS-CoV), this newly emerged SARS-CoV-2 virus belongs to the B lineage of the β-CoVs ,.
The most important transmission route that is currently agreed upon is human-to-human transmission via respiratory droplets or direct contact. Like other viruses of the Coronaviridae family, the main clinical manifestations of the disease are fever, which occurs in 99% of the affected persons, as well as dry cough, dyspnea, and bilateral patchy lung infiltration on imaging. The estimated overall mortality rate of COVID-19 is ∼2%, which is much lower than that of the SARS-CoV and MERS-CoV .
The WHO has declared COVID-19 a public health emergency of international concern. However, there are no available vaccines against or specific therapeutic agents SARS-CoV-2. Owing to the interventions and control measures (shutting down public transportation and implementing a treatment strategy) and the change in personal behaviors (wearing masks and reducing contact with others), the number of confirmed and suspected cases have started to decrease .
The best preventive measure is to avoid being exposed to COVID-19. This can be achieved through following simple hygienic practices like washing hands with soap and water, using face masks, and isolating confirmed and suspected cases ,.
This study aimed to assess the hygienic practices and preventive measures of individuals at the beginning of COVID-19 infection and after 3 months of its appearance in Egypt.
| Patients and methods|| |
This cross-sectional study was conducted on Egyptian individuals aged 18 years or older. The study was approved by the Institutional Review Board of Faculty of Medicine, Menoufia University, according to the Declaration of Helsinki. All the participants were volunteers, and their data would be kept confidential and would be used only for research purposes. An informed consent was attached to the first part of the questionnaire before any questions.
The self-administered anonymous questionnaire was prepared by the authors and was distributed online as a Google form through different social networks. It was based on the WHO COVID-19 advice for the public (Arabic version) (https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for public) and the recommendations for personal protection published by the Egyptian Ministry of Health (MOH).
The questionnaire consisted of three parts (Appendix 1):
- The first part included sociodemographic data like age, sex, residence, level of education, marital status, occupation, risk of COVID-19 exposure, and family income.
- The second part included 20 questions inquiring about the hygienic practices and preventive measures of the participants at the beginning of COVID-19 infection.
- The third part included the same 20 questions inquiring about the hygienic practices and preventive measures of the participants but after 3 months of COVID-19 appearance.
All items in the second and third parts were answered using a 3-point Likert scale format, where never = 0, sometimes = 1, and always = 2. The answers of all the points were summed for each participant, and the higher the score, the better the practices. The validity of this questionnaire was established by a panel of experts consisted of an epidemiologist and two infection control experts. Questionnaire reliability was tested by a pilot study on 20 participants (who were later excluded from the main study) using Cronbach's alpha. The alpha for validity and reliability was 0.87 and 0.80, respectively.
Data were analyzed by Statistical Package of Social Science (SPSS), version 22 (SPSS Inc., Chicago, Illinois, USA). Quantitative data were presented as mean and SD, whereas qualitative data were presented in the form of numbers and percentages. Student t test was used for comparison between two groups having quantitative variables. Paired t test was used for comparison between two related quantitative measures, and marginal homogeneity test was used for categorical ones. Two-sided P value less than 0.05 was considered statistically significant.
| Results|| |
The mean age of the studied group was 31.7 years (range, 18–58 years). Among them, 72.4% were females, 81.8% were highly educated, 74.4% were living in urban areas, 58.1% of were married, and 70.3% have sufficient income. More than two-thirds (68.8%) of the participants were currently working, and 51.7% reported that their job put them at high risk of exposure to COVID-19 infection [Table 1].
Many hygienic practices did not show any statistically significant difference at the beginning of COVID-19 and after 3 months of its appearance. These practices included hand washing with soap and water, disinfecting hands with alcohol, using above elbow area or tissue when coughing with safe disposal of the tissue, hanging outfit clothes for sufficient time before reuse, disinfecting surfaces and commonly shared areas continuously, keeping good personal hygiene, eating balanced and healthy food, exercising (working out), and disinfecting personal belonging like keys and cell phones [Table 2].
|Table 2: Number and percentage distribution of hygienic practices of the studied group at the beginning and after 3 months of coronavirus disease-19 pandemic|
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Some other practices, including avoid touching eyes, nose, and mouth with hands; wearing face masks in crowded places; wearing gloves when going outside; social distancing in public places; avoid hand shaking; washing purchased supplies before using it; immediate discard of grocery bags; washing the outfits separately; preventing home visits to avoid gathering as possible; and working out, showed significant difference after 3 months of COVID-19 (P = 0.002, P < 0.001, P = 0.018, P = 0.031, P = 0.031, P < 0.001, P = 0.009, P = 0.001, P = 0.030, and P = 0.001, respectively) [Table 2].
The mean total score of the hygienic practices was significantly higher after 3 months of COVID-19 pandemic (49.1 ± 7.82) than the mean total score at its beginning (47.8 ± 6.88), with P value less than 0.001 [Figure 1].
|Figure 1: Mean total score of hygienic practice of the studied group at the beginning and after 3 months of corona epidemic.|
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The mean hygienic score at the beginning of COVID-19 was significantly higher among participants older than 30 years (P = 0.001), married (P = 0.026), or who were working (P = 0.001).
After 3 months of COVID-19, the mean hygienic score continued to be significantly higher among participants who were older than 30 years, married, or working. Participants who were females, living in urban areas and who had high-risk jobs (e.g., bankers, health care workers, and customer services) showed significantly higher hygienic scores than participants who were males, living in rural areas and with low-risk jobs. No significant association was found at any time between hygienic practice score and any of the educational level or sufficiency of the income (P > 0.05) [Table 3].
|Table 3: Relation between hygienic practice after 3 months of corona epidemic and sociodemographic characters of the studied group (n=391)|
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| Discussion|| |
The WHO detailed different hygienic and sanitation measures in their interim guide published on April 23, 2020. The WHO descried the hand hygiene as 'extremely important' in preventing the spread of COVID-19 pandemic. Hand hygiene includes washing hands by soap and water or by alcohol-based hand sanitizers. The guide, not only emphasized on the importance of hand hygiene but also on the environmental and personal cleanliness, water sanitation, and proper waste disposal .
At the beginning of COVID-19 pandemic, most participants of this study were washing their hands (with either soap and water or alcohol-based sanitizers), disposed used tissues in a safe way, and kept a good personal hygiene. More than half of them used a tissue or above-elbow area when they wanted to cough or sneeze; applied social distancing in public places; avoided shaking hands, hugs, or kisses; prevented home visits; and disinfected their personal belongings. Less than half of them avoided touching their eye, nose, and mouth; wore face masks in public areas; washed grocery and other supplies before use; hanged their outfits for sufficient time before reuse; disinfected surfaces; and ate balanced diet. Few of them wore gloves outdoor, washed their outfits separately, and kept exercising (working out). The participants had a good overall hygienic score, as their mean was 47.8 out of total 60 points.
This was in agreement with Taghrir et al. , who conducted a study in Iran to assess the preventive behaviors and risk perception among Iranian medical students and found that the majority (94.2%) of the participants had high performance in preventive behaviors, and only 5.8% had low performance scores. Moreover, Wolf et al.  who assessed the awareness, attitudes, and actions related to COVID-19 among adults with chronic conditions at the onset of the US epidemic have found that only 21.9% reported that COVID-19 had little or no effect on their daily routine behavior. Another study carried out by Al-Hanawi et al.  to assess knowledge, attitude, and practice toward COVID-19 among the public in the kingdom of Saudi Arabia had found that the mean score for practices was 4.34 (SD = 0.87; range, 0–5), indicating good practices for preventive measures.
The participants maintained good level of hygienic practices according to what they reported in the part related to the practices 3 months after COVID-19 appearance in Egypt. Some practices were even improved like avoid touching eye, nose, and mouth; wearing masks and gloves in the outdoors; avoid shaking hands, hugs, and kisses; washing grocery and other supplies before use; and preventing home visits.
At the beginning of COVID-19 pandemic, participants aged 30 years or more had significantly higher hygienic score than younger participants. Moreover, married participants and participants who are currently working showed higher scores than single or not currently working ones. After 3 months of COVID-19 appearance, more categories of the participants started to show higher hygienic score. This included females, participants of urban residents, and those with high-risk jobs. No significant association was observed between the hygienic score and any of the educational level or the income status.
This was consistent with ALdowyan et al. , who assessed knowledge, attitude, and practice about MERS-CoV among a population in Saudi Arabia. They found that males were significantly less than females in taking safety precautions and prevention by 0.563 time [odds ratio: 0.563 (0.341–0.94), P ≤ 0.05).
According to our search, this is the first descriptive study to assess the hygienic practices and preventive measures of individuals at the beginning of COVID-19 outbreak and after 3 months of its appearance in Egypt.
| Conclusion|| |
Most participants of this study applied and maintained most of the recommended preventive measures to avoid COVID-19 since its beginning and after 3 months of its appearance. Some of the practices were even improved after 3 months of COVID-19 appearance in Egypt.
Limitations of the study
- As an internet-based study, it needed participants with smart phones and have a basic level knowledge of internet use.
- Some recall biases were faced regarding the part related to the practices at the beginning of COVID-19 lockdown.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
Evaluation of hygienic practice at the beginning of COVID 19 infection and after 3 months of its appearance
This survey contains questions regarding hygienic practice and preventive measurements of individuals at the beginning of COVID 19 infection and after 3 months of its appearance. Your responses to this survey are anonymous; we ask that you answer each question honestly. However, you can skip any question that makes you feel uncomfortable and can stop completing the survey at any time.
By completing this survey you are confirming that you are at least 25 years of age, have been told that your responses are anonymous. By completing all or any part of the survey you are signifying your consent to participate in this research.
| References|| |
Acter T, Uddin N, Das J, Akhter A, Choudhury TR, Kim S. Evolution of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) as coronavirus disease 2019 (COVID-19) pandemic: a global health emergency. Sci Total Environ 2020; 730
Wong JEL, Leo YS, Tan CC. COVID-19 in Singapore-current experience: critical global issues that require attention and action. JAMA 2020; 323
Li Q, Guan X, Wu P, Li Q, Guan X, Wu P, et al
. Early transmission dynamics in Wuhan, China, of novel coronavirus-infected pneumonia. N Engl J Med 2020; 382
Lai CC, Shih TP, Ko WC, Tang HJ, Hsueh PR. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and coronavirus disease-2019 (COVID-19): the epidemic and the challenges. Int J Antimicrob Agents 2020; 55
Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al
. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020; 395
World Health Organization (WHO). WHO Director-General's opening remarks at the mission briefing on COVID-19. 2020. Available at: https://www.who.int/dg/
speeches/detail/who-director-general-s-opening-remarks-at- the-mission Briefing-on-covid-19. [Last accessed on 2020 Mar 01].
Taghrir MH, Borazjani R, Shiraly R. COVID-19 and Iranian medical students; a survey on their related-knowledge, preventive behaviors and risk perception. Arch Iran Med 2020; 23
Wolf MS, Serper M, Opsasnick L, O'Conor RM, Curtis LM, Benavente JY, et al
. Awareness, attitudes, and actions related to COVID-19 among adults with chronic conditions at the onset of the U.S. outbreak: a cross-sectional survey. Ann Intern Med 2020; 173
Al-Hanawi MK, Angawi K, Alshareef N, Qattan AM, Helmy HZ, Abudawood Y, et al
. Knowledge, attitude and practice toward COVID-19 among the public in the Kingdom of Saudi Arabia: a cross-sectional study. Front Public Health 2020; 8
ALdowyan N, Abdallah A, El-Gharabawy R. Knowledge, attitude and practice (KAP) study about Middle East Respiratory Syndrome Coronavirus (MERS-CoV) among population in Saudi Arabia. Int Arch Med 2017; 217
[Table 1], [Table 2], [Table 3]