Introduction

The outbreak of coronavirus started in Wuhan, China on December 8 2019 but the first report to the World Health Organization (WHO) was on 31st December 2019 [1]. The causative organism

“Severe Acute Respiratory Syndrome Coronavirus 2 (SARS Cov2) was later referred to as Coronavirus disease 2019 (COVID-19). The acronym COVID-19 was used to avoid stigmatization in the population [2]. From there the disease spread to other countries of the world. On January 30^th 2020, the WHO declared the disease a public health emergency of international concern and rolled out measures to slow down the disease transmission [3]. On March 1^st 2020, the disease was declared a pandemic and by WHO. By June 7^th the same year there was 7 million cases globally [4]. As at 26th of April 2023, the WHO reported 764,474,387 confirmed cases with 6,915,286 deaths [5].

Nigeria reported the first case by Nigerian Center for Disease Control (NCDC) on the 27^th of February 2020 on an Italian traveler. It then spread across the country mostly imported by travelers and returnees, affected mostly people aged 31-50 years and males more than females [6]. NCDC on April 27th 2023 reported confirmed cases of 266,665, active cases 3,559, discharged cases 259,951 and number of deaths 3,155 [7].

Ebonyi State Governor on April 26^th 2020 announced the first case in the state. The disease then spread fast in the state mostly carried by returnees. The interstate restriction of movement at the borders by security personnel was undermined by allowing free movement at night. Others took alternative routes into the state [8]. The state recorded 2,064 confirmed cases, 28 cases on admission, 2,004 discharged and 32 deaths by April 27^th, 2023 [7]. Precautionary measures were relied upon to prevent the spread as there was no cure yet. Measures like frequent hand wash with soap and water, use of hand sanitizers, social distancing were introduced and wearing of face mask, Quarantine of infected or suspected cases. In Nigeria, including Abakaliki, Ebonyi state, the existing facilities/equipment including ventilators and Personal Protective Equipment (PPE) were grossly inadequate to handle the medical emergency due to COVID-19 which affected the health care workers coping strategies and resilience during the pandemic [9]. Adherence to Infection Prevention and Control (IPC) were influenced by institutional and personal factors. Government and health administrators were required to ensure availability and adherence to IPC resources and measures in order to curb the spread [10]. Among the populace, many did not believe the protective measures will work hence did not observe them. The residents of Abakaliki metropolis were forced to use face masks but only very few used it correctly. Many used porous materials, some put their face mask around their neck leaving the mouth and nose open. Social distancing was also not strictly adhered to especially in the Banks and other public places. This made the government to close down churches and markets which brought so much hardship on the people. Because of the contagious nature of the disease more drastic measures were put in place to curb the spread. Total and or partial lockdown was enforced in many countries and states, boarder closure, travel as well as social gathering ban [11]. This restriction brought untoward hardship on the socio-economic life of the people. This confinement had significant impact on family life, especially on men and urban dwellers. It created hysteria especially among adults which may require some interventional program like psychosocial healthcare services among adults against future epidemic [12,13]. There was disruption in medical supply, blood transfusion services, diagnosis and management of diseases, people’s livelihood, health and food systems [14-18].

Vaccine was rapidly developed. Nigeria received a total of 3.94 million doses of vaccine in March 2021. Vaccination however faced the challenges of non-acceptance hence coverage remained low in the country. There was general hesitancy to and negative perception on vaccine uptake with some ‘NO VACCINE’ advocates believing that it is unwholesome and tool of the government to have control over the masses [19-21]. Global vaccination reported by WHO as at 24^th April 2023 was 13,325,228,015 and total vaccination for Nigeria was 116,606863 as at 19^th March 2023 [5]. Ebonyi State government received a delivery of 46,088 of Moderna and 10,616 doses of AstraZeneca COVID 19 vaccines. Mass immunization campaign was kicked off in Ebonyi state and set a target of 1,500,000 people on 21^st December 2021.

Most of the stringent measures against the transmission of this disease have been relaxed by most government irrespective of the fact that there is still sporadic diagnosis of this disease in many countries including Nigeria. This study is therefore set out to ascertain the behavior, knowledge of the existence of the disease, observance of safety precautions, availability, acceptability of vaccines among the Abakaliki metropolis dwellers in Ebonyi State, Southeast Nigeria.

Materials and Method

This is a cross-sectional prospective study conducted in Abakaliki metropolis, the capital city of Ebonyi state in June 2023. The study population comprised of consecutive recruitment of participants in Abakaliki metropolis. An open-ended questionnaire was administered to them. Socio-demographic information including the age, occupation, educational status, parity, religion and marital status were obtained. The details of behavior, knowledge of existence, spread, precautionary measures and vaccination were recorded.

The participants that do not practice precautionary measures or did it wrongly were adequately counseled on the importance while those that used it wrongly were thought the correct way to use them as this will also help in the control of other infections prevalent in the state like Lassa Fever.

The population of Abakaliki metropolis was 134,102 according to World Population Review 2020. According to Singh and Masuki (2014), the sample size of 400 is adequate for a population above 100,000 hence the sample size was fixed at 400 respondents.

The data was recorded in the data sheet and the coded data were fed into the computer using SPSS program version 25 

of Illinois USA and analysis done. A P value less than 0.05 was considered significant.

Results

Four hundred and twenty-two respondents 166 (44.1%) males and 236 (55.9%) females who consented were recruited. Mean age of the 34.4 (10.6) and ranged between 16yers to 74 years. The highest age group was 30-39years (38.6%) followed by those aged 2-29 years (37.7%). The median parity for the female respondents was 2.0 (2.0) and ranged between 0 – 7. Majority were civil servants (29.6%) followed by traders (24.6%). Most (98.3%) were Christians while 73.7% had tertiary education (Table 1).

Table 1: Socio-demographic characteristics of respondents.

Knowledge of the disease existence was high (98.1%) and 69.1% of the respondents believe the disease still exists while 30.9% believe the disease no longer exists, however 8 (1.9%) respondents were not aware of the existence of the pandemic (Table 2). There was very poor knowledge (19.6%) of how the disease is spread among the respondents (Table 3).

Table 2: Knowledge of COVID-19.

Table 3: Knowledge of spread.

Majority (98.3%) knew that the disease can be prevented but there was very poor knowledge of preventive measures among them (21.4%) (Table 4). Majority (92.6%) agreed that the preventive measures were strictly observed during the pandemic. The preventive measures mainly practiced now is frequent hand wash/hand sanitizers (82.5%) and use of face mask (59.4%). About 13.2% of the respondents no longer practice any of the preventive measures (Table 5).

Table 4: Knowledge of prevention.

Table 5: Preventive measures in practice now.

Majority (92.3%) were aware of availability of vaccine but only 101 (24.4%) were vaccinated. A good number of those vaccinated, had only one dose giving development of side effects and unavailability of the vaccine as the reason for not continuing. The major reason for not getting vaccinated was fear of side effect (25.8%) though 27.5% of the respondents did not give any reason. Some believed that vaccine was a scam by government (5.8%). Only 11.2% of the respondents completed the required number of doses. Fifteen (3.6%) of the respondents were infected with COVID 19 disease, 7 of them had self- isolation in their houses, 5 were managed in the government isolation/treatment center while the remaining 3 were managed in the tertiary hospital isolation area (Table 6).

Table 6: Vaccination and COVID infection among the respondents.

There was strong correlation between knowledge of spread and age (x² = 17.150, Pv = 0.001), Gender (x² = 12.904, Pv = 0.001), Occupation (x² = 25.801, Pv = 0.001) and educational level (x² = 10.503, Pv = 0.005) (Table 7).

Table 7: Relationship between the socio-demographic variables and the level of knowledge of spread of COVID-19.

Knowledge of prevention was also significantly related to age (x² = 17.038, Pv = 0.001), Gender (x² = 12.560, Pv = 0.001), Occupation (x² = 33.942, Pv = 0.001) and educational level (x² = 18.821, Pv = 0.005) (Table 8).

Table 8: Relationship between the socio-demographic variables and the level of knowledge of prevention of COVID-19.

There was weak correlation between COVD 19 infection with sex, men being more affected than women but this was not statistically significant (x² = 1.704, Pv = 0.792) (Table 9).

Table 9: Relationship between infection with COVID-19 and gender.