Original Article
Perception and knowledge of Pakistanis on COVID-19 and
its vaccination: implications for public health
Percepción y
conocimientos de los pakistaníes sobre COVID-19 y su vacunación: implicaciones
para la salud pública
Moath Refat1* ORCID: https://orcid.org/0000-0003-4017-9052
Sundus Shukar2,3 ORCID: https://orcid.org/0000-0001-8078-165X
Iltaf Hussain2,3,4 ORCID:
https://orcid.org/0000-0003-0556-0181
Ahmed Ibrahim Mohamed5,6 ORCID:
https://orcid.org/0009-0003-3654-9433
1
Department of Biochemistry and Molecular Biology, The Key Laboratory of
Environment and Genes Related to Disease of Ministry of Education, Health
Science Center, Xi’an Jiaotong University. Xi’an,
China.
2 Department
of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy Xi’an Jiaotong University. Xi’an, Shaanxi, China.
3 Center for
Drug Safety and Policy Research, Xian Jiaotong
University. Xi’an, Shaanxi, China.
4 Department
of Pharmacy Practice, Faculty of Pharmacy, Bahauddin
Zakariya University. Multan, Pakistan.
5 Health
Science Center, Xi’an Jiaotong University. Xi’an,
Shaanxi, China.
6 Internal
Medicine Department, First Affiliated Hospital of Xi’an Jiaotong
University. Xi’an, Shaanxi, China.
Autor para correspondencia: moath.refat@hotmail.com
ABSTRACT
Since the beginning,
COVID-19 caused deaths and social and economic devastation worldwide. Effective
prophylactic strategies such as personal protection measures, social
distancing, and vaccination were key players in limiting disease transmission.
The present study aimed to investigate the perception and knowledge of the
Pakistani public regarding various aspects of COVID-19 after more than 3 years
of the pandemic initiation. The study also aimed to investigate the association
between educational level and knowledge about COVID-19. An online
cross-sectional survey was conducted using a convenience sample of 1,043
individuals from different cities in Pakistan. The survey consisted of various
sets of questions covering the aspects of the study objectives. Most of the
participants reported a solid understanding of COVID-19; however, there were
some misconceptions and knowledge gaps concerning certain pandemic elements.
The study also highlighted a link between educational level and awareness of
COVID-19, with a higher education level related to a better understanding of
the pandemic and effective preventive strategies. This study provides valuable
insight into the perception and education level of the Pakistani public
regarding COVID-19. The findings highlight the need of continued public health
efforts to promote and ensure access to effective prevention measures,
particularly in vulnerable populations who may face barriers to obtaining
protective equipment.
Keywords: COVID-19; perception; health knowledge, attitudes, practice; educational
level; Pakistan.
RESUMEN
Desde el principio, la COVID-19 causó muertes y
devastación social y económica en todo el mundo. Las estrategias profilácticas
eficaces, como las medidas de protección personal, el distanciamiento social y
la vacunación fueron fundamentales para limitar la transmisión de la
enfermedad. El presente estudio tuvo como objetivo investigar la percepción y
los conocimientos del público pakistaní en relación con diversos aspectos de la
COVID-19 después de más de 3 años del inicio de la pandemia. El estudio también
pretendió investigar la asociación entre el nivel educativo y el conocimiento
sobre COVID-19. Se realizó una encuesta transversal en línea utilizando una
muestra de conveniencia de 1.043 individuos de diferentes ciudades de Pakistán.
La encuesta constaba de varios conjuntos de preguntas que cubrían los aspectos
de los objetivos del estudio. La mayoría de los participantes declararon tener
un conocimiento sólido sobre COVID-19; sin embargo, tenían algunas ideas
erróneas y lagunas de conocimiento en relación con determinados elementos de la
pandemia. El estudio también puso de relieve una relación entre el nivel
educativo y el conocimiento sobre COVID-19, relacionándose un mayor nivel
educativo con una mejor comprensión de la pandemia y de las estrategias preventivas
eficaces. Este estudio proporciona una valiosa información sobre la percepción
y el nivel de educación del público pakistaní en relación con COVID-19. Los
resultados ponen de relieve la necesidad de continuar los esfuerzos de salud
pública para promover y garantizar el acceso a medidas de prevención eficaces,
en particular en las poblaciones vulnerables que pueden enfrentarse a barreras
para obtener equipos de protección.
Palabras clave: COVID-19; percepción;
conocimientos, actitudes y práctica en salud; escolaridad; Pakistán.
Recibido: 22 de enero de 2024
Aceptado: 23 de septiembre de 2024
Introduction
COVID-19, which originated in Wuhan, China, on December 31, 2019,
quickly spread globally due to international travel and migration. Regions with
limited healthcare infrastructure and fewer medical professionals experienced
higher case burdens and poorer outcomes. Socioeconomic disparities within
cities further contributed to varying infection rates, with marginalized communities
being particularly affected. The disease’s spread highlighted significant
global and local disparities in healthcare access and outcomes.(1)
COVID-19 had a severe global impact,(2)
causing 3.29 million fatalities among 15 million infected individuals as of May
7, 2021.(3) Mortality rate varied widely, with some countries
experiencing a 50% mortality, while those with strict lockdown measures
decreased by 5%. In many countries, deaths were found 1.6 times greater than
the reported number. Additionally, the pandemic caused the loss of priceless time.(3) As reported by 81 countries
from January 2021, the pandemic stole 20.5 million years of life, nine times
higher than seasonal influenza.(4)
Public awareness about any outbreak is crucial in mitigating the impact
of such events, as increased awareness leads to quick adaptation of public
health measures, fewer fatalities, and timely control of the spread. Previous
outbreak experiences witnessed that the success of outbreak control depends upon
attitude, knowledge, and public perception about it.(5,6) Numerous studies revealed a direct correlation between public awareness
of the disease and adherence to governmental regulations, resulting in the
containment of COVID-19 spread and development.(5,6,7,8) Public
perception can also impact how government and health organizations respond to
the disease, including developing and implementing public health policies and
communication strategies.
Vaccination has played an important role in the reduction of the disease
burden, disability, and fatality saving around 5 million people from deadly
ailments per year, evidenced in a history of tackling polio, tetanus, hepatitis
B, influenza, diphtheria, MMR (measles, mumps, and rubella) and pertussis. Despite
this, vaccine hesitancy remains a significant global health threat, identified
by the World Health Organization (WHO) in 2019.(9) Nonetheless,
various countries such as Thailand, Vietnam, and Mongolia have been identified
as having high levels of vaccine reluctance, often due to religious beliefs.(9,10)
Currently, vaccination against COVID-19 is one of the most effective ways to
protect people from the virus and its potentially severe consequences.(11)
Some people worldwide also mistaken COVID-19 for seasonal influenza,
despite of key differences between the two diseases. COVID-19 caused by a novel
coronavirus, is more contagious and can cause more severe illness and death
compared to seasonal influenza which is caused by various influenza viruses. However,
both are transmissible via respiratory droplets and share symptoms such as
fever, cough, and body aches. Therefore, it is essential for people to
understand these differences, as well as the potential benefits and hazards of
vaccination against both diseases.(11)
Pakistan, a developing South Asian country, has a hybrid healthcare
system with minimum budget for medicines and medical products. With a
population estimated over 225 million in 2023 and a median age of 22.8 years,(12) the literacy rate stood at
58.0% in 2019.(13) In Pakistan, COVID-19 presented significant
challenges, particularly due to the country's dense population and limited
healthcare infrastructure. On April 10, 2020, Pakistan disclosed 4,601 confirmed cases and 66
fatalities within 45 days of initial outbreak. As of mid-2021, Pakistan reported over 1.2 million
confirmed cases and more than 27,000 deaths. As of April 13, 2024, the
total cases were 1,581,936 and total deaths
were 30,664.(14)
The WHO praised Pakistan for appropriate measures to curb the pandemic(15)
including immediate response, border control, quarantine houses,
country-wide lockdown, area cordons, testing and contact tracing, field
epidemiology laboratory training program, implementation of standard operating
procedures (masks, sanitization, and social distancing), awareness campaigns,
economic measures, and production of ventilators.(15) Six months
after first reported case, these efforts resulted in a steady decline in active
cases, with daily death rates frequently falling into the single digits. By
October 1, 2020, Pakistan had reported 312,263 confirmed cases, and 6,479 deaths.(15)
Previous studies suggest that understanding of the
pandemic and adherence to public health guidelines may be influenced by the
education level of individuals.(18) Therefore,
this study aims to evaluate how education shapes public perception of the
COVID-19 pandemic and to assess the evolution of these perceptions over time, considering that the study was conducted more than two years after the
pandemic’s initial outbreak. By incorporating multiple aspects of the pandemic,
this study provides a comprehensive understanding of the Pakistani public’s
perception of COVID-19 and the potential role of education in shaping these
views.
Materials and
Methods
Study design
A cross-sectional study design was adopted to evaluate the perception of
the Pakistani public about the COVID-19 pandemic regarding its nature, cause,
symptoms, and vaccination through an internet-based survey. The study duration
was from December 2022 to March 2023.
Study ethics
The study procedures were approved by the Department of Pharmacy
Practice, Bahauddin Zakariya University (Acad/PRAC/EXT/23/02). Participant confidentiality was
maintained throughout the study. The current study did not collect the
participant’s personal or identifying information. Informed consent was
obtained from the participants before recruiting for the study.
Data collecting tool
The research team developed the initial draft of the study questionnaire
based on previously available literature. For clarity and comprehensiveness,
face validity was done by an expert of the same background for the initial
questionnaire draft. For the reliability assessment, a pilot study was
conducted on 37 participants. A Cronbach alpha value of 0.71 was obtained to
show a valid internal consistency. For the convenience of the study population,
an Urdu translation was added alongside the English questions.
The questionnaire was comprised of six sections with a total of 37
questions. The first section consisted of participants’ demographic data (seven
questions) regarding age, gender, educational level, and current working
profile. The second section asked participants about their perception of the
nature of the COVID-19 pandemic (eight questions). The three-point Likert scale
(agree, neutral, disagree) was adopted with the perception questions items in
this section. The third section was on the participants’ perceived
susceptibility to the severe COVID-19 pandemic (single question). The fourth
section was on the perception of participants about the symptoms of COVID-19
and the way they protect themselves (eleven questions). The fifth section was
about the participants’ perception regarding the symptoms of the COVID-19
pandemic compared to seasonal influenza (three questions). The sixth section
contained questions regarding participants’ perceptions of the COVID-19 vaccine (seven questions).
Only close-ended questions were used in the questionnaire.
Participants
The final pre-tested questionnaire was utilized to create a Google
survey form and published as a cross-sectional survey on December 1st,
2022. The link of the Google survey form was designed in such a way that only
one response can be generated using one device. The inclusion criteria were
Pakistani citizens of both sexes and residing within the country. The recruitment was accomplished online (Facebook, LinkedIn, WhatsApp, Instagram, and Twitter) and offline
methods (data collectors took responses conveniently). In order to avoid
selection biases, the data collectors were hired from different regions of
Pakistan to have a representative sample (four provinces: Punjab, Sindh, Khyber
Pakhtunkhwa (KPK), and Balochistan; the Islamabad
Capital Territory; and the administrative territories of Azad Jammu and Kashmir
and Gilgit–Baltistan). Moreover, the data collectors included participants from
different age groups. Participants
declared their consent to voluntarily participate in this study prior to
filling out the survey.
Data analysis
The data collection was done using Google Forms and cleaned using
Microsoft Excel. The final datasets were integrated and analyzed using the
Statistical Package for the Social Sciences (SPSS version 21). To summarize the
results, we used descriptive statistics. The continuous variables were
tabulated as mean and standard deviation, whereas the categorical variables
were presented as frequency and percentage. A Pearson correlation analysis was
conducted to determine the relationship between medication recommendation,
vaccination status, and vaccination willingness and demographic
characteristics. All statistical tests were dееmеd
significant with a p-value < 0.05 and a 95% confidence interval
Results
Demographic characteristics
A total of 1,043
individuals participated in this current study, most of which were males (51.
05 %) compared to females (48.85 %). Most participants were aged between 18-30
years (80. 08%), with a smaller portion over 30 years old (19.83 %).
Additionally, most of the participants were students who have undergraduate
education level (59.48 %) or have attained graduate-level education (33.81 %),
and a considerable number were professional workers (33.43 %). Finally, most
indicated residing in urban areas (74.14%). The details regarding demographic
characteristics can be seen in Table 1.
Table 1. Demographic
characteristics of the participants.
|
Variables |
N (%) |
|
|
Gender |
Male |
533 (51.05) |
|
|
Female |
510 (48.85) |
|
Age (year) |
18-30 |
836 (80.08) |
|
|
>30 |
207 (19.83) |
|
Education |
Illiterate |
17 (0.67) |
|
|
Secondary education |
48 (4.60) |
|
|
Higher secondary education |
4 (0.19) |
|
|
Undergraduate |
621 (59.48) |
|
|
Graduate |
353 (33.81) |
|
Occupation |
Professional worker |
349 (33.43) |
|
|
Worker |
576 (55.17) |
|
|
Other |
118 (11.30) |
|
Residence |
Urban |
774 (74.14) |
|
|
Rural |
269 (25.77) |
Public’s knowledge of
COVID-19 virus nature and origin
Most participants (56.6%) believed that COVID-19 is a naturally occurring
human virus, while others (38.0%) believed it has a bacterial origin. A
considerable number (43.2%) believed it to be a laboratory-created virus or a
punishment from God (48.9%). The details can be seen in Table 2.
Table 2. Perception of the participants
regarding the COVID-19 virus.
|
Variables |
|
N (%) |
|
A naturally occurring human virus |
Agree |
590 (56.6) |
|
|
Neutral |
212 (20.3) |
|
|
Disagree |
241 (23.1) |
|
A lab-altered virus (man-made virus) |
Agree |
451 (43.2) |
|
|
Neutral |
297 (28.5) |
|
|
Disagree |
295 (28.3) |
|
An animal disease transmitted to human (from
animal to human) |
Agree |
517 (49.6) |
|
|
Neutral |
233 (22.3) |
|
|
Disagree |
293 (28.1) |
|
A bacterial origin |
Agree |
396 (38.0) |
|
|
Neutral |
218 (20.9) |
|
|
Disagree |
429 (41.1) |
|
A punishment from the God |
Agree |
510 (48.9) |
|
|
Neutral |
270 (25.9) |
|
|
Disagree |
263 (25.2) |
|
A serious and fatal (critical) virus |
Agree |
785 (75.3) |
|
|
Neutral |
190 (18.2) |
|
|
Disagree |
68 (6.5) |
|
A serious but not fatal |
Agree |
354 (33.9) |
|
|
Neutral |
276 (26.5) |
|
|
Disagree |
413 (39.6) |
|
A toxic gas effect on the respiratory system
(breathing system) |
Agree |
583 (55.9) |
|
|
Neutral |
194 (18.6) |
|
|
Disagree |
266 (25.5) |
Public’s knowledge of
COVID-19 disease susceptibility, self-protection measures, and antibiotics and
antimalarial use
The majority of the participants opined that COVID-19 virus could infect
any population group. However, the elder (20.4%) and co-morbidities population
(13.3%) were more susceptible to COVID-19. Most of the participants (94.4%)
confirmed the importance of having self-protection measures against the
COVID-19 pandemic, and most (66.3%) believed that antibiotics and antimalarials
(chloroquine) are effective in protection against the COVID-19 pandemic, as
shown in Table 3.
Table 3. Participants' perceptions regarding COVID-19 susceptibility,
self-protection, and use of antibiotics and antimalarial in the COVID-19
pandemic.
|
Variables |
|
N (%) |
|
In your opinion, who is the most susceptible to
severe COVID-19 pandemic? |
Children only |
70 (6.5) |
|
|
Elders people only |
220 (20.4) |
|
|
People with chronic illnesses such as heart
disease and diabetes |
143 (13.3) |
|
|
Pregnant women only |
9 (0.8) |
|
|
All of the above |
582 (57.2) |
|
|
Non |
19 (1.8) |
|
Do you know anyone infected with COVID-19? |
Yes |
855 (82.0) |
|
|
No |
188 (18.0) |
|
Are you afraid to get infected with the COVID-19
pandemic? |
Yes |
604 (57.9) |
|
|
No |
369 (35.4) |
|
|
I don’t care |
70 (6.7) |
|
Do you think you have come in contact with
COVID-19? |
Yes |
414 (39.7) |
|
|
No |
450 (43.1) |
|
|
I am not sure |
179 (17.2) |
|
Do you think it is important to have protection
measures (such as masks, hand sanitizers, etc.)? |
Yes |
985 (94.4) |
|
|
No |
58 (5.6) |
|
Do you have protection
measures (such as masks, hand sanitizers) in your place? |
Yes |
952 (91.3) |
|
|
No |
91 (8.7) |
|
Yes |
691 (66.3) |
|
|
|
No |
352 (33.7) |
Public’s drug
recommendation for COVID-19 disease
Regarding antibiotic recommendations, (34.4%) of the participants recommended
antibiotics for people in their circle; the medications included antibiotics
(4.9%), steroids (0.8%), and antiviral (0.5%). On the other hand, a majority of
participants were well knowledge about the COVID-19 symptoms (94.3%), as shown
in Table 4.
Table 4. Participant’s recommendation of medication and knowledge about the
COVID-19 pandemic.
|
Variables |
|
N (%) |
|
Do you recommend any medications for people in
your circle (area) as protection against the COVID-19 pandemic? |
Yes |
371 (34.4) |
|
|
No |
672 (65.6) |
|
Class of medication recommended by the
participants |
Antibiotics |
18 (4.9) |
|
|
Antiviral |
2 (0.5) |
|
|
Antibiotics and Antimalarial |
1 (0.3) |
|
|
Antibiotics and symptomatic treatment |
11 (3.0) |
|
|
Antibiotics and antiviral |
1 (0.3) |
|
|
Anticoagulant |
1 (0.3) |
|
|
Antibiotics, steroids, and symptomatic treatment |
2 (0.5) |
|
|
Herbal remedies |
9 (2.4) |
|
|
Symptomatic and herbal remedies |
5 (1.3) |
|
|
Symptomatic treatment |
60 (16.2) |
|
|
Steroids |
3 (0.8) |
|
|
Vaccination |
12 (3.2) |
|
|
Vaccination and antibiotics |
1 (0.3) |
|
|
Vaccination and symptomatic treatment |
1 (0.3) |
|
|
Self-Protection |
244 (65.8) |
|
Do you know the symptoms of the COVID-19 pandemic
include fever, fatigue, dry cough, loss of smell and/or taste, and muscle
pain? |
Yes |
985 (94.4) |
|
|
No |
58 (5.6) |
|
Do you know any other symptoms of the COVID-19
pandemic other than the above symptoms? |
Yes |
338 (32.4) |
|
|
No |
705 (67.6) |
|
Other symptoms reported by the participants |
Respiratory symptoms |
94 (44.8) |
|
|
Psychological symptoms |
6 (2.9) |
|
|
Multiple organ symptoms |
12 (5.7) |
|
|
General symptoms |
98 (46.7) |
Public knowledge regarding
influenza and COVID-19 viruses and their vaccination
Most participants reported
that the symptoms and vaccines for influenza and COVID-19 are very similar.
However, most participants were not vaccinated against influenza (51.7%). On
the other side, the participants vaccinated against COVID-19 were (73.8%) and
(26.2%) were still not vaccinated. The reported reasons for not-vaccinated were
the believe of vaccine’s ineffectiveness (6.5%), dependency on innate immunity
(8.7%), and safety concerns regarding the COVID-19 vaccine (5.9%). The majority
of the participants showed a willingness to recommend vaccination to others
(76.3%). Most participants decided by themselves to vaccinate and opined that healthcare
professionals should prioritize vaccination against COVID-19. The details can
be seen in Table 5.
Table 5. Participants’ perception regarding influenza and COVID-19 viruses and
their vaccination.
|
Variables |
|
N (%) |
|
To which extent do you think symptoms of COVID-19
are similar to seasonal influenza? |
No similarity |
68 (6.5) |
|
|
Small similarity |
229 (22.9) |
|
|
Similar, but I am not sure how much |
328 (31.4) |
|
|
Large extent |
1 (0.1) |
|
|
There is a big similarity |
417 (40.0) |
|
Have you ever been vaccinated against seasonal
influenza? |
Yes |
346 (33.2) |
|
|
No |
539 (51.7) |
|
|
I don’t remember |
158 (15.1) |
|
To what extent do you think there is a similarity
between the COVID-19 vaccine and the seasonal influenza vaccine? |
No similarity |
225 (21.6) |
|
|
Small similarity |
193 (18.5) |
|
|
Similar, but I am not sure how much |
377 (36.1) |
|
|
There is a big similarity |
248 (23.8) |
|
Have you ever been vaccinated against COVID-19? |
Yes |
769 (73.8) |
|
|
No |
274 (26.2) |
|
Reason for non-vaccination against COVID-19 |
The vaccine is safe and effective, but I would
prefer to depend on my innate immunity |
91 (8.7) |
|
|
Due to the cost of the vaccine |
14 (1.3) |
|
|
Fear of vaccination due to weakened immune
system, it is not safe and could be lethal |
62 (5.9) |
|
|
I believe the vaccine is not effective |
68 (6.5) |
|
|
I believe there is no such thing called COVID-19,
so I don’t need to take any vaccines |
28 (2.7) |
|
|
The vaccine is not available in my area |
11 (1.1) |
|
Do you know people who are not willing to get
vaccinated? |
Yes |
641(61.5) |
|
|
No |
402 (38.5) |
|
Do you recommend for those who are not willing
the vaccination to get vaccinated? |
Yes |
796 (76.3) |
|
|
No |
247 (23.7) |
|
Who recommends you get the COVID-19 vaccine? |
I decided myself to get vaccinated |
641 (59.5) |
|
|
Family member or friend |
174 (16.2) |
|
|
Govt. policy to get vaccinated |
40 (3.7) |
|
|
A physician or other medical professional |
85 (7.9) |
|
|
Social media or TV |
137 (12.7) |
|
In your opinion, which of the following has the
priority to receive the COVID-19 vaccine? |
18 years old or younger |
25 (2.3) |
|
|
People older than 65 years |
145 (13.5) |
|
|
Healthcare providers in direct contact with
patients |
391 (36.3) |
|
|
All of the above |
484 (44.9) |
|
|
None |
32 (3.0) |
Correlation of demographics
with medication recommendation, influenza and COVID-19 vaccination
Table 6 displays the
correlation between demographic factors (gender, age, education, occupation,
and residence) and various vaccination-related variables, including the
recommendation of medication as COVID-19 prophylaxis, seasonal influenza
vaccination, COVID-19 vaccination status, and willingness to receive the
COVID-19 vaccine. Although some correlations are statistically significant, the
small magnitude of the correlation coefficients (close to zero) suggests that
these associations are weak and may not be practically meaningful.
Table 6. Correlation of demographics with medication recommendation and
influenza and COVID-19 vaccination.
|
Variables |
|
Gender |
Age |
Education |
Occupation |
Residence |
|
Recommendation of medication as prophylaxis to
COVID -19 to other |
Pearson Correlation |
0.063* |
-0.004 |
0.045 |
0.050 |
0.012 |
|
|
Sig. (2-tailed) |
0.043 |
0.902 |
0.143 |
0.110 |
0.700 |
|
|
N |
1043 |
1043 |
1043 |
1043 |
1043 |
|
Have you ever been vaccinated against seasonal influenza? |
Pearson Correlation |
0.011 |
-0.017 |
0.020 |
0.051 |
0.011 |
|
|
Sig. (2-tailed) |
0.717 |
0.588 |
0.515 |
0.103 |
0.713 |
|
|
N |
1043 |
1043 |
1043 |
1043 |
1043 |
|
Have you ever been vaccinated against COVID-19
pandemic? |
Pearson Correlation |
-0.038 |
0.003 |
-0.026 |
0.069* |
0.000 |
|
|
Sig. (2-tailed) |
0.221 |
0.926 |
0.394 |
0.026 |
0.991 |
|
|
N |
1043 |
1043 |
1043 |
1043 |
1043 |
|
If not, are you willing to get COVID-19 vaccine? |
Pearson Correlation |
0.055 |
-0.034 |
-0.032 |
0.047 |
-0.064 |
|
|
Sig. (2-tailed) |
0.184 |
0.418 |
0.436 |
0.256 |
0.122 |
|
|
N |
581 |
581 |
581 |
581 |
581 |
|
**Correlation is significant at the 0.01 level
(2-tailed) |
||||||
|
*Correlation is significant at the 0.05 level
(2-tailed) |
||||||
Discussion
Understanding the public perception of COVID-19 is crucial for effective
public health management, policymaking, communication, and addressing the
social and economic impacts of the pandemic. It can influence public health
outcomes by affecting peoples’ adherence to preventive measures, such as
wearing masks, social distancing, and vaccination. It can also impact
policymaking decisions and help policymakers develop appropriate responses to
address the social and economic impacts of the pandemic.
Since the beginning of the COVID-19 pandemic, several studies have
examined the public’s perception of the outbreak in Pakistan from various
perspectives. For instance, Khyzar Hayat et al.
conducted a rapid online survey within 2 weeks of the outbreak to assess the public’s
general knowledge about it in different areas of Pakistan;(2) in
addition to studies conducted by other authors.(3,4,5,6) Muhammad
Junaid Tahir et al.(7) have investigated the attitudes of the
Pakistani population toward COVID-19 vaccination. This research aimed to provide
a comprehensive understanding of the Pakistani public’s perception of COVID-19
and the impact of education on their perception of the pandemic.
Concerning sample distribution in this study, age is a critical factor,
as it may influence participant’s level of knowledge and cognitive abilities;
therefore, our findings confirmed the intimate link between age and knowledge,
corroborating the findings of previous studies.(4,8,9)
Furthermore, the large proportion of educated participants in this study
suggests
a potential correlation between higher levels of education, and improved
perception and knowledge of COVID-19. Educated individuals are likely to have
higher critical thinking and access to information resources, resulting in greater
awareness, comprehension of health hazards and preventive measures.(10)
Additionally, the fact that the overwhelming majority of the participants
resided in urban areas suggests that their experience and perception may differ
from those living in rural areas. Moreover, individuals with a higher
socioeconomic status were found to possess greater knowledge about the
diseases, display optimistic attitudes, and engage in reasonable practices to
prevent their spread.(19) Interestingly,
no significant association was observed between gender and perception,
susceptibility to complications, and relationship with influenza, which is
opposite to what was mentioned by Hayat et al.(2) These findings
suggest that gender may not significantly determine an individual’s knowledge
and attitudes about COVID-19. However, further research is needed to explore
other potential factors that may influence individuals’ perceptions and
behaviors related to the disease, especially in cities where females have no
right to pursue their high education unless under special circumstances.
Since the onset of the
COVID-19 pandemic, numerous hypotheses have emerged regarding its origin. Of
particular interest is the contention that SARS-CoV-2 virus was laboratory еnginееrеd as part of an effort to
produce an acquired immunodeficiency syndrome (AIDS) vaccine. In contrast, the
belief that COVID-19 has a bacterial origin, despite its acronym indicating a
viral origin, suggests that a substantial portion of the population still lacks
awareness about the COVID-19 acronym and its corresponding meaning. The
COVID-19 pandemic has also been approached through a religious lens.(12) Since Pakistan has a
predominantly Muslim population, participants were queried about their
perspective on whether COVID-19 represents a divine punishment. Half of the
participants (48.9%) affirmed that they believed COVID-19 to be a punishment
from God. This outcome highlights the importance of spirituality in Pakistan.
Furthermore, almost half of
the participants (49.6%) believed the virus may have been transmitted to humans
from an animal host. This perspective is supported by scientific evidence
indicating that bats serve as the primary reservoir hosts of SARS-CoV-2.(13) However, it does not
necessarily suggest that COVID-19 can directly transmit to humans from animals,
particularly bats. Similarly, a significant proportion (55.9%) believed that
COVID-19 is nothing more than a toxic gas that solely affects the respiratory
system rather than a microbial organism. These findings imply that a lack of
adequate medical knowledge may impair the public’s capacity to comprehend
scientific news or that the scientific reports presented on social media may
not be sufficiently comprehensible for general publicity.
Despite the global prevalence
of the COVID-19 globally, a significant majority of the participants (75.3%)
believed COVID-19 could be fatal. Nevertheless, a minority (33.9%) believed it
was not an excessively severe life-threatening affliction. These outcomes
suggest that despite the high global mortality rate, many individuals may lack
awareness of the fatal effect of COVID-19 or express skepticism regarding the
reliability of global health authorities and statistical data. All together
suggests that knowledge promotion could contribute to the relative success of
future public health measures enforced in Pakistan.
This research also assessed
participants’ knowledge of COVID-19 disease susceptibility. Based on the
results, it is suggested that participants have linked the severity and
life-threatening consequences of COVID-19 with elderly individuals, possibly
due to their perception of the higher vulnerability of this population group.
This perception is consistent with previous studies that have reported higher
susceptibility to COVID-19 in older adults,(15)
pregnant women,(16) or those with chronic co-morbidities,(20)
including cancer and transplantation patients.(17) However, it is
important to note that COVID-19 can affect individuals of all ages,(21) and
younger individuals can also experience severe symptoms and complications, in
particular, mentally and financially.(22) This highlights the need
for continued public health efforts to promote accurate information about
COVID-19 susceptibility, effective prevention measures, and treatments,
particularly among those who may be less informed or have limited access to
information. By raising awareness about the potential risks of COVID-19 for all
age groups and providing accurate information about prevention and treatment, public
health officials can help to mitigate the spread of the disease and reduce the
incidence of severe complications.
Regarding prophylaxis
and preventive measures against COVID-19, most participants showed an
acceptable understanding with high adherence to preventive measures, including
using masks and hand sanitizers to minimize the risk of infection. In contrast,
exceeding half of the participants have used or recommended specific
medications such as antibiotics and chloroquine or suggested self-protection,
despite the lack of evidence to support these claims, indicating a potential
lack of awareness about the risk and benefits of medications. The findings
obviously indicated the participants have mixed up the use of drugs for
prophylaxis or treatment purposes. This delusion led the participants to
recommend some prescription-required medications, such as antibiotics,
antiviral, anticoagulants, and steroids. Such drugs are intended for
prophylactic use and require specialized medical supervision. The misuse of
such medications can result in severe or even lethal consequences that could be
more harmful than the pandemic itself. These findings emphasize the critical
need to increase participants’ health education and improve their health
knowledge, especially regarding over-the-counter (OTC) medications and their
appropriate use. People must be educated that non-specialized individuals
should not recommend specific medications to others, and the general public
should be aware of the potential risks and benefits of medications and consult
medical professionals for guidance.
The results suggest that
people have a good understanding of the similarities between COVID-19 and
seasonal influenza. They also showed acceptable knowledge regarding the vaccine
priorities. These findings underscore the importance of targeted health
education campaigns to address vaccine hesitancy and improve public knowledge
about the benefits of COVID-19 vaccination.
Conclusions
The present study provides valuable insights into the perception of the
Pakistani public regarding various aspects of COVID-19; the findings highlight
the importance of continued public health efforts to promote and ensure access
to effective prevention measures, particularly in vulnerable populations who may
face barriers to obtaining protective equipment. The study also highlights the
critical demand for sustained public education initiatives that advocate
accurate knowledge about COVID-19 susceptibility, effective prevention
measures, and treatments, especially for less informed people or those with
limited information access. These outcomes will significantly implicate policy
development and health interventions that aim to improve the efficiency of
COVID-19 prevention measures in public.
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Conflict of interest
The authors declare that
there is no conflict of interest.
Author’s
contributions
Moath Refat:
conceptualization, investigation, original drafting, drafting-revising,
editing.
Sundus Shukar:
conceptualization, methodology, investigation, original drafting,
drafting-revising.
Iltaf Hussain:
conceptualization, methodology, formal analysis, data curation, original
drafting, drafting-revising.
Ahmed Ibrahim Mohamed: conceptualization and methodology.
All authors have revised and approved the final manuscript before
submission. Moath Refat, Sundus
Shukar, Iltaf Hussain contributed
equally to this work.
* MSc. in
Pharmacy. Researcher at the Health Science Center at Xi’an Jiaotong
University. Xi’an, China.