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https://www.inosr.net/inosr-experimental-sciences/
147
Niwampeire
INOSR Experimental Sciences 12(2):147-157, 2023.
©INOSR PUBLICATIONS
International Network Organization for Scientific Research ISSN:2705-1692
https://doi.org/10.59298/INOSRES/2023/2.11.1000
Ugandan Pregnant and New Mothers’ Perceptions, Knowledge, and
Information Sources on COVID-19 at Jinja Regional Referral Hospital
Niwampeire Maria Prima
Department of Medicine and Surgery, Kampala International University, Uganda
ABSTRACT
COVID-19, caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), has
posed a global challenge since December 2019. This study aimed to explore risk
perceptions, knowledge, and information sources among prenatal and postnatal women at
Jinja Regional Referral Hospital (JRRH) – a group particularly vulnerable to the pandemic's
impact. Using a cross-sectional approach, 209 women were surveyed, employing a thematic
questionnaire. Data analysis involved coding and input into Epi Info version 7, then
exported to SPSS version 22.0 for analysis. Descriptive statistics summarized variables:
numerical data as means and standard deviations, and categorical data as frequencies and
proportions. Chi-square tests assessed associations between variables, with inferential
statistics exploring relationships among study variables. Statistical Package for the Social
Sciences version 26.0 conducted all analyses, with significance set at α = 0.05. Prenatal and
postnatal women at JRRH perceived a lower risk of contracting or succumbing to COVID-19
compared to influenza, yet many expressed concerns about potential COVID-19 infection.
Overall, participants demonstrated adequate knowledge about the disease. Their primary
information sources were doctors, nurses/midwives, and television, which they regarded
highly. Notably, there was no significant relationship found between perceived risk of
contracting COVID-19 and knowledge levels. These findings offer insights to healthcare
*adequate knowledge, participants had misconceptions regarding some World Health
Organization recommendations. Addressing these misunderstandings is crucial in
improving preventive practices among this vulnerable demographic.
Keywords: coronavirus disease, risk perceptions, knowledge, women
INTRODUCTION
Coronavirus disease 2019 (COVID-19) is
caused by Severe Acute Respiratory
Syndrome Coronavirus two (SARS-CoV-2),
a newly emergent coronavirus, that was
first recognized in Wuhan, China, in
December 2019. Genetic sequencing of
the virus suggests that it is a beta
coronavirus closely linked to the SARS
virus [1-6].
Epidemiology and virologic studies
suggest that transmission mainly occurs
from symptomatic people to others by
close contact through respiratory
droplets, by direct contact with infected
persons, or by contact with contaminated
objects and surfaces. Clinical and
virologic studies that have collected
repeated biological samples from
confirmed patients demonstrate that
shedding of SARS-CoV-2 is highest in the
upper respiratory tract (URT) (nose and
throat) early in the course of the disease,
within the first 3 days from onset of
symptoms. The incubation period for
COVID-19, which is the time between
exposure to the virus (becoming infected)
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148
and symptom onset, is, on average, 5–6
days, but can be up to 14 days. During
this period, also known as the
“presymptomatic” period, some infected
persons can be contagious, from 1–3 days
before symptom onset [7-14].
All countries have been challenged by the
novel coronavirus, but they have not all
fared the same. Early scenarios of the
COVID-19 pandemic often depicted waves,
including a possible second wave in late
2020. By the end of August, countries
around the globe had reported over 25
million cases, with nearly 850,000 deaths
attributed to the disease [15-19].
Since the outbreak of the novel
coronavirus disease (COVID-19), which
was first reported in Wuhan, China, on
December 31, 2019, there has been a
steep increase in the numbers of
confirmed cases, deaths, and affected
countries. According to the World Health
Organisation (WHO), it took more than
three months to reach the first 100,000
confirmed cases, 12 days to reach the
next 100,000cases, 4 days to reach
300,000 cases, and only 3 days to reach
400,000 cases [20-22].
Uganda implemented a range of actions
and policies to manage the situation,
which one of them was closing all
institutions of learning. With the
resumptions of final year students, it’s
prudent that the knowledge, attitude and
practices towards COVID-19 is known,
hence this study.
The strategies established worldwide to
reduce the transmission are mostly
behavioral (e.g., social distancing, regular
washing of hands), largely depending on
rapid change in behavior, which relies on
one’s knowledge about the problem,
ability to perceive the risk, and
willingness to change their attitude [23].
Since the outbreak of the novel
coronavirus disease (COVID-19), which
was first reported in Wuhan, China, on
December 31, 2019, there has been a
steep increase in the numbers of
confirmed cases, deaths, and affected
countries. According to the World Health
Organisation (WHO), it took more than
three months to reach the first 100,000
confirmed cases, 12 days to reach the
next 100,000cases, 4 days to reach
300,000 cases, and only 3 days to reach
400,000 cases [24].
METHODOLOGY
Study design
The study used a cross-sectional
descriptive study design where
quantitative approaches were applied to
obtain data that suites the objectives of
the study.
Study site
The study was conducted at Jinja Regional
Referral Hospital located in the newly
created Jinja City in Jinja district.
Study population
The study comprised of prenatal and
postnatal women attending JRRH at the
time of data collection.
Inclusion criteria
All pregnant women of 16 weeks
gestation or at JRRH that who
consented to take part in the
study.
All mothers with infants 6 weeks
old and below at JRRH that
consented to take part in the
study.
Exclusion criteria
Women or mothers that were
admitted for a different reason
other than nursing a child,
antenatal care or delivery.
Women or mothers perceived not
to be coherent.
Sample size determination
Fisher’s formula was used to determine
the sample size.
n=z21-α/2× p (1-p) [25]
d2
N=Minimum sample size.
α=Level of significance (0.05).
Z1-α/2= Standard normal deviate at 95%,
confidence interval (1.96).
P= Proportion in the target population
with specific characteristic [14.5% pre and
post natal women with adequate
knowledge on infections [26]
d=Absolute precision (Error margin),
(0.05).
Therefore n=1.962 × (0.47) (0.53)/0.052
n=190
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149
The minimum required sample size was
190. However, allowing for 10% non-
response the sample size was adjusted
upwards to 209.
Sampling Procedure
The study site of Jinja Hospital was
purposively selected because of its
identification it’s the biggest referral
hospital in the eastern region, and the
study subjects were sampled by simple
random sampling.
Data analysis
Questionnaire tools were checked for
their accuracy and data completeness,
then data was coded and entered into Epi
info version 7, then exported into SPSS
version 22.0 for analysis. Descriptive
statistics was used to summarize the
variables. Numerical data was
summarized as means and standard
deviations. Categorical data was
summarized as frequencies and
proportions. Associations between
independent variables and dependent
variables were assessed using chi-square
test. Inferential statistical analyses
(correlation analysis, t-test, and chi-
squared analysis) were conducted to
examine group differences and
relationships among the study variables.
All statistical analyses were conducted
using Statistical Package for the Social
Sciences version 26.0. The level of
significance was set as α = 0.05
Ethical considerations
Approval to conduct this study was
obtained from KIU – Western campus
Faculty of Clinical Medicine & Dentistry
and JRRH hospital administration. The
respondents will only participate in the
study upon informed consent and they
will be allowed the freedom to refuse to
take part at any time.
RESULTS
Among the 209 women that participated
in the study, majority 82.2% were
pregnant at the time of data collection,
and the rest had given birth within the
past six weeks. Their mean age was 29.55
±3.82 years (range = 21–39). Almost all of
them reported that they had not
experienced any complications during
pregnancy (91.8%) or chronic diseases
before pregnancy (94.5%). Most of them
held had attained a secondary education
(79.6%) and were living in a rural setting
72.5%. Regarding their occupations,
majority were peasant farmers 51.4% as
shown in Table 1 and Figure 2.
Table 1: Distribution of Sociodemographic Characteristics of prenatal and postnatal
women attending JRRH
Variable
Category
Frequency
(N=209)
Percentage
(%)
Obstetric status
Pregnant
172
82.2
postpartum
37
17.8
Age (years)
< 20
19
9.1
20 - 30
102
48.8
31 - 40
87
41.6
>40
1
0.5
Educational level
None
7
3.2
Primary
24
11.5
Secondary
166
79.6
Tertiary
12
5.7
Occupation
None
31
14.4
Peasant Farmer
107
51.4
Business
58
27.7
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150
Employed
(self/civil)
13
6.5
Place of usual residence
Rural
151
72.5
Town
57
27.7
Experience of complications during
pregnancy
Yes
17
8.2
No
192
91.8
Presence of chronic diseases prior to
pregnancy were assessed
Yes
11
5.5
No
198
94.5
Figure 2: Column bar graph showing Socio-demographic characteristics of prenatal and
postnatal women attending JRRH
The total perceived risk scores ranged
from 8 to 32 (Mean = 18.24, SD = 5.48).
The perceived risk by prenatal and
postnatal women attending JRRH of
contracting COVID-19 was lower than the
perceived risk of contracting influenza
and H1N1 infection but higher than the
perceived risk of experiencing other
adverse events (e.g., accidents, food
poisoning, cancer, and heart attack) as
shown in Table 2 and Figure 3.
0
50
100
150
200
250
Sociodemographic characteristics of prenatal postnatal women attending
JRRH
Frequency (N=209) Percentage (%)
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Table 2: Perceived risk of contracting COVID – 19 among prenatal and postnatal women
attending JRRH
Item
Mea
n
Very
unlikely
(%)
Unlikel
y (%)
Neutral
(%)
Likel
y (%)
Very
likely
(%)
Influenza
3.32
8.6
7.3
45.7
31.3
7.3
H1N1
2.42
18.7
31.3
41.3
8.7
0
COVID-19
2.34
18.4
28.9
45.4
6.6
0.7
Traffic
accident
2.21
27.3
27.3
43.3
2.0
0
Home
accident
2.16
28.7
28.7
40.7
2.0
0
Food
poisoning
2.12
28.7
34.7
34.0
2.7
0
Cancer
2.04
32.9
34.9
29.5
2.7
0
Heart attack
1.89
40.0
32.7
26.0
1.3
0
Figure 3: Stacked bar graph showing perceived risk of contracting COVID – 19 among
prenatal and postnatal women attending JRRH
The perceived risk of dying from COVID-
19 was lower than the perceived risk of
dying from influenza but higher than the
perceived risk of dying from other
adverse events as shown in Table 2. In
addition, 37.7% of the women reported
that they were worried about contracting
COVID-19 whereas 45.7% of them were
concerned about their family members
contracting COVID-19. Further, more than
half of them were worried about the
spread of COVID-19 to the areas in which
they resided as shown in Table 3 and
Figure 4.
020 40 60 80 100 120
Influenza
H1N1
COVID-19
Traffic accident
Home accident
Food poisoning
Cancer
Heart attack
Perceived risk of contracting COVID-19 among pre and postnatal women
attending JRRH
Mean Very unlikely (%) Unlikely (%) Neutral (%) Likely (%) Very likely (%)
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Table 3: Perceived risk of death due to COVID-19 and other adverse events among
prenatal and postnatal women attending JRRH
Item
Mea
n
Very
unlikely
(%)
Unlike
ly (%)
Neutr
al (%)
Likel
y (%)
Very
likely
(%)
Influenza
2.01
39.6
29.5
22.8
6.7
1.3
COVID-19
1.99
35.3
33.3
28.7
2.7
0
Traffic
accident
1.98
36.5
31.3
29.7
2.7
0
Home accident
1.96
37.8
31.8
27.7
2.0
0.7
H1N1
1.93
37.2
35.1
25.7
2.0
0
Food
poisoning
1.91
38.5
34.5
25.0
2.0
0
Cancer
1.84
42.6
32.4
23.6
1.4
0
Heart attack
1.78
45.3
33.1
20.3
1.4
0
Figure 4: Radar chart showing perceived risk of death due to COVID-19 and other adverse
events among prenatal and postnatal women attending JRRH
The rate at which correct answers were
provided to the 17 items that assessed
knowledge about COVID-19 among
prenatal and postnatal women attending
JRRH was 76.4%. The total scores ranged
from 15 to 33 (Mean = 25.99, SD = 3.75).
The rate at which correct answers were
provided to the four items that pertained
specifically to pregnancy was 77.5%
0
10
20
30
40
50
Influenza
COVID-19
Traffic accident
Home accident
H1N1
Food poisoning
Cancer
Heart attack
Perceived risk of death from COVID-19 by pre and postnatal
women attending JRRH
Mean Very unlikely (%) Unlikely (%)
Neutral (%) Likely (%) Very likely (%)
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(range = 3–8, Mean = 6.20, SD = 1.05) as shown in Table 4.
Table 4: Knowledge about COVID-19 among prenatal and postnatal women attending
JRRH
Item
Yes
No
Not
sure
(%)
(%)
(%)
If you are healthy, you need to wear a mask only if you are taking care of a
person with suspected COVID-19.
9.1
90.9a
0
You should wear a mask if you have been coughing or sneezing
82.3a
14.5
3.2
Masks are effective only when you frequently clean your hands with alcohol-
based hand sanitiser or soap and water.
47.6a
46.8
5.6
Before wearing a mask, you should clean your hands with alcohol-based
hand sanitiser or soap and water
99.2a
0.8
0
You should cover your mouth and nose with a mask and make sure that
there are no gaps between your face and the mask
97.6a
1.6
0.8
You should avoid touching the mask while using it; if you do end up
touching the mask, you should clean your hands with alcohol-based hand
sanitiser or soap and water
98.4a
1.6
0
You should replace a mask with a new one as soon as it becomes damp, and
you should not reuse single-use masks.
98.4a
0.8
0.8
You should remove the mask from behind (i.e., you should not touch the
front of mask).
27.4
2.4
0
You should immediately discard the used mask in a closed bin and clean
your hands with alcohol-based hand sanitiser or soap and water.
29.8
52.4a
0
Ultraviolet lamps should be used to sterilize hands or other areas of the
skin.
34.7
52.4a
17.7
Thermal scanners can detect those who have not developed a fever
27.4
52.4a
12.9
Spraying alcohol or chlorine all over your body will kill the novel
coronavirus
26.6a
58.9a
13.7
It is safe to receive a letter or package from China
19.4
50.0
23.4
Pets (dogs or cats) can spread COVID-19
8.9
45.2a
35.5
Vaccines against pneumonia can protect you from COVID-19
3.2
74.2a
16.9
Eating garlic can protect you from COVID-19.
13.7
81.5a
15.3
Antibiotics are effective in preventing and treating COVID-19
12.1
54.0a
32.3
Currently, there are specific medicines that can be used to prevent or treat
COVID-19
39.5
58.9a
29.0
The vertical transmission of COVID-19 from a pregnant woman to her foetus
has been confirmed
83.1a
18.5a
41.9
Pregnant women are more susceptible to COVID-19 than the general
population
85.5a
4.0
12.9
Pregnant women are more susceptible to COVID-19 than the general
population
3.2a
4.8
9.7
The neonates of pregnant women with suspected or confirmed COVID-19
should be isolated in a designated unit for at least 14 days after birth
31.5
52.9a
24.0
Women with suspected or confirmed COVID-19 can breastfeed their
neonates.
8.9
45.2a
35.5
a correct response
The three major sources from which
prenatal and postnatal women attending
JRRH obtained information about COVID-
19 were physicians (Mean = 4.22),
nurses/midwives (Mean = 4.15), and the
television (Mean = 4.14). Their level of
confidence in these three sources was
also higher than their level of confidence
in other information sources as shown in
Table 5.
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2
Table 5: Mean reliance and confidence scores for different sources of information
about COVID-19
Source
Reliance
Confidence
Score (1 – 5)
Score (1 – 5)
Physicians
4.22
4.22
Nurses/midwives
4.15
4.14
Radio
4.14
4.14
Television
3.84
3.85
Facebook
3.52
3.56
Internet
3.48
3.49
Family and friends
3.45
3.49
Whatsapp
3.30
3.41
DISCUSSION
The study has been able to establish that
nearly half of the pre and postnatal
women (47.3%) at JRRH considered it
unlikely or very unlikely that they would
contract COVID-19 disease. This shows
that pre and postnatal women at JRRH
consider the disease that has ravaged the
world quite more lightly. This finding is
inconsistent with the statistics that have
been reported for Hong Kong; specifically,
88% of the participants believed that they
were at risk of contracting the disease
[27].
The study observes that pre and postnatal
women at JRRH perceived their risk of
contracting influenza to be greater than
their risk of contracting COVID-19 as
evidenced by the study results. This
perceived risk of the women is not
farfetched, as its corroborated by a recent
Centers for Disease Control and
Prevention (CDC) report that there have
been 9–45 million infected cases,
140,000–810,000 hospitalizations, and
12,000–61,000 deaths annually since 2010
[28]. Results from this study show that
almost 3 times as many women at JRRH
believed that they were likely or very
likely to die from influenza than from
COVID-19 thus demonstrating that their
beliefs reflected the true statistics as
published by the CDC.
Pre and postnatal women at JRRH
returned possessed relatively high scores
that depict high levels of knowledge
about COVID-19 (rate of correct
responding: 76.4%).
Although the pre and postnatal women at
JRRH possessed adequate knowledge
about COVID-19, they did not provide the
correct answers to several items. For
example, only 47.6% of them were aware
that masks are effective only when the
wearer also frequently cleans his or her
hands with alcohol-based hand sanitiser
or soap and water. Similarly, 29.8% of
them were unaware that ultraviolet lamps
should not be used to sterilise hands or
other areas of the skin. Moreover, 34.7%
of them did not know that thermal
scanners cannot detect individuals who
have not developed a fever. Furthermore,
many women were unsure about the
effectiveness of antibiotics in preventing
and treating COVID-19 and the existence
of specific medicines that can be used to
prevent or treat this disease.
Nevertheless, many participants were
unsure about the possibility of the
vertical transmission of COVID-19, and
81.3% of them believed that pregnant
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women are more susceptible to COVID-19
than the general population. The
literature on the effects of COVID-19 on
pregnant women and their children is
limited. The CDC in the US reported that
severe acute respiratory syndrome
coronavirus 2 was not found in the
amniotic fluid, placenta, or breast milk of
pregnant women with COVID-19 whom
they had tested and that their babies had
not contracted the disease [29].
In addition, there is insufficient evidence
to support the claim that pregnant women
are at a greater risk of contracting COVID-
19 than the general public. Further, there
is a lack of empirical evidence regarding
the possibility of the trans-placental
transmission of COVID-19 from mothers
to foetuses. In one study, women who had
contracted COVID-19 during their third
trimester experienced only mild
symptoms. However, COVID-19 is a novel
viral infection, and much remains
unknown about its impact on pregnancy;
therefore, further investigation is needed
[29].
Pre and postnatal women at JRRH
obtained information about COVID-19
from various sources. However, fewer
women relied on social media, family
members, and friends for information,
and they placed lower levels of
confidence in these sources. Physicians,
nurses/midwives, and the television were
the sources upon which they most
frequently relied, and they placed greater
confidence in them. It is not surprising
that the preferred source of information
about COVID-19 was doctors and that
their confidence in doctors ranked the
highest among the various sources of
information.
CONCLUSION
Prenatal and postnatal women attending
JRRH perceived their risk of contracting
COVID-19 to be higher than their risk of
contracting other health conditions except
influenza. They were worried that they or
their family members might contract
COVID-19. They possessed adequate
knowledge about COVID-19. Doctors,
nurses, and the television were the three
major sources from which they obtained
information about COVID-19, and they
placed high levels of confidence in these
sources.
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