E-ISSN:2349-4166
P-ISSN:2349-4158

Research Article

Face mask

Public Health Review - International Journal of Public Health Research

2021 Volume 8 Number 5 September October
Publisherwww.medresearch.in

Face mask usage during COVID-19 pandemic in rural population of Madhya Pradesh: A knowledge, attitude and practice study

Kawanpure H.1*, Gandhe M.2
DOI: https://doi.org/10.17511/ijphr.2021.i05.03

1* Harshal Kawanpure, Associate Professor, Department of Community Medicine, Peoples College of Medical Sciences and Research Centre, Bhopal, MP, India.

2 Mahendra Gandhe, Professor and Head, Department of Biochemistry, Chhindwara Institute of Medical Sciences, Chhindwara, MP, India.

Introduction: A face mask is a perfect tool to control the spread of COVID-19 infection. The knowledge, attitudes and practices toward the use of face masks will be helpful to understand society's readiness to accept and follow preventive guidelines from the health authorities. Baseline information collected in this study can be used for the implementation of the COVID-19 control programme. Hence, this study was conducted. Material and methods: This is a cross-sectional study conducted in a rural area of Madhyapradesh. House to house survey was completed to collect the information on knowledge, attitude and practice regarding face masks. Result: Out of 400 participants, 318 (79.5%) participants know that COVID-19 can be transmitted by respiratory droplet and 253(63.3%) participants know that COVID-19 can be sent by contact route. Total 349(87.3%) participants responded that wearing a face mask can prevent COVID-19 transmission. Maximum participants know about cloth masks, i.e. 367(91.8%) and surgical masks, i.e.277 (69.3%). Conclusions: Maximum participants learn various types of face masks, and they also know that they can prevent COVID-19 disease. Maximum participants had a positive attitude towards wearing a face mask at crowded places. One crucial finding came out that some participants had shared their face masks with other people. Maximum participants had motivated their family members for wearing a face mask. IEC activities can be conducted by a health worker in a rural area on proper use, proper disposal and storage of face masks.

Keywords: Face mask use, COVID-19 pandemic

Corresponding Author How to Cite this Article To Browse
Harshal Kawanpure, Associate Professor, Department of Community Medicine, Peoples College of Medical Sciences and Research Centre, Bhopal, MP, India.
Email: 		Harshal Kawanpure, Mahendra Gandhe, Face mask usage during COVID-19 pandemic in rural population of Madhya Pradesh: A knowledge, attitude and practice study. Public Health Rev Int J Public Health Res. 2021;8(5):78-85.
Available From
https://publichealth.medresearch.in/index.php/ijphr/article/view/171

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2021-09-04 2021-09-06 2021-09-13 2021-09-20 2021-09-27
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
Nil Nil Yes 16%

© 2021by Harshal Kawanpure, Mahendra Gandheand Published by Siddharth Health Research and Social Welfare Society. This is an Open Access article licensed under a Creative Commons Attribution 4.0 International License https://creativecommons.org/licenses/by/4.0/ unported [CC BY 4.0].

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Kawanpure H et al: Face mask usage during COVID-19 pandemic in rural population of MP

Introduction

Coronavirus Disease 2019 (COVID-19) is a respiratory disease caused by the SARS-CoV-2 virus, and on March 11, 2020, the World Health Organization (WHO) declared COVID-19 a pandemic. [1]. The incubation period of covid 19 is 2 to 14days, during which all infected patients can transmit the disease to a non-infected person.[1]. For prevention of COVID-19 spread, the public is required to follow some infection control practices [2]. and these include community-based measures such as self-isolation, use of alcohol-based hand sanitizer or hand-washing with soap, restriction of movements with lockdown measures, sanitization of surfaces and use of non-medical cloth mask or face covering. [3, 4]. The use of a face mask is a perfect tool to control the spread of COVID-19 infection. The main benefit of wearing a face mask is to reduce the amount of Coronavirus (or Influenza virus) being released to the environment by those with the infection, thereby reducing its spread through droplets. [2]. There are different types of face masks in use by the community, including N95, N99, surgical masks and cloth masks. [7]. The WHO states that incorrect use and disposal of face masks can increase the rate of transmission.[2]. Studies on knowledge, attitude and practices about measures to prevent the spread of the COVID-19 pandemic have reported a nonlinear relationship between the knowledge and practice of using face masks to prevent the spread of COVID-19 among different categories of participants. [6, 8, 9]. The knowledge, attitudes and practices toward the use of face masks will be useful to understand society's readiness to accept and follow preventive guidelines from the health authorities. This baseline information may be helpful to determine the type of intervention needed for the implementation of the COVID-19 control programme. [10,11]. Hence, this study was conducted to investigate the knowledge, attitude and practices in the rural population regarding the usage of face masks during the COVID-19 pandemic to limit the spread of the coronavirus disease.

Material and methods

This is a cross-sectional study conducted in a rural area of Madhyapradesh. House to house survey was conducted to collect information on knowledge, attitude and practice regarding the use of face

masks. Information was collected through a preformed questionnaire. The study was a cross-sectional study and was conducted during the period of 01 August to 31 August 2021. Data was collected by simple random sampling technique by doing house to house survey. The sample size was calculated by formula 4PQ/L2, assuming a 50% prevalence of knowledge of the use of face masks and taking 5% allowable error. After calculation final sample size was 400. Inclusion criteria were the person in the age group of 18 years and above and those residing in a rural area of Madhyapradesh. Exclusion criteria were those below 18 years of age and not residing in rural areas. The data tool was performed questionnaire. No ethical issues were involved as the study was a cross-sectional study and only those participants were included who gave prior consent. To assess the knowledge of the participant score was given from 0-12. The highest score was 12 and the lowest score was 0. Data were entered in Microsoft excel and analyzed on SPSS version 25. Mann-Whitney test and Kruskal Wallis test were utilized to determine the differences between groups for selected demographic variables. The statistical significance level was set at P < 0.05.

Result

Demographic characteristics: Table 1 showing out of a total of 400 participants, the average age was 32.73 ± 13.40 years (range 18-71 years).  222 (55.5%) were male and 178(44.5%) were female. Out of a total of 400(100%), participants the majority of them belongs to the younger age group (18-27 years) i.e. 186(46.5%) shown in figure 1. Out of total 355 (88.8%) were Hindu and 45(11.3%) were Muslim by religion. The majority of the participants have taken education up to primary school i.e 158(39.5%). The majority of the participants belong to socioeconomic status class 4 i.e.193 (48.3%) and class 5 i.e. 141(35.3%) according to the modified BG Prasad scale 2021 shown in figure 2. The majority of participants were housewives 116(29.0%) by occupation followed by 80(20.0%) who had business which is shown in figure 3.

Assessment of Knowledge: A total of seven questions were used to measure knowledge on mask usage during the COVID-19 pandemic. A score of 1 is given for the correct answer. The maximum score was 12 and the minimum was 0.


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Table 1: Demographic characteristics of participants.

Variable Frequency Percentage
Sample size 400 100.00
Age groups in years    
18-27 186 46.5
28-37 88 22.0
38-47 58 14.5
>48 68 17.0
Gender    
Male 222 55.5
Female 178 44.5
Marital status    
Single 131 32.8
Married 269 67.3
Religion    
Hindu 355 88.8
Muslim 45 11.3
Education level    
Illiterate 49 12.3
Primary 158 39.5
Secondary 86 21.5
Preuniversity 62 15.5
Graduate 40 10.0
Postgraduate 5 1.3
Occupation    
Student 74 18.5
Business 80 20.0
Labour 20 5.0
Farmer 75 18.8
Housewife 116 29.0
Unemployed 35 8.8
Socioeconomic status    
Class 1(Upper class) 10 2.5
Class 2(Upper middle class) 33 8.3
Class 3(Middle class) 23 5.8
Class 4(Lower middle class) 193 48.3
Class 5(Lower class) 141 35.3

public_171_01.JPG

Table 2 shows the total of 318 (79.5%) participants who knew that COVID-19 can be transmitted by

respiratory droplet and 253(63.3%) participants knew that COVID-19 can be transmitted by contact route. Total 349(87.3%) participants responded that wearing a face mask can prevent COVID-19 transmission. Maximum participants knew about cloth masks i.e. 367(91.8%) and surgical masks i.e.277 (69.3%).

Table 2: Assessment of the knowledge.

Variable Frequency Percentage
Transmission by respiratory droplet    
Yes 318 79.5
No 82 20.5
Transmission by contact route    
Yes 253 63.3
No 147 36.8
Wearing a face mask can prevent COVID-19    
Yes 349 87.3
No 51 12.8
Know about cloth mask    
Yes 367 91.8
No 33 8.3
Know about the surgical mask    
Yes 277 69.3
No 123 30.8
Know about the N95 mask    
Yes 186 46.5
No 214 53.5
Know about the N99 mask    
Yes 58 14.5
No 342 85.5
Necessary to wear a face mask when you don't have COVID-19    
Yes 383 95.8
No 17 4.3
A cloth mask is effective as a surgical or N95 mask    
Yes 296 74.0
No 59 14.8
Do not know 45 11.3
Best face mask to protect from COVID-19    
Cloth face mask 135 33.8
Surgical mask 47 11.8
N95 mask 150 37.5
Do not know 68 17.0
A most important time to use a face mask    
At home 10 2.5
When talking to someone else 53 13.3
At crowded places 319 79.8
Do not know 18 4.5

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Only 186(46.5%) and 58(14.5%) participants knew about N95 and N99 face masks respectively (shown in table 2). Total 383(95.8%) participants think that it is necessary to wear a face mask when you don't have COVID-19. Total 15(37.5%) participants knew that the best face mask to protect from COVID-19 is N95. 319(79.8%) participants knew that the most important time to use a face mask is at crowded places (shown in table 2).

Table 3 shows, a comparison of total knowledge score with gender by applying the Mann Whitney test; it is found that the difference is statistically significant with a p-value of 0.003. Males are having better knowledge than females. When the total knowledge score is compared with religion by applying the Mann Whitney test, it is found that the difference is statistically significant with a p-value of 0.00. Hindus are having better knowledge than Muslims.

When the total knowledge score is compared with different classes of socioeconomic status by applying the Kruskal Wallis test which is shown in table 4, it is found that the difference is statistically significant with a p-value of 0.006 which is <0.05. Participants of classes 1and 2 had better knowledge than classes 4 and 5. When the total knowledge score is compared with the age group (shown in table 4) by applying the Kruskal Wallis test, it is found that the difference is statistically significant with a p-value of 0.00. The younger age group (18-27 years) is having better knowledge than the older age group (>48 years). When the total knowledge score is compared with different occupations by applying the Kruskal Wallis test, it is found that the difference is statistically significant with a p-value of 0.00. Students are having better knowledge than other participants. When the total knowledge score is compared with education by applying the Kruskal Wallis test, it is found that the difference is statistically significant with a p-value of 0.00. Graduates and postgraduates are having better knowledge than other participants.

Attitude: Table 5 shows a total of 359(89.8%) participants believe that wearing a face mask can protect them from COVID-19. Only 38(9.5%) participants shared their face masks with another person. Most of the participants 363(90.8%) believe that it is necessary to wear a face mask in this COVID-19 pandemic (shown in table 5). Maximum participants 337(84.3%) motivated their family members to wear a face mask whenever required.

Table 3: Comparison of gender and religion with knowledge.

Variable Frequency Mean score Mean Rank P-value
Gender        
Male 222 8.14 215.09 0.003
Female 178 7.42 182.30  
Religion        
Hindu 355 8.15 214.95 0.000
Muslim 45 5.22 86.50  

Table 4: Comparison of knowledge with demographic characteristics.

SES Frequency Mean score Mean Rank P value
Class 1 10 9.50 291.25 0.006
Class 2 33 9.00 240.36
Class 3 23 7.30 166.30
Class 4 193 7.82 202.99
Class 5 141 7.52 186.90
Total 400 7.82  
Age in years        
18-27 186 8.58 239.56 0.000
28-37 88 7.41 181.31
38-47 58 7.59 183.35
>48 68 6.49 133.12
  400 7.82  
Occupation        
Student 74 10.58 334.81 0.000
Business 80 8.08 209.59
Labour 20 6.25 105.38
Farmer 75 7.27 177.52
Housewife 116 6.90 158.98
Unemployed 35 6.57 136.96
Education        
Illiterate 49 5.33 93.43 0.000
Primary 158 6.82 149.08
Secondary 86 8.28 219.65
Preuniversity 62 9.58 291.14
Graduate 40 10.63 330.14
Postgraduate 5 12.00 384.50

Total 229(57.3%) were comfortable with a face mask when wearing it for a longer time (shown in table 5).

Practice: In table 6, it is shown that most of the participants 375(93.8%) were used face masks during the COVID-19 pandemic. 316(79.0%) participants had reused face masks. 134(33.5%) participants had reused face masks for 2-5 days followed by 112 (28.0%) had used for 6-10 days (shown in table 6). 284(71.0%) participants


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were used to washing their hands before wearing and after removing face masks. Most of the participants 128(32.0%) were used to hang face masks on a wooden hanger (khuti) after the use and 70(17.5%0 participants were used to store face masks in their pocket (shown in table 6). 260(65.0%) participants were used to dispose of face masks in dust bean after the use. But 86(21.5%) participants were used to dispose of face masks in open places and by dumping which is an unhygienic method of disposal (shown in table 6). 317(79.3%) participants had used Rumal/Gamacha/Dupatta when the face mask is not available with them.   

Table 5: Assessment of Attitude.

Variable Frequency Percentage
Believe that wearing a face mask can protect from COVID-19    
Agree 359 89.8
Disagree 41 10.3
Ever shared a face mask    
Yes 38 9.5
No 362 90.5
Believe that it is necessary to wear a face mask in this COVID-19 pandemic    
Yes 363 90.8
No 37 9.3
Motivated family member to wear a face mask    
Yes 337 84.3
No 63 15.8
Comfortable with a face mask when wearing for a longer time    
Yes 229 57.3
No 171 42.8

Table 6: Assessment of the practice.

Variable Frequency Percentage
Ever used the face mask    
Yes 375 93.8
No 25 6.3
Reused face mask    
Yes 316 79.0
No 84 21.0
Reused for how many days    
Not Reused face mask 84 21.0
<1 day 41 10.3
2-5 days 134 33.5
6-10 days 112 28.0
>10 days 29 7.3
Use to wash your hands before wearing and after
removing the face mask    
Yes 284 71.0
No 116 29.0
Storage of face mask    
Bag 35 8.8
Box 49 12.3
Khuti 128 32.0
Not Used mask 84 21.0
pocket 70 17.5
Table 34 8.5
Disposal of face mask    
Not used face mask 25 6.3
Dust bean 260 65.0
Dumping 86 21.5
Burning 29 7.3
Ever used Rumal/Gamacha/Dupatta when a face mask is not available    
Yes 317 79.3
No 83 20.8

Discussion

The majority of the 318 (79.5%) participants knew about transmission by respiratory and contact route. Similar findings were found by Sikakulya FK et al [13] with knowledge of respiratory route (56.9%) and contact route (39.6%) of transmission for the spread of COVID-19.  Total 349(87.3%) participants responded that wearing a face mask can prevent COVID-19 transmission, similar findings i.e (90.3%) seen in a study conducted by Sikakulya FK et al. [13]. Total 383(95.8%) participants think that it is necessary to wear a face mask when you don't have COVID-19. Similar findings (86.4%) can also be seen in a study conducted by Sikakulya FK et al. [13]. Total 15(37.5%) participants knew that the best face mask to protect from COVID-19 is N95, similar findings i.e (72.17%) seen in a study conducted by Sayare B et al. [12]. 319(79.8%) participants knew that the most important time to use a face mask is at crowded places, similar findings i.e (16.7%) seen in a study conducted by Sayare B et al [12].


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In this study, it is found that there is a significant difference in the knowledge of males and females, similar findings seen in a study conducted by Sayare B et al [12]. Lee et al [8]. and Hager et al [17]. Males are having better knowledge than females. Opposite findings were found in a study conducted by Agarwal Prachi et al [15]. females have better knowledge than males. When the total knowledge score is compared with religion, it is found that the difference is statistically significant with a p-value of 0.00. Hindus are having better knowledge than Muslims, similar findings seen in a study conducted by Sayare B et al [12].

In this study, we found that socioeconomic status is having a significant impact on knowledge, class 1 and 2 are having better knowledge as compared to classes 4 and 5. Similar findings are seen in a study conducted by Al Hanafi et al. [14] Younger age group (18-27 years) is having better knowledge than the older age group (>48 years). Most of the young people are actively involved with social media sites which are the reason for better knowledge. Students are having better knowledge than other participants. Graduates and postgraduates are having better knowledge than participants having education up to primary and secondary school. Similar findings were seen in a study conducted by Sayare B et al [12].  Lee et al [16].  and al Hanafi et al[14]. 

Total 359(89.8%) have a positive attitude that wearing a face mask can protect them from COVID-19. Similar findings were seen in a study conducted by Sayare B et al. [12]. 38(9.5%) participants have shared their face masks with another person which can transmit COVID-19 infection. Higher findings are seen in a study conducted by Sikakulya FK [13].  i.e 24% of participants had shared their face masks. In our study most of the participants were from lower socioeconomic status and lack of knowledge about transmission of COVID-19, this could be the reason for sharing the mask. Most of the participants 363(90.8%) believe that it is necessary to wear a face mask in this COVID-19 pandemic which is a good attitude towards preventing COVID-19 infection. Similar findings were seen in a study conducted by Sayare B et al [12].  Maximum participants 337(84.3%) had motivated their family members to wear a face mask whenever required. This kind of attitude is necessary to control COVID-19 spread among family members. Total 229(57.3%) were

comfortable with a face mask when wearing it for a longer time.

Most of the participants 375(93.8%) were used a face mask during the COVID-19 pandemic which is similar to the findings of Sikakulya FK [13]. 95.2% of participants had used a face mask. This is because of intensive IEC activities by health authorities and Govt. of India for the prevention of COVID-19. 316(79.0%) participants had reused face masks. Similar findings 55.8% had reused face masks seen in a study conducted by Sayare B et al [12]. In our study most of the participants were belong to a lower socioeconomic class and have lower education status, this could the reason for reusing masks. 134 (33.5%) participants had reused face masks for 2-5 days followed by 112 (28.0%) had used for 6-10 days. Most of the participants 284 (71.0%) were used to wash their hands before wearing and after removing face masks similar findings were seen in a study conducted by Sikakulya FK et al [13]. The remaining 29% of participants never washed their hands before wearing and after removing face masks. Lack of knowledge and ignorance could be the reason for this. Most of the participants 128(32.0%) were used to hang their face masks on a wooden hanger (khuti) after the use and 70(17.5%) participants were used to store face masks in their pocket. Storing face masks on wooden hangers and in the pocket can contaminate them by pathogenic microorganisms. These contaminated face masks can transmit a lot of infectious diseases. Most of the 260(65.0%) participants were used to dispose of face masks in dust bean after the use. But 86(21.5%) participants were used to dispose of face masks in open places and by dumping which is an unhygienic method of disposal. This is because of a lack of knowledge on the proper disposal of face masks. 317(79.3%) participants had used Rumal/Gamacha/Dupatta when the face mask is not available with them.

Conclusions

This is the study to investigate KAP for the COVID-19 outbreak, among the rural population of Madhya Pradesh. Our findings suggest that rural residents, especially men, have good knowledge of COVID-19 and face mask use. Most of the participants know about the route of transmission. Maximum participants have good knowledge of various types


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of face masks and they also know that it can prevent COVID-19 disease. Maximum participants had a positive attitude towards wearing a face mask at crowded places. Upper classes of socioeconomic status have better knowledge than lower classes. In this study, we found that education is a very important determinant of knowledge about face mask use. Those who are having higher education levels were having better knowledge than lower education levels. In our study, one important finding came out that some participants had shared their face masks with other people. This kind of practice can be dangerous and can transmit COVID-19 in the community. Maximum participants had motivated their family members for wearing a face mask. This reflects the responsibility of preventing COVID-19 in the family. Most of the participants had reused face masks for 2-5 days, which could be a harmful practice. Because repeated use of the same face mask can result in the transmission of not only COVID-19 but also other respiratory diseases. Participants do not have proper knowledge of the storage of face masks, they use to store them on wooden hangers and pockets. On wooden hangers and in pocket face masks can get contaminated with pathogenic microorganisms. Some participants disposed of used face masks in open places which can result in the spread of COVID-19 in the community. Rumal/Gamaccha/Dupatta is used as an alternative to face masks by some participants. This is the new finding found in the study. IEC activities and small group sessions can be conducted by a health worker in a rural area on proper use, proper techniques of disposal and storage of face masks. Behaviour, change, communication activities for motivating and encouraging people of rural areas for using face masks need to be conducted.

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