Background: The COVID-19 pandemic has created a global health emergency requiring an effective public health response including citizen's roles in preventing spread and controlling the pandemic. Little is known about public knowledge, beliefs and behaviors in-relation to the pandemic in Nepal. This study aims to assess knowledge, attitude and practices (KAP) toward COVID-19 among the general public and to identify associated factors.Methods: A cross-sectional survey was conducted between May–June 2020 with a sample of 645, recruited from 26 hospitals across Nepal. We conducted telephone interviews using a semi-structured questionnaire related to KAP regarding COVID-19. T-test and one-way ANOVA was conducted to determine group differences for socio-demographic variables. Linear regression and correlational analysis were performed to identify associated factors and measure strength and direction of relationships.Results: Overall mean scores for knowledge, attitude and practice were 11.6 (SD 4.5), 2.7 (SD 1.8), and 9.9 (SD 1.93) respectively, but differed by socio-demographic characteristics. Positive but weak linear correlations were observed between knowledge-practice (r = 0.19, p < 0.01) and attitude-practice (r = 0.08, p < 0.05). The relationship between knowledge and education was fairly strong (r = 0.34, p < 0.01). Province, place of residence, ecological area, age, gender and caste/ethnicity were also significantly associated with KAP score of participants.Conclusion: The study found varying degrees of correlation between Knowledge, Attitude and Practice that may increase as the pandemic evolves in Nepal. Knowledge and level of education had positive associations with attitude and adherence to precautionary measures. The findings suggest a need for targeted community awareness interventions for the most vulnerable populations, men, those with no school education, the elderly and people living in rural areas.

Background The COVID-19 pandemic has been creating a panic and distressing situations among the entire population globally including Nepal. No study has been conducted assessing the psychological impact of this pandemic on the general public in Nepal. The objective of this study is to assess the mental health status during COVID-19 outbreak and explore the potential influencing factors among the population attending the hospital fever clinics with COVID–19 symptoms. Methods A cross-sectional survey was conducted between May—June, 2020 with a sample of 645 participants aged 18 and above in 26 hospitals across Nepal. Telephone interviews were conducted using a semi-structured questionnaire along with a validated psychometric tool, the Depression, Anxiety and Stress (DASS-21) scale. The metrics and scores of symptoms and their severity were created and analyzed. Multivariate logistic regression was used to determine the association of potential covariates with outcome variables. Results The prevalence of anxiety, depression and stress were 14%, 7% and 5% respectively. In reference to Karnali, participants from Bagmati province reported higher level of anxiety (OR 3.44, 95% CI 1.31–9.06), while stress (OR 4.27, 95% CI 1.09–18.32) and depressive symptoms (OR 3.11, 95% CI 1.05–9.23) observed higher among the participants in Province 1. Women were more at risk of anxiety (OR 3.41, 95% CI 1.83–6.36) than men. Similarly, people currently living in rented houses reported more stress (OR 2.97, 95% CI 1.05–8.43) and those living far from family reported higher rates of depressive symptoms (OR 3.44, 95% CI 1.03–11.46). Conclusion The study identified increased prevalence of stress, anxiety and depressive symptoms during the initial stage of COVID-19 pandemic in Nepal. Considering the findings, there is urgent need to develop and implement appropriate community-based mental health programs targeting individuals who have had COVID-19 symptoms and who are prone to develop adverse mental health outcomes.

 The COVID-19 pandemic has negative impacts on most Sustainable Development Goals, which may subside in the medium and long terms. Key impeding factors causing the negative impacts include lockdowns, unemployment, and diluted focus on non-COVID-19-related issues. The COVID-19 pandemic has also opened a short-lived and narrow window of opportunity for sustainable transformation.

Background: The COVID 19 pandemic has been creating a panic and distressing situations among the entire population globally including Nepal. No study has been conducted assessing the psychological impact of this pandemic on the general public in Nepal. The objective of this study is to assess the mental health status during COVID 19 outbreak and explore the potential influencing factors among the population attending the hospital fever clinics with COVID 19 symptoms. Methods: A cross sectional survey was conducted between May to June, 2020 with a sample of 645 participants aged 18 and above in 26 hospitals across Nepal. Telephone interviews were conducted using a semi-structured questionnaire along with a validated psychometric tool, the Depression, Anxiety and Stress (DASS21) scale. The metrics and scores of symptoms and their severity were created and analyzed. Multivariate logistic regression was used to determine the association of potential covariates with outcome variables. Results: The prevalence of anxiety, depression and stress were 14%, 7% and 5% respectively. Participants from Bagmati province reported higher level of anxiety (OR 3.87, 95% CI 1.42 10.59), while stress (OR 4.78, 95% CI 1.09 21.29) and depressive symptoms (OR 3.37, 95% CI 1.10 10.35) observed higher among the participants in Province 1. Women were more at risk of anxiety (OR 4.26, 95% CI 2.21 8.20) and depression (2.75, 95% CI 1.16 6.51) than men. Similarly, people with primary level education found more prone to all factors, stress (OR 20.35, 95% CI 2.06 201.19), anxiety (OR 3.10, 95% CI 1.24 7.91), and depression (OR 4.41, 95% CI 1.29 15.07). More farmers than labors showed higher odds (OR 2.25, 95% CI 1.01 5.01) for anxiety, while individuals surveyed who reported their health status as poor-had higher odds (OR 5.95, 95% CI 1.08 32.68) for depression. Also, people currently living in rented houses reported more stress (OR 3.11, 95% CI 1.07 9.05) and those living far from family reported higher rates of depressive symptoms (OR 3.57, 95% CI 1.01 12.58). Conclusion: The study identified increased prevalence of stress, anxiety and depressive symptoms during the initial stage of COVID 19 pandemic in Nepal. Considering the findings, there is urgent need to develop and implement appropriate community-based mental health programs targeting individuals who have had COVID 19 symptoms and who are prone to develop adverse mental health outcomes. Key words: COVID 19, Depression, Anxiety, Stress, Pandemic, Public Health, Nepal

Background: The COVID 19 pandemic has created a global health emergency requiring an effective public health response including citizens' roles in preventing the spread and controlling the pandemic. Little is known about public knowledge, beliefs, and behaviors in relation to the pandemic in Nepal. This study aims to assess knowledge, attitude, and practices (KAP) towards COVID 19 among the general public and to identify associated factors. Methods: A cross-sectional survey was conducted between May to June 2020 with a sample of 645, recruited from 26 hospitals across Nepal. We conducted telephone interviews using a semi-structured questionnaire related to KAP regarding COVID 19. T-test and one-way ANOVA was conducted to determine group differences for socio-demographic variables. Linear regression and correlational analysis were performed to identify associated factors and measure the strength and direction of relationships. Results: Overall mean scores for knowledge, attitude and practice were 11.6 (SD 4.5), 2.7 (SD 1.8), and 9.9 (SD 1.93) respectively but differed by socio-demographic characteristics. Positive but weak linear correlations were observed between knowledge-practice (r=0.19, p<0.01) and attitude-practice (r=0.08, p<0.05). The relationship between knowledge and education was fairly strong (r = 0.34, p< 0.01). Province, place of residence, ecological area, age, gender, and caste/ethnicity were also significantly associated with the KAP score of participants. Conclusion: The study found varying degrees of correlation between Knowledge, Attitude, and Practice that may increase as the pandemic evolves in Nepal. Knowledge and level of education had positive associations with attitude and adherence to precautionary measures. The findings suggest a need for targeted community awareness interventions for the most vulnerable populations, men, those with no school education, the elderly, and people living in rural areas. Keywords: COVID-19, Knowledge, Attitude, Practice, Correlates, Nepal