COVID-19 preventive measures in Rohingya refugee camps: An assessment of knowledge, attitude and practice toward COVID-19

Abstract

Background: Although many studies were conducted on COVID-19 knowledge, attitude, and practice among the general population in many countries, very little is known about refugees, particularly Rohingya refugees in Cox's Bazar. A vast array of Risk Communication and Community Engagement (RCCE) interventions were implemented in Cox’s Bazar with the intent of reducing disease transmission by empowering the community to adopt public health measures. Objectives: The study aimed to evaluate the current state of knowledge, attitude, and practice among Rohingya refugees as a result of RCCE initiatives. Materials and Methods: A cross-sectional study was conducted with 500 Rohingya individuals. Participants in the study were Rohingya refugees residing in five randomly selected camps where IOM health was operating. Using a structured questionnaire, skilled community health workers surveyed the Rohingya population. In addition to the survey on knowledge, attitude, and practice, the study gathered information on the perspectives and relevance of sociodemographic factors that influence KAP. Results: The study findings indicate that the mean scores for knowledge, attitude, and practice were 9.93 (out of 14), 7.55 (out of 11), and 2.71 (out of 7) respectively. Association was found between knowledge and practice level and age group – elderly age group (>/= 61 years) had less level of knowledge (AOR 0.42, P value= 0.05) and the late mid age group (46 – 60 years) had better practice level (AOR 2.67, P value <0.001). A significant association was also found between good knowledge level and medium family size (5 – 6 members) (P value= 0.02). Conclusions: The study reveals that the Cox's Bazar Rohingya refugee community has a low knowledge and attitude score about COVID-19 prevention measures. Especially the KAP scores were found significantly low in elderly population. Despite RCCE interventions, the practice level of these measures exhibited a considerably low score. Poor implementation of preventive measures must be identified and remedied, involving the community in future outbreaks of a similar nature.

Understanding the challenges and gaps in community engagement interventions for COVID-19 prevention strategies in Rohingya refugees: a qualitative study with frontline workers and community representatives

“…It is recognized in some COVID-19 public health guidance that older people, persons with disabilities and/or chronic illnesses face higher risk of COVID-19 and face inequality and barriers to access information, education and services (28). The earlier KAP study found the association between knowledge and practice level and age group, specifically, the older adult age group (≥61 years) had less level of knowledge (AOR 0.42, p = 0.05) (15). This could be explained by the findings of study that the RCCE strategy, messages and the materials were not responsive to the special needs of vulnerable groups, specially, older adult and persons with disability.…”

“…A quantitative KAP study conducted by the same authors prior to this qualitative study found that the majority of the community had a good level of knowledge or awareness on COVID-19 and an average to good level of attitude, however, a significantly low level of practice toward the preventive measures (15). There was a significant improvement in knowledge and attitude among Rohingya refugees compared to the results of previous research (22), however, the practice was not improved as much as the level of knowledge and attitude (15).…”

“…A quantitative KAP study conducted by the same authors prior to this qualitative study found that the majority of the community had a good level of knowledge or awareness on COVID-19 and an average to good level of attitude, however, a significantly low level of practice toward the preventive measures (15). There was a significant improvement in knowledge and attitude among Rohingya refugees compared to the results of previous research (22), however, the practice was not improved as much as the level of knowledge and attitude (15). This improvement in the level of knowledge and attitude can be potentially linked with the extensive community outreach activities and best practices of community health interventions as identified by our study, which include the selection of CHWs from local community, deployment of female CHWs, longstanding relationship of the CHWs with the community, speaking in the local dialect, engaging with the community and religious leaders, and effort to build community trust, reliability and respect.…”

“…It was cross-sectional study, 500 Rohingya individuals were surveyed using a structured questionnaire. The study found that the mean scores for knowledge, attitude and practice were, respectively, 9.93 (out of 14), 7.55, respectively, (out of 11) and 2.71 (out of 7) indicating that the Rohingya refugee community in Cox's Bazar had improved knowledge and attitude toward COVID-19 preventive measures, however, the practice level of these measures remained low compared to the knowledge and positive attitude (15). Also, different forums and reports have highlighted the issue of noncompliance among the population with COVID-19 measures; however, there is no evidence as to why the public health measures are not accepted or practiced by the community and/or how the issue can be addressed using local knowledge and resources.…”

“…The successful implementation of public health measures is largely dependent on what people know about those measures (knowledge), how they think or believe in those measures (attitude), and how they do or experience those measures (practice) (14). Prior to this qualitative study, a quantitative study was carried out by the same study team to assess the level of knowledge, attitude and practice of COVID-19 preventive measures among the community following the RCCE interventions carried out (15). It was cross-sectional study, 500 Rohingya individuals were surveyed using a structured questionnaire.…”