Knowledge of Covid-19 among Medical Scientists in Nigeria

Background: The impacts of the ongoing COVID-19 pandemic have created a need for constant improvement in the effectiveness and efficiency of laboratory diagnosis to contain the spread, aid the treatment and management of positive cases. Inadequate knowledge of COVD-19 and its laboratory diagnosis among medical scientists is detrimental to the reliability of laboratory results, which are critical in the control, and management of the COVID-19 pandemic. The purposes of this study are to determine the knowledge of COVD-19 and to assess the knowledge of laboratory diagnosis of SARS-CoV-2 among medical scientists. Methodology: An internet-broadcasted and validated questionnaire was used to obtain data from 131 medical scientists in Nigeria. The generated data were analyzed using IBM SPSS Statistics version 25. Results: More than half of respondents had good general knowledge and causes (52%), mode of transmission (52.7%), and symptoms (54.2%) of COVID-19. However, only a few (<40%) knew the hallmark of laboratory diagnosis of COVID-19 and Coronavirus detection steps in the right order (45%). Surprisingly, age (F-ratio = 2.729 p = 0.032), gender (χ 2 = 4.173; p = 0.041) and level at work (F-ratio = 3.552, p = 0.016) have significant effects on the knowledge of COVID-19 and knowledge of laboratory diagnosis of SARS-CoV-2 among the study participants. Conclusion: There is a need for improvement in the knowledge of COVID-19 diagnosis through relevant work level (work experience) and gender-based training as well as continuous professional development programs for medical scientists in Nigeria.


Background
Six weeks after the first reported case of the novel Coronavirus infection in Wuhan, China, Africa continent recorded her first case in Egypt [1]. On 27 th February 2020, which was, almost two weeks after it was reported in Egypt, Nigeria recorded her first COVID-19 case [2]. In this unprecedented time in the world's history, the COVID-19 test has become a household vocabulary. This is because COVID-19 testing is the fundamental core of COVID-19 pandemic response to It was discovered that the incubation period of SAR-CoV-2 is 14 days [3], while the mode of transmission is through physical contact, droplets, aerosol, and contaminated environments [4] [5].
The symptoms of COVID-19 infection ranges from an asymptomatic form to a severe acute respiratory syndrome-a severe complication of SAR-CoV-2, which could lead to viral sepsis, disseminated intravascular coagulopathy (DIC), or multiple organ failure (MOF). However, common symptoms include dry cough, fever, and fatigue [6] [7].
Early laboratory diagnosis of COVID-19 plays a major role in the control and management of the COVID-19 pandemic. The laboratory confirmation of suspected cases of COVID-19 is done using Nucleic Acid Amplification tests (NAAT) which detect the unique viral RNA sequences. A major example of NAAT is real-time reverse transcription polymerase chain reaction (RT-PCR) and the most widely used type is quantitative fluorescence-based reverse transcription polymerase chain reaction (RT-qPCR). The common targeted viral genes are N, E, S, and RdRP [8]. RT-PCR detects SARS-CoV-2 during the acute phase of infection.
RT-PCR involves the extraction of viral genomic RNA, conversion of the RNA into complementary DNA (cDNA) by RNA-dependent DNA polymerase (reverse transcriptase)-the binding of primers to the DNA provides a template for DNA replication by DNA polymerase enzyme, leading to degradation of the bound probe which generates fluorescence signal. Fluorescence signal increases as more copies of DNA are produced. In quantitative fluorescence-based reverse transcription polymerase chain reaction (RT-qPCR), real-time monitoring of DNA amplification is monitored using fluorescent dye or a sequence-specific DNA probe labeled with a fluorescent molecule (reporter molecule) and a quencher molecule. As the PCR reaction progresses, the amplification is then repeated by an automated system for about 40 cycles until the viral cDNA can be identified by fluorescent or electrical signal [8].
RT-PCR can be carried out using either a one-step or a two-step procedure but the preferred method is one-step because it is faster-reduces exposure and bench time and it decreases pipetting errors as well as cross-contamination between the RT and real-time PCR steps [9].
Serological (antibody-based) testing, which is recently being introduced as supplemental testing, identifies antibodies developed to the virus in individuals who previously had the infection [10]. This plays a great role in unveiling the epidemiology of SARS-CoV-2 [11]. The rate and degree of mutation variability of SARS-CoV-2 and the identification of emerging viral strains for more effective vaccine development are done using viral genomic sequencing, which is a more complex diagnostic testing [5].
The role of medical laboratory science in the monitoring patients cannot be overemphasized. Many laboratory tests help in assessing the severity of disease (disease staging) as well as prognosis (assessing the risk of progression of COVID-19 towards ARDS, DIC, and/or MOF).
To meet up with the demands of quality healthcare service and the expectations to produce timely, reliable, and accurate results, which serve as the basis for effective, as well as efficient diagnosis, treatment, and management of COVID-19 cases, it is expedient for medical scientists to have accurate and in-depth knowledge of the epidemiology and laboratory diagnosis of COVID-19.
This will bring about an impactful pandemic response by reducing the spread and mortality rate.
The purposes of this study are to determine the knowledge of COVD-19 (general knowledge and causes, symptoms, and mode of transmission) and assess the knowledge of laboratory diagnosis of SARS-CoV-2 among medical scientists.

Methodology
One hundred and thirty-one medical scientists participated in the descriptive cross-sectional survey conducted in Nigeria. The participants were recruited from the six-geopolitical zones in Nigeria. Participants were required to give informed consent to take part in the survey and they were the assurance of absolute respect, confidentiality and anonymity.

Survey Instrument
The questionnaire used for this survey was adapted from the World Health Organization interim guidance document for laboratory testing for Coronavirus disease 2019 ( COVID-19) in suspected human cases [8] and was designed using Google form. It was validated by face validity and has an overall internal consistency of 0.8 (Cronbach's Alpha method). Due to the lockdown in the country during the period of the data collection, the questionnaire was broadcasted by the internet and the link was sent to interested participants. The questionnaire sought information on respondents' socio-demographic, general knowledge and causes, mode of transmission, symptoms associated with COVID-19, and laboratory diagnosis of COVID-19.
The general knowledge and causes section had 5 items, the mode of transmission section had 8 items, the symptoms associated with COVID-19 section had 3 items and the knowledge of laboratory diagnosis of COVID-19 section had 7 items. Most questions were recorded on a six-point Likert scale with a few multiple-choice questions. Strongly agree and agree responses were reported as agree while strongly disagree and disagree responses were reported as agree.

Inclusion and Exclusion Criteria
Medical scientists from the six geopolitical zones of Nigeria were included in the study while medical scientists working in hospitals and diagnostic centres with no facilities for COVID-testing were excluded from the study.

Data Analysis
To ascertain the accuracy and completeness of the data obtained, the data were entered and cleaned. The 6-points Likert Scale questions were coded from 1 to 6. "Strongly disagreed" was coded as 1, "Disagree" was coded as 2 "Slightly Disagree" was coded as 3, "Slightly Agree" was coded as 4, "Agree" was coded as 5, and "Strongly Agree" was coded as 6. The maximum obtainable score for ques- level was set at 95% and the significant level at p < 0.05.

General Knowledge of COVID-19
Most of the respondents (84.7%) recognized the causative agent of COVID-19 to  and that Coronavirus is an infectious agent (96.9%) ( Table 2). The mean score of general knowledge and causes of COVID-19 was 22.4 (±3.6) with 68 (52%) respondents scoring above the mean and were classified as having good knowledge of COVID-19 and its cause ( Figure 4).

Knowledge of COVID-19's Mode of Transmission
The majority of the respondents opined that Coronavirus disease  can be transmitted through handshaking (90.9%), through droplets during coughing or sneezing (99.2%) and that COVID-19 is more contagious but less severe compared to Acute respiratory syndrome SARS and middle east respiratory syndrome MERS(54.2%) ( Table 3). The mean knowledge score of the mode of transmission of COVID-19 was 38.8 (±4.5) and 69 (52.7%) respondents were categorized as having good knowledge of COVID-19 mode of transmission as they scored above mean as seen in Figure 5.

Knowledge of Symptoms of COVID-19
One hundred and eight (84.4%) respondents confirmed that the most typical clinical symptom in laboratory-confirmed cases of COVID-19 is "dry cough" (Table 4(a)). Most of the respondents (71%) agreed that according to the World Health Organization (WHO), the percentage of patients with severe SARS-CoV-2 infection who experience mild symptoms are higher than the percentage of those who are critically ill (Table 4(b)). The mean score for knowledge of COVID-19 symptoms was 8.4 (±2.0). Seventy-one (54.2%) respondents scored above mean

Knowledge Level of Laboratory Diagnosis of SARS-CoV-2
It was shown in Table 5 that the majority of respondents agreed that the collected specimen must be put into a viral transport medium (96.1%) and that diffuse alveolar damage characterized by the presence of cellular fibromyxoid exudates, desquamation of pneumocytes, and hyaline membrane formation is diagnostic pulmonary histology in COVID-19 (75.6%).
However, only a few study participants knew the hallmark of laboratory diagnosis of COVID-19 (Lymphopenia 37.4%, Increase LDH 20.69% and Prolong PT 13.7%) and Coronavirus detection steps in the right order (45%).

Relationship between General Knowledge of COVID-19, Knowledge of Laboratory Diagnosis of SARS-CoV-2, and Respondents' Demographics.
The overall knowledge level of COVID-19 (causes, mode of transmission, symptoms and knowledge laboratory diagnosis of SARS-CoV-2) was significantly associated with the respondents' gender, (χ 2 = 4.173; p = 0.041).
Besides, respondents who were between ages 40 and 49 years had the highest mean knowledge score of 75.6 (±7.9) over other age groups (Table 6)     knowledge score in education.

Discussion
As part of a multidisciplinary medical team, medical scientists play a great role in the detection, management, and containment of the spread of SARS-CoV-2 infection. The quality of care provided by the medical scientists depends on the level of the general knowledge and knowledge of diagnosis of SARS-CoV-2 they possess. According to a study in Zambia, the majority of the participating medical laboratory professionals (84.1%) had good knowledge of COVID-19 [14].
This finding is in tandem with the discovery in this study as more than half of the respondents had good general knowledge and causes (52%), mode of trans-  [18]. This striking difference may be due to the recent pressure on the Nigerian health system due to the COVID-19 pandemic to improve the efficiency, efficacy as well as the capacities of medical laboratory systems. The bulk of these responsibilities are saddled by the leaders in the profession and this automatically confers the need to be more informed to be able to handle the situation more proficiently.

Limitations
The participants' responses were given online based on the reliable reports of the real-time laboratory experiences. These reports may be liable to recall bias. Also generalization the study findings may be difficult due to the potential for sample clustering as well as the limited number of study participants.

Conclusion
This study revealed that even though the majority of the respondents had a good

Ethics Approval and Consent to Participate
Ethics approval was waived for this study. The study participants gave informed consent to participate in the survey and they were assured of absolute respect, confidentiality and anonymity.

Consent for Publication
The study participants gave informed consent for their responses to be published.

Availability of Data and Materials
The datasets supporting the conclusions of this article are included within the article.

Funding
This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.