Knowledge, Attitude, and Perception of COVID-19 among Maritime Workers in the United Kingdom and Nigeria during the First Wave of the Pandemic

In this study, knowledge, attitude and perception (KAP) of maritime workers’ towards COVID-19 during the rapid outbreak in Nigeria and the UK were examined. The study participants completed a self-developed online KAP questionnaire prepared by the convenience sampling method. The knowledge questionnaire comprised questions regarding the clinical characteristics and prevention of COVID-19. The assessments regarding the maritime workers’ attitudes and perceptions towards COVID-19 included questions on preventive measures such as wearing masks on the ships and the attitude towards continuous trade with the Chinese communities. A multiple logistic regression analysis was done using SPSS Statistics version 23.0 to analyse the results of the two groups. The three explanatory variables, gender, residence and age used in the two models applied were not significant predictors of the participants’ knowledge, attitude and perception about COVID-19. The odds ratio was small, except for the age group, which was 6.72 in the first model. This implies that the odds of having knowledge about COVID-19 during the pandemic were 6.72 times higher for the older age group. The odds ratios were generally low for attitude and perception about COVID-19, as shown in Table 4. Participants had considerable knowledge about COVID-19 and could


Introduction
Since the global outbreak of the coronavirus disease in 2019 (COVID- 19), health professionals have been working to accelerate research and development that aids to minimise the spread of the pandemic. This has also helped governments to develop standards and measures to contain the spread of the pandemic across their countries. To contain the spread of any diseases, researchers agreed that, whatever measures and standard operating procedures need to be put in place, the effectiveness of those measures are highly dependent on knowledge, attitude, and perception (KAP) of the people within the affected areas [1]. The World Health Organization (WHO) declared the spread of the novel coronavirus caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) a matter of public health emergency on 30 January 2020, and later a pandemic on 11 March 2020 [2]. Since this declaration, the disease has spread across 270 countries, including Nigeria and the United Kingdom (UK). As of mid-July 2020, Nigeria recorded 35,454 confirmed cases and 772 deaths, which was reported by the Nigeria Centre for Disease Control (NCDC). The UK has had a total number of 293,239 people who tested positive for COVID-19, with 45,233 associated deaths and 1230 recoveries, according to the Department of Health and Social Care. Even though COVID-19 emerged in Wuhan, China, the history of COVID-19 in Nigeria cannot be told without referring to the first index case recorded in Nigeria on 27 February 2020, which was an Italian citizen that arrived in the country from Europe. Since then, Nigeria has witnessed the direct effects of the pandemic and the confirmed cases have risen to over 40,532. As of 26 July 2020, an additional 858 deaths have been recorded [3]. However, the first index case entered the UK earlier, on 23 January 2020 from the Hubei Province in China [4].
The virus has spread across many countries and provinces within Nigeria and the UK, and researchers have put several unprecedented measures in place to combat the pandemic, such as lockdown, travel control, social distancing, hand-washing requirements, and the use of face masks, as recommended by the WHO. Apart from the general preventive and control measures, the government has additionally employed quarantine to help limit the number of cases. Thus, this has been adjudged to help slowing down the spread of COVID-19 in many countries. However, despite these measures, the pandemic is still expanding in Nigeria and the UK. This study examines the risk implication with maritime workers, as shipping was exempted from the travel control ordered during the pandemic. Global shipping still depends on nearly two million seafarers worldwide to provide goods that are needed for everyday life, irrespective of the pandemic [5]. According to the International Labour Organization (ILO), a seafarer is any person who is employed or engaged in work in any capacity on board a ship [6]. This definition is broad and includes not only seafarers in the merchant marine but also those working in the cruise industry. Since the shipping industry is important for any country's economic development, the safety of seafarers amongst other maritime workers was a concern in the industry and among medical researchers, especially during the outbreak of COVID-19 [7]. For instance, Doumbia-Henry (2020) indicates that it is essential for all maritime stakeholders to collectively address the pandemic and minimise the risks for global trade and human health [5]. Most governments worldwide declared seafarers essential workers during this pandemic, as the health and safety of the seafarers became a concern. The Nigerian Maritime Administration and Safety Agency (NIMASA) was the first government agency in West Africa to declare seafarers as frontline workers during the pandemic. The agency issued a Marine Notice in furtherance of the Presidential directive on COVID-19 to restate the responsibilities of seafarers in the Nigerian economy. Seafarers, both on board and on offshore platforms in anchorages, seaports, and on terminals and jetties are now considered essential workers and as a result, they have been granted passage to join their respective vessels at anchorages, seaports, and on terminal and jetties around the world [8]. Thus, several precautionary measures that consider the need to keep the supply systems working were established in the UK.
The International Maritime Organization has also declared shipping activities essential services. As essential workers, seafarers are allowed to move in and out of the country [9]. However, after providing adequate freedom of movement to seafarers, the nation should expect some implications, particularly the maritime industry and the seafarers themselves. Previous studies established seafarers have a higher risk of being infected than the general population because of their

Novel Coronavirus 2019 Outbreak
During the COVID-19 outbreak, there was a need to control the rapid spread of the ongoing pandemic in any community. Since the shipping industry is crucial for the development of Nigeria and the UK, the health and safety of maritime workers is also a concern. To study the adherence to preventive measures regarding the disease using the knowledge, attitude and perception (KAP) theory is therefore important [1] [16]. This theory is used to investigate a person's intention to a specific behaviour or attitude towards a particular behaviour. The The study was used to predict the willingness of medical staff to care for patients with COVID-19. The important contribution of the study is that increased attention should be paid to the knowledge and attitudes of staff considered as essential workers. Although Zhong et al. (2020) argued that the KAP study is also applicable to the general population during the rapid outbreak of COVID-19, little or no research has been conducted in the context of seafarers [16]. This study is the first on the KAP of participants and also covers maritime workers, including U. N. Obiageli et al. Journal of Biosciences and Medicines seafarers of more than one country. The findings of this study will contribute to the global efforts to control the pandemic within the maritime community.

Research Methodology
This study was a quantitative-based cross-sectional study. The study was con-

Data Analysis and Results
This section deals with the data analysis and results of the study. The categorical

Description of the Participants
A total of 100 participants completed the survey; 66 were women, 34 were men, and the average age was 39.5 years (SD ± 3.3). Sixty per cent of the participants were from Nigeria, while 40% were from the UK. A significant proportion of the participants (86%) were maritime workers of varying staff categories, while only 14% were seafarers.

Knowledge of Maritime Workers and Perceived Risk of Transmission of COVID-19
About 57% of the participants in Nigeria and 37% of those in the UK had heard about the novel coronavirus at the time this study was conducted.      Table 4.

Discussion
The three explanatory variables gender, residence and age in the first model were not significant predictors of the participants' knowledge about COVID-19.
People's adherence to control measures were affected by their knowledge, attitude and perception (KAP) towards COVID-19 (Zhong et al., 2020) and the classification of maritime workers as essential workers during the pandemic.
Having the knowledge about the disease is not dependent on gender, residence or age of the participants. This might be because participants in this study were all adults who had knowledge about COVID-19 and hence have been taken precautions to avoid contacts with infected persons. The odds ratio was low, except that for the age group, which was 6.72. This implies that the odds of having the knowledge about COVID-19 during the pandemic were 6.72 times higher for the age group. Gender, residence and age were also not significant predictors of participants' knowledge about COVID-19 in the second model. The perception is  (Table 1). This might be because of adequate publicity and training provided during the pandemic. The odds ratios were low, as listed in Table 4.
However, the results also showed that a significant number of maritime workers from both countries shared similar negative attitudes and perceptions towards the Asian community in contracting the coronavirus. These included to reject navigating a cruise ship with people having Asian sounding names, to eat in Asian restaurants and to use personal protective equipment from China. Also, most workers did not believe that people once infected by the virus develop lifetime immunity regarding COVID-19, irrespective of the residence of the maritime workers. This also indicated their belief to survive while still at work if the disease was contracted during the initial outbreak of the pandemic.
The study is limited by the small number of seafarers compared to the other occupational groups that participated in the study. Also, the disproportionate sample size of maritime workers from the UK and Nigeria is another constraint.
This unequal sample size limited the effective comparison of the KAP of maritime workers between the two countries and the KAP between seafarers and other occupational groups. However, since this study was not a comparative study, the outcome is not affected by the occupation within the maritime industry and the dissimilar population size from both countries. As the maritime workers on board of ships during the peak of the pandemic were identified here as seafarers, a larger sample size is needed to generalise their KAP towards COVID-19 and compare it with other seafarers in the maritime community.
However, it was difficult to obtain a larger number of study participants during the first wave because of their mental state at that time. Further research is needed in this field to implement the necessary policies on shipping in the future.

Conclusion
The study participants had considerable knowledge about COVID-19 and were able to stay healthy during the first wave of the novel coronavirus in 2019. This achievement is due to the result of measures such as social distancing at gatherings and workplaces, the lockdown, the use of face masks and a host of other initiatives imposed by the government of Nigeria and the United Kingdom. The participants had a good perception about COVID-19 regardless of the negative rumour that it was a conspiracy to reduce the world population. COVID-19 has indeed become the most significant reality of the twenty-first century. This research concluded that gender, residence and age were not significant predictors of knowledge and perception about COVID-19 in the investigated study group.