Personal Hygiene Concept, Knowledge, and Awareness Regarding COVID-19 among Bangladeshi People

Aim: Novel coronavirus disease 2019 (COVID-19) has emerged as an un-known fallacy that forced into a global pandemic. Only a few vaccines are available for a limited number of people, and most of the population are not vaccinated yet. So, social distancing, proper personal hygiene, and sanitization concepts are the main factors to prevent the spread of this disease. For a densely populated country like Bangladesh, the concepts of social distancing are unpopular, and people are reluctant to follow community health guidelines. This study aimed to understand the personal hygiene concept, knowledge, and awareness of Bangladeshi people against COVID-19. Subject and Methods: This cross-sectional study was conducted from March to June 2020 through an online Google survey. Those who answered all the questions were finally included for result calculation (n = 182). The chi-square test was ap-plied to evaluate the correlations among the groups based on education, income level, and occupation. Results: The results showed that education level and occupational status play a vital role in awareness about the general symptoms of COVID-19. Students have a lower rate of washing hands for 20 sec than people of other occupations (p = 0.037). The rate of using masks while going outside is not common in the low-income firmly than others. They know the differences and significance of these two interventions properly. Conclusion: More comprehensive education pro-grams could be helpful to enhance the concept of personal hygiene, knowledge, and awareness level of the people for a country like Bangladesh.


Introduction
Coronavirus disease 2019 (COVID-19) has risen as an unpredictable and esoteric infectious disease caused by a newly emergent virus, which was outbreak in Wuhan, China, in December 2019 [1] [2]. The novel infection already called 2019-novel coronavirus (2019-nCoV), is assigned as the severe acute respiratory syndrome coronavirus-2 or SARS-CoV-2 shortly [3]. This novel infection is additionally getting to be a mounting risk to the whole world. Genetic sequencing of the virus suggests that SARS-CoV-2 is a betacoronavirus closely linked to the SARS virus [4]. The causative pathogen was identified as a new coronavirus (2019-nCoV), followed by gene sequence analysis and the development of detection methods. Even though the infection is comparable to SARS-CoV and MERS-CoV, it is distinctive. Early cases indicate that it may not be as severe as SARS-CoV and MERS-CoV [4]. However, the rapid increase in incidence and increasing evidence of interpersonal transmission suggest that the virus is more contagious than SARS-CoV and MERS-CoV. Most individuals with COVID-19 create a mild or uncomplicated sickness, including fever, weakness, cough, diarrhea, loss of taste and smell [5] [6]. Roughly 14% develop serious illnesses requiring hospitalization, and they may need medicated oxygen support. Besides, 5% may, too, require admission to an intensive care unit [4].
Coronavirus disease 2019  virus is spreading rapidly, and scientists are endeavoring to discover drugs for its efficacious treatment. Chloroquine phosphate, an old drug for the treatment of malaria, is shown to have apparent efficacy and acceptable safety against COVID-19 associated pneumonia in multicenter clinical trials conducted in China [7]. First-line therapy for fevers incorporates antipyretic treatment such as Paracetamol, while expectorants such as guaifenesin may be utilized for a non-productive cough [8]. One of the most important commitments we can make to abating down the transmission of COVID-19 and keeping ourselves and our communities secure to wash our hands. Hand cleanliness is presently respected as one of the critical components of disease control exercises [9] [10]. Appropriate handwashing and individual cleanliness practices are fundamental for all, particularly in healthcare settings, where it secures patients and healthcare specialists. Also, it provides specific recommendations to promote improved hand-hygiene practices and reduce the transmission of pathogenic microorganisms to patients and personnel in healthcare settings [11]. However, when the facility for hand wash is not available, alcohol-based hand sanitizers can play a vital role as an alternative in disinfecting the hands instantly [12] [13]. According to the world health organization (WHO), these hand rubs should contain either 80% (v/v) pharmacopoeial grade or food standard ethanol or 75% (v/v) pharmacopoeial standard isopropyl alcohol to work effectively against this virus. Othercritical pieces of protective equipment are the facemask. The principal function of the mask is to prevent the spread of respiratory particles from the source, such as splashes, saliva, or mucus. Medical or surgical facial masks are characterized as loose-fitting, expendable devices that make a physical boundary between the mouth and nose of the wearer and potential contaminants within the immediate environment [14]. Masks are suggested to be worn by sick people to avoid onward transmission, known by source control [15] [16] [17]. It is also possible that COVID-19 infected patients could transmit the virus before symptoms develop. Moreover, complete vaccination coverage is still challenging due to the availability of vaccines as well as the mutating nature of the virus. Considering these facts, applying nonpharmaceutical intervention and proper self-hygiene practice might be the best possible way to limit the spread of this disease.
Several cross-sectional studies had been performed in Canada, Australia, Ethiopia, India and many other places that have come out with a varying degree of perceptions among the participants [18] [19] [20] [21]. It is evident that, awareness and adherence to basic health measures (hand hygiene, social distancing, avoiding traveling, etc.) are more common among healthcare professionals [22]. Other studies have identified the education level of the subjects as a significant factor for knowledge scores [23]. But, there are limited observations on personal hygiene, knowledge, and awareness concepts among the Bangladeshi population regarding COVID-19. So, this study aimed at finding the scenario in Bangladesh's context. The final result may help to gather information gaps regarding this issue, which may further contribute to understand the present condition of the people of Bangladesh and develop national hygiene policies.

Study Design and Area
An online survey was conducted using Google form to understand the consciousness level among Bangladeshi people on the current outbreak of COVID-19.
Only the participants whose residing location is within the geographical area of

Time of Study and Question Types
The first COVID-19 patient was identified on March 08, 2020, and the first

Ethical Approval
The present survey was conducted following the Declaration of Helsinki and its later amendments or comparable ethical standard. Additionally, before the study was conducted, it received ethical approval from the Jagannath University Research Cell, Bangladesh (reference No. JnURes-002/2020). The objectives, potential benefits, risks, the confidentiality of given responses, etc., were communicated with participants prior to starting the online survey.

Statistical Analysis
M.S. Excel was used as the primary data analysis tool. The response was taken from each responder of a particular question to the questionnaire form, and final results were presented with absolute numbers and percentages. The chi-square test was done by using IBM SPSS Statistics software (version 23).

Result
A total of 182 participants completed all the questionnaires, among which around two-thirds were Male (62%). Most of the participants were young, aged between 18 -25 years (77%) and were students in occupation (64%). In case of monthly income, the low income group (<BDT 10,000 monthly income) was predominant and there was almost similar distribution in education level.
Among these 182 participants, 85% of responders understand all the common symptoms of COVID-19 properly compared to 15% who did not know about it.
Also, participants' overall response to the knowledge and awareness on COVID-19 showed demonstrated that although the situation is new, they are conscious of the impact of this pandemic. The overall response is illustrated in Table 2.
Alongside, the distribution of responses about understanding all the common symptoms of COVID-19 by gender, monthly income, education, and occupation are demonstrated in Table 3. There were around 80% of people who believed that they know all the common symptoms of COVID-19. However, Table 3 suggested significant differences (χ 2 = 7.674, p = 0.006) in this understanding between participants regarding education level (below graduation vs. graduated and above). There were no significant differences in gender (χ 2 = 1.020, p = 0.313), monthly income (χ 2 = 0.847, p = 0.357), and occupation (χ 2 = 3.151, p = 0.076) in this understanding.
The distribution of participants' responses to the personal hygiene level in terms of occupation is enlisted in Table 4. In this observation, around 90% of participants use masks when they go outside. Regarding the frequency of hand wash in a day, most of them wash hands 6 -10 times a day (students 40.5% and others 59.1%).   ≥10,000 BDT). There were significant differences in using mask (χ 2 = 9.184, p = 0.010) and time spent on washing hands (χ 2 = 6.533, p = 0.038). Although the proportion of using masks was almost the same between these groups, 6% of participants in the lower-income group didn't use masks. Similarly, 81.8% of participants in the higher-income group washed their hands for 20 seconds, but this ratio was only 64.7% for participants from the lower-income group.  In Table 7, the variations in the perception and knowledge of participants regarding COVID-19 in different groups are observed. A significant difference was observed in the income group on the understanding of why participants use masks (χ 2 = 9.203; p = 0.027). There was a substantial difference in the occupation group of participants regarding the difference between the Home Quarantine and Isolation (χ 2 = 5.727; p = 0.017). Respondents from other occupations were more aware than the students in this regard. The level of education also played a vital role among the participants in this particular topic (χ 2 = 15.227; p < 0.001). Participants whose education level was graduation or more tend to know the difference of nearly 40% more than those of below graduation. Also, a vast difference was observed in participants' knowledge of the activities that they  think should not be done during the quarantine. Participants other than students were twice more concerned about not going outside during quarantine (χ 2 = 20.419; p < 0.001). Nearly similar results were observed in income groups where participants of higher-income groups were almost twice more concerned about not going outside during quarantine than those of lower-income groups (χ 2 = 12.410; p = 0.006).

Discussion
The principal objective of this study was to understand the awareness level, per- Intending to prevent the spread of this infection, using different hand sanitizers and soaps has started to become familiar. Still, the general people have been ambiguous regarding the effectiveness of these materials to get protection against the virus. They had no clear idea of why they choose those. Both hand sanitizers and soaps are sufficient to kill viruses in distinct ways. In general, soap or detergents contain surfactants, emulsifying agents, and other excipients [30] [31]. Several studies confirmed that surfactants and emulsifying agents are capable of deactivating viruses by entrapping viruses or rupturing the virus envelop or following a simple elution mechanism [32] [33] [34]. Hand sanitizers containing a high concentration of alcohol are also capable of exerting their virucidal activity against enveloped viruses as well as the majority of clinically essential viruses [35] [36]. When handwashing with cleanser and water is inaccessible, applying an adequate sanitizer is suggested to ensure hand cleanliness [37]. This study found that a more significant portion of the participants prefers hand sanitizers over soap water for their hand hygiene. Nevertheless, there are scopes of encouraging people to wash their hands properly with normal soap water more frequently, which is cheap and readily available in their homes and workplaces. Also, personal hygiene knowledge is additionally crucial for those who are living below the poverty level or have low health literacy, perceptions of own risk and the ability to prevent infection may be limited [38]. Urban peoples also fall behind in their basic knowledge of personal sanitization. Unfortunately, People still are oblivious about maintaining social distance.
Moreover, young people have an increased tendency to ignore the care to eliminate the chance of infection. According to the Institute of Epidemiology, Disease Control and Research (IEDCR) in Bangladesh, around 24% of young people are affected by COVID-19 in Bangladesh due to unawareness and lack of social distancing [15]. This study may help communicate that we need more effort to fight the lack of awareness against COVID-19.
As the pandemic situation is new to the people and available authentic information was also limited, people were reluctant to participate in this study.
Moreover, this survey data solely represents the scenario of the participants who have access to the internet. But internet facilities are not still available for the mass number of people living in Bangladesh. It wasn't possible to get the responses of those people who were out of internet facilities. As a result, the observed effect may not be generalizable to the entire population of Bangladesh.

Conclusion
This survey result depicts that, a significant percentage of people are lack of personal sanitization and hygiene concept, knowledge, and awareness against COVID-19. This study was conducted at the very beginning of the pandemic situation when people were unaware of the broad spectrum symptoms as well the severity of the disease. However, the situation might be changed now, as we have new variants of the virus, which are much more virulent and many people got sick, and died from our surroundings. A proper guideline and self-awareness may control the spreading of COVID-19. Also, the necessity to make people understand more about personal sanitization and knowledge is crucial while developing and implementing national policies. After all, still, personal sanitization and awareness are vital remedies to combat COVID-19.

Conflicts of Interest
The authors declare that they have no conflict of interest.