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The perception of COVID-19 pandemic response and factors associated with non-utilization of face masks in communities with previous exposure to Ebola virus outbreak, Liberia, 2020: A mixed-method study
Abstract
Introduction: The COVID-19 pandemic disrupted social life and the economy across the world. In communities with prior experience of Ebola virus disease (EVD) epidemics, this previous exposure was expected to influence the response to the COVID-19 pandemic. This study described communities' perceptions and responses to COVID-19 in Liberia and identified factors associated with the non-utilization of face masks.
Methods: A cross-sectional study, using a qualitative and quantitative design, was conducted in Liberia six months into the COVID-19 outbreak. Forty-two communities were randomly selected from catchment communities around twentyone main referral health facilities. In each community, a focus group discussion was conducted, ten community members were systematically selected for a face-to-face interview and a checklist was used to assess the community preparedness and response.
Results: COVID-19 was reported in thirty-six of the forty-two communities (85.7%). Among the respondents, COVID-19 awareness was 96.2% (404/420), and 34.5% (145/420) reported using a face mask. Some communities initiated and implemented response strategies to COVID-19 without waiting for the government. Strong community leadership and collaboration strengthened community ownership and participation in the response. The non-involvement of the communities in response planning by the government and poor monitoring of adherence to COVID-19 preventive protocols were identified as gaps. Poor knowledge of COVID-19 preventive measures (aOR 5.3, 95% C.I., 3.3 – 8.6; p < 0.01), being a female (aOR 1.7, 95% CI., 1.1 – 2.7; p = 0.03), and being in the 50 – 59 years age group (aOR 5.0, 95% C.I., 1.5 – 16.4; p = 0.01) compared to age < 20 years were significantly associated with the non-utilization of face masks.
Conclusion: The high COVID-19 pandemic awareness did not translate into face mask utilization. Poor knowledge of COVID-19 preventive measures, being in the 50 – 59 years age group, and being female were associated with the non-utilization of face masks.
