Characteristics of study participants
A total of 2,177 youth were reached through the online survey. Twenty-one (21) did not complete all the questions, hence data for a total of 2,156 youth was used for the analysis. The average age of participating youth was 26 years. Most of the respondents were aged between 25-29 years and 74% had completed higher education. In terms of marital status, 70% were single and nearly 50% were not employed.
Knowledge of COVID-19 symptoms and preventive measures
Knowledge on symptoms of COVID-19 was generally high with most respondents being able to correctly identify an average of five symptoms of COVID-19, out of the ten examined. Female respondents were more likely to identify more symptoms correctly compared to men; p<0.001. High fever (96%), difficulty in breathing (91%) and dry cough (84%) were the symptoms commonly mentioned with the least being loss of taste (18%), loss of smell (15%) and diarrhea (12%).
A multivariate linear regression analysis was conducted to examine whether gender, education level and employment status predicts the level of awareness of signs and symptoms measured by total scores achieved. Female respondents had on average higher levels of awareness than males in identifying signs and symptoms compared to the male respondents (Coeff: 0.36; p<0.001, CI (0.19, 0.53). Those with college education had higher level of awareness of identifying signs and symptoms compared to those lower levels of education (Coeff: 0.29; p=0.03, CI (0.10, 0.49). Consequently, young people in formal employment had higher levels of awareness of signs and symptoms compared to the unemployed (Coeff: 0.35, p=0.001, CI (0.15, 0.55). However, those who were in self-employment had on average lower levels of awareness of identifying signs and symptoms of COVID-19 compared to those in formal employment (Coeff: -0.15, p=0.191, CI ( -0.37, 0.07).
In terms of preventive measures, the most common preventive measures mentioned were washing hands with soap and running water (98.1%), use of hand sanitizers (95.6%), use of mask (93.1%), maintaining social distance of 1-2 meters away (88%), and staying home unless urgent (87.5%). On average, the youth mentioned at least 11 preventive measures correctly out of the 14 examined, with no significant differences by gender. When we examined the relationship between ability to identify preventive measures using multivariate linear regression analysis, there were no associations between gender, education, and employment status. However, young people in formal employment had on average higher levels of awareness of preventive measures compared to those without employment: (Coeff: 0.38, p=0.037 CI (0.02 0 .74).
Perception of Risk of COVID-19
Among the young people, knowledge on who is at risk of infection of COVID-19 indicated variations. Despite nearly 64% and 60% correctly identifying that the elderly and those with weak immune are at risk of infection, only 7% of young people reported that anyone is at risk of infection. When asked what the chances were of getting infected with COVID-19, about 29% perceived themselves being at low risk, 39% at medium risk, less than 3% reported no risk at all. Overall, 32% reported low or no risk at all with no differences between gender. Among those who reported no or low risk, reasons for their response were: they had not travelled (43%) or that God protects them (24%).
We computed multiple logistic regression analysis by examining the odds of those reporting being at any risk compared to those who did not perceive themselves at risk. There were no associations between those who reported any risk with gender OR: 1.1, P=0.416 95% CI (0.89, 1.30) and education OR: 0.85, P=0.174 95% CI (0.68, 1.1). However, those in formal employment and self-employed were less likely to report any risk compared to the unemployed: OR: 0.77, P=0.028, 95% CI (0.62, 0.97); OR 0.76, P=0.033, 95% CI (0.58, 0.97) respectively.
Over 90% (n=2112) of the youth reported that they would be very concerned if they became infected with Corona virus (figure 1). Similarly, they reported higher levels of concern (96% n=2115) if any of their household members was infected with the virus.
Sources of information about COVID-19
Young people were asked how often they used various sources of information to stay informed about the COVID-19 virus. The response was on a scale of 1-4 with 1 being none, 2 - rarely, 3 - sometimes and 4 - all the times. Table 4 shows the proportion of young people who mentioned using each of the channels as sources of information for COVID-19. The most common sources which were used all the time were social media sources (67%), followed by television programs (62%) and friends and internet at 49% percent each. The least used channels were community health workers (8%), church (5%), pharmacy and community meetings at 5 % and 3% respectively.
Adoption of preventive behaviors
To assess adoption of preventive behaviors, young people were asked what they are doing differently since they started receiving messages about COVID-19. Figure 2 shows that most young people were adopting behavior necessary to slow down the infection. For example, nearly all respondents (99%) avoided unnecessary travel, 98% wash hands more frequently and 97% avoid crowded places. Among those that reported that they do not always wash hands with soap and water more frequently n=397, the main barriers were: cannot afford extra water (21.4%), or there was no water in community (16.4%) or in the house 16.1%. Apparently 192 of them reported no barrier at all, representing 48%.
The other important preventive measure was use of masks, with 98% reported wearing masks while going out. When asked the type of mask they owned, 42% reported using surgical mask with more female reporting using such masks compared to men p=0.009 while majority (67%) use cloth masks. The key barriers to wearing of masks among those who mentioned they do not own any were: ability to afford (51%), not knowing where to get one (36%) and discomfort at 29%. Only 7% reported that they do not think it works or they were not allowed to wear one (2%). The third preventive measure was use of hand sanitizer if respondents cannot access water and soap. This was reported among 80% of the youth. Among those who did not use hand sanitizer (n=420), 87% reported that they do not use it because it is very expensive, 20% said they were not available in shops and less than 2% said they do not think it works.
COVID-19 effects on health care seeking behaviors and social economic effects
Young people were asked what health care services or medicines they were not able to access due to the COVID-19 pandemic. There were generally very low reported levels of inability to access certain services linked to SRH. For example, only 4% of the female reported being unable to access E-pills and other contraceptives, 5% were not able to access sanitary towels while 8% were not able to access condoms. Additionally, only less than 5% were not able to access anti-retroviral drugs (ARV) while 8% were not able to access drugs to relieve anxiety or depression.
In terms of social effects, 41% reported seeing friends less or family less (39%). Nearly a third reported living in fear, while 27% reported feeling stressed. Less than 3% reported experiencing some form of stigma. However, COVID-19 was reported to have affected the youth economically with half of them reporting significant reduction in income with more male reporting compared to female p<0.001. About a third reported increased expense in their house or increased food prices and less than 23% reported loss of job. Of those with no form of employment, 23% were more likely to report complete loss of job compared to those with any form of employment (15%), p<0.001.