COVID-19 pandemic has severely impacted individuals and health care workers throughout the world. At the end of June 2020, cases are slowly decreasing in countries where there was early outbreak of the pandemic, while in Nepal the number of cases has started to rise rapidly. This study was conducted to ascertain the current status of students’ knowledge about the COVID-19 pandemic. Most students had good knowledge about the corona virus disease, its signs, and symptoms. Students from MBBS and BDS stream were aware of facts like the causative factors for the COVID-19 disease (95.6%) and the type of virus causing this infection (92.7%). This was in accordance with a recent study from Turkey and Pakistan [17, 21], where majority of students, (97.4%) were aware about the causes and the viral nature of the disease and also with another study from India, which showed 92.7% of the participants’ had good knowledge. [22] Our study showed that only 71% of students were aware about the mode of transmission of this virus, which is lesser compared to a similar study from India among students, where 91% knew about the transmission modes and the signs and symptoms of the disease.[22]
A study from Jordan evaluated the knowledge of transmissions of infection from one infected individual to others.[19] Our study did not have such type of question. In the present study 78.4% of participants knew about the signs and symptoms of COVID-19, which is lesser compared to a study from India, in which 86.7% of participants were aware of these symptoms and from Uganda, where 95% of students were aware of it. [22, 23] In the present study 99.3% of participants were aware about the important protective measures like avoiding crowds and maintaining hand hygiene. This is also in accordance to a study from India, where 96.9% of participants knew about preventive measures. Similar observations were seen for the recommended 14 days of isolation period for the affected patients. [22]
In this study, medical and dental students had acceptable (70% of maximum) knowledge about coronavirus. Good knowledge about the causative factors, the virus, and the routes of transmission can be attributed to the availability of information in the electronic media such as television, radio, social networking sites, and different websites. These findings were also seen in a study done among university students in Jordan. [20] Studies have shown that availability of information in mass and social media can be a source of information for the students. [22] Respondents, (91.5%) were also aware of the cautionary actions, self-isolation period as per WHO guidelines and the effective use of mask for preventing corona infection (94.3%). These results were like those from other published studies. [24,25] The knowledge levels regarding these questions were high in our study as compared to another study, where the knowledge for social distancing and wearing a mask was found to be 62.64% and the same for hand sanitization was 66.42% [26].
The results showed that for the questions regarding self-isolation in COVID-19 infection and recommended test for early case detection, a smaller number of participants responded correctly. The correct responses were only from 35% of participants. Similarly, for the statements for WHO recommendation for isolation of a patient with confirmed case of COVID-19 infection, and the survival of corona virus on plastic and stainless-steel surfaces, only 35% of participants responded correctly. Results were better for the statements regarding thermal scanners; 58.1% of participants responded that these were used to detect raised temperature from any infection. Social distancing issues were responded correctly by only 41.2% of students.
The knowledge levels among interns and graduated students were higher as compared to the students who are studying in other years according to another study from Iran. [27] The scores for the medical and dental students were significantly different according to years of study (p=0.033). Median score was significantly higher among those in the higher years of study. This may be due to content and curricula during the years of study created better understanding about diseases. [28] There was no difference in total score among BDS and MBBS students (P value=0.732). This may be due to access to various sources of information including government health authorities and social media which plays pivotal role in knowledge gain. [29] Similar findings were indicated in a study where older students in a higher year of study showed better knowledge as compared to the younger students from initial years of medical education. [18]
Regarding the treatment of corona virus by antibiotics, our study has shown that 77.3% of participants have responded correctly, which is lesser compared to a similar study from Jordan and Italy, where 88.6% and 80.7% of participants responded correctly. [18, 30] Similarly, the responses for a question regarding the specific drugs available for treating corona virus, in our study correct responses were obtained from 92.2% of respondents, which was better than the Italian study, where the correct responses were only 69.7%. [30]
The median knowledge score in our study was 70% (21 out of 30). The study conducted in Debre Birhan University, Ethiopia showed that the knowledge score was 73.8% [31], while it was 88.2% in a multicenter study from Ethiopia. [32] The knowledge score depends on a number of parameters including the respondents and the questions used to assess knowledge and understanding. Another study from Jordan showed a high knowledge of more than 80% and a Turkish study revealed a higher knowledge levels in female midwifery students compared to the present one. [17, 18]
The areas where the participants were having lesser knowledge were on PPE and facilities for proper management of COVID-19 at health facilities. In today’s circumstances when there is high demand of PPEs, health science students must have correct knowledge on types of PPEs recommended at various work stations at health facilities. [30] Also only 31% of respondents were aware that COVID-19 treatment guidelines have been developed for healthcare professionals working at hospitals in Nepal. [33] These are the areas where educational interventions can be targeted for better level of knowledge and also to fill in the gaps of knowledge related to COVID-19. Thus, student knowledge in our study is lower compared to that noted in other studies in the literature as mentioned. Some of the questions used in our study were similar while others were different from previous studies. The overall knowledge score was above 70% of the total.
Universities and medical colleges also share information about COVID-19 with students for better understanding of the disease along with its preventive measures. The students have not yet been placed in clinical settings for volunteering to help with the pandemic. An informal survey was done prior to conducting online learning at the institution to assess the availability of stable internet and the devices needed such as smart phones, laptops and desktops. Majority of the students had the access needed for successful conduct of online learning. Very few students (less than 2%) were not able to attend online learning due to slow internet speed. The institution is situated in the Kathmandu valley and most students are from within the valley and other urban centers. Medical and dental colleges in the country have shifted to online learning according to the authors’ informal discussions with educators in other institutions.
Universities in Nepal had instructed affiliated medical colleges to conduct online teaching and learning to reduce any delays and disturbances in academics due to the pandemic. [34] Various online software was used for initiating online teaching and learning sessions by the faculty members. This process was full of challenges for both the educators and the learners especially considering the unstable internet and less knowledge in the areas of digital learning. [34]
The knowledge gap mentioned above should be addressed through designing an educational intervention. Regular education programs covering areas where student knowledge was lower can be considered. The education process can be made more interesting through activities and group work. The major problems were noted in practical clinical and prevention and control aspects of COVID-19. A short module about these aspects of the pandemic can be offered by the 0departments of Community medicine and General medicine. Online videos and other resources are available for some diagnostic and treatment procedures and these can be incorporated into the module. The knowledge gaps can be addressed by preparing the guidelines and standard operating procedures with a clear detail towards the roles of medical and dental students in managing such pandemics. [35] Dental students face the risk of airborne and respiratory droplet borne infections during dental procedures and this should be properly addressed during the course. [36]
Students may not have a secure and private space for participating in digital learning due to the presence of family members due to the lockdown. Online learning can be considered as half a loaf of bread is better than nothing especially in the Nepalese context. [34] A recent article mentions about the challenges of online learning in low- and middle-income countries. [37] Most are applicable in the Nepalese context also. Online learning has not been used much previously in the institution. Online resources and an online library are absent. A learning management system is also not available. The institution has not conducted any assessments online. A situation similar to ours we believe may be prevalent in many medical and dental schools in developing countries. We are not sure how the pandemic will progress but medical and dental students can be a useful addition to the health manpower (with an emphasis on keeping them safe and only carrying out tasks under supervision and within their abilities). A similar study could be conducted in other institutions in developing nations to identify possible knowledge gaps and develop learning programs to address these.
Strength and limitations: Good response rate was the strength of the study. The study also had limitations. Student knowledge was tested only by using a questionnaire and the information was not triangulated with that obtained from other sources. The study was cross-sectional and was conducted only in a single institution. Despite the integrity pledge we are not completely sure that students did not consult other information sources or their friends and family members while answering the questionnaire.