Transmission And Prevention of Covid 19 Among Drivers and Touts: A Case Study of Ongata Rongai Town, Kajiando County

Background: The Kenya ministry of health implemented initial measures on prevention and mitigation measures to contain the spread of COVID 19 virus. It has based its concern in the transport sector in the urban areas where sanitation and social distancing are almost impossible according to Kenya Bureau of Statistics, (2019). Ongata - Rongai covers approximately 212927 square kilometers with a recorded population of 1117840 based on 2019 census. There are 316179 households with an average size of 3 persons per household and a population density of 51 people per square kilometer. Ongata-Rongai confirmed 80,102 COVID 19 cases as of November 27 2020 since the first incidence was confirmed in the county (Ref). The number of COVID 19 deaths recorded is at 1427 which is quite worrying. This study is hence meant to assess the knowledge and practice on transmission and prevention of COVID 19 among the drivers and touts of Ongata -Rongai bus terminal

Objective: The main aim of the study was to determine the level of knowledge and practices on transmission and prevention of COVID 19 among drivers and touts in Ongata-Rongai bus terminal.

Materials and Methods: The study was a descriptive cross-sectional study among drivers and touts in Ongata- Rongai bus terminal. Systematic random sampling technique was used to recruit the study participants. Data collection was done through face-to-face interviews guided by a structured questionnaire. Data was coded and entered into SPSS version 22 software for analysis. The data collected was analyzed using mean, proportion and frequency tables.

Results: The study indicates that of the targeted respondents, there were more males 196 (98%) than females 4(2%) interviewed for the study. Additionally, the age group with most participants was 18-22 years, n=122 (61%). The respondents aged 28-38 years old were n=66 (33%), those aged 38-48 years were n=7 (3,5%). those aged 48-58 years were n=4(2%) and the least age group was 58-68 years, n==1 accounting to 0.5%. Furthermore, a majority n=177(88.5%) agreed that Covid 19 can be transmitted by air. Those who stated that Covid 19 can be transmitted through body fluids were n=18(9%) while those that stated that Covid 19 can be transmitted through sexual intercourse were n=5(2.5%) which comprised of the least percentage. We also found that the level of Education significantly affected the practices of Covid-19 prevention with a p value of 0.000 and a chi square value of 47. 531.Religious affiliation also has a significant effect on Covid-19 prevention, p=0.000, df=3 and chi square value of 59.126.

Conclusion: This study found out high level of knowledge on transmission and prevention of COVID 19 among drivers and touts. However, the study also found out an overall level of practice on prevention of COVID 19 to be very low below among the touts and drivers. The high knowledge level has been attributed by high level of education and also health education by the government through mass media. However, the low level of practices on prevention of COVID 19 has been mainly attributed to low levels of income and reluctance of public transport sector in implementing its policies.

Coronavirus is a virus that makes up a group of viruses which cause conditions like cold and also severe ones like severe acute respiratory syndrome and Middle East syndrome of the respiratory system WHO (2020). This is the first time COVID 19 has been in humans according to WHO (2019). Investigations have found out that severe acute respiratory syndrome was transmitted in China to humans from domesticated cats (WHO, 2003) and, Middle East Respiratory Syndrome in Saudi Arabia from camels to humans in 2012 (WHO, 2012). Corona Virus Disease (COVID 19) is a disease that results from novel Corona now called acute severe Respiratory Syndrome coronaviruses. COVID 19 was identified for the first time around Hubei area in Wuhan province in China (CDC, 2019). COVID 19 was first reported to WHO on 31ST December, 2019.

On March 11, the same year world health organization declared COVID-19 a global pandemic WHO, (2020). As of November 25TH 2020, confirmed cases of COVID 19 infections affected around 59 million individuals globally and at least 1.4 million deaths. As of 22 November, the weekly global rate of infection had slowly regressed down with new cases being only about 3 million being reported, the mortality rate however still increases with more than 68,000 deaths being reported worldwide; WHO, (2020). The United States incidences of 12,498,734 cases of COVID 19 already confirmed by of 25 November resulting to 359,005 deaths, [WHO 2020]. Females were 406 cases in every 100,000 people and 400 male cases and the mean age by years was 45 years. The median age in years in European countries is 43 years and 38 in China (NEEMA, 2020). On 7 April 2020, Italy also recorded 185,000 COVID 19 cases second to USA with 17,000 deaths highest number. However, after the government introduced containment measures, lockdown, mass measures and avoidance of risk behaviors according to Signorelli (2020) its prevalence reduced to significantly.

The first confirmed case of COVID 19 in Africa was on 14 February in Egypt and has ever since recorded 114,832 cases with 6,608 deaths and 102,390 recoveries as of 28th November 2020 according to WHO, (2020). By 1st April 43 sub-Saharan countries had already reported suspected cases of COVID 19. All the 46 sub-Saharan since reported cases. South Africa leads the region with nearly 40,800 confirmed cases in writing followed by Nigeria (115,00), Ghana, (8,900) and Cameroon (7,400); WHO, (2020). However, according to the modeling by the Centre for global development, assuming a worst case of infection scenario without government intervention 1.3% of population would be killed by the epidemic. Kenya has recorded a total of 81656 global cases compared to 61.6 million global COVID 19 cases of 25TH November 2020. The number of recoveries is at 54,125 compared to 39.4 million globally. COVID 19 deaths are at 1,455 compared 1.44 million globally.

On 2nd February 2020, the Kenya Ministry of Health advised all persons to remain highly vigilant, maintain optimum level of hygiene, ensure minimal contact with any person with respiratory tract symptoms and visit a health facility nearby for checkup and treatment of Urinary Tract infection if any of respiratory symptoms were affected. Pre-cautionary measures like closure of bars, entertainments and social spaces were also directed. Social distance at 1.5 meters, disinfection of local markets, garbage collection to ensure cleanliness and provision of clean water and soap were also resolved through the executive order number 2 by the emergency response committee on 24th February. People were required to maximize home stay to reduce risk of transmission, wearing of masks was also made compulsory for all citizens. Between May and June, the same year, COVID 19 prevalence was at 8.5% in Nairobi and ,9.3% in Mombasa (Kenya ministry of health press statement on COVID 19, 2020). However, when some of the measures were eased, COVID 19 positivity rate shot up from 4% in September to 16% in October. In October only over 15,000 new corona cases were recorded with approximately 300 deaths (National multi-agency command center on COVID 19, 2020).

This study aims at assessing the knowledge and practice on the transmission and prevention of COVID 19 virus among drivers and touts in Rongai bus terminal by identifying their knowledge and awareness of COVID 19 symptoms, and ability to carry out preventive and protective behavior, misconceptions about COVID 19 and also fears. This has helped to come up with long term interventions for corona virus transmission prevention among Drivers and Touts of public transport system in Kenya and across the globe.

Study Design

Descriptive cross-sectional design was employed among drivers and touts operating in Ongata Rongai. This design helped in collection of detailed data at reasonable time and cost

Study Area

The study was conducted in Kajiado County, Ongata Rongai town which is situated 17 km south of Nairobi County and east of the Ngong hills. According to KBS (2019), by population it is the eleventh biggest center in the country and also the most populated town in Kajiado County with a total population of 172,569.

Inclusion criteria

All drivers and touts in public transport sector operating in Ongata -Rongai town who give a written consent to participate in the study

Exclusion criteria

Drivers of privately-owned vehicles as they are in minimal contact with the public together with those who did not give consent to participate in the study

Sample Size Determination

Fischer’s formula (Fischer’s et al., 1998) was used to determine the sample size.

n =   

When; n=the sample size; Z= the standard normal deviate at the required confidence interval (1.96); P= the estimated proportion present in the population that is eligible for the program 50% (0.5); d = the level of significance set (0.05) confidence limit at 95% confidence interval.

q= 1-p

Therefore n= =384

As the target population is less than 10000, the following formula is used to calculate the final sample size.

nf =

Where: nf = the preferred sample size (when the target population is less 10000); n = the desired sample size (when the target population is more than 10000); N = the estimate of population size. In this study the target population is 200.

Therefore; nf ==200

274 was the final sample size for drivers and touts.

Sampling Method and Recruitment Process

Systemic random sampling was employed involving a random start and then proceeding with selection on an interval

Recruitment and Consenting

Every driver and tout in Ongata-Rongai bus terminal that meets the inclusion criteria was selected until the desired sample size was achieved. A written consent was obtained before the participants were included in the study 

Data Collection Tools

Data collection was done through face-to-face interviews by the researcher guided by a structured questionnaire designed by the researcher. Face to face interview enabled the researcher to gather more information from the participants in the study.

Pretesting Data Collection Tools

Pretesting validity and reliability of questionnaire was done by presenting to 10% of the sample size. 20 questionnaires were administered to the study subjects. Pretesting of the tools will take one day and thereafter the necessary corrections were made.

Data Analysis and Presentation

Data collected was coded and entered into an SPSS version 22 software for analysis. Descriptive data collected was analyzed using mean, proportion and frequency tables. The Chi-square test for independence and Fischer’s exact test was used to determine the relationship between various variables. A p-value of less than 0.05 was considered statistically significant. The findings were presented in form of figures, tables, charts, pie charts and graphs.

Ethical Considerations

The research proposal was presented to the school of Nursing research committee for approval and thereafter approval was sought from Kenyatta national hospital/university of Nairobi ethical review committee (KNH-UoN: 1031676). Research permit was granted from national commission for science, technology and innovation (NACOSTI). The institutional permission was given by research ethics committee of the catholic university of eastern Africa. Consent was also e attained from study participants after a verbal explanation and a written form about the purpose of the study before data collection. All COVID 19 protocols was observed in which each participant will have a face mask, maintenance of 1.5-meter social distancing, washing hands and sanitizing before handling the questionnaires.

Demographic characteristics of the study population

The demographic characteristics of the study focused on the age, gender, sex, education level, ethnic groups, religious affiliation and income level of the respondents.

Gender distribution of the respondents

Of the targeted respondents, there were more males 196 (98%) than females 4(2%) interviewed for the study as indicated in table 1 below.

Table 1: Gender distribution of the respondents

Key: n- sample size; % -percentage 

Age of the respondents

From the table 2 below, the age group with most participants was 18-22 years, n=122 (61%). The respondents aged 28-38 years old were n=66 (33%), those aged 38-48 years were n=7 (3,5%). those aged 48-58 years were n=4(2%) and the least age group was 58-68 years, n==1 accounting to 0.5%.

Table 2: Age of the respondents

Key: n-sample size; % - percentage

Marital Status of the Respondents

From the above table, the married respondents were n=61 (30.5%), the single were n=104 (52%), the divorced were n=5 (2.5%), the separated were 5 (2.5%), the widowed were n=2(1%) while those that were cohabiting were n= 23 (11.5%).

Table 3: Marital status of the respondents

Key: n- sample size; % -percentage  

Ethnic Group of the Participants

According to the table 4 below, a majority were the Kikuyu and made-up n=77 (38.5%), the Luo’s n=25 (12.5%), the Kisii’s n=25 (12.5%), Luhya’s n=11 (5.5%), Maasai’s n=7 (3.5%), those that preferred not stating were n=42 (20.5%) while the rest of the communities accounted to n=14(7%).

Table 4: Ethnic group of the participants

Key: n- sample size; %-percentage  

Religious Affiliation of the Respondents

According to the above table 5, most of the respondents were protestants accounting for n=101 (50.5%). The Catholics were n=47 (23.5%), the Muslims were n=19 (9.5%) while the rest accounted to n=33 (16.5%).

Table 5: Religious Affiliation of the respondents

Key: n- sample size; % -percentage 

Education Level of the Respondents

According to this study most of the respondents had studied up to secondary level n=103 (51.5%), those that had no formal education were n=32 (16%), those that had reached primary school level were n=57 (28.5%) while those that had completed their tertiary level were n=8(4%).

Income Level of the Respondents

Accordingly, most of the respondents n=125(62.5%) earned between ksh 10,000-20000 monthly. Those that earned less than ksh.10000 were n=39(19.5%), those that earned between ksh. 21000-30000 were n=33 (16.5) while those that earned between ksh 31000-40000 were n=3 (1.5%).

Belief in Covid -19 existence

In this study, majority of the respondents (n=162 -(81%) believe that Covid 19 exists. The other n=38 (19%) stated that Covid 19 did not exist.

Knowledge on Covid 19 transmission

According to table 9 below, a majority n=177(88.5%) agreed that Covid 19 can be transmitted by air. Those who stated that Covid 19 can be transmitted through body fluids were n=18(9%) while those that stated that Covid 19 can be transmitted through sexual intercourse were n=5(2.5%) which comprised of the least percentage.

Table 6: How is Covid 19 transmitted

Key: n- sample size; % -percentage

How would you recognize if someone has contracted covid 19

According to the responses given by the participants in table 10 below, a majority n=160 (80%) were able to tell that fever, cough, chills were signs of Covid 19. Those that indicated fainting as a sign of Covid 19 were n=14 (7%) while those that indicated rumor from a neighbor were n=10(5%).

Table 7: How will you recognize someone has contracted Covid 19

Key: n- sample size; % -percentage 

Knowledge on social distance

According to the table 11 below, a majority n=121 (60.5%) stated that the correct social distance is > 4-meter, n=34 (17%) stated that 1 meter was the correct social distance and only n=35 (17.5%) concluded that the correct social distance was 2 meters.

Table 8: How far should people stay away from each other?

Key: n- sample size; % -percentage  

Knowledge on proper way of wearing masks

According to this question as indicated in table 12 below, n=165(82.5%) were able to tell the correct way of downing masks as covering both nose and mouth. The least was n=7(3.5%) which stated that covering nose alone was the correct way of downing masks.

Table 9: What is the proper way of wearing masks

Key: n- sample size; % -percentage  

What is the right amount of time for quarantine

Most of the respondents as depicted in table 13 below, n=133(66.5) were able to tell that the right amount of quarantine was >14 days. Those that stated 10 days being the right amount were n=33 (16.5%) while the rest n=34 (17%) stated that the right amount of quarantine was less than five days as shown in table 14 above.

Table 10: What is the right amount of quarantine

Key: n- sample size; % -percentage

Do you think sharing of personal items can facilitate spread of Covid 19

According to this study majority n=185 (92.5%) agreed that sharing personal items can spread Covid 19 while n=15 (7.5%) disagreed that sharing of personal items could spread Covid 19.

Relationship Between Social Demographic Variables and Knowledge On Covid 19 Among Touts and Matatu Drivers of Ongata Rongai

Table 11: Illustrates relationship between social demographic variables and knowledge of Covid 19 prevention.

Key: %-percentage; <-less than; >-greater than; *- statistically significant, Ksh-Kenya shillings; x2- Chi-square.

Relationship Between Social Demographic Variables and Practice of Covid 19 Prevention Among Touts and Matatu Drivers of Ongata Rongai

According to the table 15 below, Education significantly affects practice of Covid 19 prevention with a p value of 0.000 and a chi square value of 47. 531.Religious affiliation also has a significant effect on Covid 19 prevention, p=0.000, df=3 and chisquare value of 59. 126.In these the muslims are seen to demonstrate poor practice of Covid 19 prevention as compared to other religions.

Table 12: Shows relationship between social demographic variables and practice of Covid 19 prevention amongst touts and matatu drivers of Ongata Rongai

Key: %-percentage; <-less than; >-greater than; *- statistically significant, Ksh-Kenya shillings; x2- Chi-square.

From this study, majority of the study participants were able to tell on COVID-19 transmission route as being air-borne. They were also able to tell on the signs and symptoms of Covid 19 as fever, cough and chills. This is similar to a cross- sectional study conducted in that knew that Covid 19 could be spread through air droplets and 86% were also able do clearly define the signs and symptoms of Covid 19 (Bekele et a.l, 2021). Majority were also aware of the correct social distance as being 2 metres or 6 feet apart. This was similar to a cross-sectional study conducted in Saudia Arabia with regards to Knowledge and practice towards Covid transmission whereby 75% had knowledge on the right social distancing (Ammar et al., 2021). However, this did not correspond to a similar cross-sectional study conducted in Bangladesh, whereby 48.3% did not have the basic knowledge on Covid 19 (Zannatul et al., 2020). With regards to knowledge on the right amount of quarantine, a majority were able to tell that the right amount of quarantine refers to self-isolation for > 14 days. This also agrees to the cross-sectional study in Ethiopia where 90% of the residents knew on the correct amount of quarantine (Bekele et a.l, 2021).

With regards to practice, majority of the respondents downed their masks before leaving home. Majority also washed their hands with soap and water for more than 20 seconds and most also practiced social distancing. This agreed to a study in Ethiopia whereby 61% practiced hand washing, and also practiced social distancing (Bekele et al., 2021). Similar results were also seen in a study conducted in Bangladesh on Knowledge, practice and attitude on Covid-19 outbreak and prevention whereby 93.8% of the participants implemented hand washing.  Another study in China also revealed that 96.1% out of 9,764 residents practiced good hand washing technique (Bingfeng et al., 2020). However, most of the respondents in the study did not down the masks properly and often downed them below the nose. This did not correspond to the study in Bangladesh whereby 98.8% wore their masks appropriately (Zannul et al., 2020). Most of the drivers in the study exceeded passenger number and this did not follow the government directives on social distance. This did not correspond to a study in Saudi Arabia whereby 79% of the participants knew about social distance and practiced the same (Ahmed et al., 2020).

From the study, majority of the participants practiced good coughing etiquette which helps prevent the spread of Covid 19. This agrees to a similar study in Iraq whereby 86% of respondents demonstrated good coughing etiquette and general good Covid 19 prevention practices with a mean score of (12.91+_1.67). This also corresponded to a study in Saudi Arabia whereby 75% knew that coughing and sneezing etiquette prevented the spread of Covid 19 (Ammar et al, 2020)

With reference to social demographic variables affecting knowledge, religious affiliation, gender and education level were seen to have a significant relationship with knowledge towards Covid 19 prevention. In this, the Muslims respondents were viewed to have little knowledge towards the disease while the other religions had significant knowledge concerning the disease. Those who had a higher education level had more knowledge as compared to those who had no formal education while the males had more knowledge as compared to their female counterparts. However, this was not in correspondence with a similar study in Bangladesh that sited that age (Older population) and employment affected the knowledge on Covid 19 with a p value of 0.01 and 0.02 respectively (Zannahul et al., 2020). However, the study agreed that level of education significantly affected knowledge on Covid 19 with a p value of 0.01.

With regards to practice, religious affiliation and education were seen to have an effect on Covid 19 prevention. However, this was not the case in a similar study in Ethiopia whereby, Gender that is females had good practice as compared to the males, age whereby the older age group demonstrated better practice of Covid 19 prevention, higher education and family income of >30,000 all had better practices and significantly affected prevention of Covid-19 with p values of less than 0.05 (Bekele et al., 2021).

This study found out that there was high level of knowledge on transmission and prevention of COVID 19 among drivers and touts. This high knowledge level has been attributed by high level of education and also health education by the government through mass media.  However, the study also found out an overall level of practice on prevention of COVID 19 to be low, this can be attributed mainly by low levels of income and reluctance of public transport sector in implementing its preventive policies.

Recommendations

1. The traffic police need to be proactive in enforcing policies put in place in the public transport sector towards Covid-19 preventive measures
2. Health education by the health sector to emphasize on importance of putting knowledge given on COVID 19 into practice
3. Policies that protect vulnerable groups from COVID 19 like the elderly to be put in place by the government especially to those using public transport
4. Ensure every bus terminal is provided with water and soap for hand washing

Acknowledgement

We would like to appreciate the roles of Francis NK., and Ndukui JG. For conceptualizing this study and in data collection and final write-up. Lastly, the efforts of Fatuma AF., and Ishmael M., in proof reading and reviewing of the final write-up.

Conflict of Interest

No conflict of interest declared.