Nutritional knowledge attitudes and practices towards the prevention and control of COVID-19 among educated young adults in Bangladesh
Highlight box
Key findings
• Around two-third of the study population had an average level of nutritional knowledge (65.4%), attitudes (68.1%) and practices (68.6%) about prevention and control of novel coronavirus disease (COVID-19).
• The level of nutritional practices was found to be significantly related to sex.
What is known and what is new?
• It is recommended to take a well-balanced diet and nutritious foods during COVID-19 pandemic to prevent and control the disease.
• Educated people comply better with the preventive measures of any given disease.
• This study explored the information related to nutritional knowledge, attitude and practice (KAP) regarding the prevention and control COVID-19 among young adult educated individuals in Bangladesh, which is quite limited globally and is still unknown in Bangladesh.
What is the implication, and what should change now?
• We assessed to what extent the educated young adults are aware and what they believe and practice regarding the potential role of nutrition and nutrients to prevent and control COVID-19, which reflects that there is a gap in their KAP.
• We suggest that nutrition-related health promotion and health educational programs are needed to design and implement among the population.
Introduction
Since 2020, the whole world is going through a pandemic situation posed by novel coronavirus disease (COVID-19), which has become a major public health threat globally (1). As there is no specific or effective treatment yet of this deadly disease, all potential therapeutics, interventions, and prevention strategies are crucial that can reduce the incidence or severity of the disease (2). Healthy nutrition is vitally important and it is advised and suggestive to take a well-balanced diet and nutritious foods during the COVID-19 pandemic (2-4). Nutrition boosts up the immune system and a better immune system fights against the infectious diseases well. Thus, nutrition plays a vital role to prevent and control infections and their consequences (3,5-7). It is recommended that healthy food intake should be a high priority and people should be mindful of healthy eating practices in order to lower the susceptibility to and long-term complications from COVID-19 (6). Available reports show that educated people usually comply better with the preventive and treatment measures of any given disease (8). Thus, it is assumed that young educated individuals may have a good knowledge about nutritional impact on the prevention and control COVID-19. However, the relevant information focusing on this highly important issue is quite limited and is still unknown in Bangladesh. This study aimed at assessing the nutritional knowledge, attitudes, and practices (KAPs) about the prevention and control of COVID-19 among educated young adults in Bangladesh. We present this article in accordance with the STROBE reporting checklist (available at https://jxym.amegroups.com/article/view/10.21037/jxym-22-50/rc).
Methods
Design, setting and population
This cross-sectional study was carried out in 2021 among a total of 166 young adults (aged 20–40 years) recruited conveniently using online social media platforms. The potential respondents were invited to participate in this study by distributing a Google form link of the questionnaire through Facebook and Messenger.
Instrument and technique
The structured questionnaire was adopted using existing literature comprising of socio-demographic variables (e.g., sex, age, education, occupation, and area of living) and the variables related to nutritional knowledge (10 items), attitudes (9 items), and practices (11 items) towards the prevention and control of COVID-19 (total 30 items). The knowledge domain (measured with dichotomous response scale ‘Yes’ and ‘No’) consisted of the information related to the prevention and control of COVID-19. The attitude domain (measured with three-point categorical response scale ‘Agree’, ‘Neutral’ and ‘Disagree’) consisted of the information related to the thoughts and beliefs about cause and treatment as well as prevention of COVID-19. The practice domain (measured with three-point categorical scale ‘Always’, ’sometimes’, and ‘Never’) consisted of health seeking behaviors. The self-reported responses were recorded automatically in the Excel sheet created from the Google form.
Scoring of the variables
For the knowledge domain, a composite score ranging 0–10 was calculated. Each item was treated as well as scored as correct [1]; or incorrect [0], and the sum of the 10 scored items was obtained. For the attitude domain, a composite score ranging 0–9 was calculated. Each item was treated as well as scored as positive response [1]; or negative response [0], and the sum of the 9 scored items was obtained. For the practice domain, a composite score ranging 0–22 was calculated. Each item was scored 2 for ‘always’, 1 for ‘sometimes’, and 0 for ‘never’, and the sum of the 11 scored items was obtained. Finally, the levels of KAPs were categorized as poor, average, and good when the respective composite scores were < mean − 1SD, within mean ± 1SD, and > mean + 1SD, respectively, according to the Bell Curve Theory.
Statistical analysis
The data from the Excel sheet were transferred into the Statistical Package for the Social Sciences (SPSS) software version 21 for processing and analyzing. Descriptive statistics (univariate analysis) was done for all of the variables and was expressed as number, percentage, mean and standard deviation. Comparative statistics (Chi-square test) was done to assess the relationship of levels of nutritional knowledge, attitudes, and practices with the socio-demographic factors. P<0.05 level was considered as the level of statistical significance.
Ethical statement
This study was conducted in accordance with the Declaration of Helsinki (as revised in 2013) and the Bangladesh Medical and Research Council (BMRC). Ethical clearance for the study protocol was taken from the Ethical Review Committee (ERC) of Center for Noncommunicable diseases Prevention Control Rehabilitation & Research (Reference No. CeNoR/EA/2102). Written informed consent was taken in the 1st section of the Google form describing all the ethical considerations prior to filling out the form.
Results
The Table 1 describes socio-demographic information of the respondents. Of all (mean ± SD age 27.4±3.5 years), the majority were men (54.8%), completed graduation education (47.9%), were employed (42.2%), and lived in urban areas (57.8%).
Table 1
| Variables | Number | Percentage |
|---|---|---|
| Sex | ||
| Men | 91 | 54.8 |
| Women | 75 | 45.2 |
| Age (years) | ||
| Below 28 | 84 | 50.6 |
| 28 and above | 82 | 49.4 |
| Level of education (n=165) | ||
| HSC | 17 | 10.3 |
| Graduation | 79 | 47.9 |
| Master | 69 | 41.8 |
| Occupation | ||
| Employed | 70 | 42.2 |
| Business | 5 | 3.0 |
| Homemaker | 7 | 4.2 |
| Others | 84 | 50.6 |
| Area of living | ||
| Urban | 96 | 57.8 |
| Rural | 70 | 42.2 |
HSC, Higher Secondary Certificate.
Most of the respondents reported that consuming plenty of fruit and vegetables (84.3%), adequate fluids (74.5%), and vitamins and minerals (81.8%) helps to prevent and control COVID-19. Nearly three-quarter of them (73.2%) reported protein-rich foods are necessary in this regard (Table 2). Seven in every ten (70.6%) agreed that consuming fruit and vegetables is effective in preventing and treating COVID-19, whereas 53.0% believed that a balanced diet can prevent the disease. Half of them (49.7%) agreed that supplementary foods should be included within our diet. However, over one-third believed that an overconsumption of hot-tempered foods (such as garlic and ginger) can prevent the disease (Table 3).
Table 2
| Variables | Number | Percentage |
|---|---|---|
| Can consuming plenty of fruit and vegetables help to prevent & control COVID-19? | ||
| Yes | 140 | 84.3 |
| No | 26 | 15.7 |
| Can drinking fluids adequately help to prevent & control COVID-19? (n=165) | ||
| Yes | 123 | 74.5 |
| No | 42 | 25.5 |
| Can consuming certain foods affect the prevention and treatment of COVID-19? (n=165) | ||
| Yes | 116 | 70.3 |
| No | 49 | 29.7 |
| Can consuming vitamins and minerals help to prevent & control COVID-19? (n=165) | ||
| Yes | 135 | 81.8 |
| No | 30 | 18.2 |
| Can avoiding greasy and salty foods help to prevent & control COVID-19? (n=160) | ||
| Yes | 92 | 57.5 |
| No | 68 | 42.5 |
| Is consuming carbohydrates necessary to prevent & control COVID-19? (n=164) | ||
| Yes | 89 | 54.3 |
| No | 75 | 45.7 |
| Is consuming protein-rich foods necessary to prevent & control COVID- 19? (n=164) | ||
| Yes | 120 | 73.2 |
| No | 44 | 26.8 |
| Can consuming more plant oil than animal oil help to prevent & control COVID-19? (n=164) | ||
| Yes | 93 | 56.7 |
| No | 71 | 43.3 |
| Can cooking food well kill coronavirus? (n=165) | ||
| Yes | 104 | 63.0 |
| No | 61 | 37.0 |
| Can herbal medicine help to treat COVID-19? (n=164) | ||
| Yes | 60 | 36.6 |
| No | 104 | 63.4 |
COVID-19, coronavirus disease 2019.
Table 3
| Variables | Number | Percentage |
|---|---|---|
| I believe that a vegetarian diet is better than any other diet to prevent & control COVID-19 (n=165) | ||
| Agree | 72 | 43.6 |
| Neutral | 62 | 37.6 |
| Disagree | 31 | 18.8 |
| Consuming fresh (uncooked) foods is of a higher nutritional value to prevent & control COVID-19 (n=165) | ||
| Agree | 93 | 56.4 |
| Neutral | 40 | 24.2 |
| Disagree | 32 | 19.4 |
| Eating the meat of wild animals can cause COVID-19 (n=163) | ||
| Agree | 54 | 33.1 |
| Neutral | 54 | 33.1 |
| Disagree | 55 | 33.7 |
| Consuming fruit and vegetables is effective in preventing and treating COVID-19 (n=163) | ||
| Agree | 115 | 70.6 |
| Neutral | 31 | 19.0 |
| Disagree | 17 | 10.4 |
| A balanced diet can prevent COVID-19 | ||
| Agree | 88 | 53.0 |
| Neutral | 48 | 28.9 |
| Disagree | 30 | 18.1 |
| Consuming fast food is the main cause of COVID-19 (n=165) | ||
| Agree | 27 | 16.4 |
| Neutral | 30 | 18.2 |
| Disagree | 108 | 65.5 |
| Supplementary foods should be included within our diet to prevent & control COVID-19 (n=165) | ||
| Agree | 82 | 49.7 |
| Neutral | 55 | 33.3 |
| Disagree | 28 | 17.0 |
| I think herbal medicine can help to treat COVID-19 (n=165) | ||
| Agree | 41 | 24.8 |
| Neutral | 70 | 42.4 |
| Disagree | 54 | 32.7 |
| An overconsumption of hot-tempered foods such as garlic and ginger can prevent the disease (n=164) | ||
| Agree | 56 | 34.1 |
| Neutral | 54 | 32.9 |
| Disagree | 54 | 32.9 |
COVID-19, coronavirus disease 2019.
A vast majority of the respondents (81.9%) reported they washed hands always before eating and drinking anything. Around 3 in every 5 always sanitized fruits and vegetables before consuming (62.8%), purchased food materials at healthy places (58.9%) and used personal dishes while eating (60.7%). Around half of them always avoided eating at crowded and unhealthy places (47.6%) and consumed more vegetables, salad, garlic and onion (46.3%). To further strengthen their immune system, 61.0% consumed vitamin-C rich fruits such as orange, lemon, etc. and one-third consumed supplementary foods (32.3%) and dairy products rich in vitamin-D and sea foods (33.5%) always. And, when affected by COVID-19, 48.5% tended (or will tend) to consume food materials rich in protein such as eggs, meat and cereals on an always basis (Table 4).
Table 4
| Variables | Number | Percentage |
|---|---|---|
| I wash my hands before eating or drinking anything | ||
| Always | 136 | 81.9 |
| Sometimes | 18 | 10.8 |
| Never | 12 | 7.2 |
| I avoid eating fresh (uncooked) food (n=163) | ||
| Always | 50 | 30.7 |
| Sometimes | 81 | 49.7 |
| Never | 32 | 19.6 |
| Before consuming fruits and vegetables, I sanitize them (n=164) | ||
| Always | 103 | 62.8 |
| Sometimes | 42 | 25.6 |
| Never | 19 | 11.6 |
| I avoid eating at crowded and unhealthy places (n=164) | ||
| Always | 78 | 47.6 |
| Sometimes | 75 | 45.7 |
| Never | 11 | 6.7 |
| I avoid eating fast foods (n=165) | ||
| Always | 42 | 25.5 |
| Sometimes | 107 | 64.8 |
| Never | 16 | 9.7 |
| I use more packed foods (n=165) | ||
| Always | 43 | 26.1 |
| Sometimes | 101 | 61.2 |
| Never | 21 | 12.7 |
| I use supplementary foods more to strengthen my immune system (n=161) | ||
| Always | 52 | 32.3 |
| Sometimes | 85 | 52.8 |
| Never | 24 | 14.9 |
| I consume hot-tempered food materials such as ginger, cinnamon and saffron to prevent COVID-19 (n=163) | ||
| Always | 44 | 27.0 |
| Sometimes | 90 | 55.2 |
| Never | 29 | 17.8 |
| To further strengthen my immune system, I consume fruits containing vitamin-C such as orange, lemon, etc. (n=164) | ||
| Always | 100 | 61.0 |
| Sometimes | 60 | 36.6 |
| Never | 4 | 2.4 |
| To prevent COVID-19, I consume more vegetables, salad, garlic, and onion (n=164) | ||
| Always | 76 | 46.3 |
| Sometimes | 71 | 43.3 |
| Never | 17 | 10.4 |
| To strengthen the immune system, I consume dairy products rich in vitamin-D and sea foods (n=164) | ||
| Always | 55 | 33.5 |
| Sometimes | 89 | 54.3 |
| Never | 20 | 12.2 |
| To prevent the disease, I tend to consume hot drinks (n=164) | ||
| Always | 63 | 38.4 |
| Sometimes | 77 | 47.0 |
| Never | 24 | 14.6 |
| If affected by COVID-19, I tend (or will tend) to consume food materials rich in protein such as eggs, meat and cereals (n=163) | ||
| Always | 79 | 48.5 |
| Sometimes | 70 | 42.9 |
| Never | 14 | 8.6 |
| I use rich sources of minerals more, such as sea food (n=161) | ||
| Always | 34 | 21.1 |
| Sometimes | 105 | 65.2 |
| Never | 22 | 13.7 |
| To prevent COVID-19 or while affected, I drink 6–8 glasses of water or other liquids each day (n=164) | ||
| Always | 103 | 62.8 |
| Sometimes | 47 | 28.7 |
| Never | 14 | 8.5 |
| When (or if) affected, I (or I will) use more carbohydrates such as rice, bread types and cereals (n=161) | ||
| Always | 56 | 34.8 |
| Sometimes | 71 | 44.1 |
| Never | 34 | 21.1 |
| I purchase food materials at healthy places (n=163) | ||
| Always | 96 | 58.9 |
| Sometimes | 57 | 35.0 |
| Never | 10 | 6.1 |
| I use personal dishes while eating (n=163) | ||
| Always | 99 | 60.7 |
| Sometimes | 52 | 31.9 |
| Never | 12 | 7.4 |
| I eat the meat of wild animals (n=164) | ||
| Always | 25 | 15.2 |
| Sometimes | 33 | 20.1 |
| Never | 106 | 64.6 |
COVID-19, coronavirus disease 2019.
When categorized, around two-third of the respondents had average levels of nutritional knowledge (65.4%), attitudes (68.1%) and practices (68.6%) about the prevention and control of COVID-19 (Table 5). And, there was no significant relationship of any socio-demographic factors with the level of nutritional knowledge (Table 6) and attitudes (Table 7). However, the level of nutritional practices was found to be significantly related (P=0.012) to sex (Table 8).
Table 5
| Variables | Number | Percentage |
|---|---|---|
| Level of knowledge (n=156) | ||
| Good | 36 | 23.1 |
| Average | 102 | 65.4 |
| Poor | 18 | 11.5 |
| Level of attitudes (n=160) | ||
| Good | 31 | 19.4 |
| Average | 109 | 68.1 |
| Poor | 20 | 12.5 |
| Level of practices (n=153) | ||
| Good | 24 | 15.7 |
| Average | 105 | 68.6 |
| Poor | 24 | 15.7 |
COVID-19, coronavirus disease 2019.
Table 6
| Variables | Level of nutritional knowledge, n (%) | χ2 value | P | ||
|---|---|---|---|---|---|
| Good | Average | Poor | |||
| Sex | 3.852 | 0.146 | |||
| Men | 20 (22.7) | 54 (61.4) | 14 (15.9) | ||
| Women | 16 (23.5) | 48 (70.6) | 4 (5.9) | ||
| Age (years) | 1.085 | 0.581 | |||
| Below 28 | 17 (21.0) | 56 (69.1) | 8 (9.9) | ||
| 28 and above | 19 (25.3) | 46 (61.3) | 10 (13.3) | ||
| Education (n=155) | 3.583 | 0.167 | |||
| Up to graduation | 23 (25.6) | 60 (66.7) | 7 (7.8) | ||
| Masters | 12 (18.5) | 42 (64.6) | 11 (16.9) | ||
| Occupation | 5.533 | 0.063 | |||
| Employed | 18 (27.7) | 36 (55.4) | 11 (16.9) | ||
| Others | 18 (19.8) | 66 (72.5) | 7 (7.7) | ||
| Area of living | 2.975 | 0.226 | |||
| Urban | 22 (25.0) | 53 (60.2) | 13 (14.8) | ||
| Rural | 14 (20.6) | 49 (72.1) | 5 (7.4) | ||
COVID-19, coronavirus disease 2019.
Table 7
| Variables | Level of nutritional attitudes, n (%) | χ2 value | P | ||
|---|---|---|---|---|---|
| Good | Average | Poor | |||
| Sex | 0.634 | 0.728 | |||
| Men | 19 (21.1) | 59 (65.6) | 12 (13.3) | ||
| Women | 12 (17.1) | 50 (71.4) | 8 (11.4) | ||
| Age (years) | 0.991 | 0.609 | |||
| Below 28 | 18 (22.2) | 54 (66.7) | 9 (7.1) | ||
| 28 and above | 13 (16.5) | 55 (69.6) | 11 (16.3) | ||
| Education (n=159) | 1.698 | 0.428 | |||
| Up to graduation | 17 (18.5) | 66 (71.7) | 9 (9.8) | ||
| Masters | 13 (19.4) | 43 (64.2) | 11 (16.4) | ||
| Occupation | 3.090 | 0.213 | |||
| Employed | 12 (17.9) | 43 (64.2) | 12 (17.9) | ||
| Others | 19 (20.4) | 66 (71.0) | 8 (8.6) | ||
| Area of living | 0.207 | 0.902 | |||
| Urban | 17 (18.5) | 64 (69.6) | 11 (12.0) | ||
| Rural | 14 (20.6) | 45 (66.2) | 9 (13.2) | ||
COVID-19, coronavirus disease 2019.
Table 8
| Variables | Level of nutritional practices, n (%) | χ2 value | P | ||
|---|---|---|---|---|---|
| Good | Average | Poor | |||
| Sex | 8.848 | 0.012 | |||
| Men | 11 (12.8) | 55 (64.0) | 20 (23.3) | ||
| Women | 13 (19.4) | 50 (74.6) | 4 (6.0) | ||
| Age (years) | 1.138 | 0.566 | |||
| Below 28 | 11 (14.9) | 49 (66.2) | 14 (18.9) | ||
| 28 and above | 13 (16.5) | 56 (70.9) | 10 (12.7) | ||
| Education (n=152) | 2.860 | 0.239 | |||
| Up to graduation | 12 (14.3) | 55 (65.5) | 17 (20.2) | ||
| Masters | 12 (17.6) | 49 (72.1) | 7 (10.3) | ||
| Occupation | 1.569 | 0.456 | |||
| Employed | 8 (11.8) | 48 (70.6) | 12 (17.6) | ||
| Others | 16 (18.8) | 57 (67.1) | 12 (14.1) | ||
| Area of living | 1.371 | 0.504 | |||
| Urban | 16 (18.0) | 61 (68.5) | 12 (13.5) | ||
| Rural | 8 (12.5) | 44 (68.8) | 12 (18.8) | ||
COVID-19, coronavirus disease 2019.
Discussion
The current study sought for the exploration of nutritional KAPs towards the prevention and control of COVID-19 among educated young adult generations in Bangladesh. To the best of our knowledge, perhaps this is the first ever study in this country as well as a global perspective that assessed to what extent the educated young adults are aware and what they believe and practice regarding the potential role of nutrition and nutrients to prevent and control COVID-19.
In this study, we found most (around two-third) of the educated young adult population of the country possessed average levels of nutritional KAPs. This finding indicates that the majority was averagely aware and motivated about the potential impact of nutrition and nutrients in order to prevent and control the life threatening COVID-19, and also practiced the same to do so. However, we found there is a clear downward gap in the good levels of knowledge, attitudes, and practices among the population, representing 23.1%, 19.4%, and 15.7%, respectively. It indicates that the population may have some barriers or a lackadaisical attitude to practice properly even after knowing good in this regard. Also, sex could be a potential factor regarding this issue as per our findings that poor level of nutritional practices was significantly higher in men, while good level of practices was found to be higher in women (Table 8). Comparing our findings in several relevant items of KAPs domains of this study with a relevant study carried out in Iran that evaluated nutritional knowledge, attitude, and behaviors regarding COVID-19 among the general population, our study population reflected better outcomes in general, mainly in the attitude and practice domains (9). Perhaps, this is because only educated young adults were recruited in this study.
However, some recent reports suggest that overnutrition could be detrimental to the recovery from different bacterial and viral infections. From the pathophysiological point of view, the reports indicate that overnutrition plays a decisive role in inflammatory process in infectious diseases influencing negatively in the recovery process, mainly in the acute stage. Therefore, a balanced or an optimal level of nutrition has been proposed (10-12). The mentionable limitations of this study could be non-randomization and small samples (which may reflect limited specific population generalizability). We didn’t measure the non-response rate. And, there might also be a chance of social desirability bias because of the self-reported nature of the responses, especially in the practice domain. However, findings of this baseline study will be helpful for the policymakers to insight how the educated young adult population in Bangladesh possesses knowledge and attitude regarding the potential role of nutrition to combat the deadly COVID-19 as well as practice to do so.
Conclusions
Around two-third of the study population had an average level of nutritional KAPs towards the prevention and control of COVID-19, while the good levels were found in around one-fifth of them. Respondent’s level of practices was found to be significantly related to sex. Nutrition-related health promotion and health educational programs are needed to design and implement among the population. Further large scaled studies are required to explore the situation more clearly.
Acknowledgments
Funding: None.
Footnote
Reporting Checklist: The authors have completed the STROBE reporting checklist. Available at https://jxym.amegroups.com/article/view/10.21037/jxym-22-50/rc
Data Sharing Statement: Available at https://jxym.amegroups.com/article/view/10.21037/jxym-22-50/dss
Conflicts of Interest: Both authors have completed the ICMJE uniform disclosure form (available at https://jxym.amegroups.com/article/view/10.21037/jxym-22-50/coif). The authors have no conflicts of interest to declare.
Ethical Statement:
Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.
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Cite this article as: Ritu RB, Mondal R. Nutritional knowledge attitudes and practices towards the prevention and control of COVID-19 among educated young adults in Bangladesh. J Xiangya Med 2023;8:6.
