Examining the Beliefs and Perceptions Associated to the COVID-19 Virus in the Wouri Division, Littoral Region of Cameroon

COVID-19 virus has become a global threat to the human population and society. The virus which originated from China in December, 2019 has swept across continents in the world. Cameroon has been one of the countries with a high infectious rate in the recent period having a majority of the infectious cases in the Littoral region. Lack of awareness play a major role in the rise of COVID-19 cases. This paper examined the perceptions of the existence and spread of the COVID-19 virus in Wouri Division, Littoral Region of Cameroon. The study involved a qualitative survey designed by online questionnaires which were forwarded to the inhabitants of Wouri Division through e-mails and ‘WhatsApp’. The survey included the perception of the origin and existence of the COVID-19 virus, its mode of disease transmission, preventive and control measures. A total of 573 respondents were obtained (317 females and 256 males). From the results, although a greater proportion of the respondents showed knowledge towards the COVID19 virus existence, transmission and prevention that could lead to a reduction in the spread of the disease, our findings suggested that there’s more need for public sensitisation of the virus especially its method of transmission, control and prevention.


Introduction
COVID-19 virus is a zoonotic virus with bats as a major reservoir (WHO, 2020). The virus was first identified in China based on sequencing of viral genome from samples collected from clinical patients (WHO, 2020). Preliminary cases were believed to have been transmitted through Bats. The outbreak of the COVID-19 was classified as pandemic by the World Health Organisation in March 11 2020 (CDC, 2020). In the past weeks, the fast spread of  throughout continents brought about a global concern. Closely monitored statistics by the WHO (2020) showed that as of the 6 th of April 2020, the global cases of infection stood at 1,215,667 while the number of deaths recorded was 65,655 with the USA leading with 311,637 of infectious cases. Also, concerning this pandemic disease, Italy is currently leading in the number of death cases, with about 15,362 deaths closely followed by Spain having a total of 12,418 deaths recorded (Worldometers, 2020). The infectious and death rates have seen an increase over the recent period. CDC report show that the virus is transmitted from person to person through close contact with each other, via infectious droplets or in contact with surfaces containing the virus. Currently, no vaccine has yet been developed to prevent the spread of this disease. Also, non-pharmaceutical methods have been the major preventive measure implemented by WHO to be strictly adhered in countries as well as local communities. Some of these strategies include; isolation or quarantine of infected or suspected cases, lockdown of countries borders, travel bans, closure of academic structures, restriction of gatherings and drinking spots, improvement of personal hygiene and keeping a distance of at least 1m away from the next person.
Unfortunately, the acceptance and strict adherence to these measures highly depends on the perception of the disease by the population concerned. Some studies have shown that there exist a strong correlation between the understanding or perception of a disease and a ready compliance to health recommendations (Gochman et al., 1997). sector as regards to this pandemic. As of date, no exploratory study has been carried out in Cameroon as regards to this threat. The aim of this study was therefore to examine the various beliefs and perception of the population in the Littoral region of Cameroon regarding the existence and spread of the COVID-19 virus. The assessment of these beliefs will help sensitise the population on corrective and preventive measures which will go a long way to reduce the incidence of the disease.

2.1The Study Area
Cameroon is a country located in the central part of Africa ( Figure 1A). The country is comprised of ten regions. The Littoral region of Cameroon ( Figure 1B

Study design and Population
The research design used involved a qualitative survey with the use of electronic structured questionnaires carried out between April 1 and 5, 2020. The study included participants of both genders and age groups, who resided in that region and who could easily assess the online questionnaires and was willing to take part in the study. All persons who accepted to take part in the study completed the questionnaire. The participants were giving assurance on the confidentiality of their personal identification or IP addresses. The total number of respondents in the survey was 573 which included 317 females and 256 males. Results were represented using tables and bar charts.

Results and Discussion
A greater proportion of individuals who took part in the study were made up of the active age group ≤ 40. Table 1 presents the age and gender of the subjects including the number of participants involved in each of the groups.

Perception of origin and existence of the COVID-19 virus
Based on the results obtained, it was observed that a higher portion of the respondents had

Perception of the mode and mechanism of COVID-19 virus transmission
The highest proportion of the respondents (˃ 80 %) understood the mode of transmission of the virus as being through person to person contact either by handshake or through contact with infectious droplets such as saliva or sputum (Figure 3.2). From this it shows that the majority

YES NO
of the population considered the virus to exist only on human surfaces. This however showed a limited perception as regards to the mode of transmission of this virus. This belief is not appropriate but rather misleading considering that research on viruses show that they can survive outside the human body for a length of time on various types of surfaces or objects found within domestic or public places (Abad et al., 1994). Less than (˂ 20 %) of the respondents believed that the diseases was sexually transmissible and could also be spread from the consumption of contaminated food and water.

Perception of effective control and preventive measures of the COVID -19 virus
Non-pharmaceutical measures including strategies implemented by the WHO were highly understood by the population in the disease prevention. The results (Figure 3.3) showed that hygienic practices which included usage of hand sanitizers, avoidance of handshake and wearing or usage of mask were more understood and practiced in this area (˃ 80%) than the It was observed that social exclusion in this region to an extent proved difficult especially in the market places. Majority of the population testified they couldn't stay away from markets and shops as most of them used the expression 'hunger kills more than the virus'. This possibly is one of the major challenges to the social exclusion strategy as prescribed by the health officials in the control of the spread of the virus. This could probably be due to the fact that most Africans survive directly on their market sales.

LIMITATIONS
One possible limitation of this study was that of voluntary participation which could give rise to responder bias as such it was not really possible to obtain the effective rate of response. Since questions were administered through online modes, individuals living in areas lacking network facilities could not participate in the survey. Lack of technological devices such as computers and telephones made the response rate low.

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The results have a lot of significance to health experts. Firstly, it highlights that the use of non-pharmaceutical strategies such as complete public exclusion and improvement of sanitation and hygiene is most effective to prevent the contraction of the disease as vaccines are not yet available. Nonetheless, our findings also highlight the need for more sensitisation of the public concerning the existence of the virus, mechanism of transmission and effective control or preventive methods as a portion of the population still have beliefs which are contrary and inadequate. These beliefs and perception can have an adverse effect to the population on the spread of the virus and can also contribute greatly to a challenge in controlling this outbreak.

USED ABBREVIATIONS
WHO; World Health Organisation, CDC; Center for Disease Control