WITH PERSONS < 21 YEARS

SUMMARY REPORT: Adherence to COVID-19 preventive measures in Cameroon.

Background:
Cameroon has been heavily impacted by the coronavirus disease (COVID-19) outbreak.
Consequently, strict measures were taken by the government to stall its transmission at
the national level. We conducted a survey to investigate how well people adhere to the
government strategies for COVID-19 prevention;
Methods:
This was a web-based cross-sectional survey. Voluntary respondents provided data by
filling a short electronic questionnaire which was disseminated via local social media
platforms in Cameroon between June and August 2020. A Likert score (1-10) assessed
difficulty to stay at home. An adherence score (0-5) was constructed based on 5 main
preventive measures (physical distancing, face mask use, hand hygiene, mouth
covering when coughing/sneezing, and avoidance to touch face). See Table 1.
Table 1: Composition of the adherence score
Variable Scoring
I stay at 1.5-2m distance from others Yes 1 point
No 0 point
I wear face mask when going outside Yes 1 point
No 0 point
I wash hands regularly OR Yes 1 point
I use hand sanitizer No 0 point
When I cough, I cover my mouth/nose Yes 1 point
No 0 point
I avoid touching my face (eyes, nose, Yes 1 point
mouth) No 0 point
Adherence score range: 0 – 5

Results:
Of 2474 responses received, 2471 were analyzed after data cleaning. The mean age of
respondents was 33.1±11.0 years, and majority (74.9%) were males (Table 2). Based
on the PHQ-9 tool, 197 (8.0%) of participants were screened positive for depression
(score ≥10). Upon assessing the level of fear vis-à-vis COVID-19 on a 35-level score,
the mean fear score among our respondents was 19.8±6.4.
Table 2: Participant Characteristics

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[ALL] N
N=2471
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age 33.1 (11.0) 2471
age_group: 2471
21 and above 2268 (91.8%)
Less than 21 203 (8.22%)
gender: 2471
1 1852 (74.9%)
2 619 (25.1%)
region: 2471
Adamawa 138 (5.58%)
Centre 568 (23.0%)
East 81 (3.28%)
Far North 185 (7.49%)
Littoral 386 (15.6%)
North 95 (3.84%)
North West 351 (14.2%)
South 104 (4.21%)
South West 295 (11.9%)
West 268 (10.8%)
education: 2471
1Primary 28 (1.13%)
2Secondary 704 (28.5%)
3Undergrad 990 (40.1%)
4Postgrad 749 (30.3%)
language: 2471
en 865 (35.0%)
fr 1606 (65.0%)
religion: 2471
Catholic 908 (36.7%)
Jehovah Witness 59 (2.39%)
Muslim 277 (11.2%)
None 144 (5.83%)
Other 150 (6.07%)
Pentecostal 244 (9.87%)
Protestant 669 (27.1%)
Seventh Day Adventist 20 (0.81%)
residence: 2471
1Rural 247 (10.00%)
2SubUrban 465 (18.8%)
3Urban 1759 (71.2%)
Live alone: 2471
0 1990 (80.5%)
1 481 (19.5%)
Adults >70 in house: 2471
0 2136 (86.4%)
1 335 (13.6%)
profession: 2471
Student 627 (25.4%)
Jobless 426 (17.2%)
Self-employed 262 (10.6%)
Private employee 582 (23.6%)
Government 503 (20.4%)
Retired 71 (2.87%)
socio_economic: 2471
1 848 (34.3%)
2 1286 (52.0%)
3 300 (12.1%)
 4 37 (1.50%)
Work from home: 1527
0 1097 (71.8%)
1 430 (28.2%)
Healthcare worker: 2471
0 2161 (87.5%)
1 310 (12.5%)
smoking: 2471
0 2369 (95.9%)
1 102 (4.13%)
Underlying disease: 2471
0 2232 (90.3%)
1 239 (9.67%)
tested: 2471
No 1965 (79.5%)
Yes 506 (20.5%)
Covid test results: 489
Neg 459 (93.9%)
Pos 30 (6.13%)
flu_symptoms: 2471
0 1375 (55.6%)
1 1096 (44.4%)
Depression (phq≥10): 2471
0 2274 (92.0%)
1 197 (7.97%)
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Compliance to the different COVID-19 preventive measures was moderate to high. The
mean adherence score was 4.09±1.09, and 1177 (47.6%) of participants had an
adherence score of 5/5 (Table 3).
Table 3: Adherence to COVID-19 preventive measures
_________________________________
[ALL] N
N=2471
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mask_use: 2448
0 148 (6.05%)
1 2300 (94.0%)
social_distancing: 2471
0 736 (29.8%)
1 1735 (70.2%)
wash_hands: 2471
0 229 (9.27%)
1 2242 (90.7%)
Use handgel: 2471
0 766 (31.0%)
1 1705 (69.0%)
Cover mouth when coughing: 2471
0 482 (19.5%)
1 1989 (80.5%)
Avoid touching face: 2471
0 750 (30.4%)
1 1721 (69.6%)
stay_home if symp: 1388
0 413 (29.8%)
1 975 (70.2%)
market_last 7d: 2471
0 769 (31.1%)
1 1702 (68.9%)
Work from home: 1527
0 1097 (71.8%)
1 430 (28.2%)
Religious gathering: 2471
0 2149 (87.0%)
1 322 (13.0%)
Travel last 7d: 2471
No 1741 (70.5%)
National 714 (28.9%)
Abroad 16 (0.65%)
Adherence score: 2471
0 14 (0.57%)
1 51 (2.06%)
2 171 (6.92%)
3 410 (16.6%)
4 648 (26.2%)
5 1177 (47.6%)
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Among the 2297 mask users, 1755 (76.4%) reported wearing cloth (fabric) masks, 444
(19.3%) wore surgical masks, and 98 (4.3%) wore filters (eg: N95). Among the 148
persons not using face masks, the most common reason (as reported by 99 (66.9%) of
them) was that face masks made them uncomfortable. Adherence scores did not vary
significantly by gender (p= 0.9336). However, there were difference in adherence score
based on region of residence (lowest in the Centre and West regions, p<0.001);
healthcare workers also had higher adherence scores compared to the rest of the
participants (p=0.0247).
Healthcare workers often reported more flu-like symptoms compared to the rest of the
study population (Table 4). Based on the WHO clinical case definition of COVID-19
(ignoring any notion of previous contacts with an infected person), the self-reported
symptoms experienced during the past two weeks suggested that 132 (5.3%) of
respondents were suspected COVID-19 cases.
Table 4: Self-reported COVID-19 symptoms

________________________________________________
Not Healthcare
healthcare worker
(N=2161) N(=310) p.value
¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯
fever: 0.292
0 1910 (88.4%) 267 (86.1%)
1 251 (11.6%) 43 (13.9%)
loss_smell: <0.001
0 2124 (98.3%) 293 (94.5%)
1 37 (1.71%) 17 (5.48%)
dry_cough: 0.023
0 2073 (95.9%) 288 (92.9%)
1 88 (4.07%) 22 (7.10%)
productive_cough: 0.052
 0 2093 (96.9%) 293 (94.5%)
1 68 (3.15%) 17 (5.48%)
short_breath: 0.947
0 2121 (98.1%) 305 (98.4%)
1 40 (1.85%) 5 (1.61%)
sorethroat: 0.053
0 2060 (95.3%) 287 (92.6%)
1 101 (4.67%) 23 (7.42%)
coryza: 0.036
0 1943 (89.9%) 266 (85.8%)
1 218 (10.1%) 44 (14.2%)
headache: 0.003
0 1618 (74.9%) 207 (66.8%)
1 543 (25.1%) 103 (33.2%)
weakness: 0.308
0 1941 (89.8%) 272 (87.7%)
1 220 (10.2%) 38 (12.3%)
loss_taste: 0.084
0 2105 (97.4%) 296 (95.5%)
1 56 (2.59%) 14 (4.52%)
body_pains: 0.360
0 1911 (88.4%) 268 (86.5%)
1 250 (11.6%) 42 (13.5%)
nausea: 0.095
0 2104 (97.4%) 296 (95.5%)
1 57 (2.64%) 14 (4.52%)
diarrhea: 0.477
0 2061 (95.4%) 299 (96.5%)
1 100 (4.63%) 11 (3.55%)
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Factors associated with adherence score were investigated using an ordinal logistic
regression model. The final model was selected based on the least AIC value during a
backward stepwise process. This analysis found that increasing age, receiving COVID-
19 information from healthcare workers, and increasing fear of COVID-19 were
associated with higher adherence scores. Conversely, respondents who obtained
COVID-19 information from social media or who reported one or more flu-like symptoms
during the past two weeks were more likely to have low adherence scores (Table 5).
Table 5: Factors associated with COVID-19 adherence score
OR 2.5 % 97.5 % p value
age 1.0022461 0.9949462 1.0096385 5.484623e-01
education: Primary Ref
Secondary 0.7329432 0.3293997 1.5369547 4.252256e-01
Undergrad 0.5480976 0.2469066 1.1462815 1.215168e-01
Postgrad 0.5734739 0.2575780 1.2033451 1.539067e-01
Healthcare worker 1.2940845 1.0231774 1.6414011 3.241505e-02
info_social media 0.7268012 0.5950500 0.8859394 1.666890e-03
info_health worker 1.5958754 1.3597589 1.8743548 1.132155e-08
live alone 0.8806384 0.7267785 1.0681500 1.955544e-01
Flu_symptoms 0.5361453 0.4607869 0.6235476 6.534676e-16
Underlying disease 1.1171369 0.8532161 1.4676604 4.230977e-01
Fear_score 1.0507477 1.0379881 1.0637402 2.385201e-15
Live with adult>70y 0.9765522 0.7828580 1.2208568 8.341253e-01
Conclusion:
Moderate to high adherence to COVID-19 preventive measures was observed among
the Cameroonian population. Low adherence to the preventive measures increased the
likelihood to experience flu-like symptoms. While information from healthcare workers
was associated with increased adherence scores, obtaining COVID-19 information from
the social media adversely impacted adherence to preventive measures.
We recommend utilizing social media to regularly disseminate adequate information
about COVID-19 that has been validated by healthcare professionals so as to improve
adherence in the long term.