The discovery of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) COVID-19 disease came up in January 2020, and the World Health Organisation, (WHO) in collaboration with partners, expert networks, national authorities, institutions, and researchers, have been monitoring and assessing the evolution of the disease [1, 2]. The first case of COVID-19 in Nigeria was in February 2020 [3]. Since then, the Nigeria Centre for Disease Control (NCDC), and the world health agencies such as the WHO has developed a system of diagnosing and managing patients infected with the disease [1]. Efforts to reduce the spread of the COVID-19 are increasing, but the virus has continued to spread.  There were up to 191,773,590 confirmed cases, including 4,127,963 deaths by July 2021 [5].   The rate of disease spread is made worse by the emergence of COVID-19 variants, the alpha, beta, gamma, and delta variants and much more, making the disease of public health concern in the world and especially in Nigeria, that has reported the delta variant of COVID-19 [6, 7].  The need to evaluate the knowledge, attitude, and perception of the students of pharmacy, future health professionals, who will engage in disease management including that of COVID-19, is urgent, as this will contribute to the strengthening of the healthcare system in the ongoing response to the COVID-19 pandemic.

Study Design

Structured questionnaires were distributed among students in the 200 to 500 study levels of pharmacy at Madonna University, Elele, Rivers State, Nigeria. Rivers State is one of the 36 States of Nigeria, and it is in the South-south region. The stratified sampling method was employed in the survey with each class to form a stratum. Then, simple random sampling was employed within each stratum with each student in the various levels having the same probability of being chosen at any stage during the sampling process. The objective was to improve the precision of the sampling by reducing sample error. Questionnaires were self-administered to investigate students’ demographic data and to obtain information on their ages, sex, marital status, religion, and study levels. Students were asked about their knowledge of COVID-19, their attitude, and their practices on the disease. There are about 740 pharmacy students in the 200 to 500 study levels and information was obtained from 260 respondents in these classes. The students were on-campus at the time of the study. They were briefed on the significance of the study and made to recall their actions at the time of the COVID-19 pandemic lockdown, March to August 2020, before they returned to the university campus in October 2020. 

Data Analysis

The data was entered into a Microsoft-Excel worksheet and analyzed using Statistical Package for the Social Sciences (SPSS) version V27. The sample size was determined using Taro Yamane’s formula [8]. The data obtained were entered into a Microsoft-Excel worksheet and analyzed using Statistical Package for the Social Sciences (SPSS) version V27.

Inclusion Criteria

• Pharmacy students within the class of 200 to 500 study levels
• Pharmacy students present in the school during the time of administration of the questionnaire and who agreed to participate in the study

Exclusion Criteria

• Non-Pharmacy students
• Pharmacy students who were not on campus at the time of the study.

Results

Demographic Data

The respondents were more females (53.5%) than males. Most of them, 88.8%, were unmarried. Forage differentiation, 39.3% of respondents were of ages 16-20 years, 57.0 % within 21-25 years, and 3.7% within 26-30 years. Most of the respondents, 96.1%, were of the Christian faith, 1.9% Muslims, and 2% did not oblige (Table 1.)

Table 1: Demographic Data of Respondents.

Respondents Study Levels

The respondents were 24.23 % in year 200; 14, 23% in year 300; 32.69% in year 400 and 28.85% in year 500. The total number of students was grouped as one data and not differentiated into class levels because there were no significant differences in the class data.

Respondents’ knowledge and attitude towards COVID-19

The knowledge of the respondents on COVID-19 disease was evaluated using multiple questions. Most of the respondents (96.9%) understood that COVID-19 started in Wuhan, China; that the coronavirus is the cause of the disease (93.8%), and that the elderly were most badly affected by the disease (78.7%). The common symptoms of COVID-19 stated by the respondents include chronic cough, fever, fatigue, body ache, dyspnoea, ageusia, anosmia, wheezing, 88.8%. The respondents said that there is a need for symptomatic support to aid recovery for COVID-19 patients. Most of the respondents (85.3%) said that they observed the COVID-19 guidelines for the prevention of disease transmission. On the respondents’ understanding of COVID-19, the majority, 99.6% respondents, expressed doubt on the true nature of the disease and described it as a myth. This is because, at the time of the survey in 2020, most respondents had not met with real cases of COVID-19 infected persons. Such responses suggest a need for increased awareness programs by the government and by the school authorities. Most of the respondents, 87.6%, answered that there was no cure for the disease, at the time of the study, while 8.5% differed on this and suggested some local remedies such as steam inhalation, a drink of the hot extract mixture of ginger and garlic, and a drink of the mixture of some local herbs. On NCDC recommendations and keeping to recommendations, 45.7% of the respondents agreed to the importance of keeping to the rules, such as hand washing, social distancing, self-quarantining for 14 days, and prompt reporting of any suspected case, as measures for the control of the COVID-19 transmission. The drugs used in the management of COVID-19 had been in existence before the outbreak of the pandemic. As future pharmacists, respondents were asked to provide information on the drugs being repositioned for COVID-19. A majority (74%) of the respondents knew the meaning of drug repositioning and repurposed drugs. They were aware of some of the drugs and what these were used for before COVID 19. Of the respondents, 95% stated Chloroquine, the antimalarial drug; 80% named Ritonavir and Lopinar, the antiviral agents, and 60% named Tocilizumab, the immunomodulatory agent. For COVID-19 mitigation strategies, the respondents suggested that the government should provide more health facilities for both the public and private healthcare institutions, that the frontline medical personnel should always have prompt and adequate facilities, such as the provision of personal protective equipment for safety and efficiency and that there should be extra disease awareness programs to be extended to the grassroots.

Respondents’ Residence during the Covid-19 Lockdown Investigate

As COVID-9 was spreading rapidly to every part of the country and the students had to go back home at the peak period of the pandemic lockdown, it was significant to know about the location of the respondents and their abode during the pandemic.  This will inform on the spread of the data obtained from the students and the range of country coverage and reporting. The results showed that the respondents stayed in 32 out of the 36 States of the Federation including Abuja, the Federal capital territory. More respondents resided in Lagos (18%), Rivers (13%), Abuja (11%), and Anambra (11%) States than in the other States of the country (Figure 1).

Figure 1: Place of residence of respondents at the time of covid-19 lockdown.

The students of pharmacy were selected because pharmacy is a profession that is located within the health care system and pharmacy is indicated by the symbol of Hyegia, a Greek mythological goddess of health represented as holding a large bowl and snake. The bowl of Hyegia is the universally recognized symbol for pharmacy and public health. Health, hygiene, and pharmacy are inextricably linked [9]. This study was carried out in a Christian institution which attracted many more persons of the Christian faith as 96.1% of the respondents were of the Christian religion. Also, many parents believe in religious institutions and expect them to preserve a high moral discipline and so they will chose a religious institution first for their child or ward before another. The results show that female respondents (53.5%) were more than the males. This is not surprising since the females were observed to be more eager to collect the questionnaires and to participate in the study. In addition, the recently released statistics show a dramatic increase in female undergraduates in the country and that the proportion of female students in the country's universities has continued to rise since 1980 [10]. The gap between the genders in law, engineering, medicine, and pharmacy, continues to close, with the fear of a preponderance of females entering the universities. Many of the respondents were aged 21-25 (56.15%) and fit into the age group of the youths in the tertiary institutions in the country now. This age group is more eager to explore new horizons and compete for positions in the academic world. Most of them were unmarried students (88.8%). This is consistent with the fact that many students want to be done with their academic work, be independent and to secure a job before getting married. At the time of the survey the ongoing Year 400 curriculum was on disease epidemiology and clinical therapeutics, and this might have stimulated the interest of Year 4 students in participating in this study. It was observed that the Year 500, the final year students preferred to focus on completing their class projects and other clerking assignments, towards the completion of their degree program.  They had lost many months out of studies due to the closure of schools in the country.

The emergence of COVID-19 from Wuhan, China, in December 2019 and its rapid global spread across over 215 countries and territories has become one of the largest pandemics in recent times with several devastating and significant public health challenges [15]. With the infection, prevention and control (IPC) strategies adopted by the NCDC and the Nigerian government to curtail COVID-19, the adherence of the citizenry to the government’s efforts depends largely on their level of awareness and knowledge regarding the pandemic [16]. Unconcerned attitudes and, adherence to false and superstitious beliefs by the public often arise due to inadequate awareness and this further affects the level of preparedness and the proper implementation of IPC measures at the national or subnational levels. Hence the need for this study, which might prove as the baseline for planning awareness campaigns among university students, especially those in the public healthcare sectors, such as pharmacy, medicine and, nursing to help in directing the efforts and plans of the health authorities towards better containment of COVID-19 and its further spread. A global public health campaign strategy should increase knowledge of COVID-19 and control the spread of the virus from schools. In this regard, as many community pharmacists in the world continue to work in their communities to provide necessary patient care, the unending COVID-19 is a call to everyone including students, to work together to eradicate this pandemic.

At the time of the COVID-19 restrictions and lock down in the country the students stayed in different parts of the country. It was assumed that their responses to the survey would reflect the COVID-19 country response.

Ethical Review: This study was approved by the Departmental Board for students’ projects.

Conflict of Interest Statement: The authors declare that there is no conflict of interest.

We thank the students of the Faculty of Pharmacy, Madonna University that made themselves available to contribute immensely to this study.

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