Knowledge, attitude and practices of pregnant women related to COVID-19 infection: A cross- sectional survey in seven countries from the Global Network for Women's and Children's Health

Abstract

Objective: We sought to understand knowledge, attitudes and practices (KAP) re-garding COVID-19 in pregnant women in seven low and middle-income countries (LMIC).Design: Population-based prospective, observational study.Settings: Study sites in DRC, Kenya, Zambia, Bangladesh, India (two sites), Pakistan and Guatemala. 2 |NAQVI .1 | BACKGROU N DSince early 2020, the COVID-19 pandemic has had an im-portant impact on global health.1 COVID-19 has affected high-income as well as low- and middle-income coun-tries (LMICs) in Asia, Europe, North and South America, Australia, and Africa.2 On March 11, 2020, the World Health Organization (WHO) declared the COVID-19 outbreak as a global pandemic with exponential spread worldwide.1Although COVID-19 was initially considered a respiratory disease that in some cases caused severe pneumonia, it is now known as a complex multisystem disease ranging in se-verity from asymptomatic to fatal.3,4Since the emergence of the disease, COVID-19 has been accompanied by fear, lack of information and unprepared-ness.5 Because of the rapid spread of COVID-19 and its significant negative impact on the health and the socio- economic status of communities, the WHO has recom-mended several precautionary measures against the spread of COVID-19 which have been adopted by the governments of many countries. The success of these initiatives depends largely on people having accurate information about the dis-ease. Pregnant women and those with co-morbidities are at increased risk of developing complications due to severity of COVID-19 infection and due to physiological changes.4,6Limited knowledge related to COVID-19 symptoms, modes of transmission, risk status, and measures to prevent the spread of COVID-19 infection in pregnancy can increase the risk of contracting COVID-19 infection.A recent meta- analysis by Allotey et al.3 suggested that the cumulative effect of this disease on a woman and her growing fetus is detrimental. Most pregnant women remain asymptomatic and are less likely to manifest COVID-19 related symptoms than are non-pregnant women.4 Pre-existing medical conditions along with pregnancy-specific conditions such as gestational diabetes and pre-eclampsia are additional risk factors that may increase the risk of ad-verse outcomes in COVID-19-positive pregnant women as compared with women without the disease.3,7The WHO and others have emphasised the need to im-prove COVID-19 related health information in the pop-ulation.8 By understanding the knowledge, attitudes and preventive practices of the target community, informa-tional materials can be tailored to pregnant women and incorporated as part of the antenatal care (ANC) package related to COVID-19 symptoms, modes of transmission, knowledge of high-risk groups and measures to prevent contracting COVID-19 in pregnancy. Understanding how women will approach care seeking is crucial since one potential pathway relating the COVID-19 pandemic to adverse pregnancy outcomes is through a decrease in pregnancy related care.The aim of the present study was to determine the knowl-edge, attitudes, and preventive practices of pregnant women Population and sample: Pregnant women in the Global Network's Maternal and Neonatal Health Registry (MNHR).Methods: A KAP questionnaire was administered in face-to-face interviews with pregnant women from September 2020 through October 2021 in the MNHR.Main outcome measures: KAP regarding COVID-19 during pregnancy.Results: In all, 25 260 women completed the survey. Overall, 56.8% of women named ≥3 COVID-19 symptoms, 34.3% knew ≥2 transmission modes, 51.3% knew ≥3 preventive measures and 79.7% named at least one high-risk condition. Due to COVID-19 exposure concerns, 23.8% had avoided prenatal care and 7.5% planned to avoid hospital delivery. Over half the women in the Guatemalan site and 40% in the Pakistan site reduced care seeking due to COVID-19 exposure concerns. Of the women, 24.0% were afraid of getting COVID-19 from healthcare providers. Overall, 63.3% reported wearing a mask and 29.1% planned to stay at home to reduce COVID-19 exposure risk.Conclusions: We found a decrease in planned antenatal and delivery care use due to COVID-19 concerns. The clinical implications of potential decreases in care are unclear, but decline in essential healthcare utilisation during pregnancy and delivery could pose challenges for maternal and newborn health. More research is needed to address the impact of COVID-19 on routine pregnancy and delivery care.Tweetable abstract: Pregnant women in 7 low and middle income sites often had in-complete knowledge related to COVID-19 and practices to prevent COVID-19 dur-ing pregnancy varied.