Objective The aim of this study was to assess COVID-19-related knowledge, attitudes, and preventive practices of two Pakistani university populations. Methods A cross-sectional study was conducted among students and employees of two higher education institutions in Lahore, Pakistan, namely the University of Lahore and the Gulab Devi Educational Complex. Participants were recruited using a convenient sampling method. A validated 45-item, self-administered questionnaire was used to collect data. Total possible scores were 0-14 for knowledge (scores < 7, 7-10 and > 10 were considered to indicate poor, moderate and good knowledge, respectively); 0-7 for attitude (scores > 5 were considered to indicate a good attitude); and 0-18 for COVID-19 preventative practices (scores > 12 were considered to indicate good preventative practices). Results Of the 417 enrolled participants, 416 reported that they were aware of COVID-19 and social media was the major source of their information. Mean scores were 10.12 ± 2.20 for knowledge (good, moderate and poor knowledge in 50.2%, 42.8% and 7.0% of participants, respectively); 5.74 ± 1.28 for attitude (65.4% of individuals had a positive attitude); and 11.04 ± 3.34 for COVID-19 preventative practices (only 36.5% of participants had good preventive practices). Conclusion Pakistani university students and employees have good knowledge and attitudes regarding COVID-19, but unsatisfactory preventive practices. Therefore, health regulators should use multiple communication approaches, such as electronic, print and social media, phone messages, etc., to increase awareness and improve practices related to COVID-19. I use a face mask in the crowds and when I visit healthcare settings nowadays 148 (35.6) 88 (21.2) 104 (25.0) 76 (18.3)

High levels of stress are expected when crises affect people’s lives. Therefore, this web-based, cross-sectional study was conducted among university students from Pakistan to investigate the psychological impairment and coping strategies during COVID-19 pandemic. Google forms were used to disseminate the online questionnaire to assess anxiety (Generalized Anxiety disorder-7), depression (Patient Health Questionnaire-9) and the coping strategies (Brief-COPE). A total of 1134 responses (age 21.7±3.5 years) were included. The frequency of students having moderate-severe anxiety and depression (score ≥ 10) were ≍ 34% and 45%, respectively. The respondents’ aged ≥ 31 years had significantly lower depression score than those ≤ 20 years (p = 0.047). Males had significantly less anxiety (6.62 ± 5.70 vs 7.84 ± 5.60, p = 0.001) and depression (8.73 ± 6.84 vs 9.71 ± 7.06, p = 0.031) scores. Those having family member, friend or acquaintances infected with disease had significantly higher anxiety score (8.89 ± 5.74 vs 7.09 ± 5.56, p < 0.001). Regarding coping strategies, majority of respondents were found to have adopted religious/spiritual coping (6.45 ± 1.68) followed by acceptance (5.58 ± 1.65), self-distraction (4.97 ± 1.61) and active coping (4.81 ± 1.57). In conclusion, COVID-19 cause significant impairment on mental health of the students. The most frequent coping strategy adopted by students were religious/spiritual and acceptance coping. During epidemics mental health of students should not be neglected.

Introduction: Considering health professionals among high-risk individuals, we aimed to evaluate their knowledge, attitude and practices (KAP) regarding COVID-19. Methodology: This cross-sectional study was conducted among the health professionals (medical doctors, nurses, pharmacists, physiotherapists, hospital technicians and technologists) providing services at seven hospitals of Punjab province of Pakistan. A self-administered questionnaire was used to evaluate knowledge, attitude and practices regarding COVID-19. Results: All of the participants (N = 429) reported that they were aware of COVID-19 and social media was the major source (65%) of this information. Mean knowledge score was 12 ± 2.1, with 75.5% of participants having satisfactory knowledge. Doctors were found to have significantly better knowledge scores than the other health professionals (p = 0.001). Mean attitude score was 8.0 ± 1.2, with a wide majority of health professionals (86.5%) having positive attitudes. Regarding preventive practices, around 64% reported of always covering nose and mouth with a tissue paper during sneezing or coughing and nearly 65% disposed of the dirty tissue paper in trash bin. Only 40% of the participants reported that ‘if they do not have tissue, they cough or sneeze into upper sleeves’. Around 45% reported that they used face mask during their working hours in hospitals nowadays. Mean practice score was 23.3 ± 3.6, with 73.4% of health professionals having satisfactory practices. Conclusions: The overall COVID-19 related KAP of Pakistani health professionals are satisfactory, however some misperceptions and malpractices uncovered in the present study must be addressed to effectively combat COVID-19.

There is an increasing focus on researching children admitted to hospital with new variants of COVID-19, combined with concerns with hyperinflammatory syndromes and the overuse of antimicrobials. Paediatric guidelines have been produced in Bangladesh to improve their care. Consequently, the objective is to document the management of children with COVID-19 among 24 hospitals in Bangladesh. Key outcome measures included the percentage prescribed different antimicrobials, adherence to paediatric guidelines and mortality rates using purposely developed report forms. The majority of 146 admitted children were aged 5 years or under (62.3%) and were boys (58.9%). Reasons for admission included fever, respiratory distress and coughing; 86.3% were prescribed antibiotics, typically parenterally, on the WHO ‘Watch’ list, and empirically (98.4%). There were no differences in antibiotic use whether hospitals followed paediatric guidance or not. There was no prescribing of antimalarials and limited prescribing of antivirals (5.5% of children) and antiparasitic medicines (0.7%). The majority of children (92.5%) made a full recovery. It was encouraging to see the low hospitalisation rates and limited use of antimalarials, antivirals and antiparasitic medicines. However, the high empiric use of antibiotics, alongside limited switching to oral formulations, is a concern that can be addressed by instigating the appropriate programmes.

Background: COVID-19 patients are typically prescribed antibiotics empirically despite concerns. There is a need to evaluate antibiotic use among hospitalized COVID-19 patients during successive pandemic waves in Pakistan alongside co-infection rates. Methods: A retrospective review of patient records among five tertiary care hospitals during successive waves was conducted. Data were collected from confirmed COVID-19 patients during the first five waves. Results: 3221 patients were included. The majority were male (51.53%), residents from urban areas (56.35%) and aged >50 years (52.06%). Cough, fever and a sore throat were the clinical symptoms in 20.39%, 12.97% and 9.50% of patients, respectively. A total of 23.62% of COVID-19 patients presented with typically mild disease and 45.48% presented with moderate disease. A high prevalence of antibiotic prescribing (89.69%), averaging 1.66 antibiotics per patient despite there only being 1.14% bacterial co-infections and 3.14% secondary infections, was found. Antibiotic use significantly increased with increasing severity, elevated WBCs and CRP levels, a need for oxygen and admittance to the ICU; however, this decreased significantly after the second wave (p < 0.001). Commonly prescribed antibiotics were piperacillin plus an enzyme inhibitor (20.66%), azithromycin (17.37%) and meropenem (15.45%). Common pathogens were Staphylococcus aureus (24.19%) and Streptococcus pneumoniae (20.96%). The majority of the prescribed antibiotics (93.35%) were from the WHO’s “Watch” category. Conclusions: Excessive prescribing of antibiotics is still occurring among COVID-19 patients in Pakistan; however, rates are reducing. Urgent measures are needed for further reductions.