The aim of our research was to evaluate the knowledge and perceptions of childbearing women in Moramanga regarding COVID-19. In our population, only 36% had a good level of knowledge about the disease. This knowledge was influenced by several sociodemographic and sociospatial determinants. Indeed, living in an urban area, owning a mobile phone, having a radio, watching TV, reading journal papers and being aged between 27 and 41 years old increased the likelihood of having good level of knowledge of COVID-19 for our study population. On the other hand, working in the primary and tertiary sectors decreased the probability of having a good knowledge level of COVID-19.
The results obtained in studies conducted in East African countries are similar to those of the present study, where the knowledge scores of the general population are low compared to those in West African regions [15, 26], such as in Ethiopia, where almost 43% of the general population investigated in one study had an acceptable knowledge of the disease.
As in most African countries, the most common symptoms of COVID-19 reported by respondents were fever, cough, fatigue and cold in both rural and urban areas [27–29]. In southwestern Ethiopia [27], Ivory Coast [28] and Cameroon [29], during outbreaks of COVID-19, fever, dry cough, dyspnoea, myalgia and fatigue were known by the general population as the main clinical symptoms of COVID-19.
Compared to our results, which show that a high proportion of the respondents mentioned direct contact between individuals as a mode of transmission of COVID-19, for the general population in a study in southwestern Ethiopia, respiratory droplets of infected people were the mode of transmission of COVID-19 [27].
In terms of treatments against COVID-19, despite existing chemoprophylactic treatments for COVID-19, traditional, nonpharmaceutical treatments and herbal remedies, such as COVID organics or CVO, were largely used by respondents during the two waves of the COVID-19 pandemic spanning from 2020 to 2021. The CVO cure has been recommended by the Malagasy government as herbal prophylaxis to prevent and treat COVID-19 since April 2020 [22, 23]. This is probably because traditional therapy and herbal remedies are used as popular treatments for many diseases in Madagascar and in Africa, both in urban and rural areas [24, 25]. In a context where most households live below the threshold of poverty and where pharmaceutical treatments are particularly expensive for the general population in African countries, traditional treatments are less expensive alternatives or complementary treatments [25, 26]. COVID-organics or CVO has also received much attention from the Malagasy media because the Malagasy government has advocated it as a treatment for COVID-19 since April 2020 [21, 22].
The perception of epidemic waves of COVID-19 is mainly related to the restrictions imposed by the health emergency between 2020 and 2021 among childbearing women. The most severely felt were reported to be daytime travel restrictions and confinement.
Periods of health emergencies have prompted childbearing women in our sample to change their daily habits and adopt specific measures to cope with the spread of COVID-19. The first epidemic wave (March to October 2020) was perceived as more severe than the second (April to September 2021). This perception of the severity of the waves seems to be more related to the impact on women's daily lives due to restrictive measures taken during the health emergencies than to the fear of the disease. Most people living in Moramanga rural and urban areas work in the informal sector, and restrictive measures such as lockdown and displacement limitations implemented during the day have an impact on the daily income of the population, as in other African countries [26–30].
In terms of sociospatial determinants influencing perceptions and knowledge of COVID-19, the area of residence may play a central role, according to our results. Women residing in urban areas have a better knowledge of the disease than those residing in rural areas. This is probably because urban women have more access to information about the disease than rural women. This is similar to the results of a study comparing KAP levels on COVID-19 in rural and urban populations in Cameroon [29] and Ethiopia [30], where urban populations have more knowledge about the disease than rural populations. Rural populations have limited access to information channels about COVID-19 [29–32]. In relation to sociodemographic determinants, women working in the primary sector and tertiary sector are also more likely to have a lower level of knowledge of the disease than those who are not working. This is probably because women who are working are less aware of COVID-19 due to have a lower level of access to information about COVID-19 than those who are not working.
The other determinants of knowledge of COVID-19 seem to be associated with communication channels (possession of a mobile phone, television, awareness campaigns, etc.) and the knowledge of people who have already documented episodes of COVID-19. These results confirm that people with access to the media and various sources of information have a better knowledge of COVID-19, as seen in studies conducted in Cameroon [29] and Ethiopia [30].
Women aged between 27 and 41 years old may be more concerned about COVID-19 as they tend to have a family; i.e., they would be worried about the health of their young children more so than women in other age groups. Indeed, in 2018, according to the National Institute of Statistics in Madagascar regarding the last population census, the average age at childbirth was 29.4 years nationwide. By place of residence, the average age at childbirth is 28.8 in urban areas versus 29.6 in rural areas [34]. This could imply that below these ages, women would be less protective of their surroundings, whereas above the age of 41, the probability of having a young child decreases.
Limitations Of The Study
For reasons of accessibility and security, some women living in remote areas of our study were not included in our investigations. Thus, our results were limited by the lower representation of women living in remote areas. The women in remote areas who needed to be investigated were replaced by women living nearby in accessible locations.