Document Type : Original Article
Authors
Abstract
BACKGROUND: In the ongoing COVID‑19 pandemic, facemask use has been the most feasible
public health measure in preventing transmission of SARS‑CoV2 with the dual benefit of controlling
the source of infection and decreasing the risk of acquiring infection from infected people. Therefore,
COVID‑appropriate behavior regarding facemask use is imperative for controlling the pandemic. This
study aimed to assess COVID‑appropriate mask behavior and factors associated with it among the
patients attending outpatient departments of a public health institute in West Bengal.
MATERIALS AND METHODS: This cross‑sectional study was done among 298 patients attending
outpatient departments of Rural and Urban Health Units of a public health institute of Kolkata, during
October 2020–February 2021. A pretested questionnaire and an observational checklist based on the
World Health Organization guidelines were used to collect data. COVID‑appropriate mask behavior
was assessed by a five‑point domain‑wise scale, where good practice regarding facemask usage
was considered when the score was three or more. Statistical analyses were done in SPSS 16.0.
RESULTS: Good practices regarding COVID‑19 appropriate mask‑related activities were recorded
among 30.2% of the study participants. No difficulties faced during or on wearing a mask (adjusted
odds ratio [AOR] = 1.86, 95% confidence interval CI: 1.1–3.33) and higher socioeconomic
status (AOR = 2.25, 95% CI: 1.22–4.15) were significantly associated with good practice regarding
COVID‑19 appropriate facemask usage.
CONCLUSION: The magnitude of poor practice regarding COVID‑appropriate mask‑related behaviors
is quite high among the study participants. Awareness regarding correct mask handling, storage,
hygiene, disposal, and place of wearing from a reliable source would go a long way to curb the myths
and misinformation surrounding mask usage and encourage COVID‑appropriate mask behaviors
among the general population.
Keywords
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Kong. EClinicalMedicine 2020;22:100356.
41. ElacholaH, GozzerE, RahmanMN, Ditekemena J, Pando‑RoblesV,
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al. Practice and technique of using face mask amongst adults in
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45. MacIntyre CR, Chughtai AA. Facemasks for the prevention
of infection in healthcare and community settings. BMJ
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46. Tang CS, Wong CY. Factors influencing the wearing of facemasks
to prevent the severe acute respiratory syndrome among adult
Chinese in Hong Kong. Prev Med 2004;39:1187‑93.
47. Alam K, Palaian S, Shankar PR and Jha N. General public’s
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COVID-19 pandemic: a cross-sectional exploratory survey
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2. World Health Organization. Modes of Transmission of
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and review of the literature. Int J Environ Res Public Health
2020;17:5062.
8. Rothe C, Schunk M, Sothmann P, Bretzel G, Froeschl G,
Wallrauch C, et al. Transmission of 2019‑nCOV infection from an
asymptomatic contact in Germany. Engl J Med 2020;384:970‑1.
9. Tang JW, Liebner TJ, Craven BA, Settles GS. Schlieren optical
study of the human cough with and without wearing masks for
aerosol infection control. R Soc Interface 2009;6:S727‑36.
10. Wu J, Xu F, Zhou W, Feikin DR, Lin Zhu Z, Liang W, et al. Risk
factors for SARS among persons without known contact with
SARS patients, Beijing, China. Emerg Infect Dis 2004;10:210‑6.
11. Chu DK, Akl EA, El‑harakeh A, Bognanni A, Lotfi T, Hajizadeh A.
Physical distancing, face masks, and eye protection to prevent
person‑to‑person transmission of SARS‑CoV‑2 and COVID‑19:
A systematic review and meta‑analysis. Lancet 2020;395:1973‑87.
12. CDC. Use of Cloth Masks to control the Spread of SARS‑CoV‑2;
November 20, 2020. Available from: https://www, cdc.gov/
coronavirus/2019‑ncov/more/masking‑science‑sars‑cov2.
html. [Last accessed on 2021 Mar 12].
13. Leffler CT, Ing E, Lykins JD, Hogan MC, Mckeown CA,
Grzybowski A. Association of country‑wide coronavirus
mortality with demographics, testing, lockdowns, and public
wearing of masks. Am J Trop Med Hyg 2020;103:2400‑11.
14. Chen YJ, Qin G, Chen J, Xu JL, Feng DY, Wu XY, et al. Comparison
of face‑touching behaviors before and during the coronavirus
disease 2019 pandemic. JAMA Netw Open 2020;3:e2016924.
15. Shiraly R, Shayan Z, McLaws ML. Face touching in the time of
COVID‑19 in Shiraz, Iran. Am J Infect Control 2020;48:1559‑61.
16. World Health Organization. Advice on the Use of
Masks in the Context of COVID‑19: Interim Guidance;
June 05, 2020. Avaialble from: https://apps.who.int/iris/
handle/10665/332293?show=full. [Last accessed on 2021 Feb 20].
17. Office of the Principal Advisor to Government of India.
Manual on Home – Made Protective Cover for the Face
and Mouth for Curbing Spread of SARS CoV-2 Virus; 23
April, 2020. Available from: http://file://C: Users/Aiims/
Downloads/Advisory&ManualonuseofHomemade ProtectiveC
overforFace&Mouthcleanedpdf. [Last accessed on 2021 Mar 07].
18. Christopher DJ, Tharyan P. Experts Speak on Tackling COVID‑19.
Masks are Mandatory for All Now. The Hindu(Chennai); April 21,
2020. Avaialble from: https://www.thehindu.com/news/cities/
chennai/masks‑are‑mandatory‑for‑all‑now/article31400601.
ece. [Last accessed on 2021 Mar 11].
19. Asadi S, Cappa CD, Barreda S, Wexler AS, Bouvier NM,
RistenpartWD. Efficacy of masks and face coverings in controlling
outward aerosols particle emission from expiratory activities. Sci
Rep 2020;10:15665.
20. GOI: Ministry of Health & Family Welfare: Revised
guidelines for Home Isolation of Very Mild/
Pre‑Symptomatic/Asymptomatic COVID‑19 Cases; July 02,
2020. Avaialble from: https://www.mohfw.gov.in/pdf/
GuidelinesforHomeIsolationofverymildpresymptomatic
COVID19 cases.pdf. [Last accessed on 2021 Mar 02].
21. Thakur J. West Bengal Stares at COVID‑19 Biomedical Waste
Crisis as Disposal Facilities Reach Threshold Capacity.
Hindustan Times (Kolkata News); August 11, 2020.
Available from: https://www.google.com/amp/s/www.hindusthantimes.com/india-news/wb-stares-at-covid-19biomedical-waste‑crisis‑as‑disposal‑facilities‑threshold‑capa
cilty/story‑ZGSTqpCzBCtEnbZGAhhSYK_amp.html. [Last
accessed on 2021 Mar 11].
22. Tadele AA. Surgical face masks as a potential source for
microplastic pollution in the COVID‑19 scenario. Mar Pollut Bull
2020;159:e111517.
23. World Health Organisation. Coronavirus Disease (COVID‑19)
Advice for the Public: When and How to Use Masks; December
01, 2020. Avaialble from: https://www.who.int/emergencies/
diseases/novel‑coronavirus‑2019/advice‑for‑public/
when‑and‑how‑to‑use‑masks. [Last accessed on 2021 Mar 20].
24. The Principal Scientific Advisor to the Government of India. Mask
for Curbing the Spread of SARS‑CoV‑2 Coronavirus: A Manual on
Homemade Masks; March 30, 2020. Available from: https://static.
pib.gov.in/WriteReadData/userfiles/FINAL%20MASK%20
MANUAL.pdf. [Last accessed on 2021 Feb 21].
25. The Principal Scientific Advisor to the Government of India. Face
Covers for Curbing the Spread of SARS‑CoV‑2 Coronavirus:
Manual on Homemade Protective Cover for Face and Mouth;
April 03, 2020. Available from: https://mohfw.gov.inAdvisor
y&ManualonuseofHomemadeProtectiveCoverforFace&Mouth.
pdf. [Last accessed on 2021 Feb 23].
26. World Health Organization. Mask Use in the Context of COVID‑19:
Interim Guidance. Geneva: World Health Organization;
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mohfw.gov.in/covid_vaccination/vaccination/index.html.[Last
accessed on 2021 Mar 10].
28. W o r l d H e a l t h O r g a n i z a t i o n . C o r o n a v i r u s
Disease (COVID‑19): Vaccines; October 28, 2020. Available
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coronavirus/2019‑ncov/vaccines/fully‑vaccinated‑guidance.
html. [Last accessed on 2021 Apr 10].
31. Special Correspondent. Coronavirus/India Records 1.7 Lakh
New COVID‑19 Cases, 904 Deaths. The Hindu; April 11, 2021.
Available from: https://www.thehindu.com/news/national/
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eaths‑on‑april‑11‑2021/article34297190.ece/amp/.[Last accessed
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of COVID‑19; March 23, 2021. Available from: https://www.
mha.gov.in/whatsnew/mha-order-dt-230321-guidelines‑effecti
ve‑control‑of‑covid‑19. [Last accessed on 2021 Apr 11].
33. Scalvenzi M, Villani A, Ruggiero A. Community knowledge
about the use, reuse, disinfection and disposal of masks and
filtering facepiece respirators: Results of a study conducted
in a dermatology clinic at the university of Naples in Italy.
J Community Health 2021;46:786-793. Available from: https://
link.springer.com/article/100.1007/s10900‑020‑00952‑3. [Last
accessed on 2021 Feb 10].
34. Tan M, Wang Y, Luo L, Hu J. How the public used face masks in
China during the coronavirus disease pandemic: A survey study.
Int J Nurs Stud 2021;115:103853.
35. Cotrin P, Bahls AC, da Silva DO, Girão VM, Pinzan‑Vercelino CR,
de Oliveira RC, et al. The use of facemasks during the COVID‑19
pandemic by the Brazilian population. Multidiscip Healthc
2020;13:1169‑78.
36. Machida M, Nakamura I, Saito R, Nakaya T, Hanibuchi T,
Takamiya T, et al. Incorrect use of face masks during the current
COVID‑19 pandemic among the general public in Japan. Int J
Environ Res Public Health 2020;17:6484.
37. Gunasekaran GH, Gunasekaran SS, Gunasekaran SS, Halim
FH. Prevalence and acceptance of facemask practice among
individuals visiting hospital during COVID 19 pandemic: An
observational study. Preprints 2020; 2020050152. Available from:
https:// www.preprints.org/manuscript/202005.0152/v1. [Last
accessed on 2021 Apr 10].
38. Ganczak M, Pasek O, Duda‑Duma L, Swistara D, Korzen M. Use
of masks in public places in Poland during SARS‑Cov‑2 epidemic:
A covert observational study. BMC Public Health 2021;21:393.
39. Rahimi Z, Shirali GA, Araban M, Mohammadi MJ, Cheraghian B.
Mask use among pedestrians during the COVID‑19 pandemic in
Southwest Iran: An observational study on 10,440 people. BMC
Public Health 2021;21:133.
40. Tam VC, Tam SY, Poon WK, Law HK, Lee SW. reality check on
the use of face masks during the COVID‑19 outbreak in Hong
Kong. EClinicalMedicine 2020;22:100356.
41. ElacholaH, GozzerE, RahmanMN, Ditekemena J, Pando‑RoblesV,
Pa K, et al. Photo‑epidemiology to estimate face coverings use in
select areas in Asia versus the Americas and Africa during the
COVID‑19 pandemic. Travel Med 2020;27:taaa121.
42. Lee LY, Lam EP, Chan CK, Chan SY, Chiu MK, Chong WH, et
al. Practice and technique of using face mask amongst adults in
the community: A cross‑sectional descriptive study. BMC Public
Health 2020;20:948. Available from: https://bmcpublichealth.
biomedcentral.com/articles/10.1186/s12889‑020‑09087‑5. [Last
accessed on 2021 Feb 15].
43. GOI: The Principal Scientific Advisor. Advisory on Use of
Homemade Protective Cover for Face & Mouth; April 03,
2020. Available from: https://www.mohfw.gov.in>.PDF. [Last
accessed on 2021 Apr 11].
44. Al Naam YA, Elsafi SH, AlkharrazZS, AlfahadOA, Al‑Jubran KM,
Al Zahrani EM. Community practice of using face masks
for the prevention of COVID‑19 in Saudi Arabia. PLoS One
2021;16:e0247313.
45. MacIntyre CR, Chughtai AA. Facemasks for the prevention
of infection in healthcare and community settings. BMJ
2015;350:h694.
46. Tang CS, Wong CY. Factors influencing the wearing of facemasks
to prevent the severe acute respiratory syndrome among adult
Chinese in Hong Kong. Prev Med 2004;39:1187‑93.
47. Alam K, Palaian S, Shankar PR and Jha N. General public’s
knowledge and practices on face mask use during the
COVID-19 pandemic: a cross-sectional exploratory survey
from Dharan, Nepal [version 1; peer review: awaiting peer
review]. F1000Research 2021, 10:37 i6.Available from: https://
f1000research.com/articles/10-376
)