Is Tanzania Freewill Prevention A Response Enough? Reflecting Market Vendors Adherence to Covid-19 Infection Prevention Control Measures in Morogoro Municipal

Is Tanzania Freewill Prevention A Response Enough? Reflecting Market Vendors Adherence to Covid-19 Infection Prevention Control Measures in Morogoro Municipal | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Is Tanzania Freewill Prevention A Response Enough? Reflecting Market Vendors Adherence to Covid-19 Infection Prevention Control Measures in Morogoro Municipal Douglas G. Ndeki, Mackfallen Anaseli This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4423452/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract BACKGROUND The purpose of this evaluation study was to assess the status of adherence of IPC measures among market vendors in Morogoro Municipal. Specifically, the study aimed to examine IPC measure implemented, the proportion of market vendors’ adherence to IPC measures, factors influencing adherence of IPC among market vendors and perception of market vendors on COVID-19 prevention measures. METHODS We employed a cross- sectional study to 525 respondents, where 524 were market vendors and 1 respondent was from Morogoro Municipal Health authority. We deployed sequential mixed methods to the study including questionnaires (quantitative), interviews and unstructured observations (qualitative). We used descriptive statistics to summarize socio - demographic characteristics and Multivariate Logistic regression model to analyze factors influencing adherence of COVID-19. RESULTS 81.1% of market vendors adhere to IPC measure. However, there were difference in adherence across groups by education 43%. Hand hygiene was the common practiced IPC measure (60.1%), whereas the least practiced measure was mask wearing (10.5%). Age, education level, residence, knowledge on isolation period and previous experience with someone with COVID-19 had influence to adherence of COVID-19 prevention measures by significance value (P < 0.05). CONCLUSION Adherence status of market vendors to COVID-19 IPC measures is satisfying. The study recommends improved behavioral change measures such as education in rural areas as it was in urban areas and an increased budget on emergency preparedness. COVID-19 IPC IPC adherence Figures Figure 1 BACKGROUND Coronavirus disease (COVID – 19) has become the major public and global health dilemma in the contemporary world. It is an emerging respiratory disease caused by viruses known to cause illness ranging from common cold to severe acute respiratory syndrome (Yin & Wunderink, 2018 ). Evidence shows the disease was transmitted from bats to humans and was first detected in December 2019 by Chinese authorities in Wuhan city, Hubei province of China and began to spread rapidly throughout the world. The disease is highly infectious and can be transmitted from man to man through contact (Zhong et al., 2020 ). The common symptoms of COVID – 19 include dry cough, fever, myalgia, dyspnea and fatigue. Moreover, statistics shows that 18.5% of patients with COVID – 19 develop to severe stage characterized with severe acute respiratory syndrome (SARS), bleeding and coagulation dysfunction, septic shock and difficulties in tackling metabolic acidosis (Chen et al., 2020). Statistics from African Region as of September 21, 2020 reported South Africa taking the lead in highest number of COVID – 19 cases above all African countries with 661,211 confirmed COVID – 19 cases and 15,953 deaths. Other African countries with high number of COVID – 19 cases and deaths include Cameroon with 20,598 confirmed COVID – 19 cases and 416 deaths, Ghana with 46,004 confirmed COVID – 19 cases and 297 deaths and Côte d’Ivoire with 19,269 confirmed COVID – 19 cases and 120 deaths (WHO, 2020 ). Moreover, other African countries reported COVID – 19 cases and deaths, Namibia with 10,377 confirmed COVID – 19 cases and 112 deaths, Burundi reports lower COVID – 19 cases estimated at 474 confirmed cases and only one death as well as South Sudan with 2649 confirmed COVID – 19 cases and 49 deaths (WHO, 2020 ). The first case of COVID-19 disease in Tanzania was reported on 20/03/2020. Following the report, various steps were taken to prevent the disease from spreading in the country. The measures involved the formation of a disease response committee as established by the Disaster Management Act of 2015. Furthermore, the governments through the Ministry of Health Social Development gender the elderly and children provided various guidelines (IPC) on how people should live in the pandemic period. However, despite the WHO guidance on IPC, reports from Tanzania reveal that Tanzania had its own way fighting COVID-19 compared to other countries. Unlike her neighbors in East Africa such as Kenya and Uganda who initiated country lockdown interventions and imposing travelling restrictions, Tanzania issued the Community Covid-19 prevention guideline of 2020. The guideline focused on the practice IPC in pandemic which includes hand washing, social distancing as well as wearing face masks. The guideline also guided IPC education which should be given to community in order to prevent COVID-19. Experiences from other countries have revealed that implementation and practices of Tanzania way largely depends on individual choices to adhere on the prevention practices for COVID − 19 (Geldsetzer, 2020 ). This is because Tanzania did not apply force in preventing and controlling the disease as the responsibility of COVID – 19 preventions were imposed to individuals adhere IPC guidelines, contrary to other countries which forced citizens to lockdown. As of 29th April 2020, Tanzania had publicly confirmed 509 COVID-19 cases and 21 deaths (WHO, 2020 ) in the first wave. Moreover, despite the absence of official statistics of the second wave in Tanzania, The Roman Catholic Church of Tanzania has reported 85 deaths associated with COVID-19 (TEC, 2021). Henceforth, the presence of 85 reported deaths associated with COVID-19 in a single community of Tanzania indicates that COVID-19 pandemia is a public health dilemma which calls for immediate interventions. On the other hand, adherence status of the COVID-19 IPC protocols and guidelines among different groups of people in Tanzania is still unknown. As studies conducted in Tanzania on adherence of IPC were conducted at facility level (Kinyenje, 2020 ) while the other one focused economic effects of Tanzania method (Masebo, 2020). With economic activities continuing in its normal course market vendors are at risk for COVID-19 infection as they have constant interaction with different people. This is because market vendors vend basic needs of human being such as food and other needs. Therefore, understanding adherence status of COVID-19. Infection Prevention Guideline among market vendors forms a foundation on understanding Tanzania intervention as well as prevention of disease. Being one of the biggest food producers in the country, Morogoro Municipal has numerous markets which serves Morogoro Municipal residents and neighbor region such as Dar es salaam (Makorere, 2019 ). Interaction between market vendors and customers from various regions as well as residents makes markets vendors in Morogoro Municipal among risk group in the country. Hence force; this study focused on adherence status of IPC measures among market vendors in Morogoro Municipal. METHODS Evaluation design Cross sectional study design was employed in this evaluation study, and a sequential mixed method dominated by quantitative methods was used to establish both proportion of market vendors adhering to COVID-19 IPC guideline as well as factors influencing adherence to IPC guidelines among market vendors. Qualitative approach was used to explain perception of market vendors on IPC measures and IPC measures implemented by Morogoro Municipal. Theory Driven Evaluation was used to conduct an outcome evaluation whereas health belief model was used to link interventions (cues to action) and behavioral change (outcome). Evaluation was guided by Tanzania COVID-19 prevention strategies theory were COVID-19 prevention guidelines was used as the main program document. Since behavioral change after issuing guidelines was evaluated therefore outcome evaluation was appropriate for this study. Data collection procedures A standardized questionnaire was administered to market vendors in Morogoro Municipal. The questionnaire collected information on socio-demographic characteristics of study participants; age, sex, education level, marital status and residence. An interview guide that was used to collect information relating to reason facilitating or undermining the use of recommended COVID-19 infection Prevention Control guidelines as well as perception toward COVID-19 to market vendors. Observation was used to confirm physical initiatives implemented by Morogoro Municipal, photos were taken in all aspects of IPC intervention to all markets and non-participatory observation was used also to observe market vendors’ prevention behavior. Hand washing behavior, mask wearing behavior and social distance were observed. Variables and measurements The dependent variable is adherence of IPC during COVID-19 outbreak. The independent variables for this study were social – demographic characteristics such as age, sex, education level, occupation, residence and income status. Also, other factors like knowledge on IPC, training on standard precautions, availability and accessibility of PPE and attitude towards the use of PPE. Perception was measured using 6 questions and response to each question was rated using Likert scale ranging from strongly agree (1 point) to strongly disagree (5 points). It was further qualified by interview conducted to market vendors. Data Analysis All questionnaires were collected on the same day and checked for completeness and clarity. The computer software SPSS (IBM SPSS version 22) was used to analyze data. Moreover, Microsoft excel was specifically used in drawing charts. Descriptive statistics was conducted to summarize demographic characteristics. Frequencies and percentage were used to summarize categorical data on propotional of Market vendors adherence to COVID-19 IPC measures in categories such as age, sex education and residence. Odds ratios and 95% confidence intervals were used to determine the strength of the association between factors and adherence to COVID-19 prevention Measures. Moreover, multivariate logistic regression analysis was used to analyze factors associated with adherence of IPC during COVID-19 outbreak while controlling for potential confounders. Variables with p < 0.2 in the bivariate analysis were included in the multivariable model. A p-value of less than 0.05 was used as a cut-off point for assessing statistical significance. For interview data, phenomenological analysis was conducted to get market vendors experience on adhering to IPC measures as well as experience of Morogoro Municipal Authorities in implementing preventing measure in Morogoro Markets. Researcher conducted interpretation to every response of the key informant interviewed. Thematic was done to describe common theme arise from interviewed market vendors which was done together with content analysis to explain observed information such as hand washing facilities installed at Morogoro Markets and Market vendors behaviour. Interview was conducted in Swahili then transcribed in English within 24 hours after interview was conducted. Review of transcript was done by all team members in order to cross check accuracy and completeness of the data. Transcribed script showing data analyses were imported in Atlas Ti. In atlas Ti all data were coded deductively and inductively within five main predetermined themes namely perception of market vendors toward efficacy of measures, perception of market vendors toward the disease threat, perception of market vendors on susceptibility to get the disease and factors influencing adherence to COVID-19 (Cue to action). Families of content were created by grouping similar theme. Researchers coding and families creation was done together with creation of memos which helped researcher to add their insights, views and reflections on the responses. Final report was lastly written based on output downloaded from Atlas.ti and photos taken to various contents. Atlas.ti output comprised codes, families and memos. Ethical considerations The approval to undertake this study was given by the Directorate ofResearch and Publication Ethical Review Board of Mzumbe University with Ref No. MA.84/261/102/’A'/11 and authorization of the Vice Chancellor dated 11th April 2021. The permit to conduct the study in the study area was obtained from the National (PORALG), Regional, Council, Ward as well as markets management. Written informed consent for participants before participating in the study. Participation to the study was voluntary, and minimal risks confidentiality and privacy were maintained. Furthermore, the respondents were assigned with numbers so as to ensure maximum confidentiality of their information. RESULTS Social Demographic Characteristics of Respondents Table 1 shows that, a total of 525 participants were involved in this study which makes response rate 100%. The mean age of participants was 35.7 years with range of 49 years. Moreover, nearly two thirds (62.8%) of study participants were males and 37.2% were females who collectively were dominated by age group of 21–30 years (34%), followed by 31–40 years (26%), 41–50 years (25.6%), > 50 (8.5%), and under 20 years (5.9%), respectively. Furthermore, findings from this study revealed that, more than half (52.3%) of market vendors had primary education, 34.9% secondary education, 6.3% diploma and 6.5% had attained bachelor degree. The analysis also indicated that, during the time of this study 184 (35.1%) of respondents were single, 85 (16.2%) married,189 (36.1%) cohabiting and 37 (7%) widowed and 29 (5.5%) were divorced. Researcher was also interested to know residence of respondents whereas it was revealed that, a majority (91.2%) of the respondents were urban residents. Table 1 Demographic Characteristics of Respondents (n = 524) Variable Category Freq Percent Gender Male 329 62.8 Female 195 37.2 Age group 20 & below 31 5.9 21–30 178 34.0 31–40 136 26.0 41–50 134 25.6 > 50 45 8.5 Education Level Primary 274 52.3 Secondary 183 34.9 Diploma 33 6.3 University 34 6.5 Marital status Single 184 35.1 Married 85 16.2 Divorced 29 5.5 Cohabiting 189 36.1 Widow 37 7.1 Residence Rural 46 8.8 Urban 478 91.2 Measures taken by Morogoro Municipal Authorities to prevent market vendors from COVID-19. In market areas, public address system is used to ensure that market vendors have sufficient knowledge on the disease. The education provided included what is the disease and how the disease could be prevented at the market areas as it is quoted from Morogoro Municipal health authorities: At markets, we had to look for the approach that could help us because we couldn’t call vendors. For instance, in providing training to these market vendors, we used PA to sensitize them that there is this disease, make sure you wash your hands, make sure you wear masks if you’re in crowds, and sensitized them concerning the ways to prevent themselves from COVID-19. Education provided to market vendors was accompanied by construction of hand washing facilities in market areas whereas in every market six hand washing points were installed as it quoted here below: “And we had six hand washing points with 220lt and in those big drums people washed their hands and trust me people washed their hands we knew this by increased water bills in those markets and fear of the disease in early stages of the disease was an important factor that made people wash their hands”. Availability of these hand washing facilities was proved on site visit at Mawenzi, Kingalu Markets as shown in a photo below, however it was observed that these hand washing facilities were not used: Proportion of market vendors adhering to COVID-19 IPC measures The average adherence to COVID-19 IPC measures was high as more than three quarter (81%) of the market vendors were adhering the IPC measures on Covid-19 pandemic, and over 43.5% of the market vendors adhering IPC’s measures several times. Also, among market vendors who have reported to adhere with COVID-19 IPC measures, 32.1% had adhered only once, 43.5% several times and only 24.4% of market vendors are always adhering to COVID-19 IPC measures. Also, findings showed that, 90.6% of market vendors adhere to at least one recommended IPC measures whereas hand washing was the common IPC measure adhered by 60.1% (n = 315), social distancing 20% (n = 105) and mask wearing 10.5% (n = 55). Moreover, market vendors who did not use recommended IPC measures reported to use self-immolation 6.7% (n = 35) and prayers 2.7% (n = 14) to prevent themselves from COVID-19 as presented in Table 2 below: Table 2 Distribution of the IPC measures adhered by market vendors at Morogoro Municipal IPC Measures Freq Percent Handwashing/sanitizer 315 60.1 Face Mask 55 10.5 Social distancing 105 20.0 Prayer 14 2.7 self-immolation 35 6.7 Source (field data, 2021) Perception of market vendors on IPC Measures 58% market vendors had negative perception of wearing mask, hand washing and social distancing while 32% had average perception and 11.5% of market vendors had positive perception on IPC control measures for COVID-19. This was also qualified during interview with market vendors whereas believed that, these measures could prevent them from COVID-19 as it is quoted below: I don’t think if these measures can prevent us from COVID-19 that’s why as you can see no one is wearing mask and we are doing just fine. Table 3 below summarize findings on market vendors’ perception on susceptibility to COVID-19 and efficacy of IPC Measures Table 3 Market Vendors perception on Susceptibility and efficacy of IPC measures Variable Response Freq Percent Susceptibility Perception Lower 275 52.5 Average 189 36.1 Higher 60 11.5 Perception of Efficacy of measure Lower 304 58.0 Average 172 32.8 Higher 48 9.2 Source (field data, 2021) However, despite low perception on susceptibility and efficacy of preventive measures 79.1% of market vendors believed COVID-19 is a life-threatening disease. The disease is severe it kills; I haven’t personally seen a sick patient but we see on TV how people are dying in other countries it is very severe. And it kills very fast, people are dying healthy without even getting thin, you will just hear that someone has passed away this is not something that occurs to other diseases such as malaria. However, regardless of the perception on severity of diseases market vendors affirmed that they were not afraid of the disease because it is not in the country: The disease is dangerous, yes, I agree but it is not in Tanzania, so we are not afraid and we work as usual and nothing will happen to us. If it was in Tanzania, we would be the first one to die but the disease is not there. Factors relating to adherence of COVID-19 IPC measures The results showed that age, education level, residence, knowledge on isolation period and previous experience with someone with COVID-19 had more significance effects than others variables on IPC adherence (P < 0.05). Age (21–30) has less likelihood to adhere IPC measures by 0.3 than other age groups. The market vendors with secondary education level had higher likelihood (3.092) to adhere IPC measures than those with primary education level. Market vendors living in urban areas had higher likelihood (8.011) to adhere IPC measures than those living in rural areas. Also, market vendors with knowledge on isolation period had higher likelihood (3.712) to adhere IPC measures than those who don’t. Finally, the results showed that the market vendors who had experienced a friend with COVID – 19 had higher likelihood (1.414) to adhere IPC guidelines than those who never had experience. Table 4 Multivariate regression model on factors relating to adherence of COVID-19 IPC measures Characteristic Variables Odds Sign. (95% conf. Interval) Age 50 Reference 0.300 0.389 1.12 2.17E + 6 0.069 0.147 0.53 0.00 0.082 0.109 0.15 0.00 1.096 1.392 2.17 Education level Primary Secondary Diploma University Reference 3.092 0.272 1.448 0.010 0.012 0.540 1.311 0.099 0.443 7.290 0.747 4.740 Residence Rural Urban Reference 8.011 0.00 2.570 24.967 Knowledge on hand hygiene Yes No 2.092 Reference 0.088 0.895 4.889 Knowledge on isolation period Yes No 3.712 Reference 0.00 1.936 7.117 Previous experience Yes No 1.414 Reference 0.007 1.218 4.784 Source: Field data, 2020 DISCUSSION Findings showed that, Morogoro Municipal implemented various measures to prevent market vendors from COVID-19 as recommended by (CDC, 2021). However, there were differences in implementation of these measures whereas some markets did not have hand washing facilities. Also, the markets were not renovated to fit current COVID-19 situation by expanding as it is advised to allow two meters’ stroll between both market vendors and their customers. This contrary to recommendations on reduction of crowds in market areas which required markets to expend strolls (CDC, 2021). Moreover, findings have shown that training conducted in Morogoro Mc had emphasized on hand washing as the key area to reduce COVID-19. The education content used by Morogoro Municipal again are key in reducing COVID-19 as (Alzyood, 2020 ) has recommended that this is the basic human intervention during pandemic. It is opinion of this study that, training conducted to market vendors in Morogoro Municipal have changed behavior of the people as it had emphasized on hand washing which is as the training had emphasized on hand hygiene which is the most practiced IPC Measures practiced in Morogoro markets. The finding of this study concurs with the findings of Simkhada, ( 2020 ) which concluded that effective public health education can help changing community behavior. This study has also revealed 81% of market vendors adhere to recommended IPC measures in the market. Men had more adherence than female by 61.8% and 38.2% respectively. The finding contradicts with findings from other countries such as Smith, ( 2020 ) and Haischer, (2020) which concluded that, females adhere more to IPC measures than males because males may be associated with courage and pride behaviors that may lead to risk behaviors Pawlowski, ( 2008 ). Furthermore, there has been assumption that the morbidity and mortality of men from COVID-19 are high because of their risk behaviors rather than their biological make-up (Griffith, 2020 ). The variations on findings from other studies may be because of gender profile of market vendors revealed by this study which was dominated by men. This has been common culture and characteristic of economic activities in most of African countries which are dominated by men with exceptional of agricultural activities in rural areas which are dominated by female (Goldstein, 2019 ). Lastly, this study has revealed various factors influencing market vendors’ adherence to COVID-19 IPC measures namely; Age, education level, residence, knowledge on isolation period and previous experience with someone with COVID-19. The factors range from demographic factors institutional factors to psychosocial factors. Market vendors aged over 50 years had significantly likely to adhere IPC guidelines compared to other age groups. This can be attributed by perceived susceptibility of old people being the most risk group to be affected by COVID-19. This is similar with the findings of Knotek, ( 2020 ) which noted significant adherence to people aged 60 years and above. Also, market vendors with secondary education and diploma holder had higher adherence compared to those with primary education. The findings concur with the findings of Nikolov, ( 2020 ) which reported that social distancing measures increase with education level. Moreover, market vendors who lived in urban areas had higher adherence to COVID-19 IPC measures compared to those living in rural areas, same as the study conducted by (Callaghan, 2021 ). And, market vendors who had knew someone with COVID-19 had different practice and attitude to the disease and IPC measures compared to those who did not know anyone suffered from the disease, which is consistent with the findings of Karafillakis, ( 2015 ). CONCLUSION The implementation of behavioral change measures in Morogoro Municipal such as provision of education to market vendors has played a vital role towards adherence and perception to IPC measures. The insist of education provided was in hand washing since, hand washing was identified as the highly practiced measure, hence, it is opinion of this study that education provided to the people has changed behaviors of the people as far as hand hygiene is concerned. More emphasize should be putted to other methods as well since the combination of three IPC measure have been proven to control the spread of COVID-19. Declarations CONFLICT OF INTEREST The authors declare that they have no competing interests. The findings and conclusions in this paper are those of the author (s) and do not necessarily represent the official position of the Government of Tanzania. Author Contribution DN contributed to the write up, conceptualization, statistical analysis and write up of the manuscript. MA provided a technical support in survey, design, implementation and review of the manuscript. Data Availability The results achieved in this study are presented in the manuscript. Individual data are not publicly available due to ethical limitations but may be available on request. References Geldsetzer P. (2020). Knowledge and Perceptions of COVID-19 Among the General Public in the United States and the United Kingdom: A Cross-sectional Online Survey. Annals of Internal Medicine . https://annals.org/aim/fullarticle/2763550 . WHO. (2020). WHO-COVID-19-global-data . https://covid19.who.int/table . Yin Y, Wunderink RG. MERS, SARS and other coronaviruses as causes of pneumonia. Respirology. 2018;23(2):130–7. https://www.ncbi.nlm.nih.gov/pubmed/29052924 . Zhong B-L, Luo W, Li H-M, Zhang Q-Q, Liu X-G, Li W-T, Li Y. Knowledge, attitudes, and practices towards COVID-19 among Chinese residents during the rapid rise period of the COVID-19 outbreak: a quick online cross-sectional survey. Int J Biol Sci. 2020;16(10):1745. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7098034/ . Goldstein M. (2019). Tackling the Global Profitarchy,Gender and the Choice of Business Sector. Policy Research Working Paper , 8865. Griffith DM. (2020). Men and COVID-19: A Biopsychosocial Approach to Understanding Sex Differences in Mortality and Recommendations for Practice and Policy Interventions. US Public Health Response to COVID-19 and Chronic Disease special supplement. , 17. Karafillakis E. (2015). Once there is life, there is hope’ Ebola survivors' experiences, behaviours and attitudes in Sierra Leone. Br Med J Global Health, 108. Simkhada P. (2020). The Role of Health Promotion during the COVID-19 Pandemic. J Health Promotion, 1–4. Alzyood M. (2020). COVID-19 reinforces the importance of handwashing. Pub Med, 15–6. BBC. (2021, March 3). BBC Swahili . Retrieved March 2021, 5, from Virusi vya Korona:Kanisa Katoliki Tanzania limesema limepoteza mapadri 25,wauguzi na watawa 60 ndani ya miezi miwili: https://www.bbc.com/swahili/habari-56261893 . Callaghan T. (2021). Rural and Urban Differences in COVID-19 prevention beheviour. J Rural Health, 112. CDC. (2021, July 7). Mitigation measures for COVID-19 in households and markets in non-US low-resource settings . Retrieved July 14, 2021, from Centre for Disease Control: https://www.cdc.gov/coronavirus/2019-ncov/global-covid-19/global-urban-areas.html#print . Kinyenje E. (2020). Status of Infection Prevention and Control in Tanzanian Primary Health Care Facilities: Learning From Star Rating Assessment. Infect Prev Pract, 100071. Knotek ES. (2020). Consumers and COVID-19: Survey Results on Mask-Wearing Behaviors and Beliefs. Economic Commentary, 62. Makorere R. (2019). The Effect of Price on Fresh Vegetable Choices in Selected Markets of Morogoro Region. Int J Sustainable Dev Res, 5(3). Masubo V. (2020). COVID-19 in Tanzania: Is business as usual response enough? Int Growth Centre, 50–62. Nikolov P. (2020). Predictors of Social Distancing and MaskWearing Behavior: Panel Survey in Seven. Inst Labour Econ, 20067. Pawlowski B. (2008). Sex Differences in Everyday Risk-Taking Behavior in Humans. Evolutionary Psychol, 1–4. Smith A. (2020). Gender Differences in Fear and Risk Perception During the COVID-19 Pandemic. Frontier, 1–4. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4423452","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":313056303,"identity":"d26361e5-2331-4226-a711-ba8d9d507671","order_by":0,"name":"Douglas G. Ndeki","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA9UlEQVRIiWNgGAWjYDCCA0D8AMxgYzjwAUizsROjJQGq5eAMkBZmUrQw84AYhLTwHe8xfpFQU5fHd7wt8bDNr23yfMwMjB8+5uDWInnmjJlFwrHDxZJnjh04nNt327CNmYFZcuY23FoMbuSYGSSwHUjccCO94XBuz21GoBY2Zl6CWv7VJW64/7zhsGXPbXtitBg/SGxjBtrCduAww4/biQS1AL1QxpDYdzhx5pm0hIO9DbeT25gZm/H6he948+YPH77VJfYdP2b84cef27bz25sPfviIRwsQsEnAmYxtYLIBr3ogYP6AYP8hpHgUjIJRMApGIgAAiTdfYku2V+YAAAAASUVORK5CYII=","orcid":"","institution":"Mzumbe University","correspondingAuthor":true,"prefix":"","firstName":"Douglas","middleName":"G.","lastName":"Ndeki","suffix":""},{"id":313056304,"identity":"8450debe-7a70-434f-965f-f4ae353f95ca","order_by":1,"name":"Mackfallen Anaseli","email":"","orcid":"","institution":"Mzumbe University","correspondingAuthor":false,"prefix":"","firstName":"Mackfallen","middleName":"","lastName":"Anaseli","suffix":""}],"badges":[],"createdAt":"2024-05-15 07:47:46","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4423452/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4423452/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":58193702,"identity":"751ac1c6-2b98-46ff-91bb-91dce112c715","added_by":"auto","created_at":"2024-06-12 09:01:07","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":472970,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003eHand washing facility at Kingalu market\u003c/em\u003e\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-4423452/v1/d2b09a5b13666c68e58287e6.png"},{"id":63970962,"identity":"2f5e0de6-cb87-4ef6-bbea-dea70e3053c8","added_by":"auto","created_at":"2024-09-04 11:03:11","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1254835,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4423452/v1/d6e128da-57e1-4539-8fba-36f8df372c8a.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Is Tanzania Freewill Prevention A Response Enough? Reflecting Market Vendors Adherence to Covid-19 Infection Prevention Control Measures in Morogoro Municipal","fulltext":[{"header":"BACKGROUND","content":"\u003cp\u003eCoronavirus disease (COVID \u0026ndash; 19) has become the major public and global health dilemma in the contemporary world. It is an emerging respiratory disease caused by viruses known to cause illness ranging from common cold to severe acute respiratory syndrome (Yin \u0026amp; Wunderink, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). Evidence shows the disease was transmitted from bats to humans and was first detected in December 2019 by Chinese authorities in Wuhan city, Hubei province of China and began to spread rapidly throughout the world. The disease is highly infectious and can be transmitted from man to man through contact (Zhong et al., \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). The common symptoms of COVID \u0026ndash; 19 include dry cough, fever, myalgia, dyspnea and fatigue. Moreover, statistics shows that 18.5% of patients with COVID \u0026ndash; 19 develop to severe stage characterized with severe acute respiratory syndrome (SARS), bleeding and coagulation dysfunction, septic shock and difficulties in tackling metabolic acidosis (Chen et al., 2020).\u003c/p\u003e \u003cp\u003eStatistics from African Region as of September 21, 2020 reported South Africa taking the lead in highest number of COVID \u0026ndash; 19 cases above all African countries with 661,211 confirmed COVID \u0026ndash; 19 cases and 15,953 deaths. Other African countries with high number of COVID \u0026ndash; 19 cases and deaths include Cameroon with 20,598 confirmed COVID \u0026ndash; 19 cases and 416 deaths, Ghana with 46,004 confirmed COVID \u0026ndash; 19 cases and 297 deaths and C\u0026ocirc;te d\u0026rsquo;Ivoire with 19,269 confirmed COVID \u0026ndash; 19 cases and 120 deaths (WHO, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). Moreover, other African countries reported COVID \u0026ndash; 19 cases and deaths, Namibia with 10,377 confirmed COVID \u0026ndash; 19 cases and 112 deaths, Burundi reports lower COVID \u0026ndash; 19 cases estimated at 474 confirmed cases and only one death as well as South Sudan with 2649 confirmed COVID \u0026ndash; 19 cases and 49 deaths (WHO, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2020\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe first case of COVID-19 disease in Tanzania was reported on 20/03/2020. Following the report, various steps were taken to prevent the disease from spreading in the country. The measures involved the formation of a disease response committee as established by the Disaster Management Act of 2015. Furthermore, the governments through the Ministry of Health Social Development gender the elderly and children provided various guidelines (IPC) on how people should live in the pandemic period. However, despite the WHO guidance on IPC, reports from Tanzania reveal that Tanzania had its own way fighting COVID-19 compared to other countries.\u003c/p\u003e \u003cp\u003e Unlike her neighbors in East Africa such as Kenya and Uganda who initiated country lockdown interventions and imposing travelling restrictions, Tanzania issued the Community Covid-19 prevention guideline of 2020. The guideline focused on the practice IPC in pandemic which includes hand washing, social distancing as well as wearing face masks. The guideline also guided IPC education which should be given to community in order to prevent COVID-19.\u003c/p\u003e \u003cp\u003eExperiences from other countries have revealed that implementation and practices of Tanzania way largely depends on individual choices to adhere on the prevention practices for COVID \u0026minus;\u0026thinsp;19 (Geldsetzer, \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). This is because Tanzania did not apply force in preventing and controlling the disease as the responsibility of COVID \u0026ndash; 19 preventions were imposed to individuals adhere IPC guidelines, contrary to other countries which forced citizens to lockdown.\u003c/p\u003e \u003cp\u003eAs of 29th April 2020, Tanzania had publicly confirmed 509 COVID-19 cases and 21 deaths (WHO, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2020\u003c/span\u003e) in the first wave. Moreover, despite the absence of official statistics of the second wave in Tanzania, The Roman Catholic Church of Tanzania has reported 85 deaths associated with COVID-19 (TEC, 2021). Henceforth, the presence of 85 reported deaths associated with COVID-19 in a single community of Tanzania indicates that COVID-19 pandemia is a public health dilemma which calls for immediate interventions.\u003c/p\u003e \u003cp\u003e On the other hand, adherence status of the COVID-19 IPC protocols and guidelines among different groups of people in Tanzania is still unknown. As studies conducted in Tanzania on adherence of IPC were conducted at facility level (Kinyenje, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2020\u003c/span\u003e) while the other one focused economic effects of Tanzania method (Masebo, 2020).\u003c/p\u003e \u003cp\u003eWith economic activities continuing in its normal course market vendors are at risk for COVID-19 infection as they have constant interaction with different people. This is because market vendors vend basic needs of human being such as food and other needs. Therefore, understanding adherence status of COVID-19. Infection Prevention Guideline among market vendors forms a foundation on understanding Tanzania intervention as well as prevention of disease.\u003c/p\u003e \u003cp\u003eBeing one of the biggest food producers in the country, Morogoro Municipal has numerous markets which serves Morogoro Municipal residents and neighbor region such as Dar es salaam (Makorere, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). Interaction between market vendors and customers from various regions as well as residents makes markets vendors in Morogoro Municipal among risk group in the country. Hence force; this study focused on adherence status of IPC measures among market vendors in Morogoro Municipal.\u003c/p\u003e"},{"header":"METHODS","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eEvaluation design\u003c/h2\u003e \u003cp\u003e Cross sectional study design was employed in this evaluation study, and a sequential mixed method dominated by quantitative methods was used to establish both proportion of market vendors adhering to COVID-19 IPC guideline as well as factors influencing adherence to IPC guidelines among market vendors. Qualitative approach was used to explain perception of market vendors on IPC measures and IPC measures implemented by Morogoro Municipal.\u003c/p\u003e \u003cp\u003eTheory Driven Evaluation was used to conduct an outcome evaluation whereas health belief model was used to link interventions (cues to action) and behavioral change (outcome). Evaluation was guided by Tanzania COVID-19 prevention strategies theory were COVID-19 prevention guidelines was used as the main program document. Since behavioral change after issuing guidelines was evaluated therefore outcome evaluation was appropriate for this study.\u003c/p\u003e \u003cdiv id=\"Sec4\" class=\"Section3\"\u003e \u003ch2\u003eData collection procedures\u003c/h2\u003e \u003cp\u003eA standardized questionnaire was administered to market vendors in Morogoro Municipal. The questionnaire collected information on socio-demographic characteristics of study participants; age, sex, education level, marital status and residence. An interview guide that was used to collect information relating to reason facilitating or undermining the use of recommended COVID-19 infection Prevention Control guidelines as well as perception toward COVID-19 to market vendors. Observation was used to confirm physical initiatives implemented by Morogoro Municipal, photos were taken in all aspects of IPC intervention to all markets and non-participatory observation was used also to observe market vendors\u0026rsquo; prevention behavior. Hand washing behavior, mask wearing behavior and social distance were observed.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eVariables and measurements\u003c/h2\u003e \u003cp\u003eThe dependent variable is adherence of IPC during COVID-19 outbreak. The independent variables for this study were social \u0026ndash; demographic characteristics such as age, sex, education level, occupation, residence and income status. Also, other factors like knowledge on IPC, training on standard precautions, availability and accessibility of PPE and attitude towards the use of PPE. Perception was measured using 6 questions and response to each question was rated using Likert scale ranging from strongly agree (1 point) to strongly disagree (5 points). It was further qualified by interview conducted to market vendors.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eData Analysis\u003c/h2\u003e \u003cp\u003eAll questionnaires were collected on the same day and checked for completeness and clarity. The computer software SPSS (IBM SPSS version 22) was used to analyze data. Moreover, Microsoft excel was specifically used in drawing charts.\u003c/p\u003e \u003cp\u003eDescriptive statistics was conducted to summarize demographic characteristics. Frequencies and percentage were used to summarize categorical data on propotional of Market vendors adherence to COVID-19 IPC measures in categories such as age, sex education and residence.\u003c/p\u003e \u003cp\u003eOdds ratios and 95% confidence intervals were used to determine the strength of the association between factors and adherence to COVID-19 prevention Measures. Moreover, multivariate logistic regression analysis was used to analyze factors associated with adherence of IPC during COVID-19 outbreak while controlling for potential confounders. Variables with p\u0026thinsp;\u0026lt;\u0026thinsp;0.2 in the bivariate analysis were included in the multivariable model. A p-value of less than 0.05 was used as a cut-off point for assessing statistical significance.\u003c/p\u003e \u003cp\u003eFor interview data, phenomenological analysis was conducted to get market vendors experience on adhering to IPC measures as well as experience of Morogoro Municipal Authorities in implementing preventing measure in Morogoro Markets. Researcher conducted interpretation to every response of the key informant interviewed.\u003c/p\u003e \u003cp\u003eThematic was done to describe common theme arise from interviewed market vendors which was done together with content analysis to explain observed information such as hand washing facilities installed at Morogoro Markets and Market vendors behaviour. Interview was conducted in Swahili then transcribed in English within 24 hours after interview was conducted. Review of transcript was done by all team members in order to cross check accuracy and completeness of the data.\u003c/p\u003e \u003cp\u003eTranscribed script showing data analyses were imported in Atlas Ti. In atlas Ti all data were coded deductively and inductively within five main predetermined themes namely perception of market vendors toward efficacy of measures, perception of market vendors toward the disease threat, perception of market vendors on susceptibility to get the disease and factors influencing adherence to COVID-19 (Cue to action). Families of content were created by grouping similar theme. Researchers coding and families creation was done together with creation of memos which helped researcher to add their insights, views and reflections on the responses. Final report was lastly written based on output downloaded from Atlas.ti and photos taken to various contents. Atlas.ti output comprised codes, families and memos.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eEthical considerations\u003c/h2\u003e \u003cp\u003eThe approval to undertake this study was given by the Directorate ofResearch and Publication Ethical Review Board of Mzumbe University with \u003cb\u003eRef No. MA.84/261/102/\u0026rsquo;A'/11\u003c/b\u003e and authorization of the Vice Chancellor dated 11th April 2021. The permit to conduct the study in the study area was obtained from the National (PORALG), Regional, Council, Ward as well as markets management. Written informed consent for participants before participating in the study.\u003c/p\u003e \u003cp\u003eParticipation to the study was voluntary, and minimal risks confidentiality and privacy were maintained. Furthermore, the respondents were assigned with numbers so as to ensure maximum confidentiality of their information.\u003c/p\u003e \u003c/div\u003e"},{"header":"RESULTS","content":"\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eSocial Demographic Characteristics of Respondents\u003c/h2\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e shows that, a total of 525 participants were involved in this study which makes response rate 100%. The mean age of participants was 35.7 years with range of 49 years. Moreover, nearly two thirds (62.8%) of study participants were males and 37.2% were females who collectively were dominated by age group of 21\u0026ndash;30 years (34%), followed by 31\u0026ndash;40 years (26%), 41\u0026ndash;50 years (25.6%), \u0026gt;\u0026thinsp;50 (8.5%), and under 20 years (5.9%), respectively.\u003c/p\u003e \u003cp\u003eFurthermore, findings from this study revealed that, more than half (52.3%) of market vendors had primary education, 34.9% secondary education, 6.3% diploma and 6.5% had attained bachelor degree. The analysis also indicated that, during the time of this study 184 (35.1%) of respondents were single, 85 (16.2%) married,189 (36.1%) cohabiting and 37 (7%) widowed and 29 (5.5%) were divorced. Researcher was also interested to know residence of respondents whereas it was revealed that, a majority (91.2%) of the respondents were urban residents.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDemographic Characteristics of Respondents (n\u0026thinsp;=\u0026thinsp;524)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFreq\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePercent\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e329\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e62.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e195\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e37.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20 \u0026amp; below\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21\u0026ndash;30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e178\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e34.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e31\u0026ndash;40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e136\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e26.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e41\u0026ndash;50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e134\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e25.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e8.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEducation Level\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePrimary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e274\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e52.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSecondary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e183\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e34.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDiploma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e6.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUniversity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e6.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarital status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSingle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e184\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e35.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e16.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDivorced\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCohabiting\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e189\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e36.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWidow\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e7.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eResidence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRural\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e8.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUrban\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e478\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e91.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eMeasures taken by Morogoro Municipal Authorities to prevent market vendors from COVID-19.\u003c/b\u003e \u003c/p\u003e \u003cp\u003eIn market areas, public address system is used to ensure that market vendors have sufficient knowledge on the disease. The education provided included what is the disease and how the disease could be prevented at the market areas as it is quoted from Morogoro Municipal health authorities:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eAt markets, we had to look for the approach that could help us because we couldn\u0026rsquo;t call vendors. For instance, in providing training to these market vendors, we used PA to sensitize them that there is this disease, make sure you wash your hands, make sure you wear masks if you\u0026rsquo;re in crowds, and sensitized them concerning the ways to prevent themselves from COVID-19.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eEducation provided to market vendors was accompanied by construction of hand washing facilities in market areas whereas in every market six hand washing points were installed as it quoted here below:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003e\u0026ldquo;And we had six hand washing points with 220lt and in those big drums people washed their hands and trust me people washed their hands we knew this by increased water bills in those markets and fear of the disease in early stages of the disease was an important factor that made people wash their hands\u0026rdquo;.\u003c/em\u003e \u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eAvailability of these hand washing facilities was proved on site visit at Mawenzi, Kingalu Markets as shown in a photo below, however it was observed that these hand washing facilities were not used:\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eProportion of market vendors adhering to COVID-19 IPC measures\u003c/h2\u003e \u003cp\u003eThe average adherence to COVID-19 IPC measures was high as more than three quarter (81%) of the market vendors were adhering the IPC measures on Covid-19 pandemic, and over 43.5% of the market vendors adhering IPC\u0026rsquo;s measures several times. Also, among market vendors who have reported to adhere with COVID-19 IPC measures, 32.1% had adhered only once, 43.5% several times and only 24.4% of market vendors are always adhering to COVID-19 IPC measures.\u003c/p\u003e \u003cp\u003eAlso, findings showed that, 90.6% of market vendors adhere to at least one recommended IPC measures whereas hand washing was the common IPC measure adhered by 60.1% (n\u0026thinsp;=\u0026thinsp;315), social distancing 20% (n\u0026thinsp;=\u0026thinsp;105) and mask wearing 10.5% (n\u0026thinsp;=\u0026thinsp;55). Moreover, market vendors who did not use recommended IPC measures reported to use self-immolation 6.7% (n\u0026thinsp;=\u0026thinsp;35) and prayers 2.7% (n\u0026thinsp;=\u0026thinsp;14) to prevent themselves from COVID-19 as presented in Table \u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e below:\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDistribution of the IPC measures adhered by market vendors at Morogoro Municipal\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIPC Measures\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFreq\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePercent\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHandwashing/sanitizer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e315\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e60.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFace Mask\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSocial distancing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e105\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e20.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrayer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eself-immolation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eSource (field data, 2021)\u003c/h2\u003e \u003cdiv id=\"Sec12\" class=\"Section3\"\u003e \u003ch2\u003ePerception of market vendors on IPC Measures\u003c/h2\u003e \u003cp\u003e58% market vendors had negative perception of wearing mask, hand washing and social distancing while 32% had average perception and 11.5% of market vendors had positive perception on IPC control measures for COVID-19. This was also qualified during interview with market vendors whereas believed that, these measures could prevent them from COVID-19 as it is quoted below:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eI don\u0026rsquo;t think if these measures can prevent us from COVID-19 that\u0026rsquo;s why as you can see no one is wearing mask and we are doing just fine.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e below summarize findings on market vendors\u0026rsquo; perception on susceptibility to COVID-19 and efficacy of IPC Measures\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMarket Vendors perception on Susceptibility and efficacy of IPC measures\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eResponse\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFreq\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePercent\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSusceptibility Perception\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLower\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e275\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e52.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAverage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e189\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e36.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHigher\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e11.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePerception of Efficacy of measure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLower\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e304\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e58.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAverage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e172\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e32.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHigher\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e9.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eSource (field data, 2021)\u003c/h2\u003e \u003cp\u003eHowever, despite low perception on susceptibility and efficacy of preventive measures 79.1% of market vendors believed COVID-19 is a life-threatening disease.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eThe disease is severe it kills; I haven\u0026rsquo;t personally seen a sick patient but we see on TV how people are dying in other countries it is very severe. And it kills very fast, people are dying healthy without even getting thin, you will just hear that someone has passed away this is not something that occurs to other diseases such as malaria.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eHowever, regardless of the perception on severity of diseases market vendors affirmed that they were not afraid of the disease because it is not in the country:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eThe disease is dangerous, yes, I agree but it is not in Tanzania, so we are not afraid and we work as usual and nothing will happen to us. If it was in Tanzania, we would be the first one to die but the disease is not there.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eFactors relating to adherence of COVID-19 IPC measures\u003c/h2\u003e \u003cp\u003eThe results showed that age, education level, residence, knowledge on isolation period and previous experience with someone with COVID-19 had more significance effects than others variables on IPC adherence (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Age (21\u0026ndash;30) has less likelihood to adhere IPC measures by 0.3 than other age groups. The market vendors with secondary education level had higher likelihood (3.092) to adhere IPC measures than those with primary education level. Market vendors living in urban areas had higher likelihood (8.011) to adhere IPC measures than those living in rural areas. Also, market vendors with knowledge on isolation period had higher likelihood (3.712) to adhere IPC measures than those who don\u0026rsquo;t. Finally, the results showed that the market vendors who had experienced a friend with COVID \u0026ndash; 19 had higher likelihood (1.414) to adhere IPC guidelines than those who never had experience.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMultivariate regression model on factors relating to adherence of COVID-19 IPC measures\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristic\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eOdds\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSign.\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e(95% conf. Interval)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;20\u003c/p\u003e \u003cp\u003e21\u0026ndash;30\u003c/p\u003e \u003cp\u003e31\u0026ndash;40\u003c/p\u003e \u003cp\u003e41\u0026ndash;50\u003c/p\u003e \u003cp\u003e\u0026gt;\u0026thinsp;50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003cp\u003e0.300\u003c/p\u003e \u003cp\u003e0.389\u003c/p\u003e \u003cp\u003e1.12\u003c/p\u003e \u003cp\u003e2.17E\u0026thinsp;+\u0026thinsp;6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.069\u003c/p\u003e \u003cp\u003e0.147\u003c/p\u003e \u003cp\u003e0.53\u003c/p\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.082\u003c/p\u003e \u003cp\u003e0.109\u003c/p\u003e \u003cp\u003e0.15\u003c/p\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.096\u003c/p\u003e \u003cp\u003e1.392\u003c/p\u003e \u003cp\u003e2.17\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEducation level\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePrimary\u003c/p\u003e \u003cp\u003eSecondary\u003c/p\u003e \u003cp\u003eDiploma\u003c/p\u003e \u003cp\u003eUniversity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003cp\u003e3.092\u003c/p\u003e \u003cp\u003e0.272\u003c/p\u003e \u003cp\u003e1.448\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.010\u003c/p\u003e \u003cp\u003e0.012\u003c/p\u003e \u003cp\u003e0.540\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.311\u003c/p\u003e \u003cp\u003e0.099\u003c/p\u003e \u003cp\u003e0.443\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e7.290\u003c/p\u003e \u003cp\u003e0.747\u003c/p\u003e \u003cp\u003e4.740\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eResidence\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRural\u003c/p\u003e \u003cp\u003eUrban\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003cp\u003e8.011\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.570\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e24.967\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eKnowledge on hand hygiene\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.092\u003c/p\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.088\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.895\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e4.889\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eKnowledge on isolation period\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.712\u003c/p\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.936\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e7.117\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePrevious experience\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.414\u003c/p\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.007\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.218\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e4.784\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eSource: Field data, 2020\u003c/h2\u003e \u003c/div\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eFindings showed that, Morogoro Municipal implemented various measures to prevent market vendors from COVID-19 as recommended by (CDC, 2021). However, there were differences in implementation of these measures whereas some markets did not have hand washing facilities. Also, the markets were not renovated to fit current COVID-19 situation by expanding as it is advised to allow two meters\u0026rsquo; stroll between both market vendors and their customers. This contrary to recommendations on reduction of crowds in market areas which required markets to expend strolls (CDC, 2021).\u003c/p\u003e \u003cp\u003eMoreover, findings have shown that training conducted in Morogoro Mc had emphasized on hand washing as the key area to reduce COVID-19. The education content used by Morogoro Municipal again are key in reducing COVID-19 as (Alzyood, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2020\u003c/span\u003e) has recommended that this is the basic human intervention during pandemic.\u003c/p\u003e \u003cp\u003eIt is opinion of this study that, training conducted to market vendors in Morogoro Municipal have changed behavior of the people as it had emphasized on hand washing which is as the training had emphasized on hand hygiene which is the most practiced IPC Measures practiced in Morogoro markets. The finding of this study concurs with the findings of Simkhada, (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2020\u003c/span\u003e) which concluded that effective public health education can help changing community behavior.\u003c/p\u003e \u003cp\u003eThis study has also revealed 81% of market vendors adhere to recommended IPC measures in the market. Men had more adherence than female by 61.8% and 38.2% respectively. The finding contradicts with findings from other countries such as Smith, (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2020\u003c/span\u003e) and Haischer, (2020) which concluded that, females adhere more to IPC measures than males because males may be associated with courage and pride behaviors that may lead to risk behaviors Pawlowski, (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2008\u003c/span\u003e). Furthermore, there has been assumption that the morbidity and mortality of men from COVID-19 are high because of their risk behaviors rather than their biological make-up (Griffith, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2020\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe variations on findings from other studies may be because of gender profile of market vendors revealed by this study which was dominated by men. This has been common culture and characteristic of economic activities in most of African countries which are dominated by men with exceptional of agricultural activities in rural areas which are dominated by female (Goldstein, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2019\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eLastly, this study has revealed various factors influencing market vendors\u0026rsquo; adherence to COVID-19 IPC measures namely; Age, education level, residence, knowledge on isolation period and previous experience with someone with COVID-19. The factors range from demographic factors institutional factors to psychosocial factors. Market vendors aged over 50 years had significantly likely to adhere IPC guidelines compared to other age groups. This can be attributed by perceived susceptibility of old people being the most risk group to be affected by COVID-19. This is similar with the findings of Knotek, (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2020\u003c/span\u003e) which noted significant adherence to people aged 60 years and above.\u003c/p\u003e \u003cp\u003eAlso, market vendors with secondary education and diploma holder had higher adherence compared to those with primary education. The findings concur with the findings of Nikolov, (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2020\u003c/span\u003e) which reported that social distancing measures increase with education level. Moreover, market vendors who lived in urban areas had higher adherence to COVID-19 IPC measures compared to those living in rural areas, same as the study conducted by (Callaghan, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). And, market vendors who had knew someone with COVID-19 had different practice and attitude to the disease and IPC measures compared to those who did not know anyone suffered from the disease, which is consistent with the findings of Karafillakis, (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2015\u003c/span\u003e).\u003c/p\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eThe implementation of behavioral change measures in Morogoro Municipal such as provision of education to market vendors has played a vital role towards adherence and perception to IPC measures. The insist of education provided was in hand washing since, hand washing was identified as the highly practiced measure, hence, it is opinion of this study that education provided to the people has changed behaviors of the people as far as hand hygiene is concerned. More emphasize should be putted to other methods as well since the combination of three IPC measure have been proven to control the spread of COVID-19.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e \u003ch2\u003eCONFLICT OF INTEREST\u003c/h2\u003e \u003cp\u003eThe authors declare that they have no competing interests. The findings and conclusions in this paper are those of the author (s) and do not necessarily represent the official position of the Government of Tanzania.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eDN contributed to the write up, conceptualization, statistical analysis and write up of the manuscript. MA provided a technical support in survey, design, implementation and review of the manuscript.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe results achieved in this study are presented in the manuscript. Individual data are not publicly available due to ethical limitations but may be available on request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eGeldsetzer P. (2020). Knowledge and Perceptions of COVID-19 Among the General Public in the United States and the United Kingdom: A Cross-sectional Online Survey. \u003cem\u003eAnnals of Internal Medicine\u003c/em\u003e. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://annals.org/aim/fullarticle/2763550\u003c/span\u003e\u003cspan address=\"https://annals.org/aim/fullarticle/2763550\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWHO. (2020). \u003cem\u003eWHO-COVID-19-global-data\u003c/em\u003e. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://covid19.who.int/table\u003c/span\u003e\u003cspan address=\"https://covid19.who.int/table\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYin Y, Wunderink RG. MERS, SARS and other coronaviruses as causes of pneumonia. Respirology. 2018;23(2):130\u0026ndash;7. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.ncbi.nlm.nih.gov/pubmed/29052924\u003c/span\u003e\u003cspan address=\"https://www.ncbi.nlm.nih.gov/pubmed/29052924\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhong B-L, Luo W, Li H-M, Zhang Q-Q, Liu X-G, Li W-T, Li Y. Knowledge, attitudes, and practices towards COVID-19 among Chinese residents during the rapid rise period of the COVID-19 outbreak: a quick online cross-sectional survey. Int J Biol Sci. 2020;16(10):1745. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7098034/\u003c/span\u003e\u003cspan address=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7098034/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGoldstein M. (2019). Tackling the Global Profitarchy,Gender and the Choice of Business Sector. \u003cem\u003ePolicy Research Working Paper\u003c/em\u003e, 8865.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGriffith DM. (2020). Men and COVID-19: A Biopsychosocial Approach to Understanding Sex Differences in Mortality and Recommendations for Practice and Policy Interventions. \u003cem\u003eUS Public Health Response to COVID-19 and Chronic Disease special supplement.\u003c/em\u003e, 17.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKarafillakis E. (2015). Once there is life, there is hope\u0026rsquo; Ebola survivors' experiences, behaviours and attitudes in Sierra Leone. Br Med J Global Health, 108.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSimkhada P. (2020). The Role of Health Promotion during the COVID-19 Pandemic. J Health Promotion, 1\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAlzyood M. (2020). COVID-19 reinforces the importance of handwashing. Pub Med, 15\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBBC. (2021, March 3). \u003cem\u003eBBC Swahili\u003c/em\u003e. Retrieved March 2021, 5, from Virusi vya Korona:Kanisa Katoliki Tanzania limesema limepoteza mapadri 25,wauguzi na watawa 60 ndani ya miezi miwili: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.bbc.com/swahili/habari-56261893\u003c/span\u003e\u003cspan address=\"https://www.bbc.com/swahili/habari-56261893\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCallaghan T. (2021). Rural and Urban Differences in COVID-19 prevention beheviour. J Rural Health, 112.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCDC. (2021, July 7). \u003cem\u003eMitigation measures for COVID-19 in households and markets in non-US low-resource settings\u003c/em\u003e. Retrieved July 14, 2021, from Centre for Disease Control: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.cdc.gov/coronavirus/2019-ncov/global-covid-19/global-urban-areas.html#print\u003c/span\u003e\u003cspan address=\"https://www.cdc.gov/coronavirus/2019-ncov/global-covid-19/global-urban-areas.html#print\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKinyenje E. (2020). Status of Infection Prevention and Control in Tanzanian Primary Health Care Facilities: Learning From Star Rating Assessment. Infect Prev Pract, 100071.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKnotek ES. (2020). Consumers and COVID-19: Survey Results on Mask-Wearing Behaviors and Beliefs. Economic Commentary, 62.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMakorere R. (2019). The Effect of Price on Fresh Vegetable Choices in Selected Markets of Morogoro Region. Int J Sustainable Dev Res, 5(3).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMasubo V. (2020). COVID-19 in Tanzania: Is business as usual response enough? Int Growth Centre, 50\u0026ndash;62.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNikolov P. (2020). Predictors of Social Distancing and MaskWearing Behavior: Panel Survey in Seven. Inst Labour Econ, 20067.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePawlowski B. (2008). Sex Differences in Everyday Risk-Taking Behavior in Humans. Evolutionary Psychol, 1\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSmith A. (2020). Gender Differences in Fear and Risk Perception During the COVID-19 Pandemic. Frontier, 1\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"COVID-19, IPC, IPC adherence","lastPublishedDoi":"10.21203/rs.3.rs-4423452/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4423452/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBACKGROUND\u003c/h2\u003e \u003cp\u003eThe purpose of this evaluation study was to assess the status of adherence of IPC measures among market vendors in Morogoro Municipal. Specifically, the study aimed to examine IPC measure implemented, the proportion of market vendors\u0026rsquo; adherence to IPC measures, factors influencing adherence of IPC among market vendors and perception of market vendors on COVID-19 prevention measures.\u003c/p\u003e\u003ch2\u003eMETHODS\u003c/h2\u003e \u003cp\u003eWe employed a cross- sectional study to 525 respondents, where 524 were market vendors and 1 respondent was from Morogoro Municipal Health authority. We deployed sequential mixed methods to the study including questionnaires (quantitative), interviews and unstructured observations (qualitative). We used descriptive statistics to summarize socio - demographic characteristics and Multivariate Logistic regression model to analyze factors influencing adherence of COVID-19.\u003c/p\u003e\u003ch2\u003eRESULTS\u003c/h2\u003e \u003cp\u003e81.1% of market vendors adhere to IPC measure. However, there were difference in adherence across groups by education 43%. Hand hygiene was the common practiced IPC measure (60.1%), whereas the least practiced measure was mask wearing (10.5%). Age, education level, residence, knowledge on isolation period and previous experience with someone with COVID-19 had influence to adherence of COVID-19 prevention measures by significance value (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e\u003ch2\u003eCONCLUSION\u003c/h2\u003e \u003cp\u003eAdherence status of market vendors to COVID-19 IPC measures is satisfying. The study recommends improved behavioral change measures such as education in rural areas as it was in urban areas and an increased budget on emergency preparedness.\u003c/p\u003e","manuscriptTitle":"Is Tanzania Freewill Prevention A Response Enough? Reflecting Market Vendors Adherence to Covid-19 Infection Prevention Control Measures in Morogoro Municipal","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-06-12 09:01:02","doi":"10.21203/rs.3.rs-4423452/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"4d9c0e0c-f527-47f0-9392-8cf3249a3bb3","owner":[],"postedDate":"June 12th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-09-04T10:55:02+00:00","versionOfRecord":[],"versionCreatedAt":"2024-06-12 09:01:02","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4423452","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4423452","identity":"rs-4423452","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}