Main Article Content
In December 2019, an outbreak of a novel coronavirus disease (COVID-19, previously known as 2019-nCoV) was determined to be transmitted via respiratory droplets. Thus, health agencies have recommended the use of facemasks as a protective measure. The current study investigated the prevalence and factors contributing to incorrect facemask use among individuals visiting high risk public locations. A cross-sectional observational study of facemask use among individuals visiting high risk public facilities was conducted during a local COVID-19 outbreak from end of April to middle of May 2020 in Sitiawan, Perak, Malaysia. Enrolment in the study included any individuals entering the selected study facilities via a dedicated entry point. Suitable study locations were identified as a local wet market selling freshly slaughtered animals and a district specialist hospital.Trained data collectors were stationed at the entry points to observe individuals entering the selected facilities for the type, category, and correct facemask use. Individuals were categorized into two groups, correct and incorrect facemask users, based on visual observation of facemask use. The Pearson chi-square test was used for differences in investigated variables. Both binary and multiple logistic regression models were used in this study. The study protocol was approved by the institutional review board. The main outcome measure was facemask use (either correct or incorrect).A total of 3322 individuals with a high prevalence of facemask use (98.2%) consisting of a large proportion of medical-grade face masks (75.5%) were included in this study. Male individuals, Malay ethnic people, high-risk age groups, and those wearing a medical grade facemask were more likely to present incorrect facemask use. A high prevalence of facemask use among individuals visiting public facilities was observed. However, incorrect facemask use raises the need for of targeted public health strategy to mitigate the impact of COVID-19 epidemic.
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
2. Baud D, Qi X, Nielsen-Saines K, Musso D, Pomar L, Favre G. Real estimates of mortality following COVID-19 infection. The Lancet infectious diseases; 2020.
3. Sohrabi C, Alsafi Z, O’Neill N, Khan M, Kerwan A, Al-Jabir A, et al. World Health Organization declares global emergency: A review of the 2019 novel coronavirus (COVID-19). International Journal of Surgery 2020.
4. Guo Y-R, Cao Q-D, Hong Z-S, Tan Y-Y, Chen S-D, Jin H-J, et al. The origin, transmission and clinical therapies on coronavirus disease 2019 (COVID-19) outbreak–an update on the status. Military Medical Research 2020;7(1):1-10.
5. Hu Z, Song C, Xu C, Jin G, Chen Y, Xu X, et al. Clinical characteristics of 24 asymptomatic infections with COVID-19 screened among close contacts in Nanjing, China. Science China Life Sciences 2020;1-6.
6. Yuan J, Lau EH, Li K, Leung YC, Yang Z, Xie C, et al. Effect of live poultry market closure on avian influenza A (H7N9) virus activity in Guangzhou, China, 2014. Emerging infectious diseases 2015;21(10):1784.
7. Yuan J, Tang X, Yang Z, Wang M, Zheng B. Enhanced disinfection and regular closure of wet markets reduced the risk of avian influenza A virus transmission. Clinical infectious diseases 2014;58(7):1037-8.
8. Holland M, Zaloga DJ, Friderici CS. COVID-19 Personal Protective Equipment (PPE) for the emergency physician. Visual Journal of Emergency Medicine 2020;19:100740.
9. Rowan NJ, Laffey JG. Challenges and solutions for addressing critical shortage of supply chain for personal and protective equipment (PPE) arising from Coronavirus disease (COVID19) pandemic–case study from the Republic of Ireland. Science of the Total Environment 2020;138532.
10. Gunasekaran GH, Gunasekaran SSS, Gunasekaran SS, Halim FHA, Zaimi NSI. Prevalence and acceptance of glove wearing practice among general population when visiting high risk are during local COVID-19 outbreak. medRxiv 2020.
11. Feng S, Shen C, Xia N, Song W, Fan M, Cowling BJ. Rational use of face masks in the COVID-19 pandemic. The Lancet Respiratory Medicine 2020.
12. Brienen NC, Timen A, Wallinga J, Van Steenbergen JE, Teunis PF. The effect of mask use on the spread of influenza during a pandemic. Risk Analysis: An International Journal 2010;30(8):1210-8.
13. Horng W-B, Lee C-P, Chen C-W. Classification of age groups based on facial features 2001;4(3):183-92.
14. Organization WH. Population-based age-stratified seroepidemiological investigation protocol for coronavirus 2019 (COVID-19) infection, 26 May 2020: World Health Organization 2020.
15. Chen L, Xiong J, Bao L, Shi Y. Convalescent plasma as a potential therapy for COVID-19. The Lancet Infectious Diseases 2020:20(4):398-400.
16. Cortegiani A, Ingoglia G, Ippolito M, Giarratano A, Einav S. A systematic review on the efficacy and safety of chloroquine for the treatment of COVID-19. Journal of critical care 2020.
17. Chan KH, Yuen K-Y. COVID-19 epidemic: disentangling the re-emerging controversy about medical facemasks from an epidemiological perspective. International Journal of Epidemiology 2020.
18. Mahase E. Novel coronavirus: Australian GPs raise concerns about shortage of face masks. BMJ 2020;368:m477.
19. Gunasekaran GH, Gunasekaran SSS, Gunasekaran SS, Zaimi NSI, Halim NAA. Prevalence of facemask use among general public when visiting wet market during Covid-19 pandemic: An observational study. medRxiv. 2020.
20. Lee S-A, Hwang D-C, Li H-Y, Tsai C-F, Chen C-W, Chen J-K. Particle size-selective assessment of protection of European standard FFP respirators and surgical masks against particles-tested with human subjects. Journal of healthcare engineering 2016.
21. Jefferson T, Del Mar C, Dooley L, Ferroni E, Al-Ansary LA, Bawazeer GA, et al. Physical interventions to interrupt or reduce the spread of respiratory viruses: systematic review. Bmj 2009;339:b3675.
22. MacIntyre CR, Cauchemez S, Dwyer DE, Seale H, Cheung P, Browne G, et al. Face mask use and control of respiratory virus transmission in households. Emerging infectious diseases 2009;15(2):233.
23. Wu J, Xu F, Zhou W, Feikin DR, Lin C-Y, He X, et al. Risk factors for SARS among persons without known contact with SARS patients, Beijing, China. Emerging infectious diseases 2004;10(2):210.
24. Lau JT, Tsui H, Lau M, Yang X. SARS transmission, risk factors, and prevention in Hong Kong. Emerging infectious diseases 2004;10(4):587.
25. MacIntyre CR, Chughtai AA. Facemasks for the prevention of infection in healthcare and community settings. Bmj 2015;350:h694.
26. Kucharski AJ, Russell TW, Diamond C, Liu Y, Edmunds J, Funk S, et al. Early dynamics of transmission and control of COVID-19: a mathematical modelling study. The lancet infectious diseases 2020.
27. Bai Y, Yao L, Wei T, Tian F, Jin D-Y, Chen L, et al. Presumed asymptomatic carrier transmission of COVID-19. Jama 2020.
28. Cheng KK, Lam TH, Leung CC. Wearing face masks in the community during the COVID-19 pandemic: altruism and solidarity. The Lancet 2020.
29. Lau JT, Yang X, Tsui H, Kim JH. Impacts of SARS on health-seeking behaviors in general population in Hong Kong. Preventive medicine 2005;41(2):454-62.
30. Caramelo F, Ferreira N, Oliveiros B. Estimation of risk factors for COVID-19 mortality-preliminary results. medRxiv 2020
31. Alderman AK, Collins ED, Schott A, Hughes ME, Ottesen RA, Theriault RL, et al. The impact of breast reconstruction on the delivery of chemotherapy. Cancer 2010;116(7):1791-800.
32. Jin J-M, Bai P, He W, Wu F, Liu X-F, Han D-M, et al. Gender differences in patients with COVID-19: Focus on severity and mortality. medRxiv 2020.
33. Wei X, Xiao Y-T, Wang J, Chen R, Zhang W, Yang Y, et al. Sex Differences in Severity and Mortality Among Patients With COVID-19: Evidence from Pooled Literature Analysis and Insights from Integrated Bioinformatic Analysis. arXiv preprint arXiv:200313547 2020.
34. Brainard JS, Jones N, Lake I, Hooper L, Hunter P. Facemasks and similar barriers to prevent respiratory illness such as COVID-19: A rapid systematic review [Internet]. Available from: medRxiv; 2020:2020. 04.01.20049528.
35. Eikenberry SE, Mancuso M, Iboi E, Phan T, Eikenberry K, Kuang Y, et al. To mask or not to mask: Modeling the potential for face mask use by the general public to curtail the COVID-19 pandemic. Infectious Disease Modelling. 2020.
36. Lin Y-H, Liu C-H, Chiu Y-C. Google searches for the keywords of “wash hands” predict the speed of national spread of COVID-19 outbreak among 21 countries. Brain, Behavior, and Immunity. 2020.
37. Szczesniak D, Ciulkowicz M, Maciaszek J, Misiak B, Luc D, Wieczorek T, et al. Psychopathological responses and face mask restrictions during the COVID-19 outbreak: Results from a nationwide survey. Brain, behavior, and immunity. 2020:S0889-1591(20)30847-3.
38. Runge P. Not all Face Masks are Created Equal-What is Best for You. Dental Assistant ProQuest Health and Medical Complete. 2005: (74)4.