The unprecedented global health crisis due to the COVID-19 pandemic has brought critical challenges to public health with over 364 million cases and 5.6 million deaths worldwide as of 28 January 20221. The first case of COVID-19 in Bangladesh was declared on 8 March 2020 by the Institution of Epidemiology, Disease Control and Research (IEDCR)2. Since then, the situation has been deteriorating. Bangladesh faces a critical problem with 1.7 million confirmed cases and 28288 deaths as of 28 January 20221. This relatively higher mortality has led the global scientific community to focus on research for the development of treatments, vaccines and preventive strategies3. But the efficient handling of the pandemic calls for help from the vulnerable population for efforts to alleviate the transmission of the pandemic4. Knowledge about COVID-19 symptoms, transmission and prevention is crucial because better knowledge equates with stronger precautionary practices5. Insufficient information and wrong attitudes contribute to delayed diagnoses, ineffective infection management and lack of personal hygiene6. Testing, tracing, and masks can all be effective methods of limiting transmission of the COVID-19 in dynamic community settings, and better compliance with one can compensate for weaker compliance with the other, to some extent7. When a population has correct knowledge, positive attitudes and better preparedness towards COVID-19, it is able to better impede COVID-19 transmission. Various studies have reported that assessing expertise and awareness regarding the disease is important to combat any infectious disease8,9. Poor knowledge about transmission affects the control measures, as the spread rate of infectious disease has been found higher among populations with poor knowledge about the disease10. A study conducted among healthcare workers in China showed that attitudes and practices about COVID-19 were impacted by several risk factors, including work experience and job category11.

To date, male vulnerability has been observed with 54–73% of all COVID-19 infections in men12. Low knowledge about COVID-19 transmission and prevention may attribute this high infection rate in men, which requires research exploration. Furthermore, the crucial understanding of the epidemiological pattern of this epidemic and the efficacy and effectiveness of public health interventions depend on the awareness, behavior and behaviors of the general population towards COVID-1913. Though COVID-19 affected both genders, males and females have different preventive behaviors and perceptions towards this pandemic14. Females were well informed and had a better attitude to the prevention measures of the disease15. A study in the United States showed that a higher percentage of females were practicing preventive behaviors during this recent outbreak14. A survey conducted among Bangladeshi youth found that only 51.6% had good practices, whereas 61.2 % had adequate knowledge and 78.9 % had positive attitudes regarding COVID-1916. Moreover, another study from Bangladesh demonstrated that female sex, older age, higher education level, family income >30000 BDT (1000 Bangladeshi Takas about US$12), urban area location, and more positive attitudes were linked with more frequent preventive practices17. But there are no studies assessing the gender differences regarding knowledge, attitudes and preparedness toward the COVID-19 among Bangladeshi adults, which implies a knowledge gap.

Considering the importance of investigating the community’s knowledge, attitude and preparedness, this study aimed to address that knowledge gap by assessing gender differences toward the COVID-19 among Bangladeshi adults, which will help to initiate suitable health education programs for the community. We hypothesize that females would have more appropriate knowledge, better attitude and preparedness towards the COVID-19 than their male counterparts.


Study design and participants

A cross-sectional study was conducted through an online survey among the general population of Bangladesh. The study was conducted following the Checklist for Reporting Results of Internet ESurveys (CHERRIES) guidelines18. Inclusion criteria were: being Bangladeshi, willing to participate, age ≥18 years, able to understand Bangla language, and residing in Bangladesh during the survey. Respondents who were unwilling to provide electronically informed consent were excluded from the study. A convenience sampling technique and online data collection method were chosen to meet the study aims, as face-to-face interviewing was risky.

Data collection

Data collection took place March–April 2020. Responses came from 1050 participants (aged 18–68 years). An online structured questionnaire was developed using Google Forms as the data collection tool. The questionnaire was pre-tested with a small group (30 participants) to ensure its transparency and to avoid any inconsistencies in the questionnaire. The questionnaire link was disseminated online on different social media (i.e. Facebook, What’s App, Instagram, Telegram, Viber). For ensuring the quality of data, rapid checking of data was done every day. An information sheet describing the aim and process, right to refuse participation in the study was presented on the first page of the survey, attaching an electronic consent form. Participants were informed that their information would only be used for the research. The respondents voluntarily participated in the study, and no financial incentive was provided to them. Anonymity and confidentially were ensured. All the procedures of this study complied with the Code of Ethics of the World Medical Association (Declaration of Helsinki) for any experiments involving humans and Ethical clearance certificate for this study was obtained from the Institutional Review Board19, ‘Biosafety, Biosecurity & Ethical Committee’ of the Jahangirnagar University. After giving informed consent, participants voluntarily proceeded with the survey. It took participants about 10–15 minutes to complete the survey.


The questionnaire of this study was developed by gathering information from the literature20,21.When the questionnaire draft was created, it was reviewed and revised several times to fully align with the study’s objectives. A questionnaire review panel of three experts, in global mental health research, public health, and public health research, evaluated and revised the questionnaire to cover the study’s objectives. The questionnaire was updated and resent to the review panel based on their comments and suggestions for approval to begin pre-testing.

Sociodemographic characteristics

Demographic variables included age, gender, number of family members, name of the residing district, educational level, and occupation. Educational level had three subcategories:1) higher secondary; 2) honors or above; and 3) up to secondary.

Knowledge, attitude and preparedness information

The questionnaire included 29 questions about COVID-19 knowledge, 5 questions about attitudes and 9 questions about preparedness towards the COVID-19. Questions about the source of knowledge on COVID-19 symptoms (most common symptoms), transmission and prevention were administered by collecting information from the existing literature. Close-ended questions ascertained attitudes towards COVID-19. Preparedness towards COVID-19 was also assessed. The questions had two response options, either ‘yes’ or ‘no’.

Statistical analysis

Data were analyzed with STATA version 14.1 (StataCorpLP, College Station, TX, USA). Microsoft Excel was used for editing, sorting and coding of data. Descriptive statistics such as frequency and percentage were obtained to understand participants’ characteristics. Chi-squared tests were performed to identify the gender differences regarding knowledge, attitude and preparedness towards COVID-19. A p≤0.05 was considered statistically significant for all analyses.


Sociodemographic characteristics

Respondents’ sociodemographic characteristics are given in Table 1. In all, 65.9% of respondents were aged <25 years; the majority were male (63.4%);most respondents had an educational level equivalent to honors or above (83.5%); and respondents were primarily students (76.2%), but there were also government or private service holders (14.38%) and others such as housewives and freelancers (9.4%).

Table 1

Sociodemographics of the study participants, Bangladesh March–April 2020 (N=1050)

Variablesn (%)
Age (years)
<25692 (65.90)
25–35320 (30.48)
>3538 (3.62)
Male666 (63.43)
Female384 (36.57)
Family members
<5524 (49.90)
5–6398 (37.90)
>6128 (12.19)
Education level
Up to secondary37 (3.52)
Higher secondary136 (12.95)
Honors or above877 (83.52)
Student800 (76.19)
Government/private services151 (14.38)
Other99 (9.43)

Knowledge of COVID-19

Almost all the respondents knew about the virus (98.5%), and the majority acknowledged the virus to be extremely dangerous (86.3%). Most respondents came to know about the virus via social media (68.1%). Respondents’ response to ‘How did you first come to know about the virus?’ differed by gender (p<0.001).

Knowledge of COVID-19 symptoms, transmission, and prevention

With regard to symptoms for COVID-19, male respondents did not know that diarrhea (59.85%), muscle pain (58.1%), fatigue (55.3%), and vomiting (69.7%) were symptoms of COVID-19, while the corresponding proportions for females were 44.5%, 61.2%, 57.7% and 67.7%. These responses had no significant association with the gender of the respondents (Table 2).

Table 2

Knowledge of COVID-19 by gender, Bangladesh March–April 2020 (N=1050)

VariablesTotal n (%)Male (n=666) n (%)Female (n=384) n (%)χ2 [df]p
Do you know about COVID-19?
Yes1034 (98.48)657 (98.65)377 (98.18)0.36 [1]0.55
No16 (1.52)9 (1.35)7 (1.82)
How did you first come to know about the virus?
Newspaper73 (6.95)61 (9.16)12 (3.13)19.10 [3]<0.001**
Mass media (e.g. TV)218 (20.76)137 (20.57)81 (21.09)
Social media715 (68.10)448 (67.27)267 (69.53)
Doctor or family44 (4.19)20 (3.00)24 (6.25)
How dangerous is the virus?
Slightly144 (13.71)92 (13.81)52 (13.54)0.02 [1]0.90
Extremely906 (86.29)574 (86.19)332 (86.46)
Knowledge of COVID-19 symptoms
Is fever a symptom of COVID-19?
Yes1035 (98.57)655 (98.35)380 (98.96)0.64 [1]0.42
No15 (1.43)11 (1.65)4 (1.04)
Is a dry cough a symptom of COVID-19?
Yes1010 (96.19)644 (96.70)366 (95.31)1.27 [1]0.26
No40 (3.81)22 (3.30)18 (4.69)
Is difficulty breathing a symptom of COVID-19?
Yes1011 (96.29)642 (96.40)369 (96.09)0.06 [1]0.80
No39 (3.71)24 (3.60)15 (3.91)
Is a sore throat a symptom of COVID-19?
Yes891 (84.86)571 (85.74)320 (83.33)1.09 [1]0.30
No159 (15.14)95 (14.26)64 (16.67)
Is diarrhea a symptom of COVID-19?
Yes547 (52.10)334 (50.15)213 (55.47)2.76 [1]0.10
No503 (47.90)332 (49.85)171 (44.53)
Is fatigue a symptom of COVID-19?
Yes460 (43.85)298 (44.74)162 (42.30)0.59 [1]0.44
No589 (56.15)368 (55.26)221 (57.70)
Is muscle pain a symptom of COVID-19?
Yes428 (40.76)279 (41.89)149 (38.80)0.96 [1]0.33
No622 (59.24)387 (58.11)235 (61.20)
Is vomiting a symptom of COVID-19?
Yes326 (31.05)202 (30.33)124 (32.29)0.44 [1]0.51
No724 (68.95)464 (69.67)260 (67.71)
Knowledge of COVID-19 transmission
COVID-19 spreads through coughing or sneezing
Yes1032 (98.29)656 (98.50)376 (97.92)0.49 [1]0.48
No18 (1.71)10 (1.50)8 (2.08)
COVID-19 spreads through close contact with infected person
Yes1036 (98.67)654 (98.20)382 (99.48)3.04 [1]0.08
No14 (1.33)12 (1.80)2 (0.52)
COVID-19 spreads through contaminated surface
Yes979 (93.24)621 (93.24)45 (6.76)<0.001 [1]0.99
No71 (6.76)358 (93.23)26 (6.77)
COVID-19 spreads through eating with unclean hands
Yes753 (71.71)474 (71.17)279 (72.66)0.26 [1]0.61
No297 (28.29)192 (28.83)102 (27.34)
COVID-19 spreads through touching face with unclean hands
Yes906 (86.29)569 (85.44)337 (87.76)1.11 [1]0.29
No144 (13.71)97 (14.56)47 (12.24)
COVID-19 can spread via use of public transport
Yes713 (67.90)464 (69.67)249 (64.84)2.60 [1]0.11
No337 (32.10)202 (30.33)135 (35.16)
Do you think COVID-19 can spread via mosquitos?
Yes96 (9.14)78 (11.71)18 (4.69)14.47 [1]<0.001**
No954 (90.86)588 (88.29)366 (95.31)
Do you think COVID-19 can't spread in warm weather?
Yes863 (82.19)555 (83.33)308 (80.21)1.63 [1]0.20
No187 (17.81)111 (16.67)76 (19.79)
Knowledge of COVID-19 prevention
Use tissue while coughing or sneezing
Yes1035 (98.57)653 (98.05)382 (99.48)3.54 [1]0.06
No15 (1.43)13 (1.95)2 (0.52)
Wash hands with soap or using hand-sanitizers
Yes1034 (98.48)653 (98.05)381 (99.22)2.22 [1]0.14
No16 (1.52)13 (1.95)3 (0.78)
Avoid crowds
Yes1023 (97.43)648 (97.30)375 (97.66)0.13 [1]0.72
No27 (2.57)18 (2.70)9 (2.34)
Stay home if sick
Yes995 (94.76)623 (93.54)372 (96.88)5.45 [1]0.02*
No55 (5.24)43 (6.46)12 (3.13)
Is a mask enough to prevent the virus?
Yes21 (2.00)14 (2.10)7 (1.82)0.10 [1]0.76
No1029 (98.00)652 (97.90)377 (98.18)
Can antibiotics cure from COVID-19?
Yes109 (10.38)60 (9.01)49 (12.79)3.68 [1]0.06
No941 (89.62)606 (90.99)335 (87.24)
Boiling food properly
Yes810 (77.14)502 (75.38)308 (80.21)3.23 [1]0.07
No240 (22.86)164 (24.62)76 (19.79)
Isolating infected person
Yes1002 (95.43)631 (94.74)371 (96.61)1.95 [1]0.16
No48 (4.57)35 (5.26)13 (3.39)
Avoid touching face with unclean hands
Yes989 (94.19)625 (93.84)364 (94.79)0.40 [1]0.53
No61 (5.81)41 (6.16)20 (5.21)
Safe disposal of used tissues
Yes951 (90.57)602 (90.39)349 (90.89)0.07 [1]0.79
No99 (9.43)64 (9.61)35 (9.11)

* p<0.05

** p<0.01.

df=degrees of freedom.

With regard to the transmission of COVID-19, male respondents had incorrect knowledge of COVID-19 transmission as they did not know that eating with unclean/unwashed hands (28.8%), touching face with unclean hands (14.6%)and public transport (30.3%) can facilitate transmission of the infection. These responses did not differ by gender of the respondents (Table 2). However, the answers to ‘Do you think COVID-19 can spread via mosquitos?’ differed by gender (p<0.001).

Using a tissue while coughing or sneezing was the most reported prevention method for COVID-19 (98.57%). Most respondents thought that COVID-19 could not spread in warm weather (82.2%). On the other hand, most respondents knew that only a mask is insufficient to prevent the virus transmission (98%), and 89.6% correctly reported that antibiotics cannot cure COVID-19. Only 6.5% of males and 3.1% of females did not know that staying home could be a way to prevent COVID-19. The response to ‘Staying home if sick can prevent COVID-19’ also differed by gender (p=0.02).

Attitude towards COVID-19

More than half of the respondents were apprehensive about COVID-19 (51.9%). More than half of the respondents are still going out, and they reported the duration of staying out as less than half an hour (41.8%), half an hour to 2 hours (9.1%), 2 to 4 hours (1.3%) and more than 4 hours (3.0%). The responses for ‘Are you worried about COVID-19’ differed by gender (p=0.02). Again, the answers for ‘How long do you stay out lately’ differed by gender [χ2(4, N=1050)=67.78, p<0.001] (Table 3).

Table 3

Attitude towards COVID-19 by gender, Bangladesh March–April 2020 (N=1050)

VariablesTotal n (%)Male (n=666) n (%)Female (n=384) n (%)χ2 [df]p
Are you worried about COVID-19?
Worried477(45.33)290 (43.54)187 (48.70)7.73 [2]0.02*
Very worried545 (51.90)352 (52.85)193 (50.26)
Not worried28 (2.67)24 (3.60)4 (1.04)
Would you be in quarantine if you have COVID-19 like symptoms?
Yes1031 (98.19)654 (98.20)377 (98.18)<0.001 [1]0.98
No19 (1.81)12 (1.80)7 (1.82)
How long do you stay out lately?
I don’t go out471 (44.86)236 (35.44)235 (61.20)67.78 [4]<0.001**
<30 min439 (41.81)319 (47.90)120 (31.25)
30 min to 2 h95 (9.05)76 (11.41)19 (4.95)
2–4 h14 (1.33)10 (1.50)4 (1.04)
>4 h31 (2.95)25 (3.75)6 (1.56)
Would you make aware your relatives about the virus?
Yes994 (94.67)626 (93.99)368 (95.83)1.63 [1]0.20
No56 (5.33)40 (6.01)16 (4.17)
Would you move as before if you have COVID-19 like symptoms?
Yes25 (2.38)16 (2.40)9 (2.34)0.004 [1]0.95
No1025 (97.62)650 (97.60)375 (97.66)

* p<0.05

** p<0.01.

df=degrees of freedom.

Preparedness for COVID-19

Most respondents reported consulting a doctor if they have COVID-19 like symptoms (85.5%). The responses for ‘Do you wash your hands with just water?’ differed by gender[χ2(1, N=1050) =7.41, p=0.01]. Similarly, the responses for ‘Do you wash your hands with handwash?’ differed by gender[χ2(1, N=1050) =21.81, p<0.001]. Furthermore, the responses for ‘Do you wash your hands with soap?’ differed by gender [χ2(1, N=1050) =11.88, p<0.001]. Answers for other statements or questions were not significantly associated with the gender of the respondents (Table 4).

Table 4

Preparedness for COVID-19 by gender, Bangladesh March–April 2020 (N=1050)

VariablesTotal n (%)Male (n=666) n (%)Female (n=384) n (%)χ2 [df]p
How frequently do you use a mask?
Never50 (4.76)29 (4.35)21 (5.47)0.67 [2]0.72
Sometimes513 (48.86)327 (49.10)186 (48.44)
Always487 (46.38)310 (46.38)177 (46.09)
How frequently do you wash your hands in a day(times)?
01 (0.10)1 (0.15)0 (0)1.23 [2]0.54
1–394 (8.95)56 (8.41)38 (9.90)
>4955 (90.95)609 (91.44)346 (90.10)
Do you wash your hands with just water?
Yes70 (6.67)55 (8.26)15 (3.91)7.41 [1]0.01**
No980 (93.33)611 (91.74)369 (96.09)
Do you wash your hands with handwash?
Yes795 (75.71)473 (71.02)322 (83.85)21.81 [1]<0.001**
No255 (24.29)193 (28.98)62 (16.15)
Do you wash your hands with soap?
Yes659 (62.76)444 (66.67)215 (55.99)11.88 [1]<0.001**
No391 (37.24)222 (33.33)169 (44.01)
Would you consult a doctor if you have COVID-19 like symptoms?
Yes897 (85.51)569 (85.44)328 (85.64)0.01 [1]0.93
No152 (14.49)97 (14.56)55 (14.36)
Additional steps to consider to prevent COVID-19
Creating awareness
Yes1046 (99.62)664 (99.70)382 (99.48)0.31 [1]0.58
No4 (0.38)2 (0.30)2 (0.52)
Restricting immigration
Yes826 (78.67)515 (77.33)311 (80.99)1.95 [1]0.16
No224 (21.33)151 (22.67)73 (19.01)
Encouraging infected persons to be in quarantine or isolation
Yes975 (92.86)618 (92.79)357 (92.97)0.01 [1]0.92
No75 (7.14)48 (7.21)27 (7.03)


** p<0.01.

df=degrees of freedom.


Preventive and control measures regarding the virus are the most crucial, now as the COVID-19 has spread worldwide. The appropriate knowledge, attitude and preparedness towards COVID-19 among the general public are the backbone for ensuring any preventive or control measures. This study unveils the overall picture of a subset of Bangladeshi adults’ knowledge, attitude and preparedness towards COVID-19.

Our results indicate that the vast majority of respondents reported COVID-19 as dangerous. Corresponding to our study, a Bangladeshi study showed that 96.7% of the respondents said COVID-19 is a hazardous disease17. It was claimed before that a higher perceived threat of fatal infection results in higher rates of preventive practices22. A substantial proportion of respondents from the current study gave an incorrect answer about the symptoms of COVID-19 as respondents did not know that diarrhea, fatigue, muscle pain and vomiting are symptoms of COVID-19. Those incorrect answers indicate poor knowledge, which may significantly affect control measures, as public knowledge is crucial in dealing with pandemics23. A possible reason for this poor knowledge can be the source of information, as social media were the primary source of COVID-19 information. In contrast, in the present study only few respondents sought information from doctors or family. Misleading and false information can spread in social media, which might misguide the general population regarding knowledge of COVID-19. With the global pandemic, widespread misinformation has also been reported that might lead to the concern of xenophobia globally, as reported by scientists and WHO official personnel24,25. Previous studies also showed a significant association between sources of information and knowledge9. The result is in line with studies conducted in Bangladesh, Vietnam, and China in which the main source of knowledge was social media9,26,27. This finding has significant gender difference showing females used social media more that the male counterparts to gather knowledge on COVID-19. This situation demands careful evaluation of sources and ensuring of authentic information regarding COVID-19.

A previous study reported that 67% of respondents believed COVID-19 can transmit through close contact with an infected person27 and another study showed almost half of the respondents were unaware about person-to-person transmission of COVID-1928. Furthermore, the present study showed that 17.8% and 9.1% respondents had incorrect knowledge saying that COVID-19 cannot spread in warm weather and can spread via mosquitos, respectively. It was documented before that COVID-19 can be transmitted in hot and humid weather and mosquito bites cannot transmit COVID-1929. Possible explanation for this higher rate of incorrect knowledge can be the initial survey of this study, when people were confused with different myths spreading on social media. Communication between healthcare providers and the public at frequent intervals is recommended in order to overcome myths and to inform the public about health education30.

Moreover, 94.8% of respondents gave the correct answer saying that sick people should stay at home to prevent COVID-19, which is comparable to a previous study where 96.4% believed lockdown as an effective measure of transmission control31. Of note,10.4% of respondents thought that antibiotics can cure COVID-19, which is comparable to a study which showed that 41.6% of participants believed antibiotics as the first-line treatment27.

In regard to attitude towards COVID-19, 98.2% of the respondents agreed that they would like to stay in quarantine if any COVID-19 symptoms appear, which is comparable to a study where 97.9% participants agreed to isolation if needed27. This positive attitude can be the result of correct knowledge among the participants27. In our study, 44.9% participants did not go out, which is comparable to previous studies where 87% did not go to any crowded place and 95% of participants did not attend any social events28,32. Data from other countries are in accordance with our findings which showed females were 3.6 times more likely to avoid going out than males32, and women were found to have a more responsible attitude than males who tended to show risky behaviors9. This finding might be attributable to the fact that males tend to be more occupied with the office and business work outside home than females in Bangladesh. It is worthy to mention that psychological factors (i.e. behavior induced by fear, misleading information) and concerns related to economy could be behind the limited agreement to obey governmental initiatives (i.e. lockdown) by posing serious pressure33. This major finding highlights the importance of encouraging people in maintaining social distancing to prevent the transmission of COVID-19.

High positive preparedness was observed in washing hands more than 4 times a day with soap, which is similar to the findings of Maheshwari et al.34 who reported that 96.6% participants increased their frequency of washing hands. In the present study, females washed hands with handwash more than males. This finding is consistent with other previous findings showing that men were less likely to take preventive measures than women35. In our study only few reported to never use masks. If avoidance of mask usage is not managed, this could impede the progression of COVID-19 transmission control in future36. According to experts’ opinion, there prevails a lack of harmony towards the management of COVID-19 despite of having enough time37, which should be taken into account when adopting any intervention strategies.

Strengths and limitations

The findings are congruent for policy makers and other concerned authorities to address the gaps in public health knowledge, attitude and preparedness towards a pandemic like the COVID-19 by ensuring prompt yet adequate policy, effective health education programs, and short- and longterm interventions for improving COVID-19 response, prevention and control. The findings can also work as a baseline to understand public perception to contain any future outbreak in Bangladesh.

The study has some limitations to consider when interpreting the results. Firstly, the study was only able to include participants who had access to internet and were mostly educated due to the online nature of the survey. Educated people are more likely to have good knowledge and positive attitude towards COVID-19. Moreover, comparatively a higher percentage of students with lower age participated in the online survey. Thus, this may overestimate the overall result and cannot be generalized to the whole population. This problem might be overcome by replicating the study, by including all types of groups in the study population. Secondly, self-reported data and convenience sampling technique might affect the results as some biases (reporting bias, selection bias, social desirability bias) could not be ignored. Thirdly, determination of cause-effect mechanisms was not possible for the cross-sectional nature of the study. Future longitudinal study including focus group discussions and in-depth interviews are recommended.


Our findings suggest that public health education services, with special emphasis on disseminating correct knowledge with a focus on gender differences, are vital in order to encourage healthy behavior during such a pandemic. Males showed a higher tendency in believing the myths about COVID-19 than their female counterparts, which is alarming. Awareness programs should be emphasized, focusing on gender-specific proper information to ensure effective preventive measures. Furthermore, community-based health education programs and other interventions should be strengthened with the implementation of gender specific measures and policy to safeguard the general population by ensuring appropriate knowledge, positive attitudes and preparedness.