Public awareness of coronavirus in Al-Jouf region, Saudi Arabia
Identifieur interne : 000360 ( Pmc/Corpus ); précédent : 000359; suivant : 000361Public awareness of coronavirus in Al-Jouf region, Saudi Arabia
Auteurs : Hanaa Zakaria Nooh ; Rawan Humaidy Alshammary ; Jomanh Mohammed Alenezy ; Njood Hial Alrowaili ; Amani Jaded Alsharari ; Njood Menwer Alenzi ; Hanan E. SabaaSource :
- Zeitschrift Fur Gesundheitswissenschaften [ 2198-1833 ] ; 2020.
Abstract
Since 2012 and to date, outbreak/new cases of Middle East respiratory syndrome-related coronavirus (MERS-CoV) were always reported in Saudi Arabia. Al-Jouf region is considered as one of the most vulnerable areas to the disease outbreak. This research aimed to assess (to the best of our knowledge), for the first time, the current level of awareness towards MERS-CoV among the Al-Jouf region population through a well-designed multistage questionnaire.
A cross-sectional study of 384 participants recruited from various places in Al-Jouf government was conducted through a valid and reliable questionnaire including sociodemographic and MERS-CoV knowledge data.
The majority of the participants showed generally moderate knowledge about MERS-CoV. Age, education, and occupation were the only significant predictors of the level of low awareness concern. Also, the public awareness about the nature, communicability, and lethal effect of the disease was good overall; however, knowledge about incubation period, clinical picture, and epidemiology of the disease needs more governmental concern. The Ministry of Health was the main source of information.
Empowering public information regarding the incubation period and epidemiology of the disease is needed. Frequent communication between healthcare providers and both school students and non-educated individuals is recommended to help the Saudi government in controlling the disease outbreak.
The online version of this article (10.1007/s10389-020-01209-y) contains supplementary material, which is available to authorized users.
Url:
DOI: 10.1007/s10389-020-01209-y
PubMed: 32206545
PubMed Central: 7088303
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PMC:7088303Le document en format XML
<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Public awareness of coronavirus in Al-Jouf region, Saudi Arabia</title><author><name sortKey="Nooh, Hanaa Zakaria" sort="Nooh, Hanaa Zakaria" uniqKey="Nooh H" first="Hanaa Zakaria" last="Nooh">Hanaa Zakaria Nooh</name><affiliation><nlm:aff id="Aff1"></nlm:aff></affiliation></author><author><name sortKey="Alshammary, Rawan Humaidy" sort="Alshammary, Rawan Humaidy" uniqKey="Alshammary R" first="Rawan Humaidy" last="Alshammary">Rawan Humaidy Alshammary</name><affiliation><nlm:aff id="Aff1"></nlm:aff></affiliation></author><author><name sortKey="Alenezy, Jomanh Mohammed" sort="Alenezy, Jomanh Mohammed" uniqKey="Alenezy J" first="Jomanh Mohammed" last="Alenezy">Jomanh Mohammed Alenezy</name><affiliation><nlm:aff id="Aff1"></nlm:aff></affiliation></author><author><name sortKey="Alrowaili, Njood Hial" sort="Alrowaili, Njood Hial" uniqKey="Alrowaili N" first="Njood Hial" last="Alrowaili">Njood Hial Alrowaili</name><affiliation><nlm:aff id="Aff1"></nlm:aff></affiliation></author><author><name sortKey="Alsharari, Amani Jaded" sort="Alsharari, Amani Jaded" uniqKey="Alsharari A" first="Amani Jaded" last="Alsharari">Amani Jaded Alsharari</name><affiliation><nlm:aff id="Aff1"></nlm:aff></affiliation></author><author><name sortKey="Alenzi, Njood Menwer" sort="Alenzi, Njood Menwer" uniqKey="Alenzi N" first="Njood Menwer" last="Alenzi">Njood Menwer Alenzi</name><affiliation><nlm:aff id="Aff1"></nlm:aff></affiliation></author><author><name sortKey="Sabaa, Hanan E" sort="Sabaa, Hanan E" uniqKey="Sabaa H" first="Hanan E." last="Sabaa">Hanan E. Sabaa</name><affiliation><nlm:aff id="Aff1"></nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">32206545</idno><idno type="pmc">7088303</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7088303</idno><idno type="RBID">PMC:7088303</idno><idno type="doi">10.1007/s10389-020-01209-y</idno><date when="2020">2020</date><idno type="wicri:Area/Pmc/Corpus">000360</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000360</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Public awareness of coronavirus in Al-Jouf region, Saudi Arabia</title><author><name sortKey="Nooh, Hanaa Zakaria" sort="Nooh, Hanaa Zakaria" uniqKey="Nooh H" first="Hanaa Zakaria" last="Nooh">Hanaa Zakaria Nooh</name><affiliation><nlm:aff id="Aff1"></nlm:aff></affiliation></author><author><name sortKey="Alshammary, Rawan Humaidy" sort="Alshammary, Rawan Humaidy" uniqKey="Alshammary R" first="Rawan Humaidy" last="Alshammary">Rawan Humaidy Alshammary</name><affiliation><nlm:aff id="Aff1"></nlm:aff></affiliation></author><author><name sortKey="Alenezy, Jomanh Mohammed" sort="Alenezy, Jomanh Mohammed" uniqKey="Alenezy J" first="Jomanh Mohammed" last="Alenezy">Jomanh Mohammed Alenezy</name><affiliation><nlm:aff id="Aff1"></nlm:aff></affiliation></author><author><name sortKey="Alrowaili, Njood Hial" sort="Alrowaili, Njood Hial" uniqKey="Alrowaili N" first="Njood Hial" last="Alrowaili">Njood Hial Alrowaili</name><affiliation><nlm:aff id="Aff1"></nlm:aff></affiliation></author><author><name sortKey="Alsharari, Amani Jaded" sort="Alsharari, Amani Jaded" uniqKey="Alsharari A" first="Amani Jaded" last="Alsharari">Amani Jaded Alsharari</name><affiliation><nlm:aff id="Aff1"></nlm:aff></affiliation></author><author><name sortKey="Alenzi, Njood Menwer" sort="Alenzi, Njood Menwer" uniqKey="Alenzi N" first="Njood Menwer" last="Alenzi">Njood Menwer Alenzi</name><affiliation><nlm:aff id="Aff1"></nlm:aff></affiliation></author><author><name sortKey="Sabaa, Hanan E" sort="Sabaa, Hanan E" uniqKey="Sabaa H" first="Hanan E." last="Sabaa">Hanan E. Sabaa</name><affiliation><nlm:aff id="Aff1"></nlm:aff></affiliation></author></analytic><series><title level="j">Zeitschrift Fur Gesundheitswissenschaften</title><idno type="ISSN">2198-1833</idno><idno type="eISSN">1613-2238</idno><imprint><date when="2020">2020</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Aim</title><p id="Par1">Since 2012 and to date, outbreak/new cases of Middle East respiratory syndrome-related coronavirus (MERS-CoV) were always reported in Saudi Arabia. Al-Jouf region is considered as one of the most vulnerable areas to the disease outbreak. This research aimed to assess (to the best of our knowledge), for the first time, the current level of awareness towards MERS-CoV among the Al-Jouf region population through a well-designed multistage questionnaire.</p></sec><sec><title>Subjects and methods</title><p id="Par2">A cross-sectional study of 384 participants recruited from various places in Al-Jouf government was conducted through a valid and reliable questionnaire including sociodemographic and MERS-CoV knowledge data.</p></sec><sec><title>Results</title><p id="Par3">The majority of the participants showed generally moderate knowledge about MERS-CoV. Age, education, and occupation were the only significant predictors of the level of low awareness concern. Also, the public awareness about the nature, communicability, and lethal effect of the disease was good overall; however, knowledge about incubation period, clinical picture, and epidemiology of the disease needs more governmental concern. The Ministry of Health was the main source of information.</p></sec><sec><title>Conclusion</title><p id="Par4">Empowering public information regarding the incubation period and epidemiology of the disease is needed. Frequent communication between healthcare providers and both school students and non-educated individuals is recommended to help the Saudi government in controlling the disease outbreak.</p></sec><sec><title>Electronic supplementary material</title><p>The online version of this article (10.1007/s10389-020-01209-y) contains supplementary material, which is available to authorized users.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Aguanno, R" uniqKey="Aguanno R">R Aguanno</name></author><author><name sortKey="Elidrissi, A" uniqKey="Elidrissi A">A ElIdrissi</name></author><author><name sortKey="Elkholy, Aa" uniqKey="Elkholy A">AA Elkholy</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Al Abdullah, N" uniqKey="Al Abdullah N">N Al-Abdullah</name></author><author><name sortKey="Kaki, R" uniqKey="Kaki R">R Kaki</name></author><author><name sortKey="Almutairi, O" uniqKey="Almutairi O">O 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Aldawsari</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Alsahafi, Aj" uniqKey="Alsahafi A">AJ Alsahafi</name></author><author><name sortKey="Cheng, Ac" uniqKey="Cheng A">AC Cheng</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Andualem, Y" uniqKey="Andualem Y">Y Andualem</name></author><author><name sortKey="Sisay, F" uniqKey="Sisay F">F Sisay</name></author><author><name sortKey="Yimer, A" uniqKey="Yimer A">A Yimer</name></author><author><name sortKey="Fanta, S" uniqKey="Fanta S">S Fanta</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Arabi, Ym" uniqKey="Arabi Y">YM Arabi</name></author><author><name sortKey="Alothman, A" uniqKey="Alothman A">A Alothman</name></author><author><name sortKey="Balkhy, Hh" uniqKey="Balkhy H">HH Balkhy</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Assiri, A" uniqKey="Assiri A">A Assiri</name></author><author><name sortKey="Mcgeer, A" uniqKey="Mcgeer A">A McGeer</name></author><author><name sortKey="Perl, Tm" uniqKey="Perl T">TM Perl</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Elbur, A" uniqKey="Elbur A">A Elbur</name></author><author><name sortKey="Alharthi, A" uniqKey="Alharthi A">A Alharthi</name></author><author><name sortKey="Aljuaid, A" uniqKey="Aljuaid A">A Aljuaid</name></author><author><name sortKey="Hasan, N" uniqKey="Hasan N">N Hasan</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Joshi, Rm" uniqKey="Joshi R">RM Joshi</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Khan, Mu" uniqKey="Khan M">MU Khan</name></author><author><name sortKey="Shah, S" uniqKey="Shah S">S Shah</name></author><author><name sortKey="Ahmad, A" uniqKey="Ahmad A">A Ahmad</name></author><author><name sortKey="Fatokun, O" uniqKey="Fatokun O">O Fatokun</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Kharma, My" uniqKey="Kharma M">MY Kharma</name></author><author><name sortKey="Alalwani, Ms" uniqKey="Alalwani M">MS Alalwani</name></author><author><name sortKey="Amer, Mf" uniqKey="Amer M">MF Amer</name></author><author><name sortKey="Tarakji, B" uniqKey="Tarakji B">B Tarakji</name></author><author><name sortKey="Aws, G" uniqKey="Aws G">G Aws</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Lin, Q" uniqKey="Lin Q">Q Lin</name></author><author><name sortKey="Chiu, Ap" uniqKey="Chiu A">AP Chiu</name></author><author><name sortKey="Zhao, S" uniqKey="Zhao S">S Zhao</name></author><author><name sortKey="He, D" uniqKey="He D">D He</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Memish, Za" uniqKey="Memish Z">ZA Memish</name></author><author><name sortKey="Assiri, A" uniqKey="Assiri A">A Assiri</name></author><author><name sortKey="Alhakeem, R" uniqKey="Alhakeem R">R Alhakeem</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Seto, W" uniqKey="Seto W">W Seto</name></author><author><name sortKey="Conly, Jm" uniqKey="Conly J">JM Conly</name></author><author><name sortKey="Pessoa Silva, Cl" uniqKey="Pessoa Silva C">CL Pessoa-Silva</name></author><author><name sortKey="Malik, M" uniqKey="Malik M">M Malik</name></author><author><name sortKey="Eremin, S" uniqKey="Eremin S">S Eremin</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct></listBibl></div1></back></TEI><pmc article-type="research-article"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">Z Gesundh Wiss</journal-id><journal-id journal-id-type="iso-abbrev">Z Gesundh Wiss</journal-id><journal-title-group><journal-title>Zeitschrift Fur Gesundheitswissenschaften</journal-title></journal-title-group><issn pub-type="ppub">2198-1833</issn><issn pub-type="epub">1613-2238</issn><publisher><publisher-name>Springer Berlin Heidelberg</publisher-name><publisher-loc>Berlin/Heidelberg</publisher-loc></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">32206545</article-id><article-id pub-id-type="pmc">7088303</article-id><article-id pub-id-type="publisher-id">1209</article-id><article-id pub-id-type="doi">10.1007/s10389-020-01209-y</article-id><article-categories><subj-group subj-group-type="heading"><subject>Original Article</subject></subj-group></article-categories><title-group><article-title>Public awareness of coronavirus in Al-Jouf region, Saudi Arabia</article-title></title-group><contrib-group><contrib contrib-type="author" corresp="yes"><name><surname>Nooh</surname><given-names>Hanaa Zakaria</given-names></name><address><email>hznooh@ju.edu.sa</email><email>drhanaanooh@gmail.com</email></address><xref ref-type="aff" rid="Aff1"></xref></contrib><contrib contrib-type="author"><name><surname>Alshammary</surname><given-names>Rawan Humaidy</given-names></name><address><email>rawanalhumaidy@gmail.com</email></address><xref ref-type="aff" rid="Aff1"></xref></contrib><contrib contrib-type="author"><name><surname>Alenezy</surname><given-names>Jomanh Mohammed</given-names></name><address><email>Jomanh-alenezy@hotmail.com</email></address><xref ref-type="aff" rid="Aff1"></xref></contrib><contrib contrib-type="author"><name><surname>Alrowaili</surname><given-names>Njood Hial</given-names></name><address><email>Nj68140@gmail.com</email></address><xref ref-type="aff" rid="Aff1"></xref></contrib><contrib contrib-type="author"><name><surname>Alsharari</surname><given-names>Amani Jaded</given-names></name><address><email>Amaniii07@hotmail.com</email></address><xref ref-type="aff" rid="Aff1"></xref></contrib><contrib contrib-type="author"><name><surname>Alenzi</surname><given-names>Njood Menwer</given-names></name><address><email>Exbt2017@gmail.com</email></address><xref ref-type="aff" rid="Aff1"></xref></contrib><contrib contrib-type="author"><name><surname>Sabaa</surname><given-names>Hanan E.</given-names></name><address><email>Hanan123967@gmail.com</email></address><xref ref-type="aff" rid="Aff1"></xref></contrib><aff id="Aff1"><institution-wrap><institution-id institution-id-type="GRID">grid.440748.b</institution-id><institution-id institution-id-type="ISNI">0000 0004 1756 6705</institution-id><institution>Faculty of Medicine,</institution><institution>Jouf University,</institution></institution-wrap>Sakaka, Saudi Arabia</aff></contrib-group><pub-date pub-type="epub"><day>13</day><month>2</month><year>2020</year></pub-date><fpage>1</fpage><lpage>8</lpage><history><date date-type="received"><day>25</day><month>10</month><year>2019</year></date><date date-type="accepted"><day>8</day><month>1</month><year>2020</year></date></history><permissions><copyright-statement>© Springer-Verlag GmbH Germany, part of Springer Nature 2020</copyright-statement><license><license-p>This article is made available via the PMC Open Access Subset for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic.</license-p></license></permissions><abstract id="Abs1"><sec><title>Aim</title><p id="Par1">Since 2012 and to date, outbreak/new cases of Middle East respiratory syndrome-related coronavirus (MERS-CoV) were always reported in Saudi Arabia. Al-Jouf region is considered as one of the most vulnerable areas to the disease outbreak. This research aimed to assess (to the best of our knowledge), for the first time, the current level of awareness towards MERS-CoV among the Al-Jouf region population through a well-designed multistage questionnaire.</p></sec><sec><title>Subjects and methods</title><p id="Par2">A cross-sectional study of 384 participants recruited from various places in Al-Jouf government was conducted through a valid and reliable questionnaire including sociodemographic and MERS-CoV knowledge data.</p></sec><sec><title>Results</title><p id="Par3">The majority of the participants showed generally moderate knowledge about MERS-CoV. Age, education, and occupation were the only significant predictors of the level of low awareness concern. Also, the public awareness about the nature, communicability, and lethal effect of the disease was good overall; however, knowledge about incubation period, clinical picture, and epidemiology of the disease needs more governmental concern. The Ministry of Health was the main source of information.</p></sec><sec><title>Conclusion</title><p id="Par4">Empowering public information regarding the incubation period and epidemiology of the disease is needed. Frequent communication between healthcare providers and both school students and non-educated individuals is recommended to help the Saudi government in controlling the disease outbreak.</p></sec><sec><title>Electronic supplementary material</title><p>The online version of this article (10.1007/s10389-020-01209-y) contains supplementary material, which is available to authorized users.</p></sec></abstract><kwd-group xml:lang="en"><title>Keywords</title><kwd>Awareness</kwd><kwd>Coronavirus</kwd><kwd>Population</kwd><kwd>Jouf</kwd><kwd>Camels</kwd></kwd-group></article-meta></front><body><sec id="Sec1" sec-type="introduction"><title>Introduction</title><p id="Par5">Middle East respiratory syndrome-related coronavirus (MERS-CoV) is an extremely fatal viral respiratory disease. It was initially announced in Saudi Arabia in 2012 and has been spread to other countries ever since. Mortality from MERS-CoV had been reported in the Middle East; hence, it acquired its name (Al-Osail and Al-Wazzah <xref ref-type="bibr" rid="CR5">2017</xref>). The Kingdom of Saudi Arabia (KSA) remains the most affected country, with remarkable morbidity and mortality rates. This has been considered a serious health problem because millions of pilgrims from all over the world visit Saudi Arabia for Hajj annually (World Health Organization, WHO <xref ref-type="bibr" rid="CR21">2014</xref>).</p><p id="Par6">From 2012 through 31 July 2019, a total of 2458 laboratory-confirmed cases of MERS-Cov, along with 849 associated deaths, have been reported to the WHO globally in Saudi Arabia. As of 13 February, 39 cases have been identified and reported as part of the Wadi Aldwasir outbreak (WHO <xref ref-type="bibr" rid="CR22">2019</xref>). Recently, in 2017, in Al -Jouf government, 20 cases of MERS cluster were reported in an outbreak of the disease in Domat Aljandal (Arabi et al. <xref ref-type="bibr" rid="CR9">2018</xref>). Moreover, in 2018, one lethal case of non-cluster type was recorded in another outbreak in Al-Qurayat (WHO <xref ref-type="bibr" rid="CR22">2019</xref>).</p><p id="Par7">The causative agent for MERS-CoV is a positive sense single-stranded RNA virus of the beta-coronavirus measuring 120–160 nm in diameter (Al-Mohrej and Agha <xref ref-type="bibr" rid="CR3">2017</xref>; Joshi <xref ref-type="bibr" rid="CR15">2013</xref>). Bats, camels (direct contact or by camel milk), and close contact with an infected person has been identified as a mode of transmission of the virus. Other animal reservoirs are not excluded from the possibility of being the host (Elbur et al. <xref ref-type="bibr" rid="CR12">2016</xref>). Dromedaries and camels are still considered as the main animal reservoirs due to their high prevalence in the Arabian Peninsula (Memish et al. <xref ref-type="bibr" rid="CR19">2014</xref>). Human-to-human transmission in healthcare workers, due to overcrowding, has a role in disease transmission. The disease spreads through large respiratory droplets (≥10 μm in diameter), fomites, and hand contamination (Seto et al. <xref ref-type="bibr" rid="CR20">2013</xref>).</p><p id="Par8">Worldwide, due to the occurrence of recent deaths, coronavirus has become one of the crucial viruses. Globally, since 2012, the WHO has reported 1864 laboratory-confirmed MERS cases, with 659 associated deaths in 27 countries. KSA remains the most affected country, with remarkable morbidity and mortality rates. MERS-CoV has been considered a serious health problem because millions of pilgrims from all over the world visit Saudi Arabia for Hajj every year (Joshi <xref ref-type="bibr" rid="CR15">2013</xref>).</p><p id="Par9">The incubation period for MERS-CoV ranges between 5 and 14 days (Health Protection Agency (HPA) UK Novel Coronavirus Investigation Team <xref ref-type="bibr" rid="CR14">2013</xref>). In Saudi Arabia, the median incubation period was calculated as 5.2 days (Assiri et al. <xref ref-type="bibr" rid="CR10">2013</xref>). The clinical features of MERS-CoV ranged from asymptomatic or mild disease to acute respiratory distress syndrome and multiorgan failure, which leads to death (Al-Osail and Al-Wazzah <xref ref-type="bibr" rid="CR5">2017</xref>).</p><p id="Par10">Unfortunately, to date, there is no specific drug treatment or vaccination. Therefore, infection control measures are essential for the prevention of its spread in healthcare facilities, as well as in the community (Joshi <xref ref-type="bibr" rid="CR15">2013</xref>). Several studies in KSA were conducted among healthcare workers and medical students for measuring the awareness of MERS-Cov according to their sociodemographic states (Al-Mohrej and Agha <xref ref-type="bibr" rid="CR3">2017</xref>; Kharma et al. <xref ref-type="bibr" rid="CR17">2015</xref>; Alsahafi and Cheng <xref ref-type="bibr" rid="CR7">2016</xref>; Khan et al. <xref ref-type="bibr" rid="CR16">2014</xref>). Moreover, awareness towards MERS-CoV was not acknowledgeable among the Saudi population. A previous study on the disease was limited due to the insignificant number of participants (Kharma et al. <xref ref-type="bibr" rid="CR17">2015</xref>). Unfortunately, although Al-Jouf region has been considered as one of the most vulnerable areas, suspected to be due to the abruptness of MERS-CoV outbreaks, there was a lack of previous studies detecting the degree of awareness among the Al-Jouf population. Hence, we can say that the assessment of public awareness in Al-Jouf region through this survey is reasonable. So, the goal of this research was to assess (to the best of our knowledge), for the first time, the current level of awareness towards MERS in relation to sociodemographic states among the Al-Jouf region population through a well-designed multistage questionnaire (supplementary material <xref rid="MOESM1" ref-type="media">1</xref>).</p></sec><sec id="Sec2" sec-type="materials|methods"><title>Participants and methods</title><sec id="Sec3"><title>Design and sampling</title><p id="Par11">The design of the study was a descriptive cross-sectional study that was conducted in Al-Jouf region between 2018 and 2019. The sampling was a multistage random sampling and the form of the sampling is a questionnaire. Estimation of the sample size was done using <italic>n</italic> = <italic>P</italic>(1−<italic>P</italic>)<italic>Z</italic><sup>2</sup>/<italic>d</italic><sup>2</sup>, assuming unknown prevalence of 50%, <italic>Z</italic> = 1.96, <italic>d</italic> = 0.05, confidence level = 95% (margin of error = 5%), and 80% power of the study. The calculated sample size of this study is 384 participants. The sample was detected according to the last report of the General Authority for Statistics (GAS), Kingdom of Saudi Arabia in 2010 (population 440,000) (General Authority for Statistics (GAS), Kingdom of Saudi Arabia <xref ref-type="bibr" rid="CR13">2010</xref>).</p></sec><sec id="Sec4"><title>Inclusion and exclusion criteria</title><p id="Par12">Consecutive samples of all male and female Saudi and non-Saudi participants of Al-Jouf region were included in this study. The age of the sample size ranges between < 20 to 60 years. Medical students and healthcare providers were excluded from the study.</p></sec><sec id="Sec5"><title>Data collection and measures</title><p id="Par13">For data collection, a closed-ended questionnaire comprising multiple-choice questions, in both Arabic and English forms, was used. The questionnaire measured the sociodemographic data (name, age, sex, nationality, educational level, region, and income) and disease knowledge (mode of infection, clinical picture, methods of control, and sources of information). The possible responses regarding disease knowledge were classified as ‘correct’, ‘incorrect’, and ‘I do not know’. A correct answer was given 1 point, while both incorrect and ‘I do not know’ responses were assigned 0 points. The higher the score, the greater the expected knowledge the respondent had. The results of the test were represented as follows: 21–25, excellent knowledge; 16–20, good knowledge; 11–15, moderate knowledge; 6–10, fair knowledge; and 0–5, poor knowledge. The questionnaire was validated for its reliability, resulting in a statistical value of 0.90 (Cronbach’s alpha). The questionnaire was reviewed and validated by three experts in the microbiology, internal medicine, and biostatistics fields. A pilot study (tested with a group of 15 people) was done to ensure applicability of the questionnaire and to estimate the time frame needed to complete it. The questionnaires were handed out by the investigators at the site personally and collected from the respondents after they had been completed individually and anonymously. All questionnaires were attached with a greeting letter detailing the purpose of the study and informed the participants that their participation is optional, with the right of withdrawal at any stage of the study.</p></sec><sec id="Sec6"><title>Ethical approval</title><p id="Par14">This study was approved by the Institutional Review Board (IRB) committee of the College of Medicine at Al-Jouf University, Saudi Arabia.</p></sec><sec id="Sec7"><title>Statistical analysis</title><p id="Par15">Data entry and analysis was performed using SPSS version 21 (SPSS Inc. Armonk, NY). Descriptive statistics were used to describe all variables. The mean and standard deviation were used to identify the mean scores for the different studied domains. The Chi-squared test was used to depict statistical differences among groups. Significant differences were noted when <italic>p</italic>-values were less than 0.05.</p></sec></sec><sec id="Sec8" sec-type="results"><title>Results</title><p id="Par16">There was a total of 384 respondents, which were almost equally distributed in terms of gender (47.0% male; 52.9% female). More than half (61.5%) of the respondents belonged to the age group 20–39 years old and almost all of them were Saudi (88.3%), from urban regions (95.8%), and more than half had a family monthly income > 8000 SAR/month (58.9%). Though a good number of the participants graduated from university (63.8%), more than half were unemployed (56.5%). As most of the Al-Jouf region is considered as desert rural areas, about one-third of the respondents had farms (34.9%), with a few having camels (9.6%) and minimal contact with camels (6.3%) (Table <xref rid="Tab1" ref-type="table">1</xref>).<table-wrap id="Tab1"><label>Table 1</label><caption><p>Sociodemographic characteristics of the study sample</p></caption><table frame="hsides" rules="groups"><thead><tr><th>Sociodemographic data</th><th>Number</th><th>Percentage</th></tr></thead><tbody><tr><td colspan="3">Age (years)</td></tr><tr><td> < 20</td><td>100</td><td>26.0%</td></tr><tr><td> 20–39</td><td>236</td><td>61.5%</td></tr><tr><td> 40–60</td><td>48</td><td>12.5%</td></tr><tr><td colspan="3">Sex</td></tr><tr><td> Male</td><td>181</td><td>47.1%</td></tr><tr><td> Female</td><td>203</td><td>52.9%</td></tr><tr><td colspan="3">Education level</td></tr><tr><td> School</td><td>121</td><td>31.5%</td></tr><tr><td> University</td><td>245</td><td>63.8%</td></tr><tr><td> Postgraduate</td><td>18</td><td>4.7%</td></tr><tr><td colspan="3">Occupation</td></tr><tr><td> Unemployed</td><td>216</td><td>56.3%</td></tr><tr><td> Government</td><td>131</td><td>34.1%</td></tr><tr><td> Non-government</td><td>32</td><td>8.3%</td></tr><tr><td> Retired</td><td>5</td><td>1.3%</td></tr><tr><td colspan="3">Family income (SAR/month)</td></tr><tr><td> <3000</td><td>11</td><td>2.9%</td></tr><tr><td> 3000–5500</td><td>78</td><td>20.3%</td></tr><tr><td> 5500–8000</td><td>68</td><td>17.7%</td></tr><tr><td> >8000</td><td>227</td><td>59.1%</td></tr><tr><td colspan="3">Nationality</td></tr><tr><td> Saudi</td><td>339</td><td>88.3%</td></tr><tr><td> Non-Saudi</td><td>45</td><td>11.7%</td></tr><tr><td colspan="3">Region</td></tr><tr><td> Urban</td><td>368</td><td>95.8%</td></tr><tr><td> Non-urban</td><td>16</td><td>4.2%</td></tr><tr><td colspan="3">Farm owner</td></tr><tr><td> Yes</td><td>134</td><td>34.9%</td></tr><tr><td> No</td><td>250</td><td>65.1%</td></tr><tr><td colspan="3">Camel owner</td></tr><tr><td> Yes</td><td>37</td><td>9.6%</td></tr><tr><td> No</td><td>347</td><td>90.4%</td></tr><tr><td colspan="3">Contact with camels</td></tr><tr><td> Yes</td><td>24</td><td>6.3%</td></tr><tr><td> No</td><td>360</td><td>93.8%</td></tr></tbody></table></table-wrap></p><p id="Par17">The cumulative score of the respondents’ knowledge on coronavirus disease revealed that most of the respondents (309) possessed moderate knowledge, a considerable number (52) had a good knowledge, while some of them (23) had a fair knowledge on coronavirus disease, with an absence of respondents having poor and excellent knowledge (Fig. <xref rid="Fig1" ref-type="fig">1</xref>).<fig id="Fig1"><label>Fig. 1</label><caption><p>Cumulative score of the respondents’ knowledge on Middle East respiratory syndrome-related coronavirus (MERS-CoV)</p></caption><graphic xlink:href="10389_2020_1209_Fig1_HTML" id="MO1"></graphic></fig></p><p id="Par18">The relationship between the sociodemographic data and degree of knowledge about MERS-CoV is represented in Table <xref rid="Tab2" ref-type="table">2</xref>. It can be seen that there was no significant difference (<italic>p</italic> < 0.05) in the amount of knowledge between males and females, Saudis and non-Saudis, rural and urban areas, or between farmers, camel owners, and contact with camels. However, there was a significant difference regarding age (<italic>p</italic> = 0.001), level of education (<italic>p</italic> = 0.007), and occupation (<italic>p</italic> = 0.024). The groups of participants that have a high level of knowledge were 20–40 years old, postgraduates, unemployed, and government employed.<table-wrap id="Tab2"><label>Table 2</label><caption><p>Relation between sociodemographic data and Middle East respiratory syndrome-related coronavirus (MERS-CoV) knowledge</p></caption><table frame="hsides" rules="groups"><thead><tr><th rowspan="2">Sociodemographic data</th><th colspan="2">Fair</th><th colspan="2">Moderate</th><th colspan="2">High</th><th rowspan="2"><italic>p</italic>-Value</th></tr><tr><th>No.</th><th>%</th><th>No.</th><th>%</th><th>No.</th><th>%</th></tr></thead><tbody><tr><td colspan="8">Age (years)</td></tr><tr><td>< 20</td><td>13</td><td>13</td><td>78</td><td>78</td><td>9</td><td>9</td><td rowspan="3">0.001*</td></tr><tr><td>20–40</td><td>5</td><td>2.1</td><td>191</td><td>80.9</td><td>40</td><td>16.9</td></tr><tr><td>41–60</td><td>5</td><td>10.4</td><td>40</td><td>83.3</td><td>3</td><td>6.3</td></tr><tr><td colspan="8">Sex</td></tr><tr><td>Male</td><td>7</td><td>3.9</td><td>145</td><td>80.1</td><td>29</td><td>16</td><td rowspan="2">0.126</td></tr><tr><td>Female</td><td>16</td><td>7.9</td><td>164</td><td>80.8</td><td>23</td><td>11.3</td></tr><tr><td colspan="8">Education level</td></tr><tr><td>School</td><td>15</td><td>12.4</td><td>91</td><td>75.2</td><td>15</td><td>12.4</td><td rowspan="3">0.007*</td></tr><tr><td>University</td><td>8</td><td>3.3</td><td>204</td><td>83.3</td><td>33</td><td>13.5</td></tr><tr><td>Postgraduate</td><td>0</td><td>0</td><td>14</td><td>77.8</td><td>4</td><td>22.2</td></tr><tr><td colspan="8">Occupation</td></tr><tr><td>Unemployed</td><td>1</td><td>1.3</td><td>59</td><td>78.7</td><td>15</td><td>20</td><td rowspan="5">0.024*</td></tr><tr><td>Student</td><td>16</td><td>11.3</td><td>112</td><td>79.4</td><td>13</td><td>9.2</td></tr><tr><td>Government</td><td>5</td><td>3.8</td><td>105</td><td>80.2</td><td>21</td><td>16</td></tr><tr><td>Non-government</td><td>1</td><td>3.1</td><td>28</td><td>87.5</td><td>3</td><td>9.4</td></tr><tr><td>Retired</td><td>0</td><td>0</td><td>5</td><td>100</td><td>0</td><td>0</td></tr><tr><td colspan="8">Family income (SAR/month)</td></tr><tr><td>< 3000</td><td>1</td><td>9.1</td><td>9</td><td>81.8</td><td>1</td><td>9.1</td><td rowspan="4">0.960</td></tr><tr><td>3000–5500</td><td>5</td><td>6.4</td><td>61</td><td>78.2</td><td>12</td><td>15.4</td></tr><tr><td>5500–8000</td><td>3</td><td>4.4</td><td>53</td><td>77.9</td><td>12</td><td>17.6</td></tr><tr><td>> 8000</td><td>14</td><td>6.2</td><td>185</td><td>81.9</td><td>27</td><td>11.9</td></tr><tr><td colspan="8">Nationality</td></tr><tr><td>Saudi</td><td>21</td><td>6.2</td><td>272</td><td>80.2</td><td>46</td><td>13.6</td><td rowspan="2">0.894</td></tr><tr><td>Non-Saudi</td><td>2</td><td>4.4</td><td>30</td><td>82.2</td><td>6</td><td>13.3</td></tr><tr><td colspan="8">Region</td></tr><tr><td>Urban</td><td>23</td><td>6.3</td><td>294</td><td>79.9</td><td>51</td><td>13.9</td><td rowspan="2">0.364</td></tr><tr><td>Non-urban</td><td>0</td><td>0</td><td>15</td><td>93.8</td><td>1</td><td>6.3</td></tr><tr><td colspan="8">Farm owner</td></tr><tr><td>Yes</td><td>7</td><td>5.2</td><td>107</td><td>79.9</td><td>20</td><td>14.9</td><td rowspan="2">0.778</td></tr><tr><td>No</td><td>16</td><td>6.4</td><td>202</td><td>80.8</td><td>32</td><td>12.8</td></tr><tr><td colspan="8">Camel owner</td></tr><tr><td>Yes</td><td>0</td><td>0</td><td>32</td><td>86.5</td><td>5</td><td>13.5</td><td rowspan="2">0.268</td></tr><tr><td>No</td><td>23</td><td>6.6</td><td>277</td><td>79.8</td><td>47</td><td>13.5</td></tr><tr><td colspan="8">Contact with camels</td></tr><tr><td>Yes</td><td>0</td><td>0</td><td>19</td><td>79.2</td><td>5</td><td>20.8</td><td rowspan="2">0.280</td></tr><tr><td>No</td><td>23</td><td>6.4</td><td>290</td><td>80.6</td><td>47</td><td>13.1</td></tr></tbody></table><table-wrap-foot><p>*<italic>p</italic>-Value < 0.05 is considered significant.</p></table-wrap-foot></table-wrap></p><p id="Par19">On examining the data in Table <xref rid="Tab3" ref-type="table">3</xref> to obtain an idea about the quantity of knowledge among the Al-Jouf population, the researchers noticed that the vast majority of the respondents were mindful that MERS-CoV was a viral illness (93.2%), contagious, and could lead to death (86.5%) but were not aware (85.7%) that its incubation period ranged from 4 to 5 days. Moreover, less than half of the respondents (46.9%) and more than one third were mindful that camels and personal contact (respectively) can transmit the disease. However, the vast majority of them (92.2% and 97.9%, respectively) did not know that bats and domestic animals can transmit the disease also.<table-wrap id="Tab3"><label>Table 3</label><caption><p>Responses to the questionnaire on knowledge of Middle East respiratory syndrome-related coronavirus (MERS-CoV)</p></caption><table frame="hsides" rules="groups"><thead><tr><th rowspan="2">Statements</th><th colspan="2">Correct</th><th colspan="2">Incorrect</th></tr><tr><th>No.</th><th>%</th><th>No.</th><th>%</th></tr></thead><tbody><tr><td colspan="5">Knowledge on the cause</td></tr><tr><td> Corona is caused by a virus</td><td>358</td><td>93.2</td><td>26</td><td>6.8</td></tr><tr><td colspan="5">Knowledge on the communicability of the disease</td></tr><tr><td> Contagious and leads to death</td><td>332</td><td>86.5</td><td>46</td><td>13.5</td></tr><tr><td colspan="5">Knowledge on the incubation period of the disease</td></tr><tr><td> 5–14 days</td><td>51</td><td>13.3</td><td>333</td><td>86.7</td></tr><tr><td colspan="5">Knowledge on the transmission</td></tr><tr><td> The disease is transmitted by camels</td><td>180</td><td>46.9</td><td>204</td><td>53.1</td></tr><tr><td> The disease is transmitted by bats</td><td>30</td><td>7.8</td><td>354</td><td>92.2</td></tr><tr><td> The disease is transmitted by domestic animals</td><td>8</td><td>2.1</td><td>376</td><td>97.9</td></tr><tr><td> The disease is transmitted by infected persons</td><td>148</td><td>38.5</td><td>236</td><td>61.5</td></tr><tr><td colspan="5">Knowledge of symptoms of the disease</td></tr><tr><td> The disease has upper respiratory symptoms</td><td>212</td><td>55.2</td><td>172</td><td>44.8</td></tr><tr><td> The disease has lower respiratory symptoms</td><td>76</td><td>19.8</td><td>308</td><td>80.2</td></tr><tr><td> Fever and muscle pain are symptoms of the disease</td><td>45</td><td>11.7</td><td>339</td><td>88.3</td></tr><tr><td> The disease has gastrointestinal symptoms</td><td>44</td><td>11.5</td><td>340</td><td>88.5</td></tr><tr><td> The disease has central nervous system symptoms</td><td>5</td><td>1.3</td><td>379</td><td>98.7</td></tr><tr><td colspan="5">Knowledge on disease prevention</td></tr><tr><td> Hand washing with alcohol could prevent the disease</td><td>141</td><td>36.7</td><td>243</td><td>63.3</td></tr><tr><td> Covering nose and mouth could prevent the disease</td><td>158</td><td>41.1</td><td>226</td><td>58.9</td></tr><tr><td> Keep in good general health could prevent the disease</td><td>34</td><td>8.9</td><td>350</td><td>91.1</td></tr><tr><td> Vaccine could prevent the disease</td><td>89</td><td>23.2</td><td>295</td><td>76.8</td></tr><tr><td> There is no preventive measure</td><td>20</td><td>5.2</td><td>364</td><td>94.8</td></tr><tr><td colspan="5">Knowledge on disease treatment</td></tr><tr><td> Supportive treatment at home is a measure of treatment</td><td>17</td><td>4.4</td><td>367</td><td>95.6</td></tr><tr><td> Hospitalization is a measure of treatment</td><td>8</td><td>2.1</td><td>376</td><td>97.9</td></tr><tr><td> Intensive care is a measure of treatment</td><td>206</td><td>53.6</td><td>178</td><td>46.4</td></tr><tr><td> No drug treatment available</td><td>138</td><td>35.9</td><td>246</td><td>64.1</td></tr><tr><td colspan="5">Knowledge on the epidemiology of the disease</td></tr><tr><td> Arabian Peninsula is a vulnerable region</td><td>157</td><td>40.9</td><td>227</td><td>59.1</td></tr><tr><td> North and South Africa are vulnerable regions</td><td>44</td><td>11.5</td><td>340</td><td>88.5</td></tr><tr><td> South America is a vulnerable region</td><td>2</td><td>0.5</td><td>382</td><td>99.5</td></tr><tr><td align="justify"> Jordan and Lebanon are vulnerable regions</td><td>4</td><td>1.0</td><td>380</td><td>99.0</td></tr></tbody></table></table-wrap></p><p id="Par20">In regards to symptoms, more than half (55.2%) of the respondents agreed that a person with MERS-CoV may develop upper respiratory symptoms. About one fifth (19.8%) of the respondents were aware that the disease can develop lower respiratory symptoms, while a vast majority of them did not know that it can develop general symptoms (fever and muscle pain), gastrointestinal symptoms, and central nervous system symptoms (88.3%, 88.5%, and 98.7%, respectively).</p><p id="Par21">In addition to the above observations on knowledge and regarding MERS-CoV prevention, more than one third of the respondents agreed that specific hygiene and avoiding contact practices and measures are needed for protection from the disease. Although more than three quarters (76.8%) of them knew that there is no specific vaccine towards MERS-CoV, the vast majority did not know that good general health played a role in the prevention of the disease (91.1%) and, also, that there is no specific preventive measures against the disease (94.8%).</p><p id="Par22">As for knowledge on MERS-CoV treatment, a vast majority of the respondents did not know that MERS-CoV could be treated by supportive measures at home (95.6%) or a few days spent at hospital (97.9%). More than half (53.6%) of the respondents believed that the affected individuals could only be treated in the intensive care unit and one third (35.9) of them knew that there is no specific drug for the disease. Although more than one third of the respondents were knowledgeable that the Arabian Peninsula is a vulnerable region of the disease, the vast majority of them did not know about other international vulnerable regions.</p><p id="Par23">Lastly, from Fig. <xref rid="Fig2" ref-type="fig">2</xref>, we detected that the Ministry of Health, community communication, and social networks represented the highest efficiency rates as awareness sources (25%, 23.7%, and 22.6%, respectively). However, hardly any information was gained from infected people (0.52%). Medical campaigns as well as self-learning had small roles in awareness (5.73% and 4.43%, respectively) among the public in the Al-Jouf region.<fig id="Fig2"><label>Fig. 2</label><caption><p>Different sources of the respondents’ knowledge on Middle East respiratory syndrome-related coronavirus (MERS-CoV)</p></caption><graphic xlink:href="10389_2020_1209_Fig2_HTML" id="MO2"></graphic></fig></p></sec><sec id="Sec9" sec-type="discussion"><title>Discussion</title><p id="Par24">Studies have examined the various levels of knowledge towards MERS-CoV outbreaks in various regions in Saudi Arabia (Almutairi et al. <xref ref-type="bibr" rid="CR4">2015</xref>; Alqahtani and Aldawsari <xref ref-type="bibr" rid="CR6">2015</xref>; Al-Abdullah et al. <xref ref-type="bibr" rid="CR2">2016</xref>), but a literature search has not found any public reports on knowledge regarding coronavirus among the population of Al-Jouf region until now. Therefore, this population-based survey could provide baseline data to Al-Jouf government for preventive measures in case of future outbreaks.</p><p id="Par25">The present study revealed that awareness of MERS-CoV among the Al-Jouf population is generally good. This is attributed to findings of this research that indicated that the Ministry of Health campaign, social networks, and social communication were the most cited sources of information on MERS-CoV infection. The importance of these results is that this survey covered different types of population with good validity and reliability, as the study was voluntary, with personal interview methods.</p><p id="Par26">This results of this survey showed that there was no significance difference in MERS-CoV knowledge regarding sex, nationality, region, or income. However, there was a significant difference regarding age, level of education, and employment. Similar to the results of Alqahtani and Aldawsari (<xref ref-type="bibr" rid="CR6">2015</xref>) and Al-Abdullah et al. (<xref ref-type="bibr" rid="CR2">2016</xref>), the level of knowledge was higher particularly among younger individuals in the age range 20 and 40 years. This might be attributed to the capability of young persons to gain their knowledge from social media. Social media represents the second major source of information to the respondents in this work, as shown by our result. This comes in contrast to elderly people, who gained their knowledge from newspapers, television, and radio. Therefore, alleviating the concerns of the government in using various routes to reach different population groups is crucial. It is not surprising that postgraduates as well as governmental employees showed a high level of knowledge. This might be due to self-education and sharing the governmental campaign about MERS-CoV, respectively. In contrast to this, the greater knowledge of unemployed participants might come via benefiting from their free time in self-education and use of social networks.</p><p id="Par27">It is essential to note that, while the majority of the respondents were highly informed of the nature, communicability, and lethal effect of the disease, a still quite significant proportion of the respondents held wrong concepts about the mode of transmission. For instance, nearly half of the respondents were aware that corona is transmitted by camels. We considered this percentage to be insufficient and increasing public awareness of the people in Al-Jouf region, especially those who live in rural areas, should be taken seriously. Al-Jouf region, as with other desert regions in Saudi Arabia, is famous for raising camels since ancient times. There is even an area that lies 800 m from Sakaka, and known as Al-Jamal area, where large stones carved in the mountains were found in the form of camels (Center for International Communication, CIC <xref ref-type="bibr" rid="CR11">2018</xref>). It has been known that MERS-CoV was detected in dromedary camels in a number of countries and represented 22–25% of camel-to-human transmissions (Aguanno et al. <xref ref-type="bibr" rid="CR1">2018</xref>; Lin et al. <xref ref-type="bibr" rid="CR18">2018</xref>). Studies powerfully suggested that MERS-CoV has been primarily passed through an evolutionary recombination process in dromedary camels in Africa and exported to the Arabian Peninsula through the camel trading routes (Andualem <xref ref-type="bibr" rid="CR8">2017</xref>).</p><p id="Par28">On the other hand, although one third of the respondents knew that the disease could be transmitted through direct personal contact, almost all of the respondents were aware about the role of bats and domestic animals in the transmission of the disease. Due to the desert and rural nature of Al-Jouf region, it is normal to bridge this gap of knowledge to prevent epidemic outbreak of the disease.</p><p id="Par29">Good knowledge on the clinical picture of MERS-CoV is essential for recognizing the disease, obtaining appropriate measurements, and preventing outbreaks to save lives. While between one fifth to one half of the respondents knew that MERS-CoV can be represented by lower and upper respiratory symptoms, respectively, a vast majority of them did not know that it can develop general gastrointestinal and central nervous system symptoms. The accurate incubation period (Health Protection Agency (HPA) UK Novel Coronavirus Investigation Team <xref ref-type="bibr" rid="CR14">2013</xref>) of MERS-CoV was not well known by most of the respondents. However, it is crucial, as it contributes to early healthcare-seeking behavior. For that reason, periodic educational interventions from experts to demonstrate the stages and clinical picture of the disease will be beneficial in controlling the disease.</p><p id="Par30">In 2015 in King Abdullah University Hospital, it was estimated that MERS-CoV patient care costs from 4000 to 5000 SAR, despite there being no definitive treatment until now (Al-Abdullah et al. <xref ref-type="bibr" rid="CR2">2016</xref>). As the drug prices increased sharply in the past 4 years and vaccines are still in the research stages, it is reasonable to concentrate on preventive measures. The knowledge of the participants in this study about preventive measurement is still less than adequate. This implied that precautionary activities in avoiding infection by coronavirus need to be encouraged and strengthened.</p><p id="Par31">Regarding the most vulnerable area, although about 40.9% of respondents knew that Arab regions and a few (11.5%) knew about North and South Africa, almost all respondents were unaware of the other international vulnerable areas. Public awareness about outbreak areas in neighboring vulnerable places like Jordan and Lebanon that have road connections with the Al-Jouf region is crucial.</p><p id="Par32">The findings also indicated that the Ministry of Health followed by social media and community communication represented the most cited sources of information on MERS-CoV disease. Interestingly, only a small proportion of the respondents cited the university medical campaign, self-learning, and relatives of infected individuals as sources of information. This clearly proved the efficacy of governmental public health education programs as well as technology in increasing the knowledge and awareness of the disease. Thus, university medical staff and students should maximize their role in awareness campaigns as well as in research aspects.</p><sec id="Sec10"><title>Limitations of the study</title><p id="Par33">The present study has several limitations:<list list-type="order"><list-item><p id="Par34">Generalization of the result study had been potentially limited, since it depended on researchers’ convenience to the participants to share in the study. This investigation was conducted among residents in selected municipalities, with less conduction in rural areas, which is the location of the target groups (farmers and camel owners). As it was difficult for female researchers to reach these areas, due to conservative customs and traditions of the Al-Jouf community, we thought of sending the questionnaire by mail. However, it would have been troublesome, considering that the questionnaire might be misplaced during delivery and that many of the rural villages do not have postal systems.</p></list-item><list-item><p id="Par36">Difficulty in obtaining the full patient data at the hospital in Al-Jouf prevented the researchers from assessing the relationship between corona disease and other risk factors to determine a cause–effect relationship.</p></list-item></list></p></sec></sec><sec id="Sec11" sec-type="conclusion"><title>Conclusion and recommendation</title><p id="Par37">From this survey, we can conclude that:<list list-type="order"><list-item><p id="Par38">People in Al-Jouf region had good knowledge about Middle East respiratory syndrome-related coronavirus (MERS-CoV) and this may reflect the effective circulation of the information about MERS-CoV by the Ministry of Health, social networking sites, and the media. However, the university medical campaign has an unremarkable role in increasing MERS-CoV awareness in the future.</p></list-item><list-item><p id="Par39">Although the Al-Jouf public awareness level is generally good, it is less than expected, especially in regards to the modes of transmission by bats and domestic animals, incubation period, and epidemiology of the disease (especially to the neighboring countries of Jordan and Lebanon), which is still weak and insufficient, so we suggest increasing the level of awareness towards them.</p></list-item><list-item><p id="Par40">Public health education programs have confirmed their value in increasing the awareness of MERS-Cov disease. Consequently, the Ministry of Health should expand its awareness role through providing the media, schools and health centers, and governmental and non-governmental organizations with adequate and sound information and educational materials about the disease features and preventive measures. In addition to this, cooperation with the university medical research centers to invent new preventive and control agents is necessary.</p></list-item><list-item><p id="Par41">Health workers can provide public awareness and reach target groups through public health campaigns. So, improving their skills through an orientation training course about MERS-CoV disease might help to control disease outbreaks.</p></list-item><list-item><p id="Par42">Despite some limitations posed by this investigation, the results provided useful inputs and knowledge that would help the government in planning, designing, and initiating programs to help in MERS-CoV disease control and prevention.</p></list-item></list></p></sec><sec sec-type="supplementary-material"><title>Electronic supplementary material</title><sec id="Sec12"><p>Below is the link to the electronic supplementary material.<supplementary-material content-type="local-data" id="MOESM1"><media xlink:href="10389_2020_1209_MOESM1_ESM.doc"><label>ESM 1</label><caption><p>(DOC 47 kb)</p></caption></media></supplementary-material></p></sec></sec></body><back><fn-group><fn><p><bold>Publisher’s note</bold></p><p>Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.</p></fn></fn-group><notes notes-type="funding-information"><title>Funding information</title><p>The current study was not supported by any national or international institution or organization.</p></notes><notes notes-type="ethics"><title>Compliance with ethical standards</title><notes notes-type="COI-statement"><title>Conflict of interest</title><p id="Par43">All authors declare that the research was approved by all authors and was conducted in the absence of any commercial or financial relationships. Also, the authors emphasize that the research is not under consideration for publication elsewhere and, if accepted, it will not be published elsewhere in the same form, in English or in any other language, including electronically, without the written consent of the copyright holder. 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