INTRODUCTION:
COVID-19,
a disease caused by a novel coronavirus, became a major global human threat
that has turned into a pandemic. Coronavirus is one of the major pathogens that
mainly target the human respiratory system. In late December 2019, a cluster of
patients were admitted to hospitals in China with an initial diagnosis of
pneumonia of an unknown etiology1. Early reports predicted the onset of a possible coronavirus
outbreak called SARS- CoV-2, causing the disease COVID-19. The ongoing epidemic
has been declared by the World Health Organization (WHO) as a global public
health emergency2.
Most
people infected with the COVID-19 virus will experience mild to moderate
respiratory illness and recover without requiring special treatment. Older
people and those with underlying medical problems like cardiovascular disease,
diabetes, chronic respiratory disease, and cancer are more likely to develop
serious illness. The best way to prevent and slow down transmission is be well
informed about the COVID-19 virus, the disease it causes and how it spreads.
The COVID-19 virus spreads primarily through droplets of saliva or discharge
from the nose when an infected person coughs or sneezes, so it’s important that
when someone cough or sneeze they practice respiratory etiquette (for example,
by coughing into a flexed elbow). At this time, there are no specific vaccines
or treatments for COVID-19.
However,
there are many ongoing clinical trials evaluating potential treatments. Good
nutrition is very important before during and after an infection. Infections
take a toll on the body especially when these cause fever, the body needs extra
energy and nutrients. Therefore, maintaining a healthy diet is very important
during the COVID-19 pandemic. While no foods or dietary supplements can prevent
COVID-19 infection, maintaining a healthy diet is an important part of
supporting a strong immune system.
Countries
that have implemented strict lockdown and physical distancing regulations have
also put in measures that have protected access to food and have not, thus far,
experienced widespread disruptions in food supplies.3
At
the individual level, the common denominator that drives most of the nutrition
and dietary recommendations to combat viral infections, including COVID-19,
lies within the link between diet and immunity. In fact, existing evidence
highlights that diet has a profound effect on people’s immune system and
disease susceptibility. It has been demonstrated that specific nutrients or
nutrient combinations may affect the immune system through the activation of
cells, modification in the production of signaling molecules, and gene
expression4. Furthermore, dietary ingredients are significant
determinants of gut microbial composition and consequently can shape the
characteristics of immune responses in the body5. Nutritional
deficiencies of energy, protein, and specific micronutrients are associated
with depressed immune function and increased susceptibility to infection. An
adequate intake of iron, zinc, and vitamins A, E, B6, and B12 is
predominantly vital for the maintenance of immune function 6.
Therefore, the key to maintaining an effective immune system is to avoid
deficiencies of the nutrients that play an essential role in immune cell
triggering, interaction, differentiation, or functional expression.
COVID-19
world pandemic imposed a new set of challenges for the individual to maintain a
healthy diet First, the state of lockdown announced in many countries around
the globe led all public and private sector institutions, with the exception of
health care facilities and a limited number of essential services, to close
down and, if possible, carry its operations remotely (without face to face
interactions). Individuals were asked to stay home and avoid contact with other
people 7. Such measures of self-isolation and social
distancing are known to be crucial in limiting the spread of the virus,
flattening the curve of incidence rate. These measures have severe
repercussions on both food access and utilization. Food access, however, is
dependent on factors that could reach beyond the individual and are more
directly related to actions and policies at the community, national as well as
global levels. That said, the individual remains capable of making a few
choices related to food utilization. The confinement to one’s home has direct
effects on one’s lifestyle, including dietary habits, eating, and physical
activity patterns.
Confinement
increases sedentary behaviors that involve activities with very low energy
expenditure, performed mainly in a sitting or supine position8. The
low physical activity levels, even for short periods, could negatively affect
physical and mental health. The state of lockdown and confinement could also
lead to irregular eating patterns and frequent snacking, both of which are
associated with higher caloric intake and increased risk of obesity. 9
Therefore, the responsibility of the individuals during the COVID-19 pandemic
lies in making an effort to choose a healthy lifestyle, eat diets high in
fruits and vegetables, exercise during free time, try to maintain a healthy
weight, and get an adequate amount of sleep. In addition to taking care of
one’s dietary intake, the collective responsibility of individuals is to avoid
the spread of misinformation related to nutrition and dietary intake, and the
COVID-19. Balanced nutrition which can help in maintaining immunity is
essential for prevention and management of viral infections3.
Ranil Jayawardena, Piumika Sooriyaarachchi
et al. (2020) conducted a systematic review on Enhancing immunity in viral
infections, with special emphasis on COVID-19. A systematic search strategy was
employed using keywords to search the literature in 3 key medical databases:
PubMed, Web of Science and SciVerse Scopus. Studies were considered eligible if
they were controlled trials in humans, measuring immunological parameters, on
viral and respiratory infections. Clinical trials on vitamins, minerals,
nutraceuticals and probiotics were included. A total of 640 records were
identified initially and 22 studies were included from other sources. After
excluding duplicates and articles that did not meet the inclusion criteria, 43
studies were obtained (vitamins: 13; minerals: 8; nutraceuticals: 18 and
probiotics: 4). Among vitamins, A and D showed a potential benefit, especially
in deficient populations. Among trace elements, selenium and zinc have also
shown favourable immune-modulatory effects in viral respiratory infections.
Several nutraceuticals and probiotics may have some role in enhancing immune
functions. Micronutrients may be beneficial in nutritionally depleted elderly
population.
Study
summaries possible benefits of some vitamins, trace elements, nutraceuticals
and and probiotics. Nutrition principles based on these data could be useful in
possible prevention and management of COVID- 19.10 Devika I, Dr. Thahira Banu A
(2020) conducted a study to assess the nutrition related knowledge, attitude
and practice of women living with HIV (18-40 years), a viral infection. A total
of 50 HIV infected women subjects were selected by purposive sampling method.
The data was collected by personal interview with the help of pretested
questionnaire. The result of the study indicated that nutrition knowledge was
poor as 52 percent of the subject had poor score and 44 and two percent had an
average and good score respectively. Poor knowledge was also reflected with low
scores for nutritional attitude and practices and the result revealed that 54
percent of subject had poor attitude and 44percent had an average attitude
towards the importance of nutrition. Seventy- two and 28 percent was found to
have a poor and average good nutritional practice respectively. Nutrition and
HIV are interrelated and nutrition plays a major role in disease progression
and improves the quality of life in people living with HIV. According to this
study nutrition related practices was fairly good among selected HIV infected
women subjects. Thus from the study it is understood that long term nutrition
education can be a best mode to improve nutritional knowledge, attitude and
practice of People living with HIV (PLHIV).11
The
simplicity of awareness about oneself and the harmony each individual can
achieve by uplifting and maintaining his or her immunity is emphasized across
Ayurveda’s classical scriptures. Ministry of AYUSH recommends the following
self-care guidelines for preventive health measures and boosting immunity with
special reference to respiratory health. These are supported by Ayurvedic
literature and scientific publications.12
The
Food and Agriculture Organization of the United Nations (FAO) and other United
Nations (UN) agencies are also sharing best practices to help governments
ensure the food supply continues to be stable. To maintain healthy diets, FAO
encourages everyone to follow the following recommendations:
1.
To eat a variety of foods within
each food group and across all the food groups to ensure adequate intake of
important nutrients.
2.
Eat plenty of fruits and
vegetables. Fresh fruits and vegetables provide lots of vitamins and minerals
as well as fiber that we need for healthy diet.
3.
Consume a diet rich in whole
grains, nuts, and healthy fats such as in olive, sesame, peanut or other oils
rich in unsaturated fatty acids. Such diets may support the immune system and
help to reduce inflammation.
4.
Watch intake of fats, sugar, and
salt. Many people in times of high stress, use food as a comfort, which can
lead to overconsumption.
5.
Continue to practice good food
hygiene. Because of COVID-19 pandemic, everyone might be more concerned about
food safety; however, COVID-19 is a
respiratory virus and is not a food-borne disease. There is no evidence that
the disease can be spread through contact with the food purchased. However,
it’s always good to remember how we can support food safety by practicing the
five keys to food safety:
(1)
keep clean; (2) separate raw and
cooked; (3) cook thoroughly; (4) keep food at safe temperatures; and
(5)
use safe water and raw materials.
6.
Drink water regularly. Staying
well hydrated, mainly through drinking ample amounts of plain water (6-8
glasses a day for most adults) also helps our immune system. Drinking plain
water instead of sugar- sweetened beverages, also helps reduce the risk of
consuming too many calories for maintaining a healthy weight.
7.
Limit consumption of alcohol.
Another way many people try to cope with stress is through having an alcoholic
drink. These drinks have little nutritional value, are oftentimes high in
calories, and excess consumption is linked to numerous health problems. In
addition to a healthy diet, other lifestyle factors are critical part of
maintaining wellbeing and a healthy immune system. A healthy lifestyle includes
additional strategies such as: not smoking, exercising regularly, getting
adequate sleep and minimizing and coping with stress. It is still possible to
purchase and consume a healthy diet during these difficult times. Diets vary
greatly from place to place based on many factors including eating habits and
culture. Yet, when it comes to food, there is a lot that we know about how to
select the right combination of food to attain a healthy diet regardless of
where we live. As per WHO guidelines to prevent from being infected. Keep clean, Separate raw
and cooked, cook thoroughly, Keep food at safe temperatures, Use safe water and
raw materials. Guidelines for maintaining a healthy diet as per WHO are
1.
Eat a variety of food, including
fruits and vegetables
2.
Cut back on salt
3.
Eat moderate amounts of fats and oils
4.
Limit sugar intake
5.
Stay hydrated: Drink enough water
6.
Avoid hazardous and harmful
alcohol use
7.
Breastfeed babies and young children
While
much remains to be known about the COVID-19, the influence of this pandemic on
nutrition and dietary intake has already gone beyond the individual and the
community to reach national and global levels. A particular feature of this
pandemic is highlighting the interdependence of these various levels, whereby
the health of the individual became a direct function of his own awareness and
choices, the unity of the community, the preparedness of the government, and
ultimately the global engagement vis a vis this threat13.
STATEMENT
OF THE PROBLEM:
A
study to assess the knowledge regarding immunity boosting measures for self
care during COVID-19 crisis among community people in selected urban areas of
Haryana, India.
OBJECTIVES
OF THE STUDY:
1.
To assess the knowledge regarding
immunity boosting measures for self care during COVID-19 crisis among community
people in selected urban areas of Haryana, India.
2.
To find out the association
between level of knowledge regarding immunity boosting measures for self care
during COVID-19 crisis and selected demographic variables
ASSUMPTION:
People
of selected urban areas of Haryana may have knowledge about Immunity boosting
measures for self care during COVID-19 crisis.
MATERIAL
AND METHODS:
A
web-based, survey was conducted using a structured questionnaire to obtain
responses from study participants during the third week of May 2020. A 30-item
survey instrument was developed using course materials available on WHO’s
website on emerging COVID-19. The survey covered community people’s socio
demographic profile, awareness, information sources, and knowledge related to
maintenance of healthy dietary measures for self-care during COVID-19 pandemic.
The developed draft of survey instrument was made accessible through a web link
and was distributed to 10 experts from the field of nursing and health sciences
to
comprehensively
assess the content domains of the questionnaire (using a scale of 1-5 points
and encouraged open commentaries). The pilot web survey was then conducted
among 10 randomly selected community people to assess clarity, relevance, and
acceptability.
Feasibility
and time required to answer the survey were evaluated on another 5
participants. These participants were not included in the research study.
Survey Research design
Target population
People of selected urban community in gurugram
Accessible population
Community people of selected urban area
Sampling technique
Total enumerative sampling technique
Sample size
250 samples
Description of the instrument
Web based structured questionnaire
Data collection
Assessment of knowledge regarding Immunity boosting
measures for self care during COVID 19 crisis
Data analysis and
interpretation
Descriptive and inferential statistics
Findings and conclusion
Development and description of the tool: A Development of the tool:
Structured-
questionnaire was scheduled and selected for the study. The tool was developed
after adequate retrieval of research studies regarding COVID 19 pandemic and
self-care under the guidance of nursing and medical experts.
B. Description of the tool:
The
instrument used for data collection was a structured- questionnaire which
consisted of two sections.
Section
A: Socio-demographic data of the study participants.
Table 2: Association between knowledge regarding
immunity boosting measures for self-care during COVID-19 crisis and selected
demographic variables N= 218
|
S. No
|
Groups
|
χ2 value
|
P Value
|
|
1
|
Age in years
16
– 29
30-
49
50
above
|
0.02
|
0.888
|
|
2
|
Gender Male Female
|
0.35
|
0.553
|
|
3
|
Marital status
Never
married Married
|
1.65
|
0.199
|
|
4
|
Level of education Higher
Secondary Graduate
Post
Graduate
|
1.65
|
0.554
|
|
5
|
Occupation Government job Private job Business
Farming
|
1.10
|
0.199
|
|
6
|
Sources of information
about
COVID 19 News Media Social Media
Government
website Family/ Friends
Internet
|
1.03
|
0.294
|
|
7
|
Total no. of family members 3
4 More
|
1.10
|
0.310
|
|
8
|
Dietary pattern
Vegetarian
Non-
Vegetarian Eggetarian
|
1.19
|
0.313
|
|
9
|
Any Physical activity
Yoga
Exercise Gyming Running Walking
None
of them
|
0.78
|
0.201
|
Table
2 shows the calculated Chi- square values for selected demographic variables
followed by p- value calculation. For all selected demographic variables p-
value at (df= 1) were >0.05, which shows that there is no significant
association between knowledge regarding immunity boosting measures for
self-care during COVID-19 crisis and selected demographic variables.
DISCUSSION:
Present
study findings revealed that there is poor to average knowledge among the
people of Urban community though they are educated, updates with current
information but awareness is not adequate. Similar study was conducted by U.
Sheela in October 2020 to assess the Immunity boosting measures for self- care
among residents of Urban community of pune using quantitative non-experimental
survey research design with a sample size of 100. Majority of respondents have
average
knowledge (49.7%), good knowledge (04%) and 46.3% respondents had poor
knowledge. Since all the p- values are
large (greater than 0.05), there is no evidence against null hypothesis. None
of the demographic variable was found to have significant associated with
knowledge of the urban community residents regarding immunity boosting measures
for self-care. The residents had considerable average knowledge regarding
Immunity boosting measures for self-care. The enhancement in knowledge is
greatly required on Immunity boosting measures for self-care.
CONCLUSION:
The
present study assessed the knowledge among urban community people regarding
Immunity boosting measures for self-care during COVID crisis. The study
findings revealed that participants had considerable average knowledge
regarding Immunity boosting measures for self-care. The enhancement in
knowledge is greatly required on Immunity boosting measures for self-care to
enhance the natural defense system of individual.
RECOMMENDATIONS:
It
is recommended by Ministry of Ayush to follow the guidelines of immunity
booting measures for self-care to enhance one’s immunity to fight against the
COVID 19 infection. Followings are the recommendations:
1.
The same type of study can be done
on a larger sample to validate findings and make generalization.
2.
A correlation study can be
conducted with a large sample with a wide range of settings to assess the
attitude regarding immunity booting measures for self-care during COVID
pandemic.
CONFLICT
OF INTEREST:
The
author declare no conflict of interest.
ETHICAL
STATEMENT:
The
researcher obtained the University’s research Committee approval and Study was
approved by the university’s Ethical subcommittee. Informed consent was
obtained from each sample. Privacy and confidentiality maintained.
ACKNOWLEDGEMENTS:
We
feel obliged to thank all the study participants for participating in the
present study.
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1.
Farah Naja, Rena Hamadeh. Nutrition
amid the COVID-19 pandemic: a multi-level framework for action. European
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Zhu N, Zhang D, Wang W, Li X, Yang
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Ayurveda’s immunity boosting
measures for self-care during COVID 19 crisis. Available from URL: https://vikaspedia.in/news/ayurvedas-immunity-boosting-
measures-for-self-care-during-covid-19-crisis
13.
Ministry of Ayush. Ayurveda’s
Immunity booster measures for self-care during COVID-19 crises. 2020 Available
from: https://www.ayush.gov.in/
Received on 26.05.2021 Modified
on 27.06.2021
Accepted on 09.07.2021 ©A&V Publications All right reserved
Asian J. Nursing
Education and Research. 2021; 11(4):488-494.
DOI:
10.52711/2349-2996.2021.00117
