Knowledge and sources of information on COVID-19 among children in Ghana

The study addresses the research gap in Ghana concerning children’s knowledge of COVID-19, its transmission and prevention, and their sources of information. While prior global and regional studies report high awareness among children, misconceptions persist and practice may lag behind knowledge. In Ghana, most research has focused on adults. This study’s purpose was to assess the level of knowledge and identify information sources on COVID-19 among children aged 10–17 in Accra and Tema, to inform policy and public health communication strategies relevant to child development and safety.

Evidence from Cambodia, India, China, Egypt and Nigeria indicates near-universal knowledge of COVID-19 among children and adolescents, though gaps between knowledge and preventive practices exist. Misconceptions reported include low perceived risk in children and conspiracy beliefs about the virus’s origin, often linked to social media dissemination. In Ghana, departmental evidence suggested high knowledge among children, but rigorous studies on children’s knowledge and information sources were limited. The literature underscores both widespread awareness and the prevalence of misinformation, particularly via social media, motivating the present study.

Design: Cross-sectional mixed-methods study among children aged 10–17 years in Ghana. Setting: Two COVID-19 hotspot cities—Accra (capital) and Tema (coastal city in Greater Accra Region). Sampling and recruitment: Convenience sampling. Due to COVID-19 restrictions, a remote approach was used. A sampling frame of 640 parent/guardian contacts in Accra and Tema was compiled. Parents/guardians were informed of the study and asked permission for their children to participate. After parental consent, children provided assent via an online consent statement and accessed the survey. Participants: 385 children completed the online survey (188 males, 197 females). Additionally, 59 different children (30 males, 29 females) participated in phone interviews (key informant interviews) selected across residential areas in the study sites for varied perspectives. Inclusion criteria: Children aged 10–17 residing in Accra or Tema; parental/guardian consent; access to a phone, tablet, or computer with internet connectivity. Data collection: June–November 2020. A self-administered online questionnaire (KoboToolbox) captured demographics, knowledge, attitudes, and practices related to COVID-19. Phone interviews (conducted in English; ~30 minutes each) used a semi-structured guide paralleling survey topics to cross-check and enrich findings. Ethics: Instruments reviewed and approved by the National Child Protection Committee (NCPC) of the Department of Children (April 2020). Informed consent obtained from parents/guardians; assent/consent from children. Participation was voluntary, with rights to skip questions or withdraw. Data analysis: Qualitative data were thematically analyzed with coding around awareness, causes, inaccurate knowledge, who can be infected, sources of information, and sources of misinformation. Quantitative data were analyzed in SPSS v25 using descriptive statistics (frequencies, percentages) and Pearson’s chi-square tests to assess associations between knowledge and sources with sex, age, and education. Key quotes from interviews illustrated themes.

Sample characteristics: 385 survey respondents (51.2% female). Age groups: 10–12 (17.9%), 13–15 (35.1%), 16–17 (47.0%). Education: Primary (18.2%), JHS (25.7%), SHS/vocational/tertiary (56.1%). Awareness: 99.0% had heard of COVID-19; females 99.5% vs males 98.4% (P=0.293; not significant). Knowledge of causes: Overall, 6.8% believed COVID-19 is caused by bacteria (93.2% said not caused by bacteria); 96.3% believed it is caused by a virus; 96.6% recognized COVID-19 as the illness caused by the novel coronavirus. Misconceptions were more common among younger (10–13 years) and lower-education groups: age associated with bacteria misconception (P<0.001) and with recognizing the novel coronavirus as cause (P=0.026). Education associated with bacteria misconception (P<0.001). Sex differences were minimal/non-significant for cause items. Who can be infected: Healthy-looking persons (95.5%), children (97.1%), Africans/people of Black descent (96.1%), people living in hot climates (86.1%). Age and education significantly associated with these knowledge items (multiple P<0.001), with younger and lower-education groups showing lower correct recognition. Sex differences were generally non-significant, though belief about hot climates showed a small sex association (P=0.045). Sources of information: Internet/social media (39.1%), television (37.0%), radio (16.5%), friends (5.0%), publications (2.4%). Age (P<0.001) and education (P<0.001) were significantly associated with source use: younger children (10–13) and those in primary/JHS relied more on TV and friends; older (14–17) and SHS/vocational/higher relied more on internet/social media; radio use higher among older. Sex differences in source use were not statistically significant (P≈0.402), though males reported slightly higher social media use and radio, and females slightly higher TV and publications/friends. Qualitative insights: While awareness was high, some children held misconceptions, including beliefs that bacteria or mosquito/insect bites transmit COVID-19, and use of steam inhalation with lime as a cure. Social media platforms (WhatsApp, Instagram, TikTok, Facebook, Twitter) were noted as channels for misinformation (e.g., claims that COVID-19 kills only adults, or conspiracy theories about the virus’s origin). Contextual factors (household media habits, privacy, device access) influenced source preferences by sex and age.

The findings indicate near-universal awareness of COVID-19 among children in Ghana, aligning with international studies. However, notable knowledge gaps persist, particularly among younger and less-educated children, regarding the etiology and transmission of COVID-19 and who is susceptible. These gaps likely reflect differences in cognitive maturity, educational exposure, and media consumption patterns. Social media emerged as a primary information source, especially among older and more educated children, providing rapid access but also posing risks of misinformation. Television and radio remained crucial for younger children and those with limited internet access. The results underscore the need for targeted, age- and education-appropriate public health messaging and parental/teacher mediation of online content to counter misinformation and reinforce accurate knowledge, thereby supporting safer practices and preparedness for future public health crises.

This study contributes evidence that children in Accra and Tema had very high awareness of COVID-19, with generally good knowledge of causes and susceptibility. Nonetheless, qualitative data revealed specific misconceptions (e.g., bacteria or mosquitoes causing transmission; home cures), and quantitative results showed that younger and less-educated children were more prone to inaccuracies. Social media is a major information source and a conduit for misinformation, necessitating parental, teacher, and caregiver oversight. Public awareness strategies should be multifaceted—leveraging social media, television, radio, and peer channels—tailored by age, sex, and education level to ensure accurate dissemination. Although the COVID-19 pandemic has officially ended, these insights can inform communication strategies for future public health emergencies.

The cross-sectional design precludes causal inference. The convenience sample was limited to children with access to internet-enabled devices, introducing potential social-class bias and limiting generalizability to all children in Accra and Tema or Ghana. Future research should use more representative sampling to include children without device or internet access.