The current global perspective of the knowledge-attitude-behavior of the general public towards the corona virus disease -19 pandemic: Systematic review and meta-analysis on 67,143 participants.

BACKGROUND: Determining the success of infectious disease outbreak prevention is dependent mainly on public knowledge and compliance regarding the guidelines of precautionary behaviors and practices. While the current literature about the COVID-19 pandemic extensively addresses clinical and laboratory-based studies, a gap remains still present in terms of evaluating the general public knowledge and behaviors towards the COVID-19 pandemic. The aim of this review was to form a preliminary and contemporary understanding of the general public knowledge, attitude, and behaviors towards the COVID-19 pandemic globally.
METHODS: A systematic search was conducted in various databases until May 2020. Each study's characteristics including the sample size, region, and study type were examined individually. A meta-analysis with a random-effects model and pooled prevalence with 95% confidence interval (CI) of all evaluated outcomes such as adequate knowledge, positive feelings, worrisome about the COVID-19 pandemic, and practice were recorded and reported from each study. Parameters such as random distribution, blinding, incomplete outcome data, selective reporting, and other biases were utilized to assess the quality of each retrieved record. Both Begg's and Egger's tests were employed to evaluate symmetry of funnel plots for assessment of publication bias. The overall quality of evidence was evaluated using GRADEpro software.
RESULTS: A total of 26 studies with 67,143 participants were analyzed. The overall prevalence of knowledge, positive attitude, worrisome, and practice of precautionary measures were 0.87 (95%CI, 0.84-0.89), 0.85 (95%CI, 0.77-0.92), 0.71 (95%CI, 0.61-0.81), and 0.77 (95%CI, 0.70-0.83), respectively. Subgroup analysis demonstrated that social distancing was less practiced in Africa than other regions (p = 0.02), while knowledge of prevention of COVID-19 was reported higher in Asia (p = 0.001). Furthermore, people in developing countries had a higher prevalence of worrisome towards the COVID-19 pandemic with a p-value of less than 0.001. The quality of evidence was noted to be of low certainty in practice domain but moderate in the remaining outcomes.
CONCLUSION: Assessing the public's risk perception and precautionary behaviors is essential in directing future policy and health population research regarding infection control and preventing new airborne disease outbreaks.

Introduction

The novel coronavirus disease-2019 (COVID-19) pandemic represents an unprecedented crisis in the modern era resulting in deleterious consequences on public health, the economy, and healthcare systems [1-3]. On 31 December 2019, the World Health Organization (WHO) office in China was alerted to pneumonia cases of unknown origin in Wuhan City in the Hebei province [2]. By early January 2020, the Chinese government announced a new coronavirus that was later, on 11 February 2020, named the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which causes COVID-19. On 13 January 2020, the first COVID-19 case outside China was reported in Thailand [4]. On 30 January 2020, the WHO announced a global emergency, and by 11 March 2020, the WHO declared COVID-19 a global pandemic [5]. By the end of May 2020, there were approximately 6 million COVID-19 cases with 360,000 deaths worldwide [6].

Governments across the globe initiated, with various success rates, different responses involving all societal aspects to combat the spread of COVID-19. During the development of therapeutics and vaccines, the mainstay strategy to contain the spread of COVID-19 consists of following global and governmental health organizations’ recommendations and self-isolation guidelines and social distancing. China was successfully able to halt the exponential increase of COVID-19 cases by entirely restricting the mobility of residents in and between cities. Similarly, Italy implemented a lockdown on a large part of the country and prevented public mass gatherings. The United States has gradually, with various degrees of restrictions based on the state, placed guidelines for its citizens two weeks after the first confirmed case. The United Kingdom, however, delayed the prevention of public congregations and closure of school following the recommendations of its scientific advisors [7].

Over the past two decades, infectious respiratory disease outbreaks repeatedly occurred, including the severe acute respiratory syndrome (SARS) in 2003, the swine flu in 2009, and the Middle East respiratory syndrome in 2012 [8]. Health organizations employ necessary standard measures to address new infectious disease outbreaks, such as identifying the pathogen’s characteristics and dynamics, enhancing the capacity of diagnostics and screening, and development of therapeutics and vaccines [9]. Such measures are significant in determining the success of infectious disease outbreak prevention; however, they are also largely dependent on the public’s compliance regarding the guidelines of precautionary behaviors and practices [9, 10].

Health behavior theories suggested that risk perception is central in determining individuals’ precautionary behaviors. Risk communication forms the basis of risk perception, which promotes accurate knowledge enabling precautionary behaviors and practices [9, 10]. Taken together, compliance of the general public in following preventive measures plays a critical factor in reducing the widespread transmission of COVID-19. Therefore, the public’s awareness is a fundamental element in the overall public health response to the COVID-19 pandemic.

While the current literature about the COVID-19 pandemic extensively addresses clinical and laboratory-based studies, a gap remains still present in terms of evaluating the general public knowledge and behaviors towards the COVID-19 pandemic. We conducted a systematic review and meta-analysis of the existing literature (as of this writing) [11-36] regarding the general public’s knowledge, attitudes, and practices (KAP) towards the COVID-19 pandemic globally. To the best of our knowledge, this is the first-ever published comprehensive review on this topic.

Materials and methods

Search strategy and eligibility criteria

The systematic review was processed using the PRISMA (Prepared Items for Systematic Reviews and Meta-Analysis guidelines. The search strategy used a combination of the MeSH terms that include “COVID-19”, “SARS-COV-2”, “COVID”, “knowledge”, “attitude”, and “practice” as illustrated in S1 Table. The search was performed in different databases consisting of Medline using PubMed, Cochrane Library, Science Direct, and Google Scholar. All retrieved records were screened for duplications using EndNote software, which were removed if found. The initial screening process included evaluating the title, and abstract. To determine the potentially eligible studies, we included studies of only the English language, any region worldwide, published or in print, and available full-text articles. Methodologically, we included only cross-sectional studies that reported outcomes of knowledge, attitudes and precautionary behaviors towards the COVID-19 pandemic among the general public. No restriction was applied in terms of sample size, study setting, data collection protocol, or study type. We excluded studies from healthcare providers, reports from children or high school students, studies reporting perception towards coronaviruses other than COVID-19, and studies that lacked reporting the measured outcomes.

Data extraction

We extracted the following information: name of the first author, year of publication, study location (ie, country and region), sample size, study type, and reported outcomes. Outcomes were divided into 4 major domains: adequate knowledge, positive attitude, worrisome about COVID-19, and practice. The prevalence of each component under each domain was extracted from the included studies. For instance, in the knowledge domain, the correct response rates towards the clinical manifestation of COVID-19, prevention, transmission, identifying high-risk groups, and treatment were obtained. The prevalence of positive attitude towards COVID-19 in addition to the worrisome rate of acquiring COVID-19 was also obtained. Finally, the prevalence of handwashing practice, wearing a mask, and social distancing was also obtained.

Quality of evidence and risk bias assessment

We independently evaluated the quality of retrieved records using the Cochrane’s review guidelines for risk of bias assessment of cross-sectional studies. Evaluated items in each record included random distribution, blinding, incomplete outcome data, selective reporting, and other bias. Studies were categorized as high risk of bias, low risk of bias, or unclear risk of bias using the abovementioned items. Studies that had an average scoring above three were designated as average quality [37].

The overall quality of evidence was assessed using the Grading of Recommendation, Assessment, Development, and Evaluation (GRADE). This tool examines various factors including the risk of bias, directness, consistency and precision of results in addition to publication bias. The GRADE certainty of each outcome may be high, moderate, low, or very low based on the aforementioned factors.

Statistical analysis

The descriptive analysis was performed to report the characteristics of the included studies. The prevalence of appropriate knowledge and practice in each study was calculated by computing the average prevalence of components under each respective domain. The standard error of each study outcome was calculated by measuring the square root of the [reported prevalence multiplied by 1-prevalence and divided by sample size]. This was computed after ensuring that all outcomes met the requirement of n × p > 5 and n × (1-p) > 5, where n represents the sample size of each study, and p denotes the prevalence of a measured outcome.

The meta-analysis was processed via plotting the prevalence from each study and its weighted average; the latter was estimated by calculating standard error. The analysis used the inverse variance method, and the effect size was reported as the mean of the pooled prevalence with a 95% confidence interval. Heterogeneity was analyzed using the I2 test, which demonstrates the proportion of variation among the studies that are not due to chance but to heterogeneity. A percentage of <50% was considered low, but if greater than 50%, the random effect model was used to summarize the results.

The subgroup analysis was performed in two steps. First, an analysis of the major domains was stratified by the type of country where each study was conducted and illustrated in forest plots. Next, each component under knowledge and practice domains was stratified by the study’s regional location, and the outcome values are depicted in a table. Sensitivity analysis examines the difference in overall outcome results after removing each study and rerunning the analysis. Publication bias was assessed by generating funnel plots and examining its symmetry using Begg’s and Egger’s tests. The statistical analysis was performed using Review Manager version 5.3. Both Begg’s and Egger’s tests were utilized using MedCalc software. The GRADEpro GDT (Guideline Development Tool) software was utilized to evaluate the overall quality evidence. A p-value of less than 0.05 was considered statistically significant. The outcome data are presented as mean with a 95% confidence interval.

Results

Search results and descriptive characteristics

A total of 1383 articles were retrieved from a comprehensive search strategy in 4 different databases. When using the MeSH keywords in the Medline database, we noted a significant growth of literature since the beginning of 2020 (Fig 1). Most of the retrieved articles from the databases were removed for multiple reasons, most commonly due to topics, study subjects, and measured outcomes outside of this review’s scope. The studies were collected from January 1st until May 20th. The final number of studies included 26 studies comprising 67,143 participants (Fig 2). A total of 18 studies were from developing countries, while 8 were from developed nations. All studies were cross-sectional and published as full articles or ahead of print in 2020 (Table 1). Due to high heterogeneity with I2 ranging from 82% to 100%, the random effect model was deployed for all group and subgroup analyses.

Fig 1

The exponential growth of literature related to COVID-19 knowledge, attitudes, and practice among the public.

Fig 2

The search strategy employing the PRISMA.

PRISMA = Preferred Reporting Items for Systematic Reviews and Meta-Analyses.

Table 1

The characteristics of the included studies in the review.

N	Author	Year	Country	Sample size	Study type	Reported outcomes
1	Abdelhafiz et al. [11]	2020	Egypt	559	Cross-sectional study	Knowledge
						Attitude
						Practice
2	Alzoubi et al. [12]	2020	Jordan	592	Cross-sectional study	Knowledge
						Practice
3	Austrian et al. [13]	2020	Kenya	2009	Cross-sectional study	Knowledge
						Attitude
4	Azlan et al. [14]	2020	Malaysia	4850	Cross-sectional study	Knowledge
						Attitude
						Practice
5	Chen et al. [15]	2020	China	4061	Cross-sectional study	Knowledge
						Practice
6	Clements et al. [16]	2020	United States	1070	Cross-sectional study	Knowledge
						Practice
7	Cowling et al. [17]	2020	Hong Kong	3018	Cross-sectional study	Attitude
						Practice
8	Erfani et al. [18]	2020	Iran	8591	Cross-sectional study	Knowledge
						Attitude
						Practice
9	Geldsetzer et al. [19]	2020	UK & United States	2988 (UK)	Cross-sectional study	Knowledge
				2986 (US)
10	Hayat et al. [20]	2020	Pakistan	1257	Cross-sectional study	Knowledge
						Attitude
						Practice
11	Keeling et al. [21]	2020	Ireland	103	Cross-sectional study	Knowledge
						Attitude
12	Lima et al. [22]	2020	Brazil	2259	Cross-sectional study	Attitude
						Practice
13	McFadden et al. [23]	2020	United States	718	Cross-sectional study	Practice
14	Misba et al. [24]	2020	Kashmir	400	Cross-sectional study	Knowledge
						Attitude
						Practice
15	Nwafor et al. [25]	2020	Nigeria	284	Cross-sectional study	Knowledge
16	Rios-Gonzalez et al. [26]	2020	Paraguay	3141	Cross-sectional study	Attitude
						Practice
17	Roy et al. [27]	2020	India	662	Cross-sectional study	Knowledge
						Attitude
						Practice
18	Rugarabamu et al. [28]	2020	Tanzania	400	Cross-sectional study	Knowledge
						Attitude
						Practice
19	Salman et al. [29]	2020	Pakistan	417	Cross-sectional study	Knowledge
						Attitude
						Practice
20	Ssebuufu et al. [30]	2020	Uganda	1763	Cross-sectional study	Knowledge
						Attitude
						Practice
21	Toan et al. [31]	2020	United States	464	Cross-sectional study	Knowledge
						Attitude
						Practice
22	Tomar et al. [32]	2020	India	7978	Cross-sectional study	Knowledge
						Attitude
						Practice
23	Wadood et al. [33]	2020	Bangladesh	320	Cross-sectional study	Knowledge
						Attitude
24	Wolf et al. [34]	2020	United States	630	Cross-sectional study	Knowledge
						Attitude
25	Zanin et al. [35]	2020	Italy	8713	Cross-sectional study	Attitude
26	Zhong et al. [36]	2020	China	6910	Cross-sectional study	Knowledge
						Attitude
						Practice

Quality assessment outcomes

Table 2 displays the outcomes of the quality of assessment of all included studies. A total of 11 studies had a score of 4, while 10 studies had a score of 3, and 5 studies had a score of 2.

Table 2

The risk bias assessment of included records in this review.

Number	Author	Random distribution	Blinding	Incomplete outcome data	Selective reporting	Other bias	Total score
1	Abdelhafiz et al. [11]	L	U	L	L	L	4
2	Alzoubi et al. [12]	L	U	H	L	H	2
3	Austrian et al. [13]	L	U	H	L	L	3
4	Azlan et al. [14]	L	U	L	L	L	4
5	Chen et al. [15]	L	U	H	L	U	2
6	Clements et al. [16]	L	U	L	L	L	4
7	Cowling et al. [17]	L	U	U	L	L	3
8	Erfani et al. [18]	L	U	L	L	L	4
9	Geldsetzer et al. [19]	L	U	H	L	L	3
10	Hayat et al. [20]	L	U	L	L	H	3
11	Keeling et al. [21]	L	U	H	L	L	3
12	Lima et al. [22]	L	U	H	L	H	2
13	McFadden et al. [23]	L	U	L	L	L	4
14	Misba et al. [24]	L	U	L	L	L	4
15	Nwafor et al. [25]	L	U	H	L	L	3
16	Rios-Gonzalez et al. [26]	L	U	H	L	L	3
17	Roy et al. [27]	L	U	L	L	L	4
18	Rugarabamu et al. [28]	L	U	L	L	U	3
19	Salman et al. [29]	L	U	L	L	L	4
20	Ssebuufu et al. [30]	L	U	L	L	L	4
21	Toan et al. [31]	L	U	L	L	L	4
22	Tomar et al. [32]	L	U	L	L	H	3
23	Wadood et al. [33]	L	U	H	L	L	3
24	Wolf et al. [34]	L	U	H	L	U	2
25	Zanin et al. [35]	L	U	H	L	L	2
26	Zhong et al. [36]	L	U	L	L	L	4

L = low; U = unclear; H = high.

The GRADE scoring of each outcome revealed moderate level of evidence in knowledge, positive attitude and worrisome about COVID-19 domains. However, due to the presence of publication bias in the practice domain, the overall level evidence was noted to be low (Table 3).

Table 3

The level of evidence of all measured outcomes using GRADE tool.

Certainty assessment							№ of participants	Effect	Certainty	Importance
№ of studies	Study design	Risk of bias	Inconsistency	Indirectness	Imprecision	Other considerations		Prevalence (95% CI)
Knowledge about COVID-19
21	observational studies	not serious	serious a	not serious	not serious	none	46308	0.87 (0.84 to 0.89)	⨁⨁⨁◯ MODERATE	CRITICAL
Positive Attitude towards COVID-19
9	observational studies	not serious	serious a	not serious	not serious	none	33944	0.85 (0.77 to 0.92)	⨁⨁⨁◯ MODERATE	CRITICAL
Worrisome about COVID-19
13	observational studies	not serious	serious a	not serious	not serious	none	29508	0.71 (0.61 to 0.81)	⨁⨁⨁◯ MODERATE	CRITICAL
Practice towards COVID-19
20	observational studies	not serious	serious a	not serious	not serious	publication bias strongly suspected b	57823	0.77 (0.7 to 0.83)	⨁⨁◯◯ LOW	CRITICAL

CI: Confidence interval. COVID-19: Corona virus disease -19.

a. Heterogeneity test with I2 > 95%.

b. Begg’s test for publication bias (p<0.05)

Prevalence of appropriate/adequate knowledge about COVID-19

The overall prevalence of knowledge about COVID-19 was 0.87 (95%CI, 0.84–0.89) (Table 4). Sensitivity analysis showed no significant difference in reported data when each study was excluded (Fig 3). Both Begg’s and Egger’s tests indicated statistically significant asymmetry of the funnel plot with p values of 0.60 and 0.10, respectively (Fig 4).

Table 4

Pooled prevalence of knowledge, attitude and practice towards COVID-19.

	Pooled prevalence	95% confidence interval
Knowledge	0.87	0.84–0.89
Positive attitude	0.85	0.77–0.92
Worrisome	0.71	0.61–0.81
Practice	0.77	0.70–0.83

Fig 3

Forest plot demonstrating prevalence of adequate knowledge about COVID-19 among study participants (n = 49,294).

Stratification analysis between developing and developed countries (p = 0.41). CI = confidence interval; IV = inverse variance; SE = standard error.

Fig 4

Funnel plot of appropriate knowledge about COVID-19.

SE = standard error.

Stratification analysis did not demonstrate a statistically significant difference between the prevalence of adequate knowledge about COVID-19 between participants from developing and developed countries (p = 0.41; Fig 3). When examining the difference in the prevalence of different components under the knowledge domain between different regions, participants from Asia reported a higher rating in prevention knowledge than their peers in other regions with a p-value of 0.001 (Table 5).

Table 5

Subgroup meta-analysis of knowledge and practice items using stratification by regions of reported studies.

	Regions Mean (95%CI)
	Africa	Asia	Europe	North America	South America	P value
Knowledge	0.81 (0.71–0.91)	0.89 (0.87–0.91)	0.82 (0.63–1)	0.86 (0.80–0.93)	-	0.32
I2	99%	97%	95%	98%
Wt.	22%	52%	7%	19%
1) Clinical Presentation	0.88 (0.76–1)	0.93 (0.91–0.95)	0.95 (0.87–1.0)	0.90 (0.83–0.96)	-	0.65
I2	99%	99%	86%	99%
Wt.	12%	55%	10%	23%
2) Prevention	0.85 (0.77–0.94)	0.95 (0.95–0.96)	-	0.81 (0.73–0.90)	-	0.001*
I2	99%	96%		98%
Wt.	27%	57%		16%
3) Transmission	0.94 (0.90–0.98)	0.87 (0.80–0.95)	-	0.83 (0.82–0.94)	-	0.08
I2	84%	100%		99%
Wt.	15%	69%		15%
4) Identifying high risk group	0.87 (0.70–1)	0.81 (0.75–0.88)	0.75 (0.32–1)	0.92 (0.81–1)	-	0.42
I2	100%	100%	99%	99%
Wt.	22%	51%	13%	15%
5) Treatment	0.84 (0.62–1)	0.92 (0.89–0.94)	-	-	-	0.48
I2	100%	98%
Wt.	25%	75%
Practice	0.76 (0.64–0.88)	0.81 (0.77–0.85)	-	0.70 (0.46–0.94)	0.86 (0.76–0.96)	0.50
I2	98%	100%		99%	99%
Wt.	16%	58%		16%	W11%
1) Hand washing	-	0.87 (0.82–0.93)	-	0.86 (0.71–1.0)	-	0.85
I2		100%		100%
Wt.		70%		30%
2) Wearing mask	0.58 (0.15–1.0)	0.72 (0.66–0.79)	-	0.38 (0–0.78)	-	0.21
I2	100%	100%		100%
Wt.	12%	69%		19%
3) Social distancing	0.78 (0.70–0.87)	0.86 (0.81–0.90)	-	0.87 (0.73–1)	0.90 (0.88–0.92)	0.02*
I2	95%	100%		99%	82%
Wt.	17%	53%		18%	12%

Attitude of study subjects towards COVID-19

A total of 9 studies with 33,944 participants have evaluated the positive attitude of study subjects toward COVID-19 and revealed an overall positive rating of 0.85 (95%CI, 0.77–0.92; (Table 4). Due to these studies’ locations in developing countries, further stratification was not permissible (Fig 5). Sensitivity analysis showed no significant difference in the overall result after removing studies one at a time, indicating an overall reliable result. However, both Begg’s and Egger’s tests showed no statistically significant asymmetry of the funnel plot with p values of 0.75 and 0.91, respectively indicating low risk of publication bias (Fig 6).

Fig 5

Forest plot illustrating prevalence of positive attitude towards COVID-19 among study subjects (n = 33,944).

CI = confidence interval; IV = inverse variance; SE = standard error.

Fig 6

Funnel plot examining the publication bias of prevalence of positive attitude towards COVID-19.

SE = standard error.

On the contrary, studies reporting the prevalence of worrisome of its participants about COVID-19 demonstrated that around 71% of people were worried about contracting COVID-19 (Table 4). For instance, people from developing countries appeared to self-report a higher worrisome rate than those in developed countries with a p-value of less than 0.001 (Fig 7). Sensitivity analysis revealed adequacy and both Begg’s (p = 0.27) and Egger’s (p = 0.45) tests revealed no statistically significant asymmetry of the funnel plot (Fig 8).

Fig 7

Forest plot depicting the difference in the rate of worrisome about COVID-19 between studies from developing and developed countries (n = 29,508, p<0.001).

CI = confidence interval; IV = inverse variance; SE = standard error.

Fig 8

Funnel plot demonstrating asymmetric distribution of self-reported ratings of worrisome about COVID-19.

SE = standard error.

Prevalence of precautionary practice measures towards COVID-19

The use of overall practical precautions to limit the spread of COVID-19 was explored in most of the included studies with an average proportion of 0.77 (95%CI, 0.70–0.83) (Table 4). In general, no significant difference was noted in the utility of practical measures between participants from developed and developing countries (p = 0.28; Fig 9). Furthermore, sensitivity analysis showed no significant change in the outcome after removing each study and rerunning the model. However, publication bias was present using Begg’s test with p value <0.01 indicating a statistically significant asymmetry of the funnel plot (Fig 10).

Fig 9

Forest plot demonstrating the prevalence of using practical measures against COVID-19.

Stratification analysis between developing and developed countries (p = 0.28). CI = confidence interval; IV = inverse variance; SE = standard error.

Fig 10

Funnel plot evaluating publication bias of studies examining the use of practical measures against COVID-19.

SE = standard error.

Concerning stratification analysis by regions, African participants self-reported a significantly lower social distancing rate than their peers from other regions (p = 0.02). Wearing masks in public was reported by 38% of North American participants, while 72% and 58% of those from Asia and Africa reported wearing a mask.

Discussion

There is global consistency among the general public regarding the prevalence of two measured outcomes (knowledge and practice). The overall pooled prevalence in terms of an adequate knowledge level was 87%, with no statistically significant difference between developing (87%) and developed (84%) regions. Similarly, the overall pooled prevalence of precautionary behaviors and practices (social distancing, hand washing, and mask-wearing) was 77%. Even though not statistically significant, there was a slight difference between developing and developed regions regarding precautionary behaviors at 80% and 67%, respectively. In terms of attitudes, it was only assessed in developing countries, and 85% of the general public expressed positive feelings towards the implemented measures to contain the COVID-19 pandemic. Taken together, these findings demonstrate that the general public on a global level exhibit a favorable level of awareness and precautionary behavior during the COVID-19 pandemic.

The adequacy and consistency might be due to several factors. There has been global, large-scale effective communication about the COVID-19 pandemic between health organizations and the public. Because of recurrent and several worldwide outbreaks in the last two decades, the general public has become more aware and compliant in following precautionary behaviors during infectious disease outbreaks. Finally, the nature of this globalized pandemic in its dynamics and viral kinetics, seriousness, and severity have made public communities more risk perceptive [8-10].

The current analysis highlighted several important differences between developed and developing regions regarding measured items belonging to each overarching domain. While the general public shows a consistent level of adequate knowledge across the globe, our analysis revealed that prevention knowledge was statistically significantly more substantial in Asia with a measured pooled prevalence of 95%. Given the timing of these studies, the first-impacted countries such as China and Thailand, and strict measures imposed by governments in these regions, the general population in these areas is expected to assume a great level of knowledge. On the other hand, countries in developing regions had a higher level of worrisome towards COVID-19 (79%; 95%CI, 69–88) than developed countries (58%; 95%CI, 54–62). Such findings could be attributed to the general public’s perception and beliefs on the preparedness and response of healthcare systems’ capacity and infrastructure in their countries [38, 39]. This effect could have been further compounded by proximal and distal mediators, including the mortality rate of COVID-19, experiences of immediate family members or friends, impact of quarantine, and more importantly, media and leadership influence and engagement [9, 39, 40]. In terms of social distancing practices, countries in Africa scored the lowest pooled prevalence with a statistical significance at 78% compared to Asia, North America, and South America. Such distinction is not as unpredictable as following WHO recommendations of physical distancing, and handwashing poses a major challenge in African countries due to poverty, overcrowding, and insufficiently prepared healthcare systems. The policy of physical distancing may yield a temporal economic value in high-income countries versus low-income countries, and in the latter, it could result in detrimental effects on laborers’ income, especially in the absence of government policies directed towards aids reliefs of the population during this pandemic [41].

Previous reports related to recent airborne disease outbreaks demonstrated the significant role of the knowledge-attitude-behavior model in understanding the level of awareness among the public towards an emerging outbreak and, hence, compliance towards infection control and prevention measures. The current expansion of technology and social media engagement mediated the appearance of many incredible resources spreading information and misinformation about health-related issues. In 2014, a study conducted by Jalloh demonstrated that a great proportion of the public had a misconception regarding the Ebola mode of transmission and prevention strategies [42]. Similarly, studies related to SARS and Zika outbreaks evaluated the extent of public compliance and the response toward mitigation activities [42]. A large-scale investigation included 13 surveys demonstrating that understanding the public’s current knowledge, attitudes, and precautionary behaviors would facilitate public health officials and medical doctors’ role in developing communication redresses. In the same study, only half of the surveyed individuals knew that there was no effective treatment for SARS [43]. A study conducted by Burg et al. during the SARS outbreak demonstrated that while the general public had a great level of awareness, precautionary measures were not necessarily implemented [44].

The current review expands on contemporary evidence related to the general public’s KAP/behaviors towards the airborne diseases in general and COVID-19 on a global level. Reviewing all potentially available studies about the public, including over 67,000 participants, speaks to this review’s strength. Further, we performed a subgroup analysis to illuminate differences based on geographical regions. Our study is the first to report a large-scale qualitative and quantitative-based review of COVID-19 perception among the general public. Besides, this review provides implications for future policy modifications and future research directions. Our study offers a new insight for policy makers in public health services. Efforts should be directed to consistently educate the public about this growing pandemic. More strict measures and policies should be highlighting the impact of physical separation, national mask mandate, and hand washing. Policy makers in government as well as the department of health shall provide resources that will ultimately reduce the acquisition and transmission of COVID-19. A gap between first and second surge of CVOID-19 spread with absences of strict policies will create a more deleterious impact. Policy makers should utilize all available venues to spread credible information about the dynamics, updates, and seriousness of this novel coronavirus.

Our findings should be interpreted with caution as there are several critical limitations as follows: 1) these findings were restricted to the early duration of the outbreak, 2) the element of bias cannot be eliminated as participants responded subjectively, 3) studies with different qualities and variable instrumental tools were included, and 4) we included only those records available in English. Therefore, the publication bias was augmented due to heterogeneity resulting from variation in the sample size, methodological differences, inconsistent quality outcome of various studies, different regions, and sociodemographic factors. Our conclusions represent a preliminary trend that may ultimately change over time as the number of studies increases, the sample size is larger, less heterogeneity, and more rigorous methodological protocols.”

In conclusion, our review shows a consistent contemporary global perspective among the public towards the COVID-19 pandemic. Regional differences to COVID-19 precautions included greater knowledge of the disease in Asia, physical distancing was less practiced in Africa, and more worrisome was expressed in developing countries compared to developed ones. Therefore, applying policies and increasing awareness will ultimately modify the general public knowledge, attitudes and practice towards the current pandemic. Future strategies should seek to improve public risk perception towards COVID-19 (especially after social distancing deactivation) and improve accessibility and availability of credible information. Additionally, future strategies should facilitate the investigation and characterization of underrepresented minority groups’ opinions and those living in rural areas.

A sample of search strategy in Medline database using MeSH keywords.

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Click here for additional data file.

PRISMA checklist.

(DOC)

Click here for additional data file.

Dataset of extracted prevalence from reported studies.

(XLSX)

Click here for additional data file.

24 Sep 2020

PONE-D-20-19020

The Current Global Perspective of the General Public towards the COVID-19 Pandemic Using the Knowledge-Attitude-Behavior Model: Systematic Review and Meta-Analysis on 67,143 Participants.

PLOS ONE

Dear Dr. Shareef,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

Thanks for submission to Plos One. Your manuscript has been reviewed by experts and found it interesting. However, there are few concerns related to the methodology of review including quality assessment and results presentations. These concerns are needed to be addressed before considering the draft for publication.

Please include the following items when submitting your revised manuscript:

A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'.

A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'.

An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'.

If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter.

If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: http://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols

We look forward to receiving your revised manuscript.

Kind regards,

Tauqeer Hussain Mallhi, Ph.D

Academic Editor

PLOS ONE

Additional Editor Comments:

Thanks for submission to Plos One. Your manuscript has been reviewed by experts and found it interesting. However, there are few concerns related to the methodology of review including quality assessment and results presentations. These concerns are needed to be addressed before considering the draft for publication.

Journal Requirements:

When submitting your revision, we need you to address these additional requirements.

1. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. The PLOS ONE style templates can be found at

https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and

https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf

2. Please provide a brief discussion on the effect of publication bias on your conclusions.

3. Please confirm that you have included all items recommended in the PRISMA checklist including the full electronic boolean search strategy used to identify studies with all search terms and limits for at least one database. Please attach this as supplementary file.

4. Please include the specific publication date range that was used to search the databases for literature.

5. Please include captions for your Supporting Information files at the end of your manuscript, and update any in-text citations to match accordingly. Please see our Supporting Information guidelines for more information: http://journals.plos.org/plosone/s/supporting-information.

[Note: HTML markup is below. Please do not edit.]

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

**********

2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

**********

3. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: No

Reviewer #2: Yes

Reviewer #3: Yes

**********

4. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: No

**********

5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: The study was a systematic review and meta-analysis on The Current Global Perspective of the General Public towards the COVID-19 Pandemic Using the Knowledge-Attitude-Behavior Model: Systematic Review and Meta-Analysis on 67,143 Participants

The analysis was rigorous and revealed the pattern of knowledge attitude and precautionary practice globally

Among such revelations is the worrisome behavior of developing countries compared to the developed world.

Another is that, precautionary measures were similar between developed and developing countries.

However, the authors should attach an excel file of the minimum data used in the analysis

It should be accepted for publication

Reviewer #2: It is a very relevant manuscript at present situation. There are just a few suggestions:

i) There are some grammatical and topographical errors detected throughout the manuscript and a professional editing is advised

ii) In the methods section the eligibility criteria can be further described applying stage 1 and stage 2 criteria. Stage 2 focusing more on the methodology of the eligibility criteria in terms of selection of research papers selected for the review to address the research question

iii) The discussion section can be expanded with suggesting more policy recommendations that the results of the review are suggesting

Reviewer #3: This review is a significant and timely upmost required to be conducted.

However, the general suggestions and comments should be incorporated well.

There is a language editorial problems. Eg tenses, spelling error (eg Review manager), grammar usage

I personally suggest the review title is required to be reshuffled as:

Title: The current global perspective of the knowledge-attitude-behavior of the general public towards the corona virus disease -19 Pandemic: Systematic Review and Meta-Analysis

Abbreviation shouldn’t be appeared in the title.

Authors information: adhere to Plos one guideline

Abstract

Research gap was not indicated

Objective the review was not well stated

Materials and Methods

Methods of data extraction and effect size measures were not specified.

Quality of evidence assessment was not explained.

Results

The finding the review was not well written up.

Introduction

Back ground

Research gap was not explained.

Materials and methods

What are your review research development?

Search strategy

The authors didn’t use MeSH terms which was inclusive

What did the authors use to avoid duplication of records?

Data extraction

Outcomes assessment was not explained

Quality and risk bias assessment

When the 2 author reviewers faced disagreement, how did you resolve it?

How could blinding be an evaluation item for quality assessment as your studies included was cross sectional study design?

Wht did you do if certain studies didn’t meet methodological criteria?

Statistical analysis

How did you express you effect size?

How did you assess publication bias more objectively? Explain it by using statistical tests

Quality of evidence assessment for major outcomes was not explained? Use Grade pro soft ware

Results

The pooled prevalence of each outcome along with CI should be specified separately in a logical order

Discussion

The finding was not compared and contrasted.

The possible reason of the differences/similarities should be stated

Conclusion

It should be made in line to the findings.

**********

6. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #1: Yes: Abesig Julius

Reviewer #2: No

Reviewer #3: No

[NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.]

While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step.

15 Nov 2020

Editor’s Comments:

Point#1:

Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. The PLOS ONE style templates can be found at

https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and

https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf

Authors’ Response:

Thank you for your note. We made sure the manuscript meets the requirements of PLOSONE.

Point#2:

Please provide a brief discussion on the effect of publication bias on your conclusions.

Authors’ Response:

Thank you for your input.

The following segment was added in the limitation part of the discussion section of the paper.

“Therefore, the publication bias was augmented due to heterogeneity resulting from variation in the sample size, methodological differences, inconsistent quality outcome of various studies, different regions, and sociodemographic factors. Our conclusions represent a preliminary trend that may ultimately change over time as the number of studies increases, the sample size is larger, less heterogeneity, and more rigorous methodological protocols.”

Point#3:

Please confirm that you have included all items recommended in the PRISMA checklist including the full electronic boolean search strategy used to identify studies with all search terms and limits for at least one database. Please attach this as a supplementary file.

Authors’ Response:

Thank you for this important note. We confirm that we included two supplementary tables. One for the PRISMA checklist and the second document explains the keywords used for search strategy in Medline database.

Point#4:

Please include the specific publication date range that was used to search the databases for literature.

Authors’ Response:

The following paraphrase was added in the results’ section of the manuscript:

“The studies were collected from January 1st until May 20th”.

Point#5:

Please include captions for your Supporting Information files at the end of your manuscript, and update any in-text citations to match accordingly. Please see our Supporting Information guidelines for more information: http://journals.plos.org/plosone/s/supporting-information.

Authors’ Response:

Thank you for this comment as well as the abovementioned comments. All adjusted according to per your recommendations. Supporting information files captions and files was added.

Reviewers' Comments to the Authors:

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters).

Comments of Reviewer#1:

Point#1:

The study was a systematic review and meta-analysis on The Current Global Perspective of the General Public towards the COVID-19 Pandemic Using the Knowledge-Attitude-Behavior Model: Systematic Review and Meta-Analysis on 67,143 Participants. The analysis was rigorous and revealed the pattern of knowledge attitude and precautionary practice globally. Among such revelations is the worrisome behavior of developing countries compared to the developed world. Another is that precautionary measures were similar between developed and developing countries. However, the authors should attach an excel file of the minimum data used in the analysis. It should be accepted for publication.

Authors’ Response:

Thank you for these highlights. We believe it will be the first comprehensive report that will provide a preliminary finding on a large scale as well as motivating more future investigations of similar types in the future. The raw data file was added as a supplementary file for your reference.

Comments of Reviewer#2:

It is a very relevant manuscript at present situation. There are just a few suggestions:

Point#1:

There are some grammatical and topographical errors detected throughout the manuscript and a professional editing is advised.

Authors’ Response:

Thank you for your note. We consulted with a professional medical writing service that corrected the mechanical errors and performed linguistic editing in the manuscript. Corrections are highlighted throughout the manuscript.

Point#2:

In the methods section the eligibility criteria can be further described applying stage 1 and stage 2 criteria. Stage 2 focusing more on the methodology of the eligibility criteria in terms of selection of research papers selected for the review to address the research question.

Authors’ Response:

Thank you for your valuable input. We added the following paragraph in the Methods section (search strategy and eligibility criteria):

“The initial screening process included evaluating the title and abstract. To determine the potentially eligible studies, we included studies of only the English language, any region worldwide, published or in print, and available full-text articles. Methodologically, we included only cross-sectional studies that reported outcomes of knowledge, attitudes and precautionary behaviors towards the COVID-19 pandemic among the general public. No restriction was applied in terms of sample size, study setting, data collection protocol, or study type.”

Point#3:

The discussion section can be expanded by suggesting more policy recommendations that the results of the review are suggesting.

Authors’ Response:

Thank you for this comment. We added the following in the discussion.

“Our study offers a new insight for policy makers in public health services. Efforts should be directed to consistently educate the public about this growing pandemic. More strict measures and policies should be highlighting the impact of physical separation, national mask mandate, and hand washing. Policy makers in government as well as the department of health shall provide resources that will ultimately reduce the acquisition and transmission of COVID-19. A gap between first and second surge of CVOID-19 spread with absences of strict policies will create a more deleterious impact. Policy makers should utilize all available venues to spread credible information about the dynamics, updates, and seriousness of this novel coronavirus.”

Comments of Reviewer#3:

This review is a significant and timely upmost required to be conducted. However, the general suggestions and comments should be incorporated well.

Point#1:

There are language editorial problems. Eg tenses, spelling error (eg Review manager), grammar usage.

Authors’ Response:

Thank you for your comment. We consulted with a professional medical writing service that corrected the mechanical errors and performed linguistic editing in the manuscript. Corrections are highlighted throughout the manuscript.

Point#2:

I personally suggest the review title is required to be reshuffled as:

Title: The current global perspective of the knowledge-attitude-behavior of the general public towards the corona virus disease -19 Pandemic: Systematic Review and Meta-Analysis. Abbreviation shouldn’t be appeared in the title.

Authors’ Response:

Thank you for your suggestion. We changed the title according to your recommendation and added the number of participants to emphasize the strength of the study. We removed the abbreviation. The following change was incorporated:

“The current global perspective of the knowledge-attitude-behavior of the general public towards the coronavirus disease -19 Pandemic: Systematic review and meta-analysis on 67,143 participants.”

Point#3:

Authors information: adhere to Plos one guideline.

Authors’ Response:

Changed per PLOS one guideline.

Point#3:

Abstract:

Research gap was not indicated

Authors’ Response:

Thank you for your valuable note. We incorporated the following in the abstract’s background.

“While the current literature about the COVID-19 pandemic extensively addresses clinical and laboratory-based studies, a gap remains still present in terms of evaluating the general public knowledge and behaviors towards the COVID-19 pandemic.”

Point#4:

Abstract:

Objective the review was not well stated

Authors’ Response:

Thank you for your valuable note. We incorporated the following in the abstract’s background.

“The goal of this review is to form a preliminary and contemporary understanding of the general public knowledge, attitude, and behaviors towards the COVID-19 pandemic globally.”

Point#5:

Abstract:

Materials and Methods

Methods of data extraction and effect size measures were not specified.

The quality of the evidence assessment was not explained.

Authors’ Response:

Thank you for this critical comment. We incorporated the following as part of the methods in the abstract of the paper:

“A systematic search was conducted in various databases until May 2020. Each study’s characteristics including the sample size, region, and study type were examined individually. A meta-analysis with a random-effects model and pooled prevalence with 95% confidence interval (CI) of all evaluated outcomes such as adequate knowledge, positive feelings, worrisome about the COVID-19 pandemic, and practice were recorded and reported from each study. Parameters such as random distribution, blinding, incomplete outcome data, selective reporting, and other biases were utilized to assess the quality of each retrieved record. A funnel plot was employed to assess publication bias.”

Point#6:

Abstract:

Results

The finding the review was not well written up.

Authors’ Response:

Thank you for this critical comment. We incorporated the following as part of the methods in the abstract of the paper:

“A total of 26 studies with 67,143 participants were analyzed. The overall prevalence of knowledge, positive attitude, worrisome, and practice of precautionary measures were 0.87, 0.85, 0.71, and 0.77, respectively. Subgroup analysis demonstrated that social distancing is less practiced in Africa than other regions (p=0.02), while knowledge of prevention of COVID-19 was reported higher in Asia (p=0.001). Furthermore, people in developing countries had a higher prevalence of worrisome towards the COVID-19 pandemic with a p-value of less than 0.001. The funnel plot demonstrated a presence of publication bias.”

Point#7:

Introduction

Background

The research gap was not explained.

Authors’ Response:

Similarly, as we indicated in the abstract. We highlighted the gap of knowledge by stating it in the introduction again. We incorporated the following:

“While the current literature about the COVID-19 pandemic extensively addresses clinical and laboratory-based studies, a gap remains still present in terms of evaluating the general public knowledge and behaviors towards the COVID-19 pandemic.”

Point#8:

Materials and methods

What are your review research development?

Authors’ Response:

Several factors played a role in our research development. First, the risk perception of the public is very important in the overall public health response to the COVID-19 pandemic. Therefore, we touched on a topic that was not well addressed in the literature. Second, the best approach we thought about to have contemporary and preliminary evidence is by utilizing the highest level of evidence which is systematic review and meta-analysis. We also embraced the concept of the Knowledge-attitude-behavior model in the evaluation of the general public risk perception. Since there have been no interventional studies, we utilized the prevalence meta-analysis strategy which is based on pooled prevalence, as the effect size.

Point#8:

Materials and methods

Search strategy

The authors didn’t use MeSH terms which was inclusive

What did the authors use to avoid duplication of records?

Authors’ Response:

We utilized the Medical Subject Heading (MeSH) feature during our search strategy. Therefore, we used a wide variet of terms and keywords separate as well as in combination to be inclusive. We added a supplemntary table for the search strategy. We used EndNote to ensure de-duplication.

Point#9:

Data extraction

Outcomes assessment was not explained

Quality and risk bias assessment

Authors’ Response:

We have utilized the Cochrane’s review guidelines for risk of bias assessment of each included study. This model has two outcome assessment components: incomplete outcome data and selective reporting. We have reported our findings in Table 2.

Point#10:

When the 2 author reviewers faced disagreement, how did you resolve it?

Authors’ Response:

In the event of disagreement, the first and corresponding authors met to discuss and reach consensus.

Point#11:

How could blinding be an evaluation item for quality assessment as your studies included was cross sectional study design?

Authors’ Response:

Thank you for this valuable comment. True, with cross sectional study, blinding is not feasible. So, we utilized the the Cochrane’s review guidelines for quality assessment of cross sectional studies. In the absence of blinding, which was the case for all the studies, we labeled it as unclear in the quality assessment table.

Point#12:

What did you do if certain studies didn’t meet methodological criteria?

Authors’ Response:

We determined the inclusion criteria in the PRISMA chart in the paper. Any study that did not meet the inclusion criteria, we excluded it. However, for the methodological criteria, we did not have specific criteria as all the studies were of a cross sectional study design. We evaluated the quality according to the Cochrane’s review guidelines.

Point#12:

Statistical analysis

How did you express your effect size?

Authors’ Response:

Thank you for the comment. Since it was a prevalence meta-analysis, we used the prevalence as the effect size in this scenario. It was expressed as proprtions with 95% confidence interval.

Point#13:

How did you assess publication bias more objectively? Explain it by using statistical tests

Authors’ Response:

Thank you for this critical point. We were limited in this aspect as the software we used does not offer the objective emasure of publication bias. Therefore, we evaluated it sujecictively based on the observation of the symmetry or asymmetry of the funnel plot.

Point#14:

Quality of evidence assessment for major outcomes was not explained? Use Grade pro soft ware.

Authors’ Response:

There are different quality assessment models that have been employed to evaluate the quality of evidence of cross-sectional studies. The authors have utilized the Cochrane’s review guidelines to evaluate the quality of each reported study. Thank you for your suggestion to use GradePro, however, up to the knowledge of authors, we were not able to find meta-analysis that has utilized GradePro on cross-sectional studies. Of note, below is another meta-analysis that has utilized the Cochrane’s review guidelines for risk of bias assessment of cross-sectional studies.

Guo S, Yang Y, Liu, F, Li F. The awareness rate of mental health knowledge Among Chinese adolescent. Medicine 2020; 99(7).

Point#15:

Results

The pooled prevalence of each outcome along with CI should be specified separately in a logical order

Authors’ Response:

We have added another table (Table 3) in the results section to depict pooled prevalence and confidence interval of major outcomes in logical order.

Point#15:

Discussion

The finding was not compared and contrasted.

The possible reason of the differences/similarities should be stated

Authors’ Response:

Thank you for this comment. We performed compare and contrast among individual studies. Due to lack of evidence in this suject especially that our report is the first to illuminate prevalence meta analysis among the general public, we however, compared and contrasted to previous studies with similar outbreaks. We provided several explanations for the differences and smiliarties to the best of our knowledge and interpretation of the existing literature.

Point#15:

Conclusion

It should be made in line to the findings.

Authors’ Response:

Thank you. Changed per recommendation.

Submitted filename: Response to reviewers.docx

Click here for additional data file.

23 Dec 2020

PONE-D-20-19020R1

The current global perspective of the knowledge-attitude-behavior of the general public towards the corona virus disease -19 pandemic: Systematic review and meta-analysis on 67,143 participants.

PLOS ONE

Dear Dr. Shareef,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

Dear Authors, thank you very much for responding to the queries of referees. There are few more comments need your attention. Publication Bias and Quality assessment is area of concerns still needed to be addressed.

Please submit your revised manuscript by Feb 06 2021 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

Please include the following items when submitting your revised manuscript:

A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'.

A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'.

An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'.

If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter.

If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: http://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols

We look forward to receiving your revised manuscript.

Kind regards,

Tauqeer Hussain Mallhi, Ph.D

Academic Editor

PLOS ONE

[Note: HTML markup is below. Please do not edit.]

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #1: All comments have been addressed

Reviewer #2: All comments have been addressed

Reviewer #3: (No Response)

**********

2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

**********

3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

**********

4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

**********

5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: No

**********

6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: The authors have done a good job. They have addressed all the technical and grammatical errors in the manuscript. They have also addressed all the comments that i raised. The manuscript is technically sound and should be accepted for publication in you journal.

Reviewer #2: Thank you for successfully addressed all the points. The manuscript is now suitable for publication in the journal.

Reviewer #3: I have scanned the authors' work meticulously. The authors have tried to react to certain questions; nevertheless, publication bias and quality evidence assessment issues has not been addressed yet. Hint : Publication bias can be assessed objectively using statistical tests like Beggs test, Egger test and harbord test using Stata version 16/ its extension or comprehensive meta analysis software whereas quality evidence assessment can be made using Grade pro soft ware. The authors are suggested to down load the aforementioned softwares and use it.

**********

7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #1: No

Reviewer #2: No

Reviewer #3: No

[NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.]

While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step.

7 Feb 2021

We have performed quality evidence assessment of each reported outcome and used Grade pro software for that as suggested. In addition, both Begg’s and Egger’s tests were used to evaluate symmetry of funnel plots for assessment of publication bias. We have reported all the findings in the revised manuscript. We have utilized MedCalc software for meta-analysis per authors’ convenience. Thank you for your valuable suggestion.

Submitted filename: Response to reviewers-revised2.docx

Click here for additional data file.

28 Mar 2021

PONE-D-20-19020R2

The current global perspective of the knowledge-attitude-behavior of the general public towards the corona virus disease -19 pandemic: Systematic review and meta-analysis on 67,143 participants.

PLOS ONE

Dear Dr. Shareef,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

Please submit your revised manuscript by May 12 2021 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

Please include the following items when submitting your revised manuscript:

A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'.

A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'.

An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'.

If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter.

If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: http://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols. Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols.

We look forward to receiving your revised manuscript.

Kind regards,

Tauqeer Hussain Mallhi, Ph.D

Academic Editor

PLOS ONE

Journal Requirements:

Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice.

Additional Editor Comments (if provided):

Thank you very much for revisions. However, reviewer has raised few more concerns. Please address the reviewer`s queries so appropriate decision could be made.

[Note: HTML markup is below. Please do not edit.]

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #1: All comments have been addressed

Reviewer #3: All comments have been addressed

**********

2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: (No Response)

Reviewer #3: Yes

**********

3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #3: Yes

**********

4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #3: Yes

**********

5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #3: Yes

**********

6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: (No Response)

Reviewer #3: I have meticulously scanned the authors manuscript. My concerns were addressed. Nevertheless, there was some concerns. eg in abstract : background : the authors should state his purpose by using the aim instead of using goal,

Materials and methods in main text:

spelling error should be corrected: review manager not review manage

**********

7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #1: No

Reviewer #3: No

[NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.]

While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step.

29 Mar 2021

As per the third reviewer’s suggestion, we have replaced the word “goal” with “aim” in the abstract and we have corrected the spelling of “review manager” in the methods section. Thank you for your valuable feedback.

Submitted filename: Response to reviewers-revised3.docx

Click here for additional data file.

27 May 2021

PONE-D-20-19020R3

The current global perspective of the knowledge-attitude-behavior of the general public towards the corona virus disease -19 pandemic: Systematic review and meta-analysis on 67,143 participants.

PLOS ONE

Dear Dr. Shareef,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

Please submit your revised manuscript by Jul 11 2021 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

Please include the following items when submitting your revised manuscript:

A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'.

A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'.

An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'.

If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter.

If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: http://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols. Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols.

We look forward to receiving your revised manuscript.

Kind regards,

Tauqeer Hussain Mallhi, Ph.D

Academic Editor

PLOS ONE

Journal Requirements:

Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice.

Additional Editor Comments (if provided):

Thank you very much for revising the draft. I invite you to consider the few more comments from the one reviewer.

[Note: HTML markup is below. Please do not edit.]

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #1: All comments have been addressed

Reviewer #3: (No Response)

**********

2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

Reviewer #3: Yes

**********

3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #3: Yes

**********

4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #3: Yes

**********

5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #3: Yes

**********

6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: (No Response)

Reviewer #3: The overall prevalence of knowledge, positive attitude, worrisome, and practice of precautionary

measures should be indicated along with 95% confidence interval both in the abstract and main body part of the results.

**********

7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #1: No

Reviewer #3: No

[NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.]

While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step.

27 Jun 2021

Reviewers' Comments to the Authors:

Reviewer #3: The overall prevalence of knowledge, positive attitude, worrisome, and practice of precautionary measures should be indicated along with 95% confidence interval both in the abstract and main body part of the results.

Authors’ Response:

As per the third reviewer’s suggestion, we ensured that all pooled prevalence are associated with 95% confidence interval in both abstract and results sections. Thank you for your comment.

Submitted filename: Response to reviewers-revised4.docx

Click here for additional data file.

21 Jul 2021

PONE-D-20-19020R4

The current global perspective of the knowledge-attitude-behavior of the general public towards the corona virus disease -19 pandemic: Systematic review and meta-analysis on 67,143 participants.

PLOS ONE

Dear Dr. Shareef,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

Please submit your revised manuscript by Sep 04 2021 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

Please include the following items when submitting your revised manuscript:

A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'.

A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'.

An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'.

If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter.

If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: http://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols. Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols.

We look forward to receiving your revised manuscript.

Kind regards,

Tauqeer Hussain Mallhi, Ph.D

Academic Editor

PLOS ONE

Additional Editor Comments (if provided):

Thank you for revising the draft. This manuscript has been substantially improved. However, few changes are suggested by the reviewer. Moreover, It is advised to take assistance from native English speaker to revise the draft for Grammar, Syntax and spelling.

Journal Requirements:

Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice.

[Note: HTML markup is below. Please do not edit.]

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #1: All comments have been addressed

Reviewer #3: (No Response)

**********

2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

Reviewer #3: Yes

**********

3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #3: No

**********

4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #3: No

**********

5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #3: Yes

**********

6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: (No Response)

Reviewer #3: Abstract

Background

There was tense error eg

The aim of this review is to form a preliminary and contemporary understanding of the general public knowledge, attitude, and behaviors towards the COVID-19 pandemic globall

Results

The overall prevalence of knowledge, positive attitude, worrisome, and practice of precautionary

measures can't be computed using RevMan software. Use other POWERFUL software like STATA or other software.

**********

7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #1: No

Reviewer #3: No

[NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.]

While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step.

19 Sep 2021

Comments of Editor:

Editor: Thank you for revising the draft. This manuscript has been substantially improved. However, few changes are suggested by the reviewer. Moreover, It is advised to take assistance from native English speaker to revise the draft for Grammar, Syntax and spelling.

Authors’ Response:

We have initially consulted with a professional medical writing service that corrected the mechanical errors and performed linguistic editing in the manuscript. The manuscript was revised again and grammatical errors were corrected.

Reviewers' Comments to the Authors:

Reviewer #3: Abstract

Background

There was tense error eg

The aim of this review is to form a preliminary and contemporary understanding of the general public knowledge, attitude, and behaviors towards the COVID-19 pandemic global

Authors’ Response:

The manuscript was revised for any tense error and corrected accordingly. All changes have been implemented in the final manuscript. Thanks for your suggestion.

Reviewer #3:

Results

The overall prevalence of knowledge, positive attitude, worrisome, and practice of precautionary measures can't be computed using RevMan software. Use other POWERFUL software like STATA or other software.

Authors’ Response:

We have calculated pooled prevalence of studies using RevMan Software which computes the prevalence as the effect size along with 95% confidence interval. Since RevMan has an option of calculating pooled prevalence, we decided to stick with this software. Thank you for the suggestion.

Submitted filename: Response to reviewers-revised6.docx

Click here for additional data file.

8 Nov 2021

The current global perspective of the knowledge-attitude-behavior of the general public towards the corona virus disease -19 pandemic: Systematic review and meta-analysis on 67,143 participants.

PONE-D-20-19020R5

Dear Dr. Shareef,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication.

An invoice for payment will follow shortly after the formal acceptance. To ensure an efficient process, please log into Editorial Manager at http://www.editorialmanager.com/pone/, click the 'Update My Information' link at the top of the page, and double check that your user information is up-to-date. If you have any billing related questions, please contact our Author Billing department directly at authorbilling@plos.org.

If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org.

Kind regards,

Tauqeer Hussain Mallhi, Ph.D

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #3: All comments have been addressed

**********

2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #3: Yes

**********

3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #3: Yes

**********

4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #3: Yes

**********

5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #3: Yes

**********

6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #3: The authors have substantially improved their manuscript.

Title:

The number indicated on title "on 67,143 participants'' should be expunged.

Abstract

The authors should follow the PLOS ONE guidelines

Use unstructured abstract

The first 'COVID 19 " should be non abbreviated; subsequently, the authors can use abbreviation.

Main body

methods

The authors should state inclusion criteria (PCC), and study selection.

Data synthesis

Specify the cut off to deem presence of heterogeneity and publication bias.

correct language error

Rewrite" The outcome data are presented as mean with a 95% confidence interval.

**********

7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #3: No

15 Nov 2021

PONE-D-20-19020R5

The current global perspective of the knowledge-attitude-behavior of the general public towards the corona virus disease -19 pandemic: Systematic review and meta-analysis on 67,143 participants.

Dear Dr. Shareef:

I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now with our production department.

If your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information please contact onepress@plos.org.

If we can help with anything else, please email us at plosone@plos.org.

Thank you for submitting your work to PLOS ONE and supporting open access.

Kind regards,

PLOS ONE Editorial Office Staff

on behalf of

Dr. Tauqeer Hussain Mallhi

Academic Editor

PLOS ONE