Baseline knowledge and attitudes on COVID-19 among hotels' staff: A cross-sectional study in Kigali, Rwanda.

BACKGROUND: The World Health Organization declared coronavirus disease 2019 (COVID-19) as a global pandemic on the 11th of March, 2020. Hotels and other public establishments have been associated with higher transmission rates. Sensitisation of staff and strengthening of Infection Prevention and Control (IPC) practices in such settings are important interventions. This study assessed the baseline knowledge and attitudes on COVID-19 among hotels' representatives in Kigali, Rwanda.
METHODS: A cross-sectional study was conducted among hotels' staff in Kigali in July 2020. A structured questionnaire was self-administered to 104 participants. Baseline knowledge and attitudes were assessed using a number of pre-test questions and mean scores were used to dichotomise the participants' responses as satisfactory or unsatisfactory.
RESULTS: All of the 104 hotels' staff completed the self-administered questionnaires. Sixty-seven percent (n = 70) were male and 58% (n = 60) were aged between 30 and 44 years. The satisfactory rate of correct answers was 63%±2.4 (n = 66) on knowledge and 68%±1.7 (n = 71) on attitudes evaluation. Participants with University education were more likely to have satisfactory knowledge (AOR: 2.6, 95% C.I: 1.07-6.58) than those with secondary education or less. The staff working in the front-office (AOR: 0.05; 95% CI 0.01-0.54) and housekeeping (AOR: 0.09; 95% C.I: 0.01-0.87) were less likely to have satisfactory attitudes than those working in the administration.
CONCLUSIONS: Hotels' staff based in the capital of Rwanda have shown satisfactory knowledge and attitudes regarding appropriate IPC practices for preventing the COVID-19 transmission. Educational interventions are needed to improve their knowledge and attitudes for better prevention in this setting.

Introduction

The Coronavirus disease 2019 (COVID-19) is caused by a novel coronavirus (SARS-CoV-2), which was reported for the first time in December 2019 to be transmitted from an animal to humans [1]. Currently, it spreads rapidly from a person to person via droplets or direct contact and touch of a contaminated surface. In addition, it was found in faecal samples and anal swabs of some patients [2]. The main clinical signs and symptoms of COVID-19 include cough, fever ≥38°C, severe shortness of breath, dry cough and other clinical characteristics, including diarrhoea, vomiting and runny nose [3, 4].

The Rwanda Ministry of Health has strengthened the COVID-19 surveillance countrywide and different modes of technologies combined with prevention strategies were conceived to minimize the rate of transmission [5]. On the 14th of March 2020, the Government of Rwanda considered a total lockdown, including the hotel industry as a strategic measure to limit the national transmission of SARS-CoV-2 [6]. On the 4th of May 2020, Rwanda eased its total lockdown and allowed businesses and public transportation to resume but under well-defined health and safety measures. This included all re-opened public spaces mandated to have handwashing stations in place, temperature monitoring devices, use of face masks, and practice of physical distancing of at least one meter [7].

The preventive measures, health education, and public awareness have shown an impact in addressing and controlling COVID-19 [7, 8]. However, hotel establishments are more susceptible to contagion than other public establishments because they are visited by many people who interact among themselves and with the staff. Therefore, hotels’ staff are at higher risks for the aspects of lodging of guests, food and beverages handling and serving, cleaning, organisational activities and require specific attention for every member to strictly comply with the basic protective measures against COVID-19 [9]. This study assessed the baseline knowledge and attitudes of hotels’ staff regarding appropriate IPC practices required to ensure their safety and protection of guests and customers, attending hotels located in Kigali, Rwanda, in the context of pandemic COVID-19.

Materials and methods

Study design and setting

This was a cross-sectional study conducted in July 2020 to assess the baseline knowledge and attitudes of hotels’ staff in Rwandan capital, Kigali. This city is geographically located at the heart of Rwanda and it includes three districts with a total population of approximately 1.2 million inhabitants [10]. In 2012, the Rwanda Development Board (RDB) indicated that 50% of 486 hotels, which were counted countrywide, were located in Kigali [11].

Study population

This study included a total of 52 hotels, which were the most visited in Kigali, as suggested by the RDB. These hotels had common areas, which could ensure social distancing of at least one meter between guests. Each selected hotel allocated two representatives to attend a training on COVID-19 transmission and prevention, which was planned by Rwanda Biomedical Centre (RBC) in collaboration with RDB. This training took place in July 2020 and was facilitated by trainers, who were previously trained by RBC on the subject. All trainees were considered eligible to the study.

Data collection

The main investigator, also a trainer of participants, together with co-authors developed a structured questionnaire based on a core set of questions related to the knowledge and attitudes on COVID-19 transmission and prevention. These questions also included knowledge and attitudes on decontamination and waste management, as suggested by the World Health Organization and Rwandan national guidelines [12-14].

All questions were categorised into three groups. The first group included questions related to the socio-demographics characteristic of hotels’ staff: age, gender, educational level, work experience, and job category, work category inside the hotel and the most reliable sources of information about COVID-19 (family members, friends, official websites, radio, television, and other social media). The second group included questions pertaining to the participants’ disease awareness and clinical signs and symptoms of COVID-19. The third group comprised questions related to the COVID-19 prevention and control. Authors rechecked the questionnaire for accuracy and completeness prior the data collection.

Data management and analysis

Descriptive statistics were performed and data were summarised into frequency tables. The levels of knowledge and attitudes of hotels’ staff on COVID-19 were assessed using a numeric pattern of scoring, which was applied elsewhere [15]. This pattern assigned a score of “1” for the correct answer and “0” for the false answer and neutral for the unknown response. The levels of measured outcomes were expressed as mean scores with standard deviation (Mean ± SD). The cut-off points for satisfactory levels of knowledge and attitudes were set at greater than the mean scores. The unsatisfactory levels of knowledge and attitudes were considered less than the mean scores.

Cross-tabulations were applied to analyse the patterns of mean scores across various sociodemographic categories of participants. When analysing data, sociodemographic variables were considered as covariates. Logistic regression was used to analyse the association between covariates and the outcome, which was dichotomous: satisfactory or unsatisfactory mean score. The strength of association was assessed using unadjusted odd ratio (OR) in bivariate analysis and adjusted odd ratio (AOR) in multivariate analysis. The level of significance was considered as p< 0.05. Epi-Info (version March 2015, CDC Atlanta) was used for data entry and Stata version 13 (StataCorps.2013) for data analysis.

This study was done through the collaboration between Rwanda Biomedical Centre; National Infection, Prevention and Control COVID-19 Joint task force Coordination; and Rwanda Development Board. Verbal informed consent was sought from participants who were given the right to choose to respond to any question in the survey with a guaranteed confidentiality. The ethical approval was obtained from the Rwanda Public Health Surveillance and Emergency Preparedness and Response Division (Ref: No: 12/RBC/PHSEPR/2021).

Results

The Table 1 shows sociodemographic characteristics of the study population. Out of 104 participants, 57.7% (n = 60) were aged between 30 and 44 years, 67.3% (n = 70) were male, 72.1% (n = 75) had University educational level, 51.9% (n = 54) had a working experience in hotels of 4 to 10 years, and 34.6% (n = 36) were working in food and beverage unities. Those who used social media as the most reliable source of information on COVID-19 were 29.8% (n = 31).

Table 1

Sociodemographic characteristics of hotels’ staff in Kigali (N = 104).

Variables	Frequency	Percentage (%)
Age
18–29 years	35	33.6
30–44 years	60	57.7
45–60 years	7	6.7
≥61 years	2	1.9
Gender
Man	70	67.3
Woman	34	32.7
Educational level
Secondary	29	27.9
University	75	72.1
Work experience duration (years)
>1 years	23	22.1
1–3 years	18	17.3
4–10 years	54	51.9
11 years and over	9	8.6
Work category inside the hotel
Administrative	24	23.1
Food and beverage	36	34.6
Front officer	19	18.3
Housekeeping	25	24.0
Most reliable source of COVID-19 information
Radio	18	17.3
Other social media	31	29.8
Official website	21	20.2
Friends	3	2.9
Family	4	3.8
Television	27	26.0

Knowledge and attitudes of participants regarding COVID-19 prevention and control were reported in the Table 2. Most participants, 52.9% (n = 55), were aware that COVID-19 was a fatal disease. The vast majority of them; 94.2% (n = 98), showed a positive attitudes regarding the handwashing practice using clean water and soap to prevent COVID-19 transmission.

Table 2

Distribution of correct answers on baseline evaluation of knowledge and attitudes on COVID-19 among hotels’ staff in Kigali (N = 104).

Question statement			Answered correctly n (%)
Knowledge
	Is COVID-19 fatal?		55 (52.9)
	COVID-19 is thought to originate from bats?		54 (51.9)
	COVID-19 signs and symptoms are?	Headache	71 (68.3)
		Fever	91 (87.5)
		Cough	82 (78.8)
		Sore throat	49 (47.1)
		Flu	66 (63.5)
	Disease can be transmitted during the asymptomatic phase?		57 (54.8)
	COVID-19 is transmitted through?	By droplet	5(4.8%)
		Physical contact <1m	86 (82.7)
		Faecal-oral routes	38 (36.5)
		Animals to Humans	48(46.1)
Attitudes
	Washing hands should also be applied for non-infectious customer?		79 (76.0)
	Washing hands with soap & water can help in prevention of COVID-19 transmission?		98(94.2)
	After touching customer surroundings. Is it always necessary to wash hand?		99(95.2)
	Using hand Sanitizer is better than water and soap?		73(69.2)
	Social distancing of 1m can help in prevention of COVID-19 transmission?		95(91.3)
	Wearing gloves when handling customer linens can protects you from infectious diseases?		85(81.7)
	During the outbreak, eating well-cooked and safely handled meat is it safe?		53(51.0)
	The best container for chlorine solution is metallic recipient?		77(74.0)
	Sunlight makes the chlorine solution stronger?		22(21.1)
	Always carry garbage bags on your back to avoid contact with your face		55(52.9)
	Is it necessary to disinfect equipment’s, vehicles and working area contaminated with bleach solution?		88(82.7)

As shown in Table 3, most participants had satisfactory rates of correct answers on knowledge and attitudes evaluation. The maximum scores were comparable on both knowledge and attitudes evaluation.

Table 3

Scores obtained by participants on knowledge and attitudes evaluation in Kigali (N = 104).

Outcome	Scores		Mean score±SD	Satisfactory rate n (%)	Unsatisfactory rate n (%)
	Maximum	Minimum
Knowledge	12	1	6.75±2.44	66 (63.5%)	38 (36.5)
Attitudes	11	3	7.89 ± 1.78	71 (68.3%)	33 (31.7)

SD: standard deviation.

As shown in Table 4, the participants with a University educational level were more likely to have satisfactory knowledge rate (AOR: 2.6, 95% C.I: 1.07–6.58) than those with a secondary educational level or less. The staff working in the front-office (AOR: 0.05; 95% CI 0.01–0.54) and housekeeping (AOR: 0.09; 95% C.I: 0.01–0.87) were less likely to have satisfactory attitudes than those working in the administration. On bivariate analysis, the staff with a working experience of less than one year seemed to be more knowledgeable than those having more than 11 years of experience. However, this association between working experience and the level of knowledge on COVID-19 was diluted after adjustment with other covariates in multivariate analysis.

Table 4

Analysis of sociodemographic characteristics as factors influencing knowledge and attitudes on COVID-19 among hotels’ staff in Kigali.

Variables	Factors influencing the Knowledge						Factors influencing the attitudes
	Level of knowledge		OR (95% CI)	p-value	AOR (95% CI)	p-value	Level of attitudes		OR (95% CI)	p-value	AOR (95% CI)	p-value
	Satisfied n (%)	Unsatisfied n (%)					Satisfied n(%)	Unsatisfied n(%)
Age (years)
18–29 years	25 (37.9)	10 (26.3)	1				24 (33.8)	11 (33.3)	1
30–44 years	36 (54.5)	24 (63.2)	1.6 (0.67–4.08)	0.26			42 (59.1)	18 (54.5)	1.0 (0.43–2.63)	0.88
45–60 years	5 (7.6)	2 (5.3)	1 (0.16–6.02)	1.00			5 (7.0)	2 (6.1)	1.1 (0.19–6.85)	0.88
> 60 years	0	2 (5.3)	--					2 (6.1)	--
Gender
Man	42 (63.6)	28 (73.7)	1				45 (63.4)	25 (75.8)	1
Woman	24 (36.4)	10 (26.3)	1.6 (0.66–3.85)	0.29			26 (36.6)	8 (24.2)	1.8(0.71–4.58)	0.21
Educational level
Secondary	12 (19.7)	16 (42.1)	1				15 (21.1%)	14 (42.4)	1
University	53 (80.3)	22 (57.9)	2.9 (1.22–7.18)	0.016	2.6 (1.07–6.58)	0.03	56 (78.9%)	19 (57.6)	2.7 (1.12–6.73)	0.03	1.8 (0.73–0.41)	0.19
Work experience (years)
>1 years	3 (4.5%)	6 (15.8)	7.0 (1.18–41.35)	0.03			6 (8.4%)	3 (9.1%)	0.5 (0.96–3.37)	0.54
1–3 years	18 (27.3%)	5 (13.2)	2.5 (0.75–8.93)	0.13			13 (18.3%)	10 (30.3)	0.3 (0.93–1.48)	0.16
4–10 years	31 (47.0%)	23 (60.5)	0.3 (0.21–4.3)	0.97			38 (53.5%)	16 (48.5)	0.6(0.19–2.38)	0.54
>11 years	14 (21.2%)	4 (10.5)	1				14 (19.7%)	4 (12.1)	1
Job category
Administrative	19 (28.8)	5 (13.2)	1				23 (32.4)	1 (3.0)	1
Food and beverage	20 (30.3)	16 (42.1)	3.0 (0.92–9.93)	0.07			22 (31.0)	14 (42.4)	0.06 (0.01–0.56)	0.013	0.08 (0.01–0.67)	0.02
Front officer	13 (19.7)	6 (15.79)	1.8 (0.44–7.01)	0.42			10 (14.1)	9 (27.3)	0.04 (0.01–0.53)	0.007	0.05 (0.01–0.54)	0.01
Housekeeper	14 (21.2)	11 (28.95)	3.0 (0.80–10.5)	0.09			16 (22.5)	9 (27.3)	0.07 (0.01–0.67)	0.02	0.09 (0.01–0.87)	0.04
Official website	15 (22.7)	6 (15.79)	1				14(19.7)	7 (21.2)	1
Radio	8 (12.1)	10 (26.3)	3.1 (0.89–11.7)	0.09			10 (14.1)	8 (24.2)	0.6 (0.17–2.29)	0.48
Social media	22 (33.3)	9 (23.7)	1.02 (0.30–3.4)	0.97			23 (32.4)	8 (24.2)	1.4 (0.42–4.83)	0.56
Friends	2 (3.0)	1 (2.6)	1.25 (0.94–16)	0.86			2 (2.8)	1 (3.0)	1 (0.76–13.01)	1.00
Family	1 (1.50)	3 (7.9)	7.5 (0.64–87.1)	0.11			3 (4.2)	1 (3.0)	1.5 (0.13–17.10)	0.74
Television	18 (27.3)	9 (23.7)	1.25 (0.36–4.30)	0.72			19 (26.8)	8 (24.2)	1.1 (0.34–4.04)	0.78

Discussion

This study aimed to assess the baseline knowledge and attitudes of hotels’ staff regarding infection prevention and control and preparedness strategies for COVID-19 to ensure their safety and protection of guests and customers, attending hotels located in Kigali. Overall, the staff have shown satisfactory knowledge and attitudes despite the disparities among different groups. The staff with the University educational level had better knowledge than their colleagues with secondary educational level or less while those working in the administration ensured better attitudes against COVID-19 than the staff working in the front-office and housekeeping.

Our findings were similar to those found in Nigeria, which have revealed that having a University educational level was associated with improved knowledge regarding infection prevention and control measures for COVID-19 [16]. This was also echoed by another study conducted in Chine [1]. Previous authors have shown that higher educational level contributed to the development of a broader range of knowledge and skills [17], which would pave a better way of the utilization of health information. Further, reports have shown that the improved accessibility to the health information through various channels, including the internet, could enable people to change their behaviours towards the utilization of appropriate infection prevention and control measures [18].

In Rwanda, various social media platforms have been recently used to disseminate the information to prevent and control the COVID-19 transmission [19]. The better uptake of and compliance to this information would have contributed to the improved knowledge regarding the COVID-19 among the staff with higher educational level compared to others with lower educational levels.

This study has also indicated that the hotels’ personnel working in the administration had better attitudes against COVID-19 than those working in the areas of food and beverages preparation and distribution, and those based in the front-office or in charge of housekeeping. This could be explained by higher educational qualifications of the administrative staff compared to others.

One strength of this study was the focus on the infection prevention and control measures for COVID-19 in critical areas like hotels, where poor compliance to these measures may lead to high transmission of the infection. Thus, our findings may have policy implications, especially regarding strengthening the education of staff working in these areas with increased risks of infection transmission. The results highlight the importance of a systematic approach in consolidating evidence needed to identify priority populations for targeted intervention in the face of resource challenges during a public health emergency.

However, this study had some limitations, including the assessment, which has solely focused on knowledge and attitudes of the hotels’ staff. It would have been more interesting to also assess their actual practice when at work. In addition, this study was limited to the staff, working in hotels located in the capital, Kigali. Thus, our findings could not be generalised to the country as a whole since other hotels based outside of the capital were not represented. However, these findings provided some insights, which may inform further action to prevent and control the COVID-19 in Rwanda.

Conclusion

As the global threat of COVID-19 continues to rise, hotels’ staff based in the Rwandan capital have shown satisfactory levels of knowledge and attitudes regarding appropriate measures to prevent and control the COVID-19 during the period of rapid rise of the outbreak. However, the staff with higher educational level had better comprehensive knowledge than those with lower educational level. Similarly, the staff working in the administration have shown better attitudes towards the infection prevention and control than others. Thus, educational interventions targeting the groups with lower coverage in health information are highly needed for better prevention.

19 Oct 2021

PONE-D-21-30529Baseline knowledge and attitudes of COVID-19 among hotel staff.  A cross sectional study in Kigali, Rwanda.PLOS ONE

Dear Dr. Hagabimana,

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 Dec 03 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: https://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,

Sanjay Kumar Singh Patel, Ph.D.

Academic Editor

PLOS ONE

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 amend the manuscript submission data (via Edit Submission) to include authors Jared Omolo1, Ziad El-Khatib, Edson Rwagasore, Noella Benemariya, Olivier Nsekuye, Adeline Kabeja, Helene Balisanga, Angela Umutoni and Albert Ndagijimana1.

3. We note you have included a table to which you do not refer in the text of your manuscript. Please ensure that you refer to Table 3 in your text; if accepted, production will need this reference to link the reader to the Table.

4.  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. 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

**********

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

Reviewer #1: Yes

Reviewer #2: 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: Yes

Reviewer #2: 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

**********

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: Hotels and other pandemic establishments are associated with higher transmission of coronavirus. So, better sensitization of staff and strengthening is required to control the coronavirus pandemic. In this paper, the authors investigate the baseline knowledge and attitudes on COVID-19 among hotel staff in Kigali, Rwanda. A cross-sectional study is performed using structured questionnaires to 104 participants. Although the number of participants is small, it provides an essential understanding of the COVID-19 pandemic.

Minor comments:

1) Please discuss how the results stated in the manuscript are significant with only 104 hotel staff. Also, state the reason why more samples are not included in the manuscript.

2) The manuscript is well written. However, there are typos in the manuscript, such as fetal should be correct to fatal. Please go through the manuscript and correct all spelling errors.

3) In the discussion section, please discuss how present studies is relevant in the present and future pandemic.

4) There are some formatting errors in the reference section. Please correct them.

Reviewer #2: The manuscript by Hagabimana et al. “Baseline knowledge and attitudes of COVID-19 among hotel staff. A cross sectional study in Kigali, Rwanda.” requires revision to address major concerns.

Comments

1. The manuscript may be polished extensively for the English language.

2. Introduction (first paragraph): The information about mortality rate and various prevention approaches should be provided related to immunity and health i.e. doi: 10.1007/s12088-020-00908-0.

3. Introduction, the importance of this study may be more specifically highlighted and justified.

4. The author should provide at least one or two illustrations (additional Figures) to highlight the summary and significance.

6 Dec 2021

Reviewer #1:

Hotels and other pandemic establishments are associated with higher transmission of coronavirus. So, better sensitization of staff and strengthening is required to control the coronavirus pandemic. In this paper, the authors investigate the baseline knowledge and attitudes on COVID-19 among hotels’ staff in Kigali, Rwanda: a cross-sectional study is performed using structured questionnaires to 104 participants. Although the number of participants is small, it provides an essential understanding of the COVID-19 pandemic.

Authors ‘reply: We would like to thank Reviewer 1 for the overall summary and appreciation of the study in terms of an essential understanding of the COVID-19 pandemic.

Minor comments:

1) Please discuss how the results stated in the manuscript are significant with only 104 hotel staff. Also, state the reason why more samples are not included in the manuscript.

Authors’ reply: To the best of our knowledge, this was the first study that was conducted in the domain of hotel industry in urban area of a low-income country. We believe that this study provided important insights about the infection and control measures for COVID-19 in the hospitality sector. However, there were some limitations, which prevented us to conduct a larger survey among hotels’ staff in Kigali and other parts of the country. These limitations were related to the lack of study funding and movements’ restrictions during the time of the outbreak of COVID-19 pandemic. However, even though our findings may not provide a countrywide picture regarding the infection prevention and control measures for COVID-19 among hotels’ staff, we do believe that they provided some illumination on the importance of a systematic approach in consolidating evidence needed to identify priority populations for targeted intervention.

2) The manuscript is well written. However, there are typos in the manuscript, such as fetal should be correct to fatal. Please go through the manuscript and correct all spelling errors.

Authors’ reply: Thank you for pointing this out. We have revised the manuscript and addressed typos errors, as suggested.

3) In the discussion section, please discuss how present studies is relevant in the present and future pandemic.

Authors’ reply: Thank you for pointing this out. We have revised the discussion, as suggested.

4) There are some formatting errors in the reference section. Please correct them.

Authors’ reply: Thank you for pointing this out. We have corrected errors in the reference section.

Reviewer #2:

The manuscript by Hagabimana et al. “Baseline knowledge and attitudes of COVID-19 among hotel staff. A cross sectional study in Kigali, Rwanda.” requires revision to address major concerns.

Authors’ reply: We thank the esteemed Reviewer 2 for considering our paper and we hope you will find our updated version meeting your expectations.

Comments and answers:

1. The manuscript may be polished extensively for the English language.

Authors’ reply: Thank you for pointing this out. In the revised version of the manuscript, we have addressed the English language.

2. Introduction (first paragraph): The information about mortality rate and various prevention approaches should be provided related to immunity and health i.e. doi: 10.1007/s12088-020-00908-0.

Authors’ reply: We searched for the suggested reference, using the above doi, by the reviewer 2. The above doi did lead us to the reference: Rishi et.al.; Diet, Gut Microbiota and COVID-19; Indian J Microbiol; Sep 2020; https://pubmed.ncbi.nlm.nih.gov/33012868/. We feel this reference is out of scope in relation to our paper. We ask kindly reviewer 2 to confirm the reference.

3. Introduction, the importance of this study may be more specifically highlighted and justified.

Authors’ reply: Thank you for pointing this out. We have considered this comment in our revised manuscript.

4. The author should provide at least one or two illustrations (additional Figures) to highlight the summary and significance.

Authors’ reply: Thank you for pointing this out. This comment was addressed accordingly in the current version of the manuscript.

Submitted filename: Response to Reviewers.docx

Click here for additional data file.

9 Dec 2021

Baseline knowledge and attitudes of COVID-19 among hotel staff.  A cross sectional study in Kigali, Rwanda.

PONE-D-21-30529R1

Dear Dr. Hagabimana,

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,

Sanjay Kumar Singh Patel, Ph.D.

Academic Editor

PLOS ONE

20 Dec 2021

PONE-D-21-30529R1

Baseline knowledge and attitudes on COVID-19 among hotels’ staff: a cross-sectional study in Kigali, Rwanda.

Dear Dr. Hagabimana:

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. Sanjay Kumar Singh Patel

Academic Editor

PLOS ONE