The novel-coronavirus disease is currently a global health threat and an international public health emergency. In 2012, another coronavirus-caused outbreak known as Middle Eastern Respiratory Syndrome (MERS) resulted in over 1,000 infections and 400 deaths through 2015, and now the new Coronavirus disease 2019 (COVID-19) has plagued the world (1, 2). COVID-19 is a newly emerging disease caused by a highly infectious novel coronavirus that primarily affects the respiratory system (3). COVID-19 was first detected and isolated from a pneumonia patient in late December 2019 from Wuhan, China. Then WHO declared COVID-19 as a pandemic on 11 March 2020 (4). The most common symptoms include fever (78%), cough (57%), and fatigue (31%), as well as severe viral pneumonia, which can lead to acute respiratory distress syndrome, which can be fatal. COVID-19 can be transmitted to humans by touching an infected object or surface and then touching their mouth, nose, or possibly their eyes (4, 5). Both the CDC and WHO recommend that coronavirus prevention measures be known and implemented. These urge countries around the world to prioritize strict non-pharmaceutical interventions to combat the pandemic, such as the (mandatory) use of face masks, physical separation, regular hand washing and use of sanitizers, and regularly disinfecting surfaces (6).

Ethiopia is the second most populous nation in Africa, with a 9% of the African population (7). Since COVID-19 was declared a global and national public health threat, the Ethiopian government has implemented additional preventive measures such as mandatory quarantine periods for all travelers, restrictions on public gatherings, school closures, and mandatory facemasks in public places, as well as fewer passengers using public transportation. Risk communication on measures such as physical separation, wearing face masks, and hygiene, including through the media and cell-phone ring tone reminders, are critical interventions, but the infection rate continues to rise (8).

Despite government-imposed restrictions, there are inconsistencies in the implementation of COVID-19 preventive measures. Low educational status, female gender, age, urban residence, and knowledge of COVID 19 were discovered to have a significant effect on adherence to COVID preventive measures (6, 9, 10).

Poor adherence to COVID-19 mitigation measures remains a problem (11). Understanding the level of adherence to non-pharmaceutical interventions is essential to control COVID-19 disease (6). However, there is no adequate and current evidence regarding community adherence to COVID-19 preventive measures. Thus, the current study aimed to determine and provide current evidence on the community's adherence toward COVID-19 preventive measures and root causes of poor adherence among residents of Harari Region, Eastern Ethiopia.

Preventive measures play an essential role in reducing infection rates and controlling the spread of various diseases. There has been no definitive treatment found since the emergence of the COVID-19 pandemic. As a result, adhering to the recommended preventive measures is the best option for limiting the spread of the COVID-19 pandemic (11). The current study sought to investigate the community's adherence to COVID-19 prevention measures in Harari Regional State, Ethiopia. In the current study, 1,255 adults provided complete responses. According to the current study, overall poor adherence to COVID-19 preventive measures accounted for 51.5%, which was higher than the finding of another study conducted in Ethiopia, which reported a community adherence level of 44.1% to the recommended COVID-19 safety measures (15). But higher than the finding of another study conducted in Ethiopia, which found only 12.3% of the study participants adhered to the recommended COVID-19 preventive measures (16).

The current study identified various factors related to COVID-19 adherence among the study participants. For example, an educational status: primary school [AOR = 0.61 (0.43-0.87)] was associated with poor adherence to COVID-19 preventive measures that were in line with the findings reported by another study conducted in Ethiopia (15). Other factors associated with poor adherence to COVID-19 preventive measures were occupational status, monthly income, and perceived self-efficacy. The current study found that being a governmental employee [AOR = 0.5 (0.29-0.84] and formal occupations [AOR = 0.24 (0.13-0.43)] were significantly associated with poor adherence to the COVID-19 preventive measures. Another study conducted in Congo also reported that being both a private and public employee was associated with poor adherence to COVID-19 preventive measures (6). Even though the two studies' findings sound discrepant, they are almost identical in their findings except their interpretations.

The current study has also found that a monthly income of more than 5,000 ETB [AOR = 0.41 (0.28-0.59)] was significantly associated with poor adherence to the COVID-19 preventive measures. This finding was in line with the finding of another study conducted in Saudi Arabia and Mexico (16, 17).

Furthermore, the current study found a statistically significant association between perceived self-efficacy [AOR = 0.25 (0.20-0.32)] and poor adherence to COVID-19 preventive measures among the study participants. Another similar study conducted in Ethiopia reported that having no perceived efficacy was significantly associated with poor adherence to COVID-19 preventive measures (15). The discrepancy may be due to the socio-cultural differences between the two areas of communities.

Overall, the current study found more than half of the study participants had poor adherence to COVID-19 preventive measures. Therefore, to reduce these gaps and to increase the implementation of COVID-19 preventive measures, and manage the COVID-19 pandemic, the local and federal governments should design the appropriate intervention strategies based on the level of community understanding.

Appropriate implementation of COVID-19 preventive measures among community members is required to manage or control COVID-19 pandemics and reduce health-related consequences associated with COVID-19 pandemics. The current study, on the other hand, discovered that less than half of the study participants had poor adherence. As a result, in order to manage this pandemic, the relevant organizations, including the government and non-governmental organizations, must take appropriate and timely measures.

A community-based cross-sectional study design was used, and data was collected at predetermined time intervals. As a result, cause and effect relationships could not be investigated.

The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.

The studies involving human participants were reviewed and approved by Ethical clearance was taken from Institutional Health Research Ethics Review Committee (IHRERC) of Haramaya University. In addition, permission letters were obtained from all the concerned organization/bodies and from participants. The patients/participants provided their written informed consent to participate in this study.

AE conceived the idea and had major roles in the data review, drafting, and editing the manuscript. All authors contributed to data analysis, drafting and revising the manuscript, and have read and approved the final version of the manuscript to be published and agreed on all aspects of this work.

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.