Knowledge and behavior of international students studying higher education in Turkey towards personal protective measures against COVID-19

The study aim was to investigate implementation of personal protective measures among international students during COVID-19 pandemic. A total of 758 students from 95 countries were observed between October 2020 and March 2021. Their frequency of implementing the personal protective measures and their reported cases of ILIs were examined. Kaplan-Meier analysis was used to compare the occurrence of symptoms of ILIs among students who adhered and those who did not adhere to the measures. A multivariate Cox proportional regression was performed to investigate the relationships between frequency of implementing the personal protective measures and reported cases of ILIs. A total of 139 (18.3%) students reported symptoms of ILIs. Study findings showed that students who frequently wore facemasks were 33.6% less likely to show symptoms of ILIs adjusting for all the other personal protective measures (HR=0.664, 95%CI=0.494-0.893, p=0.006). Students who frequently disinfected their hands were 17.1 % less likely to report symptoms of ILIs (HR=0.821, 95%CI=0.793- 0.915, p=0.029). Furthermore, students who exercised social distancing measures were 23.5% less likely to report symptoms of ILIs adjusting for the other measures (HR= 0.765, 95%CI=0.610 - 0.960, p=0.020). Students whose personal protective measures were below the median were found to experience 2 times more cases of ILIs than students who scored above the median (HR=2.16, 95%CI=1.53-3.05, P<0.001). Study findings indicate the need to train students how to protect themselves from common airborne infections. The study also provides information about the effectiveness of personal protective measures in preventing acute respiratory infections among international students.