The prevalence and pattern of mask use and its association with COVID-19-related morbidity and mortality in Tabriz, Iran

Background. Using personal protective equipment, including masks, is one of the most important ways to prevent coronavirus disease 2019 (COVID-19). The aim of this study was to estimate the prevalence and pattern of mask use and its association with COVID-19-related morbidity and mortality in different areas of Tabriz, Iran. Methods. In this population-based study, 6,600 pedestrians were selected by multi-stage proportional sampling method in nine areas of Tabriz in 2021. The data was collected using the observation method. For each participant, we recorded gender, approximate age, mask usage, type of mask, and correct or incorrect use. The data of COVID-19-related


Background
The outbreak of coronavirus disease 2019 (COVID-19) is considered a global crisis.One of the main ways to break the chain of disease transmission is through observing the preventive behaviours by the general population.At the same time, adherence to preventive actions can be affected by the psychological state of people.There is sufficient evidence to suggest that wearing a mask reduces the transmission of contaminated droplets per contact, thereby reducing the transmission of COVID-19.Using masks in the community when the virus is Daraee, et al.
Med J Tabriz Uni Med Sciences.2023;45 (5) | 448 highly prevalent is effective in preventing the spread of the virus.Therefore, the use of personal protective equipment, including masks, is one of the most important ways to prevent coronavirus.It is partially unknown how much the mask protects from airway droplets, but face masks can reduce the risk of COVID-19 infection in the population even with limited protection.They can also reduce viral load, leading to reduced severity and risk of death.The aim of this study was to estimate the prevalence and pattern of mask use and its association with COVID-19-related morbidity and mortality.

Methods
This population-based study was conducted in Tabriz, Iran in 2021.Tabriz is the most populous city in northwestern Iran with a population of 1,773,000.To estimate the prevalence and pattern of mask use, a total of 6,600 pedestrians were selected from nine areas in Tabriz in June 2021.Data was collected using the observation method.A multi-stage proportional sampling method was used.Tabriz city is divided into 10 municipality areas (area 9 has the least population).In each area, based on the population size, some stations were randomly selected as clusters from the neighbourhood list.An average of 24 clusters was assigned to each area.The locations were chosen from the crowded walkways.In each station, 15 males and 15 females were observed in terms of mask use.For each subject, gender, approximate age, mask usage, type of mask, and correct or incorrect use of masks were recorded.We excluded the pedestrians who completely covered their faces so that the observer could not recognize the use of mask and those who were briefly exposed to the observer so that they could not record the required specifications.Observations were made during the busy hours of each area (from 9.00 to 13.00 and 17.00 to 23.00).The data on COVID-19-related morbidity and mortality for six months (from 21 March 2021 to 22 September 2021) were obtained from the Integrated Syndromic Surveillance System (ISSS) of the Vice Chancellor for Health at Tabriz University of Medical Sciences.ISSS is a national electronic platform under the supervision of the Center for Communicable Disease Management of Ministry of Health and Medical Education of Iran, which collects the data on target syndromes from public and private healthcare providers.The main purpose of ISSS is to quickly detect the outbreaks of infectious diseases, particularly the emerging ones such as COVID-19.Data on COVID-19 suspected patients have been recorded as Severe Acute Respiratory Infections (SARI) syndrome.Estimates were made with 95% confidence interval.Chi-square test and Pearson correlation coefficient were used in the SPSS-25 software.

Results
A total of 6,600 pedestrians were observed for mask use.The most observed age group was 31-40 years.Among the subjects, 3,421 (51.8%) were male.The most common type of face mask used by pedestrians was the surgical mask (70.7%).Among pedestrians who used the mask, 78.7% used the mask correctly.Among the pedestrians, 3,746 people had used face masks.The overall prevalence of facial mask use was 56.8% (95% CI: 55.56 -57.95).Out of 3,421 men, 1,599 (46.7%; 95% CI: 45.1-48.4) and out of 3,179 women, 2,147 (67.5%; 95% CI: 65.9-69.2) used face mask (P<0.001).The highest prevalence of mask use was observed in the age group of 70 years and older and the lowest in the age group of less than 10 years (71.3% and 39.4%, respectively).The range of mask use in different areas was 51.0%-64.1%.The morbidity and mortality ranges within six months were 43.5-70.6 and 3.7-10-8 per 10000, respectively.The correlations between the prevalence of mask use and morbidity (r=0.375,P=0.320) and mortality (r=0.219,P=0.571) were not statistically significant.

Conclusion
In this study, we tried to estimate the prevalence of mask use in different areas of Tabriz city.The results showed that face mask usage was 56.8%.This rate was inefficient in controlling the disease.Using face masks was relatively low, especially among males and young people.Similar to other studies, women used masks more than men, and surgical masks were used more than other types.There was no significant relationship between the rate of mask use and COVID-19-related morbidity and mortality.