Background: Coronavirus disease 2019 (COVID-19) is a global public health emergency that impacted the lives of millions of people around the world. Different measures and extraordinary steps are being taken to contain the transmission of the virus. However, there is still a gap on knowledge and implementation of preventive practices in Sub-Saharan countries. This study aimed to describe COVID-19 related knowledge, practice and its impact on mental health among adults in three Sub–Sharan Countries; Burkina Faso, Ethiopia, and Nigeria.

Method: community based cross-sectional study was conducted across the six survey sites. A total of 1797 adults were included in the survey, and data was collected using Computer Assisted Telephone Interview. Knowledge was assessed using three knowledge domains and a score was used for classifying participants as having good or poor knowledge.

Results: Proportion of adults who identified more than 80% of COVID-19 symptoms, transmission and prevention mechanisms were 69.9%, 79.2% and 90.7% respectively. Being male (aOR=1.49 95% CI:1.17 – 1.89), having primary education (aOR=1.56 95% CI: 1.08 – 2.24) and tertiary education (aOR=1.42 95% CI: 1.02 – 1.97), Urban residence (aOR=1.76 95% CI: 1.39 – 2.24) and not believing the pandemic is real (aOR=0.29 95% CI: 0.18 – 0.45) were the factors associated with poor knowledge. Leaving to earn income was reported by 80% as a primary factor that prevents quarantine if mandated by the government. Even if a greater proportion of the adults correctly identified the preventive mechanisms, self-reported practice was lower specifically for avoiding social gatherings (49.1%) and disinfecting contaminated surfaces (45.1%). Mild psychological destress was reported by 20.6% while 5.9% and 1.1% had moderate and sever psychological destress respectively.

Conclusion: Majority of the participants have a good knowledge. However different interventions are needed to address the gaps in knowledge and also strategies are required to increase uptake preventive practices among adults. Additional strategies are also required to minimizes the burden of the pandemic on mental health of the general population.

Keywords: COVID-19, sub-Saharan Africa, adults, knowledge, mental health