This was a cross-sectional study conducted among mothers that presented with their children to the paediatric wards, outpatient clinics and the children emergency room of Enugu State University Teaching Hospital from June 2020 to August 2020.

Inclusion and Exclusion criteria: Mothers who gave consent and whose children has reached school age and were out of school from lockdown were enrolled in the study while mothers who did not give consent and whose children have not reached school age were excluded. Four hundred and four mothers were in the course of the study from June to August 2020. Mothers who did not gave consent were excluded.

All procedures performed were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standard. Ethical approval was obtained from the Ethics and Research committee of the Enugu State University Teaching Hospital. (Reference number: ESUTP/C-MAC/RA/034/Vol 1/266).

Information on demography, educational status and perception on school preparedness were obtained from the mothers by means of a structured interviewer-administered questionnaire. Knowledge of spread entails; spread through contact with COVID-19 infected person(s), spread by airborne, spread by droplet infection, regular touching of face after touching infected surfaces, contact with blood and contact with blood products. The contents of the questionnaire were explained to the mother in the local language. Outcome variable was willingness of the mothers to allow their children return to school amidst the COVID-19 pandemic.

Six variables were used to assess knowledge of spread of COVID-19 among the respondents. Each correct answer was assigned a score of one while every incorrect answer was scored zero. Good knowledge of spread of COVID-19 was determined by proportion of respondents that correctly answered ≥60% of six variables used to assess mode of spread of COVID-19.

Nine variables were used to assess preventive practices against COVID-19 among the respondents. For every correct answer, a score of one was given while an incorrect answer attracted a score of zero. Good knowledge of preventive practices against COVID-19 was determined by proportion of respondents that correctly answered ≥60% of nine variables used to assess preventive practices against COVID-19.

Sample size estimation: The minimum sample size used in this study was calculated using the formula:

Where, Z=1.96 i.e., the level of significance

P=proportion of mothers willing to allow their children to return to school and assumed to be 50% (taken as 0.5 being a new study)

D=Tolerable error (0.05)

Using the above formula, the minimum sample size with 5% attrition rate was approximately 404.

Systematic random sampling technique was used to select clients as they presented on each day of data collection, using the facility register. A total of 1186 clients presented in the three Paediatric clinics in the health facility. This included the Children out-patient clinics, children emergency room and immunisation clinics on a monthly basis within this COVID-19 period. This total number, 1186 served as sampling frame. Sampling interval was determined by dividing sampling frame (1186) by sample size (404), hence a sampling interval of 3 was used. Every third client was recruited for the study based on order of registration of clients in each of the clinics on each day of data collection. The index client was selected by simple random sampling method through balloting. The clients coming for the various clinics on the five working days of the week were included in the study.

Data entry and analysis were done using IBM Statistical Package for Social Sciences (SPSS) statistical software version 25. Continuous variables were summarised using mean and standard deviation while categorical variables were summarised using frequencies and proportions. Frequency tables and cross tabulation were generated. Chi-square test of statistical significance and multivariate analysis using binary logistic regression were used in the analysis and the level of statistical significance was determined by a p-value of <0.05.

In determining the predictors of willingness of mothers to allow children to return to school amidst COVID-19 pandemic, variables that had a p-value of <0.2 on bivariate analysis were entered into the logistic regression model for that purpose. The results were reported using Adjusted Odds Ratios (AOR) and 95% confidence interval and the level of statistical significance was determined by a p-value of <0.05.

[Table/Fig-1] shows the socio-demographic characteristics of the respondents. The mean age of the respondents was 40.1±12.3 years. The highest proportion of respondents was in the age group, 30-39 years, (33.2%). Majority of the respondents (78.5%) were married. Majority (56.2%) were self-employed.

[Table/Fig-2] shows willingness of mothers to allow children resume school amidst COVID-19 pandemic. Majority of the respondents, 56.7% were willing to allow children return to school. The major reason for not allowing children return to school was lack of trust in the school’s preventive measures, 80.6%.

[Table/Fig-3] shows factors affecting mothers’ willingness to allow children resume school amidst COVID-19 pandemic. A significantly higher proportion of respondents who were 50 years and above, 77.9% were willing to allow children return to school when compared with those who were less than 30-years-old. (χ²=22.730, p<0.001). A significantly higher proportion of respondents who were single, 79.3% were willing to allow children return to school when compared with those who were married, 50.5%, (χ²=23.120, p<0.001). The higher proportion of respondents who had poor knowledge of preventive practices against COVID-19, (78.9%) were compared with those who had good knowledge of preventive practices, 46.4% and the difference in proportion was found to be statistically significant, (χ²=37.686, p<0.001).

[Table/Fig-4] shows the predictors of mothers’ willingness to allow children return to school amidst COVID-19 pandemic. The respondents who were <30 years of age were three times less likely to permit children to return to school when compared with those who were 50 years and above. (AOR=0.3, 95% CI: 0.2-0.7). Similarly, the respondents who were in the age group 30-39 years were about three times less likely to allow children to return to school when compared with those were 50 years and above, (AOR=0.4, 95% CI: 0.2-0.8). The respondents who were married were about three times less likely to allow children to resume school when compared with those who were single, (AOR=0.4, 95% CI: 0.2-0.7). The respondents who had poor knowledge of preventive practices against COVID-19 were about three times more likely to allow children resume school when compared with those who had good knowledge of preventive practices against COVID-19. (AOR=2.8, 95% CI: 1.7-4.8).

This study has shown a burning desire and quest from mothers for their children to return to school. Majority of mothers in this study wanted their children to return to school. The same desire to reopen schools was also documented in Israel where they stated that a bubble model for reopening school was used, which was based on rate of infection and spread in the locale [12]. This is very crucial, as it can be seen that in Nigeria, the rate of spread and mortality from COVID-19 is low compared to western world where schools are shut down. For instance, presently, 58,647 cases, and 1,111 deaths have been recorded in 36 states and the Federal Capital Territory [13]. Reopening of schools, if not well planned with all the preventive measures put in place, could be counter-productive. For instance, Israel was forced to close down schools after 2,026 students, teachers and staff tested positive for COVID-19 [12]. Furthermore, in South Korea, a resurgence of the infection was noted and about 1.8 million new students and older children in the elementary schools’ return to class was put on hold, because some students were found to be infected [12].

Mothers who opted that their children should not go back to school, gave, lack of trust in the school authorities’ ability to provide formidable protective measures as their reason. These findings on mothers’ willingness to send their children to school is also supported by another study [13] where two thirds of the mothers agreed that they would not like to send their children to school. However, safety measures such as decreasing the number of children on buses, daily temperature checks of the children at school, alternating between in-person and online classes, regular testing of school staff for COVID-19, and older children wearing masks have been seen by the mothers as the only criteria to reopen schools [13].

Several countries have taken some precautions and provided guidelines towards school reopening. For instance, in Denmark, students are required to maintain 2 meters of distancing in class with division of classes into one or more groups [14]. Norway’s guidance to school reopening is similar to Denmark’s, where students were limited to a class size of 15 students per class in primary school and 20 in middle school [15]. The Norwegian system took cognizance that social distancing may be difficult with young children and that, while this should be encouraged, “comfort and contact for the youngest children in day care should be paramount” [14].

In Taiwan, students are kept in a home room class with one form mistress, while children in nursery wear masks supplied by the government with desk separated from one another [16]. In Singapore, class sizes were maintained at about 30 students with desk spacing of 1-2 meters [17]. Similar measures are being taken in China where class size was reduced from 50 students to less than 30 [18].

This study showed that a significantly higher proportion of mothers who were single, were willing to allow children return to school when compared with those who were married. Anne J et al., noted that single mothers are more likely to be employed and also have a huge sense of responsibility to provide for their children’s emotional and material needs [19]. To reduce these challenges, they will prefer to keep their children in school. Further, analysis revealed that these mothers with poor knowledge of preventive practices against COVID-19 were about three times more likely to allow children resume school when compared with those who had good knowledge of preventive practices against COVID-19. This could explain why they wanted their children return to school.

It was also noted that mothers less than thirty years’ of age were three times less likely to permit children to return to school when compared with those who were over 50 years. Younger mothers are less likely to be employed in the area of study, so they will prefer to be with their children and teach them. Unlike their older counterparts who will rather be in their offices and would not have time to care for their children. Self-employed mothers are also more likely to send back their children to school in the COVID-19 pandemic. These are mothers who believe that their children’s continued stay at home will interfere with and disturb their business and they may not also have adequate time to cater for them since they rarely stay at home.

Furthermore, educational status of the mother is a good predictor of school resumption as seen in this study. This could explain why majority of mothers were willing to send their children to school, since they are better educated on the low risk of infection in children [20]. Though, some countries are putting precautionary guidelines on school reopening, delay to reopen schools could lead to huge economic costs. In addition, potential harms of school closure are undoubtedly very high [8,21,23]. For instance, it was documented that closure of schools increased vulnerability to physical and sexual abuse of the female child. Transactional sex was commonly reported among vulnerable female children, since their families could not provide basic needs [24].

This work is limited by the fact that school readiness among mothers in the multiple centers in the country was not ascertained. Also, the questionnaire used requires external validation.

Majority of mothers preferred that children should return to school. The younger age group and married women were less likely to allow children go back to school. The respondents who had poor knowledge of preventive practices were more desirous that children should return to school.