Anees ur Rehman ^1* Zermina Tasleem ^2* Sohail Ayaz Muhammad ^3* Muhammad F. Rasool ¹ Shahid Shah ⁴ Gul Jabeen ^5* Sonia Arif ^6* Lujain Salim Omar Babkair ^7* Yahya Jaber Kadumi ⁸ Saleh Alghamdi ⁹ Safa Almarzoky Abuhussain ¹⁰ Sarah M. Khayyat ^10* Raed Alharthi ¹¹ Mohammad A. Hossain ^12* Asma Abbas ¹³ Mahmoud E. Elrggal ¹² Abdul Haseeb ^14*

• ¹ Faculty of Pharmacy, Bahauddin Zakariya University, Multan, Pakistan
• ² Department of Political Sciences, Bahauddin Zakariya University, Multan, Pakistan
• ³ School of Management Sciences, University Sains Malaysia, Penang, Malaysia
• ⁴ Faculty of Pharmaceutical Sciences, Government College University Faisalabad, Faisalabad, Punjab, Pakistan
• ⁵ Faculty of Public Governance and Business, Mykolas Romeris University, Vilnius, Lithuania
• ⁶ Faculty of Medicine, University of Oslo, Oslo, Oslo, Norway
• ⁷ Infectious Diseases Department, Alnoor Specialist Hospital, Ministry of Health, Makkah, Saudi Arabia
• ⁸ Pharmacy Department, Alnoor Specialist Hospital, Ministry of Health, Makkah, Saudi Arabia
• ⁹ Department of Clinical Pharmacy, College of Clinical Pharmacy, Al Baha University, Al Baha, Al Bahah, Saudi Arabia
• ¹⁰ Department of Clinical Pharmacy, College of Pharmacy, Umm Al Qura University, Mecca, Saudi Arabia
• ¹¹ Security Forces Hospital, Riyadh, Saudi Arabia
• ¹² Department of Pharmacology and Toxicology, Faculty of Medicine, Umm Al-Qura University, Makkah, Makkah, Saudi Arabia
• ¹³ Department of Clinical Pharmacy, Pharmaceutical Care Department, Ministry of National-Guard Health, Jeddah, Saudi Arabia
• ¹⁴ Department of Clinical Pharmacy, Al Rayan private college of health sciences and nursing, Madinah, Saudi Arabia

Background: The COVID-19 comorbid population is at higher risk of developing severe health issues like acute respiratory distress syndrome, coagulation syndrome, metabolic acidosis, and septic shock, potentially leading to patient death. Patients' knowledge, attitudes, and practices (KAP) significantly influence their response to the pandemic and aid in enhancing health policy implementation. Objective: To identify and evaluate the pattern and associated factors to COVID-19 knowledge, attitude, and practice among individuals with comorbidities. Methodology: The systematic review followed the PRISMA guidelines. Relevant studies assessing the KAP of comorbid patients were retrieved by carefully searching the PubMed and Google Scholar databases. The appraisal tool for cross-sectional studies was used to determine the quality of the included studies and the risk of biases. Results: Eighteen studies met the inclusion criteria and were included in the review. The pooled sample size of the included studies was 9104. Different comorbidities reported in the studies include hypertension, diabetes, psychological disorders, and cancer. Pooled analysis showed that 65% of patients showed good knowledge, 57% of patients showed a positive attitude and 51% of patients followed good practices to manage the COVID-19 in presence of their comorbid condition. Significant factors impacting knowledge, attitude and practice in COVID-19 comorbid patients were ethnicity OR 1.78 [95% CI 1.35-2.32]; educational status 3.2 [2.79-3.58]; urban residence 2.43 [1.65-3.02]; employment Status 1.67[1.34-2.12]; financial Status 4.02[3.66-4.38]; occupation 3.65[3.31-4.25]; information Source 2.64[2.19-3.26]; comorbidity 3.28[2.78-3.61]; and duration of chronic illness 1.59[1.31-2.04]. Conclusion: Comorbid COVID-19 patients showed good knowledge, positive attitude and good practice towards the management of the disease.