COVID – 19 related knowledge and preventive practices early in the outbreak among health care workers in selected public health facilities of Illu aba Bor and Buno Bedelle zones, Southwest Ethiopia

This cross-sectional study was carried out in selected public health facilities in Ilu Abba Bor and Buno Bedelle Zones. Ilu Abba Bor zone and Buno Bedelle Zone are out of the 21 zones of Oromia National regional state situated in the southwest of the region and located at a distance of about 600 km and 483 from the center of the region respectively. They cover the western part of the region and lie between 34⁰ 52′12 “E to 41⁰ 34 ‘55” E longitudes and 7⁰ 27′ 40 “N to 9⁰ 02 ‘10” N latitude. Illu Aba Bor Zone has one town administration and 14 rural districts with a projected total population of 1,606,502. One referral and District hospital are found in the zone serving a population of the zone. Buno Bedelle Zone has one town administration and 14 rural districts with a projected total population of 815,437. The zone has three functional hospitals and one under construction, 32 health centers, and 246 health posts. The study was conducted from April 27 –May 10, 2020.

All health care providers working in service delivery units in selected health facilities in both Illu Aba Bor and Buno Bedelle Zones were the study population.

The sample size was determined by using a single population proportion formula: n = (Zα/2) ² p (1-p)/(d) ², where n denotes the sample size, Zα/2 is the reliability coefficient of standard error at 5% level of significance = 1.96, (5%) margin of error tolerated, p = proportion of good preventive practice of COVID-19 (50%, since there was no previous study available). Hence, the final sample size calculated was 345 after adjusting for the total health worker population in the two zones. First, health facilities were identified based on their proximity to metropolitan areas and ease of access, and 30% of these facilities were chosen at random. Finally, all health care workers in the selected health facilities were included.

A self-administered structured questionnaire adapted from WHO resources and a review of relevant literature was used to collect the data [10, 19, 20]. The questionnaire was first prepared in English, then translated to the local language (Afan Oromo), and translated back to English by another person who was blinded to the English version to ensure its consistency. The tool was pretested on 5% of the sample selected from health facilities in Illu aba Bor Zone that were not included in the main study and modified based on the pretest observations. The facilitators were given intensive training for two days before the actual data collection.

The knowledge questions had 12 items covering issues such as COVID-19 symptoms, risk conditions, prognosis, modes of transmission and safety, and precautions. The knowledge score was converted into tertiles, with the highest tertile defining “good knowledge” and the two lower tertiles combined defining “poor knowledge.”

The infection prevention practice was assessed using 16 items. The practice was computed by adding the responses, scoring one for each correct answer, and zero otherwise. The practice score was converted into tertile and the highest tertile was used to define “good practice”, while the two lower tertiles combined were labeled as “poor practice”.

Data were entered onto EpiData version 3.1.0 to control skip patterns and allow double entry and exported to SPSS version 23 for analysis. Recoding, transforming, and re-categorization of some variables were performed to compute some of the analyses. In all analyses of the data, a two-sided p- was used. Independent sample t-test and one-way analysis of variance (ANOVA) were performed to assess any difference in mean knowledge score by demographic characteristics. Binary and multivariable logistic regression analyses were computed to examine the association between dependent and independent variables. The odds ratio with a 95% confidence interval was used to identify the factors associated with good infection prevention and control practices. Multicollinearity between different predictor variables was assessed. The adequacy of the model was checked using the Hosmer and Lemeshow test for goodness of fit.

A total of 330 HCWs were included in the study, making the response rate 95.7%. More than half (56.1%) of the respondents were between 25 and 34 years of age. Two hundred and three (61.5%) were male participants. More than two-thirds (69.4%) of the respondents were married. Nearly half (47.6%) of the population is protestant, and Oromo is the dominant ethnic group (87.9%).More than half (53.7%) of the respondents were degree holders. One hundred eighty-four (55.8%) of the HCW were nurses and 108 (40.3%) had less than five years of experience (Table 1).

The study revealed that more than half (59.1%) of the study participants did not receive training related to infection prevention. One hundred seventy-seven (53.6%) of the study participants reported that the institution does not have an infection prevention program and 201 (60.9%) did not have an active infection prevention team. More than half (54.5%) reported that the institution does not have an emerging infectious disease taskforce (dealing with outbreaks) and infection prevention and control guidelines. Nearly two-thirds (65.8%) and 54.5% of the health workers reported the availability of water and soap at their work unit respectively. Three-fourths (75.2%) of respondents reported the availability of alcohol or hand sanitizer, and two-thirds reported adequate availability of the necessary personal protective equipment (PPE) at their facility. One hundred ninety (42.4%) of the respondents reported the availability of colored dust bins to segregate medical waste at their work unit. One hundred twenty-eight (38.8%) of the health workers reported that their place of assignment at the time of data collection was at the outpatient department (Table 2).

A greater part (93.3%) of the respondents demonstrated self-reported good knowledge towards COVID-19 and the mean (±SD) knowledge score was 9.0 4 ± 1.06. Three hundred twenty-two (97.6%) correctly answered the mode of transmission of the virus. Almost all (97%) of the respondents correctly answered that COVID-19 is a viral infection and (97.9%) answered that fever, cough, sore throats, and shortness of breath are common symptoms of COVID-19. More than 90% of HCPs were well aware of the route of transmission of the virus. A similar proportion were also aware that frequent handwashing with soap and water or alcohol-based hand rub, and using face masks can help in the prevention of disease transmission. Three hundred and 11 (94.2%) reported that healthcare workers are at a higher risk of infection. Two hundred ninety-one (88.2%) of the respondents correctly identified the isolation period to be 2 weeks. More than three-fourth (79.7%) answered that there is no vaccine available against COVID-19 and (76.1%) stated COVID-19 could be fatal. Less than three-fourths (70.3%) of the respondents indicated antibiotics are not a first-line treatment for the disease (Table 3).

A summary score was developed from continuous data of the practice of healthcare workers regarding infection prevention towards COVID-19. The mean (±SD) self-reported infection prevention practice was 10.05 ± 4.81. The overall self-reported good infection practice score towards COVID-19 among the healthcare workers was 64.2% (Fig. 1).

A mixed perception was reported by HCWs regarding barriers to infection prevention and control practices. Ninety-eight (29.7%) of the HCWs presumed that overcrowding in the emergency room was a barrier, whereas, 26.7% strongly agreed that insufficient training on infection prevention was a barrier towards infection prevention and control practices. A quarter (25.8%) of the participants strongly agreed that the limitation of infection prevention equipment was a barrier to infection prevention practices (Fig. 2).

Independent sample t-test and one-way ANOVA analysis were done to assess the mean knowledge difference between groups regarding socio-demographic characteristics. In both tests, knowledge did not differ significantly (P > 0.05) with age, gender, education, experience, or profession (Table 4).

On multivariable logistic regression analysis, gender, educational status, profession, years of service, knowledge towards COVID-19, and availability of personal protective equipment were significantly associated with good infection prevention practices. As a result, male HCWS were more than three times as good at infection prevention as female HCWS (AOR = 3.65, 95% CI: (1.96, 6.80)).Bachelor degree holders were about two times more likely to practice good infection prevention compared to diploma holders (AOR = 1.82, 95% CI (1.02, 3.22)). Physicians were 3.17 times more likely to practice infection prevention than nurses (AOR = 3.17, 95% CI (1.08, 9.33)). Service year was another factor significantly associated with infection prevention practice. Healthcare workers having a service years of 5–10 years were 2 times more likely to have good infection prevention practice (AOR = 2.00 (1.02, 3.92)) and those who have served for more than 10 years were 3.14 times more likely to have good infection prevention practice (AOR = 3.14 (1.51, 6.52)) compared to those who have served for less than 5 y. Health care workers who had enough supply of personal protective equipment at their work unit were 2 times more likely to have good infection prevention practices compared to those who did not have enough supply of the PPE (AOR = 1.96 (1.06, 3.61)). The knowledge level of health care workers was significantly associated with good infection prevention practices. Health care workers who had a good knowledge score were 2.28 times more likely to have good infection prevention practices compared to those who had poor knowledge scores (AOR = 2.61 (1.48, 4.62)) (Table 5).