|Year : 2021 | Volume
| Issue : 12 | Page : 1846-1851
Knowledge, attitudes and practices towards Covid-19 among Nigerian healthcare workers during the Covid-19 pandemic: A single centre survey
EE Abene1, AN Ocheke2, KN Ozoilo3, ZM Gimba1, EN Okeke4, OO Agbaji4, EI Agaba4
1 Department of Medicine, Jos University Teaching Hospital, Jos, Nigeria
2 Department of O and G, University of Jos and Jos University Teaching Hospital, Jos, Nigeria
3 Department of Surgery, University of Jos and Jos University Teaching Hospital, Jos, Nigeria
4 Department of Medicine, University of Jos and Jos University Teaching Hospital, Jos, Nigeria
|Date of Submission||19-Jun-2020|
|Date of Acceptance||16-Jun-2020|
|Date of Web Publication||09-Dec-2021|
Dr. E I Agaba
Department of Medicine, University of Jos, Jos
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Background: The COVID-19 pandemic has led to hundreds of thousands of deaths worldwide. Aims: Being a novel viral disease, we sought to evaluate the knowledge and practice of doctors and nurses in a tertiary hospital regarding the disease. Subjects and Methods: Using a self-administered questionnaire, respondents were asked questions on the cause, clinical features, and prevention of COVID-19. Results: We studied 409 respondents (238 doctors and 171 nurses) with a mean age of 34 ± 7 years and a median length of experience of five (IQR 2-9) years. The mean knowledge score was 9.6 ± 1.2 out of a maximum of 12 points with 337 (82.4%) respondents having good knowledge. The majority of respondents (62.8%) had not been trained on infection prevention and control since the outbreak of the pandemic. Only 95 (23.2%) had seen COVID-19 Standard Operating Procedures (SOP) displayed in the hospital. The use of the personal protective equipment (PPE) kit comprising the N-95 mask, face shield, gown, and shoes was seen by 194 (47.4%) respondents in recent times. A total of 397 (97.0%) respondents felt they were at an increased risk of contracting COVID-19 relative to the general populace. Measures taken to prevent COVID-19 included: wearing of face mask (68.7%), hand gloves (78.2%), frequent use of hand sanitizers (84.1%), frequent hand washing (84.8%), the daily wash of uniforms and ward coats (44.5%), daily cleaning of footwear (31.7%), and avoidance of taking home clothing and footwear worn in the hospital (54.2%). Conclusion: Despite having good knowledge of transmission and clinical features of SARS-CoV 2, the utilization of protective measures by HCW in this study is unsatisfactory.
Keywords: COVID-19, Coronavirus, healthcare workers, knowledge, pandemic, physical distancing
|How to cite this article:|
Abene E E, Ocheke A N, Ozoilo K N, Gimba Z M, Okeke E N, Agbaji O O, Agaba E I. Knowledge, attitudes and practices towards Covid-19 among Nigerian healthcare workers during the Covid-19 pandemic: A single centre survey. Niger J Clin Pract 2021;24:1846-51
|How to cite this URL:|
Abene E E, Ocheke A N, Ozoilo K N, Gimba Z M, Okeke E N, Agbaji O O, Agaba E I. Knowledge, attitudes and practices towards Covid-19 among Nigerian healthcare workers during the Covid-19 pandemic: A single centre survey. Niger J Clin Pract [serial online] 2021 [cited 2022 Jan 25];24:1846-51. Available from: https://www.njcponline.com/text.asp?2021/24/12/1846/332077
| Introduction|| |
In December 2019, China first reported the outbreak of severe acute respiratory syndrome Coronavirus 2 (SARSCoV-2), also called the COVID-19 virus. Since then, the virus has ravaged many countries and has become a pandemic leading to nearly a million infection worldwide and causing 33,000 deaths in four months.,, The COVID-19 syndrome primarily presents as a flu-like disease manifesting with fever, cough (initially dry) and myalgia. While the majority of infections are mild and resolve without significant morbidity, up to 18.5% develop severe disease characterized by acute respiratory distress syndrome (ARDS), septic shock, metabolic acidosis, and bleeding and coagulation dysfunction.,
While initial reports suggest that mortality was limited to the elderly and those with significant underlying co-morbidities like cardiovascular disease and diabetes, young and previously healthy persons have died from this virus. The devastating effect of this pandemic has just begun as medical personnel who care for COVID-19 infected individuals have not been left out. Recently, physicians and nurses in Europe have been infected with significant mortality. This has brought to the fore the risk healthcare workers (HCWs) are exposed to worldwide.
The literature on knowledge and practices of HCWs regarding COVID-19 is scant as it is a new illness. A recent publication from Wuhan, China assessed the knowledge and attitude of Chinese residents regarding COVID-19. Ninety percent of the respondents had correct knowledge with a knowledge score being associated with a lower likelihood of negative attitudes and preventive practices towards COVID-2019. With the recent outbreak of COVID-19 infection in Nigeria, there is panic and many feel that Nigeria will not be able to cope with the disease (Personal communication). It becomes imperative then to assess the knowledge, attitude, and practices (KAP) of HCWs towards COVID-19 infection and the HCWs' assessment of their risk of contracting the infection. We embarked on this cross-sectional study to evaluate the KAP of HCWs, their assessment of the risk they are exposed to, and the hospital's readiness to care for a patient with COVID-19 infection.
| Materials and Methods|| |
This cross-sectional questionnaire-based study was conducted among doctors and nurses at the Jos University Teaching Hospital (JUTH), located in Jos, Nigeria. The study was conducted over six weeks in the months of April and May 2020.
The Human Research Ethics Committee of the hospital approved the study. Written informed consent was obtained from the respondents before enrollment into the study. Responses obtained from the study participants were de-identified and treated with confidentiality.
Doctors (practicing in the medical and surgical specialties) and nurses working in the wards, outpatient clinics, operating suites, and other parts of the hospital were sampled in this study. In the light of the pandemic, the nonprobability sampling method where willing respondents were sampled in a consecutive manner was used in this study. Questionnaires were distributed to the nurses and doctors as we saw them in the hospital.
Using a prevalence of 90% of respondents who had correct COVID-19 knowledge from an earlier study, a confidence interval of 95% and a precision of 5%, the minimum sample size was determined as 139.
The questionnaire to be used in this study was adapted from a recent study conducted in Wuhan, China where the COVID-19 was first reported. The questionnaire used in the Wuhan study consisted of two parts: demographics and KAP. We modified this questionnaire to include an assessment of personal risk and the readiness of the hospital for the Covid-19 pandemic. Demographic variables included age, gender, marital status, education and type, and a cadre of the healthcare profession.
The COVID-19 knowledge aspect of the Questionnaire had 12 questions that evaluated factual knowledge regarding clinical presentation, transmission, and prevention of COVID-19 infection. The responses to these 12 questions included “True”, “False” or “I don't Know” and each question answered correctly (True response) was awarded one (1) point while a “False” or “I don't Know” response was awarded a zero (0) point. A score of 75% (nine questions correctly answered) was adjudged as good knowledge of COVID-19. We also included questions (third and fourth parts of the questionnaire) that assessed the attitudes and practices of the respondents in the past two weeks before they were surveyed. The last part of the questionnaire had questions that sought to self-evaluate their risk of contracting the virus and measures the respondents had taken to protect themselves. We also asked them to assess how equipped their hospital was for the proper management of COVID-19 infections.
Data obtained from the study were analyzed using the EPI Info version 18.104.22.168 (CDC, Atlanta, GA). Results were expressed as Means+Standard Deviation (SD) and proportions for quantitative and qualitative data respectively. Where continuous quantitative data were not normally distributed, median with Interquartile Range (IQR) was used.
| Results|| |
Of the 800 questionnaires placed in the wards and Doctors' common rooms, only 409 (51.1%) were filled at the end of the study period. This low response was due to the nationwide lockdown that resulted in the partial closure of businesses including hospitals. [Table 1] shows the characteristics of the respondents. Doctors constituted 238 (58.1%) respondents while the others were nurses. The mean age of the respondents was 34 ± 7 years. While the length of practice ranged from 0 to 32 years, the median was five (IQR 2-9) years.
|Table 1: Characteristics of 409 healthcare workers evaluated for the knowledge, attitude and practices towards the COVID-19 pandemic at the Jos University Teaching Hospital in Nigeria in the months of April and May 2020|
Click here to view
Knowledge and Attitude
The mean COVID 19 knowledge score was 9.6 ± 1.2 with 337 (82.4%) respondents having good knowledge as assessed by correctly identifying the appropriate responses to 9 or more of the 12 questions [Table 2]. The majority; 345 (82.4%) respondents believed that COVID-19 will be controlled. Only 199 (48.6%) had gone to crowded places and 205 (50.1%) had worn face masks each time while out in the public in the two weeks preceding the survey. Half (205) respondents had attended to patients with cough and fever in the four weeks preceding the study. Two hundred and seventeen (53.0%) indicated that they would attend to patients with fever, cough and a positive travel history to an endemic region.
|Table 2: Knowledge, attitude and practice of COVID-19 among 409 healthcare workers evaluated at the Jos University Teaching Hospital, Nigeria in the months of April and May 2020|
Click here to view
Assessment of Hospital's Readiness for COVID-19 Treatment and Prevention
The majority of respondents opined that the units in the hospital where they worked had sanitizers (87.5%) and running water (75.7%). The majority of respondents (62.8%) had not been trained on infection prevention and control (IPC) since the outbreak of the pandemic. Only 95 (23.2%) had seen COVID-19 Standard Operating Procedures (SOP) displayed in the hospital. The use of the personal protective equipment (PPE) kit comprising the N-95 mask, face shield, gown, and shoes was seen by 194 (47.4%) respondents in recent times. A total of 290 (70.9%) revealed that the hospital had ventilators with the median number of functional ventilators being 4 (IQR 2-6). On the whole, 311 (76.0%) felt that their hospital was not adequately positioned to care for COVID-19 treatment and prevention.
Assessment of Personal Risk and Use of Prevention Methods
A total of 397 (97.0%) respondents felt they were at an increased risk of contracting COVID-19 relative to the general populace. Risk level was classed as mild in 84 (20.5%), moderate in 173 (42.3%), and severe in 140 (34.2%). Twelve respondents were not sure they were at risk of COVID-19. To curb this increased risk, the respondents utilized the following measures with each patient encounter: face mask in 281 (68.7%), gloves in 320 (78.2%), and use of hand sanitizers in 344 (84.1%). Frequent hand washing was utilized by 347 (84.8%), the daily wash of uniforms and ward coats by 182 (44.5%), daily cleaning of footwear by 130 (31.7%), and avoidance of taking home clothing and footwear worn in the hospital by 222 (54.2%).
| Discussion|| |
The COVID-19 pandemic has led to hundreds of thousand deaths worldwide. Being a novel viral disease, we sought to evaluate the knowledge and practice of doctors and nurses regarding the disease. This study had a response rate of 51.1% due to the nationwide lockdown that resulted in the partial closure of businesses including hospitals. The major finding of the study was that despite the majority of the sampled population having good knowledge of SARS-CoV 2 transmission and clinical features, their use of protective measures was not adequate for a respiratory infection. We also found that majority of the respondents thought they were at increased risk of contracting the virus as their hospital was not adequately prepared to treat patients with COVID-19 and prevent the transmission of the virus.
The majority of our respondents had good knowledge of SARS-CoV 2 transmission and its clinical features. This echoes the findings of Saqlain and colleagues who reported that 93% of Pakistani HCWs had good COVID-19 knowledge. However, the respondents in our study outperformed those in the studies from the United Arab Emirates (UAE), India, and Vietnam. In a web-based survey of 453 HCWs largely made up of physicians (30.2%) and medical students (29.6%), only 61% and 63.6% respectively had good knowledge of SARS-CoV 2 transmission and clinical features. Similarly, in a multi-center survey of 1562 Indian HCWs and students of health professions in Mumbai, India, Modi and his colleagues reported that only 71.2% had correct knowledge of COVID-19. In a related study conducted among 327 Vietnamese HCWs comprising physicians (13.1%), nurses (70.9%), pharmacists (12.8%), and technical workers (10%), Giao and co-workers reported that only 67.0% and 58.4% had correct knowledge regarding virus transmission and COVID-19 management respectively. The studies from UAE, India, and Vietnam involved students and technical workers while that from Pakistan like ours involved only physicians. This difference in the sample characteristics may be responsible for the disparity in the knowledge reported in these studies.
Studies on knowledge and attitude toward COVID-19 have not been restricted to HCWs. In a study of Chinese residents, 90% of the respondents had correct knowledge. Knowledge score in that study was associated with a lower likelihood of negative attitudes to preventive practices towards COVID-2019. Similarly, Abdelhafiz and colleagues reported that over 90% of the Egyptian public had good knowledge of transmission and clinical features of SARS-CoV 2.
Although many of our respondents perceived that they were at an increased risk of contracting the virus compared to the general population, this awareness did not impact their practices as nearly half of them still frequented crowded places beside the hospital. The US Centres for Disease Control and Prevention has advocated the need for physical distancing (staying at least six feet away from people) as a major way of preventing COVID-19. Physical distancing has been found to outperform the use of facial covering/masks in COVID-19 prevention in a recent meta-analysis of 172 observational studies across 16 countries and six continents. In as much as the HCWs are at risk of contracting the virus from patients, they may also transmit the infection to their patients if infected. The transmission of infection from HCWs to patients can largely be prevented by frequent hand washing under running water/the use of hand sanitizers and the use of facial masks or covering. The practice of handwashing/use of hand sanitizers among HCWs over time has varied between 40% and 96.1%.,, The use of handwashing/use of hand sanitizers by the respondents in our study was 84.8%. Should any of our respondents be infected with the virus, such an individual presents a clear danger of infecting the patients.
The majority of the respondents in this study felt that the hospital was not adequately suited for the prevention of virus transmission and management of COVID-19 patients. The use of PPE by HCWs in the hospital setting has been advocated for the prevention of transmission of infections from patients to HCWs. Majority of our HCWs were neither aware that their hospital had PPEs nor had they seen one in use. This is the stark reality of public hospitals in most of Nigeria [personal communication]. The correct use of PPE is essential to preventing the transmission of the virus to HCWs. Modi and co-workers demonstrated that less than half of HCWs correctly identified the right sequence of wearing the N95 mask. SOPs regarding COVID-19 were seen displayed by less than a quarter of our respondents while only a third had been trained in IPC since the outbreak of the infection. Lack of SOPs and inadequate training on infection control have been identified as reasons why transmission of infections occurs in the hospital.
Our study had some limitations that must be taken into consideration. We evaluated only doctors and nurses in a single tertiary hospital. Therefore, our findings cannot be generalized to all HCWs. Our study relied on the recall and opinions of the respondents and as such has the tendency to be subject to recall bias. Despite the foregoing, our study provides information that can be utilized in management policy formulation regarding outbreaks of epidemics/pandemics of respiratory infections.
In conclusion, despite having good knowledge of SARS-CoV 2 transmission and clinical features, the utilization of protective measures by HCWs in this study is unsatisfactory. The hospital needs to instill confidence in the HCWs of its ability to be able to care for patients with COVID-19 and prevent the transmission of the virus to HCWs. PPEs should be made available for HCWs when needed.
The authors wish to acknowledge the healthcare workers at the hospital for participating in the studies and the numerous physicians who assisted in collecting the data.
Declaration of Patient Consent
The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial Support and Sponsorship
Conflicts of Interest
There are no conflicts of interest.
| References|| |
Zhu N, Zhang D, Wang W, Li X, Yang B, Song J, et al
. China novel coronavirus investigating and research team. A novel coronavirus from patients with pneumonia in China, 2019. N Engl J Med 2020;382:727-33.
Zhu ZB, Zhong CK, Zhang KX, Dong C, Peng H, Xu T, et al
. Epidemic trend of corona virus disease 2019 (COVID-19) in mainland China. Chinese Med J 2020;54:E022.
Mizumoto K, Chowell G. Estimating risk for death from 2019 novel coronavirus disease, China, January-February 2020. Emerg Infect Dis 2020;26. doi: 10.3201/eid2606.200233.
Li Q, Guan X, Wu P, Wang X, Zhou L, Tong Y, et al
. Early Transmission dynamics in Wuhan, China, of Novel Coronavirus-infected pneumonia. N Engl J Med 2020;382:1199-207.
Epidemiology Working Group for NCIP Epidemic Response, Chinese Center for Disease Control and Prevention. The epidemiological characteristics of an outbreak of 2019 novel coronavirus diseases (COVID-19) in China.
Zhonghua Liu Xing Bing Xue Za Zhi 2020;41:145–51.
Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y, et al
. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: A descriptive study. Lancet 2020;395:507-13.
Zhong BL, Luo W, Li HM, Zhang QQ, Liu XG, Li WT, et al
. Knowledge, attitudes, and practices towards COVID-19 among Chinese residents during the rapid rise period of the COVID-19 outbreak: A quick online cross-sectional survey. Int J Biol Sci 2020;16:1745-52.
Saqlain M, Munir MM, Rehman Su, Gulzar A, Naz S, Ahmed Z, et al
. Knowledge, attitude, practice and perceived barriers among healthcare professionals regarding COVID-19: A cross-sectional survey from Pakistan. J Hosp Infect 2020;105:419-23.
Bhagavathula AS, Aldhaleei WA, Rahmani J, Mahabadi MA, Bandari DK. Knowledge and perceptions of COVID-19 among health care workers: Cross-sectional study. JMIR Public Health Surveill 2020;6:e19160.
D, Nair G, Uppe A, Modi J, Tuppekar B, Gharpure AS, et al
. COVID-19 awareness among healthcare students and professionals in Mumbai metropolitan region: A questionnaire-based survey. Cureus 2020;12:e7514.
Giao H, Thi N, Han N, Vo KN, Vo VT, Pham LA. Knowledge and attitude toward COVID 19 among healthcare workers at District 2 Hospital, Ho Chi Minh City. Asian Pac J Trop Med 2020;13:1-6.
Abdelhafiz AS, Mohammed Z, Ibrahim ME, Ziady HH, Alorabi M, Ayyad M, et al
. Knowledge, perceptions, and attitude of Egyptians towards the novel Coronavirus Disease (COVID-19). J Community Health 2020;45:881-90.
Chu DK, Akl EA, Duda S, Solo K, Yaacoub S, Schünemann HJ, et al
. Physical distancing, face masks, and eye protection to prevent person-to-person transmission of SARS-CoV-2 and COVID-19: A systematic review and meta-analysis. Lancet 2020;395:1973-87.
Erasmus V, Daha TJ, Brug H, Richardus JH, Behrendt MD, Vos MC, et al
. Systematic review of studies on compliance with hand hygiene guidelines in hospital care. Infect Control Hosp Epidemiol 2010;31:283–94.
Nour MO, Babilghith AO, Natto HA, Al-Amin FO, Alawneh SM. Knowledge, attitude and practices of healthcare providers towards MERS-CoV infection at Makkah hospitals, KSA. Int Res J Med Med Sci 2017;3:103–12.
[Table 1], [Table 2]