Abstract
Background
COVID-19 is highly contagious and healthcare workers are at a higher risk of contracting the disease since they are at the frontline in an effort to control and manage it. Inadequate knowledge on COVID-19 and poor practices and preventive measures among healthcare workers may lead to the rapid spread of the disease thereby limiting the ability to manage the COVID-19 pandemic. The objective of this study was to assess the level of knowledge, risk perception, and preparedness for COVID- 19 among healthcare workers in Kenya.
Methods
A cross-sectional study was conducted from December 2020 to January 2021 to assess healthcare workers’ level of knowledge, perception of risk and preparedness to handle COVID-19 in Kenya. A link to an online self-administered questionnaire hosted on the Research Electronic Data Capture application (REDCap) was disseminated to health workers across the country via text messages, emails and social media. We collected data on demographics, knowledge, perception of risk and preparedness for COVID-19 and vaccine acceptance. Data collected in REDCap was then transferred to SPSS version 20 for analysis. Bivariate correlation analyses were used to determine associations between variables. P-value of <0.05 was considered statistically significant.
Results
A total of 997 participants including doctors (34%), nurses (26%), clinical officers (21%) and lab technologists (12%) were enrolled in the study. About half (53%) of the participants were female. The mean age was 36.54 years (SD = 8.31) and 46% of the participants were aged between 31-40years. About half (55%) of participants worked in county facilities and 64% of the respondents had at least bachelor’s degree. The overall knowledge score of health workers for COVID-19 was 80%. Most of the health workers (89%) perceived that they were at high risk of infection. Seventy-two percent of the participants felt that they were either partially or fully prepared to handle patients with COVID-19. Overall, 71% of all health workers would take a vaccine if provided free by the government.
Conclusion
Knowledge of health workers on transmission, clinical manifestations and risk factors for development of severe COVID-19 was good. Majority of the health workers perceived the risk of infection with COVID-19 as high and a significant number felt that they were not fully prepared to handle the pandemic.
Table of Contents
DECLARATION
LIST OF ACRONYMS iii
ACKNOWLEDGEMENTS iv
LIST OF TABLES vii
LIST OF FIGURES viii
Abstract ix
CHAPTER ONE
1.0 INTRODUCTION
CHAPTER TWO
2.0 LITERATURE REVIEW
2.1 Introduction 3
2.2 Knowledge of HCWs on COVID-19 3
2.3 Preparedness of HCWs for COVID-19 3
2.4 Risk perceptions and attitude of HCWs towards COVID-19 4
2.5 Conceptual Framework 5
2.6 Rationale 5
2.7 Study questions 6
2.8 Main objective 6
2.9 Specific objectives 6
CHAPTER THREE
3.0 METHODOLOGY
3.1 Study design and period 7
3.2 Study site 7
3.3 Study population 7
3.3.1 Inclusion criteria 7
3.3.2 Exclusion criteria 7
3.3.3 Sample Size 7
3.3.4 Sampling technique and Enrolment strategy 8
3.3.5 Variables 8
3.4 Study Procedure 8
3.4.1 Data Collection 8
3.5 Pilot survey, validity and reliability 9
3.6 Data management 9
3.7 Ethical considerations 9
3.7.1 COVID-19 Containment Measures 10
3.8 Study result dissemination plan 10
CHAPTER FOUR
4.0 RESULTS
4.1 Study participants Characteristics 11
4.2 Level of knowledge of HCWs for COVID-19 15
4.3 Perception of risk of infection with COVID-19 for HCWs 17
4.4 Concerns of Health Workers 19
4.5 Preparedness for COVID-19 among HCWs 19
4.6 Facilities’ preparedness for COVID-19 25
4.7 Acceptability of COVID-19 vaccine among health professions 25
4.8 Reasons for declining a COVID-19 vaccine 26
CHAPTER FIVE
5.0 DISCUSSION
5.1 Study limitations 30
CONCLUSION 30
References 31
Study Questionnaire 34
Online Consent Information Form 40
Approval Letter 42
LIST OF TABLES
Table 1 – Respondents’ Characteristics 11
Table 2 – Comparison of Knowledge score among HCWs 15
Table 3 – HCWs’ Perception of level of risk for COVID-19… 17
Table 4 – Perception of the Level of Preparedness for COVID-19 against healthcare cadre 20
Table 5 – Perception of the Level of Preparedness for COVID-19 against institution… 22
Table 6 – Perception of the Level of Preparedness for COVID-19 against location 23
Table 7 – Vaccinee Acceptability among HCWs 26
LIST OF FIGURES
Figure 1 – Conceptual Frame on Preparedness for Covid-19 among healthcare workers… 5
Figure 2 – A Graph Showing Respondents' Gender by Profession… 13
Figure 3 – Respondents' Distribution by Age Group… 13
Figure 4 – Distribution of respondents by place of work… 14
Figure 5 – HCWs' Knowledge on COVID-19 clinical manifestations 16
Figure 6 – Vaccine Acceptability per Cadre… 25
LIST OF ACRONYMS
CoV - Coronavirus
SARS - Severe Acute Respiratory Syndrome MERS - Middle East Respiratory Syndrome ACE2 - Angiotensin-Converting Enzyme 2 WHO - World Health Organization
COVID-19 - Coronavirus Disease 2019 2019-nCoV - 2019 novel Coronavirus HCW - Health Care Workers
PPE - Personal Protective Equipment
IPC - Infection Prevention Control
MoH - Ministry of Health
UoN - University of Nairobi
KNH - Kenyatta National Hospital
UNITID - University of Nairobi Institute of Tropical and Infectious Diseases REDCap - Research Electronic Data Capture
CHAPTER ONE
1.0 INTRODUCTION
Coronaviruses are infectious disease-causing viruses that range from the common cold to Severe Acute Respiratory Syndrome (SARS). There are five genera of CoV and they include, β, α, ð and γ-CoV. While birds are found to be infected by ð and γ-CoV, the mammals can be infected by both α and β-CoV. Previously, six CoV were found to affect humans. These viruses had low pathogenicity hence similar to common cold since they presented with mild respiratory symptoms (Guo, Y. R.,2020).
About 8,000 cases and 916 deaths were recorded during a SARS outbreak in 2002-2003 while between 2012 and August, 2017, the Middle East respiratory syndrome (MERS) resulted to at least 2066 confirmed cases and 720 deaths (Yin, Y., & Wunderink, R. G., 2017). MERS-CoV and SARS-CoV are two of the already known β-CoV which lead to respiratory infections that are severe and fatal. In December 2019, in Wuhan, China, a number of cases of pneumonia of unknown origin were reported and a new strain of β-CoV was soon after identified as the cause (Yin, Y., & Wunderink, R. G., 2017). The genome sequence of this new β- coronavirus (SARS-CoV-2) that was isolated from a patient in a short time on 7 January 2020 was found to be 96.2% identical to SARS-CoV. It is thought that for humans to be infected, SARS-CoV-2 might have originated from bats to humans through intermediate hosts that are not known yet (Guo, Y. R.,2020). Initially, on 12 January 2020, the coronavirus disease was named as 2019 novel coronavirus (2019-nCoV), which later on 11 February 2020, was officially named as coronavirus disease 2019 (COVID-19) by the WHO (Guo, Y. R.,2020). To prevent COVID-19 from rapidly spreading, WHO asked for a united effort of all countries as it declared on 30 January 2020 this disease to be a Public Health Emergency of International Concern (PHEIC) (WHO,2020).
The COVID-19 pandemic is spreading at a very high rate. 210 countries had been affected by this virus as of 16 April 2020 and thereby infecting 1,991,562 people out of the world population (WHO, 2020). As of that date, 130,885 deaths were recorded. Italy, the USA, Spain, UK, France, Turkey, Germany, and Belgium were some of the countries in the world that had been most severely affected by COVID-19 (WHO, 2020). 52 countries in Africa had been affected by April 14, 2020, registering a total of 11,853COVID-19 cases that were confirmed with 550 deaths being reported (WHO, 2020). As of 16 April 2020, there were 228 confirmed cases of COVID-19 in Kenya with 9 deaths being reported by the Ministry of Health (MoH) of Kenya.
Transmission of COVID-19 from human to human occurs through direct contact, droplets (Borak, J., 2020) and this disease has an incubation period of 2 days to 2 weeks. For control of the COVID-19 infection, social distancing, wearing of masks, cleaning of hands etc., are some of the preventive measures that have been emphasized by WHO.
COVID-19 has caused widespread panic and fear across the globe. Perception, knowledge, and attitude among other factors have played a role in causing this panic and fear in people. Pure emotion of fear represents an individual’s removal from an immediate risk position (Harper, C. A., et al. (2020). Healthcare workers are at a higher risk of exposure since some of the patients handled may be infected, some without any symptoms (Chen, X., et al. 2020). At the end of January, both the WHO and the CDC, in order to prevent and control this disease published vital information for use by HCWs (Bhagavathula, A., et al. 2020).
A cross-sectional study survey by Bhagavathula, A., et al. (2020) reported that sessions meant for training and materials containing information on COVID-19 were written and put online in different languages, raising awareness, preparedness training of HCWs and they are some of the strategies employed by the WHO to strengthen prevention and curb COVID-19. This disease has endangered both the life of the patients and HCWs and as of April 12, 2020, WHO had reported that there were a total of 22,000 HCWs infected with COVID-19 in 52 countries (WHO, 2020).
A cross-sectional study where data was collected by way of conducting online survey using REDCap application was utilized. The data collected was analyzed and then interpreted to provide an understanding of the research study on the knowledge, perceived risk and preparedness of HCWs on COVID-19 across the country.
The study sought to collect primary quantitative data on the healthcare workers’ knowledge on the origin, clinical manifestation, transmission, treatment and fatality of COVID-19. Data was also collected on risk perceptions of healthcare workers and it involved their perceptions on the risk of infection for instance on healthcare workers and on average Kenyans, their concerns on contacting and infecting their family members, and their concerns on working with colleagues that have recovered from COVID-19. The benefits that arise from this research study include an increase in confidence by HCWs on response to emergencies of diseases such as this in the future as well as improved competence of the HCWs in responding to diseases that are highly communicable. This will be as a result of the information available, increased training and adequacy of equipment to be used during such incidents.
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