PSYCHOLOGICAL BURDEN OF COVID-19 PANDEMIC AND ITS ASSOCIATED FACTORS AMONG FRONTLINE HEALTHCARE WORKERS IN HOSPITALS IN OSUN STATE

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ABSTRACT
Healthcare workers are defined as all the people engaged in health activities whose primary intention is to improve health. They are exposure to long working hours, psychological distress. Over 100 healthcare workers have lost lives due covid-19, a tragedy to the world and a barrier to fight against the disease. Frontline health care workers experienced unprecedented levels of workload and pressure since the outbreak of coronavirus disease 2019 (COVID-19). It has been shown that the frontline health care workers experienced a high level of emotional stress, anxiety, depression during or even after the outbreak of the infectious disease. 
This is a cross sectional descriptive survey in which 270 respondents were selected using multistage sampling technique. Data collection tools used was a pretested questionable designed based on objectives, administered, collected and analyzed using SPSS version 23. Univariate and bivariate analysis were done appropriately, chi square was used to determine the association between
Majority (84.8%) had not test positive of corona virus, 50.7% had never had contact with a COVID 19 patients, about 119 of the respondents that had contact with COVID 19 patient. About 48.7% said they rarely have contact with COVID 19 patient, 38.7% said they sometimes do while 12.6% said they always have contact with COVID 19 patient.
More than half (53.3%) of the respondents had good preventive strategy while 46.7% had poor preventive strategy.  About 49.3% said family reaction was positive, 33% said neutral, 9.6% said it was negative while 8.1% didn’t know the kind of reaction given.the preventive strategy of psychological effect of COVID 19 on frontline healthcare workers. Majority of the respondents (80%) have enough rest after work, half of them (50%) visits psychologist when tensed due to COVID 19, majority (80.7%) of them make time for friends to ease work pressure, majority (86.7%) don’t drink, smoke or take pills to ease work pressure, about 61.1% of them engage in exercise to ease work pressure while majority (80.4%) don’t use sleeping pills when unable to sleep after work
Majority of the Frontline health workers had a good knowledge about Covid-19 (86.70%). Poor knowledge about Covid-19 were significant among Frontline healthcare workers who had low educational knowledge. Which shows that there is an association of respondents’ level of education and facility description and knowledge on COVID 19.
 This study shows that the Frontline healthcare workers doesn't have any psychological burdens during the outbreak of covid-19, hence, Frontline healthcare workers should be trained to improve their knowledge, more qualified Frontline healthcare workers should be recruited to improve healthcare services.




TABLE OF CONTENTS
Title Page
Declaration 
Dedication
Acknowledgement 
Acronyms 
Table of Contents
List of Tables 
List of Figures
Abstract

CHAPTER ONE: INTRODUCTION 
1.1 Background Study
1.2 Problem Statement
1.3 Justification 
1.4 Research Questions
1.5 General and Specific Objectives
1.6 Research Hypothesis 

CHAPTER TWO: LITERATURE REVIEW
2.1 History of Covid-19
2.2 Frontline healthcare workers’ knowledge and perception of covid-19, and willingness to work during the pandemic
2.3 The Psychological and social impact of corona virus: new perspectives of well-being
2.4 Psychological impact of the quarantine on healthcare workers
2.5 The impact of the covid-19 pandemic on the mental health of healthcare professionals
2.6 Mental health and psychosocial problems of medical health workers during the covid-19 pandemic
2.7 PTSD: post-traumatic stress disorder; who: world health organization
2.8 Mental health care for medical staff in china during the outbreak
2.9 The experiences of healthcare workers during the covid-19
2.10 Mental health and psychosocial support
2.11 Sanitation, hygiene and rest facilities for the healthcare workers
2.12 Managing mental health challenges faced by healthcare workers during covid-19 pandemic
2.12.1. Early support of challenges faced by healthcare workers during pandemic
2.12.2. After care support of challenges faced by healthcare workers during pandemic

CHAPTER THREE: METHODOLOGY
3.1 Study Location 
3.2 Study Design
3.3 Study Population 
3.3 Target Population 
3.5 Inclusion and Exclusion Criteria 
3.5.1 Inclusion Criterion 
3.5.2 Exclusion Criterion 
3.6 Sample Size Determination
3.7 Sample Technique 
3.8 Study Instrument 
3.9 Pre-testing of research instruments
3.10 Development of Study Instrument
3.11 Data Collection and Analysis
3.12 Outcome Measures 
3.13 Ethical Considerations 
3.14 Study Limitations

CHAPTER FOUR
4.0 Results

CHAPTER FIVE
5.0 Discussion

CHAPTER SIX
6.1 Conclusion
6.2 Recommendations 
REFERENCES
APPENDIX
Appendix i: Questionnaire
Appendix ii: Budget
Appendix iii: Ethical Approval from the Health Research Ethics Committee
Appendix iv: Letter of Introduction to the Chief Medical Directors




LIST OF TABLES
Table 1: Socio-demographic characteristics of respondents 
Table 1b: Respondents’ level of Education and facility description
Table 2: Knowledge of frontline Healthcare workers on COVID-19 pandemic
Table 3: Psychological pattern of frontline healthcare workers towards COVID-19
Table 4 Experience of COVID-19 prevention strategies among frontline healthcare
Table 5: Preventive strategy of psychological effect of COVID-19 on frontline Healthcare workers
Table 6:  Association between sociodemographic characteristics and respondent’s knowledge on COVID-19
Table 7: Association of respondents’ level of Education and facility description and knowledge on COVID -19
Table 8: Association between respondents’ knowledge on COVID-19 and experience of prevention strategy
Table 9:  Association between knowledge and psychological pattern of frontline healthcare workers towards COVID-19
Table 10: Association between knowledge and preventive strategy of psychological effect of COVID-19 on frontline Healthcare workers



LIST OF FIGURES
Figure 1: Summarized knowledge of frontline health care workers on COVID 19 pandemic
Figure 2: Organizers of training on COVID 19 in the last 3 months
Figure 3: Psychological pattern of frontline healthcare worker on COVID 19 pandemic
Figure 4: Frequency of contact with COVID 19 patient
Figure 5: Family reaction towards respondents as medical personnel during COVID 19 pandemic
Figure 6: Ways respondents look after their mental health
Figure 7: Summarized Experience of COVID 19 preventive strategies among frontline healthcare workers
Figure 8: Preventive strategy of psychological effect of COVID 19 on frontline healthcare workers





ACRONYMS
CHEW: Community Health Extension Workers
COVID-19: Corona Virus Disease 2019
EOC: Emergency Operation Centre
EVD: Ebola Virus Disease 
FHCWs: Frontline Healthcare Workers
HCWs: Healthcare Workers
HREC: Health Research Ethics Committees
LGA: Local Government Area
NCDC: Nigeria Centre for Disease Control 
PI: Psychological Intervention 
PPE: Personal Protective Equipment
PTSD: Post Traumatic Stress Disorder
SARS: Severe Acute Respiratory Syndrome 
WHO: World Health Organization  




CHAPTER ONE

1.1 BACKGROUND STUDY
Healthcare workers are defined as all the people engaged in health activities whose primary intention is to improve health. These include, nurses, midwifes, doctors, medical officers, senior house officers, pharmacists, laboratory scientists and specialists. Not all healthcare workers are at the frontline of covid-19 pandemic, the healthcare workers that are exposed to this viral disease are frontline healthcare workers because they are the one attending to the patient directly in one way or the other, they include, nurses, doctors, midwives, cleaners, drivers etc. They are exposure to long working hours, psychological distress and physical violence. Over 100 healthcare workers have lost lives due covid-19, a tragedy to the world and a barrier to fight against the disease. Frontline health care workers experienced unprecedented levels of workload and pressure since the outbreak of coronavirus disease 2019 (COVID-19). It has been shown that the frontline health care workers experienced a high level of emotional stress, anxiety, depression during or even after the outbreak of the infectious disease. (Lancee WJ and Maunder RG, Psychiatr Serv. 2008). 
During the outbreak of COVID-19, several studies aimed to detect the mental health of medical staff were also conducted, stating that the medical staff suffered varying degrees of insomnia, fear, stress, anxiety, depression, somatization, and obsessive-compulsive symptoms, indicating targeted strategies toward improving the mental health should be provided .
Adverse psychological outcomes among healthcare workers are usually determined by a variety of factors during an outbreak of infectious disease with high level of mortality, including uncertain quarantine durationetc. Despite remaining the crisis management personnel, the healthcare workers are not themselves immune to the psychological consequences due to                  covid-19. Among the healthcare workers, the frontline workers involved directly in handling these patients are at greater risk than other health care workers. The reasons for such adverse psychological outcomes in them range from excessive workload, work hours, inadequate personal protective equipment and feeling inadequate supported. 
Another important reason for such psychological burden is the infection rate among healthcare workers. When a healthcare worker gets infected, there is a reversal of role from healthcare worker to a patient which might lead to frustration, helplessness, adjustment issues, stigma and fear 
Frontline health workers have been faced with unprecedented demands both professionally and personally, in effort to manage a disease with unclear etiology and pathology and high mortality rate. Frontline healthcare workers are obliged to make difficult ethical decision and function professionally under conditions of fear for themselves and loved ones.

1.2 PROBLEM STATEMENT 
Frontline healthcare workers are faced with numerous challenges during the COVID-19 response . The major issues frontline healthcare workers face in this situation are the critical shortage of healthcare workers, beds, and medical supplies including personal protective equipment and, as reviews indicate, psychological changes and fears of infection among frontline healthcare workers. (S. Karger AG, Basel). 
Frontline workers showed excitability, irritability, unwillingness to rest and signs of psychological distress but refused any psychological help and stated that they did not have any problems.
Then there is another issue of stress and burnout. Virtually all workers on the frontline are working for long and exhausting hours, the resultant rise in levels of stress induced by fatigue are considerable. All the while, the ongoing stress of the situation leads to conflict between colleagues as multiple stress issues and individual personal issues are brought to the surface.

1.3 JUSTIFICATION OF THE STUDY 
Frontline healthcare workers are active change agents whose expertise has been shown to contribute to the protection of any given population against viral epidemics. Some mechanisms have however been developed by healthcare workers in these difficult settings, deriving from the perceived value of their work, sense of duty, social and spiritual support, and adequate preparedness. In the COVID-19 context, healthcare workers who are involved in the care of COVID-19 cases have shown higher likelihoods of depression, anxiety, insomnia and distress than other health workers. 
Frontline healthcare workers identified the need for increased psychosocial support, and adequate provision of material and financial support. Then, the need to identify the psychological burden among frontline healthcare workers will help reduce effect of this burden in the state and Nigeria as a whole. 

1.4 OBJECTIVES
1.4.1 GENERAL OBJECTIVE 
To determine the psychological burden of COVID-19 and its associated factors among healthcare workers in private and public hospitals Osogbo LGA, Osun state

1.4.2 SPECIFIC OBJECTIVES
To identify the psychological pattern of covid-19 among frontline health care worker in public and private hospitals in Osun state
To determinethe experiences of frontline healthcare workers that are involved in the covid-19 response.
To determine the preventive practice of psychological effect of covid-19 on frontline healthcare workers in public and private hospital in Osun state.

1.5 RESEARCH QUESTIONS
What are the psychological effects of Covid-19 Pandemic among frontline healthcare workers?
What are their experiences towards taking care of covid-19 patients?
What are the preventive strategy of psychological effect of COVID 19 on frontline healthcare workers.

1.6 RESEARCH HYPOTHESIS
NULL HYPOTHESIS H0: There is no significant relationship between knowledge of frontline healthcare workers on covid-19 pandemic and psychological burden of the frontline healthcare workers
ALTERNATE HYPOTHESIS HA: There is no significant relationship between knowledge of frontline healthcare workers on covid-19 pandemic and psychological burden of the frontline healthcare workers

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