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 Table of Contents  
ORIGINAL ARTICLE
Year : 2020  |  Volume : 4  |  Issue : 3  |  Page : 109-114

Knowledge, attitude and practice (KAP) for preventing the coronavirus (COVID19) pandemic among libyan health care workers


1 Department of Public Health, Faculty of Medical Technology, Zawia University, Zawia, Libya
2 Department of Medical Laboratories, Faculty of Medical Technology, Zawia University, Zawia, Libya
3 Department of Nutrition, Faculty of Medical Technology, Zawia University, Zawia, Libya
4 Department of Biomedicine, Faculty of Dentistry, Zawia University, Zawia, Libya

Date of Submission24-Jun-2020
Date of Acceptance23-Aug-2020
Date of Web Publication21-Sep-2020

Correspondence Address:
Dr. Nada A B. Hweissa
Department of Public Health, Faculty of Medical Technology, Zawia University, Zawia
Libya
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/LJMS.LJMS_54_20

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  Abstract 


Background/Aim: The coronavirus disease 2019 (COVID-19) pandemic, also referred to as the coronavirus (CoV) pandemic, is an ongoing outbreak of COVID-19. It is caused by severe acute respiratory syndrome CoV 2. Health-care workers (HCWs) are at amplified risk of infection of CoV due to the nature of their work. This study aims to evaluate the knowledge, attitude, and practice toward (COVID-19) among Libyan HCWs. Materials and Methods: A cross-sectional survey was carried out from the 5th until the 15th of April 2020; data were collected through an online questionnaire. The study sample was not restricted to specific cities; any Libyan HCW could join. The 318 participants were Libyan residents from the various cities who had completed the online questionnaire. Results: The majority of participants were from the capital Tripoli (34.9%), Zawia (32.4%), and Benghazi (9.1%). More modest rates of responding HCWs were divided among 27 other Libyan cities. Of the participants, 79.9% were positive they have sufficient information about COVID-19, and 69.8% were following updates regarding the outbreak. Their main sources of information were health-care providers (33.3%), social media (30.2%), and journal articles (29.2%). Conclusion: Most of the Libyan HCWs had good knowledge for virus, and the knowledge scores were significantly associated with the age difference. In addition, they had a positive attitude for COVID-19. The findings will assist authorities to establish the essential educational programs to provide advanced learning by providing necessary recommendations and deliver the best practice to control the pandemic. Essentially, these procedures will ensure their health and safety.

Keywords: Attitude, coronavirus disease 2019, health-care workers, knowledge, Libya, practice


How to cite this article:
B. Hweissa NA, Shawesh FA, Krema SO, Mansour AA. Knowledge, attitude and practice (KAP) for preventing the coronavirus (COVID19) pandemic among libyan health care workers. Libyan J Med Sci 2020;4:109-14

How to cite this URL:
B. Hweissa NA, Shawesh FA, Krema SO, Mansour AA. Knowledge, attitude and practice (KAP) for preventing the coronavirus (COVID19) pandemic among libyan health care workers. Libyan J Med Sci [serial online] 2020 [cited 2020 Oct 22];4:109-14. Available from: https://www.ljmsonline.com/text.asp?2020/4/3/109/295615




  Introduction Top


Coronaviruses are a large group of common viruses accountable for several system infections in different animals. In humans, it chiefly causes respiratory tract infections.[1],[2] The examples on previous infections of the human respiratory tract include severe acute respiratory syndrome-coronavirus (SARS-CoV) in 2003 and middle east respiratory syndrome-CoV (MERS-CoV) in 2015, both of which are similar to the novel CoV.[3] In December 2019, Chinese authorities reported the several cases of pneumonia of unknown etiology in Wuhan, Hubei province, China.[4] Severe acute respiratory infection symptoms occurred in the early stages of this pneumonia, with some patients rapidly developing acute respiratory distress syndrome, acute respiratory failure, and other serious complications.[2] In January, the Chinese Center for the Disease Control and Prevention (CDC) identified a novel CoV from the throat swab sample of a patient and was subsequently named 2019-nCoV by the WHO. Its highly infective nature allowed the disease to spread rapidly, and the WHO soon proclaimed it as a public health emergency of international concern. As of March 2020, the WHO declared the outbreak to be a pandemic.[3]

According to the WHO, the most common symptoms of COVID-19 are mild and 80% of patients recovered without medical intervention. These symptoms comprise fever, dry cough, and fatigue. Other less common and more serious symptoms, that are usually begin steadily, include body aches and pains, nasal congestion, headache, conjunctivitis, sore throat, diarrhea, loss of taste or smell, skin rash, and discoloration of fingers or toes. Roughly, 20% of infected cases had a severe illness and showed shortness of breath, septic shock and multi-organ failure, and almost 2% of cases can be fatal.[3] At present, no effective treatment of COVID-19 has been found; however, several potential drug candidates have been proposed as a supportive treatment.[5],[6]

The recommendations placed for facing the pandemic control the spread of infection. The most effective prevention method is avoiding, or at least limiting, exposure to the virus by washing hands with soap and water, using face masks, staying away from crowded places, and isolation of both confirmed as well as suspected cases.[3],[7] COVID-19 primarily spreads from the respiratory tract via droplets and respiratory secretions, through close or direct contact. In addition, the transmission may also occur by touching a surface that the virus is on.[7] Initially, transmission occurs among people in close contacted with patients or carriers.[5] Older people, and those with chronic problems such as high blood pressure, heart diseases, lung problems, diabetes, or cancer, are at a greater risk of COVID-19 infection. They have a higher risk of severe symptoms, too.[3]

Besides, health-care workers (HCWs) are at amplified risk of infection due to the nature of their work. Furthermore, they are a source of transmission to the public. Infection of HCWs was the most common route of transmission in MERS-CoV cases.[8],[9] Data from China's National Health Commission indicate that over 3300 HCWs were infected as of early March, while 20% of responding HCWs in Italy became sick, and some have died.[10] Several previous studies indicated that HCWs revealed poor knowledge and attitude toward both MERS-CoV and SARS-CoV.[11] The protection of HCWs is a must to ensure their own health, as well as the safety of their patients, their families, and the wider community. As the outbreak continues to spread worldwide, it is vital to assess HCWs' knowledge, attitude, and practice (KAP) toward COVID-19. Hence, HCWs' awareness and knowledge must be raised. The findings will assist the authorities to establish the essential educational programs to provide advanced learning by providing necessary recommendations and deliver the best practice to control the pandemic. Essentially, these procedures will ensure their health and safety.

A study in Vietnam assessed the knowledge of several HCWs at District 2 Hospital in Ho Chi Minh City. The present study found that they had good knowledge and a positive attitude. Approximately two-thirds of them were familiar with the mode of transmission, the isolation period and treatment. In addition, many HCWs held a positive attitude regarding the risk of personal and family members getting the illness. Still, there was a negative correlation between knowledge scores and attitude scores. Moreover, HCWs predominately used social media to inform themselves about COVID-19.[11] The current study aims to evaluate Libyan HCWs' KAP toward COVID-19.


  Materials and Methods Top


Study population and data collection

A cross-sectional survey was conveyed from the 5th until the 15th of April 2020. Due to quarantine at that time, data were collected through an online questionnaire. Participating HCWs incorporated physicians, pharmacists, dentists, technicians, and nurses. The study sample was not restricted to specific cities; any Libyan HCW could join. The questionnaire was designed and adapted according to previous studies amid HCWs Vietnamese and Chinese HCWs to assess KAP toward COVID-19 in January and March 2020, respectively.[11],[12] Some elements were modified to be compatible with the Libyan population.

The questionnaire consisted of two parts. The first contained the demographic characteristics of participants, while the second covered the KAP measures. Demographic variables included age, gender, marital status, occupation, level of education, years of experience, and the sector of employment. KAP measurements included a total of thirty questions, divided on three groups. The first nine questions focused on symptoms, transmission, prevention, and control of the disease. The next ten questions regarded the final control of COVID-19, presumptions on the public's awareness, trust in the government's ability to control the outbreak, and the effectiveness of quarantine measures. Finally, the last eleven questions centred around the respondents' practices and behaviours toward COVID-19. These inquiries considered the use of vitamins, following a healthy diet, wearing face masks and gloves, washing hands using soap or rubbing with alcohol, staying away from others, avoiding shaking hands, and touching the face. Proceeding to work and recently visiting crowded places were also included. Most of the questions in the KAP sections were closed questions. To calculate the total scores for KAP, correct answer was assigned 1 point and no/unknown was assigned 0 point.

Content validity and reliability tests were carried out to assess the questionnaire in terms of feasibility, readability, consistency of style and formatting, and clarity of the language used. Content validity was checked with the assistance of a public health expert and epidemiologist. The questionnaire distributed across various official groups and pages on different social media platforms, and piloted on a sample of 35 participants from the target population to determine the level of difficulty in answering the questions and the time needed for the administration. Those participants were the first 35 HCWs who agreed to be involved in the study. They were then excluded from the actual study.

Statistical analysis

Data collected from the pilot survey were analyzed using the Statistical Package for the Social Sciences (SPSS), version 22, to test the internal consistency of the questionnaire, based on the Cronbach's alpha coefficient. The Cronbach's alpha value for the closed questions of KAP scale was 0.69, which is a sufficient measure of reliability or internal consistency of an instrument.[13] The collected data were entered into a computer and analyzed using IBM SPSS version 22 for computer-assisted analysis. The independent variables for this study were gender, age, marital status, level of education, occupation, years of experience, and sector of employment. HCWs' KAP toward COVID-19 were the dependent variables. As a preliminary data analysis, descriptive statistical analysis was conducted, to assess the demographic characteristics of the respondents. Furthermore, frequencies were implemented to get the percentage of correct answers regarding the disease. Analysis of variance (ANOVA) was then applied to examine the relationship between demographic factors and KAP of HCWs toward COVID-19.

Ethical consideration

The ethical approval was obtained from the Libyan National Committee for Biosafety and Bioethics, the Ministry of Higher Education and Scientific Research.


  Results Top


A total of 318 respondents completed the online questionnaire. These respondents were Libyan residents from the various cities. The majority of participants were from the capital Tripoli (34.9%), Zawia (32.4%), and Benghazi (9.1%). More modest rates of responding HCWs were divided among 27 other Libyan cities. Other demographic characteristics are displayed in [Table 1]. Of the participants, 79.9% were positive they have sufficient information about COVID-19, and 69.8% were following updates regarding the outbreak. The main sources of these updates were health-care providers (33.3%), social media (30.2%), and journal articles (29.2%).
Table 1: Demographic characteristics of health-care respondents (n=318)

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[Table 2] demonstrates the good knowledge of Libyan HCWs about COVID-19. Nearly 96.2% of respondents could recognize the main clinical symptoms of COVID-19, while 80.5% were sure that the disease is unlike the common cold. Besides, more than 98% were aware of the disease transmission routes and were also confident that the isolation and treatment of infected individuals are the most effective ways to reduce the spreading of the virus. Moreover, HCWs were familiar with the disease high-risk groups, too.
Table 2: Knowledge of health-care workers toward Coronavirus disease 2019

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The results of questions related to the attitude of HCWs are summarized in [Table 3]. Over 80% of participants were worried about being infected with COVID-19, though only 83% said they would seek help if they show any symptoms of COVID-19. Interestingly, around 30% stated that they would not get the vaccine if it were available. Furthermore, 25.5% of respondents believe that the available information on COVID-19 in the Libyan society is sufficient to avoid the prevalence of the disease. Nevertheless, only 9.1% trust that the governmental institutions in Libya can control the outbreak.
Table 3: Attitude of health-care workers toward Coronavirus disease 2019

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The findings related to HCWs' practice are illustrated in [Table 4]. Of the participated HCWs, 39.6% were taking care of themselves using vitamins and supplements to avoid getting infected with the COVID-19. Similarly, 69.5% were eating healthy food even during their duties. Nevertheless, only 30% and 26% of participants were wearing face masks and gloves, respectively. The other answers elucidate that most of the participants use several preventive measures, such as washing hands with soap, rubbing hands with alcohol, staying away from others, and avoiding touching the face. Further, 41.5% are still involved in their works and only 26.7% mentioned that they had gone to a crowded place.
Table 4: Practice of health-care workers toward Coronavirus disease 2019

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The demographic variances in HCWs' KAP scores for COVID-19 were identified using ANOVA [Table 5], [Table 6], [Table 7]. As evident in [Table 5], knowledge scores were significantly associated with the age difference. Older HCWs had significantly higher knowledge scores in regards of the disease symptoms, transmission, prevention, and control. In addition, public-sector workers had a considerably higher knowledge score for COVID-19 in comparison with those at the private-sector. Moreover, health-care providers with over 10 years of experience proved better knowledge score for COVID-19 to other groups. The attitude of HCWs toward COVID-19 and their demographic characteristics were also identified using ANOVA. In contrast to the knowledge scores, [Table 6] does not show a notable relationship between attitudes toward the disease and demographic characteristics. Correspondingly, ANOVA was also performed to identify the relationship between the practice of HCWs and their demographic characteristics [Table 7]. As evident in the table, females, older age, dentists, and those with marital status as separate had higher practice scores compared to others.
Table 5: Analysis of variance showing respondents' demographic predictors of coronavirus disease 2019 knowledge

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Table 6: Analysis of variance showing respondents' demographic predictors of coronavirus disease 2019 attitude

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Table 7: Analysis of variance showing respondents' demographic predictors of coronavirus disease 2019 practice

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  Discussion Top


As far as we know, this study is the first of its kind to be conducted in Libya. COVID-19 is the most widespread respiratory disease across the world. Among the healthy population, HCWs are considered to be at a heightened risk of infection. As a result, investigating their KAP toward the pandemic is vital.

The findings of this study showed that the majority of HCWs manifested high knowledge regarding the main clinical symptoms of COVID-19, while a large percentage of them were sure that the disease is unlike the common cold. Besides, almost all of the HCWs were aware of the transmission routes and were also confident that the isolation of infected individuals is the most effective way to reduce the spread of the virus. HCWs were familiar with high-risk groups, too. All of these conclusions are much in line with a similar Vietnamese KAP study.[11] Notwithstanding, this study perceived that the main sources of information were health-care providers, social media, and journal articles. This contrasts to the results in Vietnam, where social media was the main source HCWs obtained their knowledge from. The Libyan Ministry of Health and the National CDC of Libya should consider providing HCWs with reliable and up-to-the-minute information on the matter to further raise their consciousness. Two central examples of this include sharing electronic reports and newly released research on the ministry's and/or CDC's websites.

Furthermore, respondents believe that the information on COVID-19 available to the Libyan society is sufficient to avoid the prevalence of the disease, yet only 9.1% of them trust that Libyan governmental institutions can control the outbreak. A contradictory pattern of results was obtained in a similar Chinese survey, which found that nearly all of the respondents were confident that China can win the battle against COVID-19, while an insignificant number of them were not.[12]

From the short review above, key findings emerged that of the participated HCWs, 39.6% were taking care of themselves through the consumption of vitamins and other dietary supplements to avoid COVID-19 infection. Following, others were ensuring eating healthy food, even during their duty. Nevertheless, little of participants protected themselves using face masks and gloves. Together, the present findings confirm that most HCWs do use several preventive measures, including washing hands by soap, rubbing hands with alcohol, staying away from others, and avoiding touching the face. Further, from these results, it is explicit that 41.5% of HCWs are still involved in their work, while only 26.7% mentioned that they had gone to a crowded place. Similar conclusions were reached by Zhong et al., where they stated that the vast majority of the participants had not been to any crowded place and wore masks when going out.[12]

Knowledge scores were significantly associated with age. Older HCWs had much higher knowledge scores in terms of COVID-19 symptoms, transmission, prevention, and control. In addition, those working at a public sector also had considerably higher knowledge scores for COVID-19 in comparison with private sector workers. Moreover, health-care providers with more than 10 years of experience had a significantly better knowledge score for COVID-19 than other groups. Other studies found correlations between HCWs' knowledge scores and gender, occupation, and marital status.[11],[12] Contrary to expectations, disease knowledge scores did not significantly correlate with HCWs' attitudes and their demographic characteristics. This outcome is antithetical to that of previous literature, where strong correlations were detected.[11],[12]


  Conclusion Top


This study emphasizes many procedures to control COVID-19 infection. In the meantime, the Libyan government should develop both the quantity and quality of health services. In terms of sources information, it is important that the Libyan government consider establishing specific channels or website to provide HCWs with correct and updated information, issues, and modernise materials about this infectious disease.

Acknowledgment

The authors are gratefully pleased and thankful for all the Libyan HCWs for their cooperation and contribution to this work.

Financial support and sponsorship

Self-supported.

Conflicts of interest

There are no conflicts of interest.



 
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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.  Back to cited text no. 12
    
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  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7]



 

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