|Year : 2021 | Volume
| Issue : 3 | Page : 105-110
Perceptions and practices of health care professionals regarding coronavirus disease-19 pandemic: An online survey from two developing regions
Khawla F Ali1, Najat Buzaid2, Momna Basher3, Tawfeek A Bisheya4, Khadija A Hafidh5, Salem A Beshyah3
1 Department of Medicine, Royal College of Surgeons in Ireland Medical University of Bahrain, Adliya, Bahrain
2 Department of Medicine, Faculty of Medicine, University of Benghazi, Benghazi, Libya
3 Department of Medicine, Dubai Medical College, Dubai, United Arab Emirates
4 Department of Medicine, Faculty of Medicine, University of Tripoli, Tripoli, Libya
5 Department of Medicine, Dubai Medical College, Dubai; Department of Medicine, Rashid Hospital, DHA, Dubai, United Arab Emirates
|Date of Submission||01-Aug-2021|
|Date of Acceptance||13-Aug-2021|
|Date of Web Publication||11-Oct-2021|
Dr. Khadija A Hafidh
Department of Medicine, Dubai Medical College for Girls, Dubai
United Arab Emirates
Source of Support: None, Conflict of Interest: None
Background/Aims: Healthcare professionals (HCPs) are among the frontlines of the battle against the Coronavirus Disease-2019 (COVID-19) pandemic. Adequate knowledge of prevention and treatment practices, alongside a positive and forward attitude, are all essential for the success of the defense against COVID-19. We aimed to scope the knowledge, attitude, and practices of HCPs toward the COVID-19 pandemic at its peak time from 2 developing regions: the Middle East and North Africa (MENA). Materials and Methods: We utilized an online, electronic survey consisting of a multiple-choice questionnaire including three domains: Knowledge, attitudes, and practices, targeting a convenience sample of HCPs from the MENA region. Results: Three hundred and seventy-four respondents were included in the analysis; 68.7% resided and practiced in the Middle East, while 31.3% were from North Africa. The majority (71.2%) had postgraduate degrees and were either hospital or non-hospital doctors. Regarding basic knowledge, the majority recognized the main clinical symptoms of COVID-19 and that there was no effective antiviral treatment at the time. The majority also recognized the role of supportive measures, social distancing, isolation, and treating those infected as effective ways to reduce the spread of the virus. In addition, respondents reported that through a general curfew, social distancing was either very effective (65.8%) or effective (31.9%). Respondents were mainly worried about the health of their family members, the risk of contracting the coronavirus, and the economic situation of their family. Two-thirds considered the government's reaction to the current pandemic appropriate, while about one-fifth (21.2%) reported it somewhat insufficient. However, high levels of confidence were reported in countries' abilities to control the pandemic successfully. Regarding practices, 18.5% reported having been too crowded recently, and 16.5% admitted having not worn a mask when leaving the house. Preventative measures varied widely; the best was reported for washing hands more frequently than before (80.3%), while the worst was for the likelihood of informing people around an individual if he/she developed symptoms of sickness (56.1%). Conclusions: HCPs exhibited a reasonably high level of basic knowledge about the COVID-19 pandemic in its early months. Despite a reportedly positive attitude toward the preventative measures, these were not matched by equally strict individual behaviors.
Keywords: Coronavirus disease-19, perceptions, knowledge, practices, health care professionals, hospital doctors, nonhospital doctors, pandemic, survey, developing regions, Middle East, Africa
|How to cite this article:|
Ali KF, Buzaid N, Basher M, Bisheya TA, Hafidh KA, Beshyah SA. Perceptions and practices of health care professionals regarding coronavirus disease-19 pandemic: An online survey from two developing regions. Libyan J Med Sci 2021;5:105-10
|How to cite this URL:|
Ali KF, Buzaid N, Basher M, Bisheya TA, Hafidh KA, Beshyah SA. Perceptions and practices of health care professionals regarding coronavirus disease-19 pandemic: An online survey from two developing regions. Libyan J Med Sci [serial online] 2021 [cited 2021 Dec 5];5:105-10. Available from: https://www.ljmsonline.com/text.asp?2021/5/3/105/328087
| Introduction|| |
Coronavirus disease-2019 (COVID-19), an emerging disease first identified in 2019, has become a major global pandemic, claiming over 4 million lives as of August 2021. With its unprecedented rates of spread and fatality, extreme worldwide measures were implemented to control its rapid spread. Such measures included country-wide lockdowns, significant remodeling in the delivery of educational, healthcare, and public services, and tremendous efforts to raise public awareness. Awareness of the essential and fundamental health prevention measures has been crucial in reducing viral transmission, with erroneous practices significantly increasing transmission and death. The latter being especially important amongst those who teach and exemplify these measures, namely the healthcare workers.
Healthcare workers found themselves at the frontline of the battle against COVID-19. Adequate knowledge on prevention and treatment measures, alongside a positive and forward attitude during the downpour, has been essential for the successful defense against COVID-19. Measures such as enhancing workers' ability to avoid the risk of self-infection, decrease mortality, permit them to provide adequate medical services in this pandemic, and serve as role models for the rest of the population. On the other hand, erroneous health worker practices in prevention or treatment can directly increase the spread risk. As a result, matters are complicated further as far as the chain of infection is concerned. Furthermore, varieties of treatment options for COVID-19 infection exist. These include oxygen therapy, anti-inflammatory, antiviral drugs, antibodies, and assisted ventilation; their indications depend on disease severity. In order to achieve proper health care, health care workers should remain updated regarding new management modalities and new emerging strains of COVID-19 disease.
Therefore, this study aimed to investigate healthcare professionals' (HCPs) knowledge, attitudes, and practices toward COVID-19 from 2 developing regions: The Middle East and North Africa (MENA). The study is particularly relevant as it was conducted during the prime time of COVID-19 uncertainty when the outbreak was on a rocketing climb and with no end in sight.
| Materials and Methods|| |
A cross-sectional electronic questionnaire-based study was conducted between April and May 2020. Survey Monkey® (SVMK Inc., San Mateo, California, USA) was used for the creation, dissemination, and analysis of the questionnaire. The questionnaire was electronically sent to a convenience sample of physicians available on the authors' databases of medical contacts. The initial invitation email explained the rationale of the study. Twice weekly reminders were sent to non-responders and partial responders.
The questions were developed to cover the study's objectives. Some of the themes and contents were inspired by some of the early rapid reports from the index country. They were constructed in three domains to address the respondents' knowledge, attitudes, and personal practices concerning the coronavirus pandemic [Supplementary Material - Appendix 1]. An online sample of HCPs was recruited through the authors' networks with residents and social media in the region. Since the questions were sent to a large pool, additional questions were used to characterize the demographic and professional profiles of the respondents as described before. The knowledge questionnaire consisted of 12 questions regarding the clinical characteristics and prevention of COVID-19. Assessments of attitudes and practices towards COVID-19 included confidence in winning the battle against COVID-19 and wearing masks when going out in recent days. The survey was administered in Arabic and English.
Data management and statistical analysis
Survey responses were anonymously collected and stored electronically by the survey service, accessible in a password-protected manner. We captured no data on those who did not respond, declined to participate, or provided incomplete responses. The survey management service tools were used for the initial examination of results and descriptive analysis. Summary statistics were prepared for responses to each question. Since not every participant answered all questions, a percentage adjustment for respondents providing a given answer was calculated individually for each question, using the number of respondents to that question as the denominator.
| Results|| |
Profiles of respondents
Details of the demographic and professional profiles of the respondents are shown in [Table 1]. 374 respondents were included in the analysis; over two-thirds resided and practiced in the Middle East (68.7%) and the rest in North Africa (31.3%). More than half were in the 31–50 year age group, and over one-third were over 50 years of age; 170 (45.6%) were male, and 203 (54.4%) were female. Three quarters (76.0%) were married. The majority of the respondents (71.2%) had either a master's degree or a doctorate. Hospital doctors and nonhospital doctors represented the majority, and the rest were either pharmacists, nurses, or dentists.
The responses to questions assessing the knowledge of respondents about the COVID-19 pandemic are shown in [Table 2]. An overwhelming majority (98.3%) recognized the main clinical symptoms. However, 81.2% thought that, unlike the common cold, a blocked nose, runny nose, coronavirus, and sneezing are less common in people with coronavirus. Similarly, the majority (96.9%) thought there is currently no effective treatment for coronavirus, but early and supportive treatment can help most patients recover from the infection and that not all people with coronavirus will develop severe symptoms. Most (96.9%) recognized that risk factors for more severe disease include the elderly, those with chronic diseases, and obesity. There was a split between respondents on the statement that eating or contacting wild animals will lead to infection with the coronavirus [Table 3]. However, most did not think that people with coronavirus cannot infect others with the virus when fever is not present (96.9%). The respiratory droplets method of infection transmission was widely recognized (97.8%). 75.8% of respondents thought that ordinary residents could wear public medical masks to prevent infection with the coronavirus. The majority (97.5%) disagreed with the notion that children and young people do not need to take measures to prevent infection with the coronavirus. Almost unanimously, respondents agreed that to prevent infection, individuals should avoid going to crowded places such as train stations and avoid taking public transportation (99.2%). Isolating and treating people infected with the virus are effective ways to reduce the spread of the virus (99.7%), and that people who have contact with a person infected with the coronavirus should be immediately isolated in a suitable place (98.3%). In general, the observation period specified by respondents was between 14 days (84.1%) and more than 14 days (13.1%).
|Table 2: The knowledge of respondents of coronavirus disease-2019 pandemic|
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|Table 3: The attitudes of respondents during coronavirus disease-2019 pandemic*|
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The responses to questions exploring respondents' social practices and actual behaviors are presented in [Table 3]. Respondents thought that social distancing through a general curfew to slow the spread of the coronavirus is either very effective (65.8%) or effective (31.9%). The level of anxiety about the situation made 38.2% worried about the health of their family members, 18.1% were nervous when they thought about current circumstances. On the contrary, 32.0% were calm and relaxed. When asked how worried they are about someone in their family contracting the coronavirus, 42.2% thought it is likely, 14.2% thought it very likely, but 22.7% were neither likely nor unlikely. Regarding the effects of the coronavirus on their family's economic situation, 41.6% responded as worried, and approximately similar proportions were either unworried, neutral, or on the contrary, very worried in decreasing order [Table 3].
Two-thirds of the respondents (64.3%) considered the government's reaction to the current coronavirus pandemic appropriate, and about one-fifth (21.2%) considered it somewhat insufficient. However, the majority (86.7%) reported confidence that their own country can win the battle against the coronavirus. In addition, the majority (82.4%) agreed that the coronavirus would be successfully controlled eventually, in general, but 14.7% were not sure [Table 3].
The practices and personal behaviors
The responses to questions exploring respondents' social practices and actual behaviors are presented in [Table 4]. 18.5% reported having been to some crowded places recently, whereas 16.5% admitted having not worn a mask when leaving the house. Observing the preventative measures varied widely; the best was for washing hands more frequently compared to before by 80.3%, while the worst was for the likelihood of informing people around an individual if he/she developed symptoms of sickness (56.1%) [Table 4]. The top two reasons for leaving home were working (78.3%) and purchasing food for self or family (58.3%). Other reasons were less often remarkable [Table 4].
|Table 4: The practices of respondents during coronavirus disease-2019 pandemic*|
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| Discussion|| |
Several studies were conducted to discern HCPs knowledge, attitudes, and practices toward COVID-19 in developing countries. As of August 2, 2021, more than 11 million cases of COVID-19 have been confirmed in the MENA region. The pandemic had a significant impact on the economic and social consequences of the crisis in general, with varied responses from the three economically different components of the region, namely the Arabian Gulf, Middle East, and Maghreb.
The majority of the studied groups had good Knowledge regarding COVID-19 infection. For instance, studies from Uganda and Nigeria showed that healthcare workers with good knowledge were 99.5% and 91%, respectively. This percentage, however, dropped to 53.2% in studies from Ethiopia.,, A similar trend was observed both in Jordan and India despite these countries having diverse healthcare systems. In a study by Basu et al., in India, Knowledge on aspects of COVID-19 epidemiology, prevention, and policy was inadequate in the majority of surveyed physicians (52.8%). In Jordan and Palestine, despite overall adequacy in reported knowledge, attitudes, and practices related to COVID-19 among physicians, there remained significant differences between professional groups.,
In the present study, 96.9% of the respondents correctly identified the risk factors associated with more severe COVID-19, such as being elderly, having chronic medical conditions, and obesity, as was seen in studies from other regions., It was somewhat surprising to see that nearly 40% of respondents thought that eating wild animals could transmit the infection. According to the last update from the Center for Disease Control and Prevention (CDC), there are three potential routes for SARS-COV-2 transmission: inhalation of droplets, deposition of droplets that carry the virus on exposed mucous membranes, and touching mucous membranes with hands soiled by the virus.
Most of the participants (97.8%) knew that the transmission mode was through respiratory droplets, as was reported by other studies.,, Reassuringly, most participants had good knowledge regarding isolation and preventive measures against the spread of COVID-19 infection, as demonstrated by other studies.,,,, A relatively low percentage (75.8%) were aware that wearing medical masks could prevent COVID-19 infection compared to a study done in Thailand, where 100% of participants knew that wearing medical masks could prevent transmission of the disease.
Regarding the attitude on social distancing as a preventative measure to curb the spread of infection, most participants agreed on this being an effective strategy. A significant proportion of the respondents were afraid of transmitting the infection to their family members and close contacts; only 32.5% relaxed their response to COVID-19 disease. 41.6% of the participants expressed anxiety over the impact of COVID-19 infection on the economic situation. This might be explained by the different measures taken by individual countries in response to the pandemic. Some countries imposed strict lockdown measures, whereas others had very minimal or no lockdown policies at all. However, 64% of the participants agreed that the actions taken by their governments toward COVID-19 were appropriate. Most thought that COVID-19 would ultimately be controlled without these actions based on previous experience with other coronaviruses. The majority of participants (86.7%) were confident in their country's ability to win the battle against COVID-19. Similar sentiments were seen in a study from Saudia Arabia, where 87.8% of the participants agreed that COVID-19 would eventually be successfully controlled, and 98.2% indicated that they believe in their country's ability to fight COVID-19.,
Concerning actual practices and personal behaviors, hand washing was recognized as an essential strategy by 70%-80% of the respondents in our study. However, there were disparities amongst studies conducted in Africa, some reporting 50%, while others were reporting 80% on handwashing practices. The majority (83.5%) appreciated the role of masks in preventing disease transmission and used them while in public places. Over 80% of the respondents confirmed they avoided crowded places. The main reasons for leaving the house during the pandemic were getting food for the family (58%) and going to work (78%). The voluntary behavior of avoiding social gatherings by 70% of the respondents is yet another indication that they believed in social distancing measures to reduce transmission rates. These findings were uniform across the different participating groups in contrast to the cross-sectional survey reported by Al Damour et al., who found a significant difference in knowledge and attitudes among physicians.
The study had some important limitations. The sample size and the inhomogeneous representation between the regions may limit the generalizability of the results. The relatively low number of respondents prevents any reasonable attempt for any subgroup analysis based on geography or professional groups. The tool used for knowledge assessment may be too simple for the HCP. Nonetheless, the questions on attitudes and practices are valid to assess personal perceptions and behaviors for both HCW and the public.
| Conclusions|| |
HCPs have a reasonably high level of basic knowledge about the COVID-19 pandemic in its early months. Despite a reportedly positive attitude toward the preventative measures, these are not matched by equally strict individual behaviors. Effective interruption of COVID-19 transmission is dependent on both individual practices and government policies. Serious efforts are required in encouraging HCPs to translate their knowledge into positive behaviors that will reduce disease transmission. As HCPs are at the frontline of the battle against COVID-19 and maybe role models by the general public, their behavior is paramount in instilling public confidence in the various preventive measures.
The authors are most grateful to all the colleagues who participated in the survey.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4]