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 Table of Contents  
ORIGINAL ARTICLE
Year : 2021  |  Volume : 9  |  Issue : 2  |  Page : 100-106

Knowledge, attitude and practices of health-care professionals related to COVID-19: A multi country survey


1 Department of Restorative Dental Sciences, College of Dentistry, Jazan University, Jazan, K.S.A
2 Department of Periodontics, Armed Forces Hospital, Jazan, K.S.A
3 Department of Prosthodontics, Armed Forces Hospital, Jazan, K.S.A
4 Department of Pedodontics, Armed Forces Hospital, Jazan, K.S.A
5 Directorate of Health Services, Mumbai, Maharashtra, India
6 Libyan Authority of Scientific research, Tripoli, Libya, Libya

Date of Submission06-Sep-2021
Date of Decision07-Sep-2021
Date of Acceptance07-Sep-2021
Date of Web Publication30-Nov-2021

Correspondence Address:
Syed Nahid Basheer
Department of Restorative Dental Sciences, Jazan University, Jazan
K.S.A
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/dmr.dmr_28_21

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  Abstract 


Background: COVID-19 was declared as the global pandemic on March 11, 2020 because of the rapid increase in the cases. The high mortality rate and the spread have become the biggest concern of the hour. Objective: To assess the knowledge, attitude, and practices of health-care professionals residing in various countries regarding COVID-19. Methodology: A cross-sectional online survey was conducted and a questionnaire was administered among the participants through E-mail. The statistical significance was calculated for the collected data. Results: A total of 457 participants participated in the survey. Male (45.3%) and female (54.7%) participated with good knowledge (86%) regarding the COVID-19 transmission, while 59% participants reported of using N95 masks and 60% of the participants had attended Centers for Disease Control and Prevention (CDC) guidelines workshop. Conclusion: Findings of the present study showed a wide range of variations in both awareness and attitude of the participants. The knowledge was found to be appropriate while some of the practice-related factors need to be changed. There is a need of regular training, webinars and various educational programs to update the knowledge and the CDC guidelines to be followed.

Keywords: Attitude, coronavirus, COVID-19, health-care professionals, knowledge, practice, survey


How to cite this article:
Basheer SN, Peeran SW, Peeran SA, Zameer M, Naviwala GA, Elhassan A. Knowledge, attitude and practices of health-care professionals related to COVID-19: A multi country survey. Dent Med Res 2021;9:100-6

How to cite this URL:
Basheer SN, Peeran SW, Peeran SA, Zameer M, Naviwala GA, Elhassan A. Knowledge, attitude and practices of health-care professionals related to COVID-19: A multi country survey. Dent Med Res [serial online] 2021 [cited 2022 Jan 23];9:100-6. Available from: https://www.dmrjournal.org/text.asp?2021/9/2/100/331398




  Introduction Top


Coronavirus is a zoonotic pathogen, which can be transmitted by animal-to-human and human-to-human interaction. In the years 2002 (SARS) and 2012 (MERS) multiple epidemic outbreaks occurred which caused 800 deaths in 2002 and 860 deaths in 2012. Approximately 8 years after the MERS-CoV epidemic, a new strain of novel coronavirus (SARS-COV-2) was reported for the first time in December 2019 in Wuhan City, Hubei Province, China.[1] The term 2019 novel coronavirus was used by the World Health Organization (WHO) to refer to a coronavirus that affected the lower respiratory tract of patients with pneumonia in Wuhan, China. The virus was then officially named coronavirus disease (COVID-19).[2] It was declared as a public health emergency of international concern (PHEIC) by the WHO in January' 2020.[1]

The spread of the on-going COVID-19 epidemic was very quick and in response to this serious situation, the WHO declared it as a PHEIC on January 30 and called for collaborative efforts of all countries to prevent the rapid spread of COVID-19.[3] On March 11, 2020, the WHO declared the novel coronavirus outbreak as a global pandemic viral infection as the number of cases of COVID-19 outside China has increased within the number of countries throughout the world. The coronaviruses have become the major pathogens of emerging respiratory disease outbreaks.

The WHO used the term 2019 novel coronavirus to refer to a coronavirus that affected the lower respiratory tract of patients with pneumonia in Wuhan, China on December 29, 2019. These viruses are a large family of single-stranded RNA viruses, which can cause illness ranging from a common cold to severe symptoms like MERS and SARS. The WHO announced that the official name of the 2019 novel corona-virus is coronavirus disease (COVID-19)[2] and confirmed that the outbreak of the coronavirus epidemic was associated with the Huanan South China Seafood Marketplace. Eventually, scientists started to research the source of the new coronavirus, and the first genome of COVID-19 was published by the research team led by Prof. Yong-Zhen Zhang, on January 10, 2020.[2]

Susceptibility seems to be associated with age, biological sex, and other health conditions. Specifically, the geriatric population and patients with preexisting comorbidities such as hypertension, cardiac disease, lung disease, cancer, or diabetes were at potential risk for disease severity and mortality. The clinical symptoms of COVID-19 include fever, which is the most common symptom, cough, fatigue, malaise, and shortness of breath. The diagnosis test for the detection of coronavirus is reverse transcriptase-polymerase chain reaction test. To date, there is no antiviral promising treatment that has been recommended for COVID-19. WHO recommends prevention is the only strategy to protect the spread of the corona virus. Preventive measures such as avoiding close contacts, regular hand washing, social distancing, and respiratory hygiene like covering mouth and nose while coughing or sneezing.[4]

WHO and Centers for Disease Control and Prevention (CDC) published various recommendations for the prevention and control of COVID-19 for healthcare worker (HCWs) and also initiated several online training sessions and published materials on COVID-19 in various languages for strengthening the preventive strategies, raising awareness and to further train the HCWs in preparedness activities.[3] In few instances, misunderstandings among HCWs have also caused delayed controlling efforts to provide necessary treatment and also led to the rapid spread of infection in hospitals which further put patients' lives at risk.[5]

Since health-care professionals (HCPs) are at the frontline of this pandemic response and are exposed to dangers like virus exposure, psychological stress, fatigue, long working hours at the hospital and physical violence, occupational burnout and stigma, poor awareness among them can lead to delayed identification and decrease the quality of treatment which can lead to the rapid spread of this pandemic. With present reported morbidity and mortality among health care professionals has suggested inadequate infection control practices in health-care settings. Hence, there is a need for strict compliance for infection control guidelines prescribed by the WHO and the Center for Disease Control and Prevention (CDC) in health-care facilities to create awareness among HCWs. Therefore, the present study aims to assess the knowledge, attitude, and practice of HCWs toward COVID-19 infection.


  Methodology Top


A cross-sectional study was conducted on health-care professionals (HCP) working at different hospitals and clinics, over the duration of 2 months (July–September 2020). A total of 1000 HCPs including doctors from the medical and dental fields and paramedics were approached through E-mails, Facebook, and Instagram. To avoid the spread of the current pandemic field-based cross-sectional survey was not conducted and the questionnaires were sent online. A consent statement for voluntary participation was included in the questionnaire for all subjects to understand before their agreement. The data from participants were collected on Google forms using a validated questionnaire including the demographic, knowledge (K), awareness (A), and practice (P) assessment sections.

The questionnaire comprised 33 closed-ended questions, out of which 7 were about demographic details and the others were regarding the knowledge, attitude, and practice of the health-care professionals. The first part included questions regarding professional experience, gender, education, qualification, workplace, working sector, residing country. The questions include the knowledge regarding the awareness, etiology, mode of transmission, incubation period, signs and symptoms, duration of presence outside the human body, age group of individuals, mortality rate, ways of prevention, and treatment options currently available for COVID-19. The third section of the questionnaire had questions with regard to attitude and practice of HCP's which comprised questions related to contagious nature, prevention of spread, animal to human transmission, reinfection rate in humans, availability of the vaccine, community threats, practice of CDC guidelines and patient care. It also included encountering of patient, lectures, and workshops for knowledge of COVID-19, washing of hands before and after patient treatment, following universal precautions for infection control, and use of surface disinfectant to contain and eliminate virus clusters of COVID-19.

A total of 1000 HCPs were mailed and a questionnaire was attached to the mail, 457 of the questionnaires were filled and received back. There were no obligations placed and all the participants were also kept anonymous. Descriptive statistical analyses were carried out in the present study. Results on categorical measurement were presented in number (%). The Statistical software IBM SPSS statistics 20.0 (IBM Corporation, Armonk, NY, USA) was used for the analyses of the data and Microsoft Word and Excel were used to generate graphs, tables, etc., or equal to 0.05 was considered to be statistically significant.


  Results Top


[Table 1] represents the demographic characteristics of the study participants. Total participants were 457 among which males were 45.3% and females were 54.7%. Among the participants, maximum were either fresher or student with a percentage of 45.1, 22.1% participants had an working experience of more than 15 years, 19.9% participants had experience of 1–5 years, and the other 12.9% participants had the experience between 12–15 years. As per the designation, 61.5% participants were dentists, 20.1% had a background of medicine, 4.6% were from nursing background and the other 13.8% were from other professions. 39.8% of the HCPs had a qualification of either medical/dental or nursing, 27.8% were graduates. Majority of the participants were from the university (46%) followed by hospital (22.1%). Similarly, 40.3% of the HCPs were from private sector and 38.9% were from government sector. And majority of the HCPs were from India (23.4%), UAE (23.2%) and Kingdom of Saudi Arabia (23.2%).
Table 1: Demographic characteristics of the study participants (n=457

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Knowledge, attitude and practices of the HCPs towards COVID-19 is presented in [Table 2]. Majority of the participants (93.7) were aware about the etiology of COVID-19 and they also reported regarding the new strain of corona virus (76.4%). Eighty-six percent of the participants were aware about the mode of transmission, and 84% of the participants believed that the incubation period is for 2–14 days. Surprisingly only 46.6% of the participants reported of the awareness of the amount of time coronavirus can survive outside the body. Majority of the HCPs answered that elderly age group were most affected by the COVID-19 (80.3%) and 46.4% of the HCPs were aware about the mortality rate variations. Seventy percent of the participants were aware about the co-morbidities, and to our surprise 91.9% participants were aware about the clinical manifestations and similarly 95.2% participants knew about the ways of prevention from COVID-19. Regarding the treatment options, participants gave various opinions and majority agreed that it can be treated by preventive measures. More than 90% of participants believed that it is contagious and the spread should be prevented as it leads to mortality and morbidity. Similarly, majority of participants were aware regarding the transmission from human to animals and vice versa, availability of vaccine and also they considered it as a threat to the community.
Table 2: Descriptive statistics (n=457) (responses to various questions)

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Regarding the attitude and practice, various questions were asked and it was found that 85.8% participants followed CDC guidelines and 60% participants had attended some lectures or workshops on COVID-19. Majority of participants reported that they washed their hands before and after contact with their patients and used a surgical mask during patient contact while only 59% participants used N-95 mask and 95% participants followed universal precautions of infection control. Sixty-five percent 65% of the participants said that they used sodium hypochlorite as surface disinfectant and only 30% of the participants came across with COVID-19 patients.


  Discussion Top


COVID-19 is a matter of global concern right now and the healthcare professionals are at the highest risk as they are the ones who are exposed to maximum risk. At this point of time, the only way a person can be safe is by following the COVID guidelines strictly. Recent reports have shown a very high mortality rate among HCPs and various reports have also been presented.[1],[4],[6],[7] The most possible reasons for this increased mortality rate can be related to the knowledge and practices of the HCPs. Therefore the present study was conducted to investigate the trends in knowledge, attitude and practices of the HCPs towards COVID-19. The knowledge was found to be adequate while the practice trend among the study participants were somewhat compromised.

Present study showed that 93.7% of participants were aware about the etiology of the Corona virus and 90% of the participants knew about its contagious nature, this shows the participants were aware that strict protocols are needed for the prevention and the use of personal protective equipment's (PPE) are must for the health care professionals. This finding was in accordance with a study done on Iranian nurses where 94.11% participants believed that the infection is contagious.[1],[6],[8],[9] Extreme cross infection protocols are a must and the CDC guidelines should be practiced for all patients. In the present study 85.8% participants practiced the CDC guidelines and 60% participants agreed that they had attended some workshop related to it. This shows that even if the protocols are followed by many participants, a quarter of participants still not follows the guidelines which keeps them at risk and also there is a higher chance of cross infection among their patients, hence there is a need of organizing various workshops and webinars for the HCPs at regular intervals. Almost similar finding were also reported by various studies regarding the improvement in precautionary measures.[1],[10],[8],[11] While a previous report done in Wuhan city reported a very less knowledge levels among the HCPs.[12],[13],[9] Similar to our results, a similar study also reported that 64.3% of the HCPs completed a COVID-19 training, whereas in a web based study done among HCWs it was seen that 44.1% of their participants had an opportunity to attend a lecture/workshop/course on COVID-19 and similar results were also reported by a study done in Pakistan where they reported only 24.4% participants attending a professional scientific event for COVID-19.

Use of surface disinfectant is a part of the protocol, which should be given a higher emphasis, but in the present study only 65% participants reported of using sodium hypochlorite as a surface disinfectant, which was also reported in a similar study where 57% of the participants practiced the use hydrogen peroxide for disinfectant of the virus. In the present study 59% of participants reported using N-95 mask that again shows there is a need to emphasize on the CDC guidelines to help reduce putting themselves and others at risk.

A sound knowledge regarding the incubation period and the mode of transmission is necessary to address the contagious nature of the virus. In our study it was found that 86% of the participants were aware about the mode of transmission and 84% of the participants believed that the COVID-19 has a 2–14 days incubation period. Similar findings were also reported in a web based study, where 84.3% participants believed the same and also in a study done among the HCWs where 77.5% participants believed that the symptoms of the disease appear in about 2–14 days.[1],[14]

Based on the findings of our study, it can be concluded that there is a need of training of the HCPs to enhance their knowledge and help them change their practice and attitude towards the precautions and safety measures. Our study has given a preliminary finding on the knowledge, attitude, and practices of HCPs practicing at various locations. The results have shown a wide range of variation maybe because of the reason that the participants were from different countries with different qualifications and experiences. Hence, the findings of this study should be interpreted cautiously as cultural and contextual variation is a must in this study. According to our findings, the knowledge was found to be adequate while the attitude and practices lack more attention. Hence, it should be given a priority as the COVID-19 has become a challenge for HCWs as they are very close contact with the patients and by taking necessary precautions they can minimize the spread of infection.

Educational and training programs should be conducted to update the knowledge and findings related to the disease and management protocols for the HCPS must be made mandatory. In addition to this, all hospitals and clinics should follow the precheck triages. The symptoms like temperature and history should also be checked, and proper sanitization facilities should also be followed at the entry of the patients. The use of PPE including the N-95 mask must be made mandatory and all elective procedures in medical, dental, and surgical fields should be postponed except for emergencies. Nevertheless, the medical, financial, and psychological support for the health care professional should also be provided for the risks that they are exposed to daily. And further studies are recommended to identify the reasons for reported high infection and mortality rates among health-care professionals.


  Conclusion Top


Health-care professionals are the only ray of hope in this pandemic situation. The knowledge and practices of these practitioners can help reduce the cross infection between both the practitioners and the patients. Some aspects related to practice need to be changed like disinfection protocol, use of N-95 mask, following CDC guidelines. Webinars and professional development programs are a must to improve and update the various findings related to COVID-19 to manage the current pandemic situation and reduce the mortality and morbidity rate associated with it.

Ethical clearance

The study was approved by Institutional ethical clearance was obtained.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Ahmed N, Shakoor M, Vhrra F, Abduljabbar T, Mariam Q and Rehman MA. Knowledge, awareness and practice of health care professionals amid SARS-CoV-2, corona virus disease outbreak. Pak J Med Sci 2020;36:(COVID19-S4).  Back to cited text no. 1
    
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Adhikari SP, Meng S, Wu YJ, Mao YP, Ye RX, Wang QZ, et al. Epidemiology, causes, clinical manifestation and diagnosis, prevention and control of coronavirus disease (COVID-19) during the early outbreak period: A scoping review. Infect Dis Poverty 2020;9:1-12.  Back to cited text no. 2
    
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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. 3
    
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Nallani VRR, Nadendla RR, Kavuri NS. Knowledge, attitude and practice among healthcare professionals regarding COVID-19 and barriers faced by health care professionals in South India. Int J Community Med Public Health 2020;7:3450-8.  Back to cited text no. 4
    
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Clements JM. Knowledge and behaviors toward COVID-19 among U.S. Residents during the early days of the pandemic: Cross-Sectional Online Questionnaire. JMIR Public Health and Surveillance 2020;6:e19161.  Back to cited text no. 5
    
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Nemati M, Ebrahim B, Nemati F. Archives of Clinical Infectious Diseases: Assessment of Iranian Nurses' Knowledge and Anxiety toward COVID-19 During the Current Outbreak in Iran; 2020  Back to cited text no. 6
    
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Khan MU, Shah S, Ahmad A, Fatokun O. Knowledge and attitude of healthcare workers about middle east respiratory syndrome in multispeciality hospitals of Qassim, Saudi Arabia. BMC Public Health 2014;14:1281.  Back to cited text no. 7
    
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World Health Organization. International clinical trials registry platform. 2020.  Back to cited text no. 8
    
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World Health Organization. Coronavirus disease (COVID-2019) situation reports.  Back to cited text no. 9
    
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Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020;395:497-506  Back to cited text no. 10
    
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Kohn WG, Collins AS, Cleveland JL, Harte JA, Eklund KJ, Malvitz DM, et al. Guidelines for infection control in dental health-care settings – 2003. MMWR Recomm Rep Morb Mortal Wkly Rep Recomm Rep 2003;52:1-61.  Back to cited text no. 11
    
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Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: A retrospective cohort study. Lancet 2020;395:1054-62.  Back to cited text no. 12
    
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WHO. Advice on the use of masks in the community, during home care and in health care settings in the context of the novel coronavirus 2019- nCoV outbreak (Interim guidance). 2020. WHO/nCov/IPC_Masks/2020.  Back to cited text no. 13
    
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Omrani AS, Shalhoub S. Middle East respiratory syndrome coronavirus (MERS-CoV): What lessons can we learn? J Hosp Infect 2015;91:188-96.  Back to cited text no. 14
    



 
 
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