Healthworker preparedness for COVID-19 management and implementation experiences: a mixed methods study in Uganda’s refugee-hosting districts

Conflict and Health

Dunstan Ddamulira¹  Betty Okot²  Catherine Nakidde²  Eric Awich Ochen²  Denis Muhangi²  Eric Lugada²  Gloria Seruwagi³  Felix Otieno⁴  Stephen Lawoko⁵  Brian Luswata⁶  Joshua Kayiwa⁷  Andrew Masaba⁸ 

[1]Agency for Cooperation in Research and Development (ACORD), Nairobi, Kenya

[2]Centre for Health and Social Economic Improvement (CHASE-i) - Department of Social Work and Social Administration (SWSA), Makerere University, Kampala, Uganda

[3]Centre for Health and Social Economic Improvement (CHASE-i) - Department of Social Work and Social Administration (SWSA), Makerere University, Kampala, Uganda

[4]Department of Health Policy Planning and Management (HPPM), Makerere University School of Public Health (MakSPH), Kampala, Uganda

[5]Centre for Health and Social Economic Improvement (CHASE-i) - Department of Social Work and Social Administration (SWSA), Makerere University, Kampala, Uganda

[6]Infotrak Research Consulting, Nairobi, Kenya

[7]Department of Public Health - Faculty of Medicine, Gulu University, Gulu, Uganda

[8]Directorate of Health Governance and Regulation, Ministry of Health, Kampala, Uganda

[9]Public Health Emergency Operations Centre (PHEOC), Ministry of Health, Kampala, Uganda

[10]The Lutheran World Federation (LWF), LWF, Kampala, Uganda

关键词: Health care workers (HCWs);    Preparedness;    Resilience;    Health system;    KAP;    COVID-19;   

DOI  :  10.1186/s13031-021-00415-z

来源: Springer

【 摘 要 】

BackgroundThe negative impact of COVID-19 on population health outcomes raises critical questions on health system preparedness and resilience, especially in resource-limited settings. This study examined healthworker preparedness for COVID-19 management and implementation experiences in Uganda’s refugee-hosting districts.MethodsA cross sectional, mixed-method descriptive study in 17 health facilities in 7 districts from 4 major regions. Total sample size was 485 including > 370 health care workers (HCWs). HCW knowledge, attitude and practices (KAP) was assessed by using a pre-validated questionnaire. The quantitative data was processed and analysed using SPSS 26, and statistical significance assumed at p < 0.05 for all statistical tests. Bloom's cutoff of 80% was used to determine threshold for sufficient knowledge level and practices with scores classified as high (80.0–100.0%), average (60.0–79.0%) and low (≤ 59.0%). HCW implementation experiences and key stakeholder opinions were further explored qualitatively using interviews which were audio-recorded, coded and thematically analysed.ResultsOn average 71% of HCWs were knowledgeable on the various aspects of COVID-19, although there is a wide variation in knowledge. Awareness of symptoms ranked highest among 95% (p value < 0.0001) of HCWs while awareness of the criteria for intubation for COVID-19 patients ranked lowest with only 35% (p value < 0.0001). Variations were noted on falsehoods about COVID-19 causes, prevention and treatment across Central (p value < 0.0356) and West Nile (p value < 0.0161) regions. Protective practices include adequate ventilation, virtual meetings and HCW training. Deficient practices were around psychosocial and lifestyle support, remote working and contingency plans for HCW safety. The work environment has immensely changed with increased demands on the amount of work, skills and variation in nature of work. HCWs reported moderate control over their work environment but with a high level of support from supervisors (88%) and colleagues (93%).ConclusionsHCWs preparedness is inadequate in some aspects. Implementation of healthcare interventions is constrained by the complexity of Uganda’s health system design, top-down approach of the national response to COVID-19 and longstanding health system bottlenecks. We recommend continuous information sharing on COVID-19, a design review with capacity strengthening at all health facility levels and investing in community-facing strategies.

【 授权许可】

CC BY