Evaluating the Knowledge and Compliance to Covid-19 Protocol among Health Practitioners in Hafr Al Batin Region of Kingdom of Saudi Arabia, after 65% of its Population is Fully Immunized
Authors: Hadwan Mibrad Aldahmashi*, Sabah Alharbi, Amal Alharbi, Saad Alshammary, Oqalaa Alshammary, Sami Faisal, Fahad Naif Almutari
*Corresponding Author: Hadwan Mibrad H Aldahmashi, Hafr Albatin Directorate of Health Affairs, Ministry of Health, College of Applied Science, University of Hafr Albatin, 15 Hafr Albatin, Eastern Region, Saudi Arabia.
Received Date: 15 December, 2021
Accepted Date: 21 December, 2021
Published Date: 24 December, 2021
Citation: Aldahmashi HM, Alharbi S, Alharbi A, Alshammary S, Alshammary O, et al. (2021) Evaluating the Knowledge and Compliance to Covid-19 Protocol among Health Practitioners in Hafr Al Batin Region of Kingdom of Saudi Arabia, after 65% of its Population is Fully Immunized. J Community Med Public Health 5: 228. DOI: https://doi.org/10.29011/2577-2228.100228
Introduction
In December, 2019, Wuhan city, the capital of Hubei province in China, became the center of an outbreak of pneumonia of unknown cause which was later designated Coronavirus disease 2019 (COVID-19) by the World Health Organization. In February 2020 WHO announced that COVID- 19 has become a pandemic [1,2]. The number of cases started to increase rapidly worldwide. The challenges faced by Kingdom of Saudi Arabia were, Millions of pilgrims from all over the world visit here every year as it has the two holiest cities of the Muslim world. Saudi Arabia is also home to millions of expats who earn their livelihood here. Curbing the arrival of foreign pilgrims to implementing strict total lockdown were very difficult tasks [3]. Ministry of health of Saudi Arabia did incredible work in handling the Covid-19 pandemic. Testing, treatment and vaccination were all provided for free [4], to everyone including citizens and expats (including the illegal ones). Ministry of health constantly updated the population through social media, messaging, daily news briefing and through various digital platforms. Tremendous work by Physicians and nurses of ministry of health by strictly complying with the covid-19 protocol helped infighting the pandemic.
In this study we have tried to evaluate knowledge, attitudes and practices related to COVID -19 among nurses and physicians. At the time when Saudi Arabia has fully vaccinated 65% of its population. We aimed to explore the practice behaviours of nurses and physician in Hafr Al Batin especially during COVID-19 outbreak at various levels of care (primary, secondary) and identify the variables predicting practice performance.
Methods and Design
Due to the large number of PHC in Hafar al Batin four centres were selected according to: 1. The highest visit rate. 2. Geographical distribution. All secondary care hospitals in Hafar Al Batin were included. A minimum number of 330 participants was the target sample size.
The inclusion criteria included nurses and doctors who work in the selected health facility to visit the selected PHCs in Hafar Al-Batin. Also, those above 20 years old and has accessed and availed certain services in the selected PHCs during the period of data gathering were included. A convenience sampling method was used in which the participants were recruited on ease of accessibility. Rasoft software was used to calculate the sample size with confidence interval and margin of error set at 95% and 5% respectively.
Procedure
The data gathering was done by trained research assistants in two phases which covers the pilot testing and the final gathering. Data gathering was done in secondary care and PHCs during duty hours where respondents are conveniently available for interview.
Measurements
A modified survey questionnaire by Muhammad Umair Khan was used with permission from the authors. A pilot study was conducted on 30 respondents. Reliability coefficient was calculated by using SPSS v.20 and the value of Cronbach’s alpha was found to be 0.74. The data of the pilot study was not used for the final analysis.
The questionnaire has 2 parts. First part gathered information about the participants’ personal information. Second part had various sections. First section sought information about the knowledge of health care workers and had 17 questions regarding sources, incubation period, mode of transmission and way of diseases preventions. The second section included 7 questions assessing the attitude of health care worker toward COVID 19 as preventable, prevalence and controllable. The third section was about measures taken towards infection control practice by health care worker. It consisted of 8 questions about uses of personal equipment, hand hygiene and healthy style for health worker.
Data Analysis
Categorical variables like gender, age, profession and years of experience etc. are presented in frequencies and percentages. Chi-square / Fisher’s exact test was used according to whether the cell expected frequency is smaller than 5 and it was applied to determine the significant association among categorical variables. P-value <0.05 two-tailed was considered as statistically significant. All data was entered and analyzed through statistical package SPSS version 25.
Results
Impact and Association between primary and secondary healthcare worker knowledge, attitude and practice towards COVID19 outbreak (Table 1)
Discussion
With the recent experience of MERS-CoV Kingdom of Saudi Arabia was better prepared to handle this Covid-19 pandemic [5,6]. Ministry of health had required infrastructure such as separate isolation wards, specialized Respiratory Disease Departments, dedicated ICU beds for these respiratory diseases [7]. Along with the ground infrastructure Saudi Arabia had started National Digital Transformation “Digital Saudi Arabia” in 2019 [8,9]. Ministry of health launched various digital platforms such as Sehha App [10], Mawid E-services [11], Wasfaty [12], Tatmman app [13], Sehhaty app, Tawakkalna app, Tatmman Smart bracelet [14], official Twitter handles of Ministry of health [15], daily news briefing on national news channels. Through these digital platforms Ministry of health did aggressive campaign of educating the population and avoiding rumors [16]. Providing online consultation through Sehhaty and Tatmman apps and providing online prescriptions through wasfaty app helped in reducing the unnecessary burden on hospitals [17,18].
In our study we found that ministry of health employees in Hafar al Batin were well informed about Covid -19 protocols. Despite having the difference in qualification levels and difference in years of experience, there was a negligible difference in knowledge of Covid-19. The level of alertness and preparedness was still the same as in the beginning of the pandemic. Due to these tremendous efforts Saudi Arabia successfully avoided subsequent waves of this pandemic as observed in other countries which lead to huge loss of human lives. Where as in Saudi Arabia has been observing less than 100 daily cases for last 5 months. Despite influx of people from all around the world.
Conclusion
Our study suggest that there is very little difference between the knowledge and compliance to the Covid-19 protocol among the Physicians and nurses working at primary or secondary health centers of Hafar al Batin also their level of alertness was same as the beginning of the pandemic. This along with other efforts by Ministry of Health using digital platforms has helped in successfully avoiding subsequent waves of pandemic as observed in other parts of the world.
Tables
Variables |
Description |
Primary healthcare |
Secondary healthcare |
P- value |
Gender |
Male |
65 (32.5%) |
45 (34.6%) |
0.690 |
Female |
135 (67.5%) |
85 (65.4%) |
||
Age |
<29 |
24 (12.0%) |
29 (22.3%) |
*0.018 |
30-39 |
126 (63.0%) |
83 (63.8%) |
||
40-49 |
40 (20.0%) |
17 (13.1%) |
||
50-59 |
6 (3.0%) |
1 (0.8%) |
||
>=60 |
4 (2.0%) |
0 (0.0%) |
||
Profession |
Physician |
32 (16.0%) |
25 (19.2%) |
0.448 |
Nurse |
168 (84.0%) |
105 (80.8%) |
||
Years of experience |
<3 |
7 (3.5%) |
20 (15.4%) |
*0.002 |
3-6 |
39 (19.5%) |
21 (16.2%) |
||
7-10 |
56 (28.0%) |
31 (23.8%) |
||
>10 |
98 (49.0%) |
58 (44.6%) |
||
Education |
Diploma |
144 (72.0%) |
71 (54.6%) |
*<0.001 |
Bachelor’s degree |
43 (21.5%) |
45 (34.6%) |
||
Masters |
4 (2.0%) |
9 (6.9%) |
||
Board certified |
1 (0.5%) |
5 (3.8%) |
||
PhD |
0 (0.0%) |
0 (0.0%) |
||
Others |
8 (4.0%) |
0 (0.0%) |
||
Nationality |
Saudi |
163 (81.5%) |
88 (67.7%) |
*0.004 |
Non-Saudi |
37 (18.5%) |
42 (32.3%) |
||
COVID-19 Related Information Source |
Ministry of Health (MOH) |
168 (84.0%) |
97 (74.6%) |
0.464 |
World Health Organization |
12 (6.0%) |
11 (8.5%) |
||
Social Media/Public news |
9 (4.5%) |
11 (8.5%) |
||
Health Care Professional/ Colleague |
2 (1.0%) |
2 (1.5%) |
||
Published literature |
4 (2.0%) |
3 (2.3%) |
||
Internet resources |
3 (1.5%) |
5 (3.8%) |
||
Others |
2 (1.0%) |
1 (0.8%) |
||
Covid-19 patients develop severe acute respiratory illness |
Yes |
162 (81.0%) |
114 (88.4%) |
0.205 |
No |
31 (15.5%) |
12 (9.3%) |
||
I don't know |
7 (3.5%) |
3 (2.3%) |
||
Fever, cough and shortness of breath are hallmark symptoms of covid-19: |
Yes |
186 (93.0%) |
123 (96.1%) |
0.101 |
No |
7 (3.5%) |
5 (3.9%) |
||
I don't know |
7 (3.5%) |
0 (0.0%) |
||
Yes |
184 (92.0%) |
124 (96.9%) |
||
People with co-morbidity (Diabetes, cancer and other chronic diseases) are more likely to be infected |
No |
11 (5.5%) |
2 (1.6%) |
0.168 |
I don't know |
5 (2.5%) |
2 (1.6%) |
||
Yes |
190 (95.0%) |
126 (98.4%) |
||
Incubation time for virus is 1-14 days |
No |
6 (3.0%) |
2 (1.6%) |
0.190 |
I don't know |
4 (2.0%) |
0 (0.0%) |
||
Yes |
155 (77.5%) |
93 (72.7%) |
||
The vaccine available in Saudi Arabia are approved for emergency use by WHO?
|
No |
7 (3.5%) |
2 (1.6%) |
0.226 |
I don't know |
38 (19.0%) |
33 (25.8%) |
||
Yes |
89 (44.5%) |
51 (39.8%) |
||
Can immunized person with two doses of vaccine still have Covid-19? |
No |
47 (23.5%) |
50 (39.1%) |
*0.006 |
I don’t know |
64 (32.0%) |
27 (21.1%) |
||
Yes |
165 (82.5%) |
112 (87.5%) |
||
Can previously Covid-19 infected person get reinfected
|
No |
7 (3.5%) |
3 (2.3%) |
0.473 |
I don't know |
28 (14.0%) |
13 (10.2%) |
||
Yes |
190 (95.0%) |
126 (98.4%) |
||
The fully Immunized persons have less severe Covid-19 infection than the non-immunized person?
|
No |
6 (3.0%) |
2 (1.6%) |
0.190 |
I don't know |
4 (2.0%) |
0 (0.0%) |
||
Yes |
198 (99.0%) |
121 (94.5%) |
||
RT-PCR (Polymerase Chain Reaction) can used to diagnose covid19 |
No |
2 (1.0%) |
0 (0.0%) |
*0.002 |
I don't know |
0 (0.0%) |
7 (5.5%) |
||
Yes |
165 (82.5%) |
112 (87.5%) |
||
Has application such as Tawakkalna and Sehaty helped in controlling the spread of infection |
No |
7 (3.5%) |
3 (2.3%) |
0.473 |
I don’t know |
28 (14.0%) |
13 (10.2%) |
||
Yes |
190 (95.0%) |
126 (98.4%) |
||
Has the regular updates from Ministry of Health helped improving the knowledge and handling the situation? |
No |
6 (3.0%) |
2 (1.6%) |
0.190 |
I don’t know |
4 (2.0%) |
0 (0.0%) |
||
Yes |
89 (44.5%) |
51 (39.8%) |
||
After lifting the compulsory social distancing norms are people still conscious about the virus? |
No |
47 (23.5%) |
50 (39.1%) |
*0.006 |
I don’t know |
64 (32.0%) |
27 (21.1%) |
||
Yes |
89 (44.5%) |
51 (39.8%) |
||
Has the population become more hygiene conscious after this pandemic? |
No |
47 (23.5%) |
50 (39.1%) |
*0.006 |
I don’t know |
64 (32.0%) |
27 (21.1%) |
||
Yes |
197 (98.5%) |
125 (97.7%) |
||
Individuals who have a history of travel to countries and cities that have a spread out of infection in the past 14 days should be quarantined and tested |
No |
3 (1.5%) |
3 (2.3%) |
0.578 |
I don't know |
0 (0.0%) |
0 (0.0%) |
||
Yes |
175 (87.5%) |
119 (93.0%) |
||
Covid-19 can be fatal |
No |
16 (8.0%) |
6 (4.7%) |
0.282 |
I don't know |
9 (4.5%) |
3 (2.3%) |
||
Yes |
198 (99.0%) |
126 (98.4%) |
||
COVID-19 is transmitted from infected person to another |
No |
2 (1.0%) |
0 (0.0%) |
0.110 |
I don't know |
0 (0.0%) |
2 (1.6%) |
||
Yes |
186 (93.0%) |
125 (97.7%) |
||
Individuals who have been exposed to COVID-19 may transmit the infection even before they have symptoms |
No |
4 (2.0%) |
2 (1.6%) |
0.111 |
I don't know |
10 (5.0%) |
1 (0.8%) |
||
Yes |
89 (44.5%) |
51 (39.8%) |
||
COVID-19 has less fatality rate than MERS-CoV |
No |
47 (23.5%) |
50 (39.1%) |
*0.006 |
I don't know |
64 (32.0%) |
27 (21.1%) |
||
Yes |
179 (89.5%) |
123 (96.1%) |
||
COVID -19 can be transmitted by talking to any infected individuals with distance less than one meter |
No |
16 (8.0%) |
5 (3.9%) |
0.060 |
I don't know |
5 (2.5%) |
0 (0.0%) |
||
Yes |
196 (98.0%) |
126 (98.4%) |
||
COVID -19 can be transmitted through touching infected surfaces (door handles. stair poles, equipment) |
No |
2 (1.0%) |
2 (1.6%) |
0.476 |
I don't know |
2 (1.0%) |
0 (0.0%) |
||
Yes |
187 (93.5%) |
121 (94.5%) |
||
Health care provider are among the high risk groups |
No |
9 (4.5%) |
3 (2.3%) |
0.495 |
I don't know |
4 (2.0%) |
4 (3.1%) |
||
Strongly Disagree |
5 (2.5%) |
16 (12.5%) |
||
Transmission of covid-19 infection can be prevented by using universal precautions given by CDC, WHO etc. |
Disagree |
3 (1.5%) |
4 (3.1%) |
*0.002 |
Neutral |
0 (0.0%) |
0 (0.0%) |
||
Agree |
41 (20.5%) |
21 (16.4%) |
||
Strongly agree |
151 (75.5%) |
87 (68.0%) |
||
Strongly Disagree |
6 (3.0%) |
16 (12.5%) |
||
Prevalence of covid-19 can be reduced by active participation of health care worker in hospital infection control program |
Disagree |
3 (1.5%) |
4 (3.1%) |
*0.006 |
Neutral |
7 (3.5%) |
5 (3.9%) |
||
Agree |
47 (23.5%) |
34 (26.6%) |
||
Strongly agree |
137 (68.5%) |
69 (53.9%) |
||
Strongly Disagree |
6 (3.0%) |
19 (14.8%) |
||
Any related information about covid-19 should be disseminated among peers and other healthcare workers |
Disagree |
6 (3.0%) |
4 (3.1%) |
*0.002 |
Neutral |
3 (1.5%) |
2 (1.6%) |
||
Agree |
33 (16.5%) |
13 (10.2%) |
||
Strongly agree |
152 (76.0%) |
90 (70.3%) |
||
Strongly Disagree |
7 (3.5%) |
19 (14.8%) |
||
Covid-19 patients should be kept in isolation |
Disagree |
3 (1.5%) |
1 (0.8%) |
*0.001 |
Neutral |
4 (2.0%) |
0 (0.0%) |
||
Agree |
32 (16.0%) |
11 (8.6%) |
||
Strongly agree |
154 (77.0%) |
97 (75.8%) |
||
Strongly Disagree |
3 (1.5%) |
10 (7.8%) |
||
Intensive and emergency treatment should be given to diagnosed patients |
Disagree |
5 (2.5%) |
4 (3.1%) |
*0.045 |
Neutral |
6 (3.0%) |
2 (1.6%) |
||
Agree |
56 (28.0%) |
28 (21.9%) |
||
Strongly Agree |
130 (65.0%) |
84 (65.6%) |
||
Strongly Disagree |
7 (3.5%) |
20 (15.6%) |
||
Healthcare workers must acknowledge themselves with all the information about covid-19 |
Disagree |
2 (1.0%) |
1 (0.8%) |
*0.001 |
Neutral |
2 (1.0%) |
1 (0.8%) |
||
Agree |
24 (12.0%) |
6 (4.7%) |
||
Strongly Agree |
165 (82.5%) |
100 (78.1%) |
||
Strongly Disagree |
11 (5.5%) |
19 (14.8%) |
||
Gowns, gloves, mask and goggles must be used when dealing with covid-19 patients |
Disagree |
0 (0.0%) |
1 (0.8%) |
*0.010 |
Neutral |
4 (2.0%) |
0 (0.0%) |
||
Agree |
8 (4.0%) |
2 (1.6%) |
||
Strongly Agree |
177 (88.5%) |
106 (82.8%) |
||
Yes |
193 (96.5%) |
122 (95.3%) |
||
Use soap and water to wash my hands continuously |
No |
4 (2.0%) |
3 (2.3%) |
0.836 |
Sometimes |
3 (1.5%) |
3 (2.3%) |
||
Yes |
195 (97.5%) |
120 (93.8%) |
||
Cover my nose and mouth with a tissue during sneezing or coughing |
No |
2 (1.0%) |
2 (1.6%) |
0.201 |
Sometimes |
3 (1.5%) |
6 (4.7%) |
||
Yes |
191 (95.5%) |
124 (96.9%) |
||
Throw the used tissue in the trash |
No |
7 (3.5%) |
2 (1.6%) |
0.526 |
Sometimes |
2 (1.0%) |
2 (1.6%) |
||
Yes |
196 (98.0%) |
120 (93.8%) |
||
Avoid touching my eyes, nose or mouth as far as I can |
No |
0 (0.0%) |
1 (0.8%) |
0.105 |
Sometimes |
4 (2.0%) |
7 (5.5%) |
||
Yes |
190 (95.0%) |
121 (94.5%) |
||
Use face mask in crowds |
No |
4 (2.0%) |
2 (1.6%) |
0.872 |
Sometimes |
6 (3.0%) |
5 (3.9%) |
||
Yes |
197 (98.5%) |
128 (100.0%) |
||
Carefully handle suspected patient’s belongings |
No |
2 (1.0%) |
0 (0.0%) |
0.380 |
Sometimes |
1 (0.5%) |
0 (0.0%) |
||
Yes |
192 (96.0%) |
119 (93.0%) |
||
Keep on healthy eating and health styles |
No |
2 (1.0%) |
2 (1.6%) |
0.478 |
Sometimes |
6 (3.0%) |
7 (5.5%) |
||
Yes |
196 (98.0%) |
118 (92.2%) |
||
Do you educate your patients about the disease |
No |
2 (1.0%) |
2 (1.6%) |
*0.023 |
Sometimes |
2 (1.0%) |
8 (6.3%) |
||
Yes |
190 (95.0%) |
121 (94.5%) |
||
Do you think by strictly following the Covid-19 protocol we can manage the new waves of Covid-19 caused by new variants of the virus?
|
No |
4 (2.0%) |
2 (1.6%) |
0.872 |
I don’t know |
6 (3.0%) |
5 (3.9%) |
||
|
|
|
Table 1: Impact and Association between primary and secondary healthcare worker knowledge, attitude and practice towards COVID19 outbreak.
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