Advertisement
Browse Subject Areas
?

Click through the PLOS taxonomy to find articles in your field.

For more information about PLOS Subject Areas, click here.

  • Loading metrics

Assessment of knowledge, attitude and practice toward COVID-19 and associated factors among health care workers in Silte Zone, Southern Ethiopia

  • Mubarek Yesse ,

    Contributed equally to this work with: Mubarek Yesse, Mohammed Muze, Shemsu Kedir, Bedru Argaw, Mohammed Dengo, Tajudin Nesre, Faris Hamdalla, Awol Saliha, Tofik Mussa, India Kasim, Abdulfeta Kedir, Tofik Delebo, Awol Sunkemo, Yesuf Badeg, Dureti Ensarmu, Dereje Abebe, Amara Dessalegn, Henok Ayelign

    Roles Conceptualization, Writing – original draft

    mubarekyesse@gmail.com

    Affiliation Department of Nursing, College of Medicine and Health Sciences, Werabe University, Awasa, Southern Ethiopia

  • Mohammed Muze ,

    Contributed equally to this work with: Mubarek Yesse, Mohammed Muze, Shemsu Kedir, Bedru Argaw, Mohammed Dengo, Tajudin Nesre, Faris Hamdalla, Awol Saliha, Tofik Mussa, India Kasim, Abdulfeta Kedir, Tofik Delebo, Awol Sunkemo, Yesuf Badeg, Dureti Ensarmu, Dereje Abebe, Amara Dessalegn, Henok Ayelign

    Roles Data curation, Formal analysis, Writing – review & editing

    Affiliation Department of Nursing, College of Medicine and Health Sciences, Werabe University, Awasa, Southern Ethiopia

  • Shemsu Kedir ,

    Contributed equally to this work with: Mubarek Yesse, Mohammed Muze, Shemsu Kedir, Bedru Argaw, Mohammed Dengo, Tajudin Nesre, Faris Hamdalla, Awol Saliha, Tofik Mussa, India Kasim, Abdulfeta Kedir, Tofik Delebo, Awol Sunkemo, Yesuf Badeg, Dureti Ensarmu, Dereje Abebe, Amara Dessalegn, Henok Ayelign

    Roles Methodology

    Affiliation Department of Nursing, College of Medicine and Health Sciences, Werabe University, Awasa, Southern Ethiopia

  • Bedru Argaw ,

    Contributed equally to this work with: Mubarek Yesse, Mohammed Muze, Shemsu Kedir, Bedru Argaw, Mohammed Dengo, Tajudin Nesre, Faris Hamdalla, Awol Saliha, Tofik Mussa, India Kasim, Abdulfeta Kedir, Tofik Delebo, Awol Sunkemo, Yesuf Badeg, Dureti Ensarmu, Dereje Abebe, Amara Dessalegn, Henok Ayelign

    Roles Conceptualization

    Affiliation Department of Nursing, College of Medicine and Health Sciences, Werabe University, Awasa, Southern Ethiopia

  • Mohammed Dengo ,

    Contributed equally to this work with: Mubarek Yesse, Mohammed Muze, Shemsu Kedir, Bedru Argaw, Mohammed Dengo, Tajudin Nesre, Faris Hamdalla, Awol Saliha, Tofik Mussa, India Kasim, Abdulfeta Kedir, Tofik Delebo, Awol Sunkemo, Yesuf Badeg, Dureti Ensarmu, Dereje Abebe, Amara Dessalegn, Henok Ayelign

    Roles Investigation

    Affiliation Department of Nursing, College of Medicine and Health Sciences, Werabe University, Awasa, Southern Ethiopia

  • Tajudin Nesre ,

    Contributed equally to this work with: Mubarek Yesse, Mohammed Muze, Shemsu Kedir, Bedru Argaw, Mohammed Dengo, Tajudin Nesre, Faris Hamdalla, Awol Saliha, Tofik Mussa, India Kasim, Abdulfeta Kedir, Tofik Delebo, Awol Sunkemo, Yesuf Badeg, Dureti Ensarmu, Dereje Abebe, Amara Dessalegn, Henok Ayelign

    Roles Investigation

    Affiliation Department of Nursing, College of Medicine and Health Sciences, Werabe University, Awasa, Southern Ethiopia

  • Faris Hamdalla ,

    Contributed equally to this work with: Mubarek Yesse, Mohammed Muze, Shemsu Kedir, Bedru Argaw, Mohammed Dengo, Tajudin Nesre, Faris Hamdalla, Awol Saliha, Tofik Mussa, India Kasim, Abdulfeta Kedir, Tofik Delebo, Awol Sunkemo, Yesuf Badeg, Dureti Ensarmu, Dereje Abebe, Amara Dessalegn, Henok Ayelign

    Roles Methodology

    Affiliation Department of Statistics, College of Natural and Computational Science, Werabe University, Awasa, Southern Ethiopia

  • Awol Saliha ,

    Contributed equally to this work with: Mubarek Yesse, Mohammed Muze, Shemsu Kedir, Bedru Argaw, Mohammed Dengo, Tajudin Nesre, Faris Hamdalla, Awol Saliha, Tofik Mussa, India Kasim, Abdulfeta Kedir, Tofik Delebo, Awol Sunkemo, Yesuf Badeg, Dureti Ensarmu, Dereje Abebe, Amara Dessalegn, Henok Ayelign

    Roles Methodology

    Affiliation Department of Statistics, College of Natural and Computational Science, Werabe University, Awasa, Southern Ethiopia

  • Tofik Mussa ,

    Contributed equally to this work with: Mubarek Yesse, Mohammed Muze, Shemsu Kedir, Bedru Argaw, Mohammed Dengo, Tajudin Nesre, Faris Hamdalla, Awol Saliha, Tofik Mussa, India Kasim, Abdulfeta Kedir, Tofik Delebo, Awol Sunkemo, Yesuf Badeg, Dureti Ensarmu, Dereje Abebe, Amara Dessalegn, Henok Ayelign

    Roles Conceptualization

    Affiliation Department of Statistics, College of Natural and Computational Science, Werabe University, Awasa, Southern Ethiopia

  • India Kasim ,

    Contributed equally to this work with: Mubarek Yesse, Mohammed Muze, Shemsu Kedir, Bedru Argaw, Mohammed Dengo, Tajudin Nesre, Faris Hamdalla, Awol Saliha, Tofik Mussa, India Kasim, Abdulfeta Kedir, Tofik Delebo, Awol Sunkemo, Yesuf Badeg, Dureti Ensarmu, Dereje Abebe, Amara Dessalegn, Henok Ayelign

    Roles Formal analysis, Supervision

    Affiliation Department of Plant Science, College of Agriculture, Werabe University, Awasa, Southern Ethiopia

  • Abdulfeta Kedir ,

    Contributed equally to this work with: Mubarek Yesse, Mohammed Muze, Shemsu Kedir, Bedru Argaw, Mohammed Dengo, Tajudin Nesre, Faris Hamdalla, Awol Saliha, Tofik Mussa, India Kasim, Abdulfeta Kedir, Tofik Delebo, Awol Sunkemo, Yesuf Badeg, Dureti Ensarmu, Dereje Abebe, Amara Dessalegn, Henok Ayelign

    Roles Conceptualization, Data curation

    Affiliation Department of Siltigna, College of Humanity Sciences, Werabe University, Awasa, Southern Ethiopia

  • Tofik Delebo ,

    Contributed equally to this work with: Mubarek Yesse, Mohammed Muze, Shemsu Kedir, Bedru Argaw, Mohammed Dengo, Tajudin Nesre, Faris Hamdalla, Awol Saliha, Tofik Mussa, India Kasim, Abdulfeta Kedir, Tofik Delebo, Awol Sunkemo, Yesuf Badeg, Dureti Ensarmu, Dereje Abebe, Amara Dessalegn, Henok Ayelign

    Roles Conceptualization

    Affiliation Department of Siltigna, College of Humanity Sciences, Werabe University, Awasa, Southern Ethiopia

  • Awol Sunkemo ,

    Contributed equally to this work with: Mubarek Yesse, Mohammed Muze, Shemsu Kedir, Bedru Argaw, Mohammed Dengo, Tajudin Nesre, Faris Hamdalla, Awol Saliha, Tofik Mussa, India Kasim, Abdulfeta Kedir, Tofik Delebo, Awol Sunkemo, Yesuf Badeg, Dureti Ensarmu, Dereje Abebe, Amara Dessalegn, Henok Ayelign

    Roles Conceptualization, Supervision

    Affiliation Department of English, College of Humanity Sciences, Werabe University, Awasa, Southern Ethiopia

  • Yesuf Badeg ,

    Contributed equally to this work with: Mubarek Yesse, Mohammed Muze, Shemsu Kedir, Bedru Argaw, Mohammed Dengo, Tajudin Nesre, Faris Hamdalla, Awol Saliha, Tofik Mussa, India Kasim, Abdulfeta Kedir, Tofik Delebo, Awol Sunkemo, Yesuf Badeg, Dureti Ensarmu, Dereje Abebe, Amara Dessalegn, Henok Ayelign

    Roles Conceptualization, Data curation

    Affiliation Department of Biology, College of Natural and Computational Science, Werabe University, Awasa, Southern Ethiopia

  • Dureti Ensarmu ,

    Contributed equally to this work with: Mubarek Yesse, Mohammed Muze, Shemsu Kedir, Bedru Argaw, Mohammed Dengo, Tajudin Nesre, Faris Hamdalla, Awol Saliha, Tofik Mussa, India Kasim, Abdulfeta Kedir, Tofik Delebo, Awol Sunkemo, Yesuf Badeg, Dureti Ensarmu, Dereje Abebe, Amara Dessalegn, Henok Ayelign

    Roles Formal analysis

    Affiliation Department of Biology, College of Natural and Computational Science, Werabe University, Awasa, Southern Ethiopia

  • Dereje Abebe ,

    Contributed equally to this work with: Mubarek Yesse, Mohammed Muze, Shemsu Kedir, Bedru Argaw, Mohammed Dengo, Tajudin Nesre, Faris Hamdalla, Awol Saliha, Tofik Mussa, India Kasim, Abdulfeta Kedir, Tofik Delebo, Awol Sunkemo, Yesuf Badeg, Dureti Ensarmu, Dereje Abebe, Amara Dessalegn, Henok Ayelign

    Roles Supervision, Writing – original draft

    Affiliation Department of Biology, College of Natural and Computational Science, Werabe University, Awasa, Southern Ethiopia

  • Amara Dessalegn ,

    Contributed equally to this work with: Mubarek Yesse, Mohammed Muze, Shemsu Kedir, Bedru Argaw, Mohammed Dengo, Tajudin Nesre, Faris Hamdalla, Awol Saliha, Tofik Mussa, India Kasim, Abdulfeta Kedir, Tofik Delebo, Awol Sunkemo, Yesuf Badeg, Dureti Ensarmu, Dereje Abebe, Amara Dessalegn, Henok Ayelign

    Roles Conceptualization, Writing – review & editing

    Affiliation Department of Biology, College of Natural and Computational Science, Werabe University, Awasa, Southern Ethiopia

  •  [ ... ],
  • Henok Ayelign

    Contributed equally to this work with: Mubarek Yesse, Mohammed Muze, Shemsu Kedir, Bedru Argaw, Mohammed Dengo, Tajudin Nesre, Faris Hamdalla, Awol Saliha, Tofik Mussa, India Kasim, Abdulfeta Kedir, Tofik Delebo, Awol Sunkemo, Yesuf Badeg, Dureti Ensarmu, Dereje Abebe, Amara Dessalegn, Henok Ayelign

    Roles Conceptualization, Investigation

    Affiliation Department of Biology, College of Natural and Computational Science, Werabe University, Awasa, Southern Ethiopia

  • [ view all ]
  • [ view less ]

Assessment of knowledge, attitude and practice toward COVID-19 and associated factors among health care workers in Silte Zone, Southern Ethiopia

  • Mubarek Yesse, 
  • Mohammed Muze, 
  • Shemsu Kedir, 
  • Bedru Argaw, 
  • Mohammed Dengo, 
  • Tajudin Nesre, 
  • Faris Hamdalla, 
  • Awol Saliha, 
  • Tofik Mussa, 
  • India Kasim
PLOS
x

Abstract

Introduction

COVID-19 is a pandemic respiratory disease caused by the highly contagious novel coronavirus (SARS-CoV 2). The disease is now quickly spreading around the world, resulting in ongoing coronavirus pandemic. Healthcare workers are more susceptible to COVID-19 infection than the general population due to frequent contact with infected individuals.

Objective

This study was aimed to assess knowledge, attitude and practice towards COVID-19 and associated factors among health care workers.

Methods

Facility-based cross-sectional study design was conducted among health care workers in Silte Zone. A total of 379 health professionals were selected using multistage stratified sampling technique. Self-administered questionnaire was used to collect data. Binary logistic regression model was used to see association between outcome and independent variables.

Results

This study found 74.9%, 84.2% and 68.9% prevalence of adequate knowledge, positive attitude and good practice respectively. Working in comprehensive specialized hospital (AOR = 4.46, 95% CI = 1.46–13.62).having MSC degree (AOR = 10.26, 95% CI = 2.27–46.44), and training on COVID-19 (AOR = 6.59, 95% CI = 2.97–14.65) were strongly associated with knowledge of health care workers. On the other hand, older age (AOR = 3.35, 95% CI = 1.07–10.50), training on COVID-19 (AOR = 3.73, 95% CI = 1.82–7.63), Work experience (AOR = 3.78, 95% CI = 1.46–9.80) and Knowledge (AOR = 5.45, 95% CI = 2.60–11.43) were significantly associated with attitude, whereas source of information from friends or colleagues (AOR = 3.13, 95% CI = 1.28–7.66), working in primary hospital (AOR = 0.36, 95% CI = 0.21–0.620) and having good knowledge (AOR = 1.80, 95% CI = 1.03–3.14) were strongly associated with good practice of health care workers.

Conclusion

This study found majority of health care workers had good level of knowledge and positive attitude toward COVID-19, but lower proportion of health care workers practices sufficiently in the study area. Type of health facilities, level of education, training on COVID-19, work experience, type of source of information were significantly associated with knowledge, attitude and practice of health care workers. Stakeholders need to focus on interventions that increase preventive practices of health care workers.

Introduction

COVID-19 is an emerging respiratory disease caused by the highly contagious novel coronavirus (SARS-CoV 2) [1]. The disease was first identified in December 2019 in Wuhan, Hubei province of China, and currently quickly spreading around the world, resulting in the ongoing coronavirus pandemic [2]. As of 5th January 2020, globally more than 78.8 million cases have been reported across 218 countries and territories, resulting in more than 1,733,488 deaths. And more than 55,452,004 people have recovered [3].

Ethiopia confirmed first case of COVID-19 at 13 March 2020. Person found positive is a 48 year old Japanese man who came to Ethiopia on March 4, 2020 from Burkina Faso. Since then, number of cases is increasing. As of 5th January 2021, Ethiopia has recorded more than 125622 positive cases involving 1948 deaths [4]. Apart from personal health, COVID-19 also affects economy of the countries. According to the estimation of the United Nations Economic Commission for Africa, COVID-19 will shave 2.9 percentage points off of Ethiopia’s economic growth for fiscal year 2020 and the pandemic will also affect the Ethiopia’s export significantly [5].

Majority people infected with the COVID-19 virus will have mild to moderate respiratory illness and recover without requiring special treatment. Older people and those with underlying medical problems such as diabetes, cardiovascular disease, chronic respiratory disease, and cancer are extra likely to develop severe illness. The virus spreads primarily through droplets of saliva or discharge from the nose when an infected person sneezes or coughs [68]. The mortality rate of this infection is about 3–6% but, according to some authors, this percentage may be seriously underestimated [9].

Health care workers (HCWs) are more susceptible to COVID-19 infection than the general population due to frequent contact with infected individuals. Additionally, some procedures such as non-invasive ventilation, high-flow nasal cannula and bag-mask ventilation may generate higher aerosol volumes leads to increased risk of infection [10, 11]. The longer working hours (due to the increased number of infected people in hospital) also put them at risk of infection[12]. Number of studies reported various prevalence rate of COVID-2019 among HCWs 9.8% in New york [13] and 10.1% from a systemic review of developed countries [14].

Protection of HCWs and inhibition of intra-hospital transmission of COVID-2019 are important parts of epidemic response and this requires that HCWs must have updated knowledge regarding COVID-2019 [15]. Literature suggests that lack of knowledge and misunderstandings among HCWs leads to delayed diagnosis, spread of disease and poor infection prevention practice [16, 17]. Currently, there is scarce information regarding knowledge, attitude and practice of HCWs towards COVID-19 in Ethiopia particularly in southern part. Furthermore, previous studies in other study areas found risk factors for poor preventive practice of HCWs [1820]. The risk factors may not be the same across geographic locations. Therefore, the present study was aimed to determine current status of knowledge, attitude and practice) (KAP) towards COVID-19 and associated factors among HCWS in the study area.

Materials and methods

Study area, design and subjects

Facility-based cross-sectional study design was conducted from June 1 to July 2020 in Silte Zone. The Silte Zone is one of the Zones of the Ethiopian Southern Nations, Nationalities and Peoples Region (SNNPR) and found 172 km away from the capital city, Addis Ababa. This zone consists of 3 administration towns, 10 rural weredas and 212 kebeles. Based on last Census conducted by central statistical agency of Ethiopia (CSA), in 2018 this Zone has estimated population of 1,017,557. The Zone currently has four hospitals and 33 health centers. All HCWs working in the health facilities were source population of this study. Selected HCWs who full fill inclusion criteria were the study population. HCWs age 18 years old and above were included in the study. Sample size was calculated using single population proportion formula based on the following assumptions; 50% prevalence (P), 95% confidence level and margin of error of 5%. By applying the finite population correction formula and adding 10% non-response rate, the sample size was 391. To select study participants, First HCWs were stratified based on the type of health facilities (health center, primary hospital and comprehensive specialized hospital). Eleven health centers, one primary hospital and one compressive specialized hospital were randomly selected from each stratum. Sample size was allocated to health facilities proportionately. Accordingly, 202, 120 and 69 study participants were allocated to health centers, primary hospitals and comprehensive specialized hospital respectively. Systematic sampling technique was used to select study subjects. Total of 1871 HCWs were found in selected health facilities. Therefore, K was calculated as 5(1871/391) and from the first five HCWs, the 2nd HCW was randomly selected by using a lottery method. Accordingly, every 5th HCWs were selected based on their availability in health facilities.

Measurements and data collection tools

The structured questionnaire was prepared after reviewing published literatures [2125]. The questionnaire contains items on socio-demographic and economic factors, Knowledge related items, attitude related items and practice related items. Knowledge section comprised of 30 items assessed nature of disease, etiology, symptoms, risk group, testing, transmission, treatment and precautions/preventions. Each item was responded as yes, no or I don’t know. The right answer was labeled as 1 while wrong answer was labeled as 0. Total score ranges from 0–30 and a cut off level of <17 was set for poor knowledge and ≥18 (60% and above) for good knowledge. Attitude section comprised of 26 items assessing attitude of healthcare workers toward treatment, infection control procedure and information regarding COVID-19. Response of each item was recorded on 5-point Likert scale as follows strongly agree (5-point), agree (4-point), Undecided (3-point), disagree (2-point), and strongly disagree (1-point). Total score ranges from 26 to 130, with score of >78 (>60%) indicates positive attitude toward COVID-19 [2125]. Practice section included 16 items regarding use of face mask, and practice of other precautionary measures. Each item was responded as yes (1-point) and (0-point). Practice items total score ranged as 0–16, and a score of ≥10 demonstrated good practice and a score of <10 indicates poor practice toward precautionary measures of COVID-19 [2125].

Data quality control, processing and analysis

Data quality was assured by caring out careful design of the questionnaire, appropriate recruitment of data collectors and by giving adequate training and follow-up for data collectors and supervisors. The questionnaire was pre-tested on 5% of HCWs from health facilities not included in actual studies and modified before the main study began. The data were checked for completeness and consistency and then coded, entered and stored into the computer using Epi-data software. Data was exported to SPSS version 21 statistical packages for analysis. Descriptive statistics were calculated for demographic and economic factors, information related and job related factors. Binary logistic regression analysis was applied. All predictor variables that have an association in bivariable analysis with p-value < 0.25 were entered into multivariable logistic regression model. In multivariable logistic regression analysis, those variables with a p-value ≤ 0.05 were considered as statistically significant.

Ethical considerations

Ethical clearance was obtained from Werabe University before conducting the study. At the time of data collection, written consent was obtained from the participants. Each participant was requested to sign it to certify that he or she had agreed freely to participate in the study. Those not willing to participate were given the right to do so. Confidentiality of responses was also ensured throughout the research process.

Results

Socio-demographic characteristics of respondents

Total of 379 HCWs were participated in this study, making response rate of 96.9% were included. The mean age of the participants was 33.46 (± 6.43). Majority (87.3%) of the respondents were rural dwellers. Regarding educational level of participants, 44.9% of the respondents had first degree level of education. About 43% were married, 52.0% of the participants work at health centers and 38.3% of the participants were nurses. About one third of the respondents get information about COVID-19 mainly from TV and mean monthly income of the participant was 8192.7 (±9284.0) (Table 1).

thumbnail
Table 1. Socioeconomic and demographic characteristics of the study participants, Silte zone, southern Ethiopia, 2020.

https://doi.org/10.1371/journal.pone.0257058.t001

Knowledge of HCWs

Of the surveyed HCWs, 75% (95% CI = 70.2%-79.2%) of the HCWs had demonstrated adequate knowledge of COVID 19. In multivariate analysis, type of health institution, level of education, and training on COVID-19 were strongly associated with knowledge of HCWs about COVID-19. HCWs of comprehensive specialized hospital had good knowledge of COVID-19 4.46 times more likely than health centers (AOR = 4.46, 95% CI = 1.46–13.62). HCWS who received training on COVID-19 were 6 times had good knowledge of COVID-19 than health centers than who didn’t receive the training (AOR = 6.59, 95% CI = 2.97–14.65). Level of education also significantly associated with the knowledge. Having BSC degree (AOR = 2.84, 95% CI = 1.56–5.12) and MSC degree positively associated with of knowledge HCWs about COVID-19 (Table 2).

thumbnail
Table 2. Factors associated with Knowledge of health care workers about COVID-19 in Silte zone, southern Ethiopia, 2020.

https://doi.org/10.1371/journal.pone.0257058.t002

Attitude of HCWs

In this study, 319 (84.2%) (CI = 80.2%-87.6%) of HCWs had demonstrated positive attitude. In multivariate analysis, age of the HCWs, training on COVID-19, Work experience, and Knowledge on COVID-19 showed significant association with attitude of HCWs toward COVID-19. Age between 31–40 Years (AOR = 2.92, 95% CI = 1.44–5.92) and ≥41 Years old of HCWs (AOR = 3.35, 95% CI = 1.07–10.50) were significantly associates with positive attitude. Similarly, HCWS who received training on COVID-19 were 3.73 times had positive attitude to COVID-19 than who didn’t received the training. Work experience between 6–10 Years (AOR = 2.20, 95% CI = 1.15–4.22) and > 10 Years (AOR = 3.78, 95% CI = 1.46–9.80) were positively associated with the attitudes of the HCWs. Knowledge on COVID-19 also significantly associated with positive attitude (AOR = 5.45, 95% CI = 2.60–11.43) (Table 3).

thumbnail
Table 3. Factors associated with attitude of HCWs toward COVID-19 in Silte zone, southern Ethiopia, 2020.

https://doi.org/10.1371/journal.pone.0257058.t003

Preventive practices of HCWs

About 68.9% (CI = 64.1%-73.4%) of the HCWs had implemented appropriate preventive practice of COVID-19. In the multivariate model, source of information, type of health institution and knowledge of COVID-19 are strongly associated with preventive practice of health care workers. HCW’s source of information from friends/colleagues were 3 times more likely had good preventive practice than source of information from electronic information (AOR = 3.13, 95% CI = 1.28–7.66). HCWs of primary hospital were less likely had good practice than health centers AOR = 0.36 95% CI = 0.21–0.620). knowledge of COVID-19 also showed significant association with good preventive practices of HCWs. HCWs who had good knowledge on COVID-19 were 2 times more likely implement good preventive practice than who had poor knowledge AOR = 1.80, 95% CI = 1.03–3.14) (Table 4).

thumbnail
Table 4. Factors associated with preventive practice of COVID-19 among health care workers in Silte zone, southern Ethiopia, 2020.

https://doi.org/10.1371/journal.pone.0257058.t004

Discussion

This study was conducted to assess knowledge, attitude and practice towards COVID-19 and associated factors among HCWs in health facilities. The outputs of this study are essential to HCWs, health facilities, health management authorities to mitigate the spread of COVID-19 [26]. According to this study, 74.9% % of HCWs had demonstrated good knowledge on COVID-19. The result is comparable with other two studies conducted in Ethiopia where 70% [18] and 73.8% [27] of HCWs had sufficient knowledge. Nearly comparable finding is also reported in a study conducted in Uganda where 69% of HCWs had adequate knowledge of COVID-19 [19]. However, it is lower than findings reported in China where 89% [20], and in Pakistan 93.2% [24]. On the other hand, the finding is higher than studies conducted in Saudi Arabia and India where 45% [28] and 54.7% of HCWs had good knowledge respectively [29]. This difference might be related to variations in study area. Battling pandemic across countries may not be the same leads to deference in knowledge. Another possible reason is that it could be due to differences in the cut-off points used to categorize knowledge. In this survey, Type of health institution, level of education, and training on COVID-19 were strongly associated with knowledge of health care workers about COVID-19.

HCWs of Comprehensive specialized hospital were about 4.46 times more likely had good knowledge of COVID-19 than health centers. This may be explained by HCWs working in comprehensive specialized hospital tend to have higher level of education this may leads to deference in knowledge. HCWS who received training on COVID-19 6 times had good knowledge of COVID-19 than who didn’t receive the training.

Also level of education having BSC degree and MSC degree positively associated with the level of knowledge. Some studies have reported that educational level of HCWs had strongly associated with level of knowledge on COVID-19 [27].

Our study also found that 84.2% of HCWs had a positive attitude toward COVID -19. This finding was comparable to a study conducted in Pakistan where 86.5% of HCWs had positive attitude toward COVID-19 [28]. However, this finding was higher than other findings such as 65.7% positive attitude toward COVID-19 from northern Ethiopia [27], 53.4% from Nepal [30] and 21% from Uganda [19]. The possible reason for the difference might be due to the study setting and period; our study covers both health centers and hospitals whereas the previous was only hospital based. Other reason to the variation might be caused by differences in number of questions used and cut off value used to categorize the attitude. Increased Age of the HCWs was positively associates with positive attitude. This is in line with finding of a study done in Nepal [30]. The higher age, the longer is the experience in dealing with emergencies, ultimately showing confidence and optimism [31]. Therefore, increasing age could be the reason for a positive attitude toward COVID-19. Training on COVID-19 also demonstrated positive association with attitude. HCWS who received training on COVID-19 3.73 times had positive attitude to COVID-19 than who didn’t received the training. Training could increase knowledge leads to reduction of misinformation. Hence, training could be the reason for a positive attitude toward COVID-19. Increased work experience of HCWs significantly associated with the positive attitude toward COVID-19. This was supported by previous studies [20]. Knowledge on COVID-19 showed significant association with their attitude toward COVID-19. This finding is in congruent with previous studies [27]. Knowledge is a prerequisite for establishing beliefs, forming positive attitudes so that knowledge modulates the attitude [31].

In our study, bout 68.9% of the HCWs implemented appropriate practice. This finding was nearly comparable with studies conducted in Pakistan [29] and Uganda [19] where 73.4%, and 74% of HCWs had implemented good practice respectively. However, higher good practice 88.7% in Pakistan [28], and 81.5% in Nepal [30] were reported. Good preventive practice of the HCWs was significantly associated with source of information of COVID-19. HCW’s source of information from friends/colleagues 3 times more likely had good preventive practice than source of information from electronics. The possible reason for the association might be due to the study setting. Majority of the current study area is rural. Information from electronics (TV/Radio) no easily accessible in rural area may leads to none association with preventive practice of HCWs. HCWs of primary hospital were less likely had good practice than health centers. This is congruent with previous studies [18]. Level of knowledge also shows significant association with good practices of HCWs. HCWs who had good knowledge on COVID-19 about 2 times more likely implement good preventive practice than who had poor knowledge. Similar findings were reported in previous studies [18, 28]. Knowledge of a disease may influences practices of individuals [32].

This study has some limitations that might have minimal impact on the study findings. It is a cross-sectional survey, so we could not assess the changes, causes and effect relationship. Furthermore, there is a possibility of information bias, as surveys were self-administered. Despite these limitations, it is a survey on the KAP includes all public health facilities so that the finding is generalizable to public health facilities of the study area. This survey would probably provide up-to-date information and improve preventive practice of HCWs.

Conclusion

This study found majority of HCWs had good level of knowledge and positive attitude toward COVID-19, but lower proportion of HCWs practices sufficiently in compare to magnitude of good knowledge and positive attitude. Type of health facilities, level of education, training on COVID, work experience, type of source of information were significantly associated with knowledge, attitude and practice of HCWs toward COVID-19. So, the stakeholders must focus the training of HCWs for better practice of tackling with COVID-19. Special emphasis is required to HCWs of health centers.

Supporting information

S4 File. Containing all the supporting tables.

https://doi.org/10.1371/journal.pone.0257058.s004

(DOCX)

Acknowledgments

We wish to express our deep appreciation to all staffs and data collectors for their contribution to the overall success of this study and all respondents for their cooperation, time and genuine response.

References

  1. 1. Singhal T. A review of coronavirus disease-2019 (COVID-19). The indian journal of pediatrics. 2020;87(4):281–6. pmid:32166607
  2. 2. Hui DS, I Azhar E, Madani TA, Ntoumi F, Kock R, Dar O, et al. continuing 2019-nCoV epidemic threat of novel coronaviruses to global health—The latest 2019 novel coronavirus outbreak in Wuhan, China. Int J Infect Dis. 2019;91:264–66.
  3. 3. Worldometer. COVID-19 CORONAVIRUS PANDEMIC 2020 [cited 2020 December 23].
  4. 4. WHO. COVID-19 Situation of Ethiopia 2020 [cited 2021 5 January]. Available from: https://covid19.who.int/region/afro/country/et.
  5. 5. UNICEF. UNICEF Ethiopia Socio-economic impacts of COVID-19 Update - 14th May 20202020.
  6. 6. Adepoju P. Nigeria responds to COVID-19; first case detected in sub-Saharan Africa: Nat Med 2020.
  7. 7. Haider N, Yavlinsky A, Simons D, Osman AY, Ntoumi F, Zumla A, et al. Passengers’ destinations from China: low risk of Novel Coronavirus (2019-nCoV) transmission into Africa and South America. Epidemiology and Infection. 2020;148:e41. Epub 02/26. pmid:32100667
  8. 8. WHO. Coronavirus: WHO; 2020 [cited 2020 December 22/2020]. Available from: https://www.who.int/health-topics/coronavirus#tab=tab_1.
  9. 9. Baud D, Qi X, Nielsen-Saines K, Musso D, Pomar L, Favre G. Real estimates of mortality following COVID-19 infection. The Lancet Infectious Diseases. 2020;20(7):773. pmid:32171390
  10. 10. Gilbert M, Pullano G, Pinotti F, Valdano E, Poletto C, Boëlle P-Y, et al. Preparedness and vulnerability of African countries against importations of COVID-19: a modelling study. Lancet. 2020;395(10227):871–7. pmid:32087820.
  11. 11. Tran K, Cimon K, Severn M, Pessoa-Silva CL, Conly J. Aerosol generating procedures and risk of transmission of acute respiratory infections to healthcare workers: a systematic review. PloS one. 2012;7(4):e35797. Epub 2012/05/09. pmid:22563403
  12. 12. Lancet The. COVID-19: protecting health-care workers. The Lancet. 2020;395(10228):922. pmid:32199474
  13. 13. Jeremias A, Nguyen J, Levine J, Pollack S, Engellenner W, Thakore A, et al. Prevalence of SARS-CoV-2 Infection Among Health Care Workers in a Tertiary Community Hospital. JAMA Internal Medicine. 2020;180(12):1707–9. pmid:32780100
  14. 14. Sahu AK, Amrithanand VT, Mathew R, Aggarwal P, Nayer J, Bhoi S. COVID-19 in health care workers—A systematic review and meta-analysis. The American journal of emergency medicine. 2020;38(9):1727–31. Epub 2020/08/02. pmid:32738467.
  15. 15. Nemati M, Ebrahimi B, Nemati F. Assessment of Iranian Nurses’ Knowledge and Anxiety Toward COVID-19 During the Current Outbreak in Iran. Arch Clin Infect Dis. 2020;15(COVID-19):e102848. Epub 2020-03-02.
  16. 16. WHO. Investigation of cases of human infection with Middle East respiratory syndrome coronavirus (‎‎ MERS-CoV)‎‎: interim guidance. World Health Organization, 2018.
  17. 17. Omrani AS, Shalhoub S. Middle East respiratory syndrome coronavirus (MERS-CoV): what lessons can we learn? J Hosp Infect. 2015;91(3):188–96. Epub 08/22. pmid:26452615.
  18. 18. Asemahagn MA. Factors determining the knowledge and prevention practice of healthcare workers towards COVID-19 in Amhara region, Ethiopia: a cross-sectional survey. Tropical Medicine and Health. 2020;48(1):72. pmid:32839649
  19. 19. Olum R, Chekwech G, Wekha G, Nassozi DR, Bongomin F. Coronavirus Disease-2019: Knowledge, Attitude, and Practices of Health Care Workers at Makerere University Teaching Hospitals, Uganda. Frontiers in public health. 2020;8:181. Epub 2020/05/20. pmid:32426320; PubMed Central PMCID: PMC7204940.
  20. 20. Zhang M, Zhou M, Tang F, Wang Y, Nie H, Zhang L, et al. Knowledge, attitude, and practice regarding COVID-19 among healthcare workers in Henan, China. J Hosp Infect. 2020;105(2):183–7. Epub 2020/04/13. pmid:32278701; PubMed Central PMCID: PMC7194961.
  21. 21. Albarrak AI, Mohammed R, Al Elayan A, Al Fawaz F, Al Masry M, Al Shammari M, et al. Middle East Respiratory Syndrome (MERS): Comparing the knowledge, attitude and practices of different health care workers. J Infect Public Health. 2019;14(1):89–96. pmid:31431424.
  22. 22. Modi PD, Nair G, Uppe A, Modi J, Tuppekar B, Gharpure AS, et al. COVID-19 Awareness Among Healthcare Students and Professionals in Mumbai Metropolitan Region: A Questionnaire-Based Survey. Cureus. 2020;12(4):e7514–e. pmid:32377462.
  23. 23. Abbag HF, El-Mekki AA, Al Bshabshe AAA, Mahfouz AA, Al-Dosry AA, Mirdad RT, et al. Knowledge and attitude towards the Middle East respiratory syndrome coronavirus among healthcare personnel in the southern region of Saudi Arabia. J Infect Public Health. 2018;11(5):720–2. Epub 03/08. pmid:29525570.
  24. 24. Saqlain M, Munir MM, Rehman SU, Gulzar A, Naz S, Ahmed Z, et al. Knowledge, attitude, practice and perceived barriers among healthcare workers regarding COVID-19: a cross-sectional survey from Pakistan. J Hosp Infect. 2020;105(3):419–23. Epub 2020/05/22. pmid:32437822; PubMed Central PMCID: PMC7211584.
  25. 25. Shi Y, Wang J, Yang Y, Wang Z, Wang G, Hashimoto K, et al. Knowledge and attitudes of medical staff in Chinese psychiatric hospitals regarding COVID-19. Brain Behav Immun Health. 2020;4:100064–. Epub 03/29. pmid:32289123.
  26. 26. WHO. Infection prevention and control during health care when novel coronavirus (‎‎‎‎‎‎ nCoV)‎‎‎‎‎‎ infection is suspected: interim guidance, 25 January 2020. 2020.
  27. 27. Kassie BA, Adane A, Tilahun YT, Kassahun EA, Ayele AS, Belew AK. Knowledge and attitude towards COVID-19 and associated factors among health care providers in Northwest Ethiopia. PloS one. 2020;15(8):e0238415. Epub 2020/08/29. pmid:32857811; PubMed Central PMCID: PMC7454942.
  28. 28. Salman M, Mustafa Z, Asif N, Zaidi HA, Shehzadi N, Khan TM, et al. Knowledge, attitude and preventive practices related to COVID-19 among health professionals of Punjab province of Pakistan. Journal of infection in developing countries. 2020;14(7):707–12. Epub 2020/08/15. pmid:32794458.
  29. 29. Mehrotra S, Jambunathan P, Jindal M, Gupta A, Kapoor K. A cross-sectional survey to assess the knowledge regarding coronavirus disease (COVID-19) among health care professionals. Medical Journal Armed Forces India. 2020. pmid:32836713
  30. 30. Limbu DK, Piryani RM, Sunny AK. Healthcare workers’ knowledge, attitude and practices during the COVID-19 pandemic response in a tertiary care hospital of Nepal. 2020;15(11):e0242126. pmid:33156873.
  31. 31. Wang J, Zhou M, Liu F. Reasons for healthcare workers becoming infected with novel coronavirus disease 2019 (COVID-19) in China. J Hosp Infect. 2020;105(1):100–1. Epub 03/06. pmid:32147406.
  32. 32. McEachan R, Taylor N, Harrison R, Lawton R, Gardner P, Conner M. Meta-Analysis of the Reasoned Action Approach (RAA) to Understanding Health Behaviors. Ann Behav Med. 2016;50(4):592–612. pmid:27169555.