key: cord-0771915-lqyn6jdf authors: Shah, SM Tanjil; Akter, Kulsuma; Hasan, Md. Shazid; Chakrovarty, Tanay; Sakib, Najmuj; Islam, Md. Tanvir title: Factors determining preventive practices of the healthcare workers regarding COVID‐19 in Bangladesh date: 2022-01-07 journal: Health Sci Rep DOI: 10.1002/hsr2.484 sha: 42ddca039a39ba93b36c223fc6cc8058937e208e doc_id: 771915 cord_uid: lqyn6jdf PURPOSE: Identifying the factors influencing the preventive practices of the healthcare workers (HCWs) is crucial during the ongoing coronavirus disease 2019 (COVID‐19) because the HCWs are exposed to unparalleled levels of risks. Such concern is starting to be explored worldwide although there is only a single study available in Bangladesh with a limited scope of explorations of the domain. Therefore, this study aimed to identify the factors determining better preventive practices of HCWs toward COVID‐19. MATERIALS AND METHODS: A cross‐sectional one‐to‐one survey was carried out using a validated questionnaire from December 15, 2020 to March 15, 2021 among a sample of 640 HCWs from Khulna, a southwestern division of Bangladesh, consisting of ten districts. The measures included socio‐demographics, knowledge, attitude, and preventive practices related information. A binary logistic regression analysis was conducted to identify factors determining preventive practices of HCWs toward COVID‐19. RESULTS: More than half of the respondents (62%) were following better preventive practices. Besides, around 70% of them had better knowledge and attitudes toward the disease. Regression analysis showed a number of major determining factors of the HCWs' better preventive practices including being a nurse or other professionals (ie, radiologists and pathologists), being graduates, working in coronavirus isolation units, managing COVID‐19 patients, having previous training, and having better attitudes toward COVID‐19. CONCLUSION: The findings confirmed that the HCWs were generally practicing preventive manners although these trends followed were not at the standard level. So, providing guidance and information from authentic sources and organizing proper training could possibly enhance the preventive behavior in managing COVID‐19 patients. Whatever the case, it is evident from the spike in the number of infections as well as deaths that the coronavirus disease 2019 (COVID- 19) pandemic will be around for some time. 1 But, human survival will entirely rely on how better we are able to follow the mandatory health guidelines (eg, early detection, isolation, contact tracing, and treatment of COVID-19 patients using precision medicines) to reduce the COVID-19 spread. 2 In this ongoing battle, healthcare workers (HCWs) were on the frontline from the very beginning and prone to get infected. 3, 4 A serious occupational threat to their health has always persisted due to the frequent exposures to actively infected individuals and others (e.g., nurses had to collect clinical samples from suspected patients and deliver medicines during treatments, radiologists had to examine patients' lungs, pathologists had to perform molecular diagnosis, physicians had to treat the patients etc.). 5 In addition, the HCWs were unable to maintain proper safety in many cases owing to extreme working pressure derived from the scarce human resources in the sectors. 6 In Bangladesh, the situation in health-related sector is of great concern. It has been reported that several hospitalized COVID-19 affected patients did not disclose their travel or contact history, or other flu-like symptoms during the early surge of the pandemic. 7 With the first death case of an HCW in April 2020, the condition worsened day by day. 8 However, in terms of the HCWs, a relatively lesser mortality rate of 0.05 (per 100 000 population) was reported in Bangladesh in comparison to other nations (eg, 0.35 in Italy, 0.16 in UK etc.) which have a lower number of total population. [9] [10] [11] [12] Nevertheless, the abovementioned number is tough to justify on account of the lack of available research data and shortages of testing capacities in Bangladesh. 13 Poor knowledge and practice of the HCWs proved to play a significant role in the mismanagement of cross-infection in different studies. [14] [15] [16] The disease transmission among the HCWs is usually exaggerated by the overcrowding of patients, absence of isolation facilities, contaminated environment, and is likely to be enhanced by insufficient knowledge and awareness of infection control practices among HCWs. 2, 17 Taken that, like many other countries, the government of Bangladesh also followed WHO recommendations to prevent the spread of COVID-19, and additionally, several governmental institutes/hospitals arranged the training on managing COVID-19 for HCWs across the country. [18] [19] [20] [21] [22] For a country like Bangladesh with limited healthcare settings and high population density, fighting COVID-19 is next to impossible without regulatory guidelines. Understanding the proper preventive practices toward COVID-19 infection will train the HCWs in preparing those mandatory guidelines. There is only one study available in the country to date that addressed the issue although that study was limited to personal protective equipment as the prevention strategy, had a small sample size, and provided less information on overall preventive practices. 23 Thus, the current study thoroughly investigated the ongoing preventive practices of HCWs in relation to COVID-19 and determined the incorporated factors significant to those behaviors. A well-designed questionnaire was prepared by following the interim guidance of WHO on "Risk assessment and management of exposure of health care workers in the context of COVID-19" 22 and other previous researches. [24] [25] [26] The questionnaire was prepared in English and validated by the authors. Compatibility with the present setting and comparability with the preceding surveys were emphasized in determining the questions to be included or excluded. The questionnaire was reviewed and validated by five expert faculty members (ie, two microbiologists, one licensed health-care professional, one statistician, and one public health epidemiologist) from the relevant departments of JUST (i.e., Microbiology, Nursing and Health Science, and public health): various drafts were prepared and evaluated by them for the appropriateness of response options to be applicable in the country perspective. To simplify the data collection process, the questionnaire was translated from English to Bangla and back translated into English by two responsible persons who are fluent in both dialects. The Bangla version was handed to the data collectors. All data collectors were trained in interviewing HCWs and submitting data through the Google form. Besides, the questionnaire was pretested on 50 HCWs, and they were excluded finally from the study. Internal consistency and reliability were determined by calculating Chronbach's alpha value which was 0.665 for the revised and final questionnaire. A Google form was also created using the questionnaire that contained the fol- practices. Bad/ unacceptable practice was given 0, acceptable/ moderate practice was given 1, and best/preferred practice was scored 3. Thus, the possible maximum score was calculated as 36 and a minimum of 12. Respondents with ≥23.0 practice score were considered to have better practices. Rounded mean values of the scores were used as the thresholds for "better" knowledge, "better" attitude, and "better" practices, respectively. Detailed questionnaire with appropriate answers to justify the "better" knowledge, "better" attitude, and "better" practices for each question can be found in the Data S1. The data from the Google forms were exported to Microsoft Excel and checked for ambiguity. Data with <80% response were removed from the final analysis. After data cleaning, raw data were imported to SPSS (vs 24.0, IBM, Chicago, IL) and analyzed. Descriptive analyses were done with percentages and proportions. Individual participant's knowledge, attitude, and practice scores were calculated. A student's t test, ANOVA test, and Chi-square were used to evaluate significant differences among different demographic groups and associations with different demographic factors. Spearman rank correlation was done between knowledge and practice scores. As we observed a slightly skewed distribution in the mean scores, we categorized the mean scores and performed logistic rather than linear regression analyses. Binary logistic regression analyses were performed to identify the factors associated with better practices toward COVID-19. In all the tests, P-value <.05 was considered statistically significant. All the graphs were prepared by using GraphPad Prism 8.0 (GraphPad Software, USA). Demographic characteristics of the study participants are presented in Responses of the participants to COVID-19 knowledge related questions are shown in Figure 1 . (Table 2) . Moreover, Table 3 showed significant association in the level of knowledge with education (χ 2 = 9.042; P = .011), profession (χ 2 = 16.334; P < .001), training status (χ 2 = 5.794; P = .016), working sector (χ 2 = 4.986; P = .026), and workplace (χ 2 = 16.046, P < .001) ( Table 3 ). The mean attitude score of the participants was 10.02 ± 1.319 (ranged from 4 to 12) ( Participants' responses to practice questions are shown in Figure 3 . The Spearman rank correlation analyses revealed a positive correlation (P < .01) between knowledge, attitude, and practice scores (Table S1) In this study, maximum partakers had better knowledge of COVID-19, which is similar to a previously published work by Asemahagn. 27 However, the current finding (ie, 70%) is not up to the mark compared to Saqlain et al, 15 Wahed et al, 26 COVID-19. Providing updated information through authentic sources is also recommended. The authors declare that they have no potential conflicts of interest. Conceptualization: SM Tanjil this study and take complete responsibility for the integrity of the data and the accuracy of the data analysis. The lead author affirms that this manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned (and, if relevant, registered) have been explained. The data that support the findings of this study are available from the corresponding author upon request. ORCID SM Tanjil Shah https://orcid.org/0000-0001-8010-3365 World Health Organization. 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