Healthworker preparedness for COVID‑19 management and implementation experiences: a mixed methods study in Uganda’s refugee‑hosting districts
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Date
2021
Journal Title
Journal ISSN
Volume Title
Publisher
Conflict and Health
Abstract
The 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.
Methods: A 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.
Results: On 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%).
Conclusions: HCWs 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.
Description
Keywords
Health care workers (HCWs), Preparedness, Resilience, Health system, KAP, COVID-19
Citation
Seruwagi, G., Nakidde, C., Otieno, F., Kayiwa, J., Luswata, B., Lugada, E., ... & Lawoko, S. (2021). Healthworker preparedness for COVID-19 management and implementation experiences: a mixed methods study in Uganda’s refugee-hosting districts. Conflict and Health, 15(1), 1-22. https://doi.org/10.1186/s13031-021-00415-z