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

Abstract Background 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 U...

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Autores principales:	Gloria Seruwagi, Catherine Nakidde, Felix Otieno, Joshua Kayiwa, Brian Luswata, Eric Lugada, Eric Awich Ochen, Denis Muhangi, Betty Okot, Dunstan Ddamulira, Andrew Masaba, Stephen Lawoko
Formato:	article
Lenguaje:	EN
Publicado:	BMC 2021
Materias:	Health care workers (HCWs) Preparedness Resilience Health system KAP COVID-19 Special situations and conditions RC952-1245 Medical emergencies. Critical care. Intensive care. First aid RC86-88.9
Acceso en línea:	https://doaj.org/article/b897a6b3ff804b198bf99d3c1098ef91
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spelling	oai:doaj.org-article:b897a6b3ff804b198bf99d3c1098ef912021-11-07T12:17:32ZHealthworker preparedness for COVID-19 management and implementation experiences: a mixed methods study in Uganda’s refugee-hosting districts10.1186/s13031-021-00415-z1752-1505https://doaj.org/article/b897a6b3ff804b198bf99d3c1098ef912021-11-01T00:00:00Zhttps://doi.org/10.1186/s13031-021-00415-zhttps://doaj.org/toc/1752-1505Abstract Background 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.Gloria SeruwagiCatherine NakiddeFelix OtienoJoshua KayiwaBrian LuswataEric LugadaEric Awich OchenDenis MuhangiBetty OkotDunstan DdamuliraAndrew MasabaStephen LawokoBMCarticleHealth care workers (HCWs)PreparednessResilienceHealth systemKAPCOVID-19Special situations and conditionsRC952-1245Medical emergencies. Critical care. Intensive care. First aidRC86-88.9ENConflict and Health, Vol 15, Iss 1, Pp 1-22 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Health care workers (HCWs) Preparedness Resilience Health system KAP COVID-19 Special situations and conditions RC952-1245 Medical emergencies. Critical care. Intensive care. First aid RC86-88.9
spellingShingle	Health care workers (HCWs) Preparedness Resilience Health system KAP COVID-19 Special situations and conditions RC952-1245 Medical emergencies. Critical care. Intensive care. First aid RC86-88.9 Gloria Seruwagi Catherine Nakidde Felix Otieno Joshua Kayiwa Brian Luswata Eric Lugada Eric Awich Ochen Denis Muhangi Betty Okot Dunstan Ddamulira Andrew Masaba Stephen Lawoko Healthworker preparedness for COVID-19 management and implementation experiences: a mixed methods study in Uganda’s refugee-hosting districts
description	Abstract Background 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.
format	article
author	Gloria Seruwagi Catherine Nakidde Felix Otieno Joshua Kayiwa Brian Luswata Eric Lugada Eric Awich Ochen Denis Muhangi Betty Okot Dunstan Ddamulira Andrew Masaba Stephen Lawoko
author_facet	Gloria Seruwagi Catherine Nakidde Felix Otieno Joshua Kayiwa Brian Luswata Eric Lugada Eric Awich Ochen Denis Muhangi Betty Okot Dunstan Ddamulira Andrew Masaba Stephen Lawoko
author_sort	Gloria Seruwagi
title	Healthworker preparedness for COVID-19 management and implementation experiences: a mixed methods study in Uganda’s refugee-hosting districts
title_short	Healthworker preparedness for COVID-19 management and implementation experiences: a mixed methods study in Uganda’s refugee-hosting districts
title_full	Healthworker preparedness for COVID-19 management and implementation experiences: a mixed methods study in Uganda’s refugee-hosting districts
title_fullStr	Healthworker preparedness for COVID-19 management and implementation experiences: a mixed methods study in Uganda’s refugee-hosting districts
title_full_unstemmed	Healthworker preparedness for COVID-19 management and implementation experiences: a mixed methods study in Uganda’s refugee-hosting districts
title_sort	healthworker preparedness for covid-19 management and implementation experiences: a mixed methods study in uganda’s refugee-hosting districts
publisher	BMC
publishDate	2021
url	https://doaj.org/article/b897a6b3ff804b198bf99d3c1098ef91
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Healthworker preparedness for COVID-19 management and implementation experiences: a mixed methods study in Uganda’s refugee-hosting districts

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