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ATTITUDE, KNOWLEDGE AND PERCEPTION OF HEALTH WORKERS ON TRANSMISSION AND PREVENTION OF COVID-19 (A CASE STUDY OF HEALTH WORKERS IN THE OUTPATIENT DEPARTMENT OF UNIVERSITY COLLEGE HOSPITAL, IBADAN)

CHAPTER ONE

INTRODUCTION

1.1 Background to the Study
Health related infections are the major problems of public health in many nations of the world, which ultimately cause
an increase in the morbidity, mortality, and additional costs in health care settings (Mauldin et al 2010; Defez et al, 2008
and Llata et al, 2009). Ensuring hand hygiene is therefore one of the basic means preventing the spread of such
infections. In 1983, Semmelweis highlighted that cleansing of contaminated hands with antiseptic products before and
after contact with patients may reduce health related infections (Semmelweis I. 1988). Thereafter, Centre for Disease
Control and Prevention published the first formal guidelines on hand washing practices in hospitals (Garner JS, Favero
MS. 1986), followed by guidelines from the Association for Professionals in Infection Control and Epidemiology (APIC)
(Larson et al, 1995).
corona viruses are common viruses that most people get sometime in their life and may also infect animals.
Human coronaviruses (hCoV) which has been globally trending for over a month now usually causes upper respiratory
tract illnesses. Severe Acute Respiratory Syndrome (SARS-CoV) that occurred way back in 2003 served as a reminder
to this newly emerging zoonotic coronaviruses which has the potential to transmit from person to person and to cause
severe human illnesses. Novel coronavirus (nCoV), described as Middle East Respiratory Syndrome coronavirus
(MERS-CoV), is a particular strain different from any other known hCoV with a possibility of zoonotic transmission.
However, Centre for Disease Control and Prevention (2014) revealed that investigations was carried out to figure out
the reservoir and source of infection, route of transmission to humans, symptoms, prevention, severity and clinical
effects with gradually increasing number of reported cases on daily basis.
There has been a rapid international response following the news of this new virus from Wuhan, China on the
12th of February 2020 which has now spread to every nook and cranny of the world. An interim case definition was
developed rapidly by WHO to ensure that a systematic approach is followed for appropriate identification and
investigation of suspected cases. The body has also made arrangement for disbursing huge amount of money for the
prevention and cure of this pandemic disease now known as COVID-19 to the high risk affected nations of the world.
Understanding the knowledge, attitudes, and perception of health workers on transmission and prevention of COVID-19
is essential to bring forth a sustained change in behaviors of individuals and institutions and to improve such practices
when designing interventions. This is why health workers and the government are clamouring for hand hygiene. This can be achieved by frequently washing of the hands. Several factors are involved in hand hygiene behavior such as
attitude, perceived social norm, perceived behavioral control, perceived risk for infection, hand hygiene practices,
perceived role model, perceived knowledge, and motivation (Larson et al, 2000). Despite the number of published
studies on hand hygiene, many questions concerning attitudes and knowledge of health care workers (HCWs) remain
unanswered. This is particularly true in primary care settings where the volume of patients and complexities of cultural,
institutional, and health policy factors can influence the practice of hand washing. Various studies have confirmed an
inverse relation between intensity of patient care and adherence to hand hygiene practice (Pittet et al, 2004; Harbarth et
al, 2001 and Arenas et al, 2005). Additionally, the current burden of the spreading Middle East respiratory syndrome
coronavirus (MERS-CoV) implied an action to review our basic strategies in hand hygiene practice. In a descriptive
study (47 cases), MERS-CoV was found to be associated with substantial mortality in admitted patients who have
medical co morbidities. This brings about adequate infection control measures among health workers, for example,
hand hygiene. Hence, knowledge, attitudes, and perception of hand hygiene will continue to be a major concern and
are important to examine to bridge the theory practice gap.
The discovery of this new virus mandates it for China to demonstrate to rest of the world how vigilant and prepared they
are to prevent the global spread of a new infection and protect both global health and the wellbeing of their own
peoples. The countries of the region need to be vigilant and put in place enhanced public health surveillance plan for
identifying suspected cases using WHO’s recommended case definition and investigation protocol (Malik et al., 2012).
The US, UK, Germany, Italy and even Nigeria are currently battling with COVID-19 pandemic. It has taken a great
concern at the governmental and public levels as it led to a number of human infections and deaths. Since February 12,
to March 26, 2020; the total number of infected cases with COVID-19, as reported by worldometers, reached 478,446
of global cases of which 21,524 cases have died and a total of global recovery stands at 115,668.
We need to better understand the public health implication of emergence of this new respiratory virus from
China to understand the exposure risks. The current situation in Nigeria needs to be carefully monitored by our health
workers as there is a fear from increased number of human infections and deaths recording on daily basis. Till now, no
COVID-19 cases have been confirmed in some states in Nigeria, however, in south western part of Nigeria, as at 26th
of March, 2020, Lagos State has recorded 32 cases, while Ogun has recorded 3, Ekiti, Osunand Oyo (the case study
for this research work) has recorded 1 case each. Thus, the concern over the possibility of an outbreak in Oyo State
should not be taken lightly. The problem of COVID-19 pandemic becomes more complicated in absence of any
prophylactic vaccines, curative treatment and lack of experience in control measures (Al-Ahdal et al., 2012). It is against
this backdrop that the study sets to examine the attitude, knowledge and perception of health workers on transmission
and prevention of COVID-19 by using health workers in the outpatient department of University College hospital Ibadan
as a case study.

1.2 Statement of the Problem
Once again, the world is currently experiencing a global viral COVID-19 pandemic. As of March 26, 2020
confirmed cases of coronavirus disease (COVID-19) has been reported to be 478,446 and 21,524 deaths had been
reported in more than 30 countries of the world. The majority of cases as at the time of writing have been from China
which is closely followed by Italy, US, UK, Germany and Spain. Most countries in the world have made efforts to halt
transmission through shutting down transport, quarantining entire cities, regular washing of the hand with soap and
sanitizer and enforcing the use of face masks. International flights have been cancelled in Nigeria and other African
nations have been following suites and affected cruise ships quarantined. This has been having effects on the economy
of the world.
The effects of COVID-19 pandemic outbreak to the economy of the world will surely be discussed in its
aftermath. The initial response in China to contain the virus has been applauded by WHO and considered much
improved compared with its response to the 2003 SARS-CoV epidemic. Internationally, we have seen rapid generation
and sharing of knowledge to the benefit of the outbreak response, but also counterproductive actions by some
countries, including limiting trade and shutting of borders, to its detriment. With the increasing frequency of zoonotic
spillovers leading to human infections and transmission, it is apparent that pandemic preparedness has become a
priority for the global health agenda. It is on this claim that this study aims to examine the attitude, knowledge and
perception of health workers on transmission and prevention of COVID-19 by using health workers in the outpatient
department of University College hospital Ibadan as a case study.

1.3 Objectives of the Study
The objective of this study is to examine the attitude, knowledge and perception of health workers on transmission and
prevention of COVID-19 by using health workers in the outpatient department of University College hospital Ibadan as a
case study. However, the specific objectives are:
i) To understand the attitude, knowledge and perception of health workers to the general public towards the
prevention of COVID-19 in Oyo State
ii) To determine the strategies used by health workers in the State to stop the general spread COVID-19
iii) To study the effects of COVID-19 on the economic status of the world
iv) To establish the symptoms of COVID-19 and the steps to take when these symptoms occur

1.4 Research Questions
The following questions were generated during the course of this study:
i) What are the attitude, knowledge and perception of health workers to the general public towards the
prevention of COVID-19 in Oyo State?
ii) What are the strategies used by health workers in the State to stop the general spread COVID-19?
iii) What are the effects of COVID-19 on the economic status of the world?
iv) What are the symptoms of COVID-19 and the steps to take when these symptoms occur?

1.5 Significance of the Study
Theoretically, this study stands to provide additional knowledge to the body of existing literature on the spread this
pandemic disease to the world and of particular reference to Nigeria. The result of this study will serve as good base or
guide for future reference and it will also encourage further research on the importance of staying healthy. Furthermore,
this study will provide relevant information on the reasons for the spread of this disease from China to the rest of the
world.
Practically, the findings of this study will reveal the reasons for regular health check up for the benefit of staying healthy
at all times. The result from this research will also help health workers to design relevant, persuasive health messages
that will help change the people’s attitude on the utilization of hospitals and create more awareness on the situation of
health care services in the country. This study will be of great significant to the medical professionals who have
defaulted in carrying out their duties to their patients