Knowledge, Attitude and Practices of Frontline Health Care Workers to Disaster Risk Management in Private General Hospitals in Addis Ababa, Ethiopia: Multicenter Cross-Sectional Study (2024)

Abstract

Keywords: Disaster, risk management, private hospitals, Ethiopia

Introduction

Disaster is a serious acute deterioration of the functioning of society that overwhelms the capacity of the affected regions to overcome it with their own resources; so external assistance is required (1-4).

Around 1.6 million people have died because of disasters in the world that is approximately 65,000 deaths annually, and trillions of dollars in related damages have been lost, since 1990. Disasters are able to change the appearance of a developing nation suddenly and may collapse their years of achievement (5-7).

Disaster risk management is the knowledge, capacities and organizational systems developed by governments, response and recovery organizations, communities and individuals to effectively anticipate, respond to, and recover from the impacts of likely, imminent, emerging, or current emergencies (2, 8, 9). The health service in disasters is mainly targeted to save lives and maintain the wellbeing of the victims. Disaster response requires adequate human resources in both public and private health sectors. Uninterrupted service flow should be created and maintained from the disaster scene to final treatment centers (2, 8, 9).

Globally, disaster related impact is increased. Around 7348 natural disasters were reported in the world, from which 1.2 million people were died and 4 billion people were affected in 2000-2019. By the end of 2021, the COVID-19 pandemic had killed 2 million people, with continuous growth of infected people and emergence of new variants. Developing countries are significantly affected by disaster, and the risk is being extended with climate change (10-12).

In 2010, outbreaks of infectious diseases were reported in many African countries. In the same year, cholera affected 100,000 people and killed 3000 people while meningitis affected 29,000 people and killed 3000 people (13). Although many reports of disaster losses have been underestimated, African countries have lost around $2.5 trillion in this century (14).

Many parts of human life, particularly in developing countries, are markedly being affected with severe consequences of disastrous situations due to significant distraction and inadequate disaster preparedness, which needs involvement of public and private health institutions (6, 15). To address these problems, the 3^rd UN Conference (2015) established the “Sendai Framework for Action” across the disaster risk management continuum of prevention, preparedness, response, and recovery and focused on the resilience of communities, and health and social systems (16).

Disaster risk management needs a scientifically studied interrelated chain between community, government and private organizations. Although few published researches on disaster risk management in communities and public institutions were done in Addis Ababa (AA), there is no published study regarding disaster risk management in private health institutions. Around 40-60% of HCW in private and public hospitals of AA did not know whom to contact during infectious disease outbreak in hospitals, and the majority of HCW were not confident to handle a suspected case of COVID-19 (17).

Hence, this study assessed KAP and its influencing factors of HCW in private general hospitals and to develop recommendations for health facilities, leaders and policy makers on identified gaps. Additionally, this study could be used as a scientific evidence for future studies.

Methods

The study design was multicenter cross-sectional survey by using structured closed- and open-ended questions. The study was conducted at private general hospitals in Addis Ababa, which is a capital city of Ethiopia and the seat for the African Union (AU). It covers an area of 530 square kilometers and has a population size of 3,048,63, of whom 1,595,968 were females and the rest 1,452,663 were males during the study period. The city is divided into 11 sub-cities and has 49 hospitals. Thirteen are public hospitals. Thirty-six of the city's hospitals are private, from which 21 hospitals serve as general hospitals. The study was conducted from July 20-September 30, 2022. All HCWs in Addis Ababa private general hospitals during the study period were considered as the source population.

The sample size for the study was 270. It was determined by using population correction formula as the source population was below 10,000, and 10% drop out was added.

HCW working in, ED, triage areas, pharmacies, laboratories, and imaging rooms for at least six months were included; while HCW who are working there below 6 months, part-time HCW, and interns were excluded.

Age, gender, educational level, profession, experience, working institution, training, disaster risk management plan, and drill were independent variables. And knowledge on disaster risk management, attitude on disaster risk management, and practice on disaster risk management were dependent variables.

The questionnaire was developed after prior similar studies were reviewed and used with certain modifications (6, 18, 19). Data was collected with structured open- and close-ended items that included seven socio-demographic questions, eleven knowledge related questions, seventeen attitude questions and seven practice related questions.

Data coding and entering was performed using Epi-info 7.0. Frequency and cross-tabulation were used to check for missed values and variables. Statistical analysis was done using SPSS 25. Descriptive analyses and associations were reported and presented in figures and tables.

All data were checked for clarity, completeness and correct recording by the principal investigator. Ethical clearance was obtained from the Ethical and Research Committee of SPHMMC. The hospital administrators were informed about the purpose of the study, anticipated benefits, selection criteria, and data collection procedures. Confidentiality of participants was kept during the study and throughout dissemination of the result.

The following operational definitions are used.

Frontline HCW: HCW who are actively involved in patient diagnosis and clinical management

Drills: exercises in which health care workers simulate the circ*mstances of a disaster.

Good knowledge: participants who have scored at least 50% on knowledge questions

Poor knowledge: participants who have scored below 50% on knowledge questions

Positive attitude: participants who have scored above 50% of attitude questions

Negative attitude: participants who have scored at least 50% on attitude questions

Good practice: participants who have scored at least 50% on practice questions

Poor practice: participants who have scored below 50% on practice questions

Results

Socio-demographic characteristics of the study participants: A total of 267 health professionals participated in the study making a response rate of 98.9%. From the total participants, 139(52.1%) were females and 128(47.9%) were males, making the male-to-female ratio of 0.9:1.

More than 2/3^rd (69.7%) of the participants were in the age range of 21-30 years, and the mean age of the study participants was 28.99 with SD 5.23. Most of the taken (77.9%) had never taken training about disaster risk management (Table 1).

The majority (39%) of the participants were nurses, followed by laboratory technicians and physicians (Figure 1).

Level of knowledge towards disaster risk management: Around 64% of the participants had poor level of knowledge towards disaster risk management. The majority of the participants (70.8%) rated their level of knowledge for disaster risk management as favorable (good and very good) (Table 2).

From variables entered into multivariate logistic regression, lack of previous training (p=0.011, AOR=.406(.202-.815), 95%CI), inadequate level of practice (p=.000, AOR=.049(.014-.177), 95% CI) and health service experience below one year (p=.046, AOR=.044(.002-.948), 95% CI) were negatively associated with good level of knowledge (Table 3).

Level of attitude towards disaster risk management: Majority of the participants believed that every hospital should have disaster risk management plan to handle situations in which there is a sudden large influx of patients (Table 4).

This study revealed that overall attitude was positive in 250(93.6%) of the participants.

Level of practices towards disaster risk management: In the past one year, 238(89.1%) study participants did not practice what to do on disastrous situation (Table 5).

From eligible variables entered to multivariate logistic regression, poor level of knowledge was negatively associated with good level of practice (p=0.000, AOR=.053(.015-.186), 95% CI).

Discussion

More than 2/3^rd (69.7%) of the participants were within of 21-30 years. From the total participants, 139(52.1%) were females while 128(47.9%) were males. The majority of the participants (60.3%) had work experience of 1-5 years. Most of the respondents (77.9%) had never taken training about disaster risk management. This result is comparable with the finding of a similar study conducted in Kenyatta National Hospital (20). However, this result is lower than the finding in Seton Hall University (21), which revealed that 89.4% of participants had prior disaster preparedness training. This may be because of the difference in participants.

Level of knowledge towards disaster risk management: This study showed that 171(64%) of the participants had poor level of knowledge regarding disaster risk management, which is supported by reports of studies done in Amhara regional state and AA public hospitals (7, 22). However, it is different from a similar study in Saudi Arabia and Jimma Zone, Ethiopia (23, 24). This discrepancy may be due to the difference in study area.

Only 125(46.8%) participants gave the correct answer about the meaning of disaster risk management. In this study, 82(30.7%) of the participants knew that their institutions had disaster risk management plans, from whom 30(11.2%) knew where they could have found the copy of the plan. This result is different from a study done in AA teaching hospitals where 67% of the participants correctly responded what disaster preparedness is (25) and a result in South Gondar hospitals where 62(41.1%) participants knew the availability of disaster plan in their working institutions (18). From the variables entered into multivariate logistic regression, lack of previous training, inadequate level of practice and health service experience below one year were negatively associated with good level of knowledge. This result is comparable with a the findings of similar study in AA teaching hospitals, Kenyatta National Hospital, and Italian hospitals (20, 25, 26).

Level of attitude towards disaster risk management: This study revealed that the overall attitude of the participants was positive in 250(93.6%) of them, which is better than a similar study conducted in frontline nurses in Amhara regional state referral hospitals (7) and KAP of nurses regarding disaster and emergency preparedness in Saudi Arabia (23). From all the participants, 45% of had unfavorable attitude that the hospital is unlikely to be affected by any disaster. This is supported by a comparable study conducted in Central Saudi Arabia (19).

Level of practice towards disaster risk management: Only 10.9% of the study participants had adequate practice. This finding is lower than a study done in AA government hospitals in which 56.4% of participants had adequate practice(22). It is also lower than a study conducted in two AA teaching hospitals where 40.6% of study participants had adequate practice(25). The reason behind may be the fact that most private general hospitals did not have disaster risk management plans. Poor level of knowledge was negatively associated with good level of practice, which is in line with a research conducted in AA government hospitals (22, 25).

This study did not include other supportive staff, and the study design was also cross-sectional with limited study area. Occurrence of disaster can happen anytime and anywhere, which mainly affects those with suboptimal preparation. Since involvement of private institutions is important for disaster risk management, HCWs have to be prepared for the proper response.

This study revealed that the majority of the participants had never taken any training about disaster risk management. Only a small proportion of the study participants knew that their hospital had disaster risk management plans. Most of the participants did not know the definitions of disaster, disaster risk management and drill. Although the majority of the participants had positive attitude, the mean levels of knowledge and practice were poor to properly handle large influx of patients. Most of the participants had positive attitude towards the need of disaster training in their health education curriculum and in their working environment. Good level of knowledge was positively associated with good level of practice.

Acknowledgements

We would like to thank St. Paul's Hospital Millennium Medical College, private hospitals' administrators and health care workers.

References