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ORIGINAL RESEARCH

Healthcare Workers’ Knowledge, Attitude,

Practice and Perceived Health Facility
Preparedness Regarding COVID-19 in Sierra
Leone
This article was published in the following Dove Press journal:
Journal of Multidisciplinary Healthcare

Sulaiman Kanu 1, *
Background: Healthcare workers (HCWs) are known to spearhead the fight against the
Peter Bai James COVID-19 pandemic. As such, their knowledge, attitude, and practice (KAP) toward
2,3,* Abdulai Jawo coronavirus disease 2019 (COVID-19) are considered critical to the success of the current
Bah 2,4,5 John Alimamy COVID-19 response efforts. This study aims to determine HCWs’ KAP toward COVID-19
Kabba6 Musa Salieu
and assesses their perception of their healthcare facilities preparedness to respond appro-
Kamara 1
priately to the ongoing COVID-19 pandemic in Sierra Leone.
Christine Ellen Elleanor Williams 7 Methods: We conducted an online cross-sectional study among HCWs (n=516) between 1st
Joseph Sam Kanu8
May 2020 and 30th June 2020. We collected our data using a self-administered structured
1
University of Sierra Leone Teaching questionnaire via email and online social media platforms. We analyzed our data using
Hospital Complex, Connaught Hospital,
Freetown, Sierra Leone; 2Faculty of descriptive statistics and regression analysis (p<0.05).
Pharmaceutical Sciences, College of Results: Close to three-fourth of HCWs (n=375, 72.7%) were knowledgeable regarding
Medicine and Allied Health Sciences,
University of Sierra Leone, Freetown, COVID-19. Doctors were more knowledgeable than community health workers and
Sierra Leone; 3Australian Research Centre laboratory technicians (AOR= 2.48, 95% CI: 1.16–5.31, p=0.019) regarding COVID-19.
in Complementary and Integrative
Medicine, School of Public Health, Close to two- thirds of HCWs (n=301, 58.3%) HCWs show positive attitudes toward
Faculty of Health, University of COVID-19. Being male (AOR=2.08, 95% CI: 1.36–3.20, p=0.001) and directly involved in
Technology Sydney, Ultimo, Sydney,
NSW 2007, Australia; 4Faculty of Basic
COVID-19 patient care (AOR=3.21, 95% CI: 1.88–5.48, p<0.001) were identified as
Medical Sciences, College of Medicine predictors of positive attitude towards COVID-19. HCWs are generally adhering to COVID-
and Allied Health Sciences, University of 19 safe practices with majority indicating that they regularly wash or sanitize their hands
Sierra Leone, Freetown, Sierra Leone;
5
Institute for Global Health and (n=510, 98.8%) and used facemask at point of care (n=499, 96.7%). Majority of HCWs are
Development, Queen Margaret University of the view that their healthcare facilities are ill-prepared to adequately respond to COVID-
Edinburg, Musselburgh, Scotland, UK;
6
Department of Pharmacy Administration 19 with majority (n= 400, 77.5%) of them stating that their facilities lack enough personal
and Clinical Pharmacy, Center for Drug protective equipment.
Safety and Policy Research, Xi’an
Jiaotong University, Xi’an, People’s Conclusion: HCWs in Sierra Leone showed good knowledge, positive attitude and practice
Republic of China; 7Sierra Leone–China regarding COVID-19. However, HCWs are of the view that their healthcare facilities are ill-
Friendship Hospital, Ministry of Health
and Sanitation, Freetown, Sierra Leone; prepared to respond adequately to the COVID-19 outbreak. Health authorities and policy-
8
Directorate of Disease Prevention and makers need to provide the necessary resources to allow HCWs to work in a safe
Control, Ministry of Health and
Sanitation, Freetown, Sierra Leone environment.
Keywords: COVID-19, knowledge, attitude, practice, healthcare workers, Sierra Leone
*These authors contributed equally to
this work

Correspondence: Peter Bai James
Faculty of Pharmaceutical Sciences, College
of Medicine and Allied Health Sciences,
University of Sierra Leone, Freetown, Sierra
Leone
Email jamepeb@yahoo.com
Introduction
Pneumonia of unknown etiology was identified among patients in Wuhan, China in
December 2019. The virus isolated from samples was named severe acute respira-
tory syndrome coronavirus 2 (SARS-CoV-2), and the disease caused by it was
named Coronavirus disease 2019 (COVID-19).1 COVID-19 is a respiratory tract

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infection caused by a novel coronavirus. Genetic sequen-

Leone have been infected with COVID-19.10 Such high mor-
cing of the virus suggests that it is a beta coronavirus
bidity figures have the potential to create fear among HCWs
closely linked to the SARS virus.1 Mild or uncomplicated
to continue providing care to COVID-19 patients, which will
illness with COVID-19 has been seen among most people.
invariably undermine COVID-19 response efforts. The
At the same time, patients with under-lying comorbidity
current literature indicates a conflicting picture regarding
exhibited the worst clinical outcomes. 2 Fever, dry cough,
HCWs' KAP regarding COVID19. Some studies11–14 have
myalgia and fatigue symptoms were reported in most
indicated that HCWs have good knowledge of and positive
patients in a cohort study of 41 hospitalized Chinese
attitude toward COVID-19 as well as practice safer infection,
patients, and less often, symptoms of expectoration, head-
prevention and control practices put forward by international
ache, hemoptysis and diarrhea were also observed.3
and local health authorities. On the other hand, an Ethiopian
The World Health Organization (WHO) declared
study reported poor prevention practices toward COVID-19
Coronavirus Disease 2019 (COVID-19) a pandemic on
among HCWs15 while close to half of HCWs in Nepal were
March 11, 2020.4 As of the 3rd December 2020, WHO has
reported to have negative attitudes toward COVID-19.16
reported 63,965,092 confirmed cases and 1,488,120 deaths
Currently, it is not known how prepared frontline HCWs are
worldwide.5 The African region is least affected compared to
regarding the COVID-19 outbreak response in Sierra Leone.
other regions of the world. As of the 3rd December 2020,
Anecdotal evidence suggests that there might be a gap in the
1,520,631 confirmed cases and 24,464 deaths had been
preparedness towards COVID-19 with regards to their
reported in Africa.6 As of the 3rd December 2020, in Sierra
knowledge, attitude and practice. In order to expedite
Leone, 2,416 and 74 cumulative confirmed cases and deaths
outbreak containment and management, it is essential to
have been reported, respectively,6 Experts suggest that the
know frontline healthcare work- ers adherence to infection
current figures in Africa are likely an underestimation of the
prevention control (IPC) measures, which mostly is affected
real epidemiological picture of COVID-19 in the region.7
by their knowledge, attitude and practice, and availability of
The least number of cases in Africa, including Sierra Leone,
IPC materials. An informed policy on the training needs of
has been attributed to the fewer number of COVID-19 tests
frontline health workforce on COVID-
with respect to population size.7,8
19 and quantifying the needed resources is imperative.
Healthcare workers (HCWs) are always at the forefront in
Therefore, this study aimed to identify the gaps in
the response to emerging infectious diseases outbreaks, and
preparedness and serve to provide an evidence-based
as such, they are highly exposed to threats such as
knowledge in order to inform and guide policymakers for
psychological distress, stigma, burnout that increased their
successful containment of the spread of COVID-19 and the
risk of being infected.9 Sierra Leone healthcare workforce
adequate management of active cases of the disease. In order
was unprepared when the Ebola epidemic struck in 2014.
to identify the gaps in HCWs preparedness, the study
Close to 21% of the health workforce lost their lives. Despite
assessed HCWs’ KAP towards COVID-19. It also assessed
the implementation of post-Ebola recovery strategies, the
the HCWs’ perceived prepared- ness of their healthcare
Sierra Leonean healthcare system remains fragile. Like most
facilities to appropriately respond to the ongoing COVID-19
countries within the West African sub-region, the Sierra
response.
Leonean healthcare system was ill-equipped to respond to
the Ebola outbreak. Lack of personal protective equipment,
inadequate training and poor remunera- tions were some of Method
the challenges faced by healthcare workers during the Ebola Study Design and Setting
outbreak. Given that the current healthcare system is still We conducted a descriptive cross-sectional online survey
considered weak, similar challenges faced by healthcare among HCWs between 1st May 2020 and 30th June 2020.
workers during the Ebola outbreak may resurface during the This study design is appropriate for a survey of this nature
current COVID-19 outbreak. Some of these chal- lenges are without disrupting service delivery, considering the present
related to infrastructure, working environment as well as staff state of the pandemic, thus avoiding physical contact and
protection and welfare. breaking the chain of transmission. The study was carried out
HCWs' knowledge, attitude and practice (KAP) regarding in all public healthcare facilities across Sierra Leone.
COVID-19 are critical to stopping the spread of the SARS-
CoV-2 virus and the success of the overall COVID-19
Study Participants and Sampling
response. Current report estimates that 175 HCWs in Sierra
All healthcare workers (Doctors, Nurses/midwives,
Pharmacist, Community Health Officers, Laboratory
 Journal of Multidisciplinary Healthcare 2021:14
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