The practice of COVID-19 prevention strategy post vaccination among health professionals in Felege Hiwot Referral Hospital, Northwest Ethiopia

doi:10.21203/rs.3.rs-1742089/v1

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The practice of COVID-19 prevention strategy post vaccination among health professionals in Felege Hiwot Referral Hospital, Northwest Ethiopia

https://doi.org/10.21203/rs.3.rs-1742089/v1

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Background

Corona Virus Disease is an acute respiratory illness first discovered and identified in China. Countries are taking various precautions to prevent COVID-19 in accordance with WHO guidelines.

Objective

The objective of this study is to assess the practice of the COVID-19 prevention strategy post vaccination and associated factors among health professionals in Felege Hiwot Referral Hospital, Bahir Dar, Northwest Ethiopia, in 2021.

Methods

An institutional-based cross-sectional study was carried out at Felege Hiwot Referral Hospital, Bahir Dar Ethiopia.

Results

In this study, 68.7% (95% CI: (63.7, 73.8)) of health care professionals had good practice of the COVID-19 prevention strategy post vaccination. Sex, 1.76% (95% CI: (1.08, 2.89), Marital status (Married) 1.75% (95% CI: (1.09, 2.93)), and good attitude towards vaccination 3.42% (95% CI: (2.13, 5.48)) were significantly associated with the practices of health care professionals post vaccination.

Conclusions

The practices of COVID-19 preventive strategies post vaccination was good among healthcare professionals.

COVID-19 vaccine

health care professionals

prevention strategy

Ethiopia

Corona Virus Disease (COVID-19) is an acute respiratory illness first discovered and identified in China in late December 2019[1]. Due to the increasing incidence in China and after reports from many countries outside China, the World Health Organization (WHO) declared the disease a pandemic and a public health emergency on March 11, March 2020[2, 3]. Since the onset, the number of daily confirmed cases of COVID-19 has increased dramatically worldwide. The virus has caused morbidity and has killed millions of people since it occurred[4]. Now, the total number of cases is 272, 522, 026, and 5,346,562 total deaths globally[5]. The incidence is lower in Africa (3.35% cases and 4.22% deaths) but higher in the United States (18.82% cases and 15.4% deaths), Europe (29.1% cases and 27.59% deaths), and Asia (30.59% cases and 23.12% deaths) since 16 December 2021[5].

The first COVID-19 case in Ethiopia was reported on March 13, 2020[6, 7]. Pandemics are much more likely in Ethiopia due to a lack of good infrastructure and a health system, large family sizes, a lack of sanitation, population turnover, and an increase in the population. The wide variety of COVID-19 instances in Ethiopia has persisted and is expected to increase. For instance, the total number of COVID-19 cases within a nation by December 16, 2021, was 373,960 [8]. The mortality from the disease within a nation is likewise high, with an estimated 6,846 deaths attributed to the disease[8].

The burden of severe COVID-19 outcomes was highest in African countries with older populations, limited healthcare resources, and a high frequency of pre-existing health risks such as cancer, diabetes, air pollution, and obesity[9]. However, multiple factors can weaken epidemic preparedness. Preparedness in low-income countries (LICs) is further faced by the general weakness of health structures: poor quality of healthcare, low human resources capacity, lack of equipment and facilities, and vulnerable supply chains. The Center for Strategic and International Studies (CSIS) estimates the financing gap in epidemic preparedness at $4.5 billion per year in LICs and lower-middle income countries (LMICs)[5].

Vaccines are life-saving interventions and are responsible for eradicating and controlling many infectious diseases in many parts of the world[10]. The fight against coronavirus disease (COVID-19) by vaccination does not depend solely on the efficacy and safety of the vaccine[11–13].

Countries in Africa and Ethiopia are taking various precaution measures to prevent COVID-19 in accordance with the WHO guidelines, including frequent hand washing, social distance, wearing a face mask, limiting travel to crowded areas and avoiding and preventing consumption of raw meat to prevent cross-contamination[14]. Though, multiple interventions were employed simultaneously to minimize the spread of the disease because no one method is sufficient to prevent its transmission[15]. Beyond vaccination, proven effective strategies against COVID-19 transmission include wearing masks consistently and correctly[16, 17], maximizing ventilation through dilution[18] and filtration of air[19] ,and maintaining physical distance and avoiding crowds were necessity implemented and practiced[20]. Staying at home when sick, handwashing, and frequent cleaning of high-touch surfaces are all basic public health precautions that should be encouraged.

However, in Ethiopia, compliance with these strict measures is very low. For instance, in a study conducted in southern Ethiopia, only 12.3% of the population has taken precautions against COVID-19[21]. There is a paucity of literature on the practice of COVID-19 prevention strategy post vaccination toward the COVID-19 pandemic.

In Ethiopia, the magnitude and associated factors of COVID-19 prevention strategies post vaccination among health care professionals is a major public health problem and there were no studies done on this issue in the study area (Felege Hiwot Referral Hospital), which is unknown and the gap of the study. In this study, the magnitude and some of the factors associated with COVID 19-prevention strategies from Felege Hiwot Referral Hospital were assessed. Thus, this study will help researchers, policymakers, and employers to be aware of COVID-19-prevention strategies post-vaccination of health care professionals.

Therefore, the purpose of this study was to assess the practice of COVID-19 prevention and associated factors among health professionals in Felege Hiwot Referral Hospital, Bahir Dar, Northwest Ethiopia.

Study design and period

An institutional-based cross-sectional study was conducted from September 1 to October 29, 2021

Study area

Felege Hiwot Referral Hospital is located in Bahir Dar, the capital of Amhara, 565 km from Addis Ababa, the capital of Ethiopia. It was established as a district hospital in 1963 and was upgraded to a referral hospital in 1994. The hospital has departments of surgery, medicine, pediatrics, obstetrics and gynecology, psychiatry, dentistry, and orthopedics, as well as outpatient and inpatient departments and follow-up departments. The hospital has a total of 455 health care professionals. An infection prevention and control (IPC) committee at the facility is actively supporting the IPC program. Although, based on the local context/epidemiology of occupational health, it has all of the following guidelines and/or SOPs available: standard precautions, transmission-based precautions, decontamination of medical devices, aseptic technique for invasive procedures, including surgery, and specific SOPs to prevent the most prevalent hospital-acquired infections.

Population

Source population

All fully vaccinated health care professionals at Felege Hiwot Referral Hospital

Study population

Fully vaccinated health care professionals who had been working at the Felege Hiwot Referral Hospital at least the past 6(six) month.

Inclusion criteria

All health care professionals who had been working at the Felege Hiwot Referral Hospital for at least the past 6 (six) months.

Exclusion criteria

Health care professionals who were sick and absent at the time of data collection for different reasons were excluded (sick leave, annual leave, and maternity leave).

Sample size determination

The sample size was calculated for both determinant factors and practice towards COVID-19 prevention post vaccination. Then, the maximum sample size was considered for this study. Thus, the final sample size was calculated using a single population proportion formula with the following assumptions: 5% type I error, 95% confidence intervals, and a 50% proportion for practice towards COVID 19 prevention post vaccination level since an intensive literature search didn’t show any value for this problem. Finally, the researchers added 10% to compensate for the non-response of participants, and the final sample size became 422.

= [(1.96)2*0.5 (1-0.5)]/ (0.05)2 = 384 and adding 1 % it becomes 422. Where: n = required sample size, Zα/2 = critical value for normal distribution at 9 % confidence level (1.96), p = proportion and d = 0.05 ( % margin of error).

Sampling technique

Healthcare professionals were selected by a simple random sampling technique as the primary sampling unit for this study.

Data collection tools and procedures

Questionnaires and observation checklists were developed from different sources of literature to gather the information needed for the study population[22, 23]. The questionnaire was initially written in English, translated into Amharic (the local language), and then translated back into English to check for inconsistencies and distortions in the meaning of words and terms. Data collectors and supervisors were trained for two days before starting data collection. For the data gathering process, three BSC nurses and one BSC in environmental health were hired as data collectors and supervisors, respectively, to collect the data from healthcare professionals using a self-administered, structured questionnaire. An Amharic questionnaire that included detailed questions about all the research variables was used. The questionnaire was divided into four sections: sociodemographic characteristics, knowledge and attitudes about COVID-19 prevention strategies post vaccination, and observational practices of health care professionals on COVID-19 prevention strategies. Study participants were selected using a simple random sampling technique.

Variables

Dependent Variable:

Practice of COVID-19 prevention strategy

Independent Variables

Socio-demographic factors: sex, religion, age, marital status, educational level
Knowledge about the practice of COVID-19 prevention strategy (like eligible persons for vaccination)
Attitude about the practice of COVID-19 prevention strategy (E.g. willing to take the COVID-19 vaccine)
Sources of information

Operational definitions

Practice of COVID-19 prevention strategy

Fully vaccinated health care professionals who apply all the WHO COVID-19 prevention strategy post vaccination (social distancing, hand washing or using alcohol based hand rub, and mask use)[23, 24].

Fully vaccinated

A person is considered fully vaccinated when they have received a complete vaccine series and ≥ 2 weeks has passed since the final vaccine; as well as any boosters consistent with manufacturer instructions and applicable agency approval or authorization[25].

Knowledge

Respondents were asked 31 questions (Cronbach’s alpha 0.83) about their knowledge of and practice of COVID-19 prevention strategy post vaccination, such as; whether they know about a group of people who may or may not be eligible for taking the COVID-19 vaccine; the achievement of protective immunity against COVID-19 infection; the source of information The correct answers were coded as 1 and the wrong answers were coded as 0. The respondent’s knowledge questions responses were computed to get the total knowledge score. Those study participants who scored mean (x̅ = 13.7) and above the mean of the sum of the knowledge questions were considered to have good knowledge[23].

Attitude

Attitude towards COVID-19 prevention strategy post-vaccination was measured using twenty Likert scale questions, each rated from one to five (Strongly Disagree = 1, Disagree = 2, Neutral = 3, Agree = 4, Strongly Agree = 5 (Cronbach’s alpha = 0.97). First, the total number of responses for each sentiment level (strongly disagree, disagree, neutral, agree, strongly agree) was calculated. Then, the totals were added and divided by the total number of respondents. Those study participants who scored a mean (x̅ = 5.4) and above the mean of the sum of the attitude questions were considered to have a good attitude[23].

Practice

In this study, preventive practice refers to how clients go about preventing the COVID-19 pandemic. Clients who answered mean and above the mean score value (x̅ = 3.7) from practice-related questions (three) were regarded to have good practice in COVID-19 prevention, whereas those who answered below the mean score value from practice-related questions were judged to have poor practice[23].

Data quality control

Data collectors and a supervisor were trained to select study participants to collect data from. The questionnaire was pre-tested on 5% of the surveyed population. The completeness and accuracy of the data were checked when the data was collected. Trained data collectors were closely monitored by a trained supervisor. The supervisor closely monitored the data collection process and provided advice and feedback on the data collected daily. The daily exchange of information between the principal investigator and the supervisor took place over the phone. The principal investigator regularly supervised the supervisor and data collectors in the field on a daily basis.

Data processing and analysis

The data collected was rechecked for completeness and consistency. After entering the data into Epi-Info version 7.1 software, it was exported to SPSS version 23 for analysis. Descriptive statistics were used to describe the socio-demographic characteristics of the respondents. We performed bivariate and multivariable logistic regression and used the variable selection method of forward logistic regression to identify independent predictive variables or variables that were significantly associated with the practice of the COVID-19 prevention strategy. The crude odds ratio (COR) and adjusted odds ratio (AOR) of 95% CI were calculated to determine the associated practice of the COVID-19 prevention strategy coefficient, and P-values below 0.05 were declared statistically significant. The goodness of fit of the model was tested during the analysis using the goodness of fit of Hosmer and Lemeshow (P = 0.3012).

Socio-demographic characteristics of respondents

From a total of 422 study participants, 406 healthcare professionals were enrolled in this study, with a response rate of 96%. The majority of the 261 (64.3%) of the study participants were males; 364 (88.7%) were orthodox Christian followers in religion; and 218 (53.3%) were married. The mean (± SD) age of study participants was 30.4± (5.4) years [Table 1].

Table 1

Socio-demographic characteristics of the health care professionals, Bahir Dar, Northwest Ethiopia, September 1 to October 29, 2021 (n = 406)
Characteristics Categories		Frequency	Percent (%)
Sex	Male	261	64.3
Sex	Female	145	35.7
Religion	Orthodox	364	88.7
	Muslim	34	8.3
	Others*	8	3.0
Age	18–24	7	1.7
	25–30	274	67.5
	31–40	117	28.8
	> 40	8	2.0
Marital status	Single	176	43.7
	Married	218	53.3
	Others**	12	3.0
Educational level	Diploma	50	12.3
	First degree	329	81.0
	Second degree and above	27	6.7
: Protestant, Adventist; *: Widowed, Divorced, Separated

Knowledge regarding the COVID-19 vaccine

More than half (58.9% with 95% CI: (53.2, 61.6)) of the study participants had good knowledge of individuals eligible to take the COVID-19 vaccination. However, they did not know about the legally mandated COVID-19 vaccine [Table 2].

Table 2

Knowledge of health care professionals regarding eligibility to take COVID − 19 vaccine, Bahir Dar, Northwest Ethiopia, September1 to October29, 2021 (n = 406)
Knowledge questions	Eligible Frequency (%)	Not eligible Frequency (%)	Do not know Frequency (%)
It is legally mandatory to take COVID-19 vaccine.	53 (13.3)	5 (1.2)	348 (85.5)
infant < I years of age	179 (44.1)	111 (27.3)	116 (28.6)
Children and adolescents < 18 years of age	341 (84)	40 (9.8)	25 (6.2)
Adults > 18 years	392 (96.6)	8 (2.0)	6 (1.4)
Pregnant ladies and lactating mothers	249 (61.3)	78 (19.3)	79 (19.4)
Patients with chronic diseases like Diabetes, hypertension and heart diseases.	309 (76.1)	55 (13.5)	42 (10.4)
Persons having active COVID-19 Infection	177 (43.6)	155 (38.3)	74 (18.1)
Persons recovered from COVID-19 Infection	271 (66.7)	55 (13.6)	80 (19.7)
Persons allergic to food items drugs	174(42.9)	79 (19.8)	153 (37.3)
Immuno-compromised patients	225(55.4)	95 (23.4)	86 (21.2)

According to 62.6 percent of healthcare professionals, vaccination provided protective immunity against COVID-19 infection[Figure 1].

In this study, less than one fourth (17.2%), more than one third (36%), and nearly half (46.8%) of the health professionals reported that information from healthcare professionals had insignificant, somewhat significant, and very significant effects on implementing the COVID-19 preventive strategy after vaccination, respectively [Table 3].

Table 3

Health care professionals sources of information to implement COVID- 19 prevention strategies, Bahir Dar, Northwest Ethiopia, September to October 2021, (n = 406)
Source of Information	Insignificant effect Frequency (%)	Somewhat significant effect Frequency (%)	Very significant effect Frequency (%)
News from National TV/Radio	93 (22.9)	128 (31.5)	185 (45.6)
Government agencies	111 (27.3)	149 (36.7)	146 (36.0)
Social media (face book, Instagram and Whatspp)	102 (25.1)	155 (38.2)	149 (36.7)
Discussion amongst friends and family	139 (34.2)	198 (48.8)	69 (17.0)
Healthcare provider	70 (17.2)	146 (36.0)	190 (46.8)

Attitude regarding COVID − 19 vaccination

Nearly three-fourths (69.0%) of study participants had a good attitude towards taking the COVID-19 vaccination. The details are shown in Table 4.

Table 4

Attitude of health care professionals towards COVID-19 vaccination, Bahir Dar, Northwest Ethiopia, September to October 2021, (n = 406)
Attitude questions	Strongly agree Frequency (%)	Agree Frequency (%)	Neutral Frequency (%)	Disagree Frequency (%)	Strongly disagree Frequency (%)
When my turn of vaccination comes, I’m willing to take the COVID-19 vaccine.	99 (24.4)	225 (55.4)	28 (6.9)	44 (10.8)	10 (2.5)
I will prefer to acquire immunity against COVID-19 naturally (by having the disease/subclinical infection) rather than by vaccination.	1 (0.2)	20 (4.9)	86 (21.3)	89 (21.9)	210 (51.7)
I am willing to get the COVID-19 vaccine, even if I have to pay to get it.	62 (15.3)	203 (50.0)	45(11.1)	65 (16.0)	31 (7.6)
I will recommend my family and friends to get vaccinated against COVID 19	52 (12.8)	240 (59.1)	70(17.9)	32 (7.9)	52 (12.8)
Overall attitude towards Covid-19 vaccine	Good	280 (69.0)
Overall attitude towards Covid-19 vaccine	Poor	126 (31.0)

Magnitude of practice of prevention strategy after COVID- 19 vaccination

According to this study (68.7%, 95% CI: (63.7, 73.8)) of health care professionals had good practice of COVID-19 prevention strategy post vaccination. However, nearly one-third (31.3%) of participants were exposed to poor practice of the COVID-19 prevention strategy post vaccination.

Factors associated with practice of COVID-19 prevention strategies

Bivariable and multivariable logistic regression analysis was conducted to determine the factors associated with COVID-19 prevention strategies post vaccination among health care professionals. On bivariable analyses, sex, marital status, profession, and poor attitude towards vaccination had an association with the practice of COVID-19 prevention strategies post vaccination among health care professionals.

In multivariable logistic regression, sex (AOR: 1.76; 95% CI: (1.08, 2.89)), marital status (AOR: 1.75; 95% CI: (1.09, 2.93)), and good attitude towards vaccination (AOR: 3.24; 95% CI: (2.13, 5.48)) were significantly associated with the practice of COVID-19 prevention strategies post vaccination among health care professionals [Table 5].

Table 5

Binary logistic regression analysis and factors associated with COVID-19 prevention strategy after vaccination, Bahir Dar, Northwest Ethiopia, September to October 2021, (n = 406)
Variable		Practice		COR(95%CI)	AOR(95%CI
Variable		Poor	Good	COR(95%CI)	AOR(95%CI
Sex	Male	73	188	1.53(0.99,2.35)	1.76(1.08,2.89)*
Sex	Female	54	91	1	1
Marital status	Single	67	109	1	1
	Married	56	162	1.78(1.16,1.95)	1.75(1.09,2.93)*
	Others	4	8	1.23(0.36,4.24)	2.32(0.55,9.7)
Educational level	Diploma	22	28	0.54(0.19,1.45)	0.44(0.15,1.29)
	first degree	97	232	1.01(0.43,2.38)	0.93(0.36,2.37)
	second degree and above	8	19	1	1
Attitude towards vaccination	Poor	62	64	1	1
Attitude towards vaccination	Good	65	215	3.20(2.05,5.01)	3.42(2.13,5.48)*
Knowledge of vaccine	Poor	46	121	1	1
Knowledge of vaccine	Good	81	158	0.74(0.48,1.14)	0.82(0.51,1.32)
Note: “1 = reference group,* significant at p < 0.05; COR: Crude Odds Ratio; AOR: Adjusted Odds Ratio.” Hosmer– Lemeshow goodness-of-fit test was 0.06.

This study aimed to assess the practice of the COVID-19 prevention strategies post vaccination and its associated factors among health professionals in Felege Hiwot Referral Hospital. More than two-thirds of the participants in this study had prior experience with following the COVID-19 preventive strategy post vaccination. This is consistent with a study conducted in southwestern Ethiopia, in which 67.1% of respondents had good COVID-19 prevention practices[26]. However, the findings of this study were higher than those of a national systematic review and meta-analysis in Ethiopia (40.3%)[27], the Jimma zone (46.08%)[28], Dilla University Hospital (56.3%)[29], and in Northwest Ethiopia (38.73%)[30]. This difference might be due to differences in risk perception regarding COVID-19 infection and re-infection. This finding, on the other hand, is lower than that of a study conducted in China (89%)[31] and Uganda (74%)[32]. This might be due to the difference in the hospital community's COVID-19 prevention strategies post-vaccination practice and the presence of a lower-quality infection prevention committee. Another possible reason may be a lack of ongoing follow-up by the personnel and heads of each department.

Despite the fact that female participants are more willing to follow rules and regulations, the number of male 261 (64.3%) participants in this study was larger than their female 145 (35.7%) counterparts.

The sex bias identified in COVID-19 is a universal phenomenon with few exceptions. While there is no difference in the proportion of males and females with confirmed COVID-19, male patients have nearly three times the odds of seeking intensive treatment unit admission and have a higher risk of death than females[33]. Male study participants were 1.76 times more likely than their female counterparts to implement a COVID-19 prevention strategy post vaccination (AOR: 1.76; 95% CI: (1.08, 2.89)). They were nearly twice as likely as their female counterparts to use the COVID-19 preventive method post vaccination. This finding is supported by research done in the Republic of Congo[34]. Although another controversy from China reported that death rates and the gender gap in causality rates were also related to the COVID-19 prevention strategy after vaccination; 64 per 100 (4.7% mortality rate) for men as compared to 36 per 100 (2.8% mortality rate) for women[34]. Biologically, a mixture of factors such as genes, hormones, and dosage causes females and men to respond differently to many vaccines[35]. New evidence suggests that COVID-19 is killing more men globally and regionally. Females, on the other hand, are more likely to report long-term COVID-19 infection symptoms and worse vaccine side effects [36, 37]. Males are more likely to practice the COVID-19 prevention strategy post vaccination as compared to females. This may be from the difference in mortality and morbidity with gender.

The odds of implementing the COVID-19 prevention strategy post vaccination were increased by a factor of 1.75 times more likely among health care professionals who were married as compared to a single encounter (AOR: 1.75; 95% CI: (1.09, 2.93)). In this study, married participants had a higher chance of applying a COVID-19 prevention strategy post vaccination than single people. This finding is supported by research done in Jimma, Ethiopia[28]. Those who were married individuals were 3.36 times more likely to implement the COVID-19 prevention strategy compared to single individuals. This may be due to married individuals taking additional responsibility for their family members and having a higher risk perception of ignoring the COVID-19 prevention strategy even after vaccination.

Furthermore, health care professionals who had a good attitude towards COVID-19 vaccination were 3.24 times more likely to implement COVID-19 prevention strategies post vaccination as compared to those who had a poor attitude towards COVID-19 vaccination (AOR: 3.24; 95% CI: (2.13, 5.48)). However, healthcare workers with a positive attitude toward COVID-19 vaccination were three times more likely than those with a negative attitude to implement COVID-19 preventative strategies post vaccination. This could be due to health professionals that had a good attitude towards the COVID-19 vaccine and might have properly implemented the preventive strategies in order to prevent COVID-19 infection and re-infection. This finding is consistent with a research finding in the Republic of Congo[34] and Southwestern Ethiopia[26] where the stated intention to accept the COVID-19 vaccine was more likely among those with a positive attitude toward COVID-19 prevention than their counterparts. The possible reason may be less acceptance among study participants who had a negative attitude towards COVID-19 vaccination, which shows the optimistic bias since they are more inclined to underestimate their chance of contracting COVID-19. Hence, study participants who had a negative attitude towards COVID-19 vaccination were less likely to adhere to preventive measures like wearing a face mask, social distancing, and handwashing than other age groups.

The overall degree of the practice of COVID-19 preventive strategies post vaccination was good among healthcare professionals. Sex, marital status, and a good attitude towards vaccination were found to be significant predictors of the practice of COVID-19 preventive strategies post vaccination. Thus, a strengthening strategy for the practice of COVID-19 prevention post vaccination (availing necessary materials, giving training for staff about the vaccine, and taking precaution) is necessary for sustainability. Hospital administrations and the infection prevention committee should establish and implement preventative plans.

Recommendations: The hospital management and each department head should design and implement sustainability strategies to improve and maintain the practice of COVID-19 prevention strategies post the vaccination of health workers (coordination and planning, Engage and mobilize hospital communities to limit exposure and adapt strategies based on risk, capacity, and vulnerability). However, personal measures that reduce the risk of person-to-person transmissions, such as having positive attitude, hand washing, physical distancing, and respiratory etiquette, should be implemented.

Furthermore, further investigation with continuous observational study design and qualitative study methods is needed to improve and maintain the practice of COVID-19 prevention strategies post-vaccination of health care professionals.

Limitation: Our study has the following limitations: first, the study was cross-sectional and couldn’t identify causality because outcome and exposure cannot be determined because both are examined at the same time. Second, the practice of health care workers implementing COVID-19 prevention strategy post vaccination working in private hospitals was not taken into account. Third, the study was conducted in one hospital out of hospitals found in Northwest Ethiopia, and the study explores the practice of implementing a COVID-19 prevention strategy post vaccination in this hospital. Fourth, it lacks additional information assessed by a qualitative method.

AOR	Adjusted Odds Ratio
COR	Crude Odds Ratio
COVID-19	Corona Virus Disease
CSIS	enter for Strategic and International Studies
HCAI	Healthcare-associated Infections
LIC	Lower Income Countries
LMIC	Lower and Middle Income Countries
SPSS	Statistical Package for Social Sciences
UNESCO	United Nations Educational, Scientific and Cultural Organization
WHO	World Health Organization

Ethical consideration

Ethical clearance was approved and obtained from the Institutional Review Board of the University of Gondar College Of Medicine and Health Science, Institute of Public Health with reference number 2944/13. Then an official permission letter was collected from the Felege Hiwot Referral Hospital admin offices. Written informed consent was obtained from each study participant after they were included in this study. Study participants get an explanation of the purpose of the study before giving consent. We deliver information on the right to interrupt and refuse to fill out the self-administered questionnaires.

All the Method followed the tenets of the Declaration of Helsinki and also complied with the ethical requirements set by the University of Gondar. Written informed consent was obtained from each respondent before commencing data collection after an explanation of the nature and possible consequences of the study. The information sheet that clearly shows the research topic, the objectives of the study, confidentiality of the participant's responses, the study benefits, and associated risks was prepared and presented. We removed any personal identifiers to assure confidentiality of the participants and only anonymous data were used for interpretations.

Data Availability

All the data supporting our results is shown in the manuscript. The datasets used and/or analyzed in the current study are available from the corresponding author upon legitimate request.

Consent for publication

Not applicable

Competing Interests

We, authors, declare that we had no competing interests.

Authors’ Contributions

GTE conceived and designed the study. GTE, EAW, and BDB prepared the questionnaire. GTE conducted the statistical analysis and interpretation of the findings and wrote the first draft of the manuscript. GTE, EAW, and BDB provided manuscript editing. All authors read and approved the final version of this manuscript.

Funding

No funding was received for this study.

Acknowledgment

We are highly indebted to the College of Medicine and Health Sciences, University of Gondar, for supporting this research project. We would like to extend our thanks to the Felege Hiwot Referral Hospital administration for permission to conduct the study. We would also like to extend our appreciation to the study participants, supervisors, and data collectors.

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The practice of COVID-19 prevention strategy post vaccination among health professionals in Felege Hiwot Referral Hospital, Northwest Ethiopia

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Abstract

Background

Objective

Methods

Results

Conclusions

Figures

Background

Methods And Materials

Study design and period

Study area

Population

Source population

Study population

Inclusion criteria

Exclusion criteria

Sample size determination

Sampling technique

Data collection tools and procedures

Variables

Dependent Variable:

Independent Variables

Operational definitions

Data quality control

Data processing and analysis

Results

Socio-demographic characteristics of respondents

Knowledge regarding the COVID-19 vaccine

Attitude regarding COVID − 19 vaccination

Magnitude of practice of prevention strategy after COVID- 19 vaccination

Factors associated with practice of COVID-19 prevention strategies

Discussion

Conclusions

Abbreviation

Declarations

Ethical consideration

Data Availability

Consent for publication

Competing Interests

Authors’ Contributions

Funding

Acknowledgment

References

Additional Declarations

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