A cross-sectional research conducted to assess pharmacists' knowledge, attitude, practice, and readiness in the presence of the COVID-19 epidemic in Baghdad.

doi:10.21203/rs.3.rs-1863456/v1

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A cross-sectional research conducted to assess pharmacists' knowledge, attitude, practice, and readiness in the presence of the COVID-19 epidemic in Baghdad.

https://doi.org/10.21203/rs.3.rs-1863456/v1

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Background

- Usually, community pharmacies that are expected to take extraordinary efforts to prevent client cross-infection sell masks and disinfectants. Additionally, it is their duty to take the lead in informing the public about this outbreak. Therefore, the study aims to test Iraqi pharmacists' knowledge of COVID-19.

Methods

- Numerous pharmacies in Baghdad were randomly visited outside of lockdown hours and had to complete a Google form following each visit. The form had simple checkboxes for all desired observations and specialized spaces for any additional information that needed to be noted. The survey's statistical analyses were descriptive, and no formal hypothesis testing was performed. Numbers and percentages were used to summarize the results.

Results

- Iraqi pharmacists trusted the WHO, media and websites, and Ministry of health (MOH) websites for COVID-19 information. According to the data, pharmacists administered acetaminophen and corticosteroids for COVID-19 infection treatment. The results also showed that Zing, Vitamin C, and Vitamin D were recommended to improve immunity and that these medicines were given orally. Massive numbers of pharmacists suggest that the call center of MOH is not applicable.

Conclusion

- the Iraqi Ministry of Health did not include pharmacists in its health emergency preparations. This resulted in a general delay in pharmacies' readiness. National governments and organizations may benefit from using pharmacists' knowledge and skills to reduce or stop future COVID-19 waves and manage risk if these waves do happen.

Awareness

Community pharmacists

COVID-19

Iraq

Knowledge

Several prophylactic strategies have been proposed to limit the spread of COVID-19 viruses among humans. Face masks, excellent cleanliness, and social isolation are some of the most highly suggested approaches, during the COVID-19 pandemic (Adhikari et al., 2020). Hand sanitizers and masks are commonly purchased in pharmacies, which are regularly frequented by the general population for prescriptions, health-related products, and important information (Hayden & Parkin, 2020).

Pharmacists, as a crucial part of the healthcare system, contribute significantly to patient care and public health through dispensing prescriptions and administering treatments (Bukhari et al., 2020), vaccinations (APhA, 2020), and vital health services to the public (Song et al., 2021). The role of pharmacists in combating the pandemic is critical during this pandemic. During the COVID-19 reaction, the Centers for Disease Control and Prevention (CDC) and the International Pharmaceutical Federation (FIP) of the USA issued recommendations to pharmacists. These recommendations discuss the role and responsibilities of pharmacists during a COVID-19 pandemic. According to FIP, the community and pharmacy play an important role in: -

1- Educating and informing the people.

2- Pharmacovigilance.

3- Counselling.

4- Referring.

5- Promoting infection control.

6- Promoting disease prevention.

7- Providing patient care and support in collaboration with other healthcare professionals.

8- Assuring the safe storage and distribution of pharmaceutical supplies and devices, such as medications, masks, and other such items (International Pharmaceutical Federation (FIP), 2020). Pharmacists must be adaptable to changes in pharmacy practice (Basheti et al., 2021). During the epidemic, it is important to know how pharmacists see their roles and responsibilities.

During the COVID-19 pandemic, the number of consumers at community pharmacies increased in the United Kingdom, as did obvious improper consumer behavior regarding preventive procedures, even though the majority of pharmacies properly followed these measures (Hasan et al., 2021). In contrast, Australian research found that most pharmacists were unaware of the appropriate infection control procedures required in a community pharmacy environment during the epidemic (Sum & Ow, 2021). The situation looks to be considerably worse in Pakistan's community pharmacies, where the idea of pharmaceutical care was not widely used before the epidemic (Atif & Malik, 2020). Community pharmacists in Zimbabwe have been identified as being at risk of infection due to a lack of preparedness and prevention measures (Dzingirai et al., 2020).

Iraq (population 40 million) announced its first COVID-19 case on March 2, 2020. The patient was an Iraqi national who had recently returned from Iran. Since then, the government has taken strict measures to halt the spread of the disease, including: -

Lockdown during specific times (Various levels of lockdown are used, ranging from partial to full).
Mass gatherings are forbidden.
Even those who breach the restrictions of residency get free care and quarantine.
The development of a hygienic culture and social distance among citizens and residents, especially while visiting busy places.

In some locations, the Ministry of Health has released strict guidelines, such as the use of appropriate marks for safe isolation, the availability of freehand sanitisers, the monitoring of customers' temperatures, and the complete unwillingness of entry for customers whose temperatures exceed 38°C and who do not wear face masks. However, by the end of March 2020, the total number of COVID-19 cases in Iraq had risen to 1,519 (4: 100,000). As a result, pharmacists are required to bear the burden of disseminating information about COVID-19 and promoting the use of preventative measures to assist communities in surviving this epidemic (Cadogan & Hughes, 2021). The goal of this study was to see how prepared private community pharmacies were for a COVID-19 pandemic, in terms of the ability to deliver pharmaceutical items. The study also looked at how well Iraqi community pharmacists knew about the disease and how well they were aware of it.

2.1. Ethical statement

This study received no ethical approval since no humans or animals were involved. There was no subject engagement in this study, and solely recorded data was used.

2.2. The survey form and Selection of pharmacies

The researchers produced a Google-based form (Questionnaire/not shown) for distribution among private pharmacies (n = 68–70) in various areas of Baghdad. The researchers were advised to randomly select pharmacies outside of lockdown hours (between 9 a.m. and 3 p.m.) from March 20 to May 15, 2020, and to follow a typical scenario and complete a standard form after each visit. The form consists of easy checkboxes for all desired observations (based on existing protection rules) as well as specific areas for any extra information that needs to be recorded. Personal information about pharmacy employees was not gathered.

2.3. Precautions for researchers

During pharmacy visits, the researchers wore medical masks, used hand disinfectant before entering and after leaving the pharmacy, and maintained a 2-meter distance from anybody who came into contact with him or her.

2.4. Data analysis

The statistical analyses of the survey were descriptive and no formal hypothesis testing was performed. Numbers and percentages were used to summarize the results.

3.1. Gender and graduation level

The survey included a total of 70 pharmacists (males 51.4% and females 48.6%). The great majority of respondents had a bachelor's degree in pharmacy (62.9%), and 22.9% of the pharmacists held an M.SC degree.

3.2. Information about COVID-19

The majority of pharmacists reported that they were given information on COVID-19, mostly for an hour each day (58.6%), although some for longer than an hour (Figure 1A). As for sources of information, the most trusted were the World Health Organization (WHO) (37.1%), the media and website (20%), and the Ministry of Health (MOH) website (20%) (Figure 1B). However, less than 5% of pharmacists prefer to obtain COVID-19 information from television, Facebook, or the CDC website (same figure).

3.3. Additional matters related to the ministry of health hotline.

Surprisingly, the majority of pharmacists (36.8%) who used the health ministry's contact line during the epidemic thought it was marginally helpful (Figure 2). While a small percentage of pharmacists considered the call center useful (8%), a larger percentage (26.5%) of pharmacists thought this call center was useless and inapplicable (25%).

3.4. Iraqi pharmacists' attitudes regarding COVID-19

Figure 3A shows that a large number of pharmacists are concerned about contracting COVID-19 while at work (34.8%). While 72.5 percent of pharmacists were concerned about becoming ill and infecting their families as a result of their occupational exposure (Figure 3B). (Figure 3C) indicated that (34.3%) of pharmacists reported being stressed as a result of the pandemic but that their stress had no impact on their professional tasks or relationships with their family and coworkers.

According to these findings, the pharmacists prescribed acetaminophen (54%) and corticosteroids (17.1%) for COVID-19 infection therapy (Figure 4A1). Additionally, (Figure 4B) shows that (14.3%) of Zing, Vitamin C (8.6%), and Vitamin D (10%) were prescribed as well to boost immunity and were administered orally (84.3%) (Figure 4C).

3.5. The practice of pharmacists regarding safety

As for shifts management, when shifts overlapped, (52.9%) of pharmacists continued to work as normal, with no changes in time or rotation (Figure 5).

The behaviour of pharmacy employees in terms of adherence to COVID-19 preventive measures is shown in (Figure 6). It was detected that (91.2%) of pharmacists wore masks, (8.8%) did not wear masks or gloves (Figure 6A), and (64.3%) did wear gloves (Figure 6B).

3.6. Provision of protective devices and supplements

There was a (58.6%) failure rate when it came to the delivery of facial masks, gloves, and sanitizers for purchase on time by the supplier, whereas, 41.4% indicated that these precautionary tools were delivered on time (Figure 7).

Pharmacists are the first responders for COVID-19 patients (International Pharmaceutical Federation (FIP), 2020). In light of the rising COVID-19 infection rate in Baghdad, it was assumed that all pharmacy personnel must rigorously adhere to preventative measures. The purpose of this observational study was to investigate the services offered by community pharmacists in Baghdad, Iraq, a city with a high incidence of COVID-19 patients. In this study, the authors looked at a randomly selected sample of private pharmacists in Baghdad's knowledge, attitude, practices, and preparedness for the COVID-19 pandemic. Between March 20 and May 15, 2020, pharmacists were questioned two weeks to two months after the World Health Organization declared the COVID-19 outbreak a worldwide pandemic (Cucinotta & Vanelli, 2020).

Pharmacists play an important role in interprofessional health care teams, especially during outbreaks, where they are responsible for infection control and monitoring pharmaceutical therapies for patients hospitalized with COVID-19 or related disorders (Zheng et al., 2021). Furthermore, one of the primary professional tasks of all pharmacists is to provide medication information (Ghaibi et al., 2015). Pharmacists should be aware of the guidelines about masks, for example, when they assume their advising role on the use of medicinal goods (International Pharmaceutical Federation (FIP), 2020). In this study, some of the participants had adequate awareness of COVID-19 transmission mechanisms, preventative measures, and medicines utilized. This is consistent with the findings of several studies that questioned pharmacists in various countries (Turkey, Vietnam, and Pakistan) and found that they had an appropriate understanding of COVID-19 (Emre et al., 2020; Huynh et al., 2020; Saqlain et al., 2020).

The WHO reported in mid-February that the COVID-19 epidemic was followed by a "infodemic," which is characterized as an abundance of information that is particularly susceptible to lies and disinformation (Organization, 2020). As a result, healthcare professionals should carefully assess COVID-19 information sources and seek information from reliable sources (Abebe et al., 2016; Shimizu, 2020). The majority of pharmacists in our survey reported utilizing reliable materials from government websites such as WHO, MOH and media/website. Also, some of the pharmacists were found to use TV and CDC website as a source of knowledge. Various surveys in the US and the UK found that television viewing in March and April 2020 far surpassed previous years, when public service media is viewed as a dependable source of information on the COVID-19 situation (Euroradio), 2020; Jurkowitz & Mitchell, 2020). Approximately less amount of pharmacists acknowledged utilizing social media (Facebook) for COVID-19 information, which is a dangerous practice. According to a new report, hundreds of prominent Facebook sites are writing, republishing, and spreading fake information about the new coronavirus, including conspiracy theories and counterfeit treatments (Euronews, 2020).

Concerning Iraqi pharmacists' attitudes during the COVID-19 epidemic, the respondents indicated tiredness and fears about becoming infected as a result of their occupational exposure. On the other hand, respondents reported that their stress had little effect on their professional obligations. As the COVID-19 epidemic has spread around the world, it has made a lot of healthcare workers afraid and tired (News, 2020).

Our findings also showed that Acetaminophen and other over-the-counter (OTC) supplements such as Zink, Vitamin C and Vitamin D3 were the greatest ratios of prescribed medicines by private pharmacists for treatment of COVID-19. While corticosteroids are recommended to be prescribed by pharmacists in the lowest possible ratio, this finding was consistent with what was reported in previous studies in Saudi Arabia.(Alwhaibi et al., 2021) and China (Liao et al., 2020).

Medical devices and personal protective equipment should be appropriately provided in pharmacies since they are utilized daily to offer proper protection for healthcare workers and patients as required (CDC, 2020b; International Pharmaceutical Federation (FIP), 2020). The majority of pharmacists polled indicated favourable practices with COVID-19 infection safety and protection measures. However, they stated that masks, gloves, and hand gels were in low supply or were being delivered late. As the number of afflicted nations and sick people grew, the globe faced a worldwide scarcity, causing supply disruptions or delays (Park et al., 2020). As a result of the probable shortages, the CDC and other non-governmental groups proposed a number of ways to maximize the supply and usage of these equipment items and devices (CDC, 2020a; Park et al., 2020). Along thes lines, the WHO and the CDC have created preparation tools and checklists to help healthcare workers and facilities respond to COVID-19 (CDC, 2020c)(World Health Organization., 2020). (FIP) and the American Society of Health-System Pharmacists (ASHP) have published recommendations for health-system pharmacy departments and pharmacy personnel, respectively, to improve pharmacy department planning and increase pharmacist participation in the battle against COVID-19 at both the institutional and community levels (American Society of Health-System Pharmacists, 2020; International Pharmaceutical Federation (FIP), 2020). These suggestions largely focused on the pharmacist's role in maintaining enough medication and supply stocks, determining suitable staffing requirements, and providing adequate professional education and training. In this research, approximately two-thirds of the pharmacists took actual actions in their pharmacies to prepare for the COVID-19 pandemic or gradually work on their preparations. However, some pharmacists among those polled stated that they had taken no action. The identification of a pharmacy staff person to manage education and training on COVID-19 had the lowest level of readiness. The unpreparedness of certain pharmacies might be ascribed to the country's financial problems, which made it more difficult for Iraqi pharmacies to manage (Al-Monitor Website, 2020; Human Rights Watch Website, 2020). Another possible explanation is that the Iraqi Ministry of Health's local COVID-19 health strategic readiness and response plan did not contain comprehensive measurements or preparedness strategies for pharmacy sectors. It emphasized the necessity of ensuring healthcare service continuity by keeping enough supplies of medicines and medical devices on hand (Republic of Lebanon Ministry of Public Health, 2020). The number of sick people every day continues to rise; this necessitates the healthcare system's ongoing preparedness.

To the best of our knowledge, this is the first study to examine pharmacists' knowledge, attitudes, practices, and preparation regarding COVID-19 in Iraq. One of the potential drawbacks is the limited sample size. Also, because the surveys were self-administered, there is a risk of information bias, as some pharmacists may have misunderstood some questions. Further research is advised to address these flaws. However, there is no reason to believe that this will affect the primary findings.

According to the findings of our study, pharmacists in Iraq possess an adequate level of knowledge regarding COVID-19 as well as great practices in this area. On the other side, the Ministry of Health has chosen not to include pharmacists in its contingency preparations for health emergencies. Because of this, there was a setback in terms of the overall readiness of the pharmaceutical industry. Employing the knowledge of pharmacists may prove beneficial to national governments and organizations in their efforts to prevent or reduce the likelihood of future waves of COVID-19 and to mitigate risk in the event that such waves do materialize. In subsequent research, we will need to visit a greater number of pharmacies in Baghdad and the other cities in Iraq in order to provide further support for our findings.

Centers for Disease Control and Prevention (CDC), World Health Organization (WHO), Minstry of health (MOH), over-the-counter (OTC), International Pharmaceutical Federation (FIP).

A- Ethics approval and consent to participate

Not applicable

B- Consent for publication

Not applicable

C- Availability of data and materials

The data are available when needed it.

D- Competing interests

The authors declare no conflict of interest for this research

E- Funding

Not applicable

F- Authors' contributions

MJM conceived and designed the study. AHM and MA analyzed and interpreted data. MJM, AHM, and MA wrote initial and final draft of article, and provided logistic support. All authors have critically reviewed and approved the final draft and are responsible for the content and similarity index of the manuscript.

G- Acknowledgements

We want to express our gratitude to all of the project participants and the personnel of the Middle Technical University who contributed to making this initiative a success.

H- Authors' information (optional)

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A cross-sectional research conducted to assess pharmacists' knowledge, attitude, practice, and readiness in the presence of the COVID-19 epidemic in Baghdad.

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Version 1

Abstract

Background

Methods

Results

Conclusion

Figures

1. Introduction

2. methods

3. Results

4. Discussion

5. Conclusion

6. Abbreviations

7. Declarations

8. References

Status:

Version 1