This study assessed the attitudes, knowledge and practices of health personnel in Conakry on COVID-19 and identify factors associated with poor knowledge and attitude of these practitioners. 70.62% of the personnel have a good knowledge of COVID-19 and 57.66% have a good attitude of disease prevention. The majority of the knowledge acquired on the issue was from the media and internet (81%). The health system did not put in place anything to help the staff to become familiar with the fight because 99.60% did not know the emergency number and did not have a management algorithm (53. 80%°).
Although it was a cross-sectional survey with the possibility of information bias due to the fact that the questionnaires were not self-administered. Some staff would have had the correct answer if they had received the question beforehand. This study has the advantage of giving us an overview of the knowledge and attitudes of health staff regarding COVID-.19 in the pandemic preparedness situation.
Since the beginning of this pandemic, all efforts have been focused on management and actions to break the chain of transmission of COVID-19. The first articles published on the subject focused on the overall understanding and characteristics of the virus [4, 7, 18]. To our knowledge, no studies have yet explored the issue of the knowledge, attitudes and practices of front-line health care workers regarding COVID-19. To fill in the gaps on the issue and to guide decision-makers on the strategy for involving health care personnel, we conducted a knowledge, attitudes and practices survey among 548 health care personnel on COVID-19.
This study shows us that there are still some gains from the previous Ebola epidemic in terms of knowledge, attitudes and infection prevention and control practices.Indeed, it was observed that the majority of health workers have a good knowledge of Covid-19 (70% of the sample). However, the overwhelming majority of health workers, all statuses and structures combined (99.6%) were unaware of the existence of a toll-free number to alert on the presence of a suspected case of coronavirus and only 42.3% knew the incubation period of the virus. In a similar study of Ebola in Guinea, 95.2% of the health workers were knowledgeable and could identify an Ebola suspect [19]. Although this is not the same context, nor the same pathogen, there is an effort on the part of health workers to learn about public health threats. This is reflected in the sources of information consulted: 81% of them obtained their information from the media (Internet, radio). The same source was used by 85% of the surveys in Sierra Leone to obtain information on Ebola [20].
1. 57.1% faced with a patient with signs of COVID-19 said they would consider it but 37% would not. What seems even more worrisome is that 41.2% said they would prescribe a drug according to symptomatology or diagnosis, which raises the question of what happens to patients left to their own devices to pursue their quest for care (with a risk of spreading the virus). Also if 81.8% answered that they would wear PPE (Personal Protective Equipment) to consult them, it remains to be seen what they mean by this when in reality, all that is needed is a mask, gloves and protective glasses. This proportion of staff using personal protective equipment is almost equal to the proportion reported in Nigeria for assessing the PPE of health workers in the Ebola context [17].
2. 60.9% assured that in the event of a case with symptoms of Covid-19 they would put it in isolation and 62.6% announced that they would call the dedicated toll-free number. However, these responses clearly contained a significant desirability bias, since all the agents admitted that they were unaware of the existence of the toll-free number that would allow them to do so.
Systematic hand washing (76.6% of respondents) and glove wearing (63%) seemed to be relatively practiced but remain too weak to ensure effective protection for all agents and patients. The wearing of masks (26.1%) is largely insufficient, as is the wearing of gowns (48.7%). Concerning the literature on Haemorrhagic Fevers, the literature shows that the practice of handwashing varies according to whether health workers are practicing in a declared epidemic context or in an alert context. The practice was observed in the first case, around 80 to 85% in Sierra Leone and Nigeria [17, 20], but was very low in the second, as in Iran during the Crimean-Congo fever alert [21]. This issue is crucial for the implementation of infection prevention and control measures among health workers in the context of the COVID epidemic [19] where the feeling of health actors seems to be that if the epidemic is present, it is confined to a limited fringe of the population (elites and foreigners).
The importance of exercise conditions is clear in the question about the product used to wash hands. Only 42.5% had a hydroalcoholic gel and 55.7% used only soap and water.
81.6% of health workers reported shaking less than 50 hands a day, which is already too much. It remains to be seen how many avoided all contact.
42.5% of health workers have not received ICP training, and the vast majority of them (98%) would like to receive more information on the Coronavirus. It would also be advisable to identify, through the observation of practices, which types of actors are mainly exposed due to their contact with patients in order to prioritize their training (we can think of actors developing frequent physical contact with patients: care assistants, nurses, but also wardens or reception agents, etc.) but also how the application of ICP impacts on the quality of care produced (in particular by the absence of palpation-type contact).
The agents in the health centres and National Hospitals, a large proportion of whom have less than 5 years of seniority (Health Centre: 47%, HN 38%) compared to the CMCs (15%) had on average a better knowledge of the coronavirus (Health Centre and National Hospital 41.9%, CMC 16.3). This could be explained by the fact that the issue of zoonoses and ICP is now part of the training curriculum for health workers (Faculty of Health Sciences and Techniques and Nursing School), in which they have participated. This therefore calls for priority to be given to upgrading the skills of health professionals with more than five years' seniority.
There is no strong correlation between level of knowledge of Covid-19 and expression of intention to advise isolation in case of symptoms, systematic mobilization of barrier gestures. This invites us to go beyond the cognitive question of knowledge of the risk to question both its perceptions, in particular the conviction of the actors to be concerned by the risk of the Coronavirus and the factors which do not come under the purely biomedical register which influences it (risk scales, rumours...), This is not only the political context which gives rise to concern, putting the question of viral risk in the background), but also the conditions for appropriating the knowledge acquired in ordinary practice (conditions of practice, presence of protective equipment or disinfectant products, influx of patients, leadership role of the medical hierarchy in the establishment). Particular attention should be paid to the impact of discourse on the extraneity of viral risk on the management of national patients. Until now, prevention measures have focused on airports and the figure of the virus carrier has been embodied by the Asian or European traveller. This figure has not been contradicted by the first proven cases. However, as we enter a phase of local transmission of the virus, it is extremely important to alert health workers to the presence of the virus on national territory and to the fact that it is not limited to a section of the population of non-African origin.
We have identified the independent determinants of health personnel's knowledge and attitudes about COVID-19.
For poor knowledge, it is the female sex, being a pharmacist, having benefited from training in ICP in the past and working in the communal medical centre of Matam, in fact, women are 2.46 at risk of having poor knowledge of COVID-19 compared to men p = 0.001. This result could be explained by the gendered distribution of roles in the Guinean health system. The majority of men occupy positions of responsibility, which allows them to have easier access to information at the central level. On the other hand, they occupy a greater number of administrative positions that allow them to search for information, whereas women, who are mostly confined to care functions, have fewer opportunities. In the context of the Ebola fever epidemic on the African continent, the lack of time that women could devote to information seeking and their high exposure to risk due to their care functions has been put forward to explain their high lethality [22]. With regard to the pharmacy profession (OR = 9.83 CI [1.09–38.44], p = 0.03), it is possible that pharmacists working in health facilities or pharmacies may suffer from a lack of access to training and workshops on infection prevention and control compared to health care workers. Staff who have received ICP training in the past, the medical profession and biologists are likely to be knowledgeable about COVID.19
This may be directly associated with the effects of the Ebola epidemic from 2013 to 2016, during which much ICP training was organized for health workers.
Although we covered all public structures in the capital, this study has certain limitations: first of all, private structures were not included, nor were informal spaces for the production of care or the dispensing of medication products. In addition, assessing the level of knowledge about a new virus such as Covid-19, for which knowledge is evolving daily, may seem a challenge. In spite of these limitations, this study is of definite interest at a time when Guinea, along with the African continent, is organizing its response to the emergence of a new epidemic.