Assessment of Healthcare Workers’ Levels of Preparedness and Awareness Regarding COVID-19 Infection in Low-Resource Settings
Authors: Mohammed Abdelkabir
Hind Alameen
Ali Alsuyihili
Muhammed Elhadi
Sumayyah Bahroun
Esra Alghanai
Samer Khel
Hazim Ahmed
Ayman Al-Agile
Amna Elmabrouk
Tahani Aleiyan
Marwa Biala
Anis Buzreg
Siraj Abulmida
Jalal Ahmid
Fatima Elkhfeefi
Hamad Mughrabi
Mohammed Alkeelani
Farah Madi
Taha Khaled
Abraar Abdullah
Ahmed Msherghi
Moaz Alwarfalli
Abdulmueti Alhadi
Abdelmunam Elharb
Belal Faraag
Abdulaziz Zorgani
Rawanda Gaffaz
Hala Bikhayr
Mohamed Ismaeil
Ahmed Elhadi
Najah Ben Saleim
Mohamed Eisay
Ala Amshai
Ala Khaled
Abdulrahman Atewa
Bushray Almiqlash
Hana Yahya
Ayiman Alhashimi
Nafati Alnafati
Mohamed Abukhashem
Malack Madi
Tariq Boughididah
Moutaz Elgzairi
Majdi Badi
Safeya Alkot
Sarah Alhaddad
Ola Elmabrouk
Esra Boushi
Mawada Fadel
Malak Subhi
Ahmed Zaid
Fatimah Bin Alshiteewi
Journal: American Journal of Tropical Medicine and Hygiene (2020)
Discipline: CLINICAL MEDICINE
Keywords: COVID-19; SARS-CoV-2; healthcare workers; knowledge; preparedness
Affiliations: Faculty of Medicine, University of Tripoli, Tripoli, Libya;, Faculty of Medicine, University of Benghazi, Benghazi, Libya;, Faculty of Medicine, Sebha University, Sebha, Libya;, Faculty of Medicine, University of Zawia, Az-Zawiyah, Libya;, Faculty of Medicine, Al-Jabal Al Gharbi University, Gherian, Libya, Faculty of Medicine, University of AL-Mergib, Al Khums, Libya;, Faculty of Medicine, Al-Zintan University, Az-Zintan, Libya;, Faculty of Medicine, Misurata University, Misurata, Libya;

Abstract:  COVID-19, caused by the SARS-CoV-2 virus, is spreading rapidly worldwide, with devastating consequences for patients, healthcare workers, health systems, and economies. As it reaches low- and middle-income countries, the pandemic puts healthcare workers at high risk and challenges the abilities of healthcare systems to respond to the crisis. This study measured levels of knowledge and preparedness regarding COVID-19 among physicians and nurses. A cross-sectional survey was conducted among healthcare workers in Libya between February 26 and March 10, 2020. We obtained 1,572 valid responses of a possible 2,000 (78.6%) participants from 21 hospitals, of which 65.1% were from physicians and 34.9% from nurses. The majority of participants (70%) used social media as a source of information. A total of 47.3% of doctors and 54.7% of nurses received adequate training on how to effectively use personal protective equipment. Low confidence in managing suspected COVID-19 patients was reported by 83.8% of participants. Furthermore, 43.2% of healthcare workers were aware of proper hand hygiene techniques. Less than 7% of participants received training on how to manage COVID-19 cases, whereas 20.6% of doctors and 26.3% of nurses felt that they were personally prepared for the outbreak. Awareness and preparedness for the pandemic were low among frontline workers during the study. Therefore, an effective educational training program should be implemented to ensure maintenance of appropriate practices during the COVID-19 pandemic. 

Retracted: No

PubPeer comments:
 The data in this paper appears to contain some unexpected discrepancies. In this paper, 2,000 doctors and nurses in 21 hospitals were asked to fill out a questionnaire about their knowledge regarding COVID-19 infection. My first questions are about the questionnaire, which, according to the paper, is provided in Supplemental files I-II. * There appears to be no access to the supplemental files. There is no link to them in the paper and the  Supplements tab on the website is greyed out. Could the authors please check? The PMC version of the paper states that  *Supplemental materials are available from the authors upon request.* So please, consider this my request to see the questionnaire. ![file] Of the 2,000 doctors and nurses who were asked to participate, a whopping 1,572 responded with a completed questionnaire. As shown in several of the tables, all of them filled out the questionnaire completely. * A survey response of 78.6% is very, very high, in particular taking into account that these were busy healthcare workers during a viral pandemic. How did the authors get so many subjects to participate? ![file] , 
 The survey was completed by 1572 health care workers, i.e. 1024 doctors and 548 nurses, as shown in Table 1. But the percentages listed in Table 2 for each of these groups do not always match with the provided the overall percentages. This is in particular the case for Q1 and Q7 in the top part of the table. Q1 was answered correctly by 42.4% of the 1572 respondents. That would be 667 subjects (667 1572=42.4%). However, looking at the two subgroups, doctors and nurses, 455 doctors (455 1024=44.4%) and 174 nurses (174 548=31.7%) would add up to only 629 subjects. Q7 was answered correctly by 43.2% of the 1572 respondents. That would be 679 subjects (679 1572=43.2%). But, looking at the two subgroups, 453 doctors (453 1024=44.2%) and 183 nurses (183 548=33.4%) would add up to only 636 subjects. From what I checked, the other numbers appear to add up correctly, but I was wondering if there was an error in the percentages of Q1 and Q7. Could the authors please check? ![file] , 
 Another question is regarding the authors of this paper. The paper has 53 authors from 8 different universities. That seems a lot of names on a paper that used simple analyses (no elaborate statistics, for example) on a questionnaire with 25 or so questions. * What was each author s role in this paper? I first thought that maybe one or two authors from each of the 21 participating hospitals were included, but only 8 affiliations are listed, and none of them are at a hospital. Of the 53 authors, 52 used a personal email address (gmail, yahoo, hotmail). Only 1 author (Ahmed Zaid) used an institutional email address. While I can imagine that some authors might have short-term positions at a university, it is very unusual to see such a high percentage of authors using their personal accounts. * Why did only 1 of the authors use an institutional email address? ![file] , 
 The ethical approval for this study was obtained at the Biotechnology Research Center in Libya. What is the connection of this research center, where none of the authors work, with the 8 affiliated institutions and the 21 participating hospitals? Or does the BTRC oversee all research done in Libya? It would be helpful if the authors could provide some insight here. ,