Assessment of preparedness and response of health professionals towards COVID-19 pandemic during early period in public hospitals in Oromia regional state, Ethiopia

current flare-up of respiratory sickness caused by a novel
coronavirus (named “COVID-2019”) has bolted down the world...


Background
The current flare-up of respiratory sickness caused by a novel coronavirus (named "COVID-2019") has bolted down the world and has been recognized as a danger by US Centers for Disease Control (CDC) and pronounced pandemic by World Wellbeing Organization (WHO). The primary case was identified in Wuhan City, Hubei Area, China and since at that point, the infection has spread in disturbing rate [1]. It is one of the worldwide pandemics with colossal wellbeing, financial and psychosocial emergencies influencing the citizens of any countries.  [2].
Taking after the WHO COVID 19 crisis affirmation, local and national governments and universal bodies have forced public health and social measures on people, educate and communities to contain the illness. These measures incorporate identifying and confining cases, contact-tracing and isolate, social and physical separating counting mass get-togethers and travel confinements [5]. Accordingly, in any nation, particular areas or administrations can be the central point of the episode. In spite of the fact that healthcare is given exterior clinics (such as crisis clinics, nursing homes, community wellbeing centers), hospital-based experts stay the bunch at amazingly tall chance of exposure to the diseases and may contract or transmit it in like manner. In any case, data around the wellbeing frameworks and health professionals' readiness for combating the 2019-nCoV isn't known. Subsequently, their mindfulness and readiness in overseeing the 2019-nCoV contamination are vital to prevent the further spread of the disease.
Our study will be conducted to assess the preparedness of healthcare personnel against the 2019-nCoV outbreak and how well they respond in an outbreak [3].
Healthcare workers, are extremely exposed to the contaminations, more than any other people, as they are in contact with the infected people. Particularly, amid any flare-up, they may have to be work with a healthcare team [6] as their response to manage novel Corona infection which may put them under the most elevated chance of contracting the virus. Their behavior, mental set up and material readiness in overseeing the responding to the COVID-19 is exceptionally vital to avoid spread of this amazingly communicable illness [7]. The readiness includes from fabric accessibility such as sufficient N-95 masks for health care staff and its use according to its guidance to mental readiness to supply fundamental administrations without any fear [10,11].
Since COVID 19 pandemic is unexpected and no country aware of it prior to outbreak, there is limited or no studies and surveys all over the world and it is extremely lacking in Ethiopia.
Consequently, the preparedness and awareness level of health care providers in Oromia regional state is unknown. Therefore, this study assessed healthcare professionals' preparedness and response towards COVID 19 Pandemic in the region. The finding helps to understand how healthcare professionals' readiness to protect themselves and contain the pandemic.

Methods and material
Study setting and design This study was conducted in Oromia National regional state public hospitals.

Study population, sample size and sampling technique
All health care workers in Oromia region's Public hospitals were included as study population.
The survey was conducted in all functional public hospitals in Oromia Regional state, Ethiopia.
There was no restriction on the number of participants per hospital and convenient sampling technique was used. All Healthcare providers in the hospitals including physicians, nurses, pharmacists, and others were included. We enrolled staff members who are or were handling suspected cases in settings in their respective hospitals.

Data collection tool
The study was carried out using a structured questionnaire adapted from the CDC checklist and the previous questionnaire on the recent outbreak.

Data analysis and management
The collected data was organized by Google Sheets and collected in an Excel spreadsheet. The survey was completely anonymous. Only the study team had access to all data. Data entered into Google Sheets were quality-checked by to ensure accuracy.
The statistical computer package, IBM SPSS, Version 22 was used to perform quantitative analysis on the collected data. In order to perform analysis of data, it was necessary to code the response variables, i.e., yes = 1, no = 0. Data cleaning were carried out throughout the data entry process.
The analysis of the data was performed through descriptive statistics, such as frequencies for each of the variables. One-way ANOVA was used to determine the significant differences of each variable between the groups. The threshold for statistical significance was p≤0.05.

Results
A total of 340 healthcare professionals completed the survey, more than 72% of the respondents were male. The majority of the respondents were in the age range between 21 and 30 years. In terms of experience, 80.8% of the respondents had up to 5 years during the study period.

Discussion
The COVID-19 outbreak, which was first detected in Wuhan, China, in December 2019, has been evolving rapidly. On 30 January 2020, the WHO Director-General declared that the current outbreak constituted a public health emergency of international concern, and on 12 March 2020 the COVID-19 outbreak was declared a pandemic [3].
Ethiopia has been doing widespread efforts in containing this pandemic, whose cases are increasing slowly but the worst is feared in coming weeks or months, as pattern of COVID-19 effect being observed in many countries [18]. For this purpose, extensive media and physical campaigns about preventive mechanisms of the disease, increasing number of functional laboratories to test for the infection, tracing contacts, and others are being undergone.
Federal ministry of health and Ethiopian public health institute released a checklist to check for preparedness and response of health facilities in the country and little is included about the health care providers in that specific document [18]. Therefore, the status of preparedness and perceived response of health professionals in the country is largely unknown and this study, with its own limitations, revealed the current readiness of health professionals in Oromia regional state, Ethiopia.
Regarding the sociodemographic data of study participants, majority of them were male: and it may be due to presence of more male work forces in medical and health sector in the country due to low number of females in the profession. And most of them were in age range of 21-30 and this may be due to more social media utilization by this age group and also it can be because Ethiopian population is young making the public servants fall in young age group [20].
According to result of this online survey, healthcare professionals in Oromia public hospitals are not prepared for a COVID-19 infection outbreak and they had difficulty in accessing the research literature, felt they have no sufficient information about COVID-19 preparedness, didn't aware for guidelines and recommendations from WHO and FMoH, were not reading journals and articles about COVID-19 which shows that either they were too busy with patients or they must have limited access to literatures. They also felt that there is low support from local officials during emergency situation which may be poor communication and collaboration between different stakeholders.
Handful of respondents were also not sure who to contact during emergency situation which may be due to absence or functionality of reporting channels. Majority of participants didn't participate in educational activities about COVID-19 pandemic and this can be also due to absence of such educational opportunities or professionals busy time to take such activities seriously. Most of them didn't participate in emergency planning ad it may be because of perceiving planning something administrative and not their scope and were not familiar with local response system which can be due to absence of stressful outbreaks in their community recently. Our findings, therefore, advocate that existing systems of preparedness and response to of COVID-19 Pandemic may not be an effective way to reach, prepare and convince health care providers, which would otherwise not respond to this pandemic timely and effectively.
Healthcare professionals perceived a positive response towards some of items included in the questionnaire like Confidence in providing patient education, ability to identify sign and symptoms of COVID-19 and readiness to participate in peer evaluation skills on COVID-19. Tis may be due to extensive media campaign on sign, symptoms and prevention methods of COVID-19 pandemic so that respondents could easily know it and be confident to provide education. However, most of them perceived negative towards ability to care for COVID-19 patient without supervision, managing the common symptoms and reactions of COVID-19, and confidence in implementing emergency plan, and isolation procedure of COVID-19 which indicates low behavioral and psychological preparedness due to fear from reports from other countries regarding the disease and professionals' eminent exposure and absence of much real experiences about COVID 19 outbreak.
The total mean score for preparedness and responses to COVID-19 was negative among the health care professionals, although there was a range of variance in scores. Probable reasons may be the fact that the preparedness and response program have not been comprehensive. There may be behavioral, social and psychological factors which should be assessed in addition to absence of compulsory trainings, sufficient modules, documents and guidelines available for all at all levels including remote areas, friendly relationship with local authorities, functional and effective communication in the health system and so on [18].
Therefore, health care providers should be ready for response to COVID-19 pandemic by materials, behavior and psychology as recommended by international and national health institutions [8].
Every responsible bodies, governmental and/or non-governmental, should work hand in hand to avert this problem by equipping health care providers in all dimensions to help them respond to the pandemic quickly, effectively and successfully.

Conclusion
Healthcare professionals in the public hospitals of Oromia regional state, Ethiopia perceived that they are not yet well prepared and may not respond to the pandemic quickly and efficiently. Even

Limitation
This survey was carried out via online and didn't represent many of health care providers who didn't appear and access the questionnaire during study period. It also analyzed responses of only four groups of health professionals due to few responses from other professional groups. This study also didn't show preparedness and response of health professionals working frontline at health centers, private clinics and hospitals. was informed about the research, their right to abandon the involvement at any time and confidentiality of information were maintained during data collection, analysis, interpretation and publication of results and individual information were kept confidentially.

Consent for publication
Not applicable

Availability of data and materials
Datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Competing interests
The authors declare that they have no competing interests.

Authors Contribution
CDH and CKE designed the study, collected data, analyzed and interpreted the data. and contributed in manuscript writing. Both authors read and approved the final manuscript.