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Table of Contents
ORIGINAL ARTICLE
Year : 2023  |  Volume : 28  |  Issue : 1  |  Page : 1-6

Healthcare workers’ willingness to report to work during a pandemic in southeastern Nigeria: A hypothetical case using Ebola virus disease


1 Department of Community Medicine, University of Nigeria Teaching Hospital, Ituku/Ozalla, Enugu, Enugu State, Nigeria
2 Department of Community Medicine, Enugu State University Teaching Hospital, Enugu, Enugu State, Nigeria

Date of Submission22-Jul-2022
Date of Decision17-Aug-2022
Date of Acceptance28-Oct-2022
Date of Web Publication13-Dec-2022

Correspondence Address:
Chioma A Onyedinma
Department of Community Medicine, University of Nigeria Teaching Hospital, Ituku/Ozalla, Enugu, Enugu State
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijmh.IJMH_63_22

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  Abstract 

Background: The Ebola virus disease (EVD) outbreak of 2014–2016 in West Africa was the world’s deadliest to date, and the World Health Organization declared it an international health emergency. It adversely affected the health system with many healthcare workers (HCWs) being worried about going to work. Objective: This study therefore aimed at determining the willingness of HCWs to report to work in an outbreak of EVD. Materials and Methods: A semi-structured, self-administered, questionnaire-based cross-sectional study was conducted among 360 doctors, nurses, and medical laboratory workers in public and private health facilities in Enugu Metropolis. Results: Seventy-three percent (73%) of our respondents were willing to report to work during an outbreak of EVD. Nurses were about five times more likely to be willing to work than other categories of staff [odd ratio (OR) = 4.999; confidence interval (CI)= 2.15–11.597; P < 0.001] and female HCWs were about 1.3 times more likely to be willing to work than males during an EVD outbreak (OR =1.275; CI=0.743–2.815; P = 0.049). Availability of vaccination for healthcare staff (88.6%) and family members (79.2%) were the greatest personal and family-related motivating factors for willingness to work, whereas the provision of antiviral treatment for staff with unprotected exposure to an ill patient (78.1%) was the greatest work motivating factor. However, passion for work surpassed increased remuneration (61.4%) as a personal motivating factor for HCWs willingness to report to work during an EVD outbreak. Conclusion: Our study showed that HCWs were largely willing to work during an EVD outbreak. Personal vaccination for staff and family members and provision of antivirals were the major motivating factors.

Keywords: Ebola virus disease, healthcare worker, motivation, willingness


How to cite this article:
Ibiok N, Onyedinma CA, Agwu-Umahi OR, Kassy CW, Obionu IM, Chime OH, Ogugua IJ, Ochie CN, Arinze-Onyia SU, Ndu AC, Aguwa EN, Okeke AT. Healthcare workers’ willingness to report to work during a pandemic in southeastern Nigeria: A hypothetical case using Ebola virus disease. Int J Med Health Dev 2023;28:1-6

How to cite this URL:
Ibiok N, Onyedinma CA, Agwu-Umahi OR, Kassy CW, Obionu IM, Chime OH, Ogugua IJ, Ochie CN, Arinze-Onyia SU, Ndu AC, Aguwa EN, Okeke AT. Healthcare workers’ willingness to report to work during a pandemic in southeastern Nigeria: A hypothetical case using Ebola virus disease. Int J Med Health Dev [serial online] 2023 [cited 2023 Jan 27];28:1-6. Available from: https://www.ijmhdev.com/text.asp?2023/28/1/1/363259




  Introduction Top


In the wake of the recent COVID-19 pandemic, the world has realized the vital role that healthcare workers (HCWs) must play to deliver quality and efficient health care to citizens worldwide. Approximately, there are 59 million HCWs globally and they work directly as doctors and nurses and indirectly as laboratory scientists, aides, helpers, and even cleaners to provide routine and essential care and services to ill patients and clients.[1] These HCWs undergo long periods of training to equip them effectively for the management and control of a variety of well-known and even rare diseases, but tackling pandemics poses a special challenge as a result of poor preparedness of the health systems, institutions, governments, and nations.

The Ebola virus disease (EVD) outbreak of 2014–2016 in West Africa was one of the world’s deadliest diseases to date, and the World Health Organization (WHO) declared it an international health emergency as over 11,310 people died of the virus in Guinea, Liberia, Sierra Leone, the USA, Mali, and Nigeria.[2] The Nigerian EVD 2014 experience commenced on July 20, 2014 when the index case, a Liberian, on arrival in Lagos potentially exposed 72 persons at the airport and hospital. By September 2014, there were 19 laboratory-confirmed cases and 1 probable case. Eight hundred and ninety-four contacts were identified at that time. Eleven patients with laboratory-confirmed EVD survived, whereas eight of the confirmed cases and one probable case died.[1] The WHO declared Nigeria EVD-free on October 20, 2014, following the non-detection of new cases for 42 days.[3]

HCWs are prone to infectious diseases especially where there are poor infection prevention and control practices. During outbreaks of highly infectious diseases such as Ebola, there is a tendency for this group of HCWs to hesitate in reporting to work. This non-willingness to report to work during an epidemic can be caused by various factors. Barriers to willingness include fear and concern for family, self, and personal health problems.[4] Mistrust or a lack of confidence in the employer to maintain employee safety during a disaster correlates with a decreasing willingness to attend work.[5],[6],[7] It is suggested that a lack of confidence in hospital preparedness may be because the hospital has not made adequate disaster plans or because staff are not aware of these plans.[7] For instance, during the early years of the human immunodeficiency virus (HIV) epidemic, doctors debated whether it was ethically permissible to refuse to treat those with HIV, and during the 2003 severe acute respiratory syndrome (SARS) outbreak, some HCWs were not willing to treat SARS patients.[8],[9] HIV and SARS provide a reasonable comparison to any epidemic/pandemic such as EVD, and it is not unreasonable, therefore, to assume that the response to EVD may be similar. Hence, this study sought to know how willing HCWs in Enugu metropolis are to report to work during an EVD outbreak.


  Materials and Methods Top


This study was carried out in Enugu, the capital city of Enugu State in Nigeria. The city is known as “The Coal City” because of the discovery of coal in 1909 by the British. Enugu is home to so many healthcare facilities at the different levels of health care: tertiary, secondary, and primary healthcare facilities. In the state metropolis, there are about 204 healthcare facilities: 148 private and 56 public healthcare facilities The tertiary health facilities include Enugu State University Teaching Hospital, University of Nigeria Teaching Hospital, National Orthopedic Hospital, and Federal Neuropsychiatric Hospital. Approval was obtained from the Health Research Ethics Committee of University of Nigeria TeachingHospital, Ituku/Ozalla, Enugu State, Nigeria(NHREC/05/01/2008B-FWA00002458-IRB00002323). The management of each health facility was also approached for permission to conduct this study, and written informed consent was obtained from each respondent.

A cross-sectional analytical study was conducted in public and private health facilities in Enugu Metropolis. The study was carried out between August and November 2019. The doctors, nurses, and medical laboratory workers working in public and private health facilities in Enugu Metropolis were the respondents.

The minimum sample size for this study was determined using Fisher’s formula for calculating single proportions[10]:



A minimum sample size of 360 was calculated using the proportion (37.4%) of HCWs who were willing to report to work during the influenza pandemic in a similar study carried out in Calabar, South-south Nigeria.[11]

The number of health facilities in the three local government areas (LGAs) in Enugu Metropolis (Enugu South, Enugu North, and Enugu East) studied obtained from the State Health Management Board was 204, and this was used to determine the number of health facilities studied.

  • Stage 1: A total of 67 healthcare facilities were selected using simple random sampling by balloting.


  • Stage 2: The sampling frame for the healthcare facilities selected was 1040 HCWs. About 39% (406) of the HCWs were doctors, 50% (520) were nurses, and 10% (104) were laboratory scientists (104). Based on this sampling frame, a minimum of 140 doctors, 181 nurses, and 39 laboratory scientists were selected by simple random sampling from the selected facilities.


A self-administered pretested semi-structured questionnaire was used to collect information on the proportion and factors affecting HCWs’ willingness to report to work during an EVD outbreak. The questionnaire was pretested among nurses in two healthcare facilities in Nsukka LGA, which was not selected for the study. The questionnaire consisted of three sections: (a) sociodemographic variables, (b) HCWs’ willingness to report to work, and (c) factors motivating/hindering health workers’ willingness to report to work during an EVD outbreak. The questions in this group were categorized into personal factors, work-related factors, and family-related factors. The scoring system for this group of questions was based on a 4-point Likert scale, ranging from very willing represented as 1 to very unwilling represented as 4.

The information for this study was collected between August and November 2019. Self-administered questionnaires were distributed to the participants and collected by four trained research assistants (resident doctors) who cross-checked appropriately to minimize missing data.

Data entry and analysis were carried out using IBM Statistical Package for Social Sciences (IBM SPSS version 22). Descriptive statistics were used for data summarization and presentation. The χ2 test of significance was used to measure the association between sociodemographic characteristics and HCWs’ willingness to report to work, whereas the logistic regression model was used to determine the predictors of willingness to report to work. The level of statistical significance was at a P-value of less than 0.05.


  Results Top


[Table 1] shows the sociodemographic characteristics of respondents. The mean age of the respondents was 30.14 ± 7. 17 years. Majority of the respondents [230 (63.9%)] were females and nurses (50.3%). A greater proportion [232 (64.4%)] of the respondents had work experience of between 1 and 5 years and more than half [189 (52.5%)] of the respondents were permanent employees.
Table 1: Sociodemographic characteristics of respondents

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We also found that majority [263 (73.1%)] of our respondents were willing to report to work during an outbreak of EVD.

[Table 2] shows the association between sociodemographic characteristics and willingness to report to work. There were statistically significant differences between willingness to work with sex (P = 0.049) and occupation (P ≤ 0.001). Respondents in the nursing profession were about 4.999 (5) times more likely to be willing to work than other categories of HCWs [confidence interval (CI)= 2.15–11.597]. Females were 1.3 times more likely to be willing to work during an EVD outbreak than their male counterparts (CI= 0.743–2.185).
Table 2: Association between sociodemographics and willingness to report to work

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Table 3 shows the factors affecting HCWs’ willingness to report to work. [Table 3]A shows work-related factors affecting HCWs’ willingness to report to work. Majority of the respondents (78.1%) said that they will be willing to work if the staff is guaranteed antiviral for staff with unprotected exposure to an ill patient. Other important motivating factors were training on EVD management (76.1%), training on standard precaution (75.6%), and the presence of an existing emergency response plan (70.6%). Despite the provision of personal protective equipment (PPE) to all staffs, a high proportion (45.0%) of respondents were still not willing to work.
Table 3: Motivating factors to healthcare workers’ willingness to report to work during an outbreak of Ebola virus disease

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[Table 3]B highlights personal factors to HCWs willing to work. The majority (88.6%) of the respondents were willing to work if there was a guaranteed vaccination against EVD. A high proportion of the HCWs were found to be willing to report to work more if they were confident about their skills in managing EVD (73.6%). Interestingly, passion for work surpassed increased remuneration (61.4%) as a personal motivating factor for HCWs’ willingness to report to work during an EVD outbreak.{Table 4}

[Table 3]C shows that the majority of the respondents (79.2%) will be willing to work if there is guaranteed vaccination for their family members, whereas a very high proportion (60.3%) of respondents will be unwilling to go to work based on counsel from family members. With guaranteed medical care for family members, if exposed, the majority (72.2%) were willing to work during an outbreak.{Table 5}


  Discussion Top


Majority of the respondents (73.1%) said that they would be willing to work during an outbreak of EVD. This result is like findings from studies carried out in Germany, Singapore, and Canada, where 72%, 72.3%, and 79% of all HCWs, respectively, were willing to report to work in the event of a pandemic such as EVD.[12],[13],[14] This is an interesting finding as it shows dedication on the part of HCWs, despite the risks associated with an outbreak. They are committed to saving lives, thereby reducing morbidity and mortality. However, although 78.3% of all employees in the USA indicated willingness to come to work during a SARS pandemic, a lower proportion (53.4%) of public health workers in the same country indicated that they would report to work in the unlikely event of a future influenza pandemic.[15] The drop in the proportion of HCWs willing to report to work could be as a result of perceived severity of a new pandemic on the part of those who declined to report to work. Another study carried out in Nigeria among HCWs reported that 74.6% were not willing to work if there is an outbreak.[11] This could reflect the Nigerian poor health system, in which HCWs are not provided with the essential PPE to protect themselves thereby exposing them to the risk of contracting the infection in question. Other reasons proposed for the hesitancy to come to work during a pandemic were largely to protect the HCWs and their families from contracting the deadly disease.[12]

This study revealed that females were about 1.2 times more willing to report to work in the event of an EVD outbreak than males. This finding is not consistent with reports from a Japanese study which revealed that females were about 1.7 times more hesitant to work in the event of an outbreak.[16] Similarly, a study carried out in Israel also revealed that males were more willing to show up at work.[17] However, when a hypothetical study of influenza and SARS was carried out in the USA and Singapore, no gender difference was reported among the HCWs’ willingness to report to work during a pandemic.[15],[18] The disparity in the results between men’s and women’s willingness to show up at work may be related to the managerial positions usually taken up by men at work environments including hospitals.[16]

Nurses were five times more willing to report to work during an outbreak of EVD than other categories of staff in this study. This may be because most nurses are females, and this gender tends to be more compassionate. Two similar studies carried out in the USA and the UK reported contrary findings whereby physicians and paramedical were more willing to come to work than nurses. Although the study carried out in the UK reported that up to 50% of all nurses were less likely to report to work than doctors, the US study revealed that an alarming 73% of the nurses were of the same view.[19],[20] Many researches done show response to willingness rates that are far from universal, with the willingness gaps varying across different healthcare workforce groups, countries, and scenario contexts.[21],[22] Concerning hospital workers’ views toward pandemic influenza response, for example, a 2006 survey conducted among employees at a Level II trauma center revealed that 42% of the respondents answered “maybe” and 8% answered “no” to a question on willingness to respond to this threat.[20] These unclear or negative responses suggest that hospital workforce absenteeism/poor willingness response may be due mainly to attitudinal and related perceptual factors apart from direct illness.

This study reported that more than one-third of all HCWs would be unwilling to work even with the provision of PPE and priority allocation of antivirals in the event of exposure. This could be because of poor hazard allowance and lack of life insurance in the event of death of a HCW. A study carried out in the USA among 17,000 participants working in five large public health facilities revealed that family and personal safety were the two most common reasons for absenteeism during an outbreak. This report was equally not surprising when providing personal safety measures such as PPE and priority treatment like antivirals. These were the two leading interventions that workers wanted to be put in place to motivate them to come to work in the event of an outbreak. However, when the family members of these workers also received similar interventions like priority treatment, it greatly impacted upon their motivation to work more than when their families were excluded from the intervention.[23]


  Conclusion Top


This study showed that HCWs were willing to work during an EVD outbreak. Females and nurses were more likely to report an increased willingness to come to work than males and other categories of HCWs. Although the greatest motivating personal and family-related factors were the ability of the hospital management to provide the HCW and his/her family adequate vaccination, the most important work-related factor was having access to appropriate antivirals or treatment for the infection.

Recommendations

Government and hospital managers should develop plans to vaccinate and offer available antivirals to workers who become infected in the course of rendering services to their patients and extend this to their immediate family members when they need such interventions. The hospital managers should also ensure regular updates of staff on emergency preparedness and infection prevention and control training and practices.

Authors’ contributions

NI analyzed data, interpreted the result, and contributed to writing and revision of the manuscript. CAO conceptualized and designed the research, literature review, and contributed to writing and revision of the manuscript. ATO, ENA, ACN, and SUA contributed to concept and design, manuscript editing, and manuscript review, whereas CNO, CAO, IMO, CWK, and ORA IJO, OHC contributed to data acquisition, manuscript editing, and manuscript review.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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    Tables

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