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 Table of Contents  
ORIGINAL ARTICLE
Year : 2021  |  Volume : 10  |  Issue : 2  |  Page : 145-151

Drivers, barriers, benefits, and perceived dangers of the use of COVID-19 biosecurity protective items in a medically challenged environment of a rural hospital in Eastern Nigeria


1 Department of Family Medicine, Federal Medical Centre, Umuahia, Abia State; Department of Medicine, College of Medicine and Health Sciences, Rhema University, Aba, Nigeria
2 Department of Health Administration and Management, University of Nigeria; Department of Health Services, AIICO Multishield Ltd, Enugu, Nigeria
3 Department of Family Medicine, Alex Ekwueme Federal Teaching Hospital Abakaliki, Abakaliki; Department of Family Medicine, Alex Ekwueme University, Ndifu Alike, Ebonyi State, Nigeria
4 Department of Family Medicine, Nnamdi Azikiwe University Teaching Hospital, Nnewi; Department of Family Medicine, Nnamdi Azikiwe University, Awka, Nigeria
5 Department of Public Health, Federal University of Technology, Owerri, Nigeria

Date of Submission29-Jun-2020
Date of Decision11-Oct-2020
Date of Acceptance06-Jan-2021
Date of Web Publication18-May-2021

Correspondence Address:
Dr Gabriel Uche Iloh
Department of Family Medicine, Federal Medical Centre, Umuahia, Abia State
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijhas.IJHAS_151_20

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  Abstract 


INTRODUCTION: Coronavirus has infected and affected millions of life across the globe. As the burden of COVID-19 continues to rise, compliance with the use of COVID-19 biosecurity protective items by the public is critical in safeguarding interperson transmissions of the virus.
MATERIALS AND METHODS: A descriptive study was carried out from April to May 2020 on a cross-section of 400 adult Nigerians in a rural hospital in eastern Nigeria. Data collection was done using structured, pretested, and researcher-administered questionnaire. The questionnaire elicited information on drivers, barriers, benefits, and perceived dangers of the use of biosecurity protective items (face masks and alcohol-based hand sanitizers).
RESULTS: The study participants were aged 18–84 years with a mean age of 53 ± 11.6 years. There were 214 (53.5%) females. The most common driver of use of COVID-19 biosecurity protective items was government public health legislative directives (400/400) (100.0%). The most common barrier was a denial of the existence of COVID-19 (359/400) (89.8%). The most common benefits were protection from contracting COVID-19 (400/400) (100.0%) and prevent spreading the infection to others (400/400) (100.0%). The most commonly perceived dangers were suffocation (400/400) (100.0%) and hand irritation (377/400) (94.3%) for face masks and hand sanitizers, respectively.
CONCLUSION: The most common driver was government public health legislative directives. The most common barrier was a denial of the existence of COVID-19, while the predominant benefits were protection from contracting COVID-19 and prevent spreading the infection to others. The most commonly perceived dangers were suffocation and hand irritation for masks and sanitizers, respectively. There is a need to address the factors that constitute barriers and perceived dangers to the use of COVID-19 biosecurity items. Factors that drive the use of COVID-19 biosecurity items should be the focus of interest to contain the spread of COVID-19.

Keywords: Barriers, benefits, biosecurity items, dangers, drivers, face masks, hand sanitizer, Nigeria


How to cite this article:
Iloh GU, Obi IV, Ikwudinma AO, Emeka EA, Amadi AN. Drivers, barriers, benefits, and perceived dangers of the use of COVID-19 biosecurity protective items in a medically challenged environment of a rural hospital in Eastern Nigeria. Int J Health Allied Sci 2021;10:145-51

How to cite this URL:
Iloh GU, Obi IV, Ikwudinma AO, Emeka EA, Amadi AN. Drivers, barriers, benefits, and perceived dangers of the use of COVID-19 biosecurity protective items in a medically challenged environment of a rural hospital in Eastern Nigeria. Int J Health Allied Sci [serial online] 2021 [cited 2021 Jun 17];10:145-51. Available from: https://www.ijhas.in/text.asp?2021/10/2/145/316281




  Introduction Top


Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is a rapidly spreading viral infection that has infected humans of all ages, both sexes, with a risk of death reported in both developed and developing nations of the world.[1],[2] Coronavirus infectious disease-2019 (COVID-19) causes disruption of social dynamics leading to social dysfunction and staggering economic wealth of different nations of the world.[3] COVID-19 is caused by a positive-sense, single-stranded RNA virus that originates from the Coronaviridae family which manifest itself in so many various ways with a range of odd and frightening clinical presentations.[4] The transmission dynamics and bionomics of SARS-CoV-2 virus is still emerging in different parts of the world. The World Health Organization (WHO)[5] and US Centre for Disease Control (CDC)[6] have emphasized that the primary mode of transmission of COVID-19 is close contact (within about 6 feet) from person to person, through respiratory droplets produced when an infected person coughs, sneezes, or talks. These droplets can land on the mouths, noses, or eyes of nearby persons or possibly be inhaled into the lungs. COVID-19 virus spreads very easily and sustainably from person to person. However, other modes of transmission are still being studied.

The morbidity and mortality from COVID-19 have been reported among humans in different parts of the world such as China,[7] United States of America (USA),[8] United Kingdom (UK),[9] Italy,[9] Spain,[9] India,[10] Saudi Arabia,[11] Nigeria,[12] and other parts of the world.[2] Although every human being is at high risk of the contagion and possible mortality from the dreaded COVID-19 virus, a high number of deaths and illness experience are expected from Africa due to fragile health systems, lack of compliance with biosecurity public health preventive measures, barriers to testing, and potentially vulnerable populations in socioeconomic and epidemiological transition.[12],[13],[14] This calls for an effective and enabling response and strategies to contain the spread of the virus in the region. As a global pandemic that has altered the world outlook, international organizations like WHO,[1],[5] European CDC,[9] Africa CDC,[14] and national bodies such USA CDC,[8] Nigerian CDC,[12] and other Centres for Disease Prevention and Control[7],[8],[9],[10],[11] have issued out directives on the use of biosecurity protective items by the public to stem the spread of COVID-19 infection.

Biosecurity refers to the sum of measures designed to protect population and environment against pathogenic biological agents.[15] Aside biosecurity kits for frontline health-care workers, population-based biosecurity protective items for SARS-CoV-2 virus include face masks, alcohol-based hand sanitizers, and disinfectant sprays and other cleaning supplies.[16] As the spread of SARS-CoV-2 infection continues in different states in Nigeria, biosecurity protective items to limit spread have been in the spotlight on national and societal biosecurity discussions and arguments.[12],[17] There is overwhelming evidence that the use of biosecurity protective items for COVID-19 infection is most beneficial, while nonuse is associated with increased transmission of the coronavirus from person to persons.[18],[19],[20],[21] Of great concern is that despite the government directives on compliance with the use of COVID-19 biosecurity public protective and preventive items, nothing is published on the drivers and barriers to their utilization in resource-constrained context. As the case detection of COVID-19 increases in Nigeria, this prompted the Federal Government of Nigeria to legislate on mandatory wearing of face masks among the regular use of hand sanitizers and other COVID-19 public health directives.[12],[17] This study was therefore aimed at determining the drivers, barriers, benefits, and perceived dangers of the use of COVID-19 biosecurity protective items in a cross-section of adult Nigerians in a rural hospital in eastern Nigeria.


  Material and Methods Top


This was a descriptive cross-sectional study carried out from April to May 2020, on 400 adult Nigerians at St. Vincent De Paul Hospital, a General Hospital in Amurie-Omanze, in eastern Nigeria. The hospital renders 24 h of service every day, including public holidays to the community and its environs. The study participants consisted of adult Nigerians who were aged ≥18 years and who gave informed consent for the study and had accessed care at the hospital within the period of the study. Critically ill patients, the deaf and dumb, and those patients who were incompetent to respond to the items on the questionnaire instrument were excluded from the study.

Estimation of sample size was done using the formula for estimating minimum sample size[22] for descriptive studies when studying population of more than 10,000: n = Z2pq/d2 where n = desired sample size when the population is more than 10,000; Z = standard normal deviate set at 1.96 which corresponds to 95% confidence limit; and P = proportion of the target population expected to have maximum variability is 50% (P = 0.50); therefore q = 1.0 − p (q = 0.5) and d = desired level of precision set at 0.05. This gave a minimum sample estimate of 384 patients. To deal with incomplete response to the items on the questionnaire, the estimated sample size was increased by 5% incomplete response proportion. The sample size = n/1incomplete response proportion at 5%. This gave a sample size of 404 participants. However, a sample of 400 subjects was used for the study. The eligible participants for the study were consecutively recruited for the study based on the inclusion criteria until the sample size of 400 was achieved.

The study questionnaire consisted of sections on basic demographic information such as age and sex. The questionnaire elicited information on drivers, barriers, benefits, and perceived dangers of the use of COVID-19 biosecurity protective items such as face masks and hand sanitizers. The study questionnaire was designed by the researchers to suit the Nigerian environment through a robust review of appropriate literature on COVID-19 public health directives and protocols.[3],[5],[12],[13],[14],[15],[16],[17],[18],[19],[20],[21] The face validity of the drivers, barriers, benefits, and perceived dangers of the use of COVID-19 biosecurity item sections of the questionnaire was evaluated by a panel of knowledgeable experts in behavioral health science research, infectious disease epidemiology, and public health safety research who were not part of the study. The questionnaire was researcher administered.

Operationally, biosecurity items referred to protective and preventive materials against the risk of contracting, transmission, and contamination with COVID-19 infection. In Nigeria, the biosecurity interventions for the public include the use of face masks and hand hygiene with alcohol-based sanitizer. Drivers of COVID-19 biosecurity items use were factors that promote the likelihood of compliance with the use of face masks and hand sanitizers.

The ethical clearance was obtained from the Health Research and Ethics Committee of St Damian Hospital, Okporo, Orlu, Nigeria, with reference number SDH/003HR/20. Informed written consent was also obtained from the participants included in the study.

The data generated were analyzed using software International Business Machines Corporation, Statistical Package for Social Sciences (IBM SPSS) version 21, New York, USA, for the calculation of frequencies and proportions for categorical variables and mean for continuous variables.


  Results Top


Of the 400 patients who participated in the study, 92 (23.0%) were young adults, 185 (46.3%) were middle-aged adults, and 123 (30.7%) were older persons aged 60 years and more. The age of the respondents ranged from 18 to 84 years with a mean age of 53 ± 11.6 years. There were 214 females (53.5%) and 186 (46.5%) males [Table 1].
Table 1: Age and sex distribution of the study participants (n=400)

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The most common driver of use of COVID-19 biosecurity protective items was government public health legislative directives (400/400 [100.0%]), while the most common barrier to the use of COVID-19 biosecurity protective items was a denial of the existence of COVID-19 (359/400 [89.8%]). Other drivers and barriers to the use of COVID-19 biosecurity protective items are shown in [Table 2].
Table 2: Drivers and barriers to the use of coronavirus disease-2019 biosecurity protective items (n=400)

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The most common benefits of COVID-19 biosecurity protective items were protection from contracting COVID-19 (400/400 [100.0%]) and prevention of spreading of the infection to others (400/400 [100.0%]). The most commonly perceived danger of the use of face masks was suffocation (400/400 [100.0%]), while the most common danger of the use of hand sanitizers was skin irritations (377/400 [94.3%]). Other benefits and perceived dangers of the use of face masks and hand sanitizers are shown in [Table 3].
Table 3: Benefits and perceived dangers of coronavirus disease-2019 biosecurity protective items (n=400)

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  Discussion Top


This most common driver of the use of COVID-19 biosecurity protective items was government public health legislative directives. The Federal Government of Nigeria public health legislative directives are in consonance with public health directives by the WHO,[16] Africa CDC,[14] and other national CDCs such as India,[10] Saudi Arabia,[11] and Ghana.[23] The finding of this study is a reflection of the government responsibility to contain the spread of the virus within and across the country. Although the use of biosecurity protective items such as wearing of facemasks and use of hand sanitizers are alien to the general public, the government has made them mandatory as public health interventional measures to curtain the spread of SARS-CoV-2 infection. WHO,[16] Nigeria CDC,[12] and other national CDCs[10],[11],[23] have emphasized that face masks and hand sanitizers should be used with other comprehensive public health directives such as physical distancing and disinfecting of commonly touched surfaces among others. Admittedly, government public health legislative directives on the use of COVID-19 biosecurity items can only be effective if the general public comply with their use.[10],[24] With the easing of the lockdown measures, there is palpable fear that people will disregard the government public health directives, thus emphasizing the need for legislative enforcement and regulations to safeguard the life of the people. However, those who flout and ignore the public health directives should be prosecuted based on enabling and extant COVID-19 rules and orders. This is the need of the moment in the face of increasing cases of COVID-19 in the region[12],[14] and other parts of the world.[2]

The most common barrier to the use of COVID-19 biosecurity protective items was a denial of existence of COVID-19 infection. There is widespread information in Nigeria that COVID-19 is a hoax and political conspiracy.[25],[26],[27] Similar public orientation and disposition have also been observed even in developed nations such as USA[28] and UK.[29] Of great enthusiasms in the region amidst global infodemics[30] of COVID-19 is the belief that COVID-19 patients at the Isolation and Treatment Centres(ITCs), as well as Infectious Disease Hospitals(IDHs) in different parts of the country are being treated for malaria and there is no COVID-19 in the country.[31] This attitude by the general public is worsened by locking down of the people at their homes without palliatives and depriving them of their daily businesses with a risk of dying from hunger rather than the virus. Although COVID-19 is not as fatal as the social media portrays it, it is highly contagious and spreads fast, especially when public health directives including use of biosecurity protective items are not observed.[12],[30],[31] The denial of existence of COVID-19 among the fact that people are getting the infection and some dying from its complications escalates the spreading of the infection, thereby making its containment a mirage.[30] The distrust and disbelief among the populace in Nigeria[25],[26],[27] and other parts of the world[28],[29],[30],[31],[32],[33] need to be addressed as it has constituted a barrier to compliance with the use of COVID-19 biosecurity items among easing of lockdowns and curfews. Given the circumstantial evidence and seriousness of COVID-19 outbreak, the public should be given appropriate health information, education, and communication on the virus in line with its infectivity, prevention, and control.[30] The reality of COVID-19 should never be dismissed with a wave of the hand that it is not my portion.

The most common benefits of COVID-19 biosecurity protective items were protection from contracting the infection and preventing spreading of the infection to others. This finding is a mirror of the impact of public health directives by relevant government agencies on the mandatory use of face masks and hand hygienic measures.[12],[17] These public health directives have also been reported in other countries with COVID-19 infection[7],[10],[11],[23] following the declaration of COVID-19 as a public health emergency of great concern by the WHO.[1] According to these COVID-19 public health preventive directives, the general public is directed to wear face masks when going out whether sick or not or attending to a sick person as well as ensure regular hand hygiene. The public health benefits accrued from use of biosecurity protective items for COVID-19 have been reported in the USA,[21],[34],[35] Germany,[36] and other parts of the world.[16],[18],[19],[20] Although the prognosis of COVID-19 pandemic is relatively favorable when compared with its predecessors, public health precautionary measures remain an obligation and prevention protocols need to be aligned with the COVID-19 bionomics.[4],[5],[35],[36] It is therefore recommended that hands must be cleaned with sanitizer or and/or soap and water before putting on a mask, ensure that mask fully covers mouth and nose with no gaps between the face and the mask, avoid touching the mask after wearing it, and removing the mask through the loop of the mask behind the ear without touching the front of the mask, and apply alcohol-based hand sanitizer immediately after disposal. As many countries, especially those in socioeconomic and medical challenges, did not possess the required human, material, and monetary resources to face COVID-19 pandemic and were, thus, vulnerable to its high infectivity, widespread and appropriate use of effective public health biosecurity protective items remain paramount in these environments. The general public should always attend to their activities of daily living but should never forget to use COVID-19 biosecurity protective items as and when due. Dedicated use of COVID-19 biosecurity protective items is therefore the need of the moment, a necessity today and essentiality tomorrow as long as the coronavirus pandemic lasts.[37]

The most common danger of use of face masks among the study participants was suffocation. Suffocation from prolonged use of face masks has also been reported in biomedical literature.[38],[39] Although there are limited information on suffocating dangers of commonly used public face masks for COVID-19, the risk associated with the use of face masks depends on the type of masks, length of time on masks, and health status of the wearer. Of great concern is that the presence of poor-quality face masks in the Nigerian markets.[40] WHO,[16] Nigeria CDC,[12],[41] and other national CDCs[10],[21],[23] have emphasized the need to ensure that all masks meet the minimum standards of safety, filterability, and breathability. However, when Food and Drug Authority-approved masks are not available, a triple fabric home-made masks with appropriate specification should be used.[34] More importantly, masks should not be used for more than 12 h at a time and ought to be replaced immediately it is soiled or damp.[23],[37] In this regard, face masks should be worn based on current recommendations in addition to other public health preventive measures for COVID-19. A national concerted effort is therefore required on the part of government and Nigeria CDC to commit time to face mask safety and ensure that only face masks of acceptable quality are sold or freely distributed to the general public.

The most common danger of use of hand sanitizers among the study participants was hand irritation. These dangers of alcohol-based hand sanitizers have also been documented in the biomedical literature.[42],[43] Alcohol-based sanitizers sanitize the hand without moisturization and when not properly formulated can wash away skin's natural oils and expose the skin to irritation. Of great disturbance in the region is the presence of adulterated and substandard hand sanitizers in the Nigerian pharmaceutical and supermarket.[44] WHO,[43] Nigeria CDC,[12] and other national CDCs[12],[21],[23] have emphasized the need to ensure that all hand sanitizers meet the minimum standards of safety and anti-COVID-19 viral properties. However, in persons with sensitive skin, skin irritation can be minimized by the addition of humectants and skin emollients provided they do not promote allergic reactions or add to the toxicity of sanitizer for human use or interfere with SARS CoV-2 antiviral properties. There is a need for hand sanitizers to be made based on rich scientific research tailored toward minimizing skin irritation.

The limitations of this study are recognized by the researchers. The study was based on interviews and may thus be prone to information bias on the use of COVID-19 biosecurity protective items by the respondents. The list of COVID-19 biosecurity protective items was not exhaustively studied.


  Conclusion Top


This study has shown the drivers, barriers, benefits, and perceived dangers of the use of COVID-19 biosecurity protective items. The most common driver for the use of COVID-19 biosecurity protective items was government public health legislative directives. The most common barrier was a denial of the existence of COVID-19, while the predominant benefit was protection from contracting COVID-19 and prevents spreading to others. The most commonly perceived dangers were suffocation and hand irritation for masks and sanitizers, respectively. There is a need to address the factors that constitute barriers and perceived dangers to the use of COVID-19 biosecurity protective items. Factors that drive the use of COVID-19 biosecurity protective items should be the focus of interest to contain the spread of COVID-19. This study therefore calls for public-friendly biosecurity protective interventional measures to establish, enhance, and promote a culture of biosecurity items use for COVID-19 infection prevention and control.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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