Determinants of Knowledge, Attitudes, and Practices of Frontline Health Workers During the First Wave of COVID-19 in Africa: A Multicenter Online Cross-Sectional Study

Figures & data

Figure 1 Flowchart showing the recruitment of study participants.

Abbreviations: KAP, knowledge, attitude and practices; n, absolute frequency.

Table 1 Socio-Demographic Characteristics of Frontlines COVID-19 Health Workers

Socio-Demographic Characteristics	Frequency: n (%)
Country of residence
DRC	248 (48.0)
Uganda	60 (11.6)
Algeria	57 (11.0)
Ghana	37 (7.2)
Senegal	25 (4.8)
Others	90 (17.4)
Age category
<21 years	16 (3.1)
21–30 years	180 (34.8)
31–40 years	167 (32.3)
41–50 years	93 (18.0)
51–60 years	47 (9.1)
Sex
Male	289 (55.9)
Female	228 (44.1)
Cadre of HW
Allied HW (others)	66 (12.8)
Nurses	154 (29.8)
Doctors	297 (57.4)
Education level of HW
Certificate	15 (2.9)
Diploma	54 (10.4)
Degree/Bachelor’s	333 (64.4)
Masters	81 (15.7)
Others	22 (4.3)
Marital status of HW
Single	218 (42.2)
Married	299 (57.8)
Religion of HW
Muslim	82 (15.9)
Christians	396 (76.6)
Jehovah’s witness	16 (3.1)
Others	23 (4.4)

Abbreviations: HW, health workers; DRC, Democratic Republic of Congo.

Figure 2 Distribution of knowledge, attitudes and practices (KAP) of COVID-19 preventive measures among healthcare workers in Africa.

Table 2 Bivariate Analysis Showing Determinants of Knowledge Towards COVID-19 Infections and Prevention

Variables	Knowledge Category		p-value*
	Poor: n (%)	Good: n (%)
Country of workplace			<0.0001
Algeria	53 (93.0)	4 (7.0)
DRC	192 (77.4)	56 (22.6)
Uganda	17 (28.3)	46 (71.7)
Ghana	21 (56.8)	16 (43.2)
Others	96 (83.5)	19 (16.5)
Age category			0.216
<20 years	15 (93.8)	1 (6.2)
21–30 years	125 (69.4)	55 (30.6)
31–40 years	120 (71.9)	47 (28.1)
41–50 years	70 (75.3)	23 (24.7)
51–60 years	37 (78.7)	10 (21.3)
Sex category			0.170
Female	205 (70.9)	84 (29.1)
Male	174 (76.3)	54 (23.7)
Cadre of HW			<0.0001
Others (Allied HW)	56 (84.8)	10 (15.2)
Nurses	141 (91.6)	13 (8.4)
Doctors	182 (61.3)	115 (38.7)
Education level			<0.0001
Certificate	13 (86.7)	2 (13.3)
Diploma	49 (90.7)	5 (9.3)
Degree/Graduate	249 (74.8)	84 (25.2)
Masters	46 (56.8)	35 (43.2)
Others	22 (64.7)	12 (35.3)
Marital status			0.811
Single	161 (73.9)	57 (26.1)
Married	218 (72.9)	81 (27.1)
Religion of HW			0.195
Muslim	66 (80.5)	16 (19.5)
Christian	282 (71.2)	114 (28.8)
Jehovah’s witness	14 (87.5)	2 (12.5)
Others	17 (73.9)	6 (26.1)

Note: *p value from chi-square analysis.

Abbreviations: DRC, Democratic Republic of Congo; HW, health workers.

Table 3 Multivariate Analysis Showing Determinants of Knowledge for COVID-19 Infections and Preventions

Variables^a	Odds for Good Knowledge
	Bivariate Logistic Regression		Multivariate Logistic Regression
	Crude OR	p-value	Adjusted OR	p-value
Country				<0.0001
Algeria	Reference	-	-
DRC	3.9 (1.3–11.1)	0.012	4.59 (1.34–15.73)	0.015
Uganda	33.5 (10.5–107.0)	<0.0001	34.09 (9.26–125.48)	<0.0001
Ghana	10.1 (3.0–33.7)	<0.0001	13.22 (3.36–52.00)	<0.0001
Others	2.6 (0.8–8.1)	0.094	2.09 (0.63–6.89)	0.227
Sex				0.331
Female	Reference		-
Male	1.3 (0.89–1.96)	0.170	0.78 (0.48–1.28)	0.331
Cadre of HW				<0.0001
Others	Reference	-	-
Nurses	0.5 (0.21–1.25)	0.140	0.64 (0.23–1.75)	0.383
Doctors	3.5 (1.74–7.21)	0.001	3.26 (1.43–7.43)	0.005
Education level				0.011
Certificate	Reference		-
Diploma	0.7 (0.12–3.82)	0.046	0.17 (0.02–1.33)	0.091
Degree/Graduate	2.2 (0.48–9.92)	0.308	0.50 (0.09–3.68)	0.569
Masters	4.9 (1.05–23.35)	0.044	0.99 (0.15–6.56)	0.991
Others	3.5 (0.68–18.40)	0.132	1.46 (0.20–10.74)	0.712
Religion of HWs				0.885
Muslims	Reference	-
Christians	1.7 (0.93–3.00)	0.088	0.98 (0.43–2.22)	0.955
Jehovah’s Witnesses	0.6 (0.12–2.86)	0.512	0.67 (0.122–3.85)	0.668
Others	1.5 (0.49–4.28)	0.495	1.48 (0.38–5.75)	0.574

Note: ^aOnly variables in the bivariate analysis with p < 0.2 were included.

Abbreviations: HW, health workers; DRC, Democratic Republic of Congo.

Table 4 Analysis Showing Determinants of Attitude Towards COVID-19 Infections and Preventions Measures

Variables	Attitude Category		Bivariate Logistic Regression		Multivariate Logistic Regression
	Bad: n (%)	Good: n (%)	Crude OR	p-value	Adjusted OR	p-value*
Country						0.052
Algeria	20 (35.1)	37 (64.9)	Reference	-	-	-
DRC	19 (7.7)	229 (92.3)	6.52 (3.18–13.35)	<0.0001	3.95 (1.33–11.69)	0.013
Uganda	3 (5.0)	57 (95.0)	10.27 (2.85–37.02)	<0.0001	4.58 (1.03–20.45)	0.046
Ghana	0 (0)	37 (100)	-	-	-	-
Others	15 (13.0)	100 (87.0)	3.60 (1.67–7.77)	0.001	2.57 (1.02–6.47)	0.045
Age category						0.427
<20 years	7 (43.8)	9 (56.2)	Reference		-
21–30 years	14 (7.8)	166 (92.2)	9.22 (3.00–28.50)	<0.0001	3.35 (0.86–13.02)	0.081
31–40 years	15 (9.0)	152 (91.0)	7.88 (2.57–24.18)	<0.0001	2.41 (0.63–9.24)	0.200
41–50 years	11 (11.8)	82 (88.2)	5.80 (1.80–18.70)	0.003	1.79 (0.46–7.04)	0.403
51–60 years	7 (14.9)	40 (85.1)	4.44 (1.24–15.87)	0.022	1.84 (0.44–7.78)	0.408
Sex category						0.144
Female	36 (15.8)	192 (84.2)	Reference	-	-	-
Male	21 (7.3)	268 (92.7)	2.39 (1.35–4.23)	0.003	1.6 90.81–3.17)	0.178
Cadre of HW						0.025
Others (Allied HW)	11 (16.7)	55 (83.3)	Reference		-
Nurses	25 (16.2)	129 (83.8)	1.03 (0.48–2.24)	0.937	-	-
Doctors	21 (7.1)	276 (92.9)	2.63 (1.20–5.76)	0.016	3.60 (1.36–9.53)	0.010
Religion of HW						0.541
Muslim	19 (23.2)	63 (76.8)	Reference	-	-
Christian	29 (7.3)	367 (92.7)	3.82 (2.02–7.22)	<0.0001	1.38 (0.54–3.55)	0.504
Jehovah’s witness	4 (25.0)	12 (75.0)	0.91 (0.26–3.13)	0.875	-	-
Others	5 (21.7)	18 (78.3)	1.09 (0.36–3.31)	0.885	-	-

Note: *p-value from binary logistic regression.

Abbreviations: HW, health workers; DRC, Democratic Republic of Congo.

Table 5 Analysis Showing Determinants of Practice Towards COVID-19 Infections and Preventions

Variables	Practice Category		Bivariate Logistic Regression		Multivariate Logistic Regression
	Bad: n (%)	Good: n (%)	Crude OR	p-value	Adjusted OR	p-value*
Country						<0.0001
Algeria	20 (35.1)	37 (64.9)	Reference	-
DRC	15 (6.0)	233 (94.0)	8.40 (3.95–17.85)	<0.0001	19.72 (6.08–63.92)	<0.0001
Uganda	1 (1.7)	59 (98.3)	31.90 (4.11–247.7)	<0.0001	55.63 (5.90–524.6)	<0.0001
Ghana	6 (16.2)	31 (83.8)	2.79 (1.00–7.82)	0.001	6.00 (1.57–23.02)	0.009
Others	8 (7.0)	107 (93.0)	7.23 (2.94–17.80)	0.051	11.60 (3.87–34.74)	<0.0001
Age category						0.742
<20 years	5 (31.3)	11 (68.7)	Reference
21–30 years	18 (10.0)	162 (90.0)	4.09 (1.28–13.10)	0.003	0.50 (0.11–2.16)	0.350
31–40 years	11 (6.6)	156 (93.4)	6.45 (1.90–21.86)	0.003	0.77 (0.17–3.54)	0.737
41–50 years	11 (11.8)	82 (88.2)	3.39 (1.00–11.60)	0.052	0.46 (0.10–2.16)	0.324
51–60 years	5 (10.6)	42 (89.4)	3.82 (0.94–15.58)	0.062	0.66 (0.12–3.54)	0.624
Sex category						0.951
Female	28 (12.3)	200 (87.7)	Reference
Male	22 (7.6)	267 (92.4)	1.70 (0.94–3.06)	0.077	0.98 (0.473–2.02)	0.951
Cadre of HW						<0.0001
Others (Allied HW)	15 (22.7)	51 (77.3)	Reference
Nurses	21 (13.6)	133 (86.4)	1.86 (0.86–3.89)	0.098	4.25 (1.65–10.93)	0.003
Doctors	14 (4.7)	283 (95.3)	5.95 (2.71 −13.06)	<0.0001	8.60 (3.22–23.00)	<0.0001
Religion of HW			Reference	-
Muslim	16 (19.5)	66 (80.5)	2.96 (1.53–5.73)	0.001	0.97 (0.36–2.64)	0.957
Christian	30 (7.6)	366 (92.4)	3.64 (0.45–29.60)	0.227	2.84 (0.27–29.96)	0.386
Jehovah’s witness	1 (6.3)	15 (93.7)	1.62 (0.43–6.12)	0.480	2.25 (0.42–12.05)	0.342
Others	3 (13.0)	20 87.0)	Reference	-

Note: *p-value from binary logistic regression.

Abbreviations: HW, health workers; DRC, Democratic Republic of Congo.

Table 6 Multi-Variate Logistic Regression Showing the Influence of Health Workers’ Knowledge on Their Attitude Towards COVID-19 Prevention Measures: Adjusted for Socio-Demographic Factors

	Odds for Good Attitude			p-value*
	Adjusted Odds Ratio	95% Confidence Interval (CI)
		Lower Limit	Upper Limit
Knowledge category
Bad	Reference	-	-	-
Good	3.52	1.08	11.45	0.037
Age category
<20 years	Reference	-	-	-
21–30 years	3.67	0.93	14.42	0.063
31–40 years	2.62	0.68	10.13	0.161
41–50 years	1.92	0.49	7.57	0.353
51–60 years	2.01	0.47	8.51	0.345
Sex category
Female	Reference	-	-	-
Male	1.72	0.86	3.44	0.126
HW category
Others	Reference	-	-	-
Nurses	3.78	1.34	10.69	0.012
Doctors	3.13	1.17	8.37	0.023
Religion
Muslims	Reference	-	-	-
Christians	1.41	0.55	3.61	0.472
Jehovah’s Witnesses	0.61	0.15	2.50	0.493
Others	0.66	0.17	2.58	0.548
Country
Algeria	Reference	-	-	-
DRC	3.45	1.16	10.23	0.025
Uganda	2.31	0.48	11.21	0.300
Ghana	-	-	-	1
Others	2.55	1.01	6.44	0.048
Education level
Certificate	Reference	-	-	-
Diploma	3.62	0.49	26.58	0.206
Degree/Bachelor’s	1.84	0.33	10.37	0.492
Masters	4.59	0.61	34.34	0.138
Others	8.96	0.61	131.14	0.109

Note: *p-value from binary logistic regression.

Abbreviations: HW, health workers; DRC, Democratic Republic of Congo.

Table 7 Influence of HW’s Knowledge on Their Practice of COVID-19 Infection and Prevention Measures (Adjusted for Confounding Socio-Demographic Factors)

	Odds for Good Practice
	p-value*	Adjusted Odds Ratio	95% Confidence Interval (CI)
Knowledge category	0.189		Lower limit	Upper limit
Bad	Reference
Good	0.189	2.21	0.68	7.24
Age category	0.766
<20 years	Reference
21–30 years	0.373	0.51	0.12	2.24
31–40 years	0.761	0.79	0.17	3.63
41–50 years	0.351	0.48	0.10	2.26
51–60 years	0.680	0.70	013	3.80
Sex category	0.993
Female	Reference
Male	0.993	1.00	0.48	2.10
HW category	<0.0001
Others	Reference
Nurses	0.003	4.18	1.62	10.74
Doctors	<0.0001	7.51	2.77	20.40
Religion of respondent	0.597
Muslims	Reference
Christians	0.997	1.00	0.37	2.72
Jehovah’s Witnesses	0.337	3.17	0.30	33.29
Others	0.325	2.32	0.43	12.45
Country	<0.0001
Algeria	Reference
DRC	<0.0001	18.12	5.78	59.00
Uganda	0.002	36.16	3.61	362.05
Ghana	0.018	5.24	1.33	21.00
Others	<0.0001	11.57	3.87	34.62
Education level	0.243
Certificate	Reference
Diploma	0.334	2.77	0.35	21.78
Degree/Bachelor’s	0.725	1.40	0.22	8.92
Masters	0.122	6.33	0.61	65.50
Others	0.410	3.00	0.23	37.58

Note: *p-value from binary logistic regression.

Abbreviations: DRC, Democratic Republic of Congo; HW, health workers.

Table 8 Influence of Health Workers’ Attitude on Their Practice of COVID-19 Infection Prevention Measures; (Adjusted for Confounding Socio-Demographic Factors)

	Odds for Good Practice			p-value*
	Adjusted Odds Ratio	95% Confidence Interval (CI)
		Lower Limit	Upper Limit
Attitude category
Bad	Reference	-	-	-
Good	4.66	1.98	10.99	<0.0001
Age category
<21 years	Reference	-	-	-
21–30 years	0.33	0.07	1.57	0.162
31–40 years	057	0.11	2.84	0.488
41–50 years	0.36	0.07	1.86	0.224
51–60 years	0.61	0.10	3.65	0.586
HW category
Others	Reference	-	-	-
Nurses	3.78	1.36	9.42	0.010
Doctors	7.25	2.65	19.86	<0.0001
Religion
Muslims	Reference	-	-	-
Christians	0.85	0.30	2.43	0.756
Jehovah’s Witnesses	2.83	0.28	28.32	0.376
Others	2.91	0.45	18.56	0.26
Country
Algeria	Reference	-	-	-
DRC	18.60	5.10	61.26	<0.0001
Uganda	44.25	4.57	428.21	0.001
Ghana	3.86	0.96	15.45	0.056
Others	10.47	3.35	32.75	<0.0001
Sex category
Female	Reference	-	-	-
Male	0.90	0.43	19.20	0.792
Education level
Certificate	Reference	-	-	-
Diploma	2.02	0.20	20.32	0553
Degree/Bachelor’s	1.09	0.13	9.09	0.939
Masters	4.14	0.32	53.73	0.278
Others	2.45	0.14	42.83	0.74

Note: *p-value from binary logistic regression.

Abbreviations: HW, health workers; DRC, Democratic Republic of Congo.