Perceived Stress and Associated Factors During the Late Stages of Covid-19 Among Health Care Professionals at Eka Kotebe and Zewditu Memorial Hospital, Addis Ababa, Ethiopia: A Cross-Sectional Study

Abstract

The COVID 19 virus, also known as the coronavirus is an illness that can range from mild to severe. It is primarily transmitted through contact, with infected materials. Can cause symptoms like fever, coughing, difficulty breathing, muscle pain or fatigue and a runny nose. Health care professionals who work in the stages of the COVID 19 outbreak are at a risk of experiencing stress related issues. This is due to the workload they face concerns, about getting infected and inadequate equipment. The aim of this study was to evaluate the perceived stress levels and factors associated with it among health care professionals working in hospitals located in Addis Ababa, Ethiopia during the stages of COVID 19.

Methods: From the 30th of January to the 15th of February 2022, an institution-based cross-sectional study of 650 health care professionals was undertaken. After allocating a proportion to each health institute based on the amount of health care experts, study participants were chosen using a simple random sampling procedure. To collect data, a pre-tested and structured interviewer-administered questionnaire utilizing the KOBO collect survey tool was used. Based on the perceived stress scale, a total score of more than 20 points was determined the cut off for feeling perceived stress. To find related factors, bivariable and multivariable logistic regression analyses were used. In multivariable logistic regression, the level of statistical significance was fixed at less than 0.05.

Results: The prevalence of Perceived stress in this study was Nearly one-thirds 44.4% (95% CI: 41%, 48%) of HCPs had perceived stress. Being female (AOR = 1.4, 95% CI: 1.06, 2.06), age group 25-31 (AOR = 0.5, 95% CI:0.3, 0.9), having child/children (AOR =0.3, 95% CI:0.25, 0.52), Cigarette smoking (AOR = 2.2, 95% CI: 1.2, 3.8), and not doing exercise (AOR = 1.9, 95% CI: 1.1, 3.1) were positively association with perceived stress.

Conclusion: The current study found that perceived stress was highly prevalent among health care providers during the late stage of covid 19 pandemic and had significant associations with sex, age, having children, cigarette smoking and regular exercise. By implication, these findings should alert Health care professionals of the need to early detect these determinants of perceived stress. As a result, we recommend that health care providers to focus on early regular screening for stress.

Keywords: Perceived stress; Perceived stress scale; Health care professionals; Ethiopia

Abbreviation: AOR: Adjusted Odds Ratio; CI: Confidence Interval; COR: Crud Odds Ratio; HCPS: Health Care Professionals; PSS: Perceived Stress Scale; STATA: Statistical Software for Data Science

Introduction

The COVID 19 virus, also known as the coronavirus is an illness that can range from mild to severe and was discovered in December 2019. COVID-19 was declared a pandemic by the World Health Organization on March 11, 2020, due to the virus's subsequent global impact. It is primarily transmitted through contact, with infected materials. Can cause symptoms like fever, coughing, difficulty breathing, muscle pain or fatigue and a runny nose [1]. It is a new strain that was first discovered in 2019 in Wuhan, China. COVID-19 has wider community transmission owing to its capability to be transmitted even when carriers are asymptomatic [1]. In half of January 2021, over 98 million infections were recorded globally, claiming the lives of over 2.1 million people [2]. Ethiopia is one of the countries threatened by COVID- 19, with a total of 336,762 confirmed cases and 5,254 registered deaths as of September 23/2021 [3]. It is now the leading country in East Africa with the highest number of infected people. Thousands of HCPs have been infected with COVID-19 [4].

Fears of a pandemic of the Corona virus urge the government to mobilize an emergency response and extend a travel ban. Due to the excessive clinical workload, fear of contagion, and inadequate protective gear, healthcare workers are at a greater risk of developing mental health disorders. During outbreaks, healthcare personnel are at a significant risk of getting stress-related issues [5]. During COVID-19, the general people displayed perceived stress behaviors, resulting in a nationwide shortage of medical masks and alcohol. Furthermore, many medical professionals work more than 16 hours per day on average, resulting in insufficient sleep [1]. Many studies have been conducted around the world to examine the amount of felt stress among health care workers prior to the pandemic [6,7]. However, just a few studies on the same topic were undertaken during and after the COVID-19 pandemic. According to the existing research, health care professionals have a high perceived stress level. For example, the pooled prevalence of stress among health care professionals worldwide was 34%, and the pooled prevalence rate of psychological morbidities with regard to the impact of the COVID-19 pandemic was 44% [5,8].

A study conducted in Iraq showed that more than two-thirds of health care professionals had a moderate level of stress, nearly one-fifth had low and 9.6% of health care professionals had a high level of stress [5], the perceived stress level recorded was two-thirds 61.8% in Ethiopia [9], a systematic review and meta-analysis study in Ethiopia showed pooled prevalence of 51% [10].

The global COVID-19 pandemic has created a massive public health crisis and several challenges for healthcare providers [11]. The social, economic, and health effects are extensive, where they are related to increased all-cause mortality, occupational disability, poor quality of life, and cardiovascular disease risk [12]. Despite its multiple consequences, mental health is often neglected as a public health agenda [13].

The present pandemic's psychological consequences are produced by a number of causes, including concerns about competency when redeployed without proper training, uncertainty about the duration of the crisis, and inaccurate information about the vaccine's efficiency, depletion of personal protection equipment, workload, the need to take stressful precautions during the medical examination/in the operative fields, and the need to take stressful precautions during the medical examination/in the operative fields [1].

A number of research articles published over the past few months showed that a significant proportion of healthcare providers [1]. Despite this, there is insufficient evidence about the mental health impact of COVID-19 among front-line health care providers in Addis Abeba, Ethiopia. As a result, the current study sought to ascertain the levels and predictors of stress among front-line healthcare personnel at Addis Abeba public hospitals. This would allow policymakers, healthcare executives, and stakeholders to utilize the results as a baseline for planning and implementing interventional initiatives.

Methods and Materials

Study Design

An institutional-based cross-sectional study design was conducted.

Study Period and Area

The study was conducted at health centers in Addis Abeba city from January 30,2022 to February 15, 2022.The current metro area population of Addis Ababa in 2021 was 5,006,000. There are 11 sub-city and 116 woreda administrations and a total of 12 government-owned hospitals, 98 public health centers, 31 private hospitals, and 700 different level private clinics in Addis Ababa. Eka Kotebe General Hospital is the first COVID-19 treatment center in Ethiopia. The center is located in Addis Ababa, the capital of Ethiopia, where the highest number of cases of COVID-19 was recorded among all towns in Ethiopia. For the first time in Ethiopia, on 13 March 2020, 450 infected and suspected patients entered this facility, and 73 patients were confirmed to have COVID-19. The Eka Kotebe COVID-19 Treatment Center was relatively the only well-quipped treatment center in terms of ventilator machine, availability of the COVID-19 diagnosis test, and healthcare providers [14]. On the other hand ,Zewditu Memorial Hospital is one of the 6 hospitals administered by the Addis Ababa health office. It is located in the central part of the city. It has a total of 885 staff, 580 of them are health care professionals [15].

Source populations

All health care providers who were working in the selected public health institutions.

Study Population

The randomly selected health care providers from the selected public health institution.

Inclusion Criteria

All health care providers who were working in the selected public health institutions.

Exclusion Criteria

Those health care providers who were mentally/critically ill and on annual leave were excluded from the study.

Sample size

The minimum sample size was determined by using a single population proportion formula [n = [(Z a/2)2.P (1-P)]/d2] by assuming a 95% confidence level (Z a/2 = 1.96), a margin of error of 5%, P = proportion of health care providers who were stressed in Southern Ethiopia (61.8%) [9] and after accounting for design effect 1.5 and 5% addition for non-response rate. The final sample size became 692.

Sampling Procedure

A simple random sampling technique was applied to select the study participants. In the first stage, the two hospitals were purposely selected from 12 hospitals in the city. The total sample size was allocated to the selected hospitals proportional to their estimated HCPs at the time of the study. In the second stage, clinical departments or units were identified, and in the third stage, study participants were selected proportionally to the estimated number of HCPs listed in the different departments or units of the hospital, using simple random sampling. All eligible HCPs in each department/unit who consented to participate were selected into the study using simple random sampling.

Data Collection Tools and Methods

Quantitative data was collected using a pretested structured questionnaire using KOBO collect survey tool. The questionnaire was prepared originally in English and was translated to Amharic, and then translated back to English to ensure consistency in meaning. The questionnaire contained socio-demographic characteristics (age, sex, profession, qualification, income, religion, marital status, ethnicity, and work experience).

Data on perceived stress were collected with a perceived stress scale (PSS-10) which is a 10-item scale. The tool has a 5-point Likert response. Each item was scored with 0 = Never, 1 = Almost Never, 2 = Sometimes, 3 = Fairly Often, and 4 = Very Often, which was employed to evaluate each item. The total score ranged from 0 to 40 [16]. During data collection, a reliability analysis was done and the result showed a good score of internal consistency between the items (Cronbach’s alpha = 0.79).

Study Variable

The questionnaire contained socio-demographic characteristics (age, sex, profession, qualification, income, religion, marital status, ethnicity, and work experience), Health related issue (Previous psychiatric history, chronic illness, feir of daing due to covid 19, Substance use (Cigarette smoking, Khat chewing and Drinking Alcohol). Data on perceived stress were collected with a perceived stress scale (PSS-10) questioner which is a 10-item scale.

Operational Definition

Perceived stress

10 Likert scale questions measuring perceived stress status of the respondents was used. The score of stress assessing question was calculated for each respondent then overall score was computed and the status was classified in to no perceived stress and perceived stress. A total score of >20 points was considered as the cut off for experiencing perceived stress based on perceived stress scale [17].

Statistical Analysis

After checking for the completeness and consistency of the collected data, the data were entered into Epi-data version 3.02 and exported to SPSS version 25 for analysis. To express descriptive results, frequency with percent and mean with standard deviation were computed.

A binary logistic regression was performed to determine the crude association between each independent variable by viewing the Crude Odds Ratio (COR) result. Variables in the bi-variable analysis with a p-value< 0.25 were candidates for multi-variable binary logistic regression analysis and Adjusted Odds Ratio (AOR) with 95% CI were calculated. For the multi-variable analysis, variables with a p-value= 0.05 were considered statistically significant.

Data Collectors and Data Quality Controls

Training was given for the data collectors and supervisors for three days. Pretest was done and amendment was performed accordingly. The data was collected using ten BSC nurses and the supervision was undertaken by five MSC health care professionals. The PSS data collection tool is valid in Ethiopia [16]. To check the reliability of the data we calculated cronbach alpha result of PSS tool in this study is 0.79.

Ethical Consideration

Ethical clearance was obtained from the Ethical Review Board of University of Gondar with ethical clearance number 2478/2014. To ensure the confidentiality of respondents, an informed oral consent was obtained from each study participant and their names were not written on the questionnaire which reduce the authors access to information that could identify individual participants during or after data collection.

Result

Table 1shows that from the total sample 650 completed the interview with response rate of 93.9%. More than half 364(56%) of the respondents were males and nearly one-third 259(39.8%) of the respondents were single and regarding educational status 54(8.3%), and 555(85.4%) of the respondents were diploma and first-degree holders respectively. Regarding the profession of the respondents 368 (58.8%) of them were clinical nurse, followed by midwifery 73 (11.2%) presented on Table 1.