Lessons from Compliance to Covid-19 Infection Prevention and Control Measures Among Health Care Workers in Somalia: Making a Case to Improve Preparedness and Readiness for National Health Security in a Fragile Setting

Abstract

Introduction:During infectious disease epidemics such as the COVID-19 pandemic, health care worker (HCW) infections can trigger and propagate hospital outbreaks. This is more prevalent in low-resource countries. This study determined the compliance to infection prevention and control (IPC) measures among HCWs exposed to COVID-19 in Somalia.Methods: Using a cross-sectional survey design, a random sample of 398 COVID-19 exposed HCWs from 198 health facilities in 33 districts from all six administratve regions of Somalia were surveyed via a self-administered questionnaire. Respondents reported practices related to the application of IPC measures when caring for confirmed COVID-19 cases in facility settings. Using their responses, principal components analysis was used to categorize the HCWs as "low" or "more" IPC compliant. The independent association of different individual and sociodemographic factors with non-compliance to IPC measures was assessed using logistic regression.Results: Over half (53.3%) of the respondents were male, and 63% married. Eight of ten HCWs had tertiary education, and nearly half (45.5%) were nurses. Doctors and midwives were 13.3% and 16.3%, respectively. Nearly two-thirds (61.4%) of HCWs had low compliance. On bivariate analysis, factors associated with low compliance were lack of testing, lack of exposure to direct care/contact or aerosol-generating procedures, and state/region where HCWs worked. At multivariate analysis, not being involved in direct care for COVID-19 patients (adjusted odds ratio (aOR) 10.4; 95% confidence interval (CI): 3.4-31.7), not being exposed to aerosol-generating procedures (aOR 2.7; 95% CI: 1.2-6.2) corelated to low compliance. Odds of low compliance were higher among HCWs who had not previously tested for COVID-19 (aOR) 2.4 (95% (CI) 1.0-5.6). HCWs from