Perception and Experiences of the Front Line Health Workers (FLWs) Attending Suspected or Confirmed Covid-19 Patients in Bangladesh: a Cross-sectional Study

Abstract

Background: Front-line health workers (FLWs) are always at a very high risk of being infected by COVID 19 due to their close contact with patients; thus, proper protection is critical. Concerning the FLWs' safety, Bangladesh's haphazard health system preparedness response on the eve of the pandemic triggered an uncoordinated management crisis, making the FLWs even more vulnerable. This study aims to elicit FLWs' perceptions and experiences regarding personal safety against COVID-19 while attending suspected/confirmed cases in the pandemic's early days. Methods: A mixed-methods quick telephone survey of a cross-sectional design was conducted during April and May 2020. 60 FLWs of various categories and levels from 14 districts and 43 institutions participated in the study in two rounds (initial and follow up) by four weeks apart. The participants were chosen using a combination of purposive sampling and the snowball sampling method and responded to a semi-structured questionnaire. Descriptive analysis was done for quantitative data, and qualitative data were thematically analysed.Results: The FLWs were obvious about the necessity of using Personal Protective Equipment (PPEs) for suspected/confirmed COVID-19 cases with suspected/asymptomatic patients. All types and levels of FLWs did not get the needed formal training on COVID-19 management and prevention. During the initial round, only 75% and 57% FLWs received PPEs and training for their proper use, respectively. Concerns about spreading the infection to family members precipitated mental health problems for the FLWs, so they recommended some safety measures, e.g. separate accommodation, transport, modified duty roaster during COVID placement. After almost a month, the follow-up round showed that a total of 76% FLWs received PPEs, but only 20% received training about them during the last month. The recommended measures were found to be more beneficial for physicians than the other FLWs. Conclusion: COVID 19 highlighted the shortcomings of Bangladesh's health systems and the low priority given to public health. This hampered the COVID 19 response, which was late, fragmented, and poorly coordinated, putting the FLWs at risk even more. Nonetheless, a coordinated, integrated approach involving all relevant authorities is required, and the health ministry should direct an efficient and inclusive COVID response.