The psychological impact of the COVID-19 pandemic on healthcare workers in the sub-Saharan Africa: A narrative review of existing literature

Abstract

Background: The ongoing Coronavirus disease 2019 (COVID-19)pandemic has significantly impacted the physical and mental health of the general population world-wide with healthcare workers (HCWs) at particular risk. The effect of the pandemic on the mental wellbeing of healthcare workers has been severe and characterized by depression, anxiety, work related stress, sleep disturbances and post-traumatic stress disorders (PTSD). Therefore, protecting the mental wellbeing of HCWs is a major priority. This review is intended to determine identifiable risk factors for adverse mental health outcomes, and any protective or coping measures to mitigate the harmful effects of the COVID-19 crisis among HCWs in sub-Saharan Africa. Methods: We performed a literature search using PubMed, Google Scholar, Cochrane Library and Embase for relevant materials. All articles published between March 2020 and April 2022 which were relevant to the subject of review and met a pre-defined eligibility criteria were obtained. A total of 23 articles were selected for the initial screening and 12 articles were included in the final review. Result: A total of 5,323 participants in twelve studies predominantly from Ethiopia (08 studies), one each from Uganda, Cameroon, Mali, and Togo fulfilled the eligibility criteria. Investigators found 16.3–71.9% of HCWs with depressive symptoms, 21.9-73.5% with anxiety symptoms, 15.5-63.7% experienced work-related stress symptoms, 12.4-77% experienced sleep disturbances, and 51.6-56.8% reported PTSD symptoms. Healthcare workers especially those working in emergency units, intensive care units, infectious disease wards, pharmacies and laboratories were at higher risk of developing adverse mental health impact. HCWs had profound fear, very anxious and stressed with the high transmission rate of the virus among themselves, high death rates among their patients, and lived in constant fear of infecting their families and self. Other sources of fear and work-related stress were lack of standardized PPEs, lack of known treatment and vaccines to protect themselves against the virus. HCWs faced stigma, abuse, financial problems, and lack of support. Conclusion: The prevalence of depression, anxiety, insomnia, and PTSD in HCWs in sub-Saharan Africa during the COVID-19 pandemic has been high. Several organizational, community and work-related challenges and interventions were identified including improvement of workplace infrastructures, the adoption of correct and shared infection control measures, provision of standardized personal protective equipment (PPE), social support and the implementation of resilience training programs. Setting up permanent multidisciplinary mental health teams, at regional and national levels to deal with mental health issues and providing psychological support to patients and HCWs, supported with long term surveillance and sufficient budgetary allocation is recommended.