ABSTRACT
Background Health workers involved in COVID-19 response might be at risk of developing fear and psychological distress. This study aimed to identify factors associated with COVID-19 fear among health workers in Nepal during the early phase of pandemic. Methods A web-based cross-sectional survey was conducted in the month of April-May 2020 among 475 health workers directly involved in COVID-19 management. The Fear Scale of COVID 19 (FCV-19S) was used to measure the status of fear. Scatter plots were used to observe the relationship between fear and other psychological outcomes: anxiety, depression and insomnia. Multivariable logistic regression was done to identify factors associated with COVID fear. Results COVID-19 fear score was moderately correlated with anxiety and depression, and weakly correlated with insomnia (p<0.001). Nurses (AOR=2.29; 95% CI: 1.23-4.26), health workers experiencing stigma (AOR=1.83; 95% CI: 1.12-2.73), those working in affected district(AOR=1.76; 95% CI: 1.12-2.77) and presence of family member with chronic diseases (AOR=1.50; 95% CI: 1.01-2.25) was associated with higher odds of developing COVID-19 fear as compared to other health workers, health workers not experiencing stigma, working in non-affected district and not having family member with chronic diseases respectively. Conclusion Nurses, health workers facing stigma, those working in affect district and having family member with chronic diseases were more at risk of developing COVID-19 fear. It is thus recommended to improve work environment to reduce fear among health workers, employ stigma reduction interventions, and ensure personal and family support for those having family member with chronic diseases.
Subject(s)
COVID-19 , Anxiety Disorders , Chronic DiseaseABSTRACT
BackgroundRapidly growing coronavirus disease 2019 (COVID-19) pandemic has brought unprecedented challenges to the health system in Nepal. The main objective of this study was to explore the characteristics and drivers of the health system preparedness towards COVID-19 and its impacts on frontline health care workers (HCWs) in Nepal.MethodsSemi-structured interviews (SSIs) were conducted among 32 HCWs who were involved in clinical care of COVID-19 patients and four policymakers who were responsible for COVID-19 control and management at central and provincial level. Participants were included from all seven provinces of Nepal. All SSIs were conducted through telephone or internet based tools such as Zoom and Skype. All interviews were audio-recorded, transcribed into English, and coded using inductive and deductive approaches.ResultsBoth HCWs and policymakers reported failure to initiate pre-emptive control measures at the early stages of the outbreak as the pivot in pandemic control. Although several measures were rolled out when cases started to appear, the overall health system preparedness was low. Specifically, there was inadequate personal protective equipment for HCWs, insufficient isolation beds for patients, poor coordination between the three tiers of governance, and poor engagement of the private sector. Additionally, HCWs experienced various degrees of stigma because of their profession and yet were able to maintain their motivation to continue working in the forefront.ConclusionThis study identified poor preparedness of the health system in the course of Nepal's COVID-19 response embedded in the governance. Specifically, the lack of human resources, inadequate logistic chain management and laboratory facilities for testing COVID-19 appeared to have jeopardized the health system preparedness and escalated the pandemic in Nepal. Despite the poor preparedness, and health and safety concerns, HCWs maintained their motivation. Urgent efforts are required to reform the governance and coordination mechanism in addition to incentivizing the HCWs for the current and future pandemics.