A pandemic is the worldwide spread of a new disease. The last notable pandemic occurred in 1918 caused by an H1N1 virus with genes of avian origin [1]. It is estimated that about 500 million people or one-third of the world’s population were infected with this virus. Although there is no specific record of the statistics of the health workers who were infected, but there are speculations that a lot of health workers would have been infected as the pandemic spanned for nearly a year (1918-1919) [1].

Coronavirus disease (COVID-19) caused by severe acute respiratory syndrome: coronavirus 2 (SARS-CoV-2) virus, which was initially considered a pneumonia of unknown cause broke out in Wuhan, China on the 31^st of December 2019 [2]. The disease was later declared a Public Health Emergency of International Concern on the 30th of January 2020 and eventually a pandemic on the 11th of March 2020 due to the alarming levels of spread and severity [3]. Globally, a total of 152,888 COVID-19 infections and 1413 deaths had been reported as of August 2020. Infections were mainly in women (71.6%, n = 14,058) and nurses (38.6%, n = 10,706), but deaths were mainly in men (70.8%, n = 550) and doctors (51.4%, n = 525). Limited data suggested that general practitioners and mental health nurses were the highest risk specialties for deaths. In Africa, there are more than 10,000 health workers in the 40 countries which reported to have been infected with COVID-19 [4]. In Nigeria, as at August 2020, 2175 health workers had been infected with COVID-19, while in Rivers State, 122 health workers (97 in public and 25 in private facilities) had been infected with COVID-19. The 122 health workers infected in Rivers State are thus: 69 doctors, 31 nurses, 5 laboratory scientists, 2 health attendants and others 5 [5]. The State had her index case of COVID-19 on March 25, but as of 11th August 2020 had recorded 1972 confirmed cases of COVID-19 according to Nigerian Centre for Diseases Control (NCDC) [6].

Health workers are at the front line of the COVID-19 outbreak response and as such are exposed to hazards which include pathogen exposure, long working hours, psychological distress, fatigue, occupational burnout, stigma, and physical and psychological violence [7] [8]. These hazards predispose health workers to infection and contribute to the rising number of cases globally. In Rivers State as of 11^th August 2020, a total of 106 health workers were infected with Covid-19 with three deaths. Knowledge is a prerequisite for establishing prevention beliefs, forming positive attitudes, and promoting positive behaviours. Individuals’ cognition and attitudes towards disease affect the effectiveness of their coping strategies behaviour and practice [9].

Literature shows that there is available information on the findings from studies done in China, Pakistan and Nigeria on awareness, attitude, and other characteristics of COVID 19 [2] [7] [10] [11] [12] [13] [14]. However, few studies have been published in South-South Nigeria. Hence, this study was carried out six weeks into the pandemic response in Rivers State (which commenced on the 20^th of February 2020) to assess the knowledge, attitude, perception, and practice of Covid-19 prevention among healthcare workers in Rivers State, Nigeria. Survey findings would identify gaps in the knowledge of COVID-19 transmission and symptoms among health workers across Rivers State as was seen in published studies outside Nigeria [14] [15].

This research provides insights into gaps in awareness, knowledge, attitude, perception, and practice of Covid-19 prevention among health care workers in Rivers State. Most healthcare workers had heard about Covid-19. However, their source of information at the time of the survey was mostly through radio and television. This finding on source of information, agrees with that of other researchers [2] [3] [7] [9]. This reflects the effectiveness and influence of broadcast media in disseminating information to the public. It is therefore important that the pandemic response collaborates with broadcast media agencies to ensure right and consistent messaging for COVID-19 prevention.

Most of the respondents were aware of COVID-19, however a third of respondents did not know that it is caused by a virus. This alludes to the fact that there is a gap in knowledge of the aetiology of the disease. This gap may be because of the paucity of non-technical sources of information about the disease. This gap in knowledge could have deleterious effect on the risk perception, attitude, and behaviour of these health workers. While almost all respondents claimed they would call the NCDC phone lines for suspected cases, one-tenth of respondents will treat the suspected case themselves. This finding is corroborated by the findings of other researchers who reported similar attitude of respondents [10] [12] [13] [14] [15]. This demonstrates a gap in attitude towards COVID-19 and can lead to unnecessary risk taking in managing suspected or confirmed cases of the disease. There were also about one-fifth of all respondents have the perception that government authorities are not doing enough to curb the pandemic. This perception exposes a distrust in government and has the potential to facilitate an unwillingness among health workers to go the extra mile in implementing prevention and control measures against COVID-19. Finally, whereas it is expected that all health workers are competent in all the handwashing steps, only two-thirds of respondents demonstrated the correct handwashing technique.

The findings of this survey viz-a-viz similar research underscore the need for cascade training at all levels of healthcare such that correct knowledge and information about aetiology and disease transmission dynamics is imparted to healthcare workers who will, in turn, be veritable sources of information to the public. Accurate knowledge empowers healthcare workers to respond safely and effectively as an antidote to fear-driven responses such as turning patients away from health facilities. As seen in this study, social media is not yet a pervasive source of information at the healthcare facilities in the local government areas of the state unlike more developed climes such as Europe and the US [15] [17]. However, the major means of communication from the National Centre for Disease Control (NCDC) is social media. This implies a gap between the provision of information and guidance and access to this information which has resulted in health workers and the masses in many rural communities not utilizing the information provided. Although there are ample information, education, and communication materials on the NCDC website, these need to be printed as posters, handbills, infographics, other materials especially for community-based education for healthcare workers. The gaps identified in attitude, perception, and preventive practices will be best addressed through risk communication activities targeted at boosting knowledge, and confidence of healthcare workers in Covid-19 prevention. Health workers with good knowledge, attitudes, and practice of Covid-19 prevention are less likely to get infected with the SARS-Cov-2 virus.

This survey was carried out among many healthcare workers across all the Local Government Areas of the state with responses that cut across primary and secondary facilities. This is a strength of this study because the results are generalizable to similar populations. A limitation of this study however is the cross-sectional nature of data collection which was done six weeks into the state outbreak response. The dynamic nature of this pandemic and its response implies that a lot of changes in knowledge, attitude, perception, and practice could have occurred after the survey. A follow-up survey would be needed to access any changes that may have occurred. Finally, the findings from this study are relevant to all pandemic response teams in Nigeria and Sub-Saharan Africa for purposes of planning gap bridging interventions in knowledge, attitude, and practice of Covid-19. These findings can also be projected to the response to other highly pathogenic infectious diseases.

This survey highlights some gaps in knowledge, attitude, perception and practice of COVID-19 prevention among health workers at primary and secondary healthcare facilities in Rivers State. Interventions are needed to bridge the gaps identified because ensuring that healthcare workers have excellent knowledge, attitude, and practice of Covid-19 prevention and control is imperative for a successful response.

Disease Surveillance and Notification Officers of the Rivers State Primary Health Care Management Board for their role in data collection, Stakeholder Democracy Network for funding the survey, and the Technical and Administrative Staff of the Rivers State Public Health Emergency Operations Centre for the key roles they play in the pandemic response.

OM conceptualized the research, wrote the research protocol, the first draft of the data collection tool, and the final manuscript.

GO, IN, OM, DA, CT-W, CO, JNP, and CO reviewed and fine-tuned the research concept, the research protocol, data collection tools and all drafts of the manuscript.

OM, VA, EA, NE, DN, CO, IN, CO, and CN supported the training of the data collectors, supervision of field activities and reviewed the final draft and manuscript.

OM, CO, AO analyzed the data set, wrote up the results section and critically reviewed the final manuscript.

All authors approved the final draft of the manuscript.

This research supported by collaborative partnership and funding from the Stakeholder Democracy Network, a UK registered Charity. No. 1148143.

The authors declare no conflicts of interest regarding the publication of this paper.

Owhonda, G., Nwadiuto, I., Maduka, O., Alasia, D., Tobin-West, C., Ekanem, N., Okafor, C., Azi, E., Agala, V., Ojimah, C., Paul, J.N., Nria, D., Olofinuka, A.-M., Ndekwu, I., Opara, C. and Newsom, C. (2021) Exploring Gaps in Healthcare Workers Knowledge, Attitude, Perception and Practice of COVID-19 Prevention and Control in Rivers State Nigeria. Advances in Infectious Diseases, 11, 140-155. https://doi.org/10.4236/aid.2021.112014