From knowledge to action: understanding Ghanaian physicians' responses to COVID-19 pandemic threats

INTRODUCTION

The COVID-19 pandemic, a global health crisis of unprecedented scale and severity, has left an indelible mark on our world. Its rapid spread and severe health implications have necessitated immediate and coordinated responses from governments and healthcare systems worldwide.^1,2 The virus, with its high transmissibility and significant morbidity and mortality rates, posed a threat to public health on a global scale.³ In response, countries worldwide implemented various measures such as lockdowns, travel restrictions, and social distancing guidelines to control the spread of the virus. The economic and social repercussions have been profound, leading to a global downturn, economic recession, unprecedented unemployment rates, and heightened hardships.⁴

The population's health depends critically on having a highly trained and fearless healthcare workforce capable of adapting to the emergence of new pandemics and infections. Physicians play a crucial role in the healthcare system, serving as frontline workers responsible for diagnosing, treating, and managing patients' health conditions.^5,6 Understanding how physicians respond to public health crises like the COVID-19 pandemic is essential for informing effective strategies and interventions to support healthcare professionals and improve patient outcomes.⁷

In Ghana, where healthcare resources are often limited, the challenges posed by the COVID-19 pandemic were particularly acute. Ghanaian physicians faced many challenges, ranging from resource constraints and increased workload to psychological stress and concerns about personal safety.⁸ Despite these challenges, Ghanaian physicians demonstrated remarkable resilience and adaptability, employing innovative strategies to continue providing quality patient care while safeguarding their health and well-being.⁹

One of the most significant challenges faced by Ghanaian physicians during the COVID-19 pandemic was the lack of resources. Ghana's healthcare system, already stretched thin by limited funding and infrastructure, struggled to cope with the surge in COVID-19 cases. Essential resources such as personal protective equipment (PPE), ventilators, and testing kits were in short supply, leaving healthcare workers vulnerable to infection and hampering their ability to provide adequate care to patients.^8,10,11

However, Ghanaian physicians demonstrated remarkable resilience and adaptability in responding to the threats posed by the COVID-19 pandemic. Despite facing significant challenges, including resource constraints, increased workload, and psychological stress, Ghanaian physicians employed innovative strategies to continue providing quality patient care while safeguarding their health and well-being.^12,13 Moving forward, policymakers, healthcare institutions, and communities must continue to support and prioritize the needs of healthcare workers to ensure a robust response to future public health crises.

Objectives of the study

In the following article, we explore the knowledge, perception, and preparedness of Ghanaian physicians, lessons learned, and future pandemic outlook in the context of the COVID-19 pandemic or towards the upcoming pandemic.

METHODS

This study was conducted in Ghana, a country located in West Africa. Greater Accra, the biggest region of Ghana with the most physicians, generated more responses than the other 15 regions. Physicians from all the regions participated in this qualitative analysis. The study questionnaire was distributed through social media platforms, mainly WhatsApp and Facebook, among physicians from public and private hospitals. Precautionary measurements were implied by the collaborative programs initiated by Ghana's Ministry of Health and hospital management.

The survey was based on 55 questions related to knowledge of COVID-19. The following 29 questions were about perception, while the remaining 21 questions were about the level of preparedness. The data was collected from the respondents for three months (May-July) in 2023.

Inclusion criteria

A random technique for sampling was applied to select the participants, which only targeted physicians. This study’s inclusion criterion was limited to the participation of physicians who were directly involved in treating patients in medical settings.

Exclusion criteria

The study excluded physicians who do not practice within a medical facility and directly deal with and treat patients. We also excluded all other health-related staff, such as nurses, pharmacists, midwives, and health workers.

Demographic variables, including gender, age, region, and the number of years of practice, were captured. The study's sample size was determined using an online tool called Open Epi. This tool aimed for a 95% confidence level, a standard deviation of 0.5, and a confidence interval of ±5%. All the data collected for the study were analyzed using the statistical package for the social sciences (SPSS Inc., version 22, IBM, Chicago, IL, United States), with a significance level set at p<0.05.

Descriptive statistics like frequency, percentages, mean, standard deviation and median were employed to present the findings. All the responses and their correlations were analyzed by using SPSS ANOVA software. The statistical correlation between the data was evaluated. The University of Health and Allied Sciences, Ho, Ghana, approved the study's ethical clearance (UHAS-REC A 5 [4] 22-23).

RESULTS

Participants from all 16 regions of Ghana responded to the questionnaire, which collected 777 responses in total. The authenticity of the data obtained was validated. All eligible study participants signed informed consent.

Table 1 describes the variables observed based on gender, age, different regions, and the physicians' experience. 372 out of 777 participants were males, compared with 405 females. Most of the participants provided positive responses and yes answers.

Table 2 explained the general symptoms of coronavirus among the patients. 14 questions about observed disease symptoms evaluated the physician's knowledge level.

Responses were asked for ‘yes’, ‘no’, and ‘I do not know’ options. The p value shows the significance of the data.

Which of the following situations are means of transmission/spread of coronavirus (COVID-19)?

The primary means adopted for preventing COVID-19 was the information about viral transmission. Researchers and scientists are still investigating the origin of the coronavirus. The COVID-19 pandemic mainly originated from the SARS-CoV-2 virus.¹⁴ However, much evidence suggests that the transmission of coronavirus from bats to humans was first done in Wuhan, a city in China. There is still a lack of proper research for intermediate hosts, as this has yet to be confirmed. Further ongoing studies are still being conducted to understand viral transmission better.^15,16 The information below is related to the transmission of coronavirus questions to investigate the knowledge level of physicians across Ghana.

Severity of the coronavirus (COVID-19)

The severity of the disease depends upon the rate of death and cure. The coronavirus spreads from one country to another mainly through travelling, causing the disease to be severe worldwide. A physician’s knowledge of the earlier symptoms of the disease is essential for diagnosing the disease before the confirmatory tests.

Knowledge about contagion prevention/precaution measures

The primary precaution against COVID-19 transmission was maintaining personal hygiene, social distancing, and a healthy lifestyle. Washing hands properly repeatedly proved effective during the pandemic. Physicians recommend precautionary measurements to patients if they have enough knowledge about those measurements. Thus, the following questions related to prevention were asked and analyzed.

Perception of the physicians toward COVID-19

Participants' responses compiled with the risk of perception toward coronavirus show significant values. The responses were collected as yes, no, and I don’t know. These responses are presented in Table 3. The preparedness level of the physicians was analyzed by done, in progress and I don’t know options. The responses show significant data (Table 4).

DISCUSSION

During any pandemic outbreak, doctors or physicians are at the top of the list for public health. In every nation, the obligation of public health becomes greater and contingent upon medical professionals. Physicians' mental and physical health is a significant concern during the pandemic for disease identification, precautionary measures, and promotion of healthy lifestyles to mitigate the effects of the disease.¹⁷ In the COVID-19 pandemic, human health has unquestionably become a global concern. The viral transmission rate increased daily, and the world was at risk of disease, particularly the medical community.¹⁸ Therefore, it is more important to investigate the knowledge and perception of physicians than the public.

The following qualitative study investigates Ghanaian physicians' knowledge, perception, and preparedness levels across all regions. Contributing participants of the study show relatively excellent knowledge (97%) of the general symptoms of COVID-19. On the contrary, young doctors lack information about their knowledge related to weight loss, stomach discomfort, difficulty sleeping, and the incubation time of the coronavirus. 74% of physicians agree with stomach discomfort as a general symptom of COVID. Furthermore, the results obtained from the study's statistical analysis indicate the link between variable factors like age groups and non-variable factors. The knowledge level of the age group of 31-40 shows the highest level of correct information about the COVID-19 pandemic.

Many other studies have already been done that support these findings and show positive feedback.¹⁹ One such study expresses healthcare workers' poor knowledge about virus transmission. However, our study indicates that 90% of physicians agree that coughing or sneezing is a significant source of virus transmission.

Interestingly, 87 physicians did not consider joint and muscle pain as a general symptom of COVID-19, while 162 ruled out diarrhoea as a COVID-19 symptom. The response about COVID-19 being curable was strange; 354 agreed that it was curable, while 348 disagreed, and 75 stated that they did not know. Overwhelmingly, the respondents agreed that special care should be taken if a person has COVID-19 symptoms in the community and that personal hygiene was important regarding contagion prevention/precautionary measures. More physicians disagreed that travelling abroad was a necessary measure to prevent infection.

The mortality rate of health professionals during COVID-19 was increasing worldwide, leading to more fear and perceived susceptibility towards the disease. According to Beyuo et al, the fatality rate was 1.7% among doctors in Ghana.²⁰ However, Ghanaian physicians are more optimistic about public health and perform their duties very well. The increased level of preparedness by health communities and the government against the upcoming new wave of COVID-19 is critical to save the whole population. The preparedness level of physicians is evaluated in this specific study to improve the health facilities across the country. The overall preparedness level by the physicians was calculated as 49% as in progress.

However, physicians' readiness to face another pandemic challenge in the future was observed at 47% in progress, and 43% of physicians responded as done. Still, 10% are unaware of the current situation regarding preparedness. The responses regarding the preparedness level show that Ghana did not have everything in place to battle a pandemic.

Fortunately, this study is a separate one that focuses only on physicians and other healthcare workers like nurses, pharmacists, and midwives. Physicians are seen as frontline heroes in the pandemic.

Physicians' knowledge of coronavirus appears to be relatively good. The positive perception of virus transmission and less fear of perceived susceptibility to COVID-19 lead to physicians' preparedness for future pandemics in Ghana. However, there is still a prompt need to initiate collaborative programs among the government and the medical communities to meet the nationwide vaccine and personal protective equipment needs.

CONCLUSION

Importantly, our findings underscore the multifaceted nature of healthcare professionals' responses, influenced by information dissemination, resource availability, institutional support, and personal beliefs. As the global community continues to grapple with the evolving challenges posed by the pandemic, understanding and addressing the complexities of physician responses in diverse contexts like Ghana remains imperative for effective crisis management and public health interventions. This research contributes to the ongoing discourse on pandemic preparedness. It underscores the need for tailored approaches for the socio-cultural, economic, and systemic factors shaping healthcare delivery in resource-constrained settings. Ultimately, bridging the gap between knowledge and action is essential for fostering resilience and ensuring collective efforts towards mitigating the impact of future health issues. Ghana needs a carefully designed national blueprint for a pandemic. This will help streamline actions taken across the board and prevent the loss of lives and panic.

Funding: No funding sources

Conflict of interest: None declared

Ethical approval: The study was approved by the Institutional Ethics Committee

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