PLOS ONE

RESEARCH ARTICLE

Health professionals practice and associated

factors towards precautionary measures for
COVID-19 pandemic in public health facilities
of Gamo zone, southern Ethiopia: A cross-
sectional study
Abera Mersha ID1*, Shitaye Shibiru1, Meseret Girma2, Gistane Ayele2, Agegnehu Bante ID1,
Mekidim Kassa2, Sintayehu Abebe2, Misgun Shewangizaw2
a1111111111 1 School of Nursing, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia,
a1111111111 2 School of Public Health, College of Medicine and Health Sciences, Arba Minch University, Arba Minch,
a1111111111 Ethiopia
a1111111111
* [email protected]
a1111111111

Abstract
OPEN ACCESS Introduction
Citation: Mersha A, Shibiru S, Girma M, Ayele G,
Coronavirus disease-2019 (COVID-19) is a highly contagious acute respiratory disease,
Bante A, Kassa M, et al. (2021) Health
professionals practice and associated factors which caused by a novel coronavirus. The disease disrupts health systems and resulting in
towards precautionary measures for COVID-19 social, political, and economic crises. Health professionals are in front of this pandemic and
pandemic in public health facilities of Gamo zone, always work in a high-risk environment. The best prevention for COVID-19 is avoiding expo-
southern Ethiopia: A cross-sectional study. PLoS
sure to the virus. Some studies reported health professional’s practice of precautionary
ONE 16(3): e0248272. https://doi.org/10.1371/
journal.pone.0248272 measures for COVID-19. Nevertheless, a few have identified factors affecting. As such, this
study aimed to fill those research gaps in the study setting.
Editor: Muhammad Adrish, BronxCare Health
System, Affiliated with Icahn School of Medicine at
Mount Sinai, NY, USA, UNITED STATES Methods
Received: September 2, 2020 In this cross-sectional study, 428 health professionals involved from the public health facili-
Accepted: February 23, 2021 ties of the Gamo zone, southern Ethiopia. A simple random sampling method employed,
Published: March 9, 2021 and the data collected by the interviewer-administered Open Data Kit survey tool and obser-
vational checklist. The data analyzed in Stata version 15, and a binary logistic regression
Peer Review History: PLOS recognizes the
benefits of transparency in the peer review model used to identify factors. In this study, a statistically significant association declared at
process; therefore, we enable the publication of P< 0.05.
all of the content of peer review and author
responses alongside final, published articles. The
editorial history of this article is available here:
Results
https://doi.org/10.1371/journal.pone.0248272 In this study, 35.3% (95%CI: 30.7%, 39.8%) of health professionals’ had a good practice on
Copyright: © 2021 Mersha et al. This is an open precautionary measures for the COVID-19 pandemic. Use hand sanitizer or wash hands
access article distributed under the terms of the continuously with soap and water (68.9%), cover nose and mouth with a tissue during
Creative Commons Attribution License, which
sneezing or coughing (67.3%), and use facemask in crowds (56.8%) were the most com-
permits unrestricted use, distribution, and
reproduction in any medium, provided the original mon practice reported by study participants. Marital status, being married (AOR = 1.84, 95%
author and source are credited. CI: 1.06, 3.18), good knowledge on the COVID-19 pandemic (AOR = 2.02, 95%CI: 1.02,

PLOS ONE | https://doi.org/10.1371/journal.pone.0248272 March 9, 2021 1 / 17

PLOS ONE Practice and associated factors towards precautionary measures for COVID-19: A cross-sectional study

Data Availability Statement: All relevant data are 3.18), and positive attitude towards precautionary measures for the COVID-19 were factors
within the paper and its Supporting Information showed significant association with the practice.
files.

Funding: Arba Minch University provided funds for Conclusions

the data collection and stationary materials of this
research work with a project grant code of GOV/ The magnitude of good practice of precautionary measures for the COVID-19 pandemic
AMU/COVID-19/PDNPI/CMHS/RCSVPO/012/2020. among health professionals was low. As such, different interventions to improve the knowl-
The website of the university is www.amu.edu.et.
edge and attitude of health professionals in the health care system are highly needed to
The funders had no role in study design, data
collection, and analysis, decision to publish, or boost the practice and to advance service delivery.
preparation of the manuscript.

Competing interests: The authors have declared

that no competing interests exist.

Introduction
Coronavirus disease-2019 (COVID-19) is an emerging respiratory disease caused by a novel
coronavirus or severe acute respiratory syndrome-coronavirus-2(SARS-CoV-2). The first case
identified in Wuhan province, China. It is highly infectious, and clinical symptoms include
fever, dry cough, fatigue, myalgia, and dyspnea [1–5]. The three modes of transmission are
droplets, contact, and aerosol [6,7]. However, a few studies indicated the digestive system as a
potential transmission route for COVID-19 infection [8]. The nucleic acid of SARS-CoV-2
detects in the real-time fluorescence- polymerase chain reaction (RT-PCR) [7,9,10].
The best prevention for COVID-19 is avoiding exposure to the virus [11–19]. Health care
professionals (HCPs) are in front of this pandemic and always work in a high-risk environ-
ment. Preventing intra-hospital transmission of contagious disease is, therefore, a priority
[20,21]. Because of their direct contact with patients, health workers play critical roles in the
prevention of the COVID-19 outbreak. A combination of standards, airborne and droplet pre-
cautions should practice for all COVID-19 cases. They must use personal protective equip-
ment (PPE) such as a glove, gown or apron, and surgical mask [16,22,23].
World Health Organization (WHO) declared the 2019-nCoV outbreak as a public health
emergency of international concern (PHEIC) and as a global pandemic [24–26]. Several thou-
sand healthcare workers have already infected with COVID-19, and there is a report of deaths
in China, Italy, Spain, Pakistan, the UK, and other countries [21,27–31]. A report from China
indicated that a total of 23 of the health care professionals had died in medical facilities [28].
The pandemic significantly affects the global economy. The scale of costs reduced by invest-
ment in public health systems in all economies [32]. The public health systems in Africa are
coming under severe strain as the unprecedented COVID-19 pandemic persists [33,34].
Hospital associated transmission is suspected as the presumed mechanism of infection for
affected health professionals (29%) and hospitalized patients (12.3%) [35]. A study conducted
in Washington State reported that due to ineffective precautionary measures, 81 of the resi-
dents, 34 staff members, and 14 visitors infected and died with COVID-19 [36]. Therefore,
universal source control, early identification and isolation of patients with suspected disease,
the use of appropriate personal protective equipment (PPE) when caring for patients with
COVID-19, and environmental disinfection are obligatory in the health care settings [37].
The practice of precautionary measures for coronavirus (CoVs) among HCPs was 89.7% in
a study conducted in China [38], 87.9% in the Kingdom of Saudi Arabia [39], and 70.12% in
Iran [40]. In finding from Pakistan,96.10% of HCPs had washing hands with soap/cleaning
with sanitizers, and 84.30% had avoided touching of eyes, nose, or mouth to control pandemic
[41], and 24.2% used facemask in the crowds in the study from Saudi Arabia [42]. Another
study from the Kingdom of Saudi Arabia showed PPE used when seeing suspected cases of

PLOS ONE | https://doi.org/10.1371/journal.pone.0248272 March 9, 2021 2 / 17

PLOS ONE Practice and associated factors towards precautionary measures for COVID-19: A cross-sectional study

CoV infection was mainly the mask (94.1%), gloves (78.8%), the gown (60%), goggles (31.8%),
and the cap (22.4%) [43]. Different works of the literature indicated that age, gender, knowl-
edge level, attitude, work experience and job category, working hours, educational attainment
were factors associated with HCWs’ practice of precautionary measures towards COVID-19
[38–40].
During this time, many studies are emerging by scholars regarding the COVID-19 pan-
demic. Nevertheless, health care professionals’ practice of precautionary measures towards the
COVID-19 takes the lion’s share and vital to save the life of professionals and others. Presently,
a few studies assessed practice and factors affecting precautionary measures for the COVID-19
pandemic among health professionals. Besides, there are limited studies in Ethiopia. Therefore,
this study aimed to assess the health professional’s practice and associated factors towards pre-
cautionary measures for the COVID-19 pandemic in public health facilities of the Gamo zone,
southern Ethiopia.

Materials and methods

Study setting and period
In this study, health professionals working in public health facilities of the Gamo zone, south-
ern Ethiopia, were involved, from June 10–19, 2020. Gamo zone is one of the administrative
zones in Ethiopia. It bordered with Wolayta, Dawro, and Gofa zones in the North, on the
northeast by the Lake Abaya and the southeast by the Amaro special woreda and Dirashe spe-
cial woreda, and on the southwest by South Omo. The administrative center of the Gamo zone
is Arba Minch town. Arba Minch town, located 505 km southwest of Addis Ababa, the capital
city of Ethiopia, and 275 km southwest of Hawassa, the capital city of southern Ethiopia.
Gamo zone has one administrative town and 13 woredas. It hosted five hospitals (one general
and four primary hospitals), 56 health centers, and 299 health posts, which serve the commu-
nity by providing preventive and curative services. There are 2570 (1096 male and 1474
female) health professionals who are working in those institutions [44].

Study design
The institution-based cross-section study design employed to meet study objectives.

Population
Source population. The source population for this study was all health professionals who
work in public health facilities of the Gamo zone, southern Ethiopia.
Study population. The study population for this study was all health professionals who
were working in selected health facilities of the Gamo zone, southern Ethiopia, during the
study period.

Eligibility criteria
All health professionals who were staff and working at least for six months in selected health
facilities recruited in this study. Whereas those health professionals who were sick and on
annual leave at the time of data collection not involved in this study.

Sample size determination

Epi info 7 StatCalc software used to estimate the sample sizes. For the first specific objective, a
single population proportion was used by considering the following assumption: P = 0.897
from the study conducted in China [38], 95% level of confidence, and 3% margin of error.

PLOS ONE | https://doi.org/10.1371/journal.pone.0248272 March 9, 2021 3 / 17

PLOS ONE Practice and associated factors towards precautionary measures for COVID-19: A cross-sectional study

Therefore, based on this assumption, the calculated sample size was 394. To determine the
sample size for the second objective two-sample comparison proportion was used by consider-
ing the following assumptions: work experience of less than one year (P1) = 82.7%, and >5
years (P2) = 95.7% from the study in Pakistan [41], 95% level of confidence, Power of 90%, and
Ratio:1:1. Based on this assumption, the estimated sample size was 266. As such, the final sam-
ple size came up by adding a non-response rate of 10% to the larger sample size, which was
394 that estimated by the first objective. Therefore, the calculated sample size for this study
was 434.

Sampling procedure
Currently, there are five fully functional hospitals and fifty-six health centers in the Gamo
zone. A simple random sampling method employed to select three hospitals and fifteen health
centers from them (Fig 1). Then, the calculated sample size, proportionally allocated to those
health facilities based on the number of health professionals who were working. Finally, a sim-
ple random sampling method after generating a table of random numbers used to select health
professionals based on proportions allocated to each health facility (Table 1).

Data collection method

Interviewer-administered Open Data Kit (ODK) survey tool and observational checklist
employed to collect the data. The survey tool and observational checklist were adapted by
reviewing different works of literature, WHO, and national guidelines related to the COVID-
19 precautionary measures [41,45–47]. Eight data collectors and three supervisors involved in
data collection.

Fig 1. Schematic presentation of the sampling procedure for the study conducted among health professionals in public health facilities of
Gamo zone, southern Ethiopia, 2020.
https://doi.org/10.1371/journal.pone.0248272.g001

PLOS ONE | https://doi.org/10.1371/journal.pone.0248272 March 9, 2021 4 / 17

PLOS ONE Practice and associated factors towards precautionary measures for COVID-19: A cross-sectional study

Table 1. Number of the health professionals and the proportions allocated for the selected health facilities in Gamo zone, southern Ethiopia, 2020.
SNo Selected health facilities No of the health professionals Proportion allocated (n/N� ni)
1. Arba Minch General Hospital 456 171
2. Gerese Primary Hospital 62 23
3. Chencha Primary Hospital 94 35
4. Sikela Health Center 93 35
5. Deramallo Health Center 17 6
6. Birbir Health Center 54 20
7. Zigiti Bakole Health Center 16 6
8. Gezeso Health Center 27 10
9. Kamba Health Center 37 14
10. Lante Health Center 60 23
11. Mengeda Health Center 13 5
12. Shelle Health Center 29 11
13. Dorze Health Center 25 9
14. Garda Health Center 30 11
15. Morka Health Center 18 7
16. Zada Health Center 51 19
17. Zefine Health Center 59 22
18. Zayse Health Center 19 7
Calculated sample size (n) 434
https://doi.org/10.1371/journal.pone.0248272.t001

Before starting data collection, both the data collectors and supervisors trained on data col-
lection ways and overall procedure and ODK survey tool by experts for one day. The data col-
lectors gave information about the study’s aim before interviewing the study participants.
Then those participants who were willing and signed in the voluntary informed consent inter-
viewed. The health facilities observed for precautionary measures to the COVID-19 pandemic
by incorporating different domains.

Study variables
The dependent variable for this study was the health care professionals’ practice of precaution-
ary measures for the COVID-19. Socio-demographic and professional-related characteristics
(age, sex, education level, job category, working hours, and work experience, knowledge about
COVID-19, and attitude towards precautionary measures for the COVID-19 were the inde-
pendent variables for this study.

Measurements
The measurements of the outcome variable and some of the explanatory variables, stated
below (Table 2).

Data quality control

The tools validated by different scholars employed to collect the information, and it pre-tested
in setting with similar characteristics. Extensive training gave to both data collectors and
supervisors to maintain consistency and to standardize the data collection techniques.
The training focused on the objectives of the study, data collection tool, data collection
methods, ways of checking the completeness of data, ways of maintaining the confidentiality
of the data.

PLOS ONE | https://doi.org/10.1371/journal.pone.0248272 March 9, 2021 5 / 17

PLOS ONE Practice and associated factors towards precautionary measures for COVID-19: A cross-sectional study

Table 2. Measurements to assess the health professionals practice and associated factors towards precautionary
measures for COVID-19 pandemic in public health facilities of Gamo zone, southern Ethiopia, 2020.
Variables Measurements
Health care professionals practice of The total score of HCPs practice of precautionary measures for
precautionary measures for COVID-19 COVID-19 assessment items ranged from 0–6, and a score of �4
reported as good practice, and a score of <4 indicated as poor
practice toward precautionary measures for COVID-19 [41].
Knowledge regarding COVID-19 The total score of HCPs knowledge regarding COVID-19
assessment items ranged from 0–14, and a score of �10 reported as
Poor, and a score of �11 (more than 75%) indicated a Good level
[41].
Attitude towards precautionary measures for The response of each item of HCPs attitude towards precautionary
COVID-19 measures for COVID-19 recorded on a 5-point Likert scale;
strongly agree (1-point), agree (2-point), undecided (3-point),
disagree (4-point), and strongly disagree (5-point). Then, the total
score ranges from 7 to 35, with an overall lower than mean score
indicated a positive attitude toward COVID-19 [41].
https://doi.org/10.1371/journal.pone.0248272.t002

Data management and processing

The survey template uploaded to the ODK cloud server (ODK Aggregate platform of Arba
Minch University (AMU)), then the survey template was download to the individual data col-
lector’s smartphone for data collection. After completing the data of each study participant,
the data collectors sent the data to the ODK cloud server after confirmed by supervisors. After
cessation of the data collection, the data downloaded from ODK aggregate and then exported
to Stata version 15 for analysis.

Data analysis
The univariate analysis, such as; proportions, frequency, and summary statistics computed. The
bivariate analysis used to see the association between each independent variable and the out-
come variable by using binary logistic regression. The assumptions for binary logistic regression
checked, and the goodness of fit-tested by the log-likelihood ratio (LR). All variables with
P<0.25 in the bivariate analysis included in the final model to control all possible confounders.
A Multi-collinearity test ran to see the correlation between independent variables by using col-
linearity statistics, and Variance inflation factor (VIF) >10 and tolerance (T) <0.1 considered as
suggestive of the existence of multi-collinearity. A crude and adjusted odds ratio (OR) with 95%
CI estimated to identify factors affecting HCPs practice of precautionary measures for COVID-
19. In this study, P-value <0.05 considered in declaring a result as statistically significant.

Ethics approval and consent to participate

Ethical clearance obtained from Arba Minch University, College of Medicine and Health Sci-
ences, Institutional Research Ethics Review Board (IRB) with reference number: IRB/408/12.
Written and signed voluntary informed consent obtained from all study participants before
recruiting the health professionals into the study. The concealment of the participants kept via
the use of codes. The respondents also informed that the information obtained from them
kept with the utmost confidentiality.

Results
Socio-demographic and professional related characteristics
In this study, 428 health professionals were involved, which gave a response rate of 98.6%. The
mean and standard deviation of the age of study participants was 33.2±8.2 years old. Of the

PLOS ONE | https://doi.org/10.1371/journal.pone.0248272 March 9, 2021 6 / 17

PLOS ONE Practice and associated factors towards precautionary measures for COVID-19: A cross-sectional study

participants, 240 (56.1%) were male, and 215 (50.2%) had an educational level of Diploma.
One hundred thirty-one (30.6%) of participants have health professional qualifications of
nurses, and 270 (63.1%) had work experience of six or more years (Table 3).

Source of information about COVID-19 pandemic

Of the study participants, 256 (59.8%) heard information about COVID-19 from radio
and television, and 207 (48.4%) from social media (Facebook, telegram, and Instagram)
(Fig 2).

Knowledge regarding COVID-19 pandemic

Three hundred ninety (91.1%) of the study participants stated that COVID-19 patients develop
severe acute respiratory illness, 412 (96.3%) reported washing hands vigorously with soap and

Table 3. Socio-demographic and professional characteristics of study participants in public health facilities of
Gamo zone, southern Ethiopia, 2020 (n = 428).
Variables Frequency Percentage (%)
Age of the participant (in a year)
�30 221 51.6
31–39 117 27.3
40–49 60 14.0
�50 30 7.0
Marital status
Married 291 68.0
Other� 137 32.0
Educational level
Diploma 215 50.2
BSc 154 36.0
MSc/MPH 13 3.0
GP 28 6.5
Specialist 18 4.2
Job category/profession
Nurse 131 30.6
Public health 47 11.0
Midwives 78 18.2
Pharmacy 31 7.2
Lab technician 43 10.0
Physician 45 10.5
Other1 53 12.4
Work experience (in a year)
1–3 104 24.3
4–5 54 12.6
�6 270 63.1
Working hours per day (in hr.)
<8 11 2.6
�8 417 97.4
�
Single, divorced and widowed
1Environmental health, IESO, Anesthesia, Radiology, Dentist, and Psychiatry.

https://doi.org/10.1371/journal.pone.0248272.t003

PLOS ONE | https://doi.org/10.1371/journal.pone.0248272 March 9, 2021 7 / 17

PLOS ONE Practice and associated factors towards precautionary measures for COVID-19: A cross-sectional study

Fig 2. Source of information about COVID-19 pandemic for health professionals in public health facilities of Gamo zone, southern Ethiopia,
2020 (n = 428).
https://doi.org/10.1371/journal.pone.0248272.g002

water can prevent COVID-19, and 403 (94.2%) said fever, cough, and shortness of breath are
symptoms for COVID-19 (Fig 3). Overall, 84.1% (95%CI: 80.6%, 87.6%) of health profession-
als had good knowledge about the COVID-19 pandemic.

Attitude towards precautionary measures for COVID-19 pandemic

Out of study participants, 309 (72.2%) strongly agreed that gowns, gloves, masks, and goggles
must use when dealing with the COVID-19 patients, and 161 (37.6%) agreed that healthcare
workers must acknowledge themselves with all the information about the COVID-19
(Table 4). Overall, 53% (95%CI: 48.3%, 57.8%) of HCPs had a positive attitude towards precau-
tionary measures for the COVID-19 pandemic.

Observational findings regarding the practice of precautionary measures

for COVID-19 pandemic at the facility level
Of the health facilities, in eight (44.4%), a team of HCWs should always bed signaled to care
exclusively for suspected or confirmed cases to reduce the risk of transmission. In fourteen
(77.8%) health facilities, all persons entering the patients’ room never recorded (Table 5).

PLOS ONE | https://doi.org/10.1371/journal.pone.0248272 March 9, 2021 8 / 17

PLOS ONE Practice and associated factors towards precautionary measures for COVID-19: A cross-sectional study

Fig 3. Knowledge of health professionals about COVID-19 pandemic for health professionals in public health facilities of Gamo zone, southern
Ethiopia, 2020 (n = 428).
https://doi.org/10.1371/journal.pone.0248272.g003

PLOS ONE | https://doi.org/10.1371/journal.pone.0248272 March 9, 2021 9 / 17

PLOS ONE Practice and associated factors towards precautionary measures for COVID-19: A cross-sectional study

Table 4. Attitude of health professionals towards precautionary measures for COVID-19 pandemic in public health facilities of Gamo zone, southern Ethiopia,
2020 (n = 428).
Characteristics Strongly Disagree Neutral Agree Strongly
disagree agree
N (%) N (%) N (%) N (%) N (%)
Healthcare workers must acknowledge themselves with all the information about COVID-19 3(0.7) 27(6.3) 49 161 188(43.9)
(11.4) (37.6)
Transmission of COVID-19 infection can prevent by using universal precautions given by WHO, 7(1.6) 7(1.6) 35(8.2) 142 237(55.4)
CDC (33.2)
Any related information about COVID-19 should disseminate among healthcare workers 13(3.0) 27(6.3) 25(5.8) 157 206(48.1)
(36.7)
Prevalence of COVID-19 can reduce by the active participation of healthcare workers in the hospital 3(0.7) 8(1.9) 32(7.5) 146 239(55.8)
infection control program (34.1)
Intensive and emergency treatment should give to diagnosed patients 15(3.5) 41(9.6) 26(6.1) 130 216(50.5)
(30.4)
COVID-19 patients should keep in isolation 4(0.9) 5(1.2) 15(3.5) 105 299(69.9)
(24.5)
Gowns, gloves, masks, and goggles must use when dealing with COVID-19 patients 1(0.2) 2(0.5) 10(2.3) 106 309(72.2)
(24.8)
https://doi.org/10.1371/journal.pone.0248272.t004

Health professionals practice on precautionary measures for COVID-19

pandemic
Of the study participants, 295 (68.9%) wash hands continuously with water and soap or use
hand sanitizer, and 220 (51.4%) sometimes educate their patients about the COVID-19 (Fig 4).
Overall, 35.3% (95%CI: 30.7%, 39.8%) of health professionals had a good practice on precau-
tionary measures for the COVID-19 pandemic.

Factors associated with the health professionals practice of the

precautionary measures for the COVID-19 pandemic
In a multivariable model, marital status (being married), good knowledge about COVID-19,
and a positive attitude towards precautionary measures had shown a significant association
with health professionals’ practice of precautionary measures for the COVID-19 pandemic.
Married health professionals were 1.84 times more likely to practice precautionary mea-
sures for COVID-19 in the health facility as compared to counterparts (AOR = 1.84, 95%CI:
1.06, 3.18). The odds of good practice of precautionary measures for the COVID-19 pandemic
were 2.02 in health professionals with good knowledge of COVID-19 (AOR = 2.02, 95%CI:
1.02, 3.99). Health professionals with a positive attitude were 29% more likely to practice pre-
cautionary measures for the COVID-19 pandemic in a public health facility (AOR = 3.29, CI:
2.09, 5.19) (Table 6).

Discussion
This survey aimed to fill a research gap in Ethiopia by assessing health professionals’ practice
of precautionary measures for COVID-19 in public health facilities. In this study, 2/3rd of
health professionals’ had knowledgeable about the COVID-19 pandemic, 1/2nd were a positive
attitude towards precautionary measures for COVID-19, and only 1/3rd had a good practice
on precautionary measures in public health facilities. Marital status, knowledge about
COVID-19, and attitude towards precautionary measures were factors identified in this study
that showed significant association with good practice of precautionary measures for the
COVID-19 pandemic.

PLOS ONE | https://doi.org/10.1371/journal.pone.0248272 March 9, 2021 10 / 17

PLOS ONE Practice and associated factors towards precautionary measures for COVID-19: A cross-sectional study

Table 5. Observational findings of the practice of precautionary measures for COVID-19 pandemic in public health facilities of Gamo zone, southern Ethiopia,
2020 (n = 18).
Characteristics Never Sometimes Always
N (%) N (%) N (%)
Hand hygiene stations and waste bins installed at strategic locations across the health facility 6(33.3) 9(50.0) 3(16.7)
Health care workers applying standard precautions for all patients 8(44.4) 7(38.9) 3(16.7)
Droplets and contact precautions recommended 5(27.8) 10(55.6) 3(16.7)
Patients placed in the adequately ventilated rooms 5(27.8) 7(38.9) 6(33.3)
A one-meter distance between beds maintained 4(22.2) 6(33.3) 8(44.4)
Equipment is either single-use or disposable or if equipment (e.g., stethoscopes, blood pressure cuffs, thermometers, food trays) needs 9(50.0) 8(44.4) 1(5.6)
to be shared among patients, clean and disinfect between use for each patient (e.g., by using ethyl alcohol 70%)
Routinely clean and disinfect surfaces with which the patient is in contact 8(44.4) 8(44.4) 2(11.1)
Health care worker apply droplet and contact precautions before entering the room 10 6(33.3) 2(11.1)
(55.6)
Health care workers are used airborne precautions for aerosol-generating procedures 7(38.9) 7(38.9) 4(22.2)
Team of HCWs should bed signaled to care exclusively for suspected or confirmed cases to reduce the risk of transmission 4(22.2) 6(33.3) 8(44.4)
Staffs receive training on standard, contact, droplets, and airborne precautions 5(27.8) 7(38.9) 6(33.3)
Adequate personal protective equipment (PPE) is easily accessible to staff 6(33.3) 8(44.4) 4(22.2)
Avoid moving and transporting patients out of their room or area unless medically necessary 9(50.0) 3(16.7) 6(33.3)
HCWs who are transporting patients perform hand hygiene and wear appropriate PPE. 4(22.2) 10(55.6) 4(22.2)
The area receiving the patient arrange for all necessary precautions as early as possible before the patient’s arrival 8(44.4) 7(38.9) 3(16.7)
Visitors essential for patient support are limited 11 4(22.2) 3(16.7)
(61.1)
Visitors apply droplet and contact precautions 9(50.0) 5(27.8) 4(22.2)
All persons entering the patient’s room recorded 14 4(22.2) 0(0.0)
(77.8)
Manage laboratory specimens, laundry, food service utensils, and medical waste following safe routine procedures according to 7(38.9) 8(44.4) 3(16.7)
Infection Prevention and Control (IPC) guidelines.
https://doi.org/10.1371/journal.pone.0248272.t005

In this study, the magnitude of good practice of precautionary measures for COVID-19 was
35.3% (95%CI: 30.7%, 39.8%). These were very low as compared to studies conducted in Iran
(70.12%) [40], in China (89.7%) [38], the Kingdom of Saudi Arabia (87.9%) [39], Uganda (74%)
[48], and Ethiopia (62%) [49]. The finding of this study indicated that 50.5% of health profes-
sionals avoided touching mouse, eyes, and noses, and 68.9% had wash hands continuously with
water, soap, or use hand sanitizer. These were incongruent with studies conducted in Pakistan
(84.3% for avoiding touching eyes, nose, and mouth, and 96.1% for hand washing and use sani-
tizer) [41], in two studies from Saudi Arabia, 24.2% [42], and 94.1% [43] use facemask in
crowds. The observational finding of this study also indicated that a gap in applying droplet and
contact precautions (using PPEs), routinely cleaning and disinfecting surfaces with which the
patient contact and equipment used, and controlling visitors (there is overcrowding) in the
health facility. This discrepancy may be due to differences in socio-demographic and economic
characteristics, technological advancement and health care system, and social-cultural factors.
The other factor may be methodological aspects (the majority of previous studies were an online
survey (using email, Facebook, and telegram) that may overestimate the practice).
The health professionals’ marital status significantly associated with good practice of pre-
cautionary measures for COVID-19. However, other socio-demographic and professional fac-
tors (sex, age, educational attainment, job category/profession, and work experience) had not
shown significant association. These were not in line with studies conducted in China [38], the
Kingdom of Saudi Arabia [39], Iran [40], Pakistan [41], and Uganda [48]. This difference
might related to sampling variation or sample clustering that previous studies mainly based on

PLOS ONE | https://doi.org/10.1371/journal.pone.0248272 March 9, 2021 11 / 17

PLOS ONE Practice and associated factors towards precautionary measures for COVID-19: A cross-sectional study

Fig 4. Health professionals practice of precautionary measures for COVID-19 pandemic in public health facilities of Gamo zone, southern
Ethiopia, 2020 (n = 428).
https://doi.org/10.1371/journal.pone.0248272.g004

an online survey, and participants are only those who access the internet service during the
data collection period. Besides, a health professional who continuously manages patients with
COVID-19 might not involve in that study due to time shortage. Coronavirus disease-2019 is a
global pandemic that all the information sources (mass media, stream media, social media,
and others) and all the government sectors give focus on this issue, and health professionals
seek information utmost an equal level. Therefore, the practice of precautionary measures for
COVID-19 in health facilities does not that much vary with sex, age category, educational
level, job category, and work experience difference.
In this study, knowledge of health professionals’ on the COVID-19 had shown a significant
association with a good practice of precautionary measures in health facilities. These were in
line with studies conducted in Pakistan [41], Iran [40], the Kingdom of Saudi Arabia [39],
China [38], Ethiopia [49,50], and Uganda [48]. Similarly, the attitude of the health profession-
als’ towards precautionary measures had shown a significant association with practice in the
health facility. These were in line with the study conducted in Pakistan [41]. These are facts
that health professionals who are knowledgeable about the pandemic and positive attitude
towards precautionary measures are more likely to put in practice. In general, the positive atti-
tude of the health professional is a base to seeking information about the pandemic from dif-
ferent sources and concerning bodies to build knowledge and resulted in behavioral change
and to put the practice in the ground.

PLOS ONE | https://doi.org/10.1371/journal.pone.0248272 March 9, 2021 12 / 17

PLOS ONE Practice and associated factors towards precautionary measures for COVID-19: A cross-sectional study

Table 6. Bi-variable and multivariable analysis of factors associated with health professional practice of precautionary measures for COVID-19 pandemic in public
health facilities of Gamo zone, southern Ethiopia, 2020 (n = 428).
Variables Practice Crude OR Adjusted OR P-value
Good Poor 95%CI
Sex of the participant
Male 76(50.3%) 164(59.2%) 1 1
Female 75(49.7%) 113(40.8%) 1.43(0.96,2.13) 1.41(0.89,2.22) 0.14
Age (in a year)
�30 75(49.7%) 146(52.7%) 1 1
31–39 45(29.8%) 72(26.0%) 1.22(0.76,1.94) 1.11(0.63,1.93) 0.72
40–49 20(13.2%) 40(14.4%) 0.97(0.53,1.78) 0.72(0.35,1.49) 0.38
�50 11(7.3%) 19(6.9%) 1.13(0.51,2.49) 1.14(0.44,2.96) 0.79
Marital status
Married 116(76.8%) 175(63.2%) 1.93(1.23,3.03) 1.84(1.06,3.18)� 0.03
Other1 35(23.2%) 102(36.8%) 1 1
Educational level
Diploma 79(52.3%) 136(49.1%) 1.14(0.77,1.69) 0.91(0.54,1.56) 0.74
Other± 72(47.7%) 141(50.9%) 1 1
Job category/Profession
Nurse 55(36.4%) 76(27.4%) 1.83(0.92,3.66) 1.57(0.71,3.47) 0.27
Public health 15(9.9%) 32(11.6%) 1.19(0.51,2.79) 0.87(0.34,2.23) 0.77
Midwives 27(17.9%) 51(18.4%) 1.34(0.63,2.86) 1.33(0.57,3.12) 0.51
Pharmacy 10(6.6%) 21(7.6%) 1.21(0.46,3.16) 1.17(0.41,3.36) 0.77
Lab technician 16(10.6%) 27(9.7%) 1.50(0.64,3.55) 1.89(0.72,4.97) 0.19
Physician 13(8.6%) 32(11.6%) 1.03(0.43,2.48) 0.87(0.34,2.25) 0.77
Other© 15(9.9%) 38(13.7%) 1 1
Work experience(in a year)
1–3 28(18.5%) 76(27.4%) 1 1
4–5 15(9.9%) 39(14.1%) 1.04(0.50,2.18) 0.86(0.39,1.89) 0.70
�6 108(71.5%) 162(58.5%) 1.81(1.10,2.98) 1.33(0.70,2.54) 0.38
Knowledge about COVID-19
Poor 15(9.9%) 53(19.1%) 1 1
Good 136(90.1%) 224(80.9%) 2.15(1.16,3.95) 2.02(1.02,3.99)� 0.04
Attitude towards precautionary measures
Negative 45(29.8%) 156(56.3%) 1 1
Positive 106(70.2%) 121(43.7%) 3.04(1.99,4.63) 3.29(2.09,5.19)� <0.001

1single, widowed and divorced, ±BSc, MSc, MPH, GP, and Specialist
© Environmental health, IESO, Anesthesia, Radiology, Dentist, and Psychiatry, and
�
Significant at P-value<0.05.

https://doi.org/10.1371/journal.pone.0248272.t006

The main strength of this study was that it assessed the health professionals’ practice and
factors affecting precautionary measures for the COVID-19 pandemic in the health facilities
with limited previous studies. It also used validated Open Data Kit survey tools to collect the
information.
The limitation of this study was the study might subject to recall and social desirability
biases. The study, conducted in a very constrained environment that different activities con-
trolled by the national emergency team due to the pandemic. The study was cross-sectional,
which the causal relationship was under caution. Therefore, those issues must consider while
interpreting the study findings.

PLOS ONE | https://doi.org/10.1371/journal.pone.0248272 March 9, 2021 13 / 17

PLOS ONE Practice and associated factors towards precautionary measures for COVID-19: A cross-sectional study

The implication of this study is; it involved health professionals in health facilities, and
health professionals are in the front line to this pandemic, and different interventions needed
in the ground route to improve service quality and to stable the health care system. Currently,
millions of individuals are infected, and thousands died from this evil disease. The pandemic
disrupts the health care system. Therefore, assessing the practice and identifying the factors
affect is very important to intervene urgently to squeal the consequence within a short period.
The finding of this study can urge different stakeholders, task forces, and public health emer-
gency teams to design strategies for intervention.
In summary, there are limited studies that showed the health professionals’ practice and fac-
tors affecting precautionary measures for the COVID-19 pandemic. Therefore, this study
aimed to fill these research gaps in Ethiopia. This study identified that there was a gap in the
practice of precautionary measures for COVID-19 among health professionals, and knowledge
and attitude towards precautionary measures were the most determinate factors. The observa-
tional finding also supplementary for the results indicated based on interviewed data. This
study had its limitation, and the results must interpret by considering those limitations. These
results of this study can be input for health facilities in the Gamo zone, different stakeholders,
and task forces to design specific strategies for intervention.

Conclusions
This study showed that the practice of precautionary measures for the COVID-19 pandemic
was low. Even if, majority of the health professionals know about COVID-19, there was a gap.
Marital status, knowledge about COVID-19, and attitude towards the precautionary measures
identified as factors. Therefore, the investigators recommended that the ministry of health and
other concerning task forces should provide capacity-building activities such as in-service
training, motivate and recognize staffs to improve the knowledge, and to change the behavior
or attitude of the health professionals.

Supporting information
S1 File. English version tool and observational checklist.
(PDF)

Acknowledgments
Our heartfelt thanks go to the Gamo zone health department, Chief executive officers in the
hospitals, health center heads, task force leaders who gave support during data collection, data
collectors, and study participants. Finally, yet importantly, we would like to say thank you for
all peoples who support directly or indirectly.

Author Contributions
Conceptualization: Abera Mersha, Shitaye Shibiru, Meseret Girma, Agegnehu Bante, Sin-
tayehu Abebe.
Data curation: Abera Mersha, Shitaye Shibiru, Meseret Girma, Gistane Ayele, Agegnehu
Bante, Sintayehu Abebe.
Formal analysis: Abera Mersha, Shitaye Shibiru, Mekidim Kassa.
Funding acquisition: Abera Mersha, Shitaye Shibiru, Agegnehu Bante, Mekidim Kassa, Mis-
gun Shewangizaw.

PLOS ONE | https://doi.org/10.1371/journal.pone.0248272 March 9, 2021 14 / 17

PLOS ONE Practice and associated factors towards precautionary measures for COVID-19: A cross-sectional study

Investigation: Abera Mersha, Shitaye Shibiru, Gistane Ayele, Sintayehu Abebe.

Methodology: Abera Mersha, Meseret Girma, Gistane Ayele, Agegnehu Bante, Mekidim
Kassa.
Project administration: Abera Mersha.
Resources: Abera Mersha, Misgun Shewangizaw.
Software: Abera Mersha, Shitaye Shibiru.
Supervision: Abera Mersha, Shitaye Shibiru, Gistane Ayele, Agegnehu Bante.
Validation: Abera Mersha.
Visualization: Abera Mersha, Shitaye Shibiru.
Writing – original draft: Abera Mersha.
Writing – review & editing: Abera Mersha.

References
1. WHO. WHO Statement Regarding Cluster of Pneumonia Cases in Wuhan, China, 2020. Available at:
https://www.who.int/china/news/detail/09-01-2020-who-statement-regarding-cluster-of-pneumonia-
cases-in-wuhan-china. Access date: [April 27, 2020].
2. Xinhua News Agency, Beijing. Experts say that the pathogenic identification of the novel coronavirus of
unknown cause in Wuhan has made preliminary progress. Available at: http://www.xinhuanet.com/
2020-01/09/c_1125438971.htm. Access date: [April 27, 2020].
3. Holmes E. Novel-2019 Coronavirus Genome. Available at: http://virological.org/t/novel-2019-
coronavirus-genome/319. Access date: [April 27, 2020].
4. GenBank. Severe acute respiratory syndrome coronavirus 2 isolate Wuhan-Hu-1, complete genome.
Available at: https://www.ncbi.nlm.nih.gov/nuccore/MN908947. Access date: [April 27, 2020].
5. World Health Organization (WHO). Coronavirus disease 2019 (COVID-19)Situation Report –10, Janu-
ary 30, 2020.
6. National Health Commission of the People’s Republic of China. Prevent guidelines of 2019-nCoV.
2020. Available at: http://www.nhc.gov.cn/xcs/yqfkdt/202001/bc661e49b5bc487dba182f5c49ac445b.
shtml. Access date: [April 27, 2020].
7. National Health Commission of the People’s Republic of China. Pneumonia diagnosis and treatment of
2019-nCoV infection from Chinese NHC and CDC 2020. 2020. Available at: http://www.nhc.gov.cn/xcs/
zhengcwj/202001/4294563ed35b43209b31739bd0785e67/files/
7a9309111267475a99d4306962c8bf78.pdf. Access date: [April 27, 2020].
8. Zhang H, Kang Z, Gong H, Xu D, Wang J, Li Z, et al. The digestive system is a potential route of 2019-
nCov infection: a bioinformatics analysis based on single-cell transcriptomes. bioRxiv. 2020; https://doi.
org/10.1101/2020.01.30.927806.
9. Li T, Wei C, Li W, Hongwei F, Shi J. Beijing Union Medical College Hospital on "pneumonia of novel
coronavirus infection" diagnosis and treatment proposal (V2.0). Med J Peking Union Med Coll Hosp.
2020. Available at: http://kns.cnki.net/kcms/detail/11.5882.r.20200130.1430.002.html. Access date:
[April 27, 2020].
10. The medical expert group of Tongji hospital. A quick guide to the diagnosis and treatment of pneumonia
for novel coronavirus infections (third edition). Herald Med. 2020. Available at: http://kns.cnki.net/kcms/
detail/42.1293.r.20200130.1803.002.html. Access date: [April 27, 2020].
11. WHO. Considerations in adjusting public health and social measures in the context of COVID-19,
Interim guidance, 2020.
12. CDC. 2019 Novel coronavirus, Wuhan, China, 2020. Available at: https://www.cdc.gov/coronavirus/
2019-nCoV/summary.html. Access date: [April 27, 2020].
13. Adhikari SP, Meng S, Wu YJ, Mao YP, Ye RX, Wang QZ et al. Epidemiology, causes, clinical manifesta-
tion and diagnosis, prevention and control of coronavirus disease (COVID-19) during the early outbreak
period: a scoping review. Infectious Diseases of Poverty, 2020. 9(1):29. https://doi.org/10.1186/
s40249-020-00646-x PMID: 32183901

PLOS ONE | https://doi.org/10.1371/journal.pone.0248272 March 9, 2021 15 / 17

PLOS ONE Practice and associated factors towards precautionary measures for COVID-19: A cross-sectional study

14. Wei Q, Ren Z. Disinfection measures for pneumonia foci infected by a novel coronavirus in 2019. Chin J
Disinfect. 2020; 37:59–62.
15. World Health Organization (WHO). Coronavirus disease 2019 (COVID-19)Situation Report –72, 2020.
16. WHO. Advice on the use of masks in the community, during home care and in health care settings in the
context of the novel coronavirus 2019-nCoV outbreak (Interim guidance). 2020. Available at: WHO/
novel Cov/IPC_Masks/2020. Access date: [April 27, 2020].
17. National Health Commission of the People’s Republic of China. Guidelines for public protection against
novel coronavirus infection. 2020. Available at: http://www.nhc.gov.cn/jkj/s7915/202001/
bc661e49b5bc487dba182f5c49ac445b.shtml. Access date:[April 27, 2020].
18. Centers for Disease control for prevention and control (CDC). Information for Clinicians on Investiga-
tional Therapeutics for Patients with COVID-19, 2020. Available at: https://www.cdc.gov/coronavirus/
2019-ncov/hcp/therapeutic-options.html.
19. Ou F, Wu H, Yang Y, Tan W, Zhang J, Gu J. Countermeasures for the rapid spread of new coronavirus
pneumonia in Wuhan. Chin General Pract Nurs. 2020. Available at: http://kns.cnki.net/kcms/detail/14.
1349.R.20200131.1319.002.html. Access date: [April 27, 2020].
20. WHO. Coronavirus disease (COVID-19) outbreak: rights, roles, and responsibilities of health workers,
including key considerations for occupational safety and health, 2020. Available at: https://www.who.int/
publications-detail/coronavirus-disease-(COVID-19)-outbreak-rights-roles-and-responsibilities-of-
health-workers-including-key-considerations-for-occupational-safety-and-health. Access date: [May 2,
2020].
21. Hoe GW, Lim WJ, Koh D. Preventing intra-hospital infection and transmission of COVID-19 in health-
care workers. Safety and health at work, 2020: p. https://doi.org/10.1016/j.shaw.2020.03.001 PMID:
32292622
22. Nemati M, Ebrahimi B, Nemati F. Assessment of Iranian Nurses’ Knowledge and Anxiety Toward
COVID-19 During the Current Outbreak in Iran. Arch Clin Infect Dis 2020; In Press. https://doi.org/10.
5812/archcid.102848.
23. National Institute for Communicable Disease. Clinical Management of Suspected or Confirmed COVID-
19 Diseases, 2020. Available at: https://www.nicd.ac.za/wp-content/uploads/2020/03/Clinical-
Management-of-COVID-19-disease_Version-3_27March2020.pdf. Access date: [May 2, 2020].
24. WHO. WHO Director-General’s opening remarks at the media briefing on COVID-19, 2020. Available
at: https://www.who.int/dg/speeches/detail/who-director-general-s-opening-remarks-at-the-media-
briefing-on-COVID-19, 2020. Access date: [April 27, 2020].
25. Cucinotta D and Vanelli M. WHO Declares COVID-19 a Pandemic. (2531–6745 (Electronic)).
26. World Health Organization. The 2019-nCoV outbreak is an emergency of international concern. 2020.
Available at: http://www.euro.who.int/en/health-topics/health-emergencies/international-health-
regulations/news/news/2020/2/2019-ncov-outbreak-is-an-emergency-of-international-concern. Access
date: [May 1, 2020].
27. Olesen B, Gyrup HB, Troelstrup MW, Marloth T, Mølmer M, Infection prevention partners up with psy-
chology in a Danish Hospital successfully addressing staffs fear during the COVID-19 pandemic, Jour-
nal of Hospital Infection, https://doi.org/10.1016/j.jhin.2020.04.033.
28. Zhan M, Qin Y, Xue X, Zhu S. Death from Covid-19 of 23 Health Care Workers in China. New England
Journal of Medicine, 2020. https://doi.org/10.1056/NEJMc2005696 PMID: 32294342
29. Gujrat hospital isolation ward nurse dies of coronavirus. Available at: https://www.thenews.com.pk/
print/642662-gujrat-hospital-isolation-ward-nurse-dies-of-coronavirus. Access date: [May 2, 2020].
30. Marsh S. Doctors, nurses, porters, volunteers: the UK health workers who have died from Covid-19.
Available at: https://www.theguardian.com/world/2020/apr/16/doctors-nurses-porters-volunteers-the-
uk-health-workers-who-have-died-from-covid-19. Access date: [May 2, 2020].
31. Coronavirus: Remembering 100 NHS and healthcare workers who have died. Available at: https://www.
bbc.com/news/health-52242856. Access date: [May 2, 2020].
32. McKibbin WJ and Fernando R. The Global Macroeconomic Impacts of COVID-19: Seven Scenarios,
2020. CAMA Working Paper No. 19/2020. Available at SSRN: https://ssrn.com/abstract=3547729 or
http://dx.doi.org/10.2139/ssrn.3547729.
33. World Health Organization (WHO). Coronavirus disease 2019 (COVID-19) Situation Report –97, 2020.
34. WHO. WHO urges countries not to let COVID-19 eclipse other health issues, 2020. Available at: https://
www.afro.who.int/news/who-urges-countries-not-let-covid-19-eclipse-other-health-issues. Access
date:[April 27, 2020].
35. Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, et al. Clinical Characteristics of 138 Hospitalized Patients
With 2019 Novel Coronavirus-Infected Pneumonia in Wuhan, China. LID— https://doi.org/10.1001/
jama.2020.1585 (1538–3598 (Electronic)). PMID: 32031570

PLOS ONE | https://doi.org/10.1371/journal.pone.0248272 March 9, 2021 16 / 17

PLOS ONE Practice and associated factors towards precautionary measures for COVID-19: A cross-sectional study

36. McMichael Tm Fau—Clark, S., et al., COVID-19 in a Long-Term Care Facility—King County, Washing-
ton, February 27-March 9, 2020. (1545-861X (Electronic)).
37. UpToDate. Coronavirus disease 2019 (COVID-19): Infection control in health care and home settings.
Available at: https://www.uptodate.com/contents/coronavirus-disease-2019-covid-19-infection-control-
in-health-care-and-home-settings. Access date: [May 2, 2020].
38. Zhou M, Tang F, Wang Y, Nie H, Zhang L, You G, et al. Knowledge, attitude and practice regarding
COVID-19 among health care workers in Henan, China. Journal of Hospital Infection, 2020. https://doi.
org/10.1016/j.jhin.2020.04.012 PMID: 32278701
39. Nour MO, Babilghith AO, Natto HA, Al-Amin FO, Alawneh SM. Knowledge, attitude, and practices of
healthcare providers towards MERS-CoV infection at Makkah hospitals, KSA. Int Res J Med Med Sci
2017; 3:103–12.
40. Honarbakhsh M, Jahangiri M, and G. H., Knowledge, perceptions, and practices of healthcare workers
regarding the use of respiratory protection equipment at Iran hospitals Journal of Infection Prevention,
2018. 19(1):29–36. https://doi.org/10.1177/1757177417724880 PMID: 29317912
41. Saqlain M, Munir MM, Rehman SU, Gulzar A, Naz S, Ahmed Z, et al Knowledge, Attitude and Practice
among Healthcare Professionals regarding COVID-19: A cross-sectional survey from Pakistan. 2020.
42. Albarrak AI, Mohammed R, Elayan AA, Fawaz AF, Masry AM, Shammari AM, et al. Middle East Respi-
ratory Syndrome (MERS): Comparing the knowledge, attitude, and practices of different health care
workers. Journal of infection and public health, 2019: p. S1876-0341(19)30239-4.
43. Al-Amri S, Bharti R, Alsaleem SA, Al-Musa HM, Chaudhary S, Al-Shaikh AA. Knowledge and practices
of primary health care physicians regarding updated guidelines of MERS-CoV infection in Abha city.
Journal of family medicine and primary care, 2019. 8(2): 455–461. https://doi.org/10.4103/jfmpc.jfmpc_
336_18 PMID: 30984654
44. The Gamo zone health Department annual report, 2019.
45. WHO. Infection prevention and control during health care when COVID-19 is suspected, 2020. Avail-
able at: https://www.who.int/publications-detail/infection-prevention-and-control-during-health-care-
when-novel-coronavirus-(ncov)-infection-is-suspected-20200125. Access date: [May 4, 2020].
46. National Institute of Health (NIH), Pakistan-COVID-19. Available at: https://www.nih.org.pk/novel-
coranavirus-2019-ncov/. Access date: [May 4, 2020].
47. WHO. Regional Office for Europe, Copenhagen, 2020. Hospital Readiness Checklist for COVID-19.
Available at: http://www.euro.who.int/__data/assets/pdf_file/0010/430210/Hospital-Readiness-
Checklist.pdf. Access date: [May 6, 2020].
48. Olum R, Chekwech G, Wekha G, Nassozi DR, Bongomin F. Coronavirus Disease-2019: Knowledge,
Attitude, and Practices of Health Care Workers at Makerere University Teaching Hospitals, Uganda.
Frontiers in Public Health, 2020. 8:181.
49. Asemahagn M.A., Factors determining the knowledge and prevention practice of healthcare workers
towards COVID-19 in Amhara region, Ethiopia: a cross-sectional survey. Tropical Medicine and Health,
2020. 48(1):72. https://doi.org/10.1186/s41182-020-00254-3 PMID: 32839649
50. Girma S, Alenko A, Agenagnew L. Knowledge and Precautionary Behavioral Practice Toward COVID-
19 Among Health Professionals Working in Public University Hospitals in Ethiopia: A Web-Based Sur-
vey. Risk Management and Healthcare Policy, 2020: 13, 1327–1334. https://doi.org/10.2147/RMHP.
S267261 PMID: 32922101

PLOS ONE | https://doi.org/10.1371/journal.pone.0248272 March 9, 2021 17 / 17