One Health Community-Based Wildlife Mortality Surveillance for Ebola: Linking the Public Health and Conservation Sectors

#### Authors

Alain U. Ondzie1, Eeva Kuisma1, Sarah H. Olson2, K.N. Cameron2, P.E. Reed2, Chris Walzer2, W.B. Karesh3, M. Jeremiah Matson4, Trent Bushmaker4, Stephanie N. Seifert4, Robert J. Fischer4, Vincent J. Munster4, Cynthia Goma-Nkoua5, Jean-Vivien Mombouli5, Dania M. Figueroa4, Morgane Cournarie1, Marc-Joël Akongo1, and Serge D. Kaba1

<sup>1</sup> Wildlife Conservation Society, Wildlife Health Program, Brazzaville, Republic of the Congo


<sup>5</sup> Service d'Epidémiologie Moléculaire, Laboratoire National de Santé Publique, Brazzaville, Republic of the Congo

## **Safety Practices and COVID-19 Stigma among Healthcare Workers in Malaysia**

**Jun How Ooi¹, Rosediani Muhamad¹, Rosnani Zakaria¹, Nik Rosmawati Nik Husain², Siti Azrin Ab Hamid³, Maryam Mohd Zulkifli¹, Zainab Mat Yudin⁴, Imran Ahmad¹, and Nur Suhaila Idris¹**

¹ Department of Family Medicine, School of Medical Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia

² Department of Community Medicine, School of Medical Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia

³ Department of Biostatistics and Research Methodology, School of Medical Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia

⁴ School of Dental Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia

The COVID-19 pandemic has caused an increased workload among healthcare workers in Malaysia, which may change their safety practices, perceived risk of COVID-19 infection, and cause stigma. To assess safety practices, perceived risk, risk coping strategies, and level of perceived stigma among frontline healthcare workers in Hospital Universiti Sains Malaysia, Kelantan, Malaysia. Methods: A cross-sectional study recruiting all frontline healthcare workers who have worked for three months during the COVID-19 pandemic in Hospital Universiti Sains Malaysia, excluding those who were unable to understand the Malay language. A self-administered validated online questionnaire including socio-demographic characteristics, safety practices, perceived risk, risk coping strategies, and stigma was used. Descriptive statistics were analyzed using SPSS software version 27. Two hundred thirteen eligible healthcare workers were recruited for this study. The majority of respondents adhered to correct safety practices regularly. A total of 79.7% of respondents felt they might contract COVID-19 infection. Two-thirds of respondents felt stressed, while 38.1% felt depressed during this pandemic. A total of 75.6% of respondents regularly performed spiritual and religious prayers as a risk-coping strategy, while maladaptive strategies, including smoking, drinking alcohol, and self-isolation, were less practiced. COVID-19-related stigma among respondents was mild. Healthcare workers should be screened for mental health problems during the COVID-19 pandemic and offered appropriate counseling and treatment if required. A total of 79.7% of respondents had a high perceived risk of COVID-19 infection, with the majority performing a risk-coping strategy of spiritual and religious prayers. The majority of respondents practiced correct safety practices, while COVID-19-related stigma was mild.

### Introduction

COVID-19 was declared to be a pandemic on March 11, 2020 by the Director-General of the WHO [1]. To date, there have been 2.80 million positive COVID-19 cases detected in Malaysia, with 31793 COVID-19 deaths as of 17 January 2022 [2]. This has put unprecedented pressure and extra workloads on healthcare workers (HCWs) worldwide, as well as in Malaysia. HCWs have a higher risk of contracting COVID-19 compared to the general population, which may be due to interaction with ill patients and/or potentially infectious coworkers [3,4]. Therefore, it is important to assess safety practices among HCWs. The risk perception of HCWs towards COVID-19 plays a vital role as it shapes their preventive behaviours regarding COVID-19 [5]. However, based on previous experience during severe acute respiratory syndrome (SARS) and Ebola outbreaks, a higher perceived risk was associated with adverse mental health outcomes [6,7]. Therefore, both adaptive and maladaptive risk coping strategies among HCWs need to be identified when facing the COVID-19 pandemic. HCWs are a group of people who may be labelled, stereotyped, and discriminated against because of a perceived link to the COVID-19 pandemic. HCWs who faced stigma were significantly associated with higher odds of insomnia, depression and anxiety [8].

#### Results

A. Socio-Demographic Characteristics, n=213 64.8% were female, 93.9% were Malay and 76.1% were married; mean age of 32.9 years (SD 6.20), with a duration of service of 6.0 years (IQR 7.0); 84% had attained tertiary level education; 74.6% had previously managed suspected or confirmed COVID-19 patients; 96.7% of respondents had already received the COVID- 19 vaccine.

### B. Safety Practices:

Most respondents carried out good safety practices regularly at work. The majority of them frequently advised patients on steps to prevent COVID-19 infection; 43.2% shortened patient consultation times, 34.3% changed regular non-acute patient appointments, 13.1% increased the duration of clinical service, while 12.7% prescribed antibiotics for upper respiratory tract infections lasting more than one week, in order to ensure continuity of clinical service; 78.4% strongly agreed to undergo home self-isolation after contact with a suspected COVID-19 patient, while 87.8% strongly agreed to sanitize the workplace after managing a COVID-19- positive patient.

*Figure 1. Occupation categories of respondents.*

*Figure 2. Frequency of safety practices performed in the workplace.*

*Figure 3. Frequency of advice given to patients to prevent spread of COVID-19.*

### E. COVID-19-Related Stigma:

HCWs mostly disagreed that they were afraid to tell family members (82.2%) or others (83.5%) about their occupation; Most respondents did not feel like they lost friends (86.8%) or that their friends stayed away (82.6%); 53% did not feel guilty for causing others to be at risk of COVID-19 infection, while 77.5% did not worry that their family members would be isolated by others; Half of the participants stayed away from others to prevent the spread of COVID-19. Only a quarter of respondents felt lonely.

*Figure 6. COVID-19-related stigma among HCWs.*

### C. Perceived Risk:

23.9% felt they will definitely contract COVID-19 infection in the future, while 30% felt it was probable and 25.8% felt that it was possible; 81.7% were worried about contracting COVID-19 infection due to their occupation; 88.8% were worried about family members becoming infected with COVID-19; 98.1% of respondents felt that the COVID-19 pandemic had affected their daily activities, while 93.4% felt it had affected their quality of life; Twothirds of respondents felt stressed during the course of this pandemic, while 38.1% of respondents felt depressed.

*Figure 4. Perceived risk of COVID-19 infection.*

#### Conclusions

The majority of HCWs adhered to correct safety practices regularly during the COVID-19 pandemic. A high perceived risk of COVID-19 contributed to better safety practices; however, it is associated with worry and stress. Most HCWs performed spiritual and religious prayers as a coping strategy. Maladaptive coping strategies such as smoking, drinking alcohol and self-isolation were less practised. COVID-19-related stigma was mild among HCWs in the Hospital Universiti Sains Malaysia. Mental health training and a psychological support team are needed to ensure good mental health among HCWs during the COVID-19 pandemic.

#### References

1. World Health Organization. WHO Director-General's opening remarks at the media briefing on COVID-19-11 March 2020.

COVIDNOW in Malaysia - COVIDNOW [Internet]. [cited 2022 Jan 17]. Available from: https:// covidnow.moh.gov.my/

\*Source of photo: pixabay.com (Free photos)

### Objective

This study aims to determine safety practices, perceived risk, risk coping strategies and the level of perceived stigma among frontline healthcare workers in Hospital Universiti Sains Malaysia, Kelantan, Malaysia, while dealing with the COVID-19 pandemic.

### Methodology

A cross-sectional study was conducted among frontline healthcare workers in Hospital Universiti Sains Malaysia, Kelantan, Malaysia, from June 2021 to August 2021. Participants: A total of 213 healthcare workers working as frontliners for at least 3 months' duration during the COVID-19 pandemic participated in this study by answering a self-administered online questionnaire. Research tool: A newly validated Safety Practices, Perceived Risk, Risk Coping Strategies and Stigma Questionnaire developed in Hospital Universiti Sains Malaysia in 2021 was used. Data analysis: Statistical analysis was undertaken using SPSS software version 27. Descriptive statistics were analysed.

### D. Risk Coping Strategies:

75.6% of respondents regularly performed spiritual and religious prayers; Approximately half of respondents engaged in more conversations with family members, friends or colleagues, increased physical activity and performed relaxation techniques such as breathing exercises. Most respondents never drink alcohol (97.7%), smoke (95.8%) or take antidepressants (93.4%); The majority of respondents did not isolate themselves from friends and family (79.3%), contemplate changing work place (80.8%) or contemplate changing occupation (84.0%); Most respondents agree that mental health training (97.7%) and a psychological support team (97.2%) are needed during the COVID-19 pandemic.

*Figure 5. Frequency-of-risk coping strategies.*
