Demographic characteristics of the respondents
This study included an aggregate of 145 frontline nurses from Zanzibar; however, 6 of them didn’t complete the study and only 139 were analyzed. Of the respondents, 69.8% were aged below 30years while the majority of them (61.2%) being female. Nearly half of the respondents (44.6%) were diploma holders’ and the majority of them (43.9%) had 2 to 5 years of working experience with the higher proportion (44.6%) being those working at the Primary Health Care Units (PHCU). With regards to CPD uptakes, the majority (71.2%) had received IPC training and (66.9%) received RTI training; however, only a few (24.5%) of them had a chance to participate in any of eLearning based training.
Table 1
Demographic Characteristics of Respondents (n= 139)
Variable
|
Frequency (n)
|
Percentage (%)
|
Age
|
|
|
Below 30
|
97
|
69.8
|
31-40
|
36
|
25.9
|
41+
|
6
|
4.3
|
Gender
|
|
|
Male
|
54
|
38.8
|
Female
|
85
|
61.2
|
Residence
|
|
|
Urban West
|
82
|
59.0
|
South Unguja
|
17
|
12.2
|
North Pemba
|
40
|
28.8
|
Level of Education
|
|
|
Diploma
|
62
|
44.6
|
Advance Diploma
|
21
|
15.1
|
Bachelor
|
51
|
36.7
|
Masters+
|
5
|
3.6
|
Working Experiences
|
|
|
Less than 2years
|
22
|
15.8
|
2-5years
|
61
|
43.9
|
6-10years
|
39
|
28.1
|
More than 10years
|
17
|
12.2
|
Level of a working facility
|
|
|
Primary Health Care
|
62
|
44.6
|
Cottages Hospital
|
25
|
18.0
|
District Hospital
|
31
|
22.3
|
Referral Hospital
|
21
|
15.1
|
Received IPC training
|
|
|
Yes
|
99
|
71.2
|
No
|
40
|
28.8
|
Received RTI training
|
|
|
Yes
|
93
|
66.9
|
No
|
46
|
33.1
|
Ever use eLearning
|
|
|
Yes
|
34
|
24.5
|
No
|
105
|
75.5
|
Source: Field data 2021, Zanzibar |
Nurses knowledge on covid-19 pandemic responses
The results of the assessment of knowledge on covid-19 among frontline nurses from Zanzibar indicate that; the overall mean score knowledge of all respondents was (20.7±3.06) ranged from 13-26. Male and female respondents demonstrated nearly similar mean score knowledge (20.73±3.39 and 20.86±2.86 respectively) with no statistically significant difference.
With regards to the age groups of the respondents; elder nurses in the age group of (40+ years) shows a significantly higher mean knowledge score (23±2) compared to the young age groups P< 0.001(Table-2). However, this difference was significantly observed in the IPC and Nursing care knowledge (P< 0.001) only but not in the general knowledge of the covid-19 domain where both age groups present almost similar mean scores, age group of 20-30 years (7.81±1.1), 31-40years (8.11±1.2) and 41+ years (8.67±0.52) with P= 0.107 (Table-3)
Nurses with master degree levels were having a statistical significance mean knowledge scores (24.0±3.39) compared to those in the diploma, advanced diploma and bachelor degree level (P< 0.001). Again, there was also a statistically significant difference in the mean score knowledge between nurses with working experience of more than 10 years (22.24±3.17) compared to those with <2years, 2-5 and 6-10 years (18.8±3, 20.17±2.66 and 21.88±2.96 respectively) P< 0.001 (Table-2). This significant difference was specifically observed under the domain of IPC and Nursing care knowledge (P< 0.001) but not in the domain of general knowledge for covid-19 P=0.063 (Table-3)
Regarding the status of IPC, RTI and eLearning training uptake; nurses with a history of participation in those training demonstrated significant mean score differences while compared to those who had not (P< 0.001); yet, the difference in IPC training variable was observed being no statistical significance (P=0.132) in the domain of the general knowledge on covid-19 when it came to domain analysis.
On the other hand, no difference in knowledge was observed according to the gender, residence and level of working facility P >0.05 (Table-3). Conversely, the domains based analyses indicate significant differences in the mean knowledge score in the domain of the general knowledge on covid-19 (P< 0.001); see Table 3.
Table 2
Relationship between socio-demographic characteristics of the respondents with the overall mean knowledge and skills scores on covid_19 pandemic (n=139)
|
|
Overall Knowledge scores
|
Overall skills scores
|
variable
|
n
|
Mean
|
SD
|
P-Value
|
Mean
|
SD
|
P-Value
|
Overall Scores
|
139
|
20.69
|
3.06
|
|
12.71
|
2.61
|
|
Gender
|
|
|
|
0.901
|
|
|
0.302
|
Male
|
54
|
20.73
|
3.39
|
|
13.00
|
2.46
|
|
Female
|
85
|
20.66
|
2.86
|
|
12.53
|
2.70
|
|
Age group
|
|
|
|
0.001*
|
|
|
0.017*
|
20-30
|
97
|
20.08
|
2.79
|
|
12.32
|
2.52
|
|
31-40
|
36
|
21.96
|
3.38
|
|
13.47
|
2.71
|
|
41 +
|
6
|
23.00
|
2.00
|
|
14.50
|
1.87
|
|
Residence (Region)
|
|
|
|
0.287
|
|
|
0.177
|
Urban West
|
82
|
20.54
|
2.85
|
|
12.66
|
2.76
|
|
South Unguja
|
17
|
21.79
|
2.83
|
|
13.76
|
2.49
|
|
North Pemba
|
40
|
20.54
|
3.53
|
|
12.38
|
2.26
|
|
Level of Education
|
|
|
|
<0.001*
|
|
|
<0.001*
|
Diploma
|
62
|
19.41
|
2.92
|
|
11.73
|
2.52
|
|
Advance Diploma
|
21
|
22.86
|
2.03
|
|
12.62
|
2.29
|
|
Bachelor
|
51
|
21.03
|
2.78
|
|
13.65
|
2.35
|
|
Masters+
|
5
|
24.00
|
3.39
|
|
15.80
|
2.28
|
|
Working Experience
|
|
|
|
<0.001*
|
|
|
0.008*
|
Less than 2years
|
22
|
18.82
|
3.00
|
|
11.41
|
2.70
|
|
2-5years
|
61
|
20.17
|
2.66
|
|
12.51
|
2.41
|
|
6-10years
|
39
|
21.88
|
2.96
|
|
13.18
|
2.38
|
|
More than 10years
|
17
|
22.24
|
3.17
|
|
14.06
|
2.99
|
|
Working Facility
|
|
|
|
0.062
|
|
|
<0.001*
|
PHCU
|
62
|
20.00
|
3.14
|
|
11.90
|
2.39
|
|
Cottages
|
25
|
20.88
|
2.76
|
|
12.56
|
2.58
|
|
District
|
31
|
21.06
|
2.98
|
|
12.97
|
2.58
|
|
Referral
|
21
|
21.95
|
2.97
|
|
14.90
|
2.10
|
|
Status of IPC training
|
|
|
|
<0.001*
|
|
|
0.003*
|
Yes
|
99
|
21.34
|
2.71
|
|
13.12
|
2.50
|
|
No
|
40
|
19.08
|
3.31
|
|
11.70
|
2.63
|
|
Status of RTI training
|
|
|
|
<0.001*
|
|
|
0.001*
|
Yes
|
93
|
21.47
|
2.78
|
|
13.23
|
2.52
|
|
No
|
46
|
19.11
|
3.04
|
|
11.67
|
2.51
|
|
Ever use eLearning
|
|
|
|
<0.001*
|
|
|
<0.001*
|
Yes
|
34
|
22.43
|
2.34
|
|
14.15
|
2.20
|
|
No
|
105
|
20.13
|
3.07
|
|
12.25
|
2.57
|
|
Table 3
Relationship between socio-demographic characteristics of the respondents and the mean scores knowledge on covid_19 Pandemic within the respective study domain (n=139)
|
|
General Knowledge
|
IPC knowledge
|
Nursing care knowledge
|
variable
|
n
|
M
|
SD
|
P
|
M
|
SD
|
P
|
M
|
SD
|
P
|
Gender
|
|
|
|
0.865
|
|
|
0.936
|
|
|
0.539
|
Male
|
54
|
7.91
|
1.32
|
|
7.05
|
1.326
|
|
5.78
|
1.21
|
|
Female
|
85
|
7.94
|
1.00
|
|
7.06
|
1.313
|
|
5.66
|
1.04
|
|
Age group
|
|
|
|
0.107
|
|
|
0.001*
|
|
|
<0.001*
|
20-30
|
97
|
7.81
|
1.10
|
|
6.80
|
1.256
|
|
5.46
|
0.98
|
|
31-40
|
36
|
8.11
|
1.24
|
|
7.60
|
1.292
|
|
6.25
|
1.25
|
|
41 +
|
6
|
8.67
|
0.52
|
|
8.00
|
1.095
|
|
6.33
|
0.82
|
|
Residence (region)
|
|
|
0.263
|
|
|
0.222
|
|
|
0.417
|
Urban West
|
82
|
7.80
|
1.07
|
|
7.02
|
1.237
|
|
5.71
|
1.08
|
|
South Unguja
|
17
|
8.24
|
0.83
|
|
7.56
|
1.223
|
|
6.00
|
1.17
|
|
North Pemba
|
40
|
8.05
|
1.34
|
|
6.91
|
1.476
|
|
5.58
|
1.13
|
|
Level of Education
|
|
<0.001*
|
|
|
<0.001*
|
|
|
<0.001*
|
Diploma
|
62
|
7.48
|
1.13
|
|
6.67
|
1.434
|
|
5.26
|
0.96
|
|
Adv. Diploma
|
21
|
8.52
|
0.98
|
|
7.95
|
.669
|
|
6.38
|
0.87
|
|
Bachelor
|
51
|
8.12
|
0.97
|
|
7.07
|
1.158
|
|
5.84
|
1.10
|
|
Masters+
|
5
|
9.00
|
1.23
|
|
8.00
|
1.225
|
|
7.00
|
1.23
|
|
Working Experience
|
|
|
0.063
|
|
|
<0.001*
|
|
|
<0.001*
|
< 2years
|
22
|
7.59
|
1.18
|
|
6.23
|
1.510
|
|
5.00
|
0.82
|
|
2-5years
|
61
|
7.77
|
1.07
|
|
6.89
|
1.152
|
|
5.51
|
1.01
|
|
6-10years
|
39
|
8.21
|
1.15
|
|
7.50
|
1.187
|
|
6.18
|
1.12
|
|
> 10years
|
17
|
8.29
|
1.11
|
|
7.71
|
1.263
|
|
6.24
|
1.09
|
|
Level of a working facility
|
|
0.069
|
|
|
0.359
|
|
|
0.001
|
PHCU
|
62
|
7.68
|
1.25
|
|
6.94
|
1.380
|
|
5.39
|
1.01
|
|
Cottages
|
25
|
8.04
|
0.94
|
|
7.00
|
1.225
|
|
5.84
|
1.03
|
|
District
|
31
|
8.32
|
1.01
|
|
7.03
|
1.329
|
|
5.71
|
1.07
|
|
Referral
|
21
|
7.95
|
1.02
|
|
7.52
|
1.167
|
|
6.48
|
1.17
|
|
Status of IPC training
|
|
0.132
|
|
|
<0.001*
|
|
|
0.006*
|
Yes
|
99
|
8.02
|
1.10
|
|
7.45
|
.995
|
|
5.87
|
1.09
|
|
No
|
40
|
7.70
|
1.20
|
|
6.08
|
1.492
|
|
5.30
|
1.04
|
|
Status of RTI training
|
|
0.007*
|
|
|
<0.001*
|
|
|
<0.001*
|
Yes
|
93
|
8.11
|
1.10
|
|
7.40
|
1.117
|
|
5.97
|
1.03
|
|
No
|
46
|
7.57
|
1.13
|
|
6.37
|
1.420
|
|
5.17
|
1.08
|
|
Ever use eLearning
|
|
0.007*
|
|
|
0.001*
|
|
|
<0.001*
|
Yes
|
34
|
8.38
|
0.95
|
|
7.69
|
.817
|
|
6.35
|
0.92
|
|
No
|
105
|
7.78
|
1.15
|
|
6.85
|
1.380
|
|
5.50
|
1.08
|
|
Predictors of knowledge for covid-19 by linear regression
Multiple linear regression was run to predict the knowledge for covid-19 from age, level of education, working experience and status of nursing training uptake among nurses from Zanzibar. The results show that age, level of education and working experience were found to be the factor associated with the knowledge for covid-19 at the level of P< 0.05 (Table-4). Age was found to be a significant predictor of knowledge in this study (β= -0.354, P= 0.024) indicating the decrease of knowledge score by 0.354 as the age increase by 1 year.
Regarding the level of education; the result shows that nurses with master degree level, bachelor degree and advanced diplomas were more knowledgeable about the covid-19 pandemic compared to the reference group (diploma). All variables for master degree level (β = 4.3, P= 0.002), bachelor level (β = 1.34, P= 0.016) and advanced diploma level (β = 2.76, P= 0.001) were statistical significance at the level of 5%. The working experience was also followed the same trend (β = 0.45, P= 0.016) (Table-4)
Table 4
a predictor of knowledge for covid-19 pandemic response among frontline nurse from Zanzibar by linear regression (n=139)
Model
|
Unstandardized Coefficients
|
t
|
Sig.
|
95.0% Confidence Interval for B
|
B
|
Std. Error
|
Lower Bound
|
Upper Bound
|
(Constant)
|
30.454
|
3.798
|
8.018
|
.000*
|
22.94
|
37.97
|
Age of the respondent
|
-.354
|
.156
|
-2.277
|
.024*
|
-.662
|
-.046
|
Level of Education
|
|
|
|
|
|
|
Advance Diploma
|
2.761
|
.810
|
3.410
|
.001*
|
1.159
|
4.364
|
Bachelor Degree
|
1.339
|
.547
|
2.450
|
.016*
|
.257
|
2.420
|
Master +
|
4.300
|
1.334
|
3.224
|
.002*
|
1.661
|
6.939
|
Working experience
|
.450
|
.184
|
2.451
|
.016*
|
.087
|
.813
|
Level of a working facility
|
|
|
|
|
|
|
Cottage
|
.140
|
.656
|
.213
|
.832
|
-1.158
|
1.437
|
District
|
.799
|
.577
|
1.385
|
.169
|
-.343
|
1.941
|
Referral
|
.791
|
.730
|
1.083
|
.281
|
-.654
|
2.236
|
Status of training uptakes
|
|
|
|
|
|
|
IPC training
|
-.900
|
.618
|
-1.455
|
.148
|
-2.124
|
.324
|
RTI training
|
-.940
|
.607
|
-1.550
|
.124
|
-2.141
|
.260
|
Ever use eLearning
|
-.737
|
.580
|
-1.270
|
.206
|
-1.885
|
.411
|
Nurses cognitive skills on covid-19 pandemic response
Nurses’ cognitive skills scores were significantly different among respondents based on their demographic characteristics. Of all respondents; the overall mean scores were (20.69±3.06) ranged from 8-18. There was no statistical mean difference between male (13.00±2.46) and females (12.53±2.70) cognitive skills scores (P=0.302).
Nurses within the age group of (40+ years) were observed to have significantly higher Mean cognitive skills scores (14.50±1.87; P=0.017) when compared to the young age groups in overall cognitive skills scores (Table-2). Nevertheless; the domain-based analysis (Table-5) demonstrate that the difference was only significant in the domain of IPC skills (P=0.031) but not in Nursing care skills, where all groups present nearly the same mean scores with no statistical significance difference (P=0.077).
Regarding the level of education, nurses with a master degree were found to have higher mean cognitive skills scores (15.80±2.28) compared to those in the diploma, advanced diploma and bachelor degree level (P<0.001). Nurses with working experience of more than 10 years yet were found to significantly differ in mean cognitive skills scores (13.18±2.38, P=0.008) from those with <2years (11.41±2.70), 2-5(12.51±2.41) and 6-10 years (13.18±2.38). Specifically, this significant difference was more of IPC related skills (P=0.003) rather than nursing care skills (P=0.195) (Table-5).
A mean cognitive skills score for nurses working at the referral hospital level (14.90±2.10) was significantly higher compared to those at PHCU level (11.90±2.39), cottage (12.56±2.58) and district level (12.97±2.58) at the level of 1% (P<0.001). Concerning the status of IPC, RTI and eLearning training uptake; nurses with the history of participation in those training demonstrated a significantly higher mean score as compared to their counterpart (P< 0.01); however the domain-based analysis indicate the difference to be significant under the IPC domain only P<0.001 (Table-5)
Table 5
Relationship between socio-demographic characteristics of the respondents and the mean scores within the domains of the cognitive skills on covid_19 Pandemic (n=139)
|
|
|
Cognitive skills on IPC
|
Cognitive skills on Nursing Care
|
Variable
|
N
|
M
|
SD
|
P-value
|
M
|
SD
|
P-value
|
Gender
|
|
|
|
0.277
|
|
|
0.501
|
Male
|
54
|
6.87
|
1.42
|
|
6.13
|
1.56
|
|
Female
|
85
|
6.59
|
1.53
|
|
5.94
|
1.64
|
|
Age group
|
|
|
|
0.031*
|
|
|
0.077
|
20-30
|
97
|
6.51
|
1.48
|
|
5.81
|
1.55
|
|
31-40
|
36
|
7.03
|
1.42
|
|
6.44
|
1.72
|
|
41 +
|
6
|
7.83
|
1.33
|
|
6.67
|
1.21
|
|
Residence (region)
|
|
|
0.274
|
|
|
0.186
|
Urban West
|
82
|
6.60
|
1.54
|
|
6.06
|
1.62
|
|
South Unguja
|
17
|
7.24
|
1.44
|
|
6.53
|
1.51
|
|
North Pemba
|
40
|
6.68
|
1.39
|
|
5.70
|
1.57
|
|
Level of Education
|
|
0.003*
|
|
|
<0.001*
|
Diploma
|
62
|
6.23
|
1.43
|
|
5.50
|
1.60
|
|
Adv. Diploma
|
21
|
6.67
|
1.46
|
|
5.95
|
1.50
|
|
Bachelor
|
51
|
7.20
|
1.39
|
|
6.45
|
1.40
|
|
Masters+
|
5
|
7.60
|
1.67
|
|
8.20
|
1.10
|
|
Working Experience
|
|
|
0.003*
|
|
|
.195
|
< 2years
|
22
|
5.86
|
1.39
|
|
5.55
|
1.82
|
|
2-5years
|
61
|
6.59
|
1.50
|
|
5.92
|
1.38
|
|
6-10years
|
39
|
7.00
|
1.24
|
|
6.18
|
1.73
|
|
> 10years
|
17
|
7.47
|
1.63
|
|
6.59
|
1.66
|
|
Level of a working facility
|
|
<0.001*
|
|
|
0.003*
|
PHCU
|
62
|
6.21
|
1.36
|
|
5.69
|
1.50
|
|
Cottages
|
25
|
6.80
|
1.53
|
|
5.76
|
1.64
|
|
District
|
31
|
6.87
|
1.57
|
|
6.10
|
1.60
|
|
Referral
|
21
|
7.76
|
1.09
|
|
7.14
|
1.42
|
|
Status of IPC training
|
|
<0.001*
|
|
|
0.217
|
Yes
|
99
|
7.00
|
1.38
|
|
6.12
|
1.56
|
|
No
|
40
|
5.95
|
1.50
|
|
5.75
|
1.69
|
|
Status of RTI training
|
|
<0.001*
|
|
|
0.099
|
Yes
|
93
|
7.05
|
1.40
|
|
6.17
|
1.57
|
|
No
|
46
|
5.98
|
1.41
|
|
5.70
|
1.63
|
|
Ever use eLearning
|
|
0.001*
|
|
|
0.002*
|
Yes
|
34
|
7.41
|
1.26
|
|
6.74
|
1.52
|
|
No
|
105
|
6.47
|
1.49
|
|
5.78
|
1.56
|
|
Table 6
Predictor of Cognitive skills for covid-19 pandemic response among frontline nurse from Zanzibar by linear regression (n = 139)
Model
|
Unstandardized Coefficients
|
t
|
Sig.
|
95.0% Confidence Interval for B
|
B
|
Std. Error
|
Lower Bound
|
Upper Bound
|
(Constant)
|
16.790
|
3.248
|
5.170
|
.000*
|
10.364
|
23.217
|
Age of the respondent
|
-.124
|
.133
|
-.933
|
.353
|
-.387
|
.139
|
Level of Education
|
|
|
|
|
|
|
Advance Diploma
|
.084
|
.692
|
.122
|
.903
|
-1.286
|
1.454
|
Bachelor Degree
|
1.423
|
.467
|
3.044
|
.003*
|
.498
|
2.347
|
Master +
|
2.988
|
1.140
|
2.621
|
.010*
|
.732
|
5.245
|
Working experience
|
.169
|
.157
|
1.074
|
.285
|
-.142
|
.479
|
Level of a working facility
|
|
|
|
|
Cottage
|
.503
|
.561
|
.897
|
.372
|
-.607
|
1.613
|
District
|
.976
|
.493
|
1.978
|
.050*
|
.000
|
1.952
|
Referral
|
2.226
|
.624
|
3.565
|
.001*
|
.991
|
3.462
|
Status of training uptakes
|
|
|
|
|
|
|
IPC training
|
-.585
|
.529
|
-1.106
|
.271
|
-1.631
|
.461
|
RTI training
|
-.516
|
.519
|
-.996
|
.321
|
-1.543
|
.510
|
Ever use eLearning
|
-.778
|
.496
|
-1.569
|
.119
|
-1.760
|
.204
|