|Year : 2022 | Volume
| Issue : 4 | Page : 350-355
Perception and attitude of clinical medical students to COVID-19 containment measures
Samuel R Ohayi1, Awoere T Chinawa2, Ifeoma N Asimadu3, Josephat M Chinawa4
1 Department of Histopathology, College of Medicine, Enugu State University Teaching Hospital, Enugu, Nigeria
2 Department of Community Medicine, College of Medicine, Enugu State University Teaching Hospital, Enugu, Nigeria
3 Department of Ophthalmology, College of Medicine, Enugu State University Teaching Hospital, Enugu, Nigeria
4 Department of Paediatrics, College of Medicine, University of Nigeria, Enugu Campus, Enugu, Nigeria
|Date of Submission||07-Jan-2022|
|Date of Decision||08-Mar-2022|
|Date of Acceptance||18-Jun-2022|
|Date of Web Publication||22-Sep-2022|
Awoere T Chinawa
Department of Community Medicine, Enugu State University College of Medicine (ESUCOM) & Teaching Hospital, Park Lane GRA, P.M.B. 1030, Enugu
Source of Support: None, Conflict of Interest: None
Background: The strain put on the health systems by the COVID-19 pandemic is very significant. Measures of containment includes closure of schools, wearing of face mask, use of hand sanitizers, etc. Objectives: To determine the perception and attitude of clinical medical students to COVID-19 containment measures. Materials and Methods: This study was a cross-sectional study which utilized an online survey protocol. A self-selecting sampling method was used to select students. Data were analyzed using the Statistical Package for Social Sciences, version 20, Chicago (Ill., USA). Results: Medical students hazarded wearing of face mask 154(87.0%) and the use of hand sanitizers 59(89.8%) as the most useful containment measures against COVID-19 pandemic. Sixty six participants (37.3%) had good preventive practices. The age range of 20–25 years and male gender “disagreed” that government stoppage of medical education is an appropriate measure against COVID 19 pandemic. (p = 0.01, and 0.02, respectively). Only 10.2% of participants believed that the government is also affected by this containment measure. Age range of 20–25 years and being a catholic are predictors of good preventive practices (P = 0.05, and 0.04, respectively). Conclusion: A little proportion of medical students had good preventive practices against COVID-19. And a good proportion repudiated the policy of closure of schools during the pandemic. Factors such as male gender, and being within the 20–25 years age bracket were predictors of students’ rejection of the government’s policy on closure of schools as a containment measure for COVID pandemic.
Keywords: Attitude, COVID-19, medical students, perception
|How to cite this article:|
Ohayi SR, Chinawa AT, Asimadu IN, Chinawa JM. Perception and attitude of clinical medical students to COVID-19 containment measures. Int J Med Health Dev 2022;27:350-5
|How to cite this URL:|
Ohayi SR, Chinawa AT, Asimadu IN, Chinawa JM. Perception and attitude of clinical medical students to COVID-19 containment measures. Int J Med Health Dev [serial online] 2022 [cited 2023 Jun 6];27:350-5. Available from: https://www.ijmhdev.com/text.asp?2022/27/4/350/356621
| Introduction|| |
COVID-19 caused by the novel corona virus SARS-CoV-2 which was first seen in Wuhan, China is a highly infectious disease., On March 11, 2020 after about 3 months of capturing global attention, COVID-19 was declared a pandemic by the World Health Organization (WHO). As of November 1, 2020, there were about 46 million confirmed cases and 1.2 million deaths globally with Africa having 1, 324, 258 confirmed cases and 29, 785 deaths. The problem of high infectivity of the virus is compounded by non-availability of scientifically proven and acceptable viable treatment and vaccine against the pandemic; though by December 2020 the first viable vaccine was introduced to the health community.
With no known treatment or vaccine, the global health community focused on limiting the spread of the infection by advocating and introducing various containment measures. These measures included restriction of movement of people (general lockdown of the population), closure of schools including medical schools and scaling down of the available care in hospitals due to limitation of resources., Other measures included social distancing, wearing of face masks, regular hand washing with soap and hand sanitizing using alcohol-based solutions. These containment measures have wide implications ranging from its effects on social relations the economy and education of students among others. Also, they affect different segments of the population in different ways. Public responses to these restrictive measures have been varied and, in many cases, include resistance which range from non-compliance to outright protest against them. A fundamental element for the success of public health measures recommended by government against an infectious disease outbreak is the willingness of the public to comply with such containment measures. Therefore, understanding the factors that affect such adherence is important for the success of public health interventions.
The Nigerian government set up a Presidential Task Force which it saddled with the task of implementing government’s COVID-19 containment efforts in conjunction with the Federal Ministry of Health (FMoH) and Nigerian Center for Disease Control (NCDC). Similar agencies were set up at the state and local government levels also.
Studies on the perception and attitude of students to government containment measures against COVID-19 are few globally and, in our country, to the best of the authors’ knowledge, lacking. However, some works that explored the perception and attitude of the general public to the containment measures introduced against the virus in our country and other parts of the world, have been published. Medical students expectedly would be affected in more profound and peculiar ways than other students by specific aspects of the containment measures namely closure of schools and social distancing. Length and quality of medical student training shall be significantly affected. As a result, it would be useful to explore their perception and attitude to these measures. In this study, we examine the perceptions of clinical-level medical students to government’s containment measures against the outbreak and how these affect their reception of recommended measures. Information obtained from this study may therefore help in guiding planning, modifying and implementing response to the present and future epidemics in Nigeria.
| Materials and Methods|| |
This study was a cross-sectional study which utilized an online survey protocol. A self-selecting sampling method was used to select participants.
One hundred and seventy seven medical students from Enugu State University College of Medicine, ESUCOM, at the clinical (clerkship) level of training (late third year to sixth year) were recruited into the study by convenient sampling method. This category of students was selected because by the time of the study, they were the group in ESUCOM fully integrated into our school’s medical education routine before the commencement of the pandemic. They were invited to participate in the study through an online system. The participants were informed that the process was anonymous, that information obtained shall be treated as such and that they were at liberty to participate or not. The students were living within the campus grounds and all of their training except certain aspects of Community Medicine postings take place within the college and in the seamlessly adjoining Enugu State University Teaching Hospital.
The population of the study were undertaken using a convenience sampling technique.
The survey instrument is an online form, Google Form: (https://docs.google.com/forms/d/181P1X5_iPwAB7tHSEZpG4c_U2qYhEeIPlttb7FqKnvM/edit) created in November 2020. The questionnaire was initially administered to some medical students as a pretest for comprehensibility and completeness. It was then reviewed in a meeting of a team of five (5) researchers which included the authors. Questions were then modified by the first author as appropriate.
The study was an online opt-in survey designed to cover the clinical students of ESUCOM. At the time of this study, these students were at their various homes since medical education was shut down as part of government’s containment measures for the COVID-19 pandemic. Students were invited to participate in the study through private messages namely emails and WhatsApp and group online platform namely WhatsApp. To participate in the survey, a participant using a computer or mobile device appropriately enabled clicked on this link: https://docs.google.com/forms/d/181P1X5_iPwAB7tHSEZpG4c_U2qYhEeIPlttb7FqKnvM/edit. This then led them to the questionnaire. After completing a form, the participant clicked on a submit button and the responses are automatically submitted to the Google Analytic Tool.
The questionnaire was divided into four sections of variable numbers of structured questions. Information collected included socio-demographic characteristics, knowledge of COVID-19 and individual perception on management and response to the pandemic. The data collected from the survey and used in this study were stored electronically.
Collected data were analyzed using the Statistical Package for Social Sciences, version 20, Chicago. A p value of <0.05 was considered statistically significant.
Ethical clearance was obtained from the Ethics Committee of ESUT Teaching Hospital.
| Results|| |
[Table 1] shows the socio-demographic characteristics of the medical students. The male - female ratio is 1:1.2 and majority of the students cluster in the age range of 20–25 years 124 (70.1%). Majority of the respondents are also Catholics 89 (50.3%) and mainly in 500 level 110 (62.1%) [Figure 1].
|Figure 1: Shows medical students’ perception of containment measures for COVID-19. Medical students noted wearing of face mask 154(87.0%) and the use of hand sanitizers 59(89.8%) as the most useful containment measures against COVID-19. Sixty-six participants (37.3%) had good preventive practices|
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[Table 2] shows factors that affect medical students’ perception of government’s stoppage of medical education as an appropriate response. The age of 20–25 years and male gender disagree that government stoppage of medical education is an appropriate measure against COVID-19 [Figure 2] showed that participants believe that the health care system is the most affected, 95(53.7%) when stoppage of medical education was used as a means of preventing COVID-19.
|Table 2: Factors that affect medical students’ perception of Government’s stoppage of medical education as an appropriate response|
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|Figure 2: Perception of medical students about stakeholders most affected by the stoppage of medical education|
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According to the participants [Table 3], the serious problems caused by stoppage of medical education are mainly loss of time/delayed career progression; 130(73.4%), Deterioration of acquired academic knowledge; 119(67.2%), and idleness and feeling not being useful to the society 102(57.6%).
|Table 3: Perception of the problems caused by stoppage of medical education and the severity|
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Age between 20 and 25 and being a catholic are predictors of good preventive practices [Table 4].
| Discussion|| |
The COVID-19 pandemic has caused increased burden and stress in the healthcare system world-wide and medical education programs is not spared.
Medical students hazarded wearing of face mask and the use of hand sanitizers as the best containment measures against COVID-19. This finding is in keeping with that of Alzoubi et al, Peng et al, and Taghrir et al.
A study in Thai community setting also showed that handwashing and masking are significantly associated with lower risk of COVID-19 infection. Those who wore masks all the time also were noted to be more likely to practice social distancing.,,,
Factors that affect medical students’ perception of government’s stoppage of medical education as an appropriate response to COVID-19 pandemic in this study are mainly age and gender. The age of 20–25 years disagree that government stoppage of medical education is an appropriate measure against COVID-19. The prolong stay of this group of medical students could explain this assertion They will therefore like to finish up their curriculum even amidst COVD 19 pandemic. The male medical students disagree that Government’s stoppage of medical education is an appropriate response against COVID when compared to their female counterparts. Female medical students are more vulnerable and very cautious and may know and pay more attention to new or trending events concerning the pandemic and would not be ready to risk being infected from coming for lectures. It may also be that males in their nature are adventurous and like to take risks and therefore see the corona virus pandemic as one more adventure.
The study also that in the perception of the students, health care system is the most affected when medical education is stopped as a means of preventing COVID19. The reasons may include inadequate training of doctors and delayed turnover of manpower It also suggests that these students may actually be concerned about the poor state of healthcare system in our country.
It is expedient to note that the Coronavirus disease has caused an unprecedented disruption in medical education and healthcare systems worldwide. The disease which had caused life-threatening conditions presents challenges for medical education, as the lecturers must give their lectures in a safe environment, while ensuring the preservation of the medical education.,,,
Another area affected by the closure of medical education in this study is the effect of COVID-19 on lecturers in the school. The highly lethal effect of the virus has made it almost impossible for lectures to continue as in the pre-COVID era. This is in part because a number of the lecturers tested positive for the virus while another good number suffered the disease. This resulted in marked reduction in man hours in lecture delivery, These challenges have also caused restricted number bedside teaching opportunities for medical students. As a result, the students are not able to complete their clerkships. Furthermore students are also very afraid to contract the virus during their training and may avoid learning in the school as a result.
Medical students noted that the problems caused by stoppage of medical education to them are mainly loss of time/delay in career progression, deterioration of acquired academic knowledge and idleness and feeling of not being useful to the society. This finding was also corroborated by Ferrel et al.
The use of telemedicine in the era of COVID-19 cannot be overemphasized. This will indeed speed up learning process and will save lots of time wasted in staying at home and waiting for the pandemic to wane. Telemedicine involves a virtual visit, and virtual clinical experience may provide the patients the ease of connectivity with reduced risk of infection transmission., Chandra et al, noted in their study that students were able to provided positive feedback regarding a virtual clinical experience which entailed direct participation in patient care under clinicians’ supervision.
This study showed that only 37.3% of medical students had good preventive practices against COVID-19. This is contrary to a study that noted that most their medical students had good practice against COVID-19. [25, 26] It is also in wide contrast with a recent study, though among a different population type namely Chinese residents where nearly all of the participants (98.0%) admitted to wearing masks when leaving their homes. This finding may however be comparable with that of Asraf et al where only (9.7%) considered wearing a face mask often. The lockdown period, stoppage of medical education and medical students’ frustration in staying at home may contribute to this low level of preventive practice. Age between 20 and 25 and being a catholic are predictors of good preventive practices seen in this study.
This might be due to the misconception about the disease which is usually seen at younger age, in addition younger students engaged in risky behaviors and this could also affect a good preventive practices. Catholic mission probably has imbibed the practice of enlightenment campaign and education on the awareness and prevention of COVID-19 especially during church services.
| Conclusion|| |
A minor proportion of medical students had good preventive practices against COVID-19. Medical students in our center repudiated the policy of closure of schools during the pandemic as inappropriate measure in the containment of COVID pandemic. Factors such as male gender, and older age contributed to this perception.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Shereen MA, Khan S, Kazmi A, Bashir N, Siddique R COVID-19 infection: Origin, transmission, and characteristics of human coronaviruses. J Adv Res 2020;24:91-8.
Sanche S, Lin YT, Xu C, Romero-Severson E, Hengartner N, Ke R High contagiousness and rapid spread of severe acute respiratory syndrome coronavirus 2. Emerg Infect Dis 2020;26:1470-7.
WHO Timeline - COVID-19. Obtainabale from https://www.who.int/news-room/detail/27-04-2020-who-timeline---covid-19
. [Last accessed on 05 May 2020].
WHO Coronavirus disease (COVID-19) Situation Report – 105. Obtainabale from https://www.https://www.who.int/publications/m/item/weekly-epidemiological-update---3-november-2020
. [Last accessed on 04 Nov 2020].
WHO Considerations for quarantine of individuals in the context of containment for coronavirus disease (COVID-19): Interim guidance. Obtainabale from https://apps.who.int/iris/bitstream/handle/10665/331497/WHO-2019-nCoV-IHR_Quarantine-2020.2-eng.pdf
. [Last accessed on 05 May 2020].
Dyer O Covid-19: Trump stokes protests against social distancing measures. BMJ 2020;369:m1596.
van der Weerd W, Timmermans DR, Beaujean DJ, Oudhoff J, van Steenbergen JE Monitoring the level of government trust, risk perception and intention of the general public to adopt protective measures during the influenza A (H1N1) pandemic in the Netherlands. BMC Public Health 2011;11:575.
Oleribe O, Ezechi O, Osita-Oleribe P, Olawepo O, Musa AZ, Omoluabi A, et al
. Public perception of COVID-19 management and response in Nigeria: A cross-sectional survey. BMJ Open 2020;10:e041936.
Bol D, Giani M, Blais A, Peter JL, et al
. The effect of COVID-19 lockdowns on political support: Some good news for democracy? Eur J Polit Res 2020;60:1475-6765.
Gollust SE, Fowler EF, Niederdeppe J Ten years of messaging about the affordable care act in advertising and news media: Lessons for policy and politics. J Health Polit Policy Law 2020;45:711-28.
Khalil NS, Al-Yuzbaki DB, Tawfeeq RS COVID-19 knowledge, attitude and practice among medical undergraduate students in Baghdad City. Eurasia J Biosci 2020;14:4179-86.
Alzoubi H, Alnawaiseh N, Al-Mnayyis A, et al
. COVID-19 - Knowledge, Attitude and Practice among Medical and Non-Medical University Students in Jordan. J Pure Appl Microbiol 2020;14:17-24. doi: 10.22207/JPAM.14.1.04
Peng Y, Pei C, Zheng Y, Wang J, Zhang K, Zheng K, et al
. A cross-sectional survey of knowledge, attitude and practice associated with COVID-19 among undergraduate students in China. BMC Public Health 2020;20:1292.
Greenhalgh T, Schmid MB, Czypionka T, Bassler D, Gruer L Face masks for the public during the covid-19 crisis. Bmj 2020;369:m1435.
Cheng KK, Lam TH, Leung CC Wearing face masks in the community during the COVID-19 pandemic: Altruism and solidarity. Lancet 2020;399:39-40.
Feng S, Shen C, Xia N, Song W, Fan M, Cowling BJ. Rational use of face masks in the COVID-19 pandemic. Lancet Respir Med 2020;8:434-6.
Centers for Disease Control and Prevention. Coronavirus disease 2019 (COVID-19) How to Protect Yourself and Others. 2020. Available from: https://africacdc.org covid-19
. [Last accessed on 2022 Apr 29].
Aaron JH, Carmen L, Lee J, Robert MR, John AD, Megan BO, et al
. Effects of the COVID-19 pandemic on medical students: A multicenter quantitative study. BMC Med Educ 2021;21:14.
Woolliscroft JO Innovation in Response to the COVID-19 Pandemic Crisis. Academic Medicine: Journal of the Association of American Medical Colleges 2020;pmid: 32282372.
Sklar DP COVID-19: Lessons From the Disaster That Can Improve Health Professions Education. Academic Medicine: Journal of the Association of American Medical Colleges 2020;pmid:32544103.
Calhoun KE, Yale LA, Whipple ME, Allen SM, Wood DE, Tatum RP The impact of COVID-19 on medical student surgical education: Implementing extreme pandemic response measures in a widely distributed surgical clerkship experience. Am J Surg 2020;220:44-7.
Akers A, Blough C, Iyer MS COVID-19 implications on clinical clerkships and the residency application process for medical students. Cureus 2020;12:e7800.
Ferrel MN, Ryan JJ The impact of COVID-19 on medical education. Cureus 2020;12:e7492.
Dzau VJ, Yoediono Z, Ellaissi WF, Cho AH Fostering innovation in medicine and health care: What must academic health centers do? Acad Med 2013;88:1424-9.
Chandra S, Laoteppitaks C, Mingioni N, Papanagnou D Zooming-out COVID-19: Virtual clinical experiences in an emergency medicine clerkship. Med Educ 2020;54:1182-3.
Ashraf IK, Anas AH, Jomana WA, Bloukh S, Ramadan N, Al-Shatanawi TN, et al
. Medical Students and COVID-19: Knowledge, Attitudes, and Precautionary Measures. A Descriptive Study From Jordan. Front Public Health 2020;8. https://doi.org/10.3389/fpubh.2020.00253
Zhong BL, Luo W, Li HM, Zhang QQ, Liu XG, Li WT, et al
. Knowledge, attitudes, and practices towards COVID-19 among chinese residents during the rapid rise period of the COVID-19 outbreak: A quick online cross-sectional survey. Int J Biol Sci 2020;16:1745-52.
[Figure 1], [Figure 2]
[Table 1], [Table 2], [Table 3], [Table 4]