Abstract:

Background: As a global pandemic COVID-19 had spread worldwide. As of March 2022, there were about 464,809, 377 confirmed cases with 6,062,536 deaths globally. Africa currently, there were about 8,517,888 confirmed cases with 170,757 deaths in Africa. Community and health services in multiple rural areas in Tanzania. Therefore, Community Health Workers are set to play a crucial role in the prevention spread of COVID-19. This study was aimed at assessing the readiness of CHWs in Itilima concerning preventing the spread of COVID-19.

The study employed a mixed study design which used both qualitative and quantitative. Cross sectional design was used to capture quantitative data and case study was used to capture qualitative data. The study was conducted in Itilima district of Simiyu. The sample size calculation on based on Taro Yamane formula for sample size calculation (4) n= N/ (1+N (e) 2) n=3611+361 (.05)2=189 To get manageable sample size of 190 the sample size was increased by 1% from 189 to 190 participants.

For qualitative data, an in-depth interview was conducted by cluster sampling of 30 health sector key informants including The District Medical Officer (DMO); District Reproductive Health Coordinator (DRCHco), District Community Based Health Services Coordinator (CBHSco) and HCWs from dispensaries 20 key informants from the community local government persons, cultural are religious leaders were selected for the in-dept interview to explore a deep understanding of perceptions towards CHWs’ roles, challenges and preparedness during pandemics.

Systematic random sampling was used in the study where a list of district in the Simiyu region was considered and the Itilima district was selected. A list of CHWs in the district was obtained from district CHWs coordinators. Then CHWs were followed in their respective villages conveniently until a sample of 190 CHWs was reached.

Health sector key informants working at the district level including; DMO, DRHCco, DCBHPco were selected purposely and followed in their respective officers. Health Care Workers working in dispensaries who are also supervisors of CHWs were selected conveniently in villages where CHWs selected for quantitative interviews were selected. This was done until a total number of 30 HCWs was reached. The local leaders were also selected in the same was just as the HCWs they were selected in the same fusion until a total number of 20 leaders was reached.

For the quantitative part data was collected through interviews using a standardized questionnaire. The researcher adopted some of the questions from Desalegn et al (2020) study on the Evaluation of COVID-19 related knowledge and preparedness in health professionals at selected health facilities in a resource-limited setting in Addis Ababa, Ethiopia. Some questions were added to suit the study objectives (5). The questionnaire was developed in English Language, it will then be translated into Swahili and translated back into English for crosschecking the correctness of the translation. Questionnaire were then entered into Open Data Kit (ODK) ready for administration using tables. Since most CHWs are Swahili speakers, the questionnaire was administered in the Swahili Language.

The qualitative research methodology was used in the Assessment of involvement of CHWs in community activities that aid in the prevention of COVID-19 and knowledge on adherence to COVID-19 response protocol. Key informant interview or open in-depth methods was used, the participants were informed about the interview a day before about the venue and time. Voice recorders were used during the interview and the participants were informed about that.

The researcher worked work with 8 research assistants for data collection: Research assistants had one-day training before going to the field on 17.07.2022. Before data collection, there was a pilot study conducted in a nearby Maswa DC where a similar CHWs interventions in being implemented to check if questions on the tool ware accurate. The pilot study involved 10% of the sample size. During the pilot of the tool, research assistants documented all issues what would be raised for correction. The next day, researcher sat with research assistants for fine-tuning the tool ready for data collection.

In a qualitative study, data was collected through interviews (IDIs) guided by an interview guide. The study participants were health staff and community leaders’ representatives. Notes were also taken as a backup recording. In-depth, interviews were conducted until the saturation point was reached which was the point at which there was no newer emerging information arising. The interview guide with main and probe questions helped to direct the interview with all the key informants. In addition, the socio-demographic information of the study participants was collected using a special form. Each interview lasted for 30-60 minutes depending on the emerging new information.

Kiswahili language was used during the interview since it is a common language to most individuals in Tanzania and was translated to English language and back-translated to Kiswahili for consistency. Data were collected by two individuals with experience in conducting IDIs Quantitative data were collected using ODK Collect and analyzed using STATA version 13. Results were summarized using mean with standard deviation data were tabulated and the frequencies and percentages computed and Logistic regression test was used to test association between categorical variables between dependent variables. Knowledge was categorized into two groups i.e. adequate and inadequate from the Likert-scale using “Interval formulation” (1), then from two groups points were calculated out of eighteen knowledge questions each with one point. Each question carries 1 point, so respondents who score greater than nine points were categorized as had adequate knowledge and vice versa (2). For preparedness, out of thirteen questions which carries 1 point each. Respondents who score greater or equal to seven points were categorized to be adequate prepared and vice versa.

Digitally recorded data transferred from digital recorders into the computer where it was then transcribed verbatim (word for word). Data was manually analyzed. Thematic content analysis was used to categorize emerging themes after every interview. To enhance data analysis, Emerging themes were re-analyzed by two people with experience in qualitative research to ensure investigator triangulation for systematic comparison of identified themes and to avoid investigator bias. The following themes emerged namely; Training of COVID-19 and other infectious diseases, roles of CHWs in COVID-19 preparedness to COVID-19, Performance of COVID-19 activates in the community, and challenges faced during COVID-19 response. As highlighted in the data collection section, Swahili language was used during the interviews, so all interviews were transcribed and translated into the English language for thematic content analysis.

Study finding show that more than half of CHWs in Itilima district council have knowledge about COVID-19 and they are prepared to take up roles to respond to COVID-19. Finding showed no association between knowledge and preparedness with demographic characteristics. Factors related to this include training, provision of PPE, and incentivizing CHWs. Finding identified roles played by CHWs during COVID-19 include identifying cases from communities and linking them with health facilities, providing awareness, performing surveillance-related activities, provision of PPEs to important public places and collecting and reporting COVID-19 community-based data and reporting to the nearby health facility every month.

Though Itilima in rural district, Local government authority in collaboration with No-government actors ensured that CHWS are trained on the pandemic, they are equipped with PPEs and are getting relevant support in terms of supervisors. This could have contributed to their high level of knowledge on the subject matter as well as their sense of preparedness to take up roles in the fight against the scourge. However, this was not done to the full expectations of CHWs as the study found out that CHWs were not timely and sufficiently incentivized. They pointed out that sometimes they would run out of PPEs and hostility was mentioned in a few household visits.