Research - International Journal of Medical Research & Health Sciences ( 2021) Volume 10, Issue 5
Utilization Patterns and Counseling Practices of Alcohol-Based Hand Sanitizers during COVID-19 Pandemic in Bench Sheko Zone, Southwest EthiopiaDesalegn Feyissa1*, Fikadu Ejeta1, Tadesse Shelema4, Yitagesu Mamo1, Gizachew Ayele2, Dessalegn Mulata2, Abyot Asres3 and Andualem Henok3
2Department of Pharmacy, College of Health Science, Mettu University, Mettu, Ethiopia
3Department of Medical laboratory science, College of Medicine and Health science, Mizan-Tepi University, Mizan-Aman, Ethiopia
4Department of Medical laboratory science, College of Medicine and Health science, Mizan-Tepi University, Mizan-Aman, Ethiopia
Desalegn Feyissa, School of Pharmacy, College of Medicine and Health science, Mizan-Tepi University, Mizan-Aman, Ethiopia, Tel: +1 89568 62358, Email: firstname.lastname@example.org
Received: 21-Apr-2021 Accepted Date: May 18, 2021 ; Published: 25-May-2021, DOI: 0
Background: Coronaviruses infections are emerging respiratory viruses and are known to cause illnesses ranging from the common cold to severe acute respiratory syndrome. The most important ways to prevent the transmission of COVID-19 and other infectious diseases are frequent handwashing with soap, water and also applying alcohol-based hand sanitizers. Objective: To assess the utilization pattern and counseling practices of alcohol-based hand sanitizers during the COVID-19 pandemic in Bench-Sheko zone, Southwest Ethiopia from April 28 to June 05, 2020. Method: Community-based cross-sectional study was conducted to assess the utilization pattern and counseling practices of alcohol-based hand sanitizers during the COVID-19 pandemic in the Bench-Sheko zone, Southwest Ethiopia from April 28 to June 05, 2020. Data related to the utilization of alcohol-based hand sanitizer were collected from the selected household using the multistage sampling technique, whereas data related to counseling practices were collected from pharmacy personnel who have been working in the drug retail outlets found in the study setting. Data were entered into Epi data version 4.0.2 and then exported to statistical software package version 24.0 for data analysis. To identify the significant predictors of alcohol-based hand sanitizer utilization practice, binary and multivariable logistic regressions were carried out. Crude odds ratio and adjusted odds ratio with 95% confidence interval were calculated to determine the predictors. Result: From a total of 806 sampled populations, 784 (97.02%) of the study population responded to the questionnaire. The mean age of the study population was (34.27 ± 11.47) years. Male participants represented 53.8% of study participants. The majority (80.7%) of study participants had handwashing material for the prevention of COVID-19. Out of 784 study participants, 226 (28.8%) of them utilized alcohol-based hand sanitizer, whereas three fourth of them were non-alcohol-based hand sanitizer utilizer. Out of 29 pharmacy personnel, only 18 (62.1%) of them counseled their client during dispensing of alcohol-based hand sanitizers. Low-income status (AOR=2.71, CI; 1.18-6.19), single marital status (AOR=15.47, CI; 1.96-12.19), Lack of formal education (AOR=11.67, CI; 4.97-9.10), farmer (AOR=2.31, CI; 2.12-3.45) were significantly associated with non-utilization of alcohol-based hand sanitizer for the prevention COVID-19. Conclusion and recommendations: The utilization of alcohol-based hand sanitizer in the study area was low. About one-third of pharmacy personnel did not counsel their client during dispensing of alcohol-based hand sanitizer. Therefore, the training should be provided on rational use and dispensing of Alcohol-Based Hand Sanitizer (ABHS) for the community and pharmacy personnel respectively
Alcohol-based hand sanitizer, Counseling practice, Utilization pattern, Ethiopia
ARD: Acute Respiratory Disease, ABHS: Alcohol-Based Hand Sanitizer, COVID: Corona Virus Disease, MTU: Mizan-Tepi University, NAFDAC: National Agency for Food and Drugs Administration and Control, SARS: Severe Acute Respiratory Syndrome, WHO: World Health Organization
Hospital and community-acquired infections are escalating and pose a serious public health problem worldwide . Hands are considered to be the primary route for transmitting COVID-19 and other infections to individuals . Hand hygiene is important to prevent many communicable diseases. The importance of hygiene is universally recognized and evidence-based. It is well known that hand hygiene is crucial to prevent and minimize healthcare-associated infections .
In early December 2019, a series of pneumonia cases with unknown reasons emerged in Wuhan, Hubei, China. High throughput sequencing from lower respiratory tract samples has revealed a novel coronavirus that was named 2019 novel Coronavirus (2019-nCoV) and also named SARS-CoV-2. This newly emerging coronavirus causes fatal Acute Respiratory Disease (ARD) resembling that of SARS-CoV [4,5].
The Centre for Disease Control and Prevention, the World Health Organization, and many other health experts promote hand hygiene as the most important measure in the prevention of COVID-19. Several studies have shown the importance of proper hand hygiene in reducing the incidence of nosocomial infections [6-10].
Alcohol-based hand sanitizers are commonly used and most of them contain between 60% and 85% alcohol . However, the effectiveness of these sanitizers depends on the concentration of alcohol and the time of rubbing the sanitizer on hand. For instance, rubbing alcohol-based sanitizers for 25 seconds-30 seconds was reported to kill 99.99% of microorganisms on the hand. Sanitizers with at least 70% alcohol are suggested to kill 99.9% of the microorganisms on hands too .
Scientific studies have shown that after hand washing, as many as 80% of individuals retain some pathogenic bacteria on their hands. Hand washing removes the body’s fatty acids from the skin, which may result in cracked skin that provides an entry portal for pathogens [13,14].
To overcome the limitations of plain hand washing, hand sanitizers introduced claiming to be effective against those pathogenic microorganisms as well as to improve skin condition due to the addition of emollients in it .
Hand sanitizers also effective in reducing gastrointestinal illnesses in households, Respiratory tract infections, and skin infections [6,16,17]. Furthermore, to reduce infections in healthcare settings, alcohol-based hand sanitizers are recommended as a component of hand hygiene.
Currently, since COVID-19 disease is a serious global concern, including our community, the utilization pattern of alcohol-based hand sanitizer, counseling practice of pharmacy personnel on alcohol-based hand sanitizers should be immediately evaluated to prevent the transmission of COVID-19 pandemic.
Up to our knowledge, there were no studies conducted in Ethiopia related to the utilization of alcohol-based hand sanitizers. Therefore, this study aimed to assess the utilization patterns and counseling practice of alcohol-based hand sanitizers in the Bench-Sheko zone, Southwest Ethiopia.
Study Period and Study Area
This study was conducted in Bench-Sheko Zone, Southwest Ethiopia from April 28 to June 05/2020. Bench-Sheko zone is one of the zones in Southern nation nationality and people region. Mizan-Aman is the capital city of the Zone. It is 583 kilometers from Addis Ababa in a Southwest direction. In the Bench-Sheko zone, there is one Hospital called Mizan-Tepi University teaching hospital, 26 health centers, and 133 health posts. There are also 99 and 21 Primary and Medium clinics respectively.
Community-based cross-sectional study.
All households and pharmacy personnel of drug retail outlets found in the Bench-Sheko zone were a source of population. Whereas, all household head selected from selected Kebele of each woreda of Bench-Sheko and all pharmacy personnel in drug retail outlet that fulfill eligibility criteria were the study population.
Inclusion and Exclusion Criteria
Adults age greater than or equal to 18 years, permanent residents for greater than 6 months, and all pharmacy personnel working in drug retail outlets were included in the study whereas, participants who were not willing to participate were excluded from the study.
Sample Size Determination and Sampling Technique
The sample size was determined based on single population proportion formula: n=[(Zα/2)2p(1-p)]/d2 with the assumption of 95% confidence interval (Zα/2=1.96), marginal error (d) of 5%, P=50% and design effect=2. After a 5% non-response rate was added, the required total sample size was 806. All pharmacy personnel in the drug retail outlet in Bench-Sheko were included. For utilization of alcohol-based hand sanitizer, a multi-stage sampling technique was used to select sample households that represent the entire zone. The first household was selected by the lottery method. An in-depth interview and simulation method was used for the assessment of counseling practice of pharmacy personnel regarding alcohol-based hand sanitizer.
The outcome variables were utilization of alcohol-based sanitizers and the counseling practice of pharmacy personnel on alcohol-based hand sanitizer, whereas independent variables included sex, age, marital status, ethnicity, religion, income, educational status, occupational status, source of information, Presence of health professional in the household, hand washing material, counseling time, availability, and affordability of alcohol-based hand sanitizer.
Data Collection Instrument and Procedure
The data collection tool was developed after reviewing relevant literature. Data were collected prospectively from selected households. The questionnaires contain 3 parts Part I: background data, Part II: Counseling related questions, and Part III: Utilization related questions. The sample size was proportionally divided into all woreda and kebele based on population size. The study households were taken from every six woreda and two town administrations based on the number of household size. The 33% of kebele were selected from each woreda randomly and households randomly were selected from the selected kebele. Accordingly, the sample size was proportionated for six woreda and two town administrations of Bench-Sheko’s zone based on their population size (Figure 1).
Data Quality Assurance and Management
Data qualities were assured by careful selection and collection of complete and appropriate data. The clarity and completeness checkup of data collection formats were undertaken before the actual data collection. Data clearing to be done every day, formats with insufficient information were excluded from the study to avoid an error. Then, the collected data were processed and retained cautiously in line with its objective. A 5% sample pretest was performed on randomly selected respondents before the beginning of the study.
Data Processing and Analysis
The data on the questionnaire were entered into Epidata manager version 4.0.2 and double-entry verification was made then data were exported to SPSS version 24 statistical packages for analysis. The data were explored to check outliers, missing data, and assumptions. During analysis frequencies and percentages were used to describe categorical variables while means and standard deviations were used to describe continuous variables. All statistical procedures were performed using Statistical Package for Social Sciences (SPSS) version 21.0 software.
Counseling practice: If pharmacy personnel adhere to World Health Organization (WHO) standard counseling guidelines and counsel the client during the study period.
The ethical clearance was obtained from Mizan-Tepi University research ethical review board. The Bench-Sheko zone administration office was informed about the purpose of the study to get cooperation. The confidentiality of the respondents’ was secured. Informed consent was obtained from the respondents before conducting the study.
Socio-Demographic Characteristic of Study Participants
From a total of 806 sampled populations, 784 (97.02%) of the study population responded to the questionnaires. The mean age of the study population was (34.27 ± 11.47) years. Among 784 participants, 422 (53.8%) were male, 560 (71.4%) were married, 353 (45%) were orthodox and 379 (48.3) were a farmer. Nearly one-third (32.4%) of the study participants had an average household income range of (500-1499). One hundred twenty-nine (16.5%) of the participants had health care professionals in their homes (Table 1).
Table 1: Socio-demographic characteristics of study participants in Bench-Sheko Zone, Southwest Ethiopia, 2020
|Age (years)||18-24||131 (16.7)|
|≥ 65||14 (1.8)|
|Mean ± SD||34.27 ± 11.47|
|Marital status||Married||560 (71.4)|
|Educational status||Illiterate||146 (18.6)|
|Primary school||326 (41.6)|
|Secondary school||151 (19.3)|
|Occupational status||Farmer||379 (48.3)|
|Daily labor||89 (11.4)|
|Average monthly income of household (ETB)||500-1499||254 (32.4)|
|Presence of health professional in household||Yes||129 (16.5)|
*: Oromo, Gurage, Woliata, Silte
COVID-19 Related Information of Study Participants
From a total of 784 study participants, 772 (98.5%) had COVID-19 information. The majority (80.7%) of study participants had handwashing material for the prevention of COVID-19. The highest family’s educational level of onethird of study participants was a secondary school (Table 2). Two hundred twenty-five (28.7%) and 146 (18.6%) had got information of COVID-19 from health workers and Mass media respectively (Figure 2).
Table 2: COVID-19 related information of study participants in Bench-Sheko zone, Southwest Ethiopia, 2020
|COVID -19 information||Yes||772 (98.5)|
|Source of information||Health worker||225 (28.7)|
|Mass media||146 (18.6)|
|Health worker+ Mass media||110 (14)|
|All (HW+MM+SM+FF)||98 (12.5)|
|Family and friends||88 (11.2)|
|Social media||77 (9.8)|
|Health worker+Family friends||28 (3.6)|
|Highest educational level||No formal education||63 (8)|
|Primary education||256 (32.7)|
|Accessibility of handwashing material||Yes||633 (80.7)|
Utilization of Alcohol-Based Hand Sanitizer Related Information
From a total of 784 study participants, 226 (28.8%) utilized alcohol-based hand sanitizers (Figure 3). Five hundred fifty-eight (71.2%) of the community did not utilize ABHS for the prevention of COVID-19 (Figure 3). The major reasons for the majority of study participants did not utilize alcohol-based hand sanitizer were 257 (46.1%) non-accessibility and 160 (28.7%) unaffordability of Alcohol-based hand sanitizer. One hundred forty (61.9%) alcohol-based hand sanitizer users obtained ABHS from drug retail outlets (Figure 4). The majority of ABHS users (77.9%) utilized ABHS when they contact any material. From 226 (28.8%) ABHS users, 207 (91.6%) of them knew at least one precaution of ABHS. Half of the study participants knew the type of precaution of ABHS as keep away out of reach of children. Nearly two-thirds (69.1%) of study participants applied ABHS for less than 20 seconds at a time (Table 3).
Table 3: Utilization of ABHS in Bench-Sheko, Southwest Ethiopia, 2020
|Frequency of ABHS||Once-daily||12 (5.3)|
|Twice daily||23 (10.2)|
|Three-time daily||21 (9.3)|
|Reason for not used ABHS||I cannot afford||160 (28.7)|
|It is not accessible||257 (46.1)|
|I have no information about ABHS||63 (11.3)|
|I do not think it is effective||78 (13.9)|
|When you used ABHS||When I contact any material||176 (77.9)|
|During transportation||39 (17.3)|
|Route of administration||Topical||225 (99.6)|
|Site of application||Hand only||177 (78.3)|
|Hand and face||49 (21.7)|
|Knowing Precaution of ABHS||Yes||207 (91.6)|
|Type precaution identified||Keep away out of reach of children||106 (51.2)|
|For external use only||72 (34.8)|
|Keep away from the flammable object||29 (14)|
|Amount used at a time||<15 ml (half palm)||204 (90.3)|
|>15 (full palm)||22 (9.7)|
|Duration of use at a time(s)||<20||156 (69.1)|
*: during shopping, going to the religious area and for all listed above
Socio-demographic Characteristics and Counseling Practice of Pharmacy Personnel
Out of 29 pharmacy personnel, 16 (55.2%) were male. Seventeen (58.3%) of them were in the age category of 18-34 and 20 (69.0%) of them were married. Twenty-five (86.2%) of them had a diploma (Table 4). Out of the total of 29 respondents, only 18 (62.1%) of them counseled their client during dispensing. Of 18 (62.1%) pharmacy personnel who counsel their client, all of them counsel the client through verbal communication. The major reason for giving only verbal communication was being too busy, 9 (50%) and followed by the expectation of consumers has already got verbal information 5 (27.8%) (Table 5).
Table 4: Socio-demographic characteristics of pharmacy personnel in Bench-shako, Zone South West Ethiopia (N=29), 2020
|Age category||18-24||17 (58.6)|
|Marital status||Married||20 (69)|
|Educational level||Diploma||25 (86.2)|
Table 5: Pharmacy personnel response towards client counseling in Bench-Sheko, Zone South West Ethiopia (N=29), 2020
|Do you counsel your client when they buy ABHS?||Yes||18 (62.1)|
|Which counseling methods do you prefer most of the time?||Verbal||18 (100)|
|If you give verbal information only, what is your reason (s) for not providing written information?||The pharmacy is too busy||9 (50)|
|The consumer has already got verbal information||5 (27.8)|
|The consumer is not interested||2 (11.1)|
|What is the average length of time (in minutes) spent in providing verbal information (minutes)||2||5 (27.8)|
|Do you explain the purpose/importance of counseling to the client?||Yes||10 (55.6)|
|Do you emphasize the benefits of the ABHS if they are taken correctly?||Yes||5 (27.8)|
|Do you listen to your client carefully and respond with appropriate empathy?||Yes||18 (100)|
|Do you ask the client if they have any concerns or questions?||Yes||4 (22.2)|
|Do you ask whether the client has time to discuss the medicine with you?||Yes||5 (27.8)|
|common drug-drug interaction||Yes||2 (11.1)|
|Inform/counsel on major side effects||Yes||2 (11.1)|
|Counsel means/ways of administration (how to administered)||Yes||11 (61.1)|
|Storage place||Yes||6 (33.3)|
|Check client understanding by asking to repeat back||Yes||3 (16.7)|
|Is there any presence counseling area?||No||29 (100)|
Factor Affecting Alcohol-Based Hand Sanitizer Utilization
Low-income status (AOR=2.71, CI; 1.18-6.19), single marital status (AOR=15.47, CI; 1.96-12.19), Lack of formal education (AOR=11.67, CI; 4.97-9.10), farmer (AOR=2.31, CI; 2.12-3.45) were significantly associated with nonutilization of alcohol-based hand sanitizer for the prevention COVID-19 (Table 6).
Table 6: Bivariate and Multivariate logistic regression analysis result of factors associated with Utilization pattern of alcohol-based hand sanitizer during COVID-19 in Bench-Sheko zone, 2020
|Variables||Category||ABHS utilization||COR (95% CI)||AOR (95% CI)||p-value|
|Yes (n=226)||No (n=558)|
|Income||500-1499||168 (66.1%)||86 (33.9%)||2.88 (1.79-4.62)||2.71 (1.18-6.19)||0.018*|
|1500-2499||55 (23.2%)||182 (76.8%)||1.70 (1.08-2.66)||0.34 (0.17-0.69)||0.92|
|2500-3499||12 (10.4%)||103 (89.6%)||7.44 (3.71-15.06)||0.67 (1.29-1.92)||0.36|
|3500-4499||19 (30.6%)||43 (69.4%)||1.97 (1.02-3.78)||0.55 (0.28-0.98)||0.08|
|≥ 4500||54 (33.4%)||62 (82.6%)||1||1|
|Marital status||Divorced/ separated||0 (0%)||21 (100%)||2.59 (0.34-0.91)||3.51 (0.23-0.94)||0.99|
|Widow||1 (3.4%)||28 (96.6%)||0.67 (0.42-0.86)||1.02 (1.63-2.53)||0.93|
|Single||68 (39.1%)||106 (60.9%)||10.90 (1.40-8.08)||15.47 (1.96-12.19)||0.009*|
|Married||157 (28%)||403 (72%||1||1|
|Educational status||No formal education||11 (7.5%)||135 (92.5%)||19.59 (9.81-29.13)||11.67 (4.97-9.10)||0.0001*|
|Primary school||65 (19.9%)||261 (80.1%)||6.41 (4.22-9.79)||5.11 (2.8-27.1)||0.067|
|Secondary School||51 (33.8%)||100 (66.2%)||3.10 (1.97-4.97)||2.58 (1.40-4.73)||0.078|
|University/college||99 (61.5%)||62 (38.5%)||1||1|
|Occupational status||Farmer||52 (13.7)||327 (86.3)||11.00 (6.94-17.49)||2.31 (2.12-3.45||0.013*|
|Merchant||36 (32.4%)||75 (67.6%)||2.14 (1.23-3.70)||0.16 (0.04-0.68)||0.87|
|Daily labor||40 (44.9%)||49 (55.1%)||3.64 (2.14-6.21)||0.18 (0.07-0.79)||0.09|
|Student||11 (22.4%)||38 (34.9%)||12.25 (3.47-4.37)||0.91 (0.19-4.51)||0.91|
|Employed||84 (63.6%)||48 (36.4%)||1||1|
*: Statistically significant p-value
Ethanol-based topical antiseptic hand rubs, commonly referred to as Alcohol-Based Hand Sanitizers (ABHS), are routinely used as the standard of care to reduce the presence of viable bacteria on the skin and are an important element of infection control procedures in the healthcare industry .
In this finding, 772 (98.5%) of study participants had COVID-19 information. The most source of their COVID-19 information was 225 (28.7%) health workers and 146 (18.6%) mass media. This might be due to global concern and the federal ministry of health give due attention in providing information of COVID-19 to the community through health extension worker and other health providers.
The use of hand sanitizers now in the community has particularly gained popularity in the world including Ethiopia since the emergence of Covid-19. This has led to the development, production, and importation of several hand sanitizers by various companies with the aim of commercialization as well as supporting the health care system and community in preventing transmission of disease specially COVID-19 [7,19].
The prevalence of alcohol-based hand sanitizer utilization in the study area was 28.8% and more than two-thirds of the participants did not utilize alcohol-based hand sanitizers. The result of this finding showed that about three-fourth of ABHS users utilized ABHS in PRN bases and used these sanitizers when they contact any materials. This should be promoted since it is a key element to prevent the spread of COVID-19 and other infectious diseases by ensuring proper hand hygiene.
In this finding, about 61.9% of alcohol-based hand sanitizer users obtained it from the drug retail outlets and most all the study participants apply ABHS topically. This is in line with the finding reported by Maier, et al. . The majority of the study participants (78.3%) applied ABHS only on their hands and about 91.6% of them knew at least one precaution of ABHS and nearly two-thirds (69.1%) of study participants rubbed ABHS on their hands for less than 20 seconds at a time. This showed that the participants did not apply alcohol-based hand sanitizer appropriately. Because rubbing alcohol-based sanitizers for 25 seconds-30 seconds was reported to kill 99.99% of microorganisms on hand .
The result of this study showed about (62.1%) of pharmacy personnel counsel their client during dispensing of Alcohol- based hand sanitizers through verbal communication. The major reasons for giving only verbal communication were pharmacy personnel’s was too busy, 9 (50%).
Multiple logistic regression analysis of this finding showed that low-income status was significantly associated with non-utilization of ABHS for prevention of COVID-19. A study was done in Addis Ababa also showed that many peoples engaged in selling different ABHS in the streets of the city due to the relatively cheaper price than products obtained from legal sources . This might due to the perception of these people as the alcohol-based hand sanitizer is so expensive and they cannot afford it with their current income.
Lack of formal education was significantly associated with the non-utilization of ABHS. The possible justification might be formal education provide basic infectious disease concept, mode of transmission and its prevention. Similarly, in this finding, being single in marital status was significantly associated with non-utilization of ABHS. In this study, being a farmer was significantly associated with the non-utilization of ABHS. This might be due to the majority of the participants were non-accessible to the alcohol-based hand sanitizer since they have been lived in rural which is far from the town.
The utilization of alcohol-based hand sanitizer in the study area was low. The major reasons for the non-utilization of alcohol-based hand sanitizers were the non-accessibility and unaffordability of alcohol-based hand sanitizers. Twothird of pharmacy personnel counsel their client during dispensing of Alcohol-based hand sanitizer. Being single marital status, low-income status, lack of formal education, and being a farmer was significantly associated with nonutilization of alcohol-based hand sanitizer. Therefore, Mizan-Tepi University and other stakeholders have to provide training on the rational use and dispensing of ABHS for the community and pharmacy personnel respectively.
Conflicts of Interest
The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
We would like to express our deep appreciation and gratitude to the Mizan-Tepi University research and community service directorate and college of health science for funding, facilitating, and arranging necessary activities to conduct this research project.
All authors made substantial contributions to conception and design, acquisition of data, analysis, and interpretation of data, took part in revising the article; gave final approval of the version to be published, and agreed to be accountable for all parts of the work.
Mizan-Tepi University had funded this paper. However, the finder has no role in study design, method, data collection, and analysisrs.
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