Introduction

Emerging infectious illnesses caused by zoonoses remain a serious worldwide health problem, especially in less developed nations.¹ The pandemic of Coronavirus disease (COVID-19) caused by SARS-CoV-2 is brought on by the SARS-CoV-2 coronavirus has been classified as a zoonotic disease.² COVID-19 was first discovered in Wuhan, China, in December 2019, it was quickly distributed, and the COVID-19 outbreak was declared a pandemic on March 12, 2020.³

Most COVID-19 virus-infected individuals will experience a mild to severe respiratory infection and recover without the need for special care. Serious illnesses are more likely to emerge in older people and those with underlying medical conditions such as cardiovascular disease, diabetes, chronic respiratory disease, and cancer.⁴ Furthermore, a psychosocial crisis could result from the COVID-19 outbreak and infodemic quarantine.^5-7

Environmental pollution and rising human population density are the main causes of emerging illnesses.⁸ According to a study, incarcerated people had higher rates of infectious diseases like HIV, HCV, HBV, and tuberculosis than the general community.⁹ The incarcerated people in prisons are more prone to higher chances of COVID-19 infection because of their restricted mobility and almost inescapable interaction.¹⁰ Furthermore, they may be older, with severely less mobility/autonomy, and more likely to suffer from a chronic condition, making them more vulnerable to severe COVID.¹¹ SARS-CoV-2 can be detected in the air 3 hours after aerosolization, according to research to date.¹² Prison and detention centers are mostly indoor facilities in which maximum air exchange has happened. Accordingly, aerosolized spread is a common transmission pathway in carceral settings.¹³

Pathogenic infections are not well controlled in prisons.¹⁴ As part of the larger public health response to the COVID-19 pandemic, it is important to take into account that the population housed in prison and detention institutions is more susceptible to infections than the general population.¹⁵ Prison officials and incarcerated people who live in cramped quarters are required to share everything (air, water, kitchen), which exposes them to the same infections. People who live in prison are housed close to one another, which raises the possibility of infections like the COVID-19 outbreak spreading from person to person and by droplets.¹⁶

The World Health Organization’s recommended Efforts to control COVID-19 in the community are likely to fail if strong infection prevention and control (IPC) measures, adequate testing, treatment, and care are not carried out in prisons and other places of detention as well.¹⁷ The New Strategic Protocol of Prevention methods was a screening of the entire population (prisoners and workers) inside the prison and the reduction in overcrowding in prisons,¹⁸ and only a few studies concerned the prevention of COVID-19 infection through vaccination and the implementation of quarantine.^18,19 Moreover, attention needs to be paid specifically to the relationship between the jail and the community it serves, including visitors, incarcerated people, and the high staff turnover rate.²⁰

Despite the significant risk of COVID-19, no study has examined the knowledge of and preventive measures taken by staff members of prisons and detention facilities, particularly in Ethiopia. The employees in prisons and detention facilities in southwest Ethiopia were the subject of this study, which sought to evaluate their awareness of and practices for prevention against the COVID-19 epidemic. So the objective of this study was to assess the awareness of COVID-19 prevention strategies among prison and detention center staff in the Bench-Sheko Zone, south-west Ethiopia

Methods and Materials

Sampling size and sampling techniques

The single population proportion formula was used to calculate the sample size. Because there hasn’t been any research on the knowledge and preventive measures of correctional facility staff in Africa, including Ethiopia, we used 50% as the sample size.

Where: n = sample size

Z = Reliability coefficient with 95% confidence level = 1.96

P = Population variance available from previous data (q = 1-p)

d = Degree of precision or margin of error = 0.05

We had to consider the correction formula, nf = n/1+n/N, because the average staff size in prisons and detention facilities was 460, which is less than 10 000. As a result, the final sample size was changed to 209. Simple random sampling was used to choose locations for all prisons and 13% of detention facilities. Lastly, the study subjects were chosen using stratified systematic random selection approaches.

Results

Socio-demographic characteristics

The study was completed by 195 of the 209 employees, for a response rate of 93.3%. More than three-fourths (76.4%) and 46 (23.6%) of the participants came from urban and rural settings, respectively. The mean age was 35 ± 8 years. Eighty-four (43.1%) and 50 (25.6%) of the participants were Orthodox by religion and Kaffa by ethnicity, respectively (Table 1).

Table 1.

Socio-demographic characteristics of staff of prison and detention center in Bench-Sheko zone, Southwest Ethiopia (N = 195).

Knowledge and practice toward COVID-19

This study evaluated the correctional facility staff’s knowledge of the most recent coronavirus (COVID-19). Almost all (99%) had heard of the new coronavirus. Approximately 39% of respondents cite television as their primary information source (Figure 1). One hundred eighty-five (94.9%) specified at least one method of novel coronavirus transmission (COVID-19). One hundred twenty-four (63.6%) stated physical distance as a preventative measure (Table 2). Nearly one-fourths (23.3%) of the respondents indicated fever as a clinical symptom, followed by 17.2% dry cough and 17% trouble breathing (Figure 2). One hundred fifty-seven (80.5) of the participants regularly washed their hands to prevent the coronavirus, and 118 (60.5) avoided shaking their hands (Table 3). The percentages of prison and jail staff who had a good understanding of and practices to avoid the COVID-19 pandemic were 41.5% (95% CI: 34.4-48.3) and 39.5% (95% CI: 32.8-46.2), respectively (Figure 3).

Figure 1.

Main sources of information about the COVID-19 pandemic among the staff of prison and detention center in Bench-Sheko zone, Southwest Ethiopia (N = 195).

Table 2.

knowledge of the COVID-19 pandemic among Staff of prison and detention center in Bench-Sheko zone, Southwest Ethiopia (N = 195).

Figure 2.

Knowledge on main clinical manifestation of the COVID-19 pandemic among the staff of prison and detention in Southwest Ethiopia (N = 195).

Table 3.

Preventive practice toward COVID-19 pandemic Among Staff of prison and detention center in Bench-Sheko zone, Southwest Ethiopia (N = 195).

Figure 3.

Prevalence of knowledge and preventive practice toward COVID-19 Pandemic among the staff of prison and detention center in Bench-Sheko zone, Southwest Ethiopia (N = 195).

Factors associated with poor knowledge and practice

The levels of knowledge and practice toward COVID-19 were 41.5% and 39.5% respectively. Working in detention [AOR: 4.7, 95% CI: 2.1-10.5)] was also a risk factor for poor knowledge, and among the population working in detention, rural residence [AOR: 5.6, 95% CI: 2.2-14.3)], and lower educational level [AOR: 9.4, 95% CI: 3.3-26.9)] were additional risk factors for poor knowledge (Table 4). Furthermore, for people working in detention, lower education levels [AOR: 4.3, 95% CI: 1.3-14)], poor knowledge [AOR: 3.3, 95% CI: 1.6-6.8)], and poor attitude [AOR: 9.1, 95% CI: 1.9-43.7)], were associated with poor preventive practice (Table 5).

Table 4.

Factors associated with knowledge of the COVID-19 pandemic among the staff of prison and detention center in Bench-Sheko zone, Southwest Ethiopia (N = 195).

Table 5.

Factors associated with prevention practice of COVID-19 among staffs of prison and detention center in Bench-Sheko zone, Southwest Ethiopia (N = 195).

Discussion

With the higher levels of risk factors for infection (like overcrowding, and poor sanitation), poor ventilation, and limited access to healthcare services compared to the general population, people in prisons and detention institutions are more vulnerable to communicable diseases. People living in prison in those facilities are housed close to one another, which raises the possibility of diseases like COVID-19 spreading from person to person and via droplets. The correctional facility staff of prisons and detention facilities in southwest Ethiopia were evaluated for their knowledge and practice habits.

In our survey, 41.5% of personnel employed by prisons and correctional facilities reported having a strong understanding of the COVID-19 pandemic. Even though this percentage of the study population has a strong understanding, the majority of people do not feel responsible for protecting this highly vulnerable population. Only 16.4% of the participants had a degree or above; as a result, the low percentage of participants with higher education levels may have contributed to the prevalence of inadequate knowledge in our study. This outcome was lower than that of other studies carried out in China and 3 Arab nations (Jordan, Saudi Arabia, and Kuwait), which had good knowledge of 72% and 90%, respectively.^21,22 It might be related to disparities in education, income, and access to medical services.

The results demonstrate that 60.5% (95% CI: 52.5%-68.2%) of personnel employed by prisons and correctional facilities had subpar practices for putting COVID-19 preventive measures into action. Other studies carried out in China and India indicated 5% and 4.5%, respectively, which puts this outcome considerably behind those results.^22,23 This may be brought on by variations in the pandemic’s perceived severity, death rate, and media exposure. Additionally, it might result from variations in how easily accessible personal protective equipment is.

When compared to prison employees, detention staff were found to be 4.2 times more likely to have inadequate knowledge of COVID-19. American reports backed up this conclusion.²⁴ It can be because detention centers lack health facilities, they use resources inefficiently, the government doesn’t put much emphasis on them, or information is more difficult to acquire there than in prisons.

Based on their place of residence, respondents with low understanding were 4.2 times more likely to be from rural areas than urban ones. An Ethiopian investigation that was undertaken backs up this conclusion.²⁵ It might be brought on by disparities in socio-demographics, lifestyle, and access to and use of social media. Additionally, this study showed that employees with lower educational backgrounds were 14.6 times more likely to have a weak understanding than employees with higher educational backgrounds. High education level was a significant predictor of increased understanding of COVID-19 in a study conducted in 3 Arab nations (Jordan, Saudi Arabia, and Kuwait), and among Chinese residents, which was consistent with this study.^21,26 It might be related to accessibility and exposure to both domestic and foreign mass media. It can also be a result of variations among study participants.

The main determining criteria for using effective COVID-19 prevention methods were the respondents’ educational level, knowledge, and attitude toward COVID-19. Staff members working in prisons and detention facilities who can only read and write were 4.3 times more likely to practice COVID-19 preventive measures improperly than staff members with higher educational status. An Iranian study that found that the respondent’s level of education influences how effectively COVID-19 preventive measures are used supports this study.²⁷ It indicated that educational level plays a pivotal role in the prevention of communicable diseases such as COVID-19.

According to this study, personnel employed by prisons and correctional facilities who had low understanding were 3.3 times less likely to apply COVID-19 preventive actions than those who had excellent knowledge. When it came to acceptable practices for COVID-19 prevention, jail and prison staff that had negative views were 9.1 times more at risk than those who had favorable attitudes. This result was in line with research conducted in China and Jordan, which showed that respondents with a favorable attitude toward COVID-19 prevention behaviors also exhibit good prevention practices.^22,23

Conclusion and recommendation

According to the results of the current study, the majority of the prison and detention staff that was located in south-west Ethiopia had an inadequate understanding of and poor behavior related to the prevention and control of COVID-19 outbreaks. The independent knowledge components were a place of residence, level of education, and facility type. In addition, practice toward COVID-19 preventive measures was influenced independently by knowledge, educational attainment, and attitude. Future educational initiatives are encouraged to promote awareness of this illness among staff, incarcerated people, and detainees and should concentrate on prison facilities and rural detainee centers that lack resources and amenities. Lessons should be easier to understand and convey in their tongues. To help debunk myths and misconceptions concerning the illness, it is advised that regular communication take place between detention and prison employees, healthcare professionals, and the general public.

Limitations of the Study

The cross-sectional nature of the data makes it difficult to conclude the direction of relations among study variables. Moreover, our study only looked at the educational awareness of prison and detention center staff in southwest Ethiopia regarding COVID-19, which does not address other strategies to address or mitigate the spread of this virus in congregate settings such as reducing overcrowding.