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Harmful Alcohol Use Among Healthcare Workers at the Beginning of the COVID-19 Pandemic in Kenya

Introduction

Healthcare workers play a critical role in responding to pandemics like the coronavirus disease of 2019 (COVID-19) (1). In addition to being involved in direct patient care, they are expected to educate the public and patients on infection prevention practices, conduct public health reporting, and at the same time strictly adhere to the established occupational health and safety procedures (2). Because of this central role in responding to the COVID-19 pandemic, the World Health Organization (WHO) recommends that a number of interventions (individual, organizational and systems level) are put in place in order to preserve, manage and optimize the health workforce during the pandemic (1). This is particularly important in resource-limited settings like Kenya, where the healthcare workforce is already constrained. For example as of 2017, Kenya had a total of 90,000 physicians and nurses (3), translating to a density of 2 skilled healthcare workers per 1,000 population against the minimum recommended 4.45 (4).

At the individual level, the WHO recommends that interventions that safeguard the mental health of healthcare workers are implemented (1). Health care workers are highly vulnerable to psychological distress during pandemics because they often have direct contact with infected persons, face increased workload, and are constantly exposed to potentially traumatic events in the course of disease outbreaks. Indeed studies conducted during the COVID-19 pandemic indicate a high psychological impact on health care workers including depression, anxiety and post- traumatic stress (5).

Harmful alcohol use is a particularly important mental health problem that could impact the availability and capacity of healthcare workers to deliver health services during the pandemic (6). Interventions targeting harmful alcohol use among healthcare workers during the COVID-19 pandemic need to be prioritized for two main reasons: Firstly harmful alcohol use is associated with reduced performance and productivity in the workplace emanating from associated ill health and cognitive impairments (6). Secondly, COVID-19 puts healthcare workers at risk of increased alcohol use as a result of maladaptive attempts at coping with the high levels of burnout, depression and anxiety associated with the pandemic (79). Indeed studies conducted among healthcare workers in Europe and the United States (US) have reported an increase in alcohol consumption after the onset of the COVID-19 pandemic (1012).

The need for evidence on the prevalence of harmful alcohol use among healthcare workers during the COVID-19 pandemic is pressing, particularly in sub-Saharan Africa, which has one of the most significant healthcare worker shortages globally (13). Unfortunately, little has been done to explore the burden of harmful alcohol use in that region during the COVID-19 pandemic. Available work has mostly been conducted in western settings (1416). Rates of problem drinking among healthcare workers during the COVID-19 pandemic have been reported as 7% in the United Kingdom (UK) (15), and 42.6% in the United States (US) (14) based on AUDIT-C cut-off scores of >7 and >4 respectively. One study conducted in Ethiopia reported the prevalence rate of alcohol use, once or more in the past 3 months, as 40.2% among medical and non-medical healthcare workers during the pandemic (17).

The aim of the present study is to report on the prevalence and factors associated with harmful alcohol use among healthcare workers at the beginning of the COVID-19 pandemic in Kenya. The first case of COVID-19 was confirmed in Kenya on 12th March 2020 (18). This study was conducted between April 27th and June 5th 2020, two months after the onset of the pandemic in Kenya. During the study period, new confirmed cases rose from 15 (19) to 124 (20) while COVID-19 related deaths increased from 21 (19) to 78 (20). Public health measures included targeted testing, travel restrictions, training health providers on COVID-19 and its management, and educating the public on preventive measures (19). Health care workers faced a number of challenges at that time including inadequate personal protective equipment; lack of quarantine facilities after shifts in the isolation wards and this exposed their families to the risk of contracting COVID-19; and hostile clients (20).

The findings of our study could be useful in implementing alcohol treatment and prevention interventions aimed at preserving and optimizing the health workforce, as well as maintaining health care worker well-being during the COVID-19 pandemic in Kenya and in other settings in sub-Saharan Africa.

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