COVID-19 severity and management: a descriptive cross-sectional study among healthcare workers in selected hospitals in the Greater Accra Region, Ghana

COVID-19 severity and management: a descriptive cross-sectional study among healthcare workers in selected hospitals in the Greater Accra Region, Ghana | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article COVID-19 severity and management: a descriptive cross-sectional study among healthcare workers in selected hospitals in the Greater Accra Region, Ghana Benson Owusu, Reginald Quansah, Emilia Asuquo Udofia, Enoch Akyeampong, and 5 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8516994/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 12 You are reading this latest preprint version Abstract Introduction Despite extensive research on the severity and management strategies for COVID-19 within the general population, there remains a notable scarcity of similar investigations focused on healthcare workers (HCWs). We aimed to fill this gap by exploring the clinical features, severity, and therapeutic approaches employed for HCWs who have recovered from COVID-19 in the Greater Accra Region of Ghana. Method A cross-sectional design, utilizing complete enumeration (census), enrolled 252 HCWs with PCR-confirmed COVID-19. Stata LP Version 15 (StataCorp, College Station, Texas, USA) was utilized for data analysis. Descriptive statistics was employed to present categorical variables as frequencies and percentages. Fisher's exact and chi square tests were used to assess the relationship between COVID-19 clinical characteristics and disease severity, with a significance level set at p < 0.05. Results Among the healthcare workers, prevalent signs and symptoms during the active phase of the infection included common cold manifestations (27%), cough (25%), loss of taste (24%), fever (23%), headache (23%), and fatigue (21%). Notably, 88% experienced a mild form of the disease, which was self-managed at home, while 10% required hospitalization due to a moderate-to-severe presentation, and 2% needed supplementary oxygen and intravenous medications. Three-quarters of participants (75%) received the complete COVID-19 vaccine dosage, yet 13% tested positive post-vaccination. Predominant supplements utilized include vitamins C and Zinc (68%), and Azithromycin emerged as the most utilized antibiotic (64%), with 78% self-funding this treatment. Herbal medicine, particularly neem tree concoctions, was relied upon by over half of the respondents (52%) as an alternative in managing COVID-19. The research findings revealed that individuals with underlying comorbidities (p < 0.041), a smoking history (p < 0.001), and alcohol consumption (p = 0.054) were at an increased likelihood of encountering moderate-to-severe manifestations of COVID-19. Conclusion The study highlighted significantly low reinfection frequency among vaccinated HCWs and a heightened risk of severe COVID-19 among individuals engaging in alcohol and tobacco smoking, surpassing the risk associated with recognized underlying health conditions (comorbidities). The findings underscore the importance of advocating for vaccination among HCWs, promoting healthier lifestyle habits, and emphasizing the significance of routine medical examinations. COVID-19 clinical characteristics healthcare workers management Ghana Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Introduction The COVID-19 pandemic, caused by SARS-CoV-2, has posed an unprecedented global public health challenge. The World Health Organization (WHO) declared COVID-19 a Public Health Emergency of International Concern on January 30, 2020, and a pandemic on March 11, 2020 [ 1 ]. Despite over 13.59 billion vaccine doses administered globally, including in Ghana where 1,462 deaths were reported by February 8, 2024 [ 2 ], COVID-19 continues to affect populations. Healthcare workers (HCWs) have been at the frontline, facing elevated infection risks due to prolonged exposure. Globally, over 6 million HCWs have been infected, including more than 10,000 cases in Africa [ 3 ]. In Ghana, 779 HCWs were infected with 10 associated deaths by June 2020, rising to over 2,000 by July 2020 [ 4 , 5 ]. Protecting HCWs is crucial to maintaining healthcare delivery and ensuring outbreak containment [ 4 ]. Infection prevention and control (IPC) measures, including appropriate personal protective equipment (PPE), are essential. However, inadequate PPE, prolonged patient contact, limited IPC training, and inconsistent implementation increase HCW vulnerability [ 2 ]. Infected HCWs may also transmit the virus before isolation, highlighting the need to understand clinical presentation, management, and outcomes to improve HCW safety [ 6 – 8 ]. Evidence suggests higher COVID-19 prevalence among female HCWs, particularly nurses [ 8 – 10 ]. Symptoms range from mild respiratory complaints to severe complications, influenced by comorbidities [ 6 , 11 , 12 ]. Vaccination status also affects disease severity [ 13 ]. The Greater Accra Region, as a major COVID-19 epicenter, provides a unique context for assessing HCW experiences. Despite global research, data from this region remain limited. This study aimed to examine the clinical characteristics, severity, and management of COVID-19 among HCWs in selected hospitals and identify factors influencing disease severity to inform policies for safer healthcare environments in Ghana. Materials and Methods Study design and setting A cross-sectional study employing a complete enumeration (census) approach was conducted among healthcare workers (HCWs) who had recovered from COVID-19 infection. The study was carried out from 1 to 30 September 2021 in selected public hospitals in the Greater Accra Region of Ghana, comprising one tertiary facility (Greater Accra Regional Hospital) and three secondary-level hospitals (Tema General Hospital, Shai Osudoku District Hospital, and Achimota Hospital). These facilities were purposively selected because they recorded some of the highest numbers of COVID-19 infections among HCWs in the region in 2021 and served as designated COVID-19 treatment centers. Study population and eligibility criteria The study population included 252 HCWs, comprising doctors, nurses, midwives, pharmacists, and laboratory scientists. Eligible participants were permanent staff who had previously tested positive for COVID-19 and had subsequently obtained laboratory-confirmed negative reverse transcriptase–polymerase chain reaction (RT-PCR) results at the time of recruitment. All participants provided informed consent prior to participation. HCWs were excluded if they had never undergone RT-PCR testing for COVID-19, were non-permanent staff or students, had health conditions such as psychosis that impaired their ability to participate in the interview, or declined consent. Participant identification and recruitment Participant lists were obtained from the Records and Statistical Units of the respective hospitals. The COVID-19 focal persons at each facility were contacted to facilitate identification and initial contact with eligible participants. Multiple follow-up contacts were made to confirm eligibility and willingness to participate prior to enrolment. Data collection Data were collected using the Research Electronic Data Capture (REDCap) platform hosted by the University of Ghana. A self-administered, structured questionnaire developed by the authors (Supplementary file 1) was uploaded onto REDCap and administered using Samsung Android smartphones by four trained research assistants over a four-week period. The questionnaire comprised four sections: Sociodemographic and professional characteristics, including age, sex, profession, religion, marital status, remuneration, comorbidity status, and number of dependents; Clinical characteristics, COVID-19 testing history, signs and symptoms, and vaccination status; COVID-19 testing information, including number of tests undertaken, reasons for testing, and turnaround time for results; Management and severity of COVID-19, including admission status, laboratory investigations performed, medications prescribed, and supportive care received. Data on COVID-19 experiences and management during the active phase of infection were collected retrospectively. On average, participants required approximately 25 minutes to complete the questionnaire (Suppl. Outcome measures Outcome measures COVID-19 disease severity was classified based on management and admission status as follows: Mild disease: not admitted to hospital and able to resume normal daily activities; Moderate-Severe disease: Not admitted but unable to resume normal daily activities/ admitted to hospital but did not require supplementary oxygen; Severe disease: admitted to hospital and required supplementary oxygen support. Statistical analysis Data validation and cleaning were performed prior to analysis. The dataset was exported into Stata LP version 15 (StataCorp, College Station, TX, USA) for statistical analysis. Categorical variables were summarized using frequencies and percentages, while continuous variables were presented as medians with interquartile ranges (IQRs). Associations between clinical characteristics and COVID-19 disease severity were assessed using Fisher’s exact test when cell counts were ≤ 5 and the chi-square test when cell counts exceeded 5. Crude and adjusted odds ratios (COR and AOR) were calculated to examine the strength of associations between participant characteristics and COVID-19 disease severity Statistical significance was determined at a p-value < 0.05. Results Socio-demographic, Professional and Clinical Characteristics of Respondents The study participants exhibited a median age of 34 years (interquartile range: 30–40). The demographic composition revealed that a majority were younger individuals (49.6%), predominantly females (81.3%), married (66.3%), possessed a bachelor's degree or higher education level (59.1%), and identified as Christians (84.9%). The highest representation of respondents originated from the Shai-Osudoku district hospital (34.1%), while the Tema General Hospital accounted for the smallest proportion (15.9%). Notably, a significant proportion comprised nurses (61.5%) employed in the Medical/Surgical department (38.9%), primarily engaged solely in their permanent job (81.3%), and possessed less than 5 years of clinical experience (42.5%). The reported approximate net monthly salary range was $ 166– $ 257 for 46.8% of the respondents. Additionally, a minority (8.3%) disclosed a history of comorbidities, with diabetes being the most prevalent (3.2%). Comprehensive socio-demographic, professional, and clinical characteristics of the respondents are summarized in Table 1 . Table 1 Socio-Demographic and Professional Characteristics of Respondents (N = 252) Characteristics n (%) Participant age , median (IQR) 34 (30–40) Age group (in years) 20–29 62(24.6) 30–39 125(49.6) 40–49 39 (15.5) 50–60 26(10.3) Sex Female 205(81.3) Male 47(18.7) Highest education Certificate 5 (2.0) Diploma 98(38.9) Bachelor’s degree or higher 149(59.1) Religion Christian 214(84.9) Muslim 36 (14.3) Others 2 (0.8) Marital status Never married 71(28.2) Married 167(66.3) Previously married 14(5.6) Number of dependents , median (IQR) 2 (0 .3) Number of dependents None 88(34.9) 1–2 dependents 54(21.4) 3–4 dependents 78(31.0) 5 + dependents 32(12.7) Health facility Greater Accra Regional hospital 55(21.8) Shai-Osudoku district hospital 86(34.1) Achimota hospital 71(28.2) Tema General hospital 40 (15.9) Profession Doctor 36 (14.3) Nurse 155(61.5) Laboratory scientist 6 (2.4) Pharmacist 12(4.8) Midwives 43(17.1) Department Medical/Surgical 98(38.9) Emergency/Intensive Care Unit (ICU) 38 (15.1) Obstetrics and Gynaecology (OBS & GYN) 39 (15.5) Child health 37(14.7) Out Patient Department (OPD) 24(9.5) Pharmacy 11(4.4) Laboratory 5(2.0) Part time jobs None 205 (81.3) One 41(16.3) Two+ 6(2.4) Years worked , median (IQR) 5 (2.10) Years worked experience <5 years 107(42.5) 5–9 years 80 (31.7) 10–14 years 46(18.3) 15 + years 19 (7.5) Net monthly salary $ 257 78(31.0) History of comorbidity No 231 (91.7) Comorbidities among participants 21(8.3) Hypertension 4 (1.6) Asthma 4(1.6) Diabetes 8 (3.2) Mental illness 3 (1.2) Sickle cell disease 2(0.8) Renal disease 1(0.4) COVID-19 Testing, Signs and Symptoms and Vaccination Status Approximately thirty-three percent (33%) of the respondents underwent COVID-19 testing, either once or on multiple occasions. The primary reason for testing among most participants (35%) was the manifestation of signs and symptoms suggestive of the disease, while voluntary testing represented the least common motivation (3.6%). The most prevalent signs and symptoms exhibited by the respondents included cold symptoms (27%), cough (25%), loss of taste (23.8%), fever (23.4%), headache (22.6%), and fatigue (21%). Notably, a significant proportion of respondents (40%) experienced a waiting period of 1–2 weeks for the release of their COVID-19 test results. Regarding vaccination status, the majority of the respondents (75%) had completed the full COVID-19 vaccine dosage. However, a minority (13%) tested positive for the virus even after complete vaccination. Additional details are outlined in Table 2 . Table 2 COVID-19 testing, signs and symptoms and vaccination status Characteristics N = 252 (%) Number COVID-19 tests Once 82 (32.5) Twice 74 (29.4) Thrice 14 (5.6) Four or more 82 (32.5) Reason for testing Exhibiting signs and symptoms 87(34.5) Just decided to get tested 9 (3.6) Was exposed to a COVID 19 patient 85 (33.7) Facility policy to get tested 71 (28.2) Symptoms exhibited Fever 59 (23.4) Difficulty in breathing 32 (12.7) Cough 63 (25.0) Cold 68 (27.0) Loss of taste 60(23.8) Loss of smell 53 (21.0) Headache 57 (22.6) Fatigue 53 (21.0) Diarrhoea 7 (2.8) How long it took to receive COVID-19 results after sample taking Within 72 hours 81 (32.1) 1 to 2 weeks 101(40.1) 2–4 weeks 50 (19.8) More than a month 20(7.9) Ever vaccinated against COVID-19 Yes, full dose 188 (74.6) Yes, partial dose 28 (11.1) No 36 (14.3) Ever tested positive after vaccination No 187/216 (86.6) Yes 29/216 (13.4) Table 3 presents the strength of the association between COVID-19 clinical characteristics and disease severity. After adjusting for potential confounders, those with a bachelor’s degree or higher were 3.6 times [AOR = 3.59, 95% CI: 1.25, 10.36; p = 0.018] more likely to have moderate or severe disease than those with lower educational qualifications. Those who had worked for 5 to 9 years had 89% lower odds of moderate or severe disease compared to others, after adjusting for the influence of other variables [AOR = 0.11, 95% CI: 0.03, 0.39; p = 0.001]. Those who had 1 to 2 dependents had 3.7 times [AOR = 3.65, 95% CI: 1.15, 11.55; p = 0.028] higher odds of moderate to severe disease whereas those with 5 or more dependents had 5.7 times [AOR = 5.74, 95% CI: 1.54, 21.43; p = 0.009] higher odds of moderate to severe disease compared to those with no dependents. The study did not find enough evidence of an association between age, sex, history of smoking, presenting with symptoms of fever or difficulty in breathing, having been ever vaccinated against COVID-19 and COVID-19 disease severity. Table 3 Crude and adjusted odds ratios of the association between factors of interest and COVID-19 disease severity Variable COR [95%CI] p-value AOR [95%CI] p-value Highest education 0.21* Certificate/Diploma 1 1 Bachelor's degree or higher 2.13[0.91,4.97] 0.081 3.59 [1.25, 10.36] 0.018* Years Worked < 5 1 1 5–9 0.19 [0.05,0.68] 0.011* 0.11 [0.03, 0.39] 0.001* 10–14 1.04[ 0.42,2.60] 0.932 0.067 [0.17, 2.66] 0.567 15+ 0.58 [0.12,2.75] 0.494 0.31 [0.04, 2.75] 0.296 Number of dependents None 1 1 1–2 2.63 [0.93,7.41] 0.067 3.65 [1.15, 11.55] 0.028* 3–4 1.14 [0.38,3.42] 0.814 2.02 [0.58, 7.10] 0.271 5+ 3.24[1.03,10.15] 0.044* 5.74 [1.54, 21.43] 0.009* Footnotes: *p < 0.05; AOR, Adjusted Odds Ratio; CI, Confidence Interval; COR, Crude Odds Ratio Only variables with statistically significant associations in the adjusted model (p < 0.05) are included. Crude ORs are provided for reference, but emphasis is on the adjusted ORs. Other variables such as age, sex, smoking, fever, difficulty in breathing, and vaccination status were not statistically significant after adjustment and are omitted. Severity and Management of COVID-19 Infection among Respondents The management of COVID-19 infection among healthcare workers (HCWs) was assessed in this study. A vast majority (88%) of HCWs experienced a mild form of COVID-19 and did not necessitate hospitalization. However, 10% of the respondents encountered a moderate to severe form of the disease, requiring hospital admission without supplementary oxygen, while a minimal proportion of the participants (2%) suffered from severe COVID-19, requiring hospitalization and oxygen support (Fig. 1 ). Clinical investigations following COVID-19 infection were primarily comprised of Full Blood Count (46%), Chest X-ray (21%), Blood Urea and Creatinine tests (20%), and Liver Function Test (LFT) (17%) (Fig. 2 ). In terms of treatment, the majority of HCWs resorted to vitamin C and Zinc supplements (68%) and azithromycin (64%) (Fig. 3 ). Additionally, over 50% of HCWs supplemented orthodox medicine with herbal remedies, specifically neem tree concoctions and steam inhalation (Fig. 4 ). Figure 4 a: Use of herbal medications for COVID-19 treatment among the respondents Among the respondents, 77.4% obtained the medications used for managing COVID-19 through self-purchase as shown in Fig. 4 b. Discussion This study provides a detailed examination of the clinical characteristics, hospitalization patterns, pharmaceutical interventions, and laboratory assessments employed in managing COVID-19 among 252 healthcare workers (HCWs) in the Greater Accra Region of Ghana. The predominant symptoms among HCWs included cold, cough, loss of taste, fever, headache, and fatigue. The majority of participants (88%) experienced mild disease that did not require hospital admission, with vitamin C and zinc being commonly used supplements. Azithromycin was the most frequently administered antibiotic. Notably, many HCWs also relied on herbal remedies, particularly neem tree concoctions and steam inhalation, highlighting the role of traditional medicine in pandemic responses within resource-limited settings. These findings are relevant for healthcare systems in developing countries where data on COVID-19 clinical management among HCWs remain limited. Contrary to previous studies reporting higher infection rates among males [ 16 , 17 ], our findings indicate a higher infection rate among female HCWs. This likely reflects the predominance of female staff, particularly nurses, in Ghanaian healthcare facilities, who typically have more prolonged patient contact. Severe COVID-19 was also more common among females in this cohort, differing from findings in Turkish HCWs [ 18 ]. The age distribution, predominantly 30–39 years, aligns with similar studies from Iran, where HCWs aged 25–35 was most affected [ 19 ]. This pattern may reflect differences in PPE adherence, perceived vulnerability, or immune resilience in younger populations. The high proportion of married participants aligns with evidence suggesting that marital support can positively influence recovery and psychological resilience post-infection [ 20 , 21 ]. Educational attainment was high among participants, with most holding at least a bachelor’s degree. Education plays a critical role in understanding disease transmission, treatment, and prevention, supporting adherence to infection prevention and control (IPC) measures and prompt health-seeking behaviors [ 22 ]. Despite this knowledge, HCWs remain at elevated risk due to occupational exposure. Comorbidities, including diabetes, hypertension, asthma, mental illness, renal disease, and sickle cell disease, were reported among participants. Individuals with comorbidities demonstrated milder disease in this study, consistent with some reports indicating fewer comorbidities among hospitalized HCWs compared to non-HCWs [ 25 ]. However, comorbidities remain recognized risk factors for adverse COVID-19 outcomes [ 23 , 24 , 26 , 27 ]. Lifestyle factors, such as smoking and alcohol consumption, were associated with severe disease, emphasizing the need for healthy behaviors among HCWs to maintain workforce resilience [ 28 ]. The clinical presentation observed mirrors reports from Wuhan, China, where fever, dry cough, dyspnea, sore throat, and fatigue were commonly reported among HCWs [ 29 ]. Most participants tested positive on their initial RT-PCR test, supporting its high sensitivity, whereas Rapid Diagnostic Tests often required repeat testing due to lower sensitivity [ 23 , 30 ]. While no definitive treatment for COVID-19 exists, medications such as antimicrobials, corticosteroids, vitamins, and minerals have been utilized [ 20 , 21 , 29 ]. In Ghana, standard protocols include azithromycin, doxycycline, and supplementation with vitamin C and zinc, which aligns with practices observed in this study [ 21 , 30 ]. Interestingly, over half of HCWs used herbal remedies despite limited evidence for efficacy against COVID-19. While some traditional treatments have shown benefit for other infections in Ghana [ 31 ], the safety and effectiveness of these approaches for COVID-19 remain uncertain [ 32 ]. Most participants were managed at home, reflecting the mild nature of their disease and their generally young and active demographic [ 14 , 15 ]. Although hospitalization is often associated with comorbidities, severe cases in this cohort occurred even among fully vaccinated individuals. A high proportion (75%) of HCWs were fully vaccinated, indicating strong vaccine uptake, though breakthrough infections (13%) warrant further investigation, particularly regarding variants or delayed booster doses [ 33 ]. Strengths and Limitations Strengths This study employed a complete enumeration (census) of HCWs with prior COVID-19 infection across multiple hospitals, enhancing representativeness within the Greater Accra Region. The inclusion of diverse HCW categories, doctors, nurses, midwives, pharmacists, and laboratory scientists, provided a comprehensive perspective on occupational exposure and disease management. Data collection through REDCap ensured accuracy and standardization, while retrospective evaluation captured both clinical management and outcomes. Limitations This study has some limitations that should be considered when interpreting the findings. First, the cross-sectional design precludes causal inference between healthcare worker characteristics and COVID-19 disease severity or management outcomes. Furthermore, the data were collected retrospectively through a self-administered questionnaire, which may have introduced recall bias, particularly in reporting symptoms, treatment practices, and the use of herbal or over-the-counter medications. Social desirability bias may also have influenced responses related to infection prevention behaviours and treatment choices. Again, disease severity and management were based on self-reported information rather than standardized clinical records. Objective clinical indicators such as oxygen saturation, radiological findings, laboratory parameters, and validated severity scoring systems were not systematically verified, which may have resulted in misclassification of disease severity. Also, the study was conducted in selected public hospitals within the Greater Accra Region. Although these facilities experienced a high burden of COVID-19 cases, the findings may not be generalizable to healthcare workers in private facilities, primary healthcare settings, or other regions of Ghana with differing health system capacities and pandemic responses. Furthermore, while vaccination status was assessed, detailed information on vaccine type, timing of doses, booster administration, and circulating SARS-CoV-2 variants at the time of infection was not available. This limited the ability to fully explore vaccine-specific effects on disease severity and breakthrough infections. Finally, the study documented the use of herbal remedies but did not assess dosage, duration, safety, or potential interactions with conventional medicines. Consequently, no conclusions can be drawn regarding the effectiveness or safety of these therapies. Conclusion These findings emphasize the importance of sustained investment in HCW protection, including consistent access to personal protective equipment, regular training in infection prevention and control, timely testing, and vaccination programs. Additionally, there is a need for clear guidance on the use of adjunct therapies, including herbal medicines, during public health emergencies. Strengthening occupational health policies and support systems for HCWs is essential to ensure workforce resilience and preparedness for future infectious disease outbreaks. List of Abbreviations AOR Adjusted Odds Ratio COR Crude Odds Ratio COVID-19 Coronavirus 2019 HCW Healthcare workers IPC Infection Prevention and Control IQR Interquartile Range PPE Personal Protective Equipment REDCap Research Electronic Data Capture RT-PCR Reverse Transcriptase–Polymerase Chain Reaction WHO World Health Organization Declarations Ethics Approval and consent to participate Ethical approval for this study was obtained from the Ghana Health Service Ethics Review Board (GHS-003-03-21). Written informed consent was obtained from all participants prior to enrollment. The study was conducted in accordance with the principles of the Declaration of Helsinki and local ethical guidelines. Consent for Publication Not applicable Availability of data and materials The datasets generated and/or analyzed during the study are not publicly available due to the lack of consent from all participants to share raw data but are available from the corresponding authors. Competing interests The authors declare that they have no competing interests. Funding The authors received no specific funding for this work. Authors’ contributions BO, RQ, PT, EAU, and KPB conceptualized and designed the study. BO, MYAA, MO-M, and EA were responsible for data collection and initial analysis. RQ, PT, EAU, KPB, and MD provided methodological guidance and contributed to the interpretation of results. RQ and BO drafted the initial manuscript. All authors critically reviewed and revised the manuscript for important intellectual content and approved the final version for submission. Acknowledgment We acknowledge the support from management and healthcare workers who consented to participate in the study from the selected hospitals as well as BANGA-AFRICA. References Giri M, Puri A, Wang T, Guo S. Clinical features, comorbidities, complications and treatment options in severe and non-severe COVID-19 patients: a systematic review and meta-analysis. Nurs Open. 2021;8(3):1077–88. https://doi.org/10.1002/nop2.718 . Lartey M, Kenu E, Ganu VJ, Asiedu-Bekoe F, Opoku BK, Yawson A, et al. Risk factors for COVID-19 infections among health care workers in Ghana. PLoS ONE. 2023;18(7):e0288242. https://doi.org/10.1371/journal.pone.0288242 . Liu W, Tao ZW, Wang L, Yuan ML, Liu K, Zhou L, et al. Analysis of factors associated with disease outcomes in hospitalized patients with 2019 novel coronavirus disease. Chin Med J (Engl). 2020;133(9):1032–8. https://doi.org/10.1097/CM9.0000000000000775 . Ashinyo ME, Dubik SD, Duti V, Amegah KE, Ashinyo A, Asare BA, et al. Infection prevention and control compliance among exposed healthcare workers in COVID-19 treatment centers in Ghana: a descriptive cross-sectional study. PLoS ONE. 2021;16(3):e0248282. https://doi.org/10.1371/journal.pone.0248282 . Ofori AA, Osarfo J, Agbeno EK, Manu DO, Amoah E. Psychological impact of COVID-19 on health workers in Ghana: a multicentre cross-sectional study. SAGE Open Med. 2021;9:20503121211000919. https://doi.org/10.1177/20503121211000919 . Heinzerling A, Stuckey MJ, Scheuer T, Xu K, Perkins KM, Resseger H, et al. Transmission of COVID-19 to health care personnel during exposures to a hospitalized patient—Solano County, California, February 2020. MMWR Morb Mortal Wkly Rep. 2020;69(15):472–6. https://doi.org/10.15585/mmwr.mm6915e5 . Zhou P, Huang Z, Xiao Y, Huang X, Fan XG. Protecting Chinese healthcare workers while combating the 2019 novel coronavirus. Infect Control Hosp Epidemiol. 2020;41(6):745–6. https://doi.org/10.1017/ice.2020.60 . Dudeja M, Shaikh A, Islam F, Alvi Y, Ahmad M, Kashyap V, et al. Assessment of potential risk factors for COVID-19 among health care workers in a health care setting in Delhi, India: a cohort study. PLoS ONE. 2023;18(1):e0265290. https://doi.org/10.1371/journal.pone.0265290 . Khaing NEE, Quah C, Png GK, Wong J, Tee A, Oh HC. Association between proximity to COVID-19 and the quality of life of healthcare workers. PLoS ONE. 2023;18(3):e0283424. https://doi.org/10.1371/journal.pone.0283424 . Banu B, Akter N, Chowdhury SH, Islam KR, Islam MT, Zahangir M, et al. COVID-19 and Bangladeshi health professionals: infection status, vaccination and its immediate health consequences. PLoS ONE. 2022;17(11):e0277022. https://doi.org/10.1371/journal.pone.0277022 . Khedr EM, Daef E, Mohamed-Hussein A, Mostafa EF, Zein M, Hassany SM et al. Impact of comorbidities on COVID-19 outcome. medRxiv. 2020. https://doi.org/10.1101/2020.11.28.20240267 Guan WJ, Liang WH, He JX, Zhong NS. Cardiovascular comorbidity and its impact on patients with COVID-19. Eur Respir J. 2020;55(6):2001227. https://doi.org/10.1183/13993003.01227-2020 . Genovese C, Picerno IAM, Trimarchi G, Cannavò G, Egitto G, Cosenza B, et al. Vaccination coverage in healthcare workers: a multicenter cross-sectional study in Italy. J Prev Med Hyg. 2019;60(1):E12–7. https://doi.org/10.15167/2421-4248/jpmh2019.60.1.1097 . Liu J, Liu S. The management of coronavirus disease 2019 (COVID-19). J Med Virol. 2020;92(9):1484–90. https://doi.org/10.1002/jmv.25965 . Bose S, Adapa S, Aeddula NR, Roy S, Nandikanti D, Vupadhyayula PM, et al. Medical management of COVID-19: evidence and experience. J Clin Med Res. 2020;12(6):329–43. https://doi.org/10.14740/jocmr4201 . Al Maskari Z, Al Blushi A, Khamis F, Al Tai A, Al Salmi I, Al Harthi H, et al. Characteristics of healthcare workers infected with COVID-19: a cross-sectional observational study. Int J Infect Dis. 2021;102:32–6. https://doi.org/10.1016/j.ijid.2020.10.009 . Saki M, Haseli S, Iranpour P. Oral radiology center as a potential source of COVID-19 transmission: points to consider. Acad Radiol. 2020;27(7):1047–8. https://doi.org/10.1016/j.acra.2020.04.040 . Madran B, Akbulut Z, Akbaba G, Taş E, Güçlüoğlu T, Şencanlı Ö, et al. COVID-19 severity among healthcare workers: overweight male physicians at risk. Infect Dis Rep. 2022;14(3):310–4. https://doi.org/10.3390/idr14030036 . Sabetian G, Moghadami M, Hashemizadeh Fard Haghighi L, Shahriarirad R, Fallahi MJ, Asmarian N, et al. COVID-19 infection among healthcare workers: a cross-sectional study in southwest Iran. Virol J. 2021;18:58. https://doi.org/10.1186/s12985-021-01532-0 . Brurberg KG, Fretheim A. COVID-19: the relationship between age, comorbidity and disease severity – a rapid review, 1st update. Oslo: Norwegian Institute of Public Health; 2020. Wang B, Li R, Lu Z, Huang Y. Does comorbidity increase the risk of patients with COVID-19: evidence from a meta-analysis. Aging. 2020;12(7):6049–57. https://doi.org/10.18632/aging.103000 . Bielicki JA, Duval X, Gobat N, Goossens H, Koopmans M, Tacconelli E, et al. Monitoring approaches for health-care workers during the COVID-19 pandemic. Lancet Infect Dis. 2020;20(10):e261–7. https://doi.org/10.1016/S1473-3099(20)30458-8 . Jin YH, Cai L, Cheng ZS, Cheng H, Deng T, Fan YP, et al. A rapid advice guideline for the diagnosis and treatment of 2019 novel coronavirus (2019-nCoV) infected pneumonia (standard version). Mil Med Res. 2020;7:4. https://doi.org/10.1186/s40779-020-0233-6 . Ministry of Health (Ghana). Provisional standard treatment guidelines for novel coronavirus infection (COVID-19). Accra: Ministry of Health; 2020. Díez-Manglano J, Solís-Marquínez MN, Álvarez García A, Alcalá-Rivera N, Riesco IM, Aseguinolaza MG, et al. Healthcare workers hospitalized due to COVID-19 have no higher risk of death than the general population: data from the Spanish SEMI-COVID-19 Registry. PLoS ONE. 2021;16(2):e0247422. https://doi.org/10.1371/journal.pone.0247422 . Mhango M, Dzobo M, Chitungo I, Dzinamarira T. COVID-19 risk factors among health workers: a rapid review. Saf Health Work. 2020;11(3):262–5. https://doi.org/10.1016/j.shaw.2020.06.001 . Moustafa EF, Hassany SM, Soliman AMA, Ezz-Eldin M, Zaghloul N, Abd-Elsalam S. Infection and severity of COVID-19 infection among healthcare workers: a report from Egypt. Infect Disord Drug Targets. 2022;22(7):e390522205740. https://doi.org/10.2174/1871526522666220422105740 . Wang X, Liu W, Zhao J, Lu Y, Yu C, Hu S, et al. Clinical characteristics of 80 hospitalized frontline medical workers infected with COVID-19 in Wuhan, China. J Hosp Infect. 2020;105(3):399–403. https://doi.org/10.1016/j.jhin.2020.04.019 . Hajimonfarednejad M, Ostovar M, Hasheminasab FS, Shariati MA, Thiruvengadam M, Raee MJ, et al. Medicinal plants for viral respiratory diseases: a systematic review on Persian medicine. Evid Based Complement Alternat Med. 2023;2023:1928310. https://doi.org/10.1155/2023/1928310 . Appiah EO, Appiah S, Oti-Boadi E, Oppong-Besse A, Awuah DB, Asiedu PO, et al. Practices of herbal management of malaria among trading mothers in Shai Osudoku District, Accra. PLoS ONE. 2022;17(7):e0271669. https://doi.org/10.1371/journal.pone.0271669 . Cao B, Wang Y, Wen D, Liu W, Wang J, Fan G, et al. A trial of lopinavir–ritonavir in adults hospitalized with severe COVID-19. N Engl J Med. 2020;382(19):1787–99. https://doi.org/10.1056/NEJMoa2001282 . Havers FP, Pham H, Taylor CA, Whitaker M, Patel K, Anglin O, et al. COVID-19–associated hospitalizations among vaccinated and unvaccinated adults ≥ 18 years in 13 US states, January 2021–April 2022. JAMA Intern Med. 2022;182(10):1071–81. https://doi.org/10.1001/jamainternmed.2022.4299 . Amanatidou E, Gkiouliava A, Pella E, Serafidi M, Tsilingiris D, Vallianou NG, et al. Breakthrough infections after COVID-19 vaccination: insights, perspectives and challenges. Metab Open. 2022;14:100180. https://doi.org/10.1016/j.metop.2022.100180 . Additional Declarations No competing interests reported. Supplementary Files Supplementaryfile1QUESTIONNAIRE.docx Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 19 Feb, 2026 Reviewers agreed at journal 18 Feb, 2026 Reviews received at journal 16 Feb, 2026 Reviewers agreed at journal 09 Feb, 2026 Reviewers agreed at journal 09 Feb, 2026 Reviewers agreed at journal 08 Feb, 2026 Reviewers agreed at journal 06 Feb, 2026 Reviewers invited by journal 06 Feb, 2026 Editor assigned by journal 06 Feb, 2026 Editor invited by journal 19 Jan, 2026 Submission checks completed at journal 17 Jan, 2026 First submitted to journal 17 Jan, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Quansah","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA0ElEQVRIiWNgGAWjYBCDBH4wxQbEEsRqkWwgWYvBAWK1mLfnGH4u+GOXZ3wj/QLDh7LDDPLRDfi1yJx5Yyw9sy252OxGTgHjjHOHGQzvHMCvRUIix0Cat4E5cduNnARm3jaglhkJBLUY/+b5U5+4eQZQy18itZhJ87AdTtwgkX6AmRGoRV6CkBaeZ2XWvG3HE2ececNwsOdcOo8BQS3syZtv8/ypTuxvT3/44EeZtZw8IYcBYwTG4AFHDYQkUgv7AzAl30BQyygYBaNgFIwwAABiIkQFREvr4gAAAABJRU5ErkJggg==","orcid":"","institution":"University of Ghana","correspondingAuthor":true,"prefix":"","firstName":"Reginald","middleName":"","lastName":"Quansah","suffix":""},{"id":588634538,"identity":"63599083-e46d-47ef-8b46-0ea941bd8806","order_by":2,"name":"Emilia Asuquo Udofia","email":"","orcid":"","institution":"University of Ghana","correspondingAuthor":false,"prefix":"","firstName":"Emilia","middleName":"Asuquo","lastName":"Udofia","suffix":""},{"id":588634539,"identity":"673c8915-69f2-4343-8969-f9c299a2856c","order_by":3,"name":"Enoch Akyeampong","email":"","orcid":"","institution":"University of Mines and Technology","correspondingAuthor":false,"prefix":"","firstName":"Enoch","middleName":"","lastName":"Akyeampong","suffix":""},{"id":588634540,"identity":"3f5a230a-7c3f-43e8-ad98-f29901d2df95","order_by":4,"name":"Paul Kingsley Botwe","email":"","orcid":"","institution":"University of Sharjah","correspondingAuthor":false,"prefix":"","firstName":"Paul","middleName":"Kingsley","lastName":"Botwe","suffix":""},{"id":588634541,"identity":"1b5f5c6f-831a-4180-b7ee-c7eff744bd6f","order_by":5,"name":"Michael Opoku-Mireku","email":"","orcid":"","institution":"Catholic University College of Ghana","correspondingAuthor":false,"prefix":"","firstName":"Michael","middleName":"","lastName":"Opoku-Mireku","suffix":""},{"id":588634542,"identity":"2a4e2f57-5257-4d1e-919f-a0462fa3b9e9","order_by":6,"name":"Magdaline Yaa Amoakoa Ansah","email":"","orcid":"","institution":"Korle Bu Teaching 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04:53:41","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8516994/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8516994/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":102397891,"identity":"849ebe7c-8284-4d33-91d3-82c4dce15fe5","added_by":"auto","created_at":"2026-02-11 10:20:03","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":45041,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eCOVID-19 Severity among the HCWs\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-8516994/v1/02fd243be1902d855f28853b.png"},{"id":102380901,"identity":"8cd400a1-799a-4ebb-8219-73c509a36bd2","added_by":"auto","created_at":"2026-02-11 06:49:48","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":61225,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eLaboratory investigations conducted among the respondents\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-8516994/v1/f0e0e590534cf5f53428d631.png"},{"id":102398464,"identity":"3c23f5e4-946b-40ba-907f-976708472759","added_by":"auto","created_at":"2026-02-11 10:22:57","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":57402,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eMedications and source of medication for COVID-19 treatment among respondents\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-8516994/v1/a25a9b36e6dc0b2d2349dcdc.png"},{"id":102380903,"identity":"ced000f8-a7c4-44f3-8040-9867bd082b4c","added_by":"auto","created_at":"2026-02-11 06:49:48","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":60113,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eFigure 4a: Use of herbal medications for COVID-19 treatment among the respondents\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"4.png","url":"https://assets-eu.researchsquare.com/files/rs-8516994/v1/ef996355a8119761c19f6eab.png"},{"id":102380906,"identity":"b93295f5-ab40-488c-bc90-31d223bb377e","added_by":"auto","created_at":"2026-02-11 06:49:49","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":28973,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eFigure 4b: Source of Medications among the respondents\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"5.png","url":"https://assets-eu.researchsquare.com/files/rs-8516994/v1/ae39460026e33e07466ed5d0.png"},{"id":102399372,"identity":"c3a42585-5ba1-49fb-837a-881b4b56d2c5","added_by":"auto","created_at":"2026-02-11 10:34:17","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1588108,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8516994/v1/40bbf2ab-46e3-46d8-8b99-2e4045dad226.pdf"},{"id":102380905,"identity":"febc913f-52c8-4608-83ce-429eda7c498a","added_by":"auto","created_at":"2026-02-11 06:49:48","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":35461,"visible":true,"origin":"","legend":"","description":"","filename":"Supplementaryfile1QUESTIONNAIRE.docx","url":"https://assets-eu.researchsquare.com/files/rs-8516994/v1/790ddbc5dd6648e38f74a594.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"COVID-19 severity and management: a descriptive cross-sectional study among healthcare workers in selected hospitals in the Greater Accra Region, Ghana","fulltext":[{"header":"Introduction","content":"\u003cp\u003eThe COVID-19 pandemic, caused by SARS-CoV-2, has posed an unprecedented global public health challenge. The World Health Organization (WHO) declared COVID-19 a Public Health Emergency of International Concern on January 30, 2020, and a pandemic on March 11, 2020 [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Despite over 13.59\u0026nbsp;billion vaccine doses administered globally, including in Ghana where 1,462 deaths were reported by February 8, 2024 [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e], COVID-19 continues to affect populations.\u003c/p\u003e \u003cp\u003eHealthcare workers (HCWs) have been at the frontline, facing elevated infection risks due to prolonged exposure. Globally, over 6\u0026nbsp;million HCWs have been infected, including more than 10,000 cases in Africa [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. In Ghana, 779 HCWs were infected with 10 associated deaths by June 2020, rising to over 2,000 by July 2020 [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Protecting HCWs is crucial to maintaining healthcare delivery and ensuring outbreak containment [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eInfection prevention and control (IPC) measures, including appropriate personal protective equipment (PPE), are essential. However, inadequate PPE, prolonged patient contact, limited IPC training, and inconsistent implementation increase HCW vulnerability [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Infected HCWs may also transmit the virus before isolation, highlighting the need to understand clinical presentation, management, and outcomes to improve HCW safety [\u003cspan additionalcitationids=\"CR7\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eEvidence suggests higher COVID-19 prevalence among female HCWs, particularly nurses [\u003cspan additionalcitationids=\"CR9\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Symptoms range from mild respiratory complaints to severe complications, influenced by comorbidities [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Vaccination status also affects disease severity [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe Greater Accra Region, as a major COVID-19 epicenter, provides a unique context for assessing HCW experiences. Despite global research, data from this region remain limited. This study aimed to examine the clinical characteristics, severity, and management of COVID-19 among HCWs in selected hospitals and identify factors influencing disease severity to inform policies for safer healthcare environments in Ghana.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy design and setting\u003c/h2\u003e \u003cp\u003eA cross-sectional study employing a complete enumeration (census) approach was conducted among healthcare workers (HCWs) who had recovered from COVID-19 infection. The study was carried out from 1 to 30 September 2021 in selected public hospitals in the Greater Accra Region of Ghana, comprising one tertiary facility (Greater Accra Regional Hospital) and three secondary-level hospitals (Tema General Hospital, Shai Osudoku District Hospital, and Achimota Hospital). These facilities were purposively selected because they recorded some of the highest numbers of COVID-19 infections among HCWs in the region in 2021 and served as designated COVID-19 treatment centers.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eStudy population and eligibility criteria\u003c/h3\u003e\n\u003cp\u003eThe study population included 252 HCWs, comprising doctors, nurses, midwives, pharmacists, and laboratory scientists. Eligible participants were permanent staff who had previously tested positive for COVID-19 and had subsequently obtained laboratory-confirmed negative reverse transcriptase\u0026ndash;polymerase chain reaction (RT-PCR) results at the time of recruitment. All participants provided informed consent prior to participation.\u003c/p\u003e \u003cp\u003eHCWs were excluded if they had never undergone RT-PCR testing for COVID-19, were non-permanent staff or students, had health conditions such as psychosis that impaired their ability to participate in the interview, or declined consent.\u003c/p\u003e\n\u003ch3\u003eParticipant identification and recruitment\u003c/h3\u003e\n\u003cp\u003eParticipant lists were obtained from the Records and Statistical Units of the respective hospitals. The COVID-19 focal persons at each facility were contacted to facilitate identification and initial contact with eligible participants. Multiple follow-up contacts were made to confirm eligibility and willingness to participate prior to enrolment.\u003c/p\u003e\n\u003ch3\u003eData collection\u003c/h3\u003e\n\u003cp\u003eData were collected using the Research Electronic Data Capture (REDCap) platform hosted by the University of Ghana. A self-administered, structured questionnaire developed by the authors (Supplementary file 1) was uploaded onto REDCap and administered using Samsung Android smartphones by four trained research assistants over a four-week period. The questionnaire comprised four sections:\u003c/p\u003e \u003cp\u003e \u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eSociodemographic and professional characteristics, including age, sex, profession, religion, marital status, remuneration, comorbidity status, and number of dependents;\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eClinical characteristics, COVID-19 testing history, signs and symptoms, and vaccination status;\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eCOVID-19 testing information, including number of tests undertaken, reasons for testing, and turnaround time for results;\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eManagement and severity of COVID-19, including admission status, laboratory investigations performed, medications prescribed, and supportive care received.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e \u003cp\u003eData on COVID-19 experiences and management during the active phase of infection were collected retrospectively. On average, participants required approximately 25 minutes to complete the questionnaire (Suppl.\u003c/p\u003e\n\u003ch3\u003eOutcome measures\u003c/h3\u003e\n\u003cdiv class=\"Heading\"\u003eOutcome measures\u003c/div\u003e \u003cp\u003eCOVID-19 disease severity was classified based on management and admission status as follows:\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eMild disease: not admitted to hospital and able to resume normal daily activities;\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eModerate-Severe disease: Not admitted but unable to resume normal daily activities/ admitted to hospital but did not require supplementary oxygen;\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eSevere disease: admitted to hospital and required supplementary oxygen support.\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eData validation and cleaning were performed prior to analysis. The dataset was exported into Stata LP version 15 (StataCorp, College Station, TX, USA) for statistical analysis. Categorical variables were summarized using frequencies and percentages, while continuous variables were presented as medians with interquartile ranges (IQRs).\u003c/p\u003e \u003cp\u003eAssociations between clinical characteristics and COVID-19 disease severity were assessed using Fisher\u0026rsquo;s exact test when cell counts were \u0026le;\u0026thinsp;5 and the chi-square test when cell counts exceeded 5. Crude and adjusted odds ratios (COR and AOR) were calculated to examine the strength of associations between participant characteristics and COVID-19 disease severity Statistical significance was determined at a p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eSocio-demographic, Professional and Clinical Characteristics of Respondents\u003c/h2\u003e \u003cp\u003eThe study participants exhibited a median age of 34 years (interquartile range: 30\u0026ndash;40). The demographic composition revealed that a majority were younger individuals (49.6%), predominantly females (81.3%), married (66.3%), possessed a bachelor's degree or higher education level (59.1%), and identified as Christians (84.9%). The highest representation of respondents originated from the Shai-Osudoku district hospital (34.1%), while the Tema General Hospital accounted for the smallest proportion (15.9%). Notably, a significant proportion comprised nurses (61.5%) employed in the Medical/Surgical department (38.9%), primarily engaged solely in their permanent job (81.3%), and possessed less than 5 years of clinical experience (42.5%). The reported approximate net monthly salary range was \u003cspan\u003e$\u003c/span\u003e166\u0026ndash;\u003cspan\u003e$\u003c/span\u003e257 for 46.8% of the respondents. Additionally, a minority (8.3%) disclosed a history of comorbidities, with diabetes being the most prevalent (3.2%). Comprehensive socio-demographic, professional, and clinical characteristics of the respondents are summarized in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSocio-Demographic and Professional Characteristics of Respondents (N\u0026thinsp;=\u0026thinsp;252)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003en (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eParticipant age\u003c/b\u003e, median (IQR)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e34 (30\u0026ndash;40)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge group (in years)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e20\u0026ndash;29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e62(24.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e30\u0026ndash;39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e125(49.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e40\u0026ndash;49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e39 (15.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e50\u0026ndash;60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e26(10.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSex\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e205(81.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e47(18.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHighest education\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCertificate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 (2.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiploma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e98(38.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBachelor\u0026rsquo;s degree or higher\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e149(59.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eReligion\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChristian\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e214(84.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMuslim\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e36 (14.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOthers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (0.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMarital status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNever married\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e71(28.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e167(66.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePreviously married\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14(5.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNumber of dependents\u003c/b\u003e, median (IQR)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (0 .3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNumber of dependents\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e88(34.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u0026ndash;2 dependents\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e54(21.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3\u0026ndash;4 dependents\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e78(31.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5\u0026thinsp;+\u0026thinsp;dependents\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e32(12.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHealth facility\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGreater Accra Regional hospital\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e55(21.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eShai-Osudoku district hospital\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e86(34.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAchimota hospital\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e71(28.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTema General hospital\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e40 (15.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eProfession\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDoctor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e36 (14.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNurse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e155(61.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLaboratory scientist\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6 (2.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePharmacist\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12(4.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMidwives\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e43(17.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDepartment\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedical/Surgical\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e98(38.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEmergency/Intensive Care Unit (ICU)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e38 (15.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eObstetrics and Gynaecology (OBS \u0026amp; GYN)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e39 (15.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChild health\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e37(14.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOut Patient Department (OPD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e24(9.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePharmacy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11(4.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLaboratory\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5(2.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePart time jobs\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e205 (81.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOne\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e41(16.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTwo+\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6(2.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eYears worked\u003c/b\u003e, median (IQR)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 (2.10)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eYears worked experience\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;5 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e107(42.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5\u0026ndash;9 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e80 (31.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e10\u0026ndash;14 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e46(18.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e15\u0026thinsp;+\u0026thinsp;years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e19 (7.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNet monthly salary\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u003cspan\u003e$\u003c/span\u003e82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9(3.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cspan\u003e$\u003c/span\u003e83-\u003cspan\u003e$\u003c/span\u003e165\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e47(18.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cspan\u003e$\u003c/span\u003e166-\u003cspan\u003e$\u003c/span\u003e257\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e118 (46.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt; \u003cspan\u003e$\u003c/span\u003e257\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e78(31.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Taba\" border=\"1\"\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHistory of comorbidity\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e231 (91.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eComorbidities among participants\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e21(8.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHypertension\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4 (1.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAsthma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4(1.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiabetes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8 (3.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMental illness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3 (1.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSickle cell disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2(0.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRenal disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1(0.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eCOVID-19 Testing, Signs and Symptoms and Vaccination Status\u003c/h2\u003e \u003cp\u003eApproximately thirty-three percent (33%) of the respondents underwent COVID-19 testing, either once or on multiple occasions. The primary reason for testing among most participants (35%) was the manifestation of signs and symptoms suggestive of the disease, while voluntary testing represented the least common motivation (3.6%). The most prevalent signs and symptoms exhibited by the respondents included cold symptoms (27%), cough (25%), loss of taste (23.8%), fever (23.4%), headache (22.6%), and fatigue (21%). Notably, a significant proportion of respondents (40%) experienced a waiting period of 1\u0026ndash;2 weeks for the release of their COVID-19 test results. Regarding vaccination status, the majority of the respondents (75%) had completed the full COVID-19 vaccine dosage. However, a minority (13%) tested positive for the virus even after complete vaccination. Additional details are outlined in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCOVID-19 testing, signs and symptoms and vaccination status\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;252 (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNumber COVID-19 tests\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOnce\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e82 (32.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTwice\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e74 (29.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThrice\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e14 (5.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFour or more\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e82 (32.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eReason for testing\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eExhibiting signs and symptoms\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e87(34.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eJust decided to get tested\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e9 (3.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWas exposed to a COVID 19 patient\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e85 (33.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFacility policy to get tested\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e71 (28.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSymptoms exhibited\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFever\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e59 (23.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDifficulty in breathing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e32 (12.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCough\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e63 (25.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCold\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e68 (27.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLoss of taste\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e60(23.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLoss of smell\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e53 (21.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHeadache\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e57 (22.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFatigue\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e53 (21.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiarrhoea\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e7 (2.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHow long it took to receive COVID-19 results after sample taking\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWithin 72 hours\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e81 (32.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1 to 2 weeks\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e101(40.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u0026ndash;4 weeks\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e50 (19.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMore than a month\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e20(7.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEver vaccinated against COVID-19\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes, full dose\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e188 (74.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes, partial dose\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e28 (11.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e36 (14.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEver tested positive after vaccination\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e187/216 (86.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e29/216 (13.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e presents the strength of the association between COVID-19 clinical characteristics and disease severity. After adjusting for potential confounders, those with a bachelor\u0026rsquo;s degree or higher were 3.6 times [AOR\u0026thinsp;=\u0026thinsp;3.59, 95% CI: 1.25, 10.36; p\u0026thinsp;=\u0026thinsp;0.018] more likely to have moderate or severe disease than those with lower educational qualifications. Those who had worked for 5 to 9 years had 89% lower odds of moderate or severe disease compared to others, after adjusting for the influence of other variables [AOR\u0026thinsp;=\u0026thinsp;0.11, 95% CI: 0.03, 0.39; p\u0026thinsp;=\u0026thinsp;0.001]. Those who had 1 to 2 dependents had 3.7 times [AOR\u0026thinsp;=\u0026thinsp;3.65, 95% CI: 1.15, 11.55; p\u0026thinsp;=\u0026thinsp;0.028] higher odds of moderate to severe disease whereas those with 5 or more dependents had 5.7 times [AOR\u0026thinsp;=\u0026thinsp;5.74, 95% CI: 1.54, 21.43; p\u0026thinsp;=\u0026thinsp;0.009] higher odds of moderate to severe disease compared to those with no dependents. The study did not find enough evidence of an association between age, sex, history of smoking, presenting with symptoms of fever or difficulty in breathing, having been ever vaccinated against COVID-19 and COVID-19 disease severity.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cb\u003eCrude and adjusted odds ratios of the association between factors of interest and COVID-19 disease severity\u003c/b\u003e\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCOR [95%CI]\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAOR [95%CI]\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHighest education\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.21*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCertificate/Diploma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBachelor's degree or higher\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.13[0.91,4.97]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.081\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.59 [1.25, 10.36]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.018*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eYears Worked\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt; 5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5\u0026ndash;9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.19 [0.05,0.68]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.011*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.11 [0.03, 0.39]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.001*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e10\u0026ndash;14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.04[ 0.42,2.60]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.932\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.067 [0.17, 2.66]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.567\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e15+\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.58 [0.12,2.75]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.494\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.31 [0.04, 2.75]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.296\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNumber of dependents\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u0026ndash;2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.63 [0.93,7.41]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.067\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.65 [1.15, 11.55]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.028*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3\u0026ndash;4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.14 [0.38,3.42]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.814\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.02 [0.58, 7.10]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.271\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5+\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.24[1.03,10.15]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.044*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.74 [1.54, 21.43]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.009*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eFootnotes: *p\u0026thinsp;\u0026lt;\u0026thinsp;0.05; AOR, Adjusted Odds Ratio; CI, Confidence Interval; COR, Crude Odds Ratio\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eOnly variables with statistically significant associations in the adjusted model (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05) are included.\u003c/p\u003e \u003cp\u003eCrude ORs are provided for reference, but emphasis is on the adjusted ORs.\u003c/p\u003e \u003cp\u003eOther variables such as age, sex, smoking, fever, difficulty in breathing, and vaccination status were not statistically significant after adjustment and are omitted.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eSeverity and Management of COVID-19 Infection among Respondents\u003c/h2\u003e \u003cp\u003eThe management of COVID-19 infection among healthcare workers (HCWs) was assessed in this study. A vast majority (88%) of HCWs experienced a mild form of COVID-19 and did not necessitate hospitalization. However, 10% of the respondents encountered a moderate to severe form of the disease, requiring hospital admission without supplementary oxygen, while a minimal proportion of the participants (2%) suffered from severe COVID-19, requiring hospitalization and oxygen support (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eClinical investigations following COVID-19 infection were primarily comprised of Full Blood Count (46%), Chest X-ray (21%), Blood Urea and Creatinine tests (20%), and Liver Function Test (LFT) (17%) (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eIn terms of treatment, the majority of HCWs resorted to vitamin C and Zinc supplements (68%) and azithromycin (64%) (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eAdditionally, over 50% of HCWs supplemented orthodox medicine with herbal remedies, specifically neem tree concoctions and steam inhalation (Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eFigure \u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003ea: \u003cb\u003eUse of herbal medications for COVID-19 treatment among the respondents\u003c/b\u003e\u003c/p\u003e \u003cp\u003eAmong the respondents, 77.4% obtained the medications used for managing COVID-19 through self-purchase as shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003eb.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study provides a detailed examination of the clinical characteristics, hospitalization patterns, pharmaceutical interventions, and laboratory assessments employed in managing COVID-19 among 252 healthcare workers (HCWs) in the Greater Accra Region of Ghana. The predominant symptoms among HCWs included cold, cough, loss of taste, fever, headache, and fatigue. The majority of participants (88%) experienced mild disease that did not require hospital admission, with vitamin C and zinc being commonly used supplements. Azithromycin was the most frequently administered antibiotic. Notably, many HCWs also relied on herbal remedies, particularly neem tree concoctions and steam inhalation, highlighting the role of traditional medicine in pandemic responses within resource-limited settings. These findings are relevant for healthcare systems in developing countries where data on COVID-19 clinical management among HCWs remain limited.\u003c/p\u003e \u003cp\u003eContrary to previous studies reporting higher infection rates among males [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e], our findings indicate a higher infection rate among female HCWs. This likely reflects the predominance of female staff, particularly nurses, in Ghanaian healthcare facilities, who typically have more prolonged patient contact. Severe COVID-19 was also more common among females in this cohort, differing from findings in Turkish HCWs [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. The age distribution, predominantly 30\u0026ndash;39 years, aligns with similar studies from Iran, where HCWs aged 25\u0026ndash;35 was most affected [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. This pattern may reflect differences in PPE adherence, perceived vulnerability, or immune resilience in younger populations. The high proportion of married participants aligns with evidence suggesting that marital support can positively influence recovery and psychological resilience post-infection [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eEducational attainment was high among participants, with most holding at least a bachelor\u0026rsquo;s degree. Education plays a critical role in understanding disease transmission, treatment, and prevention, supporting adherence to infection prevention and control (IPC) measures and prompt health-seeking behaviors [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Despite this knowledge, HCWs remain at elevated risk due to occupational exposure.\u003c/p\u003e \u003cp\u003eComorbidities, including diabetes, hypertension, asthma, mental illness, renal disease, and sickle cell disease, were reported among participants. Individuals with comorbidities demonstrated milder disease in this study, consistent with some reports indicating fewer comorbidities among hospitalized HCWs compared to non-HCWs [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. However, comorbidities remain recognized risk factors for adverse COVID-19 outcomes [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. Lifestyle factors, such as smoking and alcohol consumption, were associated with severe disease, emphasizing the need for healthy behaviors among HCWs to maintain workforce resilience [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe clinical presentation observed mirrors reports from Wuhan, China, where fever, dry cough, dyspnea, sore throat, and fatigue were commonly reported among HCWs [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. Most participants tested positive on their initial RT-PCR test, supporting its high sensitivity, whereas Rapid Diagnostic Tests often required repeat testing due to lower sensitivity [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eWhile no definitive treatment for COVID-19 exists, medications such as antimicrobials, corticosteroids, vitamins, and minerals have been utilized [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. In Ghana, standard protocols include azithromycin, doxycycline, and supplementation with vitamin C and zinc, which aligns with practices observed in this study [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. Interestingly, over half of HCWs used herbal remedies despite limited evidence for efficacy against COVID-19. While some traditional treatments have shown benefit for other infections in Ghana [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e], the safety and effectiveness of these approaches for COVID-19 remain uncertain [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eMost participants were managed at home, reflecting the mild nature of their disease and their generally young and active demographic [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Although hospitalization is often associated with comorbidities, severe cases in this cohort occurred even among fully vaccinated individuals. A high proportion (75%) of HCWs were fully vaccinated, indicating strong vaccine uptake, though breakthrough infections (13%) warrant further investigation, particularly regarding variants or delayed booster doses [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e].\u003c/p\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eStrengths and Limitations\u003c/h2\u003e \u003cdiv id=\"Sec15\" class=\"Section3\"\u003e \u003ch2\u003eStrengths\u003c/h2\u003e \u003cp\u003eThis study employed a complete enumeration (census) of HCWs with prior COVID-19 infection across multiple hospitals, enhancing representativeness within the Greater Accra Region. The inclusion of diverse HCW categories, doctors, nurses, midwives, pharmacists, and laboratory scientists, provided a comprehensive perspective on occupational exposure and disease management. Data collection through REDCap ensured accuracy and standardization, while retrospective evaluation captured both clinical management and outcomes.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eLimitations\u003c/h2\u003e \u003cp\u003eThis study has some limitations that should be considered when interpreting the findings. First, the cross-sectional design precludes causal inference between healthcare worker characteristics and COVID-19 disease severity or management outcomes. Furthermore, the data were collected retrospectively through a self-administered questionnaire, which may have introduced recall bias, particularly in reporting symptoms, treatment practices, and the use of herbal or over-the-counter medications. Social desirability bias may also have influenced responses related to infection prevention behaviours and treatment choices. Again, disease severity and management were based on self-reported information rather than standardized clinical records. Objective clinical indicators such as oxygen saturation, radiological findings, laboratory parameters, and validated severity scoring systems were not systematically verified, which may have resulted in misclassification of disease severity. Also, the study was conducted in selected public hospitals within the Greater Accra Region. Although these facilities experienced a high burden of COVID-19 cases, the findings may not be generalizable to healthcare workers in private facilities, primary healthcare settings, or other regions of Ghana with differing health system capacities and pandemic responses. Furthermore, while vaccination status was assessed, detailed information on vaccine type, timing of doses, booster administration, and circulating SARS-CoV-2 variants at the time of infection was not available. This limited the ability to fully explore vaccine-specific effects on disease severity and breakthrough infections. Finally, the study documented the use of herbal remedies but did not assess dosage, duration, safety, or potential interactions with conventional medicines. Consequently, no conclusions can be drawn regarding the effectiveness or safety of these therapies.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThese findings emphasize the importance of sustained investment in HCW protection, including consistent access to personal protective equipment, regular training in infection prevention and control, timely testing, and vaccination programs. Additionally, there is a need for clear guidance on the use of adjunct therapies, including herbal medicines, during public health emergencies. Strengthening occupational health policies and support systems for HCWs is essential to ensure workforce resilience and preparedness for future infectious disease outbreaks.\u003c/p\u003e"},{"header":"List of Abbreviations","content":"\u003cp\u003eAOR\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Adjusted Odds Ratio\u003c/p\u003e\n\u003cp\u003eCOR\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Crude Odds Ratio\u003c/p\u003e\n\u003cp\u003eCOVID-19\u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Coronavirus 2019\u003c/p\u003e\n\u003cp\u003eHCW\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Healthcare workers\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIPC\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Infection Prevention and Control\u003c/p\u003e\n\u003cp\u003eIQR\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Interquartile Range\u003c/p\u003e\n\u003cp\u003ePPE\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Personal Protective Equipment\u003c/p\u003e\n\u003cp\u003eREDCap\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Research Electronic Data Capture\u003c/p\u003e\n\u003cp\u003eRT-PCR\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Reverse Transcriptase\u0026ndash;Polymerase Chain Reaction\u003c/p\u003e\n\u003cp\u003eWHO \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; World Health Organization\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics Approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical approval for this study was obtained from the Ghana Health Service Ethics Review Board (GHS-003-03-21).\u0026nbsp;Written informed consent was obtained from all participants prior to enrollment. The study was conducted in accordance with the principles of the Declaration of Helsinki and local ethical guidelines.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for Publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets generated and/or analyzed during the study are not publicly available due to the lack of consent from all participants to share raw data but are available from the corresponding authors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors received no specific funding for this work.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eBO, RQ, PT, EAU, and KPB conceptualized and designed the study. BO, MYAA, MO-M, and EA were responsible for data collection and initial analysis. RQ, PT, EAU, KPB, and MD provided methodological guidance and contributed to the interpretation of results. RQ and BO drafted the initial manuscript. All authors critically reviewed and revised the manuscript for important intellectual content and approved the final version for submission.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgment\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe acknowledge the support from management and healthcare workers who consented to\u003c/p\u003e\n\u003cp\u003eparticipate in the study from the selected hospitals as well as BANGA-AFRICA.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eGiri M, Puri A, Wang T, Guo S. Clinical features, comorbidities, complications and treatment options in severe and non-severe COVID-19 patients: a systematic review and meta-analysis. Nurs Open. 2021;8(3):1077\u0026ndash;88. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1002/nop2.718\u003c/span\u003e\u003cspan address=\"10.1002/nop2.718\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLartey M, Kenu E, Ganu VJ, Asiedu-Bekoe F, Opoku BK, Yawson A, et al. Risk factors for COVID-19 infections among health care workers in Ghana. PLoS ONE. 2023;18(7):e0288242. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1371/journal.pone.0288242\u003c/span\u003e\u003cspan address=\"10.1371/journal.pone.0288242\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLiu W, Tao ZW, Wang L, Yuan ML, Liu K, Zhou L, et al. Analysis of factors associated with disease outcomes in hospitalized patients with 2019 novel coronavirus disease. Chin Med J (Engl). 2020;133(9):1032\u0026ndash;8. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1097/CM9.0000000000000775\u003c/span\u003e\u003cspan address=\"10.1097/CM9.0000000000000775\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAshinyo ME, Dubik SD, Duti V, Amegah KE, Ashinyo A, Asare BA, et al. Infection prevention and control compliance among exposed healthcare workers in COVID-19 treatment centers in Ghana: a descriptive cross-sectional study. PLoS ONE. 2021;16(3):e0248282. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1371/journal.pone.0248282\u003c/span\u003e\u003cspan address=\"10.1371/journal.pone.0248282\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOfori AA, Osarfo J, Agbeno EK, Manu DO, Amoah E. Psychological impact of COVID-19 on health workers in Ghana: a multicentre cross-sectional study. SAGE Open Med. 2021;9:20503121211000919. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1177/20503121211000919\u003c/span\u003e\u003cspan address=\"10.1177/20503121211000919\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHeinzerling A, Stuckey MJ, Scheuer T, Xu K, Perkins KM, Resseger H, et al. Transmission of COVID-19 to health care personnel during exposures to a hospitalized patient\u0026mdash;Solano County, California, February 2020. MMWR Morb Mortal Wkly Rep. 2020;69(15):472\u0026ndash;6. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.15585/mmwr.mm6915e5\u003c/span\u003e\u003cspan address=\"10.15585/mmwr.mm6915e5\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhou P, Huang Z, Xiao Y, Huang X, Fan XG. Protecting Chinese healthcare workers while combating the 2019 novel coronavirus. Infect Control Hosp Epidemiol. 2020;41(6):745\u0026ndash;6. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1017/ice.2020.60\u003c/span\u003e\u003cspan address=\"10.1017/ice.2020.60\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDudeja M, Shaikh A, Islam F, Alvi Y, Ahmad M, Kashyap V, et al. Assessment of potential risk factors for COVID-19 among health care workers in a health care setting in Delhi, India: a cohort study. PLoS ONE. 2023;18(1):e0265290. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1371/journal.pone.0265290\u003c/span\u003e\u003cspan address=\"10.1371/journal.pone.0265290\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKhaing NEE, Quah C, Png GK, Wong J, Tee A, Oh HC. Association between proximity to COVID-19 and the quality of life of healthcare workers. PLoS ONE. 2023;18(3):e0283424. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1371/journal.pone.0283424\u003c/span\u003e\u003cspan address=\"10.1371/journal.pone.0283424\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBanu B, Akter N, Chowdhury SH, Islam KR, Islam MT, Zahangir M, et al. COVID-19 and Bangladeshi health professionals: infection status, vaccination and its immediate health consequences. PLoS ONE. 2022;17(11):e0277022. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1371/journal.pone.0277022\u003c/span\u003e\u003cspan address=\"10.1371/journal.pone.0277022\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKhedr EM, Daef E, Mohamed-Hussein A, Mostafa EF, Zein M, Hassany SM et al. Impact of comorbidities on COVID-19 outcome. medRxiv. 2020. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1101/2020.11.28.20240267\u003c/span\u003e\u003cspan address=\"10.1101/2020.11.28.20240267\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGuan WJ, Liang WH, He JX, Zhong NS. Cardiovascular comorbidity and its impact on patients with COVID-19. Eur Respir J. 2020;55(6):2001227. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1183/13993003.01227-2020\u003c/span\u003e\u003cspan address=\"10.1183/13993003.01227-2020\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGenovese C, Picerno IAM, Trimarchi G, Cannav\u0026ograve; G, Egitto G, Cosenza B, et al. Vaccination coverage in healthcare workers: a multicenter cross-sectional study in Italy. J Prev Med Hyg. 2019;60(1):E12\u0026ndash;7. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.15167/2421-4248/jpmh2019.60.1.1097\u003c/span\u003e\u003cspan address=\"10.15167/2421-4248/jpmh2019.60.1.1097\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLiu J, Liu S. The management of coronavirus disease 2019 (COVID-19). J Med Virol. 2020;92(9):1484\u0026ndash;90. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1002/jmv.25965\u003c/span\u003e\u003cspan address=\"10.1002/jmv.25965\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBose S, Adapa S, Aeddula NR, Roy S, Nandikanti D, Vupadhyayula PM, et al. Medical management of COVID-19: evidence and experience. J Clin Med Res. 2020;12(6):329\u0026ndash;43. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.14740/jocmr4201\u003c/span\u003e\u003cspan address=\"10.14740/jocmr4201\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAl Maskari Z, Al Blushi A, Khamis F, Al Tai A, Al Salmi I, Al Harthi H, et al. Characteristics of healthcare workers infected with COVID-19: a cross-sectional observational study. Int J Infect Dis. 2021;102:32\u0026ndash;6. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.ijid.2020.10.009\u003c/span\u003e\u003cspan address=\"10.1016/j.ijid.2020.10.009\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSaki M, Haseli S, Iranpour P. Oral radiology center as a potential source of COVID-19 transmission: points to consider. Acad Radiol. 2020;27(7):1047\u0026ndash;8. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.acra.2020.04.040\u003c/span\u003e\u003cspan address=\"10.1016/j.acra.2020.04.040\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMadran B, Akbulut Z, Akbaba G, Taş E, G\u0026uuml;\u0026ccedil;l\u0026uuml;oğlu T, Şencanlı \u0026Ouml;, et al. COVID-19 severity among healthcare workers: overweight male physicians at risk. Infect Dis Rep. 2022;14(3):310\u0026ndash;4. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3390/idr14030036\u003c/span\u003e\u003cspan address=\"10.3390/idr14030036\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSabetian G, Moghadami M, Hashemizadeh Fard Haghighi L, Shahriarirad R, Fallahi MJ, Asmarian N, et al. COVID-19 infection among healthcare workers: a cross-sectional study in southwest Iran. Virol J. 2021;18:58. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/s12985-021-01532-0\u003c/span\u003e\u003cspan address=\"10.1186/s12985-021-01532-0\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBrurberg KG, Fretheim A. COVID-19: the relationship between age, comorbidity and disease severity \u0026ndash; a rapid review, 1st update. Oslo: Norwegian Institute of Public Health; 2020.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWang B, Li R, Lu Z, Huang Y. Does comorbidity increase the risk of patients with COVID-19: evidence from a meta-analysis. Aging. 2020;12(7):6049\u0026ndash;57. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.18632/aging.103000\u003c/span\u003e\u003cspan address=\"10.18632/aging.103000\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBielicki JA, Duval X, Gobat N, Goossens H, Koopmans M, Tacconelli E, et al. Monitoring approaches for health-care workers during the COVID-19 pandemic. Lancet Infect Dis. 2020;20(10):e261\u0026ndash;7. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/S1473-3099(20)30458-8\u003c/span\u003e\u003cspan address=\"10.1016/S1473-3099(20)30458-8\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJin YH, Cai L, Cheng ZS, Cheng H, Deng T, Fan YP, et al. A rapid advice guideline for the diagnosis and treatment of 2019 novel coronavirus (2019-nCoV) infected pneumonia (standard version). Mil Med Res. 2020;7:4. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/s40779-020-0233-6\u003c/span\u003e\u003cspan address=\"10.1186/s40779-020-0233-6\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMinistry of Health (Ghana). Provisional standard treatment guidelines for novel coronavirus infection (COVID-19). Accra: Ministry of Health; 2020.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eD\u0026iacute;ez-Manglano J, Sol\u0026iacute;s-Marqu\u0026iacute;nez MN, \u0026Aacute;lvarez Garc\u0026iacute;a A, Alcal\u0026aacute;-Rivera N, Riesco IM, Aseguinolaza MG, et al. Healthcare workers hospitalized due to COVID-19 have no higher risk of death than the general population: data from the Spanish SEMI-COVID-19 Registry. PLoS ONE. 2021;16(2):e0247422. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1371/journal.pone.0247422\u003c/span\u003e\u003cspan address=\"10.1371/journal.pone.0247422\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMhango M, Dzobo M, Chitungo I, Dzinamarira T. COVID-19 risk factors among health workers: a rapid review. Saf Health Work. 2020;11(3):262\u0026ndash;5. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.shaw.2020.06.001\u003c/span\u003e\u003cspan address=\"10.1016/j.shaw.2020.06.001\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMoustafa EF, Hassany SM, Soliman AMA, Ezz-Eldin M, Zaghloul N, Abd-Elsalam S. Infection and severity of COVID-19 infection among healthcare workers: a report from Egypt. Infect Disord Drug Targets. 2022;22(7):e390522205740. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.2174/1871526522666220422105740\u003c/span\u003e\u003cspan address=\"10.2174/1871526522666220422105740\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWang X, Liu W, Zhao J, Lu Y, Yu C, Hu S, et al. Clinical characteristics of 80 hospitalized frontline medical workers infected with COVID-19 in Wuhan, China. J Hosp Infect. 2020;105(3):399\u0026ndash;403. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.jhin.2020.04.019\u003c/span\u003e\u003cspan address=\"10.1016/j.jhin.2020.04.019\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHajimonfarednejad M, Ostovar M, Hasheminasab FS, Shariati MA, Thiruvengadam M, Raee MJ, et al. Medicinal plants for viral respiratory diseases: a systematic review on Persian medicine. Evid Based Complement Alternat Med. 2023;2023:1928310. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1155/2023/1928310\u003c/span\u003e\u003cspan address=\"10.1155/2023/1928310\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAppiah EO, Appiah S, Oti-Boadi E, Oppong-Besse A, Awuah DB, Asiedu PO, et al. Practices of herbal management of malaria among trading mothers in Shai Osudoku District, Accra. PLoS ONE. 2022;17(7):e0271669. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1371/journal.pone.0271669\u003c/span\u003e\u003cspan address=\"10.1371/journal.pone.0271669\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCao B, Wang Y, Wen D, Liu W, Wang J, Fan G, et al. A trial of lopinavir\u0026ndash;ritonavir in adults hospitalized with severe COVID-19. N Engl J Med. 2020;382(19):1787\u0026ndash;99. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1056/NEJMoa2001282\u003c/span\u003e\u003cspan address=\"10.1056/NEJMoa2001282\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHavers FP, Pham H, Taylor CA, Whitaker M, Patel K, Anglin O, et al. COVID-19\u0026ndash;associated hospitalizations among vaccinated and unvaccinated adults\u0026thinsp;\u0026ge;\u0026thinsp;18 years in 13 US states, January 2021\u0026ndash;April 2022. JAMA Intern Med. 2022;182(10):1071\u0026ndash;81. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1001/jamainternmed.2022.4299\u003c/span\u003e\u003cspan address=\"10.1001/jamainternmed.2022.4299\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAmanatidou E, Gkiouliava A, Pella E, Serafidi M, Tsilingiris D, Vallianou NG, et al. Breakthrough infections after COVID-19 vaccination: insights, perspectives and challenges. Metab Open. 2022;14:100180. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.metop.2022.100180\u003c/span\u003e\u003cspan address=\"10.1016/j.metop.2022.100180\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"COVID-19, clinical characteristics, healthcare workers, management, Ghana","lastPublishedDoi":"10.21203/rs.3.rs-8516994/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8516994/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eIntroduction\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDespite extensive research on the severity and management strategies for COVID-19 within the general population, there remains a notable scarcity of similar investigations focused on healthcare workers (HCWs). We aimed to fill this gap by exploring the clinical features, severity, and therapeutic approaches employed for HCWs who have recovered from COVID-19 in the Greater Accra Region of Ghana.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethod\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA cross-sectional design, utilizing complete enumeration (census), enrolled 252 HCWs with PCR-confirmed COVID-19. Stata LP Version 15 (StataCorp, College Station, Texas, USA) was utilized for data analysis. Descriptive statistics was employed to present categorical variables as frequencies and percentages. Fisher's exact and chi square tests were used to assess the relationship between COVID-19 clinical characteristics and disease severity, with a significance level set at p \u0026lt; 0.05.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAmong the healthcare workers, prevalent signs and symptoms during the active phase of the infection included common cold manifestations (27%), cough (25%), loss of taste (24%), fever (23%), headache (23%), and fatigue (21%). Notably, 88% experienced a mild form of the disease, which was self-managed at home, while 10% required hospitalization due to a moderate-to-severe presentation, and 2% needed supplementary oxygen and intravenous medications. Three-quarters of participants (75%) received the complete COVID-19 vaccine dosage, yet 13% tested positive post-vaccination. Predominant supplements utilized include vitamins C and Zinc (68%), and Azithromycin emerged as the most utilized antibiotic (64%), with 78% self-funding this treatment. Herbal medicine, particularly neem tree concoctions, was relied upon by over half of the respondents (52%) as an alternative in managing COVID-19. The research findings revealed that individuals with underlying comorbidities (p \u0026lt; 0.041), a smoking history (p \u0026lt; 0.001), and alcohol consumption (p = 0.054) were at an increased likelihood of encountering moderate-to-severe manifestations of COVID-19.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study highlighted significantly low reinfection frequency among vaccinated HCWs and a heightened risk of severe COVID-19 among individuals engaging in alcohol and tobacco smoking, surpassing the risk associated with recognized underlying health conditions (comorbidities). The findings underscore the importance of advocating for vaccination among HCWs, promoting healthier lifestyle habits, and emphasizing the significance of routine medical examinations.\u003c/p\u003e","manuscriptTitle":"COVID-19 severity and management: a descriptive cross-sectional study among healthcare workers in selected hospitals in the Greater Accra Region, Ghana","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-11 06:49:43","doi":"10.21203/rs.3.rs-8516994/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-02-19T20:16:46+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"149747983025920257140758137157044881130","date":"2026-02-18T08:42:31+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-16T14:53:27+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"166261948095720446036554554345172155497","date":"2026-02-10T02:03:31+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"103928914785283608877093229312001259778","date":"2026-02-09T13:53:59+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"219554814992015890873135348312568763112","date":"2026-02-08T19:55:00+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"88359506621271434798516307235777370644","date":"2026-02-06T12:49:14+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-02-06T12:33:55+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-02-06T08:34:26+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-01-19T15:03:38+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-01-18T04:49:27+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Public Health","date":"2026-01-18T04:44:10+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"c542f1b2-8384-4c9d-91f1-d0deeb8cf4c7","owner":[],"postedDate":"February 11th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-02-11T06:49:44+00:00","versionOfRecord":[],"versionCreatedAt":"2026-02-11 06:49:43","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8516994","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8516994","identity":"rs-8516994","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}