Obstetric Services Preparedness Among Healthcare Workers in Maternal Wards During COVID-19 Pandemic

Obstetric Services Preparedness Among Healthcare Workers in Maternal Wards During COVID-19 Pandemic | 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 Obstetric Services Preparedness Among Healthcare Workers in Maternal Wards During COVID-19 Pandemic Sumaiyah Isamail, Idayu Badilla Idris, Hanizah Mohd Yusoff This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5015500/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 14 Apr, 2025 Read the published version in BMC Pregnancy and Childbirth → Version 1 posted 4 You are reading this latest preprint version Abstract Background The COVID-19 pandemic has been spreading rapidly since 2019, leading to devastating consequences worldwide, as well as putting healthcare providers at high risk. This study intends to assess the awareness and preparedness activities among maternal healthcare (MHC) workers and to determine factors that lead to obstetric services’ preparedness in ten Government Hospitals in Selangor, Malaysia. Methods A cross-sectional survey was conducted among 409 MHC workers which include doctors, nurses, and midwives in the government hospitals in Selangor, Malaysia between May 2022 till June 2022. Respondents were given validated questionnaires which include socio-demographic background, knowledge, awareness, and attitude as well as the obstetric services’ preparedness activities in managing the COVID-19 pandemic. Results Majority of the respondents were nurses/midwives (87.5%), female (98.5%), age 35–45 years old (48.5%), had working experience of more than 5 years (92.7%), had good knowledge and awareness (92.2%) and good obstetric services preparedness (88.3%). However, only about half (54.0%) of them had positive attitude towards COVID-19. When controlling for confounding factors, multivariate analysis showed that working period factor (p < 0.001), knowledge and awareness factor (p < 0.001) and attitude factor (p < 0.001) were significant predictive factors of obstetric services preparedness during the COVID-19 pandemic. Conclusions The findings in this study revealed that efforts should be made to further increase the knowledge and awareness of MHC workers on COVID-19 and to improve the positivity of their attitude towards this pandemic so that they can provide better obstetric services especially in the current and future pandemics to come. obstetric services COVID-19 level of preparedness maternal healthcare workers Figures Figure 1 BACKGROUND The novel coronavirus 2019 disease or Coronavirus disease 2019 (COVID-19) is a respiratory tract infection that was first identified in China. Since its emergence in December 2019, the virus had spread rapidly, exceeding geographical barriers. The World Health Organization (WHO) and the Centers for Disease Control and Prevention (CDC) have declared COVID-19 as a public health crisis [1]. WHO declared COVID-19 a pandemic on March 11, 2020, after it was first reported in Hubei Province, China in December 2019. COVID-19 spreads so rapidly around the world and leads to dire consequences for patients, healthcare workers, the health system, as well as the economy. As it reaches low- and middle-income countries, the pandemic puts healthcare workers including maternal health care (MHCs) workers, at high risk and challenges the ability of the healthcare system to respond to crises. Therefore, health authorities have initiated awareness and preparedness activities around the world including among MHC workers as poor understanding of the disease can result in delayed treatment and rapid spread of infection [2], [3]. Governments around the world have implemented various public and social health measures to reduce the spread of COVID-19. By reducing the provision of services for non-COVID-19 health emergencies and essential health services, the provision of health services has been modified in many settings to focus on managing COVID-19 cases. Thus, the health system has struggled to maintain essential health services while trying to control infection. In fact, out of all health services, maternal or obstetric health services could have been affected the most, as in previous infectious disease outbreaks [4]. MHC workers, including doctors, nurses, and midwives, were among the healthcare workers who served at the frontline during the COVID-19 pandemic to detect, control, and stop the spread of the disease to provide well-prepared obstetric services. Therefore, to ensure that MHC workers are safe from exposure to future diseases during employment or healthcare-related infections, risk mitigation strategies including Infection Prevention and Control (IPC) should be enforced [5]. Despite the continued efforts of the IPC, this increased infection rate signals that these mitigation measures were inadequate at all levels, as well as pointing to a potential critical point towards failure in efforts to provide well-prepared obstetric services during the COVID-19 pandemic. The fact that healthcare workers including MHC workers continued to be infected were a source of infection during this critical public health time exposed weaknesses in the readiness of obstetric services and global readiness efforts [5]. Therefore, it is very important for MHC workers to have a good level of obstetric service preparedness especially during the COVID-19 or during other pandemics as maternal patients are more susceptible to COVID-19 infection and severe pneumonia (due to physiological changes in the immune and cardio-pulmonary system during pregnancy) and death than other patients or populations [6], [7]. Recent studies conducted in Sweden and the United States have shown that pregnant and postnatal women faced an increased risk of more severe complications related to COVID‐19 than non-pregnant women of the same age. COVID-19 prevention should be emphasized for pregnant women and potential obstacles in complying with these measures need to be addressed [8], [9]. Therefore, it is necessary for MHC workers to have good obstetric service readiness especially during the COVID-19 pandemic. Several researchers have studied issues covering the preparedness of healthcare systems for COVID-19 including the availability of obstetric services, especially in developing countries, where resources and facilities are limited. Many concerns have been raised about the readiness of these countries to this COVID-19 pandemic and their ability to maintain such control. Since healthcare workers including MHC workers are the main role that interact with many maternity patients and are an important source of exposure to infected cases while in healthcare, they are also expected to be at high risk of infection. Therefore, by the end of January 2020, WHO and CDC have proposed recommendations for the prevention and control of COVID-19 for healthcare workers including MHC workers [10]. WHO had also initiated several online training sessions and materials on COVID-19 in various languages provided to strengthen preventive knowledge and strategies, including raising awareness and training healthcare workers including MHC workers in readiness activities [11], [12]. In some situations, misunderstandings among MHC workers have slowed control efforts to provide the necessary treatment and have led to the rapid spread of infection in hospitals and endangered the lives of patients [13], [14], [15]. There were shortages of personal protective equipment (PPE) and insufficient training for MHC workers, especially in countries with limited resources. Therefore, it is important to assess obstetric service preparedness and to implement screening for patients admitted to the obstetric unit to reduce the risk to MHC workers. Adequate or prepared obstetric services depend on several factors, including the attitude and skills of healthcare practitioners and the resources allocated to the hospitals. Many hospitals and healthcare programs had been affected, leading to a crisis within the hospital due to staff shortages, fatigue, and other factors. There were concerns for countries with limited resources in terms of the availability of their obstetric services to manage the COVID-19 pandemic [2]. As MHC workers who are part of the front line against the COVID-19 pandemic, their knowledge, awareness, and attitude towards COVID-19 are crucial in controlling and minimizing exposure and spread of infection to better manage maternity patients during this COVID-19 pandemic and be prepared to provide good obstetric services. Government hospitals in the state of Selangor, Malaysia, were selected in this study as the state of Selangor continued to record the highest number of COVID-19 cases in the country. In March 2021 in Malaysia, over 300 thousand cases were reported with over 1,000 deaths recorded at the same time, with the state of Selangor reported to have the highest number of cases with over 100 thousand cases. A year later in March 2022, more than four million total cases were reported and over 30,000 deaths were recorded, with the state of Selangor still recording the highest number of cases exceeding 1.3 million and over 10 thousand deaths recorded [16]. In addition, 1,359 healthcare workers have been infected with COVID-19 since the third wave of the pandemic began in September 2020, bringing the confirmed cases to date among healthcare workers in the country to 1,771 and the group of healthcare workers with the highest number of COVID-19 infections being Nurses (690 cases) followed by Medical Officers (211 cases). As for the source of infection, 587 healthcare workers were infected by the community, 565 cases from transmission among colleagues, 152 from patients who had not been diagnosed with COVID-19, 58 of whom were unknown while 409 were still under investigation [17]. According to a global cross-sectional study by Semaan (2020) that was carried out during the early hours of the pandemic (between March 24 to April 10, 2020), the experience of frontline MHC workers was documented in 81 countries and had 714 respondents, of which 47% were from low- and middle-income countries (LMICs). Studies showed only one-third of respondents received training on COVID-19 from their health facilities, and almost all of them were looking for information about COVID-19 on their own. Only half of respondents in LMICs received the latest guidelines for care protocols compared with 82% in high-income countries (HIC). Overall, only 47% of participants in LMICs and 69% in HICs felt they had a lot of knowledge on how to care for maternity patients infected with COVID-19. Preparations at the facility level against COVID-19 (signage, inspection, testing, and isolation rooms) were more at HIC compared to LMICs. There was also a widespread perception of a reduction in the routine use of maternity care services and modifications in the care process. Moreover, globally there were 90% of respondents reported that they faced higher levels of stress during the pandemic [18]. Since the Semaan study (2020), WHO has produced guidelines for managing COVID-19 and for maintaining essential health services. This has been practiced by many countries in sub-Saharan Africa or similar to it to strengthen the responsiveness of their health systems [19]. These guidelines contain key proposals to optimize health capacity, including recruitment, reuse in training and skills capacity, redistributing roles among health workers while keeping health workers safe, as well as providing mental and psychosocial support. However, it was not clear to what extent these guidelines have been implemented in health facilities and how they have affected health facility administrators' perceptions of their facility's readiness to manage COVID-19. Other studies have also assessed readiness to manage COVID-19 in terms of assessment of health workers' knowledge, attitudes, and practices, but these studies did not explore complex interactions between fear, anxiety, stress, support systems and health facility preparedness [20], [21]. Generally, there are still many knowledge gaps that exist in the guidance on the management of cases of maternity patients especially those infected with COVID-19. Official information sharing channels for the administration of health facilities must be established and mental health support should be provided. Therefore, a review of the administrative preparedness at obstetric facilities can help detect conditions, unravel innovation, and support rapid development of effective responses. Therefore, this study can provide an overview of these matters and the impact of the COVID-19 pandemic on the maternal healthcare system in Malaysia, as there are currently no such studies or surveys conducted in this region. Methods Study Design, Study setting and Sampling A cross-sectional study using quantitative data analysis was conducted among MHC workers (doctors, nurses, and midwives) in the Department of Obstetrics and Gynecology in all 10 government hospitals located in all districts in the state of Selangor, Malaysia, between May 2022 till June 2022. Government hospitals in the state of Selangor, Malaysia, were selected in this study as the state of Selangor continued to record the highest number of COVID-19 cases in the country, with the highest number healthcare workers that have been infected with COVID-19, as well as having the highest number of deaths due to COVID-19 [16], [17]. Four hundred and nine respondents participated in this study and they were selected by proportionate stratified random sampling method. The proportion (percentage) of the number of respondents required from each hospital is determined by the number of their MHC workers relative to the entire target population, which is the total number of MHC workers in government hospitals in the state of Selangor, Malaysia. It determines the number of respondents representing each hospital to meet the sample size of 359 respondents (minimum recommended sample size) required for this study ( Figure 1 ). Following this, the selection of specific respondents from each hospital was then selected through computer-assisted random sampling using SPSS version 28. Study Tool This questionnaire was adapted from two studies by Elhadi et al. (2020) which was mostly based on service preparedness checklists by WHO and CDC [22]. Some of those questions were based on a framework similar to the studies conducted earlier on infectious disease outbreaks [23][24], [25], [26]. Reliability for knowledge, awareness & attitude and preparedness questionnaires was determined using Cronbach alpha, which each revealed a score of 0.72 for knowledge and awareness scales, and 0.68 for attitude and the obstetric service preparedness scale respectively. This questionnaire has also been prepared in the Malay language version that was translated from the original language (English). To assess the respondent's level of obstetric service preparedness, each correct answer was assigned a score of 1, and the wrong answer was given a score of zero. The score for this 4 th part was summed up for a total score of 32, which ranges from 0 to 32 (score included for answers to sub-unit questions). Those who scored ≥22 was considered to have a good level of obstetric service preparedness, while a score of <22 was considered to have poor levels of obstetric service preparedness. Data Collection Data collection was done through dissemination of the validated questionnaire using Google form via WhatsApp application. Respondents did not need to sign in to any account to fill out this questionnaire. The questionnaire took about 20 minutes in average to complete. The accompanying consent form was completed first by the respondent before proceeding to participate in the survey. The data were then analyzed by using the SPSS version 28 to explore the distribution and association between the knowledge, awareness, attitude, and obstetric services preparedness during this COVID-19 pandemic. Results Background of the respondents The results showed that out of 409 respondents, the majority of the respondents i.e. 403 (98.5%) were female respondents, while only 6 (1.5%) were male respondents. From these statistics, we can make the general impression that the number of female respondents was significantly greater than male respondents. There was a wide age range among respondents, with the youngest aged 23 and the oldest aged 58. The results showed that respondents aged 35–45 years showed the highest number of 199 (48.7%), followed by respondents aged 45 years old with 70 (17.1%). The average age of the respondents was 38.38 ± 7.17 years. In terms of profession, most respondents involved were nurses or midwives i.e. 358 people (87.6%), while the medical staffs were 33 (8.0%), followed by specialist doctors, 18 (4.4%). For the duration aspect of working experience for the respondents, majority 380 (92.9%) respondents had more than five years of working experience while only 7.1% of respondents had less than five years of experience. There was a large range of total hours worked (in a week) among respondents with a minimum of 40 hours up to a maximum of 145 hours. Most of the respondents (65.0%) worked more than 45 hours a week. The average number of hours respondents worked in a week was 50.19 ± 12.38 hours. More than half of respondents (55.3%) stated that the average number of hours worked per week was more than before the COVID-19 pandemic. There was also a large range of total number of shifts (within a month) among respondents with a minimum of 20 shifts up to a maximum of 77 shifts. Most of the respondents (75.6%) worked more than 25 shifts per month. The average number of shifts in a month was 27.25 ± 6.33 shifts. However, less than half of respondents (48.7%) stated that the average number of shifts in a month was more than before this COVID-19 pandemic. Majority of respondents (85.1%) were from seven hospitals in urban areas, while only 14.6% of them were from three hospitals in rural areas. Majority respondents (89.2%) worked in the same hospital more than a year. The most frequently obtained sources of information by respondents about COVID-19 were from their workplaces (50.9%), followed by from government sources (48.9%) and social media (41.3%). For history of previous epidemic/pandemic experience, only 40.8% respondents had no history of previous outbreaks. Meanwhile, 33.9% of respondents had history with severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS) outbreaks, 21.9% had a history with Bird Flu outbreaks, 7.6% had a history with the H1N1 outbreak, 3.4% had a history with the Japanese Encephalitis (JE) outbreak, 0.7% had a history with the Ebola epidemic, and the remaining 1.4% of respondents had a history with the Diphtheria, Measles, Cholera and Chikungunya outbreak. The results also showed that in the previous one year, only 243 people (59.4%) felt confident and prepared to manage and treat COVID-19 patients, while only 113 people (27.6%) felt slightly confident. In addition, only 5.6% of respondents felt very confident in managing and treating COVID-19 patients, while 7.3% of respondents felt unconfident. As for the current time, majority of 271 respondents (66.3%) felt more confident and prepared in managing and treating COVID-19 patients, and 73 (17.8%) of them felt very confident. Only 15.4% of respondents felt slightly more confident, and very few (0.5%) of them still felt unconfident in managing and treating COVID-19 patients at the current time ( Table 1 ). Knowledge and awareness of MHC workers during the COVID-19 pandemic The results showed that the majority 407 (99.5%) respondents knew the symptoms of COVID-19 infection, 381 (93.2%) of them knew the latest information on the definition of cases for COVID-19 infection, 406 (99.3%) of them knew how to use PPE correctly in the event of exposure to COVID-19 infection currently, and 404 (98.8%) of them knew how to properly wash their hands and hand hygiene care in line with WHO and CDC guidelines currently. However, only 37.4% of respondents knew the main type of treatment for COVID-19 infection and only 40.3% of respondents knew the most common way of spreading COVID-19 infection. In addition, only 34.7% of respondents knew how to reduce the risk of COVID-19 infection ( Table 2 ). The mean score for knowledge and awareness factors is 14.20 ± 1.66 (total score = 17). Majority 378 (92.2%) respondents had good level of knowledge and awareness regarding COVID-19 pandemic ( Table 5 ). Attitude of MHC workers towards COVID-19 pandemic The results showed that during the previous year, majority of the respondents i.e. 305 (74.6%) respondents had increased in stress level, 321 (78.5%) respondents felt very tired from work caused by the COVID-19 pandemic, 254 (62.1%) respondents felt fear of contracting COVID-19 which would hinder their ability to provide quality obstetric health services, and 277 (67.7%) respondents felt stigmatized by the community. However, only half of the respondents (50.1%) felt protected from COVID-19 infection in their workplace, and only 58.2% felt ready to manage the COVID-19 pandemic. Meanwhile, at the present time, majority 307 (75.1%) respondents felt more protected from COVID-19 infection at their workplace, and 384 (93.9%) felt ready to manage the COVID-19 pandemic. However, currently 32.3% of respondents still felt their stress level increasing, 36.9% of respondents felt their work as healthcare workers were still getting stigmatized from the community, and 31.3% of respondents still felt very tired or burnout from work caused by the COVID-19 pandemic ( Table 3 ). The mean score for the attitude factor is 8.17 ± 2.87 (total score = 15). Only about half (54.0%) of the respondents had a positive attitude towards COVID-19 ( Table 5 ). Obstetric services preparedness during the COVID-19 pandemic The findings showed that during the previous year, majority 377 (92.2%) respondents said that they had been informed by the hospital/obstetric unit administration regarding the protocol for triage and isolation for suspected COVID-19 cases, 389 (95.1%) respondents said that they have been informed regarding the isolation procedures, and 391 (95.6%) respondents said that their hospital/obstetric unit provided isolation room for suspected or confirmed COVID-19 cases for maternity patients. In addition, 326 (79.7%) respondents said they knew how to report potential cases for COVID-19 and be ready to do so, 85.8% of them said they knew the protocol that need to be done if they have any signs of contracting COVID-19, and 76.8% of them said they knew how to make an assessment for a patient who is under investigation. However, 22.5% of respondents said that there were no training courses for COVID-19 management been given, 26.9% of them said that there were no dedicated teams provided by the hospital/obstetric unit in the management and treatment of pregnant/maternity mothers who have COVID-19, 11.0% of them said obstetric emergency services (surgical room for Caesarean section surgery/any obstetric emergency surgery/procedure) were not available for maternity patients for suspected or confirmed cases of COVID-19, and 11.5% of them said that they were not sure that their hospitals/ obstetric units were prepared to manage COVID-19 pandemic. Meanwhile, at the present time, majority 393 (96.1%) respondents said that currently they have been informed by their hospitals/obstetric units regarding the protocol for triage and isolation for suspected COVID-19 cases and 96.8% of them said that they have been informed regarding the isolation procedure. In addition, majority 397 (97.1%) respondents said that currently their hospitals/obstetric units provided isolation rooms for suspected or confirmed COVID-19 cases for maternity patients, and 83.1% of them said that obstetric emergency services (surgical room for Caesarean section surgery/any obstetric emergency surgery/procedure) were available for maternity patients for suspected or confirmed cases of COVID-19. Moreover, majority 378 (92.4%) respondents said that currently they knew how to report potential cases for COVID-19 and were ready to do so, 96.3% of them knew the protocol that need to be adhered to if they had any signs of contracting COVID-19, 86.8% of them knew the safety measures for aerosol transmission for maternity patients infected with COVID-19, 93.9% of them knew how to make an assessment for a patient who was under investigation, and 95.6% of the respondents were sure that their hospitals/obstetric units was prepared to manage the COVID-19 pandemic currently. However, there were 119 (29.1%) respondents said that there were no training courses for COVID-19 management been given, and 29.6% of them said that there were no dedicated teams provided by the hospital/obstetrics unit in the management and treatment of pregnant/maternity mothers who have COVID-19 ( Table 6 ). The mean score for obstetric service preparedness is 25.93 ± 4.87 (total score = 32). Majority 362 (88.3%) respondents had good level of obstetric service preparedness during the COVID-19 pandemic ( Table 5 ). Relationship between background of respondents, knowledge, awareness, attitudes, and obstetric services preparedness A paired t-test was done to identify any significant differences between previous 1 year ago (the peak time of the COVID-19 pandemic) and the present time for MHC workers' knowledge and awareness factor, attitudes factor, and obstetric services preparedness during the COVID-19 pandemic. The findings showed significant differences (p < 0.05) between the previous 1 year (the peak time of the COVID-19 pandemic) and the current time for the following factors which were: 1) knowledge of proper use of PPE in the event of exposure to COVID-19; 2) adequate preparation of PPE in the obstetric unit; 3) adequate provision of soap, water and disinfectants for health workers, patients, and visitors in the obstetric unit; 4) adequate provision of adequate face masks for health workers, patients, and visitors in the obstetric unit; 5) increased level of self-stress; 6) feeling protected from COVID-19 infection at work; 7) work as a health worker gets stigma from society; 8) always feeling very tired from work caused by the COVID-19 pandemic; 9) feeling ready to manage the COVID-19 pandemic; 10) knowledge of the protocols to be made in case of any signs of contracting COVID-19; and 11) knowledge of safety measures for aerosol transmission for maternity patients infected with COVID-19 ( Table 6 ). Furthermore, there was a significant relationship (p < 0.05) that was positive and weak between knowledge and awareness factor (r = 0.330) and attitude factor (r = 0.227) with obstetric services preparedness. This result indicates that with increasing scores for knowledge and awareness factor and scores for attitude factor, will result in higher scores for obstetric service preparedness. Linear regression analysis was done to look at predicting factors that have the potential to influence the level of obstetric services preparedness. The confidence interval (CI) was set at 95% and the p-value < 0.05 was set as statistically significant. Before conducting a multiple linear regression (MLR) test, all factors or variables went through a simple linear regression test by using the 'Enter' method. Following that the MLR test was conducted using the ' Forward ', 'Backward' and 'Stepwise' methods. For the last model, the 'Stepwise' method was selected. Table 1. Distribution for the background of respondent (N=409) Variable N (%) Mean (SD) A. SOCIODEMOGRAPHIC CHARACTERISTICS Gender Male Female 6 (1.5) 403 (98.5) Age 45 years old 140 (34.2) 199 (48.7) 70 (17.1) 38.39 (7.17) Profession Specialist doctor Medical officer Nurse or midwifery Duration of working experience Less than 5 years More than 5 years 18 (4.4) 33 (8.0) 358 (87.6) 29 (7.1) 380 (92.9) Total hours worked in a week <45 hours ≥45 hours 143 (35.0) 266 (65.0) 50.19 (12.38) Is the average number of hours working in a week more than before the pandemic? Yes No 226 (55.3) 183 (44.7) Total number of shifts in a month <25 shifts ≥25 shifts 99 (24.1) 310 (75.8) 27.25 (6.33) Is the average number of shifts in a month more than before the pandemic? Yes No 199 (48.7) 210 (51.3) Current working place Hospital Serdang Hospital Kajang Hospital Selayang Hospital Sungai Buloh Hospital Shah Alam Hospital Tengku Ampuan Rahimah Hospital Kuala Kubu Bharu (rural area) Hospital Banting Hospital Tanjung Karang (rural area) Hospital Tengku Ampuan Jemaah (rural area) Hospitals in urban area Hospitals in rural area 17 (4.2) 70 (17.1) 120 (29.3) 58 (14.2) 50 (12.2) 14 (3.4) 20 (4.9) 20 (4.9) 16 (3.9) 24 (5.9) 349 (85.3) 60 (14.7) Does the period of work in the current place exceed a year? Yes No 365 (89.2) 44 (10.8) B. SOURCES OF INFORMATION OBTAINED ABOUT COVID-19 Value of frequency of sources of information obtained about COVID-19 i) government resources The most frequent Frequently Less frequent The least frequent ii) internet The most frequent Frequently Less frequent The least frequent iii) social media The most frequent Frequently Less frequent The least frequent iv) Workplaces The most frequent Frequently Less frequent The least frequent 200 (48.9) 121 (29.6) 36 (8.8) 52 (12.7) 132 (32.3) 130 (31.8) 87 (21.3) 60 (14.7) 169 (41.3) 130 (31.8) 74 (18.1) 36 (8.8) 208 (50.9) 128 (31.3) 30 (7.3) 43 (10.5) C. HISTORY OF PREVIOUS PANDEMIC/OUTBREAKS Bird Flu MERS and SARS No experience 90 (21.9) 139 (33.9) 167 (40.8) Others: Diphtheria Ebola H1N1 Japanese Encephalitis Cholera Chikungunya Measles 1 (0.2) 3 (0.7) 30 (7.6) 13 (3.4) 1 (0.2) 2 (0.5) 2 (0.5) D. CONFIDENCE IN THE MANAGEMENT OF THE COVID-19 PANDEMIC Feeling confident and prepared in managing and treating COVID-19 patients over THE PAST 1 YEAR Not confident Slightly confident Confidently Very confident 30 (7.3) 113 (27.6) 243 (59.5) 23 (5.6) Feeling confident and prepared in managing and treating COVID-19 patients AT PRESENT Still not confident Slightly more confident More confident Very confident 2 (0.5) 63 (15.4) 271 (66.3) 73 (17.8) Table 2. Distribution of knowledge and awareness factors of MHC workers during the COVID-19 pandemic (N=409) Knowledge and Awareness Factors N (N=409) (%) All the below are the symptoms of COVID-19 infection EXCEPT? Rashes Headache Sore throat and flu 407 1 1 99.6 0.2 0.2 What is the MAIN type of treatment for COVID-19 infection? Supportive care Anti-virus treatment Vaccination 153 30 226 37.4 7.3 55.3 Do you know the latest information on the definition of cases for COVID-19 infection? Yes No 381 28 93.2 6.8 What is the most common mode of transmission for COVID-19 infection? Air Contact Oral feces All of the above None in the above 165 46 3 190 5 40.3 11.2 0.8 46.5 1.2 How to reduce the risk of transmission of COVID-19 infection? Hand hygiene Close the nose and mouth during coughing Avoid close contact with patient Eat fully cooked eggs and meat All of the above options 93 99 74 1 142 22.7 24.2 18.1 0.3 34.7 Do you know how to use personal protective equipment (PPE) correctly in the event of exposure to COVID-19 infection AT 1 YEAR AGO? Yes, I know No, I do not know 366 43 89.5 10.5 Do you know how to use personal protective equipment (PPE) correctly in the event of exposure to COVID-19 infection CURRENTLY? Yes, I know No, I do not know 406 3 99.3 0.7 Are PPEs been adequately provided in your obstetric unit AT 1 YEAR AGO? Yes No 334 75 81.7 18.3 Are PPEs been adequately provided in your obstetric unit CURRENTLY? Yes No 382 27 93.4 6.6 Do you know how to properly wash your hands and hand hygiene care in line with WHO and CDC guidelines AT 1 YEAR AGO? Yes, I know No, I do not know 402 7 98.3 1.7 Do you know how to properly wash your hands and hand hygiene care in line with WHO and CDC guidelines CURRENTLY? Yes, I know No, I do not know 404 5 98.8 1.2 Are soap, water and disinfectant provided sufficiently for healthcare workers, patients, and visitors in your obstetric unit AT 1 YEAR AGO? Yes No 383 26 93.6 6.4 Are soap, water and disinfectant provided sufficiently for healthcare workers, patients, and visitors in your obstetric unit CURRENTLY? Yes No 405 4 99.0 1.0 Are cleaning activities done more frequently in your obstetric unit during this COVID-19 pandemic AT 1 YEAR AGO? Yes No 365 44 89.2 10.8 Are cleaning activities done more frequently in your obstetric unit during this COVID-19 PANDEMIC CURRENTLY? Yes No 361 48 88.3 11.7 Are masks adequately provided for healthcare workers, patients, and visitors in your obstetric unit AT 1 YEAR AGO? Yes No 352 57 86.1 13.9 Are masks adequately provided for healthcare workers, patients, and visitors in your obstetric unit CURRENTLY? Yes No 397 12 97.1 2.9 Table 3. Distribution of MHC workers' attitudes towards COVID-19 pandemic (N=409) Variable n (%) (N=409) Agree Disagree Not sure Your self-stress levels increased at 1 YEAR AGO 305 (74.6) 54 (13.2) 50 (12.2) Your self-stress levels are increasing CURRENTLY 132 (32.3) 215 (52.6) 62 (15.2) Your self-stress levels are higher now than 1 year ago 110 (26.9) 249 (60.9) 50 (12.2) At 1 YEAR AGO, you feel protected from COVID-19 infection in your workplace 205 (50.1) 143 (35.0) 61 (14.9) You feel more protected from COVID-19 infection at your workplace CURRENTLY 307 (75.1) 45 (11.0) 57 (13.9) Fear of contracting COVID-19 will hinder your ability to provide quality obstetric health services 254 (62.1) 132 (32.3) 23 (5.6) My work as a healthcare worker has been stigmatized by the community 1 YEAR AGO 277 (67.7) 85 (20.8) 47 (11.5) My work as a healthcare worker is getting stigmatized from the community CURRENTLY 151 (36.9) 193 (47.2) 65 (15.9) My job as a healthcare worker is getting more stigmatized from the community currently than 1 year ago 72 (17.6) 265 (64.8) 72 (17.6) Always feeling very tired from work caused by the COVID-19 pandemic at 1 YEAR AGO 321 (78.5) 61 (14.9) 27 (6.6) Always feeling very tired from work caused by the COVID-19 pandemic CURRENTLY 128 (31.3) 231 (56.5) 50 (12.2) Feeling very tired from work caused by the COVID-19 pandemic currently more than 1 year ago 82 (20.0) 273 (66.7) 54 (13.2) Feeling ready to manage the COVID-19 pandemic at 1 YEAR AGO 238 (58.2) 105 (25.7) 66 (16.1) Feeling ready to manage the COVID-19 pandemic CURRENTLY 384 (93.9) 6 (1.5) 19 (4.6) CURRENTLY feel more ready to manage the COVID-19 pandemic than 1 year ago 375 (91.7) 10 (2.4) 24 (5.9) Table 4. Distribution for obstetric services preparedness during the COVID-19 pandemic (N=409) Variable n (%) (N=409) Yes No Not sure Are there any training courses for COVID-19 management been given at 1 YEAR AGO? 293 (71.6) 92 (22.5) 24 (5.9) Are there any training courses for COVID-19 management been given CURRENTLY? 255 (62.3) 119 (29.1) 35 (8.6) Currently training courses for COVID-19 management are given MORE than previous 1 year ago 170 (41.6) 158 (38.6) 81 (19.8) Have you been informed by the hospital/obstetric unit administration regarding the protocol for triage and isolation for suspected COVID-19 cases at 1 YEAR AGO? 377 (92.2) 16 (3.9) 16 (3.9) Have you been informed by the hospital/obstetric unit regarding the protocol for triage and isolation for suspected COVID-19 cases CURRENTLY? 393 (96.1) 6 (1.5) 10 (2.4) Currently, protocol notification for triage and isolation for suspected COVID-19 cases is given MORE by hospitals/obstetric units than previous 1 year ago 291 (71.1) 75 (18.3) 43 (10.5) Does your hospital/obstetric unit provide isolation room for suspected or confirmed COVID-19 cases for maternity patients at 1 YEAR AGO? 391 (95.6) 12 (2.9) 6 (1.5) Does your hospital/obstetric unit provide isolation rooms for suspected or confirmed COVID-19 cases for maternity patients CURRENTLY? 397 (97.1) 7 (1.7) 5 (1.2) Currently, isolation rooms for suspected or confirmed COVID-19 cases for maternity patients are MORE provided by hospitals/obstetric units than previous 1 year ago 216 (52.8) 155 (37.9) 38 (9.3) Have you been informed by the hospital/obstetric unit administration regarding the isolation procedures at 1 YEAR AGO? 389 (95.1) 8 (2.0) 12 (2.9) Have you been informed by the hospital/obstetric unit administration regarding the isolation procedure CURRENTLY? 396 (96.8) 7 (1.7) 6 (1.5) Currently, the notification of isolation procedures is given MORE by hospitals/obstetric units administration than previous 1 year ago 262 (64.1) 108 (26.4) 39 (9.5) Are the obstetric emergency services (surgical room for Caesarean section surgery/any obstetric emergency surgery/procedure) available for maternity patients for suspected or confirmed cases of COVID-19 at 1 YEAR AGO? 336 (82.2) 45 (11.0) 28 (6.8) Are the obstetric emergency services (surgical room for Caesarean section surgery/any obstetric emergency surgery/procedure) available for maternity patients for suspected or confirmed cases of COVID-19 CURRENTLY? 340 (83.1) 38 (9.3) 31 (7.6) Currently, obstetric emergency services (surgical room for Caesarean section surgery/any obstetric emergency surgery/procedure) for maternity patients for suspected or confirmed cases of COVID-19 are MORE provided by the hospital/unit 219 (53.5) 127 (31.1) 63 (15.4) Are there any dedicated teams provided by the hospital/obstetric unit in the management and treatment of pregnant/maternity mothers who have COVID-19 at 1 YEAR AGO? 270 (66.0) 110 (26.9) 29 (7.1) Are there any dedicated teams provided by the hospital/obstetrics unit in the management and treatment of pregnant/maternity mothers who have COVID-19 CURRENTLY? 266 (65.0) 121 (29.6) 22 (5.4) Do you know how to report potential cases for COVID-19 and be ready to do so at 1 YEAR AGO? 326 (79.7) 38 (9.3) 45 (11.0) Do you know how to report potential cases for COVID-19 and are ready to do so CURRENTLY? 378 (92.4) 8 (2.0) 23 (5.6) Currently know more on how to report potential cases for COVID-19 and more ready to do so than previous 1 year ago 373 (91.2) 7 (1.7) 29 (7.1) Do you know the protocol that need to be done if you have any signs of contracting COVID-19 at 1 YEAR AGO? 351 (85.8) 33 (8.1) 25 (6.1) Do you know the protocol that need to be done if you have any signs of contracting COVID-19 CURRENTLY? 394 (96.3) 3 (0.7) 12 (2.9) Currently know more of the protocols that need to be done in case of having signs of contracting COVID-19 compared to previous 1 year ago 380 (92.9) 8 (2.0) 21 (5.1) Do you know the safety measures for aerosol transmission for maternity patients infected with COVID-19 at 1 YEAR AGO? 294 (71.9) 54 (13.2) 61 (14.9) Do you know the safety measures for aerosol transmission for maternity patients infected with COVID-19 CURRENTLY? 355 (86.8) 13 (3.2) 41 (10.0) Currently know more about safety measures for aerosol transmission for maternity patients infected with COVID-19 than previous 1 year ago 344 (84.1) 18 (4.4) 47 (11.5) Do you know how to make an assessment for a patient who is under investigation at 1 YEAR AGO? 314 (76.8) 39 (9.5) 56 (13.7) Do you know how to make an assessment for a patient who is under investigation CURRENTLY? 381 (93.9) 8 (2.0) 20 (4.9) CURRENTLY know more on how to make assessments for patients under investigation than previous 1 year ago 367 (89.7) 11 (2.7) 31 (7.6) Are you sure that your hospital/ obstetric unit is prepared to manage COVID-19 pandemic at 1 YEAR AGO? 311 (76.0) 47 (11.5) 51 (12.5) Are you sure that your hospital/obstetric unit is prepared to manage the COVID-19 pandemic CURRENTLY? 391 (95.6) 5 (1.2) 13 (3.2) Currently in obstetric hospitals/units are more confident to manage the COVID-19 pandemic compared to previous 1 year ago 387 (94.6) 5 (1.2) 17 (4.2) Table 5. Distribution of mean score and the level of knowledge level and awareness, attitude, and obstetric services preparedness for MHC workers (N=409) Factors Mean score Level Good/Positive Poor/Negative Knowledge and awareness 14.20±1.66 92.2% (score ≥12) 7.8% (score <12) Attitude 8.17±2.87 54.0% (score ≥8) 46.0% (score <8) Obstetric services preparedness 25.93±4.87 88.3% (score ≥22) 11.7% (score <22) Table 6. Comparison between previous 1 year ago (the peak time of the COVID-19 pandemic) and currently for MHC workers' knowledge and awareness factors on COVID-19, attitudes towards the COVID-19 pandemic, and obstetric services preparedness during the COVID-19 pandemic (N=409) Comparison between a year ago and now Mean SD SEM 95% CI of the Difference t P-value Lower Upper Knowledge of proper use of PPE in the event of exposure to COVID-19 -0.098 0.313 0.015 -0.128 0.067 -6.310 <0.001* Adequate preparation of PPE in the obstetric unit -0.117 0.385 0.019 -0.155 -0.080 -6.170 <0.001* Knowledge of the right way to wash hands and hand hygiene care in line with WHO and CDC guideline -0.005 0.156 0.008 -0.020 0.010 -0.632 0.528 Adequate provision of soap, water and disinfectants for health workers, patients, and visitors in the obstetric unit -0.054 0.247 0.012 -0.078 -0.030 -4.411 <0.001* Cleaning activities are carried out more frequently in the obstetric unit during the COVID-19 pandemic 0.010 0.383 0.019 -0.027 0.047 0.303 0.606 Provision of adequate face masks for health workers, patients and visitors in the obstetric unit -0.110 0.350 0.017 -0.144 -0.076 -6.353 <0.001* Increased level of self-stress 0.364 0.799 0.040 0.287 0.442 9.217 <0.001* Feeling protected from COVID-19 infection at workplace -0.230 0.751 0.037 -0.303 -0.157 -6.185 <0.001* Work as a health worker gets stigma from society 0.220 0.725 0.036 0.150 0.290 6.142 <0.001* Always feeling very tired from work caused by the COVID-19 pandemic 0.359 0.661 0.033 0.295 0.424 11.000 <0.001* Feeling ready to manage the COVID-19 pandemic -0.127 0.617 0.031 -0.187 -0.067 -4.166 <0.001* Provision of training courses for the management of the COVID-19 pandemic 0.039 0.597 0.030 -0.019 0.097 1.325 0.186 Notification by the hospital/obstetric unit regarding protocols for triage and isolation for suspected COVID-19 cases -0.010 0.313 0.015 -0.040 0.021 -0.632 0.528 Provision of isolation room for suspected or confirmed COVID-19 cases for maternity patients by hospital/obstetric unit -0.010 0.232 0.011 -0.032 0.013 -0.853 0.394 Notification by the hospital/obstetric unit regarding isolation procedures 0.012 0.247 0.012 -0.012 0.036 1.000 0.318 Provision of obstetric emergency services for maternity patients for suspected or confirmed cases of COVID-19 -0.024 0.304 0.015 -0.054 0.005 -1.625 0.105 Provision of dedicated teams by hospitals/obstetric units in management and treatment for pregnant/maternity mothers with COVID-19 0.044 0.473 0.023 -0.002 0.090 1.882 0.060 Knowledge to report potential cases for COVID-19 and be prepared to do so -0.020 0.448 0.022 -0.063 0.024 -0.883 0.378 Knowledge of the protocols that need to be done if any signs of contracting COVID-19 -0.042 0.365 0.018 -0.077 -0.006 -2.304 0.022* Knowledge of safety measures for aerosol transmission for maternity patients infected with COVID-19 -0.051 0.490 0.024 -0.099 -0.004 -2.120 0.035* Knowledge in making assessments for patients under investigation 0.012 0.434 0.021 -0.030 0.054 0.569 0.569 Confidence that hospitals/obstetric units are ready to manage the COVID-19 pandemic -0.010 0.475 0.023 -0.056 0.036 -0.417 0.677 A paired t-test was done. Significant at p<0.05. SD: Standard Deviation. SEM: Standard Error Mean . CI: Confidence Interval Table 7 Linear relationship between background factor, knowledge and awareness factor and attitude factor with obstetric service readiness (N = 409). Factors B SE Statistics t P-value 95% CI for difference Lower Limit Upper Limit Gender -1.460 2.014 -0.725 0.469 -5.420 2.500 Age 0.012 0.035 0.343 0.732 -0.056 0.080 Profession -0.453 0.893 -0.507 0.613 -2.208 1.303 Work duration -2.226 1.037 -2.146 0.033* -4.266 -0.186 The number of hours worked per week -0.021 0.021 -0.972 0.332 -0.062 0.021 The number of shifts per month -0.064 0.036 -1.772 0.077 -0.135 0.007 Workplace 0.695 0.654 1.064 0.288 -0.590 1.981 Government resources 0.017 0.461 0.038 0.970 -0.890 0.925 Internet resources 0.264 0.510 0.517 0.605 -0.739 1.266 Social media resources -0.168 0.472 -0.357 0.721 -1.095 0.759 Workplace resources 0.193 0.463 0.416 0.677 -0.718 1.103 Previous epidemic experience 0.281 0.491 0.571 0.568 -0.685 1.247 Confidence in managing COVID-19 0.622 0.613 1.014 0.311 -0.584 1.828 Knowledge and awareness on COVID-19 0.940 0.135 6.976 < 0.001* 0.675 1.206 Attitudes towards the COVID-19 pandemic 0.449 0.079 5.680 < 0.001* 0.294 0.605 Linear regression test was done. *Significant at p < 0.05. B: Coefficient. SE: Standard Error. CI: Confidence interval. Table 8 Predicting factors affecting the level of obstetric services preparedness. Factors Adj. B SE t P-value 95% CI for difference Lower Limit Upper Limit Knowledge and awareness on COVID-19 0.926 0.132 7.023 < 0.001* 0.666 1.185 Attitudes towards the COVID-19 pandemic 0.463 0.076 6.053 < 0.001* 0.313 0.613 Work duration -1.721 0.850 -2.024 < 0.001* -3.392 -0.050 A multiple linear regression (MLR) test is carried out. *Significant at p < 0.05. Adj. B: Adjusted coefficient. SE: Standard Error. CI: Confidence interval. Dependent variable = Obstetric service preparedness. The results showed that there were significant direct linear relationships (p < 0.001) between: 1) the work duration factor with obstetric services preparedness (B=-1.721, 95% CI: -3.392, -0.050, p < 0.001); 2) knowledge and awareness factor with obstetric service preparedness (B = 0.926, 95% CI: 0.666, 1.185, p < 0.001); 3) attitude factor with obstetric services preparedness (B = 0.463, 95% SK: 0.313, 0.613, p < 0.001) (Tables 7 and 8 ). This means that respondents who have 1 more year of work duration will have a higher obstetric service preparedness score of 1.721, respondents who have 1 more point for knowledge and awareness score will have a higher obstetric service preparedness score of 0.926, and respondents who have 1 more point for the attitude score will have a higher obstetric service readiness score of 0.463. The adjusted value of R 2 for this test was 0.188. This suggests that 18.8% of the variance in obstetric service preparedness can be predicted from working duration factor, knowledge, and awareness factor as well as attitude factor. Additionally, no interaction between these three factors was found. The variant-inflation factor (VIF) was less than 10, indicating that multicollinearity was not a problem in this model. However, for other factors such as age, gender, profession, number of hours worked per week, total number of shifts in a month, place of work, information resources, history of previous pandemic experiences, and confidence in the management of the COVID-19 pandemic showed a p-value of more than 0.05. Therefore, there was no provable relationship or association between these factors and the level of obstetric services preparedness. Discussion COVID-19 infection has put the health system under unprecedented pressure [ 22 ]. Therefore, foresight and planning for service preparedness are key factors to avoid disaster. Every facility that provides obstetric services requires a certain level of readiness to be able to handle at least a suspected COVID-19 pregnant woman waiting for a test report, and for those who need to be managed as COVID-19 positive patients until a report is available. Therefore, these facilities need to have triage or screening areas and isolation rooms for suspected COVID-19. Healthcare facilities need to have designated areas for COVID-19 positive patients or have a referral relationship with a designated COVID-19 positive hospital. Preparations are needed including structural restructuring by providing facilities for suspected COVID-19 and COVID-19-positive maternal patients in sufficient spaces, as well as extensive training among MHC workers on infection control practices and proper use of PPE. In this study, a majority 88.3% of the respondents had a good level of obstetric services preparedness during the COVID-19 pandemic. This percentage was higher than in the study conducted by Patience Afulani et al. (2020) where only 27.8% of respondents had a good level of service preparedness [ 27 ], as well as in the study by Elhadi et. al (2020) of which only 7.8% of respondents had a good level of obstetric services preparedness [ 20 ]. The mean score for obstetric services preparedness in this study was 25.93 ± 4.87. This score was slightly higher than in a study by Patience Afulani et al. (2020) with the mean score of 24 ± 8.9 [ 27 ]. COVID-19 pandemic management training Only 62.3% of respondents in this study stated that they received a training course for the management of the COVID-19 pandemic. This can also be seen in studies by Patience Afulani et al. (2020) and Elhadi et. al (2020) which stated just over half (54% and 56% respectively) of respondents were able to participate in training for COVID-19 case management [ 20 ], [ 27 ]. Similarly, a study by Huy et al. (2021) found that out of 17,302 healthcare workers, less than half of the respondents which was only 6,287 people (36.6%) were able to participate in training for COVID-19 management [ 28 ]. Similar reports from studies in India also show that only about half (56.1%) of respondents received COVID-19-related training and < 50% were satisfied with the quality of training. If more training was given to healthcare workers including MHC workers in preparation for the pandemic as advised by WHO, this will contribute to more trained workforce and better services readiness [ 29 ]. To ensure adequate resources and staff, it is necessary to quickly train many healthcare workers including MHC workers who are at the forefront. Ideally, training and education in preparation for the threat of new infectious diseases should continue and be planned. Specialized training in equipping healthcare workers including MHC workers with knowledge and skills is necessary to provide safer and better care for patients, to reduce mortality during the pandemic and to prevent and control nosocomial infections [ 30 ], [ 31 ]. Although there are key capacities considered in the evaluation for this study, the current COVID-19 pandemic has highlighted the need to increase the number of healthcare workers including sufficiently trained MHC workers. There is still an urgent need for best practices in the development and implementation of training programs during this COVID-19 pandemic [ 32 ]. Screening, procedures, and isolation rooms In this study, most respondents stated that they had been informed by their hospitals/obstetric units about protocols for screening and isolation procedures for suspected COVID-19 cases (96.1% and 96.8% of respondents respectively). Compared to previous one year which only 67.7% of respondents stated that isolation rooms for suspected or confirmed COVID-19 cases were provided for maternity patients, currently majority (97.1%) of respondents reported an increase in the provision of this facility. Meanwhile, in the study by Elhadi et. al (2020) showed that only about 63% of respondents reported that they had isolation procedures, only 43% of hospitals had screening or screening areas for cases of pregnant women suspected of COVID-19, and only 63.8% and 61.5% of respondents stated there were isolation rooms for suspected COVID-19 cases and screening procedures for maternity patients with COVID-19 symptoms respectively [ 20 ]. Whereby in the study by Patience Afulani et al. (2020), only 76% of respondents knew how to report suspected COVID-19 cases and only two-thirds reported that they had isolation wards for COVID-19 cases at the health facility [ 27 ]. Based on the findings of this study, as for screening measures, majority 92.4% of respondents knew how to report potential cases for COVID-19 and were ready to do so compared to previous one year which was only 79.7%. Majority (96.3%) of respondents also knew what protocols to do if they had signs of contracting COVID-19 and 93.9% of respondents said they knew how to make an assessment for patients under investigation (PUI). The study by Patience Afulani et al. (2020) also found that a majority 80% of the respondents reported that their health facilities had protocols for screening for potential COVID-19 patients [ 27 ]. However, this contrasts with a study by Elhadi et al. (2020) in which only two-thirds of respondents (66.7%) reported they knew what to do if they suspected a patient might have COVID-19, only as many as 22% said they knew how to manage confirmed COVID-19 cases, and only a third of respondents (32.8%) were sure about where to quarantine at home without contact with their family [ 20 ]. In addition, 45.1% of doctors and 37.0% of nurses were not ready to manage cases that had signs and symptoms of COVID-19 infection. There were only 21.2% of doctors and 23.9% of nurses knew the criteria for evaluating people investigated for COVID-19 infection, and only 25.0% of doctors knew how to report potential COVID-19 cases. This can lead to an unexpected increase in undiagnosed cases, thus increasing the burden of infection in the community. This situation can highlight the risk of cross-contamination in hospitals and can lead to higher rates of hospital-acquired infections [ 20 ]. Moreover, in this study, majority (86.8%) of respondents were aware of safety measures for aerosol transmission for maternity patients infected with COVID-19. Meanwhile, in the study by Elhadi et. al (2020) showed only about 67.0% of respondents were not prepared to take safety precautions to prevent the transmission of aerosols through individuals suspected of COVID-19 infection, and only about 68% of the participants were aware of measures to prevent the transmission of the COVID-19 virus [ 20 ]. These issues raised fears and concerns over the safety of healthcare workers including MHC workers and their ability to access safety measures as well as question the ability of the healthcare system to prevent hospital-acquired infections. Hospitals can also be contagious sites that spread COVID-19 infections into communities and healthcare workers had the potential to transmit the infection to family members at home [ 33 ]. Obstetric emergency services and dedicated teams for obstetric services For obstetric emergency services which include the operating room for Caesarean section or any obstetric emergency procedure, in this study it was found that more than 80% of respondents stated that it was provided for maternity patients for suspected or confirmed cases of COVID-19. This is in line with the results of a study by Elhadi et al. (2020) in which 81.0% of respondents thought that they could provide care for obstetric emergency cases and 89.1% of respondents stated that their health facilities could perform cesarean section [ 20 ]. As for the dedicated team in the management and treatment of pregnant women, in this study showed only over 60% of the respondents said it was provided by their hospitals/obstetric units. However, the results of the study by Elhadi et. al (2020) showed as many as 70.1% of respondents reported that there was no dedicated team that was designated to treat patients with COVID-19 in the maternity ward [ 20 ]. Relationship between significant factors with obstetric services preparedness In this study, majority or 380 (92.7%) respondents had more than 5 years of working experience. It differs from the study by Elhadi et al. (2020) where only about half of respondents (53.4%) had more than 5 years of working experience [ 20 ], as well as in a study by Huynh et al. (2020a) where most of them had less than 5 years (62.9%) experience [ 34 ]. The findings of this study through multiple linear regression (MLR) test conducted showed that the working duration factor showed a statistically significant direct linear relationship (p < 0.05) with obstetric services preparedness. This is because the more time the respondents' work experience had, the more prepared they will be to provide good obstetric services during the COVID-19 pandemic. This was equivalent to a study by Zewudie et al. (2021) that showed the working duration factor had a statistically significant relationship with service preparedness during COVID-19 (p < 0.001). The findings in the study also showed that having more than five years of working experience is one of the factors (which independently and significantly) predicts readiness to work (AOR = 4.04, CI: 1.05–15.58) [ 35 ]. This was different from the results of studies by Elhadi et al. (2020) and study by Huynh et al. (2020) in which this factor was statistically insignificant (p > 0.05) [ 20 ], [ 34 ]. Through the Pearson correlation test, the findings showed that there was a significant positive and weak relationship between knowledge and awareness factors (r = 0.330, p < 0.001) and attitude factors (r = 0.227, p < 0.001) with obstetric service readiness. This shows that the higher the score for knowledge and awareness factors on COVID-19 and attitude factors towards the COVID-19 pandemic, the higher the score for the availability of obstetric services. The same was true in a study by Saqlain et al. (2020) in which the Pearson correlation test showed a significant and positive and weak linear correlation of knowledge and attitude factors (r = 0.106, p = 0.030) [ 36 ]. Recent studies of knowledge, attitudes and practices or preparedness about COVID-19 reported considerable level of knowledge and positive attitudes contributing to good services preparedness in some countries [ 34 ], [ 36 ], [ 37 ], [ 38 ], [ 39 ]. In other studies, from previous H1N1 outbreaks, knowledge was found to correlate strongly with practice scores or preparedness and attitudes [ 40 ]. Interestingly, the same study found that higher knowledge scores were a significant predictor of higher practice scores or preparedness. It also found that higher knowledge was also a significant predictor of higher attitude scores. These data demonstrate the importance of having sufficient knowledge to be able to provide optimal patient care and good service preparedness. Based on the findings of this study, knowledge and awareness factors had a mean score of 14.20 ± 1.66 (total score = 17) and majority 92.2% of respondents had good level of knowledge and awareness. Similarly in a study by Huynh et al. (2020) in which a total of 327 eligible healthcare workers had a mean knowledge factor score of 8.17 ± 1.3 (range 4–10) and as many as 289 (88.4%) respondents showed good level of knowledge [ 34 ]. This may be due to the success in communication for the prevention and control of COVID-19 in the state of Selangor which contributes to the improvement of knowledge and practices for healthcare workers including MHC workers. Before an effective approach to supporting healthcare workers including MHC workers can be developed, it is important to understand the source of their concerns and fears in detail. This means that focusing more on addressing those concerns should be the focus of support efforts, rather than teaching generic approaches to stress reduction or resilience. This discussion has consistently focused on eight sources of concern, namely: 1) access to appropriate PPE; 2) being exposed to COVID-19 at work and bringing infection home to their families; 3) not having quick access to tests if they experience COVID-19 symptoms and at the same time fear of spreading infection at work; 4) uncertainty that their organization will support/care for their personal and family needs if they are infected infection; 5) access to childcare during working hours due to increased school closures; 6) support for other personal and family needs as working hours and demand increase (food, hydration, accommodation, transportation); 7) can provide efficient medical care if placed in a new area (for example, not an ICU nurse but need to function as an ICU nurse); and 8) lack of access to the latest information and communications. Recognizing the source of these concerns can enable leaders and healthcare organizations to develop targeted approaches to address these concerns and provide specific support to their healthcare workforce [ 41 ]. As there were significant differences (p < 0.05) between previous one year (the peak time of the COVID-19 pandemic) and the present time of this study for many factors in this study, various efforts need to be made continuously to ensure improvement in knowledge, awareness, and attitudes for MHC workers so that they can always be prepared in providing good obstetric services. Among them are: 1) provide regular educational courses for the knowledge of the correct use of PPE in the event of exposure to COVID-19; 2) always ensure adequate supply and preparation of PPE in the obstetric unit; 3) always ensure adequate supply and preparation of soap, water and disinfectants for health workers, patients, and visitors in the obstetric unit; 4) always ensure adequate supply and preparation of masks for health workers, patients, and visitors in the obstetric unit; 5) provide counselling or psychiatric services and perform peers group support for MHC workers who experience increased levels of self-stress, work fatigue and depression. MHC workers are also advised to take self-care measures to create a healthy and cheerful work culture such as working effectively as a team to ease the burden of tasks, building good relationships between colleagues and family members, ready to share and listen to views and advice in case of problems, practice exercise and breathing control techniques to reduce stress, and get enough rest and practice a balanced diet; 6) ensure that all safety measures and SOPs are carried out carefully in all parts and levels in the hospital so that MHC workers feel protected from COVID-19 infection at work; 7) to increase and expand awareness campaigns to the community through various mass media so that jobs as health workers are less stigmatized from the community; 8) adopting the concept of regular rounds of work (Job Rotation) and reducing the number of hours and shifts worked so that MHC workers feel less tired and burn-out from works caused by the COVID-19 pandemic; 9) always provide effective training and continuous education as well as the need for adequate equipment so that MHC workers can feel better prepared to manage the COVID-19 pandemic; 10) ongoing and up-to-date information from the management of facilities and obstetric units to the MHC workers on the protocols and safety measures to reduce aerosol transmission from maternity patients infected with COVID-19. COVID-19 poses a higher risk for doctors and nurses working in maternal health care. Therefore, adequate PPE, proper hand washing methods, and hand hygiene are essential in reducing the transmission and risk of COVID-19 infection in hospitals. Therefore, adequate training, education courses and resources are provided to prevent hospital-acquired infections due to cross-contamination to other patients receiving treatment in the Department of Obstetrics and Gynecology and reduce the risk of exposure to COVID-19 infection to MHC workers. In addition, a comprehensive training program targeting all MHC workers should be provided to promote all COVID-19 precautions and prevention measures to achieve a balance in terms of clinical knowledge of COVID-19. Conclusions Overall, the mean of total score and the level of obstetric services preparedness found from this study was high. Majority 99.5% of the respondents had good knowledge and awareness, while 96.8% of the respondents had a good level of obstetric services preparedness. However, only about half (54.0%) of them had a positive attitude towards COVID-19. Among all the factors involved in this study, there were three predictors that influenced the level of obstetric services preparedness, namely the working duration factor, knowledge, and awareness factor about COVID-19 and attitude factor towards the COVID-19 pandemic. Based on the findings of this study, we proposed several recommendations that are considered appropriate for this study to increase the knowledge and awareness of MHC workers, as well as a positive attitude, so that they can provide better and more optimal obstetric services in the future pandemic/outbreak, as there were still MHC workers with poor knowledge and awareness of COVID-19 and about half of them had negative attitude towards the COVID-19 pandemic. Abbreviations WHO : World Health Organisation CDC : Centers for Disease Control and Prevention COVID-19 : Coronavirus Disease 2019 MHC : Maternal Healthcare IPC : Infection Prevention and Control PPE : Personal Protective Equipment HIC : High-Income Countries LMICs : Low- and Middle-Income Countries SOPs : Standard Operating Procedures Declarations Ethics approval and consent to participate The permission to perform this study was sought from the Selangor State Health Department, and the study proposal was approved by the Medical Research and Ethics Committee, Ministry of Health, Malaysia (NMRR ID-21-02291-DV9) and the Ethics and Research Committee of Universiti Kebangsaan Malaysia (The National University of Malaysia) (Project code: FF-2021-347). Before any data being collected at each of the hospitals, permission was also obtained from the hospital’s Director, Clinical Research Centre (CRC) officer, and the Head of the Obstetrics & Gynecology Department. Acknowledgements Special thanks to the Medical Research and Ethics Committee (Ministry of Health, Malaysia), and the Ethics and Research Committee of Universiti Kebangsaan Malaysia (The National University of Malaysia) for their approval for this research and for permission for publication . Special gratitude to Selangor State Health Department, and all the hospitals’ Directors, Clinical Research Centre (CRC) officers, the Heads of Obstetrics & Gynecology Departments, the chiefs of medical officers and nurses for contributing in this study Availability of data and materials All data and materials for this study are available. Competing interests We declared that there are no competing interests in this study. Funding No funding received for this study. Authors' contributions All authors contribute equally in this study. . Conflict of Interest We declare that we have no conflict of interest. References A. J. Stephens, J. R. Barton, N.-A. A. Bentum, S. C. Blackwell, and B. M. 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Huy et al. , “Awareness and preparedness of healthcare workers against the first wave of the COVID-19 pandemic: A cross-sectional survey across 57 countries,” PLoS One , vol. 16, no. 12, p. e0258348, Dec. 2021, doi: 10.1371/JOURNAL.PONE.0258348. H. Singh and S. Sharma, “Concerns of Frontline Doctors in India during COVID-19: A Cross-Sectional Survey,” Indian J Public Health , vol. 64, no. Supplement, pp. S237–S239, Jun. 2020, doi: 10.4103/IJPH.IJPH_472_20. S. J. Rajakaruna, W. Bin Liu, Y. B. Ding, and G. W. Cao, “Strategy and technology to prevent hospital-acquired infections: Lessons from SARS, Ebola, and MERS in Asia and West Africa,” Mil Med Res , vol. 4, no. 1, pp. 1–6, Oct. 2017, doi: 10.1186/S40779-017-0142-5/FIGURES/1. J. Xiao, M. Fang, Q. Chen, and B. He, “SARS, MERS and COVID-19 among healthcare workers: A narrative review,” J Infect Public Health , vol. 13, no. 6, pp. 843–848, Jun. 2020, doi: 10.1016/J.JIPH.2020.05.019. L. Li, Q. Xv, and J. 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Saqlain et al. , “Knowledge, attitude, practice and perceived barriers among healthcare workers regarding COVID-19: a cross-sectional survey from Pakistan,” Journal of Hospital Infection , vol. 105, no. 3, pp. 419–423, Jul. 2020, doi: 10.1016/J.JHIN.2020.05.007/ATTACHMENT/4960F19B-B469-4E4A-916E-DA45397D072C/MMC1.DOCX. M. K. Al-Hanawi et al. , “Knowledge, Attitude and Practice Toward COVID-19 Among the Public in the Kingdom of Saudi Arabia: A Cross-Sectional Study,” Front Public Health , vol. 8, p. 217, May 2020, doi: 10.3389/FPUBH.2020.00217/BIBTEX. R. Olum, G. Chekwech, G. Wekha, D. R. Nassozi, and F. Bongomin, “Coronavirus Disease-2019: Knowledge, Attitude, and Practices of Health Care Workers at Makerere University Teaching Hospitals, Uganda,” Front Public Health , vol. 8, p. 181, Apr. 2020, doi: 10.3389/FPUBH.2020.00181/BIBTEX. R. C. Reuben, M. M. A. Danladi, D. A. Saleh, and P. E. 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Cite Share Download PDF Status: Published Journal Publication published 14 Apr, 2025 Read the published version in BMC Pregnancy and Childbirth → Version 1 posted Editorial decision: Revision requested 18 Sep, 2024 Editor assigned by journal 16 Sep, 2024 Submission checks completed at journal 16 Sep, 2024 First submitted to journal 02 Sep, 2024 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. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5015500","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":355548618,"identity":"4d496ed2-3700-43ec-ab14-ae9519f79db0","order_by":0,"name":"Sumaiyah Isamail","email":"","orcid":"","institution":"Universiti Kebangsaan Malaysia","correspondingAuthor":false,"prefix":"","firstName":"Sumaiyah","middleName":"","lastName":"Isamail","suffix":""},{"id":355548620,"identity":"03ebae66-371a-40f8-a043-da3c42fcd468","order_by":1,"name":"Idayu Badilla Idris","email":"data:image/png;base64,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","orcid":"","institution":"Universiti Kebangsaan Malaysia","correspondingAuthor":true,"prefix":"","firstName":"Idayu","middleName":"Badilla","lastName":"Idris","suffix":""},{"id":355548622,"identity":"fe8a5b97-5fa9-419e-ba91-8f18d1ec0d77","order_by":2,"name":"Hanizah Mohd Yusoff","email":"","orcid":"","institution":"Universiti Kebangsaan Malaysia","correspondingAuthor":false,"prefix":"","firstName":"Hanizah","middleName":"Mohd","lastName":"Yusoff","suffix":""}],"badges":[],"createdAt":"2024-09-02 05:14:11","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5015500/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5015500/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12884-025-07474-7","type":"published","date":"2025-04-14T15:57:50+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":69863583,"identity":"d46d6d55-b64c-416f-8bbc-fea0e023199c","added_by":"auto","created_at":"2024-11-26 06:32:19","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":57623,"visible":true,"origin":"","legend":"\u003cp\u003eStudy sampling flowchart\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-5015500/v1/e49bc2071e92df8450f8f553.png"},{"id":81050929,"identity":"976bc9f4-d637-4abe-a805-a6fd4e9d8a0c","added_by":"auto","created_at":"2025-04-21 16:07:10","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2782862,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5015500/v1/02238c3d-294a-4b52-bf6d-3c64ea9637ed.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Obstetric Services Preparedness Among Healthcare Workers in Maternal Wards During COVID-19 Pandemic","fulltext":[{"header":"BACKGROUND","content":"\u003cp\u003eThe novel coronavirus 2019 disease or Coronavirus disease 2019 (COVID-19) is a respiratory tract infection that was first identified in China. Since its emergence in December 2019, the virus had spread rapidly, exceeding geographical barriers. The World Health Organization (WHO) and the Centers for Disease Control and Prevention (CDC) have declared COVID-19 as a public health crisis [1]. WHO declared COVID-19 a pandemic on March 11, 2020, after it was first reported in Hubei Province, China in December 2019.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eCOVID-19 spreads so rapidly around the world and leads to dire consequences for patients, healthcare workers, the health system, as well as the economy. As it reaches low- and middle-income countries, the pandemic puts healthcare workers including maternal health care (MHCs) workers, at high risk and challenges the ability of the healthcare system to respond to crises. Therefore, health authorities have initiated awareness and preparedness activities around the world including among MHC workers as poor understanding of the disease can result in delayed treatment and rapid spread of infection [2], [3].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eGovernments around the world have implemented various public and social health measures to reduce the spread of COVID-19. By reducing the provision of services for non-COVID-19 health emergencies and essential health services, the provision of health services has been modified in many settings to focus on managing COVID-19 cases. Thus, the health system has struggled to maintain essential health services while trying to control infection. In fact, out of all health services, maternal or obstetric health services could have been affected the most, as in previous infectious disease outbreaks [4].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eMHC workers, including doctors, nurses, and midwives, were among the healthcare workers who served at the frontline during the COVID-19 pandemic to detect, control, and stop the spread of the disease to provide well-prepared obstetric services. Therefore, to ensure that MHC workers are safe from exposure to future diseases during employment or healthcare-related infections, risk mitigation strategies including Infection Prevention and Control (IPC) should be enforced [5].\u003c/p\u003e\n\u003cp\u003eDespite the continued efforts of the IPC, this increased infection rate signals that these mitigation measures were inadequate at all levels, as well as pointing to a potential critical point towards failure in efforts to provide well-prepared obstetric services during the COVID-19 pandemic. The fact that healthcare workers including MHC workers continued to be infected were a source of infection during this critical public health time exposed weaknesses in the readiness of obstetric services and global readiness efforts [5].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTherefore, it is very important for MHC workers to have a good level of obstetric service preparedness especially during the COVID-19 or during other pandemics as maternal patients are more susceptible to COVID-19 infection and severe pneumonia (due to physiological changes in the immune and cardio-pulmonary system during pregnancy) and death than other patients or populations [6], [7].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eRecent studies conducted in Sweden and the United States have shown that pregnant and postnatal women faced an increased risk of more severe complications related to COVID‐19 than non-pregnant women of the same age. COVID-19 prevention should be emphasized for pregnant women and potential obstacles in complying with these measures need to be addressed [8], [9]. Therefore, it is necessary for MHC workers to have good obstetric service readiness especially during the COVID-19 pandemic.\u003c/p\u003e\n\u003cp\u003eSeveral researchers have studied issues covering the preparedness of healthcare systems for COVID-19 including the availability of obstetric services, especially in developing countries, where resources and facilities are limited. Many concerns have been raised about the readiness of these countries to this COVID-19 pandemic and their ability to maintain such control. Since healthcare workers including MHC workers are the main role that interact with many maternity patients and are an important source of exposure to infected cases while in healthcare, they are also expected to be at high risk of infection. Therefore, by the end of January 2020, WHO and CDC have proposed recommendations for the prevention and control of COVID-19 for healthcare workers including MHC workers [10]. WHO had also initiated several online training sessions and materials on COVID-19 in various languages provided to strengthen preventive knowledge and strategies, including raising awareness and training healthcare workers including MHC workers in readiness activities [11], [12].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn some situations, misunderstandings among MHC workers have slowed control efforts to provide the necessary treatment and have led to the rapid spread of infection in hospitals and endangered the lives of patients [13], [14], [15]. There were shortages of personal protective equipment (PPE) and insufficient training for MHC workers, especially in countries with limited resources. Therefore, it is important to assess obstetric service preparedness and to implement screening for patients admitted to the obstetric unit to reduce the risk to MHC workers. Adequate or prepared obstetric services depend on several factors, including the attitude and skills of healthcare practitioners and the resources allocated to the hospitals. Many hospitals and healthcare programs had been affected, leading to a crisis within the hospital due to staff shortages, fatigue, and other factors. There were concerns for countries with limited resources in terms of the availability of their obstetric services to manage the COVID-19 pandemic [2].\u003c/p\u003e\n\u003cp\u003eAs MHC workers who are part of the front line against the COVID-19 pandemic, their knowledge, awareness, and attitude towards COVID-19 are crucial in controlling and minimizing exposure and spread of infection to better manage maternity patients during this COVID-19 pandemic and be prepared to provide good obstetric services.\u003c/p\u003e\n\u003cp\u003eGovernment hospitals in the state of Selangor, Malaysia, were selected in this study as the state of Selangor continued to record the highest number of COVID-19 cases in the country. In March 2021 in Malaysia, over 300 thousand cases were reported with over 1,000 deaths recorded at the same time, with the state of Selangor reported to have the highest number of cases with over 100 thousand cases. A year later in March 2022, more than four million total cases were reported and over 30,000 deaths were recorded, with the state of Selangor still recording the highest number of cases exceeding 1.3 million and over 10 thousand deaths recorded [16].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn addition, 1,359 healthcare workers have been infected with COVID-19 since the third wave of the pandemic began in September 2020, bringing the confirmed cases to date among healthcare workers in the country to 1,771 and the group of healthcare workers with the highest number of COVID-19 infections being Nurses (690 cases) followed by Medical Officers (211 cases). As for the source of infection, 587 healthcare workers were infected by the community, 565 cases from transmission among colleagues, 152 from patients who had not been diagnosed with COVID-19, 58 of whom were unknown while 409 were still under investigation [17].\u003c/p\u003e\n\u003cp\u003eAccording to a global cross-sectional study by Semaan (2020) that was carried out during the early hours of the pandemic (between March 24 to April 10, 2020), the experience of frontline MHC workers was documented in 81 countries and had 714 respondents, of which 47% were from low- and middle-income countries (LMICs). Studies showed only one-third of respondents received training on COVID-19 from their health facilities, and almost all of them were looking for information about COVID-19 on their own. Only half of respondents in LMICs received the latest guidelines for care protocols compared with 82% in high-income countries (HIC). Overall, only 47% of participants in LMICs and 69% in HICs felt they had a lot of knowledge on how to care for maternity patients infected with COVID-19. Preparations at the facility level against COVID-19 (signage, inspection, testing, and isolation rooms) were more at HIC compared to LMICs. There was also a widespread perception of a reduction in the routine use of maternity care services and modifications in the care process. Moreover, globally there were 90% of respondents reported that they faced higher levels of stress during the pandemic [18].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eSince the Semaan study (2020), WHO has produced guidelines for managing COVID-19 and for maintaining essential health services. This has been practiced by many countries in sub-Saharan Africa or similar to it to strengthen the responsiveness of their health systems [19]. These guidelines contain key proposals to optimize health capacity, including recruitment, reuse in training and skills capacity, redistributing roles among health workers while keeping health workers safe, as well as providing mental and psychosocial support. However, it was not clear to what extent these guidelines have been implemented in health facilities and how they have affected health facility administrators\u0026apos; perceptions of their facility\u0026apos;s readiness to manage COVID-19. Other studies have also assessed readiness to manage COVID-19 in terms of assessment of health workers\u0026apos; knowledge, attitudes, and practices, but these studies did not explore complex interactions between fear, anxiety, stress, support systems and health facility preparedness [20], [21].\u003c/p\u003e\n\u003cp\u003eGenerally, there are still many knowledge gaps that exist in the guidance on the management of cases of maternity patients especially those infected with COVID-19. Official information sharing channels for the administration of health facilities must be established and mental health support should be provided. Therefore, a review of the administrative preparedness at obstetric facilities can help detect conditions, unravel innovation, and support rapid development of effective responses. Therefore, this study can provide an overview of these matters and the impact of the COVID-19 pandemic on the maternal healthcare system in Malaysia, as there are currently no such studies or surveys conducted in this region.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cstrong\u003eStudy Design, Study setting and Sampling\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA cross-sectional study using quantitative data analysis was conducted among MHC workers (doctors, nurses, and midwives) in the Department of Obstetrics and Gynecology in all 10 government hospitals located in all districts in the state of Selangor, Malaysia, between May 2022 till June 2022. Government hospitals in the state of Selangor, Malaysia, were selected in this study as the state of Selangor continued to record the highest number of COVID-19 cases in the country, with the highest number healthcare workers that have been infected with COVID-19, as well as having the highest number of deaths due to COVID-19 [16], [17].\u003c/p\u003e\n\u003cp\u003eFour hundred and nine respondents participated in this study and they were selected by proportionate stratified random sampling method. The proportion (percentage) of the number of respondents required from each hospital is determined by the number of their MHC workers relative to the entire target population, which is the total number of MHC workers in government hospitals in the state of Selangor, Malaysia. It determines the number of respondents representing each hospital to meet the sample size of 359 respondents (minimum recommended sample size) required for this study (\u003cstrong\u003eFigure 1\u003c/strong\u003e). Following this, the selection of specific respondents from each hospital was then selected through computer-assisted random sampling using SPSS version 28.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eStudy Tool\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis questionnaire was adapted from two studies by Elhadi et al. (2020) which was mostly based on service preparedness checklists by WHO and CDC [22]. Some of those questions were based on a framework similar to the studies conducted earlier on infectious disease outbreaks [23][24], [25], [26]. Reliability for knowledge, awareness \u0026amp; attitude and preparedness questionnaires was determined using Cronbach alpha, which each revealed a score of 0.72 for knowledge and awareness scales, and 0.68 for attitude and the obstetric service preparedness scale respectively. This questionnaire has also been prepared in the Malay language version that was translated from the original language (English).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTo assess the respondent\u0026apos;s level of obstetric service preparedness, each correct answer was assigned a score of 1, and the wrong answer was given a score of zero. The score for this 4\u003csup\u003eth\u003c/sup\u003e part was summed up for a total score of 32, which ranges from 0 to 32 (score included for answers to sub-unit questions). Those who scored \u0026ge;22 was considered to have a good level of obstetric service preparedness, while a score of \u0026lt;22 was considered to have poor levels of obstetric service preparedness.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Collection\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData collection was done through dissemination of the validated questionnaire using Google form via WhatsApp application. Respondents did not need to sign in to any account to fill out this questionnaire. The questionnaire took about 20 minutes in average to complete. The accompanying consent form was completed first by the respondent before proceeding to participate in the survey. The data were then analyzed by using the SPSS version 28 to explore the distribution and association between the knowledge, awareness, attitude, and obstetric services preparedness during this COVID-19 pandemic.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e"},{"header":"Results","content":"\n\u003ch3\u003eBackground of the respondents\u003c/h3\u003e\n\u003cp\u003eThe results showed that out of 409 respondents, the majority of the respondents i.e. 403 (98.5%) were female respondents, while only 6 (1.5%) were male respondents. From these statistics, we can make the general impression that the number of female respondents was significantly greater than male respondents. There was a wide age range among respondents, with the youngest aged 23 and the oldest aged 58. The results showed that respondents aged 35\u0026ndash;45 years showed the highest number of 199 (48.7%), followed by respondents aged\u0026thinsp;\u0026lt;\u0026thinsp;35 years at 140 (34.2%) and respondents aged\u0026thinsp;\u0026gt;\u0026thinsp;45 years old with 70 (17.1%). The average age of the respondents was 38.38\u0026thinsp;\u0026plusmn;\u0026thinsp;7.17 years. In terms of profession, most respondents involved were nurses or midwives i.e. 358 people (87.6%), while the medical staffs were 33 (8.0%), followed by specialist doctors, 18 (4.4%).\u003c/p\u003e \u003cp\u003eFor the duration aspect of working experience for the respondents, majority 380 (92.9%) respondents had more than five years of working experience while only 7.1% of respondents had less than five years of experience. There was a large range of total hours worked (in a week) among respondents with a minimum of 40 hours up to a maximum of 145 hours. Most of the respondents (65.0%) worked more than 45 hours a week. The average number of hours respondents worked in a week was 50.19\u0026thinsp;\u0026plusmn;\u0026thinsp;12.38 hours.\u003c/p\u003e \u003cp\u003eMore than half of respondents (55.3%) stated that the average number of hours worked per week was more than before the COVID-19 pandemic. There was also a large range of total number of shifts (within a month) among respondents with a minimum of 20 shifts up to a maximum of 77 shifts. Most of the respondents (75.6%) worked more than 25 shifts per month. The average number of shifts in a month was 27.25\u0026thinsp;\u0026plusmn;\u0026thinsp;6.33 shifts. However, less than half of respondents (48.7%) stated that the average number of shifts in a month was more than before this COVID-19 pandemic. Majority of respondents (85.1%) were from seven hospitals in urban areas, while only 14.6% of them were from three hospitals in rural areas. Majority respondents (89.2%) worked in the same hospital more than a year.\u003c/p\u003e \u003cp\u003eThe most frequently obtained sources of information by respondents about COVID-19 were from their workplaces (50.9%), followed by from government sources (48.9%) and social media (41.3%). For history of previous epidemic/pandemic experience, only 40.8% respondents had no history of previous outbreaks. Meanwhile, 33.9% of respondents had history with severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS) outbreaks, 21.9% had a history with Bird Flu outbreaks, 7.6% had a history with the H1N1 outbreak, 3.4% had a history with the Japanese Encephalitis (JE) outbreak, 0.7% had a history with the Ebola epidemic, and the remaining 1.4% of respondents had a history with the Diphtheria, Measles, Cholera and Chikungunya outbreak.\u003c/p\u003e \u003cp\u003eThe results also showed that in the previous one year, only 243 people (59.4%) felt confident and prepared to manage and treat COVID-19 patients, while only 113 people (27.6%) felt slightly confident. In addition, only 5.6% of respondents felt very confident in managing and treating COVID-19 patients, while 7.3% of respondents felt unconfident. As for the current time, majority of 271 respondents (66.3%) felt more confident and prepared in managing and treating COVID-19 patients, and 73 (17.8%) of them felt very confident. Only 15.4% of respondents felt slightly more confident, and very few (0.5%) of them still felt unconfident in managing and treating COVID-19 patients at the current time (\u003cb\u003eTable\u0026nbsp;1\u003c/b\u003e).\u003c/p\u003e \u003cdiv id=\"Sec2\" class=\"Section2\"\u003e \u003ch2\u003eKnowledge and awareness of MHC workers during the COVID-19 pandemic\u003c/h2\u003e \u003cp\u003e The results showed that the majority 407 (99.5%) respondents knew the symptoms of COVID-19 infection, 381 (93.2%) of them knew the latest information on the definition of cases for COVID-19 infection, 406 (99.3%) of them knew how to use PPE correctly in the event of exposure to COVID-19 infection currently, and 404 (98.8%) of them knew how to properly wash their hands and hand hygiene care in line with WHO and CDC guidelines currently. However, only 37.4% of respondents knew the main type of treatment for COVID-19 infection and only 40.3% of respondents knew the most common way of spreading COVID-19 infection. In addition, only 34.7% of respondents knew how to reduce the risk of COVID-19 infection (\u003cb\u003eTable\u0026nbsp;2\u003c/b\u003e).\u003c/p\u003e \u003cp\u003eThe mean score for knowledge and awareness factors is 14.20\u0026thinsp;\u0026plusmn;\u0026thinsp;1.66 (total score\u0026thinsp;=\u0026thinsp;17). Majority 378 (92.2%) respondents had good level of knowledge and awareness regarding COVID-19 pandemic (\u003cb\u003eTable\u0026nbsp;5\u003c/b\u003e).\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eAttitude of MHC workers towards COVID-19 pandemic\u003c/h3\u003e\n\u003cp\u003eThe results showed that during the previous year, majority of the respondents i.e. 305 (74.6%) respondents had increased in stress level, 321 (78.5%) respondents felt very tired from work caused by the COVID-19 pandemic, 254 (62.1%) respondents felt fear of contracting COVID-19 which would hinder their ability to provide quality obstetric health services, and 277 (67.7%) respondents felt stigmatized by the community. However, only half of the respondents (50.1%) felt protected from COVID-19 infection in their workplace, and only 58.2% felt ready to manage the COVID-19 pandemic.\u003c/p\u003e \u003cp\u003eMeanwhile, at the present time, majority 307 (75.1%) respondents felt more protected from COVID-19 infection at their workplace, and 384 (93.9%) felt ready to manage the COVID-19 pandemic. However, currently 32.3% of respondents still felt their stress level increasing, 36.9% of respondents felt their work as healthcare workers were still getting stigmatized from the community, and 31.3% of respondents still felt very tired or burnout from work caused by the COVID-19 pandemic (\u003cb\u003eTable\u0026nbsp;3\u003c/b\u003e).\u003c/p\u003e \u003cp\u003eThe mean score for the attitude factor is 8.17\u0026thinsp;\u0026plusmn;\u0026thinsp;2.87 (total score\u0026thinsp;=\u0026thinsp;15). Only about half (54.0%) of the respondents had a positive attitude towards COVID-19 (\u003cb\u003eTable\u0026nbsp;5\u003c/b\u003e).\u003c/p\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eObstetric services preparedness during the COVID-19 pandemic\u003c/h2\u003e \u003cp\u003eThe findings showed that during the previous year, majority 377 (92.2%) respondents said that they had been informed by the hospital/obstetric unit administration regarding the protocol for triage and isolation for suspected COVID-19 cases, 389 (95.1%) respondents said that they have been informed regarding the isolation procedures, and 391 (95.6%) respondents said that their hospital/obstetric unit provided isolation room for suspected or confirmed COVID-19 cases for maternity patients. In addition, 326 (79.7%) respondents said they knew how to report potential cases for COVID-19 and be ready to do so, 85.8% of them said they knew the protocol that need to be done if they have any signs of contracting COVID-19, and 76.8% of them said they knew how to make an assessment for a patient who is under investigation.\u003c/p\u003e \u003cp\u003eHowever, 22.5% of respondents said that there were no training courses for COVID-19 management been given, 26.9% of them said that there were no dedicated teams provided by the hospital/obstetric unit in the management and treatment of pregnant/maternity mothers who have COVID-19, 11.0% of them said obstetric emergency services (surgical room for Caesarean section surgery/any obstetric emergency surgery/procedure) were not available for maternity patients for suspected or confirmed cases of COVID-19, and 11.5% of them said that they were not sure that their hospitals/ obstetric units were prepared to manage COVID-19 pandemic.\u003c/p\u003e \u003cp\u003eMeanwhile, at the present time, majority 393 (96.1%) respondents said that currently they have been informed by their hospitals/obstetric units regarding the protocol for triage and isolation for suspected COVID-19 cases and 96.8% of them said that they have been informed regarding the isolation procedure. In addition, majority 397 (97.1%) respondents said that currently their hospitals/obstetric units provided isolation rooms for suspected or confirmed COVID-19 cases for maternity patients, and 83.1% of them said that obstetric emergency services (surgical room for Caesarean section surgery/any obstetric emergency surgery/procedure) were available for maternity patients for suspected or confirmed cases of COVID-19.\u003c/p\u003e \u003cp\u003eMoreover, majority 378 (92.4%) respondents said that currently they knew how to report potential cases for COVID-19 and were ready to do so, 96.3% of them knew the protocol that need to be adhered to if they had any signs of contracting COVID-19, 86.8% of them knew the safety measures for aerosol transmission for maternity patients infected with COVID-19, 93.9% of them knew how to make an assessment for a patient who was under investigation, and 95.6% of the respondents were sure that their hospitals/obstetric units was prepared to manage the COVID-19 pandemic currently. However, there were 119 (29.1%) respondents said that there were no training courses for COVID-19 management been given, and 29.6% of them said that there were no dedicated teams provided by the hospital/obstetrics unit in the management and treatment of pregnant/maternity mothers who have COVID-19 (\u003cb\u003eTable\u0026nbsp;6\u003c/b\u003e).\u003c/p\u003e \u003cp\u003eThe mean score for obstetric service preparedness is 25.93\u0026thinsp;\u0026plusmn;\u0026thinsp;4.87 (total score\u0026thinsp;=\u0026thinsp;32). Majority 362 (88.3%) respondents had good level of obstetric service preparedness during the COVID-19 pandemic (\u003cb\u003eTable\u0026nbsp;5\u003c/b\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eRelationship between background of respondents, knowledge, awareness, attitudes, and obstetric services preparedness\u003c/h2\u003e \u003cp\u003eA paired t-test was done to identify any significant differences between previous 1 year ago (the peak time of the COVID-19 pandemic) and the present time for MHC workers' knowledge and awareness factor, attitudes factor, and obstetric services preparedness during the COVID-19 pandemic.\u003c/p\u003e \u003cp\u003eThe findings showed significant differences (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05) between the previous 1 year (the peak time of the COVID-19 pandemic) and the current time for the following factors which were: 1) knowledge of proper use of PPE in the event of exposure to COVID-19; 2) adequate preparation of PPE in the obstetric unit; 3) adequate provision of soap, water and disinfectants for health workers, patients, and visitors in the obstetric unit; 4) adequate provision of adequate face masks for health workers, patients, and visitors in the obstetric unit; 5) increased level of self-stress; 6) feeling protected from COVID-19 infection at work; 7) work as a health worker gets stigma from society; 8) always feeling very tired from work caused by the COVID-19 pandemic; 9) feeling ready to manage the COVID-19 pandemic; 10) knowledge of the protocols to be made in case of any signs of contracting COVID-19; and 11) knowledge of safety measures for aerosol transmission for maternity patients infected with COVID-19 (\u003cb\u003eTable\u0026nbsp;6\u003c/b\u003e).\u003c/p\u003e \u003cp\u003eFurthermore, there was a significant relationship (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05) that was positive and weak between knowledge and awareness factor (r\u0026thinsp;=\u0026thinsp;0.330) and attitude factor (r\u0026thinsp;=\u0026thinsp;0.227) with obstetric services preparedness. This result indicates that with increasing scores for knowledge and awareness factor and scores for attitude factor, will result in higher scores for obstetric service preparedness.\u003c/p\u003e \u003cp\u003eLinear regression analysis was done to look at predicting factors that have the potential to influence the level of obstetric services preparedness. The confidence interval (CI) was set at 95% and the p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was set as statistically significant. Before conducting a multiple linear regression (MLR) test, all factors or variables went through a simple linear regression test by using the 'Enter' method. Following that the MLR test was conducted using the '\u003cem\u003eForward\u003c/em\u003e', 'Backward' and 'Stepwise' methods. For the last model, the 'Stepwise' method was selected.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eTable 1. Distribution for the background of respondent (N=409)\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 321px;\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003eN (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003eMean (SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 321px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eA. SOCIODEMOGRAPHIC CHARACTERISTICS\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 321px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGender\u003cbr\u003e\u0026nbsp;\u003c/strong\u003eMale\u003cbr\u003e\u0026nbsp;Female\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cbr\u003e\u0026nbsp;6 (1.5)\u003cbr\u003e\u0026nbsp;403 (98.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 321px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge\u003c/strong\u003e\u0026nbsp;\u003cbr\u003e\u0026nbsp;\u0026lt;35 years old\u0026nbsp;\u003cbr\u003e\u0026nbsp;35-45 years old\u0026nbsp;\u003cbr\u003e\u0026nbsp;\u0026gt;45 years old \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cbr\u003e\u0026nbsp;140 (34.2)\u003cbr\u003e\u0026nbsp;199 (48.7)\u003cbr\u003e\u0026nbsp;70 (17.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e38.39 (7.17)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 321px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eProfession\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;Specialist doctor\u0026nbsp;\u003cbr\u003e\u0026nbsp;Medical officer\u003cbr\u003e\u0026nbsp;Nurse or midwifery\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eDuration of working experience\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;Less than 5 years\u0026nbsp;\u003cbr\u003e\u0026nbsp;More than 5 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cbr\u003e\u0026nbsp;18 (4.4)\u003cbr\u003e\u0026nbsp;33 (8.0)\u003cbr\u003e\u0026nbsp;358 (87.6)\u003c/p\u003e\n \u003cp\u003e\u003cbr\u003e\u0026nbsp;29 (7.1)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e380 (92.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 321px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal hours worked in a week\u003c/strong\u003e\u0026nbsp;\u003cbr\u003e\u0026nbsp;\u0026lt;45 hours\u003cbr\u003e\u0026nbsp; \u0026ge;45 hours\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cbr\u003e\u0026nbsp;143 (35.0)\u003cbr\u003e\u0026nbsp;266 (65.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e50.19 (12.38)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 321px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eIs the average number of hours working in a week more than before the pandemic?\u003c/strong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003cbr\u003e\u0026nbsp;Yes\u0026nbsp;\u003cbr\u003e\u0026nbsp;No\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cbr\u003e\u0026nbsp;\u003cbr\u003e\u0026nbsp;226 (55.3)\u003cbr\u003e\u0026nbsp;183 (44.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 321px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal number of shifts in a month\u003c/strong\u003e\u0026nbsp;\u003cbr\u003e\u0026nbsp;\u0026lt;25 shifts\u0026nbsp;\u003cbr\u003e\u0026nbsp;\u0026ge;25 shifts\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cbr\u003e\u0026nbsp;99 (24.1)\u003cbr\u003e\u0026nbsp;310 (75.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e27.25 (6.33)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 321px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eIs the average number of shifts in a month more than before the pandemic?\u003c/strong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003cbr\u003e\u0026nbsp;Yes\u0026nbsp;\u003cbr\u003e\u0026nbsp;No\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cbr\u003e\u0026nbsp;\u003cbr\u003e\u0026nbsp;199 (48.7)\u003cbr\u003e\u0026nbsp;210 (51.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e\u003cbr\u003e\u0026nbsp;\u003cbr\u003e\u0026nbsp;\u003cbr\u003e\u0026nbsp;\u003cbr\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 321px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCurrent working place\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;Hospital Serdang\u0026nbsp;\u003cbr\u003e\u0026nbsp;Hospital Kajang\u0026nbsp;\u003cbr\u003e\u0026nbsp;Hospital Selayang\u0026nbsp;\u003cbr\u003e\u0026nbsp;Hospital Sungai Buloh\u0026nbsp;\u003cbr\u003e\u0026nbsp;Hospital Shah Alam\u0026nbsp;\u003cbr\u003e\u0026nbsp;Hospital Tengku Ampuan Rahimah\u0026nbsp;\u003cbr\u003eHospital Kuala Kubu Bharu \u003cstrong\u003e(rural area)\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;Hospital Banting\u0026nbsp;\u003cbr\u003eHospital Tanjung Karang \u003cstrong\u003e(rural area)\u003c/strong\u003e\u003cbr\u003eHospital Tengku Ampuan Jemaah \u003cstrong\u003e(rural area)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eHospitals in\u003cstrong\u003e\u0026nbsp;urban area\u003cbr\u003e\u0026nbsp;\u003c/strong\u003eHospitals in\u003cstrong\u003e\u0026nbsp;rural area\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cbr\u003e\u0026nbsp;17 (4.2)\u003cbr\u003e\u0026nbsp;70 (17.1)\u003cbr\u003e\u0026nbsp;120 (29.3)\u003cbr\u003e\u0026nbsp;58 (14.2)\u003cbr\u003e\u0026nbsp;50 (12.2)\u003cbr\u003e\u0026nbsp;14 (3.4)\u003cbr\u003e\u0026nbsp;20 (4.9)\u003cbr\u003e\u0026nbsp;20 (4.9)\u003cbr\u003e\u0026nbsp;16 (3.9)\u003cbr\u003e\u0026nbsp;24 (5.9)\u003cbr\u003e\u0026nbsp;\u003cbr\u003e\u0026nbsp;349 (85.3)\u003cbr\u003e\u0026nbsp;60 (14.7)\u003cbr\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 321px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDoes the period of work in the current place exceed a year?\u003c/strong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003cbr\u003e\u0026nbsp;Yes\u0026nbsp;\u003cbr\u003e\u0026nbsp;No\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e365 (89.2)\u003cbr\u003e\u0026nbsp;44 (10.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 321px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eB. SOURCES OF INFORMATION OBTAINED ABOUT COVID-19\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 321px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eValue of frequency of sources of information obtained about COVID-19\u003c/strong\u003e\u0026nbsp;\u003cbr\u003e\u003cstrong\u003ei) government resources\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;The most frequent\u003cbr\u003e\u0026nbsp;Frequently\u003cbr\u003e\u0026nbsp;Less frequent\u003cbr\u003e\u0026nbsp;The least frequent\u0026nbsp;\u003cbr\u003e\u003cstrong\u003eii) internet\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;The most frequent\u003cbr\u003e\u0026nbsp;Frequently\u003cbr\u003e\u0026nbsp;Less frequent\u0026nbsp;\u003cbr\u003e\u0026nbsp;The least frequent\u0026nbsp;\u003cbr\u003e\u003cstrong\u003eiii) social media\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;The most frequent\u003cbr\u003e\u0026nbsp;Frequently\u0026nbsp;\u003cbr\u003e\u0026nbsp;Less frequent \u0026nbsp;\u003cbr\u003e\u0026nbsp;The least frequent\u0026nbsp;\u003cbr\u003e\u003cstrong\u003eiv) Workplaces\u003cbr\u003e\u0026nbsp;\u003c/strong\u003eThe most frequent\u003cbr\u003e\u0026nbsp;Frequently\u0026nbsp;\u003cbr\u003e\u0026nbsp;Less frequent \u0026nbsp;\u003cbr\u003e\u0026nbsp;The least frequent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cbr\u003e\u0026nbsp;\u003cbr\u003e\u0026nbsp;\u003cbr\u003e\u0026nbsp;200 (48.9)\u003cbr\u003e\u0026nbsp;121 (29.6)\u003cbr\u003e\u0026nbsp;36 (8.8)\u003cbr\u003e\u0026nbsp;52 (12.7)\u003cbr\u003e\u0026nbsp;\u003cbr\u003e\u0026nbsp;132 (32.3)\u003cbr\u003e\u0026nbsp;130 (31.8)\u003cbr\u003e\u0026nbsp;87 (21.3)\u003cbr\u003e\u0026nbsp;60 (14.7)\u003cbr\u003e\u0026nbsp;\u003cbr\u003e\u0026nbsp;169 (41.3)\u003cbr\u003e\u0026nbsp;130 (31.8)\u003cbr\u003e\u0026nbsp;74 (18.1)\u003cbr\u003e\u0026nbsp;36 (8.8)\u003cbr\u003e\u0026nbsp;\u003cbr\u003e\u0026nbsp;208 (50.9)\u003cbr\u003e\u0026nbsp;128 (31.3)\u003cbr\u003e\u0026nbsp;30 (7.3)\u003cbr\u003e\u0026nbsp;43 (10.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\u0026nbsp;\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 321px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eC. HISTORY OF PREVIOUS PANDEMIC/OUTBREAKS\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;\u003cbr\u003e\u0026nbsp;Bird Flu\u003cbr\u003e\u0026nbsp;MERS and SARS\u003cbr\u003e\u0026nbsp;No experience\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cbr\u003e\u0026nbsp;\u003cbr\u003e\u0026nbsp;90 (21.9)\u003cbr\u003e\u0026nbsp;139 (33.9)\u003cbr\u003e\u0026nbsp;167 (40.8)\u003cbr\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 321px;\"\u003e\n \u003cp\u003eOthers:\u003cbr\u003e\u0026nbsp;Diphtheria\u0026nbsp;\u003cbr\u003e\u0026nbsp;Ebola\u0026nbsp;\u003cbr\u003e\u0026nbsp;H1N1\u0026nbsp;\u003cbr\u003e\u0026nbsp;Japanese Encephalitis\u0026nbsp;\u003cbr\u003e\u0026nbsp;Cholera\u0026nbsp;\u003cbr\u003e\u0026nbsp;Chikungunya\u0026nbsp;\u003cbr\u003e\u0026nbsp;Measles\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cbr\u003e\u0026nbsp;1 (0.2)\u003cbr\u003e\u0026nbsp;3 (0.7)\u003cbr\u003e\u0026nbsp;30 (7.6)\u003cbr\u003e\u0026nbsp;13 (3.4)\u003cbr\u003e\u0026nbsp;1 (0.2)\u003cbr\u003e\u0026nbsp;2 (0.5)\u003cbr\u003e\u0026nbsp;2 (0.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 321px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eD. CONFIDENCE IN THE MANAGEMENT OF THE COVID-19 PANDEMIC\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 321px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFeeling confident and prepared in managing and treating COVID-19 patients over THE PAST 1 YEAR\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;\u003cbr\u003e\u0026nbsp;Not confident\u003cbr\u003e\u0026nbsp;Slightly confident\u0026nbsp;\u003cbr\u003e\u0026nbsp;Confidently\u003cbr\u003e\u0026nbsp;Very confident\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cbr\u003e\u0026nbsp;\u003cbr\u003e\u0026nbsp;\u003cbr\u003e\u0026nbsp;30 (7.3)\u003cbr\u003e\u0026nbsp;113 (27.6)\u003cbr\u003e\u0026nbsp;243 (59.5)\u003cbr\u003e\u0026nbsp;23 (5.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 321px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFeeling confident and prepared in managing and treating COVID-19 patients AT PRESENT\u003c/strong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003cbr\u003e\u0026nbsp;Still not confident\u003cbr\u003e\u0026nbsp;Slightly more confident\u0026nbsp;\u003cbr\u003e\u0026nbsp;More confident\u003cbr\u003e\u0026nbsp;Very confident\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cbr\u003e\u0026nbsp;\u003cbr\u003e\u0026nbsp;\u003cbr\u003e\u0026nbsp;2 (0.5)\u003cbr\u003e\u0026nbsp;63 (15.4)\u003cbr\u003e\u0026nbsp;271 (66.3)\u003cbr\u003e\u0026nbsp;73 (17.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2. Distribution of knowledge and awareness factors of MHC workers during the COVID-19 pandemic (N=409)\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 73.1532%;\"\u003e\n \u003cp\u003eKnowledge and Awareness Factors\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.6937%;\"\u003e\n \u003cp\u003eN\u0026nbsp;\u003cbr\u003e\u0026nbsp;(N=409)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.1532%;\"\u003e\n \u003cp\u003e(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 73.1532%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAll the below are the symptoms of COVID-19 infection EXCEPT?\u003c/strong\u003e\u003cbr\u003eRashes \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003cbr\u003e\u0026nbsp;Headache\u003cbr\u003e\u0026nbsp;Sore throat and flu\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.6937%;\"\u003e\n \u003cp\u003e\u003cbr\u003e\u0026nbsp;\u003cbr\u003e\u0026nbsp;407\u003cbr\u003e\u0026nbsp;1\u0026nbsp;\u003cbr\u003e\u0026nbsp;1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.1532%;\"\u003e\n \u003cp\u003e\u003cbr\u003e\u0026nbsp;\u003cbr\u003e\u0026nbsp;99.6\u003cbr\u003e\u0026nbsp;0.2\u003cbr\u003e\u0026nbsp;0.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 73.1532%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eWhat is the MAIN type of treatment for COVID-19 infection?\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;Supportive care\u0026nbsp;\u003cbr\u003e\u0026nbsp;Anti-virus treatment\u003cbr\u003e\u0026nbsp;Vaccination\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.6937%;\"\u003e\n \u003cp\u003e\u003cbr\u003e\u0026nbsp;153\u0026nbsp;\u003cbr\u003e\u0026nbsp;30\u003cbr\u003e\u0026nbsp;226\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.1532%;\"\u003e\n \u003cp\u003e\u003cbr\u003e\u0026nbsp;37.4\u003cbr\u003e\u0026nbsp;7.3\u003cbr\u003e\u0026nbsp;55.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 73.1532%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDo you know the latest information on the definition of cases for COVID-19 infection?\u0026nbsp;\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;Yes\u0026nbsp;\u003cbr\u003e\u0026nbsp;No\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.6937%;\"\u003e\n \u003cp\u003e\u003cbr\u003e\u0026nbsp;\u003cbr\u003e\u0026nbsp;381\u0026nbsp;\u003cbr\u003e\u0026nbsp;28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.1532%;\"\u003e\n \u003cp\u003e\u003cbr\u003e\u0026nbsp;\u003cbr\u003e\u0026nbsp;93.2\u003cbr\u003e\u0026nbsp;6.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 73.1532%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eWhat is the most common mode of transmission for COVID-19 infection?\u003cbr\u003e\u0026nbsp;\u003c/strong\u003eAir\u0026nbsp;\u003cbr\u003e\u0026nbsp;Contact\u0026nbsp;\u003cbr\u003e\u0026nbsp;Oral feces\u0026nbsp;\u003cbr\u003e\u0026nbsp;All of the above\u003cbr\u003e\u0026nbsp;None in the above\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.6937%;\"\u003e\n \u003cp\u003e\u003cbr\u003e\u0026nbsp;\u003cbr\u003e\u0026nbsp;165\u003cbr\u003e\u0026nbsp;46\u003cbr\u003e\u0026nbsp;3\u003cbr\u003e\u0026nbsp;190\u003cbr\u003e\u0026nbsp;5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.1532%;\"\u003e\n \u003cp\u003e\u003cbr\u003e\u0026nbsp;\u003cbr\u003e\u0026nbsp;40.3\u003cbr\u003e\u0026nbsp;11.2\u003cbr\u003e\u0026nbsp;0.8\u003cbr\u003e\u0026nbsp;46.5\u003cbr\u003e\u0026nbsp;1.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 73.1532%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHow to reduce the risk of transmission of COVID-19 infection?\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;Hand hygiene\u0026nbsp;\u003cbr\u003e\u0026nbsp;Close the nose and mouth during coughing\u003cbr\u003e\u0026nbsp;Avoid close contact with patient\u0026nbsp;\u003cbr\u003e\u0026nbsp;Eat fully cooked eggs and meat\u0026nbsp;\u003cbr\u003e\u0026nbsp;All of the above options\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.6937%;\"\u003e\n \u003cp\u003e\u003cbr\u003e\u0026nbsp;93\u0026nbsp;\u003cbr\u003e\u0026nbsp;99\u003cbr\u003e\u0026nbsp;74\u003cbr\u003e\u0026nbsp;1\u003cbr\u003e\u0026nbsp;142\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.1532%;\"\u003e\n \u003cp\u003e\u003cbr\u003e\u0026nbsp;22.7\u003cbr\u003e\u0026nbsp;24.2\u003cbr\u003e\u0026nbsp;18.1\u003cbr\u003e\u0026nbsp;0.3\u003cbr\u003e\u0026nbsp;34.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 73.1532%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDo you know how to use personal protective equipment (PPE) correctly in the event of exposure to COVID-19 infection AT 1 YEAR AGO?\u003c/strong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003cbr\u003e\u0026nbsp;Yes, I know\u003cbr\u003eNo, I do not know \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.6937%;\"\u003e\n \u003cp\u003e\u003cbr\u003e\u0026nbsp;\u003cbr\u003e\u0026nbsp;\u003cbr\u003e\u0026nbsp;366\u003cbr\u003e\u0026nbsp;43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.1532%;\"\u003e\n \u003cp\u003e\u003cbr\u003e\u0026nbsp;\u003cbr\u003e\u0026nbsp;\u003cbr\u003e\u0026nbsp;89.5\u003cbr\u003e\u0026nbsp;10.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 73.1532%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDo you know how to use personal protective equipment (PPE) correctly in the event of exposure to COVID-19 infection CURRENTLY?\u003c/strong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003cbr\u003e\u0026nbsp; Yes, I know\u0026nbsp;\u003cbr\u003e\u0026nbsp;No, I do not know\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.6937%;\"\u003e\n \u003cp\u003e\u003cbr\u003e\u0026nbsp;\u003cbr\u003e\u0026nbsp;\u003cbr\u003e\u0026nbsp;406\u0026nbsp;\u003cbr\u003e\u0026nbsp;3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.1532%;\"\u003e\n \u003cp\u003e\u003cbr\u003e\u0026nbsp;\u003cbr\u003e\u0026nbsp;\u003cbr\u003e\u0026nbsp;99.3\u003cbr\u003e\u0026nbsp;0.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 73.1532%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAre PPEs been adequately provided in your obstetric unit AT 1 YEAR AGO?\u003c/strong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003cbr\u003e\u0026nbsp;Yes\u0026nbsp;\u003cbr\u003e\u0026nbsp;No\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.6937%;\"\u003e\n \u003cp\u003e\u003cbr\u003e\u0026nbsp;\u003cbr\u003e\u0026nbsp;334\u003cbr\u003e\u0026nbsp;75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.1532%;\"\u003e\n \u003cp\u003e\u003cbr\u003e\u0026nbsp;\u003cbr\u003e\u0026nbsp;81.7\u003cbr\u003e\u0026nbsp;18.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 73.1532%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAre PPEs been adequately provided in your obstetric unit CURRENTLY?\u003cbr\u003e\u0026nbsp;\u003c/strong\u003eYes\u0026nbsp;\u003cbr\u003e\u0026nbsp;No\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.6937%;\"\u003e\n \u003cp\u003e\u003cbr\u003e\u0026nbsp;\u003cbr\u003e\u0026nbsp;382\u003cbr\u003e\u0026nbsp;27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.1532%;\"\u003e\n \u003cp\u003e\u003cbr\u003e\u0026nbsp;\u003cbr\u003e\u0026nbsp;93.4\u003cbr\u003e\u0026nbsp;6.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 73.1532%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDo you know how to properly wash your hands and hand hygiene care in line with WHO and CDC guidelines AT 1 YEAR AGO?\u003c/strong\u003e\u0026nbsp;\u003cbr\u003eYes, I know \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003cbr\u003e\u0026nbsp;No, I do not know\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.6937%;\"\u003e\n \u003cp\u003e\u003cbr\u003e\u0026nbsp;\u003cbr\u003e\u0026nbsp;402\u003cbr\u003e\u0026nbsp; 7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.1532%;\"\u003e\n \u003cp\u003e\u003cbr\u003e\u0026nbsp;\u003cbr\u003e\u0026nbsp;98.3\u003cbr\u003e\u0026nbsp;1.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 73.1532%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDo you know how to properly wash your hands and hand hygiene care in line with WHO and CDC guidelines CURRENTLY?\u003c/strong\u003e\u003cbr\u003eYes, I know \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003cbr\u003e\u0026nbsp;No, I do not know\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.6937%;\"\u003e\n \u003cp\u003e\u003cbr\u003e\u0026nbsp;\u003cbr\u003e\u0026nbsp;404\u0026nbsp;\u003cbr\u003e\u0026nbsp;5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.1532%;\"\u003e\n \u003cp\u003e\u003cbr\u003e\u0026nbsp;\u003cbr\u003e\u0026nbsp;98.8\u003cbr\u003e\u0026nbsp;1.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 73.1532%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAre soap, water and disinfectant provided sufficiently for healthcare workers, patients, and visitors in your obstetric unit AT 1 YEAR AGO?\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;Yes\u003cbr\u003e\u0026nbsp; No\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.6937%;\"\u003e\n \u003cp\u003e\u003cbr\u003e\u0026nbsp;\u003cbr\u003e\u0026nbsp;\u003cbr\u003e\u0026nbsp;383\u003cbr\u003e\u0026nbsp;26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.1532%;\"\u003e\n \u003cp\u003e\u003cbr\u003e\u0026nbsp;\u003cbr\u003e\u0026nbsp;\u003cbr\u003e\u0026nbsp;93.6\u003cbr\u003e\u0026nbsp;6.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 73.1532%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAre soap, water and disinfectant provided sufficiently for healthcare workers, patients, and visitors in your obstetric unit CURRENTLY?\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;Yes\u003cbr\u003e\u0026nbsp; No\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.6937%;\"\u003e\n \u003cp\u003e\u003cbr\u003e\u0026nbsp;\u003cbr\u003e\u0026nbsp;\u003cbr\u003e\u0026nbsp;405\u003cbr\u003e\u0026nbsp;4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.1532%;\"\u003e\n \u003cp\u003e\u003cbr\u003e\u0026nbsp;\u003cbr\u003e\u0026nbsp;\u003cbr\u003e\u0026nbsp;99.0\u003cbr\u003e\u0026nbsp;1.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 73.1532%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAre cleaning activities done more frequently in your obstetric unit during this COVID-19 pandemic AT 1 YEAR AGO?\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;Yes\u0026nbsp;\u003cbr\u003e\u0026nbsp;No\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.6937%;\"\u003e\n \u003cp\u003e\u003cbr\u003e\u0026nbsp;\u003cbr\u003e\u0026nbsp;365\u003cbr\u003e\u0026nbsp;44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.1532%;\"\u003e\n \u003cp\u003e\u003cbr\u003e\u0026nbsp;\u003cbr\u003e\u0026nbsp;89.2\u003cbr\u003e\u0026nbsp;10.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 73.1532%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAre cleaning activities done more frequently in your obstetric unit during this COVID-19 PANDEMIC CURRENTLY?\u003c/strong\u003e\u0026nbsp;\u003cbr\u003e\u0026nbsp;Yes\u0026nbsp;\u003cbr\u003e\u0026nbsp;No\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.6937%;\"\u003e\n \u003cp\u003e\u003cbr\u003e\u0026nbsp;\u003cbr\u003e\u0026nbsp;361\u003cbr\u003e\u0026nbsp;48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.1532%;\"\u003e\n \u003cp\u003e\u003cbr\u003e\u0026nbsp;\u003cbr\u003e\u0026nbsp;88.3\u003cbr\u003e\u0026nbsp;11.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 73.1532%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAre masks adequately provided for healthcare workers, patients, and visitors in your obstetric unit AT 1 YEAR AGO?\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;Yes\u003cbr\u003e\u0026nbsp; No\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.6937%;\"\u003e\n \u003cp\u003e\u003cbr\u003e\u0026nbsp;\u003cbr\u003e\u0026nbsp;352\u003cbr\u003e\u0026nbsp;57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.1532%;\"\u003e\n \u003cp\u003e\u003cbr\u003e\u0026nbsp;\u003cbr\u003e\u0026nbsp;86.1\u003cbr\u003e\u0026nbsp;13.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 73.1532%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAre masks adequately provided for healthcare workers, patients, and visitors in your obstetric unit CURRENTLY?\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;Yes\u0026nbsp;\u003cbr\u003e\u0026nbsp;No\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.6937%;\"\u003e\n \u003cp\u003e\u003cbr\u003e\u0026nbsp;\u003cbr\u003e\u0026nbsp;397\u003cbr\u003e\u0026nbsp;12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.1532%;\"\u003e\n \u003cp\u003e\u003cbr\u003e\u0026nbsp;\u003cbr\u003e\u0026nbsp;97.1\u003cbr\u003e\u0026nbsp;2.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eTable 3. Distribution of MHC workers\u0026apos; attitudes towards COVID-19 pandemic (N=409)\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"99%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 61%;\"\u003e\n \u003cp\u003e\u003cbr\u003e\u0026nbsp;Variable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 38%;\"\u003e\n \u003cp\u003en (%)\u003cbr\u003e\u0026nbsp;(N=409)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 12%;\"\u003e\n \u003cp\u003eAgree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12%;\"\u003e\n \u003cp\u003eDisagree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12%;\"\u003e\n \u003cp\u003eNot sure\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 61%;\"\u003e\n \u003cp\u003eYour self-stress levels increased at 1 YEAR AGO \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12%;\"\u003e\n \u003cp\u003e305 (74.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12%;\"\u003e\n \u003cp\u003e54 (13.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12%;\"\u003e\n \u003cp\u003e50 (12.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 61%;\"\u003e\n \u003cp\u003eYour self-stress levels are increasing CURRENTLY \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12%;\"\u003e\n \u003cp\u003e132 (32.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12%;\"\u003e\n \u003cp\u003e215 (52.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12%;\"\u003e\n \u003cp\u003e62 (15.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 61%;\"\u003e\n \u003cp\u003eYour self-stress levels are higher now than 1 year ago \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12%;\"\u003e\n \u003cp\u003e110 (26.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12%;\"\u003e\n \u003cp\u003e249 (60.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12%;\"\u003e\n \u003cp\u003e50 (12.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 61%;\"\u003e\n \u003cp\u003eAt 1 YEAR AGO, you feel protected from COVID-19 infection in your workplace\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12%;\"\u003e\n \u003cp\u003e205 (50.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12%;\"\u003e\n \u003cp\u003e143 (35.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12%;\"\u003e\n \u003cp\u003e61 (14.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 61%;\"\u003e\n \u003cp\u003eYou feel more protected from COVID-19 infection at your workplace CURRENTLY \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12%;\"\u003e\n \u003cp\u003e307 (75.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12%;\"\u003e\n \u003cp\u003e45 (11.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12%;\"\u003e\n \u003cp\u003e57 (13.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 61%;\"\u003e\n \u003cp\u003eFear of contracting COVID-19 will hinder your ability to provide quality obstetric health services\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12%;\"\u003e\n \u003cp\u003e254 (62.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12%;\"\u003e\n \u003cp\u003e132 (32.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12%;\"\u003e\n \u003cp\u003e23 (5.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 61%;\"\u003e\n \u003cp\u003eMy work as a healthcare worker has been stigmatized by the community 1 YEAR AGO \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12%;\"\u003e\n \u003cp\u003e277 (67.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12%;\"\u003e\n \u003cp\u003e85 (20.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12%;\"\u003e\n \u003cp\u003e47 (11.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 61%;\"\u003e\n \u003cp\u003eMy work as a healthcare worker is getting stigmatized from the community CURRENTLY\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12%;\"\u003e\n \u003cp\u003e151 (36.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12%;\"\u003e\n \u003cp\u003e193 (47.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12%;\"\u003e\n \u003cp\u003e65 (15.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 61%;\"\u003e\n \u003cp\u003eMy job as a healthcare worker is getting more stigmatized from the community currently than 1 year ago \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12%;\"\u003e\n \u003cp\u003e72 (17.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12%;\"\u003e\n \u003cp\u003e265 (64.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12%;\"\u003e\n \u003cp\u003e72 (17.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 61%;\"\u003e\n \u003cp\u003eAlways feeling very tired from work caused by the COVID-19 pandemic at 1 YEAR AGO \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12%;\"\u003e\n \u003cp\u003e321 (78.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12%;\"\u003e\n \u003cp\u003e61 (14.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12%;\"\u003e\n \u003cp\u003e27 (6.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 61%;\"\u003e\n \u003cp\u003eAlways feeling very tired from work caused by the COVID-19 pandemic CURRENTLY\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12%;\"\u003e\n \u003cp\u003e128 (31.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12%;\"\u003e\n \u003cp\u003e231 (56.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12%;\"\u003e\n \u003cp\u003e50 (12.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 61%;\"\u003e\n \u003cp\u003eFeeling very tired from work caused by the COVID-19 pandemic currently more than 1 year ago\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12%;\"\u003e\n \u003cp\u003e82 (20.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12%;\"\u003e\n \u003cp\u003e273 (66.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12%;\"\u003e\n \u003cp\u003e54 (13.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 61%;\"\u003e\n \u003cp\u003eFeeling ready to manage the COVID-19 pandemic at 1 YEAR AGO\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12%;\"\u003e\n \u003cp\u003e238 (58.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12%;\"\u003e\n \u003cp\u003e105 (25.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12%;\"\u003e\n \u003cp\u003e66 (16.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 61%;\"\u003e\n \u003cp\u003eFeeling ready to manage the COVID-19 pandemic CURRENTLY \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12%;\"\u003e\n \u003cp\u003e384 (93.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12%;\"\u003e\n \u003cp\u003e6 (1.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12%;\"\u003e\n \u003cp\u003e19 (4.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 61%;\"\u003e\n \u003cp\u003e\u0026nbsp;CURRENTLY feel more ready to manage the COVID-19 pandemic than 1 year ago \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12%;\"\u003e\n \u003cp\u003e375 (91.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12%;\"\u003e\n \u003cp\u003e10 (2.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12%;\"\u003e\n \u003cp\u003e24 (5.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eTable 4. Distribution for obstetric services preparedness during the COVID-19 pandemic (N=409)\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"99%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 63%;\"\u003e\n \u003cp\u003e\u003cbr\u003e\u0026nbsp;Variable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 36%;\"\u003e\n \u003cp\u003en (%)\u003cbr\u003e\u0026nbsp;(N=409)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 12%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12%;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12%;\"\u003e\n \u003cp\u003eNot sure\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 63%;\"\u003e\n \u003cp\u003eAre there any training courses for COVID-19 management been given at 1 YEAR AGO? \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12%;\"\u003e\n \u003cp\u003e293 (71.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12%;\"\u003e\n \u003cp\u003e92\u0026nbsp;\u003cbr\u003e\u0026nbsp;(22.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12%;\"\u003e\n \u003cp\u003e24\u0026nbsp;\u003cbr\u003e\u0026nbsp;(5.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 63%;\"\u003e\n \u003cp\u003eAre there any training courses for COVID-19 management been given CURRENTLY? \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12%;\"\u003e\n \u003cp\u003e255 (62.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12%;\"\u003e\n \u003cp\u003e119 (29.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12%;\"\u003e\n \u003cp\u003e35\u0026nbsp;\u003cbr\u003e\u0026nbsp;(8.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 63%;\"\u003e\n \u003cp\u003eCurrently training courses for COVID-19 management are given MORE than previous 1 year ago \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12%;\"\u003e\n \u003cp\u003e170 (41.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12%;\"\u003e\n \u003cp\u003e158 (38.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12%;\"\u003e\n \u003cp\u003e81\u0026nbsp;\u003cbr\u003e\u0026nbsp;(19.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 63%;\"\u003e\n \u003cp\u003eHave you been informed by the hospital/obstetric unit administration regarding the protocol for triage and isolation for suspected COVID-19 cases at 1 YEAR AGO? \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12%;\"\u003e\n \u003cp\u003e377 (92.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12%;\"\u003e\n \u003cp\u003e16\u0026nbsp;\u003cbr\u003e\u0026nbsp;(3.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12%;\"\u003e\n \u003cp\u003e16\u0026nbsp;\u003cbr\u003e\u0026nbsp;(3.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 63%;\"\u003e\n \u003cp\u003eHave you been informed by the hospital/obstetric unit regarding the protocol for triage and isolation for suspected COVID-19 cases CURRENTLY? \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12%;\"\u003e\n \u003cp\u003e393 (96.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12%;\"\u003e\n \u003cp\u003e6\u0026nbsp;\u003cbr\u003e\u0026nbsp;(1.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12%;\"\u003e\n \u003cp\u003e10\u0026nbsp;\u003cbr\u003e\u0026nbsp;(2.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 63%;\"\u003e\n \u003cp\u003eCurrently, protocol notification for triage and isolation for suspected COVID-19 cases is given MORE by hospitals/obstetric units than previous 1 year ago \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12%;\"\u003e\n \u003cp\u003e291 (71.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12%;\"\u003e\n \u003cp\u003e75\u0026nbsp;\u003cbr\u003e\u0026nbsp;(18.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12%;\"\u003e\n \u003cp\u003e43\u0026nbsp;\u003cbr\u003e\u0026nbsp;(10.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 63%;\"\u003e\n \u003cp\u003eDoes your hospital/obstetric unit provide isolation room for suspected or confirmed COVID-19 cases for maternity patients at 1 YEAR AGO? \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12%;\"\u003e\n \u003cp\u003e391 (95.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12%;\"\u003e\n \u003cp\u003e12\u0026nbsp;\u003cbr\u003e\u0026nbsp;(2.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12%;\"\u003e\n \u003cp\u003e6\u0026nbsp;\u003cbr\u003e\u0026nbsp;(1.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 63%;\"\u003e\n \u003cp\u003eDoes your hospital/obstetric unit provide isolation rooms for suspected or confirmed COVID-19 cases for maternity patients CURRENTLY? \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12%;\"\u003e\n \u003cp\u003e397 (97.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12%;\"\u003e\n \u003cp\u003e7\u0026nbsp;\u003cbr\u003e\u0026nbsp;(1.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12%;\"\u003e\n \u003cp\u003e5\u0026nbsp;\u003cbr\u003e\u0026nbsp;(1.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 63%;\"\u003e\n \u003cp\u003eCurrently, isolation rooms for suspected or confirmed COVID-19 cases for maternity patients are MORE provided by hospitals/obstetric units than previous 1 year ago \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12%;\"\u003e\n \u003cp\u003e216 (52.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12%;\"\u003e\n \u003cp\u003e155 (37.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12%;\"\u003e\n \u003cp\u003e38\u0026nbsp;\u003cbr\u003e\u0026nbsp;(9.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 63%;\"\u003e\n \u003cp\u003eHave you been informed by the hospital/obstetric unit administration regarding the isolation procedures at 1 YEAR AGO? \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12%;\"\u003e\n \u003cp\u003e389 (95.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12%;\"\u003e\n \u003cp\u003e8\u003cbr\u003e\u0026nbsp; (2.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12%;\"\u003e\n \u003cp\u003e12\u003cbr\u003e\u0026nbsp; (2.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 63%;\"\u003e\n \u003cp\u003eHave you been informed by the hospital/obstetric unit administration regarding the isolation procedure CURRENTLY? \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12%;\"\u003e\n \u003cp\u003e396 (96.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12%;\"\u003e\n \u003cp\u003e7\u0026nbsp;\u003cbr\u003e\u0026nbsp;(1.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12%;\"\u003e\n \u003cp\u003e6\u0026nbsp;\u003cbr\u003e\u0026nbsp;(1.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 63%;\"\u003e\n \u003cp\u003eCurrently, the notification of isolation procedures is given MORE by hospitals/obstetric units administration than previous 1 year ago\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12%;\"\u003e\n \u003cp\u003e262 (64.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12%;\"\u003e\n \u003cp\u003e108 (26.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12%;\"\u003e\n \u003cp\u003e39\u0026nbsp;\u003cbr\u003e\u0026nbsp;(9.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 63%;\"\u003e\n \u003cp\u003eAre the obstetric emergency services (surgical room for Caesarean section surgery/any obstetric emergency surgery/procedure) available for maternity patients for suspected or confirmed cases of COVID-19 at 1 YEAR AGO?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12%;\"\u003e\n \u003cp\u003e336 (82.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12%;\"\u003e\n \u003cp\u003e45\u0026nbsp;\u003cbr\u003e\u0026nbsp;(11.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12%;\"\u003e\n \u003cp\u003e28\u0026nbsp;\u003cbr\u003e\u0026nbsp;(6.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 63%;\"\u003e\n \u003cp\u003eAre the obstetric emergency services (surgical room for Caesarean section surgery/any obstetric emergency surgery/procedure) available for maternity patients for suspected or confirmed cases of COVID-19 CURRENTLY? \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12%;\"\u003e\n \u003cp\u003e340 (83.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12%;\"\u003e\n \u003cp\u003e38\u003cbr\u003e\u0026nbsp; (9.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12%;\"\u003e\n \u003cp\u003e31\u003cbr\u003e\u0026nbsp; (7.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 63%;\"\u003e\n \u003cp\u003eCurrently, obstetric emergency services (surgical room for Caesarean section surgery/any obstetric emergency surgery/procedure) for maternity patients for suspected or confirmed cases of COVID-19 are MORE provided by the hospital/unit \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12%;\"\u003e\n \u003cp\u003e219 (53.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12%;\"\u003e\n \u003cp\u003e127 (31.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12%;\"\u003e\n \u003cp\u003e63\u0026nbsp;\u003cbr\u003e\u0026nbsp;(15.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 63%;\"\u003e\n \u003cp\u003eAre there any dedicated teams provided by the hospital/obstetric unit in the management and treatment of pregnant/maternity mothers who have COVID-19 at 1 YEAR AGO?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12%;\"\u003e\n \u003cp\u003e270 (66.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12%;\"\u003e\n \u003cp\u003e110 (26.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12%;\"\u003e\n \u003cp\u003e29\u0026nbsp;\u003cbr\u003e\u0026nbsp;(7.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 63%;\"\u003e\n \u003cp\u003eAre there any dedicated teams provided by the hospital/obstetrics unit in the management and treatment of pregnant/maternity mothers who have COVID-19 CURRENTLY?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12%;\"\u003e\n \u003cp\u003e266 (65.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12%;\"\u003e\n \u003cp\u003e121 (29.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12%;\"\u003e\n \u003cp\u003e22\u003cbr\u003e\u0026nbsp; (5.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 63%;\"\u003e\n \u003cp\u003eDo you know how to report potential cases for COVID-19 and be ready to do so at 1 YEAR AGO? \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12%;\"\u003e\n \u003cp\u003e326 (79.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12%;\"\u003e\n \u003cp\u003e38\u0026nbsp;\u003cbr\u003e\u0026nbsp;(9.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12%;\"\u003e\n \u003cp\u003e45\u0026nbsp;\u003cbr\u003e\u0026nbsp;(11.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 63%;\"\u003e\n \u003cp\u003eDo you know how to report potential cases for COVID-19 and are ready to do so CURRENTLY? \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12%;\"\u003e\n \u003cp\u003e378 (92.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12%;\"\u003e\n \u003cp\u003e8\u003cbr\u003e\u0026nbsp; (2.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12%;\"\u003e\n \u003cp\u003e23\u003cbr\u003e\u0026nbsp; (5.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 63%;\"\u003e\n \u003cp\u003eCurrently know more on how to report potential cases for COVID-19 and more ready to do so than previous 1 year ago\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12%;\"\u003e\n \u003cp\u003e373 (91.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12%;\"\u003e\n \u003cp\u003e7\u0026nbsp;\u003cbr\u003e\u0026nbsp;(1.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12%;\"\u003e\n \u003cp\u003e29\u003cbr\u003e\u0026nbsp; (7.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"99%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 62.8866%;\"\u003e\n \u003cp\u003eDo you know the protocol that need to be done if you have any signs of contracting COVID-19 at 1 YEAR AGO?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.3711%;\"\u003e\n \u003cp\u003e351\u003cbr\u003e\u0026nbsp; (85.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.3711%;\"\u003e\n \u003cp\u003e33\u0026nbsp;\u003cbr\u003e\u0026nbsp;(8.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.3711%;\"\u003e\n \u003cp\u003e25\u0026nbsp;\u003cbr\u003e\u0026nbsp;(6.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 62.8866%;\"\u003e\n \u003cp\u003eDo you know the protocol that need to be done if you have any signs of contracting COVID-19 CURRENTLY? \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.3711%;\"\u003e\n \u003cp\u003e394\u0026nbsp;\u003cbr\u003e\u0026nbsp;(96.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.3711%;\"\u003e\n \u003cp\u003e3\u0026nbsp;\u003cbr\u003e\u0026nbsp;(0.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.3711%;\"\u003e\n \u003cp\u003e12\u003cbr\u003e\u0026nbsp; (2.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 62.8866%;\"\u003e\n \u003cp\u003eCurrently know more of the protocols that need to be done in case of having signs of contracting COVID-19 compared to previous 1 year ago \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.3711%;\"\u003e\n \u003cp\u003e380\u0026nbsp;\u003cbr\u003e\u0026nbsp;(92.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.3711%;\"\u003e\n \u003cp\u003e8\u0026nbsp;\u003cbr\u003e\u0026nbsp;(2.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.3711%;\"\u003e\n \u003cp\u003e21\u0026nbsp;\u003cbr\u003e\u0026nbsp;(5.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 62.8866%;\"\u003e\n \u003cp\u003eDo you know the safety measures for aerosol transmission for maternity patients infected with COVID-19 at 1 YEAR AGO? \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.3711%;\"\u003e\n \u003cp\u003e294\u0026nbsp;\u003cbr\u003e\u0026nbsp;(71.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.3711%;\"\u003e\n \u003cp\u003e54\u0026nbsp;\u003cbr\u003e\u0026nbsp;(13.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.3711%;\"\u003e\n \u003cp\u003e61\u0026nbsp;\u003cbr\u003e\u0026nbsp;(14.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 62.8866%;\"\u003e\n \u003cp\u003eDo you know the safety measures for aerosol transmission for maternity patients infected with COVID-19 CURRENTLY?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.3711%;\"\u003e\n \u003cp\u003e355\u0026nbsp;\u003cbr\u003e\u0026nbsp;(86.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.3711%;\"\u003e\n \u003cp\u003e13\u003cbr\u003e\u0026nbsp; (3.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.3711%;\"\u003e\n \u003cp\u003e41\u003cbr\u003e\u0026nbsp; (10.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 62.8866%;\"\u003e\n \u003cp\u003eCurrently know more about safety measures for aerosol transmission for maternity patients infected with COVID-19 than previous 1 year ago\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.3711%;\"\u003e\n \u003cp\u003e344\u003cbr\u003e\u0026nbsp; (84.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.3711%;\"\u003e\n \u003cp\u003e18\u0026nbsp;\u003cbr\u003e\u0026nbsp;(4.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.3711%;\"\u003e\n \u003cp\u003e47\u0026nbsp;\u003cbr\u003e\u0026nbsp;(11.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 62.8866%;\"\u003e\n \u003cp\u003eDo you know how to make an assessment for a patient who is under investigation at 1 YEAR AGO?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.3711%;\"\u003e\n \u003cp\u003e314\u0026nbsp;\u003cbr\u003e\u0026nbsp;(76.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.3711%;\"\u003e\n \u003cp\u003e39\u003cbr\u003e\u0026nbsp; (9.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.3711%;\"\u003e\n \u003cp\u003e56\u003cbr\u003e\u0026nbsp; (13.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 62.8866%;\"\u003e\n \u003cp\u003eDo you know how to make an assessment for a patient who is under investigation CURRENTLY? \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.3711%;\"\u003e\n \u003cp\u003e381\u003cbr\u003e\u0026nbsp; (93.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.3711%;\"\u003e\n \u003cp\u003e8\u0026nbsp;\u003cbr\u003e\u0026nbsp;(2.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.3711%;\"\u003e\n \u003cp\u003e20\u0026nbsp;\u003cbr\u003e\u0026nbsp;(4.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 62.8866%;\"\u003e\n \u003cp\u003eCURRENTLY know more on how to make assessments for patients under investigation than previous 1 year ago\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.3711%;\"\u003e\n \u003cp\u003e367\u0026nbsp;\u003cbr\u003e\u0026nbsp;(89.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.3711%;\"\u003e\n \u003cp\u003e11\u0026nbsp;\u003cbr\u003e\u0026nbsp;(2.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.3711%;\"\u003e\n \u003cp\u003e31\u0026nbsp;\u003cbr\u003e\u0026nbsp;(7.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 62.8866%;\"\u003e\n \u003cp\u003eAre you sure that your hospital/ obstetric unit is prepared to manage COVID-19 pandemic at 1 YEAR AGO?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.3711%;\"\u003e\n \u003cp\u003e311\u0026nbsp;\u003cbr\u003e\u0026nbsp;(76.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.3711%;\"\u003e\n \u003cp\u003e47\u0026nbsp;\u003cbr\u003e\u0026nbsp;(11.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.3711%;\"\u003e\n \u003cp\u003e51\u0026nbsp;\u003cbr\u003e\u0026nbsp;(12.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 62.8866%;\"\u003e\n \u003cp\u003eAre you sure that your hospital/obstetric unit is prepared to manage the COVID-19 pandemic CURRENTLY?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.3711%;\"\u003e\n \u003cp\u003e391\u0026nbsp;\u003cbr\u003e\u0026nbsp;(95.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.3711%;\"\u003e\n \u003cp\u003e5\u0026nbsp;\u003cbr\u003e\u0026nbsp;(1.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.3711%;\"\u003e\n \u003cp\u003e13\u0026nbsp;\u003cbr\u003e\u0026nbsp;(3.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 62.8866%;\"\u003e\n \u003cp\u003eCurrently in obstetric hospitals/units are more confident to manage the COVID-19 pandemic compared to previous 1 year ago\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.3711%;\"\u003e\n \u003cp\u003e387\u0026nbsp;\u003cbr\u003e\u0026nbsp;(94.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.3711%;\"\u003e\n \u003cp\u003e5\u0026nbsp;\u003cbr\u003e\u0026nbsp;(1.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.3711%;\"\u003e\n \u003cp\u003e17\u0026nbsp;\u003cbr\u003e\u0026nbsp;(4.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eTable 5. Distribution of mean score and the level of knowledge level and awareness, attitude, and obstetric services preparedness for MHC workers (N=409)\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 219px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eFactors\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eMean score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003eLevel\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003eGood/Positive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003ePoor/Negative\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 219px;\"\u003e\n \u003cp\u003eKnowledge and awareness\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e14.20\u0026plusmn;1.66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e92.2%\u0026nbsp;\u003cbr\u003e\u0026nbsp;(score \u0026ge;12)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e7.8%\u003cbr\u003e\u0026nbsp;(score \u0026lt;12)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 219px;\"\u003e\n \u003cp\u003eAttitude\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e8.17\u0026plusmn;2.87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e54.0%\u003cbr\u003e\u0026nbsp;(score \u0026ge;8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e46.0%\u003cbr\u003e\u0026nbsp;(score \u0026lt;8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 219px;\"\u003e\n \u003cp\u003eObstetric services preparedness\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e25.93\u0026plusmn;4.87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e88.3%\u003cbr\u003e\u0026nbsp;(score \u0026ge;22)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e11.7%\u003cbr\u003e\u0026nbsp;(score \u0026lt;22)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eTable 6. Comparison between previous 1 year ago (the peak time of the COVID-19 pandemic) and currently for MHC workers\u0026apos; knowledge and awareness factors on COVID-19, attitudes towards the COVID-19 pandemic, and obstetric services preparedness during the COVID-19 pandemic (N=409)\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eComparison between a year ago and now\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eMean\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eSD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eSEM\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e95% CI of the Difference\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003et\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eP-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLower\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eUpper\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eKnowledge of proper use of PPE in the event of exposure to COVID-19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e-0.098\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.313\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.015\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e-0.128\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.067\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e-6.310\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eAdequate preparation of PPE in the obstetric unit\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e-0.117\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.385\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.019\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e-0.155\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e-0.080\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e-6.170\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eKnowledge of the right way to wash hands and hand hygiene care in line with WHO and CDC guideline\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e-0.005\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.156\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.008\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e-0.020\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.010\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e-0.632\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.528\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eAdequate provision of soap, water and disinfectants for health workers, patients, and visitors in the obstetric unit\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e-0.054\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.247\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.012\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e-0.078\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e-0.030\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e-4.411\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eCleaning activities are carried out more frequently in the obstetric unit during the COVID-19 pandemic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.010\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.383\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.019\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e-0.027\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.047\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.303\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.606\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eProvision of adequate face masks for health workers, patients and visitors in the obstetric unit\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e-0.110\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.350\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.017\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e-0.144\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e-0.076\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e-6.353\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eIncreased level of self-stress\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.364\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.799\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.040\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.287\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.442\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e9.217\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eFeeling protected from COVID-19 infection at workplace\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e-0.230\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.751\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.037\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e-0.303\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e-0.157\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e-6.185\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eWork as a health worker gets stigma from society\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.220\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.725\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.036\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.150\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.290\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e6.142\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eAlways feeling very tired from work caused by the COVID-19 pandemic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.359\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.661\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.033\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.295\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.424\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e11.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eFeeling ready to manage the COVID-19 pandemic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e-0.127\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.617\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.031\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e-0.187\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e-0.067\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e-4.166\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eProvision of training courses for the management of the COVID-19 pandemic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.039\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.597\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.030\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e-0.019\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.097\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e1.325\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.186\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eNotification by the hospital/obstetric unit regarding protocols for triage and isolation for suspected COVID-19 cases\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e-0.010\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.313\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.015\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e-0.040\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.021\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e-0.632\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.528\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eProvision of isolation room for suspected or confirmed COVID-19 cases for maternity patients by hospital/obstetric unit\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e-0.010\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.232\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.011\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e-0.032\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.013\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e-0.853\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.394\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eNotification by the hospital/obstetric unit regarding isolation procedures\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.012\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.247\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.012\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e-0.012\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.036\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.318\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eProvision of obstetric emergency services for maternity patients for suspected or confirmed cases of COVID-19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e-0.024\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.304\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.015\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e-0.054\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.005\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e-1.625\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.105\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eProvision of dedicated teams by hospitals/obstetric units in management and treatment for pregnant/maternity mothers with COVID-19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.044\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.473\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.023\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e-0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.090\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e1.882\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.060\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eKnowledge to report potential cases for COVID-19 and be prepared to do so\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e-0.020\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.448\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.022\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e-0.063\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.024\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e-0.883\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.378\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eKnowledge of the protocols that need to be done if any signs of contracting COVID-19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e-0.042\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.365\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.018\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e-0.077\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e-0.006\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e-2.304\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.022*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eKnowledge of safety measures for aerosol transmission for maternity patients infected with COVID-19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e-0.051\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.490\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.024\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e-0.099\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e-0.004\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e-2.120\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.035*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eKnowledge in making assessments for patients under investigation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.012\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.434\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.021\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e-0.030\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.054\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.569\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.569\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eConfidence that hospitals/obstetric units are ready to manage the COVID-19 pandemic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e-0.010\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.475\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.023\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e-0.056\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.036\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e-0.417\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.677\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eA paired t-test was done. Significant at p\u0026lt;0.05. SD: Standard Deviation. SEM: Standard Error Mean\u003cem\u003e.\u0026nbsp;\u003c/em\u003eCI: Confidence\u003cem\u003e\u0026nbsp;\u003c/em\u003eInterval\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 7\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eLinear relationship between background factor, knowledge and awareness factor and attitude factor with obstetric service readiness (N\u0026thinsp;=\u0026thinsp;409).\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\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 \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eFactors\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eB\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSE\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eStatistics t\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e95% CI for difference\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eLower Limit\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eUpper \u003c/p\u003e \u003cp\u003eLimit \u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-1.460\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.014\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-0.725\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.469\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e-5.420\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e2.500\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.012\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.035\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.343\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.732\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e-0.056\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.080\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProfession\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.453\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.893\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-0.507\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.613\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e-2.208\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e1.303\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWork duration\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-2.226\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.037\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-2.146\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.033*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e-4.266\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e-0.186\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThe number of hours worked per week\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.021\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.021\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-0.972\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.332\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e-0.062\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.021\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThe number of shifts per month\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.064\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.036\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-1.772\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.077\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e-0.135\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.007\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWorkplace\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.695\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.654\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.064\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.288\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e-0.590\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e1.981\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGovernment resources\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.017\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.461\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.038\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.970\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e-0.890\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.925\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInternet resources\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.264\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.510\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.517\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.605\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e-0.739\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e1.266\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSocial media resources\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.168\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.472\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-0.357\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.721\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e-1.095\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.759\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWorkplace resources\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.193\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.463\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.416\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.677\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e-0.718\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e1.103\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrevious epidemic experience\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.281\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.491\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.571\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.568\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e-0.685\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e1.247\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eConfidence in managing COVID-19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.622\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.613\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.014\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.311\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e-0.584\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e1.828\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKnowledge and awareness on COVID-19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.940\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.135\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e6.976\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.675\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e1.206\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAttitudes towards the COVID-19 pandemic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.449\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.079\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5.680\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.294\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.605\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\u003eLinear regression test was done. *Significant at p\u0026thinsp;\u0026lt;\u0026thinsp;0.05. B: Coefficient. SE: Standard Error. CI: Confidence interval.\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 8\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePredicting factors affecting the level of obstetric services preparedness.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\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 \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eFactors\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eAdj.\u003c/p\u003e \u003cp\u003eB\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSE\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003et\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e95% CI for difference\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eLower Limit\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eUpper Limit \u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKnowledge and awareness on COVID-19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.926\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.132\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e7.023\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.666\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e1.185\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAttitudes towards the COVID-19 pandemic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.463\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.076\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e6.053\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.313\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.613\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWork\u0026nbsp;duration\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-1.721\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.850\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-2.024\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e-3.392\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e-0.050\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\u003eA multiple linear regression (MLR) test is carried out. *Significant at p\u0026thinsp;\u0026lt;\u0026thinsp;0.05. Adj. B: Adjusted coefficient. SE: Standard Error. CI: Confidence interval. Dependent variable\u0026thinsp;=\u0026thinsp;Obstetric service preparedness.\u003c/p\u003e \u003cp\u003eThe results showed that there were significant direct linear relationships (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) between: 1) the work duration factor with obstetric services preparedness (B=-1.721, 95% CI: -3.392, -0.050, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001); 2) knowledge and awareness factor with obstetric service preparedness (B\u0026thinsp;=\u0026thinsp;0.926, 95% CI: 0.666, 1.185, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001); 3) attitude factor with obstetric services preparedness (B\u0026thinsp;=\u0026thinsp;0.463, 95% SK: 0.313, 0.613, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) (Tables\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e7\u003c/span\u003e and \u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e8\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThis means that respondents who have 1 more year of work duration will have a higher obstetric service preparedness score of 1.721, respondents who have 1 more point for knowledge and awareness score will have a higher obstetric service preparedness score of 0.926, and respondents who have 1 more point for the attitude score will have a higher obstetric service readiness score of 0.463.\u003c/p\u003e \u003cp\u003eThe adjusted value of R\u003csup\u003e2\u003c/sup\u003e for this test was 0.188. This suggests that 18.8% of the variance in obstetric service preparedness can be predicted from working duration factor, knowledge, and awareness factor as well as attitude factor. Additionally, no interaction between these three factors was found. The variant-inflation factor (VIF) was less than 10, indicating that multicollinearity was not a problem in this model.\u003c/p\u003e \u003cp\u003eHowever, for other factors such as age, gender, profession, number of hours worked per week, total number of shifts in a month, place of work, information resources, history of previous pandemic experiences, and confidence in the management of the COVID-19 pandemic showed a p-value of more than 0.05. Therefore, there was no provable relationship or association between these factors and the level of obstetric services preparedness.\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eCOVID-19 infection has put the health system under unprecedented pressure [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Therefore, foresight and planning for service preparedness are key factors to avoid disaster. Every facility that provides obstetric services requires a certain level of readiness to be able to handle at least a suspected COVID-19 pregnant woman waiting for a test report, and for those who need to be managed as COVID-19 positive patients until a report is available. Therefore, these facilities need to have triage or screening areas and isolation rooms for suspected COVID-19. Healthcare facilities need to have designated areas for COVID-19 positive patients or have a referral relationship with a designated COVID-19 positive hospital. Preparations are needed including structural restructuring by providing facilities for suspected COVID-19 and COVID-19-positive maternal patients in sufficient spaces, as well as extensive training among MHC workers on infection control practices and proper use of PPE.\u003c/p\u003e \u003cp\u003eIn this study, a majority 88.3% of the respondents had a good level of obstetric services preparedness during the COVID-19 pandemic. This percentage was higher than in the study conducted by Patience Afulani et al. (2020) where only 27.8% of respondents had a good level of service preparedness [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e], as well as in the study by Elhadi et. al (2020) of which only 7.8% of respondents had a good level of obstetric services preparedness [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. The mean score for obstetric services preparedness in this study was 25.93\u0026thinsp;\u0026plusmn;\u0026thinsp;4.87. This score was slightly higher than in a study by Patience Afulani et al. (2020) with the mean score of 24\u0026thinsp;\u0026plusmn;\u0026thinsp;8.9 [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e].\u003c/p\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eCOVID-19 pandemic management training\u003c/h2\u003e \u003cp\u003eOnly 62.3% of respondents in this study stated that they received a training course for the management of the COVID-19 pandemic. This can also be seen in studies by Patience Afulani et al. (2020) and Elhadi et. al (2020) which stated just over half (54% and 56% respectively) of respondents were able to participate in training for COVID-19 case management [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e], [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. Similarly, a study by Huy et al. (2021) found that out of 17,302 healthcare workers, less than half of the respondents which was only 6,287 people (36.6%) were able to participate in training for COVID-19 management [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. Similar reports from studies in India also show that only about half (56.1%) of respondents received COVID-19-related training and \u0026lt;\u0026thinsp;50% were satisfied with the quality of training.\u003c/p\u003e \u003cp\u003eIf more training was given to healthcare workers including MHC workers in preparation for the pandemic as advised by WHO, this will contribute to more trained workforce and better services readiness [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. To ensure adequate resources and staff, it is necessary to quickly train many healthcare workers including MHC workers who are at the forefront. Ideally, training and education in preparation for the threat of new infectious diseases should continue and be planned. Specialized training in equipping healthcare workers including MHC workers with knowledge and skills is necessary to provide safer and better care for patients, to reduce mortality during the pandemic and to prevent and control nosocomial infections [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e], [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAlthough there are key capacities considered in the evaluation for this study, the current COVID-19 pandemic has highlighted the need to increase the number of healthcare workers including sufficiently trained MHC workers. There is still an urgent need for best practices in the development and implementation of training programs during this COVID-19 pandemic [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eScreening, procedures, and isolation rooms\u003c/h2\u003e \u003cp\u003eIn this study, most respondents stated that they had been informed by their hospitals/obstetric units about protocols for screening and isolation procedures for suspected COVID-19 cases (96.1% and 96.8% of respondents respectively). Compared to previous one year which only 67.7% of respondents stated that isolation rooms for suspected or confirmed COVID-19 cases were provided for maternity patients, currently majority (97.1%) of respondents reported an increase in the provision of this facility.\u003c/p\u003e \u003cp\u003eMeanwhile, in the study by Elhadi et. al (2020) showed that only about 63% of respondents reported that they had isolation procedures, only 43% of hospitals had screening or screening areas for cases of pregnant women suspected of COVID-19, and only 63.8% and 61.5% of respondents stated there were isolation rooms for suspected COVID-19 cases and screening procedures for maternity patients with COVID-19 symptoms respectively [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Whereby in the study by Patience Afulani et al. (2020), only 76% of respondents knew how to report suspected COVID-19 cases and only two-thirds reported that they had isolation wards for COVID-19 cases at the health facility [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eBased on the findings of this study, as for screening measures, majority 92.4% of respondents knew how to report potential cases for COVID-19 and were ready to do so compared to previous one year which was only 79.7%. Majority (96.3%) of respondents also knew what protocols to do if they had signs of contracting COVID-19 and 93.9% of respondents said they knew how to make an assessment for patients under investigation (PUI). The study by Patience Afulani et al. (2020) also found that a majority 80% of the respondents reported that their health facilities had protocols for screening for potential COVID-19 patients [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eHowever, this contrasts with a study by Elhadi et al. (2020) in which only two-thirds of respondents (66.7%) reported they knew what to do if they suspected a patient might have COVID-19, only as many as 22% said they knew how to manage confirmed COVID-19 cases, and only a third of respondents (32.8%) were sure about where to quarantine at home without contact with their family [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn addition, 45.1% of doctors and 37.0% of nurses were not ready to manage cases that had signs and symptoms of COVID-19 infection. There were only 21.2% of doctors and 23.9% of nurses knew the criteria for evaluating people investigated for COVID-19 infection, and only 25.0% of doctors knew how to report potential COVID-19 cases. This can lead to an unexpected increase in undiagnosed cases, thus increasing the burden of infection in the community. This situation can highlight the risk of cross-contamination in hospitals and can lead to higher rates of hospital-acquired infections [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eMoreover, in this study, majority (86.8%) of respondents were aware of safety measures for aerosol transmission for maternity patients infected with COVID-19. Meanwhile, in the study by Elhadi et. al (2020) showed only about 67.0% of respondents were not prepared to take safety precautions to prevent the transmission of aerosols through individuals suspected of COVID-19 infection, and only about 68% of the participants were aware of measures to prevent the transmission of the COVID-19 virus [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThese issues raised fears and concerns over the safety of healthcare workers including MHC workers and their ability to access safety measures as well as question the ability of the healthcare system to prevent hospital-acquired infections. Hospitals can also be contagious sites that spread COVID-19 infections into communities and healthcare workers had the potential to transmit the infection to family members at home [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eObstetric emergency services and dedicated teams for obstetric services\u003c/h2\u003e \u003cp\u003eFor obstetric emergency services which include the operating room for Caesarean section or any obstetric emergency procedure, in this study it was found that more than 80% of respondents stated that it was provided for maternity patients for suspected or confirmed cases of COVID-19. This is in line with the results of a study by Elhadi et al. (2020) in which 81.0% of respondents thought that they could provide care for obstetric emergency cases and 89.1% of respondents stated that their health facilities could perform cesarean section [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAs for the dedicated team in the management and treatment of pregnant women, in this study showed only over 60% of the respondents said it was provided by their hospitals/obstetric units. However, the results of the study by Elhadi et. al (2020) showed as many as 70.1% of respondents reported that there was no dedicated team that was designated to treat patients with COVID-19 in the maternity ward [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eRelationship between significant factors with obstetric services preparedness\u003c/h3\u003e\n\u003cp\u003eIn this study, majority or 380 (92.7%) respondents had more than 5 years of working experience. It differs from the study by Elhadi et al. (2020) where only about half of respondents (53.4%) had more than 5 years of working experience [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e], as well as in a study by Huynh et al. (2020a) where most of them had less than 5 years (62.9%) experience [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe findings of this study through multiple linear regression (MLR) test conducted showed that the working duration factor showed a statistically significant direct linear relationship (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05) with obstetric services preparedness. This is because the more time the respondents' work experience had, the more prepared they will be to provide good obstetric services during the COVID-19 pandemic. This was equivalent to a study by Zewudie et al. (2021) that showed the working duration factor had a statistically significant relationship with service preparedness during COVID-19 (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The findings in the study also showed that having more than five years of working experience is one of the factors (which independently and significantly) predicts readiness to work (AOR\u0026thinsp;=\u0026thinsp;4.04, CI: 1.05\u0026ndash;15.58) [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. This was different from the results of studies by Elhadi et al. (2020) and study by Huynh et al. (2020) in which this factor was statistically insignificant (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05) [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e], [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThrough the Pearson correlation test, the findings showed that there was a significant positive and weak relationship between knowledge and awareness factors (r\u0026thinsp;=\u0026thinsp;0.330, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and attitude factors (r\u0026thinsp;=\u0026thinsp;0.227, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) with obstetric service readiness. This shows that the higher the score for knowledge and awareness factors on COVID-19 and attitude factors towards the COVID-19 pandemic, the higher the score for the availability of obstetric services. The same was true in a study by Saqlain et al. (2020) in which the Pearson correlation test showed a significant and positive and weak linear correlation of knowledge and attitude factors (r\u0026thinsp;=\u0026thinsp;0.106, p\u0026thinsp;=\u0026thinsp;0.030) [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eRecent studies of knowledge, attitudes and practices or preparedness about COVID-19 reported considerable level of knowledge and positive attitudes contributing to good services preparedness in some countries [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e], [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e], [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e], [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e], [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. In other studies, from previous H1N1 outbreaks, knowledge was found to correlate strongly with practice scores or preparedness and attitudes [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e]. Interestingly, the same study found that higher knowledge scores were a significant predictor of higher practice scores or preparedness. It also found that higher knowledge was also a significant predictor of higher attitude scores. These data demonstrate the importance of having sufficient knowledge to be able to provide optimal patient care and good service preparedness.\u003c/p\u003e \u003cp\u003eBased on the findings of this study, knowledge and awareness factors had a mean score of 14.20\u0026thinsp;\u0026plusmn;\u0026thinsp;1.66 (total score\u0026thinsp;=\u0026thinsp;17) and majority 92.2% of respondents had good level of knowledge and awareness. Similarly in a study by Huynh et al. (2020) in which a total of 327 eligible healthcare workers had a mean knowledge factor score of 8.17\u0026thinsp;\u0026plusmn;\u0026thinsp;1.3 (range 4\u0026ndash;10) and as many as 289 (88.4%) respondents showed good level of knowledge [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. This may be due to the success in communication for the prevention and control of COVID-19 in the state of Selangor which contributes to the improvement of knowledge and practices for healthcare workers including MHC workers.\u003c/p\u003e \u003cp\u003eBefore an effective approach to supporting healthcare workers including MHC workers can be developed, it is important to understand the source of their concerns and fears in detail. This means that focusing more on addressing those concerns should be the focus of support efforts, rather than teaching generic approaches to stress reduction or resilience. This discussion has consistently focused on eight sources of concern, namely: 1) access to appropriate PPE; 2) being exposed to COVID-19 at work and bringing infection home to their families; 3) not having quick access to tests if they experience COVID-19 symptoms and at the same time fear of spreading infection at work; 4) uncertainty that their organization will support/care for their personal and family needs if they are infected infection; 5) access to childcare during working hours due to increased school closures; 6) support for other personal and family needs as working hours and demand increase (food, hydration, accommodation, transportation); 7) can provide efficient medical care if placed in a new area (for example, not an ICU nurse but need to function as an ICU nurse); and 8) lack of access to the latest information and communications. Recognizing the source of these concerns can enable leaders and healthcare organizations to develop targeted approaches to address these concerns and provide specific support to their healthcare workforce [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAs there were significant differences (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05) between previous one year (the peak time of the COVID-19 pandemic) and the present time of this study for many factors in this study, various efforts need to be made continuously to ensure improvement in knowledge, awareness, and attitudes for MHC workers so that they can always be prepared in providing good obstetric services. Among them are: 1) provide regular educational courses for the knowledge of the correct use of PPE in the event of exposure to COVID-19; 2) always ensure adequate supply and preparation of PPE in the obstetric unit; 3) always ensure adequate supply and preparation of soap, water and disinfectants for health workers, patients, and visitors in the obstetric unit; 4) always ensure adequate supply and preparation of masks for health workers, patients, and visitors in the obstetric unit; 5) provide counselling or psychiatric services and perform peers group support for MHC workers who experience increased levels of self-stress, work fatigue and depression. MHC workers are also advised to take self-care measures to create a healthy and cheerful work culture such as working effectively as a team to ease the burden of tasks, building good relationships between colleagues and family members, ready to share and listen to views and advice in case of problems, practice exercise and breathing control techniques to reduce stress, and get enough rest and practice a balanced diet; 6) ensure that all safety measures and SOPs are carried out carefully in all parts and levels in the hospital so that MHC workers feel protected from COVID-19 infection at work; 7) to increase and expand awareness campaigns to the community through various mass media so that jobs as health workers are less stigmatized from the community; 8) adopting the concept of regular rounds of work (Job Rotation) and reducing the number of hours and shifts worked so that MHC workers feel less tired and burn-out from works caused by the COVID-19 pandemic; 9) always provide effective training and continuous education as well as the need for adequate equipment so that MHC workers can feel better prepared to manage the COVID-19 pandemic; 10) ongoing and up-to-date information from the management of facilities and obstetric units to the MHC workers on the protocols and safety measures to reduce aerosol transmission from maternity patients infected with COVID-19.\u003c/p\u003e \u003cp\u003eCOVID-19 poses a higher risk for doctors and nurses working in maternal health care. Therefore, adequate PPE, proper hand washing methods, and hand hygiene are essential in reducing the transmission and risk of COVID-19 infection in hospitals. Therefore, adequate training, education courses and resources are provided to prevent hospital-acquired infections due to cross-contamination to other patients receiving treatment in the Department of Obstetrics and Gynecology and reduce the risk of exposure to COVID-19 infection to MHC workers. In addition, a comprehensive training program targeting all MHC workers should be provided to promote all COVID-19 precautions and prevention measures to achieve a balance in terms of clinical knowledge of COVID-19.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eOverall, the mean of total score and the level of obstetric services preparedness found from this study was high. Majority 99.5% of the respondents had good knowledge and awareness, while 96.8% of the respondents had a good level of obstetric services preparedness. However, only about half (54.0%) of them had a positive attitude towards COVID-19. Among all the factors involved in this study, there were three predictors that influenced the level of obstetric services preparedness, namely the working duration factor, knowledge, and awareness factor about COVID-19 and attitude factor towards the COVID-19 pandemic. Based on the findings of this study, we proposed several recommendations that are considered appropriate for this study to increase the knowledge and awareness of MHC workers, as well as a positive attitude, so that they can provide better and more optimal obstetric services in the future pandemic/outbreak, as there were still MHC workers with poor knowledge and awareness of COVID-19 and about half of them had negative attitude towards the COVID-19 pandemic.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eWHO \u0026nbsp;: \u0026nbsp; World Health Organisation\u003c/p\u003e\n\u003cp\u003eCDC \u0026nbsp; : \u0026nbsp; \u0026nbsp;Centers for Disease Control and Prevention\u003c/p\u003e\n\u003cp\u003eCOVID-19 \u0026nbsp; : \u0026nbsp; Coronavirus Disease 2019\u003c/p\u003e\n\u003cp\u003eMHC \u0026nbsp; : \u0026nbsp; \u0026nbsp;Maternal Healthcare\u003c/p\u003e\n\u003cp\u003eIPC \u0026nbsp; : \u0026nbsp; \u0026nbsp;Infection Prevention and Control\u003c/p\u003e\n\u003cp\u003ePPE \u0026nbsp;: \u0026nbsp; \u0026nbsp;Personal Protective Equipment\u003c/p\u003e\n\u003cp\u003eHIC \u0026nbsp;: \u0026nbsp; \u0026nbsp;High-Income Countries\u003c/p\u003e\n\u003cp\u003eLMICs \u0026nbsp; : \u0026nbsp; \u0026nbsp;Low- and Middle-Income Countries\u003c/p\u003e\n\u003cp\u003eSOPs \u0026nbsp;: \u0026nbsp; \u0026nbsp;Standard Operating Procedures\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe permission to perform this study was sought from the Selangor State Health Department, and the study proposal was approved by the Medical Research and Ethics Committee, Ministry of Health, Malaysia (NMRR ID-21-02291-DV9) and the Ethics and Research Committee of Universiti Kebangsaan Malaysia (The National University of Malaysia) (Project code: FF-2021-347). Before any data being collected at each of the hospitals, permission was also obtained from the hospital\u0026rsquo;s Director, Clinical Research Centre (CRC) officer, and the Head of the Obstetrics \u0026amp; Gynecology Department.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSpecial thanks to the Medical Research and Ethics Committee (Ministry of Health, Malaysia), and the Ethics and Research Committee of Universiti Kebangsaan Malaysia (The National University of Malaysia) for their approval for this research and \u003cstrong\u003efor permission for publication\u003c/strong\u003e. Special gratitude to Selangor State Health Department, and all the hospitals\u0026rsquo; Directors, Clinical Research Centre (CRC) officers, the Heads of Obstetrics \u0026amp; Gynecology Departments, the chiefs of medical officers and nurses for contributing in this study\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll data and materials for this study are available.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe declared that there are no competing interests in this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo funding received for this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors contribute equally in this study.\u003c/p\u003e\n\u003cp\u003e.\u003cstrong\u003eConflict of Interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe declare that we have no conflict of interest.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eA. 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Trockel, \u0026ldquo;Understanding and Addressing Sources of Anxiety Among Health Care Professionals During the COVID-19 Pandemic,\u0026rdquo; \u003cem\u003eJAMA\u003c/em\u003e, vol. 323, no. 21, pp. 2133\u0026ndash;2134, Jun. 2020, doi: 10.1001/JAMA.2020.5893.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-pregnancy-and-childbirth","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"prch","sideBox":"Learn more about [BMC Pregnancy and Childbirth](http://bmcpregnancychildbirth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/prch/default.aspx","title":"BMC Pregnancy and Childbirth","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"obstetric services, COVID-19, level of preparedness, maternal, healthcare workers","lastPublishedDoi":"10.21203/rs.3.rs-5015500/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5015500/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eThe COVID-19 pandemic has been spreading rapidly since 2019, leading to devastating consequences worldwide, as well as putting healthcare providers at high risk. This study intends to assess the awareness and preparedness activities among maternal healthcare (MHC) workers and to determine factors that lead to obstetric services\u0026rsquo; preparedness in ten Government Hospitals in Selangor, Malaysia.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA cross-sectional survey was conducted among 409 MHC workers which include doctors, nurses, and midwives in the government hospitals in Selangor, Malaysia between May 2022 till June 2022. Respondents were given validated questionnaires which include socio-demographic background, knowledge, awareness, and attitude as well as the obstetric services\u0026rsquo; preparedness activities in managing the COVID-19 pandemic.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eMajority of the respondents were nurses/midwives (87.5%), female (98.5%), age 35\u0026ndash;45 years old (48.5%), had working experience of more than 5 years (92.7%), had good knowledge and awareness (92.2%) and good obstetric services preparedness (88.3%). However, only about half (54.0%) of them had positive attitude towards COVID-19. When controlling for confounding factors, multivariate analysis showed that working period factor (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), knowledge and awareness factor (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and attitude factor (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) were significant predictive factors of obstetric services preparedness during the COVID-19 pandemic.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eThe findings in this study revealed that efforts should be made to further increase the knowledge and awareness of MHC workers on COVID-19 and to improve the positivity of their attitude towards this pandemic so that they can provide better obstetric services especially in the current and future pandemics to come.\u003c/p\u003e","manuscriptTitle":"Obstetric Services Preparedness Among Healthcare Workers in Maternal Wards During COVID-19 Pandemic","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-11-26 06:32:14","doi":"10.21203/rs.3.rs-5015500/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-09-18T06:44:30+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-09-16T07:21:32+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-09-16T07:17:37+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Pregnancy and Childbirth","date":"2024-09-02T05:12:34+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-pregnancy-and-childbirth","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"prch","sideBox":"Learn more about [BMC Pregnancy and Childbirth](http://bmcpregnancychildbirth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/prch/default.aspx","title":"BMC Pregnancy and Childbirth","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"ef95a718-1a8b-4b07-8eca-b00448430c8f","owner":[],"postedDate":"November 26th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-04-21T16:01:50+00:00","versionOfRecord":{"articleIdentity":"rs-5015500","link":"https://doi.org/10.1186/s12884-025-07474-7","journal":{"identity":"bmc-pregnancy-and-childbirth","isVorOnly":false,"title":"BMC Pregnancy and Childbirth"},"publishedOn":"2025-04-14 15:57:50","publishedOnDateReadable":"April 14th, 2025"},"versionCreatedAt":"2024-11-26 06:32:14","video":"","vorDoi":"10.1186/s12884-025-07474-7","vorDoiUrl":"https://doi.org/10.1186/s12884-025-07474-7","workflowStages":[]},"version":"v1","identity":"rs-5015500","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5015500","identity":"rs-5015500","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}