DEVISING EFFECTIVE STRATEGIES TO PREVENT MENTAL ILLNESS

AND PROMOTE MENTAL HEALTH AMONG HEALTH CARE PROVIDERS

IN SOUTH WEST PUBLIC HOSPITALS IN THE CONTEXT OF PUBLIC
HEALTH EMERGENCES: LESSON FROM COVID -19 EFFECTS.

A PHD Research Proposal

Wasihun Adraro

Mizan Aman College of health science, South West Ethiopia

Tel: 0912686241; email: waseadraro@gmail.com

Background
Addressing mental health is currently seen as a very important development issue, especially in
the case of public health emergency(1).The 2019 novel coronavirus (2019-nCoV) pneumonia,
believed to have originated in a wet market in Wuhan, Hubei province, China at the end of 2019,
has gained intense attention nationwide and globally (1,2). Coronavirus disease 2019 (COVID-
19), an acute respiratory infectious disease with the main symptoms of fever, cough, and
shortness of breath, was first reported in Wuhan, Hubei province, China, in December 2019, and
has turned into a pandemic(2). Severe acute respiratory infection remains one of the leading
causes of mortality around the world. A recent cluster of pneumonia cases in Wuhan, China, was
caused by a novel beta coronavirus, the 2019 novel coronavirus (2019-nCoV) (3). Although the
COVID-19 crisis is, in the first instance, a physical health crisis, it has the seeds of a major
mental health crisis as well, if action is not taken. Good mental health is critical to the
functioning of society at the best of times. It must be front and center of every country’s response
to and recovery from the COVID-19 pandemic(4). The mental health and wellbeing of whole
societies have been severely impacted by this crisis and are a priority to be addressed
urgently(4). Healthcare professionals, especially those with exposure to COVID-19 in locked-
down cities, experienced severe psychological burden during the COVID-19 outbreak (2). Health
care workers may experience considerable psychological distress as a result of the COVID-19
pandemic due to providing direct patient care, vicarious trauma, quarantine or self- isolation (5).
COVID-19 is a major public health emergency, and could result in severe and even fatal
respiratory diseases such as acute respiratory distress syndrome (2). Severe acute respiratory
infection remains one of the leading causes of mortality around the world (3). As highlighted by
WHO in their mental health out-line stigmatization and scapegoating of affected persons, health
care professionals and authority figures is very common occurrence during epidemics (Rubin &
Wessely 2020, Shigemura et al. 2020)(6).Many healthcare personnel in the SARS epidemic
experienced severe and persistent psychological burden that affected mood, cognition, physical
health, and interpersonal relationships for days or weeks (2). The outbreak of severe acute
respiratory syndrome (SARS) was unique because it was highly concentrated in health care
settings and a large number of health care workers were infected (7). Early identification and
timely intervention that aim to promote psychological health of healthcare professionals facing
emerging infectious diseases are urgently needed (2).

Since reporting of confirmed case in the country, there is increase in the number of confirmed
COVID-19 cases/patients and death nationally. In our country there is small number of health
care professionals and scarcity of medical equipment/personal protective equipment (PPE).
The health care settings also expose the health care professionals. There is also increase
confirmed case and death of the health care professional. Their isolation from their family
members, quarantine and increase the cases and death in the institutional and community level
affects their daily activities and strike their mental health.
Therefore; identifying the level of anxiety, depression, stress, Post traumatic stress disorder and
risk factors will be important to provide direction, develop policies, and develop management
strategies.
The researcher strongly believed that this study will be highly valuable, timely and
important. It helps to raise awareness of the existing problem, promote research resources; help
the health system, and different stake holders to design appropriate treatment intervention and
program.
The finding of the study will give insight to federal ministry of health, Regional Health Bureau,
health institution management, and health professional how to manage and improve their health
status during their working time.
Finally; this study will helps Southwest administrator, health office and health care
professional in the study area in Exploring the psychological impact of COVID-19 pandemic
on mental health and associated factors among health care providers, Exploring the health
care providers copping strategies (resiliencies) to respond to psychological effects of the
COVID-19 pandemic and Developing effective strategies to prevent and promote mental
health problems in the context of public health emergences. It can also provide a strategic
guideline for program planner and other stake holder beside with partial fulfillment for my
PHD study.
Conceptual frame work

Conceptual frame work describe the dependent variables i.e. anxiety, depression, distress and
PTSD and the independent variables socio demographic factors, environmental and institutional
factors and that adapted from different literature that done in less developed countries and has
significant associate.

Sociodemographic factors
age, sex, educational status,
ethnicity, marital status,
parental status, religion, Medical &
professional status, income, behavior
family history, working
expriance and contact history. past medical
history, past
psychatric history,
contact history and
(mental substance history
Institutional factors ilness) (copping style)
PPE supply, trainng, extra fee, Anxiety,
load/day, transport Psychological
depression,
accessibility, place of work Biological
and department distress &
PTSD Social

Figure 1: Conceptual framework for assessment of anxiety, depression, distress, insomnia and
risk factors among health care professional during COVID-19 pandemic, Southwest Ethiopia.
(Adapted from searching for different literature and psychological assessment tools)
Objectives (sub research topics)

The dissertation is intended to answer the following interrelated objectives (sub research topics)

These are:

1. Exploring the psychological impact of COVID-19 pandemic on mental health and

associated factors among health care providers

2. Exploring the health care providers copping strategies (resiliencies) to respond to

psychological effects of the COVID-19 pandemic
3. Developing effective strategies to prevent and promote mental health problems in the
context of public health emergences
Study area and study period
The study will be conducted in southwest public hospitals, Southern, Ethiopia. Southwest has
four zones i.e. bench- sheko, kaffa, mirab omo and sheka zone. 6 Hospitals, The area is located
at the south west direction of the capital city, Addis Ababa. It has a total 650 health
professionals.
Study design
By mixed method research like grounded theory and ecological model approach; gathering,
synthesizing, analyzing and conceptualizing qualitative data for exploring psychological impact
and copping (resilience). For quantitative (prevalence) measurement for mental illness both
descriptive and analytical design will be used.
Population
Source of population
All health professional who work at southwest public Hospitals
Study population
All health care professional who work at southwest public hospitals during the study period
Sample size determination and sampling technique:
Sampling depend on research question and purposes but for quantitative measurement the sample
size will be determined by using single population proportion formula by assumption of 95%
confidence interval, marginal error (d) of 5 %, and by taking 50% prevalence (P).

ni =¿ ¿
 Where ni= initial sample size
d= margin of error
z= confidence interval
p= level of client satisfaction
( 1.96 )2 ( 0.5 ) (1−0.5)
ni =
(0.05)2
ni =384
Because the source population N will be less than 10, 000; we adjusted the sample size using the
correction formula
nf = ¿ 384
1+ ¿ nf =
1+384 / 650
N
n f =241
Where nf is final sample size.
N is the Number of health professional in southwest public hospitals
Non respondents =10%, 241+24 = 265
Sampling technique and procedure
Stratified sampling method will be used to select the study sample from each hospital.
Stratified sampling and proportional allocation was done for the health institution by
n
¿= ∗Nj equation. Number of study subjects in each stratum determined by proportion to
N
population size from each hospital. This sampling procedure is presented schematically as
follows. (Figure2).
 Total health professional
(650)

Gebretsadik
Mizan Tepi Tepi Bachuma Primary
Shawo General
Hospital
University Hopsital hospital
Teaching (100)=41
(160)=65 (180)=73
hospital n=265
(210)=86

Figure 2: Schematic presentation of sampling procedure at southwest public hospitals

 Proposed time 2020/2021

activity 2020/ 2022 2023 2

21
0
2
4
Oct Jan Feb. Mar. Apr. May Jun Jul. Aug. Sept Oct Nov. Dec. Jan. Feb. Mar. Apr. May J
2020- . . . . . . u
Dec202 n.
1

Literature
surveys
and review
Proposal
write up
Ethical
clearance
Obtaining
data
Data
analysis
and write-
up
for paper I
Publishing
paper I
Data
Analysis
and write
up
for paper II
Publishing
paper II
Data
Analysis
and write
up
for paper
III
Publishing
paper III
Writing
the PhD
dissertation
Public
defense and
submission
References

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0366(20)30046-8
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NZ andLiping L. Psychological burden in health care professionals in Chinese cities
during the coronavirus disease 2019 (COVID-19) outbreak. 2020;
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