Double Face Mask Use for COVID-19 Infection Prevention and Control Among Medical Students at Makerere University: A Cross-Section Survey

Racheal Nalunkuma; Derrick Bary Abila; Nelson Ssewante; Blaise Kiyimba; Edwin Kigozi; Ruth Ketty Kisuza; Fulugensio Kasekende; Jonathan Nkalubo; Samuel Kalungi; Winters Muttamba; Sarah Kiguli

doi:10.2147/RMHP.S347972

Double Face Mask Use for COVID-19 Infection Prevention and Control Among Medical Students at Makerere University: A Cross-Section Survey

Risk Manag Healthc Policy. 2022 Jan 20:15:111-120. doi: 10.2147/RMHP.S347972. eCollection 2022.

Authors

Affiliations

¹ School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda.
² Faculty of Biology, Medicine, and Health, University of Manchester, Manchester, UK.
³ School of Health Sciences, College of Health Sciences, Makerere University, Kampala, Uganda.
⁴ Department of Pathology, Mulago National Referral Hospital, Kampala, Uganda.
⁵ Makerere University Lung Institute, Makerere University, Kampala, Uganda.
⁶ Department of Paediatrics and Child Health, School of Medicine, Makerere University, Kampala, Uganda.

Abstract

Introduction: The second wave of COVID-19 greatly affected the health care and education systems in Uganda, due to the infection itself and the lockdowns instituted. Double masking has been suggested as a safe alternative to double-layered masks, where the quality of the latter may not be guaranteed. This study aimed to determine patterns of double mask use among undergraduate medical students at Makerere University, Uganda.

Methods: We conducted a descriptive cross-sectional study using an online questionnaire. All students enrolled at the College of Health Sciences; Makerere University received the link to this questionnaire to participate. Logistic regression analysis was used to assess factors associated with double mask use.

Results: A total of 348 participants were enrolled. The majority (61.8%) were male; the median age was 23 (range: 32) years. Up to 10.3%, 42%, and 4.3% reported past COVID-19 positive test, history of COVID-19 symptoms, and having comorbidities, respectively. Up to 40.8% had been vaccinated against COVID-19. More than half (68.7%) believed double masking was superior to single masking for COVID-19 IPC, but only 20.5% reported double masking. Participants with a past COVID-19 positive test [aOR: 2.5; 95% CI: 1.1-5.8, p = 0.026] and participants who believed double masks had a superior protective advantage [aOR: 20; 95% CI: 4.9-86.2, p < 0.001] were more likely to double mask. Lack of trust in the quality of masks (46.5%) was the most frequent motivation for double masking, while excessive sweating (68.4%), high cost of masks (66.4%), and difficulty in breathing (66.1%) were the major barriers.

Conclusion: Very few medical students practice double masking to prevent COVID-19. Coupled with inconsistencies in the availability of the recommended four-layered masks in Uganda and increased exposure in lecture rooms and clinical rotations, medical students may be at risk of contracting COVID-19.

Keywords: COVID-19; double masking; infection prevention and control; second wave.

Grants and funding

R25 TW011213/TW/FIC NIH HHS/United States