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Sarah Maria Najjuka,1 Tom Denis Ngabirano,2 Thomas Balizzakiwa,1 Rebecca Nabadda,1 Mark Mohan Kaggwa,3 David Patrick Kateete,4 Samuel Kalungi,5 Jolly Beyeza-Kashesya,6 Sarah Kiguli7 1College of Health Sciences, Makerere University, Kampala, Uganda; 2Department of Nursing, College of Health Sciences, Makerere University, Kampala, Uganda; 3Department of Psychiatry, Mbarara University of Science and Technology, Mbarara, Uganda; 4Department of Immunology and Molecular Biology, College of Health Sciences Makerere University, Kampala, Uganda; 5Department of Pathology, Mulago National Referral Hospital, Kampala, Uganda; 6Department of Obstetrics and Gynecology, Mulago Specialized Women and Neonatal Hospital, Kampala, Uganda; 7Department of Pediatrics and Child Health, School of Medicine, College of Health Sciences, Makerere University, Kampala, UgandaCorrespondence: Sarah Maria Najjuka, College of Health Sciences, Makerere University, Kampala, Uganda, Email najjukasarah@gmail.comBackground: The novel coronavirus disease 2019 (COVID-19) pandemic placed health workers at the frontline of the emergency task force response; a duty that requires professional expertise and confidence to rapidly identify and treat patients with COVID-19. This study explored perceived self-efficacy (PSE) of health care workers (HCWs) in the management of patients with COVID-19 and associated factors in central Uganda.Methods: We recruited 418 HCWs from four national referral hospitals in Uganda. Multivariate linear regression analysis was utilized to determine factors associated with PSE. A p-value > 0.05 was considered statistically significant.Results: Majority of the participants were female, about half were nurses/midwives, and had 10 years of work experience on average. Overall, HCWs reported moderate PSE in managing COVID-19 patients which reduced with increasing severity of the COVID-19 illness. Having a PhD, being a medical doctor, agreeing or completely agreeing that one has knowledge about COVID-19 management, and having COVID-19 management training were significantly associated with increase in one’s level of PSE.Conclusion: This study highlights an unsatisfactory, moderate level of PSE among HCWs in the management of patients with COVID-19 in central Uganda. The health sector should focus on improving HCWs’ self-efficacy through continuous training of all HCWs in the clinical management of especially the severe and critically ill cases of COVID-19. Non-doctor HCWs should be given priority as they scored lower levels of PSE; yet they are the corner stone of the primary health care system and make majority of the health human resource in low- and middle-income countries. Interventions towards creating a safe working environment for HCWs through provision of adequate infection prevention and control strategies are essential in boosting HCWs confidence to manage COVID-19 patients.Keywords: perceived self-efficacy, COVID-19, Uganda, health care workers, COVID-19 knowledge, COVID-19 management, COVID-19 training

Racheal Nalunkuma,1 Derrick Bary Abila,1,2 Nelson Ssewante,1 Blaise Kiyimba,1 Edwin Kigozi,3 Ruth Ketty Kisuza,1 Fulugensio Kasekende,1 Jonathan Nkalubo,1 Samuel Kalungi,4 Winters Muttamba,5 Sarah Kiguli6 1School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda; 2Faculty of Biology, Medicine, and Health, University of Manchester, Manchester, UK; 3School of Health Sciences, College of Health Sciences, Makerere University, Kampala, Uganda; 4Department of Pathology, Mulago National Referral Hospital, Kampala, Uganda; 5Makerere University Lung Institute, Makerere University, Kampala, Uganda; 6Department of Paediatrics and Child Health, School of Medicine, Makerere University, Kampala, UgandaCorrespondence: Racheal NalunkumaSchool of Medicine, College of Health Sciences, Makerere University, P.O Box 7072, Kampala, Uganda, Tel +256 704150697, Email kasoziracheal@gmail.comIntroduction: 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, infection prevention and control, double masking, second wave