Social media, vaccine hesitancy and trust deficit in immunization programs: a qualitative enquiry in Malappuram District of Kerala, India

BACKGROUND

With increased penetration of the internet and social media, there are concerns regarding its negative role in influencing parents' decisions regarding vaccination for their children. It is perceived that a mix of religious reasons and propaganda by anti-vaccination groups on social media are lowering the vaccination coverage in Malappuram district of Kerala. We undertook a qualitative study to understand the factors responsible for generating and perpetuating vaccine hesitancy, the pathways of trust deficit in immunization programs and the interaction between various social media actors.

METHODS

In-depth interviews and focus group discussions were conducted among parents/caregivers, physicians, public sector health staff, alternative system medical practitioners, field healthcare workers and teachers in areas with highest and lowest vaccination coverage in the district, as well as with communication experts.

RESULTS

The trust deficit between parents/caregivers and healthcare providers is created by multiple factors, such as providers' lack of technical knowledge, existing patriarchal societal norms and critical views of vaccine by naturopaths and homeopaths. Anti-vaccine groups use social media to influence caregivers' perceptions and beliefs. Religion does not appear to play a major role in creating vaccine resistance in this setting.

CONCLUSIONS

A long-term, multipronged strategy should be adopted to address the trust deficit. In the short to medium term, the health sector can focus on appropriate and targeted vaccine-related communication strategies, including the use of infographics, soft skills training for healthcare workers, technical competency improvement through a mobile application-based repository of information and creation of a media cell to monitor vaccine-related conversations in social media and to intervene if needed.

COVID-19: Challenges and its consequences for rural health care in India

This commentary highlights the potential consequences of the COVID-19 pandemic for India's rural population. The rural health care system in India is not adequate or prepared to contain COVID-19 transmission, especially in many densely populated northern Indian States because of the shortage of doctors, hospital beds, and equipment. The COVID-19 pandemic creates a special challenge due to the paucity of testing services, weak surveillance system and above all poor medical care. The impacts of this pandemic, and especially the lockdown strategy, are multi-dimensional. The authors argue for the need to take immediate steps to control the spread and its aftereffects and to use this opportunity to strengthen and improve its primary health care system in rural India.

Debate: COVID-19 and children in India

The COVID-19 pandemic impact on children is a growing concern. The United Nations and its agencies (the World Health Organization and UNICEF), Indian Association For Child and Adolescent Mental Health and National Institute of Mental Health and Neuroscience in India warn about the broader impacts on children and call for urgent action to support the world's children amidst the pandemic which may have lasting consequences. The COVID-19 pandemic and unprecedented control measures to prevent its spread have disrupted nearly every aspect of children's lives - their health, development, learning, behaviour and their families' economic security, including protection from violence and abuse. Given this background, there is an urgent need for action through screening to minimize the mental health issues of children in India who constitute a substantial proportion of the population.

COVID-19 and Domestic Violence: A Possible Public Health Crisis

The COVID-19 pandemic and subsequent lockdown to mitigate the spread of the pandemic has led to social isolation, reduced social support system and increased cases of domestic violence against women. The United Nations and other international and national agencies speculate further increase in it and have suggested governments to take appropriate action to safeguard the health and human rights of women. Many governments have also taken steps and working towards it by starting helpline and counselling services. This article reviews the concerns raised by these agencies, interventions introduced and its future implications. It also argues that apart from reported cases of domestic violence and its negative consequences on individuals and families, it would be interesting to study the positive impact of living together as this pandemic is different from other emergencies. The sociologist Marianne Hester argued that ‘domestic violence goes up whenever families spend more time together’. It would be interesting to study and examine it in the context of COVID-19 pandemic. This article also suggests the need for further research to understand the reason and dynamics of such violence considering men and women both are engaged in such violence against each other and bear its consequences together.

COVID-19 and Domestic Violence: A Possible Public Health Crisis

The COVID-19 pandemic and subsequent lockdown to mitigate the spread of the pandemic has led to social isolation, reduced social support system and increased cases of domestic violence against women. The United Nations and other international and national agencies speculate further increase in it and have suggested governments to take appropriate action to safeguard the health and human rights of women. Many governments have also taken steps and working towards it by starting helpline and counselling services. This article reviews the concerns raised by these agencies, interventions introduced and its future implications. It also argues that apart from reported cases of domestic violence and its negative consequences on individuals and families, it would be interesting to study the positive impact of living together as this pandemic is different from other emergencies. The sociologist Marianne Hester argued that ‘domestic violence goes up whenever families spend more time together’. It would be interesting to study and examine it in the context of COVID-19 pandemic. This article also suggests the need for further research to understand the reason and dynamics of such violence considering men and women both are engaged in such violence against each other and bear its consequences together.

COVID-19 and Mass Fatality Management: A Public Health Challenge

The COVID-19 pandemic has posed a serious question over preparedness to deal with mass fatality. The current trend shows that there would be more bodies than the capacity and resources to handle them. The international agencies have alerted governments that the number of deaths may overwhelm the local capacity to handle dead bodies properly. Mass fatality management and planning are important to respecting the dignity of the deceased and surviving family. Inadequate capacity to deal with dead bodies may affect the psychological well-being of survivors which may result in distress to families and community.

Social determinants of environmental health: A case of sanitation in rural Jharkhand

An estimated 56% of households in rural India defecated in the open in 2015, making India the most significant contributor to the global sanitation burden. This cross-sectional study uses data collected in 2016 from 499 households in rural Jharkhand to understand the constraints of latrine adoption and drivers of sanitation preferences (plans to adopt toilets and willingness to pay for toilets). Focusing on a region with a large tribal population, the study examines two types of predictors, namely structural factors (objective socioeconomic, sociocultural and ecological characteristics) and psychosocial drivers (perceived unaffordability of toilet, hygiene and sanitation knowledge, perceived health risks, attitudes, both descriptive and injunctive social norms, and perceived water stress). We find that structural constraints related to educational, economic and sociocultural inequalities predict toilet ownership. Low sanitation rates can neither be attributed to a lack of expressed demand nor lack of recognition of the disadvantages of open defecation. Similarly, variations in sanitation preferences are neither explained by differences in hygiene and sanitation knowledge nor by understandings of sanitation health risks. We find that perceived unaffordability, attitudes (perceived benefits of toilet and disadvantages of OD) and perceived descriptive social norms are of key importance. This implies a potential for persuasive strategies that manipulate social norms around sanitation, particularly if they simultaneously address perceptions around financial unaffordability of toilets and around the benefits of toilets. Importantly, however, attempts to change sanitation preferences by acting on forces of social (dis)approval (i.e. through perceived injunctive social norms) may be ineffective and generate negative unintended consequences.

Communicating Care in Insulin Therapy

The current study was carried out to find out patients’ needs related to insulin therapy, and to understand the current practices and missing links from the public health perspective. The study was conducted in urban Delhi. The sample was selected using the multi-stage sampling technique. Structured interviews were used to collect data from respondents. In all, 279 interviews were conducted, out of which 96 respondents were patients of type 1 and 183 of type 2 diabetes. The patients participating in the study were taking at least one shot of insulin per day. Findings indicate that diagnosis of diabetes is a stressful event in an individual's life, and insulin therapy adds to this stress. This needs special attention from doctors and family members considering its psychological impact, which is missing in currently available treatment practices. It was also found that the whole emphasis of treat-ment was on curative aspects rather than preventive and promotive aspects given that diabetes is an emerging public health problem. Further, the study highlights various other associated factors that need to be addressed from the patient's perspective.

Communicating Care in Insulin Therapy

The current study was carried out to find out patients’ needs related to insulin therapy, and to understand the current practices and missing links from the public health perspective. The study was conducted in urban Delhi. The sample was selected using the multi-stage sampling technique. Structured interviews were used to collect data from respondents. In all, 279 interviews were conducted, out of which 96 respondents were patients of type 1 and 183 of type 2 diabetes. The patients participating in the study were taking at least one shot of insulin per day. Findings indicate that diagnosis of diabetes is a stressful event in an individual's life, and insulin therapy adds to this stress. This needs special attention from doctors and family members considering its psychological impact, which is missing in currently available treatment practices. It was also found that the whole emphasis of treat-ment was on curative aspects rather than preventive and promotive aspects given that diabetes is an emerging public health problem. Further, the study highlights various other associated factors that need to be addressed from the patient's perspective.

Health and Social Security Needs of Rickshaw Pullers in Ranchi

A significant number of "marginalized" population groups are denied their health rights, healthcare access, benefits of government health programs, and other health-related social security benefits. These population groups, particularly the rickshaw pullers of India, are vulnerable because of their poor social and economic status, migration history, lack of permanent settlements, lack of social capital, and so on. These reasons, coupled with other social-political reasons, lead to no or limited access to health services and poor health conditions. This study intends to explore and understand the context and health seeking behavior of rickshaw pullers in Ranchi, the capital city of Jharkhand state in India, with special reference to wider social determinants of health such as, access, affordability, and delivery of health services. The data was collected from 1,000 rickshaw pullers from 40 "rickshaw garages" in Ranchi. The findings of the study show that rickshaw pullers can't afford to "attach" much importance to their health due to various reasons and suffer from a variety of occupational and other illnesses. The health conditions of the rickshaw pullers are affected by poverty, negligence, illiteracy, lack of awareness and unavailability of affordable, quality health services. These are only a symptom of the larger structural issues affecting health. The study suggests that rickshaw pullers, being a marginalized and excluded population group, require special health and social security programs that include safe, affordable, and accessible services along with a special focus on health education, behavior change, and promotion of appropriate health-seeking behavior.

Complementing Gender Analysis Methods

The existing gender analysis frameworks start with a premise that men and women are equal and should be treated equally. These frameworks give emphasis on equal distribution of resources between men and women and believe that this will bring equality which is not always true. Despite equal distribution of resources, women tend to suffer and experience discrimination in many areas of their lives such as the power to control resources within social relationships, and the need for emotional security and reproductive rights within interpersonal relationships. These frameworks believe that patriarchy as an institution plays an important role in women's oppression, exploitation, and it is a barrier in their empowerment and rights. Thus, some think that by ensuring equal distribution of resources and empowering women economically, institutions like patriarchy can be challenged. These frameworks are based on proposed equality principle which puts men and women in competing roles. Thus, the real equality will never be achieved. Contrary to the existing gender analysis frameworks, the Complementing Gender Analysis framework proposed by the author provides a new approach toward gender analysis which not only recognizes the role of economic empowerment and equal distribution of resources but suggests to incorporate the concept and role of social capital, equity, and doing gender in gender analysis which is based on perceived equity principle, putting men and women in complementing roles that may lead to equality. In this article the author reviews the mainstream gender theories in development from the viewpoint of the complementary roles of gender. This alternative view is argued based on existing literature and an anecdote of observations made by the author. While criticizing the equality theory, the author offers equity theory in resolving the gender conflict by using the concept of social and psychological capital.

Operations research in HIV/AIDS

Operations research is mainly applied to decision making in industries and corporations using quantitative methods to optimize production. The applications of operations research in social sciences research or health research in HIV, service delivery, and program performance improvement are minimal. Considering the complexity of the HIV/AIDS epidemic, it is imperative to learn from operations research in scaling up HIV treatment, prevention, and intervention in resource-poor settings. In this article the author discusses the methodological issues in operations research within the context of HIV/AIDS research. The author also suggests a framework for using operations research in the field of HIV/AIDS research and program intervention.

Training needs assessment of service providers: targeted intervention for HIV/AIDS in Jharkhand, India

Training needs assessments are pivotal for any capacity building program. Building capacity of service providers and staff involved in HIV/AIDS intervention programs is crucial because of the distinct nature of such programs. It requires specific knowledge, skills, and attitudes that are of utmost importance, influencing the reach of the program and its impact in halting and reversing the epidemic. This study was conducted to identify the training needs assessment of personnel involved in targeted intervention for high risk populations vulnerable to HIV infection in Jharkhand, India. Through the study the authors critically examine the existing training needs and gaps and suggest strategies to address them.

HIV/AIDS program in Jharkhand: a critical review

This article is an attempt to present and elaborate the HIV/AIDS scenario in Jharkhand state of India, services available, key issues, challenges, and concerns at various levels to mitigate the epidemic. It also examines the role of different stakeholders and agencies in halting and reversing the epidemic. The findings show that there are various challenges that need immediate attention. The article critically examines these issues in detail and suggests the approach to address the epidemic.

AIDS orphans and vulnerable children in India: problems, prospects, and concerns

This article reviews and discusses the problems, responses, and concerns of orphans and vulnerable children in India. The article shows that HIV/AIDS programs and interventions are vital for survival and welfare of orphan and vulnerable children, but they have reached only to a small fraction of the most vulnerable children. The article suggests a number of measures that government and civil society could take to address the problems and emphasizes the need to learn from other countries' experience and initiatives in developing appropriate policy and programmes for orphan and vulnerable children.

Cultural and social practices regarding menstruation among adolescent girls

The study attempts to find out the existing social and cultural practices regarding menstruation, awareness levels, and the behavioral changes that come about in adolescent girls during menstruation, their perception about menarche, how do they treat it, and the various taboos, norms, and cultural practices associated with menarche. The study was conducted on 117 adolescent girls (age 11-20 years) and 41 mothers from various communities and classes in Ranchi comprising residential colonies and urban slums. The findings unfolds many practices: cultural and social restrictions associated with menstruation, myth, and misconception; the adaptability of the adolescent girls toward it; their reaction, reaction of the family; realization of the importance of menstruation; and the changes that have come in their life after menarche and their resistance to such changes. The article also suggests the strategies to improve menstrual health and hygiene among adolescent girls. The study concludes that cultural and social practices regarding menstruation depend on girls' education, attitude, family environment, culture, and belief.

Brucellosis: need of public health intervention in rural India

AIM

To present the epidemiology of brucellosis and to assess and suggest public health intervention strategies to control brucellosis in rural India.

METHODS

The paper is based on a review of various serological and other studies and evidence on brucellosis in India.

RESULTS

Brucellosis is present in all livestock systems. Although the true incidence for human brucellosis is not available, various state specific studies and extrapolated incidence (321 cases annually) have shown that it is a serious disease present in the population. The studies also show that there is a conducive condition and environment for wide-spread human infection on account of unhygienic conditions and poverty in rural areas which need public health attention and intervention.

CONCLUSION

The paper suggests that brucellosis needs to be included in public health education and public awareness programmes, particularly in the rural areas of India. It also suggests promoting safe livestock practices, active co-operation between health and veterinary services and a paradigm shift from the current 'biomedical model' to a 'sociocultural model' for the elimination of brucellosis in India.