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Ogboghodo EO, Osaigbovo II, Obaseki DE, Iduitua MTN, Asamah D, Oduware E, Okwara BU. Implementation of a COVID-19 screening tool in a southern Nigerian tertiary health facility. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000578. [PMID: 36962763 PMCID: PMC10021546 DOI: 10.1371/journal.pgph.0000578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 07/25/2022] [Indexed: 11/18/2022]
Abstract
Screening for coronavirus disease 2019 (COVID-19) in emergency rooms of health facilities during outbreaks prevents nosocomial transmission. However, effective tools adapted for use in African countries are lacking. This study appraised an indigenous screening and triage tool for COVID-19 deployed at the medical emergency room of a Nigerian tertiary facility and determined the predictors of a positive molecular diagnostic test for COVID-19. A cross-sectional study of all patients seen between May and July 2020 at the Accident and Emergency of the University of Benin Teaching Hospital was conducted. Patients with any one of the inputs- presence of COVID-19 symptoms, history of international travel, age 60 years and above, presence of comorbidities and oxygen saturation < 94%- were stratified as high-risk and subjected to molecular testing for Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). Data was obtained from the screening record book patterned after a modified screening tool for COVID-19, deidentified and entered into IBM-SPSS version 25.0. Binary logistic regression was conducted to determine significant predictors of a positive SARS-CoV-2 test. The level of significance was set at p < 0.05. In total, 1,624 patients were screened. Mean age (standard deviation) was 53.9±18.0 years and 651 (40.1%) were 60 years and above. One or more symptoms of COVID-19 were present in 586 (36.1%) patients. Overall, 1,116 (68.7%) patients were designated high risk and tested for SARS-CoV-2, of which 359 (32.2%) were positive. Additional inputs, besides symptoms, increased COVID-19 detection by 108%. Predictors of a positive test were elderly age [AOR = 1.545 (1.127-2.116)], co-morbidity [AOR = 1.811 (1.296-2.530)] and oxygen saturation [AOR = 3.427 (2.595-4.528)]. This protocol using additional inputs such as oxygen saturation improved upon symptoms-based screening for COVID-19. Models incorporating identified predictors will be invaluable in resource limited settings.
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Affiliation(s)
- Esohe O Ogboghodo
- Department of Public Health and Community Medicine, University of Benin Teaching Hospital, Benin City, Edo State, Nigeria
| | - Iriagbonse I Osaigbovo
- Department of Medical Microbiology, University of Benin Teaching Hospital, Benin City, Edo State, Nigeria
| | - Darlington E Obaseki
- Chief Medical Director's Office, University of Benin Teaching Hospital, Benin City, Edo State, Nigeria
| | - Micah T N Iduitua
- Accident and Emergency Department, University of Benin Teaching Hospital, Benin City, Edo State, Nigeria
| | - Doris Asamah
- Department of Nursing Services, University of Benin Teaching Hospital, Benin City, Edo State, Nigeria
| | - Emmanuel Oduware
- Department of Family Medicine, University of Benin Teaching Hospital, Benin City, Edo State, Nigeria
| | - Benson U Okwara
- Department of Internal Medicine, University of Benin Teaching Hospital, Benin City, Edo State, Nigeria
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Afolabi MO, Wariri O, Saidu Y, Otu A, Omoleke SA, Ebenso B, Adebiyi A, Ooko M, Ahinkorah BO, Ameyaw EK, Seidu AA, Agogo E, Nomhwange T, Salami K, Mohammed NI, Yaya S. Tracking the uptake and trajectory of COVID-19 vaccination coverage in 15 West African countries: an interim analysis. BMJ Glob Health 2021; 6:bmjgh-2021-007518. [PMID: 34906987 PMCID: PMC8718349 DOI: 10.1136/bmjgh-2021-007518] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 10/28/2021] [Indexed: 11/04/2022] Open
Abstract
The African Union Bureau of Heads of State and Government endorsed the COVID-19 Vaccine Development and Access Strategy to vaccinate at least 60% of each country's population with a safe and efficacious vaccine by 2022, to achieve the population-level immunity needed to bring the pandemic under control. Using publicly available, country-level population estimates and COVID-19 vaccination data, we provide unique insights into the uptake trends of COVID-19 vaccinations in the 15 countries that comprise the Economic Community of West Africa States (ECOWAS). Based on the vaccination rates in the ECOWAS region after three months of commencing COVID-19 vaccinations, we provide a projection of the trajectory and speed of vaccination needed to achieve a COVID-19 vaccination coverage rate of at least 60% of the total ECOWAS population. After three months of the deployment of COVID-19 vaccines across the ECOWAS countries, only 0.27% of the region's total population had been fully vaccinated. If ECOWAS countries follow this trajectory, the sub-region will have less than 1.6% of the total population fully vaccinated after 18 months of vaccine deployment. Our projection shows that to achieve a COVID-19 vaccination coverage of at least 60% of the total population in the ECOWAS sub-region after 9, 12 and 18 months of vaccine deployment; the speed of vaccination must be increased to 10, 7 and 4 times the current trajectory, respectively. West African governments must deploy contextually relevant and culturally acceptable strategies for COVID-19 vaccine procurements, distributions and implementations in order to achieve reasonable coverage and save lives, sooner rather than later.
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Affiliation(s)
| | - Oghenebrume Wariri
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK.,Vaccines and Immunity Theme, Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Yauba Saidu
- Clinton Health Access Initiative, Yaounde, Cameroon.,Institute for Global Health, University of Siena, Siena, Italy
| | - Akaninyene Otu
- Department of Infection and Travel Medicine, Leeds Teaching Hospitals NHS Trust, Leeds, UK.,Department of Internal Medicine, College of Medical Sciences, Faculty of Clinical Sciences, University of Calabar, Calabar, Cross River State, Nigeria
| | | | - Bassey Ebenso
- Nuffield Centre for International Health and Development, University of Leeds, Leeds, UK
| | - Adekola Adebiyi
- College of Agriculture, Engineering and Environmental Design, Legacy University, Banjul, Gambia
| | - Michael Ooko
- Statistics & Bioinformatics, Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Bright Opoku Ahinkorah
- School of Public Health, Faculty of Health, University of Technology Sydney, Liverpool, New South Wales, Australia
| | - Edward Kwabena Ameyaw
- School of Public Health, Faculty of Health, University of Technology Sydney, Liverpool, New South Wales, Australia
| | - Abdul-Aziz Seidu
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia.,Department of Estate Management, Takoradi Technical University, Takoradi, Ghana
| | - Emmanuel Agogo
- Resolve to Save Lives, (Vital Strategies), Regus 4th Floor, Tower C, Churchgate Plaza, 473 Constitution Avenue, Central Business District, Abuja, Nigeria
| | | | | | - Nuredin Ibrahim Mohammed
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK.,Statistics & Bioinformatics, Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Sanni Yaya
- School of International Development and Global Studies, University of Ottawa, Ottawa, Ontario, Canada.,The George Institute for Global Health, Imperial College London, London, UK
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53
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Stein RA, Ometa O, Broker TR. COVID-19: The Pseudo-Environment and the Need for a Paradigm Change. Germs 2021; 11:468-477. [PMID: 35096665 DOI: 10.18683/germs.2021.1283] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Richard A Stein
- MD, PhD, NYU Tandon School of Engineering, Department of Chemical and Biomolecular Engineering, 6 MetroTech Center, Brooklyn, NY 11201, USA
| | - Oana Ometa
- PhD, Department of Journalism and Digital Media, Faculty of Political, Administrative and Communication Sciences, Babes-Bolyai University, Cluj-Napoca, Romania
| | - Thomas R Broker
- PhD, Department of Biochemistry and Molecular Genetics, University of Alabama at Birmingham, Birmingham, Alabama 35294-0024, USA
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54
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Murewanhema G, Burukai TV, Chireka B, Kunonga E. Implementing national COVID-19 vaccination programmes in sub-Saharan Africa- early lessons from Zimbabwe: a descriptive cross-sectional study. Pan Afr Med J 2021; 40:180. [PMID: 35018213 PMCID: PMC8720230 DOI: 10.11604/pamj.2021.40.180.30824] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 11/17/2021] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Zimbabwe was one of the first countries to run a national COVID-19 vaccination programme in Africa. Lessons learnt could inform the roll-out of similar programmes in sub-Saharan Africa. To describe the trends of uptake of the COVID-19 vaccines in the first three months (February - May 2021) of the Zimbabwe vaccination programme and the lessons learnt. METHODS a secondary descriptive analysis of routinely available COVID-19 vaccination data extracted from the daily situation reports published by the Ministry of Health and Child Care. RESULTS in the first three months of the programme, 1 020 078 doses were administered, with 675 678 being first doses and 344 400 were second doses. Using population estimates, at three months, 5.2% of the population had received at least one dose and 2.6% had received the full two doses. Uptake was initially slow, followed by a gradual, and subsequently an exponential increase. CONCLUSION by the end of May 2021, Zimbabwe had rolled out one of the largest COVID-19 vaccination programme in sub-Saharan Africa. The uptake followed a pattern and trend that is consistent with vaccine hesitancy reported in the literature, driven by a combination of confidence, complacency and convenience factors. The gradual increase in uptake followed a series of national and local community engagement programmes. The roll-out of similar programmes must recognise likely patterns of uptake across the population and ensure plans are in place to address vaccine hesitancy. The available data did not allow granular analysis to understand the demographics of people who participated in the programme, which is important for surveillance, targeted action, preventing inequalities and ensuring adequate and proportionate protection of residents prioritising the most vulnerable. Further analysis of the process, outcomes and impact of the programme will be helpful in informing the roll-out of similar programmes across Africa.
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Affiliation(s)
- Grant Murewanhema
- Unit of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
- Zimbabwe College of Public Health Physicians, Harare, Zimbabwe
| | - Trouble Victor Burukai
- Department of Anatomy, Faculty of Medicine and Health Sciences, Midlands State University Harare, Harare, Zimbabwe
| | - Brighton Chireka
- Zimbabwe College of Public Health Physicians, Harare, Zimbabwe
- School of Health and Life Sciences, Teesside University, Middlesbrough, United Kingdom
| | - Edward Kunonga
- Zimbabwe College of Public Health Physicians, Harare, Zimbabwe
- School of Health and Life Sciences, Teesside University, Middlesbrough, United Kingdom
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Murewanhema G, Mutsigiri-Murewanhema F. Drivers of the third wave of COVID-19 in Zimbabwe and challenges for control: perspectives and recommendations. Pan Afr Med J 2021; 40:46. [PMID: 34795827 PMCID: PMC8571916 DOI: 10.11604/pamj.2021.40.46.31237] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 09/01/2021] [Indexed: 12/23/2022] Open
Abstract
Since the beginning of June 2021, Zimbabwe entered into a harsh third wave of the COVID-19 pandemic, which saw an increase in the cumulative number of cases from approximately 38,000 to 120,000 in just two months. This exponential case rise was accompanied by an increase in the absolute number of case fatalities, with a corresponding strain on the public health sector. To effectively inform public health responses, policy and strategy to deal with the current wave and prepare for further waves, we discuss the drivers and challenges of control for this current wave and future waves, and offer practical recommendations. Vaccination will be the most important public health intervention to deal with the spread, morbidity and mortality of COVID-19, therefore, efforts to fight vaccine hesitancy and build vaccine confidence and availability will be critical. Similarly, it will be important to build public health sector capacity and resilience to adequately deal with large-scale outbreaks and absorb the shock waves associated with such. Resuscitating and building the economy is an indispensable component of protecting public health. Therefore, collaborative efforts from relevant public health stakeholders, economists, politicians and other players are required to effectively coordinate the necessary responses and formulate the right policies and strategies.
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Affiliation(s)
- Grant Murewanhema
- Unit of Obstetrics and Gynaecology, Department of Primary Health Care Sciences, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Faith Mutsigiri-Murewanhema
- Department of Community Medicine, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
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56
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Kim D, Pekgün P, Yildirim İ, Keskinocak P. Resource allocation for different types of vaccines against COVID-19: Tradeoffs and synergies between efficacy and reach. Vaccine 2021; 39:6876-6882. [PMID: 34688498 PMCID: PMC8520874 DOI: 10.1016/j.vaccine.2021.10.025] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 10/08/2021] [Accepted: 10/12/2021] [Indexed: 02/03/2023]
Abstract
Objective Vaccine shortage and supply-chain challenges have caused limited access by many resource-limited countries during the COVID-19 pandemic. One of the primary decisions for a vaccine-ordering decision-maker is how to allocate the limited resources between different types of vaccines effectively. We studied the tradeoff between efficacy and reach of the two vaccine types that become available at different times. Methods We extended a Susceptible-Infected-Recovered-Deceased (SIR-D) model with vaccination, ran extensive simulations with different settings, and compared the level of infection attack rate (IAR) under different reach ratios between two vaccine types under different resource allocation decisions. Results We found that when there were limited resources, allocating resources to a vaccine with high efficacy that became available earlier than a vaccine with lower efficacy did not always lead to a lower IAR, particularly if the former could vaccinate less than 42.5% of the population (with the selected study parameters) who could have received the latter. Sensitivity analyses showed that this result stayed robust under different study parameters. Conclusions Our results showed that a vaccine with lower resource requirements (wider reach) can significantly contribute to reducing IAR, even if it becomes available later in the pandemic, compared to a higher efficacy vaccine that becomes available earlier but requires more resources. Limited resource in vaccine distribution is significant challenge in many parts of the world that needs to be addressed to improve the global access to life-saving vaccines. Understanding the tradeoffs between efficacy and reach is critical for resource allocation decisions between different vaccine types for improving health outcomes.
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Affiliation(s)
- Daniel Kim
- H. Milton Stewart School of Industrial and Systems Engineering, Georgia Institute of Technology, Atlanta, GA 30332, USA.
| | - Pelin Pekgün
- Moore School of Business, University of South Carolina, Columbia, SC 29208, USA.
| | - İnci Yildirim
- Department of Pediatrics, Section of Infectious Diseases and Global Health, Yale School of Medicine and Yale Institute of Global Health, 1 Church Street, New Haven, CT 06510, USA.
| | - Pınar Keskinocak
- H. Milton Stewart School of Industrial and Systems Engineering, Georgia Institute of Technology, Atlanta, GA 30332, USA.
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57
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Hinson RE, Hein W, Tettey LN, Nartey BA, Harant A, Struck NS, Fobil JN. Critical prerequisites for Covid-19 vaccine acceleration: A developing economy perspective. JOURNAL OF PUBLIC AFFAIRS 2021; 21:e2723. [PMID: 34512185 PMCID: PMC8420375 DOI: 10.1002/pa.2723] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 05/13/2021] [Accepted: 07/05/2021] [Indexed: 06/13/2023]
Abstract
This study aims to explore the critical prerequisites for accelerating the distribution of the COVID-19 vaccine in developing countries by using Ghana as a case study. A qualitative study method and content analysis approach was used. In-depth interviews were conducted with health experts from the Ghana Health Service, World Health Organization (WHO), AstraZeneca, Novartis, and Medtronic Inc. in Ghana. Our analysis of data revealed that new structures, committees, advisory bodies and lines of communication in government evolved during this pandemic and are underlying the current strategy development and decision-making on COVID-19 vaccines. The interviews gave insights into six major factors that will aid COVID-19 vaccine acceleration in Ghana. These factors are: (1) Access to vaccines through delivery, (2) national manufacturing of vaccines, (3) choosing the best vaccine candidates, (4) financial resources, (5) transparency, and (6) vaccine roll-out and administration. These results could guide policymakers and other relevant stakeholders in prioritizing activities that will aid COVID-19 vaccine acceleration in Ghana and other lower-middle-income countries, tailored to their specific context. As a recommendation, the Ghanaian government should embrace a multisectoral synergy approach to fight the disease. The study also provides insights into how vaccine adoption can be accelerated in the case of future pandemics.
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Affiliation(s)
- Robert E. Hinson
- University of Ghana Business SchoolAccraGhana
- North‐West University Business SchoolSouth Africa
| | - Wolfgang Hein
- German Institute for Global and Area Studies (GIGA)University of HamburgHamburgGermany
| | | | | | - Anne Harant
- German Institute for Global and Area Studies (GIGA)University of HamburgHamburgGermany
| | - Nicole S. Struck
- Department of Infectious Disease EpidemiologyBernhard Nocht Institute for Tropical MedicineHamburgGermany
- German Centre for Infection Research (DZIF)Hamburg‐Lübeck‐Borstel‐RiemsGermany
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58
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Iliyasu Z, Umar AA, Abdullahi HM, Kwaku AA, Amole TG, Tsiga-Ahmed FI, Garba RM, Salihu HM, Aliyu MH. "They have produced a vaccine, but we doubt if COVID-19 exists": correlates of COVID-19 vaccine acceptability among adults in Kano, Nigeria. Hum Vaccin Immunother 2021; 17:4057-4064. [PMID: 34613864 DOI: 10.1080/21645515.2021.1974796] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Vaccination is a critical tool in the global response to the COVID-19 pandemic. Yet, COVID-19 vaccine hesitancy has not been well explored in parts of Nigeria. We assessed the predictors of acceptability of the COVID-19 vaccine and identified reasons for vaccine hesitancy among adults in urban Kano, northern Nigeria. Using a mixed-methods design, we administered structured questionnaires to a cross-section of adults (n = 446), complemented with 20 in-depth interviews. Binary logistic regression and the framework approach were used to analyze the data. About one-half (51.1%, n = 228) of the respondents were willing to take the COVID-19 vaccine. Vaccine acceptance was higher among older respondents (≥30 years) (adjusted Odds Ratio (aOR) = 1.76, 95% Confidence Interval (CI): 1.14-2.99 (≥30 vs. <30), higher-income earners (≥30,000 Naira) (aOR = 2.06, 95%CI:1.12-3.80, ≥30,000 vs. <30,000), and those with a history of a chronic medical disorder (aOR = 1.90, 95%CI:1.06-3.72). Vaccine acceptance was also higher in persons with high risk perception (aOR = 1.61, 95%CI:1.13-2.81, high vs. low), those who were unconcerned about vaccine safety (aOR = 1.71, 95%CI:1.13-3.55), and those who were not worried about efficacy (aOR = 2.02, 95%CI:1.14-4.11) and infertility-related rumors (aOR = 1.98, 95%CI:1.24-3.18). Themes revealed doubts about the existence of COVID-19, mistrust for authorities, and popular credence to rumors and conspiracy theories. In conclusion, COVID-19 vaccine acceptance was sub-optimal and influenced by respondent's age, income, co-morbidities, risk perception, and concerns about vaccine safety, efficacy, and rumors. Context-specific, evidence-based risk communication strategies and trust-building measures could boost vaccine confidence in similar settings.
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Affiliation(s)
- Zubairu Iliyasu
- Department of Community Medicine, Bayero University, Kano, Nigeria
| | - Amina A Umar
- Department of Community Medicine, Bayero University, Kano, Nigeria
| | | | - Aminatu A Kwaku
- Department of Community Medicine, Bayero University, Kano, Nigeria
| | - Taiwo G Amole
- Department of Community Medicine, Bayero University, Kano, Nigeria
| | | | - Rayyan M Garba
- Department of Community Medicine, Bayero University, Kano, Nigeria
| | - Hamisu M Salihu
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Muktar H Aliyu
- Department of Health Policy & Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, TN, USA
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Dembek ZF, Schwartz-Watjen KT, Swiatecka AL, Broadway KM, Hadeed SJ, Mothershead JL, Chekol T, Owens AN, Wu A. Coronavirus Disease 2019 on the Heels of Ebola Virus Disease in West Africa. Pathogens 2021; 10:1266. [PMID: 34684215 PMCID: PMC8537256 DOI: 10.3390/pathogens10101266] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 09/27/2021] [Accepted: 09/29/2021] [Indexed: 01/08/2023] Open
Abstract
This study utilized modeling and simulation to examine the effectiveness of current and potential future COVID-19 response interventions in the West African countries of Guinea, Liberia, and Sierra Leone. A comparison between simulations can highlight which interventions could have an effect on the pandemic in these countries. An extended compartmental model was used to run simulations incorporating multiple vaccination strategies and non-pharmaceutical interventions (NPIs). In addition to the customary categories of susceptible, exposed, infected, and recovered (SEIR) compartments, this COVID-19 model incorporated early and late disease states, isolation, treatment, and death. Lessons learned from the 2014-2016 Ebola virus disease outbreak-especially the optimization of each country's resource allocation-were incorporated in the presented models. For each country, models were calibrated to an estimated number of infections based on actual reported cases and deaths. Simulations were run to test the potential future effects of vaccination and NPIs. Multiple levels of vaccination were considered, based on announced vaccine allocation plans and notional scenarios. Increased vaccination combined with NPI mitigation strategies resulted in thousands of fewer COVID-19 infections in each country. This study demonstrates the importance of increased vaccinations. The levels of vaccination in this study would require substantial increases in vaccination supplies obtained through national purchases or international aid. While this study does not aim to develop a model that predicts the future, it can provide useful information for decision-makers in low- and middle-income nations. Such information can be used to prioritize and optimize limited available resources for targeted interventions that will have the greatest impact on COVID-19 pandemic response.
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Affiliation(s)
- Zygmunt F. Dembek
- Battelle Memorial Institute, Support to DTRA Technical Reachback, Columbus, OH 43201, USA; (Z.F.D.); (A.L.S.); (S.J.H.); (T.C.)
| | - Kierstyn T. Schwartz-Watjen
- Applied Research Associates (ARA), Support to DTRA Technical Reachback, Albuquerque, NM 87110, USA; (K.T.S.-W.); (J.L.M.)
| | - Anna L. Swiatecka
- Battelle Memorial Institute, Support to DTRA Technical Reachback, Columbus, OH 43201, USA; (Z.F.D.); (A.L.S.); (S.J.H.); (T.C.)
| | - Katherine M. Broadway
- Defense Sciences, Inc. (DSI), Support to DTRA Technical Reachback, San Antonio, TX 78230, USA;
| | - Steven J. Hadeed
- Battelle Memorial Institute, Support to DTRA Technical Reachback, Columbus, OH 43201, USA; (Z.F.D.); (A.L.S.); (S.J.H.); (T.C.)
| | - Jerry L. Mothershead
- Applied Research Associates (ARA), Support to DTRA Technical Reachback, Albuquerque, NM 87110, USA; (K.T.S.-W.); (J.L.M.)
| | - Tesema Chekol
- Battelle Memorial Institute, Support to DTRA Technical Reachback, Columbus, OH 43201, USA; (Z.F.D.); (A.L.S.); (S.J.H.); (T.C.)
| | - Akeisha N. Owens
- Defense Threat Reduction Agency (DTRA), Fort Belvoir, VA 22060, USA;
| | - Aiguo Wu
- Defense Threat Reduction Agency (DTRA), Fort Belvoir, VA 22060, USA;
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McAbee L, Tapera O, Kanyangarara M. Factors Associated with COVID-19 Vaccine Intentions in Eastern Zimbabwe: A Cross-Sectional Study. Vaccines (Basel) 2021; 9:1109. [PMID: 34696215 PMCID: PMC8538260 DOI: 10.3390/vaccines9101109] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 09/24/2021] [Accepted: 09/27/2021] [Indexed: 11/23/2022] Open
Abstract
Vaccines are one of the most effective public health strategies to protect against infectious diseases, yet vaccine hesitancy has emerged as a global health threat. Understanding COVID-19 knowledge and attitudes and their association with vaccine intentions can help the targeting of strategies to increase vaccination uptake and achieve herd immunity. The goal of this study was to assess COVID-19 knowledge, attitudes, and behaviors, and identify factors associated with COVID-19 vaccine intentions among heads of households in Manicaland Province, Zimbabwe. A cross-sectional survey was conducted in May 2021 among 551 randomly selected households. Data were collected on socio-demographic characteristics, and knowledge, attitudes, and behaviors regarding COVID-19 and the vaccines. More than half (55.7%) of the respondents reported intending to vaccinate themselves or their households. Multivariate logistic regression indicated that the likelihood of vaccine intentions was most strongly associated with confidence in vaccine safety. Additionally, the odds of intending to get vaccinated were significantly higher among heads of households who were male, had a higher level of education, and identified vaccination and face mask usage as prevention measures. Among perceived motivators to vaccinate, recommendations from the World Health Organization and availability of the vaccine free of charge increased the likelihood of vaccine intentions, while country of vaccine manufacturer posed a barrier to vaccine intentions. As the vaccine rollout in Zimbabwe continues, efforts to increase COVID-19 vaccination coverage and achieve herd immunity should target females and less educated populations and be tailored to address concerns about vaccine safety and country of manufacturer.
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Affiliation(s)
- Lauren McAbee
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA;
| | - Oscar Tapera
- SADTAP Health Research Institute, Harare 00263, Zimbabwe;
| | - Mufaro Kanyangarara
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA;
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61
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AlShurman BA, Khan AF, Mac C, Majeed M, Butt ZA. What Demographic, Social, and Contextual Factors Influence the Intention to Use COVID-19 Vaccines: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:9342. [PMID: 34501932 PMCID: PMC8431323 DOI: 10.3390/ijerph18179342] [Citation(s) in RCA: 73] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 08/21/2021] [Accepted: 08/31/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND During the COVID-19 crisis, an apparent growth in vaccine hesitancy has been noticed due to different factors and reasons. Therefore, this scoping review was performed to determine the prevalence of intention to use COVID-19 vaccines among adults aged 18-60, and to identify the demographic, social, and contextual factors that influence the intention to use COVID-19 vaccines. METHODS This scoping review was conducted by using the methodological framework for scoping review outlined by Arksey and O'Malley. A search strategy was carried out on four electronic databases: PubMed, Scopus, CINAHL, and PsycINFO. All peer-reviewed articles published between November 2019 and December 2020 were reviewed. Data were extracted to identify the prevalence of, and factors that influence, the intention to use COVID-19 vaccines. RESULTS A total of 48 relevant articles were identified for inclusion in the review. Outcomes presented fell into seven themes: demographics, social factors, vaccination beliefs and attitudes, vaccine-related perceptions, health-related perceptions, perceived barriers, and vaccine recommendations. Age, gender, education level, race/ethnicity, vaccine safety and effectiveness, influenza vaccination history, and self-protection from COVID-19 were the most prominent factors associated with intention to use COVID-19 vaccines. Furthermore, the majority of studies (n = 34/48) reported a relatively high prevalence of intention to get vaccinated against COVID-19, with a range from 60% to 93%. CONCLUSION This scoping review enables the creation of demographic, social, and contextual constructs associated with intention to vaccinate among the adult population. These factors are likely to play a major role in any targeted vaccination programs, particularly COVID-19 vaccination. Thus, our review suggests focusing on the development of strategies to promote the intention to get vaccinated against COVID-19 and to overcome vaccine hesitancy and refusal. These strategies could include transparent communication, social media engagement, and the initiation of education programs.
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Affiliation(s)
- Bara’ Abdallah AlShurman
- School of Public Health Sciences, University of Waterloo, Waterloo, ON N2L 3G1, Canada; (B.A.A.); (A.F.K.); (C.M.)
| | - Amber Fozia Khan
- School of Public Health Sciences, University of Waterloo, Waterloo, ON N2L 3G1, Canada; (B.A.A.); (A.F.K.); (C.M.)
| | - Christina Mac
- School of Public Health Sciences, University of Waterloo, Waterloo, ON N2L 3G1, Canada; (B.A.A.); (A.F.K.); (C.M.)
| | - Meerab Majeed
- Faculty of Health Sciences, McMaster University, Hamilton, ON L8N 3Z5, Canada;
| | - Zahid Ahmad Butt
- School of Public Health Sciences, University of Waterloo, Waterloo, ON N2L 3G1, Canada; (B.A.A.); (A.F.K.); (C.M.)
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Ozoh OB, Mbatchou Ngahane BH, Zar HJ, Masekela R, Chakaya J, Aluoch J. Lung health in Africa: challenges and opportunities in the context of COVID-19. Am J Physiol Lung Cell Mol Physiol 2021; 321:L619-L623. [PMID: 34378415 PMCID: PMC8435940 DOI: 10.1152/ajplung.00322.2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 08/02/2021] [Indexed: 11/22/2022] Open
Affiliation(s)
- Obianuju B Ozoh
- Department of Medicine, Faculty of Clinical Sciences, College of Medicine, University of Lagos, and The Lagos University Teaching Hospital, Lagos, Nigeria
| | | | - Heather J Zar
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital and SA-MRC Unit for Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
| | - Refiloe Masekela
- Department of Paediatrics and Child Health, School of Clinical Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
- Centre for Child Health, Blizard Institute, Queen Mary University of London, London, United Kingdom
| | - Jeremiah Chakaya
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Department of Medicine, Dermatology and Therapeutics, Kenyatta University, Nairobi, Kenya
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63
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Orangi S, Pinchoff J, Mwanga D, Abuya T, Hamaluba M, Warimwe G, Austrian K, Barasa E. Assessing the Level and Determinants of COVID-19 Vaccine Confidence in Kenya. Vaccines (Basel) 2021; 9:vaccines9080936. [PMID: 34452061 PMCID: PMC8402839 DOI: 10.3390/vaccines9080936] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 08/11/2021] [Accepted: 08/16/2021] [Indexed: 11/16/2022] Open
Abstract
The government of Kenya has launched a phased rollout of COVID-19 vaccination. A major barrier is vaccine hesitancy; the refusal or delay of accepting vaccination. This study evaluated the level and determinants of vaccine hesitancy in Kenya. We conducted a cross-sectional study administered through a phone-based survey in February 2021 in four counties of Kenya. Multilevel logistic regression was used to identify individual perceived risks and influences, context-specific factors and vaccine-specific issues associated with COVID-19 vaccine hesitancy. COVID-19 vaccine hesitancy in Kenya was high: 36.5%. Factors associated with vaccine hesitancy included: Rural regions, perceived difficulty in adhering to government regulations on COVID-19 prevention, no perceived COVID-19 infection risk, concerns regarding vaccine safety and effectiveness, and religious and cultural reasons. There is a need for the prioritization of interventions to address vaccine hesitancy and improve vaccine confidence as part of the vaccine roll-out plan. These messaging and/or interventions should be holistic to include the value of other public health measures, be focused and targeted to specific groups, raise awareness on the risks of COVID-19 and effectively communicate the benefits and risks of vaccines.
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Affiliation(s)
- Stacey Orangi
- Health Economics Research Unit (HERU), KEMRI-Wellcome Trust Research Program, Nairobi P.O. Box 43640-00100, Kenya;
- Institute of Healthcare Management, Strathmore University, Nairobi P.O. Box 59857-0200, Kenya
- Correspondence:
| | | | - Daniel Mwanga
- Population Council, Nairobi P.O. Box 17643-00500, Kenya; (D.M.); (T.A.); (K.A.)
| | - Timothy Abuya
- Population Council, Nairobi P.O. Box 17643-00500, Kenya; (D.M.); (T.A.); (K.A.)
| | - Mainga Hamaluba
- KEMRI-Wellcome Trust Research Programme, Kilifi P.O. Box 230-80108, Kenya; (M.H.); (G.W.)
- Nuffield Department of Medicine, Oxford University, Oxford OX3 7LG, UK
| | - George Warimwe
- KEMRI-Wellcome Trust Research Programme, Kilifi P.O. Box 230-80108, Kenya; (M.H.); (G.W.)
- Nuffield Department of Medicine, Oxford University, Oxford OX3 7LG, UK
| | - Karen Austrian
- Population Council, Nairobi P.O. Box 17643-00500, Kenya; (D.M.); (T.A.); (K.A.)
| | - Edwine Barasa
- Health Economics Research Unit (HERU), KEMRI-Wellcome Trust Research Program, Nairobi P.O. Box 43640-00100, Kenya;
- Nuffield Department of Medicine, Oxford University, Oxford OX3 7LG, UK
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64
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Kouamou V, Matarise R, Santos ED, Elose N, Manasa J. SARS-CoV-2 in Zimbabwe: milestones and challenges faced towards achieving the expected 60% herd immunity. Pan Afr Med J 2021; 39:255. [PMID: 34707756 PMCID: PMC8520422 DOI: 10.11604/pamj.2021.39.255.30331] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Accepted: 08/18/2021] [Indexed: 12/12/2022] Open
Abstract
In response to COVID-19 pandemic, the Zimbabwe government put in place various rigorous measures to curb the spread of the virus. Although roll-out and access to COVID-19 vaccines in Africa have been slow, the World Health Organization (WHO)-led COVID-19 Vaccines Global Access (COVAX) consortium and the African vaccine acquisition task team are striving to provide 720 million doses of COVID-19 vaccines to achieve 60% coverage in Africa by June, 2022. In line with this, the Zimbabwe vaccination programme commenced on the 26th February 2021 and as of 9th June 2021, approximately, 2.6% of the population have been fully vaccinated in the country. Although the COVID-19 pandemic has crippled the economy and caused significant strain on the public health system, much has been done in the country since the first case was recorded (20th March 2020). However, much more needs to be done to finally reach the expected 60% herd immunity by June 2022.
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Affiliation(s)
- Vinie Kouamou
- Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Richard Matarise
- Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Elizabeth Dos Santos
- Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Nyasha Elose
- Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Justen Manasa
- Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
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65
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Liao SH, Hung CC, Chen CN, Yen JY, Hsu CY, Yen AMF, Chen CL. Assessing efficacy of antiviral therapy for COVID-19 patients: A case study on remdesivir with bayesian synthesis design and multistate analysis. J Formos Med Assoc 2021; 120 Suppl 1:S77-S85. [PMID: 34074579 PMCID: PMC8096194 DOI: 10.1016/j.jfma.2021.04.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 04/18/2021] [Accepted: 04/21/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND/PURPOSE A synthesis design and multistate analysis is required for assessing the clinical efficacy of antiviral therapy on dynamics of multistate disease progression and in reducing the mortality and enhancing the recovery of patients with COVID-19. A case study on remdesivir was illustrated for the clinical application of such a novel design and analysis. METHODS A Bayesian synthesis design was applied to integrating the empirical evidence on the one-arm compassion study and the two-arm ACTT-1 trial for COVID-19 patients treated with remdesivir. A multistate model was developed to model the dynamics of hospitalized COVID-19 patients from three transient states of low, medium-, and high-risk until the two outcomes of recovery and death. The outcome measures for clinical efficacy comprised high-risk state, death, and discharge. RESULTS The efficacy of remdesivir in reducing the risk of death and enhancing the odds of recovery were estimated as 31% (95% CI, 18-44%) and 10% (95% CI, 1-18%), respectively. Remdesivir therapy for patients with low-risk state showed the efficacy in reducing subsequent progression to high-risk state and death by 26% (relative rate (RR), 0.74; 95% CI, 0.55-0.93) and 62% (RR, 0.38; 95% CI, 0.29-0.48), respectively. Less but still statistically significant efficacy in mortality reduction was noted for the medium- and high-risk patients. Remdesivir treated patients had a significantly shorter period of hospitalization (9.9 days) compared with standard care group (12.9 days). CONCLUSION The clinical efficacy of remdesvir therapy in reducing mortality and accelerating discharge has been proved by the Bayesian synthesis design and multistate analysis.
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Affiliation(s)
- Sih-Han Liao
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan; Section of Gastroenterology, Department of Medicine, National Taiwan University Cancer Center, Taipei, Taiwan; Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Chien-Ching Hung
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan; Department of Tropical Medicine and Parasitology, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Chiung-Nien Chen
- Center for Functional Image and Interventional Therapy, National Taiwan University, Taipei, Taiwan; Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Jui-Yi Yen
- Department of Anesthesiology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chen-Yang Hsu
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan; Dachung Hospital, Miaoli, Taiwan
| | - Amy Ming-Fang Yen
- School of Oral Hygiene, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan
| | - Chi-Ling Chen
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan; Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.
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Kaseje N, Oruenjo K, Kaseje D, Evans TG, Tanner M, Haines A, Nyikal J. Leveraging latent assets to strengthen the COVID-19 response and vaccine roll-out in Africa. BMJ Glob Health 2021; 6:e006289. [PMID: 34045185 PMCID: PMC8727652 DOI: 10.1136/bmjgh-2021-006289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 05/18/2021] [Indexed: 11/23/2022] Open
Affiliation(s)
| | | | - Dan Kaseje
- Tropical Institute of Community Health and Development, Kisumu, Kenya
| | | | - Marcel Tanner
- Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Andy Haines
- London School of Hygiene and Tropical Medicine, London, UK
| | - James Nyikal
- Parliament of the Republic of Kenya, Nairobi, Kenya
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Murewanhema G. Vaccination hesitancy among women of reproductive age in resource-challenged settings: a cause for public health concern. Pan Afr Med J 2021; 38:336. [PMID: 34285758 PMCID: PMC8265245 DOI: 10.11604/pamj.2021.38.336.28953] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 04/06/2021] [Indexed: 11/11/2022] Open
Abstract
Women of reproductive age are a key population for the control of COVID-19 owing to their levels of socio-economic activities and central role in the upkeep of stable families. Therefore, adequate vaccination uptake in this population is critical. However, this may be negatively affected by circulating rumours regarding SARS-CoV-2 vaccines and subfertility and pregnancy and breastfeeding concerns that have circulated widely on diverse social media. Urgent public health interventions are required to deal with vaccination hesitancy and promote uptake in this key population. This calls for concerted, multidisciplinary and multistakeholder consultative public health forums, public health research and action in the shortest possible period.
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Affiliation(s)
- Grant Murewanhema
- Unit of Obstetrics and Gynaecology, Department of Primary Health Sciences, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
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