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Geng DC, Innes JL, Wang G. Survive, revive, and thrive: The impact of COVID-19 on global park visitation. THE SCIENCE OF THE TOTAL ENVIRONMENT 2024; 946:174077. [PMID: 38908585 DOI: 10.1016/j.scitotenv.2024.174077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Revised: 06/14/2024] [Accepted: 06/15/2024] [Indexed: 06/24/2024]
Abstract
The COVID-19 pandemic has had detrimental effects on both the physical and psychological well-being of individuals. Throughout the pandemic and in response to various policies, such as lockdowns, movement restrictions and social distancing measures, parks and greenspaces received renewed attention as people used them to help cope with the adverse effects of the pandemic. This study explored the factors influencing park and greenspace visitation at different stages of the pandemic in 2020, 2021, and 2022, from both global and regional perspectives. Data were collected primarily from Our World in Data, Google's Community Mobility Reports and the Oxford Coronavirus Government Response Tracker, and a total of 125,422 park visits were processed. Stay-at-home mandates, vaccination availability, and school closures were the most influential factors globally affecting park and greenspace visitation in 2020, 2021, and 2022, respectively. Post-2021, vaccination-related policies began to play a significantly positive role in the increase in park and greenspace visits. Following a global analysis, countries were categorized into five clusters based on social, economic, and cultural indices. The analysis revealed varying patterns of factors influencing park visitation across these clusters. Notably, income support policies were positively correlated with higher park visitation, particularly in low-income countries. Recognizing the significance of parks and green spaces as essential green infrastructure, this study suggests how the use of parks might have better coped with the COVID-19 pandemic and how future health crises might be addressed. At the same time, it considers different social, economic, and cultural contexts. Additionally, this work provides insights and suggestions as to how parks and greenspaces might be used to reduce the social inequalities exacerbated during the pandemic, especially in low-income developing countries.
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Affiliation(s)
- Dehui Christina Geng
- Faculty of Forestry, University of British Columbia, 2424 Main Mall, Vancouver, BC, Canada
| | - John L Innes
- Faculty of Forestry, University of British Columbia, 2424 Main Mall, Vancouver, BC, Canada
| | - Guangyu Wang
- Faculty of Forestry, University of British Columbia, 2424 Main Mall, Vancouver, BC, Canada.
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Escribà-Salvans A, Jerez-Roig J, Farrés-Godayol P, Bezerra de Souza DL, Skelton DA, Minobes-Molina E. Health and sociodemographic determinants of excess mortality in Spanish nursing homes during the COVID-19 pandemic: a 2-year prospective longitudinal study. Z Gerontol Geriatr 2024; 57:459-466. [PMID: 38625391 PMCID: PMC11422266 DOI: 10.1007/s00391-024-02294-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 03/06/2024] [Indexed: 04/17/2024]
Abstract
BACKGROUND Age, multimorbidity, immunodeficiency and frailty of older people living in nursing homes make them vulnerable to COVID-19 and overall mortality. OBJECTIVE To estimate overall and COVID-19 mortality parameters and analyse their predictive factors in older people living in nursing homes over a 2-year period. METHOD Design: A 2-year prospective longitudinal multicentre study was conducted between 2020 and 2022. SETTING This study involved five nursing homes in Central Catalonia (Spain). PARTICIPANTS Residents aged 65 years or older who lived in the nursing homes on a permanent basis. MEASUREMENTS Date and causes of deaths were recorded. In addition, sociodemographic and health data were collected. For the effect on mortality, survival curves were performed using the Kaplan-Meier method and multivariate analysis using Cox regression. RESULTS The total sample of 125 subjects had a mean age of 85.10 years (standard deviation = 7.3 years). There were 59 (47.2%) deaths at 24 months (95% confidence interval, CI, 38.6-55.9) and 25 (20.0%) were due to COVID-19, mostly in the first 3 months. In multivariate analysis, functional impairment (hazard ratio, HR 2.40; 95% CI 1.33-4.32) was a significant risk factor for mortality independent of age (HR 1.17; 95% CI 0.69-2.00) and risk of sarcopenia (HR 1.40; 95% CI 0.63-3.12). CONCLUSION Almost half of this sample of nursing home residents died in the 2‑year period, and one fifth were attributed to COVID-19. Functional impairment was a risk factor for overall mortality and COVID-19 mortality, independent of age and risk of sarcopenia.
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Affiliation(s)
- Anna Escribà-Salvans
- Research group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O). Faculty of Health Sciences and Welfare. Centre for Health and Social Care Research (CESS), University of Vic-Central University of Catalonia (UVic-UCC), C. Sagrada Família 7, 08500, Vic, Spain
- Institute for Research and Innovation in Life Sciences and Health in Central Catalonia (IRIS-CC), Vic, Spain
| | - Javier Jerez-Roig
- Research group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O). Faculty of Health Sciences and Welfare. Centre for Health and Social Care Research (CESS), University of Vic-Central University of Catalonia (UVic-UCC), C. Sagrada Família 7, 08500, Vic, Spain.
- Institute for Research and Innovation in Life Sciences and Health in Central Catalonia (IRIS-CC), Vic, Spain.
- Department of Health Promotion and Rehabilitation, Institute of Sport Science and Innovations, Lithuanian Sports University, Kaunas, Lithuania.
| | - Pau Farrés-Godayol
- Research group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O). Faculty of Health Sciences and Welfare. Centre for Health and Social Care Research (CESS), University of Vic-Central University of Catalonia (UVic-UCC), C. Sagrada Família 7, 08500, Vic, Spain
- Institute for Research and Innovation in Life Sciences and Health in Central Catalonia (IRIS-CC), Vic, Spain
| | | | - Dawn A Skelton
- Research Centre for Health (ReaCH), School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Eduard Minobes-Molina
- Research group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O). Faculty of Health Sciences and Welfare. Centre for Health and Social Care Research (CESS), University of Vic-Central University of Catalonia (UVic-UCC), C. Sagrada Família 7, 08500, Vic, Spain
- Institute for Research and Innovation in Life Sciences and Health in Central Catalonia (IRIS-CC), Vic, Spain
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Beegle K, Demombynes G, de Walque D, Gubbins P, Veillard J. COVID-19 Increased Existing Gender Mortality Gaps in High Income More than Middle Income Countries. Int J Infect Dis 2024:107167. [PMID: 39233048 DOI: 10.1016/j.ijid.2024.107167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Revised: 06/27/2024] [Accepted: 07/03/2024] [Indexed: 09/06/2024] Open
Abstract
OJECTIVE To analyze how patterns of excess mortality varied by sex and age groups across countries during the COVID-19 pandemic and their association with country income level. METHODS We used World Health Organization excess mortality estimates by sex and age groups for 75 countries in 2020 and 62 countries in 2021, restricting the sample to estimates based on recorded all-cause mortality data. We examined patterns across countries using country-specific Poisson regressions with observations consisting of the number of excess deaths by groups defined by sex and age. FINDINGS Men die at higher rates in nearly all places and at all ages beyond age 45. In 2020, the pandemic amplified this gender mortality gap for the world, but with variation across countries and by country income level. In high-income countries, rates of excess mortality were much higher for men than women. In contrast, in middle-income countries, the sex ratio of excess mortality was similar to the sex ratio of expected all-cause mortality. The exacerbation of the sex ratio of excess mortality observed in 2020 in high-income countries, however, declined in 2021. CONCLUSION The COVID-19 pandemic has killed men at much higher rates than women, as has been well documented, but these gender differences have varied by country income. These differences were the result of some combination of variation in gender patterns of infection rates and infection fatality rates across countries. The gender gap in mortality declined in high-income countries in 2021, likely as a result of the faster rollout of vaccination against COVID-19.
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Azambuja P, Bastos LS, Batista-da-Silva AA, Ramos GV, Kurtz P, Dias CM, da Silva EP, Arouca LE, Soares J, Sejvar JJ, Sigfrid L, Ranzani OT, Hamacher S, Bozza FA. Prevalence, risk factors, and impact of long COVID in a socially vulnerable community in Brazil: a prospective cohort study. LANCET REGIONAL HEALTH. AMERICAS 2024; 37:100839. [PMID: 39100241 PMCID: PMC11295704 DOI: 10.1016/j.lana.2024.100839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Revised: 05/24/2024] [Accepted: 07/02/2024] [Indexed: 08/06/2024]
Abstract
Background Long COVID is an emerging global public health issue. Socially vulnerable communities in low- and-middle-income countries were severely impacted by the pandemic and are underrepresented in research. This prospective study aimed to determine the prevalence of long COVID, its impact on health, and associated risk factors in one such community in Rio de Janeiro, Brazil. Methods A total of 710 individuals aged 18 and older, with confirmed SARS-CoV-2 infection at least three months prior, were enrolled between November 25, 2021, and May 5, 2022. Participants were assessed via telephone or in person using a standardized questionnaire to evaluate their perception of recovery, symptoms, quality of life, and functional status. Findings Twenty percent of participants did not feel fully recovered, 22% experienced new or persistent symptoms, 26% had worsened functional status, 18% had increased dyspnoea, and 32% reported a worse quality of life. Persistent symptoms included headache, cough, fatigue, muscle pain, and shortness of breath. Dyspnoea during the acute phase was the strongest independent predictor of worsening outcomes. Females and individuals with comorbidities were more likely to report worse recovery, functioning, dyspnoea, and quality of life. Interpretation Our findings reveal a high burden of severe and persistent physical and mental health sequelae in a socially vulnerable community following COVID-19. Funding UK Foreign, Commonwealth and Development Office and Wellcome Trust Grant (222048/Z/20/Z), Fundação Oswaldo Cruz (FIOCRUZ), Fundação de Amparo à Pesquisa do Estado do Rio de Janeiro (FAPERJ), and the Centers for Disease Control and Prevention (CDC).
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Affiliation(s)
- Pedro Azambuja
- National Institute of Infectious Diseases Evandro Chagas, Oswaldo Cruz Foundation (INI-FIOCRUZ), Rio de Janeiro, RJ, Brazil
| | - Leonardo S.L. Bastos
- Department of Industrial Engineering (DEI), Pontifical Catholic University of Rio de Janeiro (PUC-Rio), Rio de Janeiro, RJ, Brazil
- Tecgraf Institute, Pontifical Catholic University of Rio de Janeiro (PUC-Rio), Rio de Janeiro, RJ, Brazil
| | - Amanda A. Batista-da-Silva
- Department of Industrial Engineering (DEI), Pontifical Catholic University of Rio de Janeiro (PUC-Rio), Rio de Janeiro, RJ, Brazil
- Tecgraf Institute, Pontifical Catholic University of Rio de Janeiro (PUC-Rio), Rio de Janeiro, RJ, Brazil
| | | | - Pedro Kurtz
- D’Or Institute for Research and Education (IDOR), Rio de Janeiro, RJ, Brazil
- Hospital Copa Star, Rio de Janeiro, RJ, Brazil
- Paulo Niemeyer State Brain Institute (IECPN), Rio de Janeiro, RJ, Brazil
| | | | | | - Luna E. Arouca
- Associação de Desenvolvimento Redes da Maré, Rio de Janeiro, RJ, Brazil
| | - Jesus Soares
- Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - James J. Sejvar
- Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Louise Sigfrid
- ISARIC Global Support Centre, Policy and Practice Research Group, Pandemic Sciences Institute, University of Oxford, Oxford, UK
| | - Otavio T. Ranzani
- Barcelona Institute for Global Health, ISGlobal, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
- Pulmonary Division, Heart Institute (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, SP, Brazil
| | - Silvio Hamacher
- Department of Industrial Engineering (DEI), Pontifical Catholic University of Rio de Janeiro (PUC-Rio), Rio de Janeiro, RJ, Brazil
- Tecgraf Institute, Pontifical Catholic University of Rio de Janeiro (PUC-Rio), Rio de Janeiro, RJ, Brazil
| | - Fernando A. Bozza
- National Institute of Infectious Diseases Evandro Chagas, Oswaldo Cruz Foundation (INI-FIOCRUZ), Rio de Janeiro, RJ, Brazil
- D’Or Institute for Research and Education (IDOR), Rio de Janeiro, RJ, Brazil
- Comprehensive Health Research Centre (CHRC), NOVA Medical School, Universidade NOVA de Lisboa, Lisbon, Portugal
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Safiah MH, Alchallah MO, ElHomsi MO, Kalalib Al Ashabi K, Ataya S, Alolabi H, Mohsen F, Darjazini Nahas L. The attitudes of Syrian Private University Medical Students towards E-Learning during the COVID-19 pandemic: a cross-sectional study. BMC MEDICAL EDUCATION 2024; 24:826. [PMID: 39085920 PMCID: PMC11293193 DOI: 10.1186/s12909-024-05817-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 07/24/2024] [Indexed: 08/02/2024]
Abstract
BACKGROUND The COVID-19 pandemic has had a significant impact on the education sector, leading to the closure of colleges and schools and disrupting the learning process for an uncertain duration. In response, electronic learning has emerged as a suitable method for continuing the educational process during the lockdown. This study aimed to assess the attitudes, practices, and barriers to e-learning among medical students at Syrian Private University. METHODS A cross-sectional survey study was conducted at the Faculty of Medicine of the Syrian Private University (SPU) in Damascus, Syria. The study used a convenience sampling approach and was carried out from June 2021 to January 2022. Data were collected using a self-administered questionnaire structured into two sections. The first section included 12 sociodemographic questions. The second section assessed students' attitudes, practices, and barriers related to e-learning, and consisted of 14 questions on attitudes, 11 questions on practices, and 9 questions on barriers. RESULTS Of the 519 participating students, over half (55.1%) exhibited a negative attitude towards e-learning. However, more than 60% reported engaging in e-learning activities such as downloading educational content and participating in virtual study groups. The main barriers identified were unstable internet connections (92.7%) and challenges in communication with educators (82.7%). Bionomical logistic regression revealed that negative attitudes were predicted by housing status, academic year, health status, lack of engagement with colleagues in e-learning practices, and the reported barriers of difficulty adjusting learning style, lack of technical skills, poor communication with educators, limited access to devices, and limited space conducive for studying (P < 0.05). CONCLUSION While medical students at SPU were actively engaged in e-learning, over half held negative attitudes. These negative attitudes were associated with the various barriers that students reported. The findings can inform stakeholders in our institution and other Syrian universities about the challenges of implementing e-learning in medical colleges.
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Affiliation(s)
- Mhd Homam Safiah
- Faculty of Medicine, Syrian Private University, Mazzeh Street, P.O. Box 36822, Damascus, Syrian Arab Republic
| | - Mhd Obai Alchallah
- Faculty of Medicine, Syrian Private University, Mazzeh Street, P.O. Box 36822, Damascus, Syrian Arab Republic
| | - Muhammad Omar ElHomsi
- Faculty of Medicine, Syrian Private University, Mazzeh Street, P.O. Box 36822, Damascus, Syrian Arab Republic.
| | | | - Sham Ataya
- Faculty of Medicine, Syrian Private University, Mazzeh Street, P.O. Box 36822, Damascus, Syrian Arab Republic
| | - Homam Alolabi
- Faculty of Medicine, Syrian Private University, Mazzeh Street, P.O. Box 36822, Damascus, Syrian Arab Republic
| | - Fatema Mohsen
- Faculty of Medicine, Syrian Private University, Mazzeh Street, P.O. Box 36822, Damascus, Syrian Arab Republic
| | - Louei Darjazini Nahas
- Faculty of Medicine, Syrian Private University, Mazzeh Street, P.O. Box 36822, Damascus, Syrian Arab Republic
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Huang Y, Feng S, Zhao Y, Wang H, Jiang H. Preferences for COVID-19 Vaccines: Systematic Literature Review of Discrete Choice Experiments. JMIR Public Health Surveill 2024; 10:e56546. [PMID: 39073875 PMCID: PMC11319885 DOI: 10.2196/56546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 05/01/2024] [Accepted: 05/26/2024] [Indexed: 07/30/2024] Open
Abstract
BACKGROUND Vaccination can be viewed as comprising the most important defensive barriers to protect susceptible groups from infection. However, vaccine hesitancy for COVID-19 is widespread worldwide. OBJECTIVE We aimed to systematically review studies eliciting the COVID-19 vaccine preference using discrete choice experiments. METHODS A literature search was conducted in PubMed, Embase, Web of Science, Scopus, and CINAHL Plus platforms in April 2023. Search terms included discrete choice experiments, COVID-19, and vaccines and related synonyms. Descriptive statistics were used to summarize the study characteristics. Subgroup analyses were performed by factors such as high-income countries and low- and middle-income countries and study period (before, during, and after the pandemic wave). Quality appraisal was performed using the 5-item Purpose, Respondents, Explanation, Findings, and Significance checklist. RESULTS The search yield a total of 623 records, and 47 studies with 53 data points were finally included. Attributes were grouped into 4 categories: outcome, process, cost, and others. The vaccine effectiveness (21/53, 40%) and safety (7/53, 13%) were the most frequently reported and important attributes. Subgroup analyses showed that vaccine effectiveness was the most important attribute, although the preference varied by subgroups. Compared to high-income countries (3/29, 10%), a higher proportion of low- and middle-income countries (4/24, 17%) prioritized safety. As the pandemic progressed, the duration of protection (2/24, 8%) during the pandemic wave and COVID-19 mortality risk (5/25, 20%) after the pandemic wave emerged as 2 of the most important attributes. CONCLUSIONS Our review revealed the critical role of vaccine effectiveness and safety in COVID-19 vaccine preference. However, it should be noticed that preference heterogeneity was observed across subpopulations and may change over time. TRIAL REGISTRATION PROSPERO CRD42023422720; https://tinyurl.com/2etf7ny7.
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Affiliation(s)
- Yiting Huang
- Department of Epidemiology and Biostatistics, School of Public Health, Guangdong Pharmaceutical University, Guangzhou, China
- Department of Medical Statistics, School of Basic Medicine and Public Health, Jinan University, Guangzhou, China
| | - Shuaixin Feng
- Outpatient department of Baogang, the First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, China
| | - Yuyan Zhao
- Department of Epidemiology and Biostatistics, School of Public Health, Guangdong Pharmaceutical University, Guangzhou, China
| | - Haode Wang
- School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom
| | - Hongbo Jiang
- Department of Epidemiology and Biostatistics, School of Public Health, Guangdong Pharmaceutical University, Guangzhou, China
- Institute for Global Health, University College London, London, United Kingdom
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Gupta A, Hathi P, Banaji M, Gupta P, Kashyap R, Paikra V, Sharma K, Somanchi A, Sudharsanan N, Vyas S. Large and unequal life expectancy declines during the COVID-19 pandemic in India in 2020. SCIENCE ADVANCES 2024; 10:eadk2070. [PMID: 39028821 PMCID: PMC11259167 DOI: 10.1126/sciadv.adk2070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 06/17/2024] [Indexed: 07/21/2024]
Abstract
Global population health during the COVID-19 pandemic is poorly understood because of weak mortality monitoring in low- and middle-income countries. High-quality survey data on 765,180 individuals, representative of one-fourth of India's population, uncover patterns missed by incomplete vital statistics and disease surveillance. Compared to 2019, life expectancy at birth was 2.6 years lower and mortality was 17% higher in 2020, implying 1.19 million excess deaths in 2020. Life expectancy declines in India were larger and had a younger age profile than in high-income countries. Increases in mortality were greater than expected based on observed seroprevalence and international infection fatality rates, most prominently among the youngest and older age groups. In contrast to global patterns, females in India experienced a life expectancy decline that was 1 year larger than losses for males. Marginalized social groups experienced greater declines than the most privileged social group. These findings uncover large and unequal mortality impacts during the pandemic in the world's most populous country.
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Affiliation(s)
- Aashish Gupta
- Department of Sociology, University of Oxford, 42-43 Park End Street, Oxford OX1 1JD, England
- Nuffield College, New Road, Oxford OX1 1NF, England
- Leverhulme Centre for Demographic Science, University of Oxford, 42-43 Park End Street, Oxford OX1 1JD, England
- Research Institute for Compassionate Economics, 472 Old Colchester Rd., Amston, CT 06231, USA
| | - Payal Hathi
- Research Institute for Compassionate Economics, 472 Old Colchester Rd., Amston, CT 06231, USA
- Department of Demography and Sociology, University of California, Berkeley, 310 Social Sciences Building, Berkeley, CA 94720, USA
| | - Murad Banaji
- Mathematical Institute, University of Oxford, Andrew Wiles Building, Radcliffe Observatory Quarter (550), Woodstock Road, Oxford OX2 6GG, England
| | - Prankur Gupta
- Department of Economics, University of Texas at Austin, 2225 Speedway, Austin, TX 78712, USA
| | - Ridhi Kashyap
- Department of Sociology, University of Oxford, 42-43 Park End Street, Oxford OX1 1JD, England
- Nuffield College, New Road, Oxford OX1 1NF, England
- Leverhulme Centre for Demographic Science, University of Oxford, 42-43 Park End Street, Oxford OX1 1JD, England
| | - Vipul Paikra
- Research Institute for Compassionate Economics, 472 Old Colchester Rd., Amston, CT 06231, USA
| | - Kanika Sharma
- Department of Sociology, Emory University, 1555 Dickey Dr, Atlanta, GA 30322, USA
| | - Anmol Somanchi
- Paris School of Economics, 48 Boulevard Jourdan, 75014 Paris, France
| | - Nikkil Sudharsanan
- TUM School of Medicine and Health, Technical University of Munich, Georg-Brauchle-Ring 60, 80992 Munich, Germany
- Heidelberg Institute of Global Health, Heidelberg University, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany
| | - Sangita Vyas
- Research Institute for Compassionate Economics, 472 Old Colchester Rd., Amston, CT 06231, USA
- Department of Economics, Hunter College (CUNY), 695 Park Ave., New York, NY 10065, USA
- CUNY Institute for Demographic Research, 135 E. 22nd St., New York, NY 10010, USA
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Rasmussen L, Sanders S, Sosa M, McKellip S, Nebane NM, Martinez-Gzegozewska Y, Reece A, Ruiz P, Manuvakhova A, Zhai L, Warren B, Curry A, Zeng Q, Bostwick JR, Vinson PN. A high-throughput response to the SARS-CoV-2 pandemic. SLAS DISCOVERY : ADVANCING LIFE SCIENCES R & D 2024; 29:100160. [PMID: 38761981 DOI: 10.1016/j.slasd.2024.100160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 04/24/2024] [Accepted: 05/06/2024] [Indexed: 05/20/2024]
Abstract
Four years after the beginning of the COVID-19 pandemic, it is important to reflect on the events that have occurred during that time and the knowledge that has been gained. The response to the pandemic was rapid and highly resourced; it was also built upon a foundation of decades of federally funded basic and applied research. Laboratories in government, pharmaceutical, academic, and non-profit institutions all played roles in advancing pre-2020 discoveries to produce clinical treatments. This perspective provides a summary of how the development of high-throughput screening methods in a biosafety level 3 (BSL-3) environment at Southern Research Institute (SR) contributed to pandemic response efforts. The challenges encountered are described, including those of a technical nature as well as those of working under the pressures of an unpredictable virus and pandemic.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Ling Zhai
- Southern Research, Birmingham, AL, USA
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Gmanyami JM, Quentin W, Lambert O, Jarynowski A, Belik V, Amuasi JH. Excess mortality during the COVID-19 pandemic in low-and lower-middle-income countries: a systematic review and meta-analysis. BMC Public Health 2024; 24:1643. [PMID: 38902661 PMCID: PMC11188207 DOI: 10.1186/s12889-024-19154-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Accepted: 06/14/2024] [Indexed: 06/22/2024] Open
Abstract
BACKGROUND Although the COVID-19 pandemic claimed a great deal of lives, it is still unclear how it affected mortality in low- and lower-middle-income countries (LLMICs). This review summarized the available literature on excess mortality during the COVID-19 pandemic in LLMICs, including methods, sources of data, and potential contributing factors that might have influenced excess mortality. METHODS We conducted a systematic review and meta-analysis on excess mortality during the COVID-19 pandemic in LLMICs in line with the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) 2020 guidelines We searched PubMed, Embase, Web of Science, Cochrane Library, Google Scholar, and Scopus. We included studies published from 2019 onwards with a non-COVID-19 period of at least one year as a comparator. The meta-analysis included studies reporting data on population size, as well as observed and expected deaths. We used the Mantel-Haenszel method to estimate the pooled risk ratio with 95% confidence intervals. The protocol was registered in PROSPERO (ID: CRD42022378267). RESULTS The review covered 29 countries, with 10 countries included in the meta-analysis. The pooled meta-analysis included 1,405,128,717 individuals, for which 2,152,474 deaths were expected, and 3,555,880 deaths were reported. Calculated excess mortality was 100.3 deaths per 100,000 population per year, with an excess risk of death of 1.65 (95% CI: 1.649, 1.655, p < 0.001). The data sources used in the studies included civil registration systems, surveys, public cemeteries, funeral counts, obituary notifications, burial site imaging, and demographic surveillance systems. The primary techniques used to estimate excess mortality were statistical forecast modelling and geospatial analysis. One out of the 24 studies found higher excess mortality in urban settings. CONCLUSION Our findings demonstrate that excess mortality in LLMICs during the pandemic was substantial. However, estimates of excess mortality are uncertain due to relatively poor data. Understanding the drivers of excess mortality, will require more research using various techniques and data sources.
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Affiliation(s)
- Jonathan Mawutor Gmanyami
- School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
- German West-African Centre for Global Health and Pandemic Prevention, Berlin, Germany.
- Global Health and Infectious Diseases Research Group, Kumasi Centre for Collaborative Research in Tropical Medicine, Kumasi, Ghana.
| | - Wilm Quentin
- German West-African Centre for Global Health and Pandemic Prevention, Berlin, Germany
- Department of Health Care Management, Technische Universität Berlin, Berlin, Germany
- Chair of Planetary & Public Health, University of Bayreuth, Bayreuth, Germany
| | - Oscar Lambert
- School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Andrzej Jarynowski
- Department of Veterinary Medicine, Freie Universität Berlin, Berlin, Germany
| | - Vitaly Belik
- Department of Veterinary Medicine, Freie Universität Berlin, Berlin, Germany
| | - John Humphrey Amuasi
- School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- German West-African Centre for Global Health and Pandemic Prevention, Berlin, Germany
- Global Health and Infectious Diseases Research Group, Kumasi Centre for Collaborative Research in Tropical Medicine, Kumasi, Ghana
- Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
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Bremner L, Vitola J, Cerci R, Campisi R, Araujo Ríos R, Massardo T, Gutierrez-Villamil C, Solis F, Peix A, Speckter H, Sanchez Velez M, Flores AC, Madu E, Alexánderson-Rosas E, Ortellado J, Morales R, Mut F, Vera L, Hirschfeld CB, Shaw LJ, Williams MC, Villines TC, Better N, Dorbala S, Karthikeyan G, Malkovskiy E, Cohen YA, Randazzo M, Pascual TN, Pynda Y, Dondi M, Paez D, Einstein AJ. Cardiovascular testing recovery in Latin America one year into the COVID-19 pandemic: An analysis of data from an international longitudinal survey. IJC HEART & VASCULATURE 2024; 52:101404. [PMID: 38590383 PMCID: PMC11000160 DOI: 10.1016/j.ijcha.2024.101404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 03/23/2024] [Accepted: 04/01/2024] [Indexed: 04/10/2024]
Abstract
Background The COVID-19 pandemic disproportionately impacted Latin America (LATAM), significantly disrupting cardiovascular testing. This study evaluated cardiac procedure recovery in LATAM one year after the outbreak. Methods The International Atomic Energy Agency (IAEA) surveyed 669 centers in 107 countries worldwide, including 135 facilities in 19 LATAM countries, to assess cardiovascular procedure volumes in March 2019, April 2020, and April 2021, and changes in center practices and staffing conditions one year into the COVID-19 pandemic. Findings LATAM centers reported a 21 % decrease in procedure volumes in April 2021 from pre-pandemic-baseline, vs. a 0 % change in the rest of the world (RoW), and greater volume reductions for almost all procedure types. Centers in Central America and Mexico reported the largest procedure reductions (47 % reduction) compared to the Caribbean (15 %), and South America (14 %, p = 0.01), and this LATAM region was a significant predictor of lower procedure recovery in multivariable regression. More LATAM centers reported reduced salaries and increased layoffs of clinical staff compared to RoW, and LATAM respondents estimated that half of physician and non-physician staff experienced excess psychological stress related to the pandemic, compared to 25 % and 30 % in RoW (p < 0.001). Conclusions Cardiovascular testing recovery in LATAM trailed behind RoW for most procedure types, with centers in Central America and Mexico reporting the greatest volume reductions. This study found lasting impacts of COVID-19 on cardiovascular care in LATAM and the need for mental health support for LATAM healthcare workers in current and future pandemics.
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Affiliation(s)
- Luca Bremner
- Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | | | | | - Roxana Campisi
- Diagnóstico Maipú and Instituto Argentino de Diagnóstico Y Tratamiento S.A., Buenos Aires, Argentina
| | | | | | | | - Felix Solis
- Hospital Escalante Pradilla, Perez Zeledon, Costa Rica
| | - Amalia Peix
- Institute of Cardiology and Cardiovascular Surgery, La Habana, Cuba
| | | | - Mayra Sanchez Velez
- Sociedad Ecuatoriana de Cardiología Y a La Sociedad Española de Imagen Cardíaca, Ecuador
| | | | - Ernest Madu
- Heart Institute of the Caribbean and HIC Heart Hospital, Kingston, Jamaica
| | | | | | - Rosanna Morales
- Departamento de Medicina Nuclear, Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru
| | | | | | - Cole B. Hirschfeld
- Division of Cardiology, Weill Cornell Medicine and NewYork-Presbyterian Hospital, New York, NY, USA
| | - Leslee J. Shaw
- Blavatnik Family Women’s Health Research Institute, Mount Sinai Medical Center, New York, NY, USA
| | | | - Todd C. Villines
- Division of Cardiovascular Medicine, Department of Medicine, University of Virginia, Charlottesville, VA, USA
| | - Nathan Better
- Cabrini Health, Royal Melbourne Hospital, Monash University and University of Melbourne, Melbourne, Australia, Melbourne, Australia
| | - Sharmila Dorbala
- Departments of Medicine and Radiology, Brigham and Women’s Hospital, Boston, MA, USA
| | - Ganesan Karthikeyan
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | - Eli Malkovskiy
- Seymour, Paul and Gloria Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center and NewYork-Presbyterian Hospital, New York, NY, USA
- University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Yosef A. Cohen
- Seymour, Paul and Gloria Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center and NewYork-Presbyterian Hospital, New York, NY, USA
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
- Children's Hospital at Montefiore, New York, NY, USA
| | - Michael Randazzo
- Section of Cardiology, University of Chicago Medical Center, Chicago, IL, USA
| | | | - Yaroslav Pynda
- Division of Human Health, Department of Nuclear Sciences and Applications, International Atomic Energy Agency, Vienna, Austria
| | - Maurizio Dondi
- Division of Human Health, Department of Nuclear Sciences and Applications, International Atomic Energy Agency, Vienna, Austria
| | - Diana Paez
- Division of Human Health, Department of Nuclear Sciences and Applications, International Atomic Energy Agency, Vienna, Austria
| | - Andrew J. Einstein
- Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
- Seymour, Paul and Gloria Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center and NewYork-Presbyterian Hospital, New York, NY, USA
- Department of Radiology, Columbia University Irving Medical Center and New York-Presbyterian Hospital, New York, NY, USA
| | - INCAPS COVID
- Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
- Quanta Diagnostico, Curitiba, Brazil
- Diagnóstico Maipú and Instituto Argentino de Diagnóstico Y Tratamiento S.A., Buenos Aires, Argentina
- Instituto de Medicina Nuclear, Sucre, Bolivia
- Hospital Clinico Universidad de Chile, Santiago, Chile
- Fundacion Cardioinfantil, Instituto de Cardiologia, Bogota, Colombia
- Hospital Escalante Pradilla, Perez Zeledon, Costa Rica
- Institute of Cardiology and Cardiovascular Surgery, La Habana, Cuba
- Cedimat, Santo Domingo, Dominican Republic
- Sociedad Ecuatoriana de Cardiología Y a La Sociedad Española de Imagen Cardíaca, Ecuador
- Clinica de Radiologia Brito Mejia Peña, San Salvador, El Salvador
- Heart Institute of the Caribbean and HIC Heart Hospital, Kingston, Jamaica
- Instituto Nacional de Cardiologia Ignacio Chavez, Ciudad de Mexico, Mexico
- Central Hospital, Social Institute, Asunción, Paraguay
- Departamento de Medicina Nuclear, Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru
- Italian Hospital, Montevideo, Uruguay
- Urologico San Roman, Caracas, Venezuela
- Division of Cardiology, Weill Cornell Medicine and NewYork-Presbyterian Hospital, New York, NY, USA
- Blavatnik Family Women’s Health Research Institute, Mount Sinai Medical Center, New York, NY, USA
- BHF Centre for Cardiovascular Science, University of Edinburgh, United Kingdom
- Division of Cardiovascular Medicine, Department of Medicine, University of Virginia, Charlottesville, VA, USA
- Cabrini Health, Royal Melbourne Hospital, Monash University and University of Melbourne, Melbourne, Australia, Melbourne, Australia
- Departments of Medicine and Radiology, Brigham and Women’s Hospital, Boston, MA, USA
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
- Seymour, Paul and Gloria Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center and NewYork-Presbyterian Hospital, New York, NY, USA
- University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
- Children's Hospital at Montefiore, New York, NY, USA
- Section of Cardiology, University of Chicago Medical Center, Chicago, IL, USA
- Philippine Nuclear Research Institute, Quezon City, Philippines
- Division of Human Health, Department of Nuclear Sciences and Applications, International Atomic Energy Agency, Vienna, Austria
- Department of Radiology, Columbia University Irving Medical Center and New York-Presbyterian Hospital, New York, NY, USA
| | - 2
- Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
- Quanta Diagnostico, Curitiba, Brazil
- Diagnóstico Maipú and Instituto Argentino de Diagnóstico Y Tratamiento S.A., Buenos Aires, Argentina
- Instituto de Medicina Nuclear, Sucre, Bolivia
- Hospital Clinico Universidad de Chile, Santiago, Chile
- Fundacion Cardioinfantil, Instituto de Cardiologia, Bogota, Colombia
- Hospital Escalante Pradilla, Perez Zeledon, Costa Rica
- Institute of Cardiology and Cardiovascular Surgery, La Habana, Cuba
- Cedimat, Santo Domingo, Dominican Republic
- Sociedad Ecuatoriana de Cardiología Y a La Sociedad Española de Imagen Cardíaca, Ecuador
- Clinica de Radiologia Brito Mejia Peña, San Salvador, El Salvador
- Heart Institute of the Caribbean and HIC Heart Hospital, Kingston, Jamaica
- Instituto Nacional de Cardiologia Ignacio Chavez, Ciudad de Mexico, Mexico
- Central Hospital, Social Institute, Asunción, Paraguay
- Departamento de Medicina Nuclear, Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru
- Italian Hospital, Montevideo, Uruguay
- Urologico San Roman, Caracas, Venezuela
- Division of Cardiology, Weill Cornell Medicine and NewYork-Presbyterian Hospital, New York, NY, USA
- Blavatnik Family Women’s Health Research Institute, Mount Sinai Medical Center, New York, NY, USA
- BHF Centre for Cardiovascular Science, University of Edinburgh, United Kingdom
- Division of Cardiovascular Medicine, Department of Medicine, University of Virginia, Charlottesville, VA, USA
- Cabrini Health, Royal Melbourne Hospital, Monash University and University of Melbourne, Melbourne, Australia, Melbourne, Australia
- Departments of Medicine and Radiology, Brigham and Women’s Hospital, Boston, MA, USA
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
- Seymour, Paul and Gloria Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center and NewYork-Presbyterian Hospital, New York, NY, USA
- University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
- Children's Hospital at Montefiore, New York, NY, USA
- Section of Cardiology, University of Chicago Medical Center, Chicago, IL, USA
- Philippine Nuclear Research Institute, Quezon City, Philippines
- Division of Human Health, Department of Nuclear Sciences and Applications, International Atomic Energy Agency, Vienna, Austria
- Department of Radiology, Columbia University Irving Medical Center and New York-Presbyterian Hospital, New York, NY, USA
| | - Investigators Group
- Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
- Quanta Diagnostico, Curitiba, Brazil
- Diagnóstico Maipú and Instituto Argentino de Diagnóstico Y Tratamiento S.A., Buenos Aires, Argentina
- Instituto de Medicina Nuclear, Sucre, Bolivia
- Hospital Clinico Universidad de Chile, Santiago, Chile
- Fundacion Cardioinfantil, Instituto de Cardiologia, Bogota, Colombia
- Hospital Escalante Pradilla, Perez Zeledon, Costa Rica
- Institute of Cardiology and Cardiovascular Surgery, La Habana, Cuba
- Cedimat, Santo Domingo, Dominican Republic
- Sociedad Ecuatoriana de Cardiología Y a La Sociedad Española de Imagen Cardíaca, Ecuador
- Clinica de Radiologia Brito Mejia Peña, San Salvador, El Salvador
- Heart Institute of the Caribbean and HIC Heart Hospital, Kingston, Jamaica
- Instituto Nacional de Cardiologia Ignacio Chavez, Ciudad de Mexico, Mexico
- Central Hospital, Social Institute, Asunción, Paraguay
- Departamento de Medicina Nuclear, Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru
- Italian Hospital, Montevideo, Uruguay
- Urologico San Roman, Caracas, Venezuela
- Division of Cardiology, Weill Cornell Medicine and NewYork-Presbyterian Hospital, New York, NY, USA
- Blavatnik Family Women’s Health Research Institute, Mount Sinai Medical Center, New York, NY, USA
- BHF Centre for Cardiovascular Science, University of Edinburgh, United Kingdom
- Division of Cardiovascular Medicine, Department of Medicine, University of Virginia, Charlottesville, VA, USA
- Cabrini Health, Royal Melbourne Hospital, Monash University and University of Melbourne, Melbourne, Australia, Melbourne, Australia
- Departments of Medicine and Radiology, Brigham and Women’s Hospital, Boston, MA, USA
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
- Seymour, Paul and Gloria Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center and NewYork-Presbyterian Hospital, New York, NY, USA
- University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
- Children's Hospital at Montefiore, New York, NY, USA
- Section of Cardiology, University of Chicago Medical Center, Chicago, IL, USA
- Philippine Nuclear Research Institute, Quezon City, Philippines
- Division of Human Health, Department of Nuclear Sciences and Applications, International Atomic Energy Agency, Vienna, Austria
- Department of Radiology, Columbia University Irving Medical Center and New York-Presbyterian Hospital, New York, NY, USA
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Naghavi M, Ong KL, Aali A, Ababneh HS, Abate YH, Abbafati C, Abbasgholizadeh R, Abbasian M, Abbasi-Kangevari M, Abbastabar H, Abd ElHafeez S, Abdelmasseh M, Abd-Elsalam S, Abdelwahab A, Abdollahi M, Abdollahifar MA, Abdoun M, Abdulah DM, Abdullahi A, Abebe M, Abebe SS, Abedi A, Abegaz KH, Abhilash ES, Abidi H, Abiodun O, Aboagye RG, Abolhassani H, Abolmaali M, Abouzid M, Aboye GB, Abreu LG, Abrha WA, Abtahi D, Abu Rumeileh S, Abualruz H, Abubakar B, Abu-Gharbieh E, Abu-Rmeileh NME, Aburuz S, Abu-Zaid A, Accrombessi MMK, Adal TG, Adamu AA, Addo IY, Addolorato G, Adebiyi AO, Adekanmbi V, Adepoju AV, Adetunji CO, Adetunji JB, Adeyeoluwa TE, Adeyinka DA, Adeyomoye OI, Admass BAA, Adnani QES, Adra S, Afolabi AA, Afzal MS, Afzal S, Agampodi SB, Agasthi P, Aggarwal M, Aghamiri S, Agide FD, Agodi A, Agrawal A, Agyemang-Duah W, Ahinkorah BO, Ahmad A, Ahmad D, Ahmad F, Ahmad MM, Ahmad S, Ahmad S, Ahmad T, Ahmadi K, Ahmadzade AM, Ahmed A, Ahmed A, Ahmed H, Ahmed LA, Ahmed MS, Ahmed MS, Ahmed MB, Ahmed SA, Ajami M, Aji B, Akara EM, Akbarialiabad H, Akinosoglou K, Akinyemiju T, Akkaif MA, Akyirem S, Al Hamad H, Al Hasan SM, Alahdab F, Alalalmeh SO, Alalwan TA, Al-Aly Z, Alam K, Alam M, Alam N, Al-amer RM, Alanezi FM, Alanzi TM, Al-Azzam S, Albakri A, Albashtawy M, AlBataineh MT, Alcalde-Rabanal JE, Aldawsari KA, Aldhaleei WA, Aldridge RW, Alema HB, Alemayohu MA, Alemi S, Alemu YM, Al-Gheethi AAS, Alhabib KF, Alhalaiqa FAN, Al-Hanawi MK, Ali A, Ali A, Ali L, Ali MU, Ali R, Ali S, Ali SSS, Alicandro G, Alif SM, Alikhani R, Alimohamadi Y, Aliyi AA, Aljasir MAM, Aljunid SM, Alla F, Allebeck P, Al-Marwani S, Al-Maweri SAA, Almazan JU, Al-Mekhlafi HM, Almidani L, Almidani O, Alomari MA, Al-Omari B, Alonso J, Alqahtani JS, Alqalyoobi S, Alqutaibi AY, Al-Sabah SK, Altaany Z, Altaf A, Al-Tawfiq JA, Altirkawi KA, Aluh DO, Alvis-Guzman N, Alwafi H, Al-Worafi YM, Aly H, Aly S, Alzoubi KH, Amani R, Amare AT, Amegbor PM, Ameyaw EK, Amin TT, Amindarolzarbi A, Amiri S, Amirzade-Iranaq MH, Amu H, Amugsi DA, Amusa GA, Ancuceanu R, Anderlini D, Anderson DB, Andrade PP, Andrei CL, Andrei T, Angus C, Anil A, Anil S, Anoushiravani A, Ansari H, Ansariadi A, Ansari-Moghaddam A, Antony CM, Antriyandarti E, Anvari D, Anvari S, Anwar S, Anwar SL, Anwer R, Anyasodor AE, Aqeel M, Arab JP, Arabloo J, Arafat M, Aravkin AY, Areda D, Aremu A, Aremu O, Ariffin H, Arkew M, Armocida B, Arndt MB, Ärnlöv J, Arooj M, Artamonov AA, Arulappan J, Aruleba RT, Arumugam A, Asaad M, Asadi-Lari M, Asgedom AA, Asghariahmadabad M, Asghari-Jafarabadi M, Ashraf M, Aslani A, Astell-Burt T, Athar M, Athari SS, Atinafu BTT, Atlaw HW, Atorkey P, Atout MMW, Atreya A, Aujayeb A, Ausloos M, Avan A, Awedew AF, Aweke AM, Ayala Quintanilla BP, Ayatollahi H, Ayuso-Mateos JL, Ayyoubzadeh SM, Azadnajafabad S, Azevedo RMS, Azzam AY, B DB, Babu AS, Badar M, Badiye AD, Baghdadi S, Bagheri N, Bagherieh S, Bah S, Bahadorikhalili S, Bahmanziari N, Bai R, Baig AA, Baker JL, Bako AT, Bakshi RK, Balakrishnan S, Balasubramanian M, Baltatu OC, Bam K, Banach M, Bandyopadhyay S, Banik PC, Bansal H, Bansal K, Barbic F, Barchitta M, Bardhan M, Bardideh E, Barker-Collo SL, Bärnighausen TW, Barone-Adesi F, Barqawi HJ, Barrero LH, Barrow A, Barteit S, Barua L, Basharat Z, Bashiri A, Basiru A, Baskaran P, Basnyat B, Bassat Q, Basso JD, Basting AVL, Basu S, Batra K, Baune BT, Bayati M, Bayileyegn NS, Beaney T, Bedi N, Beghi M, Behboudi E, Behera P, Behnoush AH, Behzadifar M, Beiranvand M, Bejarano Ramirez DF, Béjot Y, Belay SA, Belete CM, Bell ML, Bello MB, Bello OO, Belo L, Beloukas A, Bender RG, Bensenor IM, Beran A, Berezvai Z, Berhie AY, Berice BN, Bernstein RS, Bertolacci GJ, Bettencourt PJG, Beyene KA, Bhagat DS, Bhagavathula AS, Bhala N, Bhalla A, Bhandari D, Bhangdia K, Bhardwaj N, Bhardwaj P, Bhardwaj PV, Bhargava A, Bhaskar S, Bhat V, Bhatti GK, Bhatti JS, Bhatti MS, Bhatti R, Bhutta ZA, Bikbov B, Bishai JD, Bisignano C, Bisulli F, Biswas A, Biswas B, Bitaraf S, Bitew BD, Bitra VR, Bjørge T, Boachie MK, Boampong MS, Bobirca AV, Bodolica V, Bodunrin AO, Bogale EK, Bogale KA, Bohlouli S, Bolarinwa OA, Boloor A, Bonakdar Hashemi M, Bonny A, Bora K, Bora Basara B, Borhany H, Borzutzky A, Bouaoud S, Boustany A, Boxe C, Boyko EJ, Brady OJ, Braithwaite D, Brant LC, Brauer M, Brazinova A, Brazo-Sayavera J, Breitborde NJK, Breitner S, Brenner H, Briko AN, Briko NI, Britton G, Brown J, Brugha T, Bulamu NB, Bulto LN, Buonsenso D, Burns RA, Busse R, Bustanji Y, Butt NS, Butt ZA, Caetano dos Santos FL, Calina D, Cámera LA, Campos LA, Campos-Nonato IR, Cao C, Cao Y, Capodici A, Cárdenas R, Carr S, Carreras G, Carrero JJ, Carugno A, Carvalheiro CG, Carvalho F, Carvalho M, Castaldelli-Maia JM, Castañeda-Orjuela CA, Castelpietra G, Catalá-López F, Catapano AL, Cattaruzza MS, Cederroth CR, Cegolon L, Cembranel F, Cenderadewi M, Cercy KM, Cerin E, Cevik M, Chadwick J, Chahine Y, Chakraborty C, Chakraborty PA, Chan JSK, Chan RNC, Chandika RM, Chandrasekar EK, Chang CK, Chang JC, Chanie GS, Charalampous P, Chattu VK, Chaturvedi P, Chatzimavridou-Grigoriadou V, Chaurasia A, Chen AW, Chen AT, Chen CS, Chen H, Chen MX, Chen S, Cheng CY, Cheng ETW, Cherbuin N, Cheru WA, Chien JH, Chimed-Ochir O, Chimoriya R, Ching PR, Chirinos-Caceres JL, Chitheer A, Cho WCS, Chong B, Chopra H, Choudhari SG, Chowdhury R, Christopher DJ, Chukwu IS, Chung E, Chung E, Chung E, Chung SC, Chutiyami M, Cindi Z, Cioffi I, Claassens MM, Claro RM, Coberly K, Cogen RM, Columbus A, Comfort H, Conde J, Cortese S, Cortesi PA, Costa VM, Costanzo S, Cousin E, Couto RAS, Cowden RG, Cramer KM, Criqui MH, Cruz-Martins N, Cuadra-Hernández SM, Culbreth GT, Cullen P, Cunningham M, Curado MP, Dadana S, Dadras O, Dai S, Dai X, Dai Z, Dalli LL, Damiani G, Darega Gela J, Das JK, Das S, Das S, Dascalu AM, Dash NR, Dashti M, Dastiridou A, Davey G, Dávila-Cervantes CA, Davis Weaver N, Davletov K, De Leo D, de Luca K, Debele AT, Debopadhaya S, Degenhardt L, Dehghan A, Deitesfeld L, Del Bo' C, Delgado-Enciso I, Demessa BH, Demetriades AK, Deng K, Deng X, Denova-Gutiérrez E, Deravi N, Dereje N, Dervenis N, Dervišević E, Des Jarlais DC, Desai HD, Desai R, Devanbu VGC, Dewan SMR, Dhali A, Dhama K, Dhimal M, Dhingra S, Dhulipala VR, Dias da Silva D, Diaz D, Diaz MJ, Dima A, Ding DD, Ding H, Dinis-Oliveira RJ, Dirac MA, Djalalinia S, Do THP, do Prado CB, Doaei S, Dodangeh M, Dodangeh M, Dohare S, Dokova KG, Dolecek C, Dominguez RMV, Dong W, Dongarwar D, D'Oria M, Dorostkar F, Dorsey ER, dos Santos WM, Doshi R, Doshmangir L, Dowou RK, Driscoll TR, Dsouza HL, Dsouza V, Du M, Dube J, Duncan BB, Duraes AR, Duraisamy S, Durojaiye OC, Dwyer-Lindgren L, Dzianach PA, Dziedzic AM, E'mar AR, Eboreime E, Ebrahimi A, Echieh CP, Edinur HA, Edvardsson D, Edvardsson K, Efendi D, Efendi F, Effendi DE, Eikemo TA, Eini E, Ekholuenetale M, Ekundayo TC, El Sayed I, Elbarazi I, Elema TB, Elemam NM, Elgar FJ, Elgendy IY, ElGohary GMT, Elhabashy HR, Elhadi M, El-Huneidi W, Elilo LT, Elmeligy OAA, Elmonem MA, Elshaer M, Elsohaby I, Emeto TI, Engelbert Bain L, Erkhembayar R, Esezobor CI, Eshrati B, Eskandarieh S, Espinosa-Montero J, Esubalew H, Etaee F, Fabin N, Fadaka AO, Fagbamigbe AF, Fahim A, Fahimi S, Fakhri-Demeshghieh A, Falzone L, Fareed M, Farinha CSES, Faris MEM, Faris PS, Faro A, Fasanmi AO, Fatehizadeh A, Fattahi H, Fauk NK, Fazeli P, Feigin VL, Feizkhah A, Fekadu G, Feng X, Fereshtehnejad SM, Feroze AH, Ferrante D, Ferrari AJ, Ferreira N, Fetensa G, Feyisa BR, Filip I, Fischer F, Flavel J, Flood D, Florin BT, Foigt NA, Folayan MO, Fomenkov AA, Foroutan B, Foroutan M, Forthun I, Fortuna D, Foschi M, Fowobaje KR, Francis KL, Franklin RC, Freitas A, Friedman J, Friedman SD, Fukumoto T, Fuller JE, Fux B, Gaal PA, Gadanya MA, Gaidhane AM, Gaihre S, Gakidou E, Galali Y, Galles NC, Gallus S, Ganbat M, Gandhi AP, Ganesan B, Ganiyani MA, Garcia-Gordillo MA, Gardner WM, Garg J, Garg N, Gautam RK, Gbadamosi SO, Gebi TG, Gebregergis MW, Gebrehiwot M, Gebremeskel TG, Georgescu SR, Getachew T, Gething PW, Getie M, Ghadiri K, 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Zhang J, Zhang L, Zhang Y, Zhang ZJ, Zhao H, Zhong C, Zhou J, Zhu B, Zhu L, Ziafati M, Zielińska M, Zitoun OA, Zoladl M, Zou Z, Zuhlke LJ, Zumla A, Zweck E, Zyoud SH, Wool EE, Murray CJL. Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990-2021: a systematic analysis for the Global Burden of Disease Study 2021. Lancet 2024; 403:2100-2132. [PMID: 38582094 PMCID: PMC11126520 DOI: 10.1016/s0140-6736(24)00367-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 02/15/2024] [Accepted: 02/22/2024] [Indexed: 04/08/2024]
Abstract
BACKGROUND Regular, detailed reporting on population health by underlying cause of death is fundamental for public health decision making. Cause-specific estimates of mortality and the subsequent effects on life expectancy worldwide are valuable metrics to gauge progress in reducing mortality rates. These estimates are particularly important following large-scale mortality spikes, such as the COVID-19 pandemic. When systematically analysed, mortality rates and life expectancy allow comparisons of the consequences of causes of death globally and over time, providing a nuanced understanding of the effect of these causes on global populations. METHODS The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 cause-of-death analysis estimated mortality and years of life lost (YLLs) from 288 causes of death by age-sex-location-year in 204 countries and territories and 811 subnational locations for each year from 1990 until 2021. The analysis used 56 604 data sources, including data from vital registration and verbal autopsy as well as surveys, censuses, surveillance systems, and cancer registries, among others. As with previous GBD rounds, cause-specific death rates for most causes were estimated using the Cause of Death Ensemble model-a modelling tool developed for GBD to assess the out-of-sample predictive validity of different statistical models and covariate permutations and combine those results to produce cause-specific mortality estimates-with alternative strategies adapted to model causes with insufficient data, substantial changes in reporting over the study period, or unusual epidemiology. YLLs were computed as the product of the number of deaths for each cause-age-sex-location-year and the standard life expectancy at each age. As part of the modelling process, uncertainty intervals (UIs) were generated using the 2·5th and 97·5th percentiles from a 1000-draw distribution for each metric. We decomposed life expectancy by cause of death, location, and year to show cause-specific effects on life expectancy from 1990 to 2021. We also used the coefficient of variation and the fraction of population affected by 90% of deaths to highlight concentrations of mortality. Findings are reported in counts and age-standardised rates. Methodological improvements for cause-of-death estimates in GBD 2021 include the expansion of under-5-years age group to include four new age groups, enhanced methods to account for stochastic variation of sparse data, and the inclusion of COVID-19 and other pandemic-related mortality-which includes excess mortality associated with the pandemic, excluding COVID-19, lower respiratory infections, measles, malaria, and pertussis. For this analysis, 199 new country-years of vital registration cause-of-death data, 5 country-years of surveillance data, 21 country-years of verbal autopsy data, and 94 country-years of other data types were added to those used in previous GBD rounds. FINDINGS The leading causes of age-standardised deaths globally were the same in 2019 as they were in 1990; in descending order, these were, ischaemic heart disease, stroke, chronic obstructive pulmonary disease, and lower respiratory infections. In 2021, however, COVID-19 replaced stroke as the second-leading age-standardised cause of death, with 94·0 deaths (95% UI 89·2-100·0) per 100 000 population. The COVID-19 pandemic shifted the rankings of the leading five causes, lowering stroke to the third-leading and chronic obstructive pulmonary disease to the fourth-leading position. In 2021, the highest age-standardised death rates from COVID-19 occurred in sub-Saharan Africa (271·0 deaths [250·1-290·7] per 100 000 population) and Latin America and the Caribbean (195·4 deaths [182·1-211·4] per 100 000 population). The lowest age-standardised death rates from COVID-19 were in the high-income super-region (48·1 deaths [47·4-48·8] per 100 000 population) and southeast Asia, east Asia, and Oceania (23·2 deaths [16·3-37·2] per 100 000 population). Globally, life expectancy steadily improved between 1990 and 2019 for 18 of the 22 investigated causes. Decomposition of global and regional life expectancy showed the positive effect that reductions in deaths from enteric infections, lower respiratory infections, stroke, and neonatal deaths, among others have contributed to improved survival over the study period. However, a net reduction of 1·6 years occurred in global life expectancy between 2019 and 2021, primarily due to increased death rates from COVID-19 and other pandemic-related mortality. Life expectancy was highly variable between super-regions over the study period, with southeast Asia, east Asia, and Oceania gaining 8·3 years (6·7-9·9) overall, while having the smallest reduction in life expectancy due to COVID-19 (0·4 years). The largest reduction in life expectancy due to COVID-19 occurred in Latin America and the Caribbean (3·6 years). Additionally, 53 of the 288 causes of death were highly concentrated in locations with less than 50% of the global population as of 2021, and these causes of death became progressively more concentrated since 1990, when only 44 causes showed this pattern. The concentration phenomenon is discussed heuristically with respect to enteric and lower respiratory infections, malaria, HIV/AIDS, neonatal disorders, tuberculosis, and measles. INTERPRETATION Long-standing gains in life expectancy and reductions in many of the leading causes of death have been disrupted by the COVID-19 pandemic, the adverse effects of which were spread unevenly among populations. Despite the pandemic, there has been continued progress in combatting several notable causes of death, leading to improved global life expectancy over the study period. Each of the seven GBD super-regions showed an overall improvement from 1990 and 2021, obscuring the negative effect in the years of the pandemic. Additionally, our findings regarding regional variation in causes of death driving increases in life expectancy hold clear policy utility. Analyses of shifting mortality trends reveal that several causes, once widespread globally, are now increasingly concentrated geographically. These changes in mortality concentration, alongside further investigation of changing risks, interventions, and relevant policy, present an important opportunity to deepen our understanding of mortality-reduction strategies. Examining patterns in mortality concentration might reveal areas where successful public health interventions have been implemented. Translating these successes to locations where certain causes of death remain entrenched can inform policies that work to improve life expectancy for people everywhere. FUNDING Bill & Melinda Gates Foundation.
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Hladish TJ, Pillai AN, Pearson CAB, Toh KB, Tamayo AC, Stoltzfus A, Longini IM. Evaluating targeted COVID-19 vaccination strategies with agent-based modeling. PLoS Comput Biol 2024; 20:e1012128. [PMID: 38820570 PMCID: PMC11230632 DOI: 10.1371/journal.pcbi.1012128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 07/08/2024] [Accepted: 05/02/2024] [Indexed: 06/02/2024] Open
Abstract
We evaluate approaches to vaccine distribution using an agent-based model of human activity and COVID-19 transmission calibrated to detailed trends in cases, hospitalizations, deaths, seroprevalence, and vaccine breakthrough infections in Florida, USA. We compare the incremental effectiveness for four different distribution strategies at four different levels of vaccine supply, starting in late 2020 through early 2022. Our analysis indicates that the best strategy to reduce severe outcomes would be to actively target high disease-risk individuals. This was true in every scenario, although the advantage was greatest for the intermediate vaccine availability assumptions and relatively modest compared to a simple mass vaccination approach under high vaccine availability. Ring vaccination, while generally the most effective strategy for reducing infections, ultimately proved least effective at preventing deaths. We also consider using age group as a practical surrogate measure for actual disease-risk targeting; this approach also outperforms both simple mass distribution and ring vaccination. We find that quantitative effectiveness of a strategy depends on whether effectiveness is assessed after the alpha, delta, or omicron wave. However, these differences in absolute benefit for the strategies do not change the ranking of their performance at preventing severe outcomes across vaccine availability assumptions.
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Affiliation(s)
- Thomas J Hladish
- Department of Biology, University of Florida, Gainesville, Florida, United States of America
- Emerging Pathogens Institute, University of Florida, Gainesville, Florida, United States of America
| | - Alexander N Pillai
- Department of Biology, University of Florida, Gainesville, Florida, United States of America
| | - Carl A B Pearson
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
- South African DSI-NRF Centre of Excellence in Epidemiological Modelling and Analysis (SACEMA), Stellenbosch University, Stellenbosch, South Africa
| | - Kok Ben Toh
- Department of Biology, University of Florida, Gainesville, Florida, United States of America
- Institute of Global Health and Department of Preventive Medicine Northwestern University, Chicago, Illinois, United States of America
| | - Andrea C Tamayo
- Department of Biology, University of Florida, Gainesville, Florida, United States of America
| | - Arlin Stoltzfus
- Office of Data and Informatics, National Institute of Standards and Technology, Gaithersburg, Maryland, United States of America
| | - Ira M Longini
- Emerging Pathogens Institute, University of Florida, Gainesville, Florida, United States of America
- Department of Biostatistics, University of Florida, Gainesville, Florida, United States of America
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Ul Mustafa Z, Batool A, Ibrar H, Salman M, Khan YH, Mallhi TH, Meyer JC, Godman B, Moore CE. Bacterial co-infections, secondary infections and antimicrobial use among hospitalized COVID-19 patients in the sixth wave in Pakistan: findings and implications. Expert Rev Anti Infect Ther 2024; 22:229-240. [PMID: 38146949 DOI: 10.1080/14787210.2023.2299387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 11/15/2023] [Indexed: 12/27/2023]
Abstract
INTRODUCTION Previous studies in Pakistan have shown considerable over prescribing of antibiotics in patients hospitalized with COVID-19 despite very low prevalence of bacterial infections. Irrational use of antibiotics will worsen antimicrobial resistance (AMR). METHODS Retrospective analysis of medical records of patients in the COVID-19 wards of three tertiary care hospitals to assess antibiotic use during the sixth COVID-19 wave. RESULTS A total of 284 patients were included, most were male (66.9%), aged 30-50 years (50.7%) with diabetes mellitus the most common comorbidity. The most common symptoms at presentation were cough (47.9%) and arthralgia-myalgia (41.5%). Around 3% were asymptomatic, 34.9% had mild, 30.3% moderate, and 23.6% had severe disease, with 8.1% critical. Chest X-ray abnormalities were seen in 43.3% of patients and 37% had elevated white cell counts, with 35.2% having elevated C-reactive protein levels. Around 91% COVID-19 patients were prescribed antibiotics during their hospital stay, with only a few with proven bacterial co-infections or secondary bacterial infections. Most antibiotics were from the 'Watch' category (90.8%) followed by the 'Reserve' category (4.8%), similar to previous COVID-19 waves. CONCLUSION There continued to be excessive antibiotics use among hospitalized COVID-19 patients in Pakistan. Urgent measures are needed to address inappropriate prescribing including greater prescribing of Access antibiotics where pertinent.
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Affiliation(s)
- Zia Ul Mustafa
- Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
- Department of Pharmacy Services, District Headquarter (DHQ) Hospital, Pakpattan, Pakistan
| | - Arfa Batool
- Department of Medicine, Sheikh Zaid Medical College, Rahim Yar Khan, Pakistan
| | - Hadia Ibrar
- Department of Medicine, Wah Medical College, Rawalpindi, Pakistan
| | - Muhammad Salman
- Institute of Pharmacy, Faculty of Pharmaceutical and Allied Health Sciences, Lahore College for Women University, Lahore, Pakistan
| | - Yusra Habib Khan
- Department of Clinical Pharmacy, College of Pharmacy, Jouf University, Sakaka, Saudi Arabia
| | - Tauqeer Hussain Mallhi
- Department of Clinical Pharmacy, College of Pharmacy, Jouf University, Sakaka, Saudi Arabia
| | - Johanna C Meyer
- Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa, South Africa
- South African Vaccination and Immunisation Centre, Sefako Makgatho Health Sciences University, Garankuwa, Pretoria, South Africa
| | - Brian Godman
- Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa, South Africa
- Strathclyde Institute of Pharmacy and Biomedical Science (SIPBS), University of Strathclyde, Glasgow, UK
| | - Catrin E Moore
- Centre for Neonatal and Pediatric Infection, St. George's University of London, London, UK
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14
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Crombez J, De Staelen RH. Flatten the curve. On a new covid-19 (hit) severity. Acta Clin Belg 2024; 79:87-96. [PMID: 38367010 DOI: 10.1080/17843286.2024.2314240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 01/13/2024] [Indexed: 02/19/2024]
Abstract
BACKGROUND During the health crisis of the COVID-19 pandemic, the adagium was to 'flatten the curve'. We investigate how well countries succeeded in this aim by constructing an appropriate severity measure. It is able to distinguish between countries that, e.g., experienced identical overall (excess) mortality rates or attained equal case load peaks over a certain period of time. Concretely, this implies that an identical total number of infections or deaths over a certain period is considered relatively worse if there is a higher and/or more peaks. More classical measures (like the total number or the maximum of cases/deaths) neglect this and are therefore inappropriate to assess the resilience of a health care system nor pandemic policy ex post performance. METHODS & RESULTS We applied our new (hit) severity to a set of 32 countries, and found that the flattening didn't go equally well. The difference in severity is large, with Norway being consistently the least severely hit by the pandemic (using deaths as indicator) during the whole observation period, while Hungary comes out as eventually being hit the hardest in our sample. CONCLUSIONS Having constructed a (hit) severity measure that enables to differentiate between countries' performances in a sound way, further research should now relate these observed differences to the pre-pandemic health care status and the sanitary measures or restrictions imposed during the pandemic; in order to reveal what measures help the most in what type of health care system and society.
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Affiliation(s)
- J Crombez
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
- Beheer en Algemene Directie, Ghent University Hospital, Ghent, Belgium
| | - R H De Staelen
- Beheer en Algemene Directie, Ghent University Hospital, Ghent, Belgium
- Research Department, Ghent University, Ghent, Belgium
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15
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Feng Y, Tuan TD, Shi J, Li Z, Maimaitiming M, Jin Y, Zheng Z. Progress towards health equity in Vietnam: evidence from nationwide official health statistics, 2010-2020. BMJ Glob Health 2024; 9:e014739. [PMID: 38503427 PMCID: PMC10952956 DOI: 10.1136/bmjgh-2023-014739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 02/26/2024] [Indexed: 03/21/2024] Open
Abstract
INTRODUCTION One of the ultimate goals of strengthening the health system is to achieve health equity. Vietnam is considered one of the 'fast-track countries' to achieve the health-related Millennium Development Goals, but research on its equity strategies remains inadequate. METHODS Using Vietnamese official health statistics, we investigated inequity in four dimensions including health resources, service delivery, service utilisation and residents' health status from the perspectives of income levels, poverty rates and subnational regions. The Slope Index of Inequality, concentration curve/Concentration Index, absolute difference and Theil Index were used. RESULTS Four indicators showed 'pro-poor' inequality in health resources, including the per capita health budget, per capita health personnel, per capita health personnel at the community level and per capita hospital beds at the community level, while provincial hospital beds showed 'pro-rich' inequality. Two health service delivery indicators (delivery of antenatal care ≥3 times and proportion of community health service centres with medical doctors) show 'pro-rich' inequality, although two health status indicators, mortality and malnutrition rates for children under five, showed 'pro-poor' inequality. The Northern Midlands and Mountain Areas, and the Central Highlands were disadvantaged regarding service delivery and health status. Intraregional differences were the main factors contributing to the inequalities in delivery of antenatal care ≥3 times, provincial hospital beds and percentage of community health centres with medical doctors, with the Red River Delta and the South East region experiencing the greatest inequalities. CONCLUSION The overall level of health equity in Vietnam has increased over the past decade, although inequality in health service delivery has hindered progress towards health equity based on income, poverty and subnational regions. Targeted policies need to be introduced to reduce inequities relating to the health workforce and service delivery capacity.
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Affiliation(s)
- Yikai Feng
- Department of Global Health, School of Public Health, Peking University, Beijing, China
- Institute for Global Health and Development, Peking University, Beijing, China
| | - Tran Diep Tuan
- University of Medicine and Pharmacy, Ho Chi Minh City, Viet Nam
| | - Junyi Shi
- Department of Global Health, School of Public Health, Peking University, Beijing, China
- Institute for Global Health and Development, Peking University, Beijing, China
| | - Zhuo Li
- Institute of Area Studies, Peking University, Beijing, China
| | - Mailikezhati Maimaitiming
- Department of Global Health, School of Public Health, Peking University, Beijing, China
- Institute for Global Health and Development, Peking University, Beijing, China
| | - Yinzi Jin
- Department of Global Health, School of Public Health, Peking University, Beijing, China
- Institute for Global Health and Development, Peking University, Beijing, China
| | - Zhijie Zheng
- Department of Global Health, School of Public Health, Peking University, Beijing, China
- Institute for Global Health and Development, Peking University, Beijing, China
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16
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Bell K, White S, Diaz A, Bahria P, Sima F, Al-Delaimy WK, dosReis S, Hassan O, Drabarek D, Nisha M, Baptiste-Roberts K, Gwiazdon K, Raynes-Greenow C, Taylor Wilson R, Gaudino JA, da Silveira Moreira R, Jennings B, Gulliver P. Can evidence drive health equity in the COVID-19 pandemic and beyond? J Public Health Policy 2024; 45:137-151. [PMID: 38216689 PMCID: PMC10920204 DOI: 10.1057/s41271-023-00452-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/10/2023] [Indexed: 01/14/2024]
Abstract
Using scoping review methods, we systematically searched multiple online databases for publications in the first year of the pandemic that proposed pragmatic population or health system-level solutions to health inequities. We found 77 publications with proposed solutions to pandemic-related health inequities. Most were commentaries, letters, or editorials from the USA, offering untested solutions, and no robust evidence on effectiveness. Some of the proposed solutions could unintentionally exacerbate health inequities. We call on health policymakers to co-create, co-design, and co-produce equity-focussed, evidence-based interventions with communities, focussing on those most at risk to protect the population as a whole. Epidemiologists collaborating with people from other relevant disciplines may provide methodological expertise for these processes. As epidemiologists, we must interrogate our own methods to avoid propagating any unscientific biases we may hold. Epidemiology must be used to address, and never exacerbate, health inequities-in the pandemic and beyond.
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Affiliation(s)
- Katy Bell
- Sydney School of Public Health, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Edward Ford Building (A27), Camperdown, Sydney, NSW, 2006, Australia.
- International Network for Epidemiology in Policy, Sydney, NSW, Australia.
| | - Sam White
- International Network for Epidemiology in Policy, Sydney, NSW, Australia
| | - Abbey Diaz
- Sydney School of Public Health, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Edward Ford Building (A27), Camperdown, Sydney, NSW, 2006, Australia
- First Nations Cancer and Wellbeing Research Team, School of Public Health, University of Queensland, Brisbane, QLD, Australia
| | - Priya Bahria
- Sydney School of Public Health, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Edward Ford Building (A27), Camperdown, Sydney, NSW, 2006, Australia
- European Medicines Agency, Amsterdam, The Netherlands
| | - Fiona Sima
- Sydney School of Public Health, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Edward Ford Building (A27), Camperdown, Sydney, NSW, 2006, Australia
- Institute for Health Research, University of Bedfordshire, Luton, England, UK
| | - Wael K Al-Delaimy
- Sydney School of Public Health, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Edward Ford Building (A27), Camperdown, Sydney, NSW, 2006, Australia
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, San Diego, CA, USA
| | - Susan dosReis
- Sydney School of Public Health, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Edward Ford Building (A27), Camperdown, Sydney, NSW, 2006, Australia
- University of Maryland School of Pharmacy, Pharmaceutical Health Services Research, Baltimore, MD, USA
| | - Omar Hassan
- International Network for Epidemiology in Policy, Sydney, NSW, Australia
| | - Dorothy Drabarek
- International Network for Epidemiology in Policy, Sydney, NSW, Australia
| | - Monjura Nisha
- International Network for Epidemiology in Policy, Sydney, NSW, Australia
| | - Kesha Baptiste-Roberts
- Department of Public Health Analysis, School of Community Health and Policy, Morgan State University, Baltimore, MD, USA
| | - Katy Gwiazdon
- Sydney School of Public Health, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Edward Ford Building (A27), Camperdown, Sydney, NSW, 2006, Australia
- Center for Environmental Ethics and Law, Vienna, VA, USA
| | - Camille Raynes-Greenow
- Sydney School of Public Health, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Edward Ford Building (A27), Camperdown, Sydney, NSW, 2006, Australia
- International Network for Epidemiology in Policy, Sydney, NSW, Australia
| | - Robin Taylor Wilson
- Sydney School of Public Health, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Edward Ford Building (A27), Camperdown, Sydney, NSW, 2006, Australia
- Department of Epidemiology & Biostatistics, College of Public Health, Temple University, Philadelphia, PA, USA
| | - James A Gaudino
- Sydney School of Public Health, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Edward Ford Building (A27), Camperdown, Sydney, NSW, 2006, Australia
- School of Public Health, Oregon Health & Sciences University and Portland State University, Portland, OR, USA
| | - Rafael da Silveira Moreira
- Sydney School of Public Health, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Edward Ford Building (A27), Camperdown, Sydney, NSW, 2006, Australia
- Area of Social Medicine, Faculty of Medicine, Federal University of Pernambuco, Recife, Pernambuco, Brazil
| | - Bruce Jennings
- Sydney School of Public Health, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Edward Ford Building (A27), Camperdown, Sydney, NSW, 2006, Australia
- Center for Biomedical Ethics and Society, Vanderbilt University, Nashville, TN, USA
| | - Pauline Gulliver
- Sydney School of Public Health, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Edward Ford Building (A27), Camperdown, Sydney, NSW, 2006, Australia
- Section of Social and Community Health, University of Auckland, Auckland, New Zealand
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Akinocho H, Brackstone K, Eastment N, Fantognon JP, Head MG. COVID-19 vaccine hesitancy and conspiracy beliefs in Togo: Findings from two cross-sectional surveys. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002375. [PMID: 38421973 PMCID: PMC10903826 DOI: 10.1371/journal.pgph.0002375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 01/29/2024] [Indexed: 03/02/2024]
Abstract
Togo is a low-income country in West Africa. Estimates from Our World in Data suggest that only 25% of the Togolese population have received at least one dose of any COVID-19 vaccine by June 2023. Whilst the early phase of the pandemic vaccine rollout across 2021 was dominated by higher-income countries taking much of the available supply, there have long been sufficient supplies for all nations. Thus, there remains a need to understand reasons for low uptake in countries such as Togo, here focusing on population confidence and trust, essentially characteristics that could potentially be addressed within health promotion strategies. Two cross-sectional telephone surveys of Togo residents were conducted in December 2020 and January 2022. These surveys asked questions around perceptions of COVID-19, trust in public health messaging, belief in conspiracy theories, and hesitancy around COVID-19 vaccination. Analyses here focus on unvaccinated respondents. Across Survey 1 (N = 1430) and Survey 2 (N = 212), 65% of respondents were men, and 47% lived in Lomé (capital city of Togo). Between Surveys 1 and 2, overall hesitancy (33.0% to 58.0% respectively) and beliefs in conspiracy theories (29% to 65%) significantly increased. Using logistics regression, governmental mistrust was the strongest significant predictor of hesitancy (OR: 2.90). Participants who indicated agreement or uncertainty with at least one conspiracy belief also predicted greater vaccine hesitancy (OR: 1.36). Proactive approaches to public health messaging, that better understand reasons for hesitancy across different demographics, can support uptake of COVID-19 vaccinations within Togo. This includes health promotion campaigns that use locally and nationally trusted knowledge providers (e.g. the health service or religious leaders) for greatest effectiveness at reducing impact of misinformation. Key future research should focus around knowledge gaps and areas of mistrust created by the pandemic, such as the impact of misinformation upon routine immunisation uptake.
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Affiliation(s)
| | - Ken Brackstone
- Clinical Informatics Research Unit, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Nia Eastment
- Clinical Informatics Research Unit, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Jean-Paul Fantognon
- Ministry of Health Public Hygiene, and Universal Health Coverage, Lomé, Togo
| | - Michael G. Head
- Clinical Informatics Research Unit, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
- School of Medicine, University for Development Studies, Tamale, Ghana
- School of Public Health, University for Health and Allied Sciences, Hohoe, Ghana
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18
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Pugh S, Fosdick BK, Nehring M, Gallichotte EN, VandeWoude S, Wilson A. Estimating cutoff values for diagnostic tests to achieve target specificity using extreme value theory. BMC Med Res Methodol 2024; 24:30. [PMID: 38331732 PMCID: PMC10851584 DOI: 10.1186/s12874-023-02139-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 12/28/2023] [Indexed: 02/10/2024] Open
Abstract
BACKGROUND Rapidly developing tests for emerging diseases is critical for early disease monitoring. In the early stages of an epidemic, when low prevalences are expected, high specificity tests are desired to avoid numerous false positives. Selecting a cutoff to classify positive and negative test results that has the desired operating characteristics, such as specificity, is challenging for new tests because of limited validation data with known disease status. While there is ample statistical literature on estimating quantiles of a distribution, there is limited evidence on estimating extreme quantiles from limited validation data and the resulting test characteristics in the disease testing context. METHODS We propose using extreme value theory to select a cutoff with predetermined specificity by fitting a Pareto distribution to the upper tail of the negative controls. We compared this method to five previously proposed cutoff selection methods in a data analysis and simulation study. We analyzed COVID-19 enzyme linked immunosorbent assay antibody test results from long-term care facilities and skilled nursing staff in Colorado between May and December of 2020. RESULTS We found the extreme value approach had minimal bias when targeting a specificity of 0.995. Using the empirical quantile of the negative controls performed well when targeting a specificity of 0.95. The higher target specificity is preferred for overall test accuracy when prevalence is low, whereas the lower target specificity is preferred when prevalence is higher and resulted in less variable prevalence estimation. DISCUSSION While commonly used, the normal based methods showed considerable bias compared to the empirical and extreme value theory-based methods. CONCLUSIONS When determining disease testing cutoffs from small training data samples, we recommend using the extreme value based-methods when targeting a high specificity and the empirical quantile when targeting a lower specificity.
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Affiliation(s)
- Sierra Pugh
- Department of Statistics, Colorado State University, 102 Statistics Building, Fort Collins, 80523, Colorado, USA
| | - Bailey K Fosdick
- Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, Colorado, USA
| | - Mary Nehring
- Department of Microbiology, Immunology, and Pathology, Colorado State University, Fort Collins, Colorado, USA
| | - Emily N Gallichotte
- Department of Microbiology, Immunology, and Pathology, Colorado State University, Fort Collins, Colorado, USA
| | - Sue VandeWoude
- Department of Microbiology, Immunology, and Pathology, Colorado State University, Fort Collins, Colorado, USA
| | - Ander Wilson
- Department of Statistics, Colorado State University, 102 Statistics Building, Fort Collins, 80523, Colorado, USA.
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19
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Leong DP, Loeb M, Mony PK, Rangarajan S, Mushtaha M, Miller MS, Dias M, Yegorov S, V M, Telci Caklili O, Temizhan A, Szuba A, Abat MEM, Mat-Nasir N, Diaz ML, Khansaheb H, Lopez-Jaramillo P, Duong M, Teo KK, Poirier P, Oliveira G, Avezum Á, Yusuf S. Risk factors for recognized and unrecognized SARS-CoV-2 infection: a seroepidemiologic analysis of the Prospective Urban Rural Epidemiology (PURE) study. Microbiol Spectr 2024; 12:e0149223. [PMID: 38214526 PMCID: PMC10845948 DOI: 10.1128/spectrum.01492-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 10/26/2023] [Indexed: 01/13/2024] Open
Abstract
There are limited data on individual risk factors for SARS-CoV-2 infection (including unrecognized infection). In this seroepidemiologic substudy of an ongoing prospective cohort study of community-dwelling adults, participants were thoroughly characterized pre-pandemic. The SARS-CoV-2 infection was ascertained by serology. Among 8,719 participants from 11 high-, middle-, and low-income countries, 3,009 (35%) were seropositive for SARS-CoV-2. Characteristics independently associated with seropositivity were younger age (odds ratio, OR; 95% confidence interval, CI, per five-year increase: 0.95; 0.91-0.98) and body mass index >25 kg/m2 (OR, 95% CI: 1.16, 1.01-1.34). Smoking (as compared with never smoking, OR, 95% CI: 0.83, 0.70-0.97) and COVID-19 vaccination (OR, 95% CI: 0.70, 0.60-0.82) were associated with a reduced risk of seropositivity. Among seropositive participants, 83% were unaware of having been infected with SARS-CoV-2. Seropositivity and a lack of awareness of infection were more common in lower-income countries. The COVID-19 vaccination reduces the risk of SARS-CoV-2 infection (including recognized and unrecognized infections). Overweight or obesity is an independent risk factor for SARS-CoV-2 infection. Infection and lack of infection awareness are more common in lower-income countries.IMPORTANCEIn this large, international study, evidence of SARS-CoV-2 infection was obtained by testing blood specimens from 8,719 community-dwelling adults from 11 countries. The key findings are that (i) the large majority (83%) of community-dwelling adults from several high-, middle-, and low-income countries with blood test evidence of SARS-CoV-2 infection were unaware of this infection-especially in lower-income countries; and (ii) overweight/obesity predisposes to SARS-CoV-2 infection, while COVID-19 vaccination is associated with a reduced risk of SARS-CoV-2 infection. These observations are not attributable to other individual characteristics, highlighting the importance of the COVID-19 vaccination to prevent not only severe infection but possibly any infection. Further research is needed to understand the mechanisms by which overweight/obesity might increase the risk of SARS-CoV-2 infection.
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Affiliation(s)
- Darryl P. Leong
- The Population Health Research Institute, McMaster University, Hamilton, Canada
- Department of Medicine, McMaster University, Hamilton, Canada
| | - Mark Loeb
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
| | - Prem K. Mony
- Division of Epidemiology and Population Health, St. John’s Research Institute, St. John’s Medical College, Bangalore, India
| | - Sumathy Rangarajan
- The Population Health Research Institute, McMaster University, Hamilton, Canada
| | - Maha Mushtaha
- The Population Health Research Institute, McMaster University, Hamilton, Canada
| | - Matthew S. Miller
- Department of Biochemistry and Biomedical Sciences, McMaster University, Hamilton, Canada
| | - Mary Dias
- Department of Microbiology and Infectious Diseases, St. John’s Medical College, Bangalore, India
| | - Sergey Yegorov
- Department of Biochemistry and Biomedical Sciences, McMaster University, Hamilton, Canada
| | - Mamatha V
- Department of Microbiology and Infectious Diseases, St. John’s Medical College, Bangalore, India
| | - Ozge Telci Caklili
- Department of Endocrinology and Metabolism, Istanbul University, Istanbul, Turkey
| | - Ahmet Temizhan
- Cardiology Department, Ankara Bilkent City Hospital, Ankara, Turkey
| | - Andrzej Szuba
- Department of Angiology, Hypertension and Diabetology, Wroclaw Medical University, Wroclaw, Poland
| | - Marc Evans M. Abat
- Department of Medicine, Philippine General Hospital, Manila, Philippines
| | - Nafiza Mat-Nasir
- Department of Primary Care Medicine, Universiti Teknologi MARA (UiTM), Petaling Jaya, Malaysia
| | - Maria Luz Diaz
- Estudios Clinicos Latinamérica (ECLA), Instituto Cardiovascular de Rosario, Rosario, Argentina
| | | | | | - MyLinh Duong
- Department of Medicine, McMaster University, Hamilton, Canada
| | - Koon K. Teo
- The Population Health Research Institute, McMaster University, Hamilton, Canada
- Department of Medicine, McMaster University, Hamilton, Canada
| | - Paul Poirier
- Faculté de pharmacie, Université Laval, Québec, Canada
| | | | | | - Salim Yusuf
- The Population Health Research Institute, McMaster University, Hamilton, Canada
- Department of Medicine, McMaster University, Hamilton, Canada
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20
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Kyaw MH, Spinardi JR, Jagun O, Franco Villalobos C, Kapetanakis V, Sharf-Williams R, Yarnoff B. Descriptive analysis to assess seasonal patterns of COVID-19 and influenza in low-income and middle-income countries in Asia, the Middle East and Latin America. BMJ Open 2024; 14:e081019. [PMID: 38296298 PMCID: PMC10831443 DOI: 10.1136/bmjopen-2023-081019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 01/22/2024] [Indexed: 02/03/2024] Open
Abstract
OBJECTIVES Understanding disease seasonality can help predict the occurrence of outbreaks and inform public health planning. Respiratory diseases typically follow seasonal patterns; however, knowledge regarding the seasonality of COVID-19 and its impact on the seasonality of influenza remains limited. The objective of this study was to provide more evidence to understand the circulation of SARS-CoV-2, the virus responsible for COVID-19, in an endemic scenario to guide potential preventive strategies. DESIGN In this study, a descriptive analysis was undertaken to describe seasonality trends and/or overlap between COVID-19 and influenza in 12 low-income and middle-income countries using Our World in Data and FluMart data sources. Plots of COVID-19 and influenza cases were analysed. SETTING Singapore, Thailand, Malaysia, the Philippines, Argentina, Brazil, Mexico, South Africa, Morocco, Bahrain, Qatar and Saudi Arabia. OUTCOME MEASURES COVID-19 cases and influenza cases. RESULTS No seasonal patterns of SARS-CoV-2 or SARS-CoV-2/influenza cocirculation were observed in most countries, even when considering the avian influenza pandemic period. CONCLUSIONS These results can inform public health strategies. The lack of observed seasonal behaviour highlights the importance of maintaining year-round vaccination rather than implementing seasonal campaigns. Further research investigating the influence of climate conditions, social behaviour and year-round preventive measures could be fundamental for shaping appropriate policies related to COVID-19 and respiratory viral disease control in low-income and middle-income countries as COVID-19 variant data and epidemiologic patterns accrue over time.
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Dutta A, Mukherjee S, Haldar J, Maitra U. Augmenting Antimicrobial Resistance Surveillance: Rapid Detection of β-Lactamase-Expressing Drug-Resistant Bacteria through Sensitized Luminescence on a Paper-Supported Hydrogel. ACS Sens 2024; 9:351-360. [PMID: 38156608 DOI: 10.1021/acssensors.3c02065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
The emergence of antimicrobial resistance (AMR) in pathogenic bacteria, expedited by the overuse and misuse of antibiotics, necessitates the development of a rapid and pan-territorially accessible diagnostic protocol for resistant bacterial infections, which would not only enable judicious prescription of drugs, leading to infection control but also augment AMR surveillance. In this study, we introduce for the first time a "turn-on" terbium (Tb3+) photoluminescence assay supported on a paper-based platform for rapid point-of-care (POC) detection of β-lactamase (BL)-producing bacteria. We strategically conjugated biphenyl-4-carboxylic acid (BCA), a potent Tb3+ sensitizer, with cephalosporin to engineer a BL substrate CCS, where the energy transfer to terbium is arrested. However, BL, a major resistance element produced by bacteria resistant to β-lactam antibiotics, triggers a spontaneous release of BCA, empowering terbium sensitization within a supramolecular scaffold supported on paper. The remarkable optical response facilitates quick assessment with a binary answer, and the time-gated signal acquisition ensues improved sensitivity with a detection limit as low as 0.1 mU/mL. Furthermore, to ensure accessibility, particularly in resource-limited areas, we have developed an in loco imaging device as an affordable alternative to high-end instruments. The integration of the assay with the device readily identified the BL-associated drug-resistant strains in the mimic urinary tract infection samples within 2 h, demonstrating its excellent potential for in-field translation. We believe that this rapid paper-based POC assay, coupled with the in loco device, can be deployed anywhere, especially in developing regions, and will enable extensive surveillance on antibiotic-resistant infections.
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Affiliation(s)
- Arnab Dutta
- Department of Organic Chemistry, Indian Institute of Science, Bengaluru, Karnataka 560012, India
| | - Sudip Mukherjee
- New Chemistry Unit, Jawaharlal Nehru Centre for Advanced Scientific Research, Bengaluru, Karnataka 560064, India
| | - Jayanta Haldar
- New Chemistry Unit, Jawaharlal Nehru Centre for Advanced Scientific Research, Bengaluru, Karnataka 560064, India
| | - Uday Maitra
- Department of Organic Chemistry, Indian Institute of Science, Bengaluru, Karnataka 560012, India
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22
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Kusnadi G, Fletcher E, Espressivo A, Fitrianingrum NM, Saputra MA, Sophiarany N, Soebagio F. Essential healthcare services during the COVID-19 pandemic: a cross-sectional study of community needs and perspectives in West Java, Indonesia. BMJ Open 2024; 14:e077585. [PMID: 38253458 PMCID: PMC10806686 DOI: 10.1136/bmjopen-2023-077585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 12/20/2023] [Indexed: 01/24/2024] Open
Abstract
OBJECTIVES While issues in healthcare facilities during the COVID-19 pandemic have been widely discussed, little is known about health service issues from community (demand) sides. This study aimed to identify community needs in the utilisation of health services and highlight the key roles and barriers that community health workers (CHWs) face in delivering community-based services during the pandemic. DESIGN Cross-sectional study. SETTING 38 randomly selected villages covered by 21 preidentified community health centres in 3 districts in West Java, Indonesia. The survey was conducted from 22 January 2022 to 7 February 2022 (2 years after the pandemic began). PARTICIPANTS 118 respondents, consisting of community leaders, vulnerable group representatives and CHWs. RESULTS Laboratory examination (55.1%), emergency care (52.5%), non-communicable disease screening (50%) and routine treatment (49.2%) were perceived as the highest unmet needs of essential healthcare services. Fear of infection (90.3%) became one main barrier to access healthcare services. Vulnerable populations including lower socioeconomic groups (61.2%), households with elderly (25.4%), persons with disabilities (25.4%), pregnant women, people with mental illness and people with lower education (26.9%) were reported facing difficulties in accessing healthcare services. Further, the pandemic was deemed to have significantly impacted the community economic situation (91.5%). CHWs were actively engaged in community-based services and were mentioned as the first contact when the community needed help (57.6%). CHWs reported essential needs on financial support (45.2%), logistics (54.8%) and protective equipment (22.6%). CONCLUSIONS Essential health services for the community, including those belonging to vulnerable groups, were highly impacted during the pandemic. CHWs appear to have significant roles in delivering health services during this health crisis, hence, adequate support is needed to equip them in strengthening pandemic response.
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Affiliation(s)
- Gita Kusnadi
- Center for Indonesia's Strategic Development Initiatives, Jakarta Pusat, Indonesia
| | - Emma Fletcher
- Center for Indonesia's Strategic Development Initiatives, Jakarta Pusat, Indonesia
- Johns Hopkins University, Baltimore, Maryland, USA
| | - Aufia Espressivo
- Center for Indonesia's Strategic Development Initiatives, Jakarta Pusat, Indonesia
| | | | | | - Nabilla Sophiarany
- Center for Indonesia's Strategic Development Initiatives, Jakarta Pusat, Indonesia
| | - Febriansyah Soebagio
- Center for Indonesia's Strategic Development Initiatives, Jakarta Pusat, Indonesia
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23
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Kiptoo J, Isiiko J, Yadesa TM, Rhodah T, Alele PE, Mulogo EM. COVID-19 vaccine hesitancy: assessing the prevalence, predictors, and effectiveness of a community pharmacy based counseling intervention. BMC Public Health 2024; 24:111. [PMID: 38184570 PMCID: PMC10771691 DOI: 10.1186/s12889-023-17532-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 12/19/2023] [Indexed: 01/08/2024] Open
Abstract
BACKGROUND Coronavirus disease (COVID-19) vaccine hesitancy is a global challenge. In low- and middle-income countries (LMICs), the problem has persisted despite vaccine availability and decreasing infections. In Uganda, there is still limited information on the extent and predictors of vaccine hesitancy. This study sought to assess the prevalence and predictors of COVID-19 vaccine hesitancy, and the effectiveness of an intervention that involved community pharmacy counseling in combating COVID-19 vaccine hesitancy. METHODS A total of 394 participants were enrolled in a 4-week prospective cohort interventional study. The study was conducted across eight community pharmacies in Mbarara City, between 9:00 AM and 5:00 PM daily. The study personnel ascertained the vaccination status of all clients seeking community pharmacy services. All unvaccinated clients were consecutively assessed for eligibility, and eligible clients were systematically enrolled after receiving the community pharmacy services for which they requested. The study intervention involved structured participant counseling (within the pharmacy premise), follow-up short message service (weekly), and telephone calls (bi-weekly). Only participants who did not accept to receive the COVID-19 vaccine despite counseling were followed up for four weeks, or until they accepted to receive a COVID-19 vaccine. The effectiveness of the community pharmacy counseling intervention was determined as an increase in COVID-19 vaccine acceptance, and desirable attitudinal change towards COVID-19 disease, vaccination exercise, and vaccines. Descriptive analysis was used to summarize data, and multivariate analysis was used to determine the predictors of COVID-19 vaccine hesitancy. A p-value < 0.05 was considered statistically significant. RESULTS Out of 394 participants, 221 (56%) were hesitant to receive a COVID-19 vaccine. Participants expressed several reasons (mean 2±1) for COVID-19 vaccine hesitancy, mostly concerning vaccine safety (N=160, 47.3%). The overall COVID-19 vaccine acceptance rate increased by 25.4 percent points (43.9 - 69.3 percent points) after the study intervention. Age, religion, level of education, distance from the nearest public health facility, having a friend/family diagnosed with COVID-19, and personal suspicion of contracting COVID-19 were significant predictors of COVID-19 vaccine hesitancy. CONCLUSION COVID-19 vaccine hesitancy is a big challenge in Uganda. A mix of sociodemographic and COVID-19 vaccine perceptions are the key predictors of COVID-19 vaccine hesitancy. Although COVID-19 vaccines were not available at the time of the study, this study found that structured counseling interventions can improve COVID-19 vaccine acceptance rates. Larger prospective studies should evaluate the effectiveness of similar interventions in community pharmacies and other healthcare settings.
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Affiliation(s)
- Joshua Kiptoo
- Department of Pharmacy, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - John Isiiko
- Department of Pharmacy, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
- Department of Pharmacy, Uganda Cancer Institute, Mbarara, Uganda
| | - Tadele Mekuriya Yadesa
- Department of Pharmacy, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
- Department of Clinical Pharmacy and Pharmacy Practice, Kampala International University, Ishaka, Uganda
| | - Tumugumye Rhodah
- Department of Nursing, Mbarara Regional Referral Hospital, Mbarara, Uganda
| | - Paul E Alele
- Department of Pharmacology and Therapeutics, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda.
| | - Edgar Mugema Mulogo
- Department of Community Health, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
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Gmanyami JM, Jarynowski A, Belik V, Lambert O, Amuasi J, Quentin W. Excess mortality during the COVID-19 pandemic in low-income and lower middle-income countries: protocol for a systematic review and meta-analysis. BMJ Open 2024; 14:e079862. [PMID: 38167281 PMCID: PMC10773359 DOI: 10.1136/bmjopen-2023-079862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 12/13/2023] [Indexed: 01/05/2024] Open
Abstract
INTRODUCTION The COVID-19 pandemic has been marked by a massive death toll. However, the overall effect of the pandemic, including potential unintended negative impacts of some control measures, on mortality remains poorly understood in low-income and lower middle-income countries (LLMICs). This review aims to summarise the available literature on excess mortality in LLMICs, focusing on the methods and data sources used in estimating excess mortality and the drivers of excess mortality. METHODS AND ANALYSIS We will review the available literature and report results in line with the Preferred Reporting Items for Systematic Review and Meta-Analysis. Searches will be conducted in PubMed, Embase, Web of Science, Cochrane Library, Google Scholar and Scopus. All published studies that report on the estimates of excess mortality in populations of LLMICs will be included. This will include those with a publication date from 2019 onwards and those with at least a 1-year non-COVID-19 period as the comparator in the estimation of excess mortality during the pandemic. There will be no language restrictions on the search. The meta-analysis will include studies with extractable data on excess mortality, methods, population size, and observed and expected deaths. We will use the Mantel-Haenszel method to estimate the pooled risk ratio with 95% CIs. ETHICS AND DISSEMINATION As there is no primary data collection, there is no requirement for ethical review. The results will be disseminated through peer-reviewed journal publication and conference presentations. PROSPERO REGISTRATION NUMBER CRD42022378267.
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Affiliation(s)
- Jonathan Mawutor Gmanyami
- School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- German West-African Centre for Global Health and Pandemic Prevention, Kumasi, Ghana
- Global Health and Infectious Diseases Research Group, Kumasi Centre for Collaborative Research in Tropical Medicine, Kumasi, Ghana
| | - Andrzej Jarynowski
- Department of Veterinary Medicine, Freie Universität Berlin, Berlin, Germany
| | - Vitaly Belik
- Department of Veterinary Medicine, Freie Universität Berlin, Berlin, Germany
| | - Oscar Lambert
- School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - John Amuasi
- School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- German West-African Centre for Global Health and Pandemic Prevention, Kumasi, Ghana
- Global Health and Infectious Diseases Research Group, Kumasi Centre for Collaborative Research in Tropical Medicine, Kumasi, Ghana
- Bernhard Nocht Institute of Tropical Medicine, Hamburg, Germany
| | - Wilm Quentin
- Department of Health Care Management, Technical University of Berlin, Berlin, Germany
- German West-African Centre for Global Health and Pandemic Prevention, Berlin, Germany
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25
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Ferranna M. Causes and costs of global COVID-19 vaccine inequity. Semin Immunopathol 2024; 45:469-480. [PMID: 37870569 PMCID: PMC11136847 DOI: 10.1007/s00281-023-00998-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 09/22/2023] [Indexed: 10/24/2023]
Abstract
Despite the rapid development of safe and effective COVID-19 vaccines and the widely recognized health and economic benefits of vaccination, there exist stark differences in vaccination rates across country income groups. While more than 70% of the population is fully vaccinated in high-income countries, vaccination rates in low-income countries are only around 30%. The paper reviews the factors behind global COVID-19 vaccine inequity and the health, social, and economic costs triggered by this inequity. The main contributors to vaccine inequity include vaccine nationalism, intellectual property rights, constraints in manufacturing capacity, poor resilience of healthcare systems, and vaccine hesitancy. Vaccine inequity has high costs, including preventable deaths and cases of illnesses in low-income countries, slow economic recovery, and large learning losses among children. Increasing vaccination rates in low-income countries is in the self-interest of higher-income countries as it may prevent the emergence of new variants and continuous disruptions to global supply chains.
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Affiliation(s)
- Maddalena Ferranna
- Department of Pharmaceutical and Health Economics, Alfred E. Mann School of Pharmacy and Pharmaceutical Sciences, University of Southern California, Los Angeles, CA, USA.
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26
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Carson RT, Hanemann M, Köhlin G, Adamowicz W, Sterner T, Amuakwa-Mensah F, Alpizar F, Khossravi EA, Jeuland M, Bonilla JA, Tan-Soo JS, Nam PK, Ndiritu SW, Wadehra S, Chegere MJ, Visser M, Chukwuone NA, Whittington D. Perceptions of the seriousness of major public health problems during the COVID-19 pandemic in seven middle-income countries. COMMUNICATIONS MEDICINE 2023; 3:193. [PMID: 38129511 PMCID: PMC10739711 DOI: 10.1038/s43856-023-00377-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 10/04/2023] [Indexed: 12/23/2023] Open
Abstract
INTRODUCTION Public perception of the seriousness of the COVID-19 pandemic compared to six other major public health problems (alcoholism and drug use, HIV/AIDS, malaria, tuberculosis, lung cancer and respiratory diseases caused by air pollution and smoking, and water-borne diseases like diarrhea) is unclear. We designed a survey to examine this issue using YouGov's internet panels in seven middle-income countries in Africa, Asia, and Latin America in early 2022. METHODS Respondents rank ordered the seriousness of the seven health problems using a repeated best-worst question format. Rank-ordered logit models allow comparisons within and across countries and assessment of covariates. RESULTS In six of the seven countries, respondents perceived other respiratory illnesses to be a more serious problem than COVID-19. Only in Vietnam was COVID-19 ranked above other respiratory illnesses. Alcoholism and drug use was ranked the second most serious problem in the African countries. HIV/AIDS ranked relatively high in all countries. Covariates, particularly a COVID-19 knowledge scale, explained differences within countries; statistics about the pandemic were highly correlated with differences in COVID-19's perceived seriousness. CONCLUSIONS People in the seven middle-income countries perceived COVID-19 to be serious (on par with HIV/AIDS) but not as serious as other respiratory illnesses. In the African countries, respondents perceived alcoholism and drug use as more serious than COVID-19. Our survey-based approach can be used to quickly understand how the threat of a newly emergent disease, like COVID-19, fits into the larger context of public perceptions of the seriousness of health problems.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Dale Whittington
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
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27
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Bell D, Brown GW, Oyibo WA, Ouédraogo S, Tacheva B, Barbaud E, Kalk A, Ridde V, Paul E. COVAX - Time to reconsider the strategy and its target. HEALTH POLICY OPEN 2023; 4:100096. [PMID: 37073303 PMCID: PMC10098302 DOI: 10.1016/j.hpopen.2023.100096] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 03/29/2023] [Accepted: 04/03/2023] [Indexed: 04/20/2023] Open
Abstract
COVAX, the international initiative supporting COVID-19 vaccination campaigns globally, is budgeted to be the costliest public health initiative in low- and middle-income countries, with over 16 billion US dollars already committed. While some claim that the target of vaccinating 70% of people worldwide is justified on equity grounds, we argue that this rationale is wrong for two reasons. First, mass COVID-19 vaccination campaigns do not meet standard public health requirements for clear expected benefit, based on costs, disease burden and intervention effectiveness. Second, it constitutes a diversion of resources from more cost-effective and impactful public health programmes, thus reducing health equity. We conclude that the COVAX initiative warrants urgent review.
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Affiliation(s)
- David Bell
- Independent Consultant, Lake Jackson, TX, USA
| | - Garrett W Brown
- Professor of Global Health Policy, University of Leeds, United Kingdom
| | - Wellington A Oyibo
- University of Lagos, College of Medicine, Department of Medical Microbiology and Parasitology, Lagos, Nigeria
| | - Samiratou Ouédraogo
- Observatoire national de la santé de la population (ONSP), Institut National de Santé Publique (INSP), Ouagadougou, Burkina Faso
| | | | - Elena Barbaud
- University of Leeds, Global Health Research Unit, United Kingdom
| | - Andreas Kalk
- Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ), Kinshasa Country Office, Democratic Republic of the Congo
| | - Valéry Ridde
- Université Paris Cité, IRD, Inserm, Ceped, F-75006 Paris, France
| | - Elisabeth Paul
- Université libre de Bruxelles, School of Public Health, Belgium
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28
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Njororai F, Nyaranga KC, Cholo W, Amulla W, Ndetan H. Correlates of COVID-19 Vaccine Acceptance and Hesitancy in Rural Communities in Western Kenya. Vaccines (Basel) 2023; 11:1516. [PMID: 37896920 PMCID: PMC10610933 DOI: 10.3390/vaccines11101516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 09/13/2023] [Accepted: 09/18/2023] [Indexed: 10/29/2023] Open
Abstract
Vaccine hesitancy is a significant global public health concern. This study sought to determine the correlates of acceptance and hesitancy regarding COVID-19 vaccines in rural populations of selected counties in Western Kenya and assess the strategies that can be used to improve COVID-19 vaccine acceptance in Kenya. The study used a quantitative research strategy with a sample of 806 individuals in the Kisumu, Vihiga, and Kakamega counties. Descriptive statistics, correlations and regression analyses were used. Of the 806 study participants, 55% were males and 45% females. Vaccine acceptance was significantly associated with being a male (AOR: 1.46, 95% CI: 1.24-1.59, p < 0.031), having no formal education (AOR: 2.25, 95% CI: 1.16-4.40, p < 0.02), working in the private sector (AOR: 5.78, 95% CI: 3.28-10.88 p < 0.02), and have low income (KES 0-999 (USD 0-9.16)), (AOR: 2.35, 95% CI: 1.13-3.47, p < 0.02). Conclusions: The current study suggests that male gender, no formal education, working in the private sector, and low income KES 0-999 (USD 0-9.6) are significant factors influencing awareness of and possible acceptance of COVID-19 vaccination.
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Affiliation(s)
- Fletcher Njororai
- Department of Public Health, The University of Texas at Tyler, Tyler, TX 75799, USA
| | - Kogutu Caleb Nyaranga
- Department of Public Health, South Eastern Kenya University (SEKU), Kitui 90200, Kenya
| | - Wilberforce Cholo
- Department of Public Health, Masinde Muliro University of Science and Technology, Kakamega 50100, Kenya
| | - Walter Amulla
- Department of Public Health, Kisii University, Kisii 40200, Kenya
| | - Harrison Ndetan
- School of Medicine at the Health Science Center, The University of Texas at Tyler, Tyler, TX 75799, USA
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Rzymski P, Pokorska-Śpiewak M, Jackowska T, Kuchar E, Nitsch-Osuch A, Pawłowska M, Babicki M, Jaroszewicz J, Szenborn L, Wysocki J, Flisiak R. Key Considerations during the Transition from the Acute Phase of the COVID-19 Pandemic: A Narrative Review. Vaccines (Basel) 2023; 11:1502. [PMID: 37766178 PMCID: PMC10537111 DOI: 10.3390/vaccines11091502] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Revised: 09/12/2023] [Accepted: 09/15/2023] [Indexed: 09/29/2023] Open
Abstract
The COVID-19 pandemic has been met with an unprecedented response from the scientific community, leading to the development, investigation, and authorization of vaccines and antivirals, ultimately reducing the impact of SARS-CoV-2 on global public health. However, SARS-CoV-2 is far from being eradicated, continues to evolve, and causes substantial health and economic burdens. In this narrative review, we posit essential points on SARS-CoV-2 and its responsible management during the transition from the acute phase of the COVID-19 pandemic. As discussed, despite Omicron (sub)variant(s) causing clinically milder infections, SARS-CoV-2 is far from being a negligible pathogen. It requires continued genomic surveillance, particularly if one considers that its future (sub)lineages do not necessarily have to be milder. Antivirals and vaccines remain the essential elements in COVID-19 management. However, the former could benefit from further development and improvements in dosing, while the seasonal administration of the latter requires simplification to increase interest and tackle vaccine hesitancy. It is also essential to ensure the accessibility of COVID-19 pharmaceuticals and vaccines in low-income countries and improve the understanding of their use in the context of the long-term goals of SARS-CoV-2 management. Regardless of location, the primary role of COVID-19 awareness and education must be played by healthcare workers, who directly communicate with patients and serve as role models for healthy behaviors.
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Affiliation(s)
- Piotr Rzymski
- Department of Environmental Medicine, Poznan University of Medical Sciences, 60-806 Poznań, Poland
| | - Maria Pokorska-Śpiewak
- Department of Children’s Infectious Diseases, Medical University of Warsaw, 02-091 Warsaw, Poland;
| | - Teresa Jackowska
- Department of Pediatrics, Centre for Postgraduate Medical Education, 01-813 Warsaw, Poland;
| | - Ernest Kuchar
- Department of Pediatrics with Clinical Assessment Unit, Medical University of Warsaw, 02-091 Warsaw, Poland;
| | - Aneta Nitsch-Osuch
- Department of Social Medicine and Public Health, Medical University of Warsaw, 02-007 Warsaw, Poland;
| | - Małgorzata Pawłowska
- Department of Infectious Diseases and Hepatology, Faculty of Medicine, Collegium Medicum, Nicolaus Copernicus University, 85-067 Bydgoszcz, Poland;
| | - Mateusz Babicki
- Department of Family Medicine, Wroclaw Medical University, 51-141 Wroclaw, Poland;
| | - Jerzy Jaroszewicz
- Department of Infectious Diseases and Hepatology, Medical University of Silesia, 41-902 Bytom, Poland;
| | - Leszek Szenborn
- Department of Pediatric Infectious Diseases, Wrocław Medical University, 50-367 Wroclaw, Poland;
| | - Jacek Wysocki
- Department of Preventive Medicine, Poznan University of Medical Sciences, 61-701 Poznań, Poland;
| | - Robert Flisiak
- Department of Infectious Diseases and Hepatology, Medical University of Białystok, 15-089 Bialystok, Poland;
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Mitangala PN, Irenge LM, Musubao ET, Kahindo JBM, Ayonga PN, Kyembwa Safari I, Kubuya JB, Ntabe EN, Kabangwa Senga RK, Mutombo GN, Ambroise J, Gala JL. Prevalence of anti-SARS-CoV-2 antibodies in people attending the two main Goma markets in the eastern Democratic Republic of the Congo. Epidemiol Infect 2023; 151:e167. [PMID: 37724000 PMCID: PMC10600894 DOI: 10.1017/s0950268823001498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 08/16/2023] [Accepted: 09/03/2023] [Indexed: 09/20/2023] Open
Abstract
The Democratic Republic of the Congo (DRC) officially reports low coronavirus disease 19 (COVID-19) prevalence. This cross-sectional study, conducted between September and November 2021, assessed the COVID-19 seroprevalence in people attending Goma's two largest markets, Kituku and Virunga. A similar study in a slum of Bukavu overlapped for 1 month using identical methods. COVID-19-unvaccinated participants (n = 796 including 454 vendors and 342 customers, 60% of whom were women) were surveyed. The median age of vendors and customers was 34.2 and 30.1 years, respectively. The crude and adjusted anti-SARS-CoV-2 antibody seroprevalence rates were 70.2% (95% CI 66.9-73.4%) and 98.8% (95% CI 94.1-100%), respectively, with no difference between vendors and customers. COVID-19 symptoms reported by survey participants in the previous 6 months were mild or absent in 58.9% and 41.1% of participants with anti-SARS-CoV-2 antibodies, respectively. No COVID-19-seropositive participants reported hospitalisation in the last 6 months. These findings are consistent with those reported in Bukavu. They confirm that SARS-CoV-2 spread without causing severe symptoms in densely populated settlements and markets and suggest that many COVID-19 cases went unreported. Based on these results, the relevance of an untargeted hypothetical vaccination programme in these communities should be questioned.
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Affiliation(s)
- Prudence Ndeba Mitangala
- Université Catholique de Bukavu, Bukavu, Democratic Republic of Congo
- Université Officielle de Ruwenzori, Butembo, Democratic Republic of Congo
| | - Leonid M. Irenge
- Center for Applied Molecular Technologies, Institute of Clinical and Experimental Research, Université catholique de Louvain (UCLouvain), Woluwe-Saint-Lambert, Belgium
| | | | | | - Patrick Ndeba Ayonga
- Département des maladies infectieuses et tropicales, Université de Bordeaux, Bordeaux, France
| | | | | | | | | | - Guy Ndongala Mutombo
- Division Provinciale de la Santé du Nord Kivu, Goma, Democratic Republic of Congo
| | - Jérôme Ambroise
- Center for Applied Molecular Technologies, Institute of Clinical and Experimental Research, Université catholique de Louvain (UCLouvain), Woluwe-Saint-Lambert, Belgium
| | - Jean-Luc Gala
- Center for Applied Molecular Technologies, Institute of Clinical and Experimental Research, Université catholique de Louvain (UCLouvain), Woluwe-Saint-Lambert, Belgium
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Backhaus A. Socio-demographic factors associated with COVID-19 vaccine uptake and refusal among Ugandan women. Global Health 2023; 19:68. [PMID: 37674181 PMCID: PMC10481614 DOI: 10.1186/s12992-023-00968-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 08/29/2023] [Indexed: 09/08/2023] Open
Abstract
BACKGROUND This paper analyzes associations of socio-demographic factors with the uptake of COVID-19 vaccines, the refusal to get vaccinated against COVID-19, and various reasons stated for refusing vaccination against COVID-19 among a representative sample of Ugandan women. METHODS This paper utilizes a representative cross-sectional survey collected among women aged 15-49 years in Uganda between September and November 2021. Regression analyses are used to study the associations of a broad range of socio-demographic characteristics with COVID-19 vaccine uptake, refusal of vaccination, and reasons for refusal among the respondents. RESULTS 4211 women were included in the analysis. 11% of them were vaccinated against COVID-19, 76% were willing to get vaccinated, 13% were unwilling to get vaccinated. Fear of side effects was the most commonly stated reason for refusing vaccination (69%). Factors significantly and positively associated with being vaccinated against COVID-19 were age, higher education, urban residency, having savings, partial instead of complete income loss during the pandemic, and usage of modern contraceptives. Factors significantly and positively associated with refusing vaccination against COVID-19 were urban residency and current pregnancy, while age, having savings, and using modern contraceptives were factors associated with a lower likelihood of refusing vaccination, albeit with varying statistical significance. Few factors were strongly related to the stated reasons for refusing the vaccines; the fear of side effects significantly increased with age, while having received negative information on the vaccines was significantly less common among women with higher education. CONCLUSIONS This study documents a low COVID-19 vaccination rate and a high willingness to get vaccinated among Ugandan women. Positive age and education gradients in vaccine uptake point to inequity in access to vaccination, potentially resulting from prioritizations of groups at particularly high risk. Refusal to be vaccinated was relatively low and systematic factors behind vaccine refusal were hardly to be found, even less so for particular reasons given for refusal.
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Affiliation(s)
- Andreas Backhaus
- Federal Institute for Population Research (BiB), Wiesbaden, Germany.
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Gleeson D, Townsend B, Tenni BF, Phillips T. Global inequities in access to COVID-19 health products and technologies: A political economy analysis. Health Place 2023; 83:103051. [PMID: 37379732 PMCID: PMC10247888 DOI: 10.1016/j.healthplace.2023.103051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 05/30/2023] [Accepted: 05/31/2023] [Indexed: 06/30/2023]
Abstract
This paper presents a political economy analysis of global inequities in access to COVID-19 vaccines, treatments, and diagnostic tests. We adapt a conceptual model used for analysing the political economy of global extraction and health to examine the politico-economic factors affecting access to COVID-19 health products and technologies in four interconnected layers: the social, political, and historical context; politics, institutions, and policies; pathways to ill-health; and health consequences. Our analysis finds that battles over access to COVID-19 products occur in a profoundly unequal playing field, and that efforts to improve access that do not shift the fundamental power imbalances are bound to fail. Inequitable access has both direct effects on health (preventable illness and death) and indirect effects through exacerbation of poverty and inequality. We highlight how the case of COVID-19 products reflects broader patterns of structural violence, in which the political economy is structured to improve and lengthen the lives of those in the Global North while neglecting and shortening the lives of those in the Global South. We conclude that achieving equitable access to pandemic response products requires shifting longstanding power imbalances and the institutions and processes that entrench and enable them.
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Affiliation(s)
- Deborah Gleeson
- School of Psychology and Public Health, La Trobe University, VIC, 3086, Australia.
| | - Belinda Townsend
- Menzies Centre for Health Governance, School of Regulation and Global Governance, Australian National University, 8 Fellows Road Acton, Canberra, ACT, 2000, Australia
| | - Brigitte F Tenni
- School of Psychology and Public Health, La Trobe University, VIC, 3086, Australia; Nossal Institute for Global Health, University of Melbourne, 5th Floor, 333 Exhibition Street, Melbourne, Victoria, 3189, Australia
| | - Tarryn Phillips
- Department of Social Inquiry, La Trobe University, VIC, 3086, Australia
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Cuevas Barron G, Koonin J, Akselrod S, Fogstad H, Karema C, Ditiu L, Dain K, Joshi N. Universal health coverage is a matter of equity, rights, and justice. Lancet Glob Health 2023; 11:e1335-e1336. [PMID: 37429304 DOI: 10.1016/s2214-109x(23)00317-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 06/30/2023] [Indexed: 07/12/2023]
Affiliation(s)
| | | | | | - Helga Fogstad
- Partnership for Maternal, Newborn, and Child Health, Geneva 1211, Switzerland
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Zavalis EA, Contopoulos-Ioannidis DG, Ioannidis JPA. Transparency in Infectious Disease Research: Meta-research Survey of Specialty Journals. J Infect Dis 2023; 228:227-234. [PMID: 37132475 DOI: 10.1093/infdis/jiad130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 02/24/2023] [Accepted: 05/01/2023] [Indexed: 05/04/2023] Open
Abstract
BACKGROUND Infectious diseases carry large global burdens and have implications for society at large. Therefore, reproducible, transparent research is extremely important. METHODS We evaluated transparency indicators (code and data sharing, registration, and conflict and funding disclosures) in the 5340 PubMed Central Open Access articles published in 2019 or 2021 in the 9 most cited specialty journals in infectious diseases using the text-mining R package, rtransparent. RESULTS A total of 5340 articles were evaluated (1860 published in 2019 and 3480 in 2021 [of which 1828 were on coronavirus disease 2019, or COVID-19]). Text mining identified code sharing in 98 (2%) articles, data sharing in 498 (9%), registration in 446 (8%), conflict of interest disclosures in 4209 (79%), and funding disclosures in 4866 (91%). There were substantial differences across the 9 journals: 1%-9% for code sharing, 5%-25% for data sharing, 1%-31% for registration, 7%-100% for conflicts of interest, and 65%-100% for funding disclosures. Validation-corrected imputed estimates were 3%, 11%, 8%, 79%, and 92%, respectively. There were no major differences between articles published in 2019 and non-COVID-19 articles in 2021. In 2021, non-COVID-19 articles had more data sharing (12%) than COVID-19 articles (4%). CONCLUSIONS Data sharing, code sharing, and registration are very uncommon in infectious disease specialty journals. Increased transparency is required.
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Affiliation(s)
- Emmanuel A Zavalis
- Department of Learning Informatics Management and Ethics, Karolinska Institutet, Stockholm, Sweden
- Meta-Research Innovation Center at Stanford (METRICS), Stanford University
| | | | - John P A Ioannidis
- Meta-Research Innovation Center at Stanford (METRICS), Stanford University
- Stanford Prevention Research Center, Department of Medicine
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, California, USA
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Mudenda S, Daka V, Matafwali SK, Skosana P, Chabalenge B, Mukosha M, Fadare JO, Mfune RL, Witika BA, Alumeta MG, Mufwambi W, Godman B, Meyer JC, Bwalya AG. COVID-19 Vaccine Acceptance and Hesitancy among Healthcare Workers in Lusaka, Zambia; Findings and Implications for the Future. Vaccines (Basel) 2023; 11:1350. [PMID: 37631918 PMCID: PMC10459437 DOI: 10.3390/vaccines11081350] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 08/05/2023] [Accepted: 08/07/2023] [Indexed: 08/29/2023] Open
Abstract
The uptake of COVID-19 vaccines is critical to address the severe consequences of the disease. Previous studies have suggested that many healthcare workers (HCWs) are hesitant to receive the COVID-19 vaccine, further enhancing hesitancy rates within countries. COVID-19 vaccine acceptance and hesitancy levels are currently unknown among HCWs in Zambia, which is a concern given the burden of infectious diseases in the country. Consequently, this study assessed COVID-19 vaccine acceptance and hesitancy among HCWs in Lusaka, Zambia. A cross-sectional study was conducted among 240 HCWs between August and September 2022, using a semi-structured questionnaire. Multivariable analysis was used to determine the key factors associated with vaccine hesitancy among HCWs. Of the 240 HCWs who participated, 54.2% were females. A total of 72.1% of the HCWs would accept being vaccinated, while 27.9% were hesitant. Moreover, 93.3% of HCWs had positive attitudes towards COVID-19 vaccines, with medical doctors having the highest mean attitude score (82%). Encouragingly, HCWs with positive attitudes towards COVID-19 vaccines had reduced odds of being hesitant (AOR = 0.02, 95% CI: 0.01-0.11, p < 0.001). Overall, acceptance of the COVID-19 vaccine among HCWs in Lusaka, Zambia, was high, especially by those with positive attitudes. However, the current hesitancy among some HCWs is a concern. Consequently, there is a need to address this and encourage HCWs to fully promote vaccination programs going forward.
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Affiliation(s)
- Steward Mudenda
- Department of Pharmacy, School of Health Sciences, University of Zambia, Lusaka 10101, Zambia; (M.M.); (M.G.A.); (W.M.); (A.G.B.)
| | - Victor Daka
- Department of Public Health, Michael Chilufya Sata School of Medicine, Copperbelt University, Ndola 21692, Zambia; (V.D.); (R.L.M.)
| | - Scott K. Matafwali
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK;
| | - Phumzile Skosana
- Department of Clinical Pharmacy, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria 0208, South Africa;
| | - Billy Chabalenge
- Department of Medicines Control, Zambia Medicines Regulatory Authority, Lusaka 31890, Zambia;
| | - Moses Mukosha
- Department of Pharmacy, School of Health Sciences, University of Zambia, Lusaka 10101, Zambia; (M.M.); (M.G.A.); (W.M.); (A.G.B.)
| | - Joseph O. Fadare
- Department of Pharmacology and Therapeutics, Ekiti State University College of Medicine, Ado-Ekiti 362103, Nigeria;
- Department of Medicine, Ekiti State University Teaching Hospital, Ado-Ekiti 362103, Nigeria
| | - Ruth L. Mfune
- Department of Public Health, Michael Chilufya Sata School of Medicine, Copperbelt University, Ndola 21692, Zambia; (V.D.); (R.L.M.)
| | - Bwalya A. Witika
- Department of Pharmaceutical Sciences, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria 0208, South Africa;
| | - Mirriam G. Alumeta
- Department of Pharmacy, School of Health Sciences, University of Zambia, Lusaka 10101, Zambia; (M.M.); (M.G.A.); (W.M.); (A.G.B.)
| | - Webrod Mufwambi
- Department of Pharmacy, School of Health Sciences, University of Zambia, Lusaka 10101, Zambia; (M.M.); (M.G.A.); (W.M.); (A.G.B.)
| | - Brian Godman
- Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria 0208, South Africa;
- Department of Pharmacoepidemiology, Strathclyde Institute of Pharmacy and Biomedical Science, University of Strathclyde, Glasgow G4 0RE, UK
| | - Johanna C. Meyer
- Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria 0208, South Africa;
- South African Vaccination and Immunisation Centre, Sefako Makgatho Health Sciences University, Molotlegi Street, Garankuwa, Pretoria 0208, South Africa
| | - Angela G. Bwalya
- Department of Pharmacy, School of Health Sciences, University of Zambia, Lusaka 10101, Zambia; (M.M.); (M.G.A.); (W.M.); (A.G.B.)
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Dimitrov G, Valkov T, Batselova H, Kounchev O, Momekov G, Argirova R. Nationwide analysis of the impact of COVID-19 in patients with a cardiovascular, oncological or chronic pulmonary disease in the context of an Eastern European country with a low vaccination rate, Bulgaria: March 2020-April 2022. BMJ Open 2023; 13:e068431. [PMID: 37532478 PMCID: PMC10401219 DOI: 10.1136/bmjopen-2022-068431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/04/2023] Open
Abstract
OBJECTIVE This study focused on Bulgarian patient cohorts harbouring a single documented chronic comorbidity-cardiovascular pathology, an oncological disease or a chronic pulmonary diseases (CPD) comparing the outcomes in fully vaccinated and non-vaccinated populations classified by sex and age groups in ambulatory, hospital and intensive care unit (ICU) settings at the national level. DESIGN Retrospective analysis SETTINGS, PARTICIPANTS AND OUTCOME MEASURES: In total, 1 126 946 patients with confirmed COVID-19, on a national level, were retrospectively analysed between March 2020 and April 2022, using data from the Ministry of Health's United Information Portal, launched in March 2020. RESULTS Of all the confirmed 247 441 hospitalised cases of COVID-19, 67 723 (27.3%) had documented cardiovascular disease (CVD), 2140 (0.9%) had confirmed solid malignancy (regardless of stage) and 3243 (1.3%) had established CPD as their only chronic pathology. The number of cumulative deaths in each subgroup was 10 165 (in-hospital=5812 and ICU=4353); 4.0% vaccinated (410/10 165, p<0.001), 344 (in-hospital=196 and ICU=148), 4.9% vaccinated (17/344, p<0.001), 494 (in-hospital=287 and ICU=207) and 5.2% vaccinated (26/494, p<0.001), respectively. Statistical significance (p<0.001) was obtained in favour of reduced ambulatory, hospitalisation and both in-hospital and ICU-related mortality in the vaccinated cohorts, and BNT162b2 was the most effective at preventing mortality in all age groups. CONCLUSIONS This retrospective analysis shows that patients vaccinated against COVID-19 demonstrated trends of reduced hospitalisations and premature mortality in patients with CVD, solid malignancy or CPD as a single comorbidity.
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Affiliation(s)
- George Dimitrov
- Medical University Sofia, Sofia, Bulgaria
- Department of Medical Oncology, Medical University of Sofia, Sofia, Bulgaria
| | - Trifon Valkov
- Medical University Sofia, Sofia, Bulgaria
- Department of Infectious Diseases, Medical University of Sofia, Sofia, Bulgaria
| | - Hristiana Batselova
- Department of Epidemiology and Disaster Medicine, Medical University of Plovdiv, Plovdiv, Bulgaria
| | - Ognyan Kounchev
- Institute of Mathematics and Informatics, Bulgarian Academy of Sciences, Sofia, Bulgaria
| | - Georgi Momekov
- Medical University Sofia, Sofia, Bulgaria
- Department of Pharmacology, Pharmacotherapy, and Toxicology, Faculty of Pharmacy, Medical University of Sofia, Sofia, Bulgaria
| | - Radka Argirova
- Department of Clinical Laboratory, Acibadem City Clinic Tokuda Hospital, Sofia, Bulgaria
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Alfadul ESA, Idrees Abdalmotalib MM, Alrawa SSK, Osman ROA, Hassan HMA, Albasheir AT, Hasabo EA, Mohamed SOO, Shaaban KMA. Burnout and its associated factors among healthcare workers in COVID-19 isolation centres in Khartoum, Sudan: A cross-sectional study. PLoS One 2023; 18:e0288638. [PMID: 37478101 PMCID: PMC10361487 DOI: 10.1371/journal.pone.0288638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 06/30/2023] [Indexed: 07/23/2023] Open
Abstract
BACKGROUND Burnout prevalence and its consequences on healthcare workers during the Omicron wave are not well investigated in Sudan. This study aims to assess the prevalence of burnout and its associated factors among doctors and nurses during the omicron wave in COVID-19 isolation centres in Khartoum, Sudan. METHOD This cross-sectional survey study was conducted at multiple COVID-19 isolation centres in Khartoum state during the omicron wave of Coronavirus Disease 2019 between 20th February 2022 and 10th April 2022. A total of 306 doctors and nurses filled out the questionnaire, with a response rate of 64.8℅. They were recruited from 5 isolation centers scattered in the three cities of Khartoum Metropolis. The level of burnout was assessed using an online semi-structured questionnaire based on the Oldenburg Burnout Inventory questionnaire. Descriptive statistics were used for continuous variables and frequencies with percentages for categorical variables. The Chi-square test and Fisher exact test were used to identify variables associated with burnout. Logistic regression was used to determine the factors associated with burnout, and the p-value of ≤ .05 is considered statistically significant. RESULTS The prevalence of burnout was 45.7%. Doctors were more likely to have burnout than nurses (OR: 2.01, CI 95% 1.24-3.27; p = 0.005). Also, married healthcare workers were more likely to suffer burnout than single healthcare workers (OR: 3.89, CI 95% 1.41-12.5; P = 0.013). The number of household members (p = 0.035) was associated with burnout among participants. CONCLUSION There is a high prevalence of burnout among healthcare workers in Khartoum Isolation Centers, which is more apparent among doctors.
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Abedi P, Afshari P, Ansari S, Alavi SM, Dashtpayma S, Amiri H. The prevalence of and factors related to reinfection with COVID-19 in Ahvaz, Iran: A comparative cross-sectional study. Health Sci Rep 2023; 6:e1420. [PMID: 37492272 PMCID: PMC10363822 DOI: 10.1002/hsr2.1420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 06/07/2023] [Accepted: 06/14/2023] [Indexed: 07/27/2023] Open
Abstract
Background and Aims Reinfection with the coronavirus disease 2019 (COVID-19) virus may be as serious as the first infection, exposing people to risks such as admission to hospital or even death. This study aimed to evaluate the prevalence of and the factors related to reinfection in Ahvaz, Iran. Methods This was a comparative cross-sectional study that was conducted on 200 reinfected individuals and 200 people who had once been infected with COVID-19. Infection with COVID-19 was confirmed using the polymerase chain reaction (PCR) test, and those with reinfection had to have a negative PCR test after recovery from the first infection and a positive PCR test for COVID-19 > 90 days after the first infection. Data was collected using a questionnaire and a checklist. Data were analyzed using the Chi-square test, independent t-test, and logistic regression test. Results Around 7000 reinfections were observed in this study, and the prevalence of reinfection was 0.59% in Ahvaz City. A large proportion of the participants in the control group, 133 (66.5%) received two doses of COVID-19 vaccines compared with 110 (55%) in the reinfected group (p = 0.003), and 43 (21.5%) of reinfected participants did not receive any vaccine. Older people were 0.982 times more likely to get reinfected with COVID-19 (95% confidence interval [CI]: 0.966-0.997). Also, those receiving vaccination once or twice were 2.311 and 2.498 times less likely to get reinfected with COVID-19, respectively (95% CI: 1.093-4.887 and 1.281-4.872, respectively). Conclusion The findings of this study showed that the prevalence of reinfection among people in Ahvaz City was 0.59%. Older individuals, those without vaccination or with suboptimal vaccination, and people with comorbidities were at a higher risk for reinfection. Health policymakers should pay more attention to factors related to reinfection with COVID-19.
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Affiliation(s)
- Parvin Abedi
- Department of Midwifery, Menopause Andropause Research CenterAhvaz Jundishapur University of Medical SciencesAhvazIran
| | - Poorandokht Afshari
- Department of Midwifery, Reproductive Health Promotion Research CenterAhvaz Jundishapur University of Medical SciencesAhvazIran
| | - Somayeh Ansari
- Department of Midwifery, Reproductive Health Promotion Research CenterAhvaz Jundishapur University of Medical SciencesAhvazIran
| | - Seyed Mohammad Alavi
- Infectious and Tropical Diseases Research Center, Health Research InstituteAhvaz Jundishapur University of Medical SciencesAhvazIran
| | - Shohreh Dashtpayma
- Department of Midwifery, Reproductive Health Promotion Research CenterAhvaz Jundishapur University of Medical SciencesAhvazIran
| | - Homayon Amiri
- Infectious and Tropical Diseases Research Center, Health Research InstituteAhvaz Jundishapur University of Medical SciencesAhvazIran
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McCabe R, Whittaker C, Sheppard RJ, Abdelmagid N, Ahmed A, Alabdeen IZ, Brazeau NF, Ahmed Abd Elhameed AE, Bin-Ghouth AS, Hamlet A, AbuKoura R, Barnsley G, Hay JA, Alhaffar M, Koum Besson E, Saje SM, Sisay BG, Gebreyesus SH, Sikamo AP, Worku A, Ahmed YS, Mariam DH, Sisay MM, Checchi F, Dahab M, Endris BS, Ghani AC, Walker PG, Donnelly CA, Watson OJ. Alternative epidemic indicators for COVID-19 in three settings with incomplete death registration systems. SCIENCE ADVANCES 2023; 9:eadg7676. [PMID: 37294754 PMCID: PMC10256151 DOI: 10.1126/sciadv.adg7676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 05/05/2023] [Indexed: 06/11/2023]
Abstract
Not all COVID-19 deaths are officially reported, and particularly in low-income and humanitarian settings, the magnitude of reporting gaps remains sparsely characterized. Alternative data sources, including burial site worker reports, satellite imagery of cemeteries, and social media-conducted surveys of infection may offer solutions. By merging these data with independently conducted, representative serological studies within a mathematical modeling framework, we aim to better understand the range of underreporting using examples from three major cities: Addis Ababa (Ethiopia), Aden (Yemen), and Khartoum (Sudan) during 2020. We estimate that 69 to 100%, 0.8 to 8.0%, and 3.0 to 6.0% of COVID-19 deaths were reported in each setting, respectively. In future epidemics, and in settings where vital registration systems are limited, using multiple alternative data sources could provide critically needed, improved estimates of epidemic impact. However, ultimately, these systems are needed to ensure that, in contrast to COVID-19, the impact of future pandemics or other drivers of mortality is reported and understood worldwide.
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Affiliation(s)
- Ruth McCabe
- Department of Statistics, University of Oxford, Oxford, UK
- NIHR Health Research Protection Unit in Emerging and Zoonotic Infections, Liverpool, UK
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, UK
| | - Charles Whittaker
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, UK
| | - Richard J. Sheppard
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, UK
| | - Nada Abdelmagid
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
- Sudan COVID-19 Research Group, Khartoum, Sudan
| | - Aljaile Ahmed
- Sudan COVID-19 Research Group, Khartoum, Sudan
- Sudan Youth Peer Education Network, Khartoum, Sudan
| | | | - Nicholas F. Brazeau
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, UK
- University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | | | | | - Arran Hamlet
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, UK
| | - Rahaf AbuKoura
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
- Sudan COVID-19 Research Group, Khartoum, Sudan
| | - Gregory Barnsley
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, UK
| | - James A. Hay
- Center for Communicable Disease Dynamics, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Mervat Alhaffar
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
- Syria Research Group (SyRG), co-hosted by the London School of Hygiene and Tropical Medicine, London, UK and Saw Swee Hock School of Public Health, Singapore, Singapore
| | - Emilie Koum Besson
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Semira Mitiku Saje
- School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Binyam Girma Sisay
- School of Exercise and Nutrition Science, Institute for Physical Activity and Nutrition (IPAN), Deakin University, Melbourne, Victoria, Australia
| | - Seifu Hagos Gebreyesus
- School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Adane Petros Sikamo
- School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Aschalew Worku
- School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | | | - Damen Haile Mariam
- School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Mitike Molla Sisay
- School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Francesco Checchi
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Maysoon Dahab
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
- Sudan COVID-19 Research Group, Khartoum, Sudan
| | - Bilal Shikur Endris
- School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Azra C. Ghani
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, UK
| | - Patrick G. T. Walker
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, UK
| | - Christl A. Donnelly
- Department of Statistics, University of Oxford, Oxford, UK
- NIHR Health Research Protection Unit in Emerging and Zoonotic Infections, Liverpool, UK
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, UK
| | - Oliver J. Watson
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, UK
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
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Huang Q. Age-based spatial disparities of COVID-19 incidence rates in the United States counties. PLoS One 2023; 18:e0286881. [PMID: 37289782 PMCID: PMC10249835 DOI: 10.1371/journal.pone.0286881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Accepted: 05/24/2023] [Indexed: 06/10/2023] Open
Abstract
COVID-19 incidence disparities have been documented in the literature, but the different driving factors among age groups have yet to be explicitly explained. This study proposes a community-based COVID-19 spatial disparity model, considering different levels of geographic units (individual and community), various contextual variables, multiple COVID-19 outcomes, and different geographic contextual elements. The model assumes the existence of age nonstationarity effects on health determinants, suggesting that health effects of contextual variables vary among place and age groups. Based on this conceptual model and theory, the study selected 62 county-level variables for 1,748 U.S. counties during the pandemic, and created an Adjustable COVID-19 Potential Exposure Index (ACOVIDPEI) using principal component analysis (PCA). The validation was done with 71,521,009 COVID-19 patients in the U.S. from January 2020 through June 2022, with high incidence rates shifting from the Midwest, South Carolina, North Carolina, Arizona, and Tennessee to the West and East coasts. This study corroborates the age nonstationarity effect of health determinants on COVID-19 exposures. These results empirically identify the geographic disparities of COVID-19 incidence rates among age groups and provide the evidentiary guide for targeting pandemic recovery, mitigation, and preparedness in communities.
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Affiliation(s)
- Qian Huang
- Center for Rural Health Research, College of Public Health, East Tennessee State University, Johnson City, Tennessee, United States of America
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Wainstein M, Spyrison N, Dai D, Ghadimi M, Chávez-Iñiguez JS, Rizo-Topete L, Citarella BW, Merson L, Pole JD, Claure-Del Granado R, Johnson DW, Shrapnel S. Association of Country Income Level With the Characteristics and Outcomes of Critically Ill Patients Hospitalized With Acute Kidney Injury and COVID-19. Kidney Int Rep 2023; 8:S2468-0249(23)01310-4. [PMID: 37360820 PMCID: PMC10219675 DOI: 10.1016/j.ekir.2023.05.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 05/10/2023] [Accepted: 05/15/2023] [Indexed: 06/28/2023] Open
Abstract
Introduction Acute kidney injury (AKI) has been identified as one of the most common and significant problems in hospitalized patients with COVID-19. However, studies examining the relationship between COVID-19 and AKI in low- and low-middle income countries (LLMIC) are lacking. Given that AKI is known to carry a higher mortality rate in these countries, it is important to understand differences in this population. Methods This prospective, observational study examines the AKI incidence and characteristics of 32,210 patients with COVID-19 from 49 countries across all income levels who were admitted to an intensive care unit during their hospital stay. Results Among patients with COVID-19 admitted to the intensive care unit, AKI incidence was highest in patients in LLMIC, followed by patients in upper-middle income countries (UMIC) and high-income countries (HIC) (53%, 38%, and 30%, respectively), whereas dialysis rates were lowest among patients with AKI from LLMIC and highest among those from HIC (27% vs. 45%). Patients with AKI in LLMIC had the largest proportion of community-acquired AKI (CA-AKI) and highest rate of in-hospital death (79% vs. 54% in HIC and 66% in UMIC). The association between AKI, being from LLMIC and in-hospital death persisted even after adjusting for disease severity. Conclusions AKI is a particularly devastating complication of COVID-19 among patients from poorer nations where the gaps in accessibility and quality of healthcare delivery have a major impact on patient outcomes.
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Affiliation(s)
- Marina Wainstein
- Faculty of Medicine, University of Queensland, Brisbane, Australia
- West Moreton Kidney Health Service, Brisbane, Queensland, Australia
- International Severe Acute Respiratory and emerging Infections Consortium (ISARIC), Pandemic Sciences Institute, University of Oxford, Oxford, UK
| | - Nicholas Spyrison
- School of Mathematics and Physics, University of Queensland, Brisbane, Australia
| | - Danyang Dai
- Centre for Health Services Research, Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Moji Ghadimi
- School of Mathematics and Physics, University of Queensland, Brisbane, Australia
| | | | - Lilia Rizo-Topete
- Autonomous University of Nuevo León, San Nicolas de los Garza, México
| | - Barbara Wanjiru Citarella
- International Severe Acute Respiratory and emerging Infections Consortium (ISARIC), Pandemic Sciences Institute, University of Oxford, Oxford, UK
| | - Laura Merson
- International Severe Acute Respiratory and emerging Infections Consortium (ISARIC), Pandemic Sciences Institute, University of Oxford, Oxford, UK
| | - Jason D. Pole
- Centre for Health Services Research, Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Rolando Claure-Del Granado
- Division of Nephrology Hospital Obrero No 2 - CNS, Cochabamba, Bolivia
- Universidad Mayor de San Simon, School of Medicine, Cochabamba, Bolivia
| | - David W. Johnson
- Metro South Kidney and Transplant Services (MSKATS), Princess Alexandra Hospital, Brisbane, Queensland, Australia
- Centre for Kidney Disease Research, University of Queensland at Princess Alexandra Hospital, Brisbane, Queensland, Australia
- Translational Research Institute, Brisbane, Queensland, Australia
| | - Sally Shrapnel
- International Severe Acute Respiratory and emerging Infections Consortium (ISARIC), Pandemic Sciences Institute, University of Oxford, Oxford, UK
- Centre for Health Services Research, Faculty of Medicine, University of Queensland, Brisbane, Australia
- ARC Centre of Excellence for Engineered Quantum Systems, School of Mathematics and Physics, University of Queensland, Queensland, Australia
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Owusu-Boaitey N, Russell TW, Meyerowitz-Katz G, Levin AT, Herrera-Esposito D. Dynamics of SARS-CoV-2 seroassay sensitivity: a systematic review and modelling study. Euro Surveill 2023; 28:2200809. [PMID: 37227301 PMCID: PMC10283460 DOI: 10.2807/1560-7917.es.2023.28.21.2200809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 03/10/2023] [Indexed: 05/26/2023] Open
Abstract
BackgroundSerological surveys have been the gold standard to estimate numbers of SARS-CoV-2 infections, the dynamics of the epidemic, and disease severity. Serological assays have decaying sensitivity with time that can bias their results, but there is a lack of guidelines to account for this phenomenon for SARS-CoV-2.AimOur goal was to assess the sensitivity decay of seroassays for detecting SARS-CoV-2 infections, the dependence of this decay on assay characteristics, and to provide a simple method to correct for this phenomenon.MethodsWe performed a systematic review and meta-analysis of SARS-CoV-2 serology studies. We included studies testing previously diagnosed, unvaccinated individuals, and excluded studies of cohorts highly unrepresentative of the general population (e.g. hospitalised patients).ResultsOf the 488 screened studies, 76 studies reporting on 50 different seroassays were included in the analysis. Sensitivity decay depended strongly on the antigen and the analytic technique used by the assay, with average sensitivities ranging between 26% and 98% at 6 months after infection, depending on assay characteristics. We found that a third of the included assays departed considerably from manufacturer specifications after 6 months.ConclusionsSeroassay sensitivity decay depends on assay characteristics, and for some types of assays, it can make manufacturer specifications highly unreliable. We provide a tool to correct for this phenomenon and to assess the risk of decay for a given assay. Our analysis can guide the design and interpretation of serosurveys for SARS-CoV-2 and other pathogens and quantify systematic biases in the existing serology literature.
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Affiliation(s)
- Nana Owusu-Boaitey
- Case Western Reserve University School of Medicine, Cleveland, United States
- These authors contributed equally to this work
| | - Timothy W Russell
- Centre for the Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | | | - Andrew T Levin
- Dartmouth College, Hanover, United States
- National Bureau for Economic Research, Cambridge, United States
- Centre for Economic Policy Research, London, United Kingdom
| | - Daniel Herrera-Esposito
- These authors contributed equally to this work
- Department of Psychology, University of Pennsylvania, Philadelphia, United States
- Laboratorio de Neurociencias, Universidad de la República, Montevideo, Uruguay
- Centro Interdisciplinario en Ciencia de Datos y Aprendizaje Automático, Universidad de la República, Montevideo, Uruguay
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Ferrara G, Aguina M, Mirochnick E, Wiphatphumiprates P, Moreira DC, Sniderman E, Villegas CA, Kaye EC, Ragab I, Maliti B, Naidu G, Gassant PY, Arce D, Arora RS, Alcasabas AP, Raza MR, Velasco P, Kambugu J, Vinitsky A, Rodriguez Galindo C, Agulnik A, Graetz DE. Communication transforms the impact of the COVID-19 pandemic on children with cancer and their families. Cancer Med 2023. [PMID: 37081718 DOI: 10.1002/cam4.5950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 03/15/2023] [Accepted: 04/02/2023] [Indexed: 04/22/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic altered healthcare systems globally, causing delays in care delivery and increased anxiety among patients and families. This study examined how hospital stakeholders and clinicians perceived the global impact of the COVID-19 pandemic on children with cancer and their families. METHODS This secondary analysis examined data from a qualitative study consisting of 19 focus groups conducted in 8 languages throughout 16 countries. A codebook was developed with novel codes derived inductively from transcript review. In-depth analysis focused on the impact of the COVID-19 pandemic on children with cancer and their families. RESULTS Eight themes describing the impact of the pandemic on patients and their families were identified and classified into three domains: contributing factors (COVID-19 Policies, Cancer Treatment Modifications, COVID-19 Symptoms, Beliefs), patient-related impacts (Quality of Care, Psychosocial impacts, Treatment Reluctance), and the central transformer (Communication). Participants described the ability of communication to transform the effect of contributing factors on patient-related impacts. The valence of impacts depended on the quality and quantity of communication among clinicians and between clinicians and patients and families. CONCLUSIONS Communication served as the central factor impacting whether the COVID-19 pandemic positively or negatively affected children with cancer and families. These findings emphasize the key role communication plays in delivering patient-centered care and can guide future development of communication-centered interventions globally.
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Affiliation(s)
- Gia Ferrara
- St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Molly Aguina
- Princeton University, Princeton, New Jersey, USA
| | - Emily Mirochnick
- The Chicago Medical School at Rosalind Franklin University of Medicine and Science, North Chicago, Illinois, USA
| | | | | | - Elizabeth Sniderman
- Northern Alberta Children's Cancer Program, Stollery Children's Hospital, Edmonton, Alberta, Canada
| | | | - Erica C Kaye
- St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Iman Ragab
- Ain Shams University, Children's Hospital, Hematology-Oncology Unit, Cairo, Egypt
| | | | - Gita Naidu
- Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Daniela Arce
- Hospital Pediátrico de Sinaloa, Culiacan, Mexico
| | | | | | | | - Pablo Velasco
- Pediatric Oncology and Hematology Department, Vall d'Hebron Hospital, Barcelona, Spain
| | | | - Anna Vinitsky
- St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | | | - Asya Agulnik
- St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Dylan E Graetz
- St. Jude Children's Research Hospital, Memphis, Tennessee, USA
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Hata R, Hart A, Hertelendy A, Tin D, Taubman C, Cheng L, Ciottone GR. Terrorist Attacks in Sub-Saharan Africa from 1970 through 2020: Analysis and Impact from a Counter-Terrorism Medicine Perspective. Prehosp Disaster Med 2023; 38:216-222. [PMID: 36710636 DOI: 10.1017/s1049023x23000080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Sub-Saharan Africa (SSA) has become a hotspot for global terrorism, with nearly 50% of global terror-related deaths occurring in SSA in 2021. With a large population and complex geopolitical and social climate, terrorist activity further burdens an already strained medical system. This study provides a retrospective descriptive analysis of terrorist-related activity in SSA from 1970-2020. METHODS A retrospective analysis of the Global Terrorism Database (GTD) was performed for the region of SSA from 1970-2020. Data were filtered using the internal database search function for all events in the following countries: Angola, Benin, Botswana, Burkina Faso, Burundi, Cameroon, Central African Republic, Chad, Comoros, the Democratic Republic of the Congo, Djibouti, Equatorial Guinea, Eritrea, Ethiopia, Gabon, Gambia, Ghana, Guinea, Guinea-Bissau, Ivory Coast, Kenya, Lesotho, Liberia, Madagascar, Malawi, Mali, Mauritania, Mozambique, Namibia, Niger, Nigeria, People's Republic of the Congo, Republic of the Congo, Rhodesia, Rwanda, Senegal, Seychelles, Sierra Leone, Somalia, South Africa, South Sudan, Sudan, Swaziland, Tanzania, Togo, Uganda, Zaire, Zambia, and Zimbabwe. Number of attacks, deaths, and injuries, as well as primary weapons types, country where attacks occurred, and primary target types, were collated and analyzed. RESULTS A total 19,320 attacks were recorded, resulting in 77,565 deaths and 52,986 injuries. Firearms were the most frequent weapons used (8,745), followed by explosives (6,031), unknown (2,615), and incendiary (1,246), with all others making up the remainder (683.) Private citizens and property were the most frequently targeted entities (8,031), followed by general government facilities (2,582), police (1,854), business (1,446), military (805), diplomatic government facilities (741), and religious figures/institution (678), with all other targets making up the remainder (3,183). CONCLUSION The majority of deaths from terrorism in SSA are the result of firearm attacks and explosions. Nigeria, Somalia, South Africa, The Democratic Republic of the Congo, and Sudan have had the largest number of attacks since 1970, and Nigeria has the largest number of people killed and injured. The health implications of terrorist attacks are often compounded by violence and pose unique challenges to governments, populations, and aid organizations. By understanding the impact and scope of terrorist activity in SSA, Counter-Terrorism Medicine (CTM) initiatives can be employed to improve health care outcomes.
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Affiliation(s)
- Ryan Hata
- BIDMC Fellowship in Disaster Medicine, Department of Emergency Medicine, Boston, MassachusettsUSA
- Harvard Medical School, Boston, MassachusettsUSA
| | - Alexander Hart
- BIDMC Fellowship in Disaster Medicine, Department of Emergency Medicine, Boston, MassachusettsUSA
- Department of Emergency Medicine, Hartford Hospital, Hartford, ConnecticutUSA
- University of Connecticut School of Medicine, Farmington, ConnecticutUSA
| | - Attila Hertelendy
- BIDMC Fellowship in Disaster Medicine, Department of Emergency Medicine, Boston, MassachusettsUSA
- Florida International University, Miami, FloridaUSA
| | - Derrick Tin
- BIDMC Fellowship in Disaster Medicine, Department of Emergency Medicine, Boston, MassachusettsUSA
- Harvard Medical School, Boston, MassachusettsUSA
| | - Cara Taubman
- BIDMC Fellowship in Disaster Medicine, Department of Emergency Medicine, Boston, MassachusettsUSA
| | - Lenard Cheng
- BIDMC Fellowship in Disaster Medicine, Department of Emergency Medicine, Boston, MassachusettsUSA
- Harvard Medical School, Boston, MassachusettsUSA
| | - Gregory R Ciottone
- BIDMC Fellowship in Disaster Medicine, Department of Emergency Medicine, Boston, MassachusettsUSA
- Harvard Medical School, Boston, MassachusettsUSA
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Akase IE, Akintan PE, Otrofanowei E, Olopade OB, Olorunfemi G, Opawoye A, Ima-Edomwomyi UE, Akinbolagbe YO, Agabi OP, Nmadu DA, Akinbode GO, Olasope AC, Ogundare A, Bolarinwa AB, Otokiti EO, Enajeroh PJ, Karami M, Esezobor CI, Oshodi Y, Oluwole AA, Adeyemo WL, Bode CO. Clinical predictors of Covid-19 mortality in a tertiary hospital in Lagos, Nigeria: A retrospective cohort study. Niger J Clin Pract 2023; 26:424-431. [PMID: 37203106 DOI: 10.4103/njcp.njcp_454_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Background The predictors of mortality among patients presenting with severe to critical disease in Nigeria are presently unknown. Aim The aim of this study was to identify the predictors of mortality among patients with COVID-19 presenting for admission in a tertiary referral hospital in Lagos, Nigeria. Patients and Methods The study was a retrospective study. Patients' sociodemographics, clinical characteristics, comorbidities, complications, treatment outcomes, and hospital duration were documented. Pearson's Chi-square, Fischer's Exact test, or Student's t-test were used to assess the relationship between the variables and mortality. To compare the survival experience across medical comorbidities, Kaplan Meir plots and life tables were used. Univariable and multivariable Cox-proportional hazard analyses were conducted. Results A total of 734 patients were recruited. Participants' age ranged from five months to 92 years, with a mean ± SD of 47.4 ± 17.2 years, and a male preponderance (58.5% vs. 41.5%). The mortality rate was 9.07 per thousand person-days. About 73.9% (n = 51/69) of the deceased had one or more co-morbidities, compared to 41.6% (252/606) of those discharged. Patients who were older than 50 years, with diabetes mellitus, hypertension, chronic renal illness, and cancer had a statistically significant relationship with mortality. Conclusion These findings call for a more comprehensive approach to the control of non-communicable diseases, the allocation of sufficient resources for ICU care during outbreaks, an improvement in the quality of health care available to Nigerians, and further research into the relationship between obesity and COVID-19 in Nigerians.
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Affiliation(s)
- I E Akase
- Department of Medicine, College of Medicine, University of Lagos, Lagos, Nigeria
| | - P E Akintan
- Department of Pediatrics, College of Medicine, University of Lagos, Lagos, Nigeria
| | - E Otrofanowei
- Department of Medicine, College of Medicine, University of Lagos, Lagos, Nigeria
| | - O B Olopade
- Department of Medicine, Lagos University Teaching Hospital, Lagos, Nigeria
| | - G Olorunfemi
- Division of Epidemiology and Biostatistics, School of Public Health, University of Witwatersrand, Johannesburg, South Africa
| | - A Opawoye
- Department of Medicine, Lagos University Teaching Hospital, Lagos, Nigeria
| | - U E Ima-Edomwomyi
- Department of Medicine, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Y O Akinbolagbe
- Department of Pediatrics, College of Medicine, University of Lagos, Lagos, Nigeria
| | - O P Agabi
- Department of Medicine, College of Medicine, University of Lagos, Lagos, Nigeria
| | - D A Nmadu
- Department of Medicine, Lagos University Teaching Hospital, Lagos, Nigeria
| | - G O Akinbode
- Department of Surgery, Lagos University Teaching Hospital, Lagos, Nigeria
| | - A C Olasope
- Department of Medicine, Lagos University Teaching Hospital, Lagos, Nigeria
| | - A Ogundare
- Department of Medicine, Lagos University Teaching Hospital, Lagos, Nigeria
| | - A B Bolarinwa
- Department of Hematology and Blood Transfusion, Lagos University Teaching Hospital, Lagos, Nigeria
| | - E O Otokiti
- Department of Hematology and Blood Transfusion, Lagos University Teaching Hospital, Lagos, Nigeria
| | - P J Enajeroh
- Department of Medicine, Lagos University Teaching Hospital, Lagos, Nigeria
| | - M Karami
- Department of Medicine, Lagos University Teaching Hospital, Lagos, Nigeria
| | - C I Esezobor
- Department of Medicine, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Y Oshodi
- Department of Psychiatry, College of Medicine, University of Lagos, Lagos, Nigeria
| | - A A Oluwole
- Department of Obstetrics and Gynaecology, College of Medicine, University of Lagos, Lagos, Nigeria
| | - W L Adeyemo
- Department of Oral and Maxillofacial Surgery, College of Medicine, University of Lagos, Lagos, Nigeria
| | - C O Bode
- Department of Surgery, College of Medicine, University of Lagos, Lagos, Nigeria
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Alshomrani A. Arabic language version of the obsession with COVID-19 scale adaptation and validity evaluation in Saudi sample. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2023; 59:43. [PMID: 37009466 PMCID: PMC10047459 DOI: 10.1186/s41983-023-00641-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 03/09/2023] [Indexed: 03/30/2023] Open
Abstract
Abstract
Background
The obsession with COVID-19 scale is a reliable and validated scale developed to assess obsessions related to coronavirus infection (COVID-2019) and because of its usefulness, this paper is aiming to develop an Arabic version of the obsession with COVID-19 scale and evaluate its validity. Firstly, scale translated to Arabic through the guidelines of Sousa and Rojjanasriratw for scale translation and adaptation. Then we distributed the final version with some sociodemographic questions and an Arabic version of the COVID-19 fear scale to a convenient sample of college students. Internal consistency, factor analysis, average variable extraction, composite reliability, Pearson correlation, and mean differences has been measured.
Results
Out of 253 students, 233 responded to the survey, where 44.6% of them were female. Calculated Cronbach’s alpha was 0.82, item-total correlations were 0.891–0.905, and inter-item correlations were 0.722–0.805. Factor analysis identified one factor which reflects 80.76% of the cumulative variances. The average variance extracted was 0.80, and the composite reliability was 0.95. The correlation coefficient between the two scales was 0.472.
Conclusions
The Arabic version of obsession with COVID-19 scale has high values of internal consistency, and convergent validity, and has a unidimensional factor that reflects its reliability and validity.
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Ruiz FJ, Torres-Rueda S, Pearson CAB, Bergren E, Okeke C, Procter SR, Madriz-Montero A, Jit M, Vassall A, Uzochukwu BSC. What, how and who: Cost-effectiveness analyses of COVID-19 vaccination to inform key policies in Nigeria. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001693. [PMID: 36963054 PMCID: PMC10032534 DOI: 10.1371/journal.pgph.0001693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 02/10/2023] [Indexed: 03/24/2023]
Abstract
While safe and efficacious COVID-19 vaccines have achieved high coverage in high-income settings, roll-out remains slow in sub-Saharan Africa. By April 2022, Nigeria, a country of over 200 million people, had only distributed 34 million doses. To ensure the optimal use of health resources, cost-effectiveness analyses can inform key policy questions in the health technology assessment process. We carried out several cost-effectiveness analyses exploring different COVID-19 vaccination scenarios in Nigeria. In consultation with Nigerian stakeholders, we addressed three key questions: what vaccines to buy, how to deliver them and what age groups to target. We combined an epidemiological model of virus transmission parameterised with Nigeria specific data with a costing model that incorporated local resource use assumptions and prices, both for vaccine delivery as well as costs associated with care and treatment of COVID-19. Scenarios of vaccination were compared with no vaccination. Incremental cost-effectiveness ratios were estimated in terms of costs per disability-adjusted life years averted and compared to commonly used cost-effectiveness ratios. Viral vector vaccines are cost-effective (or cost saving), particularly when targeting older adults. Despite higher efficacy, vaccines employing mRNA technologies are less cost-effective due to high current dose prices. The method of delivery of vaccines makes little difference to the cost-effectiveness of the vaccine. COVID-19 vaccines can be highly effective and cost-effective (as well as cost-saving), although an important determinant of the latter is the price per dose and the age groups prioritised for vaccination. From a health system perspective, viral vector vaccines may represent most cost-effective choices for Nigeria, although this may change with price negotiation.
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Affiliation(s)
- Francis J. Ruiz
- Department of Global Health & Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
- * E-mail:
| | - Sergio Torres-Rueda
- Department of Global Health & Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Carl A. B. Pearson
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
- South African DSI-NRF Centre of Excellence in Epidemiological Modelling and Analysis, Stellenbosch University, Stellenbosch, Republic of South Africa
| | - Eleanor Bergren
- Department of Global Health & Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Chinyere Okeke
- Department of Community Medicine, University of Nigeria Nsukka, Enugu Campus, Nsukka, Nigeria
| | - Simon R. Procter
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Andres Madriz-Montero
- Department of Global Health & Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Mark Jit
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Anna Vassall
- Department of Global Health & Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Parker W, Patel E, Jirků-Pomajbíková K, Laman JD. COVID-19 morbidity in lower versus higher income populations underscores the need to restore lost biodiversity of eukaryotic symbionts. iScience 2023; 26:106167. [PMID: 36785786 PMCID: PMC9908430 DOI: 10.1016/j.isci.2023.106167] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023] Open
Abstract
The avoidance of infectious disease by widespread use of 'systems hygiene', defined by hygiene-enhancing technology such as sewage systems, water treatment facilities, and secure food storage containers, has led to a dramatic decrease in symbiotic helminths and protists in high-income human populations. Over a half-century of research has revealed that this 'biota alteration' leads to altered immune function and a propensity for chronic inflammatory diseases, including allergic, autoimmune and neuropsychiatric disorders. A recent Ethiopian study (EClinicalMedicine 39: 101054), validating predictions made by several laboratories, found that symbiotic helminths and protists were associated with a reduced risk of severe COVID-19 (adjusted odds ratio = 0.35; p<0.0001). Thus, it is now apparent that 'biome reconstitution', defined as the artificial re-introduction of benign, symbiotic helminths or protists into the ecosystem of the human body, is important not only for alleviation of chronic immune disease, but likely also for pandemic preparedness.
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Affiliation(s)
| | | | - Kateřina Jirků-Pomajbíková
- Institute of Parasitology, Biology Centre, Czech Academy of Sciences, 370 05 České Budějovice, Czech Republic
- Faculty of Science, University of South Bohemia, 370 05 České Budějovice, Czech Republic
| | - Jon D. Laman
- Department of Pathology and Medical Biology, University Groningen, University Medical Center Groningen, Groningen, the Netherlands
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Hladish TJ, Pillai AN, Pearson CAB, Toh KB, Tamayo A, Stoltzfus A, Longini IM. Evaluating targeted COVID-19 vaccination strategies with agent-based modeling. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.03.09.23285319. [PMID: 36945423 PMCID: PMC10029084 DOI: 10.1101/2023.03.09.23285319] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/12/2023]
Abstract
We evaluate approaches to vaccine distribution using an agent-based model of human activity and COVID-19 transmission calibrated to detailed trends in cases, hospitalizations, deaths, seroprevalence, and vaccine breakthrough infections in Florida, USA. We compare the incremental effectiveness for four different distribution strategies at four different levels of vaccine availability, reflecting different income settings' historical COVID-19 vaccine distribution. Our analysis indicates that the best strategy to reduce severe outcomes is to actively target high disease-risk individuals. This was true in every scenario, although the advantage was greatest for the middle-income-country availability assumptions, and relatively modest compared to a simple mass vaccination approach for rapid, high levels of vaccine availability. Ring vaccination, while generally the most effective strategy for reducing infections, ultimately proved least effective at preventing deaths. We also consider using age group as a practical, surrogate measure for actual disease-risk targeting; this approach still outperforms both simple mass distribution and ring vaccination. We also find that the magnitude of strategy effectiveness depends on when assessment occurs (e.g., after delta vs. after omicron variants). However, these differences in absolute benefit for the strategies do not change the ranking of their performance at preventing severe outcomes across vaccine availability assumptions.
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Affiliation(s)
- Thomas J. Hladish
- Department of Biology, University of Florida, Gainesville, Florida, USA
- Emerging Pathogens Institute, University of Florida, Gainesville, Florida, USA
| | | | - Carl A. B. Pearson
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
- South African DSI-NRF Centre of Excellence in Epidemiological Modelling and Analysis (SACEMA), Stellenbosch University, Stellenbosch, RSA
| | - Kok Ben Toh
- Department of Biology, University of Florida, Gainesville, Florida, USA
- Institute of Global Health and Department of Preventive Medicine Northwestern University, Chicago, IL, USA
| | - Andrea Tamayo
- Department of Biology, University of Florida, Gainesville, Florida, USA
| | - Arlin Stoltzfus
- Office of Data and Informatics, National Institute of Standards and Technology, Gaithersburg, MD, USA
| | - Ira M. Longini
- Emerging Pathogens Institute, University of Florida, Gainesville, Florida, USA
- Department of Biostatistics, University of Florida, Gainesville, Florida, USA
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He D, Lin L, Artzy-Randrup Y, Demirhan H, Cowling BJ, Stone L. Resolving the enigma of Iquitos and Manaus: A modeling analysis of multiple COVID-19 epidemic waves in two Amazonian cities. Proc Natl Acad Sci U S A 2023; 120:e2211422120. [PMID: 36848558 PMCID: PMC10013854 DOI: 10.1073/pnas.2211422120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 01/17/2023] [Indexed: 03/01/2023] Open
Abstract
The two nearby Amazonian cities of Iquitos and Manaus endured explosive COVID-19 epidemics and may well have suffered the world's highest infection and death rates over 2020, the first year of the pandemic. State-of-the-art epidemiological and modeling studies estimated that the populations of both cities came close to attaining herd immunity (>70% infected) at the termination of the first wave and were thus protected. This makes it difficult to explain the more deadly second wave of COVID-19 that struck again in Manaus just months later, simultaneous with the appearance of a new P.1 variant of concern, creating a catastrophe for the unprepared population. It was suggested that the second wave was driven by reinfections, but the episode has become controversial and an enigma in the history of the pandemic. We present a data-driven model of epidemic dynamics in Iquitos, which we also use to explain and model events in Manaus. By reverse engineering the multiple epidemic waves over 2 y in these two cities, the partially observed Markov process model inferred that the first wave left Manaus with a highly susceptible and vulnerable population (≈40% infected) open to invasion by P.1, in contrast to Iquitos (≈72% infected). The model reconstructed the full epidemic outbreak dynamics from mortality data by fitting a flexible time-varying reproductive number [Formula: see text] while estimating reinfection and impulsive immune evasion. The approach is currently highly relevant given the lack of tools available to assess these factors as new SARS-CoV-2 virus variants appear with different degrees of immune evasion.
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Affiliation(s)
- Daihai He
- Department of Applied Mathematics, Hong Kong Polytechnic University, Hong Kong, China
- Research Institute for Future Food, The Hong Kong Polytechnic University, Hong Kong, China
| | - Lixin Lin
- Mathematical Sciences, School of Science, Royal Melbourne Institute of Technology (RMIT) University, Melbourne, Victoria 3000, Australia
| | - Yael Artzy-Randrup
- Department of Theoretical and Computational Ecology, Institute for Biodiversity and Ecosystem Dynamics (IBED), University of Amsterdam, 1090 GE, Amsterdam, Netherlands
| | - Haydar Demirhan
- Mathematical Sciences, School of Science, Royal Melbourne Institute of Technology (RMIT) University, Melbourne, Victoria 3000, Australia
| | - Benjamin J. Cowling
- World Health Organization (WHO) Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Lewi Stone
- Mathematical Sciences, School of Science, Royal Melbourne Institute of Technology (RMIT) University, Melbourne, Victoria 3000, Australia
- Biomathematics Unit, School of Zoology, Faculty of Life Sciences, Tel Aviv University, Ramat Aviv69978, Israel
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